. 2024 Apr 9;32(10):427–438. doi: 10.5435/JAAOS-D-23-00464

Table 3.

Medicare Recognized Coding Systems Used in Medicare Payment Systems in 2023

Medicare Payment Systems	Medicare Coding Systems	Medicare Payment Systems	Medicare Coding Systems
Physician Payment System	ICD-10-CM, CPT (HCPCS I), HCPCS II, POS, NDC, LOINC^a, SNOMED CT^a	Inpatient Psychiatric Facilities Prospective Payment System	ICD-10-CM, ICD-10-PCS, Revenue Codes, NDC, LOINC^a, SNOMED CT^a
Acute Care Hospital Inpatient Prospective Payment System	ICD-10-CM, ICD-10-PCS, HCPCS II, CMG in the form of MS-DRG, Revenue Codes, NDC, LOINC^a, SNOMED CT^a	Long-Term Care Hospital Prospective Payment System	ICD-10-CM, ICD-10-PCS, CMG in the form of MS-LTC-DRG, Revenue Codes, NDC, LOINC^a, SNOMED CT^a
Hospital Outpatient Prospective Payment System	ICD-10-CM, ICD-10-PCS, CPT (HCPCS I), HCPCS II, APC, POS, Revenue Codes, NDC, LOINC^a, SNOMED CT^a	Skilled Nursing Facility Prospective Payment System	ICD-10-CM, CPT (HCPCS I), HCPCS II, HIPPS, CMG in the form of RUG, NDC, LOINC^a, SNOMED CT^a
Inpatient Rehabilitation Facility Prospective Payment System	ICD-10-CM, ICD-10-PCS, CMG, LOINC^a, SNOMED CT^a	Hospice Payment System	ICD-10-CM, HCPCS II, Revenue Codes, NDC, LOINC^a, SNOMED CT^a
Home Health Prospective Payment System	ICD-10-CM, CPT (HCPCS I), HCPCS II, HIPPS, NDC, LOINC^a, SNOMED CT^a	End-Stage Renal Disease Prospective Payment System	ICD-10, HCPCS II, ESRD CMC; Revenue Codes, NDC, LOINC^a, SNOMED CT^a
Ambulatory Surgical Center Payment System	ICD-10-CM CPT (HCPCS I), HCPCS II, APC, POS, Revenue Codes, NDC, LOINC^a, SNOMED CT^a	—	—

ICD-10-CM = International Classification of Diseases, 10th Revision, Clinical Modification; ICD-10-PCS = International Classification of Diseases, 10th Revision, Procedure Coding System, CPT = Current Procedure Terminology (designate services or procedures), HCPCS I = Healthcare Common Procedure Coding System I (designate services or procedures—same as the CPT coding system), HCPS II = Healthcare Common Procedure Coding System II (designate medications, durable medical equipment, ambulance transport services, prosthetics, orthotics), POS = Place of Service (designate where service was performed), Revenue Codes (designate type of service or item associated with a specific charge), CMG = Case-Mix Group (designate patient groups with similar clinical and resource utilization characteristics), NDC = National Drug Codes (identify specific drugs and medications), LOINC = Logical Observation Identifiers Names and Codes (designate laboratory tests and results), SNOMED CT = Systemized Nomenclature of Medicine Clinical Terms (designate standardized electronic health information exchange), APC = Ambulatory Payment Classification (designate outpatient services), MS-DRG = Medicare Severity Diagnosis-Related Groups (designate patient groups based on similar clinical and resource utilization characteristics), HIPPS, Health Insurance Prospective Payment System rate codes (designate specific sets of patient characteristics), MS-LTC-DRG = Medicare Severity Long-Term Care Diagnosis Related Groups (designate patient groups based on similar clinical and resource utilization characteristics) RUG = Resource Utilization Group (classify patients based on care needs), ESRD CMC = End-Stage Renal Disease Claim Modifier Codes.

Codes not used directly in the Medicare Payment System but may play a role in data exchange; dental codes are not included in this table.