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Step by Step {CBCS}
Intro to Level 2 National Codes HCPCS
| Term | Definition |
|---|---|
| HCPCS | stands for: Healthcare Common Procedure System | developed by CMS in 1983 |
| HCPCS: Level 2 (national codes) | is a collection of codes that represents procedures, supplies, products, Medi/Medi & Private Insurance services |
| HCPCS | is divided into two levels or groups (Level 1 & Level 2) |
| DMEPOS | Durable Medical Equipment, Prosthetics, Orthotics, & Supplies |
| HCPCS: Level 1 | includes CPT codes in the CPT manual, which are developed, maintained, & copyrighted by the AMA |
| HCPCS: Level 2 (national codes) | are approved & maintained jointly by the Alpha-Numeric workgroup, consisting of the CMS, HIAA, and BCBS association |
| HCPCS: Level 2 (national codes) | includes national codes that are revised on a quarterly basis |
| HIAA | Health Insurance Association of America |
| HCPCS: Level 2 (national codes) | are five-character alphanumeric codes representing physician & nonphysician services, products, & supplies that are not represented in the Level 1 codes |
| HCPCS: Level 2 (national codes) | Durable Medical Equipment, Prosthetics, Orthotics, Supplies, & ambulance services are included in this code set |
| HCPCS: Level 2 (national codes) | in some instances, Medicare requires the use of these codes to override an already existing CPT code |
| HCPCS: Level 2 (national codes) | in Oct 2003, the HHS delegated authority under HIPAA legislation to CMS to maintain & distribute these national codes |
| CMS (Centers for Medicare and Medicaid Services) | establishes uniform national definitions of services, codes to represent services, & payment modifiers to the codes |
| Level 3 (local codes) | are no longer available since the implementation of HIPAA in 1996, although some were integrated into the National Codes |
| Level 3 (local codes) | developed by Medicare carriers or state payers for use at the local carrier level |
| Level 3 (local codes) | 5-character alphanumeric codes representing physician & nonphysician services not represented in Level 1 (CPT) or Level 2 codes |
| CPT codes | DO NOT cover all services | there are no specific codes for many of the supplies that are used in patient care |
| National codes | reporting is mandatory on all Medicare and Medicaid claims |
| National codes | many 3rd party payers now require that providers use this when submitting bills for non-Medicare patients |
| National codes | not used by health care facilities to report services provided to inpatients |
| National codes | these two levels are used in outpatient settings where the basis of payment is the service rendered |
| A codes | Transportation Services, Med/Surgical Supplies, Gradient Compression Stockings; Wound Care; Respiratory DME, Inexpensive & Routinely Purchases, Administrative, Misc, and Investigational |
| B codes | Enteral & Parenteral Therapy |
| C codes | CMS Hospital Outpatient Prospective Payment System |
| D codes | Dental Procedures |
| E codes | Durable Medical Equipment; Misc.; Skin Protection, Wheelchair; Arm Support; Gait Trainer |
| G codes | Temporary Procedures/Professional Services |
| H codes | Behavioral Health and/or Substance Abuse Treatment Services |
| J codes | Drugs Other Than Chemotherapy; Chemotherapy Drugs |
| K codes | Temporary Codes Assigned to DME Regional Carriers |
| L codes | Orthotics; Prosthetics |
| M codes | Other Medical Services |
| P codes | Laboratory Services |
| Q codes | Temporary Codes Assigned by CMS |
| R codes | Diagnostic Radiology Services |
| S codes | Temporary National Codes Established by Private Payers |
| T codes | Temporary National Codes Established by Medicaid |
| V codes | Vision Services; Hearing Services |
| Codes beginning with: G, K, Q, S, and T | are for temporary assignment of items and services |
| Codes beginning with: G, K, Q, S, and T | these codes remain active until a definitive decision can be made about appropriate code assignment or deletion |
| G codes | are temporary codes used to identify professional health care procedures & services when no CPT code has been established |
| G codes | are used to report some services for Medicare beneficiaries when other carriers would instead report the existing CPT codes |
| K codes | assigned by CMS, and are temporary codes for the use of DME |
| Q codes | are used to identify services that are not reported with a CPT code, such as: drugs biologicals, and types of medical equipment/services |
| Q codes | not identified by Level I HCPCS, these codes are still required for processing claims |
| S codes | are temporary Blue Cross/Blue Shield (private payer) codes that are not valid for Medicare or Medicaid patients |
| T codes | are used by State Medicaid agencies for items without permanent national codes but meet a national Medicaid program operating need |
| Miscellaneous HCPCS codes | are reported when no existing Level 2 code adequately describes the service or item being billed |
| Miscellaneous HCPCS codes | are used to serve as a placeholder until more specific HCPCS codes are identified |
| Miscellaneous HCPCS codes | submittal without further explanation or accompanying documentation will result in a denial until the necessary info is documented & resubmitted |
| Miscellaneous HCPCS codes | may be assigned by insurers for use during the period of time a request for a new code is being considered under HCPCS review |
| HCPCS manuals | are updated annually by CMS in November for use the following January (1). updates are also provided quarterly online |
| HCPCS manuals | includes the General Guidelines for National Codes, a list of modifiers, the codes, a Table of Drugs, and an Index |
| J codes | identify the drugs administered & the amounts or dosages given |
| J codes | refer to drugs only by generic name |
| Routes of Administration of Drugs: INJ | Injection |
| Routes of Administration of Drugs: IT | Intrathecal |
| Routes of Administration of Drugs: IV | Intravenous |
| Routes of Administration of Drugs: IM | Intramuscular |
| Routes of Administration of Drugs: SC | Subcutaneous |
| Routes of Administration of Drugs: INH | Inhalant Solution |
| Routes of Administration of Drugs: VAR | Various Routes |
| Routes of Administration of Drugs: OTH | Other Routes |
| CNS | Certificate of Medical Necessity |
| Certificate of Medical Necessity (CNS) forms | CMS-848 & CMS-484 |
Created by:
VA_MedCod3r