Healthcare Common Procedure Coding System (HCPCS)

Each year in the U.S., health care insurers process over 5 billion claims for payment. Standardized coding systems are essential so Medicare and other health insurance programs can process claims in an orderly and consistent manner. HCPCS is divided into 2 main subsystems — Level I and Level II.

HCPCS Level I: Comprised of Current Procedural Terminology (CPT®), a numeric coding system maintained by the American Medical Association (AMA). 

• CPT® is a uniform coding system consisting of descriptive terms and identifying codes used primarily to identify medical services and procedures furnished by physicians and other health care professionals for which they bill public or private health insurance programs. 
• The AMA annually republishes and updates CPT® codes.
• CPT® codes consist of 5 numeric digits.
• Contact the AMA for issues related to the application of HCPCS Level I CPT® codes for physicians.

HCPCS Level II: A standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT® codes, such as ambulance services or durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office.

• Medicare and other insurers cover a variety of services, supplies, and equipment that aren't identified by CPT® codes. The HCPCS Level II codes were established so providers and suppliers can submit claims for these items. 
• HCPCS Level II codes (also known as alpha-numeric codes) consist of a single alphabetical letter followed by 4 numeric digits. 
• CMS maintains HCPCS Level II codes, including decisions about additions, revisions, and deletions to the codes.
  • The HCPCS Level II coding system began in the 1980s.
  • In 2003, under 42 CFR 414.40(a), the HHS Secretary delegated authority to CMS to establish and maintain uniform national definitions of services, codes to represent services, and payment modifiers to the codes.
•  For questions about HCPCS Level II, contact [email protected].

Medicare Electronic Application Request Information System (MEARIS™)

Visit MEARIS™ to submit HCPCS Level II coding application.

• Anyone may submit a request to modify the HCPCS Level II national code set.
• Use the MEARIS™ electronic application to submit HCPCS Level II:
  • Quarterly drug and biological product applications.
  • Biannual non-drug and non-biological items and services applications.
• Application due dates: 
  • Drug and biological products: The first business day of each quarter (January, April, July, and October)
  • Non-drug and non-biological items and services: The first business day of January and July

What's New

08/16/2024

PUBLICATION OF CODING DECISIONS AND MEDICARE BENEFIT CATEGORY & PAYMENT DETERMINATIONS FOR B1 2024 HCPCS LEVEL II NON-DRUG AND NON-BIOLOGICAL ITEMS AND SERVICES APPLICATIONS

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce publication of its Healthcare Common Procedure Coding System (HCPCS) Application Summaries, Coding Decisions and Benefit Category & Payment Determinations for the first bi-annual (B1) 2024 Non-Drug and Non-Biological Items and Services at: https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/Prior-Years-CMS-HCPCS-LevelII-Coding-Decisions-Narrative-Summary.

This narrative summary document includes the B1 2024 HCPCS Level II applications for non-drug and non-biological items and services coding requests. For each application, the following information is provided:

• a statement of the topic/issue;
• a summary of the applicant’s request;
• CMS’ preliminary coding recommendation;
• CMS’ preliminary Medicare benefit category determination;
• CMS’ preliminary Medicare payment determination;
• Summary of public feedback;
• CMS’ final HCPCS coding decision;
• Final Medicare benefit category determination; and
• Final Medicare payment determination.

Please continue to monitor this web site for CMS’ October 2024 HCPCS Update file, which will be published separately in the coming weeks, at: https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/HCPCS-Quarterly-Update.  

To view older announcements, visit HCPCS Level II Archive.

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