List of new codes and changes to the 2021 HCPCS code set along with their effective date. Includes discontinued codes that are no longer used.
Legend:
A Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2021 |
|
Fluoroestradiol f 18, diagnostic, 1 millicurie
No maintenance for this code |
|
| 04/01/2021 |
|
Copper cu-64, dotatate, diagnostic, 1 millicurie | |
C Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2021 |
|
Hemostatic agent, gastrointestinal, topical
No maintenance for this code |
|
| 01/01/2021 |
|
Intravertebral body fracture augmentation with implant (e.g., metal, polymer)
No maintenance for this code |
|
| 01/01/2021 |
|
Generator, neurostimulator (implantable), non-rechargeable with carotid sinus baroreceptor stimulation lead(s)
No maintenance for this code |
|
| 01/01/2021 |
|
Fluoroestradiol f18, diagnostic, 1 mci
No maintenance for this code |
|
| 01/01/2021 |
|
Injection, daratumumab 10 mg and hyaluronidase-fihj
No maintenance for this code |
|
| 01/01/2021 |
|
Mitomycin pyelocalyceal instillation, 1 mg
No maintenance for this code |
|
| 01/01/2021 |
|
Injection, sacituzumab govitecan-hziy, 2.5 mg
No maintenance for this code |
|
| 04/01/2021 |
|
Copper cu-64, dotatate, diagnostic, 1 millicurie
Code Discontinued |
|
| 04/01/2021 |
|
Injection, belantamab mafodontin-blmf, 0.5 mg
Code Discontinued |
|
| 04/01/2021 |
|
Injection, tafasitamab-cxix, 2 mg
Code Discontinued |
|
| 04/01/2021 |
|
Injection, viltolarsen, 10 mg
Code Discontinued |
|
| 04/01/2021 |
|
Injection, immune globulin (asceniv), 500 mg
Code Discontinued |
|
| 04/01/2021 |
|
Brexucabtagene autoleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
Code Discontinued |
|
| 04/01/2021 |
|
Injection, lumasiran, 0.5 mg | |
| 04/01/2021 |
|
Mometasone furoate sinus implant, 10 micrograms (sinuva)
Code Discontinued |
|
| 01/01/2021 |
|
Nasal endoscopy, surgical; balloon dilation of eustachian tube
No maintenance for this code |
|
| 01/01/2021 |
|
Ablation of prostate, transrectal, high intensity focused ultrasound (hifu), including imaging guidance
No maintenance for this code |
|
| 01/01/2021 |
|
Repair of nasal vestibular lateral wall stenosis with implant(s)
No maintenance for this code |
|
| 01/01/2021 |
|
Non-randomized, non-blinded procedure for nyha class ii, iii, iv heart failure; transcatheter implantation of interatrial shunt, including right and left heart catheterization, transeptal puncture, trans-esophageal echocardiography (tee)/intracardiac echocardiography (ice), and all imaging with or without guidance (e.g., ultrasound, fluoroscopy), performed in an approved investigational device exemption (ide) study
No maintenance for this code |
|
| 01/01/2021 |
|
Vitrectomy, mechanical, pars plana approach, with subretinal injection of pharmacologic/biologic agent
No maintenance for this code |
|
| 01/01/2021 |
|
Nasal/sinus endoscopy, cryoablation nasal tissue(s) and/or nerve(s), unilateral or bilateral
No maintenance for this code |
|
| 01/01/2021 |
|
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery(ies), with intravascular lithotripsy, includes angioplasty within the same vessel (s), when performed
No maintenance for this code |
|
| 01/01/2021 |
|
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery(ies); with intravascular lithotripsy, and transluminal stent placement(s), includes angioplasty within the same vessel(s), when performed
No maintenance for this code |
|
| 01/01/2021 |
|
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery(ies); with intravascular lithotripsy and atherectomy, includes angioplasty within the same vessel (s), when performed
No maintenance for this code |
|
| 01/01/2021 |
|
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery(ies); with intravascular lithotripsy and transluminal stent placement(s), and atherectomy, includes angioplasty within the same vessel (s), when performed
No maintenance for this code |
|
| 04/01/2021 |
|
Intraoperative near-infrared fluorescence imaging of major extra-hepatic bile duct(s) (e.g., cystic duct, common bile duct and common hepatic duct) with intravenous administration of indocyanine green (icg) (list separately in addition to code for primary procedure) | |
| 04/01/2021 |
|
Esophageal mucosal integrity testing by electrical impedance, transoral (list separately in addition to code for primary procedure) | |
G Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2021 |
|
Professional services for the administration of anti-infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy or other highly complex drug or biological) for each infusion drug administration calendar day in the individual's home, each 15 minutes
No maintenance for this code |
|
| 01/01/2021 |
|
Professional services for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes
No maintenance for this code |
|
| 01/01/2021 |
|
Professional services for the administration of intravenous chemotherapy or other intravenous highly complex drug or biological infusion for each infusion drug administration calendar day in the individual's home, each 15 minutes
No maintenance for this code |
|
| 01/01/2021 |
|
Professional services, initial visit, for the administration of anti-infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy or other highly complex drug or biological) for each infusion drug administration calendar day in the individual's home, each 15 minutes
No maintenance for this code |
|
| 01/01/2021 |
|
Professional services, initial visit, for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes
No maintenance for this code |
|
| 01/01/2021 |
|
Professional services, initial visit, for the administration of intravenous chemotherapy or other highly complex infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes
No maintenance for this code |
|
| 01/01/2021 |
|
Low dose ct scan (ldct) for lung cancer screening
No maintenance for this code |
|
| 01/01/2021 |
|
Clinical decision support mechanism national imaging associates, as defined by the medicare appropriate use criteria program
No maintenance for this code |
|
| 01/01/2021 |
|
Clinical decision support mechanism test appropriate, as defined by the medicare appropriate use criteria program
No maintenance for this code |
|
| 04/01/2021 |
|
Services for high intensity clinical services associated with the initial engagement and outreach of beneficiaries assigned to the sip component of the pcf model (do not bill with chronic care management codes) | |
| 01/01/2021 |
|
Chronic care management services, each additional 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (list separately in addition to code for primary procedure). (do not report g2058 for care management services of less than 20 minutes additional to the first 20 minutes of chronic care management services during a calendar month). (use g2058 in conjunction with 99490). (do not report 99490, g2058 in the same calendar month as 99487, 99489, 99491)).
