Medical Billing Code Search
What is a code?
8892 results found
| 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) |
| 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) |
| 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 |
| 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) |
| 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 |
| G0412 | Open tx iliac spine uni/bil | Description: Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s), unilateral or bilateral for pelvic bone fracture patterns which do not disrupt the pelvic ring includes internal fixation, when performed |
| G0413 | Pelvic ring fracture uni/bil | Description: Percutaneous skeletal fixation of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, (includes ilium, sacroiliac joint and/or sacrum) |
| G0414 | Pelvic ring fx treat int fix | Description: Open treatment of anterior pelvic bone fracture and/or dislocation for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation when performed (includes pubic symphysis and/or superior/inferior rami) |
| G0415 | Open tx post pelvic fxcture | Description: Open treatment of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation, when performed (includes ilium, sacroiliac joint and/or sacrum) |
| G0416 | Prostate biopsy, any mthd | Description: Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method |
| 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 |
| 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) |
| 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 |
| G0435 | Oral hiv-1/hiv-2 screen | Description: Infectious agent antibody detection by rapid antibody test, hiv-1 and/or hiv-2, screening |
| G0438 | Ppps, initial visit | Description: Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit |
| 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 |
| 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 |
| G0463 | Hospital outpt clinic visit | Description: Hospital outpatient clinic visit for assessment and management of a patient |
| 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 |
| 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) |
| 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) |
| 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 |
| G0511 | Ccm/bhi by rhc/fqhc 20min mo | Description: Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month |
| G0512 | Cocm by rhc/fqhc 60 min mo | Description: Rural health clinic or federally qualified health center (rhc/fqhc) only, psychiatric collaborative care model (psychiatric cocm), 60 minutes or more of clinical staff time for psychiatric cocm services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm) and including services furnished by a behavioral health care manager and consultation with a psychiatric consultant, per calendar month |
| 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) |
| 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) |
| 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 |
| 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 |
| G0915 | No improve visual funct | Description: Improvement in visual function not achieved within 90 days following cataract surgery |
| G0916 | Satisfy with care | Description: Satisfaction with care achieved within 90 days following cataract surgery |
| G0917 | Care survey not complete | Description: Patient care survey was not completed by patient |
| G0918 | No satisfy with care | Description: Satisfaction with care not achieved within 90 days following cataract surgery |
| G1001 | Cdsm evicore | Description: Clinical decision support mechanism evicore, as defined by the medicare appropriate use criteria program |
| G1002 | Cdsm medcurrent | Description: Clinical decision support mechanism medcurrent, as defined by the medicare appropriate use criteria program |
| G1003 | Cdsm medicalis | Description: Clinical decision support mechanism medicalis, as defined by the medicare appropriate use criteria program |
| G1004 | Cdsm ndsc | Description: Clinical decision support mechanism national decision support company, as defined by the medicare appropriate use criteria program |
| G1007 | Cdsm aim | Description: Clinical decision support mechanism aim specialty health, as defined by the medicare appropriate use criteria program |
| G1008 | Cdsm cranberry pk | Description: Clinical decision support mechanism cranberry peak, as defined by the medicare appropriate use criteria program |
| G1010 | Cdsm stanson | Description: Clinical decision support mechanism stanson, as defined by the medicare appropriate use criteria program |
| G1011 | Cdsm qualified nos | Description: Clinical decision support mechanism, qualified tool not otherwise specified, as defined by the medicare appropriate use criteria program |
| G1012 | Cdsm agilemd | Description: Clinical decision support mechanism agilemd, as defined by the medicare appropriate use criteria program |
| G1013 | Cdsm evidencecare | Description: Clinical decision support mechanism evidencecare imagingcare, as defined by the medicare appropriate use criteria program |
| G1014 | Cdsm inveniqa | Description: Clinical decision support mechanism inveniqa semantic answers in medicine, as defined by the medicare appropriate use criteria program |
| G1015 | Cdsm reliant | Description: Clinical decision support mechanism reliant medical group, as defined by the medicare appropriate use criteria program |
| G1016 | Cdsm speed of care | Description: Clinical decision support mechanism speed of care, as defined by the medicare appropriate use criteria program |
| G1017 | Cdsm healthhelp | Description: Clinical decision support mechanism healthhelp, as defined by the medicare appropriate use criteria program |
| G1018 | Cdsm infinx | Description: Clinical decision support mechanism infinx, as defined by the medicare appropriate use criteria program |
| G1019 | Cdsm logicnets | Description: Clinical decision support mechanism logicnets, as defined by the medicare appropriate use criteria program |
| G1020 | Cdsm curbside | Description: Clinical decision support mechanism curbside clinical augmented workflow, as defined by the medicare appropriate use criteria program |
| G1021 | Cdsm ehealthline | Description: Clinical decision support mechanism ehealthline clinical decision support mechanism, as defined by the medicare appropriate use criteria program |
| G1022 | Cdsm intermountain | Description: Clinical decision support mechanism intermountain clinical decision support mechanism, as defined by the medicare appropriate use criteria program |
| G1023 | Cdsm persivia | Description: Clinical decision support mechanism persivia clinical decision support, as defined by the medicare appropriate use criteria program |
| G1024 | Cdsm radrite | Description: Clinical decision support mechanism radrite, as defined by the medicare appropriate use criteria program |
| G1025 | Pt mnth 1 mcp prov | Description: Patient-months where there are more than one medicare capitated payment (mcp) provider listed for the month |
| G1026 | Pt hemo > 3mo | Description: The number of adult patient-months in the denominator who were on maintenance hemodialysis using a catheter continuously for three months or longer under the care of the same practitioner or group partner as of the last hemodialysis session of the reporting month |
| G1027 | Pt hemo < 3mo | Description: The number of adult patient-months in the denominator who were on maintenance hemodialysis under the care of the same practitioner or group partner as of the last hemodialysis session of the reporting month using a catheter continuously for less than three months |
