The Healthcare Common Procedure Coding System (HCPCS, often pronounced by its acronym as "hick picks") is a set of
health care procedure codes
Procedure codes are a sub-type of medical classification used to identify specific surgical, medical, or diagnostic interventions. The structure of the codes will depend on the classification; for example some use a numerical system, others al ...
based on the
American Medical Association
The American Medical Association (AMA) is a professional association and lobbying group of physicians and medical students. Founded in 1847, it is headquartered in Chicago, Illinois. Membership was approximately 240,000 in 2016.
The AMA's sta ...
's
Current Procedural Terminology (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 (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
Medicaid in the United States is a federal and state program that helps with healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and per ...
, 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
The American Medical Association (AMA) is a professional association and lobbying group of physicians and medical students. Founded in 1847, it is headquartered in Chicago, Illinois. Membership was approximately 240,000 in 2016.
The AMA's sta ...
's
Current Procedural Terminology (CPT) and is numeric.
*
Level II codes are alphanumeric and primarily include non-physician services such as
ambulance
An ambulance is a medically equipped vehicle which transports patients to treatment facilities, such as hospitals. Typically, out-of-hospital medical care is provided to the patient during the transport.
Ambulances are used to respond to medi ...
services and
prosthetic
In medicine, a prosthesis (plural: prostheses; from grc, πρόσθεσις, prósthesis, addition, application, attachment), or a prosthetic implant, is an artificial device that replaces a missing body part, which may be lost through trau ...
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
*
Current Dental Terminology Current Dental Terminology (CDT) is a code set with descriptive terms developed and updated by the American Dental Association (ADA) for reporting dental services and procedures to dental benefits plans. Prior to 2010 many of the codes were publi ...
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