No maintenance for this code |
|
| 01/01/2021 |
|
Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 5-10 minutes
No maintenance for this code |
|
| 01/01/2021 |
|
Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11-20 minutes
No maintenance for this code |
|
| 01/01/2021 |
|
Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes
No maintenance for this code |
|
| 01/01/2021 |
|
Most recent hemoglobin a1c (hba1c) level 7.0 to 9.0%
No maintenance for this code |
|
| 01/01/2021 |
|
Episodes where the patient had a competing diagnosis within three days after the episode date (e.g., intestinal infection, pertussis, bacterial infection, lyme disease, otitis media, acute sinusitis, chronic sinusitis, infection of the adenoids, prostatitis, cellulitis, mastoiditis, or bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia/gonococcal infections, venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis or uti)
No maintenance for this code |
|
| 01/01/2021 |
|
Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed
No maintenance for this code |
|
| 01/01/2021 |
|
Seven standard field stereoscopic photos with interpretation by an ophthalmologist or optometrist documented and reviewed
No maintenance for this code |
|
| 01/01/2021 |
|
Eye imaging validated to match diagnosis from seven standard field stereoscopic photos results documented and reviewed
No maintenance for this code |
|
| 01/01/2021 |
|
Patient age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Patient age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Patients 66 - 80 years of age with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Patients 66 - 80 years of age with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Patients 81 years of age and older with at least one claim/encounter for frailty during the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Within the past 2 years, calcium and/or vitamin d optimization has been ordered or performed
No maintenance for this code |
|
| 01/01/2021 |
|
Within the past 2 years, calcium and/or vitamin d optimization has not been ordered or performed
No maintenance for this code |
|
| 01/01/2021 |
|
Patients 66-80 years of age and had at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Patients 66-80 years of age and had at least one claim/encounter for frailty during the measurement period and a dispensed dementia medication
No maintenance for this code |
|
| 01/01/2021 |
|
Patients 81 years of age and older with at least one claim/encounter for frailty during the six months prior to the measurement period through december 31 of the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Patients 66 - 80 years of age with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Patients age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 days during the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Patients 81 years and older with a diagnosis of frailty
No maintenance for this code |
|
| 01/01/2021 |
|
Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Patients 66 years of age or older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Patients 66 years of age or older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Back pain measured by the visual analog scale (vas) at three months (6 - 20 weeks) postoperatively was less than or equal to 3.0 or back pain measured by the visual analog scale (vas) within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated an improvement of 5.0 points or greater
No maintenance for this code |
|
| 01/01/2021 |
|
Back pain as measured by the visual analog scale (vas) at one year (9 to 15 months) postoperatively was less than or equal to 3.0 or back pain measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated a change of 5.0 points or greater
No maintenance for this code |
|
| 01/01/2021 |
|
Functional status measured by the oswestry disability index (odi version 2.1a) at three months (6 - 20 weeks) postoperatively was less than or equal to 22 or functional status measured by the odi version 2.1a within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated a change of 30 points or greater
No maintenance for this code |
|
| 01/01/2021 |
|
Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time before or during the episode of care
No maintenance for this code |
|
| 01/01/2021 |
|
Risk-adjusted functional status change residual score for the neck impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
No maintenance for this code |
|
| 01/01/2021 |
|
In hospice or using hospice services during the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Patient received at least one td vaccine or one tdap vaccine between nine years prior to the start of the measurement period and the end of the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Patient had history of at least one of the following contraindications any time during or before the measurement period: anaphylaxis due to tdap vaccine, anaphylaxis due to td vaccine or its components; encephalopathy due to tdap or td vaccination (post tetanus vaccination encephalitis, post diphtheria vaccination encephalitis or post pertussis vaccination encephalitis.)
No maintenance for this code |
|
| 01/01/2021 |
|
Patient did not receive at least one td vaccine or one tdap vaccine between nine years prior to the start of the measurement period and the end of the measurement period; or have history of at least one of the following contraindications any time during or before the measurement period: anaphylaxis due to tdap vaccine, anaphylaxis due to td vaccine or its components; encephalopathy due to tdap or td vaccination (post tetanus vaccination encephalitis, post diphtheria vaccination encephalitis or post pertussis vaccination encephalitis.)
No maintenance for this code |
|
| 01/01/2021 |
|
Patients received both the 13-valent pneumococcal conjugate vaccine and the 23-valent pneumococcal polysaccharide vaccine at least 12 months apart, with the first occurrence after the age of 60 before or during the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Patient had prior pneumococcal vaccine adverse reaction any time during or before the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Patient did not receive both the 13-valent pneumococcal conjugate vaccine and the 23-valent pneumococcal polysaccharide vaccine at least 12 months apart, with the first occurrence after the age of 60 before or during measurement period; or have prior pneumococcal vaccine adverse reaction any time during or before the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Patient received at least one dose of the herpes zoster live vaccine or two doses of the herpes zoster recombinant vaccine (at least 28 days apart) anytime on or after the patient's 50th birthday before or during the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Patient had prior adverse reaction caused by zoster vaccine or its components any time during or before the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Patient did not receive at least one dose of the herpes zoster live vaccine or two doses of the herpes zoster recombinant vaccine (at least 28 days apart) anytime on or after the patient's 50th birthday before or during the measurement period; or have prior adverse reaction caused by zoster vaccine or its components any time during or before the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Patient received an influenza vaccine on or between july 1 of the year prior to the measurement period and june 30 of the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Patient had a prior influenza virus vaccine adverse reaction any time before or during the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Patient did not receive an influenza vaccine on or between july 1 of the year prior to the measurement period and june 30 of the measurement period; or did not have a prior influenza virus vaccine adverse reaction any time before or during the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Patient refused to participate at admission and/or discharge; patient unable to complete the neck fs prom at admission or discharge due to cognitive deficit, visual deficit, motor deficit, language barrier, or low reading level, and a suitable proxy/recorder is not available; patient self-discharged early; medical reason
