List of new codes and changes to the 2022 HCPCS code set along with their effective date. Includes discontinued codes that are no longer used.
Legend:
A Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2022 |
|
Innovamatrix ac, per square centimeter | |
| 01/01/2022 |
|
Mirragen advanced wound matrix, per square centimeter | |
| 01/01/2022 |
|
Xcellistem, per square centimeter | |
| 01/01/2022 |
|
Microlyte matrix, per square centimeter | |
| 01/01/2022 |
|
Novosorb synpath dermal matrix, per square centimeter | |
| 01/01/2022 |
|
Restrata, per square centimeter | |
| 01/01/2022 |
|
Theragenesis, per square centimeter | |
| 01/01/2022 |
|
Symphony, per square centimeter | |
| 01/01/2022 |
|
Apis, per square centimeter | |
| 01/01/2022 |
|
Irrigation supply; sleeve, each
Code Discontinued |
|
| 01/01/2022 |
|
Irrigation supply; sleeve, reusable, per month | |
| 01/01/2022 |
|
Irrigation supply; sleeve, disposable, per month | |
| 01/01/2022 |
|
Piflufolastat f-18, diagnostic, 1 millicurie | |
C Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2022 |
|
Autograft suspension, including cell processing and application, and all system components | |
| 01/01/2022 |
|
Monitor, cardiac, including intracardiac lead and all system components (implantable) | |
| 01/01/2022 |
|
Idecabtagene vicleucel, up to 460 million autologous anti-bcma car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
Code Discontinued |
|
| 01/01/2022 |
|
Injection, dostarlimab-gxly, 100 mg
Code Discontinued |
|
| 01/01/2022 |
|
Injection, amivantamab-vmjw, 10 mg
Code Discontinued |
|
| 01/01/2022 |
|
Injection, avalglucosidase alfa-ngpt, 4 mg | |
| 01/01/2022 |
|
Injection, anifrolumab-fnia, 1 mg | |
| 01/01/2022 |
|
Injection, cyclophosphamide, (auromedics), 10 mg | |
| 01/01/2022 |
|
Instillation, bupivacaine and meloxicam, 1 mg/0.03 mg | |
| 01/01/2022 |
|
Bupivacaine, collagen-matrix implant, 1 mg | |
| 01/01/2022 |
|
Injection, clevidipine butyrate, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2022 |
|
Injection, delafloxacin, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2022 |
|
Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum
Code Discontinued |
|
| 01/01/2022 |
|
Destruction of intraosseous basivertebral nerve, each additional vertebral body, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum (list separately in addition to code for primary procedure)
Code Discontinued |
|
| 01/01/2022 |
|
Esophageal mucosal integrity testing by electrical impedance, transoral, includes esophagoscopy or esophagogastroduodenoscopy
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Endoscopic submucosal dissection (esd), including endoscopy or colonoscopy, mucosal closure, when performed
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2022 |
|
Insertion of central venous catheter through central venous occlusion via inferior and superior approaches (e.g., inside-out technique), including imaging guidance
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
E Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2022 |
|
Tablo hemodialysis system for the billable dialysis service | |
G Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2022 |
|
Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason) | |
| 01/01/2022 |
|
Tobacco screening not performed or tobacco cessation intervention not provided on the date of the encounter or within the previous 12 months, reason not otherwise specified | |
| 01/01/2022 |
|
Patient screened for tobacco use and received tobacco cessation intervention on the date of the encounter or within the previous 12 months (counseling, pharmacotherapy, or both), if identified as a tobacco user | |
| 01/01/2022 |
|
Palliative care services given to patient any time during the measurement period | |
| 01/01/2022 |
|
Two or more antipsychotic prescriptions ordered for patients who had a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between january 1 of the year prior to the measurement period and the index prescription start date (ipsd) for antipsychotics | |
| 01/01/2022 |
|
Two or more benzodiazepine prescriptions ordered for patients who had a diagnosis of seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, or severe generalized anxiety disorder on or between january 1 of the year prior to the measurement period and the ipsd for benzodiazepines | |
| 01/01/2022 |
|
Patients receiving palliative care during the measurement period | |
| 01/01/2022 |
|
Patient has any emergency department encounter during the performance period with place of service indicator 23 | |
| 01/01/2022 |
|
Patient or care partner decline assessment | |
| 01/01/2022 |
|
On date of encounter, patient is not able to participate in assessment or screening, including non-verbal patients, delirious, severely aphasic, severely developmentally delayed, severe visual or hearing impairment and for those patients, no knowledgeable informant available | |
