HCPCS Lookup Dictionary for Level II Codes Home>Reports>Healthcare>Clinical Codes
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HCPCS Lookup Code TypeHCPCS Lookup CodeHCPCS Lookup Description
Lab Certification010010 = Histocompatibility testing
Lab Certification100100 = Microbiology
Lab Certification110110 = Bacteriology
Lab Certification115115 = Mycobacteriology
Lab Certification120120 = Mycology
Lab Certification130130 = Parasitology
Lab Certification140140 = Virology
Lab Certification150150 = Other microbiology
Lab Certification200200 = Diagnostic immunology
Lab Certification210210 = Syphilis serology
Lab Certification220220 = General immunology
Lab Certification300300 = Chemistry
Lab Certification310310 = Routine chemistry
Lab Certification320320 = Urinalysis
Lab Certification330330 = Endocrinology
Lab Certification340340 = Toxicology
Lab Certification350350 = Other chemistry
Lab Certification400400 = Hematology
Lab Certification500500 = Immunohematology
Lab Certification510510 = Abo group & RH type
Lab Certification520520 = Antibody detection (transfusion)
Lab Certification530530 = Antibody detection (nontransfusion)
Lab Certification540540 = Antibody identification
Lab Certification550550 = Compatibility testing
Lab Certification560560 = Other immunohematology
Lab Certification600600 = Pathology
Lab Certification610610 = Histopathology
Lab Certification620620 = Oral pathology
Lab Certification630630 = Cytology
Lab Certification800800 = Radiobioassay
Lab Certification900900 = Clinical cytogenetics
Multiple Pricing Indicator9Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established (pricing indicator is '99')
Multiple Pricing IndicatorAA = Not applicable as HCPCS priced under one methodology.
Multiple Pricing IndicatorBB = Professional component of HCPCS priced using RVU's, while technical component and global service priced by Medicare part B carriers
Multiple Pricing IndicatorCC = Physician interpretation of clinical lab service is priced under physician fee schedule using RVU's, while pricing of lab service is paid under clinical lab fee schedule
Multiple Pricing IndicatorDD = Service performed by physician is priced under physician fee schedule using RVU's, while service performed by clinical psychologist is priced under clinical psychologist fee schedule (not applicable as of January 1, 1998)
Multiple Pricing IndicatorEE = Service performed by physician is priced under physician fee schedule using RVU's, service performed by clinical psychologist is priced under clinical psychologist's fee schedule and service performed by clinical social worker is price
Multiple Pricing IndicatorFF = Service performed by physician is priced under physician fee schedule by carriers, service performed by clinical psychologist is priced under clinical psychologist's fee schedule and service performed by clinical social worker is price
Multiple Pricing IndicatorGG = Clinical lab service priced under reasonable charge when service is submitted on claim with blood products, while service is priced under clinical lab fee schedule when there are no blood products on claim.
Coverage CodeDD = Special coverage instructions apply
Coverage CodeII = Not payable by Medicare
Coverage CodeMM = Non-covered by Medicare
Coverage CodeSS = Non-covered by Medicare statute
Coverage CodeCC = Carrier judgment
Payment Group Code000000 = No MOG applies
Payment Group Code102102 = Level II needle biopsy/aspiration (Integumentary)
Payment Group Code112112 = Level II incision and drainage (Integumentary
Payment Group Code132132 = Level II debridement/destruction (Integumentary)
Payment Group Code142142 = Level II excision/biopsy (Integumentary)
Payment Group Code143143 = Level III excision/biopsy (Integumentary)