No maintenance for this code |
|
| 01/01/2021 |
|
Risk-adjusted functional status change residual score for the neck impairment successfully calculated and the score was less than zero (< 0)
No maintenance for this code |
|
| 04/01/2021 |
|
All inclusive payment for services related to highly coordinated and integrated opioid use disorder (oud) treatment services furnished for the demonstration project | |
| 01/01/2021 |
|
Uri episodes where the patient had a competing comorbid condition during the 12 months prior to or on the episode date (e.g., tuberculosis, neutropenia, cystic fibrosis, chronic bronchitis, pulmonary edema, respiratory failure, rheumatoid lung disease)
No maintenance for this code |
|
| 01/01/2021 |
|
Uri episodes when the patient had a new or refill prescription of antibiotics (table 1) in the 30 days prior to or on the episode date
No maintenance for this code |
|
| 01/01/2021 |
|
Episodes where the patient had a competing comorbid condition during the 12 months prior to or on the episode date (e.g., tuberculosis, neutropenia, cystic fibrosis, chronic bronchitis, pulmonary edema, respiratory failure, rheumatoid lung disease)
No maintenance for this code |
|
| 01/01/2021 |
|
Outpatient, ed, or observation visits that result in an inpatient admission
No maintenance for this code |
|
| 01/01/2021 |
|
Acute bronchitis/bronchiolitis episodes when the patient had a new or refill prescription of antibiotics (table 1) in the 30 days prior to or on the episode date
No maintenance for this code |
|
| 01/01/2021 |
|
Clinician documented that patient was not an eligible candidate for lower extremity neurological exam measure, for example patient bilateral amputee; patient has condition that would not allow them to accurately respond to a neurological exam (dementia, alzheimer's, etc.); patient has previously documented diabetic peripheral neuropathy with loss of protective sensation
No maintenance for this code |
|
| 01/01/2021 |
|
Clinician documented that patient had medical reason for not performing lower extremity neurological exam
No maintenance for this code |
|
| 01/01/2021 |
|
Clinician documented that patient was not an eligible candidate for evaluation of footwear as patient is bilateral lower extremity amputee
No maintenance for this code |
|
| 01/01/2021 |
|
Bmi not documented due to medical reason or patient refusal of height or weight measurement
No maintenance for this code |
|
| 01/01/2021 |
|
Patient receiving first-time biologic disease modifying anti-rheumatic drug therapy
No maintenance for this code |
|
| 01/01/2021 |
|
Documentation patient unable to communicate and informant not available
No maintenance for this code |
|
| 01/01/2021 |
|
Patient does not have a caregiver
No maintenance for this code |
|
| 01/01/2021 |
|
Documentation caregiver is trained and certified in dementia care
No maintenance for this code |
|
| 01/01/2021 |
|
Patient /caregiver dyad has been referred to appropriate resources and connection to those resources is confirmed
No maintenance for this code |
|
| 01/01/2021 |
|
Patients with clinical indications for imaging of the head: head trauma
No maintenance for this code |
|
| 01/01/2021 |
|
Patients with clinical indications for imaging of the head: new or change in headache above 50 years of age
No maintenance for this code |
|
| 01/01/2021 |
|
Patients with clinical indications for imaging of the head: abnormal neurologic exam
No maintenance for this code |
|
| 01/01/2021 |
|
Patients with clinical indications for imaging of the head: headache radiating to the neck
No maintenance for this code |
|
| 01/01/2021 |
|
Patients with clinical indications for imaging of the head: positional headaches
No maintenance for this code |
|
| 01/01/2021 |
|
Patients with clinical indications for imaging of the head: temporal headaches in patients over 55 years of age
No maintenance for this code |
|
| 01/01/2021 |
|
Patients with clinical indications for imaging of the head: new onset headache in pre-school children or younger (<6 years of age)
No maintenance for this code |
|
| 01/01/2021 |
|
Patients with clinical indications for imaging of the head: new onset headache in pediatric patients with disabilities for which headache is a concern as inferred from behavior
No maintenance for this code |
|
| 01/01/2021 |
|
Patients with clinical indications for imaging of the head: occipital headache in children
No maintenance for this code |
|
| 01/01/2021 |
|
Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method
No maintenance for this code |
|
| 01/01/2021 |
|
Patient screened for unhealthy alcohol use using a systematic screening method and not identified as an unhealthy alcohol user
No maintenance for this code |
|
| 01/01/2021 |
|
Documentation of medical reason(s) for not screening for unhealthy alcohol use using a systematic screening method (e.g., limited life expectancy, other medical reasons)
No maintenance for this code |
|
| 01/01/2021 |
|
Patient not screened for unhealthy alcohol use using a systematic screening method, reason not given
No maintenance for this code |
|
| 01/01/2021 |
|
Patient identified as an unhealthy alcohol user received brief counseling
No maintenance for this code |
|
| 01/01/2021 |
|
Documentation of medical reason(s) for not providing brief counseling (e.g., limited life expectancy, other medical reasons)
No maintenance for this code |
|
| 01/01/2021 |
|
Patient did not receive brief counseling if identified as an unhealthy alcohol user, reason not given
No maintenance for this code |
|
| 01/01/2021 |
|
Documentation of medical reason(s) for not providing brief counseling if identified as an unhealthy alcohol user (e.g., limited life expectancy, other medical reasons)
No maintenance for this code |
|
| 01/01/2021 |
|
Patients between 50 and 85 years of age who received a screening colonoscopy during the performance period
No maintenance for this code |
|
| 01/01/2021 |
|
Patients with pregnancy during adjuvant treatment course
No maintenance for this code |
|
| 01/01/2021 |
|
Patient received adjuvant treatment course including both chemotherapy and her2-targeted therapy
No maintenance for this code |
|
| 01/01/2021 |
|
