List of new codes and changes to the 2018 HCPCS code set along with their effective date. Includes discontinued codes that are no longer used.
Legend:
A Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2018 |
|
Ostomy supply; miscellaneous
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Florbetapir f18, diagnostic, per study dose, up to 10 millicuries
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Radiopharmaceutical, diagnostic, for beta-amyloid positron emission tomography (pet) imaging, per study dose, not otherwise specified
Code Discontinued |
|
| 01/01/2018 |
|
Radium ra-223 dichloride, therapeutic, per microcurie
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
C Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2018 |
|
Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Lung biopsy plug with delivery system
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Catheter, transluminal angioplasty, drug-coated, non-laser
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, cerliponase alfa, 1 mg | |
| 01/01/2018 |
|
Injection, c-1 esterase inhibitor (human), haegarda, 10 units | |
| 01/01/2018 |
|
Injection, triptorelin extended release, 3.75 mg | |
| 01/01/2018 |
|
Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine | |
| 01/01/2018 |
|
Injection, inotuzumab ozogamicin, 0.1 mg | |
| 01/01/2018 |
|
Injection, guselkumab, 1 mg | |
| 07/01/2018 |
|
Injection, copanlisib, 1 mg | |
| 07/01/2018 |
|
Lutetium Lu 177, dotatate, therapeutic, 1 mCi | |
| 07/01/2018 |
|
Injection, voretigene neparvovec-rzyl, 1 billion vector genome | |
| 10/01/2018 |
|
Injection, fosnetupitant 235 mg and palonosetron 0.25 mg | |
| 10/01/2018 |
|
Injection, dexamethasone 9%, intraocular, 1 mcg | |
| 01/01/2018 |
|
Injection, factor viii (antihemophilic factor, recombinant) (afstyla), 1 i.u.
Code Discontinued |
|
| 01/01/2018 |
|
Injection, clevidipine butyrate, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, phenylephrine and ketorolac, 4 ml vial
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 04/01/2018 |
|
Injection, delafloxacin, 1 mg | |
| 04/01/2018 |
|
Injection, aprepitant, 1 mg | |
| 04/01/2018 |
|
Injection, rolapitant, 0.5 mg | |
| 04/01/2018 |
|
Hyaluronan or derivative, Durolane, for intra-articular injection, per dose | |
| 04/01/2018 |
|
Injection, benralizumab, 1 mg | |
| 04/01/2018 |
|
Injection, rituximab and hyaluronidase, 10 mg | |
| 04/01/2018 |
|
Injection, factor ix (antihemophilic factor, recombinant), glycopegylated, Rebinyn, 1 i.u. | |
| 06/30/2018 |
|
Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg
Code Discontinued |
|
| 01/01/2018 |
|
Injection, atezolizumab, 10 mg
Code Discontinued |
|
| 01/01/2018 |
|
Injection, eteplirsen, 10 mg
Code Discontinued |
|
| 01/01/2018 |
|
Injection, olaratumab, 10 mg
Code Discontinued |
|
| 01/01/2018 |
|
Injection, granisetron extended release, 0.1 mg
Code Discontinued |
|
| 01/01/2018 |
|
Injection, nusinersen, 0.1 mg
Code Discontinued |
|
| 01/01/2018 |
|
Injection, bezlotoxumab, 10 mg
Code Discontinued |
|
| 01/01/2018 |
|
Injection, avelumab, 10 mg
Code Discontinued |
|
| 01/01/2018 |
|
Injection, ocrelizumab, 1 mg
Code Discontinued |
|
| 01/01/2018 |
|
Adjunctive blue light cystoscopy with fluorescent imaging agent (list separately in addition to code for primary procedure) | |
| 01/01/2018 |
|
Transurethral destruction of prostate tissue; by radiofrequency water vapor (steam) thermal therapy | |
| 04/01/2018 |
|
Repair of nasal vestibular lateral wall stenosis with implant(s) | |
| 10/01/2018 |
|
Insertion or removal and replacement of intracardiac ischemia monitoring system including imaging supervision and interpretation and peri-operative interrogation and programming; complete system (includes device and electrode) | |
E Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2018 |
|
Nebulizer, ultrasonic, large volume
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Wheelchair accessory, tray, each
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each | |
| 01/01/2018 |
|
Wheelchair accessory, foot box, any type, includes attachment and mounting hardware, each foot | |
| 01/01/2018 |
|
Scale, each
Change in short description of procedure code |
|
G Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2018 |
|
Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (cad) when performed
Code Discontinued |
|
| 01/01/2018 |
|
Diagnostic mammography, including computer-aided detection (cad) when performed; bilateral
Code Discontinued |
|
| 01/01/2018 |
|
Diagnostic mammography, including computer-aided detection (cad) when performed; unilateral
Code Discontinued |
|
| 01/01/2018 |
|
Low dose rate (ldr) prostate brachytherapy services, composite rate
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month | |
| 01/01/2018 |
|
Rural health clinic or federally qualified health center (rhc/fqhc) only, psychiatric collaborative care model (psychiatric cocm), 60 minutes or more of clinical staff time for psychiatric cocm services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm) and including services furnished by a behavioral health care manager and consultation with a psychiatric consultant, per calendar month | |
| 01/01/2018 |
|
Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (list separately in addition to code for preventive service) | |
| 01/01/2018 |
|
Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes (list separately in addition to code g0513 for additional 30 minutes of preventive service) | |
| 01/01/2018 |
|
Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes | |
| 01/01/2018 |
|
Insertion of non-biodegradable drug delivery implants, 4 or more (services for subdermal rod implant)
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Removal of non-biodegradable drug delivery implants, 4 or more (services for subdermal implants) | |
| 01/01/2018 |
|
Removal with reinsertion, non-biodegradable drug delivery implants, 4 or more (services for subdermal implants) | |
| 01/01/2018 |
|
Eligible clinician attests to documenting in the medical record the patient is not eligible for a current list of medications being obtained, updated, or reviewed by the eligible clinician
Change in short description of procedure code |
|
| 01/01/2018 |
|
Screening for depression not completed, documented reason
Change in short description of procedure code |
|
| 01/01/2018 |
|
Pain assessment not documented as being performed, documentation the patient is not eligible for a pain assessment using a standardized tool at the time of the encounter
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Elder maltreatment screen not documented; documentation that patient is not eligible for the elder maltreatment screen at the time of the encounter
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Functional outcome assessment not documented as being performed, documentation the patient is not eligible for a functional outcome assessment using a standardized tool at the time of the encounter
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Antithrombotic therapy prescribed at discharge
Code Discontinued |
|
| 01/01/2018 |
|
Antithrombotic therapy not prescribed for documented reasons (e.g., patient had stroke during hospital stay, patient expired during inpatient stay, other medical reason(s)); (e.g., patient left against medical advice, other patient reason(s))
Code Discontinued |
|
| 01/01/2018 |
|
Antithrombotic therapy was not prescribed at discharge, reason not given
Code Discontinued |
|
| 01/01/2018 |
|
Trans-abdominal or trans-vaginal ultrasound not performed, reason not given
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Patient has documented immunity to hepatitis b and initiating anti-tnf therapy
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer
Code Discontinued |
|
| 01/01/2018 |
|
Documentation of reason(s) sentinel lymph node biopsy not performed (e.g., reasons could include but not limited to; non-invasive cancer, incidental discovery of breast cancer on prophylactic mastectomy, incidental discovery of breast cancer on reduction mammoplasty, pre-operative biopsy proven lymph node (ln) metastases, inflammatory carcinoma, stage 3 locally advanced cancer, recurrent invasive breast cancer, clinically node positive after neoadjuvant systemic therapy, patient refusal after informed consent)
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Bmi is documented as being outside of normal limits, follow-up plan is not documented, documentation the patient is not eligible
Change in short description of procedure code |
|
| 01/01/2018 |
|
Pain assessment documented as positive, follow-up plan not documented, documentation the patient is not eligible at the time of the encounter
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Elder maltreatment screen documented as positive, follow-up plan not documented, documentation the patient is not eligible for follow-up plan at the time of the encounter
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
One or more neuropsychiatric symptoms
Code Discontinued |
|
| 01/01/2018 |
|
Warfarin or another fda approved oral anticoagulant is prescribed
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Documentation of medical reason(s) for not prescribing warfarin or another fda-approved anticoagulant (e.g., atrial appendage device in place)
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Documentation of patient reason(s) for not prescribing warfarin or another fda-approved oral anticoagulant that is fda approved for the prevention of thromboembolism (e.g., patient choice of having atrial appendage device placed)
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Warfarin or another oral anticoagulant that is fda approved not prescribed, reason not given
Code Discontinued |
|
| 01/01/2018 |
|
One or more high risk factors for thromboembolism or more than one moderate risk factor for thromboembolism
Code Discontinued |
|
| 01/01/2018 |
|
Functional outcome assessment documented, care plan not documented, documentation the patient is not eligible for a care plan at the time of the encounter
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Documentation of patient death following cas
Change in short description of procedure code |
|
| 01/01/2018 |
|
Documentation of patient stroke following cas
Change in short description of procedure code |
|
| 01/01/2018 |
|
Documentation of patient stroke following cea
Change in short description of procedure code |
|
| 01/01/2018 |
|
Documentation of patient survival and absence of stroke following cas
Change in short description of procedure code |
|
| 01/01/2018 |
|
Documentation of patient death following cea
Change in short description of procedure code |
|
| 01/01/2018 |
|
Documentation of patient survival and absence of stroke following cea
Change in short description of procedure code |
|
| 01/01/2018 |
|
Documentation of patient death in the hospital following endovascular aaa repair
Change in short description of procedure code |
|
| 01/01/2018 |
|
Documentation of patient discharged alive following endovascular aaa repair
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis for documented reason
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Ct scan of the paranasal sinuses ordered at the time of diagnosis for documented reasons
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Documentation of medical reason(s) for not offering assistance with end of life issues (e.g., patient in hospice care, patient in terminal phase) during the measurement period
Code Discontinued |
|
| 01/01/2018 |
|
Documentation of medical reason(s) for not receiving annual screening for hcv infection (e.g., decompensated cirrhosis indicating advanced disease [i.e., ascites, esophageal variceal bleeding, hepatic encephalopathy], hepatocellular carcinoma, waitlist for organ transplant, limited life expectancy, other medical reasons)
Change in short description of procedure code |
|
| 01/01/2018 |
|
Documentation of reason for not detecting adenoma(s) or other neoplasm. (e.g., neoplasm detected is only diagnosed as traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma
Code Discontinued |
|
| 01/01/2018 |
|
Documented reason for not assessing hepatitis b virus (hbv) status (e.g., patient not initiating anti-tnf therapy, patient declined) prior to initiating anti-tnf therapy
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Filter removed within 3 months of placement
Change in short description of procedure code |
|
| 01/01/2018 |
|
Documented medical reasons for not performing intraoperative cystoscopy (e.g., urethral pathology precluding cystoscopy, any patient who has a congenital or acquired absence of the urethra) or in the case of patient death
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Patient not screened for unhealthy alcohol use using a systematic screening method or patient did not receive brief counseling if identified as an unhealthy alcohol user, reason not given
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
At least two orders for the same high-risk medication
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
At least two orders for the same high-risk medications not ordered
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Patient transferred directly from anesthetizing location to pacu or other non-icu location
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Bmi is documented as being outside of normal limits, follow-up plan is not completed for documented reason
Change in short description of procedure code |
|
| 01/01/2018 |
|
Documentation stating the patient has an active diagnosis of depression or has a diagnosed bipolar disorder, therefore screening or follow-up not required
Change in short description of procedure code |
|
| 01/01/2018 |
|
Patient not eligible due to active diagnosis of hypertension
Change in short description of procedure code |
|
| 01/01/2018 |
|
Documented reason for not screening or recommending a follow-up for high blood pressure
Change in short description of procedure code |
|
| 01/01/2018 |
|
Patient in hospice at any time during the measurement period
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Patient had at least two hpv vaccines (with at least 146 days between the two) or three hpv vaccines on or between the patient's 9th and 13th birthdays
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Patient did not have at least two hpv vaccines (with at least 146 days between the two) or three hpv vaccines on or between the patient's 9th and 13th birthdays
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Patient has been treated with an oral systemic or biologic medication for psoriasis vulgaris
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Documentation that the patient declined therapy change or alternative therapies were unavailable, has documented contraindications, or has not been treated with an oral systemic or biologic for at least six consecutive months (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by pga, bsa, pasi, or dlqi
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Pathologists/dermatopathologists providing a second opinion on a biopsy
Change in short description of procedure code |
|
| 01/01/2018 |
|
Pathology report diagnosing cutaneous basal cell carcinoma or squamous cell carcinoma (to include in situ disease) sent from the pathologist/dermatopathologist to the biopsying clinician for review within 7 days from the time when the tissue specimen was received by the pathologist
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Pathology report diagnosing cutaneous basal cell carcinoma or squamous cell carcinoma (to include in situ disease) was not sent from the pathologist/dermatopathologist to the biopsying clinician for review within 7 days from the time when the tissue specimen was received by the pathologist
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Documentation of medical reason(s) for not on a daily aspirin or other antiplatelet (e.g., history of gastrointestinal bleed, intra-cranial bleed, idiopathic thrombocytopenic purpura (itp), gastric bypass or documentation of active anticoagulant use during the measurement period)
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Death occurring during the index acute care hospitalization
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Death did not occur during the index acute care hospitalization
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Death occurring after discharge from the hospital but within 30 days post procedure
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Death did not occur after discharge from the hospital within 30 days post procedure
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Ras (kras and nras) gene mutation testing performed before initiation of anti-egfr moab
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Ras (kras and nras) gene mutation testing not performed before initiation of anti-egfr moab
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Ras (kras or nras) gene mutation
Change in long description of procedure or modifier code |
|
| 04/01/2018 |
|
First Medicare Diabetes Prevention Program (MDPP) core session was attended by an MDPP beneficiary under the MDPP Expanded Model (EM). | |
| 04/01/2018 |
|
Four total Medicare Diabetes Prevention Program (MDPP) core sessions were attended by an MDPP beneficiary under the MDPP Expanded Model (EM). | |
| 04/01/2018 |
|
Nine total Medicare Diabetes Prevention Program (MDPP) core sessions were attended by an MDPP beneficiary under the MDPP Expanded Model (EM). | |
| 04/01/2018 |
|
Two Medicare Diabetes Prevention Program (MDPP) core maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 7-9 under the MDPP Expanded Model (EM). | |
| 04/01/2018 |
|
Two Medicare Diabetes Prevention Program (MDPP) core maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 10-12 under the MDPP Expanded Model (EM). A core maintenance session is an MDPP service that: (1) is furnished by an MDPP supplier during months 7 through 12 of the MDPP services period; (2) is approximately 1 hour in length; and (3) adheres to a CDC-approved DPP curriculum for maintenance sessions. | |
| 04/01/2018 |
|
Two Medicare Diabetes Prevention Program (MDPP) core maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 7-9 under the MDPP Expanded Model (EM). | |
| 04/01/2018 |
|
Two Medicare Diabetes Prevention Program (MDPP) core maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 10-12 under the MDPP Expanded Model (EM). | |
| 04/01/2018 |
|
The MDPP beneficiary achieved at least 5% weight loss (WL) from his/her baseline weight in months 1-12 of the MDPP services period under the MDPP Expanded Model (EM). | |
| 04/01/2018 |
|
The MDPP beneficiary achieved at least 9% weight loss (WL) from his/her baseline weight in months 1-24 under the MDPP Expanded Model (EM). | |
| 04/01/2018 |
|
Two Medicare Diabetes Prevention Program (MDPP) ongoing maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 13-15 under the MDPP Expanded Model (EM). | |
| 04/01/2018 |
|
Two Medicare Diabetes Prevention Program (MDPP) ongoing maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 16-18 under the MDPP Expanded Model (EM). | |
| 04/01/2018 |
|
Two Medicare Diabetes Prevention Program (MDPP) ongoing maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 19-21 under the MDPP Expanded Model (EM). | |
| 04/01/2018 |
|
Two Medicare Diabetes Prevention Program (MDPP) ongoing maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 22-24 under the MDPP Expanded Model (EM). | |
| 01/01/2018 |
|
Dilated macular exam performed, including documentation of the presence or absence of macular thickening or geographic atrophy or hemorrhage and the level of macular degeneration severity | |
| 01/01/2018 |
|
Documentation of medical reason(s) for not performing a dilated macular examination | |
| 01/01/2018 |
|
Documentation of patient reason(s) for not performing a dilated macular examination | |
| 01/01/2018 |
|
Dilated macular exam was not performed, reason not otherwise specified | |
| 01/01/2018 |
|
Androgen deprivation therapy prescribed/administered in combination with external beam radiotherapy to the prostate | |
| 01/01/2018 |
|
Documentation of medical reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate (e.g., salvage therapy) | |
| 01/01/2018 |
|
Documentation of patient reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate | |
| 01/01/2018 |
|
Patients who were not prescribed/administered androgen deprivation therapy in combination with external beam radiotherapy to the prostate, reason not given | |
| 01/01/2018 |
|
Patient age 65 or older in institutinal special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 any time during the measurement period | |
| 01/01/2018 |
|
Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results documented and reviewed | |
| 01/01/2018 |
|
Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results were not documented and reviewed, reason not otherwise specified | |
| 01/01/2018 |
|
Patient age 65 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 any time during the measurement period | |
| 01/01/2018 |
|
Patient screened for tobacco use and identified as a tobacco user | |
| 01/01/2018 |
|
Patient screened for tobacco use and identified as a tobacco non-user | |
| 01/01/2018 |
|
Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason) | |
| 01/01/2018 |
|
Patient not screened for tobacco use, reason not given | |
| 01/01/2018 |
|
Patient identified as a tobacco user received tobacco cessation intervention (counseling and/or pharmacotherapy) | |
| 01/01/2018 |
|
Documentation of medical reason(s) for not providing tobacco cessation intervention (e.g., limited life expectancy, other medical reason) | |
| 01/01/2018 |
|
Patient identified as tobacco user did not receive tobacco cessation intervention (counseling and/or pharmacotherapy), reason not given | |
| 01/01/2018 |
|
Documentation of medical reason(s) for not providing tobacco cessation intervention if identified as a tobacco user (eg, limited life expectancy, other medical reason) | |
| 01/01/2018 |
|
Patients age 65 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 anytime during the measurement period | |
| 01/01/2018 |
|
Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer before or after neoadjuvant systemic therapy | |
| 01/01/2018 |
|
Hepatitis b virus (hbv) status assessed and results interpreted prior to initiating anti-tnf (tumor necrosis factor) therapy | |
| 01/01/2018 |
|
Hepatitis b virus (hbv) status not assessed and results interpreted prior to initiating anti-tnf (tumor necrosis factor) therapy, reason not given | |
| 01/01/2018 |
|
Patient receiving an anti-tnf agent | |
| 01/01/2018 |
|
No record of hbv results documented | |
| 01/01/2018 |
|
Functional status performed once in the last 12 months | |
| 01/01/2018 |
|
Documentation of medical reason(s) for not performing functional status (e.g., patient is severely impaired and caregiver knowledge is limited, other medical reason) | |
| 01/01/2018 |
|
Functional status not performed, reason not otherwise specified | |
| 01/01/2018 |
|
Screening performed and positive and provision of recommendations | |
| 01/01/2018 |
|
Screening performed and negative | |
| 01/01/2018 |
|
No screening performed, partial screening performed or positive screen without recommendations and reason is not given or otherwise specified | |
| 01/01/2018 |
|
Safety concerns screen provided and if positive then documented mitigation recommendations | |
| 01/01/2018 |
|
Safety concerns screen provided and negative | |
| 01/01/2018 |
|
Documentation of medical reason(s) for not providing safety concerns screen or for not providing recommendations, orders or referrals for positive screen (e.g., patient in palliative care, other medical reason) | |
| 01/01/2018 |
|
Safety concerns screening not provided, reason not otherwise specified | |
| 01/01/2018 |
|
Safety concerns screening positive screen is without provision of mitigation recommendations, including but not limited to referral to other resources | |
| 01/01/2018 |
|
Documentation of system reason(s) for not prescribing warfarin or another fda-approved anticoagulation due to patient being currently enrolled in a clinical trial related to af/atrial flutter treatment | |
| 01/01/2018 |
|
Warfarin or another fda-approved anticoagulant not prescribed, reason not given | |
| 01/01/2018 |
|
Patient with transient or reversible cause of af (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac surgery) | |
| 01/01/2018 |
|
Patients who are receiving comfort care only | |
| 01/01/2018 |
|
Documentation of cha2ds2-vasc risk score of 0 or 1 | |
| 01/01/2018 |
|
Documentation of patient reason(s) for not having records of negative or managed positive tb screen (e.g., patient does not return for mantoux (ppd) skin test evaluation) | |
| 01/01/2018 |
|
Adenoma(s) or colorectal cancer detected during screening colonoscopy | |
| 01/01/2018 |
|
Documentation that neoplasm detected is only diagnosed as traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma | |
| 01/01/2018 |
|
Adenoma(s) or colorectal cancer not detected during screening colonoscopy | |
| 01/01/2018 |
|
Surveillance colonoscopy - personal history of colonic polyps, colon cancer, or other malignant neoplasm of rectum, rectosigmoid junction, and anus | |
| 01/01/2018 |
|
Diagnostic colonoscopy | |
| 01/01/2018 |
|
Patients age 65 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 any time during the measurement period | |
| 01/01/2018 |
|
Pathologists/dermatopathologists is the same clinician who performed the biopsy | |
| 01/01/2018 |
|
Documentation of medical reason(s) for not on a statin (e.g., pregnancy, in vitro fertilization, clomiphene rx, esrd, cirrhosis, muscular pain and disease during the measurement period or prior year) | |
| 01/01/2018 |
|
Back pain was measured by the visual analog scale (vas) within three months preoperatively and at three months (6 - 20 weeks) postoperatively | |
| 01/01/2018 |
|
Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminotomy | |
| 01/01/2018 |
|
Back pain was not measured by the visual analog scale (vas) within three months preoperatively and at three months ( 6 - 20 weeks) postoperatively | |
| 01/01/2018 |
|
Back pain was measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively | |
| 01/01/2018 |
|
Patient had cancer, fracture or infection related to the lumbar spine or patient had idiopathic or congenital scoliosis | |
| 01/01/2018 |
|
Back pain was not measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively | |
| 01/01/2018 |
|
Leg pain was measured by the visual analog scale (vas) within three months preoperatively and at three months (6 to 20 weeks) postoperatively | |
| 01/01/2018 |
|
Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminotomy | |
| 01/01/2018 |
|
Leg pain was not measured by the visual analog scale (vas) within three months preoperatively and at three months (6 to 20 weeks) postoperatively | |
| 01/01/2018 |
|
Patient exhibits 2 or more risk factors for post-operative vomiting | |
| 01/01/2018 |
|
Cases in which an inhalational anesthetic is used only for induction | |
| 01/01/2018 |
|
Patient received combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively | |
| 01/01/2018 |
|
Documentation of medical reason for not receiving combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively (e.g., intolerance or other medical reason) | |
| 01/01/2018 |
|
Patient did not receive combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively | |
| 01/01/2018 |
|
Systemic antimicrobials not prescribed | |
| 01/01/2018 |
|
Documentation of medical reason(s) for prescribing systemic antimicrobials | |
| 01/01/2018 |
|
Systemic antimicrobials prescribed | |
| 01/01/2018 |
|
Embolization endpoints are documented separately for each embolized vessel and ovarian artery angiography or embolization performed in the presence of variant uterine artery anatomy | |
| 01/01/2018 |
|
Embolization endpoints are not documented separately for each embolized vessel or ovarian artery angiography or embolization not performed in the presence of variant uterine artery anatomy | |
| 01/01/2018 |
|
Patient received at least one well-child visit with a pcp during the performance period | |
| 01/01/2018 |
|
Patient did not receive at least one well-child visit with a pcp during the performance period | |
| 01/01/2018 |
|
Children who were screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report | |
| 01/01/2018 |
|
Children who were not screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report | |
| 01/01/2018 |
|
Patient was referred to another provider or specialist during the performance period | |
| 01/01/2018 |
|
Provider who referred the patient to another provider received a report from the provider to whom the patient was referred | |
| 01/01/2018 |
|
Provider who referred the patient to another provider did not receive a report from the provider to whom the patient was referred | |
| 01/01/2018 |
|
Dilated macular exam performed, including documentation of the presence or absence of macular thickening or geographic atrophy or hemorrhage and the level of macular degeneration severity | |
| 01/01/2018 |
|
Documentation of medical reason(s) for not performing a dilated macular examination | |
| 01/01/2018 |
|
Documentation of patient reason(s) for not performing a dilated macular examination | |
| 01/01/2018 |
|
Dilated macular exam was not performed, reason not otherwise specified | |
| 10/01/2018 |
|
Remote in-home visit for the evaluation and management of a new patient for use only in a Medicare-approved Bundled Payments for Care Improvement Advanced (BPCI Advanced) model episode of care, which requires these 3 key components: * A problem focused history; * A problem focused examination; and; * Straightforward medical decision making, furnished in real time using interactive audio and video technology. Counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology. | |
| 10/01/2018 |
|
Remote in-home visit for the evaluation and management of a new patient for use only in a Medicare-approved Bundled Payments for Care Improvement Advanced (BPCI Advanced) model episode of care, which requires these 3 key components: * An expanded problem focused history; * An expanded problem focused examination; * Straightforward medical decision making, furnished in real time using interactive audio and video technology. Counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. Usually, the presenting problem(s) are of low to moderate severity. Typically, 20 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology. | |
| 10/01/2018 |
|
Remote in-home visit for the evaluation and management of a new patient for use only in a Medicare-approved Bundled Payments for Care Improvement Advanced (BPCI Advanced) model episode of care, which requires these 3 key components: * A detailed history; * A detailed examination; * Medical decision making of low complexity, furnished in real time using interactive audio and video technology. Counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology. | |
| 10/01/2018 |
|
Remote in-home visit for the evaluation and management of a new patient for use only in a Medicare-approved Bundled Payments for Care Improvement Advanced (BPCI Advanced) model episode of care, which requires these 3 key components: * A comprehensive history; * A comprehensive examination; * Medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. Counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology. | |
| 10/01/2018 |
|
Remote in-home visit for the evaluation and management of a new patient for use only in a Medicare-approved Bundled Payments for Care Improvement Advanced (BPCI Advanced) model episode of care, which requires these 3 key components: * A comprehensive history; * A comprehensive examination; * Medical decision making of high complexity, furnished in real time using interactive audio and video technology. Counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. Usually, the presenting problem(s) are of moderate to high severity. Typically, 60 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology. | |
| 10/01/2018 |
|
Remote in-home visit for the evaluation and management of an established patient for use only in a Medicare-approved Bundled Payments for Care Improvement Advanced (BPCI Advanced) model episode of care, which requires at least 2 of the following 3 key components: * A problem focused history; * A problem focused examination; * Straightforward medical decision making, furnished in real time using interactive audio and video technology. Counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology. | |
| 10/01/2018 |
|
Remote in-home visit for the evaluation and management of an established patient for use only in a Medicare-approved Bundled Payments for Care Improvement Advanced (BPCI Advanced) model episode of care, which requires at least 2 of the following 3 key components: * An expanded problem focused history; * An expanded problem focused examination; * Medical decision making of low complexity, furnished in real time using interactive audio and video technology. Counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. Usually, the presenting problem(s) are of low to moderate severity. Typically, 15 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology. | |
| 10/01/2018 |
|
Remote in-home visit for the evaluation and management of an established patient for use only in a Medicare-approved Bundled Payments for Care Improvement Advanced (BPCI Advanced) model episode of care, which requires at least 2 of the following 3 key components: * A detailed history; * A detailed examination; * Medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. Counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. Usually, the presenting problem(s) are of moderate to high severity. Typically, 25 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology. | |
| 10/01/2018 |
|
Remote in-home visit for the evaluation and management of an established patient for use only in a Medicare-approved Bundled Payments for Care Improvement Advanced (BPCI Advanced) model episode of care, which requires at least 2 of the following 3 key components: * A comprehensive history; * A comprehensive examination; * Medical decision making of high complexity, furnished in real time using interactive audio and video technology. Counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. Usually, the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology. | |
| 10/01/2018 |
|
Bundled Payments for Care Improvement Advanced (BPCI Advanced) model home visit for patient assessment performed by clinical staff for an individual not considered homebound, including, but not necessarily limited to patient assessment of clinical status, safety/fall prevention, functional status/ambulation, medication reconciliation/management, compliance with orders/plan of care, performance of activities of daily living, and ensuring beneficiary connections to community and other services; for use only for a BPCI Advanced model episode of care; may not be billed for a 30-day period covered by a transitional care management code. | |
J Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2018 |
|
Injection, tetracycline, up to 250 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection abciximab, 10 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, acetylcysteine, 100 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, alefacept, 0.5 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, aprotonin, 10,000 kiu
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, aripiprazole, intramuscular, 0.25 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, dimercaprol, per 100 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, bezlotoxumab, 10 mg | |
| 01/01/2018 |
|
Injection, bivalirudin, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Cinacalcet, oral, 1 mg, (for esrd on dialysis) | |
| 01/01/2018 |
|
Injection, etelcalcetide, 0.1 mg | |
| 01/01/2018 |
|
Injection, chloramphenicol sodium succinate, up to 1 gm
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, chorionic gonadotropin, per 1,000 usp units
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, cosyntropin, not otherwise specified, 0.25 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, argatroban, 1 mg (for esrd on dialysis)
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, epoetin beta, 1 microgram, (for non esrd use)
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, dihydroergotamine mesylate, per 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, diclofenac sodium, 0.5 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, chlorothiazide sodium, per 500 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, enfuvirtide, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, eteplirsen, 10 mg | |
| 01/01/2018 |
|
Injection, immune globulin (cuvitru), 100 mg | |
| 01/01/2018 |
|
Injection, granisetron, extended-release, 0.1 mg | |
| 01/01/2018 |
|
Injection, hydroxyprogesterone caproate, 1 mg
Code Discontinued |
|
| 01/01/2018 |
|
Injection, hydroxyprogesterone caproate, (makena), 10 mg | |
| 01/01/2018 |
|
Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg | |
| 01/01/2018 |
|
Injection, diazoxide, up to 300 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, lepirudin, 50 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, linezolid, 200 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, milrinone lactate, 5 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg
Change in short description of procedure code |
|
| 01/01/2018 |
|
Injection, nusinersen, 0.1 mg | |
| 01/01/2018 |
|
Injection, ocrelizumab, 1 mg | |
| 01/01/2018 |
|
Injection, olanzapine, long-acting, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, penicillin g procaine, aqueous, up to 600,000 units
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, tolazoline hcl, up to 25 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, pralidoxime chloride, up to 1 gm
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, urofollitropin, 75 iu
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Ustekinumab, for intravenous injection, 1 mg | |
| 01/01/2018 |
|
Injection, iv, urokinase, 250,000 i.u. vial
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, zoledronic acid, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Factor viii (antihemophilic factor (porcine)), per i.u.
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, antithrombin recombinant, 50 i.u.
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, factor viii, (antihemophilic factor, recombinant), (afstyla), 1 i.u. | |
| 01/01/2018 |
|
Injection, factor viii, (antihemophilic factor, recombinant), (kovaltry), 1 i.u. | |
| 01/01/2018 |
|
Levonorgestrel-releasing intrauterine contraceptive system, (kyleena), 19.5 mg | |
| 01/01/2018 |
|
Methyl aminolevulinate (mal) for topical administration, 16.8%, 1 gram
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Ganciclovir, 4.5 mg, long-acting implant
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Hyaluronan or derivitive, genvisc 850, for intra-articular injection, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Hyaluronan or derivative, gelsyn-3, for intra-articular injection, 0.1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg | |
| 01/01/2018 |
|
Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Daclizumab, parenteral, 25 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Busulfan; oral, 2 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Nabilone, oral, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Temozolomide, oral, 5 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, atezolizumab, 10 mg | |
| 01/01/2018 |
|
Injection, avelumab, 10 mg | |
| 01/01/2018 |
|
Injection, daunorubicin citrate, liposomal formulation, 10 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, fludarabine phosphate, 50 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, floxuridine, 500 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, gemtuzumab ozogamicin, 0.1 mg | |
| 01/01/2018 |
|
Injection, ifosfamide, 1 gram
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, interferon, alfa-2a, recombinant, 3 million units
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Leuprolide acetate implant, 65 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, oxaliplatin, 0.5 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Injection, olaratumab, 10 mg | |
| 01/01/2018 |
|
Injection, gemtuzumab ozogamicin, 5 mg
Code Discontinued |
|
| 01/01/2018 |
|
Injection, topotecan, 0.1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
K Codes↑ Top | |||
| Effective | Code | Description | |
| 04/01/2018 |
|
For Diabetics Only, Multiple Density Insert, Made By Direct Carving With CAM Technology From A Rectified CAD Model Created From A Digitized Scan Of The Patient, Total Contact With Patient's Foot, Including Arch, Base Layer Minimum Of 3/16 Inch Material Of | |
L Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2018 |
|
Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, off-the-shelf | |
| 01/01/2018 |
|
Gasket or seal, for use with prosthetic socket insert, any type, each | |
| 01/01/2018 |
|
Transmitter cable for use with cochlear implant device or auditory osseointegrated device, replacement
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Lithium ion battery for use with cochlear implant or auditory osseointegrated device speech processor, ear level, replacement, each
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
External recharging system for battery for use with cochlear implant or auditory osseointegrated device, replacement only, each | |
| 01/01/2018 |
|
Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, each
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Auditory osseointegrated device, transducer/actuator, replacement only, each | |
P Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2018 |
|
Platelets, pheresis, pathogen reduced or rapid bacterial tested, each unit
Code Discontinued |
|
| 01/01/2018 |
|
Platelets, pheresis, pathogen-reduced, each unit | |
| 01/01/2018 |
|
Pathogen(s) test for platelets | |
Q Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2018 |
|
Power module patient cable for use with electric or electric/pneumatic ventricular assist device, replacement only | |
| 01/01/2018 |
|
Injection, fosphenytoin, 50 mg phenytoin equivalent
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Tisagenlecleucel, up to 250 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per infusion | |
| 04/01/2018 |
|
Axicabtagene Ciloleucel, up to 200 Million Autologous Anti-CD19 CAR T Cells, Including Leukapheresis And Dose Preparation Procedures, Per Infusion | |
| 01/01/2018 |
|
Theraskin, per square centimeter
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Grafix core and grafixpl core, per square centimeter
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Grafix prime and grafixpl prime, per square centimeter
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Neox cord 1k, neox cord rt, or clarix cord 1k, per square centimeter
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Neox 100 or clarix 100, per square centimeter
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Kerecis omega3, per square centimeter
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Woundex flow, bioskin flow, 0.5 cc
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Woundex, bioskin, per square centimeter
Change in long description of procedure or modifier code |
|
| 01/01/2018 |
|
Puraply or puraply am, per square centimeter
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Neopatch, per square centimeter | |
| 01/01/2018 |
|
Floweramnioflo, 0.1 cc | |
| 01/01/2018 |
|
Floweramniopatch, per square centimeter | |
| 01/01/2018 |
|
Flowerderm, per square centimeter | |
| 01/01/2018 |
|
Revita, per square centimeter | |
| 01/01/2018 |
|
Amnio wound, per square centimeter | |
| 01/01/2018 |
|
Transcyte, per square centimeter | |
| 01/01/2018 |
|
Injection, infliximab, biosimilar, 10 mg
Code Discontinued |
|
| 04/01/2018 |
|
Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg | |
| 04/01/2018 |
|
Injection, infliximab-abda, biosimilar, (renflexis), 10 mg | |
| 07/01/2018 |
|
Injection, epoetin alfa, biosimilar, (Retacrit) (for esrd on dialysis), 100 units | |
| 07/01/2018 |
|
Injection, epoetin alfa, biosimilar, (Retacrit) (for non-esrd use), 1000 units | |
| 10/01/2018 |
|
Injection, pegfilgrastim-jmdb, biosimilar, (fulphila), 0.5 mg | |
| 01/01/2018 |
|
Injection, sulfur hexafluoride lipid microspheres, per ml
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2018 |
|
Levonorgestrel-releasing intrauterine contraceptive system (kyleena), 19.5 mg
Code Discontinued |
|
| 01/01/2018 |
|
Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg
Code Discontinued |
|
| 01/01/2018 |
|
Injection, hydroxyprogesterone caproate, (makena), 10 mg
Code Discontinued |
|
| 01/01/2018 |
|
Pathogen(s) test for platelets
Code Discontinued |
|
| 01/01/2018 |
|
Platelets, pheresis, pathogen-reduced, each unit
Code Discontinued |
|
| 01/01/2018 |
|
Ustekinumab, for intravenous injection, 1 mg
Code Discontinued |
|
| 07/01/2018 |
|
Injection, buprenorphine extended-release (sublocade), less than or equal to 100 mg | |
| 07/01/2018 |
|
Injection, buprenorphine extended-release (sublocade), greater than 100 mg | |
| 07/01/2018 |
|
Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg | |
| 07/13/2018 |
|
In-line cartridge containing digestive enzyme(s) for enteral feeding, each | |
| 07/01/2018 |
|
Injection, emicizumab-kxwh, 0.5 mg | |
Legend:
