The Healthcare Common Procedure Coding System (HCPCS)

Great news, we will be adding all HCPCS Level II codes to our 2022 Contract Analyzer. Two principal subsystems, referred to as Level I and Level II of the HCPCS. Level I of the HCPCS is comprised of Current Procedural Terminology (CPT-4). The CPT-4 is a uniform coding system consisting of descriptive terms and identifying codes that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals.

Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT-4 codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician’s office.

Currently, Level II HCPCS codes represent ∼4,000 separate categories of like items or services that encompass millions of products from different manufacturers.

Although relative value units (RVUs) are not assigned to these codes, they are billable and reimbursable by most payers. Level II codes are broken down into the following categories:

  • Level II Modifiers
  • Medical and Surgical Supplies (A)
  • CMS Hospital Outpatient Payment System
  • Durable Medical Equipment (DME)
  • Temporary Procedures/Professional Services (G)
  • Drugs and Chemotherapy Drugs (J)
  • Temporary DME for Regional Carriers (K)
  • Orthotics and Prosthetics (L)
  • Temporary Codes assigned by CMS (Q)
  • Temporary National Codes by Private Payers (S)
  • Temporary Codes by Medicaid (T)
  • Vision and Hearing Services (V)

Level II codes and modifiers were developed to track performance measurement. Providers who submit quality measures via claims are using Category II codes to do so.

All Category II codes fall within 0001F-9007F. Modifiers include 1P, 2P, 3P, and 8P. Many practices use Category II codes internally to track practice quality measures since this method is easier than reviewing charts or manually tracking quality measures.

It is important that practices familiarize themselves with the entire HCPCS system to ensure appropriate coding and claims reporting of quality measures.

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