Medical Billing Code Search
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8892 results found
| L6905 | Hand restoration multiple fi | Description: Hand restoration (casts, shading and measurements included), partial hand, with glove, multiple fingers remaining |
| L6910 | Hand restoration no fingers | Description: Hand restoration (casts, shading and measurements included), partial hand, with glove, no fingers remaining |
| L6915 | Hand restoration replacmnt g | Description: Hand restoration (shading, and measurements included), replacement glove for above |
| L6920 | Wrist disarticul switch ctrl | Description: Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, otto bock or equal, switch, cables, two batteries and one charger, switch control of terminal device |
| L6925 | Wrist disart myoelectronic c | Description: Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device |
| L6930 | Below elbow switch control | Description: Below elbow, external power, self-suspended inner socket, removable forearm shell, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device |
| L6935 | Below elbow myoelectronic ct | Description: Below elbow, external power, self-suspended inner socket, removable forearm shell, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device |
| L6940 | Elbow disarticulation switch | Description: Elbow disarticulation, external power, molded inner socket, removable humeral shell, outside locking hinges, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device |
| L6945 | Elbow disart myoelectronic c | Description: Elbow disarticulation, external power, molded inner socket, removable humeral shell, outside locking hinges, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device |
| L6950 | Above elbow switch control | Description: Above elbow, external power, molded inner socket, removable humeral shell, internal locking elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device |
| L6955 | Above elbow myoelectronic ct | Description: Above elbow, external power, molded inner socket, removable humeral shell, internal locking elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device |
| L6960 | Shldr disartic switch contro | Description: Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device |
| L6965 | Shldr disartic myoelectronic | Description: Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device |
| L6970 | Interscapular-thor switch ct | Description: Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device |
| L6975 | Interscap-thor myoelectronic | Description: Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device |
| L7007 | Adult electric hand | Description: Electric hand, switch or myoelectric controlled, adult |
| L7008 | Pediatric electric hand | Description: Electric hand, switch or myoelectric, controlled, pediatric |
| L7009 | Adult electric hook | Description: Electric hook, switch or myoelectric controlled, adult |
| L7040 | Prehensile actuator | Description: Prehensile actuator, switch controlled |
| L7045 | Pediatric electric hook | Description: Electric hook, switch or myoelectric controlled, pediatric |
| L7170 | Electronic elbow hosmer swit | Description: Electronic elbow, hosmer or equal, switch controlled |
| L7180 | Electronic elbow sequential | Description: Electronic elbow, microprocessor sequential control of elbow and terminal device |
| L7181 | Electronic elbo simultaneous | Description: Electronic elbow, microprocessor simultaneous control of elbow and terminal device |
| L7185 | Electron elbow adolescent sw | Description: Electronic elbow, adolescent, variety village or equal, switch controlled |
| L7186 | Electron elbow child switch | Description: Electronic elbow, child, variety village or equal, switch controlled |
| L7190 | Elbow adolescent myoelectron | Description: Electronic elbow, adolescent, variety village or equal, myoelectronically controlled |
| L7191 | Elbow child myoelectronic ct | Description: Electronic elbow, child, variety village or equal, myoelectronically controlled |
| L7259 | Electronic wrist rotator any | Description: Electronic wrist rotator, any type |
| L7360 | Six volt bat otto bock/eq ea | Description: Six volt battery, each |
| L7362 | Battery chrgr six volt otto | Description: Battery charger, six volt, each |
| L7364 | Twelve volt battery utah/equ | Description: Twelve volt battery, each |
| L7366 | Battery chrgr 12 volt utah/e | Description: Battery charger, twelve volt, each |
| L7367 | Replacemnt lithium ionbatter | Description: Lithium ion battery, rechargeable, replacement |
| L7368 | Lithium ion battery charger | Description: Lithium ion battery charger, replacement only |
| L7400 | Add ue prost be/wd, ultlite | Description: Addition to upper extremity prosthesis, below elbow/wrist disarticulation, ultralight material (titanium, carbon fiber or equal) |
| L7401 | Add ue prost a/e ultlite mat | Description: Addition to upper extremity prosthesis, above elbow disarticulation, ultralight material (titanium, carbon fiber or equal) |
| L7402 | Add ue prost s/d ultlite mat | Description: Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, ultralight material (titanium, carbon fiber or equal) |
| L7403 | Add ue prost b/e acrylic | Description: Addition to upper extremity prosthesis, below elbow/wrist disarticulation, acrylic material |
| L7404 | Add ue prost a/e acrylic | Description: Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material |
| L7405 | Add ue prost s/d acrylic | Description: Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, acrylic material |
| L7499 | Upper extremity prosthes nos | Description: Upper extremity prosthesis, not otherwise specified |
| L7510 | Prosthetic device repair rep | Description: Repair of prosthetic device, repair or replace minor parts |
| L7520 | Repair prosthesis per 15 min | Description: Repair prosthetic device, labor component, per 15 minutes |
| L7600 | Prosthetic donning sleeve | Description: Prosthetic donning sleeve, any material, each |
| L7700 | Pros soc insert gasket/seal | Description: Gasket or seal, for use with prosthetic socket insert, any type, each |
| L7900 | Male vacuum erection system | Description: Male vacuum erection system |
| L7902 | Tension ring, vac erect dev | Description: Tension ring, for vacuum erection device, any type, replacement only, each |
| L8000 | Mastectomy bra | Description: Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
| L8001 | Breast prosthesis bra & form | Description: Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type |
| L8002 | Brst prsth bra & bilat form | Description: Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type |
| L8015 | Ext breastprosthesis garment | Description: External breast prosthesis garment, with mastectomy form, post mastectomy |
| L8020 | Mastectomy form | Description: Breast prosthesis, mastectomy form |
| L8030 | Breast prosthes w/o adhesive | Description: Breast prosthesis, silicone or equal, without integral adhesive |
| L8031 | Breast prosthesis w adhesive | Description: Breast prosthesis, silicone or equal, with integral adhesive |
| L8032 | Reusable nipple prosthesis | Description: Nipple prosthesis, prefabricated, reusable, any type, each |
| L8033 | Nipple prosthesis custom, ea | Description: Nipple prosthesis, custom fabricated, reusable, any material, any type, each |
| L8035 | Custom breast prosthesis | Description: Custom breast prosthesis, post mastectomy, molded to patient model |
| L8039 | Breast prosthesis nos | Description: Breast prosthesis, not otherwise specified |
| L8040 | Nasal prosthesis | Description: Nasal prosthesis, provided by a non-physician |
| L8041 | Midfacial prosthesis | Description: Midfacial prosthesis, provided by a non-physician |
| L8042 | Orbital prosthesis | Description: Orbital prosthesis, provided by a non-physician |
| L8043 | Upper facial prosthesis | Description: Upper facial prosthesis, provided by a non-physician |
| L8044 | Hemi-facial prosthesis | Description: Hemi-facial prosthesis, provided by a non-physician |
| L8045 | Auricular prosthesis | Description: Auricular prosthesis, provided by a non-physician |
| L8046 | Partial facial prosthesis | Description: Partial facial prosthesis, provided by a non-physician |
| L8047 | Nasal septal prosthesis | Description: Nasal septal prosthesis, provided by a non-physician |
| L8048 | Unspec maxillofacial prosth | Description: Unspecified maxillofacial prosthesis, by report, provided by a non-physician |
| L8049 | Repair maxillofacial prosth | Description: Repair or modification of maxillofacial prosthesis, labor component, 15 minute increments, provided by a non-physician |
| L8300 | Truss single w/ standard pad | Description: Truss, single with standard pad |
