Overview

The Healthcare Common Procedure Coding System (HCPCS) was established in 1978 to provide a standardized coding system for describing the specific items and services provided in the delivery of health care. Such coding is necessary for Medicare, Medicaid, and other health insurance programs to ensure that insurance claims are processed in an orderly and consistent manner. Initially, use of the codes was voluntary, but with the implementation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) use of the HCPCS for transactions involving health care information became mandatory.

The HCPCS is divided into two principal subsystems, referred to as Level I and Level II. Level I is comprised of the CPT-4, a numeric coding system maintained by the American Medical Association (AMA) to identify medical services and procedures furnished by physicians and other health care professionals. The Level II HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT-4 codes. HCPCS is not a methodology or system for making coverage or payment determinations, and the existence of a code does not, of itself, determine coverage or non-coverage for an item or service.  The Level II HCPCS is maintained and distributed by CMS, in conjunction with private payer organizations.

Public requests for modifications to the existing HCPCS Level II Code Set must be submitted by following the procedures outlined at the Medicare HCPCS website identified in the related link below. 

State Medicaid agency requests for modifications to the existing HCPCS Level II Code Set should be submitted by following the procedures outlined at the Medicaid HCPCS website identified in the related link below.