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.
Medicare Guideline posts
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