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Medical Billing Glossary

HCPCS Code

Codes for supplies, drugs, equipment, and services that CPT alone does not cover.

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Definition

The Healthcare Common Procedure Coding System (HCPCS) is a coding set used mainly for Medicare, Medicaid, and many other payers. Level I of HCPCS is the CPT code set; Level II is a separate group of alphanumeric codes for things CPT does not describe — such as durable medical equipment, drugs, supplies, prosthetics, and certain services.

Level II codes start with a letter followed by four digits. They are how a claim reports items like a wheelchair, an injectable drug, or a supply that a plain procedure code cannot capture.

Why it matters for billing

When a service involves a drug, supply, or piece of equipment, using the correct HCPCS Level II code — with the right units and any required modifiers — is what gets those items reimbursed. Wrong or missing HCPCS coding leaves money uncollected or triggers denials.

Related terms

Terms that come up alongside HCPCS Code in the revenue cycle.

Billing that gets HCPCS Code right

EnVisionMD RCM handles eligibility, coding, documentation, denials and follow-up end to end — so the details behind terms like this one are managed for you, not left to chance.

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HCPCS Code — frequently asked questions

What is the difference between HCPCS Level I and Level II?

Level I is the CPT code set for procedures and services; Level II is a separate alphanumeric set for supplies, drugs, equipment, and services not found in CPT.

Who maintains HCPCS Level II codes?

The Centers for Medicare & Medicaid Services (CMS) maintains the HCPCS Level II code set.

Authoritative References

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