HCPCS 'G' Codes (1,941)
Procedures / Professional Services (Temporary Codes)
| Code | Description |
| G0008 | Administration of influenza virus vaccine |
| G0009 | Administration of pneumococcal vaccine |
| G0010 | Administration of hepatitis b vaccine |
| G0011 | Individual counseling for pre-exposure prophylaxis (prep) by physician or qualified health care professional (qhp )to prevent human immunodeficiency virus (hiv), includes hiv risk assessment (initial or continued assessment of risk), hiv risk reduction and medication adherence, 15-30 minutes |
| G0012 | Injection of pre-exposure prophylaxis (prep) drug for hiv prevention, under skin or into muscle |
| G0013 | Individual counseling for pre-exposure prophylaxis (prep) by clinical staff to prevent human immunodeficiency virus (hiv), includes: hiv risk assessment (initial or continued assessment of risk), hiv risk reduction and medication adherence |
| G0017 | Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); first 60 minutes |
| G0018 | Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); each additional 30 minutes (list separately in addition to code for primary service) |
| G0019 | Community health integration services performed by certified or trained auxiliary personnel, including a community health worker, under the direction of a physician or other practitioner; 60 minutes per calendar month, in the following activities to address social determinants of health (sdoh) need(s) that are significantly limiting the ability to diagnose or treat problem(s) addressed in an initiating visit: person-centered assessment, performed to better understand the individualized context of the intersection between the sdoh need(s) and the problem(s) addressed in the initiating visit. ++ conducting a person-centered assessment to understand patient's life story, strengths, needs, goals, preferences and desired outcomes, including understanding cultural and linguistic factors and including unmet sdoh needs (that are not separately billed). ++ facilitating patient-driven goal-setting and establishing an action plan. ++ providing tailored support to the patient as needed to accomplish the practitioner's treatment plan. practitioner, home-, and community-based care coordination. ++ coordinating receipt of needed services from healthcare practitioners, providers, and facilities; and from home- and community-based service providers, social service providers, and caregiver (if applicable). ++ communication with practitioners, home- and community-based service providers, hospitals, and skilled nursing facilities (or other health care facilities) regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors. ++ coordination of care transitions between and among health care practitioners and settings, including transitions involving referral to other clinicians; follow-up after an emergency department visit; or follow-up after discharges from hospitals, skilled nursing facilities or other health care facilities. ++ facilitating access to community-based social services (e.g., housing, utilities, transportation, food assistance) to address the sdoh need(s). health education- helping the patient contextualize health education provided by the patient's treatment team with the patient's individual needs, goals, and preferences, in the context of the sdoh need(s), and educating the patient on how to best participate in medical decision-making. building patient self-advocacy skills, so that the patient can interact with members of the health care team and related community-based services addressing the sdoh need(s), in ways that are more likely to promote personalized and effective diagnosis or treatment. health care access / health system navigation. ++ helping the patient access healthcare, including identifying appropriate practitioners or providers for clinical care and helping secure appointments with them. facilitating behavioral change as necessary for meeting diagnosis and treatment goals, including promoting patient motivation to participate in care and reach person-centered diagnosis or treatment goals. facilitating and providing social and emotional support to help the patient cope with the problem(s) addressed in the initiating visit, the sdoh need(s), and adjust daily routines to better meet diagnosis and treatment goals. leveraging lived experience when applicable to provide support, mentorship, or inspiration to meet treatment goals |
| G0022 | Community health integration services, each additional 30 minutes per calendar month (list separately in addition to g0019) |
| G0023 | Principal illness navigation services by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a patient navigator; 60 minutes per calendar month, in the following activities: person-centered assessment, performed to better understand the individual context of the serious, high-risk condition. ++ conducting a person-centered assessment to understand the patient's life story, strengths, needs, goals, preferences, and desired outcomes, including understanding cultural and linguistic factors and including unmet sdoh needs (that are not separately billed). ++ facilitating patient-driven goal setting and establishing an action plan. ++ providing tailored support as needed to accomplish the practitioner's treatment plan. identifying or referring patient (and caregiver or family, if applicable) to appropriate supportive services. practitioner, home, and community-based care coordination. ++ coordinating receipt of needed services from healthcare practitioners, providers, and facilities; home- and community-based service providers; and caregiver (if applicable). ++ communication with practitioners, home-, and community-based service providers, hospitals, and skilled nursing facilities (or other health care facilities) regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors. ++ coordination of care transitions between and among health care practitioners and settings, including transitions involving referral to other clinicians; follow-up after an emergency department visit; or follow-up after discharges from hospitals, skilled nursing facilities or other health care facilities. ++ facilitating access to community-based social services (e.g., housing, utilities, transportation, food assistance) as needed to address sdoh need(s). health education- helping the patient contextualize health education provided by the patient's treatment team with the patient's individual needs, goals, preferences, and sdoh need(s), and educating the patient (and caregiver if applicable) on how to best participate in medical decision-making. building patient self-advocacy skills, so that the patient can interact with members of the health care team and related community-based services (as needed), in ways that are more likely to promote personalized and effective treatment of their condition. health care access / health system navigation. ++ helping the patient access healthcare, including identifying appropriate practitioners or providers for clinical care, and helping secure appointments with them. ++ providing the patient with information/resources to consider participation in clinical trials or clinical research as applicable. facilitating behavioral change as necessary for meeting diagnosis and treatment goals, including promoting patient motivation to participate in care and reach person-centered diagnosis or treatment goals. facilitating and providing social and emotional support to help the patient cope with the condition, sdoh need(s), and adjust daily routines to better meet diagnosis and treatment goals. leverage knowledge of the serious, high-risk condition and/or lived experience when applicable to provide support, mentorship, or inspiration to meet treatment goals |
| G0024 | Principal illness navigation services, additional 30 minutes per calendar month (list separately in addition to g0023) |
| G0027 | Semen analysis; presence and/or motility of sperm excluding huhner |
| G0028 | Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason) Terminated: December 31, 2022 |
| G0029 | Tobacco screening not performed or tobacco cessation intervention not provided during the measurement period or in the six months prior to the measurement period |
| G0030 | Patient screened for tobacco use and received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling, pharmacotherapy, or both), if identified as a tobacco user |
| G0031 | Palliative care services given to patient any time during the measurement period |
| G0032 | Two or more antipsychotic prescriptions ordered for patients who had a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between january 1 of the year prior to the measurement period and the index prescription start date (ipsd) for antipsychotics |
| G0033 | Two or more benzodiazepine prescriptions ordered for patients who had a diagnosis of seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, or severe generalized anxiety disorder on or between january 1 of the year prior to the measurement period and the ipsd for benzodiazepines |
| G0034 | Patients receiving palliative care during the measurement period |
| G0035 | Patient has any emergency department encounter during the performance period with place of service indicator 23 |
| G0036 | Patient or care partner decline assessment |
| G0037 | On date of encounter, patient is not able to participate in assessment or screening, including non-verbal patients, delirious, severely aphasic, severely developmentally delayed, severe visual or hearing impairment and for those patients, no knowledgeable informant available |
| G0038 | Clinician determines patient does not require referral |
| G0039 | Patient not referred, reason not otherwise specified |
| G0040 | Patient already receiving physical/occupational/speech/recreational therapy during the measurement period |
| G0041 | Patient and/or care partner decline referral |
| G0042 | Referral to physical, occupational, speech, or recreational therapy |
| G0043 | Patients with mechanical prosthetic heart valve |
| G0044 | Patients with moderate or severe mitral stenosis |
| G0045 | Clinical follow-up and mrs score assessed at 90 days following endovascular stroke intervention |
| G0046 | Clinical follow-up and mrs score not assessed at 90 days following endovascular stroke intervention |
| G0047 | Pediatric patient with minor blunt head trauma and pecarn prediction criteria are not assessed |
| G0048 | Patients who receive palliative care services any time during the intake period through the end of the measurement year |
| G0049 | With maintenance hemodialysis (in-center and home hd) for the complete reporting month |
| G0050 | Patients with a catheter that have limited life expectancy |
| G0051 | Patients under hospice care in the current reporting month |
| G0052 | Patients on peritoneal dialysis for any portion of the reporting month |
| G0053 | Advancing rheumatology patient care mips value pathways |
| G0054 | Coordinating stroke care to promote prevention and cultivate positive outcomes mips value pathways |
| G0055 | Advancing care for heart disease mips value pathways |
| G0056 | Optimizing chronic disease management mips value pathways Terminated: December 31, 2023 |
| G0057 | Proposed adopting best practices and promoting patient safety within emergency medicine mips value pathways |
| G0058 | Improving care for lower extremity joint repair mips value pathways |
| G0059 | Patient safety and support of positive experiences with anesthesia mips value pathways |
| G0060 | Allergy/immunology mips specialty set |
| G0061 | Anesthesiology mips specialty set |
| G0062 | Audiology mips specialty set |
| G0063 | Cardiology mips specialty set |
| G0064 | Certified nurse midwife mips specialty set |
| G0065 | Chiropractic medicine mips specialty set |
| G0066 | Clinical social work mips specialty set |
| G0067 | Dentistry mips specialty set |
| G0068 | Professional services for the administration of anti-infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy or other highly complex drug or biological) for each infusion drug administration calendar day in the individual's home, each 15 minutes |
| G0069 | Professional services for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes |
| G0070 | Professional services for the administration of intravenous chemotherapy or other intravenous highly complex drug or biological infusion for each infusion drug administration calendar day in the individual's home, each 15 minutes |
| G0071 | Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only |
| G0076 | Brief (20 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) |
| G0077 | Limited (30 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) |
| G0078 | Moderate (45 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) |
| G0079 | Comprehensive (60 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) |
| G0080 | Extensive (75 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) |
| G0081 | Brief (20 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) |
| G0082 | Limited (30 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) |
| G0083 | Moderate (45 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) |
| G0084 | Comprehensive (60 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) |
| G0085 | Extensive (75 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) |
| G0086 | Limited (30 minutes) care management home care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) |
| G0087 | Comprehensive (60 minutes) care management home care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) |
| G0088 | Professional services, initial visit, for the administration of anti-infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy or other highly complex drug or biological) for each infusion drug administration calendar day in the individual's home, each 15 minutes |
| G0089 | Professional services, initial visit, for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes |
| G0090 | Professional services, initial visit, for the administration of intravenous chemotherapy or other highly complex infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes |
| G0101 | Cervical or vaginal cancer screening; pelvic and clinical breast examination |
| G0102 | Prostate cancer screening; digital rectal examination |
| G0103 | Prostate cancer screening; prostate specific antigen test (psa) |
| G0104 | Colorectal cancer screening; flexible sigmoidoscopy |
| G0105 | Colorectal cancer screening; colonoscopy on individual at high risk |
| G0106 | Colorectal cancer screening; alternative to g0104, screening sigmoidoscopy, barium enema |
| G0108 | Diabetes outpatient self-management training services, individual, per 30 minutes |
| G0109 | Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes |
| G0117 | Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist |
| G0118 | Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist |
| G0120 | Colorectal cancer screening; alternative to g0105, screening colonoscopy, barium enema. |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk |
| G0122 | Colorectal cancer screening; barium enema |
| G0123 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision |
| G0124 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician |
| G0127 | Trimming of dystrophic nails, any number |
| G0128 | Direct (face-to-face with patient) skilled nursing services of a registered nurse provided in a comprehensive outpatient rehabilitation facility, each 10 minutes beyond the first 5 minutes |
| G0129 | Occupational therapy services requiring the skills of a qualified occupational therapist, furnished as a component of a partial hospitalization or intensive outpatient treatment program, per session (45 minutes or more) |
| G0130 | Single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel) |
| G0136 | Administration of a standardized, evidence-based social determinants of health risk assessment tool, 5-15 minutes |
| G0137 | Intensive outpatient services; weekly bundle, minimum of 9 services over a 7 contiguous day period, which can include individual and group therapy with physicians or psychologists (or other mental health professionals to the extent authorized under state law); occupational therapy requiring the skills of a qualified occupational therapist; services of social workers, trained psychiatric nurses, and other staff trained to work with psychiatric patients; individualized activity therapies that are not primarily recreational or diversionary; family counseling (the primary purpose of which is treatment of the individual's condition); patient training and education (to the extent that training and educational activities are closely and clearly related to individual's care and treatment); diagnostic services; and such other items and services (excluding meals and transportation) that are reasonable and necessary for the diagnosis or active treatment of the individual's condition, reasonably expected to improve or maintain the individual's condition and functional level and to prevent relapse or hospitalization, and furnished pursuant to such guidelines relating to frequency and duration of services in accordance with a physician certification and plan of treatment (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure |
| G0138 | Intravenous infusion of cipaglucosidase alfa-atga, including provider/supplier acquisition and clinical supervision of oral administration of miglustat in preparation of receipt of cipaglucosidase alfa-atga |
| G0140 | Principal illness navigation - peer support by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a certified peer specialist; 60 minutes per calendar month, in the following activities: person-centered interview, performed to better understand the individual context of the serious, high-risk condition. ++ conducting a person-centered interview to understand the patient's life story, strengths, needs, goals, preferences, and desired outcomes, including understanding cultural and linguistic factors, and including unmet sdoh needs (that are not billed separately). ++ facilitating patient-driven goal setting and establishing an action plan. ++ providing tailored support as needed to accomplish the person-centered goals in the practitioner's treatment plan. identifying or referring patient (and caregiver or family, if applicable) to appropriate supportive services. practitioner, home, and community-based care communication. ++ assist the patient in communicating with their practitioners, home-, and community-based service providers, hospitals, and skilled nursing facilities (or other health care facilities) regarding the patient's psychosocial strengths and needs, goals, preferences, and desired outcomes, including cultural and linguistic factors. ++ facilitating access to community-based social services (e.g., housing, utilities, transportation, food assistance) as needed to address sdoh need(s). health education. helping the patient contextualize health education provided by the patient's treatment team with the patient's individual needs, goals, preferences, and sdoh need(s), and educating the patient (and caregiver if applicable) on how to best participate in medical decision-making. building patient self-advocacy skills, so that the patient can interact with members of the health care team and related community-based services (as needed), in ways that are more likely to promote personalized and effective treatment of their condition. developing and proposing strategies to help meet person-centered treatment goals and supporting the patient in using chosen strategies to reach person-centered treatment goals. facilitating and providing social and emotional support to help the patient cope with the condition, sdoh need(s), and adjust daily routines to better meet person-centered diagnosis and treatment goals. leverage knowledge of the serious, high-risk condition and/or lived experience when applicable to provide support, mentorship, or inspiration to meet treatment goals |
| G0141 | Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician |
| G0143 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under physician supervision |
| G0144 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervision |
| G0145 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision |
| G0146 | Principal illness navigation - peer support, additional 30 minutes per calendar month (list separately in addition to g0140) |
| G0147 | Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision |
| G0148 | Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening |
| G0151 | Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes |
| G0152 | Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes |
| G0153 | Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes |
| G0154 | Direct skilled nursing services of a licensed nurse (lpn or rn) in the home health or hospice setting, each 15 minutes Terminated: February 29, 2016 |
| G0155 | Services of clinical social worker in home health or hospice settings, each 15 minutes |
| G0156 | Services of home health/hospice aide in home health or hospice settings, each 15 minutes |
| G0157 | Services performed by a qualified physical therapist assistant in the home health or hospice setting, each 15 minutes |
| G0158 | Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes |
| G0159 | Services performed by a qualified physical therapist, in the home health setting, in the establishment or delivery of a safe and effective physical therapy maintenance program, each 15 minutes |
| G0160 | Services performed by a qualified occupational therapist, in the home health setting, in the establishment or delivery of a safe and effective occupational therapy maintenance program, each 15 minutes |
| G0161 | Services performed by a qualified speech-language pathologist, in the home health setting, in the establishment or delivery of a safe and effective speech-language pathology maintenance program, each 15 minutes |
| G0162 | Skilled services by a registered nurse (rn) for management and evaluation of the plan of care; each 15 minutes (the patient's underlying condition or complication requires an rn to ensure that essential non-skilled care achieves its purpose in the home health or hospice setting) |
| G0163 | Skilled services of a licensed nurse (lpn or rn) for the observation and assessment of the patient's condition, each 15 minutes (the change in the patient's condition requires skilled nursing personnel to identify and evaluate the patient's need for possible modification of treatment in the home health or hospice setting) Terminated: December 31, 2016 |
| G0164 | Skilled services of a licensed nurse (lpn or rn), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes Terminated: December 31, 2016 |
| G0166 | External counterpulsation, per treatment session |
| G0168 | Wound closure utilizing tissue adhesive(s) only |
| G0173 | Linear accelerator based stereotactic radiosurgery, complete course of therapy in one session Terminated: December 31, 2014 |
| G0175 | Scheduled interdisciplinary team conference (minimum of three exclusive of patient care nursing staff) with patient present |
| G0176 | Activity therapy, such as music, dance, art or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more) |
| G0177 | Training and educational services related to the care and treatment of patient's disabling mental health problems per session (45 minutes or more) |
| G0179 | Physician or allowed practitioner re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and allowed practitioners to affirm the initial implementation of the plan of care |
| G0180 | Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and allowed practitioners to affirm the initial implementation of the plan of care |
| G0181 | Physician or allowed practitioner supervision of a patient receiving medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician or allowed practitioner development and/or revision of care plans |
| G0182 | Physician supervision of a patient under a medicare-approved hospice (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of laboratory and other studies, communication (including telephone calls) with other health care professionals involved in the patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month, 30 minutes or more |
| G0186 | Destruction of localized lesion of choroid (for example, choroidal neovascularization); photocoagulation, feeder vessel technique (one or more sessions) |
| G0202 | Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (cad) when performed Terminated: December 31, 2017 |
| G0204 | Diagnostic mammography, including computer-aided detection (cad) when performed; bilateral Terminated: December 31, 2017 |
| G0206 | Diagnostic mammography, including computer-aided detection (cad) when performed; unilateral Terminated: December 31, 2017 |
| G0219 | Pet imaging whole body; melanoma for non-covered indications |
| G0235 | Pet imaging, any site, not otherwise specified |
| G0237 | Therapeutic procedures to increase strength or endurance of respiratory muscles, face to face, one on one, each 15 minutes (includes monitoring) |
| G0238 | Therapeutic procedures to improve respiratory function, other than described by g0237, one on one, face to face, per 15 minutes (includes monitoring) |
| G0239 | Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring) |
| G0245 | Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) which must include: (1) the diagnosis of lops, (2) a patient history, (3) a physical examination that consists of at least the following elements: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of a protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear and (4) patient education |
| G0246 | Follow-up physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) to include at least the following: (1) a patient history, (2) a physical examination that includes: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear, and (3) patient education |
| G0247 | Routine foot care by a physician of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) to include, the local care of superficial wounds (i.e. superficial to muscle and fascia) and at least the following if present: (1) local care of superficial wounds, (2) debridement of corns and calluses, and (3) trimming and debridement of nails |
| G0248 | Demonstration, prior to initiation of home inr monitoring, for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria, under the direction of a physician; includes: face-to-face demonstration of use and care of the inr monitor, obtaining at least one blood sample, provision of instructions for reporting home inr test results, and documentation of patient's ability to perform testing and report results |
| G0249 | Provision of test materials and equipment for home inr monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; includes: provision of materials for use in the home and reporting of test results to physician; testing not occurring more frequently than once a week; testing materials, billing units of service include 4 tests |
| G0250 | Physician review, interpretation, and patient management of home inr testing for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; testing not occurring more frequently than once a week; billing units of service include 4 tests |
| G0251 | Linear accelerator based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, maximum five sessions per course of treatment Terminated: December 31, 2014 |
| G0252 | Pet imaging, full and partial-ring pet scanners only, for initial diagnosis of breast cancer and/or surgical planning for breast cancer (e.g., initial staging of axillary lymph nodes) |
| G0255 | Current perception threshold/sensory nerve conduction test, (snct) per limb, any nerve |
| G0257 | Unscheduled or emergency dialysis treatment for an esrd patient in a hospital outpatient department that is not certified as an esrd facility |
| G0259 | Injection procedure for sacroiliac joint; arthrography |
| G0260 | Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography |
| G0268 | Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing |
| G0269 | Placement of occlusive device into either a venous or arterial access site, post surgical or interventional procedure (e.g., angioseal plug, vascular plug) |
| G0270 | Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes |
| G0271 | Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes |
| G0276 | Blinded procedure for lumbar stenosis, percutaneous image-guided lumbar decompression (pild) or placebo-control, performed in an approved coverage with evidence development (ced) clinical trial |
| G0277 | Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval |
| G0278 | Iliac and/or femoral artery angiography, non-selective, bilateral or ipsilateral to catheter insertion, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of the catheter in the distal aorta or ipsilateral femoral or iliac artery, injection of dye, production of permanent images, and radiologic supervision and interpretation (list separately in addition to primary procedure) |
| G0279 | Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) |
| G0281 | Electrical stimulation, (unattended), to one or more areas, for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of care |
| G0282 | Electrical stimulation, (unattended), to one or more areas, for wound care other than described in g0281 |
| G0283 | Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care |
| G0288 | Reconstruction, computed tomographic angiography of aorta for surgical planning for vascular surgery |
| G0289 | Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage (chondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee |
| G0293 | Noncovered surgical procedure(s) using conscious sedation, regional, general or spinal anesthesia in a medicare qualifying clinical trial, per day |
| G0294 | Noncovered procedure(s) using either no anesthesia or local anesthesia only, in a medicare qualifying clinical trial, per day |
| G0295 | Electromagnetic therapy, to one or more areas, for wound care other than described in g0329 or for other uses |
| G0296 | Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making) |
| G0297 | Low dose ct scan (ldct) for lung cancer screening Terminated: December 31, 2020 |
| G0299 | Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes |
| G0300 | Direct skilled nursing services of a licensed practical nurse (lpn) in the home health or hospice setting, each 15 minutes |
| G0302 | Pre-operative pulmonary surgery services for preparation for lvrs, complete course of services, to include a minimum of 16 days of services |
| G0303 | Pre-operative pulmonary surgery services for preparation for lvrs, 10 to 15 days of services |
| G0304 | Pre-operative pulmonary surgery services for preparation for lvrs, 1 to 9 days of services |
| G0305 | Post-discharge pulmonary surgery services after lvrs, minimum of 6 days of services |
| G0306 | Complete cbc, automated (hgb, hct, rbc, wbc, without platelet count) and automated wbc differential count |
| G0307 | Complete (cbc), automated (hgb, hct, rbc, wbc; without platelet count) |
| G0308 | Creation of subcutaneous pocket with insertion of 180 day implantable interstitial glucose sensor, including system activation and patient training Terminated: December 31, 2022 |
| G0309 | Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and insertion of new 180 day implantable sensor, including system activation Terminated: December 31, 2022 |
| G0310 | Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service, 5 to 15 mins time (this code is used for medicaid billing purposes) |
| G0311 | Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service, 16-30 mins time (this code is used for medicaid billing purposes) |
| G0312 | Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service for ages under 21, 5 to 15 mins time (this code is used for medicaid billing purposes) |
| G0313 | Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service for ages under 21, 16-30 mins time (this code is used for medicaid billing purposes) |
| G0314 | Immunization counseling by a physician or other qualified health care professional for covid-19, ages under 21, 16-30 mins time (this code is used for the medicaid early and periodic screening, diagnostic, and treatment benefit (epsdt) |
| G0315 | Immunization counseling by a physician or other qualified health care professional for covid-19, ages under 21, 5-15 mins time (this code is used for the medicaid early and periodic screening, diagnostic, and treatment benefit (epsdt) |
| G0316 | Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99223, 99233, and 99236 for hospital inpatient or observation care evaluation and management services). (do not report g0316 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99418, 99415, 99416). (do not report g0316 for any time unit less than 15 minutes) |
| G0317 | Prolonged nursing facility evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99306, 99310 for nursing facility evaluation and management services). (do not report g0317 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99418). (do not report g0317 for any time unit less than 15 minutes) |
| G0318 | Prolonged home or residence evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99345, 99350 for home or residence evaluation and management services). (do not report g0318 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99417). (do not report g0318 for any time unit less than 15 minutes) |
| G0320 | Home health services furnished using synchronous telemedicine rendered via a real-time two-way audio and video telecommunications system |
| G0321 | Home health services furnished using synchronous telemedicine rendered via telephone or other real-time interactive audio-only telecommunications system |
| G0322 | The collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency (i.e., remote patient monitoring) |
| G0323 | Care management services for behavioral health conditions, at least 20 minutes of clinical psychologist, clinical social worker, mental health counselor, or marriage and family therapist time, per calendar month. (these services include the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales; behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes; facilitating and coordinating treatment such as psychotherapy, coordination with and/or referral to physicians and practitioners who are authorized by medicare to prescribe medications and furnish e/m services, counseling and/or psychiatric consultation; and continuity of care with a designated member of the care team) |
| G0327 | Colorectal cancer screening; blood-based biomarker |
| G0328 | Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous |
| G0329 | Electromagnetic therapy, to one or more areas for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care as part of a therapy plan of care |
| G0330 | Facility services for dental rehabilitation procedure(s) performed on a patient who requires monitored anesthesia (e.g., general, intravenous sedation (monitored anesthesia care) and use of an operating room |
| G0333 | Pharmacy dispensing fee for inhalation drug(s); initial 30-day supply as a beneficiary |
| G0337 | Hospice evaluation and counseling services, pre-election |
