Modifier and HCPCS Changes for 2022 - JE Part B
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