When is it appropriate to use HCPCS codes over CPT codes?
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It is appropriate to use HCPCS codes over CPT codes when you are billing for services, supplies, or equipment that CPT codes do not cover.
Key Differences:
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CPT codes (Current Procedural Terminology) are maintained by the American Medical Association (AMA) and are primarily used to describe medical, surgical, and diagnostic procedures performed by healthcare providers.
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HCPCS codes (Healthcare Common Procedure Coding System), especially Level II codes, are maintained by CMS (Centers for Medicare & Medicaid Services) and are used to report non-physician services, supplies, durable medical equipment (DME), ambulance services, prosthetics, orthotics, and drugs.
Use HCPCS codes when billing for:
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Medical supplies (e.g., surgical dressings, catheters)
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Equipment (e.g., wheelchairs, oxygen tanks)
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Injectable drugs not included in CPT
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Ambulance services
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Orthotic/prosthetic devices
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Hearing and vision services/equipment
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Services rendered by non-physician providers (like physical therapists or nurses)
Example:
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A wheelchair would be billed using HCPCS code E1234.
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A colonoscopy procedure would be billed using CPT code 45378.
Summary:
Use CPT codes for procedures and provider services, and HCPCS codes for supplies, equipment, and non-physician services—especially when billing Medicare or Medicaid, as they often require HCPCS codes for reimbursement.
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