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HCPCS Level II Codes

The Centers for Medicare and Medicaid Services (CMS) created the Healthcare Common Procedure Coding System (HCPCS) to comply with the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The HCPCS established a standardized coding system for medical procedures regardless of the provider or insurer. HCPCS consists of medical procedures as described in the Current Procedural Terminology (CPT) written by the American Medical Association (AMA). HCPCS level II covers all medical procedures, services and equipment not covered in HCPCS level I.

  1. Permanent National Codes

    • The CMS HCPCS workgroup maintains the list of permanent national codes. All insurance providers, both public and private, as well as Price, Data, Analysis and Coding (PDAC) and Medicaid all have a representative in the workgroup. Members vote on the addition, deletion or revision of codes. This prevents any one insurer from changing the body of the HCPCS for its own purposes. The permanent national codes provide a stable set of billing codes. The workgroup publishes any changes annually on January 1.

    Dental Codes

    • The HCPCS level II coding system contains all the codes necessary for dental billing. The American Dental Association (ADA) publishes the Current Dental Terminology (CDT), which the CMS incorporated into the HCPCS level II coding system. The ADA oversees any changes made to this portion of the code and is not required to report to the CMS HCPCS workgroup.

    Miscellaneous Codes

    • Miscellaneous codes allow suppliers to bill for services and equipment that may not be listed in the current HCPCS level II. These codes also allow billing for unique, one-time services. If the supplier cannot locate an appropriate code, he must contact the PDAC. The PDAC will help the supplier locate an appropriate code or instruct the supplier to submit the claim under a "miscellaneous/not otherwise classified" code. If the supplier feels that the service will be used frequently, he can submit a request for a revision of the HCPCS level II to create a permanent code.

    Temporary National Codes

    • The CMS HCPCS workgroup issues temporary codes on a quarterly basis to help insurance providers meet billing needs before the annual issuance of permanent codes. A temporary code allows the insurer to bill for a specific item rather than using a miscellaneous code. The insurer should expect a 90-day window before implementation after a temporary code is issued. This allows for notification and education of all billing entities. Temporary codes have the potential to become permanent codes. However, the workgroup is not under any obligation to convert the code, and temporary codes do not expire. If the workgroup selects a temporary code to be converted or incorporated into a permanent national code, the temporary code is deleted.

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