Code Sets Overview
Guidance for specific code sets for diagnoses and procedures used in all transactions.
Final
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: September 11, 2020
Code Sets Overview
Under HIPAA, HHS adopted specific code sets for diagnoses and procedures used in all transactions.
About Code Sets
Code sets ify medical:
- Diagnoses
- Procedures
- Diagnostic tests
- Treatments
- Equipment and supplies
They inform diverse health care functions, from billing to tracking public health.
HIPAA Code Sets
Code sets outlined in HIPAA regulations include:
- ICD-10 – International Classification of Diseases, 10th edition
- HCPCS – Health Care Common Procedure Coding System
- CPT – Current Procedure Terminology
- CDT – Code on Dental Procedures and Nomenclature
- NDC – National Drug Codes
Violations
You can submit complaints about potential code sets violations via the Administrative Simplification Enforcement and Testing Tool (ASETT). Learn how to file a complaint.
Exceptions
An organization may request an exception from the use of a standard transaction from the Secretary to test a proposed modification to that standard. Learn about our exceptions process and the principles for requesting an exception (PDF).
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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.