Procedure Codes: CPT and HCPCS
Procedure codes describe the services performed by healthcare providers. The Healthcare Common Procedure Coding System (HCPCS) establishes the framework for procedure coding, with two levels of codes.
HCPCS Level I: CPT Codes
HCPCS Level I consists of CPT (Current Procedural Terminology) codes, developed and maintained by the American Medical Association. CPT codes are five-digit numeric codes that describe medical, surgical, and diagnostic services performed by physicians and other qualified providers. These are the primary codes used on CMS-1500 claims.
CPT codes are organized into three categories:
- Category I codes are the main set of procedure codes used for billing.
- Category II codes are optional tracking codes used for quality reporting.
- Category III codes are temporary codes for emerging technologies and services.
HCPCS Level II Codes
HCPCS Level II codes are alphanumeric codes (a letter followed by four digits) maintained by CMS. These codes describe items and services not covered by CPT, including:
- Durable medical equipment
- Supplies
- Prosthetics
- Ambulance services
- Certain drugs
Level II codes are essential for practices that provide these types of services.
The CPT manual is updated annually, with new codes added, existing codes revised, and obsolete codes deleted. Staying current with these changes is essential for accurate coding and maximum reimbursement.