What is the difference between CPT and Hcpcs codes?
Asked by: Keven Okuneva V | Last update: September 19, 2025Score: 4.6/5 (10 votes)
What is the difference between CPT and HCPCS?
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 difference between ICD-10 CPT and Hcpcs 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 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 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.
The Difference Between HCPCS and CPT Codes
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 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 should HCPCS codes be used?
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.
Who accepts Hcpcs codes?
National HCPCS Level II codes are maintained by CMS, but all private and public health insurers may use them.
What is a CPT code example?
Some CPT codes are only used occasionally, and some are not really used at all. Other CPT codes are used frequently. For example, 99213 and 99214 are codes for general office visits, usually to address one or more new concerns or complaints, or to follow up on one or more problems from a previous visit.
What are the two types 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.
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.
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).
What is the use of HCPCS?
HCPCS Level II is a standardized coding system that is used primarily to identify drugs, biologicals and non-drug and non-biological items, supplies, and services not included in the CPT® code set jurisdiction, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when ...
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.
What is the CPT code 99213?
CPT® code 99213: Established patient office visit, 20-29 minutes | American Medical Association.
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.
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 does CPT stand for?
Current Procedural Terminology (CPT®) codes provide a uniform nomenclature for coding medical procedures and services.
When would you use a CPT code?
2. CPT Codes or current procedural terminology codes are used to identify procedures or services performed and are maintained by the AMA. 3. HCPCS codes or the Healthcare Common Procedure Coding System (HCPCS) is used to identify equipment, medication and out-patient services not include in CPT.
Do Hcpcs codes always start with a letter?
While Level I codes are almost always numeric, Level II codes always begin with single alphabetical character, ranging from A to V, followed by four numbers. In coding and policy discussions the term HCPCS is typically used in reference to Level II codes, while Level I codes are referred to as CPT codes.
Are Hcpcs codes only for outpatient?
The Healthcare Common Procedure Coding System (HCPCS) is used to report hospital outpatient procedures and physician services. These coding systems serve an important function for physician reimbursement, hospital payments, quality review, benchmarking measurement and the collection of general medical statistical data.
What are the 6 things Medicare doesn't cover?
- Eye exams (for prescription eyeglasses)
- Long-term care.
- Cosmetic surgery.
- Massage therapy.
- Routine physical exams.
- Hearing aids and exams for fitting them.
Which payer will require the HCPCS code instead of the CPT?
In terms of payer, it's usually the government-based payers such as Medicare that would require the HCPCS code instead of the CPT since these are codes developed by Centers for Medicare and Medicaid Services (CMS).
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.