| G1028 | Take home supply 8mg per 0.1 | Description: Take-home supply of nasal naloxone; 2-pack of 8mg per 0.1 ml nasal spray (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure |
| G2000 | Blinded conv. tx mdd clin tr | Description: Blinded administration of convulsive therapy procedure, either electroconvulsive therapy (ect, current covered gold standard) or magnetic seizure therapy (mst, non-covered experimental therapy), performed in an approved ide-based clinical trial, per treatment session |
| G2001 | Post d/c h vst new pt 20 m | Description: Brief (20 minutes) in-home visit for a new patient post-discharge. 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 within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2002 | Post-d/c h vst new pt 30 m | Description: Limited (30 minutes) in-home visit for a new patient post-discharge. 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 within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2003 | Post-d/c h vst new pt 45 m | Description: Moderate (45 minutes) in-home visit for a new patient post-discharge. 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 within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2004 | Post-d/c h vst new pt 60 m | Description: Comprehensive (60 minutes) in-home visit for a new patient post-discharge. 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 within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2005 | Post-d/c h vst new pt 75 m | Description: Extensive (75 minutes) in-home visit for a new patient post-discharge. 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 within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2006 | Post-d/c h vst ext pt 20 m | Description: Brief (20 minutes) in-home visit for an existing patient post-discharge. 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 within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2007 | Post-d/c h vst ext pt 30 m | Description: Limited (30 minutes) in-home visit for an existing patient post-discharge. 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 within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2008 | Post-d/c h vst ext pt 45 m | Description: Moderate (45 minutes) in-home visit for an existing patient post-discharge. 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 within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2009 | Post-d/c h vst ext pt 60 m | Description: Comprehensive (60 minutes) in-home visit for an existing patient post-discharge. 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 within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2010 | Remot image submit by pt | Description: Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment |
| G2011 | Alcohol/sub misuse assess | Description: Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention, 5-14 minutes |
| G2013 | Post-d/c h vst ext pt 75 m | Description: Extensive (75 minutes) in-home visit for an existing patient post-discharge. 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 within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2014 | Post-d/c care plan overs 30m | Description: Limited (30 minutes) 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 within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2015 | Post-d/c care plan overs 60m | Description: Comprehensive (60 mins) 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 within 90 days following discharge from an inpatient facility.) |
| G2020 | Hi inten serv for sip model | Description: Services for high intensity clinical services associated with the initial engagement and outreach of beneficiaries assigned to the sip component of the pcf model (do not bill with chronic care management codes) |
| G2021 | Hea care pract tx in place | Description: Health care practitioners rendering treatment in place (tip) |
| G2022 | Benef refuses service, mod | Description: A model participant (ambulance supplier/provider), the beneficiary refuses services covered under the model (transport to an alternate destination/treatment in place) |
| G2025 | Dis site tele svcs rhc/fqhc | Description: Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
| G2067 | Med assist tx meth wk | Description: Medication assisted treatment, methadone; 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) |
| G2068 | Med assist tx bupre oral | Description: Medication assisted treatment, buprenorphine (oral); 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) |
| G2073 | Med tx naltrexone | Description: Medication assisted treatment, naltrexone; 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) |
| G2074 | Med assist tx no drug | Description: Medication assisted treatment, weekly bundle not including the drug, including substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) |
| G2075 | Med tx meds nos | Description: Medication assisted treatment, medication not otherwise specified; 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) |
| G2078 | Take-home meth | Description: Take-home supply of methadone; up to 7 additional day supply (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure |
| G2079 | Take-hom buprenorphine | Description: Take-home supply of buprenorphine (oral); up to 7 additional day supply (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure |
| G2080 | Add 30 mins counsel | Description: Each additional 30 minutes of counseling in a week of medication assisted treatment, (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure |
| G2081 | Pt 66+ snp or ltc pos > 90d | Description: Patients age 66 and older in institutional special needs plans (snp) or residing in long-term care with a pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period |
| G2082 | Visit esketamine 56m or less | Description: Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of up to 56 mg of esketamine nasal self-administration, includes 2 hours post-administration observation |
| G2083 | Visit esketamine, > 56m | Description: Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of greater than 56 mg esketamine nasal self-administration, includes 2 hours post-administration observation |
| G2086 | Off base opioid tx 70min | Description: Office-based treatment for opioid use disorder, including development of the treatment plan, care coordination, individual therapy and group therapy and counseling; at least 70 minutes in the first calendar month |
| G2087 | Off base opioid tx, 60 m | Description: Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; at least 60 minutes in a subsequent calendar month |
| G2088 | Off base opioid tx, add30 | Description: Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; each additional 30 minutes beyond the first 120 minutes (list separately in addition to code for primary procedure) |
| G2090 | Pt 66+ frailty and med dem | Description: Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period |
| G2092 | Ace arb arni | Description: Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) or angiotensin receptor-neprilysin inhibitor (arni) therapy prescribed or currently being taken |
| G2093 | Med doc rsn no ace arn arni | Description: Documentation of medical reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., hypotensive patients who are at immediate risk of cardiogenic shock, hospitalized patients who have experienced marked azotemia, allergy, intolerance, other medical reasons) |
| G2094 | Pt rsn no ace arn arni | Description: Documentation of patient reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., patient declined, other patient reasons) |
| G2096 | No rsn ace arb arni | Description: Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) or angiotensin receptor-neprilysin inhibitor (arni) therapy was not prescribed, reason not given |
| G2097 | Dx uri 3d after other dx | Description: Episodes where the patient had a competing diagnosis on or within three days after the episode date (e.g., intestinal infection, pertussis, bacterial infection, lyme disease, otitis media, acute sinusitis, chronic sinusitis, infection of the adenoids, prostatitis, cellulitis, mastoiditis, or bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia/gonococcal infections, venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis or uti) |
| G2098 | Pt 66+ frailty and med dem | Description: Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period |
| G2100 | Pt 66+ frailty and med dem | Description: Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period |
| G2105 | Pt 66+ snp or ltc pos > 90d | Description: Patient age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period |
| G2106 | Pt 66+ frailty and med dem | Description: Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period |
| G2112 | Pred<=5 mg ra glu <6m | Description: Patient receiving <=5 mg daily prednisone (or equivalent), or ra activity is worsening, or glucocorticoid use is for less than 6 months |
| G2113 | Pred>5 mg >6m, no chg da | Description: Patient receiving >5 mg daily prednisone (or equivalent) for longer than 6 months, and improvement or no change in disease activity |
| G2115 | Pt 66-80 frailty and med dem | Description: Patients 66 - 80 years of age with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period |
| G2118 | Pt 81+ frailty | Description: Patients 81 years of age and older with at least one claim/encounter for frailty during the measurement period |
| G2121 | Psy dep anx ap and icd asse | Description: Depression, anxiety, apathy, and psychosis assessed |
| G2122 | Psy/dep/anx/apandicd noasse | Description: Depression, anxiety, apathy, and psychosis not assessed |
| G2125 | Pt 81+ frailty | Description: Patients 81 years of age and older with at least one claim/encounter for frailty during the six months prior to the measurement period through december 31 of the measurement period |
| G2127 | Pt 66-80 frailty and med dem | Description: Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period |
| G2128 | No aspirin med rsn | Description: Documentation of medical reason(s) for not on a daily aspirin or other antiplatelet (e.g. history of gastrointestinal bleed, intra-cranial bleed, blood disorders, idiopathic thrombocytopenic purpura (itp), gastric bypass or documentation of active anticoagulant use during the measurement period) |
| G2129 | No bp outpt | Description: Procedure-related bp's not taken during an outpatient visit. examples include same day surgery, ambulatory service center, g.i. lab, dialysis, infusion center, chemotherapy |
| G2136 | Bk pain vas 6-20wk <= 3 | Description: Back pain measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively was less than or equal to 3.0 or back pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated an improvement of 5.0 points or greater |
| G2137 | Bk pain vas 6-20wk > 3 | Description: Back pain measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively was greater than 3.0 and back pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated improvement of less than 5.0 points |
| G2138 | Bk pain vas 9-15mo <= 3 | Description: Back pain as measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively was less than or equal to 3.0 or back pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of 5.0 points or greater |
| G2139 | Bk pain vas 9-15mo > 3 | Description: Back pain measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively was greater than 3.0 and back pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated improvement of less than 5.0 points |
| G2140 | Leg pain vas 6-20wk <= 3 | Description: Leg pain measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively was less than or equal to 3.0 or leg pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated an improvement of 5.0 points or greater |
| G2141 | Leg pain vas 6-20wk > 3 | Description: Leg pain measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively was greater than 3.0 and leg pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated improvement of less than 5.0 points |
| G2142 | Fs odi 9-15mo postop<= 22 | Description: Functional status measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively was less than or equal to 22 or functional status measured by the odi version 2.1a within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of 30 points or greater |
| G2143 | Fs odi 9-15mo > 22 | Description: Functional status measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively was greater than 22 and functional status measured by the odi version 2.1a within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of less than 30 points |
| G2144 | Fs odi 6-20wk postop <= 22 | Description: Functional status measured by the oswestry disability index (odi version 2.1a) at three months (6-20 weeks) postoperatively was less than or equal to 22 or functional status measured by the odi version 2.1a within three months preoperatively and at three months (6-20 weeks) postoperatively demonstrated an improvement of 30 points or greater |
| G2145 | Fsodi 6-20wk >22 or chg 30pt | Description: Functional status measured by the oswestry disability index (odi version 2.1a) at three months (6 - 20 weeks) postoperatively was greater than 22 and functional status measured by the odi version 2.1a within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated an improvement of less than 30 points |
| G2146 | Leg pain vas 9-15mo <= 3 | Description: Leg pain as measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively was less than or equal to 3.0 or leg pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of 5.0 points or greater |
| G2147 | Leg pain vas 9-15mo > 3 | Description: Leg pain measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively was greater than 3.0 and leg pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated improvement of less than 5.0 points |
| G2148 | Mpm used | Description: Multimodal pain management was used |
| G2149 | No mpm med rsn | Description: Documentation of medical reason(s) for not using multimodal pain management (e.g., allergy to multiple classes of analgesics, intubated patient, hepatic failure, patient reports no pain during pacu stay, other medical reason(s)) |
| G2150 | No mpm | Description: Multimodal pain management was not used |
| G2151 | Dx degen neuro | Description: Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time before or during the episode of care |
| G2152 | Res change sc >=0 | Description: Residual score for the neck impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) |
| G2167 | Res change sc < 0 | Description: Residual score for the neck impairment successfully calculated and the score was less than zero (< 0) |
| G2168 | Svs by pt in home health | Description: Services performed by a physical therapist assistant in the home health setting in the delivery of a safe and effective physical therapy maintenance program, each 15 minutes |
| G2169 | Svs by ot in home health | Description: Services performed by an occupational therapist assistant in the home health setting in the delivery of a safe and effective occupational therapy maintenance program, each 15 minutes |
