Questions and Answers
HCPCS level II codes are considered ____ codes:
national
HCPCS level II codes describe procedures, services, and _______:
durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)
CPT codes are included as HCPCS ____ codes:
Level I
HCPCS level II codes are ____ characters in length:
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HCPCS level II codes begin with the letters ____:
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HCPCS level II codes are developed and maintained by the _____:
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Services and procedures that are reimbursed by a MAC can be found in the _______:
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Whether a service is covered or excluded under the Medicare program can be found in the _______:
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HCPCS level II _____ are attached to any HCPCS level I (CPT) or II (national) code to provide additional information regarding the product or service reported.:
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HCPCS level II and CPT codes and multiple modifiers are reported on the same line of Block 24D on the _____ claim, such as 26010 FA F1.:
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HCPCS level II miscellaneous codes are reported when a(n) ______ HCPCS level II miscellaneous codes are reported when a(n):
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HCPCS level II temporary codes allow payers the flexibility to establish codes that are needed before the next annual update on _____:
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Modifier ___ is added to codes for procedures that are performed on both sides during the same operative session.:
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HCPCS level II ____ are added to HCPCS level I (CPT) and level II (national) codes.:
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Some services must be reported by assigning both a CPT and an HCPCS level II code; the most common scenario uses a CPT code for administration of a(n) ____ and the HCPCS level II code to identify the ______:
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If a drug is administered in a 100-mg dose and the HCPCS level II code description states 'per 50 mg,' the quantity billed is ____:
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If just 10 mg of a drug were administered and the HCPCS level II code description stated 'up to 15 mg,' the quantity billed is ____:
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The charge for office visit or procedure usually includes ____ used to perform the procedure or service.:
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Although CMS developed this system, some HCPCS level I and II services are not payable by ____:
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Some HCPCS level II coding manuals include a table of drugs that lists J codes assigned to ____:
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CMS developed the level II codes for Medicare, but _____ also adopted them:
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When a physician treats a Medicare patient for a fractured femur and supplies the patient with crutches, two claims are generated. The physician's claim for the fracture care is sent to the _____, and the claim for the crutches is sent to the _____:
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For certain items or services reported on a claim submitted to the DME MAC, the DMEPOS dealer must receive a signed _______:
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Which processes claims for providers?
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Which processes claims for DMEPOS dealers?
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Study Notes
HCPCS Level II Codes
- HCPCS level II codes are national codes used to describe services and procedures.
- They cover durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).
- These codes are developed and maintained by the CMS HCPCS workgroup.
Code Structure and Characteristics
- HCPCS level II codes consist of 5 characters.
- They begin with the letters A through V.
- Level I codes (CPT) are included in HCPCS, often referred to as CPT level I codes.
Claims and Coverage
- Services reimbursed by a MAC are detailed in the Medicare Benefit Policy Manual.
- Coverage determinations under Medicare can be found in the Medicare National Coverage Determinations Manual.
- Claims for both HCPCS and CPT codes, including modifiers, are reported on the same line of Block 24D of the CMS-1500 claim form.
Modifiers and Special Codes
- Modifiers such as -50 are used for procedures performed bilaterally in the same session.
- HCPCS level II miscellaneous codes apply when a DMEPOS dealer is involved, used for unspecified products.
- Temporary HCPCS level II codes provide flexibility for payers to establish necessary codes before the annual January 1 update.
Billing and Quantity
- Specific scenarios require both a CPT and an HCPCS level II code, often for injections where a CPT code is used for administration.
- Billing practices dictate specific quantities; for example, if a 100-mg drug described as "per 50 mg" is given, the quantity billed would be 2.
- If 10 mg is given and described as "up to 15 mg," the quantity billed would be 1.
Other Considerations
- Office visits or procedures generally include the cost of supplies.
- Some level I and II services may not be reimbursed by Medicare despite CMS's development of these codes.
- Certain coding manuals for HCPCS level II list J codes for medications.
Insurance Claims Processing
- Claims for services are processed differently; the physician's claims go to the primary MAC while DME-related claims are sent to the DME MAC.
- A signed certificate of medical necessity (CMN) is required for specific items or services reported to the DME MAC.
- Primary MAC handles claims for providers whereas DME MAC processes claims for DMEPOS dealers.
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Test your knowledge of HCPCS Level II codes with this set of flashcards. Each card presents a question about the codes, definitions, and their applications. Perfect for healthcare professionals looking to enhance their coding skills.
