HCPCS FINAL EXAM ACTUAL 2026/2027 QUESTIONS AND
SOLUTIONS RATED A+
✔✔B-codes (example: B4034) - ✔✔Enteral and Parenteral Therapy
✔✔C-codes (example: C1300) - ✔✔Temporary Hospital Outpatient Prospective
Payment System
✔✔D-codes: - ✔✔Dental Procedures- not listed in HCPCS
✔✔E-codes (example: E0100) - ✔✔Durable Medical Equipment
✔✔G-codes (example: G0008) - ✔✔Temporary Procedures & Professional Services
✔✔H-codes (example: H0001) - ✔✔Rehabilitative Services
✔✔J-codes (example: J0120) - ✔✔Drugs Administered Other Than Oral Method,
Chemotherapy Drugs
✔✔K-codes (example: K0001) - ✔✔Temporary Codes for Durable Medical Equipment
Regional Carriers
✔✔L-codes (example: L0112) - ✔✔Orthotic/Prosthetic Procedures
✔✔M-codes (example: M0064) - ✔✔Medical Services
✔✔P-codes (example: P2028) - ✔✔Pathology and Laboratory
✔✔Q-codes (example: Q0035) - ✔✔Temporary Codes
✔✔R-codes (example: R0070) - ✔✔Diagnostic Radiology Services
✔✔S-codes (example: S0012) - ✔✔Private Payer Codes
✔✔T-codes (example: T1000) - ✔✔State Medicaid Agency Codes
✔✔V-codes (example: V2020) - ✔✔Vision/Hearing Services
✔✔Place-of-Service codes - ✔✔are a two-digit code used on CMS 1500 claim form
(Box# 24B) to indicate where health care services are rendered.
✔✔Guidelines for reporting unlisted procedures - ✔✔Should those instances occur,
then the procedure must be reported using an appropriate "unlisted" CPT code.
, ✔✔prior authorization - ✔✔Most payors have a prior authorization form that allows the
surgeon to describe the planned procedure and the medical necessity of the operation.
✔✔To justify the service fee - ✔✔it is recommended that a cover letter is attached
✔✔ Current Procedural Terminology (CPT) - ✔✔used by physicians and other
healthcare providers. It is considered Level I of the HCPCS.
✔✔History of Present Illness - ✔✔description of its development from the first sign or
symptom that the patient experienced to the present time.
✔✔Past Medical History - ✔✔the patient's experiences with illnesses, injuries, and
treatments in addition to operations, injuries and hospitalizations.
✔✔Family History - ✔✔reviews the medical history of the patient's family.
✔✔Social History - ✔✔patient's age, marital status, employment, etc.
✔✔Chief complaint - ✔✔Of present illness, review of symptom,Past, Family and or
Social History
✔✔History Levels - ✔✔Problem focused, expanded problem focused, Detailed,
Comprehensive
✔✔Examination Levels - ✔✔Problem focused, expanded problem focused, Detailed,
Comprehensive
✔✔Medical Decision-Making Complexity Levels - ✔✔Straightforward, Low, Moderate,
High
✔✔Straightforward - ✔✔Minimal diagnosis, Minimal Risk, Minimal complexity of data
✔✔Low - ✔✔Limited diagnosis, Limited/Low risk to patient, Limited data
✔✔Moderate - ✔✔Multiple diagnoses, Moderate risk to the patient, Moderate amount of
complexity of data
✔✔High - ✔✔Extensive diagnoses , High risk to patient, Extensive amount and
comp,lexity of data
✔✔Physical Status Modifiers - ✔✔P1 A normal healthy patient
✔✔P2 - ✔✔A patient with mild systemic disease
SOLUTIONS RATED A+
✔✔B-codes (example: B4034) - ✔✔Enteral and Parenteral Therapy
✔✔C-codes (example: C1300) - ✔✔Temporary Hospital Outpatient Prospective
Payment System
✔✔D-codes: - ✔✔Dental Procedures- not listed in HCPCS
✔✔E-codes (example: E0100) - ✔✔Durable Medical Equipment
✔✔G-codes (example: G0008) - ✔✔Temporary Procedures & Professional Services
✔✔H-codes (example: H0001) - ✔✔Rehabilitative Services
✔✔J-codes (example: J0120) - ✔✔Drugs Administered Other Than Oral Method,
Chemotherapy Drugs
✔✔K-codes (example: K0001) - ✔✔Temporary Codes for Durable Medical Equipment
Regional Carriers
✔✔L-codes (example: L0112) - ✔✔Orthotic/Prosthetic Procedures
✔✔M-codes (example: M0064) - ✔✔Medical Services
✔✔P-codes (example: P2028) - ✔✔Pathology and Laboratory
✔✔Q-codes (example: Q0035) - ✔✔Temporary Codes
✔✔R-codes (example: R0070) - ✔✔Diagnostic Radiology Services
✔✔S-codes (example: S0012) - ✔✔Private Payer Codes
✔✔T-codes (example: T1000) - ✔✔State Medicaid Agency Codes
✔✔V-codes (example: V2020) - ✔✔Vision/Hearing Services
✔✔Place-of-Service codes - ✔✔are a two-digit code used on CMS 1500 claim form
(Box# 24B) to indicate where health care services are rendered.
✔✔Guidelines for reporting unlisted procedures - ✔✔Should those instances occur,
then the procedure must be reported using an appropriate "unlisted" CPT code.
, ✔✔prior authorization - ✔✔Most payors have a prior authorization form that allows the
surgeon to describe the planned procedure and the medical necessity of the operation.
✔✔To justify the service fee - ✔✔it is recommended that a cover letter is attached
✔✔ Current Procedural Terminology (CPT) - ✔✔used by physicians and other
healthcare providers. It is considered Level I of the HCPCS.
✔✔History of Present Illness - ✔✔description of its development from the first sign or
symptom that the patient experienced to the present time.
✔✔Past Medical History - ✔✔the patient's experiences with illnesses, injuries, and
treatments in addition to operations, injuries and hospitalizations.
✔✔Family History - ✔✔reviews the medical history of the patient's family.
✔✔Social History - ✔✔patient's age, marital status, employment, etc.
✔✔Chief complaint - ✔✔Of present illness, review of symptom,Past, Family and or
Social History
✔✔History Levels - ✔✔Problem focused, expanded problem focused, Detailed,
Comprehensive
✔✔Examination Levels - ✔✔Problem focused, expanded problem focused, Detailed,
Comprehensive
✔✔Medical Decision-Making Complexity Levels - ✔✔Straightforward, Low, Moderate,
High
✔✔Straightforward - ✔✔Minimal diagnosis, Minimal Risk, Minimal complexity of data
✔✔Low - ✔✔Limited diagnosis, Limited/Low risk to patient, Limited data
✔✔Moderate - ✔✔Multiple diagnoses, Moderate risk to the patient, Moderate amount of
complexity of data
✔✔High - ✔✔Extensive diagnoses , High risk to patient, Extensive amount and
comp,lexity of data
✔✔Physical Status Modifiers - ✔✔P1 A normal healthy patient
✔✔P2 - ✔✔A patient with mild systemic disease
