OAR 410-122-0180: Healthcare Common Procedure Coding System Level II Coding

(1) The Healthcare Common Procedure Coding System (HCPCS) level II is a comprehensive and standardized system that classifies similar products that are medical in nature into categories for the purpose of efficient claims processing. For each alphanumeric HCPCS code, there is descriptive terminology that identifies a category of like items. These codes are used primarily for billing purposes. The Centers for Medicare and Medicaid Services (CMS) maintain and distribute HCPCS Level II Codes. (2) HCPCS is a system for identifying items and services. It is not a methodology or system for making coverage or payment determinations. The existence of a code does not, of itself, determine coverage for an item or service. While these codes are used for billing purposes, decisions regarding the addition, deletion, or revision of HCPCS codes are made independently of the process for making coverage and payment determinations for medical items or services. Items billed with a miscellaneous or not otherwise classified HCPCS code may be reviewed by the Division on a case-by-case basis in accordance with Chapter 410 Division 122 rules. (3) The Division uses the HCPCS Level II Code Set to ensure that claims are processed in an orderly and consistent manner. (4) When requesting authorization and submitting claims, DMEPOS providers must use HCPCS codes to identify the items they are billing. The descriptor that is assigned to a code represents the definition of the items and services that can be billed using that code. (5) This rule division may not contain all code updates needed to report medical services and supplies. (6) For the most up-to-date information on code additions, changes, or deletions, refer to the fee schedule posted on the Division Web site. (7) The Division fee schedule is updated quarterly and lists the current HCPCS codes in an alphanumeric index. (8) Newly established temporary codes and effective dates for their use are also posted on the Division website at https://www.oregon.gov/oha/hsd/ohp/pages/fee-schedule.aspx. (9) CMS updates new, revised, and discontinued HCPCS codes on a quarterly basis. (10) The Medicare Pricing, Data Analysis and Coding (PDAC) contractor assists in determining which HCPCS code shall be used to describe and bill DMEPOS items. Refer to the product classification list on the PDAC contractor website for appropriate HCPCS codes.