| G2172 | Tx for opioid use demo proj | Description: All inclusive payment for services related to highly coordinated and integrated opioid use disorder (oud) treatment services furnished for the demonstration project |
| G2173 | Uri w comorb 12m oth dx | Description: Uri episodes where the patient had a comorbid condition during the 12 months prior to or on the episode date (e.g., tuberculosis, neutropenia, cystic fibrosis, chronic bronchitis, pulmonary edema, respiratory failure, rheumatoid lung disease) |
| G2174 | Uri new rx antibiotic 30d | Description: Uri episodes where the patient is taking antibiotics (table 1) in the 30 days prior to the episode date |
| G2175 | Pt comorb dx 12m of epi | Description: Episodes where the patient had a comorbid condition during the 12 months prior to or on the episode date (e.g., tuberculosis, neutropenia, cystic fibrosis, chronic bronchitis, pulmonary edema, respiratory failure, rheumatoid lung disease) |
| G2176 | Outpt ed obs w inpt admit | Description: Outpatient, ed, or observation visits that result in an inpatient admission |
| G2177 | Bronch w rx antibx 30d | Description: Acute bronchitis/bronchiolitis episodes when the patient had a new or refill prescription of antibiotics (table 1) in the 30 days prior to the episode date |
| G2178 | Pt not elig low neuro ex | Description: Clinician documented that patient was not an eligible candidate for lower extremity neurological exam measure, for example patient bilateral amputee; patient has condition that would not allow them to accurately respond to a neurological exam (dementia, alzheimer's, etc.); patient has previously documented diabetic peripheral neuropathy with loss of protective sensation |
| G2179 | Med doc rsn no low ex | Description: Clinician documented that patient had medical reason for not performing lower extremity neurological exam |
| G2180 | Inelig footwr eval | Description: Clinician documented that patient was not an eligible candidate for evaluation of footwear as patient is bilateral lower extremity amputee |
| G2181 | Bmi not doc medrsn ptref | Description: Bmi not documented due to medical reason or patient refusal of height or weight measurement |
| G2182 | Pt 1st biolog antirheum | Description: Patient receiving first-time biologic and/or immune response modifier therapy |
| G2183 | Doc pt unable comm | Description: Documentation patient unable to communicate and informant not available |
| G2184 | No caregiver | Description: Patient does not have a caregiver |
| G2185 | Caregiver dem trained | Description: Documentation caregiver is trained and certified in dementia care |
| G2186 | Pt ref app rsrcs | Description: Patient /caregiver dyad has been referred to appropriate resources and connection to those resources is confirmed |
| G2187 | Clin ind img hd trauma | Description: Patients with clinical indications for imaging of the head: head trauma |
| G2188 | Pt 50 yrs w/clin ind hd | Description: Patients with clinical indications for imaging of the head: new or change in headache above 50 years of age |
| G2189 | Img hd abnml neuro exam | Description: Patients with clinical indications for imaging of the head: abnormal neurologic exam |
| G2190 | Ind img hd rad neck | Description: Patients with clinical indications for imaging of the head: headache radiating to the neck |
| G2191 | Ind img hd pos hd ache | Description: Patients with clinical indications for imaging of the head: positional headaches |
| G2192 | >55 yrs temp hd ache | Description: Patients with clinical indications for imaging of the head: temporal headaches in patients over 55 years of age |
| G2193 | <6yr new onset hd ache | Description: Patients with clinical indications for imaging of the head: new onset headache in pre-school children or younger (<6 years of age) |
| G2194 | New hdache ped pt dis | Description: Patients with clinical indications for imaging of the head: new onset headache in pediatric patients with disabilities for which headache is a concern as inferred from behavior |
| G2195 | Occip hdache child | Description: Patients with clinical indications for imaging of the head: occipital headache in children |
| G2196 | Screen unhlthy etoh use | Description: Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method |
| G2197 | Screen hlthy etoh use | Description: Patient screened for unhealthy alcohol use using a systematic screening method and not identified as an unhealthy alcohol user |
| G2199 | Not scrn etoh no rsn | Description: Patient not screened for unhealthy alcohol use using a systematic screening method |
| G2200 | Unhlthy etoh rcvd couns | Description: Patient identified as an unhealthy alcohol user received brief counseling |
| G2202 | No rsn no brief couns | Description: Patient did not receive brief counseling if identified as an unhealthy alcohol user |
| G2204 | Pt 45-85 w/ scope | Description: Patients between 45 and 85 years of age who received a screening colonoscopy during the performance period |
| G2205 | Preg drng adjv trtmt | Description: Patients with pregnancy during adjuvant treatment course |
| G2206 | Adjv trtmt chemo her2 | Description: Patient received adjuvant treatment course including both chemotherapy and her2-targeted therapy |
| G2207 | Rsn no trtmt chem her2 | Description: Reason for not administering adjuvant treatment course including both chemotherapy and her2-targeted therapy (e.g. poor performance status (ecog 3-4; karnofsky <=50), cardiac contraindications, insufficient renal function, insufficient hepatic function, other active or secondary cancer diagnoses, other medical contraindications, patients who died during initial treatment course or transferred during or after initial treatment course) |
| G2208 | No trtmt chemo and her2 | Description: Patient did not receive adjuvant treatment course including both chemotherapy and her2-targeted therapy |
| G2209 | Refused to participate | Description: Patient refused to participate |
| G2210 | No neck fs prom no rsn | Description: Residual score for the neck impairment not measured because the patient did not complete the neck fs prom at initial evaluation and/or near discharge, reason not given |
| G2211 | Complex e/m visit add on | Description: Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established) |
| G2212 | Prolong outpt/office vis | Description: Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total 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 99205, 99215, 99483 for office or other outpatient evaluation and management services) (do not report g2212 on the same date of service as 99358, 99359, 99415, 99416). (do not report g2212 for any time unit less than 15 minutes) |
| G2213 | Initiat med assist tx in er | Description: Initiation of medication for the treatment of opioid use disorder in the emergency department setting, including assessment, referral to ongoing care, and arranging access to supportive services (list separately in addition to code for primary procedure) |
| G2214 | Init/sub psych care m 1st 30 | Description: Initial or subsequent psychiatric collaborative care management, first 30 minutes in a 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 |
| G2215 | Home supply nasal naloxone | Description: Take-home supply of nasal naloxone; 2-pack of 4mg per 0.1 ml nasal spray (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure |
| G2216 | Home supply inject naloxon | Description: Take-home supply of injectable naloxone (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure |
| G2250 | Remot img sub by pt, non e/m | Description: Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment |
| G2251 | Brief chkin, 5-10, non-e/m | Description: Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of clinical discussion |
| G2252 | Brief chkin by md/qhp, 11-20 | Description: Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion |
| G3002 | Chronic pain mgmt 30 mins | Description: Chronic pain management and treatment, monthly bundle including, diagnosis; assessment and monitoring; administration of a validated pain rating scale or tool; the development, implementation, revision, and/or maintenance of a person-centered care plan that includes strengths, goals, clinical needs, and desired outcomes; overall treatment management; facilitation and coordination of any necessary behavioral health treatment; medication management; pain and health literacy counseling; any necessary chronic pain related crisis care; and ongoing communication and care coordination between relevant practitioners furnishing care, e.g. physical therapy and occupational therapy, complementary and integrative approaches, and community-based care, as appropriate. required initial face-to-face visit at least 30 minutes provided by a physician or other qualified health professional; first 30 minutes personally provided by physician or other qualified health care professional, per calendar month. (when using g3002, 30 minutes must be met or exceeded.) |
| G3003 | Chronic pain mgmt addl 15m | Description: Each additional 15 minutes of chronic pain management and treatment by a physician or other qualified health care professional, per calendar month. (list separately in addition to code for g3002. when using g3003, 15 minutes must be met or exceeded.) |
| G4000 | Dermatology ss | Description: Dermatology mips specialty set |
| G4001 | Diagnostic rad ss | Description: Diagnostic radiology mips specialty set |
| G4002 | Ep cardio ss | Description: Electrophysiology cardiac specialist mips specialty set |
| G4003 | Emergency med ss | Description: Emergency medicine mips specialty set |
| G4004 | Endocrinology ss | Description: Endocrinology mips specialty set |
| G4005 | Family medicine ss | Description: Family medicine mips specialty set |
| G4006 | Gastroenterology ss | Description: Gastro-enterology mips specialty set |
| G4007 | General surgery ss | Description: General surgery mips specialty set |
| G4008 | Geriatrics ss | Description: Geriatrics mips specialty set |
| G4009 | Hospitalists ss | Description: Hospitalists mips specialty set |
| G4010 | Infectious disease ss | Description: Infectious disease mips specialty set |
| G4011 | Internal medicine ss | Description: Internal medicine mips specialty set |
| G4012 | Interventional rad ss | Description: Interventional radiology mips specialty set |
| G4013 | Mntal/behav/psych hlth ss | Description: Mental/behavioral and psychiatry mips specialty set |
| G4014 | Nephrology ss | Description: Nephrology mips specialty set |
| G4015 | Neurology ss | Description: Neurology mips specialty set |
| G4016 | Neurosurgical ss | Description: Neurosurgical mips specialty set |
| G4017 | Nutrition/dietician ss | Description: Nutrition/dietician mips specialty set |
| G4018 | Ob/gyn ss | Description: Obstetrics/gynecology mips specialty set |
| G4019 | Oncology/hema ss | Description: Oncology/hematology mips specialty set |
| G4020 | Ophthalmology/optometry ss | Description: Ophthalmology/optometry mips specialty set |
| G4021 | Orthopedic surgery ss | Description: Orthopedic surgery mips specialty set |
| G4022 | Otolaryngology ss | Description: Otolaryngology mips specialty set |
| G4023 | Pathology ss | Description: Pathology mips specialty set |
| G4024 | Pediatrics ss | Description: Pediatrics mips specialty set |
| G4025 | Physical medicine ss | Description: Physical medicine mips specialty set |
| G4026 | Phys/occ therapy ss | Description: Physical therapy/occupational therapy mips specialty set |
| G4027 | Plastic surgery ss | Description: Plastic surgery mips specialty set |
| G4028 | Podiatry ss | Description: Podiatry mips specialty set |
| G4029 | Preventive medicine ss | Description: Preventive medicine mips specialty set |
| G4030 | Pulmonology ss | Description: Pulmonology mips specialty set |
| G4031 | Radiation oncology ss | Description: Radiation oncology mips specialty set |
| G4032 | Rheumatology ss | Description: Rheumatology mips specialty set |
| G4033 | Skilled nursing facility ss | Description: Skilled nursing facility mips specialty set |
| G4034 | Speech language path ss | Description: Speech language pathology mips specialty set |
| G4035 | Thoracic surgery ss | Description: Thoracic surgery mips specialty set |
| G4036 | Urgent care ss | Description: Urgent care mips specialty set |
| G4037 | Urology ss | Description: Urology mips specialty set |
| G4038 | Vascular surgery ss | Description: Vascular surgery mips specialty set |
| G6001 | Echo guidance radiotherapy | Description: Ultrasonic guidance for placement of radiation therapy fields |
| G6002 | Stereoscopic x-ray guidance | Description: Stereoscopic x-ray guidance for localization of target volume for the delivery of radiation therapy |
| G6003 | Radiation treatment delivery | Description: Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: up to 5 mev |
| G6004 | Radiation treatment delivery | Description: Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: 6-10 mev |
| G6005 | Radiation treatment delivery | Description: Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: 11-19 mev |
| G6006 | Radiation treatment delivery | Description: Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: 20 mev or greater |
| G6007 | Radiation treatment delivery | Description: Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: up to 5 mev |
| G6008 | Radiation treatment delivery | Description: Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 6-10 mev |
| G6009 | Radiation treatment delivery | Description: Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 11-19 mev |
| G6010 | Radiation treatment delivery | Description: Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 20 mev or greater |
| G6011 | Radiation treatment delivery | Description: Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; up to 5 mev |
| G6012 | Radiation treatment delivery | Description: Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 6-10 mev |
| G6013 | Radiation treatment delivery | Description: Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 11-19 mev |
| G6014 | Radiation treatment delivery | Description: Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 20 mev or greater |
| G6015 | Radiation tx delivery imrt | Description: Intensity modulated treatment delivery, single or multiple fields/arcs,via narrow spatially and temporally modulated beams, binary, dynamic mlc, per treatment session |
| G6016 | Delivery comp imrt | Description: Compensator-based beam modulation treatment delivery of inverse planned treatment using 3 or more high resolution (milled or cast) compensator, convergent beam modulated fields, per treatment session |
| G6017 | Intrafraction track motion | Description: Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy (eg,3d positional tracking, gating, 3d surface tracking), each fraction of treatment |
| G8395 | Lvef>=40% doc normal or mild | Description: Left ventricular ejection fraction (lvef) >= 40% or documentation as normal or mildly depressed left ventricular systolic function |
| G8396 | Lvef not performed | Description: Left ventricular ejection fraction (lvef) not performed or documented |
