Coding System: HCPCS

Usage

System URI: https://bluebutton.cms.gov/resources/codesystem/hcpcs

Appears In:

• ExplanationOfBenefit.item.service
• ExplanationOfBenefit.item.modifier

This FHIR Coding.system value is used for the Codings that identify the procedures, supplies, products, and services for each ExplanationOfBenefit.item (EOB.item) in the PAI results. Such Codings are used in all ExplanationOfBenefit resources returned by the API, excepting those for Part D events.

This Coding is simply a combination of these two variables, as received from the source Medicare records system:

• Coding.code:
  • For ExplanationOfBenefit.item.service: HCPCS_CD
  • For ExplanationOfBenefit.item.modifier, one of:
    • HCPCS_1ST_MDFR_CD
    • HCPCS_2ND_MDFR_CD
    • HCPCS_3RD_MDFR_CD
    • HCPCS_4TH_MDFR_CD
• Coding.version: CARR_CLM_HCPCS_YR_CD
  • Note: Coding.version is only available for some Carrier and DME claims. It is not available at all for other claim/event types.

Additional Information

As described on HCPCS_CD, the HCPCS code set is a combination of different code sets that can be disambiguated based on their value format. See CMS’ HCPCS - General Information for further information.