Healthcare Common Procedure Coding System (HCPCS)

Level II Coding Procedures called HCPCS or Level II codes.

There are three main code sets and the Healthcare Common Procedure Coding System (HCPCS) is the third most common code set used. They are often called Level II codes and are used to report non-physician products, supplies, and procedures not found in CPT, such as ambulance services, DME, drugs, orthotics, supplies, and temporary codes. HCPCS has its own coding guidelines and is used along with CPT codes. There are often modifiers reported with HCPCS to help identify the area of the body, discontinued procedures, or multiple procedures in the same session.

Dental codes are published and copyrighted by the American Dental Association (ADA) and used for billed dental procedures and supplies. An example of a Dental code is D0120 Periodic oral evaluation - established patient.

Miscellaneous codes are used when a supplier is submitting a bill for an item prior to an existing code being assigned to adequately describe the item or service. They may also be used while a code is being considered. All miscellaneous codes will be manually reviewed and the following must be included when submitting a miscellaneous code:

• The item or service must be clearly described
• Pricing information
• Documentation explaining the reason for the service or item

Items Requiring Coding Verification Reviews

To avoid denials, be sure you verify with your supplier to determine if there is a more specific code that should be used. For coding questions contact the Pricing, Data Analysis, and Coding (PDAC) contractor to CMS. The PDAC is responsible for providing suppliers and manufacturers with assistance in determining which HCPCS code should be used to describe DMEPOS items for the purpose of billing Medicare. The PDAC has a toll-free helpline for this purpose, (877) 735-1326, Fax (803) 264-0648, or email. In addition, the PDAC publishes a product classification list on its website that lists individual items to code categories. More information about the PDAC and the PDAC’s product classification list can be found at dmepdac.com.

View the Code Verification Request Application Instructions webpage for application instructions and additional information.

• Application for Code Verification Review Form
• Reconsideration Form
• Additional Verification Information Form

• Section C/Product Specific
• DME Supplies
• Enteral Nutrition
• Manual Wheelchairs
• Orthosis
• Section C Power Wheelchairs and Power Operated Vehicles
• Support Surfaces
• Surgical Dressings
• Therapeutic Inserts
• Wheelchair Cushions (Backs and Seats)

• Manufacturer Name Change (PDF, 13 KB) - Attestation regarding Manufacturer name change resulting from a corporate merger/purchase
• Model Number Addition (PDF, 13 KB) - Attestation regarding addition of model numbers. Must print/submit on company letterhead. Submit product literature and effective begin date for new product(s)
• Private Label Agreement – Distributor Attestation (PDF, 16 KB) - Attestation Regarding Addition of New Manufacturer/Distributor Name Resulting from Private Label Agreement – Distributor Attestation
• Private Label Agreement – Manufacturer Attestation (PDF, 16 KB) - Attestation Regarding Addition of New Manufacturer/Distributor Name Resulting from Private Label Agreement – Manufacturer Attestation

References:
cms.gov HEALTHCARE COMMON PROCEDURE CODING SYSTEM
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