What are CPT 2 or Category II codes used for?
Asked by: Dr. Corene Smith PhD | Last update: May 4, 2025Score: 4.5/5 (1 votes)
What are CPT category II codes used for?
Category II codes are intended to facilitate the collection of information about the quality of care delivered by coding a number of services or test results that support performance measures.
What is the difference between category 1 and 2 CPT codes?
Category I: These codes have descriptors that correspond to a procedure or service. Codes range from 00100–99499 and are generally ordered into sub-categories based on procedure/service type and anatomy. Category II: These alphanumeric tracking codes are supplemental codes used for performance measurement.
What is the purpose of Hcpcs Level II codes?
HCPCS Level II C codes are utilized to report drugs, biologicals, magnetic resonance angiography (MRA), and devices used for CMS' Medicare Hospital Outpatient Prospective Payment System (HOPPS). For information about the HOPPS pass-through process, visit the HOPPS website.
Are category 2 codes reimbursable?
Reimbursement for the administrative work and effort of completing and reporting CPT Category II codes can only be claimed once per service, per member, per year; it is earned by completing the criteria for billing the CPT Category II codes listed in Table 1 included below, including the corresponding diagnosis codes.
CPT Category II Codes | When To Use Them
What are Category 2 codes primarily used for and are optional?
These codes are optional and are not typically used for billing purposes. Instead, they are primarily used for quality reporting, research, and performance measurement purposes.
Can category II codes be billed alone?
CPT II codes are not associated with any relative value and can be billed with a $0.00 charge amount. As these codes are for reporting purposes only, they are nonpayable and will be processed accordingly.
What is the difference between CPT and Hcpcs codes?
CPT codes are used to report medical, surgical, and diagnostic services performed by healthcare professionals. HCPCS codes are used to report medical procedures and services to Medicare, Medicaid, and other health insurance programs.
What is the difference between Level 1 and Level 2 codes in HCPCS?
The standard, national HCPCS Level II coding system is used primarily to identify products, supplies, and services that are not included in the HCPCS Level I (CPT®) codes.
How many categories of CPT codes are there?
With CPT, 'Category' refers to the division of the code set. CPT codes are divided into three Categories. Category I is the most common and widely used set of codes within CPT.
Can you bill CPT II codes to Medicare?
Beginning June 1, 2021, we will add CPT II codes to the fee schedule at a price of $0.01, which will allow billing of these codes while avoiding claim denial due to a “non-payable code”.
Are Category 2 CPT codes only numeric?
Category II CPT codes are alphanumeric — consisting of four digits followed by the use of the alpha character 'F. ' (Category I CPT codes are five-digit numeric codes.)
What is CPT I and CPT II?
The CPT1 enzyme helps get fatty acids inside your cells. CPT 2 deficiency. This type causes problems with the CPT2 enzyme. The CPT2 enzyme helps make sure your body can use fatty acids once they are inside your cells.
What is CPT Type 2?
Carnitine palmitoyltransferase type II deficiency (CPTII) is a condition in which the body is unable to break down certain fats. It is considered a fatty acid oxidation condition because people affected with CPTII are unable to change some of the fats they eat into energy the body needs to function.
What is the difference between CPT 1 and CPT 2?
In California, you must have a license to practice phlebotomy. California has two levels of license: CPT-I: Allows you to do skin puncture and venipuncture. CPT-II: Allows you to do skin puncture, venipuncture, and arterial puncture, but is only needed for specialized work environments.
Is HCPCS only for Medicare?
Coders today use HCPCS codes to represent medical procedures to Medicare, Medicaid, and several other third-party payers. The code set is divided into three levels. Level one is identical to CPT, though technically those codes, when used to bill Medicare or Medicaid, are HCPCS codes.
Who uses HCPCS Level II codes?
HCPCS Level II: A standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT® codes, such as ambulance services or durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office.
What are level 1 and level 2 CPT codes?
Category I CPT codes describe distinct medical procedures or services furnished by QHPs and are identified by a 5-digit numeric code [e.g., 29580: Unna boot]. New Category I CPT codes are released annually. Category II CPT codes are supplemental tracking codes, also referred to as performance measurement codes.
What are the two main coding systems?
Two common medical coding classification systems are in use — the International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT).
Can CPT and HCPCS be billed together?
Each edit table contains edits which are pairs of HCPCS/CPT codes that in general should not be reported together. Each edit has a Column One and Column Two HCPCS/CPT code. If a provider/supplier reports the 2 codes of an edit pair, the Column Two code is denied, and the Column One code is eligible for payment.
Is a CPT code a diagnosis code?
While CPT codes are similar to ICD-10 codes, CPT codes identify services rendered, whereas ICD-10 codes represent patient diagnoses.
When to use category II codes?
Category II CPT codes: performance measurement
These codes are intended to facilitate data collection about quality of care by coding certain services and/or test results that support performance measures and that have been agreed upon as contributing to good patient care.
Are CPT II codes reimbursable?
Reimbursement for the administrative work and effort of completing and reporting CPT Category II codes can only be claimed once per service, per member, per year, and are earned by completing the criteria for billing the CPT Category II codes listed in Table 1 following this letter.
Can you bill a revenue code without a CPT code?
Non-exempt Revenue Codes
For revenue codes that are not exempt, providers are required to indicate valid and most appropriate HCPCS or CPT procedure codes in addition to the revenue codes on outpatient hospital claims.