Did you know that each year, insurance payers process more than 5 billion medical claims? That is roughly 13.7 million claims each day! Can you imagine the time and effort it would take to go over each service, procedure, or product description and decide whether the claim should be paid? The US healthcare industry cannot afford such delays and backlogs. Healthcare providers need reimbursements on time to keep revenue cycles moving and their practices thriving.
That’s why, nearly six decades ago, standardized coding systems were introduced, including HCPCS and CPT. These allowed insurance payers to “process claims in an orderly and consistent manner”.
Today, we will dive deep into HCPCS codes vs. CPT codes to understand their differences and the nitty-gritty. Read on to master the specifics.
What are HCPCS Codes?
Healthcare Common Procedure Coding System (HCPCS) codes are five-digit alphanumeric codes that are used for standardized reporting of medical services, procedures, supplies, and equipment. These codes are commonly known as HCPCS Level II codes and inform the government (Medicare and Medicaid) and private insurance payers about the services and products (e.g., drugs and prosthetics) provided to patients.
The typical format of an HCPCS code is an alphabetical letter followed by four numbers. For example, B4034. Here, letter B denotes enteral and parenteral products, equipment, and supplies, including pumps, nutritional formulas, and tubing. Whereas 4034 specifies an enteral feeding supply kit (syringe-fed), including dressings, tape, set tubing, and a feeding syringe.
When to Use HCPCS Codes?
HCPCS codes are reported on medical claims when a qualified healthcare provider or facility wants to bill the insurance payer for non-physician services, supplies, drugs, or durable medical equipment. Generally, healthcare providers are advised to refer to the HCPCS codes when the rendered services or products are not listed under the CPT coding system.
Categories of HCPCS Codes
According to an article published on the American Academy of Professional Coders (AAPC)’s official website, the Centers for Medicare and Medicaid Services (CMS) introduced three levels of HCPCS codes in 1983.
- HCPCS Level I: Same as CPT codes
- HCPCS Level II: Medicare National Codes (for non-physician services, drugs, supplies, and equipment)
- HCPCS Level III: Local Regional Codes
HCPCS Level III or local regional codes were created by Medicare Administrative Contractors (MACs), state Medicaid agencies, and private insurance companies to represent services that were not covered under HCPCS Level I and II codes.
It is also important to note that Level III codes were discontinued in December 2003. To comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the CMS was required to standardize coding for reporting of healthcare transactions across the United States. As a result, state-based, local HCPCS Level III codes were eliminated, and Level I and II codes were expanded.
Common HCPCS Codes
The following are some of the widely used HCPCS codes in 2026. The CMS organizes them alphabetically to ensure that each letter represents products and services grouped under a category. For example, there are over 1,200 J-codes, and all of them report drugs (e.g., chemotherapy drugs) that are not administered orally.
| HCPCS Code Type | Scope of Products & Services | Examples |
|---|---|---|
| A codes | Transportation services, including ambulance, medical, and surgical supplies. | A0021, A0435, A4208, A6565, A7504, A9577 |
| C codes | For use with the Outpatient Prospective Payment System (OPPS) billing by hospitals. Cover new drugs, biologicals, devices, and radiopharmaceuticals. | C1052, C1814, C2636, C7500, C7900, C8908 |
| E codes | Durable Medical Equipment (DME). | E0100, E0193, E0255, E0459, E1405, E3000 |
| G codes | Temporary codes that report procedures, supplies, and professional services. | G0008, G0161, G0333, G0442, G2086, G4033 |
| H codes | Alcohol/drug abuse treatment, mental health services, and community support services. | H0001, H1001, H0025, H0052, H2000, H2021 |
| J codes | Non-orally administered drugs and biologicals, including chemotherapy, injections, and inhalation solutions. | J0013, J0123, J1162, J2315, J3300, J7210 |
| K codes | Specialized durable medical equipment, specifically wheelchairs and accessories, for Medicare Administrative Contractors. | K0001, K0018, K0195, K0552, K0822, K1037 |
| L codes | Orthotic and prosthetic procedures, devices. | L0112, L0454, L0650, L1600, L2550, L5250 |
| P codes | Pathology and laboratory services, especially blood, blood products, and related processing or storage. | P2028, P9010, P9021, P9034, P9046, P9100 |
| S codes | Temporary codes. Used primarily by commercial insurance payers. Cover drugs, services, and supplies. | S0012, S0023, S0170, S0201, S0317, S0610 |
| T codes | Primarily for State Medicaid Agencies to report services and supplies not included in the CPT code set. | T1000, T1012, T1026, T2001, T2013, T4525 |
What are CPT Codes?
The Current Procedural Terminology (CPT) codes are also five-digit codes that are used for standardization in medical billing. However, unlike HCPCS codes, CPT codes are numerical. Also, CPT codes are maintained by the American Medical Association (AMA) and not CMS.
This coding system includes more than 11,000 codes, where each code represents a physician-provided medical, surgical, or diagnostic service.
Like HCPCS codes, CPT codes are organized into code ranges according to the type and site of procedure. For example, CPT codes 20100 to 29999 represent surgical procedures on the musculoskeletal system.
