HCPCS - General Information

What's New

The Centers for Medicare & Medicaid Services is pleased to announce the release of Application Summaries for external HCPCS code applications submitted in the 2016-2017 coding cycle. These summaries are arranged in order of the public meeting date at which the individual applications were discussed. The summaries include CMS’ final coding decisions.

The Centers for Medicare & Medicaid Services is pleased to announce the scheduled release of modifications to the 2017 Healthcare Common Procedure Coding System (HCPCS) code set.  These changes have been posted to the Alpha-Numeric HCPCS code list.  Final decisions for individual HCPCS code applications will be published soon, in this section. 

The Centers for Medicare & Medicaid Services is pleased to announce the release of  2016 Public Meeting Summaries [ZIP, 484KB]   for the 2016-2107 cycle.  This release is a series of Application Summary documents arranged based on product category as presented in CMS’ 2016 HCPCS public meeting agendas and public meeting summaries.

CMS has released notice of new Internal HCPCS Coding Decisions on July 5, 2016. Use the following link to view the document and instructions for submitting comments:   CMS Internal HCPCS Coding Decisions

The Centers for Medicare and Medicaid Services is pleased to announce the scheduled release of modifications to the Healthcare Common Procedure Coding System (HCPCS) code set.  These changes have been posted to the HCPCS Quarterly Update website. Changes are effective on the date indicated on the update.

The Centers for Medicare and Medicaid Services announces the release of a revised March 2016 Quarterly Update Chart for “Other Codes Effective July 1, 2016”.  The revised Quarterly HCPCS update includes new coding actions effective July 1, 2016 that were not included in the previously published file.  The revised file has been posted to CMS’ HCPCS website at HCPCS Quarterly Update . The coding changes are effective on the date indicated in the update.

The Centers for Medicare and Medicaid Services is pleased to announce the scheduled release of modifications to the Healthcare Common Procedure Coding System (HCPCS) code set.  These changes have been posted to the HCPCS website at http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/HCPCS_Quarterly_Update.html.  Changes are effective on the date indicated on the update.

CMS has released notice that the proposed revisions to HCPCS Level II Miscellaneous codes will not be implemented in 2016:   CMS Internal HCPCS Coding Decisions [PDF, 50KB] .

The Centers for Medicare & Medicaid Services Level II  HCPCS Code application deadline for the 2016-2017 coding cycle is January 4, 2016.  The updated application form and instructions, including the revised application deadline, is posted at 2018 Application & Instructions [PDF, 107KB] .

The Centers for Medicare & Medicaid Services is pleased to announce the release of final decision information pertaining to individual Level II HCPCS code applications in the 2015-2016 HCPCS coding cycle.  This information is included in an Excel spreadsheet entitled " CMS Level II HCPCS Coding Decisions for the 2016-2017 Coding Cycle [ZIP, 36KB] ."

This release is part of CMS’ 3-phase plan for adding transparency to the Level II HCPCS coding process implemented in 2014.  Other phases also implemented this year include employing live-stream technology to enable remote attendance to CMS’ HCPCS Public Meetings; and the initiation of a demonstration for a web-based notice and comment mechanism for allowing public input on requests to discontinue Level II HCPCS codes that are generated internally based on national program operating needs; are not the subject of other notice and comment mechanisms; and that are not replaced by other or new codes.

The Centers for Medicare & Medicaid Services is pleased to announce its plans to initiate a limited demonstration for web-based notice and comment mechanism for allowing public input on requests to discontinue Level II HCPCS codes, that are generated internally based on national program operating needs, are not the subject of other notice and comment mechanisms; and that are not replaced by other or new codes.

This demonstration will add further transparency to CMS’ HCPCS coding process by providing advance notice regarding internal decisions to discontinue HCPCS codes and an opportunity for public input into these decisions.  Additionally, this demonstration provides a valuable opportunity for CMS to gather critical data related to the logistics, time and resources involved in adding a public component to CMS’ internal code request process, so that we can find an appropriate balance between the need for transparency and stakeholder input, and the  need to be nimble in making coding changes to improve program administration, to the extent practicable. 

CMS reserves the right to make immediate changes without notice (and take comments afterwards), when we have a national program operating need to do so.

The first year of the demonstration will be conducted in the current (2014/2015) HCPCS coding cycle.  Afterwards, CMS will consider the results of the demonstration.

The timing and logistics of the demonstration, as follows, will also be discussed in CMS’ “Level II Coding Procedures” document, published at the HCPCS Level II Coding Process & Criteria web page.

Summaries of internal requests to discontinue permanent level II HCPCS codes (that are not the subject of other notice and comment mechanisms and/or that are not replaced by other or new codes) are published by July 1, 2014 on the CMS Internal HCPCS Coding Decisions web page.

Public comments are due, in writing, via hcpcs@cms.hhs.gov by July 21, 2014.

CMS’ HCPCS Workgroup will re-review the internal requests, together with input received timely via the above process. The final decision will be folded into the outgoing HCPCS Annual Update.

CMS has additional plans for adding transparency to the Level II HCPCS coding process, which include employing live-stream technology to enable remote attendance to CMS’ HCPCS Public meetings, effective as of the 2014 CMS’ HCPCS public meetings.  Details are published in our document entitled: “Guidelines for Participation in CMS’ HCPCS Public Meetings" on CMS’ official HCPCS website. CMS is also developing a mechanism to share information pertaining to final decisions for individual HCPCS code applications. 

HCPCS Background Information

Each year, in the United States, health care insurers process over 5 billion claims for payment. For Medicare and other health insurance programs to ensure that these claims are processed in an orderly and consistent manner, standardized coding systems are essential. The HCPCS Level II Code Set is one of the standard code sets used for this purpose. The HCPCS is divided into two principal subsystems, referred to as level I and level II of the HCPCS. Level I of the HCPCS is comprised of CPT (Current Procedural Terminology), a numeric coding system maintained by the American Medical Association (AMA). The CPT is a uniform coding system consisting of descriptive terms and identifying codes that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals. These health care professionals use the CPT to identify services and procedures for which they bill public or private health insurance programs. Decisions regarding the addition, deletion, or revision of CPT codes are made by the AMA. The CPT codes are republished and updated annually by the AMA. Level I of the HCPCS, the CPT codes, does not include codes needed to separately report medical items or services that are regularly billed by suppliers other than physicians.

Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office. Because Medicare and other insurers cover a variety of services, supplies, and equipment that are not identified by CPT codes, the level II HCPCS codes were established for submitting claims for these items. The development and use of level II of the HCPCS began in the 1980's. Level II codes are also referred to as alpha-numeric codes because they consist of a single alphabetical letter followed by 4 numeric digits, while CPT codes are identified using 5 numeric digits.