HCPCS (Healthcare Common Procedure Coding System) codes and CPT (Current Procedural Terminology) codes are both code sets used in healthcare to describe medical procedures, services, and supplies provided to patients. However, there are some key differences between the two:
| Criteria | HCPCS Codes | CPT Codes |
|---|---|---|
| Purpose | Developed by CMS to describe and report medical services and supplies provided to Medicare and Medicaid beneficiaries | Developed by AMA to describe medical services provided by physicians and other healthcare professionals |
| Scope | Used to describe a wider range of healthcare services and supplies than CPT codes, including DMEPOS and services provided by non-physician healthcare providers | Focus primarily on services provided by physicians and other healthcare professionals |
| Code Structure | Consist of a letter followed by four digits | Consist of five digits |
| Code Levels | Divided into two levels: Level I (similar to CPT codes) and Level II (used for DMEPOS and other non-physician services) | Only one level |
| Code Updates | Updated annually by CMS | Updated annually by AMA |
While there are some differences between the two code sets, healthcare providers need to be familiar with both HCPCS codes and CPT codes in order to accurately describe and report the services they provide to their patients.
HCPCS Codes:
- Used to describe and report medical services and supplies provided to Medicare and Medicaid beneficiaries
- Used to describe and bill for DMEPOS (durable medical equipment, prosthetics, orthotics, and supplies)
- Used to describe and bill for non-physician healthcare services, such as ambulance transportation, physical therapy, and other services provided by non-physician providers
CPT Codes:
- Used to describe medical services provided by physicians and other healthcare professionals
- Used to report services provided to patients for payment purposes
- Used to document services provided for quality reporting purposes, such as reporting to insurance companies or other third-party payers
In general, HCPCS codes are used to describe and report services and supplies provided to Medicare and Medicaid beneficiaries, as well as non-physician healthcare services, while CPT codes are used primarily to describe and report services provided by physicians and other healthcare professionals. However, there may be some overlap between the two code sets, and healthcare providers need to be familiar with both in order to accurately describe and report the services they provide to their patients. For medical biller and coder help, Schedule a 1:1 with us.
