HCPCS Code: G0008
Short Description: Admin influenza virus vac
Long Description: Administration of influenza virus vaccine
HCPCS Code: G0009
Short Description: Admin pneumococcal vaccine
Long Description: Administration of pneumococcal vaccine
HCPCS Code: G0010
Short Description: Admin hepatitis b vaccine
Long Description: Administration of hepatitis b vaccine
HCPCS Code: G0027
Short Description: Semen analysis
Long Description: Semen analysis; presence and/or motility of sperm excluding huhner
HCPCS Code: G0101
Short Description: Ca screen;pelvic/breast exam
Long Description: Cervical or vaginal cancer screening; pelvic and clinical breast examination
HCPCS Code: G0102
Short Description: Prostate ca screening; dre
Long Description: Prostate cancer screening; digital rectal examination
HCPCS Code: G0103
Short Description: Psa screening
Long Description: Prostate cancer screening; prostate specific antigen test (psa)
HCPCS Code: G0104
Short Description: Ca screen;flexi sigmoidscope
Long Description: Colorectal cancer screening; flexible sigmoidoscopy
HCPCS Code: G0105
Short Description: Colorectal scrn; hi risk ind
Long Description: Colorectal cancer screening; colonoscopy on individual at high risk
HCPCS Code: G0106
Short Description: Colon ca screen;barium enema
Long Description: Colorectal cancer screening; alternative to g0104, screening sigmoidoscopy, barium enema
HCPCS Code: G0108
Short Description: Diab manage trn per indiv
Long Description: Diabetes outpatient self-management training services, individual, per 30 minutes
HCPCS Code: G0109
Short Description: Diab manage trn ind/group
Long Description: Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes
HCPCS Code: G0117
Short Description: Glaucoma scrn hgh risk direc
Long Description: Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist
HCPCS Code: G0118
Short Description: Glaucoma scrn hgh risk direc
Long Description: Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist
HCPCS Code: G0120
Short Description: Colon ca scrn; barium enema
Long Description: Colorectal cancer screening; alternative to g0105, screening colonoscopy, barium enema.
HCPCS Code: G0121
Short Description: Colon ca scrn not hi rsk ind
Long Description: Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk
HCPCS Code: G0122
Short Description: Colon ca scrn; barium enema
Long Description: Colorectal cancer screening; barium enema
HCPCS Code: G0123
Short Description: Screen cerv/vag thin layer
Long Description: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision
HCPCS Code: G0124
Short Description: Screen c/v thin layer by md
Long Description: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician
HCPCS Code: G0127
Short Description: Trim nail(s)
Long Description: Trimming of dystrophic nails, any number
HCPCS Code: G0128
Short Description: Corf skilled nursing service
Long Description: Direct (face-to-face with patient) skilled nursing services of a registered nurse provided in a comprehensive outpatient rehabilitation facility, each 10 minutes beyond the first 5 minutes
HCPCS Code: G0129
Short Description: Partial hosp prog service
Long Description: Occupational therapy services requiring the skills of a qualified occupational therapist, furnished as a component of a partial hospitalization treatment program, per session (45 minutes or more)
HCPCS Code: G0130
Short Description: Single energy x-ray study
Long Description: Single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
HCPCS Code: G0141
Short Description: Scr c/v cyto,autosys and md
Long Description: Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician
HCPCS Code: G0143
Short Description: Scr c/v cyto,thinlayer,rescr
Long Description: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under physician supervision
HCPCS Code: G0144
Short Description: Scr c/v cyto,thinlayer,rescr
Long Description: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervision
HCPCS Code: G0145
Short Description: Scr c/v cyto,thinlayer,rescr
Long Description: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision
HCPCS Code: G0147
Short Description: Scr c/v cyto, automated sys
Long Description: Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision
HCPCS Code: G0148
Short Description: Scr c/v cyto, autosys, rescr
Long Description: Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening
HCPCS Code: G0151
Short Description: Hhcp-serv of pt,ea 15 min
Long Description: Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes
HCPCS Code: G0152
Short Description: Hhcp-serv of ot,ea 15 min
Long Description: Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes
HCPCS Code: G0153
Short Description: Hhcp-svs of s/l path,ea 15mn
Long Description: Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
HCPCS Code: G0154
Short Description: Hhcp-svs of rn,ea 15 min
Long Description: Direct skilled nursing services of a licensed nurse (lpn or rn) in the home health or hospice setting, each 15 minutes
HCPCS Code: G0155
Short Description: Hhcp-svs of csw,ea 15 min
Long Description: Services of clinical social worker in home health or hospice settings, each 15 minutes
HCPCS Code: G0156
Short Description: Hhcp-svs of aide,ea 15 min
Long Description: Services of home health/hospice aide in home health or hospice settings, each 15 minutes
HCPCS Code: G0157
Short Description: Hhc pt assistant ea 15
Long Description: Services performed by a qualified physical therapist assistant in the home health or hospice setting, each 15 minutes
HCPCS Code: G0158
Short Description: Hhc ot assistant ea 15
Long Description: Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes
HCPCS Code: G0159
Short Description: Hhc pt maint ea 15 min
Long Description: Services performed by a qualified physical therapist, in the home health setting, in the establishment or delivery of a safe and effective physical therapy maintenance program, each 15 minutes
HCPCS Code: G0160
Short Description: Hhc occup therapy ea 15
Long Description: Services performed by a qualified occupational therapist, in the home health setting, in the establishment or delivery of a safe and effective occupational therapy maintenance program, each 15 minutes
HCPCS Code: G0161
Short Description: Hhc slp ea 15 min
Long Description: Services performed by a qualified speech-language pathologist, in the home health setting, in the establishment or delivery of a safe and effective speech-language pathology maintenance program, each 15 minutes
HCPCS Code: G0162
Short Description: Hhc rn e&m plan svs, 15 min
Long Description: Skilled services by a registered nurse (rn) for management and evaluation of the plan of care; each 15 minutes (the patient's underlying condition or complication requires an rn to ensure that essential non-skilled care achieves its purpose in the home health or hospice setting)
HCPCS Code: G0163
Short Description: Hhc lpn/rn obs/asses ea 15
Long Description: Skilled services of a licensed nurse (lpn or rn) for the observation and assessment of the patient's condition, each 15 minutes (the change in the patient's condition requires skilled nursing personnel to identify and evaluate the patient's need for possible modification of treatment in the home health or hospice setting)
HCPCS Code: G0164
Short Description: Hhc lis nurse train ea 15
Long Description: Skilled services of a licensed nurse (lpn or rn), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes
HCPCS Code: G0166
Short Description: Extrnl counterpulse, per tx
Long Description: External counterpulsation, per treatment session
HCPCS Code: G0168
Short Description: Wound closure by adhesive
Long Description: Wound closure utilizing tissue adhesive(s) only
HCPCS Code: G0173
Short Description: Linear acc stereo radsur com
Long Description: Linear accelerator based stereotactic radiosurgery, complete course of therapy in one session
HCPCS Code: G0175
Short Description: Opps service,sched team conf
Long Description: Scheduled interdisciplinary team conference (minimum of three exclusive of patient care nursing staff) with patient present
HCPCS Code: G0176
Short Description: Opps/php;activity therapy
Long Description: Activity therapy, such as music, dance, art or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more)
HCPCS Code: G0177
Short Description: Opps/php; train & educ serv
Long Description: Training and educational services related to the care and treatment of patient's disabling mental health problems per session (45 minutes or more)
HCPCS Code: G0179
Short Description: Md recertification hha pt
Long Description: Physician re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implementation of the plan of care that meets patient's needs, per re-certification period
HCPCS Code: G0180
Short Description: Md certification hha patient
Long Description: Physician certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implementation of the plan of care that meets patient's needs, per certification period
HCPCS Code: G0181
Short Description: Home health care supervision
Long Description: Physician supervision of a patient receiving medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of laboratory and other studies, communication (including telephone calls) with other health care professionals involved in the patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month, 30 minutes or more
HCPCS Code: G0182
Short Description: Hospice care supervision
Long Description: Physician supervision of a patient under a medicare-approved hospice (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of laboratory and other studies, communication (including telephone calls) with other health care professionals involved in the patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month, 30 minutes or more
HCPCS Code: G0186
Short Description: Dstry eye lesn,fdr vssl tech
Long Description: Destruction of localized lesion of choroid (for example, choroidal neovascularization); photocoagulation, feeder vessel technique (one or more sessions)
HCPCS Code: G0202
Short Description: Screeningmammographydigital
Long Description: Screening mammography, producing direct digital image, bilateral, all views
HCPCS Code: G0204
Short Description: Diagnosticmammographydigital
Long Description: Diagnostic mammography, producing direct 2-d digital image, bilateral, all views
HCPCS Code: G0206
Short Description: Diagnosticmammographydigital
Long Description: Diagnostic mammography, producing direct 2-d digital image, unilateral, all views
HCPCS Code: G0219
Short Description: Pet img wholbod melano nonco
Long Description: Pet imaging whole body; melanoma for non-covered indications
HCPCS Code: G0235
Short Description: Pet not otherwise specified
Long Description: Pet imaging, any site, not otherwise specified
HCPCS Code: G0237
Short Description: Therapeutic procd strg endur
Long Description: Therapeutic procedures to increase strength or endurance of respiratory muscles, face to face, one on one, each 15 minutes (includes monitoring)
HCPCS Code: G0238
Short Description: Oth resp proc, indiv
Long Description: Therapeutic procedures to improve respiratory function, other than described by g0237, one on one, face to face, per 15 minutes (includes monitoring)
HCPCS Code: G0239
Short Description: Oth resp proc, group
Long Description: Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring)
HCPCS Code: G0245
Short Description: Initial foot exam pt lops
Long Description: Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) which must include: (1) the diagnosis of lops, (2) a patient history, (3) a physical examination that consists of at least the following elements: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of a protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear and (4) patient education
HCPCS Code: G0246
Short Description: Followup eval of foot pt lop
Long Description: Follow-up physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) to include at least the following: (1) a patient history, (2) a physical examination that includes: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear, and (3) patient education
HCPCS Code: G0247
Short Description: Routine footcare pt w lops
Long Description: Routine foot care by a physician of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) to include, the local care of superficial wounds (i.e. superficial to muscle and fascia) and at least the following if present: (1) local care of superficial wounds, (2) debridement of corns and calluses, and (3) trimming and debridement of nails
HCPCS Code: G0248
Short Description: Demonstrate use home inr mon
Long Description: Demonstration, prior to initiation of home inr monitoring, for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria, under the direction of a physician; includes: face-to-face demonstration of use and care of the inr monitor, obtaining at least one blood sample, provision of instructions for reporting home inr test results, and documentation of patient's ability to perform testing and report results
HCPCS Code: G0249
Short Description: Provide inr test mater/equip
Long Description: Provision of test materials and equipment for home inr monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; includes: provision of materials for use in the home and reporting of test results to physician; testing not occurring more frequently than once a week; testing materials, billing units of service include 4 tests
HCPCS Code: G0250
Short Description: Md inr test revie inter mgmt
Long Description: Physician review, interpretation, and patient management of home inr testing for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; testing not occurring more frequently than once a week; billing units of service include 4 tests
HCPCS Code: G0251
Short Description: Linear acc based stero radio
Long Description: Linear accelerator based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, maximum five sessions per course of treatment
HCPCS Code: G0252
Short Description: Pet imaging initial dx
Long Description: Pet imaging, full and partial-ring pet scanners only, for initial diagnosis of breast cancer and/or surgical planning for breast cancer (e.g., initial staging of axillary lymph nodes)
HCPCS Code: G0255
Short Description: Current percep threshold tst
Long Description: Current perception threshold/sensory nerve conduction test, (snct) per limb, any nerve
HCPCS Code: G0257
Short Description: Unsched dialysis esrd pt hos
Long Description: Unscheduled or emergency dialysis treatment for an esrd patient in a hospital outpatient department that is not certified as an esrd facility
HCPCS Code: G0259
Short Description: Inject for sacroiliac joint
Long Description: Injection procedure for sacroiliac joint; arthrograpy
HCPCS Code: G0260
Short Description: Inj for sacroiliac jt anesth
Long Description: Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography
HCPCS Code: G0268
Short Description: Removal of impacted wax md
Long Description: Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing
HCPCS Code: G0269
Short Description: Occlusive device in vein art
Long Description: Placement of occlusive device into either a venous or arterial access site, post surgical or interventional procedure (e.g., angioseal plug, vascular plug)
HCPCS Code: G0270
Short Description: Mnt subs tx for change dx
Long Description: Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes
HCPCS Code: G0271
Short Description: Group mnt 2 or more 30 mins
Long Description: Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes
HCPCS Code: G0275
Short Description: Renal angio, cardiac cath
Long Description: Renal angiography, non-selective, one or both kidneys, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of any catheter in the abdominal aorta at or near the origins (ostia) of the renal arteries, injection of dye, flush aortogram, production of permanent images, and radiologic supervision and interpretation (list separately in addition to primary procedure)
HCPCS Code: G0276
Short Description: Pild/placebo control clin tr
Long Description: Blinded procedure for lumbar stenosis, percutaneous image-guided lumbar decompression (pild) or placebo-control, performed in an approved coverage with evidence development (ced) clinical trial
HCPCS Code: G0277
Short Description: Hbot, full body chamber, 30m
Long Description: Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval
HCPCS Code: G0278
Short Description: Iliac art angio,cardiac cath
Long Description: Iliac and/or femoral artery angiography, non-selective, bilateral or ipsilateral to catheter insertion, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of the catheter in the distal aorta or ipsilateral femoral or iliac artery, injection of dye, production of permanent images, and radiologic supervision and interpretation (list separately in addition to primary procedure)
HCPCS Code: G0279
Short Description: Tomosynthesis, mammo
Long Description: Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to g0204 or g0206)
HCPCS Code: G0281
Short Description: Elec stim unattend for press
Long Description: Electrical stimulation, (unattended), to one or more areas, for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers, and venous statsis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of care
HCPCS Code: G0282
Short Description: Elect stim wound care not pd
Long Description: Electrical stimulation, (unattended), to one or more areas, for wound care other than described in g0281
HCPCS Code: G0283
Short Description: Elec stim other than wound
Long Description: Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care
HCPCS Code: G0288
Short Description: Recon, cta for surg plan
Long Description: Reconstruction, computed tomographic angiography of aorta for surgical planning for vascular surgery
HCPCS Code: G0289
Short Description: Arthro, loose body + chondro
Long Description: Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage (chondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee
HCPCS Code: G0290
Short Description: Drug-eluting stents, single
Long Description: Transcatheter placement of a drug eluting intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; single vessel
HCPCS Code: G0291
Short Description: Drug-eluting stents,each add
Long Description: Transcatheter placement of a drug eluting intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; each additional vessel
HCPCS Code: G0293
Short Description: Non-cov surg proc,clin trial
Long Description: Noncovered surgical procedure(s) using conscious sedation, regional, general or spinal anesthesia in a medicare qualifying clinical trial, per day
HCPCS Code: G0294
Short Description: Non-cov proc, clinical trial
Long Description: Noncovered procedure(s) using either no anesthesia or local anesthesia only, in a medicare qualifying clinical trial, per day
HCPCS Code: G0295
Short Description: Electromagnetic therapy onc
Long Description: Electromagnetic therapy, to one or more areas, for wound care other than described in g0329 or for other uses
HCPCS Code: G0296
Short Description: Visit to determ ldct elig
Long Description: Counseling visit to discuss need for lung cancer screening (ldct) using low dose ct scan (service is for eligibility determination and shared decision making)
HCPCS Code: G0297
Short Description: Ldct for lung ca screen
Long Description: Low dose ct scan (ldct) for lung cancer screening
HCPCS Code: G0298
Short Description: Hiv combination assay
Long Description: Hiv antigen/antibody, combination assay, screening
HCPCS Code: G0299
Short Description: Hhs/hospice of rn ea 15 min
Long Description: Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes
HCPCS Code: G0300
Short Description: Hhs/hospice of lpn ea 15 min
Long Description: Direct skilled nursing services of a license practical nurse (lpn) in the home health or hospice setting, each 15 minutes
HCPCS Code: G0302
Short Description: Pre-op service lvrs complete
Long Description: Pre-operative pulmonary surgery services for preparation for lvrs, complete course of services, to include a minimum of 16 days of services
HCPCS Code: G0303
Short Description: Pre-op service lvrs 10-15dos
Long Description: Pre-operative pulmonary surgery services for preparation for lvrs, 10 to 15 days of services
HCPCS Code: G0304
Short Description: Pre-op service lvrs 1-9 dos
Long Description: Pre-operative pulmonary surgery services for preparation for lvrs, 1 to 9 days of services
HCPCS Code: G0305
Short Description: Post op service lvrs min 6
Long Description: Post-discharge pulmonary surgery services after lvrs, minimum of 6 days of services
HCPCS Code: G0306
Short Description: Cbc/diffwbc w/o platelet
Long Description: Complete cbc, automated (hgb, hct, rbc, wbc, without platelet count) and automated wbc differential count
HCPCS Code: G0307
Short Description: Cbc without platelet
Long Description: Complete (cbc), automated (hgb, hct, rbc, wbc; without platelet count)
HCPCS Code: G0328
Short Description: Fecal blood scrn immunoassay
Long Description: Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous
HCPCS Code: G0329
Short Description: Electromagntic tx for ulcers
Long Description: Electromagnetic therapy, to one or more areas for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care as part of a therapy plan of care
HCPCS Code: G0333
Short Description: Dispense fee initial 30 day
Long Description: Pharmacy dispensing fee for inhalation drug(s); initial 30-day supply as a beneficiary
HCPCS Code: G0337
Short Description: Hospice evaluation preelecti
Long Description: Hospice evaluation and counseling services, pre-election
HCPCS Code: G0339
Short Description: Robot lin-radsurg com, first
Long Description: Image-guided robotic linear accelerator-based stereotactic radiosurgery, complete course of therapy in one session or first session of fractionated treatment
HCPCS Code: G0340
Short Description: Robt lin-radsurg fractx 2-5
Long Description: Image-guided robotic linear accelerator-based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, second through fifth sessions, maximum five sessions per course of treatment
HCPCS Code: G0341
Short Description: Percutaneous islet celltrans
Long Description: Percutaneous islet cell transplant, includes portal vein catheterization and infusion
HCPCS Code: G0342
Short Description: Laparoscopy islet cell trans
Long Description: Laparoscopy for islet cell transplant, includes portal vein catheterization and infusion
HCPCS Code: G0343
Short Description: Laparotomy islet cell transp
Long Description: Laparotomy for islet cell transplant, includes portal vein catheterization and infusion
HCPCS Code: G0364
Short Description: Bone marrow aspirate &biopsy
Long Description: Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service
HCPCS Code: G0365
Short Description: Vessel mapping hemo access
Long Description: Vessel mapping of vessels for hemodialysis access (services for preoperative vessel mapping prior to creation of hemodialysis access using an autogenous hemodialysis conduit, including arterial inflow and venous outflow)
HCPCS Code: G0372
Short Description: Md service required for pmd
Long Description: Physician service required to establish and document the need for a power mobility device
HCPCS Code: G0378
Short Description: Hospital observation per hr
Long Description: Hospital observation service, per hour
HCPCS Code: G0379
Short Description: Direct refer hospital observ
Long Description: Direct admission of patient for hospital observation care
HCPCS Code: G0380
Short Description: Lev 1 hosp type b ed visit
Long Description: Level 1 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)
HCPCS Code: G0381
Short Description: Lev 2 hosp type b ed visit
Long Description: Level 2 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)
HCPCS Code: G0382
Short Description: Lev 3 hosp type b ed visit
Long Description: Level 3 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)
HCPCS Code: G0383
Short Description: Lev 4 hosp type b ed visit
Long Description: Level 4 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)
HCPCS Code: G0384
Short Description: Lev 5 hosp type b ed visit
Long Description: Level 5 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)
HCPCS Code: G0389
Short Description: Ultrasound exam aaa screen
Long Description: Ultrasound b-scan and/or real time with image documentation; for abdominal aortic aneurysm (aaa) screening
HCPCS Code: G0390
Short Description: Trauma respons w/hosp criti
Long Description: Trauma response team associated with hospital critical care service
HCPCS Code: G0396
Short Description: Alcohol/subs interv 15-30mn
Long Description: Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes
HCPCS Code: G0397
Short Description: Alcohol/subs interv >30 min
Long Description: Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes
HCPCS Code: G0398
Short Description: Home sleep test/type 2 porta
Long Description: Home sleep study test (hst) with type ii portable monitor, unattended; minimum of 7 channels: eeg, eog, emg, ecg/heart rate, airflow, respiratory effort and oxygen saturation
HCPCS Code: G0399
Short Description: Home sleep test/type 3 porta
Long Description: Home sleep test (hst) with type iii portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ecg/heart rate and 1 oxygen saturation
HCPCS Code: G0400
Short Description: Home sleep test/type 4 porta
Long Description: Home sleep test (hst) with type iv portable monitor, unattended; minimum of 3 channels
HCPCS Code: G0402
Short Description: Initial preventive exam
Long Description: Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
HCPCS Code: G0403
Short Description: Ekg for initial prevent exam
Long Description: Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report
HCPCS Code: G0404
Short Description: Ekg tracing for initial prev
Long Description: Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination
HCPCS Code: G0405
Short Description: Ekg interpret & report preve
Long Description: Electrocardiogram, routine ecg with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination
HCPCS Code: G0406
Short Description: Inpt/tele follow up 15
Long Description: Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth
HCPCS Code: G0407
Short Description: Inpt/tele follow up 25
Long Description: Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth
HCPCS Code: G0408
Short Description: Inpt/tele follow up 35
Long Description: Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth
HCPCS Code: G0409
Short Description: Corf related serv 15 mins ea
Long Description: Social work and psychological services, directly relating to and/or furthering the patient's rehabilitation goals, each 15 minutes, face-to-face; individual (services provided by a corf-qualified social worker or psychologist in a corf)
HCPCS Code: G0410
Short Description: Grp psych partial hosp 45-50
Long Description: Group psychotherapy other than of a multiple-family group, in a partial hospitalization setting, approximately 45 to 50 minutes
HCPCS Code: G0411
Short Description: Inter active grp psych parti
Long Description: Interactive group psychotherapy, in a partial hospitalization setting, approximately 45 to 50 minutes
HCPCS Code: G0412
Short Description: Open tx iliac spine uni/bil
Long Description: Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s), unilateral or bilateral for pelvic bone fracture patterns which do not disrupt the pelvic ring includes internal fixation, when performed
HCPCS Code: G0413
Short Description: Pelvic ring fracture uni/bil
Long Description: Percutaneous skeletal fixation of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, (includes ilium, sacroiliac joint and/or sacrum)
HCPCS Code: G0414
Short Description: Pelvic ring fx treat int fix
Long Description: Open treatment of anterior pelvic bone fracture and/or dislocation for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation when performed (includes pubic symphysis and/or superior/inferior rami)
HCPCS Code: G0415
Short Description: Open tx post pelvic fxcture
Long Description: Open treatment of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation, when performed (includes ilium, sacroiliac joint and/or sacrum)
HCPCS Code: G0416
Short Description: Prostate biopsy, any mthd
Long Description: Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method
HCPCS Code: G0417
Short Description: Sat biopsy prostate 21-40
Long Description: Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, 21-40 specimens
HCPCS Code: G0418
Short Description: Sat biopsy prostate 41-60
Long Description: Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, 41-60 specimens
HCPCS Code: G0419
Short Description: Sat biopsy prostate: >60
Long Description: Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, >60 specimens
HCPCS Code: G0420
Short Description: Ed svc ckd ind per session
Long Description: Face-to-face educational services related to the care of chronic kidney disease; individual, per session, per one hour
HCPCS Code: G0421
Short Description: Ed svc ckd grp per session
Long Description: Face-to-face educational services related to the care of chronic kidney disease; group, per session, per one hour
HCPCS Code: G0422
Short Description: Intens cardiac rehab w/exerc
Long Description: Intensive cardiac rehabilitation; with or without continuous ecg monitoring with exercise, per session
HCPCS Code: G0423
Short Description: Intens cardiac rehab no exer
Long Description: Intensive cardiac rehabilitation; with or without continuous ecg monitoring; without exercise, per session
HCPCS Code: G0424
Short Description: Pulmonary rehab w exer
Long Description: Pulmonary rehabilitation, including exercise (includes monitoring), one hour, per session, up to two sessions per day
HCPCS Code: G0425
Short Description: Inpt/ed teleconsult30
Long Description: Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth
HCPCS Code: G0426
Short Description: Inpt/ed teleconsult50
Long Description: Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth
HCPCS Code: G0427
Short Description: Inpt/ed teleconsult70
Long Description: Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth
HCPCS Code: G0428
Short Description: Collagen meniscus implant
Long Description: Collagen meniscus implant procedure for filling meniscal defects (e.g., cmi, collagen scaffold, menaflex)
HCPCS Code: G0429
Short Description: Dermal filler injection(s)
Long Description: Dermal filler injection(s) for the treatment of facial lipodystrophy syndrome (lds) (e.g., as a result of highly active antiretroviral therapy)
HCPCS Code: G0431
Short Description: Drug screen multiple class
