November 3, 1999 HIPAA Announcement:

State Medicaid Plans Get Delay in Use of HCPC Codes

(added 08/19/03)

On June 6, 2003 David Greenberg wrote:

**** National Medicaid EDI HIPAA (NMEH) Mailing List ****

Covered entities under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) are required to conduct covered transactions in standard form as of October 16, 2003 if they submitted a compliance plan by October 15, 2002. This has previously been interpreted to mean that State Medicaid agencies and State Child Health Insurance Programs (SCHIP) must use national Healthcare Common Procedure Coding System (HCPCS) Level I and Level II codes in lieu of local codes as of October 16, 2003.

Section 532 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) authorizes the Secretary of Health and Human Services to allow the public to continue using HCPCS Level III codes through December 31, 2003. The BIPA defines "HCPCS Level III codes" as "the alphanumeric codes for local use under the Health Care Financing Administration [now Healthcare] Common Procedure Coding System (HCPCS)".

The Centers for Medicare & Medicaid Services has determined that the term, HCPCS Level III codes, as used in this BIPA provision, applies both to the codes that Medicare has approved for local contractor use and to the local codes that state Medicaid agencies and SCHIP programs

have developed and used for their own purposes. Therefore, local codes developed by state Medicaid and SCHIP programs may be used through December 31, 2003. We recognize that many states may benefit from additional time beyond October 15, 2003 to continue using local codes while they take the actions necessary to convert to standard national HCPCS codes.

J. David Greenberg
Senior Health Insurance Specialist
Centers for Medicare and Medicaid Services
Mail Stop S2-01-16
7500 Security Boulevard
Baltimore, Maryland 21244
Phone: (410) 786-2637
Fax: (410) 786-5882
E-Mail: dgreenberg@cms.hhs.gov