Attribute: HCPCS Code
The Healthcare Common Procedure Coding System (HCPCS) is a standardized coding system used primarily for billing purposes. GHX uses only level II codes, which identify products, supplies, and services not included in provider codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).
Data Sources
HCPCS codes are maintained by the Centers for Medicare & Medicaid Services (CMS). In Data Connect, a HCPCS is assigned by Internal GHX HCPCS Coding Specialists that hold, at a minimum, the AHIMA-accredited CCS and/or AAPC-accredited CPC certifications.
Standardization
HCPCS codes are standardized in Data Connect based on GHX Assignment and may vary from the manufacturer catalog/website.
Considerations
The HCPCS Level II coding system includes CMS-maintained codes for supplies.
Most GHX HCPCS assignments are derived by GHX UNSPSC/Noun/Type designations.
Even if an item is not separately billable, the supply cost should still be considered when calculating procedural-based reimbursement rates (e.g., during an annual Medicare audit).
HCPCS Status
Coded: A HCPCS code is assigned by GHX.
No Code: GHX reviewed the item for possible HCPCS code assignment, but no code was deemed appropriate.
Non Billable: GHX reviewed the item, and it was determined to be non-billable. No revenue code is assigned.