What's the difference between CPT and HCPCS codes?
Asked by: Cordia Morar | Last update: June 7, 2025Score: 4.3/5 (57 votes)
Are HCPCS and CPT codes the same?
Some CPT codes are even used internationally. Medical providers often use these codes to describe and document the services they offer, in addition to using them for billing purposes. On the other hand, HCPCS codes are used to bill for a much smaller, more specific range of medical services.
Are CPT codes included as HCPCS level 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).
What is the difference between CPT code and J code?
J-codes consist of a letter followed by four numbers, representing specific medications and their dosages within the HCPCS. Physicians pair J-codes with standardized Current Procedural Terminology (CPT) codes when prescribing medication.
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.
The Difference Between HCPCS and CPT Codes
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.
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.
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 ...
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 is an example of a CPT code?
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 CPT codes are deleted for 2025?
In recognition of these changes, for CPT 2025, codes 49203, 49204, 49205 have been deleted and replaced by new codes 49186, 49187, 49188, 49189, 49190 that describe open excision or destruction of intra-abdominal primary or secondary tumor(s) or cyst(s), including cytoreduction, debulking, or other methods of removal ...
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.
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 is the difference between CPT code and procedure code?
The ICD-10 procedural coding system (ICD-10-PCS) is used by facilities (e.g., hospital) to code procedures. CPT codes are, and will continue to be, used by physicians (and other providers) to report professional services. The two systems are unique and very different.
What is the CPT code 99213?
CPT® code 99213: Established patient office visit, 20-29 minutes | American Medical Association.
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 does CPT stand for?
Current Procedural Terminology (CPT®) codes provide a uniform nomenclature for coding medical procedures and services.
What is the primary purpose of HCPCS coding?
These coding systems serve an important function for physician reimbursement, hospital payments, quality review, benchmarking measurement and the collection of general medical statistical data.
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.
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 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.