Medicare Code

The Medicare Code: Can it be cracked?

In 2005 there were around 42.5 million citizens and permanent residents claiming health care through Medicare. Most people are aware of the United States Governments program, supplying health insurance to those who are 65 years or older. Individuals are automatically included in the Medicare Part A program or if they so wish, paying for the Part B program. Younger people meeting a certain medical criteria are also included.

With Medicare estimated to increase by 7% every year, will the system be able to handle it? The government handles the money side of the program so you shouldn’t have to worry about that. To keep the patient care up-to-date, Medicare brings out a form for every conceivable situation, and a new one every time there is a situation not covered by the huge paper trail. To keep this system in order there is a Medicare code for every known drug and medical condition.

Here is quick overview how this Medicare code actually works and an examples to get your head round.

A straight-forward example

The Medicare code is made up of alphanumeric characters, so it consists of either numbers of letters. If there is a treatment required then there will be a specific code just for that service. When a claim is put through for reimbursement by the provider they must put the correct Medicare code for what service or product they provided.

As a general rule the Medicare systems systematically reimburses a set amount for each medical service. Each amount is matched up with different Medicare code. The individual reimbursement amounts linked to each code are then totalled up ending with a total payment to reimburse the provider.

This is a very basic example, and does not take into account the problems and awkward claims that may be put through. Not every medical item has a set reimbursement amount and not all of them are covered. Basically without the Medicare code in place the system would fall to pieces and there would be some unhappy people.

Healthcare Common Procedure Coding System

The Healthcare Common Procedure Coding System (aka HCPCS) is an assortment of codes that corresponds to products, procedures, supplies and services that can provided beneficiaries of Medicare or members involved in health insurance plans. These codes are separated into three levels or groups.

Level 1

This Medicare code lists descriptors developed by the American Medical Association’s up-to-date procedural technology. Each Medicare code has 5 numbers which refers to both physicians and non-physician procedures.

Level 2

This Medicare code list contains descriptors used by the American Dental Association’s up-to-date technology. Every Level 2 Medicare code consists of an alphanumeric code covering the D series.

Level 3

This Medicare code list consists of descriptors utilized by Medicare carriers for usage at a local level. This Medicare code is represented by a 5 character alphanumeric code referring to physicians and non-physician practices that were not already covered using level 1 and 2 codes.


This is the Medicare code at its simplest level and it’s not even close to how many sections, sub-sections, sub-sub-sections, sub-sub… you get the point. The Medicare code system is a highly impressive codes system. So can you crack the Medicare code? Depends on how many years you have got!

Entry Filed under: Claims

Leave a Comment


Required, hidden

Some HTML allowed:
<a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>

Trackback this post  |  Subscribe to the comments via RSS Feed

Most Recent Posts