Medical Billing Code Search
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8892 results found
| E1800 | Adjust elbow ext & flex dev | Description: Dynamic adjustable elbow extension and flexion device, includes soft interface material |
| E1803 | Adjust elbow extension dev | Description: Dynamic adjustable elbow extension only device, includes soft interface material |
| E1804 | Adjust elbow flexion dev | Description: Dynamic adjustable elbow flexion only device, includes soft interface material |
| E1805 | Adjust wrist ext & flex dev | Description: Dynamic adjustable wrist extension and flexion device, includes soft interface material |
| E1807 | Adjust wrist extension dev | Description: Dynamic adjustable wrist extension only device, includes soft interface material |
| E1808 | Adjust wrist flexion device | Description: Dynamic adjustable wrist flexion only device, includes soft interface material |
| E1810 | Adjust knee ext & flex dev | Description: Dynamic adjustable knee extension and flexion device, includes soft interface material |
| E1813 | Adjust knee extension device | Description: Dynamic adjustable knee extension only device, includes soft interface material |
| E1814 | Adjust knee flexion device | Description: Dynamic adjustable knee flexion only device, includes soft interface material |
| E1815 | Adjust ankle ext & flex dev | Description: Dynamic adjustable ankle extension and flexion device, includes soft interface material |
| E1822 | Adjust ankle extension dev | Description: Dynamic adjustable ankle extension only device, includes soft interface material |
| E1823 | Adjust ankle flexion device | Description: Dynamic adjustable ankle flexion only device, includes soft interface material |
| E1825 | Adjust finger ext & flex dev | Description: Dynamic adjustable finger extension and flexion device, includes soft interface material |
| E1826 | Adjust finger extension dev | Description: Dynamic adjustable finger extension only device, includes soft interface material |
| E1827 | Adjust finger flexion device | Description: Dynamic adjustable finger flexion only device, includes soft interface material |
| E1828 | Adjust toe extension device | Description: Dynamic adjustable toe extension only device, includes soft interface material |
| E1829 | Adjust toe flexion device | Description: Dynamic adjustable toe flexion only device, includes soft interface material |
| E1830 | Adjust toe ext & flex device | Description: Dynamic adjustable toe extension and flexion device, includes soft interface material |
| G0532 | Take home supp nasal spray | Description: Take-home supply of nasal nalmefene hydrochloride; one carton of two, 2.7 mg per 0.1 ml nasal sprays (provision of the services by a medicare-enrolled opioid treatment program);( list separately in addition to each primary code) |
| G0533 | Buprenorphone inj weekly | Description: Medication assisted treatment, buprenorphine (injectable) administered on a weekly basis; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) |
| G0534 | Coordinated care/or referral | Description: Coordinated care and/or referral services, such as to adequate and accessible community resources to address unmet health-related social needs, including harm reduction interventions and recovery support services a patient needs and wishes to pursue, which significantly limit the ability to diagnose or treat an opioid use disorder; each additional 30 minutes of services (provision of the services by a medicare-enrolled opioid treatment program); (list separately in addition to each primary code) |
| G0535 | Pt navigat svs direct/ref | Description: Patient navigational services, provided directly or by referral; including helping the patient to navigate health systems and identify care providers and supportive services, to build patient self-advocacy and communication skills with care providers, and to promote patient-driven action plans and goals; each additional 30 minutes of services (provision of the services by a medicare-enrolled opioid treatment program); (list separately in addition to each primary code) |
| G0536 | Peer recover support svs | Description: Peer recovery support services, provided directly or by referral; including leveraging knowledge of the condition or lived experience to provide support, mentorship, or inspiration to meet oud treatment and recovery goals; conducting a person-centered interview to understand the patient's life story, strengths, needs, goals, preferences, and desired outcomes; developing and proposing strategies to help meet person-centered treatment goals; assisting the patient in locating or navigating recovery support services; each additional 30 minutes of services (provision of the services by a medicare-enrolled opioid treatment program); (list separately in addition to each primary code) |
| G0537 | Risk ascvd tst once pr 12 mo | Description: Administration of a standardized, evidence-based atherosclerotic cardiovascular disease (ascvd) risk assessment, 5-15 minutes, not more often than every 12 months |
| G0538 | Ascvd rsk mng clin stf pr mo | Description: Atherosclerotic cardiovascular disease (ascvd) risk management services; clinical staff time; per calendar month |
| G0539 | Initial care training 30 m | Description: Caregiver training in behavior management/modification for caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face-to-face; initial 30 minutes |
| G0540 | Train for caregiver add 15 | Description: Caregiver training in behavior management/modification for parent(s)/guardian(s)/caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face-to-face; each additional 15 minutes |
| G0541 | No pt prsnt train initial 30 | Description: Caregiver training in direct care strategies and techniques to support care for patients with an ongoing condition or illness and to reduce complications (including, but not limited to, techniques to prevent decubitus ulcer formation, wound care, and infection control) (without the patient present), face-to-face; initial 30 minutes |
| G0542 | No pt prsnt train add 15 | Description: Caregiver training in direct care strategies and techniques to support care for patients with an ongoing condition or illness and to reduce complications (including, but not limited to, techniques to prevent decubitus ulcer formation, wound care, and infection control) (without the patient present), face-to-face; each additional 15 minutes (list separately in addition to code for primary service) (use g0542 in conjunction with g0541) |
| G0543 | Group train w/o patient | Description: Group caregiver training in direct care strategies and techniques to support care for patients with an ongoing condition or illness and to reduce complications (including, but not limited to, techniques to prevent decubitus ulcer formation, wound care, and infection control) (without the patient present), face-to-face with multiple sets of caregivers |
| G0544 | Post d/c phone follow up | Description: Post discharge telephonic follow-up contacts performed in conjunction with a discharge from the emergency department for behavioral health or other crisis encounter, 4 calls per calendar month |
| G0545 | Inherent visit to inpt | Description: Visit complexity inherent to hospital inpatient or observation care associated with a confirmed or suspected infectious disease by an infectious diseases specialist, including disease transmission risk assessment and mitigation, public health investigation, analysis, and testing, and complex antimicrobial therapy counseling and treatment (add-on code, list separately in addition to hospital inpatient or observation evaluation and management visit, initial, same day discharge, subsequent or discharge) |
| G0546 | Phone/internet ehr assess | Description: Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, including a verbal and written report to the patient's treating/requesting practitioner; 5-10 minutes of medical consultative discussion and review |
| G0547 | Phone/internet svs 11-20 m | Description: Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, including a verbal and written report to the patient's treating/requesting practitioner; 11-20 minutes of medical consultative discussion and review |
| G0548 | Phone/inter svs 21-30 m | Description: Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, including a verbal and written report to the patient's treating/requesting practitioner; 21-30 minutes of medical consultative discussion and review |
| G0549 | Phone/inter for treat>31m | Description: Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, including a verbal and written report to the patient's treating/requesting practitioner; 31 or more minutes of medical consultative discussion and review |
| G0550 | Phone/inter for dx/treat >5m | Description: Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, including a written report to the patient's treating/requesting practitioner, 5 minutes or more of medical consultative time |
| G0551 | Phn/intr svs fr dx treat 30m | Description: Interprofessional telephone/internet/electronic health record referral service(s) provided by a treating/requesting practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, 30 minutes |
| G0552 | Supply of digital device | Description: Supply of digital mental health treatment device and initial education and onboarding, per course of treatment that augments a behavioral therapy plan |
