Written and maintained by CASRAI Editorial Board
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Short answer: HCPCS Level II codes (also written HCPCS Level 2 codes) are the national alphanumeric codes, one letter followed by four digits, that identify products, supplies and services the AMA’s CPT codes do not cover, such as ambulance services and durable medical equipment. CMS maintains the code set and publishes the official list as a dated quarterly file.
This guide is general reference information for lab, clinic and supply staff. It is not billing, coding or medical advice for any individual case.
What HCPCS Level II codes are
CMS describes the Healthcare Common Procedure Coding System (HCPCS) as divided into two main subsystems, Level I and Level II. Level II is, in CMS’s words, a standardized coding system used primarily to identify products, supplies and services not included in the CPT codes, for example ambulance services or durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) when used outside a physician’s office. Level II codes are also called alphanumeric codes and consist of a single letter followed by four numeric digits.
The system began in the 1980s. In 2003, under 42 CFR 414.40(a), the HHS Secretary delegated to CMS the authority to establish and maintain uniform national definitions of services, codes to represent them, and payment modifiers.
What is the difference between HCPCS Level I and Level II?
Level I is Current Procedural Terminology (CPT), a numeric system maintained by the American Medical Association (AMA); CPT codes consist of five numeric digits, and the AMA republishes and updates them annually. Level II is maintained by CMS, uses a letter plus four digits, and covers items that CPT does not describe. For a short side-by-side, see HCPCS vs CPT codes.
| Point | Level I (CPT) | Level II |
|---|---|---|
| Maintained by | AMA | CMS |
| Code format | 5 numeric digits | 1 letter followed by 4 digits |
| Typical scope (CMS wording) | Procedures and services described by CPT | Products, supplies and services not in CPT, such as ambulance services or DMEPOS |
Source for the table: CMS, Healthcare Common Procedure Coding System page, checked 2026-11-01.
How CMS updates the Level II code set
CMS decides additions, revisions and deletions to Level II codes. Anyone may ask CMS to modify the national code set through its Medicare Electronic Application Request Information System (MEARIS). The application windows differ by item type, which is the part most catalogue and procurement staff overlook.
| Request type | Application cycle | Due date (CMS) |
|---|---|---|
| Drugs and biological products | Quarterly | First business day of January, April, July and October |
| Non-drug, non-biological items and services (the category covering most supplies and equipment) | Twice a year | First business day of January and July |
Source: CMS HCPCS page, checked 2026-11-01. A practical consequence: a new supply or device type can only be coded in Level II on a cycle, so a product on a supplier’s catalogue may exist before any code describes it.
Where can I find a list of HCPCS codes?
The official source is CMS. The HCPCS Quarterly Update page states that the official update of the code system is available as a public use file, with the effective date noted in the file title. The files are titled “Alpha-Numeric HCPCS File” and are published as ZIP downloads; the newest listed on 2026-11-01 was the October 2026 file, updated 09/23/2026. CMS also states that, because updates are now fully searchable and sortable electronic files, it no longer publishes the Table of Drugs and HCPCS Index as part of the quarterly updates.
What about a HCPCS Level II code book?
CMS’s own publication is the dated electronic file described above, not a printed book. Any printed or third-party code book is a separate product, so check its edition against the effective date of the current CMS file.
Level II modifiers
Modifiers are used alongside a code to give additional information about the item or service on a claim. Modifiers that supply and equipment staff meet often are explained in separate CASRAI guides rather than repeated here: GX, GY, GZ and GA (advance beneficiary notice situations), the KX modifier (coverage requirements met) and JW and JZ (drug wastage reporting). For the durable-equipment code families, see DME HCPCS codes.
Checklist for supply catalogue and lab staff
This checklist is an editorial aid built from the sourced points above; it is not a CMS document.
- Confirm the effective date in the title of the CMS Alpha-Numeric HCPCS file you are working from, and replace it when a newer quarterly file appears.
- Check that the code has the Level II shape: one letter followed by four digits. A five-digit numeric code is a CPT (Level I) code, which belongs to the AMA.
- Look the code up in the CMS file itself rather than in a copied list, since CMS no longer publishes the Table of Drugs and Index.
- Treat a missing code for a new product as a possible timing issue: non-drug items are only considered on the January and July cycles.
- Record which modifier, if any, a payer requires, and link that decision to the relevant modifier guide above.
- For fee and coverage questions on durable equipment, continue to the DMEPOS fee schedule guide; for how product types are grouped, see types of medical supplies.
Common misunderstandings
- “HCPCS and CPT are the same thing.” CPT is Level I of HCPCS. Level II is the separate, CMS-maintained part for items CPT does not cover.
- “A code means the item is covered.” The code identifies a product, supply or service. CMS describes its purpose as letting providers and suppliers submit claims; coverage is decided separately by the payer.
- “An old list is good enough.” The official file is revised quarterly and its effective date is in the file title, so a copied list can be out of date.
Frequently asked questions
Where can I find a list of HCPCS codes?
On the CMS HCPCS Quarterly Update page, as the Alpha-Numeric HCPCS File for the current quarter.
What is the difference between HCPCS Level I and Level II?
Level I is CPT, maintained by the AMA with five-digit numeric codes. Level II is maintained by CMS, uses a letter plus four digits, and identifies products, supplies and services not in CPT.
What are some examples of HCPCS Level II codes?
CMS names ambulance services and durable medical equipment, prosthetics, orthotics and supplies as examples of what Level II covers. Specific DME code families are covered in DME HCPCS codes; individual codes should be looked up in the current CMS file.
What does “HCPCS Level II” versus “Level 2” mean?
Nothing different: “Level II” and “Level 2” refer to the same alphanumeric code set, the HCPCS Level II codes maintained by CMS.
Sources
- CMS, Healthcare Common Procedure Coding System (HCPCS), checked 2026-11-01.
- CMS, HCPCS Quarterly Update, checked 2026-11-01.
