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HCPCS

QuestionAnswer
How many levels of HCPCS codes are there? 2
What are HCPCS level I codes? Current Procedural Terminology (CPT)
What are HCPCS level II codes? national codes (HCPCS book)
DME durable medical equipment
What is the definition of durable medical equipment? equipment that can withstand repeated use, is primarily used to serve a medical purpose, is used in the patient's home, and would not be used in the absence of illness or injury
DMEPOS durable medical equipment, prosthetics, orthotics, and supplies
Who is responsible for HCPCS level I codes? American Medical Association (AMA)
What is the format of a CPT code? 5 digits, hyphen and 2 digit modifier if necessary
Who is responsible for HCPCS level II codes? CMS
Name the 5 types of HCPCS level II codes 1. Permanent national codes 2. Temporary codes 3. Miscellaneous codes 4. Modifiers 5. Dental codes
Who is responsible for maintaining permanent national codes? HCPCS National Panel
Name the members of the HCPCS National Panel BCBS Association HIAA (Health Insurance Association of America) CMS
Where are dental codes found? CDT - Current Dental Terminology
Who is responsible for maintaining dental codes? ADA (American Dental Association)
Who can bill using miscellaneous codes? DMEPOS dealers because they can submit claims for a product or service as soon as it's FDA approved, even if there is no code yet
Who is responsible for maintaining temporary codes? CMS and other members of the HCPCS National Panel
How long can a code remain temporary? indefinitely
What does a modifier do? Clarifies services and procedures performed by providers
MAC Medicare Administrative Contractor
What determines whether a DME claim should be submitted to the local MAC or the regional DME MAC? The letter the code begins with
What happens to a temporary code when it is replaced with a permanent code? It is deleted and cross-referenced to the new permanent code
When would a CPT and HCPCS code be needed on a claim? When the procedure and medication need to be billed, i.e. giving an injection (CPT for the procedure and HCPCS for the actual medication)
What is the format for a HCPCS level II code? letter followed by 4 numbers, hyphen and 2 digit modifier if necessary
 

 



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