10 Difference Between HCPCS And CPT Codes

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What Is CPT?

CPT stands for Current Procedural Terminology. It is a medical code set that is used to report medical, surgical, and diagnostic procedures and services to entities such as Physicians, coders, patients, health insurance companies, accreditation organizations and payers for administrative, financial and analytical purposes. Specifically, CPT codes are used to report procedures and services to federal and private payers for reimbursement of rendered healthcare.

CPT was created in 1966 by the American Medical Association (AMA)to standardize reporting of medical, surgical and diagnostic services and procedures performed in inpatient and outpatient settings. Each CPT code represents a written description of a procedure or service eliminating the subjective interpretation of precisely what was provided to the patient.  CPT even includes codes referred to as unlisted codes for those services and procedures not specifically named in another defined CPT code.

Given the vast number of services and procedures, the American Medical Association (AMA) has organized CPT codes logically, beginning with classifying them into three types:

  • CPT Category I
  • CPT Category II
  • CPT Category III

CPT Category I is the largest body of codes consisting of those commonly used by providers to report their services and procedures. CPT Category II consists of supplemental tracking codes used for performance management. CPT Category III consists of temporary codes used to report emerging and experimental services and procedures.

To keep abreast with the evolving world of healthcare, including availability of new services and retirement of outdated procedures among other consideration, the AMA updates the CPT codes annually,  releasing new, revised and deleted codes, as well as changes to CPT coding guidelines. Additionally, the AMA updates CPT nomenclature or medical language to reflect advances in medicine. Even though AMA owns the copyright to CPT, it invites providers and organizations to participate in the ongoing maintenance of the code set, welcoming those who use it to suggest changes to codes and code descriptors.

What You Need To Know About CPT

  • CPT stands for Current Procedural Terminology.
  • CPT is a medical code set that is used to report medical, surgical, and diagnostic procedures and services to entities such as Physicians, health insurance companies and accreditation organizations.
  • CPT was introduced in 1966.
  • CPT was developed by the American Medical Association (AMA).
  • CPT is largely private and therefore access to the codes is not free,
  •  CPT is a registered trademark of the American Medical Association (AMA).
  • There are three types of CPT codes: Category 1, Category 2 and Category 3.
  • CPT codes are used in conjunction with ICD-9-CM or ICD-10-CM numerical diagnostic coding during the electronic medical billing process.
  • Use of the CPT codes for transactions involving health care information is voluntary.
  • CPT describes the procedure performed on the patient; it doesn’t have many codes for the products used in the procedure. 

What Is HCPCS?

HCPCS stands for Healthcare Common Procedural Coding System. It is a standardized code system necessary for medical providers to submit healthcare claims to Medicare and other health insurances in a consistent and orderly manner. HCPCS was developed by the Centers For Medicare and Medicaid (CMS) in 1978. CMS looked at the established CPT codes and decided that they didn’t need to improve upon or vary those codes, so instead they folded all of CPT into HCPCS. Up until 1996, use of HCPCS was voluntary or optional. However, the government passed the Health Information Portability And Accountability Act or HIPAA which made the use of HCPCS mandatory for transactions involving health care information. HCPCS has its own coding guidelines and works hand in hand with CPT.

HCPCS comprises of three separate medical code sets:

  • HCPCS Level I
  • HCPCS Level II
  • HCPCS Level III

HCPCS Level I consist of the Current Procedural Terminology (CPT) code set and is used to submit medical claims to players for procedures and services performed by physicians, nonphysical practitioners, hospitals, laboratories  and outpatient facilities.

HCPCS Level II is the national procedure code set for healthcare practitioners, providers and medical equipment suppliers when filling health plan claims for medical devices, supplies, medications, transportation services and other items and services. When medical coders and billers talk about HCPCS codes, they are referring to HCPCS Level II codes and when they talk about CPT coding, they are actually referring to HCPCS Level I.

HCPCS Level III, also referred to as HCPCS local codes, were developed by state Medicaid agencies, Medicare contractors and private insurers for use in specific programs and jurisdictions. These are still included in the HCPCS reference coding book. Some payers prefer that coders report the Level III codes in addition to Level I and Level II code sets. However, Level III codes are not nationally recognized.

HCPCS alerts you which codes are new and which codes have been revised. New codes are listed with a circle, while revised codes have a triangle next to them. HCPCS is constantly being updated and CMS which maintains the code set, will often recycle codes. HCPCS features a number of strikethrough codes, and these let you know that a code that used to be listed there has been deleted and moved elsewhere.

What You Need To Know About HCPCS

  • HCPCS stands for Healthcare Common Procedural Coding System.
  • HCPCS is a standardized code system necessary for medical providers to submit healthcare claims to Medicare and other health insurances in a consistent and orderly manner.
  • CTP was developed in 1978.
  • HCPCS was created by the Centers for Medicare and Medicaid (CMS).
  • HCPCS is public and everyone must have access to the HCPCS codes.
  • It was established under Healthcare and Information Portability and Protection Act of 1996, thus its access is free.
  • HCPCS comprises three medical code sets, HCPCS Level I, HCPCS Level II and HCPCS Level III.
  • Use of the HCPCS codes for transactions involving health care information is mandatory.
  • HCPCS Level II describes the procedure performed on the patient; it has many codes for the products and pieces of medical equipment used in the procedure. 

Difference Between HCPCS And CPT Codes In Tabular Form

BASIS OF COMPARISON HCPCS CODES CPT CODES
Acronym HCPCS stands for Healthcare Common Procedural Coding System.   CPT stands for Current Procedural Terminology.  
Description HCPCS is a standardized code system necessary for medical providers to submit healthcare claims to Medicare and other health insurances in a consistent and orderly manner.   CPT is a medical code set that is used to report medical, surgical, and diagnostic procedures and services to entities such as Physicians, health insurance companies and accreditation organizations.  
Year Of Development CTP was developed in 1978.   CPT was introduced in 1966.  
Development HCPCS was created by the Centers for Medicare and Medicaid (CMS).   CPT was developed by the American Medical Association (AMA).  
Access HCPCS is public and everyone must have access to the HCPCS codes.   CPT is largely private and therefore access to the codes is not free,  
Ownership It was established under Healthcare and Information Portability and Protection Act of 1996, thus its access is free.   CPT is a registered trademark of the American Medical Association (AMA).  
Classes HCPCS comprises three medical code sets, HCPCS Level I, HCPCS Level II and HCPCS Level III.     There are three types of CPT codes: Category 1, Category 2 and Category 3.  
Usage Use of the CPT codes for transactions involving health care information is mandatory.   Use of the CPT codes for transactions involving health care information is voluntary.  
Codes For Products HCPCS Level II describes the procedure performed on the patient; it has many codes for the products and pieces of medical equipment used in the procedure.    CPT describes the procedure performed on the patient; it doesn’t have many codes for the products used in the procedure.