Modifier and HCPCS Changes for 2023

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, 2023.

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
AB Audiology service furnished personally by an audiologist without a physician/npp order for non-acute hearing assessment unrelated to disequilibrium, or hearing aids, or examinations for the purpose of prescribing, fitting, or changing hearing aids; service may be performed once every 12 months, per beneficiary
JZ Zero drug amount discarded/not administered to any patient
LU Fractionated payment of car-t therapy
N1 Group 1 oxygen coverage criteria met
N2 Group 2 oxygen coverage criteria met
N3 Group 3 oxygen coverage criteria met

 

New Codes

HCPCS DESCRIPTION
C1747 Endoscope, single-use (i.e. disposable), urinary tract, imaging/illumination device (insertable)
C1826 Generator, neurostimulator (implantable), includes closed feedback loop leads and all implantable components, with rechargeable battery and charging system
C1827 Generator, neurostimulator (implantable), non-rechargeable, with implantable stimulation lead and external paired stimulation controller
C7500 Debridement, bone including epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed, first 20 sq cm or less with manual preparation and insertion of deep (eg, subfacial) drug-delivery device(s)
C7501 Percutaneous breast biopsies using stereotactic guidance, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, all lesions unilateral and bilateral (for single lesion biopsy, use appropriate code)
C7502 Percutaneous breast biopsies using magnetic resonance guidance, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, all lesions unilateral or bilateral (for single lesion biopsy, use appropriate code)
C7503 Open biopsy or excision of deep cervical node(s) with intraoperative identification (eg, mapping) of sentinel lymph node(s) including injection of non-radioactive dye when performed
C7504 Percutaneous vertebroplasties (bone biopsies included when performed), first cervicothoracic and any additional cervicothoracic or lumbosacral vertebral bodies, unilateral or bilateral injection, inclusive of all imaging guidance
C7505 Percutaneous vertebroplasties (bone biopsies included when performed), first lumbosacral and any additional cervicothoracic or lumbosacral vertebral bodies, unilateral or bilateral injection, inclusive of all imaging guidance
C7506 Arthrodesis, interphalangeal joints, with or without internal fixation
C7507 Percutaneous vertebral augmentations, first thoracic and any additional thoracic or lumbar vertebral bodies, including cavity creations (fracture reductions and bone biopsies included when performed) using mechanical device (eg, kyphoplasty), unilateral or bilateral cannulations, inclusive of all imaging guidance
C7508 Percutaneous vertebral augmentations, first lumbar and any additional thoracic or lumbar vertebral bodies, including cavity creations (fracture reductions and bone biopsies included when performed) using mechanical device (eg, kyphoplasty), unilateral or bilateral cannulations, inclusive of all imaging guidance
C7509 Bronchoscopy, rigid or flexible, diagnostic with cell washing(s) when performed, with computer-assisted image-guided navigation, including fluoroscopic guidance when performed
C7510 Bronchoscopy, rigid or flexible, with bronchial alveolar lavage(s), with computer-assisted image-guided navigation, including fluoroscopic guidance when performed
C7511 Bronchoscopy, rigid or flexible, with single or multiple bronchial or endobronchial biopsy(ies), single or multiple sites, with computer-assisted image-guided navigation, including fluoroscopic guidance when performed
C7512 Bronchoscopy, rigid or flexible, with single or multiple bronchial or endobronchial biopsy(ies), single or multiple sites, with transendoscopic endobronchial ultrasound (ebus) during bronchoscopic diagnostic or therapeutic intervention(s) for peripheral lesion(s), including fluoroscopic guidance when performed
C7513 Dialysis circuit, introduction of needle(s) and/or catheter(s), with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, with transluminal balloon angioplasty of central dialysis segment, performed through dialysis circuit, including all required imaging, radiological supervision and interpretation, image documentation and report
C7514 Dialysis circuit, introduction of needle(s) and/or catheter(s), with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, with all angioplasty in the central dialysis segment, and transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all required imaging, radiological supervision and interpretation, image documentation and report
C7515 Dialysis circuit, introduction of needle(s) and/or catheter(s), with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, with dialysis circuit permanent endovascular embolization or occlusion of main circuit or any accessory veins, including all required imaging, radiological supervision and interpretation, image documentation and report
C7516 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report
C7517 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, with 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
C7518 Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging, supervision, interpretation and report
C7519 Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress
C7520 Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) includes intraprocedural injection(s) for bypass graft angiography with 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
C7521 Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography with right heart catheterization with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report
C7522 Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation with right heart catheterization, with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress
C7523 Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report
C7524 Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress
C7525 Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report
C7526 Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress
C7527 Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report
C7528 Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress
C7529 Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress
C7530 Dialysis circuit, introduction of needle(s) and/or catheter(s), with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty and all angioplasty in the central dialysis segment, with transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all imaging, radiological supervision and interpretation, documentation and report
C7531 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(ies), unilateral, with transluminal angioplasty with intravascular ultrasound (initial noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation
C7532 Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), initial artery, open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, with intravascular ultrasound (initial noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation
C7533 Percutaneous transluminal coronary angioplasty, single major coronary artery or branch with transcatheter placement of radiation delivery device for subsequent coronary intravascular brachytherapy
C7534 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(ies), unilateral, with atherectomy, includes angioplasty within the same vessel, when performed with intravascular ultrasound (initial noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation
C7535 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(ies), unilateral, with transluminal stent placement(s), includes angioplasty within the same vessel, when performed, with intravascular ultrasound (initial noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation
C7537 Insertion of new or replacement of permanent pacemaker with atrial transvenous electrode(s), with insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system)
C7538 Insertion of new or replacement of permanent pacemaker with ventricular transvenous electrode(s), with insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system)
C7539 Insertion of new or replacement of permanent pacemaker with atrial and ventricular transvenous electrode(s), with insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system)
C7540 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator, dual lead system, with insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system)
C7541 Diagnostic endoscopic retrograde cholangiopancreatography (ercp), including collection of specimen(s) by brushing or washing, when performed, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s)
C7542 Endoscopic retrograde cholangiopancreatography (ercp) with biopsy, single or multiple, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s)
C7543 Endoscopic retrograde cholangiopancreatography (ercp) with sphincterotomy/papillotomy, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s)
C7544 Endoscopic retrograde cholangiopancreatography (ercp) with removal of calculi/debris from biliary/pancreatic duct(s), with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s)
C7545 Percutaneous exchange of biliary drainage catheter (eg, external, internal-external, or conversion of internal-external to external only), with removal of calculi/debris from biliary duct(s) and/or gallbladder, including destruction of calculi by any method (eg, mechanical, electrohydraulic, lithotripsy) when performed, including diagnostic cholangiography(ies) when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation
C7546 Removal and replacement of externally accessible nephroureteral catheter (eg, external/internal stent) requiring fluoroscopic guidance, with ureteral stricture balloon dilation, including imaging guidance and all associated radiological supervision and interpretation
C7547 Convert nephrostomy catheter to nephroureteral catheter, percutaneous via pre-existing nephrostomy tract, with ureteral stricture balloon dialation, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation
C7548 Exchange nephrostomy catheter, percutaneous, with ureteral stricture balloon dilation, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation
C7549 Change of ureterostomy tube or externally accessible ureteral stent via ileal conduit with ureteral stricture balloon dilation, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation
C7550 Cystourethroscopy, with biopsy(ies) with adjuctive blue light cystoscopy with fluorescent imaging agent
C7551 Excision of major peripheral nerve neuroma, except sciatic, with implantation of nerve end into bone or muscle
C7552 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography and right heart catheterization with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress, initial vessel
C7553 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography with pharmacologic agent administration (eg, inhaled nitric oxide, intravenous infusion of nitroprusside, dobutamine, milrinone, or other agent) including assessing hemodynamic measurements before, during, after and repeat pharmacologic agent administration, when performed
C7554 Cystourethroscopy with adjunctive blue light cystoscopy with fluorescent imaging agent
C7555 Thyroidectomy, total or complete with parathyroid autotransplantation
C7900 Service for diagnosis, evaluation, or treatment of a mental health or substance use disorder, initial 15-29 minutes, provided remotely by hospital staff who are licensed to provide mental health services under applicable state law(s), when the patient is in their home, and there is no associated professional service
C7901 Service for diagnosis, evaluation, or treatment of a mental health or substance use disorder, initial 30-60 minutes, provided remotely by hospital staff who are licensed to provided mental health services under applicable state law(s), when the patient is in their home, and there is no associated professional service
C7902 Service for diagnosis, evaluation, or treatment of a mental health or substance use disorder, each additional 15 minutes, provided remotely by hospital staff who are licensed to provide mental health services under applicable state law(s), when the patient is in their home, and there is no associated professional service (list separately in addition to code for primary service)
C9143 Cocaine hydrochloride nasal solution (numbrino), 1 mg
C9144 Injection, bupivacaine (posimir), 1 mg
D0372 Intraoral tomosynthesis - comprehensive series of radiographic images
D0373 Intraoral tomosynthesis - bitewing radiographic image
D0374 Intraoral tomosynthesis - periapical radiographic image
D0387 Intraoral tomosynthesis - comprehensive series of radiographic images - image capture only
D0388 Intraoral tomosynthesis - bitewing radiographic image - image capture only
D0389 Intraoral tomosynthesis - periapical radiographic image - image capture only
D0801 3d dental surface scan - direct
D0802 3d dental surface scan - indirect
D0803 3d facial surface scan - direct
D0804 3d facial surface scan - indirect
D1781 Vaccine administration - human papillomavirus - dose 1
D1782 Vaccine administration - human papillomavirus - dose 2
D1783 Vaccine administration - human papillomavirus - dose 3
D4286 Removal of non-resorbable barrier
D6105 Removal of implant body not requiring bone removal or flap elevation
D6106 Guided tissue regeneration - resorbable barrier, per implant
D6107 Guided tissue regeneration - non-resorbable barrier, per implant
D6197 Replacement of restorative material used to close an access opening of a screw-retained implant supported prosthesis, per implant
D7509 Marsupialization of odontogenic cyst
D7956 Guided tissue regeneration, edentulous area - resorbable barrier, per site
D7957 Guided tissue regeneration, edentulous area - non-resorbable barrier, per site
D9953 Reline custom sleep apnea appliance (indirect)
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 or clinical social worker 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)
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
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.)
J0134 Injection, acetaminophen (fresenius kabi) not therapeutically equivalent to j0131, 10 mg
J0136 Injection, acetaminophen (b braun) not therapeutically equivalent to j0131, 10 mg
J0173 Injection, epinephrine (belcher) not therapeutically equivalent to j0171, 0.1 mg
J0225 Injection, vutrisiran, 1 mg
J0283 Injection, amiodarone hydrochloride (nexterone), 30 mg
J0611 Injection, calcium gluconate (wg critical care), per 10 ml
J0689 Injection, cefazolin sodium (baxter), not therapeutically equivalent to j0690, 500 mg
J0701 Injection, cefepime hydrochloride (baxter), not therapeutically equivalent to maxipime, 500 mg
J0703 Injection, cefepime hydrochloride (b braun), not therapeutically equivalent to maxipime, 500 mg
J0877 Injection, daptomycin (hospira), not therapeutically equivalent to j0878, 1 mg
J0891 Injection, argatroban (accord), not therapeutically equivalent to j0883, 1 mg (for non-esrd use)
J0892 Injection, argatroban (accord), not therapeutically equivalent to j0884, 1 mg (for esrd on dialysis)
J0893 Injection, decitabine (sun pharma) not therapeutically equivalent to j0894, 1 mg
J0898 Injection, argatroban (auromedics), not therapeutically equivalent to j0883, 1 mg (for non-esrd use)
J0899 Injection, argatroban (auromedics), not therapeutically equivalent to j0884, 1 mg (for esrd on dialysis)
J1456 Injection, fosaprepitant (teva), not therapeutically equivalent to j1453, 1 mg
J1574 Injection, ganciclovir sodium (exela) not therapeutically equivalent to j1570, 500 mg
J1611 Injection, glucagon hydrochloride (fresenius kabi), not therapeutically equivalent to j1610, per 1 mg
J1643 Injection, heparin sodium (pfizer), not therapeutically equivalent to j1644, per 1000 units
J1954 Injection, leuprolide acetate for depot suspension (lutrate), 7.5 mg
J2021 Injection, linezolid (hospira) not therapeutically equivalent to j2020, 200 mg
J2184 Injection, meropenem (b. braun) not therapeutically equivalent to j2185, 100 mg
J2247 Injection, micafungin sodium (par pharm) not thereapeutically equivalent to j2248, 1 mg
J2251 Injection, midazolam hydrochloride (wg critical care) not therapeutically equivalent to j2250, per 1 mg
J2272 Injection, morphine sulfate (fresenius kabi) not therapeutically equivalent to j2270, up to 10 mg
J2281 Injection, moxifloxacin (fresenius kabi) not therapeutically equivalent to j2280, 100 mg
J2311 Injection, naloxone hydrochloride (zimhi), 1 mg
J2327 Injection, risankizumab-rzaa, intravenous, 1 mg
J2401 Injection, chloroprocaine hydrochloride, per 1 mg
J2402 Injection, chloroprocaine hydrochloride (clorotekal), per 1 mg
J3244 Injection, tigecycline (accord) not therapeutically equivalent to j3243, 1 mg
J3371 Injection, vancomycin hcl (mylan) not therapeutically equivalent to j3370, 500 mg
J3372 Injection, vancomycin hcl (xellia) not therapeutically equivalent to j3370, 500 mg
J9046 Injection, bortezomib, (dr. reddy's), not therapeutically equivalent to j9041, 0.1 mg
J9048 Injection, bortezomib (fresenius kabi), not therapeutically equivalent to j9041, 0.1 mg
J9049 Injection, bortezomib (hospira), not therapeutically equivalent to j9041, 0.1 mg
J9314 Injection, pemetrexed (teva) not therapeutically equivalent to J9305, 10 mg
J9393 Injection, fulvestrant (teva) not therapeutically equivalent to j9395, 25 mg
J9394 Injection, fulvestrant (fresenius kabi) not therapeutically equivalent to j9395, 25 mg
M0001 Advancing cancer care mips value pathways
M0002 Optimal care for kidney health mips value pathways
M0003 Optimal care for patients with episodic neurological conditions mips value pathways
M0004 Supportive care for neurodegenerative conditions mips value pathways
M0005 Promoting wellness mips value pathways
M1150 Left ventricular ejection fraction (lvef) less than or equal to 40% or documentation of moderately or severely depressed left ventricular systolic function
M1151 Patients with a history of heart transplant or with a left ventricular assist device (lvad)
M1152 Patients with a history of heart transplant or with a left ventricular assist device (lvad)
M1153 Patient with diagnosis of osteoporosis on date of encounter
M1154 Hospice services provided to patient any time during the measurement period
M1155 Patient had anaphylaxis due to the pneumococcal vaccine any time during or before the measurement period
M1156 Patient received active chemotherapy any time during the measurement period
M1157 Patient received bone marrow transplant any time during the measurement period
M1158 Patient had history of immunocompromising conditions prior to or during the measurement period
M1159 Hospice services provided to patient any time during the measurement period
M1160 Patient had anaphylaxis due to the meningococcal vaccine any time on or before the patient's 13th birthday
M1161 Patient had anaphylaxis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient's 13th birthday
M1162 Patient had encephalitis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient's 13th birthday
M1163 Patient had anaphylaxis due to the hpv vaccine any time on or before the patient's 13th birthday
M1164 Patients with dementia any time during the patient's history through the end of the measurement period
M1165 Patients who use hospice services any time during the measurement period
M1166 Pathology report for tissue specimens produced from wide local excisions or re-excisions
M1167 In hospice or using hospice services during the measurement period
M1168 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
M1169 Documentation of medical reason(s) for not administering influenza vaccine (e.g., prior anaphylaxis due to the influenza vaccine)
M1170 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
M1171 Patient received at least one td vaccine or one tdap vaccine between nine years prior to the encounter and the end of the measurement period
M1172 Documentation of medical reason(s) for not administering td or tdap vaccine (e.g., prior anaphylaxis due to the td or tdap vaccine or history of encephalopathy within seven days after a previous dose of a td-containing vaccine)
M1173 Patient did not receive at least one td vaccine or one tdap vaccine between nine years prior to the encounter and the end of the measurement period
M1174 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
M1175 Documentation of medical reason(s) for not administering zoster vaccine (e.g., prior anaphylaxis due to the zoster vaccine)
M1176 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
M1177 Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 60th birthday and before the end of the measurement period
M1178 Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., prior anaphylaxis due to the pneumococcal vaccine)
M1179 Patient did not receive any pneumococcal conjugate or polysaccharide vaccine, on or after their 60th birthday and before or during measurement period
M1180 Patients on immune checkpoint inhibitor therapy
M1181 Grade 2 or above diarrhea and/or grade 2 or above colitis
M1182 Patients not eligible due to pre-existing inflammatory bowel disease (ibd) (e.g., ulcerative colitis, crohn's disease)
M1183 Documentation of immune checkpoint inhibitor therapy held and corticosteroids or immunosuppressants prescribed or administered
M1184 Documentation of medical reason(s) for not prescribing or administering corticosteroid or immunosuppressant treatment (e.g., allergy, intolerance, infectious etiology, pancreatic insufficiency, hyperthyroidism, prior bowel surgical interventions, celiac disease, receiving other medication, awaiting diagnostic workup results for alternative etiologies, other medical reasons/contraindication)
M1185 Documentation of immune checkpoint inhibitor therapy not held and/or corticosteroids or immunosuppressants prescribed or administered was not performed, reason not given
M1186 Patients who have an order for or are receiving hospice or palliative care
M1187 Patients with a diagnosis of end stage renal disease (esrd)
M1188 Patients with a diagnosis of chronic kidney disease (ckd) stage 5
M1189 Documentation of a kidney health evaluation defined by an estimated glomerular filtration rate (egfr) and urine albumin-creatinine ratio (uacr) performed
M1190 Documentation of a kidney health evaluation was not performed or defined by an estimated glomerular filtration rate (egfr) and urine albumin-creatinine ratio (uacr)
M1191 Hospice services provided to patient any time during the measurement period
M1192 Patients with an existing diagnosis of squamous cell carcinoma of the esophagus
M1193 Surgical pathology reports that contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-based testing status, or both
M1194 Documentation of medical reason(s) surgical pathology reports did not contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-based testing status, or both tests were not included (e.g., patient will not be treated with checkpoint inhibitor therapy, no residual carcinoma is present in the sample [tissue exhausted or status post neoadjuvant treatment], insufficient tumor for testing)
M1195 Surgical pathology reports that do not contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-based testing status, or both, reason not given
M1196 Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4
M1197 Itch severity assessment score is reduced by 2 or more points from the initial (index) assessment score to the follow-up visit score
M1198 Itch severity assessment score was not reduced by at least 2 points from initial (index) score to the follow-up visit score or assessment was not completed during the follow-up encounter
M1199 Patients receiving rrt
M1200 Ace inhibitor (ace-i) or arb therapy prescribed during the measurement period
M1201 Documentation of medical reason(s) for not prescribing ace inhibitor (ace-i) or arb therapy during the measurement period (e.g., pregnancy, history of angioedema to ace-i, other allergy to ace-i and arb, hyperkalemia or history of hyperkalemia while on ace-i or arb therapy, acute kidney injury due to ace-i or arb therapy), other medical reasons)
M1202 Documentation of patient reason(s) for not prescribing ace inhibitor or arb therapy during the measurement period, (e.g., patient declined, other patient reasons)
M1203 Ace inhibitor or arb therapy not prescribed during the measurement period, reason not given
M1204 Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4
M1205 Itch severity assessment score is reduced by 2 or more points from the initial (index) assessment score to the follow-up visit score
M1206 Itch severity assessment score was not reduced by at least 2 points from initial (index) score to the follow-up visit score or assessment was not completed during the follow-up encounter
M1207 Number of patients screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety
M1208 Number of patients not screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety
M1209 At least two orders for high-risk medications from the same drug class, (table 4), not ordered
M1210 At least two orders for high-risk medications from the same drug class, (table 4), not ordered
Q4236 Carepatch, per square centimeter
Q4262 Dual layer impax membrane, per square centimeter
Q4263 Surgraft tl, per square centimeter
Q4264 Cocoon membrane, per square centimeter
Q5126 Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg

 

Deleted Codes

HCPCS DESCRIPTION
C1841 Retinal prosthesis, includes all internal and external components
C1842 Retinal prosthesis, includes all internal and external components; add-on to c1841
C1849 Skin substitute, synthetic, resorbable, per square centimeter
C9142 Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg
D0351 3d photographic image
D0704 3-d photographic image - image capture only
G0028 Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)
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
G2095 Documentation of system reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., other system reasons)
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
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)
G2201 Documentation of medical reason(s) for not providing brief counseling (e.g., limited life expectancy, other medical reasons)
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)
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
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
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
G9506 Biologic immune response modifier prescribed
G9618 Documentation of screening for uterine malignancy or those that had an ultrasound and/or endometrial sampling of any kind
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
G9623 Documentation of medical reason(s) for not screening for unhealthy alcohol use (e.g., limited life expectancy, other medical reasons)
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
G9718 Hospice services for patient provided any time during the measurement period
G9774 Patients who have had a hysterectomy
G9778 Patients who have a diagnosis of pregnancy at any time during the measurement period
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
G9904 Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)
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)
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)
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)
G9942 Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminectomy
G9948 Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminectomy
G9989 Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., adverse reaction to vaccine)
J2400 Injection, chloroprocaine hydrochloride, per 30 ml
J9044 Injection, bortezomib, not otherwise specified, 0.1 mg
K0553 Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service
K0554 Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system
M1017 Patient admitted to palliative care services
M1071 Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminotomy

 

Source

  • Transmittal 11566, CR 12833 dated August 18, 2022

 

Last Updated Dec 09 , 2023