What is the difference between HCPCS I and HCPCS II?
Asked by: Joaquin Osinski | Last update: August 10, 2025Score: 4.9/5 (39 votes)
What is the difference between CPT I and CPT II?
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 difference between a Level 1 and Level 2 codes in the procedural setting?
Level II of the HCPCS is used primarily to identify products, supplies and medical services that are not identified by Level I (CPT-4) codes. Examples of Level II HCPCS include: Ambulance services. Durable medical equipment.
What is Hcpcs II used for?
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 is an example of a Level 1 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. Coders use this code to denote the transportation of personnel and portable X-ray equipment to nursing homes or homes.
The Difference Between HCPCS and CPT Codes
What is the difference between HCPCS Level 1 and Level 2?
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). HCPCS Level II codes are established and maintained by CMS.
What is a Level 3 HCPCS code?
Level III of HCPCS is the subsystem of codes that was developed by Medicaid State agencies, Medicare contractors, and private insurers for use in their specific programs or local areas of jurisdiction. Level III codes are also referred to as local codes.
Why is HCPCS important?
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 three types of codes printed in the HCPCS Level II codebook?
Three types of HCPCS codes printed in the HCPCS Level II codebook consist of Permanent National Codes, Miscellaneous Codes/not otherwise classified, Temporary National Codes.
What are the levels of CPT codes?
CPT® Category I: The largest body of codes, consisting of those commonly used by providers to report their services and procedures. CPT® Category II: Supplemental tracking codes used for performance management. CPT® Category III: Temporary codes used to report emerging and experimental services and procedures.
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 are the two primary types of codes in medical coding?
The ICD codes denote your diagnosis and are used on hospital records, medical charts, visit summaries, bills and other patient paperwork to ensure the proper delivery of medical care. Meanwhile, the CPT codes correspond to the medical treatments you received during a visit.
What are the three levels of code?
The Glaserian Grounded Theory method uses three levels of coding – open coding, selective coding, and theoretical coding (Figure 26). Open coding is the initial phase of grounded theory analysis (Glaser and Strauss, 1967; Strauss and Corbin, 1990).
When to use HCPCS vs cpt?
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 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 F code for A1c?
To report most recent hemoglobin A1c level hemoglobin A1c level greater than or equal to 8.0% and less than 9.0%, use 3052F. To report most recent A1c level ≤9.0%, use codes 3044F, 3051F, 3052F.
What are the main differences between HCPCS Level I and Level II?
Why Level II Exists: While CPT-4 codes detail the actions of the provider, Level II codes document the items or services utilized. Despite not all payers accepting HCPCS Level II codes, many have integrated this code set, especially for Medicare claims.
What is the forbidden symbol in medical coding?
In the CPT code list, a forbidden () symbol is employed to describe codes that are not to be used separately. These are the codes always used in conjunction with another service and not separately billable.
What does a 59 modifier mean?
Modifier 59 Distinct Procedural Service indicates that a procedure is separate and distinct from another procedure on the same date of service. Typically, this modifier is applied to a procedure code that is not ordinarily paid separately from the first procedure but should be paid per the specifics of the situation.
What is an example of HCPCS?
Often pronounced by its acronym as "hick picks," HCPCS is a set of health care procedure codes. Examples: G0008 Administration of influenza virus vaccine.
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 is the last step in the coding process?
The 'four-step coding process' is the method used by clinical coders to ensure accurate and consistent code assignment. As the name suggests, there are four important steps to follow to ensure you arrive at the correct diagnosis or procedure code. Step 1: Analyse, Step 2: Locate, Step 3: Assign, Step 4: Verify.
What does ICD-10 stand for?
The International Classification of Diseases, Tenth Revision (ICD-10) is a global system for coding causes of death.
What is CPT code 11111?
The 11111 CPT code will register as a no charge visit to your front office staff on the practice management side.
What are J codes in medical billing?
J-codes, part of HCPCS Level II, are alpha-numeric codes used only for non-oral medications. The medicines they are referring to, like chemotherapy, inhalation products, and immunosuppressant drugs, are part of J-codes for drugs.