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© 2021 Palmetto GBA, LLC

We frequently update our articles to reflect the latest changes and updates to Medicare, and strongly recommend you visit this article at link below to confirm you have the latest version.

Published Date:12/01/2020

Printed Date: 9/22/2015

URL: http://palmgba.com/marlowe/redesign6/article.html

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You are responsible for determining the correct diagnostic and procedural coding for the services you furnish to Medicare patients. Medicare contractors cannot make determinations about the proper use of codes for you or your staff. If you have a question about interpretation of procedural and diagnostic coding, please contact the entities that have responsibility for those coding sets:
  • Current Procedural Terminology (CPT) codes are proprietary to the American Medical Association (AMA). As such, CPT coding questions should be referred to the AMA. The AMA offers CPT Information Services (CPT-IS). This Internet-based service is a benefit to AMA members and is available as a subscription fee-based service for non-members and non-physicians. The AMA also offers CPT Assistant. Information about these resources is found on the AMA's website.
  • The American Hospital Association (AHA) has a website with many resources for answers to coding questions. The website also has a direct link to the AHA Coding Clinic whereby coding questions may be submitted and tracked.
  • Level II Healthcare Common Procedure Coding System (HCPCS) codes related to durable medical equipment or prosthetics, orthotics, and supplies are answered by the Pricing, Data Analysis and Coding (PDAC) Contractor. Information about the PDAC Contractor and the services it provides can be found on the PDAC's website.
  • Additional information can be found about these resources on the CMS HCPCS General Information web page.
The information above can be found on the CMS IOM Manuals, Publication 100-09, Chapter 6, and Section 30.1.1 (PDF, 1.32 MB).

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Last Updated: 12/01/2020

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