HCPCS Codes Were NOT all Created for the Same Purpose

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Jun 29th, 2020

Having problems finding a particular product/code with our DMEPOS search? When looking for HCPCS Level II codes, there are several kinds of codes, and not all HCPCS codes were created for the same purpose. If you are searching for a certain HCPCS product using our DMEPOS search, you may think the tool is incorrect or missing results. This is not the case - the DMEPOS tool is looking for products that are sold by a supplier to be used in the home, not in a hospital or facility setting. The DMEPOS search will assist with items such as durable medical, some medical supplies, and prosthetics and orthotics.

For example, if you are looking for C-Codes, you will need to search with our comprehensive search. We have had a lot of questions on the DMEPOS search missing catheters being billed with C-Codes. You will find catheters but these are only for home use, such as urinary catheters. Products that are assigned with a C-Code are a different type of product, such as graphs, stents, and pacemakers, used with procedures only done in the hospital or outpatient setting. 

C-Codes are temporary codes used to report device categories, new technology procedures, and drugs, biologicals, and radiopharmaceuticals that do not have other HCPCS code assignments. C-Codes are also known as pass-through and are only payable on claims for hospital outpatient department services and procedures. C-Codes are unique to items that can be used either inpatient or outpatient but are only reported on outpatient claims. 

NOTE: Effective October 1, 2006, the following Non-OPPS providers may elect to bill using C- codes (or appropriate CPT codes) on Type of Bills (TOBs) 12X, 13X, or 85X:

• Critical access hospitals (CAHs)

• Indian Health Service Hospitals (IHS)

• Hospitals located in American Samoa, Guam, Saipan, or the Virgin Islands

• Maryland waiver hospitals.

For more information on this refer to Billing of Temporary “C” HCPCS Codes by Non-Outpatient Prospective Payment System (Non-OPPS) Providers, MLN Matters Number: MM5027.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM5027.pdf

Pass-through

We briefly mentioned above C-codes are pass-through codes. These are codes that were created by CMS when there is not enough information about the technology to determine the use and pricing. Therefore, a pass-through code allows CMS to gather the information then adjust the rates to reflect the resources used for the new technology.

Here is a list of HCPCS codes and the sections they are assigned to.