CPC EXAM: HCPCS LEVEL II
HCPCS
● Healthcare Common Procedure Coding
System
● Based on CPT
● Developed by the Center for Medicare and
Medicaid Services (CMS)
● Approximately five questions on the CPC
exam on HCPCS Level II
● Covered in Human Anatomy and Medical Technology and
Intro to HCPCS in section 2
HCPCS CONT.
● Includes codes for procedures, services,
medicine, medical products, and equipment
● Used to report procedures, services, and
equipment to Medicare, Medicaid, and many
third-party payers
STRUCTURE OF HCPCS
● Divided into two Levels
● Level I
● Identical to CPT
● Whether a code is a CPT code or HCPCS code depends on the
payer it’s being sent to
● If a CPT code is sent to Medicaid, it’s technically a HCPCS
code
● For CPC exam, you’ll need to be familiar with
HCPCS Level II
HCPCS LEVEL II
● Five characters long
● Each code starts with a letter and is followed
by four numbers
● Grouped by like procedures, services, and
equipment
● Letter denotes what grouping the codes are
in
HCPCS LEVEL II CONT.
● A-codes: Transportation, Medical and
Surgical Supplies, Miscellaneous and
Experimental
● B-codes: Enteral and Parenteral Therapy
● C-codes: Temporary Hospital Outpatient
Prospective Payment System
● D-codes: Dental codes
● E-codes: Durable Medical Equipment
● G-codes: Temporary Procedures and
Professional Services
● H-codes: Rehabilitative Services
HCPCS LEVEL II CONT.
● J-codes: Drugs administered other than oral
method, chemotherapy drugs
● K-codes: Temporary codes for durable
medical equipment regional carriers
● L-codes: Orthotic/prosthetic services
● M-codes: Medical services
● P-codes: Pathology and Laboratory
● Q-codes: Temporary codes
● R-codes: Diagnostic radiology services
● S-codes: Private payer codes
● T-codes: State Medicaid agency codes
● V-codes: Vision/hearing services
HCPCS LEVEL II CONT.
● HCPCS Level II includes things that medical
professionals use
● HCPCS Level I/CPT codes are the procedures
professionals perform using those things
● HCPCS Level II is the most specific code set
● There are different codes for each type of
wrist brace, for instance
HCPCS LEVEL II ON THE CPC EXAM
● Again, there are approximately five
questions on the CPC exam on HCPCS Level II
● If you see a HCPCS code, pay attention to the
details given and always look the code up
and confirm in the HCPCS manual
● It’s easy to find four codes that look almost
exactly the same
● Devil’s in the details
HCPCS MODIFIERS AND CPT MODIFIERS
● HCPCS has a set of two-character alpha and
alphanumeric modifiers that are added to
procedure codes with a hyphen
● These may be used with CPT modifiers
● Remember: CPT modifiers are always two
numbers
● E.g. -53
● HCPCS modifiers may be two letters or one letter
and one number
● E.g. –RT, or –A1
WHAT TO KNOW
● Medical Terminology
● Makeup of sections of HCPCS Level II
● Especially E-codes (Durable Medical Equipment)
● HCPCS Modifiers
● HCPCS coding guidelines