Long Description: Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter
HCPCS Code: G0432
Short Description: Eia hiv-1/hiv-2 screen
Long Description: Infectious agent antibody detection by enzyme immunoassay (eia) technique, hiv-1 and/or hiv-2, screening
HCPCS Code: G0433
Short Description: Elisa hiv-1/hiv-2 screen
Long Description: Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening
HCPCS Code: G0434
Short Description: Drug screen multi drug class
Long Description: Drug screen, other than chromatographic; any number of drug classes, by clia waived test or moderate complexity test, per patient encounter
HCPCS Code: G0435
Short Description: Oral hiv-1/hiv-2 screen
Long Description: Infectious agent antibody detection by rapid antibody test, hiv-1 and/or hiv-2, screening
HCPCS Code: G0436
Short Description: Tobacco-use counsel 3-10 min
Long Description: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes
HCPCS Code: G0437
Short Description: Tobacco-use counsel>10min
Long Description: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes
HCPCS Code: G0438
Short Description: Ppps, initial visit
Long Description: Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
HCPCS Code: G0439
Short Description: Ppps, subseq visit
Long Description: Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
HCPCS Code: G0442
Short Description: Annual alcohol screen 15 min
Long Description: Annual alcohol misuse screening, 15 minutes
HCPCS Code: G0443
Short Description: Brief alcohol misuse counsel
Long Description: Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes
HCPCS Code: G0444
Short Description: Depression screen annual
Long Description: Annual depression screening, 15 minutes
HCPCS Code: G0445
Short Description: High inten beh couns std 30m
Long Description: High intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual, includes: education, skills training and guidance on how to change sexual behavior; performed semi-annually, 30 minutes
HCPCS Code: G0446
Short Description: Intens behave ther cardio dx
Long Description: Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes
HCPCS Code: G0447
Short Description: Behavior counsel obesity 15m
Long Description: Face-to-face behavioral counseling for obesity, 15 minutes
HCPCS Code: G0448
Short Description: Place perm pacing cardiovert
Long Description: Insertion or replacement of a permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber with insertion of pacing electrode, cardiac venous system, for left ventricular pacing
HCPCS Code: G0451
Short Description: Devlopment test interpt&rep
Long Description: Development testing, with interpretation and report, per standardized instrument form
HCPCS Code: G0452
Short Description: Molecular pathology interpr
Long Description: Molecular pathology procedure; physician interpretation and report
HCPCS Code: G0453
Short Description: Cont intraop neuro monitor
Long Description: Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition to primary procedure)
HCPCS Code: G0454
Short Description: Md document visit by npp
Long Description: Physician documentation of face-to-face visit for durable medical equipment determination performed by nurse practitioner, physician assistant or clinical nurse specialist
HCPCS Code: G0455
Short Description: Fecal microbiota prep instil
Long Description: Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen
HCPCS Code: G0456
Short Description: Neg pre wound <=50 sq cm
Long Description: Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area less than or equal to 50 square centimeters
HCPCS Code: G0457
Short Description: Neg pres wound >50 sq cm
Long Description: Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area greater than 50 square centimeters
HCPCS Code: G0458
Short Description: Ldr prostate brachy comp rat
Long Description: Low dose rate (ldr) prostate brachytherapy services, composite rate
HCPCS Code: G0459
Short Description: Telehealth inpt pharm mgmt
Long Description: Inpatient telehealth pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy
HCPCS Code: G0460
Short Description: Autologous prp for ulcers
Long Description: Autologous platelet rich plasma for chronic wounds/ulcers, including phlebotomy, centrifugation, and all other preparatory procedures, administration and dressings, per treatment
HCPCS Code: G0461
Short Description: Immunohisto/cyto chem 1st st
Long Description: Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stain
HCPCS Code: G0462
Short Description: Immunohisto/cyto chem add
Long Description: Immunohistochemistry or immunocytochemistry, per specimen; each additional single or multiplex antibody stain (list separately in addition to code for primary procedure)
HCPCS Code: G0463
Short Description: Hospital outpt clinic visit
Long Description: Hospital outpatient clinic visit for assessment and management of a patient
HCPCS Code: G0464
Short Description: Colorec ca scr, sto bas dna
Long Description: Colorectal cancer screening; stool-based dna and fecal occult hemoglobin (e.g., kras, ndrg4 and bmp3)
HCPCS Code: G0466
Short Description: Fqhc visit new patient
Long Description: Federally qualified health center (fqhc) visit, new patient; a medically-necessary, face-to-face encounter (one-on-one) between a new patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit
HCPCS Code: G0467
Short Description: Fqhc visit, estab pt
Long Description: Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit
HCPCS Code: G0468
Short Description: Fqhc visit, ippe or awv
Long Description: Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv
HCPCS Code: G0469
Short Description: Fqhc visit, mh new pt
Long Description: Federally qualified health center (fqhc) visit, mental health, new patient; a medically-necessary, face-to-face mental health encounter (one-on-one) between a new patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a mental health visit
HCPCS Code: G0470
Short Description: Fqhc visit, mh estab pt
Long Description: Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a mental health visit
HCPCS Code: G0471
Short Description: Ven blood coll snf/hha
Long Description: Collection of venous blood by venipuncture or urine sample by catheterization from an individual in a skilled nursing facility (snf) or by a laboratory on behalf of a home health agency (hha)
HCPCS Code: G0472
Short Description: Hep c screen high risk/other
Long Description: Hepatitis c antibody screening, for individual at high risk and other covered indication(s)
HCPCS Code: G0473
Short Description: Group behave couns 2-10
Long Description: Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes
HCPCS Code: G0475
Short Description: Hiv combination assay
Long Description: Hiv antigen/antibody, combination assay, screening
HCPCS Code: G0476
Short Description: Hpv combo assay ca screen
Long Description: Infectious agent detection by nucleic acid (dna or rna); human papillomavirus (hpv), high-risk types (eg, 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
HCPCS Code: G0908
Short Description: Hgb > 12 g/dl
Long Description: Most recent hemoglobin (hgb) level > 12.0 g/dl
HCPCS Code: G0909
Short Description: Hbg not doc
Long Description: Hemoglobin level measurement not documented, reason not given
HCPCS Code: G0910
Short Description: Hgb <= 12 g/dl
Long Description: Most recent hemoglobin level <= 12.0 g/dl
HCPCS Code: G0911
Short Description: Assess activity symptoms
Long Description: Assessed level of activity and symptoms
HCPCS Code: G0912
Short Description: No assess activity symptoms
Long Description: Level of activity and symptoms not assessed
HCPCS Code: G0913
Short Description: Improve visual funct
Long Description: Improvement in visual function achieved within 90 days following cataract surgery
HCPCS Code: G0914
Short Description: Survey not complete
Long Description: Patient care survey was not completed by patient
HCPCS Code: G0915
Short Description: No improve visual funct
Long Description: Improvement in visual function not achieved within 90 days following cataract surgery
HCPCS Code: G0916
Short Description: Satisfy with care
Long Description: Satisfaction with care achieved within 90 days following cataract surgery
HCPCS Code: G0917
Short Description: Satisfy survey not complete
Long Description: Patient satisfaction survey was not completed by patient
HCPCS Code: G0918
Short Description: No satisfy with care
Long Description: Satisfaction with care not achieved within 90 days following cataract surgery
HCPCS Code: G0919
Short Description: Flu immunize not avail
Long Description: Influenza immunization ordered or recommended (to be given at alternate location or alternate provider); vaccine not available at time of visit
HCPCS Code: G0920
Short Description: Type loc act doc
Long Description: Type, anatomic location, and activity all documented
HCPCS Code: G0921
Short Description: Doc pt reas no assess
Long Description: Documentation of patient reason(s) for not being able to assess (e.g., patient refuses endoscopic and/or radiologic assessment)
HCPCS Code: G0922
Short Description: Type loc act not doc
Long Description: No documentation of disease type, anatomic location, and activity, reason not given
HCPCS Code: G1
Short Description: Urr reading of less than 60
Long Description: Most recent urr reading of less than 60
HCPCS Code: G2
Short Description: Urr reading of 60 to 64.9
Long Description: Most recent urr reading of 60 to 64.9
HCPCS Code: G3
Short Description: Urr reading of 65 to 69.9
Long Description: Most recent urr reading of 65 to 69.9
HCPCS Code: G3001
Short Description: Admin + supply, tositumomab
Long Description: Administration and supply of tositumomab, 450 mg
HCPCS Code: G4
Short Description: Urr reading of 70 to 74.9
Long Description: Most recent urr reading of 70 to 74.9
HCPCS Code: G5
Short Description: Urr reading of 75 or greater
Long Description: Most recent urr reading of 75 or greater
HCPCS Code: G6
Short Description: Esrd patient <6 dialysis/mth
Long Description: Esrd patient for whom less than six dialysis sessions have been provided in a month
HCPCS Code: G6001
Short Description: Echo guidance radiotherapy
Long Description: Ultrasonic guidance for placement of radiation therapy fields
HCPCS Code: G6002
Short Description: Stereoscopic x-ray guidance
Long Description: Stereoscopic x-ray guidance for localization of target volume for the delivery of radiation therapy
HCPCS Code: G6003
Short Description: Radiation treatment delivery
Long Description: Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: up to 5 mev
HCPCS Code: G6004
Short Description: Radiation treatment delivery
Long Description: Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: 6-10 mev
HCPCS Code: G6005
Short Description: Radiation treatment delivery
Long Description: Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: 11-19 mev
HCPCS Code: G6006
Short Description: Radiation treatment delivery
Long Description: Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: 20 mev or greater
HCPCS Code: G6007
Short Description: Radiation treatment delivery
Long Description: Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: up to 5 mev
HCPCS Code: G6008
Short Description: Radiation treatment delivery
Long Description: Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 6-10 mev
HCPCS Code: G6009
Short Description: Radiation treatment delivery
Long Description: Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 11-19 mev
HCPCS Code: G6010
Short Description: Radiation treatment delivery
Long Description: Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 20 mev or greater
HCPCS Code: G6011
Short Description: Radiation treatment delivery
Long Description: Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; up to 5 mev
HCPCS Code: G6012
Short Description: Radiation treatment delivery
Long Description: Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 6-10 mev
HCPCS Code: G6013
Short Description: Radiation treatment delivery
Long Description: Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 11-19 mev
HCPCS Code: G6014
Short Description: Radiation treatment delivery
Long Description: Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 20 mev or greater
HCPCS Code: G6015
Short Description: Radiation tx delivery imrt
Long Description: Intensity modulated treatment delivery, single or multiple fields/arcs,via narrow spatially and temporally modulated beams, binary, dynamic mlc, per treatment session
HCPCS Code: G6016
Short Description: Delivery comp imrt
Long Description: Compensator-based beam modulation treatment delivery of inverse planned treatment using 3 or more high resolution (milled or cast) compensator, convergent beam modulated fields, per treatment session
HCPCS Code: G6017
Short Description: Intrafraction track motion
Long Description: Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy (eg,3d positional tracking, gating, 3d surface tracking), each fraction of treatment
HCPCS Code: G6018
Short Description: Ileoscopy w/stent
Long Description: Ileoscopy,through stoma; with transendoscopic stent placement (includes predilation)
HCPCS Code: G6019
Short Description: Colonoscopy lesion removal
Long Description: Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
HCPCS Code: G6020
Short Description: Colonoscopy w/stent
Long Description: Colonoscopy through stoma; with transendoscopic stent placement (includes predilation)
HCPCS Code: G6021
Short Description: Unlisted px small intestine
Long Description: Unlisted procedure, intestine
HCPCS Code: G6022
Short Description: Sigmoidoscopy w/ablate tumr
Long Description: Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesions(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
HCPCS Code: G6023
Short Description: Sigmoidoscopy w/stent
Long Description: Sigmoidoscopy, flexible; with transendoscopic stent placement (includes predilation)
HCPCS Code: G6024
Short Description: Lesion removal colonoscopy
Long Description: Colonoscopy, flexible; proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare tehnique
HCPCS Code: G6025
Short Description: Colonoscopy w/stent
Long Description: Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic stent placement (includes predilation)
HCPCS Code: G6027
Short Description: Anoscopy hra w/spec collect
Long Description: Anoscopy, high resolution (hra) (with magnification and chemical agent enhancement); diagnostic, including collection of specimen(s) by brushing or washing when performed
HCPCS Code: G6028
Short Description: Anoscopy hra w/biopsy
Long Description: Anoscopy, high resolution (hra) (with magnification and chemical agent enhancement); with biopsy(ies)
HCPCS Code: G6030
Short Description: Assay of amitriptyline
Long Description: Amitriptyline
HCPCS Code: G6031
Short Description: Assay of benzodiazepines
Long Description: Benzodiazepines
HCPCS Code: G6032
Short Description: Assay of desipramine
Long Description: Desipramine
HCPCS Code: G6034
Short Description: Assay of doxepin
Long Description: Doxepin
HCPCS Code: G6035
Short Description: Assay of gold
Long Description: Gold
HCPCS Code: G6036
Short Description: Assay of imipramine
Long Description: Assay of imipramine
HCPCS Code: G6037
Short Description: Assay of nortiptyline
Long Description: Nortriptyline
HCPCS Code: G6038
Short Description: Assay of salicylate
Long Description: Salicylate
HCPCS Code: G6039
Short Description: Assay of acetaminophen
Long Description: Acetaminophen
HCPCS Code: G6040
Short Description: Assay of ethanol
Long Description: Alcohol (ethanol); any specimen except breath
HCPCS Code: G6041
Short Description: Assay of urine alkaloids
Long Description: Alkaloids, urine, quantitative
HCPCS Code: G6042
Short Description: Assay of amphetamines
Long Description: Amphetamine or methamphetamine
HCPCS Code: G6043
Short Description: Assay of barbiturates
Long Description: Barbiturates, not elsewhere specified
HCPCS Code: G6044
Short Description: Assay of cocaine
Long Description: Cocaine or metabolite
HCPCS Code: G6045
Short Description: Assay of dihydrocodeinone
Long Description: Dihydrocodeinone
HCPCS Code: G6046
Short Description: Assay of dihydromorphinone
Long Description: Dihydromorphinone
HCPCS Code: G6047
Short Description: Assay of dihydrotestosterone
Long Description: Dihydrotestosterone
HCPCS Code: G6048
Short Description: Assay of dimethadione
Long Description: Dimethadione
HCPCS Code: G6049
Short Description: Asssay of epiandrosterone
Long Description: Epiandrosterone
HCPCS Code: G6050
Short Description: Assay of ethchlorvynol
Long Description: Ethchlorvynol
HCPCS Code: G6051
Short Description: Assay of flurazepam
Long Description: Flurazepam
HCPCS Code: G6052
Short Description: Assay of meprobamate
Long Description: Meprobamate
HCPCS Code: G6053
Short Description: Assay of methadone
Long Description: Methadone
HCPCS Code: G6054
Short Description: Assay of methsuximide
Long Description: Methsuximide
HCPCS Code: G6055
Short Description: Assay of nicotine
Long Description: Nicotine
HCPCS Code: G6056
Short Description: Assay of opiates
Long Description: Opiate(s), drug and metabolites, each procedure
HCPCS Code: G6057
Short Description: Assay of phenothiazine
Long Description: Phenothiazine
HCPCS Code: G6058
Short Description: Drug confirmation
Long Description: Drug confirmation, each procedure
HCPCS Code: G7
Short Description: Payment limits do not apply
Long Description: Pregnancy resulted from rape or incest or pregnancy certified by physician as life threatening
HCPCS Code: G8
Short Description: Monitored anesthesia care
Long Description: Monitored anesthesia care (mac) for deep complex, complicated, or markedly invasive surgical procedure
HCPCS Code: G8126
Short Description: Pt treat w/antidepress12wks
Long Description: Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phase
HCPCS Code: G8127
Short Description: Pt not treat w/antidepres12w
Long Description: Patient with a diagnosis of major depression not documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phase
HCPCS Code: G8128
Short Description: Pt inelig for antidepres med
Long Description: Clinician documented that patient was not an eligible candidate for antidepressant medication during the entire 12 week acute treatment phase measure
HCPCS Code: G8395
Short Description: Lvef>=40% doc normal or mild
Long Description: Left ventricular ejection fraction (lvef) >= 40% or documentation as normal or mildly depressed left ventricular systolic function
HCPCS Code: G8396
Short Description: Lvef not performed
Long Description: Left ventricular ejection fraction (lvef) not performed or documented
HCPCS Code: G8397
Short Description: Dil macula/fundus exam/w doc
Long Description: Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema and level of severity of retinopathy
HCPCS Code: G8398
Short Description: Dil macular/fundus not perfo
Long Description: Dilated macular or fundus exam not performed
HCPCS Code: G8399
Short Description: Pt w/dxa results document
Long Description: Patient with documented results of a central dual-energy x-ray absorptiometry (dxa) ever being performed
HCPCS Code: G8400
Short Description: Pt w/dxa no results doc
Long Description: Patient with central dual-energy x-ray absorptiometry (dxa) results not documented, reason not given
HCPCS Code: G8401
Short Description: Pt inelig osteo screen measu
Long Description: Clinician documented that patient was not an eligible candidate for screening
HCPCS Code: G8404
Short Description: Low extemity neur exam docum
Long Description: Lower extremity neurological exam performed and documented
HCPCS Code: G8405
Short Description: Low extemity neur not perfor
Long Description: Lower extremity neurological exam not performed
HCPCS Code: G8406
Short Description: Pt inelig lower extrem neuro
Long Description: Clinician documented that patient was not an eligible candidate for lower extremity neurological exam measure
HCPCS Code: G8410
Short Description: Eval on foot documented
Long Description: Footwear evaluation performed and documented
HCPCS Code: G8415
Short Description: Eval on foot not performed
Long Description: Footwear evaluation was not performed
HCPCS Code: G8416
Short Description: Pt inelig footwear evaluatio
Long Description: Clinician documented that patient was not an eligible candidate for footwear evaluation measure
HCPCS Code: G8417
Short Description: Calc bmi abv up param f/u
Long Description: Bmi is documented above normal parameters and a follow-up plan is documented
HCPCS Code: G8418
Short Description: Calc bmi blw low param f/u
Long Description: Bmi is documented below normal parameters and a follow-up plan is documented
HCPCS Code: G8419
Short Description: Calc bmi out nrm param nof/u
Long Description: Bmi documented outside normal parameters, no follow-up plan documented, no reason given
HCPCS Code: G8420
Short Description: Calc bmi norm parameters
Long Description: Bmi is documented within normal parameters and no follow-up plan is required
HCPCS Code: G8421
Short Description: Bmi not calculated
Long Description: Bmi not documented and no reason is given
HCPCS Code: G8422
Short Description: Pt inelig bmi calculation
Long Description: Bmi not documented, documentation the patient is not eligible for bmi calculation
HCPCS Code: G8427
Short Description: Doc cur meds by prov
Long Description: Eligible professional attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications
HCPCS Code: G8428
Short Description: Cur meds not document
Long Description: Current list of medications not documented as obtained, updated, or reviewed by the eligible professional, reason not given
HCPCS Code: G8430
Short Description: Pt inelig med check
Long Description: Eligible professional attests to documenting in the medical record the patient is not eligible for a current list of medications being obtained, updated, or reviewed by the eligible professional
HCPCS Code: G8431
Short Description: Pos clin depres scrn f/u doc
Long Description: Screening for clinical depression is documented as being positive and a follow-up plan is documented
HCPCS Code: G8432
Short Description: Clin depression screen not d
Long Description: Clinical depression screening not documented, reason not given
HCPCS Code: G8433
Short Description: Pt inelig; scrn clin dep
Long Description: Screening for clinical depression not documented, documentation stating the patient is not eligible
HCPCS Code: G8442
Short Description: Pt inelig pain assessment
Long Description: Pain assessment not documented as being performed, documentation the patient is not eligible for a pain assessment using a standardized tool
HCPCS Code: G8447
Short Description: Pt vis doc use ehr cer atcb
Long Description: Patient encounter was documented using an ehr system that has been certified by an authorized testing and certification body (atcb)
HCPCS Code: G8448
Short Description: Pt vis doc w/pqri qual ehr
Long Description: Patient encounter was documented using a pqri qualified ehr or other acceptable systems
HCPCS Code: G8450
Short Description: Beta-bloc rx pt w/abn lvef
Long Description: Beta-blocker therapy prescribed
HCPCS Code: G8451
Short Description: Pt w/abn lvef inelig b-bloc
Long Description: Beta-blocker therapy for lvef < 40% not prescribed for reasons documented by the clinician (e.g., low blood pressure, fluid overload, asthma, patients recently treated with an intravenous positive inotropic agent, allergy, intolerance, other medical reasons, patient declined, other patient reasons, or other reasons attributable to the healthcare system)
HCPCS Code: G8452
Short Description: Pt w/abn lvef b-bloc no rx
Long Description: Beta-blocker therapy not prescribed
HCPCS Code: G8458
Short Description: Pt inelig geno no antvir tx
Long Description: Clinician documented that patient is not an eligible candidate for genotype testing; patient not receiving antiviral treatment for hepatitis c during the measurement period (e.g. genotype test done prior to the reporting period, patient declines, patient not a candidate for antiviral treatment)
HCPCS Code: G8459
Short Description: Doc pt rec antivir treat
Long Description: Clinician documented that patient is receiving antiviral treatment for hepatitis c
HCPCS Code: G8460
Short Description: Pt inelig rna no antvir tx
Long Description: Clinician documented that patient is not an eligible candidate for quantitative rna testing at week 12; patient not receiving antiviral treatment for hepatitis c
HCPCS Code: G8461
Short Description: Pt rec antivir treat hep c
Long Description: Patient receiving antiviral treatment for hepatitis c during the measurement period
HCPCS Code: G8462
Short Description: Pt inelig couns no antvir tx
Long Description: Clinician documented that patient is not an eligible candidate for counseling regarding contraception prior to antiviral treatment; patient not receiving antiviral treatment for hepatitis c
HCPCS Code: G8463
Short Description: Pt rec antiviral treat doc
Long Description: Patient receiving antiviral treatment for hepatitis c documented
HCPCS Code: G8464
Short Description: Pt inelig; lo to no dter rsk
Long Description: Clinician documented that prostate cancer patient is not an eligible candidate for adjuvant hormonal therapy; low or intermediate risk of recurrence or risk of recurrence not determined
HCPCS Code: G8465
Short Description: High risk recurrence pro ca
Long Description: High or very high risk of recurrence of prostate cancer
HCPCS Code: G8468
Short Description: Ace/arb rx pt w/abn lvef
Long Description: Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy prescribed for patients with a left ventricular ejection fraction (lvef) <40% or documentation of moderately or severely depressed left ventricular systolic function
HCPCS Code: G8469
Short Description: Pt w/abn lvef inelig ace/arb
Long Description: Clinician documented that patient with a left ventricular ejection fraction (lvef) <40% or documentation of moderately or severely depressed left ventricular systolic function was not an eligible candidate for angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy
HCPCS Code: G8470
Short Description: Pt w/ normal lvef
Long Description: Patient with left ventricular ejection fraction (lvef) >=40% or documentation as normal or mildly depressed left ventricular systolic function
HCPCS Code: G8471
Short Description: Lvef not performed/doc
Long Description: Left ventricular ejection fraction (lvef) was not performed or documented
HCPCS Code: G8472
Short Description: Ace/arb no rx pt w/abn lvef
Long Description: Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy not prescribed for patients with a left ventricular ejection fraction (lvef) <40% or documentation of moderately or severely depressed left ventricular systolic function, reason not specified
HCPCS Code: G8473
Short Description: Ace/arb thxpy rx'd
Long Description: Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy prescribed
HCPCS Code: G8474
Short Description: Ace/arb not rx'd; doc reas
Long Description: Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy not prescribed for reasons documented by the clinician (e.g., allergy, intolerance, pregnancy, renal failure due to ace inhibitor, diseases of the aortic or mitral valve, other medical reasons) or (e.g., patient declined, other patient reasons) or (e.g., lack of drug availability, other reasons attributable to the health care system)
HCPCS Code: G8475
Short Description: Ace/arb thxpy not rx'd
Long Description: Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy not prescribed, reason not given
HCPCS Code: G8476
Short Description: Bp sys <140 and dias <90
Long Description: Most recent blood pressure has a systolic measurement of < 140 mmhg and a diastolic measurement of < 90 mmhg
HCPCS Code: G8477
Short Description: Bp sys>=140 and/or dias >=90
Long Description: Most recent blood pressure has a systolic measurement of >= 140 mmhg and/or a diastolic measurement of >= 90 mmhg
HCPCS Code: G8478
Short Description: Bp not performed/doc
Long Description: Blood pressure measurement not performed or documented, reason not given
HCPCS Code: G8482
Short Description: Flu immunize order/admin
Long Description: Influenza immunization administered or previously received
HCPCS Code: G8483
Short Description: Flu imm no admin doc rea
Long Description: Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons)
HCPCS Code: G8484
Short Description: Flu immunize no admin
Long Description: Influenza immunization was not administered, reason not given
HCPCS Code: G8485
Short Description: Report, diabetes measures
Long Description: I intend to report the diabetes mellitus (dm) measures group
HCPCS Code: G8486
Short Description: Report, prev care measures
Long Description: I intend to report the preventive care measures group
HCPCS Code: G8487
Short Description: Report ckd measures
Long Description: I intend to report the chronic kidney disease (ckd) measures group
HCPCS Code: G8489
Short Description: Cad measures grp
Long Description: I intend to report the coronary artery disease (cad) measures group
HCPCS Code: G8490
Short Description: Ra measures grp
Long Description: I intend to report the rheumatoid arthritis (ra) measures group
HCPCS Code: G8491
Short Description: Hiv/aids measures grp
Long Description: I intend to report the hiv/aids measures group
HCPCS Code: G8492
Short Description: Periop care measures grp
Long Description: I intend to report the perioperative care measures group
HCPCS Code: G8493
Short Description: Back pain measures grp
Long Description: I intend to report the back pain measures group
HCPCS Code: G8494
Short Description: Dm meas qual act perform
Long Description: All quality actions for the applicable measures in the diabetes mellitus (dm) measures group have been performed for this patient
HCPCS Code: G8495
Short Description: Ckd meas qual act perform
Long Description: All quality actions for the applicable measures in the chronic kidney disease (ckd) measures group have been performed for this patient
HCPCS Code: G8496
Short Description: Prev care mg qual act perfrm
Long Description: All quality actions for the applicable measures in the preventive care measures group have been performed for this patient
HCPCS Code: G8497
Short Description: Cabg meas qual act perform
Long Description: All quality actions for the applicable measures in the coronary artery bypass graft (cabg) measures group have been performed for this patient
HCPCS Code: G8498
Short Description: Cad meas qual act perform
Long Description: All quality actions for the applicable measures in the coronary artery disease (cad) measures group have been performed for this patient
HCPCS Code: G8499
