Legend:

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

A Codes

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Effective Code   Description
01/01/2018

A4421

Ostomy supply; miscellaneous
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

A9586

Florbetapir f18, diagnostic, per study dose, up to 10 millicuries
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

A9599

Radiopharmaceutical, diagnostic, for beta-amyloid positron emission tomography (pet) imaging, per study dose, not otherwise specified
Code Discontinued
01/01/2018

A9606

Radium ra-223 dichloride, therapeutic, per microcurie
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)

C Codes

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Effective Code   Description
01/01/2018

C1822

Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

C2613

Lung biopsy plug with delivery system
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

C2623

Catheter, transluminal angioplasty, drug-coated, non-laser
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

C2624

Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

C9014

Injection, cerliponase alfa, 1 mg
01/01/2018

C9015

Injection, c-1 esterase inhibitor (human), haegarda, 10 units
01/01/2018

C9016

Injection, triptorelin extended release, 3.75 mg
01/01/2018

C9024

Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine
01/01/2018

C9028

Injection, inotuzumab ozogamicin, 0.1 mg
01/01/2018

C9029

Injection, guselkumab, 1 mg
07/01/2018

C9030

Injection, copanlisib, 1 mg
07/01/2018

C9031

Lutetium Lu 177, dotatate, therapeutic, 1 mCi
07/01/2018

C9032

Injection, voretigene neparvovec-rzyl, 1 billion vector genome
01/01/2018

C9140

Injection, factor viii (antihemophilic factor, recombinant) (afstyla), 1 i.u.
Code Discontinued
01/01/2018

C9248

Injection, clevidipine butyrate, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

C9447

Injection, phenylephrine and ketorolac, 4 ml vial
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
04/01/2018

C9462

Injection, delafloxacin, 1 mg
04/01/2018

C9463

Injection, aprepitant, 1 mg
04/01/2018

C9464

Injection, rolapitant, 0.5 mg
04/01/2018

C9465

Hyaluronan or derivative, Durolane, for intra-articular injection, per dose
04/01/2018

C9466

Injection, benralizumab, 1 mg
04/01/2018

C9467

Injection, rituximab and hyaluronidase, 10 mg
04/01/2018

C9468

Injection, factor ix (antihemophilic factor, recombinant), glycopegylated, Rebinyn, 1 i.u.
06/30/2018

C9469

Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg
Code Discontinued
01/01/2018

C9483

Injection, atezolizumab, 10 mg
Code Discontinued
01/01/2018

C9484

Injection, eteplirsen, 10 mg
Code Discontinued
01/01/2018

C9485

Injection, olaratumab, 10 mg
Code Discontinued
01/01/2018

C9486

Injection, granisetron extended release, 0.1 mg
Code Discontinued
01/01/2018

C9489

Injection, nusinersen, 0.1 mg
Code Discontinued
01/01/2018

C9490

Injection, bezlotoxumab, 10 mg
Code Discontinued
01/01/2018

C9491

Injection, avelumab, 10 mg
Code Discontinued
01/01/2018

C9494

Injection, ocrelizumab, 1 mg
Code Discontinued
01/01/2018

C9738

Adjunctive blue light cystoscopy with fluorescent imaging agent (list separately in addition to code for primary procedure)
01/01/2018

C9748

Transurethral destruction of prostate tissue; by radiofrequency water vapor (steam) thermal therapy
04/01/2018

C9749

Repair of nasal vestibular lateral wall stenosis with implant(s)

E Codes

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Effective Code   Description
01/01/2018

E0575

Nebulizer, ultrasonic, large volume
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

E0950

Wheelchair accessory, tray, each
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

E0953

Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each
01/01/2018

E0954

Wheelchair accessory, foot box, any type, includes attachment and mounting hardware, each foot
01/01/2018

E1639

Scale, each
Change in short description of procedure code

G Codes

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Effective Code   Description
01/01/2018

G0202

Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (cad) when performed
Code Discontinued
01/01/2018

G0204

Diagnostic mammography, including computer-aided detection (cad) when performed; bilateral
Code Discontinued
01/01/2018

G0206

Diagnostic mammography, including computer-aided detection (cad) when performed; unilateral
Code Discontinued
01/01/2018

G0458

Low dose rate (ldr) prostate brachytherapy services, composite rate
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

