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

A Codes

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Effective Code   Description
01/01/2023

A4238

Supply allowance for adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service
Change in long description of procedure or modifier code
01/01/2023

A4239

Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service
01/01/2023

A9276

Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply
Change in both administrative data field and long description of procedure or modifier code
01/01/2023

A9277

Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system
Change in both administrative data field and long description of procedure or modifier code
01/01/2023

A9278

Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system
Change in both administrative data field and long description of procedure or modifier code

C Codes

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Effective Code   Description
01/01/2023

C1734

Orthopedic/device/drug matrix for opposing bone-to-bone or soft tissue-to bone (implantable)
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

C1747

Endoscope, single-use (i.e. disposable), urinary tract, imaging/illumination device (insertable)
01/01/2023

C1823

Generator, neurostimulator (implantable), non-rechargeable, with transvenous sensing and stimulation leads
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

C1824

Generator, cardiac contractility modulation (implantable)
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

C1826

Generator, neurostimulator (implantable), includes closed feedback loop leads and all implantable components, with rechargeable battery and charging system
01/01/2023

C1827

Generator, neurostimulator (implantable), non-rechargeable, with implantable stimulation lead and external paired stimulation controller
01/01/2023

C1831

Interbody cage, anterior, lateral or posterior, personalized (implantable)
Change in long description of procedure or modifier code
01/01/2023

C1839

Iris prosthesis
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

C1841

Retinal prosthesis, includes all internal and external components
Code Discontinued
01/01/2023

C1842

Retinal prosthesis, includes all internal and external components; add-on to c1841
Code Discontinued
01/01/2023

C1849

Skin substitute, synthetic, resorbable, per square centimeter
Code Discontinued
01/01/2023

C1982

Catheter, pressure-generating, one-way valve, intermittently occlusive
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

C2596

Probe, image-guided, robotic, waterjet ablation
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

C7500

Debridement, bone including epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed, first 20 sq cm or less with manual preparation and insertion of deep (eg, subfacial) drug-delivery device(s)
01/01/2023

C7501

Percutaneous breast biopsies using stereotactic guidance, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, all lesions unilateral and bilateral (for single lesion biopsy, use appropriate code)
01/01/2023

C7502

Percutaneous breast biopsies using magnetic resonance guidance, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, all lesions unilateral or bilateral (for single lesion biopsy, use appropriate code)
01/01/2023

C7503

Open biopsy or excision of deep cervical node(s) with intraoperative identification (eg, mapping) of sentinel lymph node(s) including injection of non-radioactive dye when performed
01/01/2023

C7504

Percutaneous vertebroplasties (bone biopsies included when performed), first cervicothoracic and any additional cervicothoracic or lumbosacral vertebral bodies, unilateral or bilateral injection, inclusive of all imaging guidance
01/01/2023

C7505

Percutaneous vertebroplasties (bone biopsies included when performed), first lumbosacral and any additional cervicothoracic or lumbosacral vertebral bodies, unilateral or bilateral injection, inclusive of all imaging guidance
01/01/2023

C7506

Arthrodesis, interphalangeal joints, with or without internal fixation
01/01/2023

C7507

Percutaneous vertebral augmentations, first thoracic and any additional thoracic or lumbar vertebral bodies, including cavity creations (fracture reductions and bone biopsies included when performed) using mechanical device (eg, kyphoplasty), unilateral or bilateral cannulations, inclusive of all imaging guidance
01/01/2023

C7508

Percutaneous vertebral augmentations, first lumbar and any additional thoracic or lumbar vertebral bodies, including cavity creations (fracture reductions and bone biopsies included when performed) using mechanical device (eg, kyphoplasty), unilateral or bilateral cannulations, inclusive of all imaging guidance
01/01/2023

C7509

Bronchoscopy, rigid or flexible, diagnostic with cell washing(s) when performed, with computer-assisted image-guided navigation, including fluoroscopic guidance when performed
01/01/2023

C7510

Bronchoscopy, rigid or flexible, with bronchial alveolar lavage(s), with computer-assisted image-guided navigation, including fluoroscopic guidance when performed
01/01/2023

C7511

Bronchoscopy, rigid or flexible, with single or multiple bronchial or endobronchial biopsy(ies), single or multiple sites, with computer-assisted image-guided navigation, including fluoroscopic guidance when performed
01/01/2023

C7512

Bronchoscopy, rigid or flexible, with single or multiple bronchial or endobronchial biopsy(ies), single or multiple sites, with transendoscopic endobronchial ultrasound (ebus) during bronchoscopic diagnostic or therapeutic intervention(s) for peripheral lesion(s), including fluoroscopic guidance when performed
01/01/2023

C7513

Dialysis circuit, introduction of needle(s) and/or catheter(s), with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, with transluminal balloon angioplasty of central dialysis segment, performed through dialysis circuit, including all required imaging, radiological supervision and interpretation, image documentation and report
01/01/2023

C7514

Dialysis circuit, introduction of needle(s) and/or catheter(s), with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, with all angioplasty in the central dialysis segment, and transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all required imaging, radiological supervision and interpretation, image documentation and report
01/01/2023

C7515

Dialysis circuit, introduction of needle(s) and/or catheter(s), with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, with dialysis circuit permanent endovascular embolization or occlusion of main circuit or any accessory veins, including all required imaging, radiological supervision and interpretation, image documentation and report
01/01/2023

C7516

Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report
01/01/2023

C7517

Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, with iliac and/or femoral artery angiography, non-selective, bilateral or ipsilateral to catheter insertion, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of the catheter in the distal aorta or ipsilateral femoral or iliac artery, injection of dye, production of permanent images, and radiologic supervision and interpretation
01/01/2023

C7518

Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging, supervision, interpretation and report
01/01/2023

C7519

Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress
01/01/2023

C7520

Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) includes intraprocedural injection(s) for bypass graft angiography with iliac and/or femoral artery angiography, non-selective, bilateral or ipsilateral to catheter insertion, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of the catheter in the distal aorta or ipsilateral femoral or iliac artery, injection of dye, production of permanent images, and radiologic supervision and interpretation
01/01/2023

C7521

Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography with right heart catheterization with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report
01/01/2023

C7522

Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation with right heart catheterization, with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress
01/01/2023

C7523

Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report
01/01/2023

C7524

Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress
01/01/2023

C7525

Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report
01/01/2023

C7526

Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress
01/01/2023

C7527

Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report
01/01/2023

C7528

Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress
01/01/2023

C7529

Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress
01/01/2023

C7530

Dialysis circuit, introduction of needle(s) and/or catheter(s), with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty and all angioplasty in the central dialysis segment, with transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all imaging, radiological supervision and interpretation, documentation and report
01/01/2023

C7531

Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(ies), unilateral, with transluminal angioplasty with intravascular ultrasound (initial noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation
01/01/2023

C7532

Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), initial artery, open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, with intravascular ultrasound (initial noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation
01/01/2023

C7533

Percutaneous transluminal coronary angioplasty, single major coronary artery or branch with transcatheter placement of radiation delivery device for subsequent coronary intravascular brachytherapy
01/01/2023

C7534

Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(ies), unilateral, with atherectomy, includes angioplasty within the same vessel, when performed with intravascular ultrasound (initial noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation
01/01/2023

C7535

Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(ies), unilateral, with transluminal stent placement(s), includes angioplasty within the same vessel, when performed, with intravascular ultrasound (initial noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation
01/01/2023

C7537

Insertion of new or replacement of permanent pacemaker with atrial transvenous electrode(s), with insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable debribrillator or pacemake pulse generator (eg, for upgrade to dual chamber system)
01/01/2023

C7538

Insertion of new or replacement of permanent pacemaker with ventricular transvenous electrode(s), with insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defribrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system)
01/01/2023

C7539

Insertion of new or replacement of permanent pacemaker with atrial and ventricular transvenous electrode(s), with insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system)
01/01/2023

C7540

Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator, dual lead system, with insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system)
01/01/2023

C7541

Diagnostic endoscopic retrograde cholangiopancreatography (ercp), including collection of specimen(s) by brushing or washing, when performed, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s)
01/01/2023

C7542

Endoscopic retrograde cholangiopancreatography (ercp) with biopsy, single or multiple, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s)
01/01/2023

C7543

Endoscopic retrograde cholangiopancreatography (ercp) with sphincterotomy/papillotomy, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s)
01/01/2023

C7544

Endoscopic retrograde cholangiopancreatography (ercp) with removal of calculi/debris from biliary/pancreatic duct(s), with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s)
01/01/2023

C7545

Percutaneous exchange of biliary drainage catheter (eg, external, internal-external, or conversion of internal-external to external only), with removal of calculi/debris from biliary duct(s) and/or gallbladder, including destruction of calculi by any method (eg, mechanical, electrohydraulic, lithotripsy) when performed, including diagnostic cholangiography(ies) when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation
01/01/2023

C7546

Removal and replacement of externally accessible nephroureteral catheter (eg, external/internal stent) requiring fluoroscopic guidance, with ureteral stricture balloon dilation, including imaging guidance and all associated radiological supervision and interpretation
01/01/2023

C7547

Convert nephrostomy catheter to nephroureteral catheter, percutaneous via pre-existing nephrostomy tract, with ureteral stricture balloon dialation, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation
01/01/2023

C7548

Exchange nephrostomy catheter, percutaneous, with ureteral stricture balloon dilation, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation
01/01/2023

C7549

Change of ureterostomy tube or externally accessible ureteral stent via ileal conduit with ureteral stricture balloon dilation, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation
01/01/2023

C7550

Cystourethroscopy, with biopsy(ies) with adjuctive blue light cystoscopy with fluorescent imaging agent
01/01/2023

C7551

Excision of major peripheral nerve neuroma, except sciatic, with implantation of nerve end into bone or muscle
01/01/2023

C7552

Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography and right heart catheterization with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress, initial vessel
01/01/2023

C7553

Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography with pharmacologic agent administration (eg, inhaled nitric oxide, intravenous infusion of nitroprusside, dobutamine, milrinone, or other agent) including assessing hemodynamic measurements before, during, after and repeat pharmacologic agent administration, when performed
01/01/2023

C7554

Cystourethroscopy with adjunctive blue light cystoscopy with fluorescent imaging agent
01/01/2023

C7555

Thyroidectomy, total or complete with parathyroid autotransplantation
01/01/2023

C7900

Service for diagnosis, evaluation, or treatment of a mental health or substance use disorder, initial 15-29 minutes, provided remotely by hospital staff who are licensed to provide mental health services under applicable state law(s), when the patient is in their home, and there is no associated professional service
01/01/2023

C7901

Service for diagnosis, evaluation, or treatment of a mental health or substance use disorder, initial 30-60 minutes, provided remotely by hospital staff who are licensed to provided mental health services under applicable state law(s), when the patient is in their home, and there is no associated professional service
01/01/2023

C7902

Service for diagnosis, evaluation, or treatment of a mental health or substance use disorder, each additional 15 minutes, provided remotely by hospital staff who are licensed to provide mental health services under applicable state law(s), when the patient is in their home, and there is no associated professional service (list separately in addition to code for primary service)
01/01/2023

C9046

Cocaine hydrochloride nasal solution (goprelto), 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

C9142

Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg
Code Discontinued
01/01/2023

C9143

Cocaine hydrochloride nasal solution (numbrino), 1 mg
01/01/2023

C9144

Injection, bupivacaine (posimir), 1 mg
01/01/2023

C9248

Injection, clevidipine butyrate, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

C9761

Cystourethroscopy, with ureteroscopy and/or pyeloscopy, with lithotripsy, and ureteral catheterization for steerable vacuum aspiration of the kidney, collecting system, ureter, bladder, and urethra if applicable (must use a steerable ureteral catheter)
Change in long description of procedure or modifier code

E Codes

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Effective Code   Description
01/01/2023

E2102

Adjunctive, non-implanted continuous glucose monitor or receiver
Change in long description of procedure or modifier code
01/01/2023

E2103

Non-adjunctive, non-implanted continuous glucose monitor or receiver

G Codes

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Effective Code   Description
01/01/2023

G0028

Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)
Code Discontinued
01/01/2023

G0029

Tobacco screening not performed or tobacco cessation intervention not provided during the measurement period or in the six months prior to the measurement period
Change in long description of procedure or modifier code
01/01/2023

G0030

Patient screened for tobacco use and received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling, pharmacotherapy, or both), if identified as a tobacco user
Change in long description of procedure or modifier code
01/01/2023

G0308

Creation of subcutaneous pocket with insertion of 180 day implantable interstitial glucose sensor, including system activation and patient training
Code Discontinued
01/01/2023

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
Code Discontinued
01/01/2023

G0316

Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99223, 99233, and 99236 for hospital inpatient or observation care evaluation and management services). (do not report g0316 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99418, 99415, 99416). (do not report g0316 for any time unit less than 15 minutes)
01/01/2023

G0317

Prolonged nursing facility evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99306, 99310 for nursing facility evaluation and management services). (do not report g0317 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99418). (do not report g0317 for any time unit less than 15 minutes)
01/01/2023

G0318

Prolonged home or residence evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99345, 99350 for home or residence evaluation and management services). (do not report g0318 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99417). (do not report g0318 for any time unit less than 15 minutes)
01/01/2023

G0320

Home health services furnished using synchronous telemedicine rendered via a real-time two-way audio and video telecommunications system
01/01/2023

G0321

Home health services furnished using synchronous telemedicine rendered via telephone or other real-time interactive audio-only telecommunications system
01/01/2023

G0322

The collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency (i.e., remote patient monitoring)
01/01/2023

G0323

Care management services for behavioral health conditions, at least 20 minutes of clinical psychologist or clinical social worker time, per calendar month. (these services include the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales; behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes; facilitating and coordinating treatment such as psychotherapy, coordination with and/or referral to physicians and practitioners who are authorized by medicare to prescribe medications and furnish e/m services, counseling and/or psychiatric consultation; and continuity of care with a designated member of the care team)
01/01/2023

G0330

Facility services for dental rehabilitation procedure(s) performed on a patient who requires monitored anesthesia (e.g., general, intravenous sedation (monitored anesthesia care) and use of an operating room
01/01/2023

G0442

Annual alcohol misuse screening, 5 to 15 minutes
Change in long description of procedure or modifier code
01/01/2023

G0444

Annual depression screening, 5 to 15 minutes
Change in long description of procedure or modifier code
01/01/2023

G0917

Patient care survey was not completed by patient
Change in long description of procedure or modifier code
01/01/2023

G2095

Documentation of system reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., other system reasons)
Code Discontinued
01/01/2023

G2136

Back pain measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively was less than or equal to 3.0 or back pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated an improvement of 5.0 points or greater
Change in long description of procedure or modifier code
01/01/2023

G2137

Back pain measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively was greater than 3.0 and back pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated less than an improvement of 5.0 points
Change in long description of procedure or modifier code
01/01/2023

G2138

Back pain as measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively was less than or equal to 3.0 or back pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of 5.0 points or greater
Change in long description of procedure or modifier code
01/01/2023

G2139

Back pain measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively was greater than 3.0 and back pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated less than an improvement of 5.0 points
Change in long description of procedure or modifier code
01/01/2023

G2140

Leg pain measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively was less than or equal to 3.0 or leg pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated an improvement of 5.0 points or greater
Change in long description of procedure or modifier code
01/01/2023

G2141

Leg pain measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively was greater than 3.0 and leg pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated less than an improvement of 5.0 points
Change in long description of procedure or modifier code
01/01/2023

G2146

Leg pain as measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively was less than or equal to 3.0 or leg pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of 5.0 points or greater
Change in long description of procedure or modifier code
01/01/2023

G2147

Leg pain measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively was greater than 3.0 and leg pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated less than an improvement of 5.0 points
Change in long description of procedure or modifier code
01/01/2023

G2152

Residual score for the neck impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
Change in long description of procedure or modifier code
01/01/2023

G2167

Residual score for the neck impairment successfully calculated and the score was less than zero (< 0)
Change in long description of procedure or modifier code
01/01/2023

G2170

Percutaneous arteriovenous fistula creation (avf), direct, any site, by tissue approximation using thermal resistance energy, and secondary procedures to redirect blood flow (e.g., transluminal balloon angioplasty, coil embolization) when performed, and includes all imaging and radiologic guidance, supervision and interpretation, when performed
Code Discontinued
01/01/2023

G2171

Percutaneous arteriovenous fistula creation (avf), direct, any site, using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, wen performed) and fistulogram(s), angiography, enography, and/or ultrasound, with radiologic supervision and interpretation, when performed
Code Discontinued
01/01/2023

G2174

Uri episodes when the patient had an active prescription of antibiotics in the 30 days prior to the episode date or is still active the same day of the encounter
Change in long description of procedure or modifier code
01/01/2023

G2182

Patient receiving first-time biologic and/or immune response modifier therapy
Change in long description of procedure or modifier code
01/01/2023

G2198

Documentation of medical reason(s) for not screening for unhealthy alcohol use using a systematic screening method (e.g., limited life expectancy, other medical reasons)
Code Discontinued
01/01/2023

G2199

Patient not screened for unhealthy alcohol use using a systematic screening method
Change in long description of procedure or modifier code
01/01/2023

G2201

Documentation of medical reason(s) for not providing brief counseling (e.g., limited life expectancy, other medical reasons)
Code Discontinued
01/01/2023

G2202

Patient did not receive brief counseling if identified as an unhealthy alcohol user
Change in long description of procedure or modifier code
01/01/2023

G2203

Documentation of medical reason(s) for not providing brief counseling if identified as an unhealthy alcohol user (e.g., limited life expectancy, other medical reasons)
Code Discontinued
01/01/2023

G2204

Patients between 45 and 85 years of age who received a screening colonoscopy during the performance period
Change in long description of procedure or modifier code
01/01/2023

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)
Change in long description of procedure or modifier code
01/01/2023

G2210

Residual score for the neck impairment not measured because the patient did not complete the neck fs prom at initial evaluation and/or near discharge, reason not given
Change in long description of procedure or modifier code
01/01/2023

G2212

Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99205, 99215, 99483 for office or other outpatient evaluation and management services) (do not report g2212 on the same date of service as 99358, 99359, 99415, 99416). (do not report g2212 for any time unit less than 15 minutes)
Change in long description of procedure or modifier code
01/01/2023

G3002

Chronic pain management and treatment, monthly bundle including, diagnosis; assessment and monitoring; administration of a validated pain rating scale or tool; the development, implementation, revision, and/or maintenance of a person-centered care plan that includes strengths, goals, clinical needs, and desired outcomes; overall treatment management; facilitation and coordination of any necessary behavioral health treatment; medication management; pain and health literacy counseling; any necessary chronic pain related crisis care; and ongoing communication and care coordination between relevant practitioners furnishing care, e.g. physical therapy and occupational therapy, complementary and integrative approaches, and community-based care, as appropriate. required initial face-to-face visit at least 30 minutes provided by a physician or other qualified health professional; first 30 minutes personally provided by physician or other qualified health care professional, per calendar month. (when using g3002, 30 minutes must be met or exceeded.)
01/01/2023

G3003

Each additional 15 minutes of chronic pain management and treatment by a physician or other qualified health care professional, per calendar month. (list separately in addition to code for g3002. when using g3003, 15 minutes must be met or exceeded.)
01/01/2023

G4013

Mental/behavioral and psychiatry mips specialty set
Change in long description of procedure or modifier code
01/01/2023

G4020

Ophthalmology/optometry mips specialty set
Change in long description of procedure or modifier code
01/01/2023

G8451

Beta-blocker therapy for lvef <=40% not prescribed for reasons documented by the clinician (e.g., low blood pressure, fluid overload, asthma, patients recently treated with an intravenous positive inotropic agent, allergy, intolerance, other medical reasons, patient declined, other patient reasons)
Change in long description of procedure or modifier code
01/01/2023

G8539

Functional outcome assessment documented as positive using a standardized tool and a care plan based on identified deficiencies is documented within two days of the functional outcome assessment
Change in long description of procedure or modifier code
01/01/2023

G8543

Documentation of a positive functional outcome assessment using a standardized tool; care plan not documented within two days of assessment, reason not given
Change in long description of procedure or modifier code
01/01/2023

G8600

Iv thrombolytic therapy initiated within 4.5 hours (<= 270 minutes) of time last known well
Change in long description of procedure or modifier code
01/01/2023

G8601

Iv thrombolytic therapy not initiated within 4.5 hours (= 270 minutes) of time last known well for reasons documented by clinician (e.g. patient enrolled in clinical trial for stroke, patient admitted for elective carotid intervention, patient received tenecteplase (tnk))
Change in long description of procedure or modifier code
01/01/2023

G8602

Iv thrombolytic therapy not initiated within 4.5 hours (<= 270 minutes) of time last known well, reason not given
Change in long description of procedure or modifier code
01/01/2023

G8633

Pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed
Change in long description of procedure or modifier code
01/01/2023

G8647

Residual score for the knee impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
Change in long description of procedure or modifier code
01/01/2023

G8648

Residual score for the knee impairment successfully calculated and the score was less than zero (< 0)
Change in long description of procedure or modifier code
01/01/2023

G8650

Residual score for the knee impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given
Change in long description of procedure or modifier code
01/01/2023

G8651

Residual score for the hip impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
Change in long description of procedure or modifier code
01/01/2023

G8652

Residual score for the hip impairment successfully calculated and the score was less than zero (< 0)
Change in long description of procedure or modifier code
01/01/2023

G8654

Residual score for the hip impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given
Change in long description of procedure or modifier code
01/01/2023

G8655

Residual score for the lower leg, foot or ankle impairment successfully calculated and the score was equal to zero (0) or greater than zero ( > 0)
Change in long description of procedure or modifier code
01/01/2023

G8656

Residual score for the lower leg, foot or ankle impairment successfully calculated and the score was less than zero (< 0)
Change in long description of procedure or modifier code
01/01/2023

G8658

Residual score for the lower leg, foot or ankle impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given
Change in long description of procedure or modifier code
01/01/2023

G8659

Residual score for the low back impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
Change in long description of procedure or modifier code
01/01/2023

G8660

Residual score for the low back impairment successfully calculated and the score was less than zero (< 0)
Change in long description of procedure or modifier code
01/01/2023

G8662

Residual score for the low back impairment not measured because the patient did not complete the low back fs prom at initial evaluation and/or near discharge, reason not given
Change in long description of procedure or modifier code
01/01/2023

G8663

Residual score for the shoulder impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
Change in long description of procedure or modifier code
01/01/2023

G8664

Residual score for the shoulder impairment successfully calculated and the score was less than zero (< 0)
Change in long description of procedure or modifier code
01/01/2023

G8666

Residual score for the shoulder impairment not measured because the patient did not complete the shoulder fs prom at initial evaluation and/or near discharge, reason not given
Change in long description of procedure or modifier code
01/01/2023

G8667

Residual score for the elbow, wrist or hand impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
Change in long description of procedure or modifier code
01/01/2023

G8668

Residual score for the elbow, wrist or hand impairment successfully calculated and the score was less than zero (< 0)
Change in long description of procedure or modifier code
01/01/2023

G8670

Residual score for the elbow, wrist or hand impairment not measured because the patient did not complete the elbow/wrist/hand fs prom at initial evaluation and/or near discharge, reason not given
Change in long description of procedure or modifier code
01/01/2023

G8694

Left ventricular ejection fraction (lvef) < = 40% or documentation of moderate or severe lvsd
Change in long description of procedure or modifier code
01/01/2023

G8708

Patient not prescribed antibiotic
Change in long description of procedure or modifier code
01/01/2023

G8710

Patient prescribed antibiotic
Change in long description of procedure or modifier code
01/01/2023

G8711

Prescribed antibiotic on or within 3 days after the episode date
Change in long description of procedure or modifier code
01/01/2023

G8734

Elder maltreatment screen documented as negative, follow-up is not required
Change in long description of procedure or modifier code
01/01/2023

G8826

Patient discharged to home no later than post-operative day #2 following evar
Change in long description of procedure or modifier code
01/01/2023

G8842

Apnea hypopnea index (ahi), respiratory disturbance index (rdi) or respiratory event index (rei) documented or measured within 2 months of initial evaluation for suspected obstructive sleep apnea
Change in long description of procedure or modifier code
01/01/2023

