HCPCS G Codes | Procedures / Professional Services (Temporary Codes)

Welcome to our in-depth guide on HCPCS G Codes, a vital aspect of medical billing and coding. These codes play a pivotal role in accurately documenting and reimbursing for essential medical services. In this guide, we delve into the specifics of HCPCS G Codes. Additionally we discover where these codes are applied and a list of HCPCS G-Codes with detailed descriptions for seamless navigation.

HCPCS G Codes

HCPCS G Codes

Procedures / Professional Services (Temporary Codes)

HCPCS G codes play a crucial role in the healthcare industry, particularly in the realm of procedures and professional services. These temporary G-codes are assigned to services and procedures that are under review before being included in the CPT coding-system. G-codes are essential for accurately documenting and billing for a wide range of medical services. In this guide, we delve into the intricacies of G-codes, their significance, and how they impact the healthcare reimbursement process.

HCPCS G Codes ListHCPCS G Codes Description
G0008Administration of influenza virus vaccine
G0009Administration of pneumococcal vaccine
G0010Administration of hepatitis b vaccine
G0011Individual counseling for pre-exposure prophylaxis (prep) by physician or qualified health care professional (qhp )to prevent human immunodeficiency virus (hiv), includes hiv risk assessment (initial or continued assessment of risk), hiv risk reduction and medication adherence, 15-30 minutes   New
G0012Injection of pre-exposure prophylaxis (prep) drug for hiv prevention, under skin or into muscle   New
G0013Individual counseling for pre-exposure prophylaxis (prep) by clinical staff to prevent human immunodeficiency virus (hiv), includes: hiv risk assessment (initial or continued assessment of risk), hiv risk reduction and medication adherence   NewHCPCS C Codes
Enteral and Parenteral Therapy
G0017Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); first 60 minutes   New
G0018Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); each additional 30 minutes (list separately in addition to code for primary service)   New
G0019Community health integration services performed by certified or trained auxiliary personnel, including a community health worker, under the direction of a physician or other practitioner; 60 minutes per calendar month, in the following activities to address social determinants of health (sdoh) need(s) that are significantly limiting the ability to diagnose or treat problem(s) addressed in an initiating visit: person-centered assessment, performed to better understand the individualized context of the intersection between the sdoh need(s) and the problem(s) addressed in the initiating visit. ++ conducting a person-centered assessment to understand patient’s life story, strengths, needs, goals, preferences and desired outcomes, including understanding cultural and linguistic factors and including unmet sdoh needs (that are not separately billed). ++ facilitating patient-driven goal-setting and establishing an action plan. ++ providing tailored support to the patient as needed to accomplish the practitioner’s treatment plan. practitioner, home-, and community-based care coordination. ++ coordinating receipt of needed services from healthcare practitioners, providers, and facilities; and from home- and community-based service providers, social service providers, and caregiver (if applicable). ++ communication with practitioners, home- and community-based service providers, hospitals, and skilled nursing facilities (or other health care facilities) regarding the patient’s psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors. ++ coordination of care transitions between and among health care practitioners and settings, including transitions involving referral to other clinicians; follow-up after an emergency department visit; or follow-up after discharges from hospitals, skilled nursing facilities or other health care facilities. ++ facilitating access to community-based social services (e.g., housing, utilities, transportation, food assistance) to address the sdoh need(s). health education- helping the patient contextualize health education provided by the patient’s treatment team with the patient’s individual needs, goals, and preferences, in the context of the sdoh need(s), and educating the patient on how to best participate in medical decision-making. building patient self-advocacy skills, so that the patient can interact with members of the health care team and related community-based services addressing the sdoh need(s), in ways that are more likely to promote personalized and effective diagnosis or treatment. health care access / health system navigation. ++ helping the patient access healthcare, including identifying appropriate practitioners or providers for clinical care and helping secure appointments with them. facilitating behavioral change as necessary for meeting diagnosis and treatment goals, including promoting patient motivation to participate in care and reach person-centered diagnosis or treatment goals. facilitating and providing social and emotional support to help the patient cope with the problem(s) addressed in the initiating visit, the sdoh need(s), and adjust daily routines to better meet diagnosis and treatment goals. leveraging lived experience when applicable to provide support, mentorship, or inspiration to meet treatment goals   New
G0022Community health integration services, each additional 30 minutes per calendar month (list separately in addition to g0019)   New
G0023Principal illness navigation services by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a patient navigator; 60 minutes per calendar month, in the following activities: person-centered assessment, performed to better understand the individual context of the serious, high-risk condition. ++ conducting a person-centered assessment to understand the patient’s life story, strengths, needs, goals, preferences, and desired outcomes, including understanding cultural and linguistic factors and including unmet sdoh needs (that are not separately billed). ++ facilitating patient-driven goal setting and establishing an action plan. ++ providing tailored support as needed to accomplish the practitioner’s treatment plan. identifying or referring patient (and caregiver or family, if applicable) to appropriate supportive services. practitioner, home, and community-based care coordination. ++ coordinating receipt of needed services from healthcare practitioners, providers, and facilities; home- and community-based service providers; and caregiver (if applicable). ++ communication with practitioners, home-, and community-based service providers, hospitals, and skilled nursing facilities (or other health care facilities) regarding the patient’s psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors. ++ coordination of care transitions between and among health care practitioners and settings, including transitions involving referral to other clinicians; follow-up after an emergency department visit; or follow-up after discharges from hospitals, skilled nursing facilities or other health care facilities. ++ facilitating access to community-based social services (e.g., housing, utilities, transportation, food assistance) as needed to address sdoh need(s). health education- helping the patient contextualize health education provided by the patient’s treatment team with the patient’s individual needs, goals, preferences, and sdoh need(s), and educating the patient (and caregiver if applicable) on how to best participate in medical decision-making. building patient self-advocacy skills, so that the patient can interact with members of the health care team and related community-based services (as needed), in ways that are more likely to promote personalized and effective treatment of their condition. health care access / health system navigation. ++ helping the patient access healthcare, including identifying appropriate practitioners or providers for clinical care, and helping secure appointments with them. ++ providing the patient with information/resources to consider participation in clinical trials or clinical research as applicable. facilitating behavioral change as necessary for meeting diagnosis and treatment goals, including promoting patient motivation to participate in care and reach person-centered diagnosis or treatment goals. facilitating and providing social and emotional support to help the patient cope with the condition, sdoh need(s), and adjust daily routines to better meet diagnosis and treatment goals. leverage knowledge of the serious, high-risk condition and/or lived experience when applicable to provide support, mentorship, or inspiration to meet treatment goals   New
G0024Principal illness navigation services, additional 30 minutes per calendar month (list separately in addition to g0023)   New
G0027Semen analysis; presence and/or motility of sperm excluding huhner
G0028Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)
G0029Tobacco screening not performed or tobacco cessation intervention not provided during the measurement period or in the six months prior to the measurement period
G0030Patient screened for tobacco use and received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling, pharmacotherapy, or both), if identified as a tobacco user
G0031Palliative care services given to patient any time during the measurement period
G0032Two or more antipsychotic prescriptions ordered for patients who had a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between january 1 of the year prior to the measurement period and the index prescription start date (ipsd) for antipsychotics
G0033Two or more benzodiazepine prescriptions ordered for patients who had a diagnosis of seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, or severe generalized anxiety disorder on or between january 1 of the year prior to the measurement period and the ipsd for benzodiazepines
G0034Patients receiving palliative care during the measurement period
G0035Patient has any emergency department encounter during the performance period with place of service indicator 23
G0036Patient or care partner decline assessment
G0037On date of encounter, patient is not able to participate in assessment or screening, including non-verbal patients, delirious, severely aphasic, severely developmentally delayed, severe visual or hearing impairment and for those patients, no knowledgeable informant available
G0038Clinician determines patient does not require referral
G0039Patient not referred, reason not otherwise specified
G0040Patient already receiving physical/occupational/speech/recreational therapy during the measurement period
G0041Patient and/or care partner decline referral
G0042Referral to physical, occupational, speech, or recreational therapy
G0043Patients with mechanical prosthetic heart valve
G0044Patients with moderate or severe mitral stenosis
G0045Clinical follow-up and mrs score assessed at 90 days following endovascular stroke intervention
G0046Clinical follow-up and mrs score not assessed at 90 days following endovascular stroke intervention
G0047Pediatric patient with minor blunt head trauma and pecarn prediction criteria are not assessed
G0048Patients who receive palliative care services any time during the intake period through the end of the measurement year
G0049With maintenance hemodialysis (in-center and home hd) for the complete reporting month
G0050Patients with a catheter that have limited life expectancy
G0051Patients under hospice care in the current reporting month
G0052Patients on peritoneal dialysis for any portion of the reporting month
G0053Advancing rheumatology patient care mips value pathways
G0054Coordinating stroke care to promote prevention and cultivate positive outcomes mips value pathways
G0055Advancing care for heart disease mips value pathways
G0056Optimizing chronic disease management mips value pathways   Discontinued
G0057Proposed adopting best practices and promoting patient safety within emergency medicine mips value pathways
G0058Improving care for lower extremity joint repair mips value pathways
G0059Patient safety and support of positive experiences with anesthesia mips value pathways
G0060Allergy/immunology mips specialty set
G0061Anesthesiology mips specialty set
G0062Audiology mips specialty set
G0063Cardiology mips specialty set
G0064Certified nurse midwife mips specialty set
G0065Chiropractic medicine mips specialty set
G0066Clinical social work mips specialty set
G0067Dentistry mips specialty set
G0068Professional services for the administration of anti-infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy or other highly complex drug or biological) for each infusion drug administration calendar day in the individual’s home, each 15 minutes
G0069Professional services for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual’s home, each 15 minutes
G0070Professional services for the administration of intravenous chemotherapy or other intravenous highly complex drug or biological infusion for each infusion drug administration calendar day in the individual’s home, each 15 minutes
G0071Payment 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
G0076Brief (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)
G0077Limited (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)
G0078Moderate (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)
G0079Comprehensive (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)
G0080Extensive (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)
G0081Brief (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)
G0082Limited (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)
G0083Moderate (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)
G0084Comprehensive (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)
G0085Extensive (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)
G0086Limited (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)
G0087Comprehensive (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)
G0088Professional services, initial visit, for the administration of anti-infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy or other highly complex drug or biological) for each infusion drug administration calendar day in the individual’s home, each 15 minutes
G0089Professional services, initial visit, for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual’s home, each 15 minutes
G0090Professional services, initial visit, for the administration of intravenous chemotherapy or other highly complex infusion drug or biological for each infusion drug administration calendar day in the individual’s home, each 15 minutes
G0101Cervical or vaginal cancer screening; pelvic and clinical breast examination
G0102Prostate cancer screening; digital rectal examination
G0103Prostate cancer screening; prostate specific antigen test (psa)
G0104Colorectal cancer screening; flexible sigmoidoscopy
G0105Colorectal cancer screening; colonoscopy on individual at high risk
G0106Colorectal cancer screening; alternative to g0104, screening sigmoidoscopy, barium enema
G0108Diabetes outpatient self-management training services, individual, per 30 minutes
G0109Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes
G0117Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist
G0118Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist
G0120Colorectal cancer screening; alternative to g0105, screening colonoscopy, barium enema.
G0121Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk
G0122Colorectal cancer screening; barium enema
G0123Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision
G0124Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician
G0127Trimming of dystrophic nails, any number
G0128Direct (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
G0129Occupational therapy services requiring the skills of a qualified occupational therapist, furnished as a component of a partial hospitalization or intensive outpatient treatment program, per session (45 minutes or more)
G0130Single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
G0136Administration of a standardized, evidence-based social determinants of health risk assessment tool, 5-15 minutes   New
G0137Intensive outpatient services; weekly bundle, minimum of 9 services over a 7 contiguous day period, which can include individual and group therapy with physicians or psychologists (or other mental health professionals to the extent authorized under state law); occupational therapy requiring the skills of a qualified occupational therapist; services of social workers, trained psychiatric nurses, and other staff trained to work with psychiatric patients; individualized activity therapies that are not primarily recreational or diversionary; family counseling (the primary purpose of which is treatment of the individual’s condition); patient training and education (to the extent that training and educational activities are closely and clearly related to individual’s care and treatment); diagnostic services; and such other items and services (excluding meals and transportation) that are reasonable and necessary for the diagnosis or active treatment of the individual’s condition, reasonably expected to improve or maintain the individual’s condition and functional level and to prevent relapse or hospitalization, and furnished pursuant to such guidelines relating to frequency and duration of services in accordance with a physician certification and plan of treatment (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure   New
G0140Principal illness navigation – peer support by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a certified peer specialist; 60 minutes per calendar month, in the following activities: person-centered interview, performed to better understand the individual context of the serious, high-risk condition. ++ conducting a person-centered interview to understand the patient’s life story, strengths, needs, goals, preferences, and desired outcomes, including understanding cultural and linguistic factors, and including unmet sdoh needs (that are not billed separately). ++ facilitating patient-driven goal setting and establishing an action plan. ++ providing tailored support as needed to accomplish the person-centered goals in the practitioner’s treatment plan. identifying or referring patient (and caregiver or family, if applicable) to appropriate supportive services. practitioner, home, and community-based care communication. ++ assist the patient in communicating with their practitioners, home-, and community-based service providers, hospitals, and skilled nursing facilities (or other health care facilities) regarding the patient’s psychosocial strengths and needs, goals, preferences, and desired outcomes, including cultural and linguistic factors. ++ facilitating access to community-based social services (e.g., housing, utilities, transportation, food assistance) as needed to address sdoh need(s). health education. helping the patient contextualize health education provided by the patient’s treatment team with the patient’s individual needs, goals, preferences, and sdoh need(s), and educating the patient (and caregiver if applicable) on how to best participate in medical decision-making. building patient self-advocacy skills, so that the patient can interact with members of the health care team and related community-based services (as needed), in ways that are more likely to promote personalized and effective treatment of their condition. developing and proposing strategies to help meet person-centered treatment goals and supporting the patient in using chosen strategies to reach person-centered treatment goals. facilitating and providing social and emotional support to help the patient cope with the condition, sdoh need(s), and adjust daily routines to better meet person-centered diagnosis and treatment goals. leverage knowledge of the serious, high-risk condition and/or lived experience when applicable to provide support, mentorship, or inspiration to meet treatment goals   New
G0141Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician
G0143Screening 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
G0144Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervision
G0145Screening 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
G0146Principal illness navigation – peer support, additional 30 minutes per calendar month (list separately in addition to g0140)   New
G0147Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision
G0148Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening
G0151Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes
G0152Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes
G0153Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
G0154Direct skilled nursing services of a licensed nurse (lpn or rn) in the home health or hospice setting, each 15 minutes
G0155Services of clinical social worker in home health or hospice settings, each 15 minutes
G0156Services of home health/hospice aide in home health or hospice settings, each 15 minutes
G0157Services performed by a qualified physical therapist assistant in the home health or hospice setting, each 15 minutes
G0158Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes
G0159Services 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
G0160Services 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
G0161Services 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
G0162Skilled 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)
G0163Skilled 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)
G0164Skilled 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
G0166External counterpulsation, per treatment session
G0168Wound closure utilizing tissue adhesive(s) only
G0173Linear accelerator based stereotactic radiosurgery, complete course of therapy in one session
G0175Scheduled interdisciplinary team conference (minimum of three exclusive of patient care nursing staff) with patient present
G0176Activity 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)
G0177Training and educational services related to the care and treatment of patient’s disabling mental health problems per session (45 minutes or more)
G0179Physician or allowed practitioner re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and allowed practitioners to affirm the initial implementation of the plan of care
G0180Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and allowed practitioners to affirm the initial implementation of the plan of care
G0181Physician or allowed practitioner supervision of a patient receiving medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician or allowed practitioner development and/or revision of care plans
G0182Physician 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
G0186Destruction of localized lesion of choroid (for example, choroidal neovascularization); photocoagulation, feeder vessel technique (one or more sessions)
G0202Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (cad) when performed
G0204Diagnostic mammography, including computer-aided detection (cad) when performed; bilateral
G0206Diagnostic mammography, including computer-aided detection (cad) when performed; unilateral
G0219Pet imaging whole body; melanoma for non-covered indications
G0235Pet imaging, any site, not otherwise specified
G0237Therapeutic procedures to increase strength or endurance of respiratory muscles, face to face, one on one, each 15 minutes (includes monitoring)
G0238Therapeutic procedures to improve respiratory function, other than described by g0237, one on one, face to face, per 15 minutes (includes monitoring)
G0239Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring)
G0245Initial 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
G0246Follow-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
G0247Routine 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
G0248Demonstration, 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
G0249Provision 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
G0250Physician 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
G0251Linear accelerator based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, maximum five sessions per course of treatment
G0252Pet 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)
G0255Current perception threshold/sensory nerve conduction test, (snct) per limb, any nerve
G0257Unscheduled or emergency dialysis treatment for an esrd patient in a hospital outpatient department that is not certified as an esrd facility
G0259Injection procedure for sacroiliac joint; arthrography
G0260Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography
G0268Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing
G0269Placement of occlusive device into either a venous or arterial access site, post surgical or interventional procedure (e.g., angioseal plug, vascular plug)
G0270Medical 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
G0271Medical 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
G0276Blinded procedure for lumbar stenosis, percutaneous image-guided lumbar decompression (pild) or placebo-control, performed in an approved coverage with evidence development (ced) clinical trial
G0277Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval
G0278Iliac 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)
G0279Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)
G0281Electrical 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
G0282Electrical stimulation, (unattended), to one or more areas, for wound care other than described in g0281
G0283Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care
G0288Reconstruction, computed tomographic angiography of aorta for surgical planning for vascular surgery
G0289Arthroscopy, 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
G0293Noncovered surgical procedure(s) using conscious sedation, regional, general or spinal anesthesia in a medicare qualifying clinical trial, per day
G0294Noncovered procedure(s) using either no anesthesia or local anesthesia only, in a medicare qualifying clinical trial, per day
G0295Electromagnetic therapy, to one or more areas, for wound care other than described in g0329 or for other uses
G0296Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making)
G0297Low dose ct scan (ldct) for lung cancer screening
G0299Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes
G0300Direct skilled nursing services of a licensed practical nurse (lpn) in the home health or hospice setting, each 15 minutes
G0302Pre-operative pulmonary surgery services for preparation for lvrs, complete course of services, to include a minimum of 16 days of services
G0303Pre-operative pulmonary surgery services for preparation for lvrs, 10 to 15 days of services
G0304Pre-operative pulmonary surgery services for preparation for lvrs, 1 to 9 days of services
