HCPCS codes - ReimbursementCodes.com

Our online database of HCPCS codes (Healthcare Common Procedure Coding Systems) and medical reimbursement codes provides an up-to-date pricing resource for J-Code, A-Codes, C-Codes, K-Codes, Q-Codes, S-Codes, WW-Codes and CPT (Current Procedural Terminology) Codes for medical codes which may be administered in a health care provider's office, clinic or health agency employing CMS guidelines.

About HCPCS Codes

Health care insurers process over 5 billion claims every year. HCPCS codes were developed to help ensure that claims could be processed in a consistent and simplified way. HCPCS codes are divided into three subsystems: level I, level II and level III, each designated for a specific purpose.

HCPCS Codes - Level I

Level I HCPCS codes are made up of CPT-4 codes (a numeric coding system devised by the American Medical Association). Health care professionals use this notation to identify services and procedures, for which they bill insurance programs. Level I HCPCS codes consist of 5 numeric digits.

HCPCS Codes - Level II

Level II HCPCS codes identify products, supplies, materials and services which are not included in the CPT-4 code, such as ambulance services, prosthetics, medical equipment and supplies (DMEPOS) when used outside a medical office. Level II HCPCS codes are also called alpha-numeric codes because they consist of one letter followed by 4 numeric digits.

HCPCS - Level III

Level III HCPCS codes are developed by Medicaid State Agencies, Medicare contractors and private insurers for use in specific programs and jusrisdictions. HCPCS Level III codes are also called local codes. These codes allow insurers to electronically process claims for new services for which a level I or level II code has not yet been established.

National Permanent Level II HCPCS Codes

National Permanent Level II HCPCS Codes are maintained by the HCPCS National Panel, a group comprised of representatives from the Blue Cross/Blue Sheild Association (BCBSA), the Health Insurance Association of America (HIAA), and CMS. Permanent Level II HCPCS Codes provide a standardized coding system that is managed jointly by public and private insurers, thus providing a stable system for claims processing. These codes can be used by all private and public insurers.

Temporary Level II HCPCS codes

Temporary Level II HCPCS codes make up 35% of all level II codes. These codes help insurers meet operational needs which are not met with existing codes. In the case of Medicare, the HCPCS workgroup makes decisions regarding temporary HCPCS codes. Even though temporary HCPCS codes are established to meet the needs of a particular insurer, they can also be used by other insurers. These codes can remain "temporary" indefinitely.

Types of Temporary HCPCS codes

C codes

Identify idems that may qualify fdor "pass through" payments under the hospital outpatient prospective payment system (HOPPS)

G codes

Identify professional health care procedures and services that would be coded as CPT-4, but for which no CPT-4 code exists.

Q codes

Identify services that would not be given a CPT-4 code such as drugs, biologicals, and other medical equipment or services.

K Codes

Used by DMERCs in situations when the national permanent HCPCS level II codes do not include codes needed to implement a DMERC medical review policy.

S Codes

Used by the BCBSA and the HIAA to report drugs and services for which there are no national permanent Level II HCPCS codes.

H Codes

Used by state Medicaid agencies to identify mental health services.

T Codes

Used by state Medicaid agencies for Medicaid Program administration.

The ReimbursementCodes.com database of HCPCS codes

The up to date reference provided by ReimbursementCodes.com allows MCOs, Insurance Companies and providers to accurately price and reimburse for medications administered in the providers office, resulting in:

• More rapid claims processing.
• Faster reimbursement for services rendered.
• Fewer rejected claims.
• Fewer calls to provider relations.
• Improved provider relations.
• More accurate revenue forecasts.

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