Short Description: Ra meas qual act perform
Long Description: All quality actions for the applicable measures in the rheumatoid arthritis (ra) measures group have been performed for this patient
HCPCS Code: G8500
Short Description: Hiv meas qual act perform
Long Description: All quality actions for the applicable measures in the hiv/aids measures group have been performed for this patient
HCPCS Code: G8501
Short Description: Perio meas qual act perform
Long Description: All quality actions for the applicable measures in the perioperative care measures group have been performed for this patient
HCPCS Code: G8502
Short Description: Back pain mg qual act perfrm
Long Description: All quality actions for the applicable measures in the back pain measures group have been performed for this patient
HCPCS Code: G8506
Short Description: Pt rec ace/arb
Long Description: Patient receiving angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy
HCPCS Code: G8509
Short Description: Pos pain assess no f/u doc
Long Description: Pain assessment documented as positive using a standardized tool, follow-up plan not documented, reason not given
HCPCS Code: G8510
Short Description: Pt inelig neg scrn depres
Long Description: Screening for clinical depression is documented as negative, a follow-up plan is not required
HCPCS Code: G8511
Short Description: Clin depres scrn no f/u doc
Long Description: Screening for clinical depression documented as positive, follow-up plan not documented, reason not given
HCPCS Code: G8524
Short Description: Patch closure conv cea
Long Description: Patch closure used for patient undergoing conventional cea
HCPCS Code: G8525
Short Description: No patch closure cea
Long Description: Clinician documented that patient did not receive conventional cea
HCPCS Code: G8526
Short Description: No patch closure conv cea
Long Description: Patch closure not used for patient undergoing conventional cea, reason not specified
HCPCS Code: G8530
Short Description: Auto av fistula recd
Long Description: Autogenous av fistula received
HCPCS Code: G8531
Short Description: Pt inelig; auto av fistula
Long Description: Clinician documented that patient was not an eligible candidate for autogenous av fistula
HCPCS Code: G8532
Short Description: No auto av fistula; no reas
Long Description: Clinician documented that patient recevied vascular access other than autogenous av fistula, reason not given
HCPCS Code: G8535
Short Description: Pt inelig no eld mal scrn
Long Description: Elder maltreatment screen not documented; documentation that patient not eligible for the elder maltreatment screen
HCPCS Code: G8536
Short Description: No doc elder mal scrn
Long Description: No documentation of an elder maltreatment screen, reason not given
HCPCS Code: G8539
Short Description: Doc funct and care plan
Long Description: Functional outcome assessment documented as positive using a standardized tool and a care plan based on identified deficiencies on the date of functional outcome assessment, is documented
HCPCS Code: G8540
Short Description: Pt inelig funct assess
Long Description: Functional outcome assessment not documented as being performed, documentation the patient is not eligible for a functional outcome assessment using a standardized tool
HCPCS Code: G8541
Short Description: No doc cur funct assess
Long Description: Functional outcome assessment using a standardized tool not documented, reason not given
HCPCS Code: G8542
Short Description: Doc funct no deficiencies
Long Description: Functional outcome assessment using a standardized tool is documented; no functional deficiencies identified, care plan not required
HCPCS Code: G8543
Short Description: Cur funct asses; no care pln
Long Description: Documentation of a positive functional outcome assessment using a standardized tool; care plan not documented, reason not given
HCPCS Code: G8544
Short Description: Cabg measures grp
Long Description: I intend to report the coronary artery bypass graft (cabg) measures group
HCPCS Code: G8545
Short Description: Hepc measures grp
Long Description: I intend to report the hepatitis c measures group
HCPCS Code: G8546
Short Description: Cap measures grp
Long Description: I intend to report the community-acquired pneumonia (cap) measures group
HCPCS Code: G8547
Short Description: Ivd measures grp
Long Description: I intend to report the ischemic vascular disease (ivd) measures group
HCPCS Code: G8548
Short Description: Hf measures grp
Long Description: I intend to report the heart failure (hf) measures group
HCPCS Code: G8549
Short Description: Hepc mg qual act perform
Long Description: All quality actions for the applicable measures in the hepatitis c measures group have been performed for this patient
HCPCS Code: G8550
Short Description: Cap mg qual act perform
Long Description: All quality actions for the applicable measures in the community-acquired pneumonia (cap) measures group have been performed for this patient
HCPCS Code: G8551
Short Description: Hf mg qual act perform
Long Description: All quality actions for the applicable measures in the heart failure (hf) measures group have been performed for this patient
HCPCS Code: G8552
Short Description: Ivd mg qual act perform
Long Description: All quality actions for the applicable measures in the ischemic vascular disease (ivd) measures group have been performed for this patient
HCPCS Code: G8553
Short Description: Prescrip transmit via erx sy
Long Description: Prescription(s) generated and transmitted via a qualified erx system
HCPCS Code: G8556
Short Description: Ref to doc otolog eval
Long Description: Referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation
HCPCS Code: G8557
Short Description: Pt inelig ref otolog eval
Long Description: Patient is not eligible for the referral for otologic evaluation measure
HCPCS Code: G8558
Short Description: No ref to doc otolog eval
Long Description: Not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not given
HCPCS Code: G8559
Short Description: Pt ref doc oto eval
Long Description: Patient referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation
HCPCS Code: G8560
Short Description: Pt hx act drain prev 90 days
Long Description: Patient has a history of active drainage from the ear within the previous 90 days
HCPCS Code: G8561
Short Description: Pt inelig for ref oto eval
Long Description: Patient is not eligible for the referral for otologic evaluation for patients with a history of active drainage measure
HCPCS Code: G8562
Short Description: Pt no hx act drain 90 d
Long Description: Patient does not have a history of active drainage from the ear within the previous 90 days
HCPCS Code: G8563
Short Description: Pt no ref oto reas no spec
Long Description: Patient not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not given
HCPCS Code: G8564
Short Description: Pt ref oto eval
Long Description: Patient was referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not specified)
HCPCS Code: G8565
Short Description: Ver doc hear loss
Long Description: Verification and documentation of sudden or rapidly progressive hearing loss
HCPCS Code: G8566
Short Description: Pt inelig ref oto eval
Long Description: Patient is not eligible for the "referral for otologic evaluation for sudden or rapidly progressive hearing loss" measure
HCPCS Code: G8567
Short Description: Pt no doc hear loss
Long Description: Patient does not have verification and documentation of sudden or rapidly progressive hearing loss
HCPCS Code: G8568
Short Description: Pt no ref otolo no spec
Long Description: Patient was not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not given
HCPCS Code: G8569
Short Description: Prol intubation req
Long Description: Prolonged postoperative intubation (> 24 hrs) required
HCPCS Code: G8570
Short Description: No prol intub req
Long Description: Prolonged postoperative intubation (> 24 hrs) not required
HCPCS Code: G8571
Short Description: Ster wd ifx 30 d postop
Long Description: Development of deep sternal wound infection/mediastinitis within 30 days postoperatively
HCPCS Code: G8572
Short Description: No ster wd ifx
Long Description: No deep sternal wound infection/mediastinitis
HCPCS Code: G8573
Short Description: Stk cabg
Long Description: Stroke following isolated cabg surgery
HCPCS Code: G8574
Short Description: No strk cabg
Long Description: No stroke following isolated cabg surgery
HCPCS Code: G8575
Short Description: Postop ren fail
Long Description: Developed postoperative renal failure or required dialysis
HCPCS Code: G8576
Short Description: No postop ren fail
Long Description: No postoperative renal failure/dialysis not required
HCPCS Code: G8577
Short Description: Reop req bld grft oth
Long Description: Re-exploration required due to mediastinal bleeding with or without tamponade, graft occlusion, valve dysfunction or other cardiac reason
HCPCS Code: G8578
Short Description: No reop req bld grft oth
Long Description: Re-exploration not required due to mediastinal bleeding with or without tamponade, graft occlusion, valve dysfunction or other cardiac reason
HCPCS Code: G8579
Short Description: Antplt med disch
Long Description: Antiplatelet medication at discharge
HCPCS Code: G8580
Short Description: Antplt med contraind
Long Description: Antiplatelet medication contraindicated
HCPCS Code: G8581
Short Description: No antplt med disch
Long Description: No antiplatelet medication at discharge
HCPCS Code: G8582
Short Description: Bblock disch
Long Description: Beta-blocker at discharge
HCPCS Code: G8583
Short Description: Bblock contraind
Long Description: Beta-blocker contraindicated
HCPCS Code: G8584
Short Description: No bblock disch
Long Description: No beta-blocker at discharge
HCPCS Code: G8585
Short Description: Antilipid treat disch
Long Description: Anti-lipid treatment at discharge
HCPCS Code: G8586
Short Description: Antlip disch contra
Long Description: Anti-lipid treatment contraindicated
HCPCS Code: G8587
Short Description: No antlipid treat disch
Long Description: No anti-lipid treatment at discharge
HCPCS Code: G8588
Short Description: Sys bp <140
Long Description: Most recent systolic blood pressure < 140 mmhg
HCPCS Code: G8589
Short Description: Sys bp >= 140
Long Description: Most recent systolic blood pressure >= 140 mmhg
HCPCS Code: G8590
Short Description: Dia bp < 90
Long Description: Most recent diastolic blood pressure < 90 mmhg
HCPCS Code: G8591
Short Description: Dia bp >= 90
Long Description: Most recent diastolic blood pressure >= 90 mmhg
HCPCS Code: G8592
Short Description: No bp measure
Long Description: No documentation of blood pressure measurement, reason not given
HCPCS Code: G8593
Short Description: Lipid pn results
Long Description: Lipid profile results documented and reviewed (must include total cholesterol, hdl-c, triglycerides and calculated ldl-c)
HCPCS Code: G8594
Short Description: No lipid prof perf
Long Description: Lipid profile not performed, reason not given
HCPCS Code: G8595
Short Description: Ldl < 100
Long Description: Most recent ldl-c < 100 mg/dl
HCPCS Code: G8596
Short Description: No ldl perf
Long Description: Ldl-c was not performed
HCPCS Code: G8597
Short Description: Ldl >= 100
Long Description: Most recent ldl-c >= 100 mg/dl
HCPCS Code: G8598
Short Description: Asp therp used
Long Description: Aspirin or another antithrombotic therapy used
HCPCS Code: G8599
Short Description: No asp therp used
Long Description: Aspirin or another antithrombotic therapy not used, reason not given
HCPCS Code: G8600
Short Description: Tpa initi w/in 3 hrs
Long Description: Iv t-pa initiated within three hours (<= 180 minutes) of time last known well
HCPCS Code: G8601
Short Description: No elig tpa init w/in 3 hrs
Long Description: Iv t-pa not initiated within three hours (<= 180 minutes) of time last known well for reasons documented by clinician
HCPCS Code: G8602
Short Description: No tpa init w/in 3 hrs
Long Description: Iv t-pa not initiated within three hours (<= 180 minutes) of time last known well, reason not given
HCPCS Code: G8603
Short Description: Spok lang comp score
Long Description: Score on the spoken language comprehension functional communication measure at discharge was higher than at admission
HCPCS Code: G8604
Short Description: No high score spok lang
Long Description: Score on the spoken language comprehension functional communication measure at discharge was not higher than at admission, reason not given
HCPCS Code: G8605
Short Description: No spok lang comp score
Long Description: Patient treated for spoken language comprehension but not scored on the spoken language comprehension functional communication measure either at admission or at discharge
HCPCS Code: G8606
Short Description: Attention score
Long Description: Score on the attention functional communication measure at discharge was higher than at admission
HCPCS Code: G8607
Short Description: No high score attention
Long Description: Score on the attention functional communication measure at discharge was not higher than at admission, reason not given
HCPCS Code: G8608
Short Description: No attention score
Long Description: Patient treated for attention but not scored on the attention functional communication measure either at admission or at discharge
HCPCS Code: G8609
Short Description: Memory score
Long Description: Score on the memory functional communication measure at discharge was higher than at admission
HCPCS Code: G8610
Short Description: No high score memory
Long Description: Score on the memory functional communication measure at discharge was not higher than at admission, reason not given
HCPCS Code: G8611
Short Description: No memory score
Long Description: Patient treated for memory but not scored on the memory functional communication measure either at admission or at discharge
HCPCS Code: G8612
Short Description: Moto speech score
Long Description: Score on the motor speech functional communication measure at discharge was higher than at admission
HCPCS Code: G8613
Short Description: No high score moto speech
Long Description: Score on the motor speech functional communication measure at discharge was not higher than at admission, reason not given
HCPCS Code: G8614
Short Description: No moto speech score
Long Description: Patient treated for motor speech but not scored on the motor speech comprehension functional communication measure either at admission or at discharge
HCPCS Code: G8615
Short Description: Reading score
Long Description: Score on the reading functional communication measure at discharge was higher than at admission
HCPCS Code: G8616
Short Description: No high score reading
Long Description: Score on the reading functional communication measure at discharge was not higher than at admission, reason not given
HCPCS Code: G8617
Short Description: No reading score
Long Description: Patient treated for reading but not scored on the reading functional communication measure either at admission or at discharge
HCPCS Code: G8618
Short Description: Spok lang exp score
Long Description: Score on the spoken language expression functional communication measure at discharge was higher than at admission
HCPCS Code: G8619
Short Description: No high score spok lang exp
Long Description: Score on the spoken language expression functional communication measure at discharge was not higher than at admission, reason not given
HCPCS Code: G8620
Short Description: No spok lang exp score
Long Description: Patient treated for spoken language expression but not scored on the spoken language expression functional communication measure either at admission or at discharge
HCPCS Code: G8621
Short Description: Writing score
Long Description: Score on the writing functional communication measure at discharge was higher than at admission
HCPCS Code: G8622
Short Description: No high score writing
Long Description: Score on the writing functional communication measure at discharge was not higher than at admission, reason not given
HCPCS Code: G8623
Short Description: No writing score
Long Description: Patient treated for writing but not scored on the writing functional communication measure either at admission or at discharge
HCPCS Code: G8624
Short Description: Swallowing score
Long Description: Score on the swallowing functional communication measure at discharge was higher than at admission
HCPCS Code: G8625
Short Description: No high score swallowing
Long Description: Score on the swallowing functional communication measure at discharge was not higher than at admission, reason not given
HCPCS Code: G8626
Short Description: No swallowing score
Long Description: Patient treated for swallowing but not scored on the swallowing functional communication measure at admission or at discharge
HCPCS Code: G8627
Short Description: Surg proc w/in 30 days
Long Description: Surgical procedure performed within 30 days following cataract surgery for major complications (e.g., retained nuclear fragments, endophthalmitis, dislocated or wrong power iol, retinal detachment, or wound dehiscence)
HCPCS Code: G8628
Short Description: No surg proc w/in 30 days
Long Description: Surgical procedure not performed within 30 days following cataract surgery for major complications (e.g., retained nuclear fragments, endophthalmitis, dislocated or wrong power iol, retinal detachment, or wound dehiscence)
HCPCS Code: G8629
Short Description: Doc antibio order b/4 surg
Long Description: Documentation of order for prophylactic parenteral antibiotic to be given within one hour (if fluoroquinolone or vancomycin, two hours) prior to surgical incision (or start of procedure when no incision is required)
HCPCS Code: G8630
Short Description: Doc antibio given b/4 surg
Long Description: Documentation that administration of prophylactic parenteral antibiotics was initiated within one hour (if fluoroquinolone or vancomycin, two hours) prior to surgical incision (or start of procedure when no incision is required), as ordered
HCPCS Code: G8631
Short Description: Pt no elg 4 order antbi give
Long Description: Clinician documented that patient was not an eligible candidate for ordering prophylactic parenteral antibiotics to be given within one hour (if fluoroquinolone or vancomycin, two hours) prior to surgical incision (or start of procedure when no incision is required)
HCPCS Code: G8632
Short Description: Doc no antibi order b/4 surg
Long Description: Prophylactic parenteral antibiotics were not ordered to be given or given within one hour (if fluoroquinolone or vancomycin, two hours) prior to the surgical incision (or start of procedure when no incision is required), reason not given
HCPCS Code: G8633
Short Description: Pharm ther osteo rx
Long Description: Pharmacologic therapy (other than minierals/vitamins) for osteoporosis prescribed
HCPCS Code: G8634
Short Description: Pt no elg phar ther osteo
Long Description: Clinician documented patient not an eligible candidate to receive pharmacologic therapy for osteoporosis
HCPCS Code: G8635
Short Description: No pharm ther osteo rx
Long Description: Pharmacologic therapy for osteoporosis was not prescribed, reason not given
HCPCS Code: G8642
Short Description: Hrdshp rural w/o internet
Long Description: The eligible professional practices in a rural area without sufficient high speed internet access and requests a hardship exemption from the application of the payment adjustment under section 1848(a)(5)(a) of the social security act
HCPCS Code: G8643
Short Description: Hrdshp w/o suff pharm w/erx
Long Description: The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing and requests a hardship exemption for the application of the payment adjustment under section 1848(a)(5)(a) of the social security act
HCPCS Code: G8644
Short Description: Ep no prescribe priv
Long Description: Eligible professional does not have prescribing privileges
HCPCS Code: G8645
Short Description: Asthma measures grp
Long Description: I intend to report the asthma measures group
HCPCS Code: G8646
Short Description: Asthma mg qual act perform
Long Description: All quality actions for the applicable measures in the asthma measures group have been performed for this patient
HCPCS Code: G8647
Short Description: Fun stat score knee >= 0
Long Description: Risk-adjusted functional status change residual score for the knee successfully calculated and the score was equal to zero (0) or greater than zero (>0)
HCPCS Code: G8648
Short Description: Fun stat score knee < 0
Long Description: Risk-adjusted functional status change residual score for the knee successfully calculated and the score was less than zero (<0)
HCPCS Code: G8649
Short Description: Fun stat score knee pt noelg
Long Description: Risk-adjusted functional status change residual scores for the knee not measured because the patient did not complete foto's functional intake on admission and/or follow up status survey near discharge, patient not eligible/not appropriate
HCPCS Code: G8650
Short Description: Fun stat score knee not done
Long Description: Risk-adjusted functional status change residual scores for the knee not measured because the patient did not complete foto's functional intake on admission and/or follow up status survey near discharge, reason not given
HCPCS Code: G8651
Short Description: Fun stat score hip >= 0
Long Description: Risk-adjusted functional status change residual score for the hip successfully calculated and the score was equal to zero (0) or greater than zero (>0)
HCPCS Code: G8652
Short Description: Fun stat score hip < 0
Long Description: Risk-adjusted functional status change residual score for the hip successfully calculated and the score was less than zero (<0)
HCPCS Code: G8653
Short Description: Fun stat score hip pt no elg
Long Description: Risk-adjusted functional status change residual scores for the hip not measured because the patient did not complete foto's functional intake on admission and/or follow up status survey near discharge, patient not eligible/not appropriate
HCPCS Code: G8654
Short Description: Fun stat score hip not done
Long Description: Risk-adjusted functional status change residual scores for the hip not measured because the patient did not complete foto's functional intake on admission and/or follow up status survey near discharge, reason not given
HCPCS Code: G8655
Short Description: Fun stat score le >= 0
Long Description: Risk-adjusted functional status change residual score for the lower leg, foot or ankle successfully calculated and the score was equal to zero (0) or greater than zero(>0)
HCPCS Code: G8656
Short Description: Fun stat score le < 0
Long Description: Risk-adjusted functional status change residual score for the lower leg, foot or ankle successfully calculated and the score was less than zero (<0)
HCPCS Code: G8657
Short Description: Fun stat score le pt no elg
Long Description: Risk-adjusted functional status change residual scores for the lower leg, foot or ankle not measured because the patient did not complete foto's functional intake on admission and/or follow up status survey near discharge, patient not eligible/not appropriate
HCPCS Code: G8658
Short Description: Fun stat score le not done
Long Description: Risk-adjusted functional status change residual scores for the lower leg, foot or ankle not measured because the patient did not complete foto's functional intake on admission and/or follow up status survey near discharge, reason not given
HCPCS Code: G8659
Short Description: Fun stat score ls >= 0
Long Description: Risk-adjusted functional status change residual score for the lumbar spine successfully calculated and the score was equal to zero (0) or greater than zero (>0)
HCPCS Code: G8660
Short Description: Fun stat score ls < 0
Long Description: Risk-adjusted functional status change residual score for the lumbar spine successfully calculated and the score was less than zero (<0)
HCPCS Code: G8661
Short Description: Fun stat score ls pt no elg
Long Description: Risk-adjusted functional status change residual scores for the lumbar spine not measured because the patient did not complete foto's functional intake on admission and/or follow up status survey near discharge, patient not eligible/not appropriate
HCPCS Code: G8662
Short Description: Fun stat score ls not done
Long Description: Risk-adjusted functional status change residual scores for the lumbar spine not measured because the patient did not complete foto's functional intake on admission and/or follow up status survey near discharge, reason not given
HCPCS Code: G8663
Short Description: Fun stat score shdl >=0
Long Description: Risk-adjusted functional status change residual score for the shoulder successfully calculated and the score was equal to zero (0) or greater than zero (>0)
HCPCS Code: G8664
Short Description: Fun stat score shdl < 0
Long Description: Risk-adjusted functional status change residual score for the shoulder successfully calculated and the score was less than zero (<0)
HCPCS Code: G8665
Short Description: Fun stat score shdl pt no el
Long Description: Risk-adjusted functional status change residual scores for the shoulder not measured because the patient did not complete foto's functional intake on admission and/or follow up status survey near discharge, patient not eligible/not appropriate
HCPCS Code: G8666
Short Description: Fun stat score shdl not done
Long Description: Risk-adjusted functional status change residual scores for the shoulder not measured because the patient did not complete foto's functional intake on admission and/or follow up status survey near discharge, reason not given
HCPCS Code: G8667
Short Description: Fun stat score ue >=0
Long Description: Risk-adjusted functional status change residual score for the elbow, wrist or hand successfully calculated and the score was equal to zero (0) or greater than zero (>0)
HCPCS Code: G8668
Short Description: Fun stat score ue < 0
Long Description: Risk-adjusted functional status change residual score for the elbow, wrist or hand successfully calculated and the score was less than zero (<0)
HCPCS Code: G8669
Short Description: Fun stat score ue pt no elg
Long Description: Risk-adjusted functional status change residual scores for the elbow, wrist or hand not measured because the patient did not complete foto's functional intake on admission and/or follow up status survey near discharge, patient not eligible/not appropriate
HCPCS Code: G8670
Short Description: Fun stat score ue not done
Long Description: Risk-adjusted functional status change residual scores for the elbow, wrist or hand not measured because the patient did not complete foto's functional intake on admission and/or follow up status survey near discharge, reason not given
HCPCS Code: G8671
Short Description: Fun stat score neck/ts >=0
Long Description: Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs, or other general orthopedic impairment successfully calculated and the score was equal to zero (0) or greater than zero (>0)
HCPCS Code: G8672
Short Description: Fun stat score neck/ts < 0
Long Description: Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs, or other general orthopedic impairment successfully calculated and the score was less than zero (<0)
HCPCS Code: G8673
Short Description: Fun stat scor nek/ts pt no e
Long Description: Risk-adjusted functional status change residual scores for the neck, cranium, mandible, thoracic spine, ribs, or other general orthopedic impairment not measured because the patient did not complete foto's functional intake on admission and/or follow up status survey near discharge, patient not eligible/not appropriate
HCPCS Code: G8674
Short Description: Fun stat scor nek/ts not don
Long Description: Risk-adjusted functional status change residual scores for the neck, cranium, mandible, thoracic spine, ribs, or other general orthopedic impairment not measured because the patient did not complete foto's functional intake on admission and/or follow up status survey near discharge, reason not given
HCPCS Code: G8675
Short Description: Bp syst >= 140 mmhg
Long Description: Most recent systolic blood pressure >= 140 mm hg
HCPCS Code: G8676
Short Description: Bp diast >= 90 mmhg
Long Description: Most recent diastolic blood pressure >= 90 mm hg
HCPCS Code: G8677
Short Description: Bp syst < 130 mmhg
Long Description: Most recent systolic blood pressure < 130 mm hg
HCPCS Code: G8678
Short Description: Bp syst >=130 - 139 mmhg
Long Description: Most recent systolic blood pressure 130 to 139 mm hg
HCPCS Code: G8679
Short Description: Bp diast < 80 mmhg
Long Description: Most recent diastolic blood pressure < 80 mm hg
HCPCS Code: G8680
Short Description: Bp diast 80-89 mmhg
Long Description: Most recent diastolic blood pressure 80 - 89 mm hg
HCPCS Code: G8682
Short Description: Lvg test perf
Long Description: Lvf testing documented as being performed prior to discharge or in the previous 12 months
HCPCS Code: G8683
Short Description: Pt not elig for lvf test
Long Description: Lvf testing not performed prior to discharge or in the previous 12 months for a medical or patient documented reason
HCPCS Code: G8685
Short Description: Lvf test not perf
Long Description: Lvf testing not documented as being performed prior to discharge or in the previous 12 months, reason not given
HCPCS Code: G8694
Short Description: Lvef <40%
Long Description: Left ventricular ejection fraction (lvef) < 40%
HCPCS Code: G8695
Short Description: Lvef >=40%
Long Description: Left ventricular ejection fraction (lvef) >= 40% or documentation as mildly depressed left ventricular systolic function or normal
HCPCS Code: G8696
Short Description: Antithromb thx presc
Long Description: Antithrombotic therapy prescribed at discharge
HCPCS Code: G8697
Short Description: Antithromb no presc doc reas
Long Description: Antithrombotic therapy not prescribed for documented reasons (e.g., patients admitted for performance of elective carotid intervention, 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))
HCPCS Code: G8698
Short Description: Antithromb no presc no reas
Long Description: Antithrombotic therapy was not prescribed at discharge, reason not given
HCPCS Code: G8699
Short Description: Rehab ordered disch
Long Description: Rehabilitation services (occupational, physical or speech) ordered at or prior to discharge
HCPCS Code: G8700
Short Description: Rehab not indicated disch
Long Description: Rehabilitation services (occupational, physical or speech) not indicated at or prior to discharge
HCPCS Code: G8701
Short Description: Rehab not ordered
