All terms
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- •Failing to regularly check CMS updates for HCPCS codes can result in using outdated or incorrect codes.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
Related terms
Shared paths + categoryReimbursement
CPT Codes(CPT)
AMA-maintained codes that describe medical procedures and services.
Reimbursement & Market Access · adjacent
Reimbursement
ICD-10-CM / ICD-10-PCS
Diagnosis (CM) and inpatient procedure (PCS) coding systems used in U.S. claims.
Reimbursement & Market Access · adjacent
Reimbursement
Budget Impact Model(BIM)
Financial model that estimates the total cost consequences of adopting a new technology to a payer's budget over a defined horizon.
Reimbursement & Market Access
Reimbursement
Current Procedural Terminology Codes(CPT)
AMA-maintained codes used to report medical procedures and services for billing.
Reimbursement & Market Access
Reimbursement
Health Technology Assessment(HTA)
Systematic evaluation of clinical and economic value of a health technology.
Reimbursement & Market Access
Reimbursement
LCD and NCD
Local and National Coverage Determinations from Medicare.
Reimbursement & Market Access
Latest in MedTech
Primary references
3 sourcesLink health: 3 verified· last checked 2026-06-20
CMS·1AdvaMed·1AMA·1
- 1CMS HCPCSVerifiedCMScms.gov
- 2AdvaMed - Payment & CoverageVerifiedAdvaMedadvamed.org
- 3AMA CPT ResourcesVerifiedAMAama-assn.org
Inline markers like [1] jump to the matching reference above.