G0511

Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month
01/01/2018

G0512

Rural health clinic or federally qualified health center (rhc/fqhc) only, psychiatric collaborative care model (psychiatric cocm), 60 minutes or more of clinical staff time for psychiatric cocm services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm) and including services furnished by a behavioral health care manager and consultation with a psychiatric consultant, per calendar month
01/01/2018

G0513

Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (list separately in addition to code for preventive service)
01/01/2018

G0514

Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes (list separately in addition to code g0513 for additional 30 minutes of preventive service)
01/01/2018

G0515

Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes
01/01/2018

G0516

Insertion of non-biodegradable drug delivery implants, 4 or more (services for subdermal rod implant)
Change in long description of procedure or modifier code
01/01/2018

G0517

Removal of non-biodegradable drug delivery implants, 4 or more (services for subdermal implants)
01/01/2018

G0518

Removal with reinsertion, non-biodegradable drug delivery implants, 4 or more (services for subdermal implants)
01/01/2018

G8430

Eligible clinician attests to documenting in the medical record the patient is not eligible for a current list of medications being obtained, updated, or reviewed by the eligible clinician
Change in short description of procedure code
01/01/2018

G8433

Screening for depression not completed, documented reason
Change in short description of procedure code
01/01/2018

G8442

Pain assessment not documented as being performed, documentation the patient is not eligible for a pain assessment using a standardized tool at the time of the encounter
Change in long description of procedure or modifier code
01/01/2018

G8535

Elder maltreatment screen not documented; documentation that patient is not eligible for the elder maltreatment screen at the time of the encounter
Change in long description of procedure or modifier code
01/01/2018

G8540

Functional outcome assessment not documented as being performed, documentation the patient is not eligible for a functional outcome assessment using a standardized tool at the time of the encounter
Change in long description of procedure or modifier code
01/01/2018

G8696

Antithrombotic therapy prescribed at discharge
Code Discontinued
01/01/2018

G8697

Antithrombotic therapy not prescribed for documented reasons (e.g., patient had stroke during hospital stay, patient expired during inpatient stay, other medical reason(s)); (e.g., patient left against medical advice, other patient reason(s))
Code Discontinued
01/01/2018

G8698

Antithrombotic therapy was not prescribed at discharge, reason not given
Code Discontinued
01/01/2018

G8808

Trans-abdominal or trans-vaginal ultrasound not performed, reason not given
Change in long description of procedure or modifier code
01/01/2018

G8869

Patient has documented immunity to hepatitis b and initiating anti-tnf therapy
Change in long description of procedure or modifier code
01/01/2018

G8879

Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer
Code Discontinued
01/01/2018

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)
Change in long description of procedure or modifier code
01/01/2018

G8938

Bmi is documented as being outside of normal limits, follow-up plan is not documented, documentation the patient is not eligible
Change in short description of procedure code
01/01/2018

G8939

Pain assessment documented as positive, follow-up plan not documented, documentation the patient is not eligible at the time of the encounter
Change in long description of procedure or modifier code
01/01/2018

G8941

Elder maltreatment screen documented as positive, follow-up plan not documented, documentation the patient is not eligible for follow-up plan at the time of the encounter
Change in long description of procedure or modifier code
01/01/2018

G8947

One or more neuropsychiatric symptoms
Code Discontinued
01/01/2018

G8967

Warfarin or another fda approved oral anticoagulant is prescribed
Change in long description of procedure or modifier code
01/01/2018

G8968

Documentation of medical reason(s) for not prescribing warfarin or another fda-approved anticoagulant (e.g., atrial appendage device in place)
Change in long description of procedure or modifier code
01/01/2018

G8969

Documentation of patient reason(s) for not prescribing warfarin or another fda-approved oral anticoagulant that is fda approved for the prevention of thromboembolism (e.g., patient choice of having atrial appendage device placed)
Change in long description of procedure or modifier code
01/01/2018

G8971

Warfarin or another oral anticoagulant that is fda approved not prescribed, reason not given
Code Discontinued
01/01/2018

G8972

One or more high risk factors for thromboembolism or more than one moderate risk factor for thromboembolism
Code Discontinued
01/01/2018

G9227

Functional outcome assessment documented, care plan not documented, documentation the patient is not eligible for a care plan at the time of the encounter
Change in long description of procedure or modifier code
01/01/2018

G9256

Documentation of patient death following cas
Change in short description of procedure code
01/01/2018

G9257

Documentation of patient stroke following cas
Change in short description of procedure code
01/01/2018

G9258

Documentation of patient stroke following cea
Change in short description of procedure code
01/01/2018

G9259

Documentation of patient survival and absence of stroke following cas
Change in short description of procedure code
01/01/2018

G9260

Documentation of patient death following cea
Change in short description of procedure code
01/01/2018

G9261

Documentation of patient survival and absence of stroke following cea
Change in short description of procedure code
01/01/2018

G9262

Documentation of patient death in the hospital following endovascular aaa repair
Change in short description of procedure code
01/01/2018

G9263

Documentation of patient discharged alive following endovascular aaa repair
Change in long description of procedure or modifier code
01/01/2018

G9313

Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis for documented reason
Change in long description of procedure or modifier code
01/01/2018

G9348

Ct scan of the paranasal sinuses ordered at the time of diagnosis for documented reasons
Change in long description of procedure or modifier code
01/01/2018

G9381

Documentation of medical reason(s) for not offering assistance with end of life issues (e.g., patient in hospice care, patient in terminal phase) during the measurement period
Code Discontinued
01/01/2018

G9384

Documentation of medical reason(s) for not receiving annual screening for hcv infection (e.g., decompensated cirrhosis indicating advanced disease [i.e., ascites, esophageal variceal bleeding, hepatic encephalopathy], hepatocellular carcinoma, waitlist for organ transplant, limited life expectancy, other medical reasons)
Change in short description of procedure code
01/01/2018

G9496

Documentation of reason for not detecting adenoma(s) or other neoplasm. (e.g., neoplasm detected is only diagnosed as traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma
Code Discontinued
01/01/2018

G9504

Documented reason for not assessing hepatitis b virus (hbv) status (e.g., patient not initiating anti-tnf therapy, patient declined) prior to initiating anti-tnf therapy
Change in long description of procedure or modifier code
01/01/2018

G9541

Filter removed within 3 months of placement
Change in short description of procedure code
01/01/2018

G9607

Documented medical reasons for not performing intraoperative cystoscopy (e.g., urethral pathology precluding cystoscopy, any patient who has a congenital or acquired absence of the urethra) or in the case of patient death
Change in long description of procedure or modifier code
01/01/2018

G9624

Patient not screened for unhealthy alcohol use using a systematic screening method or patient did not receive brief counseling if identified as an unhealthy alcohol user, reason not given
Change in long description of procedure or modifier code
01/01/2018

G9637

At least two orders for the same high-risk medication
Change in long description of procedure or modifier code
01/01/2018

G9638

At least two orders for the same high-risk medications not ordered
Change in long description of procedure or modifier code
01/01/2018

G9656

Patient transferred directly from anesthetizing location to pacu or other non-icu location
Change in long description of procedure or modifier code
01/01/2018

G9716

Bmi is documented as being outside of normal limits, follow-up plan is not completed for documented reason
Change in short description of procedure code
01/01/2018

G9717

Documentation stating the patient has an active diagnosis of depression or has a diagnosed bipolar disorder, therefore screening or follow-up not required
Change in short description of procedure code
01/01/2018

G9744

Patient not eligible due to active diagnosis of hypertension
Change in short description of procedure code
01/01/2018

G9745

Documented reason for not screening or recommending a follow-up for high blood pressure
Change in short description of procedure code
01/01/2018

G9758

Patient in hospice at any time during the measurement period
Change in long description of procedure or modifier code
01/01/2018

G9762

Patient had at least two hpv vaccines (with at least 146 days between the two) or three hpv vaccines on or between the patient's 9th and 13th birthdays
Change in long description of procedure or modifier code
01/01/2018

G9763

Patient did not have at least two hpv vaccines (with at least 146 days between the two) or three hpv vaccines on or between the patient's 9th and 13th birthdays
Change in long description of procedure or modifier code
01/01/2018

G9764

Patient has been treated with an oral systemic or biologic medication for psoriasis vulgaris
Change in long description of procedure or modifier code
01/01/2018

G9765

Documentation that the patient declined therapy change or alternative therapies were unavailable, has documented contraindications, or has not been treated with an oral systemic or biologic 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
01/01/2018

G9784

Pathologists/dermatopathologists providing a second opinion on a biopsy
Change in short description of procedure code
01/01/2018