| G8397 | Dil macula/fundus exam/w doc | Description: Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema and level of severity of retinopathy |
| G8399 | Pt w/dxa results document | Description: Patient with documented results of a central dual-energy x-ray absorptiometry (dxa) ever being performed |
| G8400 | Pt w/dxa no results doc | Description: Patient with central dual-energy x-ray absorptiometry (dxa) results not documented, reason not given |
| G8404 | Low extemity neur exam docum | Description: Lower extremity neurological exam performed and documented |
| G8405 | Low extemity neur not perfor | Description: Lower extremity neurological exam not performed |
| G8410 | Eval on foot documented | Description: Footwear evaluation performed and documented |
| G8415 | Eval on foot not performed | Description: Footwear evaluation was not performed |
| G8416 | Pt inelig footwear evaluatio | Description: Clinician documented that patient was not an eligible candidate for footwear evaluation measure |
| G8417 | Calc bmi abv up param f/u | Description: Bmi is documented above normal parameters and a follow-up plan is documented |
| G8418 | Calc bmi blw low param f/u | Description: Bmi is documented below normal parameters and a follow-up plan is documented |
| G8419 | Calc bmi out nrm param nof/u | Description: Bmi documented outside normal parameters, no follow-up plan documented, no reason given |
| G8420 | Calc bmi norm parameters | Description: Bmi is documented within normal parameters and no follow-up plan is required |
| G8421 | Bmi not calculated | Description: Bmi not documented and no reason is given |
| G8427 | Docrev cur meds by elig clin | Description: Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications |
| G8428 | Cur meds not document | Description: Current list of medications not documented as obtained, updated, or reviewed by the eligible clinician, reason not given |
| G8430 | Doc med rsn no medrec | Description: Documentation of a medical reason(s) for not documenting, updating, or reviewing the patient's current medications list (e.g., patient is in an urgent or emergent medical situation) |
| G8431 | Pos clin depres scrn f/u doc | Description: Screening for depression is documented as being positive and a follow-up plan is documented |
| G8432 | Dep scr not doc, rng | Description: Depression screening not documented, reason not given |
| G8433 | Scr for dep not cpt doc rsn | Description: Screening for depression not completed, documented patient or medical reason |
| G8450 | Beta-bloc rx pt w/abn lvef | Description: Beta-blocker therapy prescribed |
| G8451 | Pt w/abn lvef inelig b-bloc | Description: Beta-blocker therapy for lvef <=40% not prescribed for reasons documented by the clinician (e.g., low blood pressure, fluid overload, asthma, patients recently treated with an intravenous positive inotropic agent, allergy, intolerance, other medical reasons, patient declined, other patient reasons) |
| G8452 | Pt w/abn lvef b-bloc no rx | Description: Beta-blocker therapy not prescribed |
| G8465 | High risk recurrence pro ca | Description: High or very high risk of recurrence of prostate cancer |
| G8473 | Ace/arb thxpy rx'd | Description: Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy prescribed |
| G8474 | Ace/arb not rx'd; doc reas | Description: Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy not prescribed for reasons documented by the clinician (e.g., allergy, intolerance, pregnancy, renal failure due to ace inhibitor, diseases of the aortic or mitral valve, other medical reasons) or (e.g., patient declined, other patient reasons) |
| G8475 | Ace/arb thxpy not rx'd | Description: Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy not prescribed, reason not given |
| G8476 | Bp sys <140 and dias <90 | Description: Most recent blood pressure has a systolic measurement of < 140 mmhg and a diastolic measurement of < 90 mmhg |
| G8477 | Bp sys>=140 and/or dias >=90 | Description: Most recent blood pressure has a systolic measurement of >= 140 mmhg and/or a diastolic measurement of >= 90 mmhg |
| G8478 | Bp not performed/doc | Description: Blood pressure measurement not performed or documented, reason not given |
| G8510 | Scr dep neg, no plan reqd | Description: Screening for depression is documented as negative, a follow-up plan is not required |
| G8511 | Scr dep pos, no plan doc rng | Description: Screening for depression documented as positive, follow-up plan not documented, reason not given |
| G8535 | Eld maltreatment not doc | Description: Elder maltreatment screen not documented; documentation that patient is not eligible for the elder maltreatment screen at the time of the encounter related to one of the following reasons: (1) patient refuses to participate in the screening and has reasonable decisional capacity for self-protection, or (2) patient is in an urgent or emergent situation where time is of the essence and to delay treatment to perform the screening would jeopardize the patient's health status |
| G8536 | No doc elder mal scrn | Description: No documentation of an elder maltreatment screen, reason not given |
| G8539 | Doc funct and care plan | Description: Functional outcome assessment documented as positive using a standardized tool and a care plan based on identified deficiencies is documented within two days of the functional outcome assessment |
| G8540 | Foa not doc as being perf | Description: Functional outcome assessment not documented as being performed, documentation the patient is not eligible for a functional outcome assessment using a standardized tool at the time of the encounter |
| G8541 | No doc cur funct assess | Description: Functional outcome assessment using a standardized tool not documented, reason not given |
| G8542 | Doc funct no deficiencies | Description: Functional outcome assessment using a standardized tool is documented; no functional deficiencies identified, care plan not required |
| G8543 | Cur funct asses; no care pln | Description: Documentation of a positive functional outcome assessment using a standardized tool; care plan not documented within two days of assessment, reason not given |
| G8559 | Pt ref doc oto eval | Description: Patient referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation |
| G8560 | Pt hx act drain prev 90 days | Description: Patient has a history of active drainage from the ear within the previous 90 days |
| G8561 | Pt inelig for ref oto eval | Description: Patient is not eligible for the referral for otologic evaluation for patients with a history of active drainage measure |
| G8562 | Pt no hx act drain 90 d | Description: Patient does not have a history of active drainage from the ear within the previous 90 days |
| G8563 | Pt no ref oto reas no spec | Description: Patient not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not given |
| G8564 | Pt ref oto eval | Description: Patient was referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not specified) |
| G8565 | Ver doc hear loss | Description: Verification and documentation of sudden or rapidly progressive hearing loss |
| G8566 | Pt inelig ref oto eval | Description: Patient is not eligible for the 'referral for otologic evaluation for sudden or rapidly progressive hearing loss' measure |
| G8567 | Pt no doc hear loss | Description: Patient does not have verification and documentation of sudden or rapidly progressive hearing loss |
| G8568 | Pt no ref otolo no spec | Description: Patient was not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not given |
| G8569 | Prol intubation req | Description: Prolonged postoperative intubation (> 24 hrs) required |