Payment Group Code151151 = Level I skin repair (Integumentary)
Payment Group Code152152 = Level II skin repair (Integumentary)
Payment Group Code153153 = Level III skin repair (Integumentary)
Payment Group Code160160 = Incision/excision breast (Integumentary)
Payment Group Code169169 = Breast reconstruction/mastectomy (Integumentary)
Payment Group Code201201 = Level I skull and facial bone procedures (Musculoskeletal)
Payment Group Code202202 = Level II skull and facial bone procedures (Musculoskeletal)
Payment Group Code211211 = Level I hand musculoskeletal procedures
Payment Group Code212212 = Level II hand musculoskeletal procedures
Payment Group Code221221 = Level I foot musculoskeletal procedures
Payment Group Code222222 = Level II foot musculoskeletal procedures
Payment Group Code231231 = Level I musculoskeletal procedures
Payment Group Code232232 = Level II musculoskeletal procedures
Payment Group Code233233 = Level III musculoskeletal procedures
Payment Group Code241241 = Level I arthroscopy (Musculoskeletal)
Payment Group Code242242 = Level II arthroscopy (Musculoskeletal)
Payment Group Code260260 = Closed treatment fracture finger/toe/trunk
Payment Group Code269269 = Closed treatment fracture/dislocation/except finger/toe/trunk
Payment Group Code270270 = Open/percutaneous treatment fracture or dislocation
Payment Group Code279279 = Bone/joint manipulation under anesthesia
Payment Group Code280280 = Bunion procedures
Payment Group Code289289 = Arthroplasty (Musculoskeletal)
Payment Group Code290290 = Arthroplasty with prosthesis (Musculoskeletal)
Payment Group Code302302 = Level II ENT procedures
Payment Group Code303303 = Level III ENT procedures
Payment Group Code304304 = Level IV ENT procedures
Payment Group Code309309 = Implantation of cochlear device (ASC rate does not include cost of implant)
Payment Group Code310310 = Nasal cauterization/packing
Payment Group Code319319 = Tonsil/adenoid procedures
Payment Group Code322322 = Level II endoscopy upper airway
Payment Group Code323323 = Level III endoscopy upper airway
Payment Group Code329329 = Endoscopy lower airway
Payment Group Code330330 = Thoracentesis/lavage procedures
Payment Group Code350350 = Placement transvenous caths/cutdown
Payment Group Code359359 = Removal/revision, pacemaker/vascular device
Payment Group Code360360 = Vascular ligation
Payment Group Code369369 = Vascular repair/fistula construction
Payment Group Code370370 = Lymph node excisions
Payment Group Code379379 = Thyroid/lymphadenectomy procedures
Payment Group Code400400 = Esophageal dilation without endoscopy
Payment Group Code410410 = Esophagoscopy
Payment Group Code421421 = Level I upper GI endoscopy/intubation
Payment Group Code422422 = Level II upper GI endoscopy/intubation
Payment Group Code429429 = Lower GI endoscopy
Payment Group Code430430 = Anoscopy and diagnostic sigmoidoscopy
Payment Group Code439439 = Therapeutic proctosigmoidoscopy
Payment Group Code440440 = Small intestine endoscopy
Payment Group Code449449 = Percutaneous biliary endoscopic procedures
Payment Group Code450450 = Endoscopic retrograde cholangio-pancreatography (ERCP)
Payment Group Code460460 = Hernia/hydrocele procedures
Payment Group Code472472 = Level II anal/rectal procedures
Payment Group Code473473 = Level III anal/rectal procedures
Payment Group Code480480 = Peritoneal and abdominal procedures
Payment Group Code490490 = Tube procedures
Payment Group Code501501 = Level I laparoscopy
Payment Group Code502502 = Level II laparoscopy
Payment Group Code509509 = Lithotripsy
Payment Group Code511511 = Level I cystourethroscopy and other genitourinary procedures
Payment Group Code512512 = Level II cystourethroscopy and other genitourinary procedures
Payment Group Code513513 = Level III cystourethroscopy and other genitourinary procedures
