Legend:

  • Code discontinued
  • New code added
  • Code changed (Administrative / Payment)

A Codes

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Effective Code   Description
01/01/2019

A4563

Rectal control system for vaginal insertion, for long term use, includes pump and all supplies and accessories, any type each
01/01/2019

A5512

For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each
Change in administrative data field of procedure or modifier code
01/01/2019

A5514

For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each
01/01/2019

A6460

Synthetic resorbable wound dressing, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing
01/01/2019

A6461

Synthetic resorbable wound dressing, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing
01/01/2019

A9273

Cold or hot fluid bottle, ice cap or collar, heat and/or cold wrap, any type
Change in long description of procedure or modifier code
01/01/2019

A9513

Lutetium lu 177, dotatate, therapeutic, 1 millicurie
01/01/2019

A9515

Choline c-11, diagnostic, per study dose up to 20 millicuries
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

A9589

Instillation, hexaminolevulinate hydrochloride, 100 mg

B Codes

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Effective Code   Description
01/01/2019

B4105

In-line cartridge containing digestive enzyme(s) for enteral feeding, each

C Codes

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Effective Code   Description
01/01/2019

C1823

Generator, neurostimulator (implantable), non-rechargeable, with transvenous sensing and stimulation leads
01/01/2019

C1889

Implantable/insertable device, not otherwise classified
Change in long description of procedure or modifier code
01/01/2019

C2644

Brachytherapy source, cesium-131 chloride solution, per millicurie
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

C8904

Magnetic resonance imaging without contrast, breast; unilateral
Code Discontinued
01/01/2019

C8907

Magnetic resonance imaging without contrast, breast; bilateral
Code Discontinued
01/01/2019

C8937

Computer-aided detection, including computer algorithm analysis of breast mri image data for lesion detection/characterization, pharmacokinetic analysis, with further physician review for interpretation (list separately in addition to code for primary procedure)
01/01/2019

C9014

Injection, cerliponase alfa, 1 mg
Code Discontinued
01/01/2019

C9015

Injection, c-1 esterase inhibitor (human), haegarda, 10 units
Code Discontinued
01/01/2019

C9016

Injection, triptorelin extended release, 3.75 mg
Code Discontinued
01/01/2019

C9024

Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine
Code Discontinued
01/01/2019

C9028

Injection, inotuzumab ozogamicin, 0.1 mg
Code Discontinued
01/01/2019

C9029

Injection, guselkumab, 1 mg
Code Discontinued
01/01/2019

C9030

Injection, copanlisib, 1 mg
Code Discontinued
01/01/2019

C9031

Lutetium lu 177, dotatate, therapeutic, 1 mci
Code Discontinued
01/01/2019

C9032

Injection, voretigene neparvovec-rzyl, 1 billion vector genome
Code Discontinued
01/01/2019

C9033

Injection, fosnetupitant 235 mg and palonosetron 0.25 mg
Code Discontinued
01/01/2019

C9035

Injection, aripiprazole lauroxil (aristada initio), 1 mg
01/01/2019

C9036

Injection, patisiran, 0.1 mg
01/01/2019

C9037

Injection, risperidone (perseris), 0.5 mg
01/01/2019

C9038

Injection, mogamulizumab-kpkc, 1 mg
01/01/2019

C9039

Injection, plazomicin, 5 mg
04/01/2019

C9040

Injection, fremanezumab-vfrm, 1mg
04/01/2019

C9041

Injection, coagulation factor Xa (recombinant), inactivated (andexxa), 10 mg
04/01/2019

C9042

Injection, bendamustine hcl (belrapzo), 1 mg
Code Discontinued
04/01/2019

C9043

Injection, levoleucovorin, 1 mg
04/01/2019

C9044

Injection, cemiplimab-rwlc, 1 mg
04/01/2019

C9045

Injection, moxetumomab pasudotox-tdfk, 0.01 mg
04/01/2019

C9046

Cocaine hydrochloride nasal solution for topical administration, 1 mg
07/01/2019

C9047

Injection, caplacizumab-yhdp, 1 mg
07/01/2019

C9048

Dexamethasone, lacrimal ophthalmic insert, 0.1 mg
07/01/2019

C9049

Injection, tagraxofusp-erzs, 10 mcg
07/01/2019

C9050

Injection, emapalumab-lzsg, 1 mg
07/01/2019

C9051

Injection, omadacycline, 1 mg
07/01/2019

C9052

Injection, ravulizumab-cwvz, 10 mg
04/01/2019

C9141

Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl (jivi), 1 i.u.
Code Discontinued
01/01/2019

C9248

Injection, clevidipine butyrate, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

C9275

Injection, hexaminolevulinate hydrochloride, 100 mg, per study dose
Code Discontinued
01/01/2019

C9290

Injection, bupivacaine liposome, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

C9407

Iodine i-131 iobenguane, diagnostic, 1 millicurie
01/01/2019

C9408

Iodine i-131 iobenguane, therapeutic, 1 millicurie
01/01/2019

C9463

Injection, aprepitant, 1 mg
Code Discontinued
01/01/2019

C9464

Injection, rolapitant, 0.5 mg
Code Discontinued
01/01/2019

C9465

Hyaluronan or derivative, durolane, for intra-articular injection, per dose
Code Discontinued
01/01/2019

C9466

Injection, benralizumab, 1 mg
Code Discontinued
01/01/2019

C9467

Injection, rituximab and hyaluronidase, 10 mg
Code Discontinued
01/01/2019

C9468

Injection, factor ix (antihemophilic factor, recombinant), glycopegylated, rebinyn, 1 i.u.
Code Discontinued
01/01/2019

C9492

Injection, durvalumab, 10 mg
Code Discontinued
01/01/2019

C9493

Injection, edaravone, 1 mg
Code Discontinued
01/01/2019

C9497

Loxapine, inhalation powder, 10 mg
Code Discontinued
01/01/2019

C9741

Right heart catheterization with implantation of wireless pressure sensor in the pulmonary artery, including any type of measurement, angiography, imaging supervision, interpretation, and report
Code Discontinued
01/01/2019

C9744

Ultrasound, abdominal, with contrast
Code Discontinued
01/01/2019

C9748

Transurethral destruction of prostate tissue; by radiofrequency water vapor (steam) thermal therapy
Code Discontinued
01/01/2019

C9750

Insertion or removal and replacement of intracardiac ischemia monitoring system including imaging supervision and interpretation and peri-operative interrogation and programming; complete system (includes device and electrode)
Code Discontinued
01/01/2019

C9751

Bronchoscopy, rigid or flexible, transbronchial ablation of lesion(s) by microwave energy, including fluoroscopic guidance, when performed, with computed tomography acquisition(s) and 3-d rendering, computer-assisted, image-guided navigation, and endobronchial ultrasound (ebus) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]) and all mediastinal and/or hilar lymph node stations or structures and therapeutic intervention(s)
01/01/2019

C9752

Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum
01/01/2019

C9753

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)
01/01/2019

C9754

Creation of arteriovenous fistula, percutaneous; direct, any site, including all imaging and radiologic supervision and interpretation, when performed and secondary procedures to redirect blood flow (e.g., transluminal balloon angioplasty, coil embolization, when performed)
01/01/2019

C9755

Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed
07/01/2019

C9756

Intraoperative near-infrared fluorescence lymphatic mapping of lymph node(s) (sentinel or tumor draining) with administration of indocyanine green (ICG) (List separately in addition to code for primary procedure)

E Codes

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Effective Code   Description
01/01/2019

E0218

Fluid circulating cold pad with pump, any type
Change in long description of procedure or modifier code
01/01/2019

E0447

Portable oxygen contents, liquid, 1 month's supply = 1 unit, prescribed amount at rest or nighttime exceeds 4 liters per minute (lpm)
01/01/2019

E0467

Home ventilator, multi-function respiratory device, also performs any or all of the additional functions of oxygen concentration, drug nebulization, aspiration, and cough stimulation, includes all accessories, components and supplies for all functions
01/01/2019

E0483

High frequency chest wall oscillation system, includes all accessories and supplies, each
Change in long description of procedure or modifier code
01/01/2019

E2351

Power wheelchair accessory, electronic interface to operate speech generating device using power wheelchair control interface
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

E2500

Speech generating device, digitized speech, using pre-recorded messages, less than or equal to 8 minutes recording time
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

E2502

Speech generating device, digitized speech, using pre-recorded messages, greater than 8 minutes but less than or equal to 20 minutes recording time
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

E2504

Speech generating device, digitized speech, using pre-recorded messages, greater than 20 minutes but less than or equal to 40 minutes recording time
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

E2506

Speech generating device, digitized speech, using pre-recorded messages, greater than 40 minutes recording time
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

E2508

Speech generating device, synthesized speech, requiring message formulation by spelling and access by physical contact with the device
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

E2510

Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)

G Codes

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Effective Code   Description
01/01/2019

G0068

Professional services for the administration of anti-infective, pain management, chelation, pulmonary hypertension, and/or inotropic infusion drug(s) for each infusion drug administration calendar day in the individual's home, each 15 minutes
01/01/2019

G0069

Professional services for the administration of subcutaneous immunotherapy for each infusion drug administration calendar day in the individual's home, each 15 minutes
01/01/2019

G0070

Professional services for the administration of chemotherapy for each infusion drug administration calendar day in the individual's home, each 15 minutes
01/01/2019

G0071

Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only
01/01/2019

G0076

Brief (20 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
01/01/2019

G0077

Limited (30 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
01/01/2019

G0078

Moderate (45 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
01/01/2019

G0079

Comprehensive (60 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
01/01/2019

G0080

Extensive (75 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
01/01/2019

G0081

Brief (20 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
01/01/2019

G0082

Limited (30 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
01/01/2019

G0083

Moderate (45 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
01/01/2019

G0084

Comprehensive (60 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
01/01/2019

G0085

Extensive (75 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
01/01/2019

G0086

Limited (30 minutes) care management home care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
01/01/2019

G0087

Comprehensive (60 minutes) care management home care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
04/01/2019

G2001

Brief (20 minutes) in-home visit for a new patient post-discharge. For use only in a Medicare-approved CMMI model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
04/01/2019

G2002

Limited (30 minutes) in-home visit for a new patient post-discharge. For use only in a Medicare-approved CMMI model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
04/01/2019

G2003

Moderate (45 minutes) in-home visit for a new patient post-discharge. For use only in a Medicare-approved CMMI model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
04/01/2019

G2004

Comprehensive (60 minutes) in-home visit for a new patient post-discharge. For use only in a Medicare-approved CMMI model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
04/01/2019

G2005

Extensive (75 minutes) in-home visit for a new patient post-discharge. For use only in a Medicare-approved CMMI model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
04/01/2019

G2006

Brief (20 minutes) in-home visit for an existing patient post-discharge. For use only in a Medicare-approved CMMI model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
04/01/2019

G2007

Limited (30 minutes) in-home visit for an existing patient post-discharge. For use only in a Medicare-approved CMMI model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
04/01/2019

G2008

Moderate (45 minutes) in-home visit for an existing patient post-discharge. For use only in a Medicare-approved CMMI model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
04/01/2019

G2009

Comprehensive (60 minutes) in-home visit for an existing patient post-discharge. For use only in a Medicare-approved CMMI model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
01/01/2019

G2010

Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment
01/01/2019

G2011

Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention, 5-14 minutes
01/01/2019

G2012

Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
04/01/2019

G2013

Extensive (75 minutes) in-home visit for an existing patient post-discharge. For use only in a Medicare-approved CMMI model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
04/01/2019

G2014

Limited (30 minutes) care plan oversight. For use only in a Medicare-approved CMMI model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
04/01/2019

G2015

Comprehensive (60 mins) home care plan oversight. For use only in a Medicare-approved CMMI model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility.)
01/01/2019

G8647

Risk-adjusted functional status change residual score for the knee impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
Change in long description of procedure or modifier code
01/01/2019

G8648

Risk-adjusted functional status change residual score for the knee impairment successfully calculated and the score was less than zero (< 0)
Change in long description of procedure or modifier code
01/01/2019

G8649

Risk-adjusted functional status change residual score for the knee impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate
Change in long description of procedure or modifier code
01/01/2019

G8650

Risk-adjusted functional status change residual scores for the knee impairment not measured because the patient did not complete the fs intake survey on admission and/or follow up fs status survey near discharge, reason not given
Change in long description of procedure or modifier code
01/01/2019

G8651

Risk-adjusted functional status change residual score for the hip impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
Change in long description of procedure or modifier code
01/01/2019

G8652

Risk-adjusted functional status change residual score for the hip impairment successfully calculated and the score was less than zero (< 0)
Change in long description of procedure or modifier code
01/01/2019

