Key Takeaways
- HCPCS Level II codes are maintained by CMS and cover items, supplies, and services not included in CPT (Level I), such as DME, drugs, ambulance services, and prosthetics.
- HCPCS Level II codes consist of one letter (A-V) followed by four digits (e.g., J1100 for dexamethasone injection).
- J codes (J0120-J9999) represent drugs administered by a healthcare professional — they are among the most commonly tested HCPCS codes on the CPC exam.
- DME (Durable Medical Equipment) codes cover items like wheelchairs (E1161), hospital beds (E0250-E0373), CPAP machines, and oxygen equipment.
- Ambulance services are coded with A0000-A0999 codes and require specific origin/destination modifiers to describe the transport.
- HCPCS modifiers differ from CPT modifiers and include anatomical modifiers (e.g., -FA through -F9 for fingers, -TA through -T9 for toes) and other specialized modifiers.
- Medicare and Medicaid are the primary payers that require HCPCS Level II codes, though many private payers also accept them.
- When a CPT code and a HCPCS Level II code describe the same service, payer guidelines determine which to use — CMS generally requires the HCPCS Level II code.
HCPCS Level II Coding
The Healthcare Common Procedure Coding System (HCPCS) has two levels. Level I is CPT, which you have already studied. Level II covers items, supplies, and services that are not adequately described by CPT codes. HCPCS Level II is maintained by the Centers for Medicare & Medicaid Services (CMS).
HCPCS Level II Code Structure
HCPCS Level II codes consist of one letter followed by four digits:
Format: A0000 - V9999
| Letter Range | Category | Examples |
|---|---|---|
| A0000-A0999 | Ambulance/Transportation | A0425 (ground mileage), A0427 (ALS1 emergency) |
| A4000-A8999 | Medical/Surgical Supplies | A4206 (syringe with needle), A6250 (skin substitute) |
| B4000-B9999 | Enteral/Parenteral Therapy | B4150 (enteral formula), B4185 (parenteral solution) |
| C1000-C9999 | Outpatient PPS/Temporary | C1713 (anchor/screw), C9399 (unclassified drugs) |
| D0000-D9999 | Dental Procedures | D0120 (periodic oral evaluation) |
| E0100-E9999 | Durable Medical Equipment (DME) | E0601 (CPAP), E1390 (oxygen concentrator) |
| G0000-G9999 | Temporary Procedures/Services | G0101 (cervical/vaginal cancer screening), G0438 (Annual wellness visit) |
| J0000-J9999 | Drugs (Non-Oral, Non-Self-Administered) | J1100 (dexamethasone), J2001 (lidocaine), J9035 (bevacizumab) |
| K0000-K9999 | Temporary DME Codes | K0001 (standard wheelchair), K0823 (power wheelchair) |
| L0000-L9999 | Orthotics/Prosthetics | L3000 (foot insert), L5000 (partial foot prosthesis) |
| P0000-P9999 | Pathology/Laboratory | P9612 (catheterize for urine specimen) |
| Q0000-Q9999 | Temporary/Miscellaneous | Q0138 (ferumoxytol injection), Q4121 (skin substitute graft) |
| S0000-S9999 | Temporary National Codes (Private Payers) | S0395 (impression for hearing aid) |
| V0000-V5999 | Vision/Hearing Services | V2020 (eyeglasses frames), V5008 (hearing screening) |
J Codes: Drug Coding (Most Commonly Tested)
J codes represent drugs administered by a healthcare provider (not self-administered oral medications). These are heavily tested on the CPC exam.
Key J Code Concepts
| Concept | Rule |
|---|---|
| Unit of measure | Each J code specifies a unit (e.g., J1100 = dexamethasone sodium phosphate, 1 mg). If 4 mg is administered, report 4 units. |
| Rounding | If the dose administered exceeds the stated unit, round UP to the next full unit. Example: J1100 x 4.5 mg → report 5 units. |
| Route | J codes cover IM, IV, SC, and other provider-administered routes — NOT oral medications taken by the patient at home. |
| NDC | National Drug Code may be required on claims in addition to the J code. |
Commonly Tested J Codes
| Code | Drug | Unit |
|---|---|---|
| J1100 | Dexamethasone sodium phosphate | 1 mg |
| J1885 | Ketorolac (Toradol) | 15 mg |
| J2001 | Lidocaine | 10 mg |
| J0170 | Epinephrine | 0.1 mg |
| J2550 | Promethazine (Phenergan) | 50 mg |
| J3301 | Triamcinolone acetonide | 10 mg |
| J1020 | Methylprednisolone | 40 mg |
| J0690 | Cefazolin | 500 mg |
DME Coding (E Codes)
Durable Medical Equipment (DME) must meet four criteria to qualify:
- Can withstand repeated use (durable)
- Primarily and customarily used for a medical purpose
- Not useful to a person who is not sick or injured
- Appropriate for use in the home
Key DME Concepts for the CPC Exam
| Concept | Details |
|---|---|
| Certificate of Medical Necessity (CMN) | Required for many DME items; documents medical justification |
| Rental vs. purchase | Some DME is rented (monthly payments), others are purchased outright |
| DMEPOS | DME, Prosthetics, Orthotics, and Supplies — the broader category |
| ABN (Advance Beneficiary Notice) | Required when Medicare may not cover the DME item |
Ambulance Coding (A Codes)
Ambulance codes describe the type and level of service:
| Code | Service |
|---|---|
| A0425 | Ground mileage (per loaded mile) |
| A0427 | ALS1 — Advanced Life Support, Level 1, emergency |
| A0428 | BLS — Basic Life Support, emergency |
| A0429 | BLS — Basic Life Support, non-emergency |
| A0430 | Fixed-wing air ambulance |
| A0431 | Rotary-wing (helicopter) air ambulance |
Origin/Destination Modifiers for Ambulance
| Modifier | Location |
|---|---|
| D | Diagnostic or therapeutic site (other than hospital or physician's office) |
| E | Residential/domiciliary/custodial facility |
| G | Hospital-based dialysis facility |
| H | Hospital |
| I | Site of transfer (e.g., airport) |
| J | Non-hospital-based dialysis facility |
| N | Skilled nursing facility (SNF) |
| P | Physician's office |
| R | Residence |
| S | Scene of accident or acute event |
| X | Intermediate stop at physician's office |
Modifier usage: Two modifiers are used together to indicate origin and destination. The first modifier = origin, the second = destination.
Example: A0427-SH = ALS1 emergency transport from the Scene of an accident to a Hospital
A physician administers 8 mg of dexamethasone sodium phosphate (J1100 = 1 mg per unit). How many units of J1100 should be reported?
Which HCPCS Level II code section covers drugs administered by healthcare professionals?
An ambulance transports a patient from the scene of a car accident to a hospital. Which modifier combination should be used with the ambulance transport code?
HCPCS Level II codes consist of one _____ followed by four digits.
Type your answer below
Which of the following are required criteria for an item to qualify as Durable Medical Equipment (DME)? (Select all that apply)
Select all that apply
Match each HCPCS Level II code section to the category it covers:
Match each item on the left with the correct item on the right