| G0553 | Monthly tx for dmht 20mins | Description: First 20 minutes of monthly treatment management services directly related to the patient's therapeutic use of the digital mental health treatment (dmht) device that augments a behavioral therapy plan, physician/other qualified health care professional time reviewing information related to the use of the dmht device, including patient observations and patient specific inputs in a calendar month and requiring at least one interactive communication with the patient/caregiver during the calendar month |
| G0554 | Add 20 m of monthly tx | Description: Each additional 20 minutes of monthly treatment management services directly related to the patient's therapeutic use of the digital mental health treatment (dmht) device that augments a behavioral therapy plan, physician/other qualified health care professional time reviewing data generated from the dmht device from patient observations and patient specific inputs in a calendar month and requiring at least one interactive communication with the patient/caregiver during the calendar month |
| G0555 | Replacment pt electronic sys | Description: Provision of replacement patient electronics system (e.g., system pillow, handheld reader) for home pulmonary artery pressure monitoring |
| G0556 | Adv prim care mgmt lvl 1 | Description: Advanced primary care management services for a patient with one chronic condition [expected to last at least 12 months, or until the death of the patient, which place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline], or fewer, provided by clinical staff and directed by a physician or other qualified health care professional who is responsible for all primary care and serves as the continuing focal point for all needed health care services, per calendar month, with the following elements, as appropriate: consent; ++ inform the patient of the availability of the service; that only one practitioner can furnish and be paid for the service during a calendar month; of the right to stop the services at any time (effective at the end of the calendar month); and that cost sharing may apply. ++ document in patient's medical record that consent was obtained. initiation during a qualifying visit for new patients or patients not seen within 3 years; provide 24/7 access for urgent needs to care team/practitioner, including providing patients/caregivers with a way to contact health care professionals in the practice to discuss urgent needs regardless of the time of day or day of week; continuity of care with a designated member of the care team with whom the patient is able to schedule successive routine appointments; deliver care in alternative ways to traditional office visits to best meet the patient's needs, such as home visits and/or expanded hours; overall comprehensive care management; ++ systematic needs assessment (medical and psychosocial). ++ system-based approaches to ensure receipt of preventive services. ++ medication reconciliation, management and oversight of self-management. development, implementation, revision, and maintenance of an electronic patient-centered comprehensive care plan with typical care plan elements when clinically relevant; ++ care plan is available timely within and outside the billing practice as appropriate to individuals involved in the beneficiary's care, can be routinely accessed and updated by care team/practitioner, and copy of care plan to patient/caregiver; coordination of care transitions between and among health care providers and settings, including referrals to other clinicians and follow-up after an emergency department visit and discharges from hospitals, skilled nursing facilities or other health care facilities as applicable; ++ ensure timely exchange of electronic health information with other practitioners and providers to support continuity of care. ++ ensure timely follow-up communication (direct contact, telephone, electronic) with the patient and/or caregiver after an emergency department visit and discharges from hospitals, skilled nursing facilities, or other health care facilities, within 7 calendar days of discharge, as clinically indicated. ongoing communication and coordinating receipt of needed services from practitioners, home- and community-based service providers, community-based social service providers, hospitals, and skilled nursing facilities (or other health care facilities), and document communication regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors, in the patient's medical record; enhanced opportunities for the beneficiary and any caregiver to communicate with the care team/practitioner regarding the beneficiary's care through the use of asynchronous non-face-to-face consultation methods other than telephone, such as secure messaging, email, internet, or patient portal, and other communication-technology based services, including remote evaluation of pre-recorded patient information and interprofessional telephone/internet/ehr referral service(s), to maintain ongoing communication with patients, as appropriate; ++ ensure access to patient-initiated digital communications that require a clinical decision, such as virtual check-ins and digital online assessment and management and e/m visits (or e-visits). analyze patient population data to identify gaps in care and offer additional interventions, as appropriate; risk stratify the practice population based on defined diagnoses, claims, or other electronic data to identify and target services to patients; be assessed through performance measurement of primary care quality, total cost of care, and meaningful use of certified ehr technology |
| G0557 | Adv prim care mgmt lvl 2 | Description: Advanced primary care management services for a patient with multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, which place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, provided by clinical staff and directed by a physician or other qualified health care professional who is responsible for all primary care and serves as the continuing focal point for all needed health care services, per calendar month, with the following elements, as appropriate: consent; ++ inform the patient of the availability of the service; that only one practitioner can furnish and be paid for the service during a calendar month; of the right to stop the services at any time (effective at the end of the calendar month); and that cost sharing may apply. ++ document in patient's medical record that consent was obtained. initiation during a qualifying visit for new patients or patients not seen within 3 years; provide 24/7 access for urgent needs to care team/practitioner, including providing patients/caregivers with a way to contact health care professionals in the practice to discuss urgent needs regardless of the time of day or day of week; continuity of care with a designated member of the care team with whom the patient is able to schedule successive routine appointments; deliver care in alternative ways to traditional office visits to best meet the patient's needs, such as home visits and/or expanded hours; overall comprehensive care management; ++ systematic needs assessment (medical and psychosocial). ++ system-based approaches to ensure receipt of preventive services. ++ medication reconciliation, management and oversight of self-management. development, implementation, revision, and maintenance of an electronic patient-centered comprehensive care plan; ++ care plan is available timely within and outside the billing practice as appropriate to individuals involved in the beneficiary's care, can be routinely accessed and updated by care team/practitioner, and copy of care plan to patient/caregiver; coordination of care transitions between and among health care providers and settings, including referrals to other clinicians and follow-up after an emergency department visit and discharges from hospitals, skilled nursing facilities or other health care facilities as applicable; ++ ensure timely exchange of electronic health information with other practitioners and providers to support continuity of care. ++ ensure timely follow-up communication (direct contact, telephone, electronic) with the patient and/or caregiver after an emergency department visit and discharges from hospitals, skilled nursing facilities, or other health care facilities, within 7 calendar days of discharge, as clinically indicated. ongoing communication and coordinating receipt of needed services from practitioners, home- and community-based service providers, community-based social service providers, hospitals, and skilled nursing facilities (or other health care facilities), and document communication regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors, in the patient's medical record; enhanced opportunities for the beneficiary and any caregiver to communicate with the care team/practitioner regarding the beneficiary's care through the use of asynchronous non-face-to-face consultation methods other than telephone, such as secure messaging, email, internet, or patient portal, and other communication-technology based services, including remote evaluation of pre-recorded patient information and interprofessional telephone/internet/ehr referral service(s), to maintain ongoing communication with patients, as appropriate; ++ ensure access to patient-initiated digital communications that require a clinical decision, such as virtual check-ins and digital online assessment and management and e/m visits (or e-visits). analyze patient population data to identify gaps in care and offer additional interventions, as appropriate; risk stratify the practice population based on defined diagnoses, claims, or other electronic data to identify and target services to patients; be assessed through performance measurement of primary care quality, total cost of care, and meaningful use of certified ehr technology |
