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

  • G9311

    No surgical site infection

  • G9312

    Surgical site infection

  • G9313

    Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis for documented reason

  • G9314

    Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis, reason not given

  • G9315

    Amoxicillin, with or without clavulanate, prescribed as a first line antibiotic at the time of diagnosis

  • G9316

    Documentation of patient-specific risk assessment with a risk calculator based on multi-institutional clinical data, the specific risk calculator used, and communication of risk assessment from risk calculator with the patient or family

  • G9317

    Documentation of patient-specific risk assessment with a risk calculator based on multi-institutional clinical data, the specific risk calculator used, and communication of risk assessment from risk calculator with the patient or family not completed

  • G9318

    Imaging study named according to standardized nomenclature

  • G9319

    Imaging study not named according to standardized nomenclature, reason not given

  • G9320

    Documentation of medical reason(s) for not naming ct studies according to a standardized nomenclature provided (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)

  • 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

  • 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

  • G9323

    Documentation of medical reason(s) for not counting previous ct and cardiac nuclear medicine (myocardial perfusion) studies (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)

  • G9324

    All necessary data elements not included, reason not given

  • G9325

    Ct studies not reported to a radiation dose index registry due to medical reasons (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)

  • G9326

    Ct studies performed not reported to a radiation dose index registry that is capable of collecting at a minimum all necessary data elements, reason not given

  • G9327

    Ct studies performed reported to a radiation dose index registry that is capable of collecting at a minimum all necessary data elements

  • G9328

    Dicom format image data availability not documented in final report due to medical reasons (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)

  • G9329

    Dicom format image data available to non-affiliated external healthcare facilities or entities on a secure, media free, reciprocally searchable basis with patient authorization for at least a 12-month period after the study not documented in final report, reason not given

  • G9340

    Final report documented that dicom format image data available to non-affiliated external healthcare facilities or entities on a secure, media free, reciprocally searchable basis with patient authorization for at least a 12-month period after the study

  • G9341

    Search conducted for prior patient ct studies completed at non-affiliated external healthcare facilities or entities within the past 12-months and are available through a secure, authorized, media-free, shared archive prior to an imaging study being performed

  • G9342

    Search not conducted prior to an imaging study being performed for prior patient ct studies completed at non-affiliated external healthcare facilities or entities within the past 12-months and are available through a secure, authorized, media-free, shared archive, reason not given

  • G9343

    Due to medical reasons, search not conducted for dicom format images for prior patient ct imaging studies completed at non-affiliated external healthcare facilities or entities within the past 12 months that are available through a secure, authorized, media-free, shared archive (e.g., ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)

  • G9344

    Due to system reasons search not conducted for dicom format images for prior patient ct imaging studies completed at non-affiliated external healthcare facilities or entities within the past 12 months that are available through a secure, authorized, media-free, shared archive (e.g., non-affiliated external healthcare facilities or entities does not have archival abilities through a shared archival system)

  • G9345

    Follow-up recommendations documented according to recommended guidelines for incidentally detected pulmonary nodules (e.g., follow-up ct imaging studies needed or that no follow-up is needed) based at a minimum on nodule size and patient risk factors

  • G9346

    Follow-up recommendations not documented according to recommended guidelines for incidentally detected pulmonary nodules due to medical reasons (e.g., patients with known malignant disease, patients with unexplained fever, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)

  • G9347

    Follow-up recommendations not documented according to recommended guidelines for incidentally detected pulmonary nodules, reason not given

  • G9348

    Ct scan of the paranasal sinuses ordered at the time of diagnosis for documented reasons

  • G9349

    Ct scan of the paranasal sinuses ordered at the time of diagnosis or received within 28 days after date of diagnosis

  • G9350

    Ct scan of the paranasal sinuses not ordered at the time of diagnosis or received within 28 days after date of diagnosis

  • G9351

    More than one ct scan of the paranasal sinuses ordered or received within 90 days after diagnosis

  • G9352

    More than one ct scan of the paranasal sinuses ordered or received within 90 days after the date of diagnosis, reason not given

  • G9353

    More than one ct scan of the paranasal sinuses ordered or received within 90 days after the date of diagnosis for documented reasons (eg, patients with complications, second ct obtained prior to surgery, other medical reasons)

  • G9354

    One ct scan or no ct scan of the paranasal sinuses ordered within 90 days after the date of diagnosis

  • G9355

    Elective delivery (without medical indication) by cesarean birth or induction of labor not performed (<39 weeks of gestation)

  • G9356

    Elective delivery (without medical indication) by cesarean birth or induction of labor performed (<39 weeks of gestation)

  • G9357

    Post-partum screenings, evaluations and education performed

  • G9358

    Post-partum screenings, evaluations and education not performed

  • G9359

    Documentation of negative or managed positive tb screen with further evidence that tb is not active prior to treatment with a biologic immune response modifier

  • G9360

    No documentation of negative or managed positive tb screen

  • G9361

    Medical indication for delivery by cesarean birth or induction of labor (<39 weeks of gestation) [documentation of reason(s) for elective delivery (e.g., hemorrhage and placental complications, hypertension, preeclampsia and eclampsia, rupture of membranes (premature or prolonged), maternal conditions complicating pregnancy/delivery, fetal conditions complicating pregnancy/delivery, late pregnancy, prior uterine surgery, or participation in clinical trial)]

  • G9362

    Duration of monitored anesthesia care (mac) or peripheral nerve block (pnb) without the use of general anesthesia during an applicable procedure 60 minutes or longer, as documented in the anesthesia record

  • G9363

    Duration of monitored anesthesia care (mac) or peripheral nerve block (pnb) without the use of general anesthesia during an applicable procedure or general or neuraxial anesthesia less than 60 minutes, as documented in the anesthesia record

  • G9364

    Sinusitis caused by, or presumed to be caused by, bacterial infection

  • G9365

    One high-risk medication ordered

  • G9366

    One high-risk medication not ordered

  • G9367

    At least two orders for high-risk medications from the same drug class

  • G9368

    At least two orders for high-risk medications from the same drug class not ordered

  • G9369

    Individual filled at least two prescriptions for any antipsychotic medication and had a pdc of 0.8 or greater

  • G9370

    Individual who did not fill at least two prescriptions for any antipsychotic medication or did not have a pdc of 0.8 or greater