Long Description: Rehabilitation services were not ordered, reason not otherwise specified
HCPCS Code: G8702
Short Description: Antiobiotics 4 hr prior surg
Long Description: Documentation that prophylactic antibiotics were given within 4 hours prior to surgical incision or intraoperatively
HCPCS Code: G8703
Short Description: Antibiotics not prior surg
Long Description: Documentation that prophylactic antibiotics were neither given within 4 hours prior to surgical incision nor intraoperatively
HCPCS Code: G8704
Short Description: Ecg performed
Long Description: 12-lead electrocardiogram (ecg) performed
HCPCS Code: G8705
Short Description: Med reas no ecg
Long Description: Documentation of medical reason(s) for not performing a 12-lead electrocardiogram (ecg)
HCPCS Code: G8706
Short Description: Pt reas no ecg
Long Description: Documentation of patient reason(s) for not performing a 12-lead electrocardiogram (ecg)
HCPCS Code: G8707
Short Description: Ecg not performed
Long Description: 12-lead electrocardiogram (ecg) not performed, reason not given
HCPCS Code: G8708
Short Description: Antibiotic not pres
Long Description: Patient not prescribed or dispensed antibiotic
HCPCS Code: G8709
Short Description: Med reas antibiotic pres
Long Description: Patient prescribed or dispensed antibiotic for documented medical reason(s) (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)
HCPCS Code: G8710
Short Description: Pt pres antibiotic
Long Description: Patient prescribed or dispensed antibiotic
HCPCS Code: G8711
Short Description: Pres antibiotic
Long Description: Prescribed or dispensed antibiotic
HCPCS Code: G8712
Short Description: Not pres antibiotic
Long Description: Antibiotic not prescribed or dispensed
HCPCS Code: G8713
Short Description: Spkt/v great 1.2 kt/v
Long Description: Spkt/v greater than or equal to 1.2 (single-pool clearance of urea [kt] / volume [v])
HCPCS Code: G8714
Short Description: Hemodialysis 3 times week
Long Description: Hemodialysis treatment performed exactly three times per week for > 90 days
HCPCS Code: G8715
Short Description: Hemodialysis not 3 times wk
Long Description: Hemodialysis treatment performed less than three times per week or greater than three times per week
HCPCS Code: G8716
Short Description: Pt reas not great 1.2kt/v
Long Description: Documentation of reason(s) for patient not having greater than or equal to 1.2 (single-pool clearance of urea [kt] / volume [v])
HCPCS Code: G8717
Short Description: Less 1.2 kt/v
Long Description: Spkt/v less than 1.2 (single-pool clearance of urea [kt] / volume [v]), reason not given
HCPCS Code: G8718
Short Description: Great 1.7 kt/v per week
Long Description: Total kt/v greater than or equal to 1.7 per week (total clearance of urea [kt] / volume [v])
HCPCS Code: G8720
Short Description: Less 1.7 kt/v per week
Long Description: Total kt/v less than 1.7 per week (total clearance of urea [kt] / volume [v])
HCPCS Code: G8721
Short Description: Pt, pn, hist grade doc
Long Description: Pt category (primary tumor), pn category (regional lymph nodes), and histologic grade were documented in pathology report
HCPCS Code: G8722
Short Description: Med reas pt, pn, not doc
Long Description: Documentation of medical reason(s) for not including the pt category, the pn category or the histologic grade in the pathology report (e.g., re-excision without residual tumor; non-carcinomasanal canal)
HCPCS Code: G8723
Short Description: Spec sit not prim tumor
Long Description: Specimen site is other than anatomic location of primary tumor
HCPCS Code: G8724
Short Description: Pt, pn, hist grade not doc
Long Description: Pt category, pn category and histologic grade were not documented in the pathology report, reason not given
HCPCS Code: G8725
Short Description: Lipid profile perf doc
Long Description: Fasting lipid profile performed (triglycerides, ldl-c, hdl-c and total cholesterol)
HCPCS Code: G8726
Short Description: Doc reas no lipid profile
Long Description: Clinician has documented reason for not performing fasting lipid profile (e.g., patient declined, other patient reasons)
HCPCS Code: G8727
Short Description: Hemo, perit, or kidney trans
Long Description: Patient receiving hemodialysis, peritoneal dialysis or kidney transplantation
HCPCS Code: G8728
Short Description: Lipid profile not perf
Long Description: Fasting lipid profile not performed, reason not given
HCPCS Code: G8730
Short Description: Pain doc pos and plan
Long Description: Pain assessment documented as positive using a standardized tool and a follow-up plan is documented
HCPCS Code: G8731
Short Description: Pain neg no plan
Long Description: Pain assessment using a standardized tool is documented as negative, no follow-up plan required
HCPCS Code: G8732
Short Description: No doc of pain
Long Description: No documentation of pain assessment, reason not given
HCPCS Code: G8733
Short Description: Doc pos elder mal scrn plan
Long Description: Elder maltreatment screen documented as positive and a follow-up plan is documented
HCPCS Code: G8734
Short Description: Doc neg elder mal no plan
Long Description: Elder maltreatment screen documented as negative, no follow-up required
HCPCS Code: G8735
Short Description: Eld mal scrn pos no plan
Long Description: Elder maltreatment screen documented as positive, follow-up plan not documented, reason not given
HCPCS Code: G8736
Short Description: Ldl-c <100mg/dl
Long Description: Most current ldl-c <100mg/dl
HCPCS Code: G8737
Short Description: Ldl-c >=100mg/dl
Long Description: Most current ldl-c >=100mg/dl
HCPCS Code: G8738
Short Description: Lvef < 40%
Long Description: Left ventricular ejection fraction (lvef) < 40% or documentation of severely or moderately depressed left ventricular systolic function
HCPCS Code: G8739
Short Description: Lvef >= 40%
Long Description: Left ventricular ejection fraction (lvef) >= 40% or documentation as normal or mildly depressed left ventricular systolic function
HCPCS Code: G8740
Short Description: Lvef not perfrmd
Long Description: Left ventricular ejection fraction (lvef) not performed or assessed, reason not given
HCPCS Code: G8741
Short Description: Not tx spoken lang
Long Description: Patient not treated for spoken language comprehension disorder
HCPCS Code: G8742
Short Description: Not tx attention
Long Description: Patient not treated for attention disorder
HCPCS Code: G8743
Short Description: Not tx memory
Long Description: Patient not treated for memory disorder
HCPCS Code: G8744
Short Description: Not tx motor speech
Long Description: Patient not treated for motor speech disorder
HCPCS Code: G8745
Short Description: Not tx reading
Long Description: Patient not treated for reading disorder
HCPCS Code: G8746
Short Description: Not tx spoken lang express
Long Description: Patient not treated for spoken language expression disorder
HCPCS Code: G8747
Short Description: Not tx writing
Long Description: Patient not treated for writing disorder
HCPCS Code: G8748
Short Description: Not tx swallowing
Long Description: Patient not treated for swallowing disorder
HCPCS Code: G8749
Short Description: Signs of melanoma absent
Long Description: Absence of signs of melanoma (cough, dyspnea, tenderness, localized neurologic signs such as weakness, jaundice or any other sign suggesting systemic spread) or absence of symptoms of melanoma (pain, paresthesia, or any other symptom suggesting the possibility of systemic spread of melanoma)
HCPCS Code: G8750
Short Description: Signs of melanoma present
Long Description: Presence of signs of melanoma (cough, dyspnea, tenderness, localized neurologic signs such as weakness, jaundice or any other sign suggesting systemic spread) or presence of symptoms of melanoma (pain, paresthesia, or any other symptom suggesting the possibility of systemic spread of melanoma)
HCPCS Code: G8751
Short Description: Smkg status not assess
Long Description: Smoking status and exposure to second hand smoke in the home not assessed, reason not given
HCPCS Code: G8752
Short Description: Sys bp less 140
Long Description: Most recent systolic blood pressure < 140 mmhg
HCPCS Code: G8753
Short Description: Sys bp > or = 140
Long Description: Most recent systolic blood pressure >= 140 mmhg
HCPCS Code: G8754
Short Description: Dias bp less 90
Long Description: Most recent diastolic blood pressure < 90 mmhg
HCPCS Code: G8755
Short Description: Dias bp > or = 90
Long Description: Most recent diastolic blood pressure >= 90 mmhg
HCPCS Code: G8756
Short Description: No bp measure doc
Long Description: No documentation of blood pressure measurement, reason not given
HCPCS Code: G8757
Short Description: Copd mg qual act perform
Long Description: All quality actions for the applicable measures in the chronic obstructive pulmonary disease (copd) measures group have been performed for this patient
HCPCS Code: G8758
Short Description: Ibd mg qual act perform
Long Description: All quality actions for the applicable measures in the inflammatory bowel disease (ibd) measures group have been performed for this patient
HCPCS Code: G8759
Short Description: Osa mg qual act perform
Long Description: All quality actions for the applicable measures in the sleep apnea measures group have been performed for this patient
HCPCS Code: G8760
Short Description: Epilepsy mg qual act perform
Long Description: All quality actions for the applicable measures in the epilepsy measures group have been performed for this patient
HCPCS Code: G8761
Short Description: Dementia mg qual act perform
Long Description: All quality actions for the applicable measures in the dementia measures group have been performed for this patient
HCPCS Code: G8762
Short Description: Pd mg qual act perform
Long Description: All quality actions for the applicable measures in the parkinson's disease measures group have been performed for this patient
HCPCS Code: G8763
Short Description: Hyperten mg qual act perform
Long Description: All quality actions for the applicable measures in the hypertension (htn) measures group have been performed for this patient
HCPCS Code: G8764
Short Description: Car prev mg qual act perform
Long Description: All quality actions for the applicable measures in the cardiovascular prevention measures group have bee performed for this patient
HCPCS Code: G8765
Short Description: Cataract mg qual act perform
Long Description: All quality actions for the applicable measures in the cataract measures group have been performed for this patient
HCPCS Code: G8767
Short Description: Lipid panel res doc rev
Long Description: Lipid panel results documented and reviewed (must include total cholesterol, hdl-c, triglycerides and calculated ldl-c)
HCPCS Code: G8768
Short Description: Doc med reas no lipid profle
Long Description: Documentation of medical reason(s) for not performing lipid profile (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)
HCPCS Code: G8769
Short Description: Lipid profile not perform
Long Description: Lipid profile not performed, reason not given
HCPCS Code: G8770
Short Description: Urine protein test doc rev
Long Description: Urine protein test result documented and reviewed
HCPCS Code: G8771
Short Description: Doc dx ckd
Long Description: Documentation of diagnosis of chronic kidney disease
HCPCS Code: G8772
Short Description: Doc med reas no urine protn
Long Description: Documentation of medical reason(s) for not performing urine protein test (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not cllinically appropriate)
HCPCS Code: G8773
Short Description: No urine protein test
Long Description: Urine protein test was not performed, reason not given
HCPCS Code: G8774
Short Description: Serum creatinine doc rev
Long Description: Serum creatinine test result documented and reviewed
HCPCS Code: G8775
Short Description: Doc med reas no serum crtn
Long Description: Documentation of medical reason(s) for not performing serum creatinine test (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)
HCPCS Code: G8776
Short Description: No serum creatinine test
Long Description: Serum creatinine test not performed, reason not given
HCPCS Code: G8777
Short Description: Diabetes screen
Long Description: Diabetes screening test performed
HCPCS Code: G8778
Short Description: Doc med reas no diabete scrn
Long Description: Documentation of medical reason(s) for not performing diabetes screening test (e.g., patients with a diagnosis of diabetes, or with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)
HCPCS Code: G8779
Short Description: No diabetes screen
Long Description: Diabetes screening test not performed, reason not given
HCPCS Code: G8780
Short Description: Counsel diet phys activity
Long Description: Counseling for diet and physical activity performed
HCPCS Code: G8781
Short Description: Doc med reas no counsel diet
Long Description: Documentation of medical reason(s) for patient not receiving counseling for diet and physical activity (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)
HCPCS Code: G8782
Short Description: No counsel diet phys act
Long Description: Counseling for diet and physical activity not performed, reason not given
HCPCS Code: G8783
Short Description: Bp scrn perf rec interval
Long Description: Normal blood pressure reading documented, follow-up not required
HCPCS Code: G8784
Short Description: Pt no elig for bp assess
Long Description: Patient not eligible (e.g., documentation the patient is not eligible due to active diagnosis of hypertension, patient refuses, urgent or emergent situation)
HCPCS Code: G8785
Short Description: Bp scrn no perf at interval
Long Description: Blood pressure reading not documented, reason not given
HCPCS Code: G8786
Short Description: Severity of angina assess
Long Description: Severity of angina assessed according to level of activity
HCPCS Code: G8787
Short Description: Angina present
Long Description: Angina assessed as present
HCPCS Code: G8788
Short Description: Angina absent
Long Description: Angina assessed as absent
HCPCS Code: G8789
Short Description: Severity angina not assess
Long Description: Severity of angina not assessed according to level of activity
HCPCS Code: G8790
Short Description: Systolic <130mmhg
Long Description: Most recent office visit systolic blood pressure <130 mm hg
HCPCS Code: G8791
Short Description: Systolic 130-139mmhg
Long Description: Most recent office visit systolic blood pressure, 130 to 139 mm hg
HCPCS Code: G8792
Short Description: Systolic >=140mmhg
Long Description: Most recent office visit systolic blood pressure >=140 mm hg
HCPCS Code: G8793
Short Description: Diastolic <80mmhg
Long Description: Most recent office visit diastolic blood pressure, <80 mm hg
HCPCS Code: G8794
Short Description: Diastolic 80-89mmhg
Long Description: Most recent office visit diastolic blood pressure, 80 - 89 mm hg
HCPCS Code: G8795
Short Description: Diastolic >=90mmhg
Long Description: Most recent office visit diastolic blood pressure >=90 mm hg
HCPCS Code: G8796
Short Description: Bp not doc
Long Description: Blood pressure measurement not documented, reason not given
HCPCS Code: G8797
Short Description: Specimen site not esophagus
Long Description: Specimen site other than anatomic location of esophagus
HCPCS Code: G8798
Short Description: Specimen site not prostate
Long Description: Specimen site other than anatomic location of prostate
HCPCS Code: G8799
Short Description: Anticoag ordered
Long Description: Anticoagulation ordered
HCPCS Code: G8800
Short Description: Doc reas anticoag not order
Long Description: Anticoagulation not ordered for reasons documented by clinician
HCPCS Code: G8801
Short Description: Anticoag not ordered
Long Description: Anticoagulation was not ordered, reason not given
HCPCS Code: G8802
Short Description: Pregnancy test order
Long Description: Pregnancy test (urine or serum) ordered
HCPCS Code: G8803
Short Description: Doc reas no pregnancy test
Long Description: Pregnancy test (urine or serum) not ordered for reasons documented by clinician
HCPCS Code: G8805
Short Description: Pregnancy test not order
Long Description: Pregnancy test (urine or serum) was not ordered, reason not specified
HCPCS Code: G8806
Short Description: Transab or transvag us
Long Description: Performance of trans-abdominal or trans-vaginal ultrasound
HCPCS Code: G8807
Short Description: Doc reas no us
Long Description: Trans-abdominal or trans-vaginal ultrasound not performed for reasons documented by clinician (e.g., patient has visited the ed multiple times within 72 hours, patient has a documented intrauterine pregnancy [iup])
HCPCS Code: G8808
Short Description: No transab or transvag us
Long Description: Performance of trans-abdominal or trans-vaginal ultrasound not ordered, reason not given (e.g., patient has visited the ed multiple times with no documentation of a trans-abdominal or trans-vaginal ultrasound within ed or from referring eligible professional)
HCPCS Code: G8809
Short Description: Rh-immunoglobulin order
Long Description: Rh-immunoglobulin (rhogam) ordered
HCPCS Code: G8810
Short Description: Doc reas no rh-immuno
Long Description: Rh-immunoglobulin (rhogam) not ordered for reasons documented by clinician (e.g., patient had prior documented receipt of rhogam within 12 weeks, patient refusal)
HCPCS Code: G8811
Short Description: No rh-immunoglobulin order
Long Description: Documentation rh-immunoglobulin (rhogam) was not ordered, reason not given
HCPCS Code: G8812
Short Description: Pt not elig cta, duplex, mra
Long Description: Patient is not eligible for follow-up cta, duplex, or mra (e.g., patient death, failure to return for scheduled follow-up exam, planned follow-up study which will meet numerator criteria has not yet occurred at the time of reporting)
HCPCS Code: G8813
Short Description: Cta, duplex, mra performed
Long Description: Follow-up cta, duplex, or mra of the abdomen and pelvis performed
HCPCS Code: G8814
Short Description: No cta, duplex, mra
Long Description: Follow-up cta, duplex, or mra of the abdomen and pelvis not performed
HCPCS Code: G8815
Short Description: Doc reas no statin therapy
Long Description: Statin therapy not prescribed for documented reasons (e.g., medical intolerance to statin, death of patient prior to discharge, transfer of care to another acute care or federal hospital, hospice admission, left against medical advice)
HCPCS Code: G8816
Short Description: Statin med pres at disch
Long Description: Statin medication prescribed at discharge
HCPCS Code: G8817
Short Description: Doc reas no statin med disch
Long Description: Statin therapy not prescribed at discharge, reason not given
HCPCS Code: G8818
Short Description: Pt disch to home by day#7
Long Description: Patient discharge to home no later than post-operative day #7
HCPCS Code: G8819
Short Description: Aneurysm <= 5.5 cm
Long Description: Aneurysm minor diameter <= 5.5 cm
HCPCS Code: G8820
Short Description: Aneurysm 5.6-6.0 cm
Long Description: Aneurysm minor diameter 5.6-6.0 cm
HCPCS Code: G8821
Short Description: Aneurysm not infarenal
Long Description: Abdominal aortic aneurysm is not infarenal
HCPCS Code: G8822
Short Description: Male aneurysms >6cm
Long Description: Male patients with aneurysms minor diameter >6 cm
HCPCS Code: G8823
Short Description: Female aneurysm >6cm
Long Description: Female patients with aneurysm minor diameter >6cm
HCPCS Code: G8824
Short Description: Female aneurysm 5.6-6.0 cm
Long Description: Female patients with aneurysm minor diameter 5.6-6.0 cm
HCPCS Code: G8825
Short Description: Pt not disch to home day#7
Long Description: Patient not discharged to home by post-operative day #7
HCPCS Code: G8826
Short Description: Pt disch home day #2 evar
Long Description: Patient discharge to home no later than post-operative day #2 following evar
HCPCS Code: G8827
Short Description: Aneurysm <= 5.5cm for women
Long Description: Aneurysm minor diameter <= 5.5 cm for women
HCPCS Code: G8828
Short Description: Aneurysm <= 5.5cm for men
Long Description: Aneurysm minor diameter <= 5.5 cm for men
HCPCS Code: G8829
Short Description: Aneurysm 5.6-6.0 cm for men
Long Description: Aneurysm minor diameter 5.6-6.0 cm for men
HCPCS Code: G8830
Short Description: Aneurysm >6cm for men
Long Description: Aneurysm minor diameter >6cm for men
HCPCS Code: G8831
Short Description: Aneurysm >-6cm for women
Long Description: Aneurysm minor diameter >6cm for women
HCPCS Code: G8832
Short Description: Aneurysm 5.6-6.0 women
Long Description: Aneurysm minor diameter 5.6-6.0 cm for women
HCPCS Code: G8833
Short Description: Pt not disch home day#2 evar
Long Description: Patient not discharged to home by post-operative day #2 following evar
HCPCS Code: G8834
Short Description: Pt disch home day #2 cea
Long Description: Patient discharged to home no later than post-operative day #2 following cea
HCPCS Code: G8835
Short Description: Asymptom no trans
Long Description: Asymptomatic patient with no history of any transient ischemic attack or stroke in any carotid or vertebrobasilar territory
HCPCS Code: G8836
Short Description: Stroke or tia <120 days cea
Long Description: Symptomatic patient with ipsilateral stroke or tia within 120 days prior to cea
HCPCS Code: G8837
Short Description: Stroke or tia >120 days cea
Long Description: Other symptomatic patient with ipsilateral carotid territory tia or stroke > 120 days prior to cea, or contralateral carotid territory tia or stroke or vertebrobasilar tia or stroke
HCPCS Code: G8838
Short Description: Not disch home by day #2
Long Description: Patient not discharged to home by post-operative day #2 following cea
HCPCS Code: G8839
Short Description: Sleep apnea assess
Long Description: Sleep apnea symptoms assessed, including presence or absence of snoring and daytime sleepiness
HCPCS Code: G8840
Short Description: Doc reas no sleep apnea
Long Description: Documentation of reason(s) for not documenting an assessment of sleep symptoms (e.g., patient didn't have initial daytime sleepiness, patient visited between initial testing and initiation of therapy)
HCPCS Code: G8841
Short Description: No sleep apnea assess
Long Description: Sleep apnea symptoms not assessed, reason not given
HCPCS Code: G8842
Short Description: Ahi or rdi initial dx
Long Description: Apnea hypopnea index (ahi) or respiratory disturbance index (rdi) measured at the time of initial diagnosis
HCPCS Code: G8843
Short Description: Doc reas no ahi or rdi
Long Description: Documentation of reason(s) for not measuring an apnea hypopnea index (ahi) or a respiratory disturbance index (rdi) at the time of initial diagnosis (e.g., psychiatric disease, dementia, patient declined, financial, insurance coverage, test ordered but not yet completed)
HCPCS Code: G8844
Short Description: No ahi or rdi initial dx
Long Description: Apnea hypopnea index (ahi) or respiratory disturbance index (rdi) not measured at the time of initial diagnosis, reason not given
HCPCS Code: G8845
Short Description: Pos airway press prescribed
Long Description: Positive airway pressure therapy prescribed
HCPCS Code: G8846
Short Description: Mod or severe osa
Long Description: Moderate or severe obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory disturbance index (rdi) of 15 or greater)
HCPCS Code: G8847
Short Description: Pos air press not prescribed
Long Description: Positive airway pressure therapy not prescribed
HCPCS Code: G8848
Short Description: Mild osa
Long Description: Mild obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory disturbance index (rdi) of less than 15)
HCPCS Code: G8849
Short Description: Doc reas no pos air press
Long Description: Documentation of reason(s) for not prescribing positive airway pressure therapy (e.g., patient unable to tolerate, alternative therapies use, patient declined, financial, insurance coverage)
HCPCS Code: G8850
Short Description: No pap prescribed
Long Description: Positive airway pressure therapy not prescribed, reason not given
HCPCS Code: G8851
Short Description: Adhere pos air press therapy
Long Description: Objective measurement of adherence to positive airway pressure therapy, documented
HCPCS Code: G8852
Short Description: Pos air press prescribe
Long Description: Positive airway pressure therapy prescribed
HCPCS Code: G8853
Short Description: Pos air press not prescribe
Long Description: Positive airway pressure therapy not prescribed
HCPCS Code: G8854
Short Description: Reas no adhere pos air pres
Long Description: Documentation of reason(s) for not objectively measuring adherence to positive airway pressure therapy (e.g., patient didn't bring data from continous positive airway pressure [cpap], therapy not yet initiated, not available on machine)
HCPCS Code: G8855
Short Description: Pos air press adhere no perf
Long Description: Objective measurement of adherence to positive airway pressure therapy not performed, reason not given
HCPCS Code: G8856
Short Description: Ref for oto eval
Long Description: Referral to a physician for an otologic evaluation performed
HCPCS Code: G8857
Short Description: No elig ref for oto eval
Long Description: Patient is not eligible for the referral for otologic evaluation measure (e.g., patients who are already under the care of a physician for acute or chronic dizziness)
HCPCS Code: G8858
Short Description: Not ref for oto eval
Long Description: Referral to a physician for an otologic evaluation not performed, reason not given
HCPCS Code: G8859
Short Description: Corticosteroids 10mg 60 days
Long Description: Patient receiving corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days
HCPCS Code: G8860
Short Description: Corticosteroid 10 mg 60 days
Long Description: Patients who have received dose of corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days
HCPCS Code: G8861
Short Description: Dxa ordered for osteo
Long Description: Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) ordered and documented, review of systems and medication history or pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed
HCPCS Code: G8862
Short Description: No corticostrd 10mg 60 days
Long Description: Patients not receiving corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days
HCPCS Code: G8863
Short Description: No assess bone loss
Long Description: Patients not assessed for risk of bone loss, reason not given
HCPCS Code: G8864
Short Description: Pneumococcal vaccine admin
Long Description: Pneumococcal vaccine administered or previously received
HCPCS Code: G8865
Short Description: Doc med reas no pneumococcal
Long Description: Documentation of medical reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient allergic reaction, potential adverse drug reaction)
HCPCS Code: G8866
Short Description: Doc pt reas no pneumococcal
Long Description: Documentation of patient reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient refusal)
HCPCS Code: G8867
Short Description: No pneumococcal admin
Long Description: Pneumococcal vaccine not administered or previously received, reason not given
HCPCS Code: G8868
Short Description: 1st course antitnf
Long Description: Patients receiving a first course of anti-tnf therapy
HCPCS Code: G8869
Short Description: Doc immun hep b 1st antitnf
Long Description: Patient has documented immunity to hepatitis b and is receiving a first course of anti-tnf therapy
HCPCS Code: G8870
Short Description: Hepb admin 1st antitnf
Long Description: Hepatitis b vaccine injection administered or previously received and is receiving a first course of anti-tnf therapy
HCPCS Code: G8871
Short Description: No 1st antitnf
Long Description: Patient not receiving a first course of anti-tnf therapy
HCPCS Code: G8872
Short Description: Intraop image confirm excise
Long Description: Excised tissue evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesion
HCPCS Code: G8873
Short Description: Specimen not intraop image
Long Description: Patients with needle localization specimens which are not amenable to intraoperative imaging such as mri needle wire localization, or targets which are tentatively identified on mammogram or ultrasound which do not contain a biopsy marker but which can be verified on intraoperative inspection or pathology (e.g., needle biopsy site where the biopsy marker is remote from the actual biopsy site)
HCPCS Code: G8874
Short Description: Tissue not image intraop
Long Description: Excised tissue not evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesion
HCPCS Code: G8875
Short Description: Breast cancer dx min invsive
Long Description: Clinician diagnosed breast cancer preoperatively by a minimally invasive biopsy method
HCPCS Code: G8876
Short Description: Doc reas no min inv dx
Long Description: Documentation of reason(s) for not performing minimally invasive biopsy to diagnose breast cancer preoperatively (e.g., lesion too close to skin, implant, chest wall, etc., lesion could not be adequately visualized for needle biopsy, patient condition prevents needle biopsy [weight, breast thickness, etc.], duct excision without imaging abnormality, prophylactic mastectomy, reduction mammoplasty, excisional biopsy performed by another physician)
HCPCS Code: G8877
Short Description: No brst cncr dx min invasive
Long Description: Clinician did not attempt to achieve the diagnosis of breast cancer preoperatively by a minimally invasive biopsy method, reason not given
HCPCS Code: G8878
Short Description: Sent lymph node biopsy
Long Description: Sentinel lymph node biopsy procedure performed
HCPCS Code: G8879
Short Description: Node neg inv brst cncr
Long Description: Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer
HCPCS Code: G8880
Short Description: Doc reas no lymph node biop
Long Description: Documentation of reason(s) sentinel lymph node biopsy not performed (e.g., reasons could include but not limited to; non-invasive cancer, incidental discovery of breast cancer on prophylactic mastectomy, incidental discovery of breast cancer on reduction mammoplasty, pre-operative biopsy proven lymph node (ln) metastases, inflammatory carcinoma, stage 3 locally advanced cancer, recurrent invasive breast cancer, patient refusal after informed consent)
HCPCS Code: G8881
Short Description: Brst cncr stage > t1n0m0
Long Description: Stage of breast cancer is greater than t1n0m0 or t2n0m0
HCPCS Code: G8882
Short Description: No sent lymph node biopsy
Long Description: Sentinel lymph node biopsy procedure not performed, reason not given
HCPCS Code: G8883
Short Description: Rev, comm, track, doc biopsy
Long Description: Biopsy results reviewed, communicated, tracked and documented
HCPCS Code: G8884
Short Description: Doc reas biopsy not review
Long Description: Clinician documented reason that patient's biopsy results were not reviewed
HCPCS Code: G8885
Short Description: No rev, comm, track biopsy
Long Description: Biopsy results not reviewed, communicated, tracked or documented
HCPCS Code: G8886
Short Description: Bp under control
Long Description: Most recent blood pressure under control
HCPCS Code: G8887
Short Description: Doc med reas bp not control
Long Description: Documentation of medical reason(s) for most recent blood pressure not being under control (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)
HCPCS Code: G8888
Short Description: Bp not under control
Long Description: Most recent blood pressure not under control, results documented and reviewed
HCPCS Code: G8889
Short Description: No doc bp
Long Description: No documentation of blood pressure measurement, reason not given
HCPCS Code: G8890
Short Description: Ldl-c under control
Long Description: Most recent ldl-c under control, results documented and reviewed
HCPCS Code: G8891
Short Description: Doc med reas no ldl-c contrl
Long Description: Documentation of medical reason(s) for most recent ldl-c not under control (e.g., patients with palliative goals for for whom treatment of hypertension with standard treatment goals is not clinically appropriate)
HCPCS Code: G8892
Short Description: Doc med reas no ldl-c test
Long Description: Documentation of medical reason(s) for not performing ldl-c test (e.g. patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)
HCPCS Code: G8893
Short Description: Ldl-c not under control
Long Description: Most recent ldl-c not under control, results documented and reviewed
HCPCS Code: G8894
Short Description: Ldl-c not performed
Long Description: Ldl-c not performed, reason not given
HCPCS Code: G8895
Short Description: Antrom prescribe
Long Description: Oral aspirin or other antithrombotic therapy prescribed
HCPCS Code: G8896
Short Description: Doc med reas no antihtrom
Long Description: Documentation of medical reason(s) for not prescribing oral aspirin or other antthrombotic 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)
HCPCS Code: G8897
Short Description: Antithrom not prescribe
Long Description: Oral aspirin or other antithrombotic therapy was not prescribed, reason not given
HCPCS Code: G8898
Short Description: Copd measures group
Long Description: I intend to report the chronic obstructive pulmonary disease (copd) measures group
HCPCS Code: G8899
Short Description: Inflammatory bowel dis mg
Long Description: I intend to report the inflammatory bowel disease (ibd) measures group
HCPCS Code: G8900
Short Description: Obstructive sleep apnea mg
Long Description: I intend to report the sleep apnea measures group
HCPCS Code: G8901
Short Description: Epilepsy measures group
Long Description: I intend to report the epilepsy measures group
HCPCS Code: G8902
Short Description: Dementia measures group
Long Description: I intend to report the dementia measures group
HCPCS Code: G8903
Short Description: Parkinson's disease mg
Long Description: I intend to report the parkinson's disease measures group
HCPCS Code: G8904
Short Description: Hypertension mg
Long Description: I intend to report the hypertension (htn) measures group
HCPCS Code: G8905
Short Description: Cardiovascular prevention mg
Long Description: I intend to report the cardiovascular prevention measures group
HCPCS Code: G8906
Short Description: Cataract measures group
Long Description: I intend to report the cataract measures group
HCPCS Code: G8907
Short Description: Pt doc no events on discharg
Long Description: Patient documented not to have experienced any of the following events: a burn prior to discharge; a fall within the facility; wrong site/side/patient/procedure/implant event; or a hospital transfer or hospital admission upon discharge from the facility
HCPCS Code: G8908
Short Description: Pt doc w burn prior to d/c
Long Description: Patient documented to have received a burn prior to discharge
HCPCS Code: G8909
Short Description: Pt doc no burn prior to d/c
Long Description: Patient documented not to have received a burn prior to discharge
HCPCS Code: G8910
Short Description: Pt doc to have fall in asc
Long Description: Patient documented to have experienced a fall within asc
HCPCS Code: G8911
Short Description: Pt doc no fall in asc
Long Description: Patient documented not to have experienced a fall within ambulatory surgical center
HCPCS Code: G8912
Short Description: Pt doc with wrong event
Long Description: Patient documented to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event
HCPCS Code: G8913
Short Description: Pt doc no wrong event
Long Description: Patient documented not to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event
HCPCS Code: G8914
Short Description: Pt trans to hosp post d/c
Long Description: Patient documented to have experienced a hospital transfer or hospital admission upon discharge from asc
HCPCS Code: G8915
Short Description: Pt not trans to hosp at d/c
Long Description: Patient documented not to have experienced a hospital transfer or hospital admission upon discharge from asc
HCPCS Code: G8916
Short Description: Pt w iv ab given on time
Long Description: Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic initiated on time
HCPCS Code: G8917
Short Description: Pt w iv ab not given on time
Long Description: Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic not initiated on time
HCPCS Code: G8918
Short Description: Pt w/o preop order iv ab pro
Long Description: Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis
HCPCS Code: G8919
Short Description: Mst rcnt sys bp <140mmg
Long Description: Most recent systolic blood pressure < 140 mmhg
HCPCS Code: G8920
Short Description: Mst rcnt sys bp >=140mmhg
Long Description: Most recent systolic blood pressure >= 140 mmhg
HCPCS Code: G8921
Short Description: Mst rcnt dia bp <90mmhg
Long Description: Most recent diastolic blood pressure < 90 mmhg
HCPCS Code: G8922
Short Description: Mst rcnt dia bp >=90mmhg
Long Description: Most recent diastolic blood pressure >= 90 mmhg
HCPCS Code: G8923
Short Description: Lvef < 40% or lvsd
Long Description: Left ventricular ejection fraction (lvef) < 40% or documentation of moderately or severely depressed left ventricular systolic function
HCPCS Code: G8924
Short Description: Fev<60% pred & copd sym
Long Description: Spirometry test results demonstrate fev1 < 60% predicted and patient has copd symptoms (e.g., dyspnea, cough/sputum, wheezing)
HCPCS Code: G8925
Short Description: Fev<60% pred & no copd sym
Long Description: Spirometry test results demonstrate fev1 = 60% predicted or patient does not have copd symptoms
HCPCS Code: G8926
Short Description: Spiro no perf or doc
Long Description: Spirometry test not performed or documented, reason not given
HCPCS Code: G8927
Short Description: Adj chem pres ajcc iii
Long Description: Adjuvant chemotherapy referred, prescribed or previously received for ajcc stage iii, colon cancer
HCPCS Code: G8928
Short Description: Adj chem not pres rsn spec
Long Description: Adjuvant chemotherapy not prescribed or previously received, for documented reasons (e.g., medical co-morbidities, diagnosis date more than 5 years prior to the current visit date, patient's diagnosis date is within 120 days of the end of the 12 month reporting period, patient's cancer has metastasized, medical contraindication/allergy, poor performance status, other medical reasons, patient refusal, other patient reasons, patient is currently enrolled in a clinical trial that precludes prescription of chemotherapy, other system reasons)
HCPCS Code: G8929
Short Description: Adj cmo not pres rsn not gvn
Long Description: Adjuvant chemotherapy not prescribed or previously received, reason not given
HCPCS Code: G8930
Short Description: Assess of dep @ initial eval
Long Description: Assessment of depression severity at the initial evaluation
HCPCS Code: G8931
Short Description: Asses of dep not documented
Long Description: Assessment of depression severity not documented, reason not given
HCPCS Code: G8932
Short Description: Suicd rsk assessed init eval
Long Description: Suicide risk assessed at the initial evaluation
HCPCS Code: G8933
Short Description: Suicide risk not assessed
Long Description: Suicide risk not assessed at the initial evaluation, reason not given
HCPCS Code: G8934
Short Description: Lvef <40% or dep lv sys fcn
Long Description: Left ventricular ejection fraction (lvef) <40% or documentation of moderately or severely depressed left ventricular systolic function
HCPCS Code: G8935
Short Description: Rx ace or arb therapy
Long Description: Clinician prescribed angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy
HCPCS Code: G8936
Short Description: Pt not eligible ace/arb
Long Description: Clinician documented that patient was not an eligible candidate for angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy (eg, allergy, intolerance, pregnancy, renal failure due to ace inhibitor, diseases of the aortic or mitral valve, other medical reasons) or (eg, patient declined, other patient reasons) or (eg, lack of drug availability, other reasons attributable to the health care system)
HCPCS Code: G8937
Short Description: No rx ace/arb therapy
Long Description: Clinician did not prescribe angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy, reason not given
HCPCS Code: G8938
Short Description: Bmi calc, pt no f/u plan elg
Long Description: Bmi is documented as being outside of normal limits, follow-up plan is not documented, documentation the patient is not eligible
HCPCS Code: G8939
Short Description: Pain assess doc, f/u no doc
Long Description: Pain assessment documented as positive, follow-up plan not documented, documentation the patient is not eligible
HCPCS Code: G8940
Short Description: Srn clin dep doc no f/u pln
Long Description: Screening for clinical depression documented as positive, a follow-up plan not documented, documentation stating the patient is not eligible
HCPCS Code: G8941
Short Description: No doc elder scrn, pt no el
Long Description: Elder maltreatment screen documented as positive, follow-up plan not documented, documentation the patient is not eligible
HCPCS Code: G8942
Short Description: Doc fcn/care plan w/30 days
Long Description: Functional outcomes assessment using a standardized tool is documented within the previous 30 days and care plan, based on identified deficiencies on the date of the functional outcome assessment, is documented
HCPCS Code: G8943
Short Description: Ldlc not pres w/i 12 mo prir
Long Description: Ldl-c result not present or not within 12 months prior
HCPCS Code: G8944
Short Description: Ajcc mel cnr stg 0 - iic
Long Description: Ajcc melanoma cancer stage 0 through iic melanoma
HCPCS Code: G8945
Short Description: Aneurysm <=6 cm for men
Long Description: Aneurysm minor diameter <= 6 cm for men
HCPCS Code: G8946
Short Description: Mibm but no dx of breast ca
Long Description: Minimally invasive biopsy method attempted but not diagnostic of breast cancer (e.g., high risk lesion of breast such as atypical ductal hyperplasia, lobular neoplasia, atypical lobular hyperplasia, lobular carcinoma in situ, atypical columnar hyperplasica, flat epithelial atypia, radial scar, complex sclerosing lesion, papillary lesion, or any lesion with spindle cells)
HCPCS Code: G8947
Short Description: 1 or more neuropsych
Long Description: One or more neuropsychiatric symptoms
HCPCS Code: G8948
Short Description: No neuropsych symptoms
Long Description: No neuropsychiatric symptoms
HCPCS Code: G8949
Short Description: Doc pt reas on counsel diet
Long Description: Documentation of patient reason(s) for patient not receiving counseling for diet and physical activity (e.g., patient is not willing to discuss diet or exercise interventions to help control blood pressure, or the patient said he/she refused to make these changes)
HCPCS Code: G8950
Short Description: Pre-htn or htn doc, f/u indc
Long Description: Pre-hypertensive or hypertensive blood pressure reading documented, and the indicated follow-up is documented
HCPCS Code: G8951
Short Description: Pre-htn/htn doc, no pt f/u
Long Description: Pre-hypertensive or hypertensive blood pressure reading documented, indicated follow-up not documented, documentation the patient is not eligible
HCPCS Code: G8952
Short Description: Pre-htn/htn, no f/u, not gvn
Long Description: Pre-hypertensive or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given
HCPCS Code: G8953
Short Description: Oncology mg qual act perform
Long Description: All quality actions for the applicable measures in the oncology measures group have been performed for this patient
HCPCS Code: G8954
Short Description: Pt data rpt qual clin db reg
Long Description: Complete and appropriate patient data were reported to a qualified clinical database registry
HCPCS Code: G8955
Short Description: Most recent assess vol mgmt
Long Description: Most recent assessment of adequacy of volume management documented
HCPCS Code: G8956
Short Description: Pt rcv hedia outpt dyls fac
Long Description: Patient receiving maintenance hemodialysis in an outpatient dialysis facility
HCPCS Code: G8957
Short Description: Pt no hedia in outpt fac
Long Description: Patient not receiving maintenance hemodialysis in an outpatient dialysis facility
HCPCS Code: G8958
Short Description: Assess vol mgmt not doc
Long Description: Assessment of adequacy of volume management not documented, reason not given
HCPCS Code: G8959
Short Description: Clin tx mdd comm to tx clin
Long Description: Clinician treating major depressive disorder communicates to clinician treating comorbid condition
HCPCS Code: G8960
Short Description: Clin tx mdd not comm
Long Description: Clinician treating major depressive disorder did not communicate to clinician treating comorbid condition, reason not given
HCPCS Code: G8961
Short Description: Csit lowrisk surg pts preop
Long Description: Cardiac stress imaging test primarily performed on low-risk surgery patient for preoperative evaluation within 30 days preceding this surgery
HCPCS Code: G8962
Short Description: Csit on pt any reas 30 days
Long Description: Cardiac stress imaging test performed on patient for any reason including those who did not have low risk surgery or test that was performed more than 30 days preceding low risk surgery
HCPCS Code: G8963
Short Description: Csi per asx pt w/pci 2 yrs
Long Description: Cardiac stress imaging performed primarily for monitoring of asymptomatic patient who had pci within 2 years
HCPCS Code: G8964
Short Description: Csi any other than pci 2 yr
Long Description: Cardiac stress imaging test performed primarily for any other reason than monitoring of asymptomatic patient who had pci within 2 years (e.g., symptomatic patient, patient greater than 2 years since pci, initial evaluation, etc)
HCPCS Code: G8965
Short Description: Csit perf on low chd rsk
Long Description: Cardiac stress imaging test primarily performed on low chd risk patient for initial detection and risk assessment
HCPCS Code: G8966
Short Description: Csit perf sx or high chd rsk
Long Description: Cardiac stress imaging test performed on symptomatic or higher than low chd risk patient or for any reason other than initial detection and risk assessment
HCPCS Code: G8967
Short Description: Wrfrn or oral antigoag pres
Long Description: Warfarin or another oral anticoagulant that is fda approved prescribed
HCPCS Code: G8968
Short Description: Md rsn no pres wrfrn or othr
Long Description: Documentation of medical reason(s) for not prescribing warfarin or another oral anticoagulant that is fda approved for the prevention of thromboembolism [e.g., patients with mitral stenosis or prosthetic heart valves, patients with transient or reversible causes of af (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac surgery), allergy, risk of bleeding, other medical reasons]
HCPCS Code: G8969
Short Description: Pt rsn no pres wrfrn or othr
Long Description: Documentation of patient reason(s) for not prescribing warfarin or another oral anticoagulant that is fda approved (e.g., economic, social, and/or religious impediments, noncompliance patient refusal, other patient reasons)
HCPCS Code: G8970
Short Description: No rsk fac or 1 mod risk te
Long Description: No risk factors or one moderate risk factor for thromboembolism
HCPCS Code: G8971
Short Description: Warfrn or othr antcog no rx
Long Description: Warfarin or another oral anticoagulant that is fda approved not prescribed, reason not given
HCPCS Code: G8972
Short Description: 1>=risk or>= mod risk for te
Long Description: One or more high risk factors for thromboembolism or more than one moderate risk factor for thromboembolism
HCPCS Code: G8973
Short Description: Mst rcnt hbb < 10g/dl
Long Description: Most recent hemoglobin (hgb) level < 10 g/dl
HCPCS Code: G8974
Short Description: Hgb not doc rns not gvn
Long Description: Hemoglobin level measurement not documented, reason not given
HCPCS Code: G8975
Short Description: Hgb <10g/dl, med rsn
Long Description: Documentation of medical reason(s) for patient having a hemoglobin level < 10 g/dl (e.g., patients who have non-renal etiologies of anemia [e.g., sickle cell anemia or other hemoglobinopathies, hypersplenism, primary bone marrow disease, anemia related to chemotherapy for diagnosis of malignancy, postoperative bleeding, active bloodstream or peritoneal infection], other medical reasons)
HCPCS Code: G8976
Short Description: Hgb >= 10 g/dl
Long Description: Most recent hemoglobin (hgb) level >= 10 g/dl
HCPCS Code: G8977
Short Description: Oncology measures grp
Long Description: I intend to report the oncology measures group
HCPCS Code: G8978
Short Description: Mobility current status
Long Description: Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals
HCPCS Code: G8979
Short Description: Mobility goal status
Long Description: Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
HCPCS Code: G8980
Short Description: Mobility d/c status
Long Description: Mobility: walking & moving around functional limitation, discharge status, at discharge from therapy or to end reporting
HCPCS Code: G8981
Short Description: Body pos current status
Long Description: Changing & maintaining body position functional limitation, current status, at therapy episode outset and at reporting intervals
HCPCS Code: G8982
Short Description: Body pos goal status
Long Description: Changing & maintaining body position functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
HCPCS Code: G8983
Short Description: Body pos d/c status
Long Description: Changing & maintaining body position functional limitation, discharge status, at discharge from therapy or to end reporting
HCPCS Code: G8984
Short Description: Carry current status
Long Description: Carrying, moving & handling objects functional limitation, current status, at therapy episode outset and at reporting intervals
HCPCS Code: G8985
Short Description: Carry goal status
Long Description: Carrying, moving and handling objects, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
HCPCS Code: G8986
Short Description: Carry d/c status
Long Description: Carrying, moving & handling objects functional limitation, discharge status, at discharge from therapy or to end reporting
HCPCS Code: G8987
Short Description: Self care current status
Long Description: Self care functional limitation, current status, at therapy episode outset and at reporting intervals
HCPCS Code: G8988
Short Description: Self care goal status
Long Description: Self care functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
HCPCS Code: G8989
Short Description: Self care d/c status
Long Description: Self care functional limitation, discharge status, at discharge from therapy or to end reporting
HCPCS Code: G8990
Short Description: Other pt/ot current status
Long Description: Other physical or occupational therapy primary functional limitation, current status, at therapy episode outset and at reporting intervals
HCPCS Code: G8991
Short Description: Other pt/ot goal status
Long Description: Other physical or occupational therapy primary functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
HCPCS Code: G8992
Short Description: Other pt/ot d/c status
Long Description: Other physical or occupational therapy primary functional limitation, discharge status, at discharge from therapy or to end reporting
HCPCS Code: G8993
Short Description: Sub pt/ot current status
Long Description: Other physical or occupational therapy subsequent functional limitation, current status, at therapy episode outset and at reporting intervals
HCPCS Code: G8994
Short Description: Sub pt/ot goal status
Long Description: Other physical or occupational therapy subsequent functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
HCPCS Code: G8995
Short Description: Sub pt/ot d/c status
Long Description: Other physical or occupational therapy subsequent functional limitation, discharge status, at discharge from therapy or to end reporting
HCPCS Code: G8996
Short Description: Swallow current status
Long Description: Swallowing functional limitation, current status at therapy episode outset and at reporting intervals
HCPCS Code: G8997
Short Description: Swallow goal status
Long Description: Swallowing functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
HCPCS Code: G8998
Short Description: Swallow d/c status
Long Description: Swallowing functional limitation, discharge status, at discharge from therapy or to end reporting
HCPCS Code: G8999
Short Description: Motor speech current status
Long Description: Motor speech functional limitation, current status at therapy episode outset and at reporting intervals
HCPCS Code: G9
Short Description: Mac for at risk patient
Long Description: Monitored anesthesia care for patient who has history of severe cardio-pulmonary condition
HCPCS Code: G9001
Short Description: Mccd, initial rate
Long Description: Coordinated care fee, initial rate
HCPCS Code: G9002
Short Description: Mccd,maintenance rate
Long Description: Coordinated care fee, maintenance rate
HCPCS Code: G9003
Short Description: Mccd, risk adj hi, initial
Long Description: Coordinated care fee, risk adjusted high, initial
HCPCS Code: G9004
Short Description: Mccd, risk adj lo, initial
Long Description: Coordinated care fee, risk adjusted low, initial
HCPCS Code: G9005
Short Description: Mccd, risk adj, maintenance
Long Description: Coordinated care fee, risk adjusted maintenance
HCPCS Code: G9006
Short Description: Mccd, home monitoring
Long Description: Coordinated care fee, home monitoring
HCPCS Code: G9007
Short Description: Mccd, sch team conf
Long Description: Coordinated care fee, scheduled team conference
HCPCS Code: G9008
Short Description: Mccd,phys coor-care ovrsght
Long Description: Coordinated care fee, physician coordinated care oversight services
HCPCS Code: G9009
Short Description: Mccd, risk adj, level 3
Long Description: Coordinated care fee, risk adjusted maintenance, level 3
HCPCS Code: G9010
Short Description: Mccd, risk adj, level 4
Long Description: Coordinated care fee, risk adjusted maintenance, level 4
HCPCS Code: G9011
Short Description: Mccd, risk adj, level 5
Long Description: Coordinated care fee, risk adjusted maintenance, level 5
HCPCS Code: G9012
Short Description: Other specified case mgmt
Long Description: Other specified case management service not elsewhere classified
HCPCS Code: G9013
Short Description: Esrd demo bundle level i
Long Description: Esrd demo basic bundle level i
HCPCS Code: G9014
Short Description: Esrd demo bundle-level ii
Long Description: Esrd demo expanded bundle including venous access and related services
HCPCS Code: G9016
Short Description: Demo-smoking cessation coun
Long Description: Smoking cessation counseling, individual, in the absence of or in addition to any other evaluation and management service, per session (6-10 minutes) [demo project code only]
HCPCS Code: G9017
Short Description: Amantadine hcl 100mg oral
Long Description: Amantadine hydrochloride, oral, per 100 mg (for use in a medicare-approved demonstration project)
HCPCS Code: G9018
Short Description: Zanamivir,inhalation pwd 10m
Long Description: Zanamivir, inhalation powder, administered through inhaler, per 10 mg (for use in a medicare-approved demonstration project)
HCPCS Code: G9019
Short Description: Oseltamivir phosphate 75mg
Long Description: Oseltamivir phosphate, oral, per 75 mg (for use in a medicare-approved demonstration project)
HCPCS Code: G9020
Short Description: Rimantadine hcl 100mg oral
Long Description: Rimantadine hydrochloride, oral, per 100 mg (for use in a medicare-approved demonstration project)
HCPCS Code: G9033
Short Description: Amantadine hcl oral brand
Long Description: Amantadine hydrochloride, oral brand, per 100 mg (for use in a medicare-approved demonstration project)
HCPCS Code: G9034
Short Description: Zanamivir, inh pwdr, brand
Long Description: Zanamivir, inhalation powder, administered through inhaler, brand, per 10 mg (for use in a medicare-approved demonstration project)
HCPCS Code: G9035
Short Description: Oseltamivir phosp, brand
Long Description: Oseltamivir phosphate, oral, brand, per 75 mg (for use in a medicare-approved demonstration project)
HCPCS Code: G9036
Short Description: Rimantadine hcl, brand
Long Description: Rimantadine hydrochloride, oral, brand, per 100 mg (for use in a medicare-approved demonstration project)
HCPCS Code: G9050
Short Description: Oncology work-up evaluation
Long Description: Oncology; primary focus of visit; work-up, evaluation, or staging at the time of cancer diagnosis or recurrence (for use in a medicare-approved demonstration project)
HCPCS Code: G9051
Short Description: Oncology tx decision-mgmt
Long Description: Oncology; primary focus of visit; treatment decision-making after disease is staged or restaged, discussion of treatment options, supervising/coordinating active cancer directed therapy or managing consequences of cancer directed therapy (for use in a medicare-approved demonstration project)
HCPCS Code: G9052
Short Description: Onc surveillance for disease
Long Description: Oncology; primary focus of visit; surveillance for disease recurrence for patient who has completed definitive cancer-directed therapy and currently lacks evidence of recurrent disease; cancer directed therapy might be considered in the future (for use in a medicare-approved demonstration project)
HCPCS Code: G9053
Short Description: Onc expectant management pt
Long Description: Oncology; primary focus of visit; expectant management of patient with evidence of cancer for whom no cancer directed therapy is being administered or arranged at present; cancer directed therapy might be considered in the future (for use in a medicare-approved demonstration project)
HCPCS Code: G9054
Short Description: Onc supervision palliative
Long Description: Oncology; primary focus of visit; supervising, coordinating or managing care of patient with terminal cancer or for whom other medical illness prevents further cancer treatment; includes symptom management, end-of-life care planning, management of palliative therapies (for use in a medicare-approved demonstration project)
HCPCS Code: G9055
Short Description: Onc visit unspecified nos
Long Description: Oncology; primary focus of visit; other, unspecified service not otherwise listed (for use in a medicare-approved demonstration project)
HCPCS Code: G9056
Short Description: Onc prac mgmt adheres guide
Long Description: Oncology; practice guidelines; management adheres to guidelines (for use in a medicare-approved demonstration project)
HCPCS Code: G9057
Short Description: Onc pract mgmt differs trial
Long Description: Oncology; practice guidelines; management differs from guidelines as a result of patient enrollment in an institutional review board approved clinical trial (for use in a medicare-approved demonstration project)
HCPCS Code: G9058
Short Description: Onc prac mgmt disagree w/gui
Long Description: Oncology; practice guidelines; management differs from guidelines because the treating physician disagrees with guideline recommendations (for use in a medicare-approved demonstration project)
HCPCS Code: G9059
Short Description: Onc prac mgmt pt opt alterna
Long Description: Oncology; practice guidelines; management differs from guidelines because the patient, after being offered treatment consistent with guidelines, has opted for alternative treatment or management, including no treatment (for use in a medicare-approved demonstration project)
HCPCS Code: G9060
Short Description: Onc prac mgmt dif pt comorb
Long Description: Oncology; practice guidelines; management differs from guidelines for reason(s) associated with patient comorbid illness or performance status not factored into guidelines (for use in a medicare-approved demonstration project)
HCPCS Code: G9061
Short Description: Onc prac cond noadd by guide
Long Description: Oncology; practice guidelines; patient's condition not addressed by available guidelines (for use in a medicare-approved demonstration project)
HCPCS Code: G9062
Short Description: Onc prac guide differs nos
Long Description: Oncology; practice guidelines; management differs from guidelines for other reason(s) not listed (for use in a medicare-approved demonstration project)
HCPCS Code: G9063
Short Description: Onc dx nsclc stgi no progres
Long Description: Oncology; disease status; limited to non-small cell lung cancer; extent of disease initially established as stage i (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9064
Short Description: Onc dx nsclc stg2 no progres
Long Description: Oncology; disease status; limited to non-small cell lung cancer; extent of disease initially established as stage ii (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9065
Short Description: Onc dx nsclc stg3a no progre
Long Description: Oncology; disease status; limited to non-small cell lung cancer; extent of disease initially established as stage iii a (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9066
Short Description: Onc dx nsclc stg3b-4 metasta
Long Description: Oncology; disease status; limited to non-small cell lung cancer; stage iii b- iv at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
HCPCS Code: G9067
Short Description: Onc dx nsclc dx unknown nos
Long Description: Oncology; disease status; limited to non-small cell lung cancer; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
HCPCS Code: G9068
Short Description: Onc dx sclc/nsclc limited