| G0339 | Image-guided robotic linear accelerator-based stereotactic radiosurgery, complete course of therapy in one session or first session of fractionated treatment |
| G0340 | Image-guided robotic linear accelerator-based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, second through fifth sessions, maximum five sessions per course of treatment |
| G0341 | Percutaneous islet cell transplant, includes portal vein catheterization and infusion |
| G0342 | Laparoscopy for islet cell transplant, includes portal vein catheterization and infusion |
| G0343 | Laparotomy for islet cell transplant, includes portal vein catheterization and infusion |
| G0364 | Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service Terminated: December 31, 2017 |
| G0365 | Vessel mapping of vessels for hemodialysis access (services for preoperative vessel mapping prior to creation of hemodialysis access using an autogenous hemodialysis conduit, including arterial inflow and venous outflow) Terminated: December 31, 2019 |
| G0372 | Physician service required to establish and document the need for a power mobility device |
| G0378 | Hospital observation service, per hour |
| G0379 | Direct admission of patient for hospital observation care |
| G0380 | Level 1 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) |
| G0381 | Level 2 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) |
| G0382 | Level 3 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) |
| G0383 | Level 4 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) |
| G0384 | Level 5 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) |
| G0389 | Ultrasound b-scan and/or real time with image documentation; for abdominal aortic aneurysm (aaa) screening Terminated: December 31, 2016 |
| G0390 | Trauma response team associated with hospital critical care service |
| G0396 | Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes |
| G0397 | Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes |
| G0398 | Home sleep study test (hst) with type ii portable monitor, unattended; minimum of 7 channels: eeg, eog, emg, ecg/heart rate, airflow, respiratory effort and oxygen saturation |
| G0399 | Home sleep test (hst) with type iii portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ecg/heart rate and 1 oxygen saturation |
| G0400 | Home sleep test (hst) with type iv portable monitor, unattended; minimum of 3 channels |
| G0402 | Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment |
| G0403 | Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report |
| G0404 | Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination |
| G0405 | Electrocardiogram, routine ecg with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination |
| G0406 | Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth |
| G0407 | Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth |
| G0408 | Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth |
| G0409 | Social work and psychological services, directly relating to and/or furthering the patient's rehabilitation goals, each 15 minutes, face-to-face; individual (services provided by a corf-qualified social worker or psychologist in a corf) |
| G0410 | Group psychotherapy other than of a multiple-family group, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes |
| G0411 | Interactive group psychotherapy, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes |
| G0412 | Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s), unilateral or bilateral for pelvic bone fracture patterns which do not disrupt the pelvic ring includes internal fixation, when performed |
| G0413 | Percutaneous skeletal fixation of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, (includes ilium, sacroiliac joint and/or sacrum) |
| G0414 | Open treatment of anterior pelvic bone fracture and/or dislocation for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation when performed (includes pubic symphysis and/or superior/inferior rami) |
| G0415 | Open treatment of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation, when performed (includes ilium, sacroiliac joint and/or sacrum) |
| G0416 | Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method |
| G0417 | Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, 21-40 specimens Terminated: December 31, 2014 |
| G0418 | Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, 41-60 specimens Terminated: December 31, 2014 |
| G0419 | Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, >60 specimens Terminated: December 31, 2014 |
| G0420 | Face-to-face educational services related to the care of chronic kidney disease; individual, per session, per one hour |
| G0421 | Face-to-face educational services related to the care of chronic kidney disease; group, per session, per one hour |
| G0422 | Intensive cardiac rehabilitation; with or without continuous ecg monitoring with exercise, per session |
| G0423 | Intensive cardiac rehabilitation; with or without continuous ecg monitoring; without exercise, per session |
| G0424 | Pulmonary rehabilitation, including exercise (includes monitoring), one hour, per session, up to two sessions per day Terminated: December 31, 2021 |
| G0425 | Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth |
| G0426 | Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth |
| G0427 | Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth |
| G0428 | Collagen meniscus implant procedure for filling meniscal defects (e.g., cmi, collagen scaffold, menaflex) |
| G0429 | Dermal filler injection(s) for the treatment of facial lipodystrophy syndrome (lds) (e.g., as a result of highly active antiretroviral therapy) |
| G0431 | Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter Terminated: December 31, 2015 |
| G0432 | Infectious agent antibody detection by enzyme immunoassay (eia) technique, hiv-1 and/or hiv-2, screening |
| G0433 | Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening |
| G0434 | Drug screen, other than chromatographic; any number of drug classes, by clia waived test or moderate complexity test, per patient encounter Terminated: December 31, 2015 |
| G0435 | Infectious agent antibody detection by rapid antibody test, hiv-1 and/or hiv-2, screening |
| G0436 | Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes Terminated: September 30, 2016 |
| G0437 | Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes Terminated: September 30, 2016 |
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
| G0442 | Annual alcohol misuse screening, 5 to 15 minutes |
| G0443 | Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes |
| G0444 | Annual depression screening, 5 to 15 minutes |
| G0445 | High intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual, includes: education, skills training and guidance on how to change sexual behavior; performed semi-annually, 30 minutes |
| G0446 | Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes |
| G0447 | Face-to-face behavioral counseling for obesity, 15 minutes |
| G0448 | Insertion or replacement of a permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber with insertion of pacing electrode, cardiac venous system, for left ventricular pacing |
| G0451 | Development testing, with interpretation and report, per standardized instrument form |
| G0452 | Molecular pathology procedure; physician interpretation and report |
| G0453 | Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition to primary procedure) |
| G0454 | Physician documentation of face-to-face visit for durable medical equipment determination performed by nurse practitioner, physician assistant or clinical nurse specialist |
| G0455 | Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen |
| G0456 | Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area less than or equal to 50 square centimeters Terminated: December 31, 2014 |
| G0457 | Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area greater than 50 square centimeters Terminated: December 31, 2014 |
| G0458 | Low dose rate (ldr) prostate brachytherapy services, composite rate |
| G0459 | Inpatient telehealth pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy |
| G0460 | Autologous platelet rich plasma or other blood-derived product for non-diabetic chronic wounds/ulcers, including as applicable phlebotomy, centrifugation or mixing, and all other preparatory procedures, administration and dressings, per treatment |
| G0461 | Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stain Terminated: December 31, 2014 |
| G0462 | Immunohistochemistry or immunocytochemistry, per specimen; each additional single or multiplex antibody stain (list separately in addition to code for primary procedure) Terminated: December 31, 2014 |
| G0463 | Hospital outpatient clinic visit for assessment and management of a patient |
| G0464 | Colorectal cancer screening; stool-based dna and fecal occult hemoglobin (e.g., kras, ndrg4 and bmp3) Terminated: December 31, 2015 |
| G0465 | Autologous platelet rich plasma (prp) or other blood-derived product for diabetic chronic wounds/ulcers, using an fda-cleared device for this indication, (includes as applicable administration, dressings, phlebotomy, centrifugation or mixing, and all other preparatory procedures, per treatment) |
| G0466 | Federally qualified health center (fqhc) visit, new patient; a medically-necessary, face-to-face encounter (one-on-one) between a new patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit |
| G0467 | Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit |
| G0468 | Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv |
| G0469 | Federally qualified health center (fqhc) visit, mental health, new patient; a medically-necessary, face-to-face mental health encounter (one-on-one) between a new patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a mental health visit |
| G0470 | Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a mental health visit |
| G0471 | Collection of venous blood by venipuncture or urine sample by catheterization from an individual in a skilled nursing facility (snf) or by a laboratory on behalf of a home health agency (hha) |
| G0472 | Hepatitis c antibody screening, for individual at high risk and other covered indication(s) |
| G0473 | Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes |
| G0475 | Hiv antigen/antibody, combination assay, screening |
| G0476 | Infectious agent detection by nucleic acid (dna or rna); human papillomavirus (hpv), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test |
| G0477 | Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) capable of being read by direct optical observation only (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service Terminated: December 31, 2016 |
| G0478 | Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) read by instrument-assisted direct optical observation (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service Terminated: December 31, 2016 |
| G0479 | Drug test(s), presumptive, any number of drug classes; any number of devices or procedures by instrumented chemistry analyzers utilizing immunoassay, enzyme assay, tof, maldi, ldtd, desi, dart, ghpc, gc mass spectrometry), includes sample validation when performed, per date of service Terminated: December 31, 2016 |
| G0480 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed |
| G0481 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 8-14 drug class(es), including metabolite(s) if performed |
| G0482 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 15-21 drug class(es), including metabolite(s) if performed |
| G0483 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed |
| G0490 | Face-to-face home health nursing visit by a rural health clinic (rhc) or federally qualified health center (fqhc) in an area with a shortage of home health agencies; (services limited to rn or lpn only) |
| G0491 | Dialysis procedure at a medicare certified esrd facility for acute kidney injury without esrd |
| G0492 | Dialysis procedure with single evaluation by a physician or other qualified health care professional for acute kidney injury without esrd |
| G0493 | Skilled services of a registered nurse (rn) for the observation and assessment of the patient's condition, each 15 minutes (the change in the patient's condition requires skilled nursing personnel to identify and evaluate the patient's need for possible modification of treatment in the home health or hospice setting) |
| G0494 | Skilled services of a licensed practical nurse (lpn) for the observation and assessment of the patient's condition, each 15 minutes (the change in the patient's condition requires skilled nursing personnel to identify and evaluate the patient's need for possible modification of treatment in the home health or hospice setting) |
| G0495 | Skilled services of a registered nurse (rn), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes |
| G0496 | Skilled services of a licensed practical nurse (lpn), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes |
| G0498 | Chemotherapy administration, intravenous infusion technique; initiation of infusion in the office/clinic setting using office/clinic pump/supplies, with continuation of the infusion in the community setting (e.g., home, domiciliary, rest home or assisted living) using a portable pump provided by the office/clinic, includes follow up office/clinic visit at the conclusion of the infusion |
| G0499 | Hepatitis b screening in non-pregnant, high risk individual includes hepatitis b surface antigen (hbsag), antibodies to hbsag (anti-hbs) and antibodies to hepatitis b core antigen (anti-hbc), and is followed by a neutralizing confirmatory test, when performed, only for an initially reactive hbsag result |
| G0500 | Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intra-service time; patient age 5 years or older (additional time may be reported with 99153, as appropriate) |
| G0501 | Resource-intensive services for patients for whom the use of specialized mobility-assistive technology (such as adjustable height chairs or tables, patient lift, and adjustable padded leg supports) is medically necessary and used during the provision of an office/outpatient, evaluation and management visit (list separately in addition to primary service) |
| G0502 | Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: outreach to and engagement in treatment of a patient directed by the treating physician or other qualified health care professional; initial assessment of the patient, including administration of validated rating scales, with the development of an individualized treatment plan; review by the psychiatric consultant with modifications of the plan if recommended; entering patient in a registry and tracking patient follow-up and progress using the registry, with appropriate documentation, and participation in weekly caseload consultation with the psychiatric consultant; and provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies Terminated: December 31, 2017 |
| G0503 | Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: tracking patient follow-up and progress using the registry, with appropriate documentation; participation in weekly caseload consultation with the psychiatric consultant; ongoing collaboration with and coordination of the patient's mental health care with the treating physician or other qualified health care professional and any other treating mental health providers; additional review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations provided by the psychiatric consultant; provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies; monitoring of patient outcomes using validated rating scales; and relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharge from active treatment Terminated: December 31, 2017 |
| G0504 | Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional (list separately in addition to code for primary procedure); (use g0504 in conjunction with g0502, g0503) Terminated: December 31, 2017 |
| G0505 | Cognition and functional assessment using standardized instruments with development of recorded care plan for the patient with cognitive impairment, history obtained from patient and/or caregiver, in office or other outpatient setting or home or domiciliary or rest home Terminated: December 31, 2017 |
| G0506 | Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service) |
| G0507 | Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month, with the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales; behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes; facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation; and continuity of care with a designated member of the care team Terminated: December 31, 2017 |
| G0508 | Telehealth consultation, critical care, initial , physicians typically spend 60 minutes communicating with the patient and providers via telehealth |
| G0509 | Telehealth consultation, critical care, subsequent, physicians typically spend 50 minutes communicating with the patient and providers via telehealth |
| G0511 | Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month |
| G0512 | Rural health clinic or federally qualified health center (rhc/fqhc) only, psychiatric collaborative care model (psychiatric cocm), 60 minutes or more of clinical staff time for psychiatric cocm services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm) and including services furnished by a behavioral health care manager and consultation with a psychiatric consultant, per calendar month |
| G0513 | Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (list separately in addition to code for preventive service) |
| G0514 | Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes (list separately in addition to code g0513 for additional 30 minutes of preventive service) |
| G0515 | Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes Terminated: December 31, 2019 |
| G0516 | Insertion of non-biodegradable drug delivery implants, 4 or more (services for subdermal rod implant) |
| G0517 | Removal of non-biodegradable drug delivery implants, 4 or more (services for subdermal implants) |
| G0518 | Removal with reinsertion, non-biodegradable drug delivery implants, 4 or more (services for subdermal implants) |
| G0519 | Management of new patient-caregiver dyad with dementia, low complexity, for use in cmmi model |
| G0520 | Management of new patient-caregiver dyad with dementia, moderate complexity, for use in cmmi model |
| G0521 | Management of new patient-caregiver dyad with dementia, high complexity, for use in cmmi model |
| G0522 | Management of a new patient with dementia, low complexity, for use in cmmi model |
| G0523 | Management of a new patient with dementia, moderate to high complexity, for use in cmmi model |
| G0524 | Management of established patient-caregiver dyad with dementia, low complexity, for use in cmmi model |
| G0525 | Management of established patient-caregiver dyad with dementia, moderate complexity, for use in cmmi model |
| G0526 | Management of established patient-caregiver dyad with dementia, high complexity, for use in cmmi model |
| G0527 | Management of established patient with dementia, low complexity, for use in cmmi model |
| G0528 | Management of established patient with dementia, moderate to high complexity, for use in cmmi model |
| G0529 | In-home respite care, 4-hour unit, for use in cmmi model |
| G0530 | Adult day center, 8-hour unit, for use in cmmi model |
| G0531 | Facility-based respite, 24-hour unit, for use in cmmi model |
| G0659 | Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem), excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase), performed without method or drug-specific calibration, without matrix-matched quality control material, or without use of stable isotope or other universally recognized internal standard(s) for each drug, drug metabolite or drug class per specimen; qualitative or quantitative, all sources, includes specimen validity testing, per day, any number of drug classes |
| G0908 | Most recent hemoglobin (hgb) level > 12.0 g/dl Terminated: December 31, 2014 |
| G0909 | Hemoglobin level measurement not documented, reason not given Terminated: December 31, 2014 |
| G0910 | Most recent hemoglobin level <= 12.0 g/dl Terminated: December 31, 2014 |
| G0913 | Improvement in visual function achieved within 90 days following cataract surgery |
| G0914 | Patient care survey was not completed by patient |
| G0915 | Improvement in visual function not achieved within 90 days following cataract surgery |
| G0916 | Satisfaction with care achieved within 90 days following cataract surgery |
| G0917 | Patient care survey was not completed by patient |
| G0918 | Satisfaction with care not achieved within 90 days following cataract surgery |
| G0919 | Influenza immunization ordered or recommended (to be given at alternate location or alternate provider); vaccine not available at time of visit Terminated: December 31, 2014 |
| G0920 | Type, anatomic location, and activity all documented Terminated: December 31, 2014 |
| G0921 | Documentation of patient reason(s) for not being able to assess (e.g., patient refuses endoscopic and/or radiologic assessment) Terminated: December 31, 2014 |
| G0922 | No documentation of disease type, anatomic location, and activity, reason not given Terminated: December 31, 2014 |
| G1000 | Clinical decision support mechanism applied pathways, as defined by the medicare appropriate use criteria program Terminated: March 31, 2020 |
| G1001 | Clinical decision support mechanism evicore, as defined by the medicare appropriate use criteria program |
| G1002 | Clinical decision support mechanism medcurrent, as defined by the medicare appropriate use criteria program |
| G1003 | Clinical decision support mechanism medicalis, as defined by the medicare appropriate use criteria program |
| G1004 | Clinical decision support mechanism national decision support company, as defined by the medicare appropriate use criteria program |
| G1005 | Clinical decision support mechanism national imaging associates, as defined by the medicare appropriate use criteria program Terminated: December 31, 2020 |
| G1006 | Clinical decision support mechanism test appropriate, as defined by the medicare appropriate use criteria program Terminated: December 31, 2020 |
| G1007 | Clinical decision support mechanism aim specialty health, as defined by the medicare appropriate use criteria program |
| G1008 | Clinical decision support mechanism cranberry peak, as defined by the medicare appropriate use criteria program |
| G1009 | Clinical decision support mechanism sage health management solutions, as defined by the medicare appropriate use criteria program Terminated: March 31, 2022 |
| G1010 | Clinical decision support mechanism stanson, as defined by the medicare appropriate use criteria program |
| G1011 | Clinical decision support mechanism, qualified tool not otherwise specified, as defined by the medicare appropriate use criteria program |
| G1012 | Clinical decision support mechanism agilemd, as defined by the medicare appropriate use criteria program |
| G1013 | Clinical decision support mechanism evidencecare imagingcare, as defined by the medicare appropriate use criteria program |
| G1014 | Clinical decision support mechanism inveniqa semantic answers in medicine, as defined by the medicare appropriate use criteria program |
| G1015 | Clinical decision support mechanism reliant medical group, as defined by the medicare appropriate use criteria program |
| G1016 | Clinical decision support mechanism speed of care, as defined by the medicare appropriate use criteria program |
| G1017 | Clinical decision support mechanism healthhelp, as defined by the medicare appropriate use criteria program |
| G1018 | Clinical decision support mechanism infinx, as defined by the medicare appropriate use criteria program |
| G1019 | Clinical decision support mechanism logicnets, as defined by the medicare appropriate use criteria program |
| G1020 | Clinical decision support mechanism curbside clinical augmented workflow, as defined by the medicare appropriate use criteria program |
| G1021 | Clinical decision support mechanism ehealthline clinical decision support mechanism, as defined by the medicare appropriate use criteria program |
| G1022 | Clinical decision support mechanism intermountain clinical decision support mechanism, as defined by the medicare appropriate use criteria program |
| G1023 | Clinical decision support mechanism persivia clinical decision support, as defined by the medicare appropriate use criteria program |
| G1024 | Clinical decision support mechanism radrite, as defined by the medicare appropriate use criteria program |
| G1025 | Patient-months where there are more than one medicare capitated payment (mcp) provider listed for the month |
| G1026 | The number of adult patient-months in the denominator who were on maintenance hemodialysis using a catheter continuously for three months or longer under the care of the same practitioner or group partner as of the last hemodialysis session of the reporting month |
| G1027 | The number of adult patient-months in the denominator who were on maintenance hemodialysis under the care of the same practitioner or group partner as of the last hemodialysis session of the reporting month using a catheter continuously for less than three months |
| G1028 | Take-home supply of nasal naloxone; 2-pack of 8mg per 0.1 ml nasal spray (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure |
| G2000 | Blinded administration of convulsive therapy procedure, either electroconvulsive therapy (ect, current covered gold standard) or magnetic seizure therapy (mst, non-covered experimental therapy), performed in an approved ide-based clinical trial, per treatment session |
| G2001 | Brief (20 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2002 | Limited (30 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2003 | Moderate (45 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2004 | Comprehensive (60 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2005 | Extensive (75 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2006 | Brief (20 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2007 | Limited (30 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2008 | Moderate (45 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2009 | Comprehensive (60 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2010 | Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment |
| G2011 | Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention, 5-14 minutes |
| G2012 | Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion |
| G2013 | Extensive (75 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2014 | Limited (30 minutes) care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2015 | Comprehensive (60 mins) home care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility.) |
| G2020 | Services for high intensity clinical services associated with the initial engagement and outreach of beneficiaries assigned to the sip component of the pcf model (do not bill with chronic care management codes) |
| G2021 | Health care practitioners rendering treatment in place (tip) |
| G2022 | A model participant (ambulance supplier/provider), the beneficiary refuses services covered under the model (transport to an alternate destination/treatment in place) |
| G2023 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source Terminated: May 11, 2023 |
| G2024 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) from an individual in a snf or by a laboratory on behalf of a hha, any specimen source Terminated: May 11, 2023 |
| G2025 | Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
| G2058 | Chronic care management services, each additional 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (list separately in addition to code for primary procedure). (do not report g2058 for care management services of less than 20 minutes additional to the first 20 minutes of chronic care management services during a calendar month). (use g2058 in conjunction with 99490). (do not report 99490, g2058 in the same calendar month as 99487, 99489, 99491)). Terminated: December 31, 2020 |
| G2061 | Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 5-10 minutes Terminated: December 31, 2020 |
| G2062 | Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11-20 minutes Terminated: December 31, 2020 |
| G2063 | Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes Terminated: December 31, 2020 |
| G2064 | Comprehensive care management services for a single high-risk disease, e.g., principal care management, at least 30 minutes of physician or other qualified health care professional time per calendar month with the following elements: one complex chronic condition lasting at least 3 months, which is the focus of the care plan, the condition is of sufficient severity to place patient at risk of hospitalization or have been the cause of a recent hospitalization, the condition requires development or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities Terminated: December 31, 2021 |
| G2065 | Comprehensive care management for a single high-risk disease services, e.g. principal care management, at least 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month with the following elements: one complex chronic condition lasting at least 3 months, which is the focus of the care plan, the condition is of sufficient severity to place patient at risk of hospitalization or have been cause of a recent hospitalization, the condition requires development or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities Terminated: December 31, 2021 |
| G2066 | Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, implantable loop recorder system, or subcutaneous cardiac rhythm monitor system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results Terminated: December 31, 2023 |
| G2067 | Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a medicare-enrolled opioid treatment program) |
| G2068 | Medication assisted treatment, buprenorphine (oral); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) |
| G2069 | Medication assisted treatment, buprenorphine (injectable); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) |
| G2070 | Medication assisted treatment, buprenorphine (implant insertion); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) |
| G2071 | Medication assisted treatment, buprenorphine (implant removal); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) |
| G2072 | Medication assisted treatment, buprenorphine (implant insertion and removal); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) |
| G2073 | Medication assisted treatment, naltrexone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) |
| G2074 | Medication assisted treatment, weekly bundle not including the drug, including substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) |
| G2075 | Medication assisted treatment, medication not otherwise specified; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a medicare-enrolled opioid treatment program) |
| G2076 | Intake activities, including initial medical examination that is a complete, fully documented physical evaluation and initial assessment by a program physician or a primary care physician, or an authorized healthcare professional under the supervision of a program physician qualified personnel that includes preparation of a treatment plan that includes the patient's short-term goals and the tasks the patient must perform to complete the short-term goals; the patient's requirements for education, vocational rehabilitation, and employment; and the medical, psycho- social, economic, legal, or other supportive services that a patient needs, conducted by qualified personnel (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure |
| G2077 | Periodic assessment; assessing periodically by qualified personnel to determine the most appropriate combination of services and treatment (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure |
| G2078 | Take-home supply of methadone; up to 7 additional day supply (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure |
| G2079 | Take-home supply of buprenorphine (oral); up to 7 additional day supply (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure |
| G2080 | Each additional 30 minutes of counseling in a week of medication assisted treatment, (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure |
| G2081 | Patients age 66 and older in institutional special needs plans (snp) or residing in long-term care with a pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period |
| G2082 | Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of up to 56 mg of esketamine nasal self-administration, includes 2 hours post-administration observation |
| G2083 | Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of greater than 56 mg esketamine nasal self-administration, includes 2 hours post-administration observation |
| G2086 | Office-based treatment for opioid use disorder, including development of the treatment plan, care coordination, individual therapy and group therapy and counseling; at least 70 minutes in the first calendar month |
| G2087 | Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; at least 60 minutes in a subsequent calendar month |
| G2088 | Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; each additional 30 minutes beyond the first 120 minutes (list separately in addition to code for primary procedure) |
| G2089 | Most recent hemoglobin a1c (hba1c) level 7.0 to 9.0% Terminated: December 31, 2020 |
| G2090 | Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period |
| G2091 | Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period |
| G2092 | Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) or angiotensin receptor-neprilysin inhibitor (arni) therapy prescribed or currently being taken |
| G2093 | Documentation of medical reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., hypotensive patients who are at immediate risk of cardiogenic shock, hospitalized patients who have experienced marked azotemia, allergy, intolerance, other medical reasons) |
| G2094 | Documentation of patient reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., patient declined, other patient reasons) |
| G2095 | Documentation of system reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., other system reasons) Terminated: December 31, 2022 |
| G2096 | Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) or angiotensin receptor-neprilysin inhibitor (arni) therapy was not prescribed, reason not given |
| G2097 | Episodes where the patient had a competing diagnosis on or within three days after the episode date (e.g., intestinal infection, pertussis, bacterial infection, lyme disease, otitis media, acute sinusitis, chronic sinusitis, infection of the adenoids, prostatitis, cellulitis, mastoiditis, or bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia/gonococcal infections, venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis or uti) |
| G2098 | Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period |
| G2099 | Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period |
| G2100 | Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period |
| G2101 | Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period |
