CMC HCPCS Level II Coding 3

Question 1

A Medicare patient receives a power wheelchair. Which HCPCS Level II code range is most appropriate?

Accepted Answer

E codes (DME)

Answer

Power wheelchairs are classified as Durable Medical Equipment (DME) and are found in the E code range (E1130–E1298) of HCPCS Level II.

Question 2

HCPCS Level II S codes are primarily used by which payers?

Accepted Answer

Private insurers and Medicaid (non-Medicare payers)

Answer

S codes are used by private insurers and Medicaid for items and services not covered by Medicare or not yet accepted for Medicare billing purposes.

Question 3

When billing Medicare for a non-covered item, which approach is correct?

Accepted Answer

Append the appropriate modifier such as GY or GA to the HCPCS code

Answer

When billing non-covered items to Medicare, modifiers such as GY (statutorily excluded) or GA (ABN on file) are appended to communicate the coverage status to the payer.

Question 4

Which of the following best describes a HCPCS Level II 'miscellaneous' or 'not otherwise classified' code?

Accepted Answer

A code used when no specific code adequately describes the item or service

Answer

Miscellaneous HCPCS codes (e.g., E1399, A9999) are used when no other specific code adequately describes the item or service being billed and typically require additional documentation.

Question 5

What is the primary purpose of HCPCS Level II T codes?

Accepted Answer

State Medicaid agency codes for items and services not covered by national Medicare/Medicaid codes

Answer

T codes are used by state Medicaid agencies for items and services not covered by the Medicare or national Medicaid system but required by individual state Medicaid programs.

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CMC HCPCS Level II Coding 3