List of new codes and changes to the 2019 HCPCS code set along with their effective date. Includes discontinued codes that are no longer used.
Legend:
A Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2019 |
|
Rectal control system for vaginal insertion, for long term use, includes pump and all supplies and accessories, any type each | |
| 01/01/2019 |
|
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 |
|
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 |
|
Synthetic resorbable wound dressing, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | |
| 01/01/2019 |
|
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 |
|
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 |
|
Lutetium lu 177, dotatate, therapeutic, 1 millicurie | |
| 01/01/2019 |
|
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 |
|
Instillation, hexaminolevulinate hydrochloride, 100 mg | |
B Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2019 |
|
In-line cartridge containing digestive enzyme(s) for enteral feeding, each | |
C Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2019 |
|
Generator, neurostimulator (implantable), non-rechargeable, with transvenous sensing and stimulation leads | |
| 01/01/2019 |
|
Implantable/insertable device, not otherwise classified
Change in long description of procedure or modifier code |
|
| 01/01/2019 |
|
Brachytherapy source, cesium-131 chloride solution, per millicurie
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2019 |
|
Magnetic resonance imaging without contrast, breast; unilateral
Code Discontinued |
|
| 01/01/2019 |
|
Magnetic resonance imaging without contrast, breast; bilateral
Code Discontinued |
|
| 01/01/2019 |
|
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 |
|
Injection, cerliponase alfa, 1 mg
Code Discontinued |
|
| 01/01/2019 |
|
Injection, c-1 esterase inhibitor (human), haegarda, 10 units
Code Discontinued |
|
| 01/01/2019 |
|
Injection, triptorelin extended release, 3.75 mg
Code Discontinued |
|
| 01/01/2019 |
|
Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine
Code Discontinued |
|
| 01/01/2019 |
|
Injection, inotuzumab ozogamicin, 0.1 mg
Code Discontinued |
|
| 01/01/2019 |
|
Injection, guselkumab, 1 mg
Code Discontinued |
|
| 01/01/2019 |
|
Injection, copanlisib, 1 mg
Code Discontinued |
|
| 01/01/2019 |
|
Lutetium lu 177, dotatate, therapeutic, 1 mci
Code Discontinued |
|
| 01/01/2019 |
|
Injection, voretigene neparvovec-rzyl, 1 billion vector genome
Code Discontinued |
|
| 01/01/2019 |
|
Injection, fosnetupitant 235 mg and palonosetron 0.25 mg
Code Discontinued |
|
| 01/01/2019 |
|
Injection, aripiprazole lauroxil (aristada initio), 1 mg | |
| 01/01/2019 |
|
Injection, patisiran, 0.1 mg | |
| 01/01/2019 |
|
Injection, risperidone (perseris), 0.5 mg | |
| 01/01/2019 |
|
Injection, mogamulizumab-kpkc, 1 mg | |
| 01/01/2019 |
|
Injection, plazomicin, 5 mg | |
| 04/01/2019 |
|
Injection, fremanezumab-vfrm, 1mg | |
| 04/01/2019 |
|
Injection, coagulation factor Xa (recombinant), inactivated (andexxa), 10 mg | |
| 04/01/2019 |
|
Injection, bendamustine hcl (belrapzo), 1 mg
Code Discontinued |
|
| 04/01/2019 |
|
Injection, levoleucovorin, 1 mg | |
| 04/01/2019 |
|
Injection, cemiplimab-rwlc, 1 mg | |
| 04/01/2019 |
|
Injection, moxetumomab pasudotox-tdfk, 0.01 mg | |
| 04/01/2019 |
|
Cocaine hydrochloride nasal solution for topical administration, 1 mg | |
| 07/01/2019 |
|
Injection, caplacizumab-yhdp, 1 mg | |
| 07/01/2019 |
|
Dexamethasone, lacrimal ophthalmic insert, 0.1 mg | |
| 07/01/2019 |
|
Injection, tagraxofusp-erzs, 10 mcg | |
| 07/01/2019 |
|
Injection, emapalumab-lzsg, 1 mg | |
| 07/01/2019 |
|
Injection, omadacycline, 1 mg | |
| 07/01/2019 |
|
Injection, ravulizumab-cwvz, 10 mg | |
| 04/01/2019 |
|
Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl (jivi), 1 i.u.
Code Discontinued |
|
| 01/01/2019 |
|
Injection, clevidipine butyrate, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2019 |
|
Injection, hexaminolevulinate hydrochloride, 100 mg, per study dose
Code Discontinued |
|
| 01/01/2019 |
|
Injection, bupivacaine liposome, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2019 |
|
Iodine i-131 iobenguane, diagnostic, 1 millicurie | |
| 01/01/2019 |
|
Iodine i-131 iobenguane, therapeutic, 1 millicurie | |
| 01/01/2019 |
|
Injection, aprepitant, 1 mg
Code Discontinued |
|
| 01/01/2019 |
|
Injection, rolapitant, 0.5 mg
Code Discontinued |
|
| 01/01/2019 |
|
Hyaluronan or derivative, durolane, for intra-articular injection, per dose
Code Discontinued |
|
| 01/01/2019 |
|
Injection, benralizumab, 1 mg
Code Discontinued |
|
| 01/01/2019 |
|
Injection, rituximab and hyaluronidase, 10 mg
Code Discontinued |
|
| 01/01/2019 |
|
Injection, factor ix (antihemophilic factor, recombinant), glycopegylated, rebinyn, 1 i.u.
Code Discontinued |
|
| 01/01/2019 |
|
Injection, durvalumab, 10 mg
Code Discontinued |
|
| 01/01/2019 |
|
Injection, edaravone, 1 mg
Code Discontinued |
|
| 01/01/2019 |
|
Loxapine, inhalation powder, 10 mg
Code Discontinued |
|
| 01/01/2019 |
|
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 |
|
Ultrasound, abdominal, with contrast
Code Discontinued |
|
| 01/01/2019 |
|
Transurethral destruction of prostate tissue; by radiofrequency water vapor (steam) thermal therapy
Code Discontinued |
|
| 01/01/2019 |
|
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 |
|
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 |
|
Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum | |
| 01/01/2019 |
|
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 |
|
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 |
|
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 |
|
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↑ Top | |||
| Effective | Code | Description | |
| 01/01/2019 |
|
Fluid circulating cold pad with pump, any type
Change in long description of procedure or modifier code |
|
| 01/01/2019 |
|
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 |
|
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 |
|
High frequency chest wall oscillation system, includes all accessories and supplies, each
Change in long description of procedure or modifier code |
|
| 01/01/2019 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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↑ Top | |||
| Effective | Code | Description | |
| 01/01/2019 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention, 5-14 minutes | |
| 01/01/2019 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
Performance of trans-abdominal or trans-vaginal ultrasound and pregnancy location documented
Change in long description of procedure or modifier code |
|
| 01/01/2019 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
Advanced brain imaging (cta, ct, mra or mri) was not ordered
Code Discontinued |
|
| 01/01/2019 |
|
Patients with a normal neurological examination
Code Discontinued |
|
| 01/01/2019 |
|
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 |
|
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 |
|
Advanced brain imaging (cta, ct, mra or mri) was ordered
Code Discontinued |
|
| 01/01/2019 |
|
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 |
|
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 |
|
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 |
|
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 |
|
Photodocumentation of two or more cecal landmarks to establish a complete examination
Change in long description of procedure or modifier code |
|
| 01/01/2019 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
Patient receiving hospice services any time during the measurement period
Change in short description of procedure code |
|
| 01/01/2019 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
Patient has been treated with a systemic medication for psoriasis vulgaris
Change in long description of procedure or modifier code |
|
| 01/01/2019 |
|
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 |
|
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 |
|
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 |
|
Patient alive as of the last day of the measurement year
Change in short description of procedure code |
|
| 01/01/2019 |
|
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 |
|
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 |
|
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 |
|
Documentation of medical reason(s) for not performing a dilated macular examination
Change in short description of procedure code |
|
J Codes↑ Top | |||
| Effective | Code | Description | |
| 10/01/2019 |
|
Injection, omadacycline, 1 mg | |
| 10/01/2019 |
|
Injection, eravacycline, 1 mg | |
| 01/01/2019 |
|
Injection, aprepitant, 1 mg | |
| 10/01/2019 |
|
Injection, Patisiran, 0.1 mg
No maintenance for this code |
|
| 10/01/2019 |
|
Injection, plazomicin, 5 mg
No maintenance for this code |
|
| 01/01/2019 |
|
Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm
Change in short description of procedure code |
|
| 01/01/2019 |
|
Injection, aripiprazole, intramuscular, 0.25 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2019 |
|
Injection, dimercaprol, per 100 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2019 |
|
Injection, baclofen, 50 mcg for intrathecal trial
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2019 |
|
Injection, benralizumab, 1 mg | |
| 01/01/2019 |
|
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 |
|
Injection, cerliponase alfa, 1 mg | |
| 01/01/2019 |
|
Injection, burosumab-twza 1 mg | |
| 10/01/2019 |
|
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 |
|
Injection, c-1 esterase inhibitor (human), (haegarda), 10 units | |
| 10/01/2019 |
|
Injection, levoleucovorin, 0.5 mg
Change in long description of procedure or modifier code |
|
| 10/01/2019 |
|
Injection, levoleucovorin (khapzory), 0.5 mg | |
| 01/01/2019 |
|
Injection, chorionic gonadotropin, per 1,000 usp units
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2019 |
|
Injection, corticotropin, up to 40 units
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2019 |
|
Injection, cosyntropin, not otherwise specified, 0.25 mg
Code Discontinued |
|
| 01/01/2019 |
|
Injection, cosyntropin, 0.25 mg
Change in long description of procedure or modifier code |
|
| 01/01/2019 |
|
Injection, crotalidae immune f(ab')2 (equine), 120 mg | |
| 01/01/2019 |
|
Injection, epoetin beta, 1 microgram, (for non esrd use)
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 10/01/2019 |
|
Dexamethasone, lacrimal ophthalmic insert, 0.1 mg | |
| 10/01/2019 |
|
Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml | |
| 01/01/2019 |
|
Injection, dihydroergotamine mesylate, per 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2019 |
|
Injection, diclofenac sodium, 0.5 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2019 |
|
Injection, edaravone, 1 mg | |
| 10/01/2019 |
|
Injection, ravulizumab-cwvz, 10 mg | |
| 07/01/2019 |
|
Injection, ferric pyrophosphate citrate powder, 0.1 mg of iron | |
| 01/01/2019 |
|
Injection, fosnetupitant 235 mg and palonosetron 0.25 mg | |
| 01/01/2019 |
|
Injection, guselkumab, 1 mg | |
| 01/01/2019 |
|
Injection, ibalizumab-uiyk, 10 mg | |
| 10/01/2019 |
|
Injection, aripiprazole lauroxil, 1 mg
Code Discontinued |
|
| 10/01/2019 |
|
Injection, aripiprazole lauroxil, (aristada initio), 1 mg | |
| 10/01/2019 |
|
Injection, aripiprazole lauroxil, (aristada), 1 mg | |
| 01/01/2019 |
|
Loxapine for inhalation, 1 mg | |
| 01/01/2019 |
|
Injection, pegaptanib sodium, 0.3 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2019 |
|
Injection, rilonacept, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 10/01/2019 |
|
Injection, risperidone (risperdal consta), 0.5 mg
Change in long description of procedure or modifier code |
|
| 01/01/2019 |
|
Injection, rolapitant, 0.5 mg | |
| 10/01/2019 |
|
Injection, risperidone, (perseris), 0.5 mg | |
| 01/01/2019 |
|
Injection, somatropin, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 10/01/2019 |
|
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 |
|
Injection, pentazocine, 30 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 10/01/2019 |
|
Injection, romosozumab-aqqg, 1 mg | |
| 01/01/2019 |
|
Injection, tildrakizumab, 1 mg | |
| 01/01/2019 |
|
Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg | |
| 01/01/2019 |
|
Injection, triptorelin, extended-release, 3.75 mg | |
| 01/01/2019 |
|
Injection, vestronidase alfa-vjbk, 1 mg | |
| 01/01/2019 |
|
Injection, voretigene neparvovec-rzyl, 1 billion vector genomes | |
| 01/01/2019 |
|
Injection, voriconazole, 10 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2019 |
|
Unclassified drug or biological used for esrd on dialysis | |
| 01/01/2019 |
|
Injection, emicizumab-kxwh, 0.5 mg | |
| 01/01/2019 |
|
Injection, human fibrinogen concentrate (fibryga), 1 mg | |
| 01/01/2019 |
|
Injection, human fibrinogen concentrate, not otherwise specified, 1 mg
Change in long description of procedure or modifier code |
|
| 01/01/2019 |
|
Injection factor ix, (antihemophilic factor, recombinant), glycopegylated, (rebinyn), 1 iu | |
| 07/01/2019 |
|
Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl, (jivi), 1 i.u. | |
| 10/01/2019 |
|
Injection, fluocinolone acetonide, intravitreal implant (Iluvien), 0.01 mg
Change in long description of procedure or modifier code |
|
| 10/01/2019 |
|
Injection, fluocinolone acetonide, intravitreal implant (Yutiq), 0.01 mg | |
| 01/01/2019 |
|
Hyaluronan or derivative, durolane, for intra-articular injection, 1 mg | |
| 01/01/2019 |
|
Hyaluronan or derivative, trivisc, for intra-articular injection, 1 mg | |
| 10/01/2019 |
|
Hyaluronan or derivative, synojoynt, for intra-articular injection, 1 mg | |
| 10/01/2019 |
|
Hyaluronan or derivative, triluron, for intra-articular injection, 1 mg | |
| 01/01/2019 |
|
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 |
|
Mometasone furoate sinus implant, 10 micrograms | |
| 01/01/2019 |
|
Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2019 |
|
Muromonab-cd3, parenteral, 5 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 07/01/2019 |
|
Revefenacin inhalation solution, fda-approved final product, non-compounded, administered through DME, 1 microgram | |
| 01/01/2019 |
|
Aprepitant, oral, 5 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2019 |
|
Fludarabine phosphate, oral, 10 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2019 |
|
Melphalan; oral, 2 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2019 |
|
Netupitant 300 mg and palonosetron 0.5 mg, oral
Change in long description of procedure or modifier code |
|
| 01/01/2019 |
|
Topotecan, oral, 0.25 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 07/01/2019 |
|
BCG live intravesical instillation, 1 mg | |
| 07/01/2019 |
|
Injection, bendamustine hydrochloride, (Belrapzo/bendamustine), 1 mg | |
| 01/01/2019 |
|
Injection, bortezomib (velcade), 0.1 mg
Change in long description of procedure or modifier code |
|
| 01/01/2019 |
|
Injection, bortezomib, not otherwise specified, 0.1 mg | |
| 01/01/2019 |
|
Injection, copanlisib, 1 mg | |
| 10/01/2019 |
|
Injection, calaspargase pegol-mknl, 10 units | |
| 10/01/2019 |
|
Injection, cemiplimab-rwlc, 1 mg | |
| 01/01/2019 |
|
Injection, daunorubicin citrate, liposomal formulation, 10 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2019 |
|
Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine | |
| 01/01/2019 |
|
Injection, durvalumab, 10 mg | |
| 01/01/2019 |
|
Injection, fludarabine phosphate, 50 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 10/01/2019 |
|
Injection, mogamulizumab-kpkc, 1 mg | |
| 10/01/2019 |
|
Injection, emapalumab-lzsg, 1 mg | |
| 01/01/2019 |
|
Injection, idarubicin hydrochloride, 5 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2019 |
|
Injection, interferon, alfa-2a, recombinant, 3 million units
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2019 |
|
Injection, interferon, gamma 1-b, 3 million units
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2019 |
|
Leuprolide acetate, per 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2019 |
|
Injection, inotuzumab ozogamicin, 0.1 mg | |
| 10/01/2019 |
|
Injection, tagraxofusp-erzs, 10 micrograms | |
| 01/01/2019 |
|
Injection, plicamycin, 2.5 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2019 |
|
Injection, rituximab, 100 mg
Code Discontinued |
|
| 01/01/2019 |
|
Injection, rituximab 10 mg and hyaluronidase | |
| 01/01/2019 |
|
Injection, rituximab, 10 mg | |
| 10/01/2019 |
|
Injection, moxetumomab pasudotox-tdfk, 0.01 mg | |
| 07/01/2019 |
|
Injection, trastuzumab, 10 mg and Hyaluronidase-oysk | |
K Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2019 |
|
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 |
|
Miscellaneous external component, supply or accessory for use with the argus ii retinal prosthesis system | |
| 01/01/2019 |
|
Miscellaneous component, supply or accessory for use with total artificial heart system | |
| 01/01/2019 |
|
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 |
|
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 |
|
Pain screened as moderate to severe | |
| 01/01/2019 |
|
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 |
|
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 |
|
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 |
|
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 |
|
Tb screening not performed or results not interpreted, reason not given | |
| 01/01/2019 |
|
Disease activity not assessed, reason not given | |
| 01/01/2019 |
|
>=50% of total number of a patient's outpatient ra encounters assessed | |
| 01/01/2019 |
|
<50% of total number of a patient's outpatient ra encounters assessed | |
| 01/01/2019 |
|
Patient treatment and final evaluation complete | |
| 01/01/2019 |
|
Patient treatment and final evaluation complete | |
| 01/01/2019 |
|
Patient treatment and final evaluation complete | |
| 01/01/2019 |
|
Patient treatment and final evaluation complete | |
| 01/01/2019 |
|
Patient treatment and final evaluation complete | |
| 01/01/2019 |
|
Patient treatment and final evaluation complete | |
| 01/01/2019 |
|
Patient treatment and final evaluation complete | |
| 01/01/2019 |
|
Female patients unable to bear children | |
| 01/01/2019 |
|
Patient admitted to palliative care services | |
| 01/01/2019 |
|
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 |
|
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 |
|
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 |
|
Patient had only urgent care visits during the performance period | |
| 01/01/2019 |
|
Patients who were in hospice at any time during the performance period | |
| 01/01/2019 |
|
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 |
|
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 |
|
Patients who were in hospice at any time during the performance period | |
| 01/01/2019 |
|
Patients who were in hospice at any time during the performance period | |
| 01/01/2019 |
|
Imaging of the head (ct or mri) was obtained | |
| 01/01/2019 |
|
Documentation of patients with primary headache diagnosis and imaging other than ct or mri obtained | |
| 01/01/2019 |
|
Imaging of the head (ct or mri) was not obtained, reason not given | |
| 01/01/2019 |
|
Patients with clinical indications for imaging of the head | |
| 01/01/2019 |
|
Patients with no clinical indications for imaging of the head | |
| 01/01/2019 |
|
Adults currently taking pharmacotherapy for oud | |
| 01/01/2019 |
|
Pharmacotherapy for oud initiated after june 30th of performance period | |
| 01/01/2019 |
|
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 |
|
Adults who are deliberately phased out of medication assisted treatment (mat) prior to 180 days of continuous treatment | |
| 01/01/2019 |
|
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 |
|
Patients with a diagnosis of lumbar spine region cancer at the time of the procedure | |
| 01/01/2019 |
|
Patients with a diagnosis of lumbar spine region fracture at the time of the procedure | |
| 01/01/2019 |
|
Patients with a diagnosis of lumbar spine region infection at the time of the procedure | |
| 01/01/2019 |
|
Patients with a diagnosis of lumbar idiopathic or congenital scoliosis | |
| 01/01/2019 |
|
Patient had cancer, fracture or infection related to the lumbar spine or patient had idiopathic or congenital scoliosis | |
| 01/01/2019 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
Patient had cancer, fracture or infection related to the lumbar spine or patient had idiopathic or congenital scoliosis | |
| 01/01/2019 |
|
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 |
|
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 |
|
Patient had only urgent care visits during the performance period | |
| 01/01/2019 |
|
Aspirin or another antiplatelet therapy used | |
| 01/01/2019 |
|
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 |
|
Aspirin or another antiplatelet therapy not used, reason not given | |
| 01/01/2019 |
|
Patient was a permanent nursing home resident at any time during the performance period | |
| 01/01/2019 |
|
Patient was in hospice or receiving palliative care at any time during the performance period | |
| 01/01/2019 |
|
Patient died prior to the end of the performance period | |
| 01/01/2019 |
|
Patient pregnancy | |
| 01/01/2019 |
|
Patient immunocompromised | |
| 01/01/2019 |
|
Patients receiving high doses of immunosuppressive therapy | |
| 01/01/2019 |
|
Shingrix vaccine documented as administered or previously received | |
| 01/01/2019 |
|
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 |
|
Shingrix vaccine not documented as administered, reason not given | |
| 01/01/2019 |
|
Hospice services for patient provided any time during the measurement period | |
| 01/01/2019 |
|
Adults who are not ambulatory | |
| 01/01/2019 |
|
Patient screened for future fall risk | |
| 01/01/2019 |
|
Patient not screened for future fall risk, reason not given | |
| 01/01/2019 |
|
Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminotomy | |
P Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2019 |
|
Platelets, pheresis, pathogen-reduced, each unit
Change in short description of procedure code |
|
Q Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2019 |
|
Injection, fosphenytoin, 50 mg phenytoin equivalent
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2019 |
|
Injection, radiesse, 0.1 ml
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2019 |
|
Injection, sculptra, 0.5 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2019 |
|
Tisagenlecleucel, up to 250 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per infusion
Code Discontinued |
|
| 01/01/2019 |
|
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 |
|
Tisagenlecleucel, up to 600 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose | |
| 01/01/2019 |
|
Epifix or epicord, per square centimeter
Code Discontinued |
|
| 01/01/2019 |
|
Grafix prime, grafixpl prime, stravix and stravixpl, per square centimeter
Change in long description of procedure or modifier code |
|
| 01/01/2019 |
|
Amnioexcel, amnioexcel plus or biodexcel, per square centimeter
Change in long description of procedure or modifier code |
|
| 01/01/2019 |
|
Puraply or puraply am, per square centimeter
Code Discontinued |
|
| 01/01/2019 |
|
Surgigraft, per square centimeter | |
| 01/01/2019 |
|
Cellesta or cellesta duo, per square centimeter
Change in long description of procedure or modifier code |
|
| 01/01/2019 |
|
Cellesta flowable amnion (25 mg per cc); per 0.5 cc | |
| 01/01/2019 |
|
Epifix, per square centimeter | |
| 01/01/2019 |
|
Epicord, per square centimeter | |
| 01/01/2019 |
|
Amnioarmor, per square centimeter | |
| 01/01/2019 |
|
Artacent ac, 1 mg | |
| 01/01/2019 |
|
Artacent ac, per square centimeter | |
| 01/01/2019 |
|
Restorigin, per square centimeter | |
| 01/01/2019 |
|
Restorigin, 1 cc | |
| 01/01/2019 |
|
Coll-e-derm, per square centimeter | |
| 01/01/2019 |
|
Novachor, per square centimeter | |
| 01/01/2019 |
|
Puraply, per square centimeter | |
| 01/01/2019 |
|
Puraply am, per square centimeter | |
| 01/01/2019 |
|
Puraply xt, per square centimeter | |
| 01/01/2019 |
|
Genesis amniotic membrane, per square centimeter | |
| 01/01/2019 |
|
Skin te, per square centimeter | |
| 01/01/2019 |
|
Matrion, per square centimeter | |
| 01/01/2019 |
|
Keroxx (2.5g/cc), 1cc | |
| 01/01/2019 |
|
Derma-gide, per square centimeter | |
| 01/01/2019 |
|
Xwrap, per square centimeter | |