G8843

Documentation of reason(s) for not measuring an apnea hypopnea index (ahi), a respiratory disturbance index (rdi), or a respiratory event index (rei) within 2 months of initial evaluation for suspected obstructive sleep apnea (e.g., medical, neurological, or psychiatric disease that prohibits successful completion of a sleep study, patients for whom a sleep study would present a bigger risk than benefit or would pose an undue burden, dementia, patients who decline ahi/rdi/rei measurement, patients who had a financial reason for not completing testing, test was ordered but not completed, patients decline because their insurance (payer) does not cover the expense))
Change in long description of procedure or modifier code
01/01/2023

G8844

Apnea hypopnea index (ahi), respiratory disturbance index (rdi), or respiratory event index (rei) not documented or measured within 2 months of initial evaluation for suspected obstructive sleep apnea, reason not given
Change in long description of procedure or modifier code
01/01/2023

G8852

Positive airway pressure therapy was prescribed
Change in long description of procedure or modifier code
01/01/2023

G8854

Documentation of reason(s) for not objectively measuring adherence to positive airway pressure therapy (e.g., patient didn't bring data from continuous positive airway pressure [cpap], therapy not yet initiated, not available on machine)
Change in long description of procedure or modifier code
01/01/2023

G8923

Left ventricular ejection fraction (lvef) <= 40% or documentation of moderately or severely depressed left ventricular systolic function
Change in long description of procedure or modifier code
01/01/2023

G8934

Left ventricular ejection fraction (lvef) <=40% or documentation of moderately or severely depressed left ventricular systolic function
Change in long description of procedure or modifier code
01/01/2023

G8942

Functional outcomes assessment using a standardized tool is documented within the previous 30 days and care plan, based on identified deficiencies is documented within two days of the functional outcome assessment
Change in long description of procedure or modifier code
01/01/2023

G8968

Documentation of medical reason(s) for not prescribing an fda-approved anticoagulant (e.g., present or planned atrial appendage occlusion or ligation)
Change in long description of procedure or modifier code
01/01/2023

G9196

Documentation of medical reason(s) for not ordering a first or second generation cephalosporin for antimicrobial prophylaxis (e.g., patients enrolled in clinical trials, patients with documented infection prior to surgical procedure of interest, patients who were receiving antibiotics more than 24 hours prior to surgery [except colon surgery patients taking oral prophylactic antibiotics], patients who were receiving antibiotics within 24 hours prior to arrival [except colon surgery patients taking oral prophylactic antibiotics], other medical reason(s))
Code Discontinued
01/01/2023

G9197

Documentation of order for first or second generation cephalosporin for antimicrobial prophylaxis
Code Discontinued
01/01/2023

G9198

Order for first or second generation cephalosporin for antimicrobial prophylaxis was not documented, reason not given
Code Discontinued
01/01/2023

G9250

Documentation of patient pain brought to a comfortable level within 48 hours from initial assessment
Code Discontinued
01/01/2023

G9251

Documentation of patient with pain not brought to a comfortable level within 48 hours from initial assessment
Code Discontinued
01/01/2023

G9315

Amoxicillin, with or without clavulanate, prescribed as a first line antibiotic at the time of diagnosis
Change in long description of procedure or modifier code
01/01/2023

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
Code Discontinued
01/01/2023

G9360

No documentation of negative or managed positive tb screen
Code Discontinued
01/01/2023

G9404

Patient did not receive follow-up within 30 days after discharge
Change in long description of procedure or modifier code
01/01/2023

G9407

Patient did not receive follow-up within 7 days after discharge
Change in long description of procedure or modifier code
01/01/2023

G9418

Primary non-small cell lung cancer lung biopsy and cytology specimen report documents classification into specific histologic type following iaslc guidance or classified as nsclc-nos with an explanation
Change in long description of procedure or modifier code
01/01/2023

G9500

Radiation exposure indices documented in final report for procedure using fluoroscopy
Change in long description of procedure or modifier code
01/01/2023

G9501

Radiation exposure indices not documented in final report for procedure using fluoroscopy, reason not given
Change in long description of procedure or modifier code
01/01/2023

G9506

Biologic immune response modifier prescribed
Code Discontinued
01/01/2023

G9618

Documentation of screening for uterine malignancy or those that had an ultrasound and/or endometrial sampling of any kind
Code Discontinued
01/01/2023

G9620

Patient not screened for uterine malignancy, or those that have not had an ultrasound and/or endometrial sampling of any kind, reason not given
Code Discontinued
01/01/2023

G9623

Documentation of medical reason(s) for not screening for unhealthy alcohol use (e.g., limited life expectancy, other medical reasons)
Code Discontinued
01/01/2023

G9624

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
Change in long description of procedure or modifier code
01/01/2023

G9626

Documented medical reason for not reporting bladder injury (e.g., gynecologic or other pelvic malignancy documented, concurrent surgery involving bladder pathology, injury that occurs during a urinary incontinence procedure, patient death from non-medical causes not related to surgery, patient died during procedure without evidence of bladder injury)
Change in long description of procedure or modifier code
01/01/2023

G9631

Patient sustained ureter injury at the time of surgery or discovered subsequently up to 30 days post-surgery
Code Discontinued
01/01/2023

G9632

Documented medical reasons for not reporting ureter injury (e.g., gynecologic or other pelvic malignancy documented, concurrent surgery involving bladder pathology, injury that occurs during a urinary incontinence procedure, patient death from non-medical causes not related to surgery, patient died during procedure without evidence of ureter injury)
Code Discontinued
01/01/2023

G9633

Patient did not sustain ureter injury at the time of surgery nor discovered subsequently up to 30 days post-surgery
Code Discontinued
01/01/2023

G9662

Previously diagnosed or have a diagnosis of clinical ascvd, including ascvd procedure
Change in long description of procedure or modifier code
01/01/2023

G9663

Any ldl-c laboratory result >= 190 mg/dl
Change in long description of procedure or modifier code
01/01/2023

G9718

Hospice services for patient provided any time during the measurement period
Code Discontinued
01/01/2023

G9774

Patients who have had a hysterectomy
Code Discontinued
01/01/2023

G9778

Patients who have a diagnosis of pregnancy at any time during the measurement period
Code Discontinued
01/01/2023

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, patients with end stage renal disease [esrd], or other medical reasons)
Change in long description of procedure or modifier code
01/01/2023

G9789

Blood pressure recorded during inpatient stays, emergency room visits, or urgent care visits
Change in long description of procedure or modifier code
01/01/2023

G9808

Any patients who had no asthma controller medications dispensed during the measurement year
Code Discontinued
01/01/2023

G9809

Patients who use hospice services any time during the measurement period
Code Discontinued
01/01/2023

G9810

Patient achieved a pdc of at least 75% for their asthma controller medication
Code Discontinued
01/01/2023

G9811

Patient did not achieve a pdc of at least 75% for their asthma controller medication
Code Discontinued
01/01/2023

G9847

Patient received systemic cancer-directed therapy in the last 14 days of life
Change in long description of procedure or modifier code
01/01/2023

G9848

Patient did not receive systemic cancer-directed therapy in the last 14 days of life
Change in long description of procedure or modifier code
01/01/2023

G9904

Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)
Code Discontinued
01/01/2023

G9905

Patient not screened for tobacco use
Change in long description of procedure or modifier code
01/01/2023

G9906

Patient identified as a tobacco user received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy)
Change in long description of procedure or modifier code
01/01/2023

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)
Code Discontinued
01/01/2023

G9908

Patient identified as tobacco user did not receive tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy)
Change in long description of procedure or modifier code
01/01/2023

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)
Code Discontinued
01/01/2023

G9913

Hepatitis b virus (hbv) status not assessed and results interpreted prior to initiating anti-tnf (tumor necrosis factor) therapy, reason not otherwise specified
Change in long description of procedure or modifier code
01/01/2023

G9932

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)
Code Discontinued
01/01/2023

G9942

Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminectomy
Code Discontinued
01/01/2023

G9943

Back pain was not measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively
Change in long description of procedure or modifier code
01/01/2023

G9946

Back pain was not measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively
Change in long description of procedure or modifier code
01/01/2023

G9948

Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminectomy
Code Discontinued
01/01/2023

G9949

Leg pain was not measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively
Change in long description of procedure or modifier code
01/01/2023

G9968

Patient was referred to another clinician or specialist during the measurement period
Change in long description of procedure or modifier code
01/01/2023

G9969

Clinician who referred the patient to another clinician received a report from the clinician to whom the patient was referred
Change in long description of procedure or modifier code
01/01/2023

G9970

Clinician who referred the patient to another clinician did not receive a report from the clinician to whom the patient was referred
Change in long description of procedure or modifier code
01/01/2023

G9989

Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., adverse reaction to vaccine)
Code Discontinued
01/01/2023

G9990

Patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 60th birthday and before the end of the measurement period
Change in long description of procedure or modifier code
01/01/2023

G9991

Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 60th birthday and before the end of the measurement period
Change in long description of procedure or modifier code
01/01/2023

G9993

Patient was provided palliative care services any time during the measurement period
Change in long description of procedure or modifier code

J Codes

↑ Top
Effective Code   Description
01/01/2023

J0131

Injection, acetaminophen, not otherwise specified,10 mg
Change in long description of procedure or modifier code
01/01/2023

J0134

Injection, acetaminophen (fresenius kabi) not therapeutically equivalent to j0131, 10 mg
01/01/2023

J0136

Injection, acetaminophen (b braun) not therapeutically equivalent to j0131, 10 mg
01/01/2023

J0173

Injection, epinephrine (belcher) not therapeutically equivalent to j0171, 0.1 mg
01/01/2023

J0207

Injection, amifostine, 500 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

J0225

Injection, vutrisiran, 1 mg
01/01/2023

J0283

Injection, amiodarone hydrochloride (nexterone), 30 mg
01/01/2023

J0400

Injection, aripiprazole, intramuscular, 0.25 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

J0470

Injection, dimercaprol, per 100 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

J0610

Injection, calcium gluconate (fresenius kabi), per 10 ml
Change in long description of procedure or modifier code
01/01/2023

J0611

Injection, calcium gluconate (wg critical care), per 10 ml
01/01/2023

J0641

Injection, levoleucovorin, not otherwise specified, 0.5 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

J0642

Injection, levoleucovorin (khapzory), 0.5 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

J0689

Injection, cefazolin sodium (baxter), not therapeutically equivalent to j0690, 500 mg
01/01/2023

J0691

Injection, lefamulin, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

J0701

Injection, cefepime hydrochloride (baxter), not therapeutically equivalent to maxipime, 500 mg
01/01/2023

J0703

Injection, cefepime hydrochloride (b braun), not therapeutically equivalent to maxipime, 500 mg
01/01/2023

J0795

Injection, corticorelin ovine triflutate, 1 microgram
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

J0877

Injection, daptomycin (hospira), not therapeutically equivalent to j0878, 1 mg
01/01/2023

J0887

Injection, epoetin beta, 1 microgram, (for esrd on dialysis)
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

J0891

Injection, argatroban (accord), not therapeutically equivalent to j0883, 1 mg (for non-esrd use)
01/01/2023

J0892

Injection, argatroban (accord), not therapeutically equivalent to j0884, 1 mg (for esrd on dialysis)
01/01/2023

J0893

Injection, decitabine (sun pharma) not therapeutically equivalent to j0894, 1 mg
01/01/2023

J0894

Injection, decitabine, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

J0898

Injection, argatroban (auromedics), not therapeutically equivalent to j0883, 1 mg (for non-esrd use)
01/01/2023

J0899

Injection, argatroban (auromedics), not therapeutically equivalent to j0884, 1 mg (for esrd on dialysis)
01/01/2023

J1095

Injection, dexamethasone 9 percent, intraocular, 1 microgram
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

J1327

Injection, eptifibatide, 5 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

J1364

Injection, erythromycin lactobionate, per 500 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

J1437

Injection, ferric derisomaltose, 10 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

J1456

Injection, fosaprepitant (teva), not therapeutically equivalent to j1453, 1 mg
01/01/2023

J1458

Injection, galsulfase, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

J1574

Injection, ganciclovir sodium (exela) not therapeutically equivalent to j1570, 500 mg
01/01/2023

J1611

Injection, glucagon hydrochloride (fresenius kabi), not therapeutically equivalent to j1610, per 1 mg
01/01/2023

J1632

Injection, brexanolone, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

J1643

Injection, heparin sodium (pfizer), not therapeutically equivalent to j1644, per 1000 units
01/01/2023

J1740

Injection, ibandronate sodium, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

J1830

Injection, interferon beta-1b, 0.25 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

J1954

Injection, leuprolide acetate for depot suspension (lutrate), 7.5 mg
01/01/2023

J2021

Injection, linezolid (hospira) not therapeutically equivalent to j2020, 200 mg
01/01/2023

J2184

Injection, meropenem (b. braun) not therapeutically equivalent to j2185, 100 mg
01/01/2023

J2247

Injection, micafungin sodium (par pharm) not thereapeutically equivalent to j2248, 1 mg
01/01/2023

J2251

Injection, midazolam hydrochloride (wg critical care) not therapeutically equivalent to j2250, per 1 mg
01/01/2023

J2272

Injection, morphine sulfate (fresenius kabi) not therapeutically equivalent to j2270, up to 10 mg
01/01/2023

J2281

Injection, moxifloxacin (fresenius kabi) not therapeutically equivalent to j2280, 100 mg
01/01/2023

J2311

Injection, naloxone hydrochloride (zimhi), 1 mg
01/01/2023

J2327

Injection, risankizumab-rzaa, intravenous, 1 mg
01/01/2023

J2400

Injection, chloroprocaine hydrochloride, per 30 ml
Code Discontinued
01/01/2023

J2401

Injection, chloroprocaine hydrochloride, per 1 mg
01/01/2023

J2402

Injection, chloroprocaine hydrochloride (clorotekal), per 1 mg
01/01/2023

J2510

Injection, penicillin g procaine, aqueous, up to 600,000 units
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

J2515

Injection, pentobarbital sodium, per 50 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

J2941

Injection, somatropin, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

J3244

Injection, tigecycline (accord) not therapeutically equivalent to j3243, 1 mg
01/01/2023

J3246

Injection, tirofiban hcl, 0.25 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

J3371

Injection, vancomycin hcl (mylan) not therapeutically equivalent to j3370, 500 mg
01/01/2023

J3372

Injection, vancomycin hcl (xellia) not therapeutically equivalent to j3370, 500 mg
01/01/2023

J7180

Injection, factor xiii (antihemophilic factor, human), 1 i.u.
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

J7181

Injection, factor xiii a-subunit, (recombinant), per iu
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

J9025

Injection, azacitidine, 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

J9041

Injection, bortezomib, 0.1 mg
Change in long description of procedure or modifier code
01/01/2023

J9044

Injection, bortezomib, not otherwise specified, 0.1 mg
Code Discontinued
01/01/2023

J9046

Injection, bortezomib, (dr. reddy's), not therapeutically equivalent to j9041, 0.1 mg
01/01/2023

J9048

Injection, bortezomib (fresenius kabi), not therapeutically equivalent to j9041, 0.1 mg
01/01/2023

J9049

Injection, bortezomib (hospira), not therapeutically equivalent to j9041, 0.1 mg
01/01/2023

J9185

Injection, fludarabine phosphate, 50 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

J9218

Leuprolide acetate, per 1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

J9226

Histrelin implant (supprelin la), 50 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

J9230

Injection, mechlorethamine hydrochloride, (nitrogen mustard), 10 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

J9270

Injection, plicamycin, 2.5 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

J9285

Injection, olaratumab, 10 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

J9314

Injection, pemetrexed (teva) not therapeutically equivalent to J9305, 10 mg
01/01/2023

J9393

Injection, fulvestrant (teva) not therapeutically equivalent to j9395, 25 mg
01/01/2023

J9394

Injection, fulvestrant (fresenius kabi) not therapeutically equivalent to j9395, 25 mg

K Codes

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Effective Code   Description
01/01/2023

K0553

Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service
Code Discontinued
01/01/2023

K0554

Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system
Code Discontinued

M Codes

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Effective Code   Description
01/01/2023

M0001

Advancing cancer care mips value pathways
01/01/2023

M0002

Optimal care for kidney health mips value pathways
01/01/2023

M0003

Optimal care for patients with episodic neurological conditions mips value pathways
01/01/2023

M0004

Supportive care for neurodegenerative conditions mips value pathways
01/01/2023

M0005

Promoting wellness mips value pathways
01/01/2023

M1003

Tb screening performed and results interpreted within twelve months prior to initiation of first-time biologic and/or immune response modifier therapy
Change in long description of procedure or modifier code
01/01/2023

M1017

Patient admitted to palliative care services
Code Discontinued
01/01/2023

M1052

Leg pain was not measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively
Change in long description of procedure or modifier code
01/01/2023

M1071

Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminotomy
Code Discontinued
01/01/2023

M1150

Left ventricular ejection fraction (lvef) less than or equal to 40% or documentation of moderately or severely depressed left ventricular systolic function
01/01/2023

M1151

Patients with a history of heart transplant or with a left ventricular assist device (lvad)
01/01/2023

M1152

Patients with a history of heart transplant or with a left ventricular assist device (lvad)
01/01/2023

M1153

Patient with diagnosis of osteoporosis on date of encounter
01/01/2023

M1154

Hospice services provided to patient any time during the measurement period
01/01/2023

M1155

Patient had anaphylaxis due to the pneumococcal vaccine any time during or before the measurement period
01/01/2023

M1156

Patient received active chemotherapy any time during the measurement period
01/01/2023

M1157

Patient received bone marrow transplant any time during the measurement period
01/01/2023

M1158

Patient had history of immunocompromising conditions prior to or during the measurement period
01/01/2023

M1159

Hospice services provided to patient any time during the measurement period
01/01/2023

M1160

Patient had anaphylaxis due to the meningococcal vaccine any time on or before the patient's 13th birthday
01/01/2023

M1161

Patient had anaphylaxis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient's 13th birthday
01/01/2023

M1162

Patient had encephalitis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient's 13th birthday
01/01/2023

M1163

Patient had anaphylaxis due to the hpv vaccine any time on or before the patient's 13th birthday
01/01/2023

M1164

Patients with dementia any time during the patient's history through the end of the measurement period
01/01/2023

M1165

Patients who use hospice services any time during the measurement period
01/01/2023

M1166

Pathology report for tissue specimens produced from wide local excisions or re-excisions
01/01/2023

M1167

In hospice or using hospice services during the measurement period
01/01/2023

M1168

Patient received an influenza vaccine on or between july 1 of the year prior to the measurement period and june 30 of the measurement period
01/01/2023

M1169

Documentation of medical reason(s) for not administering influenza vaccine (e.g., prior anaphylaxis due to the influenza vaccine)
01/01/2023

M1170

Patient did not receive an influenza vaccine on or between july 1 of the year prior to the measurement period and june 30 of the measurement period
01/01/2023

M1171

Patient received at least one td vaccine or one tdap vaccine between nine years prior to the encounter and the end of the measurement period
01/01/2023

M1172

Documentation of medical reason(s) for not administering td or tdap vaccine (e.g., prior anaphylaxis due to the td or tdap vaccine or history of encephalopathy within seven days after a previous dose of a td-containing vaccine)
01/01/2023

M1173

Patient did not receive at least one td vaccine or one tdap vaccine between nine years prior to the encounter and the end of the measurement period
01/01/2023

M1174

Patient received at least one dose of the herpes zoster live vaccine or two doses of the herpes zoster recombinant vaccine (at least 28 days apart) anytime on or after the patient's 50th birthday before or during the measurement period
01/01/2023

M1175

Documentation of medical reason(s) for not administering zoster vaccine (e.g., prior anaphylaxis due to the zoster vaccine)
01/01/2023

M1176

Patient did not receive at least one dose of the herpes zoster live vaccine or two doses of the herpes zoster recombinant vaccine (at least 28 days apart) anytime on or after the patient's 50th birthday before or during the measurement period
01/01/2023

M1177

Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 60th birthday and before the end of the measurement period
01/01/2023

M1178

Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., prior anaphylaxis due to the pneumococcal vaccine)
01/01/2023

M1179

Patient did not receive any pneumococcal conjugate or polysaccharide vaccine, on or after their 60th birthday and before or during measurement period
01/01/2023

M1180

Patients on immune checkpoint inhibitor therapy
01/01/2023

M1181

Grade 2 or above diarrhea and/or grade 2 or above colitis
01/01/2023

M1182

Patients not eligible due to pre-existing inflammatory bowel disease (ibd) (e.g., ulcerative colitis, crohn's disease)
01/01/2023

M1183

Documentation of immune checkpoint inhibitor therapy held and corticosteroids or immunosuppressants prescribed or administered
01/01/2023

M1184

Documentation of medical reason(s) for not prescribing or administering corticosteroid or immunosuppressant treatment (e.g., allergy, intolerance, infectious etiology, pancreatic insufficiency, hyperthyroidism, prior bowel surgical interventions, celiac disease, receiving other medication, awaiting diagnostic workup results for alternative etiologies, other medical reasons/contraindication)
01/01/2023

M1185

Documentation of immune checkpoint inhibitor therapy not held and/or corticosteroids or immunosuppressants prescribed or administered was not performed, reason not given
01/01/2023

M1186

Patients who have an order for or are receiving hospice or palliative care
01/01/2023

M1187

Patients with a diagnosis of end stage renal disease (esrd)
01/01/2023

M1188

Patients with a diagnosis of chronic kidney disease (ckd) stage 5
01/01/2023

M1189

Documentation of a kidney health evaluation defined by an estimated glomerular filtration rate (egfr) and urine albumin-creatinine ratio (uacr) performed
01/01/2023

M1190

Documentation of a kidney health evaluation was not performed or defined by an estimated glomerular filtration rate (egfr) and urine albumin-creatinine ratio (uacr)
01/01/2023

M1191

Hospice services provided to patient any time during the measurement period
01/01/2023

M1192

Patients with an existing diagnosis of squamous cell carcinoma of the esophagus
01/01/2023

M1193

Surgical pathology reports that contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-based testing status, or both
01/01/2023

M1194

Documentation of medical reason(s) surgical pathology reports did not contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-based testing status, or both tests were not included (e.g., patient will not be treated with checkpoint inhibitor therapy, no residual carcinoma is present in the sample [tissue exhausted or status post neoadjuvant treatment], insufficient tumor for testing)
01/01/2023

M1195

Surgical pathology reports that do not contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-based testing status, or both, reason not given
01/01/2023

M1196

Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4
01/01/2023

M1197

Itch severity assessment score is reduced by 2 or more points from the initial (index) assessment score to the follow-up visit score
01/01/2023

M1198

Itch severity assessment score was not reduced by at least 2 points from initial (index) score to the follow-up visit score or assessment was not completed during the follow-up encounter
01/01/2023

M1199

Patients receiving rrt
01/01/2023

M1200

Ace inhibitor (ace-i) or arb therapy prescribed during the measurement period
01/01/2023

M1201

Documentation of medical reason(s) for not prescribing ace inhibitor (ace-i) or arb therapy during the measurement period (e.g., pregnancy, history of angioedema to ace-i, other allergy to ace-i and arb, hyperkalemia or history of hyperkalemia while on ace-i or arb therapy, acute kidney injury due to ace-i or arb therapy), other medical reasons)
01/01/2023

M1202

Documentation of patient reason(s) for not prescribing ace inhibitor or arb therapy during the measurement period, (e.g., patient declined, other patient reasons)
01/01/2023

M1203

Ace inhibitor or arb therapy not prescribed during the measurement period, reason not given
01/01/2023

M1204

Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4
01/01/2023

M1205

Itch severity assessment score is reduced by 2 or more points from the initial (index) assessment score to the follow-up visit score
01/01/2023

M1206

Itch severity assessment score was not reduced by at least 2 points from initial (index) score to the follow-up visit score or assessment was not completed during the follow-up encounter
01/01/2023

M1207

Number of patients screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety
01/01/2023

M1208

Number of patients not screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety
01/01/2023

M1209

At least two orders for high-risk medications from the same drug class, (table 4), without appropriate diagnoses
01/01/2023

M1210

At least two orders for high-risk medications from the same drug class, (table 4), not ordered

Q Codes

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Effective Code   Description
01/01/2023

Q2017

Injection, teniposide, 50 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

Q4236

Carepatch, per square centimeter
Re-activate discontinued/deleted procedure or modifier code
01/01/2023

Q4262

Dual layer impax membrane, per square centimeter
01/01/2023

Q4263

Surgraft tl, per square centimeter
01/01/2023

Q4264

Cocoon membrane, per square centimeter
01/01/2023

Q5101

Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

Q5124

Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2023

Q5126

Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg

Legend:

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