G8653

Risk-adjusted functional status change residual scores for the hip impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate
Change in long description of procedure or modifier code
01/01/2019

G8654

Risk-adjusted functional status change residual score for the hip impairment not measured because the patient did not complete the fs intake survey on admission and/or follow up fs status survey near discharge, reason not given
Change in long description of procedure or modifier code
01/01/2019

G8655

Risk-adjusted functional status change residual score for the lower leg, foot or ankle impairment successfully calculated and the score was equal to zero (0) or greater than zero ( > 0)
Change in long description of procedure or modifier code
01/01/2019

G8656

Risk-adjusted functional status change residual score for the lower leg, foot or ankle impairment successfully calculated and the score was less than zero (< 0)
Change in long description of procedure or modifier code
01/01/2019

G8657

Risk-adjusted functional status change residual score for the lower leg, foot or ankle impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate
Change in long description of procedure or modifier code
01/01/2019

G8658

Risk-adjusted functional status change residual score for the lower leg, foot or ankle impairment not measured because the patient did not complete the fs intake survey on admission and/or follow up fs status survey near discharge, reason not given
Change in long description of procedure or modifier code
01/01/2019

G8659

Risk-adjusted functional status change residual score for the low back impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
Change in long description of procedure or modifier code
01/01/2019

G8660

Risk-adjusted functional status change residual score for the low back impairment successfully calculated and the score was less than zero (< 0)
Change in long description of procedure or modifier code
01/01/2019

G8661

Risk-adjusted functional status change residual score for the low back impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate
Change in long description of procedure or modifier code
01/01/2019

G8662

Risk-adjusted functional status change residual score for the low back impairment not measured because the patient did not complete the fs intake survey on admission and/or follow up fs status survey near discharge, reason not given
Change in long description of procedure or modifier code
01/01/2019

G8663

Risk-adjusted functional status change residual score for the shoulder impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
Change in long description of procedure or modifier code
01/01/2019

G8664

Risk-adjusted functional status change residual score for the shoulder impairment successfully calculated and the score was less than zero (< 0)
Change in long description of procedure or modifier code
01/01/2019

G8665

Risk-adjusted functional status change residual score for the shoulder impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate
Change in long description of procedure or modifier code
01/01/2019

G8666

Risk-adjusted functional status change residual score for the shoulder impairment not measured because the patient did not complete the fs intake survey on admission and/or follow up fs status survey near discharge, reason not given
Change in long description of procedure or modifier code
01/01/2019

G8667

Risk-adjusted functional status change residual score for the elbow, wrist or hand impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
Change in long description of procedure or modifier code
01/01/2019

G8668

Risk-adjusted functional status change residual score for the elbow, wrist or hand impairment successfully calculated and the score was less than zero (< 0)
Change in long description of procedure or modifier code
01/01/2019

G8669

Risk-adjusted functional status change residual score for the elbow, wrist or hand impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate
Change in long description of procedure or modifier code
01/01/2019

G8670

Risk-adjusted functional status change residual score for the elbow, wrist or hand impairment not measured because the patient did not complete the fs intake survey on admission and/or follow up fs status survey near discharge, reason not given
Change in long description of procedure or modifier code
01/01/2019

G8671

Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs or other general orthopedic impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
Change in long description of procedure or modifier code
01/01/2019

G8672

Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs or other general orthopedic impairment successfully calculated and the score was less than zero (< 0)
Change in long description of procedure or modifier code
01/01/2019

G8673

Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs or other general orthopedic impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate
Change in long description of procedure or modifier code
01/01/2019

G8674

Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs or other general orthopedic impairment not measured because the patient did not complete the fs status survey on admission and/or follow up fs status survey near discharge, reason not given
Change in long description of procedure or modifier code
01/01/2019

G8709

Patient prescribed or dispensed antibiotic for documented medical reason(s) within three days after the initial diagnosis of uri (e.g., intestinal infection, pertussis, bacterial infection, lyme disease, otitis media, acute sinusitis, acute pharyngitis, acute tonsillitis, chronic sinusitis, infection of the pharynx/larynx/tonsils/adenoids, prostatitis, cellulitis, mastoiditis, or bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia/gonococcal infections, venereal disease (syphilis, chlamydia, inflammatory diseases (female reproductive organs)), infections of the kidney, cystitis or uti, and acne)
Change in long description of procedure or modifier code
01/01/2019

G8749

Absence of signs of melanoma (tenderness, jaundice, localized neurologic signs such as weakness, or any other sign suggesting systemic spread) or absence of symptoms of melanoma (cough, dyspnea, pain, paresthesia, or any other symptom suggesting the possibility of systemic spread of melanoma)
Change in long description of procedure or modifier code
01/01/2019

G8806

Performance of trans-abdominal or trans-vaginal ultrasound and pregnancy location documented
Change in long description of procedure or modifier code
01/01/2019

G8807

Trans-abdominal or trans-vaginal ultrasound not performed for reasons documented by clinician (e.g., patient has visited the ed multiple times within 72 hours, patient has a documented intrauterine pregnancy [iup])
Change in short description of procedure code
01/01/2019

G8880

Documentation of reason(s) sentinel lymph node biopsy not performed (e.g., reasons could include but not limited to; non-invasive cancer, incidental discovery of breast cancer on prophylactic mastectomy, incidental discovery of breast cancer on reduction mammoplasty, pre-operative biopsy proven lymph node (ln) metastases, inflammatory carcinoma, stage 3 locally advanced cancer, recurrent invasive breast cancer, clinically node positive after neoadjuvant systemic therapy, patient refusal after informed consent, patient with significant age, comorbidities, or limited life expectancy and favorable tumor; adjuvant systemic therapy unlikely to change)
Change in long description of procedure or modifier code
01/01/2019

G9428

Pathology report includes the pt category and a statement on thickness, ulceration and mitotic rate
Change in long description of procedure or modifier code
01/01/2019

G9429

Documentation of medical reason(s) for not including pt category and a statement on thickness, ulceration and mitotic rate (e.g., negative skin biopsies in a patient with a history of melanoma or other documented medical reasons)
Change in long description of procedure or modifier code
01/01/2019

G9431

Pathology report does not include the pt category and a statement on thickness, ulceration and mitotic rate
Change in long description of procedure or modifier code
01/01/2019

G9454

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
Change in long description of procedure or modifier code
01/01/2019

