HCPCS G codes: Procedures and professional services (temporary)
1276 active HCPCS Level II codes beginning with G, from the CMS October 2026 quarterly file. "Added" is the year the code first appeared in the HCPCS file.
| Code | Long description | Short description | Added |
|---|---|---|---|
G0008 | Administration of influenza virus vaccine | Admin influenza virus vac | 1994 |
G0009 | Administration of pneumococcal vaccine | Admin pneumococcal vaccine | 1994 |
G0010 | Administration of hepatitis b vaccine | Admin hepatitis b vaccine | 1994 |
G0011 | Individual counseling for pre-exposure prophylaxis (prep) by physician or qualified health care professional (qhp) to prevent human immunodeficiency virus (hiv), includes hiv risk assessment (initial or continued assessment of risk), hiv risk reduction and medication adherence, 15-30 minutes | Hiv prep counsel, md 15-30m | 2024 |
G0012 | Injection of pre-exposure prophylaxis (prep) drug for hiv prevention, under skin or into muscle | Injection of hiv prep drug | 2024 |
G0013 | Individual counseling for pre-exposure prophylaxis (prep) by clinical staff to prevent human immunodeficiency virus (hiv), includes: hiv risk assessment (initial or continued assessment of risk), hiv risk reduction and medication adherence | Hiv prep counsel, clin staff | 2024 |
G0017 | Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); first 60 minutes | Crisis psychotherapy 60m | 2024 |
G0018 | Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); each additional 30 minutes (list separately in addition to code for primary service) | Crisis psychotherapy add 30m | 2024 |
G0019 | Community health integration services performed by certified or trained auxiliary personnel, including a community health worker, under the direction of a physician or other practitioner; 60 minutes per calendar month, in the following activities to address social determinants of health (sdoh) need(s) that are significantly limiting the ability to diagnose or treat problem(s) addressed in an initiating visit: person-centered assessment, performed to better understand the individualized context of the intersection between the sdoh need(s) and the problem(s) addressed in the initiating visit. ++ conducting a person-centered assessment to understand patient's life story, strengths, needs, goals, preferences and desired outcomes, including understanding cultural and linguistic factors and including unmet sdoh needs (that are not separately billed). ++ facilitating patient-driven goal-setting and establishing an action plan. ++ providing tailored support to the patient as needed to accomplish the practitioner's treatment plan. practitioner, home-, and community-based care coordination. ++ coordinating receipt of needed services from healthcare practitioners, providers, and facilities; and from home- and community-based service providers, social service providers, and caregiver (if applicable). ++ communication with practitioners, home- and community-based service providers, hospitals, and skilled nursing facilities (or other health care facilities) regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors. ++ coordination of care transitions between and among health care practitioners and settings, including transitions involving referral to other clinicians; follow-up after an emergency department visit; or follow-up after discharges from hospitals, skilled nursing facilities or other health care facilities. ++ facilitating access to community-based social services (e.g., housing, utilities, transportation, food assistance) to address the sdoh need(s). health education- helping the patient contextualize health education provided by the patient's treatment team with the patient's individual needs, goals, and preferences, in the context of the sdoh need(s), and educating the patient on how to best participate in medical decision-making. building patient self-advocacy skills, so that the patient can interact with members of the health care team and related community-based services addressing the sdoh need(s), in ways that are more likely to promote personalized and effective diagnosis or treatment. health care access / health system navigation. ++ helping the patient access healthcare, including identifying appropriate practitioners or providers for clinical care and helping secure appointments with them. facilitating behavioral change as necessary for meeting diagnosis and treatment goals, including promoting patient motivation to participate in care and reach person-centered diagnosis or treatment goals. facilitating and providing social and emotional support to help the patient cope with the problem(s) addressed in the initiating visit, the sdoh need(s), and adjust daily routines to better meet diagnosis and treatment goals. leveraging lived experience when applicable to provide support, mentorship, or inspiration to meet treatment goals | Comm hlth intg svs sdoh 60mn | 2024 |
G0022 | Community health integration services, each additional 30 minutes per calendar month (list separately in addition to g0019) | Comm hlth intg svs add 30 m | 2024 |
G0023 | Principal illness navigation services by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a patient navigator; 60 minutes per calendar month, in the following activities: person-centered assessment, performed to better understand the individual context of the serious, high-risk condition. ++ conducting a person-centered assessment to understand the patient's life story, strengths, needs, goals, preferences, and desired outcomes, including understanding cultural and linguistic factors and including unmet sdoh needs (that are not separately billed). ++ facilitating patient-driven goal setting and establishing an action plan. ++ providing tailored support as needed to accomplish the practitioner's treatment plan. identifying or referring patient (and caregiver or family, if applicable) to appropriate supportive services. practitioner, home, and community-based care coordination. ++ coordinating receipt of needed services from healthcare practitioners, providers, and facilities; home- and community-based service providers; and caregiver (if applicable). ++ communication with practitioners, home-, and community-based service providers, hospitals, and skilled nursing facilities (or other health care facilities) regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors. ++ coordination of care transitions between and among health care practitioners and settings, including transitions involving referral to other clinicians; follow-up after an emergency department visit; or follow-up after discharges from hospitals, skilled nursing facilities or other health care facilities. ++ facilitating access to community-based social services (e.g., housing, utilities, transportation, food assistance) as needed to address sdoh need(s). health education- helping the patient contextualize health education provided by the patient's treatment team with the patient's individual needs, goals, preferences, and sdoh need(s), and educating the patient (and caregiver if applicable) on how to best participate in medical decision-making. building patient self-advocacy skills, so that the patient can interact with members of the health care team and related community-based services (as needed), in ways that are more likely to promote personalized and effective treatment of their condition. health care access / health system navigation. ++ helping the patient access healthcare, including identifying appropriate practitioners or providers for clinical care, and helping secure appointments with them. ++ providing the patient with information/resources to consider participation in clinical trials or clinical research as applicable. facilitating behavioral change as necessary for meeting diagnosis and treatment goals, including promoting patient motivation to participate in care and reach person-centered diagnosis or treatment goals. facilitating and providing social and emotional support to help the patient cope with the condition, sdoh need(s), and adjust daily routines to better meet diagnosis and treatment goals. leverage knowledge of the serious, high-risk condition and/or lived experience when applicable to provide support, mentorship, or inspiration to meet treatment goals | Pin service 60m per month | 2024 |
G0024 | Principal illness navigation services, additional 30 minutes per calendar month (list separately in addition to g0023) | Pin srv add 30 min pr m | 2024 |
G0027 | Semen analysis; presence and/or motility of sperm excluding huhner | Semen analysis | 1995 |
G0029 | Tobacco screening not performed or tobacco cessation intervention not provided during the measurement period or in the six months prior to the measurement period | No tob scr/cess int | 2022 |
G0030 | Patient screened for tobacco use and received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling, pharmacotherapy, or both), if identified as a tobacco user | Pt scr tob & cess int | 2022 |
G0031 | Palliative care services given to patient any time during the measurement period | Pall serv during meas | 2022 |
G0032 | Two or more antipsychotic prescriptions ordered for patients who had a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between january 1 of the year prior to the measurement period and the index prescription start date (ipsd) for antipsychotics | 2+ antipsy schiz | 2022 |
G0033 | Two or more benzodiazepine prescriptions ordered for patients who had a diagnosis of seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, or severe generalized anxiety disorder on or between january 1 of the year prior to the measurement period and the ipsd for benzodiazepines | 2+ benzo seiz | 2022 |
G0034 | Patients receiving palliative care during the measurement period | Pall serv during meas | 2022 |
G0035 | Patient has any emergency department encounter during the performance period with place of service indicator 23 | Pt ed pos 23 | 2022 |
G0036 | Patient or care partner decline assessment | Pt/ptn decln assess | 2022 |
G0037 | On date of encounter, patient is not able to participate in assessment or screening, including non-verbal patients, delirious, severely aphasic, severely developmentally delayed, severe visual or hearing impairment and for those patients, no knowledgeable informant available | Pt not able to participate | 2022 |
G0038 | Clinician determines patient does not require referral | Clin pt no ref | 2022 |
G0039 | Patient not referred, reason not otherwise specified | Pt no ref, rn spec | 2022 |
G0040 | Patient already receiving physical/occupational/speech/recreational therapy during the measurement period | Pt phys/occ therapy | 2022 |
G0041 | Patient and/or care partner decline referral | Pt/ptn decln referral | 2022 |
G0042 | Referral to physical, occupational, speech, or recreational therapy | Ref to therapy | 2022 |
G0043 | Patients with mechanical prosthetic heart valve | Pt mech pros ht valv | 2022 |
G0044 | Patients with moderate or severe mitral stenosis | Pt mitral stenosis | 2022 |
G0045 | Clinical follow-up and mrs score assessed at 90 days following endovascular stroke intervention | Mrs 90 days post stk | 2022 |
G0046 | Clinical follow-up and mrs score not assessed at 90 days following endovascular stroke intervention | No mrs 90 days post stk | 2022 |
G0047 | Pediatric patient with minor blunt head trauma and pecarn prediction criteria are not assessed | Ped blunt hd traum | 2022 |
G0048 | Patients who receive palliative care services any time during the intake period through the end of the measurement year | Pall serv during meas | 2022 |
G0049 | With maintenance hemodialysis (in-center and home hd) for the complete reporting month | Main hemo in-cntr | 2022 |
G0050 | Patients with a catheter that have limited life expectancy | Pt w/ lmted life expec | 2022 |
G0051 | Patients under hospice care in the current reporting month | Pt hospice mnth | 2022 |
G0052 | Patients on peritoneal dialysis for any portion of the reporting month | Pt peri dialysis dur mo | 2022 |
G0053 | Advancing rheumatology patient care mips value pathways | Adv rheum pt care mvp | 2022 |
G0054 | Coordinating stroke care to promote prevention and cultivate positive outcomes mips value pathways | Strk cr prev pos outcme mvp | 2022 |
G0055 | Advancing care for heart disease mips value pathways | Adv care heart dx mvp | 2022 |
G0057 | Proposed adopting best practices and promoting patient safety within emergency medicine mips value pathways | Best pct pt safety em mvp | 2022 |
G0058 | Improving care for lower extremity joint repair mips value pathways | Imprv care le jnt repr mvp | 2022 |
G0059 | Patient safety and support of positive experiences with anesthesia mips value pathways | Pt sfty pos exp w aneth mvp | 2022 |
G0060 | Allergy/immunology mips specialty set | Allergy/immunology ss | 2022 |
G0061 | Anesthesiology mips specialty set | Anesthesiology ss | 2022 |
G0062 | Audiology mips specialty set | Audiology ss | 2022 |
G0063 | Cardiology mips specialty set | Cardiology ss | 2022 |
G0064 | Certified nurse midwife mips specialty set | Cert nurse midwife ss | 2022 |
G0065 | Chiropractic medicine mips specialty set | Chiropractic ss | 2022 |
G0066 | Clinical social work mips specialty set | Clinical social work ss | 2022 |
G0067 | Dentistry mips specialty set | Dentistry ss | 2022 |
G0068 | Professional services for the administration of anti-infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy or other highly complex drug or biological) for each infusion drug administration calendar day in the individual's home, each 15 minutes | Adm iv infusion drug in home | 2019 |
G0069 | Professional services for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes | Adm sq infusion drug in home | 2019 |
G0070 | Professional services for the administration of intravenous chemotherapy or other intravenous highly complex drug or biological infusion for each infusion drug administration calendar day in the individual's home, each 15 minutes | Adm of chemo drug in home | 2019 |
G0076 | Brief (20 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) | Care manag h vst new pt 20 m | 2019 |
G0077 | Limited (30 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) | Care manag h vst new pt 30 m | 2019 |
G0078 | Moderate (45 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) | Care manag h vst new pt 45 m | 2019 |
G0079 | Comprehensive (60 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) | Care manag h vst new pt 60 m | 2019 |
G0080 | Extensive (75 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) | Care manag h vst new pt 75 m | 2019 |
G0081 | Brief (20 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) | Care man h v ext pt 20 mi | 2019 |
G0082 | Limited (30 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) | Care man h v ext pt 30 m | 2019 |
G0083 | Moderate (45 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) | Care man h v ext pt 45 m | 2019 |
G0084 | Comprehensive (60 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) | Care man h v ext pt 60 m | 2019 |
G0085 | Extensive (75 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) | Care man h v ext pt 75 m | 2019 |
G0086 | Limited (30 minutes) care management home care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) | Care man home care plan 30 m | 2019 |
G0087 | Comprehensive (60 minutes) care management home care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) | Care man home care plan 60 m | 2019 |
G0088 | Professional services, initial visit, for the administration of anti-infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy or other highly complex drug or biological) for each infusion drug administration calendar day in the individual's home, each 15 minutes | Adm iv drug 1st home visit | 2021 |
G0089 | Professional services, initial visit, for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes | Adm subq drug 1st home visit | 2021 |
G0090 | Professional services, initial visit, for the administration of intravenous chemotherapy or other highly complex infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes | Adm iv chemo 1st home visit | 2021 |
G0101 | Cervical or vaginal cancer screening; pelvic and clinical breast examination | Ca screen;pelvic/breast exam | 1998 |
G0102 | Prostate cancer screening; digital rectal examination | Prostate ca screening; dre | 2000 |
G0103 | Prostate cancer screening; prostate specific antigen test (psa) | Psa screening | 2000 |
G0104 | Colorectal cancer screening; flexible sigmoidoscopy | Ca screen;flexi sigmoidscope | 1998 |
G0105 | Colorectal cancer screening; colonoscopy on individual at high risk | Colorectal scrn; hi risk ind | 1998 |
G0108 | Diabetes outpatient self-management training services, individual, per 30 minutes | Diab manage trn per indiv | 1998 |
G0109 | Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes | Diab manage trn ind/group | 1998 |
G0117 | Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist | Glaucoma scrn hgh risk direc | 2002 |
G0118 | Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist | Glaucoma scrn hgh risk direc | 2002 |
G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | Colon ca scrn not hi rsk ind | 1998 |
G0123 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision | Screen cerv/vag thin layer | 1998 |
G0124 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician | Screen c/v thin layer by md | 1998 |
G0127 | Trimming of dystrophic nails, any number | Trim nail(s) | 1998 |
G0128 | Direct (face-to-face with patient) skilled nursing services of a registered nurse provided in a comprehensive outpatient rehabilitation facility, each 10 minutes beyond the first 5 minutes | Corf skilled nursing service | 1998 |
G0129 | Occupational therapy services requiring the skills of a qualified occupational therapist, furnished as a component of a partial hospitalization or intensive outpatient treatment program, per session (45 minutes or more) | Php/iop ot service | 2000 |
G0130 | Single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel) | Single energy x-ray study | 1998 |
G0136 | Administration of a standardized, evidence-based assessment of physical activity and nutrition, 5-15 minutes, not more often than every 6 months | Adm of pa/n assess 5-15 m | 2024 |
G0137 | Intensive outpatient services; weekly bundle, minimum of 9 services over a 7 contiguous day period, which can include individual and group therapy with physicians or psychologists (or other mental health professionals to the extent authorized under state law); occupational therapy requiring the skills of a qualified occupational therapist; services of social workers, trained psychiatric nurses, and other staff trained to work with psychiatric patients; individualized activity therapies that are not primarily recreational or diversionary; family counseling (the primary purpose of which is treatment of the individual's condition); patient training and education (to the extent that training and educational activities are closely and clearly related to individual's care and treatment); diagnostic services; and such other items and services (excluding meals and transportation) that are reasonable and necessary for the diagnosis or active treatment of the individual's condition, reasonably expected to improve or maintain the individual's condition and functional level and to prevent relapse or hospitalization, and furnished pursuant to such guidelines relating to frequency and duration of services in accordance with a physician certification and plan of treatment (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure | Inten outpt svs,min 9 pr 7 d | 2024 |
G0138 | Intravenous infusion of cipaglucosidase alfa-atga, including provider/supplier acquisition and clinical supervision of oral administration of miglustat in preparation of receipt of cipaglucosidase alfa-atga | Iv cipaglucosidase alfa-atga | 2024 |
G0140 | Principal illness navigation - peer support by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a certified peer specialist; 60 minutes per calendar month, in the following activities: person-centered interview, performed to better understand the individual context of the serious, high-risk condition. ++ conducting a person-centered interview to understand the patient's life story, strengths, needs, goals, preferences, and desired outcomes, including understanding cultural and linguistic factors, and including unmet sdoh needs (that are not billed separately). ++ facilitating patient-driven goal setting and establishing an action plan. ++ providing tailored support as needed to accomplish the person-centered goals in the practitioner's treatment plan. identifying or referring patient (and caregiver or family, if applicable) to appropriate supportive services. practitioner, home, and community-based care communication. ++ assist the patient in communicating with their practitioners, home-, and community-based service providers, hospitals, and skilled nursing facilities (or other health care facilities) regarding the patient's psychosocial strengths and needs, goals, preferences, and desired outcomes, including cultural and linguistic factors. ++ facilitating access to community-based social services (e.g., housing, utilities, transportation, food assistance) as needed to address sdoh need(s). health education. helping the patient contextualize health education provided by the patient's treatment team with the patient's individual needs, goals, preferences, and sdoh need(s), and educating the patient (and caregiver if applicable) on how to best participate in medical decision-making. building patient self-advocacy skills, so that the patient can interact with members of the health care team and related community-based services (as needed), in ways that are more likely to promote personalized and effective treatment of their condition. developing and proposing strategies to help meet person-centered treatment goals and supporting the patient in using chosen strategies to reach person-centered treatment goals. facilitating and providing social and emotional support to help the patient cope with the condition, sdoh need(s), and adjust daily routines to better meet person-centered diagnosis and treatment goals. leverage knowledge of the serious, high-risk condition and/or lived experience when applicable to provide support, mentorship, or inspiration to meet treatment goals | Nav srv peer sup 60 min pr m | 2024 |
G0141 | Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician | Scr c/v cyto,autosys and md | 1999 |
G0143 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under physician supervision | Scr c/v cyto,thinlayer,rescr | 1999 |
G0144 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervision | Scr c/v cyto,thinlayer,rescr | 1999 |
G0145 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision | Scr c/v cyto,thinlayer,rescr | 1999 |
G0146 | Principal illness navigation - peer support, additional 30 minutes per calendar month (list separately in addition to g0140) | Nav srv peer sup add 30 pr m | 2024 |
G0147 | Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision | Scr c/v cyto, automated sys | 1999 |
G0148 | Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening | Scr c/v cyto, autosys, rescr | 1999 |
G0151 | Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes | Hhcp-serv of pt,ea 15 min | 1999 |
G0152 | Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes | Hhcp-serv of ot,ea 15 min | 1999 |
G0153 | Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes | Hhcp-svs of s/l path,ea 15mn | 1999 |
G0155 | Services of clinical social worker in home health or hospice settings, each 15 minutes | Hhcp-svs of csw,ea 15 min | 1999 |
G0156 | Services of home health/hospice aide in home health or hospice settings, each 15 minutes | Hhcp-svs of aide,ea 15 min | 1999 |
G0157 | Services performed by a qualified physical therapist assistant in the home health or hospice setting, each 15 minutes | Hhc pt assistant ea 15 | 2011 |
G0158 | Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes | Hhc ot assistant ea 15 | 2011 |
G0159 | Services performed by a qualified physical therapist, in the home health setting, in the establishment or delivery of a safe and effective physical therapy maintenance program, each 15 minutes | Hhc pt maint ea 15 min | 2011 |
G0160 | Services performed by a qualified occupational therapist, in the home health setting, in the establishment or delivery of a safe and effective occupational therapy maintenance program, each 15 minutes | Hhc occup therapy ea 15 | 2011 |
G0161 | Services performed by a qualified speech-language pathologist, in the home health setting, in the establishment or delivery of a safe and effective speech-language pathology maintenance program, each 15 minutes | Hhc slp ea 15 min | 2011 |
G0162 | Skilled services by a registered nurse (rn) for management and evaluation of the plan of care; each 15 minutes (the patient's underlying condition or complication requires an rn to ensure that essential non-skilled care achieves its purpose in the home health or hospice setting) | Hhc rn e&m plan svs, 15 min | 2011 |
G0166 | External counterpulsation, per treatment session | Extrnl counterpulse, per tx | 2000 |
G0168 | Wound closure utilizing tissue adhesive(s) only | Wound closure by adhesive | 2000 |
G0175 | Scheduled interdisciplinary team conference (minimum of three exclusive of patient care nursing staff) with patient present | Opps service,sched team conf | 2000 |
G0176 | Activity therapy, such as music, dance, art or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more) | Opps/php/iop; activity thrpy | 2001 |
G0177 | Training and educational services related to the care and treatment of patient's disabling mental health problems per session (45 minutes or more) | Opps/php/iop; train & educ | 2001 |
G0179 | Physician or allowed practitioner re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and allowed practitioners to affirm the initial implementation of the plan of care | Md recertification hha pt | 2001 |
G0180 | Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and allowed practitioners to affirm the initial implementation of the plan of care | Md certification hha patient | 2000 |
G0181 | Physician or allowed practitioner supervision of a patient receiving medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician or allowed practitioner development and/or revision of care plans | Home health care supervision | 2001 |
G0182 | Physician supervision of a patient under a medicare-approved hospice (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of laboratory and other studies, communication (including telephone calls) with other health care professionals involved in the patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month, 30 minutes or more | Hospice care supervision | 2001 |
G0183 | Quantitative software measurements of cardiac volume, cardiac chambers volumes and left ventricular wall mass derived from ct scan(s) data of the chest/heart (with or without contrast) | Software meas of cardiac vol | 2025 |
G0186 | Destruction of localized lesion of choroid (for example, choroidal neovascularization); photocoagulation, feeder vessel technique (one or more sessions) | Dstry eye lesn,fdr vssl tech | 2001 |
G0219 | Pet imaging whole body; melanoma for non-covered indications | Pet img wholbod melano nonco | 2001 |
G0235 | Pet imaging, any site, not otherwise specified | Pet not otherwise specified | 2006 |
G0237 | Therapeutic procedures to increase strength or endurance of respiratory muscles, face to face, one on one, each 15 minutes (includes monitoring) | Therapeutic procd strg endur | 2002 |
G0238 | Therapeutic procedures to improve respiratory function, other than described by g0237, one on one, face to face, per 15 minutes (includes monitoring) | Oth resp proc, indiv | 2002 |
G0239 | Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring) | Oth resp proc, group | 2002 |
G0245 | Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) which must include: (1) the diagnosis of lops, (2) a patient history, (3) a physical examination that consists of at least the following elements: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of a protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear and (4) patient education | Initial foot exam pt lops | 2002 |
G0246 | Follow-up physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) to include at least the following: (1) a patient history, (2) a physical examination that includes: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear, and (3) patient education | Followup eval of foot pt lop | 2002 |
G0247 | Routine foot care by a physician of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) to include, the local care of superficial wounds (i.e. superficial to muscle and fascia) and at least the following if present: (1) local care of superficial wounds, (2) debridement of corns and calluses, and (3) trimming and debridement of nails | Routine footcare pt w lops | 2002 |
G0248 | Demonstration, prior to initiation of home inr monitoring, for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria, under the direction of a physician; includes: face-to-face demonstration of use and care of the inr monitor, obtaining at least one blood sample, provision of instructions for reporting home inr test results, and documentation of patient's ability to perform testing and report results | Demonstrate use home inr mon | 2002 |
G0249 | Provision of test materials and equipment for home inr monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; includes: provision of materials for use in the home and reporting of test results to physician; testing not occurring more frequently than once a week; testing materials, billing units of service include 4 tests | Provide inr test mater/equip | 2002 |
G0250 | Physician review, interpretation, and patient management of home inr testing for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; testing not occurring more frequently than once a week; billing units of service include 4 tests | Md inr test revie inter mgmt | 2002 |
G0252 | 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) | Pet imaging initial dx | 2002 |
G0255 | Current perception threshold/sensory nerve conduction test, (snct) per limb, any nerve | Current percep threshold tst | 2002 |
G0257 | Unscheduled or emergency dialysis treatment for an esrd patient in a hospital outpatient department that is not certified as an esrd facility | Unsched dialysis esrd pt hos | 2003 |
G0259 | Injection procedure for sacroiliac joint; arthrography | Inject for sacroiliac joint | 2003 |
G0260 | Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography | Inj for sacroiliac jt anesth | 2003 |
G0268 | Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing | Removal of impacted wax md | 2003 |
G0269 | Placement of occlusive device into either a venous or arterial access site, post surgical or interventional procedure (e.g., angioseal plug, vascular plug) | Occlusive device in vein art | 2003 |
G0270 | 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 | Mnt subs tx for change dx | 2003 |
G0271 | 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 | Group mnt 2 or more 30 mins | 2003 |
G0276 | 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 | Pild/placebo control clin tr | 2015 |
G0277 | Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval | Hbot, full body chamber, 30m | 2015 |
G0278 | 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) | Iliac art angio,cardiac cath | 2003 |
G0279 | Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) | Tomosynthesis, mammo | 2015 |
G0281 | 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 | Elec stim unattend for press | 2003 |
G0282 | Electrical stimulation, (unattended), to one or more areas, for wound care other than described in g0281 | Elect stim wound care not pd | 2003 |
G0283 | Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care | Elec stim other than wound | 2003 |
G0288 | Reconstruction, computed tomographic angiography of aorta for surgical planning for vascular surgery | Recon, cta for surg plan | 2003 |
G0289 | 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 | Arthro, loose body + chondro | 2003 |
G0293 | Noncovered surgical procedure(s) using conscious sedation, regional, general or spinal anesthesia in a medicare qualifying clinical trial, per day | Non-cov surg proc,clin trial | 2003 |
G0294 | Noncovered procedure(s) using either no anesthesia or local anesthesia only, in a medicare qualifying clinical trial, per day | Non-cov proc, clinical trial | 2003 |
G0295 | Electromagnetic therapy, to one or more areas, for wound care other than described in g0329 or for other uses | Electromagnetic therapy onc | 2003 |
G0296 | Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making) | Visit to determ ldct elig | 2015 |
G0299 | Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes | Hhs/hospice of rn ea 15 min | 2015 |
G0300 | Direct skilled nursing services of a licensed practical nurse (lpn) in the home health or hospice setting, each 15 minutes | Hhs/hospice of lpn ea 15 min | 2015 |
G0302 | Pre-operative pulmonary surgery services for preparation for lvrs, complete course of services, to include a minimum of 16 days of services | Pre-op service lvrs complete | 2004 |
G0303 | Pre-operative pulmonary surgery services for preparation for lvrs, 10 to 15 days of services | Pre-op service lvrs 10-15dos | 2004 |
G0304 | Pre-operative pulmonary surgery services for preparation for lvrs, 1 to 9 days of services | Pre-op service lvrs 1-9 dos | 2004 |
G0305 | Post-discharge pulmonary surgery services after lvrs, minimum of 6 days of services | Post op service lvrs min 6 | 2004 |
G0306 | Complete cbc, automated (hgb, hct, rbc, wbc, without platelet count) and automated wbc differential count | Cbc/diffwbc w/o platelet | 2004 |
G0307 | Complete (cbc), automated (hgb, hct, rbc, wbc; without platelet count) | Cbc without platelet | 2004 |
G0310 | 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) | Immunize counsel 5-15 min | 2022 |
G0311 | 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) | Immunize counsel 16-30 mins | 2022 |
G0312 | 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) | Immunize couns < 21yr 5-15 m | 2022 |
G0313 | 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) | Immunize couns < 21yr 6-30 m | 2022 |
G0314 | 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) | Counsel immune <21 16-30 m | 2022 |
G0315 | 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) | Counsel immune <21 5-15 m | 2022 |
G0316 | 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) | Prolong inpt eval add15 m | 2023 |
G0317 | 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) | Prolong nursin fac eval 15m | 2023 |
G0318 | 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) | Prolong home eval add 15m | 2023 |
G0320 | Home health services furnished using synchronous telemedicine rendered via a real-time two-way audio and video telecommunications system | Two-way audio and video hhs | 2023 |
G0321 | Home health services furnished using synchronous telemedicine rendered via telephone or other real-time interactive audio-only telecommunications system | Audio-only hhs | 2023 |
G0322 | The collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency (i.e., remote patient monitoring) | Home h physio data collec tr | 2023 |
G0323 | 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) | Care manage beh svs 20mins | 2023 |
G0327 | Colorectal cancer screening; blood-based biomarker | Colon ca scrn;bld-bsd biomrk | 2021 |
G0328 | Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous | Fecal blood scrn immunoassay | 2004 |
G0329 | 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 | Electromagntic tx for ulcers | 2004 |
G0330 | 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 | Facility svs dental rehab | 2023 |
G0333 | Pharmacy dispensing fee for inhalation drug(s); initial 30-day supply as a beneficiary | Dispense fee initial 30 day | 2006 |
G0337 | Hospice evaluation and counseling services, pre-election | Hospice evaluation preelecti | 2005 |
G0339 | Image-guided robotic linear accelerator-based stereotactic radiosurgery, complete course of therapy in one session or first session of fractionated treatment | Robot lin-radsurg com, first | 2004 |
G0340 | 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 | Robt lin-radsurg fractx 2-5 | 2004 |
G0341 | Percutaneous islet cell transplant, includes portal vein catheterization and infusion | Percutaneous islet celltrans | 2004 |
G0342 | Laparoscopy for islet cell transplant, includes portal vein catheterization and infusion | Laparoscopy islet cell trans | 2004 |
G0343 | Laparotomy for islet cell transplant, includes portal vein catheterization and infusion | Laparotomy islet cell transp | 2004 |
G0372 | Physician service required to establish and document the need for a power mobility device | Md service required for pmd | 2005 |
G0378 | Hospital observation service, per hour | Hospital observation per hr | 2006 |
G0379 | Direct admission of patient for hospital observation care | Direct refer hospital observ | 2006 |
G0380 | 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) | Lev 1 hosp type b ed visit | 2007 |
G0381 | 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) | Lev 2 hosp type b ed visit | 2007 |
G0382 | 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) | Lev 3 hosp type b ed visit | 2007 |
G0383 | 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) | Lev 4 hosp type b ed visit | 2007 |
G0384 | 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) | Lev 5 hosp type b ed visit | 2007 |
G0390 | Trauma response team associated with hospital critical care service | Trauma respons w/hosp criti | 2007 |
G0396 | Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes | Alcohol/subs interv 15-30mn | 2008 |
G0397 | Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes | Alcohol/subs interv >30 min | 2008 |
G0398 | 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 | Home sleep test/type 2 porta | 2008 |
G0399 | 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 | Home sleep test/type 3 porta | 2008 |
G0400 | Home sleep test (hst) with type iv portable monitor, unattended; minimum of 3 channels | Home sleep test/type 4 porta | 2008 |
G0402 | Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment | Initial preventive exam | 2009 |
G0403 | Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report | Ekg for initial prevent exam | 2009 |
G0404 | Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination | Ekg tracing for initial prev | 2009 |
G0405 | Electrocardiogram, routine ecg with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination | Ekg interpret & report preve | 2009 |
G0406 | Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth | Inpt/tele follow up 15 | 2009 |
G0407 | Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth | Inpt/tele follow up 25 | 2009 |
G0408 | Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth | Inpt/tele follow up 35 | 2009 |
G0409 | 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) | Corf related serv 15 mins ea | 2009 |
G0410 | Group psychotherapy other than of a multiple-family group, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes | Grp psych php/iop 45-50 | 2009 |
G0411 | Interactive group psychotherapy, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes | Interactive grp psyc php/iop | 2009 |
G0412 | 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 | Open tx iliac spine uni/bil | 2009 |
G0413 | 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) | Pelvic ring fracture uni/bil | 2009 |
G0414 | 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) | Pelvic ring fx treat int fix | 2009 |
G0415 | 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) | Open tx post pelvic fxcture | 2009 |
G0416 | Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method | Prostate biopsy, any mthd | 2009 |
G0420 | Face-to-face educational services related to the care of chronic kidney disease; individual, per session, per one hour | Ed svc ckd ind per session | 2010 |
G0421 | Face-to-face educational services related to the care of chronic kidney disease; group, per session, per one hour | Ed svc ckd grp per session | 2010 |
G0422 | Intensive cardiac rehabilitation; with or without continuous ecg monitoring with exercise, per session | Intens cardiac rehab w/exerc | 2010 |
G0423 | Intensive cardiac rehabilitation; with or without continuous ecg monitoring; without exercise, per session | Intens cardiac rehab no exer | 2010 |
G0425 | Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth | Inpt/ed teleconsult30 | 2010 |
G0426 | Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth | Inpt/ed teleconsult50 | 2010 |
G0427 | Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth | Inpt/ed teleconsult70 | 2010 |
G0428 | Collagen meniscus implant procedure for filling meniscal defects (e.g., cmi, collagen scaffold, menaflex) | Collagen meniscus implant | 2010 |
G0429 | Dermal filler injection(s) for the treatment of facial lipodystrophy syndrome (lds) (e.g., as a result of highly active antiretroviral therapy) | Dermal filler injection(s) | 2010 |
G0432 | Infectious agent antibody detection by enzyme immunoassay (eia) technique, hiv-1 and/or hiv-2, screening | Eia hiv-1/hiv-2 screen | 2009 |
G0433 | Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening | Elisa hiv-1/hiv-2 screen | 2009 |
G0435 | Infectious agent antibody detection by rapid antibody test, hiv-1 and/or hiv-2, screening | Oral hiv-1/hiv-2 screen | 2009 |
G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | Ppps, initial visit | 2011 |
G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | Ppps, subseq visit | 2011 |
G0442 | Annual alcohol misuse screening, 5 to 15 minutes | Annual alcohol screen 15 min | 2011 |
G0443 | Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes | Brief alcohol misuse counsel | 2011 |
G0444 | Annual depression screening, 5 to 15 minutes | Depression screen annual | 2011 |
G0445 | 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 | High inten beh couns std 30m | 2011 |
G0446 | Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes | Intens behave ther cardio dx | 2011 |
G0447 | Face-to-face behavioral counseling for obesity, 15 minutes | Behavior counsel obesity 15m | 2011 |
G0448 | 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 | Place perm pacing cardiovert | 2012 |
G0451 | Development testing, with interpretation and report, per standardized instrument form | Devlopment test interpt&rep | 2012 |
G0452 | Molecular pathology procedure; physician interpretation and report | Molecular pathology interpr | 2013 |
G0453 | 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) | Cont intraop neuro monitor | 2013 |
G0454 | Physician documentation of face-to-face visit for durable medical equipment determination performed by nurse practitioner, physician assistant or clinical nurse specialist | Md document visit by npp | 2013 |
G0455 | Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen | Fecal microbiota prep instil | 2013 |
G0458 | Low dose rate (ldr) prostate brachytherapy services, composite rate | Ldr prostate brachy comp rat | 2013 |
G0459 | Inpatient telehealth pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy | Telehealth inpt pharm mgmt | 2012 |
G0460 | 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 | Autolog prp not diab ulcer | 2012 |
G0463 | Hospital outpatient clinic visit for assessment and management of a patient | Hospital outpt clinic visit | 2014 |
G0465 | 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) | Autolog prp diab wound ulcer | 2021 |
G0466 | 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 | Fqhc visit new patient | 2014 |
G0467 | 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 | Fqhc visit, estab pt | 2014 |
G0468 | 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 | Fqhc visit, ippe or awv | 2014 |
G0469 | 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 | Fqhc visit, mh new pt | 2014 |
G0470 | 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 | Fqhc visit, mh estab pt | 2014 |
G0471 | 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) | Ven blood coll snf/hha | 2014 |
G0472 | Hepatitis c antibody screening, for individual at high risk and other covered indication(s) | Hep c screen high risk/other | 2014 |
G0473 | Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes | Group behave couns 2-10 | 2015 |
G0475 | Hiv antigen/antibody, combination assay, screening | Hiv combination assay | 2015 |
G0476 | 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 | Hpv combo assay ca screen | 2015 |
G0480 | 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 | Drug test def 1-7 classes | 2016 |
G0481 | 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 | Drug test def 8-14 classes | 2016 |
G0482 | 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 | Drug test def 15-21 classes | 2016 |
G0483 | 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 | Drug test def 22+ classes | 2016 |
G0490 | 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) | Home visit rn, lpn by rhc/fq | 2016 |
G0491 | Dialysis procedure at a medicare certified esrd facility for acute kidney injury without esrd | Dialysis acu kidney no esrd | 2017 |
G0492 | Dialysis procedure with single evaluation by a physician or other qualified health care professional for acute kidney injury without esrd | Md/oth eval acut kid no esrd | 2017 |
G0493 | 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) | Rn care ea 15 min hh/hospice | 2017 |
G0494 | 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) | Lpn care ea 15min hh/hospice | 2017 |
G0495 | 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 | Rn care train/edu in hh | 2017 |
G0496 | 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 | Lpn care train/edu in hh | 2017 |
G0498 | 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 | Chemo extend iv infus w/pump | 2016 |
G0499 | 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 | Hepb screen high risk indiv | 2016 |
G0500 | 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) | Mod sedat endo service >5yrs | 2017 |
G0501 | 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) | Resource-inten svc during ov | 2017 |
G0506 | Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service) | Comp asses care plan ccm svc | 2017 |
G0508 | Telehealth consultation, critical care, initial , physicians typically spend 60 minutes communicating with the patient and providers via telehealth | Crit care telehea consult 60 | 2017 |
G0509 | Telehealth consultation, critical care, subsequent, physicians typically spend 50 minutes communicating with the patient and providers via telehealth | Crit care telehea consult 50 | 2017 |
G0513 | 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) | Prolong prev svcs, first 30m | 2018 |
G0514 | 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) | Prolong prev svcs, addl 30m | 2018 |
G0516 | Insertion of non-biodegradable drug delivery implants, 4 or more (services for subdermal rod implant) | Insert drug del implant, >=4 | 2018 |
G0517 | Removal of non-biodegradable drug delivery implants, 4 or more (services for subdermal implants) | Remove drug implant | 2018 |
G0518 | Removal with reinsertion, non-biodegradable drug delivery implants, 4 or more (services for subdermal implants) | Remove w insert drug implant | 2018 |
G0519 | Management of new patient-caregiver dyad with dementia, low complexity, for use in cmmi model | New pt-cg dyad dem low cmplx | 2024 |
G0520 | Management of new patient-caregiver dyad with dementia, moderate complexity, for use in cmmi model | New pt-cg dyad dem mod cmplx | 2024 |
G0521 | Management of new patient-caregiver dyad with dementia, high complexity, for use in cmmi model | New pt-cg dyad dem hig cmplx | 2024 |
G0522 | Management of a new patient with dementia, low complexity, for use in cmmi model | Mgt nw pt dementia low cmplx | 2024 |
G0523 | Management of a new patient with dementia, moderate to high complexity, for use in cmmi model | Mgt nw pt dem mod-high cmplx | 2024 |
G0524 | Management of established patient-caregiver dyad with dementia, low complexity, for use in cmmi model | Est pt-cg dyad dem low cmplx | 2024 |
G0525 | Management of established patient-caregiver dyad with dementia, moderate complexity, for use in cmmi model | Est pt-cg dyad dem mod cmplx | 2024 |
G0526 | Management of established patient-caregiver dyad with dementia, high complexity, for use in cmmi model | Est pt-cg dyad dem hig cmplx | 2024 |
G0527 | Management of established patient with dementia, low complexity, for use in cmmi model | Mgt est pt dmentia low cmplx | 2024 |
G0528 | Management of established patient with dementia, moderate to high complexity, for use in cmmi model | Mgt est pt dem mod-hi cmplx | 2024 |
G0529 | In-home respite care, 4-hour unit, for use in cmmi model | In home respite care, 4 hr u | 2024 |
G0530 | Adult day center, 8-hour unit, for use in cmmi model | Adult daycare center, 8 hr u | 2024 |
G0531 | Facility-based respite, 24-hour unit, for use in cmmi model | Fclty-based respite, 24 hr u | 2024 |
G0532 | Take-home supply of nasal nalmefene hydrochloride; one carton of two, 2.7 mg per 0.1 ml nasal sprays (provision of the services by a medicare-enrolled opioid treatment program);( list separately in addition to each primary code) | Take home supp nasal spray | 2025 |
G0533 | Medication assisted treatment, buprenorphine (injectable) administered on a weekly basis; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) | Buprenorphone inj weekly | 2025 |
G0534 | Coordinated care and/or referral services, such as to adequate and accessible community resources to address unmet health-related social needs, including harm reduction interventions and recovery support services a patient needs and wishes to pursue, which significantly limit the ability to diagnose or treat an opioid use disorder; each additional 30 minutes of services (provision of the services by a medicare-enrolled opioid treatment program); (list separately in addition to each primary code) | Coordinated care/or referral | 2025 |
G0535 | Patient navigational services, provided directly or by referral; including helping the patient to navigate health systems and identify care providers and supportive services, to build patient self-advocacy and communication skills with care providers, and to promote patient-driven action plans and goals; each additional 30 minutes of services (provision of the services by a medicare-enrolled opioid treatment program); (list separately in addition to each primary code) | Pt navigat svs direct/ref | 2025 |
G0536 | Peer recovery support services, provided directly or by referral; including leveraging knowledge of the condition or lived experience to provide support, mentorship, or inspiration to meet oud treatment and recovery goals; conducting a person-centered interview to understand the patient's life story, strengths, needs, goals, preferences, and desired outcomes; developing and proposing strategies to help meet person-centered treatment goals; assisting the patient in locating or navigating recovery support services; each additional 30 minutes of services (provision of the services by a medicare-enrolled opioid treatment program); (list separately in addition to each primary code) | Peer recover support svs | 2025 |
G0537 | Administration of a standardized, evidence-based atherosclerotic cardiovascular disease (ascvd) risk assessment, 5-15 minutes, not more often than every 12 months | Risk ascvd tst once pr 12 mo | 2025 |
G0538 | Atherosclerotic cardiovascular disease (ascvd) risk management services; clinical staff time; per calendar month | Ascvd rsk mng clin stf pr mo | 2025 |
G0539 | Caregiver training in behavior management/modification for caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face-to-face; initial 30 minutes | Initial care training 30 m | 2025 |
G0540 | Caregiver training in behavior management/modification for parent(s)/guardian(s)/caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face-to-face; each additional 15 minutes | Train for caregiver add 15 | 2025 |
G0541 | Caregiver training in direct care strategies and techniques to support care for patients with an ongoing condition or illness and to reduce complications (including, but not limited to, techniques to prevent decubitus ulcer formation, wound care, and infection control) (without the patient present), face-to-face; initial 30 minutes | No pt prsnt train initial 30 | 2025 |
G0542 | Caregiver training in direct care strategies and techniques to support care for patients with an ongoing condition or illness and to reduce complications (including, but not limited to, techniques to prevent decubitus ulcer formation, wound care, and infection control) (without the patient present), face-to-face; each additional 15 minutes (list separately in addition to code for primary service) (use g0542 in conjunction with g0541) | No pt prsnt train add 15 | 2025 |
G0543 | Group caregiver training in direct care strategies and techniques to support care for patients with an ongoing condition or illness and to reduce complications (including, but not limited to, techniques to prevent decubitus ulcer formation, wound care, and infection control) (without the patient present), face-to-face with multiple sets of caregivers | Group train w/o patient | 2025 |
G0544 | Post discharge telephonic follow-up contacts performed in conjunction with a discharge from the emergency department for behavioral health or other crisis encounter, 4 calls per calendar month | Post d/c phone follow up | 2025 |
G0545 | Visit complexity inherent to hospital inpatient or observation care associated with a confirmed or suspected infectious disease by an infectious diseases specialist, including disease transmission risk assessment and mitigation, public health investigation, analysis, and testing, and complex antimicrobial therapy counseling and treatment (add-on code, list separately in addition to hospital inpatient or observation evaluation and management visit, initial, same day discharge, subsequent or discharge) | Inherent visit to inpt | 2025 |
G0546 | Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, including a verbal and written report to the patient's treating/requesting practitioner; 5-10 minutes of medical consultative discussion and review | Phone/internet ehr assess | 2025 |
G0547 | Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, including a verbal and written report to the patient's treating/requesting practitioner; 11-20 minutes of medical consultative discussion and review | Phone/internet svs 11-20 m | 2025 |
G0548 | Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, including a verbal and written report to the patient's treating/requesting practitioner; 21-30 minutes of medical consultative discussion and review | Phone/inter svs 21-30 m | 2025 |
G0549 | Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, including a verbal and written report to the patient's treating/requesting practitioner; 31 or more minutes of medical consultative discussion and review | Phone/inter for treat>31m | 2025 |
G0550 | Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, including a written report to the patient's treating/requesting practitioner, 5 minutes or more of medical consultative time | Phone/inter for dx/treat >5m | 2025 |
G0551 | Interprofessional telephone/internet/electronic health record referral service(s) provided by a treating/requesting practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, 30 minutes | Phn/intr svs fr dx treat 30m | 2025 |
G0552 | Supply of digital mental health treatment device and initial education and onboarding, per course of treatment that augments a behavioral therapy plan | Supply of digital device | 2025 |
G0553 | First 20 minutes of monthly treatment management services directly related to the patient's therapeutic use of the digital mental health treatment (dmht) device that augments a behavioral therapy plan, physician/other qualified health care professional time reviewing information related to the use of the dmht device, including patient observations and patient specific inputs in a calendar month and requiring at least one interactive communication with the patient/caregiver during the calendar month | Monthly tx for dmht 20mins | 2025 |
G0554 | Each additional 20 minutes of monthly treatment management services directly related to the patient's therapeutic use of the digital mental health treatment (dmht) device that augments a behavioral therapy plan, physician/other qualified health care professional time reviewing data generated from the dmht device from patient observations and patient specific inputs in a calendar month and requiring at least one interactive communication with the patient/caregiver during the calendar month | Add 20 m of monthly tx | 2025 |
G0555 | Provision of replacement patient electronics system (e.g., system pillow, handheld reader) for home pulmonary artery pressure monitoring | Replacment pt electronic sys | 2025 |
G0556 | Advanced primary care management services for a patient with one chronic condition [expected to last at least 12 months, or until the death of the patient, which place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline], or fewer, provided by clinical staff and directed by a physician or other qualified health care professional who is responsible for all primary care and serves as the continuing focal point for all needed health care services, per calendar month, with the following elements, as appropriate: consent; ++ inform the patient of the availability of the service; that only one practitioner can furnish and be paid for the service during a calendar month; of the right to stop the services at any time (effective at the end of the calendar month); and that cost sharing may apply. ++ document in patient's medical record that consent was obtained. initiation during a qualifying visit for new patients or patients not seen within 3 years; provide 24/7 access for urgent needs to care team/practitioner, including providing patients/caregivers with a way to contact health care professionals in the practice to discuss urgent needs regardless of the time of day or day of week; continuity of care with a designated member of the care team with whom the patient is able to schedule successive routine appointments; deliver care in alternative ways to traditional office visits to best meet the patient's needs, such as home visits and/or expanded hours; overall comprehensive care management; ++ systematic needs assessment (medical and psychosocial). ++ system-based approaches to ensure receipt of preventive services. ++ medication reconciliation, management and oversight of self-management. development, implementation, revision, and maintenance of an electronic patient-centered comprehensive care plan with typical care plan elements when clinically relevant; ++ care plan is available timely within and outside the billing practice as appropriate to individuals involved in the beneficiary's care, can be routinely accessed and updated by care team/practitioner, and copy of care plan to patient/caregiver; coordination of care transitions between and among health care providers and settings, including referrals to other clinicians and follow-up after an emergency department visit and discharges from hospitals, skilled nursing facilities or other health care facilities as applicable; ++ ensure timely exchange of electronic health information with other practitioners and providers to support continuity of care. ++ ensure timely follow-up communication (direct contact, telephone, electronic) with the patient and/or caregiver after an emergency department visit and discharges from hospitals, skilled nursing facilities, or other health care facilities, within 7 calendar days of discharge, as clinically indicated. ongoing communication and coordinating receipt of needed services from practitioners, home- and community-based service providers, community-based social service providers, hospitals, and skilled nursing facilities (or other health care facilities), and document communication regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors, in the patient's medical record; enhanced opportunities for the beneficiary and any caregiver to communicate with the care team/practitioner regarding the beneficiary's care through the use of asynchronous non-face-to-face consultation methods other than telephone, such as secure messaging, email, internet, or patient portal, and other communication-technology based services, including remote evaluation of pre-recorded patient information and interprofessional telephone/internet/ehr referral service(s), to maintain ongoing communication with patients, as appropriate; ++ ensure access to patient-initiated digital communications that require a clinical decision, such as virtual check-ins and digital online assessment and management and e/m visits (or e-visits). analyze patient population data to identify gaps in care and offer additional interventions, as appropriate; risk stratify the practice population based on defined diagnoses, claims, or other electronic data to identify and target services to patients; be assessed through performance measurement of primary care quality, total cost of care, and meaningful use of certified ehr technology | Adv prim care mgmt lvl 1 | 2025 |
G0557 | Advanced primary care management services for a patient with multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, which place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, provided by clinical staff and directed by a physician or other qualified health care professional who is responsible for all primary care and serves as the continuing focal point for all needed health care services, per calendar month, with the following elements, as appropriate: consent; ++ inform the patient of the availability of the service; that only one practitioner can furnish and be paid for the service during a calendar month; of the right to stop the services at any time (effective at the end of the calendar month); and that cost sharing may apply. ++ document in patient's medical record that consent was obtained. initiation during a qualifying visit for new patients or patients not seen within 3 years; provide 24/7 access for urgent needs to care team/practitioner, including providing patients/caregivers with a way to contact health care professionals in the practice to discuss urgent needs regardless of the time of day or day of week; continuity of care with a designated member of the care team with whom the patient is able to schedule successive routine appointments; deliver care in alternative ways to traditional office visits to best meet the patient's needs, such as home visits and/or expanded hours; overall comprehensive care management; ++ systematic needs assessment (medical and psychosocial). ++ system-based approaches to ensure receipt of preventive services. ++ medication reconciliation, management and oversight of self-management. development, implementation, revision, and maintenance of an electronic patient-centered comprehensive care plan; ++ care plan is available timely within and outside the billing practice as appropriate to individuals involved in the beneficiary's care, can be routinely accessed and updated by care team/practitioner, and copy of care plan to patient/caregiver; coordination of care transitions between and among health care providers and settings, including referrals to other clinicians and follow-up after an emergency department visit and discharges from hospitals, skilled nursing facilities or other health care facilities as applicable; ++ ensure timely exchange of electronic health information with other practitioners and providers to support continuity of care. ++ ensure timely follow-up communication (direct contact, telephone, electronic) with the patient and/or caregiver after an emergency department visit and discharges from hospitals, skilled nursing facilities, or other health care facilities, within 7 calendar days of discharge, as clinically indicated. ongoing communication and coordinating receipt of needed services from practitioners, home- and community-based service providers, community-based social service providers, hospitals, and skilled nursing facilities (or other health care facilities), and document communication regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors, in the patient's medical record; enhanced opportunities for the beneficiary and any caregiver to communicate with the care team/practitioner regarding the beneficiary's care through the use of asynchronous non-face-to-face consultation methods other than telephone, such as secure messaging, email, internet, or patient portal, and other communication-technology based services, including remote evaluation of pre-recorded patient information and interprofessional telephone/internet/ehr referral service(s), to maintain ongoing communication with patients, as appropriate; ++ ensure access to patient-initiated digital communications that require a clinical decision, such as virtual check-ins and digital online assessment and management and e/m visits (or e-visits). analyze patient population data to identify gaps in care and offer additional interventions, as appropriate; risk stratify the practice population based on defined diagnoses, claims, or other electronic data to identify and target services to patients; be assessed through performance measurement of primary care quality, total cost of care, and meaningful use of certified ehr technology | Adv prim care mgmt lvl 2 | 2025 |
G0558 | Advanced primary care management services for a patient that is a qualified medicare beneficiary with multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, which place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, provided by clinical staff and directed by a physician or other qualified health care professional who is responsible for all primary care and serves as the continuing focal point for all needed health care services, per calendar month, with the following elements, as appropriate: consent; ++ inform the patient of the availability of the service; that only one practitioner can furnish and be paid for the service during a calendar month; of the right to stop the services at any time (effective at the end of the calendar month); and that cost sharing may apply. ++ document in patient's medical record that consent was obtained. initiation during a qualifying visit for new patients or patients not seen within 3 years; provide 24/7 access for urgent needs to care team/practitioner, including providing patients/caregivers with a way to contact health care professionals in the practice to discuss urgent needs regardless of the time of day or day of week; continuity of care with a designated member of the care team with whom the patient is able to schedule successive routine appointments; deliver care in alternative ways to traditional office visits to best meet the patient's needs, such as home visits and/or expanded hours; overall comprehensive care management; ++ systematic needs assessment (medical and psychosocial). ++ system-based approaches to ensure receipt of preventive services. ++ medication reconciliation, management and oversight of self-management. development, implementation, revision, and maintenance of an electronic patient-centered comprehensive care plan; ++ care plan is available timely within and outside the billing practice as appropriate to individuals involved in the beneficiary's care, can be routinely accessed and updated by care team/practitioner, and copy of care plan to patient/caregiver; coordination of care transitions between and among health care providers and settings, including referrals to other clinicians and follow-up after an emergency department visit and discharges from hospitals, skilled nursing facilities or other health care facilities as applicable; ++ ensure timely exchange of electronic health information with other practitioners and providers to support continuity of care. ++ ensure timely follow-up communication (direct contact, telephone, electronic) with the patient and/or caregiver after an emergency department visit and discharges from hospitals, skilled nursing facilities, or other health care facilities, within 7 calendar days of discharge, as clinically indicated. ongoing communication and coordinating receipt of needed services from practitioners, home- and community-based service providers, community-based social service providers, hospitals, and skilled nursing facilities (or other health care facilities), and document communication regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors, in the patient's medical record; enhanced opportunities for the beneficiary and any caregiver to communicate with the care team/practitioner regarding the beneficiary's care through the use of asynchronous non-face-to-face consultation methods other than telephone, such as secure messaging, email, internet, or patient portal, and other communication-technology based services, including remote evaluation of pre-recorded patient information and interprofessional telephone/internet/ehr referral service(s), to maintain ongoing communication with patients, as appropriate; ++ ensure access to patient-initiated digital communications that require a clinical decision, such as virtual check-ins and digital online assessment and management and e/m visits (or e-visits). analyze patient population data to identify gaps in care and offer additional interventions, as appropriate; risk stratify the practice population based on defined diagnoses, claims, or other electronic data to identify and target services to patients; be assessed through performance measurement of primary care quality, total cost of care, and meaningful use of certified ehr technology | Adv prim care mgmt lvl 3 | 2025 |
G0559 | Post-operative follow-up visit complexity inherent to evaluation and management services addressing surgical procedure(s), provided by a physician or qualified health care professional who is not the practitioner who performed the procedure (or in the same group practice) and is of the same or of a different specialty than the practitioner who performed the procedure, within the 90-day global period of the procedure(s), once per 90-day global period, when there has not been a formal transfer of care and requires the following required elements, when possible and applicable: reading available surgical note to understand the relative success of the procedure, the anatomy that was affected, and potential complications that could have arisen due to the unique circumstances of the patient's operation. research the procedure to determine expected post-operative course and potential complications (in the case of doing a post-op for a procedure outside the specialty). evaluate and physically examine the patient to determine whether the post-operative course is progressing appropriately. communicate with the practitioner who performed the procedure if any questions or concerns arise. (list separately in addition to office/outpatient evaluation and management visit, new or established) | Unrelat prac follow up visit | 2025 |
G0560 | Safety planning interventions, each 20 minutes personally performed by the billing practitioner, including assisting the patient in the identification of the following personalized elements of a safety plan: recognizing warning signs of an impending suicidal or substance use-related crisis; employing internal coping strategies; utilizing social contacts and social settings as a means of distraction from suicidal thoughts or risky substance use; utilizing family members, significant others, caregivers, and/or friends to help resolve the crisis; contacting mental health or substance use disorder professionals or agencies; and making the environment safe | Safety plan interven | 2025 |
G0561 | Tympanostomy with local or topical anesthesia and insertion of a ventilating tube when performed with tympanostomy tube delivery device, unilateral (list separately in addition to 69433) (do not use in conjunction with 0583t) | Temp tube delivery, unil | 2025 |
G0562 | Therapeutic radiology simulation-aided field setting; complex, including acquisition of pet and ct imaging data required for radiopharmaceutical-directed radiation therapy treatment planning (i.e., modeling) | Complex simulation w/pet-ct | 2025 |
G0563 | Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance and real-time positron emissions-based delivery adjustments to 1 or more lesions, entire course not to exceed 5 fractions | Sbrt w/positron emission del | 2025 |
G0566 | 3d radiodensity-value bone imaging, algorithm derived, from previous magnetic resonance examination of the same anatomy | 3d bn img algor drvd fr mri | 2025 |
G0567 | Infectious agent detection by nucleic acid (dna or rna); hepatitis c, screening, amplified probe technique | Screening hep c detect | 2024 |
G0568 | Initial psychiatric collaborative care management, in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: outreach to and engagement in treatment of a patient directed by the treating physician or other qualified health care professional, initial assessment of the patient, including administration of validated rating scales, with the development of an individualized treatment plan, review by the psychiatric consultant with modifications of the plan if recommended, entering patient in a registry and tracking patient follow-up and progress using the registry, with appropriate documentation, and participation in weekly caseload consultation with the psychiatric consultant, and provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies (list separately in addition to the advanced primary care management code) | Int psych care mng, 1 cal mo | 2026 |
G0569 | Subsequent psychiatric collaborative care management, in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: tracking patient follow-up and progress using the registry, with appropriate documentation, participation in weekly caseload consultation with the psychiatric consultant, ongoing collaboration with and coordination of the patient's mental health care with the treating physician or other qualified health care professional and any other treating mental health providers, additional review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations provided by the psychiatric consultant, provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies, monitoring of patient outcomes using validated rating scales, and relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharge from active treatment (list separately in addition to advanced primary care management code) | Subs psych care mng, subs mo | 2026 |
G0570 | Care management services for behavioral health conditions, directed by a physician or other qualified health care professional, per calendar month, with the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales, behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes, facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation, and continuity of care with a designated member of the care team (list separately in addition to advanced primary care management code) | Care manage serv, pr cal mo | 2026 |
G0571 | Intraoperative nerve(s) cryoablation for post-surgical pain relief (list separately in addition to code for primary service) | Intraop nerve cryoablation | 2026 |
G0574 | Management of new patient with dementia residing in an eligible residential care community, for use only in a medicare-approved cmmi model (services must be furnished within a patient's eligible residential care community, including assisted living facilities, board and care homes, or other qualifying residential settings where dementia care services are provided) | Mgt new pt dem res care cmmi | 2026 |
G0575 | Management of established patient with dementia residing in an eligible residential care community, for use only in a medicare-approved cmmi model (services must be furnished within a patient's eligible residential care community, including assisted living facilities, board and care homes, or other qualifying residential settings where dementia care services are provided) | Mgt est pt dem res care cmmi | 2026 |
G0577 | Vascular embolization or occlusion procedure with use of a pressure-generating catheter (e.g., one-way valve, intermittently occluding), inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction performed in the non-facility setting | Vasc emb/occl organ, pgc | 2026 |
G0659 | 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 | Drug test def simple all cl | 2017 |
G0660 | Team remote e/m new pt 10mins | Team remote e/m new pt 10 mn | 2026 |
G0661 | Team remote e/m new pt 20mins | Team remote e/m new pt 20 mn | 2026 |
G0662 | Team remote e/m new pt 30 mins | Team remote e/m new pt 30 mn | 2026 |
G0663 | Team remote e/m new pt 45mins | Team remote e/m new pt 45 mn | 2026 |
G0664 | Team remote e/m new pt 60mins | Team remote e/m new pt 60 mn | 2026 |
G0665 | Team remote e/m est. pt 10mins | Team remote e/m est pt 10 mn | 2026 |
G0666 | Team remote e/m est. pt 15mins | Team remote e/m est pt 15 mn | 2026 |
G0667 | Team remote e/m est. pt 25mins | Team remote e/m est pt 25 mn | 2026 |
G0668 | Team remote e/m est. pt 40mins | Team remote e/m est pt 40 mn | 2026 |
G0669 | Outcome-aligned payment (oap) for technology-enabled chronic care management of early cardio-kidney-metabolic (eckm) conditions (hypertension, or two or more of: dyslipidemia, obesity/overweight with central obesity marker, prediabetes); initial 12-month period; per month | Eckm oap-initial period | 2026 |
G0670 | Outcome-aligned payment (oap) for technology-enabled chronic care management of early cardio-kidney-metabolic (eckm) conditions (hypertension, or two or more of: dyslipidemia, obesity/overweight with central obesity marker, prediabetes); follow-on 12-month period; per month | Eckm oap-follow-on period(s) | 2026 |
G0671 | Outcome-aligned payment (oap) for technology-enabled chronic care management of cardio-kidney-metabolic (ckm) conditions (one or more of: diabetes mellitus, chronic kidney disease stage 3a or 3b, atherosclerotic cardiovascular disease); initial 12-month period; per month | Ckm oap-initial period | 2026 |
G0672 | Outcome-aligned payment (oap) for technology-enabled chronic care management of cardio-kidney-metabolic (ckm) conditions (one or more of: diabetes mellitus, chronic kidney disease stage 3a or 3b, atherosclerotic cardiovascular disease); follow-on 12-month period; per month | Ckm oap-follow-on period(s) | 2026 |
G0673 | Outcome-aligned payment (oap) for technology-enabled chronic care management of musculoskeletal (msk) conditions (chronic musculoskeletal pain); initial 12-month treatment period; per month | Msk oap-initial period | 2026 |
G0674 | Outcome-aligned payment (oap) for technology-enabled chronic care management of behavioral health (bh) conditions (one or more of: depression, anxiety); initial 12-month period; per month | Bh oap-initial period | 2026 |
G0675 | Outcome-aligned payment (oap) for technology-enabled chronic care management of behavioral health (bh) conditions (one or more of: depression, anxiety); follow-on 12-month period; per month | Bh oap-follow-on period(s) | 2026 |
G0676 | Standard co-management service payment for documented review of clinical updates from access participant managing cardio-kidney-metabolic conditions (early cardio-kidney-metabolic [eckm] or cardio-kidney-metabolic [ckm] track); per review | Std co-mgmt-eckm, ckm | 2026 |
G0677 | Standard co-management service payment for documented review of clinical updates from access participant managing musculoskeletal (msk) conditions; per review | Std co-mgmt-msk | 2026 |
G0678 | Standard co-management service payment for documented review of clinical updates from access participant managing behavioral health (bh) conditions (depression, anxiety); per review | Std co-mgmt-bh | 2026 |
G0680 | Detection and quantification of coronary artery calcium and/or aortic valve calcification from algorithmic analysis of computed tomography of the chest with report | Cr art clc art vlv clc w rpt | 2026 |
G0681 | Application of a premarket approval (pma), 510(k), 361 human cells, tissues or cellular and tissue-based products (hct/p) non-sheet form skin substitute for a wound surface area up to 100 sq cm; first 25 sq cm or less of wound surface area | App of non-sheet skin sub | 2026 |
G0682 | Application of a premarket approval (pma), 510(k), 361 human cells, tissues or cellular and tissue-based products (hct/p) non-sheet form skin substitute for a wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary procedure) | App non-sheet skin sub add | 2026 |
G0683 | Application of a premarket approval (pma), 510(k), 361 human cells, tissues or cellular and tissue-based products (hct/p) non-sheet form skin substitute graft for a wound surface greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children | App of non-sheet skin sub g | 2026 |
G0684 | Application of a premarket approval (pma), 510(k), 361 human cells, tissues or cellular and tissue-based products (hct/p) non-sheet form skin substitute graft for a wound surface greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area or part thereof, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure) | App non-sheet skin sb g addl | 2026 |
G0685 | Algorithm-based assessment of likelihood of autism spectrum disorder (asd), derived from validated analysis of eye-gaze data or other technology | Algorithm assessment for asd | 2026 |
G0913 | Improvement in visual function achieved within 90 days following cataract surgery | Improve visual funct | 2012 |
G0914 | Patient care survey was not completed by patient | Survey not complete | 2012 |
G0915 | Improvement in visual function not achieved within 90 days following cataract surgery | No improve visual funct | 2012 |
G0916 | Satisfaction with care achieved within 90 days following cataract surgery | Satisfy with care | 2012 |
G0917 | Patient care survey was not completed by patient | Care survey not complete | 2012 |
G0918 | Satisfaction with care not achieved within 90 days following cataract surgery | No satisfy with care | 2012 |
G1025 | Patient-months where there are more than one medicare capitated payment (mcp) provider listed for the month | Pt mnth 1 mcp prov | 2022 |
G1026 | 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 | Pt hemo > 3mo | 2022 |
G1027 | 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 | Pt hemo < 3mo | 2022 |
G1028 | 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 | Take home supply 8mg per 0.1 | 2022 |
G2000 | 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 | Blinded conv. tx mdd clin tr | 2018 |
G2001 | 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.) | Post d/c h vst new pt 20 m | 2019 |
G2002 | 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.) | Post-d/c h vst new pt 30 m | 2019 |
G2003 | 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.) | Post-d/c h vst new pt 45 m | 2019 |
G2004 | 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.) | Post-d/c h vst new pt 60 m | 2019 |
G2005 | 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.) | Post-d/c h vst new pt 75 m | 2019 |
G2006 | 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.) | Post-d/c h vst ext pt 20 m | 2019 |
G2007 | 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.) | Post-d/c h vst ext pt 30 m | 2019 |
G2008 | 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.) | Post-d/c h vst ext pt 45 m | 2019 |
G2009 | 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.) | Post-d/c h vst ext pt 60 m | 2019 |
G2010 | 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 | Remot image submit by pt | 2019 |
G2011 | Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention, 5-14 minutes | Alcohol/sub misuse assess | 2019 |
G2013 | 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.) | Post-d/c h vst ext pt 75 m | 2019 |
G2014 | 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.) | Post-d/c care plan overs 30m | 2019 |
G2015 | 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.) | Post-d/c care plan overs 60m | 2019 |
G2020 | 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) | Hi inten serv for sip model | 2021 |
G2021 | Health care practitioners rendering treatment in place (tip) | Hea care pract tx in place | 2020 |
G2022 | A model participant (ambulance supplier/provider), the beneficiary refuses services covered under the model (transport to an alternate destination/treatment in place) | Benef refuses service, mod | 2020 |
G2025 | Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only | Dis site tele svcs rhc/fqhc | 2020 |
G2067 | 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) | Med assist tx meth wk | 2020 |
G2068 | 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) | Med assist tx bupre oral | 2020 |
G2069 | Medication assisted treatment, buprenorphine (injectable) administered on a monthly basis; bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) | Med assist tx inject | 2020 |
G2073 | 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) | Med tx naltrexone | 2020 |
G2074 | 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) | Med assist tx no drug | 2020 |
G2075 | 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) | Med tx meds nos | 2020 |
G2076 | Intake activities, including initial medical examination that is conducted by an appropriately licensed practitioner and preparation of a care plan, which may be informed by administration of a standardized, evidence-based assessment, and that includes the patient's goals and mutually agreed-upon actions for the patient to meet those goals, including harm reduction interventions; the patient's needs and goals in the areas of education, vocational training, and employment; and the medical and psychiatric, psychosocial, economic, legal, housing, physical activity and/or nutrition needs and other recovery support services that a patient needs and wishes to pursue, conducted by an appropriately licensed/credentialed personnel (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to each primary code | Intake act w/med exam | 2020 |
G2077 | Periodic assessment; assessing periodically by an otp practitioner and includes a review of moud dosing, treatment response, other substance use disorder treatment needs, responses and patient-identified goals, and other relevant physical, nutrition and psychiatric treatment needs and goals; may be informed by administration of a standardized, evidence-based assessment, or the need and interest for harm reduction interventions and recovery support services (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to each primary code | Periodic assessment | 2020 |
G2078 | 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 | Take-home meth | 2020 |
G2079 | 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 | Take-hom buprenorphine | 2020 |
G2080 | 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 | Add 30 mins counsel | 2020 |
G2081 | 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 | Pt 66+ snp or ltc pos > 90d | 2020 |
G2082 | 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 | Visit esketamine 56m or less | 2020 |
G2083 | 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 | Visit esketamine, > 56m | 2020 |
G2086 | 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 | Off base opioid tx 70min | 2020 |
G2087 | 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 | Off base opioid tx, 60 m | 2020 |
G2088 | 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) | Off base opioid tx, add30 | 2020 |
G2090 | 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 | Pt 66+ frailty and med dem | 2020 |
G2091 | Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period | Pt 66+ frailty and adv ill | 2020 |
G2092 | Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) or angiotensin receptor-neprilysin inhibitor (arni) therapy prescribed or currently being taken | Ace arb arni | 2020 |
G2093 | 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) | Med doc rsn no ace arn arni | 2020 |
G2094 | Documentation of patient reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., patient declined, other patient reasons) | Pt rsn no ace arn arni | 2020 |
G2096 | Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) or angiotensin receptor-neprilysin inhibitor (arni) therapy was not prescribed, reason not given | No rsn ace arb arni | 2020 |
G2097 | 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) | Dx uri 3d after other dx | 2020 |
G2098 | 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 | Pt 66+ frailty and med dem | 2020 |
G2099 | Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period | Pt 66+ frailty and adv ill | 2020 |
G2100 | 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 | Pt 66+ frailty and med dem | 2020 |
G2101 | Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period | Pt 66+ frailty and adv ill | 2020 |
G2105 | 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 | Pt 66+ snp or ltc pos > 90d | 2020 |
G2106 | 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 | Pt 66+ frailty and med dem | 2020 |
G2107 | Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period | Pt 66+ frailty and adv ill | 2020 |
G2112 | Patient receiving <=5 mg daily prednisone (or equivalent), or ra activity is worsening, or glucocorticoid use is for less than 6 months | Pred<=5 mg ra glu <6m | 2020 |
G2113 | Patient receiving >5 mg daily prednisone (or equivalent) for longer than 6 months, and improvement or no change in disease activity | Pred>5 mg >6m, no chg da | 2020 |
G2115 | 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 | Pt 66-80 frailty and med dem | 2020 |
G2116 | Patients 66 - 80 years of age with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period | Pt 66-80 frailty and adv ill | 2020 |
G2118 | Patients 81 years of age and older with at least one claim/encounter for frailty during the measurement period | Pt 81+ frailty | 2020 |
G2121 | Depression, anxiety, apathy, and psychosis assessed | Psy dep anx ap and icd asse | 2020 |
G2122 | Depression, anxiety, apathy, and psychosis not assessed | Psy/dep/anx/apandicd noasse | 2020 |
G2125 | 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 | Pt 81+ frailty | 2020 |
G2126 | Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period | Pt 66-80 frailty and adv ill | 2020 |
G2127 | 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 | Pt 66-80 frailty and med dem | 2020 |
G2128 | 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) | No aspirin med rsn | 2020 |
G2129 | 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 | No bp outpt | 2020 |
G2136 | 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 | Bk pain vas 6-20wk <= 3 | 2020 |
G2137 | 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 | Bk pain vas 6-20wk > 3 | 2020 |
G2138 | 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 | Bk pain vas 9-15mo <= 3 | 2020 |
G2139 | 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 | Bk pain vas 9-15mo > 3 | 2020 |
G2140 | 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 | Leg pain vas 6-20wk <= 3 | 2020 |
G2141 | 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 | Leg pain vas 6-20wk > 3 | 2020 |
G2142 | 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 | Fs odi 9-15mo postop<= 22 | 2020 |
G2143 | 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 | Fs odi 9-15mo > 22 | 2020 |
G2144 | 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 | Fs odi 6-20wk postop <= 22 | 2020 |
G2145 | 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 | Fsodi 6-20wk >22 or chg 30pt | 2020 |
G2146 | 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 | Leg pain vas 9-15mo <= 3 | 2020 |
G2147 | 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 | Leg pain vas 9-15mo > 3 | 2020 |
G2148 | Multimodal pain management was used | Mpm used | 2020 |
G2149 | 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)) | No mpm med rsn | 2020 |
G2150 | Multimodal pain management was not used | No mpm | 2020 |
G2151 | 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 | Dx degen neuro | 2020 |
G2152 | Residual score for the neck impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) | Res change sc >=0 | 2020 |
G2167 | Residual score for the neck impairment successfully calculated and the score was less than zero (< 0) | Res change sc < 0 | 2020 |
G2168 | 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 | Svs by pt in home health | 2020 |
G2169 | 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 | Svs by ot in home health | 2020 |
G2172 | All inclusive payment for services related to highly coordinated and integrated opioid use disorder (oud) treatment services furnished for the demonstration project | Tx for opioid use demo proj | 2021 |
G2173 | 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) | Uri w comorb 12m oth dx | 2021 |
G2174 | Uri episodes where the patient is taking antibiotics (table 1) in the 30 days prior to the episode date | Uri new rx antibiotic 30d | 2021 |
G2175 | 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) | Pt comorb dx 12m of epi | 2021 |
G2176 | Outpatient, ed, or observation visits that result in an inpatient admission | Outpt ed obs w inpt admit | 2021 |
G2177 | 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 | Bronch w rx antibx 30d | 2021 |
G2178 | 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 | Pt not elig low neuro ex | 2021 |
G2179 | Clinician documented that patient had medical reason for not performing lower extremity neurological exam | Med doc rsn no low ex | 2021 |
G2180 | Clinician documented that patient was not an eligible candidate for evaluation of footwear as patient is bilateral lower extremity amputee | Inelig footwr eval | 2021 |
G2181 | Bmi not documented due to medical reason or patient refusal of height or weight measurement | Bmi not doc medrsn ptref | 2021 |
G2182 | Patient receiving first-time biologic and/or immune response modifier therapy | Pt 1st biolog antirheum | 2021 |
G2183 | Documentation patient unable to communicate and informant not available | Doc pt unable comm | 2021 |
G2184 | Patient does not have a caregiver | No caregiver | 2021 |
G2185 | Documentation caregiver is trained and certified in dementia care | Caregiver dem trained | 2021 |
G2186 | Patient /caregiver dyad has been referred to appropriate resources and connection to those resources is confirmed | Pt ref app rsrcs | 2021 |
G2187 | Patients with clinical indications for imaging of the head: head trauma | Clin ind img hd trauma | 2021 |
G2188 | Patients with clinical indications for imaging of the head: new or change in headache above 50 years of age | Pt 50 yrs w/clin ind hd | 2021 |
G2189 | Patients with clinical indications for imaging of the head: abnormal neurologic exam | Img hd abnml neuro exam | 2021 |
G2190 | Patients with clinical indications for imaging of the head: headache radiating to the neck | Ind img hd rad neck | 2021 |
G2191 | Patients with clinical indications for imaging of the head: positional headaches | Ind img hd pos hd ache | 2021 |
G2192 | Patients with clinical indications for imaging of the head: temporal headaches in patients over 55 years of age | >55 yrs temp hd ache | 2021 |
G2193 | Patients with clinical indications for imaging of the head: new onset headache in pre-school children or younger (<6 years of age) | <6yr new onset hd ache | 2021 |
G2194 | 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 | New hdache ped pt dis | 2021 |
G2195 | Patients with clinical indications for imaging of the head: occipital headache in children | Occip hdache child | 2021 |
G2196 | Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method | Screen unhlthy etoh use | 2021 |
G2197 | Patient screened for unhealthy alcohol use using a systematic screening method and not identified as an unhealthy alcohol user | Screen hlthy etoh use | 2021 |
G2199 | Patient not screened for unhealthy alcohol use using a systematic screening method | Not scrn etoh no rsn | 2021 |
G2200 | Patient identified as an unhealthy alcohol user received brief counseling | Unhlthy etoh rcvd couns | 2021 |
G2202 | Patient did not receive brief counseling if identified as an unhealthy alcohol user | No rsn no brief couns | 2021 |
G2204 | Patients between 45 and 85 years of age who received a screening colonoscopy during the performance period | Pt 45-85 w/ scope | 2021 |
G2205 | Patients with pregnancy during adjuvant treatment course | Preg drng adjv trtmt | 2021 |
G2206 | Patient received adjuvant treatment course including both chemotherapy and her2-targeted therapy | Adjv trtmt chemo her2 | 2021 |
G2207 | 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) | Rsn no trtmt chem her2 | 2021 |
G2208 | Patient did not receive adjuvant treatment course including both chemotherapy and her2-targeted therapy | No trtmt chemo and her2 | 2021 |
G2209 | Patient refused to participate | Refused to participate | 2021 |
G2210 | 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 | No neck fs prom no rsn | 2021 |
G2211 | 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 home or residence or office/outpatient evaluation and management service, new or established) | Complex e/m visit add on | 2021 |
G2212 | 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) | Prolong outpt/office vis | 2021 |
G2213 | 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) | Initiat med assist tx in er | 2021 |
G2214 | 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 | Init/sub psych care m 1st 30 | 2021 |
G2215 | 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 | Home supply nasal naloxone | 2021 |
G2216 | 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 | Home supply inject naloxon | 2021 |
G2250 | 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 | Remot img sub by pt, non e/m | 2021 |
G2251 | 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 | Brief chkin, 5-10, non-e/m | 2021 |
G2252 | 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 | Brief chkin by md/qhp, 11-20 | 2021 |
G3002 | 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.) | Chronic pain mgmt 30 mins | 2023 |
G3003 | 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.) | Chronic pain mgmt addl 15m | 2023 |
G4000 | Dermatology mips specialty set | Dermatology ss | 2022 |
G4001 | Diagnostic radiology mips specialty set | Diagnostic rad ss | 2022 |
G4002 | Electrophysiology cardiac specialist mips specialty set | Ep cardio ss | 2022 |
G4003 | Emergency medicine mips specialty set | Emergency med ss | 2022 |
G4004 | Endocrinology mips specialty set | Endocrinology ss | 2022 |
G4005 | Family medicine mips specialty set | Family medicine ss | 2022 |
G4006 | Gastro-enterology mips specialty set | Gastroenterology ss | 2022 |
G4007 | General surgery mips specialty set | General surgery ss | 2022 |
G4008 | Geriatrics mips specialty set | Geriatrics ss | 2022 |
G4009 | Hospitalists mips specialty set | Hospitalists ss | 2022 |
G4010 | Infectious disease mips specialty set | Infectious disease ss | 2022 |
G4011 | Internal medicine mips specialty set | Internal medicine ss | 2022 |
G4012 | Interventional radiology mips specialty set | Interventional rad ss | 2022 |
G4013 | Mental/behavioral and psychiatry mips specialty set | Mntal/behav/psych hlth ss | 2022 |
G4014 | Nephrology mips specialty set | Nephrology ss | 2022 |
G4015 | Neurology mips specialty set | Neurology ss | 2022 |
G4016 | Neurosurgical mips specialty set | Neurosurgical ss | 2022 |
G4017 | Nutrition/dietician mips specialty set | Nutrition/dietician ss | 2022 |
G4018 | Obstetrics/gynecology mips specialty set | Ob/gyn ss | 2022 |
G4019 | Oncology/hematology mips specialty set | Oncology/hema ss | 2022 |
G4020 | Ophthalmology/optometry mips specialty set | Ophthalmology/optometry ss | 2022 |
G4021 | Orthopedic surgery mips specialty set | Orthopedic surgery ss | 2022 |
G4022 | Otolaryngology mips specialty set | Otolaryngology ss | 2022 |
G4023 | Pathology mips specialty set | Pathology ss | 2022 |
G4024 | Pediatrics mips specialty set | Pediatrics ss | 2022 |
G4025 | Physical medicine mips specialty set | Physical medicine ss | 2022 |
G4026 | Physical therapy/occupational therapy mips specialty set | Phys/occ therapy ss | 2022 |
G4027 | Plastic surgery mips specialty set | Plastic surgery ss | 2022 |
G4028 | Podiatry mips specialty set | Podiatry ss | 2022 |
G4029 | Preventive medicine mips specialty set | Preventive medicine ss | 2022 |
G4030 | Pulmonology mips specialty set | Pulmonology ss | 2022 |
G4031 | Radiation oncology mips specialty set | Radiation oncology ss | 2022 |
G4032 | Rheumatology mips specialty set | Rheumatology ss | 2022 |
G4033 | Skilled nursing facility mips specialty set | Skilled nursing facility ss | 2022 |
G4034 | Speech language pathology mips specialty set | Speech language path ss | 2022 |
G4035 | Thoracic surgery mips specialty set | Thoracic surgery ss | 2022 |
G4036 | Urgent care mips specialty set | Urgent care ss | 2022 |
G4037 | Urology mips specialty set | Urology ss | 2022 |
G4038 | Vascular surgery mips specialty set | Vascular surgery ss | 2022 |
G8395 | Left ventricular ejection fraction (lvef) >= 40% or documentation as normal or mildly depressed left ventricular systolic function | Lvef>=40% doc normal or mild | 2008 |
G8396 | Left ventricular ejection fraction (lvef) not performed or documented | Lvef not performed | 2008 |
G8397 | Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema and level of severity of retinopathy | Dil macula/fundus exam/w doc | 2008 |
G8399 | Patient with documented results of a central dual-energy x-ray absorptiometry (dxa) ever being performed | Pt w/dxa results document | 2008 |
G8400 | Patient with central dual-energy x-ray absorptiometry (dxa) results not documented, reason not given | Pt w/dxa no results doc | 2008 |
G8404 | Lower extremity neurological exam performed and documented | Low extemity neur exam docum | 2008 |
G8405 | Lower extremity neurological exam not performed | Low extemity neur not perfor | 2008 |
G8410 | Footwear evaluation performed and documented | Eval on foot documented | 2008 |
G8415 | Footwear evaluation was not performed | Eval on foot not performed | 2008 |
G8416 | Clinician documented that patient was not an eligible candidate for footwear evaluation measure | Pt inelig footwear evaluatio | 2008 |
G8417 | Bmi is documented above normal parameters and a follow-up plan is documented | Calc bmi abv up param f/u | 2008 |
G8418 | Bmi is documented below normal parameters and a follow-up plan is documented | Calc bmi blw low param f/u | 2008 |
G8419 | Bmi documented outside normal parameters, no follow-up plan documented, no reason given | Calc bmi out nrm param nof/u | 2008 |
G8420 | Bmi is documented within normal parameters and no follow-up plan is required | Calc bmi norm parameters | 2008 |
G8421 | Bmi not documented and no reason is given | Bmi not calculated | 2008 |
G8427 | Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications | Docrev cur meds by elig clin | 2008 |
G8428 | Current list of medications not documented as obtained, updated, or reviewed by the eligible clinician, reason not given | Cur meds not document | 2008 |
G8430 | Documentation of a medical reason(s) for not documenting, updating, or reviewing the patient's current medications list (e.g., patient is in an acute health crisis where time is of the essence and delay of treatment would jeopardize the patient's health status) | Doc med rsn no medrec | 2008 |
G8431 | Screening for depression is documented as being positive and a follow-up plan is documented | Pos clin depres scrn f/u doc | 2008 |
G8432 | Depression screening not documented, reason not given | Dep scr not doc, rng | 2008 |
G8433 | Screening for depression not completed, documented patient or medical reason | Scr for dep not cpt doc rsn | 2008 |
G8450 | Beta-blocker therapy prescribed | Beta-bloc rx pt w/abn lvef | 2008 |
G8451 | 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) | Pt w/abn lvef inelig b-bloc | 2008 |
G8452 | Beta-blocker therapy not prescribed | Pt w/abn lvef b-bloc no rx | 2008 |
G8465 | High or very high risk of recurrence of prostate cancer | High risk recurrence pro ca | 2008 |
G8473 | Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy prescribed | Ace/arb thxpy rx'd | 2008 |
G8474 | 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) | Ace/arb not rx'd; doc reas | 2008 |
G8475 | Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy not prescribed, reason not given | Ace/arb thxpy not rx'd | 2008 |
G8476 | Most recent blood pressure has a systolic measurement of < 140 mmhg and a diastolic measurement of < 90 mmhg | Bp sys <140 and dias <90 | 2008 |
G8477 | Most recent blood pressure has a systolic measurement of >= 140 mmhg and/or a diastolic measurement of >= 90 mmhg | Bp sys>=140 and/or dias >=90 | 2008 |
G8478 | Blood pressure measurement not performed or documented, reason not given | Bp not performed/doc | 2008 |
G8510 | Screening for depression is documented as negative, a follow-up plan is not required | Scr dep neg, no plan reqd | 2009 |
G8511 | Screening for depression documented as positive, follow-up plan not documented, reason not given | Scr dep pos, no plan doc rng | 2009 |
G8535 | 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 | Eld maltreatment not doc | 2009 |
G8536 | No documentation of an elder maltreatment screen, reason not given | No doc elder mal scrn | 2009 |
G8539 | 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 | Doc funct and care plan | 2009 |
G8540 | 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 | Foa not doc as being perf | 2009 |
G8541 | Functional outcome assessment using a standardized tool not documented, reason not given | No doc cur funct assess | 2009 |
G8542 | Functional outcome assessment using a standardized tool is documented; no functional deficiencies identified, care plan not required | Doc funct no deficiencies | 2009 |
G8543 | Documentation of a positive functional outcome assessment using a standardized tool; care plan not documented within two days of assessment, reason not given | Cur funct asses; no care pln | 2009 |
G8559 | Patient referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation | Pt ref doc oto eval | 2010 |
G8560 | Patient has a history of active drainage from the ear within the previous 90 days | Pt hx act drain prev 90 days | 2010 |
G8561 | Patient is not eligible for the referral for otologic evaluation for patients with a history of active drainage measure | Pt inelig for ref oto eval | 2010 |
G8562 | Patient does not have a history of active drainage from the ear within the previous 90 days | Pt no hx act drain 90 d | 2010 |
G8563 | Patient not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not given | Pt no ref oto reas no spec | 2010 |
G8564 | Patient was referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not specified) | Pt ref oto eval | 2010 |
G8565 | Verification and documentation of sudden or rapidly progressive hearing loss | Ver doc hear loss | 2010 |
G8566 | Patient is not eligible for the "referral for otologic evaluation for sudden or rapidly progressive hearing loss" measure | Pt inelig ref oto eval | 2010 |
G8567 | Patient does not have verification and documentation of sudden or rapidly progressive hearing loss | Pt no doc hear loss | 2010 |
G8568 | Patient was not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not given | Pt no ref otolo no spec | 2010 |
G8569 | Prolonged postoperative intubation (> 24 hrs) required | Prol intubation req | 2010 |
G8570 | Prolonged postoperative intubation (> 24 hrs) not required | No prol intub req | 2010 |
G8575 | Developed postoperative renal failure or required dialysis | Postop ren fail | 2010 |
G8576 | No postoperative renal failure/dialysis not required | No postop ren fail | 2010 |
G8577 | Re-exploration required due to mediastinal bleeding with or without tamponade, unplanned coronary artery intervention (native, vessel, graft, or both), valve dysfunction, aortic reintervention, or other cardiac reason | Reop req bld grft oth | 2010 |
G8578 | Re-exploration not required due to mediastinal bleeding with or without tamponade, unplanned coronary artery intervention (native, vessel, graft, or both), valve dysfunction, aortic reintervention, or other cardiac reason | No reop req bld grft oth | 2010 |
G8598 | Aspirin or another antiplatelet therapy used | Asa/antiplat ther used | 2010 |
G8599 | Aspirin or another antiplatelet therapy not used, reason not given | No asa/antiplat ther use rng | 2010 |
G8600 | Iv thrombolytic therapy initiated within 4.5 hours (<= 270 minutes) of time last known well | Tpa initi w/in 4.5 hr | 2010 |
G8601 | 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) | No elig tpa init w/in 4.5 hr | 2010 |
G8602 | Iv thrombolytic therapy not initiated within 4.5 hours (<= 270 minutes) of time last known well, reason not given | No tpa init w/in 4.5 hr | 2010 |
G8633 | Pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed | Pharm ther osteo rx | 2011 |
G8635 | Pharmacologic therapy for osteoporosis was not prescribed, reason not given | No pharm ther osteo rx | 2011 |
G8647 | Residual score for the knee impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) | Rafscrs ki scor >= 0 | 2011 |
G8648 | Residual score for the knee impairment successfully calculated and the score was less than zero (< 0) | Rafscrs ki scor < 0 | 2011 |
G8650 | 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 | Rafs crs ki no scor no rsn | 2011 |
G8651 | Residual score for the hip impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) | Rafscrs hi scor >=0 | 2011 |
G8652 | Residual score for the hip impairment successfully calculated and the score was less than zero (< 0) | Rafscrs hi scor < 0 | 2011 |
G8654 | 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 | Rafs crs hi no scor no surv | 2011 |
G8655 | 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) | Rafscrs llfai scor >= 0 | 2011 |
G8656 | Residual score for the lower leg, foot or ankle impairment successfully calculated and the score was less than zero (< 0) | Rafscrs llfai scor < 0 | 2011 |
G8658 | 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 | Rafscrs llfai no scor + surv | 2011 |
G8659 | Residual score for the low back impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) | Rafscrs lbi scor >= 0 | 2011 |
G8660 | Residual score for the low back impairment successfully calculated and the score was less than zero (< 0) | Rafscrs lbi scor < 0 | 2011 |
G8661 | 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 | Rafscrs lbi no scor | 2011 |
G8662 | 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 | Rafs crs lbi no scor no surv | 2011 |
G8663 | Residual score for the shoulder impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) | Rafscrs si scor >= 0 | 2011 |
G8664 | Residual score for the shoulder impairment successfully calculated and the score was less than zero (< 0) | Rafscrs si scor < 0 | 2011 |
G8666 | 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 | Rafs crs si no scor no surv | 2011 |
G8667 | Residual score for the elbow, wrist or hand impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) | Rafscrs ewh scor >= 0 | 2011 |
G8668 | Residual score for the elbow, wrist or hand impairment successfully calculated and the score was less than zero (< 0) | Rafscrs ewh scor < 0 | 2011 |
G8670 | 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 | Rafs crs ewh no scor no surv | 2011 |
G8694 | Current or prior left ventricular ejection fraction (lvef) < = 40% or documentation of moderate or severe lvsd | Lvef <=40% | 2012 |
G8708 | Patient not prescribed antibiotic | Antibiotic not pres | 2012 |
G8709 | 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) | Uri ep compete diag | 2012 |
G8710 | Patient prescribed antibiotic | Pt pres antibiotic | 2012 |
G8711 | Prescribed antibiotic on or within 3 days after the episode date | Pres antibx on/within 3 day | 2012 |
G8712 | Antibiotic not prescribed or dispensed | Not pres antibiotic | 2012 |
G8721 | Pt category (primary tumor), pn category (regional lymph nodes), and histologic grade were documented in pathology report | Pt, pn, hist grade doc | 2012 |
G8722 | 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) | Med reas pt, pn, not doc | 2012 |
G8723 | Specimen site is other than anatomic location of primary tumor | Spec sit not prim tumor | 2012 |
G8724 | Pt category, pn category and histologic grade were not documented in the pathology report, reason not given | Pt, pn, hist grade not doc | 2012 |
G8733 | Elder maltreatment screen documented as positive and a follow-up plan is documented | Doc pos elder mal scrn plan | 2012 |
G8734 | Elder maltreatment screen documented as negative, follow-up is not required | Doc neg eld req | 2012 |
G8735 | Elder maltreatment screen documented as positive, follow-up plan not documented, reason not given | Eld mal scrn pos no plan | 2012 |
G8749 | 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) | No signs melanoma | 2012 |
G8752 | Most recent systolic blood pressure < 140 mmhg | Sys bp less 140 | 2012 |
G8753 | Most recent systolic blood pressure >= 140 mmhg | Sys bp > or = 140 | 2012 |
G8754 | Most recent diastolic blood pressure < 90 mmhg | Dias bp less 90 | 2012 |
G8755 | Most recent diastolic blood pressure >= 90 mmhg | Dias bp > or = 90 | 2012 |
G8756 | No documentation of blood pressure measurement, reason not given | No bp measure doc | 2012 |
G8783 | Normal blood pressure reading documented, follow-up not required | Bp scrn perf rec interval | 2012 |
G8785 | Blood pressure reading not documented, reason not given | Bp scrn no perf at interval | 2012 |
G8797 | Specimen site other than anatomic location of esophagus | Specimen site not esophagus | 2012 |
G8798 | Specimen site other than anatomic location of prostate | Specimen site not prostate | 2012 |
G8806 | Performance of trans-abdominal or trans-vaginal ultrasound and pregnancy location documented | Perf ultrsnd to lct preg doc | 2012 |
G8807 | Trans-abdominal or trans-vaginal ultrasound not performed for reasons documented by clinician (e.g., patient has a documented intrauterine pregnancy [iup]) | No ta tv ultrasnd | 2012 |
G8808 | Trans-abdominal or trans-vaginal ultrasound not performed, reason not given | Ultrasound not perf, rng | 2012 |
G8815 | 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) | Doc reas no statin therapy | 2012 |
G8816 | Statin medication prescribed at discharge | Statin med pres at disch | 2012 |
G8817 | Statin therapy not prescribed at discharge, reason not given | Doc reas no statin med disch | 2012 |
G8826 | Patient discharged to home no later than post-operative day #2 following evar | Pt disch home day #2 evar | 2012 |
G8833 | Patient not discharged to home by post-operative day #2 following evar | Pt not disch home day#2 evar | 2012 |
G8834 | Patient discharged to home no later than post-operative day #2 following cea | Pt disch home day #2 cea | 2012 |
G8838 | Patient not discharged to home by post-operative day #2 following cea | Not disch home by day #2 | 2012 |
G8839 | Sleep apnea symptoms assessed, including presence or absence of snoring and daytime sleepiness | Sleep apnea assess | 2012 |
G8840 | 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) | Doc reas no sleep apnea | 2012 |
G8841 | Sleep apnea symptoms not assessed, reason not given | No sleep apnea assess | 2012 |
G8842 | Apnea hypopnea index (ahi), respiratory disturbance index (rdi) or respiratory event index (rei) documented or measured within 2 months after initial evaluation for suspected obstructive sleep apnea | Ahi rdi rei doc win 2mo | 2012 |
G8843 | Documentation of reason(s) for not measuring an apnea hypopnea index (ahi), a respiratory disturbance index (rdi), or a respiratory event index (rei) within 2 months after initial evaluation for suspected obstructive sleep apnea (e.g., medical, neurological, or psychiatric disease that prohibits successful completion of a sleep study, patients for whom a sleep study would present a bigger risk than benefit or would pose an undue burden, dementia, patients previously diagnosed with osa and severity assessed by another provider, patients who decline ahi/rdi/rei measurement, patients who had a financial reason for not completing testing, test was ordered but not completed, patients decline because their insurance (payer) does not cover the expense) | Doc reas no ahi rdi rei | 2012 |
G8844 | Apnea hypopnea index (ahi), respiratory disturbance index (rdi), or respiratory event index (rei) not documented or measured within 2 months after initial evaluation for suspected obstructive sleep apnea, reason not given | No ahi rdi rei ini dx no rsn | 2012 |
G8845 | Positive airway pressure therapy prescribed | Pos airway press prescribed | 2012 |
G8846 | Moderate or severe obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory disturbance index (rdi) of 15 or greater) | Mod or severe osa | 2012 |
G8849 | 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) | Doc reas no pos air press | 2012 |
G8850 | Positive airway pressure therapy not prescribed, reason not given | No pap prescribed | 2012 |
G8851 | Adherence to therapy was assessed at least annually through an objective informatics system or through self-reporting (if objective reporting is not available, documented) | Adhere tx assess at lst ann | 2012 |
G8854 | 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) | Reas no adhere therapy | 2012 |
G8855 | 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 | Ther not assessed annually | 2012 |
G8856 | Referral to a physician for an otologic evaluation performed | Ref for oto eval | 2012 |
G8857 | 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) | No elig ref for oto eval | 2012 |
G8858 | Referral to a physician for an otologic evaluation not performed, reason not given | Not ref for oto eval | 2012 |
G8863 | Patients not assessed for risk of bone loss, reason not given | No assess bone loss | 2012 |
G8864 | Pneumococcal vaccine administered or previously received | Pneumococcal vaccine admin | 2012 |
G8865 | Documentation of medical reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient allergic reaction, potential adverse drug reaction) | Doc med reas no pneumococcal | 2012 |
G8866 | Documentation of patient reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient refusal) | Doc pt reas no pneumococcal | 2012 |
G8867 | Pneumococcal vaccine not administered or previously received, reason not given | No pneumococcal admin | 2012 |
G8869 | Patient has documented immunity to hepatitis b and initiating anti-tnf therapy | Doc immune hep b antitnf | 2012 |
G8875 | Clinician diagnosed breast cancer preoperatively by a minimally invasive biopsy method | Breast cancer dx min invsive | 2012 |
G8876 | 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) | Doc reas no min inv dx | 2012 |
G8877 | Clinician did not attempt to achieve the diagnosis of breast cancer preoperatively by a minimally invasive biopsy method, reason not given | No brst cncr dx min invasive | 2012 |
G8878 | Sentinel lymph node biopsy procedure performed | Sent lymph node biopsy | 2012 |
G8880 | 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) | Sen lym p node biop not perf | 2012 |
G8881 | Stage of breast cancer is greater than t1n0m0 or t2n0m0 | Brst cncr stage > t1n0m0 | 2012 |
G8882 | Sentinel lymph node biopsy procedure not performed, reason not given | No sent lymph node biopsy | 2012 |
G8907 | 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 | Pt doc no events on discharg | 2012 |
G8908 | Patient documented to have received a burn prior to discharge | Pt doc w burn prior to d/c | 2012 |
G8909 | Patient documented not to have received a burn prior to discharge | Pt doc no burn prior to d/c | 2012 |
G8910 | Patient documented to have experienced a fall within asc | Pt doc to have fall in asc | 2012 |
G8911 | Patient documented not to have experienced a fall within ambulatory surgical center | Pt doc no fall in asc | 2012 |
G8912 | Patient documented to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event | Pt doc with wrong event | 2012 |
G8913 | Patient documented not to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event | Pt doc no wrong event | 2012 |
G8914 | Patient documented to have experienced a hospital transfer or hospital admission upon discharge from asc | Pt trans to hosp post d/c | 2012 |
G8915 | Patient documented not to have experienced a hospital transfer or hospital admission upon discharge from asc | Pt not trans to hosp at d/c | 2012 |
G8916 | Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic initiated on time | Pt w iv ab given on time | 2012 |
G8917 | Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic not initiated on time | Pt w iv ab not given on time | 2012 |
G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | Pt w/o preop order iv ab pro | 2012 |
G8923 | Current or prior left ventricular ejection fraction (lvef) <= 40% or documentation of moderately or severely depressed left ventricular systolic function | Lvef <= 40% or lvsd | 2013 |
G8924 | Spirometry results documented (fev1/fvc < 70%) | Spir res doc fev1/fvc<70% | 2013 |
G8934 | Current or prior left ventricular ejection fraction (lvef) <=40% or documentation of moderately or severely depressed left ventricular systolic function | Lvef <=40% or dep lv sys fcn | 2013 |
G8935 | Clinician prescribed angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy | Rx ace or arb therapy | 2013 |
G8936 | Clinician documented that patient was not an eligible candidate for angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy (eg, allergy, intolerance, pregnancy, renal failure due to ace inhibitor, diseases of the aortic or mitral valve, other medical reasons) or (eg, patient declined, other patient reasons) | Pt not eligible ace/arb | 2013 |
G8937 | Clinician did not prescribe angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy, reason not given | No rx ace/arb therapy | 2013 |
G8942 | Functional outcome assessment using a standardized tool is documented within the previous 30 days and a care plan, based on identified deficiencies is documented within two days of the functional outcome assessment | Doc fcn/care plan w/30 days | 2013 |
G8944 | Ajcc melanoma cancer stage 0 through iic melanoma | Ajcc mel cnr stg 0 - iic | 2013 |
G8946 | Minimally invasive biopsy method attempted but not diagnostic of breast cancer (e.g., high risk lesion of breast such as atypical ductal hyperplasia, lobular neoplasia, atypical lobular hyperplasia, lobular carcinoma in situ, atypical columnar hyperplasia, flat epithelial atypia, radial scar, complex sclerosing lesion, papillary lesion, or any lesion with spindle cells) | Mibm but no dx of breast ca | 2013 |
G8950 | Elevated or hypertensive blood pressure reading documented, and the indicated follow-up is documented | Pre-htn or htn doc, f/u indc | 2013 |
G8952 | Elevated or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given | Pre-htn/htn, no f/u, not gvn | 2013 |
G8955 | Most recent assessment of adequacy of volume management documented | Most recent assess vol mgmt | 2013 |
G8956 | Patient receiving maintenance hemodialysis in an outpatient dialysis facility | Pt rcv hedia outpt dyls fac | 2013 |
G8958 | Assessment of adequacy of volume management not documented, reason not given | Assess vol mgmt not doc | 2013 |
G8961 | Cardiac stress imaging test primarily performed on low-risk surgery patient for preoperative evaluation within 30 days preceding this surgery | Csit lowrisk surg pts preop | 2013 |
G8962 | Cardiac stress imaging test performed on patient for any reason including those who did not have low risk surgery or test that was performed more than 30 days preceding low risk surgery | Csit on pt any reas 30 days | 2013 |
G8967 | Fda approved oral anticoagulant is prescribed | Warf or other fda drug presc | 2013 |
G8968 | Documentation of medical reason(s) for not prescribing an fda-approved anticoagulant (e.g., present or planned atrial appendage occlusion or ligation or patient being currently enrolled in a clinical trial related to af/atrial flutter treatment) | Doc med not presb | 2013 |
G8969 | Documentation of patient reason(s) for not prescribing an oral anticoagulant that is fda approved for the prevention of thromboembolism (e.g., patient preference for not receiving anticoagulation) | Doc pt rsn no presc warf/fda | 2013 |
G8970 | No risk factors or one moderate risk factor for thromboembolism | No rsk fac or 1 mod risk te | 2013 |
G9001 | Coordinated care fee, initial rate | Mccd, initial rate | 2000 |
G9002 | Coordinated care fee, maintenance rate | Mccd,maintenance rate | 2000 |
G9003 | Coordinated care fee, risk adjusted high, initial | Mccd, risk adj hi, initial | 2000 |
G9004 | Coordinated care fee, risk adjusted low, initial | Mccd, risk adj lo, initial | 2000 |
G9005 | Coordinated care fee, risk adjusted maintenance | Mccd, risk adj, maintenance | 2000 |
G9006 | Coordinated care fee, home monitoring | Mccd, home monitoring | 2000 |
G9007 | Coordinated care fee, scheduled team conference | Mccd, sch team conf | 2000 |
G9008 | Coordinated care fee, physician coordinated care oversight services | Mccd,phys coor-care ovrsght | 2000 |
G9009 | Coordinated care fee, risk adjusted maintenance, level 3 | Mccd, risk adj, level 3 | 2001 |
G9010 | Coordinated care fee, risk adjusted maintenance, level 4 | Mccd, risk adj, level 4 | 2001 |
G9011 | Coordinated care fee, risk adjusted maintenance, level 5 | Mccd, risk adj, level 5 | 2001 |
G9012 | Other specified case management service not elsewhere classified | Other specified case mgmt | 2001 |
G9013 | Esrd demo basic bundle level i | Esrd demo bundle level i | 2004 |
G9014 | Esrd demo expanded bundle including venous access and related services | Esrd demo bundle-level ii | 2004 |
G9016 | Smoking cessation counseling, individual, in the absence of or in addition to any other evaluation and management service, per session (6-10 minutes) [demo project code only] | Demo-smoking cessation coun | 2001 |
G9050 | Oncology; primary focus of visit; work-up, evaluation, or staging at the time of cancer diagnosis or recurrence (for use in a medicare-approved demonstration project) | Oncology work-up evaluation | 2006 |
G9051 | Oncology; primary focus of visit; treatment decision-making after disease is staged or restaged, discussion of treatment options, supervising/coordinating active cancer directed therapy or managing consequences of cancer directed therapy (for use in a medicare-approved demonstration project) | Oncology tx decision-mgmt | 2006 |
G9052 | Oncology; primary focus of visit; surveillance for disease recurrence for patient who has completed definitive cancer-directed therapy and currently lacks evidence of recurrent disease; cancer directed therapy might be considered in the future (for use in a medicare-approved demonstration project) | Onc surveillance for disease | 2006 |
G9053 | Oncology; primary focus of visit; expectant management of patient with evidence of cancer for whom no cancer directed therapy is being administered or arranged at present; cancer directed therapy might be considered in the future (for use in a medicare-approved demonstration project) | Onc expectant management pt | 2006 |
G9054 | Oncology; primary focus of visit; supervising, coordinating or managing care of patient with terminal cancer or for whom other medical illness prevents further cancer treatment; includes symptom management, end-of-life care planning, management of palliative therapies (for use in a medicare-approved demonstration project) | Onc supervision palliative | 2006 |
G9055 | Oncology; primary focus of visit; other, unspecified service not otherwise listed (for use in a medicare-approved demonstration project) | Onc visit unspecified nos | 2006 |
G9056 | Oncology; practice guidelines; management adheres to guidelines (for use in a medicare-approved demonstration project) | Onc prac mgmt adheres guide | 2006 |
G9057 | Oncology; practice guidelines; management differs from guidelines as a result of patient enrollment in an institutional review board approved clinical trial (for use in a medicare-approved demonstration project) | Onc pract mgmt differs trial | 2006 |
G9058 | Oncology; practice guidelines; management differs from guidelines because the treating physician disagrees with guideline recommendations (for use in a medicare-approved demonstration project) | Onc prac mgmt disagree w/gui | 2006 |
G9059 | Oncology; practice guidelines; management differs from guidelines because the patient, after being offered treatment consistent with guidelines, has opted for alternative treatment or management, including no treatment (for use in a medicare-approved demonstration project) | Onc prac mgmt pt opt alterna | 2006 |
G9060 | Oncology; practice guidelines; management differs from guidelines for reason(s) associated with patient comorbid illness or performance status not factored into guidelines (for use in a medicare-approved demonstration project) | Onc prac mgmt dif pt comorb | 2006 |
G9061 | Oncology; practice guidelines; patient's condition not addressed by available guidelines (for use in a medicare-approved demonstration project) | Onc prac cond noadd by guide | 2006 |
G9062 | Oncology; practice guidelines; management differs from guidelines for other reason(s) not listed (for use in a medicare-approved demonstration project) | Onc prac guide differs nos | 2006 |
G9063 | Oncology; disease status; limited to non-small cell lung cancer; extent of disease initially established as stage i (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) | Onc dx nsclc stgi no progres | 2006 |
G9064 | Oncology; disease status; limited to non-small cell lung cancer; extent of disease initially established as stage ii (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) | Onc dx nsclc stg2 no progres | 2006 |
G9065 | Oncology; disease status; limited to non-small cell lung cancer; extent of disease initially established as stage iii a (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) | Onc dx nsclc stg3a no progre | 2006 |
G9066 | Oncology; disease status; limited to non-small cell lung cancer; stage iii b- iv at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) | Onc dx nsclc stg3b-4 metasta | 2006 |
G9067 | Oncology; disease status; limited to non-small cell lung cancer; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) | Onc dx nsclc dx unknown nos | 2006 |
G9068 | Oncology; disease status; limited to small cell and combined small cell/non-small cell; extent of disease initially established as limited with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) | Onc dx sclc/nsclc limited | 2006 |
G9069 | Oncology; disease status; small cell lung cancer, limited to small cell and combined small cell/non-small cell; extensive stage at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) | Onc dx sclc/nsclc ext at dx | 2006 |
G9070 | Oncology; disease status; small cell lung cancer, limited to small cell and combined small cell/non-small; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) | Onc dx sclc/nsclc ext unknwn | 2006 |
G9071 | Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage i or stage iia-iib; or t3, n1, m0; and er and/or pr positive; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) | Onc dx brst stg1-2b hr,nopro | 2006 |
G9072 | Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage i, or stage iia-iib; or t3, n1, m0; and er and pr negative; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) | Onc dx brst stg1-2 noprogres | 2006 |
G9073 | Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage iiia-iiib; and not t3, n1, m0; and er and/or pr positive; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) | Onc dx brst stg3-hr, no pro | 2006 |
G9074 | Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage iiia-iiib; and not t3, n1, m0; and er and pr negative; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) | Onc dx brst stg3-noprogress | 2006 |
G9075 | Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) | Onc dx brst metastic/ recur | 2006 |
G9077 | Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t1-t2c and gleason 2-7 and psa < or equal to 20 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) | Onc dx prostate t1no progres | 2006 |
G9078 | Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t2 or t3a gleason 8-10 or psa > 20 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) | Onc dx prostate t2no progres | 2006 |
G9079 | Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t3b-t4, any n; any t, n1 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) | Onc dx prostate t3b-t4noprog | 2006 |
G9080 | Oncology; disease status; prostate cancer, limited to adenocarcinoma; after initial treatment with rising psa or failure of psa decline (for use in a medicare-approved demonstration project) | Onc dx prostate w/rise psa | 2006 |
G9083 | Oncology; disease status; prostate cancer, limited to adenocarcinoma; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) | Onc dx prostate unknwn nos | 2006 |
G9084 | Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-3, n0, m0 with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) | Onc dx colon t1-3,n1-2,no pr | 2006 |
G9085 | Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t4, n0, m0 with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) | Onc dx colon t4, n0 w/o prog | 2006 |
G9086 | Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-4, n1-2, m0 with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) | Onc dx colon t1-4 no dx prog | 2006 |
G9087 | Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive with current clinical, radiologic, or biochemical evidence of disease (for use in a medicare-approved demonstration project) | Onc dx colon metas evid dx | 2006 |
G9088 | Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive without current clinical, radiologic, or biochemical evidence of disease (for use in a medicare-approved demonstration project) | Onc dx colon metas noevid dx | 2006 |
G9089 | Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) | Onc dx colon extent unknown | 2006 |
G9090 | Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-2, n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) | Onc dx rectal t1-2 no progr | 2006 |
G9091 | Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t3, n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) | Onc dx rectal t3 n0 no prog | 2006 |
G9092 | Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-3, n1-2, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence or metastases (for use in a medicare-approved demonstration project) | Onc dx rectal t1-3,n1-2noprg | 2006 |
G9093 | Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t4, any n, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) | Onc dx rectal t4,n,m0 no prg | 2006 |
G9094 | Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) | Onc dx rectal m1 w/mets prog | 2006 |
G9095 | Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) | Onc dx rectal extent unknwn | 2006 |
G9096 | Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; extent of disease initially established as t1-t3, n0-n1 or nx (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) | Onc dx esophag t1-t3 noprog | 2006 |
G9097 | Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; extent of disease initially established as t4, any n, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) | Onc dx esophageal t4 no prog | 2006 |
G9098 | Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) | Onc dx esophageal mets recur | 2006 |
G9099 | Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) | Onc dx esophageal unknown | 2006 |
G9100 | Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; post r0 resection (with or without neoadjuvant therapy) with no evidence of disease recurrence, progression, or metastases (for use in a medicare-approved demonstration project) | Onc dx gastric no recurrence | 2006 |
G9101 | Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; post r1 or r2 resection (with or without neoadjuvant therapy) with no evidence of disease progression, or metastases (for use in a medicare-approved demonstration project) | Onc dx gastric p r1-r2noprog | 2006 |
G9102 | Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; clinical or pathologic m0, unresectable with no evidence of disease progression, or metastases (for use in a medicare-approved demonstration project) | Onc dx gastric unresectable | 2006 |
G9103 | Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; clinical or pathologic m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) | Onc dx gastric recurrent | 2006 |
G9104 | Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) | Onc dx gastric unknown nos | 2006 |
G9105 | Oncology; disease status; pancreatic cancer, limited to adenocarcinoma as predominant cell type; post r0 resection without evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) | Onc dx pancreatc p r0 res no | 2006 |
G9106 | Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; post r1 or r2 resection with no evidence of disease progression, or metastases (for use in a medicare-approved demonstration project) | Onc dx pancreatc p r1/r2 no | 2006 |
G9107 | Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; unresectable at diagnosis, m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) | Onc dx pancreatic unresectab | 2006 |
G9108 | Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) | Onc dx pancreatic unknwn nos | 2006 |
G9109 | Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; extent of disease initially established as t1-t2 and n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) | Onc dx head/neck t1-t2no prg | 2006 |
G9110 | Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; extent of disease initially established as t3-4 and/or n1-3, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) | Onc dx head/neck t3-4 noprog | 2006 |
G9111 | Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) | Onc dx head/neck m1 mets rec | 2006 |
G9112 | Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) | Onc dx head/neck ext unknown | 2006 |
G9113 | Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage ia-b (grade 1) without evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) | Onc dx ovarian stg1a-b no pr | 2006 |
G9114 | Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage ia-b (grade 2-3); or stage ic (all grades); or stage ii; without evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) | Onc dx ovarian stg1a-b or 2 | 2006 |
G9115 | Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage iii-iv; without evidence of progression, recurrence, or metastases (for use in a medicare-approved demonstration project) | Onc dx ovarian stg3/4 noprog | 2006 |
G9116 | Oncology; disease status; ovarian cancer, limited to epithelial cancer; evidence of disease progression, or recurrence, and/or platinum resistance (for use in a medicare-approved demonstration project) | Onc dx ovarian recurrence | 2006 |
G9117 | Oncology; disease status; ovarian cancer, limited to epithelial cancer; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) | Onc dx ovarian unknown nos | 2006 |
G9123 | Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; chronic phase not in hematologic, cytogenetic, or molecular remission (for use in a medicare-approved demonstration project) | Onc dx cml chronic phase | 2006 |
G9124 | Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; accelerated phase not in hematologic cytogenetic, or molecular remission (for use in a medicare-approved demonstration project) | Onc dx cml acceler phase | 2006 |
G9125 | Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; blast phase not in hematologic, cytogenetic, or molecular remission (for use in a medicare-approved demonstration project) | Onc dx cml blast phase | 2006 |
G9126 | Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; in hematologic, cytogenetic, or molecular remission (for use in a medicare-approved demonstration project) | Onc dx cml remission | 2006 |
G9128 | Oncology; disease status; limited to multiple myeloma, systemic disease; smoldering, stage i (for use in a medicare-approved demonstration project) | Onc dx multi myeloma stage i | 2006 |
G9129 | Oncology; disease status; limited to multiple myeloma, systemic disease; stage ii or higher (for use in a medicare-approved demonstration project) | Onc dx mult myeloma stg2 hig | 2006 |
G9130 | Oncology; disease status; limited to multiple myeloma, systemic disease; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) | Onc dx multi myeloma unknown | 2006 |
G9131 | Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) | Onc dx brst unknown nos | 2007 |
G9132 | Oncology; disease status; prostate cancer, limited to adenocarcinoma; hormone-refractory/androgen-independent (e.g., rising psa on anti-androgen therapy or post-orchiectomy); clinical metastases (for use in a medicare-approved demonstration project) | Onc dx prostate mets no cast | 2007 |
G9133 | Oncology; disease status; prostate cancer, limited to adenocarcinoma; hormone-responsive; clinical metastases or m1 at diagnosis (for use in a medicare-approved demonstration project) | Onc dx prostate clinical met | 2007 |
G9134 | Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; stage i, ii at diagnosis, not relapsed, not refractory (for use in a medicare-approved demonstration project) | Onc nhlstg 1-2 no relap no | 2007 |
G9135 | Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; stage iii, iv, not relapsed, not refractory (for use in a medicare-approved demonstration project) | Onc dx nhl stg 3-4 not relap | 2007 |
G9136 | Oncology; disease status; non-hodgkin's lymphoma, transformed from original cellular diagnosis to a second cellular classification (for use in a medicare-approved demonstration project) | Onc dx nhl trans to lg bcell | 2007 |
G9137 | Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; relapsed/refractory (for use in a medicare-approved demonstration project) | Onc dx nhl relapse/refractor | 2007 |
G9138 | Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; diagnostic evaluation, stage not determined, evaluation of possible relapse or non-response to therapy, or not listed (for use in a medicare-approved demonstration project) | Onc dx nhl stg unknown | 2007 |
G9139 | Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; extent of disease unknown, staging in progress, not listed (for use in a medicare-approved demonstration project) | Onc dx cml dx status unknown | 2007 |
G9140 | Frontier extended stay clinic demonstration; for a patient stay in a clinic approved for the cms demonstration project; the following measures should be present: the stay must be equal to or greater than 4 hours; weather or other conditions must prevent transfer or the case falls into a category of monitoring and observation cases that are permitted by the rules of the demonstration; there is a maximum frontier extended stay clinic (fesc) visit of 48 hours, except in the case when weather or other conditions prevent transfer; payment is made on each period up to 4 hours, after the first 4 hours | Frontier extended stay demo | 2007 |
G9143 | Warfarin responsiveness testing by genetic technique using any method, any number of specimen(s) | Warfarin respon genetic test | 2009 |
G9147 | Outpatient intravenous insulin treatment (oivit) either pulsatile or continuous, by any means, guided by the results of measurements for: respiratory quotient; and/or, urine urea nitrogen (uun); and/or, arterial, venous or capillary glucose; and/or potassium concentration | Outpt iv insulin tx any mea | 2009 |
G9148 | National committee for quality assurance - level 1 medical home | Medical home level 1 | 2011 |
G9149 | National committee for quality assurance - level 2 medical home | Medical home level ii | 2011 |
G9150 | National committee for quality assurance - level 3 medical home | Medical home level iii | 2011 |
G9151 | Mapcp demonstration - state provided services | Mapcp demo state | 2011 |
G9152 | Mapcp demonstration - community health teams | Mapcp demo community | 2011 |
G9153 | Mapcp demonstration - physician incentive pool | Mapcp demo physician | 2011 |
G9156 | Evaluation for wheelchair requiring face to face visit with physician | Evaluation for wheelchair | 2012 |
G9157 | Transesophageal doppler measurement of cardiac output (including probe placement, image acquisition, and interpretation per course of treatment) for monitoring purposes | Transesoph doppl cardiac mon | 2013 |
G9187 | Bundled payments for care improvement initiative home visit for patient assessment performed by a qualified health care professional for individuals not considered homebound including, but not limited to, assessment of safety, falls, clinical status, fluid status, medication reconciliation/management, patient compliance with orders/plan of care, performance of activities of daily living, appropriateness of care setting; (for use only in the meidcare-approved bundled payments for care improvement initiative); may not be billed for a 30-day period covered by a transitional care management code | Bpci home visit | 2013 |
G9188 | Beta-blocker therapy not prescribed, reason not given | Beta not given no reason | 2014 |
G9189 | Beta-blocker therapy prescribed or currently being taken | Beta pres or already taking | 2014 |
G9190 | Documentation of medical reason(s) for not prescribing beta-blocker therapy (eg, allergy, intolerance, other medical reasons) | Medical reason for no beta | 2014 |
G9191 | Documentation of patient reason(s) for not prescribing beta-blocker therapy (eg, patient declined, other patient reasons) | Pt reason for no beta | 2014 |
G9212 | Dsm-ivtm criteria for major depressive disorder documented at the initial evaluation | Doc of dsm-iv init eval | 2014 |
G9213 | Dsm-iv-tr criteria for major depressive disorder not documented at the initial evaluation, reason not otherwise specified | No doc of dsm-iv | 2014 |
G9223 | Pneumocystis jiroveci pneumonia prophylaxis prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15% | Pjp proph ordered cd4 low | 2014 |
G9225 | Foot exam was not performed, reason not given | Norsn no foot exam | 2014 |
G9226 | Foot examination performed (includes examination through visual inspection, sensory exam with 10-g monofilament plus testing any one of the following: vibration using 128-hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception threshold, and pulse exam; report when all of the 3 components are completed) | 3 comp foot exam completed | 2014 |
G9227 | Functional outcome assessment documented, care plan not documented, documentation the patient is not eligible for a care plan at the time of the encounter | Foa doc, care plan not doc | 2014 |
G9228 | Chlamydia, gonorrhea and syphilis screening results documented (report when results are present for all of the 3 screenings) | Gc chl syp documented | 2014 |
G9230 | Chlamydia, gonorrhea, and syphilis not screened, reason not given | Norsn for gc chl syp test | 2014 |
G9231 | Documentation of end stage renal disease (esrd), dialysis, renal transplant before or during the measurement period or pregnancy during the measurement period | Doc esrd dia trans preg | 2014 |
G9242 | Documentation of viral load equal to or greater than 200 copies/ml or viral load not performed | Doc viral load >=200 | 2014 |
G9243 | Documentation of viral load less than 200 copies/ml | Doc viral load <200 | 2014 |
G9246 | Patient did not have two eligible encounters at least 90 days apart or one eligible encounter and one hiv viral load test at least 90 days apart | No enc or enc/vir ld 90days | 2014 |
G9247 | Patient had two eligible encounters at least 90 days apart or one eligible encounter and one hiv viral load test at least 90 days apart | 2 enc enc/vir ld 90d | 2014 |
G9254 | Documentation of patient discharged to home later than post-operative day 2 following cea or cas | Doc pt dischg >2d | 2014 |
G9255 | Documentation of patient discharged to home no later than post operative day 2 following cea or cas | Pt dc home 2nd po day | 2014 |
G9273 | Blood pressure has a systolic value of < 140 and a diastolic value of < 90 | Sys<140 and dia<90 | 2014 |
G9274 | Blood pressure has a systolic value of =140 and a diastolic value of = 90 or systolic value < 140 and diastolic value = 90 or systolic value = 140 and diastolic value < 90 | Bp out of nrml limits | 2014 |
G9275 | Documentation that patient is a current non-tobacco user | Doc of non tobacco user | 2014 |
G9276 | Documentation that patient is a current tobacco user | Doc of tobacco user | 2014 |
G9277 | Documentation that the patient is on daily aspirin or anti-platelet or has documentation of a valid contraindication or exception to aspirin/anti-platelet; contraindications/exceptions include anti-coagulant use, allergy to aspirin or anti-platelets, history of gastrointestinal bleed and bleeding disorder; additionally, the following exceptions documented by the physician as a reason for not taking daily aspirin or anti-platelet are acceptable (use of non-steroidal anti-inflammatory agents, documented risk for drug interaction, uncontrolled hypertension defined as >180 systolic or >110 diastolic or gastroesophageal reflux) | Doc daily aspirin or contra | 2014 |
G9278 | Documentation that the patient is not on daily aspirin or anti-platelet regimen | Doc no daily aspirin | 2014 |
G9279 | Pneumococcal screening performed and documentation of vaccination received prior to discharge | Pne scrn done doc vac done | 2014 |
G9280 | Pneumococcal vaccination not administered prior to discharge, reason not specified | Pne not given norsn | 2014 |
G9281 | Screening performed and documentation that vaccination not indicated/patient refusal | Pne scrn done doc not ind | 2014 |
G9282 | Documentation of medical reason(s) for not reporting the histological type or nsclc-nos classification with an explanation (e.g., biopsy taken for other purposes in a patient with a history of non-small cell lung cancer or other documented medical reasons) | Doc medrsn no histo type | 2014 |
G9283 | Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation | Hist type doc on report | 2014 |
G9284 | Non small cell lung cancer biopsy and cytology specimen report does not document classification into specific histologic type or classified as nsclc-nos with an explanation | No hist type doc on report | 2014 |
G9285 | Specimen site other than anatomic location of lung or is not classified as non small cell lung cancer | Site not small cell lung ca | 2014 |
G9286 | Antibiotic regimen prescribed within 10 days after onset of symptoms | Antibio rx w in 10d of sympt | 2014 |
G9287 | Antibiotic regimen not prescribed within 10 days after onset of symptoms | No antibio w in 10d of sympt | 2014 |
G9288 | Documentation of medical reason(s) for not reporting the histological type or nsclc-nos classification with an explanation (e.g., a solitary fibrous tumor in a person with a history of non-small cell carcinoma or other documented medical reasons) | Doc medrsn no hist type rpt | 2014 |
G9289 | Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation | Doc type nsm lung ca | 2014 |
G9290 | Non small cell lung cancer biopsy and cytology specimen report does not document classification into specific histologic type or classified as nsclc-nos with an explanation | No doc type nsm lung ca | 2014 |
G9291 | Specimen site other than anatomic location of lung, is not classified as non small cell lung cancer or classified as nsclc-nos | Not nsm lung ca | 2014 |
G9292 | Documentation of medical reason(s) for not reporting pt category and a statement on thickness and ulceration and for pt1, mitotic rate (e.g., negative skin biopsies in a patient with a history of melanoma or other documented medical reasons) | Medrsn no pt category | 2014 |
G9293 | Pathology report does not include the pt category and a statement on thickness and ulceration and for pt1, mitotic rate | No pt category on report | 2014 |
G9294 | Pathology report includes the pt category and a statement on thickness and ulceration and for pt1, mitotic rate | Pt cat and thck on report | 2014 |
G9295 | Specimen site other than anatomic cutaneous location | Non cutaneous loc | 2014 |
G9296 | Patients with documented shared decision-making including discussion of conservative (non-surgical) therapy (e.g., nsaids, analgesics, weight loss, exercise, injections) prior to the procedure | Doc share dec prior proc | 2014 |
G9297 | Shared decision-making including discussion of conservative (non-surgical) therapy (e.g., nsaids, analgesics, weight loss, exercise, injections) prior to the procedure, not documented, reason not given | No doc share dec prior proc | 2014 |
G9298 | Patients who are evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (e.g., history of dvt, pe, mi, arrhythmia and stroke) | Eval risk vte card 30d prior | 2014 |
G9299 | Patients who are not evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (e.g., history of dvt, pe, mi, arrhythmia and stroke, reason not given) | No eval risk vte card prior | 2014 |
G9305 | Intervention for presence of leak of endoluminal contents through an anastomosis not required | No interv req for leak | 2014 |
G9306 | Intervention for presence of leak of endoluminal contents through an anastomosis required | Interv req for leak | 2014 |
G9307 | No return to the operating room for a surgical procedure, for complications of the principal operative procedure, within 30 days of the principal operative procedure | No ret for surg w in 30d | 2014 |
G9308 | Unplanned return to the operating room for a surgical procedure, for complications of the principal operative procedure, within 30 days of the principal operative procedure | Unpl ret or w/compl w/in 30d | 2014 |
G9309 | No unplanned hospital readmission within 30 days of principal procedure | No unplnd hosp readm in 30d | 2014 |
G9310 | Unplanned hospital readmission within 30 days of principal procedure | Unplnd hosp readm in 30d | 2014 |
G9311 | No surgical site infection | No surg site infection | 2014 |
G9312 | Surgical site infection | Surgical site infection | 2014 |
G9313 | Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis for documented reason | Amoxic not presc as 1st line | 2014 |
G9314 | Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis, reason not given | Norsn not first line amox | 2014 |
G9315 | Amoxicillin, with or without clavulanate, prescribed as a first line antibiotic at the time of diagnosis | Amox w/wo clav rx | 2014 |
G9316 | Documentation of patient-specific risk assessment with a risk calculator based on multi-institutional clinical data, the specific risk calculator used, and communication of risk assessment from risk calculator with the patient or family | Doc comm risk calc | 2014 |
G9317 | Documentation of patient-specific risk assessment with a risk calculator based on multi-institutional clinical data, the specific risk calculator used, and communication of risk assessment from risk calculator with the patient or family not completed | No doc comm risk calc | 2014 |
G9318 | Imaging study named according to standardized nomenclature | Image std nomenclature | 2014 |
G9319 | Imaging study not named according to standardized nomenclature, reason not given | Image not std nomenclature | 2014 |
G9321 | Count of previous ct (any type of ct) and cardiac nuclear medicine (myocardial perfusion or infarct avid imaging) studies documented in the 12-month period prior to the current study | Prev ct nuc med cnt doc 12mo | 2014 |
G9322 | Count of previous ct and cardiac nuclear medicine (myocardial perfusion or infarct avid imaging) studies not documented in the 12-month period prior to the current study, reason not given | No cnt ct nuc med doc 12mo | 2014 |
G9341 | Search conducted for prior patient ct studies completed at non-affiliated external healthcare facilities or entities within the past 12-months and are available through a secure, authorized, media-free, shared archive prior to an imaging study being performed | Srch for ct w in 12 mos | 2014 |
G9342 | Search not conducted prior to an imaging study being performed for prior patient ct studies completed at non-affiliated external healthcare facilities or entities within the past 12-months and are available through a secure, authorized, media-free, shared archive, reason not given | No srch for ct in 12mo norsn | 2014 |
G9344 | Due to system reasons search not conducted for dicom format images for prior patient ct imaging studies completed at non-affiliated external healthcare facilities or entities within the past 12 months that are available through a secure, authorized, media-free, shared archive (e.g., non-affiliated external healthcare facilities or entities does not have archival abilities through a shared archival system) | Sysrsn no dicom srch | 2014 |
G9345 | Follow-up recommendations documented according to recommended guidelines for incidentally detected pulmonary nodules (e.g., follow-up ct imaging studies needed or that no follow-up is needed) based at a minimum on nodule size and patient risk factors | Follow up pulm nod | 2014 |
G9347 | Follow-up recommendations not documented according to recommended guidelines for incidentally detected pulmonary nodules, reason not given | No follow up pulm nod norsn | 2014 |
G9351 | More than one ct scan of the paranasal sinuses ordered or received within 90 days after diagnosis | Doc >1 sinus ct w 90d dx | 2014 |
G9352 | More than one ct scan of the paranasal sinuses ordered or received within 90 days after the date of diagnosis, reason not given | Not >1 sinus ct w 90d dx | 2014 |
G9353 | More than one ct scan of the paranasal sinuses ordered or received within 90 days after the date of diagnosis for documented reasons (eg, patients with complications, second ct obtained prior to surgery, other medical reasons) | Medrsn >1 sinus ct w 90d dx | 2014 |
G9354 | One ct scan or no ct scan of the paranasal sinuses ordered within 90 days after the date of diagnosis | 1 or no ct sinus w/in 90d dx | 2014 |
G9355 | Elective delivery (without medical indication) by cesarean birth or induction of labor not performed (<39 weeks of gestation) | No early ind/delivery | 2014 |
G9356 | Elective delivery (without medical indication) by cesarean birth or induction of labor performed (<39 weeks of gestation) | Early ind/delivery | 2014 |
G9357 | Post-partum screenings, evaluations and education performed | Pp eval/edu perf | 2014 |
G9358 | Post-partum screenings, evaluations and education not performed | Pp eval/edu not perf | 2014 |
G9361 | Medical indication for delivery by cesarean birth or induction of labor (<39 weeks of gestation) [documentation of reason(s) for elective delivery (e.g., hemorrhage and placental complications, hypertension, preeclampsia and eclampsia, rupture of membranes (premature or prolonged), maternal conditions complicating pregnancy/delivery, fetal conditions complicating pregnancy/delivery, late pregnancy, prior uterine surgery, or participation in clinical trial)] | Doc rsn elect c-sec/induct | 2014 |
G9364 | Sinusitis caused by, or presumed to be caused by, bacterial infection | Sinus caus bac inx | 2015 |
G9367 | At least two orders for high-risk medications from the same drug class | >= 2 same hi-rsk med ord | 2015 |
G9368 | At least two orders for high-risk medications from the same drug class not ordered | >= 2 same hi-rsk med not ord | 2015 |
G9380 | Patient offered assistance with end of life issues or existing end of life plan was reviewed or updated during the measurement period | Off assis eol iss | 2015 |
G9382 | Patient not offered assistance with end of life issues or existing end of life plan was not reviewed or updated during the measurement period | No off assis eol | 2015 |
G9383 | Patient received screening for hcv infection within the 12 month reporting period | Recd scrn hcv infec | 2015 |
G9384 | Documentation of medical reason(s) for not receiving annual screening for hcv infection (e.g., decompensated cirrhosis indicating advanced disease [i.e., ascites, esophageal variceal bleeding, hepatic encephalopathy], hepatocellular carcinoma, waitlist for organ transplant, limited life expectancy, other medical reasons) | Doc med rsn no hcv scrn | 2015 |
G9385 | Documentation of patient reason(s) for not receiving annual screening for hcv infection (e.g., patient declined, other patient reasons) | Doc pt reas not rec hcv srn | 2015 |
G9386 | Screening for hcv infection not received within the 12 month reporting period, reason not given | Scrn hcv infec not recd | 2015 |
G9393 | Patient with an initial phq-9 score greater than nine who achieves remission at twelve months as demonstrated by a twelve month (+/- 30 days) phq-9 score of less than five | Ini phq9 >9 remiss <5 | 2015 |
G9394 | Patient who had a diagnosis of bipolar disorder or personality disorder, death, permanent nursing home resident or receiving hospice or palliative care any time during the measurement or assessment period | Dx bipol, death, nhres, hosp | 2015 |
G9395 | Patient with an initial phq-9 score greater than nine who did not achieve remission at twelve months as demonstrated by a twelve month (+/- 30 days) phq-9 score greater than or equal to five | Ini phq9 >9 no remiss >=5 | 2015 |
G9396 | Patient with an initial phq-9 score greater than nine who was not assessed for remission at twelve months (+/- 30 days) | Ini phq9 >9 not assess | 2015 |
G9408 | Patients with cardiac tamponade and/or pericardiocentesis occurring within 30 days | Card tamp w/in 30d | 2015 |
G9409 | Patients without cardiac tamponade and/or pericardiocentesis occurring within 30 days | No card tamp e/in 30d | 2015 |
G9410 | Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision | Admit w/in 180d req remov | 2015 |
G9411 | Patient not admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision | No admit w/in 180d req remov | 2015 |
G9412 | Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision | Admit w/in 180d req surg rev | 2015 |
G9413 | Patient not admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision | No admit req surg rev | 2015 |
G9414 | Patient had one dose of meningococcal vaccine (serogroups a, c, w, y or a, c, w, y, b) on or between the patient's 10th and 13th birthdays | 1dose menig vac btwn 10 & 13 | 2015 |
G9415 | Patient did not have one dose of meningococcal vaccine (serogroups a, c, w, y or a, c, w, y, b), on or between the patient's 10th and 13th birthdays | No 1dose meni vac btwn 10&13 | 2015 |
G9416 | Patient had one tetanus, diphtheria toxoids and acellular pertussis vaccine (tdap) on or between the patient's 10th and 13th birthdays | Pt 1 tdap betw 10-13 yrs | 2015 |
G9417 | Patient did not have one tetanus, diphtheria toxoids and acellular pertussis vaccine (tdap) on or between the patient's 10th and 13th birthdays | Pt not 1 tdap betw 10-13 yrs | 2015 |
G9418 | Primary non-small cell lung cancer lung biopsy and cytology specimen report documents classification into specific histologic type following iaslc guidance or classified as nsclc-nos with an explanation | Lungcx bx rpt docs class | 2015 |
G9419 | Documentation of medical reason(s) for not including the histological type or nsclc-nos classification with an explanation (e.g. specimen insufficient or non-diagnostic, specimen does not contain cancer, or other documented medical reasons) | Med reas not incl histo type | 2015 |
G9420 | Specimen site other than anatomic location of lung or is not classified as primary non-small cell lung cancer | Spec site no lung | 2015 |
G9421 | Primary non-small cell lung cancer lung biopsy and cytology specimen report does not document classification into specific histologic type or histologic type does not follow iaslc guidance or is classified as nsclc-nos but without an explanation | Lung cx bx rpt no doc class | 2015 |
G9422 | Primary lung carcinoma resection report documents pt category, pn category and for non-small cell lung cancer, histologic type (e.g., squamous cell carcinoma, adenocarcinoma and not nsclc-nos) | Rpt doc class histo type | 2015 |
G9423 | Documentation of medical reason for not including pt category, pn category and histologic type [for patient with appropriate exclusion criteria (e.g., metastatic disease, benign tumors, malignant tumors other than carcinomas, inadequate surgical specimens)] | Med reas rpt no histo type | 2015 |
G9424 | Specimen site other than anatomic location of lung, or classified as nsclc-nos | Site no lung or lung cx | 2015 |
G9425 | Primary lung carcinoma resection report does not document pt category, pn category and for non-small cell lung cancer, histologic type (e.g., squamous cell carcinoma, adenocarcinoma) | Spec rpt no doc class histo | 2015 |
G9426 | Improvement in median time from ed arrival to initial ed oral or parenteral pain medication administration performed for ed admitted patients | Impr med time edarr pain med | 2015 |
G9427 | Improvement in median time from ed arrival to initial ed oral or parenteral pain medication administration not performed for ed admitted patients | No impro med time pain med | 2015 |
G9428 | Pathology report includes the pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors | Patho rpt incl pt ctg | 2015 |
G9429 | Documentation of medical reason(s) for not including pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors (e.g., negative skin biopsies, insufficient tissue, or other documented medical reasons) | Doc med rsn no pt cat | 2015 |
G9430 | Specimen site other than anatomic cutaneous location | Spec site no cutaneous | 2015 |
G9431 | Pathology report does not include the pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors | Patho rpt no pt ctg | 2015 |
G9432 | Asthma well-controlled based on the act, c-act, acq, or ataq score and results documented | Asth controlled | 2015 |
G9434 | Asthma not well-controlled based on the act, c-act, acq, or ataq score, or specified asthma control tool not used, reason not given | Asth not controlled | 2015 |
G9452 | Documentation of medical reason(s) for not receiving hcv antibody test due to limited life expectancy | Doc med reas no hcv test | 2015 |
G9455 | Patient underwent abdominal imaging with ultrasound, contrast enhanced ct or contrast mri for hcc | Abd imag w/us, ct or mri | 2015 |
G9456 | Documentation of medical or patient reason(s) for not ordering or performing screening for hcc. medical reason: comorbid medical conditions with expected survival < 5 years, hepatic decompensation and not a candidate for liver transplantation, or other medical reasons; patient reasons: patient declined or other patient reasons (e.g., cost of tests, time related to accessing testing equipment) | Doc med pt reas no hcc scrn | 2015 |
G9457 | Patient did not undergo abdominal imaging and did not have a documented reason for not undergoing abdominal imaging in the submission period | Pt no abd img no doc rsn | 2015 |
G9468 | Patient not receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 60 or greater consecutive days or a single prescription equating to 600 mg prednisone or greater for all fills | No recd cortico>=10mg/d >60d | 2015 |
G9470 | Patients not receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 60 or greater consecutive days or a single prescription equating to 600 mg prednisone or greater for all fills | No rec cortico>60d 1rx 600mg | 2015 |
G9471 | Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) not ordered or documented | W/in 2yr dxa not order | 2015 |
G9473 | Services performed by chaplain in the hospice setting, each 15 minutes | Chap services at hospice | 2016 |
G9474 | Services performed by dietary counselor in the hospice setting, each 15 minutes | Diet counsel at hospice | 2016 |
G9475 | Services performed by other counselor in the hospice setting, each 15 minutes | Other counselor at hospice | 2016 |
G9476 | Services performed by volunteer in the hospice setting, each 15 minutes | Volun service at hospice | 2016 |
G9477 | Services performed by care coordinator in the hospice setting, each 15 minutes | Care coord at hospice | 2016 |
G9478 | Services performed by other qualified therapist in the hospice setting, each 15 minutes | Othe therapist at hospice | 2016 |
G9479 | Services performed by qualified pharmacist in the hospice setting, each 15 minutes | Pharmacist at hospice | 2016 |
G9480 | Admission to medicare care choice model program (mccm) | Admission to mccm | 2016 |
G9481 | Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a problem focused history; a problem focused examination; and straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology | Remote e/m new pt 10mins | 2016 |
G9482 | Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 20 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology | Remote e/m new pt 20mins | 2016 |
G9483 | Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a detailed history; a detailed examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate severity. typically, 30 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology | Remote e/m new pt 30mins | 2016 |
G9484 | Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 45 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology | Remote e/m new pt 45mins | 2016 |
G9485 | Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 60 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology | Remote e/m new pt 60mins | 2016 |
G9486 | Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology | Remote e/m est. pt 10mins | 2016 |
G9487 | Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 15 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology | Remote e/m est. pt 15mins | 2016 |
G9488 | Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 25 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology | Remote e/m est. pt 25mins | 2016 |
G9489 | Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved coms innovation center demonstration project, which requires at least 2 of the following 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 40 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology | Remote e/m est. pt 40mins | 2016 |
G9490 | Cms innovation center models, home visit for patient assessment performed by clinical staff for an individual not considered homebound, including, but not necessarily limited to patient assessment of clinical status, safety/fall prevention, functional status/ambulation, medication reconciliation/management, compliance with orders/plan of care, performance of activities of daily living, and ensuring beneficiary connections to community and other services. (for use only in medicare-approved cms innovation center models); may not be billed for a 30 day period covered by a transitional care management code | Cmmi mod home visit | 2016 |
G9497 | Received instruction from the anesthesiologist or proxy prior to the day of surgery to abstain from smoking on the day of surgery | Rec inst no smoke day surg | 2016 |
G9498 | Antibiotic regimen prescribed | Abx reg prescribed | 2016 |
G9500 | Radiation exposure indices documented in final report for procedure using fluoroscopy | Rad expos ind/exp tm doc | 2016 |
G9501 | Radiation exposure indices not documented in final report for procedure using fluoroscopy, reason not given | Rad expos ind/exp tm no doc | 2016 |
G9502 | Documentation of medical reason for not performing foot exam (i.e., patients who have had either a bilateral amputation above or below the knee, or both a left and right amputation above or below the knee before or during the measurement period) | Med reas no perf foot exam | 2016 |
G9504 | Documented reason for not assessing hepatitis b virus (hbv) status (e.g., patient not initiating anti-tnf therapy, patient declined) prior to initiating anti-tnf therapy | Doc rsn hep b stat not asses | 2016 |
G9505 | Antibiotic regimen prescribed within 10 days after onset of symptoms for documented medical reason | Abx pres w/in 10 dys of symp | 2016 |
G9507 | Documentation that the patient is on a statin medication or has documentation of a valid contraindication or exception to statin medications; contraindications/exceptions that can be defined by diagnosis codes include pregnancy during the measurement period, active liver disease, rhabdomyolysis, end stage renal disease on dialysis and heart failure; provider documented contraindications/exceptions include breastfeeding during the measurement period, woman of child-bearing age not actively taking birth control, allergy to statin, drug interaction (hiv protease inhibitors, nefazodone, cyclosporine, gemfibrozil, and danazol) and intolerance (with supporting documentation of trying a statin at least once within the last 5 years or diagnosis codes for myostitis or toxic myopathy related to drugs) | Doc reas on statin or contra | 2016 |
G9508 | Documentation that the patient is not on a statin medication | Doc pt not on statin | 2016 |
G9509 | Adult patients 18 years of age or older with major depression or dysthymia who reached remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5 | Adit mdd dys rem 12 mnths | 2016 |
G9510 | Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5. either phq- 9 or phq-9m score was not assessed or is greater than or equal to 5 | Remis12m not phq-9 score <5 | 2016 |
G9511 | Index event date phq-9 or phq-9m score greater than 9 documented during the twelve month denominator identification period | Idx evt dte phq>9 doc 12 mo | 2016 |
G9512 | Individual had a pdc of 0.8 or greater | Indiv pdc > 0.8 | 2016 |
G9513 | Individual did not have a pdc of 0.8 or greater | Indiv pdc not > 0.8 | 2016 |
G9514 | Patient required a return to the operating room within 90 days of surgery | Req ret or w/in 90d of surg | 2016 |
G9515 | Patient did not require a return to the operating room within 90 days of surgery | No reas, no ret or w/in 90d | 2016 |
G9516 | Patient achieved an improvement in visual acuity, from their preoperative level, within 90 days of surgery | Impr vis acuit w/in 90d | 2016 |
G9517 | Patient did not achieve an improvement in visual acuity, from their preoperative level, within 90 days of surgery, reason not given | No impr vis acuit w/in 90d | 2016 |
G9518 | Documentation of active injection drug use | Doc active inj drug use | 2016 |
G9519 | Patient achieves final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery | Final ref +/- 1.0 w/in 90d | 2016 |
G9520 | Patient does not achieve final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery | Refract not +/- 1.0 w/in 90d | 2016 |
G9521 | Total number of emergency department visits and inpatient hospitalizations less than two in the past 12 months | Er and ip hosp <2 in 12 mos | 2016 |
G9522 | Total number of emergency department visits and inpatient hospitalizations equal to or greater than two in the past 12 months or patient not screened, reason not given | Er/ip hosp =/>2 in 12 mos | 2016 |
G9529 | Patient with minor blunt head trauma had an appropriate indication(s) for a head ct | Minor blunt trauma w/head ct | 2016 |
G9530 | Patient presented with a minor blunt head trauma and had a head ct ordered for trauma by an emergency care provider | Pt mbht hd ct ord ec prov | 2016 |
G9531 | Patient has documentation of ventricular shunt, brain tumor, multisystem trauma, or is currently taking an antiplatelet medication including: abciximab, anagrelide, cangrelor, cilostazol, clopidogrel, dipyridamole, eptifibatide, prasugrel, ticlopidine, ticagrelor, tirofiban, or vorapaxar | Pt doc | 2016 |
G9533 | Patient with minor blunt head trauma did not have an appropriate indication(s) for a head ct | Indic for head ct not valid | 2016 |
G9537 | Imaging needed as part of a clinical trial; or other clinician ordered the study | Img hd clin trial | 2016 |
G9539 | Intent for potential removal at time of placement | Intent pot remv time placemt | 2016 |
G9540 | Patient alive 3 months post procedure | Pt alive 3 mos post proc | 2016 |
G9541 | Filter removed within 3 months of placement | Filter rem 3 mon plmt | 2016 |
G9542 | Documented re-assessment for the appropriateness of filter removal within 3 months of placement | Doc reass appr remo filt 3ms | 2016 |
G9543 | Documentation of at least two attempts to reach the patient to arrange a clinical re-assessment for the appropriateness of filter removal within 3 months of placement | Doc 2x re-assess filt remov | 2016 |
G9544 | Patients that do not have the filter removed, documented re-assessment for the appropriateness of filter removal, or documentation of at least two attempts to reach the patient to arrange a clinical re-assessment for the appropriateness of filter removal within 3 months of placement | No filt remov w/in 3mos plcm | 2016 |
G9547 | Cystic renal lesion that is simple appearing (bosniak i or ii) , or adrenal lesion less than or equal to 1.0 cm or adrenal lesion greater than 1.0 cm but less than or equal to 4.0 cm classified as likely benign by unenhanced ct or washout protocol ct, or mri with in- and opposed-phase sequences or other equivalent institutional imaging protocols | Cys ren les or adren | 2016 |
G9548 | Final reports for imaging studies stating no follow-up imaging is recommended | No f/u rec image study | 2016 |
G9549 | Documentation of medical reason(s) that follow-up imaging is indicated (e.g., patient has lymphadenopathy, signs of metastasis or an active diagnosis or history of cancer, and other medical reason(s)) | Doc med rsn for f/u imag | 2016 |
G9550 | Final reports for imaging studies with follow-up imaging recommended, or final reports that do not include a specific recommendation of no follow-up | Imag rec | 2016 |
G9551 | Final reports for imaging studies without an incidentally found lesion noted | Imag no les | 2016 |
G9552 | Incidental thyroid nodule < 1.0 cm noted in report | Inc thyr node <1.0 in rpt | 2016 |
G9553 | Prior thyroid disease diagnosis | Prior thyroid dise dx | 2016 |
G9554 | Final reports for ct, cta, mri or mra of the chest or neck with follow-up imaging recommended | Ct/cta/mri/a chst foll rec | 2016 |
G9555 | Documentation of medical reason(s) for recommending follow up imaging (e.g., patient has multiple endocrine neoplasia, patient has cervical lymphadenopathy, other medical reason(s)) | Doc med rsn for follup image | 2016 |
G9556 | Final reports for ct, cta, mri or mra of the chest or neck with follow-up imaging not recommended | Ct/cta/mri/a no follup imag | 2016 |
G9557 | Final reports for ct, cta, mri or mra studies of the chest or neck without an incidentally found thyroid nodule < 1.0 cm noted or no nodule found | Ct/cta/mri/a no thyr <1.0cm | 2016 |
G9580 | Door to puncture time of 90 minutes or less | Door to punc time <2hrs | 2016 |
G9582 | Door to puncture time of greater than 90 minutes, no reason given | Door to punc time >2hr, nrg | 2016 |
G9593 | Pediatric patient with minor blunt head trauma classified as low risk according to the pecarn prediction rules | Low pecarn ped head trauma | 2016 |
G9594 | Patient presented with a minor blunt head trauma and had a head ct ordered for trauma by an emergency care provider | Pt mbht hd ct ord ec prov | 2016 |
G9595 | Patient has documentation of ventricular shunt, brain tumor, or coagulopathy | Doc shnt/tum/coag | 2016 |
G9597 | Pediatric patient with minor blunt head trauma not classified as low risk according to the pecarn prediction rules | No low pecarn ped head traum | 2016 |
G9598 | Aortic aneurysm 5.5 - 5.9 cm maximum diameter on centerline formatted ct or minor diameter on axial formatted ct | Aor ane 5.5-5.9 cm max diam | 2016 |
G9599 | Aortic aneurysm 6.0 cm or greater maximum diameter on centerline formatted ct or minor diameter on axial formatted ct | Aor ane >=6.0 cm max diam | 2016 |
G9603 | Patient survey score improved from baseline following treatment | Pt surv improv bsline tx | 2016 |
G9605 | Patient survey score did not improve from baseline following treatment | Surv score no improv w/tx | 2016 |
G9606 | Intraoperative cystoscopy performed to evaluate for lower tract injury | Intraop cyst eval trac inj | 2016 |
G9607 | Documented medical reasons for not performing intraoperative cystoscopy (e.g., urethral pathology precluding cystoscopy, any patient who has a congenital or acquired absence of the urethra) or in the case of patient death | Doc med rsn not perf cystosc | 2016 |
G9608 | Intraoperative cystoscopy not performed to evaluate for lower tract injury | Intraop cyst eval not done | 2016 |
G9609 | Documentation of an order for anti-platelet agents | Doc order anti-plat | 2016 |
G9610 | Documentation of medical reason(s) in the patient's record for not ordering anti-platelet agents | Doc md rsn no antipla | 2016 |
G9611 | Order for anti-platelet agents was not documented in the patient's record, reason not given | No doc order anti-plat rng | 2016 |
G9621 | Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method and received brief counseling | Scr unheal etoh w/counsel | 2016 |
G9622 | Patient not identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method | No unheal etoh user | 2016 |
G9624 | Patient not screened for unhealthy alcohol use using a systematic screening method or patient did not receive brief counseling if identified as an unhealthy alcohol user | Pt not scrn or no counseling | 2016 |
G9625 | Patient sustained bladder injury at the time of surgery or discovered subsequently up to 30 days post-surgery | Pt bl srg 30 day pst srg | 2016 |
G9626 | Documented medical reason for not reporting bladder injury (e.g., gynecologic or other pelvic malignancy documented, concurrent surgery involving bladder pathology, injury that occurs during a urinary incontinence procedure, patient death from non-medical causes not related to surgery, patient died during procedure without evidence of bladder injury) | Med rsn no rpt bladder inj | 2016 |
G9627 | Patient did not sustain bladder injury at the time of surgery nor discovered subsequently up to 30 days post-surgery | Pt no bl srg 30 day pst srg | 2016 |
G9628 | Patient sustained bowel injury at the time of surgery or discovered subsequently up to 30 days post-surgery | Pt bwli srg 30 day pst srg | 2016 |
G9629 | Documented medical reasons for not reporting bowel injury (e.g., gynecologic or other pelvic malignancy documented, planned (e.g., not due to an unexpected bowel injury) resection and/or re-anastomosis of bowel, or patient death from non-medical causes not related to surgery, patient died during procedure without evidence of bowel injury) | Med rsn no rpt bowel inj | 2016 |
G9630 | Patient did not sustain a bowel injury at the time of surgery nor discovered subsequently up to 30 days post-surgery | Pt no bwli srg 30 day srg | 2016 |
G9637 | Final reports with documentation of one or more dose reduction techniques (e.g., automated exposure control, adjustment of the ma and/or kv according to patient size, use of iterative reconstruction technique) | Doc >1 dose reduc tech | 2016 |
G9638 | Final reports without documentation of one or more dose reduction techniques (e.g., automated exposure control, adjustment of the ma and/or kv according to patient size, use of iterative reconstruction technique) | No doc >1 dose reduc tech | 2016 |
G9642 | Current smoker (e.g., cigarette, cigar, pipe, e-cigarette or marijuana) | Current smoker | 2016 |
G9643 | Elective surgery | Elective surgery | 2016 |
G9644 | Patients who abstained from smoking prior to anesthesia on the day of surgery or procedure | No smok b/4 anes day of surg | 2016 |
G9645 | Patients who did not abstain from smoking prior to anesthesia on the day of surgery or procedure | Had smoke b/4 anes day surg | 2016 |
G9646 | Patients with 90 day mrs score of 0 to 2 | Pt w/90d mrs 0-2 | 2016 |
G9648 | Patients with 90 day mrs score greater than 2 | Pt w/90d mrs >2 | 2016 |
G9649 | Psoriasis assessment tool documented meeting any one of the specified benchmarks (e.g., (pga; 5-point or 6-point scale), body surface area (bsa), psoriasis area and severity index (pasi) and/or dermatology life quality index) (dlqi)) | Psor as doc spc bm | 2016 |
G9651 | Psoriasis assessment tool documented not meeting any one of the specified benchmarks (e.g., (pga; 5-point or 6-point scale), body surface area (bsa), psoriasis area and severity index (pasi) and/or dermatology life quality index) (dlqi)) or psoriasis assessment tool not documented | Psor as doc no spc bm | 2016 |
G9654 | Monitored anesthesia care (mac) | Mon anesth care | 2016 |
G9655 | A transfer of care protocol or handoff tool/checklist that includes the required key handoff elements is used | Toc tool incl key elem | 2016 |
G9656 | Patient transferred directly from anesthetizing location to pacu or other non-icu location | Pt trans from anest to pacu | 2016 |
G9658 | A transfer of care protocol or handoff tool/checklist that includes the required key handoff elements is not used | Toc tool incl elem not used | 2016 |
G9659 | Patients greater than or equal to 86 years of age who underwent a screening colonoscopy and did not have a history of colorectal cancer or other valid medical reason for the colonoscopy, including: iron deficiency anemia, lower gastrointestinal bleeding, familial adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease (i.e., crohn's disease or ulcerative colitis), abnormal finding of gastrointestinal tract, weight loss, or changes in bowel habits | >=86y scr colo nomed rsn | 2016 |
G9660 | Documentation of medical reason(s) for a colonoscopy performed on a patient greater than or equal to 86 years of age (e.g., iron deficiency anemia, lower gastrointestinal bleeding, familial history of adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease (i.e., crohn's disease or ulcerative colitis), abnormal finding of gastrointestinal tract, weight loss, or changes in bowel habits) | Doc med rsn colo pt >= 86y | 2016 |
G9661 | Patients greater than or equal to 86 years of age who received a colonoscopy for an assessment of signs/symptoms of gi tract illness, and/or because the patient meets high risk criteria, and/or to follow-up on previously diagnosed advanced lesions | Pt >= 86 w/ hi risk | 2016 |
G9662 | Previously diagnosed or have a diagnosis of clinical ascvd, including ascvd procedure | Prior dx/active clin ascvd | 2016 |
G9663 | Any ldl-c laboratory result >= 190 mg/dl | Fast/dir ldl >= 190 mg/dl | 2016 |
G9664 | Patients who are currently statin therapy users or received an order (prescription) for statin therapy | Taking statin or rec'd order | 2016 |
G9665 | Patients who are not currently statin therapy users or did not receive an order (prescription) for statin therapy | No statin/no order statin | 2016 |
G9674 | Patients with clinical ascvd diagnosis | Pt w/clin ascvd dx | 2016 |
G9675 | Patients who have ever had a fasting or direct laboratory result of ldl-c = 190 mg/dl | Pt w/fast/dir lab ldl-c >190 | 2016 |
G9676 | Patients aged 40 to 75 years at the beginning of the measurement period with type 1 or type 2 diabetes and with an ldl-c result of 70-189 mg/dl recorded as the highest fasting or direct laboratory test result in the measurement year or during the two years prior to the beginning of the measurement period | 40-75y w/type 1/2 w/ldl-c rs | 2016 |
G9679 | This code is for onsite acute care treatment of a nursing facility resident with pneumonia; may only be billed once per day per beneficiary | Acute care pneumonia | 2016 |
G9680 | This code is for onsite acute care treatment of a nursing facility resident with chf; may only be billed once per day per beneficiary | Acute care congestive heart | 2016 |
G9681 | This code is for onsite acute care treatment of a resident with copd or asthma; may only be billed once per day per beneficiary | Acute care chronic obstruct | 2016 |
G9682 | This code is for the onsite acute care treatment a nursing facility resident with a skin infection; may only be billed once per day per beneficiary | Acute care skin infection | 2016 |
G9683 | Facility service(s) for the onsite acute care treatment of a nursing facility resident with fluid or electrolyte disorder. (may only be billed once per day per beneficiary). this service is for a demonstration project | Acute fluid/electro disorder | 2016 |
G9684 | This code is for the onsite acute care treatment of a nursing facility resident for a uti; may only be billed once per day per beneficiary | Acute care urinary tract inf | 2016 |
G9685 | Physician service or other qualified health care professional for the evaluation and management of a beneficiary's acute change in condition in a nursing facility. this service is for a demonstration project | Acute nursing facility care | 2016 |
G9687 | Hospice services provided to patient any time during the measurement period | Hospice anytime msmt per | 2017 |
G9688 | Patients using hospice services any time during the measurement period | Pt w/hosp anytime msmt per | 2017 |
G9689 | Patient admitted for performance of elective carotid intervention | Inpt elect carotid intervent | 2017 |
G9690 | Patient receiving hospice services any time during the measurement period | Pt in hos | 2017 |
G9691 | Patient had hospice services any time during the measurement period | Pt hosp dur msmt period | 2017 |
G9692 | Hospice services received by patient any time during the measurement period | Hosp recd by pt dur msmt per | 2017 |
G9693 | Patient use of hospice services any time during the measurement period | Pt use hosp during msmt per | 2017 |
G9694 | Hospice services utilized by patient any time during the measurement period | Hosp srv used pt in msmt per | 2017 |
G9695 | Long-acting inhaled bronchodilator prescribed | Long act inhal bronchdil pre | 2017 |
G9696 | Documentation of medical reason(s) for not prescribing a long-acting inhaled bronchodilator (e.g., patient intolerance or history of side effects) | Med rsn no presc bronchdil | 2017 |
G9698 | Documentation of system reason(s) for not prescribing a long-acting inhaled bronchodilator (e.g., cost of treatment or lack of insurance) | Sys rsn no presc bronchdil | 2017 |
G9699 | Long-acting inhaled bronchodilator not prescribed, reason not otherwise specified | Long inhal bronchdil no pres | 2017 |
G9700 | Patients who use hospice services any time during the measurement period | Pt is w/hosp during msmt per | 2017 |
G9702 | Patients who use hospice services any time during the measurement period | Pt use hosp during msmt per | 2017 |
G9703 | Episodes where the patient is taking antibiotics (table 1) in the 30 days prior to the episode date | Anbx 30 prior to episode | 2017 |
G9704 | Ajcc breast cancer stage i: t1 mic or t1a documented | Ajcc br ca stg i: t1 mic/t1a | 2017 |
G9705 | Ajcc breast cancer stage i: t1b (tumor > 0.5 cm but <= 1 cm in greatest dimension) documented | Ajcc br ca stg ib | 2017 |
G9706 | Low (or very low) risk of recurrence, prostate cancer | Low recur prost ca | 2017 |
G9708 | Women who had a bilateral mastectomy or who have a history of a bilateral mastectomy or for whom there is evidence of a right and a left unilateral mastectomy | Bilat mast/hx bi /unilat mas | 2017 |
G9709 | Hospice services used by patient any time during the measurement period | Hosp srv used pt in msmt per | 2017 |
G9710 | Patient was provided hospice services any time during the measurement period | Pt prov hosp srv msmt per | 2017 |
G9711 | Patients with a diagnosis or past history of total colectomy or colorectal cancer | Pt hx tot col or colon ca | 2017 |
G9712 | Documentation of medical reason(s) for prescribing or dispensing antibiotic (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/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/uti, acne, hiv disease/asymptomatic hiv, cystic fibrosis, disorders of the immune system, malignancy neoplasms, chronic bronchitis, emphysema, bronchiectasis, extrinsic allergic alveolitis, chronic airway obstruction, chronic obstructive asthma, pneumoconiosis and other lung disease due to external agents, other diseases of the respiratory system, and tuberculosis | Doc med rsn presc anbx | 2017 |
G9713 | Patients who use hospice services any time during the measurement period | Pt use hosp during msmt per | 2017 |
G9714 | Patient is using hospice services any time during the measurement period | Pt is w/hosp during msmt per | 2017 |
G9716 | Bmi is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reason | Bmi doc onl fup not cmpltd | 2017 |
G9717 | Documentation stating the patient has had a diagnosis of bipolar disorder | Doc pt dx bipol | 2017 |
G9719 | Patient is not ambulatory, bed ridden, immobile, confined to chair, wheelchair bound, dependent on helper pushing wheelchair, independent in wheelchair or minimal help in wheelchair | Pt not ambul/immob/wc | 2017 |
G9720 | Hospice services for patient occurred any time during the measurement period | Hospice anytime msmt per | 2017 |
G9721 | Patient not ambulatory, bed ridden, immobile, confined to chair, wheelchair bound, dependent on helper pushing wheelchair, independent in wheelchair or minimal help in wheelchair | Pt not ambul/immob/wc | 2017 |
G9722 | Documented history of renal failure or baseline serum creatinine >= 4.0 mg/dl; renal transplant recipients are not considered to have preoperative renal failure, unless, since transplantation the cr has been or is 4.0 or higher | Doc hx renal fail or cr+ >=4 | 2017 |
G9723 | Hospice services for patient received any time during the measurement period | Hosp recd by pt dur msmt per | 2017 |
G9724 | Patients who had documentation of use of anticoagulant medications overlapping the measurement year | Pt w/doc use anticoag mst yr | 2017 |
G9726 | Patient refused to participate | Refused to participate | 2017 |
G9727 | Patient unable to complete the lepf prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available | Pt unable cmplt lepf prom | 2017 |
G9728 | Patient refused to participate | Refused to participate | 2017 |
G9729 | Patient unable to complete the lepf prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available | Pt unbl cmplt lepf prom | 2017 |
G9730 | Patient refused to participate | Refused to participate | 2017 |
G9731 | Patient unable to complete the lepf prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available | Pt unbl cmplt lepf prom | 2017 |
G9732 | Patient refused to participate | Refused to participate | 2017 |
G9733 | Patient unable to complete the low back fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available | Pt unbl cmplt lb fs prom | 2017 |
G9734 | Patient refused to participate | Refused to participate | 2017 |
G9735 | Patient unable to complete the shoulder fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available | Pt unbl cmplt shld fs prom | 2017 |
G9736 | Patient refused to participate | Refused to participate | 2017 |
G9737 | Patient unable to complete the elbow/wrist/hand fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available | Pt unbl cmplt ewh fs prom | 2017 |
G9740 | Hospice services given to patient any time during the measurement period | Hosp srv to pt dur msmt per | 2017 |
G9741 | Patients who use hospice services any time during the measurement period | Pt w/hosp anytime msmt per | 2017 |
G9744 | Patient not eligible due to active diagnosis of hypertension | Pt not eli d/t act dig htn | 2017 |
G9745 | Documented reason for not screening or recommending a follow-up for high blood pressure | Doc rsn no hbp scrn or f/u | 2017 |
G9746 | Patient has mitral stenosis or prosthetic heart valves or patient has transient or reversible cause of af (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac surgery) | Mit sten, valve or trans af | 2017 |
G9752 | Emergency surgery | Urgent surgery | 2017 |
G9753 | Documentation of medical reason for not conducting a search for dicom format images for prior patient ct imaging studies completed at non-affiliated external healthcare facilities or entities within the past 12 months that are available through a secure, authorized, media-free, shared archive (e.g., trauma, acute myocardial infarction, stroke, aortic aneurysm where time is of the essence) | Doc no dicom, ct other fac | 2017 |
G9754 | A finding of an incidental pulmonary nodule | Incid pulm nodule | 2017 |
G9755 | Documentation of medical reason(s) for not including a recommended interval and modality for follow-up or for no follow-up, and source of recommendations (e.g., patients with unexplained fever, immunocompromised patients who are at risk for infection) | Doc med rsn no fllw up | 2017 |
G9756 | Surgical procedures that included the use of silicone oil | Surg proc w/silicone oil | 2017 |
G9757 | Surgical procedures that included the use of silicone oil | Surg proc w/silicone oil | 2017 |
G9758 | Patient in hospice at any time during the measurement period | Pt in hos | 2017 |
G9761 | Patients who use hospice services any time during the measurement period | Pt w/hosp anytime msmt per | 2017 |
G9762 | Patient had at least two hpv vaccines (with at least 146 days between the two) or three hpv vaccines on or between the patient's 9th and 13th birthdays | Pt had >= 2-3 hpv vaccines | 2017 |
G9763 | Patient did not have at least two hpv vaccines (with at least 146 days between the two) or three hpv vaccines on or between the patient's 9th and 13th birthdays | Pt not have 2-3 hpv vaccines | 2017 |
G9764 | Patient has been treated with a systemic medication for psoriasis vulgaris | Pt treatd w/oral syst or bio | 2017 |
G9765 | Documentation that the patient declined change in medication or alternative therapies were unavailable, has documented contraindications, or has not been treated with a systemic medication for at least six consecutive months (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by pga, bsa, pasi, or dlqi | Doc pat declined therapy | 2017 |
G9766 | Patients who are transferred from one institution to another with a known diagnosis of cva for endovascular stroke treatment | Cva stroke dx tx transf fac | 2017 |
G9767 | Hospitalized patients with newly diagnosed cva considered for endovascular stroke treatment | Hosp new dx cva consid evst | 2017 |
G9768 | Patients who utilize hospice services any time during the measurement period | Pt w/hosp anytime msmt per | 2017 |
G9769 | Patient had a bone mineral density test in the past two years or received osteoporosis medication or therapy in the past 12 months | Bn den 2yr/got ost med/ther | 2017 |
G9770 | Peripheral nerve block (pnb) | Perip nerve block | 2017 |
G9771 | At least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) achieved within the 30 minutes immediately before or 15 minutes immediately after anesthesia end time | Anes end, 1 temp >35.5(95.9) | 2017 |
G9772 | Documentation of medical reason(s) for not achieving at least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) within the 30 minutes immediately before or 15 minutes immediately after anesthesia end time (e.g., emergency cases, intentional hypothermia, etc.) | Doc med rsn no temp >= 35.5 | 2017 |
G9773 | At least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) not achieved within the 30 minutes immediately before or 15 minutes immediately after anesthesia end time, reason not given | 1 bod temp >=35.5 | 2017 |
G9775 | Patient received at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively | Recd 2 anti-emet pre/intraop | 2017 |
G9776 | Documentation of medical reason for not receiving at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively (e.g., intolerance or other medical reason) | Doc med rsn no proph antiem | 2017 |
G9777 | Patient did not receive at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively | Pt no antiemet pre/intraop | 2017 |
G9779 | Patients who are breastfeeding at any time during the performance period | Pts breastfeeding | 2017 |
G9780 | Patients who have a diagnosis of rhabdomyolysis at any time during the performance period | Pts dx w/rhabdomyolysis | 2017 |
G9781 | Documentation of medical reason(s) for not currently being a statin therapy user or receiving an order (prescription) for statin therapy (e.g., patients with statin-associated muscle symptoms or an allergy to statin medication therapy, patients who are receiving palliative or hospice care, patients with active liver disease or hepatic disease or insufficiency, patients with end stage renal disease [esrd], or other medical reasons) | Doc rsn no statin | 2017 |
G9782 | History of or active diagnosis of familial hypercholesterolemia | Hx dx fam/pure hypercholes | 2017 |
G9784 | Pathologists/dermatopathologists providing a second opinion on a biopsy | Path/derm prov 2nd biop opin | 2017 |
G9785 | Pathology report diagnosing cutaneous basal cell carcinoma, squamous cell carcinoma, or melanoma (to include in situ disease) sent from the pathologist/ dermatopathologist to the biopsying clinician for review within 7 days from the time when the tissue specimen was received by the pathologist | Path report sent | 2017 |
G9786 | Pathology report diagnosing cutaneous basal cell carcinoma, squamous cell carcinoma, or melanoma (to include in situ disease) was not sent from the pathologist/ dermatopathologist to the biopsying clinician for review within 7 days from the time when the tissue specimen was received by the pathologist | Path report not sent | 2017 |
G9787 | Patient alive as of the last day of the measurement year | Pt alive | 2017 |
G9788 | Most recent bp is less than or equal to 130/80 mm hg | Most rct bp </= 130/80 | 2017 |
G9789 | Blood pressure recorded during inpatient stays, emergency room visits, or urgent care visits | Record bp ip, er, urg/self | 2017 |
G9790 | Most recent bp is greater than 130/80 mm hg, or blood pressure not documented | Most rct bp >/= 130/80 | 2017 |
G9791 | Most recent tobacco status is tobacco free | Most rct tob stat free | 2017 |
G9792 | Most recent tobacco status is not tobacco free | Most rct tob stat not free | 2017 |
G9793 | Patient is currently on a daily aspirin or other antiplatelet | Pt on daily asa/antiplat | 2017 |
G9794 | Documentation of medical reason(s) for not on a daily aspirin or other antiplatelet (e.g., history of gastrointestinal bleed, intra-cranial bleed, idiopathic thrombocytopenic purpura (itp), gastric bypass or documentation of active anticoagulant use during the measurement period) | Doc med rsn no daily aspirin | 2017 |
G9795 | Patient is not currently on a daily aspirin or other antiplatelet | Pt no daily asa/antiplat | 2017 |
G9796 | Patient is currently on a high intensity statin therapy | Pt currently on statin | 2017 |
G9797 | Patient is not on a high intensity statin therapy | Pt not currently on statin | 2017 |
G9805 | Patients who use hospice services any time during the measurement period | Pt w/hosp anytime msmt per | 2017 |
G9806 | Patients who received cervical cytology or an hpv test | Pt recd cerv cyto/hpv | 2017 |
G9807 | Patients who did not receive cervical cytology or an hpv test | Pt no recd cerv cyto/hpv | 2017 |
G9812 | Patient died including all deaths occurring during the hospitalization in which the operation was performed, even if after 30 days, and those deaths occurring after discharge from the hospital, but within 30 days of the procedure | Pt died during inpt/30d aft | 2017 |
G9813 | Patient did not die within 30 days of the procedure or during the index hospitalization | Pt not died w/in 30d of proc | 2017 |
G9818 | Documentation of sexual activity | Doc sex activity | 2017 |
G9819 | Patients who use hospice services any time during the measurement period | Pt w/hosp anytime msmt per | 2017 |
G9820 | Documentation of a chlamydia screening test with proper follow-up | Doc chlam scr test w/follow | 2017 |
G9821 | No documentation of a chlamydia screening test with proper follow-up | No doc chlam scr ts w/follow | 2017 |
G9822 | Patients who had an endometrial ablation procedure during the 12 months prior to the index date (exclusive of the index date) | Endo abl proc yr prev ind dt | 2017 |
G9823 | Endometrial sampling or hysteroscopy with biopsy and results documented during the 12 months prior to the index date (exclusive of the index date) of the endometrial ablation | Endo smpl/hyst bx res doc | 2017 |
G9824 | Endometrial sampling or hysteroscopy with biopsy and results not documented during the 12 months prior to the index date (exclusive of the index date) of the endometrial ablation | Endo smpl/hyst bx res no doc | 2017 |
G9830 | Her-2/neu positive | Her-2 pos | 2017 |
G9831 | Ajcc stage at breast cancer diagnosis = ii or iii | Ajcc stg brt ca dx ii or iii | 2017 |
G9832 | Ajcc stage at breast cancer diagnosis = i (ia or ib) and t-stage at breast cancer diagnosis = t1c | Br ca stg = 1 t stg = t1c | 2017 |
G9838 | Patient has metastatic disease at diagnosis | Pt met dis at dx | 2017 |
G9839 | Anti-egfr monoclonal antibody therapy | Anti-egfr mon anti ther | 2017 |
G9840 | Ras (kras and nras) gene mutation testing performed before initiation of anti-egfr moab | Gene testing performed | 2017 |
G9841 | Ras (kras and nras) gene mutation testing not performed before initiation of anti-egfr moab | Gene testing not performed | 2017 |
G9842 | Patient has metastatic disease at diagnosis | Pt met dis at dx | 2017 |
G9843 | Ras (kras or nras) gene mutation | Kras or nras gene mutation | 2017 |
G9844 | Patient did not receive anti-egfr monoclonal antibody therapy | Pt no recd anti-egfr ther | 2017 |
G9845 | Patient received anti-egfr monoclonal antibody therapy | Pt recd anti-egfr ther | 2017 |
G9846 | Patients who died from cancer | Pt died from cancer | 2017 |
G9847 | Patient received systemic cancer-directed therapy in the last 14 days of life | Pt recd chemo last 14d life | 2017 |
G9848 | Patient did not receive systemic cancer-directed therapy in the last 14 days of life | Pt no chemo last 14d life | 2017 |
G9858 | Patient enrolled in hospice | Pt enroll hospice | 2017 |
G9859 | Patients who died from cancer | Pt died from cancer | 2017 |
G9860 | Patient spent less than three days in hospice care | Pt less 3d hospice | 2017 |
G9861 | Patient spent greater than or equal to three days in hospice care | Pt more than 3d hospice | 2017 |
G9862 | Documentation of medical reason(s) for not recommending at least a 10 year follow-up interval (e.g., inadequate prep, familial or personal history of colonic polyps, patient had no adenoma and age is = 66 years old, or life expectancy < 10 years old, other medical reasons) | Doc rsn no 10 yr follow | 2017 |
G9868 | Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, less than 10 minutes | Cmmi asyntelehealth <10min | 2018 |
G9869 | Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, 10-20 minutes | Cmmi asyntelehealth 10-20min | 2018 |
G9870 | Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, more than 20 minutes | Cmmi asyntelehealth >20min | 2018 |
G9871 | Behavioral counseling for diabetes prevention, online, 60 minutes | Bhv couns dm prev, onln 60 m | 2026 |
G9873 | First medicare diabetes prevention program (mdpp) core session was attended by an mdpp beneficiary under the mdpp expanded model (em). a core session is an mdpp service that: (1) is furnished by an mdpp supplier during months 1 through 6 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for core sessions | 1 em core session | 2018 |
G9874 | Four total medicare diabetes prevention program (mdpp) core sessions were attended by an mdpp beneficiary under the mdpp expanded model (em). a core session is an mdpp service that: (1) is furnished by an mdpp supplier during months 1 through 6 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for core sessions | 4 em core sessions | 2018 |
G9875 | Nine total medicare diabetes prevention program (mdpp) core sessions were attended by an mdpp beneficiary under the mdpp expanded model (em). a core session is an mdpp service that: (1) is furnished by an mdpp supplier during months 1 through 6 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for core sessions | 9 em core sessions | 2018 |
G9876 | Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 7-9 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary did not achieve at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 7-9 | 2 em core ms mo 7-9 no wl | 2018 |
G9877 | Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 10-12 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary did not achieve at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 10-12 | 2 em core ms mo 10-12 no wl | 2018 |
G9878 | Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 7-9 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions.the beneficiary achieved at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 7-9 | 2 em core ms mo 7-9 wl | 2018 |
G9879 | Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 10-12 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary achieved at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 10-12 | 2 em core ms mo 10-12 wl | 2018 |
G9880 | The mdpp beneficiary achieved at least 5% weight loss (wl) from his/her baseline weight in months 1-12 of the mdpp services period under the mdpp expanded model (em). this is a one-time payment available when a beneficiary first achieves at least 5% weight loss from baseline as measured by an in-person weight measurement at a core session or core maintenance session | Em 5 percent wl | 2018 |
G9881 | The mdpp beneficiary achieved at least 9% weight loss (wl) from his/her baseline weight in months 1-24 under the mdpp expanded model (em). this is a one-time payment available when a beneficiary first achieves at least 9% weight loss from baseline as measured by an in-person weight measurement at a core session, core maintenance session, or ongoing maintenance session | Em 9 percent wl | 2018 |
G9882 | Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 13-15 under the mdpp expanded model (em). an ongoing maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary maintained at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 13-15 | 2 em ongoing ms mo 13-15 wl | 2018 |
G9883 | Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 16-18 under the mdpp expanded model (em). an ongoing maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary maintained at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 16-18 | 2 em ongoing ms mo 16-18 wl | 2018 |
G9884 | Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 19-21 under the mdpp expanded model (em). an ongoing maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary maintained at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 19-21 | 2 em ongoing ms mo 19-21 wl | 2018 |
G9885 | Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 22-24 under the mdpp expanded model (em). an ongoing maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary maintained at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 22-24 | 2 em ongoing ms mo 22-24 wl | 2018 |
G9886 | Behavioral counseling for diabetes prevention, in-person, group, 60 minutes | In-person attendance g code | 2024 |
G9887 | Behavioral counseling for diabetes prevention, distance learning, 60 minutes | Distance learning attendance | 2024 |
G9888 | Maintenance 5% wl from baseline weight in months 7-12 | 5% wl maintnd from bsline wt | 2024 |
G9890 | Bridge payment: a one-time payment for the first medicare diabetes prevention program (mdpp) core session, core maintenance session, or ongoing maintenance session furnished by an mdpp supplier to an mdpp beneficiary during months 1-24 of the mdpp expanded model (em) who has previously received mdpp services from a different mdpp supplier under the mdpp expanded model. a supplier may only receive one bridge payment per mdpp beneficiary | Em bridge payment | 2018 |
G9891 | Mdpp session reported as a line-item on a claim for a payable mdpp expanded model (em) hcpcs code for a session furnished by the billing supplier under the mdpp expanded model and counting toward achievement of the attendance performance goal for the payable mdpp expanded model hcpcs code (this code is for reporting purposes only) | Em session reporting | 2018 |
G9894 | Androgen deprivation therapy prescribed/administered in combination with external beam radiotherapy to the prostate | Adr dep thrpy prescribed | 2018 |
G9895 | Documentation of medical reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate (e.g., salvage therapy) | Doc med rsn no adr dep thrpy | 2018 |
G9896 | Documentation of patient reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate | Doc pt rsn no adr dep thrpy | 2018 |
G9897 | Patients who were not prescribed/administered androgen deprivation therapy in combination with external beam radiotherapy to the prostate, reason not given | Pt nt prsc adr dep thrpy rng | 2018 |
G9898 | Patients age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the measurement period | Pt 66+ snp or ltc pos > 90d | 2018 |
G9899 | Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results documented and reviewed | Scrn mam perf rslts doc | 2018 |
G9900 | Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results were not documented and reviewed, reason not otherwise specified | Scrn mam perf rslts not doc | 2018 |
G9901 | 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 | Pt 66+ snp or ltc pos > 90d | 2018 |
G9902 | Patient screened for tobacco use and identified as a tobacco user | Pt scrn tbco and id as user | 2018 |
G9903 | Patient screened for tobacco use and identified as a tobacco non-user | Pt scrn tbco id as non user | 2018 |
G9905 | Patient not screened for tobacco use | No pt tbco scrn rng | 2018 |
G9906 | Patient identified as a tobacco user received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy) | Pt recv tbco cess interv | 2018 |
G9908 | Patient identified as tobacco user did not receive tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy) | No pt tbco cess interv rng | 2018 |
G9910 | Patients age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period | Pt 66+ snp or ltc pos > 90d | 2018 |
G9911 | Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer before or after neoadjuvant systemic therapy | Node neg pre/post syst ther | 2018 |
G9912 | Hepatitis b virus (hbv) status assessed and results interpreted prior to initiating anti-tnf (tumor necrosis factor) therapy | Hbv status assesed and int | 2018 |
G9913 | Hepatitis b virus (hbv) status not assessed and results interpreted prior to initiating anti-tnf (tumor necrosis factor) therapy, reason not otherwise specified | No hbv status assesd and int | 2018 |
G9914 | Patient initiated an anti-tnf agent | Pt initiated anti-tnf agent | 2018 |
G9915 | No record of hbv results documented | No documntd hbv results rcd | 2018 |
G9916 | Functional status performed once in the last 12 months | Funct status past 12 months | 2018 |
G9917 | Documentation of advanced stage dementia and caregiver knowledge is limited | Adv dem crgvr limited | 2018 |
G9918 | Functional status not performed, reason not otherwise specified | No funct stat perf, rsn nos | 2018 |
G9919 | Screening performed and positive and provision of recommendations | Scrn nd pos nd prov of rec | 2018 |
G9920 | Screening performed and negative | Scrning perf and negative | 2018 |
G9922 | Safety concerns screen provided and if positive then documented mitigation recommendations | Sfty cncrns scrn nd mit recs | 2018 |
G9923 | Safety concerns screen provided and negative | Safty cncrns scrn and neg | 2018 |
G9925 | Safety concerns screening not provided, reason not otherwise specified | No scrn prov rsn nos | 2018 |
G9926 | Safety concerns screening positive screen is without provision of mitigation recommendations, including but not limited to referral to other resources | Sfty cncrns scrn but no recs | 2018 |
G9928 | Fda-approved anticoagulant not prescribed, reason not given | No warf or fda drug presc | 2018 |
G9929 | Patient with transient or reversible cause of af (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac surgery) | Trs/rev af | 2018 |
G9930 | Patients who are receiving comfort care only | Com care | 2018 |
G9931 | Documentation of cha2ds2-vasc risk score of 0 or 1 for men; or 0, 1, or 2 for women | No chad or chad scr 0 or 1 | 2018 |
G9938 | Patients aged 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 six months prior to the measurement period through december 31 of the measurement period | Pt 66+ snp or ltc pos > 90d | 2018 |
G9939 | Pathologists/dermatopathologists is the same clinician who performed the biopsy | Same path/derm perf biopsy | 2018 |
G9940 | Documentation of medical reason(s) for not on a statin (e.g., pregnancy, in vitro fertilization, clomiphene rx, esrd, cirrhosis, muscular pain and disease during the measurement period or prior year) | Doc reas no statin therapy | 2018 |
G9943 | Back pain was not measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively | Bk pn nt msr vas scl pre/pst | 2018 |
G9945 | Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis | Pt w/cancer scoliosis | 2018 |
G9946 | Back pain was not measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively | Bk pain no vas | 2018 |
G9949 | Leg pain was not measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively | Leg pain no vas | 2018 |
G9954 | Patient exhibits 2 or more risk factors for post-operative vomiting | Pt >2 rsk fac post-op vomit | 2018 |
G9955 | Cases in which an inhalational anesthetic is used only for induction | Inhlnt anesth only for induc | 2018 |
G9956 | Patient received combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively | Combo thrpy of >= 2 prophly | 2018 |
G9957 | Documentation of medical reason for not receiving combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively (e.g., intolerance or other medical reason) | Doc med rsn no combo thrpy | 2018 |
G9958 | Patient did not receive combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively | No combo prohpyl thrp for pt | 2018 |
G9959 | Systemic antimicrobials not prescribed | Systemic antimicro not presc | 2018 |
G9960 | Documentation of medical reason(s) for prescribing systemic antimicrobials | Med rsn sys antimi nt rx | 2018 |
G9961 | Systemic antimicrobials prescribed | Systemic antimicro presc | 2018 |
G9962 | Embolization endpoints are documented separately for each embolized vessel and ovarian artery angiography or embolization performed in the presence of variant uterine artery anatomy | Embolization doc separatly | 2018 |
G9963 | Embolization endpoints are not documented separately for each embolized vessel or ovarian artery angiography or embolization not performed in the presence of variant uterine artery anatomy | Embolization not doc separat | 2018 |
G9964 | Patient received at least one well-child visit with a pcp during the performance period | Pt recv >=1 well-chld visit | 2018 |
G9965 | Patient did not receive at least one well-child visit with a pcp during the performance period | No well-chld vist recv by pt | 2018 |
G9968 | Patient was referred to another clinician or specialist during the measurement period | Pt refrd 2 pvdr/spclst in pp | 2018 |
G9969 | Clinician who referred the patient to another clinician received a report from the clinician to whom the patient was referred | Pvdr rfrd pt rprt rcvd | 2018 |
G9970 | Clinician who referred the patient to another clinician did not receive a report from the clinician to whom the patient was referred | Pvdr rfrd pt no rprt rcvd | 2018 |
G9978 | Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a problem focused history; a problem focused examination; and straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology | Remote e/m new pt 10mins | 2018 |
G9979 | Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 20 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology | Remote e/m new pt 20mins | 2018 |
G9980 | Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a detailed history; a detailed examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate severity. typically, 30 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology | Remote e/m new pt 30 mins | 2018 |
G9981 | Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 45 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology | Remote e/m new pt 45mins | 2018 |
G9982 | Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 60 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology | Remote e/m new pt 60mins | 2018 |
G9983 | Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology | Remote e/m est. pt 10mins | 2018 |
G9984 | Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 15 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology | Remote e/m est. pt 15mins | 2018 |
G9985 | Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 25 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology | Remote e/m est. pt 25mins | 2018 |
G9986 | Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 40 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology | Remote e/m est. pt 40mins | 2018 |
G9987 | Bundled payments for care improvement advanced (bpci advanced) model home visit for patient assessment performed by clinical staff for an individual not considered homebound, including, but not necessarily limited to patient assessment of clinical status, safety/fall prevention, functional status/ambulation, medication reconciliation/management, compliance with orders/plan of care, performance of activities of daily living, and ensuring beneficiary connections to community and other services; for use only for a bpci advanced model episode of care; may not be billed for a 30-day period covered by a transitional care management code | Bpci advanced in home visit | 2018 |
G9988 | Palliative care services provided to patient any time during the measurement period | Pall serv during meas | 2022 |
G9992 | Palliative care services used by patient any time during the measurement period | Pall serv during meas | 2022 |
G9993 | Patient was provided palliative care services any time during the measurement period | Pall serv during meas | 2022 |
G9994 | Patient is using palliative care services any time during the measurement period | Pall serv during meas | 2022 |
G9996 | Documentation stating the patient has received or is currently receiving palliative or hospice care | Doc pt pal or hospice | 2022 |
G9997 | Documentation of patient pregnancy anytime during the measurement period prior to and including the current encounter | Doc pt preg dur msrmt pd | 2022 |
G9998 | Documentation of medical reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., last colonoscopy incomplete, last colonoscopy had inadequate prep, piecemeal removal of adenomas, or sessile serrated polyps >= 20 mm in size, last colonoscopy found greater than 10 adenomas, lower gastrointestinal bleeding, or patient at high risk for colon cancer due to underlying medical history ([i.e. crohn's disease, ulcerative colitis, personal or family history of colon cancer, hereditary colorectal cancer syndromes]) | Doc med rsn <3 colon | 2022 |
G9999 | Documentation of system reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., unable to locate previous colonoscopy report, patient cannot provide precise date or details from previous colonoscopy, previous colonoscopy report was incomplete) | Doc sys rsn <3 colon | 2022 |
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