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    HCPCS Codes

    CMS-maintained codes for products, supplies, and services not in CPT.

    Reviewed by Christian Espinosa, Founder, Blue Goat CyberLast reviewed May 5, 2026

    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).
    What the regulation says
    HCPCS codes are maintained by the Centers for Medicare & Medicaid Services (CMS) and are essential for billing medical devices and services to Medicare, Medicaid, and other insurers. While not directly a regulatory requirement for medical device approval, accurate HCPCS coding is crucial for market access and reimbursement in the United States, as outlined in CMS guidance.

    What this means in practice

    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.

    Examples

    • A manufacturer of a new type of wound dressing must identify the appropriate HCPCS code to ensure their product can be billed to Medicare beneficiaries.
    • A MedTech company developing a novel home-use diagnostic device needs to obtain a specific HCPCS code or ensure their device fits an existing code for reimbursement.
    • A provider billing for a physician-administered drug, a J-code, uses HCPCS codes to get reimbursement from health insurance payers.
    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    • •Failing to regularly check CMS updates for HCPCS codes can result in using outdated or incorrect codes.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.

    Frequently asked questions

    HCPCS Level II codes primarily describe products, supplies, drugs, and services not included in CPT codes, such as durable medical equipment, prosthetics, orthotics, and physician-administered drugs.

    Cross-references

    See also

    Closely related context worth reading.

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    Primary references

    3 sources
    Link health: 3 verified· last checked 2026-06-20
    CMS·1AdvaMed·1AMA·1
    1. 1
      CMS HCPCS
      Verified
      CMScms.gov
    2. 2
      AdvaMed - Payment & Coverage
      Verified
      AdvaMedadvamed.org
    3. 3
      AMA CPT Resources
      Verified
      AMAama-assn.org

    Inline markers like [1] jump to the matching reference above.