G9457

Patient did not undergo abdominal imaging and did not have a documented reason for not undergoing abdominal imaging in the submission period
Change in long description of procedure or modifier code
01/01/2019

G9509

Adult patients 18 years of age or older with major depression or dysthymia who reached remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5
Change in long description of procedure or modifier code
01/01/2019

G9511

Index event date phq-9 or phq-9m score greater than 9 documented during the twelve month denominator identification period
Change in long description of procedure or modifier code
01/01/2019

G9530

Patient presented with a minor blunt head trauma and had a head ct ordered for trauma by an emergency care provider
Change in long description of procedure or modifier code
01/01/2019

G9531

Patient has documentation of ventricular shunt, brain tumor, multisystem trauma, pregnancy, or is currently taking an antiplatelet medication including: abciximab, cangrelor, cilostazol, clopidogrel, eptifibatide, prasugrel, ticlopidine, ticagrelor, tirofiban, or vorapaxar
Change in long description of procedure or modifier code
01/01/2019

G9532

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
Change in long description of procedure or modifier code
01/01/2019

G9534

Advanced brain imaging (cta, ct, mra or mri) was not ordered
Code Discontinued
01/01/2019

G9535

Patients with a normal neurological examination
Code Discontinued
01/01/2019

G9536

Documentation of medical reason(s) for ordering an advanced brain imaging study (i.e., patient has an abnormal neurological examination; patient has the coexistence of seizures, or both; recent onset of severe headache; change in the type of headache; signs of increased intracranial pressure (e.g., papilledema, absent venous pulsations on funduscopic examination, altered mental status, focal neurologic deficits, signs of meningeal irritation); hiv-positive patients with a new type of headache; immunocompromised patient with unexplained headache symptoms; patient on coagulopathy/anti-coagulation or anti-platelet therapy; very young patients with unexplained headache symptoms)
Code Discontinued
01/01/2019

G9537

Documentation of system reason(s) for obtaining imaging of the head (ct or mri) (i.e., needed as part of a clinical trial; other clinician ordered the study)
Change in long description of procedure or modifier code
01/01/2019

G9538

Advanced brain imaging (cta, ct, mra or mri) was ordered
Code Discontinued
01/01/2019

G9573

Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at six months as demonstrated by a six month (+/-60 days) phq-9 or phq-9m score of less than five
Change in long description of procedure or modifier code
01/01/2019

G9574

Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at six months as demonstrated by a six month (+/-60 days) phq-9 or phq-9m score of less than five; either phq-9 or phq-9m score was not assessed or is greater than or equal to five
Change in long description of procedure or modifier code
01/01/2019

G9594

Patient presented with a minor blunt head trauma and had a head ct ordered for trauma by an emergency care provider
Change in long description of procedure or modifier code
01/01/2019

G9596

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
Change in long description of procedure or modifier code
01/01/2019

G9612

Photodocumentation of two or more cecal landmarks to establish a complete examination
Change in long description of procedure or modifier code
01/01/2019

G9614

Photodocumentation of less than two cecal landmarks (i.e., no cecal landmarks or only one cecal landmark) to establish a complete examination
Change in long description of procedure or modifier code
01/01/2019

G9625

Patient sustained bladder injury at the time of surgery or discovered subsequently up to 30 days post-surgery
Change in long description of procedure or modifier code
01/01/2019

G9627

Patient did not sustain bladder injury at the time of surgery nor discovered subsequently up to 30n days post-surgery
Change in long description of procedure or modifier code
01/01/2019

G9628

Patient sustained bowel injury at the time of surgery or discovered subsequently up to 30 days post-surgery
Change in long description of procedure or modifier code
01/01/2019

G9630

Patient did not sustain a bowel injury at the time of surgery nor discovered subsequently up to 30 days post-surgery
Change in long description of procedure or modifier code
01/01/2019

G9631

Patient sustained ureter injury at the time of surgery or discovered subsequently up to 30 days post-surgery
Change in long description of procedure or modifier code
01/01/2019

G9633

Patient did not sustain ureter injury at the time of surgery nor discovered subsequently up to 30 days post-surgery
Change in long description of procedure or modifier code
01/01/2019

G9649

Psoriasis assessment tool documented meeting any one of the specified benchmarks (e.g., (pga; 5-point or 6-point scale), body surface area (bsa), psoriasis area and severity index (pasi) and/or dermatology life quality index) (dlqi))
Change in long description of procedure or modifier code
01/01/2019

G9651

Psoriasis assessment tool documented not meeting any one of the specified benchmarks (e.g., (pga; 5-point or 6-point scale), body surface area (bsa), psoriasis area and severity index (pasi) and/or dermatology life quality index) (dlqi)) or psoriasis assessment tool not documented
Change in long description of procedure or modifier code
01/01/2019

G9683

Facility service(s) for the onsite acute care treatment of a nursing facility resident with fluid or electrolyte disorder. (may only be billed once per day per beneficiary). this service is for a demonstration project
Change in long description of procedure or modifier code
01/01/2019

G9685

Physician service or other qualified health care professional for the evaluation and management of a beneficiary's acute change in condition in a nursing facility. this service is for a demonstration project
Change in long description of procedure or modifier code
01/01/2019

G9686

Onsite nursing facility conference, that is separate and distinct from an evaluation and management visit, including qualified practitioner and at least one member of the nursing facility interdisciplinary care team
Code Discontinued
01/01/2019

G9690

Patient receiving hospice services any time during the measurement period
Change in short description of procedure code
01/01/2019

G9727

Patient unable to complete the knee fs prom at admission and discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
Change in long description of procedure or modifier code
01/01/2019

G9729

Patient unable to complete the hip fs prom at admission and discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
Change in long description of procedure or modifier code
01/01/2019

G9731

Patient unable to complete the foot/ankle fs prom at admission and discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
Change in long description of procedure or modifier code
01/01/2019

G9733

Patient unable to complete the low back fs prom at admission and discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
Change in long description of procedure or modifier code
01/01/2019

G9735

Patient unable to complete the shoulder fs prom at admission and discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
Change in long description of procedure or modifier code
01/01/2019

G9737

Patient unable to complete the elbow/wrist/hand fs prom at admission and discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
Change in long description of procedure or modifier code
01/01/2019

G9739

Patient unable to complete the general orthopedic fs prom at admission and discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
Change in long description of procedure or modifier code
01/01/2019

