HCPCS Codes
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.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.
- •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- •Failing to regularly check CMS updates for HCPCS codes can result in using outdated or incorrect codes.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
Cross-references
Related terms
Grouped by themeEditor's picks
· Hand-selected related conceptsReimbursement & Market Access
· From this learning pathDiagnosis (CM) and inpatient procedure (PCS) coding systems used in U.S. claims.
Financial model that estimates the total cost consequences of adopting a new technology to a payer's budget over a defined horizon.
AMA-maintained codes used to report medical procedures and services for billing.
Systematic evaluation of clinical and economic value of a health technology.
More in Reimbursement
· Same categoryLocal and National Coverage Determinations from Medicare.
Private contractors that process Medicare Part A/B and DME claims and issue Local Coverage Determinations within their jurisdictions.
Medicare coverage policies issued nationally (NCD) or by individual MAC contractors (LCD).
Where this term appears across MedTech Terms.
- Reimbursement & Market AccessLesson 3 of 14
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Sources
3 sourcesEvery citation below opens the original document. Each is graded against our source-tier hierarchy so you can see what rests on binding law versus commentary.
- 1CMS HCPCSTier 2 VerifiedCMScms.gov
- 2AdvaMed - Payment & CoverageTier 4 VerifiedAdvaMedadvamed.org
- 3AMA CPT ResourcesTier 4 VerifiedAMAama-assn.org
Inline markers like [1] jump to the matching reference above.