In the United States healthcare system, the efficient processing of insurance claims is paramount. With billions of claims submitted annually, standardized coding systems are crucial. The Health Care Financing Administration Common Procedural Coding System (HCPCS) plays this vital role, ensuring that Medicare and other health insurance programs can manage claims in a consistent and orderly manner. HCPCS is essentially divided into two main subsystems: Level I and Level II.
Delving into HCPCS Level I: CPT® Codes
HCPCS Level I is primarily composed of Current Procedural Terminology (CPT®), a coding system maintained by the American Medical Association (AMA). CPT® codes are numeric and form a uniform system used to describe medical, surgical, and diagnostic services. Healthcare professionals, especially physicians, utilize CPT® when billing public and private health insurance programs. These codes provide a standardized language for reporting medical procedures and services. The AMA is responsible for the annual updates and republication of CPT® codes, ensuring they remain current with medical advancements. CPT® codes are easily identifiable as they consist of five numeric digits. For specific inquiries or issues concerning the application of HCPCS Level I CPT® codes related to physician services, the AMA is the primary point of contact.
Exploring HCPCS Level II: National Codes
HCPCS Level II is a distinct standardized coding system designed to capture products, supplies, and services not covered by CPT® codes. These alphanumeric codes are essential for billing items such as ambulance services, durable medical equipment (DME), prosthetics, orthotics, and various supplies (DMEPOS), particularly when these are used outside of a physician’s office setting. Medicare and other insurance providers recognize that numerous necessary healthcare items and services fall outside the scope of CPT® codes. Therefore, HCPCS Level II codes were established by the Centers for Medicare & Medicaid Services (CMS) to enable providers and suppliers to accurately submit claims for these additional items. These Level II codes are alphanumeric, beginning with a single alphabetical letter followed by four numeric digits. CMS is responsible for the maintenance of HCPCS Level II codes, overseeing additions, revisions, and deletions to ensure the system remains relevant and comprehensive. The history of HCPCS Level II dates back to the 1980s. The authority for CMS to manage these codes was formalized in 2003 under 42 CFR 414.40(a), where the Department of Health and Human Services (HHS) Secretary delegated this responsibility. For any questions regarding HCPCS Level II codes, inquiries can be directed to [email protected].
Utilizing MEARIS™ for HCPCS Level II Applications
The Medicare Electronic Application Request Information System (MEARIS™) is the designated online portal for submitting HCPCS Level II coding applications. Accessible at MEARIS™, MEARIS™ allows anyone to propose modifications to the national HCPCS Level II code set. This system streamlines the application process for both quarterly drug and biological product applications, and biannual applications for non-drug and non-biological items and services. Deadlines for applications are set as follows: for drug and biological products, the first business day of each quarter (January, April, July, and October); and for non-drug and non-biological items and services, the first business day of January and July.
Stay Updated with HCPCS
For the latest information on HCPCS Level II codes, including updates and changes, subscribing to the HCPCS Level II Updates Listserv is recommended. This ensures you receive the most current and accurate details directly from CMS.
