HCPCS Coding System Toolkit
Everything You Need to Know
What is the HCPCS Coding System?
Any item or service not described by a Category I CPT code is eligible to be coding under the HCPCS coding system. HCPCS Level II provides a coding system for such items as durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) used outside of a physician’s office; drugs and biologicals not classified by CPT; ambulance services and more.
How does the HCPCS Coding System Work?
Over 8,000 categories of medical items and services are categories under the HCPCS coding system. HCPCS codes are five characters long, begin with a letter end end with four digits. The first character identifies the category, or type of services that are in that grouping.
Wound Dressings and Garments
Enteral and Parenteral Nutrition
Temporary HCPCS Level II codes that are used by Outpatient Prospective Payment System (OPPS) hospitals for reporting technical services.
Durable medical equipment including
Wheelchairs & accessories
Professional healthcare services not coded elsewhere, including:
Home care management oversight
Certain screening tests
Medical nutrition therapy
Behavioral health services, including:
Community based mental and behavioral health services
Drugs and biologicals
Durable Medical Equipment, including:
Cochlear implants and accessories
These codes are not payable by Medicare.
Independent nursing service,
Administration of medication,
Air ambulance and non-emergency vehicle
How long does it take to get a HCPCS code?
It can take 6 to 12 months (or longer!) to get a HCPCS code, and there are many opportunities for mistakes along the way. Don’t worry, we’ve got you covered. At Gettysburg Healthcare Consulting, our expert consultants have the knowledge and experience to navigate the complex world of Medicare and Medicaid policies. We understand the frustration and risks involved in the process, which is why we’re here to help. Reach out to us today and let us take care of your HCPCS code needs. Trust the Medicare and Medicaid policy pros at Gettysburg Healthcare Consulting.
Are you in need of expert healthcare consulting services to help you through the coding process? Look no further than Gettysburg Healthcare Consulting. Our team of Medicare and Medicaid policy pros is dedicated to providing top-notch support for all your needs. From compliance and reimbursement to strategic planning, our knowledgeable consultants are here to guide you every step of the way. With years of experience and in-depth understanding of healthcare policy, you can trust us to navigate the complex world of healthcare with confidence. Discover the difference that Gettysburg Healthcare Consulting can make for your organization. Medicare and Medicaid Policy Pros – that’s who we are!
Our Expertise in HCPCS Coding Shines
- Working with an experienced healthcare consultant with over 30 years of experience with the Medicare program provides you with a level of knowledge and skill unmatched in the industry.
- Our comprehensive understanding of AMA coding rules and requirements will help to avoid pitfalls and mistakes that might occur.
- Clients trust us to determine the best coding approach for their unique needs.
How often are HCPCS codes established?
CMS recognizes the critical importance of staying up-to-date with coding updates, and at Gettysburg Healthcare Consulting, we share that commitment. Our team understands that timely and accurate coding is key, which is why we strive to accommodate your requests within CMS’s coding cycles. While these cycles typically occur quarterly for drugs or biologicals and bi-annually for non-drug, non-biological items or services, we acknowledge that some decisions may require additional time. In urgent situations or during public health emergencies, CMS also considers applications outside of the regular cycles. These coding cycles were introduced in January 2020, benefitting providers and patients alike by facilitating the introduction of new products into the marketplace. It is worth noting that prior to 2020, CMS only accepted and reviewed HCPCS Level II code applications once a year. Count on our expertise in Medicare and Medicaid policy to provide you with expert guidance as you navigate the ever-evolving coding landscape.
What information are coding decisions based on?
In assessing requests for new codes, the CMS Workgroup thoroughly evaluates whether a product offers a distinct functionality or operates in a significantly different manner from existing coding categories. The company seeking the code must demonstrate a substantial therapeutic differentiation compared to currently coded treatments or products. Our comprehensive application process includes specific inquiries to differentiate why a new code is needed. For instance, in the case of devices, we inquire about the coding for the FDA predicate device and why the proposed device should not be coded in a similar manner. At Gettysburg Healthcare Consulting, we are committed to providing diligent and knowledgeable Medicare and Medicaid policy expertise as your trusted partner.
Does coding equal payment?
ABSOLUTELY NOT! CMS wants to ensure clarity regarding HCPCS codes. These codes serve to identify items and services, but they do not guarantee Medicare coverage or payment. Medicare determines coverage based on evidence-based National Coverage Determinations (NCDs) or Local Coverage Determinations (LCDs) established by Medicare Administrative Contractors (MACs). Payment rates for drugs and biologicals with HCPCS codes are typically published through fee schedules and pricing files.
Starting in 2022, CMS aims to enhance reimbursement transparency by including payment determinations in the public HCPCS process for non-drug and non-biological items and services. Previously, payment determinations were not accessible, and reimbursement was only available through the quarterly DMEPOS fee schedule update. At Gettysburg Healthcare Consulting, we stay updated with Medicare and Medicaid policies to ensure you receive expert guidance. Trust our Medicare and Medicaid Policy Pros for all your healthcare consulting needs.