Billing coding
HCPCS

Medical providers use the Healthcare Common Procedure Coding System for a variety of services.

Level 1 of the HCPCS is comprised of Current Procedural Terminology, a numeric coding system maintained by the American Medical Association. The CPT-4 is used primarily to identify medical services and procedures for which physicians and other health care professionals bill public or private health insurance programs.

Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies and services not included in the CPT-4 codes. These include items such as ambulance services and durable medical equipment, prosthetics, orthotics and supplies when used outside a physician’s office.

NCCI

Both Medicare and Medicaid use the National Correct Coding Edits to ensure correct coding. The Centers for Medicare and Medicaid Services developed the Medically Unlikely Edits, or MUE, to reduce the paid claims error rate for Part B claims. An MUE for a HCPCS/CPT code is the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service. All HCPCS/CPT codes do not have an MUE.

The NCCI "Look-up Tool" will help you to learn how to access and view the NCCI edits and determine proper use for certain modifiers and more.

The NCCI Edits will indicate services that are bundled and cannot be billed separately as well as list services that may be unbundled under certain conditions.

Modifiers
Place of Service Codes