Can HCPCS or CPT® code descriptions be changed by payers or providers, i.e. use the code with a different meaning?
No. A goal for HIPAA administrative simplification was to end “custom coding”, including prohibiting changing the meanings assigned to what would otherwise be standardized codes. The HIPAA regulations are very clear in this area. Of course, the law is the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191. The relevant HIPAA regulations are found in 45 CFR Part 162 and were released as part of the August 17, 2000 Transactions and Coding Standards Rule. There are two separate parts of these regulations prohibiting change of code descriptions. The first part is actually a composite of different regulation sections.
Related Questions
- How should providers bill for different non-contracted items that have the same HCPCS Level II code (such as administration sets/extension sets) without the claim being denied or rejected for duplicate charges?
- Are the Healthcare Common Procedure Coding System (HCPCS) National Code descriptions listed as the brand name or the generic name of the medication?
- Are the HCPCS National Code descriptions listed as the brand name or the generic name of the medication?