Long Description: Oncology; disease status; limited to small cell and combined small cell/non-small cell; extent of disease initially established as limited with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9069
Short Description: Onc dx sclc/nsclc ext at dx
Long Description: Oncology; disease status; small cell lung cancer, limited to small cell and combined small cell/non-small cell; extensive stage at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
HCPCS Code: G9070
Short Description: Onc dx sclc/nsclc ext unknwn
Long Description: Oncology; disease status; small cell lung cancer, limited to small cell and combined small cell/non-small; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
HCPCS Code: G9071
Short Description: Onc dx brst stg1-2b hr,nopro
Long Description: Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage i or stage iia-iib; or t3, n1, m0; and er and/or pr positive; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9072
Short Description: Onc dx brst stg1-2 noprogres
Long Description: Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage i, or stage iia-iib; or t3, n1, m0; and er and pr negative; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9073
Short Description: Onc dx brst stg3-hr, no pro
Long Description: Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage iiia-iiib; and not t3, n1, m0; and er and/or pr positive; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9074
Short Description: Onc dx brst stg3-noprogress
Long Description: Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage iiia-iiib; and not t3, n1, m0; and er and pr negative; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9075
Short Description: Onc dx brst metastic/ recur
Long Description: Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
HCPCS Code: G9077
Short Description: Onc dx prostate t1no progres
Long Description: Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t1-t2c and gleason 2-7 and psa < or equal to 20 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9078
Short Description: Onc dx prostate t2no progres
Long Description: Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t2 or t3a gleason 8-10 or psa > 20 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9079
Short Description: Onc dx prostate t3b-t4noprog
Long Description: Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t3b-t4, any n; any t, n1 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9080
Short Description: Onc dx prostate w/rise psa
Long Description: Oncology; disease status; prostate cancer, limited to adenocarcinoma; after initial treatment with rising psa or failure of psa decline (for use in a medicare-approved demonstration project)
HCPCS Code: G9083
Short Description: Onc dx prostate unknwn nos
Long Description: Oncology; disease status; prostate cancer, limited to adenocarcinoma; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
HCPCS Code: G9084
Short Description: Onc dx colon t1-3,n1-2,no pr
Long Description: Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-3, n0, m0 with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9085
Short Description: Onc dx colon t4, n0 w/o prog
Long Description: Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t4, n0, m0 with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9086
Short Description: Onc dx colon t1-4 no dx prog
Long Description: Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-4, n1-2, m0 with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9087
Short Description: Onc dx colon metas evid dx
Long Description: Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive with current clinical, radiologic, or biochemical evidence of disease (for use in a medicare-approved demonstration project)
HCPCS Code: G9088
Short Description: Onc dx colon metas noevid dx
Long Description: Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive without current clinical, radiologic, or biochemical evidence of disease (for use in a medicare-approved demonstration project)
HCPCS Code: G9089
Short Description: Onc dx colon extent unknown
Long Description: Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
HCPCS Code: G9090
Short Description: Onc dx rectal t1-2 no progr
Long Description: Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-2, n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9091
Short Description: Onc dx rectal t3 n0 no prog
Long Description: Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t3, n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9092
Short Description: Onc dx rectal t1-3,n1-2noprg
Long Description: Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-3, n1-2, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence or metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9093
Short Description: Onc dx rectal t4,n,m0 no prg
Long Description: Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t4, any n, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9094
Short Description: Onc dx rectal m1 w/mets prog
Long Description: Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
HCPCS Code: G9095
Short Description: Onc dx rectal extent unknwn
Long Description: Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
HCPCS Code: G9096
Short Description: Onc dx esophag t1-t3 noprog
Long Description: Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; extent of disease initially established as t1-t3, n0-n1 or nx (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9097
Short Description: Onc dx esophageal t4 no prog
Long Description: Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; extent of disease initially established as t4, any n, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9098
Short Description: Onc dx esophageal mets recur
Long Description: Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
HCPCS Code: G9099
Short Description: Onc dx esophageal unknown
Long Description: Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
HCPCS Code: G9100
Short Description: Onc dx gastric no recurrence
Long Description: Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; post r0 resection (with or without neoadjuvant therapy) with no evidence of disease recurrence, progression, or metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9101
Short Description: Onc dx gastric p r1-r2noprog
Long Description: Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; post r1 or r2 resection (with or without neoadjuvant therapy) with no evidence of disease progression, or metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9102
Short Description: Onc dx gastric unresectable
Long Description: Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; clinical or pathologic m0, unresectable with no evidence of disease progression, or metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9103
Short Description: Onc dx gastric recurrent
Long Description: Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; clinical or pathologic m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
HCPCS Code: G9104
Short Description: Onc dx gastric unknown nos
Long Description: Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
HCPCS Code: G9105
Short Description: Onc dx pancreatc p r0 res no
Long Description: Oncology; disease status; pancreatic cancer, limited to adenocarcinoma as predominant cell type; post r0 resection without evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9106
Short Description: Onc dx pancreatc p r1/r2 no
Long Description: Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; post r1 or r2 resection with no evidence of disease progression, or metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9107
Short Description: Onc dx pancreatic unresectab
Long Description: Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; unresectable at diagnosis, m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
HCPCS Code: G9108
Short Description: Onc dx pancreatic unknwn nos
Long Description: Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
HCPCS Code: G9109
Short Description: Onc dx head/neck t1-t2no prg
Long Description: Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; extent of disease initially established as t1-t2 and n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9110
Short Description: Onc dx head/neck t3-4 noprog
Long Description: Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; extent of disease initially established as t3-4 and/or n1-3, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9111
Short Description: Onc dx head/neck m1 mets rec
Long Description: Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
HCPCS Code: G9112
Short Description: Onc dx head/neck ext unknown
Long Description: Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
HCPCS Code: G9113
Short Description: Onc dx ovarian stg1a-b no pr
Long Description: Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage ia-b (grade 1) without evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9114
Short Description: Onc dx ovarian stg1a-b or 2
Long Description: Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage ia-b (grade 2-3); or stage ic (all grades); or stage ii; without evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9115
Short Description: Onc dx ovarian stg3/4 noprog
Long Description: Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage iii-iv; without evidence of progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9116
Short Description: Onc dx ovarian recurrence
Long Description: Oncology; disease status; ovarian cancer, limited to epithelial cancer; evidence of disease progression, or recurrence, and/or platinum resistance (for use in a medicare-approved demonstration project)
HCPCS Code: G9117
Short Description: Onc dx ovarian unknown nos
Long Description: Oncology; disease status; ovarian cancer, limited to epithelial cancer; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
HCPCS Code: G9123
Short Description: Onc dx cml chronic phase
Long Description: Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; chronic phase not in hematologic, cytogenetic, or molecular remission (for use in a medicare-approved demonstration project)
HCPCS Code: G9124
Short Description: Onc dx cml acceler phase
Long Description: Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; accelerated phase not in hematologic cytogenetic, or molecular remission (for use in a medicare-approved demonstration project)
HCPCS Code: G9125
Short Description: Onc dx cml blast phase
Long Description: Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; blast phase not in hematologic, cytogenetic, or molecular remission (for use in a medicare-approved demonstration project)
HCPCS Code: G9126
Short Description: Onc dx cml remission
Long Description: Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; in hematologic, cytogenetic, or molecular remission (for use in a medicare-approved demonstration project)
HCPCS Code: G9128
Short Description: Onc dx multi myeloma stage i
Long Description: Oncology; disease status; limited to multiple myeloma, systemic disease; smoldering, stage i (for use in a medicare-approved demonstration project)
HCPCS Code: G9129
Short Description: Onc dx mult myeloma stg2 hig
Long Description: Oncology; disease status; limited to multiple myeloma, systemic disease; stage ii or higher (for use in a medicare-approved demonstration project)
HCPCS Code: G9130
Short Description: Onc dx multi myeloma unknown
Long Description: Oncology; disease status; limited to multiple myeloma, systemic disease; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
HCPCS Code: G9131
Short Description: Onc dx brst unknown nos
Long Description: Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
HCPCS Code: G9132
Short Description: Onc dx prostate mets no cast
Long Description: Oncology; disease status; prostate cancer, limited to adenocarcinoma; hormone-refractory/androgen-independent (e.g., rising psa on anti-androgen therapy or post-orchiectomy); clinical metastases (for use in a medicare-approved demonstration project)
HCPCS Code: G9133
Short Description: Onc dx prostate clinical met
Long Description: Oncology; disease status; prostate cancer, limited to adenocarcinoma; hormone-responsive; clinical metastases or m1 at diagnosis (for use in a medicare-approved demonstration project)
HCPCS Code: G9134
Short Description: Onc nhlstg 1-2 no relap no
Long Description: Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; stage i, ii at diagnosis, not relapsed, not refractory (for use in a medicare-approved demonstration project)
HCPCS Code: G9135
Short Description: Onc dx nhl stg 3-4 not relap
Long Description: Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; stage iii, iv, not relapsed, not refractory (for use in a medicare-approved demonstration project)
HCPCS Code: G9136
Short Description: Onc dx nhl trans to lg bcell
Long Description: Oncology; disease status; non-hodgkin's lymphoma, transformed from original cellular diagnosis to a second cellular classification (for use in a medicare-approved demonstration project)
HCPCS Code: G9137
Short Description: Onc dx nhl relapse/refractor
Long Description: Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; relapsed/refractory (for use in a medicare-approved demonstration project)
HCPCS Code: G9138
Short Description: Onc dx nhl stg unknown
Long Description: Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; diagnostic evaluation, stage not determined, evaluation of possible relapse or non-response to therapy, or not listed (for use in a medicare-approved demonstration project)
HCPCS Code: G9139
Short Description: Onc dx cml dx status unknown
Long Description: Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; extent of disease unknown, staging in progress, not listed (for use in a medicare-approved demonstration project)
HCPCS Code: G9140
Short Description: Frontier extended stay demo
Long Description: Frontier extended stay clinic demonstration; for a patient stay in a clinic approved for the cms demonstration project; the following measures should be present: the stay must be equal to or greater than 4 hours; weather or other conditions must prevent transfer or the case falls into a category of monitoring and observation cases that are permitted by the rules of the demonstration; there is a maximum frontier extended stay clinic (fesc) visit of 48 hours, except in the case when weather or other conditions prevent transfer; payment is made on each period up to 4 hours, after the first 4 hours
HCPCS Code: G9141
Short Description: Influenza a h1n1,admin w cou
Long Description: Influenza a (h1n1) immunization administration (includes the physician counseling the patient/family)
HCPCS Code: G9142
Short Description: Influenza a h1n1, vaccine
Long Description: Influenza a (h1n1) vaccine, any route of administration
HCPCS Code: G9143
Short Description: Warfarin respon genetic test
Long Description: Warfarin responsiveness testing by genetic technique using any method, any number of specimen(s)
HCPCS Code: G9147
Short Description: Outpt iv insulin tx any mea
Long Description: Outpatient intravenous insulin treatment (oivit) either pulsatile or continuous, by any means, guided by the results of measurements for: respiratory quotient; and/or, urine urea nitrogen (uun); and/or, arterial, venous or capillary glucose; and/or potassium concentration
HCPCS Code: G9148
Short Description: Medical home level 1
Long Description: National committee for quality assurance - level 1 medical home
HCPCS Code: G9149
Short Description: Medical home level ii
Long Description: National committee for quality assurance - level 2 medical home
HCPCS Code: G9150
Short Description: Medical home level iii
Long Description: National committee for quality assurance - level 3 medical home
HCPCS Code: G9151
Short Description: Mapcp demo state
Long Description: Mapcp demonstration - state provided services
HCPCS Code: G9152
Short Description: Mapcp demo community
Long Description: Mapcp demonstration - community health teams
HCPCS Code: G9153
Short Description: Mapcp demo physician
Long Description: Mapcp demonstration - physician incentive pool
HCPCS Code: G9156
Short Description: Evaluation for wheelchair
Long Description: Evaluation for wheelchair requiring face to face visit with physician
HCPCS Code: G9157
Short Description: Transesoph doppl cardiac mon
Long Description: Transesophageal doppler measurement of cardiac output (including probe placement, image acquisition, and interpretation per course of treatment) for monitoring purposes
HCPCS Code: G9158
Short Description: Motor speech d/c status
Long Description: Motor speech functional limitation, discharge status, at discharge from therapy or to end reporting
HCPCS Code: G9159
Short Description: Lang comp current status
Long Description: Spoken language comprehension functional limitation, current status at therapy episode outset and at reporting intervals
HCPCS Code: G9160
Short Description: Lang comp goal status
Long Description: Spoken language comprehension functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
HCPCS Code: G9161
Short Description: Lang comp d/c status
Long Description: Spoken language comprehension functional limitation, discharge status, at discharge from therapy or to end reporting
HCPCS Code: G9162
Short Description: Lang express current status
Long Description: Spoken language expression functional limitation, current status at therapy episode outset and at reporting intervals
HCPCS Code: G9163
Short Description: Lang express goal status
Long Description: Spoken language expression functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
HCPCS Code: G9164
Short Description: Lang express d/c status
Long Description: Spoken language expression functional limitation, discharge status at discharge from therapy or to end reporting
HCPCS Code: G9165
Short Description: Atten current status
Long Description: Attention functional limitation, current status at therapy episode outset and at reporting intervals
HCPCS Code: G9166
Short Description: Atten goal status
Long Description: Attention functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
HCPCS Code: G9167
Short Description: Atten d/c status
Long Description: Attention functional limitation, discharge status at discharge from therapy or to end reporting
HCPCS Code: G9168
Short Description: Memory current status
Long Description: Memory functional limitation, current status at therapy episode outset and at reporting intervals
HCPCS Code: G9169
Short Description: Memory goal status
Long Description: Memory functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
HCPCS Code: G9170
Short Description: Memory d/c status
Long Description: Memory functional limitation, discharge status at discharge from therapy or to end reporting
HCPCS Code: G9171
Short Description: Voice current status
Long Description: Voice functional limitation, current status at therapy episode outset and at reporting intervals
HCPCS Code: G9172
Short Description: Voice goal status
Long Description: Voice functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
HCPCS Code: G9173
Short Description: Voice d/c status
Long Description: Voice functional limitation, discharge status at discharge from therapy or to end reporting
HCPCS Code: G9174
Short Description: Speech lang current status
Long Description: Other speech language pathology functional limitation, current status at therapy episode outset and at reporting intervals
HCPCS Code: G9175
Short Description: Speech lang goal status
Long Description: Other speech language pathology functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
HCPCS Code: G9176
Short Description: Speech lang d/c status
Long Description: Other speech language pathology functional limitation, discharge status at discharge from therapy or to end reporting
HCPCS Code: G9186
Short Description: Motor speech goal status
Long Description: Motor speech functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
HCPCS Code: G9187
Short Description: Bpci home visit
Long Description: Bundled payments for care improvement initiative home visit for patient assessment performed by a qualified health care professional for individuals not considered homebound including, but not limited to, assessment of safety, falls, clinical status, fluid status, medication reconciliation/management, patient compliance with orders/plan of care, performance of activities of daily living, appropriateness of care setting; (for use only in the meidcare-approved bundled payments for care improvement initiative); may not be billed for a 30-day period covered by a transitional care management code
HCPCS Code: G9188
Short Description: Beta not given no reason
Long Description: Beta-blocker therapy not prescribed, reason not given
HCPCS Code: G9189
Short Description: Beta pres or already taking
Long Description: Beta-blocker therapy prescribed or currently being taken
HCPCS Code: G9190
Short Description: Medical reason for no beta
Long Description: Documentation of medical reason(s) for not prescribing beta-blocker therapy (eg, allergy, intolerance, other medical reasons)
HCPCS Code: G9191
Short Description: Pt reason for no beta
Long Description: Documentation of patient reason(s) for not prescribing beta-blocker therapy (eg, patient declined, other patient reasons)
HCPCS Code: G9192
Short Description: System reason for no beta
Long Description: Documentation of system reason(s) for not prescribing beta-blocker therapy (eg, other reasons attributable to the health care system)
HCPCS Code: G9193
Short Description: Doc not eligible for dep med
Long Description: Clinician documented that patient with a diagnosis of major depression was not an eligible candidate for antidepressant medication treatment or patient did not have a diagnosis of major depression
HCPCS Code: G9194
Short Description: Mdd pt treated for 180d
Long Description: Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 180 day (6 month) continuation treatment phase
HCPCS Code: G9195
Short Description: Mdd pt not treated for 180d
Long Description: Patient with a diagnosis of major depression not documented as being treated with antidepressant medication during the entire 180 day (6 months) continuation treatment phase
HCPCS Code: G9196
Short Description: Med reason for no ceph
Long Description: Documentation of medical reason(s) for not ordering a first or second generation cephalosporin for antimicrobial prophylaxis (e.g., patients enrolled in clinical trials, patients with documented infection prior to surgical procedure of interest, patients who were receiving antibiotics more than 24 hours prior to surgery [except colon surgery patients taking oral prophylactic antibiotics], patients who were receiving antibiotics within 24 hours prior to arrival [except colon surgery patients taking oral prophylactic antibiotics], other medical reason(s))
HCPCS Code: G9197
Short Description: Order for ceph
Long Description: Documentation of order for first or second generation cephalosporin for antimicrobial prophylaxis
HCPCS Code: G9198
Short Description: No order for ceph no reason
Long Description: Order for first or second generation cephalosporin for antimicrobial prophylaxis was not documented, reason not given
HCPCS Code: G9199
Short Description: Doc reason for no vte
Long Description: Venous thromboembolism (vte) prophylaxis not administered the day of or the day after hospital admission for documented reasons (eg, patient is ambulatory, patient expired during inpatient stay, patient already on warfarin or another anticoagulant, other medical reason(s) or eg, patient left against medical advice, other patient reason(s))
HCPCS Code: G9200
Short Description: No reason for no vte
Long Description: Venous thromboembolism (vte) prophylaxis was not administered the day of or the day after hospital admission, reason not given
HCPCS Code: G9201
Short Description: Vte given upon admission
Long Description: Venous thromboembolism (vte) prophylaxis administered the day of or the day after hospital admission
HCPCS Code: G9202
Short Description: Hep c aby pos
Long Description: Patients with a positive hepatitis c antibody test
HCPCS Code: G9203
Short Description: Hep c rna done prior to med
Long Description: Rna testing for hepatitis c documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c
HCPCS Code: G9204
Short Description: No reason for no hep c rna
Long Description: Rna testing for hepatitis c was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c, reason not given
HCPCS Code: G9205
Short Description: Hep c antiviral started
Long Description: Patient starting antiviral treatmentfor hepatitis c during the measurement period
HCPCS Code: G9206
Short Description: Hep c therapy started
Long Description: Patient starting antiviral treatment for hepatitis c during the measurement period
HCPCS Code: G9207
Short Description: Hep c genotype prior to med
Long Description: Hepatitis c genotype testing documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c
HCPCS Code: G9208
Short Description: No reason for no hep c geno
Long Description: Hepatitis c genotype testing was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c, reason not given
HCPCS Code: G9209
Short Description: Hep c rna 4to12 wk after med
Long Description: Hepatitis c quantitative rna testing documented as performed between 4-12 weeks after the initiation of antiviral treatment
HCPCS Code: G9210
Short Description: No hepc rna after med docrsn
Long Description: Hepatitis c quantitative rna testing not performed between 4-12 weeks after the initiation of antiviral treatment for documented reason(s) (e.g., patients whose treatment was discontinued during the testing period prior to testing, other medical reasons, patient declined, other patient reasons)
HCPCS Code: G9211
Short Description: No hepc rna after med no rsn
Long Description: Hepatitis c quantitative rna testing was not documented as performed between 4-12 weeks after the initiation of antiviral treatment, reason not given
HCPCS Code: G9212
Short Description: Doc of dsm-iv init eval
Long Description: Dsm-ivtm criteria for major depressive disorder documented at the initial evaluation
HCPCS Code: G9213
Short Description: No doc of dsm-iv
Long Description: Dsm-iv-tr criteria for major depressive disorder not documented at the initial evaluation, reason not otherwise specified
HCPCS Code: G9214
Short Description: Cd4 count documented
Long Description: Cd4+ cell count or cd4+ cell percentage results documented
HCPCS Code: G9215
Short Description: No cd4 count no reason
Long Description: Cd4+ cell count or percentage not documented as performed, reason not given
HCPCS Code: G9216
Short Description: No pcp proph at dx no reason
Long Description: Pcp prophylaxis was not prescribed at time of diagnosis of hiv, reason not given
HCPCS Code: G9217
Short Description: No pcp proph low cd4 norsn
Long Description: Pcp prophylaxis was not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3, reason not given
HCPCS Code: G9218
Short Description: No pcp prop low at cd4 norsn
Long Description: Pcp prophylaxis was not prescribed within 3 months oflow cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%, reason not given
HCPCS Code: G9219
Short Description: No oder pjp for med reason
Long Description: Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3 for medical reason (i.e., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis)
HCPCS Code: G9220
Short Description: No order for pjp for medrsn
Long Description: Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15% for medical reason (i.e., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis)
HCPCS Code: G9221
Short Description: Pjp proph prescribed
Long Description: Pneumocystis jiroveci pneumonia prophlaxis prescribed
HCPCS Code: G9222
Short Description: Pjp proph ordered low cd4
Long Description: Pneumocystis jiroveci pneumonia prophylaxis prescribed wthin 3 months of low cd4+ cell count below 200 cells/mm3
HCPCS Code: G9223
Short Description: Pjp proph ordered cd4 low
Long Description: Pneumocystis jiroveci pneumonia prophylaxis prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%
HCPCS Code: G9224
Short Description: Medrsn no foot exam
Long Description: Documentation of medical reason for not performing foot exam (e.g., patient with bilateral foot/leg amputation)
HCPCS Code: G9225
Short Description: Norsn no foot exam
Long Description: Foot exam was not performed, reason not given
HCPCS Code: G9226
Short Description: 3 comp foot exam completed
Long Description: Foot examination performed (includes examination through visual inspection, sensory exam with 10-g monofilament plus testing any one of the following: vibration using 128-hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception threshold, and pulse exam ? report when all of the 3 components are completed)
HCPCS Code: G9227
Short Description: Docrsn no care plan
Long Description: Functional outcome assessment documented, care plan not documented, documentation the patient is not eligible for a care plan
HCPCS Code: G9228
Short Description: Gc chl syp documented
Long Description: Chlamydia, gonorrhea and syphilis screening results documented (report when results are present for all of the 3 screenings)
HCPCS Code: G9229
Short Description: Ptrsn no gc chl syp test
Long Description: Chlamydia, gonorrhea, and syphilis not screened, due to documented reason (patient refusal is the only allowed exclusion)
HCPCS Code: G9230
Short Description: Norsn for gc chl syp test
Long Description: Chlamydia, gonorrhea, and syphilis not screened, reason not given
HCPCS Code: G9231
Short Description: Doc esrd dia trans preg
Long Description: Documentation of end stage renal disease (esrd), dialysis, renal transplant or pregnancy
HCPCS Code: G9232
Short Description: Docrsn no comm comorb
Long Description: Clinician treating major depressive disorder did not communicate to clinician treating comorbid condition for specified patient reason
HCPCS Code: G9233
Short Description: Tkr composite
Long Description: All quality actions for the applicable measures in the total knee replacement measures group have been performed for this patient
HCPCS Code: G9234
Short Description: Tkr intent
Long Description: I intend to report the total knee replacement measures group
HCPCS Code: G9235
Short Description: Gs mg composite
Long Description: All quality actions for the applicable measures in the general surgery measures group have been performed for this patient
HCPCS Code: G9236
Short Description: Op rad mg composite
Long Description: All quality actions for the applicable measures in the optimizing patient exposure to ionizing radiation measures group have been performed for this patient
