HCPCS	   LONG DESCRIPTION									   ADD DATE   TERM DATE	
A0392      Als specialized service disposable supplies; defibrillation (to be used only in         19950101
A0392      jurisdictions where defibrillation cannot be performed in bls ambulances)
A0999      Unlisted ambulance service                                                              19870101
A4223      Infusion supplies not used with external infusion pump, per cassette or bag             20050101
A4223      (list drugs separately)
A4335      Incontinence supply; miscellaneous                                                      19900101
A4356      External urethral clamp or compression device (not to be used for catheter              19850101
A4356      clamp), each
A4421      Ostomy supply; miscellaneous                                                            19850101
A4641      Radiopharmaceutical, diagnostic, not otherwise classified                               19940101
A4642      Indium in-111 satumomab pendetide, diagnostic, per study dose, up to 6                  19950101
A4642      millicuries
A4649      Surgical supply; miscellaneous                                                          19820101
A4913      Miscellaneous dialysis supplies, not otherwise specified                                19860101
A5507      For diabetics only, not otherwise specified modification (including fitting) of         19950101
A5507      off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe
A6261      Wound filler, gel/paste, per fluid ounce, not otherwise specified                       19970101
A6262      Wound filler, dry form, per gram, not otherwise specified                               19970101
A6512      Compression burn garment, not otherwise classified                                      20030101
A6549      Gradient compression stocking/sleeve, not otherwise specified                           20060101
A7017      Nebulizer, durable, glass or autoclavable plastic, bottle type, not used with           20000101
A7017      oxygen
A9152      Single vitamin/mineral/trace element, oral, per dose, not otherwise specified           20050101
A9153      Multiple vitamins, with or without minerals and trace elements, oral, per dose,         20050101
A9153      not otherwise specified
A9279      Monitoring feature/device, stand-alone or integrated, any type, includes all            20070101
A9279      accessories, components and electronics, not otherwise classified
A9280      Alert or alarm device, not otherwise classified                                         20040101
A9500      Technetium tc-99m sestamibi, diagnostic, per study dose                                 19960101
A9501      Technetium tc-99m teboroxime, diagnostic, per study dose                                20080101
A9502      Technetium tc-99m tetrofosmin, diagnostic, per study dose                               19980101
A9503      Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries           19970101
A9504      Technetium tc-99m apcitide, diagnostic, per study dose, up to 20 millicuries            20000101
A9505      Thallium tl-201 thallous chloride, diagnostic, per millicurie                           19960101
A9507      Indium in-111 capromab pendetide, diagnostic, per study dose, up to 10                  19990101
A9507      millicuries
A9508      Iodine i-131 iobenguane sulfate, diagnostic, per 0.5 millicurie                         20010101
A9509      Iodine i-123 sodium iodide, diagnostic, per millicurie                                  20080101
A9510      Technetium tc-99m disofenin, diagnostic, per study dose, up to 15 millicuries           20010101
A9512      Technetium tc-99m pertechnetate, diagnostic, per millicurie                             20030101
A9515      Choline c-11, diagnostic, per study dose up to 20 millicuries                           20170101
A9516      Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999                  20030101
A9516      microcuries
A9520      Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries                        20140101
A9521      Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries         20030101
A9524      Iodine i-131 iodinated serum albumin, diagnostic, per 5 microcuries                     20030101
A9526      Nitrogen n-13 ammonia, diagnostic, per study dose, up to 40 millicuries                 20040101
A9528      Iodine i-131 sodium iodide capsule(s), diagnostic, per millicurie                       20040101
A9529      Iodine i-131 sodium iodide solution, diagnostic, per millicurie                         20040101
A9531      Iodine i-131 sodium iodide, diagnostic, per microcurie (up to 100 microcuries)          20040101
A9532      Iodine i-125 serum albumin, diagnostic, per 5 microcuries                               20040101
A9536      Technetium tc-99m depreotide, diagnostic, per study dose, up to 35 millicuries          20060101
A9537      Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries          20060101
A9538      Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25                   20060101
A9538      millicuries
A9539      Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries           20060101
A9540      Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10         20060101
A9540      millicuries
A9541      Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20                  20060101
A9541      millicuries
A9542      Indium in-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5                 20060101
A9542      millicuries
A9544      Iodine i-131 tositumomab, diagnostic, per study dose                                    20060101            20161231
A9546      Cobalt co-57/58, cyanocobalamin, diagnostic, per study dose, up to 1 microcurie         20060101
A9547      Indium in-111 oxyquinoline, diagnostic, per 0.5 millicurie                              20060101
A9548      Indium in-111 pentetate, diagnostic, per 0.5 millicurie                                 20060101
A9550      Technetium tc-99m sodium gluceptate, diagnostic, per study dose, up to 25               20060101
A9550      millicurie
A9551      Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries            20060101
A9552      Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries           20060101
A9553      Chromium cr-51 sodium chromate, diagnostic, per study dose, up to 250                   20060101
A9553      microcuries
A9554      Iodine i-125 sodium iothalamate, diagnostic, per study dose, up to 10                   20060101
A9554      microcuries
A9555      Rubidium rb-82, diagnostic, per study dose, up to 60 millicuries                        20060101
A9556      Gallium ga-67 citrate, diagnostic, per millicurie                                       20060101
A9557      Technetium tc-99m bicisate, diagnostic, per study dose, up to 25 millicuries            20060101
A9558      Xenon xe-133 gas, diagnostic, per 10 millicuries                                        20060101
A9559      Cobalt co-57 cyanocobalamin, oral, diagnostic, per study dose, up to 1                  20060101
A9559      microcurie
A9560      Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30         20060101
A9560      millicuries
A9561      Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries          20060101
A9562      Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries          20060101
A9566      Technetium tc-99m fanolesomab, diagnostic, per study dose, up to 25 millicuries         20060101
A9567      Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75              20060101
A9567      millicuries
A9568      Technetium tc-99m arcitumomab, diagnostic, per study dose, up to 45 millicuries         20070101
A9569      Technetium tc-99m exametazime labeled autologous white blood cells, diagnostic,         20080101
A9569      per study dose
A9570      Indium in-111 labeled autologous white blood cells, diagnostic, per study dose          20080101
A9571      Indium in-111 labeled autologous platelets, diagnostic, per study dose                  20080101
A9572      Indium in-111 pentetreotide, diagnostic, per study dose, up to 6 millicuries            20080101
A9579      Injection, gadolinium-based magnetic resonance contrast agent, not otherwise            20080101
A9579      specified (nos), per ml
A9580      Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries                  20090101
A9582      Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries               20100101
A9584      Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries                 20120101
A9586      Florbetapir f18, diagnostic, per study dose, up to 10 millicuries                       20130101
A9587      Gallium ga-68, dotatate, diagnostic, 0.1 millicurie                                     20170101
A9588      Fluciclovine f-18, diagnostic, 1 millicurie                                             20170101
A9597      Positron emission tomography radiopharmaceutical, diagnostic, for tumor                 20170101
A9597      identification, not otherwise classified
A9598      Positron emission tomography radiopharmaceutical, diagnostic, for non-tumor             20170101
A9598      identification, not otherwise classified
A9599      Radiopharmaceutical, diagnostic, for beta-amyloid positron emission tomography          20140101
A9599      (pet) imaging, per study dose, not otherwise specified
A9698      Non-radioactive contrast imaging material, not otherwise classified, per study          20060101
A9699      Radiopharmaceutical, therapeutic, not otherwise classified                              20030101
A9900      Miscellaneous dme supply, accessory, and/or service component of another hcpcs          20000101
A9900      code
A9901      Dme delivery, set up, and/or dispensing service component of another hcpcs code         20000101
A9999      Miscellaneous dme supply or accessory, not otherwise specified                          20040101
B4034      Enteral feeding supply kit; syringe fed, per day, includes but not limited to           19860101
B4034      feeding/flushing syringe, administration set tubing, dressings, tape
B4035      Enteral feeding supply kit; pump fed, per day, includes but not limited to              19860101
B4035      feeding/flushing syringe, administration set tubing, dressings, tape
B4036      Enteral feeding supply kit; gravity fed, per day, includes but not limited to           19860101
B4036      feeding/flushing syringe, administration set tubing, dressings, tape
B4087      Gastrostomy/jejunostomy tube, standard, any material, any type, each                    20080101
B4088      Gastrostomy/jejunostomy tube, low-profile, any material, any type, each                 20080101
B5000      Parenteral nutrition solution compounded amino acid and carbohydrates with              19880101
B5000      electrolytes, trace elements, and vitamins, including preparation, any
B5000      strength, renal-aminosyn-rf, nephramine, renamine-premix
B9998      Noc for enteral supplies                                                                19850101
B9999      Noc for parenteral supplies                                                             19850101
C1204      Technetium tc 99m tilmanocept, diagnostic, up to 0.5 millicuries                        20131001            20131231
C1730      Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer             20010401
C1730      electrodes)
C1731      Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more              20010401
C1731      electrodes)
C1732      Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping                  20010401
C1733      Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector               20010401
C1733      mapping, other than cool-tip
C1749      Endoscope, retrograde imaging/illumination colonoscope device (implantable)             20101001
C1889      Implantable/insertable device for device intensive procedure, not otherwise             20170101
C1889      classified
C2630      Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector               20010401
C2630      mapping, cool-tip
C2698      Brachytherapy source, stranded, not otherwise specified, per source                     20070701
C2699      Brachytherapy source, non-stranded, not otherwise specified, per source                 20070701
C8957      Intravenous infusion for therapy/diagnosis; initiation of prolonged infusion            20060101
C8957      (more than 8 hours), requiring use of portable or implantable pump
C9399      Unclassified drugs or biologicals                                                       20040101
C9442      Injection, belinostat, 10 mg                                                            20150101            20151231
C9448      Netupitant 300 mg and palonosetron 0.5 mg, oral                                         20150401            20150630
C9458      Florbetaben f18, diagnostic, per study dose, up to 8.1 millicuries                      20160101            20160630
C9459      Flutemetamol f18, diagnostic, per study dose, up to 5 millicuries                       20160101            20160630
C9461      Choline c 11, diagnostic, per study dose                                                20160401            20161231
C9474      Injection, irinotecan liposome, 1 mg                                                    20160401            20161231
C9735      Anoscopy; with directed submucosal injection(s), any substance                          20130401            20141231
C9742      Laryngoscopy, flexible fiberoptic, with injection into vocal cord(s),                   20150101            20161231
C9742      therapeutic, including diagnostic laryngoscopy, if performed
C9743      Injection/implantation of bulking or spacer material (any type) with or without         20151001            20160630
C9743      image guidance (not to be used if a more specific code applies)
C9899      Implanted prosthetic device, payable only for inpatients who do not have                20090101
C9899      inpatient coverage
D0170      Re-evaluation-limited, problem focused (established patient; not post-operative         20000101
D0170      visit)
D0391      Interpretation of diagnostic image by a practitioner not associated with                20130101
D0391      capture of the image, including report
D0417      Collection and preparation of saliva sample for laboratory diagnostic testing           20090101
D0431      Adjunctive pre-diagnostic test that aids in detection of mucosal abnormalities          20050101
D0431      including premalignant and malignant lesions, not to include cytology or biopsy
D0431      procedures
D0470      Diagnostic casts                                                                        19820101
D0477      Special stains, not for microorganisms                                                  20050101
D0600      Non-ionizing diagnostic procedure capable of quantifying, monitoring, and               20170101
D0600      recording changes in structure of enamel, dentin, and cementum
D0999      Unspecified diagnostic procedure, by report                                             19840101
D1999      Unspecified preventive procedure, by report                                             20140101
D2799      Provisional crown - further treatment or completion of diagnosis necessary              20000101
D2799      prior to final impression
D2999      Unspecified restorative procedure, by report                                            19860101
D3220      Therapeutic pulpotomy (excluding final restoration)  removal of pulp coronal to         19840101
D3220      the dentinocemental junction and application of medicament
D3354      Pulpal regeneration (completion of regenerative treatment in an immature                20110101            20131231
D3354      permanent tooth with a necrotic pulp); does not include final restoration
D3920      Hemisection (including any root removal), not including root canal therapy              19840101
D3999      Unspecified endodontic procedure, by report                                             19840101
D4274      Mesial/distal wedge procedure, single tooth (when not performed in conjunction          19960101
D4274      with surgical procedures in the same anatomical area)
D4355      Full mouth debridement to enable comprehensive evaluation and diagnosis                 19960101
D4999      Unspecified periodontal procedure, by report                                            19840101
D5899      Unspecified removable prosthodontic procedure, by report                                19860101
D5937      Trismus appliance (not for tm treatment)                                                19920101
D5999      Unspecified maxillofacial prosthesis, by report                                         19860101
D6103      Bone graft for repair of peri-implant defect - does not include flap entry and          20130101
D6103      closure
D6199      Unspecified implant procedure, by report                                                19920101
D6253      Provisional pontic - further treatment or completion of diagnosis necessary             20030101
D6253      prior to final impression
D6793      Provisional retainer crown - further treatment or completion of diagnosis               20030101
D6793      necessary prior to final impression
D6999      Unspecified fixed prosthodontic procedure, by report                                    19840101
D7272      Tooth transplantation (includes reimplantation from one site to another and             19820101
D7272      splinting and/or stabilization)
D7320      Alveoloplasty not in conjunction with extractions - four or more teeth or tooth         19840101
D7320      spaces, per quadrant
D7321      Alveoloplasty not in conjunction with extractions - one to three teeth or tooth         20050101
D7321      spaces, per quadrant
D7872      Arthroscopy-diagnosis, with or without biopsy                                           19920101
D7899      Unspecified tmd therapy, by report                                                      19920101
D7960      Frenulectomy - also known as frenectomy or frenotomy - separate procedure not           19840101
D7960      incidental to another procedure
D7997      Appliance removal (not by dentist who placed appliance), includes removal of            20000101
D7997      archbar
D7998      Intraoral placement of a fixation device not in conjunction with a fracture             20070101
D7999      Unspecified oral surgery procedure, by report                                           19840101
D8999      Unspecified orthodontic procedure, by report                                            19840101
D9210      Local anesthesia  not in conjunction with operative or surgical procedures              19840101
D9310      Consultation - diagnostic service provided by dentist or physician other than           19820101
D9310      requesting dentist or physician
D9999      Unspecified adjunctive procedure, by report                                             19840101
E0446      Topical oxygen delivery system, not otherwise specified, includes all supplies          20110101
E0446      and accessories
E0565      Compressor, air power source for equipment which is not self-contained or               19820101
E0565      cylinder driven
E0625      Patient lift, bathroom or toilet, not otherwise classified                              19860101
E0676      Intermittent limb compression device (includes all accessories), not otherwise          20070101
E0676      specified
E0769      Electrical stimulation or electromagnetic wound treatment device, not otherwise         20050101
E0769      classified
E0770      Functional electrical stimulator, transcutaneous stimulation of nerve and/or            20090101
E0770      muscle groups, any type, complete system, not otherwise specified
E0855      Cervical traction equipment not requiring additional stand or frame                     19980101
E1011      Modification to pediatric size wheelchair, width adjustment package (not to be          20030101
E1011      dispensed with initial chair)
E1229      Wheelchair, pediatric size, not otherwise specified                                     20050101
E1239      Power wheelchair, pediatric size, not otherwise specified                               20050101
E1399      Durable medical equipment, miscellaneous                                                19860101
E1699      Dialysis equipment, not otherwise specified                                             19860101
E2374      Power wheelchair accessory, hand or chin control interface, standard remote             20070101
E2374      joystick (not including controller), proportional, including all related
E2374      electronics and fixed mounting hardware, replacement only
E2599      Accessory for speech generating device, not otherwise classified                        20040101
E2630      Wheelchair accessory, shoulder elbow, mobile arm support, monosuspension arm            20120101
E2630      and hand support, overhead elbow forearm hand sling support, yoke type
E2630      suspension support
G0105      Colorectal cancer screening; colonoscopy on individual at high risk                     19980101
G0120      Colorectal cancer screening; alternative to g0105, screening colonoscopy,               19980101
G0120      barium enema.
G0121      Colorectal cancer screening; colonoscopy on individual not meeting criteria for         19980101
G0121      high risk
G0176      Activity therapy, such as music, dance, art or play therapies not for                   20010101
G0176      recreation, related to the care and treatment of patient's disabling mental
G0176      health problems, per session (45 minutes or more)
G0179      Physician re-certification for medicare-covered home health services under a            20010101
G0179      home health plan of care (patient not present), including contacts with home
G0179      health agency and review of reports of patient status required by physicians to
G0179      affirm the initial implementation of the plan of care that meets patient's
G0179      needs, per re-certification period
G0180      Physician certification for medicare-covered home health services under a home          20001001
G0180      health plan of care (patient not present), including contacts with home health
G0180      agency and review of reports of patient status required by physicians to affirm
G0180      the initial implementation of the plan of care that meets patient's needs, per
G0180      certification period
G0181      Physician supervision of a patient receiving medicare-covered services provided         20010101
G0181      by a participating home health agency (patient not present) requiring complex
G0181      and multidisciplinary care modalities involving regular physician development
G0181      and/or revision of care plans, review of subsequent reports of patient status,
G0181      review of laboratory and other studies, communication (including telephone
G0181      calls) with other health care professionals involved in the patient's care,
G0181      integration of new information into the medical treatment plan and/or
G0181      adjustment of medical therapy, within a calendar month, 30 minutes or more
G0182      Physician supervision of a patient under a medicare-approved hospice (patient           20010101
G0182      not present) requiring complex and multidisciplinary care modalities involving
G0182      regular physician development and/or revision of care plans, review of
G0182      subsequent reports of patient status, review of laboratory and other studies,
G0182      communication (including telephone calls) with other health care professionals
G0182      involved in the patient's care, integration of new information into the medical
G0182      treatment plan and/or adjustment of medical therapy, within a calendar month,
G0182      30 minutes or more
G0204      Diagnostic mammography, including computer-aided detection (cad) when                   20010401
G0204      performed; bilateral
G0206      Diagnostic mammography, including computer-aided detection (cad) when                   20010401
G0206      performed; unilateral
G0235      Pet imaging, any site, not otherwise specified                                          20060101
G0245      Initial physician evaluation and management of a diabetic patient with diabetic         20020701
G0245      sensory neuropathy resulting in a loss of protective sensation (lops) which
G0245      must include: (1) the diagnosis of lops, (2) a patient history, (3) a physical
G0245      examination that consists of at least the following elements: (a) visual
G0245      inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of a
G0245      protective sensation, (c) evaluation of foot structure and biomechanics, (d)
G0245      evaluation of vascular status and skin integrity, and (e) evaluation and
G0245      recommendation of footwear and (4) patient education
G0249      Provision of test materials and equipment for home inr monitoring of patient            20020701
G0249      with either mechanical heart valve(s), chronic atrial fibrillation, or venous
G0249      thromboembolism who meets medicare coverage criteria; includes: provision of
G0249      materials for use in the home and reporting of test results to physician;
G0249      testing not occurring more frequently than once a week; testing materials,
G0249      billing units of service include 4 tests
G0250      Physician review, interpretation, and patient management of home inr testing            20020701
G0250      for patient with either mechanical heart valve(s), chronic atrial fibrillation,
G0250      or venous thromboembolism who meets medicare coverage criteria; testing not
G0250      occurring more frequently than once a week; billing units of service include 4
G0250      tests
G0252      Pet imaging, full and partial-ring pet scanners only, for initial diagnosis of          20021001
G0252      breast cancer and/or surgical planning for breast cancer (e.g., initial staging
G0252      of axillary lymph nodes)
G0257      Unscheduled or emergency dialysis treatment for an esrd patient in a hospital           20030101
G0257      outpatient department that is not certified as an esrd facility
G0270      Medical nutrition therapy; reassessment and subsequent intervention(s)                  20030101
G0270      following second referral in same year for change in diagnosis, medical
G0270      condition or treatment regimen (including additional hours needed for renal
G0270      disease), individual, face to face with the patient, each 15 minutes
G0271      Medical nutrition therapy, reassessment and subsequent intervention(s)                  20030101
G0271      following second referral in same year for change in diagnosis, medical
G0271      condition, or treatment regimen (including additional hours needed for renal
G0271      disease), group (2 or more individuals), each 30 minutes
G0276      Blinded procedure for lumbar stenosis, percutaneous image-guided lumbar                 20150101
G0276      decompression (pild) or placebo-control, performed in an approved coverage with
G0276      evidence development (ced) clinical trial
G0279      Diagnostic digital breast tomosynthesis, unilateral or bilateral (list                  20150101
G0279      separately in addition to g0204 or g0206)
G0281      Electrical stimulation, (unattended), to one or more areas, for chronic stage           20030401
G0281      iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers, and venous
G0281      stasis ulcers not demonstrating measurable signs of healing after 30 days of
G0281      conventional care, as part of a therapy plan of care
G0329      Electromagnetic therapy, to one or more areas for chronic stage iii and stage           20040701
G0329      iv pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers
G0329      not demonstrating measurable signs of healing after 30 days of conventional
G0329      care as part of a therapy plan of care
G0412      Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing                    20090101
G0412      fracture(s), unilateral or bilateral for pelvic bone fracture patterns which do
G0412      not disrupt the pelvic ring includes internal fixation, when performed
G0433      Infectious agent antibody detection by enzyme-linked immunosorbent assay                20091208
G0433      (elisa) technique, hiv-1 and/or hiv-2, screening
G0456      Negative pressure wound therapy, (e.g. vacuum assisted drainage collection)             20130101            20141231
G0456      using a mechanically-powered device, not durable medical equipment, including
G0456      provision of cartridge and dressing(s), topical application(s), wound
G0456      assessment, and instructions for ongoing care, per session; total wounds(s)
G0456      surface area less than or equal to 50 square centimeters
G0457      Negative pressure wound therapy, (e.g. vacuum assisted drainage collection)             20130101            20141231
G0457      using a mechanically-powered device, not durable medical equipment, including
G0457      provision of cartridge and dressing(s), topical application(s), wound
G0457      assessment, and instructions for ongoing care, per session; total wounds(s)
G0457      surface area greater than 50 square centimeters
G0461      Immunohistochemistry or immunocytochemistry, per specimen; first single or              20140101            20141231
G0461      multiplex antibody stain
G0462      Immunohistochemistry or immunocytochemistry, per specimen; each additional              20140101            20141231
G0462      single or multiplex antibody stain (list separately in addition to code for
G0462      primary procedure)
G0480      Drug test(s), definitive, utilizing drug identification methods able to                 20160101
G0480      identify individual drugs and distinguish between structural isomers (but not
G0480      necessarily stereoisomers), including, but not limited to gc/ms (any type,
G0480      single or tandem) and lc/ms (any type, single or tandem and excluding
G0480      immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g.,
G0480      alcohol dehydrogenase)); qualitative or quantitative, all sources(s), includes
G0480      specimen validity testing, per day, 1-7 drug class(es), including metabolite(s)
G0480      if performed
G0481      Drug test(s), definitive, utilizing drug identification methods able to                 20160101
G0481      identify individual drugs and distinguish between structural isomers (but not
G0481      necessarily stereoisomers), including, but not limited to gc/ms (any type,
G0481      single or tandem) and lc/ms (any type, single or tandem and excluding
G0481      immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g.,
G0481      alcohol dehydrogenase)); qualitative or quantitative, all sources(s), includes
G0481      specimen validity testing, per day, 8-14 drug class(es), including
G0481      metabolite(s) if performed
G0482      Drug test(s), definitive, utilizing drug identification methods able to                 20160101
G0482      identify individual drugs and distinguish between structural isomers (but not
G0482      necessarily stereoisomers), including, but not limited to gc/ms (any type,
G0482      single or tandem) and lc/ms (any type, single or tandem and excluding
G0482      immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g.,
G0482      alcohol dehydrogenase)); qualitative or quantitative, all sources(s), includes
G0482      specimen validity testing, per day, 15-21 drug class(es), including
G0482      metabolite(s) if performed
G0483      Drug test(s), definitive, utilizing drug identification methods able to                 20160101
G0483      identify individual drugs and distinguish between structural isomers (but not
G0483      necessarily stereoisomers), including, but not limited to gc/ms (any type,
G0483      single or tandem) and lc/ms (any type, single or tandem and excluding
G0483      immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g.,
G0483      alcohol dehydrogenase)); qualitative or quantitative, all sources(s), includes
G0483      specimen validity testing, per day, 22 or more drug class(es), including
G0483      metabolite(s) if performed
G0507      Care management services for behavioral health conditions, at least 20 minutes          20170101
G0507      of clinical staff time, directed by a physician or other qualified health care
G0507      professional, per calendar month, with the following required elements: initial
G0507      assessment or follow-up monitoring, including the use of applicable validated
G0507      rating scales; behavioral health care planning in relation to
G0507      behavioral/psychiatric health problems, including revision for patients who are
G0507      not progressing or whose status changes; facilitating and coordinating
G0507      treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric
G0507      consultation; and continuity of care with a designated member of the care team
G0909      Hemoglobin level measurement not documented, reason not given                           20120101            20141231
G0914      Patient care survey was not completed by patient                                        20120101
G0915      Improvement in visual function not achieved within 90 days following cataract           20120101
G0915      surgery
G0917      Patient satisfaction survey was not completed by patient                                20120101
G0918      Satisfaction with care not achieved within 90 days following cataract surgery           20120101
G0919      Influenza immunization ordered or recommended (to be given at alternate                 20120101            20141231
G0919      location or alternate provider); vaccine not available at time of visit
G0921      Documentation of patient reason(s) for not being able to assess (e.g., patient          20120101            20141231
G0921      refuses endoscopic and/or radiologic assessment)
G0922      No documentation of disease type, anatomic location, and activity, reason not           20120101            20141231
G0922      given
G6019      Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other                20150101            20151231
G6019      lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or
G6019      snare technique
G6020      Colonoscopy through stoma; with transendoscopic stent placement (includes               20150101            20151231
G6020      predilation)
G6021      Unlisted procedure, intestine                                                           20150101            20151231
G6022      Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other                  20150101            20151231
G6022      lesions(s) not amenable to removal by hot biopsy forceps, bipolar cautery or
G6022      snare technique
G6024      Colonoscopy, flexible; proximal to splenic flexure; with ablation of tumor(s),          20150101            20151231
G6024      polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps,
G6024      bipolar cautery or snare technique
G6025      Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic stent          20150101            20151231
G6025      placement (includes predilation)
G6027      Anoscopy, high resolution (hra) (with magnification and chemical agent                  20150101            20151231
G6027      enhancement); diagnostic, including collection of specimen(s) by brushing or
G6027      washing when performed
G6028      Anoscopy, high resolution (hra) (with magnification and chemical agent                  20150101            20151231
G6028      enhancement); with biopsy(ies)
G6043      Barbiturates, not elsewhere specified                                                   20150101            20151231
G6057      Phenothiazine                                                                           20150101            20151231
G8126      Patient with a diagnosis of major depression documented as being treated with           20060101            20141231
G8126      antidepressant medication during the entire 84 day (12 week)  acute treatment
G8126      phase
G8127      Patient with a diagnosis of major depression not documented as being treated            20060101            20141231
G8127      with antidepressant medication during the entire 84 day (12 week) acute
G8127      treatment phase
G8128      Clinician documented that patient was not an eligible candidate for                     20060101            20141231
G8128      antidepressant medication during the entire 12 week acute treatment phase
G8128      measure
G8396      Left ventricular ejection fraction (lvef) not performed or documented                   20080101
G8398      Dilated macular or fundus exam not performed                                            20080101
G8400      Patient with central dual-energy x-ray absorptiometry (dxa) results not                 20080101
G8400      documented, reason not given
G8401      Clinician documented that patient was not an eligible candidate for screening           20080101            20161231
G8405      Lower extremity neurological exam not performed                                         20080101
G8406      Clinician documented that patient was not an eligible candidate for lower               20080101            20141231
G8406      extremity neurological exam measure
G8415      Footwear evaluation was not performed                                                   20080101
G8416      Clinician documented that patient was not an eligible candidate for footwear            20080101
G8416      evaluation measure
G8421      Bmi not documented and no reason is given                                               20080101
G8422      Bmi not documented, documentation the patient is not eligible for bmi                   20080101
G8422      calculation
G8428      Current list of medications not documented as obtained, updated, or reviewed by         20080101
G8428      the eligible clinician, reason not given
G8430      Eligible clinician attests to documenting in the medical record the patient is          20080101
G8430      not eligible for a current list of medications being obtained, updated, or
G8430      reviewed by the eligible clinician
G8432      Depression screening not documented, reason not given                                   20080101
G8433      Screening for depression not completed, documented reason                               20080101
G8442      Pain assessment not documented as being performed, documentation the patient is         20080101
G8442      not eligible for a pain assessment using a standardized tool
G8451      Beta-blocker therapy for lvef < 40% not prescribed for reasons documented by            20080101
G8451      the clinician (e.g., low blood pressure, fluid overload, asthma, patients
G8451      recently treated with an intravenous positive inotropic agent, allergy,
G8451      intolerance, other medical reasons, patient declined, other patient reasons, or
G8451      other reasons attributable to the healthcare system)
G8452      Beta-blocker therapy not prescribed                                                     20080101
G8458      Clinician documented that patient is not an eligible candidate for genotype             20080101            20161231
G8458      testing; patient not receiving antiviral treatment for hepatitis c during the
G8458      measurement period (e.g. genotype test done prior to the reporting period,
G8458      patient declines, patient not a candidate for antiviral treatment)
G8460      Clinician documented that patient is not an eligible candidate for quantitative         20080101            20161231
G8460      rna testing at week 12; patient not receiving antiviral treatment for hepatitis
G8460      c
G8462      Clinician documented that patient is not an eligible candidate for counseling           20080101            20131231
G8462      regarding contraception prior to antiviral treatment; patient not receiving
G8462      antiviral treatment for hepatitis c
G8464      Clinician documented that prostate cancer patient is not an eligible candidate          20080101            20141231
G8464      for adjuvant hormonal therapy; low or intermediate risk of recurrence or risk
G8464      of recurrence not determined
G8474      Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker           20080101
G8474      (arb) therapy not prescribed for reasons documented by the clinician (e.g.,
G8474      allergy, intolerance, pregnancy, renal failure due to ace inhibitor, diseases
G8474      of the aortic or mitral valve, other medical reasons) or (e.g., patient
G8474      declined, other patient reasons) or (e.g., lack of drug availability, other
G8474      reasons attributable to the health care system)
G8475      Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker           20080101
G8475      (arb) therapy not prescribed, reason not given
G8478      Blood pressure measurement not performed or documented, reason not given                20080101
G8483      Influenza immunization was not administered for reasons documented by clinician         20080101
G8483      (e.g., patient allergy or other medical reasons, patient declined or other
G8483      patient reasons, vaccine not available or other system reasons)
G8484      Influenza immunization was not administered, reason not given                           20080101
G8509      Pain assessment documented as positive using a standardized tool, follow-up             20090101
G8509      plan not documented, reason not given
G8510      Screening for depression is documented as negative, a follow-up plan is not             20090101
G8510      required
G8511      Screening for depression documented as positive, follow-up plan not documented,         20090101
G8511      reason not given
G8531      Clinician documented that patient was not an eligible candidate for autogenous          20090101            20151231
G8531      av fistula
G8532      Clinician documented that patient received vascular access other than                   20090101            20151231
G8532      autogenous av fistula, reason not given
G8535      Elder maltreatment screen not documented; documentation that patient not                20090101
G8535      eligible for the elder maltreatment screen
G8536      No documentation of an elder maltreatment screen, reason not given                      20090101
G8540      Functional outcome assessment not documented as being performed, documentation          20090101
G8540      the patient is not eligible for a functional outcome assessment using a
G8540      standardized tool
G8541      Functional outcome assessment using a standardized tool not documented, reason          20090101
G8541      not given
G8542      Functional outcome assessment using a standardized tool is documented; no               20090101
G8542      functional deficiencies identified, care plan not required
G8543      Documentation of a positive functional outcome assessment using a standardized          20090101
G8543      tool; care plan not documented, reason not given
G8557      Patient is not eligible for the referral for otologic evaluation measure                20100101            20131231
G8558      Not referred to a physician (preferably a physician with training in disorders          20100101            20131231
G8558      of the ear) for an otologic evaluation, reason not given
G8561      Patient is not eligible for the referral for otologic evaluation for patients           20100101
G8561      with a history of active drainage measure
G8562      Patient does not have a history of active drainage from the ear within the              20100101
G8562      previous 90 days
G8563      Patient not referred to a physician (preferably a physician with training in            20100101
G8563      disorders of the ear) for an otologic evaluation, reason not given
G8564      Patient was referred to a physician (preferably a physician with training in            20100101
G8564      disorders of the ear) for an otologic evaluation, reason not specified)
G8566      Patient is not eligible for the "referral for otologic evaluation for sudden or         20100101
G8566      rapidly progressive hearing loss" measure
G8567      Patient does not have verification and documentation of sudden or rapidly               20100101
G8567      progressive hearing loss
G8568      Patient was not referred to a physician (preferably a physician with training           20100101
G8568      in disorders of the ear) for an otologic evaluation, reason not given
G8570      Prolonged postoperative intubation (> 24 hrs) not required                              20100101
G8576      No postoperative renal failure/dialysis not required                                    20100101
G8578      Re-exploration not required due to mediastinal bleeding with or without                 20100101
G8578      tamponade, graft occlusion, valve dysfunction or other cardiac reason
G8592      No documentation of blood pressure measurement, reason not given                        20100101            20131231
G8594      Lipid profile not performed, reason not given                                           20100101            20141231
G8596      Ldl-c was not performed                                                                 20100101            20131231
G8598      Aspirin or another antiplatelet therapy used                                            20100101
G8599      Aspirin or another antiplatelet therapy not used, reason not given                      20100101
G8601      Iv t-pa not initiated within three hours (<= 180 minutes) of time last known            20100101
G8601      well for reasons documented by clinician
G8602      Iv t-pa not initiated within three hours (<= 180 minutes) of time last known            20100101
G8602      well, reason not given
G8604      Score on the spoken language comprehension functional communication measure at          20100101            20131231
G8604      discharge was not higher than at admission, reason not given
G8605      Patient treated for spoken language comprehension but not scored on the spoken          20100101            20131231
G8605      language comprehension functional communication measure either at admission or
G8605      at discharge
G8607      Score on the attention functional communication measure at discharge was not            20100101            20131231
G8607      higher than at admission, reason not given
G8608      Patient treated for attention but not scored on the attention functional                20100101            20131231
G8608      communication measure either at admission or at discharge
G8610      Score on the memory functional communication measure at discharge was not               20100101            20131231
G8610      higher than at admission, reason not given
G8611      Patient treated for memory but not scored on the memory functional                      20100101            20131231
G8611      communication measure either at admission or at discharge
G8613      Score on the motor speech functional communication measure at discharge was not         20100101            20131231
G8613      higher than at admission, reason not given
G8614      Patient treated for motor speech but not scored on the motor speech                     20100101            20131231
G8614      comprehension functional communication measure either at admission or at
G8614      discharge
G8616      Score on the reading functional communication measure at discharge was not              20100101            20131231
G8616      higher than at admission, reason not given
