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CPT vs HCPCS codes: what's the difference?

Q: What does a HCPCS Level II code look like?

HCPCS Level II codes are alphanumeric: one letter followed by four digits. They identify products, supplies, and services not in CPT, such as injectable drugs, durable medical equipment, and ambulance services.

By the Capsa Coding team Last updated June 3, 2026 Reviewed against primary sources (CMS, AMA CPT)

Quick answer

CPT and HCPCS are two overlapping code sets for reporting medical procedures and services. CPT (Current Procedural Terminology) is the five-character set maintained and copyrighted by the American Medical Association (AMA) that describes physician and other professional services. HCPCS (Healthcare Common Procedure Coding System) is the broader system maintained by the Centers for Medicare & Medicaid Services (CMS): its Level I is the CPT code set, and its Level II is a separate alphanumeric set for items CPT doesn't cover — drugs, supplies, and equipment.

What is CPT?

CPT (Current Procedural Terminology) is the code set used to report physician and other qualified health professional services — office visits, surgeries, diagnostic tests, immunization administration, and similar professional work. Per the AMA, CPT is developed, maintained, and copyrighted by the American Medical Association, which convenes the CPT Editorial Panel to update it each year.

CPT codes are five characters. Category I codes — the everyday procedure codes — are five digits. Category II performance-measurement codes end in the letter F, and Category III emerging-technology codes end in T. On a claim, CPT codes appear on the professional (physician) claim form, the CMS-1500 or its electronic 837P equivalent.

What is HCPCS?

HCPCS (Healthcare Common Procedure Coding System, pronounced “hick-picks”) is a CMS-maintained coding system organized into two levels. Per CMS, Level I is the CPT code set maintained by the AMA, and Level II is a standardized national code set, maintained by CMS, that identifies products, supplies, and services not included in CPT.

HCPCS Level II codes are alphanumeric — one letter followed by four digits. They cover things a professional-service CPT code can't describe on its own: injectable drugs and biologicals, durable medical equipment, prosthetics, orthotics and supplies (DMEPOS), and ambulance services, among others.

How CPT and HCPCS relate

The key point that trips people up: CPT is inside HCPCS. Every CPT code is a HCPCS Level I code. So “CPT vs HCPCS” is really a comparison between CPT (HCPCS Level I) and HCPCS Level II — two complementary sets that together cover most outpatient professional billing.

	CPT · HCPCS Level I	HCPCS Level II
Maintained by	American Medical Association (AMA)	Centers for Medicare & Medicaid Services (CMS)
Format	Five characters (Category I = five digits)	One letter + four digits
Describes	Physician / professional procedures and services	Drugs, supplies, equipment & services not in CPT
Typical examples	Office visit; immunization administration; developmental screening	Injectable drugs; wheelchairs and DME; ambulance transport

When you use each

You use whichever set most specifically describes the item or service — and you frequently use both on the same claim. A few illustrative examples (descriptors paraphrased; see the official code books for exact language):

A professional service → CPT. Counseling-based pediatric vaccine administration is reported with a CPT code (for example, 90460), and a developmental screening with a standardized instrument is reported with 96110.
A drug or supply → HCPCS Level II. The injectable drug itself is typically reported with a HCPCS Level II “J” code, while the act of administering it is a CPT code.
Equipment → HCPCS Level II. Durable medical equipment such as a wheelchair is reported with a HCPCS Level II code, not a CPT code.

On copyright: the full CPT descriptors are owned by the AMA and the HCPCS Level II long descriptions are governed by CMS terms. This page explains the systems and cites public examples; it does not reproduce proprietary code lists. Always verify codes against current official sources.

How this shows up in Capsa

Capsa Charge Capture operates at the professional CPT/HCPCS layer. It reads the signed clinical note and recommends every billable professional code the chart supports, each cited to verbatim chart text. Capsa's currently validated skills are in pediatric ambulatory professional coding — vaccine administration and health/developmental screening — which is why those CPT codes appear in our examples. (This is distinct from facility billing, which uses revenue codes; see revenue code vs CPT.)

Frequently asked questions

Is CPT part of HCPCS?+

Yes. The CPT code set is HCPCS Level I. HCPCS Level II is a separate alphanumeric set, maintained by CMS, for items CPT does not describe — such as drugs, supplies, and durable medical equipment.

Who maintains CPT and HCPCS codes?+

The American Medical Association maintains and copyrights CPT (HCPCS Level I). The Centers for Medicare & Medicaid Services maintains HCPCS Level II.

What does a HCPCS Level II code look like?+

HCPCS Level II codes are alphanumeric — one letter followed by four digits. They identify products, supplies, and services not in CPT, such as injectable drugs, durable medical equipment, and ambulance services.

Which code set does professional charge capture use?+

Professional (physician-side) coding and charge capture report CPT and HCPCS codes on the CMS-1500 / 837P claim. Capsa Charge Capture works at this professional CPT/HCPCS layer.

Sources

Centers for Medicare & Medicaid Services (CMS), “Overview of Coding & Classification Systems.” cms.gov
American Medical Association, CPT (Current Procedural Terminology). ama-assn.org
CMS, HCPCS — General Information. cms.gov/…/hcpcs