HCSPCS level I and Level II codes & relation to CPT.

In general terms — with some exceptions — medical coders use the three code sets when submitting medical claims to report the following:

  • CPT® codes: What the provider did

  • HCPCS codes: What the provider used

  • ICD-10-CM: Why the provider 'did' and 'used'. 

An  example can make it more clear. 

If a urologist diagnoses a patient with bladder cancer and performs a bladder instillation of 1 mg of Bacillus Calmette-Guerin (BCG) to treat the tumor, the medical coder might assign:

  • CPT® codes (did): 51720 Bladder instillation of anticarcinogenic agent (including retention time)

  • HCPCS Level II code (used): J9030 BCG live intravesical instillation, 1mg

  • ICD-10-CM code (why): C67.9 Malignant neoplasm of bladder, unspecified


A. HCSPCS level I and II

HCPCS Level I: Current Procedural Terminology, Fourth Edition:

Procedures and services provided by physicians and other allied healthcare professionals


HCPCS Level II codes :

Consist of drugs, supplies, equipment, non-physician services, and services not represented in CPT


Example:

J9355: Injection, trastuzumab, excludes biosimilar, 10 mg.

G9631: Patient sustained ureter injury at the time of surgery or discovered subsequently up to 30 days post-surgery

C1823: Generator, neurostimulator (implantable), non-rechargeable, with transvenous sensing and stimulation leads

V2599: Contact lens, other type

B.

HCPCS Code Ranges


A0021-A0999


Ambulance and Other Transport Services and Supplies


A2001-A2013


Matrix for Wound Management (Placental, Equine, Synthetic)


A4100


Skin Substitute Device


A4206-A8004


Medical And Surgical Supplies


Detailed list on the URL in Ref


Timeline:



Ref

https://www.aapc.com/resources/what-is-hcpcs

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