Payment Group Code521521 = Level I urethral procedures
Payment Group Code522522 = Level II urethral procedures
Payment Group Code530530 = Circumcision
Payment Group Code539539 = Penile procedures
Payment Group Code540540 = Insertion of penile prosthesis (ASC rate does include cost of implant)
Payment Group Code549549 = Testes/epididymis procedures
Payment Group Code550550 = Prostrate biopsy
Payment Group Code562562 = Level II female reproductive procedures
Payment Group Code563563 = Level III female reproductive procedures
Payment Group Code570570 = Surgical hysteroscopy
Payment Group Code579579 = D & C
Payment Group Code580580 = Spontaneous abortion
Payment Group Code589589 = Therapeutic abortion
Payment Group Code602602 = Level II nervous system injections
Payment Group Code609609 = Revision/removal neurological device
Payment Group Code610610 = Implantation of neurostimulator electrodes (ASC rate does not include cost of implant)
Payment Group Code619619 = Implantation of neurological devices (asc rate does not include cost of implant)
Payment Group Code621621 = Level I nerve procedures
Payment Group Code622622 = Level II nerve procedures
Payment Group Code629629 = Spinal tap
Payment Group Code639639 = Laser eye procedures except retinal
Payment Group Code640640 = Cataract procedures 649 = Cataract procedures with IOL insert (includes $150 insert)
Payment Group Code651651 = Level I anterior segment eye procedures
Payment Group Code652652 = Level II anterior segment eye procedures
Payment Group Code659659 = Corneal transplant (ASC rate includes price of transplant)
Payment Group Code660660 = Posterior segment eye procedures
Payment Group Code669669 = Strabismus/muscle procedures
Payment Group Code673673 = Level III eye procedure
Payment Group Code674674 = Level IV eye procedure
Payment Group Code680680 = Vitrectomy
Payment Group Code689689 = Implantation/replacement of intraitreal drug
Action CodeAA = Add procedure or modifier code
Action CodeBB = Change in both administrative data field and long description of procedure or modifier code
Action CodeCC = Change in long description of procedure or modifier code
Action CodeDD = Discontinue procedure or modifier code
Action CodeFF = Change in administrative data field of procedure or modifier code
Action CodeNN = No maintenance for this code
Action CodePP = Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
Action CodeRR = Re-activate discontinued/deleted procedure or modifier code
Action CodeSS = Change in short description of procedure code
Action CodeTT = Miscellaneous change (BETOS, type of service)
Pricing Indicator00 = Service not separately priced by part B
Pricing Indicator1111 = Price established using national rvu's (Physician Fee Schedule)
Pricing Indicator1212 = Price established using national anesthesia base units (Physician Fee Schedule)
Pricing Indicator1313 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule)
Pricing Indicator2121 = Price subject to national limitation amount
Pricing Indicator2222 = Price established by carriers (e.G., gap-fills, carrier established panels)
Pricing Indicator3131 = Frequently serviced DME (price subject to floors and ceilings)
Pricing Indicator3232 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)
Pricing Indicator3333 = Oxygen and oxygen equipment (price subject to floors and ceilings)
Pricing Indicator3434 = DME supplies (price subject to floors and ceilings)
Pricing Indicator3535 = Surgical dressings (price subject to floors and ceilings)
Pricing Indicator3636 = Capped rental DME (price subject to floors and ceilings)
Pricing Indicator3737 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)
Pricing Indicator3838 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)
