Difference Between HCPCS and CPT (With Table)

HCPCS vs CPT

HCPCS and CPT work hand in hand. HCPCS is the abbreviation for Healthcare Common Procedure Coding System. It is used by medical workers to claim their healthcare insurance to the insurance companies. The Current Procedural Terminology (CPT) is the set of code that is used to direct the usage of medical procedures to the authorities.

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. This practice is done in Level 1 coding. The Level 2 coding is for healthcare workers for claiming medical insurance for medical instruments. This level consists of nationalized codes.

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. The American Medical Association has assigned three categories in CPT coding. They are Category 1, Category 2, and Category 3.

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.


 

Comparison Table Between HCPCS and CPT (in Tabular Form)

Parameters of ComparisonHCPCSCPT
ValueHCPCS 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.
ProtectionThe 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.
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 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. It is now been easily accessible by anyone since the HIPAA has made it free of cost. It has three levels. Each of these levels describes the procedures needed by different health workers.

Level 1 contains the codes that the American Medical Association has addressed. These are the CPT codes. These codes are being used by the direct health workers. They consist of the procedures that have to be known while operating on a patient. These medical services are to be known by medical, surgical, and diagnostic departments.

The Level 2 of HCPCS consists of the codes that are related to non-physical service providers. Mainly the ambulance services are noted here. Subdivisions of Level 2 are in the format of a capital letter followed by a four-digit number. For example, the code A0021 denotes the procedures noted for Transportation, Medical and Surgical Supplies, and Miscellaneous and Experimental activities.

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. This is because a more reliable set of codes was developed by CPT to describe the Health Insurance in a specific program.

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HCPCS
 

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. In October every year, the updated version of CPT is released. There are three categories in CPT.

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. When checked deeply, all these divisions are mainly influencing the head level, medical workers.

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 codes are named in a pattern that begins with four digits followed by a capital letter.

The third category of CPT is addressed by the emerging technology in the medical field. It starts from 0016T – 0207T. Since the AMA holds the rights of CPT, any organization that needs to access these codes has to pay them for doing so. The latest version of CPT is CPT2020.

CPT

Main Differences Between HCPCS and CPT

  • 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.
  • The HIPAA has made it mandatory that anyone can access HCPCS. The CPT is copyrighted by AMA and hence it is a paid service.
  • 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.
  • The Centers for Medicare and Medicaid developed HCPCS. The American Medical Association is the creator of CPT.
  • 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.

 

Conclusion

Both HCPCS codes and CPT codes are used to direct the services offered by medical practitioners. HCPCS consists of three levels. Each of these levels consists of the codes that different people who are related to the medical field have to follow while performing their duties. While claiming their medical insurance, these are t be submitted.

The CPT codes are a part of the HCPCS codes. They contain the codes that practitioners have to follow while diagnosing and treating a patient.  There are three categories through which these procedures have been explained. The AMA holds the rights for publishing and renewing these procedures.


 

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The following is a collection of the most used terms in this article on HCPCS and CPT. This should help in recalling related terms as used in this article at a later stage for you.

Difference Between HCPCS and CPT