HCPCS Codes Were NOT all Created for the Same Purpose

June 29th, 2020 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Categories:   HCPCS Coding   DME|Supplies|Equipment   Claims   Billing   Coding  
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Having problems finding a particular product/code with our DMEPOS search? When looking for HCPCS Level II codes, there are several kinds of codes, and not all HCPCS codes were created for the same purpose. If you are searching for a certain HCPCS product using our DMEPOS search, you may think the tool is incorrect or missing results. This is not the case - the DMEPOS tool is looking for products that are sold by a supplier to be used in the home, not in a hospital or facility setting. The DMEPOS search will assist with items such as durable medical, some medical supplies, and prosthetics and orthotics.

For example, if you are looking for C-Codes, you will need to search with our comprehensive search. We have had a lot of questions on the DMEPOS search missing catheters being billed with C-Codes. You will find catheters but these are only for home use, such as urinary catheters. Products that are assigned with a C-Code are a different type of product, such as graphs, stents, and pacemakers, used with procedures only done in the hospital or outpatient setting. 

C-Codes are temporary codes used to report device categories, new technology procedures, and drugs, biologicals, and radiopharmaceuticals that do not have other HCPCS code assignments. C-Codes are also known as pass-through and are only payable on claims for hospital outpatient department services and procedures. C-Codes are unique to items that can be used either inpatient or outpatient but are only reported on outpatient claims. 

NOTE: Effective October 1, 2006, the following Non-OPPS providers may elect to bill using C- codes (or appropriate CPT codes) on Type of Bills (TOBs) 12X, 13X, or 85X:

• Critical access hospitals (CAHs)

• Indian Health Service Hospitals (IHS)

• Hospitals located in American Samoa, Guam, Saipan, or the Virgin Islands

• Maryland waiver hospitals.

For more information on this refer to Billing of Temporary “C” HCPCS Codes by Non-Outpatient Prospective Payment System (Non-OPPS) Providers, MLN Matters Number: MM5027.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM5027.pdf

Pass-through

We briefly mentioned above C-codes are pass-through codes. These are codes that were created by CMS when there is not enough information about the technology to determine the use and pricing. Therefore, a pass-through code allows CMS to gather the information then adjust the rates to reflect the resources used for the new technology.

Here is a list of HCPCS codes and the sections they are assigned to. 

A0021 A0999     Transportation Services
A4206 A9598     Medical And Surgical Supplies
A9150 A9999     Administrative, Miscellaneous and Experimental
B4034 B9999     Enteral And Parenteral Therapy
C1713 C9899     Temporary Hospital Outpatient PPS
D-Codes      Dental Procedures
E0100 E8002     Durable Medical Equipment (DME)
G0008 G9987     Temporary Procedures & Professional Services
H0001 H2037     Rehabilitative Services
J0120 J9312     Drugs Administered
J8670 J9999     Oncology Drugs
K0001 K1005     Temporary Codes For DMERCS
L0112 L4631     Orthotic Devices & Services
L5000 L9900     Prosthetic Procedures
M0075 M1144     Medical Services
P2028 P9615     Pathology And Laboratory
Q0035 Q9992     Temporary Codes
R0070 R0076     Diagnostic Radiology Services
S0012 S9999     Private Payer Codes
T1000 T5999     State Medicaid Agency Codes
U0001 U0004     Other
V2020 V2799     Vision Services
V5008 V5364     Hearing Services

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Questions, comments?

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