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Chapter 8: HCPCS

Question	Answer
Durable Medical Equipment	is used primarily in the patient's home and used for medical purposes
The HCPCS level ll miscellaneous codes	allow DMEPOS dealers to submit a claim for a product or service as soon as it is approved by the Food and Drug Administration (FDA) even though there is no code that describes the product or service.
The ACA provides a ninety-day grace period	b4 insurer can discontinue some1s coverage for failure to pay monthly premium.Applies only to those who have received an advanced an advance premium tax credit to purchase health insurance through the Marketplace&have previously paid at least 1 months ful
AMA (American Medical Association)	is responsible for annual updates
HCPCS	is commonly referred to as HCPCS Level l & ll codes and is not a reimbursement methodology.
HCPCS furnishes	health care providres and suppliers with a standardized lanuage for reporting professional services, procedure, supplies and equipment.
HCPCS Level l	codes are procedures and services reported using the CPT manual.
The HCPCS National Panel is responsible	for making decisions about additions, revisions,and deletions to the permanent national alphanumeric codes.
HCPCS Level ll	ar3e maintained by the CMS & are miscellaneous codes that're reported when a durable medical equipment, prosthetiss, orthotics and supplies (DEMPOS) dealer submits a claim for a product or service.
HCPCS Level ll codes have 5 types of codes	Permanent national codes Dental codes Miscellaneous codes Temporary codes Modifiers
HCPCS Level ll are maintained by	CMS
HCPCS Level ll whenever a permanent code is established by the HCPCS National Panel to replace a temporary code,	the temporary code is deleted and cross referenced to the new permanent codes.
Both CPT & HCPCS Level ll	national code is published by the American Dental Association
The HCPCS Level ll dental codes are contained	in the Current Dental Terminology (CDT) , a coding manual published by the American Dental Association
G codes	identify professional health care procedures and services that do not have codes identified in CPT and are temporary codes.
HCPCS Level ll modifiers are	alphabetic (two letters) or alphanumeric ( one letter followed by one number)
Which HCPCS Level ll codes are reported to the local MAC?	D G M P
NEVER CODE FROM THE THE INDEX	ALWAYS VERIFY IN THE TABULAR SECTION
Codes used to report DMEPOS	are HCPCS Level ll
CMS was previously known as	HCFA
Permanent National Codes	makes decisions regarding additions, revisions, and deletions
The purpose of the CDT (Current Dental Terminology)	is to achieve uniformity,consistency&specificity in accurately reporting dental treatment. One use of the CDT Code is to provide for the efficient processing of dental claims.
Not otherwise classified codes	are miscellaneous codes
Hospital Outpatient prospective payment system (OOPS)	Section 4523 of the Balanced Budget Act of 1997 (BBA) provides authority for CMS to implement a prospective payment system (PPS) under Medicare for hospital outpatient services.
Use Modifier-UE	for "used equipment" products
J codes	are found on the Table of Drugs (medications)
Location of service or procedures are found in the	index
Medicare Administrative Contractor (MAC)	process Medicare claims,enroll healthcare providers in Medicare program&educate providers on Medicare billing requirements. They also handle claims appeals&answer beneficiary&provider inquiries.Section 1861 of Social Security Act(the act)defines item&serv
Medicare Carriers Manual (MCM)	are guidelines established by Medicare about coverage for HCPCS Level ll service/ consult when descriptor of HCPCS Level ll
assigning both a CPT code and HCPCS code	the health care provider would use a CPT code for the administration of an injection and a HCPCS code to identify the medication.
The three characteristics of the HCPCS Level ll code system	ensuring uniform reporting of medical products or services. uses code descriptors to identify similar products or services rather than brand names. not a reimbursement methodology for making coverage or payment determination
claims that contain miscellaneous codes	are manually revised by the payer must have a complete description of the product or service, pricing information for product or service, documentation to explain why the item or service is needed.
Temporary codes	allow payers the flexibility to establish codes that are needed before the next January 1 update
Transitional pass-through paymetns	are temporary additional payments made for certain innovative medical devices, drugs, and biological provided to Medicare beneficiaries
H codes are reported	to state Medicaid agencies that are mandated by state law to establish separate codes for identifying mental health services (e.x. alcohol and drug treatment services)

Created by: dd1025dl

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