Modifier and HCPCS Changes for January 2026 - JE Part B
Modifier and HCPCS Changes for January 2026
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, 2026.
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
There are no new modifiers being implemented.
New Codes
| HCPCS | DESCRIPTION |
|---|---|
| C1607 | Neurostimulator, integrated (implantable), rechargeable with all implantable and external components including charging system |
| C1608 | Prosthesis, total, dual mobility, first carpometacarpal joint (implantable) |
| C7566 | Arthrodesis, interphalangeal joints, with or without internal fixation, with autografts (includes obtaining grafts) |
| C7567 | Bronchoscopy, rigid or flexible, including fluoroscopic guidance when performed, with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus(i), with computer-assisted image-guided naviagation |
| C7568 | Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress |
| C7569 | Percutaneous transluminal coronary angioplasty, single major coronary artery or branch 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 |
| C7570 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation with intraprocedural coronary fractional flow reserve (ffr) with 3d functional mapping of color-coded ffr values for the coronary tree, derived from coronary angiogram data, for real-time review and interpretation of possible atherosclerotic stenosis(es) intervention (list separately in addition to code for primary procedure) |
| C7571 | Percutaneous transluminal coronary angioplasty, single major coronary artery or branch with percutaneous transluminal coronary lithotripsy |
| C9176 | Tc-99m from domestically produced non-heu mo-99, [minimum 50 percent], full cost recovery add-on, per study dose |
| C9307 | Injection, linvoseltamab-gcpt, 1 mg |
| C9308 | Injection, carboplatin (avyxa), 1 mg |
| C9810 | Water circulating motorized cold therapy device (e.g., iceman) including all system components (e.g. pads, console, disposable parts), non-opioid medical device (must be a qualifying medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the caa, 2023) |
| C9811 | Electronic ambulatory infusion pump (e.g. sapphire pump), including all pump components, including disposable components , non-opioid medical device (must be a qualifying medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the caa, 2023) |
| C9812 | Echogenic nerve block needles (e.g. sonoplex, sonoblock, sonotap), non-opioid medical device (must be a qualifying medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the caa, 2023) |
| C9813 | Perforated continuous infusion catheter set (e.g. infiltralong), including all components, non-opioid medical device (must be a qualifying medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the caa, 2023) |
| C9814 | Continuous anesthesia echogenic conduction catheter set (e.g. sonolong), non-opioid medical device (must be a qualifying medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the caa, 2023) |
| C9815 | Linear peristaltic pain management infusion pump (e.g. cadd-solis ambulatory infusion pump), and all disposable system components, non-opioid medical device (must be a qualifying medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the caa, 2023) |
| C9816 | Rotary peristaltic infusion pump (e.g., reusable ambit pump) including all disposable system components, reusable non-opioid medical device (must be a qualifying medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the caa, 2023) |
| C9817 | Electronic cryo-pneumatic compression, pain management system (e.g. game ready grpro 2.1 system), including control unit, anatomically correct wrap(s), and other system component(s), non-opioid medical device (must be a qualifying medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the caa, 2023) |
| D0426 | Collection, preparation, and analysis of saliva sample - point-of-care |
| D0461 | Testing for cracked tooth |
| D1720 | Influenza vaccine administration |
| D5877 | Duplication of complete denture - maxillary |
| D5878 | Duplication of complete denture - mandibular |
| D5909 | Maxillary guidance prosthesis with guide flange |
| D5930 | Maxillary guidance prosthesis without guide flange |
| D5938 | Resection prosthesis, maxillary complete removable |
| D5939 | Resection prosthesis, mandibular complete removable |
| D5940 | Resection prosthesis, maxillary partial removable |
| D5941 | Resection prosthesis, mandibular partial removable |
| D5942 | Resection prosthesis, maxillary implant/abutment supported removable prosthesis for edentulous arch |
| D5943 | Resection prosthesis, mandibular implant/abutment supported removable prosthesis for edentulous arch |
| D5944 | Resection prosthesis, maxillary implant/abutment supported removable prosthesis for the partial edentulous arch |
| D5945 | Resection prosthesis, mandibular implant/abutment supported removable prosthesis for the partial edentulous arch |
| D5946 | Resection prosthesis, maxillary implant/abutment supported fixed prosthesis for edentulous arch |
| D5947 | Resection prosthesis, mandibular implant/abutment supported fixed prosthesis for edentulous arch |
| D5948 | Resection prosthesis, maxillary implant/abutment supported fixed prosthesis for the partial edentulous arch |
| D5949 | Resection prosthesis, mandibular implant/abutment supported fixed prosthesis for the partial edentulous arch |
| D6049 | Scaling and debridement of a single implant in the presence of peri-implantitis inflammation, bleeding upon probing and increased pocket depths, including cleaning of the implant surfaces, without flap entry and closure |
| D6196 | Removal of an indirect restoration on an implant retained abutment |
| D6280 | Implant maintenance procedures when a full arch removable implant/abutment supported denture is removed and reinserted, including cleansing of prosthesis and abutments - per arch |
| D9128 | Photobiomodulation therapy - first 15 minute increment, or any portion thereof |
| D9129 | Photobiomodulation therapy - each subsequent 15 minute increment, or any portion thereof |
| D9224 | Administration of general anesthesia with advanced airway - first 15 minute increment, or any portion thereof |
| D9225 | Administration of general anesthesia with advanced airway - each subsequent 15 minute increment, or any portion thereof |
| D9244 | In-office administration of minimal sedation - single drug - enteral |
| D9245 | Administration of moderate sedation - enteral |
| D9246 | Administration of moderate sedation - non-intravenous parenteral - first 15 minute increment, or any portion thereof |
| D9247 | Administration of moderate sedation - non-intravenous parenteral - each subsequent 15 minute increment, or any portion thereof |
| D9936 | Cleaning and inspection of occlusal guard - per appliance |
| 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) |
| 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 |
| G9871 | Behavioral counseling for diabetes prevention, online, 60 minutes |
| J0013 | Esketamine, nasal spray, 1 mg |
| J0162 | Injection, epinephrine (fresenius), not therapeutically equivalent to j0165, 0.1 mg |
| J0654 | Injection, liothyronine, 1 mcg |
| J1073 | Testosterone pellet, implant, 75 mg |
| J1736 | Injection, meloxicam (delova), 1 mg |
| J1737 | Injection, meloxicam (azurity), 1 mg |
| J1837 | Injection, posaconazole, 1 mg |
| J2516 | Injection, pentamidine isethionate, 1 mg |
| J2596 | Injection, vasopressin (long grove), not therapeutically equivalent to j2598, 1 unit |
| J2711 | Injection, neostigmine methylsulfate 0.1 mg and glycopyrrolate 0.02 mg |
| J3291 | Injection, tranexamic acid in sodium chloride, 5 mg |
| J3376 | Injection, vancomycin hcl (hikma), not therapeutically equivalent to j3373, 10 mg |
| J3379 | Injection, valproate sodium, 5 mg |
| J3387 | Injection, elivaldogene autotemcel, per treatment |
| J3389 | Topical administration, prademagene zamikeracel, per treatment |
| J7299 | Intrauterine copper contraceptive (miudella) |
| J7528 | Mycophenolate mofetil, for suspension, oral, 100 mg |
| J9184 | Injection, gemcitabine hydrochloride (avyxa), 200 mg |
| J9256 | Injection, nipocalimab-aahu, 3 mg |
| J9282 | Mitomycin, intravesical instillation, 1 mg |
| J9326 | Injection, telisotuzumab vedotin-tllv, 1 mg |
| M1426 | Encounters conducted via telehealth |
| M1427 | Documentation of medical reason(s) for performing a bone scan (including documented pain related to prostate cancer, salvage therapy, other medical reasons) |
| M1428 | Patients who have bilateral absence of eyes any time during the patient's history through the end of the measurement period |
| M1429 | Retinal exam finding with evidence of retinopathy in left, right or both eyes with severity level documented |
| M1430 | Retinal exam finding without evidence of retinopathy in both eyes with severity level documented (in measurement year or in the prior year) |
| M1431 | Encounters conducted via telehealth |
| M1432 | Encounters conducted via telehealth |
| M1433 | Patient on oral chemotherapy on or within 30 days before denominator eligible encounter |
| M1434 | Patient on oral chemotherapy on or within 30 days after denominator eligible encounter |
| M1435 | Patient on oral chemotherapy during the performance period |
| M1436 | Encounters conducted via telehealth |
| M1437 | Encounters conducted via telehealth |
| M1438 | Time last known well to hospital arrival less than or equal to 3.5 hours (<= 210 minutes) |
| M1439 | Significant ocular conditions that impact the visual outcome of surgery |
| M1440 | Encounters conducted via telehealth |
| M1441 | Encounter corresponds to initial diagnosis of sleep apnea or first contact with sleep apnea diagnosed patient |
| M1442 | Encounters conducted via telehealth |
| M1443 | Encounters conducted via telehealth |
| M1444 | Delivery at < 39 weeks of gestation |
| M1445 | Postpartum care visit before or at 12 weeks of giving birth |
| M1446 | Patients who died any time prior to the end of the measure assessment period |
| M1447 | Patients with an active diagnosis of bipolar disorder any time prior to the end of the measure assessment period |
| M1448 | Patients with an active diagnosis of personality disorder any time prior to the end of the measure assessment period |
| M1449 | Patients with an active diagnosis of schizophrenia or psychotic disorder any time prior to the end of the measure assessment period |
| M1450 | Patients who received hospice or palliative care service any time during denominator identification period or the measure assessment period |
| M1451 | Patients with an active diagnosis of pervasive developmental disorder any time prior to the end of the measure assessment period |
| M1452 | Patient ever had a diagnosis of dementia |
| M1453 | Patients with a pre-operative visual acuity better than 20/40 |
| M1454 | New cied |
| M1455 | Replaced or revised cied |
| M1456 | Patient had a heart transplant |
| M1457 | Patient had a diagnosis of asthma with any contact during the current or prior performance period or had asthma present on an active problem list any time during the performance period |
| M1458 | Patient died prior to the end of the performance period |
| M1459 | Patient was in hospice or receiving palliative care services at any time during the performance period |
| M1460 | Diagnosis for chronic obstructive pulmonary disease, emphysema, cystic fibrosis, or acute respiratory failure |
| M1461 | Patient diagnosis for chronic hepatitis c |
| M1462 | Patients with clinical indications for imaging of the head |
| M1463 | Documentation of at least two attempts to follow up with patient within 180 days of treatment |
| M1464 | No documentation of at least two attempts to follow up with patient within 180 days of treatment |
| M1465 | Patient follow up more than 180 days after treatment |
| M1466 | Patient had a lumbar fusion on the same date as the discectomy/laminectomy procedure |
| M1467 | Patients with an existing diagnosis of lynch syndrome |
| M1468 | Patient received recommended doses of hepatitis b vaccination based on age |
| M1469 | Patient has a history of hepatitis b illness or received a hepatitis b surface antigen, hepatitis b surface antibody, or total antibody to hepatitis b core antigen test with a positive result any time before or during the measurement period |
| M1470 | Documentation of medical reason(s) for not administering hepatitis b vaccine (e.g., prior anaphylaxis due to the hepatitis b vaccine) |
| M1471 | Documentation that patient is a medicare fee-for-service beneficiary and without additional supplementary insurance coverage for whom hep b vaccination is not reimbursable under current medicare part b coverage rules |
| M1472 | Patient did not receive recommended doses of hepatitis b vaccination based on age |
| M1473 | Patient situations, at any point during the denominator identification period, where the patient's functional capacity or motivation (or lack thereof) to improve may impact the accuracy of results of validated tools, such as delirium, dementia, intellectual disabilities, and pervasive and specific development disorders |
| M1474 | Patients with diagnosis of dementia |
| M1475 | Patients with diagnosis of huntington's disease |
| M1476 | Patients with diagnosis of cognitive impairment or alzheimer's disease |
| M1477 | Diagnosis of delirium |
| M1478 | Psychoactive substance abuse |
| M1479 | Patients whose functional capacity or motivation (or lack thereof) to improve may impact the accuracy of results of validated tools such as delirium, dementia, intellectual disabilities, and pervasive and specific development disorders |
| M1480 | Patients whose functional capacity or motivation (or lack thereof) to improve may impact the accuracy of results of validated tools such as delirium, dementia, intellectual disabilities, and pervasive and specific development disorders |
| M1481 | Patients receiving hospice or palliative care or who died during the measurement period |
| M1482 | Positive/detectable hepatitis c virus quantitative or qualitative rna test result during the denominator identification period |
| M1483 | Patients who achieve sustained virological response as identified by an hcv rna test (cpt 87522) or (cpt 87521) with a negative/undetectable hcv rna result that occurred 20 weeks to 12 months after the first positive/detectable hcv rna test result within the denominator identification period |
| M1484 | Patients who did not have a repeat hcv rna labs performed for medical reasons documented by clinician (e.g., patient with limited life expectancy, delay in treatment of hcv related to treatment of hiv, hbv, hepatocellular carcinoma, decompensated cirrhosis) |
| M1485 | Patients who did not achieve sustained virological response as identified by an hcv rna test (cpt 87522) or (cpt 87521) with a negative/undetectable hcv rna result that occurred 20 weeks to 12 months after the first positive/detectable hcv rna test result within the denominator identification period |
| M1486 | Patients admitted to a skilled nursing facility (snf) during the period of evaluation |
| M1487 | Patients in hospice in the year before or during the period of evaluation |
| M1488 | Patients with a diagnosis for dementia in the year before or during the period of evaluation |
| M1489 | Patient status documented |
| M1490 | Patient status not documented |
| M1491 | Receiving esrd mcp dialysis services by the provider during the performance period |
| M1492 | Patients who did not report a fall |
| M1493 | Documentation of falls not performed due to medical reasons (e.g., syncope, vertigo and related disorders, restless leg syndrome, tourette syndrome/tic disorder, back pain, concussion/mild traumatic brain injury (mtbi), cervical dystonia, or epilepsy) |
| M1494 | Patients that reported a fall since the last visit |
| M1495 | Patients that reported a fall occurred who had a plan of care for falls documented or patients that did not report a fall |
| M1496 | Patients that had a fall who did not have a plan of care for falls documented or do not have documentation of being assessed for falls |
| M1497 | Documentation of falls not performed due to medical reasons (e.g., syncope, vertigo and related disorders, restless leg syndrome, tourette syndrome/tic disorder, back pain, concussion/mild traumatic brain injury (mtbi), cervical dystonia, or epilepsy) |
| M1498 | Diagnostic radiology mips value pathway |
| M1499 | Interventional radiology mips value pathway |
| M1500 | Neuropsychology mips value pathway |
| M1501 | Pathology mips value pathway |
| M1502 | Podiatry mips value pathway |
| M1503 | Vascular surgery mips value pathway |
| Q4398 | Summit ac, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4399 | Summit fx, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4400 | Polygon3 membrane, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4401 | Absolv3 membrane, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4402 | Xwrap 2.0, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4403 | Xwrap dual plus, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4404 | Xwrap hydro plus, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4405 | Xwrap fenestra plus, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4406 | Xwrap fenestra, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4407 | Xwrap tribus, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4408 | Xwrap hydro, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4409 | Amniomatrixf3x, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4410 | Amchomatrixdl, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4411 | Amniomatrixf4x, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4412 | Choriofix, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4413 | Cygnus solo, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4414 | Simplichor, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4415 | Alexiguard sl-t, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4416 | Alexiguard tl-t, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4417 | Alexiguard dl-t, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4420 | Nuform, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4431 | Pma skin substitute product, not otherwise specified (list in addition to primary procedure) |
| Q4432 | 510(k) skin substitute product, not otherwise specified (list in addition to primary procedure) |
| Q4433 | 361 hct/p skin substitute product, not otherwise specified (list in addition to primary procedure) |
| Q5160 | Injection, bevacizumab-nwgd (jobevne), biosimilar, 10 mg |
| 0600U | Infectious disease (wound infection), identification of 65 organisms and 30 antibiotic resistance genes, wound swab, real-time pcr, reported as positive or negative for each organism |
| 0601U | Infectious disease (periprosthetic joint infection), analysis of 11 biomarkers (alpha defensins 1-3, creactive protein, microbial antigens for staphylococcus [spa, spb], enterococcus, candida, and c. acnes, total nucleated cell count, percent neutrophils, rbc count, and absorbance at 280 nm) using immunoassays, hematology, clinical chemistry, synovial fluid, and diagnostic algorithm reported as a probability score |
| 0602U | Endocrinology (diabetes), insulin (ins) gene methylation using digital droplet pcr, insulin, and cpeptide immunoassay, serum, hemoglobin a1c immunoassay, whole blood, algorithm reported as diabetes-risk score |
| 0603U | Drug assay, presumptive, 77 drugs or metabolites, urine, liquid chromatography with tandem mass spectrometry (lc-ms/ms), results reported as positive or negative |
| 0604U | Allergy and immunology (chronic recurrent angioedema), 4 bradykinin peptides, liquid chromatography and tandem mass spectrometry (lc-ms/ ms), whole blood, quantitative |
| 0605U | Allergy and immunology (hereditary alpha tryptasemia), dna, analysis of tpsab1 gene copy number variation using digital pcr, whole blood, results reported with genotypespecific interpretation of alpha-tryptase copy number and algorithmic classification as normal or abnormal |
| 0606U | Hematology (red cell membrane disorders), rbcs, osmotic gradient ektacytometry, whole blood, quantitative |
| 0607U | Reproductive medicine (endometrial microbiome assessment), real-time pcr analysis for 31 bacterial dna targets from endometrial biopsy, reported with quantified levels of bacterial presence and targeted treatment recommendations |
| 0608U | Reproductive medicine (endometrial microbiome assessment), real-time pcr analysis for 10 bacterial dna targets from endometrial biopsy, reported with quantified levels of bacterial presence and targeted treatment recommendations |
| 0609U | Oncology (prostate), immunoassay for total prostate-specific antigen (psa) and free psa, serum or plasma, combined with clinical features, algorithm reported as a probability score for clinically significant prostate cancer |
| 0610U | Infectious disease (antimicrobial susceptibility), phenotypic antimicrobial susceptibility testing of positive blood culture using microfluidic sensor technology to quantify bacterial growth response to multiple antibiotic types, reporting categorical susceptibility (susceptible, susceptible dose dependent, intermediate, resistant), minimum inhibitory concentration, and interpretive comments |
| 0611U | Oncology (liver), analysis of over 1,000 methylated regions, cell-free dna from plasma, algorithm reported as a quantitative result |
| 0612U | Oncology (liver), analysis of over 1,000 methylated regions, cell-free dna from plasma, algorithm reported as a quantitative result |
| 0613U | Oncology (urothelial carcinoma), dna methylation and mutation analysis of 6 biomarkers (twist1, otx1, onecut2, fgfr3, hras, tert promoter region), methylation-specific pcr and targeted next-generation sequencing, urine, algorithm reported as a probability index for bladder cancer and upper tract urothelial carcinoma |
Deleted Codes
| HCPCS | DESCRIPTION |
|---|---|
| C5271 | Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area |
| C5272 | Application of low cost skin substitute graft to trunk, arms, legs, total 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) |
| C5273 | Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children |
| C5274 | Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area 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) |
| C5275 | Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area |
| C5276 | Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total 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) |
| C5277 | Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children |
| C5278 | Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area 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) |
| C9089 | Bupivacaine, collagen-matrix implant, 1 mg |
| C9305 | Injection, nipocalimab-aahu, 3 mg |
| C9306 | Injection, telisotuzumab vedotin-tllv, 1 mg |
| C9751 | Bronchoscopy, rigid or flexible, transbronchial ablation of lesion(s) by microwave energy, including fluoroscopic guidance, when performed, with computed tomography acquisition(s) and 3-d rendering, computer-assisted, image-guided navigation, and endobronchial ultrasound (ebus) guided transtracheal and/or transbronchial sampling (e.g., aspiration[s]/biopsy[ies]) and all mediastinal and/or hilar lymph node stations or structures and therapeutic intervention(s) |
| C9784 | Gastric restrictive procedure, endoscopic sleeve gastroplasty, with esophagogastroduodenoscopy and intraluminal tube insertion, if performed, including all system and tissue anchoring components |
| D1352 | Preventive resin restoration in a moderate to high caries risk patient - permanent tooth |
| D1705 | Astrazeneca covid-19 vaccine administration - first dose |
| D1706 | Astrazeneca covid-19 vaccine administration - second dose |
| D1707 | Janssen covid-19 vaccine administration |
| D1712 | Janssen covid-19 vaccine administration - booster dose |
| D9248 | Non-intravenous conscious sedation |
| 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 |
| 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 |
| 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 |
| G9604 | Patient survey results not available |
| J0172 | Injection, aducanumab-avwa, 2 mg |
| J0190 | Injection, biperiden lactate, per 5 mg |
| J0200 | Injection, alatrofloxacin mesylate, 100 mg |
| J0205 | Injection, alglucerase, per 10 units |
| J0215 | Injection, alefacept, 0.5 mg |
| J0288 | Injection, amphotericin b cholesteryl sulfate complex, 10 mg |
| J0350 | Injection, anistreplase, per 30 units |
| J0365 | Injection, aprotonin, 10,000 kiu |
| J0380 | Injection, metaraminol bitartrate, per 10 mg |
| J0395 | Injection, arbutamine hcl, 1 mg |
| J0710 | Injection, cephapirin sodium, up to 1 gm |
| J0715 | Injection, ceftizoxime sodium, per 500 mg |
| J0795 | Injection, corticorelin ovine triflutate, 1 microgram |
| J0889 | Daprodustat, oral, 1 mg, (for esrd on dialysis) |
| J1267 | Injection, doripenem, 10 mg |
| J1330 | Injection, ergonovine maleate, up to 0.2 mg |
| J1443 | Injection, ferric pyrophosphate citrate solution (triferic), 0.1 mg of iron |
| J1444 | Injection, ferric pyrophosphate citrate powder, 0.1 mg of iron |
| J1445 | Injection, ferric pyrophosphate citrate solution (triferic avnu), 0.1 mg of iron |
| J1452 | Injection, fomivirsen sodium, intraocular, 1.65 mg |
| J1457 | Injection, gallium nitrate, 1 mg |
| J1562 | Injection, immune globulin (vivaglobin), 100 mg |
| J1572 | Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg |
| J1620 | Injection, gonadorelin hydrochloride, per 100 mcg |
| J1655 | Injection, tinzaparin sodium, 1000 iu |
| J1710 | Injection, hydrocortisone sodium phosphate, up to 50 mg |
| J1945 | Injection, lepirudin, 50 mg |
| J2504 | Injection, pegademase bovine, 25 iu |
| J2513 | Injection, pentastarch, 10% solution, 100 ml |
| J2910 | Injection, aurothioglucose, up to 50 mg |
| J2940 | Injection, somatrem, 1 mg |
| J2995 | Injection, streptokinase, per 250,000 iu |
| J3280 | Injection, thiethylperazine maleate, up to 10 mg |
| J3305 | Injection, trimetrexate glucuronate, per 25 mg |
| J3310 | Injection, perphenazine, up to 5 mg |
| J3320 | Injection, spectinomycin dihydrochloride, up to 2 gm |
| J3355 | Injection, urofollitropin, 75 iu |
| J3364 | Injection, urokinase, 5000 iu vial |
| J3365 | Injection, iv, urokinase, 250,000 i.u. vial |
| J3400 | Injection, triflupromazine hcl, up to 20 mg |
| J7309 | Methyl aminolevulinate (mal) for topical administration, 16.8%, 1 gram |
| J7310 | Ganciclovir, 4.5 mg, long-acting implant |
| J7505 | Muromonab-cd3, parenteral, 5 mg |
| J7513 | Daclizumab, parenteral, 25 mg |
| J8562 | Fludarabine phosphate, oral, 10 mg |
| J8650 | Nabilone, oral, 1 mg |
| J9019 | Injection, asparaginase (erwinaze), 1,000 iu |
| J9020 | Injection, asparaginase, not otherwise specified, 10,000 units |
| J9098 | Injection, cytarabine liposome, 10 mg |
| J9151 | Injection, daunorubicin citrate, liposomal formulation, 10 mg |
| J9165 | Injection, diethylstilbestrol diphosphate, 250 mg |
| J9212 | Injection, interferon alfacon-1, recombinant, 1 microgram |
| J9270 | Injection, plicamycin, 2.5 mg |
| Q0174 | Thiethylperazine maleate, 10 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen |
| Q2017 | Injection, teniposide, 50 mg |
| Q4100 | Skin substitute, not otherwise specified |
| Q4106 | Dermagraft, per square centimeter |
| Q5109 | Injection, infliximab-qbtx, biosimilar, (ixifi), 10 mg |
| Q9969 | Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose |
| S0013 | Esketamine, nasal spray, 1 mg |
| S0080 | Injection, pentamidine isethionate, 300 mg |
| 0033U | Gene analysis (5-hydroxytryptamine receptor 2A) for common variants |
| 0131U | Targeted mRNA sequence analysis of 13 genes associated with hereditary breast cancer and related disorders |
| 0132U | Targeted mRNA sequence analysis of 17 genes associated with hereditary ovarian cancer and related disorders |
| 0135U | Targeted mRNA sequence analysis of 12 genes associated with hereditary gynecological cancer |
| 0361U | Digital immunoassay in plasma for neurofilament light chain |
| 0508U | Testing for quantification of donor-derived cell-free DNA using 40 single-nucleotide polymorphisms to determine risk for active transplant rejection |
| 0509U | Testing for quantification of donor-derived cell-free DNA using up to 12 single-nucleotide polymorphisms to determine risk for active transplant rejection |
| 0544U | Testing of 48 variants reported as risk for transplant rejection |
| 0550U | Testing for prostate-specific antigen, reported as a risk score for the presence of high-grade prostate cancer |
| 0551U | Testing for phosphorylated Tau (pTau217) |
Source
Transmittal 13377, CR 14183 dated August 21, 2025
Last Updated Dec 17 , 2025
