What are Medicare's HCPCS Codes?

Billing Codes Used for Medicare Payment

Medicare HCPCS Codes
Image courtesy FederalRegister.gov

HCPCS codes are numbers Medicare assigns to every task and service a medical practitioner may provide to a patient including medical, surgical and diagnostic services. HCPCS stands for Healthcare Common Procedure Coding System. The numbers are billing codes used by Medicare and monitored by CMS, the Centers for Medicare and Medicaid Services.They are based on the CPT Codes (Current Procedural Technology codes) developed by the American Medical Association.

HCPCS Codes Ensure Uniform Billing to Medicare

Since everyone uses the same codes to mean the same thing, they ensure uniformity. For example, no matter what doctor a Medicare patient visits for an allergy injection (HCPCS code 95115) that doctor will be paid by Medicare the same amount another doctor in that same geographic region would be for that same service.

Some examples you might see of HCPCS / CPT Codes:

  • 99214 may be used for a physical examination
  • 90658 indicates an influenza vaccine shot
  • 12002 may be used to stitch up a one-inch cut on a patient's arm

There are two sets of codes. The first set, HCPCS Level I, are based on and identical to CPT codes, the codes developed by the American Medical Association. Level II HCPCS codes are used by medical suppliers other than physicians, such as ambulance services or durable medical equipment. These are typically not costs that get passed through a physician's office so they must be dealt with by Medicare or Medicaid differently from the way a health insurance company would deal with them.

Sometimes services are always grouped together, in which case their codes may also be grouped. These are called "bundled" codes.

Where You Find HCPCS / CPT Codes and How to Use Them

Patients can find HCPCS / CPT Codes in a number of places. As you leave the doctor's office, you are handed a review of your appointment which may have a long list of possible services your doctor provided, with some of them circled.

The associated numbers, usually five digits, are the codes.

If your appointment requires a follow-up billing by your doctor for copays or co-insurance, then the codes may be on those bills.

A wise patient and smart healthcare consumer will use these codes to review medical billings from practitioners, testing centers, hospitals or other facilities. It's a good way to be sure your insurance (and your co-pays and co-insurances) are paying only for those services you received.

If you receive statements from either the doctor or your health insurance and the HCPCS / CPT codes do not appear, then contact the party who sent them and request a new statement that does include the codes.

How Can You Decode HCPCS and CPT Codes?

To learn more about HCPCS / CPT codes, which codes mean which services and how they are used by doctors and insurance or Medicare, explore more in this article about CPT codes.

You may also wish to find instructions to look up or match a HCPCS code to the service it represents for free.

These can satisfy your curiosity and help ensure your coding was correct.

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