The HCPCS code set is based on the AMA CPT processes. HCPCS was established in 1978 to provide a standardized coding system for describing specific items and services. Initially, facilities voluntarily used HCPCS codes, but with the implementation of HIPAA in 1996, facilities began to report HCPCS for transaction codes. HCPCS has its own coding guidelines and works hand in hand with CPT. HCPCS includes three separate levels of codes:
- Level I codes consist of the AMAâ„¢s CPT codes and is numeric.
- Level II codes are the HCPCS alphanumeric code set and primarily include non-physician products, supplies, and procedures not included in CPT.
- Level III codes, also called HCPCS local codes, were developed by state Medicaid agencies, Medicare contractors, and private insurers for use in specific programs and jurisdictions. These are still included in the HCPCS reference coding book. Some payers prefer that coders report the Level III codes in addition to the Level I and Level II code sets. However, these codes are not nationally recognized.
As with CPT, the HCPCS Level II codes standardize similar products and categories for processing the medical claim. The HCPCS codes are primarily used for billing and identifying items and services. These items and services primarily include non-physician based services such as:
- Ambulance services
- Prosthetic devices
- Drugs, infusion additives, and ancillary surgical supplies
- Non-physician services not covered by CPT codes (Level I codes)
Divisions within HCPCSCoders will find the following sections in the HCPCS Manual:
- A codes, transportation, medical and surgical supplies, miscellaneous and experimental
- B codes, enteral and parenteral therapy
- C codes, temporary hospital OPPS
- E codes, durable medical equipment
- G codes, temporary procedures and professional services
- H codes, behavioral health/substance abuse services
- J codes, drugs administered other than oral method, chemotherapy drugs
- K codes, temporary codes for durable medical equipment regional carriers
- L codes, orthotic/prosthetic procedures
- M codes, other medical services
- P codes, pathology and laboratory
- Q codes, temporary codes (limited use and guidelines specific)
- R codes, diagnostic radiology services
- S codes, temporary national codes (non-Medicare) codes
- T codes, temporary state Medicaid agency codes
- V codes, vision/hearing services
