OMB Memorandum: Managing Federal Contract Performance Issues Associated with the Novel Coronavirus (March 20th, 2020)
G0000–G9999: Procedures/Professional Services
| HCPC | SEQNUM | RECID | LONG DESCRIPTION | SHORT DESCRIPTION |
|---|---|---|---|---|
| G0008 | 0010 | 3 | Administration of influenza virus vaccine | Admin influenza virus vac |
| G0009 | 0010 | 3 | Administration of pneumococcal vaccine | Admin pneumococcal vaccine |
| G0010 | 0010 | 3 | Administration of hepatitis b vaccine | Admin hepatitis b vaccine |
| G0027 | 0010 | 3 | Semen analysis; presence and/or motility of sperm excluding huhner | Semen analysis |
| G0068 | 0010 | 3 | Professional services for the administration of anti-infective, pain management, chelation, pulmonary hypertension, and/or inotropic infusion drug(s) for each infusion drug administration calendar day in the individual’s home, each 15 minutes | Adm of infusion drug in home |
| G0069 | 0010 | 3 | Professional services for the administration of subcutaneous immunotherapy for each infusion drug administration calendar day in the individual’s home, each 15 minutes | Adm of immune drug in home |
| G0070 | 0010 | 3 | Professional services for the administration of chemotherapy for each infusion drug administration calendar day in the individual’s home, each 15 minutes | Adm of chemo drug in home |
| G0071 | 0010 | 3 | 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 | Comm svcs by rhc/fqhc 5 min |
| G0076 | 0010 | 3 | 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) | Care manag h vst new pt 20 m |
| G0077 | 0010 | 3 | 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) | Care manag h vst new pt 30 m |
| G0078 | 0010 | 3 | 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) | Care manag h vst new pt 45 m |
| G0079 | 0010 | 3 | 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) | Care manag h vst new pt 60 m |
| G0080 | 0010 | 3 | 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) | Care manag h vst new pt 75 m |
| G0081 | 0010 | 3 | 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) | Care man h v ext pt 20 mi |
| G0082 | 0010 | 3 | 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) | Care man h v ext pt 30 m |
| G0083 | 0010 | 3 | 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) | Care man h v ext pt 45 m |
| G0084 | 0010 | 3 | 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) | Care man h v ext pt 60 m |
| G0085 | 0010 | 3 | 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) | Care man h v ext pt 75 m |
| G0086 | 0010 | 3 | 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) | Care man home care plan 30 m |
| G0087 | 0010 | 3 | 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) | Care man home care plan 60 m |
| G0101 | 0010 | 3 | Cervical or vaginal cancer screening; pelvic and clinical breast examination | Ca screen;pelvic/breast exam |
| G0102 | 0010 | 3 | Prostate cancer screening; digital rectal examination | Prostate ca screening; dre |
| G0103 | 0010 | 3 | Prostate cancer screening; prostate specific antigen test (psa) | Psa screening |
| G0104 | 0010 | 3 | Colorectal cancer screening; flexible sigmoidoscopy | Ca screen;flexi sigmoidscope |
| G0105 | 0010 | 3 | Colorectal cancer screening; colonoscopy on individual at high risk | Colorectal scrn; hi risk ind |
| G0106 | 0010 | 3 | Colorectal cancer screening; alternative to g0104, screening sigmoidoscopy, barium enema | Colon ca screen;barium enema |
| G0108 | 0010 | 3 | Diabetes outpatient self-management training services, individual, per 30 minutes | Diab manage trn per indiv |
| G0109 | 0010 | 3 | Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes | Diab manage trn ind/group |
| G0117 | 0010 | 3 | Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist | Glaucoma scrn hgh risk direc |
| G0118 | 0010 | 3 | Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist | Glaucoma scrn hgh risk direc |
| G0120 | 0010 | 3 | Colorectal cancer screening; alternative to g0105, screening colonoscopy, barium enema. | Colon ca scrn; barium enema |
| G0121 | 0010 | 3 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | Colon ca scrn not hi rsk ind |
| G0122 | 0010 | 3 | Colorectal cancer screening; barium enema | Colon ca scrn; barium enema |
| G0123 | 0010 | 3 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision | Screen cerv/vag thin layer |
| G0124 | 0010 | 3 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician | Screen c/v thin layer by md |
| G0127 | 0010 | 3 | Trimming of dystrophic nails, any number | Trim nail(s) |
| G0128 | 0010 | 3 | 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 | Corf skilled nursing service |
| G0129 | 0010 | 3 | Occupational therapy services requiring the skills of a qualified occupational therapist, furnished as a component of a partial hospitalization treatment program, per session (45 minutes or more) | Partial hosp prog service |
| G0130 | 0010 | 3 | Single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel) | Single energy x-ray study |
| G0141 | 0010 | 3 | Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician | Scr c/v cyto,autosys and md |
| G0143 | 0010 | 3 | 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 | Scr c/v cyto,thinlayer,rescr |
| G0144 | 0010 | 3 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervision | Scr c/v cyto,thinlayer,rescr |
| G0145 | 0010 | 3 | 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 | Scr c/v cyto,thinlayer,rescr |
| G0147 | 0010 | 3 | Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision | Scr c/v cyto, automated sys |
| G0148 | 0010 | 3 | Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening | Scr c/v cyto, autosys, rescr |
| G0151 | 0010 | 3 | Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes | Hhcp-serv of pt,ea 15 min |
| G0152 | 0010 | 3 | Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes | Hhcp-serv of ot,ea 15 min |
| G0153 | 0010 | 3 | Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes | Hhcp-svs of s/l path,ea 15mn |
| G0154 | 0010 | 3 | Direct skilled nursing services of a licensed nurse (lpn or rn) in the home health or hospice setting, each 15 minutes | Hhcp-svs of rn,ea 15 min |
| G0155 | 0010 | 3 | Services of clinical social worker in home health or hospice settings, each 15 minutes | Hhcp-svs of csw,ea 15 min |
| G0156 | 0010 | 3 | Services of home health/hospice aide in home health or hospice settings, each 15 minutes | Hhcp-svs of aide,ea 15 min |
| G0157 | 0010 | 3 | Services performed by a qualified physical therapist assistant in the home health or hospice setting, each 15 minutes | Hhc pt assistant ea 15 |
| G0158 | 0010 | 3 | Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes | Hhc ot assistant ea 15 |
| G0159 | 0010 | 3 | 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 | Hhc pt maint ea 15 min |
| G0160 | 0010 | 3 | 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 | Hhc occup therapy ea 15 |
| G0161 | 0010 | 3 | 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 | Hhc slp ea 15 min |
| G0162 | 0010 | 3 | 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) | Hhc rn e&m plan svs, 15 min |
| G0163 | 0010 | 3 | 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) | Hhc lpn/rn obs/asses ea 15 |
| G0164 | 0010 | 3 | 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 | Hhc lis nurse train ea 15 |
| G0166 | 0010 | 3 | External counterpulsation, per treatment session | Extrnl counterpulse, per tx |
| G0168 | 0010 | 3 | Wound closure utilizing tissue adhesive(s) only | Wound closure by adhesive |
| G0173 | 0010 | 3 | Linear accelerator based stereotactic radiosurgery, complete course of therapy in one session | Linear acc stereo radsur com |
| G0175 | 0010 | 3 | Scheduled interdisciplinary team conference (minimum of three exclusive of patient care nursing staff) with patient present | Opps service,sched team conf |
| G0176 | 0010 | 3 | 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) | Opps/php;activity therapy |
| G0177 | 0010 | 3 | Training and educational services related to the care and treatment of patient’s disabling mental health problems per session (45 minutes or more) | Opps/php; train & educ serv |
| G0179 | 0010 | 3 | Physician 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 to affirm the initial implementation of the plan of care that meets patient’s needs, per re-certification period | Md recertification hha pt |
| G0180 | 0010 | 3 | Physician 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 to affirm the initial implementation of the plan of care that meets patient’s needs, per certification period | Md certification hha patient |
| G0181 | 0010 | 3 | Physician 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 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 | Home health care supervision |
| G0182 | 0010 | 3 | 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 | Hospice care supervision |
| G0186 | 0010 | 3 | Destruction of localized lesion of choroid (for example, choroidal neovascularization); photocoagulation, feeder vessel technique (one or more sessions) | Dstry eye lesn,fdr vssl tech |
| G0202 | 0010 | 3 | Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (cad) when performed | Scr mammo bi incl cad |
| G0204 | 0010 | 3 | Diagnostic mammography, including computer-aided detection (cad) when performed; bilateral | Dx mammo incl cad bi |
| G0206 | 0010 | 3 | Diagnostic mammography, including computer-aided detection (cad) when performed; unilateral | Dx mammo incl cad uni |
| G0219 | 0010 | 3 | Pet imaging whole body; melanoma for non-covered indications | Pet img wholbod melano nonco |
| G0235 | 0010 | 3 | Pet imaging, any site, not otherwise specified | Pet not otherwise specified |
| G0237 | 0010 | 3 | Therapeutic procedures to increase strength or endurance of respiratory muscles, face to face, one on one, each 15 minutes (includes monitoring) | Therapeutic procd strg endur |
| G0238 | 0010 | 3 | Therapeutic procedures to improve respiratory function, other than described by g0237, one on one, face to face, per 15 minutes (includes monitoring) | Oth resp proc, indiv |
| G0239 | 0010 | 3 | Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring) | Oth resp proc, group |
| G0245 | 0010 | 3 | 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 | Initial foot exam pt lops |
| G0246 | 0010 | 3 | 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 | Followup eval of foot pt lop |
| G0247 | 0010 | 3 | 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 | Routine footcare pt w lops |
| G0248 | 0010 | 3 | 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 | Demonstrate use home inr mon |
| G0249 | 0010 | 3 | 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 | Provide inr test mater/equip |
| G0250 | 0010 | 3 | 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 | Md inr test revie inter mgmt |
| G0251 | 0010 | 3 | 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 | Linear acc based stero radio |
| G0252 | 0010 | 3 | 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) | Pet imaging initial dx |
| G0255 | 0010 | 3 | Current perception threshold/sensory nerve conduction test, (snct) per limb, any nerve | Current percep threshold tst |
| G0257 | 0010 | 3 | Unscheduled or emergency dialysis treatment for an esrd patient in a hospital outpatient department that is not certified as an esrd facility | Unsched dialysis esrd pt hos |
| G0259 | 0010 | 3 | Injection procedure for sacroiliac joint; arthrography | Inject for sacroiliac joint |
| G0260 | 0010 | 3 | Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography | Inj for sacroiliac jt anesth |
| G0268 | 0010 | 3 | Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing | Removal of impacted wax md |
| G0269 | 0010 | 3 | Placement of occlusive device into either a venous or arterial access site, post surgical or interventional procedure (e.g., angioseal plug, vascular plug) | Occlusive device in vein art |
| G0270 | 0010 | 3 | 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 | Mnt subs tx for change dx |
| G0271 | 0010 | 3 | 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 | Group mnt 2 or more 30 mins |
| G0276 | 0010 | 3 | 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 | Pild/placebo control clin tr |
| G0277 | 0010 | 3 | Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval | Hbot, full body chamber, 30m |
| G0278 | 0010 | 3 | 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) | Iliac art angio,cardiac cath |
| G0279 | 0010 | 3 | Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) | Tomosynthesis, mammo |
| G0281 | 0010 | 3 | 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 | Elec stim unattend for press |
| G0282 | 0010 | 3 | Electrical stimulation, (unattended), to one or more areas, for wound care other than described in g0281 | Elect stim wound care not pd |
| G0283 | 0010 | 3 | Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care | Elec stim other than wound |
| G0288 | 0010 | 3 | Reconstruction, computed tomographic angiography of aorta for surgical planning for vascular surgery | Recon, cta for surg plan |
| G0289 | 0010 | 3 | 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 | Arthro, loose body + chondro |
| G0293 | 0010 | 3 | Noncovered surgical procedure(s) using conscious sedation, regional, general or spinal anesthesia in a medicare qualifying clinical trial, per day | Non-cov surg proc,clin trial |
| G0294 | 0010 | 3 | Noncovered procedure(s) using either no anesthesia or local anesthesia only, in a medicare qualifying clinical trial, per day | Non-cov proc, clinical trial |
| G0295 | 0010 | 3 | Electromagnetic therapy, to one or more areas, for wound care other than described in g0329 or for other uses | Electromagnetic therapy onc |
| G0296 | 0010 | 3 | Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making) | Visit to determ ldct elig |
| G0297 | 0010 | 3 | Low dose ct scan (ldct) for lung cancer screening | Ldct for lung ca screen |
| G0299 | 0010 | 3 | Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes | Hhs/hospice of rn ea 15 min |
| G0300 | 0010 | 3 | Direct skilled nursing services of a licensed practical nurse (lpn) in the home health or hospice setting, each 15 minutes | Hhs/hospice of lpn ea 15 min |
| G0302 | 0010 | 3 | Pre-operative pulmonary surgery services for preparation for lvrs, complete course of services, to include a minimum of 16 days of services | Pre-op service lvrs complete |
| G0303 | 0010 | 3 | Pre-operative pulmonary surgery services for preparation for lvrs, 10 to 15 days of services | Pre-op service lvrs 10-15dos |
| G0304 | 0010 | 3 | Pre-operative pulmonary surgery services for preparation for lvrs, 1 to 9 days of services | Pre-op service lvrs 1-9 dos |
| G0305 | 0010 | 3 | Post-discharge pulmonary surgery services after lvrs, minimum of 6 days of services | Post op service lvrs min 6 |
| G0306 | 0010 | 3 | Complete cbc, automated (hgb, hct, rbc, wbc, without platelet count) and automated wbc differential count | Cbc/diffwbc w/o platelet |
| G0307 | 0010 | 3 | Complete (cbc), automated (hgb, hct, rbc, wbc; without platelet count) | Cbc without platelet |
| G0328 | 0010 | 3 | Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous | Fecal blood scrn immunoassay |
| G0329 | 0010 | 3 | 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 | Electromagntic tx for ulcers |
| G0333 | 0010 | 3 | Pharmacy dispensing fee for inhalation drug(s); initial 30-day supply as a beneficiary | Dispense fee initial 30 day |
| G0337 | 0010 | 3 | Hospice evaluation and counseling services, pre-election | Hospice evaluation preelecti |
| G0339 | 0010 | 3 | Image-guided robotic linear accelerator-based stereotactic radiosurgery, complete course of therapy in one session or first session of fractionated treatment | Robot lin-radsurg com, first |
| G0340 | 0010 | 3 | 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 | Robt lin-radsurg fractx 2-5 |
| G0341 | 0010 | 3 | Percutaneous islet cell transplant, includes portal vein catheterization and infusion | Percutaneous islet celltrans |
| G0342 | 0010 | 3 | Laparoscopy for islet cell transplant, includes portal vein catheterization and infusion | Laparoscopy islet cell trans |
| G0343 | 0010 | 3 | Laparotomy for islet cell transplant, includes portal vein catheterization and infusion | Laparotomy islet cell transp |
| G0364 | 0010 | 3 | Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service | Bone marrow aspirate &biopsy |
| G0365 | 0010 | 3 | 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) | Vessel mapping hemo access |
| G0372 | 0010 | 3 | Physician service required to establish and document the need for a power mobility device | Md service required for pmd |
| G0378 | 0010 | 3 | Hospital observation service, per hour | Hospital observation per hr |
| G0379 | 0010 | 3 | Direct admission of patient for hospital observation care | Direct refer hospital observ |
| G0380 | 0010 | 3 | 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) | Lev 1 hosp type b ed visit |
| G0381 | 0010 | 3 | 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) | Lev 2 hosp type b ed visit |
| G0382 | 0010 | 3 | 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) | Lev 3 hosp type b ed visit |
| G0383 | 0010 | 3 | 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) | Lev 4 hosp type b ed visit |
| G0384 | 0010 | 3 | 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) | Lev 5 hosp type b ed visit |
| G0389 | 0010 | 3 | Ultrasound b-scan and/or real time with image documentation; for abdominal aortic aneurysm (aaa) screening | Ultrasound exam aaa screen |
| G0390 | 0010 | 3 | Trauma response team associated with hospital critical care service | Trauma respons w/hosp criti |
| G0396 | 0010 | 3 | Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes | Alcohol/subs interv 15-30mn |
| G0397 | 0010 | 3 | Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes | Alcohol/subs interv >30 min |
| G0398 | 0010 | 3 | 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 | Home sleep test/type 2 porta |
| G0399 | 0010 | 3 | 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 | Home sleep test/type 3 porta |
| G0400 | 0010 | 3 | Home sleep test (hst) with type iv portable monitor, unattended; minimum of 3 channels | Home sleep test/type 4 porta |
| G0402 | 0010 | 3 | Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment | Initial preventive exam |
| G0403 | 0010 | 3 | Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report | Ekg for initial prevent exam |
| G0404 | 0010 | 3 | Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination | Ekg tracing for initial prev |
| G0405 | 0010 | 3 | Electrocardiogram, routine ecg with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination | Ekg interpret & report preve |
| G0406 | 0010 | 3 | Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth | Inpt/tele follow up 15 |
| G0407 | 0010 | 3 | Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth | Inpt/tele follow up 25 |
| G0408 | 0010 | 3 | Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth | Inpt/tele follow up 35 |
| G0409 | 0010 | 3 | 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) | Corf related serv 15 mins ea |
| G0410 | 0010 | 3 | Group psychotherapy other than of a multiple-family group, in a partial hospitalization setting, approximately 45 to 50 minutes | Grp psych partial hosp 45-50 |
| G0411 | 0010 | 3 | Interactive group psychotherapy, in a partial hospitalization setting, approximately 45 to 50 minutes | Inter active grp psych parti |
| G0412 | 0010 | 3 | 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 | Open tx iliac spine uni/bil |
| G0413 | 0010 | 3 | 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) | Pelvic ring fracture uni/bil |
| G0414 | 0010 | 3 | 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) | Pelvic ring fx treat int fix |
| G0415 | 0010 | 3 | 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) | Open tx post pelvic fxcture |
| G0416 | 0010 | 3 | Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method | Prostate biopsy, any mthd |
| G0417 | 0010 | 3 | Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, 21-40 specimens | Sat biopsy prostate 21-40 |
| G0418 | 0010 | 3 | Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, 41-60 specimens | Sat biopsy prostate 41-60 |
| G0419 | 0010 | 3 | Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, >60 specimens | Sat biopsy prostate: >60 |
| G0420 | 0010 | 3 | Face-to-face educational services related to the care of chronic kidney disease; individual, per session, per one hour | Ed svc ckd ind per session |
| G0421 | 0010 | 3 | Face-to-face educational services related to the care of chronic kidney disease; group, per session, per one hour | Ed svc ckd grp per session |
| G0422 | 0010 | 3 | Intensive cardiac rehabilitation; with or without continuous ecg monitoring with exercise, per session | Intens cardiac rehab w/exerc |
| G0423 | 0010 | 3 | Intensive cardiac rehabilitation; with or without continuous ecg monitoring; without exercise, per session | Intens cardiac rehab no exer |
| G0424 | 0010 | 3 | Pulmonary rehabilitation, including exercise (includes monitoring), one hour, per session, up to two sessions per day | Pulmonary rehab w exer |
| G0425 | 0010 | 3 | Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth | Inpt/ed teleconsult30 |
| G0426 | 0010 | 3 | Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth | Inpt/ed teleconsult50 |
| G0427 | 0010 | 3 | Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth | Inpt/ed teleconsult70 |
| G0428 | 0010 | 3 | Collagen meniscus implant procedure for filling meniscal defects (e.g., cmi, collagen scaffold, menaflex) | Collagen meniscus implant |
| G0429 | 0010 | 3 | Dermal filler injection(s) for the treatment of facial lipodystrophy syndrome (lds) (e.g., as a result of highly active antiretroviral therapy) | Dermal filler injection(s) |
| G0431 | 0010 | 3 | Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter | Drug screen multiple class |
| G0432 | 0010 | 3 | Infectious agent antibody detection by enzyme immunoassay (eia) technique, hiv-1 and/or hiv-2, screening | Eia hiv-1/hiv-2 screen |
| G0433 | 0010 | 3 | Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening | Elisa hiv-1/hiv-2 screen |
| G0434 | 0010 | 3 | Drug screen, other than chromatographic; any number of drug classes, by clia waived test or moderate complexity test, per patient encounter | Drug screen multi drug class |
| G0435 | 0010 | 3 | Infectious agent antibody detection by rapid antibody test, hiv-1 and/or hiv-2, screening | Oral hiv-1/hiv-2 screen |
| G0436 | 0010 | 3 | Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes | Tobacco-use counsel 3-10 min |
| G0437 | 0010 | 3 | Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes | Tobacco-use counsel>10min |
| G0438 | 0010 | 3 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | Ppps, initial visit |
| G0439 | 0010 | 3 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | Ppps, subseq visit |
| G0442 | 0010 | 3 | Annual alcohol misuse screening, 15 minutes | Annual alcohol screen 15 min |
| G0443 | 0010 | 3 | Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes | Brief alcohol misuse counsel |
| G0444 | 0010 | 3 | Annual depression screening, 15 minutes | Depression screen annual |
| G0445 | 0010 | 3 | 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 | High inten beh couns std 30m |
| G0446 | 0010 | 3 | Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes | Intens behave ther cardio dx |
| G0447 | 0010 | 3 | Face-to-face behavioral counseling for obesity, 15 minutes | Behavior counsel obesity 15m |
| G0448 | 0010 | 3 | 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 | Place perm pacing cardiovert |
| G0451 | 0010 | 3 | Development testing, with interpretation and report, per standardized instrument form | Devlopment test interpt&rep |
| G0452 | 0010 | 3 | Molecular pathology procedure; physician interpretation and report | Molecular pathology interpr |
| G0453 | 0010 | 3 | 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) | Cont intraop neuro monitor |
| G0454 | 0010 | 3 | Physician documentation of face-to-face visit for durable medical equipment determination performed by nurse practitioner, physician assistant or clinical nurse specialist | Md document visit by npp |
| G0455 | 0010 | 3 | Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen | Fecal microbiota prep instil |
| G0456 | 0010 | 3 | 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 | Neg pre wound <=50 sq cm |
| G0457 | 0010 | 3 | 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 | Neg pres wound >50 sq cm |
| G0458 | 0010 | 3 | Low dose rate (ldr) prostate brachytherapy services, composite rate | Ldr prostate brachy comp rat |
| G0459 | 0010 | 3 | Inpatient telehealth pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy | Telehealth inpt pharm mgmt |
| G0460 | 0010 | 3 | Autologous platelet rich plasma for chronic wounds/ulcers, including phlebotomy, centrifugation, and all other preparatory procedures, administration and dressings, per treatment | Autologous prp for ulcers |
| G0461 | 0010 | 3 | Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stain | Immunohisto/cyto chem 1st st |
| G0462 | 0010 | 3 | Immunohistochemistry or immunocytochemistry, per specimen; each additional single or multiplex antibody stain (list separately in addition to code for primary procedure) | Immunohisto/cyto chem add |
| G0463 | 0010 | 3 | Hospital outpatient clinic visit for assessment and management of a patient | Hospital outpt clinic visit |
| G0464 | 0010 | 3 | Colorectal cancer screening; stool-based dna and fecal occult hemoglobin (e.g., kras, ndrg4 and bmp3) | Colorec ca scr, sto bas dna |
| G0466 | 0010 | 3 | 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 | Fqhc visit new patient |
| G0467 | 0010 | 3 | 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 | Fqhc visit, estab pt |
| G0468 | 0010 | 3 | 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 | Fqhc visit, ippe or awv |
| G0469 | 0010 | 3 | 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 | Fqhc visit, mh new pt |
| G0470 | 0010 | 3 | 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 | Fqhc visit, mh estab pt |
| G0471 | 0010 | 3 | 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) | Ven blood coll snf/hha |
| G0472 | 0010 | 3 | Hepatitis c antibody screening, for individual at high risk and other covered indication(s) | Hep c screen high risk/other |
| G0473 | 0010 | 3 | Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes | Group behave couns 2-10 |
| G0475 | 0010 | 3 | Hiv antigen/antibody, combination assay, screening | Hiv combination assay |
| G0476 | 0010 | 3 | 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 | Hpv combo assay ca screen |
| G0477 | 0010 | 3 | 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 | Drug test presump optical |
| G0478 | 0010 | 3 | 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 | Drug test presump opt inst |
| G0479 | 0010 | 3 | 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 | Drug test presump not opt |
| G0480 | 0010 | 3 | 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 | Drug test def 1-7 classes |
| G0481 | 0010 | 3 | 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 | Drug test def 8-14 classes |
| G0482 | 0010 | 3 | 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 | Drug test def 15-21 classes |