HCPCS Code: G9237
Short Description: Gs mg intent
Long Description: I intend to report the general surgery measures group
HCPCS Code: G9238
Short Description: Op rad mg intent
Long Description: I intend to report the optimizing patient exposure to ionizing radiation measures group
HCPCS Code: G9239
Short Description: Docrsn for catheter
Long Description: Documentation of reasons for patient initiaiting maintenance hemodialysis with a catheter as the mode of vascular access (eg, patient has a maturing avf/avg, time-limited trial of hemodialysis, patients undergoing palliative dialysis, other medical reasons, patient declined avf/avg, other patient reasons, patient followed by reporting nephrologist for fewer than 90 days, other system reasons)
HCPCS Code: G9240
Short Description: Doc pt w cath maint dia
Long Description: Patient whose mode of vascular access is a catheter at the time maintenance hemodialysis is initiated
HCPCS Code: G9241
Short Description: Doc pt w out cath maint dia
Long Description: Patient whose mode of vascular access is not a catheter at the time maintenance hemodialysis is initiated
HCPCS Code: G9242
Short Description: Doc viral load >=200
Long Description: Documentation of viral load equal to or greater than 200 copies/ml or viral load not performed
HCPCS Code: G9243
Short Description: Doc viral load <200
Long Description: Documentation of viral load less than 200 copies/ml
HCPCS Code: G9244
Short Description: Antiviral not ordered
Long Description: Antiretroviral thereapy not prescribed
HCPCS Code: G9245
Short Description: Antiviral ordered
Long Description: Antiretroviral therapy prescribed
HCPCS Code: G9246
Short Description: No med visit in 24mo
Long Description: Patient did not have at least one medical visit in each 6 month period of the 24 month measurement period, with a minimum of 60 days between medical visits
HCPCS Code: G9247
Short Description: 1 med visit in 24mo
Long Description: Patient had at least one medical visit in each 6 month period of the 24 month measurement period, with a minimum of 60 days between medical visits
HCPCS Code: G9248
Short Description: No med visit 6mo
Long Description: Patient did not have a medical visit in the last 6 months
HCPCS Code: G9249
Short Description: Med visit w in 6mo
Long Description: Patient had a medical visit in the last 6 months
HCPCS Code: G9250
Short Description: Doc of pain comfort 48hr
Long Description: Documentation of patient pain brought to a comfortable level within 48 hours from initial assessment
HCPCS Code: G9251
Short Description: Doc no pain comfort 48hr
Long Description: Documentation of patient with pain not brought to a comfortable level within 48 hours from initial assessment
HCPCS Code: G9252
Short Description: Neo detect scrn colo
Long Description: Adenoma(s) or other neoplasm detected during screening colonoscopy
HCPCS Code: G9253
Short Description: No neo detect scrn colo
Long Description: Adenoma(s) or other neoplasm not detected during screening colonoscopy
HCPCS Code: G9254
Short Description: Doc pt dischg >2d
Long Description: Documentation of patient discharged to home later than post-operative day 2 following cas
HCPCS Code: G9255
Short Description: Doc pt dischg <=2d
Long Description: Documentation of patient discharged to home no later than post operative day 2 following cas
HCPCS Code: G9256
Short Description: Doc death after cas
Long Description: Documentation of patient death following cas
HCPCS Code: G9257
Short Description: Doc stroke after cas
Long Description: Documentation of patient stroke following cas
HCPCS Code: G9258
Short Description: Doc stroke after cea
Long Description: Documentation of patient stroke following cea
HCPCS Code: G9259
Short Description: Doc surv no stroke after cas
Long Description: Documentation of patient survival and absence of stroke following cas
HCPCS Code: G9260
Short Description: Doc death after cea
Long Description: Documentation of patient death following cea
HCPCS Code: G9261
Short Description: Doc surv no stroke after cea
Long Description: Documentation of patient survival and absence of stroke following cea
HCPCS Code: G9262
Short Description: Doc death in hosp aaa repair
Long Description: Documentation of patient death in the hospital following endovascular aaa repair
HCPCS Code: G9263
Short Description: Doc surv in hosp aaa repair
Long Description: Documentation of patient survival in the hospital following endovascular aaa repair
HCPCS Code: G9264
Short Description: Docrsn for cath maint dia
Long Description: Documentation of patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter for documented reasons (eg, patient is undergoing palliative dialysis with a catheter, patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant, other medical reasons, patient declined avf/avg, other patient reasons)
HCPCS Code: G9265
Short Description: Doc cath >90d for maint dia
Long Description: Patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter as the mode of vascular access
HCPCS Code: G9266
Short Description: Norsn pt cath >=90d
Long Description: Patient receiving maintenance hemodialysis for greater than or equal to 90 days without a catheter as the mode of vascular access
HCPCS Code: G9267
Short Description: Doc comp or mort w in 30d
Long Description: Documentation of patient with one or more complications or mortality within 30 days
HCPCS Code: G9268
Short Description: Doc comp or mort w in 90d
Long Description: Documentation of patient with one or more complications within 90 days
HCPCS Code: G9269
Short Description: Doc no comp or mort w in 30d
Long Description: Documentation of patient without one or more complications and without mortality within 30 days
HCPCS Code: G9270
Short Description: Doc no comp or mort w in 90d
Long Description: Documentation of patient without one or more complications within 90 days
HCPCS Code: G9271
Short Description: Ldl under 100
Long Description: Ldl value < 100
HCPCS Code: G9272
Short Description: Ldl 100 and over
Long Description: Ldl value >= 100
HCPCS Code: G9273
Short Description: Sys<140 and dia<90
Long Description: Blood pressure has a systolic value of < 140 and a diastolic value of < 90
HCPCS Code: G9274
Short Description: Bp out of nrml limits
Long Description: Blood pressure has a systolic value of =140 and a diastolic value of = 90 or systolic value < 140 and diastolic value = 90 or systolic value = 140 and diastolic value < 90
HCPCS Code: G9275
Short Description: Doc of non tobacco user
Long Description: Documentation that patient is a current non-tobacco user
HCPCS Code: G9276
Short Description: Doc of tobacco user
Long Description: Documentation that patient is a current tobacco user
HCPCS Code: G9277
Short Description: Doc daily aspirin or contra
Long Description: Documentation that the patient is on daily aspirin or anti-platelet or has documentation of a valid contraindication or exception to aspirin/anti-platelet; contraindications/exceptions include anti-coagulant use, allergy to aspirin or anti-platelets, history of gastrointestinal bleed and bleeding disorder; additionally, the following exceptions documented by the physician as a reason for not taking daily aspirin or anti-platelet are acceptable (use of non-steroidal anti-inflammatory agents, documented risk for drug interaction, uncontrolled hypertension defined as >180 systolic or >110 diastolic or gastroesophageal reflux)
HCPCS Code: G9278
Short Description: Doc no daily aspirin
Long Description: Documentation that the patient is not on daily aspirin or anti-platelet regimen
HCPCS Code: G9279
Short Description: Pne scrn done doc vac done
Long Description: Pneumococcal screening performed and documentation of vaccination received prior to discharge
HCPCS Code: G9280
Short Description: Pne not given norsn
Long Description: Pneumococcal vaccination not administered prior to discharge, reason not specified
HCPCS Code: G9281
Short Description: Pne scrn done doc not ind
Long Description: Screening performed and documentation that vaccination not indicated/patient refusal
HCPCS Code: G9282
Short Description: Doc medrsn no histo type
Long Description: Documentation of medical reason(s) for not reporting the histological type or nsclc-nos classification with an explanation (e.g., biopsy taken for other purposes in a patient with a history of non-small cell lung cancer or other documented medical reasons)
HCPCS Code: G9283
Short Description: Hist type doc on report
Long Description: Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation
HCPCS Code: G9284
Short Description: No hist type doc on report
Long Description: Non small cell lung cancer biopsy and cytology specimen report does not document classification into specific histologic type or classified as nsclc-nos with an explanation
HCPCS Code: G9285
Short Description: Site not small cell lung ca
Long Description: Specimen site other than anatomic location of lung or is not classified as non small cell lung cancer
HCPCS Code: G9286
Short Description: Antibio rx w in 10d of sympt
Long Description: Antibiotic regimen prescribed within10 days after onset of symptoms
HCPCS Code: G9287
Short Description: No antibio w in 10d of sympt
Long Description: Antibiotic regimen not prescribed within 10 days after onset of symptoms
HCPCS Code: G9288
Short Description: Doc medrsn no hist type rpt
Long Description: Documentation of medical reason(s) for not reporting the histological type or nsclc-nos classification with an explanation (e.g., a solitary fibrous tumor in a person with a history of non-small cell carcinoma or other documented medical reasons)
HCPCS Code: G9289
Short Description: Doc type nsm lung ca
Long Description: Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation
HCPCS Code: G9290
Short Description: No doc type nsm lung ca
Long Description: Non small cell lung cancer biopsy and cytology specimen report does not document classification into specific histologic type or classified as nsclc-nos with an explanation
HCPCS Code: G9291
Short Description: Not nsm lung ca
Long Description: Specimen site other than anatomic location of lung, is not classified as non small cell lung cancer or classified as nsclc-nos
HCPCS Code: G9292
Short Description: Medrsn no pt category
Long Description: Documentation of medical reason(s) for not reporting pt category and a statement on thickness and ulceration and for pt1, mitotic rate (e.g., negative skin biopsies in a patient with a history of melanoma or other documented medical reasons)
HCPCS Code: G9293
Short Description: No pt category on report
Long Description: Pathology report does not include the pt category and a statement on thickness and ulceration and for pt1, mitotic rate
HCPCS Code: G9294
Short Description: Pt cat and thck on report
Long Description: Pathology report includes the pt category and a statement on thickness and ulceration and for pt1, mitotic rate
HCPCS Code: G9295
Short Description: Non cutaneous loc
Long Description: Specimen site other than anatomic cutaneous location
HCPCS Code: G9296
Short Description: Doc share dec prior proc
Long Description: Patients with documented shared decision-making including discussion of conservative (non-surgical) therapy (e.g., nsaids, analgesics, weight loss, exercise, injections) prior to the procedure
HCPCS Code: G9297
Short Description: No doc share dec prior proc
Long Description: Shared decision-making including discussion of conservative (non-surgical) therapy (e.g., nsaids, analgesics, weight loss, exercise, injections) prior to the procedure, not documented, reason not given
HCPCS Code: G9298
Short Description: Eval risk vte card 30d prior
Long Description: Patients who are evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (e.g. history of dvt, pe, mi, arrhythmia and stroke)
HCPCS Code: G9299
Short Description: No eval riskk vte card prior
Long Description: Patients who are not evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure including (e.g., history of dvt, pe, mi, arrhythmia and stroke, reason not given)
HCPCS Code: G9300
Short Description: Doc medrsn no compl antibio
Long Description: Documentation of medical reason(s) for not completely infusing the prophylactic antibiotic prior to the inflation of the proximal tourniquet (e.g., a tourniquet was not used)
HCPCS Code: G9301
Short Description: Doc compl inf antibio
Long Description: Patients who had the prophylactic antibiotic completely infused prior to the inflation of the proximal tourniquet
HCPCS Code: G9302
Short Description: Norsn incomp inf antibio
Long Description: Prophylactic antibiotic not completely infused prior to the inflation of the proximal tourniquet, reason not given
HCPCS Code: G9303
Short Description: Norsn no pros info op rpt
Long Description: Operative report does not identify the prosthetic implant specifications including the prosthetic implant manufacturer, the brand name of the prosthetic implant and the size of each prosthetic implant, reason not given
HCPCS Code: G9304
Short Description: Pros info op rpt
Long Description: Operative report identifies the prosthetic implant specifications including the prosthetic implant manufacturer, the brand name of the prosthetic implant and the size of each prosthetic implant
HCPCS Code: G9305
Short Description: No interv req for leak
Long Description: Intervention for presence of leak of endoluminal contents through an anastomosis not required
HCPCS Code: G9306
Short Description: Interv req for leak
Long Description: Intervention for presence of leak of endoluminal contents through an anastomosis required
HCPCS Code: G9307
Short Description: No ret for surg w in 30d
Long Description: No return to the operating room for a surgical procedure, for any reason, within 30 days of the principal operative procedure
HCPCS Code: G9308
Short Description: Unplnd ret to surg w in 30d
Long Description: Unplanned return to the operating room for a surgical procedure, for any reason, within 30 days of the principal operative procedure
HCPCS Code: G9309
Short Description: No unplnd hosp readm in 30d
Long Description: No unplanned hospital readmission within 30 days of principal procedure
HCPCS Code: G9310
Short Description: Unplnd hosp readm in 30d
Long Description: Unplanned hospital readmission within 30 days of principal procedure
HCPCS Code: G9311
Short Description: No surg site infection
Long Description: No surgical site infection
HCPCS Code: G9312
Short Description: Surgical site infection
Long Description: Surgical site infection
HCPCS Code: G9313
Short Description: Docrsn not first line amox
Long Description: Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis for documented reason (eg, cystic fibrosis, immotile cilia disorders, ciliary dyskinesia, immune deficiency, prior history of sinus surgery within the past 12 months, and anatomic abnormalities, such as deviated nasal septum, resistant organisms, allergy to medication, recurrent sinusitis, chronic sinusitis, or other reasons)
HCPCS Code: G9314
Short Description: Norsn not first line amox
Long Description: Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis, reason not given
HCPCS Code: G9315
Short Description: Doc first line amox
Long Description: Documentation amoxicillin, with or without clavulanate, prescribed as a first line antibiotic at the time of diagnosis
HCPCS Code: G9316
Short Description: Doc comm risk calc
Long Description: Documentation of patient-specific risk assessment with a risk calculator based on multi-institutional clinical data, the specific risk calculator used, and communication of risk assessment from risk calculator with the patient or family
HCPCS Code: G9317
Short Description: No doc comm risk calc
Long Description: Documentation of patient-specific risk assessment with a risk calculator based on multi-institutional clinical data, the specific risk calculator used, and communication of risk assessment from risk calculator with the patient or family not completed
HCPCS Code: G9318
Short Description: Image std nomenclature
Long Description: Imaging study named according to standardized nomenclature
HCPCS Code: G9319
Short Description: Image not std nomenclature
Long Description: Imaging study not named according to standardized nomenclature, reason not given
HCPCS Code: G9320
Short Description: Medrsn no std nomenclature
Long Description: Documentation of medical reason(s) for not naming ct studies according to a standardized nomenclature provided (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)
HCPCS Code: G9321
Short Description: Doc count of ct in 12mo
Long Description: Count of previous ct (any type of ct) and cardiac nuclear medicine (myocardial perfusion) studies documented in the 12-month period prior to the current study
HCPCS Code: G9322
Short Description: No doc count of ct in 12mo
Long Description: Count of previous ct and cardiac nuclear medicine (myocardial perfusion) studies not documented in the 12-month period prior to the current study, reason not given
HCPCS Code: G9323
Short Description: Mdrsn no doc cnt of ct
Long Description: Documentation of medical reason(s) for not counting previous ct and cardiac nuclear medicine (myocardial perfusion) studies (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)
HCPCS Code: G9324
Short Description: Not all data norsn
Long Description: All necessary data elements not included, reason not given
HCPCS Code: G9325
Short Description: Medrsn no ct rpt to reg
Long Description: Ct studies not reported to a radiation dose index registry due to medical reasons (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)
HCPCS Code: G9326
Short Description: Norsn no ct rpt to reg
Long Description: Ct studies performed not reported to a radiation dose index registry, reason not given
HCPCS Code: G9327
Short Description: Ct rpt to reg
Long Description: Ct studies performed reported to a radiation dose index registry with all necessary data elements
HCPCS Code: G9328
Short Description: Medrsn no dicom format doc
Long Description: Dicom format image data availability not documented in final report due to medical reasons (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)
HCPCS Code: G9329
Short Description: Norsn no dicom format doc
Long Description: Dicom format image data available to non-affiliated external healthcare facilities or entities on a secure, media free, reciprocally searchable basis with patient authorization for at least a 12-month period after the study not documented in final report, reason not given
HCPCS Code: G9340
Short Description: Dicom format doc on rpt
Long Description: Final report documented that dicom format image data available to non-affiliated external healthcare facilities or entities on a secure, media free, reciprocally searchable basis with patient authorization for at least a 12-month period after the study
HCPCS Code: G9341
Short Description: Srch for ct w in 12 mos
Long Description: Search conducted for prior patient ct studies completed at non-affiliated external healthcare facilities or entities within the past 12-months and are available through a secure, authorized, media-free, shared archive prior to an imaging study being performed
HCPCS Code: G9342
Short Description: No srch for ct in 12mo norsn
Long Description: Search not conducted prior to an imaging study being performed for prior patient ct studies completed at non-affiliated external healthcare facilities or entities within the past 12-months and are available through a secure, authorized, media-free, shared archive, reason not given
HCPCS Code: G9343
Short Description: Medrsn no dicom srch
Long Description: Due to medical reasons, search not conducted for dicom format images for prior patient ct imaging studies completed at non-affiliated external heatlhcare 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)
HCPCS Code: G9344
Short Description: Sysrsn no dicom srch
Long Description: Due to system reasons search not conducted for dicom format images for prior patient ct imaging studies completed at non-affiliated external healthcare facilities or entities within the past 12 months that are available through a secure, authorized, media-free, shared archive (e.g., non-affiliated external healthcare facilities or entities does not have archival abilities through a shared archival system)
HCPCS Code: G9345
Short Description: Follow up pulm nod
Long Description: Follow-up recommendations documented according to recommended guidelines for incidentally detected pulmonary nodules (e.g., follow-up ct imaging studies needed or that no follow-up is needed) based at a minimum on nodule size and patient risk factors
HCPCS Code: G9346
Short Description: No follow up pulm nod
Long Description: Follow-up recommendations not documented according to recommended guidelines for incidentally detected pulmonary nodules due to medical reasons (e.g., patients with known malignant disease, patients with unexplained fever, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)
HCPCS Code: G9347
Short Description: No follow up pulm nod norsn
Long Description: Follow-up recommendations not documented according to recommended guidelines for incidentally detected pulmonary nodules, reason not given
HCPCS Code: G9348
Short Description: Docrsn no sinus ct dx
Long Description: Ct scan of the paranasal sinuses ordered at the time of diagnosis for documented reasons (eg, persons with sinusitis symptoms lasting at least 7 to 10 days, antibiotic resistance, immunocompromised, recurrent sinusitis, acute frontal sinusitis, acute sphenoid sinusitis, periorbital cellulitis, or other medical)
HCPCS Code: G9349
Short Description: Doc sinus ct 28d
Long Description: Documentation of a ct scan of the paranasal sinuses ordered at the time of diagnosis or received within 28 days after date of diagnosis
HCPCS Code: G9350
Short Description: No doc sinus ct 28d or dx
Long Description: Ct scan of the paranasal sinuses not ordered at the time of diagnosis or received within 28 days after date of diagnosis
HCPCS Code: G9351
Short Description: Doc >1 sinus ct w 90d dx
Long Description: More than one ct scan of the paranasal sinuses ordered or received within 90 days after diagnosis
HCPCS Code: G9352
Short Description: Not >1 sinus ct w 90d dx
Long Description: More than one ct scan of the paranasal sinuses ordered or received within 90 days after the date of diagnosis, reason not given
HCPCS Code: G9353
Short Description: Medrsn >1 sinus ct w 90d dx
Long Description: More than one ct scan of the paranasal sinuses ordered or received within 90 days after the date of diagnosis for documented reasons (eg, patients with complications, second ct obtained prior to surgery, other medical reasons)
HCPCS Code: G9354
Short Description: 1 or no ct sinus w/in 90d dx
Long Description: One ct scan or no ct scan of the paranasal sinuses ordered within 90 days after the date of diagnosis
HCPCS Code: G9355
Short Description: No early ind/delivery
Long Description: Elective delivery or early induction not performed
HCPCS Code: G9356
Short Description: Early ind/delivery
Long Description: Elective delivery or early induction performed
HCPCS Code: G9357
Short Description: Pp eval/edu perf
Long Description: Post-partum screenings, evaluations and education performed
HCPCS Code: G9358
Short Description: Pp eval/edu not perf
Long Description: Post-partum screenings, evaluations and education not performed
HCPCS Code: G9359
Short Description: Doc of neg or man pos tb scn
Long Description: Documentation of negative or managed positive tb screen with further evidence that tb is not active
HCPCS Code: G9360
Short Description: No doc of neg or man pos tb
Long Description: No documentation of negative or managed positive tb screen
HCPCS Code: G9361
Short Description: Med ind for induction
Long Description: Medical indication for induction (documentation of reason(s) for elective delivery or early induction (e.g., hemorrhage and placental complications, hypertension, preeclampsia and eclampsia, rupture of membranes-premature, prolonged maternal conditions complicating pregnancy/delivery, fetal conditions complicating pregnancy/delivery, malposition and malpresentation of fetus, late pregnancy, prior uterine surgery, or participation in clinical trial))
HCPCS Code: G9362
Short Description: Mac or pnb w/o genanes >60m
Long Description: Duration of monitored anesthesia care (mac) or peripheral nerve block (pnb) without the use of general anesthesia during an applicable procedure 60 minutes or longer, as documented in the anesthesia record
HCPCS Code: G9363
Short Description: Mac or pnb w/o genanes <60m
Long Description: Duration of monitored anesthesia care (mac) or peripheral nerve block (pnb) without the use of general anesthesia during an applicable procedure or general or neuraxial anesthesia less than 60 minutes, as documented in the anesthesia record
HCPCS Code: G9364
Short Description: Sinus caus bac inx
Long Description: Sinusitis caused by, or presumed to be caused by, bacterial infection
HCPCS Code: G9365
Short Description: 1high risk med ord
Long Description: One high-risk medication ordered
HCPCS Code: G9366
Short Description: 1high risk no ord
Long Description: One high-risk medication not ordered
HCPCS Code: G9367
Short Description: 2high risk med ord
Long Description: At least two different high-risk medications ordered
HCPCS Code: G9368
Short Description: 2high risk no ord
Long Description: At least two different high-risk medications not ordered
HCPCS Code: G9369
Short Description: Fill 2 rx antipsych
Long Description: Individual filled at least two prescriptions for any antipsychotic medication and had a pdc of 0.8 or greater
HCPCS Code: G9370
Short Description: Not fill 2 rx antipsych
Long Description: Individual who did not fill at least two prescriptions for any antipsychotic medication or did not have a pdc of 0.8 or greater
HCPCS Code: G9376
Short Description: Contd ret attach at 6mth f/u
Long Description: Patient continued to have the retina attached at the 6 months follow up visit (+/- 1 month) following only one surgery
HCPCS Code: G9377
Short Description: No ret attach after 6mt
Long Description: Patient did not have the retina attached after 6 months following only one surgery
HCPCS Code: G9378
Short Description: Contd ret attach f/u vis
Long Description: Patient continued to have the retina attached at the 6 months follow up visit (+/- 1 month)
HCPCS Code: G9379
Short Description: No acheive flat ret 6mth
Long Description: Patient did not achieve flat retinas six months post surgery
HCPCS Code: G9380
Short Description: Off assis eol iss
Long Description: Patient offered assistance with end of life issues during the measurement period
HCPCS Code: G9381
Short Description: Doc med reas no offer eol
Long Description: Documentation of medical reason(s) for not offering assistance with end of life issues (eg, patient in hospice and in terminal phase) during the measurement period
HCPCS Code: G9382
Short Description: No off assis eol
Long Description: Patient not offered assistance with end of life issues during the measurement period
HCPCS Code: G9383
Short Description: Recd scrn hcv infec
Long Description: Patient received screening for hcv infection within the 12 month reporting period
HCPCS Code: G9384
Short Description: Doc med reas no ann srn hcv
Long Description: Documentation of medical reason(s) for not receiving annual screening for hcv infection (e.g., decompensated cirrhosis indicating advanced disease [i.e., ascites, esophageal variceal bleeding, hepatic encephalopathy], hepatocellular carcinoma, waitlist for organ transplant, limited life expectancy, other medical reasons)
HCPCS Code: G9385
Short Description: Doc pt reas not rec hcv srn
Long Description: Documentation of patient reason(s) for not receiving annual screening for hcv infection (e.g., patient declined, other patient reasons)
HCPCS Code: G9386
Short Description: Scrn hcv infec not recd
Long Description: Screening for hcv infection not received within the 12 month reporting period, reason not given
HCPCS Code: G9389
Short Description: Unpln rup post cap
Long Description: Unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery
HCPCS Code: G9390
Short Description: No unpln rup post cap
Long Description: No unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery
HCPCS Code: G9391
Short Description: Achv refrac +1d
Long Description: Patient achieves refraction +-1 d for the eye that underwent cataract surgery, measured at the one month follow up visit
HCPCS Code: G9392
Short Description: Not achv refrac +1d
Long Description: Patient does not achieve refraction +-1 d for the eye that underwent cataract surgery, measured at the one month follow up visit
HCPCS Code: G9393
Short Description: Ini phq9 >9 remiss <5
Long Description: Patient with an initial phq-9 score greater than nine who achieves remission at twelve months as demonstrated by a twelve month (+/- 30 days) phq-9 score of less than five
HCPCS Code: G9394
Short Description: Dx bipol, death, nhres, hosp
Long Description: Patient who had a diagnosis of bipolar disorder or personality disorder, death, permanent nursing home resident or receiving hospice or palliative care any time during the measurement or assessment period
HCPCS Code: G9395
Short Description: Ini phq9 >9 no remiss >=5
Long Description: Patient with an initial phq-9 score greater than nine who did not achieve remission at twelve months as demonstrated by a twelve month (+/- 30 days) phq-9 score greater than or equal to five
HCPCS Code: G9396
Short Description: Ini phq9 >9 not assess
Long Description: Patient with an initial phq-9 score greater than nine who was not assessed for remission at twelve months (+/- 30 days)
HCPCS Code: G9399
Short Description: Doc disc tx choices
Long Description: Documentation in the patient record of a discussion between the physician/clinician and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward the outcome of the treatment
HCPCS Code: G9400
Short Description: Doc reas no disc tx opt
Long Description: Documentation of medical or patient reason(s) for not discussing treatment options; medical reasons: patient is not a candidate for treatment due to advanced physical or mental health comorbidity (including active substance use); currently receiving antiviral treatment; successful antiviral treatment (with sustained virologic response) prior to reporting period; other documented medical reasons; patient reasons: patient unable or unwilling to participate in the discussion or other patient reasons
HCPCS Code: G9401
