HCPCS

AHA Central Office serves as the only official clearinghouse for information on the proper use of Level I HCPCS (CPT-4 codes) for hospital providers and certain Level II HCPCS codes for hospitals, physicians and other health professionals.

AHA Central Office on HCPCS is committed to providing assistance to institutional providers in this new and challenging area.

Question Submission for AHA Central Office on HCPCS

To submit a HCPCS related question to the Central Office on HCPCS, please click here to download the form. All questions must be faxed or mailed to the AHA Central Office.

The AHA's Central Office will handle the clearinghouse functions and provide interpretation and explanations of the proper use for HCPCS questions related to:

• Level I HCPCS (CPT-4 codes) for hospital providers
• Certain Level II HCPCS codes, specifically:
  • A-codes for ambulance services and radiopharmaceuticals
  • C-codes
  • G-codes
  • J-codes
  • Q-codes, except Q0136 through Q0181 for hospitals, physicians and other health professionals who bill Medicare.

The AHA Clearinghouse will not respond to the following related to HCPCS codes:

• Inquiries from physician providers related to CPT-4. These questions will be referred to the American Medical Association (AMA).
• Questions related to A-codes, except those for ambulance services and radiopharmaceuticals, and Q-codes Q0136 through Q0181. These questions will be referred to the Statistical Analysis Durable Medical Equipment Regional Carriers (SADMERCs).
• The remainder of the body of Level II HCPCS codes related to durable medical equipment, prosthetics, orthotics, and other supplies. These questions will be referred to Durable Medical Equipment Regional Carriers (DMERCs) or their successors, the DME Medicare Administrative Contractors (MACs). These codes do not apply to hospital or physician providers.

Information on How Questions are Processed

The following describes how a question submitted to the AHA Central Office is processed. It is a rigorous review where both the complexity and uniqueness of the question determines response time. This process ensures the integrity and reliability of the answer provided.

Each question submitted with all necessary supporting medical record documentation is assigned a unique ID and entered into the AHA Central Office database.

The internal database, previous AHA Coding Clinic advice, previous CPT Assistant advice, Editorial Advisory Board (EAB) minutes, and Medicare instructions, manuals and transmittals, are reviewed to determine if the issue has been previously addressed.

If the issue has been addressed, a response is drafted. The response is reviewed by AHA Central Office staff and if consensus is reached, the response is approved and sent.

If the question has never been addressed before or consensus cannot be reached, it is submitted to the EAB and the requestor is notified.

The AHA Central Office staff is responsible for reviewing all related medical literature, contacting requestor for additional information and medical experts as needed.

This cumulative research is included in the issue summary document prepared for the EAB along with possible code options. Once reviewed and approved, it is included in the agenda for the next EAB meeting.

Review by the EAB is an iterative process. The issue summary document is reviewed and discussed during the EAB meeting. The group may determine an answer at that time or request additional research be conducted and presented at a subsequent EAB meeting.

Once an answer is derived, general consensus must be reached among the members of the Editorial Advisory Board. CMS has veto power. The Editorial Advisory Board may request additional research and re-review or accept.

If accepted, the formal response is drafted, reviewed and signed-off by the Editorial Advisory Board.