What are HCPCS Level I and Level II codes?

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HCPCS (Healthcare Common Procedure Coding System) is a standardized coding system used in the U.S. to describe medical services, procedures, and supplies for billing, especially in Medicare and Medicaid.

HCPCS has two levels

🔹 Level I: CPT Codes

• Developed by: American Medical Association (AMA)

• Format: 5-digit numeric codes (e.g., 99213)

• Purpose: Identifies physician services and procedures, such as:

  • Office visits

  • Surgeries

  • Radiology

  • Laboratory tests

  • Anesthesia

These are the same codes used in the CPT (Current Procedural Terminology) coding system and are widely used in both public and private insurance billing.

🔹 Level II: National Codes

• Developed by: Centers for Medicare & Medicaid Services (CMS)

• Format: 1 letter + 4 digits (e.g., A0428)

• Purpose: Covers services not included in CPT codes, such as:

  • Ambulance services

  • Durable medical equipment (DME)

  • Prosthetics and orthotics

  • Supplies and medications not self-administered

These codes are essential for billing Medicare and other federal programs.

Summary:

• HCPCS Level I = CPT codes for medical procedures by providers.

• HCPCS Level II = National codes for non-physician services, equipment, and supplies.
  Both levels ensure complete and standardized medical billing across all healthcare services.

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