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CODE.MODE

HCPCS: LEVEL II

Healthcare Common Procedure Coding System: Level II

The Healthcare Common Procedure Coding System (HCPCS) was created by Medicare in 1983 by Medicare and it is a requirement when reporting services and procedures for payment. 

Level II of the HCPCS is a standardized coding system that is used primarily to identify the products, supplies,  medications, and services which not included in the CPT codes. They include codes for ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when they are used outside of a physician's office. Level II HCPCS codes are a letter followed by 4 numeric digits.

 

Level II Codes and associated descriptors are approved and maintained jointly by the alphanumeric editoral panel, which consists of CMS, the Blue Cross and Blue Shield Association, and the Health Insurance Association.  

 

LAYOUT

Introduction 

The introduction of the HCPCS manual offers instructions and valuable information, such as an explanation of symbols and conventions, status indicators, payment indicators, and HCPCS updates.  

Index 

The Index of the HCPCS Level II manual is arranged by bold face main terms, which are arranged in alphabetic order. These entries can include tests, services, supplies, orthotics, prostheses, medical equipment, drugs, and therapies, as well as some medical and surgical procedures. Entries are listed under a common main term, when possible, which may be a noun or a descriptor. 

Code Format  

Level II codes are 5-character codes, consisting of one alphabetic character (letters A through V), followed by four numbers. 

 

Table of Drugs

The HCPCS Level II manual is equipped with a Table of Drugs, which provides the drug name, dosage, method of administration, and HCPCS code. 

Modifiers 

HCPCS National Level II modifiers are composed of two alpha or alphanumeric characters that range from AA to VP.

Sections

The HCPCS coding system is arranged in 17 sections (as seen on right), beginning with codes from A0021 and ending with V5364. 

Appendix 

The back of the manual includes Appendix A, entitled "General Correct Coding Policies For National Correct Coding Initiative Policy Manual For Medicare Services."    

PROCEDURAL

FORMAT

Five-Character Codes (Alphanumeric)

_####

SECTIONS

  • Ambulance and Other Transport Services and Supplies

  • Medical And Surgical Supplies

  • Administrative, Miscellaneous and Investigational

  • Enteral and Parenteral Therapy

  • Outpatient PPS

  • Durable Medical Equipment

  • Procedures / Professional Services

  • Alcohol and Drug Abuse Treatment

  • Drugs Administered Other than Oral Methods 

  • Chemotherapy Drugs

  • Durable medical equipment (DME) Medicare administrative contractors (MACs)

  • Orthotic Procedures and services

  • Prosthetic Procedures

  • Miscellaneous Medical Services

  • Pathology and Laboratory Services

  • Temporary Codes

  • Diagnostic Radiology Services

  • Temporary National Codes (Non-Medicare) 

  • National Codes Established for State Medicaid Agencies

  • Vision Services

  • Hearing Services

MODIFIERS

  • Level II National Modifiers  

PUBLICATION

  • CMS

HELPFUL LINKS

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