What is the difference between a CPT code and a HCPCS code?
Asked by: Miss Abigayle Parker IV | Last update: March 15, 2025Score: 4.5/5 (50 votes)
What is the difference between HCPCS and CPT 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.
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.
What is an example of a HCPCS code?
An example of an HCPCS Level I is 90716, which coders can use to denote the administration of varicella or chickenpox vaccine. Meanwhile, an example of an HCPCS Level II code is R0070.
Does Medicare prefer CPT or HCPCS?
Today, the CPT coding system is the preferred system for coding and describing healthcare services and procedures in federal programs (Medicare and Medicaid) and throughout the United States by private insurers and providers of healthcare services.
The Difference Between HCPCS and CPT Codes
How does HCPCS differ from ICD-10 and CPT codes?
ICD-10-CM diagnosis codes provide the reason for seeking health care; ICD-10-PCS procedure codes tell what inpatient treatment and services the patient got; CPT (HCPCS Level I) codes describe outpatient services and procedures; and providers generally use HCPCS (Level II) codes for equipment, drugs, and supplies for ...
What are the three levels of CPT codes?
- Category I: These codes have descriptors that correspond to a procedure or service. ...
- Category II: These alphanumeric tracking codes are supplemental codes used for performance measurement. ...
- Category III: These are temporary alphanumeric codes for new and developing technology, procedures and services.
What is a CPT code?
Current Procedural Terminology (CPT®) codes provide a uniform nomenclature for coding medical procedures and services. Medical CPT codes are critical to streamlining reporting and increasing accuracy and efficiency, as well as for administrative purposes such as claims processing and developing guid.
Are HCPCS codes still used?
National HCPCS Level II codes are maintained by CMS, but all private and public health insurers may use them.
Are HCPCS G codes for Medicare only?
As G codes are part of the national HCPCS Level II code set, they may also be used by non-Medicare insurers.
Can you bill without a CPT code?
When billing a service or procedure, select the CPT or HCPCS code that accurately identifies the service or procedure performed. If no such code exists, report the service or procedure using the appropriate unlisted procedure or Not Otherwise Classified (NOC) code (which often end in 99).
What is a 58 modifier used for?
Modifier 58 is defined as a staged or related procedure performed during the postoperative period of the first procedure by the same physician. A new postoperative period begins when the staged procedure is billed.
What CPT codes are changing for 2024?
Several Category III codes will be converted to Category I codes in the Current Procedural Termi- nology (CPT®) 2024 code set, these include: dorsal sacroiliac (SI) arthrodesis; coronary fractional flow reserve (FFR) with computerized tomography (CT); coronary intravascular lithotripsy (IVL) interventions; ...
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 physicians bill HCPCS codes?
HCPCS allows physicians to document the services provided. These codes are added to insurance claims and submitted to insurance companies for payment.
Who issues CPT codes?
The CPT® Editorial Panel is responsible for maintaining the CPT code set. The Panel is authorized by the AMA Board of Trustees to revise, update, or modify CPT codes, descriptors, rules and guidelines.
How is HCPCS different from CPT?
CPT codes are entirely numeric and consist of five digits. HCPCS codes are alphanumeric, which means they use both numbers and letters. You'll always see a letter followed by four numbers. These structures make it easy to differentiate between an HCPCS code vs.
What is the purpose of HCPCS?
The Healthcare Common Procedure Coding System (HCPCS) is a national, uniform coding structure developed by the Centers for Medicare & Medicaid Services (CMS) to standardize the coding systems used to process Medicare and Medicaid (Medi-Cal) claims on a national basis.
What type of code is 99211?
Code 99211 is commonly used for services such as patient education, simple rechecks and medication reviews. Some procedures can also appropriately be reported with this code.
What are the two types of 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 is the CPT HCPCS code?
We maintain and annually update a List of Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) Codes (the Code List), which identifies all the items and services included within certain designated health services (DHS) categories or that may qualify for certain exceptions.
What does CPT mean?
CPT or Carriage Paid To is an incoterm definition used to explain that the cost of the goods includes everything required to bring the products to the agreed destination. The buyer is only responsible for import requirements and local delivery and unloading charges.
Where can I look up CPT codes for free?
The Centers for Medicare & Medicaid Services offer a free search (CPT code lookup) for RVU for every CPT code. Users can also request a CPT/RVU Data File license from the AMA to easily import codes and descriptions into existing claims and medical billing systems.
What is the CPT code 90837?
For CPT code 90837 (psychotherapy, 60 minutes with patient), a physician or other qualified health care professional can report a prolonged service code if the psychotherapy service, not performed with an E/M service, is 90 minutes or longer involving direct patient contact.