What's the difference between CPT and HCPCS coding?
Asked by: Dr. Nyasia Mills Jr. | Last update: May 12, 2025Score: 4.4/5 (9 votes)
Is the CPT code the same as HCPCS?
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.
What is the difference between CPT ICD-10 and HCPCS coding?
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 a HCPCS code used for?
The Healthcare Common Procedure Coding System (HCPCS) is a collection of codes that represent procedures, supplies, products and services which may be provided to Medicare beneficiaries and to individuals enrolled in private 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.
The Difference Between HCPCS and CPT Codes
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.
What are HCPCS G-codes used for?
G-codes are used to report a beneficiary's functional limitation being treated and note whether the report is on the beneficiary's current status, projected goal status, or discharge status. There are 42 functional G-codes that are comprised of 14 functional code sets with three types of codes in each set.
What is CPT coding?
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 purpose of CPT Level 1 HCPCS?
The Healthcare Common Procedure Coding System (HCPCS) consists of two levels: HCPCS Level I codes – These are the CPT codes which consists of codes and descriptive terms that are used to report medical services and procedures furnished by physicians, other providers, and healthcare facilities.
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 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).
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 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 is ICD-CPT and HCPCS?
Let's get the acronyms out of the way first: ICD: International Statistical Classification of Disease and Related Health Problems. CPT: Current Procedural Terminology. HCPCS: Healthcare Common Procedures Coding System.
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 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.
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.
Is a CPT code a diagnosis code?
While CPT codes are similar to ICD-10 codes, CPT codes identify services rendered, whereas ICD-10 codes represent patient diagnoses.
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 3 things does the CPT code tell you?
CPT codes are used to describe tests, surgeries, evaluations, and any other medical procedure performed by a healthcare provider on a patient.
Is CPT coding hard to learn?
Medical billing and coding can be challenging, especially if you are not familiar with medical terminology, codes, and procedures. To be successful in this field, you must have a good understanding of these concepts.
What is the HCPCS procedure code?
HCPCS is an acronym for Healthcare Common Procedure Coding System (HCPCS). When medical coders and billers talk about HCPCS codes, they're actually referring to HCPCS Level II codes.
Who uses HCPCS codes?
Medicare and other insurers cover a variety of services, supplies, and equipment that aren't identified by CPT® codes. The HCPCS Level II codes were established so providers and suppliers can submit claims for these items.
What is the 8 minute rule for Medicare therapy?
What is the 8-Minute Rule? To receive payment from Medicare for a time-based CPT code, a therapist must provide direct treatment for at least eight minutes. Providers must add the total minutes of skilled, one-on-one therapy and divide by 15. If eight or more minutes remain, you can bill one more unit.
What is modifier 59 in medical billing?
The CPT Manual defines modifier 59 as: “Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a. procedure or service was distinct or independent from other non-E/M (Evaluation/Management) services.