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What is the difference between HCPCS codes and CPT codes?

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Quick Answer

HCPCS coding is based on three distinct levels, and two of these differ from CPT codes in the items and procedures they describe, according to a 2012 article in JustCoding News: Outpatient, posted on the HCPro website. Level I HCPCS codes are numeric codes consistent with the American Medical Association's CPT coding; level II codes are alphanumeric designations used to identify procedures and non-physician products; and level III codes are specific to particular jurisdictions and programs.

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Full Answer

HCPCS level II codes are used for identifying non-physician based medical services and products such as prosthetic devices, ambulance services, surgical supplies and drugs, and non-physician services not covered by level I codes, notes JustCoding News: Outpatient. Level II codes also include dental codes, but these are a separate category of national codes governed by the American Dental Association. As of 2011, these are in the Current Dental Terminology book, not the HCPCS manual.

The HCPCS code set was created in 1978 and was initially used on a voluntary basis, but after the passage of the Health Insurance Portability and Accountability Act in 1996, these codes must be used by any organization defined as a health plan, explains the article on HCPro.com. When a service or procedure is described the same by both CPT coding and HCPCS coding, the CPT code is used. When a CPT code includes instructions to add more information, a HCPCS code is used. There are 16 sections in the HCPCS manual.

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