5 Difference between HCPCS and CPT with Comparison Table

What is the difference between HCPCS and CPT codes?

CPT is an abbreviation of Current Procedural Terminology administered by the American Medical Association. HCPCS is an abbreviation of Healthcare Common Procedural Coding System that uses CPT code.

The main difference between CPT and HCPCS is that the former is a set code meant for directing the usage of medical procedures to the authorities while the latter is used by medical workers to claim health insurance from their insurance companies.

difference between hcpcs and cpt

Comparison Table (HCPCS vs CPT)

Basic Terms HCPCS CPT
Significance Provide a standardized description of delivering healthcare services Provide service description that medical workers have to acknowledge
Protection Everyone is entitled to free access to HCPCS procedures Outsiders need to pay for service to access the CPT procedures
Divisions Operate under three-level i.e Level 1, Level 2, and Level 3. Operate under three categories i.e Category 1, Category 2, and Category 3.
Creators Centers for Medicare and Medicaid (CMS) American Medical Association (AMA).
Affect Have codes that affect both direct healthcare workers and non-direct healthcare workers Code provides procedures for the operation of the patient

What Is HCPCS?

Centers for Medicare and Medicaid organizations are responsible for the development of HCPCS codes. HCPCS stands for Healthcare Common Procedure coding system.

It is used by healthcare workers to claim medical insurance from their insurance companies. It can be used by everyone to access HCPCS procedures. Thanks to the HIPAA for making it possible.

It is free of cost and it operates under three levels. Each level has a way of affecting both direct and non-direct healthcare workers.

Level 1 contains CPT codes addressed by American Medical Association. The CPT codes are mainly used by direct healthcare workers to offer medical services to the patient.

Level 2 consists of codes that are associated with non-physical service providers. Ambulance services fall under this level and it is subdivided into a format of capital letters followed by four digits.

Level 3 is also known as local codes. HCPCS codes lookup the medical history of the patient and provides descriptions for healthcare insurance of a certain program.

What Is CPT?

American Medical Association is linked to the development of CPT codes. The CPT stands for the Current Procedural Terminology.

The CPT codes provide direction to medical professionals to consider while attending to the patient. It is published in the CPT editorial panel in the American Medical Association.

It operates under three category and each category plays a crucial role in delivering medical services to the patient.

Category 1 contains six sections that are influenced by medical workers and head level. These sections are codes for medicine, radiology, anesthesia, surgery, pathology and laboratory, evaluation, and management.

Category 2 provides descriptions of the codes that clinics have to follow while evaluating and managing patients. The advisory board of CPT is the Performance Measures Advisory Group.

Category 3 meant for addressing the emerging technology in the medical field. Any organization with the desire to access this category has paid since it is owned by AMA.

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Main Differences between HCPCS and CPT

  1. HCPCS was developed by the Centers for Medicare and Medicaid while CPT was developed by American Medical Association.
  2. CPT is divided into three categories while HCPCS is divided into three levels
  3. HCPCS encourage free access due to HIPAA while CPT has paid access service due to a copyrighted issue
  4. HCPCS is applicable for both indirect and direct professionals while CPT provides rules to be followed when treating a patient.
  5. HCPCS is a standardized description rule to be followed by professionals while attending to the patient while CPT consists of codes that set procedures.

Comparison Video

In Conclusion

Both HCPCS and CPT are used to direct the services carried out by medical professionals. HCPCS consists of three levels and each level plays a crucial role when it comes to patient attendance. CPT is part and parcel of HCPCS but it is a paid service for outsiders.

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