List of new codes and changes to the 2024 HCPCS code set along with their effective date. Includes discontinued codes that are no longer used.
Legend:
A Codes↑ Top | |||
| Effective | Code | Description | |
| 04/01/2024 |
|
Restrata minimatrix, 5 mg | |
| 04/01/2024 |
|
Integrated lancing and blood sample testing cartridges for home blood glucose monitor, per month | |
| 01/01/2024 |
|
Disposable collection and storage bag for breast milk, any size, any type, each
No maintenance for this code |
|
| 04/01/2024 |
|
Adhesive clip applied to the skin to secure external electrical nerve stimulator controller, each | |
| 01/01/2024 |
|
Enema tube, with or without adapter, any type, replacement only, each
No maintenance for this code |
|
| 01/01/2024 |
|
Exsufflation belt, includes all supplies and accessories
No maintenance for this code |
|
| 01/01/2024 |
|
Distal transcutaneous electrical nerve stimulator, stimulates peripheral nerves of the upper arm
No maintenance for this code |
|
| 01/01/2024 |
|
Monthly supplies for use of device coded at e0733
No maintenance for this code |
|
| 01/01/2024 |
|
Supplies and accessories for external upper limb tremor stimulator of the peripheral nerves of the wrist
No maintenance for this code |
|
| 04/01/2024 |
|
Pessary, reusable, rubber, any type
Change in long description of procedure or modifier code |
|
| 04/01/2024 |
|
Pessary, reusable, non rubber, any type
Change in long description of procedure or modifier code |
|
| 04/01/2024 |
|
Pessary, disposable, any type | |
| 04/01/2024 |
|
Neuromodulation stimulator system, adjunct to rehabilitation therapy regime, controller | |
| 04/01/2024 |
|
Neuromodulation stimulator system, adjunct to rehabilitation therapy regime, mouthpiece each | |
| 04/01/2024 |
|
Skin sealants, protectants, moisturizers, ointments, any type, any size
Miscellaneous change (BETOS, type of service) |
|
| 01/01/2024 |
|
Gradient compression garment, glove, padded, for nighttime use, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression garment, glove, padded, for nighttime use, custom, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression garment, arm, padded, for nighttime use, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression garment, arm, padded, for nighttime use, custom, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression garment, lower leg and foot, padded, for nighttime use, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression garment, lower leg and foot, padded, for nighttime use, custom, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression garment, full leg and foot, padded, for nighttime use, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression garment, full leg and foot, padded, for nighttime use, custom, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression garment, bra, for nighttime use, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression garment, bra, for nighttime use, custom, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression stocking, below knee, 18-30 mmhg, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression stocking, below knee, 30-40 mmhg, used as a surgical dressing, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression stocking, below knee, 40-50 mmhg, used as a surgical dressing, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression stocking, thigh length, 18-30 mmhg, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression stocking, thigh length, 30-40 mmhg, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression stocking, thigh length, 40 mmhg or greater, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression stocking, full length/chap style, 18-30 mmhg, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression stocking, full length/chap style, 30-40 mmhg, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression stocking, full length/chap style, 40 mmhg or greater, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression stocking, waist length, 18-30 mmhg, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression stocking, waist length, 30-40 mmhg, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression stocking, waist length, 40 mmhg or greater, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression wrap, non-elastic, below knee, 30-50 mmhg, used as a surgical dressing, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression garment, not otherwise specified
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression stocking, below knee, 30-40 mmhg, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression stocking, below knee, 30-40 mmhg, custom, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression stocking, below knee, 40 mmhg or greater, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression stocking, below knee, 40 mmhg or greater, custom, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression stocking, thigh length, 18-30 mmhg, custom, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression stocking, thigh length, 30-40 mmhg, custom, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression stocking, thigh length, 40 mmhg or greater, custom, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression stocking, full length/chap style, 18-30 mmhg, custom, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression stocking, full length/chap style, 30-40 mmhg, custom, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression stocking, full length/chap style, 40 mmhg or greater, custom, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression stocking, waist length, 18-30 mmhg, custom, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression stocking, waist length, 30-40 mmhg, custom, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression stocking, waist length, 40 mmhg or greater, custom, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression gauntlet, custom, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression garment, neck/head, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression garment, neck/head, custom, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression garment, torso and shoulder, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression garment, torso/shoulder, custom, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression garment, genital region, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression garment, genital region, custom, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression garment, toe caps, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression garment, toe caps, custom, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression arm sleeve and glove combination, custom, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression arm sleeve and glove combination, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression arm sleeve, custom, medium weight, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression arm sleeve, custom, heavy weight, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression arm sleeve, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression glove, custom, medium weight, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression glove, custom, heavy weight, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression glove, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression gauntlet, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression wrap with adjustable straps, below knee, 30-50 mmhg, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression wrap with adjustable straps, not otherwise specified
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient pressure wrap with adjustable straps, above knee, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient pressure wrap with adjustable straps, full leg, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient pressure wrap with adjustable straps, foot, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient pressure wrap with adjustable straps, arm, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient pressure wrap with adjustable straps, bra, each
No maintenance for this code |
|
| 01/01/2024 |
|
Accessory for gradient compression garment or wrap with adjustable straps, not-otherwise specified
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression bandaging supply, bandage liner, lower extremity, any size or length, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression bandaging supply, bandage liner, upper extremity, any size or length, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression bandaging supply, conforming gauze, per linear yard, any width, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression bandage roll, elastic long stretch, linear yard, any width, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression bandage roll, elastic medium stretch, per linear yard, any width, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression bandage roll, inelastic short stretch, per linear yard, any width, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression bandaging supply, high density foam sheet, per 250 square centimeters, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression bandaging supply, high density foam pad, any size or shape, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression bandaging supply, high density foam roll for bandage, per linear yard, any width, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression bandaging supply, low density channel foam sheet, per 250 square centimeters, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression bandaging supply, low density flat foam sheet, per 250 square centimeters, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression bandaging supply, padded foam, per linear yard, any width, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression bandaging supply, padded textile, per linear yard, any width, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression bandaging supply, tubular protective absorption layer, per linear yard, any width, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression bandaging supply, tubular protective absorption padded layer, per linear yard, any width, each
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression bandaging supply, not otherwise specified
No maintenance for this code |
|
| 01/01/2024 |
|
Gradient compression stocking, below knee, 18-30 mmhg, custom, each
No maintenance for this code |
|
| 01/01/2024 |
|
Mechanical allergen particle barrier/inhalation filter, cream, nasal, topical
No maintenance for this code |
|
| 01/01/2024 |
|
Wound suction, disposable, includes dressing, all accessories and components, any type, each
No maintenance for this code |
|
| 04/01/2024 |
|
Fertility cycle (contraception & conception) tracking software application, fda cleared, per month, includes accessories (e.g., thermometer) | |
| 01/01/2024 |
|
Lutetium lu 177, dotatate, therapeutic, 1 millicurie
No maintenance for this code |
|
| 01/01/2024 |
|
Florbetapir f18, diagnostic, per study dose, up to 10 millicuries
No maintenance for this code |
|
| 01/01/2024 |
|
Gallium ga-68, dotatate, diagnostic, 0.1 millicurie
No maintenance for this code |
|
| 01/01/2024 |
|
Fluciclovine f-18, diagnostic, 1 millicurie
No maintenance for this code |
|
| 01/01/2024 |
|
Fluoroestradiol f 18, diagnostic, 1 millicurie
No maintenance for this code |
|
| 01/01/2024 |
|
Copper cu-64, dotatate, diagnostic, 1 millicurie
No maintenance for this code |
|
| 01/01/2024 |
|
Flotufolastat f 18, diagnostic, 1 millicurie
No maintenance for this code |
|
| 01/01/2024 |
|
Fludeoxyglucose f18 up to 15 millicuries
No maintenance for this code |
|
C Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2024 |
|
Hemostatic agent, gastrointestinal, topical
No maintenance for this code |
|
| 01/01/2024 |
|
Intravertebral body fracture augmentation with implant (e.g., metal, polymer)
No maintenance for this code |
|
| 01/01/2024 |
|
Catheter, transluminal intravascular lesion preparation device, bladed, sheathed (insertable)
No maintenance for this code |
|
| 01/01/2024 |
|
Endoscope, single-use (i.e. disposable), pulmonary, imaging/illumination device (insertable)
No maintenance for this code |
|
| 01/01/2024 |
|
Orthopedic/device/drug matrix/absorbable bone void filler, antimicrobial-eluting (implantable)
No maintenance for this code |
|
| 01/01/2024 |
|
Retrieval device, insertable, laser (used to retrieve intravascular inferior vena cava filter)
No maintenance for this code |
|
| 01/01/2024 |
|
Graft, transmural transvenous arterial bypass (implantable), with all delivery system components
No maintenance for this code |
|
| 01/01/2024 |
|
Endoscope, single-use (i.e. disposable), upper gi, imaging/illumination device (insertable)
No maintenance for this code |
|
| 01/01/2024 |
|
Generator, neurostimulator (implantable), non-rechargeable with carotid sinus baroreceptor stimulation lead(s)
No maintenance for this code |
|
| 01/01/2024 |
|
Debridement, bone including epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed, first 20 sq cm or less with manual preparation and insertion of deep (eg, subfacial) drug-delivery device(s)
No maintenance for this code |
|
| 01/01/2024 |
|
Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging, supervision, interpretation and report
No maintenance for this code |
|
| 01/01/2024 |
|
Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress
No maintenance for this code |
|
| 01/01/2024 |
|
Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(ies), unilateral, with atherectomy, includes angioplasty within the same vessel, when performed with intravascular ultrasound (initial noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation
No maintenance for this code |
|
| 01/01/2024 |
|
Diagnostic endoscopic retrograde cholangiopancreatography (ercp), including collection of specimen(s) by brushing or washing, when performed, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s)
No maintenance for this code |
|
| 01/01/2024 |
|
Endoscopic retrograde cholangiopancreatography (ercp) with biopsy, single or multiple, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s)
No maintenance for this code |
|
| 01/01/2024 |
|
Endoscopic retrograde cholangiopancreatography (ercp) with sphincterotomy/papillotomy, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s)
No maintenance for this code |
|
| 01/01/2024 |
|
Endoscopic retrograde cholangiopancreatography (ercp) with removal of calculi/debris from biliary/pancreatic duct(s), with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s)
No maintenance for this code |
|
| 01/01/2024 |
|
Removal and replacement of externally accessible nephroureteral catheter (eg, external/internal stent) requiring fluoroscopic guidance, with ureteral stricture balloon dilation, including imaging guidance and all associated radiological supervision and interpretation
No maintenance for this code |
|
| 01/01/2024 |
|
Change of ureterostomy tube or externally accessible ureteral stent via ileal conduit with ureteral stricture balloon dilation, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation
No maintenance for this code |
|
| 01/01/2024 |
|
Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography and right heart catheterization with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress, initial vessel
No maintenance for this code |
|
| 01/01/2024 |
|
Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography with pharmacologic agent administration (eg, inhaled nitric oxide, intravenous infusion of nitroprusside, dobutamine, milrinone, or other agent) including assessing hemodynamic measurements before, during, after and repeat pharmacologic agent administration, when performed
No maintenance for this code |
|
| 01/01/2024 |
|
Thyroidectomy, total or complete with parathyroid autotransplantation
No maintenance for this code |
|
| 01/01/2024 |
|
Bronchoscopy, rigid or flexible, with bronchial alveolar lavage and transendoscopic endobronchial ultrasound (ebus) during bronchoscopic diagnostic or therapeutic intervention(s) for peripheral lesion(s), including fluoroscopic guidance, when performed
No maintenance for this code |
|
| 01/01/2024 |
|
Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed and intraprocedural coronary fractional flow reserve (ffr) with 3d functional mapping of color-coded ffr values for the coronary tree, derived from coronary angiogram data, for real-time review and interpretation of possible atherosclerotic stenosis(es) intervention
No maintenance for this code |
|
| 01/01/2024 |
|
Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography with pharmacologic agent administration (eg, inhaled nitric oxide, intravenous infusion of nitroprusside, dobutamine, milrinone, or other agent) including assessing hemodynamic measurements before, during, after and repeat pharmacologic agent administration, when performed
No maintenance for this code |
|
| 01/01/2024 |
|
Endoscopic retrograde cholangiopancreatography (ercp) with removal of foreign body(s) or stent(s) from biliary/pancreatic duct(s) and endoscopic cannulation of papilla with direct visualization of pancreatic/common bile duct(s)
No maintenance for this code |
|
| 01/01/2024 |
|
Service for diagnosis, evaluation, or treatment of a mental health or substance use disorder, 15-29 minutes, provided remotely by hospital staff who are licensed to provide mental health services under applicable state law(s), when the patient is in their home, and there is no associated professional service
No maintenance for this code |
|
| 01/01/2024 |
|
Service for diagnosis, evaluation, or treatment of a mental health or substance use disorder, 30-60 minutes, provided remotely by hospital staff who are licensed to provided mental health services under applicable state law(s), when the patient is in their home, and there is no associated professional service
No maintenance for this code |
|
| 01/01/2024 |
|
Group psychotherapy service for diagnosis, evaluation, or treatment of a mental health or substance use disorder provided remotely by hospital staff who are licensed to provide mental health services under applicable state law(s), when the patient is in their home, and there is no associated professional service
No maintenance for this code |
|
| 01/01/2024 |
|
Gallium ga-68, dotatoc, diagnostic, 0.01 mci
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, aripiprazole, (abilify asimtufii), 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, amisulpride, 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, buprenorphine extended-release (brixadi), 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, epcoritamab-bysp, 0.16 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Flotufolastat f 18, diagnostic, 1 millicurie
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, tofersen, 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, risperidone, (uzedy), 1 mg
No maintenance for this code |
|
| 04/01/2024 |
|
Injection, prothrombin complex concentrate (human), balfaxar, per i.u. of factor ix activity
Code Discontinued |
|
| 04/01/2024 |
|
Injection, daxibotulinumtoxina-lanm, 1 unit
Code Discontinued |
|
| 04/01/2024 |
|
Injection, aflibercept hd, 1 mg
Code Discontinued |
|
| 04/01/2024 |
|
Injection, avacincaptad pegol, 0.1 mg
Code Discontinued |
|
| 04/01/2024 |
|
Injection, talquetamab-tgvs, 0.25 mg
Code Discontinued |
|
| 04/01/2024 |
|
Cantharidin for topical administration, 0.7%, single unit dose applicator (3.2 mg)
Code Discontinued |
|
| 04/01/2024 |
|
Injection, elranatamab-bcmm, 1 mg
Code Discontinued |
|
| 04/01/2024 |
|
Injection, secukinumab, intravenous, 1 mg | |
| 04/01/2024 |
|
Injection, apadamtase alfa, 10 units | |
| 04/01/2024 |
|
Injection, mirikizumab-mrkz, 1 mg | |
| 01/01/2024 |
|
Injection, clevidipine butyrate, 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, glucarpidase, 10 units
No maintenance for this code |
|
| 01/01/2024 |
|
Focused ultrasound ablation/therapeutic intervention, other than uterine leiomyomata, with magnetic resonance (mr) guidance
No maintenance for this code |
|
| 01/01/2024 |
|
Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and excision of herniated intervertebral disc, and repair of annular defect with implantation of bone anchored annular closure device, including annular defect measurement, alignment and sizing assessment, and image guidance; 1 interspace, lumbar
No maintenance for this code |
|
| 01/01/2024 |
|
Vitrectomy, mechanical, pars plana approach, with subretinal injection of pharmacologic/biologic agent
No maintenance for this code |
|
| 01/01/2024 |
|
Nasal/sinus endoscopy, cryoablation nasal tissue(s) and/or nerve(s), unilateral or bilateral
No maintenance for this code |
|
| 01/01/2024 |
|
Endoscopic submucosal dissection (esd), including endoscopy or colonoscopy, mucosal closure, when performed
No maintenance for this code |
|
| 01/01/2024 |
|
Insertion of central venous catheter through central venous occlusion via inferior and superior approaches (e.g., inside-out technique), including imaging guidance
No maintenance for this code |
|
| 01/01/2024 |
|
Opto-acoustic imaging, breast (including axilla when performed), unilateral, with image documentation, analysis and report, obtained with ultrasound examination
No maintenance for this code |
|
| 01/01/2024 |
|
3d predictive model generation for pre-planning of a cardiac procedure, using data from cardiac computed tomographic angiography with report
No maintenance for this code |
|
| 01/01/2024 |
|
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)
No maintenance for this code |
|
| 01/01/2024 |
|
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
No maintenance for this code |
|
| 01/01/2024 |
|
Repair of enterocutaneous fistula small intestine or colon (excluding anorectal fistula) with plug (e.g., porcine small intestine submucosa [sis]) | |
| 01/01/2024 |
|
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 | |
| 01/01/2024 |
|
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source
No maintenance for this code |
|
E Codes↑ Top | |||
| Effective | Code | Description | |
| 04/01/2024 |
|
Walker, battery powered, wheeled, folding, adjustable or fixed height | |
| 04/01/2024 |
|
Home ventilator, dual-function respiratory device, also performs additional function of cough stimulation, includes all accessories, components and supplies for all functions | |
| 01/01/2024 |
|
Power source and control electronics unit for oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, controlled by phone application
No maintenance for this code |
|
| 01/01/2024 |
|
Oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, used in conjunction with the power source and control electronics unit, controlled by phone application, 90-day supply
No maintenance for this code |
|
| 01/01/2024 |
|
Electronic positional obstructive sleep apnea treatment, with sensor, includes all components and accessories, any type
No maintenance for this code |
|
| 01/01/2024 |
|
Non-pneumatic sequential compression garment, full leg
No maintenance for this code |
|
| 01/01/2024 |
|
Non-pneumatic sequential compression garment, half leg
No maintenance for this code |
|
| 01/01/2024 |
|
Non-pneumatic compression controller with sequential calibrated gradient pressure
No maintenance for this code |
|
| 01/01/2024 |
|
Non-pneumatic compression controller without calibrated gradient pressure
No maintenance for this code |
|
| 01/01/2024 |
|
Non-pneumatic sequential compression garment, full arm
No maintenance for this code |
|
| 01/01/2024 |
|
Cranial electrotherapy stimulation (ces) system, any type
No maintenance for this code |
|
| 01/01/2024 |
|
Transcutaneous electrical nerve stimulator for electrical stimulation of the trigeminal nerve
No maintenance for this code |
|
| 01/01/2024 |
|
External upper limb tremor stimulator of the peripheral nerves of the wrist
No maintenance for this code |
|
| 01/01/2024 |
|
Non-invasive vagus nerve stimulator
No maintenance for this code |
|
| 04/01/2024 |
|
Transcutaneous tibial nerve stimulator | |
| 04/01/2024 |
|
Upper extremity rehabilitation system providing active assistance to facilitate muscle re-education, include microprocessor, all components and accessories | |
| 04/01/2024 |
|
Rehab system with interactive interface providing active assistance in rehabilitation therapy, includes all components and accessories, motors, microprocessors, sensors | |
| 01/01/2024 |
|
Whirlpool tub, walk-in, portable
No maintenance for this code |
|
| 04/01/2024 |
|
Suction pump, home model, portable or stationary, electric, any type, for use with external urine and/or fecal management system
Change in long description of procedure or modifier code |
|
| 04/01/2024 |
|
Home blood glucose monitor for use with integrated lancing/blood sample testing cartridge | |
| 04/01/2024 |
|
Complex rehabilitative power wheelchair accessory, power seat elevation system, any type | |
| 04/01/2024 |
|
Wheelchair accessory, power seat elevation system, any type
Code Discontinued |
|
| 01/01/2024 |
|
Wheelchair accessory, dynamic positioning hardware for back
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2024 |
|
Speech volume modulation system, any type, including all components and accessories
No maintenance for this code |
|
G Codes↑ Top | |||
| Effective | Code | Description | |
| 01/02/2024 |
|
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
No maintenance for this code |
|
| 01/02/2024 |
|
Injection of pre-exposure prophylaxis (prep) drug for hiv prevention, under skin or into muscle
No maintenance for this code |
|
| 01/02/2024 |
|
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
No maintenance for this code |
|
| 01/01/2024 |
|
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
No maintenance for this code |
|
| 01/01/2024 |
|
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)
No maintenance for this code |
|
| 01/01/2024 |
|
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
No maintenance for this code |
|
| 01/01/2024 |
|
Community health integration services, each additional 30 minutes per calendar month (list separately in addition to g0019)
No maintenance for this code |
|
| 01/01/2024 |
|
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
No maintenance for this code |
|
| 01/01/2024 |
|
Principal illness navigation services, additional 30 minutes per calendar month (list separately in addition to g0023)
No maintenance for this code |
|
| 01/01/2024 |
|
Optimizing chronic disease management mips value pathways
No maintenance for this code |
|
| 01/01/2024 |
|
Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk
No maintenance for this code |
|
| 01/01/2024 |
|
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)
No maintenance for this code |
|
| 01/01/2024 |
|
Administration of a standardized, evidence-based social determinants of health risk assessment tool, 5-15 minutes
No maintenance for this code |
|
| 01/01/2024 |
|
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
No maintenance for this code |
|
| 04/01/2024 |
|
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 | |
| 01/01/2024 |
|
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
No maintenance for this code |
|
| 01/01/2024 |
|
Principal illness navigation - peer support, additional 30 minutes per calendar month (list separately in addition to g0140)
No maintenance for this code |
|
| 01/01/2024 |
|
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)
No maintenance for this code |
|
| 01/01/2024 |
|
Training and educational services related to the care and treatment of patient's disabling mental health problems per session (45 minutes or more)
No maintenance for this code |
|
| 01/01/2024 |
|
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)
No maintenance for this code |
|
| 01/01/2024 |
|
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
No maintenance for this code |
|
| 01/01/2024 |
|
Group psychotherapy other than of a multiple-family group, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes
No maintenance for this code |
|
| 01/01/2024 |
|
Interactive group psychotherapy, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes
No maintenance for this code |
|
| 01/01/2024 |
|
Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, implantable loop recorder system, or subcutaneous cardiac rhythm monitor system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results
No maintenance for this code |
|
| 01/01/2024 |
|
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
No maintenance for this code |
|
| 01/01/2024 |
|
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
No maintenance for this code |
|
| 01/01/2024 |
|
Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period
No maintenance for this code |
|
| 01/01/2024 |
|
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
No maintenance for this code |
|
| 01/01/2024 |
|
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
No maintenance for this code |
|
| 01/01/2024 |
|
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
No maintenance for this code |
|
| 01/01/2024 |
|
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
No maintenance for this code |
|
| 01/01/2024 |
|
Uri episodes where the patient is taking antibiotics (table 1) in the 30 days prior to the episode date
No maintenance for this code |
|
| 01/01/2024 |
|
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)
No maintenance for this code |
|
| 01/01/2024 |
|
Patient receiving angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy
No maintenance for this code |
|
| 01/01/2024 |
|
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
No maintenance for this code |
|
| 01/01/2024 |
|
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 maintenance for this code |
|
| 01/01/2024 |
|
Trans-abdominal or trans-vaginal ultrasound not performed for reasons documented by clinician (e.g., patient has a documented intrauterine pregnancy [iup])
No maintenance for this code |
|
| 01/01/2024 |
|
Patient discharge to home no later than post-operative day #7
No maintenance for this code |
|
| 01/01/2024 |
|
Patient not discharged to home by post-operative day #7
No maintenance for this code |
|
| 01/01/2024 |
|
Adherence to therapy was assessed at least annually through an objective informatics system or through self-reporting (if objective reporting is not available, documented)
No maintenance for this code |
|
| 01/01/2024 |
|
Positive airway pressure therapy was prescribed
No maintenance for this code |
|
| 01/01/2024 |
|
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)
No maintenance for this code |
|
| 01/01/2024 |
|
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
No maintenance for this code |
|
| 01/01/2024 |
|
Biopsy results reviewed, communicated, tracked and documented
No maintenance for this code |
|
| 01/01/2024 |
|
Clinician documented reason that patient's biopsy results were not reviewed
No maintenance for this code |
|
| 01/01/2024 |
|
Biopsy results not reviewed, communicated, tracked or documented
No maintenance for this code |
|
| 01/01/2024 |
|
Spirometry results documented (fev1/fvc < 70%)
No maintenance for this code |
|
| 01/01/2024 |
|
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)
No maintenance for this code |
|
| 01/01/2024 |
|
Elder maltreatment screen documented as positive, follow-up plan not documented, documentation the patient is not eligible for follow-up plan at the time of the encounter
No maintenance for this code |
|
| 01/01/2024 |
|
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
No maintenance for this code |
|
| 01/01/2024 |
|
Cardiac stress imaging performed primarily for monitoring of asymptomatic patient who had pci within 2 years
No maintenance for this code |
|
| 01/01/2024 |
|
Cardiac stress imaging test performed primarily for any other reason than monitoring of asymptomatic patient who had pci within 2 years (e.g., symptomatic patient, patient greater than 2 years since pci, initial evaluation, etc)
No maintenance for this code |
|
| 01/01/2024 |
|
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)
No maintenance for this code |
|
| 01/01/2024 |
|
Documentation of system reason(s) for not prescribing beta-blocker therapy (eg, other reasons attributable to the health care system)
No maintenance for this code |
|
| 01/01/2024 |
|
Chlamydia, gonorrhea, and syphilis screening results not documented (patient refusal is the only allowed exception)
No maintenance for this code |
|
| 01/01/2024 |
|
Patient offered assistance with end of life issues or existing end of life plan was reviewed or updated during the measurement period
No maintenance for this code |
|
| 01/01/2024 |
|
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 maintenance for this code |
|
| 01/01/2024 |
|
Patient received one-time screening for hcv infection
No maintenance for this code |
|
| 01/01/2024 |
|
Documentation of medical reason(s) for not receiving hcv antibody test due to limited life expectancy
No maintenance for this code |
|
| 01/01/2024 |
|
Documentation of patient reason(s) for not receiving one-time screening for hcv infection (e.g., patient declined, other patient reasons)
No maintenance for this code |
|
| 01/01/2024 |
|
One-time screening for hcv infection not received within 12-month reporting period and no documentation of prior screening for hcv infection, reason not given
No maintenance for this code |
|
| 01/01/2024 |
|
Pediatric patient had a head ct for trauma ordered by someone other than an emergency care provider or was ordered for a reason other than trauma
No maintenance for this code |
|
| 01/01/2024 |
|
Photodocumentation of two or more cecal landmarks to establish a complete examination
No maintenance for this code |
|
| 01/01/2024 |
|
Documentation of post-surgical anatomy (e.g., right hemicolectomy, ileocecal resection, etc.)
No maintenance for this code |
|
| 01/01/2024 |
|
Photodocumentation of less than two cecal landmarks (i.e., no cecal landmarks or only one cecal landmark) to establish a complete examination
No maintenance for this code |
|
| 01/01/2024 |
|
Documentation of medical reason(s) for not prescribing a long-acting inhaled bronchodilator (e.g., patient intolerance or history of side effects)
No maintenance for this code |
|
| 01/01/2024 |
|
Documentation of patient reason(s) for not prescribing a long-acting inhaled bronchodilator
No maintenance for this code |
|
| 01/01/2024 |
|
Documentation of system reason(s) for not prescribing a long-acting inhaled bronchodilator (e.g., cost of treatment or lack of insurance)
No maintenance for this code |
|
| 01/01/2024 |
|
Episodes where the patient is taking antibiotics (table 1) in the 30 days prior to the episode date
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who use hospice services any time during the measurement period
No maintenance for this code |
|
| 01/01/2024 |
|
Documentation stating the patient has had a diagnosis of bipolar disorder
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who use hospice services any time during the measurement period
No maintenance for this code |
|
| 01/01/2024 |
|
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
No maintenance for this code |
|
| 01/01/2024 |
|
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.)
No maintenance for this code |
|
| 01/01/2024 |
|
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
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who are breastfeeding at any time during the performance period
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who have a diagnosis of rhabdomyolysis at any time during the performance period
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who died from cancer
No maintenance for this code |
|
| 01/01/2024 |
|
Patient admitted to the icu in the last 30 days of life
No maintenance for this code |
|
| 01/01/2024 |
|
Patient was not admitted to the icu in the last 30 days of life
No maintenance for this code |
|
| 01/01/2024 |
|
Behavioral counseling for diabetes prevention, in-person, group, 60 minutes
No maintenance for this code |
|
| 01/01/2024 |
|
Behavioral counseling for diabetes prevention, distance learning, 60 minutes
No maintenance for this code |
|
| 01/01/2024 |
|
Maintenance 5% wl from baseline weight in months 7-12
No maintenance for this code |
|
| 01/01/2024 |
|
Patient initiated an anti-tnf agent
No maintenance for this code |
|
| 01/01/2024 |
|
Documentation of system reason(s) for not prescribing an fda-approved anticoagulation due to patient being currently enrolled in a clinical trial related to af/atrial flutter treatment
No maintenance for this code |
|
| 01/01/2024 |
|
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
No maintenance for this code |
|
| 01/01/2024 |
|
Patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period
No maintenance for this code |
|
| 01/01/2024 |
|
Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who use palliative care services any time during the measurement period
No maintenance for this code |
|
| 01/01/2024 |
|
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])
No maintenance for this code |
|
H Codes↑ Top | |||
| Effective | Code | Description | |
| 04/01/2024 |
|
Traditional healing service | |
J Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2024 |
|
Injection, acetaminophen (fresenius kabi) not therapeutically equivalent to j0131, 10 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, acetaminophen (b braun) not therapeutically equivalent to j0131, 10 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, acetaminophen (hikma) not therapeutically equivalent to j0131, 10 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, epinephrine (belcher) not therapeutically equivalent to j0171, 0.1 mg
No maintenance for this code |
|
| 04/01/2024 |
|
Injection, aflibercept hd, 1 mg | |
| 01/01/2024 |
|
Injection, amisulpride, 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, allopurinol sodium, 1 mg
No maintenance for this code |
|
| 04/01/2024 |
|
Injection, sodium thiosulfate (pedmark), 100 mg
Change in long description of procedure or modifier code |
|
| 04/01/2024 |
|
Injection, sodium thiosulfate (hope), 100 mg | |
| 01/01/2024 |
|
Injection, velmanase alfa-tycv, 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, artesunate, 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, aripiprazole, intramuscular, 0.25 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, aripiprazole (abilify asimtufii), 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, aztreonam, 100 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, cerliponase alfa, 1 mg
No maintenance for this code |
|
| 04/01/2024 |
|
Injection, buprenorphine extended-release (brixadi), 1 mg
Code Discontinued |
|
| 04/01/2024 |
|
Injection, buprenorphine extended-release (brixadi), less than or equal to 7 days of therapy | |
| 04/01/2024 |
|
Injection, buprenorphine extended release (brixadi), greater than 7 days and up to 28 days of therapy | |
| 04/01/2024 |
|
Injection, daxibotulinumtoxina-lanm, 1 unit | |
| 01/01/2024 |
|
Injection, lanadelumab-flyo, 1 mg (code may be used for medicare when drug administered under direct supervision of a physician, not for use when drug is self-administered)
No maintenance for this code |
|
| 04/01/2024 |
|
Injection, calcium gluconate, not otherwise specified, 10 mg
Change in long description of procedure or modifier code |
|
| 04/01/2024 |
|
Injection, calcium gluconate (wg critical care), not therapeutically equivalent to j0612, 10 mg
Change in long description of procedure or modifier code |
|
| 01/01/2024 |
|
Injection, caspofungin acetate, 5 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, levoleucovorin (khapzory), 0.5 mg
No maintenance for this code |
|
| 04/01/2024 |
|
Injection, levothyroxine sodium, not otherwise specified, 10 mcg | |
| 04/01/2024 |
|
Injection, levothyroxine sodium (fresenius kabi) not therapeutically equivalent to j0650, 10 mcg | |
| 04/01/2024 |
|
Injection, levothyroxine sodium (hikma) not therapeutically equivalent to j0650, 10 mcg | |
| 01/01/2024 |
|
Injection, bupivicaine, not otherwise specified, 0.5 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, cefazolin sodium (hikma), not therapeutically equivalent to j0690, 500 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, cefazolin sodium (baxter), not therapeutically equivalent to j0690, 500 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, lefamulin, 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, cefepime hydrochloride (baxter), not therapeutically equivalent to maxipime, 500 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, cefepime hydrochloride (b braun), not therapeutically equivalent to maxipime, 500 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, chorionic gonadotropin, per 1,000 usp units
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, clindamycin phosphate, 300 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, clindamycin phosphate (baxter), not therapeutically equivalent to j0736, 300 mg
No maintenance for this code |
|
| 01/02/2024 |
|
Injection, cabotegravir, 1mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)
No maintenance for this code |
|
| 01/02/2024 |
|
Emtricitabine 200mg and tenofovir disoproxil fumarate 300mg, oral, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment of hiv)
No maintenance for this code |
|
| 01/02/2024 |
|
Emtricitabine 200mg and tenofovir alafenamide 25mg, oral, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment of hiv)
No maintenance for this code |
|
| 01/02/2024 |
|
Fda approved prescription drug, only for use as hiv pre-exposure prophylaxis (not for use as treatment of hiv), not otherwise classified
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, daptomycin (xellia) not therapeutically equivalent to j0878, 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, daptomycin (hospira), not therapeutically equivalent to j0878, 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, daptomycin, 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, difelikefalin, 0.1 microgram, (for esrd on dialysis)
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, epoetin beta, 1 microgram, (for non esrd use)
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, decitabine (sun pharma) not therapeutically equivalent to j0894, 1 mg
No maintenance for this code |
|
| 04/01/2024 |
|
Injection, methylprednisolone acetate, 1 mg | |
| 04/01/2024 |
|
Injection, methylprednisolone acetate, 20 mg
Code Discontinued |
|
| 04/01/2024 |
|
Injection, methylprednisolone acetate, 40 mg
Code Discontinued |
|
| 04/01/2024 |
|
Injection, methylprednisolone acetate, 80 mg
Code Discontinued |
|
| 01/01/2024 |
|
Dexmedetomidine, oral, 1 mcg
No maintenance for this code |
|
| 04/01/2024 |
|
Miglustat, oral, 65 mg | |
| 04/01/2024 |
|
Injection, cipaglucosidase alfa-atga, 5 mg | |
| 01/01/2024 |
|
Injection, doripenem, 10 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, tofersen, 1 mg
No maintenance for this code |
|
| 04/01/2024 |
|
Injection, elranatamab-bcmm, 1 mg | |
| 01/01/2024 |
|
Injection, eptifibatide, 5 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, valoctocogene roxaparvovec-rvox, per ml, containing nominal 2 x 10^13 vector genomes
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, delandistrogene moxeparvovec-rokl, per therapeutic dose
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, eteplirsen, 10 mg
No maintenance for this code |
|
| 04/01/2024 |
|
Injection, fosaprepitant (focinvez), 1 mg | |
| 01/01/2024 |
|
Injection, fosaprepitant (teva), not therapeutically equivalent to j1453, 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, galsulfase, 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, glycopyrrolate, 0.1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, brexanolone, 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, heparin sodium (pfizer), not therapeutically equivalent to j1644, per 1000 units
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, meloxicam, 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, ibandronate sodium, 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, esmolol hydrochloride, 10 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, esmolol hydrochloride (wg critical care) not therapeutically equivalent to j1805, 10 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Insulin (fiasp) for administration through dme (i.e., insulin pump) per 50 units
No maintenance for this code |
|
| 01/01/2024 |
|
Insulin (lyumjev) for administration through dme (i.e., insulin pump) per 50 units
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, metronidazole, 10 mg
No maintenance for this code |
|
| 04/01/2024 |
|
Injection, kanamycin sulfate, up to 500 mg
Code Discontinued |
|
| 04/01/2024 |
|
Injection, kanamycin sulfate, up to 75 mg
Code Discontinued |
|
| 01/01/2024 |
|
Injection, labetalol hydrochloride, 5 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, labetalol hydrochloride (hikma) not therapeutically equivalent to j1920, 5 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, bumetanide, 0.5 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, linezolid (hospira) not therapeutically equivalent to j2020, 200 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Loxapine for inhalation, 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, meropenem (b. braun) not therapeutically equivalent to j2185, 100 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, methylnaltrexone, 0.1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, micafungin sodium (par pharm) not thereapeutically equivalent to j2248, 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, midazolam hydrochloride (wg critical care) not therapeutically equivalent to j2250, per 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, morphine sulfate (fresenius kabi) not therapeutically equivalent to j2270, up to 10 mg
No maintenance for this code |
|
| 04/01/2024 |
|
Injection, motixafortide, 0.25 mg | |
| 01/01/2024 |
|
Injection, moxifloxacin (fresenius kabi) not therapeutically equivalent to j2280, 100 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, nitroglycerin, 5 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, naloxone hydrochloride (zimhi), 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, nandrolone decanoate, up to 50 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, nesiritide, 0.1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, oprelvekin, 5 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, olanzapine, long-acting, 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, olanzapine, 0.5 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, phenylephrine hydrochloride (biorphen), 20 micrograms
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, chloroprocaine hydrochloride, per 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, nicardipine, 0.1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, palonosetron hcl, 25 mcg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, pegunigalsidase alfa-iwxj, 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, pentobarbital sodium, per 50 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, vasopressin, 1 unit
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, vasopressin (american regent) not therapeutically equivalent to j2598, 1 unit
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, fluphenazine hcl, 1.25 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, procainamide hcl, up to 1 gm
No maintenance for this code |
|
| 04/01/2024 |
|
Injection, avacincaptad pegol, 0.1 mg | |
| 01/01/2024 |
|
Injection, rolapitant, 0.5 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, risperidone (uzedy), 1 mg
No maintenance for this code |
|
| 04/01/2024 |
|
Injection, risperidone (rykindo), 0.5 mg | |
| 04/01/2024 |
|
Injection, methylprednisolone sodium succinate, 5 mg | |
| 04/01/2024 |
|
Injection, methylprednisolone sodium succinate, up to 40 mg
Code Discontinued |
|
| 04/01/2024 |
|
Injection, methylprednisolone sodium succinate, up to 125 mg
Code Discontinued |
|
| 04/01/2024 |
|
Injection, talquetamab-tgvs, 0.25 mg | |
| 01/01/2024 |
|
Injection, tigecycline (accord) not therapeutically equivalent to j3243, 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, tirofiban hcl, 0.25 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, triamcinolone acetonide, preservative free, 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, vancomycin hcl (mylan) not therapeutically equivalent to j3370, 500 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, vancomycin hcl (xellia) not therapeutically equivalent to j3370, 500 mg
No maintenance for this code |
|
| 04/01/2024 |
|
Injection, vedolizumab, intravenous, 1 mg
Change in long description of procedure or modifier code |
|
| 01/01/2024 |
|
Injection, vestronidase alfa-vjbk, 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, onasemnogene abeparvovec-xioi, per treatment, up to 5x10^15 vector genomes
No maintenance for this code |
|
| 01/01/2024 |
|
Beremagene geperpavec-svdt for topical administration, containing nominal 5 x 10^9 pfu/ml vector genomes, per 0.1 ml
No maintenance for this code |
|
| 04/01/2024 |
|
Injection, hydroxocobalamin, intravenous, 25 mg | |
| 04/01/2024 |
|
Injection, hydroxocobalamin, intramuscular, 10 mcg
Change in long description of procedure or modifier code |
|
| 04/01/2024 |
|
Injection, prothrombin complex concentrate, human-lans, per i.u. of factor ix activity | |
| 01/01/2024 |
|
Injection, factor xiii (antihemophilic factor, human), 1 i.u.
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, factor xiii a-subunit, (recombinant), per iu
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, antithrombin recombinant, 50 i.u.
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, ocriplasmin, 0.125 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose
No maintenance for this code |
|
| 01/01/2024 |
|
Hyaluronan or derivative, triluron, for intra-articular injection, 1 mg
No maintenance for this code |
|
| 04/01/2024 |
|
Cantharidin for topical administration, 0.7%, single unit dose applicator (3.2 mg) | |
| 04/01/2024 |
|
Injection, cyclosporine, 250 mg
Change in long description of procedure or modifier code |
|
| 01/01/2024 |
|
Busulfan; oral, 2 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Fludarabine phosphate, oral, 10 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Melphalan; oral, 2 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Topotecan, oral, 0.25 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Intravesical instillation, nadofaragene firadenovec-vncg, per therapeutic dose
Change in long description of procedure or modifier code |
|
| 01/01/2024 |
|
Bcg live intravesical instillation, 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, carmustine (accord), not therapeutically equivalent to j9050, 100 mg
No maintenance for this code |
|
| 04/01/2024 |
|
Cyclophosphamide, 100 mg
Code Discontinued |
|
| 04/01/2024 |
|
Injection, cyclophosphamide (auromedics), 5 mg
Change in both administrative data field and long description of procedure or modifier code |
|
| 04/01/2024 |
|
Injection, cyclophosphamide (dr. reddy's), 5 mg
Change in both administrative data field and long description of procedure or modifier code |
|
| 04/01/2024 |
|
Injection, cyclophosphamide (ingenus), 5 mg | |
| 04/01/2024 |
|
Injection, cyclophosphamide (sandoz), 5 mg | |
| 04/01/2024 |
|
Injection, cyclophosphamide, not otherwise specified, 5 mg | |
| 01/01/2024 |
|
Injection, cytarabine liposome, 10 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, daunorubicin citrate, liposomal formulation, 10 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, denileukin diftitox, 300 micrograms
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, docetaxel, 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, docetaxel (ingenus) not therapeutically equivalent to j9171, 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, gemcitabine hydrochloride (accord), not therapeutically equivalent to j9201, 200 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, floxuridine, 500 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, interferon, alfa-2a, recombinant, 3 million units
No maintenance for this code |
|
| 01/01/2024 |
|
Histrelin implant (supprelin la), 50 mg
No maintenance for this code |
|
| 04/01/2024 |
|
Injection, melphalan (hepzato), 1 mg | |
| 04/01/2024 |
|
Injection, melphalan (apotex), 1 mg | |
| 04/01/2024 |
|
Methotrexate sodium, 5 mg
Code Discontinued |
|
| 04/01/2024 |
|
Injection, methotrexate (accord), not therapeutically equivalent to j9260, 50 mg
Change in long description of procedure or modifier code |
|
| 01/01/2024 |
|
Injection, paclitaxel protein-bound particles (teva) not therapeutically equivalent to j9264, 1 mg
No maintenance for this code |
|
| 04/01/2024 |
|
Injection, methotrexate sodium, 50 mg
Change in long description of procedure or modifier code |
|
| 01/01/2024 |
|
Injection, glofitamab-gxbm, 2.5 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, epcoritamab-bysp, 0.16 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, pemetrexed (pemrydi rtu), 10 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, rozanolixizumab-noli, 1 mg
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, efgartigimod alfa, 2 mg and hyaluronidase-qvfc
No maintenance for this code |
|
| 04/01/2024 |
|
Injection, pozelimab-bbfg, 1 mg | |
K Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2024 |
|
Electronic positional obstructive sleep apnea treatment, with sensor, includes all components and accessories, any type
No maintenance for this code |
|
| 01/01/2024 |
|
Cranial electrotherapy stimulation (ces) system, any type
No maintenance for this code |
|
| 01/01/2024 |
|
Whirlpool tub, walk-in, portable
No maintenance for this code |
|
| 01/01/2024 |
|
Disposable collection and storage bag for breast milk, any size, any type, each
No maintenance for this code |
|
| 01/01/2024 |
|
Suction pump, home model, portable or stationary, electric, any type, for use with external urine management system
No maintenance for this code |
|
| 01/01/2024 |
|
Bilateral hip, knee, ankle, foot device, powered, includes pelvic component, single or double upright(s), knee joints any type, with or without ankle joints any type, includes all components and accessories, motors, microprocessors, sensors
No maintenance for this code |
|
| 01/01/2024 |
|
Speech volume modulation system, any type, including all components and accessories
No maintenance for this code |
|
| 01/01/2024 |
|
Enema tube, with or without adapter, any type, replacement only, each
No maintenance for this code |
|
| 01/01/2024 |
|
Addition, endoskeletal knee-shin system, 4 bar linkage or multiaxial, fluid swing and stance phase control
No maintenance for this code |
|
| 01/01/2024 |
|
Foot, adductus positioning device, adjustable
No maintenance for this code |
|
| 01/01/2024 |
|
Transcutaneous electrical nerve stimulator for electrical stimulation of the trigeminal nerve
No maintenance for this code |
|
| 01/01/2024 |
|
Monthly supplies for use of device coded at k1016
No maintenance for this code |
|
| 01/01/2024 |
|
External upper limb tremor stimulator of the peripheral nerves of the wrist
No maintenance for this code |
|
| 01/01/2024 |
|
Supplies and accessories for external upper limb tremor stimulator of the peripheral nerves of the wrist
No maintenance for this code |
|
| 01/01/2024 |
|
Non-invasive vagus nerve stimulator
No maintenance for this code |
|
| 01/01/2024 |
|
Exsufflation belt, includes all supplies and accessories
No maintenance for this code |
|
| 01/01/2024 |
|
Addition to lower extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type
No maintenance for this code |
|
| 01/01/2024 |
|
Distal transcutaneous electrical nerve stimulator, stimulates peripheral nerves of the upper arm
No maintenance for this code |
|
| 01/01/2024 |
|
Non-pneumatic compression controller with sequential calibrated gradient pressure
No maintenance for this code |
|
| 01/01/2024 |
|
Non-pneumatic sequential compression garment, full arm
No maintenance for this code |
|
| 01/01/2024 |
|
Mechanical allergen particle barrier/inhalation filter, cream, nasal, topical
No maintenance for this code |
|
| 01/01/2024 |
|
Power source and control electronics unit for oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, controlled by phone application
No maintenance for this code |
|
| 01/01/2024 |
|
Oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, used in conjunction with the power source and control electronics unit, controlled by phone application, 90-day supply
No maintenance for this code |
|
| 01/01/2024 |
|
Non-pneumatic compression controller without calibrated gradient pressure
No maintenance for this code |
|
| 01/01/2024 |
|
Non-pneumatic sequential compression garment, full leg
No maintenance for this code |
|
| 01/01/2024 |
|
Non-pneumatic sequential compression garment, half leg
No maintenance for this code |
|
| 04/01/2024 |
|
Docking station for use with oral device/appliance used to reduce upper airway collapsibility | |
L Codes↑ Top | |||
| Effective | Code | Description | |
| 04/01/2024 |
|
Thoracic, pectus carinatum orthosis, sternal compression, rigid circumferential frame with anterior and posterior rigid pads, custom fabricated | |
| 01/01/2024 |
|
Foot, adductus positioning device, adjustable
No maintenance for this code |
|
| 01/01/2024 |
|
Addition, endoskeletal knee-shin system, 4 bar linkage or multiaxial, fluid swing and stance phase control
No maintenance for this code |
|
| 04/01/2024 |
|
Addition to lower extremity, user adjustable, mechanical, residual limb volume management system | |
| 04/01/2024 |
|
Addition, endoskeletal knee-shin system, polycentric, pneumatic swing, and stance phase control | |
| 01/01/2024 |
|
Addition to lower extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type
No maintenance for this code |
|
| 01/01/2024 |
|
Powered upper extremity range of motion assist device, elbow, wrist, hand with single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated
No maintenance for this code |
|
| 01/01/2024 |
|
Powered upper extremity range of motion assist device, elbow, wrist, hand, finger, single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated
No maintenance for this code |
|
M Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2024 |
|
Value in primary care mips value pathway
No maintenance for this code |
|
| 01/01/2024 |
|
Administration of pneumococcal, influenza, hepatitis b, and/or covid-19 vaccine inside a patient's home; reported only once per individual home per date of service when such vaccine administration(s) are performed at the patient's home
No maintenance for this code |
|
| 01/01/2024 |
|
Patient received active chemotherapy any time during the measurement period
No maintenance for this code |
|
| 01/01/2024 |
|
Patient received bone marrow transplant any time during the measurement period
No maintenance for this code |
|
| 01/01/2024 |
|
Patient had history of immunocompromising conditions prior to or during the measurement period
No maintenance for this code |
|
| 01/01/2024 |
|
Patient received at least two doses of the herpes zoster recombinant vaccine (at least 28 days apart) anytime on or after the patient's 50th birthday before or during the measurement period
No maintenance for this code |
|
| 01/01/2024 |
|
Patient did not receive at least two doses of the herpes zoster recombinant vaccine (at least 28 days apart) anytime on or after the patient's 50th birthday before or during the measurement period
No maintenance for this code |
|
| 01/01/2024 |
|
Itch severity assessment score is reduced by 3 or more points from the initial (index) assessment score to the follow-up visit score
No maintenance for this code |
|
| 01/01/2024 |
|
Itch severity assessment score was not reduced by at least 3 points from initial (index) score to the follow-up visit score or assessment was not completed during the follow-up encounter
No maintenance for this code |
|
| 01/01/2024 |
|
Itch severity assessment score is reduced by 3 or more points from the initial (index) assessment score to the follow-up visit score
No maintenance for this code |
|
| 01/01/2024 |
|
Itch severity assessment score was not reduced by at least 3 points from initial (index) score to the follow-up visit score or assessment was not completed during the follow-up encounter
No maintenance for this code |
|
| 01/01/2024 |
|
Patient is screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety
No maintenance for this code |
|
| 01/01/2024 |
|
Patient is not screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety
No maintenance for this code |
|
| 01/01/2024 |
|
Most recent hemoglobin a1c level > 9.0%
No maintenance for this code |
|
| 01/01/2024 |
|
Hemoglobin a1c level is missing, or was not performed during the measurement period (12 months)
No maintenance for this code |
|
| 01/01/2024 |
|
No history of spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) and present spirometry is >= 70%
No maintenance for this code |
|
| 01/01/2024 |
|
Spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) documented and reviewed
No maintenance for this code |
|
| 01/01/2024 |
|
Documentation of medical reason(s) for not documenting and reviewing spirometry results (e.g., patients with dementia or tracheostomy)
No maintenance for this code |
|
| 01/01/2024 |
|
No spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) documented and/or no spirometry performed with results documented during the encounter
No maintenance for this code |
|
| 01/01/2024 |
|
Documentation of system reason(s) for not documenting and reviewing spirometry results (e.g., spirometry equipment not available at the time of the encounter)
No maintenance for this code |
|
| 01/01/2024 |
|
Patient has copd symptoms (e.g., dyspnea, cough/sputum, wheezing)
No maintenance for this code |
|
| 01/01/2024 |
|
Anaphylaxis due to the vaccine on or before the date of the encounter
No maintenance for this code |
|
| 01/01/2024 |
|
Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; with evidence of retinopathy
No maintenance for this code |
|
| 01/01/2024 |
|
Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; without evidence of retinopathy
No maintenance for this code |
|
| 01/01/2024 |
|
Glaucoma plan of care not documented, reason not otherwise specified
No maintenance for this code |
|
| 01/01/2024 |
|
Glaucoma plan of care documented
No maintenance for this code |
|
| 01/01/2024 |
|
Intraocular pressure (iop) reduced by a value less than 20% from the pre-intervention level
No maintenance for this code |
|
| 01/01/2024 |
|
Intraocular pressure (iop) reduced by a value of greater than or equal to 20% from the pre-intervention level
No maintenance for this code |
|
| 01/01/2024 |
|
Iop measurement not documented, reason not otherwise specified
No maintenance for this code |
|
| 01/01/2024 |
|
Evidence-based therapy was prescribed
No maintenance for this code |
|
| 01/01/2024 |
|
Patient, who has a reactive hcv antibody test, and has a follow up hcv viral test that detected hcv viremia, has hcv treatment initiated within 3 months of the reactive hcv antibody test
No maintenance for this code |
|
| 01/01/2024 |
|
Patient, who has a reactive hcv antibody test, and has a follow up hcv viral test that detected hcv viremia, is referred within 1 month of the reactive hcv antibody test to a clinician who treats hcv infection
No maintenance for this code |
|
| 01/01/2024 |
|
Patient has a reactive hcv antibody test and does not have a follow up hcv viral test, or patient has a reactive hcv antibody test and has a follow up hcv viral test that detects hcv viremia and is not referred to a clinician who treats hcv infection within 1 month and does not have hcv treatment initiated within 3 months of the reactive hcv antibody test, reason not given
No maintenance for this code |
|
| 01/01/2024 |
|
Patient receives hcv antibody test with nonreactive result
No maintenance for this code |
|
| 01/01/2024 |
|
Patient receives hcv antibody test with reactive result
No maintenance for this code |
|
| 01/01/2024 |
|
Patient does not receive hcv antibody test or patient does receive hcv antibody test but results not documented, reason not given
No maintenance for this code |
|
| 01/01/2024 |
|
Patient has a reactive hcv antibody test, and has a follow up hcv viral test that does not detect hcv viremia
No maintenance for this code |
|
| 01/01/2024 |
|
Documentation or patient report of hcv antibody test or hcv rna test which occurred prior to the performance period
No maintenance for this code |
|
| 01/01/2024 |
|
Baseline mrs > 2
No maintenance for this code |
|
| 01/01/2024 |
|
Patient reason for not screening for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety (e.g., patient declined or other patient reasons)
No maintenance for this code |
|
| 01/01/2024 |
|
Documentation that administration of second recombinant zoster vaccine could not occur during the performance period due to the recommended 2-6 month interval between doses (i.e, first dose received after october 31)
No maintenance for this code |
|
| 01/01/2024 |
|
Patient did not respond to the question of patient felt heard and understood by this provider and team
No maintenance for this code |
|
| 01/01/2024 |
|
Patient did not respond to the question of patient felt this provider and team put my best interests first when making recommendations about my care
No maintenance for this code |
|
| 01/01/2024 |
|
Patient did not respond to the question of patient felt this provider and team saw me as a person, not just someone with a medical problem
No maintenance for this code |
|
| 01/01/2024 |
|
Patient did not respond to the question of patient felt this provider and team understood what is important to me in my life
No maintenance for this code |
|
| 01/01/2024 |
|
Patient provided a response other than "completely true" for the question of patient felt heard and understood by this provider and team
No maintenance for this code |
|
| 01/01/2024 |
|
Patient provided a response other than "completely true" for the question of patient felt this provider and team put my best interests first when making recommendations about my care
No maintenance for this code |
|
| 01/01/2024 |
|
Patient provided a response other than "completely true" for the question of patient felt this provider and team saw me as a person, not just someone with a medical problem
No maintenance for this code |
|
| 01/01/2024 |
|
Patient provided a response other than "completely true" for the question of patient felt this provider and team understood what is important to me in my life
No maintenance for this code |
|
| 01/01/2024 |
|
Patient responded "completely true" for the question of patient felt this provider and team put my best interests first when making recommendations about my care
No maintenance for this code |
|
| 01/01/2024 |
|
Patient responded "completely true" for the question of patient felt this provider and team saw me as a person, not just someone with a medical problem
No maintenance for this code |
|
| 01/01/2024 |
|
Patient responded "completely true" for the question of patient felt this provider and team understood what is important to me in my life
No maintenance for this code |
|
| 01/01/2024 |
|
Patient responded as "completely true" for the question of patient felt heard and understood by this provider and team
No maintenance for this code |
|
| 01/01/2024 |
|
Patients for whom a proxy completed the entire hu survey on their behalf for any reason (no patient involvement)
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who did not complete at least one of the four patient experience hu survey items and return the hu survey within 60 days of the ambulatory palliative care visit
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who respond on the patient experience hu survey that they did not receive care by the listed ambulatory palliative care provider in the last 60 days (disavowal)
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who were deceased when the hu survey reached them
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who have another reason for visiting the clinic [not prenatal or postpartum care] and have a positive pregnancy test but have not established the clinic as an ob provider (e.g., plan to terminate the pregnancy or seek prenatal services elsewhere)
No maintenance for this code |
|
| 01/01/2024 |
|
Prior history of known cvd
No maintenance for this code |
|
| 01/01/2024 |
|
Cvd risk assessment not performed or incomplete (e.g., cvd risk assessment was not documented), reason not otherwise specified
No maintenance for this code |
|
| 01/01/2024 |
|
Cvd risk assessment performed, have a documented calculated risk score
No maintenance for this code |
|
| 01/01/2024 |
|
Patients listed on the kidney-pancreas transplant waitlist or who received a living donor transplant within the first year following initiation of dialysis
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who were not listed on the kidney-pancreas transplant waitlist or patients who did not receive a living donor transplant within the first year following initiation of dialysis
No maintenance for this code |
|
| 01/01/2024 |
|
Patients that were on the kidney or kidney-pancreas waitlist prior to initiation of dialysis
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who had a transplant prior to initiation of dialysis
No maintenance for this code |
|
| 01/01/2024 |
|
Patients in hospice on their initiation of dialysis date or during the month of evaluation
No maintenance for this code |
|
| 01/01/2024 |
|
Patients age 75 or older on their initiation of dialysis date
No maintenance for this code |
|
| 01/01/2024 |
|
Cms medical evidence form 2728 for dialysis patients: initial form completed
No maintenance for this code |
|
| 01/01/2024 |
|
Patients admitted to a skilled nursing facility (snf)
No maintenance for this code |
|
| 01/01/2024 |
|
Patients not on any kidney or kidney-pancreas transplant waitlist or is not in active status on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period
No maintenance for this code |
|
| 01/01/2024 |
|
Patients on active status on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period
No maintenance for this code |
|
| 01/01/2024 |
|
Receiving esrd mcp dialysis services by the provider on the last day of the reporting month
No maintenance for this code |
|
| 01/01/2024 |
|
Patients not on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period
No maintenance for this code |
|
| 01/01/2024 |
|
Patients with dementia at any time prior to or during the month
No maintenance for this code |
|
| 01/01/2024 |
|
Patients on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who were admitted to a skilled nursing facility (snf) within one year of dialysis initiation according to the cms-2728 form
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who were admitted to a skilled nursing facility (snf) during the month of evaluation were excluded from that month
No maintenance for this code |
|
| 01/01/2024 |
|
Patients determined to be in hospice were excluded from month of evaluation and the remainder of reporting period
No maintenance for this code |
|
| 01/01/2024 |
|
Bmi documented outside normal parameters, no follow-up plan documented, no reason given
No maintenance for this code |
|
| 01/01/2024 |
|
Colorectal cancer screening results documented and reviewed
No maintenance for this code |
|
| 01/01/2024 |
|
Elevated or hypertensive blood pressure reading documented, and the indicated follow-up is documented
No maintenance for this code |
|
| 01/01/2024 |
|
Elevated or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given
No maintenance for this code |
|
| 01/01/2024 |
|
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
No maintenance for this code |
|
| 01/01/2024 |
|
Blood pressure reading not documented, reason not given
No maintenance for this code |
|
| 01/01/2024 |
|
Patient screened for tobacco use and identified as a tobacco non-user
No maintenance for this code |
|
| 01/01/2024 |
|
Patient screened for tobacco use and identified as a tobacco user
No maintenance for this code |
|
| 01/01/2024 |
|
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
No maintenance for this code |
|
| 01/01/2024 |
|
Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results were not documented and reviewed, reason not otherwise specified
No maintenance for this code |
|
| 01/01/2024 |
|
Bmi is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reason
No maintenance for this code |
|
| 01/01/2024 |
|
Bmi is documented below normal parameters and a follow-up plan is documented
No maintenance for this code |
|
| 01/01/2024 |
|
Documented reason for not screening or recommending a follow-up for high blood pressure
No maintenance for this code |
|
| 01/01/2024 |
|
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 maintenance for this code |
|
| 01/01/2024 |
|
Patient not eligible due to active diagnosis of hypertension
No maintenance for this code |
|
| 01/01/2024 |
|
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
No maintenance for this code |
|
| 01/01/2024 |
|
Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period
No maintenance for this code |
|
| 01/01/2024 |
|
Bmi is documented above normal parameters and a follow-up plan is documented
No maintenance for this code |
|
| 01/01/2024 |
|
Normal blood pressure reading documented, follow-up not required
No maintenance for this code |
|
| 01/01/2024 |
|
Patients with a diagnosis or past history of total colectomy or colorectal cancer
No maintenance for this code |
|
| 01/01/2024 |
|
Bmi is documented within normal parameters and no follow-up plan is required
No maintenance for this code |
|
| 01/01/2024 |
|
Bmi not documented due to medical reason or patient refusal of height or weight measurement
No maintenance for this code |
|
| 01/01/2024 |
|
Documentation of patient pregnancy anytime during the measurement period prior to and including the current encounter
No maintenance for this code |
|
| 01/01/2024 |
|
Influenza immunization administered or previously received
No maintenance for this code |
|
| 01/01/2024 |
|
Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons)
No maintenance for this code |
|
| 01/01/2024 |
|
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)
No maintenance for this code |
|
| 01/01/2024 |
|
Screening, diagnostic, film digital or digital breast tomosynthesis (3d) mammography results documented and reviewed
No maintenance for this code |
|
| 01/01/2024 |
|
Hospice services provided to patient any time during the measurement period
No maintenance for this code |
|
| 01/01/2024 |
|
Patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period
No maintenance for this code |
|
| 01/01/2024 |
|
Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period
No maintenance for this code |
|
| 01/01/2024 |
|
Patient had anaphylaxis due to the pneumococcal vaccine any time during or before the measurement period
No maintenance for this code |
|
| 01/01/2024 |
|
Documentation stating the patient has received or is currently receiving palliative or hospice care
No maintenance for this code |
|
| 01/01/2024 |
|
Influenza immunization was not administered, reason not given
No maintenance for this code |
|
| 01/01/2024 |
|
Palliative care services provided to patient any time during the measurement period
No maintenance for this code |
|
| 01/01/2024 |
|
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
No maintenance for this code |
|
| 01/01/2024 |
|
Anaphylaxis due to the vaccine on or before the date of the encounter
No maintenance for this code |
|
| 01/01/2024 |
|
Patient not screened for tobacco use
No maintenance for this code |
|
| 01/01/2024 |
|
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 maintenance for this code |
|
| 01/01/2024 |
|
Bmi not documented and no reason is given
No maintenance for this code |
|
| 01/01/2024 |
|
Colorectal cancer screening results were not documented and reviewed; reason not otherwise specified
No maintenance for this code |
|
| 01/01/2024 |
|
Current tobacco non-user
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who are counseled on connection with a csp and explicitly opt out
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who did not have documented contact with a csp for at least one of their screened positive hrsns within 60 days after screening or documentation that there was no contact with a csp
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who had documented contact with a csp for at least one of their screened positive hrsns within 60 days after screening
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who screened positive for at least 1 of the 5 hrsns
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who were not seen within 7 weeks following the date of injection for follow up or who did not have a documented iop or no plan of care documented if the iop was >25 mm hg
No maintenance for this code |
|
| 01/01/2024 |
|
Patients seen within 7 weeks following the date of injection and are screened for elevated intraocular pressure (iop) with tonometry with documented iop =<25 mm hg for injected eye
No maintenance for this code |
|
| 01/01/2024 |
|
Patients seen within 7 weeks following the date of injection and are screened for elevated intraocular pressure (iop) with tonometry with documented iop >25 mm hg and a plan of care was documented
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who had an intravitreal or periocular corticosteroid injection (e.g., triamcinolone, preservative-free triamcinolone, dexamethasone, dexamethasone intravitreal implant, or fluocinolone intravitreal implant)
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who were not seen for reasons documented by clinician for patient or medical reasons (e.g., inadequate time for follow-up, patients who received a prior intravitreal or periocular steroid injection within the last six (6) months and had a subsequent iop evaluation with iop <25mm hg within seven (7) weeks of treatment)
No maintenance for this code |
|
| 01/01/2024 |
|
Patients with a diagnosis of hypotony
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who were not appropriately evaluated during the initial exam and/or who were not re-evaluated within 8 weeks
No maintenance for this code |
|
| 01/01/2024 |
|
Patients with a diagnosis of acute vitreous hemorrhage
No maintenance for this code |
|
| 01/01/2024 |
|
Patients with a post-operative encounter of the eye with the acute pvd within 2 weeks before the initial encounter or 8 weeks after initial acute pvd encounter
No maintenance for this code |
|
| 01/01/2024 |
|
Documentation of patient reason(s) for not having a follow up exam (e.g., inadequate time for follow up)
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who were appropriately evaluated during the initial exam and were re-evaluated no later than 8 weeks from initial exam
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who were not appropriately evaluated during the initial exam and/or who were not re-evaluated within 2 weeks
No maintenance for this code |
|
| 01/01/2024 |
|
Acute vitreous hemorrhage
No maintenance for this code |
|
| 01/01/2024 |
|
Patients with a post-operative encounter of the eye with the acute pvd within 2 weeks before the initial encounter or 2 weeks after initial acute pvd encounter
No maintenance for this code |
|
| 01/01/2024 |
|
Documentation of patient reason(s) for not having a follow up exam (e.g., inadequate time for follow up)
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who were appropriately evaluated during the initial exam and were re-evaluated no later than 2 weeks
No maintenance for this code |
|
| 01/01/2024 |
|
Acute pvd
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who had follow-up assessment 30 to 180 days after the index assessment who did not demonstrate positive improvement or maintenance of functioning scores during the performance period
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who had follow-up assessment 30 to 180 days after the index assessment who demonstrated positive improvement or maintenance of functioning scores during the performance period
No maintenance for this code |
|
| 01/01/2024 |
|
Index assessment completed using the 12-item whodas 2.0 or sds during the denominator identification period
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who did not have a follow-up assessment or did not have an assessment within 30 to 180 days after the index assessment during the performance period
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who died during the performance period
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who are at pam level 4 at baseline or patients who are flagged with extreme straight line response sets on the pam
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who did not have a baseline pam score and/or a second score within 6 to 12 month of baseline pam score
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who had a baseline pam score and a second score within 6 to 12 month of baseline pam score
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who did not have a net increase in pam score of at least 6 points within a 6 to 12 month period
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who achieved a net increase in pam score of at least 3 points in a 6 to 12 month period (passing)
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who achieved a net increase in pam score of at least 6-points in a 6 to 12 month period (excellent)
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who did not have a net increase in pam score of at least 3 points within 6 to 12 month period
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who had a completed suicide safety plan initiated, reviewed or updated in collaboration with their clinician (concurrent or within 24 hours) of the index clinical encounter
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who had a suicide safety plan initiated, reviewed, or updated and reviewed and updated in collaboration with the patient and their clinician concurrent or within 24 hours of clinical encounter and within 120 days after initiation
No maintenance for this code |
|
| 01/01/2024 |
|
Suicidal ideation and/or behavior symptoms based on the c-ssrs or equivalent assessment
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who did not have a completed suicide safety plan initiated, reviewed or updated in collaboration with their clinician (concurrent or within 24 hours) of the index clinical encounter
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who did not have a suicide safety plan initiated, reviewed, or updated or reviewed and updated in collaboration with the patient and their clinician concurrent or within 24 hours of clinical encounter and within 120 days after initiation
No maintenance for this code |
|
| 01/01/2024 |
|
Suicide risk based on their clinician's evaluation or a clinician-rated tool
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who died during the measurement period
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who had a reduction in suicidal ideation and/or behavior upon follow-up assessment within 120 days of index assessment
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who did not have a reduction in suicidal ideation and/or behavior upon follow-up assessment within 120 days of index assessment
No maintenance for this code |
|
| 01/01/2024 |
|
Index assessment during the denominator period when the suicidal ideation and/or behavior symptoms or increased suicide risk by clinician determination occurs and a non-zero c-ssrs score is obtained
No maintenance for this code |
|
| 01/01/2024 |
|
Suicidal ideation and/or behavior symptoms based on the c-ssrs
No maintenance for this code |
|
| 01/01/2024 |
|
Suicide risk based on their clinician's evaluation or a clinician-rated tool
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who died during the measurement period
No maintenance for this code |
|
| 01/01/2024 |
|
Patients who did not have a follow-up assessment within 120 days of the index assessment
No maintenance for this code |
|
| 01/01/2024 |
|
Calculated 10-year ascvd risk score of >= 20 percent during the performance period
No maintenance for this code |
|
| 01/01/2024 |
|
Patient encounter during the performance period with hospice and palliative care specialty code 17
No maintenance for this code |
|
| 01/01/2024 |
|
Focusing on women's health mips value pathway
No maintenance for this code |
|
| 01/01/2024 |
|
Quality care for the treatment of ear, nose, and throat disorders mips value pathway
No maintenance for this code |
|
| 01/01/2024 |
|
Prevention and treatment of infectious disorders including hepatitis c and hiv mips value pathway
No maintenance for this code |
|
| 01/01/2024 |
|
Quality care in mental health and substance use disorders mips value pathway
No maintenance for this code |
|
| 01/01/2024 |
|
Rehabilitative support for musculoskeletal care mips value pathway
No maintenance for this code |
|
Q Codes↑ Top | |||
| Effective | Code | Description | |
| 01/02/2024 |
|
Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription drug, per 30-days
No maintenance for this code |
|
| 01/02/2024 |
|
Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription drug, per 60-days
No maintenance for this code |
|
| 01/02/2024 |
|
Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription drug, per 90-days
No maintenance for this code |
|
| 01/01/2024 |
|
Irrigation solution for treatment of bladder calculi, for example renacidin, per 500 ml
No maintenance for this code |
|
| 01/01/2024 |
|
Puraply, per square centimeter
No maintenance for this code |
|
| 01/01/2024 |
|
Puraply am, per square centimeter
No maintenance for this code |
|
| 01/01/2024 |
|
Amniobind or dermabind tl, per square centimeter
No maintenance for this code |
|
| 04/01/2024 |
|
Procenta, per 200 mg
Code Discontinued |
|
| 01/01/2024 |
|
Vendaje ac, per square centimeter
No maintenance for this code |
|
| 01/01/2024 |
|
Dermabind dl, per square centimeter
No maintenance for this code |
|
| 01/01/2024 |
|
Dermabind ch, per square centimeter
No maintenance for this code |
|
| 01/01/2024 |
|
Revoshield + amniotic barrier, per square centimeter
No maintenance for this code |
|
| 01/01/2024 |
|
Membrane wrap-hydro, per square centimeter
No maintenance for this code |
|
| 01/01/2024 |
|
Lamellas xt, per square centimeter
No maintenance for this code |
|
| 01/01/2024 |
|
Lamellas, per square centimeter
No maintenance for this code |
|
| 01/01/2024 |
|
Acesso dl, per square centimeter
No maintenance for this code |
|
| 01/01/2024 |
|
Amnio quad-core, per square centimeter
No maintenance for this code |
|
| 01/01/2024 |
|
Amnio tri-core amniotic, per square centimeter
No maintenance for this code |
|
| 01/01/2024 |
|
Rebound matrix, per square centimeter
No maintenance for this code |
|
| 01/01/2024 |
|
Emerge matrix, per square centimeter
No maintenance for this code |
|
| 01/01/2024 |
|
Amnicore pro, per square centimeter
No maintenance for this code |
|
| 01/01/2024 |
|
Amnicore pro+, per square centimeter
No maintenance for this code |
|
| 01/01/2024 |
|
Acesso tl, per square centimeter
No maintenance for this code |
|
| 01/01/2024 |
|
Activate matrix, per square centimeter
No maintenance for this code |
|
| 01/01/2024 |
|
Complete aca, per square centimeter
No maintenance for this code |
|
| 01/01/2024 |
|
Complete aa, per square centimeter
No maintenance for this code |
|
| 01/01/2024 |
|
Grafix plus, per square centimeter
No maintenance for this code |
|
| 04/01/2024 |
|
American amnion ac tri-layer, per square centimeter | |
| 04/01/2024 |
|
American amnion ac, per square centimeter | |
| 04/01/2024 |
|
American amnion, per square centimeter | |
| 04/01/2024 |
|
Sanopellis, per square centimeter | |
| 04/01/2024 |
|
Via matrix, per square centimeter | |
| 04/01/2024 |
|
Procenta, per 100 mg | |
| 01/01/2024 |
|
Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram
No maintenance for this code |
|
| 01/01/2024 |
|
Injection, adalimumab-afzb (abrilada), biosimilar, 10 mg
No maintenance for this code |
|
| 04/01/2024 |
|
Injection, tocilizumab-bavi (tofidence), biosimilar, 1 mg | |
| 04/01/2024 |
|
Injection, natalizumab-sztn (tyruko), biosimilar, 1 mg | |
| 01/01/2024 |
|
Injection, sulfur hexafluoride lipid microspheres, per ml
No maintenance for this code |
|
S Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2024 |
|
Injection, bumetanide, 0.5 mg
No maintenance for this code |
|
| 04/01/2024 |
|
Penile contracture device, manual, greater than 3 lbs traction force | |
| 04/01/2024 |
|
Intra-vaginal motion sensor system, provides biofeedback for pelvic floor muscle rehabilitation device | |
T Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2024 |
|
Intensive, extended multidisciplinary services provided in a clinic setting to children with complex medical, physical, mental and psychosocial impairments, per hour
No maintenance for this code |
|
Legend: