SpeechPathology.com Phone: 800-242-5183


Presence - Apply Now - September 2022

Healthcare Common Procedure Coding System (HCPCS)

Dee Adams Nikjeh, PhD, CCC-SLP

June 18, 2018

Share:

Question

What are the two levels of the Healthcare Common Procedure Coding System?

Answer

The first coding system is the HCPCS codes.  We have HCPCS Level I and their current procedural terminology. However, we rarely hear that phrase being used, usually we hear “CPT codes”. So, HCPCS Level I is CPT codes. HCPCS Level II are codes that are used to report supplies, equipment and other devices. For SLPs, and especially for those of us specializing in voice, that would include our TEP supplies or electrolarynx. It also applies to alternative and augmentative communication devices as well.

HCPCS Level I - Current Procedural Terminology (aka CPT Codes)

These are codes that represent every medical, surgical, and diagnostic procedure that we have, and they are assigned a five digit code. A CPT code represents what we do, current procedural terminology, what procedures we are going to perform or provide to the client and the patient.

Why do we have these CPT codes? They provide a common language among all providers, our payers and administrators. They give a standardized descriptions of procedures. They also provide data for the government to look at our utilization patterns; such as who's billing this procedure? How many times is this procedure being used? How many times has one procedure combined with another procedure? Additionally, these codes provide a lot of data for health-related research.

At this time, there are actually over 10,000 CPT codes. It's important to remember that CPT codes - this HCPCS Level I - is developed, maintained, and copyrighted by the American Medical Association, not the government. It is owned by the American Medical Association, and is actually a continuous process which gets updated annually.

HCPCS Level II - Supplies, Equipment, Devices, and Procedures not found in the CPT system, e.g., durable medical equipment (DME)

Level II refers to the supplies, equipment, devices and any procedures that are not found in the CPT system. Durable medical equipment is found under Level II. This is administered by the Centers for Medicare and Medicaid Services, not by the American Medical Association.

These codes begin with a single letter, and are followed by four numbers. For example, for voice and voice disorders, the most common would be perhaps the code for artificial larynx, any type which is an L8500. There's also a code for tracheoesophageal voice prostheses (L8509) which are grouped by the type of service or the supply that they represent.

These codes are also updated annually, and there are also Medicare claims for E and L codes and V codes, which all fall under the jurisdiction of Durable Medical Equipment Medicare Administrative Contractors (DME MACs).

For more information on any of the coding systems, there is a reference that is freely available on the ASHA website where all these things are listed and explained: www.asha.org/practice/reimbursement/coding/hcpcs_slp/.

Please refer to the SpeechPathology.com course, Unique Coding, Billing, Reimbursement, and Supervision Issues for SLP Voice Specialists, for more in-depth information on the unique coding, billing and supervision issues specific to SLPs who provide behavioral and qualitative analysis of voice, instrumental laryngeal assessments, and therapeutic intervention of voice and upper airway disorders.


dee adams nikjeh

Dee Adams Nikjeh, PhD, CCC-SLP

Dee Adams Nikjeh, PhD, CCC-SLP, ASHA Fellow, is an expert in health care coding, billing, and documentation. She is Co-Chair of ASHA’s Health Care Economics Committee, Co-Chair of the American Medical Association’s Relative Value Update Committee/Health Care Professionals Advisory Committee and an Expert Witness for the United States Department of Justice Civil Division-Fraud Section.  Dr. Nikjeh has more than 35 years of clinical experience in the evaluation and treatment of individuals with communication impairments specializing in endoscopic procedures for the evaluation and management of voice and swallowing disorders.


Related Courses

Speech Language Pathology Healthcare Coding and Payment Update: What’s New for ‘22!
Presented by Dee Adams Nikjeh, PhD, CCC-SLP, ASHA Fellow
Video

Presenter

Dee Adams Nikjeh, PhD, CCC-SLP, ASHA Fellow
Course: #10031Level: Intermediate1.5 Hours
  'I learned new information about coding for evaluation and treatment of cognitive communication function to using new CPT codes'   Read Reviews
Up-to-date knowledge of healthcare code sets, including Current Procedural Terminology (CPT) and International Classification of Diseases, 10th revision (ICD-10) diagnostic codes, is a MUST for optimal professional practice. The latest modifications impacting SLP clinical practice and claim submissions are discussed, as well as relevant adjustments in the 2022 Medicare Physician Fee Schedule.

Payment for SLP Services: Navigating Payer Sources, Payment Systems, & Practice Settings
Presented by Dee Adams Nikjeh, PhD, CCC-SLP, ASHA Fellow
Video

Presenter

Dee Adams Nikjeh, PhD, CCC-SLP, ASHA Fellow
Course: #9453Level: Intermediate1 Hour
  'The information was very helpful'   Read Reviews
Accurate payment for SLP services depends on compliance with payer guidelines (e.g., coverage, supervision) and the specific payment system (e.g., prospective payment, fee-for-service) relevant to the practice setting (e.g., inpatient, outpatient) in which the service is provided. This course will define and illustrate the interrelationship of these three professional elements, including their relevance to supervision requirements, and will provide resources for further assistance.

Treating in the Gray Zone: Post-Acute Care Considerations
Presented by Melissa Collier, MS, CCC-SLP, CHC, CDP
Video

Presenter

Melissa Collier, MS, CCC-SLP, CHC, CDP
Course: #10066Level: Intermediate1 Hour
  'Confirmed my clinical philosophy for pt care with focus on pt's rights - especially related to diet choices'   Read Reviews
This course helps post-acute care clinicians better understand how to approach treatment when things aren’t black and white. It addresses scenarios such as geriatric frailty/weight loss and diet modification, the paradigm shift to a patient-choice model, legal considerations regarding diet waivers, and the care plan process. The SLP's role on the post-acute interdisciplinary team is also discussed.

Building Your Case for Medical Necessity: The Nuts and Bolts of Skilled Therapy Documentation
Presented by Melissa Collier, MS, CCC-SLP, CHC, CDP
Video

Presenter

Melissa Collier, MS, CCC-SLP, CHC, CDP
Course: #9839Level: Introductory1.5 Hours
  'Good functional examples'   Read Reviews
This course provides participants with an understanding of documentation requirements in a post-acute setting, including Medicare regulations and guidelines. It identifies why speech therapy services are denied and ways to mitigate the denial of skilled services, and describes how to document medical necessity.

Gold-Standard Documentation Strategies: Medicare and PDPM SNF Documentation
Presented by Lorelei O'Hara, M.A., CCC-SLP
Video

Presenter

Lorelei O'Hara, M.A., CCC-SLP
Course: #9673Level: Intermediate1.5 Hours
  'The examples were very helpful to me'   Read Reviews
Scrutiny is the name of the game in skilled nursing facility (SNF) clinical service delivery. This course discusses how to create bullet-proof documentation using appropriate language and coding for Medicare Part A and B claims, and how to support the interdisciplinary team with iron-clad support for patient-driven payment model (PDPM) payment components, including cognitive and mood assessment tools.

Our site uses cookies to improve your experience. By using our site, you agree to our Privacy Policy.