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What is HCPCS?

Medical providers must use the Healthcare Common Procedure Coding System (HCPCS), a standardised code system, to file healthcare claims to Medicare and other insurance providers in a consistent and organised method. HCPCS Level I and Level II are two medical code sets that are included in HCPCS coding.

Medical claims for procedures and services rendered by physicians, non-physicians, hospitals, labs, and outpatient facilities are submitted to payers using HCPCS Level I. It is made up of the Current Procedural Terminology (CPT) code set.

When submitting health plan claims for medical equipment, supplies, drugs, transportation services, and other goods and services, healthcare professionals, suppliers, and medical equipment suppliers use the HCPCS Level II national procedure code set.

Origin of HCPCS Codes

In order to create a uniform coding method for defining healthcare BPO, the Healthcare Common Procedure Coding System was established in 1978. Medicaid, Medicare, and other healthcare insurance programmes needed such a coding system to guarantee that insurance claims were routinely and properly processed. The use of level II HCPCS codes in healthcare had previously been voluntary, but since the establishment of HIPAA in 1996, it is a mandate.

Why the HCPCS Coding System Is Important
  • –  Physician Compensation
  • –  Hospital Bills
  • –  Quality Check
  • –  Measuring Benchmarks
HCPCS Code Levels

Level I codes are primarily comprised of the AMA’s current procedural nomenclature (CPT), which are numerical in nature (American Medical Association). These codes match CTP codes exactly.

Alphanumeric Level II codes are used primarily for non-medical services like prosthetic devices or ambulance services. These codes reflect goods and services that are outside the scope of Level I codes. Ambulance vendors, vendors of medical supplies, etc. utilise Level II HCPCS codes.

The Level III codes are known as HCPCS local codes, which implies that local/state Medicare and Medicaid agencies/contractors as well as private health insurers follow these codes. These codes, unlike Level I and Level II, are only accepted in a few jurisdictions, and are not nationally recognised.

HCPCS code structure

All HCPCS Level II codes are made up of five characters, each starting with a letter (A through V), then four digits. The HCPCS Level II code’s initial letter identifies the code chapter to which it belongs and serves to categorise related things.

Each HCPCS Level II code range’s codes are classified according to the letter they start with. For instance, codes that begin with J are known as J codes and are used to report chemotherapeutic treatments and non-oral medications. J codes are among the HCPCS Level II code set’s most frequently reported codes, incidentally.

HCPC Coding by Info Hub Consultancy Services (ICS)

All of our knowledgeable and skilled coding specialists have earned certification from the American Academy of Professional Coders (AAPC), the industry’s preeminent coding organisation. A thorough understanding of HCPCS procedure codes is necessary for accurate HCPCS coding because these codes are continually changing. 

Is your medical practice facing trouble with internal HCPCS coding that is costing you valuable time, money, and effort? Resort to offshore medical billing with Info Hub Consultancy Services (ICS) to give your practice a competitive edge. Our expert coders are adept with the nuances of HCPCS coding, and keep themselves updated with changing codes and guidelines. 

Although not all HCPCS codes are CPT codes, all CPT codes are HCPCS codes. Our skilled medical coders use accurate codes that will yield the highest reimbursement because they are aware of the distinction between the two. They are adept in providing accurate and efficient coding for all major medical specialities, including Cardiology, Radiology, Neurology, Internal Medicine, Pathology, and Oncology. They are well-versed in all coding rules and payer laws.

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