Difference Between HCPCS and CPT

HCPCS and CPT work hand in hand. HCPCS is the abbreviation for Healthcare Common Procedure Coding System.

Key Takeaways

• HCPCS (Healthcare Common Procedure Coding System) is a standardized coding system for billing medical procedures and services in the United States, including CPT and additional alphanumeric codes.
• CPT (Current Procedural Terminology) is a subset of HCPCS, consisting of numerical codes specifically for billing medical services performed by physicians and other healthcare professionals.
• HCPCS and CPT codes are crucial in medical billing and insurance reimbursement, ensuring accurate and consistent communication between providers, payers, and patients.

HCPCS vs CPT

The difference between HCPCS and CPT is that HCPCS is used to provide a standardized system for coding the healthcare services using the CPT codes. While the CPT codes are the ones that contain a detailed description of the codes that the medical instrument users have to follow while using surgical, medical, and diagnostic instruments.

The HCPCS codes consist of three levels, Level 1, Level 2, and Level 3. It needs CPT codes to claim the services by physicians and surgeons to the payers of these services.

The CPT codes are the ones that are used in the HCPCS Level 1 coding. They contain the procedures that different medical departments have to follow during an operation.

---

 

Comparison Table

Parameters of Comparison	HCPCS	CPT
Value	HCPCS codes are used to give a standardized description of delivering healthcare services.	CPT codes are used to describe the services that medical workers have to be acknowledged.
Protection	The Health Insurance Portability and Accountability Act states that everyone should be free to access HCPCS procedures.	CPT codes have been owned by the American Medical Association and outsiders have to pay for accessing these.
Divisions	HCPCS operates on three levels. Namely, Level 1, Level 2, and Level 3.	CPT has three categories. They are Category 1, Category 2, and Category 3.
Creators	HCPCS was created by the Centers for Medicare and Medicaid (CMS).	CPT was developed by the American Medical Association (AMA).
The Affected	HCPCS has codes for both direct healthcare workers and non-direct healthcare workers.	The CPT codes are only for the procedures that are to be operated upon a patient.

---

 

What is HCPCS?

HCPCS codes have been developed by the Centers for Medicare and Medicaid organization. It was developed for identifying the insurance policies one is eligible for.

Level 1 contains the codes that the American Medical Association has addressed. These are the CPT codes.

The Level 2 of HCPCS consists of the codes that are related to non-physical service providers. Mainly the ambulance services are noted here.

The Level 3 codes are called the local codes. These codes are presently not in use but they have a history until December 31, 2003.

 

What is CPT?

The American Medical Association has produced CPT for addressing the procedures that medical professionals have to follow while attending patients. This is published by the CPT editorial panel in the AMA.

Category 1 contains six main sections. They are Codes for evaluation and management, codes for anesthesia, codes for surgery, codes for radiology, codes for pathology and laboratory, and codes for medicine.

The second category in CPT defines the codes that clinics have to follow while evaluating and managing them. The advisory board of CPT – Performance Measures Advisory Group edits and reviews this category.

The third category of CPT is addressed by the emerging technology in the medical field. It starts from 0016T – 0207T.

---

Main Differences Between HCPCS and CPT

1. HCPCS is a standardized description of the procedures a medical professional has to follow while attending a patient. CPT consists of the codes that describe these set of procedures.
2. The HIPAA has made it mandatory that anyone can access HCPCS. The CPT is copyrighted by AMA and hence it is a paid service.
3. HCPCS is divided into three levels, mainly Level 1, Level 2, and Level 3. The CPT is divided into three categories namely, Category 1, Category, and Category 3.
4. The Centers for Medicare and Medicaid developed HCPCS. The American Medical Association is the creator of CPT.
5. The codes in HCPCS are applicable for both direct and indirect medical professionals. The CPT is a part of HCPCS and it contains the rules to follow while treating a patient.

---

References

1. https://www.aafp.org/fpm/2001/0100/p14.html