HCPCS Codes - Medical Procedures, Supplies & DME Codes - l4 Codes
HCPCS Procedure, Supply & DME (Durable Medical Equipment) Codes ("l4" Codes):- L4000 replace girdle spinal orthosis ctlso so HCPCS Code Code
- L4002 replacement strap any orthosis includes all HCPCS Code Code
- L4010 replace trilateral socket brim HCPCS Code Code
- L4020 replace quadrilateral socket brim molded patient HCPCS Code Code
- L4030 replace quadrilateral socket brim custom fitted HCPCS Code Code
- L4040 replace molded thigh lacer custom fabricated HCPCS Code Code
- L4045 replace nonmolded thigh lacer custom fabricated HCPCS Code Code
- L4050 replace molded calf lacer custom fabricated HCPCS Code Code
- L4055 replace nonmolded calf lacer custom fabricated HCPCS Code Code
- L4060 replace high roll cuff HCPCS Code Code
- L4070 replace proximal distal upright kafo HCPCS Code Code
- L4080 replace metal bands kafo proximal thigh HCPCS Code Code
- L4090 replace metal bands kafoafo calf distal HCPCS Code Code
- L4100 replace leather cuff kafo proximal thigh HCPCS Code Code
- L4110 replace leather cuff kafoafo calf distal HCPCS Code Code
- L4130 replace pretibial shell HCPCS Code Code
- L4205 repair orthotic device labor component per HCPCS Code Code
- L4210 repair orthotic device repair replace minor HCPCS Code Code
- L4350 ankle control orthosis stirrup style rigid HCPCS Code Code
- L4360 walking boot pneumatic joints interface material HCPCS Code Code
- L4361 Walking boot, pneumatic and/or vacuum, with or HCPCS Code Code
- L4370 pneumatic full leg splint prefabricated includes HCPCS Code Code
- L4380 pneumatic knee splint prefabricated includes fitting HCPCS Code Code
- L4386 walking boot nonpneumatic joints interface material HCPCS Code Code
- L4387 Walking boot, non-pneumatic, with or without joints, HCPCS Code Code
- L4392 replacement soft interface material static afo HCPCS Code Code
- L4394 replace soft interface material foot drop HCPCS Code Code
- L4396 static ankle foot orthosis including soft HCPCS Code Code
- L4397 Static or dynamic ankle foot orthosis, including HCPCS Code Code
- L4398 foot drop splint recumbent positioning device HCPCS Code Code
- L4631 Ankle foot orthosis, walking boot type, varus/valgus HCPCS Code Code
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HCPCS Medical Codes & Code Modifiers
(HCPCS is commonly pronounced Hick-Picks.)Each year, in the United States, health care insurers process over 5 billion claims for payment. For Medicare and other health insurance programs to ensure that these claims are processed in an orderly and consistent manner, standardized coding systems are essential. The HCPCS Level II Code Set is one of the standard code sets used for this purpose. The HCPCS is divided into two principal subsystems, referred to as level I and level II of the HCPCS. Level I of the HCPCS is comprised of CPT (Current Procedural Terminology), a numeric coding system maintained by the American Medical Association (AMA). The CPT is a uniform coding system consisting of descriptive terms and identifying codes that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals. These health care professionals use the CPT to identify services and procedures for which they bill public or private health insurance programs. Decisions regarding the addition, deletion, or revision of CPT codes are made by the AMA. The CPT codes are republished and updated annually by the AMA. Level I of the HCPCS, the CPT codes, does not include codes needed to separately report medical items or services that are regularly billed by suppliers other than physicians.
Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office. Because Medicare and other insurers cover a variety of services, supplies, and equipment that are not identified by CPT codes, the level II HCPCS codes were established for submitting claims for these items. The development and use of level II of the HCPCS began in the 1980's. Level II codes are also referred to as alpha-numeric codes because they consist of a single alphabetical letter followed by 4 numeric digits, while CPT codes are identified using 5 numeric digits.
In October of 2003, the Secretary of HHS delegated authority under the HIPAA legislation to CMS to maintain and distribute HCPCS Level II Codes. As stated in 42 CFR Sec. 414.40 (a) CMS establishes uniform national definitions of services, codes to represent services, and payment modifiers to the codes. Within CMS there is a CMS HCPCS Workgroup which is an internal workgroup comprised of representatives of the major components of CMS, as well as other consultants from pertinent Federal agencies. Prior to December 31, 2003, Level III HCPCS were developed and used by Medicaid State agencies, Medicare contractors, and private insurers in their specific programs or local areas of jurisdiction. For purposes of Medicare, level III codes were also referred to as local codes. Local codes were established when an insurer preferred that suppliers use a local code to identify a service, for which there is no level I or level II code, rather than use a "miscellaneous or not otherwise classified code." The Health Insurance Portability and Accountability Act of 1996 (HIPAA) required CMS to adopt standards for coding systems that are used for reporting health care transactions. We published, in the Federal Register on August 17, 2000 (65 FR 50312), regulations to implement this part of the HIPAA legislation. These regulations provided for the elimination of level III local codes by October 2002, at which time, the level I and level II code sets could be used. The elimination of local codes was postponed, as a result of section 532(a) of BIPA, which continued the use of local codes through December 31, 2003.
(Source: http://www.cms.hhs.gov/MedHCPCSGenInfo/)
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