List of new codes and changes to the 2022 HCPCS code set along with their effective date. Includes discontinued codes that are no longer used.
Legend:
A Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2022 |
|
Innovamatrix ac, per square centimeter
No maintenance for this code |
|
| 01/01/2022 |
|
Mirragen advanced wound matrix, per square centimeter
No maintenance for this code |
|
| 01/01/2022 |
|
Xcellistem, per square centimeter
No maintenance for this code |
|
| 01/01/2022 |
|
Microlyte matrix, per square centimeter
No maintenance for this code |
|
| 01/01/2022 |
|
Novosorb synpath dermal matrix, per square centimeter
No maintenance for this code |
|
| 01/01/2022 |
|
Restrata, per square centimeter
No maintenance for this code |
|
| 01/01/2022 |
|
Theragenesis, per square centimeter
No maintenance for this code |
|
| 01/01/2022 |
|
Symphony, per square centimeter
No maintenance for this code |
|
| 01/01/2022 |
|
Apis, per square centimeter
No maintenance for this code |
|
| 04/01/2022 |
|
Supra sdrm, per square centimeter | |
| 04/01/2022 |
|
Suprathel, per square centimeter | |
| 04/01/2022 |
|
Innovamatrix fs, per square centimeter | |
| 04/01/2022 |
|
Skin substitute, fda cleared as a device, not otherwise specified | |
| 04/01/2022 |
|
Supply allowance for adjunctive continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service | |
| 01/01/2022 |
|
Irrigation supply; sleeve, each
No maintenance for this code |
|
| 01/01/2022 |
|
Irrigation supply; sleeve, reusable, per month
No maintenance for this code |
|
| 01/01/2022 |
|
Irrigation supply; sleeve, disposable, per month
No maintenance for this code |
|
| 04/01/2022 |
|
Sensor; invasive (e.g., subcutaneous), disposable, for use with interstitial continuous glucose monitoring system, one unit = 1 day supply
Change in administrative data field of procedure or modifier code |
|
| 04/01/2022 |
|
Transmitter; external, for use with interstitial continuous glucose monitoring system
Change in administrative data field of procedure or modifier code |
|
| 04/01/2022 |
|
Receiver (monitor); external, for use with interstitial continuous glucose monitoring system
Change in administrative data field of procedure or modifier code |
|
| 04/01/2022 |
|
Prescription digital behavioral therapy, fda cleared, per course of treatment | |
| 01/01/2022 |
|
Piflufolastat f-18, diagnostic, 1 millicurie
No maintenance for this code |
|
C Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2022 |
|
Autograft suspension, including cell processing and application, and all system components
No maintenance for this code |
|
| 01/01/2022 |
|
Monitor, cardiac, including intracardiac lead and all system components (implantable)
No maintenance for this code |
|
| 01/01/2022 |
|
Idecabtagene vicleucel, up to 460 million autologous anti-bcma car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
No maintenance for this code |
|
| 01/01/2022 |
|
Injection, dostarlimab-gxly, 100 mg
No maintenance for this code |
|
| 01/01/2022 |
|
Injection, amivantamab-vmjw, 10 mg
No maintenance for this code |
|
| 04/01/2022 |
|
Injection, loncastuximab tesirine-lpyl, 0.1 mg
Code Discontinued |
|
| 04/01/2022 |
|
Injection, avalglucosidase alfa-ngpt, 4 mg
Code Discontinued |
|
| 04/01/2022 |
|
Injection, anifrolumab-fnia, 1 mg
Code Discontinued |
|
| 04/01/2022 |
|
Injection, cyclophosphamide, (auromedics), 10 mg
Code Discontinued |
|
| 01/01/2022 |
|
Instillation, bupivacaine and meloxicam, 1 mg/0.03 mg
No maintenance for this code |
|
| 01/01/2022 |
|
Bupivacaine, collagen-matrix implant, 1 mg
No maintenance for this code |
|
| 04/01/2022 |
|
Injection, plasminogen, human-tvmh, 1 mg | |
| 04/01/2022 |
|
Injection, sirolimus protein-bound particles, 1 mg | |
| 04/01/2022 |
|
Injection, triamcinolone acetonide, suprachoroidal (xipere), 1 mg | |
| 04/01/2022 |
|
Injection, ranibizumab, via sustained release intravitreal implant (susvimo), 0.1 mg | |
| 01/01/2022 |
|
Injection, clevidipine butyrate, 1 mg
No maintenance for this code |
|
| 01/01/2022 |
|
Injection, delafloxacin, 1 mg
No maintenance for this code |
|
| 01/01/2022 |
|
Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum
No maintenance for this code |
|
| 01/01/2022 |
|
Destruction of intraosseous basivertebral nerve, each additional vertebral body, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum (list separately in addition to code for primary procedure)
No maintenance for this code |
|
| 01/01/2022 |
|
Esophageal mucosal integrity testing by electrical impedance, transoral, includes esophagoscopy or esophagogastroduodenoscopy
No maintenance for this code |
|
| 01/01/2022 |
|
Endoscopic submucosal dissection (esd), including endoscopy or colonoscopy, mucosal closure, when performed
No maintenance for this code |
|
| 01/01/2022 |
|
Insertion of central venous catheter through central venous occlusion via inferior and superior approaches (e.g., inside-out technique), including imaging guidance
No maintenance for this code |
|
| 04/01/2022 |
|
Arthroscopy, shoulder, surgical; with implantation of subacromial spacer (e.g., balloon), includes debridement (e.g., limited or extensive), subacromial decompression, acromioplasty, and biceps tenodesis when performed | |
| 04/01/2022 |
|
Blinded procedure for new york heart association (nyha) class ii or iii heart failure, or canadian cardiovascular society (ccs) class iii or iv chronic refractory angina; transcatheter intramyocardial transplantation of autologous bone marrow cells (e.g., mononuclear) or placebo control, autologous bone marrow harvesting and preparation for transplantation, left heart catheterization including ventriculography, all laboratory services, and all imaging with or without guidance (e.g., transthoracic echocardiography, ultrasound, fluoroscopy), performed in an approved investigational device exemption (ide) study | |
| 04/01/2022 |
|
Blinded procedure for transcatheter implantation of coronary sinus reduction device or placebo control, including vascular access and closure, right heart catherization, venous and coronary sinus angiography, imaging guidance and supervision and interpretation when performed in an approved investigational device exemption (ide) study | |
E Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2022 |
|
Tablo hemodialysis system for the billable dialysis service
No maintenance for this code |
|
| 04/01/2022 |
|
Adjunctive continuous glucose monitor or receiver | |
G Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2022 |
|
Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)
No maintenance for this code |
|
| 01/01/2022 |
|
Tobacco screening not performed or tobacco cessation intervention not provided on the date of the encounter or within the previous 12 months, reason not otherwise specified
No maintenance for this code |
|
| 01/01/2022 |
|
Patient screened for tobacco use and received tobacco cessation intervention on the date of the encounter or within the previous 12 months (counseling, pharmacotherapy, or both), if identified as a tobacco user
No maintenance for this code |
|
| 01/01/2022 |
|
Palliative care services given to patient any time during the measurement period
No maintenance for this code |
|
| 01/01/2022 |
|
Two or more antipsychotic prescriptions ordered for patients who had a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between january 1 of the year prior to the measurement period and the index prescription start date (ipsd) for antipsychotics
No maintenance for this code |
|
| 01/01/2022 |
|
Two or more benzodiazepine prescriptions ordered for patients who had a diagnosis of seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, or severe generalized anxiety disorder on or between january 1 of the year prior to the measurement period and the ipsd for benzodiazepines
No maintenance for this code |
|
| 01/01/2022 |
|
Patients receiving palliative care during the measurement period
No maintenance for this code |
|
| 01/01/2022 |
|
Patient has any emergency department encounter during the performance period with place of service indicator 23
No maintenance for this code |
|
| 01/01/2022 |
|
Patient or care partner decline assessment
No maintenance for this code |
|
| 01/01/2022 |
|
On date of encounter, patient is not able to participate in assessment or screening, including non-verbal patients, delirious, severely aphasic, severely developmentally delayed, severe visual or hearing impairment and for those patients, no knowledgeable informant available
No maintenance for this code |
|
| 01/01/2022 |
|
Clinician determines patient does not require referral
No maintenance for this code |
|
| 01/01/2022 |
|
Patient not referred, reason not otherwise specified
No maintenance for this code |
|
| 01/01/2022 |
|
Patient already receiving physical/occupational/speech/recreational therapy during the measurement period
No maintenance for this code |
|
| 01/01/2022 |
|
Patient and/or care partner decline referral
No maintenance for this code |
|
| 01/01/2022 |
|
Referral to physical, occupational, speech, or recreational therapy
No maintenance for this code |
|
| 01/01/2022 |
|
Patients with mechanical prosthetic heart valve
No maintenance for this code |
|
| 01/01/2022 |
|
Patients with moderate or severe mitral stenosis
No maintenance for this code |
|
| 01/01/2022 |
|
Clinical follow-up and mrs score assessed at 90 days following endovascular stroke intervention
No maintenance for this code |
|
| 01/01/2022 |
|
Clinical follow-up and mrs score not assessed at 90 days following endovascular stroke intervention
No maintenance for this code |
|
| 01/01/2022 |
|
Pediatric patient with minor blunt head trauma and pecarn prediction criteria are not assessed
No maintenance for this code |
|
| 01/01/2022 |
|
Patients who receive palliative care services any time during the intake period through the end of the measurement year
No maintenance for this code |
|
| 01/01/2022 |
|
With maintenance hemodialysis (in-center and home hd) for the complete reporting month
No maintenance for this code |
|
| 01/01/2022 |
|
Patients with a catheter that have limited life expectancy
No maintenance for this code |
|
| 01/01/2022 |
|
Patients under hospice care in the current reporting month
No maintenance for this code |
|
| 01/01/2022 |
|
Patients on peritoneal dialysis for any portion of the reporting month
No maintenance for this code |
|
| 01/01/2022 |
|
Advancing rheumatology patient care mips value pathways
No maintenance for this code |
|
| 01/01/2022 |
|
Coordinating stroke care to promote prevention and cultivate positive outcomes mips value pathways
No maintenance for this code |
|
| 01/01/2022 |
|
Advancing care for heart disease mips value pathways
No maintenance for this code |
|
| 01/01/2022 |
|
Optimizing chronic disease management mips value pathways
No maintenance for this code |
|
| 01/01/2022 |
|
Proposed adopting best practices and promoting patient safety within emergency medicine mips value pathways
No maintenance for this code |
|
| 01/01/2022 |
|
Improving care for lower extremity joint repair mips value pathways
No maintenance for this code |
|
| 01/01/2022 |
|
Patient safety and support of positive experiences with anesthesia mips value pathways
No maintenance for this code |
|
| 01/01/2022 |
|
Allergy/immunology mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Anesthesiology mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Audiology mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Cardiology mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Certified nurse midwife mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Chiropractic medicine mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Clinical social work mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Dentistry mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Pulmonary rehabilitation, including exercise (includes monitoring), one hour, per session, up to two sessions per day
No maintenance for this code |
|
| 04/01/2022 |
|
Clinical decision support mechanism sage health management solutions, as defined by the medicare appropriate use criteria program
Code Discontinued |
|
| 01/01/2022 |
|
Clinical decision support mechanism evidencecare imagingcare, as defined by the medicare appropriate use criteria program
No maintenance for this code |
|
| 01/01/2022 |
|
Clinical decision support mechanism radrite, as defined by the medicare appropriate use criteria program
No maintenance for this code |
|
| 01/01/2022 |
|
Patient-months where there are more than one medicare capitated payment (mcp) provider listed for the month
No maintenance for this code |
|
| 01/01/2022 |
|
The number of adult patient-months in the denominator who were on maintenance hemodialysis using a catheter continuously for three months or longer under the care of the same practitioner or group partner as of the last hemodialysis session of the reporting month
No maintenance for this code |
|
| 01/01/2022 |
|
The number of adult patient-months in the denominator who were on maintenance hemodialysis under the care of the same practitioner or group partner as of the last hemodialysis session of the reporting month using a catheter continuously for less than three months
No maintenance for this code |
|
| 01/01/2022 |
|
Take-home supply of nasal naloxone; 2-pack of 8mg per 0.1 ml nasal spray (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure
No maintenance for this code |
|
| 01/01/2022 |
|
Comprehensive care management services for a single high-risk disease, e.g., principal care management, at least 30 minutes of physician or other qualified health care professional time per calendar month with the following elements: one complex chronic condition lasting at least 3 months, which is the focus of the care plan, the condition is of sufficient severity to place patient at risk of hospitalization or have been the cause of a recent hospitalization, the condition requires development or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities
No maintenance for this code |
|
| 01/01/2022 |
|
Comprehensive care management for a single high-risk disease services, e.g. principal care management, at least 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month with the following elements: one complex chronic condition lasting at least 3 months, which is the focus of the care plan, the condition is of sufficient severity to place patient at risk of hospitalization or have been cause of a recent hospitalization, the condition requires development or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities
No maintenance for this code |
|
| 01/01/2022 |
|
Patients age 66 and older in institutional special needs plans (snp) or residing in long-term care with a pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period
No maintenance for this code |
|
| 01/01/2022 |
|
Episodes where the patient had a competing diagnosis on or within three days after the episode date (e.g., intestinal infection, pertussis, bacterial infection, lyme disease, otitis media, acute sinusitis, chronic sinusitis, infection of the adenoids, prostatitis, cellulitis, mastoiditis, or bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia/gonococcal infections, venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis or uti)
No maintenance for this code |
|
| 01/01/2022 |
|
Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
No maintenance for this code |
|
| 01/01/2022 |
|
Depression, anxiety, apathy, and psychosis assessed
No maintenance for this code |
|
| 01/01/2022 |
|
Depression, anxiety, apathy, and psychosis not assessed
No maintenance for this code |
|
| 01/01/2022 |
|
Functional status measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively was less than or equal to 22 or functional status measured by the odi version 2.1a within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of 30 points or greater
No maintenance for this code |
|
| 01/01/2022 |
|
Functional status measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively was greater than 22 and functional status measured by the odi version 2.1a within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of less than 30 points
No maintenance for this code |
|
| 01/01/2022 |
|
Functional status measured by the oswestry disability index (odi version 2.1a) at three months (6 ? 20 weeks) postoperatively was less than or equal to 22 or functional status measured by the odi version 2.1a within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated an improvement of 30 points or greater
No maintenance for this code |
|
| 01/01/2022 |
|
Functional status measured by the oswestry disability index (odi version 2.1a) at three months (6 - 20 weeks) postoperatively was greater than 22 and functional status measured by the odi version 2.1a within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated an improvement of less than 30 points
No maintenance for this code |
|
| 01/01/2022 |
|
Multimodal pain management was used
No maintenance for this code |
|
| 01/01/2022 |
|
Multimodal pain management was not used
No maintenance for this code |
|
| 01/01/2022 |
|
Uri episodes where the patient had a comorbid condition during the 12 months prior to or on the episode date (e.g., tuberculosis, neutropenia, cystic fibrosis, chronic bronchitis, pulmonary edema, respiratory failure, rheumatoid lung disease)
No maintenance for this code |
|
| 01/01/2022 |
|
Uri episodes when the patient had an active prescription of antibiotics (table 1) in the 30 days prior to the episode date
No maintenance for this code |
|
| 01/01/2022 |
|
Episodes where the patient had a comorbid condition during the 12 months prior to or on the episode date (e.g., tuberculosis, neutropenia, cystic fibrosis, chronic bronchitis, pulmonary edema, respiratory failure, rheumatoid lung disease)
No maintenance for this code |
|
| 01/01/2022 |
|
Acute bronchitis/bronchiolitis episodes when the patient had a new or refill prescription of antibiotics (table 1) in the 30 days prior to the episode date
No maintenance for this code |
|
| 01/01/2022 |
|
Reason for not administering adjuvant treatment course including both chemotherapy and her2-targeted therapy (e.g. poor performance status (ecog 3-4; karnofsky =50), cardiac contraindications, insufficient renal function, insufficient hepatic function, other active or secondary cancer diagnoses, other medical contraindications, patients who died during initial treatment course or transferred during or after initial treatment course)
No maintenance for this code |
|
| 01/01/2022 |
|
Take-home supply of nasal naloxone; 2-pack of 4mg per 0.1 ml nasal spray (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure
No maintenance for this code |
|
| 01/01/2022 |
|
Dermatology mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Diagnostic radiology mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Electrophysiology cardiac specialist mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Emergency medicine mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Endocrinology mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Family medicine mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Gastro-enterology mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
General surgery mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Geriatrics mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Hospitalists mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Infectious disease mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Internal medicine mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Interventional radiology mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Mental/behavioral health mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Nephrology mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Neurology mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Neurosurgical mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Nutrition/dietician mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Obstetrics/gynecology mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Oncology/hematology mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Ophthalmology mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Orthopedic surgery mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Otolaryngology mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Pathology mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Pediatrics mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Physical medicine mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Physical therapy/occupational therapy mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Plastic surgery mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Podiatry mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Preventive medicine mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Pulmonology mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Radiation oncology mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Rheumatology mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Skilled nursing facility mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Speech language pathology mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Thoracic surgery mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Urgent care mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Urology mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Vascular surgery mips specialty set
No maintenance for this code |
|
| 01/01/2022 |
|
Bmi not documented, documentation the patient is not eligible for bmi calculation
No maintenance for this code |
|
| 01/01/2022 |
|
Screening for depression not completed, documented patient or medical reason
No maintenance for this code |
|
| 01/01/2022 |
|
Prescribed or dispensed antibiotic on or within 3 days after the episode date
No maintenance for this code |
|
| 01/01/2022 |
|
Spirometry test results demonstrate fev1 >= 60% fev1/fvc >= 70%, predicted or patient does not have copd symptoms
No maintenance for this code |
|
| 01/01/2022 |
|
Spirometry test not performed or documented, reason not given
No maintenance for this code |
|
| 01/01/2022 |
|
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 |
|
| 01/01/2022 |
|
Elevated or hypertensive blood pressure reading documented, and the indicated follow-up is documented
No maintenance for this code |
|
| 01/01/2022 |
|
Elevated or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given
No maintenance for this code |
|
| 01/01/2022 |
|
Fda approved oral anticoagulant is prescribed
No maintenance for this code |
|
| 01/01/2022 |
|
Documentation of medical reason(s) for not prescribing an fda-approved anticoagulant to a patient with a cha2ds2-vasc score of 0 or 1 for men; or 0, 1, or 2 for women (e.g., present or planned atrial appendage occlusion or ligation)
No maintenance for this code |
|
| 01/01/2022 |
|
Documentation of patient reason(s) for not prescribing an oral anticoagulant that is fda approved for the prevention of thromboembolism (e.g., patient preference for not receiving anticoagulation)
No maintenance for this code |
|
| 01/01/2022 |
|
Documentation of patient with one or more complications or mortality within 30 days
No maintenance for this code |
|
| 01/01/2022 |
|
Documentation of patient with one or more complications within 90 days
No maintenance for this code |
|
| 01/01/2022 |
|
Documentation of patient without one or more complications and without mortality within 30 days
No maintenance for this code |
|
| 01/01/2022 |
|
Documentation of patient without one or more complications within 90 days
No maintenance for this code |
|
| 01/01/2022 |
|
Ct scan of the paranasal sinuses ordered at the time of diagnosis for documented reasons
No maintenance for this code |
|
| 01/01/2022 |
|
Ct scan of the paranasal sinuses ordered at the time of diagnosis or received within 28 days after date of diagnosis
No maintenance for this code |
|
| 01/01/2022 |
|
Ct scan of the paranasal sinuses not ordered at the time of diagnosis or received within 28 days after date of diagnosis
No maintenance for this code |
|
| 01/01/2022 |
|
Elective delivery (without medical indication) by cesarean birth or induction of labor not performed (<39 weeks of gestation)
No maintenance for this code |
|
| 01/01/2022 |
|
Elective delivery (without medical indication) by cesarean birth or induction of labor performed (<39 weeks of gestation)
No maintenance for this code |
|
| 01/01/2022 |
|
Documentation of negative or managed positive tb screen with further evidence that tb is not active prior to treatment with a biologic immune response modifier
No maintenance for this code |
|
| 01/01/2022 |
|
Medical indication for delivery by cesarean birth or induction of labor (<39 weeks of gestation) [documentation of reason(s) for elective delivery (e.g., hemorrhage and placental complications, hypertension, preeclampsia and eclampsia, rupture of membranes (premature or prolonged), maternal conditions complicating pregnancy/delivery, fetal conditions complicating pregnancy/delivery, late pregnancy, prior uterine surgery, or participation in clinical trial)]
No maintenance for this code |
|
| 01/01/2022 |
|
At least two orders for high-risk medications from the same drug class
No maintenance for this code |
|
| 01/01/2022 |
|
At least two orders for high-risk medications from the same drug class not ordered
No maintenance for this code |
|
| 01/01/2022 |
|
Documentation in the patient record of a discussion between the physician/clinician and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward the outcome of the treatment
No maintenance for this code |
|
| 01/01/2022 |
|
Documentation of medical or patient reason(s) for not discussing treatment options; medical reasons: patient is not a candidate for treatment due to advanced physical or mental health comorbidity (including active substance use); currently receiving antiviral treatment; successful antiviral treatment (with sustained virologic response) prior to reporting period; other documented medical reasons; patient reasons: patient unable or unwilling to participate in the discussion or other patient reasons
No maintenance for this code |
|
| 01/01/2022 |
|
No documentation in the patient record of a discussion between the physician or other qualified healthcare professional and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward treatment
No maintenance for this code |
|
| 01/01/2022 |
|
Primary non-small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type following iaslc guidance or classified as nsclc-nos with an explanation
No maintenance for this code |
|
| 01/01/2022 |
|
Documentation of medical reason(s) for not including the histological type or nsclc-nos classification with an explanation (e.g. specimen insufficient or non-diagnostic, specimen does not contain cancer, or other documented medical reasons)
No maintenance for this code |
|
| 01/01/2022 |
|
Primary non-small cell lung cancer lung biopsy and cytology specimen report does not document classification into specific histologic type or histologic type does not follow iaslc guidance or is classified as nsclc-nos but without an explanation
No maintenance for this code |
|
| 01/01/2022 |
|
Primary lung carcinoma resection report documents pt category, pn category and for non-small cell lung cancer, histologic type (e.g., squamous cell carcinoma, adenocarcinoma and not nsclc-nos)
No maintenance for this code |
|
| 01/01/2022 |
|
Primary lung carcinoma resection report does not document pt category, pn category and for non-small cell lung cancer, histologic type (e.g., squamous cell carcinoma, adenocarcinoma)
No maintenance for this code |
|
| 01/01/2022 |
|
Pathology report includes the pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors
No maintenance for this code |
|
| 01/01/2022 |
|
Documentation of medical reason(s) for not including pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors (e.g., negative skin biopsies, insufficient tissue, or other documented medical reasons)
No maintenance for this code |
|
| 01/01/2022 |
|
Pathology report does not include the pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors
No maintenance for this code |
|
| 01/01/2022 |
|
Patients who were born in the years 1945 to 1965
No maintenance for this code |
|
| 01/01/2022 |
|
History of receiving blood transfusions prior to 1992
No maintenance for this code |
|
| 01/01/2022 |
|
History of injection drug use
No maintenance for this code |
|
| 01/01/2022 |
|
Final reports for ct, cta, mri or mra of the chest or neck with follow-up imaging recommended
No maintenance for this code |
|
| 01/01/2022 |
|
Final reports for ct, cta, mri or mra of the chest or neck with follow-up imaging not recommended
No maintenance for this code |
|
| 01/01/2022 |
|
Final reports for ct, cta, mri or mra studies of the chest or neck without an incidentally found thyroid nodule < 1.0 cm noted or no nodule found
No maintenance for this code |
|
| 01/01/2022 |
|
Patients prescribed opiates for longer than six weeks
No maintenance for this code |
|
| 01/01/2022 |
|
Patients who had a follow-up evaluation conducted at least every three months during opioid therapy
No maintenance for this code |
|
| 01/01/2022 |
|
Patients who did not have a follow-up evaluation conducted at least every three months during opioid therapy
No maintenance for this code |
|
| 01/01/2022 |
|
Patients prescribed opiates for longer than six weeks
No maintenance for this code |
|
| 01/01/2022 |
|
Documentation of signed opioid treatment agreement at least once during opioid therapy
No maintenance for this code |
|
| 01/01/2022 |
|
No documentation of signed an opioid treatment agreement at least once during opioid therapy
No maintenance for this code |
|
| 01/01/2022 |
|
Door to puncture time of 90 minutes or less
No maintenance for this code |
|
| 01/01/2022 |
|
Door to puncture time of greater than 90 minutes, no reason given
No maintenance for this code |
|
| 01/01/2022 |
|
Patients prescribed opiates for longer than six weeks
No maintenance for this code |
|
| 01/01/2022 |
|
Patient evaluated for risk of misuse of opiates by using a brief validated instrument (e.g., opioid risk tool, soapp-r) or patient interviewed at least once during opioid therapy
No maintenance for this code |
|
| 01/01/2022 |
|
Patient not evaluated for risk of misuse of opiates by using a brief validated instrument (e.g., opioid risk tool, soapp-r) or patient not interviewed at least once during opioid therapy
No maintenance for this code |
|
| 01/01/2022 |
|
Patient did not sustain bladder injury at the time of surgery nor discovered subsequently up to 30 days post-surgery
No maintenance for this code |
|
| 01/01/2022 |
|
Health-related quality of life assessed with tool during at least two visits and quality of life score remained the same or improved
No maintenance for this code |
|
| 01/01/2022 |
|
Health-related quality of life not assessed with tool for documented reason(s) (e.g., patient has a cognitive or neuropsychiatric impairment that impairs his/her ability to complete the hrqol survey, patient has the inability to read and/or write in order to complete the hrqol questionnaire)
No maintenance for this code |
|
| 01/01/2022 |
|
Health-related quality of life not assessed with tool during at least two visits or quality of life score declined
No maintenance for this code |
|
| 01/01/2022 |
|
Major amputation or open surgical bypass not required within 48 hours of the index endovascular lower extremity revascularization procedure
No maintenance for this code |
|
| 01/01/2022 |
|
Documentation of planned hybrid or staged procedure
No maintenance for this code |
|
| 01/01/2022 |
|
Major amputation or open surgical bypass required within 48 hours of the index endovascular lower extremity revascularization procedure
No maintenance for this code |
|
| 01/01/2022 |
|
Patients in whom mrs score could not be obtained at 90 day follow-up
No maintenance for this code |
|
| 01/01/2022 |
|
Previously diagnosed or have an active diagnosis of clinical ascvd, including ascvd procedure
No maintenance for this code |
|
| 01/01/2022 |
|
Any ldl-c laboratory test result >= 190 mg/dl
No maintenance for this code |
|
| 01/01/2022 |
|
Patient's highest fasting or direct ldl-c laboratory test result in the measurement period or two years prior to the beginning of the measurement period is 70-189 mg/dl
No maintenance for this code |
|
| 01/01/2022 |
|
Episodes where the patient is taking antibiotics (table 1) in the 30 days prior to the episode date, or had an active prescription on the episode date
No maintenance for this code |
|
| 01/01/2022 |
|
Bmi is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reason
No maintenance for this code |
|
| 01/01/2022 |
|
Patients who have a diagnosis of pregnancy at any time during the measurement period
No maintenance for this code |
|
| 01/01/2022 |
|
Patients who are breastfeeding at any time during the measurement period
No maintenance for this code |
|
| 01/01/2022 |
|
Patients who have a diagnosis of rhabdomyolysis at any time during the measurement period
No maintenance for this code |
|
| 01/01/2022 |
|
Documentation of medical reason(s) for not currently being a statin therapy user or receiving an order (prescription) for statin therapy (e.g., patients with statin-associated muscle symptoms or an allergy to statin medication therapy, patients who are receiving palliative or hospice care, patients with active liver disease or hepatic disease or insufficiency, and patients with end stage renal disease [esrd])
No maintenance for this code |
|
| 01/01/2022 |
|
History of or active diagnosis of familial hypercholesterolemia
No maintenance for this code |
|
| 01/01/2022 |
|
Documentation of patients with diabetes who have a most recent fasting or direct ldl- c laboratory test result < 70 mg/dl and are not taking statin therapy
No maintenance for this code |
|
| 01/01/2022 |
|
Patients who had an endometrial ablation procedure during the 12 months prior to the index date (exclusive of the index date)
No maintenance for this code |
|
| 01/01/2022 |
|
Endometrial sampling or hysteroscopy with biopsy and results documented during the 12 months prior to the index date (exclusive of the index date) of the endometrial ablation
No maintenance for this code |
|
| 01/01/2022 |
|
Endometrial sampling or hysteroscopy with biopsy and results not documented during the 12 months prior to the index date (exclusive of the index date) of the endometrial ablation
No maintenance for this code |
|
| 01/01/2022 |
|
Patient identified as a tobacco user received tobacco cessation intervention on the date of the encounter or within the previous 12 months (counseling and/or pharmacotherapy)
No maintenance for this code |
|
| 01/01/2022 |
|
Documentation of medical reason(s) for not providing tobacco cessation intervention on the date of the encounter or within the previous 12 months (e.g., limited life expectancy, other medical reason)
No maintenance for this code |
|
| 01/01/2022 |
|
Patient identified as tobacco user did not receive tobacco cessation intervention on the date of the encounter or within the previous 12 months (counseling and/or pharmacotherapy), reason not given
No maintenance for this code |
|
| 01/01/2022 |
|
Documentation of medical reason(s) for not providing tobacco cessation intervention on the date of the encounter or within the previous 12 months if identified as a tobacco user (e.g., limited life expectancy, other medical reason)
No maintenance for this code |
|
| 01/01/2022 |
|
Documentation of system reason(s) for not prescribing an fda-approved anticoagulation due to patient being currently enrolled in a clinical trial related to af/atrial flutter treatment
No maintenance for this code |
|
| 01/01/2022 |
|
Fda-approved anticoagulant not prescribed, reason not given
No maintenance for this code |
|
| 01/01/2022 |
|
Palliative care services provided to patient any time during the measurement period
No maintenance for this code |
|
| 01/01/2022 |
|
Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., adverse reaction to vaccine)
No maintenance for this code |
|
| 01/01/2022 |
|
Pneumococcal vaccine was not administered on or after patient's 60th birthday and before the end of the measurement period, reason not otherwise specified
No maintenance for this code |
|
| 01/01/2022 |
|
Pneumococcal vaccine administered on or after patient's 60th birthday and before the end of the measurement period
No maintenance for this code |
|
| 01/01/2022 |
|
Palliative care services used by patient any time during the measurement period
No maintenance for this code |
|
| 01/01/2022 |
|
Patient was provided pallative care services any time during the measurement period
No maintenance for this code |
|
| 01/01/2022 |
|
Patient is using palliative care services any time during the measurement period
No maintenance for this code |
|
| 01/01/2022 |
|
Patients who use palliative care services any time during the measurement period
No maintenance for this code |
|
| 01/01/2022 |
|
Documentation stating the patient has received or is currently receiving palliative or hospice care
No maintenance for this code |
|
| 01/01/2022 |
|
Documentation of patient pregnancy anytime during the measurement period prior to and including the current encounter
No maintenance for this code |
|
| 01/01/2022 |
|
Documentation of medical reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., last colonoscopy incomplete, last colonoscopy had inadequate prep, piecemeal removal of adenomas, last colonoscopy found greater than 10 adenomas, or patient at high risk for colon cancer [crohn's disease, ulcerative colitis, lower gastrointestinal bleeding, personal or family history of colon cancer, hereditary colorectal cancer syndromes])
No maintenance for this code |
|
| 01/01/2022 |
|
Documentation of system reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., unable to locate previous colonoscopy report, previous colonoscopy report was incomplete)
No maintenance for this code |
|
H Codes↑ Top | |||
| Effective | Code | Description | |
| 04/01/2022 |
|
Skills training and development, per diem | |
J Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2022 |
|
Injection, aducanumab-avwa, 2 mg
No maintenance for this code |
|
| 04/01/2022 |
|
Injection, avalglucosidase alfa-ngpt, 4 mg | |
| 04/01/2022 |
|
Injection, anifrolumab-fnia, 1 mg | |
| 01/01/2022 |
|
Injection, c-1 esterase inhibitor (human), (haegarda), 10 units
No maintenance for this code |
|
| 01/01/2022 |
|
Injection, levoleucovorin, not otherwise specified, 0.5 mg
No maintenance for this code |
|
| 04/01/2022 |
|
Injection, difelikefalin, 0.1 microgram, (for esrd on dialysis) | |
| 01/01/2022 |
|
Injection, erythromycin lactobionate, per 500 mg
No maintenance for this code |
|
| 01/01/2022 |
|
Injection, fosaprepitant, 1 mg
No maintenance for this code |
|
| 01/01/2022 |
|
Injection, ibandronate sodium, 1 mg
No maintenance for this code |
|
| 01/01/2022 |
|
Leuprolide injectable, camcevi, 1 mg
No maintenance for this code |
|
| 01/01/2022 |
|
Injection, pegademase bovine, 25 iu
No maintenance for this code |
|
| 01/01/2022 |
|
Injection, pegfilgrastim, 6 mg
No maintenance for this code |
|
| 01/01/2022 |
|
Injection, pegfilgrastim, excludes biosimilar, 0.5 mg
No maintenance for this code |
|
| 01/01/2022 |
|
Injection, pentobarbital sodium, per 50 mg
No maintenance for this code |
|
| 01/01/2022 |
|
Injection, risperidone, (perseris), 0.5 mg
No maintenance for this code |
|
| 01/01/2022 |
|
Injection, somatropin, 1 mg
No maintenance for this code |
|
| 01/01/2022 |
|
Injection, tigecycline, 1 mg
No maintenance for this code |
|
| 01/01/2022 |
|
Injection, asparaginase, recombinant, (rylaze), 0.1 mg
No maintenance for this code |
|
| 01/01/2022 |
|
Injection, amivantamab-vmjw, 2 mg
No maintenance for this code |
|
| 04/01/2022 |
|
Injection, cyclophosphamide, (auromedics), 5 mg | |
| 01/01/2022 |
|
Injection, dostarlimab-gxly, 10 mg
No maintenance for this code |
|
| 04/01/2022 |
|
Injection, tisotumab vedotin-tftv, 1 mg | |
| 04/01/2022 |
|
Injection, loncastuximab tesirine-lpyl, 0.075 mg | |
K Codes↑ Top | |||
| Effective | Code | Description | |
| 04/01/2022 |
|
Power source and control electronics unit for oral device/appliance for neuromuscular electrical stimulation of the tongue muscle for the reduction of snoring and obstructive sleep apnea, controlled by phone application | |
| 04/01/2022 |
|
Oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, used in conjunction with the power source and control electronics unit, controlled by phone application, 90-day supply | |
| 04/01/2022 |
|
External recharging system for battery (internal) for use with implanted cardiac contractility modulation generator, replacement only | |
| 04/01/2022 |
|
Non-pneumatic compression controller without calibrated gradient pressure | |
| 04/01/2022 |
|
Non-pneumatic sequential compression garment, full leg | |
| 04/01/2022 |
|
Non-pneumatic sequential compression garment, half leg | |
M Codes↑ Top | |||
| Effective | Code | Description | |
| 02/11/2022 |
|
Intravenous injection, bebtelovimab, includes injection and post administration monitoring | |
| 02/11/2022 |
|
Intravenous injection, bebtelovimab, includes injection and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency | |
| 01/01/2022 |
|
Patients who were in hospice at any time during the performance period
No maintenance for this code |
|
| 01/01/2022 |
|
Patients who were in hospice at any time during the performance period
No maintenance for this code |
|
| 01/01/2022 |
|
Patients who were in hospice at any time during the performance period
No maintenance for this code |
|
| 01/01/2022 |
|
Patients with no clinical indications for imaging of the head
No maintenance for this code |
|
| 02/28/2022 |
|
Most favored nation (mfn) model drug add-on amount, per dose, (do not bill with line items that have the jw modifier)
Code Discontinued |
|
Q Codes↑ Top | |||
| Effective | Code | Description | |
| 02/11/2022 |
|
Injection, bebtelovimab, 175 mg | |
| 01/01/2022 |
|
Idecabtagene vicleucel, up to 460 million autologous b-cell maturation antigen (bcma) directed car-positive t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
No maintenance for this code |
|
| 01/01/2022 |
|
Cygnus matrix, per square centimeter
No maintenance for this code |
|
| 04/01/2022 |
|
Human health factor 10 amniotic patch (hhf10-p), per square centimeter | |
| 04/01/2022 |
|
Amniobind, per square centimeter | |
| 04/01/2022 |
|
Mlg-complete, per square centimeter | |
| 04/01/2022 |
|
Relese, per square centimeter | |
| 04/01/2022 |
|
Enverse, per square centimeter | |
| 04/01/2022 |
|
Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg | |
T Codes↑ Top | |||
| Effective | Code | Description | |
| 04/01/2022 |
|
Financial management, self-directed, waiver; per diem | |
| 04/01/2022 |
|
Supports brokerage, self-directed, waiver; per diem | |
V Codes↑ Top | |||
| Effective | Code | Description | |
| 04/01/2022 |
|
Contact lens, hydrophilic, dual focus, per lens | |
Legend: