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HCPCS codes.

The Healthcare Common Procedure Coding System (HCPCS) codes are level II codes that provide practitioners with the terminology and other information needed to bill for some of the supplies and products we use during patient care (figure). (Level I codes are CPT codes.) Failure to use the correct HCPCS codes may result in claims denial.

The level II HCPCS codes were initially described on the Centers for Medicare and Medicaid Services' Web site ( as follows:

"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 1980s. Level II codes are also referred to as alphanumeric codes because they consist of a single alphabetical letter followed by 4 numeric digits, while CPT codes are identified using 5 numeric digits."

As time progressed, the currently used HCPCS codes were adopted for all supply billing because of the acceptance by most payers: "The regulation that CMS published on August 17, 2000 (45 CFR 162.10002) to implement the HIPAA requirement for standardized coding systems established the HCPCS level II codes as the standardized coding system for describing and identifying health care equipment and supplies in health care transactions that are not identified by the HCPCS level I, CPT codes. The HCPCS level II coding system was selected as the standardized coding system because of its wide acceptance among both public and private insurers." *

Some of the supplies you use might be reimbursable. Don't leave any potential reimbursement on the table, regardless of how small it may seem. They add up over time. To bill for such items, you will need a current HCPCS book. HCPCS codes (and regularly published updates) are available on the CMS provider Web site ( for downloading. The AMA sells the HCPCS publication to providers, and it is also available through many publication vendors.

* Dr. Isenberg is an otolaryngologist in private practice in Indianapolis;
Figure. Software shows four examples of paid reimbursements fbr three
CPT codes and one HCPCS code. For the bottom entry on this list (HCPCS
code J3301 2007 descriptor: injection, triamcinolone acetonide, per 10
mg), the physician was reimbursed $7.22 (the fees shown here are

(1-4 displayed of 4 total results)

Date of Proc/Rev Charge Paid Phy/Prov Not Remark
Service Code Amount Amount Adj/Disc Covered Code

01/05/2007 312310 300.00 125.00 150.00 0.00 D1
01/05/2007 302000 150.00 52.50 97.50 0.00 EC
01/05/2007 99213 85.00 58.00 27.00 0.00 D1
01/05/2007 J3301 44.00 7.22 36.78 0.00 D1

Date of Copay/ Paitent Plan Denied
Service Deduct Responsibility Reserve Coverage Date

01/05/2007 25.00 0.00 0.00 100% N/A
01/05/2007 0.00 0.00 0.00 100% N/A
01/05/2007 0.00 0.00 0.00 100% N/A
01/05/2007 0.00 0.00 0.00 100% N/A

Date of Check Check Description
Service Date Number ICD9 of Service

01/05/2007 01/12/2007 0713154500 470 SURGERY
01/05/2007 01/12/2007 0713154500 470 SURGERY
01/05/2007 01/12/2007 0713154500 470 OFFICE V
01/05/2007 01/12/2007 0713154500 470 PRESCRIP
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Article Details
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Author:Isenberg, Steven F.
Publication:Ear, Nose and Throat Journal
Date:Jun 1, 2007
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