What is HCPCS Level II used for?

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HCPCS Level II (Healthcare Common Procedure Coding System Level II) is a standardized coding system used primarily to identify non-physician services and products not covered by the CPT (Current Procedural Terminology) codes, which are considered HCPCS Level I.

Purpose of HCPCS Level II:

HCPCS Level II codes are used to bill Medicare, Medicaid, and other insurers for a wide range of medical services and supplies that are not included in CPT, such as:

• Medical equipment and supplies (e.g., wheelchairs, crutches, oxygen tanks)

• Prosthetics and orthotics

• Ambulance services

• Drugs and biologicals not self-administered

• Vision, dental, and hearing services in some cases

Format:

HCPCS Level II codes are alphanumeric, consisting of a single letter followed by four digits (e.g., E0110 for crutches, forearm type).

Why It Matters:

While CPT codes (Level I) cover physician services and procedures, many essential items and services fall outside that scope. HCPCS Level II ensures providers can bill appropriately for these items and receive reimbursement from payers like Medicare.

Example Uses:

• A0428 – Ambulance service, basic life support

• J1885 – Injection, ketorolac tromethamine, per 15 mg

• L1830 – Knee orthosis, immobilizer

Summary:

HCPCS Level II is essential for billing durable medical equipment (DME), medications, transport, and other non-physician services. It complements CPT codes and is a critical part of accurate and complete medical billing and claims processing.

Read More

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