What Is the Difference Between CPT and HCPCS Codes?

CPT stands for Current Procedural Terminology and is administered by the AMA (American Medical Association). HCPCS stands for Healthcare Common Procedural Coding System and is based on CPT. HCPCS was developed in 1978 in order to provide a standardized coding system for the description of specific services and items. All CPT codes are HCPCS codes; however, HCPCS codes have more than one level, and Level II codes are not CPT.

CPT codes are HCPCS Level I codes. Other HCPCS codes include place-of-service codes, revenue codes, type-of-service codes, diagnosis codes and Level II codes. HIPAA, the Healthcare and Information Portability and Protection Act, mandated that all healthcare claims be reported utilizing HCPCS codes. CMS, the Centers for Medicare and Medicaid Services, oversees both the definition and usage of HCPCS codes. CPT codes can be used to describe medical services provided. However, when billing Medicare, HCPCS codes must be used.

HCPCS Level II codes are alphanumeric and primarily include non-physician supplies, products and procedures such as prosthetic devices, ambulance services, drugs, infusion additives and ancillary surgical supplies not included in CPT. HCPCS Level III codes are also called HCPCS local codes and are for use in specific jurisdictions and program. HCPCS Level III codes are not nationally recognized.

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.