| G2102 | Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed Terminated: December 31, 2020 |
| G2103 | Seven standard field stereoscopic photos with interpretation by an ophthalmologist or optometrist documented and reviewed Terminated: December 31, 2020 |
| G2104 | Eye imaging validated to match diagnosis from seven standard field stereoscopic photos results documented and reviewed Terminated: December 31, 2020 |
| G2105 | Patient age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period |
| G2106 | Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period |
| G2107 | Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period |
| G2108 | Patient age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period Terminated: December 31, 2023 |
| G2109 | Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period Terminated: December 31, 2023 |
| G2110 | Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period Terminated: December 31, 2023 |
| G2112 | Patient receiving <=5 mg daily prednisone (or equivalent), or ra activity is worsening, or glucocorticoid use is for less than 6 months |
| G2113 | Patient receiving >5 mg daily prednisone (or equivalent) for longer than 6 months, and improvement or no change in disease activity |
| G2114 | Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period Terminated: December 31, 2020 |
| G2115 | Patients 66 - 80 years of age with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period |
| G2116 | Patients 66 - 80 years of age with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period |
| G2117 | Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period Terminated: December 31, 2020 |
| G2118 | Patients 81 years of age and older with at least one claim/encounter for frailty during the measurement period |
| G2119 | Within the past 2 years, calcium and/or vitamin d optimization has been ordered or performed Terminated: December 31, 2020 |
| G2120 | Within the past 2 years, calcium and/or vitamin d optimization has not been ordered or performed Terminated: December 31, 2020 |
| G2121 | Depression, anxiety, apathy, and psychosis assessed |
| G2122 | Depression, anxiety, apathy, and psychosis not assessed |
| G2123 | Patients 66-80 years of age and had at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period Terminated: December 31, 2020 |
| G2124 | Patients 66-80 years of age and had at least one claim/encounter for frailty during the measurement period and a dispensed dementia medication Terminated: December 31, 2020 |
| G2125 | Patients 81 years of age and older with at least one claim/encounter for frailty during the six months prior to the measurement period through december 31 of the measurement period |
| G2126 | Patients 66 - 80 years of age with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period |
| G2127 | Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period |
| G2128 | Documentation of medical reason(s) for not on a daily aspirin or other antiplatelet (e.g. history of gastrointestinal bleed, intra-cranial bleed, blood disorders, idiopathic thrombocytopenic purpura (itp), gastric bypass or documentation of active anticoagulant use during the measurement period) |
| G2129 | Procedure-related bp's not taken during an outpatient visit. examples include same day surgery, ambulatory service center, g.i. lab, dialysis, infusion center, chemotherapy |
| G2130 | Patients age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 days during the measurement period Terminated: December 31, 2020 |
| G2131 | Patients 81 years and older with a diagnosis of frailty Terminated: December 31, 2020 |
| G2132 | Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period Terminated: December 31, 2020 |
| G2133 | Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period Terminated: December 31, 2020 |
| G2134 | Patients 66 years of age or older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period Terminated: December 31, 2020 |
| G2135 | Patients 66 years of age or older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period Terminated: December 31, 2020 |
| G2136 | Back pain measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively was less than or equal to 3.0 or back pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated an improvement of 5.0 points or greater |
| G2137 | Back pain measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively was greater than 3.0 and back pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated improvement of less than 5.0 points |
| G2138 | Back pain as measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively was less than or equal to 3.0 or back pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of 5.0 points or greater |
| G2139 | Back pain measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively was greater than 3.0 and back pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated improvement of less than 5.0 points |
| G2140 | Leg pain measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively was less than or equal to 3.0 or leg pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated an improvement of 5.0 points or greater |
| G2141 | Leg pain measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively was greater than 3.0 and leg pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated improvement of less than 5.0 points |
| G2142 | Functional status measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively was less than or equal to 22 or functional status measured by the odi version 2.1a within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of 30 points or greater |
| G2143 | Functional status measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively was greater than 22 and functional status measured by the odi version 2.1a within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of less than 30 points |
| G2144 | Functional status measured by the oswestry disability index (odi version 2.1a) at three months (6-20 weeks) postoperatively was less than or equal to 22 or functional status measured by the odi version 2.1a within three months preoperatively and at three months (6-20 weeks) postoperatively demonstrated an improvement of 30 points or greater |
| G2145 | Functional status measured by the oswestry disability index (odi version 2.1a) at three months (6 - 20 weeks) postoperatively was greater than 22 and functional status measured by the odi version 2.1a within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated an improvement of less than 30 points |
| G2146 | Leg pain as measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively was less than or equal to 3.0 or leg pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of 5.0 points or greater |
| G2147 | Leg pain measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively was greater than 3.0 and leg pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated improvement of less than 5.0 points |
| G2148 | Multimodal pain management was used |
| G2149 | Documentation of medical reason(s) for not using multimodal pain management (e.g., allergy to multiple classes of analgesics, intubated patient, hepatic failure, patient reports no pain during pacu stay, other medical reason(s)) |
| G2150 | Multimodal pain management was not used |
| G2151 | Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time before or during the episode of care |
| G2152 | Residual score for the neck impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) |
| G2153 | In hospice or using hospice services during the measurement period Terminated: December 31, 2020 |
| G2154 | Patient received at least one td vaccine or one tdap vaccine between nine years prior to the start of the measurement period and the end of the measurement period Terminated: December 31, 2020 |
| G2155 | Patient had history of at least one of the following contraindications any time during or before the measurement period: anaphylaxis due to tdap vaccine, anaphylaxis due to td vaccine or its components; encephalopathy due to tdap or td vaccination (post tetanus vaccination encephalitis, post diphtheria vaccination encephalitis or post pertussis vaccination encephalitis.) Terminated: December 31, 2020 |
| G2156 | Patient did not receive at least one td vaccine or one tdap vaccine between nine years prior to the start of the measurement period and the end of the measurement period; or have history of at least one of the following contraindications any time during or before the measurement period: anaphylaxis due to tdap vaccine, anaphylaxis due to td vaccine or its components; encephalopathy due to tdap or td vaccination (post tetanus vaccination encephalitis, post diphtheria vaccination encephalitis or post pertussis vaccination encephalitis.) Terminated: December 31, 2020 |
| G2157 | Patients received both the 13-valent pneumococcal conjugate vaccine and the 23-valent pneumococcal polysaccharide vaccine at least 12 months apart, with the first occurrence after the age of 60 before or during the measurement period Terminated: December 31, 2020 |
| G2158 | Patient had prior pneumococcal vaccine adverse reaction any time during or before the measurement period Terminated: December 31, 2020 |
| G2159 | Patient did not receive both the 13-valent pneumococcal conjugate vaccine and the 23-valent pneumococcal polysaccharide vaccine at least 12 months apart, with the first occurrence after the age of 60 before or during measurement period; or have prior pneumococcal vaccine adverse reaction any time during or before the measurement period Terminated: December 31, 2020 |
| G2160 | Patient received at least one dose of the herpes zoster live vaccine or two doses of the herpes zoster recombinant vaccine (at least 28 days apart) anytime on or after the patient's 50th birthday before or during the measurement period Terminated: December 31, 2020 |
| G2161 | Patient had prior adverse reaction caused by zoster vaccine or its components any time during or before the measurement period Terminated: December 31, 2020 |
| G2162 | Patient did not receive at least one dose of the herpes zoster live vaccine or two doses of the herpes zoster recombinant vaccine (at least 28 days apart) anytime on or after the patient's 50th birthday before or during the measurement period; or have prior adverse reaction caused by zoster vaccine or its components any time during or before the measurement period Terminated: December 31, 2020 |
| G2163 | Patient received an influenza vaccine on or between july 1 of the year prior to the measurement period and june 30 of the measurement period Terminated: December 31, 2020 |
| G2164 | Patient had a prior influenza virus vaccine adverse reaction any time before or during the measurement period Terminated: December 31, 2020 |
| G2165 | Patient did not receive an influenza vaccine on or between july 1 of the year prior to the measurement period and june 30 of the measurement period; or did not have a prior influenza virus vaccine adverse reaction any time before or during the measurement period Terminated: December 31, 2020 |
| G2166 | Patient refused to participate at admission and/or discharge; patient unable to complete the neck fs prom at admission or discharge due to cognitive deficit, visual deficit, motor deficit, language barrier, or low reading level, and a suitable proxy/recorder is not available; patient self-discharged early; medical reason Terminated: December 31, 2020 |
| G2167 | Residual score for the neck impairment successfully calculated and the score was less than zero (< 0) |
| G2168 | Services performed by a physical therapist assistant in the home health setting in the delivery of a safe and effective physical therapy maintenance program, each 15 minutes |
| G2169 | Services performed by an occupational therapist assistant in the home health setting in the delivery of a safe and effective occupational therapy maintenance program, each 15 minutes |
| G2170 | Percutaneous arteriovenous fistula creation (avf), direct, any site, by tissue approximation using thermal resistance energy, and secondary procedures to redirect blood flow (e.g., transluminal balloon angioplasty, coil embolization) when performed, and includes all imaging and radiologic guidance, supervision and interpretation, when performed Terminated: December 31, 2022 |
| G2171 | Percutaneous arteriovenous fistula creation (avf), direct, any site, using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, wen performed) and fistulogram(s), angiography, enography, and/or ultrasound, with radiologic supervision and interpretation, when performed Terminated: December 31, 2022 |
| G2172 | All inclusive payment for services related to highly coordinated and integrated opioid use disorder (oud) treatment services furnished for the demonstration project |
| G2173 | Uri episodes where the patient had a comorbid condition during the 12 months prior to or on the episode date (e.g., tuberculosis, neutropenia, cystic fibrosis, chronic bronchitis, pulmonary edema, respiratory failure, rheumatoid lung disease) |
| G2174 | Uri episodes where the patient is taking antibiotics (table 1) in the 30 days prior to the episode date |
| G2175 | Episodes where the patient had a comorbid condition during the 12 months prior to or on the episode date (e.g., tuberculosis, neutropenia, cystic fibrosis, chronic bronchitis, pulmonary edema, respiratory failure, rheumatoid lung disease) |
| G2176 | Outpatient, ed, or observation visits that result in an inpatient admission |
| G2177 | Acute bronchitis/bronchiolitis episodes when the patient had a new or refill prescription of antibiotics (table 1) in the 30 days prior to the episode date |
| G2178 | Clinician documented that patient was not an eligible candidate for lower extremity neurological exam measure, for example patient bilateral amputee; patient has condition that would not allow them to accurately respond to a neurological exam (dementia, alzheimer's, etc.); patient has previously documented diabetic peripheral neuropathy with loss of protective sensation |
| G2179 | Clinician documented that patient had medical reason for not performing lower extremity neurological exam |
| G2180 | Clinician documented that patient was not an eligible candidate for evaluation of footwear as patient is bilateral lower extremity amputee |
| G2181 | Bmi not documented due to medical reason or patient refusal of height or weight measurement |
| G2182 | Patient receiving first-time biologic and/or immune response modifier therapy |
| G2183 | Documentation patient unable to communicate and informant not available |
| G2184 | Patient does not have a caregiver |
| G2185 | Documentation caregiver is trained and certified in dementia care |
| G2186 | Patient /caregiver dyad has been referred to appropriate resources and connection to those resources is confirmed |
| G2187 | Patients with clinical indications for imaging of the head: head trauma |
| G2188 | Patients with clinical indications for imaging of the head: new or change in headache above 50 years of age |
| G2189 | Patients with clinical indications for imaging of the head: abnormal neurologic exam |
| G2190 | Patients with clinical indications for imaging of the head: headache radiating to the neck |
| G2191 | Patients with clinical indications for imaging of the head: positional headaches |
| G2192 | Patients with clinical indications for imaging of the head: temporal headaches in patients over 55 years of age |
| G2193 | Patients with clinical indications for imaging of the head: new onset headache in pre-school children or younger (<6 years of age) |
| G2194 | Patients with clinical indications for imaging of the head: new onset headache in pediatric patients with disabilities for which headache is a concern as inferred from behavior |
| G2195 | Patients with clinical indications for imaging of the head: occipital headache in children |
| G2196 | Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method |
| G2197 | Patient screened for unhealthy alcohol use using a systematic screening method and not identified as an unhealthy alcohol user |
| G2198 | Documentation of medical reason(s) for not screening for unhealthy alcohol use using a systematic screening method (e.g., limited life expectancy, other medical reasons) Terminated: December 31, 2022 |
| G2199 | Patient not screened for unhealthy alcohol use using a systematic screening method |
| G2200 | Patient identified as an unhealthy alcohol user received brief counseling |
| G2201 | Documentation of medical reason(s) for not providing brief counseling (e.g., limited life expectancy, other medical reasons) Terminated: December 31, 2022 |
| G2202 | Patient did not receive brief counseling if identified as an unhealthy alcohol user |
| G2203 | Documentation of medical reason(s) for not providing brief counseling if identified as an unhealthy alcohol user (e.g., limited life expectancy, other medical reasons) Terminated: December 31, 2022 |
| G2204 | Patients between 45 and 85 years of age who received a screening colonoscopy during the performance period |
| G2205 | Patients with pregnancy during adjuvant treatment course |
| G2206 | Patient received adjuvant treatment course including both chemotherapy and her2-targeted therapy |
| G2207 | Reason for not administering adjuvant treatment course including both chemotherapy and her2-targeted therapy (e.g. poor performance status (ecog 3-4; karnofsky <=50), cardiac contraindications, insufficient renal function, insufficient hepatic function, other active or secondary cancer diagnoses, other medical contraindications, patients who died during initial treatment course or transferred during or after initial treatment course) |
| G2208 | Patient did not receive adjuvant treatment course including both chemotherapy and her2-targeted therapy |
| G2209 | Patient refused to participate |
| G2210 | Residual score for the neck impairment not measured because the patient did not complete the neck fs prom at initial evaluation and/or near discharge, reason not given |
| G2211 | Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established) |
| G2212 | Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99205, 99215, 99483 for office or other outpatient evaluation and management services) (do not report g2212 on the same date of service as 99358, 99359, 99415, 99416). (do not report g2212 for any time unit less than 15 minutes) |
| G2213 | Initiation of medication for the treatment of opioid use disorder in the emergency department setting, including assessment, referral to ongoing care, and arranging access to supportive services (list separately in addition to code for primary procedure) |
| G2214 | Initial or subsequent psychiatric collaborative care management, first 30 minutes in a month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional |
| G2215 | Take-home supply of nasal naloxone; 2-pack of 4mg per 0.1 ml nasal spray (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure |
| G2216 | Take-home supply of injectable naloxone (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure |
| G2250 | Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment |
| G2251 | Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of clinical discussion |
| G2252 | Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion |
| G3001 | Administration and supply of tositumomab, 450 mg Terminated: December 31, 2016 |
| G3002 | Chronic pain management and treatment, monthly bundle including, diagnosis; assessment and monitoring; administration of a validated pain rating scale or tool; the development, implementation, revision, and/or maintenance of a person-centered care plan that includes strengths, goals, clinical needs, and desired outcomes; overall treatment management; facilitation and coordination of any necessary behavioral health treatment; medication management; pain and health literacy counseling; any necessary chronic pain related crisis care; and ongoing communication and care coordination between relevant practitioners furnishing care, e.g. physical therapy and occupational therapy, complementary and integrative approaches, and community-based care, as appropriate. required initial face-to-face visit at least 30 minutes provided by a physician or other qualified health professional; first 30 minutes personally provided by physician or other qualified health care professional, per calendar month. (when using g3002, 30 minutes must be met or exceeded.) |
| G3003 | Each additional 15 minutes of chronic pain management and treatment by a physician or other qualified health care professional, per calendar month. (list separately in addition to code for g3002. when using g3003, 15 minutes must be met or exceeded.) |
| G4000 | Dermatology mips specialty set |
| G4001 | Diagnostic radiology mips specialty set |
| G4002 | Electrophysiology cardiac specialist mips specialty set |
| G4003 | Emergency medicine mips specialty set |
| G4004 | Endocrinology mips specialty set |
| G4005 | Family medicine mips specialty set |
| G4006 | Gastro-enterology mips specialty set |
| G4007 | General surgery mips specialty set |
| G4008 | Geriatrics mips specialty set |
| G4009 | Hospitalists mips specialty set |
| G4010 | Infectious disease mips specialty set |
| G4011 | Internal medicine mips specialty set |
| G4012 | Interventional radiology mips specialty set |
| G4013 | Mental/behavioral and psychiatry mips specialty set |
| G4014 | Nephrology mips specialty set |
| G4015 | Neurology mips specialty set |
| G4016 | Neurosurgical mips specialty set |
| G4017 | Nutrition/dietician mips specialty set |
| G4018 | Obstetrics/gynecology mips specialty set |
| G4019 | Oncology/hematology mips specialty set |
| G4020 | Ophthalmology/optometry mips specialty set |
| G4021 | Orthopedic surgery mips specialty set |
| G4022 | Otolaryngology mips specialty set |
| G4023 | Pathology mips specialty set |
| G4024 | Pediatrics mips specialty set |
| G4025 | Physical medicine mips specialty set |
| G4026 | Physical therapy/occupational therapy mips specialty set |
| G4027 | Plastic surgery mips specialty set |
| G4028 | Podiatry mips specialty set |
| G4029 | Preventive medicine mips specialty set |
| G4030 | Pulmonology mips specialty set |
| G4031 | Radiation oncology mips specialty set |
| G4032 | Rheumatology mips specialty set |
| G4033 | Skilled nursing facility mips specialty set |
| G4034 | Speech language pathology mips specialty set |
| G4035 | Thoracic surgery mips specialty set |
| G4036 | Urgent care mips specialty set |
| G4037 | Urology mips specialty set |
| G4038 | Vascular surgery mips specialty set |
| G6001 | Ultrasonic guidance for placement of radiation therapy fields |
| G6002 | Stereoscopic x-ray guidance for localization of target volume for the delivery of radiation therapy |
| G6003 | Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: up to 5 mev |
| G6004 | Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: 6-10 mev |
| G6005 | Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: 11-19 mev |
| G6006 | Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: 20 mev or greater |
| G6007 | Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: up to 5 mev |
| G6008 | Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 6-10 mev |
| G6009 | Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 11-19 mev |
| G6010 | Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 20 mev or greater |
| G6011 | Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; up to 5 mev |
| G6012 | Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 6-10 mev |
| G6013 | Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 11-19 mev |
| G6014 | Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 20 mev or greater |
| G6015 | Intensity modulated treatment delivery, single or multiple fields/arcs,via narrow spatially and temporally modulated beams, binary, dynamic mlc, per treatment session |
| G6016 | Compensator-based beam modulation treatment delivery of inverse planned treatment using 3 or more high resolution (milled or cast) compensator, convergent beam modulated fields, per treatment session |
| G6017 | Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy (eg,3d positional tracking, gating, 3d surface tracking), each fraction of treatment |
| G6018 | Ileoscopy, through stoma; with transendoscopic stent placement (includes predilation) Terminated: December 31, 2015 |
| G6019 | Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique Terminated: December 31, 2015 |
| G6020 | Colonoscopy through stoma; with transendoscopic stent placement (includes predilation) Terminated: December 31, 2015 |
| G6021 | Unlisted procedure, intestine Terminated: December 31, 2015 |
| G6022 | Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesions(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique Terminated: December 31, 2015 |
| G6023 | Sigmoidoscopy, flexible; with transendoscopic stent placement (includes predilation) Terminated: December 31, 2015 |
| G6024 | Colonoscopy, flexible; proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique Terminated: December 31, 2015 |
| G6025 | Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic stent placement (includes predilation) Terminated: December 31, 2015 |
| G6027 | Anoscopy, high resolution (hra) (with magnification and chemical agent enhancement); diagnostic, including collection of specimen(s) by brushing or washing when performed Terminated: December 31, 2015 |
| G6028 | Anoscopy, high resolution (hra) (with magnification and chemical agent enhancement); with biopsy(ies) Terminated: December 31, 2015 |
| G6030 | Amitriptyline Terminated: December 31, 2015 |
| G6031 | Benzodiazepines Terminated: December 31, 2015 |
| G6032 | Desipramine Terminated: December 31, 2015 |
| G6034 | Doxepin Terminated: December 31, 2015 |
| G6035 | Gold Terminated: December 31, 2015 |
| G6036 | Assay of imipramine Terminated: December 31, 2015 |
| G6037 | Nortriptyline Terminated: December 31, 2015 |
| G6038 | Salicylate Terminated: December 31, 2015 |
| G6039 | Acetaminophen Terminated: December 31, 2015 |
| G6040 | Alcohol (ethanol); any specimen except breath Terminated: December 31, 2015 |
| G6041 | Alkaloids, urine, quantitative Terminated: December 31, 2015 |
| G6042 | Amphetamine or methamphetamine Terminated: December 31, 2015 |
| G6043 | Barbiturates, not elsewhere specified Terminated: December 31, 2015 |
| G6044 | Cocaine or metabolite Terminated: December 31, 2015 |
| G6045 | Dihydrocodeinone Terminated: December 31, 2015 |
| G6046 | Dihydromorphinone Terminated: December 31, 2015 |
| G6047 | Dihydrotestosterone Terminated: December 31, 2015 |
| G6048 | Dimethadione Terminated: December 31, 2015 |
| G6049 | Epiandrosterone Terminated: December 31, 2015 |
| G6050 | Ethchlorvynol Terminated: December 31, 2015 |
| G6051 | Flurazepam Terminated: December 31, 2015 |
| G6052 | Meprobamate Terminated: December 31, 2015 |
| G6053 | Methadone Terminated: December 31, 2015 |
| G6054 | Methsuximide Terminated: December 31, 2015 |
| G6055 | Nicotine Terminated: December 31, 2015 |
| G6056 | Opiate(s), drug and metabolites, each procedure Terminated: December 31, 2015 |
| G6057 | Phenothiazine Terminated: December 31, 2015 |
| G6058 | Drug confirmation, each procedure Terminated: December 31, 2015 |
| G8126 | Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phase Terminated: December 31, 2014 |
| G8127 | Patient with a diagnosis of major depression not documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phase Terminated: December 31, 2014 |
| G8128 | Clinician documented that patient was not an eligible candidate for antidepressant medication during the entire 12 week acute treatment phase measure Terminated: December 31, 2014 |
| G8395 | Left ventricular ejection fraction (lvef) >= 40% or documentation as normal or mildly depressed left ventricular systolic function |
| G8396 | Left ventricular ejection fraction (lvef) not performed or documented |
| G8397 | Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema and level of severity of retinopathy |
| G8398 | Dilated macular or fundus exam not performed Terminated: December 31, 2020 |
| G8399 | Patient with documented results of a central dual-energy x-ray absorptiometry (dxa) ever being performed |
| G8400 | Patient with central dual-energy x-ray absorptiometry (dxa) results not documented, reason not given |
| G8401 | Clinician documented that patient was not an eligible candidate for screening Terminated: December 31, 2016 |
| G8404 | Lower extremity neurological exam performed and documented |
| G8405 | Lower extremity neurological exam not performed |
| G8406 | Clinician documented that patient was not an eligible candidate for lower extremity neurological exam measure Terminated: December 31, 2014 |
| G8410 | Footwear evaluation performed and documented |
| G8415 | Footwear evaluation was not performed |
| G8416 | Clinician documented that patient was not an eligible candidate for footwear evaluation measure |
| G8417 | Bmi is documented above normal parameters and a follow-up plan is documented |
| G8418 | Bmi is documented below normal parameters and a follow-up plan is documented |
| G8419 | Bmi documented outside normal parameters, no follow-up plan documented, no reason given |
| G8420 | Bmi is documented within normal parameters and no follow-up plan is required |
| G8421 | Bmi not documented and no reason is given |
| G8422 | Bmi not documented, documentation the patient is not eligible for bmi calculation Terminated: December 31, 2021 |
| G8427 | Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications |
| G8428 | Current list of medications not documented as obtained, updated, or reviewed by the eligible clinician, reason not given |
| G8430 | Documentation of a medical reason(s) for not documenting, updating, or reviewing the patient's current medications list (e.g., patient is in an urgent or emergent medical situation) |
| G8431 | Screening for depression is documented as being positive and a follow-up plan is documented |
| G8432 | Depression screening not documented, reason not given |
| G8433 | Screening for depression not completed, documented patient or medical reason |
| G8442 | Pain assessment not documented as being performed, documentation the patient is not eligible for a pain assessment using a standardized tool at the time of the encounter Terminated: December 31, 2020 |
| G8450 | Beta-blocker therapy prescribed |
| G8451 | Beta-blocker therapy for lvef <=40% not prescribed for reasons documented by the clinician (e.g., low blood pressure, fluid overload, asthma, patients recently treated with an intravenous positive inotropic agent, allergy, intolerance, other medical reasons, patient declined, other patient reasons) |
| G8452 | Beta-blocker therapy not prescribed |
| G8458 | Clinician documented that patient is not an eligible candidate for genotype testing; patient not receiving antiviral treatment for hepatitis c during the measurement period (e.g. genotype test done prior to the reporting period, patient declines, patient not a candidate for antiviral treatment) Terminated: December 31, 2016 |
| G8460 | Clinician documented that patient is not an eligible candidate for quantitative rna testing at week 12; patient not receiving antiviral treatment for hepatitis c Terminated: December 31, 2016 |
| G8461 | Patient receiving antiviral treatment for hepatitis c during the measurement period Terminated: December 31, 2016 |
| G8464 | Clinician documented that prostate cancer patient is not an eligible candidate for adjuvant hormonal therapy; low or intermediate risk of recurrence or risk of recurrence not determined Terminated: December 31, 2014 |
| G8465 | High or very high risk of recurrence of prostate cancer |
| G8473 | Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy prescribed |
| G8474 | Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy not prescribed for reasons documented by the clinician (e.g., allergy, intolerance, pregnancy, renal failure due to ace inhibitor, diseases of the aortic or mitral valve, other medical reasons) or (e.g., patient declined, other patient reasons) |
| G8475 | Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy not prescribed, reason not given |
| G8476 | Most recent blood pressure has a systolic measurement of < 140 mmhg and a diastolic measurement of < 90 mmhg |
| G8477 | Most recent blood pressure has a systolic measurement of >= 140 mmhg and/or a diastolic measurement of >= 90 mmhg |
| G8478 | Blood pressure measurement not performed or documented, reason not given |
| G8482 | Influenza immunization administered or previously received |
| G8483 | Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons) |
| G8484 | Influenza immunization was not administered, reason not given |
| G8485 | I intend to report the diabetes mellitus (dm) measures group Terminated: December 31, 2016 |
| G8486 | I intend to report the preventive care measures group Terminated: December 31, 2016 |
| G8487 | I intend to report the chronic kidney disease (ckd) measures group Terminated: December 31, 2016 |
| G8489 | I intend to report the coronary artery disease (cad) measures group Terminated: December 31, 2016 |
| G8490 | I intend to report the rheumatoid arthritis (ra) measures group Terminated: December 31, 2016 |
| G8491 | I intend to report the hiv/aids measures group Terminated: December 31, 2016 |
| G8492 | I intend to report the perioperative care measures group Terminated: December 31, 2014 |
| G8493 | I intend to report the back pain measures group Terminated: December 31, 2014 |
| G8494 | All quality actions for the applicable measures in the diabetes mellitus (dm) measures group have been performed for this patient Terminated: December 31, 2016 |
| G8495 | All quality actions for the applicable measures in the chronic kidney disease (ckd) measures group have been performed for this patient Terminated: December 31, 2016 |
| G8496 | All quality actions for the applicable measures in the preventive care measures group have been performed for this patient Terminated: December 31, 2016 |
| G8497 | All quality actions for the applicable measures in the coronary artery bypass graft (cabg) measures group have been performed for this patient Terminated: December 31, 2016 |
| G8498 | All quality actions for the applicable measures in the coronary artery disease (cad) measures group have been performed for this patient Terminated: December 31, 2016 |
| G8499 | All quality actions for the applicable measures in the rheumatoid arthritis (ra) measures group have been performed for this patient Terminated: December 31, 2016 |
| G8500 | All quality actions for the applicable measures in the hiv/aids measures group have been performed for this patient Terminated: December 31, 2016 |
| G8501 | All quality actions for the applicable measures in the perioperative care measures group have been performed for this patient Terminated: December 31, 2014 |
| G8502 | All quality actions for the applicable measures in the back pain measures group have been performed for this patient Terminated: December 31, 2014 |
| G8506 | Patient receiving angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy Terminated: December 31, 2023 |
| G8509 | Pain assessment documented as positive using a standardized tool, follow-up plan not documented, reason not given Terminated: December 31, 2020 |
| G8510 | Screening for depression is documented as negative, a follow-up plan is not required |
| G8511 | Screening for depression documented as positive, follow-up plan not documented, reason not given |
| G8530 | Autogenous av fistula received Terminated: December 31, 2015 |
| G8531 | Clinician documented that patient was not an eligible candidate for autogenous av fistula Terminated: December 31, 2015 |
| G8532 | Clinician documented that patient received vascular access other than autogenous av fistula, reason not given Terminated: December 31, 2015 |
| G8535 | Elder maltreatment screen not documented; documentation that patient is not eligible for the elder maltreatment screen at the time of the encounter related to one of the following reasons: (1) patient refuses to participate in the screening and has reasonable decisional capacity for self-protection, or (2) patient is in an urgent or emergent situation where time is of the essence and to delay treatment to perform the screening would jeopardize the patient's health status |
| G8536 | No documentation of an elder maltreatment screen, reason not given |
| G8539 | Functional outcome assessment documented as positive using a standardized tool and a care plan based on identified deficiencies is documented within two days of the functional outcome assessment |
| G8540 | Functional outcome assessment not documented as being performed, documentation the patient is not eligible for a functional outcome assessment using a standardized tool at the time of the encounter |
| G8541 | Functional outcome assessment using a standardized tool not documented, reason not given |
| G8542 | Functional outcome assessment using a standardized tool is documented; no functional deficiencies identified, care plan not required |
| G8543 | Documentation of a positive functional outcome assessment using a standardized tool; care plan not documented within two days of assessment, reason not given |
| G8544 | I intend to report the coronary artery bypass graft (cabg) measures group Terminated: December 31, 2016 |
| G8545 | I intend to report the hepatitis c measures group Terminated: December 31, 2016 |
| G8547 | I intend to report the ischemic vascular disease (ivd) measures group Terminated: December 31, 2014 |
| G8548 | I intend to report the heart failure (hf) measures group Terminated: December 31, 2016 |
| G8549 | All quality actions for the applicable measures in the hepatitis c measures group have been performed for this patient Terminated: December 31, 2016 |
| G8551 | All quality actions for the applicable measures in the heart failure (hf) measures group have been performed for this patient Terminated: December 31, 2016 |
| G8552 | All quality actions for the applicable measures in the ischemic vascular disease (ivd) measures group have been performed for this patient Terminated: December 31, 2014 |
| G8559 | Patient referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation |
| G8560 | Patient has a history of active drainage from the ear within the previous 90 days |
| G8561 | Patient is not eligible for the referral for otologic evaluation for patients with a history of active drainage measure |
| G8562 | Patient does not have a history of active drainage from the ear within the previous 90 days |
| G8563 | Patient not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not given |
| G8564 | Patient was referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not specified) |
| G8565 | Verification and documentation of sudden or rapidly progressive hearing loss |
| G8566 | Patient is not eligible for the "referral for otologic evaluation for sudden or rapidly progressive hearing loss" measure |
| G8567 | Patient does not have verification and documentation of sudden or rapidly progressive hearing loss |
| G8568 | Patient was not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not given |
| G8569 | Prolonged postoperative intubation (> 24 hrs) required |
| G8570 | Prolonged postoperative intubation (> 24 hrs) not required |
| G8571 | Development of deep sternal wound infection/mediastinitis within 30 days postoperatively Terminated: December 31, 2020 |
| G8572 | No deep sternal wound infection/mediastinitis Terminated: December 31, 2020 |
| G8573 | Stroke following isolated cabg surgery Terminated: December 31, 2020 |
| G8574 | No stroke following isolated cabg surgery Terminated: December 31, 2020 |
| G8575 | Developed postoperative renal failure or required dialysis |
| G8576 | No postoperative renal failure/dialysis not required |
| G8577 | Re-exploration required due to mediastinal bleeding with or without tamponade, graft occlusion, valve dysfunction or other cardiac reason |
| G8578 | Re-exploration not required due to mediastinal bleeding with or without tamponade, graft occlusion, valve dysfunction or other cardiac reason |
| G8579 | Antiplatelet medication at discharge Terminated: December 31, 2014 |
| G8580 | Antiplatelet medication contraindicated Terminated: December 31, 2014 |
| G8581 | No antiplatelet medication at discharge Terminated: December 31, 2014 |
| G8582 | Beta-blocker at discharge Terminated: December 31, 2014 |
| G8583 | Beta-blocker contraindicated Terminated: December 31, 2014 |
| G8584 | No beta-blocker at discharge Terminated: December 31, 2014 |
| G8585 | Anti-lipid treatment at discharge Terminated: December 31, 2014 |
| G8586 | Anti-lipid treatment contraindicated Terminated: December 31, 2014 |
| G8587 | No anti-lipid treatment at discharge Terminated: December 31, 2014 |
| G8593 | Lipid profile results documented and reviewed (must include total cholesterol, hdl-c, triglycerides and calculated ldl-c) Terminated: December 31, 2014 |
| G8594 | Lipid profile not performed, reason not given Terminated: December 31, 2014 |
| G8595 | Most recent ldl-c < 100 mg/dl Terminated: December 31, 2014 |
| G8597 | Most recent ldl-c >= 100 mg/dl Terminated: December 31, 2014 |
| G8598 | Aspirin or another antiplatelet therapy used |
| G8599 | Aspirin or another antiplatelet therapy not used, reason not given |
| G8600 | Iv thrombolytic therapy initiated within 4.5 hours (<= 270 minutes) of time last known well |
| G8601 | Iv thrombolytic therapy not initiated within 4.5 hours (<= 270 minutes) of time last known well for reasons documented by clinician (e.g. patient enrolled in clinical trial for stroke, patient admitted for elective carotid intervention) |
| G8602 | Iv thrombolytic therapy not initiated within 4.5 hours (<= 270 minutes) of time last known well, reason not given |
| G8627 | Surgical procedure performed within 30 days following cataract surgery for major complications (e.g., retained nuclear fragments, endophthalmitis, dislocated or wrong power iol, retinal detachment, or wound dehiscence) Terminated: December 31, 2020 |
| G8628 | Surgical procedure not performed within 30 days following cataract surgery for major complications (e.g., retained nuclear fragments, endophthalmitis, dislocated or wrong power iol, retinal detachment, or wound dehiscence) Terminated: December 31, 2020 |
| G8629 | Documentation of order for prophylactic parenteral antibiotic to be given within one hour (if fluoroquinolone or vancomycin, two hours) prior to surgical incision (or start of procedure when no incision is required) Terminated: December 31, 2014 |
| G8630 | Documentation that administration of prophylactic parenteral antibiotics was initiated within one hour (if fluoroquinolone or vancomycin, two hours) prior to surgical incision (or start of procedure when no incision is required), as ordered Terminated: December 31, 2014 |
| G8631 | Clinician documented that patient was not an eligible candidate for ordering prophylactic parenteral antibiotics to be given within one hour (if fluoroquinolone or vancomycin, two hours) prior to surgical incision (or start of procedure when no incision is required) Terminated: December 31, 2014 |
| G8632 | Prophylactic parenteral antibiotics were not ordered to be given or given within one hour (if fluoroquinolone or vancomycin, two hours) prior to the surgical incision (or start of procedure when no incision is required), reason not given Terminated: December 31, 2014 |
| G8633 | Pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed |
| G8634 | Clinician documented patient not an eligible candidate to receive pharmacologic therapy for osteoporosis Terminated: December 31, 2016 |
| G8635 | Pharmacologic therapy for osteoporosis was not prescribed, reason not given |
| G8645 | I intend to report the asthma measures group Terminated: December 31, 2016 |
| G8646 | All quality actions for the applicable measures in the asthma measures group have been performed for this patient Terminated: December 31, 2016 |
| G8647 | Residual score for the knee impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) |
| G8648 | Residual score for the knee impairment successfully calculated and the score was less than zero (< 0) |
| G8649 | Risk-adjusted functional status change residual score for the knee impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate Terminated: December 31, 2019 |
| G8650 | Residual score for the knee impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given |
| G8651 | Residual score for the hip impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) |
| G8652 | Residual score for the hip impairment successfully calculated and the score was less than zero (< 0) |
| G8653 | Risk-adjusted functional status change residual scores for the hip impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate Terminated: December 31, 2019 |
| G8654 | Residual score for the hip impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given |
| G8655 | Residual score for the lower leg, foot or ankle impairment successfully calculated and the score was equal to zero (0) or greater than zero ( > 0) |
| G8656 | Residual score for the lower leg, foot or ankle impairment successfully calculated and the score was less than zero (< 0) |
| G8657 | Risk-adjusted functional status change residual score for the lower leg, foot or ankle impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate Terminated: December 31, 2019 |
| G8658 | Residual score for the lower leg, foot or ankle impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given |
| G8659 | Residual score for the low back impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) |
| G8660 | Residual score for the low back impairment successfully calculated and the score was less than zero (< 0) |
| G8661 | Risk-adjusted functional status change residual score for the low back impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate |
| G8662 | Residual score for the low back impairment not measured because the patient did not complete the low back fs prom at initial evaluation and/or near discharge, reason not given |
| G8663 | Residual score for the shoulder impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) |
| G8664 | Residual score for the shoulder impairment successfully calculated and the score was less than zero (< 0) |
| G8665 | Risk-adjusted functional status change residual score for the shoulder impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate Terminated: December 31, 2019 |
| G8666 | Residual score for the shoulder impairment not measured because the patient did not complete the shoulder fs prom at initial evaluation and/or near discharge, reason not given |
| G8667 | Residual score for the elbow, wrist or hand impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) |
| G8668 | Residual score for the elbow, wrist or hand impairment successfully calculated and the score was less than zero (< 0) |
| G8669 | Risk-adjusted functional status change residual score for the elbow, wrist or hand impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate Terminated: December 31, 2019 |
| G8670 | Residual score for the elbow, wrist or hand impairment not measured because the patient did not complete the elbow/wrist/hand fs prom at initial evaluation and/or near discharge, reason not given |
| G8671 | Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs or other general orthopedic impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) Terminated: December 31, 2020 |
| G8672 | Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs or other general orthopedic impairment successfully calculated and the score was less than zero (< 0) Terminated: December 31, 2020 |
| G8673 | Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs or other general orthopedic impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate Terminated: December 31, 2019 |
| G8674 | Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs or other general orthopedic impairment not measured because the patient did not complete the general orthopedic fs prom at initial evaluation and/or near discharge, reason not given Terminated: December 31, 2020 |
| G8682 | Lvf testing documented as being performed prior to discharge or in the previous 12 months Terminated: December 31, 2014 |
| G8683 | Lvf testing not performed prior to discharge or in the previous 12 months for a medical or patient documented reason Terminated: December 31, 2014 |
| G8685 | Lvf testing not documented as being performed prior to discharge or in the previous 12 months, reason not given Terminated: December 31, 2014 |
| G8694 | Left ventricular ejection fraction (lvef) < = 40% or documentation of moderate or severe lvsd |
| G8696 | Antithrombotic therapy prescribed at discharge Terminated: December 31, 2017 |
| G8697 | Antithrombotic therapy not prescribed for documented reasons (e.g., patient had stroke during hospital stay, patient expired during inpatient stay, other medical reason(s)); (e.g., patient left against medical advice, other patient reason(s)) Terminated: December 31, 2017 |
| G8698 | Antithrombotic therapy was not prescribed at discharge, reason not given Terminated: December 31, 2017 |
| G8699 | Rehabilitation services (occupational, physical or speech) ordered at or prior to discharge Terminated: December 31, 2014 |
| G8700 | Rehabilitation services (occupational, physical or speech) not indicated at or prior to discharge Terminated: December 31, 2014 |
| G8701 | Rehabilitation services were not ordered, reason not otherwise specified Terminated: December 31, 2014 |
| G8702 | Documentation that prophylactic antibiotics were given within 4 hours prior to surgical incision or intraoperatively Terminated: December 31, 2014 |
| G8703 | Documentation that prophylactic antibiotics were neither given within 4 hours prior to surgical incision nor intraoperatively Terminated: December 31, 2014 |
| G8704 | 12-lead electrocardiogram (ecg) performed Terminated: December 31, 2014 |
| G8705 | Documentation of medical reason(s) for not performing a 12-lead electrocardiogram (ecg) Terminated: December 31, 2014 |
| G8706 | Documentation of patient reason(s) for not performing a 12-lead electrocardiogram (ecg) Terminated: December 31, 2014 |
| G8707 | 12-lead electrocardiogram (ecg) not performed, reason not given Terminated: December 31, 2014 |
| G8708 | Patient not prescribed antibiotic |
| G8709 | Uri episodes when the patient had competing diagnoses on or three days after the episode date (e.g., intestinal infection, pertussis, bacterial infection, lyme disease, otitis media, acute sinusitis, acute pharyngitis, acute tonsillitis, chronic sinusitis, infection of the pharynx/larynx/tonsils/adenoids, prostatitis, cellulitis, mastoiditis, or bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia/gonococcal infections, venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis or uti, and acne) |
| G8710 | Patient prescribed antibiotic |
| G8711 | Prescribed antibiotic on or within 3 days after the episode date |
| G8712 | Antibiotic not prescribed or dispensed |
| G8713 | Spkt/v greater than or equal to 1.2 (single-pool clearance of urea [kt] / volume [v]) Terminated: December 31, 2015 |
| G8714 | Hemodialysis treatment performed exactly three times per week for > 90 days Terminated: December 31, 2015 |
| G8717 | Spkt/v less than 1.2 (single-pool clearance of urea [kt] / volume [v]), reason not given Terminated: December 31, 2015 |
| G8718 | Total kt/v greater than or equal to 1.7 per week (total clearance of urea [kt] / volume [v]) Terminated: December 31, 2015 |
| G8720 | Total kt/v less than 1.7 per week (total clearance of urea [kt] / volume [v]) Terminated: December 31, 2015 |
| G8721 | Pt category (primary tumor), pn category (regional lymph nodes), and histologic grade were documented in pathology report |
| G8722 | Documentation of medical reason(s) for not including the pt category, the pn category or the histologic grade in the pathology report (e.g., re-excision without residual tumor; non-carcinomasanal canal) |
| G8723 | Specimen site is other than anatomic location of primary tumor |
| G8724 | Pt category, pn category and histologic grade were not documented in the pathology report, reason not given |
| G8725 | Fasting lipid profile performed (triglycerides, ldl-c, hdl-c and total cholesterol) Terminated: December 31, 2016 |
| G8726 | Clinician has documented reason for not performing fasting lipid profile (e.g., patient declined, other patient reasons) Terminated: December 31, 2016 |
| G8728 | Fasting lipid profile not performed, reason not given Terminated: December 31, 2016 |
| G8730 | Pain assessment documented as positive using a standardized tool and a follow-up plan is documented Terminated: December 31, 2020 |
| G8731 | Pain assessment using a standardized tool is documented as negative, no follow-up plan required Terminated: December 31, 2020 |
| G8732 | No documentation of pain assessment, reason not given Terminated: December 31, 2020 |
| G8733 | Elder maltreatment screen documented as positive and a follow-up plan is documented |
| G8734 | Elder maltreatment screen documented as negative, follow-up is not required |
| G8735 | Elder maltreatment screen documented as positive, follow-up plan not documented, reason not given |
| G8736 | Most current ldl-c <100mg/dl Terminated: December 31, 2014 |
| G8737 | Most current ldl-c >=100mg/dl Terminated: December 31, 2014 |
| G8738 | Left ventricular ejection fraction (lvef) < 40% or documentation of severely or moderately depressed left ventricular systolic function Terminated: December 31, 2014 |
| G8739 | Left ventricular ejection fraction (lvef) >= 40% or documentation as normal or mildly depressed left ventricular systolic function Terminated: December 31, 2014 |
| G8740 | Left ventricular ejection fraction (lvef) not performed or assessed, reason not given Terminated: December 31, 2014 |
| G8749 | Absence of signs of melanoma (tenderness, jaundice, localized neurologic signs such as weakness, or any other sign suggesting systemic spread) or absence of symptoms of melanoma (cough, dyspnea, pain, paresthesia, or any other symptom suggesting the possibility of systemic spread of melanoma) |
| G8751 | Smoking status and exposure to second hand smoke in the home not assessed, reason not given Terminated: December 31, 2014 |
| G8752 | Most recent systolic blood pressure < 140 mmhg |
| G8753 | Most recent systolic blood pressure >= 140 mmhg |
| G8754 | Most recent diastolic blood pressure < 90 mmhg |
| G8755 | Most recent diastolic blood pressure >= 90 mmhg |
| G8756 | No documentation of blood pressure measurement, reason not given |
| G8757 | All quality actions for the applicable measures in the chronic obstructive pulmonary disease (copd) measures group have been performed for this patient Terminated: December 31, 2016 |
| G8758 | All quality actions for the applicable measures in the inflammatory bowel disease (ibd) measures group have been performed for this patient Terminated: December 31, 2016 |
| G8759 | All quality actions for the applicable measures in the sleep apnea measures group have been performed for this patient Terminated: December 31, 2016 |
| G8761 | All quality actions for the applicable measures in the dementia measures group have been performed for this patient Terminated: December 31, 2016 |
| G8762 | All quality actions for the applicable measures in the parkinson's disease measures group have been performed for this patient Terminated: December 31, 2016 |
| G8763 | All quality actions for the applicable measures in the hypertension (htn) measures group have been performed for this patient Terminated: December 31, 2014 |
| G8764 | All quality actions for the applicable measures in the cardiovascular prevention measures group have bee performed for this patient Terminated: December 31, 2014 |
| G8765 | All quality actions for the applicable measures in the cataract measures group have been performed for this patient Terminated: December 31, 2016 |
| G8767 | Lipid panel results documented and reviewed (must include total cholesterol, hdl-c, triglycerides and calculated ldl-c) Terminated: December 31, 2014 |
| G8768 | Documentation of medical reason(s) for not performing lipid profile (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate) Terminated: December 31, 2014 |
| G8769 | Lipid profile not performed, reason not given Terminated: December 31, 2014 |
| G8770 | Urine protein test result documented and reviewed Terminated: December 31, 2014 |
| G8771 | Documentation of diagnosis of chronic kidney disease Terminated: December 31, 2014 |
| G8772 | Documentation of medical reason(s) for not performing urine protein test (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not cllinically appropriate) Terminated: December 31, 2014 |
| G8773 | Urine protein test was not performed, reason not given Terminated: December 31, 2014 |
| G8774 | Serum creatinine test result documented and reviewed Terminated: December 31, 2014 |
| G8775 | Documentation of medical reason(s) for not performing serum creatinine test (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate) Terminated: December 31, 2014 |
| G8776 | Serum creatinine test not performed, reason not given Terminated: December 31, 2014 |
| G8777 | Diabetes screening test performed Terminated: December 31, 2014 |
| G8778 | Documentation of medical reason(s) for not performing diabetes screening test (e.g., patients with a diagnosis of diabetes, or with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate) Terminated: December 31, 2014 |
| G8779 | Diabetes screening test not performed, reason not given Terminated: December 31, 2014 |
| G8780 | Counseling for diet and physical activity performed Terminated: December 31, 2014 |
| G8781 | Documentation of medical reason(s) for patient not receiving counseling for diet and physical activity (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate) Terminated: December 31, 2014 |
| G8782 | Counseling for diet and physical activity not performed, reason not given Terminated: December 31, 2014 |
| G8783 | Normal blood pressure reading documented, follow-up not required |
| G8784 | Patient not eligible (e.g., documentation the patient is not eligible due to active diagnosis of hypertension, patient refuses, urgent or emergent situation) Terminated: December 31, 2016 |
| G8785 | Blood pressure reading not documented, reason not given |
| G8797 | Specimen site other than anatomic location of esophagus |
| G8798 | Specimen site other than anatomic location of prostate |
| G8806 | Performance of trans-abdominal or trans-vaginal ultrasound and pregnancy location documented |
| G8807 | Trans-abdominal or trans-vaginal ultrasound not performed for reasons documented by clinician (e.g., patient has a documented intrauterine pregnancy [iup]) |
| G8808 | Trans-abdominal or trans-vaginal ultrasound not performed, reason not given |
| G8809 | Rh-immunoglobulin (rhogam) ordered Terminated: December 31, 2020 |
| G8810 | Rh-immunoglobulin (rhogam) not ordered for reasons documented by clinician (e.g., patient had prior documented receipt of rhogam within 12 weeks, patient refusal) Terminated: December 31, 2020 |
| G8811 | Documentation rh-immunoglobulin (rhogam) was not ordered, reason not given Terminated: December 31, 2020 |
| G8815 | Documented reason in the medical records for why the statin therapy was not prescribed (i.e., lower extremity bypass was for a patient with non-artherosclerotic disease) |
| G8816 | Statin medication prescribed at discharge |
| G8817 | Statin therapy not prescribed at discharge, reason not given |
| G8818 | Patient discharge to home no later than post-operative day #7 Terminated: December 31, 2023 |
| G8825 | Patient not discharged to home by post-operative day #7 Terminated: December 31, 2023 |
| G8826 | Patient discharged to home no later than post-operative day #2 following evar |
| G8833 | Patient not discharged to home by post-operative day #2 following evar |
| G8834 | Patient discharged to home no later than post-operative day #2 following cea |
| G8838 | Patient not discharged to home by post-operative day #2 following cea |
| G8839 | Sleep apnea symptoms assessed, including presence or absence of snoring and daytime sleepiness |
| G8840 | Documentation of reason(s) for not documenting an assessment of sleep symptoms (e.g., patient didn't have initial daytime sleepiness, patient visited between initial testing and initiation of therapy) |
| G8841 | Sleep apnea symptoms not assessed, reason not given |
| G8842 | Apnea hypopnea index (ahi), respiratory disturbance index (rdi) or respiratory event index (rei) documented or measured within 2 months of initial evaluation for suspected obstructive sleep apnea |
| G8843 | Documentation of reason(s) for not measuring an apnea hypopnea index (ahi), a respiratory disturbance index (rdi), or a respiratory event index (rei) within 2 months of initial evaluation for suspected obstructive sleep apnea (e.g., medical, neurological, or psychiatric disease that prohibits successful completion of a sleep study, patients for whom a sleep study would present a bigger risk than benefit or would pose an undue burden, dementia, patients who decline ahi/rdi/rei measurement, patients who had a financial reason for not completing testing, test was ordered but not completed, patients decline because their insurance (payer) does not cover the expense)) |
| G8844 | Apnea hypopnea index (ahi), respiratory disturbance index (rdi), or respiratory event index (rei) not documented or measured within 2 months of initial evaluation for suspected obstructive sleep apnea, reason not given |
| G8845 | Positive airway pressure therapy prescribed |
| G8846 | Moderate or severe obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory disturbance index (rdi) of 15 or greater) |
| G8848 | Mild obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory disturbance index (rdi) of less than 15) Terminated: December 31, 2016 |
| G8849 | Documentation of reason(s) for not prescribing positive airway pressure therapy (e.g., patient unable to tolerate, alternative therapies use, patient declined, financial, insurance coverage) |
| G8850 | Positive airway pressure therapy not prescribed, reason not given |
| G8851 | Adherence to therapy was assessed at least annually through an objective informatics system or through self-reporting (if objective reporting is not available, documented) |
| G8852 | Positive airway pressure therapy was prescribed Terminated: December 31, 2023 |
| G8853 | Positive airway pressure therapy not prescribed Terminated: December 31, 2016 |
| G8854 | Documentation of reason(s) for not objectively reporting adherence to evidence-based therapy (e.g., patients who have been diagnosed with a terminal or advanced disease with an expected life span of less than 6 months, patients who decline therapy, patients who do not return for follow-up at least annually, patients unable to access/afford therapy, patient's insurance will not cover therapy) |
| G8855 | Adherence to therapy was not assessed at least annually through an objective informatics system or through self-reporting (if objective reporting is not available), reason not given |
| G8856 | Referral to a physician for an otologic evaluation performed |
| G8857 | Patient is not eligible for the referral for otologic evaluation measure (e.g., patients who are already under the care of a physician for acute or chronic dizziness) |
| G8858 | Referral to a physician for an otologic evaluation not performed, reason not given |
| G8859 | Patient receiving corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days Terminated: December 31, 2014 |
| G8860 | Patients who have received dose of corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days Terminated: December 31, 2014 |
| G8861 | Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) ordered and documented, review of systems and medication history or pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed Terminated: December 31, 2019 |
| G8862 | Patients not receiving corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days Terminated: December 31, 2014 |
| G8863 | Patients not assessed for risk of bone loss, reason not given |
| G8864 | Pneumococcal vaccine administered or previously received |
| G8865 | Documentation of medical reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient allergic reaction, potential adverse drug reaction) |
| G8866 | Documentation of patient reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient refusal) |
| G8867 | Pneumococcal vaccine not administered or previously received, reason not given |
| G8868 | Patients receiving a first course of anti-tnf therapy Terminated: December 31, 2016 |
| G8869 | Patient has documented immunity to hepatitis b and initiating anti-tnf therapy |
| G8870 | Hepatitis b vaccine injection administered or previously received and is receiving a first course of anti-tnf therapy Terminated: December 31, 2015 |
| G8871 | Patient not receiving a first course of anti-tnf therapy Terminated: December 31, 2015 |
| G8872 | Excised tissue evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesion Terminated: December 31, 2020 |
| G8873 | Patients with needle localization specimens which are not amenable to intraoperative imaging such as mri needle wire localization, or targets which are tentatively identified on mammogram or ultrasound which do not contain a biopsy marker but which can be verified on intraoperative inspection or pathology (e.g., needle biopsy site where the biopsy marker is remote from the actual biopsy site) Terminated: December 31, 2020 |
| G8874 | Excised tissue not evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesion Terminated: December 31, 2020 |
| G8875 | Clinician diagnosed breast cancer preoperatively by a minimally invasive biopsy method |
| G8876 | Documentation of reason(s) for not performing minimally invasive biopsy to diagnose breast cancer preoperatively (e.g., lesion too close to skin, implant, chest wall, etc., lesion could not be adequately visualized for needle biopsy, patient condition prevents needle biopsy [weight, breast thickness, etc.], duct excision without imaging abnormality, prophylactic mastectomy, reduction mammoplasty, excisional biopsy performed by another physician) |
| G8877 | Clinician did not attempt to achieve the diagnosis of breast cancer preoperatively by a minimally invasive biopsy method, reason not given |
| G8878 | Sentinel lymph node biopsy procedure performed |
| G8879 | Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer Terminated: December 31, 2017 |
| G8880 | Documentation of reason(s) sentinel lymph node biopsy not performed (e.g., reasons could include but not limited to; non-invasive cancer, incidental discovery of breast cancer on prophylactic mastectomy, incidental discovery of breast cancer on reduction mammoplasty, pre-operative biopsy proven lymph node (ln) metastases, inflammatory carcinoma, stage 3 locally advanced cancer, recurrent invasive breast cancer, clinically node positive after neoadjuvant systemic therapy, patient refusal after informed consent, patient with significant age, comorbidities, or limited life expectancy and favorable tumor; adjuvant systemic therapy unlikely to change) |
| G8881 | Stage of breast cancer is greater than t1n0m0 or t2n0m0 |
| G8882 | Sentinel lymph node biopsy procedure not performed, reason not given |
| G8883 | Biopsy results reviewed, communicated, tracked and documented Terminated: December 31, 2023 |
| G8884 | Clinician documented reason that patient's biopsy results were not reviewed Terminated: December 31, 2023 |
| G8885 | Biopsy results not reviewed, communicated, tracked or documented Terminated: December 31, 2023 |
| G8886 | Most recent blood pressure under control Terminated: December 31, 2014 |
| G8887 | Documentation of medical reason(s) for most recent blood pressure not being under control (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate) Terminated: December 31, 2014 |
| G8888 | Most recent blood pressure not under control, results documented and reviewed Terminated: December 31, 2014 |
| G8889 | No documentation of blood pressure measurement, reason not given Terminated: December 31, 2014 |
| G8890 | Most recent ldl-c under control, results documented and reviewed Terminated: December 31, 2014 |
| G8891 | Documentation of medical reason(s) for most recent ldl-c not under control (e.g., patients with palliative goals for whom treatment of hypertension with standard treatment goals is not clinically appropriate) Terminated: December 31, 2014 |
| G8892 | Documentation of medical reason(s) for not performing ldl-c test (e.g. patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate) Terminated: December 31, 2014 |
| G8893 | Most recent ldl-c not under control, results documented and reviewed Terminated: December 31, 2014 |
| G8894 | Ldl-c not performed, reason not given Terminated: December 31, 2014 |
| G8895 | Oral aspirin or other antithrombotic therapy prescribed Terminated: December 31, 2014 |
| G8896 | Documentation of medical reason(s) for not prescribing oral aspirin or other antithrombotic therapy (e.g., patient documented to be low risk or patient with terminal illness or treatment of hypertension with standard treatment goals is not clinically appropriate, or for whom risk of aspirin or other antithrombotic therapy exceeds potential benefits such as for individuals whose blood pressure is poorly controlled) Terminated: December 31, 2014 |
| G8897 | Oral aspirin or other antithrombotic therapy was not prescribed, reason not given Terminated: December 31, 2014 |
| G8898 | I intend to report the chronic obstructive pulmonary disease (copd) measures group Terminated: December 31, 2016 |
| G8899 | I intend to report the inflammatory bowel disease (ibd) measures group Terminated: December 31, 2016 |
| G8900 | I intend to report the sleep apnea measures group Terminated: December 31, 2016 |
| G8902 | I intend to report the dementia measures group Terminated: December 31, 2016 |
| G8903 | I intend to report the parkinson's disease measures group Terminated: December 31, 2016 |
| G8904 | I intend to report the hypertension (htn) measures group Terminated: December 31, 2014 |
| G8905 | I intend to report the cardiovascular prevention measures group Terminated: December 31, 2014 |
| G8906 | I intend to report the cataract measures group Terminated: December 31, 2016 |
| G8907 | Patient documented not to have experienced any of the following events: a burn prior to discharge; a fall within the facility; wrong site/side/patient/procedure/implant event; or a hospital transfer or hospital admission upon discharge from the facility |
| G8908 | Patient documented to have received a burn prior to discharge |
| G8909 | Patient documented not to have received a burn prior to discharge |
| G8910 | Patient documented to have experienced a fall within asc |
| G8911 | Patient documented not to have experienced a fall within ambulatory surgical center |
| G8912 | Patient documented to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event |
| G8913 | Patient documented not to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event |
| G8914 | Patient documented to have experienced a hospital transfer or hospital admission upon discharge from asc |
| G8915 | Patient documented not to have experienced a hospital transfer or hospital admission upon discharge from asc |
| G8916 | Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic initiated on time |
| G8917 | Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic not initiated on time |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis |
| G8923 | Left ventricular ejection fraction (lvef) <= 40% or documentation of moderately or severely depressed left ventricular systolic function |
| G8924 | Spirometry results documented (fev1/fvc < 70%) |
| G8925 | Spirometry test results demonstrate fev1 >= 60% fev1/fvc >= 70%, predicted or patient does not have copd symptoms Terminated: December 31, 2021 |
| G8926 | Spirometry test not performed or documented, reason not given Terminated: December 31, 2021 |
| G8927 | Adjuvant chemotherapy referred, prescribed or previously received for ajcc stage iii, colon cancer Terminated: December 31, 2016 |
| G8928 | Adjuvant chemotherapy not prescribed or previously received, for documented reasons (e.g., medical co-morbidities, diagnosis date more than 5 years prior to the current visit date, patient's diagnosis date is within 120 days of the end of the 12 month reporting period, patient's cancer has metastasized, medical contraindication/allergy, poor performance status, other medical reasons, patient refusal, other patient reasons, patient is currently enrolled in a clinical trial that precludes prescription of chemotherapy, other system reasons) Terminated: December 31, 2016 |
| G8929 | Adjuvant chemotherapy not prescribed or previously received, reason not given Terminated: December 31, 2016 |
| G8930 | Assessment of depression severity at the initial evaluation Terminated: December 31, 2014 |
| G8931 | Assessment of depression severity not documented, reason not given Terminated: December 31, 2014 |
| G8932 | Suicide risk assessed at the initial evaluation Terminated: December 31, 2014 |
| G8933 | Suicide risk not assessed at the initial evaluation, reason not given Terminated: December 31, 2014 |
| G8934 | Left ventricular ejection fraction (lvef) <=40% or documentation of moderately or severely depressed left ventricular systolic function |
| G8935 | Clinician prescribed angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy |
| G8936 | Clinician documented that patient was not an eligible candidate for angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy (eg, allergy, intolerance, pregnancy, renal failure due to ace inhibitor, diseases of the aortic or mitral valve, other medical reasons) or (eg, patient declined, other patient reasons) |
| G8937 | Clinician did not prescribe angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy, reason not given |
| G8938 | Bmi is documented as being outside of normal parameters, follow-up plan is not documented, documentation the patient is not eligible Terminated: December 31, 2021 |
| G8939 | Pain assessment documented as positive, follow-up plan not documented, documentation the patient is not eligible at the time of the encounter Terminated: December 31, 2020 |
| G8940 | Screening for depression documented as positive, a follow-up plan not completed, documented reason Terminated: December 31, 2016 |
| G8941 | Elder maltreatment screen documented as positive, follow-up plan not documented, documentation the patient is not eligible for follow-up plan at the time of the encounter Terminated: December 31, 2023 |
| G8942 | Functional outcome assessment using a standardized tool is documented within the previous 30 days and a care plan, based on identified deficiencies is documented within two days of the functional outcome assessment |
| G8943 | Ldl-c result not present or not within 12 months prior Terminated: December 31, 2014 |
| G8944 | Ajcc melanoma cancer stage 0 through iic melanoma |
| G8946 | Minimally invasive biopsy method attempted but not diagnostic of breast cancer (e.g., high risk lesion of breast such as atypical ductal hyperplasia, lobular neoplasia, atypical lobular hyperplasia, lobular carcinoma in situ, atypical columnar hyperplasia, flat epithelial atypia, radial scar, complex sclerosing lesion, papillary lesion, or any lesion with spindle cells) |
| G8947 | One or more neuropsychiatric symptoms Terminated: December 31, 2017 |
| G8948 | No neuropsychiatric symptoms Terminated: December 31, 2016 |
| G8949 | Documentation of patient reason(s) for patient not receiving counseling for diet and physical activity (e.g., patient is not willing to discuss diet or exercise interventions to help control blood pressure, or the patient said he/she refused to make these changes) Terminated: December 31, 2014 |
| G8950 | Elevated or hypertensive blood pressure reading documented, and the indicated follow-up is documented |
| G8951 | Pre-hypertensive or hypertensive blood pressure reading documented, indicated follow-up not documented, documentation the patient is not eligible Terminated: December 31, 2015 |
| G8952 | Elevated or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given |
| G8953 | All quality actions for the applicable measures in the oncology measures group have been performed for this patient Terminated: December 31, 2016 |
| G8955 | Most recent assessment of adequacy of volume management documented |
| G8956 | Patient receiving maintenance hemodialysis in an outpatient dialysis facility |
| G8957 | Patient not receiving maintenance hemodialysis in an outpatient dialysis facility Terminated: December 31, 2014 |
| G8958 | Assessment of adequacy of volume management not documented, reason not given |
| G8959 | Clinician treating major depressive disorder communicates to clinician treating comorbid condition Terminated: December 31, 2020 |
| G8960 | Clinician treating major depressive disorder did not communicate to clinician treating comorbid condition, reason not given Terminated: December 31, 2020 |
| G8961 | Cardiac stress imaging test primarily performed on low-risk surgery patient for preoperative evaluation within 30 days preceding this surgery |
| G8962 | Cardiac stress imaging test performed on patient for any reason including those who did not have low risk surgery or test that was performed more than 30 days preceding low risk surgery |
| G8963 | Cardiac stress imaging performed primarily for monitoring of asymptomatic patient who had pci within 2 years Terminated: December 31, 2023 |
| G8964 | Cardiac stress imaging test performed primarily for any other reason than monitoring of asymptomatic patient who had pci within 2 years (e.g., symptomatic patient, patient greater than 2 years since pci, initial evaluation, etc) Terminated: December 31, 2023 |
| G8965 | Cardiac stress imaging test primarily performed on low chd risk patient for initial detection and risk assessment |
| G8966 | Cardiac stress imaging test performed on symptomatic or higher than low chd risk patient or for any reason other than initial detection and risk assessment |
| G8967 | Fda approved oral anticoagulant is prescribed |
| G8968 | Documentation of medical reason(s) for not prescribing an fda-approved anticoagulant (e.g., present or planned atrial appendage occlusion or ligation or patient being currently enrolled in a clinical trial related to af/atrial flutter treatment) |
| G8969 | Documentation of patient reason(s) for not prescribing an oral anticoagulant that is fda approved for the prevention of thromboembolism (e.g., patient preference for not receiving anticoagulation) |
| G8970 | No risk factors or one moderate risk factor for thromboembolism |
| G8971 | Warfarin or another oral anticoagulant that is fda approved not prescribed, reason not given Terminated: December 31, 2017 |
| G8972 | One or more high risk factors for thromboembolism or more than one moderate risk factor for thromboembolism Terminated: December 31, 2017 |
| G8973 | Most recent hemoglobin (hgb) level < 10 g/dl Terminated: December 31, 2020 |
| G8974 | Hemoglobin level measurement not documented, reason not given Terminated: December 31, 2020 |
| G8975 | Documentation of medical reason(s) for patient having a hemoglobin level < 10 g/dl (e.g., patients who have non-renal etiologies of anemia [e.g., sickle cell anemia or other hemoglobinopathies, hypersplenism, primary bone marrow disease, anemia related to chemotherapy for diagnosis of malignancy, postoperative bleeding, active bloodstream or peritoneal infection], other medical reasons) Terminated: December 31, 2020 |
| G8976 | Most recent hemoglobin (hgb) level >= 10 g/dl Terminated: December 31, 2020 |
| G8977 | I intend to report the oncology measures group Terminated: December 31, 2016 |
| G8978 | Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals Terminated: December 31, 2019 |
| G8979 | Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting Terminated: December 31, 2019 |
| G8980 | Mobility: walking & moving around functional limitation, discharge status, at discharge from therapy or to end reporting Terminated: December 31, 2019 |
| G8981 | Changing & maintaining body position functional limitation, current status, at therapy episode outset and at reporting intervals Terminated: December 31, 2019 |
| G8982 | Changing & maintaining body position functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting Terminated: December 31, 2019 |
| G8983 | Changing & maintaining body position functional limitation, discharge status, at discharge from therapy or to end reporting Terminated: December 31, 2019 |
| G8984 | Carrying, moving & handling objects functional limitation, current status, at therapy episode outset and at reporting intervals Terminated: December 31, 2019 |
| G8985 | Carrying, moving and handling objects, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting Terminated: December 31, 2019 |
| G8986 | Carrying, moving & handling objects functional limitation, discharge status, at discharge from therapy or to end reporting Terminated: December 31, 2019 |
| G8987 | Self care functional limitation, current status, at therapy episode outset and at reporting intervals Terminated: December 31, 2019 |
| G8988 | Self care functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting Terminated: December 31, 2019 |
| G8989 | Self care functional limitation, discharge status, at discharge from therapy or to end reporting Terminated: December 31, 2019 |
| G8990 | Other physical or occupational therapy primary functional limitation, current status, at therapy episode outset and at reporting intervals Terminated: December 31, 2019 |
| G8991 | Other physical or occupational therapy primary functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting Terminated: December 31, 2019 |
| G8992 | Other physical or occupational therapy primary functional limitation, discharge status, at discharge from therapy or to end reporting Terminated: December 31, 2019 |
| G8993 | Other physical or occupational therapy subsequent functional limitation, current status, at therapy episode outset and at reporting intervals Terminated: December 31, 2019 |
| G8994 | Other physical or occupational therapy subsequent functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting Terminated: December 31, 2019 |
| G8995 | Other physical or occupational therapy subsequent functional limitation, discharge status, at discharge from therapy or to end reporting Terminated: December 31, 2019 |
| G8996 | Swallowing functional limitation, current status at therapy episode outset and at reporting intervals Terminated: December 31, 2019 |
| G8997 | Swallowing functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting Terminated: December 31, 2019 |
| G8998 | Swallowing functional limitation, discharge status, at discharge from therapy or to end reporting Terminated: December 31, 2019 |
| G8999 | Motor speech functional limitation, current status at therapy episode outset and at reporting intervals Terminated: December 31, 2019 |
| G9001 | Coordinated care fee, initial rate |
| G9002 | Coordinated care fee, maintenance rate |
| G9003 | Coordinated care fee, risk adjusted high, initial |
| G9004 | Coordinated care fee, risk adjusted low, initial |
| G9005 | Coordinated care fee, risk adjusted maintenance |
| G9006 | Coordinated care fee, home monitoring |
| G9007 | Coordinated care fee, scheduled team conference |
| G9008 | Coordinated care fee, physician coordinated care oversight services |
| G9009 | Coordinated care fee, risk adjusted maintenance, level 3 |
| G9010 | Coordinated care fee, risk adjusted maintenance, level 4 |
| G9011 | Coordinated care fee, risk adjusted maintenance, level 5 |
| G9012 | Other specified case management service not elsewhere classified |
| G9013 | Esrd demo basic bundle level i |
| G9014 | Esrd demo expanded bundle including venous access and related services |
| G9016 | Smoking cessation counseling, individual, in the absence of or in addition to any other evaluation and management service, per session (6-10 minutes) [demo project code only] |
| G9017 | Amantadine hydrochloride, oral, per 100 mg (for use in a medicare-approved demonstration project) Terminated: December 31, 2019 |
| G9018 | Zanamivir, inhalation powder, administered through inhaler, per 10 mg (for use in a medicare-approved demonstration project) Terminated: December 31, 2019 |
| G9019 | Oseltamivir phosphate, oral, per 75 mg (for use in a medicare-approved demonstration project) Terminated: December 31, 2019 |
| G9020 | Rimantadine hydrochloride, oral, per 100 mg (for use in a medicare-approved demonstration project) Terminated: December 31, 2019 |
| G9033 | Amantadine hydrochloride, oral brand, per 100 mg (for use in a medicare-approved demonstration project) Terminated: December 31, 2019 |
| G9034 | Zanamivir, inhalation powder, administered through inhaler, brand, per 10 mg (for use in a medicare-approved demonstration project) Terminated: December 31, 2019 |
| G9035 | Oseltamivir phosphate, oral, brand, per 75 mg (for use in a medicare-approved demonstration project) Terminated: December 31, 2019 |
| G9036 | Rimantadine hydrochloride, oral, brand, per 100 mg (for use in a medicare-approved demonstration project) Terminated: December 31, 2019 |
| G9037 | Interprofessional telephone/internet/electronic health record clinical question/request for specialty recommendations by a treating/requesting physician or other qualified health care professional for the care of the patient (i.e. not for professional education or scheduling) and may include subsequent follow up on the specialist's recommendations; 30 minutes |
| G9038 | Co-management services with the following elements: new diagnosis or acute exacerbation and stabilization of existing condition; condition which may benefit from joint care planning; condition for which specialist is taking a co-management role; condition expected to last at least 3 months; comprehensive care plan established, implemented, revised or monitored in partnership with co-managing clinicians; ongoing communication and care coordination between co-managing clinicians furnishing care |
| G9050 | Oncology; primary focus of visit; work-up, evaluation, or staging at the time of cancer diagnosis or recurrence (for use in a medicare-approved demonstration project) |
| G9051 | Oncology; primary focus of visit; treatment decision-making after disease is staged or restaged, discussion of treatment options, supervising/coordinating active cancer directed therapy or managing consequences of cancer directed therapy (for use in a medicare-approved demonstration project) |
| G9052 | Oncology; primary focus of visit; surveillance for disease recurrence for patient who has completed definitive cancer-directed therapy and currently lacks evidence of recurrent disease; cancer directed therapy might be considered in the future (for use in a medicare-approved demonstration project) |
| G9053 | Oncology; primary focus of visit; expectant management of patient with evidence of cancer for whom no cancer directed therapy is being administered or arranged at present; cancer directed therapy might be considered in the future (for use in a medicare-approved demonstration project) |
| G9054 | Oncology; primary focus of visit; supervising, coordinating or managing care of patient with terminal cancer or for whom other medical illness prevents further cancer treatment; includes symptom management, end-of-life care planning, management of palliative therapies (for use in a medicare-approved demonstration project) |
| G9055 | Oncology; primary focus of visit; other, unspecified service not otherwise listed (for use in a medicare-approved demonstration project) |
| G9056 | Oncology; practice guidelines; management adheres to guidelines (for use in a medicare-approved demonstration project) |
| G9057 | Oncology; practice guidelines; management differs from guidelines as a result of patient enrollment in an institutional review board approved clinical trial (for use in a medicare-approved demonstration project) |
| G9058 | Oncology; practice guidelines; management differs from guidelines because the treating physician disagrees with guideline recommendations (for use in a medicare-approved demonstration project) |
| G9059 | Oncology; practice guidelines; management differs from guidelines because the patient, after being offered treatment consistent with guidelines, has opted for alternative treatment or management, including no treatment (for use in a medicare-approved demonstration project) |
| G9060 | Oncology; practice guidelines; management differs from guidelines for reason(s) associated with patient comorbid illness or performance status not factored into guidelines (for use in a medicare-approved demonstration project) |
| G9061 | Oncology; practice guidelines; patient's condition not addressed by available guidelines (for use in a medicare-approved demonstration project) |
| G9062 | Oncology; practice guidelines; management differs from guidelines for other reason(s) not listed (for use in a medicare-approved demonstration project) |
| G9063 | Oncology; disease status; limited to non-small cell lung cancer; extent of disease initially established as stage i (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9064 | Oncology; disease status; limited to non-small cell lung cancer; extent of disease initially established as stage ii (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9065 | Oncology; disease status; limited to non-small cell lung cancer; extent of disease initially established as stage iii a (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9066 | Oncology; disease status; limited to non-small cell lung cancer; stage iii b- iv at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) |
| G9067 | Oncology; disease status; limited to non-small cell lung cancer; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
| G9068 | Oncology; disease status; limited to small cell and combined small cell/non-small cell; extent of disease initially established as limited with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9069 | Oncology; disease status; small cell lung cancer, limited to small cell and combined small cell/non-small cell; extensive stage at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) |
| G9070 | Oncology; disease status; small cell lung cancer, limited to small cell and combined small cell/non-small; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
| G9071 | Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage i or stage iia-iib; or t3, n1, m0; and er and/or pr positive; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9072 | Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage i, or stage iia-iib; or t3, n1, m0; and er and pr negative; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9073 | Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage iiia-iiib; and not t3, n1, m0; and er and/or pr positive; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9074 | Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage iiia-iiib; and not t3, n1, m0; and er and pr negative; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9075 | Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) |
| G9077 | Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t1-t2c and gleason 2-7 and psa < or equal to 20 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9078 | Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t2 or t3a gleason 8-10 or psa > 20 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9079 | Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t3b-t4, any n; any t, n1 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9080 | Oncology; disease status; prostate cancer, limited to adenocarcinoma; after initial treatment with rising psa or failure of psa decline (for use in a medicare-approved demonstration project) |
| G9083 | Oncology; disease status; prostate cancer, limited to adenocarcinoma; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
| G9084 | Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-3, n0, m0 with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9085 | Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t4, n0, m0 with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9086 | Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-4, n1-2, m0 with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9087 | Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive with current clinical, radiologic, or biochemical evidence of disease (for use in a medicare-approved demonstration project) |
| G9088 | Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive without current clinical, radiologic, or biochemical evidence of disease (for use in a medicare-approved demonstration project) |
| G9089 | Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
| G9090 | Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-2, n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9091 | Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t3, n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9092 | Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-3, n1-2, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence or metastases (for use in a medicare-approved demonstration project) |
| G9093 | Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t4, any n, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9094 | Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) |
| G9095 | Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
| G9096 | Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; extent of disease initially established as t1-t3, n0-n1 or nx (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9097 | Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; extent of disease initially established as t4, any n, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9098 | Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) |
| G9099 | Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
| G9100 | Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; post r0 resection (with or without neoadjuvant therapy) with no evidence of disease recurrence, progression, or metastases (for use in a medicare-approved demonstration project) |
| G9101 | Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; post r1 or r2 resection (with or without neoadjuvant therapy) with no evidence of disease progression, or metastases (for use in a medicare-approved demonstration project) |
| G9102 | Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; clinical or pathologic m0, unresectable with no evidence of disease progression, or metastases (for use in a medicare-approved demonstration project) |
| G9103 | Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; clinical or pathologic m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) |
| G9104 | Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
| G9105 | Oncology; disease status; pancreatic cancer, limited to adenocarcinoma as predominant cell type; post r0 resection without evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9106 | Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; post r1 or r2 resection with no evidence of disease progression, or metastases (for use in a medicare-approved demonstration project) |
| G9107 | Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; unresectable at diagnosis, m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) |
| G9108 | Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
| G9109 | Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; extent of disease initially established as t1-t2 and n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9110 | Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; extent of disease initially established as t3-4 and/or n1-3, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9111 | Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) |
| G9112 | Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
| G9113 | Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage ia-b (grade 1) without evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9114 | Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage ia-b (grade 2-3); or stage ic (all grades); or stage ii; without evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9115 | Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage iii-iv; without evidence of progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9116 | Oncology; disease status; ovarian cancer, limited to epithelial cancer; evidence of disease progression, or recurrence, and/or platinum resistance (for use in a medicare-approved demonstration project) |
| G9117 | Oncology; disease status; ovarian cancer, limited to epithelial cancer; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
| G9123 | Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; chronic phase not in hematologic, cytogenetic, or molecular remission (for use in a medicare-approved demonstration project) |
| G9124 | Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; accelerated phase not in hematologic cytogenetic, or molecular remission (for use in a medicare-approved demonstration project) |
| G9125 | Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; blast phase not in hematologic, cytogenetic, or molecular remission (for use in a medicare-approved demonstration project) |
| G9126 | Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; in hematologic, cytogenetic, or molecular remission (for use in a medicare-approved demonstration project) |
| G9128 | Oncology; disease status; limited to multiple myeloma, systemic disease; smoldering, stage i (for use in a medicare-approved demonstration project) |
| G9129 | Oncology; disease status; limited to multiple myeloma, systemic disease; stage ii or higher (for use in a medicare-approved demonstration project) |
| G9130 | Oncology; disease status; limited to multiple myeloma, systemic disease; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
| G9131 | Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
| G9132 | Oncology; disease status; prostate cancer, limited to adenocarcinoma; hormone-refractory/androgen-independent (e.g., rising psa on anti-androgen therapy or post-orchiectomy); clinical metastases (for use in a medicare-approved demonstration project) |
| G9133 | Oncology; disease status; prostate cancer, limited to adenocarcinoma; hormone-responsive; clinical metastases or m1 at diagnosis (for use in a medicare-approved demonstration project) |
| G9134 | Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; stage i, ii at diagnosis, not relapsed, not refractory (for use in a medicare-approved demonstration project) |
| G9135 | Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; stage iii, iv, not relapsed, not refractory (for use in a medicare-approved demonstration project) |
| G9136 | Oncology; disease status; non-hodgkin's lymphoma, transformed from original cellular diagnosis to a second cellular classification (for use in a medicare-approved demonstration project) |
| G9137 | Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; relapsed/refractory (for use in a medicare-approved demonstration project) |
| G9138 | Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; diagnostic evaluation, stage not determined, evaluation of possible relapse or non-response to therapy, or not listed (for use in a medicare-approved demonstration project) |
| G9139 | Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; extent of disease unknown, staging in progress, not listed (for use in a medicare-approved demonstration project) |
| G9140 | Frontier extended stay clinic demonstration; for a patient stay in a clinic approved for the cms demonstration project; the following measures should be present: the stay must be equal to or greater than 4 hours; weather or other conditions must prevent transfer or the case falls into a category of monitoring and observation cases that are permitted by the rules of the demonstration; there is a maximum frontier extended stay clinic (fesc) visit of 48 hours, except in the case when weather or other conditions prevent transfer; payment is made on each period up to 4 hours, after the first 4 hours |
| G9143 | Warfarin responsiveness testing by genetic technique using any method, any number of specimen(s) |
| G9147 | Outpatient intravenous insulin treatment (oivit) either pulsatile or continuous, by any means, guided by the results of measurements for: respiratory quotient; and/or, urine urea nitrogen (uun); and/or, arterial, venous or capillary glucose; and/or potassium concentration |
| G9148 | National committee for quality assurance - level 1 medical home |
| G9149 | National committee for quality assurance - level 2 medical home |
| G9150 | National committee for quality assurance - level 3 medical home |
| G9151 | Mapcp demonstration - state provided services |
| G9152 | Mapcp demonstration - community health teams |
| G9153 | Mapcp demonstration - physician incentive pool |
| G9156 | Evaluation for wheelchair requiring face to face visit with physician |
| G9157 | Transesophageal doppler measurement of cardiac output (including probe placement, image acquisition, and interpretation per course of treatment) for monitoring purposes |
| G9158 | Motor speech functional limitation, discharge status, at discharge from therapy or to end reporting Terminated: December 31, 2019 |
| G9159 | Spoken language comprehension functional limitation, current status at therapy episode outset and at reporting intervals Terminated: December 31, 2019 |
| G9160 | Spoken language comprehension functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting Terminated: December 31, 2019 |
| G9161 | Spoken language comprehension functional limitation, discharge status, at discharge from therapy or to end reporting Terminated: December 31, 2019 |
| G9162 | Spoken language expression functional limitation, current status at therapy episode outset and at reporting intervals Terminated: December 31, 2019 |
| G9163 | Spoken language expression functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting Terminated: December 31, 2019 |
| G9164 | Spoken language expression functional limitation, discharge status at discharge from therapy or to end reporting Terminated: December 31, 2019 |
| G9165 | Attention functional limitation, current status at therapy episode outset and at reporting intervals Terminated: December 31, 2019 |
| G9166 | Attention functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting Terminated: December 31, 2019 |
| G9167 | Attention functional limitation, discharge status at discharge from therapy or to end reporting Terminated: December 31, 2019 |
| G9168 | Memory functional limitation, current status at therapy episode outset and at reporting intervals Terminated: December 31, 2019 |
| G9169 | Memory functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting Terminated: December 31, 2019 |
| G9170 | Memory functional limitation, discharge status at discharge from therapy or to end reporting Terminated: December 31, 2019 |
| G9171 | Voice functional limitation, current status at therapy episode outset and at reporting intervals Terminated: December 31, 2019 |
| G9172 | Voice functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting Terminated: December 31, 2019 |
| G9173 | Voice functional limitation, discharge status at discharge from therapy or to end reporting Terminated: December 31, 2019 |
| G9174 | Other speech language pathology functional limitation, current status at therapy episode outset and at reporting intervals Terminated: December 31, 2019 |
| G9175 | Other speech language pathology functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting Terminated: December 31, 2019 |
| G9176 | Other speech language pathology functional limitation, discharge status at discharge from therapy or to end reporting Terminated: December 31, 2019 |
| G9186 | Motor speech functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting Terminated: December 31, 2019 |
| G9187 | Bundled payments for care improvement initiative home visit for patient assessment performed by a qualified health care professional for individuals not considered homebound including, but not limited to, assessment of safety, falls, clinical status, fluid status, medication reconciliation/management, patient compliance with orders/plan of care, performance of activities of daily living, appropriateness of care setting; (for use only in the meidcare-approved bundled payments for care improvement initiative); may not be billed for a 30-day period covered by a transitional care management code |
| G9188 | Beta-blocker therapy not prescribed, reason not given |
| G9189 | Beta-blocker therapy prescribed or currently being taken |
| G9190 | Documentation of medical reason(s) for not prescribing beta-blocker therapy (eg, allergy, intolerance, other medical reasons) |
| G9191 | Documentation of patient reason(s) for not prescribing beta-blocker therapy (eg, patient declined, other patient reasons) |
| G9192 | Documentation of system reason(s) for not prescribing beta-blocker therapy (eg, other reasons attributable to the health care system) Terminated: December 31, 2023 |
| G9193 | Clinician documented that patient with a diagnosis of major depression was not an eligible candidate for antidepressant medication treatment or patient did not have a diagnosis of major depression Terminated: December 31, 2014 |
| G9194 | Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 180 day (6 month) continuation treatment phase Terminated: December 31, 2014 |
| G9195 | Patient with a diagnosis of major depression not documented as being treated with antidepressant medication during the entire 180 day (6 months) continuation treatment phase Terminated: December 31, 2014 |
| G9196 | Documentation of medical reason(s) for not ordering a first or second generation cephalosporin for antimicrobial prophylaxis (e.g., patients enrolled in clinical trials, patients with documented infection prior to surgical procedure of interest, patients who were receiving antibiotics more than 24 hours prior to surgery [except colon surgery patients taking oral prophylactic antibiotics], patients who were receiving antibiotics within 24 hours prior to arrival [except colon surgery patients taking oral prophylactic antibiotics], other medical reason(s)) Terminated: December 31, 2022 |
| G9197 | Documentation of order for first or second generation cephalosporin for antimicrobial prophylaxis Terminated: December 31, 2022 |
| G9198 | Order for first or second generation cephalosporin for antimicrobial prophylaxis was not documented, reason not given Terminated: December 31, 2022 |
| G9199 | Venous thromboembolism (vte) prophylaxis not administered the day of or the day after hospital admission for documented reasons (eg, patient is ambulatory, patient expired during inpatient stay, patient already on warfarin or another anticoagulant, other medical reason(s) or eg, patient left against medical advice, other patient reason(s)) Terminated: December 31, 2014 |
| G9200 | Venous thromboembolism (vte) prophylaxis was not administered the day of or the day after hospital admission, reason not given Terminated: December 31, 2014 |
| G9201 | Venous thromboembolism (vte) prophylaxis administered the day of or the day after hospital admission Terminated: December 31, 2014 |
| G9202 | Patients with a positive hepatitis c antibody test Terminated: December 31, 2014 |
| G9203 | Rna testing for hepatitis c documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c Terminated: December 31, 2016 |
| G9204 | Rna testing for hepatitis c was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c, reason not given Terminated: December 31, 2016 |
| G9205 | Patient starting antiviral treatmentfor hepatitis c during the measurement period Terminated: December 31, 2016 |
| G9206 | Patient starting antiviral treatment for hepatitis c during the measurement period Terminated: December 31, 2016 |
| G9207 | Hepatitis c genotype testing documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c Terminated: December 31, 2016 |
| G9208 | Hepatitis c genotype testing was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c, reason not given Terminated: December 31, 2016 |
| G9209 | Hepatitis c quantitative rna testing documented as performed between 4-12 weeks after the initiation of antiviral treatment Terminated: December 31, 2016 |
| G9210 | Hepatitis c quantitative rna testing not performed between 4-12 weeks after the initiation of antiviral treatment for documented reason(s) (e.g., patients whose treatment was discontinued during the testing period prior to testing, other medical reasons, patient declined, other patient reasons) Terminated: December 31, 2016 |
| G9211 | Hepatitis c quantitative rna testing was not documented as performed between 4-12 weeks after the initiation of antiviral treatment, reason not given Terminated: December 31, 2016 |
| G9212 | Dsm-ivtm criteria for major depressive disorder documented at the initial evaluation |
| G9213 | Dsm-iv-tr criteria for major depressive disorder not documented at the initial evaluation, reason not otherwise specified |
| G9214 | Cd4+ cell count or cd4+ cell percentage results documented Terminated: December 31, 2014 |
| G9215 | Cd4+ cell count or percentage not documented as performed, reason not given Terminated: December 31, 2014 |
| G9216 | Pcp prophylaxis was not prescribed at time of diagnosis of hiv, reason not given Terminated: December 31, 2014 |
| G9217 | Pcp prophylaxis was not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3, reason not given Terminated: December 31, 2016 |
| G9218 | Pcp prophylaxis was not prescribed within 3 months oflow cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%, reason not given Terminated: December 31, 2014 |
| G9219 | Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3 for medical reason (i.e., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis) Terminated: December 31, 2016 |
| G9220 | Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15% for medical reason (i.e., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis) Terminated: December 31, 2014 |
| G9221 | Pneumocystis jiroveci pneumonia prophlaxis prescribed Terminated: December 31, 2014 |
| G9222 | Pneumocystis jiroveci pneumonia prophylaxis prescribed wthin 3 months of low cd4+ cell count below 200 cells/mm3 Terminated: December 31, 2016 |
| G9223 | Pneumocystis jiroveci pneumonia prophylaxis prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15% |
| G9224 | Documentation of medical reason for not performing foot exam (e.g., patient with bilateral foot/leg amputation) Terminated: December 31, 2014 |
| G9225 | Foot exam was not performed, reason not given |
| G9226 | Foot examination performed (includes examination through visual inspection, sensory exam with 10-g monofilament plus testing any one of the following: vibration using 128-hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception threshold, and pulse exam; report when all of the 3 components are completed) |
| G9227 | Functional outcome assessment documented, care plan not documented, documentation the patient is not eligible for a care plan at the time of the encounter |
| G9228 | Chlamydia, gonorrhea and syphilis screening results documented (report when results are present for all of the 3 screenings) |
| G9229 | Chlamydia, gonorrhea, and syphilis screening results not documented (patient refusal is the only allowed exception) Terminated: December 31, 2023 |
| G9230 | Chlamydia, gonorrhea, and syphilis not screened, reason not given |
| G9231 | Documentation of end stage renal disease (esrd), dialysis, renal transplant before or during the measurement period or pregnancy during the measurement period |
| G9232 | Clinician treating major depressive disorder did not communicate to clinician treating comorbid condition for specified patient reason (e.g., patient is unable to communicate the diagnosis of a comorbid condition; the patient is unwilling to communicate the diagnosis of a comorbid condition; or the patient is unaware of the comorbid condition, or any other specified patient reason) Terminated: December 31, 2020 |
| G9233 | All quality actions for the applicable measures in the total knee replacement measures group have been performed for this patient Terminated: December 31, 2016 |
| G9234 | I intend to report the total knee replacement measures group Terminated: December 31, 2016 |
| G9235 | All quality actions for the applicable measures in the general surgery measures group have been performed for this patient Terminated: December 31, 2016 |
| G9236 | All quality actions for the applicable measures in the optimizing patient exposure to ionizing radiation measures group have been performed for this patient Terminated: December 31, 2016 |
| G9237 | I intend to report the general surgery measures group Terminated: December 31, 2016 |
| G9238 | I intend to report the optimizing patient exposure to ionizing radiation measures group Terminated: December 31, 2016 |
| G9239 | Documentation of reasons for patient initiating maintenance hemodialysis with a catheter as the mode of vascular access (e.g., patient has a maturing arteriovenous fistula (avf)/arteriovenous graft (avg), time-limited trial of hemodialysis, other medical reasons, patient declined avf/avg, other patient reasons, patient followed by reporting nephrologist for fewer than 90 days, other system reasons) Terminated: December 31, 2020 |
| G9240 | Patient whose mode of vascular access is a catheter at the time maintenance hemodialysis is initiated Terminated: December 31, 2020 |
| G9241 | Patient whose mode of vascular access is not a catheter at the time maintenance hemodialysis is initiated Terminated: December 31, 2020 |
| G9242 | Documentation of viral load equal to or greater than 200 copies/ml or viral load not performed |
| G9243 | Documentation of viral load less than 200 copies/ml |
| G9244 | Antiretroviral thereapy not prescribed Terminated: December 31, 2016 |
| G9245 | Antiretroviral therapy prescribed Terminated: December 31, 2016 |
| G9246 | Patient did not have at least one medical visit in each 6 month period of the 24 month measurement period, with a minimum of 60 days between medical visits |
| G9247 | Patient had at least one medical visit in each 6 month period of the 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 Terminated: December 31, 2014 |
| G9249 | Patient had a medical visit in the last 6 months Terminated: December 31, 2014 |
| G9250 | Documentation of patient pain brought to a comfortable level within 48 hours from initial assessment Terminated: December 31, 2022 |
| G9251 | Documentation of patient with pain not brought to a comfortable level within 48 hours from initial assessment Terminated: December 31, 2022 |
| G9252 | Adenoma(s) or other neoplasm detected during screening colonoscopy Terminated: December 31, 2014 |
| G9253 | Adenoma(s) or other neoplasm not detected during screening colonoscopy Terminated: December 31, 2014 |
| G9254 | Documentation of patient discharged to home later than post-operative day 2 following cas |
| G9255 | Documentation of patient discharged to home no later than post operative day 2 following cas |
| G9256 | Documentation of patient death following cas Terminated: December 31, 2020 |
| G9257 | Documentation of patient stroke following cas Terminated: December 31, 2020 |
| G9258 | Documentation of patient stroke following cea Terminated: December 31, 2020 |
| G9259 | Documentation of patient survival and absence of stroke following cas Terminated: December 31, 2020 |
| G9260 | Documentation of patient death following cea Terminated: December 31, 2020 |
| G9261 | Documentation of patient survival and absence of stroke following cea Terminated: December 31, 2020 |
| G9262 | Documentation of patient death in the hospital following endovascular aaa repair Terminated: December 31, 2020 |
| G9263 | Documentation of patient discharged alive following endovascular aaa repair Terminated: December 31, 2020 |
| G9264 | Documentation of patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter for documented reasons (e.g., other medical reasons, patient declined arteriovenous fistula (avf)/arteriovenous graft (avg), other patient reasons) Terminated: December 31, 2020 |
| G9265 | Patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter as the mode of vascular access Terminated: December 31, 2020 |
| G9266 | Patient receiving maintenance hemodialysis for greater than or equal to 90 days without a catheter as the mode of vascular access Terminated: December 31, 2020 |
| G9267 | Documentation of patient with one or more complications or mortality within 30 days Terminated: December 31, 2021 |
| G9268 | Documentation of patient with one or more complications within 90 days Terminated: December 31, 2021 |
| G9269 | Documentation of patient without one or more complications and without mortality within 30 days Terminated: December 31, 2021 |
| G9270 | Documentation of patient without one or more complications within 90 days Terminated: December 31, 2021 |
| G9271 | Ldl value < 100 Terminated: December 31, 2014 |
| G9272 | Ldl value >= 100 Terminated: December 31, 2014 |
| G9273 | Blood pressure has a systolic value of < 140 and a diastolic value of < 90 |
| G9274 | Blood pressure has a systolic value of =140 and a diastolic value of = 90 or systolic value < 140 and diastolic value = 90 or systolic value = 140 and diastolic value < 90 |
| G9275 | Documentation that patient is a current non-tobacco user |
| G9276 | Documentation that patient is a current tobacco user |
| G9277 | Documentation that the patient is on daily aspirin or anti-platelet or has documentation of a valid contraindication or exception to aspirin/anti-platelet; contraindications/exceptions include anti-coagulant use, allergy to aspirin or anti-platelets, history of gastrointestinal bleed and bleeding disorder; additionally, the following exceptions documented by the physician as a reason for not taking daily aspirin or anti-platelet are acceptable (use of non-steroidal anti-inflammatory agents, documented risk for drug interaction, uncontrolled hypertension defined as >180 systolic or >110 diastolic or gastroesophageal reflux) |
| G9278 | Documentation that the patient is not on daily aspirin or anti-platelet regimen |
| G9279 | Pneumococcal screening performed and documentation of vaccination received prior to discharge |
| G9280 | Pneumococcal vaccination not administered prior to discharge, reason not specified |
| G9281 | Screening performed and documentation that vaccination not indicated/patient refusal |
| G9282 | Documentation of medical reason(s) for not reporting the histological type or nsclc-nos classification with an explanation (e.g., biopsy taken for other purposes in a patient with a history of non-small cell lung cancer or other documented medical reasons) |
| G9283 | Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation |
| G9284 | Non small cell lung cancer biopsy and cytology specimen report does not document classification into specific histologic type or classified as nsclc-nos with an explanation |
| G9285 | Specimen site other than anatomic location of lung or is not classified as non small cell lung cancer |
| G9286 | Antibiotic regimen prescribed within 10 days after onset of symptoms |
| G9287 | Antibiotic regimen not prescribed within 10 days after onset of symptoms |
| G9288 | Documentation of medical reason(s) for not reporting the histological type or nsclc-nos classification with an explanation (e.g., a solitary fibrous tumor in a person with a history of non-small cell carcinoma or other documented medical reasons) |
| G9289 | Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation |
| G9290 | Non small cell lung cancer biopsy and cytology specimen report does not document classification into specific histologic type or classified as nsclc-nos with an explanation |
| G9291 | Specimen site other than anatomic location of lung, is not classified as non small cell lung cancer or classified as nsclc-nos |
| G9292 | Documentation of medical reason(s) for not reporting pt category and a statement on thickness and ulceration and for pt1, mitotic rate (e.g., negative skin biopsies in a patient with a history of melanoma or other documented medical reasons) |
| G9293 | Pathology report does not include the pt category and a statement on thickness and ulceration and for pt1, mitotic rate |
| G9294 | Pathology report includes the pt category and a statement on thickness and ulceration and for pt1, mitotic rate |
| G9295 | Specimen site other than anatomic cutaneous location |
| G9296 | Patients with documented shared decision-making including discussion of conservative (non-surgical) therapy (e.g., nsaids, analgesics, weight loss, exercise, injections) prior to the procedure |
| G9297 | Shared decision-making including discussion of conservative (non-surgical) therapy (e.g., nsaids, analgesics, weight loss, exercise, injections) prior to the procedure, not documented, reason not given |
| G9298 | Patients who are evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (e.g., history of dvt, pe, mi, arrhythmia and stroke) |
| G9299 | Patients who are not evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (e.g., history of dvt, pe, mi, arrhythmia and stroke, reason not given) |
| G9300 | Documentation of medical reason(s) for not completely infusing the prophylactic antibiotic prior to the inflation of the proximal tourniquet (e.g., a tourniquet was not used) Terminated: December 31, 2020 |
| G9301 | Patients who had the prophylactic antibiotic completely infused prior to the inflation of the proximal tourniquet Terminated: December 31, 2020 |
| G9302 | Prophylactic antibiotic not completely infused prior to the inflation of the proximal tourniquet, reason not given Terminated: December 31, 2020 |
| G9303 | Operative report does not identify the prosthetic implant specifications including the prosthetic implant manufacturer, the brand name of the prosthetic implant and the size of each prosthetic implant, reason not given Terminated: December 31, 2020 |
| G9304 | Operative report identifies the prosthetic implant specifications including the prosthetic implant manufacturer, the brand name of the prosthetic implant and the size of each prosthetic implant Terminated: December 31, 2020 |
| G9305 | Intervention for presence of leak of endoluminal contents through an anastomosis not required |
| G9306 | Intervention for presence of leak of endoluminal contents through an anastomosis required |
| G9307 | No return to the operating room for a surgical procedure, for complications of the principal operative procedure, within 30 days of the principal operative procedure |
| G9308 | Unplanned return to the operating room for a surgical procedure, for complications of the principal operative procedure, within 30 days of the principal operative procedure |
| G9309 | No unplanned hospital readmission within 30 days of principal procedure |
| G9310 | Unplanned hospital readmission within 30 days of principal procedure |
| G9311 | No surgical site infection |
| G9312 | Surgical site infection |
| G9313 | Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis for documented reason |
| G9314 | Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis, reason not given |
| G9315 | Amoxicillin, with or without clavulanate, prescribed as a first line antibiotic at the time of diagnosis |
| G9316 | Documentation of patient-specific risk assessment with a risk calculator based on multi-institutional clinical data, the specific risk calculator used, and communication of risk assessment from risk calculator with the patient or family |
| G9317 | Documentation of patient-specific risk assessment with a risk calculator based on multi-institutional clinical data, the specific risk calculator used, and communication of risk assessment from risk calculator with the patient or family not completed |
| G9318 | Imaging study named according to standardized nomenclature |
| G9319 | Imaging study not named according to standardized nomenclature, reason not given |
| G9320 | Documentation of medical reason(s) for not naming ct studies according to a standardized nomenclature provided (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery) Terminated: December 31, 2015 |
| G9321 | Count of previous ct (any type of ct) and cardiac nuclear medicine (myocardial perfusion) studies documented in the 12-month period prior to the current study |
| G9322 | Count of previous ct and cardiac nuclear medicine (myocardial perfusion) studies not documented in the 12-month period prior to the current study, reason not given |
| G9323 | Documentation of medical reason(s) for not counting previous ct and cardiac nuclear medicine (myocardial perfusion) studies (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery) Terminated: December 31, 2015 |
| G9324 | All necessary data elements not included, reason not given Terminated: December 31, 2016 |
| G9325 | Ct studies not reported to a radiation dose index registry due to medical reasons (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery) Terminated: December 31, 2015 |
| G9326 | Ct studies performed not reported to a radiation dose index registry that is capable of collecting at a minimum all necessary data elements, reason not given Terminated: December 31, 2020 |
| G9327 | Ct studies performed reported to a radiation dose index registry that is capable of collecting at a minimum all necessary data elements Terminated: December 31, 2020 |
| G9328 | Dicom format image data availability not documented in final report due to medical reasons (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery) Terminated: December 31, 2015 |
| G9329 | Dicom format image data available to non-affiliated external healthcare facilities or entities on a secure, media free, reciprocally searchable basis with patient authorization for at least a 12-month period after the study not documented in final report, reason not given Terminated: December 31, 2020 |
| G9340 | Final report documented that dicom format image data available to non-affiliated external healthcare facilities or entities on a secure, media free, reciprocally searchable basis with patient authorization for at least a 12-month period after the study Terminated: December 31, 2020 |
| G9341 | Search conducted for prior patient ct studies completed at non-affiliated external healthcare facilities or entities within the past 12-months and are available through a secure, authorized, media-free, shared archive prior to an imaging study being performed |
| G9342 | Search not conducted prior to an imaging study being performed for prior patient ct studies completed at non-affiliated external healthcare facilities or entities within the past 12-months and are available through a secure, authorized, media-free, shared archive, reason not given |
| G9343 | Due to medical reasons, search not conducted for dicom format images for prior patient ct imaging studies completed at non-affiliated external healthcare facilities or entities within the past 12 months that are available through a secure, authorized, media-free, shared archive (e.g., ct studies performed for radiation treatment planning or image-guided radiation treatment delivery) Terminated: December 31, 2015 |
| G9344 | Due to system reasons search not conducted for dicom format images for prior patient ct imaging studies completed at non-affiliated external healthcare facilities or entities within the past 12 months that are available through a secure, authorized, media-free, shared archive (e.g., non-affiliated external healthcare facilities or entities does not have archival abilities through a shared archival system) |
| G9345 | Follow-up recommendations documented according to recommended guidelines for incidentally detected pulmonary nodules (e.g., follow-up ct imaging studies needed or that no follow-up is needed) based at a minimum on nodule size and patient risk factors |
| G9346 | Follow-up recommendations not documented according to recommended guidelines for incidentally detected pulmonary nodules due to medical reasons (e.g., patients with known malignant disease, patients with unexplained fever, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery) Terminated: December 31, 2015 |
| G9347 | Follow-up recommendations not documented according to recommended guidelines for incidentally detected pulmonary nodules, reason not given |
| G9348 | Ct scan of the paranasal sinuses ordered at the time of diagnosis for documented reasons Terminated: December 31, 2021 |
| G9349 | Ct scan of the paranasal sinuses ordered at the time of diagnosis or received within 28 days after date of diagnosis Terminated: December 31, 2021 |
| G9350 | Ct scan of the paranasal sinuses not ordered at the time of diagnosis or received within 28 days after date of diagnosis Terminated: December 31, 2021 |
| G9351 | More than one ct scan of the paranasal sinuses ordered or received within 90 days after diagnosis |
| G9352 | More than one ct scan of the paranasal sinuses ordered or received within 90 days after the date of diagnosis, reason not given |
| G9353 | More than one ct scan of the paranasal sinuses ordered or received within 90 days after the date of diagnosis for documented reasons (eg, patients with 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 the date of diagnosis |
| G9355 | Elective delivery (without medical indication) by cesarean birth or induction of labor not performed (<39 weeks of gestation) |
| G9356 | Elective delivery (without medical indication) by cesarean birth or induction of labor performed (<39 weeks of gestation) |
| G9357 | Post-partum screenings, evaluations and education performed |
| G9358 | Post-partum screenings, evaluations and education not performed |
| G9359 | Documentation of negative or managed positive tb screen with further evidence that tb is not active prior to treatment with a biologic immune response modifier Terminated: December 31, 2022 |
| G9360 | No documentation of negative or managed positive tb screen Terminated: December 31, 2022 |
| G9361 | Medical indication for delivery by cesarean birth or induction of labor (<39 weeks of gestation) [documentation of reason(s) for elective delivery (e.g., hemorrhage and placental complications, hypertension, preeclampsia and eclampsia, rupture of membranes (premature or prolonged), maternal conditions complicating pregnancy/delivery, fetal conditions complicating pregnancy/delivery, late pregnancy, prior uterine surgery, or participation in clinical trial)] |
| G9362 | Duration of monitored anesthesia care (mac) or peripheral nerve block (pnb) without the use of general anesthesia during an applicable procedure 60 minutes or longer, as documented in the anesthesia record Terminated: December 31, 2015 |
| G9363 | Duration of monitored anesthesia care (mac) or peripheral nerve block (pnb) without the use of general anesthesia during an applicable procedure or general or neuraxial anesthesia less than 60 minutes, as documented in the anesthesia record Terminated: December 31, 2015 |
| G9364 | Sinusitis caused by, or presumed to be caused by, bacterial infection |
| G9365 | One high-risk medication ordered Terminated: December 31, 2020 |
| G9366 | One high-risk medication not ordered Terminated: December 31, 2020 |
| G9367 | At least two orders for high-risk medications from the same drug class |
| G9368 | At least two orders for high-risk medications from the same drug class not ordered |
| G9369 | Individual filled at least two prescriptions for any antipsychotic medication and had a pdc of 0.8 or greater Terminated: December 31, 2015 |
| G9370 | Individual who did not fill at least two prescriptions for any antipsychotic medication or did not have a pdc of 0.8 or greater Terminated: December 31, 2015 |
| G9376 | Patient continued to have the retina attached at the 6 months follow up visit (+/- 1 month) following only one surgery Terminated: December 31, 2015 |
| G9377 | Patient did not have the retina attached after 6 months following only one surgery Terminated: December 31, 2015 |
| G9378 | Patient continued to have the retina attached at the 6 months follow up visit (+/- 1 month) Terminated: December 31, 2015 |
| G9379 | Patient did not achieve flat retinas six months post surgery Terminated: December 31, 2015 |
| G9380 | Patient offered assistance with end of life issues or existing end of life plan was reviewed or updated during the measurement period |
| G9381 | Documentation of medical reason(s) for not offering assistance with end of life issues (e.g., patient in hospice care, patient in terminal phase) during the measurement period Terminated: December 31, 2017 |
| G9382 | Patient not offered assistance with end of life issues or existing end of life plan was not reviewed or updated during the measurement period |
| G9383 | Patient received screening for hcv infection within the 12 month reporting period |
| G9384 | Documentation of medical reason(s) for not receiving annual screening for hcv infection (e.g., decompensated cirrhosis indicating advanced disease [i.e., ascites, esophageal variceal bleeding, hepatic encephalopathy], hepatocellular carcinoma, waitlist for organ transplant, limited life expectancy, other medical reasons) |
| G9385 | Documentation of patient reason(s) for not receiving annual screening for hcv infection (e.g., patient declined, other patient reasons) |
| G9386 | Screening for hcv infection not received within the 12 month reporting period, reason not given |
| G9389 | Unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery Terminated: December 31, 2020 |
| G9390 | No unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery Terminated: December 31, 2020 |
| G9391 | Patient achieves refraction +-1 d for the eye that underwent cataract surgery, measured at the one month follow up visit Terminated: December 31, 2015 |
| G9392 | Patient does not achieve refraction +-1 d for the eye that underwent cataract surgery, measured at the one month follow up visit Terminated: December 31, 2015 |
| G9393 | Patient with an initial phq-9 score greater than nine who achieves remission at twelve months as demonstrated by a twelve month (+/- 30 days) phq-9 score of less than five |
| G9394 | Patient who had a diagnosis of bipolar disorder or personality disorder, death, permanent nursing home resident or receiving hospice or palliative care any time during the measurement or assessment period |
| G9395 | Patient with an initial phq-9 score greater than nine who did not achieve remission at twelve months as demonstrated by a twelve month (+/- 30 days) 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 remission at twelve months (+/- 30 days) |
| G9399 | Documentation in the patient record of a discussion between the physician/clinician and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward the outcome of the treatment Terminated: December 31, 2021 |
| G9400 | Documentation of medical or patient reason(s) for not discussing treatment options; medical reasons: patient is not a candidate for treatment due to advanced physical or mental health comorbidity (including active substance use); currently receiving antiviral treatment; successful antiviral treatment (with sustained virologic response) prior to reporting period; other documented medical reasons; patient reasons: patient unable or unwilling to participate in the discussion or other patient reasons Terminated: December 31, 2021 |
| G9401 | No documentation in the patient record of a discussion between the physician or other qualified healthcare professional and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward treatment Terminated: December 31, 2021 |
| G9402 | Patient received follow-up within 30 days after discharge |
| G9403 | Clinician documented reason patient was not able to complete 30 day follow-up from acute inpatient setting discharge (e.g., patient death prior to follow-up visit, patient non-compliant for visit follow-up) |
| G9404 | Patient did not receive follow-up within 30 days after discharge |
| G9405 | Patient received follow-up within 7 days after discharge |
| G9406 | Clinician documented reason patient was not able to complete 7 day follow-up from acute inpatient setting discharge (i.e patient death prior to follow-up visit, patient non-compliance for visit follow-up) |
| G9407 | Patient did not receive follow-up within 7 days after discharge |
| G9408 | Patients with cardiac tamponade and/or pericardiocentesis occurring within 30 days |
| G9409 | Patients without cardiac tamponade and/or pericardiocentesis occurring within 30 days |
| G9410 | Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision |
| G9411 | Patient not admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision |
| G9412 | Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision |
| G9413 | Patient not admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision |
| G9414 | Patient had one dose of meningococcal vaccine (serogroups a, c, w, y) on or between the patient's 11th and 13th birthdays |
| G9415 | Patient did not have one dose of meningococcal vaccine (serogroups a, c, w, y) on or between the patient's 11th and 13th birthdays |
| G9416 | Patient had one tetanus, diphtheria toxoids and acellular pertussis vaccine (tdap) on or between the patient's 10th and 13th birthdays |
| G9417 | Patient did not have one tetanus, diphtheria toxoids and acellular pertussis vaccine (tdap) on or between the patient's 10th and 13th birthdays |
| G9418 | Primary non-small cell lung cancer lung biopsy and cytology specimen report documents classification into specific histologic type following iaslc guidance or classified as nsclc-nos with an explanation |
| G9419 | Documentation of medical reason(s) for not including the histological type or nsclc-nos classification with an explanation (e.g. specimen insufficient or non-diagnostic, specimen does not contain cancer, or other documented medical reasons) |
| G9420 | Specimen site other than anatomic location of lung or is not classified as primary non-small cell lung cancer |
| G9421 | Primary non-small cell lung cancer lung biopsy and cytology specimen report does not document classification into specific histologic type or histologic type does not follow iaslc guidance or is classified as nsclc-nos but without an explanation |
| G9422 | Primary lung carcinoma resection report documents pt category, pn category and for non-small cell lung cancer, histologic type (e.g., squamous cell carcinoma, adenocarcinoma and not nsclc-nos) |
| G9423 | Documentation of medical reason for not including pt category, pn category and histologic type [for patient with appropriate exclusion criteria (e.g., metastatic disease, benign tumors, malignant tumors other than carcinomas, inadequate surgical specimens)] |
| G9424 | Specimen site other than anatomic location of lung, or classified as nsclc-nos |
| G9425 | Primary lung carcinoma resection report does not document pt category, pn category and for non-small cell lung cancer, histologic type (e.g., squamous cell carcinoma, adenocarcinoma) |
| G9426 | Improvement in median time from ed arrival to initial ed oral or parenteral pain medication administration performed for ed admitted patients |
| G9427 | Improvement in median time from ed arrival to initial ed oral or parenteral pain medication administration not performed for ed admitted patients |
| G9428 | Pathology report includes the pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors |
| G9429 | Documentation of medical reason(s) for not including pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors (e.g., negative skin biopsies, insufficient tissue, or other documented medical reasons) |
| G9430 | Specimen site other than anatomic cutaneous location |
| G9431 | Pathology report does not include the pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors |
| G9432 | Asthma well-controlled based on the act, c-act, acq, or ataq score and results documented |
| G9433 | Death, permanent nursing home resident or receiving hospice or palliative care any time during the measurement period Terminated: December 31, 2015 |
| G9434 | Asthma not well-controlled based on the act, c-act, acq, or ataq score, or specified asthma control tool not used, reason not given |
| G9435 | Aspirin prescribed at discharge Terminated: December 31, 2016 |
| G9436 | Aspirin not prescribed for documented reasons (e.g., allergy, medical intolerance, history of bleed) Terminated: December 31, 2016 |
| G9437 | Aspirin not prescribed at discharge Terminated: December 31, 2016 |
| G9438 | P2y inhibitor prescribed at discharge Terminated: December 31, 2016 |
| G9439 | P2y inhibitor not prescribed for documented reasons (e.g., allergy, medical intolerance, history of bleed) Terminated: December 31, 2016 |
| G9440 | P2y inhibitor not prescribed at discharge Terminated: December 31, 2016 |
| G9441 | Statin prescribed at discharge Terminated: December 31, 2016 |
| G9442 | Statin not prescribed for documented reasons (e.g., allergy, medical intolerance) Terminated: December 31, 2016 |
| G9443 | Statin not prescribed at discharge Terminated: December 31, 2016 |
| G9448 | Patients who were born in the years 1945 to 1965 Terminated: December 31, 2021 |
| G9449 | History of receiving blood transfusions prior to 1992 Terminated: December 31, 2021 |
| G9450 | History of injection drug use Terminated: December 31, 2021 |
| G9451 | Patient received one-time screening for hcv infection Terminated: December 31, 2023 |
| G9452 | Documentation of medical reason(s) for not receiving hcv antibody test due to limited life expectancy |
| G9453 | Documentation of patient reason(s) for not receiving one-time screening for hcv infection (e.g., patient declined, other patient reasons) Terminated: December 31, 2023 |
| G9454 | One-time screening for hcv infection not received within 12-month reporting period and no documentation of prior screening for hcv infection, reason not given Terminated: December 31, 2023 |
| G9455 | Patient underwent abdominal imaging with ultrasound, contrast enhanced ct or contrast mri for hcc |
| G9456 | Documentation of medical or patient reason(s) for not ordering or performing screening for hcc. medical reason: comorbid medical conditions with expected survival < 5 years, hepatic decompensation and not a candidate for liver transplantation, or other medical reasons; patient reasons: patient declined or other patient reasons (e.g., cost of tests, time related to accessing testing equipment) |
| G9457 | Patient did not undergo abdominal imaging and did not have a documented reason for not undergoing abdominal imaging in the submission period |
| G9458 | Patient documented as tobacco user and received tobacco cessation intervention (must include at least one of the following: advice given to quit smoking or tobacco use, counseling on the benefits of quitting smoking or tobacco use, assistance with or referral to external smoking or tobacco cessation support programs, or current enrollment in smoking or tobacco use cessation program) if identified as a tobacco user |
| G9459 | Currently a tobacco non-user |
| G9460 | Tobacco assessment or tobacco cessation intervention not performed, reason not given |
| G9463 | I intend to report the sinusitis measures group Terminated: December 31, 2016 |
| G9464 | All quality actions for the applicable measures in the sinusitis measures group have been performed for this patient Terminated: December 31, 2016 |
| G9465 | I intend to report the acute otitis externa (aoe) measures group Terminated: December 31, 2016 |
| G9466 | All quality actions for the applicable measures in the aoe measures group have been performed for this patient Terminated: December 31, 2016 |
| G9467 | Patient who have received or are receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 60 or greater consecutive days or a single prescription equating to 600 mg prednisone or greater for all fills within the last twelve months Terminated: December 31, 2016 |
| G9468 | Patient not receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 60 or greater consecutive days or a single prescription equating to 600 mg prednisone or greater for all fills |
| G9469 | Patients who have received or are receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 90 or greater consecutive days or a single prescription equating to 900 mg prednisone or greater for all fills Terminated: December 31, 2020 |
| G9470 | Patients not receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 60 or greater consecutive days or a single 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 ordered or documented |
| G9472 | Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) not ordered and documented, no review of systems and no medication history or pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed Terminated: December 31, 2019 |
| G9473 | Services performed by chaplain in the hospice setting, each 15 minutes |
| G9474 | Services performed by dietary counselor in the hospice setting, each 15 minutes |
| G9475 | Services performed by other counselor in the hospice setting, each 15 minutes |
| G9476 | Services performed by volunteer in the hospice setting, each 15 minutes |
| G9477 | Services performed by care coordinator in the hospice setting, each 15 minutes |
| G9478 | Services performed by other qualified therapist in the hospice setting, each 15 minutes |
| G9479 | Services performed by qualified pharmacist in the hospice setting, each 15 minutes |
| G9480 | Admission to medicare care choice model program (mccm) |
| G9481 | Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a problem focused history; a problem focused examination; and straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology |
| G9482 | Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 20 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology |
| G9483 | Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a detailed history; a detailed examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate severity. typically, 30 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology |
| G9484 | Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 45 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology |
| G9485 | Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 60 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology |
| G9486 | Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology |
| G9487 | Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 15 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology |
| G9488 | Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 25 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology |
| G9489 | Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved coms innovation center demonstration project, which requires at least 2 of the following 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 40 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology |
| G9490 | Cms innovation center models, home visit for patient assessment performed by clinical staff for an individual not considered homebound, including, but not necessarily limited to patient assessment of clinical status, safety/fall prevention, functional status/ambulation, medication reconciliation/management, compliance with orders/plan of care, performance of activities of daily living, and ensuring beneficiary connections to community and other services. (for use only in medicare-approved cms innovation center models); may not be billed for a 30 day period covered by a transitional care management code |
| G9496 | Documentation of reason for not detecting adenoma(s) or other neoplasm. (e.g., neoplasm detected is only diagnosed as traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma Terminated: December 31, 2017 |
| G9497 | Received instruction from the anesthesiologist or proxy prior to the day of surgery to abstain from smoking on the day of surgery |
| G9498 | Antibiotic regimen prescribed |
| G9499 | Patient did not start or is not receiving antiviral treatment for hepatitis c during the measurement period Terminated: December 31, 2016 |
| G9500 | Radiation exposure indices documented in final report for procedure using fluoroscopy |
| G9501 | Radiation exposure indices 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 who have had either a bilateral amputation above or below the knee, or both a left and right amputation above or below the knee before or during the measurement period) |
| G9503 | Patient taking tamsulosin hydrochloride Terminated: December 31, 2020 |
| G9504 | Documented reason for not assessing hepatitis b virus (hbv) status (e.g., patient not initiating anti-tnf therapy, patient declined) prior to initiating anti-tnf therapy |
| G9505 | Antibiotic regimen prescribed within 10 days after onset of symptoms for documented medical reason |
| G9506 | Biologic immune response modifier prescribed Terminated: December 31, 2022 |
| G9507 | Documentation that the patient is on a statin medication or has documentation of a valid contraindication or exception to statin medications; contraindications/exceptions that can be defined by diagnosis codes include pregnancy during the measurement period, active liver disease, rhabdomyolysis, end stage renal disease on dialysis and heart failure; provider documented contraindications/exceptions include breastfeeding during the measurement period, woman of child-bearing age not actively taking birth control, allergy to statin, drug interaction (hiv protease inhibitors, nefazodone, cyclosporine, gemfibrozil, and danazol) and intolerance (with supporting documentation of trying a statin at least once within the last 5 years or diagnosis codes for myostitis or toxic myopathy related to drugs) |
| G9508 | Documentation that the patient is not on a statin medication |
| G9509 | Adult patients 18 years of age or older with major depression or dysthymia who reached remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5 |
| G9510 | Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5. either phq- 9 or phq-9m score was not assessed or is greater than or equal to 5 |
| G9511 | Index event date phq-9 or phq-9m score greater than 9 documented during the twelve month denominator identification period |
| G9512 | Individual had a pdc of 0.8 or greater |
| G9513 | Individual did not have a pdc of 0.8 or greater |
| G9514 | Patient required a return to the operating room within 90 days of surgery |
| G9515 | Patient did not require a return to the operating room within 90 days of surgery |
| G9516 | Patient achieved an improvement in visual acuity, from their preoperative level, within 90 days of surgery |
| G9517 | Patient did not achieve an improvement in visual acuity, from their preoperative level, within 90 days of surgery, reason not given |
| G9518 | Documentation of active injection drug use |
| G9519 | Patient achieves final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery |
| G9520 | Patient does not achieve final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery |
| G9521 | Total number of emergency department visits and inpatient hospitalizations less than two in the past 12 months |
| G9522 | Total number of emergency department visits and inpatient hospitalizations equal to or greater than two in the past 12 months or patient not screened, reason not given |
| G9523 | Patient discontinued from hemodialysis or peritoneal dialysis Terminated: December 31, 2020 |
| G9524 | Patient was referred to hospice care Terminated: December 31, 2020 |
| G9525 | Documentation of patient reason(s) for not referring to hospice care (e.g., patient declined, other patient reasons) Terminated: December 31, 2020 |
| G9526 | Patient was not referred to hospice care, reason not given Terminated: December 31, 2020 |
| G9529 | Patient with minor blunt head trauma had an appropriate indication(s) for a head ct |
| G9530 | Patient presented with a minor blunt head trauma and had a head ct ordered for trauma by an emergency care provider |
| G9531 | Patient has documentation of ventricular shunt, brain tumor, multisystem trauma, or is currently taking an antiplatelet medication including: abciximab, anagrelide, cangrelor, cilostazol, clopidogrel, dipyridamole, eptifibatide, prasugrel, ticlopidine, ticagrelor, tirofiban, or vorapaxar |
| G9532 | Patient had a head ct for trauma ordered by someone other than an emergency care provider or was ordered for a reason other than trauma Terminated: December 31, 2020 |
| G9533 | Patient with minor blunt head trauma did not have an appropriate indication(s) for a head ct |
| G9534 | Advanced brain imaging (cta, ct, mra or mri) was not ordered Terminated: December 31, 2018 |
| G9535 | Patients with a normal neurological examination Terminated: December 31, 2018 |
| G9536 | Documentation of medical reason(s) for ordering an advanced brain imaging study (i.e., patient has an abnormal neurological examination; patient has the coexistence of seizures, or both; recent onset of severe headache; change in the type of headache; signs of increased intracranial pressure (e.g., papilledema, absent venous pulsations on funduscopic examination, altered mental status, focal neurologic deficits, signs of meningeal irritation); hiv-positive patients with a new type of headache; immunocompromised patient with unexplained headache symptoms; patient on coagulopathy/anti-coagulation or anti-platelet therapy; very young patients with unexplained headache symptoms) Terminated: December 31, 2018 |
| G9537 | Imaging needed as part of a clinical trial; or other clinician ordered the study |
| G9538 | Advanced brain imaging (cta, ct, mra or mri) was ordered Terminated: December 31, 2018 |
| G9539 | Intent for potential removal at time of placement |
| G9540 | Patient alive 3 months post procedure |
| G9541 | Filter removed within 3 months of placement |
| G9542 | Documented re-assessment for the appropriateness of filter removal within 3 months of placement |
| G9543 | Documentation of at least two attempts to reach the patient to arrange a clinical re-assessment for the appropriateness of filter removal within 3 months of placement |
| G9544 | Patients that do not have the filter removed, documented re-assessment for the appropriateness of filter removal, or documentation of at least two attempts to reach the patient to arrange a clinical re-assessment for the appropriateness of filter removal within 3 months of placement |
| G9547 | Cystic renal lesion that is simple appearing (bosniak i or ii) , or adrenal lesion less than or equal to 1.0 cm or adrenal lesion greater than 1.0 cm but less than or equal to 4.0 cm classified as likely benign by unenhanced ct or washout protocol ct, or mri with in- and opposed-phase sequences or other equivalent institutional imaging protocols |
| G9548 | Final reports for imaging studies stating no follow-up imaging is recommended |
| G9549 | Documentation of medical reason(s) that follow-up imaging is indicated (e.g., patient has lymphadenopathy, signs of metastasis or an active diagnosis or history of cancer, and other medical reason(s)) |
| G9550 | Final reports for imaging studies with follow-up imaging recommended, or final reports that do not include a specific recommendation of no follow-up |
| G9551 | Final reports for imaging studies without an incidentally found lesion noted |
| G9552 | Incidental thyroid nodule < 1.0 cm noted in report |
| G9553 | Prior thyroid disease diagnosis |
| G9554 | Final reports for ct, cta, mri or mra of the chest or neck with follow-up imaging recommended |
| G9555 | Documentation of medical reason(s) for recommending follow up imaging (e.g., patient has multiple endocrine neoplasia, patient has cervical lymphadenopathy, other medical reason(s)) |
| G9556 | Final reports for ct, cta, mri or mra of the chest or neck with follow-up imaging not recommended |
| G9557 | Final reports for ct, cta, mri or mra studies of the chest or neck without an incidentally found thyroid nodule < 1.0 cm noted or no nodule found |
| G9558 | Patient treated with a beta-lactam antibiotic as definitive therapy Terminated: December 31, 2020 |
| G9559 | Documentation of medical reason(s) for not prescribing a beta-lactam antibiotic (e.g., allergy, intolerance to beta-lactam antibiotics) Terminated: December 31, 2020 |
| G9560 | Patient not treated with a beta-lactam antibiotic as definitive therapy, reason not given Terminated: December 31, 2020 |
| G9561 | Patients prescribed opiates for longer than six weeks Terminated: December 31, 2021 |
| G9562 | Patients who had a follow-up evaluation conducted at least every three months during opioid therapy Terminated: December 31, 2021 |
| G9563 | Patients who did not have a follow-up evaluation conducted at least every three months during opioid therapy Terminated: December 31, 2021 |
| G9572 | Index date phq-score greater than 9 documented during the twelve month denominator identification period Terminated: December 31, 2016 |
| G9573 | Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at six months as demonstrated by a six month (+/-60 days) phq-9 or phq-9m score of less than five Terminated: December 31, 2020 |
| G9574 | Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at six months as demonstrated by a six month (+/-60 days) phq-9 or phq-9m score of less than five; either phq-9 or phq-9m score was not assessed or is greater than or equal to five Terminated: December 31, 2020 |
| G9577 | Patients prescribed opiates for longer than six weeks Terminated: December 31, 2021 |
| G9578 | Documentation of signed opioid treatment agreement at least once during opioid therapy Terminated: December 31, 2021 |
| G9579 | No documentation of signed an opioid treatment agreement at least once during opioid therapy Terminated: December 31, 2021 |
| G9580 | Door to puncture time of 90 minutes or less |
| G9581 | Door to puncture time of greater than 2 hours for reasons documented by clinician (e.g., patients who are transferred from one institution to another with a known diagnosis of cva for endovascular stroke treatment; hospitalized patients with newly diagnosed cva considered for endovascular stroke treatment) Terminated: December 31, 2016 |
| G9582 | Door to puncture time of greater than 90 minutes, no reason given |
| G9583 | Patients prescribed opiates for longer than six weeks Terminated: December 31, 2021 |
| G9584 | Patient evaluated for risk of misuse of opiates by using a brief validated instrument (e.g., opioid risk tool, soapp-r) or patient interviewed at least once during opioid therapy Terminated: December 31, 2021 |
| G9585 | Patient not evaluated for risk of misuse of opiates by using a brief validated instrument (e.g., opioid risk tool, soapp-r) or patient not interviewed at least once during opioid therapy Terminated: December 31, 2021 |
| G9593 | Pediatric patient with minor blunt head trauma classified as low risk according to the pecarn prediction rules |
| G9594 | Patient presented with a minor blunt head trauma and had a head ct ordered for trauma by an emergency care provider |
| G9595 | Patient has documentation of ventricular shunt, brain tumor, or coagulopathy |
| G9596 | Pediatric patient had a head ct for trauma ordered by someone other than an emergency care provider or was ordered for a reason other than trauma Terminated: December 31, 2023 |
| G9597 | Pediatric patient with minor blunt head trauma not classified as low risk according to the pecarn prediction rules |
| G9598 | Aortic aneurysm 5.5 - 5.9 cm maximum diameter on centerline formatted ct or minor diameter on axial formatted ct |
| G9599 | Aortic aneurysm 6.0 cm or greater maximum diameter on centerline formatted ct or minor diameter on axial formatted ct |
| G9600 | Symptomatic aaas that required urgent/emergent (non-elective) repair Terminated: December 31, 2020 |
| G9601 | Patient discharge to home no later than post-operative day #7 Terminated: December 31, 2020 |
| G9602 | Patient not discharged to home by post-operative day #7 Terminated: December 31, 2020 |
| G9603 | Patient survey score improved from baseline following treatment |
| G9604 | Patient survey results not available |
| G9605 | Patient survey score did not improve from baseline following treatment |
| G9606 | Intraoperative cystoscopy performed to evaluate for lower tract injury |
| G9607 | Documented medical reasons for not performing intraoperative cystoscopy (e.g., urethral pathology precluding cystoscopy, any patient who has a congenital or acquired absence of the urethra) or in the case of patient death |
| G9608 | Intraoperative cystoscopy not performed to evaluate for lower tract injury |
| G9609 | Documentation of an order for anti-platelet agents |
| G9610 | Documentation of medical reason(s) in the patient's record for not ordering anti-platelet agents |
| G9611 | Order for anti-platelet agents was not documented in the patient's record, reason not given |
| G9612 | Photodocumentation of two or more cecal landmarks to establish a complete examination Terminated: December 31, 2023 |
| G9613 | Documentation of post-surgical anatomy (e.g., right hemicolectomy, ileocecal resection, etc.) Terminated: December 31, 2023 |
| G9614 | Photodocumentation of less than two cecal landmarks (i.e., no cecal landmarks or only one cecal landmark) to establish a complete examination Terminated: December 31, 2023 |
| G9615 | Preoperative assessment documented Terminated: December 31, 2020 |
| G9616 | Documentation of reason(s) for not documenting a preoperative assessment (e.g., patient with a gynecologic or other pelvic malignancy noted at the time of surgery) Terminated: December 31, 2020 |
| G9617 | Preoperative assessment not documented, reason not given Terminated: December 31, 2020 |
| G9618 | Documentation of screening for uterine malignancy or those that had an ultrasound and/or endometrial sampling of any kind Terminated: December 31, 2022 |
| G9619 | Documentation of reason(s) for not screening for uterine malignancy (e.g., prior hysterectomy) Terminated: December 31, 2016 |
| G9620 | Patient not screened for uterine malignancy, or those that have not had an ultrasound and/or endometrial sampling of any kind, reason not given Terminated: December 31, 2022 |
| G9621 | Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method and received brief counseling |
| G9622 | Patient not identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method |
| G9623 | Documentation of medical reason(s) for not screening for unhealthy alcohol use (e.g., limited life expectancy, other medical reasons) Terminated: December 31, 2022 |
| G9624 | Patient not screened for unhealthy alcohol use using a systematic screening method or patient did not receive brief counseling if identified as an unhealthy alcohol user |
| G9625 | Patient sustained bladder injury at the time of surgery or discovered subsequently up to 30 days post-surgery |
| G9626 | Documented medical reason for not reporting bladder injury (e.g., gynecologic or other pelvic malignancy documented, concurrent surgery involving bladder pathology, injury that occurs during a urinary incontinence procedure, patient death from non-medical causes not related to surgery, patient died during procedure without evidence of bladder injury) |
| G9627 | Patient did not sustain bladder injury at the time of surgery nor discovered subsequently up to 30 days post-surgery |
| G9628 | Patient sustained bowel injury at the time of surgery or discovered subsequently up to 30 days post-surgery |
| G9629 | Documented medical reasons for not reporting bowel injury (e.g., gynecologic or other pelvic malignancy documented, planned (e.g., not due to an unexpected bowel injury) resection and/or re-anastomosis of bowel, or patient death from non-medical causes not related to surgery, patient died during procedure without evidence of bowel injury) |
| G9630 | Patient did not sustain a bowel injury at the time of surgery nor discovered subsequently up to 30 days post-surgery |
| G9631 | Patient sustained ureter injury at the time of surgery or discovered subsequently up to 30 days post-surgery Terminated: December 31, 2022 |
| G9632 | Documented medical reasons for not reporting ureter injury (e.g., gynecologic or other pelvic malignancy documented, concurrent surgery involving bladder pathology, injury that occurs during a urinary incontinence procedure, patient death from non-medical causes not related to surgery, patient died during procedure without evidence of ureter injury) Terminated: December 31, 2022 |
| G9633 | Patient did not sustain ureter injury at the time of surgery nor discovered subsequently up to 30 days post-surgery Terminated: December 31, 2022 |
| G9634 | Health-related quality of life assessed with tool during at least two visits and quality of life score remained the same or improved Terminated: December 31, 2021 |
| G9635 | Health-related quality of life not assessed with tool for documented reason(s) (e.g., patient has a cognitive or neuropsychiatric impairment that impairs his/her ability to complete the hrqol survey, patient has the inability to read and/or write in order to complete the hrqol questionnaire) Terminated: December 31, 2021 |
| G9636 | Health-related quality of life not assessed with tool during at least two visits or quality of life score declined Terminated: December 31, 2021 |
| G9637 | Final reports with documentation of one or more dose reduction techniques (e.g., automated exposure control, adjustment of the ma and/or kv according to patient size, use of iterative reconstruction technique) |
| G9638 | Final reports without documentation of one or more dose reduction techniques (e.g., automated exposure control, adjustment of the ma and/or kv according to patient size, use of iterative reconstruction technique) |
| G9639 | Major amputation or open surgical bypass not required within 48 hours of the index endovascular lower extremity revascularization procedure Terminated: December 31, 2021 |
| G9640 | Documentation of planned hybrid or staged procedure Terminated: December 31, 2021 |
| G9641 | Major amputation or open surgical bypass required within 48 hours of the index endovascular lower extremity revascularization procedure Terminated: December 31, 2021 |
| G9642 | Current smoker (e.g., cigarette, cigar, pipe, e-cigarette or marijuana) |
| G9643 | Elective surgery |
| G9644 | Patients who abstained from smoking prior to anesthesia on the day of surgery or procedure |
| G9645 | Patients who did not abstain from smoking prior to anesthesia on the day of surgery or procedure |
| G9646 | Patients with 90 day mrs score of 0 to 2 |
| G9647 | Patients in whom mrs score could not be obtained at 90 day follow-up Terminated: December 31, 2021 |
| G9648 | Patients with 90 day mrs score greater than 2 |
| G9649 | Psoriasis assessment tool documented meeting any one of the specified benchmarks (e.g., (pga; 5-point or 6-point scale), body surface area (bsa), psoriasis area and severity index (pasi) and/or dermatology life quality index) (dlqi)) |
| G9650 | Documentation that the patient declined therapy change or has documented contraindications (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by pga, bsa, pasi, or dlqi Terminated: December 31, 2016 |
| G9651 | Psoriasis assessment tool documented not meeting any one of the specified benchmarks (e.g., (pga; 5-point or 6-point scale), body surface area (bsa), psoriasis area and severity index (pasi) and/or dermatology life quality index) (dlqi)) or psoriasis assessment tool not documented |
| G9652 | Patient has been treated with a systemic or biologic medication for psoriasis for at least six months Terminated: December 31, 2016 |
| G9653 | Patient has not been treated with a systemic or biologic medication for psoriasis for at least six months Terminated: December 31, 2016 |
| G9654 | Monitored anesthesia care (mac) |
| G9655 | A transfer of care protocol or handoff tool/checklist that includes the required key handoff elements is used |
| G9656 | Patient transferred directly from anesthetizing location to pacu or other non-icu location |
| G9657 | Transfer of care during an anesthetic or to the intensive care unit Terminated: December 31, 2016 |
| G9658 | A transfer of care protocol or handoff tool/checklist that includes the required key handoff elements is not used |
| G9659 | Patients greater than or equal to 86 years of age who underwent a screening colonoscopy and did not have a history of colorectal cancer or other valid medical reason for the colonoscopy, including: iron deficiency anemia, lower gastrointestinal bleeding, crohn's disease (i.e., regional enteritis), familial adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease, ulcerative colitis, abnormal finding of gastrointestinal tract, or changes in bowel habits |
| G9660 | Documentation of medical reason(s) for a colonoscopy performed on a patient greater than or equal to 86 years of age (e.g., iron deficiency anemia, lower gastrointestinal bleeding, crohn's disease (i.e., regional enteritis), familial history of adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease, ulcerative colitis, abnormal finding of gastrointestinal tract, or changes in bowel habits) |
| G9661 | Patients greater than or equal to 86 years of age who received a colonoscopy for an assessment of signs/symptoms of gi tract illness, and/or because the patient meets high risk criteria, and/or to follow-up on previously diagnosed advanced lesions |
| G9662 | Previously diagnosed or have a diagnosis of clinical ascvd, including ascvd procedure |
| G9663 | Any ldl-c laboratory result >= 190 mg/dl |
| G9664 | Patients who are currently statin therapy users or received an order (prescription) for statin therapy |
| G9665 | Patients who are not currently statin therapy users or did not receive an order (prescription) for statin therapy |
| G9666 | Patient's highest fasting or direct ldl-c laboratory test result in the measurement period or two years prior to the beginning of the measurement period is 70-189 mg/dl Terminated: December 31, 2021 |
| G9667 | Documentation of medical reason(s) for not currently being a statin therapy user or receive an order (prescription) for statin therapy (e.g., patient with adverse effect, allergy or intolerance to statin medication therapy, patients who have an active diagnosis of pregnancy or who are breastfeeding, patients who are receiving palliative care, patients with active liver disease or hepatic disease or insufficiency, patients with end stage renal disease (esrd), and patients with diabetes who have a fasting or direct ldl-c laboratory test result < 70 mg/dl and are not taking statin therapy) Terminated: December 31, 2016 |
| G9669 | I intend to report the multiple chronic conditions measures group Terminated: December 31, 2016 |
| G9670 | All quality actions for the applicable measures in the multiple chronic conditions measures group have been performed for this patient Terminated: December 31, 2016 |
| G9671 | I intend to report the diabetic retinopathy measures group Terminated: December 31, 2016 |
| G9672 | All quality actions for the applicable measures in the diabetic retinopathy measures group have been performed for this patient Terminated: December 31, 2016 |
| G9673 | I intend to report the cardiovascular prevention measures group Terminated: December 31, 2016 |
| G9674 | Patients with clinical ascvd diagnosis |
| G9675 | Patients who have ever had a fasting or direct laboratory result of ldl-c = 190 mg/dl |
| G9676 | Patients aged 40 to 75 years at the beginning of the measurement period with type 1 or type 2 diabetes and with an ldl-c result of 70-189 mg/dl recorded as the highest fasting or direct laboratory test result in the measurement year or during the two years prior to the beginning of the measurement period |
| G9677 | All quality actions for the applicable measures in the cardiovascular prevention measures group have been performed for this patient Terminated: December 31, 2016 |
| G9678 | Oncology care model (ocm) monthly enhanced oncology services (meos) payment for ocm enhanced services. g9678 payments may only be made to ocm practitioners for ocm beneficiaries for the furnishment of enhanced services as defined in the ocm participation agreement Terminated: June 30, 2022 |
| G9679 | This code is for onsite acute care treatment of a nursing facility resident with pneumonia; may only be billed once per day per beneficiary |
| G9680 | This code is for onsite acute care treatment of a nursing facility resident with chf; may only be billed once per day per beneficiary |
| G9681 | This code is for onsite acute care treatment of a resident with copd or asthma; may only be billed once per day per beneficiary |
| G9682 | This code is for the onsite acute care treatment a nursing facility resident with a skin infection; may only be billed once per day per beneficiary |
| G9683 | Facility service(s) for the onsite acute care treatment of a nursing facility resident with fluid or electrolyte disorder. (may only be billed once per day per beneficiary). this service is for a demonstration project |
| G9684 | This code is for the onsite acute care treatment of a nursing facility resident for a uti; may only be billed once per day per beneficiary |
| G9685 | Physician service or other qualified health care professional for the evaluation and management of a beneficiary's acute change in condition in a nursing facility. this service is for a demonstration project |
| G9686 | Onsite nursing facility conference, that is separate and distinct from an evaluation and management visit, including qualified practitioner and at least one member of the nursing facility interdisciplinary care team Terminated: December 31, 2018 |
| G9687 | Hospice services provided to patient any time during the measurement period |
| G9688 | Patients using hospice services any time during the measurement period |
| G9689 | Patient admitted for performance of elective carotid intervention |
| G9690 | Patient receiving hospice services any time during the measurement period |
| G9691 | Patient had hospice services any time during the measurement period |
| G9692 | Hospice services received by patient any time during the measurement period |
| G9693 | Patient use of hospice services any time during the measurement period |
| G9694 | Hospice services utilized by patient any time during the measurement period |
| G9695 | Long-acting inhaled bronchodilator prescribed |
| G9696 | Documentation of medical reason(s) for not prescribing a long-acting inhaled bronchodilator (e.g., patient intolerance or history of side effects) |
| G9697 | Documentation of patient reason(s) for not prescribing a long-acting inhaled bronchodilator Terminated: December 31, 2023 |
| G9698 | Documentation of system reason(s) for not prescribing a long-acting inhaled bronchodilator (e.g., cost of treatment or lack of insurance) |
| G9699 | Long-acting inhaled bronchodilator not prescribed, reason not otherwise specified |
| G9700 | Patients who use hospice services any time during the measurement period |
| G9701 | Children who are taking antibiotics in the 30 days prior to the date of the encounter during which the diagnosis was established Terminated: December 31, 2020 |
| G9702 | Patients who use hospice services any time during the measurement period |
| G9703 | Episodes where the patient is taking antibiotics (table 1) in the 30 days prior to the episode date |
| G9704 | Ajcc breast cancer stage i: t1 mic or t1a documented |
| G9705 | Ajcc breast cancer stage i: t1b (tumor > 0.5 cm but <= 1 cm in greatest dimension) documented |
| G9706 | Low (or very low) risk of recurrence, prostate cancer |
| G9707 | Patient received hospice services any time during the measurement period |
| G9708 | Women who had a bilateral mastectomy or who have a history of a bilateral mastectomy or for whom there is evidence of a right and a left unilateral mastectomy |
| G9709 | Hospice services used by patient any time during the measurement period |
| G9710 | Patient was provided hospice services any time during the measurement period |
| G9711 | Patients with a diagnosis or past history of total colectomy or colorectal cancer |
| G9712 | Documentation of medical reason(s) for prescribing or dispensing antibiotic (e.g., intestinal infection, pertussis, bacterial infection, lyme disease, otitis media, acute sinusitis, acute pharyngitis, acute tonsillitis, chronic sinusitis, infection of the pharynx/larynx/tonsils/adenoids, prostatitis, cellulitis/ mastoiditis/bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia, gonococcal infections/venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis/uti, acne, hiv disease/asymptomatic hiv, cystic fibrosis, disorders of the immune system, malignancy neoplasms, chronic bronchitis, emphysema, bronchiectasis, extrinsic allergic alveolitis, chronic airway obstruction, chronic obstructive asthma, pneumoconiosis and other lung disease due to external agents, other diseases of the respiratory system, and tuberculosis |
| G9713 | Patients who use hospice services any time during the measurement period |
| G9714 | Patient is using hospice services any time during the measurement period |
| G9715 | Patients who use hospice services any time during the measurement period Terminated: December 31, 2023 |
| G9716 | Bmi is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reason |
| G9717 | Documentation stating the patient has had a diagnosis of bipolar disorder |
| G9718 | Hospice services for patient provided any time during the measurement period Terminated: December 31, 2022 |
| G9719 | Patient is not ambulatory, bed ridden, immobile, confined to chair, wheelchair bound, dependent on helper pushing wheelchair, independent in wheelchair or minimal help in wheelchair |
| G9720 | Hospice services for patient occurred any time during the measurement period |
| G9721 | Patient not ambulatory, bed ridden, immobile, confined to chair, wheelchair bound, dependent on helper pushing wheelchair, independent in wheelchair or minimal help in wheelchair |
| G9722 | Documented history of renal failure or baseline serum creatinine >= 4.0 mg/dl; renal transplant recipients are not considered to have preoperative renal failure, unless, since transplantation the cr has been or is 4.0 or higher |
| G9723 | Hospice services for patient received any time during the measurement period |
| G9724 | Patients who had documentation of use of anticoagulant medications overlapping the measurement year |
| G9725 | Patients who use hospice services any time during the measurement period Terminated: December 31, 2023 |
| G9726 | Patient refused to participate |
| G9727 | Patient unable to complete the lepf prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available |
| G9728 | Patient refused to participate |
| G9729 | Patient unable to complete the lepf prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available |
| G9730 | Patient refused to participate |
| G9731 | Patient unable to complete the lepf prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available |
| G9732 | Patient refused to participate |
| G9733 | Patient unable to complete the low back fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available |
| G9734 | Patient refused to participate |
| G9735 | Patient unable to complete the shoulder fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available |
| G9736 | Patient refused to participate |
| G9737 | Patient unable to complete the elbow/wrist/hand fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available |
| G9738 | Patient refused to participate Terminated: December 31, 2020 |
| G9739 | Patient unable to complete the general orthopedic fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available Terminated: December 31, 2020 |
| G9740 | Hospice services given to patient any time during the measurement period |
| G9741 | Patients who use hospice services any time during the measurement period |
| G9742 | Psychiatric symptoms assessed Terminated: December 31, 2019 |
| G9743 | Psychiatric symptoms not assessed, reason not otherwise specified Terminated: December 31, 2019 |
| G9744 | Patient not eligible due to active diagnosis of hypertension |
| G9745 | Documented reason for not screening or recommending a follow-up for high blood pressure |
| G9746 | Patient has mitral stenosis or prosthetic heart valves or patient has transient or reversible cause of af (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac surgery) |
| G9747 | Patient is undergoing palliative dialysis with a catheter Terminated: December 31, 2020 |
| G9748 | Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant Terminated: December 31, 2020 |
| G9749 | Patient is undergoing palliative dialysis with a catheter Terminated: December 31, 2020 |
| G9750 | Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant Terminated: December 31, 2020 |
| G9751 | Patient died at any time during the 24-month measurement period |
| G9752 | Emergency surgery |
| G9753 | Documentation of medical reason for not conducting a search for dicom format images for prior patient ct imaging studies completed at non-affiliated external healthcare facilities or entities within the past 12 months that are available through a secure, authorized, media-free, shared archive (e.g., trauma, acute myocardial infarction, stroke, aortic aneurysm where time is of the essence) |
| G9754 | A finding of an incidental pulmonary nodule |
| G9755 | Documentation of medical reason(s) for not including a recommended interval and modality for follow-up or for no follow-up, and source of recommendations (e.g., patients with unexplained fever, immunocompromised patients who are at risk for infection) |
| G9756 | Surgical procedures that included the use of silicone oil |
| G9757 | Surgical procedures that included the use of silicone oil |
| G9758 | Patient in hospice at any time during the measurement period |
| G9759 | History of preoperative posterior capsule rupture Terminated: December 31, 2020 |
| G9760 | Patients who use hospice services any time during the measurement period |
| G9761 | Patients who use hospice services any time during the measurement period |
| G9762 | Patient had at least two hpv vaccines (with at least 146 days between the two) or three hpv vaccines on or between the patient's 9th and 13th birthdays |
| G9763 | Patient did not have at least two hpv vaccines (with at least 146 days between the two) or three hpv vaccines on or between the patient's 9th and 13th birthdays |
| G9764 | Patient has been treated with a systemic medication for psoriasis vulgaris |
| G9765 | Documentation that the patient declined change in medication or alternative therapies were unavailable, has documented contraindications, or has not been treated with a systemic medication for at least six consecutive months (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by pga, bsa, pasi, or dlqi |
| G9766 | Patients who are transferred from one institution to another with a known diagnosis of cva for endovascular stroke treatment |
| G9767 | Hospitalized patients with newly diagnosed cva considered for endovascular stroke treatment |
| G9768 | Patients who utilize hospice services any time during the measurement period |
| G9769 | Patient had a bone mineral density test in the past two years or received osteoporosis medication or therapy in the past 12 months |
| G9770 | Peripheral nerve block (pnb) |
| G9771 | At least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) achieved within the 30 minutes immediately before or 15 minutes immediately after anesthesia end time |
| G9772 | Documentation of medical reason(s) for not achieving at least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) within the 30 minutes immediately before or 15 minutes immediately after anesthesia end time (e.g., emergency cases, intentional hypothermia, etc.) |
| G9773 | At least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) not achieved within the 30 minutes immediately before or 15 minutes immediately after anesthesia end time, reason not given |
| G9774 | Patients who have had a hysterectomy Terminated: December 31, 2022 |
| G9775 | Patient received at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively |
| G9776 | Documentation of medical reason for not receiving at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively (e.g., intolerance or other medical reason) |
| G9777 | Patient did not receive at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively |
| G9778 | Patients who have a diagnosis of pregnancy at any time during the measurement period Terminated: December 31, 2022 |
| G9779 | Patients who are breastfeeding at any time during the performance period |
| G9780 | Patients who have a diagnosis of rhabdomyolysis at any time during the performance period |
| G9781 | Documentation of medical reason(s) for not currently being a statin therapy user or receiving an order (prescription) for statin therapy (e.g., patients with statin-associated muscle symptoms or an allergy to statin medication therapy, patients who are receiving palliative or hospice care, patients with active liver disease or hepatic disease or insufficiency, patients with end stage renal disease [esrd], or other medical reasons) |
| G9782 | History of or active diagnosis of familial hypercholesterolemia |
| G9783 | Documentation of patients with diabetes who have a most recent fasting or direct ldl- c laboratory test result < 70 mg/dl and are not taking statin therapy Terminated: December 31, 2021 |
| G9784 | Pathologists/dermatopathologists providing a second opinion on a biopsy |
| G9785 | Pathology report diagnosing cutaneous basal cell carcinoma, squamous cell carcinoma, or melanoma (to include in situ disease) sent from the pathologist/ dermatopathologist to the biopsying clinician for review within 7 days from the time when the tissue specimen was received by the pathologist |
| G9786 | Pathology report diagnosing cutaneous basal cell carcinoma, squamous cell carcinoma, or melanoma (to include in situ disease) was not sent from the pathologist/ dermatopathologist to the biopsying clinician for review within 7 days from the time when the tissue specimen was received by the pathologist |
| G9787 | Patient alive as of the last day of the measurement year |
| G9788 | Most recent bp is less than or equal to 140/90 mm hg |
| G9789 | Blood pressure recorded during inpatient stays, emergency room visits, or urgent care visits |
| G9790 | Most recent bp is greater than 140/90 mm hg, or blood pressure not documented |
| G9791 | Most recent tobacco status is tobacco free |
| G9792 | Most recent tobacco status is not tobacco free |
| G9793 | Patient is currently on a daily aspirin or other antiplatelet |
| G9794 | Documentation of medical reason(s) for not on a daily aspirin or other antiplatelet (e.g., history of gastrointestinal bleed, intra-cranial bleed, idiopathic thrombocytopenic purpura (itp), gastric bypass or documentation of active anticoagulant use during the measurement period) |
| G9795 | Patient is not currently on a daily aspirin or other antiplatelet |
| G9796 | Patient is currently on a statin therapy |
| G9797 | Patient is not on a statin therapy |
| G9798 | Discharge(s) for ami between july 1 of the year prior measurement period to june 30 of the measurement period Terminated: December 31, 2020 |
| G9799 | Patients with a medication dispensing event indicator of a history of asthma any time during the patient's history through the end of the measure period Terminated: December 31, 2020 |
| G9800 | Patients who are identified as having an intolerance or allergy to beta-blocker therapy Terminated: December 31, 2020 |
| G9801 | Hospitalizations in which the patient was transferred directly to a non-acute care facility for any diagnosis Terminated: December 31, 2020 |
| G9802 | Patients who use hospice services any time during the measurement period Terminated: December 31, 2020 |
| G9803 | Patient prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami Terminated: December 31, 2020 |
| G9804 | Patient was not prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami Terminated: December 31, 2020 |
| G9805 | Patients who use hospice services any time during the measurement period |
| G9806 | Patients who received cervical cytology or an hpv test |
| G9807 | Patients who did not receive cervical cytology or an hpv test |
| G9808 | Any patients who had no asthma controller medications dispensed during the measurement year Terminated: December 31, 2022 |
| G9809 | Patients who use hospice services any time during the measurement period Terminated: December 31, 2022 |
| G9810 | Patient achieved a pdc of at least 75% for their asthma controller medication Terminated: December 31, 2022 |
| G9811 | Patient did not achieve a pdc of at least 75% for their asthma controller medication Terminated: December 31, 2022 |
| G9812 | Patient died including all deaths occurring during the hospitalization in which the operation was performed, even if after 30 days, and those deaths occurring after discharge from the hospital, but within 30 days of the procedure |
| G9813 | Patient did not die within 30 days of the procedure or during the index hospitalization |
| G9814 | Death occurring during the index acute care hospitalization Terminated: December 31, 2020 |
| G9815 | Death did not occur during the index acute care hospitalization Terminated: December 31, 2020 |
| G9816 | Death occurring after discharge from the hospital but within 30 days post procedure Terminated: December 31, 2020 |
| G9817 | Death did not occur after discharge from the hospital within 30 days post procedure Terminated: December 31, 2020 |
| G9818 | Documentation of sexual activity |
| G9819 | Patients who use hospice services any time during the measurement period |
| G9820 | Documentation of a chlamydia screening test with proper follow-up |
| G9821 | No documentation of a chlamydia screening test with proper follow-up |
| G9822 | Patients who had an endometrial ablation procedure during the 12 months prior to the index date (exclusive of the index date) |
| G9823 | Endometrial sampling or hysteroscopy with biopsy and results documented during the 12 months prior to the index date (exclusive of the index date) of the endometrial ablation |
| G9824 | Endometrial sampling or hysteroscopy with biopsy and results not documented during the 12 months prior to the index date (exclusive of the index date) of the endometrial ablation |
| G9825 | Her-2/neu negative or undocumented/unknown Terminated: December 31, 2020 |
| G9826 | Patient transferred to practice after initiation of chemotherapy Terminated: December 31, 2020 |
| G9827 | Her2-targeted therapies not administered during the initial course of treatment Terminated: December 31, 2020 |
| G9828 | Her2-targeted therapies administered during the initial course of treatment Terminated: December 31, 2020 |
| G9829 | Breast adjuvant chemotherapy administered Terminated: December 31, 2020 |
| G9830 | Her-2/neu positive |
| G9831 | Ajcc stage at breast cancer diagnosis = ii or iii |
| G9832 | Ajcc stage at breast cancer diagnosis = i (ia or ib) and t-stage at breast cancer diagnosis does not equal = t1, t1a, t1b |
| G9833 | Patient transfer to practice after initiation of chemotherapy Terminated: December 31, 2020 |
| G9834 | Patient has metastatic disease at diagnosis Terminated: December 31, 2020 |
| G9835 | Trastuzumab administered within 12 months of diagnosis Terminated: December 31, 2020 |
| G9836 | Reason for not administering trastuzumab documented (e.g. patient declined, patient died, patient transferred, contraindication or other clinical exclusion, neoadjuvant chemotherapy or radiation not complete) Terminated: December 31, 2020 |
| G9837 | Trastuzumab not administered within 12 months of diagnosis Terminated: December 31, 2020 |
| G9838 | Patient has metastatic disease at diagnosis |
| G9839 | Anti-egfr monoclonal antibody therapy |
| G9840 | Ras (kras and nras) gene mutation testing performed before initiation of anti-egfr moab |
| G9841 | Ras (kras and nras) gene mutation testing not performed before initiation of anti-egfr moab |
| G9842 | Patient has metastatic disease at diagnosis |
| G9843 | Ras (kras or nras) gene mutation |
| G9844 | Patient did not receive anti-egfr monoclonal antibody therapy |
| G9845 | Patient received anti-egfr monoclonal antibody therapy |
| G9846 | Patients who died from cancer |
| G9847 | Patient received systemic cancer-directed therapy in the last 14 days of life |
| G9848 | Patient did not receive systemic cancer-directed therapy in the last 14 days of life |
| G9849 | Patients who died from cancer Terminated: December 31, 2020 |
| G9850 | Patient had more than one emergency department visit in the last 30 days of life Terminated: December 31, 2020 |
| G9851 | Patient had one or less emergency department visits in the last 30 days of life Terminated: December 31, 2020 |
| G9852 | Patients who died from cancer Terminated: December 31, 2023 |
| G9853 | Patient admitted to the icu in the last 30 days of life Terminated: December 31, 2023 |
| G9854 | Patient was not admitted to the icu in the last 30 days of life Terminated: December 31, 2023 |
| G9855 | Patients who died from cancer Terminated: December 31, 2020 |
| G9856 | Patient was not admitted to hospice Terminated: December 31, 2020 |
| G9857 | Patient admitted to hospice Terminated: December 31, 2020 |
| G9858 | Patient enrolled in hospice |
| G9859 | Patients who died from cancer |
| G9860 | Patient spent less than three days in hospice care |
| G9861 | Patient spent greater than or equal to three days in hospice care |
| G9862 | Documentation of medical reason(s) for not recommending at least a 10 year follow-up interval (e.g., inadequate prep, familial or personal history of colonic polyps, patient had no adenoma and age is = 66 years old, or life expectancy < 10 years old, other medical reasons) |
| G9868 | Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, less than 10 minutes |
| G9869 | Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, 10-20 minutes |
| G9870 | Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, more than 20 minutes |
| G9873 | First medicare diabetes prevention program (mdpp) core session was attended by an mdpp beneficiary under the mdpp expanded model (em). a core session is an mdpp service that: (1) is furnished by an mdpp supplier during months 1 through 6 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for core sessions |
| G9874 | Four total medicare diabetes prevention program (mdpp) core sessions were attended by an mdpp beneficiary under the mdpp expanded model (em). a core session is an mdpp service that: (1) is furnished by an mdpp supplier during months 1 through 6 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for core sessions |
| G9875 | Nine total medicare diabetes prevention program (mdpp) core sessions were attended by an mdpp beneficiary under the mdpp expanded model (em). a core session is an mdpp service that: (1) is furnished by an mdpp supplier during months 1 through 6 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for core sessions |
| G9876 | Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 7-9 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary did not achieve at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 7-9 |
| G9877 | Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 10-12 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary did not achieve at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 10-12 |
| G9878 | Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 7-9 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions.the beneficiary achieved at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 7-9 |
| G9879 | Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 10-12 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary achieved at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 10-12 |
| G9880 | The mdpp beneficiary achieved at least 5% weight loss (wl) from his/her baseline weight in months 1-12 of the mdpp services period under the mdpp expanded model (em). this is a one-time payment available when a beneficiary first achieves at least 5% weight loss from baseline as measured by an in-person weight measurement at a core session or core maintenance session |
| G9881 | The mdpp beneficiary achieved at least 9% weight loss (wl) from his/her baseline weight in months 1-24 under the mdpp expanded model (em). this is a one-time payment available when a beneficiary first achieves at least 9% weight loss from baseline as measured by an in-person weight measurement at a core session, core maintenance session, or ongoing maintenance session |
| G9882 | Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 13-15 under the mdpp expanded model (em). an ongoing maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary maintained at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 13-15 |
| G9883 | Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 16-18 under the mdpp expanded model (em). an ongoing maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary maintained at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 16-18 |
| G9884 | Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 19-21 under the mdpp expanded model (em). an ongoing maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary maintained at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 19-21 |
| G9885 | Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 22-24 under the mdpp expanded model (em). an ongoing maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary maintained at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 22-24 |
| G9886 | Behavioral counseling for diabetes prevention, in-person, group, 60 minutes |
| G9887 | Behavioral counseling for diabetes prevention, distance learning, 60 minutes |
| G9888 | Maintenance 5% wl from baseline weight in months 7-12 |
| G9890 | Bridge payment: a one-time payment for the first medicare diabetes prevention program (mdpp) core session, core maintenance session, or ongoing maintenance session furnished by an mdpp supplier to an mdpp beneficiary during months 1-24 of the mdpp expanded model (em) who has previously received mdpp services from a different mdpp supplier under the mdpp expanded model. a supplier may only receive one bridge payment per mdpp beneficiary |
| G9891 | Mdpp session reported as a line-item on a claim for a payable mdpp expanded model (em) hcpcs code for a session furnished by the billing supplier under the mdpp expanded model and counting toward achievement of the attendance performance goal for the payable mdpp expanded model hcpcs code (this code is for reporting purposes only) |
| G9892 | Documentation of patient reason(s) for not performing a dilated macular examination |
| G9893 | Dilated macular exam was not performed, reason not otherwise specified |
| G9894 | Androgen deprivation therapy prescribed/administered in combination with external beam radiotherapy to the prostate |
| G9895 | Documentation of medical reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate (e.g., salvage therapy) |
| G9896 | Documentation of patient reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate |
| G9897 | Patients who were not prescribed/administered androgen deprivation therapy in combination with external beam radiotherapy to the prostate, reason not given |
| G9898 | Patients age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the measurement period |
| G9899 | Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results documented and reviewed |
| G9900 | Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results were not documented and reviewed, reason not otherwise specified |
| G9901 | Patient age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the measurement period |
| G9902 | Patient screened for tobacco use and identified as a tobacco user |
| G9903 | Patient screened for tobacco use and identified as a tobacco non-user |
| G9904 | Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason) Terminated: December 31, 2022 |
| G9905 | Patient not screened for tobacco use |
| G9906 | Patient identified as a tobacco user received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy) |
| G9907 | Documentation of medical reason(s) for not providing tobacco cessation intervention on the date of the encounter or within the previous 12 months (e.g., limited life expectancy, other medical reason) Terminated: December 31, 2022 |
| G9908 | Patient identified as tobacco user did not receive tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy) |
| G9909 | Documentation of medical reason(s) for not providing tobacco cessation intervention on the date of the encounter or within the previous 12 months if identified as a tobacco user (e.g., limited life expectancy, other medical reason) Terminated: December 31, 2022 |
| G9910 | Patients age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period |
| G9911 | Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer before or after neoadjuvant systemic therapy |
| G9912 | Hepatitis b virus (hbv) status assessed and results interpreted prior to initiating anti-tnf (tumor necrosis factor) therapy |
| G9913 | Hepatitis b virus (hbv) status not assessed and results interpreted prior to initiating anti-tnf (tumor necrosis factor) therapy, reason not otherwise specified |
| G9914 | Patient initiated an anti-tnf agent |
| G9915 | No record of hbv results documented |
| G9916 | Functional status performed once in the last 12 months |
| G9917 | Documentation of advanced stage dementia and caregiver knowledge is limited |
| G9918 | Functional status not performed, reason not otherwise specified |
| G9919 | Screening performed and positive and provision of recommendations |
| G9920 | Screening performed and negative |
| G9921 | No screening performed, partial screening performed or positive screen without recommendations and reason is not given or otherwise specified |
| G9922 | Safety concerns screen provided and if positive then documented mitigation recommendations |
| G9923 | Safety concerns screen provided and negative |
| G9924 | Documentation of medical reason(s) for not providing safety concerns screen or for not providing recommendations, orders or referrals for positive screen (e.g., patient in palliative care, other medical reason) Terminated: December 31, 2020 |
| G9925 | Safety concerns screening not provided, reason not otherwise specified |
| G9926 | Safety concerns screening positive screen is without provision of mitigation recommendations, including but not limited to referral to other resources |
| G9927 | Documentation of system reason(s) for not prescribing an fda-approved anticoagulation due to patient being currently enrolled in a clinical trial related to af/atrial flutter treatment Terminated: December 31, 2023 |
| G9928 | Fda-approved anticoagulant not prescribed, reason not given |
| G9929 | Patient with transient or reversible cause of af (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac surgery) |
| G9930 | Patients who are receiving comfort care only |
| G9931 | Documentation of cha2ds2-vasc risk score of 0 or 1 for men; or 0, 1, or 2 for women |
| G9932 | Documentation of patient reason(s) for not having records of negative or managed positive tb screen (e.g., patient does not return for mantoux (ppd) skin test evaluation) Terminated: December 31, 2022 |
| G9933 | Adenoma(s) or colorectal cancer detected during screening colonoscopy Terminated: December 31, 2020 |
| G9934 | Documentation that neoplasm detected is only diagnosed as traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma Terminated: December 31, 2020 |
| G9935 | Adenoma(s) or colorectal cancer not detected during screening colonoscopy Terminated: December 31, 2020 |
| G9936 | Surveillance colonoscopy - personal history of colonic polyps, colon cancer, or other malignant neoplasm of rectum, rectosigmoid junction, and anus Terminated: December 31, 2020 |
| G9937 | Diagnostic colonoscopy Terminated: December 31, 2020 |
| G9938 | Patients aged 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the six months prior to the measurement period through december 31 of the measurement period |
| G9939 | Pathologists/dermatopathologists is the same clinician who performed the biopsy |
| G9940 | Documentation of medical reason(s) for not on a statin (e.g., pregnancy, in vitro fertilization, clomiphene rx, esrd, cirrhosis, muscular pain and disease during the measurement period or prior year) |
| G9941 | Back pain was measured by the visual analog scale (vas) within three months preoperatively and at three months (6 - 20 weeks) postoperatively Terminated: December 31, 2019 |
| G9942 | Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminectomy Terminated: December 31, 2022 |
| G9943 | Back pain was not measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively |
| G9944 | Back pain was measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively Terminated: December 31, 2019 |
| G9945 | Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis |
| G9946 | Back pain was not measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively |
| G9947 | Leg pain was measured by the visual analog scale (vas) within three months preoperatively and at three months (6 to 20 weeks) postoperatively Terminated: December 31, 2019 |
| G9948 | Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminectomy Terminated: December 31, 2022 |
| G9949 | Leg pain was not measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively |
| G9954 | Patient exhibits 2 or more risk factors for post-operative vomiting |
| G9955 | Cases in which an inhalational anesthetic is used only for induction |
| G9956 | Patient received combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively |
| G9957 | Documentation of medical reason for not receiving combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively (e.g., intolerance or other medical reason) |
| G9958 | Patient did not receive combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively |
| G9959 | Systemic antimicrobials not prescribed |
| G9960 | Documentation of medical reason(s) for prescribing systemic antimicrobials |
| G9961 | Systemic antimicrobials prescribed |
| G9962 | Embolization endpoints are documented separately for each embolized vessel and ovarian artery angiography or embolization performed in the presence of variant uterine artery anatomy |
| G9963 | Embolization endpoints are not documented separately for each embolized vessel or ovarian artery angiography or embolization not performed in the presence of variant uterine artery anatomy |
| G9964 | Patient received at least one well-child visit with a pcp during the performance period |
| G9965 | Patient did not receive at least one well-child visit with a pcp during the performance period |
| G9966 | Children who were screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report Terminated: December 31, 2020 |
| G9967 | Children who were not screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report Terminated: December 31, 2020 |
| G9968 | Patient was referred to another clinician or specialist during the measurement period |
| G9969 | Clinician who referred the patient to another clinician received a report from the clinician to whom the patient was referred |
| G9970 | Clinician who referred the patient to another clinician did not receive a report from the clinician to whom the patient was referred |
| G9974 | Dilated macular exam performed, including documentation of the presence or absence of macular thickening or geographic atrophy or hemorrhage and the level of macular degeneration severity |
| G9975 | Documentation of medical reason(s) for not performing a dilated macular examination |
| G9978 | Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a problem focused history; a problem focused examination; and straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology |
| G9979 | Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 20 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology |
| G9980 | Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a detailed history; a detailed examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate severity. typically, 30 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology |
| G9981 | Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 45 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology |
| G9982 | Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 60 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology |
| G9983 | Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology |
| G9984 | Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 15 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology |
| G9985 | Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 25 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology |
| G9986 | Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 40 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology |
| G9987 | Bundled payments for care improvement advanced (bpci advanced) model home visit for patient assessment performed by clinical staff for an individual not considered homebound, including, but not necessarily limited to patient assessment of clinical status, safety/fall prevention, functional status/ambulation, medication reconciliation/management, compliance with orders/plan of care, performance of activities of daily living, and ensuring beneficiary connections to community and other services; for use only for a bpci advanced model episode of care; may not be billed for a 30-day period covered by a transitional care management code |
| G9988 | Palliative care services provided to patient any time during the measurement period |
| G9989 | Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., adverse reaction to vaccine) Terminated: December 31, 2022 |
| G9990 | Patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period |
| G9991 | Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period |
| G9992 | Palliative care services used by patient any time during the measurement period |
| G9993 | Patient was provided palliative care services any time during the measurement period |
| G9994 | Patient is using palliative care services any time during the measurement period |
| G9995 | Patients who use palliative care services any time during the measurement period Terminated: December 31, 2023 |
| G9996 | Documentation stating the patient has received or is currently receiving palliative or hospice care |
| G9997 | Documentation of patient pregnancy anytime during the measurement period prior to and including the current encounter |
| G9998 | Documentation of medical reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., last colonoscopy incomplete, last colonoscopy had inadequate prep, piecemeal removal of adenomas, or sessile serrated polyps >= 20 mm in size, last colonoscopy found greater than 10 adenomas, lower gastrointestinal bleeding, or patient at high risk for colon cancer due to underlying medical history ([i.e. crohn's disease, ulcerative colitis, personal or family history of colon cancer, hereditary colorectal cancer syndromes]) |
| G9999 | Documentation of system reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., unable to locate previous colonoscopy report, previous colonoscopy report was incomplete) |