| G8570 | No prol intub req | Description: Prolonged postoperative intubation (> 24 hrs) not required |
| G8575 | Postop ren fail | Description: Developed postoperative renal failure or required dialysis |
| G8576 | No postop ren fail | Description: No postoperative renal failure/dialysis not required |
| G8598 | Asa/antiplat ther used | Description: Aspirin or another antiplatelet therapy used |
| G8599 | No asa/antiplat ther use rng | Description: Aspirin or another antiplatelet therapy not used, reason not given |
| G8600 | Tpa initi w/in 4.5 hr | Description: Iv thrombolytic therapy initiated within 4.5 hours (<= 270 minutes) of time last known well |
| G8601 | No elig tpa init w/in 4.5 hr | Description: Iv thrombolytic therapy not initiated within 4.5 hours (<= 270 minutes) of time last known well for reasons documented by clinician (e.g. patient enrolled in clinical trial for stroke, patient admitted for elective carotid intervention) |
| G8602 | No tpa init w/in 4.5 hr | Description: Iv thrombolytic therapy not initiated within 4.5 hours (<= 270 minutes) of time last known well, reason not given |
| G8633 | Pharm ther osteo rx | Description: Pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed |
| G8635 | No pharm ther osteo rx | Description: Pharmacologic therapy for osteoporosis was not prescribed, reason not given |
| G8647 | Rafscrs ki scor >= 0 | Description: Residual score for the knee impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) |
| G8648 | Rafscrs ki scor < 0 | Description: Residual score for the knee impairment successfully calculated and the score was less than zero (< 0) |
| G8650 | Rafs crs ki no scor no rsn | Description: Residual score for the knee impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given |
| G8651 | Rafscrs hi scor >=0 | Description: Residual score for the hip impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) |
| G8652 | Rafscrs hi scor < 0 | Description: Residual score for the hip impairment successfully calculated and the score was less than zero (< 0) |
| G8654 | Rafs crs hi no scor no surv | Description: Residual score for the hip impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given |
| G8655 | Rafscrs llfai scor >= 0 | Description: Residual score for the lower leg, foot or ankle impairment successfully calculated and the score was equal to zero (0) or greater than zero ( > 0) |
| G8656 | Rafscrs llfai scor < 0 | Description: Residual score for the lower leg, foot or ankle impairment successfully calculated and the score was less than zero (< 0) |
| G8658 | Rafscrs llfai no scor + surv | Description: Residual score for the lower leg, foot or ankle impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given |
| G8659 | Rafscrs lbi scor >= 0 | Description: Residual score for the low back impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) |
| G8660 | Rafscrs lbi scor < 0 | Description: Residual score for the low back impairment successfully calculated and the score was less than zero (< 0) |
| G8661 | Rafscrs lbi no scor | Description: Risk-adjusted functional status change residual score for the low back impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate |
| G8662 | Rafs crs lbi no scor no surv | Description: Residual score for the low back impairment not measured because the patient did not complete the low back fs prom at initial evaluation and/or near discharge, reason not given |
| G8663 | Rafscrs si scor >= 0 | Description: Residual score for the shoulder impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) |
| G8664 | Rafscrs si scor < 0 | Description: Residual score for the shoulder impairment successfully calculated and the score was less than zero (< 0) |
| G8666 | Rafs crs si no scor no surv | Description: Residual score for the shoulder impairment not measured because the patient did not complete the shoulder fs prom at initial evaluation and/or near discharge, reason not given |
| G8667 | Rafscrs ewh scor >= 0 | Description: Residual score for the elbow, wrist or hand impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) |
| G8668 | Rafscrs ewh scor < 0 | Description: Residual score for the elbow, wrist or hand impairment successfully calculated and the score was less than zero (< 0) |
| G8670 | Rafs crs ewh no scor no surv | Description: Residual score for the elbow, wrist or hand impairment not measured because the patient did not complete the elbow/wrist/hand fs prom at initial evaluation and/or near discharge, reason not given |
| G8708 | Antibiotic not pres | Description: Patient not prescribed antibiotic |
| G8709 | Uri ep compete diag | Description: Uri episodes when the patient had competing diagnoses on or three days after the episode date (e.g., intestinal infection, pertussis, bacterial infection, lyme disease, otitis media, acute sinusitis, acute pharyngitis, acute tonsillitis, chronic sinusitis, infection of the pharynx/larynx/tonsils/adenoids, prostatitis, cellulitis, mastoiditis, or bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia/gonococcal infections, venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis or uti, and acne) |
| G8710 | Pt pres antibiotic | Description: Patient prescribed antibiotic |
| G8711 | Pres antibx on/within 3 day | Description: Prescribed antibiotic on or within 3 days after the episode date |
| G8712 | Not pres antibiotic | Description: Antibiotic not prescribed or dispensed |
| G8721 | Pt, pn, hist grade doc | Description: Pt category (primary tumor), pn category (regional lymph nodes), and histologic grade were documented in pathology report |
| G8722 | Med reas pt, pn, not doc | Description: Documentation of medical reason(s) for not including the pt category, the pn category or the histologic grade in the pathology report (e.g., re-excision without residual tumor; non-carcinomasanal canal) |
| G8723 | Spec sit not prim tumor | Description: Specimen site is other than anatomic location of primary tumor |
| G8724 | Pt, pn, hist grade not doc | Description: Pt category, pn category and histologic grade were not documented in the pathology report, reason not given |
| G8733 | Doc pos elder mal scrn plan | Description: Elder maltreatment screen documented as positive and a follow-up plan is documented |
| G8734 | Doc neg eld req | Description: Elder maltreatment screen documented as negative, follow-up is not required |
| G8735 | Eld mal scrn pos no plan | Description: Elder maltreatment screen documented as positive, follow-up plan not documented, reason not given |
| G8749 | No signs melanoma | Description: Absence of signs of melanoma (tenderness, jaundice, localized neurologic signs such as weakness, or any other sign suggesting systemic spread) or absence of symptoms of melanoma (cough, dyspnea, pain, paresthesia, or any other symptom suggesting the possibility of systemic spread of melanoma) |
| G8752 | Sys bp less 140 | Description: Most recent systolic blood pressure < 140 mmhg |
| G8753 | Sys bp > or = 140 | Description: Most recent systolic blood pressure >= 140 mmhg |
| G8754 | Dias bp less 90 | Description: Most recent diastolic blood pressure < 90 mmhg |
| G8755 | Dias bp > or = 90 | Description: Most recent diastolic blood pressure >= 90 mmhg |
| G8756 | No bp measure doc | Description: No documentation of blood pressure measurement, reason not given |
| G8783 | Bp scrn perf rec interval | Description: Normal blood pressure reading documented, follow-up not required |
| G8785 | Bp scrn no perf at interval | Description: Blood pressure reading not documented, reason not given |
| G8797 | Specimen site not esophagus | Description: Specimen site other than anatomic location of esophagus |
| G8798 | Specimen site not prostate | Description: Specimen site other than anatomic location of prostate |
| G8806 | Perf ultrsnd to lct preg doc | Description: Performance of trans-abdominal or trans-vaginal ultrasound and pregnancy location documented |
| G8807 | No ta tv ultrasnd | Description: Trans-abdominal or trans-vaginal ultrasound not performed for reasons documented by clinician (e.g., patient has a documented intrauterine pregnancy [iup]) |
| G8808 | Ultrasound not perf, rng | Description: Trans-abdominal or trans-vaginal ultrasound not performed, reason not given |
| G8815 | Doc reas no statin therapy | Description: Documented reason in the medical records for why the statin therapy was not prescribed (i.e., lower extremity bypass was for a patient with non-artherosclerotic disease) |
| G8816 | Statin med pres at disch | Description: Statin medication prescribed at discharge |
| G8817 | Doc reas no statin med disch | Description: Statin therapy not prescribed at discharge, reason not given |
| G8826 | Pt disch home day #2 evar | Description: Patient discharged to home no later than post-operative day #2 following evar |
| G8833 | Pt not disch home day#2 evar | Description: Patient not discharged to home by post-operative day #2 following evar |
| G8834 | Pt disch home day #2 cea | Description: Patient discharged to home no later than post-operative day #2 following cea |
| G8838 | Not disch home by day #2 | Description: Patient not discharged to home by post-operative day #2 following cea |
| G8839 | Sleep apnea assess | Description: Sleep apnea symptoms assessed, including presence or absence of snoring and daytime sleepiness |
| G8840 | Doc reas no sleep apnea | Description: Documentation of reason(s) for not documenting an assessment of sleep symptoms (e.g., patient didn't have initial daytime sleepiness, patient visited between initial testing and initiation of therapy) |
| G8841 | No sleep apnea assess | Description: Sleep apnea symptoms not assessed, reason not given |
| G8845 | Pos airway press prescribed | Description: Positive airway pressure therapy prescribed |
| G8846 | Mod or severe osa | Description: Moderate or severe obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory disturbance index (rdi) of 15 or greater) |
| G8849 | Doc reas no pos air press | Description: Documentation of reason(s) for not prescribing positive airway pressure therapy (e.g., patient unable to tolerate, alternative therapies use, patient declined, financial, insurance coverage) |
| G8850 | No pap prescribed | Description: Positive airway pressure therapy not prescribed, reason not given |
| G8851 | Adhere tx assess at lst ann | Description: Adherence to therapy was assessed at least annually through an objective informatics system or through self-reporting (if objective reporting is not available, documented) |
| G8854 | Reas no adhere therapy | Description: Documentation of reason(s) for not objectively reporting adherence to evidence-based therapy (e.g., patients who have been diagnosed with a terminal or advanced disease with an expected life span of less than 6 months, patients who decline therapy, patients who do not return for follow-up at least annually, patients unable to access/afford therapy, patient's insurance will not cover therapy) |
| G8855 | Ther not assessed annually | Description: Adherence to therapy was not assessed at least annually through an objective informatics system or through self-reporting (if objective reporting is not available), reason not given |
| G8856 | Ref for oto eval | Description: Referral to a physician for an otologic evaluation performed |
| G8857 | No elig ref for oto eval | Description: Patient is not eligible for the referral for otologic evaluation measure (e.g., patients who are already under the care of a physician for acute or chronic dizziness) |
| G8858 | Not ref for oto eval | Description: Referral to a physician for an otologic evaluation not performed, reason not given |
| G8863 | No assess bone loss | Description: Patients not assessed for risk of bone loss, reason not given |
| G8864 | Pneumococcal vaccine admin | Description: Pneumococcal vaccine administered or previously received |
| G8865 | Doc med reas no pneumococcal | Description: Documentation of medical reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient allergic reaction, potential adverse drug reaction) |
| G8866 | Doc pt reas no pneumococcal | Description: Documentation of patient reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient refusal) |
| G8867 | No pneumococcal admin | Description: Pneumococcal vaccine not administered or previously received, reason not given |
| G8869 | Doc immune hep b antitnf | Description: Patient has documented immunity to hepatitis b and initiating anti-tnf therapy |
| G8875 | Breast cancer dx min invsive | Description: Clinician diagnosed breast cancer preoperatively by a minimally invasive biopsy method |
| G8876 | Doc reas no min inv dx | Description: Documentation of reason(s) for not performing minimally invasive biopsy to diagnose breast cancer preoperatively (e.g., lesion too close to skin, implant, chest wall, etc., lesion could not be adequately visualized for needle biopsy, patient condition prevents needle biopsy [weight, breast thickness, etc.], duct excision without imaging abnormality, prophylactic mastectomy, reduction mammoplasty, excisional biopsy performed by another physician) |
| G8877 | No brst cncr dx min invasive | Description: Clinician did not attempt to achieve the diagnosis of breast cancer preoperatively by a minimally invasive biopsy method, reason not given |
| G8878 | Sent lymph node biopsy | Description: Sentinel lymph node biopsy procedure performed |
| G8880 | Sen lym p node biop not perf | Description: Documentation of reason(s) sentinel lymph node biopsy not performed (e.g., reasons could include but not limited to; non-invasive cancer, incidental discovery of breast cancer on prophylactic mastectomy, incidental discovery of breast cancer on reduction mammoplasty, pre-operative biopsy proven lymph node (ln) metastases, inflammatory carcinoma, stage 3 locally advanced cancer, recurrent invasive breast cancer, clinically node positive after neoadjuvant systemic therapy, patient refusal after informed consent, patient with significant age, comorbidities, or limited life expectancy and favorable tumor; adjuvant systemic therapy unlikely to change) |
| G8881 | Brst cncr stage > t1n0m0 | Description: Stage of breast cancer is greater than t1n0m0 or t2n0m0 |
| G8882 | No sent lymph node biopsy | Description: Sentinel lymph node biopsy procedure not performed, reason not given |
| G8907 | Pt doc no events on discharg | Description: Patient documented not to have experienced any of the following events: a burn prior to discharge; a fall within the facility; wrong site/side/patient/procedure/implant event; or a hospital transfer or hospital admission upon discharge from the facility |
| G8908 | Pt doc w burn prior to d/c | Description: Patient documented to have received a burn prior to discharge |
| G8909 | Pt doc no burn prior to d/c | Description: Patient documented not to have received a burn prior to discharge |
| G8910 | Pt doc to have fall in asc | Description: Patient documented to have experienced a fall within asc |
| G8911 | Pt doc no fall in asc | Description: Patient documented not to have experienced a fall within ambulatory surgical center |