MedicalDevice_TLB_8.25

Reimbursement Consulting

Available from mdi Consultants, Inc.

Current Procedural Terminology (CPT Codes) and ICD-9 Codes
Level I Codes (Current Procedural Terminology)are medical services and procedures codes used by physicians filing for payment for services rendered. The CPT Codes are maintained and republished annually by the American Medical Association. ICD-9 codes are used in conjunction with CPT-Codes .ICD-9 Codes are diagnostic codes used by the physician to indicate treatment for a specific injury/disease. The CPT Code (services/treatment} must match the ICD-9 Code (specific disease or injury) for payment to be approved. CMS (Central Management Services) provides a strong consulting role with changes, new codes, etc.

Healthcare Common Procedural Coding System (HCPCS Codes)
Level II Codes-HCPCS Codes (Healthcare Common Procedural Coding System) are used by providers other than physicians to file for payment of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). Statistical Analysis Durable Medical Regional Carriers (SADMERC) has primary responsibility for assigning codes and maintaing the product classification list. SADMERC is under contract by CMS (Central Medical Services) to manage this portion of HCPCS. Over 4000 HCPCS Codes currently exists for Durable Medical Equipment and Supplies. To file for HCPCS codes the product must either have a 510k or a letter of exemption from the FDA.

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