While CPT codes identify procedures or services, HCPCS Level II codes identify supplies, equipment and devices, and procedures not found in the CPT system. The HCPCS codes (referred to as Hic-Picks) are administered by the Centers for Medicare and Medicaid Services (CMS) and begin with a single letter (A through V), followed by four numeric digits. They are grouped by the type of service or supply they represent and are updated annually by CMS with input from private insurance companies. HCPCS Level II codes are required for claims for supplies and devices covered by Medicare and Medicaid and by most private payers. Providers should always check with payers regarding coverage of HCPCS Level II codes.
HCPCS Level II includes codes for speech generating devices, voice prosthetics, voice amplifiers, and repair of AAC systems or devices. Please note that Medicare claims for E and L codes and V5336 fall under the jurisdiction of the Durable Medical Equipment Medicare Administrative Contractors (DME MACs).
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|A7503||Filter holder or filter cap, reusable, for use in a tracheostoma heat and moisture exchange system, each|
|A7504||Filter for use in a tracheostoma heat and moisture exchange system, each|
|A7505||Housing, reusable without adhesive, for use in heat and moisture exchange system and/or with a tracheostoma valve, each|
|A7506||Adhesive disc for use in a heat and moisture exchange system and/or with tracheostoma valve, and type, each|
|A7507||Filter holder and integrated filter without adhesive, for use in a tracheostoma health and moisture exchange system, each|
|A7508||Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each|
|A7509||Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, each|
|A7520||Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each|
|A7521||Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each|
|A7522||Tracheostomy/laryngectomy tube, stainless steel or equal (sterilizable and reusable), each|
|A7523||Tracheostomy shower protector, each|
|A7524||Tracheostoma stent/stud/button, each|
|A7525||Tracheostomy mask, each|
|A7526||Tracheostomy tube collar/holder, each|
|A7527||Tracheostomy/laryngectomy tube plug/stop, each|
|A9900||Miscellaneous dme supply, accessory, and/or service component of another hcpcs code|
|A9901||Dme delivery, set up, and/or dispensing service component of another hcpcs code|
|A9999||Miscellaneous dme supply or accessory, not otherwise specified|
|E1902||Communication board, nonelectronic augmentative or alternative communication device|
|E2500||Speech generating device, digitized speech, using prerecorded messages, less than or equal to 8 minutes recording time|
|E2502||Speech generating device, digitized speech, using prerecorded messages, greater than 8 minutes but less than or equal to 20 minutes of recording time|
|E2504||Speech generating device, digitized speech, using prerecorded messages, greater than 20 minutes but less than or equal to 40 minutes of recording time|
|E2506||Speech generating device, digitized speech, using prerecorded messages, greater than 40 minutes of recording time|
|E2508||Speech generating device, synthesized speech, requiring message formulation by spelling and access by physical contact with the device|
|E2510||Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access|
|E2511||Speech generating software program, for personal computer or personal digital assistant|
|E2512||Accessory for speech generating device, mounting system|
|E2599||Accessory for speech generating device, not otherwise specified|
|G0161||Services performed by a qualified speech-language pathologist, in the home health setting, in the establishment or delivery of a safe and effective speech-language pathology maintenance program, each 15 minutes|
|G0451||Developmental testing with interpretation and report, per standardized instrument|
|L8499||Unlisted procedure for miscellaneous prosthetic services|
|L8500||Artificial larynx, any type|
|L8501||Tracheostomy speaking valve|
|L8505||Artificial larynx replacement battery/accessory, any type|
|L8507||Tracheo-esophageal voice prosthesis, patient inserted, any type, each|
|L8509||Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type|
|L8511||Insert for indwelling tracheoesophageal prosthesis, with our without valve, replacement only, each|
|L8512||Gelatin capsules or equivalent, for use with tracheoesophageal voice prosthesis, replacement only, per 10|
|L8513||Cleaning device used with tracheoesophageal voice prosthesis, pipet, brush, or equal, replacement only, each|
|L8514||Tracheoesophageal puncture dilator, replacement only, each|
|L8515||Gelatin capsule, application device for use with tracheoesophageal voice prosthesis, each|
|S8940||Equestrian/hippotherapy, per session |
|S9128||Speech therapy, in the home, per diem|
|S9152||Speech therapy, re-evaluation|
|S9986||Not medically necessary service (patient is aware that service not medically necessary)|
|T1018||School-based individualized education program (iep) services, bundled|
|V5336||Repair/modification of augmentative communicative system or device (excludes adaptive hearing aid)|
Modifiers are used when a HCPCS code needs to be supplemented to identify specific circumstances that may apply to an item or service.
 HCPCS Level II G codes are temporary codes developed and used by Medicare to identify professional health care procedures and services that would otherwise be reported using CPT codes, but for which there are no CPT codes. Medicare providers should check with their MACs regarding use of G codes for reporting procedures and services. Medicaid and other private payers may or may not adopt G codes.
 Because CMS will no longer cover CPT 96110 Developmental screen, this supplemental G code, which is valued on the previously-published values of CPT code 96110, was added as a temporary code. Medicaid and private payers may sometimes, but not always, follow suit. There is no guarantee of continued reimbursement, but G0451 may be an alternative to 96110. Because of the potential for confusion with these codes, documentation should be very clear.
 S codes are primarily used by private insurers to report drugs, services, and supplies for which there are no national codes but for which codes are needed by the private sector to implement policies, programs, or claims processing. These codes may also used by Medicaid programs, but they are not payable by Medicare. Providers should always check with payers regarding use of S codes.
 Speech-language pathology services are typically reported using Current Procedural Terminology (CPT) codes, regardless of the treatment technique used, such as hippotherapy. Additional information on hippotherapy is available from the American Hippotherapy Association, Inc. Speech-language pathologists should should contact payers directly regarding use of S8940.
 T codes are for use primarily by Medicaid State agencies to identify items for which there are no permanent national codes and for which codes are necessary to meet a national Medicaid program operating need. T codes may be also used by private insurance programs, but they are not payable by Medicare. Providers should always check with payers regarding use of T codes.