G0305Post-discharge pulmonary surgery services after lvrs, minimum of 6 days of services
G0306Complete cbc, automated (hgb, hct, rbc, wbc, without platelet count) and automated wbc differential count
G0307Complete (cbc), automated (hgb, hct, rbc, wbc; without platelet count)
G0308Creation of subcutaneous pocket with insertion of 180 day implantable interstitial glucose sensor, including system activation and patient training
G0309Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and insertion of new 180 day implantable sensor, including system activation
G0310Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service, 5 to 15 mins time (this code is used for medicaid billing purposes)
G0311Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service, 16-30 mins time (this code is used for medicaid billing purposes)
G0312Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service for ages under 21, 5 to 15 mins time (this code is used for medicaid billing purposes)
G0313Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service for ages under 21, 16-30 mins time (this code is used for medicaid billing purposes)
G0314Immunization counseling by a physician or other qualified health care professional for covid-19, ages under 21, 16-30 mins time (this code is used for the medicaid early and periodic screening, diagnostic, and treatment benefit (epsdt)
G0315Immunization counseling by a physician or other qualified health care professional for covid-19, ages under 21, 5-15 mins time (this code is used for the medicaid early and periodic screening, diagnostic, and treatment benefit (epsdt)
G0316Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99223, 99233, and 99236 for hospital inpatient or observation care evaluation and management services). (do not report g0316 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99418, 99415, 99416). (do not report g0316 for any time unit less than 15 minutes)
G0317Prolonged nursing facility evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99306, 99310 for nursing facility evaluation and management services). (do not report g0317 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99418). (do not report g0317
G0318Prolonged home or residence evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99345, 99350 for home or residence evaluation and management services). (do not report g0318 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99417). (do not report g0318 for any time unit less than 15 minutes)
G0320Home health services furnished using synchronous telemedicine rendered via a real-time two-way audio and video telecommunications system
G0321Home health services furnished using synchronous telemedicine rendered via telephone or other real-time interactive audio-only telecommunications system
G0322The collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency (i.e., remote patient monitoring)
G0323Care management services for behavioral health conditions, at least 20 minutes of clinical psychologist, clinical social worker, mental health counselor, or marriage and family therapist time, per calendar month. (these services include the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales; behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes; facilitating and coordinating treatment such as psychotherapy, coordination with and/or referral to physicians and practitioners who are authorized by medicare to prescribe medications and furnish e/m services, counseling and/or psychiatric consultation; and continuity of care with a designated member of the care team)
G0327Colorectal cancer screening; blood-based biomarker
G0328Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous
G0329Electromagnetic 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
G0330Facility services for dental rehabilitation procedure(s) performed on a patient who requires monitored anesthesia (e.g., general, intravenous sedation (monitored anesthesia care) and use of an operating room
G0333Pharmacy dispensing fee for inhalation drug(s); initial 30-day supply as a beneficiary
G0337Hospice evaluation and counseling services, pre-election
G0339Image-guided robotic linear accelerator-based stereotactic radiosurgery, complete course of therapy in one session or first session of fractionated treatment
G0340Image-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
G0341Percutaneous islet cell transplant, includes portal vein catheterization and infusion
G0342Laparoscopy for islet cell transplant, includes portal vein catheterization and infusion
G0343Laparotomy for islet cell transplant, includes portal vein catheterization and infusion
G0364Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service
G0365Vessel 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)
G0372Physician service required to establish and document the need for a power mobility device
G0378Hospital observation service, per hour
G0379Direct admission of patient for hospital observation care
G0380Level 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)
G0381Level 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)
G0382Level 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)
G0383Level 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)
G0384Level 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)
G0389Ultrasound b-scan and/or real time with image documentation; for abdominal aortic aneurysm (aaa) screening
G0390Trauma response team associated with hospital critical care service
G0396Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes
G0397Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes
G0398Home 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
G0399Home 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
G0400Home sleep test (hst) with type iv portable monitor, unattended; minimum of 3 channels
G0402Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
G0403Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report
G0404Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination
G0405Electrocardiogram, routine ecg with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination
G0406Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth
G0407Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth
G0408Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth
G0409Social 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)
G0410Group psychotherapy other than of a multiple-family group, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes
G0411Interactive group psychotherapy, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes
G0412Open 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
G0413Percutaneous 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)
G0414Open 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)
G0415Open 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)
G0416Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method
G0417Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, 21-40 specimens
G0418Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, 41-60 specimens
G0419Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, >60 specimens
G0420Face-to-face educational services related to the care of chronic kidney disease; individual, per session, per one hour
G0421Face-to-face educational services related to the care of chronic kidney disease; group, per session, per one hour
G0422Intensive cardiac rehabilitation; with or without continuous ecg monitoring with exercise, per session
G0423Intensive cardiac rehabilitation; with or without continuous ecg monitoring; without exercise, per session
G0424Pulmonary rehabilitation, including exercise (includes monitoring), one hour, per session, up to two sessions per day
G0425Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth
G0426Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth
G0427Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth
G0428Collagen meniscus implant procedure for filling meniscal defects (e.g., cmi, collagen scaffold, menaflex)
G0429Dermal filler injection(s) for the treatment of facial lipodystrophy syndrome (lds) (e.g., as a result of highly active antiretroviral therapy)
G0431Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter
G0432Infectious agent antibody detection by enzyme immunoassay (eia) technique, hiv-1 and/or hiv-2, screening
G0433Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening
G0434Drug screen, other than chromatographic; any number of drug classes, by clia waived test or moderate complexity test, per patient encounter
G0435Infectious agent antibody detection by rapid antibody test, hiv-1 and/or hiv-2, screening
G0436Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes
G0437Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes
G0438Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
G0439Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
G0442Annual alcohol misuse screening, 5 to 15 minutes
G0443Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes
G0444Annual depression screening, 5 to 15 minutes
G0445High 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
G0446Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes
G0447Face-to-face behavioral counseling for obesity, 15 minutes
G0448Insertion 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
G0451Development testing, with interpretation and report, per standardized instrument form
G0452Molecular pathology procedure; physician interpretation and report
G0453Continuous 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)
G0454Physician documentation of face-to-face visit for durable medical equipment determination performed by nurse practitioner, physician assistant or clinical nurse specialist
G0455Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen
G0456Negative 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
G0457Negative 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
G0458Low dose rate (ldr) prostate brachytherapy services, composite rate
G0459Inpatient telehealth pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy
G0460Autologous platelet rich plasma or other blood-derived product for non-diabetic chronic wounds/ulcers, including as applicable phlebotomy, centrifugation or mixing, and all other preparatory procedures, administration and dressings, per treatment
G0461Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stain
G0462Immunohistochemistry or immunocytochemistry, per specimen; each additional single or multiplex antibody stain (list separately in addition to code for primary procedure)
G0463Hospital outpatient clinic visit for assessment and management of a patient
G0464Colorectal cancer screening; stool-based dna and fecal occult hemoglobin (e.g., kras, ndrg4 and bmp3)
G0465Autologous platelet rich plasma (prp) or other blood-derived product for diabetic chronic wounds/ulcers, using an fda-cleared device for this indication, (includes as applicable administration, dressings, phlebotomy, centrifugation or mixing, and all other preparatory procedures, per treatment)
G0466Federally 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
G0467Federally 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
G0468Federally 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
G0469Federally 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
G0470Federally 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
G0471Collection 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)
G0472Hepatitis c antibody screening, for individual at high risk and other covered indication(s)
G0473Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes
G0475Hiv antigen/antibody, combination assay, screening
G0476Infectious 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
G0477Drug 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
G0478Drug 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
G0479Drug 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
G0480Drug 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
G0481Drug 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
G0482Drug 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
G0483Drug 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
G0490Face-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)
G0491Dialysis procedure at a medicare certified esrd facility for acute kidney injury without esrd
G0492Dialysis procedure with single evaluation by a physician or other qualified health care professional for acute kidney injury without esrd
G0493Skilled 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)
G0494Skilled 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)
G0495Skilled 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
G0496Skilled 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
G0498Chemotherapy 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
G0499Hepatitis 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
G0500Moderate 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)
G0501Resource-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)
G0502Initial 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
G0503Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: tracking patient follow-up and progress using the registry, with appropriate documentation; participation in weekly caseload consultation with the psychiatric consultant; ongoing collaboration with and coordination of the patient’s mental health care with the treating physician or other qualified health care professional and any other treating mental health providers; additional review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations provided by the psychiatric consultant; provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies; monitoring of patient outcomes using validated rating scales; and relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharge from active treatment
G0504Initial 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)
G0505Cognition 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
G0506Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service)
G0507Care 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
G0508Telehealth consultation, critical care, initial, physicians typically spend 60 minutes communicating with the patient and providers via telehealth
G0509Telehealth consultation, critical care, subsequent, physicians typically spend 50 minutes communicating with the patient and providers via telehealth
G0511Rural 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
G0512Rural 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
G0513Prolonged 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)
G0514Prolonged 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)
G0515Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes
G0516Insertion of non-biodegradable drug delivery implants, 4 or more (services for subdermal rod implant)
G0517Removal of non-biodegradable drug delivery implants, 4 or more (services for subdermal implants)
G0518Removal with reinsertion, non-biodegradable drug delivery implants, 4 or more (services for subdermal implants)
G0659Drug 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
G0908Most recent hemoglobin (hgb) level > 12.0 g/dl
G0909Hemoglobin level measurement not documented, reason not given
G0910Most recent hemoglobin level <= 12.0 g/dl
G0913Improvement in visual function achieved within 90 days following cataract surgery
G0914Patient care survey was not completed by patient
G0915Improvement in visual function not achieved within 90 days following cataract surgery
G0916Satisfaction with care achieved within 90 days following cataract surgery
G0917Patient care survey was not completed by patient
G0918Satisfaction with care not achieved within 90 days following cataract surgery
G0919Influenza immunization ordered or recommended (to be given at alternate location or alternate provider); vaccine not available at time of visit
G0920Type, anatomic location, and activity all documented
G0921Documentation of patient reason(s) for not being able to assess (e.g., patient refuses endoscopic and/or radiologic assessment)
G0922No documentation of disease type, anatomic location, and activity, reason not given
G1000Clinical decision support mechanism applied pathways, as defined by the medicare appropriate use criteria program
G1001Clinical decision support mechanism evicore, as defined by the medicare appropriate use criteria program
G1002Clinical decision support mechanism medcurrent, as defined by the medicare appropriate use criteria program
G1003Clinical decision support mechanism medicalis, as defined by the medicare appropriate use criteria program
G1004Clinical decision support mechanism national decision support company, as defined by the medicare appropriate use criteria program
G1005Clinical decision support mechanism national imaging associates, as defined by the medicare appropriate use criteria program
G1006Clinical decision support mechanism test appropriate, as defined by the medicare appropriate use criteria program
G1007Clinical decision support mechanism aim specialty health, as defined by the medicare appropriate use criteria program
G1008Clinical decision support mechanism cranberry peak, as defined by the medicare appropriate use criteria program
G1009Clinical decision support mechanism sage health management solutions, as defined by the medicare appropriate use criteria program
G1010Clinical decision support mechanism stanson, as defined by the medicare appropriate use criteria program
G1011Clinical decision support mechanism, qualified tool not otherwise specified, as defined by the medicare appropriate use criteria program
G1012Clinical decision support mechanism agilemd, as defined by the medicare appropriate use criteria program
G1013Clinical decision support mechanism evidencecare imagingcare, as defined by the medicare appropriate use criteria program
G1014Clinical decision support mechanism inveniqa semantic answers in medicine, as defined by the medicare appropriate use criteria program
G1015Clinical decision support mechanism reliant medical group, as defined by the medicare appropriate use criteria program
G1016Clinical decision support mechanism speed of care, as defined by the medicare appropriate use criteria program
G1017Clinical decision support mechanism healthhelp, as defined by the medicare appropriate use criteria program
G1018Clinical decision support mechanism infinx, as defined by the medicare appropriate use criteria program
G1019Clinical decision support mechanism logicnets, as defined by the medicare appropriate use criteria program
G1020Clinical decision support mechanism curbside clinical augmented workflow, as defined by the medicare appropriate use criteria program
G1021Clinical decision support mechanism ehealthline clinical decision support mechanism, as defined by the medicare appropriate use criteria program
G1022Clinical decision support mechanism intermountain clinical decision support mechanism, as defined by the medicare appropriate use criteria program
G1023Clinical decision support mechanism persivia clinical decision support, as defined by the medicare appropriate use criteria program
G1024Clinical decision support mechanism radrite, as defined by the medicare appropriate use criteria program
G1025Patient-months where there are more than one medicare capitated payment (mcp) provider listed for the month
G1026The number of adult patient-months in the denominator who were on maintenance hemodialysis using a catheter continuously for three months or longer under the care of the same practitioner or group partner as of the last hemodialysis session of the reporting month
G1027The number of adult patient-months in the denominator who were on maintenance hemodialysis under the care of the same practitioner or group partner as of the last hemodialysis session of the reporting month using a catheter continuously for less than three months
G1028Take-home supply of nasal naloxone; 2-pack of 8mg per 0.1 ml nasal spray (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure
G2000Blinded 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
G2001Brief (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.)
G2002Limited (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.)
G2003Moderate (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.)
G2004Comprehensive (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.)
G2005Extensive (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.)
G2006Brief (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.)
G2007Limited (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.)
G2008Moderate (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.)
G2009Comprehensive (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.)
G2010Remote 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
G2011Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention, 5-14 minutes
G2012Brief 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
G2013Extensive (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.)
G2014Limited (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.)
G2015Comprehensive (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.)
G2020Services for high intensity clinical services associated with the initial engagement and outreach of beneficiaries assigned to the sip component of the pcf model (do not bill with chronic care management codes)
G2021Health care practitioners rendering treatment in place (tip)
G2022A model participant (ambulance supplier/provider), the beneficiary refuses services covered under the model (transport to an alternate destination/treatment in place)
G2023Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source
G2024Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) from an individual in a snf or by a laboratory on behalf of a hha, any specimen source
G2025Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only
G2058Chronic 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)).
G2061Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 5-10 minutes
G2062Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11-20 minutes
G2063Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes
G2064Comprehensive 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
G2065Comprehensive 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
G2066Interrogation 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   Discontinued
G2067Medication 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)
G2068Medication 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)
G2069Medication 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)
G2070Medication 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)
G2071Medication 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)
G2072Medication 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)
G2073Medication 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)
G2074Medication 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)
G2075Medication 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)
G2076Intake 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
G2077Periodic 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
G2078Take-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
G2079Take-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
G2080Each 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
G2081Patients age 66 and older in institutional special needs plans (snp) or residing in long-term care with a pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period
G2082Office 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
G2083Office 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
G2086Office-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
G2087Office-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
G2088Office-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)
G2089Most recent hemoglobin a1c (hba1c) level 7.0 to 9.0%
G2090Patients 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
G2091Patients 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
G2092Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) or angiotensin receptor-neprilysin inhibitor (arni) therapy prescribed or currently being taken
G2093Documentation 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)
G2094Documentation of patient reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., patient declined, other patient reasons)
G2095Documentation of system reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., other system reasons)
G2096Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) or angiotensin receptor-neprilysin inhibitor (arni) therapy was not prescribed, reason not given
G2097Episodes where the patient had a competing diagnosis on or within three days after the episode date (e.g., intestinal infection, pertussis, bacterial infection, lyme disease, otitis media, acute sinusitis, chronic sinusitis, infection of the adenoids, prostatitis, cellulitis, mastoiditis, or bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia/gonococcal infections, venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis or uti)
G2098Patients 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
G2099Patients 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
G2100Patients 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
G2101Patients 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
G2102Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed
G2103Seven standard field stereoscopic photos with interpretation by an ophthalmologist or optometrist documented and reviewed
G2104Eye imaging validated to match diagnosis from seven standard field stereoscopic photos results documented and reviewed
G2105Patient age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period
G2106Patients 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
G2107Patients 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
G2108Patient age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period   Discontinued
G2109Patients 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   Discontinued
G2110Patients 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   Discontinued
G2112Patient receiving <=5 mg daily prednisone (or equivalent), or ra activity is worsening, or glucocorticoid use is for less than 6 months
G2113Patient receiving >5 mg daily prednisone (or equivalent) for longer than 6 months, and improvement or no change in disease activity
G2114Patients 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
G2115Patients 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
G2116Patients 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
G2117Patients 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
G2118Patients 81 years of age and older with at least one claim/encounter for frailty during the measurement period
G2119Within the past 2 years, calcium and/or vitamin d optimization has been ordered or performed
G2120Within the past 2 years, calcium and/or vitamin d optimization has not been ordered or performed
G2121Depression, anxiety, apathy, and psychosis assessed
G2122Depression, anxiety, apathy, and psychosis not assessed
G2123Patients 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
G2124Patients 66-80 years of age and had at least one claim/encounter for frailty during the measurement period and a dispensed dementia medication
G2125Patients 81 years of age and older with at least one claim/encounter for frailty during the six months prior to the measurement period through december 31 of the measurement period
G2126Patients 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
G2127Patients 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
G2128Documentation 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)
G2129Procedure-related bp’s not taken during an outpatient visit. examples include same day surgery, ambulatory service center, g.i. lab, dialysis, infusion center, chemotherapy
G2130Patients 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
G2131Patients 81 years and older with a diagnosis of frailty
G2132Patients 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
G2133Patients 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
G2134Patients 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
G2135Patients 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
G2136Back pain measured by the visual analog scale (vas) or numeric pain scale at three months (6 – 20 weeks) postoperatively was less than or equal to 3.0 or back pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at three months (6 – 20 weeks) postoperatively demonstrated an improvement of 5.0 points or greater
G2137Back pain measured by the visual analog scale (vas) or numeric pain scale at three months (6 – 20 weeks) postoperatively was greater than 3.0 and back pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at three months (6 – 20 weeks) postoperatively demonstrated improvement of less than 5.0 points
G2138Back pain as measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively was less than or equal to 3.0 or back pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of 5.0 points or greater
G2139Back pain measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively was greater than 3.0 and back pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated improvement of less than 5.0 points
G2140Leg pain measured by the visual analog scale (vas) or numeric pain scale at three months (6 – 20 weeks) postoperatively was less than or equal to 3.0 or leg pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at three months (6 – 20 weeks) postoperatively demonstrated an improvement of 5.0 points or greater
G2141Leg pain measured by the visual analog scale (vas) or numeric pain scale at three months (6 – 20 weeks) postoperatively was greater than 3.0 and leg pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at three months (6 – 20 weeks) postoperatively demonstrated improvement of less than 5.0 points
G2142Functional status measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively was less than or equal to 22 or functional status measured by the odi version 2.1a within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of 30 points or greater
G2143Functional status measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively was greater than 22 and functional status measured by the odi version 2.1a within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of less than 30 points
G2144Functional status measured by the oswestry disability index (odi version 2.1a) at three months (6-20 weeks) postoperatively was less than or equal to 22 or functional status measured by the odi version 2.1a within three months preoperatively and at three months (6-20 weeks) postoperatively demonstrated an improvement of 30 points or greater
G2145Functional status measured by the oswestry disability index (odi version 2.1a) at three months (6 – 20 weeks) postoperatively was greater than 22 and functional status measured by the odi version 2.1a within three months preoperatively and at three months (6 – 20 weeks) postoperatively demonstrated an improvement of less than 30 points
G2146Leg pain as measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively was less than or equal to 3.0 or leg pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of 5.0 points or greater
G2147Leg pain measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively was greater than 3.0 and leg pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated improvement of less than 5.0 points
G2148Multimodal pain management was used
G2149Documentation 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))
G2150Multimodal pain management was not used
G2151Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson’s diagnosed at any time before or during the episode of care
G2152Residual score for the neck impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
G2153In hospice or using hospice services during the measurement period
G2154Patient 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
G2155Patient 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.)
G2156Patient 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.)
G2157Patients 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
G2158Patient had prior pneumococcal vaccine adverse reaction any time during or before the measurement period
G2159Patient 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
G2160Patient 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
G2161Patient had prior adverse reaction caused by zoster vaccine or its components any time during or before the measurement period
G2162Patient 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
G2163Patient received an influenza vaccine on or between july 1 of the year prior to the measurement period and june 30 of the measurement period
G2164Patient had a prior influenza virus vaccine adverse reaction any time before or during the measurement period
G2165Patient 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
G2166Patient 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
G2167Residual score for the neck impairment successfully calculated and the score was less than zero (< 0)
G2168Services performed by a physical therapist assistant in the home health setting in the delivery of a safe and effective physical therapy maintenance program, each 15 minutes
G2169Services performed by an occupational therapist assistant in the home health setting in the delivery of a safe and effective occupational therapy maintenance program, each 15 minutes
G2170Percutaneous arteriovenous fistula creation (avf), direct, any site, by tissue approximation using thermal resistance energy, and secondary procedures to redirect blood flow (e.g., transluminal balloon angioplasty, coil embolization) when performed, and includes all imaging and radiologic guidance, supervision and interpretation, when performed
G2171Percutaneous arteriovenous fistula creation (avf), direct, any site, using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, wen performed) and fistulogram(s), angiography, enography, and/or ultrasound, with radiologic supervision and interpretation, when performed
G2172All inclusive payment for services related to highly coordinated and integrated opioid use disorder (oud) treatment services furnished for the demonstration project
G2173Uri episodes where the patient had a comorbid condition during the 12 months prior to or on the episode date (e.g., tuberculosis, neutropenia, cystic fibrosis, chronic bronchitis, pulmonary edema, respiratory failure, rheumatoid lung disease)
G2174Uri episodes where the patient is taking antibiotics (table 1) in the 30 days prior to the episode date
G2175Episodes where the patient had a comorbid condition during the 12 months prior to or on the episode date (e.g., tuberculosis, neutropenia, cystic fibrosis, chronic bronchitis, pulmonary edema, respiratory failure, rheumatoid lung disease)
G2176Outpatient, ed, or observation visits that result in an inpatient admission
G2177Acute bronchitis/bronchiolitis episodes when the patient had a new or refill prescription of antibiotics (table 1) in the 30 days prior to the episode date
G2178Clinician documented that patient was not an eligible candidate for lower extremity neurological exam measure, for example patient bilateral amputee; patient has condition that would not allow them to accurately respond to a neurological exam (dementia, alzheimer’s, etc.); patient has previously documented diabetic peripheral neuropathy with loss of protective sensation
G2179Clinician documented that patient had medical reason for not performing lower extremity neurological exam
G2180Clinician documented that patient was not an eligible candidate for evaluation of footwear as patient is bilateral lower extremity amputee
G2181Bmi not documented due to medical reason or patient refusal of height or weight measurement
G2182Patient receiving first-time biologic and/or immune response modifier therapy
G2183Documentation patient unable to communicate and informant not available
G2184Patient does not have a caregiver
G2185Documentation caregiver is trained and certified in dementia care
G2186Patient /caregiver dyad has been referred to appropriate resources and connection to those resources is confirmed
G2187Patients with clinical indications for imaging of the head: head trauma
G2188Patients with clinical indications for imaging of the head: new or change in headache above 50 years of age
G2189Patients with clinical indications for imaging of the head: abnormal neurologic exam
G2190Patients with clinical indications for imaging of the head: headache radiating to the neck
G2191Patients with clinical indications for imaging of the head: positional headaches
G2192Patients with clinical indications for imaging of the head: temporal headaches in patients over 55 years of age
G2193Patients with clinical indications for imaging of the head: new onset headache in pre-school children or younger (<6 years of age)
G2194Patients with clinical indications for imaging of the head: new onset headache in pediatric patients with disabilities for which headache is a concern as inferred from behavior
G2195Patients with clinical indications for imaging of the head: occipital headache in children
G2196Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method
G2197Patient screened for unhealthy alcohol use using a systematic screening method and not identified as an unhealthy alcohol user
G2198Documentation of medical reason(s) for not screening for unhealthy alcohol use using a systematic screening method (e.g., limited life expectancy, other medical reasons)
G2199Patient not screened for unhealthy alcohol use using a systematic screening method
G2200Patient identified as an unhealthy alcohol user received brief counseling
G2201Documentation of medical reason(s) for not providing brief counseling (e.g., limited life expectancy, other medical reasons)
G2202Patient did not receive brief counseling if identified as an unhealthy alcohol user
G2203Documentation of medical reason(s) for not providing brief counseling if identified as an unhealthy alcohol user (e.g., limited life expectancy, other medical reasons)
G2204Patients between 45 and 85 years of age who received a screening colonoscopy during the performance period
G2205Patients with pregnancy during adjuvant treatment course
G2206Patient received adjuvant treatment course including both chemotherapy and her2-targeted therapy
G2207Reason for not administering adjuvant treatment course including both chemotherapy and her2-targeted therapy (e.g. poor performance status (ecog 3-4; karnofsky <=50), cardiac contraindications, insufficient renal function, insufficient hepatic function, other active or secondary cancer diagnoses, other medical contraindications, patients who died during initial treatment course or transferred during or after initial treatment course)
G2208Patient did not receive adjuvant treatment course including both chemotherapy and her2-targeted therapy
G2209Patient refused to participate
G2210Residual score for the neck impairment not measured because the patient did not complete the neck fs prom at initial evaluation and/or near discharge, reason not given
G2211Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient’s single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established)
G2212for office or other outpatient evaluation and management services) (do not report g2212 on the same date of service as 99358, 99359, 99415, 99416). (do not report g2212 for any time unit less than 15 minutes)
G2213Initiation of medication for the treatment of opioid use disorder in the emergency department setting, including assessment, referral to ongoing care, and arranging access to supportive services (list separately in addition to code for primary procedure)
G2214Initial or subsequent psychiatric collaborative care management, first 30 minutes in a month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional
G2215Take-home supply of nasal naloxone; 2-pack of 4mg per 0.1 ml nasal spray (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure
G2216Take-home supply of injectable naloxone (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure
G2250Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment
G2251Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of clinical discussion
G2252Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion
G3001Administration and supply of tositumomab, 450 mg
G3002Chronic pain management and treatment, monthly bundle including, diagnosis; assessment and monitoring; administration of a validated pain rating scale or tool; the development, implementation, revision, and/or maintenance of a person-centered care plan that includes strengths, goals, clinical needs, and desired outcomes; overall treatment management; facilitation and coordination of any necessary behavioral health treatment; medication management; pain and health literacy counseling; any necessary chronic pain related crisis care; and ongoing communication and care coordination between relevant practitioners furnishing care, e.g. physical therapy and occupational therapy, complementary and integrative approaches, and community-based care, as appropriate. required initial face-to-face visit at least 30 minutes provided by a physician or other qualified health professional; first 30 minutes personally provided by physician or other qualified health care professional, per calendar month. (when using g3002, 30 minutes must be met or exceeded.)
G3003Each additional 15 minutes of chronic pain management and treatment by a physician or other qualified health care professional, per calendar month. (list separately in addition to code for g3002. when using g3003, 15 minutes must be met or exceeded.)
G4000Dermatology mips specialty set
G4001Diagnostic radiology mips specialty set
G4002Electrophysiology cardiac specialist mips specialty set
G4003Emergency medicine mips specialty set
G4004Endocrinology mips specialty set
G4005Family medicine mips specialty set
G4006Gastro-enterology mips specialty set
G4007General surgery mips specialty set
G4008Geriatrics mips specialty set
G4009Hospitalists mips specialty set
G4010Infectious disease mips specialty set
G4011Internal medicine mips specialty set
G4012Interventional radiology mips specialty set
G4013Mental/behavioral and psychiatry mips specialty set
G4014Nephrology mips specialty set
G4015Neurology mips specialty set
G4016Neurosurgical mips specialty set
G4017Nutrition/dietician mips specialty set
G4018Obstetrics/gynecology mips specialty set
G4019Oncology/hematology mips specialty set
G4020Ophthalmology/optometry mips specialty set
G4021Orthopedic surgery mips specialty set
G4022Otolaryngology mips specialty set
G4023Pathology mips specialty set
G4024Pediatrics mips specialty set
G4025Physical medicine mips specialty set
G4026Physical therapy/occupational therapy mips specialty set
G4027Plastic surgery mips specialty set
G4028Podiatry mips specialty set
G4029Preventive medicine mips specialty set
G4030Pulmonology mips specialty set
G4031Radiation oncology mips specialty set
G4032Rheumatology mips specialty set
G4033Skilled nursing facility mips specialty set
G4034Speech language pathology mips specialty set
G4035Thoracic surgery mips specialty set
G4036Urgent care mips specialty set
G4037Urology mips specialty set
G4038Vascular surgery mips specialty set
G6001Ultrasonic guidance for placement of radiation therapy fields
G6002Stereoscopic x-ray guidance for localization of target volume for the delivery of radiation therapy
G6003Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: up to 5 mev
G6004Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: 6-10 mev
G6005Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: 11-19 mev
G6006Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: 20 mev or greater
G6007Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: up to 5 mev
G6008Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 6-10 mev
G6009Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 11-19 mev
G6010Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 20 mev or greater
G6011Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; up to 5 mev
G6012Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 6-10 mev
G6013Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 11-19 mev
G6014Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 20 mev or greater
G6015Intensity modulated treatment delivery, single or multiple fields/arcs,via narrow spatially and temporally modulated beams, binary, dynamic mlc, per treatment session
G6016Compensator-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
G6017Intra-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
G6018Ileoscopy, through stoma; with transendoscopic stent placement (includes predilation)
G6019Colonoscopy 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
G6020Colonoscopy through stoma; with transendoscopic stent placement (includes predilation)
G6021Unlisted procedure, intestine
G6022Sigmoidoscopy, 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
G6023Sigmoidoscopy, flexible; with transendoscopic stent placement (includes predilation)
G6024Colonoscopy, 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
G6025Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic stent placement (includes predilation)
G6027Anoscopy, high resolution (hra) (with magnification and chemical agent enhancement); diagnostic, including collection of specimen(s) by brushing or washing when performed
G6028Anoscopy, high resolution (hra) (with magnification and chemical agent enhancement); with biopsy(ies)
G6030Amitriptyline
G6031Benzodiazepines
G6032Desipramine
G6034Doxepin
G6035Gold
G6036Assay of imipramine
G6037Nortriptyline
G6038Salicylate
G6039Acetaminophen
G6040Alcohol (ethanol); any specimen except breath
G6041Alkaloids, urine, quantitative
G6042Amphetamine or methamphetamine
G6043Barbiturates, not elsewhere specified
G6044Cocaine or metabolite
G6045Dihydrocodeinone
G6046Dihydromorphinone
G6047Dihydrotestosterone
G6048Dimethadione
G6049Epiandrosterone
G6050Ethchlorvynol
G6051Flurazepam
G6052Meprobamate
G6053Methadone
G6054Methsuximide
G6055Nicotine
G6056Opiate(s), drug and metabolites, each procedure
G6057Phenothiazine
G6058Drug confirmation, each procedure
G8126Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phase
G8127Patient with a diagnosis of major depression not documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phase
G8128Clinician documented that patient was not an eligible candidate for antidepressant medication during the entire 12 week acute treatment phase measure
G8395Left ventricular ejection fraction (lvef) >= 40% or documentation as normal or mildly depressed left ventricular systolic function
G8396Left ventricular ejection fraction (lvef) not performed or documented
G8397Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema and level of severity of retinopathy
G8398Dilated macular or fundus exam not performed
G8399Patient with documented results of a central dual-energy x-ray absorptiometry (dxa) ever being performed
G8400Patient with central dual-energy x-ray absorptiometry (dxa) results not documented, reason not given
G8401Clinician documented that patient was not an eligible candidate for screening
G8404Lower extremity neurological exam performed and documented
G8405Lower extremity neurological exam not performed
G8406Clinician documented that patient was not an eligible candidate for lower extremity neurological exam measure
G8410Footwear evaluation performed and documented
G8415Footwear evaluation was not performed
G8416Clinician documented that patient was not an eligible candidate for footwear evaluation measure
G8417Bmi is documented above normal parameters and a follow-up plan is documented
G8418Bmi is documented below normal parameters and a follow-up plan is documented
G8419Bmi documented outside normal parameters, no follow-up plan documented, no reason given
G8420Bmi is documented within normal parameters and no follow-up plan is required
G8421Bmi not documented and no reason is given
G8422Bmi not documented, documentation the patient is not eligible for bmi calculation
G8427Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient’s current medications
G8428Current list of medications not documented as obtained, updated, or reviewed by the eligible clinician, reason not given
G8430Documentation of a medical reason(s) for not documenting, updating, or reviewing the patient’s current medications list (e.g., patient is in an urgent or emergent medical situation)
G8431Screening for depression is documented as being positive and a follow-up plan is documented
G8432Depression screening not documented, reason not given
G8433Screening for depression not completed, documented patient or medical reason
G8442Pain 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
G8450Beta-blocker therapy prescribed
G8451Beta-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)
G8452Beta-blocker therapy not prescribed
G8458Clinician 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)
G8460Clinician documented that patient is not an eligible candidate for quantitative rna testing at week 12; patient not receiving antiviral treatment for hepatitis c
G8461Patient receiving antiviral treatment for hepatitis c during the measurement period
G8464Clinician 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
G8465High or very high risk of recurrence of prostate cancer
G8473Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy prescribed
G8474Angiotensin 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)
G8475Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy not prescribed, reason not given
G8476Most recent blood pressure has a systolic measurement of < 140 mmhg and a diastolic measurement of < 90 mmhg
G8477Most recent blood pressure has a systolic measurement of >= 140 mmhg and/or a diastolic measurement of >= 90 mmhg
G8478Blood pressure measurement not performed or documented, reason not given
G8482Influenza immunization administered or previously received
G8483Influenza 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)
G8484Influenza immunization was not administered, reason not given
G8485I intend to report the diabetes mellitus (dm) measures group
G8486I intend to report the preventive care measures group
G8487I intend to report the chronic kidney disease (ckd) measures group
G8489I intend to report the coronary artery disease (cad) measures group
G8490I intend to report the rheumatoid arthritis (ra) measures group
G8491I intend to report the hiv/aids measures group
G8492I intend to report the perioperative care measures group
G8493I intend to report the back pain measures group
G8494All quality actions for the applicable measures in the diabetes mellitus (dm) measures group have been performed for this patient
G8495All quality actions for the applicable measures in the chronic kidney disease (ckd) measures group have been performed for this patient
G8496All quality actions for the applicable measures in the preventive care measures group have been performed for this patient
G8497All quality actions for the applicable measures in the coronary artery bypass graft (cabg) measures group have been performed for this patient
G8498All quality actions for the applicable measures in the coronary artery disease (cad) measures group have been performed for this patient
G8499All quality actions for the applicable measures in the rheumatoid arthritis (ra) measures group have been performed for this patient
G8500All quality actions for the applicable measures in the hiv/aids measures group have been performed for this patient
G8501All quality actions for the applicable measures in the perioperative care measures group have been performed for this patient
G8502All quality actions for the applicable measures in the back pain measures group have been performed for this patient
G8506Patient receiving angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy   Discontinued
G8509Pain assessment documented as positive using a standardized tool, follow-up plan not documented, reason not given
G8510Screening for depression is documented as negative, a follow-up plan is not required
G8511Screening for depression documented as positive, follow-up plan not documented, reason not given
G8530Autogenous av fistula received
G8531Clinician documented that patient was not an eligible candidate for autogenous av fistula
G8532Clinician documented that patient received vascular access other than autogenous av fistula, reason not given
G8535Elder maltreatment screen not documented; documentation that patient is not eligible for the elder maltreatment screen at the time of the encounter related to one of the following reasons: (1) patient refuses to participate in the screening and has reasonable decisional capacity for self-protection, or (2) patient is in an urgent or emergent situation where time is of the essence and to delay treatment to perform the screening would jeopardize the patient’s health status
G8536No documentation of an elder maltreatment screen, reason not given
G8539Functional outcome assessment documented as positive using a standardized tool and a care plan based on identified deficiencies is documented within two days of the functional outcome assessment
G8540Functional 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
G8541Functional outcome assessment using a standardized tool not documented, reason not given
G8542Functional outcome assessment using a standardized tool is documented; no functional deficiencies identified, care plan not required
G8543Documentation of a positive functional outcome assessment using a standardized tool; care plan not documented within two days of assessment, reason not given
G8544I intend to report the coronary artery bypass graft (cabg) measures group
G8545I intend to report the hepatitis c measures group
G8547I intend to report the ischemic vascular disease (ivd) measures group
G8548I intend to report the heart failure (hf) measures group
G8549All quality actions for the applicable measures in the hepatitis c measures group have been performed for this patient
G8551All quality actions for the applicable measures in the heart failure (hf) measures group have been performed for this patient
G8552All quality actions for the applicable measures in the ischemic vascular disease (ivd) measures group have been performed for this patient
G8559Patient referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation
G8560Patient has a history of active drainage from the ear within the previous 90 days
G8561Patient is not eligible for the referral for otologic evaluation for patients with a history of active drainage measure
G8562Patient does not have a history of active drainage from the ear within the previous 90 days
G8563Patient not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not given
G8564Patient was referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not specified)
G8565Verification and documentation of sudden or rapidly progressive hearing loss
G8566Patient is not eligible for the “referral for otologic evaluation for sudden or rapidly progressive hearing loss” measure
G8567Patient does not have verification and documentation of sudden or rapidly progressive hearing loss
G8568Patient was not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not given
G8569Prolonged postoperative intubation (> 24 hrs) required
G8570Prolonged postoperative intubation (> 24 hrs) not required
G8571Development of deep sternal wound infection/mediastinitis within 30 days postoperatively
G8572No deep sternal wound infection/mediastinitis
G8573Stroke following isolated cabg surgery
G8574No stroke following isolated cabg surgery
G8575Developed postoperative renal failure or required dialysis
G8576No postoperative renal failure/dialysis not required
G8577Re-exploration required due to mediastinal bleeding with or without tamponade, graft occlusion, valve dysfunction or other cardiac reason
G8578Re-exploration not required due to mediastinal bleeding with or without tamponade, graft occlusion, valve dysfunction or other cardiac reason
G8579Antiplatelet medication at discharge
G8580Antiplatelet medication contraindicated
G8581No antiplatelet medication at discharge
G8582Beta-blocker at discharge
G8583Beta-blocker contraindicated
G8584No beta-blocker at discharge
G8585Anti-lipid treatment at discharge
G8586Anti-lipid treatment contraindicated
G8587No anti-lipid treatment at discharge
G8593Lipid profile results documented and reviewed (must include total cholesterol, hdl-c, triglycerides and calculated ldl-c)
G8594Lipid profile not performed, reason not given
G8595Most recent ldl-c < 100 mg/dl
G8597Most recent ldl-c >= 100 mg/dl
G8598Aspirin or another antiplatelet therapy used
G8599Aspirin or another antiplatelet therapy not used, reason not given
G8600Iv thrombolytic therapy initiated within 4.5 hours (<= 270 minutes) of time last known well
G8601Iv thrombolytic therapy not initiated within 4.5 hours (<= 270 minutes) of time last known well for reasons documented by clinician (e.g. patient enrolled in clinical trial for stroke, patient admitted for elective carotid intervention)
G8602Iv thrombolytic therapy not initiated within 4.5 hours (<= 270 minutes) of time last known well, reason not given
G8627Surgical 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)
G8628Surgical 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)
G8629Documentation 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)
G8630Documentation 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
G8631Clinician 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)
G8632Prophylactic 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
G8633Pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed
G8634Clinician documented patient not an eligible candidate to receive pharmacologic therapy for osteoporosis
G8635Pharmacologic therapy for osteoporosis was not prescribed, reason not given
G8645I intend to report the asthma measures group
G8646All quality actions for the applicable measures in the asthma measures group have been performed for this patient
G8647Residual score for the knee impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
G8648Residual score for the knee impairment successfully calculated and the score was less than zero (< 0)
G8649Risk-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
G8650Residual score for the knee impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given
G8651Residual score for the hip impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
G8652Residual score for the hip impairment successfully calculated and the score was less than zero (< 0)
G8653Risk-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
G8654Residual score for the hip impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given
G8655Residual score for the lower leg, foot or ankle impairment successfully calculated and the score was equal to zero (0) or greater than zero ( > 0)
G8656Residual score for the lower leg, foot or ankle impairment successfully calculated and the score was less than zero (< 0)
G8657Risk-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
G8658Residual score for the lower leg, foot or ankle impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given
G8659Residual score for the low back impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
G8660Residual score for the low back impairment successfully calculated and the score was less than zero (< 0)
G8661Risk-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
G8662Residual 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
G8663Residual score for the shoulder impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
G8664Residual score for the shoulder impairment successfully calculated and the score was less than zero (< 0)
G8665Risk-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
G8666Residual 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
G8667Residual score for the elbow, wrist or hand impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
G8668Residual score for the elbow, wrist or hand impairment successfully calculated and the score was less than zero (< 0)
G8669Risk-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
G8670Residual 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
G8671Risk-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)
G8672Risk-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)
G8673Risk-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
G8674Risk-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
G8682Lvf testing documented as being performed prior to discharge or in the previous 12 months
G8683Lvf testing not performed prior to discharge or in the previous 12 months for a medical or patient documented reason
G8685Lvf testing not documented as being performed prior to discharge or in the previous 12 months, reason not given
G8694Left ventricular ejection fraction (lvef) < = 40% or documentation of moderate or severe lvsd
G8696Antithrombotic therapy prescribed at discharge
G8697Antithrombotic 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))
G8698Antithrombotic therapy was not prescribed at discharge, reason not given
G8699Rehabilitation services (occupational, physical or speech) ordered at or prior to discharge
G8700Rehabilitation services (occupational, physical or speech) not indicated at or prior to discharge
G8701Rehabilitation services were not ordered, reason not otherwise specified
G8702Documentation that prophylactic antibiotics were given within 4 hours prior to surgical incision or intraoperatively
G8703Documentation that prophylactic antibiotics were neither given within 4 hours prior to surgical incision nor intraoperatively
G870412-lead electrocardiogram (ecg) performed
G8705Documentation of medical reason(s) for not performing a 12-lead electrocardiogram (ecg)
G8706Documentation of patient reason(s) for not performing a 12-lead electrocardiogram (ecg)
G870712-lead electrocardiogram (ecg) not performed, reason not given
G8708Patient not prescribed antibiotic
G8709Uri episodes when the patient had competing diagnoses on or three days after the episode date (e.g., intestinal infection, pertussis, bacterial infection, lyme disease, otitis media, acute sinusitis, acute pharyngitis, acute tonsillitis, chronic sinusitis, infection of the pharynx/larynx/tonsils/adenoids, prostatitis, cellulitis, mastoiditis, or bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia/gonococcal infections, venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis or uti, and acne)
G8710Patient prescribed antibiotic
G8711Prescribed antibiotic on or within 3 days after the episode date
G8712Antibiotic not prescribed or dispensed
G8713Spkt/v greater than or equal to 1.2 (single-pool clearance of urea [kt] / volume [v])
G8714Hemodialysis treatment performed exactly three times per week for > 90 days
G8717Spkt/v less than 1.2 (single-pool clearance of urea [kt] / volume [v]), reason not given
G8718Total kt/v greater than or equal to 1.7 per week (total clearance of urea [kt] / volume [v])
G8720Total kt/v less than 1.7 per week (total clearance of urea [kt] / volume [v])
G8721Pt category (primary tumor), pn category (regional lymph nodes), and histologic grade were documented in pathology report
G8722Documentation 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)
G8723Specimen site is other than anatomic location of primary tumor
G8724Pt category, pn category and histologic grade were not documented in the pathology report, reason not given
G8725Fasting lipid profile performed (triglycerides, ldl-c, hdl-c and total cholesterol)
G8726Clinician has documented reason for not performing fasting lipid profile (e.g., patient declined, other patient reasons)
G8728Fasting lipid profile not performed, reason not given
G8730Pain assessment documented as positive using a standardized tool and a follow-up plan is documented
G8731Pain assessment using a standardized tool is documented as negative, no follow-up plan required
G8732No documentation of pain assessment, reason not given
G8733Elder maltreatment screen documented as positive and a follow-up plan is documented
G8734Elder maltreatment screen documented as negative, follow-up is not required
G8735Elder maltreatment screen documented as positive, follow-up plan not documented, reason not given
G8736Most current ldl-c <100mg/dl
G8737Most current ldl-c >=100mg/dl
G8738Left ventricular ejection fraction (lvef) < 40% or documentation of severely or moderately depressed left ventricular systolic function
G8739Left ventricular ejection fraction (lvef) >= 40% or documentation as normal or mildly depressed left ventricular systolic function
G8740Left ventricular ejection fraction (lvef) not performed or assessed, reason not given
G8749Absence 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)
G8751Smoking status and exposure to second hand smoke in the home not assessed, reason not given
G8752Most recent systolic blood pressure < 140 mmhg
G8753Most recent systolic blood pressure >= 140 mmhg
G8754Most recent diastolic blood pressure < 90 mmhg
G8755Most recent diastolic blood pressure >= 90 mmhg
G8756No documentation of blood pressure measurement, reason not given
G8757All quality actions for the applicable measures in the chronic obstructive pulmonary disease (copd) measures group have been performed for this patient
G8758All quality actions for the applicable measures in the inflammatory bowel disease (ibd) measures group have been performed for this patient
G8759All quality actions for the applicable measures in the sleep apnea measures group have been performed for this patient
G8761All quality actions for the applicable measures in the dementia measures group have been performed for this patient
G8762All quality actions for the applicable measures in the parkinson’s disease measures group have been performed for this patient
G8763All quality actions for the applicable measures in the hypertension (htn) measures group have been performed for this patient
G8764All quality actions for the applicable measures in the cardiovascular prevention measures group have bee performed for this patient
G8765All quality actions for the applicable measures in the cataract measures group have been performed for this patient
G8767Lipid panel results documented and reviewed (must include total cholesterol, hdl-c, triglycerides and calculated ldl-c)
G8768Documentation 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)
G8769Lipid profile not performed, reason not given
G8770Urine protein test result documented and reviewed
G8771Documentation of diagnosis of chronic kidney disease
G8772Documentation 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)
G8773Urine protein test was not performed, reason not given
G8774Serum creatinine test result documented and reviewed
G8775Documentation 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)
G8776Serum creatinine test not performed, reason not given
G8777Diabetes screening test performed
G8778Documentation 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)
G8779Diabetes screening test not performed, reason not given
G8780Counseling for diet and physical activity performed
G8781Documentation 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)
G8782Counseling for diet and physical activity not performed, reason not given
G8783Normal blood pressure reading documented, follow-up not required
G8784Patient not eligible (e.g., documentation the patient is not eligible due to active diagnosis of hypertension, patient refuses, urgent or emergent situation)
G8785Blood pressure reading not documented, reason not given
G8797Specimen site other than anatomic location of esophagus
G8798Specimen site other than anatomic location of prostate
G8806Performance of trans-abdominal or trans-vaginal ultrasound and pregnancy location documented
G8807Trans-abdominal or trans-vaginal ultrasound not performed for reasons documented by clinician (e.g., patient has a documented intrauterine pregnancy [iup])
G8808Trans-abdominal or trans-vaginal ultrasound not performed, reason not given
G8809Rh-immunoglobulin (rhogam) ordered
G8810Rh-immunoglobulin (rhogam) not ordered for reasons documented by clinician (e.g., patient had prior documented receipt of rhogam within 12 weeks, patient refusal)
G8811Documentation rh-immunoglobulin (rhogam) was not ordered, reason not given
G8815Documented 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)
G8816Statin medication prescribed at discharge
G8817Statin therapy not prescribed at discharge, reason not given
G8818Patient discharge to home no later than post-operative day #7   Discontinued
G8825Patient not discharged to home by post-operative day #7   Discontinued
G8826Patient discharged to home no later than post-operative day #2 following evar
G8833Patient not discharged to home by post-operative day #2 following evar
G8834Patient discharged to home no later than post-operative day #2 following cea
G8838Patient not discharged to home by post-operative day #2 following cea
G8839Sleep apnea symptoms assessed, including presence or absence of snoring and daytime sleepiness
G8840Documentation 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)
G8841Sleep apnea symptoms not assessed, reason not given
G8842Apnea hypopnea index (ahi), respiratory disturbance index (rdi) or respiratory event index (rei) documented or measured within 2 months of initial evaluation for suspected obstructive sleep apnea
G8843Documentation of reason(s) for not measuring an apnea hypopnea index (ahi), a respiratory disturbance index (rdi), or a respiratory event index (rei) within 2 months of initial evaluation for suspected obstructive sleep apnea (e.g., medical, neurological, or psychiatric disease that prohibits successful completion of a sleep study, patients for whom a sleep study would present a bigger risk than benefit or would pose an undue burden, dementia, patients who decline ahi/rdi/rei measurement, patients who had a financial reason for not completing testing, test was ordered but not completed, patients decline because their insurance (payer) does not cover the expense))
G8844Apnea hypopnea index (ahi), respiratory disturbance index (rdi), or respiratory event index (rei) not documented or measured within 2 months of initial evaluation for suspected obstructive sleep apnea, reason not given
G8845Positive airway pressure therapy prescribed
G8846Moderate or severe obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory disturbance index (rdi) of 15 or greater)
G8848Mild obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory disturbance index (rdi) of less than 15)
G8849Documentation of reason(s) for not prescribing positive airway pressure therapy (e.g., patient unable to tolerate, alternative therapies use, patient declined, financial, insurance coverage)
G8850Positive airway pressure therapy not prescribed, reason not given
G8851Adherence to therapy was assessed at least annually through an objective informatics system or through self-reporting (if objective reporting is not available, documented)
G8852Positive airway pressure therapy was prescribed   Discontinued
G8853Positive airway pressure therapy not prescribed
G8854Documentation of reason(s) for not objectively reporting adherence to evidence-based therapy (e.g., patients who have been diagnosed with a terminal or advanced disease with an expected life span of less than 6 months, patients who decline therapy, patients who do not return for follow-up at least annually, patients unable to access/afford therapy, patient’s insurance will not cover therapy)
G8855Adherence to therapy was not assessed at least annually through an objective informatics system or through self-reporting (if objective reporting is not available), reason not given
G8856Referral to a physician for an otologic evaluation performed
G8857Patient 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)
G8858Referral to a physician for an otologic evaluation not performed, reason not given
G8859Patient receiving corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days
G8860Patients who have received dose of corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days
G8861Within 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
G8862Patients not receiving corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days
G8863Patients not assessed for risk of bone loss, reason not given
G8864Pneumococcal vaccine administered or previously received
G8865Documentation of medical reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient allergic reaction, potential adverse drug reaction)
G8866Documentation of patient reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient refusal)
G8867Pneumococcal vaccine not administered or previously received, reason not given
G8868Patients receiving a first course of anti-tnf therapy
G8869Patient has documented immunity to hepatitis b and initiating anti-tnf therapy
G8870Hepatitis b vaccine injection administered or previously received and is receiving a first course of anti-tnf therapy
G8871Patient not receiving a first course of anti-tnf therapy
G8872Excised tissue evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesion
G8873Patients 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)
G8874Excised tissue not evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesion
G8875Clinician diagnosed breast cancer preoperatively by a minimally invasive biopsy method
G8876Documentation 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)
G8877Clinician did not attempt to achieve the diagnosis of breast cancer preoperatively by a minimally invasive biopsy method, reason not given
G8878Sentinel lymph node biopsy procedure performed
G8879Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer
G8880Documentation 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)
G8881Stage of breast cancer is greater than t1n0m0 or t2n0m0
G8882Sentinel lymph node biopsy procedure not performed, reason not given
G8883Biopsy results reviewed, communicated, tracked and documented   Discontinued
G8884Clinician documented reason that patient’s biopsy results were not reviewed   Discontinued
G8885Biopsy results not reviewed, communicated, tracked or documented   Discontinued
G8886Most recent blood pressure under control
G8887Documentation 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)
G8888Most recent blood pressure not under control, results documented and reviewed
G8889No documentation of blood pressure measurement, reason not given
G8890Most recent ldl-c under control, results documented and reviewed
G8891Documentation 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)
G8892Documentation 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)
G8893Most recent ldl-c not under control, results documented and reviewed
G8894Ldl-c not performed, reason not given
G8895Oral aspirin or other antithrombotic therapy prescribed
G8896Documentation 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)
G8897Oral aspirin or other antithrombotic therapy was not prescribed, reason not given
G8898I intend to report the chronic obstructive pulmonary disease (copd) measures group
G8899I intend to report the inflammatory bowel disease (ibd) measures group
G8900I intend to report the sleep apnea measures group
G8902I intend to report the dementia measures group
G8903I intend to report the parkinson’s disease measures group
G8904I intend to report the hypertension (htn) measures group
G8905I intend to report the cardiovascular prevention measures group
G8906I intend to report the cataract measures group
G8907Patient 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
G8908Patient documented to have received a burn prior to discharge
G8909Patient documented not to have received a burn prior to discharge
G8910Patient documented to have experienced a fall within asc
G8911Patient documented not to have experienced a fall within ambulatory surgical center
G8912Patient documented to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event
G8913Patient documented not to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event
G8914Patient documented to have experienced a hospital transfer or hospital admission upon discharge from asc
G8915Patient documented not to have experienced a hospital transfer or hospital admission upon discharge from asc
G8916Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic initiated on time
G8917Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic not initiated on time
G8918Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis
G8923Left ventricular ejection fraction (lvef) <= 40% or documentation of moderately or severely depressed left ventricular systolic function
G8924Spirometry results documented (fev1/fvc < 70%)
G8925Spirometry test results demonstrate fev1 >= 60% fev1/fvc >= 70%, predicted or patient does not have copd symptoms
G8926Spirometry test not performed or documented, reason not given
G8927Adjuvant chemotherapy referred, prescribed or previously received for ajcc stage iii, colon cancer
G8928Adjuvant 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)
G8929Adjuvant chemotherapy not prescribed or previously received, reason not given
G8930Assessment of depression severity at the initial evaluation
G8931Assessment of depression severity not documented, reason not given
G8932Suicide risk assessed at the initial evaluation
G8933Suicide risk not assessed at the initial evaluation, reason not given
G8934Left ventricular ejection fraction (lvef) <=40% or documentation of moderately or severely depressed left ventricular systolic function
G8935Clinician prescribed angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy
G8936Clinician 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)
G8937Clinician did not prescribe angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy, reason not given
G8938Bmi is documented as being outside of normal parameters, follow-up plan is not documented, documentation the patient is not eligible
G8939Pain assessment documented as positive, follow-up plan not documented, documentation the patient is not eligible at the time of the encounter
G8940Screening for depression documented as positive, a follow-up plan not completed, documented reason
G8941Elder 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   Discontinued
G8942Functional outcome assessment using a standardized tool is documented within the previous 30 days and a care plan, based on identified deficiencies is documented within two days of the functional outcome assessment
G8943Ldl-c result not present or not within 12 months prior
G8944Ajcc melanoma cancer stage 0 through iic melanoma
G8946Minimally 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)
G8947One or more neuropsychiatric symptoms
G8948No neuropsychiatric symptoms
G8949Documentation 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)
G8950Elevated or hypertensive blood pressure reading documented, and the indicated follow-up is documented
G8951Pre-hypertensive or hypertensive blood pressure reading documented, indicated follow-up not documented, documentation the patient is not eligible
G8952Elevated or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given
G8953All quality actions for the applicable measures in the oncology measures group have been performed for this patient
G8955Most recent assessment of adequacy of volume management documented
G8956Patient receiving maintenance hemodialysis in an outpatient dialysis facility
G8957Patient not receiving maintenance hemodialysis in an outpatient dialysis facility
G8958Assessment of adequacy of volume management not documented, reason not given
G8959Clinician treating major depressive disorder communicates to clinician treating comorbid condition
G8960Clinician treating major depressive disorder did not communicate to clinician treating comorbid condition, reason not given
G8961Cardiac stress imaging test primarily performed on low-risk surgery patient for preoperative evaluation within 30 days preceding this surgery
G8962Cardiac 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
G8963Cardiac stress imaging performed primarily for monitoring of asymptomatic patient who had pci within 2 years   Discontinued
G8964Cardiac 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)   Discontinued
G8965Cardiac stress imaging test primarily performed on low chd risk patient for initial detection and risk assessment
G8966Cardiac stress imaging test performed on symptomatic or higher than low chd risk patient or for any reason other than initial detection and risk assessment
G8967Fda approved oral anticoagulant is prescribed
G8968Documentation of medical reason(s) for not prescribing an fda-approved anticoagulant (e.g., present or planned atrial appendage occlusion or ligation or patient being currently enrolled in a clinical trial related to af/atrial flutter treatment)
G8969Documentation of patient reason(s) for not prescribing an oral anticoagulant that is fda approved for the prevention of thromboembolism (e.g., patient preference for not receiving anticoagulation)
G8970No risk factors or one moderate risk factor for thromboembolism
G8971Warfarin or another oral anticoagulant that is fda approved not prescribed, reason not given
G8972One or more high risk factors for thromboembolism or more than one moderate risk factor for thromboembolism
G8973Most recent hemoglobin (hgb) level < 10 g/dl
G8974Hemoglobin level measurement not documented, reason not given
G8975Documentation 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)
G8976Most recent hemoglobin (hgb) level >= 10 g/dl
G8977I intend to report the oncology measures group
G8978Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals
G8979Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G8980Mobility: walking & moving around functional limitation, discharge status, at discharge from therapy or to end reporting
G8981Changing & maintaining body position functional limitation, current status, at therapy episode outset and at reporting intervals
G8982Changing & maintaining body position functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G8983Changing & maintaining body position functional limitation, discharge status, at discharge from therapy or to end reporting
G8984Carrying, moving & handling objects functional limitation, current status, at therapy episode outset and at reporting intervals
G8985Carrying, moving and handling objects, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G8986Carrying, moving & handling objects functional limitation, discharge status, at discharge from therapy or to end reporting
G8987Self care functional limitation, current status, at therapy episode outset and at reporting intervals
G8988Self care functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G8989Self care functional limitation, discharge status, at discharge from therapy or to end reporting
G8990Other physical or occupational therapy primary functional limitation, current status, at therapy episode outset and at reporting intervals
G8991Other physical or occupational therapy primary functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G8992Other physical or occupational therapy primary functional limitation, discharge status, at discharge from therapy or to end reporting
G8993Other physical or occupational therapy subsequent functional limitation, current status, at therapy episode outset and at reporting intervals
G8994Other physical or occupational therapy subsequent functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G8995Other physical or occupational therapy subsequent functional limitation, discharge status, at discharge from therapy or to end reporting
G8996Swallowing functional limitation, current status at therapy episode outset and at reporting intervals
G8997Swallowing functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G8998Swallowing functional limitation, discharge status, at discharge from therapy or to end reporting
G8999Motor speech functional limitation, current status at therapy episode outset and at reporting intervals
G9001Coordinated care fee, initial rate
G9002Coordinated care fee, maintenance rate
G9003Coordinated care fee, risk adjusted high, initial
G9004Coordinated care fee, risk adjusted low, initial
G9005Coordinated care fee, risk adjusted maintenance
G9006Coordinated care fee, home monitoring
G9007Coordinated care fee, scheduled team conference
G9008Coordinated care fee, physician coordinated care oversight services
G9009Coordinated care fee, risk adjusted maintenance, level 3
G9010Coordinated care fee, risk adjusted maintenance, level 4
G9011Coordinated care fee, risk adjusted maintenance, level 5
G9012Other specified case management service not elsewhere classified
G9013Esrd demo basic bundle level i
G9014Esrd demo expanded bundle including venous access and related services
G9016Smoking 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]
G9017Amantadine hydrochloride, oral, per 100 mg (for use in a medicare-approved demonstration project)
G9018Zanamivir, inhalation powder, administered through inhaler, per 10 mg (for use in a medicare-approved demonstration project)
G9019Oseltamivir phosphate, oral, per 75 mg (for use in a medicare-approved demonstration project)
G9020Rimantadine hydrochloride, oral, per 100 mg (for use in a medicare-approved demonstration project)
G9033Amantadine hydrochloride, oral brand, per 100 mg (for use in a medicare-approved demonstration project)
G9034Zanamivir, inhalation powder, administered through inhaler, brand, per 10 mg (for use in a medicare-approved demonstration project)
G9035Oseltamivir phosphate, oral, brand, per 75 mg (for use in a medicare-approved demonstration project)
G9036Rimantadine hydrochloride, oral, brand, per 100 mg (for use in a medicare-approved demonstration project)
G9050Oncology; 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)
G9051Oncology; 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)
G9052Oncology; 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)
G9053Oncology; 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)
G9054Oncology; 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)
G9055Oncology; primary focus of visit; other, unspecified service not otherwise listed (for use in a medicare-approved demonstration project)
G9056Oncology; practice guidelines; management adheres to guidelines (for use in a medicare-approved demonstration project)
G9057Oncology; 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)
G9058Oncology; practice guidelines; management differs from guidelines because the treating physician disagrees with guideline recommendations (for use in a medicare-approved demonstration project)
G9059Oncology; 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)
G9060Oncology; 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)
G9061Oncology; practice guidelines; patient’s condition not addressed by available guidelines (for use in a medicare-approved demonstration project)
G9062Oncology; practice guidelines; management differs from guidelines for other reason(s) not listed (for use in a medicare-approved demonstration project)
G9063Oncology; 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)
G9064Oncology; 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)
G9065Oncology; 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)
G9066Oncology; 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)
G9067Oncology; 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)
G9068Oncology; 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)
G9069Oncology; 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)
G9070Oncology; 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)
G9071Oncology; 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)
G9072Oncology; 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)
G9073Oncology; 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)
G9074Oncology; 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)
G9075Oncology; 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)
G9077Oncology; 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)
G9078Oncology; 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)
G9079Oncology; 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)
G9080Oncology; 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)
G9083Oncology; 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)
G9084Oncology; 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)
G9085Oncology; 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)
G9086Oncology; 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)
G9087Oncology; 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)
G9088Oncology; 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)
G9089Oncology; 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)
G9090Oncology; 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)
G9091Oncology; 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)
G9092Oncology; 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)
G9093Oncology; 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)
G9094Oncology; 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)
G9095Oncology; 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)
G9096Oncology; 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)
G9097Oncology; 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)
G9098Oncology; 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)
G9099Oncology; 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)
G9100Oncology; 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)
G9101Oncology; 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)
G9102Oncology; 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)
G9103Oncology; 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)
G9104Oncology; 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)
G9105Oncology; 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)
G9106Oncology; 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)
G9107Oncology; 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)
G9108Oncology; 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)
G9109Oncology; 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)
G9110Oncology; 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)
G9111Oncology; 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)
G9112Oncology; 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)
G9113Oncology; 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)
G9114Oncology; 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)
G9115Oncology; 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)
G9116Oncology; 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)
G9117Oncology; 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)
G9123Oncology; 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)
G9124Oncology; 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)
G9125Oncology; 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)
G9126Oncology; 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)
G9128Oncology; disease status; limited to multiple myeloma, systemic disease; smoldering, stage i (for use in a medicare-approved demonstration project)
G9129Oncology; disease status; limited to multiple myeloma, systemic disease; stage ii or higher (for use in a medicare-approved demonstration project)
G9130Oncology; 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)
G9131Oncology; 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)
G9132Oncology; 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)
G9133Oncology; disease status; prostate cancer, limited to adenocarcinoma; hormone-responsive; clinical metastases or m1 at diagnosis (for use in a medicare-approved demonstration project)
G9134Oncology; 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)
G9135Oncology; disease status; non-hodgkin’s lymphoma, any cellular classification; stage iii, iv, not relapsed, not refractory (for use in a medicare-approved demonstration project)
G9136Oncology; disease status; non-hodgkin’s lymphoma, transformed from original cellular diagnosis to a second cellular classification (for use in a medicare-approved demonstration project)
G9137Oncology; disease status; non-hodgkin’s lymphoma, any cellular classification; relapsed/refractory (for use in a medicare-approved demonstration project)
G9138Oncology; 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)
G9139Oncology; 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)
G9140Frontier 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
G9143Warfarin responsiveness testing by genetic technique using any method, any number of specimen(s)
G9147Outpatient 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
G9148National committee for quality assurance – level 1 medical home
G9149National committee for quality assurance – level 2 medical home
G9150National committee for quality assurance – level 3 medical home
G9151 Mapcp demonstration – state provided services
G9152Mapcp demonstration – community health teams
G9153Mapcp demonstration – physician incentive pool
G9156Evaluation for wheelchair requiring face to face visit with physician
G9157Transesophageal doppler measurement of cardiac output (including probe placement, image acquisition, and interpretation per course of treatment) for monitoring purposes
G9158Motor speech functional limitation, discharge status, at discharge from therapy or to end reporting
G9159Spoken language comprehension functional limitation, current status at therapy episode outset and at reporting intervals
G9160Spoken language comprehension functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G9161Spoken language comprehension functional limitation, discharge status, at discharge from therapy or to end reporting
G9162Spoken language expression functional limitation, current status at therapy episode outset and at reporting intervals
G9163Spoken language expression functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G9164Spoken language expression functional limitation, discharge status at discharge from therapy or to end reporting
G9165Attention functional limitation, current status at therapy episode outset and at reporting intervals
G9166Attention functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G9167Attention functional limitation, discharge status at discharge from therapy or to end reporting
G9168Memory functional limitation, current status at therapy episode outset and at reporting intervals
G9169Memory functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G9170Memory functional limitation, discharge status at discharge from therapy or to end reporting
G9171Voice functional limitation, current status at therapy episode outset and at reporting intervals
G9172Voice functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G9173Voice functional limitation, discharge status at discharge from therapy or to end reporting
G9174Other speech language pathology functional limitation, current status at therapy episode outset and at reporting intervals
G9175Other speech language pathology functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G9176Other speech language pathology functional limitation, discharge status at discharge from therapy or to end reporting
G9186Motor speech functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G9187Bundled 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
G9188Beta-blocker therapy not prescribed, reason not given
G9189Beta-blocker therapy prescribed or currently being taken
G9190Documentation of medical reason(s) for not prescribing beta-blocker therapy (eg, allergy, intolerance, other medical reasons)
G9191Documentation of patient reason(s) for not prescribing beta-blocker therapy (eg, patient declined, other patient reasons)
G9192Documentation of system reason(s) for not prescribing beta-blocker therapy (eg, other reasons attributable to the health care system)   Discontinued
G9193Clinician 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
G9194Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 180 day (6 month) continuation treatment phase
G9195Patient with a diagnosis of major depression not documented as being treated with antidepressant medication during the entire 180 day (6 months) continuation treatment phase
G9196Documentation 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))
G9197Documentation of order for first or second generation cephalosporin for antimicrobial prophylaxis
G9198Order for first or second generation cephalosporin for antimicrobial prophylaxis was not documented, reason not given
G9199Venous 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))
G9200Venous thromboembolism (vte) prophylaxis was not administered the day of or the day after hospital admission, reason not given
G9201Venous thromboembolism (vte) prophylaxis administered the day of or the day after hospital admission
G9202Patients with a positive hepatitis c antibody test
G9203Rna testing for hepatitis c documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c
G9204Rna testing for hepatitis c was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c, reason not given
G9205Patient starting antiviral treatmentfor hepatitis c during the measurement period
G9206Patient starting antiviral treatment for hepatitis c during the measurement period
G9207Hepatitis c genotype testing documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c
G9208Hepatitis c genotype testing was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c, reason not given
G9209Hepatitis c quantitative rna testing documented as performed between 4-12 weeks after the initiation of antiviral treatment
G9210Hepatitis 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)
G9211Hepatitis c quantitative rna testing was not documented as performed between 4-12 weeks after the initiation of antiviral treatment, reason not given
G9212Dsm-ivtm criteria for major depressive disorder documented at the initial evaluation
G9213Dsm-iv-tr criteria for major depressive disorder not documented at the initial evaluation, reason not otherwise specified
G9214Cd4+ cell count or cd4+ cell percentage results documented
G9215Cd4+ cell count or percentage not documented as performed, reason not given
G9216Pcp prophylaxis was not prescribed at time of diagnosis of hiv, reason not given
G9217Pcp prophylaxis was not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3, reason not given
G9218Pcp prophylaxis was not prescribed within 3 months oflow cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%, reason not given
G9219Pneumocystis 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)
G9220Pneumocystis 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)
G9221Pneumocystis jiroveci pneumonia prophlaxis prescribed
G9222Pneumocystis jiroveci pneumonia prophylaxis prescribed wthin 3 months of low cd4+ cell count below 200 cells/mm3
G9223Pneumocystis jiroveci pneumonia prophylaxis prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%
G9224Documentation of medical reason for not performing foot exam (e.g., patient with bilateral foot/leg amputation)
G9225Foot exam was not performed, reason not given
G9226Foot 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)
G9227Functional outcome assessment documented, care plan not documented, documentation the patient is not eligible for a care plan at the time of the encounter
G9228Chlamydia, gonorrhea and syphilis screening results documented (report when results are present for all of the 3 screenings)
G9229Chlamydia, gonorrhea, and syphilis screening results not documented (patient refusal is the only allowed exception)   Discontinued
G9230 Chlamydia, gonorrhea, and syphilis not screened, reason not given 
G9231Documentation of end stage renal disease (esrd), dialysis, renal transplant before or during the measurement period or pregnancy during the measurement period
G9232Clinician 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)
G9233All quality actions for the applicable measures in the total knee replacement measures group have been performed for this patient
G9234I intend to report the total knee replacement measures group
G9235All quality actions for the applicable measures in the general surgery measures group have been performed for this patient
G9236All quality actions for the applicable measures in the optimizing patient exposure to ionizing radiation measures group have been performed for this patient
G9237I intend to report the general surgery measures group
G9238I intend to report the optimizing patient exposure to ionizing radiation measures group
G9239Documentation 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)
G9240Patient whose mode of vascular access is a catheter at the time maintenance hemodialysis is initiated
G9241Patient whose mode of vascular access is not a catheter at the time maintenance hemodialysis is initiated
G9242Documentation of viral load equal to or greater than 200 copies/ml or viral load not performed
G9243Documentation of viral load less than 200 copies/ml
G9244Antiretroviral thereapy not prescribed
G9245Antiretroviral therapy prescribed
G9246Patient 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
G9247Patient 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
G9248Patient did not have a medical visit in the last 6 months
G9249Patient had a medical visit in the last 6 months
G9250Documentation of patient pain brought to a comfortable level within 48 hours from initial assessment
G9251Documentation of patient with pain not brought to a comfortable level within 48 hours from initial assessment
G9252Adenoma(s) or other neoplasm detected during screening colonoscopy
G9253Adenoma(s) or other neoplasm not detected during screening colonoscopy
G9254Documentation of patient discharged to home later than post-operative day 2 following cas
G9255Documentation of patient discharged to home no later than post operative day 2 following cas
G9256Documentation of patient death following cas
G9257Documentation of patient stroke following cas
G9258Documentation of patient stroke following cea
G9259Documentation of patient survival and absence of stroke following cas
G9260Documentation of patient death following cea
G9261Documentation of patient survival and absence of stroke following cea
G9262Documentation of patient death in the hospital following endovascular aaa repair
G9263Documentation of patient discharged alive following endovascular aaa repair
G9264Documentation 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)
G9265Patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter as the mode of vascular access
G9266Patient receiving maintenance hemodialysis for greater than or equal to 90 days without a catheter as the mode of vascular access
G9267Documentation of patient with one or more complications or mortality within 30 days
G9268Documentation of patient with one or more complications within 90 days
G9269Documentation of patient without one or more complications and without mortality within 30 days
G9270Documentation of patient without one or more complications within 90 days
G9271Ldl value < 100
G9272Ldl value >= 100
G9273Blood pressure has a systolic value of < 140 and a diastolic value of < 90
G9274Blood 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
G9275Documentation that patient is a current non-tobacco user
G9276Documentation that patient is a current tobacco user
G9277Documentation 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)
G9278Documentation that the patient is not on daily aspirin or anti-platelet regimen
G9279Pneumococcal screening performed and documentation of vaccination received prior to discharge
G9280Pneumococcal vaccination not administered prior to discharge, reason not specified
G9281Screening performed and documentation that vaccination not indicated/patient refusal
G9282Documentation 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)
G9283Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation
G9284Non 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
G9285Specimen site other than anatomic location of lung or is not classified as non small cell lung cancer
G9286Antibiotic regimen prescribed within 10 days after onset of symptoms
G9287Antibiotic regimen not prescribed within 10 days after onset of symptoms
G9288Documentation 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)
G9289Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation
G9290Non 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
G9291Specimen site other than anatomic location of lung, is not classified as non small cell lung cancer or classified as nsclc-nos
G9292Documentation 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)
G9293Pathology report does not include the pt category and a statement on thickness and ulceration and for pt1, mitotic rate
G9294Pathology report includes the pt category and a statement on thickness and ulceration and for pt1, mitotic rate
G9295Specimen site other than anatomic cutaneous location
G9296Patients with documented shared decision-making including discussion of conservative (non-surgical) therapy (e.g., nsaids, analgesics, weight loss, exercise, injections) prior to the procedure
G9297Shared 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
G9298Patients 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)
G9299Patients who are not evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (e.g., history of dvt, pe, mi, arrhythmia and stroke, reason not given)
G9300Documentation 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)
G9301Patients who had the prophylactic antibiotic completely infused prior to the inflation of the proximal tourniquet
G9302Prophylactic antibiotic not completely infused prior to the inflation of the proximal tourniquet, reason not given
G9303Operative 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
G9304Operative 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
G9305Intervention for presence of leak of endoluminal contents through an anastomosis not required
G9306Intervention for presence of leak of endoluminal contents through an anastomosis required
G9307No return to the operating room for a surgical procedure, for complications of the principal operative procedure, within 30 days of the principal operative procedure
G9308Unplanned return to the operating room for a surgical procedure, for complications of the principal operative procedure, within 30 days of the principal operative procedure
G9309No unplanned hospital readmission within 30 days of principal procedure
G9310Unplanned hospital readmission within 30 days of principal procedure
G9311No surgical site infection
G9312Surgical site infection
G9313Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis for documented reason
G9314Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis, reason not given
G9315Amoxicillin, with or without clavulanate, prescribed as a first line antibiotic at the time of diagnosis
G9316Documentation 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
G9317Documentation 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
G9318Imaging study named according to standardized nomenclature
G9319Imaging study not named according to standardized nomenclature, reason not given
G9320Documentation 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)
G9321Count 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
G9322Count 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
G9323Documentation 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)
G9324All necessary data elements not included, reason not given
G9325Ct 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)
G9326Ct 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
G9327Ct studies performed reported to a radiation dose index registry that is capable of collecting at a minimum all necessary data elements
G9328Dicom 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)
G9329Dicom 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
G9340Final 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
G9341Search 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
G9342Search 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
G9343Due 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)
G9344Due 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)
G9345Follow-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
G9346Follow-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)
G9347Follow-up recommendations not documented according to recommended guidelines for incidentally detected pulmonary nodules, reason not given
G9348Ct scan of the paranasal sinuses ordered at the time of diagnosis for documented reasons
G9349Ct scan of the paranasal sinuses ordered at the time of diagnosis or received within 28 days after date of diagnosis
G9350Ct scan of the paranasal sinuses not ordered at the time of diagnosis or received within 28 days after date of diagnosis
G9351More than one ct scan of the paranasal sinuses ordered or received within 90 days after diagnosis
G9352More than one ct scan of the paranasal sinuses ordered or received within 90 days after the date of diagnosis, reason not given
G9353More 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)
G9354One ct scan or no ct scan of the paranasal sinuses ordered within 90 days after the date of diagnosis
G9355Elective delivery (without medical indication) by cesarean birth or induction of labor not performed (<39 weeks of gestation)
G9356Elective delivery (without medical indication) by cesarean birth or induction of labor performed (<39 weeks of gestation)
G9357Post-partum screenings, evaluations and education performed
G9358Post-partum screenings, evaluations and education not performed
G9359Documentation of negative or managed positive tb screen with further evidence that tb is not active prior to treatment with a biologic immune response modifier
G9360No documentation of negative or managed positive tb screen
G9361Medical indication for delivery by cesarean birth or induction of labor (<39 weeks of gestation) [documentation of reason(s) for elective delivery (e.g., hemorrhage and placental complications, hypertension, preeclampsia and eclampsia, rupture of membranes (premature or prolonged), maternal conditions complicating pregnancy/delivery, fetal conditions complicating pregnancy/delivery, late pregnancy, prior uterine surgery, or participation in clinical trial)]
G9362Duration 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
G9363Duration 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
G9364Sinusitis caused by, or presumed to be caused by, bacterial infection
G9365One high-risk medication ordered
G9366One high-risk medication not ordered
G9367At least two orders for high-risk medications from the same drug class
G9368At least two orders for high-risk medications from the same drug class not ordered
G9369Individual filled at least two prescriptions for any antipsychotic medication and had a pdc of 0.8 or greater
G9370Individual who did not fill at least two prescriptions for any antipsychotic medication or did not have a pdc of 0.8 or greater
G9376Patient continued to have the retina attached at the 6 months follow up visit (+/- 1 month) following only one surgery
G9377Patient did not have the retina attached after 6 months following only one surgery
G9378Patient continued to have the retina attached at the 6 months follow up visit (+/- 1 month)
G9379Patient did not achieve flat retinas six months post surgery
G9380Patient offered assistance with end of life issues or existing end of life plan was reviewed or updated during the measurement period
G9381Documentation 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
G9382Patient not offered assistance with end of life issues or existing end of life plan was not reviewed or updated during the measurement period
G9383Patient received screening for hcv infection within the 12 month reporting period
G9384Documentation 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)
G9385Documentation of patient reason(s) for not receiving annual screening for hcv infection (e.g., patient declined, other patient reasons)
G9386Screening for hcv infection not received within the 12 month reporting period, reason not given
G9389Unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery
G9390No unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery
G9391Patient achieves refraction +-1 d for the eye that underwent cataract surgery, measured at the one month follow up visit
G9392Patient does not achieve refraction +-1 d for the eye that underwent cataract surgery, measured at the one month follow up visit
G9393Patient 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
G9394Patient 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
G9395Patient 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
G9396Patient with an initial phq-9 score greater than nine who was not assessed for remission at twelve months (+/- 30 days)
G9399Documentation 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
G9400Documentation 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
G9401No documentation in the patient record of a discussion between the physician or other qualified healthcare professional and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward treatment
G9402Patient received follow-up within 30 days after discharge
G9403Clinician 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)
G9404Patient did not receive follow-up within 30 days after discharge
G9405Patient received follow-up within 7 days after discharge
G9406Clinician 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)
G9407Patient did not receive follow-up within 7 days after discharge
G9408Patients with cardiac tamponade and/or pericardiocentesis occurring within 30 days
G9409Patients without cardiac tamponade and/or pericardiocentesis occurring within 30 days
G9410Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision
G9411Patient not admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision
G9412Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision
G9413Patient not admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision
G9414Patient had one dose of meningococcal vaccine (serogroups a, c, w, y) on or between the patient’s 11th and 13th birthdays
G941Patient did not have one dose of meningococcal vaccine (serogroups a, c, w, y) on or between the patient’s 11th and 13th birthdays
G9416Patient had one tetanus, diphtheria toxoids and acellular pertussis vaccine (tdap) on or between the patient’s 10th and 13th birthdays
G9417Patient did not have one tetanus, diphtheria toxoids and acellular pertussis vaccine (tdap) on or between the patient’s 10th and 13th birthdays
G9418Primary non-small cell lung cancer lung biopsy and cytology specimen report documents classification into specific histologic type following iaslc guidance or classified as nsclc-nos with an explanation
G9419Documentation of medical reason(s) for not including the histological type or nsclc-nos classification with an explanation (e.g. specimen insufficient or non-diagnostic, specimen does not contain cancer, or other documented medical reasons)
G9420Specimen site other than anatomic location of lung or is not classified as primary non-small cell lung cancer
G9421Primary non-small cell lung cancer lung biopsy and cytology specimen report does not document classification into specific histologic type or histologic type does not follow iaslc guidance or is classified as nsclc-nos but without an explanation
G9422Primary lung carcinoma resection report documents pt category, pn category and for non-small cell lung cancer, histologic type (e.g., squamous cell carcinoma, adenocarcinoma and not nsclc-nos)
G9423Documentation 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)]
G9424Specimen site other than anatomic location of lung, or classified as nsclc-nos
G9425Primary lung carcinoma resection report does not document pt category, pn category and for non-small cell lung cancer, histologic type (e.g., squamous cell carcinoma, adenocarcinoma)
G9426Improvement in median time from ed arrival to initial ed oral or parenteral pain medication administration performed for ed admitted patients
G9427Improvement in median time from ed arrival to initial ed oral or parenteral pain medication administration not performed for ed admitted patients
G9428Pathology report includes the pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors
G9429Documentation of medical reason(s) for not including pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors (e.g., negative skin biopsies, insufficient tissue, or other documented medical reasons)
G9430Specimen site other than anatomic cutaneous location
G9431Pathology report does not include the pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors
G9432Asthma well-controlled based on the act, c-act, acq, or ataq score and results documented
G9433Death, permanent nursing home resident or receiving hospice or palliative care any time during the measurement period
G9434Asthma not well-controlled based on the act, c-act, acq, or ataq score, or specified asthma control tool not used, reason not given
G9435Aspirin prescribed at discharge
G9436Aspirin not prescribed for documented reasons (e.g., allergy, medical intolerance, history of bleed)
G9437Aspirin not prescribed at discharge
G9438P2y inhibitor prescribed at discharge
G9439P2y inhibitor not prescribed for documented reasons (e.g., allergy, medical intolerance, history of bleed)
G9440P2y inhibitor not prescribed at discharge
G9441Statin prescribed at discharge
G9442Statin not prescribed for documented reasons (e.g., allergy, medical intolerance)
G9443Statin not prescribed at discharge
G9448Patients who were born in the years 1945 to 1965
G9449History of receiving blood transfusions prior to 1992
G9450History of injection drug use
G9451Patient received one-time screening for hcv infection   Discontinued
G9452Documentation of medical reason(s) for not receiving hcv antibody test due to limited life expectancy
G9453Documentation of patient reason(s) for not receiving one-time screening for hcv infection (e.g., patient declined, other patient reasons)   Discontinued
G9454One-time screening for hcv infection not received within 12-month reporting period and no documentation of prior screening for hcv infection, reason not given   Discontinued
G9455Patient underwent abdominal imaging with ultrasound, contrast enhanced ct or contrast mri for hcc
G9456Documentation 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)
G9457Patient did not undergo abdominal imaging and did not have a documented reason for not undergoing abdominal imaging in the submission period
G9458Patient 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
G9459Currently a tobacco non-user
G9460Tobacco assessment or tobacco cessation intervention not performed, reason not given
G9463I intend to report the sinusitis measures group
G9464All quality actions for the applicable measures in the sinusitis measures group have been performed for this patient
G9465I intend to report the acute otitis externa (aoe) measures group
G9466All quality actions for the applicable measures in the aoe measures group have been performed for this patient
G9467Patient 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
G9468Patient 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
G9469Patients 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
G9470Patients 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
G9471Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) not ordered or documented
G9472Within 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
G9473Services performed by chaplain in the hospice setting, each 15 minutes
G9474Services performed by dietary counselor in the hospice setting, each 15 minutes
G9475Services performed by other counselor in the hospice setting, each 15 minutes
G9476Services performed by volunteer in the hospice setting, each 15 minutes
G9477Services performed by care coordinator in the hospice setting, each 15 minutes
G9478Services performed by other qualified therapist in the hospice setting, each 15 minutes
G9479Services performed by qualified pharmacist in the hospice setting, each 15 minutes
G9480Admission to medicare care choice model program (mccm)
G9481Remote 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
G9482Remote 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
G9483Remote 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
G9484Remote 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
G9485Remote 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
G9486Remote 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
G9487Remote 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
G9488Remote 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
G9489Remote 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
G9490Cms 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
G9496Documentation 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
G9497Received instruction from the anesthesiologist or proxy prior to the day of surgery to abstain from smoking on the day of surgery
G9498Antibiotic regimen prescribed
G9499Patient did not start or is not receiving antiviral treatment for hepatitis c during the measurement period
G9500Radiation exposure indices documented in final report for procedure using fluoroscopy
G9501Radiation exposure indices not documented in final report for procedure using fluoroscopy, reason not given
G9502Documentation 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)
G9503Patient taking tamsulosin hydrochloride
G9504Documented 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
G9505Antibiotic regimen prescribed within 10 days after onset of symptoms for documented medical reason
G9506Biologic immune response modifier prescribed
G9507Documentation 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)
G9508Documentation that the patient is not on a statin medication
G9509Adult 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
G9510Adult 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
G9511Index event date phq-9 or phq-9m score greater than 9 documented during the twelve month denominator identification period
G9512Individual had a pdc of 0.8 or greater
G9513Individual did not have a pdc of 0.8 or greater
G9514Patient required a return to the operating room within 90 days of surgery
G9515Patient did not require a return to the operating room within 90 days of surgery
G9516Patient achieved an improvement in visual acuity, from their preoperative level, within 90 days of surgery
G9517Patient did not achieve an improvement in visual acuity, from their preoperative level, within 90 days of surgery, reason not given
G9518Documentation of active injection drug use
G9519Patient achieves final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery
G9520Patient does not achieve final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery
G9521Total number of emergency department visits and inpatient hospitalizations less than two in the past 12 months
G9522Total 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
G9523Patient discontinued from hemodialysis or peritoneal dialysis
G9524Patient was referred to hospice care
G9525Documentation of patient reason(s) for not referring to hospice care (e.g., patient declined, other patient reasons)
G9526Patient was not referred to hospice care, reason not given
G9529Patient with minor blunt head trauma had an appropriate indication(s) for a head ct
G9530Patient presented with a minor blunt head trauma and had a head ct ordered for trauma by an emergency care provider
G9531Patient 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
G9532Patient had a head ct for trauma ordered by someone other than an emergency care provider or was ordered for a reason other than trauma
G9533Patient with minor blunt head trauma did not have an appropriate indication(s) for a head ct
G9534Advanced brain imaging (cta, ct, mra or mri) was not ordered
G9535Patients with a normal neurological examination
G9536Documentation 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)
G9537Imaging needed as part of a clinical trial; or other clinician ordered the study
G9538Advanced brain imaging (cta, ct, mra or mri) was ordered
G9539Intent for potential removal at time of placement
G9540Patient alive 3 months post procedure
G9541Filter removed within 3 months of placement
G9542Documented re-assessment for the appropriateness of filter removal within 3 months of placement
G9543Documentation 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
G9544Patients 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
G9547Cystic 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
G9548Final reports for imaging studies stating no follow-up imaging is recommended
G9549Documentation 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))
G9550Final reports for imaging studies with follow-up imaging recommended, or final reports that do not include a specific recommendation of no follow-up
G9551Final reports for imaging studies without an incidentally found lesion noted
G9552Incidental thyroid nodule < 1.0 cm noted in report
G9553Prior thyroid disease diagnosis
G9554Final reports for ct, cta, mri or mra of the chest or neck with follow-up imaging recommended
G9555Documentation of medical reason(s) for recommending follow up imaging (e.g., patient has multiple endocrine neoplasia, patient has cervical lymphadenopathy, other medical reason(s))
G9556Final reports for ct, cta, mri or mra of the chest or neck with follow-up imaging not recommended
G9557Final reports for ct, cta, mri or mra studies of the chest or neck without an incidentally found thyroid nodule < 1.0 cm noted or no nodule found
G9558Patient treated with a beta-lactam antibiotic as definitive therapy
G9559Documentation of medical reason(s) for not prescribing a beta-lactam antibiotic (e.g., allergy, intolerance to beta-lactam antibiotics)
G9560Patient not treated with a beta-lactam antibiotic as definitive therapy, reason not given
G9561Patients prescribed opiates for longer than six weeks
G9562Patients who had a follow-up evaluation conducted at least every three months during opioid therapy
G9563Patients who did not have a follow-up evaluation conducted at least every three months during opioid therapy
G9572Index date phq-score greater than 9 documented during the twelve month denominator identification period
G9573Adult 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
G9574Adult 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
G9577Patients prescribed opiates for longer than six weeks
G9578Documentation of signed opioid treatment agreement at least once during opioid therapy
G9579No documentation of signed an opioid treatment agreement at least once during opioid therapy
G9580Door to puncture time of 90 minutes or less
G9581Door 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)
G9582Door to puncture time of greater than 90 minutes, no reason given
G9583Patients prescribed opiates for longer than six weeks
G9584Patient 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
G9585Patient 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
G9593Pediatric patient with minor blunt head trauma classified as low risk according to the pecarn prediction rules
G9594Patient presented with a minor blunt head trauma and had a head ct ordered for trauma by an emergency care provider
G9595Patient has documentation of ventricular shunt, brain tumor, or coagulopathy
G9596Pediatric 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   Discontinued
G9597Pediatric patient with minor blunt head trauma not classified as low risk according to the pecarn prediction rules
G9598Aortic aneurysm 5.5 – 5.9 cm maximum diameter on centerline formatted ct or minor diameter on axial formatted ct
G9599Aortic aneurysm 6.0 cm or greater maximum diameter on centerline formatted ct or minor diameter on axial formatted ct
G9600Symptomatic aaas that required urgent/emergent (non-elective) repair
G9601Patient discharge to home no later than post-operative day #7
G9602Patient not discharged to home by post-operative day #7
G9603Patient survey score improved from baseline following treatment
G9604Patient survey results not available
G9605Patient survey score did not improve from baseline following treatment
G9606Intraoperative cystoscopy performed to evaluate for lower tract injury
G9607Documented 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
G9608Intraoperative cystoscopy not performed to evaluate for lower tract injury
G9609Documentation of an order for anti-platelet agents
G9610Documentation of medical reason(s) in the patient’s record for not ordering anti-platelet agents
G9611Order for anti-platelet agents was not documented in the patient’s record, reason not given
G9612Photodocumentation of two or more cecal landmarks to establish a complete examination   Discontinued
G9613Documentation of post-surgical anatomy (e.g., right hemicolectomy, ileocecal resection, etc.)   Discontinued
G9614Photodocumentation of less than two cecal landmarks (i.e., no cecal landmarks or only one cecal landmark) to establish a complete examination   Discontinued
G9615Preoperative assessment documented
G9616Documentation 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)
G9617Preoperative assessment not documented, reason not given
G9618Documentation of screening for uterine malignancy or those that had an ultrasound and/or endometrial sampling of any kind
G9619Documentation of reason(s) for not screening for uterine malignancy (e.g., prior hysterectomy)
G9620Patient not screened for uterine malignancy, or those that have not had an ultrasound and/or endometrial sampling of any kind, reason not given
G9621Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method and received brief counseling
G9622Patient not identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method
G9623Documentation of medical reason(s) for not screening for unhealthy alcohol use (e.g., limited life expectancy, other medical reasons)
G9624Patient 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
G9625Patient sustained bladder injury at the time of surgery or discovered subsequently up to 30 days post-surgery
G9626Documented medical reason for not reporting bladder injury (e.g., gynecologic or other pelvic malignancy documented, concurrent surgery involving bladder pathology, injury that occurs during a urinary incontinence procedure, patient death from non-medical causes not related to surgery, patient died during procedure without evidence of bladder injury)
G9627Patient did not sustain bladder injury at the time of surgery nor discovered subsequently up to 30 days post-surgery
G9628Patient sustained bowel injury at the time of surgery or discovered subsequently up to 30 days post-surgery
G9629Documented 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)
G9630Patient did not sustain a bowel injury at the time of surgery nor discovered subsequently up to 30 days post-surgery
G9631Patient sustained ureter injury at the time of surgery or discovered subsequently up to 30 days post-surgery
G9632Documented 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)
G9633Patient did not sustain ureter injury at the time of surgery nor discovered subsequently up to 30 days post-surgery
G9634Health-related quality of life assessed with tool during at least two visits and quality of life score remained the same or improved
G9635Health-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)
G9636Health-related quality of life not assessed with tool during at least two visits or quality of life score declined
G9637Final 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)
G9638Final 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)
G9639Major amputation or open surgical bypass not required within 48 hours of the index endovascular lower extremity revascularization procedure
G9640Documentation of planned hybrid or staged procedure
G9641Major amputation or open surgical bypass required within 48 hours of the index endovascular lower extremity revascularization procedure
G9642Current smoker (e.g., cigarette, cigar, pipe, e-cigarette or marijuana)
G9643Elective surgery
G9644Patients who abstained from smoking prior to anesthesia on the day of surgery or procedure
G9645Patients who did not abstain from smoking prior to anesthesia on the day of surgery or procedure
G9646Patients with 90 day mrs score of 0 to 2
G9647Patients in whom mrs score could not be obtained at 90 day follow-up
G9648Patients with 90 day mrs score greater than 2
G9649Psoriasis 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))
G9650Documentation 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
G9651Psoriasis 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
G9652Patient has been treated with a systemic or biologic medication for psoriasis for at least six months
G9653Patient has not been treated with a systemic or biologic medication for psoriasis for at least six months
G9654Monitored anesthesia care (mac)
G9655A transfer of care protocol or handoff tool/checklist that includes the required key handoff elements is used
G9656Patient transferred directly from anesthetizing location to pacu or other non-icu location
G9657Transfer of care during an anesthetic or to the intensive care unit
G9658A transfer of care protocol or handoff tool/checklist that includes the required key handoff elements is not used
G9659Patients greater than or equal to 86 years of age who underwent a screening colonoscopy and did not have a history of colorectal cancer or other valid medical reason for the colonoscopy, including: iron deficiency anemia, lower gastrointestinal bleeding, crohn’s disease (i.e., regional enteritis), familial adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease, ulcerative colitis, abnormal finding of gastrointestinal tract, or changes in bowel habits
G9660Documentation of medical reason(s) for a colonoscopy performed on a patient greater than or equal to 86 years of age (e.g., iron deficiency anemia, lower gastrointestinal bleeding, crohn’s disease (i.e., regional enteritis), familial history of adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease, ulcerative colitis, abnormal finding of gastrointestinal tract, or changes in bowel habits)
G9661Patients greater than or equal to 86 years of age who received a colonoscopy for an assessment of signs/symptoms of gi tract illness, and/or because the patient meets high risk criteria, and/or to follow-up on previously diagnosed advanced lesions
G9662Previously diagnosed or have a diagnosis of clinical ascvd, including ascvd procedure
G9663Any ldl-c laboratory result >= 190 mg/dl
G9664Patients who are currently statin therapy users or received an order (prescription) for statin therapy
G9665Patients who are not currently statin therapy users or did not receive an order (prescription) for statin therapy
G9666Patient’s highest fasting or direct ldl-c laboratory test result in the measurement period or two years prior to the beginning of the measurement period is 70-189 mg/dl
  
