HCPCS Modifier Codes - C Codes
HCPCS Modifier Codes for Procedure, Supply & DME (Durable Medical Equipment) Codes ("C" Codes):- CA PROCEDURE PAYABLE ONLY IN THE INPATIENT SETTING - HCPCS Modifier Code Code
- CB SERVICE ORDERED BY A RENAL DIALYSIS FACILITY - HCPCS Modifier Code Code
- CC PROCEDURE CODE CHANGE (USE 'CC' WHEN THE - HCPCS Modifier Code Code
- CD AMCC TEST HAS BEEN ORDERED BY AN - HCPCS Modifier Code Code
- CE AMCC TEST HAS BEEN ORDERED BY AN - HCPCS Modifier Code Code
- CF CF AMCC TEST HAS BEEN ORDERED BY - HCPCS Modifier Code Code
- CG POLICY CRITERIA APPLIED HCPCS Modifier Code Code
- CH 0 percent impaired, limited or restricted HCPCS Modifier Code Code
- CI At least 1 percent but less than HCPCS Modifier Code Code
- CJ At least 20 percent but less than HCPCS Modifier Code Code
- CK At least 40 percent but less than HCPCS Modifier Code Code
- CL At least 60 percent but less than HCPCS Modifier Code Code
- CM At least 80 percent but less than HCPCS Modifier Code Code
- CN 100 percent impaired, limited or restricted HCPCS Modifier Code Code
- CO Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant HCPCS Modifier Code Code
- CP Adjunctive service related to a procedure assigned to a comprehensive ambulatory payment classification (c-apc) procedure, but reported on a differ Code
- CQ Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant HCPCS Modifier Code Code
- CR CATASTROPHE/DISASTER RELATED HCPCS Modifier Code Code
- CS ITEM OR SERVICE RELATED, IN WHOLE OR HCPCS Modifier Code Code
- CT Computed tomography services furnished using equipment that does not meet each of the attributes of the national electrical manufacturers associati Code
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HCPCS Medical Codes & Code Modifiers
(HCPCS is commonly pronounced Hick-Picks.)Each year, in the United States, health care insurers process over 5 billion claims for payment. For Medicare and other health insurance programs to ensure that these claims are processed in an orderly and consistent manner, standardized coding systems are essential. The HCPCS Level II Code Set is one of the standard code sets used for this purpose. The HCPCS is divided into two principal subsystems, referred to as level I and level II of the HCPCS. Level I of the HCPCS is comprised of CPT (Current Procedural Terminology), a numeric coding system maintained by the American Medical Association (AMA). The CPT is a uniform coding system consisting of descriptive terms and identifying codes that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals. These health care professionals use the CPT to identify services and procedures for which they bill public or private health insurance programs. Decisions regarding the addition, deletion, or revision of CPT codes are made by the AMA. The CPT codes are republished and updated annually by the AMA. Level I of the HCPCS, the CPT codes, does not include codes needed to separately report medical items or services that are regularly billed by suppliers other than physicians.
Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office. Because Medicare and other insurers cover a variety of services, supplies, and equipment that are not identified by CPT codes, the level II HCPCS codes were established for submitting claims for these items. The development and use of level II of the HCPCS began in the 1980's. Level II codes are also referred to as alpha-numeric codes because they consist of a single alphabetical letter followed by 4 numeric digits, while CPT codes are identified using 5 numeric digits.
In October of 2003, the Secretary of HHS delegated authority under the HIPAA legislation to CMS to maintain and distribute HCPCS Level II Codes. As stated in 42 CFR Sec. 414.40 (a) CMS establishes uniform national definitions of services, codes to represent services, and payment modifiers to the codes. Within CMS there is a CMS HCPCS Workgroup which is an internal workgroup comprised of representatives of the major components of CMS, as well as other consultants from pertinent Federal agencies. Prior to December 31, 2003, Level III HCPCS were developed and used by Medicaid State agencies, Medicare contractors, and private insurers in their specific programs or local areas of jurisdiction. For purposes of Medicare, level III codes were also referred to as local codes. Local codes were established when an insurer preferred that suppliers use a local code to identify a service, for which there is no level I or level II code, rather than use a "miscellaneous or not otherwise classified code." The Health Insurance Portability and Accountability Act of 1996 (HIPAA) required CMS to adopt standards for coding systems that are used for reporting health care transactions. We published, in the Federal Register on August 17, 2000 (65 FR 50312), regulations to implement this part of the HIPAA legislation. These regulations provided for the elimination of level III local codes by October 2002, at which time, the level I and level II code sets could be used. The elimination of local codes was postponed, as a result of section 532(a) of BIPA, which continued the use of local codes through December 31, 2003.
(Source: http://www.cms.hhs.gov/MedHCPCSGenInfo/)
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