What is an HCPCS code?
An HCPCS code identifies a health care service, supply, drug, or piece of equipment for billing Medicare, Medicaid, and other programs under the Healthcare Common Procedure Coding System. Level I codes are AMA CPT codes; Level II codes are alphanumeric CMS-maintained codes covering durable medical equipment, prosthetics, supplies, and drugs, published annually by CMS.
Full name: Healthcare Common Procedure Coding System
Short explanation
The Healthcare Common Procedure Coding System (HCPCS) is a standardized coding system used to identify health care services, supplies, products, and equipment for billing in Medicare, Medicaid, and other programs. HCPCS Level I codes are AMA CPT codes; HCPCS Level II codes are alphanumeric codes maintained by CMS covering durable medical equipment, prosthetics, orthotics, supplies, drugs, and other items not covered by CPT. CMS publishes the HCPCS Level II code set annually.
How it’s used
- CMS Care Compare — ASC Quality Measures: ASC quality metrics use HCPCS/CPT codes to define the denominator populations for reportable procedures.
- CMS QPP MIPS: MIPS measure specifications reference both CPT and HCPCS Level II codes to define reporting populations for eligible clinicians.
Frequently asked questions
- What is HCPCS?
- HCPCS (Healthcare Common Procedure Coding System) is a CMS coding system used to bill Medicare and Medicaid for services, supplies, drugs, and equipment.
- What is the difference between HCPCS Level I and Level II?
- Level I codes are CPT codes (maintained by AMA). Level II codes are alphanumeric codes maintained by CMS for items like durable medical equipment and drugs.
- Who uses HCPCS codes?
- Providers, suppliers, and durable medical equipment companies use HCPCS codes to bill Medicare, Medicaid, and other payers for covered services and supplies.