List of new codes and changes to the 2023 HCPCS code set along with their effective date. Includes discontinued codes that are no longer used.
Legend:
A Codes↑ Top | |||
| Effective | Code | Description | |
| 04/01/2023 |
|
Kerecis omega3 marigen shield, per square centimeter | |
| 04/01/2023 |
|
Ac5 advanced wound system (ac5) | |
| 04/01/2023 |
|
Neomatrix, per square centimeter | |
| 01/01/2023 |
|
Supply allowance for adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service
No maintenance for this code |
|
| 01/01/2023 |
|
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service
No maintenance for this code |
|
| 04/01/2023 |
|
Indwelling intraurethral drainage device with valve, patient inserted, replacement only, each | |
| 04/01/2023 |
|
Accessories for patient inserted indwelling intraurethral drainage device with valve, replacement only, each | |
| 04/01/2023 |
|
Neuromuscular electrical stimulator (nmes), disposable, replacement only | |
| 04/01/2023 |
|
Oral and/or oropharyngeal suction catheter, each
Change in long description of procedure or modifier code |
|
| 04/01/2023 |
|
External urinary catheters; disposable, with wicking material, for use with suction pump, per month | |
| 04/01/2023 |
|
External urinary catheter; non-disposable, for use with suction pump, per month | |
| 04/01/2023 |
|
Expiratory positive airway pressure intranasal resistance valve | |
| 01/01/2023 |
|
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply
No maintenance for this code |
|
| 01/01/2023 |
|
Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system
No maintenance for this code |
|
| 01/01/2023 |
|
Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system
No maintenance for this code |
|
C Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2023 |
|
Orthopedic/device/drug matrix for opposing bone-to-bone or soft tissue-to bone (implantable)
No maintenance for this code |
|
| 01/01/2023 |
|
Endoscope, single-use (i.e. disposable), urinary tract, imaging/illumination device (insertable)
No maintenance for this code |
|
| 01/01/2023 |
|
Generator, neurostimulator (implantable), non-rechargeable, with transvenous sensing and stimulation leads
No maintenance for this code |
|
| 01/01/2023 |
|
Generator, cardiac contractility modulation (implantable)
No maintenance for this code |
|
| 01/01/2023 |
|
Generator, neurostimulator (implantable), includes closed feedback loop leads and all implantable components, with rechargeable battery and charging system
No maintenance for this code |
|
| 01/01/2023 |
|
Generator, neurostimulator (implantable), non-rechargeable, with implantable stimulation lead and external paired stimulation controller
No maintenance for this code |
|
| 01/01/2023 |
|
Interbody cage, anterior, lateral or posterior, personalized (implantable)
No maintenance for this code |
|
| 04/01/2023 |
|
Pressure sensor system, includes all components (e.g., introducer, sensor), intramuscular (implantable), excludes mobile (wireless) software application
Code Discontinued |
|
| 01/01/2023 |
|
Iris prosthesis
No maintenance for this code |
|
| 01/01/2023 |
|
Retinal prosthesis, includes all internal and external components
No maintenance for this code |
|
| 01/01/2023 |
|
Retinal prosthesis, includes all internal and external components; add-on to c1841
No maintenance for this code |
|
| 01/01/2023 |
|
Skin substitute, synthetic, resorbable, per square centimeter
No maintenance for this code |
|
| 01/01/2023 |
|
Catheter, pressure-generating, one-way valve, intermittently occlusive
No maintenance for this code |
|
| 01/01/2023 |
|
Probe, image-guided, robotic, waterjet ablation
No maintenance for this code |
|
| 01/01/2023 |
|
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)
No maintenance for this code |
|
| 01/01/2023 |
|
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)
No maintenance for this code |
|
| 01/01/2023 |
|
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)
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
Arthrodesis, interphalangeal joints, with or without internal fixation
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
Bronchoscopy, rigid or flexible, diagnostic with cell washing(s) when performed, with computer-assisted image-guided navigation, including fluoroscopic guidance when performed
No maintenance for this code |
|
| 01/01/2023 |
|
Bronchoscopy, rigid or flexible, with bronchial alveolar lavage(s), with computer-assisted image-guided navigation, including fluoroscopic guidance when performed
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
Percutaneous transluminal coronary angioplasty, single major coronary artery or branch with transcatheter placement of radiation delivery device for subsequent coronary intravascular brachytherapy
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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)
No maintenance for this code |
|
| 01/01/2023 |
|
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)
No maintenance for this code |
|
| 01/01/2023 |
|
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)
No maintenance for this code |
|
| 01/01/2023 |
|
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)
No maintenance for this code |
|
| 01/01/2023 |
|
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)
No maintenance for this code |
|
| 01/01/2023 |
|
Endoscopic retrograde cholangiopancreatography (ercp) with biopsy, single or multiple, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s)
No maintenance for this code |
|
| 01/01/2023 |
|
Endoscopic retrograde cholangiopancreatography (ercp) with sphincterotomy/papillotomy, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s)
No maintenance for this code |
|
| 01/01/2023 |
|
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)
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
Cystourethroscopy, with biopsy(ies) with adjuctive blue light cystoscopy with fluorescent imaging agent
No maintenance for this code |
|
| 01/01/2023 |
|
Excision of major peripheral nerve neuroma, except sciatic, with implantation of nerve end into bone or muscle
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
Cystourethroscopy with adjunctive blue light cystoscopy with fluorescent imaging agent
No maintenance for this code |
|
| 01/01/2023 |
|
Thyroidectomy, total or complete with parathyroid autotransplantation
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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)
No maintenance for this code |
|
| 01/01/2023 |
|
Cocaine hydrochloride nasal solution (goprelto), 1 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Cocaine hydrochloride nasal solution (numbrino), 1 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, bupivacaine (posimir), 1 mg
No maintenance for this code |
|
| 04/01/2023 |
|
Injection, aprepitant, (aponvie), 1 mg | |
| 04/01/2023 |
|
Injection, mirvetuximab soravtansine-gynx, 1 mg | |
| 04/01/2023 |
|
Injection, tremelimumab-actl, 1 mg | |
| 04/01/2023 |
|
Injection, teclistamab-cqyv, 0.5 mg | |
| 04/01/2023 |
|
Injection, teplizumab-mzwv, 5 mcg | |
| 01/01/2023 |
|
Injection, clevidipine butyrate, 1 mg
No maintenance for this code |
|
| 01/01/2023 |
|
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)
No maintenance for this code |
|
E Codes↑ Top | |||
| Effective | Code | Description | |
| 04/01/2023 |
|
Non-pneumatic sequential compression garment, trunk | |
| 04/01/2023 |
|
Upper extremity medical tubing/lines enclosure or covering device, restricts elbow range of motion | |
| 04/01/2023 |
|
Virtual reality cognitive behavioral therapy device (cbt), including pre-programmed therapy software | |
| 01/01/2023 |
|
Adjunctive, non-implanted continuous glucose monitor or receiver
No maintenance for this code |
|
| 01/01/2023 |
|
Non-adjunctive, non-implanted continuous glucose monitor or receiver
No maintenance for this code |
|
G Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2023 |
|
Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)
No maintenance for this code |
|
| 01/01/2023 |
|
Tobacco screening not performed or tobacco cessation intervention not provided during the measurement period or in the six months prior to the measurement period
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
Creation of subcutaneous pocket with insertion of 180 day implantable interstitial glucose sensor, including system activation and patient training
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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)
No maintenance for this code |
|
| 01/01/2023 |
|
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)
No maintenance for this code |
|
| 01/01/2023 |
|
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)
No maintenance for this code |
|
| 01/01/2023 |
|
Home health services furnished using synchronous telemedicine rendered via a real-time two-way audio and video telecommunications system
No maintenance for this code |
|
| 01/01/2023 |
|
Home health services furnished using synchronous telemedicine rendered via telephone or other real-time interactive audio-only telecommunications system
No maintenance for this code |
|
| 01/01/2023 |
|
The collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency (i.e., remote patient monitoring)
No maintenance for this code |
|
| 01/01/2023 |
|
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)
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
Annual alcohol misuse screening, 5 to 15 minutes
No maintenance for this code |
|
| 01/01/2023 |
|
Annual depression screening, 5 to 15 minutes
No maintenance for this code |
|
| 01/01/2023 |
|
Patient care survey was not completed by patient
No maintenance for this code |
|
| 05/12/2023 |
|
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source
Code Discontinued |
|
| 05/12/2023 |
|
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) from an individual in a snf or by a laboratory on behalf of a hha, any specimen source
Code Discontinued |
|
| 01/01/2023 |
|
Documentation of system reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., other system reasons)
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
Residual score for the neck impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
No maintenance for this code |
|
| 01/01/2023 |
|
Residual score for the neck impairment successfully calculated and the score was less than zero (< 0)
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
Patient receiving first-time biologic and/or immune response modifier therapy
No maintenance for this code |
|
| 01/01/2023 |
|
Documentation of medical reason(s) for not screening for unhealthy alcohol use using a systematic screening method (e.g., limited life expectancy, other medical reasons)
No maintenance for this code |
|
| 01/01/2023 |
|
Patient not screened for unhealthy alcohol use using a systematic screening method
No maintenance for this code |
|
| 01/01/2023 |
|
Documentation of medical reason(s) for not providing brief counseling (e.g., limited life expectancy, other medical reasons)
No maintenance for this code |
|
| 01/01/2023 |
|
Patient did not receive brief counseling if identified as an unhealthy alcohol user
No maintenance for this code |
|
| 01/01/2023 |
|
Documentation of medical reason(s) for not providing brief counseling if identified as an unhealthy alcohol user (e.g., limited life expectancy, other medical reasons)
No maintenance for this code |
|
| 01/01/2023 |
|
Patients between 45 and 85 years of age who received a screening colonoscopy during the performance period
No maintenance for this code |
|
| 01/01/2023 |
|
Reason for not administering adjuvant treatment course including both chemotherapy and her2-targeted therapy (e.g. poor performance status (ecog 3-4; karnofsky <=50), cardiac contraindications, insufficient renal function, insufficient hepatic function, other active or secondary cancer diagnoses, other medical contraindications, patients who died during initial treatment course or transferred during or after initial treatment course)
No maintenance for this code |
|
| 01/01/2023 |
|
Residual score for the neck impairment not measured because the patient did not complete the neck fs prom at initial evaluation and/or near discharge, reason not given
No maintenance for this code |
|
| 01/01/2023 |
|
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)
No maintenance for this code |
|
| 01/01/2023 |
|
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.)
No maintenance for this code |
|
| 01/01/2023 |
|
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.)
No maintenance for this code |
|
| 01/01/2023 |
|
Mental/behavioral and psychiatry mips specialty set
No maintenance for this code |
|
| 01/01/2023 |
|
Ophthalmology/optometry mips specialty set
No maintenance for this code |
|
| 01/01/2023 |
|
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)
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
Documentation of a positive functional outcome assessment using a standardized tool; care plan not documented within two days of assessment, reason not given
No maintenance for this code |
|
| 01/01/2023 |
|
Iv thrombolytic therapy initiated within 4.5 hours (<= 270 minutes) of time last known well
No maintenance for this code |
|
| 01/01/2023 |
|
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))
No maintenance for this code |
|
| 01/01/2023 |
|
Iv thrombolytic therapy not initiated within 4.5 hours (<= 270 minutes) of time last known well, reason not given
No maintenance for this code |
|
| 01/01/2023 |
|
Pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed
No maintenance for this code |
|
| 01/01/2023 |
|
Residual score for the knee impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
No maintenance for this code |
|
| 01/01/2023 |
|
Residual score for the knee impairment successfully calculated and the score was less than zero (< 0)
No maintenance for this code |
|
| 01/01/2023 |
|
Residual score for the knee impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given
No maintenance for this code |
|
| 01/01/2023 |
|
Residual score for the hip impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
No maintenance for this code |
|
| 01/01/2023 |
|
Residual score for the hip impairment successfully calculated and the score was less than zero (< 0)
No maintenance for this code |
|
| 01/01/2023 |
|
Residual score for the hip impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given
No maintenance for this code |
|
| 01/01/2023 |
|
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)
No maintenance for this code |
|
| 01/01/2023 |
|
Residual score for the lower leg, foot or ankle impairment successfully calculated and the score was less than zero (< 0)
No maintenance for this code |
|
| 01/01/2023 |
|
Residual score for the lower leg, foot or ankle impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given
No maintenance for this code |
|
| 01/01/2023 |
|
Residual score for the low back impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
No maintenance for this code |
|
| 01/01/2023 |
|
Residual score for the low back impairment successfully calculated and the score was less than zero (< 0)
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
Residual score for the shoulder impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
No maintenance for this code |
|
| 01/01/2023 |
|
Residual score for the shoulder impairment successfully calculated and the score was less than zero (< 0)
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
Residual score for the elbow, wrist or hand impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
No maintenance for this code |
|
| 01/01/2023 |
|
Residual score for the elbow, wrist or hand impairment successfully calculated and the score was less than zero (< 0)
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
Left ventricular ejection fraction (lvef) < = 40% or documentation of moderate or severe lvsd
No maintenance for this code |
|
| 01/01/2023 |
|
Patient not prescribed antibiotic
No maintenance for this code |
|
| 01/01/2023 |
|
Patient prescribed antibiotic
No maintenance for this code |
|
| 01/01/2023 |
|
Prescribed antibiotic on or within 3 days after the episode date
No maintenance for this code |
|
| 01/01/2023 |
|
Elder maltreatment screen documented as negative, follow-up is not required
No maintenance for this code |
|
| 01/01/2023 |
|
Patient discharged to home no later than post-operative day #2 following evar
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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))
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
Positive airway pressure therapy was prescribed
No maintenance for this code |
|
| 01/01/2023 |
|
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)
No maintenance for this code |
|
| 01/01/2023 |
|
Left ventricular ejection fraction (lvef) <= 40% or documentation of moderately or severely depressed left ventricular systolic function
No maintenance for this code |
|
| 01/01/2023 |
|
Left ventricular ejection fraction (lvef) <=40% or documentation of moderately or severely depressed left ventricular systolic function
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
Documentation of medical reason(s) for not prescribing an fda-approved anticoagulant (e.g., present or planned atrial appendage occlusion or ligation)
No maintenance for this code |
|
| 01/01/2023 |
|
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))
No maintenance for this code |
|
| 01/01/2023 |
|
Documentation of order for first or second generation cephalosporin for antimicrobial prophylaxis
No maintenance for this code |
|
| 01/01/2023 |
|
Order for first or second generation cephalosporin for antimicrobial prophylaxis was not documented, reason not given
No maintenance for this code |
|
| 01/01/2023 |
|
Documentation of patient pain brought to a comfortable level within 48 hours from initial assessment
No maintenance for this code |
|
| 01/01/2023 |
|
Documentation of patient with pain not brought to a comfortable level within 48 hours from initial assessment
No maintenance for this code |
|
| 01/01/2023 |
|
Amoxicillin, with or without clavulanate, prescribed as a first line antibiotic at the time of diagnosis
No maintenance for this code |
|
| 01/01/2023 |
|
Documentation of negative or managed positive tb screen with further evidence that tb is not active prior to treatment with a biologic immune response modifier
No maintenance for this code |
|
| 01/01/2023 |
|
No documentation of negative or managed positive tb screen
No maintenance for this code |
|
| 01/01/2023 |
|
Patient did not receive follow-up within 30 days after discharge
No maintenance for this code |
|
| 01/01/2023 |
|
Patient did not receive follow-up within 7 days after discharge
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
Radiation exposure indices documented in final report for procedure using fluoroscopy
No maintenance for this code |
|
| 01/01/2023 |
|
Radiation exposure indices not documented in final report for procedure using fluoroscopy, reason not given
No maintenance for this code |
|
| 01/01/2023 |
|
Biologic immune response modifier prescribed
No maintenance for this code |
|
| 01/01/2023 |
|
Documentation of screening for uterine malignancy or those that had an ultrasound and/or endometrial sampling of any kind
No maintenance for this code |
|
| 01/01/2023 |
|
Patient not screened for uterine malignancy, or those that have not had an ultrasound and/or endometrial sampling of any kind, reason not given
No maintenance for this code |
|
| 01/01/2023 |
|
Documentation of medical reason(s) for not screening for unhealthy alcohol use (e.g., limited life expectancy, other medical reasons)
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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)
No maintenance for this code |
|
| 01/01/2023 |
|
Patient sustained ureter injury at the time of surgery or discovered subsequently up to 30 days post-surgery
No maintenance for this code |
|
| 01/01/2023 |
|
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)
No maintenance for this code |
|
| 01/01/2023 |
|
Patient did not sustain ureter injury at the time of surgery nor discovered subsequently up to 30 days post-surgery
No maintenance for this code |
|
| 01/01/2023 |
|
Previously diagnosed or have a diagnosis of clinical ascvd, including ascvd procedure
No maintenance for this code |
|
| 01/01/2023 |
|
Any ldl-c laboratory result >= 190 mg/dl
No maintenance for this code |
|
| 01/01/2023 |
|
Hospice services for patient provided any time during the measurement period
No maintenance for this code |
|
| 01/01/2023 |
|
Patients who have had a hysterectomy
No maintenance for this code |
|
| 01/01/2023 |
|
Patients who have a diagnosis of pregnancy at any time during the measurement period
No maintenance for this code |
|
| 01/01/2023 |
|
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)
No maintenance for this code |
|
| 01/01/2023 |
|
Blood pressure recorded during inpatient stays, emergency room visits, or urgent care visits
No maintenance for this code |
|
| 01/01/2023 |
|
Any patients who had no asthma controller medications dispensed during the measurement year
No maintenance for this code |
|
| 01/01/2023 |
|
Patients who use hospice services any time during the measurement period
No maintenance for this code |
|
| 01/01/2023 |
|
Patient achieved a pdc of at least 75% for their asthma controller medication
No maintenance for this code |
|
| 01/01/2023 |
|
Patient did not achieve a pdc of at least 75% for their asthma controller medication
No maintenance for this code |
|
| 01/01/2023 |
|
Patient received systemic cancer-directed therapy in the last 14 days of life
No maintenance for this code |
|
| 01/01/2023 |
|
Patient did not receive systemic cancer-directed therapy in the last 14 days of life
No maintenance for this code |
|
| 01/01/2023 |
|
Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)
No maintenance for this code |
|
| 01/01/2023 |
|
Patient not screened for tobacco use
No maintenance for this code |
|
| 01/01/2023 |
|
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)
No maintenance for this code |
|
| 01/01/2023 |
|
Documentation of medical reason(s) for not providing tobacco cessation intervention on the date of the encounter or within the previous 12 months (e.g., limited life expectancy, other medical reason)
No maintenance for this code |
|
| 01/01/2023 |
|
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)
No maintenance for this code |
|
| 01/01/2023 |
|
Documentation of medical reason(s) for not providing tobacco cessation intervention on the date of the encounter or within the previous 12 months if identified as a tobacco user (e.g., limited life expectancy, other medical reason)
No maintenance for this code |
|
| 01/01/2023 |
|
Hepatitis b virus (hbv) status not assessed and results interpreted prior to initiating anti-tnf (tumor necrosis factor) therapy, reason not otherwise specified
No maintenance for this code |
|
| 01/01/2023 |
|
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)
No maintenance for this code |
|
| 01/01/2023 |
|
Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminectomy
No maintenance for this code |
|
| 01/01/2023 |
|
Back pain was not measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively
No maintenance for this code |
|
| 01/01/2023 |
|
Back pain was not measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively
No maintenance for this code |
|
| 01/01/2023 |
|
Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminectomy
No maintenance for this code |
|
| 01/01/2023 |
|
Leg pain was not measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively
No maintenance for this code |
|
| 01/01/2023 |
|
Patient was referred to another clinician or specialist during the measurement period
No maintenance for this code |
|
| 01/01/2023 |
|
Clinician who referred the patient to another clinician received a report from the clinician to whom the patient was referred
No maintenance for this code |
|
| 01/01/2023 |
|
Clinician who referred the patient to another clinician did not receive a report from the clinician to whom the patient was referred
No maintenance for this code |
|
| 01/01/2023 |
|
Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., adverse reaction to vaccine)
No maintenance for this code |
|
| 01/01/2023 |
|
Patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 60th birthday and before the end of the measurement period
No maintenance for this code |
|
| 01/01/2023 |
|
Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 60th birthday and before the end of the measurement period
No maintenance for this code |
|
| 01/01/2023 |
|
Patient was provided palliative care services any time during the measurement period
No maintenance for this code |
|
J Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2023 |
|
Injection, acetaminophen, not otherwise specified,10 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, acetaminophen (fresenius kabi) not therapeutically equivalent to j0131, 10 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, acetaminophen (b braun) not therapeutically equivalent to j0131, 10 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, epinephrine (belcher) not therapeutically equivalent to j0171, 0.1 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, amifostine, 500 mg
No maintenance for this code |
|
| 04/01/2023 |
|
Injection, sodium thiosulfate, 100 mg | |
| 04/01/2023 |
|
Injection, olipudase alfa-rpcp, 1 mg | |
| 01/01/2023 |
|
Injection, vutrisiran, 1 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, amiodarone hydrochloride (nexterone), 30 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, aripiprazole, intramuscular, 0.25 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, dimercaprol, per 100 mg
No maintenance for this code |
|
| 04/01/2023 |
|
Injection, calcium gluconate (fresenius kabi), per 10 ml
Code Discontinued |
|
| 04/01/2023 |
|
Injection, calcium gluconate (wg critical care), per 10 ml
Code Discontinued |
|
| 04/01/2023 |
|
Injection, calcium gluconate (fresenius kabi), per 10 mg | |
| 04/01/2023 |
|
Injection, calcium gluconate (wg critical care), per 10 mg | |
| 01/01/2023 |
|
Injection, levoleucovorin, not otherwise specified, 0.5 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, levoleucovorin (khapzory), 0.5 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, cefazolin sodium (baxter), not therapeutically equivalent to j0690, 500 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, lefamulin, 1 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, cefepime hydrochloride (baxter), not therapeutically equivalent to maxipime, 500 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, cefepime hydrochloride (b braun), not therapeutically equivalent to maxipime, 500 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, corticorelin ovine triflutate, 1 microgram
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, daptomycin (hospira), not therapeutically equivalent to j0878, 1 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, epoetin beta, 1 microgram, (for esrd on dialysis)
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, argatroban (accord), not therapeutically equivalent to j0883, 1 mg (for non-esrd use)
No maintenance for this code |
|
| 04/01/2023 |
|
Injection, argatroban (accord), not therapeutically equivalent to j0884, 1 mg (for esrd on dialysis)
Change in administrative data field of procedure or modifier code |
|
| 01/01/2023 |
|
Injection, decitabine (sun pharma) not therapeutically equivalent to j0894, 1 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, decitabine, 1 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, argatroban (auromedics), not therapeutically equivalent to j0883, 1 mg (for non-esrd use)
No maintenance for this code |
|
| 04/01/2023 |
|
Injection, argatroban (auromedics), not therapeutically equivalent to j0884, 1 mg (for esrd on dialysis)
Change in administrative data field of procedure or modifier code |
|
| 01/01/2023 |
|
Injection, dexamethasone 9 percent, intraocular, 1 microgram
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, eptifibatide, 5 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, erythromycin lactobionate, per 500 mg
No maintenance for this code |
|
| 04/01/2023 |
|
Injection, etranacogene dezaparvovec-drlb, per therapeutic dose | |
| 01/01/2023 |
|
Injection, ferric derisomaltose, 10 mg
No maintenance for this code |
|
| 04/01/2023 |
|
Injection, eflapegrastim-xnst, 0.1 mg | |
| 01/01/2023 |
|
Injection, fosaprepitant (teva), not therapeutically equivalent to j1453, 1 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, galsulfase, 1 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, ganciclovir sodium (exela) not therapeutically equivalent to j1570, 500 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, glucagon hydrochloride (fresenius kabi), not therapeutically equivalent to j1610, per 1 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, brexanolone, 1 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, heparin sodium (pfizer), not therapeutically equivalent to j1644, per 1000 units
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, ibandronate sodium, 1 mg
No maintenance for this code |
|
| 04/01/2023 |
|
Injection, spesolimab-sbzo, 1 mg | |
| 01/01/2023 |
|
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)
No maintenance for this code |
|
| 04/01/2023 |
|
Injection, leuprolide acetate for depot suspension (cipla), 7.5 mg
Change in long description of procedure or modifier code |
|
| 01/01/2023 |
|
Injection, linezolid (hospira) not therapeutically equivalent to j2020, 200 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, meropenem (b. braun) not therapeutically equivalent to j2185, 100 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, micafungin sodium (par pharm) not thereapeutically equivalent to j2248, 1 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, midazolam hydrochloride (wg critical care) not therapeutically equivalent to j2250, per 1 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, morphine sulfate (fresenius kabi) not therapeutically equivalent to j2270, up to 10 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, moxifloxacin (fresenius kabi) not therapeutically equivalent to j2280, 100 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, naloxone hydrochloride (zimhi), 1 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, risankizumab-rzaa, intravenous, 1 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, chloroprocaine hydrochloride, per 30 ml
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, chloroprocaine hydrochloride, per 1 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, chloroprocaine hydrochloride (clorotekal), per 1 mg
No maintenance for this code |
|
| 04/01/2023 |
|
Chloroprocaine hcl ophthalmic, 3% gel, 1 mg | |
| 04/01/2023 |
|
Injection, pegfilgrastim, excludes biosimilar, 0.5 mg
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 01/01/2023 |
|
Injection, penicillin g procaine, aqueous, up to 600,000 units
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, pentobarbital sodium, per 50 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, somatropin, 1 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, tigecycline (accord) not therapeutically equivalent to j3243, 1 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, tirofiban hcl, 0.25 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, vancomycin hcl (mylan) not therapeutically equivalent to j3370, 500 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, vancomycin hcl (xellia) not therapeutically equivalent to j3370, 500 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, factor xiii (antihemophilic factor, human), 1 i.u.
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, factor xiii a-subunit, (recombinant), per iu
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, azacitidine, 1 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, bortezomib, 0.1 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, bortezomib, not otherwise specified, 0.1 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, bortezomib, (dr. reddy's), not therapeutically equivalent to j9041, 0.1 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, bortezomib (fresenius kabi), not therapeutically equivalent to j9041, 0.1 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, bortezomib (hospira), not therapeutically equivalent to j9041, 0.1 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, fludarabine phosphate, 50 mg
No maintenance for this code |
|
| 04/01/2023 |
|
Injection, gemcitabine hydrochloride (accord), not therapeutically equivalent to j9201, 200 mg | |
| 01/01/2023 |
|
Leuprolide acetate, per 1 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Histrelin implant (supprelin la), 50 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, mechlorethamine hydrochloride, (nitrogen mustard), 10 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, plicamycin, 2.5 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, olaratumab, 10 mg
No maintenance for this code |
|
| 04/01/2023 |
|
Injection, pemetrexed (hospira) not therapeutically equivalent to j9305, 10 mg | |
| 04/01/2023 |
|
Injection, pemetrexed (accord) not therapeutically equivalent to j9305, 10 mg | |
| 04/01/2023 |
|
Injection, pemetrexed (sandoz), not therapeutically equivalent to j9305, 10 mg | |
| 01/01/2023 |
|
Injection, pemetrexed (teva) not therapeutically equivalent to j9305, 10 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, fulvestrant (teva) not therapeutically equivalent to j9395, 25 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, fulvestrant (fresenius kabi) not therapeutically equivalent to j9395, 25 mg
No maintenance for this code |
|
K Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2023 |
|
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service
No maintenance for this code |
|
| 01/01/2023 |
|
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system
No maintenance for this code |
|
| 04/01/2023 |
|
Electronic positional obstructive sleep apnea treatment, with sensor, includes all components and accessories, any type
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 04/01/2023 |
|
Suction pump, home model, portable or stationary, electric, any type, for use with external urine management system
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers) |
|
| 04/01/2023 |
|
Supplies and accessories for external upper limb tremor stimulator of the peripheral nerves of the wrist
Change in long description of procedure or modifier code |
|
| 04/01/2023 |
|
Molecular diagnostic test reader, nonprescription self-administered and self-collected use, fda approved, authorized or cleared | |
L Codes↑ Top | |||
| Effective | Code | Description | |
| 04/01/2023 |
|
Electrical stimulator supplies (external) for use with implantable neurostimulator, per month | |
M Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2023 |
|
Advancing cancer care mips value pathways
No maintenance for this code |
|
| 01/01/2023 |
|
Optimal care for kidney health mips value pathways
No maintenance for this code |
|
| 01/01/2023 |
|
Optimal care for patients with episodic neurological conditions mips value pathways
No maintenance for this code |
|
| 01/01/2023 |
|
Supportive care for neurodegenerative conditions mips value pathways
No maintenance for this code |
|
| 01/01/2023 |
|
Promoting wellness mips value pathways
No maintenance for this code |
|
| 04/01/2023 |
|
Enhancing oncology model (eom) monthly enhanced oncology services (meos) payment for eom enhanced services | |
| 01/01/2023 |
|
Tb screening performed and results interpreted within twelve months prior to initiation of first-time biologic and/or immune response modifier therapy
No maintenance for this code |
|
| 01/01/2023 |
|
Patient admitted to palliative care services
No maintenance for this code |
|
| 01/01/2023 |
|
Leg pain was not measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively
No maintenance for this code |
|
| 01/01/2023 |
|
Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminotomy
No maintenance for this code |
|
| 01/01/2023 |
|
Left ventricular ejection fraction (lvef) less than or equal to 40% or documentation of moderately or severely depressed left ventricular systolic function
No maintenance for this code |
|
| 01/01/2023 |
|
Patients with a history of heart transplant or with a left ventricular assist device (lvad)
No maintenance for this code |
|
| 01/01/2023 |
|
Patients with a history of heart transplant or with a left ventricular assist device (lvad)
No maintenance for this code |
|
| 01/01/2023 |
|
Patient with diagnosis of osteoporosis on date of encounter
No maintenance for this code |
|
| 01/01/2023 |
|
Hospice services provided to patient any time during the measurement period
No maintenance for this code |
|
| 01/01/2023 |
|
Patient had anaphylaxis due to the pneumococcal vaccine any time during or before the measurement period
No maintenance for this code |
|
| 01/01/2023 |
|
Patient received active chemotherapy any time during the measurement period
No maintenance for this code |
|
| 01/01/2023 |
|
Patient received bone marrow transplant any time during the measurement period
No maintenance for this code |
|
| 01/01/2023 |
|
Patient had history of immunocompromising conditions prior to or during the measurement period
No maintenance for this code |
|
| 01/01/2023 |
|
Hospice services provided to patient any time during the measurement period
No maintenance for this code |
|
| 01/01/2023 |
|
Patient had anaphylaxis due to the meningococcal vaccine any time on or before the patient's 13th birthday
No maintenance for this code |
|
| 01/01/2023 |
|
Patient had anaphylaxis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient's 13th birthday
No maintenance for this code |
|
| 01/01/2023 |
|
Patient had encephalitis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient's 13th birthday
No maintenance for this code |
|
| 01/01/2023 |
|
Patient had anaphylaxis due to the hpv vaccine any time on or before the patient's 13th birthday
No maintenance for this code |
|
| 01/01/2023 |
|
Patients with dementia any time during the patient's history through the end of the measurement period
No maintenance for this code |
|
| 01/01/2023 |
|
Patients who use hospice services any time during the measurement period
No maintenance for this code |
|
| 01/01/2023 |
|
Pathology report for tissue specimens produced from wide local excisions or re-excisions
No maintenance for this code |
|
| 01/01/2023 |
|
In hospice or using hospice services during the measurement period
No maintenance for this code |
|
| 01/01/2023 |
|
Patient received an influenza vaccine on or between july 1 of the year prior to the measurement period and june 30 of the measurement period
No maintenance for this code |
|
| 01/01/2023 |
|
Documentation of medical reason(s) for not administering influenza vaccine (e.g., prior anaphylaxis due to the influenza vaccine)
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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)
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
Patient received at least one dose of the herpes zoster live vaccine or two doses of the herpes zoster recombinant vaccine (at least 28 days apart) anytime on or after the patient's 50th birthday before or during the measurement period
No maintenance for this code |
|
| 01/01/2023 |
|
Documentation of medical reason(s) for not administering zoster vaccine (e.g., prior anaphylaxis due to the zoster vaccine)
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 60th birthday and before the end of the measurement period
No maintenance for this code |
|
| 01/01/2023 |
|
Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., prior anaphylaxis due to the pneumococcal vaccine)
No maintenance for this code |
|
| 01/01/2023 |
|
Patient did not receive any pneumococcal conjugate or polysaccharide vaccine, on or after their 60th birthday and before or during measurement period
No maintenance for this code |
|
| 01/01/2023 |
|
Patients on immune checkpoint inhibitor therapy
No maintenance for this code |
|
| 01/01/2023 |
|
Grade 2 or above diarrhea and/or grade 2 or above colitis
No maintenance for this code |
|
| 01/01/2023 |
|
Patients not eligible due to pre-existing inflammatory bowel disease (ibd) (e.g., ulcerative colitis, crohn's disease)
No maintenance for this code |
|
| 01/01/2023 |
|
Documentation of immune checkpoint inhibitor therapy held and corticosteroids or immunosuppressants prescribed or administered
No maintenance for this code |
|
| 01/01/2023 |
|
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)
No maintenance for this code |
|
| 01/01/2023 |
|
Documentation of immune checkpoint inhibitor therapy not held and/or corticosteroids or immunosuppressants prescribed or administered was not performed, reason not given
No maintenance for this code |
|
| 01/01/2023 |
|
Patients who have an order for or are receiving hospice or palliative care
No maintenance for this code |
|
| 01/01/2023 |
|
Patients with a diagnosis of end stage renal disease (esrd)
No maintenance for this code |
|
| 01/01/2023 |
|
Patients with a diagnosis of chronic kidney disease (ckd) stage 5
No maintenance for this code |
|
| 01/01/2023 |
|
Documentation of a kidney health evaluation defined by an estimated glomerular filtration rate (egfr) and urine albumin-creatinine ratio (uacr) performed
No maintenance for this code |
|
| 01/01/2023 |
|
Documentation of a kidney health evaluation was not performed or defined by an estimated glomerular filtration rate (egfr) and urine albumin-creatinine ratio (uacr)
No maintenance for this code |
|
| 01/01/2023 |
|
Hospice services provided to patient any time during the measurement period
No maintenance for this code |
|
| 01/01/2023 |
|
Patients with an existing diagnosis of squamous cell carcinoma of the esophagus
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
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)
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4
No maintenance for this code |
|
| 01/01/2023 |
|
Itch severity assessment score is reduced by 2 or more points from the initial (index) assessment score to the follow-up visit score
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
Patients receiving rrt
No maintenance for this code |
|
| 01/01/2023 |
|
Ace inhibitor (ace-i) or arb therapy prescribed during the measurement period
No maintenance for this code |
|
| 01/01/2023 |
|
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)
No maintenance for this code |
|
| 01/01/2023 |
|
Documentation of patient reason(s) for not prescribing ace inhibitor or arb therapy during the measurement period, (e.g., patient declined, other patient reasons)
No maintenance for this code |
|
| 01/01/2023 |
|
Ace inhibitor or arb therapy not prescribed during the measurement period, reason not given
No maintenance for this code |
|
| 01/01/2023 |
|
Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4
No maintenance for this code |
|
| 01/01/2023 |
|
Itch severity assessment score is reduced by 2 or more points from the initial (index) assessment score to the follow-up visit score
No maintenance for this code |
|
| 01/01/2023 |
|
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
No maintenance for this code |
|
| 01/01/2023 |
|
Number of patients screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety
No maintenance for this code |
|
| 01/01/2023 |
|
Number of patients not screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety
No maintenance for this code |
|
| 01/01/2023 |
|
At least two orders for high-risk medications from the same drug class, (table 4), without appropriate diagnoses
No maintenance for this code |
|
| 01/01/2023 |
|
At least two orders for high-risk medications from the same drug class, (table 4), not ordered
No maintenance for this code |
|
Q Codes↑ Top | |||
| Effective | Code | Description | |
| 01/01/2023 |
|
Injection, teniposide, 50 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Carepatch, per square centimeter
No maintenance for this code |
|
| 01/01/2023 |
|
Dual layer impax membrane, per square centimeter
No maintenance for this code |
|
| 01/01/2023 |
|
Surgraft tl, per square centimeter
No maintenance for this code |
|
| 01/01/2023 |
|
Cocoon membrane, per square centimeter
No maintenance for this code |
|
| 04/01/2023 |
|
Neostim tl, per square centimeter | |
| 04/01/2023 |
|
Neostim membrane, per square centimeter | |
| 04/01/2023 |
|
Neostim dl, per square centimeter | |
| 04/01/2023 |
|
Surgraft ft, per square centimeter | |
| 04/01/2023 |
|
Surgraft xt, per square centimeter | |
| 04/01/2023 |
|
Complete sl, per square centimeter | |
| 04/01/2023 |
|
Complete ft, per square centimeter | |
| 01/01/2023 |
|
Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram
No maintenance for this code |
|
| 04/01/2023 |
|
Injection, pegfilgrastim-jmdb (fulphila), biosimilar, 0.5 mg
Change in long description of procedure or modifier code |
|
| 04/01/2023 |
|
Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg
Change in long description of procedure or modifier code |
|
| 04/01/2023 |
|
Injection, pegfilgrastim-bmez (ziextenzo), biosimilar, 0.5 mg
Change in long description of procedure or modifier code |
|
| 04/01/2023 |
|
Injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mg
Change in long description of procedure or modifier code |
|
| 01/01/2023 |
|
Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg
No maintenance for this code |
|
| 01/01/2023 |
|
Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg
No maintenance for this code |
|
| 04/01/2023 |
|
Injection, pegfilgrastim-fpgk (stimufend), biosimilar, 0.5 mg | |
| 04/01/2023 |
|
Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg | |
| 04/01/2023 |
|
Injection, bevacizumab-adcd (vegzelma), biosimilar, 10 mg | |
| 04/01/2023 |
|
Injection, pegfilgrastim-pbbk (fylnetra), biosimilar, 0.5 mg | |
S Codes↑ Top | |||
| Effective | Code | Description | |
| 04/01/2023 |
|
Home injectable therapy, palivizumab or other monoclonal antibody for rsv, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
Change in long description of procedure or modifier code |
|
| 04/01/2023 |
|
Home injectable therapy, immunotherapy, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | |
U Codes↑ Top | |||
| Effective | Code | Description | |
| 05/12/2023 |
|
Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r
Code Discontinued |
|
| 05/12/2023 |
|
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by cms-2020-01-r
Code Discontinued |
|
| 05/12/2023 |
|
Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2
Code Discontinued |
|
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