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Understanding the Healthcare Common Procedure Coding System (HCPCS)

What Is HCPCS? The Centers for Medicare and Medicaid Services (CMS) created the HCPCS. It is a collection of codes and descriptors that represent procedures, supplies, products and services that may be provided to Medicare beneficiaries and to patients enrolled in private health insurance programs. The codes are divided into two levels. Level I consists of Current Procedural Terminology (CPT), a numeric coding system maintained by the American Medical Association. The CPT is a uniform coding system of descriptive terms and identifier codes that are used primarily to identify medical services and procedures furnished by physicians and other healthcare professionals. Providers use the CPT to identify services for which they bill public or private insurance programs. The codes do not include those to support medical items or services that are regularly billed by suppliers other than physicians. The codes are updated yearly. Level II is a standardized coding system used primarily to identify products, supplies and services that are not included in the CPT codes, such as ambulance services, durable medical equipment, prosthetics, orthotics and, when they are used outside a medical office, basic supplies. Because Medicare and other insurers cover a variety of services that are not identified by CPT codes, the Level II codes were established for submitting claims for those items. Level II codes consist of a single letter followed by four numeric digits. CPT codes have five numeric digits. Modifiers HCPCS also contain modifiers, which are two-position codes and descriptors used to indicate that a service or procedure has been altered by specific circumstances. However, this alteration did not change the definition or the code. Modifiers are also grouped into two levels following the same subsystem as the codes. Modifiers are two letters or one letter and one number. CMS involves providers in making changes to codes and updates the status of new and changed codes every quarter. To stay abreast of the changes or to provide input, visit http://www.cms.gov/medhcpcsgeninfo.

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INDUSTRY NEWS TAGS: Other Healthcare News


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