HCPCS Codes

When we think of medical billing and coding our first thought is of the coding systems that are critical to the process.

So what is a HCPCS Code?

A HCPCS (pronounced like hicks picks) code is not unlike any other billing code that is used to describe the service, treatment or supplies that can be provided to a patient. The unique difference is the fact that these codes are divided into level I and level II codes.

  • Level I HCPCS codes are five-digit numeric codes that look identical to and are used the same way as CPT-4 codes.  
  • Level II HCPCS codes are five-digit, alpha-numeric codes that are used to bill for non-physician services.

HCPCS II codes include but are not limited to:

  • Ambulance rides.
  • Durable medical equipment.
  • Alcohol and Drug abuse treatment.
  • Miscellaneous Medical Services.
  • Prosthetic and Orthotics.
  • Medical supplies.
  • Chemotherapy drugs. 

HCPCS level I

So why do we need both HCPCS Level I and CPT- 4 codes if they are identical?

This is a bit confusing but CPT-4 codes were designed for billing to private and commercial health insurance carriers and HCPCS level I codes were designed for billing to Medicare, Medicaid and some other payers. CMS adopted the same codes as the CPT-4, so for billing purposes the codes are the same but the main difference depends on who you are billing to.

For example 

When 99214 is billed to a commercial carrier it is considered a CPT-4 code

and

When 99214 is billed to Medicare it is considered a HCPCS level I code.

HCPCS Level II codes

HCPCS Level II codes are used to identify products, services, drugs and supplies, including durable medical equipment, and they are used as temporary codes when a valid code does not exist yet.


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