G9755

Documentation of medical reason(s) for not including a recommended interval and modality for follow-up or for no follow-up, and source of recommendations (e.g., patients with unexplained fever, immunocompromised patients who are at risk for infection)
Change in long description of procedure or modifier code
01/01/2019

G9764

Patient has been treated with a systemic medication for psoriasis vulgaris
Change in long description of procedure or modifier code
01/01/2019

G9765

Documentation that the patient declined change in medication or alternative therapies were unavailable, has documented contraindications, or has not been treated with a systemic medication for at least six consecutive months (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by pga, bsa, pasi, or dlqi
Change in long description of procedure or modifier code
01/01/2019

G9772

Documentation of one of the following 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 the 15 minutes immediately after anesthesia end time (e.g., emergency cases, intentional hypothermia, etc.)
Change in long description of procedure or modifier code
01/01/2019

G9773

At least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) not achieved within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time, reason not given
Change in long description of procedure or modifier code
01/01/2019

G9787

Patient alive as of the last day of the measurement year
Change in short description of procedure code
01/01/2019

G9803

Patient prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami
Change in long description of procedure or modifier code
01/01/2019

G9804

Patient was not prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami
Change in long description of procedure or modifier code
01/01/2019

G9974

Dilated macular exam performed, including documentation of the presence or absence of macular thickening or geographic atrophy or hemorrhage and the level of macular degeneration severity
Change in short description of procedure code
01/01/2019

G9975

Documentation of medical reason(s) for not performing a dilated macular examination
Change in short description of procedure code

J Codes

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Effective Code   Description
10/01/2019

J0121

Injection, omadacycline, 1 mg
10/01/2019

J0122

Injection, eravacycline, 1 mg
01/01/2019

J0185

Injection, aprepitant, 1 mg
10/01/2019

J0222

Injection, Patisiran, 0.1 mg
No maintenance for this code
10/01/2019

J0291

Injection, plazomicin, 5 mg
No maintenance for this code
01/01/2019

J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm
Change in short description of procedure code
01/01/2019

J0400

Injection, aripiprazole, intramuscular, 0.25 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

J0470

Injection, dimercaprol, per 100 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

J0476

Injection, baclofen, 50 mcg for intrathecal trial
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

J0517

Injection, benralizumab, 1 mg
01/01/2019

J0558

Injection, penicillin g benzathine and penicillin g procaine, 100,000 units
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

J0567

Injection, cerliponase alfa, 1 mg
01/01/2019

J0584

Injection, burosumab-twza 1 mg
10/01/2019

J0593

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)
01/01/2019

J0599

Injection, c-1 esterase inhibitor (human), (haegarda), 10 units
10/01/2019

J0641

Injection, levoleucovorin, 0.5 mg
Change in long description of procedure or modifier code
10/01/2019

J0642

Injection, levoleucovorin (khapzory), 0.5 mg
01/01/2019

J0725

Injection, chorionic gonadotropin, per 1,000 usp units
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

J0800

Injection, corticotropin, up to 40 units
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

J0833

Injection, cosyntropin, not otherwise specified, 0.25 mg
Code Discontinued
01/01/2019

J0834

Injection, cosyntropin, 0.25 mg
Change in long description of procedure or modifier code
01/01/2019

J0841

Injection, crotalidae immune f(ab')2 (equine), 120 mg
01/01/2019

J0888

Injection, epoetin beta, 1 microgram, (for non esrd use)
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
10/01/2019

J1096

Dexamethasone, lacrimal ophthalmic insert, 0.1 mg
10/01/2019

J1097

Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml
01/01/2019

J1110

Injection, dihydroergotamine mesylate, per 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

J1130

Injection, diclofenac sodium, 0.5 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

J1301

Injection, edaravone, 1 mg
10/01/2019

J1303

Injection, ravulizumab-cwvz, 10 mg
07/01/2019

J1444

Injection, ferric pyrophosphate citrate powder, 0.1 mg of iron
01/01/2019

J1454

Injection, fosnetupitant 235 mg and palonosetron 0.25 mg
01/01/2019

J1628

Injection, guselkumab, 1 mg
01/01/2019

J1746

Injection, ibalizumab-uiyk, 10 mg
10/01/2019

J1942

Injection, aripiprazole lauroxil, 1 mg
Code Discontinued
10/01/2019

J1943

Injection, aripiprazole lauroxil, (aristada initio), 1 mg
10/01/2019

J1944

Injection, aripiprazole lauroxil, (aristada), 1 mg
01/01/2019

J2062

Loxapine for inhalation, 1 mg
01/01/2019

J2503

Injection, pegaptanib sodium, 0.3 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

J2793

Injection, rilonacept, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
10/01/2019

J2794

Injection, risperidone (risperdal consta), 0.5 mg
Change in long description of procedure or modifier code
01/01/2019

J2797

Injection, rolapitant, 0.5 mg
10/01/2019

J2798

Injection, risperidone, (perseris), 0.5 mg
01/01/2019

J2941

Injection, somatropin, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
10/01/2019

J3031

Injection, fremanezumab-vfrm, 1 mg (code may be used for Medicare when drug administered under the direct supervision of a physician, not for use when drug is self-administered)
01/01/2019

J3070

Injection, pentazocine, 30 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
10/01/2019

J3111

Injection, romosozumab-aqqg, 1 mg
01/01/2019

J3245

Injection, tildrakizumab, 1 mg
01/01/2019

J3304

Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg
01/01/2019

J3316

Injection, triptorelin, extended-release, 3.75 mg
01/01/2019

J3397

Injection, vestronidase alfa-vjbk, 1 mg
01/01/2019

J3398

Injection, voretigene neparvovec-rzyl, 1 billion vector genomes
01/01/2019

J3465

Injection, voriconazole, 10 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

J3591

Unclassified drug or biological used for esrd on dialysis
01/01/2019

J7170

Injection, emicizumab-kxwh, 0.5 mg
01/01/2019

J7177

Injection, human fibrinogen concentrate (fibryga), 1 mg
01/01/2019

J7178

Injection, human fibrinogen concentrate, not otherwise specified, 1 mg
Change in long description of procedure or modifier code
01/01/2019

J7203

Injection factor ix, (antihemophilic factor, recombinant), glycopegylated, (rebinyn), 1 iu
07/01/2019

J7208

Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl, (jivi), 1 i.u.
10/01/2019

