HCPCS Level II Certification Guide
Certifications Covering HCPCS
|------|----------|------|---------|
| **CPC (Certified Professional Coder)** | AAPC | $399 | HCPCS tested in exam |
|---|
| CDEO (Clinical Documentation Expert) | AAPC | $399 | Documentation side |
| CCS (Certified Coding Specialist) | AHIMA | $299 | HCPCS included |
| CHCA (Certified Home Care Aide) | NAHC | Varies | Home health focus |
HCPCS Level II Structure
FORMAT: 1 letter + 4 digits = 5 characters (e.g., A4570, E0100, G0439)
CODE RANGES BY SECTION:
A0000-A9999: Transportation, medical/surgical supplies
B4000-B9999: Enteral and parenteral therapy
C1000-C9999: Outpatient PPS codes (hospital outpatient only)
D0000-D9999: Dental codes (CDT, not strictly HCPCS but cross-referenced)
E0100-E9999: Durable Medical Equipment (DME)
G0000-G9999: Temporary procedures/professional services
H0001-H2037: Behavioral health services
J0000-J9999: Drugs administered other than oral method
K0000-K9999: Temporary DME codes for Medicare contractors
L0000-L9999: Orthotic and prosthetic procedures
M0000-M0302: Medical services (misc)
P0000-P9999: Pathology and lab
Q0000-Q9999: Temporary codes (misc services)
R0000-R5999: Diagnostic radiology services
S0000-S9999: Private payer codes (not Medicare/Medicaid)
T1000-T9999: State Medicaid agency codes
V0000-V5999: Vision and hearing
Key HCPCS Code Categories
DME (E codes — most commonly billed):
E0100 Cane, includes all canes, any material/type
E0105 Cane, adjustable/extension type, with offset handle
E0130 Walker, rigid (pickup), adjustable or fixed height
E0141 Walker, folding, adjustable or fixed height
E0601 Continuous positive airway pressure (CPAP) device
E0627 Seat lift mechanism — freestanding
E1390 Oxygen concentrator, single delivery port
DRUGS (J codes):
J0702 Betamethasone, injection, 3mg
J1040 Methylprednisolone, injection, 80mg
J1100 Dexamethasone sodium phosphate, 1mg
J1644 Heparin sodium, 1000 units
J2550 Promethazine HCl injection, per 50mg
J3490 Unclassified drugs (requires special report)
J9000 Doxorubicin HCl injection, 10mg (chemotherapy)
G CODES (preventive and quality):
G0008 Administration of influenza virus vaccine
G0009 Administration of pneumococcal vaccine
G0101 Cervical/vaginal cancer screening; pelvic and breast exam
G0439 Annual wellness visit; includes a personalized prevention plan
Study Resources
•CMS HCPCS Release and Code Sets (cms.gov/Medicare/Coding/HCPCSReleaseCodeSets) — free
•AAPC HCPCS Level II Expert — annual codebook with guidelines
•Optum360 HCPCS Level II — popular alternative codebook
•Medicare Coverage Database (cms.gov) — coverage policies for specific HCPCS codes
Revision Notes
HCPCS II: for items NOT in CPT — supplies, DME, drugs, ambulance, vaccines
Use when: no CPT code exists, Medicare/Medicaid requires it
Letter ranges: A=supplies/transport | E=DME | J=drugs | G=temp services
MODIFIER EXAMPLES:
KX: requirement in LCD met | GA: ABN on file | GZ: ABN not on file required
RR: rental | NU: new item | UE: used item | RP: replacement
MEDICARE COVERAGE: check LCD (Local Coverage Determination) before billing
ABN (Advance Beneficiary Notice): get signature when coverage uncertain
