HCPCS Level II
Supplies & drugs · Beginner · 2 lessons
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HCPCS Level II structure & when to use it
12 min read
HCPCS Level II codes are one letter followed by four digits and cover items CPT® does not: drugs, durable medical equipment, prosthetics, orthotics, supplies, ambulance, and certain Medicare-specific services. Level II is maintained by CMS and updated quarterly for drugs. Medicare and most payers require Level II codes for these items even when a CPT® code seems similar.
- ✓A-codes ambulance & supplies · B enteral/parenteral · E DME · G Medicare procedural/professional · J drugs administered other than oral · K DME MAC temporary · L orthotics/prosthetics · Q temporary · S private payer.
- ✓J-code units are dosage-based: report the number of units defined in the code descriptor, not the number of vials.
- ✓Report wasted single-dose vial drug with modifier JW (and JZ to attest no waste, when required).
- ✓G-codes often replace a CPT® code for Medicare (e.g., screening colonoscopy G0121/G0105).
- ✓Level II modifiers are two alphabetic or alphanumeric characters — LT/RT, F1–FA fingers, T1–TA toes, GA/GX/GY/GZ ABN modifiers, KX requirements met.
Flashcards
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Case studies
Apply the guidelines to real documentation
Injection encounter
Established patient presents solely for a scheduled therapeutic injection of 40 mg methylprednisolone acetate (J1030 = 40 mg) administered IM by the nurse under the physician's order. No E/M service performed.
What is reported?
Knowledge check
3 questions
1. J1885 is 'injection, ketorolac tromethamine, per 15 mg.' The provider administers 60 mg. Units reported?
2. Which modifier indicates the beneficiary signed an ABN because the service may be denied as not medically necessary?
3. A single-dose 100 mg vial is used; 30 mg is administered and 70 mg discarded. How is the waste reported?