Modifier and HCPCS Changes for 2023 - JF Part B
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
