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HCFA Common Procedure Coding System (HCPCS)

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HCPCS (pronounced "hick-picks") is the acronym for the HCFA Common Procedure Coding System. This coding system provides a uniform method for healthcare providers and medical suppliers to report and bill for professional services, such as medical supplies, DME and transportation services (including ambulance services). Originally developed for use in billing the Medicare and Medicaid systems, it is now also recognized and used by other claim payors, educational and research groups, and utilization review organizations. HCPCS coding is broken down into two primary subsystems, which are referred to as level I and level II.

Level I of the HCPCS, the CPT codes, does not include codes needed to separately report medical items or services that are regularly billed by suppliers other than physicians.

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 codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office. Because Medicare and other insurers cover a variety of services, supplies, and equipment that are not identified by CPT codes, the level II HCPCS codes were established for submitting claims for these items. The development and use of level II of the HCPCS began in the 1980's. Level II codes are also referred to as alpha-numeric codes because they consist of a single alphabetical letter followed by 4 numeric digits, while CPT codes are identified using 5 numeric digits. They begin with an Alpha character, followed by four numerals, such as: A0304, A4232, E0130, J7030, L1900, L6000, V2020, etc.

As of 2003, HCPCS level III codes became established. Rather than being nationally accepted, the level III codes became considered local codes that established a code for items or services not included in either of the two previous levels. As the healthcare industry continues to advance, the need to refine and expand the HCPCS coding continues. This allows insurance companies and providers to determine billing and coverage. Each time a new procedure or service is developed, a code that identifies it must also be established.

It is divided into section by type of service/supply, such as Transportation Services, Enteral and Parenteral Therapy, Dental procedures, Durable Medical Equipment, Chemotherapy Drugs, Orthotic Devices, Prosthetics, Vision care and Hearing services, etc.

For further information about HCPCS, please visit their website.

Last Updated ( Monday, 02 July 2007 11:05 )  

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