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Back to the blogJan 27, 2023

What Does HCPCS Stand for in Medical Billing?

What Does HCPCS Stand for in Medical Billing?

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The Healthcare Common Procedure Coding System or HCPCS is a collection of standardized codes produced by the Centers for Medicare and Medicaid Systems (CMS). As part of the annual release, CMS distributes code sets that detail the procedure and modifier codes with descriptions, coverage, and pricing that are able to be billed on a claim. Utilizing up-to-date HCPCS codes and making simple yet effective adjustments to your processes and templates can dramatically affect your revenue streams while improving your workflow.  

What is the Purpose of Healthcare Common Procedure Coding System Coding (HCPCS)?  

The HCPCS or Healthcare Common Procedure Coding System is a standardized coding system. These codes are used to indicate the supplies, medical procedures, products, and services medical coders process as part of a medical billing claim sent to health insurance companies.  

History of Healthcare Common Procedure Coding System Coding (HCPCS) 

The federal government created the HCPCS coding system in 1978 to standardize medical service reporting. As with most of these coding systems, though, it has evolved over the years. The adoption of the HCPCS was finally mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). 

Before the implementation of coding systems, healthcare providers submitted written descriptions for the treatments and services to the insurance providers for medical billing. The American Medical Association (AMA) developed the first coding system with the Current Procedural Terminology (CPT®) code set in 1966.  

CPT® codes are a component of Level I HCPCS. Level II HCPCS is focused on devices, products, and supplies. Level III HCPCS was a relatively short-lived coding system used for local, regional codes. Level III was discontinued in 2003 to support more consistent coding system standards.

What Is Level I HCPCS? 

Level I HCPCS features the CPT-4 coding system, used to identify medical procedures and services. These five-digit codes are used to represent the care and treatment provided to patients in the medical billing process.

What Is Level II HCPCS? 

Level II HCPCS was set up in the 1980s to represent medical devices, products, and supplies ordered as part of the patient's care and treatment. The codes might be for orthotics, prosthetics, or other supplies that patients will take home with them and use outside the office. As part of the medical billing process, the medical coder will need to include the ICD-10 diagnosis code to indicate why the device or supplies are needed based on the patient's diagnosis and demonstrated medical necessity.  

Level II HCPCS is dynamic. It could also include any home health equipment or devices for remote patient monitoring (RPM) or other healthcare management. Because of the nature of the Level II coding system, it also represents prescription drugs and non-physician services that are not currently covered by the Level I coding system.  

CMS also periodically releases coding cycle deadlines and modifications to the code set form. At TempDev, we can help you optimize your NextGen practice management and NextGen Electronic Health Records (EHRs) to better prepare you for the current and future demands of coding and submitting accurate medical claims when dealing with CMS and other insurance providers for your patients.  

With so much at stake for your organization, you can't afford for your revenue cycle to be peppered with high rates of late payments, denied claims, and other delays. That's why it's so important to have a firm understanding on medical coding, so you can submit accurate claims and get the best results from your revenue cycle process.  

How Can TempDev Help With Your Medical Billing System? 

TempDev offers consulting, templates, tools, and resources to support and optimize your practice management (PM) and electronic health records (EHRs) systems as part of your medical billing cycle. If you're struggling to manage your patients with your limited staffing, TempDev offers outsourcing best practices, training for medical billing specialists, and even temporary staffing solutions to get you through rough patches in your revenue cycle.  

We deliver the targeted solutions you need the most for your organization. With TempDev's TempBill, you'll tap into expert staff who will support your revenue cycle management. The many successes and rave reviews speak for themselves. Still, our focus is on offering the consulting, support, and services that will boost your current financial outlook and put you on a trajectory for success both now and in the future.  

Contact us here or call us a 888.TEMP.DEV To Get the Help You Need With Your Medical Billing System. 

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