Procedure codes are standard codes used to provide consistency when submitting claims to any health care insurer.
The Healthcare Common Procedure Coding System (HCPCS) was established in 1978. It is a standard code set that is used to provide this consistency and describes the specific items and services provided for health care. Its use was voluntary until the implementation of the Health Insurance Portability and Accountability Act of 1996 made it mandatory.
The HCPCS Code Set is divided into the following two subsystems:
Within the ND MMIS, the procedure tables contain HCPCS and Current Procedural Terminology (CPT) procedure code data, American Dental Association (ADA) dental procedure code data, and lab class data. Procedure in the Code Maintenance function of Rules Management allows you to maintain information about these codes.
Level I of the HCPCS code set is comprised of CPT. CPT is a uniform coding set that is updated on a quarterly basis consisting of descriptive terms and codes that are used to identify medical services and procedures provided by physicians and other health care professionals. These services and procedures are submitted on a claim which is sent to the health care insurer for payment.
Level I Code Set does not include codes that are needed to report medical items or services that are billed on a regular basis by suppliers not physicians.
The format for a HCPCS Level I Code Set is five numeric digits; for example: 90212.
The HCPCS Level I codes are reviewed and updated on a quarterly basis by the American Medical Association (AMA).
CPT codes are filed on claims for services and procedures done by:
Level II of the HCPCS code set is comprised of products, supplies, and services not included in Level I Code Set. These consists of ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). These are used by suppliers when submitting a claim. These suppliers are not located in a physician's office.
The format for a HCPCS Level II Code Set starts with a character followed by 4 numeric digits, e.g., C9728.
The HCPCS Level II Code Set is maintained and distributed by CMS, in conjunction with private payer organizations.
Procedure Code Page
About Procedure Code Batch Process
Version as of 5/16/14.
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