HCPCS Codes: Level I vs. Level II
HCPCS Codes: Level I vs. Level II
What Are HCPCS Codes?
HCPCS stands for Healthcare Common Procedure Coding System. These codes are used primarily in the United States to standardize the identification of medical procedures, supplies, products, and services for billing and reporting purposes.
Level I HCPCS Codes
Also Known As: CPT Codes (Current Procedural Terminology)
Issued By: American Medical Association (AMA)
Purpose: Describe medical, surgical, and diagnostic services and procedures performed by healthcare professionals.
Format: Five-digit numeric codes (e.g., 99213 for a standard office visit).
Used For: Physician services, hospital outpatient procedures, diagnostic tests, and surgeries.
Example:
99213: Office or other outpatient visit for an established patient.
Level II HCPCS Codes
Issued By: Centers for Medicare & Medicaid Services (CMS)
Purpose: Identify products, supplies, and services not covered by CPT codes.
Format: Alphanumeric codes starting with a letter followed by four digits (e.g., A4206).
Used For: Ambulance services, durable medical equipment (DME), prosthetics, orthotics, and supplies.
Example:
A4206: Disposable needles.
E0110: Crutches, underarm, wood.
Key Differences
Feature Level I HCPCS (CPT) Level II HCPCS
Issuer American Medical Association (AMA) Centers for Medicare & Medicaid Services (CMS)
Code Format 5-digit numeric (e.g., 99213) 1 letter + 4 digits (e.g., A4206)
Purpose Medical procedures and services Supplies, equipment, non-physician services
Usage Physician billing, clinical procedures Billing for DME, ambulance, drugs, supplies
Examples Office visits, surgeries Wheelchairs, oxygen tanks, ambulance transport
Why Are Both Levels Important?
Level I codes cover the majority of medical services and procedures performed by providers.
Level II codes ensure that items and services not described by CPT are consistently coded and billed.
Together, they provide a comprehensive coding system for healthcare billing and insurance claims.
Summary
HCPCS coding is essential for accurate medical billing, insurance reimbursement, and healthcare data tracking. Understanding the difference between Level I and Level II codes helps providers submit correct claims and get timely payments.
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