Code Search
GO TO
BILLING → CODE SEARCH
STEPS
- Crosswalks– Use this to determine if a CPT Code has a Local Coverage Determination
- Enter the HCPC Code and/or ICD Code
- Change the State
- Change the Date
- Select Find Related Codes
- Select on the Relevant LCDs link to view the details
NOTES
What’s a “Local Coverage Determination” (LCD)?
- Local Coverage Determination or LCDs are decisions made by a Medicare Administrative Contractor
(MAC) whether to cover a particular item or service in a MAC’s jurisdiction (region) in accordance with
section 1862(a)(1)(A) of the Social Security Act. MACs are Medicare contractors that develop LCDs and
process Medicare claims. The MAC’s decision is based on whether the service or item is considered
reasonable and necessary.
2. HCPCS Excludes/Includes
– Use this to determine if CPT codes are Mutually Exclusive
- Enter HCPC 1, HCPC 2 …
- Select Take 10 or enter a CPT Code in the HCPC Code section
- Select Lookup Includes Excludes
NOTES
What are Mutually Exclusive Procedures?
- A procedure that can’t be done in combination with another. Because some procedures can’t be successfully performed together, they are not going to be paid on the same claim.
3. HCPC Code Lookup
– Use this to search for CPT Codes or Procedure Codes
- Enter a CPT Code in the HCPC Code section or enter a Description
- Select Lookup Code
4. ICD9 Code Lookup
– Use this to search for ICD or Diagnosis Codes
- Enter an ICD Code in the ICD-9/10 Code section or enter a Description
- Select Lookup Code
5. Modifier Lookup
– Use this to search for Modifiers
- Enter a Modifier
- Select Lookup Code to view the description
6. Medicare Fee Schedule Lookup
– Use this to search for the Medicare Fee Schedule and/or Global Days for a specific CPT Code
- Enter the Zip Code and HCPC Code
- Select Lookup Fee Schedule
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