The Healthcare Common Procedure Coding System (HCPCS) is a collection of standardized codes for medical procedures, supplies, products and services. HCPCS codes are used to process health insurance claims for the Centers for Medicare and Medicaid Services (CMS).
In 1983, Centers for Medicare & Medicaid Services (CMS) established HCPCS.1
The Health Insurance Portability and Accountability Act (HIPAA) of 1996, made Current Procedural Terminology (CPT) and HCPCS as the national standards for electronic transaction of healthcare information.1
HCPCS is a necessary reporting system for health services because it allows for standardization in medical reporting.
HCPCS includes two levels of codes. Level I consists of CPT codes which are used to identify medical services and procedures ordered by physicians or other licensed professionals. Level II of the HCPCS is managed by CMS and identifies non-physician services (e.g. ambulance services, durable medical equipment, or pharmacy). Level II codes are alphanumeric, containing one letter followed by four numbers.2 HCPCS Level II codes are divided into the following sections:
A codes, transportation, medical and surgical supplies, miscellaneous and experimental
B codes, enteral and parenteral therapy
C codes, temporary hospital OPPS
E codes, durable medical equipment
G codes, temporary procedures and professional services
H codes, behavioral health/substance abuse services
J codes, drugs administered other than oral method, chemotherapy drugs
K codes, temporary codes for durable medical equipment regional carriers
L codes, orthotic/prosthetic procedures
M codes, other medical services
P codes, pathology and laboratory
Q codes, temporary codes (limited use and guidelines specific)
R codes, diagnostic radiology services
S codes, temporary national codes (non-Medicare) codes
T codes, temporary state Medicaid agency codes
V codes, vision/hearing services2
Some HCPCS codes require the use of modifiers to provide additional information about the service or procedure. They consist of a two digit number, two letters or alphanumeric characters. Modifiers can be used to identify where in the body a procedure was performed, multiple procedures in the same session, or indicate that a procedure was not completed.3 HCPCS codes are updated periodically to reflect new procedures and revision or deletion of current codes.3
As of 2021, there are nearly 7,000 HCPCS codes, with G codes comprising the largest category with over 1,500 codes.4
When some procedures are always grouped together, they are identified with "bundled" codes.3
Dotson P. CPT® Codes: What Are They, Why Are They Necessary, and How Are They Developed?. Adv Wound Care (New Rochelle). 2013;2(10):583-587. doi:10.1089/wound.2013.0483
Webb L. Note similarities and differences between HCPCS, CPT® codes. JustCoding News: Outpatient. https://www.hcpro.com/HIM-284009-8160/Note-similarities-and-differences-between-HCPCS-CPT-codes.html. Published 2012.
Torrey T. Medicare's HCPCS Codes for Payments. VeryWell Health. https://www.verywellhealth.com/what-are-medicares-hcpcs-codes-2614952. Published 2020.
2020/2021 HCPCS Codes. HCPCSData.com. https://www.hcpcsdata.com/Codes. Published 2020.