| L8310 | Truss double w/ standard pad | Description: Truss, double with standard pads |
| L8320 | Truss addition to std pad wa | Description: Truss, addition to standard pad, water pad |
| L8330 | Truss add to std pad scrotal | Description: Truss, addition to standard pad, scrotal pad |
| L8400 | Sheath below knee | Description: Prosthetic sheath, below knee, each |
| L8410 | Sheath above knee | Description: Prosthetic sheath, above knee, each |
| L8415 | Sheath upper limb | Description: Prosthetic sheath, upper limb, each |
| L8417 | Pros sheath/sock w gel cushn | Description: Prosthetic sheath/sock, including a gel cushion layer, below knee or above knee, each |
| L8420 | Prosthetic sock multi ply bk | Description: Prosthetic sock, multiple ply, below knee, each |
| L8430 | Prosthetic sock multi ply ak | Description: Prosthetic sock, multiple ply, above knee, each |
| L8435 | Pros sock multi ply upper lm | Description: Prosthetic sock, multiple ply, upper limb, each |
| L8440 | Shrinker below knee | Description: Prosthetic shrinker, below knee, each |
| L8460 | Shrinker above knee | Description: Prosthetic shrinker, above knee, each |
| L8465 | Shrinker upper limb | Description: Prosthetic shrinker, upper limb, each |
| L8470 | Pros sock single ply bk | Description: Prosthetic sock, single ply, fitting, below knee, each |
| L8480 | Pros sock single ply ak | Description: Prosthetic sock, single ply, fitting, above knee, each |
| L8485 | Pros sock single ply upper l | Description: Prosthetic sock, single ply, fitting, upper limb, each |
| L8499 | Unlisted misc prosthetic ser | Description: Unlisted procedure for miscellaneous prosthetic services |
| L8500 | Artificial larynx | Description: Artificial larynx, any type |
| L8501 | Tracheostomy speaking valve | Description: Tracheostomy speaking valve |
| L8505 | Artificial larynx, accessory | Description: Artificial larynx replacement battery / accessory, any type |
| L8507 | Trach-esoph voice pros pt in | Description: Tracheo-esophageal voice prosthesis, patient inserted, any type, each |
| L8509 | Trach-esoph voice pros md in | Description: Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type |
| L8510 | Voice amplifier | Description: Voice amplifier |
| L8511 | Indwelling trach insert | Description: Insert for indwelling tracheoesophageal prosthesis, with or without valve, replacement only, each |
| L8512 | Gel cap for trach voice pros | Description: Gelatin capsules or equivalent, for use with tracheoesophageal voice prosthesis, replacement only, per 10 |
| L8513 | Trach pros cleaning device | Description: Cleaning device used with tracheoesophageal voice prosthesis, pipet, brush, or equal, replacement only, each |
| L8514 | Repl trach puncture dilator | Description: Tracheoesophageal puncture dilator, replacement only, each |
| L8515 | Gel cap app device for trach | Description: Gelatin capsule, application device for use with tracheoesophageal voice prosthesis, each |
| L8600 | Implant breast silicone/eq | Description: Implantable breast prosthesis, silicone or equal |
| L8603 | Collagen imp urinary 2.5 ml | Description: Injectable bulking agent, collagen implant, urinary tract, 2.5 ml syringe, includes shipping and necessary supplies |
| L8604 | Dextranomer/hyaluronic acid | Description: Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, urinary tract, 1 ml, includes shipping and necessary supplies |
| L8605 | Inj bulking agent anal canal | Description: Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, anal canal, 1 ml, includes shipping and necessary supplies |
| L8606 | Synthetic implnt urinary 1ml | Description: Injectable bulking agent, synthetic implant, urinary tract, 1 ml syringe, includes shipping and necessary supplies |
| L8607 | Inj vocal cord bulking agent | Description: Injectable bulking agent for vocal cord medialization, 0.1 ml, includes shipping and necessary supplies |
| L8608 | Arg ii ext com/sup/acc misc | Description: Miscellaneous external component, supply or accessory for use with the argus ii retinal prosthesis system |
| L8609 | Artificial cornea | Description: Artificial cornea |
| L8610 | Ocular implant | Description: Ocular implant |
| L8612 | Aqueous shunt prosthesis | Description: Aqueous shunt |
| L8613 | Ossicular implant | Description: Ossicula implant |
| L8614 | Cochlear device | Description: Cochlear device, includes all internal and external components |
| L8615 | Coch implant headset replace | Description: Headset/headpiece for use with cochlear implant device, replacement |
| L8616 | Coch implant microphone repl | Description: Microphone for use with cochlear implant device, replacement |
| L8617 | Coch implant trans coil repl | Description: Transmitting coil for use with cochlear implant device, replacement |
| L8618 | Coch implant tran cable repl | Description: Transmitter cable for use with cochlear implant device or auditory osseointegrated device, replacement |
| L8619 | Coch imp ext proc/contr rplc | Description: Cochlear implant, external speech processor and controller, integrated system, replacement |
| L8621 | Repl zinc air battery | Description: Zinc air battery for use with cochlear implant device and auditory osseointegrated sound processors, replacement, each |
| L8622 | Repl alkaline battery | Description: Alkaline battery for use with cochlear implant device, any size, replacement, each |
| L8623 | Lith ion batt cid,non-earlvl | Description: Lithium ion battery for use with cochlear implant device speech processor, other than ear level, replacement, each |
| L8624 | Lith ion batt cid, ear level | Description: Lithium ion battery for use with cochlear implant or auditory osseointegrated device speech processor, ear level, replacement, each |
| L8625 | Charger coch impl/aoi battry | Description: External recharging system for battery for use with cochlear implant or auditory osseointegrated device, replacement only, each |
| L8627 | Cid ext speech process repl | Description: Cochlear implant, external speech processor, component, replacement |
| L8628 | Cid ext controller repl | Description: Cochlear implant, external controller component, replacement |
| L8629 | Cid transmit coil and cable | Description: Transmitting coil and cable, integrated, for use with cochlear implant device, replacement |
| L8630 | Metacarpophalangeal implant | Description: Metacarpophalangeal joint implant |
| L8631 | Mcp joint repl 2 pc or more | Description: Metacarpal phalangeal joint replacement, two or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon), for surgical implantation (all sizes, includes entire system) |
| L8641 | Metatarsal joint implant | Description: Metatarsal joint implant |
| L8642 | Hallux implant | Description: Hallux implant |
| L8658 | Interphalangeal joint spacer | Description: Interphalangeal joint spacer, silicone or equal, each |
| L8659 | Interphalangeal joint repl | Description: Interphalangeal finger joint replacement, 2 or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon) for surgical implantation, any size |
| L8670 | Vascular graft, synthetic | Description: Vascular graft material, synthetic, implant |
| L8678 | Ext sply implt neurostim | Description: Electrical stimulator supplies (external) for use with implantable neurostimulator, per month |
| L8679 | Imp neurosti pls gn any type | Description: Implantable neurostimulator, pulse generator, any type |
| L8680 | Implt neurostim elctr each | Description: Implantable neurostimulator electrode, each |
| L8681 | Pt prgrm for implt neurostim | Description: Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only |
| L8682 | Implt neurostim radiofq rec | Description: Implantable neurostimulator radiofrequency receiver |
| L8683 | Radiofq trsmtr for implt neu | Description: Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver |
| L8684 | Radiof trsmtr implt scrl neu | Description: Radiofrequency transmitter (external) for use with implantable sacral root neurostimulator receiver for bowel and bladder management, replacement |
| L8685 | Implt nrostm pls gen sng rec | Description: Implantable neurostimulator pulse generator, single array, rechargeable, includes extension |
| L8686 | Implt nrostm pls gen sng non | Description: Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension |
| L8687 | Implt nrostm pls gen dua rec | Description: Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension |
| L8688 | Implt nrostm pls gen dua non | Description: Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension |
| L8689 | External recharg sys intern | Description: External recharging system for battery (internal) for use with implantable neurostimulator, replacement only |
| L8690 | Aud osseo dev, int/ext comp | Description: Auditory osseointegrated device, includes all internal and external components |
| L8691 | Aoi snd proc repl excl actua | Description: Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, each |
| L8692 | Non-osseointegrated snd proc | Description: Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment |
| L8693 | Aud osseo dev, abutment | Description: Auditory osseointegrated device abutment, any length, replacement only |
| L8694 | Aoi transducer/actuator repl | Description: Auditory osseointegrated device, transducer/actuator, replacement only, each |
| L8695 | External recharg sys extern | Description: External recharging system for battery (external) for use with implantable neurostimulator, replacement only |
| L8696 | Ext antenna phren nerve stim | Description: Antenna (external) for use with implantable diaphragmatic/phrenic nerve stimulation device, replacement, each |
| L8698 | Misc used with tot art heart | Description: Miscellaneous component, supply or accessory for use with total artificial heart system |
| L8699 | Prosthetic implant nos | Description: Prosthetic implant, not otherwise specified |
| L8701 | Ewh s/d uprt micro sensor | Description: Powered upper extremity range of motion assist device, elbow, wrist, hand with single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated |
| L8702 | Ewhf s/d uprt micro sensor | Description: Powered upper extremity range of motion assist device, elbow, wrist, hand, finger, single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated |
| L9900 | O&p supply/accessory/service | Description: Orthotic and prosthetic supply, accessory, and/or service component of another hcpcs 'l' code |
| M0001 | Advancing cancer care mvp | Description: Advancing cancer care mips value pathways |
| M0002 | Opt care kidney hlth mvp | Description: Optimal care for kidney health mips value pathways |
| M0005 | Value in primary care mvp | Description: Value in primary care mips value pathway |
| M0010 | Eom meos payment | Description: Enhancing oncology model (eom) monthly enhanced oncology services (meos) payment for eom enhanced services |
| M0075 | Cellular therapy | Description: Cellular therapy |
| M0076 | Prolotherapy | Description: Prolotherapy |
| M0100 | Intragastric hypothermia | Description: Intragastric hypothermia using gastric freezing |
| M0201 | Pne flu hepb cov home admin | Description: Administration of pneumococcal, influenza, hepatitis b, and/or covid-19 vaccine inside a patient's home; reported only once per individual home per date of service when such vaccine administration(s) are performed at the patient's home |
| M0220 | Tixagev and cilgav inj | Description: Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring |
| M0221 | Tixagev and cilgav inj hm | Description: Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency |
| M0222 | Bebtelovimab injection | Description: Intravenous injection, bebtelovimab, includes injection and post administration monitoring |
| M0223 | Bebtelovimab injection home | Description: Intravenous injection, bebtelovimab, includes injection and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency |
| M0240 | Casiri and imdev repeat | Description: Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses |
| M0241 | Casiri and imdev repeat hm | Description: Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency, subsequent repeat doses |
| M0243 | Casirivi and imdevi inj | Description: Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring |
| M0244 | Casirivi and imdevi inj hm | Description: Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency |
| M0245 | Bamlan and etesev infusion | Description: Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring |
| M0246 | Bamlan and etesev infus home | Description: Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider based to the hospital during the covid 19 public health emergency |
| M0247 | Sotrovimab infusion | Description: Intravenous infusion, sotrovimab, includes infusion and post administration monitoring |
| M0248 | Sotrovimab inf, home admin | Description: Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency |
| M0249 | Adm tocilizu covid-19 1st | Description: Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, first dose |
| M0250 | Adm tocilizu covid-19 2nd | Description: Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, second dose |
| M0300 | Iv chelationtherapy | Description: Iv chelation therapy (chemical endarterectomy) |
| M0301 | Fabric wrapping of aneurysm | Description: Fabric wrapping of abdominal aneurysm |
| M1003 | Tb scr 12 mo pri fst bio dz | Description: Tb screening performed and results interpreted within twelve months prior to initiation of first-time biologic and/or immune response modifier therapy |
| M1004 | Doc med rsn no srn tb | Description: Documentation of medical reason for not screening for tb or interpreting results (i.e., patient positive for tb and documentation of past treatment; patient who has recently completed a course of anti-tb therapy) |
| M1005 | Tb scr no perf | Description: Tb screening not performed or results not interpreted, reason not given |
| M1006 | Dz not ases, no rsn | Description: Disease activity not assessed, reason not given |
| M1007 | >=50% total pt outpt ra enct | Description: >=50% of total number of a patient's outpatient ra encounters assessed |
| M1008 | <50% total pt outpt ra encts | Description: <50% of total number of a patient's outpatient ra encounters assessed |
| M1009 | Dc eoc doc med rec | Description: Discharge/discontinuation of the episode of care documented in the medical record |
| M1010 | Dc eoc doc med rec | Description: Discharge/discontinuation of the episode of care documented in the medical record |
| M1011 | Dc eoc doc med rec | Description: Discharge/discontinuation of the episode of care documented in the medical record |
| M1012 | Dc eoc doc med rec | Description: Discharge/discontinuation of the episode of care documented in the medical record |
| M1013 | Dc eoc doc med rec | Description: Discharge/discontinuation of the episode of care documented in the medical record |
| M1014 | Dc epi care doc medrec | Description: Discharge/discontinuation of the episode of care documented in the medical record |
| M1016 | Pt dx meop or sur steri | Description: Female patients unable to bear children |
| M1018 | Pt dx hst cr pt sk lg cr scr | Description: Patients with an active diagnosis or history of cancer (except basal cell and squamous cell skin carcinoma), patients who are heavy tobacco smokers, lung cancer screening patients |
| M1019 | Adl pt mj dep ds rs 12 phq<5 | Description: Adolescent patients 12 to 17 years of age with major depression or dysthymia who reached remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5 |
| M1020 | Adl pt mj dep ds no rs 12 mo | Description: Adolescent patients 12 to 17 years of age with major depression or dysthymia who did not reach remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5. either phq-9 or phq-9m score was not assessed or is greater than or equal to 5 |
| M1021 | Pt uc in pp | Description: Patient had only urgent care visits during the performance period |
| M1027 | Img head (ct or mri) obtnd | Description: Imaging of the head (ct or mri) was obtained |
| M1028 | Doc of pt prm hda dx and otr | Description: Documentation of patients with primary headache diagnosis and imaging other than ct or mri obtained |
| M1029 | Doc sysm rsn img hd | Description: Imaging of the head (ct or mri) was not obtained, reason not given |
| M1032 | Adt tkng pharmthry for oud | Description: Adults currently taking pharmacotherapy for oud |
| M1034 | Adt 180 dys pharmthry oud | Description: Adults who have at least 180 days of continuous pharmacotherapy with a medication prescribed for oud without a gap of more than seven days |
| M1035 | Adt pd out mat pr 180 dys tx | Description: Adults who are deliberately phased out of medication assisted treatment (mat) prior to 180 days of continuous treatment |
| M1036 | Adt no 180 dys pharmthry oud | Description: Adults who have not had at least 180 days of continuous pharmacotherapy with a medication prescribed for oud without a gap of more than seven days |
| M1037 | Pt dx lum sp reg cacr | Description: Patients with a diagnosis of lumbar spine region cancer at the time of the procedure |
| M1038 | Pt dx lum sp reg fract | Description: Patients with a diagnosis of lumbar spine region fracture at the time of the procedure |
| M1039 | Pt dx lum sp reg inf | Description: Patients with a diagnosis of lumbar spine region infection at the time of the procedure |
| M1040 | Pt dx lum idi or cong scol | Description: Patients with a diagnosis of lumbar idiopathic or congenital scoliosis |
| M1041 | Pt cr ft inf lm or pt id sl | Description: Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis |
| M1043 | Fs no odi 9-15mo | Description: Functional status was not measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively |
| M1045 | Fs oks 9-15mo >= 37 >= 71 | Description: Functional status measured by the oxford knee score (oks) at one year (9 to 15 months) postoperatively was greater than or equal to 37 or knee injury and osteoarthritis outcome score joint replacement (koos, jr.) was greater than or equal to 71 |
| M1046 | Fs oks 9-15mo < 37 < 71 | Description: Functional status measured by the oxford knee score (oks) at one year (9 to 15 months) postoperatively was less than 37 or the knee injury and osteoarthritis outcome score joint replacement (koos, jr.) was less than 71 postoperatively |
| M1049 | Fs wth scr no odi pre and p | Description: Functional status was not measured by the oswestry disability index (odi version 2.1a) at three months (6 - 20 weeks) postoperatively |
| M1051 | Pt w/cancer scoliosis | Description: Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis |
| M1052 | Lg pn not meas w/ vas 1yr po | Description: Leg pain was not measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively |
| M1054 | Pt uc in pp | Description: Patient had only urgent care visits during the performance period |
| M1055 | Aspirin used | Description: Aspirin or another antiplatelet therapy used |
| M1056 | Presc antico med in pp | Description: Prescribed anticoagulant medication during the performance period, history of gi bleeding, history of intracranial bleeding, bleeding disorder and specific provider documented reasons: allergy to aspirin or anti-platelets, use of non-steroidal anti-inflammatory agents, drug-drug interaction, uncontrolled hypertension > 180/110 mmhg or gastroesophageal reflux disease |
| M1057 | Aspirin not used, no rsn | Description: Aspirin or another antiplatelet therapy not used, reason not given |
| M1058 | Pt prm nurs hm res in pp | Description: Patient was a permanent nursing home resident at any time during the performance period |
| M1059 | Pt no prm nurs hm res in pp | Description: Patient was in hospice or receiving palliative care at any time during the performance period |
| M1060 | Pt died in pp | Description: Patient died prior to the end of the performance period |
| M1067 | Hspc pt prv time meam per | Description: Hospice services for patient provided any time during the measurement period |
| M1068 | Pt not ambulatory | Description: Adults who are not ambulatory |
| M1069 | Pt scr ft fall rsk | Description: Patient screened for future fall risk |
| M1070 | Pt not scrn fut fall no rsn | Description: Patient not screened for future fall risk, reason not given |
| M1106 | Start eoc doc med rec | Description: The start of an episode of care documented in the medical record |
| M1107 | Docu dx degen neuro | Description: Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time before or during the episode of care |
| M1108 | Oc ni pt home prog | Description: Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record |
| M1109 | Oc ni pt dc | Description: Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery |
| M1110 | Oc not p pt selfdc | Description: Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) |
| M1111 | Start eoc doc med rec | Description: The start of an episode of care documented in the medical record |
| M1112 | Docu dx degen neuro | Description: Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time before or during the episode of care |
| M1113 | Oc ni pt home prog | Description: Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record |
| M1114 | Oc ni pt dc | Description: Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery |
| M1115 | Oc ni pt selfdc | Description: Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) |
| M1116 | Start eoc doc med rec | Description: The start of an episode of care documented in the medical record |
| M1117 | Docu dx degen neuro | Description: Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time before or during the episode of care |
| M1118 | Oc ni pt home prog | Description: Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record |
| M1119 | Oc ni pt dc | Description: Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery |
| M1120 | Oc ni pt selfdc | Description: Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) |
| M1121 | Start eoc doc med rec | Description: The start of an episode of care documented in the medical record |
| M1122 | Docu dx degen neuro | Description: Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time before or during the episode of care |
| M1123 | Oc ni pt home prog | Description: Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record |
| M1124 | Oc ni pt dc 1-2 vis | Description: Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery |
| M1125 | Oc ni pt selfdc 1-2 vis | Description: Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) |
| M1126 | Start eoc doc med rec | Description: The start of an episode of care documented in the medical record |
| M1127 | Docu dx degen neuro | Description: Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time before or during the episode of care |
| M1128 | Oc ni pt home prog | Description: Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record |
| M1129 | Oc ni pt dc | Description: Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery |
| M1130 | Oc ni pt selfdc | Description: Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) |
| M1131 | Docu dx degen neuro | Description: Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time before or during the episode of care |
| M1132 | Oc ni pt home prog | Description: Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record |
| M1133 | Oc ni pt dc | Description: Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery |
| M1134 | Oc ni pt selfdc | Description: Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) |
| M1135 | Start eoc doc med rec | Description: The start of an episode of care documented in the medical record |
| M1141 | Fs no oks | Description: Functional status was not measured by the oxford knee score (oks) or the knee injury and osteoarthritis outcome score joint replacement (koos, jr.) at one year (9 to 15 months) postoperatively |
| M1142 | Emerge cases | Description: Emergent cases |
| M1143 | Ni rehab med chiro | Description: Initiated episode of rehabilitation therapy, medical, or chiropractic care for neck impairment |
| M1146 | Ongoing care not ind | Description: Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record |
| M1147 | Care not poss med rsn | Description: Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery |
| M1148 | Pt self dschg | Description: Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) |
| M1149 | No neck fs prom incap | Description: Patient unable to complete the neck fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility, and an adequate proxy is not available |
| M1151 | Pt w/ hx trnsplt or lvad | Description: Patients with a history of heart transplant or with a left ventricular assist device (lvad) |
| M1152 | Pt w/ hx trnsplt or lvad | Description: Patients with a history of heart transplant or with a left ventricular assist device (lvad) |
| M1153 | Pt w/ dx osteo doe | Description: Patient with diagnosis of osteoporosis on date of encounter |
| M1159 | Hospc serv dur meas pd | Description: Hospice services provided to patient any time during the measurement period |
| M1160 | Pt anphx due to mengb bef 13 | Description: Patient had anaphylaxis due to the meningococcal vaccine any time on or before the patient's 13th birthday |
| M1161 | Pt anphx due to dtp bef 13 | Description: Patient had anaphylaxis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient's 13th birthday |
| M1162 | Pt enceph due to dtp bef 13 | Description: Patient had encephalitis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient's 13th birthday |
| M1163 | Pt anphx due to hpv bef 13 | Description: Patient had anaphylaxis due to the hpv vaccine any time on or before the patient's 13th birthday |
| M1164 | Pt w/ dementia any time | Description: Patients with dementia any time during the patient's history through the end of the measurement period |
| M1165 | Pt use hspc dur meas pd | Description: Patients who use hospice services any time during the measurement period |
| M1166 | Path rpt tis spec wle/reexc | Description: Pathology report for tissue specimens produced from wide local excisions or re-excisions |
| M1167 | Hspc dur meas pd | Description: In hospice or using hospice services during the measurement period |
| M1168 | Pt recd flu vax 7/1-6/30 | Description: Patient received an influenza vaccine on or between july 1 of the year prior to the measurement period and june 30 of the measurement period |
| M1169 | Doc med rsn no flu vax | Description: Documentation of medical reason(s) for not administering influenza vaccine (e.g., prior anaphylaxis due to the influenza vaccine) |
| M1170 | Pt w/o flu vax 7/1-6/30 | Description: Patient did not receive an influenza vaccine on or between july 1 of the year prior to the measurement period and june 30 of the measurement period |
| M1171 | Pt recd 1 td/tdap 9yrs prior | Description: Patient received at least one td vaccine or one tdap vaccine between nine years prior to the encounter and the end of the measurement period |
| M1172 | Doc med rsn no td/tdap | Description: Documentation of medical reason(s) for not administering td or tdap vaccine (e.g., prior anaphylaxis due to the td or tdap vaccine or history of encephalopathy within seven days after a previous dose of a td-containing vaccine) |
| M1173 | Pt no rec td/tdap 9yrs prior | Description: Patient did not receive at least one td vaccine or one tdap vaccine between nine years prior to the encounter and the end of the measurement period |
| M1174 | Pt w 2 hzv on/aft 50 | Description: Patient received at least two doses of the herpes zoster recombinant vaccine (at least 28 days apart) anytime on or after the patient's 50th birthday before or during the measurement period |
| M1175 | Doc med rsn no hzv | Description: Documentation of medical reason(s) for not administering zoster vaccine (e.g., prior anaphylaxis due to the zoster vaccine) |
| M1178 | Doc med rsn no pcv | Description: Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., prior anaphylaxis due to the pneumococcal vaccine) |
| M1180 | Pt imm ckpt inhib therapy | Description: Patients on immune checkpoint inhibitor therapy |
| M1181 | Gr 2 or> dia or gr2 or> col | Description: Grade 2 or above diarrhea and/or grade 2 or above colitis |
| M1182 | Not elg pre ex ibd/uc/crohn | Description: Patients not eligible due to pre-existing inflammatory bowel disease (ibd) (e.g., ulcerative colitis, crohn's disease) |
| M1183 | Doc imm ckpt inhib hld | Description: Documentation of immune checkpoint inhibitor therapy held and corticosteroids or immunosuppressants prescribed or administered |
| M1184 | Doc med rsn no cst/ist rx | Description: Documentation of medical reason(s) for not prescribing or administering corticosteroid or immunosuppressant treatment (e.g., allergy, intolerance, infectious etiology, pancreatic insufficiency, hyperthyroidism, prior bowel surgical interventions, celiac disease, receiving other medication, awaiting diagnostic workup results for alternative etiologies, other medical reasons/contraindication) |
| M1185 | Imm ckpt inhib not hld no rx | Description: Documentation of immune checkpoint inhibitor therapy not held and/or corticosteroids or immunosuppressants prescribed or administered was not performed, reason not given |
| M1186 | Pt w/ rx for hspc/plltv care | Description: Patients who have an order for or are receiving hospice or palliative care |
| M1187 | Pt w/ esrd | Description: Patients with a diagnosis of end stage renal disease (esrd) |
| M1188 | Pt w/ ckd stg 5 | Description: Patients with a diagnosis of chronic kidney disease (ckd) stage 5 |
| M1189 | Doc khe pef w/efgr/uacr | Description: Documentation of a kidney health evaluation defined by an estimated glomerular filtration rate (egfr) and urine albumin-creatinine ratio (uacr) performed |
| M1190 | Doc khe not pef w/efgr/uacr | Description: Documentation of a kidney health evaluation was not performed or defined by an estimated glomerular filtration rate (egfr) and urine albumin-creatinine ratio (uacr) |
| M1191 | Hspc svc any time in meas pd | Description: Hospice services provided to patient any time during the measurement period |
| M1192 | Pt w/ dx sq cell ca of esoph | Description: Patients with an existing diagnosis of squamous cell carcinoma of the esophagus |
| M1193 | Rpts w/ imp/con mmr/msi | Description: Surgical pathology reports that contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-based testing status, or both |
| M1194 | Med rsn no imp/con mmr/msi | Description: Documentation of medical reason(s) surgical pathology reports did not contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-based testing status, or both tests were not included (e.g., patient will not be treated with checkpoint inhibitor therapy, no residual carcinoma is present in the sample [tissue exhausted or status post neoadjuvant treatment], insufficient tumor for testing) |
| M1195 | Rpt wo imp/con mmr/msi | Description: Surgical pathology reports that do not contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-based testing status, or both, reason not given |
| M1196 | Ixv nrs vrs iqa >=4 | Description: Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4 |
| M1197 | Isa reduced >=3 fr ixv | Description: Itch severity assessment score is reduced by 3 or more points from the initial (index) assessment score to the follow-up visit score |
| M1198 | Isa not red 3pts /no assess | Description: Itch severity assessment score was not reduced by at least 3 points from initial (index) score to the follow-up visit score or assessment was not completed during the follow-up encounter |
| M1199 | Pt rec'g rrt | Description: Patients receiving rrt |
| M1200 | Ace-i/arb rx | Description: Ace inhibitor (ace-i) or arb therapy prescribed during the measurement period |
| M1201 | Med rsn no ace-i/arb rx | Description: Documentation of medical reason(s) for not prescribing ace inhibitor (ace-i) or arb therapy during the measurement period (e.g., pregnancy, history of angioedema to ace-i, other allergy to ace-i and arb, hyperkalemia or history of hyperkalemia while on ace-i or arb therapy, acute kidney injury due to ace-i or arb therapy), other medical reasons) |
| M1202 | Pt rsn no ace-i/arb rx | Description: Documentation of patient reason(s) for not prescribing ace inhibitor or arb therapy during the measurement period, (e.g., patient declined, other patient reasons) |
| M1203 | No rsn ace-i/arb rx | Description: Ace inhibitor or arb therapy not prescribed during the measurement period, reason not given |
| M1204 | Ixv nrs vrs iqa >=4 | Description: Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4 |
| M1205 | Isa reduced >=3 | Description: Itch severity assessment score is reduced by 3 or more points from the initial (index) assessment score to the follow-up visit score |
| M1206 | Isa not red 3pts/no assess | Description: Itch severity assessment score was not reduced by at least 3 points from initial (index) score to the follow-up visit score or assessment was not completed during the follow-up encounter |
| M1207 | Pt scrn sdoh | Description: Patient is screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety |
| M1208 | Pt no scrn sdoh | Description: Patient is not screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety |
| M1209 | >=2 same hi-rsk med w/o diag | Description: At least two orders for high-risk medications from the same drug class, (table 4), without appropriate diagnoses |
| M1210 | >=2 same meds tbl4 not ord | Description: At least two orders for high-risk medications from the same drug class, (table 4), not ordered |
| M1213 | No hx spiro prs spiro>=70% | Description: No history of spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) and present spirometry is >= 70% |
| M1214 | Spiro results wth obs doc | Description: Spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) documented and reviewed |
| M1215 | Med rsn for no doc spiro | Description: Documentation of medical reason(s) for not documenting and reviewing spirometry results (e.g., patients with dementia or tracheostomy) |
| M1216 | No spiro doc no res doc | Description: No spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) documented and/or no spirometry performed with results documented during the encounter |
| M1217 | Sys rsn no doc spiro | Description: Documentation of system reason(s) for not documenting and reviewing spirometry results (e.g., spirometry equipment not available at the time of the encounter) |
| M1218 | Pt copd symptoms | Description: Patient has copd symptoms (e.g., dyspnea, cough/sputum, wheezing) |
| M1220 | Dre wth interp rtnopthy | Description: Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; with evidence of retinopathy |
| M1221 | Dre w/o rtnopthy | Description: Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; without evidence of retinopathy |
| M1222 | Glaucoma pln of care not doc | Description: Glaucoma plan of care not documented, reason not otherwise specified |
| M1223 | Glaucoma plan of care doc | Description: Glaucoma plan of care documented |
| M1224 | Iop dec <20% from base | Description: Intraocular pressure (iop) reduced by a value less than 20% from the pre-intervention level |
| M1225 | Iop dec>=20% from base | Description: Intraocular pressure (iop) reduced by a value of greater than or equal to 20% from the pre-intervention level |
| M1226 | Iop not doc | Description: Iop measurement not documented, reason not otherwise specified |
| M1227 | Eb therapy prescribed | Description: Evidence-based therapy was prescribed |
| M1228 | Pt + hcv aby +vir w/ rx 3 mo | Description: Patient, who has a reactive hcv antibody test, and has a follow up hcv viral test that detected hcv viremia, has hcv treatment initiated within 3 months of the reactive hcv antibody test |
| M1229 | Pt w/ +hcv +vir ref win 1 mo | Description: Patient, who has a reactive hcv antibody test, and has a follow up hcv viral test that detected hcv viremia, is referred within 1 month of the reactive hcv antibody test to a clinician who treats hcv infection |
| M1230 | Pt hcv rctv aby no f/u tst | Description: Patient has a reactive hcv antibody test and does not have a follow up hcv viral test, or patient has a reactive hcv antibody test and has a follow up hcv viral test that detects hcv viremia and is not referred to a clinician who treats hcv infection within 1 month and does not have hcv treatment initiated within 3 months of the reactive hcv antibody test, reason not given |
| M1231 | Pt hcv tst no reactive res | Description: Patient receives hcv antibody test with nonreactive result |
| M1232 | Pt hcv tst reactive result | Description: Patient receives hcv antibody test with reactive result |
| M1233 | Pt no hcv aby or result | Description: Patient does not receive hcv antibody test or patient does receive hcv antibody test but results not documented, reason not given |
| M1234 | Pt hcv rctv aby f/u neg | Description: Patient has a reactive hcv antibody test, and has a follow up hcv viral test that does not detect hcv viremia |
| M1235 | Doc pt hcv aby rna tst | Description: Documentation or patient report of hcv antibody test or hcv rna test which occurred prior to the performance period |
| M1236 | Baseline mrs > 2 | Description: Baseline mrs > 2 |
| M1237 | Pt rsn no scrn | Description: Patient reason for not screening for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety (e.g., patient declined or other patient reasons) |
| M1238 | Doc 2nd recom hzv 2-6 mo int | Description: Documentation that administration of second recombinant zoster vaccine could not occur during the performance period due to the recommended 2-6 month interval between doses (i.e, first dose received after october 31) |
| M1239 | Pt no resp heard | Description: Patient did not respond to the question of patient felt heard and understood by this provider and team |
| M1240 | Pt no resp best int | Description: Patient did not respond to the question of patient felt this provider and team put my best interests first when making recommendations about my care |
| M1241 | Pt no resp seen as person | Description: Patient did not respond to the question of patient felt this provider and team saw me as a person, not just someone with a medical problem |
| M1242 | Pt no resp imprt to me | Description: Patient did not respond to the question of patient felt this provider and team understood what is important to me in my life |
| M1243 | Pt othr thn true heard | Description: Patient provided a response other than 'completely true' for the question of patient felt heard and understood by this provider and team |
| M1244 | Pt othr thn true best int | Description: Patient provided a response other than 'completely true' for the question of patient felt this provider and team put my best interests first when making recommendations about my care |
| M1245 | Pt othr thn true person | Description: Patient provided a response other than 'completely true' for the question of patient felt this provider and team saw me as a person, not just someone with a medical problem |
| M1246 | Pt othr thn true imprt to me | Description: Patient provided a response other than 'completely true' for the question of patient felt this provider and team understood what is important to me in my life |
| M1247 | Pt resp true best int | Description: Patient responded 'completely true' for the question of patient felt this provider and team put my best interests first when making recommendations about my care |
| M1248 | Pt resp true seen as person | Description: Patient responded 'completely true' for the question of patient felt this provider and team saw me as a person, not just someone with a medical problem |
| M1249 | Pt resp true imprt to me | Description: Patient responded 'completely true' for the question of patient felt this provider and team understood what is important to me in my life |
| M1250 | Pt resp true heard | Description: Patient responded as 'completely true' for the question of patient felt heard and understood by this provider and team |
| M1251 | Pts proxy cmplt hu surv | Description: Patients for whom a proxy completed the entire hu survey on their behalf for any reason (no patient involvement) |
| M1252 | Pts no cmplt hu survey | Description: Patients who did not complete at least one of the four patient experience hu survey items and return the hu survey within 60 days of the ambulatory palliative care visit |
| M1253 | Pts hu surv no amb plltv | Description: Patients who respond on the patient experience hu survey that they did not receive care by the listed ambulatory palliative care provider in the last 60 days (disavowal) |
| M1254 | Pts deceased prior hu surv | Description: Patients who were deceased when the hu survey reached them |
| M1255 | Pts w/ othr rsn vst,+prg tst | Description: Patients who have another reason for visiting the clinic [not prenatal or postpartum care] and have a positive pregnancy test but have not established the clinic as an ob provider (e.g., plan to terminate the pregnancy or seek prenatal services elsewhere) |
| M1256 | Prior history of known cvd | Description: Prior history of known cvd |
| M1257 | Cvd risk assess not perf | Description: Cvd risk assessment not performed or incomplete (e.g., cvd risk assessment was not documented), reason not otherwise specified |
| M1258 | Cvd risk assess perf | Description: Cvd risk assessment performed, have a documented calculated risk score |
| M1261 | Pts on wtlist bef dialysis | Description: Patients that were on the kidney or kidney-pancreas waitlist prior to initiation of dialysis |
| M1262 | Pts transplt bef dialysis | Description: Patients who had a transplant prior to initiation of dialysis |
| M1263 | Pts hosp dialysis dt | Description: Patients in hospice on their initiation of dialysis date or during the month of evaluation |
| M1265 | Cms 2728 completed | Description: Cms medical evidence form 2728 for dialysis patients: initial form completed |
| M1266 | Pts admit snf | Description: Patients admitted to a skilled nursing facility (snf) |
| M1269 | Rec'd esrd mcp lst day of mo | Description: Receiving esrd mcp dialysis services by the provider on the last day of the reporting month |
| M1270 | Pts no kid transplt wtlst | Description: Patients not on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period |
| M1271 | Pts dem any time/dur mo | Description: Patients with dementia at any time prior to or during the month |
| M1273 | Pts snf 1 yr dialysis | Description: Patients who were admitted to a skilled nursing facility (snf) within one year of dialysis initiation according to the cms-2728 form |
| M1274 | Pts snf exl mo | Description: Patients who were admitted to a skilled nursing facility (snf) during the month of evaluation were excluded from that month |
| M1275 | Pts hosp exl | Description: Patients determined to be in hospice were excluded from month of evaluation and the remainder of reporting period |
| M1276 | Calc bmi out nrm param nof/u | Description: Bmi documented outside normal parameters, no follow-up plan documented, no reason given |
| M1277 | Colorectal ca screen doc rev | Description: Colorectal cancer screening results documented and reviewed |
| M1278 | Pre-htn or htn doc, f/u indc | Description: Elevated or hypertensive blood pressure reading documented, and the indicated follow-up is documented |
| M1279 | Pre-htn/htn, no f/u, not gvn | Description: Elevated or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given |
| M1280 | Bilat mast/hx bi /unilat mas | Description: Women who had a bilateral mastectomy or who have a history of a bilateral mastectomy or for whom there is evidence of a right and a left unilateral mastectomy |
| M1281 | Bp scrn no perf at interval | Description: Blood pressure reading not documented, reason not given |
| M1282 | Pt scrn tbco id as non user | Description: Patient screened for tobacco use and identified as a tobacco non-user |
| M1283 | Pt scrn tbco and id as user | Description: Patient screened for tobacco use and identified as a tobacco user |
| M1284 | Pt 66+ snp or ltc pos > 90d | Description: Patients age 66 or older in institutional special needs plans (snp) or residing in long term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the measurement period |
| M1285 | Scrn mam perf rslts not doc | Description: Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results were not documented and reviewed, reason not otherwise specified |
| M1286 | Bmi doc onl fup not cmpltd | Description: Bmi is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reason |
| M1287 | Calc bmi blw low param f/u | Description: Bmi is documented below normal parameters and a follow-up plan is documented |
| M1288 | Doc rsn no hbp scrn or f/u | Description: Documented reason for not screening or recommending a follow-up for high blood pressure |
| M1289 | No pt tbco cess interv rng | Description: Patient identified as tobacco user did not receive tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy) |
| M1290 | Pt not eli d/t act dig htn | Description: Patient not eligible due to active diagnosis of hypertension |
| M1291 | Pt 66+ frailty and med dem | Description: Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period |
| M1293 | Calc bmi abv up param f/u | Description: Bmi is documented above normal parameters and a follow-up plan is documented |
| M1294 | Bp scrn perf rec interval | Description: Normal blood pressure reading documented, follow-up not required |
| M1295 | Pt hx tot col or colon ca | Description: Patients with a diagnosis or past history of total colectomy or colorectal cancer |
| M1296 | Calc bmi norm parameters | Description: Bmi is documented within normal parameters and no follow-up plan is required |
| M1297 | Bmi not doc medrsn ptref | Description: Bmi not documented due to medical reason or patient refusal of height or weight measurement |
| M1298 | Doc pt preg dur msrmt pd | Description: Documentation of patient pregnancy anytime during the measurement period prior to and including the current encounter |
| M1299 | Flu immunize order/admin | Description: Influenza immunization administered or previously received |
| M1300 | Flu imm no admin doc rea | Description: Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons) |
| M1301 | Pt recv tbco cess interv | Description: Patient identified as a tobacco user received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy) |
| M1302 | Scrn mam perf rslts doc | Description: Screening, diagnostic, film digital or digital breast tomosynthesis (3d) mammography results documented and reviewed |
| M1303 | Hospc serv dur meas pd | Description: Hospice services provided to patient any time during the measurement period |
| M1304 | No pneum vax admin 19+ | Description: Patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period |
| M1305 | Pneum vax admin 19+ | Description: Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period |
| M1306 | Pt anphx due to pneum | Description: Patient had anaphylaxis due to the pneumococcal vaccine any time during or before the measurement period |
| M1307 | Doc pt pal or hospice | Description: Documentation stating the patient has received or is currently receiving palliative or hospice care |
| M1308 | Flu immunize no admin | Description: Influenza immunization was not administered, reason not given |
| M1309 | Pall serv during meas | Description: Palliative care services provided to patient any time during the measurement period |
| M1310 | Pt scr tob & cess int | Description: Patient screened for tobacco use and received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling, pharmacotherapy, or both), if identified as a tobacco user |
| M1311 | Aphlx to vax bef enc | Description: Anaphylaxis due to the vaccine on or before the date of the encounter |
| M1312 | No pt tbco scrn rng | Description: Patient not screened for tobacco use |
| M1313 | No tob scr/cess int | Description: Tobacco screening not performed or tobacco cessation intervention not provided during the measurement period or in the six months prior to the measurement period |
| M1314 | Bmi not calculated | Description: Bmi not documented and no reason is given |
| M1315 | Crc no doc no rsn | Description: Colorectal cancer screening results were not documented and reviewed; reason not otherwise specified |
| M1316 | Tobacco non-user | Description: Current tobacco non-user |
| M1317 | Pts counsl cpt opt out | Description: Patients who are counseled on connection with a csp and explicitly opt out |
| M1318 | Pts no csp doc contact | Description: Patients who did not have documented contact with a csp for at least one of their screened positive hrsns within 60 days after screening or documentation that there was no contact with a csp |
| M1319 | Pts csp doc contact | Description: Patients who had documented contact with a csp for at least one of their screened positive hrsns within 60 days after screening |
| M1320 | Pts scrn + hrsn | Description: Patients who screened positive for at least 1 of the 5 hrsns |
| M1321 | Pts no 7wk inj,no iop,iop>25 | Description: Patients who were not seen within 7 weeks following the date of injection for follow up or who did not have a documented iop or no plan of care documented if the iop was >25 mm hg |
| M1322 | Pts 7wk inj, scrn iop =<25 | Description: Patients seen within 7 weeks following the date of injection and are screened for elevated intraocular pressure (iop) with tonometry with documented iop =<25 mm hg for injected eye |
| M1323 | Pts 7wk inj, scrn iop >25 | Description: Patients seen within 7 weeks following the date of injection and are screened for elevated intraocular pressure (iop) with tonometry with documented iop >25 mm hg and a plan of care was documented |
| M1324 | Pts intravitreal/pci | Description: Patients who had an intravitreal or periocular corticosteroid injection (e.g., triamcinolone, preservative-free triamcinolone, dexamethasone, dexamethasone intravitreal implant, or fluocinolone intravitreal implant) |
| M1325 | Doc med rsn not seen | Description: Patients who were not seen for reasons documented by clinician for patient or medical reasons (e.g., inadequate time for follow-up, patients who received a prior intravitreal or periocular steroid injection within the last six (6) months and had a subsequent iop evaluation with iop <25mm hg within seven (7) weeks of treatment) |
| M1326 | Pts dx hypotony | Description: Patients with a diagnosis of hypotony |
| M1327 | Pts no eval ini xm no 8 wks | Description: Patients who were not appropriately evaluated during the initial exam and/or who were not re-evaluated within 8 weeks |
| M1328 | Pts dx acute vitreous hem | Description: Patients with a diagnosis of acute vitreous hemorrhage |
| M1329 | Pts act pvd 2 wks 8 wks | Description: Patients with a post-operative encounter of the eye with the acute pvd within 2 weeks before the initial encounter or 8 weeks after initial acute pvd encounter |
| M1330 | Doc pts rsn no f/u xm | Description: Documentation of patient reason(s) for not having a follow up exam (e.g., inadequate time for follow up) |
| M1331 | Pts eval ini xm 8 wks | Description: Patients who were appropriately evaluated during the initial exam and were re-evaluated no later than 8 weeks from initial exam |
| M1332 | Pts no eval ini xm no 2 wks | Description: Patients who were not appropriately evaluated during the initial exam and/or who were not re-evaluated within 2 weeks |
| M1333 | Acute vitreous hemorrhage | Description: Acute vitreous hemorrhage |
| M1334 | Pts act pvd 2 wks 2 wks | Description: Patients with a post-operative encounter of the eye with the acute pvd within 2 weeks before the initial encounter or 2 weeks after initial acute pvd encounter |
| M1335 | Doc pts rsn no f/u xm | Description: Documentation of patient reason(s) for not having a follow up exam (e.g., inadequate time for follow up) |
| M1336 | Pts eval ini xm 2 wks | Description: Patients who were appropriately evaluated during the initial exam and were re-evaluated no later than 2 weeks |
| M1337 | Acute pvd | Description: Acute pvd |
| M1338 | Pt f/u 30-180 dys no + imprv | Description: Patients who had follow-up assessment 30 to 180 days after the index assessment who did not demonstrate positive improvement or maintenance of functioning scores during the performance period |
| M1339 | Pts f/u 30-180 dys + improv | Description: Patients who had follow-up assessment 30 to 180 days after the index assessment who demonstrated positive improvement or maintenance of functioning scores during the performance period |
| M1340 | Indx whodas 2.0 or sds | Description: Index assessment completed using the 12-item whodas 2.0 or sds during the denominator identification period |
| M1341 | Pt no f/u 30-180 dys | Description: Patients who did not have a follow-up assessment or did not have an assessment within 30 to 180 days after the index assessment during the performance period |
| M1342 | Pts died perf per | Description: Patients who died during the performance period |
| M1350 | Pt w/ suic saf pln init rev | Description: Patients who had a completed suicide safety plan initiated, reviewed or updated in collaboration with their clinician (concurrent or within 24 hours) of the index clinical encounter |
| M1351 | Pt cmplt suicd saf pln 120dy | Description: Patients who had a suicide safety plan initiated, reviewed, or updated and reviewed and updated in collaboration with the patient and their clinician concurrent or within 24 hours of clinical encounter and within 120 days after initiation |
| M1352 | Suicd c-ssrs assessment, equ | Description: Suicidal ideation and/or behavior symptoms based on the c-ssrs or equivalent assessment |
| M1353 | Pts no cmplt suicd saf pln | Description: Patients who did not have a completed suicide safety plan initiated, reviewed or updated in collaboration with their clinician (concurrent or within 24 hours) of the index clinical encounter |
| M1354 | Pt no suicd saf pln 120dy | Description: Patients who did not have a suicide safety plan initiated, reviewed, or updated or reviewed and updated in collaboration with the patient and their clinician concurrent or within 24 hours of clinical encounter and within 120 days after initiation |
| M1355 | Suicd based cln eval | Description: Suicide risk based on their clinician's evaluation or a clinician-rated tool |
| M1356 | Pt died dur meas pd | Description: Patients who died during the measurement period |
| M1357 | Pt w/red suic idea 120 days | Description: Patients who had a reduction in suicidal ideation and/or behavior upon follow-up assessment within 120 days of index assessment |
| M1358 | Pts no | Description: Patients who did not have a reduction in suicidal ideation and/or behavior upon follow-up assessment within 120 days of index assessment |
| M1359 | Indx suicd idea, no 0 scr | Description: Index assessment during the denominator period when the suicidal ideation and/or behavior symptoms or increased suicide risk by clinician determination occurs and a non-zero c-ssrs score is obtained |
| M1360 | Suicd c-ssrs assessment | Description: Suicidal ideation and/or behavior symptoms based on the c-ssrs |
| M1361 | Suicd based cln eval | Description: Suicide risk based on their clinician's evaluation or a clinician-rated tool |
| M1362 | Pt died dur meas pd | Description: Patients who died during the measurement period |
| M1363 | Pts no f/u 120 dys | Description: Patients who did not have a follow-up assessment within 120 days of the index assessment |
| M1364 | Ascvd risk >=20pct | Description: Calculated 10-year ascvd risk score of >= 20 percent during the performance period |
| M1365 | Hosp+pall care spec code 17 | Description: Patient encounter during the performance period with hospice and palliative care specialty code 17 |
| M1366 | Focus on women's health mvp | Description: Focusing on women's health mips value pathway |
| M1367 | Qual care ent disorder mvp | Description: Quality care for the treatment of ear, nose, and throat disorders mips value pathway |
| M1368 | Prev trt inf d/o hiv/hep mvp | Description: Prevention and treatment of infectious disorders including hepatitis c and hiv mips value pathway |
| M1369 | Qualcare mental hlth/sud mvp | Description: Quality care in mental health and substance use disorders mips value pathway |
| M1370 | Rehab support msk care mvp | Description: Rehabilitative support for musculoskeletal care mips value pathway |
| P2028 | Cephalin floculation test | Description: Cephalin floculation, blood |
| P2029 | Congo red blood test | Description: Congo red, blood |
| P2031 | Hair analysis | Description: Hair analysis (excluding arsenic) |
| P2033 | Blood thymol turbidity | Description: Thymol turbidity, blood |
| P2038 | Blood mucoprotein | Description: Mucoprotein, blood (seromucoid) (medical necessity procedure) |
| P3000 | Screen pap by tech w md supv | Description: Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision |
| P3001 | Screening pap smear by phys | Description: Screening papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician |
| P7001 | Culture bacterial urine | Description: Culture, bacterial, urine; quantitative, sensitivity study |
| P9010 | Whole blood for transfusion | Description: Blood (whole), for transfusion, per unit |
| P9011 | Blood split unit | Description: Blood, split unit |
| P9012 | Cryoprecipitate each unit | Description: Cryoprecipitate, each unit |
| P9016 | Rbc leukocytes reduced | Description: Red blood cells, leukocytes reduced, each unit |
| P9017 | Plasma 1 donor frz w/in 8 hr | Description: Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit |
| P9019 | Platelets, each unit | Description: Platelets, each unit |
| P9020 | Plaelet rich plasma unit | Description: Platelet rich plasma, each unit |
| P9021 | Red blood cells unit | Description: Red blood cells, each unit |
| P9022 | Washed red blood cells unit | Description: Red blood cells, washed, each unit |
| P9023 | Frozen plasma, pooled, sd | Description: Plasma, pooled multiple donor, solvent/detergent treated, frozen, each unit |
| P9025 | Plasma cryo redu path each | Description: Plasma, cryoprecipitate reduced, pathogen reduced, each unit |
| P9026 | Cryo fib comp path redu each | Description: Cryoprecipitated fibrinogen complex, pathogen reduced, each unit |
| P9031 | Platelets leukocytes reduced | Description: Platelets, leukocytes reduced, each unit |
| P9032 | Platelets, irradiated | Description: Platelets, irradiated, each unit |
| P9033 | Platelets leukoreduced irrad | Description: Platelets, leukocytes reduced, irradiated, each unit |
| P9034 | Platelets, pheresis | Description: Platelets, pheresis, each unit |
| P9035 | Platelet pheres leukoreduced | Description: Platelets, pheresis, leukocytes reduced, each unit |
| P9036 | Platelet pheresis irradiated | Description: Platelets, pheresis, irradiated, each unit |
| P9037 | Plate pheres leukoredu irrad | Description: Platelets, pheresis, leukocytes reduced, irradiated, each unit |
| P9038 | Rbc irradiated | Description: Red blood cells, irradiated, each unit |
| P9039 | Rbc deglycerolized | Description: Red blood cells, deglycerolized, each unit |
| P9040 | Rbc leukoreduced irradiated | Description: Red blood cells, leukocytes reduced, irradiated, each unit |
| P9041 | Albumin (human),5%, 50ml | Description: Infusion, albumin (human), 5%, 50 ml |
| P9043 | Plasma protein fract,5%,50ml | Description: Infusion, plasma protein fraction (human), 5%, 50 ml |
| P9044 | Cryoprecipitatereducedplasma | Description: Plasma, cryoprecipitate reduced, each unit |
| P9045 | Albumin (human), 5%, 250 ml | Description: Infusion, albumin (human), 5%, 250 ml |
| P9046 | Albumin (human), 25%, 20 ml | Description: Infusion, albumin (human), 25%, 20 ml |
| P9047 | Albumin (human), 25%, 50ml | Description: Infusion, albumin (human), 25%, 50 ml |
| P9048 | Plasmaprotein fract,5%,250ml | Description: Infusion, plasma protein fraction (human), 5%, 250 ml |
| P9050 | Granulocytes, pheresis unit | Description: Granulocytes, pheresis, each unit |
| P9051 | Blood, l/r, cmv-neg | Description: Whole blood or red blood cells, leukocytes reduced, cmv-negative, each unit |
| P9052 | Platelets, hla-m, l/r, unit | Description: Platelets, hla-matched leukocytes reduced, apheresis/pheresis, each unit |
| P9053 | Plt, pher, l/r cmv-neg, irr | Description: Platelets, pheresis, leukocytes reduced, cmv-negative, irradiated, each unit |
| P9054 | Blood, l/r, froz/degly/wash | Description: Whole blood or red blood cells, leukocytes reduced, frozen, deglycerol, washed, each unit |
| P9055 | Plt, aph/pher, l/r, cmv-neg | Description: Platelets, leukocytes reduced, cmv-negative, apheresis/pheresis, each unit |
| P9056 | Blood, l/r, irradiated | Description: Whole blood, leukocytes reduced, irradiated, each unit |
| P9057 | Rbc, frz/deg/wsh, l/r, irrad | Description: Red blood cells, frozen/deglycerolized/washed, leukocytes reduced, irradiated, each unit |