HCPCS

Background

Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT-4 codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office. Because Medicare and other insurers cover a variety of services, supplies, and equipment that are not identified by CPT codes, the level II HCPCS codes were established for submitting claims for these items. The development and use of level II of the HCPCS began in the 1980's. Level II codes are also referred to as alpha-numeric codes because they consist of a single alphabetical letter followed by 4 numeric digits, while CPT codes are identified using 5 numeric digits.

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HCPCS Datasets
The following are the various datasets available on CDH for HCPCS. Please note that some of the datasets require a paid subscription (indicated by the symbol), primarily due to the value-add of consolidating various sources, additional attributes, and incremental updates. All reasonable commercial attempt is made to keep the information up-to-date.
HC02 HCPCS Level II Alpha-numeric codes - 2008/2009 Level II alphanumeric HCPCS procedure and modifier codes, their long and short descriptions, and applicable Medicare administrative, coverage, and pricing data as released by CMS.
HC03 HCPCS Lookup Dictionary for Level II Codes Lookup value decodes used in the HCPCS Level II Alpha-numeric codes
Dataset Features and Price List
Feature HCO2
$100
HCO3
FREE
HCPCS Code: Five-character alpha-numeric code. X
HCPCS Long Description: Contains all text of procedure or modifier long descriptions. X
HCPCS Short Description: Short descriptive text of procedure or modifier code. X
HCPCS Pricing Indicator Code (1): used to identify the appropriate methodology for developing unique pricing amounts under part B. X
HCPCS Pricing Indicator Code (2): used to identify the appropriate methodology for developing unique pricing amounts under part B. X
HCPCS Multiple Pricing Indicator Code: Code used to identify instances where a procedure could be priced under multiple methodologies. X
Coverage Issues Manual Reference Section Number(s)(HCPCS): Number identifying the reference section of the coverage issues manual. X
Medicare Carriers Manual Reference Section Number(s)(HCPCS): Number identifying a section of the Medicare carriers manual. X
HCPCS Statute Number: Number identifying the statute reference for coverage or noncoverage of procedure or service. X
HCPCS Lab Certification Code (1): Code used to classify laboratory procedures according to the specialty certification categories listed by CMS. Any generally certified laboratory (e.g., 100) may perform any of the tests in its subgroups (e.g., 110, 120, etc.). X
HCPCS Lab Certification Code (2): Code used to classify laboratory procedures according to the specialty certification categories listed by CMS. Any generally certified laboratory (e.g., 100) may perform any of the tests in its subgroups (e.g., 110, 120, etc.). X
HCPCS Cross Reference Code: An explicit reference crosswalking a deleted code or a code that is not valid for Medicare to a valid current code (or range of codes). X
HCPCS Coverage Code: A code denoting Medicare coverage status. X
ASC Payment Group Code (HCPCS): The 'YY' indicator denotes that this procedure is approved to be performed in an ambulatory surgical center. X
ASC Payment Group Effective Date (HCPCS): Date the procedure is assigned to the ASC payment group. X
MOG Payment Group Code (HCPCS): Medicare outpatient groups (MOG) payment group code. X
MOG Payment Policy Indicator (HCPCS): Code identifying whether a HCPCS code is subject to payment of an ASC facility fee, a separate fee under another provision of Medicare, or to no fee at all. X
MOG Effective Date (HCPCS): Date the procedure is assigned to the Medicare outpatient group (MOG) payment group. X
Processing Note Number (HCPCS): A number identifying the processing note contained in Appendix A of the HCPCS manual. X
BETOS Code (HCPCS): This field is valid beginning with 2003 data. The Berenson-Eggers Type of Service (BETOS) for the procedure code based on generally agreed upon clinically meaningful groupings of procedures and services. X
HCPCS Type Of Service Code: The carrier-assigned CMS type of service which describes the particular kind(s) of service represented by the procedure code. X
HCPCS Code Added Date: The date that a procedure or modifier code was added. X
HCPCS Action Effective Date: Effective date of action to a procedure or modifier code. X
HCPCS Termination Date: Last date for which a procedure or modifier code may be used by Medicare providers. X
HCPCS Action Code: Denotes the change made to a procedure or modifier code within the HCPCS system. X
HCPCS Lookup Code Type: Type of Code in the Lookup Dictionary. X
HCPCS Lookup Code: Alphanumeric code used in the Lookup Dictionary. X
HCPCS Lookup Description: Includes alphanumeric code and description for the Lookup Dictionary. X
Automated Notification: Automated Notification of Changes. X
Free Email Support. X X
Free Telephone Support. X
Attribute Sources
A list of all attributes of the datasets, along with relevant sources. The field Portal Release Date is the date this information was published on CommonDataHub.

Attribute Source Portal Release Date
HCPCS Code CMS 15-May-2008
HCPCS Long Description CMS 15-May-2008
HCPCS Short Description CMS 15-May-2008
HCPCS Pricing Indicator Code (1) CMS 15-May-2008
HCPCS Pricing Indicator Code (2) CMS 15-May-2008
HCPCS Multiple Pricing Indicator Code CMS 15-May-2008
Coverage Issues Manual Reference Section Number(s)(HCPCS) CMS 15-May-2008
Medicare Carriers Manual Reference Section Number(s)(HCPCS) CMS 15-May-2008
HCPCS Statute Number CMS 15-May-2008
HCPCS Lab Certification Code (1) CMS 15-May-2008
HCPCS Lab Certification Code (2) CMS 15-May-2008
HCPCS Cross Reference Code CMS 15-May-2008
HCPCS Coverage Code CMS 15-May-2008
ASC Payment Group Code (HCPCS) CMS 15-May-2008
ASC Payment Group Effective Date (HCPCS) CMS 15-May-2008
MOG Payment Group Code (HCPCS) CMS 15-May-2008
MOG Payment Policy Indicator (HCPCS) CMS 15-May-2008
MOG Effective Date (HCPCS) CMS 15-May-2008
Processing Note Number (HCPCS) CMS 15-May-2008
BETOS Code (HCPCS) CMS 15-May-2008
HCPCS Type Of Service Code CMS 15-May-2008
HCPCS Code Added Date CMS 15-May-2008
HCPCS Action Effective Date CMS 15-May-2008
HCPCS Termination Date CMS 15-May-2008
HCPCS Action Code CMS 15-May-2008
HCPCS Lookup Code Type CMS 15-May-2008
HCPCS Lookup Code CMS 15-May-2008
HCPCS Lookup Description CMS 15-May-2008
Details of the sources used:

HCPCS:
http://www.cms.hhs.gov

Acronyms
A listing of the acronyms and abbreviations used.
CDH: CommonDataHub
HCPCS: Healthcare Common Procedure Coding System
CMS: Centers for Medicare and Medicaid Services
MOG: Medicare Outpatient Group
BETOS: Berenson-Eggers Type of Service
ASC: Ambulatory Surgical Center
 
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