What is the difference between a HCPCS and CPT code?
Asked by: Friedrich Strosin II | Last update: June 23, 2025Score: 4.5/5 (35 votes)
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.
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.
Does Medicare prefer CPT or HCPCS codes?
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.
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 ...
The Difference Between HCPCS and CPT Codes
Is CPT and HCPCS the same thing?
HCPCS stands for Healthcare Common Procedure Coding System and is used to classify medical procedures and services. Meanwhile, CPT, or Current Procedural Terminology, is used to describe medical procedures and services.
Are CPT codes included as HCPCS codes?
HCPCS is divided into 2 main subsystems — Level I and Level II. HCPCS Level I: Comprised of Current Procedural Terminology (CPT®), a numeric coding system maintained by the American Medical Association (AMA).
Why are CPT codes also called HCPCS Level I codes?
HCPCS is divided into two principal subsystems, referred to as Level I and Level II of the HCPCS. HCPCS Level I codes are part of the Current Procedural Terminology (CPT®) code set maintained by the CPT® Editorial Panel and copyrighted by the American Medical Association (AMA).
What CPT codes are not covered by Medicare?
Certain services are never considered for payment by Medicare. These include preventive examinations represented by CPT codes 99381-99397. Medicare only covers three immunizations (influenza, pneumonia, and hepatitis B) as prophylactic physician services.
When to use HCPCS code?
Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes such as drugs and biologicals, or durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) used in outpatient settings such as hospital outpatient ...
What are the three categories 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.
Will Medicare pay for two different doctor visits on the same day?
The para states that as for all other E/M services except where expressly noted, the Medicare Administrative Contractors (MACs) may not pay two E/M office visits billed by a physician (or physician of the same specialty from the same group practice) for the same beneficiary on the same day unless the physician ...
What CPT codes are deleted for 2024?
Existing codes 99441-99443 will be deleted. For additional information, refer to Appendices P and T in the CPT 2024 code book. The following E/M codes have been revised in the CPT 2024 code set.
Are HCPCS codes only for outpatient?
HCPCS Level I consists of the Current Procedural Terminology (CPT)® code set and is used to submit medical claims to payers for procedures and services performed by physicians, non-physician practitioners, hospitals, laboratories, and outpatient facilities.
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.
What is the difference between CPT and HCPCS codes?
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 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).
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.
What does HCPCS stand for?
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 3 things does the CPT code tell you?
A CPT code is a number used to identify a medical service or procedure. CPT codes are used by healthcare providers for reporting, billing, and administration purposes. Some CPT codes are only used occasionally, and some are not really used at all.
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.
What is CPT code 99214?
According to CPT, 99214 is indicated for an “office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a detailed history, a detailed examination and medical decision making of moderate complexity.” [For more detailed ...
What code does CPT fall under?
The HCPCS coding system is divided into two levels. Level I of the HCPCS is comprised of CPT codes. Level II of the HCPCS is a standardized coding system that is used primarily to identify products, suppliers, and services not included in the CPT code set jurisdiction.
Can you 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.