WHG Helps Clients Develop Targeted HCPCS Level I (CPT) and Level II Coding Strategies and Execute HCPCS Coding Application Processes to Maximize Stakeholder Value 

HCPCS level I or HCPCS Level II Coding Pathways? - Not Always Clear Cut!​

​The Healthcare Common Procedure Coding System (HCPCS) is divided into two principal subsystems, referred to as Level I and Level II of the HCPCS.
  • Level I - CPT-4 codes are maintained by the AMA (physician procedure codes)
  • Level II - Alpha Numeric codes are maintained by CMS (Ambulance services, non-self administered drugs, practitioner procedures not included in CPT, DME, prosthetics, orthotics and supplies)
  • Level I of the HCPCS is comprised of Current Procedural Terminology (CPT-4) , a numeric coding system maintained by the American Medical Association (AMA). The CPT-4 is a uniform coding system consisting of descriptive terms and identifying codes that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals. These health care professionals use the CPT-4 to identify services and procedures for which they bill public or private health insurance programs. Level I of the HCPCS, the CPT-4 codes, does not include codes needed to separately report medical items or services that are regularly billed by suppliers other than physicians.​
  • 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, such as ambulance services,  drugs that are usually not self administered (i.e.vaccines) practitioner procedures not included in CPT and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office. Because Medicare and other insurers cover a variety of services, supplies, and equipment that are not identified by CPT-4 codes, the level II HCPCS codes were established for submitting claims for these items.

Critical to HCPCS Coding Success - Prior to Submitting HCPCS Applications

  • WHG's comprehensive assessment of the clients coding requirements through all 7-Reimbursement Steps​ - from 1) diagnosis, 2) treatment plan, 3) site of care, and 4) benefit category to 5) coding, 6) coverage and 7) payment.
  • Clients can miss critical analytics at the beginning of the 7-step reimbursement process focusing first on coding, then coverage and payment.  
  • Coding, coverage and payment pathways first require a defined site of care and respective benefit category.
  • Clients frequently encounter denials because of site of care or benefit category issues.

​Critical to HCPCS Coding Success - ​Submitting the Actual HCPCS Application

  • Level I  (AMA - CPT) and Level II (CMS - Alpha Numeric) HCPCS coding applications and processes are significantly different and require expertise to help avoid rejections and/or delays.
  • Both coding applications are time sensitive, rigid and require pre-work with the appropriate AMA or CMS committees to help avoid rejections and/or miss categorized benefits, coding, coverage and payment decisions. ​
  • Good science and the ability to articulate and demonstrate cost effective clinical outcomes is a critical component to achieving a successful HCPCS coding, coverage and payment result.

Why Choose Wells Health Group

  • WHG understands the nuances of the complex HCPCS Level I and Level II coding pathways. 
  • WHG provides strategy analytics and reimbursement pathways based on our real-life successful HCPCS coding track record.
  • WHG is strategically located on Pennsylvania Avenue between the Capitol and the White House and just six blocks from the main HHS building. Because of our location, WHG has been able, pre-pandemic, to more readily access face-to-face meetings at multiple levels of the HHS Agencies and on Capitol Hill.
  • WHG is a known entity because of previous years Washington D.C. presence, participating in face-to-face meetings at multiple levels of  the HHS Agencies. As a known entity WHG knows how to leverage  virtual access  to key decision-makers at the HHS Agencies.
  • WHG is a member of the HCPCS Coding Reform Alliance. The Alliance is advocating for transparency, and separation of the coverage and coding process, among other problematic issues.
  • Deb Wells has been recognized for her participation in the CMS HCPCS New Coding Application Beta testing and the HCPCS Coding Reform Alliance.