CPT Codes and HCPCS Codes

What They Are and How They Work

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CPT® codes and HCPCS codes are used instead of words in the United States to describe medical services and procedures. Health care services and procedures each have a specific CPT® code or HCPCS code assigned to describe them; each code describes a distinct service or procedure. There are codes to describe simple services and procedures like a quick physical exam performed in a doctor’s office, and there are codes used to describe more complicated procedures like surgeries.

What Are CPT Codes?

CPT® stands for Current Procedural Terminology. CPT® codes are primarily used to describe services and procedures provided by physicians, nurse practitioners, and physician’s assistants. They were developed by the American Medical Association, and the AMA maintains them, updates them routinely, and holds the copyrights to them.

CPT® codes consist of five numbers; they don’t include letters. Sometimes, CPT® codes have a couple of extra digits stuck onto the end. These two extra digits are called modifiers and bring the number of digits included in the CPT® code up from the standard five to seven. Modifiers add extra information to the CPT® code they modify. For example, there is a two-digit modifier code to indicate that a procedure took longer than it normally takes to accomplish. There’s another modifier to indicate that, when two procedures were done during the same surgery, this one was the secondary procedure.

What Are HCPCS Codes?

HCPCS stands for Healthcare Common Procedure Coding System. It’s used, maintained, and updated by the Centers for Medicare & Medicaid Services. HCPCS codes come in different levels. HCPCS level I codes use the AMA’s CPT® codes and describe services and procedures that physicians usually provide.

HCPCS level II codes describe services and procedures that aren’t provided by physicians. For example, ambulance services; medical equipment such as hospital beds, home oxygen, and wheelchairs; prosthetics; orthotics; and supplies such as bandages, syringes, and gloves are all billed using HCPCS level II codes.

HCPCS level II codes are 5 digits and can have modifiers just like CPT codes. However, unlike CPT® codes, HCPCS level II codes are alphanumeric. They start with a letter and then have four numbers. HCPCS modifiers are two characters and can be either two letters or a letter and a number.

How Are CPT & HCPCS Codes Used?

Procedures documented in doctor’s notes and medical records are translated into CPT® codes or HCPCS codes. If the doctor does her own coding, you’ve probably watched it happening. When you leave the exam room, frequently the doctor hands you a piece of paper to take to the check-out desk. This form, known as an encounter form, has a list of the most common CPT® codes used in that doctor’s office.

The doctor circles one or two of the CPT® codes. That’s how she tells the office staff which billing codes describe the services she provided that visit or which procedures took place during the visit.

If the doctor doesn’t do her own coding, she might employ a coder or may contract the coding out to a medical coding and billing service. In this case, the coder reads the medical record, translates the procedures into CPT® or HCPCS codes, and translates the diagnoses into ICD-9 or ICD-10 diagnosis codes.

Once a medical record has been coded, the codes are used in a variety of ways. Most apropos to you, your doctor’s office uses the codes to file a claim with your health insurance company. Your health plan uses the codes to process the claim and figure out how much to pay your doctor.

The government’s health policy experts may use codes from aggregated claims data to determine how often a particular procedure is being performed, track trends in medical treatments, or figure out where best to spend limited financial resources. Health insurance companies and statisticians may use CPT® code data from prior claims to try to predict future health care costs. Researchers may cross reference CPT® or HCPCS codes with ICD diagnosis codes to study how often a certain disease is associated with a particular procedure, for example.

How Can I figure Out What the Codes on My Medical Bill Mean?

First, analyze the code you’re wondering about. Is it a CPT® code or an HCPCS level II code? Both CPT® and HCPCS codes are five digits with the possibility of an added two-digit modifier. Remember, CPT® codes are numeric only, and HCPCS level II codes start with a letter.

If the code you’re looking at doesn’t fit either of these descriptions, it may be code describing your diagnosis rather a code describing a billable service or procedure.  Learn more about ICD-10 diagnosis codes.

If you have a CPT® code, the AMA allows you, for your personal use only, to look up the meaning of a limited number of codes for free on its website. You’ll need to register (also for free) with the AMA first.

If you have an HCPCS code, CMS allows you to look up its meaning, although this web page is actually dedicated to looking up physician fee schedules. As an alternative, a simple web search for the term “Look up an HCPCS Level II code” will return multiple websites that allow you to type in the code from your medical record or medical bill and get back the meaning of the code.


CPT Process – How a Code Becomes a Code, Resources, American Medical Association. http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/cpt-process-faq/code-becomes-cpt.page  Accessed July 7, 2015. Access requires user registration, available free of charge.

Claim Moifiers: What Are They and How Do They Affect Me? Fair Health. http://fairhealthconsumer.org/reimbursementseries.php?id=34 Accessed on July 7, 2015.

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