| 10/01/2019 |
|
Membrane graft or membrane wrap, per square centimeter | |
| 10/01/2019 |
|
Fluid flow or fluid gf 1 cc | |
| 10/01/2019 |
|
Novafix, per square centimeter | |
| 10/01/2019 |
|
Surgraft, per square centimeter | |
| 10/01/2019 |
|
Axolotl graft or axolotl dualgraft, per square centimeter | |
| 10/01/2019 |
|
Amnion bio or Axobiomembrane, per square centimeter | |
| 10/01/2019 |
|
Allogen, per cc | |
| 10/01/2019 |
|
Ascent, 0.5 mg | |
| 10/01/2019 |
|
Cellesta cord, per square centimeter | |
| 10/01/2019 |
|
Axolotl ambient or axolotl cryo, 0.1 mg | |
| 10/01/2019 |
|
Artacent cord, per square centimeter | |
| 10/01/2019 |
|
Woundfix, BioWound, Woundfix Plus, BioWound Plus, Woundfix Xplus or BioWound Xplus, per square centimeter | |
| 10/01/2019 |
|
Surgicord, per square centimeter | |
| 10/01/2019 |
|
Surgigraft-dual, per square centimeter | |
| 10/01/2019 |
|
BellaCell HD or Surederm, per square centimeter | |
| 10/01/2019 |
|
Amniowrap2, per square centimeter | |
| 10/01/2019 |
|
Progenamatrix, per square centimeter | |
| 10/01/2019 |
|
MyOwn skin, includes harvesting and preparation procedures, per square centimeter | |
| 01/01/2019 |
|
Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg | |
| 01/01/2019 |
|
Injection, infliximab-qbtx, biosimilar, (ixifi), 10 mg | |
| 07/01/2019 |
|
Injection, trastuzumab-dttb, biosimilar, (Ontruzant), 10 mg | |
| 07/01/2019 |
|
Injection, trastuzumab-pkrb, biosimilar, (Herzuma), 10 mg | |
| 07/01/2019 |
|
Injection, Trastuzumab-dkst, biosimilar, (Ogivri), 10 mg | |
| 07/01/2019 |
|
Injection, rituximab-abbs, biosimilar, (Truxima), 10 mg | |
| 10/01/2019 |
|
Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg | |
| 10/01/2019 |
|
Injection, trastuzumab-anns, biosimilar, (kanjinti), 10 mg | |
| 10/01/2019 |
|
Injection, bevacizumab-bvzr, biosimilar, (Zirabev), 10 mg | |
| 01/01/2019 |
|
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 |
|
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 |
|
Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg
Code Discontinued |
|
| 01/01/2019 |
|
In-line cartridge containing digestive enzyme(s) for enteral feeding, each
Code Discontinued |
|
| 01/01/2019 |
|
Injection, emicizumab-kxwh, 0.5 mg
Code Discontinued |
|
S Codes↑ Top | |||
| Effective | Code | Description | |
| 10/01/2019 |
|
Mometasone furoate sinus implant, 370 micrograms
Code Discontinued |
|
T Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2019 |
|
Incontinence product, disposable, penile wrap, each | |
V Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2019 |
|
Hearing aid, cros, in the ear
Code Discontinued |
|
| 01/01/2019 |
|
Hearing aid, contralateral routing device, monaural, in the ear (ite) | |
| 01/01/2019 |
|
Hearing aid, contralateral routing device, monaural, in the canal (itc) | |
| 01/01/2019 |
|
Hearing aid, cros, behind the ear
Code Discontinued |
|
| 01/01/2019 |
|
Hearing aid, contralateral routing device, monaural, behind the ear (bte) | |
| 01/01/2019 |
|
Hearing aid, contralateral routing, monaural, glasses
Change in long description of procedure or modifier code |
|
| 01/01/2019 |
|
Dispensing fee, contralateral, monaural
Change in long description of procedure or modifier code |
|
| 01/01/2019 |
|
Hearing aid, bicros, in the ear
Code Discontinued |
|
| 01/01/2019 |
|
Hearing aid, contralateral routing system, binaural, ite/ite | |
| 01/01/2019 |
|
Hearing aid, contralateral routing system, binaural, ite/itc | |
| 01/01/2019 |
|
Hearing aid, contralateral routing system, binaural, ite/bte | |
| 01/01/2019 |
|
Hearing aid, contralateral routing system, binaural, itc/itc | |
| 01/01/2019 |
|
Hearing aid, contralateral routing system, binaural, itc/bte | |
| 01/01/2019 |
|
Hearing aid, bicros, behind the ear
Code Discontinued |
|
| 01/01/2019 |
|
Hearing aid, contralateral routing system, binaural, bte/bte | |
| 01/01/2019 |
|
Hearing aid, contralateral routing system, binaural, glasses
Change in long description of procedure or modifier code |
|
| 01/01/2019 |
|
Dispensing fee, contralateral routing system, binaural
Change in long description of procedure or modifier code |
|
Legend:
