Reimbursement
HCPCS Codes(HCPCS)
In one line
CMS-maintained codes for products, supplies, and services not in CPT.
Definition
Healthcare Common Procedure Coding System Level II codes describe products, supplies, drugs, and services not included in CPT - durable medical equipment, prosthetics, orthotics, supplies (DMEPOS), and physician-administered drugs (J-codes).
CMS maintains Level II codes and reviews applications in quarterly or biannual cycles, with public meetings for some categories. Codes starting with E, K and L cover durable medical equipment, temporary items and orthotics or prosthetics, while C codes are used for hospital outpatient pass-through devices. A code does not guarantee coverage or payment.
Why it matters
DME, supplies, and many home-use medical devices are billed under HCPCS. Code assignment, coverage, and pricing are coordinated through CMS quarterly and annual updates.
Common pitfalls
- •Misinterpreting HCPCS code descriptions can lead to claim denials and payment delays.
- •Failing to regularly check CMS updates for HCPCS codes can result in using outdated or incorrect codes.
- •Assuming a HCPCS code guarantees reimbursement without verifying coverage policies of specific payers is a common mistake.
- •Coding medical devices with generic HCPCS codes when more specific, product-specific codes exist can lead to lower reimbursement or scrutiny.
- •Not understanding the difference between HCPCS Level I (CPT) and Level II codes can result in incorrect billing practices.
Sources