How do HCPCS codes differ from CPT codes?

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HCPCS codes and CPT codes are both used in medical billing to describe procedures, services, and products, but they serve different purposes and cover different types of care.

1. Definition and Structure

• CPT Codes (HCPCS Level I):
  Created by the American Medical Association (AMA), these 5-digit numeric codes (e.g., 99213) describe medical, surgical, and diagnostic procedures provided by physicians and healthcare professionals.

• HCPCS Level II Codes:
  Maintained by the Centers for Medicare & Medicaid Services (CMS), these are alphanumeric codes (1 letter + 4 digits, e.g., A0428) used for non-physician services, such as ambulance transport, durable medical equipment (DME), prosthetics, and medications.

2. Scope

• CPT codes focus on:

  • Office visits

  • Surgeries

  • Diagnostic tests

  • Medical decision-making

• HCPCS Level II codes cover:

  • Medical supplies (e.g., catheters, oxygen tanks)

  • Injectable drugs

  • Ambulance services

  • Orthotics and prosthetics

3. Use in Billing

• CPT is used by all payers, including Medicare and private insurance, to bill for provider services.

• HCPCS Level II is primarily used for Medicare and Medicaid billing for services and items not included in CPT.

Summary:

• CPT = Provider procedures and services

• HCPCS Level II = Supplies, equipment, and non-physician services

Together, they ensure comprehensive documentation and billing for all aspects of patient care.

Read More

What is HCPCS Level II used for?

What CPT code would be used for a basic office visit?

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