G9785

Pathology report diagnosing cutaneous basal cell carcinoma or squamous cell carcinoma (to include in situ disease) sent from the pathologist/dermatopathologist to the biopsying clinician for review within 7 days from the time when the tissue specimen was received by the pathologist
Change in long description of procedure or modifier code
01/01/2018

G9786

Pathology report diagnosing cutaneous basal cell carcinoma or squamous cell carcinoma (to include in situ disease) was not sent from the pathologist/dermatopathologist to the biopsying clinician for review within 7 days from the time when the tissue specimen was received by the pathologist
Change in long description of procedure or modifier code
01/01/2018

G9794

Documentation of medical reason(s) for not on a daily aspirin or other antiplatelet (e.g., history of gastrointestinal bleed, intra-cranial bleed, idiopathic thrombocytopenic purpura (itp), gastric bypass or documentation of active anticoagulant use during the measurement period)
Change in long description of procedure or modifier code
01/01/2018

G9814

Death occurring during the index acute care hospitalization
Change in long description of procedure or modifier code
01/01/2018

G9815

Death did not occur during the index acute care hospitalization
Change in long description of procedure or modifier code
01/01/2018

G9816

Death occurring after discharge from the hospital but within 30 days post procedure
Change in long description of procedure or modifier code
01/01/2018

G9817

Death did not occur after discharge from the hospital within 30 days post procedure
Change in long description of procedure or modifier code
01/01/2018

G9840

Ras (kras and nras) gene mutation testing performed before initiation of anti-egfr moab
Change in long description of procedure or modifier code
01/01/2018

G9841

Ras (kras and nras) gene mutation testing not performed before initiation of anti-egfr moab
Change in long description of procedure or modifier code
01/01/2018

G9843

Ras (kras or nras) gene mutation
Change in long description of procedure or modifier code
04/01/2018

G9873

First Medicare Diabetes Prevention Program (MDPP) core session was attended by an MDPP beneficiary under the MDPP Expanded Model (EM).
04/01/2018

G9874

Four total Medicare Diabetes Prevention Program (MDPP) core sessions were attended by an MDPP beneficiary under the MDPP Expanded Model (EM).
04/01/2018

G9875

Nine total Medicare Diabetes Prevention Program (MDPP) core sessions were attended by an MDPP beneficiary under the MDPP Expanded Model (EM).
04/01/2018

G9876

Two Medicare Diabetes Prevention Program (MDPP) core maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 7-9 under the MDPP Expanded Model (EM).
04/01/2018

G9877

Two Medicare Diabetes Prevention Program (MDPP) core maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 10-12 under the MDPP Expanded Model (EM). A core maintenance session is an MDPP service that: (1) is furnished by an MDPP supplier during months 7 through 12 of the MDPP services period; (2) is approximately 1 hour in length; and (3) adheres to a CDC-approved DPP curriculum for maintenance sessions.
04/01/2018

G9878

Two Medicare Diabetes Prevention Program (MDPP) core maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 7-9 under the MDPP Expanded Model (EM).
04/01/2018

G9879

Two Medicare Diabetes Prevention Program (MDPP) core maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 10-12 under the MDPP Expanded Model (EM).
04/01/2018

G9880

The MDPP beneficiary achieved at least 5% weight loss (WL) from his/her baseline weight in months 1-12 of the MDPP services period under the MDPP Expanded Model (EM).
04/01/2018

G9881

The MDPP beneficiary achieved at least 9% weight loss (WL) from his/her baseline weight in months 1-24 under the MDPP Expanded Model (EM).
04/01/2018

G9882

Two Medicare Diabetes Prevention Program (MDPP) ongoing maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 13-15 under the MDPP Expanded Model (EM).
04/01/2018

G9883

Two Medicare Diabetes Prevention Program (MDPP) ongoing maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 16-18 under the MDPP Expanded Model (EM).
04/01/2018

G9884

Two Medicare Diabetes Prevention Program (MDPP) ongoing maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 19-21 under the MDPP Expanded Model (EM).
04/01/2018

G9885

Two Medicare Diabetes Prevention Program (MDPP) ongoing maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 22-24 under the MDPP Expanded Model (EM).
01/01/2018

G9890

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
01/01/2018

G9891

Documentation of medical reason(s) for not performing a dilated macular examination
01/01/2018

G9892

Documentation of patient reason(s) for not performing a dilated macular examination
01/01/2018