| 01/01/2022 |
|
Clinician determines patient does not require referral | |
| 01/01/2022 |
|
Patient not referred, reason not otherwise specified | |
| 01/01/2022 |
|
Patient already receiving physical/occupational/speech/recreational therapy during the measurement period | |
| 01/01/2022 |
|
Patient and/or care partner decline referral | |
| 01/01/2022 |
|
Referral to physical, occupational, speech, or recreational therapy | |
| 01/01/2022 |
|
Patients with mechanical prosthetic heart valve | |
| 01/01/2022 |
|
Patients with moderate or severe mitral stenosis | |
| 01/01/2022 |
|
Clinical follow-up and mrs score assessed at 90 days following endovascular stroke intervention | |
| 01/01/2022 |
|
Clinical follow-up and mrs score not assessed at 90 days following endovascular stroke intervention | |
| 01/01/2022 |
|
Pediatric patient with minor blunt head trauma and pecarn prediction criteria are not assessed | |
| 01/01/2022 |
|
Patients who receive palliative care services any time during the intake period through the end of the measurement year | |
| 01/01/2022 |
|
With maintenance hemodialysis (in-center and home hd) for the complete reporting month | |
| 01/01/2022 |
|
Patients with a catheter that have limited life expectancy | |
| 01/01/2022 |
|
Patients under hospice care in the current reporting month | |
| 01/01/2022 |
|
Patients on peritoneal dialysis for any portion of the reporting month | |
| 01/01/2022 |
|
Advancing rheumatology patient care mips value pathways | |
| 01/01/2022 |
|
Coordinating stroke care to promote prevention and cultivate positive outcomes mips value pathways | |
| 01/01/2022 |
|
Advancing care for heart disease mips value pathways | |
| 01/01/2022 |
|
Optimizing chronic disease management mips value pathways | |
| 01/01/2022 |
|
Proposed adopting best practices and promoting patient safety within emergency medicine mips value pathways | |
| 01/01/2022 |
|
Improving care for lower extremity joint repair mips value pathways | |
| 01/01/2022 |
|
Patient safety and support of positive experiences with anesthesia mips value pathways | |
| 01/01/2022 |
|
Allergy/immunology mips specialty set | |
| 01/01/2022 |
|
Anesthesiology mips specialty set | |
| 01/01/2022 |
|
Audiology mips specialty set | |
| 01/01/2022 |
|
Cardiology mips specialty set | |
| 01/01/2022 |
|
Certified nurse midwife mips specialty set | |
| 01/01/2022 |
|
Chiropractic medicine mips specialty set | |
| 01/01/2022 |
|
Clinical social work mips specialty set | |
| 01/01/2022 |
|
Dentistry mips specialty set | |
| 01/01/2022 |
|
Pulmonary rehabilitation, including exercise (includes monitoring), one hour, per session, up to two sessions per day
Code Discontinued |
|
| 01/01/2022 |
|
Clinical decision support mechanism evidencecare imagingcare, as defined by the medicare appropriate use criteria program
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Clinical decision support mechanism radrite, as defined by the medicare appropriate use criteria program | |
| 01/01/2022 |
|
Patient-months where there are more than one medicare capitated payment (mcp) provider listed for the month | |
| 01/01/2022 |
|
The number of adult patient-months in the denominator who were on maintenance hemodialysis using a catheter continuously for three months or longer under the care of the same practitioner or group partner as of the last hemodialysis session of the reporting month | |
| 01/01/2022 |
|
The number of adult patient-months in the denominator who were on maintenance hemodialysis under the care of the same practitioner or group partner as of the last hemodialysis session of the reporting month using a catheter continuously for less than three months | |
| 01/01/2022 |
|
Take-home supply of nasal naloxone; 2-pack of 8mg per 0.1 ml nasal spray (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure | |
| 01/01/2022 |
|
Comprehensive care management services for a single high-risk disease, e.g., principal care management, at least 30 minutes of physician or other qualified health care professional time per calendar month with the following elements: one complex chronic condition lasting at least 3 months, which is the focus of the care plan, the condition is of sufficient severity to place patient at risk of hospitalization or have been the cause of a recent hospitalization, the condition requires development or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities
Code Discontinued |
|
| 01/01/2022 |
|
Comprehensive care management for a single high-risk disease services, e.g. principal care management, at least 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month with the following elements: one complex chronic condition lasting at least 3 months, which is the focus of the care plan, the condition is of sufficient severity to place patient at risk of hospitalization or have been cause of a recent hospitalization, the condition requires development or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities
Code Discontinued |
|
| 01/01/2022 |
|
Patients age 66 and older in institutional special needs plans (snp) or residing in long-term care with a pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Episodes where the patient had a competing diagnosis on or within three days after the episode date (e.g., intestinal infection, pertussis, bacterial infection, lyme disease, otitis media, acute sinusitis, chronic sinusitis, infection of the adenoids, prostatitis, cellulitis, mastoiditis, or bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia/gonococcal infections, venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis or uti)
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
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
Change in short description of procedure code |
|
| 01/01/2022 |
|
Depression, anxiety, apathy, and psychosis assessed
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Depression, anxiety, apathy, and psychosis not assessed
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Functional status measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively was less than or equal to 22 or functional status measured by the odi version 2.1a within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of 30 points or greater
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Functional status measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively was greater than 22 and functional status measured by the odi version 2.1a within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of less than 30 points
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Functional status measured by the oswestry disability index (odi version 2.1a) at three months (6 ? 20 weeks) postoperatively was less than or equal to 22 or functional status measured by the odi version 2.1a within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated an improvement of 30 points or greater
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Functional status measured by the oswestry disability index (odi version 2.1a) at three months (6 - 20 weeks) postoperatively was greater than 22 and functional status measured by the odi version 2.1a within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated an improvement of less than 30 points
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Multimodal pain management was used
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Multimodal pain management was not used
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Uri episodes where the patient had a comorbid condition during the 12 months prior to or on the episode date (e.g., tuberculosis, neutropenia, cystic fibrosis, chronic bronchitis, pulmonary edema, respiratory failure, rheumatoid lung disease)
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Uri episodes when the patient had an active prescription of antibiotics (table 1) in the 30 days prior to the episode date
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Episodes where the patient had a comorbid condition during the 12 months prior to or on the episode date (e.g., tuberculosis, neutropenia, cystic fibrosis, chronic bronchitis, pulmonary edema, respiratory failure, rheumatoid lung disease)
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Acute bronchitis/bronchiolitis episodes when the patient had a new or refill prescription of antibiotics (table 1) in the 30 days prior to the episode date
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Reason for not administering adjuvant treatment course including both chemotherapy and her2-targeted therapy (e.g. poor performance status (ecog 3-4; karnofsky =50), cardiac contraindications, insufficient renal function, insufficient hepatic function, other active or secondary cancer diagnoses, other medical contraindications, patients who died during initial treatment course or transferred during or after initial treatment course)
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Take-home supply of nasal naloxone; 2-pack of 4mg per 0.1 ml nasal spray (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Dermatology mips specialty set | |
| 01/01/2022 |
|
Diagnostic radiology mips specialty set | |
| 01/01/2022 |
|
Electrophysiology cardiac specialist mips specialty set | |
| 01/01/2022 |
|
Emergency medicine mips specialty set | |
| 01/01/2022 |
|
Endocrinology mips specialty set | |
| 01/01/2022 |
|
Family medicine mips specialty set | |
| 01/01/2022 |
|
Gastro-enterology mips specialty set | |
| 01/01/2022 |
|
General surgery mips specialty set | |
| 01/01/2022 |
|
Geriatrics mips specialty set | |
| 01/01/2022 |
|
Hospitalists mips specialty set | |
| 01/01/2022 |
|
Infectious disease mips specialty set | |
| 01/01/2022 |
|
Internal medicine mips specialty set | |
| 01/01/2022 |
|
Interventional radiology mips specialty set | |
| 01/01/2022 |
|
Mental/behavioral health mips specialty set | |
| 01/01/2022 |
|
Nephrology mips specialty set | |
| 01/01/2022 |
|
Neurology mips specialty set | |
| 01/01/2022 |
|
Neurosurgical mips specialty set | |
| 01/01/2022 |
|
Nutrition/dietician mips specialty set | |
| 01/01/2022 |
|
Obstetrics/gynecology mips specialty set | |
| 01/01/2022 |
|
Oncology/hematology mips specialty set | |
| 01/01/2022 |
|
Ophthalmology mips specialty set | |
| 01/01/2022 |
|
Orthopedic surgery mips specialty set | |
| 01/01/2022 |
|
Otolaryngology mips specialty set | |
| 01/01/2022 |
|
Pathology mips specialty set | |
| 01/01/2022 |
|
Pediatrics mips specialty set | |
| 01/01/2022 |
|
Physical medicine mips specialty set | |
| 01/01/2022 |
|
Physical therapy/occupational therapy mips specialty set | |
| 01/01/2022 |
|
Plastic surgery mips specialty set | |
| 01/01/2022 |
|
Podiatry mips specialty set | |
| 01/01/2022 |
|
Preventive medicine mips specialty set | |
| 01/01/2022 |
|
Pulmonology mips specialty set | |
| 01/01/2022 |
|
Radiation oncology mips specialty set | |
| 01/01/2022 |
|
Rheumatology mips specialty set | |
| 01/01/2022 |
|
Skilled nursing facility mips specialty set | |
| 01/01/2022 |
|
Speech language pathology mips specialty set | |
| 01/01/2022 |
|
Thoracic surgery mips specialty set | |
| 01/01/2022 |
|
Urgent care mips specialty set | |
| 01/01/2022 |
|
Urology mips specialty set | |
| 01/01/2022 |
|
Vascular surgery mips specialty set | |
| 01/01/2022 |
|
Bmi not documented, documentation the patient is not eligible for bmi calculation
Code Discontinued |
|
| 01/01/2022 |
|
Screening for depression not completed, documented patient or medical reason
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Prescribed or dispensed antibiotic on or within 3 days after the episode date
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Spirometry test results demonstrate fev1 >= 60% fev1/fvc >= 70%, predicted or patient does not have copd symptoms
Code Discontinued |
|
| 01/01/2022 |
|
Spirometry test not performed or documented, reason not given
Code Discontinued |
|
| 01/01/2022 |
|
Bmi is documented as being outside of normal parameters, follow-up plan is not documented, documentation the patient is not eligible
Code Discontinued |
|
| 01/01/2022 |
|
Elevated or hypertensive blood pressure reading documented, and the indicated follow-up is documented
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Elevated or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Fda approved oral anticoagulant is prescribed
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Documentation of medical reason(s) for not prescribing an fda-approved anticoagulant to a patient with a cha2ds2-vasc score of 0 or 1 for men; or 0, 1, or 2 for women (e.g., present or planned atrial appendage occlusion or ligation)
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Documentation of patient reason(s) for not prescribing an oral anticoagulant that is fda approved for the prevention of thromboembolism (e.g., patient preference for not receiving anticoagulation)
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Documentation of patient with one or more complications or mortality within 30 days
Code Discontinued |
|
| 01/01/2022 |
|
Documentation of patient with one or more complications within 90 days
Code Discontinued |
|
| 01/01/2022 |
|
Documentation of patient without one or more complications and without mortality within 30 days
Code Discontinued |
|
| 01/01/2022 |
|
Documentation of patient without one or more complications within 90 days
Code Discontinued |
|
| 01/01/2022 |
|
Ct scan of the paranasal sinuses ordered at the time of diagnosis for documented reasons
Code Discontinued |
|
| 01/01/2022 |
|
Ct scan of the paranasal sinuses ordered at the time of diagnosis or received within 28 days after date of diagnosis
Code Discontinued |
|
| 01/01/2022 |
|
Ct scan of the paranasal sinuses not ordered at the time of diagnosis or received within 28 days after date of diagnosis
Code Discontinued |
|
| 01/01/2022 |
|
Elective delivery (without medical indication) by cesarean birth or induction of labor not performed (<39 weeks of gestation)
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Elective delivery (without medical indication) by cesarean birth or induction of labor performed (<39 weeks of gestation)
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Documentation of negative or managed positive tb screen with further evidence that tb is not active prior to treatment with a biologic immune response modifier
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Medical indication for delivery by cesarean birth or induction of labor (<39 weeks of gestation) [documentation of reason(s) for elective delivery (e.g., hemorrhage and placental complications, hypertension, preeclampsia and eclampsia, rupture of membranes (premature or prolonged), maternal conditions complicating pregnancy/delivery, fetal conditions complicating pregnancy/delivery, late pregnancy, prior uterine surgery, or participation in clinical trial)]
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
At least two orders for high-risk medications from the same drug class
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
At least two orders for high-risk medications from the same drug class not ordered
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Documentation in the patient record of a discussion between the physician/clinician and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward the outcome of the treatment
Code Discontinued |
|
| 01/01/2022 |
|
Documentation of medical or patient reason(s) for not discussing treatment options; medical reasons: patient is not a candidate for treatment due to advanced physical or mental health comorbidity (including active substance use); currently receiving antiviral treatment; successful antiviral treatment (with sustained virologic response) prior to reporting period; other documented medical reasons; patient reasons: patient unable or unwilling to participate in the discussion or other patient reasons
Code Discontinued |
|
| 01/01/2022 |
|
No documentation in the patient record of a discussion between the physician or other qualified healthcare professional and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward treatment
Code Discontinued |
|
| 01/01/2022 |
|
Primary non-small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type following iaslc guidance or classified as nsclc-nos with an explanation
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Documentation of medical reason(s) for not including the histological type or nsclc-nos classification with an explanation (e.g. specimen insufficient or non-diagnostic, specimen does not contain cancer, or other documented medical reasons)
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Primary non-small cell lung cancer lung biopsy and cytology specimen report does not document classification into specific histologic type or histologic type does not follow iaslc guidance or is classified as nsclc-nos but without an explanation
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Primary lung carcinoma resection report documents pt category, pn category and for non-small cell lung cancer, histologic type (e.g., squamous cell carcinoma, adenocarcinoma and not nsclc-nos)
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Primary lung carcinoma resection report does not document pt category, pn category and for non-small cell lung cancer, histologic type (e.g., squamous cell carcinoma, adenocarcinoma)
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Pathology report includes the pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Documentation of medical reason(s) for not including pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors (e.g., negative skin biopsies, insufficient tissue, or other documented medical reasons)
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Pathology report does not include the pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Patients who were born in the years 1945 to 1965
Code Discontinued |
|
| 01/01/2022 |
|
History of receiving blood transfusions prior to 1992
Code Discontinued |
|
| 01/01/2022 |
|
History of injection drug use
Code Discontinued |
|
| 01/01/2022 |
|
Final reports for ct, cta, mri or mra of the chest or neck with follow-up imaging recommended
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Final reports for ct, cta, mri or mra of the chest or neck with follow-up imaging not recommended
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Final reports for ct, cta, mri or mra studies of the chest or neck without an incidentally found thyroid nodule < 1.0 cm noted or no nodule found
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Patients prescribed opiates for longer than six weeks
Code Discontinued |
|
| 01/01/2022 |
|
Patients who had a follow-up evaluation conducted at least every three months during opioid therapy
Code Discontinued |
|
| 01/01/2022 |
|
Patients who did not have a follow-up evaluation conducted at least every three months during opioid therapy
Code Discontinued |
|
| 01/01/2022 |
|
Patients prescribed opiates for longer than six weeks
Code Discontinued |
|
| 01/01/2022 |
|
Documentation of signed opioid treatment agreement at least once during opioid therapy
Code Discontinued |
|
| 01/01/2022 |
|
No documentation of signed an opioid treatment agreement at least once during opioid therapy
Code Discontinued |
|
| 01/01/2022 |
|
Door to puncture time of 90 minutes or less
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Door to puncture time of greater than 90 minutes, no reason given
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Patients prescribed opiates for longer than six weeks
Code Discontinued |
|
| 01/01/2022 |
|
Patient evaluated for risk of misuse of opiates by using a brief validated instrument (e.g., opioid risk tool, soapp-r) or patient interviewed at least once during opioid therapy
Code Discontinued |
|
| 01/01/2022 |
|
Patient not evaluated for risk of misuse of opiates by using a brief validated instrument (e.g., opioid risk tool, soapp-r) or patient not interviewed at least once during opioid therapy
Code Discontinued |
|
| 01/01/2022 |
|
Patient did not sustain bladder injury at the time of surgery nor discovered subsequently up to 30 days post-surgery
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Health-related quality of life assessed with tool during at least two visits and quality of life score remained the same or improved
Code Discontinued |
|
| 01/01/2022 |
|
Health-related quality of life not assessed with tool for documented reason(s) (e.g., patient has a cognitive or neuropsychiatric impairment that impairs his/her ability to complete the hrqol survey, patient has the inability to read and/or write in order to complete the hrqol questionnaire)
Code Discontinued |
|
| 01/01/2022 |
|
Health-related quality of life not assessed with tool during at least two visits or quality of life score declined
Code Discontinued |
|
| 01/01/2022 |
|
Major amputation or open surgical bypass not required within 48 hours of the index endovascular lower extremity revascularization procedure
Code Discontinued |
|
| 01/01/2022 |
|
Documentation of planned hybrid or staged procedure
Code Discontinued |
|
| 01/01/2022 |
|
Major amputation or open surgical bypass required within 48 hours of the index endovascular lower extremity revascularization procedure
Code Discontinued |
|
| 01/01/2022 |
|
Patients in whom mrs score could not be obtained at 90 day follow-up
Code Discontinued |
|
| 01/01/2022 |
|
Previously diagnosed or have an active diagnosis of clinical ascvd, including ascvd procedure
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Any ldl-c laboratory test result >= 190 mg/dl
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Patient's highest fasting or direct ldl-c laboratory test result in the measurement period or two years prior to the beginning of the measurement period is 70-189 mg/dl
Code Discontinued |
|
| 01/01/2022 |
|
Episodes where the patient is taking antibiotics (table 1) in the 30 days prior to the episode date, or had an active prescription on the episode date
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Bmi is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reason
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Patients who have a diagnosis of pregnancy at any time during the measurement period
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Patients who are breastfeeding at any time during the measurement period
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Patients who have a diagnosis of rhabdomyolysis at any time during the measurement period
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Documentation of medical reason(s) for not currently being a statin therapy user or receiving an order (prescription) for statin therapy (e.g., patients with statin-associated muscle symptoms or an allergy to statin medication therapy, patients who are receiving palliative or hospice care, patients with active liver disease or hepatic disease or insufficiency, and patients with end stage renal disease [esrd])
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
History of or active diagnosis of familial hypercholesterolemia
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Documentation of patients with diabetes who have a most recent fasting or direct ldl- c laboratory test result < 70 mg/dl and are not taking statin therapy
Code Discontinued |
|
| 01/01/2022 |
|
Patients who had an endometrial ablation procedure during the 12 months prior to the index date (exclusive of the index date)
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Endometrial sampling or hysteroscopy with biopsy and results documented during the 12 months prior to the index date (exclusive of the index date) of the endometrial ablation
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Endometrial sampling or hysteroscopy with biopsy and results not documented during the 12 months prior to the index date (exclusive of the index date) of the endometrial ablation
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Patient identified as a tobacco user received tobacco cessation intervention on the date of the encounter or within the previous 12 months (counseling and/or pharmacotherapy)
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Documentation of medical reason(s) for not providing tobacco cessation intervention on the date of the encounter or within the previous 12 months (e.g., limited life expectancy, other medical reason)
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Patient identified as tobacco user did not receive tobacco cessation intervention on the date of the encounter or within the previous 12 months (counseling and/or pharmacotherapy), reason not given
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Documentation of medical reason(s) for not providing tobacco cessation intervention on the date of the encounter or within the previous 12 months if identified as a tobacco user (e.g., limited life expectancy, other medical reason)
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
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
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Fda-approved anticoagulant not prescribed, reason not given
Change in long description of procedure or modifier code |
|
| 01/01/2022 |
|
Palliative care services provided to patient any time during the measurement period | |
| 01/01/2022 |
|
Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., adverse reaction to vaccine) | |
| 01/01/2022 |
|
Pneumococcal vaccine was not administered on or after patient's 60th birthday and before the end of the measurement period, reason not otherwise specified | |
| 01/01/2022 |
|
Pneumococcal vaccine administered on or after patient's 60th birthday and before the end of the measurement period | |
| 01/01/2022 |
|
Palliative care services used by patient any time during the measurement period | |
| 01/01/2022 |
|
Patient was provided pallative care services any time during the measurement period | |
| 01/01/2022 |
|
Patient is using palliative care services any time during the measurement period | |
| 01/01/2022 |
|
Patients who use palliative care services any time during the measurement period | |
| 01/01/2022 |
|
Documentation stating the patient has received or is currently receiving palliative or hospice care | |
| 01/01/2022 |
|
Documentation of patient pregnancy anytime during the measurement period prior to and including the current encounter | |
| 01/01/2022 |
|
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, last colonoscopy found greater than 10 adenomas, or patient at high risk for colon cancer [crohn's disease, ulcerative colitis, lower gastrointestinal bleeding, personal or family history of colon cancer, hereditary colorectal cancer syndromes]) | |
| 01/01/2022 |
|
Documentation of system reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., unable to locate previous colonoscopy report, previous colonoscopy report was incomplete) | |
J Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2022 |
|
Injection, aducanumab-avwa, 2 mg | |
| 01/01/2022 |
|
Injection, c-1 esterase inhibitor (human), (haegarda), 10 units
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2022 |
|
Injection, levoleucovorin, not otherwise specified, 0.5 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2022 |
|
Injection, erythromycin lactobionate, per 500 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2022 |
|
Injection, fosaprepitant, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2022 |
|
Injection, ibandronate sodium, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2022 |
|
Leuprolide injectable, camcevi, 1 mg | |
| 01/01/2022 |
|
Injection, pegademase bovine, 25 iu
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2022 |
|
Injection, pegfilgrastim, 6 mg
Code Discontinued |
|
| 01/01/2022 |
|
Injection, pegfilgrastim, excludes biosimilar, 0.5 mg | |
| 01/01/2022 |
|
Injection, pentobarbital sodium, per 50 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2022 |
|
Injection, risperidone, (perseris), 0.5 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2022 |
|
Injection, somatropin, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2022 |
|
Injection, tigecycline, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2022 |
|
Injection, asparaginase, recombinant, (rylaze), 0.1 mg | |
| 01/01/2022 |
|
Injection, amivantamab-vmjw, 2 mg | |
| 01/01/2022 |
|
Injection, dostarlimab-gxly, 10 mg | |
M Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2022 |
|
Patients who were in hospice at any time during the performance period
Code Discontinued |
|
| 01/01/2022 |
|
Patients who were in hospice at any time during the performance period
Code Discontinued |
|
| 01/01/2022 |
|
Patients who were in hospice at any time during the performance period
Code Discontinued |
|
| 01/01/2022 |
|
Patients with no clinical indications for imaging of the head
Code Discontinued |
|
Q Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2022 |
|
Idecabtagene vicleucel, up to 460 million autologous b-cell maturation antigen (bcma) directed car-positive t cells, including leukapheresis and dose preparation procedures, per therapeutic dose | |
| 01/01/2022 |
|
Cygnus matrix, per square centimeter | |
Legend: