Legend:

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

A Codes

↑ Top
Effective Code   Description
01/01/2022

A2001

Innovamatrix ac, per square centimeter
No maintenance for this code
01/01/2022

A2002

Mirragen advanced wound matrix, per square centimeter
No maintenance for this code
01/01/2022

A2004

Xcellistem, 1 mg
Change in long description of procedure or modifier code
01/01/2022

A2005

Microlyte matrix, per square centimeter
No maintenance for this code
01/01/2022

A2006

Novosorb synpath dermal matrix, per square centimeter
No maintenance for this code
01/01/2022

A2007

Restrata, per square centimeter
No maintenance for this code
01/01/2022

A2008

Theragenesis, per square centimeter
No maintenance for this code
01/01/2022

A2009

Symphony, per square centimeter
No maintenance for this code
01/01/2022

A2010

Apis, per square centimeter
No maintenance for this code
04/01/2022

A2011

Supra sdrm, per square centimeter
No maintenance for this code
04/01/2022

A2012

Suprathel, per square centimeter
No maintenance for this code
04/01/2022

A2013

Innovamatrix fs, per square centimeter
No maintenance for this code
04/01/2022

A4100

Skin substitute, fda cleared as a device, not otherwise specified
No maintenance for this code
04/01/2022

A4238

Supply allowance for adjunctive continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service
No maintenance for this code
01/01/2022

A4397

Irrigation supply; sleeve, each
No maintenance for this code
01/01/2022

A4436

Irrigation supply; sleeve, reusable, per month
No maintenance for this code
01/01/2022

A4437

Irrigation supply; sleeve, disposable, per month
No maintenance for this code
04/01/2022

A9276

Sensor; invasive (e.g., subcutaneous), disposable, for use with interstitial continuous glucose monitoring system, one unit = 1 day supply
No maintenance for this code
04/01/2022

A9277

Transmitter; external, for use with interstitial continuous glucose monitoring system
No maintenance for this code
04/01/2022

A9278

Receiver (monitor); external, for use with interstitial continuous glucose monitoring system
No maintenance for this code
04/01/2022

A9291

Prescription digital behavioral therapy, fda cleared, per course of treatment
No maintenance for this code
01/01/2022

A9595

Piflufolastat f-18, diagnostic, 1 millicurie
No maintenance for this code
07/01/2022

A9596

Gallium ga-68 gozetotide, diagnostic, (illuccix), 1 millicurie
07/01/2022

A9601

Flortaucipir f 18 injection, diagnostic, 1 millicurie

C Codes

↑ Top
Effective Code   Description
01/01/2022

C1832

Autograft suspension, including cell processing and application, and all system components
No maintenance for this code
01/01/2022

C1833

Monitor, cardiac, including intracardiac lead and all system components (implantable)
No maintenance for this code
01/01/2022

C9081

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

C9082

Injection, dostarlimab-gxly, 100 mg
No maintenance for this code
01/01/2022

C9083

Injection, amivantamab-vmjw, 10 mg
No maintenance for this code
04/01/2022

C9084

Injection, loncastuximab tesirine-lpyl, 0.1 mg
No maintenance for this code
04/01/2022

C9085

Injection, avalglucosidase alfa-ngpt, 4 mg
No maintenance for this code
04/01/2022

C9086

Injection, anifrolumab-fnia, 1 mg
No maintenance for this code
04/01/2022

C9087

Injection, cyclophosphamide, (auromedics), 10 mg
No maintenance for this code
01/01/2022

C9088

Instillation, bupivacaine and meloxicam, 1 mg/0.03 mg
No maintenance for this code
01/01/2022

C9089

Bupivacaine, collagen-matrix implant, 1 mg
No maintenance for this code
07/01/2022

C9090

Injection, plasminogen, human-tvmh, 1 mg
Code Discontinued
07/01/2022

C9091

Injection, sirolimus protein-bound particles, 1 mg
Code Discontinued
07/01/2022

C9092

Injection, triamcinolone acetonide, suprachoroidal (xipere), 1 mg
Code Discontinued
07/01/2022

C9093

Injection, ranibizumab, via sustained release intravitreal implant (susvimo), 0.1 mg
Code Discontinued
07/01/2022

C9094

Inj, sutimlimab-jome, 10 mg
07/01/2022

C9095

Inj, tebentafusp-tebn, 1 mcg
07/01/2022

C9096

Injection, filgrastim-ayow, biosimilar, (releuko), 1 microgram
07/01/2022

C9097

Inj, faricimab-svoa, 0.1 mg
07/01/2022

C9098

Ciltacabtagene autoleucel, up to 100 million autologous b-cell maturation antigen (bcma) directed car-positive t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
01/01/2022

C9248

Injection, clevidipine butyrate, 1 mg
No maintenance for this code
01/01/2022

C9462

Injection, delafloxacin, 1 mg
No maintenance for this code
01/01/2022

C9752

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

C9753

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

C9777

Esophageal mucosal integrity testing by electrical impedance, transoral, includes esophagoscopy or esophagogastroduodenoscopy
No maintenance for this code
01/01/2022

C9779

Endoscopic submucosal dissection (esd), including endoscopy or colonoscopy, mucosal closure, when performed
No maintenance for this code
01/01/2022

C9780

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

C9781

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
No maintenance for this code
04/01/2022

C9782

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
No maintenance for this code
04/01/2022

C9783

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
No maintenance for this code

E Codes

↑ Top
Effective Code   Description
01/01/2022

E1629

Tablo hemodialysis system for the billable dialysis service
No maintenance for this code
04/01/2022

E2102

Adjunctive continuous glucose monitor or receiver
No maintenance for this code

G Codes

↑ Top
Effective Code   Description
01/01/2022

G0028

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

G0029

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

G0030

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

G0031

Palliative care services given to patient any time during the measurement period
No maintenance for this code
01/01/2022

G0032

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

G0033

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

G0034

Patients receiving palliative care during the measurement period
No maintenance for this code
01/01/2022

G0035

Patient has any emergency department encounter during the performance period with place of service indicator 23
No maintenance for this code
01/01/2022

G0036

Patient or care partner decline assessment
No maintenance for this code
01/01/2022

G0037

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

G0038

Clinician determines patient does not require referral
No maintenance for this code
01/01/2022

G0039

Patient not referred, reason not otherwise specified
No maintenance for this code
01/01/2022

G0040

Patient already receiving physical/occupational/speech/recreational therapy during the measurement period
No maintenance for this code
01/01/2022

G0041

Patient and/or care partner decline referral
No maintenance for this code
01/01/2022

G0042

Referral to physical, occupational, speech, or recreational therapy
No maintenance for this code
01/01/2022

G0043

Patients with mechanical prosthetic heart valve
No maintenance for this code
01/01/2022

G0044

Patients with moderate or severe mitral stenosis
No maintenance for this code
01/01/2022

G0045

Clinical follow-up and mrs score assessed at 90 days following endovascular stroke intervention
No maintenance for this code
01/01/2022

G0046

Clinical follow-up and mrs score not assessed at 90 days following endovascular stroke intervention
No maintenance for this code
01/01/2022

G0047

Pediatric patient with minor blunt head trauma and pecarn prediction criteria are not assessed
No maintenance for this code
01/01/2022

G0048

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

G0049

With maintenance hemodialysis (in-center and home hd) for the complete reporting month
No maintenance for this code
01/01/2022

G0050

Patients with a catheter that have limited life expectancy
No maintenance for this code
01/01/2022

G0051

Patients under hospice care in the current reporting month
No maintenance for this code
01/01/2022

G0052

Patients on peritoneal dialysis for any portion of the reporting month
No maintenance for this code
01/01/2022

G0053

Advancing rheumatology patient care mips value pathways
No maintenance for this code
01/01/2022

G0054

Coordinating stroke care to promote prevention and cultivate positive outcomes mips value pathways
No maintenance for this code
01/01/2022

G0055

Advancing care for heart disease mips value pathways
No maintenance for this code
01/01/2022

G0056

Optimizing chronic disease management mips value pathways
No maintenance for this code
01/01/2022

G0057

Proposed adopting best practices and promoting patient safety within emergency medicine mips value pathways
No maintenance for this code
01/01/2022

G0058

Improving care for lower extremity joint repair mips value pathways
No maintenance for this code
01/01/2022

G0059

Patient safety and support of positive experiences with anesthesia mips value pathways
No maintenance for this code
01/01/2022

G0060

Allergy/immunology mips specialty set
No maintenance for this code
01/01/2022

G0061

Anesthesiology mips specialty set
No maintenance for this code
01/01/2022

G0062

Audiology mips specialty set
No maintenance for this code
01/01/2022

G0063

Cardiology mips specialty set
No maintenance for this code
01/01/2022

G0064

Certified nurse midwife mips specialty set
No maintenance for this code
01/01/2022

G0065

Chiropractic medicine mips specialty set
No maintenance for this code
01/01/2022

G0066

Clinical social work mips specialty set
No maintenance for this code
01/01/2022

G0067

Dentistry mips specialty set
No maintenance for this code
07/01/2022

G0308

Creation of subcutaneous pocket with insertion of 180 day implantable interstitial glucose sensor, including system activation and patient training
07/01/2022

G0309

Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and insertion of new 180 day implantable sensor, including system activation
01/01/2022

G0424

Pulmonary rehabilitation, including exercise (includes monitoring), one hour, per session, up to two sessions per day
No maintenance for this code
04/01/2022

G1009

Clinical decision support mechanism sage health management solutions, as defined by the medicare appropriate use criteria program
No maintenance for this code
01/01/2022

G1013

Clinical decision support mechanism evidencecare imagingcare, as defined by the medicare appropriate use criteria program
No maintenance for this code
01/01/2022

G1024

Clinical decision support mechanism radrite, as defined by the medicare appropriate use criteria program
No maintenance for this code
01/01/2022

G1025

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

G1026

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

G1027

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

G1028

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

G2064

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

G2065

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

G2081

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

G2097

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

G2106

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

G2121

Depression, anxiety, apathy, and psychosis assessed
No maintenance for this code
01/01/2022

G2122

Depression, anxiety, apathy, and psychosis not assessed
No maintenance for this code
01/01/2022

G2142

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

G2143

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

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 an improvement of 30 points or greater
No maintenance for this code
01/01/2022

G2145

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

G2148

Multimodal pain management was used
No maintenance for this code
01/01/2022

G2150

Multimodal pain management was not used
No maintenance for this code
01/01/2022

G2173

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

G2174

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

G2175

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

G2177

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

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
01/01/2022

G2215

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

G4000

Dermatology mips specialty set
No maintenance for this code
01/01/2022

G4001

Diagnostic radiology mips specialty set
No maintenance for this code
01/01/2022

G4002

Electrophysiology cardiac specialist mips specialty set
No maintenance for this code
01/01/2022

G4003

Emergency medicine mips specialty set
No maintenance for this code
01/01/2022

G4004

Endocrinology mips specialty set
No maintenance for this code
01/01/2022

G4005

Family medicine mips specialty set
No maintenance for this code
01/01/2022

G4006

Gastro-enterology mips specialty set
No maintenance for this code
01/01/2022

G4007

General surgery mips specialty set
No maintenance for this code
01/01/2022

G4008

Geriatrics mips specialty set
No maintenance for this code
01/01/2022

G4009

Hospitalists mips specialty set
No maintenance for this code
01/01/2022

G4010

Infectious disease mips specialty set
No maintenance for this code
01/01/2022

G4011

Internal medicine mips specialty set
No maintenance for this code
01/01/2022

G4012

Interventional radiology mips specialty set
No maintenance for this code
01/01/2022

G4013

Mental/behavioral health mips specialty set
No maintenance for this code
01/01/2022

G4014

Nephrology mips specialty set
No maintenance for this code
01/01/2022

G4015

Neurology mips specialty set
No maintenance for this code
01/01/2022

G4016

Neurosurgical mips specialty set
No maintenance for this code
01/01/2022

G4017

Nutrition/dietician mips specialty set
No maintenance for this code
01/01/2022

G4018

Obstetrics/gynecology mips specialty set
No maintenance for this code
01/01/2022

G4019

Oncology/hematology mips specialty set
No maintenance for this code
01/01/2022

G4020

Ophthalmology mips specialty set
No maintenance for this code
01/01/2022

G4021

Orthopedic surgery mips specialty set
No maintenance for this code
01/01/2022

G4022

Otolaryngology mips specialty set
No maintenance for this code
01/01/2022

G4023

Pathology mips specialty set
No maintenance for this code
01/01/2022

G4024

Pediatrics mips specialty set
No maintenance for this code
01/01/2022

G4025

Physical medicine mips specialty set
No maintenance for this code
01/01/2022

G4026

Physical therapy/occupational therapy mips specialty set
No maintenance for this code
01/01/2022

G4027

Plastic surgery mips specialty set
No maintenance for this code
01/01/2022

G4028

Podiatry mips specialty set
No maintenance for this code
01/01/2022

G4029

Preventive medicine mips specialty set
No maintenance for this code
01/01/2022

G4030

Pulmonology mips specialty set
No maintenance for this code
01/01/2022

G4031

Radiation oncology mips specialty set
No maintenance for this code
01/01/2022

G4032

Rheumatology mips specialty set
No maintenance for this code
01/01/2022

G4033

Skilled nursing facility mips specialty set
No maintenance for this code
01/01/2022

G4034

Speech language pathology mips specialty set
No maintenance for this code
01/01/2022

G4035

Thoracic surgery mips specialty set
No maintenance for this code
01/01/2022

G4036

Urgent care mips specialty set
No maintenance for this code
01/01/2022

G4037

Urology mips specialty set
No maintenance for this code
01/01/2022

G4038

Vascular surgery mips specialty set
No maintenance for this code
01/01/2022

G8422

Bmi not documented, documentation the patient is not eligible for bmi calculation
No maintenance for this code
01/01/2022

G8433

Screening for depression not completed, documented patient or medical reason
No maintenance for this code
01/01/2022

G8711

Prescribed or dispensed antibiotic on or within 3 days after the episode date
No maintenance for this code
01/01/2022

G8925

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

G8926

Spirometry test not performed or documented, reason not given
No maintenance for this code
01/01/2022

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
01/01/2022

G8950

Elevated or hypertensive blood pressure reading documented, and the indicated follow-up is documented
No maintenance for this code
01/01/2022

G8952

Elevated or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given
No maintenance for this code
01/01/2022

G8967

Fda approved oral anticoagulant is prescribed
No maintenance for this code
01/01/2022

G8968

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

G8969

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

G9267

Documentation of patient with one or more complications or mortality within 30 days
No maintenance for this code
01/01/2022

G9268

Documentation of patient with one or more complications within 90 days
No maintenance for this code
01/01/2022

G9269

Documentation of patient without one or more complications and without mortality within 30 days
No maintenance for this code
01/01/2022

G9270

Documentation of patient without one or more complications within 90 days
No maintenance for this code
01/01/2022

G9348

Ct scan of the paranasal sinuses ordered at the time of diagnosis for documented reasons
No maintenance for this code
01/01/2022

G9349

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

G9350

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

G9355

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

G9356

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

G9359

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

G9361

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

G9367

At least two orders for high-risk medications from the same drug class
No maintenance for this code
01/01/2022

G9368

At least two orders for high-risk medications from the same drug class not ordered
No maintenance for this code
01/01/2022

G9399

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

G9400

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

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
01/01/2022

G9418

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

G9419

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

G9421

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

G9422

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

G9425

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

G9428

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

G9429

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

G9431

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

G9448

Patients who were born in the years 1945 to 1965
No maintenance for this code
01/01/2022

G9449

History of receiving blood transfusions prior to 1992
No maintenance for this code
01/01/2022

G9450

History of injection drug use
No maintenance for this code
01/01/2022

G9554

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

G9556

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

G9557

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

G9561

Patients prescribed opiates for longer than six weeks
No maintenance for this code
01/01/2022

G9562

Patients who had a follow-up evaluation conducted at least every three months during opioid therapy
No maintenance for this code
01/01/2022

G9563

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

G9577

Patients prescribed opiates for longer than six weeks
No maintenance for this code
01/01/2022

G9578

Documentation of signed opioid treatment agreement at least once during opioid therapy
No maintenance for this code
01/01/2022

G9579

No documentation of signed an opioid treatment agreement at least once during opioid therapy
No maintenance for this code
01/01/2022

G9580

Door to puncture time of 90 minutes or less
No maintenance for this code
01/01/2022

G9582

Door to puncture time of greater than 90 minutes, no reason given
No maintenance for this code
01/01/2022

G9583

Patients prescribed opiates for longer than six weeks
No maintenance for this code
01/01/2022

G9584

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

G9585

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

G9627

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

G9634

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

G9635

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

G9636

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

G9639

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

G9640

Documentation of planned hybrid or staged procedure
No maintenance for this code
01/01/2022

G9641

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

G9647

Patients in whom mrs score could not be obtained at 90 day follow-up
No maintenance for this code
01/01/2022

G9662

Previously diagnosed or have an active diagnosis of clinical ascvd, including ascvd procedure
No maintenance for this code
01/01/2022

G9663

Any ldl-c laboratory test result >= 190 mg/dl
No maintenance for this code
01/01/2022

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
07/01/2022

G9678

Oncology care model (ocm) monthly enhanced oncology services (meos) payment for ocm enhanced services. g9678 payments may only be made to ocm practitioners for ocm beneficiaries for the furnishment of enhanced services as defined in the ocm participation agreement
Code Discontinued
01/01/2022

G9703

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

G9716

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

G9778

Patients who have a diagnosis of pregnancy at any time during the measurement period
No maintenance for this code
01/01/2022

G9779

Patients who are breastfeeding at any time during the measurement period
No maintenance for this code
01/01/2022

G9780

Patients who have a diagnosis of rhabdomyolysis at any time during the measurement period
No maintenance for this code
01/01/2022

G9781

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

G9782

History of or active diagnosis of familial hypercholesterolemia
No maintenance for this code
01/01/2022

G9783

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

G9822

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

G9823

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

G9824

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

G9906

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

G9907

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

G9908

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

G9909

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

G9927

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

G9928

Fda-approved anticoagulant not prescribed, reason not given
No maintenance for this code
01/01/2022

G9988

Palliative care services provided to patient any time during the measurement period
No maintenance for this code
01/01/2022

G9989

Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., adverse reaction to vaccine)
No maintenance for this code
01/01/2022

G9990

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

G9991

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

G9992

Palliative care services used by patient any time during the measurement period
No maintenance for this code
01/01/2022

G9993

Patient was provided pallative care services any time during the measurement period
No maintenance for this code
01/01/2022

G9994

Patient is using palliative care services any time during the measurement period
No maintenance for this code
01/01/2022

G9995

Patients who use palliative care services any time during the measurement period
No maintenance for this code
01/01/2022

G9996

Documentation stating the patient has received or is currently receiving palliative or hospice care
No maintenance for this code
01/01/2022

G9997

Documentation of patient pregnancy anytime during the measurement period prior to and including the current encounter
No maintenance for this code
01/01/2022

G9998

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

G9999

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

H2038

Skills training and development, per diem
No maintenance for this code

J Codes

↑ Top
Effective Code   Description
01/01/2022

J0172

Injection, aducanumab-avwa, 2 mg
No maintenance for this code
04/01/2022

J0219

Injection, avalglucosidase alfa-ngpt, 4 mg
No maintenance for this code
04/01/2022

J0491

Injection, anifrolumab-fnia, 1 mg
No maintenance for this code
01/01/2022

J0599

Injection, c-1 esterase inhibitor (human), (haegarda), 10 units
No maintenance for this code
01/01/2022

J0641

Injection, levoleucovorin, not otherwise specified, 0.5 mg
No maintenance for this code
07/01/2022

J0739

Injection, cabotegravir, 1 mg
04/01/2022

J0879

Injection, difelikefalin, 0.1 microgram, (for esrd on dialysis)
No maintenance for this code
07/01/2022

J1306

Injection, inclisiran, 1 mg
01/01/2022

J1364

Injection, erythromycin lactobionate, per 500 mg
No maintenance for this code
01/01/2022

J1453

Injection, fosaprepitant, 1 mg
No maintenance for this code
07/01/2022

J1551

Injection, immune globulin (cutaquig), 100 mg
01/01/2022

J1740

Injection, ibandronate sodium, 1 mg
No maintenance for this code
01/01/2022

J1952

Leuprolide injectable, camcevi, 1 mg
No maintenance for this code
07/01/2022

J2356

Injection, tezepelumab-ekko, 1 mg
01/01/2022

J2504

Injection, pegademase bovine, 25 iu
No maintenance for this code
01/01/2022

J2505

Injection, pegfilgrastim, 6 mg
No maintenance for this code
01/01/2022

J2506

Injection, pegfilgrastim, excludes biosimilar, 0.5 mg
No maintenance for this code
01/01/2022

J2515

Injection, pentobarbital sodium, per 50 mg
No maintenance for this code
07/01/2022

J2779

Injection, ranibizumab, via intravitreal implant (susvimo), 0.1 mg
01/01/2022

J2798

Injection, risperidone, (perseris), 0.5 mg
No maintenance for this code
01/01/2022

J2941

Injection, somatropin, 1 mg
No maintenance for this code
07/01/2022

J2998

Injection, plasminogen, human-tvmh, 1 mg
01/01/2022

J3243

Injection, tigecycline, 1 mg
No maintenance for this code
07/01/2022

J3299

Injection, triamcinolone acetonide (xipere), 1 mg
01/01/2022

J9021

Injection, asparaginase, recombinant, (rylaze), 0.1 mg
No maintenance for this code
01/01/2022

J9061

Injection, amivantamab-vmjw, 2 mg
No maintenance for this code
04/01/2022

J9071

Injection, cyclophosphamide, (auromedics), 5 mg
No maintenance for this code
01/01/2022

J9272

Injection, dostarlimab-gxly, 10 mg
No maintenance for this code
04/01/2022

J9273

Injection, tisotumab vedotin-tftv, 1 mg
No maintenance for this code
07/01/2022

J9331

Injection, sirolimus protein-bound particles, 1 mg
07/01/2022

J9332

Injection, efgartigimod alfa-fcab, 2mg
04/01/2022

J9359

Injection, loncastuximab tesirine-lpyl, 0.075 mg
No maintenance for this code

K Codes

↑ Top
Effective Code   Description
04/01/2022

K1028

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
No maintenance for this code
04/01/2022

K1029

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
No maintenance for this code
04/01/2022

K1030

External recharging system for battery (internal) for use with implanted cardiac contractility modulation generator, replacement only
No maintenance for this code
04/01/2022

K1031

Non-pneumatic compression controller without calibrated gradient pressure
No maintenance for this code
04/01/2022

K1032

Non-pneumatic sequential compression garment, full leg
No maintenance for this code
04/01/2022

K1033

Non-pneumatic sequential compression garment, half leg
No maintenance for this code
04/04/2022

K1034

Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count

M Codes

↑ Top
Effective Code   Description
02/11/2022

M0222

Intravenous injection, bebtelovimab, includes injection and post administration monitoring
02/11/2022

M0223

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

M1022

Patients who were in hospice at any time during the performance period
No maintenance for this code
01/01/2022

M1025

Patients who were in hospice at any time during the performance period
No maintenance for this code
01/01/2022

M1026

Patients who were in hospice at any time during the performance period
No maintenance for this code
01/01/2022

M1031

Patients with no clinical indications for imaging of the head
No maintenance for this code
02/28/2022

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

Q Codes

↑ Top
Effective Code   Description
02/24/2022

Q0221

Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 600 mg
02/11/2022

Q0222

Injection, bebtelovimab, 175 mg
01/01/2022

Q2055

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

Q4199

Cygnus matrix, per square centimeter
No maintenance for this code
04/01/2022

Q4224

Human health factor 10 amniotic patch (hhf10-p), per square centimeter
No maintenance for this code
04/01/2022

Q4225

Amniobind, per square centimeter
No maintenance for this code
04/01/2022

Q4256

Mlg-complete, per square centimeter
No maintenance for this code
04/01/2022

Q4257

Relese, per square centimeter
No maintenance for this code
04/01/2022

Q4258

Enverse, per square centimeter
No maintenance for this code
07/01/2022

Q4259

Celera dual layer or celera dual membrane, per square centimeter
07/01/2022

Q4260

Signature apatch, per square centimeter
07/01/2022

Q4261

Tag, per square centimeter
04/01/2022

Q5124

Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg
No maintenance for this code

T Codes

↑ Top
Effective Code   Description
04/01/2022

T2050

Financial management, self-directed, waiver; per diem
No maintenance for this code
04/01/2022

T2051

Supports brokerage, self-directed, waiver; per diem
No maintenance for this code

V Codes

↑ Top
Effective Code   Description
04/01/2022

V2525

Contact lens, hydrophilic, dual focus, per lens
No maintenance for this code

Legend:

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