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What does HCPCS/CPT stand for?

  • Health care providers use Healthcare Common Procedure Coding System/Current Procedural Terminology (HCPCS/CPT) codes to report medical services performed on patients to state Medicaid agencies or fiscal agents. HCPCS consists of Level I CPT codes and Level II codes.

Which HCPCS codes are not applicable to valve & vascular products?

  • Level II HCPCS codes, including C codes, are not applicable to Valve and Vascular products utilized for in-patient procedures such as valve replacement. C codes are used in conjunction with the Medicare prospective payment system for outpatient procedures only. Revenue codes help hospitals categorize services provided by revenue center.

What is the ideal MUE value for a HCPCS/CPT code?

  • The ideal MUE value for a HCPCS/CPT code is the unit of service that allows the vast majority of appropriately coded claims to pass the MUE. All practitioner, ambulatory surgical center (ASC), outpatient hospital facility, and provider claims submitted to state Medicaid agencies or fiscal agents are tested against MUEs.

Does a HCPCS/CPT code indicate Medicaid coverage?

  • The presence of a HCPCS/CPT code in an NCCI PTP edit, or of an MUE value for a HCPCS/CPT code does not necessarily indicate that the code is covered by any state Medicaid program or by all state Medicaid programs.
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