The Healthcare Common Procedure Coding System (HCPCS) is a uniform coding system for submitting claims to Medicare, Medicaid, and commercial insurers for medical procedures, equipment, and services.
Example:
Level |
Description |
Format |
Example |
I |
Identical to CPT codes |
5 digits |
99213 (Office visit) |
II |
Supplies, drugs, services |
1 letter + 4 digits |
E1399 (Oxygen equipment) |
Why It Matters: Using the wrong level (e.g., billing J1100 for Dexamethasone as CPT) triggers denials.
Factor | CPT Codes | HCPCS Codes |
Managed By | AMA | CMS |
Format | 5 digits (e.g., 99213) | 1 letter + 4 digits (e.g., A0425) |
Scope | Physician services | Supplies, drugs, transport |
Updates | Yearly (Jan 1) | Yearly (Jan 1) + periodical |
Pro Tip: Use HCPCS Q9966 (high-osmolality contrast) for Medicare patients only.
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Case Study: A rheumatology clinic reduced denials by 40% after switching from unlisted J3490 to J9217 (Leuprolide acetate).
Every HCPCS Level II code begins with a letter that defines its category. Here’s how they break down:
Code Type |
Scope |
Real-World Use Case |
A-Codes |
Medical supplies, transport, experiments |
A0425: Emergency ambulance service |
B-Codes |
Enteral/parenteral nutrition |
B4034: Feeding pump supplies |
C-Codes |
Hospital outpatient’s services (Medicare) |
C1748: Endoscope for outpatient surgery |
D-Codes |
Dental procedures (managed by ADA) |
D1206: Topical fluoride treatment |
E-Codes |
E0607: CPAP machine for sleep apnea |
Critical Insight: D-codes are governed by the American Dental Association, not CMS. Always use CDT® codes for dental claims.
Modifiers add context to codes without altering their meaning. Key examples:
Level I (CPT) Modifiers
Level II Modifiers
Case Study: Using modifier 25 with 99213 (office visit) and 90471 (vaccine admin) increased reimbursement by $58 per patient at a pediatric clinic.
Struggling to generate precise patient cost estimates while juggling HCPCS codes and No Surprises Act compliance? Manual processes often lead to errors, delayed payments, and patient frustration. We integrate advanced tools like AI-powered estimation software to eliminate guesswork.
Our platform streamlines the creation of Good Faith Estimates (GFEs) by automatically applying the appropriate HCPCS codes, like E0607 for CPAP devices, helping you stay compliant and transparent. Schedule a Free Consultation to see how CuresMB can transform your revenue cycle!
J-codes are HCPCS Level II (e.g., J0592 for Botox).
To standardize billing for Medicare/Medicaid supplies and non-MD services.
Ambulance trips (A0425), drugs (J-codes), DME (E1399), and telehealth (G2012).
No—ICD-10 diagnoses (e.g., E11.9 for diabetes) justify HCPCS codes.
Yes! Private insurers like Aetna require HCPCS for DME and injectable.
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