HCPCS level II Questions and Answers(A+ Solution guide)

HCPCS Level II - also called national code used to describe common medical services/services. 5 characters in length, and they begin w/ letters A-V followed with 4 numbers. HCPCS level II used to identify services performed by: - Physician and non physician providers. Ambulance companies Durable medical equipment companies Durable Medical Equipment (DME) - Equipment that can withstand repeated use. Primarily used to serve a medical purpose. Used in the patient's home(or assisted living facility or group home) would not be used in the absence of illness or injury. Durable Medical Equipment, prosthetics, orthotics and supplies( DMEPOS ) - includes artificial limbs, braces, medications and so on. DMEPOS dealers - supply patient with DME DMEPOS claims are submitted to DME Medicare administrative contractors (DME MACs) each DME MAC covers a specific geographical region of the country and is responsible for processing DMEPOS claims for its specific region MAC - Medicare Administrative Contractor When appropriate HCPCS level II code exists, it is often assigned instead of CPt code (with same or similar code description) for: - Medicare Accounts some State Medicaid systemCMS creates Hcpcs level II code: - for services and procedures that will probably never be assigned a CPT code. to determine volume and codes of newly implemented technologies. New Hcpcs level II codes are reported for several years until - CMS initiates a process to create corresponding CPT codes When new CPT codes are published: - they are reported instead of the original HCPCS level II codes HCPCS Level II National Codes - Classify similar medical products/services. Facilitate efficient claims processing Contain a description Used primarily for billing purposes. HCPCS Level II continued to be: - reported by another payer or govt demonstration program (other than Medicare/Medicaid) Characteristic of HCPCS level II national codes: - Ensure uniform reporting of medical products or services on claims. Identify similar products or services. Not a reimbursement methodology for making coverage or payment determinations. Responsibility for HCPCS level II codes - developed and maintained by CMS DO NOT carry copyright of any organization. In public domain, which means many oublishers print annual coding manuals Some references contain: - general instructions or guidelines for each section Appendix that summarizes additions, deletions, and revisions to codes Table for DrugsTable for deleted codes. Symbols to identify codes - excluded from Medicare where paument is at payer discretion with special coverage instructions. types of HCPCS LEVEL 2 CODES - * permanent national codes, dental codes,miscellaneous codes, temporary, modifiers. Permanent national HCPCS codes are - maintained by HCPCS National Panel composed of representatives from BCBSA, HIAA and CMS Responsible for making decisions about additions , deletions and revisions to code /description Miscellaneous Code - include miscellaneous /not otherwise classified codes. Reported when DMEPOS dealer submits claim for product/servies when HC level II exists. Allow DMEPOS to submit claims for product /services as soon as FDA approval is granted. Miscellaneous Codes: Avoid inefficiency of assigning codes for - items and services that are rarely furnished. which payer expect to receive few claims. Claims w/ miscellaneous codes are manually processed and must include: - complete description of product or service. pricing information fornproduct or services. documentation to explain why item or service is needed by beneficiary.