HCPCS

The Healthcare Common Procedure Coding System is a coding system used to identify healthcare services, supplies, and equipment for billing purposes, supplementing CPT codes.

HCPCS, pronounced "hick-picks," is the coding system that covers everything CPT does not. While CPT codes cover physician services and procedures, HCPCS Level II codes cover supplies, equipment, drugs, and non-physician services that are not represented in CPT. HCPCS Level II codes are five characters long, starting with a letter followed by four digits. Examples include: J codes for injectable drugs (J0129 for abatacept injection), L codes for orthotic and prosthetic devices, E codes for durable medical equipment, A codes for ambulance services and medical supplies, and G codes for temporary Medicare-specific services. If you administer drugs in your office, you need HCPCS codes. When you give a patient a cortisone injection, you bill the CPT code for the injection procedure and the HCPCS J code for the drug itself. Getting the drug code wrong or using a deleted code is a common denial reason. HCPCS codes are maintained by CMS and updated quarterly, unlike CPT codes which update annually. The quarterly updates mean you need to check for new, revised, and deleted HCPCS codes more frequently. Missing a quarterly code change can result in denials that your billing staff does not immediately understand. During credentialing, HCPCS codes are relevant if you bill for DME, drugs, or supplies. Some payers require specific enrollment or authorization to bill certain HCPCS codes, particularly for high-cost injectable drugs. If you are administering specialty drugs like biologics, check with each payer about their prior authorization and buy-and-bill requirements for the specific HCPCS codes you use. Medicare sometimes creates temporary G codes for services that do not yet have permanent CPT codes. These are used for pilot programs, quality reporting, and new technology assessments. When CMS creates a new G code, they usually publish guidance on who can bill it and what documentation is required.