When to Use CPT Codes?
Healthcare providers (especially physicians) use CPT codes on medical claim forms when they want to bill the insurance payer for rendered services. It standardizes and simplifies communication between healthcare providers and insurance payers. How?
Before CPT codes, physicians used to write long descriptions for the procedures or services rendered to patients. 10 different physicians would describe the same service to the insurance payer in 10 different ways. This used to prolong claim processing and delay reimbursement collection. To remedy this situation, CPT codes were introduced and widely adopted by the 1970s.
Categories of CPT Codes
The following are the three categories of CPT codes:
- Category I: These codes report established medical services and procedures (with strong clinical evidence). Government and private payers accept these codes. E.g., 71250 and 98943.
- Category II: These codes describe performance measurements for tracking the quality of care. Used for MACRA and MIPS reporting. E.g., 3006F and 3573F.
- Category III: These codes track emerging medical technologies, procedures, and services, gathering data on use and effectiveness to support potential Category I conversion. E.g., 1030T and 0510T.
The AMA introduced Category II and III CPT codes in 2002 to improve patient care and ensure it was meeting the necessary quality standards. You must also remember that while Category II CPT codes typically have letter F at the end, Category III codes end with letter T.
Common CPT Codes
Listed below are some of the most frequently reported CPT code ranges.
| CPT Code Ranges | Scope of Procedures & Services | Examples |
|---|---|---|
| 10004 to 69990 | Surgery (e.g., general surgery, and surgical procedures on the respiratory, cardiovascular, digestive, urinary systems, etc.). | 10021, 31300, 33016, 40490, 50010, 52700 |
| 00100 to 01999 | Anesthesia (e.g., anesthesia for procedures on the head, neck, spine and spinal cord, upper leg, or elbow). | 00120, 00322, 00450, 00635, 00770, 01173 |
| 70010 to 79999 | Radiology (e.g., diagnostic imaging, breast mammography, ultrasound, bone/joint studies, radiation oncology, nuclear medicine). | 71045, 75557, 76604, 77048, 77076, 78012 |
| 80047 to 89398 | Pathology and laboratory (e.g., drug assays, urinalysis, organ or disease-oriented panels, molecular pathology, genome sequencing). | 80050, 80156, 81020, 81408, 81458, 82030 |
| 99202 to 99499 | Evaluation and management (e.g., new/established patient office or outpatient services, advanced care planning). | 99202, 99215, 99483, 99485, 99490, 99497 |
Key Differences: HCPCS vs. CPT Codes
Are you still wondering about the distinction between the two coding systems? Then put your mind at ease because the following table summarizes HCPCS codes vs. CPT codes. Take a look.
| HCPCS Codes | CPT Codes | |
|---|---|---|
| Coding System | Healthcare Common Procedure Coding System | Current Procedural Terminology |
| Format | Five digits. Alphanumeric. Usually, a letter followed by four numbers. | Five digits. Numerical. Organized into code ranges. |
| Purpose | Identify products, supplies, and services rendered to patients, not otherwise covered under CPT code sets. | Represent specific procedures and services that the physicians and other healthcare professionals provide. |
| Created In | 1978 | 1966 |
| Maintained By | Centers for Medicare and Medicaid Services (CMS) | American Medical Association (AMA) |
| Total No. of Codes | 9,000+ | 11,000+ |
| Frequency of Updates | Updated every quarter | Revised every year |
The Missing Link: ICD-10 Codes
HCPCS and CPT codes are entered in medical claim forms for standardized billing and payer communication. However, these two coding systems cannot fully support one another to prove the medical necessity of the service and for payment collection unless the third coding system is added to the mix. That’s right. The third coding system, International Classification of Diseases, Tenth Revision (ICD-10), is globally recognized and used to report health data, like diseases, symptoms, injuries, or causes of death.
In simple terms:
- ICD-10 codes explain the diagnosis or the WHY (why the service was needed?).
- CPT codes explain the procedure or the WHAT (what was done for treatment?).
- HCPCS codes describe the ancillary services, supplies, and equipment. They are the WHAT ELSE of the equation.
HCPCS codes, CPT codes, and ICD-10 codes all form the foundation of healthcare billing and documentation. Without these, your medical claims will most likely get denied.
Final Words
We hope that by now, you have a clear idea about the differences between HCPCS and CPT codes. Remember, HCPCS and CPT are both coding systems used in medical billing for standardized communication between healthcare providers and insurance payers. However, their structure, purpose, and scope are different. Therefore, both should be selected wisely during claim creation to ensure coding accuracy and specificity.
With thousands of HCPCS and CPT codes to choose from, medical coding can turn into a nightmare, especially when frequent revisions keep causing disruption. But you can escape the mayhem, stress, and grind by outsourcing medical coding and billing to professional companies like MediBillMD. Their complete suite of medical billing services includes ICD-10, HCPCS, and CPT coding, helping you fast-track claim creation and submission. So, let AAPC-certified coders handle billing, and you can focus on patient care.
