Data Medicaid/Medicare

How to map HCPCS codes to meaningful procedure categories

In order for health care providers to be reimbursed for the services they provide, they need to input a variety of information into health insurance claims systems including what type of services were performed. The codes used to define the services provided are Current Procedural Terminology (CPT)
or Healthcare Common Procedure Coding System (HCPCS) codes. These codes are also very helpful to researchers because they help us understand patient health care resource utilization.

A key question is, how do you map these CPT/HCPCS codes to meaningful procedure categories? There are over 14,000 HCPCS codes so unless you are a coding expert, this is a very difficult task.

Fortunately, CMS has a mapping of HCPCS codes to procedures categories known as the Berenson-Eggers Type of Service (BETOS) Codes. BETOS codes map these CPT/HCPCS procedure codes into understandable categories.

The BETOS Coding system was developed primarily for analyzing the growth in Medicare expenditures. The coding system covers all HCPCS codes; assigns a HCPCS code to only one BETOS code; consists of readily understood clinical categories (as opposed to statistical or financial categories); consists of categories that permit objective assignment; is stable overtime; and is relatively immune to minor changes in technology or practice patterns

There are 7 general categories (i) evaluation and management, (ii) procedures, (iii) imaging, (iv) tests, (v) durable medical equipment, (vi) other, and (vii) exceptions/unclassified. Within each of these broader groups are more specific groups.

Where can you find this mapping? In 2021, CMS published the Restructured BETOS Classification System also known as RBCS. The mapping of each HCPCS to an RBCS category can be found on the CMS website here.

Addendum: Learn the difference between CPT and HCPCS codes from my post “Does Medicare use CPT codes for payment?

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