Continued 
G9667Documentation 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)
G9669I intend to report the multiple chronic conditions measures group
G9670All quality actions for the applicable measures in the multiple chronic conditions measures group have been performed for this patient
G9671I intend to report the diabetic retinopathy measures group
G9672All quality actions for the applicable measures in the diabetic retinopathy measures group have been performed for this patient
G9673I intend to report the cardiovascular prevention measures group
G9674Patients with clinical ascvd diagnosis
G9675Patients who have ever had a fasting or direct laboratory result of ldl-c = 190 mg/dl
G9676Patients 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
G9677All quality actions for the applicable measures in the cardiovascular prevention measures group have been performed for this patient
G9678Oncology 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
G9679This code is for onsite acute care treatment of a nursing facility resident with pneumonia; may only be billed once per day per beneficiary
G9680This code is for onsite acute care treatment of a nursing facility resident with chf; may only be billed once per day per beneficiary
G9681This code is for onsite acute care treatment of a resident with copd or asthma; may only be billed once per day per beneficiary
G9682This 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
G9683Facility 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
G9684This 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
G9685Physician 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
G9686Onsite 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
G9687Hospice services provided to patient any time during the measurement period
G9688Patients using hospice services any time during the measurement period
G9689Patient admitted for performance of elective carotid intervention
G9690Patient receiving hospice services any time during the measurement period
G9691Patient had hospice services any time during the measurement period
G9692Hospice services received by patient any time during the measurement period
G9693Patient use of hospice services any time during the measurement period
G9694Hospice services utilized by patient any time during the measurement period
G9695Long-acting inhaled bronchodilator prescribed
G9696Documentation of medical reason(s) for not prescribing a long-acting inhaled bronchodilator (e.g., patient intolerance or history of side effects)
G9697Documentation of patient reason(s) for not prescribing a long-acting inhaled bronchodilator   Discontinued
G9698Documentation of system reason(s) for not prescribing a long-acting inhaled bronchodilator (e.g., cost of treatment or lack of insurance)
G9699Long-acting inhaled bronchodilator not prescribed, reason not otherwise specified
G9700Patients who use hospice services any time during the measurement period
G9701Children who are taking antibiotics in the 30 days prior to the date of the encounter during which the diagnosis was established
G9702Patients who use hospice services any time during the measurement period
G9703Episodes where the patient is taking antibiotics (table 1) in the 30 days prior to the episode date
G9704Ajcc breast cancer stage i: t1 mic or t1a documented
G9705Ajcc breast cancer stage i: t1b (tumor > 0.5 cm but <= 1 cm in greatest dimension) documented
G9706Low (or very low) risk of recurrence, prostate cancer
G9707Patient received hospice services any time during the measurement period
G9708Women 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
G9709Hospice services used by patient any time during the measurement period
G9710Patient was provided hospice services any time during the measurement period
G9711Patients with a diagnosis or past history of total colectomy or colorectal cancer
G9712Documentation 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
G9713Patients who use hospice services any time during the measurement period
G9714Patient is using hospice services any time during the measurement period
G9715Patients who use hospice services any time during the measurement period   Discontinued
G9716Bmi is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reason
G9717Documentation stating the patient has had a diagnosis of bipolar disorder
G9718Hospice services for patient provided any time during the measurement period
G9719Patient is not ambulatory, bed ridden, immobile, confined to chair, wheelchair bound, dependent on helper pushing wheelchair, independent in wheelchair or minimal help in wheelchair
G9720Hospice services for patient occurred any time during the measurement period
G9721Patient not ambulatory, bed ridden, immobile, confined to chair, wheelchair bound, dependent on helper pushing wheelchair, independent in wheelchair or minimal help in wheelchair
G9722Documented 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
G9723Hospice services for patient received any time during the measurement period
G9724Patients who had documentation of use of anticoagulant medications overlapping the measurement year
G9725Patients who use hospice services any time during the measurement period   Discontinued
G9726Patient refused to participate
G9727Patient unable to complete the lepf prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
G9728Patient refused to participate
G9729Patient unable to complete the lepf prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
G9730Patient refused to participate
G9731Patient unable to complete the lepf prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
G9732Patient refused to participate
G9733Patient 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
G9734Patient refused to participate
G9735Patient 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
G9736Patient refused to participate
G9737Patient 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
G9738Patient refused to participate
G9739Patient 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
G9740Hospice services given to patient any time during the measurement period
G9741Patients who use hospice services any time during the measurement period
G9742Psychiatric symptoms assessed
G9743Psychiatric symptoms not assessed, reason not otherwise specified
G9744Patient not eligible due to active diagnosis of hypertension
G9745Documented reason for not screening or recommending a follow-up for high blood pressure
G9746Patient has mitral stenosis or prosthetic heart valves or patient has transient or reversible cause of af (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac surgery)
G9747Patient is undergoing palliative dialysis with a catheter
G9748Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant
G9749Patient is undergoing palliative dialysis with a catheter
G9750Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant
G9751Patient died at any time during the 24-month measurement period
G9752Emergency surgery
G9753Documentation 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)
G9754A finding of an incidental pulmonary nodule
G9755Documentation 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)
G9756Surgical procedures that included the use of silicone oil
G9757Surgical procedures that included the use of silicone oil
G9758Patient in hospice at any time during the measurement period
G9759History of preoperative posterior capsule rupture
G9760Patients who use hospice services any time during the measurement period
G9761Patients who use hospice services any time during the measurement period
G9762Patient 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
G9763Patient 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
G9764Patient has been treated with a systemic medication for psoriasis vulgaris
G9765Documentation 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
G9766Patients who are transferred from one institution to another with a known diagnosis of cva for endovascular stroke treatment
G9767Hospitalized patients with newly diagnosed cva considered for endovascular stroke treatment
G9768Patients who utilize hospice services any time during the measurement period
G9769Patient had a bone mineral density test in the past two years or received osteoporosis medication or therapy in the past 12 months
G9770Peripheral nerve block (pnb)
G9771At least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) achieved within the 30 minutes immediately before or 15 minutes immediately after anesthesia end time
G9772Documentation of medical reason(s) for not achieving at least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) within the 30 minutes immediately before or 15 minutes immediately after anesthesia end time (e.g., emergency cases, intentional hypothermia, etc.)
G9773At least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) not achieved within the 30 minutes immediately before or 15 minutes immediately after anesthesia end time, reason not given
G9774Patients who have had a hysterectomy
G9775Patient received at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively
G9776Documentation 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)
G9777Patient did not receive at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively
G9778Patients who have a diagnosis of pregnancy at any time during the measurement period
G9779Patients who are breastfeeding at any time during the performance period
G9780Patients who have a diagnosis of rhabdomyolysis at any time during the performance period
G9781Documentation of medical reason(s) for not currently being a statin therapy user or receiving an order (prescription) for statin therapy (e.g., patients with statin-associated muscle symptoms or an allergy to statin medication therapy, patients who are receiving palliative or hospice care, patients with active liver disease or hepatic disease or insufficiency, patients with end stage renal disease [esrd], or other medical reasons)
G9782History of or active diagnosis of familial hypercholesterolemia
G9783Documentation 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
G9784Pathologists/dermatopathologists providing a second opinion on a biopsy
G9785Pathology 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
G9786Pathology 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
G9787Patient alive as of the last day of the measurement year
G9788Most recent bp is less than or equal to 140/90 mm hg
G9789Blood pressure recorded during inpatient stays, emergency room visits, or urgent care visits
G9790Most recent bp is greater than 140/90 mm hg, or blood pressure not documented
G9791Most recent tobacco status is tobacco free
G9792Most recent tobacco status is not tobacco free
G9793Patient is currently on a daily aspirin or other antiplatelet
G9794Documentation 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)
G9795Patient is not currently on a daily aspirin or other antiplatelet
G9796Patient is currently on a statin therapy
G9797Patient is not on a statin therapy
G9798Discharge(s) for ami between july 1 of the year prior measurement period to june 30 of the measurement period
G9799Patients 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
G9800Patients who are identified as having an intolerance or allergy to beta-blocker therapy
G9801Hospitalizations in which the patient was transferred directly to a non-acute care facility for any diagnosis
G9802Patients who use hospice services any time during the measurement period
G9803Patient prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami
G9804Patient was not prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami
G9805Patients who use hospice services any time during the measurement period
G9806Patients who received cervical cytology or an hpv test
G9807Patients who did not receive cervical cytology or an hpv test
G9808Any patients who had no asthma controller medications dispensed during the measurement year
G9809Patients who use hospice services any time during the measurement period
G9810Patient achieved a pdc of at least 75% for their asthma controller medication
G9811Patient did not achieve a pdc of at least 75% for their asthma controller medication
G9812Patient 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
G9813Patient did not die within 30 days of the procedure or during the index hospitalization
G9814Death occurring during the index acute care hospitalization
G9815Death did not occur during the index acute care hospitalization
G9816Death occurring after discharge from the hospital but within 30 days post procedure
G9817Death did not occur after discharge from the hospital within 30 days post procedure
G9818Documentation of sexual activity
G9819Patients who use hospice services any time during the measurement period
G9820Documentation of a chlamydia screening test with proper follow-up
G9821No documentation of a chlamydia screening test with proper follow-up
G9822Patients who had an endometrial ablation procedure during the 12 months prior to the index date (exclusive of the index date)
G9823Endometrial sampling or hysteroscopy with biopsy and results documented during the 12 months prior to the index date (exclusive of the index date) of the endometrial ablation
G9824Endometrial sampling or hysteroscopy with biopsy and results not documented during the 12 months prior to the index date (exclusive of the index date) of the endometrial ablation
G9825Her-2/neu negative or undocumented/unknown
G9826Patient transferred to practice after initiation of chemotherapy
G9827Her2-targeted therapies not administered during the initial course of treatment
G9828Her2-targeted therapies administered during the initial course of treatment
G9829Breast adjuvant chemotherapy administered
G9830Her-2/neu positive
G9831Ajcc stage at breast cancer diagnosis = ii or iii
G9832Ajcc stage at breast cancer diagnosis = i (ia or ib) and t-stage at breast cancer diagnosis does not equal = t1, t1a, t1b
G9833Patient transfer to practice after initiation of chemotherapy
G9834Patient has metastatic disease at diagnosis
G9835Trastuzumab administered within 12 months of diagnosis
G9836Reason for not administering trastuzumab documented (e.g. patient declined, patient died, patient transferred, contraindication or other clinical exclusion, neoadjuvant chemotherapy or radiation not complete)
G9837Trastuzumab not administered within 12 months of diagnosis
G9838Patient has metastatic disease at diagnosis
G9839Anti-egfr monoclonal antibody therapy
G9840Ras (kras and nras) gene mutation testing performed before initiation of anti-egfr moab
G9841Ras (kras and nras) gene mutation testing not performed before initiation of anti-egfr moab
G9842Patient has metastatic disease at diagnosis
G9843Ras (kras or nras) gene mutation
G9844Patient did not receive anti-egfr monoclonal antibody therapy
G9845Patient received anti-egfr monoclonal antibody therapy
G9846Patients who died from cancer
G9847Patient received systemic cancer-directed therapy in the last 14 days of life
G9848Patient did not receive systemic cancer-directed therapy in the last 14 days of life
G9849Patients who died from cancer
G9850Patient had more than one emergency department visit in the last 30 days of life
G9851Patient had one or less emergency department visits in the last 30 days of life
G9852Patients who died from cancer   Discontinued
G9853Patient admitted to the icu in the last 30 days of life   Discontinued
G9854Patient was not admitted to the icu in the last 30 days of life   Discontinued
G9855Patients who died from cancer
G9856Patient was not admitted to hospice
G9857Patient admitted to hospice
G9858Patient enrolled in hospice
G9859Patients who died from cancer
G9860Patient spent less than three days in hospice care
G9861Patient spent greater than or equal to three days in hospice care
G9862Documentation 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)
G9868Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, less than 10 minutes
G9869Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, 10-20 minutes
G9870Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, more than 20 minutes
G9873First 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
G9874Four 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
G9875Nine 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
G9876Two 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
G9877Two 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
G9878Two 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
G9879Two 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
G9880The 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
G9881The 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
G9882Two 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
G9883Two 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
G9884Two 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
G9885Two 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
G9886Behavioral counseling for diabetes prevention, in-person, group, 60 minutes   New
G9887Behavioral counseling for diabetes prevention, distance learning, 60 minutes   New
G9888Maintenance 5% wl from baseline weight in months 7-12   New
G9890Bridge 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
G9891Mdpp 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)
G9892Documentation of patient reason(s) for not performing a dilated macular examination
G9893Dilated macular exam was not performed, reason not otherwise specified
G9894Androgen deprivation therapy prescribed/administered in combination with external beam radiotherapy to the prostate
G9895Documentation of medical reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate (e.g., salvage therapy)
G9896Documentation of patient reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate
G9897Patients who were not prescribed/administered androgen deprivation therapy in combination with external beam radiotherapy to the prostate, reason not given
G9898Patients age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the measurement period
G9899Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results documented and reviewed
G9900Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results were not documented and reviewed, reason not otherwise specified
G9901Patient age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the measurement period
G9902Patient screened for tobacco use and identified as a tobacco user
G9903Patient screened for tobacco use and identified as a tobacco non-user
G9904Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)
G9905Patient not screened for tobacco use
G9906Patient identified as a tobacco user received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy)
G9907Documentation of medical reason(s) for not providing tobacco cessation intervention on the date of the encounter or within the previous 12 months (e.g., limited life expectancy, other medical reason)
G9908Patient identified as tobacco user did not receive tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy)
G9909Documentation of medical reason(s) for not providing tobacco cessation intervention on the date of the encounter or within the previous 12 months if identified as a tobacco user (e.g., limited life expectancy, other medical reason)
G9910Patients age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period
G9911Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer before or after neoadjuvant systemic therapy
G9912Hepatitis b virus (hbv) status assessed and results interpreted prior to initiating anti-tnf (tumor necrosis factor) therapy
G9913Hepatitis b virus (hbv) status not assessed and results interpreted prior to initiating anti-tnf (tumor necrosis factor) therapy, reason not otherwise specified
G9914Patient initiated an anti-tnf agent
G9915No record of hbv results documented
G9916Functional status performed once in the last 12 months
G9917Documentation of advanced stage dementia and caregiver knowledge is limited
G9918Functional status not performed, reason not otherwise specified
G9919Screening performed and positive and provision of recommendations
G9920Screening performed and negative
G9921No screening performed, partial screening performed or positive screen without recommendations and reason is not given or otherwise specified
G9922Safety concerns screen provided and if positive then documented mitigation recommendations
G9923Safety concerns screen provided and negative
G9924Documentation 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)
G9925Safety concerns screening not provided, reason not otherwise specified
G9926Safety concerns screening positive screen is without provision of mitigation recommendations, including but not limited to referral to other resources
G9927Documentation of system reason(s) for not prescribing an fda-approved anticoagulation due to patient being currently enrolled in a clinical trial related to af/atrial flutter treatment   Discontinued
G9928Fda-approved anticoagulant not prescribed, reason not given
G9929Patient with transient or reversible cause of af (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac surgery)
G9930Patients who are receiving comfort care only
G9931Documentation of cha2ds2-vasc risk score of 0 or 1 for men; or 0, 1, or 2 for women
G9932Documentation 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)
G9933Adenoma(s) or colorectal cancer detected during screening colonoscopy
G9934Documentation that neoplasm detected is only diagnosed as traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma
G9935Adenoma(s) or colorectal cancer not detected during screening colonoscopy
G9936Surveillance colonoscopy – personal history of colonic polyps, colon cancer, or other malignant neoplasm of rectum, rectosigmoid junction, and anus
G9937Diagnostic colonoscopy
G9938Patients aged 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the six months prior to the measurement period through december 31 of the measurement period
G9939Pathologists/dermatopathologists is the same clinician who performed the biopsy
G9940Documentation 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)
G9941Back pain was measured by the visual analog scale (vas) within three months preoperatively and at three months (6 – 20 weeks) postoperatively
G9942Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminectomy
G9943Back pain was not measured by the visual analog scale (vas) or numeric pain scale at three months (6 – 20 weeks) postoperatively
G9944Back pain was measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively
G9945Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis
G9946Back pain was not measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively
G9947Leg pain was measured by the visual analog scale (vas) within three months preoperatively and at three months (6 to 20 weeks) postoperatively
G9948Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminectomy
G9949Leg pain was not measured by the visual analog scale (vas) or numeric pain scale at three months (6 – 20 weeks) postoperatively
G9954Patient exhibits 2 or more risk factors for post-operative vomiting
G9955Cases in which an inhalational anesthetic is used only for induction
G9956Patient received combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively
G9957Documentation 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)
G9958Patient did not receive combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively
G9959Systemic antimicrobials not prescribed
G9960Documentation of medical reason(s) for prescribing systemic antimicrobials
G9961Systemic antimicrobials prescribed
G9962Embolization endpoints are documented separately for each embolized vessel and ovarian artery angiography or embolization performed in the presence of variant uterine artery anatomy
G9963Embolization 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
G9964Patient received at least one well-child visit with a pcp during the performance period
G9965Patient did not receive at least one well-child visit with a pcp during the performance period
G9966Children who were screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report
G9967Children who were not screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report
G9968Patient was referred to another clinician or specialist during the measurement period
G9969Clinician who referred the patient to another clinician received a report from the clinician to whom the patient was referred
G9970Clinician who referred the patient to another clinician did not receive a report from the clinician to whom the patient was referred
G9974Dilated 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
G9975Documentation of medical reason(s) for not performing a dilated macular examination
G9978Remote 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
G9979Remote 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
G9980Remote 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
G9981Remote 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
G9982Remote 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
G9983Remote 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
G9984Remote 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
G9985Remote 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
G9986Remote 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
G9987Bundled 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
G9988Palliative care services provided to patient any time during the measurement period
G9989Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., adverse reaction to vaccine)
G9990Patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period
G9991Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period
G9992Palliative care services used by patient any time during the measurement period
G9993Patient was provided palliative care services any time during the measurement period
G9994Patient is using palliative care services any time during the measurement period
G9995Patients who use palliative care services any time during the measurement period   Discontinued
G9996Documentation stating the patient has received or is currently receiving palliative or hospice care
G9997Documentation of patient pregnancy anytime during the measurement period prior to and including the current encounter
G9998Documentation of medical reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., last colonoscopy incomplete, last colonoscopy had inadequate prep, piecemeal removal of adenomas, or sessile serrated polyps >= 20 mm in size, last colonoscopy found greater than 10 adenomas, lower gastrointestinal bleeding, or patient at high risk for colon cancer due to underlying medical history ([i.e. crohn’s disease, ulcerative colitis, personal or family history of colon cancer, hereditary colorectal cancer syndromes])
G9999Documentation of system reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., unable to locate previous colonoscopy report, previous colonoscopy report was incomplete)