G8617      Patient treated for reading but not scored on the reading functional                    20100101            20131231
G8617      communication measure either at admission or at discharge
G8619      Score on the spoken language expression functional communication measure at             20100101            20131231
G8619      discharge was not higher than at admission, reason not given
G8620      Patient treated for spoken language expression but not scored on the spoken             20100101            20131231
G8620      language expression functional communication measure either at admission or at
G8620      discharge
G8622      Score on the writing functional communication measure at discharge was not              20100101            20131231
G8622      higher than at admission, reason not given
G8623      Patient treated for writing but not scored on the writing functional                    20100101            20131231
G8623      communication measure either at admission or at discharge
G8625      Score on the swallowing functional communication measure at discharge was not           20100101            20131231
G8625      higher than at admission, reason not given
G8626      Patient treated for swallowing but not scored on the swallowing functional              20100101            20131231
G8626      communication measure at admission or at discharge
G8628      Surgical procedure not performed within 30 days following cataract surgery for          20100101
G8628      major complications (e.g., retained nuclear fragments, endophthalmitis,
G8628      dislocated or wrong power iol, retinal detachment, or wound dehiscence)
G8631      Clinician documented that patient was not an eligible candidate for ordering            20110101            20141231
G8631      prophylactic parenteral antibiotics to be given within one hour (if
G8631      fluoroquinolone or vancomycin, two hours) prior to surgical incision (or start
G8631      of procedure when no incision is required)
G8632      Prophylactic parenteral antibiotics were not ordered to be given or given               20110101            20141231
G8632      within one hour (if fluoroquinolone or vancomycin, two hours) prior to the
G8632      surgical incision (or start of procedure when no incision is required), reason
G8632      not given
G8634      Clinician documented patient not an eligible candidate to receive pharmacologic         20110101            20161231
G8634      therapy for osteoporosis
G8635      Pharmacologic therapy for osteoporosis was not prescribed, reason not given             20110101
G8644      Eligible professional does not have prescribing privileges                              20110101            20131231
G8649      Risk-adjusted functional status change residual scores for the knee not                 20110101
G8649      measured because the patient did not complete foto's status survey near
G8649      discharge, not appropriate
G8650      Risk-adjusted functional status change residual scores for the knee not                 20110101
G8650      measured because the patient did not complete foto's functional intake on
G8650      admission and/or follow up status survey near discharge, reason not given
G8653      Risk-adjusted functional status change residual scores for the hip not measured         20110101
G8653      because the patient did not complete follow up status survey near discharge,
G8653      patient not appropriate
G8654      Risk-adjusted functional status change residual scores for the hip not measured         20110101
G8654      because the patient did not complete foto's functional intake on admission
G8654      and/or follow up status survey near discharge, reason not given
G8657      Risk-adjusted functional status change residual scores for the foot or ankle            20110101
G8657      not measured because the patient did not complete foto's status survey near
G8657      discharge, patient not appropriate
G8658      Risk-adjusted functional status change residual scores for the foot or ankle            20110101
G8658      not measured because the patient did not complete foto's functional intake on
G8658      admission and/or follow up status survey near discharge, reason not given
G8661      Risk-adjusted functional status change residual scores for the lumbar                   20110101
G8661      impairment not measured because the patient did not complete foto's status
G8661      survey near discharge, patient not appropriate
G8662      Risk-adjusted functional status change residual scores for the lumbar                   20110101
G8662      impairment not measured because the patient did not complete foto's functional
G8662      intake on admission and/or follow up status survey near discharge, reason not
G8662      given
G8665      Risk-adjusted functional status change residual scores for the shoulder not             20110101
G8665      measured because the patient did not complete foto's functional status survey
G8665      near discharge, patient not appropriate
G8666      Risk-adjusted functional status change residual scores for the shoulder not             20110101
G8666      measured because the patient did not complete foto's functional intake on
G8666      admission and/or follow up status survey near discharge, reason not given
G8669      Risk-adjusted functional status change residual scores for the elbow, wrist or          20110101
G8669      hand not measured because the patient did not complete foto's functional follow
G8669      up status survey near discharge, patient not appropriate
G8670      Risk-adjusted functional status change residual scores for the elbow, wrist or          20110101
G8670      hand not measured because the patient did not complete foto's functional intake
G8670      on admission and/or follow up status survey near discharge, reason not given
G8673      Risk-adjusted functional status change residual scores for the neck, cranium,           20110101
G8673      mandible, thoracic spine, ribs, or other general orthopaedic impairment not
G8673      measured because the patient did not complete foto's functional follow up
G8673      status survey near discharge, patient not appropriate
G8674      Risk-adjusted functional status change residual scores for the neck, cranium,           20110101
G8674      mandible, thoracic spine, ribs, or other general orthopaedic impairment not
G8674      measured because the patient did not complete foto's functional intake on
G8674      admission and/or follow up status survey near discharge, reason not given
G8683      Lvf testing not performed prior to discharge or in the previous 12 months for a         20110101            20141231
G8683      medical or patient documented reason
G8685      Lvf testing not documented as being performed prior to discharge or in the              20110101            20141231
G8685      previous 12 months, reason not given
G8697      Antithrombotic therapy not prescribed for documented reasons (e.g., patient had         20120101
G8697      stroke during hospital stay, patient expired during inpatient stay, other
G8697      medical reason(s)); (e.g., patient left against medical advice, other patient
G8697      reason(s))
G8698      Antithrombotic therapy was not prescribed at discharge, reason not given                20120101
G8700      Rehabilitation services (occupational, physical or speech) not indicated at or          20120101            20141231
G8700      prior to discharge
G8701      Rehabilitation services were not ordered, reason not otherwise specified                20120101            20141231
G8705      Documentation of medical reason(s) for not performing a 12-lead                         20120101            20141231
G8705      electrocardiogram (ecg)
G8706      Documentation of patient reason(s) for not performing a 12-lead                         20120101            20141231
G8706      electrocardiogram (ecg)
G8707      12-lead electrocardiogram (ecg) not performed, reason not given                         20120101            20141231
G8708      Patient not prescribed or dispensed antibiotic                                          20120101
G8709      Patient prescribed or dispensed antibiotic for documented medical reason(s)             20120101
G8709      (e.g., intestinal infection, pertussis, bacterial infection, lyme disease,
G8709      otitis media, acute sinusitis, acute pharyngitis, acute tonsillitis, chronic
G8709      sinusitis, infection of the pharynx/larynx/tonsils/adenoids, prostatitis,
G8709      cellulitis, mastoiditis, or bone infections, acute lymphadenitis, impetigo,
G8709      skin staph infections, pneumonia/gonococcal infections, venereal disease
G8709      (syphilis, chlamydia, inflammatory diseases (female reproductive organs)),
G8709      infections of the kidney, cystitis or uti, and acne)
G8712      Antibiotic not prescribed or dispensed                                                  20120101
G8717      Spkt/v less than 1.2 (single-pool clearance of urea [kt] / volume [v]), reason          20120101            20151231
G8717      not given
G8722      Documentation of medical reason(s) for not including the pt category, the pn            20120101
G8722      category or the histologic grade in the pathology report (e.g., re-excision
G8722      without residual tumor; non-carcinomasanal canal)
G8724      Pt category, pn category and histologic grade were not documented in the                20120101
G8724      pathology report, reason not given
G8726      Clinician has documented reason for not performing fasting lipid profile (e.g.,         20120101            20161231
G8726      patient declined, other patient reasons)
G8728      Fasting lipid profile not performed, reason not given                                   20120101            20161231
G8732      No documentation of pain assessment, reason not given                                   20120101
G8735      Elder maltreatment screen documented as positive, follow-up plan not                    20120101
G8735      documented, reason not given
G8740      Left ventricular ejection fraction (lvef) not performed or assessed, reason not         20120101            20141231
G8740      given
G8741      Patient not treated for spoken language comprehension disorder                          20120101            20131231
G8742      Patient not treated for attention disorder                                              20120101            20131231
G8743      Patient not treated for memory disorder                                                 20120101            20131231
G8744      Patient not treated for motor speech disorder                                           20120101            20131231
G8745      Patient not treated for reading disorder                                                20120101            20131231
G8746      Patient not treated for spoken language expression disorder                             20120101            20131231
G8747      Patient not treated for writing disorder                                                20120101            20131231
G8748      Patient not treated for swallowing disorder                                             20120101            20131231
G8751      Smoking status and exposure to second hand smoke in the home not assessed,              20120101            20141231
G8751      reason not given
G8756      No documentation of blood pressure measurement, reason not given                        20120101
G8768      Documentation of medical reason(s) for not performing lipid profile (e.g.,              20120101            20141231
G8768      patients with palliative goals or for whom treatment of hypertension with
G8768      standard treatment goals is not clinically appropriate)
G8769      Lipid profile not performed, reason not given                                           20120101            20141231
G8771      Documentation of diagnosis of chronic kidney disease                                    20120101            20141231
G8772      Documentation of medical reason(s) for not performing urine protein test (e.g.,         20120101            20141231
G8772      patients with palliative goals or for whom treatment of hypertension with
G8772      standard treatment goals is not cllinically appropriate)
G8773      Urine protein test was not performed, reason not given                                  20120101            20141231
G8775      Documentation of medical reason(s) for not performing serum creatinine test             20120101            20141231
G8775      (e.g., patients with palliative goals or for whom treatment of hypertension
G8775      with standard treatment goals is not clinically appropriate)
G8776      Serum creatinine test not performed, reason not given                                   20120101            20141231
G8778      Documentation of medical reason(s) for not performing diabetes screening test           20120101            20141231
G8778      (e.g., patients with a diagnosis of diabetes, or with palliative goals or for
G8778      whom treatment of hypertension with standard treatment goals is not clinically
G8778      appropriate)
G8779      Diabetes screening test not performed, reason not given                                 20120101            20141231
G8781      Documentation of medical reason(s) for patient not receiving counseling for             20120101            20141231
G8781      diet and physical activity (e.g., patients with palliative goals or for whom
G8781      treatment of hypertension with standard treatment goals is not clinically
G8781      appropriate)
G8782      Counseling for diet and physical activity not performed, reason not given               20120101            20141231
G8783      Normal blood pressure reading documented, follow-up not required                        20120101
G8784      Patient not eligible (e.g., documentation the patient is not eligible due to            20120101            20161231
G8784      active diagnosis of hypertension, patient refuses, urgent or emergent situation)
G8785      Blood pressure reading not documented, reason not given                                 20120101
G8796      Blood pressure measurement not documented, reason not given                             20120101            20131231
G8800      Anticoagulation not ordered for reasons documented by clinician                         20120101            20131231
G8801      Anticoagulation was not ordered, reason not given                                       20120101            20131231
G8807      Trans-abdominal or trans-vaginal ultrasound not performed for reasons                   20120101
G8807      documented by clinician (e.g., patient has visited the ed multiple times within
G8807      72 hours, patient has a documented intrauterine pregnancy [iup])
G8808      Performance of trans-abdominal or trans-vaginal ultrasound not ordered, reason          20120101
G8808      not given (e.g., patient has visited the ed multiple times with no
G8808      documentation of a trans-abdominal or trans-vaginal ultrasound within ed or
G8808      from referring eligible professional)
G8810      Rh-immunoglobulin (rhogam) not ordered for reasons documented by clinician              20120101
G8810      (e.g., patient had prior documented receipt of rhogam within 12 weeks, patient
G8810      refusal)
G8811      Documentation rh-immunoglobulin (rhogam) was not ordered, reason not given              20120101
G8812      Patient is not eligible for follow-up cta, duplex, or mra (e.g., patient death,         20120101            20131231
G8812      failure to return for scheduled follow-up exam, planned follow-up study which
G8812      will meet numerator criteria has not yet occurred at the time of reporting)
G8814      Follow-up cta, duplex, or mra of the abdomen and pelvis not performed                   20120101            20131231
G8815      Documented reason in the medical records for why the statin therapy was not             20120101
G8815      prescribed (i.e., lower extremity bypass was for a patient with
G8815      non-artherosclerotic disease)
G8817      Statin therapy not prescribed at discharge, reason not given                            20120101
G8825      Patient not discharged to home by post-operative day #7                                 20120101
G8833      Patient not discharged to home by post-operative day #2 following evar                  20120101
G8838      Patient not discharged to home by post-operative day #2 following cea                   20120101
G8840      Documentation of reason(s) for not documenting an assessment of sleep symptoms          20120101
G8840      (e.g., patient didn't have initial daytime sleepiness, patient visited between
G8840      initial testing and initiation of therapy)
G8841      Sleep apnea symptoms not assessed, reason not given                                     20120101
G8842      Apnea hypopnea index (ahi) or respiratory disturbance index (rdi) measured at           20120101
G8842      the time of initial diagnosis
G8843      Documentation of reason(s) for not measuring an apnea hypopnea index (ahi) or a         20120101
G8843      respiratory disturbance index (rdi) at the time of initial diagnosis (e.g.,
G8843      psychiatric disease, dementia, patient declined, financial, insurance coverage,
G8843      test ordered but not yet completed)
G8844      Apnea hypopnea index (ahi) or respiratory disturbance index (rdi) not measured          20120101
G8844      at the time of initial diagnosis, reason not given
G8849      Documentation of reason(s) for not prescribing positive airway pressure therapy         20120101
G8849      (e.g., patient unable to tolerate, alternative therapies use, patient declined,
G8849      financial, insurance coverage)
G8850      Positive airway pressure therapy not prescribed, reason not given                       20120101
G8853      Positive airway pressure therapy not prescribed                                         20120101            20161231
G8854      Documentation of reason(s) for not objectively measuring adherence to positive          20120101
G8854      airway pressure therapy (e.g., patient didn't bring data from continous
G8854      positive airway pressure [cpap], therapy not yet initiated, not available on
G8854      machine)
G8855      Objective measurement of adherence to positive airway pressure therapy not              20120101
G8855      performed, reason not given
G8857      Patient is not eligible for the referral for otologic evaluation measure (e.g.,         20120101
G8857      patients who are already under the care of a physician for acute or chronic
G8857      dizziness)
G8858      Referral to a physician for an otologic evaluation not performed, reason not            20120101
G8858      given
G8862      Patients not receiving corticosteroids greater than or equal to 10mg/day for 60         20120101            20141231
G8862      or greater consecutive days
G8863      Patients not assessed for risk of bone loss, reason not given                           20120101
G8865      Documentation of medical reason(s) for not administering or previously                  20120101
G8865      receiving pneumococcal vaccine (e.g., patient allergic reaction, potential
G8865      adverse drug reaction)
G8866      Documentation of patient reason(s) for not administering or previously                  20120101
G8866      receiving pneumococcal vaccine (e.g., patient refusal)
G8867      Pneumococcal vaccine not administered or previously received, reason not given          20120101
G8871      Patient not receiving a first course of anti-tnf therapy                                20120101            20151231
G8873      Patients with needle localization specimens which are not amenable to                   20120101
G8873      intraoperative imaging such as mri needle wire localization, or targets which
G8873      are tentatively identified on mammogram or ultrasound which do not contain a
G8873      biopsy marker but which can be verified on intraoperative inspection or
G8873      pathology (e.g., needle biopsy site where the biopsy marker is remote from the
G8873      actual biopsy site)
G8874      Excised tissue not evaluated by imaging intraoperatively to confirm successful          20120101
G8874      inclusion of targeted lesion
G8875      Clinician diagnosed breast cancer preoperatively by a minimally invasive biopsy         20120101
G8875      method
G8876      Documentation of reason(s) for not performing minimally invasive biopsy to              20120101
G8876      diagnose breast cancer preoperatively (e.g., lesion too close to skin, implant,
G8876      chest wall, etc., lesion could not be adequately visualized for needle biopsy,
G8876      patient condition prevents needle biopsy [weight, breast thickness, etc.], duct
G8876      excision without imaging abnormality, prophylactic mastectomy, reduction
G8876      mammoplasty, excisional biopsy performed by another physician)
G8877      Clinician did not attempt to achieve the diagnosis of breast cancer                     20120101
G8877      preoperatively by a minimally invasive biopsy method, reason not given
G8880      Documentation of reason(s) sentinel lymph node biopsy not performed (e.g.,              20120101
G8880      reasons could include but not limited to; non-invasive cancer, incidental
G8880      discovery of breast cancer on prophylactic mastectomy, incidental discovery of
G8880      breast cancer on reduction mammoplasty, pre-operative biopsy proven lymph node
G8880      (ln) metastases, inflammatory carcinoma, stage 3 locally advanced cancer,
G8880      recurrent invasive breast cancer, patient refusal after informed consent)
G8882      Sentinel lymph node biopsy procedure not performed, reason not given                    20120101
G8884      Clinician documented reason that patient's biopsy results were not reviewed             20120101
G8885      Biopsy results not reviewed, communicated, tracked or documented                        20120101
G8887      Documentation of medical reason(s) for most recent blood pressure not being             20120101            20141231
G8887      under control (e.g., patients with palliative goals or for whom treatment of
G8887      hypertension with standard treatment goals is not clinically appropriate)
G8888      Most recent blood pressure not under control, results documented and reviewed           20120101            20141231
G8889      No documentation of blood pressure measurement, reason not given                        20120101            20141231
G8891      Documentation of medical reason(s) for most recent ldl-c not under control              20120101            20141231
G8891      (e.g., patients with palliative goals for for whom treatment of hypertension
G8891      with standard treatment goals is not clinically appropriate)
G8892      Documentation of medical reason(s) for not performing ldl-c test (e.g. patients         20120101            20141231
G8892      with palliative goals or for whom treatment of hypertension with standard
G8892      treatment goals is not clinically appropriate)
G8893      Most recent ldl-c not under control, results documented and reviewed                    20120101            20141231
G8894      Ldl-c not performed, reason not given                                                   20120101            20141231
G8896      Documentation of medical reason(s) for not prescribing oral aspirin or other            20120101            20141231
G8896      antthrombotic therapy (e.g., patient documented to be low risk or patient with
G8896      terminal illness or treatment of hypertension with standard treatment goals is
G8896      not clinically appropriate, or for whom risk of aspirin or other antithrombotic
G8896      therapy exceeds potential benefits such as for individuals whose blood pressure
G8896      is poorly controlled)
G8897      Oral aspirin or other antithrombotic therapy was not prescribed, reason not             20120101            20141231
G8897      given
G8907      Patient documented not to have experienced any of the following events: a burn          20120401
G8907      prior to discharge; a fall within the facility; wrong
G8907      site/side/patient/procedure/implant event; or a hospital transfer or hospital
G8907      admission upon discharge from the facility
G8909      Patient documented not to have received a burn prior to discharge                       20120401
G8911      Patient documented not to have experienced a fall within ambulatory surgical            20120401
G8911      center
G8913      Patient documented not to have experienced a wrong site, wrong side, wrong              20120401
G8913      patient, wrong procedure or wrong implant event
G8915      Patient documented not to have experienced a hospital transfer or hospital              20120401
G8915      admission upon discharge from asc
G8917      Patient with preoperative order for iv antibiotic surgical site infection (ssi)         20120401
G8917      prophylaxis, antibiotic not initiated on time
G8925      Spirometry test results demonstrate fev1 >= 60% fev1/fvc >= 70%, predicted or           20130101
G8925      patient does not have copd symptoms
G8926      Spirometry test not performed or documented, reason not given                           20130101
G8928      Adjuvant chemotherapy not prescribed or previously received, for documented             20130101            20161231
G8928      reasons (e.g., medical co-morbidities, diagnosis date more than 5 years prior
G8928      to the current visit date, patient's diagnosis date is within 120 days of the
G8928      end of the 12 month reporting period, patient's cancer has metastasized,
G8928      medical contraindication/allergy, poor performance status, other medical
G8928      reasons, patient refusal, other patient reasons, patient is currently enrolled
G8928      in a clinical trial that precludes prescription of chemotherapy, other system
G8928      reasons)
G8929      Adjuvant chemotherapy not prescribed or previously received, reason not given           20130101            20161231
G8931      Assessment of depression severity not documented, reason not given                      20130101            20141231
G8933      Suicide risk not assessed at the initial evaluation, reason not given                   20130101            20141231
G8936      Clinician documented that patient was not an eligible candidate for angiotensin         20130101
G8936      converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy
G8936      (eg, allergy, intolerance, pregnancy, renal failure due to ace inhibitor,
G8936      diseases of the aortic or mitral valve, other medical reasons) or (eg, patient
G8936      declined, other patient reasons) or (eg, lack of drug availability, other
G8936      reasons attributable to the health care system)
G8937      Clinician did not prescribe angiotensin converting enzyme (ace) inhibitor or            20130101
G8937      angiotensin receptor blocker (arb) therapy, reason not given
G8938      Bmi is documented as being outside of normal limits, follow-up plan is not              20130101
G8938      documented, documentation the patient is not eligible
G8939      Pain assessment documented as positive, follow-up plan not documented,                  20130101
G8939      documentation the patient is not eligible
G8940      Screening for depression documented as positive, a follow-up plan not                   20130101            20161231
G8940      completed, documented reason
G8941      Elder maltreatment screen documented as positive, follow-up plan not                    20130101
G8941      documented, documentation the patient is not eligible
G8943      Ldl-c result not present or not within 12 months prior                                  20130101            20141231
G8946      Minimally invasive biopsy method attempted but not diagnostic of breast cancer          20130101
G8946      (e.g., high risk lesion of breast such as atypical ductal hyperplasia, lobular
G8946      neoplasia, atypical lobular hyperplasia, lobular carcinoma in situ, atypical
G8946      columnar hyperplasia, flat epithelial atypia, radial scar, complex sclerosing
G8946      lesion, papillary lesion, or any lesion with spindle cells)
G8949      Documentation of patient reason(s) for patient not receiving counseling for             20130101            20141231
G8949      diet and physical activity (e.g., patient is not willing to discuss diet or
G8949      exercise interventions to help control blood pressure, or the patient said
G8949      he/she refused to make these changes)
G8951      Pre-hypertensive or hypertensive blood pressure reading documented, indicated           20130101            20151231
G8951      follow-up not documented, documentation the patient is not eligible
G8952      Pre-hypertensive or hypertensive blood pressure reading documented, indicated           20130101
G8952      follow-up not documented, reason not given
G8957      Patient not receiving maintenance hemodialysis in an outpatient dialysis                20130101            20141231
G8957      facility
G8958      Assessment of adequacy of volume management not documented, reason not given            20130101
G8960      Clinician treating major depressive disorder did not communicate to clinician           20130101
G8960      treating comorbid condition, reason not given
G8962      Cardiac stress imaging test performed on patient for any reason including those         20130101
G8962      who did not have low risk surgery or test that was performed more than 30 days
G8962      preceding low risk surgery
G8967      Warfarin or another oral anticoagulant that is fda approved prescribed                  20130101
G8968      Documentation of medical reason(s) for not prescribing warfarin or another oral         20130101
G8968      anticoagulant that is fda approved for the prevention of thromboembolism (e.g.,
G8968      allergy, risk of bleeding, other medical reasons)
G8969      Documentation of patient reason(s) for not prescribing warfarin or another oral         20130101
G8969      anticoagulant that is fda approved (e.g., economic, social, and/or religious
G8969      impediments, noncompliance patient refusal, other patient reasons)
G8971      Warfarin or another oral anticoagulant that is fda approved not prescribed,             20130101
G8971      reason not given
G8974      Hemoglobin level measurement not documented, reason not given                           20130101
G8975      Documentation of medical reason(s) for patient having a hemoglobin level < 10           20130101
G8975      g/dl (e.g., patients who have non-renal etiologies of anemia [e.g., sickle cell
G8975      anemia or other hemoglobinopathies, hypersplenism, primary bone marrow disease,
G8975      anemia related to chemotherapy for diagnosis of malignancy, postoperative
G8975      bleeding, active bloodstream or peritoneal infection], other medical reasons)
G9012      Other specified case management service not elsewhere classified                        20011001
G9050      Oncology; primary focus of visit; work-up, evaluation, or staging at the time           20060101
G9050      of cancer diagnosis or recurrence (for use in a medicare-approved demonstration
G9050      project)
G9055      Oncology; primary focus of visit; other, unspecified service not otherwise              20060101
G9055      listed (for use in a medicare-approved demonstration project)
G9060      Oncology; practice guidelines; management differs from guidelines for reason(s)         20060101
G9060      associated with patient comorbid illness or performance status not factored
G9060      into guidelines (for use in a medicare-approved demonstration project)
G9061      Oncology; practice guidelines; patient's condition not addressed by available           20060101
G9061      guidelines (for use in a medicare-approved demonstration project)
G9062      Oncology; practice guidelines; management differs from guidelines for other             20060101
G9062      reason(s) not listed (for use in a medicare-approved demonstration project)
G9066      Oncology; disease status; limited to non-small cell lung cancer; stage iii b-           20060101
G9066      iv at diagnosis, metastatic, locally recurrent, or progressive (for use in a
G9066      medicare-approved demonstration project)
G9067      Oncology; disease status; limited to non-small cell lung cancer; extent of              20060101
G9067      disease unknown, staging in progress, or not listed (for use in a
G9067      medicare-approved demonstration project)
G9069      Oncology; disease status; small cell lung cancer, limited to small cell and             20060101
G9069      combined small cell/non-small cell; extensive stage at diagnosis, metastatic,
G9069      locally recurrent, or progressive (for use in a medicare-approved demonstration
G9069      project)
G9070      Oncology; disease status; small cell lung cancer, limited to small cell and             20060101
G9070      combined small cell/non-small; extent of disease unknown, staging in progress,
G9070      or not listed (for use in a medicare-approved demonstration project)
G9071      Oncology; disease status; invasive female breast cancer (does not include               20060101
G9071      ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage i or
G9071      stage iia-iib; or t3, n1, m0; and er and/or pr positive; with no evidence of
G9071      disease progression, recurrence, or metastases (for use in a medicare-approved
G9071      demonstration project)
G9072      Oncology; disease status; invasive female breast cancer (does not include               20060101
G9072      ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage i, or
G9072      stage iia-iib; or t3, n1, m0; and er and pr negative; with no evidence of
G9072      disease progression, recurrence, or metastases (for use in a medicare-approved
G9072      demonstration project)
G9073      Oncology; disease status; invasive female breast cancer (does not include               20060101
G9073      ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage
G9073      iiia-iiib; and not t3, n1, m0; and er and/or pr positive; with no evidence of
G9073      disease progression, recurrence, or metastases (for use in a medicare-approved
G9073      demonstration project)
G9074      Oncology; disease status; invasive female breast cancer (does not include               20060101
G9074      ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage
G9074      iiia-iiib; and not t3, n1, m0; and er and pr negative; with no evidence of
G9074      disease progression, recurrence, or metastases (for use in a medicare-approved
G9074      demonstration project)
G9075      Oncology; disease status; invasive female breast cancer (does not include               20060101
G9075      ductal carcinoma in situ); adenocarcinoma as predominant cell type; m1 at
G9075      diagnosis, metastatic, locally recurrent, or progressive (for use in a
G9075      medicare-approved demonstration project)
G9077      Oncology; disease status; prostate cancer, limited to adenocarcinoma as                 20060101
G9077      predominant cell type; t1-t2c and gleason 2-7 and psa < or equal to 20 at
G9077      diagnosis with no evidence of disease progression, recurrence, or metastases
G9077      (for use in a medicare-approved demonstration project)
G9078      Oncology; disease status; prostate cancer, limited to adenocarcinoma as                 20060101
G9078      predominant cell type; t2 or t3a gleason 8-10 or psa > 20 at diagnosis with no
G9078      evidence of disease progression, recurrence, or metastases (for use in a
G9078      medicare-approved demonstration project)
G9079      Oncology; disease status; prostate cancer, limited to adenocarcinoma as                 20060101
G9079      predominant cell type; t3b-t4, any n; any t, n1 at diagnosis with no evidence
G9079      of disease progression, recurrence, or metastases (for use in a
G9079      medicare-approved demonstration project)
G9080      Oncology; disease status; prostate cancer, limited to adenocarcinoma; after             20060101
G9080      initial treatment with rising psa or failure of psa decline (for use in a
G9080      medicare-approved demonstration project)
G9083      Oncology; disease status; prostate cancer, limited to adenocarcinoma; extent of         20060101
G9083      disease unknown, staging in progress, or not listed (for use in a
G9083      medicare-approved demonstration project)
G9084      Oncology; disease status; colon cancer, limited to invasive cancer,                     20060101
G9084      adenocarcinoma as predominant cell type; extent of disease initially
G9084      established as t1-3, n0, m0 with no evidence of disease progression,
G9084      recurrence, or metastases (for use in a medicare-approved demonstration project)
G9085      Oncology; disease status; colon cancer, limited to invasive cancer,                     20060101
G9085      adenocarcinoma as predominant cell type; extent of disease initially
G9085      established as t4, n0, m0 with no evidence of disease progression, recurrence,
G9085      or metastases (for use in a medicare-approved demonstration project)
G9086      Oncology; disease status; colon cancer, limited to invasive cancer,                     20060101
G9086      adenocarcinoma as predominant cell type; extent of disease initially
G9086      established as t1-4, n1-2, m0 with no evidence of disease progression,
G9086      recurrence, or metastases (for use in a medicare-approved demonstration project)
G9087      Oncology; disease status; colon cancer, limited to invasive cancer,                     20060101
G9087      adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally
G9087      recurrent, or progressive with current clinical, radiologic, or biochemical
G9087      evidence of disease (for use in a medicare-approved demonstration project)
G9088      Oncology; disease status; colon cancer, limited to invasive cancer,                     20060101
G9088      adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally
G9088      recurrent, or progressive without current clinical, radiologic, or biochemical
G9088      evidence of disease (for use in a medicare-approved demonstration project)
G9089      Oncology; disease status; colon cancer, limited to invasive cancer,                     20060101
G9089      adenocarcinoma as predominant cell type; extent of disease unknown, staging in
G9089      progress, or not listed (for use in a medicare-approved demonstration project)
G9090      Oncology; disease status; rectal cancer, limited to invasive cancer,                    20060101
G9090      adenocarcinoma as predominant cell type; extent of disease initially
G9090      established as t1-2, n0, m0 (prior to neo-adjuvant therapy, if any) with no
G9090      evidence of disease progression, recurrence, or metastases (for use in a
G9090      medicare-approved demonstration project)
G9091      Oncology; disease status; rectal cancer, limited to invasive cancer,                    20060101
G9091      adenocarcinoma as predominant cell type; extent of disease initially
G9091      established as t3, n0, m0 (prior to neo-adjuvant therapy, if any) with no
G9091      evidence of disease progression, recurrence, or metastases (for use in a
G9091      medicare-approved demonstration project)
G9092      Oncology; disease status; rectal cancer, limited to invasive cancer,                    20060101
G9092      adenocarcinoma as predominant cell type; extent of disease initially
G9092      established as t1-3, n1-2, m0 (prior to neo-adjuvant therapy, if any) with no
G9092      evidence of disease progression, recurrence or metastases (for use in a
G9092      medicare-approved demonstration project)
G9093      Oncology; disease status; rectal cancer, limited to invasive cancer,                    20060101
G9093      adenocarcinoma as predominant cell type; extent of disease initially
G9093      established as t4, any n, m0 (prior to neo-adjuvant therapy, if any) with no
G9093      evidence of disease progression, recurrence, or metastases (for use in a
G9093      medicare-approved demonstration project)
G9094      Oncology; disease status; rectal cancer, limited to invasive cancer,                    20060101
G9094      adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally
G9094      recurrent, or progressive (for use in a medicare-approved demonstration project)
G9095      Oncology; disease status; rectal cancer, limited to invasive cancer,                    20060101
G9095      adenocarcinoma as predominant cell type; extent of disease unknown, staging in
G9095      progress, or not listed (for use in a medicare-approved demonstration project)
G9096      Oncology; disease status; esophageal cancer, limited to adenocarcinoma or               20060101
G9096      squamous cell carcinoma as predominant cell type; extent of disease initially
G9096      established as t1-t3, n0-n1 or nx (prior to neo-adjuvant therapy, if any) with
G9096      no evidence of disease progression, recurrence, or metastases (for use in a
G9096      medicare-approved demonstration project)
G9097      Oncology; disease status; esophageal cancer, limited to adenocarcinoma or               20060101
G9097      squamous cell carcinoma as predominant cell type; extent of disease initially
G9097      established as t4, any n, m0 (prior to neo-adjuvant therapy, if any) with no
G9097      evidence of disease progression, recurrence, or metastases (for use in a
G9097      medicare-approved demonstration project)
G9098      Oncology; disease status; esophageal cancer, limited to adenocarcinoma or               20060101
G9098      squamous cell carcinoma as predominant cell type; m1 at diagnosis, metastatic,
G9098      locally recurrent, or progressive (for use in a medicare-approved demonstration
G9098      project)
G9099      Oncology; disease status; esophageal cancer, limited to adenocarcinoma or               20060101
G9099      squamous cell carcinoma as predominant cell type; extent of disease unknown,
G9099      staging in progress, or not listed (for use in a medicare-approved
G9099      demonstration project)
G9100      Oncology; disease status; gastric cancer, limited to adenocarcinoma as                  20060101
G9100      predominant cell type; post r0 resection (with or without neoadjuvant therapy)
G9100      with no evidence of disease recurrence, progression, or metastases (for use in
G9100      a medicare-approved demonstration project)
G9101      Oncology; disease status; gastric cancer, limited to adenocarcinoma as                  20060101
G9101      predominant cell type; post r1 or r2 resection (with or without neoadjuvant
G9101      therapy) with no evidence of disease progression, or metastases (for use in a
G9101      medicare-approved demonstration project)
G9102      Oncology; disease status; gastric cancer, limited to adenocarcinoma as                  20060101
G9102      predominant cell type; clinical or pathologic m0, unresectable with no evidence
G9102      of disease progression, or metastases (for use in a medicare-approved
G9102      demonstration project)
G9103      Oncology; disease status; gastric cancer, limited to adenocarcinoma as                  20060101
G9103      predominant cell type; clinical or pathologic m1 at diagnosis, metastatic,
G9103      locally recurrent, or progressive (for use in a medicare-approved demonstration
G9103      project)
G9104      Oncology; disease status; gastric cancer, limited to adenocarcinoma as                  20060101
G9104      predominant cell type; extent of disease unknown, staging in progress, or not
G9104      listed (for use in a medicare-approved demonstration project)
G9105      Oncology; disease status; pancreatic cancer, limited to adenocarcinoma as               20060101
G9105      predominant cell type; post r0 resection without evidence of disease
G9105      progression, recurrence, or metastases (for use in a medicare-approved
G9105      demonstration project)
G9106      Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; post r1         20060101
G9106      or r2 resection with no evidence of disease progression, or metastases (for use
G9106      in a medicare-approved demonstration project)
G9107      Oncology; disease status; pancreatic cancer, limited to adenocarcinoma;                 20060101
G9107      unresectable at diagnosis, m1 at diagnosis, metastatic, locally recurrent, or
G9107      progressive (for use in a medicare-approved demonstration project)
G9108      Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; extent          20060101
G9108      of disease unknown, staging in progress, or not listed (for use in a
G9108      medicare-approved demonstration project)
G9111      Oncology; disease status; head and neck cancer, limited to cancers of oral              20060101
G9111      cavity, pharynx and larynx with squamous cell as predominant cell type; m1 at
G9111      diagnosis, metastatic, locally recurrent, or progressive (for use in a
G9111      medicare-approved demonstration project)
G9112      Oncology; disease status; head and neck cancer, limited to cancers of oral              20060101
G9112      cavity, pharynx and larynx with squamous cell as predominant cell type; extent
G9112      of disease unknown, staging in progress, or not listed (for use in a
G9112      medicare-approved demonstration project)
G9117      Oncology; disease status; ovarian cancer, limited to epithelial cancer; extent          20060101
G9117      of disease unknown, staging in progress, or not listed (for use in a
G9117      medicare-approved demonstration project)
G9123      Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia         20060101
G9123      chromosome positive and/or bcr-abl positive; chronic phase not in hematologic,
G9123      cytogenetic, or molecular remission (for use in a medicare-approved
G9123      demonstration project)
G9124      Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia         20060101
G9124      chromosome positive and/or bcr-abl positive; accelerated phase not in
G9124      hematologic cytogenetic, or molecular remission (for use in a medicare-approved
G9124      demonstration project)
G9125      Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia         20060101
G9125      chromosome positive and/or bcr-abl positive; blast phase not in hematologic,
G9125      cytogenetic, or molecular remission (for use in a medicare-approved
G9125      demonstration project)
G9130      Oncology; disease status; limited to multiple myeloma, systemic disease; extent         20060101
G9130      of disease unknown, staging in progress, or not listed (for use in a
G9130      medicare-approved demonstration project)
G9131      Oncology; disease status; invasive female breast cancer (does not include               20070101
G9131      ductal carcinoma in situ); adenocarcinoma as predominant cell type; extent of
G9131      disease unknown, staging in progress, or not listed (for use in a
G9131      medicare-approved demonstration project)
G9132      Oncology; disease status; prostate cancer, limited to adenocarcinoma;                   20070101
G9132      hormone-refractory/androgen-independent (e.g., rising psa on anti-androgen
G9132      therapy or post-orchiectomy); clinical metastases (for use in a
G9132      medicare-approved demonstration project)
G9133      Oncology; disease status; prostate cancer, limited to adenocarcinoma;                   20070101
G9133      hormone-responsive; clinical metastases or m1 at diagnosis (for use in a
G9133      medicare-approved demonstration project)
G9134      Oncology; disease status; non-hodgkin's lymphoma, any cellular classification;          20070101
G9134      stage i, ii at diagnosis, not relapsed, not refractory (for use in a
G9134      medicare-approved demonstration project)
G9135      Oncology; disease status; non-hodgkin's lymphoma, any cellular classification;          20070101
G9135      stage iii, iv, not relapsed, not refractory (for use in a medicare-approved
G9135      demonstration project)
G9136      Oncology; disease status; non-hodgkin's lymphoma, transformed from original             20070101
G9136      cellular diagnosis to a second cellular classification (for use in a
G9136      medicare-approved demonstration project)
G9138      Oncology; disease status; non-hodgkin's lymphoma, any cellular classification;          20070101
G9138      diagnostic evaluation, stage not determined, evaluation of possible relapse or
G9138      non-response to therapy, or not listed (for use in a medicare-approved
G9138      demonstration project)
G9139      Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia         20070101
G9139      chromosome positive and/or bcr-abl positive; extent of disease unknown, staging
G9139      in progress, not listed (for use in a medicare-approved demonstration project)
G9187      Bundled payments for care improvement initiative home visit for patient                 20131001
G9187      assessment performed by a qualified health care professional for individuals
G9187      not considered homebound including, but not limited to, assessment of safety,
G9187      falls, clinical status, fluid status, medication reconciliation/management,
G9187      patient compliance with orders/plan of care, performance of activities of daily
G9187      living, appropriateness of care setting; (for use only in the meidcare-approved
G9187      bundled payments for care improvement initiative); may not be billed for a
G9187      30-day period covered by a transitional care management code
G9188      Beta-blocker therapy not prescribed, reason not given                                   20140101
G9190      Documentation of medical reason(s) for not prescribing beta-blocker therapy             20140101
G9190      (eg, allergy, intolerance, other medical reasons)
G9191      Documentation of patient reason(s) for not prescribing beta-blocker therapy             20140101
G9191      (eg, patient declined, other patient reasons)
G9192      Documentation of system reason(s) for not prescribing beta-blocker therapy (eg,         20140101
G9192      other reasons attributable to the health care system)
G9193      Clinician documented that patient with a diagnosis of major depression was not          20140101            20141231
G9193      an eligible candidate for antidepressant medication treatment or patient did
G9193      not have a diagnosis of major depression
G9194      Patient with a diagnosis of major depression documented as being treated with           20140101            20141231
G9194      antidepressant medication during the entire 180 day (6 month) continuation
G9194      treatment phase
G9195      Patient with a diagnosis of major depression not documented as being treated            20140101            20141231
G9195      with antidepressant medication during the entire 180 day (6 months)
G9195      continuation treatment phase
G9196      Documentation of medical reason(s) for not ordering a first or second                   20140101
G9196      generation cephalosporin for antimicrobial prophylaxis (e.g., patients enrolled
G9196      in clinical trials, patients with documented infection prior to surgical
G9196      procedure of interest, patients who were receiving antibiotics more than 24
G9196      hours prior to surgery [except colon surgery patients taking oral prophylactic
G9196      antibiotics], patients who were receiving antibiotics within 24 hours prior to
G9196      arrival [except colon surgery patients taking oral prophylactic antibiotics],
G9196      other medical reason(s))
G9198      Order for first or second generation cephalosporin for antimicrobial                    20140101
G9198      prophylaxis was not documented, reason not given
G9199      Venous thromboembolism (vte) prophylaxis not administered the day of or the day         20140101            20141231
G9199      after hospital admission for documented reasons (eg, patient is ambulatory,
G9199      patient expired during inpatient stay, patient already on warfarin or another
G9199      anticoagulant, other medical reason(s) or eg, patient left against medical
G9199      advice, other patient reason(s))
G9200      Venous thromboembolism (vte) prophylaxis was not administered the day of or the         20140101            20141231
G9200      day after hospital admission, reason not given
G9204      Rna testing for hepatitis c was not documented as performed within 12 months            20140101            20161231
G9204      prior to initiation of antiviral treatment for hepatitis c, reason not given
G9207      Hepatitis c genotype testing documented as performed within 12 months prior to          20140101            20161231
G9207      initiation of antiviral treatment for hepatitis c
G9208      Hepatitis c genotype testing was not documented as performed within 12 months           20140101            20161231
G9208      prior to initiation of antiviral treatment for hepatitis c, reason not given
G9210      Hepatitis c quantitative rna testing not performed between 4-12 weeks after the         20140101            20161231
G9210      initiation of antiviral treatment for documented reason(s) (e.g., patients
G9210      whose treatment was discontinued during the testing period prior to testing,
G9210      other medical reasons, patient declined, other patient reasons)
G9211      Hepatitis c quantitative rna testing was not documented as performed between            20140101            20161231
G9211      4-12 weeks after the initiation of antiviral treatment, reason not given
G9213      Dsm-iv-tr criteria for major depressive disorder not documented at the initial          20140101
G9213      evaluation, reason not otherwise specified
G9215      Cd4+ cell count or percentage not documented as performed, reason not given             20140101            20141231
G9216      Pcp prophylaxis was not prescribed at time of diagnosis of hiv, reason not given        20140101            20141231
G9217      Pcp prophylaxis was not prescribed within 3 months of low cd4+ cell count below         20140101            20161231
G9217      200 cells/mm3, reason not given
G9218      Pcp prophylaxis was not prescribed within 3 months oflow cd4+ cell count below          20140101            20141231
G9218      500 cells/mm3 or a cd4 percentage below 15%, reason not given
G9219      Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of           20140101            20161231
G9219      low cd4+ cell count below 200 cells/mm3 for medical reason (i.e., patient's
G9219      cd4+ cell count above threshold within 3 months after cd4+ cell count below
G9219      threshold, indicating that the patient's cd4+ levels are within an acceptable
G9219      range and the patient does not require pcp prophylaxis)
G9220      Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of           20140101            20141231
G9220      low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15% for
G9220      medical reason (i.e., patient's cd4+ cell count above threshold within 3 months
G9220      after cd4+ cell count below threshold, indicating that the patient's cd4+
G9220      levels are within an acceptable range and the patient does not require pcp
G9220      prophylaxis)
G9224      Documentation of medical reason for not performing foot exam (e.g., patient             20140101            20141231
G9224      with bilateral foot/leg amputation)
G9225      Foot exam was not performed, reason not given                                           20140101
G9227      Functional outcome assessment documented, care plan not documented,                     20140101
G9227      documentation the patient is not eligible for a care plan
G9229      Chlamydia, gonorrhea, and syphilis screening results not documented (patient            20140101
G9229      refusal is the only allowed exception)
G9230      Chlamydia, gonorrhea, and syphilis not screened, reason not given                       20140101
G9232      Clinician treating major depressive disorder did not communicate to clinician           20140101
G9232      treating comorbid condition for specified patient reason (e.g., patient is
G9232      unable to communicate the diagnosis of a comorbid condition; the patient is
G9232      unwilling to communicate the diagnosis of a comorbid condition; or the patient
G9232      is unaware of the comorbid condition, or any other specified patient reason)
G9241      Patient whose mode of vascular access is not a catheter at the time maintenance         20140101
G9241      hemodialysis is initiated
G9242      Documentation of viral load equal to or greater than 200 copies/ml or viral             20140101
G9242      load not performed
G9244      Antiretroviral thereapy not prescribed                                                  20140101            20161231
G9246      Patient did not have at least one medical visit in each 6 month period of the           20140101
G9246      24 month measurement period, with a minimum of 60 days between medical visits
G9248      Patient did not have a medical visit in the last 6 months                               20140101            20141231
G9251      Documentation of patient with pain not brought to a comfortable level within 48         20140101
G9251      hours from initial assessment
G9252      Adenoma(s) or other neoplasm detected during screening colonoscopy                      20140101            20141231
G9253      Adenoma(s) or other neoplasm not detected during screening colonoscopy                  20140101            20141231
G9277      Documentation that the patient is on daily aspirin or anti-platelet or has              20140101
G9277      documentation of a valid contraindication or exception to
G9277      aspirin/anti-platelet; contraindications/exceptions include anti-coagulant use,
G9277      allergy to aspirin or anti-platelets, history of gastrointestinal bleed and
G9277      bleeding disorder; additionally, the following exceptions documented by the
G9277      physician as a reason for not taking daily aspirin or anti-platelet are
G9277      acceptable (use of non-steroidal anti-inflammatory agents, documented risk for
G9277      drug interaction, uncontrolled hypertension defined as >180 systolic or >110
G9277      diastolic or gastroesophageal reflux)
G9278      Documentation that the patient is not on daily aspirin or anti-platelet regimen         20140101
G9280      Pneumococcal vaccination not administered prior to discharge, reason not                20140101
G9280      specified
G9281      Screening performed and documentation that vaccination not indicated/patient            20140101
G9281      refusal
G9282      Documentation of medical reason(s) for not reporting the histological type or           20140101
G9282      nsclc-nos classification with an explanation (e.g., biopsy taken for other
G9282      purposes in a patient with a history of non-small cell lung cancer or other
G9282      documented medical reasons)
G9283      Non small cell lung cancer biopsy and cytology specimen report documents                20140101
G9283      classification into specific histologic type or classified as nsclc-nos with an
G9283      explanation
G9284      Non small cell lung cancer biopsy and cytology specimen report does not                 20140101
G9284      document classification into specific histologic type or classified as
G9284      nsclc-nos with an explanation
G9285      Specimen site other than anatomic location of lung or is not classified as non          20140101
G9285      small cell lung cancer
G9287      Antibiotic regimen not prescribed within 10 days after onset of symptoms                20140101
G9288      Documentation of medical reason(s) for not reporting the histological type or           20140101
G9288      nsclc-nos classification with an explanation (e.g., a solitary fibrous tumor in
G9288      a person with a history of non-small cell carcinoma or other documented medical
G9288      reasons)
G9289      Non small cell lung cancer biopsy and cytology specimen report documents                20140101
G9289      classification into specific histologic type or classified as nsclc-nos with an
G9289      explanation
G9290      Non small cell lung cancer biopsy and cytology specimen report does not                 20140101
G9290      document classification into specific histologic type or classified as
G9290      nsclc-nos with an explanation
G9291      Specimen site other than anatomic location of lung, is not classified as non            20140101
G9291      small cell lung cancer or classified as nsclc-nos
G9292      Documentation of medical reason(s) for not reporting pt category and a                  20140101
G9292      statement on thickness and ulceration and for pt1, mitotic rate (e.g., negative
G9292      skin biopsies in a patient with a history of melanoma or other documented
G9292      medical reasons)
G9293      Pathology report does not include the pt category and a statement on thickness          20140101
G9293      and ulceration and for pt1, mitotic rate
G9297      Shared decision-making including discussion of conservative (non-surgical)              20140101
G9297      therapy (e.g., nsaids, analgesics, weight loss, exercise, injections) prior to
G9297      the procedure, not documented, reason not given
G9299      Patients who are not evaluated for venous thromboembolic and cardiovascular             20140101
G9299      risk factors within 30 days prior to the procedure including (e.g., history of
G9299      dvt, pe, mi, arrhythmia and stroke, reason not given)
G9300      Documentation of medical reason(s) for not completely infusing the prophylactic         20140101
G9300      antibiotic prior to the inflation of the proximal tourniquet (e.g., a
G9300      tourniquet was not used)
G9302      Prophylactic antibiotic not completely infused prior to the inflation of the            20140101
G9302      proximal tourniquet, reason not given
G9303      Operative report does not identify the prosthetic implant specifications                20140101
G9303      including the prosthetic implant manufacturer, the brand name of the prosthetic
G9303      implant and the size of each prosthetic implant, reason not given
G9305      Intervention for presence of leak of endoluminal contents through an                    20140101
G9305      anastomosis not required
G9313      Amoxicillin, with or without clavulanate, not prescribed as first line                  20140101
G9313      antibiotic at the time of diagnosis for documented reason (eg, cystic fibrosis,
G9313      immotile cilia disorders, ciliary dyskinesia, immune deficiency, prior history
G9313      of sinus surgery within the past 12 months, and anatomic abnormalities, such as
G9313      deviated nasal septum, resistant organisms, allergy to medication, recurrent
G9313      sinusitis, chronic sinusitis, or other reasons)
G9314      Amoxicillin, with or without clavulanate, not prescribed as first line                  20140101
G9314      antibiotic at the time of diagnosis, reason not given
G9315      Documentation amoxicillin, with or without clavulanate, prescribed as a first           20140101
G9315      line antibiotic at the time of diagnosis
G9317      Documentation of patient-specific risk assessment with a risk calculator based          20140101
G9317      on multi-institutional clinical data, the specific risk calculator used, and
G9317      communication of risk assessment from risk calculator with the patient or
G9317      family not completed
G9319      Imaging study not named according to standardized nomenclature, reason not given        20140101
G9320      Documentation of medical reason(s) for not naming ct studies according to a             20140101            20151231
G9320      standardized nomenclature provided (eg, ct studies performed for radiation
G9320      treatment planning or image-guided radiation treatment delivery)
G9322      Count of previous ct and cardiac nuclear medicine (myocardial perfusion)                20140101
G9322      studies not documented in the 12-month period prior to the current study,
G9322      reason not given
G9323      Documentation of medical reason(s) for not counting previous ct and cardiac             20140101            20151231
G9323      nuclear medicine (myocardial perfusion) studies (eg, ct studies performed for
G9323      radiation treatment planning or image-guided radiation treatment delivery)
G9324      All necessary data elements not included, reason not given                              20140101            20161231
G9325      Ct studies not reported to a radiation dose index registry due to medical               20140101            20151231
G9325      reasons (eg, ct studies performed for radiation treatment planning or
G9325      image-guided radiation treatment delivery)
G9326      Ct studies performed not reported to a radiation dose index registry that is            20140101
G9326      capable of collecting at a minimum all necessary data elements, reason not given
G9328      Dicom format image data availability not documented in final report due to              20140101            20151231
G9328      medical reasons (eg, ct studies performed for radiation treatment planning or
G9328      image-guided radiation treatment delivery)
G9329      Dicom format image data available to non-affiliated external healthcare                 20140101
G9329      facilities or entities on a secure, media free, reciprocally searchable basis
G9329      with patient authorization for at least a 12-month period after the study not
G9329      documented in final report, reason not given
G9342      Search not conducted prior to an imaging study being performed for prior                20140101
G9342      patient ct studies completed at non-affiliated external healthcare facilities
G9342      or entities within the past 12-months and are available through a secure,
G9342      authorized, media-free, shared archive, reason not given
G9343      Due to medical reasons, search not conducted for dicom format images for prior          20140101            20151231
G9343      patient ct imaging studies completed at non-affiliated external healthcare
G9343      facilities or entities within the past 12 months that are available through a
G9343      secure, authorized, media-free, shared archive (e.g., ct studies performed for
G9343      radiation treatment planning or image-guided radiation treatment delivery)
G9344      Due to system reasons search not conducted for dicom format images for prior            20140101
G9344      patient ct imaging studies completed at non-affiliated external healthcare
G9344      facilities or entities within the past 12 months that are available through a
G9344      secure, authorized, media-free, shared archive (e.g., non-affiliated external
G9344      healthcare facilities or entities does not have archival abilities through a
G9344      shared archival system)
G9346      Follow-up recommendations not documented according to recommended guidelines            20140101            20151231
G9346      for incidentally detected pulmonary nodules due to medical reasons (e.g.,
G9346      patients with known malignant disease, patients with unexplained fever, ct
G9346      studies performed for radiation treatment planning or image-guided radiation
G9346      treatment delivery)
G9347      Follow-up recommendations not documented according to recommended guidelines            20140101
G9347      for incidentally detected pulmonary nodules, reason not given
G9348      Ct scan of the paranasal sinuses ordered at the time of diagnosis for                   20140101
G9348      documented reasons (eg, persons with sinusitis symptoms lasting at least 7 to
G9348      10 days, antibiotic resistance, immunocompromised, recurrent sinusitis, acute
G9348      frontal sinusitis, acute sphenoid sinusitis, periorbital cellulitis, or other
G9348      medical)
G9349      Documentation of a ct scan of the paranasal sinuses ordered at the time of              20140101
G9349      diagnosis or received within 28 days after date of diagnosis
G9350      Ct scan of the paranasal sinuses not ordered at the time of diagnosis or                20140101
G9350      received within 28 days after date of diagnosis
G9351      More than one ct scan of the paranasal sinuses ordered or received within 90            20140101
G9351      days after diagnosis
G9352      More than one ct scan of the paranasal sinuses ordered or received within 90            20140101
G9352      days after the date of diagnosis, reason not given
G9353      More than one ct scan of the paranasal sinuses ordered or received within 90            20140101
G9353      days after the date of diagnosis for documented reasons (eg, patients with
G9353      complications, second ct obtained prior to surgery, other medical reasons)
G9354      One ct scan or no ct scan of the paranasal sinuses ordered within 90 days after         20140101
G9354      the date of diagnosis
G9355      Elective delivery or early induction not performed                                      20140101
G9358      Post-partum screenings, evaluations and education not performed                         20140101
G9359      Documentation of negative or managed positive tb screen with further evidence           20140101
G9359      that tb is not active within one year of patient visit
G9366      One high-risk medication not ordered                                                    20150101
G9368      At least two different high-risk medications not ordered                                20150101
G9370      Individual who did not fill at least two prescriptions for any antipsychotic            20150101            20151231
G9370      medication or did not have a pdc of 0.8 or greater
G9377      Patient did not have the retina attached after 6 months following only one              20150101            20151231
G9377      surgery
G9379      Patient did not achieve flat retinas six months post surgery                            20150101            20151231
G9381      Documentation of medical reason(s) for not offering assistance with end of life         20150101
G9381      issues (e.g., patient in hospice care, patient in terminal phase) during the
G9381      measurement period
G9382      Patient not offered assistance with end of life issues during the measurement           20150101
G9382      period
G9384      Documentation of medical reason(s) for not receiving annual screening for hcv           20150101
G9384      infection (e.g., decompensated cirrhosis indicating advanced disease [i.e.,
G9384      ascites, esophageal variceal bleeding, hepatic encephalopathy], hepatocellular
G9384      carcinoma, waitlist for organ transplant, limited life expectancy, other
G9384      medical reasons)
G9385      Documentation of patient reason(s) for not receiving annual screening for hcv           20150101
G9385      infection (e.g., patient declined, other patient reasons)
G9386      Screening for hcv infection not received within the 12 month reporting period,          20150101
G9386      reason not given
G9392      Patient does not achieve refraction +-1 d for the eye that underwent cataract           20150101            20151231
G9392      surgery, measured at the one month follow up visit
G9394      Patient who had a diagnosis of bipolar disorder or personality disorder, death,         20150101
G9394      permanent nursing home resident or receiving hospice or palliative care any
G9394      time during the measurement or assessment period
G9395      Patient with an initial phq-9 score greater than nine who did not achieve               20150101
G9395      remission at twelve months as demonstrated by a twelve month (+/- 30 days)
G9395      phq-9 score greater than or equal to five
G9396      Patient with an initial phq-9 score greater than nine who was not assessed for          20150101
G9396      remission at twelve months (+/- 30 days)
G9399      Documentation in the patient record of a discussion between the                         20150101
G9399      physician/clinician and the patient that includes all of the following:
G9399      treatment choices appropriate to genotype, risks and benefits, evidence of
G9399      effectiveness, and patient preferences toward the outcome of the treatment
G9400      Documentation of medical or patient reason(s) for not discussing treatment              20150101
G9400      options; medical reasons: patient is not a candidate for treatment due to
G9400      advanced physical or mental health comorbidity (including active substance
G9400      use); currently receiving antiviral treatment; successful antiviral treatment
G9400      (with sustained virologic response) prior to reporting period; other documented
G9400      medical reasons; patient reasons: patient unable or unwilling to participate in
G9400      the discussion or other patient reasons
G9401      No documentation of a discussion in the patient record of a discussion between          20150101
G9401      the physician or other qualfied healthcare professional and the patient that
G9401      includes all of the following: treatment choices appropriate to genotype, risks
G9401      and benefits, evidence of effectiveness, and patient preferences toward
G9401      treatment
G9403      Clinician documented reason patient was not able to complete 30 day follow-up           20150101
G9403      from acute inpatient setting discharge (e.g., patient death prior to follow-up
G9403      visit, patient non-compliant for visit follow-up)
G9404      Patient did not receive follow-up on the date of discharge or within 30 days            20150101
G9404      after discharge
G9406      Clinician documented reason patient was not able to complete 7 day follow-up            20150101
G9406      from acute inpatient setting discharge (i.e patient death prior to follow-up
G9406      visit, patient non-compliance for visit follow-up)
G9407      Patient did not receive follow-up on or within 7 days after discharge                   20150101
G9411      Patient not admitted within 180 days, status post cied implantation,                    20150101
G9411      replacement, or revision with an infection requiring device removal or surgical
G9411      revision
G9413      Patient not admitted within 180 days, status post cied implantation,                    20150101
G9413      replacement, or revision with an infection requiring device removal or surgical
G9413      revision
G9415      Patient did not have one dose of meningococcal vaccine on or between the                20150101
G9415      patient's 11th and 13th birthdays
G9417      Patient did not have one tetanus, diphtheria toxoids and acellular pertussis            20150101
G9417      vaccine (tdap) on or between the patient's 10th and 13th birthdays
G9418      Primary non-small cell lung cancer biopsy and cytology specimen report                  20150101
G9418      documents classification into specific histologic type or classified as
G9418      nsclc-nos with an explanation
G9419      Documentation of medical reason(s) for not including the histological type or           20150101
G9419      nsclc-nos classification with an explanation (e.g., biopsy taken for other
G9419      purposes in a patient with a history of primary non-small cell lung cancer or
G9419      other documented medical reasons)
G9420      Specimen site other than anatomic location of lung or is not classified as              20150101
G9420      primary non-small cell lung cancer
G9421      Primary non-small cell lung cancer biopsy and cytology specimen report does not         20150101
G9421      document classification into specific histologic type or classified as
G9421      nsclc-nos with an explanation
G9422      Primary lung carcinoma resection report documents pt category, pn category and          20150101
G9422      for non-small cell lung cancer, histologic type (squamous cell carcinoma,
G9422      adenocarcinoma and not nsclc-nos)
G9423      Documentation of medical reason for not including pt category, pn category and          20150101
G9423      histologic type [for patient with appropriate exclusion criteria (e.g.,
G9423      metastatic disease, benign tumors, malignant tumors other than carcinomas,
G9423      inadequate surgical specimens)]
G9424      Specimen site other than anatomic location of lung, or classified as nsclc-nos          20150101
G9425      Primary lung carcinoma resection report does not document pt category, pn               20150101
G9425      category and for non-small cell lung cancer, histologic type (squamous cell
G9425      carcinoma, adenocarcinoma)
G9427      Improvement in median time from ed arrival to initial ed oral or parenteral             20150101
G9427      pain medication administration not performed for ed admitted patients
G9429      Documentation of medical reason(s) for not including pt category and a                  20150101
G9429      statement on thickness and ulceration and for pt1, mitotic rate (e.g., negative
G9429      skin biopsies in a patient with a history of melanoma or other documented
G9429      medical reasons)
G9431      Pathology report does not include the pt category and a statement on thickness          20150101
G9431      and ulceration and for pt1, mitotic rate
G9434      Asthma not well-controlled based on the act, c-act, acq, or ataq score, or              20150101
G9434      specified asthma control tool not used, reason not given
G9436      Aspirin not prescribed for documented reasons (e.g., allergy, medical                   20150101            20161231
G9436      intolerance, history of bleed)
G9437      Aspirin not prescribed at discharge                                                     20150101            20161231
G9439      P2y inhibitor not prescribed for documented reasons (e.g., allergy, medical             20150101            20161231
G9439      intolerance, history of bleed)
G9440      P2y inhibitor not prescribed at discharge                                               20150101            20161231
G9442      Statin not prescribed for documented reasons (e.g., allergy, medical                    20150101            20161231
G9442      intolerance)
G9443      Statin not prescribed at discharge                                                      20150101            20161231
G9452      Documentation of medical reason(s) for not receiving one-time screening for hcv         20150101
G9452      infection (e.g., decompensated cirrhosis indicating advanced disease [ie,
G9452      ascites, esophageal variceal bleeding, hepatic encephalopathy], hepatocellular
G9452      carcinoma, waitlist for organ transplant, limited life expectancy, other
G9452      medical reasons)
G9453      Documentation of patient reason(s) for not receiving one-time screening for hcv         20150101
G9453      infection (e.g., patient declined, other patient reasons)
G9454      One-time screening for hcv infection not received within 12 month reporting             20150101
G9454      period and no documentation of prior screening for hcv infection, reason not
G9454      given
G9456      Documentation of medical or patient reason(s) for not ordering or performing            20150101
G9456      screening for hcc. medical reason: comorbid medical conditions with expected
G9456      survival < 5 years, hepatic decompensation and not a candidate for liver
G9456      transplantation, or other medical reasons; patient reasons: patient declined or
G9456      other patient reasons (e.g., cost of tests, time related to accessing testing
G9456      equipment)
G9457      Patient did not undergo abdominal imaging and did not have a documented reason          20150101
G9457      for not undergoing abdominal imaging in the reporting period
G9460      Tobacco assessment or tobacco cessation intervention not performed, reason not          20150101
G9460      given
G9468      Patient not receiving corticosteroids greater than or equal to 10 mg/day of             20150101
G9468      prednisone equivalents for 60 or greater consecutive days or a single
G9468      prescription equating to 600 mg prednisone or greater for all fills
G9470      Patients not receiving corticosteroids greater than or equal to 10 mg/day of            20150101
G9470      prednisone equivalents for 60 or greater consecutive days or a single
G9470      prescription equating to 600 mg prednisone or greater for all fills
G9471      Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) not             20150101
G9471      ordered or documented
G9472      Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) not             20150101
G9472      ordered and documented, no review of systems and no medication history or
G9472      pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed
G9490      Comprehensive care for joint replacement model, home visit for patient                  20160401
G9490      assessment performed by clinical staff for an individual not considered
G9490      homebound, including, but not necessarily limited to patient assessment of
G9490      clinical status, safety/fall prevention, functional status/ambulation,
G9490      medication reconciliation/management, compliance with orders/plan of care,
G9490      performance of activities of daily living, and ensuring beneficiary connections
G9490      to community and other services.  (for use only in the medicare-approved cjr
G9490      model); may not be billed for a 30 day period covered by a transitional care
G9490      management code
G9496      Documentation of reason for not detecting adenoma(s) or other neoplasm. (e.g.,          20160101
G9496      neoplasm detected is only diagnosed as traditional serrated adenoma, sessile
G9496      serrated polyp, or sessile serrated adenoma
G9499      Patient did not start or is not receiving antiviral treatment for hepatitis c           20160101            20161231
G9499      during the measurement period
G9501      Radiation exposure indices, or exposure time and number of fluorographic images         20160101
G9501      not documented in final report for procedure using fluoroscopy, reason not given
G9502      Documentation of medical reason for not performing foot exam (i.e., patients            20160101
G9502      who have had either a bilateral amputation above or below the knee, or both a
G9502      left and right amputation above or below the knee before or during the
G9502      measurement period)
G9504      Documented reason for not assessing hepatitis b virus (hbv) status (e.g.                20160101
G9504      patient not receiving a first course of anti-tnf therapy, patient declined)
G9504      within one year prior to first course of anti-tnf therapy
G9507      Documentation that the patient is on a statin medication or has documentation           20160101
G9507      of a valid contraindication or exception to statin medications;
G9507      contraindications/exceptions that can be defined by diagnosis codes include
G9507      pregnancy during the measurement period, active liver disease, rhabdomyolysis,
G9507      end stage renal disease on dialysis and heart failure; provider documented
G9507      contraindications/exceptions include breastfeeding during the measurement
G9507      period, woman of child-bearing age not actively taking birth control, allergy
G9507      to statin, drug interaction (hiv protease inhibitors, nefazodone, cyclosporine,
G9507      gemfibrozil, and danazol) and intolerance (with supporting documentation of
G9507      trying a statin at least once within the last 5 years or diagnosis codes for
G9507      myostitis or toxic myopathy related to drugs)
G9508      Documentation that the patient is not on a statin medication                            20160101
G9510      Remission at twelve months not demonstrated by a twelve month (+/-30 days)              20160101
G9510      phq-9 score of less than five; either phq-9 score was not assessed or is
G9510      greater than or equal to 5
G9513      Individual did not have a pdc of 0.8 or greater                                         20160101
G9515      Patient did not require a return to the operating room within 90 days of surgery        20160101
G9517      Patient did not achieve an improvement in visual acuity, from their                     20160101
G9517      preoperative level, within 90 days of surgery, reason not given
G9520      Patient does not achieve final refraction (spherical equivalent) +/- 0.5                20160101
G9520      diopters of their planned refraction within 90 days of surgery
G9522      Total number of emergency department visits and inpatient hospitalizations              20160101
G9522      equal to or greater than two in the past 12 months or patient not screened,
G9522      reason not given
G9525      Documentation of patient reason(s) for not referring to hospice care (e.g.,             20160101
G9525      patient declined, other patient reasons)
G9526      Patient was not referred to hospice care, reason not given                              20160101
G9532      Patient's head injury occurred greater than 24 hours before presentation to the         20160101
G9532      emergency department, or has a gcs score less than 15 or does not have a gcs
G9532      score documented, or had a head ct for trauma ordered by someone other than an
G9532      emergency care provider, or was ordered for a reason other than trauma
G9533      Patient with minor blunt head trauma did not have an appropriate indication(s)          20160101
G9533      for a head ct
G9534      Advanced brain imaging (cta, ct, mra or mri) was not ordered                            20160101
G9536      Documentation of medical reason(s) for ordering an advanced brain imaging study         20160101
G9536      (i.e., patient has an abnormal neurological examination; patient has the
G9536      coexistence of seizures, or both; recent onset of severe headache; change in
G9536      the type of headache; signs of increased intracranial pressure (e.g.,
G9536      papilledema, absent venous pulsations on funduscopic examination, altered
G9536      mental status, focal neurologic deficits, signs of meningeal irritation);
G9536      hiv-positive patients with a new type of headache; immunocompromised patient
G9536      with unexplained headache symptoms; patient on coagulopathy/anti-coagulation or
G9536      anti-platelet therapy; very young patients with unexplained headache symptoms)
G9544      Patients that do not have the filter removed, documented re-assessment for the          20160101
G9544      appropriateness of filter removal, or documentation of at least two attempts to
G9544      reach the patient to arrange a clinical re-assessment for the appropriateness
G9544      of filter removal within 3 months of placement
G9549      Documentation of medical reason(s) that follow-up imaging is indicated (e.g.,           20160101
G9549      patient has a known malignancy that can metastasize, other medical reason(s)
G9549      such as fever in an immunocompromised patient)
G9550      Final reports for abdominal imaging studies with follow-up imaging not                  20160101
G9550      recommended
G9551      Final reports for abdominal imaging studies without an incidentally found               20160101
G9551      lesion noted: liver lesion <= 0.5 cm, cystic kidney lesion < 1.0 cm or adrenal
G9551      lesion <= 1.0 cm noted or no lesion found
G9552      Incidental thyroid nodule < 1.0 cm noted in report                                      20160101
G9553      Prior thyroid disease diagnosis                                                         20160101
G9556      Final reports for ct, cta, mri or mra of the chest or neck or ultrasound of the         20160101
G9556      neck with follow-up imaging not recommended
G9557      Final reports for ct, cta, mri or mra studies of the chest or neck or                   20160101
G9557      ultrasound of the neck without an incidentally found thyroid nodule < 1.0 cm
G9557      noted or no nodule found
G9559      Documentation of medical reason(s) for not prescribing a beta-lactam antibiotic         20160101
G9559      (e.g., allergy, intolerance to beta-lactam antibiotics)
G9560      Patient not treated with a beta-lactam antibiotic as definitive therapy, reason         20160101
G9560      not given
G9563      Patients who did not have a follow-up evaluation conducted at least every three         20160101
G9563      months during opioid therapy
G9574      Remission at six months not demonstrated by a six month (+/-30 days) phq-9              20160101
G9574      score of less than five; either phq-9 score was not assessed or is greater than
G9574      or equal to five
G9581      Door to puncture time of greater than 2 hours for reasons documented by                 20160101            20161231
G9581      clinician (e.g., patients who are transferred from one institution to another
G9581      with a known diagnosis of cva for endovascular stroke treatment; hospitalized
G9581      patients with newly diagnosed cva considered for endovascular stroke treatment)
G9585      Patient not evaluated for risk of misuse of opiates by using a brief validated          20160101
G9585      instrument (e.g., opioid risk tool, soapp-r) or patient not interviewed at
G9585      least once during opioid therapy
G9593      Pediatric patient with minor blunt head trauma classified as low risk according         20160101
G9593      to the pecarn prediction rules
G9596      Pediatric patient's head injury occurred greater than 24 hours before                   20160101
G9596      presentation to the emergency department, or has a gcs score less than 15 or
G9596      does not have a gcs score documented, or had a head ct for trauma ordered by
G9596      someone other than an emergency care provider, or was ordered for a reason
G9596      other than trauma
G9597      Pediatric patient with minor blunt head trauma not classified as low risk               20160101
G9597      according to the pecarn prediction rules
G9602      Patient not discharged to home by post-operative day #7                                 20160101
G9604      Patient survey results not available                                                    20160101
G9605      Patient survey score did not improve from baseline following treatment                  20160101
G9607      Documented medical reasons for not performing intraoperative cystoscopy (e.g.,          20160101
G9607      urethral pathology precluding cystoscopy, any patient who has a congenital or
G9607      acquired absence of the urethra)
G9608      Intraoperative cystoscopy not performed to evaluate for lower tract injury              20160101
G9610      Documentation of medical reason(s) in the patient's record for not ordering             20160101
G9610      anti-platelet agents
G9611      Order for anti-platelet agents was not documented in the patient's record,              20160101
G9611      reason not given
G9616      Documentation of reason(s) for not documenting a preoperative assessment (e.g.,         20160101
G9616      patient with a gynecologic or other pelvic malignancy noted at the time of
G9616      surgery)
G9617      Preoperative assessment not documented, reason not given                                20160101
G9619      Documentation of reason(s) for not screening for uterine malignancy (e.g.,              20160101            20161231
G9619      prior hysterectomy)
G9620      Patient not screened for uterine malignancy, or those that have not had an              20160101
G9620      ultrasound and/or endometrial sampling of any kind, reason not given
G9622      Patient not identified as an unhealthy alcohol user when screened for unhealthy         20160101
G9622      alcohol use using a systematic screening method
G9623      Documentation of medical reason(s) for not screening for unhealthy alcohol use          20160101
G9623      (e.g., limited life expectancy, other medical reasons)
G9624      Patient not screened for unhealthy alcohol screening using a systematic                 20160101
G9624      screening method or patient did not receive brief counseling, reason not given
G9626      Documented medical reason for not reporting bladder injury (e.g., gynecologic           20160101
G9626      or other pelvic malignancy documented, concurrent surgery involving bladder
G9626      pathology, injury that occurs during urinary incontinence procedure, patient
G9626      death from non-medical causes not related to surgery, patient died during
G9626      procedure without evidence of bladder injury)
G9627      Patient did not sustain bladder injury at the time of surgery nor discovered            20160101
G9627      subsequently up to 1 month post-surgery
G9629      Documented medical reasons for not reporting bowel injury (e.g., gynecologic or         20160101
G9629      other pelvic malignancy documented, planned (e.g., not due to an unexpected
G9629      bowel injury) resection and/or re-anastomosis of bowel, or patient death from
G9629      non-medical causes not related to surgery, patient died during procedure
G9629      without evidence of bowel injury)
G9630      Patient did not sustain a bowel injury at the time of surgery nor discovered            20160101
G9630      subsequently up to 1 month post-surgery
G9632      Documented medical reasons for not reporting ureter injury (e.g., gynecologic           20160101
G9632      or other pelvic malignancy documented, concurrent surgery involving bladder
G9632      pathology, injury that occurs during a urinary incontinence procedure, patient
G9632      death from non-medical causes not related to surgery, patient died during
G9632      procedure without evidence of ureter injury)
G9633      Patient did not sustain ureter injury at the time of surgery nor discovered             20160101
G9633      subsequently up to 1 month post-surgery
G9635      Health-related quality of life not assessed with tool for documented reason(s)          20160101
G9635      (e.g., patient has a cognitive or neuropsychiatric impairment that impairs
G9635      his/her ability to complete the hrqol survey, patient has the inability to read
G9635      and/or write in order to complete the hrqol questionnaire)
G9636      Health-related quality of life not assessed with tool during at least two               20160101
G9636      visits or quality of life score declined
G9639      Major amputation or open surgical bypass not required within 48 hours of the            20160101
G9639      index endovascular lower extremity revascularization procedure
G9645      Patients who did not abstain from smoking prior to anesthesia on the day of             20160101
G9645      surgery or procedure
G9647      Patients in whom mrs score could not be obtained at 90 day follow-up                    20160101
G9649      Psoriasis assessment tool documented meeting any one of the specified                   20160101
G9649      benchmarks (e.g., (pga; 6-point scale), body surface area (bsa), psoriasis area
G9649      and severity index (pasi) and/or dermatology life quality index) (dlqi))
G9651      Psoriasis assessment tool documented not meeting any one of the specified               20160101
G9651      benchmarks (e.g., (pga; 6-point scale), body surface area (bsa), psoriasis area
G9651      and severity index (pasi) and/or dermatology life quality index) (dlqi)) or
G9651      psoriasis assessment tool not documented
G9653      Patient has not been treated with a systemic or biologic medication for                 20160101            20161231
G9653      psoriasis for at least six months
G9658      A transfer of care protocol or handoff tool/checklist that includes the                 20160101
G9658      required key handoff elements is not used
G9659      Patients greater than 85 years of age who did not have a history of colorectal          20160101
G9659      cancer or valid medical reason for the colonoscopy, including: iron deficiency
G9659      anemia, lower gastrointestinal bleeding, crohn's disease (i.e., regional
G9659      enteritis), familial adenomatous polyposis, lynch syndrome (i.e., hereditary
G9659      non-polyposis colorectal cancer), inflammatory bowel disease, ulcerative
G9659      colitis, abnormal finding of gastrointestinal tract, or changes in bowel habits
G9660      Documentation of medical reason(s) for a colonoscopy performed on a patient             20160101
G9660      greater than 85 years of age (e.g., last colonoscopy incomplete, last
G9660      colonoscopy had inadequate prep, iron deficiency anemia, lower gastrointestinal
G9660      bleeding, crohn's disease (i.e., regional enteritis), familial history of
G9660      adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis
G9660      colorectal cancer), inflammatory bowel disease, ulcerative colitis, abnormal
G9660      finding of gastrointestinal tract, or changes in bowel habits)
G9661      Patients greater than 85 years of age who received a routine colonoscopy for a          20160101
G9661      reason other than the following: an assessment of signs/symptoms of gi tract
G9661      illness, and/or the patient is considered high risk, and/or to follow-up on
G9661      previously diagnosed advance lesions
G9662      Previously diagnosed or have an active diagnosis of clinical ascvd                      20160101
G9665      Patients who are not currently statin therapy users or did not receive an order         20160101
G9665      (prescription) for statin therapy
G9667      Documentation of medical reason(s) for not currently being a statin   therapy           20160101            20161231
G9667      user or receive an order (prescription) for statin therapy (e.g., patient with
G9667      adverse effect, allergy or intolerance to statin medication therapy, patients
G9667      who have an active diagnosis of pregnancy or who are breastfeeding, patients
G9667      who are receiving palliative care, patients with active liver disease or
G9667      hepatic disease or insufficiency, patients with end stage renal disease (esrd),
G9667      and patients with diabetes who have a fasting or direct ldl-c laboratory test
G9667      result < 70 mg/dl and are not taking statin therapy)
G9674      Patients with clinical ascvd diagnosis                                                  20160101
G9696      Documentation of medical reason(s) for not prescribing a long-acting inhaled            20170101
G9696      bronchodilator
G9697      Documentation of patient reason(s) for not prescribing a long-acting inhaled            20170101
G9697      bronchodilator
G9698      Documentation of system reason(s) for not prescribing a long-acting inhaled             20170101
G9698      bronchodilator
G9699      Long-acting inhaled bronchodilator not prescribed, reason not otherwise                 20170101
G9699      specified
G9701      Children who are taking antibiotics in the 30 days prior to the date of the             20170101
G9701      encounter during which the diagnosis was established
G9703      Children who are taking antibiotics in the 30 days prior to the  diagnosis of           20170101
G9703      pharyngitis
G9711      Patients with a diagnosis or past history of total colectomy or colorectal              20170101
G9711      cancer
G9712      Documentation of medical reason(s) for prescribing or dispensing antibiotic             20170101
G9712      (e.g., intestinal   infection, pertussis, bacterial infection, lyme disease,
G9712      otitis media, acute sinusitis, acute pharyngitis, acute tonsillitis, chronic
G9712      sinusitis, infection of the pharynx/larynx/tonsils/adenoids, prostatitis,
G9712      cellulitis/ mastoiditis/bone infections, acute lymphadenitis, impetigo, skin
G9712      staph infections, pneumonia, gonococcal infections/venereal disease (syphilis,
G9712      chlamydia, inflammatory diseases [female reproductive organs]), infections of
G9712      the kidney, cystitis/uti, acne, hiv disease/asymptomatic hiv, cystic fibrosis,
G9712      disorders of the immune system, malignancy neoplasms, chronic bronchitis,
G9712      emphysema, bronchiectasis, extrinsic allergic alveolitis, chronic airway
G9712      obstruction, chronic obstructive asthma, pneumoconiosis and other lung disease
G9712      due to external agents, other diseases of the respiratory system, and
G9712      tuberculosis
G9716      Bmi is documented as being outside of normal limits, follow-up plan is not              20170101
G9716      completed for documented reason
G9717      Documentation stating the patient has an active diagnosis of depression or has          20170101
G9717      a diagnosed bipolar disorder, therefore screening or follow-up not required
G9719      Patient is not ambulatory, bed ridden, immobile, confined to chair, wheelchair          20170101
G9719      bound, dependent on helper pushing wheelchair, independent in wheelchair or
G9719      minimal help in wheelchair
G9721      Patient not ambulatory, bed ridden, immobile, confined to chair, wheelchair             20170101
G9721      bound, dependent on helper pushing wheelchair, independent in wheelchair or
G9721      minimal help in wheelchair
G9722      Documented history of renal failure or baseline serum creatinine = 4.0 mg/dl;           20170101
G9722      renal transplant recipients are not considered to have preoperative renal
G9722      failure, unless, since transplantation the cr has been or is 4.0 or higher
G9727      Patient unable to complete the foto knee intake prom at admission and discharge         20170101
G9727      due to blindness, illiteracy, severe mental incapacity or language
G9727      incompatibility and an adequate proxy is not available
G9729      Patient unable to complete the foto hip intake prom at admission and discharge          20170101
G9729      due to blindness, illiteracy, severe mental incapacity or language
G9729      incompatibility and an adequate proxy is not available
G9731      Patient unable to complete the foto foot or ankle intake prom at admission and          20170101
G9731      discharge due to blindness, illiteracy, severe mental incapacity or language
G9731      incompatibility and an adequate proxy is not available
G9733      Patient unable to complete the foto lumbar intake prom at admission and                 20170101
G9733      discharge due to blindness, illiteracy, severe mental incapacity or language
G9733      incompatibility and an adequate proxy is not available
G9735      Patient unable to complete the foto shoulder intake prom at admission and               20170101
G9735      discharge due to blindness, illiteracy, severe mental incapacity or language
G9735      incompatibility and an adequate proxy is not available
G9737      Patient unable to complete the foto elbow, wrist or hand intake prom at                 20170101
G9737      admission and discharge due to blindness, illiteracy, severe mental incapacity
G9737      or language incompatibility and an adequate proxy is not available
G9739      Patient unable to complete the foto general orthopedic intake prom at admission         20170101
G9739      and discharge due to blindness, illiteracy, severe mental incapacity or
G9739      language incompatibility and an adequate proxy is not available
G9743      Psychiatric symptoms not assessed, reason not otherwise specified                       20170101
G9744      Patient not eligible due to active diagnosis of hypertension                            20170101
G9745      Documented reason for not screening or recommending a follow-up for high blood          20170101
G9745      pressure
G9746      Patient has mitral stenosis or prosthetic heart valves or patient has transient         20170101
G9746      or reversible cause of af (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac
G9746      surgery)
G9753      Documentation of medical reason for not conducting a search for dicom format            20170101
G9753      images for prior patient ct imaging studies completed at non-affiliated
G9753      external healthcare facilities or entities within the past 12 months that are
G9753      available through a secure, authorized, media-free, shared archive (e.g.,
G9753      trauma, acute myocardial infarction, stroke, aortic aneurysm where time is of
G9753      the essence)
G9763      Patient did not have at least three hpv vaccines on or between the patient's            20170101
G9763      9th and 13th birthdays
G9765      Documentation that the patient declined therapy change, has documented                  20170101
G9765      contraindications, or has not been treated with an oral systemic or biologic
G9765      for at least six consecutive months (e.g., experienced adverse effects or lack
G9765      of efficacy with all other therapy options) in order to achieve better disease
G9765      control as measured by pga, bsa, pasi, or dlqi
G9766      Patients who are transferred from one institution to another with a known               20170101
G9766      diagnosis of cva for endovascular stroke treatment
G9767      Hospitalized patients with newly diagnosed cva considered for endovascular              20170101
G9767      stroke treatment
G9772      Documentation of one of the following medical reason(s) for not achieving at            20170101
G9772      least 1 body temperature measurement equal to or greater than 35.5 degrees
G9772      celsius (or 95.9 degrees fahrenheit) achieved within the 30 minutes immediately
G9772      before or the 15 minutes immediately after anesthesia end time (e.g., emergency
G9772      cases, intentional hypothermia, etc.)
G9773      At least 1 body temperature measurement equal to or greater than 35.5 degrees           20170101
G9773      celsius (or 95.9 degrees fahrenheit) not achieved within the 30 minutes
G9773      immediately before or the 15 minutes immediately after anesthesia end time
G9776      Documentation of medical reason for not receiving at least 2 prophylactic               20170101
G9776      pharmacologic anti-emetic agents of different classes preoperatively and/or
G9776      intraoperatively  (e.g., intolerance or other medical reason)
G9777      Patient did not receive at least 2 prophylactic pharmacologic anti-emetic               20170101
G9777      agents of different classes preoperatively and/or intraoperatively
G9778      Patients who have a diagnosis of pregnancy                                              20170101
G9780      Patients who have a diagnosis of rhabdomyolysis                                         20170101
G9781      Documentation of medical reason(s) for not currently being a statin therapy             20170101
G9781      user or receive an order (prescription) for statin therapy (e.g., patient with
G9781      adverse effect, allergy or intolerance to statin medication therapy, patients
G9781      who are receiving palliative care, patients with active liver disease or
G9781      hepatic disease or insufficiency, and patients with end stage renal disease
G9781      (esrd))
G9782      History of or active diagnosis of familial or pure hypercholesterolemia                 20170101
G9783      Documentation of patients with diabetes who have a most recent fasting or               20170101
G9783      direct ldl- c laboratory test result < 70 mg/dl and are not taking statin
G9783      therapy
G9785      Pathology report diagnosing cutaneous basal cell carcinoma or squamous cell             20170101
G9785      carcinoma (to include in situ disease) sent from the
G9785      pathologist/dermatopathologist to the biopsying clinician for review within 7
G9785      business days from the time when the tissue specimen was received by the
G9785      pathologist
G9786      Pathology report diagnosing cutaneous basal cell carcinoma or squamous cell             20170101
G9786      carcinoma (to include in situ disease) was not sent from the
G9786      pathologist/dermatopathologist to the biopsying clinician for review within 7
G9786      business days from the time when the tissue specimen was received by the
G9786      pathologist
G9790      Most recent bp is greater than 140/90 mm hg, or blood pressure not documented           20170101
G9792      Most recent tobacco status is not tobacco free                                          20170101
G9794      Documentation of medical reason(s) for not on a daily aspirin or other                  20170101
G9794      antiplatelet (e.g. history of gastrointestinal bleed or intra-cranial bleed or
G9794      documentation of active anticoagulant use during the measurement period
G9795      Patient is not currently on a daily aspirin or other antiplatelet                       20170101
G9797      Patient is not on a statin therapy                                                      20170101
G9801      Hospitalizations in which the patient was transferred directly to a non-acute           20170101
G9801      care facility for any diagnosis`
G9804      Patient was not prescribed a 180-day course of treatment with beta-blockers             20170101
G9804      post discharge for ami
G9807      Patients who did not receive cervical cytology or an hpv test                           20170101
G9811      Patient did not achieve a pdc of at least 75% for their asthma controller               20170101
G9811      medication
G9813      Patient did not die within 30 days of the procedure or during the index                 20170101
G9813      hospitalization
G9815      Death did not occur during hospitalization                                              20170101
G9817      Death did not occur 30 days post procedure                                              20170101
G9824      Endometrial sampling or hysteroscopy with biopsy and results not documented             20170101
G9827      Her2-targeted therapies not administered during the initial course of treatment         20170101
G9831      Ajcc stage at breast cancer diagnosis = ii or iii                                       20170101
G9832      Ajcc stage at breast cancer diagnosis = i (ia or ib) and t-stage at breast              20170101
G9832      cancer diagnosis does not equal = t1, t1a, t1b
G9834      Patient has metastatic disease at diagnosis                                             20170101
G9835      Trastuzumab administered within 12 months of diagnosis                                  20170101
G9836      Reason for not administering trastuzumab documented (e.g. patient declined,             20170101
G9836      patient died, patient transferred, contraindication or other clinical
G9836      exclusion, neoadjuvant chemotherapy or radiation not complete)
G9837      Trastuzumab not administered within 12 months of diagnosis                              20170101
G9838      Patient has metastatic disease at diagnosis                                             20170101
G9839      Anti-egfr monoclonal antibody therapy                                                   20170101
G9841      Kras gene mutation testing not performed before initiation of anti-egfr moab            20170101
G9842      Patient has metastatic disease at diagnosis                                             20170101
G9844      Patient did not receive anti-egfr monoclonal antibody therapy                           20170101
G9845      Patient received anti-egfr monoclonal antibody therapy                                  20170101
G9848      Patient did not receive chemotherapy in the last 14 days of life                        20170101
G9854      Patient was not admitted to the icu in the last 30 days of life                         20170101
G9856      Patient was not admitted to hospice                                                     20170101
G9862      Documentation of medical reason(s) for not recommending at least a 10 year              20170101
G9862      follow-up interval (e.g., inadequate prep, familial or personal history of
G9862      colonic polyps, patient had no adenoma and age is = 66 years old, or life
G9862      expectancy < 10 years old, other medical reasons)
H0021      Alcohol and/or drug training service (for staff and personnel not employed by           20010101
H0021      providers)
H0028      Alcohol and/or drug prevention problem identification and referral service              20010101
H0028      (e.g., student assistance and employee assistance programs), does not include
H0028      assessment
H0045      Respite care services, not in the home, per diem                                        20030101
H0046      Mental health services, not otherwise specified                                         20030101
H0047      Alcohol and/or other drug abuse services, not otherwise specified                       20030101
J0129      Injection, abatacept, 10 mg (code may be used for medicare when drug                    20070101
J0129      administered under the direct supervision of a physician, not for use when drug
J0129      is self administered)
J0150      Injection, adenosine for therapeutic use,  6 mg (not to be used to report any           19940101            20141231
J0150      adenosine phosphate compounds, instead use a9270)
J0151      Injection, adenosine for diagnostic use, 1 mg (not to be used to report any             20140101            20141231
J0151      adenosine phosphate compounds, instead use a9270)
J0152      Injection, adenosine for diagnostic use, 30 mg (not to be used to report any            20040101            20131231
J0152      adenosine phosphate compounds; instead use a9270)
J0153      Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate            20150101
J0153      compounds)
J0220      Injection, alglucosidase alfa, 10 mg, not otherwise specified                           20080101
J0256      Injection, alpha 1 proteinase inhibitor (human), not otherwise specified, 10 mg         19890101
J0270      Injection, alprostadil, 1.25 mcg (code may be used for medicare when drug               19970101
J0270      administered under the direct supervision of a physician, not for use when drug
J0270      is self administered)
J0275      Alprostadil urethral suppository (code may be used for medicare when drug               19990101
J0275      administered under the direct supervision of a physician, not for use when drug
J0275      is self administered)
J0717      Injection, certolizumab pegol, 1 mg (code may be used for medicare when drug            20140101
J0717      administered under the direct supervision of a physician, not for use when drug
J0717      is self administered)
J0833      Injection, cosyntropin, not otherwise specified, 0.25 mg                                20100101
J0897      Injection, denosumab, 1 mg                                                              20120101
J1438      Injection, etanercept, 25 mg (code may be used for medicare when drug                   20000101
J1438      administered under the direct supervision of a physician, not for use when drug
J1438      is self administered)
J1566      Injection, immune globulin, intravenous, lyophilized (e.g., powder), not                20060101
J1566      otherwise specified, 500 mg
J1599      Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not            20110101
J1599      otherwise specified, 500 mg
J1830      Injection, interferon beta-1b, 0.25 mg (code may be used for medicare when drug         19820101
J1830      administered under the direct supervision of a physician, not for use when drug
J1830      is self administered)
J2265      Injection, minocycline hydrochloride, 1 mg                                              20120101
J2278      Injection, ziconotide, 1 microgram                                                      20060101
J2469      Injection, palonosetron hcl, 25 mcg                                                     20050101
J2785      Injection, regadenoson, 0.1 mg                                                          20090101
J3030      Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug         19860101
J3030      administered under the direct supervision of a physician, not for use when drug
J3030      is self administered)
J3301      Injection, triamcinolone acetonide, not otherwise specified, 10 mg                      19910101
J3420      Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg                                  19860101
J3490      Unclassified drugs                                                                      19860101
J3590      Unclassified biologics                                                                  20030101
J7192      Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise                19940101
J7192      specified
J7195      Injection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise         20020101
J7195      specified
J7199      Hemophilia clotting factor, not otherwise classified                                    20000101
J7599      Immunosuppressive drug, not otherwise classified                                        19960101
J7699      Noc drugs, inhalation solution administered through dme                                 19930101
J7799      Noc drugs, other than inhalation drugs, administered through dme                        19930101
J7999      Compounded drug, not otherwise classified                                               20160101
J8498      Antiemetic drug, rectal/suppository, not otherwise specified                            20060101
J8499      Prescription drug, oral, non chemotherapeutic, nos                                      19950101
J8597      Antiemetic drug, oral, not otherwise specified                                          20060101
J8655      Netupitant 300 mg and palonosetron 0.5 mg                                               20160101
J8999      Prescription drug, oral, chemotherapeutic, nos                                          19950101
J9020      Injection, asparaginase, not otherwise specified, 10,000 units                          19840101
J9032      Injection, belinostat, 10 mg                                                            20160101
J9205      Injection, irinotecan liposome, 1 mg                                                    20170101
J9206      Injection, irinotecan, 20 mg                                                            19980101
J9999      Not otherwise classified, antineoplastic drugs                                          19860101
K0108      Wheelchair component or accessory, not otherwise specified                              19940101
K0669      Wheelchair accessory, wheelchair seat or back cushion, does not meet specific           20040701
K0669      code criteria or no written coding verification from dme pdac
K0812      Power operated vehicle, not otherwise classified                                        20061001
K0898      Power wheelchair, not otherwise classified                                              20061001
K0899      Power mobility device, not coded by dme pdac or does not meet criteria                  20061001
L0460      Tlso, triplanar control, modular segmented spinal system, two rigid plastic             20030101
L0460      shells, posterior extends from the sacrococcygeal junction and terminates just
L0460      inferior to the scapular spine, anterior extends from the symphysis pubis to
L0460      the sternal notch, soft liner, restricts gross trunk motion in the sagittal,
L0460      coronal, and transverse planes, lateral strength is provided by overlapping
L0460      plastic and stabilizing closures, includes straps and closures, prefabricated
L0460      item that has been trimmed, bent, molded, assembled, or otherwise customized to
L0460      fit a specific patient by an individual with expertise
L0462      Tlso, triplanar control, modular segmented spinal system, three rigid plastic           20030101
L0462      shells, posterior extends from the sacrococcygeal junction and terminates just
L0462      inferior to the scapular spine, anterior extends from the symphysis pubis to
L0462      the sternal notch, soft liner, restricts gross trunk motion in the sagittal,
L0462      coronal, and transverse planes, lateral strength is provided by overlapping
L0462      plastic and stabilizing closures, includes straps and closures, prefabricated,
L0462      includes fitting and adjustment
L0464      Tlso, triplanar control, modular segmented spinal system, four rigid plastic            20030101
L0464      shells, posterior extends from sacrococcygeal junction and terminates just
L0464      inferior to scapular spine, anterior extends from symphysis pubis to the
L0464      sternal notch, soft liner, restricts gross trunk motion in sagittal, coronal,
L0464      and transverse planes, lateral strength is provided by overlapping plastic and
L0464      stabilizing closures, includes straps and closures, prefabricated, includes
L0464      fitting and adjustment
L0472      Tlso, triplanar control, hyperextension, rigid anterior and lateral frame               20030101
L0472      extends from symphysis pubis to sternal notch with two anterior components (one
L0472      pubic and one sternal), posterior and lateral pads with straps and closures,
L0472      limits spinal flexion, restricts gross trunk motion in sagittal, coronal, and
L0472      transverse planes, includes fitting and shaping the frame, prefabricated,
L0472      includes fitting and adjustment
L0480      Tlso, triplanar control, one piece rigid plastic shell without interface liner,         20030101
L0480      with multiple straps and closures, posterior extends from sacrococcygeal
L0480      junction and terminates just inferior to scapular spine, anterior extends from
L0480      symphysis pubis to sternal notch, anterior or posterior opening, restricts
L0480      gross trunk motion in sagittal, coronal, and transverse planes, includes a
L0480      carved plaster or cad-cam model, custom fabricated
L0482      Tlso, triplanar control, one piece rigid plastic shell with interface liner,            20030101
L0482      multiple straps and closures, posterior extends from sacrococcygeal junction
L0482      and terminates just inferior to scapular spine, anterior extends from symphysis
L0482      pubis to sternal notch, anterior or posterior opening, restricts gross trunk
L0482      motion in sagittal, coronal, and transverse planes, includes a carved plaster
L0482      or cad-cam model, custom fabricated
L0484      Tlso, triplanar control, two piece rigid plastic shell without interface liner,         20030101
L0484      with multiple straps and closures, posterior extends from sacrococcygeal
L0484      junction and terminates just inferior to scapular spine, anterior extends from
L0484      symphysis pubis to sternal notch, lateral strength is enhanced by overlapping
L0484      plastic, restricts gross trunk motion in the sagittal, coronal, and transverse
L0484      planes, includes a carved plaster or cad-cam model, custom fabricated
L0486      Tlso, triplanar control, two piece rigid plastic shell with interface liner,            20030101
L0486      multiple straps and closures, posterior extends from sacrococcygeal junction
L0486      and terminates just inferior to scapular spine, anterior extends from symphysis
L0486      pubis to sternal notch, lateral strength is enhanced by overlapping plastic,
L0486      restricts gross trunk motion in the sagittal, coronal, and transverse planes,
L0486      includes a carved plaster or cad-cam model, custom fabricated
L0488      Tlso, triplanar control, one piece rigid plastic shell with interface liner,            20030101
L0488      multiple straps and closures, posterior extends from sacrococcygeal junction
L0488      and terminates just inferior to scapular spine, anterior extends from symphysis
L0488      pubis to sternal notch, anterior or posterior opening, restricts gross trunk
L0488      motion in sagittal, coronal, and transverse planes, prefabricated, includes
L0488      fitting and adjustment
L0999      Addition to spinal orthosis, not otherwise specified                                    19980101
L1499      Spinal orthosis, not otherwise specified                                                19820101
L2999      Lower extremity orthoses, not otherwise specified                                       19820101
L3600      Transfer of an orthosis from one shoe to another, caliper plate, existing               19860101
L3610      Transfer of an orthosis from one shoe to another, caliper plate, new                    19860101
L3620      Transfer of an orthosis from one shoe to another, solid stirrup, existing               19860101
L3630      Transfer of an orthosis from one shoe to another, solid stirrup, new                    19860101
L3640      Transfer of an orthosis from one shoe to another, dennis browne splint                  19860101
L3640      (riveton), both shoes
L3649      Orthopedic shoe, modification, addition or transfer, not otherwise specified            19820101
L3999      Upper limb orthosis, not otherwise specified                                            19820101
L5679      Addition to lower extremity, below knee/above knee, custom fabricated from              20040101
L5679      existing mold or prefabricated, socket insert, silicone gel, elastomeric or
L5679      equal, not for use with locking mechanism
L5999      Lower extremity prosthesis, not otherwise specified                                     19820101
L6695      Addition to upper extremity prosthesis, below elbow/above elbow, custom                 20050101
L6695      fabricated from existing mold or prefabricated, socket insert, silicone gel,
L6695      elastomeric or equal, not for use with locking mechanism
L7499      Upper extremity prosthesis, not otherwise specified                                     19850101
L8039      Breast prosthesis, not otherwise specified                                              19980101
L8048      Unspecified maxillofacial prosthesis, by report, provided by a non-physician            20010101
L8499      Unlisted procedure for miscellaneous prosthetic services                                19820101
L8699      Prosthetic implant, not otherwise specified                                             19980101
L9900      Orthotic and prosthetic supply, accessory, and/or service component of another          20000101
L9900      hcpcs "l" code
Q0161      Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription                     20140101
Q0161      anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic
Q0161      at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0162      Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a             20120101
Q0162      complete therapeutic substitute for an iv anti-emetic at the time of
Q0162      chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0163      Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription                   19980401
Q0163      anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic
Q0163      at time of chemotherapy treatment not to exceed a 48 hour dosage regimen
Q0164      Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic,            19980401
Q0164      for use as a complete therapeutic substitute for an iv anti-emetic at the time
Q0164      of chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0165      Prochlorperazine maleate, 10  mg, oral, fda approved prescription anti-emetic,          19980401            20131231
Q0165      for use as a complete therapeutic substitute for an iv anti-emetic at the time
Q0165      of chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0166      Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic,           19980401
Q0166      for use as a complete therapeutic substitute for an iv anti-emetic at the time
Q0166      of chemotherapy treatment, not to exceed a 24 hour dosage regimen
Q0167      Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a           19980401
Q0167      complete therapeutic substitute for an iv anti-emetic at the time of
Q0167      chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0168      Dronabinol, 5 mg, oral, fda approved prescription anti-emetic, for use as a             19980401            20131231
Q0168      complete therapeutic substitute for an iv anti-emetic at the time of
Q0168      chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0169      Promethazine hydrochloride, 12.5 mg, oral, fda approved prescription                    19980401
Q0169      anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic
Q0169      at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0170      Promethazine hydrochloride, 25  mg, oral, fda approved prescription                     19980401            20131231
Q0170      anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic
Q0170      at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0171      Chlorpromazine hydrochloride, 10  mg, oral, fda approved prescription                   19980401            20131231
Q0171      anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic
Q0171      at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0172      Chlorpromazine hydrochloride, 25 mg, oral, fda approved prescription                    19980401            20131231
Q0172      anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic
Q0172      at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0173      Trimethobenzamide hydrochloride, 250 mg, oral, fda approved prescription                19980401
Q0173      anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic
Q0173      at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0174      Thiethylperazine maleate, 10 mg, oral, fda approved prescription anti-emetic,           19980401
Q0174      for use as a complete therapeutic substitute for an iv anti-emetic at the time
Q0174      of chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0175      Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a           19980401
Q0175      complete therapeutic substitute for an iv anti-emetic at the time of
Q0175      chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0176      Perphenazine, 8mg, oral, fda approved prescription anti-emetic, for use as a            19980401            20131231
Q0176      complete therapeutic substitute for an iv anti-emetic at the time of
Q0176      chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0177      Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for            19980401
Q0177      use as a complete therapeutic substitute for an iv anti-emetic at the time of
Q0177      chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0178      Hydroxyzine pamoate, 50 mg, oral, fda approved prescription anti-emetic, for            19980401            20131231
Q0178      use as a complete therapeutic substitute for an iv anti-emetic at the time of
Q0178      chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0180      Dolasetron mesylate, 100 mg, oral, fda approved prescription anti-emetic, for           19980401
Q0180      use as a complete therapeutic substitute for an iv anti-emetic at the time of
Q0180      chemotherapy treatment, not to exceed a 24 hour dosage regimen
Q0181      Unspecified oral dosage form, fda approved prescription anti-emetic, for use as         19980401
Q0181      a complete therapeutic substitute for a iv anti-emetic at the time of
Q0181      chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0505      Miscellaneous supply or accessory for use with ventricular assist device                20051001            20130331
Q0507      Miscellaneous supply or accessory for use with an external ventricular assist           20130401
Q0507      device
Q0508      Miscellaneous supply or accessory for use with an implanted ventricular assist          20130401
Q0508      device
Q0509      Miscellaneous supply or accessory for use with any implanted ventricular assist         20130401
Q0509      device for which payment was not made under medicare part a
Q0510      Pharmacy supply fee for initial immunosuppressive drug(s), first month                  20060101
Q0510      following transplant
Q0511      Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive         20060101
Q0511      drug(s); for the first prescription in a 30-day period
Q0512      Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive         20060101
Q0512      drug(s); for a subsequent prescription in a 30-day period
Q1004      New technology intraocular lens category 4 as defined in federal register notice        19990701
Q1005      New technology intraocular lens category 5 as defined in federal register notice        19990701
Q2039      Influenza virus vaccine, not otherwise specified                                        20110101
Q2050      Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg         20130701
Q2051      Injection, zoledronic acid, not otherwise specified, 1mg                                20130701            20131231
Q4050      Cast supplies, for unlisted types and materials of casts                                20010701
Q4051      Splint supplies, miscellaneous (includes thermoplastics, strapping, fasteners,          20010701
Q4051      padding and other supplies)
Q4082      Drug or biological, not otherwise classified, part b drug competitive                   20070101
Q4082      acquisition program (cap)
Q4100      Skin substitute, not otherwise specified                                                20090101
Q5009      Hospice or home health care provided in place not otherwise specified (nos)             20070101
Q9977      Compounded drug, not otherwise classified                                               20150701            20151231
Q9978      Netupitant 300 mg and palonosetron 0.5 mg                                               20150701            20151231
Q9982      Flutemetamol f18, diagnostic, per study dose, up to 5 millicuries                       20160701
Q9983      Florbetaben f18, diagnostic, per study dose, up to 8.1 millicuries                      20160701
S0017      Injection, aminocaproic acid, 5 grams                                                   20000101
S0122      Injection, menotropins, 75 iu                                                           20020401
S0137      Didanosine (ddi), 25 mg                                                                 20030401
S0195      Pneumococcal conjugate vaccine, polyvalent, intramuscular, for children from            20030101            20151231
S0195      five years to nine years of age who have not previously received the vaccine
S0285      Colonoscopy consultation performed prior to a screening colonoscopy procedure           20160701
S0302      Completed early periodic screening diagnosis and treatment (epsdt) service              20020101
S0302      (list in addition to code for appropriate evaluation and management service)
S0590      Integral lens service, miscellaneous services reported separately                       20010701
S1016      Non-pvc (polyvinyl chloride) intravenous administration set, for use with drugs         20010101
S1016      that are not stable in pvc e.g., paclitaxel
S2107      Adoptive immunotherapy i.e. development of specific anti-tumor reactivity               20020401
S2107      (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment
S2150      Bone marrow or blood-derived stem cells (peripheral or umbilical), allogeneic           20020101
S2150      or autologous, harvesting, transplantation, and related complications;
S2150      including: pheresis and cell preparation/storage; marrow ablative therapy;
S2150      drugs, supplies, hospitalization with outpatient follow-up; medical/surgical,
S2150      diagnostic, emergency, and rehabilitative services; and the number of days of
S2150      pre-and post-transplant care in the global definition
S2152      Solid organ(s), complete or segmental, single organ or combination of organs;           20040401
S2152      deceased or living donor(s), procurement, transplantation, and related
S2152      complications; including: drugs; supplies; hospitalization with outpatient
S2152      follow-up; medical/surgical, diagnostic, emergency, and rehabilitative
S2152      services, and the number of days of pre- and post-transplant care in the global
S2152      definition
S2205      Minimally invasive direct coronary artery bypass surgery involving                      20000101
S2205      mini-thoracotomy or mini-sternotomy surgery, performed under direct vision;
S2205      using arterial graft(s), single coronary arterial graft
S2206      Minimally invasive direct coronary artery bypass surgery involving                      20000101
S2206      mini-thoracotomy or mini-sternotomy surgery, performed under direct vision;
S2206      using arterial graft(s), two coronary arterial grafts
S2207      Minimally invasive direct coronary artery bypass surgery involving                      20000101
S2207      mini-thoracotomy or mini-sternotomy surgery, performed under direct vision;
S2207      using venous graft only, single coronary venous graft
S2208      Minimally invasive direct coronary artery bypass surgery involving                      20000101
S2208      mini-thoracotomy or mini-sternotomy surgery, performed under direct vision;
S2208      using single arterial and venous graft(s), single venous graft
S2209      Minimally invasive direct coronary artery bypass surgery involving                      20000101
S2209      mini-thoracotomy or mini-sternotomy surgery, performed under direct vision;
S2209      using two arterial grafts and single venous graft
S2409      Repair, congenital malformation of fetus, procedure performed in utero, not             20020101
S2409      otherwise classified
S3620      Newborn metabolic screening panel, includes test kit, postage and the                   20010101
S3620      laboratory tests specified by the state for inclusion in this panel (e.g.,
S3620      galactose; hemoglobin, electrophoresis;  hydroxyprogesterone, 17-d;
S3620      phenylalanine (pku); and thyroxine, total)
S4005      Interim labor facility global (labor occurring but not resulting in delivery)           20020401
S4011      In vitro fertilization; including but not limited to identification and                 20020101
S4011      incubation of mature oocytes, fertilization with sperm, incubation of
S4011      embryo(s), and subsequent visualization for determination of development
S4015      Complete in vitro fertilization cycle, not otherwise specified, case rate               20020101
S4042      Management of ovulation induction (interpretation of diagnostic tests and               20050101
S4042      studies, non-face-to-face medical management of the patient), per cycle
S5105      Day care services, center-based; services not included in program fee, per diem         20030101
S5130      Homemaker service, nos; per 15 minutes                                                  20030101
S5131      Homemaker service, nos; per diem                                                        20030101
S5150      Unskilled respite care, not hospice; per 15 minutes                                     20030101
S5151      Unskilled respite care, not hospice; per diem                                           20030101
S5181      Home health respiratory therapy, nos, per diem                                          20030101
S5199      Personal care item, nos, each                                                           20030101
S5497      Home infusion therapy, catheter care / maintenance, not otherwise classified;           20020101
S5497      includes administrative services, professional pharmacy services, care
S5497      coordination, and all necessary supplies and equipment (drugs and nursing
S5497      visits coded separately), per diem
S5502      Home infusion therapy, catheter care / maintenance, implanted access device,            20020101
S5502      includes administrative services, professional pharmacy services, care
S5502      coordination and all necessary supplies and equipment, (drugs and nursing
S5502      visits coded separately), per diem (use this code for interim maintenance of
S5502      vascular access not currently in use)
S8055      Ultrasound guidance for multifetal pregnancy reduction(s), technical component          20020101
S8055      (only to be used when the physician doing the reduction procedure does not
S8055      perform the ultrasound, guidance is included in the cpt code for multifetal
S8055      pregnancy reduction - 59866)
S8080      Scintimammography (radioimmunoscintigraphy of the breast), unilateral,                  20010101
S8080      including supply of radiopharmaceutical
S8097      Asthma kit (including but not limited to portable peak expiratory flow meter,           20020101
S8097      instructional video, brochure, and/or spacer)
S8189      Tracheostomy supply, not otherwise classified                                           20020101
S8301      Infection control supplies, not otherwise specified                                     20040701
S9123      Nursing care, in the home; by registered nurse, per hour (use for general               20000101
S9123      nursing care only, not to be used when cpt codes 99500-99602 can be used)
S9145      Insulin pump initiation, instruction in initial use of pump (pump not included)         20020401
S9208      Home management of preterm labor, including administrative services,                    20020101
S9208      professional pharmacy services, care coordination, and all necessary supplies
S9208      or equipment (drugs and nursing visits coded separately), per diem (do not use
S9208      this code with any home infusion per diem code)
S9209      Home management of preterm premature rupture of membranes (pprom), including            20020101
S9209      administrative services, professional pharmacy services, care coordination, and
S9209      all necessary supplies or equipment (drugs and nursing visits coded
S9209      separately), per diem (do not use this code with any home infusion per diem
S9209      code)
S9211      Home management of gestational hypertension, includes administrative services,          20020101
S9211      professional pharmacy services, care coordination and all necessary supplies
S9211      and equipment (drugs and nursing visits coded separately); per diem (do not use
S9211      this code with any home infusion per diem code)
S9212      Home management of postpartum hypertension, includes administrative services,           20020101
S9212      professional pharmacy services, care coordination, and all necessary supplies
S9212      and equipment (drugs and nursing visits coded separately), per diem (do not use
S9212      this code with any home infusion per diem code)
S9213      Home management of preeclampsia, includes administrative services, professional         20020101
S9213      pharmacy services, care coordination, and all necessary supplies and equipment
S9213      (drugs and nursing services coded separately); per diem (do not use this code
S9213      with any home infusion per diem code)
S9214      Home management of gestational diabetes, includes administrative services,              20020101
S9214      professional pharmacy services, care coordination, and all necessary supplies
S9214      and equipment (drugs and nursing visits coded separately); per diem (do not use
S9214      this code with any home infusion per diem code)
S9325      Home infusion therapy, pain management infusion; administrative services,               20020101
S9325      professional pharmacy services, care coordination, and all necessary supplies
S9325      and equipment, (drugs and nursing visits coded separately), per diem (do not
S9325      use this code with s9326, s9327 or s9328)
S9329      Home infusion therapy, chemotherapy infusion; administrative services,                  20020101
S9329      professional pharmacy services, care coordination, and all necessary supplies
S9329      and equipment (drugs and nursing visits coded separately), per diem (do not use
S9329      this code with s9330 or s9331)
S9338      Home infusion therapy, immunotherapy, administrative services, professional             20020101
S9338      pharmacy services, care coordination, and all necessary supplies and equipment
S9338      (drugs and nursing visits coded separately), per diem
S9348      Home infusion therapy, sympathomimetic/inotropic agent infusion therapy (e.g.,          20020101
S9348      dobutamine); administrative services, professional pharmacy services, care
S9348      coordination, all necessary supplies and equipment (drugs and nursing visits
S9348      coded separately), per diem
S9364      Home infusion therapy, total parenteral nutrition (tpn); administrative                 20020101
S9364      services, professional pharmacy services, care coordination, and all necessary
S9364      supplies and equipment including standard tpn formula (lipids, specialty amino
S9364      acid formulas, drugs other than in standard formula and nursing visits coded
S9364      separately), per diem (do not use with home infusion codes s9365-s9368 using
S9364      daily volume scales)
S9372      Home therapy; intermittent anticoagulant injection therapy (e.g., heparin);             20020101
S9372      administrative services, professional pharmacy services, care coordination, and
S9372      all necessary supplies and equipment (drugs and nursing visits coded
S9372      separately), per diem (do not use this code for flushing of infusion devices
S9372      with heparin to maintain patency)
S9373      Home infusion therapy, hydration therapy; administrative services, professional         20020101
S9373      pharmacy services, care coordination, and all necessary supplies and equipment
S9373      (drugs and nursing visits coded separately), per diem (do not use with
S9373      hydration therapy codes s9374-s9377 using daily volume scales)
S9379      Home infusion therapy, infusion therapy, not otherwise classified;                      20020101
S9379      administrative services, professional pharmacy services, care coordination, and
S9379      all necessary supplies and equipment (drugs and nursing visits coded
S9379      separately), per diem
S9445      Patient education, not otherwise classified, non-physician provider,                    20020101
S9445      individual, per session
S9446      Patient education, not otherwise classified, non-physician provider, group, per         20020101
S9446      session
S9494      Home infusion therapy, antibiotic, antiviral, or antifungal therapy;                    20020101
S9494      administrative services, professional pharmacy services, care coordination, and
S9494      all necessary supplies and equipment (drugs and nursing visits coded
S9494      separately), per diem (do not use this code with home infusion codes for hourly
S9494      dosing schedules s9497-s9504)
S9542      Home injectable therapy, not otherwise classified, including administrative             20020101
S9542      services, professional pharmacy services, care coordination, and all necessary
S9542      supplies and equipment (drugs and nursing visits coded separately), per diem
S9810      Home therapy; professional pharmacy services for provision of infusion,                 20020101
S9810      specialty drug administration, and/or disease state management, not otherwise
S9810      classified, per hour (do not use this code with any per diem code)
S9976      Lodging, per diem, not otherwise classified                                             20040401
S9977      Meals, per diem, not otherwise specified                                                20040401
S9986      Not medically necessary service (patient is aware that service not medically            20020101
S9986      necessary)
T1010      Meals for individuals receiving alcohol and/or substance abuse services (when           20010701
T1010      meals not included in the program)
T1019      Personal care services, per 15 minutes, not for an inpatient or resident of a           20020701
T1019      hospital, nursing facility, icf/mr or imd, part of the individualized plan of
T1019      treatment (code may not be used to identify services provided by home health
T1019      aide or certified nurse assistant)
T1020      Personal care services, per diem, not for an inpatient or resident of a                 20020701
T1020      hospital, nursing facility, icf/mr or imd, part of the individualized plan of
T1020      treatment (code may not be used to identify services provided by home health
T1020      aide or certified nurse assistant)
T1023      Screening to determine the appropriateness of consideration of an individual            20030101
T1023      for participation in a specified program, project or treatment protocol, per
T1023      encounter
T1029      Comprehensive environmental lead investigation, not including laboratory                20030101
T1029      analysis, per dwelling
T1505      Electronic medication compliance management device, includes all components and         20110101
T1505      accessories, not otherwise classified
T1999      Miscellaneous therapeutic items and supplies, retail purchases, not otherwise           20030101
T1999      classified; identify product in "remarks"
T2025      Waiver services; not otherwise specified (nos)                                          20031001
T2028      Specialized supply, not otherwise specified, waiver                                     20031001
T2029      Specialized medical equipment, not otherwise specified, waiver                          20031001
T2032      Residential care, not otherwise specified (nos), waiver; per month                      20031001
T2033      Residential care, not otherwise specified (nos), waiver; per diem                       20031001
T5999      Supply, not otherwise specified                                                         20040101
V2199      Not otherwise classified, single vision lens                                            19850101
V2797      Vision supply, accessory and/or service component of another hcpcs vision code          20040101
V2799      Vision item or service, miscellaneous                                                   19850101
V5090      Dispensing fee, unspecified hearing aid                                                 19820101
V5264      Ear mold/insert, not disposable, any type                                               20020101
V5267      Hearing aid or assistive listening device/supplies/accessories, not otherwise           20020101
V5267      specified
V5274      Assistive listening device, not otherwise specified                                     20020101
V5287      Assistive listening device, personal fm/dm receiver, not otherwise specified            20130101
V5298      Hearing aid, not otherwise classified                                                   20030101
V5299      Hearing service, miscellaneous                                                          19820101
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