What is HCPCS?

HCPCS stands for Healthcare Common Procedure Coding System (HCPCS). For Medicare and other health insurance programs to ensure healthcare claims are processed in a consistent and orderly manner, standardized code sets are essential. The HCPCS Level II coding system is one of the standard code sets used by medical coders and billers for this purpose. The other HCPCS code set (Level I) is comprised of CPT® (Current Procedural Terminology) codes, copyrighted by the American Medical Association (AMA).

Sometimes described as the “hall closet of coding,” HCPCS Level II meets several needs. The HCPCS Level II code set is made up of five-character, alpha-numeric codes mainly representing medical supplies, durable medical goods, non-physician services, and services not represented in the Level I code set (CPT®). HCPCS Level II includes services such as ambulance, durable medical equipment, prosthetics, orthotics and supplies (DMEPOS), when used outside a physician’s office. This coding system is also used as an official code set for outpatient hospital care, chemotherapy drugs, Medicaid, and other services. The Blue Cross Blue Shield Association and the American Dental Association (ADA) post their procedure codes as part of HCPCS Level II. The Centers for Medicare & Medicaid Services (CMS) regularly uses HCPCS Level II to post codes for the tracking of demonstration projects and new technologies.

The development and use of HCPCS Level II codes began in the 1980s. In 2003, the Secretary of Health and Human Services (HHS) delegated authority (under the Health Insurance Portability & Accountability Act of 1996 [HIPAA] legislation) to CMS to maintain and distribute HCPCS Level II codes. The code set is revised quarterly based on public input, which includes feedback from providers, manufacturers, vendors, specialty societies, the ADA, Blue Cross, and others.

See the full list of HCPCS codes.

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