What are HCPCS G Codes?

HCPCS G codes, also known as temporary codes for Procedures / Professional Services. These are alphanumeric codes used to identify and report procedures and professional services provided by healthcare practitioners. These codes serve as a standardized language for communication between healthcare providers, payers, and other Medical Billers.

While CPT codes primarily cover physician services, HCPCS G-codes extend their reach to include procedures and services provided by other healthcare professionals and entities. G-codes are often used for services that do not have a corresponding CPT code or when additional specificity is required.

Format and Composition

G codes typically consist of one alphabetical character followed by four numeric characters (e.g., G1234). The alphabetical character signifies the type of service, and the numeric characters provide further specificity.

Common Categories of HCPCS G Codes

Following are the common G Codes categories.

Evaluation and Management Services

G codes in this category cover a range of evaluation and management services, including office visits, consultations, and preventive care.

Anesthesia Services

Anesthesia-related G codes are used to report the administration of anesthesia during surgical or diagnostic procedures.

Surgical Services

This category encompasses G codes for various surgical procedures, including both minor and major interventions.

Radiology Services

G codes related to radiology services cover diagnostic imaging procedures, such as X-rays, CT scans, and MRIs.

Pathology and Laboratory Services

G codes are assigned to procedures involving pathology and laboratory testing, aiding in the diagnosis and monitoring of medical conditions.

Medicine Services

This category includes G-codes for services not classified under other major code-sets, such as immunizations, vaccinations, and certain preventive measures.

Conclusion

In conclusion, mastering G-Codes is paramount for healthcare professionals seeking to navigate the intricate landscape of medical billing and coding. Navigate our guide with confidence; furthermore, Check our complete HCPCS Codes Lookup to enhance your coding proficiency. Moreover, Empower yourself and your healthcare organization with the knowledge required for efficient billing, compliance, and optimal patient care.

Similar Posts

Leave a Reply

Your email address will not be published. Required fields are marked *