| G0483 | 0010 | 3 | 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 | Drug test def 22+ classes |
| G0490 | 0010 | 3 | 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) | Home visit rn, lpn by rhc/fq |
| G0491 | 0010 | 3 | Dialysis procedure at a medicare certified esrd facility for acute kidney injury without esrd | Dialysis acu kidney no esrd |
| G0492 | 0010 | 3 | Dialysis procedure with single evaluation by a physician or other qualified health care professional for acute kidney injury without esrd | Md/oth eval acut kid no esrd |
| G0493 | 0010 | 3 | 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) | Rn care ea 15 min hh/hospice |
| G0494 | 0010 | 3 | 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) | Lpn care ea 15min hh/hospice |
| G0495 | 0010 | 3 | 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 | Rn care train/edu in hh |
| G0496 | 0010 | 3 | 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 | Lpn care train/edu in hh |
| G0498 | 0010 | 3 | 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 | Chemo extend iv infus w/pump |
| G0499 | 0010 | 3 | 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 | Hepb screen high risk indiv |
| G0500 | 0010 | 3 | 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) | Mod sedat endo service >5yrs |
| G0501 | 0010 | 3 | 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) | Resource-inten svc during ov |
| G0502 | 0010 | 3 | 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 | Init psych care manag, 70min |
| G0503 | 0010 | 3 | 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 | Subseq psych care man,60mi |
| G0503 | 0020 | 4 | goals and are prepared for discharge from active treatment | |
| G0504 | 0010 | 3 | 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) | Init/sub psych care add 30 m |
| G0505 | 0010 | 3 | 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 | Cog/func assessment outpt |
| G0506 | 0010 | 3 | Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service) | Comp asses care plan ccm svc |
| G0507 | 0010 | 3 | 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 | Care manage serv minimum 20 |
| G0508 | 0010 | 3 | Telehealth consultation, critical care, initial , physicians typically spend 60 minutes communicating with the patient and providers via telehealth | Crit care telehea consult 60 |
| G0509 | 0010 | 3 | Telehealth consultation, critical care, subsequent, physicians typically spend 50 minutes communicating with the patient and providers via telehealth | Crit care telehea consult 50 |
| G0511 | 0010 | 3 | 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 | Ccm/bhi by rhc/fqhc 20min mo |
| G0512 | 0010 | 3 | 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 | Cocm by rhc/fqhc 60 min mo |
| G0513 | 0010 | 3 | 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) | Prolong prev svcs, first 30m |
| G0514 | 0010 | 3 | 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) | Prolong prev svcs, addl 30m |
| G0515 | 0010 | 3 | Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes | Cognitive skills development |
| G0516 | 0010 | 3 | Insertion of non-biodegradable drug delivery implants, 4 or more (services for subdermal rod implant) | Insert drug del implant, >=4 |
| G0517 | 0010 | 3 | Removal of non-biodegradable drug delivery implants, 4 or more (services for subdermal implants) | Remove drug implant |
| G0518 | 0010 | 3 | Removal with reinsertion, non-biodegradable drug delivery implants, 4 or more (services for subdermal implants) | Remove w insert drug implant |
| G0659 | 0010 | 3 | 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 | Drug test def simple all cl |
| G0908 | 0010 | 3 | Most recent hemoglobin (hgb) level > 12.0 g/dl | Hgb > 12 g/dl |
| G0909 | 0010 | 3 | Hemoglobin level measurement not documented, reason not given | Hbg not doc |
| G0910 | 0010 | 3 | Most recent hemoglobin level <= 12.0 g/dl | Hgb <= 12 g/dl |
| G0913 | 0010 | 3 | Improvement in visual function achieved within 90 days following cataract surgery | Improve visual funct |
| G0914 | 0010 | 3 | Patient care survey was not completed by patient | Survey not complete |
| G0915 | 0010 | 3 | Improvement in visual function not achieved within 90 days following cataract surgery | No improve visual funct |
| G0916 | 0010 | 3 | Satisfaction with care achieved within 90 days following cataract surgery | Satisfy with care |
| G0917 | 0010 | 3 | Patient satisfaction survey was not completed by patient | Satisfy survey not complete |
| G0918 | 0010 | 3 | Satisfaction with care not achieved within 90 days following cataract surgery | No satisfy with care |
| G0919 | 0010 | 3 | Influenza immunization ordered or recommended (to be given at alternate location or alternate provider); vaccine not available at time of visit | Flu immunize not avail |
| G0920 | 0010 | 3 | Type, anatomic location, and activity all documented | Type loc act doc |
| G0921 | 0010 | 3 | Documentation of patient reason(s) for not being able to assess (e.g., patient refuses endoscopic and/or radiologic assessment) | Doc pt reas no assess |
| G0922 | 0010 | 3 | No documentation of disease type, anatomic location, and activity, reason not given | Type loc act not doc |
| G1000 | 0010 | 3 | Clinical decision support mechanism applied pathways, as defined by the medicare appropriate use criteria program | Cdsm applied pathways |
| G1001 | 0010 | 3 | Clinical decision support mechanism evicore, as defined by the medicare appropriate use criteria program | Cdsm evicore |
| G1002 | 0010 | 3 | Clinical decision support mechanism medcurrent, as defined by the medicare appropriate use criteria program | Cdsm medcurrent |
| G1003 | 0010 | 3 | Clinical decision support mechanism medicalis, as defined by the medicare appropriate use criteria program | Cdsm medicalis |
| G1004 | 0010 | 3 | Clinical decision support mechanism national decision support company, as defined by the medicare appropriate use criteria program | Cdsm ndsc |
| G1005 | 0010 | 3 | Clinical decision support mechanism national imaging associates, as defined by the medicare appropriate use criteria program | Cdsm nia |
| G1006 | 0010 | 3 | Clinical decision support mechanism test appropriate, as defined by the medicare appropriate use criteria program | Cdsm test approp |
| G1007 | 0010 | 3 | Clinical decision support mechanism aim specialty health, as defined by the medicare appropriate use criteria program | Cdsm aim |
| G1008 | 0010 | 3 | Clinical decision support mechanism cranberry peak, as defined by the medicare appropriate use criteria program | Cdsm cranberry pk |
| G1009 | 0010 | 3 | Clinical decision support mechanism sage health management solutions, as defined by the medicare appropriate use criteria program | Cdsm sage health |
| G1010 | 0010 | 3 | Clinical decision support mechanism stanson, as defined by the medicare appropriate use criteria program | Cdsm stanson |
| G1011 | 0010 | 3 | Clinical decision support mechanism, qualified tool not otherwise specified, as defined by the medicare appropriate use criteria program | Cdsm qualified nos |
| G2000 | 0010 | 3 | 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 | Blinded conv. tx mdd clin tr |
| G2001 | 0010 | 3 | 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.) | Post d/c h vst new pt 20 m |
| G2002 | 0010 | 3 | 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.) | Post-d/c h vst new pt 30 m |
| G2003 | 0010 | 3 | 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.) | Post-d/c h vst new pt 45 m |
| G2004 | 0010 | 3 | 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.) | Post-d/c h vst new pt 60 m |
| G2005 | 0010 | 3 | 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.) | Post-d/c h vst new pt 75 m |
| G2006 | 0010 | 3 | 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.) | Post-d/c h vst ext pt 20 m |
| G2007 | 0010 | 3 | 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.) | Post-d/c h vst ext pt 30 m |
| G2008 | 0010 | 3 | 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.) | Post-d/c h vst ext pt 45 m |
| G2009 | 0010 | 3 | 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.) | Post-d/c h vst ext pt 60 m |
| G2010 | 0010 | 3 | 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 | Remot image submit by pt |
| G2011 | 0010 | 3 | Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention, 5-14 minutes | Alcohol/sub abuse assess |
| G2012 | 0010 | 3 | 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 | Brief check in by md/qhp |
| G2013 | 0010 | 3 | 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.) | Post-d/c h vst ext pt 75 m |
| G2014 | 0010 | 3 | 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.) | Post-d/c care plan overs 30m |
| G2015 | 0010 | 3 | 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.) | Post-d/c care plan overs 60m |
| G2021 | 0010 | 3 | Health care practitioners rendering treatment in place (tip) | Hea care pract tx in place |
| G2022 | 0010 | 3 | A model participant (ambulance supplier/provider), the beneficiary refuses services covered under the model (transport to an alternate destination/treatment in place) | Benef refuses service, mod |
| G2058 | 0010 | 3 | 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)). | Ccm add 20min |
| G2061 | 0010 | 3 | Qualified nonphysician healthcare professional online assessment, for an established patient, for up to seven days, cumulative time during the 7 days; 5-10 minutes | Qual nonmd est pt 5-10m |
| G2062 | 0010 | 3 | Qualified nonphysician healthcare professional online assessment service, for an established patient, for up to seven days, cumulative time during the 7 days; 11-20 minutes | Qual nonmd est pt 11-20m |
| G2063 | 0010 | 3 | Qualified nonphysician qualified healthcare professional assessment service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes | Qual nonmd est pt 21>min |
| G2064 | 0010 | 3 | 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 | Md mang high risk dx 30 |
| G2065 | 0010 | 3 | 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 | Clin mang h risk dx 30 |
| G2066 | 0010 | 3 | 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 | Inter devc remote 30d |
| G2067 | 0010 | 3 | 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) | Med assist tx meth wk |
| G2068 | 0010 | 3 | 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) | Med assist tx bupre oral |
| G2069 | 0010 | 3 | 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) | Med assist tx inject |
| G2070 | 0010 | 3 | 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) | Med assist tx implant |
| G2071 | 0010 | 3 | 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) | Med tx remove implant |
| G2072 | 0010 | 3 | 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) | Med tx insert/remove imp |
| G2073 | 0010 | 3 | 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) | Med tx naltrexone |
| G2074 | 0010 | 3 | 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) | Med assist tx no drug |
| G2075 | 0010 | 3 | 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) | Med tx meds nos |
| G2076 | 0010 | 3 | 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 | Intake act w/med exam |
| G2077 | 0010 | 3 | 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 | Periodic assessment |
| G2078 | 0010 | 3 | 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 | Take-home meth |
| G2079 | 0010 | 3 | 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 | Take-hom buprenorphine |
| G2080 | 0010 | 3 | 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 | Add 30 mins counsel |
| G2081 | 0010 | 3 | 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 days during the measurement period | Pt 66+ snp or ltc pos > 90d |
| G2082 | 0010 | 3 | 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 | Visit esketamine 56m or less |
| G2083 | 0010 | 3 | 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 | Visit esketamine, > 56m |
| G2086 | 0010 | 3 | 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 | Off base opioid tx 70min |
| G2087 | 0010 | 3 | 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 | Off base opioid tx, 60 m |
| G2088 | 0010 | 3 | 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) | Off base opioid tx, add30 |
| G2089 | 0010 | 3 | Most recent hemoglobin a1c (hba1c) level 7.0 to 9.0% | A1c level 7 to 9% |
| G2090 | 0010 | 3 | 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 | Pt 66+ frailty and med dem |
| G2091 | 0010 | 3 | 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 | Pt 66+ frailty and adv ill |
| G2092 | 0010 | 3 | Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) or angiotensin receptor-neprilysin inhibitor (arni) therapy prescribed or currently being taken | Ace arb arni |
| G2093 | 0010 | 3 | 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) | Med doc rsn no ace arn arni |
| G2094 | 0010 | 3 | Documentation of patient reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., patient declined, other patient reasons) | Pt rsn no ace arn arni |
| G2095 | 0010 | 3 | Documentation of system reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., other system reasons) | Sys rsn no ace arn arni |
| G2096 | 0010 | 3 | Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) or angiotensin receptor-neprilysin inhibitor (arni) therapy was not prescribed, reason not given | No rsn ace arb arni |
| G2097 | 0010 | 3 | Children with a competing diagnosis for upper respiratory infection within three days of diagnosis of pharyngitis (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 | Child dx uri 3d of other dx |
| G2098 | 0010 | 3 | 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 | Pt 66+ frailty and med dem |
| G2099 | 0010 | 3 | 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 | Pt 66+ frailty and adv ill |
| G2100 | 0010 | 3 | 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 | Pt 66+ frailty and med dem |
| G2101 | 0010 | 3 | 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 | Pt 66+ frailty and adv ill |
| G2102 | 0010 | 3 | Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed | Dil retinal eye exam |
| G2103 | 0010 | 3 | Seven standard field stereoscopic photos with interpretation by an ophthalmologist or optometrist documented and reviewed | 7 stereo photos interpret |
| G2104 | 0010 | 3 | Eye imaging validated to match diagnosis from seven standard field stereoscopic photos results documented and reviewed | Eye img valid w/7 stereo |
| G2105 | 0010 | 3 | 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 | Pt 66+ lt ints > 90 |
| G2106 | 0010 | 3 | 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 | Pt 66+ lt ints > 90 |
| G2107 | 0010 | 3 | 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 | Pt 66+ frailty and adv ill |
| G2108 | 0010 | 3 | 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 | Pt 66+ lt ints > 90 |
| G2109 | 0010 | 3 | 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 | Pt 66+ frailty and med dem |
| G2110 | 0010 | 3 | 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 | Pt 66+ frailty and adv ill |
| G2112 | 0010 | 3 | Patient receiving <=5 mg daily prednisone (or equivalent), or ra activity is worsening, or glucocorticoid use is for less than 6 months | Pred<=5 mg ra glu <6m |
| G2113 | 0010 | 3 | Patient receiving >5 mg daily prednisone (or equivalent) for longer than 6 months, and improvement or no change in disease activity | Pred>5 mg >6m, no chg da |
| G2114 | 0010 | 3 | 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 | Pt 66-80 frailty and med dem |
| G2115 | 0010 | 3 | 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 | Pt 66+ frailty and med dem |
| G2116 | 0010 | 3 | 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 | Pt 66+ frailty and adv ill |
| G2117 | 0010 | 3 | 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 | Pt 66-80 frailty and adv ill |
| G2118 | 0010 | 3 | Patients 81 years of age and older with a evidence of frailty during the measurement period | Pt 81+ frailty |
| G2119 | 0010 | 3 | Within the past 2 years, calcium and/or vitamin d optimization has been ordered or performed | Calc vitd opt |
| G2120 | 0010 | 3 | Within the past 2 years, calcium and/or vitamin d optimization has not been ordered or performed | No calc vitd opt |
| G2121 | 0010 | 3 | Psychosis, depression, anxiety, apathy, and impulse control disorder assessed | Psy dep anx ap and icd asse |
| G2122 | 0010 | 3 | Psychosis, depression, anxiety, apathy, and impulse control disorder not assessed | Psy/dep/anx/apandicd noasse |
| G2123 | 0010 | 3 | 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 | Pt 66-80 frailty med dem |
| G2124 | 0010 | 3 | Patients 66-80 years of age and had at least one claim/encounter for frailty during the measurement period and a dispensed dementia medication | Pt 66-80 frailty adv ill |
| G2125 | 0010 | 3 | Patients 81 years of age and older with evidence of frailty during the measurement period | Pt 81+ frailty |
| G2126 | 0010 | 3 | Patients 66 years of age or older 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 | Pt 66+ frailty adv ill |
| G2127 | 0010 | 3 | Patients 66 years of age or older and had at least one claim/encounter for frailty during the measurement period and a dispensed dementia medication | Pt 66+ frailty med dem |
| G2128 | 0010 | 3 | 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) | No aspirin med rsn |
| G2129 | 0010 | 3 | 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 | No bp outpt |
| G2130 | 0010 | 3 | 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 | Pt 66+ lt inst > 90 |
| G2131 | 0010 | 3 | Patients 81 years and older with a diagnosis of frailty | Pt 81+ frailty |
| G2132 | 0010 | 3 | 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 | Pt 66-80 frailty and med dem |
| G2133 | 0010 | 3 | 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 | Pt 66-80 frailty and adv ill |
| G2134 | 0010 | 3 | 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 | Pt 66+ frailty and med dem |
| G2135 | 0010 | 3 | 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 | Pt 66+ frailty and adv ill |
| G2136 | 0010 | 3 | Back pain measured by the visual analog scale (vas) 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) within three months preoperatively and at three months (6 ? 20 weeks) postoperatively demonstrated an improvement of 5.0 points or greater | Bk pain vas 6-20wk = 3 |
| G2137 | 0010 | 3 | Back pain measured by the visual analog scale (vas) at three months (6 ? 20 weeks) postoperatively was greater than 3.0 and back pain measured by the visual analog scale (vas) within three months preoperatively and at three months (6 ? 20 weeks) postoperatively demonstrated a change of less than an improvement of 5.0 points | Bk pain vas 6-20wk > 3 |
| G2138 | 0010 | 3 | Back pain as measured by the visual analog scale (vas) 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) within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated a change of 5.0 points or greater | Bk pain vas 9-15mo = 3 |
| G2139 | 0010 | 3 | Back pain measured by the visual analog scale (vas) pain at one year (9 to 15 months) postoperatively was greater than 3.0 and back pain measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated a change of less than 5.0 | Bk pain vas 9-20mo > 3 |
| G2140 | 0010 | 3 | Leg pain measured by the visual analog scale (vas) 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) within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated an improvement of 5.0 points or greater | Leg pain vas 6-20wk = 3 |
| G2141 | 0010 | 3 | Leg pain measured by the visual analog scale (vas) at three months (6 ? 20 weeks) postoperatively was greater than 3.0 and leg pain measured by the visual analog scale (vas) within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated less than an improvement of 5.0 points | Leg pain vas 6-20wk > 3 |
| G2142 | 0010 | 3 | 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 a change of 30 points or greater | Fs odi 9-15mo postop<= 22 |
| G2143 | 0010 | 3 | 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 a change of less than 30 points | Fs odi 9-15mo > 22 |
| G2144 | 0010 | 3 | 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 a change of 30 points or greater | Fs odi 6-20wk postop > 22 |
| G2145 | 0010 | 3 | 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 a change of less than 30 points | Fsodi 6-20wk >22 or chg 30pt |
| G2146 | 0010 | 3 | Leg pain as measured by the visual analog scale (vas) 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) within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of 5.0 points or greater | Leg pain vas 9-15mo <= 3 |
| G2147 | 0010 | 3 | Leg pain measured by the visual analog scale (vas) at one year (9 to 15 months) postoperatively was greater than 3.0 and leg pain measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated less than an improvement of 5.0 points | Leg pain vas 9-15mo > 3 |
| G2148 | 0010 | 3 | Performance met: multimodal pain management was used | Mpm used |
| G2149 | 0010 | 3 | 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)) | No mpm med rsn |
| G2150 | 0010 | 3 | Performance not met: multimodal pain management was not used | No mpm |
| G2151 | 0010 | 3 | Patients with diagnosis of a degenerative neurological condition such as als, ms, parkinson’s diagnosed at any time before or during the episode of care | Dx degen neuro |
| G2152 | 0010 | 3 | Performance met: the residual change score is equal to or greater than 0 | Res change sc =0 |
| G2153 | 0010 | 3 | In hospice or using hospice services during the measurement period | Hosp dur meas pd |
| G2154 | 0010 | 3 | 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 | Td 9 yrs start end meas |
| G2155 | 0010 | 3 | 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.) | Hist contraindications |
| G2156 | 0010 | 3 | 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.) | No prior td or hx contra |
| G2157 | 0010 | 3 | 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 | Pneum vacc 12 mo 60+ |
| G2158 | 0010 | 3 | Patient had prior pneumococcal vaccine adverse reaction any time during or before the measurement period | Pneum vacc adv rx |
| G2159 | 0010 | 3 | 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 | No pneum vacc 12 mo 60+ |
| G2160 | 0010 | 3 | 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 | Herpzos 50+ |
| G2161 | 0010 | 3 | Patient had prior adverse reaction caused by zoster vaccine or its components any time during or before the measurement period | Adv rx zos |
| G2162 | 0010 | 3 | 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 | No herpzos 50+ |
| G2163 | 0010 | 3 | 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 | Infl vacc 07/01 to 06/30 |
| G2164 | 0010 | 3 | Patient had a prior influenza virus vaccine adverse reaction any time before or during the measurement period | Adv rx infl vacc |
| G2165 | 0010 | 3 | 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 | No infl vacc 07/01 to 06/30 |
| G2166 | 0010 | 3 | 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 | No pt adm dx no neck fs prom |
| G2167 | 0010 | 3 | Performance not met: the residual change score is less than 0 | Res change sc < 0 |
| G3001 | 0010 | 3 | Administration and supply of tositumomab, 450 mg | Admin + supply, tositumomab |
| G6001 | 0010 | 3 | Ultrasonic guidance for placement of radiation therapy fields | Echo guidance radiotherapy |
| G6002 | 0010 | 3 | Stereoscopic x-ray guidance for localization of target volume for the delivery of radiation therapy | Stereoscopic x-ray guidance |
| G6003 | 0010 | 3 | Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: up to 5 mev | Radiation treatment delivery |
| G6004 | 0010 | 3 | Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: 6-10 mev | Radiation treatment delivery |
| G6005 | 0010 | 3 | Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: 11-19 mev | Radiation treatment delivery |
| G6006 | 0010 | 3 | Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: 20 mev or greater | Radiation treatment delivery |
| G6007 | 0010 | 3 | Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: up to 5 mev | Radiation treatment delivery |
| G6008 | 0010 | 3 | Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 6-10 mev | Radiation treatment delivery |
| G6009 | 0010 | 3 | Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 11-19 mev | Radiation treatment delivery |
| G6010 | 0010 | 3 | Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 20 mev or greater | Radiation treatment delivery |
| G6011 | 0010 | 3 | Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; up to 5 mev | Radiation treatment delivery |
| G6012 | 0010 | 3 | Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 6-10 mev | Radiation treatment delivery |
| G6013 | 0010 | 3 | Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 11-19 mev | Radiation treatment delivery |
| G6014 | 0010 | 3 | Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 20 mev or greater | Radiation treatment delivery |
| G6015 | 0010 | 3 | Intensity modulated treatment delivery, single or multiple fields/arcs,via narrow spatially and temporally modulated beams, binary, dynamic mlc, per treatment session | Radiation tx delivery imrt |
| G6016 | 0010 | 3 | 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 | Delivery comp imrt |
| G6017 | 0010 | 3 | 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 | Intrafraction track motion |
| G6018 | 0010 | 3 | Ileoscopy, through stoma; with transendoscopic stent placement (includes predilation) | Ileoscopy w/stent |
| G6019 | 0010 | 3 | 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 | Colonoscopy lesion removal |
| G6020 | 0010 | 3 | Colonoscopy through stoma; with transendoscopic stent placement (includes predilation) | Colonoscopy w/stent |
| G6021 | 0010 | 3 | Unlisted procedure, intestine | Unlisted px small intestine |
| G6022 | 0010 | 3 | 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 | Sigmoidoscopy w/ablate tumr |
| G6023 | 0010 | 3 | Sigmoidoscopy, flexible; with transendoscopic stent placement (includes predilation) | Sigmoidoscopy w/stent |
| G6024 | 0010 | 3 | 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 | Lesion removal colonoscopy |
| G6025 | 0010 | 3 | Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic stent placement (includes predilation) | Colonoscopy w/stent |
| G6027 | 0010 | 3 | Anoscopy, high resolution (hra) (with magnification and chemical agent enhancement); diagnostic, including collection of specimen(s) by brushing or washing when performed | Anoscopy hra w/spec collect |
| G6028 | 0010 | 3 | Anoscopy, high resolution (hra) (with magnification and chemical agent enhancement); with biopsy(ies) | Anoscopy hra w/biopsy |
| G6030 | 0010 | 3 | Amitriptyline | Assay of amitriptyline |
| G6031 | 0010 | 3 | Benzodiazepines | Assay of benzodiazepines |
| G6032 | 0010 | 3 | Desipramine | Assay of desipramine |
| G6034 | 0010 | 3 | Doxepin | Assay of doxepin |
| G6035 | 0010 | 3 | Gold | Assay of gold |
| G6036 | 0010 | 3 | Assay of imipramine | Assay of imipramine |
| G6037 | 0010 | 3 | Nortriptyline | Assay of nortiptyline |
| G6038 | 0010 | 3 | Salicylate | Assay of salicylate |
| G6039 | 0010 | 3 | Acetaminophen | Assay of acetaminophen |
| G6040 | 0010 | 3 | Alcohol (ethanol); any specimen except breath | Assay of ethanol |
| G6041 | 0010 | 3 | Alkaloids, urine, quantitative | Assay of urine alkaloids |
| G6042 | 0010 | 3 | Amphetamine or methamphetamine | Assay of amphetamines |
| G6043 | 0010 | 3 | Barbiturates, not elsewhere specified | Assay of barbiturates |
| G6044 | 0010 | 3 | Cocaine or metabolite | Assay of cocaine |
| G6045 | 0010 | 3 | Dihydrocodeinone | Assay of dihydrocodeinone |
| G6046 | 0010 | 3 | Dihydromorphinone | Assay of dihydromorphinone |
| G6047 | 0010 | 3 | Dihydrotestosterone | Assay of dihydrotestosterone |
| G6048 | 0010 | 3 | Dimethadione | Assay of dimethadione |
| G6049 | 0010 | 3 | Epiandrosterone | Asssay of epiandrosterone |
| G6050 | 0010 | 3 | Ethchlorvynol | Assay of ethchlorvynol |
| G6051 | 0010 | 3 | Flurazepam | Assay of flurazepam |
| G6052 | 0010 | 3 | Meprobamate | Assay of meprobamate |
| G6053 | 0010 | 3 | Methadone | Assay of methadone |
| G6054 | 0010 | 3 | Methsuximide | Assay of methsuximide |
| G6055 | 0010 | 3 | Nicotine | Assay of nicotine |
| G6056 | 0010 | 3 | Opiate(s), drug and metabolites, each procedure | Assay of opiates |
| G6057 | 0010 | 3 | Phenothiazine | Assay of phenothiazine |
| G6058 | 0010 | 3 | Drug confirmation, each procedure | Drug confirmation |
| G8126 | 0010 | 3 | Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phase | Pt treat w/antidepress12wks |
| G8127 | 0010 | 3 | 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 | Pt not treat w/antidepres12w |
| G8128 | 0010 | 3 | Clinician documented that patient was not an eligible candidate for antidepressant medication during the entire 12 week acute treatment phase measure | Pt inelig for antidepres med |
| G8395 | 0010 | 3 | Left ventricular ejection fraction (lvef) >= 40% or documentation as normal or mildly depressed left ventricular systolic function | Lvef>=40% doc normal or mild |
| G8396 | 0010 | 3 | Left ventricular ejection fraction (lvef) not performed or documented | Lvef not performed |
| G8397 | 0010 | 3 | Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema and level of severity of retinopathy | Dil macula/fundus exam/w doc |
| G8398 | 0010 | 3 | Dilated macular or fundus exam not performed | Dil macular/fundus not perfo |
| G8399 | 0010 | 3 | Patient with documented results of a central dual-energy x-ray absorptiometry (dxa) ever being performed | Pt w/dxa results document |
| G8400 | 0010 | 3 | Patient with central dual-energy x-ray absorptiometry (dxa) results not documented, reason not given | Pt w/dxa no results doc |
| G8401 | 0010 | 3 | Clinician documented that patient was not an eligible candidate for screening | Pt inelig osteo screen measu |
| G8404 | 0010 | 3 | Lower extremity neurological exam performed and documented | Low extemity neur exam docum |
| G8405 | 0010 | 3 | Lower extremity neurological exam not performed | Low extemity neur not perfor |
| G8406 | 0010 | 3 | Clinician documented that patient was not an eligible candidate for lower extremity neurological exam measure | Pt inelig lower extrem neuro |
| G8410 | 0010 | 3 | Footwear evaluation performed and documented | Eval on foot documented |
| G8415 | 0010 | 3 | Footwear evaluation was not performed | Eval on foot not performed |
| G8416 | 0010 | 3 | Clinician documented that patient was not an eligible candidate for footwear evaluation measure | Pt inelig footwear evaluatio |
| G8417 | 0010 | 3 | Bmi is documented above normal parameters and a follow-up plan is documented | Calc bmi abv up param f/u |
| G8418 | 0010 | 3 | Bmi is documented below normal parameters and a follow-up plan is documented | Calc bmi blw low param f/u |
| G8419 | 0010 | 3 | Bmi documented outside normal parameters, no follow-up plan documented, no reason given | Calc bmi out nrm param nof/u |
| G8420 | 0010 | 3 | Bmi is documented within normal parameters and no follow-up plan is required | Calc bmi norm parameters |
| G8421 | 0010 | 3 | Bmi not documented and no reason is given | Bmi not calculated |
| G8422 | 0010 | 3 | Bmi not documented, documentation the patient is not eligible for bmi calculation | Pt inelig bmi calculation |
| G8427 | 0010 | 3 | Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient’s current medications | Docrev cur meds by elig clin |
| G8428 | 0010 | 3 | Current list of medications not documented as obtained, updated, or reviewed by the eligible clinician, reason not given | Cur meds not document |
| G8430 | 0010 | 3 | Eligible clinician attests to documenting in the medical record the patient is not eligible for a current list of medications being obtained, updated, or reviewed by the eligible clinician | Ec at doc medrec pt not elig |
| G8431 | 0010 | 3 | Screening for depression is documented as being positive and a follow-up plan is documented | Pos clin depres scrn f/u doc |
| G8432 | 0010 | 3 | Depression screening not documented, reason not given | Dep scr not doc, rng |
| G8433 | 0010 | 3 | Screening for depression not completed, documented reason | Scr for dep not cpt doc rsn |
| G8442 | 0010 | 3 | 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 | Doc pain as nt perf, not elg |
| G8450 | 0010 | 3 | Beta-blocker therapy prescribed | Beta-bloc rx pt w/abn lvef |
| G8451 | 0010 | 3 | 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, or other reasons attributable to the healthcare system) | Pt w/abn lvef inelig b-bloc |
| G8452 | 0010 | 3 | Beta-blocker therapy not prescribed | Pt w/abn lvef b-bloc no rx |
| G8458 | 0010 | 3 | 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) | Pt inelig geno no antvir tx |
| G8460 | 0010 | 3 | Clinician documented that patient is not an eligible candidate for quantitative rna testing at week 12; patient not receiving antiviral treatment for hepatitis c | Pt inelig rna no antvir tx |
| G8461 | 0010 | 3 | Patient receiving antiviral treatment for hepatitis c during the measurement period | Pt rec antivir treat hep c |
| G8464 | 0010 | 3 | 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 | Pt inelig; lo to no dter rsk |
| G8465 | 0010 | 3 | High or very high risk of recurrence of prostate cancer | High risk recurrence pro ca |
| G8473 | 0010 | 3 | Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy prescribed | Ace/arb thxpy rx’d |
| G8474 | 0010 | 3 | 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) or (e.g., lack of drug availability, other reasons attributable to the health care system) | Ace/arb not rx’d; doc reas |
| G8475 | 0010 | 3 | Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy not prescribed, reason not given | Ace/arb thxpy not rx’d |
| G8476 | 0010 | 3 | Most recent blood pressure has a systolic measurement of < 140 mmhg and a diastolic measurement of < 90 mmhg | Bp sys <140 and dias <90 |
| G8477 | 0010 | 3 | Most recent blood pressure has a systolic measurement of >= 140 mmhg and/or a diastolic measurement of >= 90 mmhg | Bp sys>=140 and/or dias >=90 |
| G8478 | 0010 | 3 | Blood pressure measurement not performed or documented, reason not given | Bp not performed/doc |
| G8482 | 0010 | 3 | Influenza immunization administered or previously received | Flu immunize order/admin |
| G8483 | 0010 | 3 | 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) | Flu imm no admin doc rea |
| G8484 | 0010 | 3 | Influenza immunization was not administered, reason not given | Flu immunize no admin |
| G8485 | 0010 | 3 | I intend to report the diabetes mellitus (dm) measures group | Report, diabetes measures |
| G8486 | 0010 | 3 | I intend to report the preventive care measures group | Report, prev care measures |
| G8487 | 0010 | 3 | I intend to report the chronic kidney disease (ckd) measures group | Report ckd measures |
| G8489 | 0010 | 3 | I intend to report the coronary artery disease (cad) measures group | Cad measures grp |
| G8490 | 0010 | 3 | I intend to report the rheumatoid arthritis (ra) measures group | Ra measures grp |
| G8491 | 0010 | 3 | I intend to report the hiv/aids measures group | Hiv/aids measures grp |
| G8492 | 0010 | 3 | I intend to report the perioperative care measures group | Periop care measures grp |
| G8493 | 0010 | 3 | I intend to report the back pain measures group | Back pain measures grp |
| G8494 | 0010 | 3 | All quality actions for the applicable measures in the diabetes mellitus (dm) measures group have been performed for this patient | Dm meas qual act perform |
| G8495 | 0010 | 3 | All quality actions for the applicable measures in the chronic kidney disease (ckd) measures group have been performed for this patient | Ckd meas qual act perform |
| G8496 | 0010 | 3 | All quality actions for the applicable measures in the preventive care measures group have been performed for this patient | Prev care mg qual act perfrm |
| G8497 | 0010 | 3 | All quality actions for the applicable measures in the coronary artery bypass graft (cabg) measures group have been performed for this patient | Cabg meas qual act perform |
| G8498 | 0010 | 3 | All quality actions for the applicable measures in the coronary artery disease (cad) measures group have been performed for this patient | Cad meas qual act perform |
| G8499 | 0010 | 3 | All quality actions for the applicable measures in the rheumatoid arthritis (ra) measures group have been performed for this patient | Ra meas qual act perform |
| G8500 | 0010 | 3 | All quality actions for the applicable measures in the hiv/aids measures group have been performed for this patient | Hiv meas qual act perform |
| G8501 | 0010 | 3 | All quality actions for the applicable measures in the perioperative care measures group have been performed for this patient | Perio meas qual act perform |
| G8502 | 0010 | 3 | All quality actions for the applicable measures in the back pain measures group have been performed for this patient | Back pain mg qual act perfrm |
| G8506 | 0010 | 3 | Patient receiving angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy | Pt rec ace/arb |
| G8509 | 0010 | 3 | Pain assessment documented as positive using a standardized tool, follow-up plan not documented, reason not given | Pos pain assess no f/u doc |
| G8510 | 0010 | 3 | Screening for depression is documented as negative, a follow-up plan is not required | Scr dep neg, no plan reqd |
| G8511 | 0010 | 3 | Screening for depression documented as positive, follow-up plan not documented, reason not given | Scr dep pos, no plan doc rng |
| G8530 | 0010 | 3 | Autogenous av fistula received | Auto av fistula recd |
| G8531 | 0010 | 3 | Clinician documented that patient was not an eligible candidate for autogenous av fistula | Pt inelig; auto av fistula |
| G8532 | 0010 | 3 | Clinician documented that patient received vascular access other than autogenous av fistula, reason not given | No auto av fistula; no reas |
| G8535 | 0010 | 3 | Elder maltreatment screen not documented; documentation that patient is not eligible for the elder maltreatment screen at the time of the encounter | Eld maltreatment not doc |
| G8536 | 0010 | 3 | No documentation of an elder maltreatment screen, reason not given | No doc elder mal scrn |
| G8539 | 0010 | 3 | Functional outcome assessment documented as positive using a standardized tool and a care plan based on identified deficiencies on the date of functional outcome assessment, is documented | Doc funct and care plan |
| G8540 | 0010 | 3 | 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 | Foa not doc as being perf |
| G8541 | 0010 | 3 | Functional outcome assessment using a standardized tool not documented, reason not given | No doc cur funct assess |
| G8542 | 0010 | 3 | Functional outcome assessment using a standardized tool is documented; no functional deficiencies identified, care plan not required | Doc funct no deficiencies |
| G8543 | 0010 | 3 | Documentation of a positive functional outcome assessment using a standardized tool; care plan not documented, reason not given | Cur funct asses; no care pln |
| G8544 | 0010 | 3 | I intend to report the coronary artery bypass graft (cabg) measures group | Cabg measures grp |
| G8545 | 0010 | 3 | I intend to report the hepatitis c measures group | Hepc measures grp |
| G8547 | 0010 | 3 | I intend to report the ischemic vascular disease (ivd) measures group | Ivd measures grp |
| G8548 | 0010 | 3 | I intend to report the heart failure (hf) measures group | Hf measures grp |
| G8549 | 0010 | 3 | All quality actions for the applicable measures in the hepatitis c measures group have been performed for this patient | Hepc mg qual act perform |
| G8551 | 0010 | 3 | All quality actions for the applicable measures in the heart failure (hf) measures group have been performed for this patient | Hf mg qual act perform |
| G8552 | 0010 | 3 | All quality actions for the applicable measures in the ischemic vascular disease (ivd) measures group have been performed for this patient | Ivd mg qual act perform |
| G8559 | 0010 | 3 | Patient referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation | Pt ref doc oto eval |
| G8560 | 0010 | 3 | Patient has a history of active drainage from the ear within the previous 90 days | Pt hx act drain prev 90 days |
| G8561 | 0010 | 3 | Patient is not eligible for the referral for otologic evaluation for patients with a history of active drainage measure | Pt inelig for ref oto eval |
| G8562 | 0010 | 3 | Patient does not have a history of active drainage from the ear within the previous 90 days | Pt no hx act drain 90 d |
| G8563 | 0010 | 3 | Patient not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not given | Pt no ref oto reas no spec |
| G8564 | 0010 | 3 | Patient was referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not specified) | Pt ref oto eval |
| G8565 | 0010 | 3 | Verification and documentation of sudden or rapidly progressive hearing loss | Ver doc hear loss |
| G8566 | 0010 | 3 | Patient is not eligible for the “referral for otologic evaluation for sudden or rapidly progressive hearing loss” measure | Pt inelig ref oto eval |
| G8567 | 0010 | 3 | Patient does not have verification and documentation of sudden or rapidly progressive hearing loss | Pt no doc hear loss |
| G8568 | 0010 | 3 | Patient was not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not given | Pt no ref otolo no spec |
| G8569 | 0010 | 3 | Prolonged postoperative intubation (> 24 hrs) required | Prol intubation req |
| G8570 | 0010 | 3 | Prolonged postoperative intubation (> 24 hrs) not required | No prol intub req |
| G8571 | 0010 | 3 | Development of deep sternal wound infection/mediastinitis within 30 days postoperatively | Ster wd ifx 30 d postop |
| G8572 | 0010 | 3 | No deep sternal wound infection/mediastinitis | No ster wd ifx |
| G8573 | 0010 | 3 | Stroke following isolated cabg surgery | Stk cabg |
| G8574 | 0010 | 3 | No stroke following isolated cabg surgery | No strk cabg |
| G8575 | 0010 | 3 | Developed postoperative renal failure or required dialysis | Postop ren fail |
| G8576 | 0010 | 3 | No postoperative renal failure/dialysis not required | No postop ren fail |
| G8577 | 0010 | 3 | Re-exploration required due to mediastinal bleeding with or without tamponade, graft occlusion, valve dysfunction or other cardiac reason | Reop req bld grft oth |
| G8578 | 0010 | 3 | Re-exploration not required due to mediastinal bleeding with or without tamponade, graft occlusion, valve dysfunction or other cardiac reason | No reop req bld grft oth |
| G8579 | 0010 | 3 | Antiplatelet medication at discharge | Antplt med disch |
| G8580 | 0010 | 3 | Antiplatelet medication contraindicated | Antplt med contraind |
| G8581 | 0010 | 3 | No antiplatelet medication at discharge | No antplt med disch |
| G8582 | 0010 | 3 | Beta-blocker at discharge | Bblock disch |
| G8583 | 0010 | 3 | Beta-blocker contraindicated | Bblock contraind |
| G8584 | 0010 | 3 | No beta-blocker at discharge | No bblock disch |
| G8585 | 0010 | 3 | Anti-lipid treatment at discharge | Antilipid treat disch |
| G8586 | 0010 | 3 | Anti-lipid treatment contraindicated | Antlip disch contra |
| G8587 | 0010 | 3 | No anti-lipid treatment at discharge | No antlipid treat disch |
| G8593 | 0010 | 3 | Lipid profile results documented and reviewed (must include total cholesterol, hdl-c, triglycerides and calculated ldl-c) | Lipid pn results |
| G8594 | 0010 | 3 | Lipid profile not performed, reason not given | No lipid prof perf |
| G8595 | 0010 | 3 | Most recent ldl-c < 100 mg/dl | Ldl < 100 |
| G8597 | 0010 | 3 | Most recent ldl-c >= 100 mg/dl | Ldl >= 100 |
| G8598 | 0010 | 3 | Aspirin or another antiplatelet therapy used | Asa/antiplat ther used |
| G8599 | 0010 | 3 | Aspirin or another antiplatelet therapy not used, reason not given | No asa/antiplat ther use rng |
| G8600 | 0010 | 3 | Iv t-pa initiated within three hours (<= 180 minutes) of time last known well | Tpa initi w/in 3 hrs |
| G8601 | 0010 | 3 | Iv t-pa not initiated within three hours (<= 180 minutes) of time last known well for reasons documented by clinician | No elig tpa init w/in 3 hrs |
| G8602 | 0010 | 3 | Iv t-pa not initiated within three hours (<= 180 minutes) of time last known well, reason not given | No tpa init w/in 3 hrs |
| G8627 | 0010 | 3 | 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) | Surg proc w/in 30 days |
| G8628 | 0010 | 3 | 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) | No surg proc w/in 30 days |
| G8629 | 0010 | 3 | 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) | Doc antibio order b/4 surg |
| G8630 | 0010 | 3 | 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 | Doc antibio given b/4 surg |
| G8631 | 0010 | 3 | 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) | Pt no elg 4 order antbi give |
| G8632 | 0010 | 3 | 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 | Doc no antibi order b/4 surg |
| G8633 | 0010 | 3 | Pharmacologic therapy (other than minierals/vitamins) for osteoporosis prescribed | Pharm ther osteo rx |
| G8634 | 0010 | 3 | Clinician documented patient not an eligible candidate to receive pharmacologic therapy for osteoporosis | Pt no elg phar ther osteo |
| G8635 | 0010 | 3 | Pharmacologic therapy for osteoporosis was not prescribed, reason not given | No pharm ther osteo rx |
| G8645 | 0010 | 3 | I intend to report the asthma measures group | Asthma measures grp |
| G8646 | 0010 | 3 | All quality actions for the applicable measures in the asthma measures group have been performed for this patient | Asthma mg qual act perform |
| G8647 | 0010 | 3 | Risk-adjusted functional status change residual score for the knee impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) | Rafscrs ki scor >= 0 |
| G8648 | 0010 | 3 | Risk-adjusted functional status change residual score for the knee impairment successfully calculated and the score was less than zero (< 0) | Rafscrs ki scor < 0 |
| G8649 | 0010 | 3 | 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 | Rafscrs ki no scor |
| G8650 | 0010 | 3 | Risk-adjusted functional status change residual score for the knee impairment not measured because the patient did not complete the knee fs prom at initial evaluation and/or near discharge, reason not given | Rafs crs ki no scor no surv |
| G8651 | 0010 | 3 | Risk-adjusted functional status change residual score for the hip impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) | Rafscrs hi scor >=0 |
| G8652 | 0010 | 3 | Risk-adjusted functional status change residual score for the hip impairment successfully calculated and the score was less than zero (< 0) | Rafscrs hi scor < 0 |
| G8653 | 0010 | 3 | 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 | Rafscrs hi no scor |
| G8654 | 0010 | 3 | Risk-adjusted functional status change residual score for the hip impairment not measured because the patient did not complete the fs intake survey on admission and/or follow up fs status survey near discharge, reason not given | Rafs crs hi no scor no surv |
| G8655 | 0010 | 3 | Risk-adjusted functional status change 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) | Rafscrs llfai scor >= 0 |
| G8656 | 0010 | 3 | Risk-adjusted functional status change residual score for the lower leg, foot or ankle impairment successfully calculated and the score was less than zero (< 0) | Rafscrs llfai scor < 0 |
| G8657 | 0010 | 3 | 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 | Rafscrs llfai no scor |
| G8658 | 0010 | 3 | 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 intake survey on admission and/or follow up fs status survey near discharge, reason not given | Rafscrs llfai no scor + surv |
| G8659 | 0010 | 3 | Risk-adjusted functional status change residual score for the low back impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) | Rafscrs lbi scor >= 0 |
| G8660 | 0010 | 3 | Risk-adjusted functional status change residual score for the low back impairment successfully calculated and the score was less than zero (< 0) | Rafscrs lbi scor < 0 |
| G8661 | 0010 | 3 | 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 | Rafscrs lbi no scor |
| G8662 | 0010 | 3 | Risk-adjusted functional status change 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 | Rafs crs lbi no scor no surv |
| G8663 | 0010 | 3 | Risk-adjusted functional status change residual score for the shoulder impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) | Rafscrs si scor >= 0 |
| G8664 | 0010 | 3 | Risk-adjusted functional status change residual score for the shoulder impairment successfully calculated and the score was less than zero (< 0) | Rafscrs si scor < 0 |
| G8665 | 0010 | 3 | 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 | Rafscrs si no scor |
| G8666 | 0010 | 3 | Risk-adjusted functional status change 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 | Rafs crs si no scor no surv |
| G8667 | 0010 | 3 | Risk-adjusted functional status change residual score for the elbow, wrist or hand impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) | Rafscrs ewh scor >= 0 |
| G8668 | 0010 | 3 | Risk-adjusted functional status change residual score for the elbow, wrist or hand impairment successfully calculated and the score was less than zero (< 0) | Rafscrs ewh scor < 0 |
| G8669 | 0010 | 3 | 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 | Rafscrs |
| G8670 | 0010 | 3 | Risk-adjusted functional status change 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 | Rafs crs ewh no scor no surv |
| G8671 | 0010 | 3 | 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) | Rafscrs goi scor >= 0 |
| G8672 | 0010 | 3 | 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) | Rafscrs goi scor < 0 |
| G8673 | 0010 | 3 | 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 | Rafscrs goi no scor |
| G8674 | 0010 | 3 | 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 | Rafscrs neck, no msr/no foto |
| G8682 | 0010 | 3 | Lvf testing documented as being performed prior to discharge or in the previous 12 months | Lvg test perf |
| G8683 | 0010 | 3 | Lvf testing not performed prior to discharge or in the previous 12 months for a medical or patient documented reason | Pt not elig for lvf test |
| G8685 | 0010 | 3 | Lvf testing not documented as being performed prior to discharge or in the previous 12 months, reason not given | Lvf test not perf |
| G8694 | 0010 | 3 | Left ventricular ejection fraction (lvef) < 40% | Lvef <40% |
| G8696 | 0010 | 3 | Antithrombotic therapy prescribed at discharge | Antithromb thx presc |
| G8697 | 0010 | 3 | 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)) | Antithromb no presc doc reas |
| G8698 | 0010 | 3 | Antithrombotic therapy was not prescribed at discharge, reason not given | Antithromb no presc no reas |
| G8699 | 0010 | 3 | Rehabilitation services (occupational, physical or speech) ordered at or prior to discharge | Rehab ordered disch |
| G8700 | 0010 | 3 | Rehabilitation services (occupational, physical or speech) not indicated at or prior to discharge | Rehab not indicated disch |
| G8701 | 0010 | 3 | Rehabilitation services were not ordered, reason not otherwise specified | Rehab not ordered |
| G8702 | 0010 | 3 | Documentation that prophylactic antibiotics were given within 4 hours prior to surgical incision or intraoperatively | Antiobiotics 4 hr prior surg |
| G8703 | 0010 | 3 | Documentation that prophylactic antibiotics were neither given within 4 hours prior to surgical incision nor intraoperatively | Antibiotics not prior surg |
| G8704 | 0010 | 3 | 12-lead electrocardiogram (ecg) performed | Ecg performed |
| G8705 | 0010 | 3 | Documentation of medical reason(s) for not performing a 12-lead electrocardiogram (ecg) | Med reas no ecg |
| G8706 | 0010 | 3 | Documentation of patient reason(s) for not performing a 12-lead electrocardiogram (ecg) | Pt reas no ecg |
| G8707 | 0010 | 3 | 12-lead electrocardiogram (ecg) not performed, reason not given | Ecg not performed |
| G8708 | 0010 | 3 | Patient not prescribed or dispensed antibiotic | Antibiotic not pres |
| G8709 | 0010 | 3 | Patient prescribed or dispensed antibiotic for documented medical reason(s) within three days after the initial diagnosis of uri (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) | Pt presc doc med rsn id uri |
| G8710 | 0010 | 3 | Patient prescribed or dispensed antibiotic | Pt pres antibiotic |
| G8711 | 0010 | 3 | Prescribed or dispensed antibiotic | Pres antibiotic |
| G8712 | 0010 | 3 | Antibiotic not prescribed or dispensed | Not pres antibiotic |
| G8713 | 0010 | 3 | Spkt/v greater than or equal to 1.2 (single-pool clearance of urea [kt] / volume [v]) | Spkt/v great 1.2 kt/v |
| G8714 | 0010 | 3 | Hemodialysis treatment performed exactly three times per week for > 90 days | Hemodialysis 3 times week |
| G8717 | 0010 | 3 | Spkt/v less than 1.2 (single-pool clearance of urea [kt] / volume [v]), reason not given | Less 1.2 kt/v |
| G8718 | 0010 | 3 | Total kt/v greater than or equal to 1.7 per week (total clearance of urea [kt] / volume [v]) | Great 1.7 kt/v per week |
| G8720 | 0010 | 3 | Total kt/v less than 1.7 per week (total clearance of urea [kt] / volume [v]) | Less 1.7 kt/v per week |
| G8721 | 0010 | 3 | Pt category (primary tumor), pn category (regional lymph nodes), and histologic grade were documented in pathology report | Pt, pn, hist grade doc |
| G8722 | 0010 | 3 | 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) | Med reas pt, pn, not doc |
| G8723 | 0010 | 3 | Specimen site is other than anatomic location of primary tumor | Spec sit not prim tumor |
| G8724 | 0010 | 3 | Pt category, pn category and histologic grade were not documented in the pathology report, reason not given | Pt, pn, hist grade not doc |
| G8725 | 0010 | 3 | Fasting lipid profile performed (triglycerides, ldl-c, hdl-c and total cholesterol) | Lipid profile perf doc |
| G8726 | 0010 | 3 | Clinician has documented reason for not performing fasting lipid profile (e.g., patient declined, other patient reasons) | Doc reas no lipid profile |
| G8728 | 0010 | 3 | Fasting lipid profile not performed, reason not given | Lipid profile not perf |
| G8730 | 0010 | 3 | Pain assessment documented as positive using a standardized tool and a follow-up plan is documented | Pain doc pos and plan |
| G8731 | 0010 | 3 | Pain assessment using a standardized tool is documented as negative, no follow-up plan required | Pain neg no plan |
| G8732 | 0010 | 3 | No documentation of pain assessment, reason not given | No doc of pain |
| G8733 | 0010 | 3 | Elder maltreatment screen documented as positive and a follow-up plan is documented | Doc pos elder mal scrn plan |
