tci Medicare Compliance & Reimbursement - 2020 Issue Q2
Reader Question: Register These HCPCS, CPT® Differences
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Article Overview
This reader Q&A reviews the difference between HCPCS Level I and HCPCS Level II, with emphasis on how each code set is described in CMS guidance and how they relate to ambulatory and outpatient reporting. It is aimed at coders and billing staff who want a general orientation to the code sets, the organizations that maintain them, and the broad categories of items and services that fall under Level II. The article is a quick-reference discussion of code-set scope rather than a detailed coding tutorial.
Why This Topic Matters
Understanding the high-level divide between these code sets helps coding and billing teams recognize when a claim may call for a procedure/service code versus a separately maintained HCPCS Level II code. That can reduce confusion in routine reporting and support more accurate claim preparation.
What You Will Learn
- How HCPCS Level I and HCPCS Level II are described in CMS guidance
- Which organizations are associated with maintaining the different code sets
- The broad categories of items and services commonly associated with HCPCS Level II
- Why HCPCS Level II codes may appear on claims for more than drugs and supplies
Who Should Read This
- Medical coders
- Billing specialists
- Revenue cycle staff
- Practice administrators
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