HCPCS vs CPT: Difference and Comparison

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

HCPCS and CPT are codes used in medical billing. HCPCS are used for services and supplies not covered by CPT codes, as basic healthcare services like medical devices, medical supplies, etc. CPT codes are used for standard medical procedures and services, like surgeries, diagnostic tests, etc.

HCPCS vs CPT 1
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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 different medical departments must follow during an operation.


 

Comparison Table

Parameters of ComparisonHCPCSCPT
ValueHCPCS codes are used to give a standardized description of delivering healthcare services.CPT codes describe the services that medical workers have to be acknowledged.
ProtectionThe Health Insurance Portability and Accountability Act state that everyone should be free to access HCPCS procedures.The American Medical Association has owned CPT codes, and outsiders have to pay to access these.
DivisionsHCPCS 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.
CreatorsHCPCS was created by the Centers for Medicare and Medicaid (CMS).CPT was developed by the American Medical Association (AMA).
The AffectedHCPCS has codes for both direct healthcare workers and non-direct healthcare workers.The CPT codes are only for the procedures to be operated upon by a patient.

 

What is HCPCS?

The Centers for Medicare and Medicaid organizations have developed HCPCS codes. It was designed to identify the insurance policies one is eligible for.

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

Level 2 of HCPCS consists of codes 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 have a history until December 31, 2003.

 

What is CPT?

The American Medical Association has produced CPT to address the procedures medical professionals must follow while attending to patients. The CPT editorial panel publishes this in the AMA.

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

The second category in CPT defines the codes clinics must 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 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 to a patient. CPT consists of the codes that describe this set of guidelines.
  2. The HIPAA has made it mandatory that anyone can access HCPCS. AMA copyrights the CPT, 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: 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 to both direct and indirect medical professionals. The CPT is a part of HCPCS, containing the rules to follow while treating a patient.

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

Last Updated : 11 June, 2023

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