Healthcare Common Procedure Coding System (HCPCS) is a set of standardized codes representing medical procedures, supplies, products, and services. These codes are used to submit medical claims to Medicare, other health insurance payers, and to create medical records.
There are currently two subsystems in HCPCS, Level I and Level II.
In the 1980s and 1990s, there was a Level III which was used locally to fill gaps where Level I and Level II codes did not exist. In 2000, The Department of Health and Human Services phased out Level III to comply with HIPAA standards and create a universally standard system that could be used at the local, state, and federal level.
History of HCPCS Coding
HCPCS was created in 1978 so government agencies like Medicare and Medicaid could reimburse medical claims in an orderly, consistent manner. The original acronym stood for HCFA Common Procedure Coding System (HCPCS), and the “H” did not stand for Healthcare as it does today. At that time, the Health Care Financing Administration (HCFA) handled government reimbursed healthcare payments. Today we know this agency as Centers for Medicare & Medicaid Services (CMS).
In 1983, HCPCS merged the Level I codes with the American Medical Association’s CPT ® codes. (More on that in the next section.)
Levels of HCPCS Codes
HCPCS codes are a two-level alphanumeric system developed for use by the CMS.
Level I
HCPCS Level I codes are the Current Procedural Terminology (CPT® codes) which are maintained by the American Medical Association (AMA).
These codes identify procedures and services provided by healthcare facilities and medical offices. Each code is five digits. There are six subcategories in Level I.
· Evaluation and Management (99202–99499)
· Anesthesia (00100–01999)
· Surgery (10004–69990)
· Radiology (70010–79999)
· Pathology and Laboratory (80047–89398)
· Medicine (90281–99199, 99500-99607)
Level II
HCPCS Level II codes identify products, supplies, and services not included in the CPT® codes, such as ambulance services, or other medically related services used outside a physician’s office. Level II codes also cover durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).
Level II codes are alphanumeric, composed of one letter followed by four numbers. CMS maintains Level II codes, including additions and revisions.
|
Code Set |
Codes
Used For |
Code Composition |
Maintaining
Body |
Frequency
of Updates |
|
HCPCS Level
I |
Procedures
and services provided by physicians and other allied healthcare professionals |
5
numeric characters |
AMA |
Yearly
major update with minor updates quarterly |
|
HCPCS
Level II |
Drugs,
supplies, equipment, non-physician services, and services not represented in
CPT® |
5 alphanumeric
characters, beginning with a single letter and followed by 4 numbers |
CMS |
Quarterly |
What's the Difference Between HCPCS and CPT Codes?
The CPT® coding system is designed to report and encode medical, surgical and diagnostic procedures administered in a medical office. The CPT® codes are also the same as Level I of the HCPCS coding system.
HCPCS was designed for use by government insurance payers like Medicaid, and Level II of HCPCS is for non-physician medical services, medical products and supplies.
What's the Difference Between HCPCS and ICD Codes?
ICD-10, which stands for the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, is a set of alphanumeric medical codes used globally. The ICD-10 is maintained and revised by the World Health Organization, about every ten years. The ICD-10 classifies every disease, injury and symptom known to the worldwide medical community.
HCPCS Level I codes are medical procedures, surgical procedures, or diagnostics, generally done in a physician’s office or hospital. HCPCS Level II codes are for services, pharmaceuticals, supplies, medical equipment, prosthetics, non-physician services, ambulance services, and other aspects of a medical visit not covered by CPT codes or ICD-10.
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