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

A Codes

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Effective Code   Description
01/01/2021

A9591

Fluoroestradiol f 18, diagnostic, 1 millicurie
No maintenance for this code
04/01/2021

A9592

Copper cu-64, dotatate, diagnostic, 1 millicurie
No maintenance for this code
07/01/2021

A9593

Gallium ga-68 psma-11, diagnostic, (ucsf), 1 millicurie
07/01/2021

A9594

Gallium ga-68 psma-11, diagnostic, (ucla), 1 millicurie

C Codes

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Effective Code   Description
01/01/2021

C1052

Hemostatic agent, gastrointestinal, topical
No maintenance for this code
01/01/2021

C1062

Intravertebral body fracture augmentation with implant (e.g., metal, polymer)
No maintenance for this code
07/01/2021

C1761

Catheter, transluminal intravascular lithotripsy, coronary
01/01/2021

C1825

Generator, neurostimulator (implantable), non-rechargeable with carotid sinus baroreceptor stimulation lead(s)
No maintenance for this code
01/01/2021

C9060

Fluoroestradiol f18, diagnostic, 1 mci
No maintenance for this code
01/01/2021

C9062

Injection, daratumumab 10 mg and hyaluronidase-fihj
No maintenance for this code
01/01/2021

C9064

Mitomycin pyelocalyceal instillation, 1 mg
No maintenance for this code
01/01/2021

C9066

Injection, sacituzumab govitecan-hziy, 2.5 mg
No maintenance for this code
04/01/2021

C9068

Copper cu-64, dotatate, diagnostic, 1 millicurie
No maintenance for this code
04/01/2021

C9069

Injection, belantamab mafodontin-blmf, 0.5 mg
No maintenance for this code
04/01/2021

C9070

Injection, tafasitamab-cxix, 2 mg
No maintenance for this code
04/01/2021

C9071

Injection, viltolarsen, 10 mg
No maintenance for this code
04/01/2021

C9072

Injection, immune globulin (asceniv), 500 mg
No maintenance for this code
04/01/2021

C9073

Brexucabtagene autoleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
No maintenance for this code
07/01/2021

C9074

Injection, lumasiran, 0.5 mg
Code Discontinued
07/01/2021

C9075

Injection, casimersen, 10 mg
07/01/2021

C9076

Lisocabtagene maraleucel, up to 110 million autologous anti-cd19 car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
07/01/2021

C9077

Injection, cabotegravir and rilpivirine, 2mg/3mg
07/01/2021

C9078

Injection, trilaciclib, 1 mg
07/01/2021

C9079

Injection, evinacumab-dgnb, 5 mg
07/01/2021

C9080

Injection, melphalan flufenamide hydrochloride, 1 mg
04/01/2021

C9122

Mometasone furoate sinus implant, 10 micrograms (sinuva)
No maintenance for this code
07/01/2021

C9132

Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity
Code Discontinued
01/01/2021

C9745

Nasal endoscopy, surgical; balloon dilation of eustachian tube
No maintenance for this code
01/01/2021

C9747

Ablation of prostate, transrectal, high intensity focused ultrasound (hifu), including imaging guidance
No maintenance for this code
01/01/2021

C9749

Repair of nasal vestibular lateral wall stenosis with implant(s)
No maintenance for this code
01/01/2021

C9760

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

C9770

Vitrectomy, mechanical, pars plana approach, with subretinal injection of pharmacologic/biologic agent
No maintenance for this code
01/01/2021

C9771

Nasal/sinus endoscopy, cryoablation nasal tissue(s) and/or nerve(s), unilateral or bilateral
No maintenance for this code
01/01/2021

C9772

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

C9773

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

C9774

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

C9775

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

C9776

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)
No maintenance for this code
04/01/2021

C9777

Esophageal mucosal integrity testing by electrical impedance, transoral (list separately in addition to code for primary procedure)
No maintenance for this code
07/01/2021

C9778

Colpopexy, vaginal; minimally invasive extra-peritoneal approach (sacrospinous)

G Codes

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Effective Code   Description
01/01/2021

G0068

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

G0069

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

G0070

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

G0088

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

G0089

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

G0090

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

G0297

Low dose ct scan (ldct) for lung cancer screening
No maintenance for this code
07/01/2021

G0327

Colorectal cancer screening; blood-based biomarker
01/01/2021

G1005

Clinical decision support mechanism national imaging associates, as defined by the medicare appropriate use criteria program
No maintenance for this code
01/01/2021

G1006

Clinical decision support mechanism test appropriate, as defined by the medicare appropriate use criteria program
No maintenance for this code
04/01/2021

G2020

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)
No maintenance for this code
01/01/2021

G2058

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

G2061

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

G2062

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

G2063

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

G2089

Most recent hemoglobin a1c (hba1c) level 7.0 to 9.0%
No maintenance for this code
01/01/2021

G2097

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

G2102

Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed
No maintenance for this code
01/01/2021

G2103

Seven standard field stereoscopic photos with interpretation by an ophthalmologist or optometrist documented and reviewed
No maintenance for this code
01/01/2021

G2104

Eye imaging validated to match diagnosis from seven standard field stereoscopic photos results documented and reviewed
No maintenance for this code
01/01/2021

G2105

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

G2108

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

G2114

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

G2115

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

G2116

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

G2117

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

G2118

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

G2119

Within the past 2 years, calcium and/or vitamin d optimization has been ordered or performed
No maintenance for this code
01/01/2021

G2120

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

G2123

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

G2124

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

G2125

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

G2126

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

G2127

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

G2130

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

G2131

Patients 81 years and older with a diagnosis of frailty
No maintenance for this code
01/01/2021

G2132

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

G2133

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

G2134

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

G2135

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

G2136

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

G2138

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

G2144

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

G2151

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

G2152

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

G2153

In hospice or using hospice services during the measurement period
No maintenance for this code
01/01/2021

G2154

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

G2155

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

G2156

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

G2157

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

G2158

Patient had prior pneumococcal vaccine adverse reaction any time during or before the measurement period
No maintenance for this code
01/01/2021

G2159

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

G2160

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

G2161

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

G2162

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

G2163

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

G2164

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

G2165

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

G2166

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

G2167

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

G2172

All inclusive payment for services related to highly coordinated and integrated opioid use disorder (oud) treatment services furnished for the demonstration project
No maintenance for this code
01/01/2021

G2173

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

G2174

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

G2175

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

G2176

Outpatient, ed, or observation visits that result in an inpatient admission
No maintenance for this code
01/01/2021

G2177

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

G2178

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

G2179

Clinician documented that patient had medical reason for not performing lower extremity neurological exam
No maintenance for this code
01/01/2021

G2180

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

G2181

Bmi not documented due to medical reason or patient refusal of height or weight measurement
No maintenance for this code
01/01/2021

G2182

Patient receiving first-time biologic disease modifying anti-rheumatic drug therapy
No maintenance for this code
01/01/2021

G2183

Documentation patient unable to communicate and informant not available
No maintenance for this code
01/01/2021

G2184

Patient does not have a caregiver
No maintenance for this code
01/01/2021

G2185

Documentation caregiver is trained and certified in dementia care
No maintenance for this code
01/01/2021

G2186

Patient /caregiver dyad has been referred to appropriate resources and connection to those resources is confirmed
No maintenance for this code
01/01/2021

G2187

Patients with clinical indications for imaging of the head: head trauma
No maintenance for this code
01/01/2021

G2188

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

G2189

Patients with clinical indications for imaging of the head: abnormal neurologic exam
No maintenance for this code
01/01/2021

G2190

Patients with clinical indications for imaging of the head: headache radiating to the neck
No maintenance for this code
01/01/2021

G2191

Patients with clinical indications for imaging of the head: positional headaches
No maintenance for this code
01/01/2021

G2192

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

G2193

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

G2194

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

G2195

Patients with clinical indications for imaging of the head: occipital headache in children
No maintenance for this code
01/01/2021

G2196

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

G2197

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

G2198

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

G2199

Patient not screened for unhealthy alcohol use using a systematic screening method, reason not given
No maintenance for this code
01/01/2021

G2200

Patient identified as an unhealthy alcohol user received brief counseling
No maintenance for this code
01/01/2021

G2201

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

G2202

Patient did not receive brief counseling if identified as an unhealthy alcohol user, reason not given
No maintenance for this code
01/01/2021

G2203

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

G2204

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

G2205

Patients with pregnancy during adjuvant treatment course
No maintenance for this code
01/01/2021

G2206

Patient received adjuvant treatment course including both chemotherapy and her2-targeted therapy
No maintenance for this code
01/01/2021

G2207

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

G2208

Patient did not receive adjuvant treatment course including both chemotherapy and her2-targeted therapy
No maintenance for this code
01/01/2021

G2209

Patient refused to participate
No maintenance for this code
01/01/2021

G2210

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

G2211

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

G2212

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

G2213

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

G2214

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

G2215

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

G2216

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

G2250

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

G2251

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

G2252

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

G8398

Dilated macular or fundus exam not performed
No maintenance for this code
01/01/2021

G8430

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

G8442

Pain assessment not documented as being performed, documentation the patient is not eligible for a pain assessment using a standardized tool at the time of the encounter
No maintenance for this code
01/01/2021

G8509

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

G8571

Development of deep sternal wound infection/mediastinitis within 30 days postoperatively
No maintenance for this code
01/01/2021

G8572

No deep sternal wound infection/mediastinitis
No maintenance for this code
01/01/2021

G8573

Stroke following isolated cabg surgery
No maintenance for this code
01/01/2021

G8574

No stroke following isolated cabg surgery
No maintenance for this code
01/01/2021

G8601

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

G8627

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

G8628

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

G8650

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

G8654

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

G8658

Risk-adjusted functional status change residual score for the lower leg, foot or ankle impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given
No maintenance for this code
01/01/2021

G8671

Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs or other general orthopedic impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
No maintenance for this code
01/01/2021

G8672

Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs or other general orthopedic impairment successfully calculated and the score was less than zero (< 0)
No maintenance for this code
01/01/2021

G8674

Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs or other general orthopedic impairment not measured because the patient did not complete the general orthopedic fs prom at initial evaluation and/or near discharge, reason not given
No maintenance for this code
01/01/2021

G8694

Left ventricular ejection fraction (lvef) < 40% or documentation of moderate or severe lvsd
No maintenance for this code
01/01/2021

G8709

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

G8730

Pain assessment documented as positive using a standardized tool and a follow-up plan is documented
No maintenance for this code
01/01/2021

G8731

Pain assessment using a standardized tool is documented as negative, no follow-up plan required
No maintenance for this code
01/01/2021

G8732

No documentation of pain assessment, reason not given
No maintenance for this code
01/01/2021

G8809

Rh-immunoglobulin (rhogam) ordered
No maintenance for this code
01/01/2021

G8810

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

G8811

Documentation rh-immunoglobulin (rhogam) was not ordered, reason not given
No maintenance for this code
01/01/2021

G8872

Excised tissue evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesion
No maintenance for this code
01/01/2021

G8873

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

G8874

Excised tissue not evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesion
No maintenance for this code
01/01/2021

G8924

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

G8938

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

G8939

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

G8959

Clinician treating major depressive disorder communicates to clinician treating comorbid condition
No maintenance for this code
01/01/2021

G8960

Clinician treating major depressive disorder did not communicate to clinician treating comorbid condition, reason not given
No maintenance for this code
01/01/2021

G8969

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

G8973

Most recent hemoglobin (hgb) level < 10 g/dl
No maintenance for this code
01/01/2021

G8974

Hemoglobin level measurement not documented, reason not given
No maintenance for this code
01/01/2021

G8975

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

G8976

Most recent hemoglobin (hgb) level >= 10 g/dl
No maintenance for this code
01/01/2021

G9232

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

G9239

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

G9240

Patient whose mode of vascular access is a catheter at the time maintenance hemodialysis is initiated
No maintenance for this code
01/01/2021

G9241

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

G9256

Documentation of patient death following cas
No maintenance for this code
01/01/2021

G9257

Documentation of patient stroke following cas
No maintenance for this code
01/01/2021

G9258

Documentation of patient stroke following cea
No maintenance for this code
01/01/2021

G9259

Documentation of patient survival and absence of stroke following cas
No maintenance for this code
01/01/2021

G9260

Documentation of patient death following cea
No maintenance for this code
01/01/2021

G9261

Documentation of patient survival and absence of stroke following cea
No maintenance for this code
01/01/2021

G9262

Documentation of patient death in the hospital following endovascular aaa repair
No maintenance for this code
01/01/2021

G9263

Documentation of patient discharged alive following endovascular aaa repair
No maintenance for this code
01/01/2021

G9264

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

G9265

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

G9266

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

G9299

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

G9300

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

G9301

Patients who had the prophylactic antibiotic completely infused prior to the inflation of the proximal tourniquet
No maintenance for this code
01/01/2021

G9302

Prophylactic antibiotic not completely infused prior to the inflation of the proximal tourniquet, reason not given
No maintenance for this code
01/01/2021

G9303

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

G9304

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

G9326

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

G9327

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

G9329

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

G9340

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

G9355

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

G9356

Early elective delivery by c-section, or early elective induction, performed (less than 39 week gestation)
No maintenance for this code
01/01/2021

G9365

One high-risk medication ordered
No maintenance for this code
01/01/2021

G9366

One high-risk medication not ordered
No maintenance for this code
01/01/2021

G9389

Unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery
No maintenance for this code
01/01/2021

G9390

No unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery
No maintenance for this code
01/01/2021

G9401

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

G9402

Patient received follow-up within 30 days after discharge
No maintenance for this code
01/01/2021

G9415

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

G9448

Patients who were born in the years 1945 to 1965
No maintenance for this code
01/01/2021

G9469

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

G9503

Patient taking tamsulosin hydrochloride
No maintenance for this code
01/01/2021

G9523

Patient discontinued from hemodialysis or peritoneal dialysis
No maintenance for this code
01/01/2021

G9524

Patient was referred to hospice care
No maintenance for this code
01/01/2021

G9525

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

G9526

Patient was not referred to hospice care, reason not given
No maintenance for this code
01/01/2021

G9532

Patient had a head ct for trauma ordered by someone other than an emergency care provider or was ordered for a reason other than trauma
No maintenance for this code
01/01/2021

G9537

Imaging needed as part of a clinical trial; or other clinician ordered the study
No maintenance for this code
01/01/2021

G9550

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

G9558

Patient treated with a beta-lactam antibiotic as definitive therapy
No maintenance for this code
01/01/2021

G9559

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

G9560

Patient not treated with a beta-lactam antibiotic as definitive therapy, reason not given
No maintenance for this code
01/01/2021

G9573

Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at six months as demonstrated by a six month (+/-60 days) phq-9 or phq-9m score of less than five
No maintenance for this code
01/01/2021

G9574

Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at six months as demonstrated by a six month (+/-60 days) phq-9 or phq-9m score of less than five; either phq-9 or phq-9m score was not assessed or is greater than or equal to five
No maintenance for this code
01/01/2021

G9600

Symptomatic aaas that required urgent/emergent (non-elective) repair
No maintenance for this code
01/01/2021

G9601

Patient discharge to home no later than post-operative day #7
No maintenance for this code
01/01/2021

G9602

Patient not discharged to home by post-operative day #7
No maintenance for this code
01/01/2021

G9615

Preoperative assessment documented
No maintenance for this code
01/01/2021

G9616

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

G9617

Preoperative assessment not documented, reason not given
No maintenance for this code
01/01/2021

G9642

Current smoker (e.g., cigarette, cigar, pipe, e-cigarette or marijuana)
No maintenance for this code
01/01/2021

G9659

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

G9660

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

G9661

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

G9663

Any fasting or direct ldl-c laboratory test result >= 190 mg/dl
No maintenance for this code
01/01/2021

G9666

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

G9701

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

G9703

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

G9716

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

G9717

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

G9722

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

G9727

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

G9729

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

G9731

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

G9738

Patient refused to participate
No maintenance for this code
01/01/2021

G9739

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

G9747

Patient is undergoing palliative dialysis with a catheter
No maintenance for this code
01/01/2021

G9748

Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant
No maintenance for this code
01/01/2021

G9749

Patient is undergoing palliative dialysis with a catheter
No maintenance for this code
01/01/2021

G9750

Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant
No maintenance for this code
01/01/2021

G9759

History of preoperative posterior capsule rupture
No maintenance for this code
01/01/2021

G9798

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

G9799

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

G9800

Patients who are identified as having an intolerance or allergy to beta-blocker therapy
No maintenance for this code
01/01/2021

G9801

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

G9802

Patients who use hospice services any time during the measurement period
No maintenance for this code
01/01/2021

G9803

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

G9804

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

G9814

Death occurring during the index acute care hospitalization
No maintenance for this code
01/01/2021

G9815

Death did not occur during the index acute care hospitalization
No maintenance for this code
01/01/2021

G9816

Death occurring after discharge from the hospital but within 30 days post procedure
No maintenance for this code
01/01/2021

G9817

Death did not occur after discharge from the hospital within 30 days post procedure
No maintenance for this code
01/01/2021

G9825

Her-2/neu negative or undocumented/unknown
No maintenance for this code
01/01/2021

G9826

Patient transferred to practice after initiation of chemotherapy
No maintenance for this code
01/01/2021

G9827

Her2-targeted therapies not administered during the initial course of treatment
No maintenance for this code
01/01/2021

G9828

Her2-targeted therapies administered during the initial course of treatment
No maintenance for this code
01/01/2021

G9829

Breast adjuvant chemotherapy administered
No maintenance for this code
01/01/2021

G9833

Patient transfer to practice after initiation of chemotherapy
No maintenance for this code
01/01/2021

G9834

Patient has metastatic disease at diagnosis
No maintenance for this code
01/01/2021

G9835

Trastuzumab administered within 12 months of diagnosis
No maintenance for this code
01/01/2021

G9836

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

G9837

Trastuzumab not administered within 12 months of diagnosis
No maintenance for this code
01/01/2021

G9849

Patients who died from cancer
No maintenance for this code
01/01/2021

G9850

Patient had more than one emergency department visit in the last 30 days of life
No maintenance for this code
01/01/2021

G9851

Patient had one or less emergency department visits in the last 30 days of life
No maintenance for this code
01/01/2021

G9855

Patients who died from cancer
No maintenance for this code
01/01/2021

G9856

Patient was not admitted to hospice
No maintenance for this code
01/01/2021

G9857

Patient admitted to hospice
No maintenance for this code
04/01/2021

G9868

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
No maintenance for this code
04/01/2021

G9869

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
No maintenance for this code
04/01/2021

G9870

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
No maintenance for this code
01/01/2021

G9898

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

G9901

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

G9910

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

G9924

Documentation of medical reason(s) for not providing safety concerns screen or for not providing recommendations, orders or referrals for positive screen (e.g., patient in palliative care, other medical reason)
No maintenance for this code
01/01/2021

G9931

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

G9933

Adenoma(s) or colorectal cancer detected during screening colonoscopy
No maintenance for this code
01/01/2021

G9934

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

G9935

Adenoma(s) or colorectal cancer not detected during screening colonoscopy
No maintenance for this code
01/01/2021

G9936

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

G9937

Diagnostic colonoscopy
No maintenance for this code
01/01/2021

G9938

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

G9945

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

G9966

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

G9967

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
07/01/2021

J0224

Injection, lumasiran, 0.5 mg
01/01/2021

J0693

Injection, cefiderocol, 5 mg
No maintenance for this code
04/01/2021

J1427

Injection, viltolarsen, 10 mg
No maintenance for this code
04/01/2021

J1554

Injection, immune globulin (asceniv), 500 mg
No maintenance for this code
01/01/2021

J1823

Injection, inebilizumab-cdon, 1 mg
No maintenance for this code
07/01/2021

J1951

Injection, leuprolide acetate for depot suspension (fensolvi), 0.25 mg
07/01/2021

J7168

Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity
01/01/2021

J7189

Factor viia (antihemophilic factor, recombinant), (novoseven rt), 1 microgram
No maintenance for this code
01/01/2021

J7212

Factor viia (antihemophilic factor, recombinant)-jncw (sevenfact), 1 microgram
No maintenance for this code
04/01/2021

J7321

Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose
No maintenance for this code
04/01/2021

J7333

Hyaluronan or derivative, visco-3, for intra-articular injection, per dose
No maintenance for this code
01/01/2021

J7352

Afamelanotide implant, 1 mg
No maintenance for this code
04/01/2021

J7401

Mometasone furoate sinus implant, 10 micrograms
No maintenance for this code
04/01/2021

J7402

Mometasone furoate sinus implant, (sinuva), 10 micrograms
No maintenance for this code
04/01/2021

J9037

Injection, belantamab mafodotin-blmf, 0.5 mg
No maintenance for this code
01/01/2021

J9144

Injection, daratumumab, 10 mg and hyaluronidase-fihj
No maintenance for this code
01/01/2021

J9223

Injection, lurbinectedin, 0.1 mg
No maintenance for this code
01/01/2021

J9281

Mitomycin pyelocalyceal instillation, 1 mg
No maintenance for this code
01/01/2021

J9316

Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg
No maintenance for this code
01/01/2021

J9317

Injection, sacituzumab govitecan-hziy, 2.5 mg
No maintenance for this code
07/01/2021

J9348

Injection, naxitamab-gqgk, 1 mg
04/01/2021

J9349

Injection, tafasitamab-cxix, 2 mg
No maintenance for this code
07/01/2021

J9353

Injection, margetuximab-cmkb, 5 mg

K Codes

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Effective Code   Description
04/01/2021

K1010

Indwelling intraurethral drainage device with valve, patient inserted, replacement only, each
No maintenance for this code
04/01/2021

K1011

Activation device for intraurethral drainage device with valve, replacement only, each
No maintenance for this code
04/01/2021

K1012

Charger and base station for intraurethral activation device, replacement only
No maintenance for this code
04/01/2021

K1013

Enema tube, any type, replacement only, each
No maintenance for this code
04/01/2021

K1014

Addition, endoskeletal knee-shin system, 4 bar linkage or multiaxial, fluid swing and stance phase control
No maintenance for this code
04/01/2021

K1015

Foot, adductus positioning device, adjustable
No maintenance for this code
04/01/2021

K1016

Transcutaneous electrical nerve stimulator for electrical stimulation of the trigeminal nerve
No maintenance for this code
04/01/2021

K1017

Monthly supplies for use of device coded at k1016
No maintenance for this code
04/01/2021

K1018

External upper limb tremor stimulator of the peripheral nerves of the wrist
No maintenance for this code
04/01/2021

K1019

Monthly supplies for use of device coded at k1018
No maintenance for this code
04/01/2021

K1020

Non-invasive vagus nerve stimulator
No maintenance for this code

M Codes

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Effective Code   Description
06/08/2021

M0201

Covid-19 vaccine administration inside a patient's home; reported only once per individual home per date of service when only covid-19 vaccine administration is performed at the patient's home
04/17/2021

M0239

Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring
Code Discontinued
05/06/2021

M0244

Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring 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
02/09/2021

M0245

Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring
No maintenance for this code
05/06/2021

M0246

Intravenous infusion, bamlanivimab and etesevimab, includes infusion 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
05/26/2021

M0247

Intravenous infusion, sotrovimab, includes infusion and post administration monitoring
05/26/2021

M0248

Intravenous infusion, sotrovimab, includes infusion 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
01/01/2021

M1003

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

M1015

Discharge/discontinuation of the episode of care documented in the medical record
No maintenance for this code
01/01/2021

M1023

Adolescent patients 12 to 17 years of age with major depression or dysthymia who reached remission at six months as demonstrated by a six month (+/-60 days) phq-9 or phq-9m score of less than five
No maintenance for this code
01/01/2021

M1024

Adolescent patients 12 to 17 years of age with major depression or dysthymia who did not reach remission at six months as demonstrated by a six month (+/-60 days) phq-9 or phq-9m score of less than five. either phq-9 or phq-9m score was not assessed or is greater than or equal to five
No maintenance for this code
01/01/2021

M1033

Pharmacotherapy for oud initiated after june 30th of performance period
No maintenance for this code
01/01/2021

M1041

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

M1045

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

M1046

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

M1051

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

M1061

Patient pregnancy
No maintenance for this code
01/01/2021

M1062

Patient immunocompromised
No maintenance for this code
01/01/2021

M1063

Patients receiving high doses of immunosuppressive therapy
No maintenance for this code
01/01/2021

M1064

Shingrix vaccine documented as administered or previously received
No maintenance for this code
01/01/2021

M1065

Shingrix vaccine was not administered for reasons documented by clinician (e.g. patient administered vaccine other than shingrix, patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons)
No maintenance for this code
01/01/2021

M1066

Shingrix vaccine not documented as administered, reason not given
No maintenance for this code
01/01/2021

M1108

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

M1109

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

M1110

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

M1113

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

M1114

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

M1115

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

M1118

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

M1119

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

M1120

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

M1123

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

M1124

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

M1125

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

M1128

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

M1129

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

M1130

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

M1132

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

M1133

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

M1134

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

M1136

The start of an episode of care documented in the medical record
No maintenance for this code
01/01/2021

M1137

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

M1138

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

M1139

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

M1140

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

M1141

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

M1144

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

M1145

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

M1146

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

M1147

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

M1148

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

M1149

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

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Effective Code   Description
04/17/2021

Q0239

Injection, bamlanivimab-xxxx, 700 mg
Code Discontinued
02/09/2021

Q0245

Injection, bamlanivimab and etesevimab, 2100 mg
No maintenance for this code
05/26/2021

Q0247

Injection, sotrovimab, 500 mg
04/01/2021

Q2053

Brexucabtagene autoleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
No maintenance for this code
01/01/2021

Q5122

Injection, pegfilgrastim-apgf, biosimilar, (nyvepria), 0.5 mg
No maintenance for this code
07/01/2021

Q5123

Injection, rituximab-arrx, biosimilar, (riabni), 10 mg

S Codes

↑ Top
Effective Code   Description
01/01/2021

S0013

Esketamine, nasal spray, 1 mg
No maintenance for this code
04/01/2021

S1091

Stent, non-coronary, temporary, with delivery system (propel)
No maintenance for this code

U Codes

↑ Top
Effective Code   Description
01/01/2021

U0005

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:

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