Pricing Indicator3939 = Parenteral and Enteral Nutrition
Pricing Indicator4545 = Customized DME items
Pricing Indicator4646 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap-filled amounts)
Pricing Indicator5151 = Drugs
Pricing Indicator5252 = Reasonable charge
Pricing Indicator5353 = Statute
Pricing Indicator5454 = Vaccinations
Pricing Indicator5555 = Priced by carriers under clinical psychologist fee schedule (not applicable as of january 1, 1998)
Pricing Indicator5656 = Priced by carriers under clinical social worker fee schedule (not applicable as of january 1, 1998)
Pricing Indicator5757 = Other carrier priced
Pricing Indicator9999 = Value not established
BETOSM1AM1A = Office visits - new
BETOSM1BM1B = Office visits - established
BETOSM2AM2A = Hospital visit - initial
BETOSM2BM2B = Hospital visit - subsequent
BETOSM2CM2C = Hospital visit - critical care
BETOSM3M3 = Emergency room visit
BETOSM4AM4A = Home visit
BETOSM4BM4B = Nursing home visit
BETOSM5AM5A = Specialist - pathology
BETOSM5BM5B = Specialist - psychiatry
BETOSM5CM5C = Specialist - opthamology
BETOSM5DM5D = Specialist - other
BETOSM6M6 = Consultations
BETOSP0P0 = Anesthesia
BETOSP1AP1A = Major procedure - breast
BETOSP1BP1B = Major procedure - colectomy
BETOSP1CP1C = Major procedure - cholecystectomy
BETOSP1DP1D = Major procedure - turp
BETOSP1EP1E = Major procedure - hysterectomy
BETOSP1FP1F = Major procedure - explor/decompr/excisdisc
BETOSP1GP1G = Major procedure - Other
BETOSP2AP2A = Major procedure, cardiovascular-CABG
BETOSP2BP2B = Major procedure, cardiovascular-Aneurysm repair
BETOSP2CP2C = Major Procedure, cardiovascular-Thromboendarterectomy
BETOSP2DP2D = Major procedure, cardiovascualr-Coronary angioplasty (PTCA)
BETOSP2EP2E = Major procedure, cardiovascular-Pacemaker insertion
BETOSP2FP2F = Major procedure, cardiovascular-Other
BETOSP3AP3A = Major procedure, orthopedic - Hip fracture repair
BETOSP3BP3B = Major procedure, orthopedic - Hip replacement
BETOSP3CP3C = Major procedure, orthopedic - Knee replacement
BETOSP3DP3D = Major procedure, orthopedic - other
BETOSP4AP4A = Eye procedure - corneal transplant
BETOSP4BP4B = Eye procedure - cataract removal/lens insertion
BETOSP4CP4C = Eye procedure - retinal detachment
BETOSP4DP4D = Eye procedure - treatment of retinal lesions
BETOSP4EP4E = Eye procedure - other
BETOSP5AP5A = Ambulatory procedures - skin
BETOSP5BP5B = Ambulatory procedures - musculoskeletal
BETOSP5CP5C = Ambulatory procedures - inguinal hernia repair
BETOSP5DP5D = Ambulatory procedures - lithotripsy
BETOSP5EP5E = Ambulatory procedures - other
BETOSP6AP6A = Minor procedures - skin
BETOSP6BP6B = Minor procedures - musculoskeletal
BETOSP6CP6C = Minor procedures - other (Medicare fee schedule)
BETOSP6DP6D = Minor procedures - other (non-Medicare fee schedule)
BETOSP7AP7A = Oncology - radiation therapy
BETOSP7BP7B = Oncology - other
BETOSP8AP8A = Endoscopy - arthroscopy
BETOSP8BP8B = Endoscopy - upper gastrointestinal
BETOSP8CP8C = Endoscopy - sigmoidoscopy
BETOSP8DP8D = Endoscopy - colonoscopy
BETOSP8EP8E = Endoscopy - cystoscopy
BETOSP8FP8F = Endoscopy - bronchoscopy
BETOSP8GP8G = Endoscopy - laparoscopic cholecystectomy
BETOSP8HP8H = Endoscopy - laryngoscopy
BETOSP8IP8I = Endoscopy - other
BETOSP9AP9A = Dialysis services (medicare fee schedule)
BETOSP9BP9B = Dialysis services (non-medicare fee schedule)
BETOSI1AI1A = Standard imaging - chest
BETOSI1BI1B = Standard imaging - musculoskeletal
BETOSI1CI1C = Standard imaging - breast
BETOSI1DI1D = Standard imaging - contrast gastrointestinal
BETOSI1EI1E = Standard imaging - nuclear medicine
BETOSI1FI1F = Standard imaging - other
BETOSI2AI2A = Advanced imaging - CAT/CT/CTA: brain/head/neck
BETOSI2BI2B = Advanced imaging - CAT/CT/CTA: other
BETOSI2CI2C = Advanced imaging - MRI/MRA: brain/head/neck
