Alpha-Numeric HCPCS Procedure and Modifier Codes

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The Healthcare Common Procedure Coding System (HCPCS) dataset is a collection of codes that represent procedures, supplies, products and services which may be provided to Medicare beneficiaries and to individuals enrolled in private health insurance programs. These files contain the 2016, 2017 and 2018 alphanumeric HCPCS procedure and modifier codes and their long and short descriptions.

Complexity

The 2016, 2017 and 2018 HCPCS (Healthcare Common Procedure Coding System) codes, which are established by CMS’s (Centers for Medicare & Medicaid Services) Alpha-Numeric Editorial Panel, primarily represent items and supplies and non-physician services not covered by the American Medical Association’s Current Procedural Terminology-4 (CPT-4) codes; Medicare, Medicaid, and private health insurers use HCPCS procedure and modifier codes for claims processing. 2017 alphanumeric procedure and modifier codes comprise the A to V range.” “With the exception of temporary codes, 2017 alphanumeric procedure and modifier codes are updated annually on January 1. Temporary codes, which begin with G, K, or Q, are updated on a flow basis throughout the year.

Level of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician’s office. Because Medicare and other insurers cover a variety of services, supplies, and equipment that are not identified by CPT codes, the 2017 HCPCS codes were established for submitting claims for these items. The development and use of 2017 HCPCS began in the 1980’s. 2017 codes are also referred to as alpha-numeric codes because they consist of a single alphabetical letter followed by 4 numeric digits, while CPT codes are identified using 5 numeric digits.

Date Created

2016-12-11

Last Modified

2017-11-03

Version

2017-11-03

Update Frequency

Annual

Temporal Coverage

2002-01-07 to 2018-11-10

Spatial Coverage

United States

Source

John Snow Labs => Centers for Medicare & Medicaid Services

Source License URL

John Snow Labs Standard License

Source License Requirements

NA

Source Citation

NA

Keywords

Billing Code, HCPCS Book, Common Procedure Coding System, Claims Processing, Alphanumeric HCPCS Procedure and Modifier Codes, HCPCS Procedure Codes 2018, HCPCS Modifier Codes 2018, HCPCS Procedure Codes 2016, HCPCS Modifier Codes 2016, HCPCS Procedure Codes 2017, HCPCS Modifier Codes 2017

Other Titles

Alpha Numeric HCPCS File, Procedure Codes and Modifiers, Alpha Numeric HCPCS File 2018, Procedure Codes and Modifiers 2018

Name Description Type Constraints
HCPCS_Code_IDThese are 2 to 5 position alphanumeric codes representing primarily items and nonphysician services that are not represented in the level I codes.stringrequired : 1
Record_Identification_CodeCode to identify record type (3 = First line of procedure record also contains detail information in positions 92-275, 4 = Second, third, fourth, etc., Description of procedure record. No detail information in positions 92-275, 7 = First line of modifier record also contains detail information in positions 92-275, 8 = Second, third, fourth, etc., Description of modifier record. No detail information in positions 92-275)integerlevel : Nominal
Long_DescriptionLong (full line / sentence) description of the code.stringrequired : 1
Short_DescriptionShortened, fixed-length description of the code.string-
Pricing_Indicator_CodeCode used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes (00 = Service not separately priced by part B, 11 = Price established using national rvu's, 12 = Price established using national anesthesia, 13 = Price established by carriers, 21 = Price subject to national limitation amount, 22 = Price established by carriers, 31 = Frequently serviced DME, 32 = Inexpensive & routinely purchased DME 33 = Oxygen and oxygen equipment, 34 = DME supplies, 35 = Surgical dressings, 36 = Capped rental DME, 37 = Ostomy, tracheostomy and urological supplies, 38 = Orthotics, prosthetics, prosthetic devices & vision services, 39 = Parenteral and Enteral Nutrition, 45 = Customized DME items, 46 = Carrier priced, 51 = Drugs, 52 = Reasonable charge, 53 = Statute, 54 = Vaccinations, 55 = Splints and Casts, 56 = IOL's inserted in a physician's office, 57 = Other carrier priced, 99 = Value not established)integerlevel : Nominal
Multiple_Pricing_Indicator_CodeCode used to identify instances where a procedure could be priced under multiple methodologiesstring-
HCPCS_Code_Added_DateThe year the HCPCS (Healthcare Common Procedure Coding System) code was added to the Healthcare common procedure coding system.date-
HCPCS_Action_Effective_DateEffective date of action to a procedure or modifier codedate-
HCPCS_Termination_DateLast date for which a procedure or modifier code may be used by Medicare providers.date-
HCPCS_Action_CodeA code denoting the change made to a procedure or modifier code within the HCPCS system (A = Add procedure or modifier code, B = Change in both administrative data field and long description of procedure or modifier code, C = Change in long description of procedure or modifier code, D = Discontinue procedure or modifier code, F = Change in administrative data field of procedure or modifier code, N = No maintenance for this code, P = Payment change, R = Re-activate discontinued/deleted procedure or modifier code, S = Change in short description of procedure code, T = Miscellaneous change)string-
YearYear (2016,2017,2018) of Healthcare Common Procedure Coding System codes established by CMSdate-
HCPCS_Code_IDRecord_Identification_CodeLong_DescriptionShort_DescriptionPricing_Indicator_CodeMultiple_Pricing_Indicator_CodeHCPCS_Code_Added_DateHCPCS_Action_Effective_DateHCPCS_Termination_DateHCPCS_Action_CodeYear
TD7RnRn2001-07-012001-07-01N2016
TD7RnRn2001-07-012001-07-01N2017
TD7RnRn2001-07-012001-07-01N2018
HL7InternIntern2003-01-012003-01-01N2016
HL7InternIntern2003-01-012003-01-01N2017
HL7InternIntern2003-01-012003-01-01N2018
TE7Lpn/lvnLpn/lvn2001-07-012001-07-01N2016
TE7Lpn/lvnLpn/lvn2001-07-012001-07-01N2017
TE7Lpn/lvnLpn/lvn2001-07-012001-07-01N2018
A45653SlingsSlings551983-01-012014-10-01N2016