In the United States healthcare system, the efficient processing of billions of insurance claims annually relies heavily on standardized coding systems. For Medicare and other health insurance programs to manage claims in a consistent and orderly manner, the Healthcare Common Procedure Coding System (HCPCS) is indispensable. HCPCS is fundamentally structured into two primary subsystems: Level I and Level II.
Decoding HCPCS Level I: CPT® Codes
HCPCS Level I is primarily composed of Current Procedural Terminology (CPT®), a universally recognized numeric coding system. This system is meticulously maintained and updated by the American Medical Association (AMA).
CPT® serves as a uniform language for coding medical procedures and services. It utilizes descriptive terms and specific identifying codes. These codes are primarily used to report medical services and procedures performed by physicians and a wide array of other healthcare professionals. These are the very services for which they bill both public and private health insurance programs. The AMA takes responsibility for the annual updates and republication of the CPT® code set, ensuring it remains current with medical advancements and practices. CPT® codes are easily identifiable, each consisting of five numeric digits. For detailed inquiries or support regarding the application of HCPCS Level I CPT® codes specifically for physician services, the AMA is the primary point of contact.
Exploring HCPCS Level II: National Codes
HCPCS Level II is another standardized coding system, but it serves a different purpose. It is mainly utilized to identify a broader range of healthcare items, supplies, and services that are not covered within the CPT® code framework. This includes services like ambulance transportation, durable medical equipment (DME), prosthetics, orthotics, and various medical supplies (often referred to as DMEPOS when utilized outside of a physician’s office setting).
Medicare, along with numerous other insurers, provides coverage for a diverse set of services, medical supplies, and equipment that fall outside the scope of CPT® codes. To facilitate claims submissions for these items, HCPCS Level II codes were established. These codes, also known as alpha-numeric codes, are structured with a single alphabetical letter followed by four numeric digits. The responsibility for maintaining HCPCS Level II codes, including decisions on additions, revisions, and deletions, rests with the Centers for Medicare & Medicaid Services (CMS). The HCPCS Level II coding system has been in use since its inception in the 1980s, providing a long-standing framework for coding these essential healthcare items and services. In 2003, the authority to establish and maintain these uniform national definitions, service codes, and payment modifiers was officially delegated to CMS by the HHS Secretary, as outlined in 42 CFR 414.40(a). For any questions or clarifications regarding HCPCS Level II codes, inquiries can be directed to [email protected].
MEARIS™: Managing HCPCS Level II Code Applications
The Medicare Electronic Application Request Information System (MEARIS™) provides a centralized platform for managing HCPCS Level II coding applications. Accessible through the MEARIS™ portal, this system allows anyone to submit requests for modifications to the national HCPCS Level II code set.
MEARIS™ is the designated electronic application system for submitting various HCPCS Level II applications. This includes quarterly applications for drug and biological products, and biannual applications for non-drug and non-biological items and services. It’s important to adhere to the specific application deadlines. For drug and biological products, applications are due on the first business day of each quarter (January, April, July, and October). For non-drug and non-biological items and services, the deadlines are the first business day of January and July.
Stay Updated on HCPCS
Recent Updates in HCPCS Level II Coding
01/10/2025: Coding Decisions for Q4 2024 Drug and Biological Applications Released
CMS has recently announced the publication of the HCPCS Application Summaries and Coding Decisions for Quarter Four (Q4) 2024 concerning Drugs and Biologicals. These details are available at: https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/Prior-Years-CMS-HCPCS-LevelII-Coding-Decisions-Narrative-Summary.
The published narrative summary provides comprehensive information for each Q4 2024 HCPCS Level II application for drug and biological coding requests. This includes the specific topic or issue, a summary of the applicant’s request, and the resulting coding decision made by CMS. For the upcoming CMS April 2025 HCPCS Update file, which will be released separately, please monitor the CMS website at: https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/HCPCS-Quarterly-Update. Archives of older announcements are also accessible on the HCPCS Level II Archive page.
Keep Informed with Email Updates
To ensure you receive the most timely and accurate information regarding HCPCS Level II codes, consider subscribing to the HCPCS Level II Updates Listserv. Signing up is a straightforward process, ensuring you stay informed about critical updates and changes.
