code
stringlengths 4
12
| description
stringlengths 2
264
| codetype
stringclasses 8
values | context
stringlengths 160
15.5k
|
|---|---|---|---|
G0416 | SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATIONS, FOR PROSTATE NEEDLE BIOPSY, ANY METHOD | HCPCS | - 4th digit of “1” defines lower urinary tract symptoms (LUTS), and directs the coder to use an additional code for the associated symptoms, when specified. - R33 is the primary descriptor for retention of urine. - 4th digit of “8” defines the urinary retention as “Other”, and includes an instructional note to code first, if applicable, any causal condition such as: enlarged prostate (N40.1). CPT Codes & Guideline for Coding
- HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. - “Medicare has decided to combine reporting of prostate biopsies regardless of number of specimens under revised code G0416. |
G0419 | Sat biopsy prostate: >60 | CPT | - 4th digit of “1” defines lower urinary tract symptoms (LUTS), and directs the coder to use an additional code for the associated symptoms, when specified. - R33 is the primary descriptor for retention of urine. - 4th digit of “8” defines the urinary retention as “Other”, and includes an instructional note to code first, if applicable, any causal condition such as: enlarged prostate (N40.1). CPT Codes & Guideline for Coding
- HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. - “Medicare has decided to combine reporting of prostate biopsies regardless of number of specimens under revised code G0416. |
88305 | Tissue exam by pathologist | HCPCS | - R33 is the primary descriptor for retention of urine. - 4th digit of “8” defines the urinary retention as “Other”, and includes an instructional note to code first, if applicable, any causal condition such as: enlarged prostate (N40.1). CPT Codes & Guideline for Coding
- HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. - “Medicare has decided to combine reporting of prostate biopsies regardless of number of specimens under revised code G0416. 88305 should not be used for the analyses of prostate biopsies for Medicare patients with dates of service on or after Jan. 1, 2015.”
Prostate biopsies were “separated” from other surgical specimens listed in 88305, even though they are still listed in the CPT code for 2015. |
G0416 | SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATIONS, FOR PROSTATE NEEDLE BIOPSY, ANY METHOD | HCPCS | - R33 is the primary descriptor for retention of urine. - 4th digit of “8” defines the urinary retention as “Other”, and includes an instructional note to code first, if applicable, any causal condition such as: enlarged prostate (N40.1). CPT Codes & Guideline for Coding
- HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. - “Medicare has decided to combine reporting of prostate biopsies regardless of number of specimens under revised code G0416. 88305 should not be used for the analyses of prostate biopsies for Medicare patients with dates of service on or after Jan. 1, 2015.”
Prostate biopsies were “separated” from other surgical specimens listed in 88305, even though they are still listed in the CPT code for 2015. |
G0419 | Sat biopsy prostate: >60 | CPT | - R33 is the primary descriptor for retention of urine. - 4th digit of “8” defines the urinary retention as “Other”, and includes an instructional note to code first, if applicable, any causal condition such as: enlarged prostate (N40.1). CPT Codes & Guideline for Coding
- HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. - “Medicare has decided to combine reporting of prostate biopsies regardless of number of specimens under revised code G0416. 88305 should not be used for the analyses of prostate biopsies for Medicare patients with dates of service on or after Jan. 1, 2015.”
Prostate biopsies were “separated” from other surgical specimens listed in 88305, even though they are still listed in the CPT code for 2015. |
88305 | Tissue exam by pathologist | HCPCS | - 4th digit of “8” defines the urinary retention as “Other”, and includes an instructional note to code first, if applicable, any causal condition such as: enlarged prostate (N40.1). CPT Codes & Guideline for Coding
- HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. - “Medicare has decided to combine reporting of prostate biopsies regardless of number of specimens under revised code G0416. 88305 should not be used for the analyses of prostate biopsies for Medicare patients with dates of service on or after Jan. 1, 2015.”
Prostate biopsies were “separated” from other surgical specimens listed in 88305, even though they are still listed in the CPT code for 2015. Medicare no longer pays 88305 for prostate needle biopsies. |
G0416 | SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATIONS, FOR PROSTATE NEEDLE BIOPSY, ANY METHOD | HCPCS | - 4th digit of “8” defines the urinary retention as “Other”, and includes an instructional note to code first, if applicable, any causal condition such as: enlarged prostate (N40.1). CPT Codes & Guideline for Coding
- HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. - “Medicare has decided to combine reporting of prostate biopsies regardless of number of specimens under revised code G0416. 88305 should not be used for the analyses of prostate biopsies for Medicare patients with dates of service on or after Jan. 1, 2015.”
Prostate biopsies were “separated” from other surgical specimens listed in 88305, even though they are still listed in the CPT code for 2015. Medicare no longer pays 88305 for prostate needle biopsies. |
G0419 | Sat biopsy prostate: >60 | CPT | - 4th digit of “8” defines the urinary retention as “Other”, and includes an instructional note to code first, if applicable, any causal condition such as: enlarged prostate (N40.1). CPT Codes & Guideline for Coding
- HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. - “Medicare has decided to combine reporting of prostate biopsies regardless of number of specimens under revised code G0416. 88305 should not be used for the analyses of prostate biopsies for Medicare patients with dates of service on or after Jan. 1, 2015.”
Prostate biopsies were “separated” from other surgical specimens listed in 88305, even though they are still listed in the CPT code for 2015. Medicare no longer pays 88305 for prostate needle biopsies. |
88305 | Tissue exam by pathologist | HCPCS | CPT Codes & Guideline for Coding
- HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. - “Medicare has decided to combine reporting of prostate biopsies regardless of number of specimens under revised code G0416. 88305 should not be used for the analyses of prostate biopsies for Medicare patients with dates of service on or after Jan. 1, 2015.”
Prostate biopsies were “separated” from other surgical specimens listed in 88305, even though they are still listed in the CPT code for 2015. Medicare no longer pays 88305 for prostate needle biopsies. G0416 is now the appropriate code for all prostate needle biopsies regardless of the number of biopsies/cores. |
G0416 | SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATIONS, FOR PROSTATE NEEDLE BIOPSY, ANY METHOD | HCPCS | CPT Codes & Guideline for Coding
- HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. - “Medicare has decided to combine reporting of prostate biopsies regardless of number of specimens under revised code G0416. 88305 should not be used for the analyses of prostate biopsies for Medicare patients with dates of service on or after Jan. 1, 2015.”
Prostate biopsies were “separated” from other surgical specimens listed in 88305, even though they are still listed in the CPT code for 2015. Medicare no longer pays 88305 for prostate needle biopsies. G0416 is now the appropriate code for all prostate needle biopsies regardless of the number of biopsies/cores. |
G0419 | Sat biopsy prostate: >60 | CPT | CPT Codes & Guideline for Coding
- HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. - “Medicare has decided to combine reporting of prostate biopsies regardless of number of specimens under revised code G0416. 88305 should not be used for the analyses of prostate biopsies for Medicare patients with dates of service on or after Jan. 1, 2015.”
Prostate biopsies were “separated” from other surgical specimens listed in 88305, even though they are still listed in the CPT code for 2015. Medicare no longer pays 88305 for prostate needle biopsies. G0416 is now the appropriate code for all prostate needle biopsies regardless of the number of biopsies/cores. |
G0417 | Sat biopsy prostate 21-40 | CPT | 88305 should not be used for the analyses of prostate biopsies for Medicare patients with dates of service on or after Jan. 1, 2015.”
Prostate biopsies were “separated” from other surgical specimens listed in 88305, even though they are still listed in the CPT code for 2015. Medicare no longer pays 88305 for prostate needle biopsies. G0416 is now the appropriate code for all prostate needle biopsies regardless of the number of biopsies/cores. G0416– Surgical pathology, gross and micro exam for prostate needle saturation biopsy sampling 1-20 specimens. G0417- ” 21-40 specimens. |
G0416 | SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATIONS, FOR PROSTATE NEEDLE BIOPSY, ANY METHOD | HCPCS | G0418- ” 41-60 specimens. G0419- ” greater than 60 specimens. NOTE : G0416 to Medicare for TURP specimens. However, per the code descriptor, (Surgical pathology, gross and microscopic examinations for prostate needle biopsy, any method), G0416 is specific to needle core biopsy samples, and not appropriate for TURP specimens. As of January 1, 2012 CMS has issued new guidance in the NCCI Policy Manual regarding these HCPCS codes. |
G0416 | SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATIONS, FOR PROSTATE NEEDLE BIOPSY, ANY METHOD | HCPCS | G0419- ” greater than 60 specimens. NOTE : G0416 to Medicare for TURP specimens. However, per the code descriptor, (Surgical pathology, gross and microscopic examinations for prostate needle biopsy, any method), G0416 is specific to needle core biopsy samples, and not appropriate for TURP specimens. As of January 1, 2012 CMS has issued new guidance in the NCCI Policy Manual regarding these HCPCS codes. It states:
HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. |
88305 | Tissue exam by pathologist | HCPCS | NOTE : G0416 to Medicare for TURP specimens. However, per the code descriptor, (Surgical pathology, gross and microscopic examinations for prostate needle biopsy, any method), G0416 is specific to needle core biopsy samples, and not appropriate for TURP specimens. As of January 1, 2012 CMS has issued new guidance in the NCCI Policy Manual regarding these HCPCS codes. It states:
HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. CMS requires that these codes rather than CPT code 88305 be utilised to report surgical pathology on prostate needle biopsy specimens only if the number of separately identified needle biopsy specimens is five or more. |
G0416 | SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATIONS, FOR PROSTATE NEEDLE BIOPSY, ANY METHOD | HCPCS | NOTE : G0416 to Medicare for TURP specimens. However, per the code descriptor, (Surgical pathology, gross and microscopic examinations for prostate needle biopsy, any method), G0416 is specific to needle core biopsy samples, and not appropriate for TURP specimens. As of January 1, 2012 CMS has issued new guidance in the NCCI Policy Manual regarding these HCPCS codes. It states:
HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. CMS requires that these codes rather than CPT code 88305 be utilised to report surgical pathology on prostate needle biopsy specimens only if the number of separately identified needle biopsy specimens is five or more. |
G0419 | Sat biopsy prostate: >60 | CPT | NOTE : G0416 to Medicare for TURP specimens. However, per the code descriptor, (Surgical pathology, gross and microscopic examinations for prostate needle biopsy, any method), G0416 is specific to needle core biopsy samples, and not appropriate for TURP specimens. As of January 1, 2012 CMS has issued new guidance in the NCCI Policy Manual regarding these HCPCS codes. It states:
HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. CMS requires that these codes rather than CPT code 88305 be utilised to report surgical pathology on prostate needle biopsy specimens only if the number of separately identified needle biopsy specimens is five or more. |
88305 | Tissue exam by pathologist | HCPCS | However, per the code descriptor, (Surgical pathology, gross and microscopic examinations for prostate needle biopsy, any method), G0416 is specific to needle core biopsy samples, and not appropriate for TURP specimens. As of January 1, 2012 CMS has issued new guidance in the NCCI Policy Manual regarding these HCPCS codes. It states:
HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. CMS requires that these codes rather than CPT code 88305 be utilised to report surgical pathology on prostate needle biopsy specimens only if the number of separately identified needle biopsy specimens is five or more. Surgical pathology on four or fewer prostate needle biopsy specimens should be reported with CPT code 88305 with the unit of service corresponding to the number of separately identified biopsy specimens. |
G0416 | SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATIONS, FOR PROSTATE NEEDLE BIOPSY, ANY METHOD | HCPCS | However, per the code descriptor, (Surgical pathology, gross and microscopic examinations for prostate needle biopsy, any method), G0416 is specific to needle core biopsy samples, and not appropriate for TURP specimens. As of January 1, 2012 CMS has issued new guidance in the NCCI Policy Manual regarding these HCPCS codes. It states:
HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. CMS requires that these codes rather than CPT code 88305 be utilised to report surgical pathology on prostate needle biopsy specimens only if the number of separately identified needle biopsy specimens is five or more. Surgical pathology on four or fewer prostate needle biopsy specimens should be reported with CPT code 88305 with the unit of service corresponding to the number of separately identified biopsy specimens. |
G0419 | Sat biopsy prostate: >60 | CPT | However, per the code descriptor, (Surgical pathology, gross and microscopic examinations for prostate needle biopsy, any method), G0416 is specific to needle core biopsy samples, and not appropriate for TURP specimens. As of January 1, 2012 CMS has issued new guidance in the NCCI Policy Manual regarding these HCPCS codes. It states:
HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. CMS requires that these codes rather than CPT code 88305 be utilised to report surgical pathology on prostate needle biopsy specimens only if the number of separately identified needle biopsy specimens is five or more. Surgical pathology on four or fewer prostate needle biopsy specimens should be reported with CPT code 88305 with the unit of service corresponding to the number of separately identified biopsy specimens. |
88305 | Tissue exam by pathologist | HCPCS | As of January 1, 2012 CMS has issued new guidance in the NCCI Policy Manual regarding these HCPCS codes. It states:
HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. CMS requires that these codes rather than CPT code 88305 be utilised to report surgical pathology on prostate needle biopsy specimens only if the number of separately identified needle biopsy specimens is five or more. Surgical pathology on four or fewer prostate needle biopsy specimens should be reported with CPT code 88305 with the unit of service corresponding to the number of separately identified biopsy specimens. The Medicare Physician Fee Schedule National Payment Amount for G0416-26 is $182.10 which is equivalent to 5 units of 88305-26 which has a National Payment Amount of $36.08 per unit. |
G0416 | SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATIONS, FOR PROSTATE NEEDLE BIOPSY, ANY METHOD | HCPCS | As of January 1, 2012 CMS has issued new guidance in the NCCI Policy Manual regarding these HCPCS codes. It states:
HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. CMS requires that these codes rather than CPT code 88305 be utilised to report surgical pathology on prostate needle biopsy specimens only if the number of separately identified needle biopsy specimens is five or more. Surgical pathology on four or fewer prostate needle biopsy specimens should be reported with CPT code 88305 with the unit of service corresponding to the number of separately identified biopsy specimens. The Medicare Physician Fee Schedule National Payment Amount for G0416-26 is $182.10 which is equivalent to 5 units of 88305-26 which has a National Payment Amount of $36.08 per unit. |
G0419 | Sat biopsy prostate: >60 | CPT | As of January 1, 2012 CMS has issued new guidance in the NCCI Policy Manual regarding these HCPCS codes. It states:
HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. CMS requires that these codes rather than CPT code 88305 be utilised to report surgical pathology on prostate needle biopsy specimens only if the number of separately identified needle biopsy specimens is five or more. Surgical pathology on four or fewer prostate needle biopsy specimens should be reported with CPT code 88305 with the unit of service corresponding to the number of separately identified biopsy specimens. The Medicare Physician Fee Schedule National Payment Amount for G0416-26 is $182.10 which is equivalent to 5 units of 88305-26 which has a National Payment Amount of $36.08 per unit. |
88305 | Tissue exam by pathologist | HCPCS | It states:
HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. CMS requires that these codes rather than CPT code 88305 be utilised to report surgical pathology on prostate needle biopsy specimens only if the number of separately identified needle biopsy specimens is five or more. Surgical pathology on four or fewer prostate needle biopsy specimens should be reported with CPT code 88305 with the unit of service corresponding to the number of separately identified biopsy specimens. The Medicare Physician Fee Schedule National Payment Amount for G0416-26 is $182.10 which is equivalent to 5 units of 88305-26 which has a National Payment Amount of $36.08 per unit. For a physician practice that typically bills for more than 6 specimens for a prostate case, you will see reimbursement capped at 5.0 units. |
G0416 | SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATIONS, FOR PROSTATE NEEDLE BIOPSY, ANY METHOD | HCPCS | It states:
HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. CMS requires that these codes rather than CPT code 88305 be utilised to report surgical pathology on prostate needle biopsy specimens only if the number of separately identified needle biopsy specimens is five or more. Surgical pathology on four or fewer prostate needle biopsy specimens should be reported with CPT code 88305 with the unit of service corresponding to the number of separately identified biopsy specimens. The Medicare Physician Fee Schedule National Payment Amount for G0416-26 is $182.10 which is equivalent to 5 units of 88305-26 which has a National Payment Amount of $36.08 per unit. For a physician practice that typically bills for more than 6 specimens for a prostate case, you will see reimbursement capped at 5.0 units. |
G0419 | Sat biopsy prostate: >60 | CPT | It states:
HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. CMS requires that these codes rather than CPT code 88305 be utilised to report surgical pathology on prostate needle biopsy specimens only if the number of separately identified needle biopsy specimens is five or more. Surgical pathology on four or fewer prostate needle biopsy specimens should be reported with CPT code 88305 with the unit of service corresponding to the number of separately identified biopsy specimens. The Medicare Physician Fee Schedule National Payment Amount for G0416-26 is $182.10 which is equivalent to 5 units of 88305-26 which has a National Payment Amount of $36.08 per unit. For a physician practice that typically bills for more than 6 specimens for a prostate case, you will see reimbursement capped at 5.0 units. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | - Why are CPT® codes also called HCPCS Level I codes? - Why are HCPCS Level II codes, which appear to represent everything but routine medical procedures, considered a national procedure code set? To understand the answers to these questions and gain a better grasp of HCPCS coding, you need to know how these two code sets came into existence. History of HCPCS Coding
The history of HCPCS coding began in 1978 when the federal government created this coding system to standardize the reporting of medical services to the federal government for reimbursement. The HCPCS system, however, underwent several changes before adoption by commercial payers, which was eventually mandated by HIPAA in 1996. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | - Why are HCPCS Level II codes, which appear to represent everything but routine medical procedures, considered a national procedure code set? To understand the answers to these questions and gain a better grasp of HCPCS coding, you need to know how these two code sets came into existence. History of HCPCS Coding
The history of HCPCS coding began in 1978 when the federal government created this coding system to standardize the reporting of medical services to the federal government for reimbursement. The HCPCS system, however, underwent several changes before adoption by commercial payers, which was eventually mandated by HIPAA in 1996. Prior to the advent of procedure coding, providers submitted written descriptions of the services they performed to payers for reimbursement. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | To understand the answers to these questions and gain a better grasp of HCPCS coding, you need to know how these two code sets came into existence. History of HCPCS Coding
The history of HCPCS coding began in 1978 when the federal government created this coding system to standardize the reporting of medical services to the federal government for reimbursement. The HCPCS system, however, underwent several changes before adoption by commercial payers, which was eventually mandated by HIPAA in 1996. Prior to the advent of procedure coding, providers submitted written descriptions of the services they performed to payers for reimbursement. This proved inefficient, in that 100 providers could report the same service with 100 different descriptions. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | The HCPCS system, however, underwent several changes before adoption by commercial payers, which was eventually mandated by HIPAA in 1996. Prior to the advent of procedure coding, providers submitted written descriptions of the services they performed to payers for reimbursement. This proved inefficient, in that 100 providers could report the same service with 100 different descriptions. The American Medical Association (AMA) was the first to tackle the problem. In efforts to standardize reporting of medical, surgical, and diagnostic services and procedures, the association created a coding system and introduced CPT® in 1966. |
J9355 | trastuzumab per 10 mg | HCPCS | HCPCS At A Glance
Among medical code sets—ICD-10, CPT®, and HCPCS Level II—HCPCS Level II is the most dynamic. CMS updates HCPCS Level II codes throughout the year, based on factors that include public input and feedback from providers, manufacturers, vendors, specialty societies, Blue Cross, and others. Further distinctions between CPT® codes (HCPCS Level I) and HCPCS Level II codes include:
||Period in Use
||Frequency of Updates
|HCPCS Level I: Current Procedural Terminology, Fourth Edition
||Procedures and services provided by physicians and other allied healthcare professionals
||5 numeric characters; some codes with a fifth alpha character
||1966 to present
||Yearly, in late summer or early fall for Jan. 1 implementation; some codes updated on Jan. 1 and July 1 for use six months later
|HCPCS Level II: National Healthcare Common Procedure Coding System
||Drugs, supplies, equipment, non-physician services and services not represented in CPT®
||5 characters, beginning with a letter and followed by 4 numbers
||1983 to present
||Yearly updates of the permanent code set, with quarterly updates of temporary codes
Structure of Level II HCPCS Codes
All HCPCS Level II codes consist of five characters, beginning with a letter—A through V—and followed by four numeric digits. The letter that begins the HCPCS Level II code represents the code chapter to which the HCPCS code belongs, thereby grouping similar items together. Some examples of HCPCS Level II codes include:
- J9355 — Injection, trastuzumab, excludes biosimilar, 10 mg
- G9631 — Patient sustained ureter injury at the time of surgery or discovered subsequently up to 30 days post-surgery
- C1823 — Generator, neurostimulator (implantable), non-rechargeable, with transvenous sensing and stimulation leads
- V2599 — Contact lens, other type
The codes in each HCPCS code range are categorically referred to by the letter they begin with. |
V2599 | HB=CONTACT LENS SYNERGEYES ULTRAHEALTH PER LENS | HCPCS | HCPCS At A Glance
Among medical code sets—ICD-10, CPT®, and HCPCS Level II—HCPCS Level II is the most dynamic. CMS updates HCPCS Level II codes throughout the year, based on factors that include public input and feedback from providers, manufacturers, vendors, specialty societies, Blue Cross, and others. Further distinctions between CPT® codes (HCPCS Level I) and HCPCS Level II codes include:
||Period in Use
||Frequency of Updates
|HCPCS Level I: Current Procedural Terminology, Fourth Edition
||Procedures and services provided by physicians and other allied healthcare professionals
||5 numeric characters; some codes with a fifth alpha character
||1966 to present
||Yearly, in late summer or early fall for Jan. 1 implementation; some codes updated on Jan. 1 and July 1 for use six months later
|HCPCS Level II: National Healthcare Common Procedure Coding System
||Drugs, supplies, equipment, non-physician services and services not represented in CPT®
||5 characters, beginning with a letter and followed by 4 numbers
||1983 to present
||Yearly updates of the permanent code set, with quarterly updates of temporary codes
Structure of Level II HCPCS Codes
All HCPCS Level II codes consist of five characters, beginning with a letter—A through V—and followed by four numeric digits. The letter that begins the HCPCS Level II code represents the code chapter to which the HCPCS code belongs, thereby grouping similar items together. Some examples of HCPCS Level II codes include:
- J9355 — Injection, trastuzumab, excludes biosimilar, 10 mg
- G9631 — Patient sustained ureter injury at the time of surgery or discovered subsequently up to 30 days post-surgery
- C1823 — Generator, neurostimulator (implantable), non-rechargeable, with transvenous sensing and stimulation leads
- V2599 — Contact lens, other type
The codes in each HCPCS code range are categorically referred to by the letter they begin with. |
C1823 | LEAD STIMULATION RESPISTIM R 20MMX50CM REMEDE | HCPCS | HCPCS At A Glance
Among medical code sets—ICD-10, CPT®, and HCPCS Level II—HCPCS Level II is the most dynamic. CMS updates HCPCS Level II codes throughout the year, based on factors that include public input and feedback from providers, manufacturers, vendors, specialty societies, Blue Cross, and others. Further distinctions between CPT® codes (HCPCS Level I) and HCPCS Level II codes include:
||Period in Use
||Frequency of Updates
|HCPCS Level I: Current Procedural Terminology, Fourth Edition
||Procedures and services provided by physicians and other allied healthcare professionals
||5 numeric characters; some codes with a fifth alpha character
||1966 to present
||Yearly, in late summer or early fall for Jan. 1 implementation; some codes updated on Jan. 1 and July 1 for use six months later
|HCPCS Level II: National Healthcare Common Procedure Coding System
||Drugs, supplies, equipment, non-physician services and services not represented in CPT®
||5 characters, beginning with a letter and followed by 4 numbers
||1983 to present
||Yearly updates of the permanent code set, with quarterly updates of temporary codes
Structure of Level II HCPCS Codes
All HCPCS Level II codes consist of five characters, beginning with a letter—A through V—and followed by four numeric digits. The letter that begins the HCPCS Level II code represents the code chapter to which the HCPCS code belongs, thereby grouping similar items together. Some examples of HCPCS Level II codes include:
- J9355 — Injection, trastuzumab, excludes biosimilar, 10 mg
- G9631 — Patient sustained ureter injury at the time of surgery or discovered subsequently up to 30 days post-surgery
- C1823 — Generator, neurostimulator (implantable), non-rechargeable, with transvenous sensing and stimulation leads
- V2599 — Contact lens, other type
The codes in each HCPCS code range are categorically referred to by the letter they begin with. |
J9355 | trastuzumab per 10 mg | HCPCS | CMS updates HCPCS Level II codes throughout the year, based on factors that include public input and feedback from providers, manufacturers, vendors, specialty societies, Blue Cross, and others. Further distinctions between CPT® codes (HCPCS Level I) and HCPCS Level II codes include:
||Period in Use
||Frequency of Updates
|HCPCS Level I: Current Procedural Terminology, Fourth Edition
||Procedures and services provided by physicians and other allied healthcare professionals
||5 numeric characters; some codes with a fifth alpha character
||1966 to present
||Yearly, in late summer or early fall for Jan. 1 implementation; some codes updated on Jan. 1 and July 1 for use six months later
|HCPCS Level II: National Healthcare Common Procedure Coding System
||Drugs, supplies, equipment, non-physician services and services not represented in CPT®
||5 characters, beginning with a letter and followed by 4 numbers
||1983 to present
||Yearly updates of the permanent code set, with quarterly updates of temporary codes
Structure of Level II HCPCS Codes
All HCPCS Level II codes consist of five characters, beginning with a letter—A through V—and followed by four numeric digits. The letter that begins the HCPCS Level II code represents the code chapter to which the HCPCS code belongs, thereby grouping similar items together. Some examples of HCPCS Level II codes include:
- J9355 — Injection, trastuzumab, excludes biosimilar, 10 mg
- G9631 — Patient sustained ureter injury at the time of surgery or discovered subsequently up to 30 days post-surgery
- C1823 — Generator, neurostimulator (implantable), non-rechargeable, with transvenous sensing and stimulation leads
- V2599 — Contact lens, other type
The codes in each HCPCS code range are categorically referred to by the letter they begin with. For example, codes beginning with the letter J—used to report non-orally administered medication and chemotherapy drugs—are called J codes. |
V2599 | HB=CONTACT LENS SYNERGEYES ULTRAHEALTH PER LENS | HCPCS | CMS updates HCPCS Level II codes throughout the year, based on factors that include public input and feedback from providers, manufacturers, vendors, specialty societies, Blue Cross, and others. Further distinctions between CPT® codes (HCPCS Level I) and HCPCS Level II codes include:
||Period in Use
||Frequency of Updates
|HCPCS Level I: Current Procedural Terminology, Fourth Edition
||Procedures and services provided by physicians and other allied healthcare professionals
||5 numeric characters; some codes with a fifth alpha character
||1966 to present
||Yearly, in late summer or early fall for Jan. 1 implementation; some codes updated on Jan. 1 and July 1 for use six months later
|HCPCS Level II: National Healthcare Common Procedure Coding System
||Drugs, supplies, equipment, non-physician services and services not represented in CPT®
||5 characters, beginning with a letter and followed by 4 numbers
||1983 to present
||Yearly updates of the permanent code set, with quarterly updates of temporary codes
Structure of Level II HCPCS Codes
All HCPCS Level II codes consist of five characters, beginning with a letter—A through V—and followed by four numeric digits. The letter that begins the HCPCS Level II code represents the code chapter to which the HCPCS code belongs, thereby grouping similar items together. Some examples of HCPCS Level II codes include:
- J9355 — Injection, trastuzumab, excludes biosimilar, 10 mg
- G9631 — Patient sustained ureter injury at the time of surgery or discovered subsequently up to 30 days post-surgery
- C1823 — Generator, neurostimulator (implantable), non-rechargeable, with transvenous sensing and stimulation leads
- V2599 — Contact lens, other type
The codes in each HCPCS code range are categorically referred to by the letter they begin with. For example, codes beginning with the letter J—used to report non-orally administered medication and chemotherapy drugs—are called J codes. |
C1823 | LEAD STIMULATION RESPISTIM R 20MMX50CM REMEDE | HCPCS | CMS updates HCPCS Level II codes throughout the year, based on factors that include public input and feedback from providers, manufacturers, vendors, specialty societies, Blue Cross, and others. Further distinctions between CPT® codes (HCPCS Level I) and HCPCS Level II codes include:
||Period in Use
||Frequency of Updates
|HCPCS Level I: Current Procedural Terminology, Fourth Edition
||Procedures and services provided by physicians and other allied healthcare professionals
||5 numeric characters; some codes with a fifth alpha character
||1966 to present
||Yearly, in late summer or early fall for Jan. 1 implementation; some codes updated on Jan. 1 and July 1 for use six months later
|HCPCS Level II: National Healthcare Common Procedure Coding System
||Drugs, supplies, equipment, non-physician services and services not represented in CPT®
||5 characters, beginning with a letter and followed by 4 numbers
||1983 to present
||Yearly updates of the permanent code set, with quarterly updates of temporary codes
Structure of Level II HCPCS Codes
All HCPCS Level II codes consist of five characters, beginning with a letter—A through V—and followed by four numeric digits. The letter that begins the HCPCS Level II code represents the code chapter to which the HCPCS code belongs, thereby grouping similar items together. Some examples of HCPCS Level II codes include:
- J9355 — Injection, trastuzumab, excludes biosimilar, 10 mg
- G9631 — Patient sustained ureter injury at the time of surgery or discovered subsequently up to 30 days post-surgery
- C1823 — Generator, neurostimulator (implantable), non-rechargeable, with transvenous sensing and stimulation leads
- V2599 — Contact lens, other type
The codes in each HCPCS code range are categorically referred to by the letter they begin with. For example, codes beginning with the letter J—used to report non-orally administered medication and chemotherapy drugs—are called J codes. |
J9355 | trastuzumab per 10 mg | HCPCS | Further distinctions between CPT® codes (HCPCS Level I) and HCPCS Level II codes include:
||Period in Use
||Frequency of Updates
|HCPCS Level I: Current Procedural Terminology, Fourth Edition
||Procedures and services provided by physicians and other allied healthcare professionals
||5 numeric characters; some codes with a fifth alpha character
||1966 to present
||Yearly, in late summer or early fall for Jan. 1 implementation; some codes updated on Jan. 1 and July 1 for use six months later
|HCPCS Level II: National Healthcare Common Procedure Coding System
||Drugs, supplies, equipment, non-physician services and services not represented in CPT®
||5 characters, beginning with a letter and followed by 4 numbers
||1983 to present
||Yearly updates of the permanent code set, with quarterly updates of temporary codes
Structure of Level II HCPCS Codes
All HCPCS Level II codes consist of five characters, beginning with a letter—A through V—and followed by four numeric digits. The letter that begins the HCPCS Level II code represents the code chapter to which the HCPCS code belongs, thereby grouping similar items together. Some examples of HCPCS Level II codes include:
- J9355 — Injection, trastuzumab, excludes biosimilar, 10 mg
- G9631 — Patient sustained ureter injury at the time of surgery or discovered subsequently up to 30 days post-surgery
- C1823 — Generator, neurostimulator (implantable), non-rechargeable, with transvenous sensing and stimulation leads
- V2599 — Contact lens, other type
The codes in each HCPCS code range are categorically referred to by the letter they begin with. For example, codes beginning with the letter J—used to report non-orally administered medication and chemotherapy drugs—are called J codes. Incidentally, J codes are among the most commonly reported codes in the HCPCS Level II code set. |
V2599 | HB=CONTACT LENS SYNERGEYES ULTRAHEALTH PER LENS | HCPCS | Further distinctions between CPT® codes (HCPCS Level I) and HCPCS Level II codes include:
||Period in Use
||Frequency of Updates
|HCPCS Level I: Current Procedural Terminology, Fourth Edition
||Procedures and services provided by physicians and other allied healthcare professionals
||5 numeric characters; some codes with a fifth alpha character
||1966 to present
||Yearly, in late summer or early fall for Jan. 1 implementation; some codes updated on Jan. 1 and July 1 for use six months later
|HCPCS Level II: National Healthcare Common Procedure Coding System
||Drugs, supplies, equipment, non-physician services and services not represented in CPT®
||5 characters, beginning with a letter and followed by 4 numbers
||1983 to present
||Yearly updates of the permanent code set, with quarterly updates of temporary codes
Structure of Level II HCPCS Codes
All HCPCS Level II codes consist of five characters, beginning with a letter—A through V—and followed by four numeric digits. The letter that begins the HCPCS Level II code represents the code chapter to which the HCPCS code belongs, thereby grouping similar items together. Some examples of HCPCS Level II codes include:
- J9355 — Injection, trastuzumab, excludes biosimilar, 10 mg
- G9631 — Patient sustained ureter injury at the time of surgery or discovered subsequently up to 30 days post-surgery
- C1823 — Generator, neurostimulator (implantable), non-rechargeable, with transvenous sensing and stimulation leads
- V2599 — Contact lens, other type
The codes in each HCPCS code range are categorically referred to by the letter they begin with. For example, codes beginning with the letter J—used to report non-orally administered medication and chemotherapy drugs—are called J codes. Incidentally, J codes are among the most commonly reported codes in the HCPCS Level II code set. |
C1823 | LEAD STIMULATION RESPISTIM R 20MMX50CM REMEDE | HCPCS | Further distinctions between CPT® codes (HCPCS Level I) and HCPCS Level II codes include:
||Period in Use
||Frequency of Updates
|HCPCS Level I: Current Procedural Terminology, Fourth Edition
||Procedures and services provided by physicians and other allied healthcare professionals
||5 numeric characters; some codes with a fifth alpha character
||1966 to present
||Yearly, in late summer or early fall for Jan. 1 implementation; some codes updated on Jan. 1 and July 1 for use six months later
|HCPCS Level II: National Healthcare Common Procedure Coding System
||Drugs, supplies, equipment, non-physician services and services not represented in CPT®
||5 characters, beginning with a letter and followed by 4 numbers
||1983 to present
||Yearly updates of the permanent code set, with quarterly updates of temporary codes
Structure of Level II HCPCS Codes
All HCPCS Level II codes consist of five characters, beginning with a letter—A through V—and followed by four numeric digits. The letter that begins the HCPCS Level II code represents the code chapter to which the HCPCS code belongs, thereby grouping similar items together. Some examples of HCPCS Level II codes include:
- J9355 — Injection, trastuzumab, excludes biosimilar, 10 mg
- G9631 — Patient sustained ureter injury at the time of surgery or discovered subsequently up to 30 days post-surgery
- C1823 — Generator, neurostimulator (implantable), non-rechargeable, with transvenous sensing and stimulation leads
- V2599 — Contact lens, other type
The codes in each HCPCS code range are categorically referred to by the letter they begin with. For example, codes beginning with the letter J—used to report non-orally administered medication and chemotherapy drugs—are called J codes. Incidentally, J codes are among the most commonly reported codes in the HCPCS Level II code set. |
J9355 | trastuzumab per 10 mg | HCPCS | Some examples of HCPCS Level II codes include:
- J9355 — Injection, trastuzumab, excludes biosimilar, 10 mg
- G9631 — Patient sustained ureter injury at the time of surgery or discovered subsequently up to 30 days post-surgery
- C1823 — Generator, neurostimulator (implantable), non-rechargeable, with transvenous sensing and stimulation leads
- V2599 — Contact lens, other type
The codes in each HCPCS code range are categorically referred to by the letter they begin with. For example, codes beginning with the letter J—used to report non-orally administered medication and chemotherapy drugs—are called J codes. Incidentally, J codes are among the most commonly reported codes in the HCPCS Level II code set. HCPCS CODES RANGE
How HCPCS Level II Codes Are Used
HCPCS Level II codes report what a provider used during a service provided to a patient to treat or assess a given diagnosis. As such, HCPCS codes are used in conjunction with CPT® and ICD-10 codes, as these three code sets are interdependent and come together in medical coding and billing, often in a single claim. |
V2599 | HB=CONTACT LENS SYNERGEYES ULTRAHEALTH PER LENS | HCPCS | Some examples of HCPCS Level II codes include:
- J9355 — Injection, trastuzumab, excludes biosimilar, 10 mg
- G9631 — Patient sustained ureter injury at the time of surgery or discovered subsequently up to 30 days post-surgery
- C1823 — Generator, neurostimulator (implantable), non-rechargeable, with transvenous sensing and stimulation leads
- V2599 — Contact lens, other type
The codes in each HCPCS code range are categorically referred to by the letter they begin with. For example, codes beginning with the letter J—used to report non-orally administered medication and chemotherapy drugs—are called J codes. Incidentally, J codes are among the most commonly reported codes in the HCPCS Level II code set. HCPCS CODES RANGE
How HCPCS Level II Codes Are Used
HCPCS Level II codes report what a provider used during a service provided to a patient to treat or assess a given diagnosis. As such, HCPCS codes are used in conjunction with CPT® and ICD-10 codes, as these three code sets are interdependent and come together in medical coding and billing, often in a single claim. |
C1823 | LEAD STIMULATION RESPISTIM R 20MMX50CM REMEDE | HCPCS | Some examples of HCPCS Level II codes include:
- J9355 — Injection, trastuzumab, excludes biosimilar, 10 mg
- G9631 — Patient sustained ureter injury at the time of surgery or discovered subsequently up to 30 days post-surgery
- C1823 — Generator, neurostimulator (implantable), non-rechargeable, with transvenous sensing and stimulation leads
- V2599 — Contact lens, other type
The codes in each HCPCS code range are categorically referred to by the letter they begin with. For example, codes beginning with the letter J—used to report non-orally administered medication and chemotherapy drugs—are called J codes. Incidentally, J codes are among the most commonly reported codes in the HCPCS Level II code set. HCPCS CODES RANGE
How HCPCS Level II Codes Are Used
HCPCS Level II codes report what a provider used during a service provided to a patient to treat or assess a given diagnosis. As such, HCPCS codes are used in conjunction with CPT® and ICD-10 codes, as these three code sets are interdependent and come together in medical coding and billing, often in a single claim. |
J9030 | HC Bcg Vaccine Tice Bu 1mg | HCPCS | A HCPCS code is then added to the claim (when required by the payer) to report products that may have been prescribed, injected, or otherwise delivered to the patient during the service. In general terms—with some exceptions—medical coders use the three code sets when submitting medical claims to report the following:
- CPT® codes: what the provider did. - HCPCS codes: what the provider used. - ICD-10-CM: why the provider 'did' and 'used'. For example, if a urologist diagnoses a patient with bladder cancer and performs a bladder instillation of 1 mg of Bacillus Calmette-Guerin (BCG) to treat the tumor, the medical coder might assign:
- CPT® codes (did): 51720 (Bladder instillation of anticarcinogenic agent (including retention time))
- HCPCS code (used): J9030 (BCG live intravesical instillation, 1mg)
- ICD-10 code (why): C67.9 (Malignant neoplasm of bladder, unspecified)
As mentioned above, though, there are some exceptions to these general code set concepts. |
51720 | Treatment of bladder lesion | HCPCS | A HCPCS code is then added to the claim (when required by the payer) to report products that may have been prescribed, injected, or otherwise delivered to the patient during the service. In general terms—with some exceptions—medical coders use the three code sets when submitting medical claims to report the following:
- CPT® codes: what the provider did. - HCPCS codes: what the provider used. - ICD-10-CM: why the provider 'did' and 'used'. For example, if a urologist diagnoses a patient with bladder cancer and performs a bladder instillation of 1 mg of Bacillus Calmette-Guerin (BCG) to treat the tumor, the medical coder might assign:
- CPT® codes (did): 51720 (Bladder instillation of anticarcinogenic agent (including retention time))
- HCPCS code (used): J9030 (BCG live intravesical instillation, 1mg)
- ICD-10 code (why): C67.9 (Malignant neoplasm of bladder, unspecified)
As mentioned above, though, there are some exceptions to these general code set concepts. |
J9030 | HC Bcg Vaccine Tice Bu 1mg | HCPCS | In general terms—with some exceptions—medical coders use the three code sets when submitting medical claims to report the following:
- CPT® codes: what the provider did. - HCPCS codes: what the provider used. - ICD-10-CM: why the provider 'did' and 'used'. For example, if a urologist diagnoses a patient with bladder cancer and performs a bladder instillation of 1 mg of Bacillus Calmette-Guerin (BCG) to treat the tumor, the medical coder might assign:
- CPT® codes (did): 51720 (Bladder instillation of anticarcinogenic agent (including retention time))
- HCPCS code (used): J9030 (BCG live intravesical instillation, 1mg)
- ICD-10 code (why): C67.9 (Malignant neoplasm of bladder, unspecified)
As mentioned above, though, there are some exceptions to these general code set concepts. WHEN TO CHOOSE CPT® Vs HCPCS
First, not all payers accept HCPCS Level II codes. |
51720 | Treatment of bladder lesion | HCPCS | In general terms—with some exceptions—medical coders use the three code sets when submitting medical claims to report the following:
- CPT® codes: what the provider did. - HCPCS codes: what the provider used. - ICD-10-CM: why the provider 'did' and 'used'. For example, if a urologist diagnoses a patient with bladder cancer and performs a bladder instillation of 1 mg of Bacillus Calmette-Guerin (BCG) to treat the tumor, the medical coder might assign:
- CPT® codes (did): 51720 (Bladder instillation of anticarcinogenic agent (including retention time))
- HCPCS code (used): J9030 (BCG live intravesical instillation, 1mg)
- ICD-10 code (why): C67.9 (Malignant neoplasm of bladder, unspecified)
As mentioned above, though, there are some exceptions to these general code set concepts. WHEN TO CHOOSE CPT® Vs HCPCS
First, not all payers accept HCPCS Level II codes. |
J9030 | HC Bcg Vaccine Tice Bu 1mg | HCPCS | - HCPCS codes: what the provider used. - ICD-10-CM: why the provider 'did' and 'used'. For example, if a urologist diagnoses a patient with bladder cancer and performs a bladder instillation of 1 mg of Bacillus Calmette-Guerin (BCG) to treat the tumor, the medical coder might assign:
- CPT® codes (did): 51720 (Bladder instillation of anticarcinogenic agent (including retention time))
- HCPCS code (used): J9030 (BCG live intravesical instillation, 1mg)
- ICD-10 code (why): C67.9 (Malignant neoplasm of bladder, unspecified)
As mentioned above, though, there are some exceptions to these general code set concepts. WHEN TO CHOOSE CPT® Vs HCPCS
First, not all payers accept HCPCS Level II codes. Initially intended for Medicare claims, many private payers have since adopted the HCPCS Level II code set. |
51720 | Treatment of bladder lesion | HCPCS | - HCPCS codes: what the provider used. - ICD-10-CM: why the provider 'did' and 'used'. For example, if a urologist diagnoses a patient with bladder cancer and performs a bladder instillation of 1 mg of Bacillus Calmette-Guerin (BCG) to treat the tumor, the medical coder might assign:
- CPT® codes (did): 51720 (Bladder instillation of anticarcinogenic agent (including retention time))
- HCPCS code (used): J9030 (BCG live intravesical instillation, 1mg)
- ICD-10 code (why): C67.9 (Malignant neoplasm of bladder, unspecified)
As mentioned above, though, there are some exceptions to these general code set concepts. WHEN TO CHOOSE CPT® Vs HCPCS
First, not all payers accept HCPCS Level II codes. Initially intended for Medicare claims, many private payers have since adopted the HCPCS Level II code set. |
J9030 | HC Bcg Vaccine Tice Bu 1mg | HCPCS | - ICD-10-CM: why the provider 'did' and 'used'. For example, if a urologist diagnoses a patient with bladder cancer and performs a bladder instillation of 1 mg of Bacillus Calmette-Guerin (BCG) to treat the tumor, the medical coder might assign:
- CPT® codes (did): 51720 (Bladder instillation of anticarcinogenic agent (including retention time))
- HCPCS code (used): J9030 (BCG live intravesical instillation, 1mg)
- ICD-10 code (why): C67.9 (Malignant neoplasm of bladder, unspecified)
As mentioned above, though, there are some exceptions to these general code set concepts. WHEN TO CHOOSE CPT® Vs HCPCS
First, not all payers accept HCPCS Level II codes. Initially intended for Medicare claims, many private payers have since adopted the HCPCS Level II code set. In fact, under the HIPAA requirement for standardized coding systems, HCPCS level II was selected for describing healthcare equipment and supplies not represented in CPT® due to its widespread commercial acceptance. |
51720 | Treatment of bladder lesion | HCPCS | - ICD-10-CM: why the provider 'did' and 'used'. For example, if a urologist diagnoses a patient with bladder cancer and performs a bladder instillation of 1 mg of Bacillus Calmette-Guerin (BCG) to treat the tumor, the medical coder might assign:
- CPT® codes (did): 51720 (Bladder instillation of anticarcinogenic agent (including retention time))
- HCPCS code (used): J9030 (BCG live intravesical instillation, 1mg)
- ICD-10 code (why): C67.9 (Malignant neoplasm of bladder, unspecified)
As mentioned above, though, there are some exceptions to these general code set concepts. WHEN TO CHOOSE CPT® Vs HCPCS
First, not all payers accept HCPCS Level II codes. Initially intended for Medicare claims, many private payers have since adopted the HCPCS Level II code set. In fact, under the HIPAA requirement for standardized coding systems, HCPCS level II was selected for describing healthcare equipment and supplies not represented in CPT® due to its widespread commercial acceptance. |
J9030 | HC Bcg Vaccine Tice Bu 1mg | HCPCS | For example, if a urologist diagnoses a patient with bladder cancer and performs a bladder instillation of 1 mg of Bacillus Calmette-Guerin (BCG) to treat the tumor, the medical coder might assign:
- CPT® codes (did): 51720 (Bladder instillation of anticarcinogenic agent (including retention time))
- HCPCS code (used): J9030 (BCG live intravesical instillation, 1mg)
- ICD-10 code (why): C67.9 (Malignant neoplasm of bladder, unspecified)
As mentioned above, though, there are some exceptions to these general code set concepts. WHEN TO CHOOSE CPT® Vs HCPCS
First, not all payers accept HCPCS Level II codes. Initially intended for Medicare claims, many private payers have since adopted the HCPCS Level II code set. In fact, under the HIPAA requirement for standardized coding systems, HCPCS level II was selected for describing healthcare equipment and supplies not represented in CPT® due to its widespread commercial acceptance. That said, the existence of a HCPCS Level II code does not indicate third-party coverage. |
51720 | Treatment of bladder lesion | HCPCS | For example, if a urologist diagnoses a patient with bladder cancer and performs a bladder instillation of 1 mg of Bacillus Calmette-Guerin (BCG) to treat the tumor, the medical coder might assign:
- CPT® codes (did): 51720 (Bladder instillation of anticarcinogenic agent (including retention time))
- HCPCS code (used): J9030 (BCG live intravesical instillation, 1mg)
- ICD-10 code (why): C67.9 (Malignant neoplasm of bladder, unspecified)
As mentioned above, though, there are some exceptions to these general code set concepts. WHEN TO CHOOSE CPT® Vs HCPCS
First, not all payers accept HCPCS Level II codes. Initially intended for Medicare claims, many private payers have since adopted the HCPCS Level II code set. In fact, under the HIPAA requirement for standardized coding systems, HCPCS level II was selected for describing healthcare equipment and supplies not represented in CPT® due to its widespread commercial acceptance. That said, the existence of a HCPCS Level II code does not indicate third-party coverage. |
G0121 | SCRN COLONOSCOPY PT NOT HI RISK | HCPCS | The operative word in each of these HCPCS G code descriptors is screening. Screening procedures are not diagnostic procedures. In other words, the HCPCS screening codes apply only to asymptomatic patients. Consider the following HCPCS code examples:
You might submit HCPCS code G0121 (Colorectal cancer screening; barium enema) when an asymptomatic patient fits the once every 10-year interval. If you bill G0121 earlier than the 10-year period, your claim will likely be denied. |
45378 | PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD | HCPCS | Screening procedures are not diagnostic procedures. In other words, the HCPCS screening codes apply only to asymptomatic patients. Consider the following HCPCS code examples:
You might submit HCPCS code G0121 (Colorectal cancer screening; barium enema) when an asymptomatic patient fits the once every 10-year interval. If you bill G0121 earlier than the 10-year period, your claim will likely be denied. But if a patient complains of symptoms such as blood in stool, and the gastroenterologist performs a diagnostic colonoscopy, you would choose CPT® code 45378 (Colonoscopy, flexible; diagnostic, including collection of specimen[s] by brushing or washing, when performed [separate procedure]). |
G0121 | SCRN COLONOSCOPY PT NOT HI RISK | HCPCS | Screening procedures are not diagnostic procedures. In other words, the HCPCS screening codes apply only to asymptomatic patients. Consider the following HCPCS code examples:
You might submit HCPCS code G0121 (Colorectal cancer screening; barium enema) when an asymptomatic patient fits the once every 10-year interval. If you bill G0121 earlier than the 10-year period, your claim will likely be denied. But if a patient complains of symptoms such as blood in stool, and the gastroenterologist performs a diagnostic colonoscopy, you would choose CPT® code 45378 (Colonoscopy, flexible; diagnostic, including collection of specimen[s] by brushing or washing, when performed [separate procedure]). |
45378 | PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD | HCPCS | In other words, the HCPCS screening codes apply only to asymptomatic patients. Consider the following HCPCS code examples:
You might submit HCPCS code G0121 (Colorectal cancer screening; barium enema) when an asymptomatic patient fits the once every 10-year interval. If you bill G0121 earlier than the 10-year period, your claim will likely be denied. But if a patient complains of symptoms such as blood in stool, and the gastroenterologist performs a diagnostic colonoscopy, you would choose CPT® code 45378 (Colonoscopy, flexible; diagnostic, including collection of specimen[s] by brushing or washing, when performed [separate procedure]). Similarly, if an abnormal finding prompts your physician to convert a colorectal cancer screening into a diagnostic procedure, you would abandon the HCPCS code for the appropriate CPT® code and append it with CPT® modifier PT (Colorectal cancer screening test; converted to diagnostic test or other procedure). |
G0121 | SCRN COLONOSCOPY PT NOT HI RISK | HCPCS | In other words, the HCPCS screening codes apply only to asymptomatic patients. Consider the following HCPCS code examples:
You might submit HCPCS code G0121 (Colorectal cancer screening; barium enema) when an asymptomatic patient fits the once every 10-year interval. If you bill G0121 earlier than the 10-year period, your claim will likely be denied. But if a patient complains of symptoms such as blood in stool, and the gastroenterologist performs a diagnostic colonoscopy, you would choose CPT® code 45378 (Colonoscopy, flexible; diagnostic, including collection of specimen[s] by brushing or washing, when performed [separate procedure]). Similarly, if an abnormal finding prompts your physician to convert a colorectal cancer screening into a diagnostic procedure, you would abandon the HCPCS code for the appropriate CPT® code and append it with CPT® modifier PT (Colorectal cancer screening test; converted to diagnostic test or other procedure). |
45378 | PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD | HCPCS | Consider the following HCPCS code examples:
You might submit HCPCS code G0121 (Colorectal cancer screening; barium enema) when an asymptomatic patient fits the once every 10-year interval. If you bill G0121 earlier than the 10-year period, your claim will likely be denied. But if a patient complains of symptoms such as blood in stool, and the gastroenterologist performs a diagnostic colonoscopy, you would choose CPT® code 45378 (Colonoscopy, flexible; diagnostic, including collection of specimen[s] by brushing or washing, when performed [separate procedure]). Similarly, if an abnormal finding prompts your physician to convert a colorectal cancer screening into a diagnostic procedure, you would abandon the HCPCS code for the appropriate CPT® code and append it with CPT® modifier PT (Colorectal cancer screening test; converted to diagnostic test or other procedure). Other circumstances may involve the option of reporting a HCPCS Level II code if the HCPCS code offers greater specificity than the CPT® code. |
G0121 | SCRN COLONOSCOPY PT NOT HI RISK | HCPCS | Consider the following HCPCS code examples:
You might submit HCPCS code G0121 (Colorectal cancer screening; barium enema) when an asymptomatic patient fits the once every 10-year interval. If you bill G0121 earlier than the 10-year period, your claim will likely be denied. But if a patient complains of symptoms such as blood in stool, and the gastroenterologist performs a diagnostic colonoscopy, you would choose CPT® code 45378 (Colonoscopy, flexible; diagnostic, including collection of specimen[s] by brushing or washing, when performed [separate procedure]). Similarly, if an abnormal finding prompts your physician to convert a colorectal cancer screening into a diagnostic procedure, you would abandon the HCPCS code for the appropriate CPT® code and append it with CPT® modifier PT (Colorectal cancer screening test; converted to diagnostic test or other procedure). Other circumstances may involve the option of reporting a HCPCS Level II code if the HCPCS code offers greater specificity than the CPT® code. |
45378 | PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD | HCPCS | If you bill G0121 earlier than the 10-year period, your claim will likely be denied. But if a patient complains of symptoms such as blood in stool, and the gastroenterologist performs a diagnostic colonoscopy, you would choose CPT® code 45378 (Colonoscopy, flexible; diagnostic, including collection of specimen[s] by brushing or washing, when performed [separate procedure]). Similarly, if an abnormal finding prompts your physician to convert a colorectal cancer screening into a diagnostic procedure, you would abandon the HCPCS code for the appropriate CPT® code and append it with CPT® modifier PT (Colorectal cancer screening test; converted to diagnostic test or other procedure). Other circumstances may involve the option of reporting a HCPCS Level II code if the HCPCS code offers greater specificity than the CPT® code. This is sometimes the case with CPT® codes that represent supplies. |
G0121 | SCRN COLONOSCOPY PT NOT HI RISK | HCPCS | If you bill G0121 earlier than the 10-year period, your claim will likely be denied. But if a patient complains of symptoms such as blood in stool, and the gastroenterologist performs a diagnostic colonoscopy, you would choose CPT® code 45378 (Colonoscopy, flexible; diagnostic, including collection of specimen[s] by brushing or washing, when performed [separate procedure]). Similarly, if an abnormal finding prompts your physician to convert a colorectal cancer screening into a diagnostic procedure, you would abandon the HCPCS code for the appropriate CPT® code and append it with CPT® modifier PT (Colorectal cancer screening test; converted to diagnostic test or other procedure). Other circumstances may involve the option of reporting a HCPCS Level II code if the HCPCS code offers greater specificity than the CPT® code. This is sometimes the case with CPT® codes that represent supplies. |
45378 | PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD | HCPCS | But if a patient complains of symptoms such as blood in stool, and the gastroenterologist performs a diagnostic colonoscopy, you would choose CPT® code 45378 (Colonoscopy, flexible; diagnostic, including collection of specimen[s] by brushing or washing, when performed [separate procedure]). Similarly, if an abnormal finding prompts your physician to convert a colorectal cancer screening into a diagnostic procedure, you would abandon the HCPCS code for the appropriate CPT® code and append it with CPT® modifier PT (Colorectal cancer screening test; converted to diagnostic test or other procedure). Other circumstances may involve the option of reporting a HCPCS Level II code if the HCPCS code offers greater specificity than the CPT® code. This is sometimes the case with CPT® codes that represent supplies. For example, you would choose CPT® code 29540 (Strapping; ankle and/or foot) to report the service of a physician who diagnosed a sprained right ankle and applied layers of web roll followed by adhesive tape to stabilize the patient’s ankle, which he then covered with the application of an elastic bandage. |
29540 | Strapping of ankle and/or ft | HCPCS | But if a patient complains of symptoms such as blood in stool, and the gastroenterologist performs a diagnostic colonoscopy, you would choose CPT® code 45378 (Colonoscopy, flexible; diagnostic, including collection of specimen[s] by brushing or washing, when performed [separate procedure]). Similarly, if an abnormal finding prompts your physician to convert a colorectal cancer screening into a diagnostic procedure, you would abandon the HCPCS code for the appropriate CPT® code and append it with CPT® modifier PT (Colorectal cancer screening test; converted to diagnostic test or other procedure). Other circumstances may involve the option of reporting a HCPCS Level II code if the HCPCS code offers greater specificity than the CPT® code. This is sometimes the case with CPT® codes that represent supplies. For example, you would choose CPT® code 29540 (Strapping; ankle and/or foot) to report the service of a physician who diagnosed a sprained right ankle and applied layers of web roll followed by adhesive tape to stabilize the patient’s ankle, which he then covered with the application of an elastic bandage. |
29540 | Strapping of ankle and/or ft | HCPCS | Similarly, if an abnormal finding prompts your physician to convert a colorectal cancer screening into a diagnostic procedure, you would abandon the HCPCS code for the appropriate CPT® code and append it with CPT® modifier PT (Colorectal cancer screening test; converted to diagnostic test or other procedure). Other circumstances may involve the option of reporting a HCPCS Level II code if the HCPCS code offers greater specificity than the CPT® code. This is sometimes the case with CPT® codes that represent supplies. For example, you would choose CPT® code 29540 (Strapping; ankle and/or foot) to report the service of a physician who diagnosed a sprained right ankle and applied layers of web roll followed by adhesive tape to stabilize the patient’s ankle, which he then covered with the application of an elastic bandage. If this encounter was an initial service with "no other procedure or treatment" required, you would also report CPT® code 99070 to document the use of supplies like tape or bandages. |
99070 | Special supplies phys/qhp | HCPCS | Similarly, if an abnormal finding prompts your physician to convert a colorectal cancer screening into a diagnostic procedure, you would abandon the HCPCS code for the appropriate CPT® code and append it with CPT® modifier PT (Colorectal cancer screening test; converted to diagnostic test or other procedure). Other circumstances may involve the option of reporting a HCPCS Level II code if the HCPCS code offers greater specificity than the CPT® code. This is sometimes the case with CPT® codes that represent supplies. For example, you would choose CPT® code 29540 (Strapping; ankle and/or foot) to report the service of a physician who diagnosed a sprained right ankle and applied layers of web roll followed by adhesive tape to stabilize the patient’s ankle, which he then covered with the application of an elastic bandage. If this encounter was an initial service with "no other procedure or treatment" required, you would also report CPT® code 99070 to document the use of supplies like tape or bandages. |
A6448 | Lt compres band <3"/yd | HCPCS | Other circumstances may involve the option of reporting a HCPCS Level II code if the HCPCS code offers greater specificity than the CPT® code. This is sometimes the case with CPT® codes that represent supplies. For example, you would choose CPT® code 29540 (Strapping; ankle and/or foot) to report the service of a physician who diagnosed a sprained right ankle and applied layers of web roll followed by adhesive tape to stabilize the patient’s ankle, which he then covered with the application of an elastic bandage. If this encounter was an initial service with "no other procedure or treatment" required, you would also report CPT® code 99070 to document the use of supplies like tape or bandages. Some coders, though, opt to forgo the generic CPT® code 99070, preferring instead the detailed HCPCS A code options, such as A6448 (Light compression bandage, elastic, knitted/woven, width less than 3 inches, per yard). |
29540 | Strapping of ankle and/or ft | HCPCS | Other circumstances may involve the option of reporting a HCPCS Level II code if the HCPCS code offers greater specificity than the CPT® code. This is sometimes the case with CPT® codes that represent supplies. For example, you would choose CPT® code 29540 (Strapping; ankle and/or foot) to report the service of a physician who diagnosed a sprained right ankle and applied layers of web roll followed by adhesive tape to stabilize the patient’s ankle, which he then covered with the application of an elastic bandage. If this encounter was an initial service with "no other procedure or treatment" required, you would also report CPT® code 99070 to document the use of supplies like tape or bandages. Some coders, though, opt to forgo the generic CPT® code 99070, preferring instead the detailed HCPCS A code options, such as A6448 (Light compression bandage, elastic, knitted/woven, width less than 3 inches, per yard). |
99070 | Special supplies phys/qhp | HCPCS | Other circumstances may involve the option of reporting a HCPCS Level II code if the HCPCS code offers greater specificity than the CPT® code. This is sometimes the case with CPT® codes that represent supplies. For example, you would choose CPT® code 29540 (Strapping; ankle and/or foot) to report the service of a physician who diagnosed a sprained right ankle and applied layers of web roll followed by adhesive tape to stabilize the patient’s ankle, which he then covered with the application of an elastic bandage. If this encounter was an initial service with "no other procedure or treatment" required, you would also report CPT® code 99070 to document the use of supplies like tape or bandages. Some coders, though, opt to forgo the generic CPT® code 99070, preferring instead the detailed HCPCS A code options, such as A6448 (Light compression bandage, elastic, knitted/woven, width less than 3 inches, per yard). |
A6448 | Lt compres band <3"/yd | HCPCS | This is sometimes the case with CPT® codes that represent supplies. For example, you would choose CPT® code 29540 (Strapping; ankle and/or foot) to report the service of a physician who diagnosed a sprained right ankle and applied layers of web roll followed by adhesive tape to stabilize the patient’s ankle, which he then covered with the application of an elastic bandage. If this encounter was an initial service with "no other procedure or treatment" required, you would also report CPT® code 99070 to document the use of supplies like tape or bandages. Some coders, though, opt to forgo the generic CPT® code 99070, preferring instead the detailed HCPCS A code options, such as A6448 (Light compression bandage, elastic, knitted/woven, width less than 3 inches, per yard). HCPCS Level II Modifiers
HCPCS modifiers consist of two alpha or alphanumeric characters and are appended with a hyphen to the end of a HCPCS (or CPT®) code to expand the description of the code. |
29540 | Strapping of ankle and/or ft | HCPCS | This is sometimes the case with CPT® codes that represent supplies. For example, you would choose CPT® code 29540 (Strapping; ankle and/or foot) to report the service of a physician who diagnosed a sprained right ankle and applied layers of web roll followed by adhesive tape to stabilize the patient’s ankle, which he then covered with the application of an elastic bandage. If this encounter was an initial service with "no other procedure or treatment" required, you would also report CPT® code 99070 to document the use of supplies like tape or bandages. Some coders, though, opt to forgo the generic CPT® code 99070, preferring instead the detailed HCPCS A code options, such as A6448 (Light compression bandage, elastic, knitted/woven, width less than 3 inches, per yard). HCPCS Level II Modifiers
HCPCS modifiers consist of two alpha or alphanumeric characters and are appended with a hyphen to the end of a HCPCS (or CPT®) code to expand the description of the code. |
99070 | Special supplies phys/qhp | HCPCS | This is sometimes the case with CPT® codes that represent supplies. For example, you would choose CPT® code 29540 (Strapping; ankle and/or foot) to report the service of a physician who diagnosed a sprained right ankle and applied layers of web roll followed by adhesive tape to stabilize the patient’s ankle, which he then covered with the application of an elastic bandage. If this encounter was an initial service with "no other procedure or treatment" required, you would also report CPT® code 99070 to document the use of supplies like tape or bandages. Some coders, though, opt to forgo the generic CPT® code 99070, preferring instead the detailed HCPCS A code options, such as A6448 (Light compression bandage, elastic, knitted/woven, width less than 3 inches, per yard). HCPCS Level II Modifiers
HCPCS modifiers consist of two alpha or alphanumeric characters and are appended with a hyphen to the end of a HCPCS (or CPT®) code to expand the description of the code. |
A6448 | Lt compres band <3"/yd | HCPCS | For example, you would choose CPT® code 29540 (Strapping; ankle and/or foot) to report the service of a physician who diagnosed a sprained right ankle and applied layers of web roll followed by adhesive tape to stabilize the patient’s ankle, which he then covered with the application of an elastic bandage. If this encounter was an initial service with "no other procedure or treatment" required, you would also report CPT® code 99070 to document the use of supplies like tape or bandages. Some coders, though, opt to forgo the generic CPT® code 99070, preferring instead the detailed HCPCS A code options, such as A6448 (Light compression bandage, elastic, knitted/woven, width less than 3 inches, per yard). HCPCS Level II Modifiers
HCPCS modifiers consist of two alpha or alphanumeric characters and are appended with a hyphen to the end of a HCPCS (or CPT®) code to expand the description of the code. Medical coders use HCPCS Level II modifiers when the information provided by a HCPCS code descriptor needs supplementation to fully capture the circumstances that apply to an item or service. |
29540 | Strapping of ankle and/or ft | HCPCS | For example, you would choose CPT® code 29540 (Strapping; ankle and/or foot) to report the service of a physician who diagnosed a sprained right ankle and applied layers of web roll followed by adhesive tape to stabilize the patient’s ankle, which he then covered with the application of an elastic bandage. If this encounter was an initial service with "no other procedure or treatment" required, you would also report CPT® code 99070 to document the use of supplies like tape or bandages. Some coders, though, opt to forgo the generic CPT® code 99070, preferring instead the detailed HCPCS A code options, such as A6448 (Light compression bandage, elastic, knitted/woven, width less than 3 inches, per yard). HCPCS Level II Modifiers
HCPCS modifiers consist of two alpha or alphanumeric characters and are appended with a hyphen to the end of a HCPCS (or CPT®) code to expand the description of the code. Medical coders use HCPCS Level II modifiers when the information provided by a HCPCS code descriptor needs supplementation to fully capture the circumstances that apply to an item or service. |
99070 | Special supplies phys/qhp | HCPCS | For example, you would choose CPT® code 29540 (Strapping; ankle and/or foot) to report the service of a physician who diagnosed a sprained right ankle and applied layers of web roll followed by adhesive tape to stabilize the patient’s ankle, which he then covered with the application of an elastic bandage. If this encounter was an initial service with "no other procedure or treatment" required, you would also report CPT® code 99070 to document the use of supplies like tape or bandages. Some coders, though, opt to forgo the generic CPT® code 99070, preferring instead the detailed HCPCS A code options, such as A6448 (Light compression bandage, elastic, knitted/woven, width less than 3 inches, per yard). HCPCS Level II Modifiers
HCPCS modifiers consist of two alpha or alphanumeric characters and are appended with a hyphen to the end of a HCPCS (or CPT®) code to expand the description of the code. Medical coders use HCPCS Level II modifiers when the information provided by a HCPCS code descriptor needs supplementation to fully capture the circumstances that apply to an item or service. |
A6448 | Lt compres band <3"/yd | HCPCS | If this encounter was an initial service with "no other procedure or treatment" required, you would also report CPT® code 99070 to document the use of supplies like tape or bandages. Some coders, though, opt to forgo the generic CPT® code 99070, preferring instead the detailed HCPCS A code options, such as A6448 (Light compression bandage, elastic, knitted/woven, width less than 3 inches, per yard). HCPCS Level II Modifiers
HCPCS modifiers consist of two alpha or alphanumeric characters and are appended with a hyphen to the end of a HCPCS (or CPT®) code to expand the description of the code. Medical coders use HCPCS Level II modifiers when the information provided by a HCPCS code descriptor needs supplementation to fully capture the circumstances that apply to an item or service. For example, you would use the HCPCS modifier UE when an item identified by a HCPCS code is “used equipment.” The NU modifier would be added to indicate “new equipment.”
So, if you're filing a claim for a patient who was prescribed and received a new wheelchair, you might report HCPCS code E1130 (Standard wheelchair, fixed full-length arms, fixed or swing away, detachable footrests) and append NU, as in E1130-NU, which would significantly affect reimbursement. |
99070 | Special supplies phys/qhp | HCPCS | If this encounter was an initial service with "no other procedure or treatment" required, you would also report CPT® code 99070 to document the use of supplies like tape or bandages. Some coders, though, opt to forgo the generic CPT® code 99070, preferring instead the detailed HCPCS A code options, such as A6448 (Light compression bandage, elastic, knitted/woven, width less than 3 inches, per yard). HCPCS Level II Modifiers
HCPCS modifiers consist of two alpha or alphanumeric characters and are appended with a hyphen to the end of a HCPCS (or CPT®) code to expand the description of the code. Medical coders use HCPCS Level II modifiers when the information provided by a HCPCS code descriptor needs supplementation to fully capture the circumstances that apply to an item or service. For example, you would use the HCPCS modifier UE when an item identified by a HCPCS code is “used equipment.” The NU modifier would be added to indicate “new equipment.”
So, if you're filing a claim for a patient who was prescribed and received a new wheelchair, you might report HCPCS code E1130 (Standard wheelchair, fixed full-length arms, fixed or swing away, detachable footrests) and append NU, as in E1130-NU, which would significantly affect reimbursement. |
E1130 | Whlchr stand fxd arm ft rest | HCPCS | If this encounter was an initial service with "no other procedure or treatment" required, you would also report CPT® code 99070 to document the use of supplies like tape or bandages. Some coders, though, opt to forgo the generic CPT® code 99070, preferring instead the detailed HCPCS A code options, such as A6448 (Light compression bandage, elastic, knitted/woven, width less than 3 inches, per yard). HCPCS Level II Modifiers
HCPCS modifiers consist of two alpha or alphanumeric characters and are appended with a hyphen to the end of a HCPCS (or CPT®) code to expand the description of the code. Medical coders use HCPCS Level II modifiers when the information provided by a HCPCS code descriptor needs supplementation to fully capture the circumstances that apply to an item or service. For example, you would use the HCPCS modifier UE when an item identified by a HCPCS code is “used equipment.” The NU modifier would be added to indicate “new equipment.”
So, if you're filing a claim for a patient who was prescribed and received a new wheelchair, you might report HCPCS code E1130 (Standard wheelchair, fixed full-length arms, fixed or swing away, detachable footrests) and append NU, as in E1130-NU, which would significantly affect reimbursement. |
A6448 | Lt compres band <3"/yd | HCPCS | Some coders, though, opt to forgo the generic CPT® code 99070, preferring instead the detailed HCPCS A code options, such as A6448 (Light compression bandage, elastic, knitted/woven, width less than 3 inches, per yard). HCPCS Level II Modifiers
HCPCS modifiers consist of two alpha or alphanumeric characters and are appended with a hyphen to the end of a HCPCS (or CPT®) code to expand the description of the code. Medical coders use HCPCS Level II modifiers when the information provided by a HCPCS code descriptor needs supplementation to fully capture the circumstances that apply to an item or service. For example, you would use the HCPCS modifier UE when an item identified by a HCPCS code is “used equipment.” The NU modifier would be added to indicate “new equipment.”
So, if you're filing a claim for a patient who was prescribed and received a new wheelchair, you might report HCPCS code E1130 (Standard wheelchair, fixed full-length arms, fixed or swing away, detachable footrests) and append NU, as in E1130-NU, which would significantly affect reimbursement. Another HCPCS code example demonstrates how modifiers affect reimbursement by accounting for loss. |
99070 | Special supplies phys/qhp | HCPCS | Some coders, though, opt to forgo the generic CPT® code 99070, preferring instead the detailed HCPCS A code options, such as A6448 (Light compression bandage, elastic, knitted/woven, width less than 3 inches, per yard). HCPCS Level II Modifiers
HCPCS modifiers consist of two alpha or alphanumeric characters and are appended with a hyphen to the end of a HCPCS (or CPT®) code to expand the description of the code. Medical coders use HCPCS Level II modifiers when the information provided by a HCPCS code descriptor needs supplementation to fully capture the circumstances that apply to an item or service. For example, you would use the HCPCS modifier UE when an item identified by a HCPCS code is “used equipment.” The NU modifier would be added to indicate “new equipment.”
So, if you're filing a claim for a patient who was prescribed and received a new wheelchair, you might report HCPCS code E1130 (Standard wheelchair, fixed full-length arms, fixed or swing away, detachable footrests) and append NU, as in E1130-NU, which would significantly affect reimbursement. Another HCPCS code example demonstrates how modifiers affect reimbursement by accounting for loss. |
E1130 | Whlchr stand fxd arm ft rest | HCPCS | Some coders, though, opt to forgo the generic CPT® code 99070, preferring instead the detailed HCPCS A code options, such as A6448 (Light compression bandage, elastic, knitted/woven, width less than 3 inches, per yard). HCPCS Level II Modifiers
HCPCS modifiers consist of two alpha or alphanumeric characters and are appended with a hyphen to the end of a HCPCS (or CPT®) code to expand the description of the code. Medical coders use HCPCS Level II modifiers when the information provided by a HCPCS code descriptor needs supplementation to fully capture the circumstances that apply to an item or service. For example, you would use the HCPCS modifier UE when an item identified by a HCPCS code is “used equipment.” The NU modifier would be added to indicate “new equipment.”
So, if you're filing a claim for a patient who was prescribed and received a new wheelchair, you might report HCPCS code E1130 (Standard wheelchair, fixed full-length arms, fixed or swing away, detachable footrests) and append NU, as in E1130-NU, which would significantly affect reimbursement. Another HCPCS code example demonstrates how modifiers affect reimbursement by accounting for loss. |
E1130 | Whlchr stand fxd arm ft rest | HCPCS | HCPCS Level II Modifiers
HCPCS modifiers consist of two alpha or alphanumeric characters and are appended with a hyphen to the end of a HCPCS (or CPT®) code to expand the description of the code. Medical coders use HCPCS Level II modifiers when the information provided by a HCPCS code descriptor needs supplementation to fully capture the circumstances that apply to an item or service. For example, you would use the HCPCS modifier UE when an item identified by a HCPCS code is “used equipment.” The NU modifier would be added to indicate “new equipment.”
So, if you're filing a claim for a patient who was prescribed and received a new wheelchair, you might report HCPCS code E1130 (Standard wheelchair, fixed full-length arms, fixed or swing away, detachable footrests) and append NU, as in E1130-NU, which would significantly affect reimbursement. Another HCPCS code example demonstrates how modifiers affect reimbursement by accounting for loss. If your provider administers 44 units of Botulinum toxin injection by direct laryngoscopy from a 100-unit single-dose vial, and then had to discard the remaining contents of the vial, you could report the discarded drug with the HCPCS JW modifier. |
J0585 | PR INJECTION,ONABOTULINUMTOXINA 1 UNITS | HCPCS | Medical coders use HCPCS Level II modifiers when the information provided by a HCPCS code descriptor needs supplementation to fully capture the circumstances that apply to an item or service. For example, you would use the HCPCS modifier UE when an item identified by a HCPCS code is “used equipment.” The NU modifier would be added to indicate “new equipment.”
So, if you're filing a claim for a patient who was prescribed and received a new wheelchair, you might report HCPCS code E1130 (Standard wheelchair, fixed full-length arms, fixed or swing away, detachable footrests) and append NU, as in E1130-NU, which would significantly affect reimbursement. Another HCPCS code example demonstrates how modifiers affect reimbursement by accounting for loss. If your provider administers 44 units of Botulinum toxin injection by direct laryngoscopy from a 100-unit single-dose vial, and then had to discard the remaining contents of the vial, you could report the discarded drug with the HCPCS JW modifier. For this scenario, you'd report HCPCS code J0585 (Injection, onabotulinumtoxinA, 1 unit) on two separate lines. |
E1130 | Whlchr stand fxd arm ft rest | HCPCS | Medical coders use HCPCS Level II modifiers when the information provided by a HCPCS code descriptor needs supplementation to fully capture the circumstances that apply to an item or service. For example, you would use the HCPCS modifier UE when an item identified by a HCPCS code is “used equipment.” The NU modifier would be added to indicate “new equipment.”
So, if you're filing a claim for a patient who was prescribed and received a new wheelchair, you might report HCPCS code E1130 (Standard wheelchair, fixed full-length arms, fixed or swing away, detachable footrests) and append NU, as in E1130-NU, which would significantly affect reimbursement. Another HCPCS code example demonstrates how modifiers affect reimbursement by accounting for loss. If your provider administers 44 units of Botulinum toxin injection by direct laryngoscopy from a 100-unit single-dose vial, and then had to discard the remaining contents of the vial, you could report the discarded drug with the HCPCS JW modifier. For this scenario, you'd report HCPCS code J0585 (Injection, onabotulinumtoxinA, 1 unit) on two separate lines. |
J0585 | PR INJECTION,ONABOTULINUMTOXINA 1 UNITS | HCPCS | For example, you would use the HCPCS modifier UE when an item identified by a HCPCS code is “used equipment.” The NU modifier would be added to indicate “new equipment.”
So, if you're filing a claim for a patient who was prescribed and received a new wheelchair, you might report HCPCS code E1130 (Standard wheelchair, fixed full-length arms, fixed or swing away, detachable footrests) and append NU, as in E1130-NU, which would significantly affect reimbursement. Another HCPCS code example demonstrates how modifiers affect reimbursement by accounting for loss. If your provider administers 44 units of Botulinum toxin injection by direct laryngoscopy from a 100-unit single-dose vial, and then had to discard the remaining contents of the vial, you could report the discarded drug with the HCPCS JW modifier. For this scenario, you'd report HCPCS code J0585 (Injection, onabotulinumtoxinA, 1 unit) on two separate lines. On the first line, you’d report J0585 x 44 to identify the amount administered. |
E1130 | Whlchr stand fxd arm ft rest | HCPCS | For example, you would use the HCPCS modifier UE when an item identified by a HCPCS code is “used equipment.” The NU modifier would be added to indicate “new equipment.”
So, if you're filing a claim for a patient who was prescribed and received a new wheelchair, you might report HCPCS code E1130 (Standard wheelchair, fixed full-length arms, fixed or swing away, detachable footrests) and append NU, as in E1130-NU, which would significantly affect reimbursement. Another HCPCS code example demonstrates how modifiers affect reimbursement by accounting for loss. If your provider administers 44 units of Botulinum toxin injection by direct laryngoscopy from a 100-unit single-dose vial, and then had to discard the remaining contents of the vial, you could report the discarded drug with the HCPCS JW modifier. For this scenario, you'd report HCPCS code J0585 (Injection, onabotulinumtoxinA, 1 unit) on two separate lines. On the first line, you’d report J0585 x 44 to identify the amount administered. |
J0585 | PR INJECTION,ONABOTULINUMTOXINA 1 UNITS | HCPCS | Another HCPCS code example demonstrates how modifiers affect reimbursement by accounting for loss. If your provider administers 44 units of Botulinum toxin injection by direct laryngoscopy from a 100-unit single-dose vial, and then had to discard the remaining contents of the vial, you could report the discarded drug with the HCPCS JW modifier. For this scenario, you'd report HCPCS code J0585 (Injection, onabotulinumtoxinA, 1 unit) on two separate lines. On the first line, you’d report J0585 x 44 to identify the amount administered. On the second line you would report J0585-JW x 56 to identify the amount discarded. |
J0585 | PR INJECTION,ONABOTULINUMTOXINA 1 UNITS | HCPCS | If your provider administers 44 units of Botulinum toxin injection by direct laryngoscopy from a 100-unit single-dose vial, and then had to discard the remaining contents of the vial, you could report the discarded drug with the HCPCS JW modifier. For this scenario, you'd report HCPCS code J0585 (Injection, onabotulinumtoxinA, 1 unit) on two separate lines. On the first line, you’d report J0585 x 44 to identify the amount administered. On the second line you would report J0585-JW x 56 to identify the amount discarded. When reporting codes with more than one modifier, always list functional or pricing modifiers in the first position. |
J0585 | PR INJECTION,ONABOTULINUMTOXINA 1 UNITS | HCPCS | For this scenario, you'd report HCPCS code J0585 (Injection, onabotulinumtoxinA, 1 unit) on two separate lines. On the first line, you’d report J0585 x 44 to identify the amount administered. On the second line you would report J0585-JW x 56 to identify the amount discarded. When reporting codes with more than one modifier, always list functional or pricing modifiers in the first position. Payers consider functional modifiers when determining reimbursement. |
D7873 | Tmj arthroscopy lysis adhesn | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 deleted from non-covered, HCPCS D2940 deleted from non-covered
3/23/2006: Coding updated. CPT4 2005 & 2006 revisions added to policy. |
96000 | PR COMPRE CPTR MTN ALYS VIDEO TAPING 3D KINEMATICS | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 deleted from non-covered, HCPCS D2940 deleted from non-covered
3/23/2006: Coding updated. CPT4 2005 & 2006 revisions added to policy. |
70320 | Full mouth x-ray of teeth | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 deleted from non-covered, HCPCS D2940 deleted from non-covered
3/23/2006: Coding updated. CPT4 2005 & 2006 revisions added to policy. |
93762 | Peripheral Thermogram | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 deleted from non-covered, HCPCS D2940 deleted from non-covered
3/23/2006: Coding updated. CPT4 2005 & 2006 revisions added to policy. |
D7877 | Tmj arthroscopy debridement | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 deleted from non-covered, HCPCS D2940 deleted from non-covered
3/23/2006: Coding updated. CPT4 2005 & 2006 revisions added to policy. |
96004 | PR PHYS/QHP R&I CPTR MTN ALYS WALK/FUNCJL ACTV REPR | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 deleted from non-covered, HCPCS D2940 deleted from non-covered
3/23/2006: Coding updated. CPT4 2005 & 2006 revisions added to policy. |
70310 | X-ray exam of teeth | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 deleted from non-covered, HCPCS D2940 deleted from non-covered
3/23/2006: Coding updated. CPT4 2005 & 2006 revisions added to policy. |
70300 | X-ray exam of teeth | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 deleted from non-covered, HCPCS D2940 deleted from non-covered
3/23/2006: Coding updated. CPT4 2005 & 2006 revisions added to policy. |
S8262 | MANDIB ORTHO REPOSITION DEVICE EACH | CPT | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 deleted from non-covered, HCPCS D2940 deleted from non-covered
3/23/2006: Coding updated. CPT4 2005 & 2006 revisions added to policy. |
93760 | Cephalic Thermogram | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 deleted from non-covered, HCPCS D2940 deleted from non-covered
3/23/2006: Coding updated. CPT4 2005 & 2006 revisions added to policy. |
D8999 | PR UNS ORTHODONTIC PROCEDURE BY REPORT | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 deleted from non-covered, HCPCS D2940 deleted from non-covered
3/23/2006: Coding updated. CPT4 2005 & 2006 revisions added to policy. |
D8010 | PR LTD ORTHODONT TX PRIMARY DENTITION | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 deleted from non-covered, HCPCS D2940 deleted from non-covered
3/23/2006: Coding updated. CPT4 2005 & 2006 revisions added to policy. |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.