The Healthcare Common Procedure Coding System (HCPCS, often pronounced by its acronym as "hick picks") is a set of
health care
Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health profe ...
procedure codes based on the
American Medical Association's
Current Procedural Terminology
The Current Procedural Terminology (CPT) code set is a procedural code set developed by the American Medical Association (AMA). It is maintained by the CPT Editorial Panel. The CPT code set describes medical, surgical, and diagnostic services and ...
(CPT).
History
The acronym ''HCPCS'' originally stood for ''HCFA Common Procedure Coding System'', a medical billing process used by the
Centers for Medicare and Medicaid Services
The Centers for Medicare & Medicaid Services (CMS), is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer M ...
(CMS). Prior to 2001, CMS was known as the Health Care Financing Administration (HCFA). HCPCS was established in 1978 to provide a standardized coding system for describing the specific items and services provided in the delivery of health care. Such coding is necessary for
Medicare,
Medicaid, and other health insurance programs to ensure that insurance claims are processed in an orderly and consistent manner. Initially, use of the codes was voluntary, but with the implementation of the
Health Insurance Portability and Accountability Act
The Health Insurance Portability and Accountability Act of 1996 (HIPAA or the Kennedy– Kassebaum Act) is a United States Act of Congress enacted by the 104th United States Congress and signed into law by President Bill Clinton on August 21, 1 ...
of 1996 (HIPAA) use of the HCPCS for transactions involving health care information became mandatory.
Levels of codes
HCPCS includes three levels of codes:
*Level I consists of the
American Medical Association's
Current Procedural Terminology
The Current Procedural Terminology (CPT) code set is a procedural code set developed by the American Medical Association (AMA). It is maintained by the CPT Editorial Panel. The CPT code set describes medical, surgical, and diagnostic services and ...
(CPT) and is numeric.
*
Level II codes are alphanumeric and primarily include non-physician services such as
ambulance services and
prosthetic devices, and represent items and supplies and non-physician services, not covered by CPT-4 codes (Level I).
*Level III codes, also called local codes, were developed by state Medicaid agencies, Medicare contractors, and private insurers for use in specific programs and jurisdictions. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) instructed CMS to adopt a standard coding systems for reporting medical transactions. The use of Level III codes was discontinued on December 31, 2003, in order to adhere to consistent coding standards. Level III codes were different from the modern CPT Category III codes, which were introduced in 2001 to code emerging technology.
See also
*
Centers for Medicare and Medicaid Services
The Centers for Medicare & Medicaid Services (CMS), is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer M ...
*
Current Dental Terminology
References
External links
Official siteHCPCS Level II alphanumeric procedure and modifier codesNDC-HCPCS crosswalk data filesHCPCS Level II Codes & Drug Pricing2020 HCPCS Level 2 codes
{{Medical classification
Clinical procedure classification
Medical manuals
Medicare and Medicaid (United States)
American Medical Association