Legend:

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

A Codes

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Effective Code   Description
01/01/2025

A4594

Neuromodulation stimulator system, adjunct to rehabilitation therapy regime, mouthpiece each
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2025

A9615

Injection, pegulicianine, 1 mg

C Codes

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Effective Code   Description
01/01/2025

C1735

Catheter(s), intravascular for renal denervation, radiofrequency, including all single use system components
01/01/2025

C1736

Catheter(s), intravascular for renal denervation, ultrasound, including all single use system components
01/01/2025

C1737

Joint fusion and fixation device(s), sacroiliac and pelvis, including all system components (implantable)
01/01/2025

C1738

Powered, single-use (i.e. disposable) endoscopic ultrasound-guided biopsy device
01/01/2025

C1739

Tissue marker, imaging and non-imaging device (implantable)
01/01/2025

C7558

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
Code Discontinued
01/01/2025

C7562

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 with intraprocedural coronary fractional flow reserve (ffr) with 3d functional mapping of color-coded ffr values for the coronary tree, derived from coronary angiogram data, for real-time review and interpretation of possible atherosclerotic stenosis(es) intervention
01/01/2025

C7563

Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, initial artery and all additional arteries
01/01/2025

C7564

Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance with intravascular ultrasound (noncoronary vessel(s)) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation
01/01/2025

C7565

Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (i.e., open, laparoscopic, robotic), recurrent, including implantation of mesh or other prosthesis when performed, total length of defect(s) less than 3 cm, reducible with removal of total or near total non-infected mesh or other prosthesis at the time of initial or recurrent anterior abdominal hernia repair or parastomal hernia repair
01/01/2025

C8000

Support device, extravascular, for arteriovenous fistula (implantable)
Miscellaneous change (BETOS, type of service)
01/01/2025

C8001

3d anatomical segmentation imaging for preoperative planning, data preparation and transmission, obtained from previous diagnostic computed tomographic or magnetic resonance examination of the same anatomy
01/01/2025

C8002

Preparation of skin cell suspension autograft, automated, including all enzymatic processing and device components (do not report with manual suspension preparation)
01/01/2025

C8003

Implantation of medial knee extraarticular implantable shock absorber spanning the knee joint from distal femur to proximal tibia, open, includes measurements, positioning and adjustments, with imaging guidance (e.g., fluoroscopy)
01/01/2025

C9169

Injection, nogapendekin alfa inbakicept-pmln, for intravesical use, 1 microgram
Code Discontinued
01/01/2025

C9170

Injection, tarlatamab-dlle, 1 mg
Code Discontinued
01/01/2025

C9171

Injection, pegulicianine, 1 mg
Code Discontinued
01/01/2025

C9172

Injection, fidanacogene elaparvovec-dzkt, per therapeutic dose
Code Discontinued
01/01/2025

C9173

Injection, filgrastim-txid (nypozi), biosimilar, 1 microgram
01/01/2025

C9290

Injection, bupivacaine liposome, 1 mg
Code Discontinued
01/01/2025

C9610

Catheter, transluminal drug delivery with or without angioplasty, coronary, non-laser (insertable)
01/01/2025

C9769

Cystourethroscopy, with insertion of temporary prostatic implant/stent with fixation/anchor and incisional struts
Code Discontinued
01/01/2025

C9786

Echocardiography image post processing for computer aided detection of heart failure with preserved ejection fraction, including interpretation and report
Code Discontinued
01/01/2025

C9794

Therapeutic radiology simulation-aided field setting; complex, including acquisition of pet and ct imaging data required for radiopharmaceutical-directed radiation therapy treatment planning (i.e., modeling)
Code Discontinued
01/01/2025

C9795

Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance and real-time positron emissions-based delivery adjustments to 1 or more lesions, entire course not to exceed 5 fractions
Code Discontinued
01/01/2025

C9804

Elastomeric infusion pump (e.g., on-q* pump with bolus), including catheter and all disposable system components, non-opioid medical device (must be a qualifying medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the caa, 2023)
01/01/2025

C9806

Rotary peristaltic infusion pump (e.g., ambit pump), including catheter and all disposable system components, non-opioid medical device (must be a qualifying medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the caa, 2023)
01/01/2025

C9807

Nerve stimulator, percutaneous, peripheral (e.g., sprint peripheral nerve stimulation system), including electrode and all disposable system components, non-opioid medical device (must be a qualifying medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the caa, 2023)
01/01/2025

C9808

Nerve cryoablation probe (e.g., cryoice, cryosphere, cryosphere max, cryoice cryosphere, cryoice cryo2), including probe and all disposable system components, non-opioid medical device (must be a qualifying medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the caa, 2023)
01/01/2025

C9809

Cryoablation needle (e.g., iovera system), including needle/tip and all disposable system components, non-opioid medical device (must be a qualifying medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the caa, 2023)

E Codes

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Effective Code   Description
01/01/2025

E0491

Oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, used in conjunction with the power source and control electronics unit, controlled by hardware remote, 90-day supply
Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
01/01/2025

E1800

Dynamic adjustable elbow extension and flexion device, includes soft interface material
Change in long description of procedure or modifier code
01/01/2025

E1803

Dynamic adjustable elbow extension only device, includes soft interface material
01/01/2025

E1804

Dynamic adjustable elbow flexion only device, includes soft interface material
01/01/2025

E1805

Dynamic adjustable wrist extension and flexion device, includes soft interface material
Change in long description of procedure or modifier code
01/01/2025

E1807

Dynamic adjustable wrist extension only device, includes soft interface material
01/01/2025

E1808

Dynamic adjustable wrist flexion only device, includes soft interface material
01/01/2025

E1810

Dynamic adjustable knee extension and flexion device, includes soft interface material
Change in long description of procedure or modifier code
01/01/2025

E1813

Dynamic adjustable knee extension only device, includes soft interface material
01/01/2025

E1814

Dynamic adjustable knee flexion only device, includes soft interface material
01/01/2025

E1815

Dynamic adjustable ankle extension and flexion device, includes soft interface material
Change in long description of procedure or modifier code
01/01/2025

E1822

Dynamic adjustable ankle extension only device, includes soft interface material
01/01/2025

E1823

Dynamic adjustable ankle flexion only device, includes soft interface material
01/01/2025

E1825

Dynamic adjustable finger extension and flexion device, includes soft interface material
Change in long description of procedure or modifier code
01/01/2025

