In the United States, the sheer volume of health care claims processed annually by insurers exceeds 5 billion. To manage this immense task effectively, standardized coding systems are indispensable. These systems ensure that programs like Medicare and other health insurance providers can handle claims in a consistent and orderly manner. The Healthcare Common Procedure Coding System (HCPCS) is a crucial element in this process, divided into two primary subsystems: Level I and Level II.
HCPCS Level I: CPT® Codes
HCPCS Level I is based on the Current Procedural Terminology (CPT®), a numeric coding system developed and maintained by the American Medical Association (AMA).
CPT® codes are a standardized and uniform system. They use descriptive terms and identifying five-digit numeric codes to report medical services and procedures. These codes are primarily used by physicians and other healthcare professionals when billing public and private health insurance programs. The AMA updates and republishes the CPT® code set annually to reflect advancements in medical practice and technology. For any inquiries or issues related to the application of HCPCS Level I CPT® codes for physician services, the AMA is the primary point of contact.
HCPCS Level II: National Codes
HCPCS Level II is a distinct standardized coding system designed to identify products, supplies, and services that are not included within the CPT® code set. These encompass a wide range of items and services, such as ambulance services, durable medical equipment (DME), prosthetics, orthotics, and supplies (DMEPOS) when utilized outside of a physician’s office.
Medicare and other health insurers provide coverage for numerous services, supplies, and equipment that are not specifically identified by CPT® codes. To facilitate claims submissions for these items, HCPCS Level II codes were established. These codes, also known as alpha-numeric codes, consist of a single alphabetical letter followed by four numeric digits. The Centers for Medicare & Medicaid Services (CMS) is responsible for maintaining HCPCS Level II codes. This includes managing additions, revisions, and deletions to ensure the codes remain current and relevant. The HCPCS Level II coding system originated in the 1980s, and in 2003, the authority to establish and maintain these codes was formally delegated to CMS by the HHS Secretary under 42 CFR 414.40(a). For questions specifically about HCPCS Level II codes, inquiries can be directed to [email protected].
Medicare Electronic Application Request Information System (MEARIS™)
The Medicare Electronic Application Request Information System (MEARIS™) serves as the platform for submitting HCPCS Level II coding applications.
Any individual or entity can propose modifications to the HCPCS Level II national code set. The MEARIS™ electronic application is used to submit applications for:
- Quarterly drug and biological product coding requests.
- Biannual non-drug and non-biological items and services coding requests.
The deadlines for application submissions are:
- Drug and biological products: The first business day of each quarter (January, April, July, and October).
- Non-drug and non-biological items and services: The first business day of January and July.
Stay Updated with HCPCS
January 10, 2025 Updates
Publication of Coding Decisions for Q4 2024 HCPCS Level II Drug and Biological Applications
CMS has announced the publication of the HCPCS Application Summaries and Coding Decisions for Quarter Four (Q4) 2024 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 narrative summary document provides information for each Q4 2024 HCPCS Level II application for drug and biological coding requests, including:
- A description of the topic or issue.
- A summary of the applicant’s request.
- CMS’s coding decision.
CMS will also publish the April 2025 HCPCS Update file separately in the coming weeks, which will be available at: https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/HCPCS-Quarterly-Update.
For older announcements, please visit the HCPCS Level II Archive.
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