G9893

Dilated macular exam was not performed, reason not otherwise specified
01/01/2018

G9894

Androgen deprivation therapy prescribed/administered in combination with external beam radiotherapy to the prostate
01/01/2018

G9895

Documentation of medical reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate (e.g., salvage therapy)
01/01/2018

G9896

Documentation of patient reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate
01/01/2018

G9897

Patients who were not prescribed/administered androgen deprivation therapy in combination with external beam radiotherapy to the prostate, reason not given
01/01/2018

G9898

Patient age 65 or older in institutinal special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 any time during the measurement period
01/01/2018

G9899

Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results documented and reviewed
01/01/2018

G9900

Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results were not documented and reviewed, reason not otherwise specified
01/01/2018

G9901

Patient age 65 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 any time during the measurement period
01/01/2018

G9902

Patient screened for tobacco use and identified as a tobacco user
01/01/2018

G9903

Patient screened for tobacco use and identified as a tobacco non-user
01/01/2018

G9904

Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)
01/01/2018

G9905

Patient not screened for tobacco use, reason not given
01/01/2018

G9906

Patient identified as a tobacco user received tobacco cessation intervention (counseling and/or pharmacotherapy)
01/01/2018

G9907

Documentation of medical reason(s) for not providing tobacco cessation intervention (e.g., limited life expectancy, other medical reason)
01/01/2018

G9908

Patient identified as tobacco user did not receive tobacco cessation intervention (counseling and/or pharmacotherapy), reason not given
01/01/2018

G9909

Documentation of medical reason(s) for not providing tobacco cessation intervention if identified as a tobacco user (eg, limited life expectancy, other medical reason)
01/01/2018

G9910

Patients age 65 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 anytime during the measurement period
01/01/2018

G9911

Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer before or after neoadjuvant systemic therapy
01/01/2018

G9912

Hepatitis b virus (hbv) status assessed and results interpreted prior to initiating anti-tnf (tumor necrosis factor) therapy
01/01/2018

G9913

Hepatitis b virus (hbv) status not assessed and results interpreted prior to initiating anti-tnf (tumor necrosis factor) therapy, reason not given
01/01/2018

G9914

Patient receiving an anti-tnf agent
01/01/2018

G9915

No record of hbv results documented
01/01/2018

G9916

Functional status performed once in the last 12 months
01/01/2018

G9917

Documentation of medical reason(s) for not performing functional status (e.g., patient is severely impaired and caregiver knowledge is limited, other medical reason)
01/01/2018

G9918

Functional status not performed, reason not otherwise specified
01/01/2018

G9919

Screening performed and positive and provision of recommendations
01/01/2018

G9920

Screening performed and negative
01/01/2018

G9921

No screening performed, partial screening performed or positive screen without recommendations and reason is not given or otherwise specified
01/01/2018

G9922

Safety concerns screen provided and if positive then documented mitigation recommendations
01/01/2018

G9923

Safety concerns screen provided and negative
01/01/2018

G9924

Documentation of medical reason(s) for not providing safety concerns screen or for not providing recommendations, orders or referrals for positive screen (e.g., patient in palliative care, other medical reason)
01/01/2018

G9925

Safety concerns screening not provided, reason not otherwise specified
01/01/2018

G9926

Safety concerns screening positive screen is without provision of mitigation recommendations, including but not limited to referral to other resources
01/01/2018

G9927

Documentation of system reason(s) for not prescribing warfarin or another fda-approved anticoagulation due to patient being currently enrolled in a clinical trial related to af/atrial flutter treatment
01/01/2018

G9928

Warfarin or another fda-approved anticoagulant not prescribed, reason not given
01/01/2018

G9929

Patient with transient or reversible cause of af (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac surgery)
01/01/2018

G9930

Patients who are receiving comfort care only
01/01/2018

G9931

Documentation of cha2ds2-vasc risk score of 0 or 1
01/01/2018

G9932

Documentation of patient reason(s) for not having records of negative or managed positive tb screen (e.g., patient does not return for mantoux (ppd) skin test evaluation)
01/01/2018

G9933

Adenoma(s) or colorectal cancer detected during screening colonoscopy
01/01/2018

G9934

Documentation that neoplasm detected is only diagnosed as traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma
01/01/2018

G9935

Adenoma(s) or colorectal cancer not detected during screening colonoscopy
01/01/2018

G9936

Surveillance colonoscopy - personal history of colonic polyps, colon cancer, or other malignant neoplasm of rectum, rectosigmoid junction, and anus
01/01/2018

G9937

Diagnostic colonoscopy
01/01/2018

G9938

Patients age 65 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 any time during the measurement period
01/01/2018

G9939

Pathologists/dermatopathologists is the same clinician who performed the biopsy
01/01/2018

G9940

Documentation of medical reason(s) for not on a statin (e.g., pregnancy, in vitro fertilization, clomiphene rx, esrd, cirrhosis, muscular pain and disease during the measurement period or prior year)
01/01/2018

G9941

Back pain was measured by the visual analog scale (vas) within three months preoperatively and at three months (6 - 20 weeks) postoperatively
01/01/2018

G9942

Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminotomy
01/01/2018

G9943

Back pain was not measured by the visual analog scale (vas) within three months preoperatively and at three months ( 6 - 20 weeks) postoperatively
01/01/2018

G9944

Back pain was measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively
01/01/2018

G9945

Patient had cancer, fracture or infection related to the lumbar spine or patient had idiopathic or congenital scoliosis
01/01/2018

G9946

Back pain was not measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively
01/01/2018

G9947

Leg pain was measured by the visual analog scale (vas) within three months preoperatively and at three months (6 to 20 weeks) postoperatively
01/01/2018

G9948

Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminotomy
01/01/2018

G9949

Leg pain was not measured by the visual analog scale (vas) within three months preoperatively and at three months (6 to 20 weeks) postoperatively
01/01/2018

G9954

Patient exhibits 2 or more risk factors for post-operative vomiting
01/01/2018

G9955

Cases in which an inhalational anesthetic is used only for induction
01/01/2018

G9956

Patient received combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively
01/01/2018

G9957

Documentation of medical reason for not receiving combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively (e.g., intolerance or other medical reason)
01/01/2018

G9958

Patient did not receive combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively
01/01/2018

G9959

Systemic antimicrobials not prescribed
01/01/2018

G9960

Documentation of medical reason(s) for prescribing systemic antimicrobials
01/01/2018

G9961

Systemic antimicrobials prescribed
01/01/2018

G9962

Embolization endpoints are documented separately for each embolized vessel and ovarian artery angiography or embolization performed in the presence of variant uterine artery anatomy
01/01/2018

G9963

Embolization endpoints are not documented separately for each embolized vessel or ovarian artery angiography or embolization not performed in the presence of variant uterine artery anatomy
01/01/2018

G9964

Patient received at least one well-child visit with a pcp during the performance period
01/01/2018

G9965

Patient did not receive at least one well-child visit with a pcp during the performance period
01/01/2018

G9966

Children who were screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report
01/01/2018

G9967

Children who were not screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report
01/01/2018

G9968

Patient was referred to another provider or specialist during the performance period
01/01/2018

G9969

Provider who referred the patient to another provider received a report from the provider to whom the patient was referred
01/01/2018

G9970

Provider who referred the patient to another provider did not receive a report from the provider to whom the patient was referred
01/01/2018

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
01/01/2018

G9975

Documentation of medical reason(s) for not performing a dilated macular examination
01/01/2018

G9976

Documentation of patient reason(s) for not performing a dilated macular examination
01/01/2018

G9977

Dilated macular exam was not performed, reason not otherwise specified

J Codes

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Effective Code   Description
01/01/2018

J0120

Injection, tetracycline, up to 250 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J0130

Injection abciximab, 10 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J0132

Injection, acetylcysteine, 100 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J0215

Injection, alefacept, 0.5 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J0365

Injection, aprotonin, 10,000 kiu
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J0400

Injection, aripiprazole, intramuscular, 0.25 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J0470

Injection, dimercaprol, per 100 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J0565

Injection, bezlotoxumab, 10 mg
01/01/2018

J0583

Injection, bivalirudin, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J0604

Cinacalcet, oral, 1 mg, (for esrd on dialysis)
01/01/2018

J0606

Injection, etelcalcetide, 0.1 mg
01/01/2018

J0720

Injection, chloramphenicol sodium succinate, up to 1 gm
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J0725

Injection, chorionic gonadotropin, per 1,000 usp units
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J0833

Injection, cosyntropin, not otherwise specified, 0.25 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J0884

Injection, argatroban, 1 mg (for esrd on dialysis)
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J0888

Injection, epoetin beta, 1 microgram, (for non esrd use)
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J1110

Injection, dihydroergotamine mesylate, per 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J1130

Injection, diclofenac sodium, 0.5 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J1205

Injection, chlorothiazide sodium, per 500 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J1324

Injection, enfuvirtide, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J1428

Injection, eteplirsen, 10 mg
01/01/2018

J1555

Injection, immune globulin (cuvitru), 100 mg
01/01/2018

J1627

Injection, granisetron, extended-release, 0.1 mg
01/01/2018

J1725

Injection, hydroxyprogesterone caproate, 1 mg
Code Discontinued
01/01/2018

J1726

Injection, hydroxyprogesterone caproate, (makena), 10 mg
01/01/2018

J1729

Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg
01/01/2018

J1730

Injection, diazoxide, up to 300 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J1945

Injection, lepirudin, 50 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J2020

Injection, linezolid, 200 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J2260

Injection, milrinone lactate, 5 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J2274

Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg
Change in short description of procedure code
01/01/2018

J2326

Injection, nusinersen, 0.1 mg
01/01/2018

J2350

Injection, ocrelizumab, 1 mg
01/01/2018

J2358

Injection, olanzapine, long-acting, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J2510

Injection, penicillin g procaine, aqueous, up to 600,000 units
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J2670

Injection, tolazoline hcl, up to 25 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J2730

Injection, pralidoxime chloride, up to 1 gm
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J3355

Injection, urofollitropin, 75 iu
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J3358

Ustekinumab, for intravenous injection, 1 mg
01/01/2018

J3365

Injection, iv, urokinase, 250,000 i.u. vial
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J3489

Injection, zoledronic acid, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J7191

Factor viii (antihemophilic factor (porcine)), per i.u.
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J7196

Injection, antithrombin recombinant, 50 i.u.
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J7210

Injection, factor viii, (antihemophilic factor, recombinant), (afstyla), 1 i.u.
01/01/2018

J7211

Injection, factor viii, (antihemophilic factor, recombinant), (kovaltry), 1 i.u.
01/01/2018

J7296

Levonorgestrel-releasing intrauterine contraceptive system, (kyleena), 19.5 mg
01/01/2018

J7309

Methyl aminolevulinate (mal) for topical administration, 16.8%, 1 gram
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J7310

Ganciclovir, 4.5 mg, long-acting implant
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J7320

Hyaluronan or derivitive, genvisc 850, for intra-articular injection, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J7321

Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose
Change in long description of procedure or modifier code
01/01/2018

J7328

Hyaluronan or derivative, gelsyn-3, for intra-articular injection, 0.1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J7345

Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg
01/01/2018

J7508

Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J7513

Daclizumab, parenteral, 25 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J8510

Busulfan; oral, 2 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J8650

Nabilone, oral, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J8700

Temozolomide, oral, 5 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J9022

Injection, atezolizumab, 10 mg
01/01/2018

J9023

Injection, avelumab, 10 mg
01/01/2018

J9151

Injection, daunorubicin citrate, liposomal formulation, 10 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J9185

Injection, fludarabine phosphate, 50 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J9200

Injection, floxuridine, 500 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J9203

Injection, gemtuzumab ozogamicin, 0.1 mg
01/01/2018

J9208

Injection, ifosfamide, 1 gram
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J9213

Injection, interferon, alfa-2a, recombinant, 3 million units
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J9219

Leuprolide acetate implant, 65 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J9263

Injection, oxaliplatin, 0.5 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

J9285

Injection, olaratumab, 10 mg
01/01/2018

J9300

Injection, gemtuzumab ozogamicin, 5 mg
Code Discontinued
01/01/2018

J9351

Injection, topotecan, 0.1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)

K Codes

↑ Top
Effective Code   Description
04/01/2018

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

L Codes

↑ Top
Effective Code   Description
01/01/2018

L3760

Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
Change in long description of procedure or modifier code
01/01/2018

L3761

Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, off-the-shelf
01/01/2018

L7700

Gasket or seal, for use with prosthetic socket insert, any type, each
01/01/2018

L8618

Transmitter cable for use with cochlear implant device or auditory osseointegrated device, replacement
Change in long description of procedure or modifier code
01/01/2018

L8624

Lithium ion battery for use with cochlear implant or auditory osseointegrated device speech processor, ear level, replacement, each
Change in long description of procedure or modifier code
01/01/2018

L8625

External recharging system for battery for use with cochlear implant or auditory osseointegrated device, replacement only, each
01/01/2018

L8691

Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, each
Change in long description of procedure or modifier code
01/01/2018

L8694

Auditory osseointegrated device, transducer/actuator, replacement only, each

P Codes

↑ Top
Effective Code   Description
01/01/2018

P9072

Platelets, pheresis, pathogen reduced or rapid bacterial tested, each unit
Code Discontinued
01/01/2018

P9073

Platelets, pheresis, pathogen-reduced, each unit
01/01/2018

P9100

Pathogen(s) test for platelets

Q Codes

↑ Top
Effective Code   Description
01/01/2018

Q0477

Power module patient cable for use with electric or electric/pneumatic ventricular assist device, replacement only
01/01/2018

Q2009

Injection, fosphenytoin, 50 mg phenytoin equivalent
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

Q2040

Tisagenlecleucel, up to 250 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per infusion
04/01/2018

Q2041

Axicabtagene Ciloleucel, up to 200 Million Autologous Anti-CD19 CAR T Cells, Including Leukapheresis And Dose Preparation Procedures, Per Infusion
01/01/2018

Q4121

Theraskin, per square centimeter
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

Q4132

Grafix core and grafixpl core, per square centimeter
Change in long description of procedure or modifier code
01/01/2018

Q4133

Grafix prime and grafixpl prime, per square centimeter
Change in long description of procedure or modifier code
01/01/2018

Q4148

Neox cord 1k, neox cord rt, or clarix cord 1k, per square centimeter
Change in long description of procedure or modifier code
01/01/2018

Q4156

Neox 100 or clarix 100, per square centimeter
Change in long description of procedure or modifier code
01/01/2018

Q4158

Kerecis omega3, per square centimeter
Change in long description of procedure or modifier code
01/01/2018

Q4162

Woundex flow, bioskin flow, 0.5 cc
Change in long description of procedure or modifier code
01/01/2018

Q4163

Woundex, bioskin, per square centimeter
Change in long description of procedure or modifier code
01/01/2018

Q4172

Puraply or puraply am, per square centimeter
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

Q4176

Neopatch, per square centimeter
01/01/2018

Q4177

Floweramnioflo, 0.1 cc
01/01/2018

Q4178

Floweramniopatch, per square centimeter
01/01/2018

Q4179

Flowerderm, per square centimeter
01/01/2018

Q4180

Revita, per square centimeter
01/01/2018

Q4181

Amnio wound, per square centimeter
01/01/2018

Q4182

Transcyte, per square centimeter
01/01/2018

Q5102

Injection, infliximab, biosimilar, 10 mg
Code Discontinued
04/01/2018

Q5103

Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg
04/01/2018

Q5104

Injection, infliximab-abda, biosimilar, (renflexis), 10 mg
07/01/2018

Q5105

Injection, epoetin alfa, biosimilar, (Retacrit) (for esrd on dialysis), 100 units
07/01/2018

Q5106

Injection, epoetin alfa, biosimilar, (Retacrit) (for non-esrd use), 1000 units
01/01/2018

Q9950

Injection, sulfur hexafluoride lipid microspheres, per ml
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2018

Q9984

Levonorgestrel-releasing intrauterine contraceptive system (kyleena), 19.5 mg
Code Discontinued
01/01/2018

Q9985

Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg
Code Discontinued
01/01/2018

Q9986

Injection, hydroxyprogesterone caproate, (makena), 10 mg
Code Discontinued
01/01/2018

Q9987

Pathogen(s) test for platelets
Code Discontinued
01/01/2018

Q9988

Platelets, pheresis, pathogen-reduced, each unit
Code Discontinued
01/01/2018

Q9989

Ustekinumab, for intravenous injection, 1 mg
Code Discontinued
07/01/2018

Q9991

Injection, buprenorphine extended-release (sublocade), less than or equal to 100 mg
07/01/2018

Q9992

Injection, buprenorphine extended-release (sublocade), greater than 100 mg
07/01/2018

Q9993

Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg
07/01/2018

Q9994

In-line cartridge containing digestive enzyme(s) for enteral feeding, each
07/01/2018

Q9995

Injection, emicizumab-kxwh, 0.5 mg

Legend:

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