HCPCS G codes

• G0008 Administration of influenza virus vaccine
• G0009 Administration of pneumococcal vaccine
• G0010 Administration of hepatitis b vaccine
• G0011 Individual counseling for pre-exposure prophylaxis (prep) by physician or qualified health care professional (qhp) to prevent human immunodeficiency virus (hiv), includes hiv risk assessment (initial or continued assessment of risk), hiv risk reduction and medication adherence, 15-30 minutes
• G0012 Injection of pre-exposure prophylaxis (prep) drug for hiv prevention, under skin or into muscle
• G0013 Individual counseling for pre-exposure prophylaxis (prep) by clinical staff to prevent human immunodeficiency virus (hiv), includes: hiv risk assessment (initial or continued assessment of risk), hiv risk reduction and medication adherence
• G0017 Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); first 60 minutes
• G0018 Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); each additional 30 minutes (list separately in addition to code for primary service)
• G0019 Community health integration services performed by certified or trained auxiliary personnel, including a community health worker, under the direction of a physician or other practitioner; 60 minutes per calendar month, in the following activities to address social determinants of health (sdoh) need(s) that are significantly limiting the ability to diagnose or treat problem(s) addressed in an initiating visit: person-centered assessment, performed to better understand the individualized context of the intersection between the sdoh need(s) and the problem(s) addressed in the initiating visit. ++ conducting a person-centered assessment to understand patient's life story, strengths, needs, goals, preferences and desired outcomes, including understanding cultural and linguistic factors and including unmet sdoh needs (that are not separately billed). ++ facilitating patient-driven goal-setting and establishing an action plan. ++ providing tailored support to the patient as needed to accomplish the practitioner's treatment plan. practitioner, home-, and community-based care coordination. ++ coordinating receipt of needed services from healthcare practitioners, providers, and facilities; and from home- and community-based service providers, social service providers, and caregiver (if applicable). ++ communication with practitioners, home- and community-based service providers, hospitals, and skilled nursing facilities (or other health care facilities) regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors. ++ coordination of care transitions between and among health care practitioners and settings, including transitions involving referral to other clinicians; follow-up after an emergency department visit; or follow-up after discharges from hospitals, skilled nursing facilities or other health care facilities. ++ facilitating access to community-based social services (e.g., housing, utilities, transportation, food assistance) to address the sdoh need(s). health education- helping the patient contextualize health education provided by the patient's treatment team with the patient's individual needs, goals, and preferences, in the context of the sdoh need(s), and educating the patient on how to best participate in medical decision-making. building patient self-advocacy skills, so that the patient can interact with members of the health care team and related community-based services addressing the sdoh need(s), in ways that are more likely to promote personalized and effective diagnosis or treatment. health care access / health system navigation. ++ helping the patient access healthcare, including identifying appropriate practitioners or providers for clinical care and helping secure appointments with them. facilitating behavioral change as necessary for meeting diagnosis and treatment goals, including promoting patient motivation to participate in care and reach person-centered diagnosis or treatment goals. facilitating and providing social and emotional support to help the patient cope with the problem(s) addressed in the initiating visit, the sdoh need(s), and adjust daily routines to better meet diagnosis and treatment goals. leveraging lived experience when applicable to provide support, mentorship, or inspiration to meet treatment goals
• G0022 Community health integration services, each additional 30 minutes per calendar month (list separately in addition to g0019)
• G0023 Principal illness navigation services by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a patient navigator; 60 minutes per calendar month, in the following activities: person-centered assessment, performed to better understand the individual context of the serious, high-risk condition. ++ conducting a person-centered assessment to understand the patient's life story, strengths, needs, goals, preferences, and desired outcomes, including understanding cultural and linguistic factors and including unmet sdoh needs (that are not separately billed). ++ facilitating patient-driven goal setting and establishing an action plan. ++ providing tailored support as needed to accomplish the practitioner's treatment plan. identifying or referring patient (and caregiver or family, if applicable) to appropriate supportive services. practitioner, home, and community-based care coordination. ++ coordinating receipt of needed services from healthcare practitioners, providers, and facilities; home- and community-based service providers; and caregiver (if applicable). ++ communication with practitioners, home-, and community-based service providers, hospitals, and skilled nursing facilities (or other health care facilities) regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors. ++ coordination of care transitions between and among health care practitioners and settings, including transitions involving referral to other clinicians; follow-up after an emergency department visit; or follow-up after discharges from hospitals, skilled nursing facilities or other health care facilities. ++ facilitating access to community-based social services (e.g., housing, utilities, transportation, food assistance) as needed to address sdoh need(s). health education- helping the patient contextualize health education provided by the patient's treatment team with the patient's individual needs, goals, preferences, and sdoh need(s), and educating the patient (and caregiver if applicable) on how to best participate in medical decision-making. building patient self-advocacy skills, so that the patient can interact with members of the health care team and related community-based services (as needed), in ways that are more likely to promote personalized and effective treatment of their condition. health care access / health system navigation. ++ helping the patient access healthcare, including identifying appropriate practitioners or providers for clinical care, and helping secure appointments with them. ++ providing the patient with information/resources to consider participation in clinical trials or clinical research as applicable. facilitating behavioral change as necessary for meeting diagnosis and treatment goals, including promoting patient motivation to participate in care and reach person-centered diagnosis or treatment goals. facilitating and providing social and emotional support to help the patient cope with the condition, sdoh need(s), and adjust daily routines to better meet diagnosis and treatment goals. leverage knowledge of the serious, high-risk condition and/or lived experience when applicable to provide support, mentorship, or inspiration to meet treatment goals
• G0024 Principal illness navigation services, additional 30 minutes per calendar month (list separately in addition to g0023)
• G0027 Semen analysis; presence and/or motility of sperm excluding huhner
• G0028 Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)
• G0029 Tobacco screening not performed or tobacco cessation intervention not provided during the measurement period or in the six months prior to the measurement period
• G0030 Patient screened for tobacco use and received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling, pharmacotherapy, or both), if identified as a tobacco user
• G0031 Palliative care services given to patient any time during the measurement period
• G0032 Two or more antipsychotic prescriptions ordered for patients who had a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between january 1 of the year prior to the measurement period and the index prescription start date (ipsd) for antipsychotics
• G0033 Two or more benzodiazepine prescriptions ordered for patients who had a diagnosis of seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, or severe generalized anxiety disorder on or between january 1 of the year prior to the measurement period and the ipsd for benzodiazepines
• G0034 Patients receiving palliative care during the measurement period
• G0035 Patient has any emergency department encounter during the performance period with place of service indicator 23
• G0036 Patient or care partner decline assessment
• G0037 On date of encounter, patient is not able to participate in assessment or screening, including non-verbal patients, delirious, severely aphasic, severely developmentally delayed, severe visual or hearing impairment and for those patients, no knowledgeable informant available
• G0038 Clinician determines patient does not require referral
• G0039 Patient not referred, reason not otherwise specified
• G0040 Patient already receiving physical/occupational/speech/recreational therapy during the measurement period
• G0041 Patient and/or care partner decline referral
• G0042 Referral to physical, occupational, speech, or recreational therapy
• G0043 Patients with mechanical prosthetic heart valve
• G0044 Patients with moderate or severe mitral stenosis
• G0045 Clinical follow-up and mrs score assessed at 90 days following endovascular stroke intervention
• G0046 Clinical follow-up and mrs score not assessed at 90 days following endovascular stroke intervention
• G0047 Pediatric patient with minor blunt head trauma and pecarn prediction criteria are not assessed
• G0048 Patients who receive palliative care services any time during the intake period through the end of the measurement year
• G0049 With maintenance hemodialysis (in-center and home hd) for the complete reporting month
• G0050 Patients with a catheter that have limited life expectancy
• G0051 Patients under hospice care in the current reporting month
• G0052 Patients on peritoneal dialysis for any portion of the reporting month
• G0053 Advancing rheumatology patient care mips value pathways
• G0054 Coordinating stroke care to promote prevention and cultivate positive outcomes mips value pathways
• G0055 Advancing care for heart disease mips value pathways
• G0056 Optimizing chronic disease management mips value pathways
• G0057 Proposed adopting best practices and promoting patient safety within emergency medicine mips value pathways
• G0058 Improving care for lower extremity joint repair mips value pathways
• G0059 Patient safety and support of positive experiences with anesthesia mips value pathways
• G0060 Allergy/immunology mips specialty set
• G0061 Anesthesiology mips specialty set
• G0062 Audiology mips specialty set
• G0063 Cardiology mips specialty set
• G0064 Certified nurse midwife mips specialty set
• G0065 Chiropractic medicine mips specialty set
• G0066 Clinical social work mips specialty set
• G0067 Dentistry mips specialty set
• G0068 Professional services for the administration of anti-infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy or other highly complex drug or biological) for each infusion drug administration calendar day in the individual's home, each 15 minutes
• G0069 Professional services for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes
• G0070 Professional services for the administration of intravenous chemotherapy or other intravenous highly complex drug or biological infusion for each infusion drug administration calendar day in the individual's home, each 15 minutes
• G0071 Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only
• G0076 Brief (20 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
• G0077 Limited (30 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
• G0078 Moderate (45 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
• G0079 Comprehensive (60 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
• G0080 Extensive (75 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
• G0081 Brief (20 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
• G0082 Limited (30 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
• G0083 Moderate (45 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
• G0084 Comprehensive (60 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
• G0085 Extensive (75 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
• G0086 Limited (30 minutes) care management home care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
• G0087 Comprehensive (60 minutes) care management home care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
• G0088 Professional services, initial visit, for the administration of anti-infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy or other highly complex drug or biological) for each infusion drug administration calendar day in the individual's home, each 15 minutes
• G0089 Professional services, initial visit, for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes
• G0090 Professional services, initial visit, for the administration of intravenous chemotherapy or other highly complex infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes
• G0101 Cervical or vaginal cancer screening; pelvic and clinical breast examination
• G0102 Prostate cancer screening; digital rectal examination
• G0103 Prostate cancer screening; prostate specific antigen test (psa)
• G0104 Colorectal cancer screening; flexible sigmoidoscopy
• G0105 Colorectal cancer screening; colonoscopy on individual at high risk
• G0106 Colorectal cancer screening; alternative to g0104, screening sigmoidoscopy, barium enema
• G0108 Diabetes outpatient self-management training services, individual, per 30 minutes
• G0109 Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes
• G0117 Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist
• G0118 Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist
• G0120 Colorectal cancer screening; alternative to g0105, screening colonoscopy, barium enema.
• G0121 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk
• G0122 Colorectal cancer screening; barium enema
• G0123 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision
• G0124 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician
• G0127 Trimming of dystrophic nails, any number
• G0128 Direct (face-to-face with patient) skilled nursing services of a registered nurse provided in a comprehensive outpatient rehabilitation facility, each 10 minutes beyond the first 5 minutes
• G0129 Occupational therapy services requiring the skills of a qualified occupational therapist, furnished as a component of a partial hospitalization or intensive outpatient treatment program, per session (45 minutes or more)
• G0130 Single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
• G0136 Administration of a standardized, evidence-based assessment of physical activity and nutrition, 5-15 minutes, not more often than every 6 months
• G0137 Intensive outpatient services; weekly bundle, minimum of 9 services over a 7 contiguous day period, which can include individual and group therapy with physicians or psychologists (or other mental health professionals to the extent authorized under state law); occupational therapy requiring the skills of a qualified occupational therapist; services of social workers, trained psychiatric nurses, and other staff trained to work with psychiatric patients; individualized activity therapies that are not primarily recreational or diversionary; family counseling (the primary purpose of which is treatment of the individual's condition); patient training and education (to the extent that training and educational activities are closely and clearly related to individual's care and treatment); diagnostic services; and such other items and services (excluding meals and transportation) that are reasonable and necessary for the diagnosis or active treatment of the individual's condition, reasonably expected to improve or maintain the individual's condition and functional level and to prevent relapse or hospitalization, and furnished pursuant to such guidelines relating to frequency and duration of services in accordance with a physician certification and plan of treatment (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure
• G0138 Intravenous infusion of cipaglucosidase alfa-atga, including provider/supplier acquisition and clinical supervision of oral administration of miglustat in preparation of receipt of cipaglucosidase alfa-atga
• G0140 Principal illness navigation - peer support by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a certified peer specialist; 60 minutes per calendar month, in the following activities: person-centered interview, performed to better understand the individual context of the serious, high-risk condition. ++ conducting a person-centered interview to understand the patient's life story, strengths, needs, goals, preferences, and desired outcomes, including understanding cultural and linguistic factors, and including unmet sdoh needs (that are not billed separately). ++ facilitating patient-driven goal setting and establishing an action plan. ++ providing tailored support as needed to accomplish the person-centered goals in the practitioner's treatment plan. identifying or referring patient (and caregiver or family, if applicable) to appropriate supportive services. practitioner, home, and community-based care communication. ++ assist the patient in communicating with their practitioners, home-, and community-based service providers, hospitals, and skilled nursing facilities (or other health care facilities) regarding the patient's psychosocial strengths and needs, goals, preferences, and desired outcomes, including cultural and linguistic factors. ++ facilitating access to community-based social services (e.g., housing, utilities, transportation, food assistance) as needed to address sdoh need(s). health education. helping the patient contextualize health education provided by the patient's treatment team with the patient's individual needs, goals, preferences, and sdoh need(s), and educating the patient (and caregiver if applicable) on how to best participate in medical decision-making. building patient self-advocacy skills, so that the patient can interact with members of the health care team and related community-based services (as needed), in ways that are more likely to promote personalized and effective treatment of their condition. developing and proposing strategies to help meet person-centered treatment goals and supporting the patient in using chosen strategies to reach person-centered treatment goals. facilitating and providing social and emotional support to help the patient cope with the condition, sdoh need(s), and adjust daily routines to better meet person-centered diagnosis and treatment goals. leverage knowledge of the serious, high-risk condition and/or lived experience when applicable to provide support, mentorship, or inspiration to meet treatment goals
• G0141 Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician
• G0143 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under physician supervision
• G0144 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervision
• G0145 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision
• G0146 Principal illness navigation - peer support, additional 30 minutes per calendar month (list separately in addition to g0140)
• G0147 Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision
• G0148 Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening
• G0151 Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes
• G0152 Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes
• G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
• G0154 Direct skilled nursing services of a licensed nurse (lpn or rn) in the home health or hospice setting, each 15 minutes
• G0155 Services of clinical social worker in home health or hospice settings, each 15 minutes
• G0156 Services of home health/hospice aide in home health or hospice settings, each 15 minutes
• G0157 Services performed by a qualified physical therapist assistant in the home health or hospice setting, each 15 minutes
• G0158 Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes
• G0159 Services performed by a qualified physical therapist, in the home health setting, in the establishment or delivery of a safe and effective physical therapy maintenance program, each 15 minutes
• G0160 Services performed by a qualified occupational therapist, in the home health setting, in the establishment or delivery of a safe and effective occupational therapy maintenance program, each 15 minutes
• G0161 Services performed by a qualified speech-language pathologist, in the home health setting, in the establishment or delivery of a safe and effective speech-language pathology maintenance program, each 15 minutes
• G0162 Skilled services by a registered nurse (rn) for management and evaluation of the plan of care; each 15 minutes (the patient's underlying condition or complication requires an rn to ensure that essential non-skilled care achieves its purpose in the home health or hospice setting)
• G0163 Skilled services of a licensed nurse (lpn or rn) for the observation and assessment of the patient's condition, each 15 minutes (the change in the patient's condition requires skilled nursing personnel to identify and evaluate the patient's need for possible modification of treatment in the home health or hospice setting)
• G0164 Skilled services of a licensed nurse (lpn or rn), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes
• G0166 External counterpulsation, per treatment session
• G0168 Wound closure utilizing tissue adhesive(s) only
• G0173 Linear accelerator based stereotactic radiosurgery, complete course of therapy in one session
• G0175 Scheduled interdisciplinary team conference (minimum of three exclusive of patient care nursing staff) with patient present
• G0176 Activity therapy, such as music, dance, art or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more)
• G0177 Training and educational services related to the care and treatment of patient's disabling mental health problems per session (45 minutes or more)
• G0179 Physician or allowed practitioner re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and allowed practitioners to affirm the initial implementation of the plan of care
• G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and allowed practitioners to affirm the initial implementation of the plan of care
• G0181 Physician or allowed practitioner supervision of a patient receiving medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician or allowed practitioner development and/or revision of care plans
• G0182 Physician supervision of a patient under a medicare-approved hospice (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of laboratory and other studies, communication (including telephone calls) with other health care professionals involved in the patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month, 30 minutes or more
• G0183 Quantitative software measurements of cardiac volume, cardiac chambers volumes and left ventricular wall mass derived from ct scan(s) data of the chest/heart (with or without contrast)
• G0186 Destruction of localized lesion of choroid (for example, choroidal neovascularization); photocoagulation, feeder vessel technique (one or more sessions)
• G0202 Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (cad) when performed
• G0204 Diagnostic mammography, including computer-aided detection (cad) when performed; bilateral
• G0206 Diagnostic mammography, including computer-aided detection (cad) when performed; unilateral
• G0219 Pet imaging whole body; melanoma for non-covered indications
• G0235 Pet imaging, any site, not otherwise specified
• G0237 Therapeutic procedures to increase strength or endurance of respiratory muscles, face to face, one on one, each 15 minutes (includes monitoring)
• G0238 Therapeutic procedures to improve respiratory function, other than described by g0237, one on one, face to face, per 15 minutes (includes monitoring)
• G0239 Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring)
• G0245 Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) which must include: (1) the diagnosis of lops, (2) a patient history, (3) a physical examination that consists of at least the following elements: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of a protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear and (4) patient education
• G0246 Follow-up physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) to include at least the following: (1) a patient history, (2) a physical examination that includes: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear, and (3) patient education
• G0247 Routine foot care by a physician of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) to include, the local care of superficial wounds (i.e. superficial to muscle and fascia) and at least the following if present: (1) local care of superficial wounds, (2) debridement of corns and calluses, and (3) trimming and debridement of nails
• G0248 Demonstration, prior to initiation of home inr monitoring, for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria, under the direction of a physician; includes: face-to-face demonstration of use and care of the inr monitor, obtaining at least one blood sample, provision of instructions for reporting home inr test results, and documentation of patient's ability to perform testing and report results
• G0249 Provision of test materials and equipment for home inr monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; includes: provision of materials for use in the home and reporting of test results to physician; testing not occurring more frequently than once a week; testing materials, billing units of service include 4 tests
• G0250 Physician review, interpretation, and patient management of home inr testing for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; testing not occurring more frequently than once a week; billing units of service include 4 tests
• G0251 Linear accelerator based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, maximum five sessions per course of treatment
• G0252 Pet imaging, full and partial-ring pet scanners only, for initial diagnosis of breast cancer and/or surgical planning for breast cancer (e.g., initial staging of axillary lymph nodes)
• G0255 Current perception threshold/sensory nerve conduction test, (snct) per limb, any nerve
• G0257 Unscheduled or emergency dialysis treatment for an esrd patient in a hospital outpatient department that is not certified as an esrd facility
• G0259 Injection procedure for sacroiliac joint; arthrography
• G0260 Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography
• G0268 Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing
• G0269 Placement of occlusive device into either a venous or arterial access site, post surgical or interventional procedure (e.g., angioseal plug, vascular plug)
• G0270 Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes
• G0271 Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes
• G0276 Blinded procedure for lumbar stenosis, percutaneous image-guided lumbar decompression (pild) or placebo-control, performed in an approved coverage with evidence development (ced) clinical trial
• G0277 Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval
• G0278 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 (list separately in addition to primary procedure)
• G0279 Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)
• G0281 Electrical stimulation, (unattended), to one or more areas, for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of care
• G0282 Electrical stimulation, (unattended), to one or more areas, for wound care other than described in g0281
• G0283 Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care
• G0288 Reconstruction, computed tomographic angiography of aorta for surgical planning for vascular surgery
• G0289 Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage (chondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee
• G0293 Noncovered surgical procedure(s) using conscious sedation, regional, general or spinal anesthesia in a medicare qualifying clinical trial, per day
• G0294 Noncovered procedure(s) using either no anesthesia or local anesthesia only, in a medicare qualifying clinical trial, per day
• G0295 Electromagnetic therapy, to one or more areas, for wound care other than described in g0329 or for other uses
• G0296 Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making)
• G0297 Low dose ct scan (ldct) for lung cancer screening
• G0299 Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes
• G0300 Direct skilled nursing services of a licensed practical nurse (lpn) in the home health or hospice setting, each 15 minutes
• G0302 Pre-operative pulmonary surgery services for preparation for lvrs, complete course of services, to include a minimum of 16 days of services
• G0303 Pre-operative pulmonary surgery services for preparation for lvrs, 10 to 15 days of services
• G0304 Pre-operative pulmonary surgery services for preparation for lvrs, 1 to 9 days of services
• G0305 Post-discharge pulmonary surgery services after lvrs, minimum of 6 days of services
• G0306 Complete cbc, automated (hgb, hct, rbc, wbc, without platelet count) and automated wbc differential count
• G0307 Complete (cbc), automated (hgb, hct, rbc, wbc; without platelet count)
• G0308 Creation of subcutaneous pocket with insertion of 180 day implantable interstitial glucose sensor, including system activation and patient training
• G0309 Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and insertion of new 180 day implantable sensor, including system activation
• G0310 Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service, 5 to 15 mins time (this code is used for medicaid billing purposes)
• G0311 Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service, 16-30 mins time (this code is used for medicaid billing purposes)
• G0312 Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service for ages under 21, 5 to 15 mins time (this code is used for medicaid billing purposes)
• G0313 Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service for ages under 21, 16-30 mins time (this code is used for medicaid billing purposes)
• G0314 Immunization counseling by a physician or other qualified health care professional for covid-19, ages under 21, 16-30 mins time (this code is used for the medicaid early and periodic screening, diagnostic, and treatment benefit (epsdt)
• G0315 Immunization counseling by a physician or other qualified health care professional for covid-19, ages under 21, 5-15 mins time (this code is used for the medicaid early and periodic screening, diagnostic, and treatment benefit (epsdt)
• G0316 Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99223, 99233, and 99236 for hospital inpatient or observation care evaluation and management services). (do not report g0316 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99418, 99415, 99416). (do not report g0316 for any time unit less than 15 minutes)
• G0317 Prolonged nursing facility evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99306, 99310 for nursing facility evaluation and management services). (do not report g0317 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99418). (do not report g0317 for any time unit less than 15 minutes)
• G0318 Prolonged home or residence evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99345, 99350 for home or residence evaluation and management services). (do not report g0318 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99417). (do not report g0318 for any time unit less than 15 minutes)
• G0320 Home health services furnished using synchronous telemedicine rendered via a real-time two-way audio and video telecommunications system
• G0321 Home health services furnished using synchronous telemedicine rendered via telephone or other real-time interactive audio-only telecommunications system
• G0322 The collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency (i.e., remote patient monitoring)
• G0323 Care management services for behavioral health conditions, at least 20 minutes of clinical psychologist, clinical social worker, mental health counselor, or marriage and family therapist 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)
• G0327 Colorectal cancer screening; blood-based biomarker
• G0328 Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous
• G0329 Electromagnetic therapy, to one or more areas for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care as part of a therapy plan of care
• G0330 Facility services for dental rehabilitation procedure(s) performed on a patient who requires monitored anesthesia (e.g., general, intravenous sedation (monitored anesthesia care) and use of an operating room
• G0333 Pharmacy dispensing fee for inhalation drug(s); initial 30-day supply as a beneficiary
• G0337 Hospice evaluation and counseling services, pre-election
• G0339 Image-guided robotic linear accelerator-based stereotactic radiosurgery, complete course of therapy in one session or first session of fractionated treatment
• G0340 Image-guided robotic linear accelerator-based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, second through fifth sessions, maximum five sessions per course of treatment
• G0341 Percutaneous islet cell transplant, includes portal vein catheterization and infusion
• G0342 Laparoscopy for islet cell transplant, includes portal vein catheterization and infusion
• G0343 Laparotomy for islet cell transplant, includes portal vein catheterization and infusion
• G0364 Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service
• G0365 Vessel mapping of vessels for hemodialysis access (services for preoperative vessel mapping prior to creation of hemodialysis access using an autogenous hemodialysis conduit, including arterial inflow and venous outflow)
• G0372 Physician service required to establish and document the need for a power mobility device
• G0378 Hospital observation service, per hour
• G0379 Direct admission of patient for hospital observation care
• G0380 Level 1 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)
• G0381 Level 2 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)
• G0382 Level 3 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)
• G0383 Level 4 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)
• G0384 Level 5 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)
• G0389 Ultrasound b-scan and/or real time with image documentation; for abdominal aortic aneurysm (aaa) screening
• G0390 Trauma response team associated with hospital critical care service
• G0396 Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes
• G0397 Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes
• G0398 Home sleep study test (hst) with type ii portable monitor, unattended; minimum of 7 channels: eeg, eog, emg, ecg/heart rate, airflow, respiratory effort and oxygen saturation
• G0399 Home sleep test (hst) with type iii portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ecg/heart rate and 1 oxygen saturation
• G0400 Home sleep test (hst) with type iv portable monitor, unattended; minimum of 3 channels
• G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
• G0403 Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report
• G0404 Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination
• G0405 Electrocardiogram, routine ecg with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination
• G0406 Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth
• G0407 Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth
• G0408 Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth
• G0409 Social work and psychological services, directly relating to and/or furthering the patient's rehabilitation goals, each 15 minutes, face-to-face; individual (services provided by a corf-qualified social worker or psychologist in a corf)
• G0410 Group psychotherapy other than of a multiple-family group, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes
• G0411 Interactive group psychotherapy, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes
• G0412 Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s), unilateral or bilateral for pelvic bone fracture patterns which do not disrupt the pelvic ring includes internal fixation, when performed
• G0413 Percutaneous skeletal fixation of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, (includes ilium, sacroiliac joint and/or sacrum)
• G0414 Open treatment of anterior pelvic bone fracture and/or dislocation for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation when performed (includes pubic symphysis and/or superior/inferior rami)
• G0415 Open treatment of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation, when performed (includes ilium, sacroiliac joint and/or sacrum)
• G0416 Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method
• G0417 Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, 21-40 specimens
• G0418 Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, 41-60 specimens
• G0419 Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, >60 specimens
• G0420 Face-to-face educational services related to the care of chronic kidney disease; individual, per session, per one hour
• G0421 Face-to-face educational services related to the care of chronic kidney disease; group, per session, per one hour
• G0422 Intensive cardiac rehabilitation; with or without continuous ecg monitoring with exercise, per session
• G0423 Intensive cardiac rehabilitation; with or without continuous ecg monitoring; without exercise, per session
• G0424 Pulmonary rehabilitation, including exercise (includes monitoring), one hour, per session, up to two sessions per day
• G0425 Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth
• G0426 Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth
• G0427 Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth
• G0428 Collagen meniscus implant procedure for filling meniscal defects (e.g., cmi, collagen scaffold, menaflex)
• G0429 Dermal filler injection(s) for the treatment of facial lipodystrophy syndrome (lds) (e.g., as a result of highly active antiretroviral therapy)
• G0431 Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter
• G0432 Infectious agent antibody detection by enzyme immunoassay (eia) technique, hiv-1 and/or hiv-2, screening
• G0433 Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening
• G0434 Drug screen, other than chromatographic; any number of drug classes, by clia waived test or moderate complexity test, per patient encounter
• G0435 Infectious agent antibody detection by rapid antibody test, hiv-1 and/or hiv-2, screening
• G0436 Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes
• G0437 Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes
• G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
• G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
• G0442 Annual alcohol misuse screening, 5 to 15 minutes
• G0443 Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes
• G0444 Annual depression screening, 5 to 15 minutes
• G0445 High intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual, includes: education, skills training and guidance on how to change sexual behavior; performed semi-annually, 30 minutes
• G0446 Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes
• G0447 Face-to-face behavioral counseling for obesity, 15 minutes
• G0448 Insertion or replacement of a permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber with insertion of pacing electrode, cardiac venous system, for left ventricular pacing
• G0451 Development testing, with interpretation and report, per standardized instrument form
• G0452 Molecular pathology procedure; physician interpretation and report
• G0453 Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition to primary procedure)
• G0454 Physician documentation of face-to-face visit for durable medical equipment determination performed by nurse practitioner, physician assistant or clinical nurse specialist
• G0455 Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen
• G0456 Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area less than or equal to 50 square centimeters
• G0457 Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area greater than 50 square centimeters
• G0458 Low dose rate (ldr) prostate brachytherapy services, composite rate
• G0459 Inpatient telehealth pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy
• G0460 Autologous platelet rich plasma or other blood-derived product for non-diabetic chronic wounds/ulcers, including as applicable phlebotomy, centrifugation or mixing, and all other preparatory procedures, administration and dressings, per treatment
• G0461 Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stain
• G0462 Immunohistochemistry or immunocytochemistry, per specimen; each additional single or multiplex antibody stain (list separately in addition to code for primary procedure)
• G0463 Hospital outpatient clinic visit for assessment and management of a patient
• G0464 Colorectal cancer screening; stool-based dna and fecal occult hemoglobin (e.g., kras, ndrg4 and bmp3)
• G0465 Autologous platelet rich plasma (prp) or other blood-derived product for diabetic chronic wounds/ulcers, using an fda-cleared device for this indication, (includes as applicable administration, dressings, phlebotomy, centrifugation or mixing, and all other preparatory procedures, per treatment)
• G0466 Federally qualified health center (fqhc) visit, new patient; a medically-necessary, face-to-face encounter (one-on-one) between a new patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit
• G0467 Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit
• G0468 Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv
• G0469 Federally qualified health center (fqhc) visit, mental health, new patient; a medically-necessary, face-to-face mental health encounter (one-on-one) between a new patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a mental health visit
• G0470 Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a mental health visit
• G0471 Collection of venous blood by venipuncture or urine sample by catheterization from an individual in a skilled nursing facility (snf) or by a laboratory on behalf of a home health agency (hha)
• G0472 Hepatitis c antibody screening, for individual at high risk and other covered indication(s)
• G0473 Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes
• G0475 Hiv antigen/antibody, combination assay, screening
• G0476 Infectious agent detection by nucleic acid (dna or rna); human papillomavirus (hpv), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test
• G0477 Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) capable of being read by direct optical observation only (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service
• G0478 Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) read by instrument-assisted direct optical observation (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service
• G0479 Drug test(s), presumptive, any number of drug classes; any number of devices or procedures by instrumented chemistry analyzers utilizing immunoassay, enzyme assay, tof, maldi, ldtd, desi, dart, ghpc, gc mass spectrometry), includes sample validation when performed, per date of service
• G0480 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed
• G0481 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 8-14 drug class(es), including metabolite(s) if performed
• G0482 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 15-21 drug class(es), including metabolite(s) if performed
• G0483 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed
• G0490 Face-to-face home health nursing visit by a rural health clinic (rhc) or federally qualified health center (fqhc) in an area with a shortage of home health agencies; (services limited to rn or lpn only)
• G0491 Dialysis procedure at a medicare certified esrd facility for acute kidney injury without esrd
• G0492 Dialysis procedure with single evaluation by a physician or other qualified health care professional for acute kidney injury without esrd
• G0493 Skilled services of a registered nurse (rn) for the observation and assessment of the patient's condition, each 15 minutes (the change in the patient's condition requires skilled nursing personnel to identify and evaluate the patient's need for possible modification of treatment in the home health or hospice setting)
• G0494 Skilled services of a licensed practical nurse (lpn) for the observation and assessment of the patient's condition, each 15 minutes (the change in the patient's condition requires skilled nursing personnel to identify and evaluate the patient's need for possible modification of treatment in the home health or hospice setting)
• G0495 Skilled services of a registered nurse (rn), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes
• G0496 Skilled services of a licensed practical nurse (lpn), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes
• G0498 Chemotherapy administration, intravenous infusion technique; initiation of infusion in the office/clinic setting using office/clinic pump/supplies, with continuation of the infusion in the community setting (e.g., home, domiciliary, rest home or assisted living) using a portable pump provided by the office/clinic, includes follow up office/clinic visit at the conclusion of the infusion
• G0499 Hepatitis b screening in non-pregnant, high risk individual includes hepatitis b surface antigen (hbsag), antibodies to hbsag (anti-hbs) and antibodies to hepatitis b core antigen (anti-hbc), and is followed by a neutralizing confirmatory test, when performed, only for an initially reactive hbsag result
• G0500 Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intra-service time; patient age 5 years or older (additional time may be reported with 99153, as appropriate)
• G0501 Resource-intensive services for patients for whom the use of specialized mobility-assistive technology (such as adjustable height chairs or tables, patient lift, and adjustable padded leg supports) is medically necessary and used during the provision of an office/outpatient, evaluation and management visit (list separately in addition to primary service)
• G0502 Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: outreach to and engagement in treatment of a patient directed by the treating physician or other qualified health care professional; initial assessment of the patient, including administration of validated rating scales, with the development of an individualized treatment plan; review by the psychiatric consultant with modifications of the plan if recommended; entering patient in a registry and tracking patient follow-up and progress using the registry, with appropriate documentation, and participation in weekly caseload consultation with the psychiatric consultant; and provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies
• G0503 Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: tracking patient follow-up and progress using the registry, with appropriate documentation; participation in weekly caseload consultation with the psychiatric consultant; ongoing collaboration with and coordination of the patient's mental health care with the treating physician or other qualified health care professional and any other treating mental health providers; additional review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations provided by the psychiatric consultant; provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies; monitoring of patient outcomes using validated rating scales; and relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharge from active treatment
• G0504 Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional (list separately in addition to code for primary procedure); (use g0504 in conjunction with g0502, g0503)
• G0505 Cognition and functional assessment using standardized instruments with development of recorded care plan for the patient with cognitive impairment, history obtained from patient and/or caregiver, in office or other outpatient setting or home or domiciliary or rest home
• G0506 Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service)
• G0507 Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month, with 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, pharmacotherapy, counseling and/or psychiatric consultation; and continuity of care with a designated member of the care team
• G0508 Telehealth consultation, critical care, initial , physicians typically spend 60 minutes communicating with the patient and providers via telehealth
• G0509 Telehealth consultation, critical care, subsequent, physicians typically spend 50 minutes communicating with the patient and providers via telehealth
• G0511 Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month
• G0512 Rural health clinic or federally qualified health center (rhc/fqhc) only, psychiatric collaborative care model (psychiatric cocm), 60 minutes or more of clinical staff time for psychiatric cocm services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm) and including services furnished by a behavioral health care manager and consultation with a psychiatric consultant, per calendar month
• G0513 Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (list separately in addition to code for preventive service)
• G0514 Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes (list separately in addition to code g0513 for additional 30 minutes of preventive service)
• G0515 Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes
• G0516 Insertion of non-biodegradable drug delivery implants, 4 or more (services for subdermal rod implant)
• G0517 Removal of non-biodegradable drug delivery implants, 4 or more (services for subdermal implants)
• G0518 Removal with reinsertion, non-biodegradable drug delivery implants, 4 or more (services for subdermal implants)
• G0519 Management of new patient-caregiver dyad with dementia, low complexity, for use in cmmi model
• G0520 Management of new patient-caregiver dyad with dementia, moderate complexity, for use in cmmi model
• G0521 Management of new patient-caregiver dyad with dementia, high complexity, for use in cmmi model
• G0522 Management of a new patient with dementia, low complexity, for use in cmmi model
• G0523 Management of a new patient with dementia, moderate to high complexity, for use in cmmi model
• G0524 Management of established patient-caregiver dyad with dementia, low complexity, for use in cmmi model
• G0525 Management of established patient-caregiver dyad with dementia, moderate complexity, for use in cmmi model
• G0526 Management of established patient-caregiver dyad with dementia, high complexity, for use in cmmi model
• G0527 Management of established patient with dementia, low complexity, for use in cmmi model
• G0528 Management of established patient with dementia, moderate to high complexity, for use in cmmi model
• G0529 In-home respite care, 4-hour unit, for use in cmmi model
• G0530 Adult day center, 8-hour unit, for use in cmmi model
• G0531 Facility-based respite, 24-hour unit, for use in cmmi model
• 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)
• 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)
• 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)
• 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)
• 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)
• G0537 Administration of a standardized, evidence-based atherosclerotic cardiovascular disease (ascvd) risk assessment, 5-15 minutes, not more often than every 12 months
• G0538 Atherosclerotic cardiovascular disease (ascvd) risk management services; clinical staff time; per calendar month
• 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
• 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
• 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
• 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)
• 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
• 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
• 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)
• 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
• 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
• 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
• 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
• 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
• 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
• G0552 Supply of digital mental health treatment device and initial education and onboarding, per course of treatment that augments a behavioral therapy plan
• 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
• 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
• G0555 Provision of replacement patient electronics system (e.g., system pillow, handheld reader) for home pulmonary artery pressure monitoring
• 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
• 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
• 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
• 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)
• 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
• 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)
• 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)
• 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
• G0564 Creation of subcutaneous pocket with insertion of 365 day implantable interstitial glucose sensor, including system activation and patient training
• 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
• G0566 3d radiodensity-value bone imaging, algorithm derived, from previous magnetic resonance examination of the same anatomy
• G0567 Infectious agent detection by nucleic acid (dna or rna); hepatitis c, screening, amplified probe technique
• G0568 Initial psychiatric collaborative care management, in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: outreach to and engagement in treatment of a patient directed by the treating physician or other qualified health care professional, initial assessment of the patient, including administration of validated rating scales, with the development of an individualized treatment plan, review by the psychiatric consultant with modifications of the plan if recommended, entering patient in a registry and tracking patient follow-up and progress using the registry, with appropriate documentation, and participation in weekly caseload consultation with the psychiatric consultant, and provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies (list separately in addition to the advanced primary care management code)
• G0569 Subsequent psychiatric collaborative care management, in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: tracking patient follow-up and progress using the registry, with appropriate documentation, participation in weekly caseload consultation with the psychiatric consultant, ongoing collaboration with and coordination of the patient's mental health care with the treating physician or other qualified health care professional and any other treating mental health providers, additional review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations provided by the psychiatric consultant, provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies, monitoring of patient outcomes using validated rating scales, and relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharge from active treatment (list separately in addition to advanced primary care management code)
• G0570 Care management services for behavioral health conditions, directed by a physician or other qualified health care professional, per calendar month, with 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, pharmacotherapy, counseling and/or psychiatric consultation, and continuity of care with a designated member of the care team (list separately in addition to advanced primary care management code)
• G0571 Intraoperative nerve(s) cryoablation for post-surgical pain relief (list separately in addition to code for primary service)
• G0574 Management of new patient with dementia residing in an eligible residential care community, for use only in a medicare-approved cmmi model (services must be furnished within a patient's eligible residential care community, including assisted living facilities, board and care homes, or other qualifying residential settings where dementia care services are provided)
• G0575 Management of established patient with dementia residing in an eligible residential care community, for use only in a medicare-approved cmmi model (services must be furnished within a patient's eligible residential care community, including assisted living facilities, board and care homes, or other qualifying residential settings where dementia care services are provided)
• G0577 Vascular embolization or occlusion procedure with use of a pressure-generating catheter (e.g., one-way valve, intermittently occluding), inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction performed in the non-facility setting
• G0659 Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem), excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase), performed without method or drug-specific calibration, without matrix-matched quality control material, or without use of stable isotope or other universally recognized internal standard(s) for each drug, drug metabolite or drug class per specimen; qualitative or quantitative, all sources, includes specimen validity testing, per day, any number of drug classes
• G0660 Team remote e/m new pt 10mins
• G0661 Team remote e/m new pt 20mins
• G0662 Team remote e/m new pt 30 mins
• G0663 Team remote e/m new pt 45mins
• G0664 Team remote e/m new pt 60mins
• G0665 Team remote e/m est. pt 10mins
• G0666 Team remote e/m est. pt 15mins
• G0667 Team remote e/m est. pt 25mins
• G0668 Team remote e/m est. pt 40mins
• G0669 Outcome-aligned payment (oap) for technology-enabled chronic care management of early cardio-kidney-metabolic (eckm) conditions (hypertension, or two or more of: dyslipidemia, obesity/overweight with central obesity marker, prediabetes); initial 12-month period; per month
• G0670 Outcome-aligned payment (oap) for technology-enabled chronic care management of early cardio-kidney-metabolic (eckm) conditions (hypertension, or two or more of: dyslipidemia, obesity/overweight with central obesity marker, prediabetes); follow-on 12-month period; per month
• G0671 Outcome-aligned payment (oap) for technology-enabled chronic care management of cardio-kidney-metabolic (ckm) conditions (one or more of: diabetes mellitus, chronic kidney disease stage 3a or 3b, atherosclerotic cardiovascular disease); initial 12-month period; per month
• G0672 Outcome-aligned payment (oap) for technology-enabled chronic care management of cardio-kidney-metabolic (ckm) conditions (one or more of: diabetes mellitus, chronic kidney disease stage 3a or 3b, atherosclerotic cardiovascular disease); follow-on 12-month period; per month
• G0673 Outcome-aligned payment (oap) for technology-enabled chronic care management of musculoskeletal (msk) conditions (chronic musculoskeletal pain); initial 12-month treatment period; per month
• G0674 Outcome-aligned payment (oap) for technology-enabled chronic care management of behavioral health (bh) conditions (one or more of: depression, anxiety); initial 12-month period; per month
• G0675 Outcome-aligned payment (oap) for technology-enabled chronic care management of behavioral health (bh) conditions (one or more of: depression, anxiety); follow-on 12-month period; per month
• G0676 Standard co-management service payment for documented review of clinical updates from access participant managing cardio-kidney-metabolic conditions (early cardio-kidney-metabolic [eckm] or cardio-kidney-metabolic [ckm] track); per review
• G0677 Standard co-management service payment for documented review of clinical updates from access participant managing musculoskeletal (msk) conditions; per review
• G0678 Standard co-management service payment for documented review of clinical updates from access participant managing behavioral health (bh) conditions (depression, anxiety); per review
• G0680 Detection and quantification of coronary artery calcium and/or aortic valve calcification from algorithmic analysis of computed tomography of the chest with report
• G0681 Application of a premarket approval (pma), 510(k), 361 human cells, tissues or cellular and tissue-based products (hct/p) non-sheet form skin substitute for a wound surface area up to 100 sq cm; first 25 sq cm or less of wound surface area
• G0682 Application of a premarket approval (pma), 510(k), 361 human cells, tissues or cellular and tissue-based products (hct/p) non-sheet form skin substitute for a wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary procedure)
• G0683 Application of a premarket approval (pma), 510(k), 361 human cells, tissues or cellular and tissue-based products (hct/p) non-sheet form skin substitute graft for a wound surface greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children
• G0684 Application of a premarket approval (pma), 510(k), 361 human cells, tissues or cellular and tissue-based products (hct/p) non-sheet form skin substitute graft for a wound surface greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area or part thereof, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure)
• G0908 Most recent hemoglobin (hgb) level > 12.0 g/dl
• G0909 Hemoglobin level measurement not documented, reason not given
• G0910 Most recent hemoglobin level <= 12.0 g/dl
• G0913 Improvement in visual function achieved within 90 days following cataract surgery
• G0914 Patient care survey was not completed by patient
• G0915 Improvement in visual function not achieved within 90 days following cataract surgery
• G0916 Satisfaction with care achieved within 90 days following cataract surgery
• G0917 Patient care survey was not completed by patient
• G0918 Satisfaction with care not achieved within 90 days following cataract surgery
• G0919 Influenza immunization ordered or recommended (to be given at alternate location or alternate provider); vaccine not available at time of visit
• G0920 Type, anatomic location, and activity all documented
• G0921 Documentation of patient reason(s) for not being able to assess (e.g., patient refuses endoscopic and/or radiologic assessment)
• G0922 No documentation of disease type, anatomic location, and activity, reason not given
• G1000 Clinical decision support mechanism applied pathways, as defined by the medicare appropriate use criteria program
• G1001 Clinical decision support mechanism evicore, as defined by the medicare appropriate use criteria program
• G1002 Clinical decision support mechanism medcurrent, as defined by the medicare appropriate use criteria program
• G1003 Clinical decision support mechanism medicalis, as defined by the medicare appropriate use criteria program
• G1004 Clinical decision support mechanism national decision support company, as defined by the medicare appropriate use criteria program
• G1005 Clinical decision support mechanism national imaging associates, as defined by the medicare appropriate use criteria program
• G1006 Clinical decision support mechanism test appropriate, as defined by the medicare appropriate use criteria program
• G1007 Clinical decision support mechanism aim specialty health, as defined by the medicare appropriate use criteria program
• G1008 Clinical decision support mechanism cranberry peak, as defined by the medicare appropriate use criteria program
• G1009 Clinical decision support mechanism sage health management solutions, as defined by the medicare appropriate use criteria program
• G1010 Clinical decision support mechanism stanson, as defined by the medicare appropriate use criteria program
• G1011 Clinical decision support mechanism, qualified tool not otherwise specified, as defined by the medicare appropriate use criteria program
• G1012 Clinical decision support mechanism agilemd, as defined by the medicare appropriate use criteria program
• G1013 Clinical decision support mechanism evidencecare imagingcare, as defined by the medicare appropriate use criteria program
• G1014 Clinical decision support mechanism inveniqa semantic answers in medicine, as defined by the medicare appropriate use criteria program
• G1015 Clinical decision support mechanism reliant medical group, as defined by the medicare appropriate use criteria program
• G1016 Clinical decision support mechanism speed of care, as defined by the medicare appropriate use criteria program
• G1017 Clinical decision support mechanism healthhelp, as defined by the medicare appropriate use criteria program
• G1018 Clinical decision support mechanism infinx, as defined by the medicare appropriate use criteria program
• G1019 Clinical decision support mechanism logicnets, as defined by the medicare appropriate use criteria program
• G1020 Clinical decision support mechanism curbside clinical augmented workflow, as defined by the medicare appropriate use criteria program
• G1021 Clinical decision support mechanism ehealthline clinical decision support mechanism, as defined by the medicare appropriate use criteria program
• G1022 Clinical decision support mechanism intermountain clinical decision support mechanism, as defined by the medicare appropriate use criteria program
• G1023 Clinical decision support mechanism persivia clinical decision support, as defined by the medicare appropriate use criteria program
• G1024 Clinical decision support mechanism radrite, as defined by the medicare appropriate use criteria program
• G1025 Patient-months where there are more than one medicare capitated payment (mcp) provider listed for the month
• G1026 The number of adult patient-months in the denominator who were on maintenance hemodialysis using a catheter continuously for three months or longer under the care of the same practitioner or group partner as of the last hemodialysis session of the reporting month
• G1027 The number of adult patient-months in the denominator who were on maintenance hemodialysis under the care of the same practitioner or group partner as of the last hemodialysis session of the reporting month using a catheter continuously for less than three months
• G1028 Take-home supply of nasal naloxone; 2-pack of 8mg per 0.1 ml nasal spray (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure
• G2000 Blinded administration of convulsive therapy procedure, either electroconvulsive therapy (ect, current covered gold standard) or magnetic seizure therapy (mst, non-covered experimental therapy), performed in an approved ide-based clinical trial, per treatment session
• G2001 Brief (20 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
• G2002 Limited (30 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
• G2003 Moderate (45 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
• G2004 Comprehensive (60 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
• G2005 Extensive (75 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
• G2006 Brief (20 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
• G2007 Limited (30 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
• G2008 Moderate (45 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
• G2009 Comprehensive (60 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
• G2010 Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, 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
• G2011 Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention, 5-14 minutes
• 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
• G2013 Extensive (75 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
• G2014 Limited (30 minutes) care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
• G2015 Comprehensive (60 mins) home care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility.)
• G2020 Services for high intensity clinical services associated with the initial engagement and outreach of beneficiaries assigned to the sip component of the pcf model (do not bill with chronic care management codes)
• G2021 Health care practitioners rendering treatment in place (tip)
• G2022 A model participant (ambulance supplier/provider), the beneficiary refuses services covered under the model (transport to an alternate destination/treatment in place)
• G2023 Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source
• G2024 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
• G2025 Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only
• G2058 Chronic care management services, each additional 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (list separately in addition to code for primary procedure). (do not report g2058 for care management services of less than 20 minutes additional to the first 20 minutes of chronic care management services during a calendar month). (use g2058 in conjunction with 99490). (do not report 99490, g2058 in the same calendar month as 99487, 99489, 99491)).
• G2061 Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 5-10 minutes
• G2062 Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11-20 minutes
• G2063 Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes
• G2064 Comprehensive care management services for a single high-risk disease, e.g., principal care management, at least 30 minutes of physician or other qualified health care professional time per calendar month with the following elements: one complex chronic condition lasting at least 3 months, which is the focus of the care plan, the condition is of sufficient severity to place patient at risk of hospitalization or have been the cause of a recent hospitalization, the condition requires development or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities
• G2065 Comprehensive care management for a single high-risk disease services, e.g. principal care management, at least 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month with the following elements: one complex chronic condition lasting at least 3 months, which is the focus of the care plan, the condition is of sufficient severity to place patient at risk of hospitalization or have been cause of a recent hospitalization, the condition requires development or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities
• G2066 Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, implantable loop recorder system, or subcutaneous cardiac rhythm monitor system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results
• G2067 Medication assisted treatment, methadone; 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)
• G2068 Medication assisted treatment, buprenorphine (oral); 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)
• 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)
• 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)
• 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)
• 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)
• G2073 Medication assisted treatment, naltrexone; 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)
• G2074 Medication assisted treatment, weekly bundle not including the drug, including substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)
• G2075 Medication assisted treatment, medication not otherwise specified; 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)
• 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 assessment, 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, physical activity and/or nutrition needs 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
• 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, nutrition and psychiatric treatment needs and goals; may be informed by administration of a standardized, evidence-based assessment, 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
• G2078 Take-home supply of methadone; up to 7 additional day supply (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure
• G2079 Take-home supply of buprenorphine (oral); up to 7 additional day supply (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure
• G2080 Each additional 30 minutes of counseling in a week of medication assisted treatment, (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure
• G2081 Patients age 66 and older in institutional special needs plans (snp) or residing in long-term care with a pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period
• G2082 Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of up to 56 mg of esketamine nasal self-administration, includes 2 hours post-administration observation
• G2083 Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of greater than 56 mg esketamine nasal self-administration, includes 2 hours post-administration observation
• G2086 Office-based treatment for opioid use disorder, including development of the treatment plan, care coordination, individual therapy and group therapy and counseling; at least 70 minutes in the first calendar month
• G2087 Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; at least 60 minutes in a subsequent calendar month
• G2088 Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; each additional 30 minutes beyond the first 120 minutes (list separately in addition to code for primary procedure)
• G2089 Most recent hemoglobin a1c (hba1c) level 7.0 to 9.0%
• G2090 Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
• 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
• G2092 Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) or angiotensin receptor-neprilysin inhibitor (arni) therapy prescribed or currently being taken
• G2093 Documentation of medical reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., hypotensive patients who are at immediate risk of cardiogenic shock, hospitalized patients who have experienced marked azotemia, allergy, intolerance, other medical reasons)
• G2094 Documentation of patient reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., patient declined, other patient reasons)
• G2095 Documentation of system reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., other system reasons)
• G2096 Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) or angiotensin receptor-neprilysin inhibitor (arni) therapy was not prescribed, reason not given
• G2097 Episodes where the patient had a competing diagnosis on or within three days after the episode date (e.g., intestinal infection, pertussis, bacterial infection, lyme disease, otitis media, acute sinusitis, chronic sinusitis, infection of the adenoids, prostatitis, cellulitis, mastoiditis, or bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia/gonococcal infections, venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis or uti)
• G2098 Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
• 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
• G2100 Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
• 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
• G2102 Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed
• G2103 Seven standard field stereoscopic photos with interpretation by an ophthalmologist or optometrist documented and reviewed
• G2104 Eye imaging validated to match diagnosis from seven standard field stereoscopic photos results documented and reviewed
• G2105 Patient age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period
• G2106 Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
• 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
• G2108 Patient age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period
• G2109 Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
• G2110 Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period
• G2112 Patient receiving <=5 mg daily prednisone (or equivalent), or ra activity is worsening, or glucocorticoid use is for less than 6 months
• G2113 Patient receiving >5 mg daily prednisone (or equivalent) for longer than 6 months, and improvement or no change in disease activity
• G2114 Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
• G2115 Patients 66 - 80 years of age with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
• 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
• G2117 Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period
• G2118 Patients 81 years of age and older with at least one claim/encounter for frailty during the measurement period
• G2119 Within the past 2 years, calcium and/or vitamin d optimization has been ordered or performed
• G2120 Within the past 2 years, calcium and/or vitamin d optimization has not been ordered or performed
• G2121 Depression, anxiety, apathy, and psychosis assessed
• G2122 Depression, anxiety, apathy, and psychosis not assessed
• G2123 Patients 66-80 years of age and had at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period
• G2124 Patients 66-80 years of age and had at least one claim/encounter for frailty during the measurement period and a dispensed dementia medication
• G2125 Patients 81 years of age and older with at least one claim/encounter for frailty during the six months prior to the measurement period through december 31 of the measurement period
• 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
• G2127 Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
• G2128 Documentation of medical reason(s) for not on a daily aspirin or other antiplatelet (e.g. history of gastrointestinal bleed, intra-cranial bleed, blood disorders, idiopathic thrombocytopenic purpura (itp), gastric bypass or documentation of active anticoagulant use during the measurement period)
• G2129 Procedure-related bp's not taken during an outpatient visit. examples include same day surgery, ambulatory service center, g.i. lab, dialysis, infusion center, chemotherapy
• G2130 Patients age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 days during the measurement period
• G2131 Patients 81 years and older with a diagnosis of frailty
• G2132 Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
• G2133 Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period
• G2134 Patients 66 years of age or older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
• G2135 Patients 66 years of age or older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period
• G2136 Back pain measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively was less than or equal to 3.0 or back pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated an improvement of 5.0 points or greater
• G2137 Back pain measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively was greater than 3.0 and back pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated improvement of less than 5.0 points
• G2138 Back pain as measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively was less than or equal to 3.0 or back pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of 5.0 points or greater
• G2139 Back pain measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively was greater than 3.0 and back pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated improvement of less than 5.0 points
• G2140 Leg pain measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively was less than or equal to 3.0 or leg pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated an improvement of 5.0 points or greater
• G2141 Leg pain measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively was greater than 3.0 and leg pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated improvement of less than 5.0 points
• G2142 Functional status measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively was less than or equal to 22 or functional status measured by the odi version 2.1a within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of 30 points or greater
• G2143 Functional status measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively was greater than 22 and functional status measured by the odi version 2.1a within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of less than 30 points
• G2144 Functional status measured by the oswestry disability index (odi version 2.1a) at three months (6-20 weeks) postoperatively was less than or equal to 22 or functional status measured by the odi version 2.1a within three months preoperatively and at three months (6-20 weeks) postoperatively demonstrated an improvement of 30 points or greater
• G2145 Functional status measured by the oswestry disability index (odi version 2.1a) at three months (6 - 20 weeks) postoperatively was greater than 22 and functional status measured by the odi version 2.1a within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated an improvement of less than 30 points
• G2146 Leg pain as measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively was less than or equal to 3.0 or leg pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of 5.0 points or greater
• G2147 Leg pain measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively was greater than 3.0 and leg pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated improvement of less than 5.0 points
• G2148 Multimodal pain management was used
• G2149 Documentation of medical reason(s) for not using multimodal pain management (e.g., allergy to multiple classes of analgesics, intubated patient, hepatic failure, patient reports no pain during pacu stay, other medical reason(s))
• G2150 Multimodal pain management was not used
• G2151 Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time before or during the episode of care
• G2152 Residual score for the neck impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
• G2153 In hospice or using hospice services during the measurement period
• G2154 Patient received at least one td vaccine or one tdap vaccine between nine years prior to the start of the measurement period and the end of the measurement period
• G2155 Patient had history of at least one of the following contraindications any time during or before the measurement period: anaphylaxis due to tdap vaccine, anaphylaxis due to td vaccine or its components; encephalopathy due to tdap or td vaccination (post tetanus vaccination encephalitis, post diphtheria vaccination encephalitis or post pertussis vaccination encephalitis.)
• G2156 Patient did not receive at least one td vaccine or one tdap vaccine between nine years prior to the start of the measurement period and the end of the measurement period; or have history of at least one of the following contraindications any time during or before the measurement period: anaphylaxis due to tdap vaccine, anaphylaxis due to td vaccine or its components; encephalopathy due to tdap or td vaccination (post tetanus vaccination encephalitis, post diphtheria vaccination encephalitis or post pertussis vaccination encephalitis.)
• G2157 Patients received both the 13-valent pneumococcal conjugate vaccine and the 23-valent pneumococcal polysaccharide vaccine at least 12 months apart, with the first occurrence after the age of 60 before or during the measurement period
• G2158 Patient had prior pneumococcal vaccine adverse reaction any time during or before the measurement period
• G2159 Patient did not receive both the 13-valent pneumococcal conjugate vaccine and the 23-valent pneumococcal polysaccharide vaccine at least 12 months apart, with the first occurrence after the age of 60 before or during measurement period; or have prior pneumococcal vaccine adverse reaction any time during or before the measurement period
• G2160 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
• G2161 Patient had prior adverse reaction caused by zoster vaccine or its components any time during or before the measurement period
• G2162 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; or have prior adverse reaction caused by zoster vaccine or its components any time during or before the measurement period
• G2163 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
• G2164 Patient had a prior influenza virus vaccine adverse reaction any time before or during the measurement period
• G2165 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; or did not have a prior influenza virus vaccine adverse reaction any time before or during the measurement period
• G2166 Patient refused to participate at admission and/or discharge; patient unable to complete the neck fs prom at admission or discharge due to cognitive deficit, visual deficit, motor deficit, language barrier, or low reading level, and a suitable proxy/recorder is not available; patient self-discharged early; medical reason
• G2167 Residual score for the neck impairment successfully calculated and the score was less than zero (< 0)
• G2168 Services performed by a physical therapist assistant in the home health setting in the delivery of a safe and effective physical therapy maintenance program, each 15 minutes
• G2169 Services performed by an occupational therapist assistant in the home health setting in the delivery of a safe and effective occupational therapy maintenance program, each 15 minutes
• G2170 Percutaneous arteriovenous fistula creation (avf), direct, any site, by tissue approximation using thermal resistance energy, and secondary procedures to redirect blood flow (e.g., transluminal balloon angioplasty, coil embolization) when performed, and includes all imaging and radiologic guidance, supervision and interpretation, when performed
• G2171 Percutaneous arteriovenous fistula creation (avf), direct, any site, using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, wen performed) and fistulogram(s), angiography, enography, and/or ultrasound, with radiologic supervision and interpretation, when performed
• G2172 All inclusive payment for services related to highly coordinated and integrated opioid use disorder (oud) treatment services furnished for the demonstration project
• G2173 Uri episodes where the patient had a comorbid condition during the 12 months prior to or on the episode date (e.g., tuberculosis, neutropenia, cystic fibrosis, chronic bronchitis, pulmonary edema, respiratory failure, rheumatoid lung disease)
• G2174 Uri episodes where the patient is taking antibiotics (table 1) in the 30 days prior to the episode date
• G2175 Episodes where the patient had a comorbid condition during the 12 months prior to or on the episode date (e.g., tuberculosis, neutropenia, cystic fibrosis, chronic bronchitis, pulmonary edema, respiratory failure, rheumatoid lung disease)
• G2176 Outpatient, ed, or observation visits that result in an inpatient admission
• G2177 Acute bronchitis/bronchiolitis episodes when the patient had a new or refill prescription of antibiotics (table 1) in the 30 days prior to the episode date
• G2178 Clinician documented that patient was not an eligible candidate for lower extremity neurological exam measure, for example patient bilateral amputee; patient has condition that would not allow them to accurately respond to a neurological exam (dementia, alzheimer's, etc.); patient has previously documented diabetic peripheral neuropathy with loss of protective sensation
• G2179 Clinician documented that patient had medical reason for not performing lower extremity neurological exam
• G2180 Clinician documented that patient was not an eligible candidate for evaluation of footwear as patient is bilateral lower extremity amputee
• G2181 Bmi not documented due to medical reason or patient refusal of height or weight measurement
• G2182 Patient receiving first-time biologic and/or immune response modifier therapy
• G2183 Documentation patient unable to communicate and informant not available
• G2184 Patient does not have a caregiver
• G2185 Documentation caregiver is trained and certified in dementia care
• G2186 Patient /caregiver dyad has been referred to appropriate resources and connection to those resources is confirmed
• G2187 Patients with clinical indications for imaging of the head: head trauma
• G2188 Patients with clinical indications for imaging of the head: new or change in headache above 50 years of age
• G2189 Patients with clinical indications for imaging of the head: abnormal neurologic exam
• G2190 Patients with clinical indications for imaging of the head: headache radiating to the neck
• G2191 Patients with clinical indications for imaging of the head: positional headaches
• G2192 Patients with clinical indications for imaging of the head: temporal headaches in patients over 55 years of age
• G2193 Patients with clinical indications for imaging of the head: new onset headache in pre-school children or younger (<6 years of age)
• G2194 Patients with clinical indications for imaging of the head: new onset headache in pediatric patients with disabilities for which headache is a concern as inferred from behavior
• G2195 Patients with clinical indications for imaging of the head: occipital headache in children
• G2196 Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method
• G2197 Patient screened for unhealthy alcohol use using a systematic screening method and not identified as an unhealthy alcohol user
• G2198 Documentation of medical reason(s) for not screening for unhealthy alcohol use using a systematic screening method (e.g., limited life expectancy, other medical reasons)
• G2199 Patient not screened for unhealthy alcohol use using a systematic screening method
• G2200 Patient identified as an unhealthy alcohol user received brief counseling
• G2201 Documentation of medical reason(s) for not providing brief counseling (e.g., limited life expectancy, other medical reasons)
• G2202 Patient did not receive brief counseling if identified as an unhealthy alcohol user
• G2203 Documentation of medical reason(s) for not providing brief counseling if identified as an unhealthy alcohol user (e.g., limited life expectancy, other medical reasons)
• G2204 Patients between 45 and 85 years of age who received a screening colonoscopy during the performance period
• G2205 Patients with pregnancy during adjuvant treatment course
• G2206 Patient received adjuvant treatment course including both chemotherapy and her2-targeted therapy
• G2207 Reason for not administering adjuvant treatment course including both chemotherapy and her2-targeted therapy (e.g. poor performance status (ecog 3-4; karnofsky <=50), cardiac contraindications, insufficient renal function, insufficient hepatic function, other active or secondary cancer diagnoses, other medical contraindications, patients who died during initial treatment course or transferred during or after initial treatment course)
• G2208 Patient did not receive adjuvant treatment course including both chemotherapy and her2-targeted therapy
• G2209 Patient refused to participate
• G2210 Residual score for the neck impairment not measured because the patient did not complete the neck fs prom at initial evaluation and/or near discharge, reason not given
• G2211 Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to home or residence or office/outpatient evaluation and management service, new or established)
• G2212 Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99205, 99215, 99483 for office or other outpatient evaluation and management services) (do not report g2212 on the same date of service as 99358, 99359, 99415, 99416). (do not report g2212 for any time unit less than 15 minutes)
• G2213 Initiation of medication for the treatment of opioid use disorder in the emergency department setting, including assessment, referral to ongoing care, and arranging access to supportive services (list separately in addition to code for primary procedure)
• G2214 Initial or subsequent psychiatric collaborative care management, first 30 minutes in a month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional
• G2215 Take-home supply of nasal naloxone; 2-pack of 4mg per 0.1 ml nasal spray (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure
• G2216 Take-home supply of injectable naloxone (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure
• G2250 Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment
• G2251 Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of clinical discussion
• G2252 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; 11-20 minutes of medical discussion
• G3001 Administration and supply of tositumomab, 450 mg
• G3002 Chronic pain management and treatment, monthly bundle including, diagnosis; assessment and monitoring; administration of a validated pain rating scale or tool; the development, implementation, revision, and/or maintenance of a person-centered care plan that includes strengths, goals, clinical needs, and desired outcomes; overall treatment management; facilitation and coordination of any necessary behavioral health treatment; medication management; pain and health literacy counseling; any necessary chronic pain related crisis care; and ongoing communication and care coordination between relevant practitioners furnishing care, e.g. physical therapy and occupational therapy, complementary and integrative approaches, and community-based care, as appropriate. required initial face-to-face visit at least 30 minutes provided by a physician or other qualified health professional; first 30 minutes personally provided by physician or other qualified health care professional, per calendar month. (when using g3002, 30 minutes must be met or exceeded.)
• G3003 Each additional 15 minutes of chronic pain management and treatment by a physician or other qualified health care professional, per calendar month. (list separately in addition to code for g3002. when using g3003, 15 minutes must be met or exceeded.)
• G4000 Dermatology mips specialty set
• G4001 Diagnostic radiology mips specialty set
• G4002 Electrophysiology cardiac specialist mips specialty set
• G4003 Emergency medicine mips specialty set
• G4004 Endocrinology mips specialty set
• G4005 Family medicine mips specialty set
• G4006 Gastro-enterology mips specialty set
• G4007 General surgery mips specialty set
• G4008 Geriatrics mips specialty set
• G4009 Hospitalists mips specialty set
• G4010 Infectious disease mips specialty set
• G4011 Internal medicine mips specialty set
• G4012 Interventional radiology mips specialty set
• G4013 Mental/behavioral and psychiatry mips specialty set
• G4014 Nephrology mips specialty set
• G4015 Neurology mips specialty set
• G4016 Neurosurgical mips specialty set
• G4017 Nutrition/dietician mips specialty set
• G4018 Obstetrics/gynecology mips specialty set
• G4019 Oncology/hematology mips specialty set
• G4020 Ophthalmology/optometry mips specialty set
• G4021 Orthopedic surgery mips specialty set
• G4022 Otolaryngology mips specialty set
• G4023 Pathology mips specialty set
• G4024 Pediatrics mips specialty set
• G4025 Physical medicine mips specialty set
• G4026 Physical therapy/occupational therapy mips specialty set
• G4027 Plastic surgery mips specialty set
• G4028 Podiatry mips specialty set
• G4029 Preventive medicine mips specialty set
• G4030 Pulmonology mips specialty set
• G4031 Radiation oncology mips specialty set
• G4032 Rheumatology mips specialty set
• G4033 Skilled nursing facility mips specialty set
• G4034 Speech language pathology mips specialty set
• G4035 Thoracic surgery mips specialty set
• G4036 Urgent care mips specialty set
• G4037 Urology mips specialty set
• G4038 Vascular surgery mips specialty set
• G6001 Ultrasonic guidance for placement of radiation therapy fields
• G6002 Stereoscopic x-ray guidance for localization of target volume for the delivery of radiation therapy
• G6003 Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks: up to 5 mev
• G6004 Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks: 6-10 mev
• G6005 Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks: 11-19 mev
• G6006 Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks: 20 mev or greater
• G6007 Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: up to 5 mev
• G6008 Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 6-10 mev
• G6009 Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 11-19 mev
• G6010 Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 20 mev or greater
• G6011 Radiation treatment delivery, 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; up to 5 mev
• G6012 Radiation treatment delivery, 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 6-10 mev
• G6013 Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 11-19 mev
• G6014 Radiation treatment delivery, 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 20 mev or greater
• G6015 Intensity modulated treatment delivery, single or multiple fields/arcs,via narrow spatially and temporally modulated beams, binary, dynamic mlc, per treatment session
• G6016 Compensator-based beam modulation treatment delivery of inverse planned treatment using 3 or more high resolution (milled or cast) compensator, convergent beam modulated fields, per treatment session
• G6017 Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy (eg,3d positional tracking, gating, 3d surface tracking), each fraction of treatment
• G6018 Ileoscopy, through stoma; with transendoscopic stent placement (includes predilation)
• G6019 Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
• G6020 Colonoscopy through stoma; with transendoscopic stent placement (includes predilation)
• G6021 Unlisted procedure, intestine
• G6022 Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesions(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
• G6023 Sigmoidoscopy, flexible; with transendoscopic stent placement (includes predilation)
• G6024 Colonoscopy, flexible; proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
• G6025 Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic stent placement (includes predilation)
• G6027 Anoscopy, high resolution (hra) (with magnification and chemical agent enhancement); diagnostic, including collection of specimen(s) by brushing or washing when performed
• G6028 Anoscopy, high resolution (hra) (with magnification and chemical agent enhancement); with biopsy(ies)
• G6030 Amitriptyline
• G6031 Benzodiazepines
• G6032 Desipramine
• G6034 Doxepin
• G6035 Gold
• G6036 Assay of imipramine
• G6037 Nortriptyline
• G6038 Salicylate
• G6039 Acetaminophen
• G6040 Alcohol (ethanol); any specimen except breath
• G6041 Alkaloids, urine, quantitative
• G6042 Amphetamine or methamphetamine
• G6043 Barbiturates, not elsewhere specified
• G6044 Cocaine or metabolite
• G6045 Dihydrocodeinone
• G6046 Dihydromorphinone
• G6047 Dihydrotestosterone
• G6048 Dimethadione
• G6049 Epiandrosterone
• G6050 Ethchlorvynol
• G6051 Flurazepam
• G6052 Meprobamate
• G6053 Methadone
• G6054 Methsuximide
• G6055 Nicotine
• G6056 Opiate(s), drug and metabolites, each procedure
• G6057 Phenothiazine
• G6058 Drug confirmation, each procedure
• G8126 Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phase
• G8127 Patient with a diagnosis of major depression not documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phase
• G8128 Clinician documented that patient was not an eligible candidate for antidepressant medication during the entire 12 week acute treatment phase measure
• G8395 Left ventricular ejection fraction (lvef) >= 40% or documentation as normal or mildly depressed left ventricular systolic function
• G8396 Left ventricular ejection fraction (lvef) not performed or documented
• G8397 Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema and level of severity of retinopathy
• G8398 Dilated macular or fundus exam not performed
• G8399 Patient with documented results of a central dual-energy x-ray absorptiometry (dxa) ever being performed
• G8400 Patient with central dual-energy x-ray absorptiometry (dxa) results not documented, reason not given
• G8401 Clinician documented that patient was not an eligible candidate for screening
• G8404 Lower extremity neurological exam performed and documented
• G8405 Lower extremity neurological exam not performed
• G8406 Clinician documented that patient was not an eligible candidate for lower extremity neurological exam measure
• G8410 Footwear evaluation performed and documented
• G8415 Footwear evaluation was not performed
• G8416 Clinician documented that patient was not an eligible candidate for footwear evaluation measure
• G8417 Bmi is documented above normal parameters and a follow-up plan is documented
• G8418 Bmi is documented below normal parameters and a follow-up plan is documented
• G8419 Bmi documented outside normal parameters, no follow-up plan documented, no reason given
• G8420 Bmi is documented within normal parameters and no follow-up plan is required
• G8421 Bmi not documented and no reason is given
• G8422 Bmi not documented, documentation the patient is not eligible for bmi calculation
• G8427 Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications
• G8428 Current list of medications not documented as obtained, updated, or reviewed by the eligible clinician, reason not given
• G8430 Documentation of a medical reason(s) for not documenting, updating, or reviewing the patient's current medications list (e.g., patient is in an acute health crisis where time is of the essence and delay of treatment would jeopardize the patient's health status)
• G8431 Screening for depression is documented as being positive and a follow-up plan is documented
• G8432 Depression screening not documented, reason not given
• G8433 Screening for depression not completed, documented patient or medical reason
• G8442 Pain assessment not documented as being performed, documentation the patient is not eligible for a pain assessment using a standardized tool at the time of the encounter
• G8450 Beta-blocker therapy prescribed
• G8451 Beta-blocker therapy for lvef <=40% not prescribed for reasons documented by the clinician (e.g., low blood pressure, fluid overload, asthma, patients recently treated with an intravenous positive inotropic agent, allergy, intolerance, other medical reasons, patient declined, other patient reasons)
• G8452 Beta-blocker therapy not prescribed
• G8458 Clinician documented that patient is not an eligible candidate for genotype testing; patient not receiving antiviral treatment for hepatitis c during the measurement period (e.g. genotype test done prior to the reporting period, patient declines, patient not a candidate for antiviral treatment)
• G8460 Clinician documented that patient is not an eligible candidate for quantitative rna testing at week 12; patient not receiving antiviral treatment for hepatitis c
• G8461 Patient receiving antiviral treatment for hepatitis c during the measurement period
• G8464 Clinician documented that prostate cancer patient is not an eligible candidate for adjuvant hormonal therapy; low or intermediate risk of recurrence or risk of recurrence not determined
• G8465 High or very high risk of recurrence of prostate cancer
• G8473 Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy prescribed
• G8474 Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy not prescribed for reasons documented by the clinician (e.g., allergy, intolerance, pregnancy, renal failure due to ace inhibitor, diseases of the aortic or mitral valve, other medical reasons) or (e.g., patient declined, other patient reasons)
• G8475 Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy not prescribed, reason not given
• G8476 Most recent blood pressure has a systolic measurement of < 140 mmhg and a diastolic measurement of < 90 mmhg
• G8477 Most recent blood pressure has a systolic measurement of >= 140 mmhg and/or a diastolic measurement of >= 90 mmhg
• G8478 Blood pressure measurement not performed or documented, reason not given
• G8482 Influenza immunization administered or previously received
• 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)
• G8484 Influenza immunization was not administered, reason not given
• G8485 I intend to report the diabetes mellitus (dm) measures group
• G8486 I intend to report the preventive care measures group
• G8487 I intend to report the chronic kidney disease (ckd) measures group
• G8489 I intend to report the coronary artery disease (cad) measures group
• G8490 I intend to report the rheumatoid arthritis (ra) measures group
• G8491 I intend to report the hiv/aids measures group
• G8492 I intend to report the perioperative care measures group
• G8493 I intend to report the back pain measures group
• G8494 All quality actions for the applicable measures in the diabetes mellitus (dm) measures group have been performed for this patient
• G8495 All quality actions for the applicable measures in the chronic kidney disease (ckd) measures group have been performed for this patient
• G8496 All quality actions for the applicable measures in the preventive care measures group have been performed for this patient
• G8497 All quality actions for the applicable measures in the coronary artery bypass graft (cabg) measures group have been performed for this patient
• G8498 All quality actions for the applicable measures in the coronary artery disease (cad) measures group have been performed for this patient
• G8499 All quality actions for the applicable measures in the rheumatoid arthritis (ra) measures group have been performed for this patient
• G8500 All quality actions for the applicable measures in the hiv/aids measures group have been performed for this patient
• G8501 All quality actions for the applicable measures in the perioperative care measures group have been performed for this patient
• G8502 All quality actions for the applicable measures in the back pain measures group have been performed for this patient
• G8506 Patient receiving angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy
• G8509 Pain assessment documented as positive using a standardized tool, follow-up plan not documented, reason not given
• G8510 Screening for depression is documented as negative, a follow-up plan is not required
• G8511 Screening for depression documented as positive, follow-up plan not documented, reason not given
• G8530 Autogenous av fistula received
• G8531 Clinician documented that patient was not an eligible candidate for autogenous av fistula
• G8532 Clinician documented that patient received vascular access other than autogenous av fistula, reason not given
• G8535 Elder maltreatment screen not documented; documentation that patient is not eligible for the elder maltreatment screen at the time of the encounter related to one of the following reasons: (1) patient refuses to participate in the screening and has reasonable decisional capacity for self-protection, or (2) patient is in an urgent or emergent situation where time is of the essence and to delay treatment to perform the screening would jeopardize the patient's health status
• G8536 No documentation of an elder maltreatment screen, reason not given
• G8539 Functional outcome assessment documented as positive using a standardized tool and a care plan based on identified deficiencies is documented within two days of the functional outcome assessment
• G8540 Functional outcome assessment not documented as being performed, documentation the patient is not eligible for a functional outcome assessment using a standardized tool at the time of the encounter
• G8541 Functional outcome assessment using a standardized tool not documented, reason not given
• G8542 Functional outcome assessment using a standardized tool is documented; no functional deficiencies identified, care plan not required
• G8543 Documentation of a positive functional outcome assessment using a standardized tool; care plan not documented within two days of assessment, reason not given
• G8544 I intend to report the coronary artery bypass graft (cabg) measures group
• G8545 I intend to report the hepatitis c measures group
• G8547 I intend to report the ischemic vascular disease (ivd) measures group
• G8548 I intend to report the heart failure (hf) measures group
• G8549 All quality actions for the applicable measures in the hepatitis c measures group have been performed for this patient
• G8551 All quality actions for the applicable measures in the heart failure (hf) measures group have been performed for this patient
• G8552 All quality actions for the applicable measures in the ischemic vascular disease (ivd) measures group have been performed for this patient
• G8559 Patient referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation
• G8560 Patient has a history of active drainage from the ear within the previous 90 days
• G8561 Patient is not eligible for the referral for otologic evaluation for patients with a history of active drainage measure
• G8562 Patient does not have a history of active drainage from the ear within the previous 90 days
• G8563 Patient not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not given
• G8564 Patient was referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not specified)
• G8565 Verification and documentation of sudden or rapidly progressive hearing loss
• G8566 Patient is not eligible for the "referral for otologic evaluation for sudden or rapidly progressive hearing loss" measure
• G8567 Patient does not have verification and documentation of sudden or rapidly progressive hearing loss
• G8568 Patient was not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not given
• G8569 Prolonged postoperative intubation (> 24 hrs) required
• G8570 Prolonged postoperative intubation (> 24 hrs) not required
• G8571 Development of deep sternal wound infection/mediastinitis within 30 days postoperatively
• G8572 No deep sternal wound infection/mediastinitis
• G8573 Stroke following isolated cabg surgery
• G8574 No stroke following isolated cabg surgery
• G8575 Developed postoperative renal failure or required dialysis
• G8576 No postoperative renal failure/dialysis not required
• 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
• 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
• G8579 Antiplatelet medication at discharge
• G8580 Antiplatelet medication contraindicated
• G8581 No antiplatelet medication at discharge
• G8582 Beta-blocker at discharge
• G8583 Beta-blocker contraindicated
• G8584 No beta-blocker at discharge
• G8585 Anti-lipid treatment at discharge
• G8586 Anti-lipid treatment contraindicated
• G8587 No anti-lipid treatment at discharge
• G8593 Lipid profile results documented and reviewed (must include total cholesterol, hdl-c, triglycerides and calculated ldl-c)
• G8594 Lipid profile not performed, reason not given
• G8595 Most recent ldl-c < 100 mg/dl
• G8597 Most recent ldl-c >= 100 mg/dl
• G8598 Aspirin or another antiplatelet therapy used
• G8599 Aspirin or another antiplatelet therapy not used, reason not given
• G8600 Iv thrombolytic therapy initiated within 4.5 hours (<= 270 minutes) of time last known well
• G8601 Iv thrombolytic therapy not initiated within 4.5 hours (<= 270 minutes) of time last known well for reasons documented by clinician (e.g. patient enrolled in clinical trial for stroke, patient admitted for elective carotid intervention)
• G8602 Iv thrombolytic therapy not initiated within 4.5 hours (<= 270 minutes) of time last known well, reason not given
• G8627 Surgical procedure performed within 30 days following cataract surgery for major complications (e.g., retained nuclear fragments, endophthalmitis, dislocated or wrong power iol, retinal detachment, or wound dehiscence)
• G8628 Surgical procedure not performed within 30 days following cataract surgery for major complications (e.g., retained nuclear fragments, endophthalmitis, dislocated or wrong power iol, retinal detachment, or wound dehiscence)
• G8629 Documentation of order for prophylactic parenteral antibiotic to be given within one hour (if fluoroquinolone or vancomycin, two hours) prior to surgical incision (or start of procedure when no incision is required)
• G8630 Documentation that administration of prophylactic parenteral antibiotics was initiated within one hour (if fluoroquinolone or vancomycin, two hours) prior to surgical incision (or start of procedure when no incision is required), as ordered
• G8631 Clinician documented that patient was not an eligible candidate for ordering prophylactic parenteral antibiotics to be given within one hour (if fluoroquinolone or vancomycin, two hours) prior to surgical incision (or start of procedure when no incision is required)
• G8632 Prophylactic parenteral antibiotics were not ordered to be given or given within one hour (if fluoroquinolone or vancomycin, two hours) prior to the surgical incision (or start of procedure when no incision is required), reason not given
• G8633 Pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed
• G8634 Clinician documented patient not an eligible candidate to receive pharmacologic therapy for osteoporosis
• G8635 Pharmacologic therapy for osteoporosis was not prescribed, reason not given
• G8645 I intend to report the asthma measures group
• G8646 All quality actions for the applicable measures in the asthma measures group have been performed for this patient
• G8647 Residual score for the knee impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
• G8648 Residual score for the knee impairment successfully calculated and the score was less than zero (< 0)
• G8649 Risk-adjusted functional status change residual score for the knee impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate
• G8650 Residual score for the knee impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given
• G8651 Residual score for the hip impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
• G8652 Residual score for the hip impairment successfully calculated and the score was less than zero (< 0)
• G8653 Risk-adjusted functional status change residual scores for the hip impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate
• G8654 Residual score for the hip impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given
• G8655 Residual score for the lower leg, foot or ankle impairment successfully calculated and the score was equal to zero (0) or greater than zero ( > 0)
• G8656 Residual score for the lower leg, foot or ankle impairment successfully calculated and the score was less than zero (< 0)
• G8657 Risk-adjusted functional status change residual score for the lower leg, foot or ankle impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate
• G8658 Residual score for the lower leg, foot or ankle impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given
• G8659 Residual score for the low back impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
• G8660 Residual score for the low back impairment successfully calculated and the score was less than zero (< 0)
• G8661 Risk-adjusted functional status change residual score for the low back impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate
• G8662 Residual score for the low back impairment not measured because the patient did not complete the low back fs prom at initial evaluation and/or near discharge, reason not given
• G8663 Residual score for the shoulder impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
• G8664 Residual score for the shoulder impairment successfully calculated and the score was less than zero (< 0)
• G8665 Risk-adjusted functional status change residual score for the shoulder impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate
• G8666 Residual score for the shoulder impairment not measured because the patient did not complete the shoulder fs prom at initial evaluation and/or near discharge, reason not given
• G8667 Residual score for the elbow, wrist or hand impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
• G8668 Residual score for the elbow, wrist or hand impairment successfully calculated and the score was less than zero (< 0)
• G8669 Risk-adjusted functional status change residual score for the elbow, wrist or hand impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate
• G8670 Residual score for the elbow, wrist or hand impairment not measured because the patient did not complete the elbow/wrist/hand fs prom at initial evaluation and/or near discharge, reason not given
• G8671 Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs or other general orthopedic impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
• G8672 Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs or other general orthopedic impairment successfully calculated and the score was less than zero (< 0)
• G8673 Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs or other general orthopedic impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate
• G8674 Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs or other general orthopedic impairment not measured because the patient did not complete the general orthopedic fs prom at initial evaluation and/or near discharge, reason not given
• G8682 Lvf testing documented as being performed prior to discharge or in the previous 12 months
• G8683 Lvf testing not performed prior to discharge or in the previous 12 months for a medical or patient documented reason
• G8685 Lvf testing not documented as being performed prior to discharge or in the previous 12 months, reason not given
• G8694 Current or prior left ventricular ejection fraction (lvef) < = 40% or documentation of moderate or severe lvsd
• G8696 Antithrombotic therapy prescribed at discharge
• G8697 Antithrombotic therapy not prescribed for documented reasons (e.g., patient had stroke during hospital stay, patient expired during inpatient stay, other medical reason(s)); (e.g., patient left against medical advice, other patient reason(s))
• G8698 Antithrombotic therapy was not prescribed at discharge, reason not given
• G8699 Rehabilitation services (occupational, physical or speech) ordered at or prior to discharge
• G8700 Rehabilitation services (occupational, physical or speech) not indicated at or prior to discharge
• G8701 Rehabilitation services were not ordered, reason not otherwise specified
• G8702 Documentation that prophylactic antibiotics were given within 4 hours prior to surgical incision or intraoperatively
• G8703 Documentation that prophylactic antibiotics were neither given within 4 hours prior to surgical incision nor intraoperatively
• G8704 12-lead electrocardiogram (ecg) performed
• G8705 Documentation of medical reason(s) for not performing a 12-lead electrocardiogram (ecg)
• G8706 Documentation of patient reason(s) for not performing a 12-lead electrocardiogram (ecg)
• G8707 12-lead electrocardiogram (ecg) not performed, reason not given
• G8708 Patient not prescribed antibiotic
• G8709 Uri episodes when the patient had competing diagnoses on or three days after the episode date (e.g., intestinal infection, pertussis, bacterial infection, lyme disease, otitis media, acute sinusitis, acute pharyngitis, acute tonsillitis, chronic sinusitis, infection of the pharynx/larynx/tonsils/adenoids, prostatitis, cellulitis, mastoiditis, or bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia/gonococcal infections, venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis or uti, and acne)
• G8710 Patient prescribed antibiotic
• G8711 Prescribed antibiotic on or within 3 days after the episode date
• G8712 Antibiotic not prescribed or dispensed
• G8713 Spkt/v greater than or equal to 1.2 (single-pool clearance of urea [kt] / volume [v])
• G8714 Hemodialysis treatment performed exactly three times per week for > 90 days
• G8717 Spkt/v less than 1.2 (single-pool clearance of urea [kt] / volume [v]), reason not given
• G8718 Total kt/v greater than or equal to 1.7 per week (total clearance of urea [kt] / volume [v])
• G8720 Total kt/v less than 1.7 per week (total clearance of urea [kt] / volume [v])
• G8721 Pt category (primary tumor), pn category (regional lymph nodes), and histologic grade were documented in pathology report
• G8722 Documentation of medical reason(s) for not including the pt category, the pn category or the histologic grade in the pathology report (e.g., re-excision without residual tumor; non-carcinomasanal canal)
• G8723 Specimen site is other than anatomic location of primary tumor
• G8724 Pt category, pn category and histologic grade were not documented in the pathology report, reason not given
• G8725 Fasting lipid profile performed (triglycerides, ldl-c, hdl-c and total cholesterol)
• G8726 Clinician has documented reason for not performing fasting lipid profile (e.g., patient declined, other patient reasons)
• G8728 Fasting lipid profile not performed, reason not given
• G8730 Pain assessment documented as positive using a standardized tool and a follow-up plan is documented
• G8731 Pain assessment using a standardized tool is documented as negative, no follow-up plan required
• G8732 No documentation of pain assessment, reason not given
• G8733 Elder maltreatment screen documented as positive and a follow-up plan is documented
• G8734 Elder maltreatment screen documented as negative, follow-up is not required
• G8735 Elder maltreatment screen documented as positive, follow-up plan not documented, reason not given
• G8736 Most current ldl-c <100mg/dl
• G8737 Most current ldl-c >=100mg/dl
• G8738 Left ventricular ejection fraction (lvef) < 40% or documentation of severely or moderately depressed left ventricular systolic function
• G8739 Left ventricular ejection fraction (lvef) >= 40% or documentation as normal or mildly depressed left ventricular systolic function
• G8740 Left ventricular ejection fraction (lvef) not performed or assessed, reason not given
• G8749 Absence of signs of melanoma (tenderness, jaundice, localized neurologic signs such as weakness, or any other sign suggesting systemic spread) or absence of symptoms of melanoma (cough, dyspnea, pain, paresthesia, or any other symptom suggesting the possibility of systemic spread of melanoma)
• G8751 Smoking status and exposure to second hand smoke in the home not assessed, reason not given
• G8752 Most recent systolic blood pressure < 140 mmhg
• G8753 Most recent systolic blood pressure >= 140 mmhg
• G8754 Most recent diastolic blood pressure < 90 mmhg
• G8755 Most recent diastolic blood pressure >= 90 mmhg
• G8756 No documentation of blood pressure measurement, reason not given
• G8757 All quality actions for the applicable measures in the chronic obstructive pulmonary disease (copd) measures group have been performed for this patient
• G8758 All quality actions for the applicable measures in the inflammatory bowel disease (ibd) measures group have been performed for this patient
• G8759 All quality actions for the applicable measures in the sleep apnea measures group have been performed for this patient
• G8761 All quality actions for the applicable measures in the dementia measures group have been performed for this patient
• G8762 All quality actions for the applicable measures in the parkinson's disease measures group have been performed for this patient
• G8763 All quality actions for the applicable measures in the hypertension (htn) measures group have been performed for this patient
• G8764 All quality actions for the applicable measures in the cardiovascular prevention measures group have bee performed for this patient
• G8765 All quality actions for the applicable measures in the cataract measures group have been performed for this patient
• G8767 Lipid panel results documented and reviewed (must include total cholesterol, hdl-c, triglycerides and calculated ldl-c)
• G8768 Documentation of medical reason(s) for not performing lipid profile (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)
• G8769 Lipid profile not performed, reason not given
• G8770 Urine protein test result documented and reviewed
• G8771 Documentation of diagnosis of chronic kidney disease
• G8772 Documentation of medical reason(s) for not performing urine protein test (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not cllinically appropriate)
• G8773 Urine protein test was not performed, reason not given
• G8774 Serum creatinine test result documented and reviewed
• G8775 Documentation of medical reason(s) for not performing serum creatinine test (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)
• G8776 Serum creatinine test not performed, reason not given
• G8777 Diabetes screening test performed
• G8778 Documentation of medical reason(s) for not performing diabetes screening test (e.g., patients with a diagnosis of diabetes, or with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)
• G8779 Diabetes screening test not performed, reason not given
• G8780 Counseling for diet and physical activity performed
• G8781 Documentation of medical reason(s) for patient not receiving counseling for diet and physical activity (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)
• G8782 Counseling for diet and physical activity not performed, reason not given
• G8783 Normal blood pressure reading documented, follow-up not required
• G8784 Patient not eligible (e.g., documentation the patient is not eligible due to active diagnosis of hypertension, patient refuses, urgent or emergent situation)
• G8785 Blood pressure reading not documented, reason not given
• G8797 Specimen site other than anatomic location of esophagus
• G8798 Specimen site other than anatomic location of prostate
• G8806 Performance of trans-abdominal or trans-vaginal ultrasound and pregnancy location documented
• G8807 Trans-abdominal or trans-vaginal ultrasound not performed for reasons documented by clinician (e.g., patient has a documented intrauterine pregnancy [iup])
• G8808 Trans-abdominal or trans-vaginal ultrasound not performed, reason not given
• G8809 Rh-immunoglobulin (rhogam) ordered
• G8810 Rh-immunoglobulin (rhogam) not ordered for reasons documented by clinician (e.g., patient had prior documented receipt of rhogam within 12 weeks, patient refusal)
• G8811 Documentation rh-immunoglobulin (rhogam) was not ordered, reason not given
• G8815 Documented reason in the medical records for why the statin therapy was not prescribed (i.e., lower extremity bypass was for a patient with non-artherosclerotic disease)
• G8816 Statin medication prescribed at discharge
• G8817 Statin therapy not prescribed at discharge, reason not given
• G8818 Patient discharge to home no later than post-operative day #7
• G8825 Patient not discharged to home by post-operative day #7
• G8826 Patient discharged to home no later than post-operative day #2 following evar
• G8833 Patient not discharged to home by post-operative day #2 following evar
• G8834 Patient discharged to home no later than post-operative day #2 following cea
• G8838 Patient not discharged to home by post-operative day #2 following cea
• G8839 Sleep apnea symptoms assessed, including presence or absence of snoring and daytime sleepiness
• G8840 Documentation of reason(s) for not documenting an assessment of sleep symptoms (e.g., patient didn't have initial daytime sleepiness, patient visited between initial testing and initiation of therapy)
• G8841 Sleep apnea symptoms not assessed, reason not given
• 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
• 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)
• 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
• G8845 Positive airway pressure therapy prescribed
• G8846 Moderate or severe obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory disturbance index (rdi) of 15 or greater)
• G8848 Mild obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory disturbance index (rdi) of less than 15)
• G8849 Documentation of reason(s) for not prescribing positive airway pressure therapy (e.g., patient unable to tolerate, alternative therapies use, patient declined, financial, insurance coverage)
• G8850 Positive airway pressure therapy not prescribed, reason not given
• G8851 Adherence to therapy was assessed at least annually through an objective informatics system or through self-reporting (if objective reporting is not available, documented)
• G8852 Positive airway pressure therapy was prescribed
• G8853 Positive airway pressure therapy not prescribed
• G8854 Documentation of reason(s) for not objectively reporting adherence to evidence-based therapy (e.g., patients who have been diagnosed with a terminal or advanced disease with an expected life span of less than 6 months, patients who decline therapy, patients who do not return for follow-up at least annually, patients unable to access/afford therapy, patient's insurance will not cover therapy)
• G8855 Adherence to therapy was not assessed at least annually through an objective informatics system or through self-reporting (if objective reporting is not available), reason not given
• G8856 Referral to a physician for an otologic evaluation performed
• G8857 Patient is not eligible for the referral for otologic evaluation measure (e.g., patients who are already under the care of a physician for acute or chronic dizziness)
• G8858 Referral to a physician for an otologic evaluation not performed, reason not given
• G8859 Patient receiving corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days
• G8860 Patients who have received dose of corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days
• G8861 Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) ordered and documented, review of systems and medication history or pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed
• G8862 Patients not receiving corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days
• G8863 Patients not assessed for risk of bone loss, reason not given
• G8864 Pneumococcal vaccine administered or previously received
• G8865 Documentation of medical reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient allergic reaction, potential adverse drug reaction)
• G8866 Documentation of patient reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient refusal)
• G8867 Pneumococcal vaccine not administered or previously received, reason not given
• G8868 Patients receiving a first course of anti-tnf therapy
• G8869 Patient has documented immunity to hepatitis b and initiating anti-tnf therapy
• G8870 Hepatitis b vaccine injection administered or previously received and is receiving a first course of anti-tnf therapy
• G8871 Patient not receiving a first course of anti-tnf therapy
• G8872 Excised tissue evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesion
• G8873 Patients with needle localization specimens which are not amenable to intraoperative imaging such as mri needle wire localization, or targets which are tentatively identified on mammogram or ultrasound which do not contain a biopsy marker but which can be verified on intraoperative inspection or pathology (e.g., needle biopsy site where the biopsy marker is remote from the actual biopsy site)
• G8874 Excised tissue not evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesion
• G8875 Clinician diagnosed breast cancer preoperatively by a minimally invasive biopsy method
• G8876 Documentation of reason(s) for not performing minimally invasive biopsy to diagnose breast cancer preoperatively (e.g., lesion too close to skin, implant, chest wall, etc., lesion could not be adequately visualized for needle biopsy, patient condition prevents needle biopsy [weight, breast thickness, etc.], duct excision without imaging abnormality, prophylactic mastectomy, reduction mammoplasty, excisional biopsy performed by another physician)
• G8877 Clinician did not attempt to achieve the diagnosis of breast cancer preoperatively by a minimally invasive biopsy method, reason not given
• G8878 Sentinel lymph node biopsy procedure performed
• G8879 Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer
• G8880 Documentation of reason(s) sentinel lymph node biopsy not performed (e.g., reasons could include but not limited to; non-invasive cancer, incidental discovery of breast cancer on prophylactic mastectomy, incidental discovery of breast cancer on reduction mammoplasty, pre-operative biopsy proven lymph node (ln) metastases, inflammatory carcinoma, stage 3 locally advanced cancer, recurrent invasive breast cancer, clinically node positive after neoadjuvant systemic therapy, patient refusal after informed consent, patient with significant age, comorbidities, or limited life expectancy and favorable tumor; adjuvant systemic therapy unlikely to change)
• G8881 Stage of breast cancer is greater than t1n0m0 or t2n0m0
• G8882 Sentinel lymph node biopsy procedure not performed, reason not given
• G8883 Biopsy results reviewed, communicated, tracked and documented
• G8884 Clinician documented reason that patient's biopsy results were not reviewed
• G8885 Biopsy results not reviewed, communicated, tracked or documented
• G8886 Most recent blood pressure under control
• G8887 Documentation of medical reason(s) for most recent blood pressure not being under control (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)
• G8888 Most recent blood pressure not under control, results documented and reviewed
• G8889 No documentation of blood pressure measurement, reason not given
• G8890 Most recent ldl-c under control, results documented and reviewed
• G8891 Documentation of medical reason(s) for most recent ldl-c not under control (e.g., patients with palliative goals for whom treatment of hypertension with standard treatment goals is not clinically appropriate)
• G8892 Documentation of medical reason(s) for not performing ldl-c test (e.g. patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)
• G8893 Most recent ldl-c not under control, results documented and reviewed
• G8894 Ldl-c not performed, reason not given
• G8895 Oral aspirin or other antithrombotic therapy prescribed
• G8896 Documentation of medical reason(s) for not prescribing oral aspirin or other antithrombotic therapy (e.g., patient documented to be low risk or patient with terminal illness or treatment of hypertension with standard treatment goals is not clinically appropriate, or for whom risk of aspirin or other antithrombotic therapy exceeds potential benefits such as for individuals whose blood pressure is poorly controlled)
• G8897 Oral aspirin or other antithrombotic therapy was not prescribed, reason not given
• G8898 I intend to report the chronic obstructive pulmonary disease (copd) measures group
• G8899 I intend to report the inflammatory bowel disease (ibd) measures group
• G8900 I intend to report the sleep apnea measures group
• G8902 I intend to report the dementia measures group
• G8903 I intend to report the parkinson's disease measures group
• G8904 I intend to report the hypertension (htn) measures group
• G8905 I intend to report the cardiovascular prevention measures group
• G8906 I intend to report the cataract measures group
• G8907 Patient documented not to have experienced any of the following events: a burn prior to discharge; a fall within the facility; wrong site/side/patient/procedure/implant event; or a hospital transfer or hospital admission upon discharge from the facility
• G8908 Patient documented to have received a burn prior to discharge
• G8909 Patient documented not to have received a burn prior to discharge
• G8910 Patient documented to have experienced a fall within asc
• G8911 Patient documented not to have experienced a fall within ambulatory surgical center
• G8912 Patient documented to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event
• G8913 Patient documented not to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event
• G8914 Patient documented to have experienced a hospital transfer or hospital admission upon discharge from asc
• G8915 Patient documented not to have experienced a hospital transfer or hospital admission upon discharge from asc
• G8916 Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic initiated on time
• G8917 Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic not initiated on time
• G8918 Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis
• G8923 Current or prior left ventricular ejection fraction (lvef) <= 40% or documentation of moderately or severely depressed left ventricular systolic function
• G8924 Spirometry results documented (fev1/fvc < 70%)
• G8925 Spirometry test results demonstrate fev1 >= 60% fev1/fvc >= 70%, predicted or patient does not have copd symptoms
• G8926 Spirometry test not performed or documented, reason not given
• G8927 Adjuvant chemotherapy referred, prescribed or previously received for ajcc stage iii, colon cancer
• G8928 Adjuvant chemotherapy not prescribed or previously received, for documented reasons (e.g., medical co-morbidities, diagnosis date more than 5 years prior to the current visit date, patient's diagnosis date is within 120 days of the end of the 12 month reporting period, patient's cancer has metastasized, medical contraindication/allergy, poor performance status, other medical reasons, patient refusal, other patient reasons, patient is currently enrolled in a clinical trial that precludes prescription of chemotherapy, other system reasons)
• G8929 Adjuvant chemotherapy not prescribed or previously received, reason not given
• G8930 Assessment of depression severity at the initial evaluation
• G8931 Assessment of depression severity not documented, reason not given
• G8932 Suicide risk assessed at the initial evaluation
• G8933 Suicide risk not assessed at the initial evaluation, reason not given
• G8934 Current or prior left ventricular ejection fraction (lvef) <=40% or documentation of moderately or severely depressed left ventricular systolic function
• G8935 Clinician prescribed angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy
• G8936 Clinician documented that patient was not an eligible candidate for angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy (eg, allergy, intolerance, pregnancy, renal failure due to ace inhibitor, diseases of the aortic or mitral valve, other medical reasons) or (eg, patient declined, other patient reasons)
• G8937 Clinician did not prescribe angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy, reason not given
• G8938 Bmi is documented as being outside of normal parameters, follow-up plan is not documented, documentation the patient is not eligible
• G8939 Pain assessment documented as positive, follow-up plan not documented, documentation the patient is not eligible at the time of the encounter
• G8940 Screening for depression documented as positive, a follow-up plan not completed, documented reason
• G8941 Elder maltreatment screen documented as positive, follow-up plan not documented, documentation the patient is not eligible for follow-up plan at the time of the encounter
• G8942 Functional outcome assessment using a standardized tool is documented within the previous 30 days and a care plan, based on identified deficiencies is documented within two days of the functional outcome assessment
• G8943 Ldl-c result not present or not within 12 months prior
• G8944 Ajcc melanoma cancer stage 0 through iic melanoma
• G8946 Minimally invasive biopsy method attempted but not diagnostic of breast cancer (e.g., high risk lesion of breast such as atypical ductal hyperplasia, lobular neoplasia, atypical lobular hyperplasia, lobular carcinoma in situ, atypical columnar hyperplasia, flat epithelial atypia, radial scar, complex sclerosing lesion, papillary lesion, or any lesion with spindle cells)
• G8947 One or more neuropsychiatric symptoms
• G8948 No neuropsychiatric symptoms
• G8949 Documentation of patient reason(s) for patient not receiving counseling for diet and physical activity (e.g., patient is not willing to discuss diet or exercise interventions to help control blood pressure, or the patient said he/she refused to make these changes)
• G8950 Elevated or hypertensive blood pressure reading documented, and the indicated follow-up is documented
• G8951 Pre-hypertensive or hypertensive blood pressure reading documented, indicated follow-up not documented, documentation the patient is not eligible
• G8952 Elevated or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given
• G8953 All quality actions for the applicable measures in the oncology measures group have been performed for this patient
• G8955 Most recent assessment of adequacy of volume management documented
• G8956 Patient receiving maintenance hemodialysis in an outpatient dialysis facility
• G8957 Patient not receiving maintenance hemodialysis in an outpatient dialysis facility
• G8958 Assessment of adequacy of volume management not documented, reason not given
• G8959 Clinician treating major depressive disorder communicates to clinician treating comorbid condition
• G8960 Clinician treating major depressive disorder did not communicate to clinician treating comorbid condition, reason not given
• G8961 Cardiac stress imaging test primarily performed on low-risk surgery patient for preoperative evaluation within 30 days preceding this surgery
• G8962 Cardiac stress imaging test performed on patient for any reason including those who did not have low risk surgery or test that was performed more than 30 days preceding low risk surgery
• G8963 Cardiac stress imaging performed primarily for monitoring of asymptomatic patient who had pci within 2 years
• G8964 Cardiac stress imaging test performed primarily for any other reason than monitoring of asymptomatic patient who had pci within 2 years (e.g., symptomatic patient, patient greater than 2 years since pci, initial evaluation, etc)
• G8965 Cardiac stress imaging test primarily performed on low chd risk patient for initial detection and risk assessment
• 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
• G8967 Fda approved oral anticoagulant is prescribed
• G8968 Documentation of medical reason(s) for not prescribing an fda-approved anticoagulant (e.g., present or planned atrial appendage occlusion or ligation or patient being currently enrolled in a clinical trial related to af/atrial flutter treatment)
• G8969 Documentation of patient reason(s) for not prescribing an oral anticoagulant that is fda approved for the prevention of thromboembolism (e.g., patient preference for not receiving anticoagulation)
• G8970 No risk factors or one moderate risk factor for thromboembolism
• G8971 Warfarin or another oral anticoagulant that is fda approved not prescribed, reason not given
• G8972 One or more high risk factors for thromboembolism or more than one moderate risk factor for thromboembolism
• G8973 Most recent hemoglobin (hgb) level < 10 g/dl
• G8974 Hemoglobin level measurement not documented, reason not given
• G8975 Documentation of medical reason(s) for patient having a hemoglobin level < 10 g/dl (e.g., patients who have non-renal etiologies of anemia [e.g., sickle cell anemia or other hemoglobinopathies, hypersplenism, primary bone marrow disease, anemia related to chemotherapy for diagnosis of malignancy, postoperative bleeding, active bloodstream or peritoneal infection], other medical reasons)
• G8976 Most recent hemoglobin (hgb) level >= 10 g/dl
• G8977 I intend to report the oncology measures group
• G8978 Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals
• G8979 Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
• G8980 Mobility: walking & moving around functional limitation, discharge status, at discharge from therapy or to end reporting
• G8981 Changing & maintaining body position functional limitation, current status, at therapy episode outset and at reporting intervals
• G8982 Changing & maintaining body position functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
• G8983 Changing & maintaining body position functional limitation, discharge status, at discharge from therapy or to end reporting
• G8984 Carrying, moving & handling objects functional limitation, current status, at therapy episode outset and at reporting intervals
• G8985 Carrying, moving and handling objects, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
• G8986 Carrying, moving & handling objects functional limitation, discharge status, at discharge from therapy or to end reporting
• G8987 Self care functional limitation, current status, at therapy episode outset and at reporting intervals
• G8988 Self care functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
• G8989 Self care functional limitation, discharge status, at discharge from therapy or to end reporting
• G8990 Other physical or occupational therapy primary functional limitation, current status, at therapy episode outset and at reporting intervals
• G8991 Other physical or occupational therapy primary functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
• G8992 Other physical or occupational therapy primary functional limitation, discharge status, at discharge from therapy or to end reporting
• G8993 Other physical or occupational therapy subsequent functional limitation, current status, at therapy episode outset and at reporting intervals
• G8994 Other physical or occupational therapy subsequent functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
• G8995 Other physical or occupational therapy subsequent functional limitation, discharge status, at discharge from therapy or to end reporting
• G8996 Swallowing functional limitation, current status at therapy episode outset and at reporting intervals
• G8997 Swallowing functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
• G8998 Swallowing functional limitation, discharge status, at discharge from therapy or to end reporting
• G8999 Motor speech functional limitation, current status at therapy episode outset and at reporting intervals
• G9001 Coordinated care fee, initial rate
• G9002 Coordinated care fee, maintenance rate
• G9003 Coordinated care fee, risk adjusted high, initial
• G9004 Coordinated care fee, risk adjusted low, initial
• G9005 Coordinated care fee, risk adjusted maintenance
• G9006 Coordinated care fee, home monitoring
• G9007 Coordinated care fee, scheduled team conference
• G9008 Coordinated care fee, physician coordinated care oversight services
• G9009 Coordinated care fee, risk adjusted maintenance, level 3
• G9010 Coordinated care fee, risk adjusted maintenance, level 4
• G9011 Coordinated care fee, risk adjusted maintenance, level 5
• G9012 Other specified case management service not elsewhere classified
• G9013 Esrd demo basic bundle level i
• G9014 Esrd demo expanded bundle including venous access and related services
• G9016 Smoking cessation counseling, individual, in the absence of or in addition to any other evaluation and management service, per session (6-10 minutes) [demo project code only]
• G9017 Amantadine hydrochloride, oral, per 100 mg (for use in a medicare-approved demonstration project)
• G9018 Zanamivir, inhalation powder, administered through inhaler, per 10 mg (for use in a medicare-approved demonstration project)
• G9019 Oseltamivir phosphate, oral, per 75 mg (for use in a medicare-approved demonstration project)
• G9020 Rimantadine hydrochloride, oral, per 100 mg (for use in a medicare-approved demonstration project)
• G9033 Amantadine hydrochloride, oral brand, per 100 mg (for use in a medicare-approved demonstration project)
• G9034 Zanamivir, inhalation powder, administered through inhaler, brand, per 10 mg (for use in a medicare-approved demonstration project)
• G9035 Oseltamivir phosphate, oral, brand, per 75 mg (for use in a medicare-approved demonstration project)
• G9036 Rimantadine hydrochloride, oral, brand, per 100 mg (for use in a medicare-approved demonstration project)
• G9037 Interprofessional telephone/internet/electronic health record clinical question/request for specialty recommendations by a treating/requesting physician or other qualified health care professional for the care of the patient (i.e. not for professional education or scheduling) and may include subsequent follow up on the specialist's recommendations; 30 minutes
• G9038 Co-management services with the following elements: new diagnosis or acute exacerbation and stabilization of existing condition; condition which may benefit from joint care planning; condition for which specialist is taking a co-management role; condition expected to last at least 3 months; comprehensive care plan established, implemented, revised or monitored in partnership with co-managing clinicians; ongoing communication and care coordination between co-managing clinicians furnishing care
• G9050 Oncology; primary focus of visit; work-up, evaluation, or staging at the time of cancer diagnosis or recurrence (for use in a medicare-approved demonstration project)
• G9051 Oncology; primary focus of visit; treatment decision-making after disease is staged or restaged, discussion of treatment options, supervising/coordinating active cancer directed therapy or managing consequences of cancer directed therapy (for use in a medicare-approved demonstration project)
• G9052 Oncology; primary focus of visit; surveillance for disease recurrence for patient who has completed definitive cancer-directed therapy and currently lacks evidence of recurrent disease; cancer directed therapy might be considered in the future (for use in a medicare-approved demonstration project)
• G9053 Oncology; primary focus of visit; expectant management of patient with evidence of cancer for whom no cancer directed therapy is being administered or arranged at present; cancer directed therapy might be considered in the future (for use in a medicare-approved demonstration project)
• G9054 Oncology; primary focus of visit; supervising, coordinating or managing care of patient with terminal cancer or for whom other medical illness prevents further cancer treatment; includes symptom management, end-of-life care planning, management of palliative therapies (for use in a medicare-approved demonstration project)
• G9055 Oncology; primary focus of visit; other, unspecified service not otherwise listed (for use in a medicare-approved demonstration project)
• G9056 Oncology; practice guidelines; management adheres to guidelines (for use in a medicare-approved demonstration project)
• G9057 Oncology; practice guidelines; management differs from guidelines as a result of patient enrollment in an institutional review board approved clinical trial (for use in a medicare-approved demonstration project)
• G9058 Oncology; practice guidelines; management differs from guidelines because the treating physician disagrees with guideline recommendations (for use in a medicare-approved demonstration project)
• G9059 Oncology; practice guidelines; management differs from guidelines because the patient, after being offered treatment consistent with guidelines, has opted for alternative treatment or management, including no treatment (for use in a medicare-approved demonstration project)
• G9060 Oncology; practice guidelines; management differs from guidelines for reason(s) associated with patient comorbid illness or performance status not factored into guidelines (for use in a medicare-approved demonstration project)
• G9061 Oncology; practice guidelines; patient's condition not addressed by available guidelines (for use in a medicare-approved demonstration project)
• G9062 Oncology; practice guidelines; management differs from guidelines for other reason(s) not listed (for use in a medicare-approved demonstration project)
• G9063 Oncology; disease status; limited to non-small cell lung cancer; extent of disease initially established as stage i (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
• G9064 Oncology; disease status; limited to non-small cell lung cancer; extent of disease initially established as stage ii (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
• G9065 Oncology; disease status; limited to non-small cell lung cancer; extent of disease initially established as stage iii a (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
• G9066 Oncology; disease status; limited to non-small cell lung cancer; stage iii b- iv at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
• G9067 Oncology; disease status; limited to non-small cell lung cancer; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
• G9068 Oncology; disease status; limited to small cell and combined small cell/non-small cell; extent of disease initially established as limited with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
• G9069 Oncology; disease status; small cell lung cancer, limited to small cell and combined small cell/non-small cell; extensive stage at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
• G9070 Oncology; disease status; small cell lung cancer, limited to small cell and combined small cell/non-small; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
• G9071 Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage i or stage iia-iib; or t3, n1, m0; and er and/or pr positive; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
• G9072 Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage i, or stage iia-iib; or t3, n1, m0; and er and pr negative; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
• G9073 Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage iiia-iiib; and not t3, n1, m0; and er and/or pr positive; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
• G9074 Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage iiia-iiib; and not t3, n1, m0; and er and pr negative; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
• G9075 Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
• G9077 Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t1-t2c and gleason 2-7 and psa < or equal to 20 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
• G9078 Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t2 or t3a gleason 8-10 or psa > 20 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
• G9079 Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t3b-t4, any n; any t, n1 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
• G9080 Oncology; disease status; prostate cancer, limited to adenocarcinoma; after initial treatment with rising psa or failure of psa decline (for use in a medicare-approved demonstration project)
• G9083 Oncology; disease status; prostate cancer, limited to adenocarcinoma; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
• G9084 Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-3, n0, m0 with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
• G9085 Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t4, n0, m0 with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
• G9086 Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-4, n1-2, m0 with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
• G9087 Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive with current clinical, radiologic, or biochemical evidence of disease (for use in a medicare-approved demonstration project)
• G9088 Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive without current clinical, radiologic, or biochemical evidence of disease (for use in a medicare-approved demonstration project)
• G9089 Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
• G9090 Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-2, n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
• G9091 Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t3, n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
• G9092 Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-3, n1-2, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence or metastases (for use in a medicare-approved demonstration project)
• G9093 Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t4, any n, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
• G9094 Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
• G9095 Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
• G9096 Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; extent of disease initially established as t1-t3, n0-n1 or nx (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
• G9097 Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; extent of disease initially established as t4, any n, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
• G9098 Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
• G9099 Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
• G9100 Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; post r0 resection (with or without neoadjuvant therapy) with no evidence of disease recurrence, progression, or metastases (for use in a medicare-approved demonstration project)
• G9101 Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; post r1 or r2 resection (with or without neoadjuvant therapy) with no evidence of disease progression, or metastases (for use in a medicare-approved demonstration project)
• G9102 Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; clinical or pathologic m0, unresectable with no evidence of disease progression, or metastases (for use in a medicare-approved demonstration project)
• G9103 Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; clinical or pathologic m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
• G9104 Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
• G9105 Oncology; disease status; pancreatic cancer, limited to adenocarcinoma as predominant cell type; post r0 resection without evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
• G9106 Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; post r1 or r2 resection with no evidence of disease progression, or metastases (for use in a medicare-approved demonstration project)
• G9107 Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; unresectable at diagnosis, m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
• G9108 Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
• G9109 Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; extent of disease initially established as t1-t2 and n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
• G9110 Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; extent of disease initially established as t3-4 and/or n1-3, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
• G9111 Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
• G9112 Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
• G9113 Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage ia-b (grade 1) without evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
• G9114 Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage ia-b (grade 2-3); or stage ic (all grades); or stage ii; without evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
• G9115 Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage iii-iv; without evidence of progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
• G9116 Oncology; disease status; ovarian cancer, limited to epithelial cancer; evidence of disease progression, or recurrence, and/or platinum resistance (for use in a medicare-approved demonstration project)
• G9117 Oncology; disease status; ovarian cancer, limited to epithelial cancer; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
• G9123 Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; chronic phase not in hematologic, cytogenetic, or molecular remission (for use in a medicare-approved demonstration project)
• G9124 Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; accelerated phase not in hematologic cytogenetic, or molecular remission (for use in a medicare-approved demonstration project)
• G9125 Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; blast phase not in hematologic, cytogenetic, or molecular remission (for use in a medicare-approved demonstration project)
• G9126 Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; in hematologic, cytogenetic, or molecular remission (for use in a medicare-approved demonstration project)
• G9128 Oncology; disease status; limited to multiple myeloma, systemic disease; smoldering, stage i (for use in a medicare-approved demonstration project)
• G9129 Oncology; disease status; limited to multiple myeloma, systemic disease; stage ii or higher (for use in a medicare-approved demonstration project)
• G9130 Oncology; disease status; limited to multiple myeloma, systemic disease; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
• G9131 Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
• G9132 Oncology; disease status; prostate cancer, limited to adenocarcinoma; hormone-refractory/androgen-independent (e.g., rising psa on anti-androgen therapy or post-orchiectomy); clinical metastases (for use in a medicare-approved demonstration project)
• G9133 Oncology; disease status; prostate cancer, limited to adenocarcinoma; hormone-responsive; clinical metastases or m1 at diagnosis (for use in a medicare-approved demonstration project)
• G9134 Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; stage i, ii at diagnosis, not relapsed, not refractory (for use in a medicare-approved demonstration project)
• G9135 Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; stage iii, iv, not relapsed, not refractory (for use in a medicare-approved demonstration project)
• G9136 Oncology; disease status; non-hodgkin's lymphoma, transformed from original cellular diagnosis to a second cellular classification (for use in a medicare-approved demonstration project)
• G9137 Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; relapsed/refractory (for use in a medicare-approved demonstration project)
• G9138 Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; diagnostic evaluation, stage not determined, evaluation of possible relapse or non-response to therapy, or not listed (for use in a medicare-approved demonstration project)
• G9139 Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; extent of disease unknown, staging in progress, not listed (for use in a medicare-approved demonstration project)
• G9140 Frontier extended stay clinic demonstration; for a patient stay in a clinic approved for the cms demonstration project; the following measures should be present: the stay must be equal to or greater than 4 hours; weather or other conditions must prevent transfer or the case falls into a category of monitoring and observation cases that are permitted by the rules of the demonstration; there is a maximum frontier extended stay clinic (fesc) visit of 48 hours, except in the case when weather or other conditions prevent transfer; payment is made on each period up to 4 hours, after the first 4 hours
• G9143 Warfarin responsiveness testing by genetic technique using any method, any number of specimen(s)
• G9147 Outpatient intravenous insulin treatment (oivit) either pulsatile or continuous, by any means, guided by the results of measurements for: respiratory quotient; and/or, urine urea nitrogen (uun); and/or, arterial, venous or capillary glucose; and/or potassium concentration
• G9148 National committee for quality assurance - level 1 medical home
• G9149 National committee for quality assurance - level 2 medical home
• G9150 National committee for quality assurance - level 3 medical home
• G9151 Mapcp demonstration - state provided services
• G9152 Mapcp demonstration - community health teams
• G9153 Mapcp demonstration - physician incentive pool
• G9156 Evaluation for wheelchair requiring face to face visit with physician
• G9157 Transesophageal doppler measurement of cardiac output (including probe placement, image acquisition, and interpretation per course of treatment) for monitoring purposes
• G9158 Motor speech functional limitation, discharge status, at discharge from therapy or to end reporting
• G9159 Spoken language comprehension functional limitation, current status at therapy episode outset and at reporting intervals
• G9160 Spoken language comprehension functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
• G9161 Spoken language comprehension functional limitation, discharge status, at discharge from therapy or to end reporting
• G9162 Spoken language expression functional limitation, current status at therapy episode outset and at reporting intervals
• G9163 Spoken language expression functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
• G9164 Spoken language expression functional limitation, discharge status at discharge from therapy or to end reporting
• G9165 Attention functional limitation, current status at therapy episode outset and at reporting intervals
• G9166 Attention functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
• G9167 Attention functional limitation, discharge status at discharge from therapy or to end reporting
• G9168 Memory functional limitation, current status at therapy episode outset and at reporting intervals
• G9169 Memory functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
• G9170 Memory functional limitation, discharge status at discharge from therapy or to end reporting
• G9171 Voice functional limitation, current status at therapy episode outset and at reporting intervals
• G9172 Voice functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
• G9173 Voice functional limitation, discharge status at discharge from therapy or to end reporting
• G9174 Other speech language pathology functional limitation, current status at therapy episode outset and at reporting intervals
• G9175 Other speech language pathology functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
• G9176 Other speech language pathology functional limitation, discharge status at discharge from therapy or to end reporting
• G9186 Motor speech functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
• G9187 Bundled payments for care improvement initiative home visit for patient assessment performed by a qualified health care professional for individuals not considered homebound including, but not limited to, assessment of safety, falls, clinical status, fluid status, medication reconciliation/management, patient compliance with orders/plan of care, performance of activities of daily living, appropriateness of care setting; (for use only in the meidcare-approved bundled payments for care improvement initiative); may not be billed for a 30-day period covered by a transitional care management code
• G9188 Beta-blocker therapy not prescribed, reason not given
• G9189 Beta-blocker therapy prescribed or currently being taken
• G9190 Documentation of medical reason(s) for not prescribing beta-blocker therapy (eg, allergy, intolerance, other medical reasons)
• G9191 Documentation of patient reason(s) for not prescribing beta-blocker therapy (eg, patient declined, other patient reasons)
• G9192 Documentation of system reason(s) for not prescribing beta-blocker therapy (eg, other reasons attributable to the health care system)
• G9193 Clinician documented that patient with a diagnosis of major depression was not an eligible candidate for antidepressant medication treatment or patient did not have a diagnosis of major depression
• G9194 Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 180 day (6 month) continuation treatment phase
• G9195 Patient with a diagnosis of major depression not documented as being treated with antidepressant medication during the entire 180 day (6 months) continuation treatment phase
• G9196 Documentation of medical reason(s) for not ordering a first or second generation cephalosporin for antimicrobial prophylaxis (e.g., patients enrolled in clinical trials, patients with documented infection prior to surgical procedure of interest, patients who were receiving antibiotics more than 24 hours prior to surgery [except colon surgery patients taking oral prophylactic antibiotics], patients who were receiving antibiotics within 24 hours prior to arrival [except colon surgery patients taking oral prophylactic antibiotics], other medical reason(s))
• G9197 Documentation of order for first or second generation cephalosporin for antimicrobial prophylaxis
• G9198 Order for first or second generation cephalosporin for antimicrobial prophylaxis was not documented, reason not given
• G9199 Venous thromboembolism (vte) prophylaxis not administered the day of or the day after hospital admission for documented reasons (eg, patient is ambulatory, patient expired during inpatient stay, patient already on warfarin or another anticoagulant, other medical reason(s) or eg, patient left against medical advice, other patient reason(s))
• 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
• G9250 Documentation of patient pain brought to a comfortable level within 48 hours from initial assessment
• G9251 Documentation of patient with pain not brought to a comfortable level within 48 hours from initial assessment
• G9252 Adenoma(s) or other neoplasm detected during screening colonoscopy
• G9253 Adenoma(s) or other neoplasm not detected during screening colonoscopy
• G9254 Documentation of patient discharged to home later than post-operative day 2 following cea or cas
• G9255 Documentation of patient discharged to home no later than post operative day 2 following cea or cas
• G9256 Documentation of patient death following cas
• G9257 Documentation of patient stroke following cas
• G9258 Documentation of patient stroke following cea
• G9259 Documentation of patient survival and absence of stroke following cas
• G9260 Documentation of patient death following cea
• G9261 Documentation of patient survival and absence of stroke following cea
• G9262 Documentation of patient death in the hospital following endovascular aaa repair
• G9263 Documentation of patient discharged alive following endovascular aaa repair
• G9264 Documentation of patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter for documented reasons (e.g., other medical reasons, patient declined arteriovenous fistula (avf)/arteriovenous graft (avg), other patient reasons)
• G9265 Patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter as the mode of vascular access
• G9266 Patient receiving maintenance hemodialysis for greater than or equal to 90 days without a catheter as the mode of vascular access
• G9267 Documentation of patient with one or more complications or mortality within 30 days
• G9268 Documentation of patient with one or more complications within 90 days
• G9269 Documentation of patient without one or more complications and without mortality within 30 days
• G9270 Documentation of patient without one or more complications within 90 days
• G9271 Ldl value < 100
• G9272 Ldl value >= 100
• G9273 Blood pressure has a systolic value of < 140 and a diastolic value of < 90
• G9274 Blood pressure has a systolic value of =140 and a diastolic value of = 90 or systolic value < 140 and diastolic value = 90 or systolic value = 140 and diastolic value < 90
• G9275 Documentation that patient is a current non-tobacco user
• G9276 Documentation that patient is a current tobacco user
• G9277 Documentation that the patient is on daily aspirin or anti-platelet or has documentation of a valid contraindication or exception to aspirin/anti-platelet; contraindications/exceptions include anti-coagulant use, allergy to aspirin or anti-platelets, history of gastrointestinal bleed and bleeding disorder; additionally, the following exceptions documented by the physician as a reason for not taking daily aspirin or anti-platelet are acceptable (use of non-steroidal anti-inflammatory agents, documented risk for drug interaction, uncontrolled hypertension defined as >180 systolic or >110 diastolic or gastroesophageal reflux)
• G9278 Documentation that the patient is not on daily aspirin or anti-platelet regimen
• G9279 Pneumococcal screening performed and documentation of vaccination received prior to discharge
• G9280 Pneumococcal vaccination not administered prior to discharge, reason not specified
• G9281 Screening performed and documentation that vaccination not indicated/patient refusal
• G9282 Documentation of medical reason(s) for not reporting the histological type or nsclc-nos classification with an explanation (e.g., biopsy taken for other purposes in a patient with a history of non-small cell lung cancer or other documented medical reasons)
• G9283 Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation
• G9284 Non small cell lung cancer biopsy and cytology specimen report does not document classification into specific histologic type or classified as nsclc-nos with an explanation
• G9285 Specimen site other than anatomic location of lung or is not classified as non small cell lung cancer
• G9286 Antibiotic regimen prescribed within 10 days after onset of symptoms
• G9287 Antibiotic regimen not prescribed within 10 days after onset of symptoms
• G9288 Documentation of medical reason(s) for not reporting the histological type or nsclc-nos classification with an explanation (e.g., a solitary fibrous tumor in a person with a history of non-small cell carcinoma or other documented medical reasons)
• G9289 Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation
• G9290 Non small cell lung cancer biopsy and cytology specimen report does not document classification into specific histologic type or classified as nsclc-nos with an explanation
• G9291 Specimen site other than anatomic location of lung, is not classified as non small cell lung cancer or classified as nsclc-nos
• G9292 Documentation of medical reason(s) for not reporting pt category and a statement on thickness and ulceration and for pt1, mitotic rate (e.g., negative skin biopsies in a patient with a history of melanoma or other documented medical reasons)
• G9293 Pathology report does not include the pt category and a statement on thickness and ulceration and for pt1, mitotic rate
• G9294 Pathology report includes the pt category and a statement on thickness and ulceration and for pt1, mitotic rate
• G9295 Specimen site other than anatomic cutaneous location
• G9296 Patients with documented shared decision-making including discussion of conservative (non-surgical) therapy (e.g., nsaids, analgesics, weight loss, exercise, injections) prior to the procedure
• G9297 Shared decision-making including discussion of conservative (non-surgical) therapy (e.g., nsaids, analgesics, weight loss, exercise, injections) prior to the procedure, not documented, reason not given
• G9298 Patients who are evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (e.g., history of dvt, pe, mi, arrhythmia and stroke)
• G9299 Patients who are not evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (e.g., history of dvt, pe, mi, arrhythmia and stroke, reason not given)
• G9300 Documentation of medical reason(s) for not completely infusing the prophylactic antibiotic prior to the inflation of the proximal tourniquet (e.g., a tourniquet was not used)
• G9301 Patients who had the prophylactic antibiotic completely infused prior to the inflation of the proximal tourniquet
• G9302 Prophylactic antibiotic not completely infused prior to the inflation of the proximal tourniquet, reason not given
• G9303 Operative report does not identify the prosthetic implant specifications including the prosthetic implant manufacturer, the brand name of the prosthetic implant and the size of each prosthetic implant, reason not given
• G9304 Operative report identifies the prosthetic implant specifications including the prosthetic implant manufacturer, the brand name of the prosthetic implant and the size of each prosthetic implant
• G9305 Intervention for presence of leak of endoluminal contents through an anastomosis not required
• G9306 Intervention for presence of leak of endoluminal contents through an anastomosis required
• G9307 No return to the operating room for a surgical procedure, for complications of the principal operative procedure, within 30 days of the principal operative procedure
• G9308 Unplanned return to the operating room for a surgical procedure, for complications of the principal operative procedure, within 30 days of the principal operative procedure
• G9309 No unplanned hospital readmission within 30 days of principal procedure
• G9310 Unplanned hospital readmission within 30 days of principal procedure
• 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
• G9376 Patient continued to have the retina attached at the 6 months follow up visit (+/- 1 month) following only one surgery
• G9377 Patient did not have the retina attached after 6 months following only one surgery
• G9378 Patient continued to have the retina attached at the 6 months follow up visit (+/- 1 month)
• G9379 Patient did not achieve flat retinas six months post surgery
• G9380 Patient offered assistance with end of life issues or existing end of life plan was reviewed or updated during the measurement period
• G9381 Documentation of medical reason(s) for not offering assistance with end of life issues (e.g., patient in hospice care, patient in terminal phase) during the measurement period
• G9382 Patient not offered assistance with end of life issues or existing end of life plan was not reviewed or updated during the measurement period
• G9383 Patient received screening for hcv infection within the 12 month reporting period
• G9384 Documentation of medical reason(s) for not receiving annual screening for hcv infection (e.g., decompensated cirrhosis indicating advanced disease [i.e., ascites, esophageal variceal bleeding, hepatic encephalopathy], hepatocellular carcinoma, waitlist for organ transplant, limited life expectancy, other medical reasons)
• G9385 Documentation of patient reason(s) for not receiving annual screening for hcv infection (e.g., patient declined, other patient reasons)
• G9386 Screening for hcv infection not received within the 12 month reporting period, reason not given
• G9389 Unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery
• G9390 No unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery
• G9391 Patient achieves refraction +-1 d for the eye that underwent cataract surgery, measured at the one month follow up visit
• G9392 Patient does not achieve refraction +-1 d for the eye that underwent cataract surgery, measured at the one month follow up visit
• G9393 Patient with an initial phq-9 score greater than nine who achieves remission at twelve months as demonstrated by a twelve month (+/- 30 days) phq-9 score of less than five
• G9394 Patient who had a diagnosis of bipolar disorder or personality disorder, death, permanent nursing home resident or receiving hospice or palliative care any time during the measurement or assessment period
• G9395 Patient with an initial phq-9 score greater than nine who did not achieve remission at twelve months as demonstrated by a twelve month (+/- 30 days) phq-9 score greater than or equal to five
• G9396 Patient with an initial phq-9 score greater than nine who was not assessed for remission at twelve months (+/- 30 days)
• G9399 Documentation in the patient record of a discussion between the physician/clinician and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward the outcome of the treatment
• G9400 Documentation of medical or patient reason(s) for not discussing treatment options; medical reasons: patient is not a candidate for treatment due to advanced physical or mental health comorbidity (including active substance use); currently receiving antiviral treatment; successful antiviral treatment (with sustained virologic response) prior to reporting period; other documented medical reasons; patient reasons: patient unable or unwilling to participate in the discussion or other patient reasons
• G9401 No documentation in the patient record of a discussion between the physician or other qualified healthcare professional and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward treatment
• G9402 Patient received follow-up within 30 days after discharge
• 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)
• G9404 Patient did not receive follow-up within 30 days after discharge
• G9405 Patient received follow-up within 7 days after discharge
• 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)
• G9407 Patient did not receive follow-up within 7 days after discharge
• G9408 Patients with cardiac tamponade and/or pericardiocentesis occurring within 30 days
• G9409 Patients without cardiac tamponade and/or pericardiocentesis occurring within 30 days
• G9410 Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision
• G9411 Patient not admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision
• G9412 Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision
• G9413 Patient not admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision
• G9414 Patient had one dose of meningococcal vaccine (serogroups a, c, w, y or a, c, w, y, b) on or between the patient's 10th and 13th birthdays
• G9415 Patient did not have one dose of meningococcal vaccine (serogroups a, c, w, y or a, c, w, y, b), on or between the patient's 10th and 13th birthdays
• G9416 Patient had one tetanus, diphtheria toxoids and acellular pertussis vaccine (tdap) on or between the patient's 10th and 13th birthdays
• G9417 Patient did not have one tetanus, diphtheria toxoids and acellular pertussis vaccine (tdap) on or between the patient's 10th and 13th birthdays
• G9418 Primary non-small cell lung cancer lung biopsy and cytology specimen report documents classification into specific histologic type following iaslc guidance or classified as nsclc-nos with an explanation
• G9419 Documentation of medical reason(s) for not including the histological type or nsclc-nos classification with an explanation (e.g. specimen insufficient or non-diagnostic, specimen does not contain cancer, or other documented medical reasons)
• G9420 Specimen site other than anatomic location of lung or is not classified as primary non-small cell lung cancer
• G9421 Primary non-small cell lung cancer lung biopsy and cytology specimen report does not document classification into specific histologic type or histologic type does not follow iaslc guidance or is classified as nsclc-nos but without an explanation
• G9422 Primary lung carcinoma resection report documents pt category, pn category and for non-small cell lung cancer, histologic type (e.g., squamous cell carcinoma, adenocarcinoma and not nsclc-nos)
• G9423 Documentation of medical reason for not including pt category, pn category and histologic type [for patient with appropriate exclusion criteria (e.g., metastatic disease, benign tumors, malignant tumors other than carcinomas, inadequate surgical specimens)]
• G9424 Specimen site other than anatomic location of lung, or classified as nsclc-nos
• G9425 Primary lung carcinoma resection report does not document pt category, pn category and for non-small cell lung cancer, histologic type (e.g., squamous cell carcinoma, adenocarcinoma)
• G9426 Improvement in median time from ed arrival to initial ed oral or parenteral pain medication administration performed for ed admitted patients
• G9427 Improvement in median time from ed arrival to initial ed oral or parenteral pain medication administration not performed for ed admitted patients
• G9428 Pathology report includes the pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors
• G9429 Documentation of medical reason(s) for not including pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors (e.g., negative skin biopsies, insufficient tissue, or other documented medical reasons)
• G9430 Specimen site other than anatomic cutaneous location
• G9431 Pathology report does not include the pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors
• G9432 Asthma well-controlled based on the act, c-act, acq, or ataq score and results documented
• G9433 Death, permanent nursing home resident or receiving hospice or palliative care any time during the measurement period
• G9434 Asthma not well-controlled based on the act, c-act, acq, or ataq score, or specified asthma control tool not used, reason not given
• G9435 Aspirin prescribed at discharge
• G9436 Aspirin not prescribed for documented reasons (e.g., allergy, medical intolerance, history of bleed)
• G9437 Aspirin not prescribed at discharge
• G9438 P2y inhibitor prescribed at discharge
• G9439 P2y inhibitor not prescribed for documented reasons (e.g., allergy, medical intolerance, history of bleed)
• G9440 P2y inhibitor not prescribed at discharge
• G9441 Statin prescribed at discharge
• G9442 Statin not prescribed for documented reasons (e.g., allergy, medical intolerance)
• G9443 Statin not prescribed at discharge
• G9448 Patients who were born in the years 1945 to 1965
• G9449 History of receiving blood transfusions prior to 1992
• G9450 History of injection drug use
• G9451 Patient received one-time screening for hcv infection
• G9452 Documentation of medical reason(s) for not receiving hcv antibody test due to limited life expectancy
• G9453 Documentation of patient reason(s) for not receiving one-time screening for hcv infection (e.g., patient declined, other patient reasons)
• G9454 One-time screening for hcv infection not received within 12-month reporting period and no documentation of prior screening for hcv infection, reason not given
• G9455 Patient underwent abdominal imaging with ultrasound, contrast enhanced ct or contrast mri for hcc
• G9456 Documentation of medical or patient reason(s) for not ordering or performing screening for hcc. medical reason: comorbid medical conditions with expected survival < 5 years, hepatic decompensation and not a candidate for liver transplantation, or other medical reasons; patient reasons: patient declined or other patient reasons (e.g., cost of tests, time related to accessing testing equipment)
• G9457 Patient did not undergo abdominal imaging and did not have a documented reason for not undergoing abdominal imaging in the submission period
• 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
• G9459 Currently a tobacco non-user
• G9460 Tobacco assessment or tobacco cessation intervention not performed, reason not given
• G9463 I intend to report the sinusitis measures group
• G9464 All quality actions for the applicable measures in the sinusitis measures group have been performed for this patient
• G9465 I intend to report the acute otitis externa (aoe) measures group
• G9466 All quality actions for the applicable measures in the aoe measures group have been performed for this patient
• G9467 Patient who have received or are receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 60 or greater consecutive days or a single prescription equating to 600 mg prednisone or greater for all fills within the last twelve months
• G9468 Patient not receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 60 or greater consecutive days or a single prescription equating to 600 mg prednisone or greater for all fills
• G9469 Patients who have received or are receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 90 or greater consecutive days or a single prescription equating to 900 mg prednisone or greater for all fills
• G9470 Patients not receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 60 or greater consecutive days or a single prescription equating to 600 mg prednisone or greater for all fills
• G9471 Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) not ordered or documented
• G9472 Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) not ordered and documented, no review of systems and no medication history or pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed
• G9473 Services performed by chaplain in the hospice setting, each 15 minutes
• G9474 Services performed by dietary counselor in the hospice setting, each 15 minutes
• G9475 Services performed by other counselor in the hospice setting, each 15 minutes
• G9476 Services performed by volunteer in the hospice setting, each 15 minutes
• G9477 Services performed by care coordinator in the hospice setting, each 15 minutes
• G9478 Services performed by other qualified therapist in the hospice setting, each 15 minutes
• G9479 Services performed by qualified pharmacist in the hospice setting, each 15 minutes
• G9480 Admission to medicare care choice model program (mccm)
• G9481 Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a problem focused history; a problem focused examination; and straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
• G9482 Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 20 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
• G9483 Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a detailed history; a detailed examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate severity. typically, 30 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
• G9484 Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 45 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
• G9485 Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 60 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
• G9486 Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
• G9487 Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 15 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
• G9488 Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 25 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
• G9489 Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved coms innovation center demonstration project, which requires at least 2 of the following 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 40 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
• G9490 Cms innovation center models, home visit for patient assessment performed by clinical staff for an individual not considered homebound, including, but not necessarily limited to patient assessment of clinical status, safety/fall prevention, functional status/ambulation, medication reconciliation/management, compliance with orders/plan of care, performance of activities of daily living, and ensuring beneficiary connections to community and other services. (for use only in medicare-approved cms innovation center models); may not be billed for a 30 day period covered by a transitional care management code
• G9496 Documentation of reason for not detecting adenoma(s) or other neoplasm. (e.g., neoplasm detected is only diagnosed as traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma
• G9497 Received instruction from the anesthesiologist or proxy prior to the day of surgery to abstain from smoking on the day of surgery
• G9498 Antibiotic regimen prescribed
• G9499 Patient did not start or is not receiving antiviral treatment for hepatitis c during the measurement period
• G9500 Radiation exposure indices documented in final report for procedure using fluoroscopy
• G9501 Radiation exposure indices not documented in final report for procedure using fluoroscopy, reason not given
• G9502 Documentation of medical reason for not performing foot exam (i.e., patients who have had either a bilateral amputation above or below the knee, or both a left and right amputation above or below the knee before or during the measurement period)
• G9503 Patient taking tamsulosin hydrochloride
• G9504 Documented reason for not assessing hepatitis b virus (hbv) status (e.g., patient not initiating anti-tnf therapy, patient declined) prior to initiating anti-tnf therapy
• G9505 Antibiotic regimen prescribed within 10 days after onset of symptoms for documented medical reason
• G9506 Biologic immune response modifier prescribed
• G9507 Documentation that the patient is on a statin medication or has documentation of a valid contraindication or exception to statin medications; contraindications/exceptions that can be defined by diagnosis codes include pregnancy during the measurement period, active liver disease, rhabdomyolysis, end stage renal disease on dialysis and heart failure; provider documented contraindications/exceptions include breastfeeding during the measurement period, woman of child-bearing age not actively taking birth control, allergy to statin, drug interaction (hiv protease inhibitors, nefazodone, cyclosporine, gemfibrozil, and danazol) and intolerance (with supporting documentation of trying a statin at least once within the last 5 years or diagnosis codes for myostitis or toxic myopathy related to drugs)
• G9508 Documentation that the patient is not on a statin medication
• G9509 Adult patients 18 years of age or older with major depression or dysthymia who reached remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5
• G9510 Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5. either phq- 9 or phq-9m score was not assessed or is greater than or equal to 5
• G9511 Index event date phq-9 or phq-9m score greater than 9 documented during the twelve month denominator identification period
• G9512 Individual had a pdc of 0.8 or greater
• G9513 Individual did not have a pdc of 0.8 or greater
• G9514 Patient required a return to the operating room within 90 days of surgery
• G9515 Patient did not require a return to the operating room within 90 days of surgery
• G9516 Patient achieved an improvement in visual acuity, from their preoperative level, within 90 days of surgery
• G9517 Patient did not achieve an improvement in visual acuity, from their preoperative level, within 90 days of surgery, reason not given
• G9518 Documentation of active injection drug use
• G9519 Patient achieves final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery
• G9520 Patient does not achieve final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery
• G9521 Total number of emergency department visits and inpatient hospitalizations less than two in the past 12 months
• G9522 Total number of emergency department visits and inpatient hospitalizations equal to or greater than two in the past 12 months or patient not screened, reason not given
• G9523 Patient discontinued from hemodialysis or peritoneal dialysis
• G9524 Patient was referred to hospice care
• G9525 Documentation of patient reason(s) for not referring to hospice care (e.g., patient declined, other patient reasons)
• G9526 Patient was not referred to hospice care, reason not given
• G9529 Patient with minor blunt head trauma had an appropriate indication(s) for a head ct
• G9530 Patient presented with a minor blunt head trauma and had a head ct ordered for trauma by an emergency care provider
• G9531 Patient has documentation of ventricular shunt, brain tumor, multisystem trauma, or is currently taking an antiplatelet medication including: abciximab, anagrelide, cangrelor, cilostazol, clopidogrel, dipyridamole, eptifibatide, prasugrel, ticlopidine, ticagrelor, tirofiban, or vorapaxar
• G9532 Patient had a head ct for trauma ordered by someone other than an emergency care provider or was ordered for a reason other than trauma
• G9533 Patient with minor blunt head trauma did not have an appropriate indication(s) for a head ct
• G9534 Advanced brain imaging (cta, ct, mra or mri) was not ordered
• G9535 Patients with a normal neurological examination
• G9536 Documentation of medical reason(s) for ordering an advanced brain imaging study (i.e., patient has an abnormal neurological examination; patient has the coexistence of seizures, or both; recent onset of severe headache; change in the type of headache; signs of increased intracranial pressure (e.g., papilledema, absent venous pulsations on funduscopic examination, altered mental status, focal neurologic deficits, signs of meningeal irritation); hiv-positive patients with a new type of headache; immunocompromised patient with unexplained headache symptoms; patient on coagulopathy/anti-coagulation or anti-platelet therapy; very young patients with unexplained headache symptoms)
• G9537 Imaging needed as part of a clinical trial; or other clinician ordered the study
• G9538 Advanced brain imaging (cta, ct, mra or mri) was ordered
• G9539 Intent for potential removal at time of placement
• G9540 Patient alive 3 months post procedure
• G9541 Filter removed within 3 months of placement
• G9542 Documented re-assessment for the appropriateness of filter removal within 3 months of placement
• G9543 Documentation of at least two attempts to reach the patient to arrange a clinical re-assessment for the appropriateness of filter removal within 3 months of placement
• G9544 Patients that do not have the filter removed, documented re-assessment for the appropriateness of filter removal, or documentation of at least two attempts to reach the patient to arrange a clinical re-assessment for the appropriateness of filter removal within 3 months of placement
• G9547 Cystic renal lesion that is simple appearing (bosniak i or ii) , or adrenal lesion less than or equal to 1.0 cm or adrenal lesion greater than 1.0 cm but less than or equal to 4.0 cm classified as likely benign by unenhanced ct or washout protocol ct, or mri with in- and opposed-phase sequences or other equivalent institutional imaging protocols
• G9548 Final reports for imaging studies stating no follow-up imaging is recommended
• G9549 Documentation of medical reason(s) that follow-up imaging is indicated (e.g., patient has lymphadenopathy, signs of metastasis or an active diagnosis or history of cancer, and other medical reason(s))
• G9550 Final reports for imaging studies with follow-up imaging recommended, or final reports that do not include a specific recommendation of no follow-up
• G9551 Final reports for imaging studies without an incidentally found lesion noted
• G9552 Incidental thyroid nodule < 1.0 cm noted in report
• G9553 Prior thyroid disease diagnosis
• G9554 Final reports for ct, cta, mri or mra of the chest or neck with follow-up imaging recommended
• G9555 Documentation of medical reason(s) for recommending follow up imaging (e.g., patient has multiple endocrine neoplasia, patient has cervical lymphadenopathy, other medical reason(s))
• G9556 Final reports for ct, cta, mri or mra of the chest or neck with follow-up imaging not recommended
• G9557 Final reports for ct, cta, mri or mra studies of the chest or neck without an incidentally found thyroid nodule < 1.0 cm noted or no nodule found
• G9558 Patient treated with a beta-lactam antibiotic as definitive therapy
• G9559 Documentation of medical reason(s) for not prescribing a beta-lactam antibiotic (e.g., allergy, intolerance to beta-lactam antibiotics)
• G9560 Patient not treated with a beta-lactam antibiotic as definitive therapy, reason not given
• G9561 Patients prescribed opiates for longer than six weeks
• G9562 Patients who had a follow-up evaluation conducted at least every three months during opioid therapy
• G9563 Patients who did not have a follow-up evaluation conducted at least every three months during opioid therapy
• G9572 Index date phq-score greater than 9 documented during the twelve month denominator identification period
• G9573 Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at six months as demonstrated by a six month (+/-60 days) phq-9 or phq-9m score of less than five
• G9574 Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at six months as demonstrated by a six month (+/-60 days) phq-9 or phq-9m score of less than five; either phq-9 or phq-9m score was not assessed or is greater than or equal to five
• G9577 Patients prescribed opiates for longer than six weeks
• G9578 Documentation of signed opioid treatment agreement at least once during opioid therapy
• G9579 No documentation of signed an opioid treatment agreement at least once during opioid therapy
• G9580 Door to puncture time of 90 minutes or less
• G9581 Door to puncture time of greater than 2 hours for reasons documented by clinician (e.g., patients who are transferred from one institution to another with a known diagnosis of cva for endovascular stroke treatment; hospitalized patients with newly diagnosed cva considered for endovascular stroke treatment)
• G9582 Door to puncture time of greater than 90 minutes, no reason given
• G9583 Patients prescribed opiates for longer than six weeks
• G9584 Patient evaluated for risk of misuse of opiates by using a brief validated instrument (e.g., opioid risk tool, soapp-r) or patient interviewed at least once during opioid therapy
• G9585 Patient not evaluated for risk of misuse of opiates by using a brief validated instrument (e.g., opioid risk tool, soapp-r) or patient not interviewed at least once during opioid therapy
• G9593 Pediatric patient with minor blunt head trauma classified as low risk according to the pecarn prediction rules
• G9594 Patient presented with a minor blunt head trauma and had a head ct ordered for trauma by an emergency care provider
• G9595 Patient has documentation of ventricular shunt, brain tumor, or coagulopathy
• G9596 Pediatric patient had a head ct for trauma ordered by someone other than an emergency care provider or was ordered for a reason other than trauma
• G9597 Pediatric patient with minor blunt head trauma not classified as low risk according to the pecarn prediction rules
• G9598 Aortic aneurysm 5.5 - 5.9 cm maximum diameter on centerline formatted ct or minor diameter on axial formatted ct
• G9599 Aortic aneurysm 6.0 cm or greater maximum diameter on centerline formatted ct or minor diameter on axial formatted ct
• G9600 Symptomatic aaas that required urgent/emergent (non-elective) repair
• G9601 Patient discharge to home no later than post-operative day #7
• G9602 Patient not discharged to home by post-operative day #7
• G9603 Patient survey score improved from baseline following treatment
• G9604 Patient survey results not available
• G9605 Patient survey score did not improve from baseline following treatment
• G9606 Intraoperative cystoscopy performed to evaluate for lower tract injury
• G9607 Documented medical reasons for not performing intraoperative cystoscopy (e.g., urethral pathology precluding cystoscopy, any patient who has a congenital or acquired absence of the urethra) or in the case of patient death
• G9608 Intraoperative cystoscopy not performed to evaluate for lower tract injury
• G9609 Documentation of an order for anti-platelet agents
• G9610 Documentation of medical reason(s) in the patient's record for not ordering anti-platelet agents
• G9611 Order for anti-platelet agents was not documented in the patient's record, reason not given
• G9612 Photodocumentation of two or more cecal landmarks to establish a complete examination
• G9613 Documentation of post-surgical anatomy (e.g., right hemicolectomy, ileocecal resection, etc.)
• G9614 Photodocumentation of less than two cecal landmarks (i.e., no cecal landmarks or only one cecal landmark) to establish a complete examination
• G9615 Preoperative assessment documented
• G9616 Documentation of reason(s) for not documenting a preoperative assessment (e.g., patient with a gynecologic or other pelvic malignancy noted at the time of surgery)
• G9617 Preoperative assessment not documented, reason not given
• G9618 Documentation of screening for uterine malignancy or those that had an ultrasound and/or endometrial sampling of any kind
• G9619 Documentation of reason(s) for not screening for uterine malignancy (e.g., prior hysterectomy)
• G9620 Patient not screened for uterine malignancy, or those that have not had an ultrasound and/or endometrial sampling of any kind, reason not given
• G9621 Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method and received brief counseling
• G9622 Patient not identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method
• G9623 Documentation of medical reason(s) for not screening for unhealthy alcohol use (e.g., limited life expectancy, other medical reasons)
• G9624 Patient not screened for unhealthy alcohol use using a systematic screening method or patient did not receive brief counseling if identified as an unhealthy alcohol user
• G9625 Patient sustained bladder injury at the time of surgery or discovered subsequently up to 30 days post-surgery
• G9626 Documented medical reason for not reporting bladder injury (e.g., gynecologic or other pelvic malignancy documented, concurrent surgery involving bladder pathology, injury that occurs during a urinary incontinence procedure, patient death from non-medical causes not related to surgery, patient died during procedure without evidence of bladder injury)
• G9627 Patient did not sustain bladder injury at the time of surgery nor discovered subsequently up to 30 days post-surgery
• G9628 Patient sustained bowel injury at the time of surgery or discovered subsequently up to 30 days post-surgery
• G9629 Documented medical reasons for not reporting bowel injury (e.g., gynecologic or other pelvic malignancy documented, planned (e.g., not due to an unexpected bowel injury) resection and/or re-anastomosis of bowel, or patient death from non-medical causes not related to surgery, patient died during procedure without evidence of bowel injury)
• G9630 Patient did not sustain a bowel injury at the time of surgery nor discovered subsequently up to 30 days post-surgery
• G9631 Patient sustained ureter injury at the time of surgery or discovered subsequently up to 30 days post-surgery
• G9632 Documented medical reasons for not reporting ureter injury (e.g., gynecologic or other pelvic malignancy documented, concurrent surgery involving bladder pathology, injury that occurs during a urinary incontinence procedure, patient death from non-medical causes not related to surgery, patient died during procedure without evidence of ureter injury)
• G9633 Patient did not sustain ureter injury at the time of surgery nor discovered subsequently up to 30 days post-surgery
• G9634 Health-related quality of life assessed with tool during at least two visits and quality of life score remained the same or improved
• G9635 Health-related quality of life not assessed with tool for documented reason(s) (e.g., patient has a cognitive or neuropsychiatric impairment that impairs his/her ability to complete the hrqol survey, patient has the inability to read and/or write in order to complete the hrqol questionnaire)
• G9636 Health-related quality of life not assessed with tool during at least two visits or quality of life score declined
• G9637 Final reports with documentation of one or more dose reduction techniques (e.g., automated exposure control, adjustment of the ma and/or kv according to patient size, use of iterative reconstruction technique)
• G9638 Final reports without documentation of one or more dose reduction techniques (e.g., automated exposure control, adjustment of the ma and/or kv according to patient size, use of iterative reconstruction technique)
• G9639 Major amputation or open surgical bypass not required within 48 hours of the index endovascular lower extremity revascularization procedure
• G9640 Documentation of planned hybrid or staged procedure
• G9641 Major amputation or open surgical bypass required within 48 hours of the index endovascular lower extremity revascularization procedure
• G9642 Current smoker (e.g., cigarette, cigar, pipe, e-cigarette or marijuana)
• G9643 Elective surgery
• G9644 Patients who abstained from smoking prior to anesthesia on the day of surgery or procedure
• G9645 Patients who did not abstain from smoking prior to anesthesia on the day of surgery or procedure
• G9646 Patients with 90 day mrs score of 0 to 2
• G9647 Patients in whom mrs score could not be obtained at 90 day follow-up
• G9648 Patients with 90 day mrs score greater than 2
• G9649 Psoriasis assessment tool documented meeting any one of the specified benchmarks (e.g., (pga; 5-point or 6-point scale), body surface area (bsa), psoriasis area and severity index (pasi) and/or dermatology life quality index) (dlqi))
• G9650 Documentation that the patient declined therapy change or has documented contraindications (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by pga, bsa, pasi, or dlqi
• G9651 Psoriasis assessment tool documented not meeting any one of the specified benchmarks (e.g., (pga; 5-point or 6-point scale), body surface area (bsa), psoriasis area and severity index (pasi) and/or dermatology life quality index) (dlqi)) or psoriasis assessment tool not documented
• G9652 Patient has been treated with a systemic or biologic medication for psoriasis for at least six months
• G9653 Patient has not been treated with a systemic or biologic medication for psoriasis for at least six months
• G9654 Monitored anesthesia care (mac)
• G9655 A transfer of care protocol or handoff tool/checklist that includes the required key handoff elements is used
• G9656 Patient transferred directly from anesthetizing location to pacu or other non-icu location
• G9657 Transfer of care during an anesthetic or to the intensive care unit
• G9658 A transfer of care protocol or handoff tool/checklist that includes the required key handoff elements is not used
• 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
• 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)
• G9661 Patients greater than or equal to 86 years of age who received a colonoscopy for an assessment of signs/symptoms of gi tract illness, and/or because the patient meets high risk criteria, and/or to follow-up on previously diagnosed advanced lesions
• G9662 Previously diagnosed or have a diagnosis of clinical ascvd, including ascvd procedure
• G9663 Any ldl-c laboratory result >= 190 mg/dl
• G9664 Patients who are currently statin therapy users or received an order (prescription) for statin therapy
• G9665 Patients who are not currently statin therapy users or did not receive an order (prescription) for statin therapy
• G9666 Patient's highest fasting or direct ldl-c laboratory test result in the measurement period or two years prior to the beginning of the measurement period is 70-189 mg/dl
• G9667 Documentation of medical reason(s) for not currently being a statin therapy user or receive an order (prescription) for statin therapy (e.g., patient with adverse effect, allergy or intolerance to statin medication therapy, patients who have an active diagnosis of pregnancy or who are breastfeeding, patients who are receiving palliative care, patients with active liver disease or hepatic disease or insufficiency, patients with end stage renal disease (esrd), and patients with diabetes who have a fasting or direct ldl-c laboratory test result < 70 mg/dl and are not taking statin therapy)
• G9669 I intend to report the multiple chronic conditions measures group
• G9670 All quality actions for the applicable measures in the multiple chronic conditions measures group have been performed for this patient
• G9671 I intend to report the diabetic retinopathy measures group
• G9672 All quality actions for the applicable measures in the diabetic retinopathy measures group have been performed for this patient
• G9673 I intend to report the cardiovascular prevention measures group
• G9674 Patients with clinical ascvd diagnosis
• G9675 Patients who have ever had a fasting or direct laboratory result of ldl-c = 190 mg/dl
• G9676 Patients aged 40 to 75 years at the beginning of the measurement period with type 1 or type 2 diabetes and with an ldl-c result of 70-189 mg/dl recorded as the highest fasting or direct laboratory test result in the measurement year or during the two years prior to the beginning of the measurement period
• G9677 All quality actions for the applicable measures in the cardiovascular prevention measures group have been performed for this patient
• G9678 Oncology care model (ocm) monthly enhanced oncology services (meos) payment for ocm enhanced services. g9678 payments may only be made to ocm practitioners for ocm beneficiaries for the furnishment of enhanced services as defined in the ocm participation agreement
• G9679 This code is for onsite acute care treatment of a nursing facility resident with pneumonia; may only be billed once per day per beneficiary
• G9680 This code is for onsite acute care treatment of a nursing facility resident with chf; may only be billed once per day per beneficiary
• G9681 This code is for onsite acute care treatment of a resident with copd or asthma; may only be billed once per day per beneficiary
• G9682 This code is for the onsite acute care treatment a nursing facility resident with a skin infection; may only be billed once per day per beneficiary
• G9683 Facility service(s) for the onsite acute care treatment of a nursing facility resident with fluid or electrolyte disorder. (may only be billed once per day per beneficiary). this service is for a demonstration project
• G9684 This code is for the onsite acute care treatment of a nursing facility resident for a uti; may only be billed once per day per beneficiary
• G9685 Physician service or other qualified health care professional for the evaluation and management of a beneficiary's acute change in condition in a nursing facility. this service is for a demonstration project
• G9686 Onsite nursing facility conference, that is separate and distinct from an evaluation and management visit, including qualified practitioner and at least one member of the nursing facility interdisciplinary care team
• G9687 Hospice services provided to patient any time during the measurement period
• G9688 Patients using hospice services any time during the measurement period
• G9689 Patient admitted for performance of elective carotid intervention
• G9690 Patient receiving hospice services any time during the measurement period
• G9691 Patient had hospice services any time during the measurement period
• G9692 Hospice services received by patient any time during the measurement period
• G9693 Patient use of hospice services any time during the measurement period
• G9694 Hospice services utilized by patient any time during the measurement period
• G9695 Long-acting inhaled bronchodilator prescribed
• G9696 Documentation of medical reason(s) for not prescribing a long-acting inhaled bronchodilator (e.g., patient intolerance or history of side effects)
• G9697 Documentation of patient reason(s) for not prescribing a long-acting inhaled bronchodilator
• G9698 Documentation of system reason(s) for not prescribing a long-acting inhaled bronchodilator (e.g., cost of treatment or lack of insurance)
• G9699 Long-acting inhaled bronchodilator not prescribed, reason not otherwise specified
• G9700 Patients who use hospice services any time during the measurement period
• G9701 Children who are taking antibiotics in the 30 days prior to the date of the encounter during which the diagnosis was established
• G9702 Patients who use hospice services any time during the measurement period
• G9703 Episodes where the patient is taking antibiotics (table 1) in the 30 days prior to the episode date
• G9704 Ajcc breast cancer stage i: t1 mic or t1a documented
• G9705 Ajcc breast cancer stage i: t1b (tumor > 0.5 cm but <= 1 cm in greatest dimension) documented
• G9706 Low (or very low) risk of recurrence, prostate cancer
• G9707 Patient received hospice services any time during the measurement period
• G9708 Women who had a bilateral mastectomy or who have a history of a bilateral mastectomy or for whom there is evidence of a right and a left unilateral mastectomy
• G9709 Hospice services used by patient any time during the measurement period
• G9710 Patient was provided hospice services any time during the measurement period
• G9711 Patients with a diagnosis or past history of total colectomy or colorectal cancer
• G9712 Documentation of medical reason(s) for prescribing or dispensing antibiotic (e.g., intestinal infection, pertussis, bacterial infection, lyme disease, otitis media, acute sinusitis, acute pharyngitis, acute tonsillitis, chronic sinusitis, infection of the pharynx/larynx/tonsils/adenoids, prostatitis, cellulitis/ mastoiditis/bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia, gonococcal infections/venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis/uti, acne, hiv disease/asymptomatic hiv, cystic fibrosis, disorders of the immune system, malignancy neoplasms, chronic bronchitis, emphysema, bronchiectasis, extrinsic allergic alveolitis, chronic airway obstruction, chronic obstructive asthma, pneumoconiosis and other lung disease due to external agents, other diseases of the respiratory system, and tuberculosis
• G9713 Patients who use hospice services any time during the measurement period
• G9714 Patient is using hospice services any time during the measurement period
• G9715 Patients who use hospice services any time during the measurement period
• G9716 Bmi is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reason
• G9717 Documentation stating the patient has had a diagnosis of bipolar disorder
• G9718 Hospice services for patient provided any time during the measurement period
• G9719 Patient is not ambulatory, bed ridden, immobile, confined to chair, wheelchair bound, dependent on helper pushing wheelchair, independent in wheelchair or minimal help in wheelchair
• G9720 Hospice services for patient occurred any time during the measurement period
• G9721 Patient not ambulatory, bed ridden, immobile, confined to chair, wheelchair bound, dependent on helper pushing wheelchair, independent in wheelchair or minimal help in wheelchair
• G9722 Documented history of renal failure or baseline serum creatinine >= 4.0 mg/dl; renal transplant recipients are not considered to have preoperative renal failure, unless, since transplantation the cr has been or is 4.0 or higher
• G9723 Hospice services for patient received any time during the measurement period
• G9724 Patients who had documentation of use of anticoagulant medications overlapping the measurement year
• G9725 Patients who use hospice services any time during the measurement period
• G9726 Patient refused to participate
• G9727 Patient unable to complete the lepf prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
• G9728 Patient refused to participate
• G9729 Patient unable to complete the lepf prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
• G9730 Patient refused to participate
• G9731 Patient unable to complete the lepf prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
• G9732 Patient refused to participate
• G9733 Patient unable to complete the low back fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
• G9734 Patient refused to participate
• G9735 Patient unable to complete the shoulder fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
• G9736 Patient refused to participate
• G9737 Patient unable to complete the elbow/wrist/hand fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
• G9738 Patient refused to participate
• G9739 Patient unable to complete the general orthopedic fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
• G9740 Hospice services given to patient any time during the measurement period
• G9741 Patients who use hospice services any time during the measurement period
• G9742 Psychiatric symptoms assessed
• G9743 Psychiatric symptoms not assessed, reason not otherwise specified
• G9744 Patient not eligible due to active diagnosis of hypertension
• G9745 Documented reason for not screening or recommending a follow-up for high blood pressure
• G9746 Patient has mitral stenosis or prosthetic heart valves or patient has transient or reversible cause of af (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac surgery)
• G9747 Patient is undergoing palliative dialysis with a catheter
• G9748 Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant
• G9749 Patient is undergoing palliative dialysis with a catheter
• G9750 Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant
• G9751 Patient died at any time during the 24-month measurement period
• G9752 Emergency surgery
• G9753 Documentation of medical reason for not conducting a search 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., trauma, acute myocardial infarction, stroke, aortic aneurysm where time is of the essence)
• G9754 A finding of an incidental pulmonary nodule
• G9755 Documentation of medical reason(s) for not including a recommended interval and modality for follow-up or for no follow-up, and source of recommendations (e.g., patients with unexplained fever, immunocompromised patients who are at risk for infection)
• G9756 Surgical procedures that included the use of silicone oil
• G9757 Surgical procedures that included the use of silicone oil
• G9758 Patient in hospice at any time during the measurement period
• G9759 History of preoperative posterior capsule rupture
• G9760 Patients who use hospice services any time during the measurement period
• G9761 Patients who use hospice services any time during the measurement period
• G9762 Patient had at least two hpv vaccines (with at least 146 days between the two) or three hpv vaccines on or between the patient's 9th and 13th birthdays
• G9763 Patient did not have at least two hpv vaccines (with at least 146 days between the two) or three hpv vaccines on or between the patient's 9th and 13th birthdays
• G9764 Patient has been treated with a systemic medication for psoriasis vulgaris
• G9765 Documentation that the patient declined change in medication or alternative therapies were unavailable, has documented contraindications, or has not been treated with a systemic medication for at least six consecutive months (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by pga, bsa, pasi, or dlqi
• G9766 Patients who are transferred from one institution to another with a known diagnosis of cva for endovascular stroke treatment
• G9767 Hospitalized patients with newly diagnosed cva considered for endovascular stroke treatment
• G9768 Patients who utilize hospice services any time during the measurement period
• G9769 Patient had a bone mineral density test in the past two years or received osteoporosis medication or therapy in the past 12 months
• G9770 Peripheral nerve block (pnb)
• G9771 At least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) achieved within the 30 minutes immediately before or 15 minutes immediately after anesthesia end time
• G9772 Documentation of medical reason(s) for not achieving at least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) within the 30 minutes immediately before or 15 minutes immediately after anesthesia end time (e.g., emergency cases, intentional hypothermia, etc.)
• G9773 At least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) not achieved within the 30 minutes immediately before or 15 minutes immediately after anesthesia end time, reason not given
• G9774 Patients who have had a hysterectomy
• G9775 Patient received at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively
• G9776 Documentation of medical reason for not receiving at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively (e.g., intolerance or other medical reason)
• G9777 Patient did not receive at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively
• G9778 Patients who have a diagnosis of pregnancy at any time during the measurement period
• G9779 Patients who are breastfeeding at any time during the performance period
• G9780 Patients who have a diagnosis of rhabdomyolysis at any time during the performance period
• G9781 Documentation of medical reason(s) for not currently being a statin therapy user or receiving an order (prescription) for statin therapy (e.g., patients with statin-associated muscle symptoms or an allergy to statin medication therapy, patients who are receiving palliative or hospice care, patients with active liver disease or hepatic disease or insufficiency, patients with end stage renal disease [esrd], or other medical reasons)
• G9782 History of or active diagnosis of familial hypercholesterolemia
• G9783 Documentation of patients with diabetes who have a most recent fasting or direct ldl- c laboratory test result < 70 mg/dl and are not taking statin therapy
• G9784 Pathologists/dermatopathologists providing a second opinion on a biopsy
• G9785 Pathology report diagnosing cutaneous basal cell carcinoma, squamous cell carcinoma, or melanoma (to include in situ disease) sent from the pathologist/ dermatopathologist to the biopsying clinician for review within 7 days from the time when the tissue specimen was received by the pathologist
• G9786 Pathology report diagnosing cutaneous basal cell carcinoma, squamous cell carcinoma, or melanoma (to include in situ disease) was not sent from the pathologist/ dermatopathologist to the biopsying clinician for review within 7 days from the time when the tissue specimen was received by the pathologist
• G9787 Patient alive as of the last day of the measurement year
• G9788 Most recent bp is less than or equal to 130/80 mm hg
• G9789 Blood pressure recorded during inpatient stays, emergency room visits, or urgent care visits
• G9790 Most recent bp is greater than 130/80 mm hg, or blood pressure not documented
• G9791 Most recent tobacco status is tobacco free
• G9792 Most recent tobacco status is not tobacco free
• G9793 Patient is currently on a daily aspirin or other antiplatelet
• G9794 Documentation of medical reason(s) for not on a daily aspirin or other antiplatelet (e.g., history of gastrointestinal bleed, intra-cranial bleed, idiopathic thrombocytopenic purpura (itp), gastric bypass or documentation of active anticoagulant use during the measurement period)
• G9795 Patient is not currently on a daily aspirin or other antiplatelet
• G9796 Patient is currently on a high intensity statin therapy
• G9797 Patient is not on a high intensity statin therapy
• G9798 Discharge(s) for ami between july 1 of the year prior measurement period to june 30 of the measurement period
• G9799 Patients with a medication dispensing event indicator of a history of asthma any time during the patient's history through the end of the measure period
• G9800 Patients who are identified as having an intolerance or allergy to beta-blocker therapy
• G9801 Hospitalizations in which the patient was transferred directly to a non-acute care facility for any diagnosis
• G9802 Patients who use hospice services any time during the measurement period
• G9803 Patient prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami
• G9804 Patient was not prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami
• G9805 Patients who use hospice services any time during the measurement period
• G9806 Patients who received cervical cytology or an hpv test
• G9807 Patients who did not receive cervical cytology or an hpv test
• G9808 Any patients who had no asthma controller medications dispensed during the measurement year
• G9809 Patients who use hospice services any time during the measurement period
• G9810 Patient achieved a pdc of at least 75% for their asthma controller medication
• G9811 Patient did not achieve a pdc of at least 75% for their asthma controller medication
• G9812 Patient died including all deaths occurring during the hospitalization in which the operation was performed, even if after 30 days, and those deaths occurring after discharge from the hospital, but within 30 days of the procedure
• G9813 Patient did not die within 30 days of the procedure or during the index hospitalization
• G9814 Death occurring during the index acute care hospitalization
• G9815 Death did not occur during the index acute care hospitalization
• G9816 Death occurring after discharge from the hospital but within 30 days post procedure
• G9817 Death did not occur after discharge from the hospital within 30 days post procedure
• G9818 Documentation of sexual activity
• G9819 Patients who use hospice services any time during the measurement period
• G9820 Documentation of a chlamydia screening test with proper follow-up
• G9821 No documentation of a chlamydia screening test with proper follow-up
• G9822 Patients who had an endometrial ablation procedure during the 12 months prior to the index date (exclusive of the index date)
• G9823 Endometrial sampling or hysteroscopy with biopsy and results documented during the 12 months prior to the index date (exclusive of the index date) of the endometrial ablation
• G9824 Endometrial sampling or hysteroscopy with biopsy and results not documented during the 12 months prior to the index date (exclusive of the index date) of the endometrial ablation
• G9825 Her-2/neu negative or undocumented/unknown
• G9826 Patient transferred to practice after initiation of chemotherapy
• G9827 Her2-targeted therapies not administered during the initial course of treatment
• G9828 Her2-targeted therapies administered during the initial course of treatment
• G9829 Breast adjuvant chemotherapy administered
• G9830 Her-2/neu positive
• G9831 Ajcc stage at breast cancer diagnosis = ii or iii
• G9832 Ajcc stage at breast cancer diagnosis = i (ia or ib) and t-stage at breast cancer diagnosis = t1c
• G9833 Patient transfer to practice after initiation of chemotherapy
• G9834 Patient has metastatic disease at diagnosis
• G9835 Trastuzumab administered within 12 months of diagnosis
• G9836 Reason for not administering trastuzumab documented (e.g. patient declined, patient died, patient transferred, contraindication or other clinical exclusion, neoadjuvant chemotherapy or radiation not complete)
• G9837 Trastuzumab not administered within 12 months of diagnosis
• G9838 Patient has metastatic disease at diagnosis
• G9839 Anti-egfr monoclonal antibody therapy
• G9840 Ras (kras and nras) gene mutation testing performed before initiation of anti-egfr moab
• G9841 Ras (kras and nras) gene mutation testing not performed before initiation of anti-egfr moab
• G9842 Patient has metastatic disease at diagnosis
• G9843 Ras (kras or nras) gene mutation
• G9844 Patient did not receive anti-egfr monoclonal antibody therapy
• G9845 Patient received anti-egfr monoclonal antibody therapy
• G9846 Patients who died from cancer
• G9847 Patient received systemic cancer-directed therapy in the last 14 days of life
• G9848 Patient did not receive systemic cancer-directed therapy in the last 14 days of life
• G9849 Patients who died from cancer
• G9850 Patient had more than one emergency department visit in the last 30 days of life
• G9851 Patient had one or less emergency department visits in the last 30 days of life
• G9852 Patients who died from cancer
• G9853 Patient admitted to the icu in the last 30 days of life
• G9854 Patient was not admitted to the icu in the last 30 days of life
• G9855 Patients who died from cancer
• G9856 Patient was not admitted to hospice
• G9857 Patient admitted to hospice
• G9858 Patient enrolled in hospice
• G9859 Patients who died from cancer
• G9860 Patient spent less than three days in hospice care
• G9861 Patient spent greater than or equal to three days in hospice care
• G9862 Documentation of medical reason(s) for not recommending at least 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 old, other medical reasons)
• G9868 Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, less than 10 minutes
• G9869 Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, 10-20 minutes
• G9870 Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, more than 20 minutes
• G9871 Behavioral counseling for diabetes prevention, online, 60 minutes
• G9873 First medicare diabetes prevention program (mdpp) core session was attended by an mdpp beneficiary under the mdpp expanded model (em). a core session is an mdpp service that: (1) is furnished by an mdpp supplier during months 1 through 6 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for core sessions
• G9874 Four total medicare diabetes prevention program (mdpp) core sessions were attended by an mdpp beneficiary under the mdpp expanded model (em). a core session is an mdpp service that: (1) is furnished by an mdpp supplier during months 1 through 6 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for core sessions
• G9875 Nine total medicare diabetes prevention program (mdpp) core sessions were attended by an mdpp beneficiary under the mdpp expanded model (em). a core session is an mdpp service that: (1) is furnished by an mdpp supplier during months 1 through 6 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for core sessions
• G9876 Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 7-9 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary did not achieve at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 7-9
• G9877 Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 10-12 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary did not achieve at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 10-12
• G9878 Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 7-9 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions.the beneficiary achieved at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 7-9
• G9879 Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 10-12 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary achieved at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 10-12
• G9880 The mdpp beneficiary achieved at least 5% weight loss (wl) from his/her baseline weight in months 1-12 of the mdpp services period under the mdpp expanded model (em). this is a one-time payment available when a beneficiary first achieves at least 5% weight loss from baseline as measured by an in-person weight measurement at a core session or core maintenance session
• G9881 The mdpp beneficiary achieved at least 9% weight loss (wl) from his/her baseline weight in months 1-24 under the mdpp expanded model (em). this is a one-time payment available when a beneficiary first achieves at least 9% weight loss from baseline as measured by an in-person weight measurement at a core session, core maintenance session, or ongoing maintenance session
• G9882 Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 13-15 under the mdpp expanded model (em). an ongoing maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary maintained at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 13-15
• G9883 Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 16-18 under the mdpp expanded model (em). an ongoing maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary maintained at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 16-18
• G9884 Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 19-21 under the mdpp expanded model (em). an ongoing maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary maintained at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 19-21
• G9885 Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 22-24 under the mdpp expanded model (em). an ongoing maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary maintained at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 22-24
• G9886 Behavioral counseling for diabetes prevention, in-person, group, 60 minutes
• G9887 Behavioral counseling for diabetes prevention, distance learning, 60 minutes
• G9888 Maintenance 5% wl from baseline weight in months 7-12
• G9890 Bridge payment: a one-time payment for the first medicare diabetes prevention program (mdpp) core session, core maintenance session, or ongoing maintenance session furnished by an mdpp supplier to an mdpp beneficiary during months 1-24 of the mdpp expanded model (em) who has previously received mdpp services from a different mdpp supplier under the mdpp expanded model. a supplier may only receive one bridge payment per mdpp beneficiary
• G9891 Mdpp session reported as a line-item on a claim for a payable mdpp expanded model (em) hcpcs code for a session furnished by the billing supplier under the mdpp expanded model and counting toward achievement of the attendance performance goal for the payable mdpp expanded model hcpcs code (this code is for reporting purposes only)
• G9892 Documentation of patient reason(s) for not performing a dilated macular examination
• G9893 Dilated macular exam was not performed, reason not otherwise specified
• G9894 Androgen deprivation therapy prescribed/administered in combination with external beam radiotherapy to the prostate
• G9895 Documentation of medical reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate (e.g., salvage therapy)
• G9896 Documentation of patient reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate
• G9897 Patients who were not prescribed/administered androgen deprivation therapy in combination with external beam radiotherapy to the prostate, reason not given
• G9898 Patients age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the measurement period
• G9899 Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results documented and reviewed
• G9900 Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results were not documented and reviewed, reason not otherwise specified
• G9901 Patient age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the measurement period
• G9902 Patient screened for tobacco use and identified as a tobacco user
• G9903 Patient screened for tobacco use and identified as a tobacco non-user
• G9904 Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)
• G9905 Patient not screened for tobacco use
• G9906 Patient identified as a tobacco user received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy)
• G9907 Documentation of medical reason(s) for not providing tobacco cessation intervention on the date of the encounter or within the previous 12 months (e.g., limited life expectancy, other medical reason)
• G9908 Patient identified as tobacco user did not receive tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy)
• G9909 Documentation of medical reason(s) for not providing tobacco cessation intervention on the date of the encounter or within the previous 12 months if identified as a tobacco user (e.g., limited life expectancy, other medical reason)
• G9910 Patients age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period
• G9911 Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer before or after neoadjuvant systemic therapy
• G9912 Hepatitis b virus (hbv) status assessed and results interpreted prior to initiating anti-tnf (tumor necrosis factor) therapy
• G9913 Hepatitis b virus (hbv) status not assessed and results interpreted prior to initiating anti-tnf (tumor necrosis factor) therapy, reason not otherwise specified
• G9914 Patient initiated an anti-tnf agent
• G9915 No record of hbv results documented
• G9916 Functional status performed once in the last 12 months
• G9917 Documentation of advanced stage dementia and caregiver knowledge is limited
• G9918 Functional status not performed, reason not otherwise specified
• G9919 Screening performed and positive and provision of recommendations
• G9920 Screening performed and negative
• G9921 No screening performed, partial screening performed or positive screen without recommendations and reason is not given or otherwise specified
• G9922 Safety concerns screen provided and if positive then documented mitigation recommendations
• G9923 Safety concerns screen provided and negative
• G9924 Documentation of medical reason(s) for not providing safety concerns screen or for not providing recommendations, orders or referrals for positive screen (e.g., patient in palliative care, other medical reason)
• G9925 Safety concerns screening not provided, reason not otherwise specified
• G9926 Safety concerns screening positive screen is without provision of mitigation recommendations, including but not limited to referral to other resources
• G9927 Documentation of system reason(s) for not prescribing an fda-approved anticoagulation due to patient being currently enrolled in a clinical trial related to af/atrial flutter treatment
• G9928 Fda-approved anticoagulant not prescribed, reason not given
• G9929 Patient with transient or reversible cause of af (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac surgery)
• G9930 Patients who are receiving comfort care only
• G9931 Documentation of cha2ds2-vasc risk score of 0 or 1 for men; or 0, 1, or 2 for women
• G9932 Documentation of patient reason(s) for not having records of negative or managed positive tb screen (e.g., patient does not return for mantoux (ppd) skin test evaluation)
• G9933 Adenoma(s) or colorectal cancer detected during screening colonoscopy
• G9934 Documentation that neoplasm detected is only diagnosed as traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma
• G9935 Adenoma(s) or colorectal cancer not detected during screening colonoscopy
• G9936 Surveillance colonoscopy - personal history of colonic polyps, colon cancer, or other malignant neoplasm of rectum, rectosigmoid junction, and anus
• G9937 Diagnostic colonoscopy
• G9938 Patients aged 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the six months prior to the measurement period through december 31 of the measurement period
• G9939 Pathologists/dermatopathologists is the same clinician who performed the biopsy
• G9940 Documentation of medical reason(s) for not on a statin (e.g., pregnancy, in vitro fertilization, clomiphene rx, esrd, cirrhosis, muscular pain and disease during the measurement period or prior year)
• G9941 Back pain was measured by the visual analog scale (vas) within three months preoperatively and at three months (6 - 20 weeks) postoperatively
• G9942 Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminectomy
• G9943 Back pain was not measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively
• G9944 Back pain was measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively
• G9945 Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis
• G9946 Back pain was not measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively
• G9947 Leg pain was measured by the visual analog scale (vas) within three months preoperatively and at three months (6 to 20 weeks) postoperatively
• G9948 Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminectomy
• G9949 Leg pain was not measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively
• G9954 Patient exhibits 2 or more risk factors for post-operative vomiting
• G9955 Cases in which an inhalational anesthetic is used only for induction
• G9956 Patient received combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively
• G9957 Documentation of medical reason for not receiving combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively (e.g., intolerance or other medical reason)
• G9958 Patient did not receive combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively
• G9959 Systemic antimicrobials not prescribed
• G9960 Documentation of medical reason(s) for prescribing systemic antimicrobials
• G9961 Systemic antimicrobials prescribed
• G9962 Embolization endpoints are documented separately for each embolized vessel and ovarian artery angiography or embolization performed in the presence of variant uterine artery anatomy
• G9963 Embolization endpoints are not documented separately for each embolized vessel or ovarian artery angiography or embolization not performed in the presence of variant uterine artery anatomy
• G9964 Patient received at least one well-child visit with a pcp during the performance period
• G9965 Patient did not receive at least one well-child visit with a pcp during the performance period
• G9966 Children who were screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report
• G9967 Children who were not screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report
• G9968 Patient was referred to another clinician or specialist during the measurement period
• G9969 Clinician who referred the patient to another clinician received a report from the clinician to whom the patient was referred
• G9970 Clinician who referred the patient to another clinician did not receive a report from the clinician to whom the patient was referred
• 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
• G9975 Documentation of medical reason(s) for not performing a dilated macular examination
• G9978 Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a problem focused history; a problem focused examination; and straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
• G9979 Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 20 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
• G9980 Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a detailed history; a detailed examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate severity. typically, 30 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
• G9981 Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 45 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
• G9982 Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 60 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
• G9983 Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
• G9984 Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 15 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
• G9985 Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 25 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
• G9986 Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 40 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
• G9987 Bundled payments for care improvement advanced (bpci advanced) model home visit for patient assessment performed by clinical staff for an individual not considered homebound, including, but not necessarily limited to patient assessment of clinical status, safety/fall prevention, functional status/ambulation, medication reconciliation/management, compliance with orders/plan of care, performance of activities of daily living, and ensuring beneficiary connections to community and other services; for use only for a bpci advanced model episode of care; may not be billed for a 30-day period covered by a transitional care management code
• G9988 Palliative care services provided to patient any time during the measurement period
• G9989 Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., adverse reaction to vaccine)
• 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
• G9991 Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period
• G9992 Palliative care services used by patient any time during the measurement period
• G9993 Patient was provided palliative care services any time during the measurement period
• G9994 Patient is using palliative care services any time during the measurement period
• G9995 Patients who use palliative care services any time during the measurement period
• G9996 Documentation stating the patient has received or is currently receiving palliative or hospice care
• G9997 Documentation of patient pregnancy anytime during the measurement period prior to and including the current encounter
• G9998 Documentation of medical reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., last colonoscopy incomplete, last colonoscopy had inadequate prep, piecemeal removal of adenomas, or sessile serrated polyps >= 20 mm in size, last colonoscopy found greater than 10 adenomas, lower gastrointestinal bleeding, or patient at high risk for colon cancer due to underlying medical history ([i.e. crohn's disease, ulcerative colitis, personal or family history of colon cancer, hereditary colorectal cancer syndromes])
• 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)