HCPCS stands for Healthcare Common Procedure Coding System. HCPCS codes are known as Level II codes, because they are additional codes created to supplement and help further define CPT-4 procedure codes. In the 1980s, the term HCPCS was used interchangeably with CPT-4, but these days the codes address separate issues.
CPT-4 vs. HCPCS
CPT-4, which stands for Current Procedure Terminology, Version 4, is a set of five-digit procedure codes that describe almost every medical procedure that can be performed by a physician. HCPCS codes cover some procedures that aren't defined within the CPT-4 structure, but mainly covers supplies, pharmaceuticals, dental, and other services that aren't considered procedures, yet are an integral part of health care billing. HCPCS codes are five-digit codes but the first digit is an alpha character, whereas CPT-4 codes are fully numeric.
Categories of Codes
There are two distinct types of category codes, and one that's not as distinct, as it's not included in any of the manuals. The first two types are national codes, even if they're for state services. The last one is always for either state or regional services.
Services and Supply Codes
Some of the more important code categories under this heading are:
A Codes: Miscellaneous Services and Supplies--There are three subcategories of A codes. They are:
• Transportation services including ambulance (A0000 - A0999)
• Medical and surgical supplies (A4000 - A8999)
• Administrative, miscellaneous and investigational (A9000 - A9999)
C Codes: Outpatient Prospective Payment System (OPPS): Lists supply items that insurance companies might pay above and beyond normal supply charges. Medicare requires some of these codes to be present with certain procedures before they will process the claim.
D Codes: Dental Codes: Dental procedures and supplies
J Codes: Drugs Administered Other than Oral Method: Lists drugs that can't be self-administered, which are noncovered pharmaceuticals. Not all J-codes are considered pharmaceuticals; some are considered treatment solutions, such as J7030, which stands for Infusion, normal saline solution, 1,000 cc.
For a complete list of codes and categories, see Resource No. 1.
Temporary Codes
Temporary codes may eventually become regular CPT codes, change to HCPCS categories, or be discontinued.
G Codes: Temporary Procedures and Professional Services--These codes are the first of four sections of temporary codes used mainly by Medicare. Sometimes Medicare will require one of these codes instead of a CPT-4 code, or a combination of a CPT-4 and HCPCS supply code.
K Codes: Temporary Codes for Supplies, Durable Medical Equipment and Drugs
Q Codes: Miscellaneous Temporary Codes--mainly temporary codes for casting supplies
S Codes: Temporary National Codes (Non-Medicare)--These codes are mainly used by the Blue Cross/Blue Shield Association and the Health Insurance Association of America to report drugs, services and supplies where no other codes are available.
Unique Codes
In some states, an insurance carrier might create its own set of HCPCS codes for services or supplies not otherwise categorized. For instance, in New York, Medicaid will create different codes beginning with the letter W for many of its grant programs. In Pennsylvania, there are codes beginning with the letter Y. Unique codes can be obtained from the insurance carrier.
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