Healthcare Common Procedure Coding System Level II (HCPCS)

The Healthcare Common Procedure Coding System (HCPCS) is a collection of codes that represent procedures, supplies, products and services which may be provided to Medicare beneficiaries and to individuals enrolled in private health insurance programs. The codes are divided into two levels, or groups, as described Below:

Level I Codes and descriptors copyrighted by the American Medical Association's current procedural terminology, fourth edition (CPT-4). These are 5 position numeric codes representing physician and non-physician services.

**** NOTE: **** CPT-4 codes including both long and short descriptions shall be used in accordance with the CMS/AMA agreement. Any other use violates the AMA copyright.

Level II Includes codes and descriptors copyrighted by the American Dental Association's current dental terminology, (CDT-2020). These are 5 position alpha-numeric codes comprising the d series. All level II codes and descriptors are approved and maintained jointly by the alpha-numeric editorial panel (consisting of CMS, the Health Insurance Association of America, and the Blue Cross and Blue Shield Association). These are 5 position alpha- numeric codes representing primarily items and non-physician services that are not represented in the level I codes.

The dataset is from the year 2020 as provided on www.cms.gov (please see link to documentation below)

The dataset consists of one table namely HCPCSLII.

Note regarding coverage and payment indicators for codes in CMS’ 2020 HCPCS Update and DMEPOS Fee Schedule Files:

If specific Medicare coverage or payment indicators or values have not been established for any new HCPCS codes, this may be because a national Medicare coverage determination and/or fee schedule amounts have not yet been established for these items.  This is neither an indicator of Medicare coverage or non-coverage.  In these cases, until national Medicare coverage and payment guidelines have been established for these codes, the Medicare coverage and payment determinations for these items may be made based on the discretion of the Medicare contractors processing claims for these items.

Following is a list of columns in the HCPCSLII table:
- HCPC
- SEQNUM
- RECID
- LONG_DESCRIPTION
- SHORT_DESCRIPTION
- PRICE1
- PRICE2
- PRICE3
- PRICE4
- MULT_PI
- CIM1
- CIM2
- CIM3
- MCM1
- MCM2
- MCM3
- STATUTE
- LABCERT1
- LABCERT2
- LABCERT3
- LABCERT4
- LABCERT5
- LABCERT6
- LABCERT7
- LABCERT8
- XREF1
- XREF2
- XREF3
- XREF4
- XREF5
- COV
- ASC_GRP
- ASC_DT
- OPPS
- OPPS_PI
- OPPS_DT
- PROCNOTE
- BETOS
- TOS1
- TOS2
- TOS3
- TOS4
- TOS5
- ANEST_BU
- ADD_DT
- ACT_EFF_DT
- TERM_DT
- ACTION_CD

Pricing details include information on how the pricing is set based on codes such as:

00 = Service not separately priced by part B
(e.G., services not covered, bundled, used
by part a only, etc.)
Physician Fee Schedule And Non-Physician Practitioners
- Linked To The Physician Fee Schedule
11 = Price established using national rvu's
- Clinical Lab Fee Schedule
21 = Price subject to national limitation amount
- Supplies And Surgical Dressings
31 = Frequently serviced DME (price
subject to floors and ceilings)

and so on...