HCPCS Service Codes - Medical care

HCPCS Service Code 1 for Medical care.

HCPCS Type of Service (TOS) code is an indicator that the contractor places on Form CMS-1500. The indicator is mainly used for data purposes, however in some instances, it affects payment. All HCPCS codes have a corresponding TOS indicator.

Below are all available HCPCS TOS codes. Find an HCPCS code based on the type of service.

HCPCS Codes for Medical care

  • G9200

    Venous thromboembolism (vte) prophylaxis was not administered the day of or the day after hospital admission, reason not given

  • G9201

    Venous thromboembolism (vte) prophylaxis administered the day of or the day after hospital admission

  • G9202

    Patients with a positive hepatitis c antibody test

  • G9203

    Rna testing for hepatitis c documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c

  • G9204

    Rna testing for hepatitis c was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c, reason not given

  • G9205

    Patient starting antiviral treatmentfor hepatitis c during the measurement period

  • G9206

    Patient starting antiviral treatment for hepatitis c during the measurement period

  • G9207

    Hepatitis c genotype testing documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c

  • G9208

    Hepatitis c genotype testing was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c, reason not given

  • G9209

    Hepatitis c quantitative rna testing documented as performed between 4-12 weeks after the initiation of antiviral treatment

  • G9210

    Hepatitis c quantitative rna testing not performed between 4-12 weeks after the initiation of antiviral treatment for documented reason(s) (e.g., patients whose treatment was discontinued during the testing period prior to testing, other medical reasons, patient declined, other patient reasons)

  • G9211

    Hepatitis c quantitative rna testing was not documented as performed between 4-12 weeks after the initiation of antiviral treatment, reason not given

  • G9212

    Dsm-ivtm criteria for major depressive disorder documented at the initial evaluation

  • G9213

    Dsm-iv-tr criteria for major depressive disorder not documented at the initial evaluation, reason not otherwise specified

  • G9214

    Cd4+ cell count or cd4+ cell percentage results documented

  • G9215

    Cd4+ cell count or percentage not documented as performed, reason not given

  • G9216

    Pcp prophylaxis was not prescribed at time of diagnosis of hiv, reason not given

  • G9217

    Pcp prophylaxis was not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3, reason not given

  • G9218

    Pcp prophylaxis was not prescribed within 3 months oflow cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%, reason not given

  • G9219

    Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3 for medical reason (i.e., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis)

  • G9220

    Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15% for medical reason (i.e., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis)

  • G9221

    Pneumocystis jiroveci pneumonia prophlaxis prescribed

  • G9222

    Pneumocystis jiroveci pneumonia prophylaxis prescribed wthin 3 months of low cd4+ cell count below 200 cells/mm3

  • G9223

    Pneumocystis jiroveci pneumonia prophylaxis prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%

  • G9224

    Documentation of medical reason for not performing foot exam (e.g., patient with bilateral foot/leg amputation)

  • G9225

    Foot exam was not performed, reason not given

  • G9226

    Foot examination performed (includes examination through visual inspection, sensory exam with 10-g monofilament plus testing any one of the following: vibration using 128-hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception threshold, and pulse exam; report when all of the 3 components are completed)

  • G9227

    Functional outcome assessment documented, care plan not documented, documentation the patient is not eligible for a care plan at the time of the encounter

  • G9228

    Chlamydia, gonorrhea and syphilis screening results documented (report when results are present for all of the 3 screenings)

  • G9229

    Chlamydia, gonorrhea, and syphilis screening results not documented (patient refusal is the only allowed exception)

  • G9230

    Chlamydia, gonorrhea, and syphilis not screened, reason not given

  • G9231

    Documentation of end stage renal disease (esrd), dialysis, renal transplant before or during the measurement period or pregnancy during the measurement period

  • G9232

    Clinician treating major depressive disorder did not communicate to clinician treating comorbid condition for specified patient reason (e.g., patient is unable to communicate the diagnosis of a comorbid condition; the patient is unwilling to communicate the diagnosis of a comorbid condition; or the patient is unaware of the comorbid condition, or any other specified patient reason)

  • G9233

    All quality actions for the applicable measures in the total knee replacement measures group have been performed for this patient

  • G9234

    I intend to report the total knee replacement measures group

  • G9235

    All quality actions for the applicable measures in the general surgery measures group have been performed for this patient

  • G9236

    All quality actions for the applicable measures in the optimizing patient exposure to ionizing radiation measures group have been performed for this patient

  • G9237

    I intend to report the general surgery measures group

  • G9238

    I intend to report the optimizing patient exposure to ionizing radiation measures group

  • G9239

    Documentation of reasons for patient initiating maintenance hemodialysis with a catheter as the mode of vascular access (e.g., patient has a maturing arteriovenous fistula (avf)/arteriovenous graft (avg), time-limited trial of hemodialysis, other medical reasons, patient declined avf/avg, other patient reasons, patient followed by reporting nephrologist for fewer than 90 days, other system reasons)

  • G9240

    Patient whose mode of vascular access is a catheter at the time maintenance hemodialysis is initiated

  • G9241

    Patient whose mode of vascular access is not a catheter at the time maintenance hemodialysis is initiated

  • G9242

    Documentation of viral load equal to or greater than 200 copies/ml or viral load not performed

  • G9243

    Documentation of viral load less than 200 copies/ml

  • G9244

    Antiretroviral thereapy not prescribed

  • G9245

    Antiretroviral therapy prescribed

  • 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

  • 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

  • G9248

    Patient did not have a medical visit in the last 6 months

  • G9249

    Patient had a medical visit in the last 6 months