Medical Billing Code Search
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9172 results found
| E2210 | Wheelchair bearings | Description: Wheelchair accessory, bearings, any type, replacement only, each |
| E2211 | Pneumatic propulsion tire | Description: Manual wheelchair accessory, pneumatic propulsion tire, any size, each |
| E2212 | Pneumatic prop tire tube | Description: Manual wheelchair accessory, tube for pneumatic propulsion tire, any size, each |
| E2213 | Pneumatic prop tire insert | Description: Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
| E2214 | Pneumatic caster tire each | Description: Manual wheelchair accessory, pneumatic caster tire, any size, each |
| E2215 | Pneumatic caster tire tube | Description: Manual wheelchair accessory, tube for pneumatic caster tire, any size, each |
| E2216 | Foam filled propulsion tire | Description: Manual wheelchair accessory, foam filled propulsion tire, any size, each |
| E2217 | Foam filled caster tire each | Description: Manual wheelchair accessory, foam filled caster tire, any size, each |
| E2218 | Foam propulsion tire each | Description: Manual wheelchair accessory, foam propulsion tire, any size, each |
| E2219 | Foam caster tire any size ea | Description: Manual wheelchair accessory, foam caster tire, any size, each |
| E2220 | Solid propuls tire, repl, ea | Description: Manual wheelchair accessory, solid (rubber/plastic) propulsion tire, any size, replacement only, each |
| E2221 | Solid caster tire repl, each | Description: Manual wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each |
| E2222 | Solid caster integ whl, repl | Description: Manual wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each |
| E2224 | Propulsion whl excl tire rep | Description: Manual wheelchair accessory, propulsion wheel excludes tire, any size, replacement only, each |
| E2225 | Caster wheel excludes tire | Description: Manual wheelchair accessory, caster wheel excludes tire, any size, replacement only, each |
| E2226 | Caster fork replacement only | Description: Manual wheelchair accessory, caster fork, any size, replacement only, each |
| E2227 | Gear reduction drive wheel | Description: Manual wheelchair accessory, gear reduction drive wheel, each |
| E2228 | Mwc acc, wheelchair brake | Description: Manual wheelchair accessory, wheel braking system and lock, complete, each |
| E2230 | Manual standing system | Description: Manual wheelchair accessory, manual standing system |
| E2231 | Solid seat support base | Description: Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware |
| E2291 | Planar back for ped size wc | Description: Back, planar, for pediatric size wheelchair including fixed attaching hardware |
| E2292 | Planar seat for ped size wc | Description: Seat, planar, for pediatric size wheelchair including fixed attaching hardware |
| E2293 | Contour back for ped size wc | Description: Back, contoured, for pediatric size wheelchair including fixed attaching hardware |
| E2294 | Contour seat for ped size wc | Description: Seat, contoured, for pediatric size wheelchair including fixed attaching hardware |
| E2295 | Ped dynamic seating frame | Description: Manual wheelchair accessory, for pediatric size wheelchair, dynamic seating frame, allows coordinated movement of multiple positioning features |
| E2298 | Pwr seat elev sys for crt | Description: Complex rehabilitative power wheelchair accessory, power seat elevation system, any type |
| E2300 | Pwr seat elevation sys | Description: Wheelchair accessory, power seat elevation system, any type |
| E2301 | Pwr standing | Description: Wheelchair accessory, power standing system, any type |
| E2310 | Electro connect btw control | Description: Power wheelchair accessory, electronic connection between wheelchair controller and one power seating system motor, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware |
| E2311 | Electro connect btw 2 sys | Description: Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware |
| E2312 | Mini-prop remote joystick | Description: Power wheelchair accessory, hand or chin control interface, mini-proportional remote joystick, proportional, including fixed mounting hardware |
| E2313 | Pwc harness, expand control | Description: Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each |
| E2321 | Hand interface joystick | Description: Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware |
| E2322 | Mult mech switches | Description: Power wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware |
| E2323 | Special joystick handle | Description: Power wheelchair accessory, specialty joystick handle for hand control interface, prefabricated |
| E2324 | Chin cup interface | Description: Power wheelchair accessory, chin cup for chin control interface |
| E2325 | Sip and puff interface | Description: Power wheelchair accessory, sip and puff interface, nonproportional, including all related electronics, mechanical stop switch, and manual swingaway mounting hardware |
| E2326 | Breath tube kit | Description: Power wheelchair accessory, breath tube kit for sip and puff interface |
| E2327 | Head control interface mech | Description: Power wheelchair accessory, head control interface, mechanical, proportional, including all related electronics, mechanical direction change switch, and fixed mounting hardware |
| E2328 | Head/extremity control inter | Description: Power wheelchair accessory, head control or extremity control interface, electronic, proportional, including all related electronics and fixed mounting hardware |
| E2329 | Head control nonproportional | Description: Power wheelchair accessory, head control interface, contact switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware |
| E2330 | Head control proximity switc | Description: Power wheelchair accessory, head control interface, proximity switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware |
| E2331 | Attendant control | Description: Power wheelchair accessory, attendant control, proportional, including all related electronics and fixed mounting hardware |
| E2340 | W/c wdth 20-23 in seat frame | Description: Power wheelchair accessory, nonstandard seat frame width, 20-23 inches |
| E2341 | W/c wdth 24-27 in seat frame | Description: Power wheelchair accessory, nonstandard seat frame width, 24-27 inches |
| E2342 | W/c dpth 20-21 in seat frame | Description: Power wheelchair accessory, nonstandard seat frame depth, 20 or 21 inches |
| E2343 | W/c dpth 22-25 in seat frame | Description: Power wheelchair accessory, nonstandard seat frame depth, 22-25 inches |
| E2351 | Electronic sgd interface | Description: Power wheelchair accessory, electronic interface to operate speech generating device using power wheelchair control interface |
| E2358 | Gr 34 nonsealed leadacid | Description: Power wheelchair accessory, group 34 non-sealed lead acid battery, each |
| E2359 | Gr34 sealed leadacid battery | Description: Power wheelchair accessory, group 34 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
| E2360 | 22nf nonsealed leadacid | Description: Power wheelchair accessory, 22nf non-sealed lead acid battery, each |
| E2361 | 22nf sealed leadacid battery | Description: Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
| E2362 | Gr24 nonsealed leadacid | Description: Power wheelchair accessory, group 24 non-sealed lead acid battery, each |
| E2363 | Gr24 sealed leadacid battery | Description: Power wheelchair accessory, group 24 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
| E2364 | U1nonsealed leadacid battery | Description: Power wheelchair accessory, u-1 non-sealed lead acid battery, each |
| E2365 | U1 sealed leadacid battery | Description: Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
| E2366 | Battery charger, single mode | Description: Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each |
| E2367 | Battery charger, dual mode | Description: Power wheelchair accessory, battery charger, dual mode, for use with either battery type, sealed or non-sealed, each |
| E2368 | Pwr wc drivewheel motor repl | Description: Power wheelchair component, drive wheel motor, replacement only |
| E2369 | Pwr wc drivewheel gear repl | Description: Power wheelchair component, drive wheel gear box, replacement only |
| E2370 | Pwr wc dr wh motor/gear comb | Description: Power wheelchair component, integrated drive wheel motor and gear box combination, replacement only |
| E2371 | Gr27 sealed leadacid battery | Description: Power wheelchair accessory, group 27 sealed lead acid battery, (e.g., gel cell, absorbed glassmat), each |
| E2372 | Gr27 non-sealed leadacid | Description: Power wheelchair accessory, group 27 non-sealed lead acid battery, each |
| E2373 | Hand/chin ctrl spec joystick | Description: Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware |
| E2374 | Hand/chin ctrl std joystick | Description: Power wheelchair accessory, hand or chin control interface, standard remote joystick (not including controller), proportional, including all related electronics and fixed mounting hardware, replacement only |
| E2375 | Non-expandable controller | Description: Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only |
| E2376 | Expandable controller, repl | Description: Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, replacement only |
| E2377 | Expandable controller, initl | Description: Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue |
| E2378 | Pw actuator replacement | Description: Power wheelchair component, actuator, replacement only |
| E2381 | Pneum drive wheel tire | Description: Power wheelchair accessory, pneumatic drive wheel tire, any size, replacement only, each |
| E2382 | Tube, pneum wheel drive tire | Description: Power wheelchair accessory, tube for pneumatic drive wheel tire, any size, replacement only, each |
| E2383 | Insert, pneum wheel drive | Description: Power wheelchair accessory, insert for pneumatic drive wheel tire (removable), any type, any size, replacement only, each |
| E2384 | Pneumatic caster tire | Description: Power wheelchair accessory, pneumatic caster tire, any size, replacement only, each |
| E2385 | Tube, pneumatic caster tire | Description: Power wheelchair accessory, tube for pneumatic caster tire, any size, replacement only, each |
| E2386 | Foam filled drive wheel tire | Description: Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each |
| E2387 | Foam filled caster tire | Description: Power wheelchair accessory, foam filled caster tire, any size, replacement only, each |
| E2388 | Foam drive wheel tire | Description: Power wheelchair accessory, foam drive wheel tire, any size, replacement only, each |
| E2389 | Foam caster tire | Description: Power wheelchair accessory, foam caster tire, any size, replacement only, each |
| E2390 | Solid drive wheel tire | Description: Power wheelchair accessory, solid (rubber/plastic) drive wheel tire, any size, replacement only, each |
| E2391 | Solid caster tire | Description: Power wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each |
| E2392 | Solid caster tire, integrate | Description: Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each |
| E2394 | Drive wheel excludes tire | Description: Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each |
| E2395 | Caster wheel excludes tire | Description: Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each |
| E2396 | Caster fork | Description: Power wheelchair accessory, caster fork, any size, replacement only, each |
| E2397 | Pwc acc, lith-based battery | Description: Power wheelchair accessory, lithium-based battery, each |
| E2398 | Wc dynamic pos back hardware | Description: Wheelchair accessory, dynamic positioning hardware for back |
| E2402 | Neg press wound therapy pump | Description: Negative pressure wound therapy electrical pump, stationary or portable |
| E2500 | Sgd digitized pre-rec <=8min | Description: Speech generating device, digitized speech, using pre-recorded messages, less than or equal to 8 minutes recording time |
| E2502 | Sgd prerec msg >8min <=20min | Description: Speech generating device, digitized speech, using pre-recorded messages, greater than 8 minutes but less than or equal to 20 minutes recording time |
| E2504 | Sgd prerec msg>20min <=40min | Description: Speech generating device, digitized speech, using pre-recorded messages, greater than 20 minutes but less than or equal to 40 minutes recording time |
| E2506 | Sgd prerec msg > 40 min | Description: Speech generating device, digitized speech, using pre-recorded messages, greater than 40 minutes recording time |
| E2508 | Sgd spelling phys contact | Description: Speech generating device, synthesized speech, requiring message formulation by spelling and access by physical contact with the device |
| E2510 | Sgd w multi methods msg/accs | Description: Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access |
| E2511 | Sgd sftwre prgrm for pc/pda | Description: Speech generating software program, for personal computer or personal digital assistant |
| E2512 | Sgd accessory, mounting sys | Description: Accessory for speech generating device, mounting system |
| E2513 | Sgd accessory, emg sensor | Description: Accessory for speech generating device, electromyographic sensor |
| E2599 | Sgd accessory noc | Description: Accessory for speech generating device, not otherwise classified |
| E2601 | Gen w/c cushion wdth < 22 in | Description: General use wheelchair seat cushion, width less than 22 inches, any depth |
| E2602 | Gen w/c cushion wdth >=22 in | Description: General use wheelchair seat cushion, width 22 inches or greater, any depth |
| E2603 | Skin protect wc cus wd <22in | Description: Skin protection wheelchair seat cushion, width less than 22 inches, any depth |
| E2604 | Skin protect wc cus wd>=22in | Description: Skin protection wheelchair seat cushion, width 22 inches or greater, any depth |
| E2605 | Position wc cush wdth <22 in | Description: Positioning wheelchair seat cushion, width less than 22 inches, any depth |
| E2606 | Position wc cush wdth>=22 in | Description: Positioning wheelchair seat cushion, width 22 inches or greater, any depth |
| E2607 | Skin pro/pos wc cus wd <22in | Description: Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
| E2608 | Skin pro/pos wc cus wd>=22in | Description: Skin protection and positioning wheelchair seat cushion, width 22 inches or greater, any depth |
| E2609 | Custom fabricate w/c cushion | Description: Custom fabricated wheelchair seat cushion, any size |
| E2610 | Powered w/c cushion | Description: Wheelchair seat cushion, powered |
| E2611 | Gen use back cush wdth <22in | Description: General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
| E2612 | Gen use back cush wdth>=22in | Description: General use wheelchair back cushion, width 22 inches or greater, any height, including any type mounting hardware |
| E2613 | Position back cush wd <22in | Description: Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware |
| E2614 | Position back cush wd>=22in | Description: Positioning wheelchair back cushion, posterior, width 22 inches or greater, any height, including any type mounting hardware |
| E2615 | Pos back post/lat wdth <22in | Description: Positioning wheelchair back cushion, posterior-lateral, width less than 22 inches, any height, including any type mounting hardware |
| E2616 | Pos back post/lat wdth>=22in | Description: Positioning wheelchair back cushion, posterior-lateral, width 22 inches or greater, any height, including any type mounting hardware |
| E2617 | Custom fab w/c back cushion | Description: Custom fabricated wheelchair back cushion, any size, including any type mounting hardware |
| E2619 | Replace cover w/c seat cush | Description: Replacement cover for wheelchair seat cushion or back cushion, each |
| E2620 | Wc planar back cush wd <22in | Description: Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware |
| E2621 | Wc planar back cush wd>=22in | Description: Positioning wheelchair back cushion, planar back with lateral supports, width 22 inches or greater, any height, including any type mounting hardware |
| E2622 | Adj skin pro w/c cus wd<22in | Description: Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth |
| E2623 | Adj skin pro wc cus wd>=22in | Description: Skin protection wheelchair seat cushion, adjustable, width 22 inches or greater, any depth |
| E2624 | Adj skin pro/pos cus<22in | Description: Skin protection and positioning wheelchair seat cushion, adjustable, width less than 22 inches, any depth |
| E2625 | Adj skin pro/pos wc cus>=22 | Description: Skin protection and positioning wheelchair seat cushion, adjustable, width 22 inches or greater, any depth |
| E2626 | Seo mobile arm sup att to wc | Description: Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable |
| E2627 | Arm supp att to wc rancho ty | Description: Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable rancho type |
| E2628 | Mobile arm supports reclinin | Description: Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, reclining |
| E2629 | Friction dampening arm supp | Description: Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, friction arm support (friction dampening to proximal and distal joints) |
| E2630 | Monosuspension arm/hand supp | Description: Wheelchair accessory, shoulder elbow, mobile arm support, monosuspension arm and hand support, overhead elbow forearm hand sling support, yoke type suspension support |
| E2631 | Elevat proximal arm support | Description: Wheelchair accessory, addition to mobile arm support, elevating proximal arm |
| E2632 | Offset/lat rocker arm w/ela | Description: Wheelchair accessory, addition to mobile arm support, offset or lateral rocker arm with elastic balance control |
| E2633 | Mobile arm support supinator | Description: Wheelchair accessory, addition to mobile arm support, supinator |
| E3000 | Speech volume modulation sys | Description: Speech volume modulation system, any type, including 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 |
| E8000 | Posterior gait trainer | Description: Gait trainer, pediatric size, posterior support, includes all accessories and components |
| E8001 | Upright gait trainer | Description: Gait trainer, pediatric size, upright support, includes all accessories and components |
| E8002 | Anterior gait trainer | Description: Gait trainer, pediatric size, anterior support, includes all accessories and components |
| G0008 | Admin influenza virus vac | Description: Administration of influenza virus vaccine |
| G0009 | Admin pneumococcal vaccine | Description: Administration of pneumococcal vaccine |
| G0010 | Admin hepatitis b vaccine | Description: Administration of hepatitis b vaccine |
| G0011 | Hiv prep counsel, md 15-30m | Description: Individual counseling for pre-exposure prophylaxis (prep) by physician or qualified health care professional (qhp) to prevent human immunodeficiency virus (hiv), includes hiv risk assessment (initial or continued assessment of risk), hiv risk reduction and medication adherence, 15-30 minutes |
| G0012 | Injection of hiv prep drug | Description: Injection of pre-exposure prophylaxis (prep) drug for hiv prevention, under skin or into muscle |
| G0013 | Hiv prep counsel, clin staff | Description: Individual counseling for pre-exposure prophylaxis (prep) by clinical staff to prevent human immunodeficiency virus (hiv), includes: hiv risk assessment (initial or continued assessment of risk), hiv risk reduction and medication adherence |
| G0017 | Crisis psychotherapy 60m | Description: Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); first 60 minutes |
| G0018 | Crisis psychotherapy add 30m | Description: Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); each additional 30 minutes (list separately in addition to code for primary service) |
