For various aspects of healthcare services, billing processes rely on specific coding systems, primarily using CPT (Current Procedural Terminology) and HCPCS (Healthcare Common Procedure Coding System) codes, instead of ICD codes in certain scenarios. CPT codes, also known as Level I HCPCS codes, are essential for billing physician services and are protected under copyright by the American Medical Association (AMA). The HCPCS system encompasses three categories, with CPT codes being five-digit numeric codes. Level II HCPCS codes, in contrast, are five-position alphanumeric codes developed by CMS. These Level II codes are mainly designated for equipment, supplies, and non-physician services not covered by AMA CPT codes. Level III HCPCS codes, previously used for local coding, are no longer in use.
Navigating Level I HCPCS (CPT) Code Resources
CPT codes, integral to Level I of the HCPCS system, are proprietary to the AMA. Access to complete and official code lists necessitates purchase, available in both electronic and hard copy formats. However, the American Medical Association website offers a valuable CPT code search tool. This resource enables researchers to search using a 5-digit CPT code or keywords to effectively identify relevant codes and their definitions.
Furthermore, the CMS website provides a platform to explore the Physician Fee Schedule, offering pricing information for specific HCPCS codes. It’s important to note that this website is primarily designed for pricing inquiries rather than detailed code definitions, resulting in somewhat concise code descriptions.
For those requiring a comprehensive list of HCPCS/CPT codes across all levels, the source files for the Physician Fee Schedule are available for download. While these files, particularly the “PFS Relative Value Files,” include code descriptions, they are brief and may not fully meet the detailed needs of all researchers.
Exploring Level II HCPCS Codes
Level II HCPCS codes, also referred to as Alpha-Numeric HCPCS codes, are available for purchase in electronic and hard-copy codebooks. Unlike Level I codes, Level II HCPCS codes are not proprietary and can be freely downloaded from the CMS website. This accessibility makes Level II codes a widely available resource for coding and billing purposes.
