What are HCPCS Level II codes?
HCPCS Level II is the national set of alphanumeric billing codes, each a letter plus four numbers, that CMS maintains for items and services CPT does not cover, such as ambulance and non-emergency transportation. HIPAA made it a standard code set. Ride codes sit mostly in the A0 range, T2001 to T2007, and T2049, with S0209 and S0215 for mileage. CMS publishes updated files every quarter.
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Two levels of one system
HCPCS, the Healthcare Common Procedure Coding System, has two levels. Level I is CPT, the American Medical Association’s numeric code set for services by physicians and other health professionals. Level II covers what CPT leaves out, including ambulance services and durable medical equipment, and it is the level every NEMT code lives in.
| Level I (CPT) | Level II | |
|---|---|---|
| Maintained by | American Medical Association | CMS |
| Format | Five digits | One letter, four digits |
| Updates | Once a year | Quarterly files |
| Used for | Physician and professional services | Ambulance, transportation, supplies, equipment, drugs, and other services outside CPT |
The federal rule that set HIPAA’s code standards, published August 17, 2000, made Level II the standard for these items. It also ended the old local codes, often called Level III, that states and insurers had created for themselves. After a delay, their use ran through December 31, 2003.
Where the transportation codes sit
| Codes | What they cover | Medicare coverage code |
|---|---|---|
| A0080 to A0210 | Non-emergency transportation: volunteer and family mileage, taxi, bus, mini-bus, wheelchair van, air travel, and ancillary costs such as tolls, lodging, and meals | I, not payable |
| A0021 and A0225 to A0999 | Ambulance services, supplies, and mileage, such as A0428 and A0425 | A0425 to A0436 carry C, carrier judgment; the others vary |
| T2001 to T2007 and T2049 | Attendant, per diem, trip, multi-pass, stretcher van, waiting time, and stretcher van mileage | I, not payable |
| S0209 and S0215 | Wheelchair van mileage and non-emergency mileage | I, not payable |
The coverage code is Medicare’s view only. Medicare’s claims manual reserves S codes for the Blue Cross Blue Shield Association and other private insurers, yet Colorado and South Dakota both pay S0209 and S0215 on Medicaid transportation claims. The same manual says states set their own Medicaid coverage, payment, and utilization rules.
Two-letter modifiers are part of Level II too. They adjust a code without changing it, like the U modifiers states define for themselves and the TK modifier for an extra passenger. A paper claim line takes up to four.
How the code set changes
CMS decides which Level II codes are added, revised, or discontinued. Anyone can ask for a change through CMS’s online application system. Requests for items and services that are not drugs or biologicals are due on the first business day of January or July, and approved changes take effect the following October or April.
CMS posts a full Level II file each quarter. The October 2026 file went up on September 23, 2026, and CMS sends each update to Medicare contractors and state Medicaid agencies 60 to 90 days before it takes effect. Codes stay active until CMS announces otherwise.
States also change which codes they accept, on their own schedule. Colorado stopped taking A0425 for non-ambulance miles on trips from July 1, 2025, and now bills ambulatory vehicle and taxi miles as S0215 and wheelchair van miles as S0209. Its old X6022 to X6030 mobility van codes gave way to A0120 billed with TK.
Reading a HCPCS entry
Each line in the CMS file gives a long descriptor, a short descriptor, a coverage code, and the date the code was added. T2049, for example, reads “Non-emergency transportation; stretcher van, mileage; per mile,” carries coverage code I, and was added July 1, 2004. The descriptor also sets the unit, here one mile. Our page on NEMT billing units explains how units work across codes.
A code does not guarantee payment. CMS says a code identifies a service and does not by itself decide coverage. Bill the codes that were valid on the day of the ride, as your payer’s current fee schedule lists them, and check NEMT billing codes to compare how several states use each code.
Frequently asked questions
- How does CPT differ from HCPCS Level II?
- CPT is HCPCS Level I. The American Medical Association maintains it, updates it every year, and uses five-digit numeric codes for services by physicians and other health professionals. Level II is maintained by CMS and uses one letter plus four digits for items and services CPT leaves out, such as ambulance trips and durable medical equipment. Transportation providers bill Level II codes.
- Does having a HCPCS code mean Medicare or Medicaid covers the service?
- No. CMS states that a code identifies an item or service and does not by itself decide coverage. Most NEMT codes are marked I in the CMS file, meaning Medicare does not pay them, and each state decides which codes its Medicaid program pays and at what rate.
- How often does the HCPCS Level II code set change?
- Every quarter. CMS posts an updated Level II file for each quarter, effective January 1, April 1, July 1, and October 1. The October 2026 file was posted on September 23, 2026. Codes stay active until CMS announces otherwise, and each claim line takes the codes that were valid when the ride happened.