| G8734 | 0010 | 3 | Elder maltreatment screen documented as negative, no follow-up required | Doc neg elder mal no plan |
| G8735 | 0010 | 3 | Elder maltreatment screen documented as positive, follow-up plan not documented, reason not given | Eld mal scrn pos no plan |
| G8736 | 0010 | 3 | Most current ldl-c <100mg/dl | Ldl-c <100mg/dl |
| G8737 | 0010 | 3 | Most current ldl-c >=100mg/dl | Ldl-c >=100mg/dl |
| G8738 | 0010 | 3 | Left ventricular ejection fraction (lvef) < 40% or documentation of severely or moderately depressed left ventricular systolic function | Lvef < 40% |
| G8739 | 0010 | 3 | Left ventricular ejection fraction (lvef) >= 40% or documentation as normal or mildly depressed left ventricular systolic function | Lvef >= 40% |
| G8740 | 0010 | 3 | Left ventricular ejection fraction (lvef) not performed or assessed, reason not given | Lvef not perfrmd |
| G8749 | 0010 | 3 | 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) | No signs melanoma |
| G8751 | 0010 | 3 | Smoking status and exposure to second hand smoke in the home not assessed, reason not given | Smkg status not assess |
| G8752 | 0010 | 3 | Most recent systolic blood pressure < 140 mmhg | Sys bp less 140 |
| G8753 | 0010 | 3 | Most recent systolic blood pressure >= 140 mmhg | Sys bp > or = 140 |
| G8754 | 0010 | 3 | Most recent diastolic blood pressure < 90 mmhg | Dias bp less 90 |
| G8755 | 0010 | 3 | Most recent diastolic blood pressure >= 90 mmhg | Dias bp > or = 90 |
| G8756 | 0010 | 3 | No documentation of blood pressure measurement, reason not given | No bp measure doc |
| G8757 | 0010 | 3 | All quality actions for the applicable measures in the chronic obstructive pulmonary disease (copd) measures group have been performed for this patient | Copd mg qual act perform |
| G8758 | 0010 | 3 | All quality actions for the applicable measures in the inflammatory bowel disease (ibd) measures group have been performed for this patient | Ibd mg qual act perform |
| G8759 | 0010 | 3 | All quality actions for the applicable measures in the sleep apnea measures group have been performed for this patient | Osa mg qual act perform |
| G8761 | 0010 | 3 | All quality actions for the applicable measures in the dementia measures group have been performed for this patient | Dementia mg qual act perform |
| G8762 | 0010 | 3 | All quality actions for the applicable measures in the parkinson’s disease measures group have been performed for this patient | Pd mg qual act perform |
| G8763 | 0010 | 3 | All quality actions for the applicable measures in the hypertension (htn) measures group have been performed for this patient | Hyperten mg qual act perform |
| G8764 | 0010 | 3 | All quality actions for the applicable measures in the cardiovascular prevention measures group have bee performed for this patient | Car prev mg qual act perform |
| G8765 | 0010 | 3 | All quality actions for the applicable measures in the cataract measures group have been performed for this patient | Cataract mg qual act perform |
| G8767 | 0010 | 3 | Lipid panel results documented and reviewed (must include total cholesterol, hdl-c, triglycerides and calculated ldl-c) | Lipid panel res doc rev |
| G8768 | 0010 | 3 | 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) | Doc med reas no lipid profle |
| G8769 | 0010 | 3 | Lipid profile not performed, reason not given | Lipid profile not perform |
| G8770 | 0010 | 3 | Urine protein test result documented and reviewed | Urine protein test doc rev |
| G8771 | 0010 | 3 | Documentation of diagnosis of chronic kidney disease | Doc dx ckd |
| G8772 | 0010 | 3 | 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) | Doc med reas no urine protn |
| G8773 | 0010 | 3 | Urine protein test was not performed, reason not given | No urine protein test |
| G8774 | 0010 | 3 | Serum creatinine test result documented and reviewed | Serum creatinine doc rev |
| G8775 | 0010 | 3 | 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) | Doc med reas no serum crtn |
| G8776 | 0010 | 3 | Serum creatinine test not performed, reason not given | No serum creatinine test |
| G8777 | 0010 | 3 | Diabetes screening test performed | Diabetes screen |
| G8778 | 0010 | 3 | 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) | Doc med reas no diabete scrn |
| G8779 | 0010 | 3 | Diabetes screening test not performed, reason not given | No diabetes screen |
| G8780 | 0010 | 3 | Counseling for diet and physical activity performed | Counsel diet phys activity |
| G8781 | 0010 | 3 | 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) | Doc med reas no counsel diet |
| G8782 | 0010 | 3 | Counseling for diet and physical activity not performed, reason not given | No counsel diet phys act |
| G8783 | 0010 | 3 | Normal blood pressure reading documented, follow-up not required | Bp scrn perf rec interval |
| G8784 | 0010 | 3 | Patient not eligible (e.g., documentation the patient is not eligible due to active diagnosis of hypertension, patient refuses, urgent or emergent situation) | Pt no elig for bp assess |
| G8785 | 0010 | 3 | Blood pressure reading not documented, reason not given | Bp scrn no perf at interval |
| G8797 | 0010 | 3 | Specimen site other than anatomic location of esophagus | Specimen site not esophagus |
| G8798 | 0010 | 3 | Specimen site other than anatomic location of prostate | Specimen site not prostate |
| G8806 | 0010 | 3 | Performance of trans-abdominal or trans-vaginal ultrasound and pregnancy location documented | Perf ultrsnd to lct preg doc |
| G8807 | 0010 | 3 | Trans-abdominal or trans-vaginal ultrasound not performed for reasons documented by clinician (e.g., patient has visited the ed multiple times within 72 hours, patient has a documented intrauterine pregnancy [iup]) | No ta tv ultrasnd |
| G8808 | 0010 | 3 | Trans-abdominal or trans-vaginal ultrasound not performed, reason not given | Ultrasound not perf, rng |
| G8809 | 0010 | 3 | Rh-immunoglobulin (rhogam) ordered | Rh-immunoglobulin order |
| G8810 | 0010 | 3 | Rh-immunoglobulin (rhogam) not ordered for reasons documented by clinician (e.g., patient had prior documented receipt of rhogam within 12 weeks, patient refusal) | Doc reas no rh-immuno |
| G8811 | 0010 | 3 | Documentation rh-immunoglobulin (rhogam) was not ordered, reason not given | No rh-immunoglobulin order |
| G8815 | 0010 | 3 | 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) | Doc reas no statin therapy |
| G8816 | 0010 | 3 | Statin medication prescribed at discharge | Statin med pres at disch |
| G8817 | 0010 | 3 | Statin therapy not prescribed at discharge, reason not given | Doc reas no statin med disch |
| G8818 | 0010 | 3 | Patient discharge to home no later than post-operative day #7 | Pt disch to home by day#7 |
| G8825 | 0010 | 3 | Patient not discharged to home by post-operative day #7 | Pt not disch to home day#7 |
| G8826 | 0010 | 3 | Patient discharge to home no later than post-operative day #2 following evar | Pt disch home day #2 evar |
| G8833 | 0010 | 3 | Patient not discharged to home by post-operative day #2 following evar | Pt not disch home day#2 evar |
| G8834 | 0010 | 3 | Patient discharged to home no later than post-operative day #2 following cea | Pt disch home day #2 cea |
| G8838 | 0010 | 3 | Patient not discharged to home by post-operative day #2 following cea | Not disch home by day #2 |
| G8839 | 0010 | 3 | Sleep apnea symptoms assessed, including presence or absence of snoring and daytime sleepiness | Sleep apnea assess |
| G8840 | 0010 | 3 | 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) | Doc reas no sleep apnea |
| G8841 | 0010 | 3 | Sleep apnea symptoms not assessed, reason not given | No sleep apnea assess |
| G8842 | 0010 | 3 | Apnea hypopnea index (ahi) or respiratory disturbance index (rdi) measured at the time of initial diagnosis | Ahi or rdi initial dx |
| G8843 | 0010 | 3 | Documentation of reason(s) for not measuring an apnea hypopnea index (ahi) or a respiratory disturbance index (rdi) at the time of initial diagnosis (e.g., psychiatric disease, dementia, patient declined, financial, insurance coverage, test ordered but not yet completed) | Doc reas no ahi or rdi |
| G8844 | 0010 | 3 | Apnea hypopnea index (ahi) or respiratory disturbance index (rdi) not measured at the time of initial diagnosis, reason not given | No ahi or rdi initial dx |
| G8845 | 0010 | 3 | Positive airway pressure therapy prescribed | Pos airway press prescribed |
| G8846 | 0010 | 3 | Moderate or severe obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory disturbance index (rdi) of 15 or greater) | Mod or severe osa |
| G8848 | 0010 | 3 | Mild obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory disturbance index (rdi) of less than 15) | Mild osa |
| G8849 | 0010 | 3 | 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) | Doc reas no pos air press |
| G8850 | 0010 | 3 | Positive airway pressure therapy not prescribed, reason not given | No pap prescribed |
| G8851 | 0010 | 3 | Objective measurement of adherence to positive airway pressure therapy, documented | Adhere pos air press therapy |
| G8852 | 0010 | 3 | Positive airway pressure therapy prescribed | Pos air press prescribe |
| G8853 | 0010 | 3 | Positive airway pressure therapy not prescribed | Pos air press not prescribe |
| G8854 | 0010 | 3 | Documentation of reason(s) for not objectively measuring adherence to positive airway pressure therapy (e.g., patient didn’t bring data from continous positive airway pressure [cpap], therapy not yet initiated, not available on machine) | Reas no adhere pos air pres |
| G8855 | 0010 | 3 | Objective measurement of adherence to positive airway pressure therapy not performed, reason not given | Pos air press adhere no perf |
| G8856 | 0010 | 3 | Referral to a physician for an otologic evaluation performed | Ref for oto eval |
| G8857 | 0010 | 3 | 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) | No elig ref for oto eval |
| G8858 | 0010 | 3 | Referral to a physician for an otologic evaluation not performed, reason not given | Not ref for oto eval |
| G8859 | 0010 | 3 | Patient receiving corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days | Corticosteroids 10mg 60 days |
| G8860 | 0010 | 3 | Patients who have received dose of corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days | Corticosteroid 10 mg 60 days |
| G8861 | 0010 | 3 | 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 | Dxa ordered for osteo |
| G8862 | 0010 | 3 | Patients not receiving corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days | No corticostrd 10mg 60 days |
| G8863 | 0010 | 3 | Patients not assessed for risk of bone loss, reason not given | No assess bone loss |
| G8864 | 0010 | 3 | Pneumococcal vaccine administered or previously received | Pneumococcal vaccine admin |
| G8865 | 0010 | 3 | Documentation of medical reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient allergic reaction, potential adverse drug reaction) | Doc med reas no pneumococcal |
| G8866 | 0010 | 3 | Documentation of patient reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient refusal) | Doc pt reas no pneumococcal |
| G8867 | 0010 | 3 | Pneumococcal vaccine not administered or previously received, reason not given | No pneumococcal admin |
| G8868 | 0010 | 3 | Patients receiving a first course of anti-tnf therapy | 1st course antitnf |
| G8869 | 0010 | 3 | Patient has documented immunity to hepatitis b and initiating anti-tnf therapy | Doc immune hep b antitnf |
| G8870 | 0010 | 3 | Hepatitis b vaccine injection administered or previously received and is receiving a first course of anti-tnf therapy | Hepb admin 1st antitnf |
| G8871 | 0010 | 3 | Patient not receiving a first course of anti-tnf therapy | No 1st antitnf |
| G8872 | 0010 | 3 | Excised tissue evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesion | Intraop image confirm excise |
| G8873 | 0010 | 3 | 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) | Specimen not intraop image |
| G8874 | 0010 | 3 | Excised tissue not evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesion | Tissue not image intraop |
| G8875 | 0010 | 3 | Clinician diagnosed breast cancer preoperatively by a minimally invasive biopsy method | Breast cancer dx min invsive |
| G8876 | 0010 | 3 | 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) | Doc reas no min inv dx |
| G8877 | 0010 | 3 | Clinician did not attempt to achieve the diagnosis of breast cancer preoperatively by a minimally invasive biopsy method, reason not given | No brst cncr dx min invasive |
| G8878 | 0010 | 3 | Sentinel lymph node biopsy procedure performed | Sent lymph node biopsy |
| G8879 | 0010 | 3 | Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer | Node neg inv brst cncr |
| G8880 | 0010 | 3 | 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) | Sen lym p node biop not perf |
| G8881 | 0010 | 3 | Stage of breast cancer is greater than t1n0m0 or t2n0m0 | Brst cncr stage > t1n0m0 |
| G8882 | 0010 | 3 | Sentinel lymph node biopsy procedure not performed, reason not given | No sent lymph node biopsy |
| G8883 | 0010 | 3 | Biopsy results reviewed, communicated, tracked and documented | Rev, comm, track, doc biopsy |
| G8884 | 0010 | 3 | Clinician documented reason that patient’s biopsy results were not reviewed | Doc reas biopsy not review |
| G8885 | 0010 | 3 | Biopsy results not reviewed, communicated, tracked or documented | No rev, comm, track biopsy |
| G8886 | 0010 | 3 | Most recent blood pressure under control | Bp under control |
| G8887 | 0010 | 3 | 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) | Doc med reas bp not control |
| G8888 | 0010 | 3 | Most recent blood pressure not under control, results documented and reviewed | Bp not under control |
| G8889 | 0010 | 3 | No documentation of blood pressure measurement, reason not given | No doc bp |
| G8890 | 0010 | 3 | Most recent ldl-c under control, results documented and reviewed | Ldl-c under control |
| G8891 | 0010 | 3 | 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) | Doc med reas no ldl-c contrl |
| G8892 | 0010 | 3 | 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) | Doc med reas no ldl-c test |
| G8893 | 0010 | 3 | Most recent ldl-c not under control, results documented and reviewed | Ldl-c not under control |
| G8894 | 0010 | 3 | Ldl-c not performed, reason not given | Ldl-c not performed |
| G8895 | 0010 | 3 | Oral aspirin or other antithrombotic therapy prescribed | Antrom prescribe |
| G8896 | 0010 | 3 | 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) | Doc med reas no antihtrom |
| G8897 | 0010 | 3 | Oral aspirin or other antithrombotic therapy was not prescribed, reason not given | Antithrom not prescribe |
| G8898 | 0010 | 3 | I intend to report the chronic obstructive pulmonary disease (copd) measures group | Copd measures group |
| G8899 | 0010 | 3 | I intend to report the inflammatory bowel disease (ibd) measures group | Inflammatory bowel dis mg |
| G8900 | 0010 | 3 | I intend to report the sleep apnea measures group | Obstructive sleep apnea mg |
| G8902 | 0010 | 3 | I intend to report the dementia measures group | Dementia measures group |
| G8903 | 0010 | 3 | I intend to report the parkinson’s disease measures group | Parkinson’s disease mg |
| G8904 | 0010 | 3 | I intend to report the hypertension (htn) measures group | Hypertension mg |
| G8905 | 0010 | 3 | I intend to report the cardiovascular prevention measures group | Cardiovascular prevention mg |
| G8906 | 0010 | 3 | I intend to report the cataract measures group | Cataract measures group |
| G8907 | 0010 | 3 | 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 | Pt doc no events on discharg |
| G8908 | 0010 | 3 | Patient documented to have received a burn prior to discharge | Pt doc w burn prior to d/c |
| G8909 | 0010 | 3 | Patient documented not to have received a burn prior to discharge | Pt doc no burn prior to d/c |
| G8910 | 0010 | 3 | Patient documented to have experienced a fall within asc | Pt doc to have fall in asc |
| G8911 | 0010 | 3 | Patient documented not to have experienced a fall within ambulatory surgical center | Pt doc no fall in asc |
| G8912 | 0010 | 3 | Patient documented to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event | Pt doc with wrong event |
| G8913 | 0010 | 3 | Patient documented not to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event | Pt doc no wrong event |
| G8914 | 0010 | 3 | Patient documented to have experienced a hospital transfer or hospital admission upon discharge from asc | Pt trans to hosp post d/c |
| G8915 | 0010 | 3 | Patient documented not to have experienced a hospital transfer or hospital admission upon discharge from asc | Pt not trans to hosp at d/c |
| G8916 | 0010 | 3 | Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic initiated on time | Pt w iv ab given on time |
| G8917 | 0010 | 3 | Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic not initiated on time | Pt w iv ab not given on time |
| G8918 | 0010 | 3 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | Pt w/o preop order iv ab pro |
| G8923 | 0010 | 3 | Left ventricular ejection fraction (lvef) < 40% or documentation of moderately or severely depressed left ventricular systolic function | Lvef < 40% or lvsd |
| G8924 | 0010 | 3 | Spirometry test results demonstrate fev1/fvc < 70%, fev < 60% predicted and patient has copd symptoms (e.g., dyspnea, cough/sputum, wheezing) | Spir fev1/fvc<70%,fev<60% |
| G8925 | 0010 | 3 | Spirometry test results demonstrate fev1 >= 60% fev1/fvc >= 70%, predicted or patient does not have copd symptoms | Spir fev1/fvc>=60% & no copd |
| G8926 | 0010 | 3 | Spirometry test not performed or documented, reason not given | Spiro no perf or doc |
| G8927 | 0010 | 3 | Adjuvant chemotherapy referred, prescribed or previously received for ajcc stage iii, colon cancer | Adj chem pres ajcc iii |
| G8928 | 0010 | 3 | 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) | Adj chem not pres rsn spec |
| G8929 | 0010 | 3 | Adjuvant chemotherapy not prescribed or previously received, reason not given | Adj cmo not pres rsn not gvn |
| G8930 | 0010 | 3 | Assessment of depression severity at the initial evaluation | Assess of dep @ initial eval |
| G8931 | 0010 | 3 | Assessment of depression severity not documented, reason not given | Asses of dep not documented |
| G8932 | 0010 | 3 | Suicide risk assessed at the initial evaluation | Suicd rsk assessed init eval |
| G8933 | 0010 | 3 | Suicide risk not assessed at the initial evaluation, reason not given | Suicide risk not assessed |
| G8934 | 0010 | 3 | Left ventricular ejection fraction (lvef) <40% or documentation of moderately or severely depressed left ventricular systolic function | Lvef <40% or dep lv sys fcn |
| G8935 | 0010 | 3 | Clinician prescribed angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy | Rx ace or arb therapy |
| G8936 | 0010 | 3 | 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) or (eg, lack of drug availability, other reasons attributable to the health care system) | Pt not eligible ace/arb |
| G8937 | 0010 | 3 | Clinician did not prescribe angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy, reason not given | No rx ace/arb therapy |
| G8938 | 0010 | 3 | Bmi is documented as being outside of normal limits, follow-up plan is not documented, documentation the patient is not eligible | Bmi doc onl fup nt doc |
| G8939 | 0010 | 3 | Pain assessment documented as positive, follow-up plan not documented, documentation the patient is not eligible at the time of the encounter | Pain as doc positive, no f/u |
| G8940 | 0010 | 3 | Screening for depression documented as positive, a follow-up plan not completed, documented reason | Scr dep pos, no plan done |
| G8941 | 0010 | 3 | 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 | Eld maltreatment doc as pos |
| G8942 | 0010 | 3 | Functional outcomes assessment using a standardized tool is documented within the previous 30 days and care plan, based on identified deficiencies on the date of the functional outcome assessment, is documented | Doc fcn/care plan w/30 days |
| G8943 | 0010 | 3 | Ldl-c result not present or not within 12 months prior | Ldlc not pres w/i 12 mo prir |
| G8944 | 0010 | 3 | Ajcc melanoma cancer stage 0 through iic melanoma | Ajcc mel cnr stg 0 - iic |
| G8946 | 0010 | 3 | 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) | Mibm but no dx of breast ca |
| G8947 | 0010 | 3 | One or more neuropsychiatric symptoms | 1 or more neuropsych |
| G8948 | 0010 | 3 | No neuropsychiatric symptoms | No neuropsych symptoms |
| G8949 | 0010 | 3 | 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) | Doc pt reas on counsel diet |
| G8950 | 0010 | 3 | Pre-hypertensive or hypertensive blood pressure reading documented, and the indicated follow-up is documented | Pre-htn or htn doc, f/u indc |
| G8951 | 0010 | 3 | Pre-hypertensive or hypertensive blood pressure reading documented, indicated follow-up not documented, documentation the patient is not eligible | Pre-htn/htn doc, no pt f/u |
| G8952 | 0010 | 3 | Pre-hypertensive or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given | Pre-htn/htn, no f/u, not gvn |
| G8953 | 0010 | 3 | All quality actions for the applicable measures in the oncology measures group have been performed for this patient | Oncology mg qual act perform |
| G8955 | 0010 | 3 | Most recent assessment of adequacy of volume management documented | Most recent assess vol mgmt |
| G8956 | 0010 | 3 | Patient receiving maintenance hemodialysis in an outpatient dialysis facility | Pt rcv hedia outpt dyls fac |
| G8957 | 0010 | 3 | Patient not receiving maintenance hemodialysis in an outpatient dialysis facility | Pt no hedia in outpt fac |
| G8958 | 0010 | 3 | Assessment of adequacy of volume management not documented, reason not given | Assess vol mgmt not doc |
| G8959 | 0010 | 3 | Clinician treating major depressive disorder communicates to clinician treating comorbid condition | Clin tx mdd comm to tx clin |
| G8960 | 0010 | 3 | Clinician treating major depressive disorder did not communicate to clinician treating comorbid condition, reason not given | Clin tx mdd not comm |
| G8961 | 0010 | 3 | Cardiac stress imaging test primarily performed on low-risk surgery patient for preoperative evaluation within 30 days preceding this surgery | Csit lowrisk surg pts preop |
| G8962 | 0010 | 3 | 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 | Csit on pt any reas 30 days |
| G8963 | 0010 | 3 | Cardiac stress imaging performed primarily for monitoring of asymptomatic patient who had pci within 2 years | Csi per asx pt w/pci 2 yrs |
| G8964 | 0010 | 3 | 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) | Csi any other than pci 2 yr |
| G8965 | 0010 | 3 | Cardiac stress imaging test primarily performed on low chd risk patient for initial detection and risk assessment | Csit perf on low chd rsk |
| G8966 | 0010 | 3 | 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 | Csit perf sx or high chd rsk |
| G8967 | 0010 | 3 | Warfarin or another fda approved oral anticoagulant is prescribed | Warf or other fda drug presc |
| G8968 | 0010 | 3 | Documentation of medical reason(s) for not prescribing warfarin or another fda-approved anticoagulant (e.g., atrial appendage device in place) | Doc med not presb |
| G8969 | 0010 | 3 | Documentation of patient reason(s) for not prescribing warfarin or another fda-approved oral anticoagulant that is fda approved for the prevention of thromboembolism (e.g., patient choice of having atrial appendage device placed) | Doc pt rsn no presc warf/fda |
| G8970 | 0010 | 3 | No risk factors or one moderate risk factor for thromboembolism | No rsk fac or 1 mod risk te |
| G8971 | 0010 | 3 | Warfarin or another oral anticoagulant that is fda approved not prescribed, reason not given | Warfrn or othr antcog no rx |
| G8972 | 0010 | 3 | One or more high risk factors for thromboembolism or more than one moderate risk factor for thromboembolism | 1>=risk or>= mod risk for te |
| G8973 | 0010 | 3 | Most recent hemoglobin (hgb) level < 10 g/dl | Mst rcnt hbb < 10g/dl |
| G8974 | 0010 | 3 | Hemoglobin level measurement not documented, reason not given | Hgb not doc rns not gvn |
| G8975 | 0010 | 3 | 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) | Hgb <10g/dl, med rsn |
| G8976 | 0010 | 3 | Most recent hemoglobin (hgb) level >= 10 g/dl | Hgb >= 10 g/dl |
| G8977 | 0010 | 3 | I intend to report the oncology measures group | Oncology measures grp |
| G8978 | 0010 | 3 | Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals | Mobility current status |
| G8979 | 0010 | 3 | Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting | Mobility goal status |
| G8980 | 0010 | 3 | Mobility: walking & moving around functional limitation, discharge status, at discharge from therapy or to end reporting | Mobility d/c status |
| G8981 | 0010 | 3 | Changing & maintaining body position functional limitation, current status, at therapy episode outset and at reporting intervals | Body pos current status |
| G8982 | 0010 | 3 | Changing & maintaining body position functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting | Body pos goal status |
| G8983 | 0010 | 3 | Changing & maintaining body position functional limitation, discharge status, at discharge from therapy or to end reporting | Body pos d/c status |
| G8984 | 0010 | 3 | Carrying, moving & handling objects functional limitation, current status, at therapy episode outset and at reporting intervals | Carry current status |
| G8985 | 0010 | 3 | Carrying, moving and handling objects, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting | Carry goal status |
| G8986 | 0010 | 3 | Carrying, moving & handling objects functional limitation, discharge status, at discharge from therapy or to end reporting | Carry d/c status |
| G8987 | 0010 | 3 | Self care functional limitation, current status, at therapy episode outset and at reporting intervals | Self care current status |
| G8988 | 0010 | 3 | Self care functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting | Self care goal status |
| G8989 | 0010 | 3 | Self care functional limitation, discharge status, at discharge from therapy or to end reporting | Self care d/c status |
| G8990 | 0010 | 3 | Other physical or occupational therapy primary functional limitation, current status, at therapy episode outset and at reporting intervals | Other pt/ot current status |
| G8991 | 0010 | 3 | 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 | Other pt/ot goal status |
| G8992 | 0010 | 3 | Other physical or occupational therapy primary functional limitation, discharge status, at discharge from therapy or to end reporting | Other pt/ot d/c status |
| G8993 | 0010 | 3 | Other physical or occupational therapy subsequent functional limitation, current status, at therapy episode outset and at reporting intervals | Sub pt/ot current status |
| G8994 | 0010 | 3 | 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 | Sub pt/ot goal status |
| G8995 | 0010 | 3 | Other physical or occupational therapy subsequent functional limitation, discharge status, at discharge from therapy or to end reporting | Sub pt/ot d/c status |
| G8996 | 0010 | 3 | Swallowing functional limitation, current status at therapy episode outset and at reporting intervals | Swallow current status |
| G8997 | 0010 | 3 | Swallowing functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting | Swallow goal status |
| G8998 | 0010 | 3 | Swallowing functional limitation, discharge status, at discharge from therapy or to end reporting | Swallow d/c status |
| G8999 | 0010 | 3 | Motor speech functional limitation, current status at therapy episode outset and at reporting intervals | Motor speech current status |
| G9001 | 0010 | 3 | Coordinated care fee, initial rate | Mccd, initial rate |
| G9002 | 0010 | 3 | Coordinated care fee, maintenance rate | Mccd,maintenance rate |
| G9003 | 0010 | 3 | Coordinated care fee, risk adjusted high, initial | Mccd, risk adj hi, initial |
| G9004 | 0010 | 3 | Coordinated care fee, risk adjusted low, initial | Mccd, risk adj lo, initial |
| G9005 | 0010 | 3 | Coordinated care fee, risk adjusted maintenance | Mccd, risk adj, maintenance |
| G9006 | 0010 | 3 | Coordinated care fee, home monitoring | Mccd, home monitoring |
| G9007 | 0010 | 3 | Coordinated care fee, scheduled team conference | Mccd, sch team conf |
| G9008 | 0010 | 3 | Coordinated care fee, physician coordinated care oversight services | Mccd,phys coor-care ovrsght |
| G9009 | 0010 | 3 | Coordinated care fee, risk adjusted maintenance, level 3 | Mccd, risk adj, level 3 |
| G9010 | 0010 | 3 | Coordinated care fee, risk adjusted maintenance, level 4 | Mccd, risk adj, level 4 |
| G9011 | 0010 | 3 | Coordinated care fee, risk adjusted maintenance, level 5 | Mccd, risk adj, level 5 |
| G9012 | 0010 | 3 | Other specified case management service not elsewhere classified | Other specified case mgmt |
| G9013 | 0010 | 3 | Esrd demo basic bundle level i | Esrd demo bundle level i |
| G9014 | 0010 | 3 | Esrd demo expanded bundle including venous access and related services | Esrd demo bundle-level ii |
| G9016 | 0010 | 3 | 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] | Demo-smoking cessation coun |
| G9017 | 0010 | 3 | Amantadine hydrochloride, oral, per 100 mg (for use in a medicare-approved demonstration project) | Amantadine hcl 100mg oral |
| G9018 | 0010 | 3 | Zanamivir, inhalation powder, administered through inhaler, per 10 mg (for use in a medicare-approved demonstration project) | Zanamivir,inhalation pwd 10m |
| G9019 | 0010 | 3 | Oseltamivir phosphate, oral, per 75 mg (for use in a medicare-approved demonstration project) | Oseltamivir phosphate 75mg |
| G9020 | 0010 | 3 | Rimantadine hydrochloride, oral, per 100 mg (for use in a medicare-approved demonstration project) | Rimantadine hcl 100mg oral |
| G9033 | 0010 | 3 | Amantadine hydrochloride, oral brand, per 100 mg (for use in a medicare-approved demonstration project) | Amantadine hcl oral brand |
| G9034 | 0010 | 3 | Zanamivir, inhalation powder, administered through inhaler, brand, per 10 mg (for use in a medicare-approved demonstration project) | Zanamivir, inh pwdr, brand |
| G9035 | 0010 | 3 | Oseltamivir phosphate, oral, brand, per 75 mg (for use in a medicare-approved demonstration project) | Oseltamivir phosp, brand |
| G9036 | 0010 | 3 | Rimantadine hydrochloride, oral, brand, per 100 mg (for use in a medicare-approved demonstration project) | Rimantadine hcl, brand |
| G9050 | 0010 | 3 | 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) | Oncology work-up evaluation |
| G9051 | 0010 | 3 | 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) | Oncology tx decision-mgmt |
| G9052 | 0010 | 3 | 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) | Onc surveillance for disease |
| G9053 | 0010 | 3 | 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) | Onc expectant management pt |
| G9054 | 0010 | 3 | 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) | Onc supervision palliative |
| G9055 | 0010 | 3 | Oncology; primary focus of visit; other, unspecified service not otherwise listed (for use in a medicare-approved demonstration project) | Onc visit unspecified nos |
| G9056 | 0010 | 3 | Oncology; practice guidelines; management adheres to guidelines (for use in a medicare-approved demonstration project) | Onc prac mgmt adheres guide |
| G9057 | 0010 | 3 | 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) | Onc pract mgmt differs trial |
| G9058 | 0010 | 3 | Oncology; practice guidelines; management differs from guidelines because the treating physician disagrees with guideline recommendations (for use in a medicare-approved demonstration project) | Onc prac mgmt disagree w/gui |
| G9059 | 0010 | 3 | 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) | Onc prac mgmt pt opt alterna |
| G9060 | 0010 | 3 | 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) | Onc prac mgmt dif pt comorb |
| G9061 | 0010 | 3 | Oncology; practice guidelines; patient’s condition not addressed by available guidelines (for use in a medicare-approved demonstration project) | Onc prac cond noadd by guide |
| G9062 | 0010 | 3 | Oncology; practice guidelines; management differs from guidelines for other reason(s) not listed (for use in a medicare-approved demonstration project) | Onc prac guide differs nos |
| G9063 | 0010 | 3 | 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) | Onc dx nsclc stgi no progres |
| G9064 | 0010 | 3 | 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) | Onc dx nsclc stg2 no progres |
| G9065 | 0010 | 3 | 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) | Onc dx nsclc stg3a no progre |
| G9066 | 0010 | 3 | 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) | Onc dx nsclc stg3b-4 metasta |
| G9067 | 0010 | 3 | 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) | Onc dx nsclc dx unknown nos |
| G9068 | 0010 | 3 | 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) | Onc dx sclc/nsclc limited |
| G9069 | 0010 | 3 | 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) | Onc dx sclc/nsclc ext at dx |
| G9070 | 0010 | 3 | 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) | Onc dx sclc/nsclc ext unknwn |
| G9071 | 0010 | 3 | 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) | Onc dx brst stg1-2b hr,nopro |
| G9072 | 0010 | 3 | 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) | Onc dx brst stg1-2 noprogres |
| G9073 | 0010 | 3 | 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) | Onc dx brst stg3-hr, no pro |
| G9074 | 0010 | 3 | 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) | Onc dx brst stg3-noprogress |
| G9075 | 0010 | 3 | 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) | Onc dx brst metastic/ recur |
| G9077 | 0010 | 3 | 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) | Onc dx prostate t1no progres |
| G9078 | 0010 | 3 | 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) | Onc dx prostate t2no progres |
| G9079 | 0010 | 3 | 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) | Onc dx prostate t3b-t4noprog |
| G9080 | 0010 | 3 | 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) | Onc dx prostate w/rise psa |
| G9083 | 0010 | 3 | 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) | Onc dx prostate unknwn nos |
| G9084 | 0010 | 3 | 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) | Onc dx colon t1-3,n1-2,no pr |
| G9085 | 0010 | 3 | 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) | Onc dx colon t4, n0 w/o prog |
| G9086 | 0010 | 3 | 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) | Onc dx colon t1-4 no dx prog |
| G9087 | 0010 | 3 | 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) | Onc dx colon metas evid dx |
| G9088 | 0010 | 3 | 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) | Onc dx colon metas noevid dx |
| G9089 | 0010 | 3 | 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) | Onc dx colon extent unknown |
| G9090 | 0010 | 3 | 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) | Onc dx rectal t1-2 no progr |
| G9091 | 0010 | 3 | 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) | Onc dx rectal t3 n0 no prog |
| G9092 | 0010 | 3 | 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) | Onc dx rectal t1-3,n1-2noprg |
| G9093 | 0010 | 3 | 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) | Onc dx rectal t4,n,m0 no prg |
| G9094 | 0010 | 3 | 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) | Onc dx rectal m1 w/mets prog |
| G9095 | 0010 | 3 | 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) | Onc dx rectal extent unknwn |
| G9096 | 0010 | 3 | 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) | Onc dx esophag t1-t3 noprog |
| G9097 | 0010 | 3 | 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) | Onc dx esophageal t4 no prog |
| G9098 | 0010 | 3 | 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) | Onc dx esophageal mets recur |
| G9099 | 0010 | 3 | 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) | Onc dx esophageal unknown |
| G9100 | 0010 | 3 | 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) | Onc dx gastric no recurrence |
| G9101 | 0010 | 3 | 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) | Onc dx gastric p r1-r2noprog |
| G9102 | 0010 | 3 | 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) | Onc dx gastric unresectable |
| G9103 | 0010 | 3 | 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) | Onc dx gastric recurrent |
| G9104 | 0010 | 3 | 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) | Onc dx gastric unknown nos |
| G9105 | 0010 | 3 | 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) | Onc dx pancreatc p r0 res no |
| G9106 | 0010 | 3 | 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) | Onc dx pancreatc p r1/r2 no |
| G9107 | 0010 | 3 | 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) | Onc dx pancreatic unresectab |
| G9108 | 0010 | 3 | 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) | Onc dx pancreatic unknwn nos |
| G9109 | 0010 | 3 | 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) | Onc dx head/neck t1-t2no prg |
| G9110 | 0010 | 3 | 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) | Onc dx head/neck t3-4 noprog |
| G9111 | 0010 | 3 | 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) | Onc dx head/neck m1 mets rec |
| G9112 | 0010 | 3 | 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) | Onc dx head/neck ext unknown |
| G9113 | 0010 | 3 | 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) | Onc dx ovarian stg1a-b no pr |
| G9114 | 0010 | 3 | 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) | Onc dx ovarian stg1a-b or 2 |
| G9115 | 0010 | 3 | 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) | Onc dx ovarian stg3/4 noprog |
| G9116 | 0010 | 3 | 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) | Onc dx ovarian recurrence |
| G9117 | 0010 | 3 | 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) | Onc dx ovarian unknown nos |
| G9123 | 0010 | 3 | 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) | Onc dx cml chronic phase |
| G9124 | 0010 | 3 | 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) | Onc dx cml acceler phase |
| G9125 | 0010 | 3 | 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) | Onc dx cml blast phase |
| G9126 | 0010 | 3 | 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) | Onc dx cml remission |
| G9128 | 0010 | 3 | Oncology; disease status; limited to multiple myeloma, systemic disease; smoldering, stage i (for use in a medicare-approved demonstration project) | Onc dx multi myeloma stage i |
| G9129 | 0010 | 3 | Oncology; disease status; limited to multiple myeloma, systemic disease; stage ii or higher (for use in a medicare-approved demonstration project) | Onc dx mult myeloma stg2 hig |
| G9130 | 0010 | 3 | 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) | Onc dx multi myeloma unknown |
| G9131 | 0010 | 3 | 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) | Onc dx brst unknown nos |
| G9132 | 0010 | 3 | 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) | Onc dx prostate mets no cast |
| G9133 | 0010 | 3 | Oncology; disease status; prostate cancer, limited to adenocarcinoma; hormone-responsive; clinical metastases or m1 at diagnosis (for use in a medicare-approved demonstration project) | Onc dx prostate clinical met |
| G9134 | 0010 | 3 | 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) | Onc nhlstg 1-2 no relap no |
| G9135 | 0010 | 3 | 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) | Onc dx nhl stg 3-4 not relap |
| G9136 | 0010 | 3 | 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) | Onc dx nhl trans to lg bcell |
| G9137 | 0010 | 3 | Oncology; disease status; non-hodgkin’s lymphoma, any cellular classification; relapsed/refractory (for use in a medicare-approved demonstration project) | Onc dx nhl relapse/refractor |
| G9138 | 0010 | 3 | 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) | Onc dx nhl stg unknown |
| G9139 | 0010 | 3 | 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) | Onc dx cml dx status unknown |
| G9140 | 0010 | 3 | 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 | Frontier extended stay demo |
| G9143 | 0010 | 3 | Warfarin responsiveness testing by genetic technique using any method, any number of specimen(s) | Warfarin respon genetic test |
| G9147 | 0010 | 3 | 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 | Outpt iv insulin tx any mea |
| G9148 | 0010 | 3 | National committee for quality assurance - level 1 medical home | Medical home level 1 |
| G9149 | 0010 | 3 | National committee for quality assurance - level 2 medical home | Medical home level ii |
| G9150 | 0010 | 3 | National committee for quality assurance - level 3 medical home | Medical home level iii |
| G9151 | 0010 | 3 | Mapcp demonstration - state provided services | Mapcp demo state |
| G9152 | 0010 | 3 | Mapcp demonstration - community health teams | Mapcp demo community |
| G9153 | 0010 | 3 | Mapcp demonstration - physician incentive pool | Mapcp demo physician |
| G9156 | 0010 | 3 | Evaluation for wheelchair requiring face to face visit with physician | Evaluation for wheelchair |
| G9157 | 0010 | 3 | Transesophageal doppler measurement of cardiac output (including probe placement, image acquisition, and interpretation per course of treatment) for monitoring purposes | Transesoph doppl cardiac mon |
| G9158 | 0010 | 3 | Motor speech functional limitation, discharge status, at discharge from therapy or to end reporting | Motor speech d/c status |
| G9159 | 0010 | 3 | Spoken language comprehension functional limitation, current status at therapy episode outset and at reporting intervals | Lang comp current status |
| G9160 | 0010 | 3 | Spoken language comprehension functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting | Lang comp goal status |
| G9161 | 0010 | 3 | Spoken language comprehension functional limitation, discharge status, at discharge from therapy or to end reporting | Lang comp d/c status |
| G9162 | 0010 | 3 | Spoken language expression functional limitation, current status at therapy episode outset and at reporting intervals | Lang express current status |
| G9163 | 0010 | 3 | Spoken language expression functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting | Lang express goal status |
| G9164 | 0010 | 3 | Spoken language expression functional limitation, discharge status at discharge from therapy or to end reporting | Lang express d/c status |
| G9165 | 0010 | 3 | Attention functional limitation, current status at therapy episode outset and at reporting intervals | Atten current status |
| G9166 | 0010 | 3 | Attention functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting | Atten goal status |
| G9167 | 0010 | 3 | Attention functional limitation, discharge status at discharge from therapy or to end reporting | Atten d/c status |
| G9168 | 0010 | 3 | Memory functional limitation, current status at therapy episode outset and at reporting intervals | Memory current status |
| G9169 | 0010 | 3 | Memory functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting | Memory goal status |
| G9170 | 0010 | 3 | Memory functional limitation, discharge status at discharge from therapy or to end reporting | Memory d/c status |
| G9171 | 0010 | 3 | Voice functional limitation, current status at therapy episode outset and at reporting intervals | Voice current status |
| G9172 | 0010 | 3 | Voice functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting | Voice goal status |
| G9173 | 0010 | 3 | Voice functional limitation, discharge status at discharge from therapy or to end reporting | Voice d/c status |
| G9174 | 0010 | 3 | Other speech language pathology functional limitation, current status at therapy episode outset and at reporting intervals | Speech lang current status |
| G9175 | 0010 | 3 | Other speech language pathology functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting | Speech lang goal status |
| G9176 | 0010 | 3 | Other speech language pathology functional limitation, discharge status at discharge from therapy or to end reporting | Speech lang d/c status |
| G9186 | 0010 | 3 | Motor speech functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting | Motor speech goal status |
| G9187 | 0010 | 3 | 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 | Bpci home visit |
| G9188 | 0010 | 3 | Beta-blocker therapy not prescribed, reason not given | Beta not given no reason |
| G9189 | 0010 | 3 | Beta-blocker therapy prescribed or currently being taken | Beta pres or already taking |
| G9190 | 0010 | 3 | Documentation of medical reason(s) for not prescribing beta-blocker therapy (eg, allergy, intolerance, other medical reasons) | Medical reason for no beta |
| G9191 | 0010 | 3 | Documentation of patient reason(s) for not prescribing beta-blocker therapy (eg, patient declined, other patient reasons) | Pt reason for no beta |
| G9192 | 0010 | 3 | Documentation of system reason(s) for not prescribing beta-blocker therapy (eg, other reasons attributable to the health care system) | System reason for no beta |
| G9193 | 0010 | 3 | 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 | Doc not eligible for dep med |
| G9194 | 0010 | 3 | Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 180 day (6 month) continuation treatment phase | Mdd pt treated for 180d |
| G9195 | 0010 | 3 | 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 | Mdd pt not treated for 180d |
| G9196 | 0010 | 3 | 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)) | Med reason for no ceph |
| G9197 | 0010 | 3 | Documentation of order for first or second generation cephalosporin for antimicrobial prophylaxis | Order for ceph |
| G9198 | 0010 | 3 | Order for first or second generation cephalosporin for antimicrobial prophylaxis was not documented, reason not given | No order for ceph no reason |
| G9199 | 0010 | 3 | 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)) | Doc reason for no vte |
| G9200 | 0010 | 3 | Venous thromboembolism (vte) prophylaxis was not administered the day of or the day after hospital admission, reason not given | No reason for no vte |
| G9201 | 0010 | 3 | Venous thromboembolism (vte) prophylaxis administered the day of or the day after hospital admission | Vte given upon admission |
| G9202 | 0010 | 3 | Patients with a positive hepatitis c antibody test | Hep c aby pos |
| G9203 | 0010 | 3 | Rna testing for hepatitis c documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c | Hep c rna done prior to med |
| G9204 | 0010 | 3 | 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 | No reason for no hep c rna |
| G9205 | 0010 | 3 | Patient starting antiviral treatmentfor hepatitis c during the measurement period | Hep c antiviral started |
| G9206 | 0010 | 3 | Patient starting antiviral treatment for hepatitis c during the measurement period | Hep c therapy started |
| G9207 | 0010 | 3 | Hepatitis c genotype testing documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c | Hep c genotype prior to med |
| G9208 | 0010 | 3 | Hepatitis c genotype testing was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c, reason not given | No reason for no hep c geno |
| G9209 | 0010 | 3 | Hepatitis c quantitative rna testing documented as performed between 4-12 weeks after the initiation of antiviral treatment | Hep c rna 4to12 wk after med |
| G9210 | 0010 | 3 | 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) | No hepc rna after med docrsn |
| G9211 | 0010 | 3 | Hepatitis c quantitative rna testing was not documented as performed between 4-12 weeks after the initiation of antiviral treatment, reason not given | No hepc rna after med no rsn |
| G9212 | 0010 | 3 | Dsm-ivtm criteria for major depressive disorder documented at the initial evaluation | Doc of dsm-iv init eval |
| G9213 | 0010 | 3 | Dsm-iv-tr criteria for major depressive disorder not documented at the initial evaluation, reason not otherwise specified | No doc of dsm-iv |
| G9214 | 0010 | 3 | Cd4+ cell count or cd4+ cell percentage results documented | Cd4 count documented |
| G9215 | 0010 | 3 | Cd4+ cell count or percentage not documented as performed, reason not given | No cd4 count no reason |
| G9216 | 0010 | 3 | Pcp prophylaxis was not prescribed at time of diagnosis of hiv, reason not given | No pcp proph at dx no reason |
| G9217 | 0010 | 3 | Pcp prophylaxis was not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3, reason not given | No pcp proph low cd4 norsn |
| G9218 | 0010 | 3 | 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 | No pcp prop low at cd4 norsn |
| G9219 | 0010 | 3 | 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) | No oder pjp for med reason |
| G9220 | 0010 | 3 | 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) | No order for pjp for medrsn |
| G9221 | 0010 | 3 | Pneumocystis jiroveci pneumonia prophlaxis prescribed | Pjp proph prescribed |
| G9222 | 0010 | 3 | Pneumocystis jiroveci pneumonia prophylaxis prescribed wthin 3 months of low cd4+ cell count below 200 cells/mm3 | Pjp proph ordered low cd4 |
| G9223 | 0010 | 3 | Pneumocystis jiroveci pneumonia prophylaxis prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15% | Pjp proph ordered cd4 low |
| G9224 | 0010 | 3 | Documentation of medical reason for not performing foot exam (e.g., patient with bilateral foot/leg amputation) | Medrsn no foot exam |
| G9225 | 0010 | 3 | Foot exam was not performed, reason not given | Norsn no foot exam |
| G9226 | 0010 | 3 | 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) | 3 comp foot exam completed |
| G9227 | 0010 | 3 | Functional outcome assessment documented, care plan not documented, documentation the patient is not eligible for a care plan at the time of the encounter | Foa doc, care plan not doc |
| G9228 | 0010 | 3 | Chlamydia, gonorrhea and syphilis screening results documented (report when results are present for all of the 3 screenings) | Gc chl syp documented |
| G9229 | 0010 | 3 | Chlamydia, gonorrhea, and syphilis screening results not documented (patient refusal is the only allowed exception) | Ptrsn no gc chl syp test |
| G9230 | 0010 | 3 | Chlamydia, gonorrhea, and syphilis not screened, reason not given | Norsn for gc chl syp test |
| G9231 | 0010 | 3 | Documentation of end stage renal disease (esrd), dialysis, renal transplant before or during the measurement period or pregnancy during the measurement period | Doc esrd dia trans preg |
| G9232 | 0010 | 3 | 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) | Ptrsn no comm comorbid |
| G9233 | 0010 | 3 | All quality actions for the applicable measures in the total knee replacement measures group have been performed for this patient | Tkr composite |
| G9234 | 0010 | 3 | I intend to report the total knee replacement measures group | Tkr intent |
| G9235 | 0010 | 3 | All quality actions for the applicable measures in the general surgery measures group have been performed for this patient | Gs mg composite |
| G9236 | 0010 | 3 | All quality actions for the applicable measures in the optimizing patient exposure to ionizing radiation measures group have been performed for this patient | Op rad mg composite |
| G9237 | 0010 | 3 | I intend to report the general surgery measures group | Gs mg intent |
| G9238 | 0010 | 3 | I intend to report the optimizing patient exposure to ionizing radiation measures group | Op rad mg intent |
| G9239 | 0010 | 3 | 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) | Doc rsn hemod & cath acc |
| G9240 | 0010 | 3 | Patient whose mode of vascular access is a catheter at the time maintenance hemodialysis is initiated | Doc pt w cath maint dia |
| G9241 | 0010 | 3 | Patient whose mode of vascular access is not a catheter at the time maintenance hemodialysis is initiated | Doc pt w out cath maint dia |
| G9242 | 0010 | 3 | Documentation of viral load equal to or greater than 200 copies/ml or viral load not performed | Doc viral load >=200 |
| G9243 | 0010 | 3 | Documentation of viral load less than 200 copies/ml | Doc viral load <200 |
| G9244 | 0010 | 3 | Antiretroviral thereapy not prescribed | Antiviral not ordered |
| G9245 | 0010 | 3 | Antiretroviral therapy prescribed | Antiviral ordered |
| G9246 | 0010 | 3 | 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 | No med visit in 24mo |
| G9247 | 0010 | 3 | 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 | 1 med visit in 24mo |
| G9248 | 0010 | 3 | Patient did not have a medical visit in the last 6 months | No med visit 6mo |
| G9249 | 0010 | 3 | Patient had a medical visit in the last 6 months | Med visit w in 6mo |
| G9250 | 0010 | 3 | Documentation of patient pain brought to a comfortable level within 48 hours from initial assessment | Doc of pain comfort 48hr |
| G9251 | 0010 | 3 | Documentation of patient with pain not brought to a comfortable level within 48 hours from initial assessment | Doc no pain comfort 48hr |
| G9252 | 0010 | 3 | Adenoma(s) or other neoplasm detected during screening colonoscopy | Neo detect scrn colo |
| G9253 | 0010 | 3 | Adenoma(s) or other neoplasm not detected during screening colonoscopy | No neo detect scrn colo |
| G9254 | 0010 | 3 | Documentation of patient discharged to home later than post-operative day 2 following cas | Doc pt dischg >2d |
| G9255 | 0010 | 3 | Documentation of patient discharged to home no later than post operative day 2 following cas | Doc pt dischg <=2d |
| G9256 | 0010 | 3 | Documentation of patient death following cas | Doc of pat death after cas |
| G9257 | 0010 | 3 | Documentation of patient stroke following cas | Doc of pat stroke after cas |
| G9258 | 0010 | 3 | Documentation of patient stroke following cea | Doc of pat stroke after cea |
| G9259 | 0010 | 3 | Documentation of patient survival and absence of stroke following cas | Survive/no stroke post cas |
| G9260 | 0010 | 3 | Documentation of patient death following cea | Doc of pat death after cea |
| G9261 | 0010 | 3 | Documentation of patient survival and absence of stroke following cea | Survive/no stroke post cea |
| G9262 | 0010 | 3 | Documentation of patient death in the hospital following endovascular aaa repair | Doc of death post-aaa repair |
| G9263 | 0010 | 3 | Documentation of patient discharged alive following endovascular aaa repair | Doc of disch post-aaa repair |
| G9264 | 0010 | 3 | 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) | Doc rsn hemod w/cath >=90d |
| G9265 | 0010 | 3 | Patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter as the mode of vascular access | Doc cath >90d for maint dia |
| G9266 | 0010 | 3 | Patient receiving maintenance hemodialysis for greater than or equal to 90 days without a catheter as the mode of vascular access | Norsn pt cath >=90d |