E1826

Dynamic adjustable finger extension only device, includes soft interface material
01/01/2025

E1827

Dynamic adjustable finger flexion only device, includes soft interface material
01/01/2025

E1828

Dynamic adjustable toe extension only device, includes soft interface material
01/01/2025

E1829

Dynamic adjustable toe flexion only device, includes soft interface material
01/01/2025

E1830

Dynamic adjustable toe extension and flexion device, includes soft interface material
Change in long description of procedure or modifier code

G Codes

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Effective Code   Description
01/01/2025

G0106

Colorectal cancer screening; alternative to g0104, screening sigmoidoscopy, barium enema
Code Discontinued
01/01/2025

G0120

Colorectal cancer screening; alternative to g0105, screening colonoscopy, barium enema.
Code Discontinued
01/01/2025

G0122

Colorectal cancer screening; barium enema
Code Discontinued
01/01/2025

G0532

Take-home supply of nasal nalmefene hydrochloride; one carton of two, 2.7 mg per 0.1 ml nasal sprays (provision of the services by a medicare-enrolled opioid treatment program);( list separately in addition to each primary code)
01/01/2025

G0533

Medication assisted treatment, buprenorphine (injectable) administered on a weekly basis; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)
01/01/2025

G0534

Coordinated care and/or referral services, such as to adequate and accessible community resources to address unmet health-related social needs, including harm reduction interventions and recovery support services a patient needs and wishes to pursue, which significantly limit the ability to diagnose or treat an opioid use disorder; each additional 30 minutes of services (provision of the services by a medicare-enrolled opioid treatment program); (list separately in addition to each primary code)
01/01/2025

G0535

Patient navigational services, provided directly or by referral; including helping the patient to navigate health systems and identify care providers and supportive services, to build patient self-advocacy and communication skills with care providers, and to promote patient-driven action plans and goals; each additional 30 minutes of services (provision of the services by a medicare-enrolled opioid treatment program); (list separately in addition to each primary code)
01/01/2025

G0536

Peer recovery support services, provided directly or by referral; including leveraging knowledge of the condition or lived experience to provide support, mentorship, or inspiration to meet oud treatment and recovery goals; conducting a person-centered interview to understand the patient's life story, strengths, needs, goals, preferences, and desired outcomes; developing and proposing strategies to help meet person-centered treatment goals; assisting the patient in locating or navigating recovery support services; each additional 30 minutes of services (provision of the services by a medicare-enrolled opioid treatment program); (list separately in addition to each primary code)
01/01/2025

G0537

Administration of a standardized, evidence-based atherosclerotic cardiovascular disease (ascvd) risk assessment, 5-15 minutes, not more often than every 12 months
01/01/2025

G0538

Atherosclerotic cardiovascular disease (ascvd) risk management services; clinical staff time; per calendar month
01/01/2025

G0539

Caregiver training in behavior management/modification for caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face-to-face; initial 30 minutes
01/01/2025

G0540

Caregiver training in behavior management/modification for parent(s)/guardian(s)/caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face-to-face; each additional 15 minutes
01/01/2025

G0541

Caregiver training in direct care strategies and techniques to support care for patients with an ongoing condition or illness and to reduce complications (including, but not limited to, techniques to prevent decubitus ulcer formation, wound care, and infection control) (without the patient present), face-to-face; initial 30 minutes
01/01/2025

G0542

Caregiver training in direct care strategies and techniques to support care for patients with an ongoing condition or illness and to reduce complications (including, but not limited to, techniques to prevent decubitus ulcer formation, wound care, and infection control) (without the patient present), face-to-face; each additional 15 minutes (list separately in addition to code for primary service) (use g0542 in conjunction with g0541)
01/01/2025

G0543

Group caregiver training in direct care strategies and techniques to support care for patients with an ongoing condition or illness and to reduce complications (including, but not limited to, techniques to prevent decubitus ulcer formation, wound care, and infection control) (without the patient present), face-to-face with multiple sets of caregivers
01/01/2025

G0544

Post discharge telephonic follow-up contacts performed in conjunction with a discharge from the emergency department for behavioral health or other crisis encounter, 4 calls per calendar month
01/01/2025

G0545

Visit complexity inherent to hospital inpatient or observation care associated with a confirmed or suspected infectious disease by an infectious diseases specialist, including disease transmission risk assessment and mitigation, public health investigation, analysis, and testing, and complex antimicrobial therapy counseling and treatment (add-on code, list separately in addition to hospital inpatient or observation evaluation and management visit, initial, same day discharge, subsequent or discharge)
01/01/2025

G0546

Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, including a verbal and written report to the patient's treating/requesting practitioner; 5-10 minutes of medical consultative discussion and review
01/01/2025

G0547

Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, including a verbal and written report to the patient's treating/requesting practitioner; 11-20 minutes of medical consultative discussion and review
01/01/2025

G0548

Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, including a verbal and written report to the patient's treating/requesting practitioner; 21-30 minutes of medical consultative discussion and review
01/01/2025

G0549

Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, including a verbal and written report to the patient's treating/requesting practitioner; 31 or more minutes of medical consultative discussion and review
01/01/2025

G0550

Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, including a written report to the patient's treating/requesting practitioner, 5 minutes or more of medical consultative time
01/01/2025

G0551

Interprofessional telephone/internet/electronic health record referral service(s) provided by a treating/requesting practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, 30 minutes
01/01/2025

G0552

Supply of digital mental health treatment device and initial education and onboarding, per course of treatment that augments a behavioral therapy plan
01/01/2025

G0553

First 20 minutes of monthly treatment management services directly related to the patient's therapeutic use of the digital mental health treatment (dmht) device that augments a behavioral therapy plan, physician/other qualified health care professional time reviewing information related to the use of the dmht device, including patient observations and patient specific inputs in a calendar month and requiring at least one interactive communication with the patient/caregiver during the calendar month
01/01/2025

G0554

Each additional 20 minutes of monthly treatment management services directly related to the patient's therapeutic use of the digital mental health treatment (dmht) device that augments a behavioral therapy plan, physician/other qualified health care professional time reviewing data generated from the dmht device from patient observations and patient specific inputs in a calendar month and requiring at least one interactive communication with the patient/caregiver during the calendar month
01/01/2025

G0555

Provision of replacement patient electronics system (e.g., system pillow, handheld reader) for home pulmonary artery pressure monitoring
01/01/2025

G0556

Advanced primary care management services for a patient with one chronic condition [expected to last at least 12 months, or until the death of the patient, which place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline], or fewer, provided by clinical staff and directed by a physician or other qualified health care professional who is responsible for all primary care and serves as the continuing focal point for all needed health care services, per calendar month, with the following elements, as appropriate: consent; ++ inform the patient of the availability of the service; that only one practitioner can furnish and be paid for the service during a calendar month; of the right to stop the services at any time (effective at the end of the calendar month); and that cost sharing may apply. ++ document in patient's medical record that consent was obtained. initiation during a qualifying visit for new patients or patients not seen within 3 years; provide 24/7 access for urgent needs to care team/practitioner, including providing patients/caregivers with a way to contact health care professionals in the practice to discuss urgent needs regardless of the time of day or day of week; continuity of care with a designated member of the care team with whom the patient is able to schedule successive routine appointments; deliver care in alternative ways to traditional office visits to best meet the patient's needs, such as home visits and/or expanded hours; overall comprehensive care management; ++ systematic needs assessment (medical and psychosocial). ++ system-based approaches to ensure receipt of preventive services. ++ medication reconciliation, management and oversight of self-management. development, implementation, revision, and maintenance of an electronic patient-centered comprehensive care plan with typical care plan elements when clinically relevant; ++ care plan is available timely within and outside the billing practice as appropriate to individuals involved in the beneficiary's care, can be routinely accessed and updated by care team/practitioner, and copy of care plan to patient/caregiver; coordination of care transitions between and among health care providers and settings, including referrals to other clinicians and follow-up after an emergency department visit and discharges from hospitals, skilled nursing facilities or other health care facilities as applicable; ++ ensure timely exchange of electronic health information with other practitioners and providers to support continuity of care. ++ ensure timely follow-up communication (direct contact, telephone, electronic) with the patient and/or caregiver after an emergency department visit and discharges from hospitals, skilled nursing facilities, or other health care facilities, within 7 calendar days of discharge, as clinically indicated. ongoing communication and coordinating receipt of needed services from practitioners, home- and community-based service providers, community-based social service providers, hospitals, and skilled nursing facilities (or other health care facilities), and document communication regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors, in the patient's medical record; enhanced opportunities for the beneficiary and any caregiver to communicate with the care team/practitioner regarding the beneficiary's care through the use of asynchronous non-face-to-face consultation methods other than telephone, such as secure messaging, email, internet, or patient portal, and other communication-technology based services, including remote evaluation of pre-recorded patient information and interprofessional telephone/internet/ehr referral service(s), to maintain ongoing communication with patients, as appropriate; ++ ensure access to patient-initiated digital communications that require a clinical decision, such as virtual check-ins and digital online assessment and management and e/m visits (or e-visits). analyze patient population data to identify gaps in care and offer additional interventions, as appropriate; risk stratify the practice population based on defined diagnoses, claims, or other electronic data to identify and target services to patients; be assessed through performance measurement of primary care quality, total cost of care, and meaningful use of certified ehr technology
01/01/2025

G0557

Advanced primary care management services for a patient with multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, which place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, provided by clinical staff and directed by a physician or other qualified health care professional who is responsible for all primary care and serves as the continuing focal point for all needed health care services, per calendar month, with the following elements, as appropriate: consent; ++ inform the patient of the availability of the service; that only one practitioner can furnish and be paid for the service during a calendar month; of the right to stop the services at any time (effective at the end of the calendar month); and that cost sharing may apply. ++ document in patient's medical record that consent was obtained. initiation during a qualifying visit for new patients or patients not seen within 3 years; provide 24/7 access for urgent needs to care team/practitioner, including providing patients/caregivers with a way to contact health care professionals in the practice to discuss urgent needs regardless of the time of day or day of week; continuity of care with a designated member of the care team with whom the patient is able to schedule successive routine appointments; deliver care in alternative ways to traditional office visits to best meet the patient's needs, such as home visits and/or expanded hours; overall comprehensive care management; ++ systematic needs assessment (medical and psychosocial). ++ system-based approaches to ensure receipt of preventive services. ++ medication reconciliation, management and oversight of self-management. development, implementation, revision, and maintenance of an electronic patient-centered comprehensive care plan; ++ care plan is available timely within and outside the billing practice as appropriate to individuals involved in the beneficiary's care, can be routinely accessed and updated by care team/practitioner, and copy of care plan to patient/caregiver; coordination of care transitions between and among health care providers and settings, including referrals to other clinicians and follow-up after an emergency department visit and discharges from hospitals, skilled nursing facilities or other health care facilities as applicable; ++ ensure timely exchange of electronic health information with other practitioners and providers to support continuity of care. ++ ensure timely follow-up communication (direct contact, telephone, electronic) with the patient and/or caregiver after an emergency department visit and discharges from hospitals, skilled nursing facilities, or other health care facilities, within 7 calendar days of discharge, as clinically indicated. ongoing communication and coordinating receipt of needed services from practitioners, home- and community-based service providers, community-based social service providers, hospitals, and skilled nursing facilities (or other health care facilities), and document communication regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors, in the patient's medical record; enhanced opportunities for the beneficiary and any caregiver to communicate with the care team/practitioner regarding the beneficiary's care through the use of asynchronous non-face-to-face consultation methods other than telephone, such as secure messaging, email, internet, or patient portal, and other communication-technology based services, including remote evaluation of pre-recorded patient information and interprofessional telephone/internet/ehr referral service(s), to maintain ongoing communication with patients, as appropriate; ++ ensure access to patient-initiated digital communications that require a clinical decision, such as virtual check-ins and digital online assessment and management and e/m visits (or e-visits). analyze patient population data to identify gaps in care and offer additional interventions, as appropriate; risk stratify the practice population based on defined diagnoses, claims, or other electronic data to identify and target services to patients; be assessed through performance measurement of primary care quality, total cost of care, and meaningful use of certified ehr technology
01/01/2025

G0558

Advanced primary care management services for a patient that is a qualified medicare beneficiary with multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, which place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, provided by clinical staff and directed by a physician or other qualified health care professional who is responsible for all primary care and serves as the continuing focal point for all needed health care services, per calendar month, with the following elements, as appropriate: consent; ++ inform the patient of the availability of the service; that only one practitioner can furnish and be paid for the service during a calendar month; of the right to stop the services at any time (effective at the end of the calendar month); and that cost sharing may apply. ++ document in patient's medical record that consent was obtained. initiation during a qualifying visit for new patients or patients not seen within 3 years; provide 24/7 access for urgent needs to care team/practitioner, including providing patients/caregivers with a way to contact health care professionals in the practice to discuss urgent needs regardless of the time of day or day of week; continuity of care with a designated member of the care team with whom the patient is able to schedule successive routine appointments; deliver care in alternative ways to traditional office visits to best meet the patient's needs, such as home visits and/or expanded hours; overall comprehensive care management; ++ systematic needs assessment (medical and psychosocial). ++ system-based approaches to ensure receipt of preventive services. ++ medication reconciliation, management and oversight of self-management. development, implementation, revision, and maintenance of an electronic patient-centered comprehensive care plan; ++ care plan is available timely within and outside the billing practice as appropriate to individuals involved in the beneficiary's care, can be routinely accessed and updated by care team/practitioner, and copy of care plan to patient/caregiver; coordination of care transitions between and among health care providers and settings, including referrals to other clinicians and follow-up after an emergency department visit and discharges from hospitals, skilled nursing facilities or other health care facilities as applicable; ++ ensure timely exchange of electronic health information with other practitioners and providers to support continuity of care. ++ ensure timely follow-up communication (direct contact, telephone, electronic) with the patient and/or caregiver after an emergency department visit and discharges from hospitals, skilled nursing facilities, or other health care facilities, within 7 calendar days of discharge, as clinically indicated. ongoing communication and coordinating receipt of needed services from practitioners, home- and community-based service providers, community-based social service providers, hospitals, and skilled nursing facilities (or other health care facilities), and document communication regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors, in the patient's medical record; enhanced opportunities for the beneficiary and any caregiver to communicate with the care team/practitioner regarding the beneficiary's care through the use of asynchronous non-face-to-face consultation methods other than telephone, such as secure messaging, email, internet, or patient portal, and other communication-technology based services, including remote evaluation of pre-recorded patient information and interprofessional telephone/internet/ehr referral service(s), to maintain ongoing communication with patients, as appropriate; ++ ensure access to patient-initiated digital communications that require a clinical decision, such as virtual check-ins and digital online assessment and management and e/m visits (or e-visits). analyze patient population data to identify gaps in care and offer additional interventions, as appropriate; risk stratify the practice population based on defined diagnoses, claims, or other electronic data to identify and target services to patients; be assessed through performance measurement of primary care quality, total cost of care, and meaningful use of certified ehr technology
01/01/2025

G0559

Post-operative follow-up visit complexity inherent to evaluation and management services addressing surgical procedure(s), provided by a physician or qualified health care professional who is not the practitioner who performed the procedure (or in the same group practice) and is of the same or of a different specialty than the practitioner who performed the procedure, within the 90-day global period of the procedure(s), once per 90-day global period, when there has not been a formal transfer of care and requires the following required elements, when possible and applicable: reading available surgical note to understand the relative success of the procedure, the anatomy that was affected, and potential complications that could have arisen due to the unique circumstances of the patient's operation. research the procedure to determine expected post-operative course and potential complications (in the case of doing a post-op for a procedure outside the specialty). evaluate and physically examine the patient to determine whether the post-operative course is progressing appropriately. communicate with the practitioner who performed the procedure if any questions or concerns arise. (list separately in addition to office/outpatient evaluation and management visit, new or established)
01/01/2025

G0560

Safety planning interventions, each 20 minutes personally performed by the billing practitioner, including assisting the patient in the identification of the following personalized elements of a safety plan: recognizing warning signs of an impending suicidal or substance use-related crisis; employing internal coping strategies; utilizing social contacts and social settings as a means of distraction from suicidal thoughts or risky substance use; utilizing family members, significant others, caregivers, and/or friends to help resolve the crisis; contacting mental health or substance use disorder professionals or agencies; and making the environment safe
01/01/2025

G0561

Tympanostomy with local or topical anesthesia and insertion of a ventilating tube when performed with tympanostomy tube delivery device, unilateral (list separately in addition to 69433) (do not use in conjunction with 0583t)
01/01/2025

G0562

Therapeutic radiology simulation-aided field setting; complex, including acquisition of pet and ct imaging data required for radiopharmaceutical-directed radiation therapy treatment planning (i.e., modeling)
01/01/2025

G0563

Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance and real-time positron emissions-based delivery adjustments to 1 or more lesions, entire course not to exceed 5 fractions
01/01/2025

G0564

Creation of subcutaneous pocket with insertion of 365 day implantable interstitial glucose sensor, including system activation and patient training
01/01/2025

G0565

Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and insertion of new 365 day implantable sensor, including system activation
01/01/2025

G1001

Clinical decision support mechanism evicore, as defined by the medicare appropriate use criteria program
Code Discontinued
01/01/2025

G1002

Clinical decision support mechanism medcurrent, as defined by the medicare appropriate use criteria program
Code Discontinued
01/01/2025

G1003

Clinical decision support mechanism medicalis, as defined by the medicare appropriate use criteria program
Code Discontinued
01/01/2025

G1004

Clinical decision support mechanism national decision support company, as defined by the medicare appropriate use criteria program
Code Discontinued
01/01/2025

G1007

Clinical decision support mechanism aim specialty health, as defined by the medicare appropriate use criteria program
Code Discontinued
01/01/2025

G1008

Clinical decision support mechanism cranberry peak, as defined by the medicare appropriate use criteria program
Code Discontinued
01/01/2025

G1010

Clinical decision support mechanism stanson, as defined by the medicare appropriate use criteria program
Code Discontinued
01/01/2025

G1011

Clinical decision support mechanism, qualified tool not otherwise specified, as defined by the medicare appropriate use criteria program
Code Discontinued
01/01/2025

G1012

Clinical decision support mechanism agilemd, as defined by the medicare appropriate use criteria program
Code Discontinued
01/01/2025

G1013

Clinical decision support mechanism evidencecare imagingcare, as defined by the medicare appropriate use criteria program
Code Discontinued
01/01/2025

G1014

Clinical decision support mechanism inveniqa semantic answers in medicine, as defined by the medicare appropriate use criteria program
Code Discontinued
01/01/2025

G1015

Clinical decision support mechanism reliant medical group, as defined by the medicare appropriate use criteria program
Code Discontinued
01/01/2025

G1016

Clinical decision support mechanism speed of care, as defined by the medicare appropriate use criteria program
Code Discontinued
01/01/2025

G1017

Clinical decision support mechanism healthhelp, as defined by the medicare appropriate use criteria program
Code Discontinued
01/01/2025

G1018

Clinical decision support mechanism infinx, as defined by the medicare appropriate use criteria program
Code Discontinued
01/01/2025

G1019

Clinical decision support mechanism logicnets, as defined by the medicare appropriate use criteria program
Code Discontinued
01/01/2025

G1020

Clinical decision support mechanism curbside clinical augmented workflow, as defined by the medicare appropriate use criteria program
Code Discontinued
01/01/2025

G1021

Clinical decision support mechanism ehealthline clinical decision support mechanism, as defined by the medicare appropriate use criteria program
Code Discontinued
01/01/2025

G1022

Clinical decision support mechanism intermountain clinical decision support mechanism, as defined by the medicare appropriate use criteria program
Code Discontinued
01/01/2025

G1023

Clinical decision support mechanism persivia clinical decision support, as defined by the medicare appropriate use criteria program
Code Discontinued
01/01/2025

G1024

Clinical decision support mechanism radrite, as defined by the medicare appropriate use criteria program
Code Discontinued
01/01/2025

G2012

Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
Code Discontinued
01/01/2025

G2069

Medication assisted treatment, buprenorphine (injectable) administered on a monthly basis; bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)
Change in long description of procedure or modifier code
01/01/2025

G2070

Medication assisted treatment, buprenorphine (implant insertion); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)
Code Discontinued
01/01/2025

G2071

Medication assisted treatment, buprenorphine (implant removal); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)
Code Discontinued
01/01/2025

G2072

Medication assisted treatment, buprenorphine (implant insertion and removal); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)
Code Discontinued
01/01/2025

G2076

Intake activities, including initial medical examination that is conducted by an appropriately licensed practitioner and preparation of a care plan, which may be informed by administration of a standardized, evidence-based social determinants of health risk assessment to identify unmet health-related social needs, and that includes the patient's goals and mutually agreed-upon actions for the patient to meet those goals, including harm reduction interventions; the patient's needs and goals in the areas of education, vocational training, and employment; and the medical and psychiatric, psychosocial, economic, legal, housing, and other recovery support services that a patient needs and wishes to pursue, conducted by an appropriately licensed/credentialed personnel (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to each primary code
Change in long description of procedure or modifier code
01/01/2025

G2077

Periodic assessment; assessing periodically by an otp practitioner and includes a review of moud dosing, treatment response, other substance use disorder treatment needs, responses and patient-identified goals, and other relevant physical and psychiatric treatment needs and goals; assessment may be informed by administration of a standardized, evidence-based social determinants of health risk assessment to identify unmet health-related social needs, or the need and interest for harm reduction interventions and recovery support services (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to each primary code
Change in long description of procedure or modifier code
01/01/2025

G2091

Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period
Change in long description of procedure or modifier code
01/01/2025

G2099

Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period
Change in long description of procedure or modifier code
01/01/2025

G2101

Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period
Change in long description of procedure or modifier code
01/01/2025

G2107

Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period
Change in long description of procedure or modifier code
01/01/2025

G2116

Patients 66 - 80 years of age with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period
Change in long description of procedure or modifier code
01/01/2025

G2126

Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period
Change in long description of procedure or modifier code
01/01/2025

G8482

Influenza immunization administered or previously received
Code Discontinued
01/01/2025

G8483

Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons)
Code Discontinued
01/01/2025

G8484

Influenza immunization was not administered, reason not given
Code Discontinued
01/01/2025

G8577

Re-exploration required due to mediastinal bleeding with or without tamponade, unplanned coronary artery intervention (native, vessel, graft, or both), valve dysfunction, aortic reintervention, or other cardiac reason
Change in long description of procedure or modifier code
01/01/2025

G8578

Re-exploration not required due to mediastinal bleeding with or without tamponade, unplanned coronary artery intervention (native, vessel, graft, or both), valve dysfunction, aortic reintervention, or other cardiac reason
Change in long description of procedure or modifier code
01/01/2025

G8694

Current or prior left ventricular ejection fraction (lvef) < = 40% or documentation of moderate or severe lvsd
Change in long description of procedure or modifier code
01/01/2025

G8842

Apnea hypopnea index (ahi), respiratory disturbance index (rdi) or respiratory event index (rei) documented or measured within 2 months after initial evaluation for suspected obstructive sleep apnea
Change in long description of procedure or modifier code
01/01/2025

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 after 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 previously diagnosed with osa and severity assessed by another provider, 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
01/01/2025

G8844

Apnea hypopnea index (ahi), respiratory disturbance index (rdi), or respiratory event index (rei) not documented or measured within 2 months after initial evaluation for suspected obstructive sleep apnea, reason not given
Change in long description of procedure or modifier code
01/01/2025

G8923

Current or prior 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
01/01/2025

G8934

Current or prior 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
01/01/2025

G8965

Cardiac stress imaging test primarily performed on low chd risk patient for initial detection and risk assessment
Code Discontinued
01/01/2025

G8966

Cardiac stress imaging test performed on symptomatic or higher than low chd risk patient or for any reason other than initial detection and risk assessment
Code Discontinued
01/01/2025

G9246

Patient did not have two eligible encounters at least 90 days apart or one eligible encounter and one hiv viral load test at least 90 days apart
Change in long description of procedure or modifier code
01/01/2025

G9247

Patient had two eligible encounters at least 90 days apart or one eligible encounter and one hiv viral load test at least 90 days apart
Change in long description of procedure or modifier code
01/01/2025

G9254

Documentation of patient discharged to home later than post-operative day 2 following cea or cas
Change in long description of procedure or modifier code
01/01/2025

G9255

Documentation of patient discharged to home no later than post operative day 2 following cea or cas
Change in long description of procedure or modifier code
01/01/2025

G9321

Count of previous ct (any type of ct) and cardiac nuclear medicine (myocardial perfusion or infarct avid imaging) studies documented in the 12-month period prior to the current study
Change in long description of procedure or modifier code
01/01/2025

G9322

Count of previous ct and cardiac nuclear medicine (myocardial perfusion or infarct avid imaging) studies not documented in the 12-month period prior to the current study, reason not given
Change in long description of procedure or modifier code
01/01/2025

G9402

Patient received follow-up within 30 days after discharge
Code Discontinued
01/01/2025

G9403

Clinician documented reason patient was not able to complete 30 day follow-up from acute inpatient setting discharge (e.g., patient death prior to follow-up visit, patient non-compliant for visit follow-up)
Code Discontinued
01/01/2025

G9404

Patient did not receive follow-up within 30 days after discharge
Code Discontinued
01/01/2025

G9405

Patient received follow-up within 7 days after discharge
Code Discontinued
01/01/2025

G9406

Clinician documented reason patient was not able to complete 7 day follow-up from acute inpatient setting discharge (i.e patient death prior to follow-up visit, patient non-compliance for visit follow-up)
Code Discontinued
01/01/2025

G9407

Patient did not receive follow-up within 7 days after discharge
Code Discontinued
01/01/2025

G9458

Patient documented as tobacco user and received tobacco cessation intervention (must include at least one of the following: advice given to quit smoking or tobacco use, counseling on the benefits of quitting smoking or tobacco use, assistance with or referral to external smoking or tobacco cessation support programs, or current enrollment in smoking or tobacco use cessation program) if identified as a tobacco user
Code Discontinued
01/01/2025

G9459

Currently a tobacco non-user
Code Discontinued
01/01/2025

G9460

Tobacco assessment or tobacco cessation intervention not performed, reason not given
Code Discontinued
01/01/2025

G9659

Patients greater than or equal to 86 years of age who underwent a screening colonoscopy and did not have a history of colorectal cancer or other valid medical reason for the colonoscopy, including: iron deficiency anemia, lower gastrointestinal bleeding, familial adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease (i.e., crohn's disease or ulcerative colitis), abnormal finding of gastrointestinal tract, weight loss, or changes in bowel habits
Change in long description of procedure or modifier code
01/01/2025

G9660

Documentation of medical reason(s) for a colonoscopy performed on a patient greater than or equal to 86 years of age (e.g., iron deficiency anemia, lower gastrointestinal bleeding, familial history of adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease (i.e., crohn's disease or ulcerative colitis), abnormal finding of gastrointestinal tract, weight loss, or changes in bowel habits)
Change in long description of procedure or modifier code
01/01/2025

G9707

Patient received hospice services any time during the measurement period
Code Discontinued
01/01/2025

G9751

Patient died at any time during the 24-month measurement period
Code Discontinued
01/01/2025

G9760

Patients who use hospice services any time during the measurement period
Code Discontinued
01/01/2025

G9892

Documentation of patient reason(s) for not performing a dilated macular examination
Code Discontinued
01/01/2025

G9893

Dilated macular exam was not performed, reason not otherwise specified
Code Discontinued
01/01/2025

G9921

No screening performed, partial screening performed or positive screen without recommendations and reason is not given or otherwise specified
Code Discontinued
01/01/2025

G9974

Dilated macular exam performed, including documentation of the presence or absence of macular thickening or geographic atrophy or hemorrhage and the level of macular degeneration severity
Code Discontinued
01/01/2025

G9975

Documentation of medical reason(s) for not performing a dilated macular examination
Code Discontinued
01/01/2025

G9990

Patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period
Code Discontinued
01/01/2025

G9991

Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period
Code Discontinued
01/01/2025

G9999

Documentation of system reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., unable to locate previous colonoscopy report, patient cannot provide precise date or details from previous colonoscopy, previous colonoscopy report was incomplete)
Change in long description of procedure or modifier code

H Codes

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Effective Code   Description
01/01/2025

H0052

Missing and murdered indigenous persons (mmip) mental health and clinical care
01/01/2025

H0053

Historical trauma (ht) mental health and clinical care for indigenous persons

J Codes

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Effective Code   Description
01/01/2025

J0135

Injection, adalimumab, 20 mg
Code Discontinued
01/01/2025

J0138

Injection, acetaminophen 10 mg and ibuprofen 3 mg
Change in short description of procedure code
01/01/2025

J0139

Injection, adalimumab, 1 mg
01/01/2025

J0570

Buprenorphine implant, 74.2 mg
Code Discontinued
01/01/2025

J0601

Sevelamer carbonate (renvela or therapeutically equivalent), oral, 20 mg (for esrd on dialysis)
01/01/2025

J0602

Sevelamer carbonate (renvela or therapeutically equivalent), oral, powder, 20 mg (for esrd on dialysis)
01/01/2025

J0603

Sevelamer hydrochloride (renagel or therapeutically equivalent), oral, 20 mg (for esrd on dialysis)
01/01/2025

J0605

Sucroferric oxyhydroxide, oral, 5 mg (for esrd on dialysis)
01/01/2025

J0607

Lanthanum carbonate, oral, 5 mg (for esrd on dialysis)
01/01/2025

J0608

Lanthanum carbonate, oral, powder, 5 mg, not therapeutically equivalent to j0607 (for esrd on dialysis)
01/01/2025

J0609

Ferric citrate, oral, 3 mg ferric iron, (for esrd on dialysis)
01/01/2025

J0615

Calcium acetate, oral, 23 mg (for esrd on dialysis)
01/01/2025

J0666

Injection, bupivacaine liposome, 1 mg
01/01/2025

J0870

Injection, imetelstat, 1 mg
01/01/2025

J0901

Vadadustat, oral, 1 mg (for esrd on dialysis)
01/01/2025

J1307

Injection, crovalimab-akkz, 10 mg
01/01/2025

J1414

Injection, fidanacogene elaparvovec-dzkt, per therapeutic dose
01/01/2025

J1552

Injection, immune globulin (alyglo), 500 mg
01/01/2025

J2290

Injection, nafcillin sodium, 20 mg
01/01/2025

J2468

Injection, palonosetron hydrochloride (posfrea), 25 micrograms
Change in long description of procedure or modifier code
01/01/2025

J2472

Injection, pantoprazole sodium in sodium chloride (baxter), 40 mg
01/01/2025

J2796

Injection, romiplostim, 10 micrograms
Code Discontinued
01/01/2025

J2802

Injection, romiplostim, 1 microgram
01/01/2025

J2806

Injection, sincalide (maia), not therapeutically equivalent to j2805, 5 micrograms
Code Discontinued
01/01/2025

J3392

Injection, exagamglogene autotemcel, per treatment
01/01/2025

J7514

Mycophenolate mofetil (myhibbin), oral suspension, 100 mg
01/01/2025

J7601

Ensifentrine, inhalation suspension, fda approved final product, non-compounded, administered through dme, unit dose form, 3 mg
01/01/2025

J9026

Injection, tarlatamab-dlle, 1 mg
01/01/2025

J9028

Injection, nogapendekin alfa inbakicept-pmln, for intravesical use, 1 microgram
01/01/2025

J9033

Injection, bendamustine hydrochloride, 1 mg
Change in long description of procedure or modifier code
01/01/2025

J9056

Injection, bendamustine hydrochloride (vivimusta), 1 mg
Change in short description of procedure code
01/01/2025

J9058

Injection, bendamustine hydrochloride (apotex), 1 mg
Code Discontinued
01/01/2025

J9059

Injection, bendamustine hydrochloride (baxter), 1 mg
Code Discontinued
01/01/2025

J9072

Injection, cyclophosphamide (avyxa), 5 mg
Change in long description of procedure or modifier code
01/01/2025

J9076

Injection, cyclophosphamide (baxter), 5 mg
01/01/2025

J9259

Injection, paclitaxel protein-bound particles (american regent), not therapeutically equivalent to j9264, 1 mg
Code Discontinued
01/01/2025

J9292

Injection, pemetrexed (avyxa), not therapeutically equivalent to j9305, 10 mg

M Codes

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Effective Code   Description
01/01/2025

M0003

Optimal care for patients with episodic neurological conditions mips value pathways
Code Discontinued
01/01/2025

M0004

Quality care for patients with neurological conditions mips value pathway
Change in long description of procedure or modifier code
01/01/2025

M1150

Current or prior left ventricular ejection fraction (lvef) less than or equal to 40% or documentation of moderately or severely depressed left ventricular systolic function
Change in long description of procedure or modifier code
01/01/2025

M1154

Hospice services provided to patient any time during the measurement period
Code Discontinued
01/01/2025

M1155

Patient had anaphylaxis due to the pneumococcal vaccine any time during or before the measurement period
Code Discontinued
01/01/2025

M1176

Patient did not receive 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
Change in long description of procedure or modifier code
01/01/2025

M1177

Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period
Change in long description of procedure or modifier code
01/01/2025

M1179

Patient did not receive any pneumococcal conjugate or polysaccharide vaccine, on or after their 19th birthday and before or during measurement period
Change in long description of procedure or modifier code
01/01/2025

M1211

Most recent glycemic status assessment (hba1c or gmi) level > 9.0%
Change in long description of procedure or modifier code
01/01/2025

M1212

Glycemic status assessment (hba1c or gmi) level is missing, or was not performed during the measurement period
Change in long description of procedure or modifier code
01/01/2025

M1219

Anaphylaxis due to the vaccine on or before the date of the encounter
Code Discontinued
01/01/2025

M1259

Patient status documented within the first year of initiating dialysis
Change in long description of procedure or modifier code
01/01/2025

M1260

Patient status not documented within the first year of initiating dialysis
Change in long description of procedure or modifier code
01/01/2025

M1264

Patients age 75 or older on their initiation of dialysis date
Code Discontinued
01/01/2025

M1267

Patients not observed in active status on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period
Change in long description of procedure or modifier code
01/01/2025

M1268

Patients observed in active status on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period
Change in long description of procedure or modifier code
01/01/2025

M1272

Patients observed on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period
Change in long description of procedure or modifier code
01/01/2025

M1292

Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period
Change in long description of procedure or modifier code
01/01/2025

M1343

Patients who are at pam level 4 at baseline or patients who are flagged with extreme straight line response sets on the pam or with excessive missing responses
Change in long description of procedure or modifier code
01/01/2025

M1344

Patients who did not have a baseline pam score and/or a second score within 4 to 12 months of baseline pam score
Change in long description of procedure or modifier code
01/01/2025

M1345

Patients who had a baseline pam score and a second score within 4 to 12 month of baseline pam score
Change in long description of procedure or modifier code
01/01/2025

M1346

Patients who did not have a net increase in pam score of at least 6 points within a 4 to 12 month period
Change in long description of procedure or modifier code
01/01/2025

M1347

Patients who achieved a net increase in pam score of at least 3 points in a 4 to 12 month period (passing)
Change in long description of procedure or modifier code
01/01/2025

M1348

Patients who achieved a net increase in pam score of at least 6-points in a 4 to 12 month period (excellent)
Change in long description of procedure or modifier code
01/01/2025

M1349

Patients who did not have a net increase in pam score of at least 3 points within a 4 to 12 month period
Change in long description of procedure or modifier code
01/01/2025

M1371

Most recent glycemic status assessment (hba1c or gmi) level < 7.0%
01/01/2025

M1372

Most recent glycemic status assessment (hba1c or gmi) level >= 7.0% and < 8.0%
01/01/2025

M1373

Most recent glycemic status assessment (hba1c or gmi) level >= 8.0% and <= 9.0%
01/01/2025

M1374

An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis during the performance period
01/01/2025

M1375

An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis during the performance period
01/01/2025

M1376

An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis during the performance period
01/01/2025

M1377

Recommended follow-up interval for repeat colonoscopy of 10 years documented in colonoscopy report and communicated with patient
01/01/2025

M1378

Documentation of medical reason(s) for not recommending a 10 year follow-up interval (e.g., inadequate prep, familial or personal history of colonic polyps, patient had no adenoma and age is >= 66 years old, or life expectancy < 10 years, other medical reasons)
01/01/2025

M1379

A 10 year follow-up interval for colonoscopy not recommended, reason not otherwise specified
01/01/2025

M1380

Filled at least two prescriptions during the performance period for any combination of the qualifying oral antipsychotic medications listed under "denominator note" or the long-acting injectable antipsychotic medications listed under "denominator note"
01/01/2025

M1381

Patients with secondary stroke (e.g., a subsequent stroke that may occur with vasospasm in the setting of subarachnoid hemorrhage) within 5 days of the initial procedure
01/01/2025

M1382

Patient encounter during the performance period with place of service code 11
01/01/2025

M1383

Acute pvd
01/01/2025

M1384

Patients who died during the performance period
01/01/2025

M1385

Documentation of patient reasons for patients who were not seen for the second pam survey (e.g., less than four months between baseline pam assessment and follow-up
01/01/2025

M1386

Patients with an excisional surgery for melanoma or melanoma in situ in the past 5 years with an initial ajcc staging of 0, i, or ii at the start of the performance period
01/01/2025

M1387

Patients who died during the performance period
01/01/2025

M1388

Patients with documentation of an exam performed for recurrence of melanoma
01/01/2025

M1390

Patients who do not have a documented exam performed for recurrence of melanoma or no documentation within the performance period
01/01/2025

M1391

All patients who were diagnosed with recurrent melanoma during the current performance period
01/01/2025

M1392

Documentation of patient reasons for no examination, i.e., refusal of examination or lost to follow-up (documentation must include information that the clinician was unable to reach the patient by phone, mail or secure electronic mail - at least one method must be documented)
01/01/2025

M1393

Patients who were not diagnosed with recurrent melanoma during the current performance period
01/01/2025

M1394

Stages i-iii breast cancer
01/01/2025

M1395

Patients receiving an initial chemotherapy regimen with a defined duration with the eligible clinician or group
01/01/2025

M1396

Patients on a therapeutic clinical trial
01/01/2025

M1397

Patients with recurrence/disease progression
01/01/2025

M1398

Patients with baseline and follow-up promis surveys documented in the medical record
01/01/2025

M1399

Patients who leave the practice during the follow-up period
01/01/2025

M1400

Patients who died during the follow-up period
01/01/2025

M1401

Stages i-iii breast cancer
01/01/2025

M1402

Patients receiving an initial chemotherapy regimen with a defined duration with the eligible clinician or group
01/01/2025

M1403

Patients with baseline and follow-up promis surveys documented in the medical record
01/01/2025

M1404

Patients on a therapeutic clinical trial
01/01/2025

M1405

Patients with recurrence/disease progression
01/01/2025

M1406

Patients who leave the practice during the follow-up period
01/01/2025

M1407

Patients who died during the follow-up period
01/01/2025

M1408

Patients who have germline brca testing completed before diagnosis of epithelial ovarian, fallopian tube, or primary peritoneal cancer
01/01/2025

M1409

Patients who received germline testing for brca1 and brca2 or genetic counseling completed within 6 months of diagnosis
01/01/2025

M1410

Patients who did not have germline testing for brca1 and brca2 or genetic counseling completed within 6 months of diagnosis
01/01/2025

M1411

Currently on first-line immune checkpoint inhibitors without chemotherapy
01/01/2025

M1412

Patients with metastatic nsclc with epidermal growth factor receptor (egfr) mutations, alk genomic tumor aberrations, or other targetable genomic abnormalities with approved first-line targeted therapy, such as nsclc with ros1 rearrangement, braf v600e mutation, ntrk 1/2/3 gene fusion, met ex14 skipping mutation, and ret rearrangement
01/01/2025

M1413

Patients who had a positive pd-l1 biomarker expression test result prior to the initiation of first-line immune checkpoint inhibitor therapy
01/01/2025

M1414

Documentation of medical reason(s) for not performing the pd-l1 biomarker expression test prior to initiation of first-line immune checkpoint inhibitor therapy (e.g., patient is in an urgent or emergent situation where delay of treatment would jeopardize the patient's health status; other medical reasons/contraindication)
01/01/2025

M1415

Patients who did not have a positive pd-l1 biomarker expression test result prior to the initiation of first-line immune checkpoint inhibitor therapy
01/01/2025

M1416

Patient received hospice services any time during the performance period
01/01/2025

M1417

Patients who are up to date on their covid-19 vaccinations as defined by cdc recommendations on current vaccination
01/01/2025

M1418

Patients who are not up to date on their covid-19 vaccinations as defined by cdc recommendations on current vaccination because of a medical contraindication documented by clinician
01/01/2025

M1419

Patients who are not up to date on their covid-19 vaccinations as defined by cdc recommendations on current vaccination
01/01/2025

M1420

Complete ophthalmologic care mips value pathway
01/01/2025

M1421

Dermatological care mips value pathway
01/01/2025

M1422

Gastroenterology care mips value pathway
01/01/2025

M1423

Optimal care for patients with urologic conditions mips value pathway
01/01/2025

M1424

Pulmonology care mips value pathway
01/01/2025

M1425

Surgical care mips value pathway

Q Codes

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Effective Code   Description
01/01/2025

Q0155

Dronabinol (syndros), 0.1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen
01/01/2025

Q0516

Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription oral drug, per 30-days
Code Discontinued
01/01/2025

Q0517

Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription oral drug, per 60-days
Code Discontinued
01/01/2025

Q0518

Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription oral drug, per 90-days
Code Discontinued
01/01/2025

Q0519

Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription injectable drug, per 30-days
Code Discontinued
01/01/2025

Q0520

Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription injectable drug, per 60-days
Code Discontinued
01/01/2025

Q0521

Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription
01/01/2025

Q4346

Shelter dm matrix, per square centimeter
01/01/2025

Q4347

Rampart dl matrix, per square centimeter
01/01/2025

Q4348

Sentry sl matrix, per square centimeter
01/01/2025

Q4349

Mantle dl matrix, per square centimeter
01/01/2025

Q4350

Palisade dm matrix, per square centimeter
01/01/2025

Q4351

Enclose tl matrix, per square centimeter
01/01/2025

Q4352

Overlay sl matrix, per square centimeter
01/01/2025

Q4353

Xceed tl matrix, per square centimeter
01/01/2025

Q5131

Injection, adalimumab-aacf (idacio), biosimilar, 20 mg
Code Discontinued
01/01/2025

Q5132

Injection, adalimumab-afzb (abrilada), biosimilar, 10 mg
Code Discontinued
01/01/2025

Q5139

Injection, eculizumab-aeeb (bkemv), biosimilar, 10 mg
01/01/2025

Q5140

Injection, adalimumab-fkjp, biosimilar, 1 mg
01/01/2025

Q5141

Injection, adalimumab-aaty, biosimilar, 1 mg
01/01/2025

Q5142

Injection, adalimumab-ryvk biosimilar, 1 mg
01/01/2025

Q5143

Injection, adalimumab-adbm, biosimilar, 1 mg
01/01/2025

Q5144

Injection, adalimumab-aacf (idacio), biosimilar, 1 mg
01/01/2025

Q5145

Injection, adalimumab-afzb (abrilada), biosimilar, 1 mg
01/01/2025

Q5146

Injection, trastuzumab-strf (hercessi), biosimilar, 10 mg
01/01/2025

Q9996

Injection, ustekinumab-ttwe (pyzchiva), subcutaneous, 1 mg
01/01/2025

Q9997

Injection, ustekinumab-ttwe (pyzchiva), intravenous, 1 mg
01/01/2025

Q9998

Injection, ustekinumab-aekn (selarsdi), 1 mg

Legend:

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