Modifier and HCPCS Changes for 2022

The following new and deleted National Level II modifiers and Healthcare Common Procedure Coding System (HCPCS) are effective for dates of service on/after January 1, 2022.

In compliance with the Health Insurance Portability and Accountability Act (HIPAA), CMS eliminated the 3-month grace period for discontinued codes in Change Request (CR) 3093 dated February 6, 2004. Effective for dates of services on/after January 1, 2010, there is no grace period for billing discontinued HCPCS codes.

Note: The inclusion of modifiers or codes on this web page do not necessarily indicate coverage. New modifiers and HCPCS identified as Durable Medical Equipment (DME) are not included in this listing.

 

New Modifiers

MODIFIER DESCRIPTION
FQ The service was furnished using audio-only communication technology
FR The supervising practitioner was present through two-way, audio/video communication technology
FS Split (or shared) evaluation and management visit
FT Unrelated evaluation and management (e/m) visit during a postoperative period, or on the same day as a procedure or another e/m visit. (report when an e/m visit is furnished within the global period but is unrelated, or when one or more additional e/m visits furnished on the same day are unrelated

 

New Codes

HCPCS DESCRIPTION
A2001 Innovamatrix ac, per square centimeter
A2002 Mirragen advanced wound matrix, per square centimeter
A2003 Bio-connekt wound matrix, per square centimeter
A2004 Xcellistem, per square centimeter
A2005 Microlyte matrix, per square centimeter
A2006 Novosorb synpath dermal matrix, per square centimeter
A2007 Restrata, per square centimeter
A2008 Theragenesis, per square centimeter
A2009 Symphony, per square centimeter
A2010 Apis, per square centimeter
A9595 Piflufolastat f-18, diagnostic, 1 millicurie
C1832 Autograft suspension, including cell processing and application, and all system components
C1833 Monitor, cardiac, including intracardiac lead and all system components (implantable)
C9085 Injection, avalglucosidase alfa-ngpt, 4 mg
C9086 Injection, anifrolumab-fnia, 1 mg
C9087 Injection, cyclophosphamide, (auromedics), 10 mg
C9088 Instillation, bupivacaine and meloxicam, 1 mg/0.03 mg
C9089 Bupivacaine, collagen-matrix implant, 1 mg
D3911 Intraorifice barrier
D3921 Decoronation or submergence of an erupted tooth
D4322 Splint - intra-coronal; natural teeth or prosthetic crowns
D4323 Splint - extra-coronal; natural teeth or prosthetic crowns
D5227 Immediate maxillary partial denture - flexible base (including any clasps, rests and teeth)
D5228 Immediate mandibular partial denture - flexible base (including any clasps, rests and teeth)
D5725 Rebase hybrid prosthesis
D5765 Soft liner for complete or partial removable denture ? indirect
D6198 Remove interim implant component
D7298 Removal of temporary anchorage device [screw retained plate], requiring flap
D7299 Removal of temporary anchorage device, requiring flap
D7300 Removal of temporary anchorage device without flap
D9912 Pre-visit patient screening
D9947 Custom sleep apnea appliance fabrication and placement
D9948 Adjustment of custom sleep apnea appliance
D9949 Repair of custom sleep apnea appliance
E1629 Tablo hemodialysis system for the billable dialysis service
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 on the date of the encounter or within the previous 12 months, reason not otherwise specified
G0030 Patient screened for tobacco use and received tobacco cessation intervention on the date of the encounter or within the previous 12 months (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
G0465 Autologous platelet rich plasma (prp) for diabetic chronic wounds/ulcers, using an fda-cleared device (includes administration, dressings, phlebotomy, centrifugation, and all other preparatory procedures, per treatment)
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
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 health 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 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
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 Pneumococcal vaccine was not administered on or after patient's 60th birthday and before the end of the measurement period, reason not otherwise specified
G9991 Pneumococcal vaccine administered on or after patient's 60th 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 pallative 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, last colonoscopy found greater than 10 adenomas, or patient at high risk for colon cancer [crohn's disease, ulcerative colitis, lower gastrointestinal bleeding, 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, previous colonoscopy report was incomplete)
J0172 Injection, aducanumab-avwa, 2 mg
J1952 Leuprolide injectable, camcevi, 1 mg
J2506 Injection, pegfilgrastim, excludes biosimilar, 0.5 mg
J9021 Injection, asparaginase, recombinant, (rylaze), 0.1 mg
J9061 Injection, amivantamab-vmjw, 2 mg
J9272 Injection, dostarlimab-gxly, 10 mg
Q2055 Idecabtagene vicleucel, up to 460 million autologous b-cell maturation antigen (bcma) directed car-positive t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
Q4199 Cygnus matrix, per square centimeter

 

Deleted Codes

HCPCS DESCRIPTION
A4397 Irrigation supply; sleeve, each
C9081 Idecabtagene vicleucel, up to 460 million autologous anti-bcma car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
C9082 Injection, dostarlimab-gxly, 100 mg
C9083 Injection, amivantamab-vmjw, 10 mg
C9752 Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum
C9753 Destruction of intraosseous basivertebral nerve, each additional vertebral body, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum (list separately in addition to code for primary procedure)
D4320 Provisional splinting-intracoronal
D4321 Provisional splinting-extracoronal
D8050 Interceptive orthodontic treatment of the primary dentition
D8060 Interceptive orthodontic treatment of the transitional dentition
D8690 Orthodontic treatment (alternative billing to a contract fee)
G0424 Pulmonary rehabilitation, including exercise (includes monitoring), one hour, per session, up to two sessions per day
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
G8422 Bmi not documented, documentation the patient is not eligible for bmi calculation
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
G8938 Bmi is documented as being outside of normal parameters, follow-up plan is not documented, documentation the patient is not eligible
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
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
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
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
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
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
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
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
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
G9647 Patients in whom mrs score could not be obtained at 90 day follow-up
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
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
J2505 Injection, pegfilgrastim, 6 mg
M1022 Patients who were in hospice at any time during the performance period
M1025 Patients who were in hospice at any time during the performance period
M1026 Patients who were in hospice at any time during the performance period
M1031 Patients with no clinical indications for imaging of the head

 

Source

  • Transmittal 10972, CR 12406 dated September 8, 2021

 

Last Updated Dec 09 , 2023