What Are HCPCS Codes?

In my previous posts, I talked about “What Are CPT Codes and Why Are They Important” and “How to Look Up CPT Codes for FREE — 7 Steps!” with the available online resources. Today, we’ll look at what’s considered to be the third major code set: the HCPCS codes.

HCPCS (often pronounced “hicks-picks”) stands for Healthcare Common Procedure Coding System. It was established in 1978 as a way to standardize identification of medical services, supplies and equipment. According to MB&C, this code set is based upon CPT. In fact, the first level of HCPCS is identical to CPT. That might sound a little confusing, so let’s take a step back

What Are HCPCS Codes Used For?

HCPCS was developed by the Centers for Medicare and Medicaid (CMS) for the same reasons that the AMA developed CPT: for reporting medical procedures and services. Up until 1996, using HCPCS was optional. In that year, however, the government passed the Health Information Portability and Accountability Act, or HIPAA.

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. CMS looked at the established CPT codes and decided that they didn’t need to improve upon or vary those codes, so instead they folded all of CPT into HCPCS. Source: http://www.medicalbillingandcoding.org/hcpcs-codes/

CPT vs. HCPCS Codes Medical Coding — Video

YouTube video

CPT Codes vs. HCPCS Codes

There are two sets of codes. The first, or Level I, code set is a five-digit numeric code that contains the Physicians= Current Procedural Terminology (CPT) maintained by the American Medical Association. The CPT is comprised of descriptive terms and identifying codes used primarily for billing for services provided by physicians and other healthcare professionals.

The second code set, or Level II, is a code set for medical services not included in Level I, such as durable medical equipment, prosthetics, orthotics and supplies. These codes are alpha-numeric in that they begin with a single letter, such as an AE or AK in the case of durable medical equipment, followed by four numbers. Source: http://www.easystand.com/documents/2012/12/faqs-about-hcpc-codes.pdf

Where the real difference between CPT and HCPCS comes in is in Level II of HCPCS and the HCPCS modifiers.

Where You Find HCPCS Codes & How To Use Them

Patients can find HCPCS / CPT Codes in a number of places. As you leave the doctor’s office, you are handed a review of your appointment which may have a long list of possible services your doctor provided, with some of them circled.

The associated numbers, usually five digits, are the codes.

If your appointment requires follow up billing by your doctor for copays or co-insurance, then the codes may be on those bills.

A wise patient and smart healthcare consumer will use these codes to review medical billings from practitioners, testing centers, hospitals or other facilities. It’s a good way to be sure your insurance (and your co-pays and co-insurances) are paying only for those services you received.

If you receive statements from either the doctor or your health insurance and the HCPCS / CPT codes do not appear, then contact the party who sent them and request a new statement that does include the codes.

Like CPT, HCPCS alerts you to which codes are new and which codes have been revised. New codes are listed with a circle, while revised codes have a triangle next to them. HCPCS is constantly being updated, and CMS, which maintains the code set, will often recycle codes. HCPCS features a number of strikethrough codes, and these let you know that a code that used to be listed there has been deleted and moved elsewhere. Source: http://patients.about.com/od/costsconsumerism/a/hcpcscodes.htm

Check out HCPCS 2016 Level II Professional Edition as a resource you might be looking for.

Related HCPCS Codes Posts:

What Are HCPCS Codes?

2 thoughts on “What Are HCPCS Codes?”

  1. This is a very good article. The thing I find with HCPCS II is that it’s not really used all that much, at least in out patient coding for a physician. We do use it probably more than some, but not all that much and it seems to me that because it’s a type of limited coding, there’s not much that is taught on these codes.I really wish I knew more about these codes and when they should be used. Why/what the reason for some of these codes are. I know some are for PQRS, but what of the ones that aren’t? It would be good to know when, for what reason or why you are supposed to use them. It just feels like they are, in my field, like they are kind of cast aside codes and then all of the sudden I find myself saying, “Oh yeah, I’m supposed to use one of those G codes.” The book is small compared to the others, and it just seems like the training for it is just as small.Thank goodness for Laureen. She did go over this in the CPC Blitz.

  2. Excellent article! The embedded video is great for review and I love the free download of the Modifiers Job Tool; I’m sure it will prove to be so valuable! Thanks to CCO !!


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