HCPCS Billing FAQ
Common questions about HCPCS Level II codes, Medicare billing, and how to use this reference.
What's the difference between HCPCS and CPT?
CPT codes are five-digit numeric codes maintained by the American Medical Association (AMA). They cover physician services, surgical procedures, and diagnostic tests. HCPCS Level II codes are alphanumeric codes (letter + four digits) maintained by CMS. They cover supplies, durable medical equipment, injectable drugs, ambulance services, orthotics, prosthetics, and other services and items not represented in CPT. Both code sets are used on Medicare claims. This site covers HCPCS Level II only. Read more: HCPCS vs CPT.
Can I use CPT and HCPCS on the same claim?
Yes. The CMS-1500 claim form (and its electronic equivalent, the 837P transaction) supports both CPT and HCPCS Level II codes on the same claim. A physician visit might include a CPT evaluation and management code alongside a HCPCS J-code for a drug injection administered during the visit. NCCI edits apply across both code sets, so you still need to check edit relationships when both appear on the same date of service.
How often does CMS update HCPCS codes?
CMS updates HCPCS Level II codes on a quarterly schedule: January 1, April 1, July 1, and October 1 of each year. The January update is the largest and coincides with the annual physician fee schedule update. Interim quarters focus on new drug codes, temporary code additions, and minor revisions. Billing teams should review the quarterly changes page before each effective date. Read more about the quarterly update process.
How do I look up a J-code for a drug?
If you have the drug's National Drug Code (NDC), use the NDC to HCPCS lookup tool to find the corresponding J-code. You can also browse all J-codes in the code browser or search by drug name. The NDC crosswalk confirms the exact J-code for a specific manufacturer and package. Read more about the NDC-to-HCPCS crosswalk.
What is an NCCI edit?
NCCI (National Correct Coding Initiative) edits define pairs of HCPCS or CPT codes that Medicare considers mutually exclusive or that represent services included within a more comprehensive procedure. When both codes from an edit pair appear on the same claim for the same beneficiary on the same date, the Column 2 code is automatically denied. Some edits can be overridden with modifier 59 or an X modifier when the services were genuinely separate. Learn more about NCCI edits or read the NCCI billing guide.
What does "non-facility rate" vs "facility rate" mean?
The Physician Fee Schedule has two rates per code. The non-facility rate applies when a service is delivered in a physician office or freestanding clinic, where the physician bears practice overhead costs. The facility rate applies when the service is delivered in a hospital or ASC, where the facility bills separately for overhead. The non-facility rate is always higher. View current physician fee schedule rates.
How do I report NDCs on a drug claim?
For Medicare Part B drug claims, the NDC must be reported in addition to the J-code. On paper CMS-1500 claims, the NDC is reported in the shaded area of the service line in the format N4 + 11-digit NDC + unit qualifier + quantity. On electronic 837P claims, the NDC goes in the 2410 loop (Drug Identification). Use the NDC lookup tool to verify the NDC-to-HCPCS mapping before submitting.
For definitions of key billing terms, see the HCPCS Glossary. For data methodology, see Methodology.