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HIPAA Transactions and Code Sets

Code Sets - HCPCS

HCPCS codes are particularly specified in the HIPAA Transactions and Code Set regulation. The Secretary of the Department of Health and Human Services has adopted the HCPCS code sets as a standard medical data code set to be used in health care services.CMS Background information on HCPCS codes

The combination of Centers for Medicare & Medicaid Services (formerly known as Health Care Financing Administration) Common Procedure Coding System (HCPCS), as updated and distributed by HHS; and Current Procedural Terminology, Fourth Edition (CPT-4), as updated and distributed by the American Medical Association, for physician services and other health related services. These services include, but are not limited to, the following:

  1. Physician services.
  2. Physical and occupational therapy services.
  3. Radiological procedures.
  4. Clinical laboratory tests.
  5. Other medical diagnostic procedures.
  6. Hearing and vision services.
  7. Transportation services including ambulance.

 The Centers for Medicare & Medicaid Services Common Procedure Coding System (HCPCS), as updated and distributed by CMS, HHS, for all other substances, equipment, supplies, or other items used in health care services. These items include, but are not limited to, the following:

  1. Medical supplies.
  2. Orthotic and prosthetic devices.
  3. Durable medical equipment.

HCPCS Level 3 codes established on a local basis can no longer be used

Quarterly Updates

NEWS: 

January 10, 2006 AHA and CMS Establish Clearinghouse for Questions on HCPCS Coding The American Hospital Association (AHA) and the Centers for Medicare & Medicaid Services (CMS) are collaborating on a clearinghouse to address questions on better using the Healthcare Common Procedure Coding System (HCPCS), a national standard code set used by healthcare practitioners, providers and suppliers throughout the US when filing insurance claims for drugs, medical devices, and other items and services. The AHA's Central Office will handle the clearinghouse functions and provide open access to anyone with questions regarding HCPCS coding. The HCPCS was established in 1978 by CMS to provide a standardized coding system for describing the specific items and services provided in the delivery of healthcare. In August 2000, HCPCS was designated a national standard code set under HIPAA for use in all electronic transactions relating to payment for the items and services it covers. (from HIPAAdvisory.com) Read more. 

HCPCS: Information about HCPCS is available from the CMS by searching their web site at http://cms.hhs.gov.

This page was last updated February 7, 2006 and is maintained by