Reason for not administering adjuvant treatment course including both chemotherapy and her2-targeted therapy (e.g. poor performance status (ecog 3-4; karnofsky =50), cardiac contraindications, insufficient renal function, insufficient hepatic function, other active or secondary cancer diagnoses, other medical contraindications, patients who died during initial treatment course or transferred during or after initial treatment course)
No maintenance for this code |
|
| 01/01/2021 |
|
Patient did not receive adjuvant treatment course including both chemotherapy and her2-targeted therapy
No maintenance for this code |
|
| 01/01/2021 |
|
Patient refused to participate
No maintenance for this code |
|
| 01/01/2021 |
|
Risk-adjusted functional status change residual score for the neck impairment not measured because the patient did not complete the neck fs prom at initial evaluation and/or near discharge, reason not given
No maintenance for this code |
|
| 01/01/2021 |
|
Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established)
No maintenance for this code |
|
| 01/01/2021 |
|
Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99205, 99215 for office or other outpatient evaluation and management services) (do not report g2212 on the same date of service as 99354, 99355, 99358, 99359, 99415, 99416). (do not report g2212 for any time unit less than 15 minutes)
No maintenance for this code |
|
| 01/01/2021 |
|
Initiation of medication for the treatment of opioid use disorder in the emergency department setting, including assessment, referral to ongoing care, and arranging access to supportive services (list separately in addition to code for primary procedure)
No maintenance for this code |
|
| 01/01/2021 |
|
Initial or subsequent psychiatric collaborative care management, first 30 minutes in a month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional
No maintenance for this code |
|
| 01/01/2021 |
|
Take-home supply of nasal naloxone (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure
No maintenance for this code |
|
| 01/01/2021 |
|
Take-home supply of injectable naloxone (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure
No maintenance for this code |
|
| 01/01/2021 |
|
Remote assessment 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 service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment
No maintenance for this code |
|
| 01/01/2021 |
|
Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of clinical discussion
No maintenance for this code |
|
| 01/01/2021 |
|
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; 11-20 minutes of medical discussion
No maintenance for this code |
|
| 01/01/2021 |
|
Dilated macular or fundus exam not performed
No maintenance for this code |
|
| 01/01/2021 |
|
Documentation of a medical reason(s) for not documenting, updating, or reviewing the patient's current medications list (e.g., patient is in an urgent or emergent medical situation)
No maintenance for this code |
|
| 01/01/2021 |
|
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
No maintenance for this code |
|
| 01/01/2021 |
|
Pain assessment documented as positive using a standardized tool, follow-up plan not documented, reason not given
No maintenance for this code |
|
| 01/01/2021 |
|
Development of deep sternal wound infection/mediastinitis within 30 days postoperatively
No maintenance for this code |
|
| 01/01/2021 |
|
No deep sternal wound infection/mediastinitis
No maintenance for this code |
|
| 01/01/2021 |
|
Stroke following isolated cabg surgery
No maintenance for this code |
|
| 01/01/2021 |
|
No stroke following isolated cabg surgery
No maintenance for this code |
|
| 01/01/2021 |
|
Iv alteplase not initiated within three hours (<= 180 minutes) of time last known well for reasons documented by clinician (e.g. patient enrolled in clinical trial for stroke, patient admitted for elective carotid intervention, patient received tenecteplase (tnk))
No maintenance for this code |
|
| 01/01/2021 |
|
Surgical procedure performed within 30 days following cataract surgery for major complications (e.g., retained nuclear fragments, endophthalmitis, dislocated or wrong power iol, retinal detachment, or wound dehiscence)
No maintenance for this code |
|
| 01/01/2021 |
|
Surgical procedure not performed within 30 days following cataract surgery for major complications (e.g., retained nuclear fragments, endophthalmitis, dislocated or wrong power iol, retinal detachment, or wound dehiscence)
No maintenance for this code |
|
| 01/01/2021 |
|
Risk-adjusted functional status change residual score for the knee impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given
No maintenance for this code |
|
| 01/01/2021 |
|
Risk-adjusted functional status change residual score for the hip impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given
No maintenance for this code |
|
| 01/01/2021 |
|
Risk-adjusted functional status change residual score for the lower leg, foot or ankle impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given
No maintenance for this code |
|
| 01/01/2021 |
|
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)
No maintenance for this code |
|
| 01/01/2021 |
|
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)
No maintenance for this code |
|
| 01/01/2021 |
|
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 general orthopedic fs prom at initial evaluation and/or near discharge, reason not given
No maintenance for this code |
|
| 01/01/2021 |
|
Left ventricular ejection fraction (lvef) < 40% or documentation of moderate or severe lvsd
No maintenance for this code |
|
| 01/01/2021 |
|
Uri episodes when the patient had competing diagnoses on or three days after the episode date (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)
No maintenance for this code |
|
| 01/01/2021 |
|
Pain assessment documented as positive using a standardized tool and a follow-up plan is documented
No maintenance for this code |
|
| 01/01/2021 |
|
Pain assessment using a standardized tool is documented as negative, no follow-up plan required
No maintenance for this code |
|
| 01/01/2021 |
|
No documentation of pain assessment, reason not given
No maintenance for this code |
|
| 01/01/2021 |
|
Rh-immunoglobulin (rhogam) ordered
No maintenance for this code |
|
| 01/01/2021 |
|
Rh-immunoglobulin (rhogam) not ordered for reasons documented by clinician (e.g., patient had prior documented receipt of rhogam within 12 weeks, patient refusal)
No maintenance for this code |
|
| 01/01/2021 |
|
Documentation rh-immunoglobulin (rhogam) was not ordered, reason not given
No maintenance for this code |
|
| 01/01/2021 |
|
Excised tissue evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesion
No maintenance for this code |
|
| 01/01/2021 |
|
Patients with needle localization specimens which are not amenable to intraoperative imaging such as mri needle wire localization, or targets which are tentatively identified on mammogram or ultrasound which do not contain a biopsy marker but which can be verified on intraoperative inspection or pathology (e.g., needle biopsy site where the biopsy marker is remote from the actual biopsy site)
No maintenance for this code |
|
| 01/01/2021 |
|
Excised tissue not evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesion
No maintenance for this code |
|
| 01/01/2021 |
|
Spirometry test results demonstrate fev1/fvc < 70%, fev1 < 60% predicted and patient has copd symptoms (e.g., dyspnea, cough/sputum, wheezing)
No maintenance for this code |
|
| 01/01/2021 |
|
Bmi is documented as being outside of normal parameters, follow-up plan is not documented, documentation the patient is not eligible
No maintenance for this code |
|
| 01/01/2021 |
|
Pain assessment documented as positive, follow-up plan not documented, documentation the patient is not eligible at the time of the encounter
No maintenance for this code |
|
| 01/01/2021 |
|
Clinician treating major depressive disorder communicates to clinician treating comorbid condition
No maintenance for this code |
|
| 01/01/2021 |
|
Clinician treating major depressive disorder did not communicate to clinician treating comorbid condition, reason not given
No maintenance for this code |
|
| 01/01/2021 |
|
Documentation of patient reason(s) for not prescribing warfarin or another oral anticoagulant that is fda approved for the prevention of thromboembolism (e.g., patient choice of having atrial appendage device placed)
No maintenance for this code |
|
| 01/01/2021 |
|
Most recent hemoglobin (hgb) level < 10 g/dl
No maintenance for this code |
|
| 01/01/2021 |
|
Hemoglobin level measurement not documented, reason not given
No maintenance for this code |
|
| 01/01/2021 |
|
Documentation of medical reason(s) for patient having a hemoglobin level < 10 g/dl (e.g., patients who have non-renal etiologies of anemia [e.g., sickle cell anemia or other hemoglobinopathies, hypersplenism, primary bone marrow disease, anemia related to chemotherapy for diagnosis of malignancy, postoperative bleeding, active bloodstream or peritoneal infection], other medical reasons)
No maintenance for this code |
|
| 01/01/2021 |
|
Most recent hemoglobin (hgb) level >= 10 g/dl
No maintenance for this code |
|
| 01/01/2021 |
|
Clinician treating major depressive disorder did not communicate to clinician treating comorbid condition for specified patient reason (e.g., patient is unable to communicate the diagnosis of a comorbid condition; the patient is unwilling to communicate the diagnosis of a comorbid condition; or the patient is unaware of the comorbid condition, or any other specified patient reason)
No maintenance for this code |
|
| 01/01/2021 |
|
Documentation of reasons for patient initiating maintenance hemodialysis with a catheter as the mode of vascular access (e.g., patient has a maturing arteriovenous fistula (avf)/arteriovenous graft (avg), time-limited trial of hemodialysis, other medical reasons, patient declined avf/avg, other patient reasons, patient followed by reporting nephrologist for fewer than 90 days, other system reasons)
No maintenance for this code |
|
| 01/01/2021 |
|
Patient whose mode of vascular access is a catheter at the time maintenance hemodialysis is initiated
No maintenance for this code |
|
| 01/01/2021 |
|
Patient whose mode of vascular access is not a catheter at the time maintenance hemodialysis is initiated
No maintenance for this code |
|
| 01/01/2021 |
|
Documentation of patient death following cas
No maintenance for this code |
|
| 01/01/2021 |
|
Documentation of patient stroke following cas
No maintenance for this code |
|
| 01/01/2021 |
|
Documentation of patient stroke following cea
No maintenance for this code |
|
| 01/01/2021 |
|
Documentation of patient survival and absence of stroke following cas
No maintenance for this code |
|
| 01/01/2021 |
|
Documentation of patient death following cea
No maintenance for this code |
|
| 01/01/2021 |
|
Documentation of patient survival and absence of stroke following cea
No maintenance for this code |
|
| 01/01/2021 |
|
Documentation of patient death in the hospital following endovascular aaa repair
No maintenance for this code |
|
| 01/01/2021 |
|
Documentation of patient discharged alive following endovascular aaa repair
No maintenance for this code |
|
| 01/01/2021 |
|
Documentation of patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter for documented reasons (e.g., other medical reasons, patient declined arteriovenous fistula (avf)/arteriovenous graft (avg), other patient reasons)
No maintenance for this code |
|
| 01/01/2021 |
|
Patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter as the mode of vascular access
No maintenance for this code |
|
| 01/01/2021 |
|
Patient receiving maintenance hemodialysis for greater than or equal to 90 days without a catheter as the mode of vascular access
No maintenance for this code |
|
| 01/01/2021 |
|
Patients who are not evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (e.g., history of dvt, pe, mi, arrhythmia and stroke, reason not given)
No maintenance for this code |
|
| 01/01/2021 |
|
Documentation of medical reason(s) for not completely infusing the prophylactic antibiotic prior to the inflation of the proximal tourniquet (e.g., a tourniquet was not used)
No maintenance for this code |
|
| 01/01/2021 |
|
Patients who had the prophylactic antibiotic completely infused prior to the inflation of the proximal tourniquet
No maintenance for this code |
|
| 01/01/2021 |
|
Prophylactic antibiotic not completely infused prior to the inflation of the proximal tourniquet, reason not given
No maintenance for this code |
|
| 01/01/2021 |
|
Operative report does not identify the prosthetic implant specifications including the prosthetic implant manufacturer, the brand name of the prosthetic implant and the size of each prosthetic implant, reason not given
No maintenance for this code |
|
| 01/01/2021 |
|
Operative report identifies the prosthetic implant specifications including the prosthetic implant manufacturer, the brand name of the prosthetic implant and the size of each prosthetic implant
No maintenance for this code |
|
| 01/01/2021 |
|
Ct studies performed not reported to a radiation dose index registry that is capable of collecting at a minimum all necessary data elements, reason not given
No maintenance for this code |
|
| 01/01/2021 |
|
Ct studies performed reported to a radiation dose index registry that is capable of collecting at a minimum all necessary data elements
No maintenance for this code |
|
| 01/01/2021 |
|
Dicom format image data available to non-affiliated external healthcare facilities or entities on a secure, media free, reciprocally searchable basis with patient authorization for at least a 12-month period after the study not documented in final report, reason not given
No maintenance for this code |
|
| 01/01/2021 |
|
Final report documented that dicom format image data available to non-affiliated external healthcare facilities or entities on a secure, media free, reciprocally searchable basis with patient authorization for at least a 12-month period after the study
No maintenance for this code |
|
| 01/01/2021 |
|
Early elective delivery by c-section, or early elective induction, not performed (less than 39 weeks gestation)
No maintenance for this code |
|
| 01/01/2021 |
|
Early elective delivery by c-section, or early elective induction, performed (less than 39 week gestation)
No maintenance for this code |
|
| 01/01/2021 |
|
One high-risk medication ordered
No maintenance for this code |
|
| 01/01/2021 |
|
One high-risk medication not ordered
No maintenance for this code |
|
| 01/01/2021 |
|
Unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery
No maintenance for this code |
|
| 01/01/2021 |
|
No unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery
No maintenance for this code |
|
| 01/01/2021 |
|
No documentation in the patient record of a discussion between the physician or other qualified healthcare professional and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward treatment
No maintenance for this code |
|
| 01/01/2021 |
|
Patient received follow-up within 30 days after discharge
No maintenance for this code |
|
| 01/01/2021 |
|
Patient did not have one dose of meningococcal vaccine (serogroups a, c, w, y) on or between the patient's 11th and 13th birthdays
No maintenance for this code |
|
| 01/01/2021 |
|
Patients who were born in the years 1945 to 1965
No maintenance for this code |
|
| 01/01/2021 |
|
Patients who have received or are receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 90 or greater consecutive days or a single prescription equating to 900 mg prednisone or greater for all fills
No maintenance for this code |
|
| 01/01/2021 |
|
Patient taking tamsulosin hydrochloride
No maintenance for this code |
|
| 01/01/2021 |
|
Patient discontinued from hemodialysis or peritoneal dialysis
No maintenance for this code |
|
| 01/01/2021 |
|
Patient was referred to hospice care
No maintenance for this code |
|
| 01/01/2021 |
|
Documentation of patient reason(s) for not referring to hospice care (e.g., patient declined, other patient reasons)
No maintenance for this code |
|
| 01/01/2021 |
|
Patient was not referred to hospice care, reason not given
No maintenance for this code |
|
| 01/01/2021 |
|
Patient had a head ct for trauma ordered by someone other than an emergency care provider or was ordered for a reason other than trauma
No maintenance for this code |
|
| 01/01/2021 |
|
Imaging needed as part of a clinical trial; or other clinician ordered the study
No maintenance for this code |
|
| 01/01/2021 |
|
Final reports for imaging studies with follow-up imaging recommended, or final reports that do not include a specific recommendation of no follow-up
No maintenance for this code |
|
| 01/01/2021 |
|
Patient treated with a beta-lactam antibiotic as definitive therapy
No maintenance for this code |
|
| 01/01/2021 |
|
Documentation of medical reason(s) for not prescribing a beta-lactam antibiotic (e.g., allergy, intolerance to beta-lactam antibiotics)
No maintenance for this code |
|
| 01/01/2021 |
|
Patient not treated with a beta-lactam antibiotic as definitive therapy, reason not given
No maintenance for this code |
|
| 01/01/2021 |
|
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
No maintenance for this code |
|
| 01/01/2021 |
|
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
No maintenance for this code |
|
| 01/01/2021 |
|
Symptomatic aaas that required urgent/emergent (non-elective) repair
No maintenance for this code |
|
| 01/01/2021 |
|
Patient discharge to home no later than post-operative day #7
No maintenance for this code |
|
| 01/01/2021 |
|
Patient not discharged to home by post-operative day #7
No maintenance for this code |
|
| 01/01/2021 |
|
Preoperative assessment documented
No maintenance for this code |
|
| 01/01/2021 |
|
Documentation of reason(s) for not documenting a preoperative assessment (e.g., patient with a gynecologic or other pelvic malignancy noted at the time of surgery)
No maintenance for this code |
|
| 01/01/2021 |
|
Preoperative assessment not documented, reason not given
No maintenance for this code |
|
| 01/01/2021 |
|
Current smoker (e.g., cigarette, cigar, pipe, e-cigarette or marijuana)
No maintenance for this code |
|
| 01/01/2021 |
|
Patients greater than or equal to 86 years of age who underwent a screening colonoscopy and did not have a history of colorectal cancer or other valid medical reason for the colonoscopy, including: iron deficiency anemia, lower gastrointestinal bleeding, crohn's disease (i.e., regional enteritis), familial adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease, ulcerative colitis, abnormal finding of gastrointestinal tract, or changes in bowel habits
No maintenance for this code |
|
| 01/01/2021 |
|
Documentation of medical reason(s) for a colonoscopy performed on a patient greater than or equal to 86 years of age (e.g., iron deficiency anemia, lower gastrointestinal bleeding, crohn's disease (i.e., regional enteritis), familial history of adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease, ulcerative colitis, abnormal finding of gastrointestinal tract, or changes in bowel habits)
No maintenance for this code |
|
| 01/01/2021 |
|
Patients greater than or equal to 86 years of age who received a colonoscopy for an assessment of signs/symptoms of gi tract illness, and/or because the patient meets high risk criteria, and/or to follow-up on previously diagnosed advanced lesions
No maintenance for this code |
|
| 01/01/2021 |
|
Any fasting or direct ldl-c laboratory test result >= 190 mg/dl
No maintenance for this code |
|
| 01/01/2021 |
|
Patient's highest fasting or direct ldl-c laboratory test result in the measurement period or two years prior to the beginning of the measurement period is 70-189 mg/dl
No maintenance for this code |
|
| 01/01/2021 |
|
Children who are taking antibiotics in the 30 days prior to the date of the encounter during which the diagnosis was established
No maintenance for this code |
|
| 01/01/2021 |
|
Episodes where the patient is taking antibiotics (table 1) in the 30 days prior to the episode date
No maintenance for this code |
|
| 01/01/2021 |
|
Bmi is documented as being outside of normal parameters, follow-up plan is not completed for documented reason
No maintenance for this code |
|
| 01/01/2021 |
|
Documentation stating the patient has had a diagnosis of depression or has had a diagnosis of bipolar disorder
No maintenance for this code |
|
| 01/01/2021 |
|
Documented history of renal failure or baseline serum creatinine >= 4.0 mg/dl; renal transplant recipients are not considered to have preoperative renal failure, unless, since transplantation the cr has been or is 4.0 or higher
No maintenance for this code |
|
| 01/01/2021 |
|
Patient unable to complete the lepf prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
No maintenance for this code |
|
| 01/01/2021 |
|
Patient unable to complete the lepf prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
No maintenance for this code |
|
| 01/01/2021 |
|
Patient unable to complete the lepf prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
No maintenance for this code |
|
| 01/01/2021 |
|
Patient refused to participate
No maintenance for this code |
|
| 01/01/2021 |
|
Patient unable to complete the general orthopedic fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
No maintenance for this code |
|
| 01/01/2021 |
|
Patient is undergoing palliative dialysis with a catheter
No maintenance for this code |
|
| 01/01/2021 |
|
Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant
No maintenance for this code |
|
| 01/01/2021 |
|
Patient is undergoing palliative dialysis with a catheter
No maintenance for this code |
|
| 01/01/2021 |
|
Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant
No maintenance for this code |
|
| 01/01/2021 |
|
History of preoperative posterior capsule rupture
No maintenance for this code |
|
| 01/01/2021 |
|
Discharge(s) for ami between july 1 of the year prior measurement period to june 30 of the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Patients with a medication dispensing event indicator of a history of asthma any time during the patient's history through the end of the measure period
No maintenance for this code |
|
| 01/01/2021 |
|
Patients who are identified as having an intolerance or allergy to beta-blocker therapy
No maintenance for this code |
|
| 01/01/2021 |
|
Hospitalizations in which the patient was transferred directly to a non-acute care facility for any diagnosis
No maintenance for this code |
|
| 01/01/2021 |
|
Patients who use hospice services any time during the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Patient prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami
No maintenance for this code |
|
| 01/01/2021 |
|
Patient was not prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami
No maintenance for this code |
|
| 01/01/2021 |
|
Death occurring during the index acute care hospitalization
No maintenance for this code |
|
| 01/01/2021 |
|
Death did not occur during the index acute care hospitalization
No maintenance for this code |
|
| 01/01/2021 |
|
Death occurring after discharge from the hospital but within 30 days post procedure
No maintenance for this code |
|
| 01/01/2021 |
|
Death did not occur after discharge from the hospital within 30 days post procedure
No maintenance for this code |
|
| 01/01/2021 |
|
Her-2/neu negative or undocumented/unknown
No maintenance for this code |
|
| 01/01/2021 |
|
Patient transferred to practice after initiation of chemotherapy
No maintenance for this code |
|
| 01/01/2021 |
|
Her2-targeted therapies not administered during the initial course of treatment
No maintenance for this code |
|
| 01/01/2021 |
|
Her2-targeted therapies administered during the initial course of treatment
No maintenance for this code |
|
| 01/01/2021 |
|
Breast adjuvant chemotherapy administered
No maintenance for this code |
|
| 01/01/2021 |
|
Patient transfer to practice after initiation of chemotherapy
No maintenance for this code |
|
| 01/01/2021 |
|
Patient has metastatic disease at diagnosis
No maintenance for this code |
|
| 01/01/2021 |
|
Trastuzumab administered within 12 months of diagnosis
No maintenance for this code |
|
| 01/01/2021 |
|
Reason for not administering trastuzumab documented (e.g. patient declined, patient died, patient transferred, contraindication or other clinical exclusion, neoadjuvant chemotherapy or radiation not complete)
No maintenance for this code |
|
| 01/01/2021 |
|
Trastuzumab not administered within 12 months of diagnosis
No maintenance for this code |
|
| 01/01/2021 |
|
Patients who died from cancer
No maintenance for this code |
|
| 01/01/2021 |
|
Patient had more than one emergency department visit in the last 30 days of life
No maintenance for this code |
|
| 01/01/2021 |
|
Patient had one or less emergency department visits in the last 30 days of life
No maintenance for this code |
|
| 01/01/2021 |
|
Patients who died from cancer
No maintenance for this code |
|
| 01/01/2021 |
|
Patient was not admitted to hospice
No maintenance for this code |
|
| 01/01/2021 |
|
Patient admitted to hospice
No maintenance for this code |
|
| 04/01/2021 |
|
Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, less than 10 minutes
Change in long description of procedure or modifier code |
|
| 04/01/2021 |
|
Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, 10-20 minutes
Change in long description of procedure or modifier code |
|
| 04/01/2021 |
|
Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, more than 20 minutes
Change in long description of procedure or modifier code |
|
| 01/01/2021 |
|
Patients age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Patient age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Patients age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
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)
No maintenance for this code |
|
| 01/01/2021 |
|
Documentation of cha2ds2-vasc risk score of 0 or 1 for men; or 0, 1, or 2 for women
No maintenance for this code |
|
| 01/01/2021 |
|
Adenoma(s) or colorectal cancer detected during screening colonoscopy
No maintenance for this code |
|
| 01/01/2021 |
|
Documentation that neoplasm detected is only diagnosed as traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma
No maintenance for this code |
|
| 01/01/2021 |
|
Adenoma(s) or colorectal cancer not detected during screening colonoscopy
No maintenance for this code |
|
| 01/01/2021 |
|
Surveillance colonoscopy - personal history of colonic polyps, colon cancer, or other malignant neoplasm of rectum, rectosigmoid junction, and anus
No maintenance for this code |
|
| 01/01/2021 |
|
Diagnostic colonoscopy
No maintenance for this code |
|
| 01/01/2021 |
|
Patients age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the six months prior to the measurement period through december 31 of the measurement period
No maintenance for this code |
|
| 01/01/2021 |
|
Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis
No maintenance for this code |
|
| 01/01/2021 |
|
Children who were screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report
No maintenance for this code |
|
| 01/01/2021 |
|
Children who were not screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report
No maintenance for this code |
|
J Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2021 |
|
Injection, cefiderocol, 5 mg
No maintenance for this code |
|
| 04/01/2021 |
|
Injection, viltolarsen, 10 mg | |
| 04/01/2021 |
|
Injection, immune globulin (asceniv), 500 mg | |
| 01/01/2021 |
|
Injection, inebilizumab-cdon, 1 mg
No maintenance for this code |
|
| 01/01/2021 |
|
Factor viia (antihemophilic factor, recombinant), (novoseven rt), 1 microgram
No maintenance for this code |
|
| 01/01/2021 |
|
Factor viia (antihemophilic factor, recombinant)-jncw (sevenfact), 1 microgram
No maintenance for this code |
|
| 04/01/2021 |
|
Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose
Change in long description of procedure or modifier code |
|
| 04/01/2021 |
|
Hyaluronan or derivative, visco-3, for intra-articular injection, per dose
Code Discontinued |
|
| 01/01/2021 |
|
Afamelanotide implant, 1 mg
No maintenance for this code |
|
| 04/01/2021 |
|
Mometasone furoate sinus implant, 10 micrograms
Code Discontinued |
|
| 04/01/2021 |
|
Mometasone furoate sinus implant, (sinuva), 10 micrograms | |
| 04/01/2021 |
|
Injection, belantamab mafodontin-blmf, 0.5 mg | |
| 01/01/2021 |
|
Injection, daratumumab, 10 mg and hyaluronidase-fihj
No maintenance for this code |
|
| 01/01/2021 |
|
Injection, lurbinectedin, 0.1 mg
No maintenance for this code |
|
| 01/01/2021 |
|
Mitomycin pyelocalyceal instillation, 1 mg
No maintenance for this code |
|
| 01/01/2021 |
|
Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg
No maintenance for this code |
|
| 01/01/2021 |
|
Injection, sacituzumab govitecan-hziy, 2.5 mg
No maintenance for this code |
|
| 04/01/2021 |
|
Injection, tafasitamab-cxix, 2 mg | |
K Codes↑ Top | |||
| Effective | Code | Description | |
| 04/01/2021 |
|
Indwelling intraurethral drainage device with valve, patient inserted, replacement only, each
Code Discontinued |
|
| 04/01/2021 |
|
Activation device for intraurethral drainage device with valve, replacement only, each
Code Discontinued |
|
| 04/01/2021 |
|
Charger and base station for intraurethral activation device, replacement only
Code Discontinued |
|
| 04/01/2021 |
|
Enema tube, any type, replacement only, each | |
| 04/01/2021 |
|
Addition, endoskeletal knee-shin system, 4 bar linkage or multiaxial, fluid swing and stance phase control | |
| 04/01/2021 |
|
Foot, adductus positioning device, adjustable | |
| 04/01/2021 |
|
Transcutaneous electrical nerve stimulator for electrical stimulation of the trigeminal nerve | |
| 04/01/2021 |
|
Monthly supplies for use of device coded at k1016 | |
| 04/01/2021 |
|
External upper limb tremor stimulator of the peripheral nerves of the wrist | |
| 04/01/2021 |
|
Monthly supplies for use of device coded at k1018 | |
| 04/01/2021 |
|
Non-invasive vagus nerve stimulator | |
M Codes↑ Top | |||
| Effective | Code | Description | |
| 02/09/2021 |
|
Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring | |
| 01/01/2021 |
|
Tb screening performed and results interpreted within twelve months prior to initiation of first-time biologic disease modifying anti-rheumatic drug therapy
No maintenance for this code |
|
| 01/01/2021 |
|
Discharge/discontinuation of the episode of care documented in the medical record
No maintenance for this code |
|
| 01/01/2021 |
|
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
No maintenance for this code |
|
| 01/01/2021 |
|
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
No maintenance for this code |
|
| 01/01/2021 |
|
Pharmacotherapy for oud initiated after june 30th of performance period
No maintenance for this code |
|
| 01/01/2021 |
|
Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis
No maintenance for this code |
|
| 01/01/2021 |
|
Functional status measured by the oxford knee score (oks) at one year (9 to 15 months) postoperatively was greater than or equal to 37 or knee injury and osteoarthritis outcome score joint replacement (koos, jr.) was greater than or equal to 71
No maintenance for this code |
|
| 01/01/2021 |
|
Functional status measured by the oxford knee score (oks) at one year (9 to 15 months) postoperatively was less than 37 or the knee injury and osteoarthritis outcome score joint replacement (koos, jr.) was less than 71 postoperatively
No maintenance for this code |
|
| 01/01/2021 |
|
Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis
No maintenance for this code |
|
| 01/01/2021 |
|
Patient pregnancy
No maintenance for this code |
|
| 01/01/2021 |
|
Patient immunocompromised
No maintenance for this code |
|
| 01/01/2021 |
|
Patients receiving high doses of immunosuppressive therapy
No maintenance for this code |
|
| 01/01/2021 |
|
Shingrix vaccine documented as administered or previously received
No maintenance for this code |
|
| 01/01/2021 |
|
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)
No maintenance for this code |
|
| 01/01/2021 |
|
Shingrix vaccine not documented as administered, reason not given
No maintenance for this code |
|
| 01/01/2021 |
|
Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record
No maintenance for this code |
|
| 01/01/2021 |
|
Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery
No maintenance for this code |
|
| 01/01/2021 |
|
Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown)
No maintenance for this code |
|
| 01/01/2021 |
|
Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record
No maintenance for this code |
|
| 01/01/2021 |
|
Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery
No maintenance for this code |
|
| 01/01/2021 |
|
Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown)
No maintenance for this code |
|
| 01/01/2021 |
|
Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record
No maintenance for this code |
|
| 01/01/2021 |
|
Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery
No maintenance for this code |
|
| 01/01/2021 |
|
Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown)
No maintenance for this code |
|
| 01/01/2021 |
|
Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record
No maintenance for this code |
|
| 01/01/2021 |
|
Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery
No maintenance for this code |
|
| 01/01/2021 |
|
Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown)
No maintenance for this code |
|
| 01/01/2021 |
|
Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record
No maintenance for this code |
|
| 01/01/2021 |
|
Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery
No maintenance for this code |
|
| 01/01/2021 |
|
Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown)
No maintenance for this code |
|
| 01/01/2021 |
|
Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record
No maintenance for this code |
|
| 01/01/2021 |
|
Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery
No maintenance for this code |
|
| 01/01/2021 |
|
Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown)
No maintenance for this code |
|
| 01/01/2021 |
|
The start of an episode of care documented in the medical record
No maintenance for this code |
|
| 01/01/2021 |
|
Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time before or during the episode of care
No maintenance for this code |
|
| 01/01/2021 |
|
Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only)
No maintenance for this code |
|
| 01/01/2021 |
|
Ongoing care not indicated, patient self-discharged early and seen only 1-2 visits (e.g., financial or insurance reasons, transportation problems, or reason unknown)
No maintenance for this code |
|
| 01/01/2021 |
|
Ongoing care not indicated, patient discharged after only 1-2 visits due to specific medical events, documented in the medical record that make the treatment episode impossible such as the patient becomes hospitalized or scheduled for surgery for surgery or hospitalized
No maintenance for this code |
|
| 01/01/2021 |
|
Functional status was not measured by the oxford knee score (oks) or the knee injury and osteoarthritis outcome score joint replacement (koos, jr.) at one year (9 to 15 months) postoperatively
No maintenance for this code |
|
| 01/01/2021 |
|
Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only
No maintenance for this code |
|
| 01/01/2021 |
|
Most favored nation (mfn) model drug add-on amount, per dose, (do not bill with line items that have the jw modifier)
No maintenance for this code |
|
| 01/01/2021 |
|
Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record
No maintenance for this code |
|
| 01/01/2021 |
|
Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery
No maintenance for this code |
|
| 01/01/2021 |
|
Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown)
No maintenance for this code |
|
| 01/01/2021 |
|
Patient unable to complete the neck fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility, and an adequate proxy is not available
No maintenance for this code |
|
Q Codes↑ Top | |||
| Effective | Code | Description | |
| 02/09/2021 |
|
Injection, bamlanivimab and etesevimab, 2100 mg | |
| 04/01/2021 |
|
Brexucabtagene autoleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose | |
| 01/01/2021 |
|
Injection, pegfilgrastim-apgf, biosimilar, (nyvepria), 0.5 mg
No maintenance for this code |
|
S Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2021 |
|
Esketamine, nasal spray, 1 mg
No maintenance for this code |
|
| 04/01/2021 |
|
Stent, non-coronary, temporary, with delivery system (propel) | |
U Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2021 |
|
Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2
No maintenance for this code |
|
Legend: