Chapter 9 Introduction to Level II
National Codes (HCPCS) Test-
Graded A
HCPCS - answer-Healthcare Common Procedure Coding System (pronounced hick-
picks)
HCPCS developed when - answer-1983
HCPCS developed by - answer-CMS
HCPCS definition - answer-a collection of codes that represents
• procedures,
• supplies,
• products, and
• services
provided to
• Medicare and
• Medicaid beneficiaries and to
• individuals enrolled in private insurance
HCPCS Levels - answer-I and II. Level III (state codes) no longer in use.
Level I - answer-includes CPT developed, maintained, and copyrighted by the AMA -- is
the primary coding system used in outpatient settings to code professional services
provided to patients
Level II - answer-HCPCS codes (National codes) represent physician and non-
physician services, products and supplies that are not represented in the Level I codes.
In some cases, Medicare requires the use of a Level II HCPCS code to override an
already existing CPT code.
Level II code examples - answer-• Ambulance services
• Durable Medical Equipment
• Drugs
• Prosthetics
• Orthotics
Level II format - answer-five character alphanumeric (first character is a letter, followed
by 4 numbers)
Level II approved and maintained by - answer-the Alpha-Numeric Group
, Alpha-Numeric Group - answer-• CMS
• Health Insurance Association of America
• the Blue Cross/Blue Shield Association
Healthcare services not covered in CPT include - answer-• Allied Healthcare
Professional (dentists, orthodontists, technical services like ambulances)
• Supplies (drugs, DME, prosthetics & orthotics)
Why 3rd party payers now require that providers use Level II codes for non-Medicare
patients - answer-allows for continuity and specificity. The uniformity also helps efforts
to collect uniform health service data.
Settings where Level I and II are use - answer-outpatient settings, where the basis of
payment is services rendered (diagnosis codes establish medical necessity)
A Codes - answer-• Transportation services including Ambulances
• Medical/Surgical Supplies
• Gradient Compression Stockings
• Wound Care
• Respiratory DME (inexpensive & routinely ordered)
• Administrative, Miscellaneous, & Investigational
B Codes - answer-Enteral and Parentral Therapy
C Codes - answer-CMS Hospital Outpatient Prospective Payment System
D Codes - answer-Dental Procedures
E Codes - answer-• DME (except inexpensive, routinely ordered respiratory - A code)
• Miscellaneous
• Skin Protection, Wheelchair
• Arm Support
• Gait Trainer
G Codes - answer-Temp Procedures/Professional Services
H Codes - answer-Behavioral Health and Substance Abuse Treatment Services
J Codes - answer-• Drugs Other Than Chemotherapy
• Chemotherapy Drugs
K Codes - answer-Temp Codes Assigned to Regional DME Carriers
L Codes - answer-• Orthotics
• Prosthetics
National Codes (HCPCS) Test-
Graded A
HCPCS - answer-Healthcare Common Procedure Coding System (pronounced hick-
picks)
HCPCS developed when - answer-1983
HCPCS developed by - answer-CMS
HCPCS definition - answer-a collection of codes that represents
• procedures,
• supplies,
• products, and
• services
provided to
• Medicare and
• Medicaid beneficiaries and to
• individuals enrolled in private insurance
HCPCS Levels - answer-I and II. Level III (state codes) no longer in use.
Level I - answer-includes CPT developed, maintained, and copyrighted by the AMA -- is
the primary coding system used in outpatient settings to code professional services
provided to patients
Level II - answer-HCPCS codes (National codes) represent physician and non-
physician services, products and supplies that are not represented in the Level I codes.
In some cases, Medicare requires the use of a Level II HCPCS code to override an
already existing CPT code.
Level II code examples - answer-• Ambulance services
• Durable Medical Equipment
• Drugs
• Prosthetics
• Orthotics
Level II format - answer-five character alphanumeric (first character is a letter, followed
by 4 numbers)
Level II approved and maintained by - answer-the Alpha-Numeric Group
, Alpha-Numeric Group - answer-• CMS
• Health Insurance Association of America
• the Blue Cross/Blue Shield Association
Healthcare services not covered in CPT include - answer-• Allied Healthcare
Professional (dentists, orthodontists, technical services like ambulances)
• Supplies (drugs, DME, prosthetics & orthotics)
Why 3rd party payers now require that providers use Level II codes for non-Medicare
patients - answer-allows for continuity and specificity. The uniformity also helps efforts
to collect uniform health service data.
Settings where Level I and II are use - answer-outpatient settings, where the basis of
payment is services rendered (diagnosis codes establish medical necessity)
A Codes - answer-• Transportation services including Ambulances
• Medical/Surgical Supplies
• Gradient Compression Stockings
• Wound Care
• Respiratory DME (inexpensive & routinely ordered)
• Administrative, Miscellaneous, & Investigational
B Codes - answer-Enteral and Parentral Therapy
C Codes - answer-CMS Hospital Outpatient Prospective Payment System
D Codes - answer-Dental Procedures
E Codes - answer-• DME (except inexpensive, routinely ordered respiratory - A code)
• Miscellaneous
• Skin Protection, Wheelchair
• Arm Support
• Gait Trainer
G Codes - answer-Temp Procedures/Professional Services
H Codes - answer-Behavioral Health and Substance Abuse Treatment Services
J Codes - answer-• Drugs Other Than Chemotherapy
• Chemotherapy Drugs
K Codes - answer-Temp Codes Assigned to Regional DME Carriers
L Codes - answer-• Orthotics
• Prosthetics