BETOSI2DI2D = Advanced imaging - MRI/MRA: other
BETOSI3AI3A = Echography/ultrasonography - eye
BETOSI3BI3B = Echography/ultrasonography - abdomen/pelvis
BETOSI3CI3C = Echography/ultrasonography - heart
BETOSI3DI3D = Echography/ultrasonography - carotid arteries
BETOSI3EI3E = Echography/ultrasonography - prostate, transrectal
BETOSI3FI3F = Echography/ultrasonography - other
BETOSI4AI4A = Imaging/procedure - heart including cardiac catheterization
BETOSI4BI4B = Imaging/procedure - other
BETOST1AT1A = Lab tests - routine venipuncture (non Medicare fee schedule)
BETOST1BT1B = Lab tests - automated general profiles
BETOST1CT1C = Lab tests - urinalysis
BETOST1DT1D = Lab tests - blood counts
BETOST1ET1E = Lab tests - glucose
BETOST1FT1F = Lab tests - bacterial cultures
BETOST1GT1G = Lab tests - other (Medicare fee schedule)
BETOST1HT1H = Lab tests - other (non-Medicare fee schedule)
BETOST2AT2A = Other tests - electrocardiograms
BETOST2BT2B = Other tests - cardiovascular stress tests
BETOST2CT2C = Other tests - EKG monitoring
BETOST2DT2D = Other tests - other
BETOSD1AD1A = Medical/surgical supplies
BETOSD1BD1B = Hospital beds
BETOSD1CD1C = Oxygen and supplies
BETOSD1DD1D = Wheelchairs
BETOSD1ED1E = Other DME
BETOSD1FD1F = Prosthetic/Orthotic devices
BETOSD1GD1G = Drugs Administered through DME
BETOSO1AO1A = Ambulance
BETOSO1BO1B = Chiropractic
BETOSO1CO1C = Enteral and parenteral
BETOSO1DO1D = Chemotherapy
BETOSO1EO1E = Other drugs
BETOSO1FO1F = Hearing and speech services
BETOSO1GO1G = Immunizations/Vaccinations
BETOSY1Y1 = Other - Medicare fee schedule
BETOSY2Y2 = Other - non-Medicare fee schedule
BETOSZ1Z1 = Local codes
BETOSZ2Z2 = Undefined codes
CMS Service Type11 = Medical care
CMS Service Type22 = Surgery
CMS Service Type33 = Consultation
CMS Service Type44 = Diagnostic radiology
CMS Service Type55 = Diagnostic laboratory
CMS Service Type66 = Therapeutic radiology
CMS Service Type77 = Anesthesia
CMS Service Type88 = Assistant at surgery
CMS Service Type99 = Other medical items or services
CMS Service Type00 = Whole blood only eff 01/96, whole blood or packed red cells before 01/96
CMS Service TypeAA = Used durable medical equipment (DME)
CMS Service TypeBB = High risk screening mammography (obsolete 1/1/98)
CMS Service TypeCC = Low risk screening mammography (obsolete 1/1/98)
CMS Service TypeDD = Ambulance (eff 04/95)
CMS Service TypeEE = Enteral/parenteral nutrients/supplies (eff 04/95)
CMS Service TypeFF = Ambulatory surgical center (facility usage for surgical services)
CMS Service TypeGG = Immunosuppressive drugs
CMS Service TypeHH = Hospice services (discontinued 01/95)
CMS Service TypeII = Purchase of DME (installment basis) (discontinued 04/95)
CMS Service TypeJJ = Diabetic shoes (eff 04/95)
CMS Service TypeKK = Hearing items and services (eff 04/95)
CMS Service TypeLL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)
CMS Service TypeMM = Monthly capitation payment for dialysis
CMS Service TypeNN = Kidney donor
CMS Service TypePP = Lump sum purchase of DME, prosthetics, orthotics
CMS Service TypeQQ = Vision items or services
CMS Service TypeRR = Rental of DME
CMS Service TypeSS = Surgical dressings or other medical supplies (eff 04/95)
CMS Service TypeTT = Psychological therapy (term. 12/31/97) outpatient mental health limitation (eff. 1/1/98)
CMS Service TypeUU = Occupational therapy
CMS Service TypeVV = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95-12/95), Pneumococcal only before 04/95
CMS Service TypeWW = Physical therapy
CMS Service TypeYY = Second opinion on elective surgery (obsoleted 1/97)
CMS Service TypeZZ = Third opinion on elective surgery (obsoleted 1/97)
Generated by CommonDataHub on 30-Oct-2008
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