Classification of current procedure codes

Current procedure code Range Description

00100-01999 Anesthesia

00021-69990 Surgery-General

10040-19499 Surgery-Integumentary System

20000-29999 Surgery-Musculoskeletal System

30000-32999 Surgery-Respiratory System

33010-37799 Surgery-Cardiovascular System

38100-38999 Surgery-Hemic and Lymphatic System

39000-39599 Surgery-Mediastinum and Diaphragm

40490-49999 Surgery-Digestive system

50010-53899 Surgery-Urinary System

54000-55899 Surgery-Male Genital System

55970-55980 Surgery-Intersex

56405-58999 Surgery-Female Genital System

59000-59899 Surgery-Maternity care and Delivery

60000-60699 Surgery-Endocrine System

61000-64999 Surgery-Nervous System

65091-68899 Surgery-Eye and Ocular Adnexa

69000-69979 Surgery-Auditory System

69990-69990 Surgery-Operating Microscope

70010-79999 Radiology

80048-89356 Pathology and Laboratory

90281-99199 Medicine – Part 1

99500-99602 Medicine – Part 2

99201-99499 Evaluation and Management

A0021-A0999 Transportation Services Including Ambulance

A4206-A7527 Medical and Surgical Supplies

A9150-A9999 Administrative, Miscellaneous & Investigational

E0100-E8002 Durable Medical Equipment

G0008-G9130 Procedures/Professional services

J0120-J8999 Drugs Administered Other than Oral method

J9000-J9999 Chemotherapy Drugs


Evaluation & Management (E&M) codes - 99201 to 99499


9920* (1,2,3,4,5)– OV -New
9921* (1,2,3,4,5)– OV -Established
9922* (1,2,3)– Hospital visit initial
9923* (1,2,3)– Hospital visit follow-up
9924* (1,2,3,4,5)– OV consulting
9925* (1,2,3,4,5)– Hospital visit consulting
99238/239 – Hospital Discharge
9935* (4,5,6,7) – Prolonged service (additional code used with E&M code)
99291/99292 – Critical care

COMMONLY USED CODES:


Office Visit (POS-11)

9920* (1,2,3,4,5) – Office visit New
9921* (1,2,3,4,5) – Office visit Established
9924* (1,2,3,4,5) – Office consultation
9938* (1 to 7) -Physical exam new patient (These codes are not covered by Medicare. We have to use 9* for the claim.)

99381 (under 1 year of age)
99382 (1-4 years of age)
99383 (5-11 years of age)
99384 (12-17 years of age)
99385 (18-39 years of age)
99386 (40-64 years of age)
99387 (65+ years of age)

9939* (1 to 7) - Physical exam established patient
93000 - EKG (Electro Cardiogram)
99000 - Specimen handling
90772 - Injection Admin
90471,90472 - Vaccination Admin
9935* (4,5,6,7)- Prolonged services


Hospital Visit In Patient (POS – 21)


9922* (1,2,3) - Hospital visit initial (admission)
9923* (1,2,3) - Hospital visit follow-up
99238 / 99239 - Hospital discharge
9925* (1,2,3,4,5)- Hospital consultation initial
99291 - Critical care (30-74 Min)
99292 - Critical care (additional 30 Min)
99234-99236 - Admit & Discharge on same day

Hospital Visit Out Patient (POS – 22)


9921* (8,9)/99220-Hospital observation care
99217 - Hospital observation Discharge

Home Visit (POS – 12)


9934* (1,2,3,4,5) - Home Visit Initial
99347 to 99350 - Home visit follow up

Nursing Visits (POS-31, 32,33)


9930* (4,5,6) - Nursing home initial
9930 *(7,8,9,10)- Nursing follow-up
99315/99316 - Nursing home discharge
9932 (4,5,6,7,8) - Rest home new patient
9933 (4,5,6,7) - Rest home follow-up

HCPCS 

• Level I codes and modifiers are the procedure codes; and

• Level II codes and modifiers primarily identify products, supplies, and services that are not included in the procedure codes (such as ambulance services; drugs; devices; and durable medical equipment, prosthetics, orthotics, and supplies).

Level I HCPCS: Current Procedure Code

• The code set providers use to report medical procedures and professional services furnished in ambulatory/ outpatient settings, including physician visits to
inpatients; and

• The American Medical Association (AMA) developed, copyrighted, and maintains the code set

Level II HCPCS: Alphanumeric HCPCS

• The code set providers use to report medical items, supplies, procedures, and certain professional services that are not described by any procedure codes; and

• CMS maintains the code set, with the exception of the code set for dental services (D-codes). The American Dental Association (ADA) developed, copyrighted, and
maintains the D-codes.