HCPCS level II Exam Questions With Answers

HCPCS level II Exam Questions With Answers
HCPCS Level II
also called national code
used to describe common medical services/services.
5 characters in length, and they begin w/ letters A-V followed with 4 numbers.


HCPCS level II used to identify services performed by:
Physician and non physician providers.
Ambulance companies
Durable medical equipment companies


Durable Medical Equipment (DME)
Equipment that can withstand repeated use.
Primarily used to serve a medical purpose.
Used in the patient's home(or assisted living facility or group home)
would not be used in the absence of illness or injury.


Durable Medical Equipment, prosthetics, orthotics and supplies( DMEPOS )
includes artificial limbs, braces, medications and so on.


DMEPOS dealers
supply patient with DME
DMEPOS claims are submitted to DME Medicare administrative contractors (DME MACs)
each DME MAC covers a specific geographical region of the country and is responsible for processing
DMEPOS claims for its specific region


MAC
Medicare Administrative Contractor


When appropriate HCPCS level II code exists, it is often assigned instead of CPt code (with same or
similar code description) for:
Medicare Accounts
some State Medicaid system


CMS creates Hcpcs level II code:
for services and procedures that will probably never be assigned a CPT code.
to determine volume and codes of newly implemented technologies.


New Hcpcs level II codes are reported for several years until
CMS initiates a process to create corresponding CPT codes


When new CPT codes are published:
they are reported instead of the original HCPCS level II codes


HCPCS Level II National Codes
Classify similar medical products/services.

, Facilitate efficient claims processing
Contain a description
Used primarily for billing purposes.


HCPCS Level II continued to be:
reported by another payer or govt demonstration program (other than Medicare/Medicaid)


Characteristic of HCPCS level II national codes:
Ensure uniform reporting of medical products or services on claims.
Identify similar products or services.
Not a reimbursement methodology for making coverage or payment determinations.


Responsibility for HCPCS level II codes
developed and maintained by CMS
DO NOT carry copyright of any organization.
In public domain, which means many oublishers print annual coding manuals


Some references contain:
general instructions or guidelines for each section
Appendix that summarizes additions, deletions, and revisions to codes
Table for Drugs
Table for deleted codes.


Symbols to identify codes
excluded from Medicare
where paument is at payer discretion
with special coverage instructions.


types of HCPCS LEVEL 2 CODES
* permanent national codes,
dental codes,miscellaneous codes, temporary, modifiers.


Permanent national HCPCS codes are
maintained by HCPCS National Panel composed of representatives from BCBSA, HIAA and CMS
Responsible for making decisions about additions , deletions and revisions to code /description


Miscellaneous Code
include miscellaneous /not otherwise classified codes.
Reported when DMEPOS dealer submits claim for product/servies when HC level II exists.
Allow DMEPOS to submit claims for product /services as soon as FDA approval is granted.


Miscellaneous Codes: Avoid inefficiency of assigning codes for
items and services that are rarely furnished.
which payer expect to receive few claims.


Claims w/ miscellaneous codes are manually processed and must include:
complete description of product or service.