What is the Difference Between CPT and HCPCS Codes
CPT (Current Procedural Terminology) & HCPCS (Healthcare Common Procedure Coding System) are essential coding systems used in the healthcare industry for documenting and billing medical services.
CPT codes are used to describe surgical, medical, and diagnostic services, while HCPCS codes are used to identify products, supplies, & services not included in the CPT codes, such as durable medical equipment, prosthetics, orthotics, and supplies. Both systems are crucial for accurate and efficient billing, reimbursement, and data analysis within the healthcare industry.
5 Key Difference Between CPT v/s HCPCS Codes
CPT (Current Procedural Terminology) and HCPCS (Healthcare Common Procedure Coding System) are both coding systems used in the healthcare industry, but they serve different purposes and are used in different contexts. Here are the main differences between CPT and HCPCS:
1. Purpose and Scope
CPT (Current Procedural Terminology):
Developed by: The American Medical Association (AMA).
Purpose: Primarily used to describe medical, surgical, and diagnostic services and procedures provided by healthcare professionals.
Scope: CPT codes are used to report services and procedures performed by physicians and other healthcare providers in outpatient settings.
HCPCS (Healthcare Common Procedure Coding System):
Developed by: The Centers for Medicare & Medicaid Services (CMS).
Purpose: Designed to ensure uniformity in coding and billing for healthcare services, supplies, and equipment not covered by CPT codes.
Scope: HCPCS includes two levels: Level I (CPT codes) and Level II (national codes for supplies, equipment, and non-physician services).
2. Code Structure
CPT:
Code Format: Consists of five numeric characters (e.g., 99213 for an office visit).
Categories: Divided into three categories:
Category I: Describes common medical procedures and services.
Category II: Supplemental tracking codes for performance management.
Category III: Temporary codes for emerging technologies and procedures.
HCPCS:
Code Format: Level I uses CPT codes; Level II codes consist of a single letter followed by four numeric characters (e.g., A0425 for ground ambulance service).
Categories:
Level I: CPT codes (as described above).
Level II: National codes for supplies, equipment, and non-physician services (e.g., ambulance services, durable medical equipment, prosthetics).
3. Usage and Application
CPT:
Usage: Commonly used in outpatient and physician office settings to report medical procedures and services to private insurers, Medicare, and Medicaid.
Application: Covers a wide range of services, including surgeries, radiology, laboratory tests, and evaluation and management services.
HCPCS:
Usage: Used by Medicare, Medicaid, and other insurers to report services, supplies, and equipment not included in CPT codes.
Application: Includes codes for durable medical equipment (DME), prosthetics, ambulance services, and certain drugs and medical supplies.
4. Regulatory Authority
CPT:
Authority: Maintained and updated annually by the American Medical Association (AMA).
HCPCS:
Authority: Level I maintained by AMA; Level II maintained and updated by CMS.
5. Examples
CPT:
99213: Office or other outpatient visit for the evaluation and management of an established patient.
71020: Radiologic examination, chest; two views, frontal and lateral.
HCPCS:
A0425: Ground mileage, per statute mile (ambulance service).
E0118: Crutch substitute, lower leg platform, with or without wheels, each.
While CPT codes are used primarily for medical procedures and services, HCPCS codes extend beyond this to include a broader range of healthcare services, supplies, and equipment. Both coding systems are essential for accurate billing and reimbursement in the healthcare industry.
