WoundSource White Papers

HCPCS Coding and Reimbursement for Wound Care Treatments, Equipment and Products

By Glenda J. Motta, RN, BSN, MPH, WOCN 

What's the relationship between coding and reimbursement? How are wound care products, services and technologies assigned codes, such as HCPCS (Healthcare Common Procedure Coding System)? What does this process entail?  

Reimbursement is a complex and often confusing subject. Asking the right questions, understanding the terminology and who and what is involved in determining reimbursement classification will help in better understanding what’s reimbursable and how the coding system works. 

This guide explores reimbursement coding systems (i.e. HCPCS) relative to wound care products, services and technologies.  

HCPCS Coding and Reimbursement

What you will get out of this guide:

  • Information for determining reimbursement of wound care products and treatments  
  • HCPCS Level I and Level II definitions and an overview of Current Procedural Terminology (CPT®) codes used in wound care 
  • The role of agencies including the Centers for Medicare & Medicaid (CMS) and the American Medical Association (AMA)  
  • The anatomy of the HCPCS code  
  • Assignment and review processes for product inclusion on the Pricing, Data Analysis and Coding Contractor (PDAC) Product Classification List