J7313

Injection, fluocinolone acetonide, intravitreal implant (Iluvien), 0.01 mg
Change in long description of procedure or modifier code
10/01/2019

J7314

Injection, fluocinolone acetonide, intravitreal implant (Yutiq), 0.01 mg
01/01/2019

J7318

Hyaluronan or derivative, durolane, for intra-articular injection, 1 mg
01/01/2019

J7329

Hyaluronan or derivative, trivisc, for intra-articular injection, 1 mg
10/01/2019

J7331

Hyaluronan or derivative, synojoynt, for intra-articular injection, 1 mg
10/01/2019

J7332

Hyaluronan or derivative, triluron, for intra-articular injection, 1 mg
01/01/2019

J7340

Carbidopa 5 mg/levodopa 20 mg enteral suspension, 100 ml
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
10/01/2019

J7401

Mometasone furoate sinus implant, 10 micrograms
01/01/2019

J7503

Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

J7505

Muromonab-cd3, parenteral, 5 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
07/01/2019

J7677

Revefenacin inhalation solution, fda-approved final product, non-compounded, administered through DME, 1 microgram
01/01/2019

J8501

Aprepitant, oral, 5 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

J8562

Fludarabine phosphate, oral, 10 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

J8600

Melphalan; oral, 2 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

J8655

Netupitant 300 mg and palonosetron 0.5 mg, oral
Change in long description of procedure or modifier code
01/01/2019

J8705

Topotecan, oral, 0.25 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
07/01/2019

J9030

BCG live intravesical instillation, 1 mg
07/01/2019

J9036

Injection, bendamustine hydrochloride, (Belrapzo/bendamustine), 1 mg
01/01/2019

J9041

Injection, bortezomib (velcade), 0.1 mg
Change in long description of procedure or modifier code
01/01/2019

J9044

Injection, bortezomib, not otherwise specified, 0.1 mg
01/01/2019

J9057

Injection, copanlisib, 1 mg
10/01/2019

J9118

Injection, calaspargase pegol-mknl, 10 units
10/01/2019

J9119

Injection, cemiplimab-rwlc, 1 mg
01/01/2019

J9151

Injection, daunorubicin citrate, liposomal formulation, 10 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

J9153

Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine
01/01/2019

J9173

Injection, durvalumab, 10 mg
01/01/2019

J9185

Injection, fludarabine phosphate, 50 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
10/01/2019

J9204

Injection, mogamulizumab-kpkc, 1 mg
10/01/2019

J9210

Injection, emapalumab-lzsg, 1 mg
01/01/2019

J9211

Injection, idarubicin hydrochloride, 5 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

J9213

Injection, interferon, alfa-2a, recombinant, 3 million units
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

J9216

Injection, interferon, gamma 1-b, 3 million units
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

J9218

Leuprolide acetate, per 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

J9229

Injection, inotuzumab ozogamicin, 0.1 mg
10/01/2019

J9269

Injection, tagraxofusp-erzs, 10 micrograms
01/01/2019

J9270

Injection, plicamycin, 2.5 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

J9310

Injection, rituximab, 100 mg
Code Discontinued
01/01/2019

J9311

Injection, rituximab 10 mg and hyaluronidase
01/01/2019

J9312

Injection, rituximab, 10 mg
10/01/2019

J9313

Injection, moxetumomab pasudotox-tdfk, 0.01 mg
07/01/2019

J9356

Injection, trastuzumab, 10 mg and Hyaluronidase-oysk

K Codes

↑ Top
Effective Code   Description
01/01/2019

K0903

For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each
Code Discontinued

L Codes

↑ Top
Effective Code   Description
01/01/2019

L8608

Miscellaneous external component, supply or accessory for use with the argus ii retinal prosthesis system
01/01/2019

L8698

Miscellaneous component, supply or accessory for use with total artificial heart system
01/01/2019

L8701

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
01/01/2019

L8702

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

M Codes

↑ Top
Effective Code   Description
01/01/2019

M1000

Pain screened as moderate to severe
01/01/2019

M1001

Plan of care to address moderate to severe pain documented on or before the date of the second visit with a clinician
01/01/2019

M1002

Plan of care for moderate to severe pain not documented on or before the date of the second visit with a clinician, reason not given
01/01/2019

M1003

Tb screening performed and results interpreted within twelve months prior to initiation of first-time biologic disease modifying anti-rheumatic drug therapy for ra
01/01/2019

M1004

Documentation of medical reason for not screening for tb or interpreting results (i.e., patient positive for tb and documentation of past treatment; patient who has recently completed a course of anti-tb therapy)
01/01/2019

M1005

Tb screening not performed or results not interpreted, reason not given
01/01/2019

M1006

Disease activity not assessed, reason not given
01/01/2019

M1007

>=50% of total number of a patient's outpatient ra encounters assessed
01/01/2019

M1008

<50% of total number of a patient's outpatient ra encounters assessed
01/01/2019

M1009

Patient treatment and final evaluation complete
01/01/2019

M1010

Patient treatment and final evaluation complete
01/01/2019

M1011

Patient treatment and final evaluation complete
01/01/2019

M1012

Patient treatment and final evaluation complete
01/01/2019

M1013

Patient treatment and final evaluation complete
01/01/2019

M1014

Patient treatment and final evaluation complete
01/01/2019

M1015

Patient treatment and final evaluation complete
01/01/2019

M1016

Female patients unable to bear children
01/01/2019

M1017

Patient admitted to palliative care services
01/01/2019

M1018

Patients with an active diagnosis or history of cancer (except basal cell and squamous cell skin carcinoma), patients who are heavy tobacco smokers, lung cancer screening patients
01/01/2019

M1019

Adolescent patients 12 to 17 years of age with major depression or dysthymia who reached remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5
01/01/2019

M1020

Adolescent patients 12 to 17 years of age with major depression or dysthymia who did not reach remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5. either phq-9 or phq-9m score was not assessed or is greater than or equal to 5
01/01/2019

M1021

Patient had only urgent care visits during the performance period
01/01/2019

M1022

Patients who were in hospice at any time during the performance period
01/01/2019

M1023

Adolescent patients 12 to 17 years of age with major depression or dysthymia who reached remission at six months as demonstrated by a six month (+/-60 days) phq-9 or phq-9m score of less than five
01/01/2019

M1024

Adolescent patients 12 to 17 years of age with major depression or dysthymia who did not reach remission at six months as demonstrated by a six month (+/-60 days) phq-9 or phq-9m score of less than five. either phq-9 or phq-9m score was not assessed or is greater than or equal to five
01/01/2019

M1025

Patients who were in hospice at any time during the performance period
01/01/2019

M1026

Patients who were in hospice at any time during the performance period
01/01/2019

M1027

Imaging of the head (ct or mri) was obtained
01/01/2019

M1028

Documentation of patients with primary headache diagnosis and imaging other than ct or mri obtained
01/01/2019

M1029

Imaging of the head (ct or mri) was not obtained, reason not given
01/01/2019

M1030

Patients with clinical indications for imaging of the head
01/01/2019

M1031

Patients with no clinical indications for imaging of the head
01/01/2019

M1032

Adults currently taking pharmacotherapy for oud
01/01/2019

M1033

Pharmacotherapy for oud initiated after june 30th of performance period
01/01/2019

M1034

Adults who have at least 180 days of continuous pharmacotherapy with a medication prescribed for oud without a gap of more than seven days
01/01/2019

M1035

Adults who are deliberately phased out of medication assisted treatment (mat) prior to 180 days of continuous treatment
01/01/2019

M1036

Adults who have not had at least 180 days of continuous pharmacotherapy with a medication prescribed for oud without a gap of more than seven days
01/01/2019

M1037

Patients with a diagnosis of lumbar spine region cancer at the time of the procedure
01/01/2019

M1038

Patients with a diagnosis of lumbar spine region fracture at the time of the procedure
01/01/2019

M1039

Patients with a diagnosis of lumbar spine region infection at the time of the procedure
01/01/2019

M1040

Patients with a diagnosis of lumbar idiopathic or congenital scoliosis
01/01/2019

M1041

Patient had cancer, fracture or infection related to the lumbar spine or patient had idiopathic or congenital scoliosis
01/01/2019

M1042

Functional status measurement with score was obtained utilizing the oswestry disability index (odi version 2.1a) patient reported outcome tool within three months preoperatively and at one year (9 to 15 months) postoperatively
01/01/2019

M1043

Functional status measurement with score was not obtained utilizing the oswestry disability index (odi version 2.1a) patient reported outcome tool within three months preoperatively and at one year (9 to 15 months) postoperatively
01/01/2019

M1044

Functional status was measured by the oswestry disability index (odi version 2.1a) patient reported outcome tool within three months preoperatively and at one year (9 to 15 months) postoperatively
01/01/2019

M1045

Functional status measurement with score was obtained utilizing the oxford knee score (oks) patient reported outcome tool within three months preoperatively and at one year (9 to 15 months) postoperatively
01/01/2019

M1046

Functional status measurement with score was not obtained utilizing the oxford knee score (oks) patient reported outcome tool within three months preoperatively and at one year (9 to 15 months) postoperatively
01/01/2019

M1047

Functional status was measured by the oxford knee score (oks) patient reported outcome tool within three months preoperatively and at one year (9 to 15 months) postoperatively
01/01/2019

M1048

Functional status measurement with score was obtained utilizing the oswestry disability index (odi version 2.1a) patient reported outcome tool within three months preoperatively and at three months (6 to 20 weeks) postoperatively
01/01/2019

M1049

Functional status measurement with score was not obtained utilizing the oswestry disability index (odi version 2.1a) patient reported outcome tool within three months preoperatively and at three months (6 to 20 weeks) postoperatively
01/01/2019

M1050

Functional status was measured by the oswestry disability index (odi version 2.1a) patient reported outcome tool within three months preoperatively and at three months (6 to 20 weeks) postoperatively
01/01/2019

M1051

Patient had cancer, fracture or infection related to the lumbar spine or patient had idiopathic or congenital scoliosis
01/01/2019

M1052

Leg pain was not measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively
01/01/2019

M1053

Leg pain was measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively
01/01/2019

M1054

Patient had only urgent care visits during the performance period
01/01/2019

M1055

Aspirin or another antiplatelet therapy used
01/01/2019

M1056

Prescribed anticoagulant medication during the performance period, history of gi bleeding, history of intracranial bleeding, bleeding disorder and specific provider documented reasons: allergy to aspirin or anti-platelets, use of non-steroidal anti-inflammatory agents, drug-drug interaction, uncontrolled hypertension > 180/110 mmhg or gastroesophageal reflux disease
01/01/2019

M1057

Aspirin or another antiplatelet therapy not used, reason not given
01/01/2019

M1058

Patient was a permanent nursing home resident at any time during the performance period
01/01/2019

M1059

Patient was in hospice or receiving palliative care at any time during the performance period
01/01/2019

M1060

Patient died prior to the end of the performance period
01/01/2019

M1061

Patient pregnancy
01/01/2019

M1062

Patient immunocompromised
01/01/2019

M1063

Patients receiving high doses of immunosuppressive therapy
01/01/2019

M1064

Shingrix vaccine documented as administered or previously received
01/01/2019

M1065

Shingrix vaccine was not administered for reasons documented by clinician (e.g. patient administered vaccine other than shingrix, patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons)
01/01/2019

M1066

Shingrix vaccine not documented as administered, reason not given
01/01/2019

M1067

Hospice services for patient provided any time during the measurement period
01/01/2019

M1068

Adults who are not ambulatory
01/01/2019

M1069

Patient screened for future fall risk
01/01/2019

M1070

Patient not screened for future fall risk, reason not given
01/01/2019

M1071

Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminotomy

P Codes

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Effective Code   Description
01/01/2019

P9073

Platelets, pheresis, pathogen-reduced, each unit
Change in short description of procedure code

Q Codes

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Effective Code   Description
01/01/2019

Q2009

Injection, fosphenytoin, 50 mg phenytoin equivalent
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

Q2026

Injection, radiesse, 0.1 ml
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

Q2028

Injection, sculptra, 0.5 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

Q2040

Tisagenlecleucel, up to 250 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per infusion
Code Discontinued
01/01/2019

Q2041

Axicabtagene ciloleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
Change in long description of procedure or modifier code
01/01/2019

Q2042

Tisagenlecleucel, up to 600 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
01/01/2019

Q4131

Epifix or epicord, per square centimeter
Code Discontinued
01/01/2019

Q4133

Grafix prime, grafixpl prime, stravix and stravixpl, per square centimeter
Change in long description of procedure or modifier code
01/01/2019

Q4137

Amnioexcel, amnioexcel plus or biodexcel, per square centimeter
Change in long description of procedure or modifier code
01/01/2019

Q4172

Puraply or puraply am, per square centimeter
Code Discontinued
01/01/2019

Q4183

Surgigraft, per square centimeter
01/01/2019

Q4184

Cellesta or cellesta duo, per square centimeter
Change in long description of procedure or modifier code
01/01/2019

Q4185

Cellesta flowable amnion (25 mg per cc); per 0.5 cc
01/01/2019

Q4186

Epifix, per square centimeter
01/01/2019

Q4187

Epicord, per square centimeter
01/01/2019

Q4188

Amnioarmor, per square centimeter
01/01/2019

Q4189

Artacent ac, 1 mg
01/01/2019

Q4190

Artacent ac, per square centimeter
01/01/2019

Q4191

Restorigin, per square centimeter
01/01/2019

Q4192

Restorigin, 1 cc
01/01/2019

Q4193

Coll-e-derm, per square centimeter
01/01/2019

Q4194

Novachor, per square centimeter
01/01/2019

Q4195

Puraply, per square centimeter
01/01/2019

Q4196

Puraply am, per square centimeter
01/01/2019

Q4197

Puraply xt, per square centimeter
01/01/2019

Q4198

Genesis amniotic membrane, per square centimeter
01/01/2019

Q4200

Skin te, per square centimeter
01/01/2019

Q4201

Matrion, per square centimeter
01/01/2019

Q4202

Keroxx (2.5g/cc), 1cc
01/01/2019

Q4203

Derma-gide, per square centimeter
01/01/2019

Q4204

Xwrap, per square centimeter
10/01/2019

Q4205

Membrane graft or membrane wrap, per square centimeter
10/01/2019

Q4206

Fluid flow or fluid gf 1 cc
10/01/2019

Q4208

Novafix, per square centimeter
10/01/2019

Q4209

Surgraft, per square centimeter
10/01/2019

Q4210

Axolotl graft or axolotl dualgraft, per square centimeter
10/01/2019

Q4211

Amnion bio or Axobiomembrane, per square centimeter
10/01/2019

Q4212

Allogen, per cc
10/01/2019

Q4213

Ascent, 0.5 mg
10/01/2019

Q4214

Cellesta cord, per square centimeter
10/01/2019

Q4215

Axolotl ambient or axolotl cryo, 0.1 mg
10/01/2019

Q4216

Artacent cord, per square centimeter
10/01/2019

Q4217

Woundfix, BioWound, Woundfix Plus, BioWound Plus, Woundfix Xplus or BioWound Xplus, per square centimeter
10/01/2019

Q4218

Surgicord, per square centimeter
10/01/2019

Q4219

Surgigraft-dual, per square centimeter
10/01/2019

Q4220

BellaCell HD or Surederm, per square centimeter
10/01/2019

Q4221

Amniowrap2, per square centimeter
10/01/2019

Q4222

Progenamatrix, per square centimeter
10/01/2019

Q4226

MyOwn skin, includes harvesting and preparation procedures, per square centimeter
01/01/2019

Q5107

Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg
01/01/2019

Q5109

Injection, infliximab-qbtx, biosimilar, (ixifi), 10 mg
07/01/2019

Q5112

Injection, trastuzumab-dttb, biosimilar, (Ontruzant), 10 mg
07/01/2019

Q5113

Injection, trastuzumab-pkrb, biosimilar, (Herzuma), 10 mg 
07/01/2019

Q5114

Injection, Trastuzumab-dkst, biosimilar, (Ogivri), 10 mg
07/01/2019

Q5115

Injection, rituximab-abbs, biosimilar, (Truxima), 10 mg
10/01/2019

Q5116

Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg
10/01/2019

Q5117

Injection, trastuzumab-anns, biosimilar, (kanjinti), 10 mg
10/01/2019

Q5118

Injection, bevacizumab-bvzr, biosimilar, (Zirabev), 10 mg
01/01/2019

Q9982

Flutemetamol f18, diagnostic, per study dose, up to 5 millicuries
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

Q9983

Florbetaben f18, diagnostic, per study dose, up to 8.1 millicuries
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2019

Q9993

Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg
Code Discontinued
01/01/2019

Q9994

In-line cartridge containing digestive enzyme(s) for enteral feeding, each
Code Discontinued
01/01/2019

Q9995

Injection, emicizumab-kxwh, 0.5 mg
Code Discontinued

S Codes

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Effective Code   Description
10/01/2019

S1090

Mometasone furoate sinus implant, 370 micrograms
Code Discontinued

T Codes

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Effective Code   Description
01/01/2019

T4545

Incontinence product, disposable, penile wrap, each

V Codes

↑ Top
Effective Code   Description
01/01/2019

V5170

Hearing aid, cros, in the ear
Code Discontinued
01/01/2019

V5171

Hearing aid, contralateral routing device, monaural, in the ear (ite)
01/01/2019

V5172

Hearing aid, contralateral routing device, monaural, in the canal (itc)
01/01/2019

V5180

Hearing aid, cros, behind the ear
Code Discontinued
01/01/2019

V5181

Hearing aid, contralateral routing device, monaural, behind the ear (bte)
01/01/2019

V5190

Hearing aid, contralateral routing, monaural, glasses
Change in long description of procedure or modifier code
01/01/2019

V5200

Dispensing fee, contralateral, monaural
Change in long description of procedure or modifier code
01/01/2019

V5210

Hearing aid, bicros, in the ear
Code Discontinued
01/01/2019

V5211

Hearing aid, contralateral routing system, binaural, ite/ite
01/01/2019

V5212

Hearing aid, contralateral routing system, binaural, ite/itc
01/01/2019

V5213

Hearing aid, contralateral routing system, binaural, ite/bte
01/01/2019

V5214

Hearing aid, contralateral routing system, binaural, itc/itc
01/01/2019

V5215

Hearing aid, contralateral routing system, binaural, itc/bte
01/01/2019

V5220

Hearing aid, bicros, behind the ear
Code Discontinued
01/01/2019

V5221

Hearing aid, contralateral routing system, binaural, bte/bte
01/01/2019

V5230

Hearing aid, contralateral routing system, binaural, glasses
Change in long description of procedure or modifier code
01/01/2019

V5240

Dispensing fee, contralateral routing system, binaural
Change in long description of procedure or modifier code

Legend:

  • Code discontinued
  • New code added
  • Code changed (Administrative / Payment)