HCPCS LEVEL II | QUESTIONS AND ANSWERS |
2025/2026 UPDATE | WITH COMPLETE SOLUTION!!
The HCPCS codes are Answer - 5 digits
The first digit is a letter, followed by four numbers. The codes and descriptions
are updated each year by CMS.
The HCPCS Level II uses several symbols and conventions to alert coders to
Answer - key pieces of information related to code assignment and/or
reimbursement.
Examples include the Answer - identification of new, revised, deleted, and
reinstated codes and the identification of codes that represent services not
covered by Medicare.
The meaning of the symbols is explained in the HCPCS book and Answer - the
symbols and their descriptions are also included in the lower margins of the
pages of the HCPCS Tabular List for ease of reference.
Special Coverage Instructions (sun) Answer - This symbol indicates that special
coverage instructions apply to the code. Coders should consult the coverage
instructions before assigning the code. The special instructions are usually
included in CMS' Internet Only Manuals (IOM). References to the location of
the IOM are presented in the form of Medicare Pub 100 reference numbers.
, Not Covered or Valid by Medicare -(red crossed out) Answer - This symbol
indicates that the service, procedure, or item represented by the code is not
covered by Medicare. The reason for non-coverage is also usually included in
CMS' Internet Only Manuals (IOM).
carrier discretion (flower) Answer - This symbol indicates that the third party
payer must be consulted to determine the coverage that will be provided for
the service or supply represented by the code.
ASC/OPPS Status Indicators - Answer - The ASC status indicators identify how a
specific procedure, item, or service is paid or not paid under the OPPS.
ASC Payment Indicators- Answer - The ASC payment indicators identify how
the ASC payment for a specific procedure, item, or service is derived under the
ASC payment system.
Locate the code G9091. Which of the following is true about the ASC Status
Indicator listed? Answer - indicates codes not allowed or paid under OPPS
The ASC Payment Indicator of N1 is listed beside code C9738. How is the
payment for this service determined? Answer - packaged service or item
The ASC Payment Indicator listed after the code C9725 indicates which of the
following? Answer - paid under OPPS; separate APC payment
The ASC Status Indicator to the right of code J7307 indicates which of the
following? Answer - payment is not allowed under the OPPS
The ASC payment indicator listed after the code J1670 indicates which of the
following? Answer - payment based on OPPS rate
2025/2026 UPDATE | WITH COMPLETE SOLUTION!!
The HCPCS codes are Answer - 5 digits
The first digit is a letter, followed by four numbers. The codes and descriptions
are updated each year by CMS.
The HCPCS Level II uses several symbols and conventions to alert coders to
Answer - key pieces of information related to code assignment and/or
reimbursement.
Examples include the Answer - identification of new, revised, deleted, and
reinstated codes and the identification of codes that represent services not
covered by Medicare.
The meaning of the symbols is explained in the HCPCS book and Answer - the
symbols and their descriptions are also included in the lower margins of the
pages of the HCPCS Tabular List for ease of reference.
Special Coverage Instructions (sun) Answer - This symbol indicates that special
coverage instructions apply to the code. Coders should consult the coverage
instructions before assigning the code. The special instructions are usually
included in CMS' Internet Only Manuals (IOM). References to the location of
the IOM are presented in the form of Medicare Pub 100 reference numbers.
, Not Covered or Valid by Medicare -(red crossed out) Answer - This symbol
indicates that the service, procedure, or item represented by the code is not
covered by Medicare. The reason for non-coverage is also usually included in
CMS' Internet Only Manuals (IOM).
carrier discretion (flower) Answer - This symbol indicates that the third party
payer must be consulted to determine the coverage that will be provided for
the service or supply represented by the code.
ASC/OPPS Status Indicators - Answer - The ASC status indicators identify how a
specific procedure, item, or service is paid or not paid under the OPPS.
ASC Payment Indicators- Answer - The ASC payment indicators identify how
the ASC payment for a specific procedure, item, or service is derived under the
ASC payment system.
Locate the code G9091. Which of the following is true about the ASC Status
Indicator listed? Answer - indicates codes not allowed or paid under OPPS
The ASC Payment Indicator of N1 is listed beside code C9738. How is the
payment for this service determined? Answer - packaged service or item
The ASC Payment Indicator listed after the code C9725 indicates which of the
following? Answer - paid under OPPS; separate APC payment
The ASC Status Indicator to the right of code J7307 indicates which of the
following? Answer - payment is not allowed under the OPPS
The ASC payment indicator listed after the code J1670 indicates which of the
following? Answer - payment based on OPPS rate
