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...

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背景与挑战

背景概述

该数据集为2020年医疗保健通用程序编码系统（HCPCS）第二级，包含字母数字代码，用于表示未在第一级编码中涵盖的物品和非医生服务。数据来源于CMS官网，以HCPCSLII表格形式提供，包含代码、描述、定价及多个相关字段，用于医保和私人保险的计费与报销管理。