| G9267 | 0010 | 3 | Documentation of patient with one or more complications or mortality within 30 days | Doc comp or mort w in 30d |
| G9268 | 0010 | 3 | Documentation of patient with one or more complications within 90 days | Doc comp or mort w in 90d |
| G9269 | 0010 | 3 | Documentation of patient without one or more complications and without mortality within 30 days | Doc no comp or mort w in 30d |
| G9270 | 0010 | 3 | Documentation of patient without one or more complications within 90 days | Doc no comp or mort w in 90d |
| G9271 | 0010 | 3 | Ldl value < 100 | Ldl under 100 |
| G9272 | 0010 | 3 | Ldl value >= 100 | Ldl 100 and over |
| G9273 | 0010 | 3 | Blood pressure has a systolic value of < 140 and a diastolic value of < 90 | Sys<140 and dia<90 |
| G9274 | 0010 | 3 | 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 | Bp out of nrml limits |
| G9275 | 0010 | 3 | Documentation that patient is a current non-tobacco user | Doc of non tobacco user |
| G9276 | 0010 | 3 | Documentation that patient is a current tobacco user | Doc of tobacco user |
| G9277 | 0010 | 3 | 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) | Doc daily aspirin or contra |
| G9278 | 0010 | 3 | Documentation that the patient is not on daily aspirin or anti-platelet regimen | Doc no daily aspirin |
| G9279 | 0010 | 3 | Pneumococcal screening performed and documentation of vaccination received prior to discharge | Pne scrn done doc vac done |
| G9280 | 0010 | 3 | Pneumococcal vaccination not administered prior to discharge, reason not specified | Pne not given norsn |
| G9281 | 0010 | 3 | Screening performed and documentation that vaccination not indicated/patient refusal | Pne scrn done doc not ind |
| G9282 | 0010 | 3 | 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) | Doc medrsn no histo type |
| G9283 | 0010 | 3 | Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation | Hist type doc on report |
| G9284 | 0010 | 3 | 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 | No hist type doc on report |
| G9285 | 0010 | 3 | Specimen site other than anatomic location of lung or is not classified as non small cell lung cancer | Site not small cell lung ca |
| G9286 | 0010 | 3 | Antibiotic regimen prescribed within 10 days after onset of symptoms | Antibio rx w in 10d of sympt |
| G9287 | 0010 | 3 | Antibiotic regimen not prescribed within 10 days after onset of symptoms | No antibio w in 10d of sympt |
| G9288 | 0010 | 3 | 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) | Doc medrsn no hist type rpt |
| G9289 | 0010 | 3 | Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation | Doc type nsm lung ca |
| G9290 | 0010 | 3 | 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 | No doc type nsm lung ca |
| G9291 | 0010 | 3 | Specimen site other than anatomic location of lung, is not classified as non small cell lung cancer or classified as nsclc-nos | Not nsm lung ca |
| G9292 | 0010 | 3 | 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) | Medrsn no pt category |
| G9293 | 0010 | 3 | Pathology report does not include the pt category and a statement on thickness and ulceration and for pt1, mitotic rate | No pt category on report |
| G9294 | 0010 | 3 | Pathology report includes the pt category and a statement on thickness and ulceration and for pt1, mitotic rate | Pt cat and thck on report |
| G9295 | 0010 | 3 | Specimen site other than anatomic cutaneous location | Non cutaneous loc |
| G9296 | 0010 | 3 | 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 | Doc share dec prior proc |
| G9297 | 0010 | 3 | 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 | No doc share dec prior proc |
| G9298 | 0010 | 3 | 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) | Eval risk vte card 30d prior |
| G9299 | 0010 | 3 | Patients who are not evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure including (e.g., history of dvt, pe, mi, arrhythmia and stroke, reason not given) | No eval riskk vte card prior |
| G9300 | 0010 | 3 | 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) | Doc medrsn no compl antibio |
| G9301 | 0010 | 3 | Patients who had the prophylactic antibiotic completely infused prior to the inflation of the proximal tourniquet | Doc compl inf antibio |
| G9302 | 0010 | 3 | Prophylactic antibiotic not completely infused prior to the inflation of the proximal tourniquet, reason not given | Norsn incomp inf antibio |
| G9303 | 0010 | 3 | 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 | Norsn no pros info op rpt |
| G9304 | 0010 | 3 | 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 | Pros info op rpt |
| G9305 | 0010 | 3 | Intervention for presence of leak of endoluminal contents through an anastomosis not required | No interv req for leak |
| G9306 | 0010 | 3 | Intervention for presence of leak of endoluminal contents through an anastomosis required | Interv req for leak |
| G9307 | 0010 | 3 | 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 | No ret for surg w in 30d |
| G9308 | 0010 | 3 | 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 | Unpl ret or w/compl w/in 30d |
| G9309 | 0010 | 3 | No unplanned hospital readmission within 30 days of principal procedure | No unplnd hosp readm in 30d |
| G9310 | 0010 | 3 | Unplanned hospital readmission within 30 days of principal procedure | Unplnd hosp readm in 30d |
| G9311 | 0010 | 3 | No surgical site infection | No surg site infection |
| G9312 | 0010 | 3 | Surgical site infection | Surgical site infection |
| G9313 | 0010 | 3 | Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis for documented reason | Amoxic not presc as 1st line |
| G9314 | 0010 | 3 | Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis, reason not given | Norsn not first line amox |
| G9315 | 0010 | 3 | Documentation amoxicillin, with or without clavulanate, prescribed as a first line antibiotic at the time of diagnosis | Doc first line amox |
| G9316 | 0010 | 3 | 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 | Doc comm risk calc |
| G9317 | 0010 | 3 | 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 | No doc comm risk calc |
| G9318 | 0010 | 3 | Imaging study named according to standardized nomenclature | Image std nomenclature |
| G9319 | 0010 | 3 | Imaging study not named according to standardized nomenclature, reason not given | Image not std nomenclature |
| G9320 | 0010 | 3 | 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) | Medrsn no std nomenclature |
| G9321 | 0010 | 3 | 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 | Doc count of ct in 12mo |
| G9322 | 0010 | 3 | 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 | No doc count of ct in 12mo |
| G9323 | 0010 | 3 | 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) | Mdrsn no doc cnt of ct |
| G9324 | 0010 | 3 | All necessary data elements not included, reason not given | Not all data norsn |
| G9325 | 0010 | 3 | 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) | Medrsn no ct rpt to reg |
| G9326 | 0010 | 3 | 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 | Ct done no rad ds index, nrg |
| G9327 | 0010 | 3 | Ct studies performed reported to a radiation dose index registry that is capable of collecting at a minimum all necessary data elements | Ct done rad ds index |
| G9328 | 0010 | 3 | 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) | Medrsn no dicom format doc |
| G9329 | 0010 | 3 | 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 | Norsn no dicom format doc |
| G9340 | 0010 | 3 | 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 | Dicom format doc on rpt |
| G9341 | 0010 | 3 | 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 | Srch for ct w in 12 mos |
| G9342 | 0010 | 3 | 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 | No srch for ct in 12mo norsn |
| G9343 | 0010 | 3 | 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) | Medrsn no dicom srch |
| G9344 | 0010 | 3 | 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) | Sysrsn no dicom srch |
| G9345 | 0010 | 3 | 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 | Follow up pulm nod |
| G9346 | 0010 | 3 | 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) | No follow up pulm nod |
| G9347 | 0010 | 3 | Follow-up recommendations not documented according to recommended guidelines for incidentally detected pulmonary nodules, reason not given | No follow up pulm nod norsn |
| G9348 | 0010 | 3 | Ct scan of the paranasal sinuses ordered at the time of diagnosis for documented reasons | Doc rsn for ord ct scan |
| G9349 | 0010 | 3 | Ct scan of the paranasal sinuses ordered at the time of diagnosis or received within 28 days after date of diagnosis | Ct within 28 days |
| G9350 | 0010 | 3 | Ct scan of the paranasal sinuses not ordered at the time of diagnosis or received within 28 days after date of diagnosis | No doc sinus ct 28d or dx |
| G9351 | 0010 | 3 | More than one ct scan of the paranasal sinuses ordered or received within 90 days after diagnosis | Doc >1 sinus ct w 90d dx |
| G9352 | 0010 | 3 | More than one ct scan of the paranasal sinuses ordered or received within 90 days after the date of diagnosis, reason not given | Not >1 sinus ct w 90d dx |
| G9353 | 0010 | 3 | 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) | Medrsn >1 sinus ct w 90d dx |
| G9354 | 0010 | 3 | One ct scan or no ct scan of the paranasal sinuses ordered within 90 days after the date of diagnosis | 1 or no ct sinus w/in 90d dx |
| G9355 | 0010 | 3 | Early elective delivery or early induction not performed (less than 39 weeks gestation) | No early ind/delivery |
| G9356 | 0010 | 3 | Early elective delivery or early induction performed (less than 39 week gestation) | Early ind/delivery |
| G9357 | 0010 | 3 | Post-partum screenings, evaluations and education performed | Pp eval/edu perf |
| G9358 | 0010 | 3 | Post-partum screenings, evaluations and education not performed | Pp eval/edu not perf |
| G9359 | 0010 | 3 | Documentation of negative or managed positive tb screen with further evidence that tb is not active prior to the treatment with a biologic immune response modifier | Neg mgd pos tb notact |
| G9360 | 0010 | 3 | No documentation of negative or managed positive tb screen | No doc of neg or man pos tb |
| G9361 | 0010 | 3 | Medical indication for induction [documentation of reason(s) for elective delivery (c-section) or early induction (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)] | Doc rsn elect c-sec/induct |
| G9362 | 0010 | 3 | 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 | Mac or pnb w/o genanes >60m |
| G9363 | 0010 | 3 | 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 | Mac or pnb w/o genanes <60m |
| G9364 | 0010 | 3 | Sinusitis caused by, or presumed to be caused by, bacterial infection | Sinus caus bac inx |
| G9365 | 0010 | 3 | One high-risk medication ordered | 1high risk med ord |
| G9366 | 0010 | 3 | One high-risk medication not ordered | 1high risk no ord |
| G9367 | 0010 | 3 | At least two orders for the same high-risk medication | >= 2 same hi-rsk med ord |
| G9368 | 0010 | 3 | At least two orders for the same high-risk medications not ordered | >= 2 same hi-rsk med not ord |
| G9369 | 0010 | 3 | Individual filled at least two prescriptions for any antipsychotic medication and had a pdc of 0.8 or greater | Fill 2 rx antipsych |
| G9370 | 0010 | 3 | Individual who did not fill at least two prescriptions for any antipsychotic medication or did not have a pdc of 0.8 or greater | Not fill 2 rx antipsych |
| G9376 | 0010 | 3 | Patient continued to have the retina attached at the 6 months follow up visit (+/- 1 month) following only one surgery | Contd ret attach at 6mth f/u |
| G9377 | 0010 | 3 | Patient did not have the retina attached after 6 months following only one surgery | No ret attach after 6mt |
| G9378 | 0010 | 3 | Patient continued to have the retina attached at the 6 months follow up visit (+/- 1 month) | Contd ret attach f/u vis |
| G9379 | 0010 | 3 | Patient did not achieve flat retinas six months post surgery | No acheive flat ret 6mth |
| G9380 | 0010 | 3 | Patient offered assistance with end of life issues during the measurement period | Off assis eol iss |
| G9381 | 0010 | 3 | 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 | Doc med reas no offer eol |
| G9382 | 0010 | 3 | Patient not offered assistance with end of life issues during the measurement period | No off assis eol |
| G9383 | 0010 | 3 | Patient received screening for hcv infection within the 12 month reporting period | Recd scrn hcv infec |
| G9384 | 0010 | 3 | 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) | Doc med rsn no hcv scrn |
| G9385 | 0010 | 3 | Documentation of patient reason(s) for not receiving annual screening for hcv infection (e.g., patient declined, other patient reasons) | Doc pt reas not rec hcv srn |
| G9386 | 0010 | 3 | Screening for hcv infection not received within the 12 month reporting period, reason not given | Scrn hcv infec not recd |
| G9389 | 0010 | 3 | Unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery | Unpln rup post cap |
| G9390 | 0010 | 3 | No unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery | No unpln rup post cap |
| G9391 | 0010 | 3 | Patient achieves refraction +-1 d for the eye that underwent cataract surgery, measured at the one month follow up visit | Achv refrac +1d |
| G9392 | 0010 | 3 | Patient does not achieve refraction +-1 d for the eye that underwent cataract surgery, measured at the one month follow up visit | Not achv refrac +1d |
| G9393 | 0010 | 3 | 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 | Ini phq9 >9 remiss <5 |
| G9394 | 0010 | 3 | 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 | Dx bipol, death, nhres, hosp |
| G9395 | 0010 | 3 | 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 | Ini phq9 >9 no remiss >=5 |
| G9396 | 0010 | 3 | Patient with an initial phq-9 score greater than nine who was not assessed for remission at twelve months (+/- 30 days) | Ini phq9 >9 not assess |
| G9399 | 0010 | 3 | 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 | Doc disc tx choices |
| G9400 | 0010 | 3 | 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 | Doc reas no disc tx opt |
| G9401 | 0010 | 3 | No documentation of a discussion in the patient record of a discussion between the physician or other qualfied 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 | No disc tx choices |
| G9402 | 0010 | 3 | Patient received follow-up on the date of discharge or within 30 days after discharge | Recd f/u w/in 30d disch |
| G9403 | 0010 | 3 | 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) | Doc reas no 30 day f/u |
| G9404 | 0010 | 3 | Patient did not receive follow-up on the date of discharge or within 30 days after discharge | No 30 day f/u |
| G9405 | 0010 | 3 | Patient received follow-up within 7 days after discharge | Recd f/u w/in 7d dc |
| G9406 | 0010 | 3 | 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) | Doc reas no 7d f/u |
| G9407 | 0010 | 3 | Patient did not receive follow-up on or within 7 days after discharge | No 7d f/u |
| G9408 | 0010 | 3 | Patients with cardiac tamponade and/or pericardiocentesis occurring within 30 days | Card tamp w/in 30d |
| G9409 | 0010 | 3 | Patients without cardiac tamponade and/or pericardiocentesis occurring within 30 days | No card tamp e/in 30d |
| G9410 | 0010 | 3 | Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision | Admit w/in 180d req remov |
| G9411 | 0010 | 3 | Patient not admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision | No admit w/in 180d req remov |
| G9412 | 0010 | 3 | Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision | Admit w/in 180d req surg rev |
| G9413 | 0010 | 3 | Patient not admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision | No admit req surg rev |
| G9414 | 0010 | 3 | Patient had one dose of meningococcal vaccine (serogroups a, c, w, y) on or between the patient’s 11th and 13th birthdays | 1dose menig vac btwn 11 & 13 |
| G9415 | 0010 | 3 | Patient did not have one dose of meningococcal vaccine on or between the patient’s 11th and 13th birthdays | No 1dose meni vac btwn 11&13 |
| G9416 | 0010 | 3 | Patient had one tetanus, diphtheria toxoids and acellular pertussis vaccine (tdap) on or between the patient’s 10th and 13th birthdays | Pt 1 tdap betw 10-13 yrs |
| G9417 | 0010 | 3 | Patient did not have one tetanus, diphtheria toxoids and acellular pertussis vaccine (tdap) on or between the patient’s 10th and 13th birthdays | Pt not 1 tdap betw 10-13 yrs |
| G9418 | 0010 | 3 | Primary non-small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation | Lungcx bx rpt docs class |
| G9419 | 0010 | 3 | Documentation of medical reason(s) for not including the histological type or nsclc-nos classification with an explanation (e.g., biopsy taken for other purposes in a patient with a history of primary non-small cell lung cancer or other documented medical reasons) | Med reas not incl histo type |
| G9420 | 0010 | 3 | Specimen site other than anatomic location of lung or is not classified as primary non-small cell lung cancer | Spec site no lung |
| G9421 | 0010 | 3 | Primary 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 | Lung cx bx rpt no doc class |
| G9422 | 0010 | 3 | Primary lung carcinoma resection report documents pt category, pn category and for non-small cell lung cancer, histologic type (squamous cell carcinoma, adenocarcinoma and not nsclc-nos) | Rpt doc class histo type |
| G9423 | 0010 | 3 | 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)] | Med reas rpt no histo type |
| G9424 | 0010 | 3 | Specimen site other than anatomic location of lung, or classified as nsclc-nos | Site no lung or lung cx |
| G9425 | 0010 | 3 | Primary lung carcinoma resection report does not document pt category, pn category and for non-small cell lung cancer, histologic type (squamous cell carcinoma, adenocarcinoma) | Spec rpt no doc class histo |
| G9426 | 0010 | 3 | Improvement in median time from ed arrival to initial ed oral or parenteral pain medication administration performed for ed admitted patients | Impr med time edarr pain med |
| G9427 | 0010 | 3 | Improvement in median time from ed arrival to initial ed oral or parenteral pain medication administration not performed for ed admitted patients | No impro med time pain med |
| G9428 | 0010 | 3 | Pathology report includes the pt category and a statement on thickness, ulceration and mitotic rate | Patho rpt incl pt ctg |
| G9429 | 0010 | 3 | Documentation of medical reason(s) for not including pt category and a statement on thickness, ulceration and mitotic rate (e.g., negative skin biopsies in a patient with a history of melanoma or other documented medical reasons) | Doc med rsn no pt cat |
| G9430 | 0010 | 3 | Specimen site other than anatomic cutaneous location | Spec site no cutaneous |
| G9431 | 0010 | 3 | Pathology report does not include the pt category and a statement on thickness, ulceration and mitotic rate | Patho rpt no pt ctg |
| G9432 | 0010 | 3 | Asthma well-controlled based on the act, c-act, acq, or ataq score and results documented | Asth controlled |
| G9433 | 0010 | 3 | Death, permanent nursing home resident or receiving hospice or palliative care any time during the measurement period | Death, nhres, hospice |
| G9434 | 0010 | 3 | Asthma not well-controlled based on the act, c-act, acq, or ataq score, or specified asthma control tool not used, reason not given | Asth not controlled |
| G9435 | 0010 | 3 | Aspirin prescribed at discharge | Asp presc disch |
| G9436 | 0010 | 3 | Aspirin not prescribed for documented reasons (e.g., allergy, medical intolerance, history of bleed) | Asp not presc doc reas |
| G9437 | 0010 | 3 | Aspirin not prescribed at discharge | Asp not presc disch |
| G9438 | 0010 | 3 | P2y inhibitor prescribed at discharge | P2y inhib presc |
| G9439 | 0010 | 3 | P2y inhibitor not prescribed for documented reasons (e.g., allergy, medical intolerance, history of bleed) | P2y inhib not presc doc reas |
| G9440 | 0010 | 3 | P2y inhibitor not prescribed at discharge | P2y inhib not presc |
| G9441 | 0010 | 3 | Statin prescribed at discharge | Statin presc disch |
| G9442 | 0010 | 3 | Statin not prescribed for documented reasons (e.g., allergy, medical intolerance) | Statin not presc doc reas |
| G9443 | 0010 | 3 | Statin not prescribed at discharge | Statin not presc disch |
| G9448 | 0010 | 3 | Patients who were born in the years 1945?1965 | Born 1945-1965 |
| G9449 | 0010 | 3 | History of receiving blood transfusions prior to 1992 | Hx bld transf b/f 1992 |
| G9450 | 0010 | 3 | History of injection drug use | Hx injec drug use |
| G9451 | 0010 | 3 | Patient received one-time screening for hcv infection | 1x scrn hcv infect |
| G9452 | 0010 | 3 | Documentation of medical reason(s) for not receiving one-time screening for hcv infection (e.g., decompensated cirrhosis indicating advanced disease [ie, ascites, esophageal variceal bleeding, hepatic encephalopathy], hepatocellular carcinoma, waitlist for organ transplant, limited life expectancy, other medical reasons) | Doc med reas no scrn hcv |
| G9453 | 0010 | 3 | Documentation of patient reason(s) for not receiving one-time screening for hcv infection (e.g., patient declined, other patient reasons) | Pt reas no hcv infect |
| G9454 | 0010 | 3 | 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 | No scr hcv inf 12 mth rp |
| G9455 | 0010 | 3 | Patient underwent abdominal imaging with ultrasound, contrast enhanced ct or contrast mri for hcc | Abd imag w/us, ct or mri |
| G9456 | 0010 | 3 | 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) | Doc med pt reas no hcc scrn |
| G9457 | 0010 | 3 | Patient did not undergo abdominal imaging and did not have a documented reason for not undergoing abdominal imaging in the submission period | Pt no abd img no doc rsn |
| G9458 | 0010 | 3 | 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 | Tob user recd cess interv |
| G9459 | 0010 | 3 | Currently a tobacco non-user | Tob non-user |
| G9460 | 0010 | 3 | Tobacco assessment or tobacco cessation intervention not performed, reason not given | No tob assess or cess inter |
| G9463 | 0010 | 3 | I intend to report the sinusitis measures group | Sinusitis intent |
| G9464 | 0010 | 3 | All quality actions for the applicable measures in the sinusitis measures group have been performed for this patient | Sinusitis comp |
| G9465 | 0010 | 3 | I intend to report the acute otitis externa (aoe) measures group | Aoe intent |
| G9466 | 0010 | 3 | All quality actions for the applicable measures in the aoe measures group have been performed for this patient | Aoe comp |
| G9467 | 0010 | 3 | 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 | Recd cortico >=10mg/day >60d |
| G9468 | 0010 | 3 | 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 | No recd cortico>=10mg/d >60d |
| G9469 | 0010 | 3 | 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 | Rec cortico>90d or 1rx 900mg |
| G9470 | 0010 | 3 | 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 | No rec cortico>60d 1rx 600mg |
| G9471 | 0010 | 3 | Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) not ordered or documented | W/in 2yr dxa not order |
| G9472 | 0010 | 3 | 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 | No dxa no med hx no rv sx |
| G9473 | 0010 | 3 | Services performed by chaplain in the hospice setting, each 15 minutes | Chap services at hospice |
| G9474 | 0010 | 3 | Services performed by dietary counselor in the hospice setting, each 15 minutes | Diet counsel at hospice |
| G9475 | 0010 | 3 | Services performed by other counselor in the hospice setting, each 15 minutes | Other counselor at hospice |
| G9476 | 0010 | 3 | Services performed by volunteer in the hospice setting, each 15 minutes | Volun service at hospice |
| G9477 | 0010 | 3 | Services performed by care coordinator in the hospice setting, each 15 minutes | Care coord at hospice |
| G9478 | 0010 | 3 | Services performed by other qualified therapist in the hospice setting, each 15 minutes | Othe therapist at hospice |
| G9479 | 0010 | 3 | Services performed by qualified pharmacist in the hospice setting, each 15 minutes | Pharmacist at hospice |
| G9480 | 0010 | 3 | Admission to medicare care choice model program (mccm) | Admission to mccm |
| G9481 | 0010 | 3 | 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 | Remote e/m new pt 10mins |
| G9482 | 0010 | 3 | 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 | Remote e/m new pt 20mins |
| G9483 | 0010 | 3 | 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 | Remote e/m new pt 30mins |
| G9484 | 0010 | 3 | 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 | Remote e/m new pt 45mins |
| G9485 | 0010 | 3 | 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 | Remote e/m new pt 60mins |
| G9486 | 0010 | 3 | 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 | Remote e/m est. pt 10mins |
| G9487 | 0010 | 3 | 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 | Remote e/m est. pt 15mins |
| G9488 | 0010 | 3 | 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 | Remote e/m est. pt 25mins |
| G9489 | 0010 | 3 | 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 | Remote e/m est. pt 40mins |
| G9490 | 0010 | 3 | 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 | Cmmi mod home visit |
| G9496 | 0010 | 3 | 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 | Doc rsn no adeno/neopl detec |
| G9497 | 0010 | 3 | Received instruction from the anesthesiologist or proxy prior to the day of surgery to abstain from smoking on the day of surgery | Rec inst no smoke day surg |
| G9498 | 0010 | 3 | Antibiotic regimen prescribed | Abx reg prescribed |
| G9499 | 0010 | 3 | Patient did not start or is not receiving antiviral treatment for hepatitis c during the measurement period | No start/rec antvir tx hep c |
| G9500 | 0010 | 3 | Radiation exposure indices, or exposure time and number of fluorographic images in final report for procedures using fluoroscopy, documented | Rad expos ind/exp tm doc |
| G9501 | 0010 | 3 | Radiation exposure indices, or exposure time and number of fluorographic images not documented in final report for procedure using fluoroscopy, reason not given | Rad expos ind/exp tm no doc |
| G9502 | 0010 | 3 | 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) | Med reas no perf foot exam |
| G9503 | 0010 | 3 | Patient taking tamsulosin hydrochloride | Pt tk tams hcl |
| G9504 | 0010 | 3 | 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 | Doc rsn hep b stat not asses |
| G9505 | 0010 | 3 | Antibiotic regimen prescribed within 10 days after onset of symptoms for documented medical reason | Abx pres w/in 10 dys of symp |
| G9506 | 0010 | 3 | Biologic immune response modifier prescribed | Bio imm resp mod presc |
| G9507 | 0010 | 3 | 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) | Doc reas on statin or contra |
| G9508 | 0010 | 3 | Documentation that the patient is not on a statin medication | Doc pt not on statin |
| G9509 | 0010 | 3 | 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 | Adit mdd dys rem 12 mnths |
| G9510 | 0010 | 3 | 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 | Remis12m not phq-9 score <5 |
| G9511 | 0010 | 3 | Index event date phq-9 or phq-9m score greater than 9 documented during the twelve month denominator identification period | Idx evt dte phq>9 doc 12 mo |
| G9512 | 0010 | 3 | Individual had a pdc of 0.8 or greater | Indiv pdc > 0.8 |
| G9513 | 0010 | 3 | Individual did not have a pdc of 0.8 or greater | Indiv pdc not > 0.8 |
| G9514 | 0010 | 3 | Patient required a return to the operating room within 90 days of surgery | Req ret or w/in 90d of surg |
| G9515 | 0010 | 3 | Patient did not require a return to the operating room within 90 days of surgery | No reas, no ret or w/in 90d |
| G9516 | 0010 | 3 | Patient achieved an improvement in visual acuity, from their preoperative level, within 90 days of surgery | Impr vis acuit w/in 90d |
| G9517 | 0010 | 3 | Patient did not achieve an improvement in visual acuity, from their preoperative level, within 90 days of surgery, reason not given | No impr vis acuit w/in 90d |
| G9518 | 0010 | 3 | Documentation of active injection drug use | Doc active inj drug use |
| G9519 | 0010 | 3 | Patient achieves final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery | Final ref +/- 1.0 w/in 90d |
| G9520 | 0010 | 3 | Patient does not achieve final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery | Refract not +/- 1.0 w/in 90d |
| G9521 | 0010 | 3 | Total number of emergency department visits and inpatient hospitalizations less than two in the past 12 months | Er and ip hosp <2 in 12 mos |
| G9522 | 0010 | 3 | 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 | Er/ip hosp =/>2 in 12 mos |
| G9523 | 0010 | 3 | Patient discontinued from hemodialysis or peritoneal dialysis | D/c hemo or perit dialysis |
| G9524 | 0010 | 3 | Patient was referred to hospice care | Refer to hospice |
| G9525 | 0010 | 3 | Documentation of patient reason(s) for not referring to hospice care (e.g., patient declined, other patient reasons) | Doc pt reas no hospice refer |
| G9526 | 0010 | 3 | Patient was not referred to hospice care, reason not given | No reason, no refer hospice |
| G9529 | 0010 | 3 | Patient with minor blunt head trauma had an appropriate indication(s) for a head ct | Minor blunt trauma w/head ct |
| G9530 | 0010 | 3 | Patient presented with a minor blunt head trauma and had a head ct ordered for trauma by an emergency care provider | Pt mbht hd ct ord ec prov |
| G9531 | 0010 | 3 | 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 | Pt doc |
| G9532 | 0010 | 3 | 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 | Pt hd ct ord |
| G9533 | 0010 | 3 | Patient with minor blunt head trauma did not have an appropriate indication(s) for a head ct | Indic for head ct not valid |
| G9534 | 0010 | 3 | Advanced brain imaging (cta, ct, mra or mri) was not ordered | Adv brain image not ordered |
| G9535 | 0010 | 3 | Patients with a normal neurological examination | Normal neuro exam |
| G9536 | 0010 | 3 | 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) | Doc med reas adv brain image |
| G9537 | 0010 | 3 | Documentation of system reason(s) for obtaining imaging of the head (ct or mri) (i.e., needed as part of a clinical trial; other clinician ordered the study) | Doc sysm rsn img hd |
| G9538 | 0010 | 3 | Advanced brain imaging (cta, ct, mra or mri) was ordered | Adv brain image ordered |
| G9539 | 0010 | 3 | Intent for potential removal at time of placement | Intent pot remv time placemt |
| G9540 | 0010 | 3 | Patient alive 3 months post procedure | Pt alive 3 mos post proc |
| G9541 | 0010 | 3 | Filter removed within 3 months of placement | Filter rem 3 mon plmt |
| G9542 | 0010 | 3 | Documented re-assessment for the appropriateness of filter removal within 3 months of placement | Doc reass appr remo filt 3ms |
| G9543 | 0010 | 3 | 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 | Doc 2x re-assess filt remov |
| G9544 | 0010 | 3 | 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 | No filt remov w/in 3mos plcm |
| G9547 | 0010 | 3 | 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 | Cys ren les or adren |
| G9548 | 0010 | 3 | Final reports for imaging studies stating no follow-up imaging is recommended | No f/u rec image study |
| G9549 | 0010 | 3 | 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)) | Doc med rsn for f/u imag |
| G9550 | 0010 | 3 | Final reports for imaging studies with follow-up imaging recommended | Imag rec |
| G9551 | 0010 | 3 | Final reports for imaging studies without an incidentally found lesion noted | Imag no les |
| G9552 | 0010 | 3 | Incidental thyroid nodule < 1.0 cm noted in report | Inc thyr node <1.0 in rpt |
| G9553 | 0010 | 3 | Prior thyroid disease diagnosis | Prior thyroid dise dx |
| G9554 | 0010 | 3 | Final reports for ct, cta, mri or mra of the chest or neck or ultrasound of the neck with follow-up imaging recommended | Ct/cta/mri/a chst foll rec |
| G9555 | 0010 | 3 | 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)) | Doc med rsn for follup image |
| G9556 | 0010 | 3 | Final reports for ct, cta, mri or mra of the chest or neck or ultrasound of the neck with follow-up imaging not recommended | Ct/cta/mri/a no follup imag |
| G9557 | 0010 | 3 | Final reports for ct, cta, mri or mra studies of the chest or neck or ultrasound of the neck without an incidentally found thyroid nodule < 1.0 cm noted or no nodule found | Ct/cta/mri/a no thyr <1.0cm |
| G9558 | 0010 | 3 | Patient treated with a beta-lactam antibiotic as definitive therapy | Tx beta-lactam abx therapy |
| G9559 | 0010 | 3 | Documentation of medical reason(s) for not prescribing a beta-lactam antibiotic (e.g., allergy, intolerance to beta-lactam antibiotics) | Doc med reas no abx therapy |
| G9560 | 0010 | 3 | Patient not treated with a beta-lactam antibiotic as definitive therapy, reason not given | No beta-lactam abx ther, rng |
| G9561 | 0010 | 3 | Patients prescribed opiates for longer than six weeks | Presc opiates >6 wks |
| G9562 | 0010 | 3 | Patients who had a follow-up evaluation conducted at least every three months during opioid therapy | Foll-up eval q3mo opiod tx |
| G9563 | 0010 | 3 | Patients who did not have a follow-up evaluation conducted at least every three months during opioid therapy | No f/u eval q3mo opiod tx |
| G9572 | 0010 | 3 | Index date phq-score greater than 9 documented during the twelve month denominator identification period | Phq-scr >9 doc in 12m time |
| G9573 | 0010 | 3 | 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 | Adl pt md or dys rem 6 mon |
| G9574 | 0010 | 3 | 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 | Adl pt md dys no rem 6 mon |
| G9577 | 0010 | 3 | Patients prescribed opiates for longer than six weeks | Presc opiates >6 wks |
| G9578 | 0010 | 3 | Documentation of signed opioid treatment agreement at least once during opioid therapy | Doc opioid tx 1x during ther |
| G9579 | 0010 | 3 | No documentation of signed an opioid treatment agreement at least once during opioid therapy | No doc opioid tx 1x at ther |
| G9580 | 0010 | 3 | Door to puncture time of less than 2 hours | Door to punc time <2hrs |
| G9581 | 0010 | 3 | 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) | Md doc, door to punc tm >2hr |
| G9582 | 0010 | 3 | Door to puncture time of greater than 2 hours, no reason given | Door to punc time >2hr, nrg |
| G9583 | 0010 | 3 | Patients prescribed opiates for longer than six weeks | Presc opiates >6 wks |
| G9584 | 0010 | 3 | 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 | Eval opioid use instr/pt int |
| G9585 | 0010 | 3 | 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 | No eval opi use instr/intv |
| G9593 | 0010 | 3 | Pediatric patient with minor blunt head trauma classified as low risk according to the pecarn prediction rules | Low pecarn ped head trauma |
| G9594 | 0010 | 3 | Patient presented with a minor blunt head trauma and had a head ct ordered for trauma by an emergency care provider | Pt mbht hd ct ord ec prov |
| G9595 | 0010 | 3 | Patient has documentation of ventricular shunt, brain tumor, or coagulopathy | Doc shnt/tum/coag |
| G9596 | 0010 | 3 | 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 | Ped pt hd ct ord |
| G9597 | 0010 | 3 | Pediatric patient with minor blunt head trauma not classified as low risk according to the pecarn prediction rules | No low pecarn ped head traum |
| G9598 | 0010 | 3 | Aortic aneurysm 5.5 - 5.9 cm maximum diameter on centerline formatted ct or minor diameter on axial formatted ct | Aor ane 5.5-5.9 cm max diam |
| G9599 | 0010 | 3 | Aortic aneurysm 6.0 cm or greater maximum diameter on centerline formatted ct or minor diameter on axial formatted ct | Aor ane >=6.0 cm max diam |
| G9600 | 0010 | 3 | Symptomatic aaas that required urgent/emergent (non-elective) repair | Symp aaa urgent repair |
| G9601 | 0010 | 3 | Patient discharge to home no later than post-operative day #7 | Pt dchg home post op day 7 |
| G9602 | 0010 | 3 | Patient not discharged to home by post-operative day #7 | Pt no dchg home postop day 7 |
| G9603 | 0010 | 3 | Patient survey score improved from baseline following treatment | Pt surv improv bsline tx |
| G9604 | 0010 | 3 | Patient survey results not available | Pt surv results not avail |
| G9605 | 0010 | 3 | Patient survey score did not improve from baseline following treatment | Surv score no improv w/tx |
| G9606 | 0010 | 3 | Intraoperative cystoscopy performed to evaluate for lower tract injury | Intraop cyst eval trac inj |
| G9607 | 0010 | 3 | 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 | Doc med rsn not perf cystosc |
| G9608 | 0010 | 3 | Intraoperative cystoscopy not performed to evaluate for lower tract injury | Intraop cyst eval not done |
| G9609 | 0010 | 3 | Documentation of an order for anti-platelet agents | Doc order anti-plat |
| G9610 | 0010 | 3 | Documentation of medical reason(s) in the patient’s record for not ordering anti-platelet agents | Doc md rsn no antipla |
| G9611 | 0010 | 3 | Order for anti-platelet agents was not documented in the patient’s record, reason not given | No doc order anti-plat rng |
| G9612 | 0010 | 3 | Photodocumentation of two or more cecal landmarks to establish a complete examination | Phodoc 2 mr cec lndmk |
| G9613 | 0010 | 3 | Documentation of post-surgical anatomy (e.g., right hemicolectomy, ileocecal resection, etc.) | Doc post surg anatomy |
| G9614 | 0010 | 3 | Photodocumentation of less than two cecal landmarks (i.e., no cecal landmarks or only one cecal landmark) to establish a complete examination | Photodoc < 2 cec lndmk |
| G9615 | 0010 | 3 | Preoperative assessment documented | Pre-op asst doc |
| G9616 | 0010 | 3 | 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) | Doc rsn no preop assmt |
| G9617 | 0010 | 3 | Preoperative assessment not documented, reason not given | Pre-op asst not doc, rng |
| G9618 | 0010 | 3 | Documentation of screening for uterine malignancy or those that had an ultrasound and/or endometrial sampling of any kind | Doc scr uter mal or us/samp |
| G9619 | 0010 | 3 | Documentation of reason(s) for not screening for uterine malignancy (e.g., prior hysterectomy) | Doc rsn no scr uter malig |
| G9620 | 0010 | 3 | Patient not screened for uterine malignancy, or those that have not had an ultrasound and/or endometrial sampling of any kind, reason not given | No scr utr malig/us/samp rng |
| G9621 | 0010 | 3 | Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method and received brief counseling | Scr unheal etoh w/counsel |
| G9622 | 0010 | 3 | Patient not identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method | No unheal etoh user |
| G9623 | 0010 | 3 | Documentation of medical reason(s) for not screening for unhealthy alcohol use (e.g., limited life expectancy, other medical reasons) | Doc med rsn no scr etoh use |
| G9624 | 0010 | 3 | 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, reason not given | Pt not scrn or no counseling |
| G9625 | 0010 | 3 | Patient sustained bladder injury at the time of surgery or discovered subsequently up to 30 days post-surgery | Pt bl srg 30 day pst srg |
| G9626 | 0010 | 3 | 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 urinary incontinence procedure, patient death from non-medical causes not related to surgery, patient died during procedure without evidence of bladder injury) | Med rsn no rpt baldder inj |
| G9627 | 0010 | 3 | Patient did not sustain bladder injury at the time of surgery nor discovered subsequently up to 30n days post-surgery | Pt no bl srg 30 day pst srg |
| G9628 | 0010 | 3 | Patient sustained bowel injury at the time of surgery or discovered subsequently up to 30 days post-surgery | Pt bwli srg 30 day pst srg |
| G9629 | 0010 | 3 | 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) | Med rsn no rpt bowel inj |
| G9630 | 0010 | 3 | Patient did not sustain a bowel injury at the time of surgery nor discovered subsequently up to 30 days post-surgery | Pt no bwli srg 30 day srg |
| G9631 | 0010 | 3 | Patient sustained ureter injury at the time of surgery or discovered subsequently up to 30 days post-surgery | Pt ui srg 30 day pst srg |
| G9632 | 0010 | 3 | 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) | Med rsn for no rpt uret inj |
| G9633 | 0010 | 3 | Patient did not sustain ureter injury at the time of surgery nor discovered subsequently up to 30 days post-surgery | Pt no ui srg 30 day pst srg |
| G9634 | 0010 | 3 | Health-related quality of life assessed with tool during at least two visits and quality of life score remained the same or improved | Qual life tool 2x same/impr |
| G9635 | 0010 | 3 | 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) | No doc rsn do qual life assm |
| G9636 | 0010 | 3 | Health-related quality of life not assessed with tool during at least two visits or quality of life score declined | No life asst 2x same/decr |
| G9637 | 0010 | 3 | 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) | Doc >1 dose reduc tech |
| G9638 | 0010 | 3 | 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) | No doc >1 dose reduc tech |
| G9639 | 0010 | 3 | Major amputation or open surgical bypass not required within 48 hours of the index endovascular lower extremity revascularization procedure | Amp no reqd in48h ieler proc |
| G9640 | 0010 | 3 | Documentation of planned hybrid or staged procedure | Doc plan hybrid/stage proc |
| G9641 | 0010 | 3 | Major amputation or open surgical bypass required within 48 hours of the index endovascular lower extremity revascularization procedure | Amp reqd w/in 48h ieler proc |
| G9642 | 0010 | 3 | Current smokers (e.g., cigarette, cigar, pipe, e-cigarette or marijuana) | Current smoker |
| G9643 | 0010 | 3 | Elective surgery | Elective surgery |
| G9644 | 0010 | 3 | Patients who abstained from smoking prior to anesthesia on the day of surgery or procedure | No smok b/4 anes day of surg |
| G9645 | 0010 | 3 | Patients who did not abstain from smoking prior to anesthesia on the day of surgery or procedure | Had smoke b/4 anes day surg |
| G9646 | 0010 | 3 | Patients with 90 day mrs score of 0 to 2 | Pt w/90d mrs 0-2 |
| G9647 | 0010 | 3 | Patients in whom mrs score could not be obtained at 90 day follow-up | No mrs score in 90d followup |
| G9648 | 0010 | 3 | Patients with 90 day mrs score greater than 2 | Pt w/90d mrs >2 |
| G9649 | 0010 | 3 | 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)) | Psor as doc spc bm |
| G9650 | 0010 | 3 | 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 | Doc pt no ther chg or contra |
| G9651 | 0010 | 3 | 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 | Psor as doc no spc bm |
| G9652 | 0010 | 3 | Patient has been treated with a systemic or biologic medication for psoriasis for at least six months | Pt tx sys bio med psori 6mth |
| G9653 | 0010 | 3 | Patient has not been treated with a systemic or biologic medication for psoriasis for at least six months | Pt no tx sys bio rx 6 mths |
| G9654 | 0010 | 3 | Monitored anesthesia care (mac) | Mon anesth care |
| G9655 | 0010 | 3 | A transfer of care protocol or handoff tool/checklist that includes the required key handoff elements is used | Toc tool incl key elem |
| G9656 | 0010 | 3 | Patient transferred directly from anesthetizing location to pacu or other non-icu location | Pt trans from anest to pacu |
| G9657 | 0010 | 3 | Transfer of care during an anesthetic or to the intensive care unit | Toc dur aneth to icu |
| G9658 | 0010 | 3 | A transfer of care protocol or handoff tool/checklist that includes the required key handoff elements is not used | Toc tool incl elem not used |
| G9659 | 0010 | 3 | Patients greater than 85 years of age who did not have a history of colorectal cancer or 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 | >85y no hx colo ca/rsn scope |
| G9660 | 0010 | 3 | Documentation of medical reason(s) for a colonoscopy performed on a patient greater than 85 years of age (e.g., last colonoscopy incomplete, last colonoscopy had inadequate prep, 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) | Doc med rsn scope pt >85y |
| G9661 | 0010 | 3 | Patients greater than 85 years of age who received a routine colonoscopy for a reason other than the following: an assessment of signs/symptoms of gi tract illness, and/or the patient is considered high risk, and/or to follow-up on previously diagnosed advance lesions | >85y scope othr rsn |
| G9662 | 0010 | 3 | Previously diagnosed or have an active diagnosis of clinical ascvd | Prior dx/active clin ascvd |
| G9663 | 0010 | 3 | Any fasting or direct ldl-c laboratory test result <= 190 mg/dl | Fast/dir ldl <= 190 mg/dl |
| G9664 | 0010 | 3 | Patients who are currently statin therapy users or received an order (prescription) for statin therapy | Taking statin or rec’d order |
| G9665 | 0010 | 3 | Patients who are not currently statin therapy users or did not receive an order (prescription) for statin therapy | No statin/no order statin |
| G9666 | 0010 | 3 | The highest fasting or direct ldl-c laboratory test result of 70-189 mg/dl in the measurement period or two years prior to the beginning of the measurement period | Fas/dir ldl 70-189mg/dl mst |
| G9667 | 0010 | 3 | 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) | Doc med rsn no stat tx/presc |
| G9669 | 0010 | 3 | I intend to report the multiple chronic conditions measures group | Intend rpt mult chr msr grp |
| G9670 | 0010 | 3 | All quality actions for the applicable measures in the multiple chronic conditions measures group have been performed for this patient | Qty act mcc mg perf |
| G9671 | 0010 | 3 | I intend to report the diabetic retinopathy measures group | Intend rpt dia retin msr grp |
| G9672 | 0010 | 3 | All quality actions for the applicable measures in the diabetic retinopathy measures group have been performed for this patient | Qty act diab retin mg perf |
| G9673 | 0010 | 3 | I intend to report the cardiovascular prevention measures group | Intend rpt card prev msr grp |
| G9674 | 0010 | 3 | Patients with clinical ascvd diagnosis | Pt w/clin ascvd dx |
| G9675 | 0010 | 3 | Patients who have ever had a fasting or direct laboratory result of ldl-c = 190 mg/dl | Pt w/fast/dir lab ldl-c >190 |
| G9676 | 0010 | 3 | 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 | 40-75y w/type 1/2 w/ldl-c rs |
| G9677 | 0010 | 3 | All quality actions for the applicable measures in the cardiovascular prevention measures group have been performed for this patient | Qty act card prev mg perf |
| G9678 | 0010 | 3 | 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 | Oncology care model service |
| G9679 | 0010 | 3 | This code is for onsite acute care treatment of a nursing facility resident with pneumonia; may only be billed once per day per beneficiary | Acute care pneumonia |
| G9680 | 0010 | 3 | This code is for onsite acute care treatment of a nursing facility resident with chf; may only be billed once per day per beneficiary | Acute care congestive heart |
| G9681 | 0010 | 3 | This code is for onsite acute care treatment of a resident with copd or asthma; may only be billed once per day per beneficiary | Acute care chronic obstruct |
| G9682 | 0010 | 3 | 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 | Acute care skin infection |
| G9683 | 0010 | 3 | 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 | Acute fluid/electro disorder |
| G9684 | 0010 | 3 | 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 | Acute care urinary tract inf |
| G9685 | 0010 | 3 | 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 | Acute nursing facility care |
| G9686 | 0010 | 3 | 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 | Nursing facility conference |
| G9687 | 0010 | 3 | Hospice services provided to patient any time during the measurement period | Hospice anytime msmt per |
| G9688 | 0010 | 3 | Patients using hospice services any time during the measurement period | Pt w/hosp anytime msmt per |
| G9689 | 0010 | 3 | Patient admitted for performance of elective carotid intervention | Inpt elect carotid intervent |
| G9690 | 0010 | 3 | Patient receiving hospice services any time during the measurement period | Pt in hos |
| G9691 | 0010 | 3 | Patient had hospice services any time during the measurement period | Pt hosp dur msmt period |
| G9692 | 0010 | 3 | Hospice services received by patient any time during the measurement period | Hosp recd by pt dur msmt per |
| G9693 | 0010 | 3 | Patient use of hospice services any time during the measurement period | Pt use hosp during msmt per |
| G9694 | 0010 | 3 | Hospice services utilized by patient any time during the measurement period | Hosp srv used pt in msmt per |
| G9695 | 0010 | 3 | Long-acting inhaled bronchodilator prescribed | Long act inhal bronchdil pre |
| G9696 | 0010 | 3 | Documentation of medical reason(s) for not prescribing a long-acting inhaled bronchodilator | Med rsn no presc bronchdil |
| G9697 | 0010 | 3 | Documentation of patient reason(s) for not prescribing a long-acting inhaled bronchodilator | Pt rsn no presc bronchdil |
| G9698 | 0010 | 3 | Documentation of system reason(s) for not prescribing a long-acting inhaled bronchodilator | Sys rsn no presc bronchdil |
| G9699 | 0010 | 3 | Long-acting inhaled bronchodilator not prescribed, reason not otherwise specified | Long inhal bronchdil no pres |
| G9700 | 0010 | 3 | Patients who use hospice services any time during the measurement period | Pt is w/hosp during msmt per |
| G9701 | 0010 | 3 | Children who are taking antibiotics in the 30 days prior to the date of the encounter during which the diagnosis was established | Child anbx 30 prior dx estab |
| G9702 | 0010 | 3 | Patients who use hospice services any time during the measurement period | Pt use hosp during msmt per |
| G9703 | 0010 | 3 | Children who are taking antibiotics in the 30 days prior to the diagnosis of pharyngitis | Child anbx 30 prior dx phary |
| G9704 | 0010 | 3 | Ajcc breast cancer stage i: t1 mic or t1a documented | Ajcc br ca stg i: t1 mic/t1a |
| G9705 | 0010 | 3 | Ajcc breast cancer stage i: t1b (tumor > 0.5 cm but <= 1 cm in greatest dimension) documented | Ajcc br ca stg ib |
| G9706 | 0010 | 3 | Low (or very low) risk of recurrence, prostate cancer | Low recur prost ca |
| G9707 | 0010 | 3 | Patient received hospice services any time during the measurement period | Pt had hosp dur msmt per |
| G9708 | 0010 | 3 | 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 | Bilat mast/hx bi /unilat mas |
| G9709 | 0010 | 3 | Hospice services used by patient any time during the measurement period | Hosp srv used pt in msmt per |
| G9710 | 0010 | 3 | Patient was provided hospice services any time during the measurement period | Pt prov hosp srv msmt per |
| G9711 | 0010 | 3 | Patients with a diagnosis or past history of total colectomy or colorectal cancer | Pt hx tot col or colon ca |
| G9712 | 0010 | 3 | 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 | Doc med rsn presc anbx |
| G9713 | 0010 | 3 | Patients who use hospice services any time during the measurement period | Pt use hosp during msmt per |
| G9714 | 0010 | 3 | Patient is using hospice services any time during the measurement period | Pt is w/hosp during msmt per |
| G9715 | 0010 | 3 | Patients who use hospice services any time during the measurement period | Pt w/hosp anytime msmt per |
| G9716 | 0010 | 3 | Bmi is documented as being outside of normal limits, follow-up plan is not completed for documented reason | Bmi doc onl fup not cmpltd |
| G9717 | 0010 | 3 | Documentation stating the patient has an active diagnosis of depression or has a diagnosed bipolar disorder, therefore screening or follow-up not required | Doc pt dx dep/bp f/u nt req |
| G9718 | 0010 | 3 | Hospice services for patient provided any time during the measurement period | Hospice anytime msmt per |
| G9719 | 0010 | 3 | 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 | Pt not ambul/immob/wc |
| G9720 | 0010 | 3 | Hospice services for patient occurred any time during the measurement period | Hospice anytime msmt per |
| G9721 | 0010 | 3 | Patient not ambulatory, bed ridden, immobile, confined to chair, wheelchair bound, dependent on helper pushing wheelchair, independent in wheelchair or minimal help in wheelchair | Pt not ambul/immob/wc |
| G9722 | 0010 | 3 | 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 | Doc hx renal fail or cr+ >4 |
| G9723 | 0010 | 3 | Hospice services for patient received any time during the measurement period | Hosp recd by pt dur msmt per |
| G9724 | 0010 | 3 | Patients who had documentation of use of anticoagulant medications overlapping the measurement year | Pt w/doc use anticoag mst yr |
| G9725 | 0010 | 3 | Patients who use hospice services any time during the measurement period | Pt w/hosp anytime msmt per |
| G9726 | 0010 | 3 | Patient refused to participate | Refused to participate |
| G9727 | 0010 | 3 | Patient unable to complete the knee 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 | Pt unable cmplt knee fs prom |
| G9728 | 0010 | 3 | Patient refused to participate | Refused to participate |
| G9729 | 0010 | 3 | Patient unable to complete the hip fs prom at initial evaluation and discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available | Pt unbl cmplt hip fs prom |
| G9730 | 0010 | 3 | Patient refused to participate | Refused to participate |
| G9731 | 0010 | 3 | Patient unable to complete the ankle/foot 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 | Pt unbl cmplt ft/ank fs prom |
| G9732 | 0010 | 3 | Patient refused to participate | Refused to participate |
| G9733 | 0010 | 3 | 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 | Pt unbl cmplt lb fs prom |
| G9734 | 0010 | 3 | Patient refused to participate | Refused to participate |
| G9735 | 0010 | 3 | 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 | Pt unbl cmplt shld fs prom |
| G9736 | 0010 | 3 | Patient refused to participate | Refused to participate |
| G9737 | 0010 | 3 | 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 | Pt unbl cmplt ewh fs prom |
| G9738 | 0010 | 3 | Patient refused to participate | Refused to participate |
| G9739 | 0010 | 3 | 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 | Pt unbl cmplt go fs prom |
| G9740 | 0010 | 3 | Hospice services given to patient any time during the measurement period | Hosp srv to pt dur msmt per |
| G9741 | 0010 | 3 | Patients who use hospice services any time during the measurement period | Pt w/hosp anytime msmt per |
| G9742 | 0010 | 3 | Psychiatric symptoms assessed | Psych sympt assessed |
| G9743 | 0010 | 3 | Psychiatric symptoms not assessed, reason not otherwise specified | Psych symp not assessed, rns |
| G9744 | 0010 | 3 | Patient not eligible due to active diagnosis of hypertension | Pt not eli d/t act dig htn |
| G9745 | 0010 | 3 | Documented reason for not screening or recommending a follow-up for high blood pressure | Doc rsn no hbp scrn or f/u |
| G9746 | 0010 | 3 | Patient has mitral stenosis or prosthetic heart valves or patient has transient or reversible cause of af (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac surgery) | Mit sten, valve or trans af |
| G9747 | 0010 | 3 | Patient is undergoing palliative dialysis with a catheter | Pall dialysis with catheter |
| G9748 | 0010 | 3 | Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant | App transpl lvg kidney donor |
| G9749 | 0010 | 3 | Patient is undergoing palliative dialysis with a catheter | Pall dialysis with catheter |
| G9750 | 0010 | 3 | Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant | App transpl lvg kidney donor |
| G9751 | 0010 | 3 | Patient died at any time during the 24-month measurement period | Pt died w/in 24 mos rpt time |
| G9752 | 0010 | 3 | Emergency surgery | Urgent surgery |
| G9753 | 0010 | 3 | 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) | Doc no dicom, ct other fac |
| G9754 | 0010 | 3 | A finding of an incidental pulmonary nodule | Incid pulm nodule |
| G9755 | 0010 | 3 | 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) | Doc med rsn no fllw up |
| G9756 | 0010 | 3 | Surgical procedures that included the use of silicone oil | Surg proc w/silicone oil |
| G9757 | 0010 | 3 | Surgical procedures that included the use of silicone oil | Surg proc w/silicone oil |
| G9758 | 0010 | 3 | Patient in hospice at any time during the measurement period | Pt in hos |
| G9759 | 0010 | 3 | History of preoperative posterior capsule rupture | Hx preop post cap rup |
| G9760 | 0010 | 3 | Patients who use hospice services any time during the measurement period | Pt w/hosp anytime msmt per |
| G9761 | 0010 | 3 | Patients who use hospice services any time during the measurement period | Pt w/hosp anytime msmt per |
| G9762 | 0010 | 3 | 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 | Pt had >= 2-3 hpv vaccines |
| G9763 | 0010 | 3 | 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 | Pt not have 2-3 hpv vaccines |
| G9764 | 0010 | 3 | Patient has been treated with a systemic medication for psoriasis vulgaris | Pt treatd w/oral syst or bio |
| G9765 | 0010 | 3 | 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 | Doc pat declined therapy |
| G9766 | 0010 | 3 | Patients who are transferred from one institution to another with a known diagnosis of cva for endovascular stroke treatment | Cva stroke dx tx transf fac |
| G9767 | 0010 | 3 | Hospitalized patients with newly diagnosed cva considered for endovascular stroke treatment | Hosp new dx cva consid evst |
| G9768 | 0010 | 3 | Patients who utilize hospice services any time during the measurement period | Pt w/hosp anytime msmt per |
| G9769 | 0010 | 3 | Patient had a bone mineral density test in the past two years or received osteoporosis medication or therapy in the past 12 months | Bn den 2yr/got ost med/ther |
| G9770 | 0010 | 3 | Peripheral nerve block (pnb) | Perip nerve block |
| G9771 | 0010 | 3 | 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 the 15 minutes immediately after anesthesia end time | Anes end, 1 temp >35.5(95.9) |
| G9772 | 0010 | 3 | 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 the 15 minutes immediately after anesthesia end time (e.g., emergency cases, intentional hypothermia, etc.) | Doc med rsn no temp >= 35.5 |
| G9773 | 0010 | 3 | 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 the 15 minutes immediately after anesthesia end time, reason not given | 1 bod temp >=35.5 |
| G9774 | 0010 | 3 | Patients who have had a hysterectomy | Pt had hyst |
| G9775 | 0010 | 3 | Patient received at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively | Recd 2 anti-emet pre/intraop |
| G9776 | 0010 | 3 | 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) | Doc med rsn no proph antiem |
| G9777 | 0010 | 3 | Patient did not receive at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively | Pt no antiemet pre/intraop |
| G9778 | 0010 | 3 | Patients who have a diagnosis of pregnancy | Pts dx w/pregn |
| G9779 | 0010 | 3 | Patients who are breastfeeding | Pts breastfeeding |
| G9780 | 0010 | 3 | Patients who have a diagnosis of rhabdomyolysis | Pts dx w/rhabdomyolysis |
| G9781 | 0010 | 3 | 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 are receiving palliative or hospice care, patients with active liver disease or hepatic disease or insufficiency, and patients with end stage renal disease (esrd)) | Doc rsn no statin |
| G9782 | 0010 | 3 | History of or active diagnosis of familial or pure hypercholesterolemia | Hx dx fam/pure hypercholes |
| G9783 | 0010 | 3 | 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 | Doc dx dm, fast <70, no stat |
| G9784 | 0010 | 3 | Pathologists/dermatopathologists providing a second opinion on a biopsy | Path/derm prov 2nd biop opin |
| G9785 | 0010 | 3 | 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 | Path report sent |
| G9786 | 0010 | 3 | 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 | Path report not sent |
| G9787 | 0010 | 3 | Patient alive as of the last day of the measurement year | Pt alive |
| G9788 | 0010 | 3 | Most recent bp is less than or equal to 140/90 mm hg | Most rct bp </= 140/90 |
| G9789 | 0010 | 3 | Blood pressure recorded during inpatient stays, emergency room visits, urgent care visits, and patient self-reported bp’s (home and health fair bp results) | Record bp ip, er, urg/self |
| G9790 | 0010 | 3 | Most recent bp is greater than 140/90 mm hg, or blood pressure not documented | Most rct bp >/= 140/90 |
| G9791 | 0010 | 3 | Most recent tobacco status is tobacco free | Most rct tob stat free |
| G9792 | 0010 | 3 | Most recent tobacco status is not tobacco free | Most rct tob stat not free |
| G9793 | 0010 | 3 | Patient is currently on a daily aspirin or other antiplatelet | Pt on daily asa/antiplat |
| G9794 | 0010 | 3 | 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) | Doc med rsn no daily aspirin |
| G9795 | 0010 | 3 | Patient is not currently on a daily aspirin or other antiplatelet | Pt no daily asa/antiplat |
| G9796 | 0010 | 3 | Patient is currently on a statin therapy | Pt not currently on statin |
| G9797 | 0010 | 3 | Patient is not on a statin therapy | Pt currently on statin |
| G9798 | 0010 | 3 | Discharge(s) for ami between july 1 of the year prior measurement period to june 30 of the measurement period | D/c ami btw 7/1-6/30 meas pd |
| G9799 | 0010 | 3 | 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 | Med disp evt indic hx asth |
| G9800 | 0010 | 3 | Patients who are identified as having an intolerance or allergy to beta-blocker therapy | Pt id intol/alleg beta-block |
| G9801 | 0010 | 3 | Hospitalizations in which the patient was transferred directly to a non-acute care facility for any diagnosis | Nonacut transf from inpt |
| G9802 | 0010 | 3 | Patients who use hospice services any time during the measurement period | Pt w/hosp anytime msmt per |
| G9803 | 0010 | 3 | Patient prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami | Pt presc 135 day trmt |
| G9804 | 0010 | 3 | Patient was not prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami | Pt not presc 135 day trmt |
| G9805 | 0010 | 3 | Patients who use hospice services any time during the measurement period | Pt w/hosp anytime msmt per |
| G9806 | 0010 | 3 | Patients who received cervical cytology or an hpv test | Pt recd cerv cyto/hpv |
| G9807 | 0010 | 3 | Patients who did not receive cervical cytology or an hpv test | Pt no recd cerv cyto/hpv |
| G9808 | 0010 | 3 | Any patients who had no asthma controller medications dispensed during the measurement year | Pt no asthm cont med mst per |
| G9809 | 0010 | 3 | Patients who use hospice services any time during the measurement period | Pt w/hosp anytime msmt per |
| G9810 | 0010 | 3 | Patient achieved a pdc of at least 75% for their asthma controller medication | Pdc 75% w/asth cont med |
| G9811 | 0010 | 3 | Patient did not achieve a pdc of at least 75% for their asthma controller medication | No pdc 75% w/asth cont med |
| G9812 | 0010 | 3 | 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 | Pt died during inpt/30d aft |
| G9813 | 0010 | 3 | Patient did not die within 30 days of the procedure or during the index hospitalization | Pt not died w/in 30d of proc |
| G9814 | 0010 | 3 | Death occurring during the index acute care hospitalization | Death during index hosp |
| G9815 | 0010 | 3 | Death did not occur during the index acute care hospitalization | Death not during index hosp |
| G9816 | 0010 | 3 | Death occurring after discharge from the hospital but within 30 days post procedure | Death <30 day post discharge |
| G9817 | 0010 | 3 | Death did not occur after discharge from the hospital within 30 days post procedure | No death 30-days post-disch |
| G9818 | 0010 | 3 | Documentation of sexual activity | Doc sex activity |
| G9819 | 0010 | 3 | Patients who use hospice services any time during the measurement period | Pt w/hosp anytime msmt per |
| G9820 | 0010 | 3 | Documentation of a chlamydia screening test with proper follow-up | Doc chlam scr test w/follow |
| G9821 | 0010 | 3 | No documentation of a chlamydia screening test with proper follow-up | No doc chlam scr ts w/follow |
| G9822 | 0010 | 3 | Women who had an endometrial ablation procedure during the year prior to the index date (exclusive of the index date) | Endo abl proc yr prev ind dt |
| G9823 | 0010 | 3 | Endometrial sampling or hysteroscopy with biopsy and results documented | Endo smpl/hyst bx res doc |
| G9824 | 0010 | 3 | Endometrial sampling or hysteroscopy with biopsy and results not documented | Endo smpl/hyst bx res no doc |
| G9825 | 0010 | 3 | Her-2/neu negative or undocumented/unknown | Her-2 neg,undoc/unkn |
| G9826 | 0010 | 3 | Patient transferred to practice after initiation of chemotherapy | Transf pract aft init chemo |
| G9827 | 0010 | 3 | Her2-targeted therapies not administered during the initial course of treatment | Her-2 targ ther no init tx |
| G9828 | 0010 | 3 | Her2-targeted therapies administered during the initial course of treatment | Her-2 targ ther dur init tx |
| G9829 | 0010 | 3 | Breast adjuvant chemotherapy administered | Breast adj chemo admin |
| G9830 | 0010 | 3 | Her-2/neu positive | Her-2 pos |
| G9831 | 0010 | 3 | Ajcc stage at breast cancer diagnosis = ii or iii | Ajcc stg brt ca dx ii or iii |
| G9832 | 0010 | 3 | Ajcc stage at breast cancer diagnosis = i (ia or ib) and t-stage at breast cancer diagnosis does not equal = t1, t1a, t1b | Brt ca dx i, no t1/t1a/t1b |
| G9833 | 0010 | 3 | Patient transfer to practice after initiation of chemotherapy | Transf pract aft init chemo |
| G9834 | 0010 | 3 | Patient has metastatic disease at diagnosis | Pt met dis at dx |
| G9835 | 0010 | 3 | Trastuzumab administered within 12 months of diagnosis | Trastuz given w/in 12 mos dx |
| G9836 | 0010 | 3 | 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) | Rsn no trast given doc |
| G9837 | 0010 | 3 | Trastuzumab not administered within 12 months of diagnosis | Trastuz not in 12 mos dx |
| G9838 | 0010 | 3 | Patient has metastatic disease at diagnosis | Pt met dis at dx |
| G9839 | 0010 | 3 | Anti-egfr monoclonal antibody therapy | Anti-egfr mon anti ther |
| G9840 | 0010 | 3 | Ras (kras and nras) gene mutation testing performed before initiation of anti-egfr moab | Gene testing performed |
| G9841 | 0010 | 3 | Ras (kras and nras) gene mutation testing not performed before initiation of anti-egfr moab | Gene testing not performed |
| G9842 | 0010 | 3 | Patient has metastatic disease at diagnosis | Pt met dis at dx |
| G9843 | 0010 | 3 | Ras (kras or nras) gene mutation | Kras or nras gene mutation |
| G9844 | 0010 | 3 | Patient did not receive anti-egfr monoclonal antibody therapy | Pt no recd anti-egfr ther |
| G9845 | 0010 | 3 | Patient received anti-egfr monoclonal antibody therapy | Pt recd anti-egfr ther |
| G9846 | 0010 | 3 | Patients who died from cancer | Pt died from cancer |
| G9847 | 0010 | 3 | Patient received chemotherapy in the last 14 days of life | Pt recd chemo last 14d life |
| G9848 | 0010 | 3 | Patient did not receive chemotherapy in the last 14 days of life | Pt no chemo last 14d life |
| G9849 | 0010 | 3 | Patients who died from cancer | Pt died from cancer |
| G9850 | 0010 | 3 | Patient had more than one emergency department visit in the last 30 days of life | 1/more ed last 30d life |
| G9851 | 0010 | 3 | Patient had one or less emergency department visits in the last 30 days of life | 1/no ed visit last 30d life |
| G9852 | 0010 | 3 | Patients who died from cancer | Pt died from cancer |
| G9853 | 0010 | 3 | Patient admitted to the icu in the last 30 days of life | Icu stay last 30d life |
| G9854 | 0010 | 3 | Patient was not admitted to the icu in the last 30 days of life | No icu stay last 30d life |
| G9855 | 0010 | 3 | Patients who died from cancer | Pt died from cancer |
| G9856 | 0010 | 3 | Patient was not admitted to hospice | Pt no hospice |
| G9857 | 0010 | 3 | Patient admitted to hospice | Pt admit hospice |
| G9858 | 0010 | 3 | Patient enrolled in hospice | Pt enroll hospice |
| G9859 | 0010 | 3 | Patients who died from cancer | Pt died from cancer |
| G9860 | 0010 | 3 | Patient spent less than three days in hospice care | Pt less 3d hospice |
| G9861 | 0010 | 3 | Patient spent greater than or equal to three days in hospice care | Pt more than 3d hospice |
| G9862 | 0010 | 3 | 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) | Doc rsn no 10 yr follow |
| G9868 | 0010 | 3 | Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use under the next generation aco model, less than 10 minutes | Next gen aco model <10min |
| G9869 | 0010 | 3 | Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use under the next generation aco model, 10-20 minutes | Next gen aco model 10-20min |
| G9870 | 0010 | 3 | Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use under the next generation aco model, 20 or more minutes | Next gen aco model >20min |
| G9873 | 0010 | 3 | 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 | 1 em core session |
| G9874 | 0010 | 3 | 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 | 4 em core sessions |
| G9875 | 0010 | 3 | 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 | 9 em core sessions |
| G9876 | 0010 | 3 | 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 | 2 em core ms mo 7-9 no wl |
| G9877 | 0010 | 3 | 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 | 2 em core ms mo 10-12 no wl |
| G9878 | 0010 | 3 | 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 | 2 em core ms mo 7-9 wl |
| G9879 | 0010 | 3 | 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 | 2 em core ms mo 10-12 wl |
| G9880 | 0010 | 3 | 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 | Em 5 percent wl |
| G9881 | 0010 | 3 | 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 | Em 9 percent wl |
| G9882 | 0010 | 3 | 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 | 2 em ongoing ms mo 13-15 wl |
| G9883 | 0010 | 3 | 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 | 2 em ongoing ms mo 16-18 wl |
| G9884 | 0010 | 3 | 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 | 2 em ongoing ms mo 19-21 wl |
| G9885 | 0010 | 3 | 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 | 2 em ongoing ms mo 22-24 wl |
| G9890 | 0010 | 3 | 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 | Em bridge payment |
| G9891 | 0010 | 3 | 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) | Em session reporting |
| G9892 | 0010 | 3 | Documentation of patient reason(s) for not performing a dilated macular examination | Doc pt rsn no dil mac exam |
| G9893 | 0010 | 3 | Dilated macular exam was not performed, reason not otherwise specified | No mac exam |
| G9894 | 0010 | 3 | Androgen deprivation therapy prescribed/administered in combination with external beam radiotherapy to the prostate | Adr dep thrpy prescribed |
| G9895 | 0010 | 3 | 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) | Doc med rsn no adr dep thrpy |
| G9896 | 0010 | 3 | Documentation of patient reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate | Doc pt rsn no adr dep thrpy |
| G9897 | 0010 | 3 | Patients who were not prescribed/administered androgen deprivation therapy in combination with external beam radiotherapy to the prostate, reason not given | Pt nt prsc adr dep thrpy rng |
| G9898 | 0010 | 3 | Patient age 65 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 | Pt 66+ snp or ltc pos |
| G9899 | 0010 | 3 | Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results documented and reviewed | Scrn mam perf rslts doc |
| G9900 | 0010 | 3 | Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results were not documented and reviewed, reason not otherwise specified | Scrn mam perf rslts not doc |
| G9901 | 0010 | 3 | Patient age 65 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 | Pt 66+ snp or ltc pos |
| G9902 | 0010 | 3 | Patient screened for tobacco use and identified as a tobacco user | Pt scrn tbco and id as user |
| G9903 | 0010 | 3 | Patient screened for tobacco use and identified as a tobacco non-user | Pt scrn tbco id as non user |
| G9904 | 0010 | 3 | Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason) | Doc med rsn no tbco scrn |
| G9905 | 0010 | 3 | Patient not screened for tobacco use, reason not given | No pt tbco scrn rng |
| G9906 | 0010 | 3 | Patient identified as a tobacco user received tobacco cessation intervention (counseling and/or pharmacotherapy) | Pt recv tbco cess interv |
| G9907 | 0010 | 3 | Documentation of medical reason(s) for not providing tobacco cessation intervention (e.g., limited life expectancy, other medical reason) | Doc med rsn no tbco interv |
| G9908 | 0010 | 3 | Patient identified as tobacco user did not receive tobacco cessation intervention (counseling and/or pharmacotherapy), reason not given | No pt tbco cess interv rng |
| G9909 | 0010 | 3 | Documentation of medical reason(s) for not providing tobacco cessation intervention if identified as a tobacco user (eg, limited life expectancy, other medical reason) | Doc med rsn no tbco interv |
| G9910 | 0010 | 3 | 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 | Pt 66+ snp or ltc pos |
| G9911 | 0010 | 3 | Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer before or after neoadjuvant systemic therapy | Node neg pre/post syst ther |
| G9912 | 0010 | 3 | Hepatitis b virus (hbv) status assessed and results interpreted prior to initiating anti-tnf (tumor necrosis factor) therapy | Hbv status assesed and int |
| G9913 | 0010 | 3 | Hepatitis b virus (hbv) status not assessed and results interpreted prior to initiating anti-tnf (tumor necrosis factor) therapy, reason not given | No hbv status assesd and int |
| G9914 | 0010 | 3 | Patient receiving an anti-tnf agent | Pt receiving anti-tnf agent |
| G9915 | 0010 | 3 | No record of hbv results documented | No documntd hbv results rcd |
| G9916 | 0010 | 3 | Functional status performed once in the last 12 months | Funct status past 12 months |
| G9917 | 0010 | 3 | Documentation of advanced stage dementia and caregiver knowledge is limited | Adv dem crgvr limited |
| G9918 | 0010 | 3 | Functional status not performed, reason not otherwise specified | No funct stat perf, rsn nos |
| G9919 | 0010 | 3 | Screening performed and positive and provision of recommendations | Scrn nd pos nd prov of rec |
| G9920 | 0010 | 3 | Screening performed and negative | Scrning perf and negative |
| G9921 | 0010 | 3 | No screening performed, partial screening performed or positive screen without recommendations and reason is not given or otherwise specified | No or part scrn nd rng or os |
| G9922 | 0010 | 3 | Safety concerns screen provided and if positive then documented mitigation recommendations | Sfty cncrns scrn nd mit recs |
| G9923 | 0010 | 3 | Safety concerns screen provided and negative | Safty cncrns scrn and neg |
| G9924 | 0010 | 3 | 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) | Doc med rsn no scrn or recs |
| G9925 | 0010 | 3 | Safety concerns screening not provided, reason not otherwise specified | No scrn prov rsn nos |
| G9926 | 0010 | 3 | Safety concerns screening positive screen is without provision of mitigation recommendations, including but not limited to referral to other resources | Sfty cncrns scrn but no recs |
| G9927 | 0010 | 3 | Documentation of system reason(s) for not prescribing warfarin or another fda-approved anticoagulation due to patient being currently enrolled in a clinical trial related to af/atrial flutter treatment | Doc no warf /fda pt trial |
| G9928 | 0010 | 3 | Warfarin or another fda-approved anticoagulant not prescribed, reason not given | No warf or fda drug presc |
| G9929 | 0010 | 3 | Patient with transient or reversible cause of af (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac surgery) | Trs/rev af |
| G9930 | 0010 | 3 | Patients who are receiving comfort care only | Com care |
| G9931 | 0010 | 3 | Documentation of cha2ds2-vasc risk score of 0 or 1 | No chad or chad scr 0 or 1 |
| G9932 | 0010 | 3 | 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) | Doc pt rsn no tb scrn recrds |
| G9933 | 0010 | 3 | Adenoma(s) or colorectal cancer detected during screening colonoscopy | Canc detectd during col scrn |
| G9934 | 0010 | 3 | Documentation that neoplasm detected is only diagnosed as traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma | Doc rsn not detecting cancer |
| G9935 | 0010 | 3 | Adenoma(s) or colorectal cancer not detected during screening colonoscopy | Canc not detectd during srcn |
| G9936 | 0010 | 3 | Surveillance colonoscopy - personal history of colonic polyps, colon cancer, or other malignant neoplasm of rectum, rectosigmoid junction, and anus | Pmh plyp/neo co/rect/jun/ans |
| G9937 | 0010 | 3 | Diagnostic colonoscopy | Dig or surv colsco |
| G9938 | 0010 | 3 | 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 | Pt 66+ snp or ltc pos |
| G9939 | 0010 | 3 | Pathologists/dermatopathologists is the same clinician who performed the biopsy | Same path/derm perf biopsy |
| G9940 | 0010 | 3 | 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) | Doc reas no statin therapy |
| G9941 | 0010 | 3 | Back pain was measured by the visual analog scale (vas) within three months preoperatively and at three months (6 - 20 weeks) postoperatively | Pre and post vas wthn 3 mos |
| G9942 | 0010 | 3 | Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminectomy | Adtl spine proc on same date |
| G9943 | 0010 | 3 | Back pain was not measured by the visual analog scale (vas) within three months preoperatively and at three months ( 6 - 20 weeks) postoperatively | Bk pn nt msr vas scl pre/pst |
| G9944 | 0010 | 3 | Back pain was measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively | Vas 3 mon pre and 1 yr post |
| G9945 | 0010 | 3 | Patient had cancer, fracture or infection related to the lumbar spine or patient had idiopathic or congenital scoliosis | Pt w/cancer scoliosis |
| G9946 | 0010 | 3 | Back pain was not measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively | Bk pain no vas |
| G9947 | 0010 | 3 | Leg pain was measured by the visual analog scale (vas) within three months preoperatively and at three months (6 to 20 weeks) postoperatively | Pre and post vas wthn 3 mos |
| G9948 | 0010 | 3 | Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminectomy | Adtl spine proc on same date |
| G9949 | 0010 | 3 | Leg pain was not measured by the visual analog scale (vas) at three months (6 ? 20 weeks) postoperatively | Leg pain no vas |
| G9954 | 0010 | 3 | Patient exhibits 2 or more risk factors for post-operative vomiting | Pt >2 rsk fac post-op vomit |
| G9955 | 0010 | 3 | Cases in which an inhalational anesthetic is used only for induction | Inhlnt anesth only for induc |
| G9956 | 0010 | 3 | Patient received combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively | Combo thrpy of >= 2 prophly |
| G9957 | 0010 | 3 | 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) | Doc med rsn no combo thrpy |
| G9958 | 0010 | 3 | Patient did not receive combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively | No combo prohpyl thrp for pt |
| G9959 | 0010 | 3 | Systemic antimicrobials not prescribed | Systemic antimicro not presc |
| G9960 | 0010 | 3 | Documentation of medical reason(s) for prescribing systemic antimicrobials | Med rsn sys antimi nt rx |
| G9961 | 0010 | 3 | Systemic antimicrobials prescribed | Systemic antimicro presc |
| G9962 | 0010 | 3 | Embolization endpoints are documented separately for each embolized vessel and ovarian artery angiography or embolization performed in the presence of variant uterine artery anatomy | Embolization doc separatly |
| G9963 | 0010 | 3 | 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 | Embolization not doc separat |
| G9964 | 0010 | 3 | Patient received at least one well-child visit with a pcp during the performance period | Pt recv >=1 well-chld visit |
| G9965 | 0010 | 3 | Patient did not receive at least one well-child visit with a pcp during the performance period | No well-chld vist recv by pt |
| G9966 | 0010 | 3 | Children who were screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report | Scrn, inter, report child |
| G9967 | 0010 | 3 | Children who were not screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report | No scrn, inter, reprt child |
| G9968 | 0010 | 3 | Patient was referred to another provider or specialist during the performance period | Pt refrd 2 pvdr/spclst in pp |
| G9969 | 0010 | 3 | Provider who referred the patient to another provider received a report from the provider to whom the patient was referred | Pvdr rfrd pt rprt rcvd |
| G9970 | 0010 | 3 | Provider who referred the patient to another provider did not receive a report from the provider to whom the patient was referred | Pvdr rfrd pt no rprt rcvd |
| G9974 | 0010 | 3 | 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 | Mac exam perf |
| G9975 | 0010 | 3 | Documentation of medical reason(s) for not performing a dilated macular examination | Doc med rsn no dil mac exam |
| G9978 | 0010 | 3 | 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 | Remote e/m new pt 10mins |
| G9979 | 0010 | 3 | 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 | Remote e/m new pt 20mins |
| G9980 | 0010 | 3 | 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 | Remote e/m new pt 30 mins |
| G9981 | 0010 | 3 | 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 | Remote e/m new pt 45mins |
| G9982 | 0010 | 3 | 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 | Remote e/m new pt 60mins |
| G9983 | 0010 | 3 | 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 | Remote e/m est. pt 10mins |
| G9984 | 0010 | 3 | 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 | Remote e/m est. pt 15mins |
| G9985 | 0010 | 3 | 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 | Remote e/m est. pt 25mins |
| G9986 | 0010 | 3 | 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 | Remote e/m est. pt 40mins |
| G9987 | 0010 | 3 | 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 | Bpci advanced in home visit |