| G0558 | Adv prim care mgmt lvl 3 | Description: Advanced primary care management services for a patient that is a qualified medicare beneficiary with multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, which place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, provided by clinical staff and directed by a physician or other qualified health care professional who is responsible for all primary care and serves as the continuing focal point for all needed health care services, per calendar month, with the following elements, as appropriate: consent; ++ inform the patient of the availability of the service; that only one practitioner can furnish and be paid for the service during a calendar month; of the right to stop the services at any time (effective at the end of the calendar month); and that cost sharing may apply. ++ document in patient's medical record that consent was obtained. initiation during a qualifying visit for new patients or patients not seen within 3 years; provide 24/7 access for urgent needs to care team/practitioner, including providing patients/caregivers with a way to contact health care professionals in the practice to discuss urgent needs regardless of the time of day or day of week; continuity of care with a designated member of the care team with whom the patient is able to schedule successive routine appointments; deliver care in alternative ways to traditional office visits to best meet the patient's needs, such as home visits and/or expanded hours; overall comprehensive care management; ++ systematic needs assessment (medical and psychosocial). ++ system-based approaches to ensure receipt of preventive services. ++ medication reconciliation, management and oversight of self-management. development, implementation, revision, and maintenance of an electronic patient-centered comprehensive care plan; ++ care plan is available timely within and outside the billing practice as appropriate to individuals involved in the beneficiary's care, can be routinely accessed and updated by care team/practitioner, and copy of care plan to patient/caregiver; coordination of care transitions between and among health care providers and settings, including referrals to other clinicians and follow-up after an emergency department visit and discharges from hospitals, skilled nursing facilities or other health care facilities as applicable; ++ ensure timely exchange of electronic health information with other practitioners and providers to support continuity of care. ++ ensure timely follow-up communication (direct contact, telephone, electronic) with the patient and/or caregiver after an emergency department visit and discharges from hospitals, skilled nursing facilities, or other health care facilities, within 7 calendar days of discharge, as clinically indicated. ongoing communication and coordinating receipt of needed services from practitioners, home- and community-based service providers, community-based social service providers, hospitals, and skilled nursing facilities (or other health care facilities), and document communication regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors, in the patient's medical record; enhanced opportunities for the beneficiary and any caregiver to communicate with the care team/practitioner regarding the beneficiary's care through the use of asynchronous non-face-to-face consultation methods other than telephone, such as secure messaging, email, internet, or patient portal, and other communication-technology based services, including remote evaluation of pre-recorded patient information and interprofessional telephone/internet/ehr referral service(s), to maintain ongoing communication with patients, as appropriate; ++ ensure access to patient-initiated digital communications that require a clinical decision, such as virtual check-ins and digital online assessment and management and e/m visits (or e-visits). analyze patient population data to identify gaps in care and offer additional interventions, as appropriate; risk stratify the practice population based on defined diagnoses, claims, or other electronic data to identify and target services to patients; be assessed through performance measurement of primary care quality, total cost of care, and meaningful use of certified ehr technology |
| G0559 | Unrelat prac follow up visit | Description: Post-operative follow-up visit complexity inherent to evaluation and management services addressing surgical procedure(s), provided by a physician or qualified health care professional who is not the practitioner who performed the procedure (or in the same group practice) and is of the same or of a different specialty than the practitioner who performed the procedure, within the 90-day global period of the procedure(s), once per 90-day global period, when there has not been a formal transfer of care and requires the following required elements, when possible and applicable: reading available surgical note to understand the relative success of the procedure, the anatomy that was affected, and potential complications that could have arisen due to the unique circumstances of the patient's operation. research the procedure to determine expected post-operative course and potential complications (in the case of doing a post-op for a procedure outside the specialty). evaluate and physically examine the patient to determine whether the post-operative course is progressing appropriately. communicate with the practitioner who performed the procedure if any questions or concerns arise. (list separately in addition to office/outpatient evaluation and management visit, new or established) |
| G0560 | Safety plan interven | Description: Safety planning interventions, each 20 minutes personally performed by the billing practitioner, including assisting the patient in the identification of the following personalized elements of a safety plan: recognizing warning signs of an impending suicidal or substance use-related crisis; employing internal coping strategies; utilizing social contacts and social settings as a means of distraction from suicidal thoughts or risky substance use; utilizing family members, significant others, caregivers, and/or friends to help resolve the crisis; contacting mental health or substance use disorder professionals or agencies; and making the environment safe |
| G0561 | Temp tube delivery, unil | Description: Tympanostomy with local or topical anesthesia and insertion of a ventilating tube when performed with tympanostomy tube delivery device, unilateral (list separately in addition to 69433) (do not use in conjunction with 0583t) |
| G0562 | Complex simulation w/pet-ct | Description: Therapeutic radiology simulation-aided field setting; complex, including acquisition of pet and ct imaging data required for radiopharmaceutical-directed radiation therapy treatment planning (i.e., modeling) |
| G0563 | Sbrt w/positron emission del | Description: Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance and real-time positron emissions-based delivery adjustments to 1 or more lesions, entire course not to exceed 5 fractions |
| G2069 | Med assist tx inject | Description: Medication assisted treatment, buprenorphine (injectable) administered on a monthly basis; bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) |
| G2076 | Intake act w/med exam | Description: Intake activities, including initial medical examination that is conducted by an appropriately licensed practitioner and preparation of a care plan, which may be informed by administration of a standardized, evidence-based social determinants of health risk assessment to identify unmet health-related social needs, and that includes the patient's goals and mutually agreed-upon actions for the patient to meet those goals, including harm reduction interventions; the patient's needs and goals in the areas of education, vocational training, and employment; and the medical and psychiatric, psychosocial, economic, legal, housing, and other recovery support services that a patient needs and wishes to pursue, conducted by an appropriately licensed/credentialed personnel (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to each primary code |
| G2077 | Periodic assessment | Description: Periodic assessment; assessing periodically by an otp practitioner and includes a review of moud dosing, treatment response, other substance use disorder treatment needs, responses and patient-identified goals, and other relevant physical and psychiatric treatment needs and goals; assessment may be informed by administration of a standardized, evidence-based social determinants of health risk assessment to identify unmet health-related social needs, or the need and interest for harm reduction interventions and recovery support services (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to each primary code |
| G2091 | Pt 66+ frailty and adv ill | Description: Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period |
| G2099 | Pt 66+ frailty and adv ill | Description: Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period |
| G2101 | Pt 66+ frailty and adv ill | Description: Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period |
| G2107 | Pt 66+ frailty and adv ill | Description: Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period |
| G2116 | Pt 66-80 frailty and adv ill | Description: Patients 66 - 80 years of age with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period |
| G2126 | Pt 66-80 frailty and adv ill | Description: Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period |
| G8577 | Reop req bld grft oth | Description: Re-exploration required due to mediastinal bleeding with or without tamponade, unplanned coronary artery intervention (native, vessel, graft, or both), valve dysfunction, aortic reintervention, or other cardiac reason |
| G8578 | No reop req bld grft oth | Description: Re-exploration not required due to mediastinal bleeding with or without tamponade, unplanned coronary artery intervention (native, vessel, graft, or both), valve dysfunction, aortic reintervention, or other cardiac reason |
| G8694 | Lvef <=40% | Description: Current or prior left ventricular ejection fraction (lvef) < = 40% or documentation of moderate or severe lvsd |
| G8842 | Ahi rdi rei doc win 2mo | Description: Apnea hypopnea index (ahi), respiratory disturbance index (rdi) or respiratory event index (rei) documented or measured within 2 months after initial evaluation for suspected obstructive sleep apnea |
| G8843 | Doc reas no ahi rdi rei | Description: Documentation of reason(s) for not measuring an apnea hypopnea index (ahi), a respiratory disturbance index (rdi), or a respiratory event index (rei) within 2 months after initial evaluation for suspected obstructive sleep apnea (e.g., medical, neurological, or psychiatric disease that prohibits successful completion of a sleep study, patients for whom a sleep study would present a bigger risk than benefit or would pose an undue burden, dementia, patients previously diagnosed with osa and severity assessed by another provider, patients who decline ahi/rdi/rei measurement, patients who had a financial reason for not completing testing, test was ordered but not completed, patients decline because their insurance (payer) does not cover the expense) |
| G8844 | No ahi rdi rei ini dx no rsn | Description: Apnea hypopnea index (ahi), respiratory disturbance index (rdi), or respiratory event index (rei) not documented or measured within 2 months after initial evaluation for suspected obstructive sleep apnea, reason not given |
| G8923 | Lvef <= 40% or lvsd | Description: Current or prior left ventricular ejection fraction (lvef) <= 40% or documentation of moderately or severely depressed left ventricular systolic function |
| G8934 | Lvef <=40% or dep lv sys fcn | Description: Current or prior left ventricular ejection fraction (lvef) <=40% or documentation of moderately or severely depressed left ventricular systolic function |
| G9246 | No enc or enc/vir ld 90days | Description: Patient did not have two eligible encounters at least 90 days apart or one eligible encounter and one hiv viral load test at least 90 days apart |
| G9247 | 2 enc enc/vir ld 90d | Description: Patient had two eligible encounters at least 90 days apart or one eligible encounter and one hiv viral load test at least 90 days apart |
| G9254 | Doc pt dischg >2d | Description: Documentation of patient discharged to home later than post-operative day 2 following cea or cas |
| G9255 | Pt dc home 2nd po day | Description: Documentation of patient discharged to home no later than post operative day 2 following cea or cas |
| G9321 | Prev ct nuc med cnt doc 12mo | Description: Count of previous ct (any type of ct) and cardiac nuclear medicine (myocardial perfusion or infarct avid imaging) studies documented in the 12-month period prior to the current study |
| G9322 | No cnt ct nuc med doc 12mo | Description: Count of previous ct and cardiac nuclear medicine (myocardial perfusion or infarct avid imaging) studies not documented in the 12-month period prior to the current study, reason not given |
| G9659 | >=86y scr colo nomed rsn | Description: Patients greater than or equal to 86 years of age who underwent a screening colonoscopy and did not have a history of colorectal cancer or other valid medical reason for the colonoscopy, including: iron deficiency anemia, lower gastrointestinal bleeding, familial adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease (i.e., crohn's disease or ulcerative colitis), abnormal finding of gastrointestinal tract, weight loss, or changes in bowel habits |
| G9660 | Doc med rsn colo pt >= 86y | Description: Documentation of medical reason(s) for a colonoscopy performed on a patient greater than or equal to 86 years of age (e.g., iron deficiency anemia, lower gastrointestinal bleeding, familial history of adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease (i.e., crohn's disease or ulcerative colitis), abnormal finding of gastrointestinal tract, weight loss, or changes in bowel habits) |
| G9999 | Doc sys rsn <3 colon | Description: Documentation of system reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., unable to locate previous colonoscopy report, patient cannot provide precise date or details from previous colonoscopy, previous colonoscopy report was incomplete) |
| H0052 | Mmip mental health and care | Description: Missing and murdered indigenous persons (mmip) mental health and clinical care |
| H0053 | Ht mental health and care | Description: Historical trauma (ht) mental health and clinical care for indigenous persons |
| J0138 | Inj acetaminoph 10mg/ibu 3mg | Description: Injection, acetaminophen 10 mg and ibuprofen 3 mg |
| J0139 | Inj, adalimumab, 1 mg | Description: Injection, adalimumab, 1 mg |
| J0601 | Sevelamer carbonate 20 mg | Description: Sevelamer carbonate (renvela or therapeutically equivalent), oral, 20 mg (for esrd on dialysis) |
| J0602 | Sevelamer carbonate pdr 20mg | Description: Sevelamer carbonate (renvela or therapeutically equivalent), oral, powder, 20 mg (for esrd on dialysis) |
| J0603 | Sevelamer hydrochloride 20mg | Description: Sevelamer hydrochloride (renagel or therapeutically equivalent), oral, 20 mg (for esrd on dialysis) |
| J0605 | Sucroferric oxyhydroxide 5mg | Description: Sucroferric oxyhydroxide, oral, 5 mg (for esrd on dialysis) |
| J0607 | Lanthanum carbonate oral 5mg | Description: Lanthanum carbonate, oral, 5 mg (for esrd on dialysis) |
| J0608 | Lanthanum carbonate pwdr 5mg | Description: Lanthanum carbonate, oral, powder, 5 mg, not therapeutically equivalent to j0607 (for esrd on dialysis) |
| J0609 | Ferric citrate orl 3 mg iron | Description: Ferric citrate, oral, 3 mg ferric iron, (for esrd on dialysis) |
| J0615 | Calcium acetate, oral, 23 mg | Description: Calcium acetate, oral, 23 mg (for esrd on dialysis) |
| J0666 | Inj, bupivacaine liposome | Description: Injection, bupivacaine liposome, 1 mg |
| J0870 | Injection, imetelstat, 1 mg | Description: Injection, imetelstat, 1 mg |
| J0901 | Vadadustat oral 1mg for esrd | Description: Vadadustat, oral, 1 mg (for esrd on dialysis) |
| J1307 | Inj, crovalimab-akkz, 10 mg | Description: Injection, crovalimab-akkz, 10 mg |
| J1414 | Inj, beqvez, per tx dose | Description: Injection, fidanacogene elaparvovec-dzkt, per therapeutic dose |
| J1552 | Inj, alyglo, 500 mg | Description: Injection, immune globulin (alyglo), 500 mg |
| J2290 | Inj, nafcillin sodium, 20 mg | Description: Injection, nafcillin sodium, 20 mg |
| J2468 | Inj, palonosetron (posfrea) | Description: Injection, palonosetron hydrochloride (posfrea), 25 micrograms |
| J2472 | Inj, pantoprazole sodium chl | Description: Injection, pantoprazole sodium in sodium chloride (baxter), 40 mg |
| J2802 | Inj, romiplostim 1 microgram | Description: Injection, romiplostim, 1 microgram |
| J3392 | Inj, exagamglogene autotem | Description: Injection, exagamglogene autotemcel, per treatment |
| J7514 | Mycophenol (myhibbin) 100 mg | Description: Mycophenolate mofetil (myhibbin), oral suspension, 100 mg |
| J7601 | Ensifentrine inh 3 mg | Description: Ensifentrine, inhalation suspension, fda approved final product, non-compounded, administered through dme, unit dose form, 3 mg |
| J9026 | Inj, tarlatamab-dlle, 1 mg | Description: Injection, tarlatamab-dlle, 1 mg |
| J9028 | Inj, nogapendekin pmln, 1mcg | Description: Injection, nogapendekin alfa inbakicept-pmln, for intravesical use, 1 microgram |
| J9033 | Inj, bendamustine hcl, 1mg | Description: Injection, bendamustine hydrochloride, 1 mg |
| J9056 | Inj, vivimusta, 1 mg | Description: Injection, bendamustine hydrochloride (vivimusta), 1 mg |
| J9072 | Inj cyclophos avyxa 5mg | Description: Injection, cyclophosphamide (avyxa), 5 mg |
| J9076 | Inj, cyclophos (baxter) 5mg | Description: Injection, cyclophosphamide (baxter), 5 mg |
| J9292 | Inj, pemetrexed (avyxa) 10mg | Description: Injection, pemetrexed (avyxa), not therapeutically equivalent to j9305, 10 mg |
| M0004 | Qual care neurologic cnd mvp | Description: Quality care for patients with neurological conditions mips value pathway |
| M1150 | Lvef <=40% or mod/sev l vsf | Description: Current or prior left ventricular ejection fraction (lvef) less than or equal to 40% or documentation of moderately or severely depressed left ventricular systolic function |
| M1176 | No 2 hzv on/aft age 50 | Description: Patient did not receive 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 |
| M1177 | Pt recd pcv on/aft 19 | Description: Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period |
| M1179 | No pcv recd | Description: Patient did not receive any pneumococcal conjugate or polysaccharide vaccine, on or after their 19th birthday and before or during measurement period |
| M1211 | Gsa level>9.0% | Description: Most recent glycemic status assessment (hba1c or gmi) level > 9.0% |
| M1212 | Missing gsa not perf | Description: Glycemic status assessment (hba1c or gmi) level is missing, or was not performed during the measurement period |
| M1259 | Pt stat doc <= 1 yr dialysis | Description: Patient status documented within the first year of initiating dialysis |
| M1260 | Pt not doc <= 1 yr dialysis | Description: Patient status not documented within the first year of initiating dialysis |
| M1267 | Pt no act kid transplt wtlst | Description: Patients not observed in active status on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period |
| M1268 | Pt ac stat kid trnsplt wtlst | Description: Patients observed in active status on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period |
| M1272 | Pts kid transplt wtlst | Description: Patients observed on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period |
| M1292 | Pt 66+ frail inpt adv ill | Description: Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period |
| M1343 | Pt pam lvl 4 base or srt lin | Description: Patients who are at pam level 4 at baseline or patients who are flagged with extreme straight line response sets on the pam or with excessive missing responses |
| M1344 | No bsln/2nd pam score 4-12mo | Description: Patients who did not have a baseline pam score and/or a second score within 4 to 12 months of baseline pam score |
| M1345 | Pt bsln pam, 2nd scr 4-12 mo | Description: Patients who had a baseline pam score and a second score within 4 to 12 month of baseline pam score |
| M1346 | No pam inc 6 pts 4-12 mo | Description: Patients who did not have a net increase in pam score of at least 6 points within a 4 to 12 month period |
| M1347 | Pt pam incr 3 pt 4-12 mo | Description: Patients who achieved a net increase in pam score of at least 3 points in a 4 to 12 month period (passing) |
| M1348 | Pam incr 6 pt 4-12 mo | Description: Patients who achieved a net increase in pam score of at least 6-points in a 4 to 12 month period (excellent) |
| M1349 | No pam inc 3 pts 4-12 mo | Description: Patients who did not have a net increase in pam score of at least 3 points within a 4 to 12 month period |
| M1371 | Mst rec gsa<7 | Description: Most recent glycemic status assessment (hba1c or gmi) level < 7.0% |
| M1372 | Mst rec gsa >=7 and<8 | Description: Most recent glycemic status assessment (hba1c or gmi) level >= 7.0% and < 8.0% |
| M1373 | Mst rec gsa >=8 and <=9 | Description: Most recent glycemic status assessment (hba1c or gmi) level >= 8.0% and <= 9.0% |
| M1374 | Ra dx enc 90 days dur per pd | Description: An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis during the performance period |
| M1375 | Ra dx enc 90 days dur per pd | Description: An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis during the performance period |
| M1376 | Ra dx enc 90 days dur per pd | Description: An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis during the performance period |
| M1377 | Fu colscop 10 yr doc w/ disc | Description: Recommended follow-up interval for repeat colonoscopy of 10 years documented in colonoscopy report and communicated with patient |
| M1378 | Med rsn no 10 yr fu colscope | Description: Documentation of medical reason(s) for not recommending a 10 year follow-up interval (e.g., inadequate prep, familial or personal history of colonic polyps, patient had no adenoma and age is >= 66 years old, or life expectancy < 10 years, other medical reasons) |
| M1379 | 10 yr fu no rec rsn not giv | Description: A 10 year follow-up interval for colonoscopy not recommended, reason not otherwise specified |
| M1380 | 2 rx in perf pd any com meds | Description: Filled at least two prescriptions during the performance period for any combination of the qualifying oral antipsychotic medications listed under 'denominator note' or the long-acting injectable antipsychotic medications listed under 'denominator note' |
| M1381 | Pt sec strk wthin 5 days | Description: Patients with secondary stroke (e.g., a subsequent stroke that may occur with vasospasm in the setting of subarachnoid hemorrhage) within 5 days of the initial procedure |
| M1382 | Enc dur perf pd pos 11 | Description: Patient encounter during the performance period with place of service code 11 |
| M1383 | Acute pvd | Description: Acute pvd |
| M1384 | Pt died dur perf pd | Description: Patients who died during the performance period |
| M1385 | Pt rsn not seen 2nd pam | Description: Documentation of patient reasons for patients who were not seen for the second pam survey (e.g., less than four months between baseline pam assessment and follow-up |
| M1386 | Exc sx melmn or mlnm is | Description: Patients with an excisional surgery for melanoma or melanoma in situ in the past 5 years with an initial ajcc staging of 0, i, or ii at the start of the performance period |
| M1387 | Pt died dur perf pd | Description: Patients who died during the performance period |
| M1388 | Pt doc exm rec melmn | Description: Patients with documentation of an exam performed for recurrence of melanoma |
| M1389 | Pt rsn no exm | Description: Documentation of patient reasons for no examination i.e., refusal of examination or lost to follow-up (documentation must include information that the clinician was unable to reach the patient by phone, mail or secure electronic mail - at least one method must be documented) |
| M1390 | Pt no doc exm for rec | Description: Patients who do not have a documented exam performed for recurrence of melanoma or no documentation within the performance period |
| M1391 | All pt dx w/ rec mlnm | Description: All patients who were diagnosed with recurrent melanoma during the current performance period |
| M1392 | Pt rsn no exm or lst to fu | Description: Documentation of patient reasons for no examination, i.e., refusal of examination or lost to follow-up (documentation must include information that the clinician was unable to reach the patient by phone, mail or secure electronic mail - at least one method must be documented) |
| M1393 | Pr no dx rec mlnm | Description: Patients who were not diagnosed with recurrent melanoma during the current performance period |
| M1394 | Stg i-iii br ca | Description: Stages i-iii breast cancer |
| M1395 | Init chemo w/def dur ec grp | Description: Patients receiving an initial chemotherapy regimen with a defined duration with the eligible clinician or group |
| M1396 | Pt ther clin trial | Description: Patients on a therapeutic clinical trial |
| M1397 | Pt w/ recur/prog | Description: Patients with recurrence/disease progression |
| M1398 | Bslne and fu promis doc | Description: Patients with baseline and follow-up promis surveys documented in the medical record |
| M1399 | Pt lve prac | Description: Patients who leave the practice during the follow-up period |
| M1400 | Pt died dur perf pd | Description: Patients who died during the follow-up period |
| M1401 | Stg i-iii br ca | Description: Stages i-iii breast cancer |
| M1402 | Init chemo w/def dur ec grp | Description: Patients receiving an initial chemotherapy regimen with a defined duration with the eligible clinician or group |
| M1403 | Bslne and fu promis doc | Description: Patients with baseline and follow-up promis surveys documented in the medical record |
| M1404 | Pt ther clin trial | Description: Patients on a therapeutic clinical trial |
| M1405 | Pt w/ recur/prog | Description: Patients with recurrence/disease progression |
| M1406 | Pt lve prac | Description: Patients who leave the practice during the follow-up period |
| M1407 | Pt died dur perf pd | Description: Patients who died during the follow-up period |
| M1408 | Gmln brca bef dx ca | Description: Patients who have germline brca testing completed before diagnosis of epithelial ovarian, fallopian tube, or primary peritoneal cancer |
| M1409 | Recd gmln brca1/brca2 couns | Description: Patients who received germline testing for brca1 and brca2 or genetic counseling completed within 6 months of diagnosis |
| M1410 | No gmln brca1/brca2 couns | Description: Patients who did not have germline testing for brca1 and brca2 or genetic counseling completed within 6 months of diagnosis |
| M1411 | 1st ln ici no chemo | Description: Currently on first-line immune checkpoint inhibitors without chemotherapy |
| M1412 | Met nsclc w/ egfr alk oth ab | Description: Patients with metastatic nsclc with epidermal growth factor receptor (egfr) mutations, alk genomic tumor aberrations, or other targetable genomic abnormalities with approved first-line targeted therapy, such as nsclc with ros1 rearrangement, braf v600e mutation, ntrk 1/2/3 gene fusion, met ex14 skipping mutation, and ret rearrangement |
| M1413 | Pos pdl1 bef init ici tx | Description: Patients who had a positive pd-l1 biomarker expression test result prior to the initiation of first-line immune checkpoint inhibitor therapy |
| M1414 | Med rsn no pdl1 bef 1st ther | Description: Documentation of medical reason(s) for not performing the pd-l1 biomarker expression test prior to initiation of first-line immune checkpoint inhibitor therapy (e.g., patient is in an urgent or emergent situation where delay of treatment would jeopardize the patient's health status; other medical reasons/contraindication) |
| M1415 | No pos pdl1 bef ici ther | Description: Patients who did not have a positive pd-l1 biomarker expression test result prior to the initiation of first-line immune checkpoint inhibitor therapy |
| M1416 | Pt rec hosp | Description: Patient received hospice services any time during the performance period |
| M1417 | Pt up to date cov | Description: Patients who are up to date on their covid-19 vaccinations as defined by cdc recommendations on current vaccination |
| M1418 | Med rsn not up to date cov | Description: Patients who are not up to date on their covid-19 vaccinations as defined by cdc recommendations on current vaccination because of a medical contraindication documented by clinician |
| M1419 | Pt not up to date cov | Description: Patients who are not up to date on their covid-19 vaccinations as defined by cdc recommendations on current vaccination |
| M1420 | Complete ophthalmologic mvp | Description: Complete ophthalmologic care mips value pathway |
| M1421 | Dermatological care mvp | Description: Dermatological care mips value pathway |
| M1422 | Gastroenterology care mvp | Description: Gastroenterology care mips value pathway |
| M1423 | Opt care urologic cnd mvp | Description: Optimal care for patients with urologic conditions mips value pathway |
| M1424 | Pulmonology care mvp | Description: Pulmonology care mips value pathway |
| M1425 | Surgical care mvp | Description: Surgical care mips value pathway |
| Q0155 | Dronabinol (syndros) 0.1 mg | Description: Dronabinol (syndros), 0.1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen |
| Q0521 | Supply fee hiv prep fda appr | Description: Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription |
| Q4346 | Shelter dm matrix per sq cm | Description: Shelter dm matrix, per square centimeter |
| Q4347 | Rampart dl matrix per sq cm | Description: Rampart dl matrix, per square centimeter |
| Q4348 | Sentry sl matrix per sq cm | Description: Sentry sl matrix, per square centimeter |
| Q4349 | Mantle dl matrix per sq cm | Description: Mantle dl matrix, per square centimeter |
| Q4350 | Palisade dm matrix per sq cm | Description: Palisade dm matrix, per square centimeter |
| Q4351 | Enclose tl matrix, per sq cm | Description: Enclose tl matrix, per square centimeter |
| Q4352 | Overlay sl matrix, per sq cm | Description: Overlay sl matrix, per square centimeter |
| Q4353 | Xceed tl matrix per sq cm | Description: Xceed tl matrix, per square centimeter |
| Q5140 | Inj adalimumab-fkjp, 1 mg | Description: Injection, adalimumab-fkjp, biosimilar, 1 mg |
| Q5141 | Inj adalimumab-aaty, 1 mg | Description: Injection, adalimumab-aaty, biosimilar, 1 mg |
| Q5142 | Inj adalimumab-ryvk, 1 mg | Description: Injection, adalimumab-ryvk biosimilar, 1 mg |
| Q5143 | Inj adalimumab-adbm, 1 mg | Description: Injection, adalimumab-adbm, biosimilar, 1 mg |
| Q5144 | Inj, idacio, 1 mg | Description: Injection, adalimumab-aacf (idacio), biosimilar, 1 mg |
| Q5145 | Inj, abrilada, 1 mg | Description: Injection, adalimumab-afzb (abrilada), biosimilar, 1 mg |
| Q5146 | Inj, hercessi, 10 mg | Description: Injection, trastuzumab-strf (hercessi), biosimilar, 10 mg |
| Q9996 | Ustekinumab- ttwe sub cu inj | Description: Injection, ustekinumab-ttwe (pyzchiva), subcutaneous, 1 mg |
| Q9997 | Ustekinumab-ttwe iv inj 1 mg | Description: Injection, ustekinumab-ttwe (pyzchiva), intravenous, 1 mg |
| Q9998 | Ustekinumab-aekn inj | Description: Injection, ustekinumab-aekn (selarsdi), 1 mg |
| C7558 | Cor angio/vent w/drug admin | Description: Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography with pharmacologic agent administration (eg, inhaled nitric oxide, intravenous infusion of nitroprusside, dobutamine, milrinone, or other agent) including assessing hemodynamic measurements before, during, after and repeat pharmacologic agent administration, when performed |
| C9169 | Inj, nogapendekin pmln 1 mcg | Description: Injection, nogapendekin alfa inbakicept-pmln, for intravesical use, 1 microgram |
| C9170 | Inj, tarlatamab-dlle, 1 mg | Description: Injection, tarlatamab-dlle, 1 mg |
| C9171 | Inj, pegulicianine, 1 mg | Description: Injection, pegulicianine, 1 mg |
| C9172 | Inj, beqvez, per tx dose | Description: Injection, fidanacogene elaparvovec-dzkt, per therapeutic dose |
| C9290 | Inj, bupivacaine liposome | Description: Injection, bupivacaine liposome, 1 mg |
| C9734 | U/s trtmt, not leiomyomata | Description: Focused ultrasound ablation/therapeutic intervention, other than uterine leiomyomata, with magnetic resonance (mr) guidance |
| C9769 | Cysto w/temp pros implant | Description: Cystourethroscopy, with insertion of temporary prostatic implant/stent with fixation/anchor and incisional struts |
| C9786 | Echo cad for hf preserved ef | Description: Echocardiography image post processing for computer aided detection of heart failure with preserved ejection fraction, including interpretation and report |
| C9794 | Complex simulation w/pet-ct | Description: Therapeutic radiology simulation-aided field setting; complex, including acquisition of pet and ct imaging data required for radiopharmaceutical-directed radiation therapy treatment planning (i.e., modeling) |
| C9795 | Sbrt w/positron emission del | Description: Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance and real-time positron emissions-based delivery adjustments to 1 or more lesions, entire course not to exceed 5 fractions |
| G0106 | Colon ca screen;barium enema | Description: Colorectal cancer screening; alternative to g0104, screening sigmoidoscopy, barium enema |
| G0120 | Colon ca scrn; barium enema | Description: Colorectal cancer screening; alternative to g0105, screening colonoscopy, barium enema. |
| G0122 | Colon ca scrn; barium enema | Description: Colorectal cancer screening; barium enema |
| G2012 | Brief check in by md/qhp | Description: Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion |
| G2070 | Med assist tx implant | Description: Medication assisted treatment, buprenorphine (implant insertion); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) |
| G2071 | Med tx remove implant | Description: Medication assisted treatment, buprenorphine (implant removal); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) |
| G2072 | Med tx insert/remove imp | Description: Medication assisted treatment, buprenorphine (implant insertion and removal); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) |
| G8482 | Flu immunize order/admin | Description: Influenza immunization administered or previously received |
| G8483 | 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) |
| G8484 | Flu immunize no admin | Description: Influenza immunization was not administered, reason not given |
| G8965 | Csit perf on low chd rsk | Description: Cardiac stress imaging test primarily performed on low chd risk patient for initial detection and risk assessment |
| G8966 | Csit perf sx or high chd rsk | Description: Cardiac stress imaging test performed on symptomatic or higher than low chd risk patient or for any reason other than initial detection and risk assessment |
| G9402 | Recd f/u w/in 30d disch | Description: Patient received follow-up within 30 days after discharge |
| G9403 | Doc reas no 30 day f/u | Description: Clinician documented reason patient was not able to complete 30 day follow-up from acute inpatient setting discharge (e.g., patient death prior to follow-up visit, patient non-compliant for visit follow-up) |
| G9404 | No 30 day f/u | Description: Patient did not receive follow-up within 30 days after discharge |
| G9405 | Recd f/u w/in 7d dc | Description: Patient received follow-up within 7 days after discharge |
| G9406 | Doc reas no 7d f/u | Description: Clinician documented reason patient was not able to complete 7 day follow-up from acute inpatient setting discharge (i.e patient death prior to follow-up visit, patient non-compliance for visit follow-up) |
| G9407 | No 7d f/u | Description: Patient did not receive follow-up within 7 days after discharge |
| G9458 | Tob user recd cess interv | Description: Patient documented as tobacco user and received tobacco cessation intervention (must include at least one of the following: advice given to quit smoking or tobacco use, counseling on the benefits of quitting smoking or tobacco use, assistance with or referral to external smoking or tobacco cessation support programs, or current enrollment in smoking or tobacco use cessation program) if identified as a tobacco user |
| G9459 | Tob non-user | Description: Currently a tobacco non-user |
| G9460 | No tob assess or cess inter | Description: Tobacco assessment or tobacco cessation intervention not performed, reason not given |
| G9707 | Pt had hosp dur msmt per | Description: Patient received hospice services any time during the measurement period |
| G9751 | Pt died w/in 24 mos rpt time | Description: Patient died at any time during the 24-month measurement period |
| G9760 | Pt w/hosp anytime msmt per | Description: Patients who use hospice services any time during the measurement period |
| G9892 | Doc pt rsn no dil mac exam | Description: Documentation of patient reason(s) for not performing a dilated macular examination |
| G9893 | No mac exam | Description: Dilated macular exam was not performed, reason not otherwise specified |
| G9919 | Scrn nd pos nd prov of rec | Description: Screening performed and positive and provision of recommendations |
| G9920 | Scrning perf and negative | Description: Screening performed and negative |
| G9921 | No or part scrn nd rng or os | Description: No screening performed, partial screening performed or positive screen without recommendations and reason is not given or otherwise specified |
| G9974 | Mac exam perf | Description: Dilated macular exam performed, including documentation of the presence or absence of macular thickening or geographic atrophy or hemorrhage and the level of macular degeneration severity |
| G9975 | Doc med rsn no dil mac exam | Description: Documentation of medical reason(s) for not performing a dilated macular examination |
| G9990 | 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 |
| G9991 | 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 |
| J0135 | Adalimumab injection | Description: Injection, adalimumab, 20 mg |
| J0570 | Buprenorphine implant 74.2mg | Description: Buprenorphine implant, 74.2 mg |
| J2796 | Romiplostim injection | Description: Injection, romiplostim, 10 micrograms |
| J2806 | Inj sincalide, maia, 5 mcg | Description: Injection, sincalide (maia), not therapeutically equivalent to j2805, 5 micrograms |
| J9058 | Inj apotex/bendamustine 1 mg | Description: Injection, bendamustine hydrochloride (apotex), 1 mg |
| J9059 | Inj bendamustine, baxter 1mg | Description: Injection, bendamustine hydrochloride (baxter), 1 mg |
| J9259 | Paclitaxel (american regent) | Description: Injection, paclitaxel protein-bound particles (american regent), not therapeutically equivalent to j9264, 1 mg |
| M0003 | Opt care episod neuro mvp | Description: Optimal care for patients with episodic neurological conditions mips value pathways |
| M1154 | Hospc serv dur meas pd | Description: Hospice services provided to patient any time during the measurement period |
| M1155 | Pt anphx due to pneum | Description: Patient had anaphylaxis due to the pneumococcal vaccine any time during or before the measurement period |
| M1219 | Anphx due to vax | Description: Anaphylaxis due to the vaccine on or before the date of the encounter |
| M1264 | Pts 75+ dialysis dt | Description: Patients age 75 or older on their initiation of dialysis date |
| Q0516 | Supply fee hiv prep oral 30 | Description: Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription oral drug, per 30-days |
| Q0517 | Supply fee hiv prep oral 60 | Description: Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription oral drug, per 60-days |
| Q0518 | Supply fee hiv prep oral 90 | Description: Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription oral drug, per 90-days |
| Q0519 | Supply fee hiv prep inj 30 | Description: Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription injectable drug, per 30-days |
| Q0520 | Supply fee hiv prep inj 60 | Description: Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription injectable drug, per 60-days |
| Q5131 | Inj, idacio, 20 mg | Description: Injection, adalimumab-aacf (idacio), biosimilar, 20 mg |
| Q5132 | Inj, abrilada, 10 mg | Description: Injection, adalimumab-afzb (abrilada), biosimilar, 10 mg |
| A2030 | Miro3d fibers, per mg | Description: Miro3d fibers, per milligram |
| A2031 | Mirodry, per sq cm | Description: Mirodry wound matrix, per square centimeter |
| A2032 | Myriad matrix, per sq cm | Description: Myriad matrix, per square centimeter |
| A2033 | Myriad morcells, 4 mg | Description: Myriad morcells, 4 milligrams |
| A2034 | Found drs solo, per sq cm | Description: Foundation drs solo, per square centimeter |
| A2035 | Corpl p therac p allac p mg | Description: Corplex p or theracor p or allacor p, per milligram |
| A4453 | Rec cath any transanal, each | Description: Rectal catheter with or without balloon, for use with any type transanal irrigation system, each |
| A4459 | Transanal irrigation, any | Description: Manual transanal irrigation system, includes water reservoir, pump, tubing, and accessories, without catheter, any type |
| A4593 | Neuromod sti sys adj rehab | Description: Neuromodulation stimulator system, adjunct to rehabilitation therapy regime, controller |
| A6515 | Grad com wrap w str fu le cu | Description: Gradient compression wrap with adjustable straps, full leg, each, custom |
| A6516 | Grad com wrap w strap foo cu | Description: Gradient compression wrap with adjustable straps, foot, each, custom |
| A6517 | Grad com wrap w strap bn cus | Description: Gradient compression wrap with adjustable straps, below knee, each, custom |
| A6518 | Grad com wrap w strap arm cu | Description: Gradient compression wrap with adjustable straps, arm, each, custom |
| A6519 | Grad com garm noc night use | Description: Gradient compression garment, not otherwise specified, for nighttime use, each |
| A6549 | Grad com garm noc day use | Description: Gradient compression garment, not otherwise specified, for daytime use, each |
| A6583 | Grad com wrap w straps bk | Description: Gradient compression wrap with adjustable straps, below knee, each |
| A6585 | Grad com wrap w straps ak | Description: Gradient compression wrap with adjustable straps, above knee, each |
| A6586 | Grad com wrap w strap fu leg | Description: Gradient compression wrap with adjustable straps, full leg, each |
| A6587 | Grad com wrap w straps foot | Description: Gradient compression wrap with adjustable straps, foot, each |
| A6588 | Grad com wrap w strap arm | Description: Gradient compression wrap with adjustable straps, arm, each |
| A6611 | Grad com wrap w strap ak cus | Description: Gradient compression wrap with adjustable straps, above knee, each, custom |
| A9154 | Artificial saliva, 1 ml | Description: Artificial saliva, 1 ml |
| A9611 | Flurpiridaz f18, diag, 1 mci | Description: Flurpiridaz f 18, diagnostic, 1 millicurie |
| C1739 | Tissue marker, detectable | Description: Tissue marker, probe detectable any method (implantable), with delivery system |
| C8004 | Sim ang w/prs cath rad emb | Description: Simulation angiogram with use of a pressure-generating catheter (e.g., one-way valve, intermittently occluding), inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the angiogram, for subsequent therapeutic radioembolization of tumors |
| C8005 | Pef bronch ablt 3d nav ebus | Description: Bronchoscopy, rigid or flexible, non-thermal transbronchial ablation of lesion(s) by pulsed electric field (pef) energy, including fluoroscopic and/or ultrasound guidance, when performed, with computed tomography acquisition(s) and 3d rendering, computer-assisted, image-guided navigation, and endobronchial ultrasound (ebus) guided transtracheal and/or transbronchial sampling (e.g., aspiration[s]/biopsy[ies]) of all mediastinal and/or hilar lymph node stations or structures, and therapeutic intervention(s) |
| C9300 | Indigotindisulfonate, 1 mg | Description: Injection, indigotindisulfonate sodium, 1 mg |
| C9301 | Obecabtagene car pos t | Description: Obecabtagene autoleucel, up to 410 million cd19 car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose |
| C9302 | Inj zanidatamab, 2 mg | Description: Injection, zanidatamab-hrii, 2 mg |
| C9303 | Inj zolbetuximab, 1 mg | Description: Injection, zolbetuximab-clzb, 1 mg |
| C9304 | Inj marstacimab, 0.5 mg | Description: Injection, marstacimab-hncq, 0.5 mg |
| C9793 | Pre 3d mdl w/ccta and/or mri | Description: 3d predictive model generation for pre-planning of a cardiac procedure, using data from cardiac computed tomographic angiography and/or magnetic resonance imaging with report |
| E0201 | Penile contractur devic manu | Description: Penile contracture device, manual, greater than 3 lbs traction force |
| E1022 | Wheelchr transport secur | Description: Wheelchair transportation securement system, any type includes all components and accessories |
| E1023 | Wheelchr transit securement | Description: Wheelchair transit securement system, includes all components and accessories |
| E1028 | W/c manual swingaway | Description: Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
| E1032 | Wheelchair joystick drive | Description: Wheelchair accessory, manual swingaway, retractable or removable mounting hardware used with joystick or other drive control interface |
| E1033 | Wheelchair hardware headrest | Description: Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for headrest, cushioned, any type |
| E1034 | Wheelchair trunk hip support | Description: Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for lateral trunk or hip support, any type |
| E1801 | Sps/pass elbow device | Description: Static progressive stretch/patient actualized serial stretch elbow device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories |
| E1811 | Sps/pass knee device | Description: Static progressive stretch/patient actualized serial stretch knee device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories |
| E1816 | Sps/pass ankle device | Description: Static progressive stretch/patient actualized serial stretch ankle device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories |
| E1818 | Sps/pass forearm device | Description: Static progressive stretch/patient actualized serial stretch forearm pronation / supination device, with or without range of motion adjustment, includes all components and accessories |
| E1832 | Sps finger device | Description: Static progressive stretch finger device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories |
| E1841 | Sps/pass shoulder device | Description: Static progressive stretch/patient actualized serial stretch shoulder device, with or without range of motion adjustment, includes all components and accessories |
| E3200 | Gait mod systm rhym auditory | Description: Gait modulation system, rhythmic auditory stimulation, including restricted therapy software, all components and accessories, prescription only |
| G0183 | Software meas of cardiac vol | Description: Quantitative software measurements of cardiac volume, cardiac chambers volumes and left ventricular wall mass derived from ct scan(s) data of the chest/heart (with or without contrast) |
| G0566 | 3d bn img algor drvd fr mri | Description: 3d radiodensity-value bone imaging, algorithm derived, from previous magnetic resonance examination of the same anatomy |
| J0281 | Inj aminocaproic acid 1 gram | Description: Injection, aminocaproic acid, 1 gram |
| J1072 | Inj, testosterone, azmiro | Description: Injection, testosterone cypionate (azmiro), 1 mg |
| J1271 | Inj doxycycline hyclate 1 mg | Description: Injection, doxycycline hyclate, 1 mg |
| J1299 | Inj, eculizumab, 2 mg | Description: Injection, eculizumab, 2 mg |
| J1308 | Inj, famotidine, 0.25 mg | Description: Injection, famotidine, 0.25 mg |
| J1808 | Inj, folic acid, 0.1 mg | Description: Injection, folic acid, 0.1 mg |
| J1938 | Inj, furosemide, 1 mg | Description: Injection, furosemide, 1 mg |
| J2351 | Inj ocrelizumab 1mg hya-ocsq | Description: Injection, ocrelizumab, 1 mg and hyaluronidase-ocsq |
| J2428 | Inj, erzofri, 1 mg | Description: Injection, paliperidone palmitate extended release (erzofri), 1 mg |
| J2804 | Inj, rifampin, 1 mg | Description: Injection, rifampin, 1 mg |
| J2865 | Inj sulfameth/trim 5 mg/1 mg | Description: Injection, sulfamethoxazole 5 mg and trimethoprim 1 mg |
| J7521 | Tacrolim granules oral susp | Description: Tacrolimus, granules, oral suspension, 0.1 mg |
| J9024 | Inj atezolizumb 5mg hya-tqjs | Description: Injection, atezolizumab, 5 mg and hyaluronidase-tqjs |
| J9038 | Inj axatilimab-csfr 0.1 mg | Description: Injection, axatilimab-csfr, 0.1 mg |
| J9054 | Inj bortezomib boruzu 0.1 mg | Description: Injection, bortezomib (boruzu), 0.1 mg |
| J9073 | Inj cyclophos dr reddys 5 mg | Description: Injection, cyclophosphamide (dr. reddy's), 5 mg |
| J9161 | Inj denileuk difti-cxdl 1mcg | Description: Injection, denileukin diftitox-cxdl, 1 mcg |
| L0720 | Ctlso a-p-l control custom | Description: Cervical-thoracic-lumbar-sacral-orthoses (ctlso), anterior-posterior-lateral control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L1932 | Afo rig ant tib tcf/= custom | Description: Ankle foot orthosis, rigid anterior tibial section, total carbon fiber or equal material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L1933 | Afo rig ant tib tcf/= ots | Description: Ankle foot orthosis, rigid anterior tibial section, total carbon fiber or equal material, prefabricated, off-the-shelf |
| L1951 | Afo spiral prefab custom | Description: Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L1952 | Afo spiral prefab ots | Description: Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated, off-the-shelf |
| L1971 | Afo w/ankle joint, prefab | Description: Ankle foot orthosis, plastic or other material with ankle joint, with or without dorsiflexion assist, prefabricated, includes fitting and adjustment |
| L5827 | Endo knee shin single axis | Description: Endoskeletal knee-shin system, single axis, electromechanical swing and stance phase control, with or without shock absorption and stance extension damping |
| L6028 | Part handfng endoskel molded | Description: Partial hand including fingers, flexible or non-flexible interface, endoskeletal system, molded to patient model, for use without external power, not including inserts described by l6692 |
| L6029 | Test interface part handfing | Description: Upper extremity addition, test socket/interface, partial hand including fingers |
| L6030 | External frame part handfing | Description: Upper extremity addition, external frame, partial hand including fingers |
| L6031 | Rep interface handfng molded | Description: Replacement socket/interface, partial hand including fingers, molded to patient model, for use with or without external power |
| L6032 | Part handfng ultralite tcf/= | Description: Addition to upper extremity prosthesis, partial hand including fingers, ultralight material (titanium, carbon fiber or equal) |
| L6033 | Part handfing acrylic | Description: Addition to upper extremity prosthesis, partial hand including fingers, acrylic material |
| L6037 | Postop dsg cast chg handfing | Description: Immediate post-surgical or early fitting, application of initial rigid dressing, including fitting alignment and suspension of components, and one cast change, partial hand including fingers |
| L6692 | Silicon gel insert w/wo lock | Description: Upper extremity addition, silicone gel insert or equal, with or without locking mechanism, each |
| L6698 | Add up-ex prosthes lock mech | Description: Addition to upper extremity prosthesis, lock mechanism, excludes socket insert |
| L6700 | Ue add ext power myoel | Description: Upper extremity addition, external powered feature, myoelectronic control module, additional emg inputs, pattern-recognition decoding intent movement |
| L7406 | Add to upp extr user adj mec | Description: Addition to upper extremity, user adjustable, mechanical, residual limb volume management system |
| Q2057 | Afamitresgene autoleucel | Description: Afamitresgene autoleucel, including leukapheresis and dose preparation procedures, per therapeutic dose |
| Q4354 | Palingen dual-layer sq cm | Description: Palingen dual-layer membrane, per square centimeter |
| Q4355 | Abio xpl abio xpl hy p sq cm | Description: Abiomend xplus membrane and abiomend xplus hydromembrane, per square centimeter |
| Q4356 | Abio mem abio hyd per sq cm | Description: Abiomend membrane and abiomend hydromembrane, per square centimeter |
| Q4357 | Xwrap plus, per sq cm | Description: Xwrap plus, per square centimeter |
| Q4358 | Xwrap dual, per sq cm | Description: Xwrap dual, per square centimeter |
| Q4359 | Choriply, per sq cm | Description: Choriply, per square centimeter |
| Q4360 | Amchoplast fd per sq cm | Description: Amchoplast fd, per square centimeter |
| Q4361 | Epixpress, per sq cm | Description: Epixpress, per square centimeter |
| Q4362 | Cygnus disk, per sq cm | Description: Cygnus disk, per square centimeter |
| Q4363 | Am bur mem hydro per sq cm | Description: Amnio burgeon membrane and hydromembrane, per square centimeter |
| Q4364 | Am bur xp mem xpl hy p sq cm | Description: Amnio burgeon xplus membrane and xplus hydromembrane, per square centimeter |
| Q4365 | Amnio bur dl mem per sq cm | Description: Amnio burgeon dual-layer membrane, per square centimeter |
| Q4366 | Dl amnio bur x-mem per sq cm | Description: Dual layer amnio burgeon x-membrane, per square centimeter |
| Q4367 | Amniocore sl, per sq cm | Description: Amniocore sl, per square centimeter |
| Q5147 | Inj, aflibercept-ayyh, 1 mg | Description: Injection, aflibercept-ayyh (pavblu), biosimilar, 1 mg |
| Q5148 | Inj, nyposi 1 mcg | Description: Injection, filgrastim-txid (nypozi), biosimilar, 1 microgram |
| Q5149 | Inj, aflibercept-abzv, 1 mg | Description: Injection, aflibercept-abzv (enzeevu), biosimilar, 1 mg |
| Q5150 | Inj, aflibercept-mrbb, 1 mg | Description: Injection, aflibercept-mrbb (ahzantive), biosimilar, 1 mg |
| Q5151 | Inj, eculizumab-aagh, 2 mg | Description: Injection, eculizumab-aagh (epysqli), biosimilar, 2 mg |
| Q5152 | Inj, eculizumab-aeeb, 2 mg | Description: Injection, eculizumab-aeeb (bkemv), biosimilar, 2 mg |
| Q9999 | Inj ustekinumab-aauz 1 mg | Description: Injection, ustekinumab-aauz (otulfi), biosimilar, 1 mg |
| S4020 | Ivf canc b4 aspir case rate | Description: In vitro fertilization procedure cancelled before aspiration, case rate |
| S4021 | Ivf canc aftr aspr case rate | Description: In vitro fertilization procedure cancelled after aspiration, case rate |
| S4024 | Air polymer foam per study | Description: Air polymer-type a intrauterine foam, per study dose |
| A9155 | Artificial saliva | Description: Artificial saliva, 30 ml |
| G0564 | 365 d implant glucose sensor | Description: Creation of subcutaneous pocket with insertion of 365 day implantable interstitial glucose sensor, including system activation and patient training |
| G0565 | Rem/ins glu snsr 365 dif sit | Description: Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and insertion of new 365 day implantable sensor, including system activation |
| J1094 | Inj dexamethasone acetate | Description: Injection, dexamethasone acetate, 1 mg |
| J1300 | Eculizumab injection | Description: Injection, eculizumab, 10 mg |
| J1810 | Droperidol/fentanyl inj | Description: Injection, droperidol and fentanyl citrate, up to 2 ml ampule |
| J1890 | Cephalothin sodium injection | Description: Injection, cephalothin sodium, up to 1 gram |
| J1940 | Furosemide injection | Description: Injection, furosemide, up to 20 mg |
| J9037 | Inj belantamab mafodot blmf | Description: Injection, belantamab mafodotin-blmf, 0.5 mg |
| J9247 | Inj, melphalan flufenami 1mg | Description: Injection, melphalan flufenamide, 1mg |
| L8010 | Mastectomy sleeve | Description: Breast prosthesis, mastectomy sleeve |
| Q4231 | Corplex p, per cc | Description: Corplex p, per cc |
| Q5139 | Inj, eculizumab-aeeb, 10 mg | Description: Injection, eculizumab-aeeb (bkemv), biosimilar, 10 mg |
| S0017 | Injection, aminocaproic acid | Description: Injection, aminocaproic acid, 5 grams |
| S0028 | Injection, famotidine, 20 mg | Description: Injection, famotidine, 20 mg |
| S0032 | Injection, nafcillin sodium | Description: Injection, nafcillin sodium, 2 grams |
| S0039 | Injection, sulfamethoxazole | Description: Injection, sulfamethoxazole and trimethoprim, 10 ml |
| S4988 | Penile contractur devic manu | Description: Penile contracture device, manual, greater than 3 lbs traction force |