| G0019 | Comm hlth intg svs sdoh 60mn | Description: Community health integration services performed by certified or trained auxiliary personnel, including a community health worker, under the direction of a physician or other practitioner; 60 minutes per calendar month, in the following activities to address social determinants of health (sdoh) need(s) that are significantly limiting the ability to diagnose or treat problem(s) addressed in an initiating visit: person-centered assessment, performed to better understand the individualized context of the intersection between the sdoh need(s) and the problem(s) addressed in the initiating visit. ++ conducting a person-centered assessment to understand patient's life story, strengths, needs, goals, preferences and desired outcomes, including understanding cultural and linguistic factors and including unmet sdoh needs (that are not separately billed). ++ facilitating patient-driven goal-setting and establishing an action plan. ++ providing tailored support to the patient as needed to accomplish the practitioner's treatment plan. practitioner, home-, and community-based care coordination. ++ coordinating receipt of needed services from healthcare practitioners, providers, and facilities; and from home- and community-based service providers, social service providers, and caregiver (if applicable). ++ communication with practitioners, home- and community-based service providers, hospitals, and skilled nursing facilities (or other health care facilities) regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors. ++ coordination of care transitions between and among health care practitioners and settings, including transitions involving referral to other clinicians; follow-up after an emergency department visit; or follow-up after discharges from hospitals, skilled nursing facilities or other health care facilities. ++ facilitating access to community-based social services (e.g., housing, utilities, transportation, food assistance) to address the sdoh need(s). health education- helping the patient contextualize health education provided by the patient's treatment team with the patient's individual needs, goals, and preferences, in the context of the sdoh need(s), and educating the patient on how to best participate in medical decision-making. building patient self-advocacy skills, so that the patient can interact with members of the health care team and related community-based services addressing the sdoh need(s), in ways that are more likely to promote personalized and effective diagnosis or treatment. health care access / health system navigation. ++ helping the patient access healthcare, including identifying appropriate practitioners or providers for clinical care and helping secure appointments with them. facilitating behavioral change as necessary for meeting diagnosis and treatment goals, including promoting patient motivation to participate in care and reach person-centered diagnosis or treatment goals. facilitating and providing social and emotional support to help the patient cope with the problem(s) addressed in the initiating visit, the sdoh need(s), and adjust daily routines to better meet diagnosis and treatment goals. leveraging lived experience when applicable to provide support, mentorship, or inspiration to meet treatment goals |
| G0022 | Comm hlth intg svs add 30 m | Description: Community health integration services, each additional 30 minutes per calendar month (list separately in addition to g0019) |
| G0023 | Pin service 60m per month | Description: Principal illness navigation services by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a patient navigator; 60 minutes per calendar month, in the following activities: person-centered assessment, performed to better understand the individual context of the serious, high-risk condition. ++ conducting a person-centered assessment to understand the patient's life story, strengths, needs, goals, preferences, and desired outcomes, including understanding cultural and linguistic factors and including unmet sdoh needs (that are not separately billed). ++ facilitating patient-driven goal setting and establishing an action plan. ++ providing tailored support as needed to accomplish the practitioner's treatment plan. identifying or referring patient (and caregiver or family, if applicable) to appropriate supportive services. practitioner, home, and community-based care coordination. ++ coordinating receipt of needed services from healthcare practitioners, providers, and facilities; home- and community-based service providers; and caregiver (if applicable). ++ communication with practitioners, home-, and community-based service providers, hospitals, and skilled nursing facilities (or other health care facilities) regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors. ++ coordination of care transitions between and among health care practitioners and settings, including transitions involving referral to other clinicians; follow-up after an emergency department visit; or follow-up after discharges from hospitals, skilled nursing facilities or other health care facilities. ++ facilitating access to community-based social services (e.g., housing, utilities, transportation, food assistance) as needed to address sdoh need(s). health education- helping the patient contextualize health education provided by the patient's treatment team with the patient's individual needs, goals, preferences, and sdoh need(s), and educating the patient (and caregiver if applicable) on how to best participate in medical decision-making. building patient self-advocacy skills, so that the patient can interact with members of the health care team and related community-based services (as needed), in ways that are more likely to promote personalized and effective treatment of their condition. health care access / health system navigation. ++ helping the patient access healthcare, including identifying appropriate practitioners or providers for clinical care, and helping secure appointments with them. ++ providing the patient with information/resources to consider participation in clinical trials or clinical research as applicable. facilitating behavioral change as necessary for meeting diagnosis and treatment goals, including promoting patient motivation to participate in care and reach person-centered diagnosis or treatment goals. facilitating and providing social and emotional support to help the patient cope with the condition, sdoh need(s), and adjust daily routines to better meet diagnosis and treatment goals. leverage knowledge of the serious, high-risk condition and/or lived experience when applicable to provide support, mentorship, or inspiration to meet treatment goals |
| G0024 | Pin srv add 30 min pr m | Description: Principal illness navigation services, additional 30 minutes per calendar month (list separately in addition to g0023) |
| G0027 | Semen analysis | Description: Semen analysis; presence and/or motility of sperm excluding huhner |
| G0028 | Doc med rsn no scr tob | Description: Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason) |
| G0029 | 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 |
| G0030 | 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 |
| G0031 | Pall serv during meas | Description: Palliative care services given to patient any time during the measurement period |
| G0032 | 2+ antipsy schiz | Description: Two or more antipsychotic prescriptions ordered for patients who had a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between january 1 of the year prior to the measurement period and the index prescription start date (ipsd) for antipsychotics |
| G0033 | 2+ benzo seiz | Description: Two or more benzodiazepine prescriptions ordered for patients who had a diagnosis of seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, or severe generalized anxiety disorder on or between january 1 of the year prior to the measurement period and the ipsd for benzodiazepines |
| G0034 | Pall serv during meas | Description: Patients receiving palliative care during the measurement period |
| G0035 | Pt ed pos 23 | Description: Patient has any emergency department encounter during the performance period with place of service indicator 23 |
| G0036 | Pt/ptn decln assess | Description: Patient or care partner decline assessment |
| G0037 | Pt not able to participate | Description: On date of encounter, patient is not able to participate in assessment or screening, including non-verbal patients, delirious, severely aphasic, severely developmentally delayed, severe visual or hearing impairment and for those patients, no knowledgeable informant available |
| G0038 | Clin pt no ref | Description: Clinician determines patient does not require referral |
| G0039 | Pt no ref, rn spec | Description: Patient not referred, reason not otherwise specified |
| G0040 | Pt phys/occ therapy | Description: Patient already receiving physical/occupational/speech/recreational therapy during the measurement period |
| G0041 | Pt/ptn decln referral | Description: Patient and/or care partner decline referral |
| G0042 | Ref to therapy | Description: Referral to physical, occupational, speech, or recreational therapy |
| G0043 | Pt mech pros ht valv | Description: Patients with mechanical prosthetic heart valve |
| G0044 | Pt mitral stenosis | Description: Patients with moderate or severe mitral stenosis |
| G0045 | Mrs 90 days post stk | Description: Clinical follow-up and mrs score assessed at 90 days following endovascular stroke intervention |
| G0046 | No mrs 90 days post stk | Description: Clinical follow-up and mrs score not assessed at 90 days following endovascular stroke intervention |
| G0047 | Ped blunt hd traum | Description: Pediatric patient with minor blunt head trauma and pecarn prediction criteria are not assessed |
| G0048 | Pall serv during meas | Description: Patients who receive palliative care services any time during the intake period through the end of the measurement year |
| G0049 | Main hemo in-cntr | Description: With maintenance hemodialysis (in-center and home hd) for the complete reporting month |
| G0050 | Pt w/ lmted life expec | Description: Patients with a catheter that have limited life expectancy |
| G0051 | Pt hospice mnth | Description: Patients under hospice care in the current reporting month |
| G0052 | Pt peri dialysis dur mo | Description: Patients on peritoneal dialysis for any portion of the reporting month |
| G0053 | Adv rheum pt care mvp | Description: Advancing rheumatology patient care mips value pathways |
| G0054 | Strk cr prev pos outcme mvp | Description: Coordinating stroke care to promote prevention and cultivate positive outcomes mips value pathways |
| G0055 | Adv care heart dx mvp | Description: Advancing care for heart disease mips value pathways |
| G0056 | Opt chronic dx mang mvp | Description: Optimizing chronic disease management mips value pathways |
| G0057 | Best pct pt safety em mvp | Description: Proposed adopting best practices and promoting patient safety within emergency medicine mips value pathways |
| G0058 | Imprv care le jnt repr mvp | Description: Improving care for lower extremity joint repair mips value pathways |
| G0059 | Pt sfty pos exp w aneth mvp | Description: Patient safety and support of positive experiences with anesthesia mips value pathways |
| G0060 | Allergy/immunology ss | Description: Allergy/immunology mips specialty set |
| G0061 | Anesthesiology ss | Description: Anesthesiology mips specialty set |
| G0062 | Audiology ss | Description: Audiology mips specialty set |
| G0063 | Cardiology ss | Description: Cardiology mips specialty set |
| G0064 | Cert nurse midwife ss | Description: Certified nurse midwife mips specialty set |
| G0065 | Chiropractic ss | Description: Chiropractic medicine mips specialty set |
| G0066 | Clinical social work ss | Description: Clinical social work mips specialty set |
| G0067 | Dentistry ss | Description: Dentistry mips specialty set |
| G0068 | Adm iv infusion drug in home | Description: Professional services for the administration of anti-infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy or other highly complex drug or biological) for each infusion drug administration calendar day in the individual's home, each 15 minutes |
| G0069 | Adm sq infusion drug in home | Description: Professional services for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes |
| G0070 | Adm of chemo drug in home | Description: Professional services for the administration of intravenous chemotherapy or other intravenous highly complex drug or biological infusion for each infusion drug administration calendar day in the individual's home, each 15 minutes |
| G0076 | Care manag h vst new pt 20 m | Description: Brief (20 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) |
| G0077 | Care manag h vst new pt 30 m | Description: Limited (30 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) |
| G0078 | Care manag h vst new pt 45 m | Description: Moderate (45 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) |
| G0079 | Care manag h vst new pt 60 m | Description: Comprehensive (60 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) |
| G0080 | Care manag h vst new pt 75 m | Description: Extensive (75 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) |
| G0081 | Care man h v ext pt 20 mi | Description: Brief (20 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) |
| G0082 | Care man h v ext pt 30 m | Description: Limited (30 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) |
| G0083 | Care man h v ext pt 45 m | Description: Moderate (45 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) |
| G0084 | Care man h v ext pt 60 m | Description: Comprehensive (60 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) |
| G0085 | Care man h v ext pt 75 m | Description: Extensive (75 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) |
| G0086 | Care man home care plan 30 m | Description: Limited (30 minutes) care management home care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) |
| G0087 | Care man home care plan 60 m | Description: Comprehensive (60 minutes) care management home care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) |
| G0088 | Adm iv drug 1st home visit | Description: Professional services, initial visit, for the administration of anti-infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy or other highly complex drug or biological) for each infusion drug administration calendar day in the individual's home, each 15 minutes |
| G0089 | Adm subq drug 1st home visit | Description: Professional services, initial visit, for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes |
| G0090 | Adm iv chemo 1st home visit | Description: Professional services, initial visit, for the administration of intravenous chemotherapy or other highly complex infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes |
| G0101 | Ca screen;pelvic/breast exam | Description: Cervical or vaginal cancer screening; pelvic and clinical breast examination |
| G0102 | Prostate ca screening; dre | Description: Prostate cancer screening; digital rectal examination |
| G0103 | Psa screening | Description: Prostate cancer screening; prostate specific antigen test (psa) |
| G0104 | Ca screen;flexi sigmoidscope | Description: Colorectal cancer screening; flexible sigmoidoscopy |
| G0105 | Colorectal scrn; hi risk ind | Description: Colorectal cancer screening; colonoscopy on individual at high risk |
| G0106 | Colon ca screen;barium enema | Description: Colorectal cancer screening; alternative to g0104, screening sigmoidoscopy, barium enema |
| G0108 | Diab manage trn per indiv | Description: Diabetes outpatient self-management training services, individual, per 30 minutes |
| G0109 | Diab manage trn ind/group | Description: Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes |
| G0117 | Glaucoma scrn hgh risk direc | Description: Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist |
| G0118 | Glaucoma scrn hgh risk direc | Description: Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist |
| G0120 | Colon ca scrn; barium enema | Description: Colorectal cancer screening; alternative to g0105, screening colonoscopy, barium enema. |
| G0121 | Colon ca scrn not hi rsk ind | Description: Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk |
| G0122 | Colon ca scrn; barium enema | Description: Colorectal cancer screening; barium enema |
| G0123 | Screen cerv/vag thin layer | Description: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision |
| G0124 | Screen c/v thin layer by md | Description: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician |
| G0127 | Trim nail(s) | Description: Trimming of dystrophic nails, any number |
| G0128 | Corf skilled nursing service | Description: Direct (face-to-face with patient) skilled nursing services of a registered nurse provided in a comprehensive outpatient rehabilitation facility, each 10 minutes beyond the first 5 minutes |
| G0129 | Php/iop ot service | Description: Occupational therapy services requiring the skills of a qualified occupational therapist, furnished as a component of a partial hospitalization or intensive outpatient treatment program, per session (45 minutes or more) |
| G0130 | Single energy x-ray study | Description: Single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel) |
| G0137 | Inten outpt svs,min 9 pr 7 d | Description: Intensive outpatient services; weekly bundle, minimum of 9 services over a 7 contiguous day period, which can include individual and group therapy with physicians or psychologists (or other mental health professionals to the extent authorized under state law); occupational therapy requiring the skills of a qualified occupational therapist; services of social workers, trained psychiatric nurses, and other staff trained to work with psychiatric patients; individualized activity therapies that are not primarily recreational or diversionary; family counseling (the primary purpose of which is treatment of the individual's condition); patient training and education (to the extent that training and educational activities are closely and clearly related to individual's care and treatment); diagnostic services; and such other items and services (excluding meals and transportation) that are reasonable and necessary for the diagnosis or active treatment of the individual's condition, reasonably expected to improve or maintain the individual's condition and functional level and to prevent relapse or hospitalization, and furnished pursuant to such guidelines relating to frequency and duration of services in accordance with a physician certification and plan of treatment (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure |
| G0138 | Iv cipaglucosidase alfa-atga | Description: Intravenous infusion of cipaglucosidase alfa-atga, including provider/supplier acquisition and clinical supervision of oral administration of miglustat in preparation of receipt of cipaglucosidase alfa-atga |
| G0140 | Nav srv peer sup 60 min pr m | Description: Principal illness navigation - peer support by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a certified peer specialist; 60 minutes per calendar month, in the following activities: person-centered interview, performed to better understand the individual context of the serious, high-risk condition. ++ conducting a person-centered interview to understand the patient's life story, strengths, needs, goals, preferences, and desired outcomes, including understanding cultural and linguistic factors, and including unmet sdoh needs (that are not billed separately). ++ facilitating patient-driven goal setting and establishing an action plan. ++ providing tailored support as needed to accomplish the person-centered goals in the practitioner's treatment plan. identifying or referring patient (and caregiver or family, if applicable) to appropriate supportive services. practitioner, home, and community-based care communication. ++ assist the patient in communicating with their practitioners, home-, and community-based service providers, hospitals, and skilled nursing facilities (or other health care facilities) regarding the patient's psychosocial strengths and needs, goals, preferences, and desired outcomes, including cultural and linguistic factors. ++ facilitating access to community-based social services (e.g., housing, utilities, transportation, food assistance) as needed to address sdoh need(s). health education. helping the patient contextualize health education provided by the patient's treatment team with the patient's individual needs, goals, preferences, and sdoh need(s), and educating the patient (and caregiver if applicable) on how to best participate in medical decision-making. building patient self-advocacy skills, so that the patient can interact with members of the health care team and related community-based services (as needed), in ways that are more likely to promote personalized and effective treatment of their condition. developing and proposing strategies to help meet person-centered treatment goals and supporting the patient in using chosen strategies to reach person-centered treatment goals. facilitating and providing social and emotional support to help the patient cope with the condition, sdoh need(s), and adjust daily routines to better meet person-centered diagnosis and treatment goals. leverage knowledge of the serious, high-risk condition and/or lived experience when applicable to provide support, mentorship, or inspiration to meet treatment goals |
| G0141 | Scr c/v cyto,autosys and md | Description: Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician |
| G0143 | Scr c/v cyto,thinlayer,rescr | Description: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under physician supervision |
| G0144 | Scr c/v cyto,thinlayer,rescr | Description: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervision |
| G0145 | Scr c/v cyto,thinlayer,rescr | Description: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision |
| G0146 | Nav srv peer sup add 30 pr m | Description: Principal illness navigation - peer support, additional 30 minutes per calendar month (list separately in addition to g0140) |
| G0147 | Scr c/v cyto, automated sys | Description: Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision |
| G0148 | Scr c/v cyto, autosys, rescr | Description: Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening |
| G0151 | Hhcp-serv of pt,ea 15 min | Description: Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes |
| G0152 | Hhcp-serv of ot,ea 15 min | Description: Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes |
| G0153 | Hhcp-svs of s/l path,ea 15mn | Description: Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes |
| G0154 | Hhcp-svs of rn,ea 15 min | Description: Direct skilled nursing services of a licensed nurse (lpn or rn) in the home health or hospice setting, each 15 minutes |
| G0155 | Hhcp-svs of csw,ea 15 min | Description: Services of clinical social worker in home health or hospice settings, each 15 minutes |
| G0156 | Hhcp-svs of aide,ea 15 min | Description: Services of home health/hospice aide in home health or hospice settings, each 15 minutes |
| G0157 | Hhc pt assistant ea 15 | Description: Services performed by a qualified physical therapist assistant in the home health or hospice setting, each 15 minutes |
| G0158 | Hhc ot assistant ea 15 | Description: Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes |
| G0159 | Hhc pt maint ea 15 min | Description: Services performed by a qualified physical therapist, in the home health setting, in the establishment or delivery of a safe and effective physical therapy maintenance program, each 15 minutes |
| G0160 | Hhc occup therapy ea 15 | Description: Services performed by a qualified occupational therapist, in the home health setting, in the establishment or delivery of a safe and effective occupational therapy maintenance program, each 15 minutes |
| G0161 | Hhc slp ea 15 min | Description: Services performed by a qualified speech-language pathologist, in the home health setting, in the establishment or delivery of a safe and effective speech-language pathology maintenance program, each 15 minutes |
| G0162 | Hhc rn e&m plan svs, 15 min | Description: Skilled services by a registered nurse (rn) for management and evaluation of the plan of care; each 15 minutes (the patient's underlying condition or complication requires an rn to ensure that essential non-skilled care achieves its purpose in the home health or hospice setting) |
| G0163 | Hhc lpn/rn obs/asses ea 15 | Description: Skilled services of a licensed nurse (lpn or rn) for the observation and assessment of the patient's condition, each 15 minutes (the change in the patient's condition requires skilled nursing personnel to identify and evaluate the patient's need for possible modification of treatment in the home health or hospice setting) |
| G0164 | Hhc lis nurse train ea 15 | Description: Skilled services of a licensed nurse (lpn or rn), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes |
| G0166 | Extrnl counterpulse, per tx | Description: External counterpulsation, per treatment session |
| G0168 | Wound closure by adhesive | Description: Wound closure utilizing tissue adhesive(s) only |
| G0173 | Linear acc stereo radsur com | Description: Linear accelerator based stereotactic radiosurgery, complete course of therapy in one session |
| G0175 | Opps service,sched team conf | Description: Scheduled interdisciplinary team conference (minimum of three exclusive of patient care nursing staff) with patient present |
| G0176 | Opps/php/iop; activity thrpy | Description: Activity therapy, such as music, dance, art or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more) |
| G0177 | Opps/php/iop; train & educ | Description: Training and educational services related to the care and treatment of patient's disabling mental health problems per session (45 minutes or more) |
| G0179 | Md recertification hha pt | Description: Physician or allowed practitioner re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and allowed practitioners to affirm the initial implementation of the plan of care |
| G0180 | Md certification hha patient | Description: Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and allowed practitioners to affirm the initial implementation of the plan of care |
| G0181 | Home health care supervision | Description: Physician or allowed practitioner supervision of a patient receiving medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician or allowed practitioner development and/or revision of care plans |
| G0182 | Hospice care supervision | Description: Physician supervision of a patient under a medicare-approved hospice (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of laboratory and other studies, communication (including telephone calls) with other health care professionals involved in the patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month, 30 minutes or more |
| 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) |
| G0186 | Dstry eye lesn,fdr vssl tech | Description: Destruction of localized lesion of choroid (for example, choroidal neovascularization); photocoagulation, feeder vessel technique (one or more sessions) |
| G0202 | Scr mammo bi incl cad | Description: Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (cad) when performed |
| G0204 | Dx mammo incl cad bi | Description: Diagnostic mammography, including computer-aided detection (cad) when performed; bilateral |
| G0206 | Dx mammo incl cad uni | Description: Diagnostic mammography, including computer-aided detection (cad) when performed; unilateral |
| G0219 | Pet img wholbod melano nonco | Description: Pet imaging whole body; melanoma for non-covered indications |
| G0235 | Pet not otherwise specified | Description: Pet imaging, any site, not otherwise specified |
| G0237 | Therapeutic procd strg endur | Description: Therapeutic procedures to increase strength or endurance of respiratory muscles, face to face, one on one, each 15 minutes (includes monitoring) |
| G0238 | Oth resp proc, indiv | Description: Therapeutic procedures to improve respiratory function, other than described by g0237, one on one, face to face, per 15 minutes (includes monitoring) |
| G0239 | Oth resp proc, group | Description: Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring) |
| G0245 | Initial foot exam pt lops | Description: Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) which must include: (1) the diagnosis of lops, (2) a patient history, (3) a physical examination that consists of at least the following elements: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of a protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear and (4) patient education |
| G0246 | Followup eval of foot pt lop | Description: Follow-up physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) to include at least the following: (1) a patient history, (2) a physical examination that includes: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear, and (3) patient education |
| G0247 | Routine footcare pt w lops | Description: Routine foot care by a physician of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) to include, the local care of superficial wounds (i.e. superficial to muscle and fascia) and at least the following if present: (1) local care of superficial wounds, (2) debridement of corns and calluses, and (3) trimming and debridement of nails |
| G0248 | Demonstrate use home inr mon | Description: Demonstration, prior to initiation of home inr monitoring, for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria, under the direction of a physician; includes: face-to-face demonstration of use and care of the inr monitor, obtaining at least one blood sample, provision of instructions for reporting home inr test results, and documentation of patient's ability to perform testing and report results |
| G0249 | Provide inr test mater/equip | Description: Provision of test materials and equipment for home inr monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; includes: provision of materials for use in the home and reporting of test results to physician; testing not occurring more frequently than once a week; testing materials, billing units of service include 4 tests |
| G0250 | Md inr test revie inter mgmt | Description: Physician review, interpretation, and patient management of home inr testing for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; testing not occurring more frequently than once a week; billing units of service include 4 tests |
| G0251 | Linear acc based stero radio | Description: Linear accelerator based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, maximum five sessions per course of treatment |
| G0252 | Pet imaging initial dx | Description: Pet imaging, full and partial-ring pet scanners only, for initial diagnosis of breast cancer and/or surgical planning for breast cancer (e.g., initial staging of axillary lymph nodes) |
| G0255 | Current percep threshold tst | Description: Current perception threshold/sensory nerve conduction test, (snct) per limb, any nerve |
| G0257 | Unsched dialysis esrd pt hos | Description: Unscheduled or emergency dialysis treatment for an esrd patient in a hospital outpatient department that is not certified as an esrd facility |
| G0259 | Inject for sacroiliac joint | Description: Injection procedure for sacroiliac joint; arthrography |
| G0260 | Inj for sacroiliac jt anesth | Description: Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography |
| G0268 | Removal of impacted wax md | Description: Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing |
| G0269 | Occlusive device in vein art | Description: Placement of occlusive device into either a venous or arterial access site, post surgical or interventional procedure (e.g., angioseal plug, vascular plug) |
| G0270 | Mnt subs tx for change dx | Description: Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes |
| G0271 | Group mnt 2 or more 30 mins | Description: Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes |
| G0276 | Pild/placebo control clin tr | Description: Blinded procedure for lumbar stenosis, percutaneous image-guided lumbar decompression (pild) or placebo-control, performed in an approved coverage with evidence development (ced) clinical trial |
| G0277 | Hbot, full body chamber, 30m | Description: Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval |
| G0278 | Iliac art angio,cardiac cath | Description: Iliac and/or femoral artery angiography, non-selective, bilateral or ipsilateral to catheter insertion, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of the catheter in the distal aorta or ipsilateral femoral or iliac artery, injection of dye, production of permanent images, and radiologic supervision and interpretation (list separately in addition to primary procedure) |
| G0279 | Tomosynthesis, mammo | Description: Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) |
| G0281 | Elec stim unattend for press | Description: Electrical stimulation, (unattended), to one or more areas, for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of care |
| G0282 | Elect stim wound care not pd | Description: Electrical stimulation, (unattended), to one or more areas, for wound care other than described in g0281 |
| G0283 | Elec stim other than wound | Description: Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care |
| G0288 | Recon, cta for surg plan | Description: Reconstruction, computed tomographic angiography of aorta for surgical planning for vascular surgery |
| G0289 | Arthro, loose body + chondro | Description: Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage (chondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee |
| G0293 | Non-cov surg proc,clin trial | Description: Noncovered surgical procedure(s) using conscious sedation, regional, general or spinal anesthesia in a medicare qualifying clinical trial, per day |
| G0294 | Non-cov proc, clinical trial | Description: Noncovered procedure(s) using either no anesthesia or local anesthesia only, in a medicare qualifying clinical trial, per day |
| G0295 | Electromagnetic therapy onc | Description: Electromagnetic therapy, to one or more areas, for wound care other than described in g0329 or for other uses |
| G0296 | Visit to determ ldct elig | Description: Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making) |
| G0297 | Ldct for lung ca screen | Description: Low dose ct scan (ldct) for lung cancer screening |
| G0299 | Hhs/hospice of rn ea 15 min | Description: Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes |
| G0300 | Hhs/hospice of lpn ea 15 min | Description: Direct skilled nursing services of a licensed practical nurse (lpn) in the home health or hospice setting, each 15 minutes |
| G0302 | Pre-op service lvrs complete | Description: Pre-operative pulmonary surgery services for preparation for lvrs, complete course of services, to include a minimum of 16 days of services |
| G0303 | Pre-op service lvrs 10-15dos | Description: Pre-operative pulmonary surgery services for preparation for lvrs, 10 to 15 days of services |
| G0304 | Pre-op service lvrs 1-9 dos | Description: Pre-operative pulmonary surgery services for preparation for lvrs, 1 to 9 days of services |
| G0305 | Post op service lvrs min 6 | Description: Post-discharge pulmonary surgery services after lvrs, minimum of 6 days of services |
| G0306 | Cbc/diffwbc w/o platelet | Description: Complete cbc, automated (hgb, hct, rbc, wbc, without platelet count) and automated wbc differential count |
| G0307 | Cbc without platelet | Description: Complete (cbc), automated (hgb, hct, rbc, wbc; without platelet count) |
| G0308 | 180 d implant glucose sensor | Description: Creation of subcutaneous pocket with insertion of 180 day implantable interstitial glucose sensor, including system activation and patient training |
| G0309 | Rem/inser glu sensor dif sit | Description: Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and insertion of new 180 day implantable sensor, including system activation |
| G0310 | Immunize counsel 5-15 min | Description: Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service, 5 to 15 mins time (this code is used for medicaid billing purposes) |
| G0311 | Immunize counsel 16-30 mins | Description: Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service, 16-30 mins time (this code is used for medicaid billing purposes) |
| G0312 | Immunize couns < 21yr 5-15 m | Description: Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service for ages under 21, 5 to 15 mins time (this code is used for medicaid billing purposes) |
| G0313 | Immunize couns < 21yr 6-30 m | Description: Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service for ages under 21, 16-30 mins time (this code is used for medicaid billing purposes) |
| G0314 | Counsel immune <21 16-30 m | Description: Immunization counseling by a physician or other qualified health care professional for covid-19, ages under 21, 16-30 mins time (this code is used for the medicaid early and periodic screening, diagnostic, and treatment benefit (epsdt) |
| G0315 | Counsel immune <21 5-15 m | Description: Immunization counseling by a physician or other qualified health care professional for covid-19, ages under 21, 5-15 mins time (this code is used for the medicaid early and periodic screening, diagnostic, and treatment benefit (epsdt) |
| G0316 | Prolong inpt eval add15 m | Description: Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99223, 99233, and 99236 for hospital inpatient or observation care evaluation and management services). (do not report g0316 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99418, 99415, 99416). (do not report g0316 for any time unit less than 15 minutes) |
| G0317 | Prolong nursin fac eval 15m | Description: Prolonged nursing facility evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99306, 99310 for nursing facility evaluation and management services). (do not report g0317 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99418). (do not report g0317 for any time unit less than 15 minutes) |
| G0318 | Prolong home eval add 15m | Description: Prolonged home or residence evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99345, 99350 for home or residence evaluation and management services). (do not report g0318 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99417). (do not report g0318 for any time unit less than 15 minutes) |
| G0320 | Two-way audio and video hhs | Description: Home health services furnished using synchronous telemedicine rendered via a real-time two-way audio and video telecommunications system |
| G0321 | Audio-only hhs | Description: Home health services furnished using synchronous telemedicine rendered via telephone or other real-time interactive audio-only telecommunications system |
| G0322 | Home h physio data collec tr | Description: The collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency (i.e., remote patient monitoring) |
| G0323 | Care manage beh svs 20mins | Description: Care management services for behavioral health conditions, at least 20 minutes of clinical psychologist, clinical social worker, mental health counselor, or marriage and family therapist time, per calendar month. (these services include the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales; behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes; facilitating and coordinating treatment such as psychotherapy, coordination with and/or referral to physicians and practitioners who are authorized by medicare to prescribe medications and furnish e/m services, counseling and/or psychiatric consultation; and continuity of care with a designated member of the care team) |
| G0327 | Colon ca scrn;bld-bsd biomrk | Description: Colorectal cancer screening; blood-based biomarker |
| G0328 | Fecal blood scrn immunoassay | Description: Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous |
| G0329 | Electromagntic tx for ulcers | Description: Electromagnetic therapy, to one or more areas for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care as part of a therapy plan of care |
| G0330 | Facility svs dental rehab | Description: Facility services for dental rehabilitation procedure(s) performed on a patient who requires monitored anesthesia (e.g., general, intravenous sedation (monitored anesthesia care) and use of an operating room |
| G0333 | Dispense fee initial 30 day | Description: Pharmacy dispensing fee for inhalation drug(s); initial 30-day supply as a beneficiary |
| G0337 | Hospice evaluation preelecti | Description: Hospice evaluation and counseling services, pre-election |
| G0339 | Robot lin-radsurg com, first | Description: Image-guided robotic linear accelerator-based stereotactic radiosurgery, complete course of therapy in one session or first session of fractionated treatment |
| G0340 | Robt lin-radsurg fractx 2-5 | Description: Image-guided robotic linear accelerator-based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, second through fifth sessions, maximum five sessions per course of treatment |
| G0341 | Percutaneous islet celltrans | Description: Percutaneous islet cell transplant, includes portal vein catheterization and infusion |
| G0342 | Laparoscopy islet cell trans | Description: Laparoscopy for islet cell transplant, includes portal vein catheterization and infusion |
| G0343 | Laparotomy islet cell transp | Description: Laparotomy for islet cell transplant, includes portal vein catheterization and infusion |
| G0364 | Bone marrow aspirate &biopsy | Description: Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service |
| G0365 | Vessel mapping hemo access | Description: Vessel mapping of vessels for hemodialysis access (services for preoperative vessel mapping prior to creation of hemodialysis access using an autogenous hemodialysis conduit, including arterial inflow and venous outflow) |
| G0372 | Md service required for pmd | Description: Physician service required to establish and document the need for a power mobility device |
| G0378 | Hospital observation per hr | Description: Hospital observation service, per hour |
| G0379 | Direct refer hospital observ | Description: Direct admission of patient for hospital observation care |
| G0380 | Lev 1 hosp type b ed visit | Description: Level 1 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) |
| G0381 | Lev 2 hosp type b ed visit | Description: Level 2 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) |
| G0382 | Lev 3 hosp type b ed visit | Description: Level 3 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) |
| G0383 | Lev 4 hosp type b ed visit | Description: Level 4 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) |
| G0384 | Lev 5 hosp type b ed visit | Description: Level 5 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) |
| G0389 | Ultrasound exam aaa screen | Description: Ultrasound b-scan and/or real time with image documentation; for abdominal aortic aneurysm (aaa) screening |
| G0390 | Trauma respons w/hosp criti | Description: Trauma response team associated with hospital critical care service |
| G0396 | Alcohol/subs interv 15-30mn | Description: Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes |
| G0397 | Alcohol/subs interv >30 min | Description: Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes |
| G0398 | Home sleep test/type 2 porta | Description: Home sleep study test (hst) with type ii portable monitor, unattended; minimum of 7 channels: eeg, eog, emg, ecg/heart rate, airflow, respiratory effort and oxygen saturation |
| G0399 | Home sleep test/type 3 porta | Description: Home sleep test (hst) with type iii portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ecg/heart rate and 1 oxygen saturation |
| G0400 | Home sleep test/type 4 porta | Description: Home sleep test (hst) with type iv portable monitor, unattended; minimum of 3 channels |
| G0402 | Initial preventive exam | Description: Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment |
| G0403 | Ekg for initial prevent exam | Description: Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report |
| G0404 | Ekg tracing for initial prev | Description: Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination |
| G0405 | Ekg interpret & report preve | Description: Electrocardiogram, routine ecg with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination |
| G0406 | Inpt/tele follow up 15 | Description: Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth |
| G0407 | Inpt/tele follow up 25 | Description: Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth |
| G0408 | Inpt/tele follow up 35 | Description: Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth |
| G0409 | Corf related serv 15 mins ea | Description: Social work and psychological services, directly relating to and/or furthering the patient's rehabilitation goals, each 15 minutes, face-to-face; individual (services provided by a corf-qualified social worker or psychologist in a corf) |
| G0410 | Grp psych php/iop 45-50 | Description: Group psychotherapy other than of a multiple-family group, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes |
| G0411 | Interactive grp psyc php/iop | Description: Interactive group psychotherapy, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes |
| G0416 | Prostate biopsy, any mthd | Description: Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method |
| G0417 | Sat biopsy prostate 21-40 | Description: Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, 21-40 specimens |
| G0418 | Sat biopsy prostate 41-60 | Description: Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, 41-60 specimens |
| G0419 | Sat biopsy prostate: >60 | Description: Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, >60 specimens |
| G0420 | Ed svc ckd ind per session | Description: Face-to-face educational services related to the care of chronic kidney disease; individual, per session, per one hour |
| G0421 | Ed svc ckd grp per session | Description: Face-to-face educational services related to the care of chronic kidney disease; group, per session, per one hour |
| G0422 | Intens cardiac rehab w/exerc | Description: Intensive cardiac rehabilitation; with or without continuous ecg monitoring with exercise, per session |
| G0423 | Intens cardiac rehab no exer | Description: Intensive cardiac rehabilitation; with or without continuous ecg monitoring; without exercise, per session |
| G0424 | Pulmonary rehab w exer | Description: Pulmonary rehabilitation, including exercise (includes monitoring), one hour, per session, up to two sessions per day |
| G0425 | Inpt/ed teleconsult30 | Description: Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth |
| G0426 | Inpt/ed teleconsult50 | Description: Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth |
| G0427 | Inpt/ed teleconsult70 | Description: Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth |
| G0428 | Collagen meniscus implant | Description: Collagen meniscus implant procedure for filling meniscal defects (e.g., cmi, collagen scaffold, menaflex) |
| G0429 | Dermal filler injection(s) | Description: Dermal filler injection(s) for the treatment of facial lipodystrophy syndrome (lds) (e.g., as a result of highly active antiretroviral therapy) |
| G0431 | Drug screen multiple class | Description: Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter |
| G0432 | Eia hiv-1/hiv-2 screen | Description: Infectious agent antibody detection by enzyme immunoassay (eia) technique, hiv-1 and/or hiv-2, screening |
| G0433 | Elisa hiv-1/hiv-2 screen | Description: Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening |
| G0434 | Drug screen multi drug class | Description: Drug screen, other than chromatographic; any number of drug classes, by clia waived test or moderate complexity test, per patient encounter |
| G0435 | Oral hiv-1/hiv-2 screen | Description: Infectious agent antibody detection by rapid antibody test, hiv-1 and/or hiv-2, screening |
| G0436 | Tobacco-use counsel 3-10 min | Description: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes |
| G0437 | Tobacco-use counsel>10min | Description: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes |
| G0439 | Ppps, subseq visit | Description: Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
| G0442 | Annual alcohol screen 15 min | Description: Annual alcohol misuse screening, 5 to 15 minutes |
| G0443 | Brief alcohol misuse counsel | Description: Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes |
| G0444 | Depression screen annual | Description: Annual depression screening, 5 to 15 minutes |
| G0445 | High inten beh couns std 30m | Description: High intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual, includes: education, skills training and guidance on how to change sexual behavior; performed semi-annually, 30 minutes |
| G0446 | Intens behave ther cardio dx | Description: Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes |
| G0447 | Behavior counsel obesity 15m | Description: Face-to-face behavioral counseling for obesity, 15 minutes |
| G0448 | Place perm pacing cardiovert | Description: Insertion or replacement of a permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber with insertion of pacing electrode, cardiac venous system, for left ventricular pacing |
| G0451 | Devlopment test interpt&rep | Description: Development testing, with interpretation and report, per standardized instrument form |
| G0452 | Molecular pathology interpr | Description: Molecular pathology procedure; physician interpretation and report |
| G0453 | Cont intraop neuro monitor | Description: Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition to primary procedure) |
| G0454 | Md document visit by npp | Description: Physician documentation of face-to-face visit for durable medical equipment determination performed by nurse practitioner, physician assistant or clinical nurse specialist |
| G0455 | Fecal microbiota prep instil | Description: Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen |
| G0456 | Neg pre wound <=50 sq cm | Description: Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area less than or equal to 50 square centimeters |
| G0457 | Neg pres wound >50 sq cm | Description: Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area greater than 50 square centimeters |
| G0458 | Ldr prostate brachy comp rat | Description: Low dose rate (ldr) prostate brachytherapy services, composite rate |
| G0459 | Telehealth inpt pharm mgmt | Description: Inpatient telehealth pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy |
| G0460 | Autolog prp not diab ulcer | Description: Autologous platelet rich plasma or other blood-derived product for non-diabetic chronic wounds/ulcers, including as applicable phlebotomy, centrifugation or mixing, and all other preparatory procedures, administration and dressings, per treatment |
| G0461 | Immunohisto/cyto chem 1st st | Description: Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stain |
| G0462 | Immunohisto/cyto chem add | Description: Immunohistochemistry or immunocytochemistry, per specimen; each additional single or multiplex antibody stain (list separately in addition to code for primary procedure) |
| G0463 | Hospital outpt clinic visit | Description: Hospital outpatient clinic visit for assessment and management of a patient |
| G0464 | Colorec ca scr, sto bas dna | Description: Colorectal cancer screening; stool-based dna and fecal occult hemoglobin (e.g., kras, ndrg4 and bmp3) |
| G0465 | Autolog prp diab wound ulcer | Description: Autologous platelet rich plasma (prp) or other blood-derived product for diabetic chronic wounds/ulcers, using an fda-cleared device for this indication, (includes as applicable administration, dressings, phlebotomy, centrifugation or mixing, and all other preparatory procedures, per treatment) |
| G0466 | Fqhc visit new patient | Description: Federally qualified health center (fqhc) visit, new patient; a medically-necessary, face-to-face encounter (one-on-one) between a new patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit |
| G0467 | Fqhc visit, estab pt | Description: Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit |
| G0468 | Fqhc visit, ippe or awv | Description: Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv |
| G0469 | Fqhc visit, mh new pt | Description: Federally qualified health center (fqhc) visit, mental health, new patient; a medically-necessary, face-to-face mental health encounter (one-on-one) between a new patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a mental health visit |
| G0470 | Fqhc visit, mh estab pt | Description: Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a mental health visit |
| G0471 | Ven blood coll snf/hha | Description: Collection of venous blood by venipuncture or urine sample by catheterization from an individual in a skilled nursing facility (snf) or by a laboratory on behalf of a home health agency (hha) |
| G0472 | Hep c screen high risk/other | Description: Hepatitis c antibody screening, for individual at high risk and other covered indication(s) |
| G0473 | Group behave couns 2-10 | Description: Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes |
| G0475 | Hiv combination assay | Description: Hiv antigen/antibody, combination assay, screening |
| G0476 | Hpv combo assay ca screen | Description: Infectious agent detection by nucleic acid (dna or rna); human papillomavirus (hpv), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test |
| G0477 | Drug test presump optical | Description: Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) capable of being read by direct optical observation only (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service |
| G0478 | Drug test presump opt inst | Description: Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) read by instrument-assisted direct optical observation (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service |
| G0479 | Drug test presump not opt | Description: Drug test(s), presumptive, any number of drug classes; any number of devices or procedures by instrumented chemistry analyzers utilizing immunoassay, enzyme assay, tof, maldi, ldtd, desi, dart, ghpc, gc mass spectrometry), includes sample validation when performed, per date of service |
| G0480 | Drug test def 1-7 classes | Description: Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed |
| G0481 | Drug test def 8-14 classes | Description: Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 8-14 drug class(es), including metabolite(s) if performed |
| G0482 | Drug test def 15-21 classes | Description: Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 15-21 drug class(es), including metabolite(s) if performed |
| G0483 | Drug test def 22+ classes | Description: Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed |
| G0490 | Home visit rn, lpn by rhc/fq | Description: Face-to-face home health nursing visit by a rural health clinic (rhc) or federally qualified health center (fqhc) in an area with a shortage of home health agencies; (services limited to rn or lpn only) |
| G0491 | Dialysis acu kidney no esrd | Description: Dialysis procedure at a medicare certified esrd facility for acute kidney injury without esrd |
| G0492 | Md/oth eval acut kid no esrd | Description: Dialysis procedure with single evaluation by a physician or other qualified health care professional for acute kidney injury without esrd |
| G0493 | Rn care ea 15 min hh/hospice | Description: Skilled services of a registered nurse (rn) for the observation and assessment of the patient's condition, each 15 minutes (the change in the patient's condition requires skilled nursing personnel to identify and evaluate the patient's need for possible modification of treatment in the home health or hospice setting) |
| G0494 | Lpn care ea 15min hh/hospice | Description: Skilled services of a licensed practical nurse (lpn) for the observation and assessment of the patient's condition, each 15 minutes (the change in the patient's condition requires skilled nursing personnel to identify and evaluate the patient's need for possible modification of treatment in the home health or hospice setting) |
| G0495 | Rn care train/edu in hh | Description: Skilled services of a registered nurse (rn), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes |
| G0496 | Lpn care train/edu in hh | Description: Skilled services of a licensed practical nurse (lpn), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes |
| G0498 | Chemo extend iv infus w/pump | Description: Chemotherapy administration, intravenous infusion technique; initiation of infusion in the office/clinic setting using office/clinic pump/supplies, with continuation of the infusion in the community setting (e.g., home, domiciliary, rest home or assisted living) using a portable pump provided by the office/clinic, includes follow up office/clinic visit at the conclusion of the infusion |
| G0499 | Hepb screen high risk indiv | Description: Hepatitis b screening in non-pregnant, high risk individual includes hepatitis b surface antigen (hbsag), antibodies to hbsag (anti-hbs) and antibodies to hepatitis b core antigen (anti-hbc), and is followed by a neutralizing confirmatory test, when performed, only for an initially reactive hbsag result |
| G0500 | Mod sedat endo service >5yrs | Description: Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intra-service time; patient age 5 years or older (additional time may be reported with 99153, as appropriate) |
| G0501 | Resource-inten svc during ov | Description: Resource-intensive services for patients for whom the use of specialized mobility-assistive technology (such as adjustable height chairs or tables, patient lift, and adjustable padded leg supports) is medically necessary and used during the provision of an office/outpatient, evaluation and management visit (list separately in addition to primary service) |
| G0502 | Init psych care manag, 70min | Description: Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: outreach to and engagement in treatment of a patient directed by the treating physician or other qualified health care professional; initial assessment of the patient, including administration of validated rating scales, with the development of an individualized treatment plan; review by the psychiatric consultant with modifications of the plan if recommended; entering patient in a registry and tracking patient follow-up and progress using the registry, with appropriate documentation, and participation in weekly caseload consultation with the psychiatric consultant; and provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies |
| G0503 | Subseq psych care man,60mi | Description: Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: tracking patient follow-up and progress using the registry, with appropriate documentation; participation in weekly caseload consultation with the psychiatric consultant; ongoing collaboration with and coordination of the patient's mental health care with the treating physician or other qualified health care professional and any other treating mental health providers; additional review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations provided by the psychiatric consultant; provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies; monitoring of patient outcomes using validated rating scales; and relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharge from active treatment |
| G0504 | Init/sub psych care add 30 m | Description: Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional (list separately in addition to code for primary procedure); (use g0504 in conjunction with g0502, g0503) |
| G0505 | Cog/func assessment outpt | Description: Cognition and functional assessment using standardized instruments with development of recorded care plan for the patient with cognitive impairment, history obtained from patient and/or caregiver, in office or other outpatient setting or home or domiciliary or rest home |
| G0506 | Comp asses care plan ccm svc | Description: Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service) |
| G0507 | Care manage serv minimum 20 | Description: Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month, with the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales; behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes; facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation; and continuity of care with a designated member of the care team |
| G0508 | Crit care telehea consult 60 | Description: Telehealth consultation, critical care, initial , physicians typically spend 60 minutes communicating with the patient and providers via telehealth |
| G0509 | Crit care telehea consult 50 | Description: Telehealth consultation, critical care, subsequent, physicians typically spend 50 minutes communicating with the patient and providers via telehealth |
| G0513 | Prolong prev svcs, first 30m | Description: Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (list separately in addition to code for preventive service) |
| G0514 | Prolong prev svcs, addl 30m | Description: Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes (list separately in addition to code g0513 for additional 30 minutes of preventive service) |
| G0515 | Cognitive skills development | Description: Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes |
| G0516 | Insert drug del implant, >=4 | Description: Insertion of non-biodegradable drug delivery implants, 4 or more (services for subdermal rod implant) |
| G0517 | Remove drug implant | Description: Removal of non-biodegradable drug delivery implants, 4 or more (services for subdermal implants) |
| G0518 | Remove w insert drug implant | Description: Removal with reinsertion, non-biodegradable drug delivery implants, 4 or more (services for subdermal implants) |
| G0519 | New pt-cg dyad dem low cmplx | Description: Management of new patient-caregiver dyad with dementia, low complexity, for use in cmmi model |
| G0520 | New pt-cg dyad dem mod cmplx | Description: Management of new patient-caregiver dyad with dementia, moderate complexity, for use in cmmi model |
| G0521 | New pt-cg dyad dem hig cmplx | Description: Management of new patient-caregiver dyad with dementia, high complexity, for use in cmmi model |
| G0522 | Mgt nw pt dementia low cmplx | Description: Management of a new patient with dementia, low complexity, for use in cmmi model |
| G0523 | Mgt nw pt dem mod-high cmplx | Description: Management of a new patient with dementia, moderate to high complexity, for use in cmmi model |
| G0524 | Est pt-cg dyad dem low cmplx | Description: Management of established patient-caregiver dyad with dementia, low complexity, for use in cmmi model |
| G0525 | Est pt-cg dyad dem mod cmplx | Description: Management of established patient-caregiver dyad with dementia, moderate complexity, for use in cmmi model |
| G0526 | Est pt-cg dyad dem hig cmplx | Description: Management of established patient-caregiver dyad with dementia, high complexity, for use in cmmi model |
| G0527 | Mgt est pt dmentia low cmplx | Description: Management of established patient with dementia, low complexity, for use in cmmi model |
| G0528 | Mgt est pt dem mod-hi cmplx | Description: Management of established patient with dementia, moderate to high complexity, for use in cmmi model |
| G0529 | In home respite care, 4 hr u | Description: In-home respite care, 4-hour unit, for use in cmmi model |
| G0530 | Adult daycare center, 8 hr u | Description: Adult day center, 8-hour unit, for use in cmmi model |
| G0531 | Fclty-based respite, 24 hr u | Description: Facility-based respite, 24-hour unit, for use in cmmi model |
| 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 |
| 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 |
| 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 |
| G0567 | Screening hep c detect | Description: Infectious agent detection by nucleic acid (dna or rna); hepatitis c, screening, amplified probe technique |
| G0659 | Drug test def simple all cl | Description: Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem), excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase), performed without method or drug-specific calibration, without matrix-matched quality control material, or without use of stable isotope or other universally recognized internal standard(s) for each drug, drug metabolite or drug class per specimen; qualitative or quantitative, all sources, includes specimen validity testing, per day, any number of drug classes |
| G0908 | Hgb > 12 g/dl | Description: Most recent hemoglobin (hgb) level > 12.0 g/dl |
| G0909 | Hbg not doc | Description: Hemoglobin level measurement not documented, reason not given |
| G0910 | Hgb <= 12 g/dl | Description: Most recent hemoglobin level <= 12.0 g/dl |
| G0913 | Improve visual funct | Description: Improvement in visual function achieved within 90 days following cataract surgery |
| G0914 | Survey not complete | Description: Patient care survey was not completed by patient |