HCPCS (Healthcare Common Procedure Coding System) is the code set used to report medical procedures, supplies, drugs and services on claims. Level I is CPT, maintained by the AMA. Level II is a letter followed by four numbers (such as J1745 or E0601), maintained by CMS, and covers items CPT does not, including DME, ambulance services, drugs and supplies.
When it comes to medical coding, understanding the different code sets is essential for accurate billing and reimbursement. One such code set that plays a critical role in healthcare services is HCPCS. But what is HCPCS in medical coding?
Understanding HCPCS
HCPCS (pronounced “hick-picks”) stands for Healthcare Common Procedure Coding System and is a standardized coding system used to describe specific items and services provided in the delivery of healthcare. The Centers for Medicare and Medicaid Services (CMS) developed it to ensure uniformity in billing and data collection across the United States.
Providers and payers primarily use HCPCS codes for:
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Billing Medicare, Medicaid, and other insurance programs
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Tracking utilization of supplies and services
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Facilitating claims processing
Levels of HCPCS Codes
HCPCS is divided into two levels, each serving a unique purpose:
Level I: CPT Codes
Level I consists of the Current Procedural Terminology (CPT) codes, maintained by the American Medical Association (AMA). These are five character codes used for:
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Physician services
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Outpatient procedures
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Diagnostic services
While CPT codes fall under the HCPCS umbrella, coders commonly refer to them separately because of their widespread use in general medical coding.
Level II: HCPCS Codes
In contrast, Level II HCPCS codes are alphanumeric and start with a letter (A–V), followed by four numbers. These codes cover:
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Durable medical equipment (DME)
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Prosthetics and orthotics
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Ambulance services
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Medical supplies
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Certain drugs and biologicals
For example, A0428 is the code for Basic Life Support, non-emergency ambulance transport.
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Why HCPCS Matters
HCPCS codes are crucial for coders working with government payers and in outpatient settings. As a result, without accurate use of HCPCS codes, healthcare providers may face claim denials, delayed payments, or compliance issues.
In addition, these codes help standardize reporting and data collection across facilities, improving the consistency of healthcare statistics and analytics.
Therefore, if you’re pursuing a career in medical coding or billing, mastering HCPCS is just as important as understanding CPT and ICD-10 codes. Because changes and updates come out annually, staying current with HCPCS guidelines is key to success in the healthcare reimbursement field.
HCPCS code free lookup by ICD-10 data .com hcpcs.codes: A Codes
Frequently Asked Questions About HCPCS
What is the difference between CPT and HCPCS?
CPT is HCPCS Level I and describes physician and outpatient services. HCPCS Level II covers items and services CPT does not include, such as durable medical equipment, ambulance transport, drugs and supplies.
Who maintains HCPCS Level II codes?
CMS maintains HCPCS Level II. CPT, which is Level I, is maintained by the American Medical Association.
How often are HCPCS codes updated?
HCPCS Level II has an annual update each January plus quarterly updates during the year, so drug and supply codes can change more than once a year.
What do HCPCS Level II modifiers do?
Level II modifiers are two characters, such as RT, LT or GA, and add information about a service, like laterality or whether an advance beneficiary notice is on file.
Is HCPCS on the CPC exam?
Yes. The CPC exam includes HCPCS Level II questions, so you need to know how to use the index and the code book. See what is on the CPC exam in 2026.