HCPCS is a standardized coding system used in the healthcare industry to represent medical procedures, supplies, and services provided to patients. It facilitates uniform reporting for billing, statistical tracking, and reimbursement purposes.
CPT codes are a subset of HCPCS used to report medical procedures and services performed by healthcare providers in outpatient settings. They are developed and maintained by the American Medical Association (AMA).
HCPCS Level I codes are identical to CPT codes and are used to report procedures and services rendered by physicians and other healthcare professionals in outpatient settings.
HCPCS Level II codes are used to report medical supplies, durable medical equipment (DME), ambulance services, and other healthcare services not covered by CPT codes. These codes are alphanumeric and are primarily used for billing Medicare and Medicaid.
DME refers to medical equipment intended for repeated use by patients in their homes, such as wheelchairs, oxygen tanks, and hospital beds. HCPCS Level II codes are used to report DME items.
Modifiers are two-digit codes appended to CPT or HCPCS codes to provide additional information about a service or procedure. They can indicate a variety of factors, including multiple procedures performed during the same encounter, professional components of a service, or unusual circumstances.
The NCCI is a set of coding policies developed by the Centers for Medicare and Medicaid Services (CMS) to promote correct coding methodologies and prevent improper payments. It includes edits that identify code pairs that should not be reported together under certain circumstances.
Place of service codes are two-digit codes used to indicate the location where a healthcare service was provided, such as a physician’s office, hospital, or nursing facility. They are often required for accurate billing and reimbursement.
HCPCS modifiers are two-character codes used with HCPCS Level II codes to provide additional information about the item or service being billed. They can indicate factors such as the brand name of a drug or the rental versus purchase of equipment.
Reimbursement refers to the compensation healthcare providers receive from payers, such as insurance companies or government programs, for services rendered to patients. The amount of reimbursement is typically determined by the payer’s fee schedule, which is based on the codes submitted for the services provided.