Short Description: No disc tx choices
Long Description: No documentation of a discussion in the patient record of a discussion between the physician or other qualfied healthcare professional and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward treatment
HCPCS Code: G9402
Short Description: Recd f/u w/in 30d disch
Long Description: Patient received follow-up on the date of discharge or within 30 days after discharge
HCPCS Code: G9403
Short Description: Doc reas no 30 day f/u
Long Description: Clinician documented reason patient was not able to complete 30 day follow-up from acute inpatient setting discharge (e.g., patient death prior to follow-up visit, patient non-compliant for visit follow-up)
HCPCS Code: G9404
Short Description: No 30 day f/u
Long Description: Patient did not receive follow-up on the date of discharge or within 30 days after discharge
HCPCS Code: G9405
Short Description: Recd f/u w/in 7d disch
Long Description: Patient received follow-up within 7 days from discharge
HCPCS Code: G9406
Short Description: Doc reas no 7d f/u
Long Description: Clinician documented reason patient was not able to complete 7 day follow-up from acute inpatient setting discharge (i.e patient death prior to follow-up visit, patient non-compliance for visit follow-up)
HCPCS Code: G9407
Short Description: No 7d f/u
Long Description: Patient did not receive follow-up on or within 7 days after discharge
HCPCS Code: G9408
Short Description: Card tamp w/in 30d
Long Description: Patients with cardiac tamponade and/or pericardiocentesis occurring within 30 days
HCPCS Code: G9409
Short Description: No card tamp e/in 30d
Long Description: Patients without cardiac tamponade and/or pericardiocentesis occurring within 30 days
HCPCS Code: G9410
Short Description: Admit w/in 180d req remov
Long Description: Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision
HCPCS Code: G9411
Short Description: No admit w/in 180d req remov
Long Description: Patient not admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision
HCPCS Code: G9412
Short Description: Admit w/in 180d req surg rev
Long Description: Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision
HCPCS Code: G9413
Short Description: No admit req surg rev
Long Description: Patient not admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision
HCPCS Code: G9414
Short Description: 1dose menig vac btwn 11 & 13
Long Description: Patient had one dose of meningococcal vaccine on or between the patient's 11th and 13th birthdays
HCPCS Code: G9415
Short Description: No 1dose meni vac btwn 11&13
Long Description: Patient did not have one dose of meningococcal vaccine on or between the patient's 11th and 13th birthdays
HCPCS Code: G9416
Short Description: Tdap or td or 1tet/dipth
Long Description: Patient had one tetanus, diphtheria toxoids and acellular pertussis vaccine (tdap) or one tetanus, diphtheria toxoids vaccine (td) on or between the patient's 10th and 13th birthdays or one tetanus and one diptheria vaccine on or between the patient's 10th and 13th birthdays
HCPCS Code: G9417
Short Description: No tdap or td or 1tet/dipth
Long Description: Patient did not have one tetanus, diphtheria toxoids and acellular pertussis vaccine (tdap) or one tetanus, diphtheria toxoids vaccine (td) on or between the patient's 10th and 13th birthdays or one tetanus and one diptheria vaccine on or between the patient's 10th and 13th birthdays
HCPCS Code: G9418
Short Description: Lungcx bx rpt docs class
Long Description: Primary non-small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation
HCPCS Code: G9419
Short Description: Med reas not incl histo type
Long Description: Documentation of medical reason(s) for not including the histological type or nsclc-nos classification with an explanation (e.g., biopsy taken for other purposes in a patient with a history of primary non-small cell lung cancer or other documented medical reasons)
HCPCS Code: G9420
Short Description: Spec site no lung
Long Description: Specimen site other than anatomic location of lung or is not classified as primary non-small cell lung cancer
HCPCS Code: G9421
Short Description: Lung cx bx rpt no doc class
Long Description: Primary non-small cell lung cancer biopsy and cytology specimen report does not document classification into specific histologic type or classified as nsclc-nos with an explanation
HCPCS Code: G9422
Short Description: Rpt doc class histo type
Long Description: Primary lung carcinoma resection report documents pt category, pn category and for non-small cell lung cancer, histologic type (squamous cell carcinoma, adenocarcinoma and not nsclc-nos)
HCPCS Code: G9423
Short Description: Med reas rpt no histo type
Long Description: Documentation of medical reason for not including pt category, pn category and histologic type (for patient with appropriate exclusion criteria (e.g. metastatic disease, benign tumors, malignant tumors other than carcinomas, inadequate surgical specimens)
HCPCS Code: G9424
Short Description: Site no lung or lung cx
Long Description: Specimen site other than anatomic location of lung or classified as nsclc-nos
HCPCS Code: G9425
Short Description: Spec rpt no doc class histo
Long Description: Primary lung carcinoma resection report does not document pt category, pn category and for non-small cell lung cancer, histologic type (squamous cell carcinoma, adenocarcinoma)
HCPCS Code: G9426
Short Description: Impr med time edarr pain med
Long Description: Improvement in median time from ed arrival to initial ed oral or parenteral pain medication administration performed for ed admitted patients
HCPCS Code: G9427
Short Description: No impro med time pain med
Long Description: Improvement in median time from ed arrival to initial ed oral or parenteral pain medication administration not performed for ed admitted patients
HCPCS Code: G9428
Short Description: Rpt pt cat and pt1
Long Description: Pathology report includes the pt category and a statement on thickness and ulceration and for pt1, mitotic rate
HCPCS Code: G9429
Short Description: Doc med reas no pt cat
Long Description: Documentation of medical reason(s) for not including 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)
HCPCS Code: G9430
Short Description: Spec site no cutaneous
Long Description: Specimen site other than anatomic cutaneous location
HCPCS Code: G9431
Short Description: No pt cat and pt1
Long Description: Pathology report does not include the pt category and a statement on thickness and ulceration and for pt1, mitotic rate
HCPCS Code: G9432
Short Description: Asth controlled
Long Description: Asthma well-controlled based on the act, c-act, acq, or ataq score and results documented
HCPCS Code: G9433
Short Description: Death, nhres, hospice
Long Description: Death, permanent nursing home resident or receiving hospice or palliative care any time during the measurement period
HCPCS Code: G9434
Short Description: Asth not controlled
Long Description: Asthma not well-controlled based on the act, c-act, acq, or ataq score, or specified asthma control tool not used, reason not given
HCPCS Code: G9435
Short Description: Asp presc disch
Long Description: Aspirin prescribed at discharge
HCPCS Code: G9436
Short Description: Asp not presc doc reas
Long Description: Aspirin not prescribed for documented reasons (e.g., allergy, medical intolerance, history of bleed)
HCPCS Code: G9437
Short Description: Asp not presc disch
Long Description: Aspirin not prescribed at discharge
HCPCS Code: G9438
Short Description: P2y inhib presc
Long Description: P2y inhibitor prescribed at discharge
HCPCS Code: G9439
Short Description: P2y inhib not presc doc reas
Long Description: P2y inhibitor not prescribed for documented reasons (e.g., allergy, medical intolerance, history of bleed)
HCPCS Code: G9440
Short Description: P2y inhib not presc
Long Description: P2y inhibitor not prescribed at discharge
HCPCS Code: G9441
Short Description: Statin presc disch
Long Description: Statin prescribed at discharge
HCPCS Code: G9442
Short Description: Statin not presc doc reas
Long Description: Statin not prescribed for documented reasons (e.g., allergy, medical intolerance)
HCPCS Code: G9443
Short Description: Statin not presc disch
Long Description: Statin not prescribed at discharge
HCPCS Code: G9448
Short Description: Born 1945-1965
Long Description: Patients who were born in the years 1945?1965
HCPCS Code: G9449
Short Description: Hx bld transf b/f 1992
Long Description: History of receiving blood transfusions prior to 1992
HCPCS Code: G9450
Short Description: Hx injec drug use
Long Description: History of injection drug use
HCPCS Code: G9451
Short Description: 1x scrn hcv infect
Long Description: Patient received one-time screening for hcv infection
HCPCS Code: G9452
Short Description: Doc med reas no scrn hcv
Long Description: Documentation of medical reason(s) for not receiving one-time screening for hcv infection (e.g., decompensated cirrhosis indicating advanced disease [ie, ascites, esophageal variceal bleeding, hepatic encephalopathy], hepatocellular carcinoma, waitlist for organ transplant, limited life expectancy, other medical reasons)
HCPCS Code: G9453
Short Description: Pt reas no hcv infect
Long Description: Documentation of patient reason(s) for not receiving one-time screening for hcv infection (e.g., patient declined, other patient reasons)
HCPCS Code: G9454
Short Description: No hcv infect srn
Long Description: One-time screening for hcv infection not received within 12 month reporting period and no documentation of prior screening for hcv infection, reason not given
HCPCS Code: G9455
Short Description: Abd imag w/us, ct or mri
Long Description: Patient underwent abdominal imaging with ultrasound, contrast enhanced ct or contrast mri for hcc
HCPCS Code: G9456
Short Description: Doc med pt reas no hcc scrn
Long Description: Documentation of medical or patient reason(s) for not ordering or performing screening for hcc. medical reason: comorbid medical conditions with expected survival < 5 years, hepatic decompensation and not a candidate for liver transplantation, or other medical reasons; patient reasons: patient declined or other patient reasons (e.g., cost of tests, time related to accessing testing equipment)
HCPCS Code: G9457
Short Description: No abd imag w/o reason
Long Description: Patient did not undergo abdominal imaging and did not have a documented reason for not undergoing abdominal imaging in the reporting period
HCPCS Code: G9458
Short Description: Tob user recd cess interv
Long Description: Patient documented as tobacco user and received tobacco cessation intervention (must include at least one of the following: advice given to quit smoking or tobacco use, counseling on the benefits of quitting smoking or tobacco use, assistance with or referral to external smoking or tobacco cessation support programs, or current enrollment in smoking or tobacco use cessation program) if identified as a tobacco user
HCPCS Code: G9459
Short Description: Tob non-user
Long Description: Currently a tobacco non-user
HCPCS Code: G9460
Short Description: No tob assess or cess inter
Long Description: Tobacco assessment or tobacco cessation intervention not performed, reason not given
HCPCS Code: G9463
Short Description: Sinusitis intent
Long Description: I intend to report the sinusitis measures group
HCPCS Code: G9464
Short Description: Sinusitis comp
Long Description: All quality actions for the applicable measures in the sinusitis measures group have been performed for this patient
HCPCS Code: G9465
Short Description: Aoe intent
Long Description: I intend to report the acute otitis externa (aoe) measures group
HCPCS Code: G9466
Short Description: Aoe comp
Long Description: All quality actions for the applicable measures in the aoe measures group have been performed for this patient
HCPCS Code: G9467
Short Description: Recd cortico >=10mg/day >60d
Long Description: Patient who have received or are receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 60 or greater consecutive days or a single prescription equating to 600mg prednisone or greater for all fills within the last twelve months
HCPCS Code: G9468
Short Description: No recd cortico>=10mg/d >60d
Long Description: Patient not receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 60 or greater consecutive days or a single prescription equating to 600 mg prednisone or greater for all fills
HCPCS Code: G9469
Short Description: Rec cortico>60d or 1rx 600mg
Long Description: Patients 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
HCPCS Code: G9470
Short Description: No rec cortico>60d 1rx 600mg
Long Description: Patients not receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 60 or greater consecutive days or a single prescription equating to 600 mg prednisone or greater for all fills
HCPCS Code: G9471
Short Description: W/in 2yr dxa not order
Long Description: Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) not ordered or documented
HCPCS Code: G9472
Short Description: No dxa no med hx no rv sx
Long Description: Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) not ordered and documented, no review of systems and no medication history or pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed
HCPCS Code: G9473
Short Description: Chap services at hospice
Long Description: Services performed by chaplain in the hospice setting, each 15 minutes
HCPCS Code: G9474
Short Description: Diet counsel at hospice
Long Description: Services performed by dietary counselor in the hospice setting, each 15 minutes
HCPCS Code: G9475
Short Description: Other counselor at hospice
Long Description: Services performed by other counselor in the hospice setting, each 15 minutes
HCPCS Code: G9476
Short Description: Volun service at hospice
Long Description: Services performed by volunteer in the hospice setting, each 15 minutes
HCPCS Code: G9477
Short Description: Care coord at hospice
Long Description: Services performed by care coordinator in the hospice setting, each 15 minutes
HCPCS Code: G9478
Short Description: Othe therapist at hospice
Long Description: Services performed by other qualified therapist in the hospice setting, each 15 minutes
HCPCS Code: G9479
Short Description: Pharmacist at hospice
Long Description: Services performed by qualified pharmacist in the hospice setting, each 15 minutes
HCPCS Code: G9480
Short Description: Admission to mccm
Long Description: Admission to medicare care choice model program (mccm)
HCPCS Code: G9496
Short Description: Doc rsn no adeno/neopl detec
Long Description: Documentation of reason for not detecting adenoma(s) or other neoplasm. (e.g., neoplasm detected is only diagnosed as traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma
HCPCS Code: G9497
Short Description: Preop anes or proxy b/4 surg
Long Description: Seen pre-operatively by anesthesiologist or proxy prior to the day of surgery
HCPCS Code: G9498
Short Description: Abx reg prescribed
Long Description: Antibiotic regimen prescribed
HCPCS Code: G9499
Short Description: No start/rec antvir tx hep c
Long Description: Patient did not start or is not receiving antiviral treatment for hepatitis c during the measurement period
HCPCS Code: G9500
Short Description: Rad exp time w/fluor doc
Long Description: Radiation exposure indices, exposure time or number of fluorographic images in final report for procedures using fluoroscopy, documented
HCPCS Code: G9501
Short Description: Rad exp time w/o fluor doc
Long Description: Radiation exposure indices, exposure time or number of fluorographic images not documented in final report for procedure using fluoroscopy, reason not given
HCPCS Code: G9502
Short Description: Med reas no perf foot exam
Long Description: Documentation of medical reason for not performing foot exam (i.e., patients who have had either a bilateral amputation above or below the knee, or both a left and right amputation above or below the knee before or during the measurement period)
HCPCS Code: G9503
Short Description: Pt tk tams hcl
Long Description: Patient taking tamsulosin hydrochloride
HCPCS Code: G9504
Short Description: Doc reas no hbv status
Long Description: Documented reason for not assessing hepatitis b virus (hbv) status (e.g. patient not receiving a first course of anti-tnf therapy, patient declined) within one year prior to first course of anti-tnf therapy
HCPCS Code: G9505
Short Description: Abx pres w/in 10 dys of symp
Long Description: Antibiotic regimen prescribed within 10 days after onset of symptoms for documented medical reason
HCPCS Code: G9506
Short Description: Bio imm resp mod presc
Long Description: Biologic immune response modifier prescribed
HCPCS Code: G9507
Short Description: Doc reas on statin or contra
Long Description: Documentation that the patient is on a statin medication or has documentation of a valid contraindication or exception to statin medications; contraindications/exceptions that can be defined by diagnosis codes include pregnancy during the measurement period, active liver disease, rhabdomyolysis, end stage renal disease on dialysis and heart failure; provider documented contraindications/exceptions include breastfeeding during the measurement period, woman of child-bearing age not actively taking birth control, allergy to statin, drug interaction (hiv protease inhibitors, nefazodone, cyclosporine, gemfibrozil, and danazol) and intolerance (with supporting documentation of trying a statin at least once within the last 5 years or diagnosis codes for myostitis or toxic myopathy related to drugs)
HCPCS Code: G9508
Short Description: Doc pt not on statin
Long Description: Documentation that the patient is not on a statin medication
HCPCS Code: G9509
Short Description: Remis 12m phq-9 score <5
Long Description: Remission at twelve months as demonstrated by a twelve month (+/-30 days) phq-9 score of less than 5
HCPCS Code: G9510
Short Description: Remis 12m not phq-9 score <5
Long Description: Remission at twelve months not demonstrated by a twelve month (+/-30 days) phq-9 score of less than five; either phq-9 score was not assessed or is greater than or equal to 5
HCPCS Code: G9511
Short Description: Phq-9 >9 during 12m time
Long Description: Index date phq-9 score greater than 9 documented during the twelve month denominator identification period
HCPCS Code: G9512
Short Description: Indiv pdc > 0.8
Long Description: Individual had a pdc of 0.8 or greater
HCPCS Code: G9513
Short Description: Indiv pdc not > 0.8
Long Description: Individual did not have a pdc of 0.8 or greater
HCPCS Code: G9514
Short Description: Req ret or w/in 90d of surg
Long Description: Patient required a return to the operating room within 90 days of surgery
HCPCS Code: G9515
Short Description: No reas, no ret or w/in 90d
Long Description: Patient did not require a return to the operating room within 90 days of surgery
HCPCS Code: G9516
Short Description: Impr vis acuit w/in 90d
Long Description: Patient achieved an improvement in visual acuity, from their preoperative level, within 90 days of surgery
HCPCS Code: G9517
Short Description: No impr vis acuit w/in 90d
Long Description: Patient did not achieve an improvement in visual acuity, from their preoperative level, within 90 days of surgery, reason not given
HCPCS Code: G9518
Short Description: Doc active inj drug use
Long Description: Documentation of active injection drug use
HCPCS Code: G9519
Short Description: Final refract +/- 1.0 in 90d
Long Description: Patient achieves final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery
HCPCS Code: G9520
Short Description: Refract not +/- 1.0 w/in 90d
Long Description: Patient does not achieve final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery, reason not given
HCPCS Code: G9521
Short Description: Er and ip hosp <2 in 12 mos
Long Description: Total number of emergency department visits and inpatient hospitalizations less than two in the past 12 months
HCPCS Code: G9522
Short Description: Er/ip hosp =/>2 in 12 mos
Long Description: Total number of emergency department visits and inpatient hospitalizations equal to or greater than two in the past 12 months or patient not screened, reason not given
HCPCS Code: G9523
Short Description: D/c hemo or perit dialysis
Long Description: Patient discontinued from hemodialysis or peritoneal dialysis
HCPCS Code: G9524
Short Description: Refer to hospice
Long Description: Patient was referred to hospice care
HCPCS Code: G9525
Short Description: Doc pt reas no hospice refer
Long Description: Documentation of patient reason(s) for not referring to hospice care (e.g., patient declined, other patient reasons)
HCPCS Code: G9526
Short Description: No reason, no refer hospice
Long Description: Patient was not referred to hospice care, reason not given
HCPCS Code: G9529
Short Description: Minor blunt trauma w/head ct
Long Description: Patient with minor blunt head trauma had an appropriate indication(s) for a head ct
HCPCS Code: G9530
Short Description: Min hd traum gcs=15 w/ct ed
Long Description: Patient presented within 24 hours of a minor blunt head trauma with a gcs score of 15 and had a head ct ordered for trauma by an emergency care provider
HCPCS Code: G9531
Short Description: Indic for head ct valid
Long Description: Patient has a valid reason for a head ct for trauma being ordered, regardless of indications (i.e., ventricular shunt, brain tumor, multisystem trauma, pregnancy, or currently taking an antiplatelet medication including: asa/dipyridamole, clopidogrel, prasugrel, ticlopidine, ticagrelor or cilstazol)
HCPCS Code: G9532
Short Description: Inj >24 hr in ed gcs <15
Long Description: Patient's head injury occurred greater than 24 hours before presentation to the emergency department, or has a gcs score less than 15, or had a head ct for trauma ordered by someone other than an emergency care provider, or was ordered for a reason other than trauma
HCPCS Code: G9533
Short Description: Indic for head ct not valid
Long Description: Patient with minor blunt head trauma did not have an appropriate indication(s) for a head ct
HCPCS Code: G9534
Short Description: Adv brain image not ordered
Long Description: Advanced brain imaging (cta, ct, mra or mri) was not ordered
HCPCS Code: G9535
Short Description: Normal neuro exam
Long Description: Patients with a normal neurological examination
HCPCS Code: G9536
Short Description: Doc med reas adv brain image
Long Description: Documentation of medical reason(s) for ordering an advanced brain imaging study (i.e., patient has an abnormal neurological examination; patient has the coexistence of seizures, or both; recent onset of severe headache; change in the type of headache; signs of increased intracranial pressure (e.g., papilledema, absent venous pulsations on funduscopic examination, altered mental status, focal neurologic deficits, signs of meningeal irritation); hiv-positive patients with a new type of headache; immunocompromised patient with unexplained headache symptoms; patient on coagulopathy/anti-coagulation or anti-platelet therapy; very young patients with unexplained headache symptoms)
HCPCS Code: G9537
Short Description: Doc system reas adv imaging
Long Description: Documentation of system reason(s) for ordering an advanced brain imaging study (i.e., needed as part of a clinical trial; other clinician ordered the study)
HCPCS Code: G9538
Short Description: Adv brain image ordered
Long Description: Advanced brain imaging (cta, ct, mra or mri) was ordered
HCPCS Code: G9539
Short Description: Intent pot remv time placemt
Long Description: Intent for potential removal at time of placement
HCPCS Code: G9540
Short Description: Pt alive 3 mos post proc
Long Description: Patient alive 3 months post procedure
HCPCS Code: G9541
Short Description: Filter gone aft 3mos placmt
Long Description: Filter removed within 3 months of placement
HCPCS Code: G9542
Short Description: Doc reass appr remo filt 3ms
Long Description: Documented re-assessment for the appropriateness of filter removal within 3 months of placement
HCPCS Code: G9543
Short Description: Doc 2x re-assess filt remov
Long Description: 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
HCPCS Code: G9544
Short Description: No filt remov w/in 3mos plcm
Long Description: Patients that do not have the filter removed, documented re-assessment for the appropriateness of filter removal, or documentation of at least two attempts to reach the patient to arrange a clinical re-assessment for the appropriateness of filter removal within 3 months of placement
HCPCS Code: G9547
Short Description: Incid ct liver/kid/adre fdg
Long Description: Incidental ct finding: liver lesion = 0.5 cm, cystic kidney lesion < 1.0 cm or adrenal lesion = 1.0 cm
HCPCS Code: G9548
Short Description: Abd imag and followup rec
Long Description: Final reports for abdominal imaging studies with follow-up imaging recommended
HCPCS Code: G9549
Short Description: Doc med reas no follow imag
Long Description: Documentation of medical reason(s) that follow-up imaging is not indicated (e.g., patient has a known malignancy that can metastasize, other medical reason(s)
HCPCS Code: G9550
Short Description: Abd imag and followup no rec
Long Description: Final reports for abdominal imaging studies with follow-up imaging not recommended
HCPCS Code: G9551
Short Description: Abd imag w/o liv/kid/adr les
Long Description: Final reports for abdominal imaging studies without a liver lesion < 0.5 cm, cystic kidney lesion < 1.0 cm or adrenal lesion < 1.0 cm noted
HCPCS Code: G9552
Short Description: Inc thyr node <1.0 in rpt
Long Description: Incidental thyroid nodule < 1.0 cm noted in report
HCPCS Code: G9553
Short Description: Prior thyroid dise dx
Long Description: Prior thyroid disease diagnosis
HCPCS Code: G9554
Short Description: Ct/mri chest/neck follup rec
Long Description: Final reports for ct or mri of the chest or neck or ultrasound of the neck with follow-up imaging recommended
HCPCS Code: G9555
Short Description: Doc med reas no follow imag
Long Description: Documentation of medical reason(s) for not including documentation that follow up imaging is not needed (e.g., patient has multiple endocrine neoplasia, patient has cervical lymphadenopathy, other medical reason(s))
HCPCS Code: G9556
Short Description: Ct/mri chest follup not rec
Long Description: Final reports for ct or mri of the chest or neck or ultrasound of the neck with follow-up imaging not recommended
HCPCS Code: G9557
Short Description: Ct/mri chest/neck no thy nod
Long Description: Final reports for ct or mri studies of the chest or neck or ultrasound of the neck without a thyroid nodule < 1.0 cm noted
HCPCS Code: G9558
Short Description: Tx beta-lactam abx therapy
Long Description: Patient treated with a beta-lactam antibiotic as definitive therapy
HCPCS Code: G9559
Short Description: Doc med reas no abx therapy
Long Description: Documentation of medical reason(s) for not prescribing a beta-lactam antibiotic (e.g., allergy, intolerance to beta -lactam antibiotics)
HCPCS Code: G9560
Short Description: No beta-lactam abx ther, rng
Long Description: Patient not treated with a beta-lactam antibiotic as definitive therapy, reason not given
HCPCS Code: G9561
Short Description: Presc opiates >6 wks
Long Description: Patients prescribed opiates for longer than six weeks
HCPCS Code: G9562
Short Description: Foll-up eval q3mo opiod tx
Long Description: Patients who had a follow-up evaluation conducted at least every three months during opioid therapy
HCPCS Code: G9563
Short Description: No f/u eval q3mo opiod tx
Long Description: Patients who did not have a follow-up evaluation conducted at least every three months during opioid therapy
HCPCS Code: G9572
Short Description: Phq-scr >9 doc in 12m time
Long Description: Index date phq-score greater than 9 documented during the twelve month denominator identification period
HCPCS Code: G9573
Short Description: Remis 6m w/6mos phq-9 <5
Long Description: Remission at six months as demonstrated by a six month (+/-30 days) phq-9 score of less than five
HCPCS Code: G9574
Short Description: Remis 6m w/o 6mos phq-9 <5
Long Description: Remission at six months not demonstrated by a six month (+/-30 days) phq-9 score of less than five. either phq-9 score was not assessed or is greater than or equal to five
HCPCS Code: G9577
Short Description: Presc opiates >6 wks
Long Description: Patients prescribed opiates for longer than six weeks
HCPCS Code: G9578
Short Description: Doc opioid tx 1x during ther
Long Description: Documentation of signed opioid treatment agreement at least once during opioid therapy
HCPCS Code: G9579
Short Description: No doc opioid tx 1x at ther
Long Description: No documentation of signed an opioid treatment agreement at least once during opioid therapy
HCPCS Code: G9580
Short Description: Door to punc time <2hrs
Long Description: Door to puncture time of less than 2 hours
HCPCS Code: G9581
Short Description: Md doc, door to punc tm >2hr
Long Description: Door to puncture time of greater than 2 hours for reasons documented by clinician (e.g., patients who are transferred from one institution to another with a known diagnosis of cva for endovascular stroke treatment; hospitalized patients with newly diagnosed cva considered for endovascular stroke treatment)
HCPCS Code: G9582
Short Description: Door to punc time >2hr, nrg
Long Description: Door to puncture time of greater than 2 hours, no reason given
HCPCS Code: G9583
Short Description: Presc opiates >6 wks
Long Description: Patients prescribed opiates for longer than six weeks
HCPCS Code: G9584
Short Description: Eval opioid use instr/pt int
Long Description: Patient evaluated for risk of misuse of opiates by using a brief validated instrument (e.g., opioid risk tool, soaap-r) or patient interviewed at least once during opioid therapy
HCPCS Code: G9585
Short Description: No eval opi use instr/intv
Long Description: Patient not evaluated for risk of misuse of opiates by using a brief validated instrument (e.g., opioid risk tool, soaap-r) or patient not interviewed at least once during opioid therapy
HCPCS Code: G9593
Short Description: Low pecarn ped head trauma
Long Description: Pediatric patient with minor blunt head trauma classified as low risk according to the pecarn prediction rules
HCPCS Code: G9594
Short Description: Gsc >15 & hd ct by ed md
Long Description: Patient presented within 24 hours of a minor blunt head trauma with a gcs score of 15 and had a head ct ordered for trauma by an emergency care provider
HCPCS Code: G9595
Short Description: Val rsn hd ct ord reg indic
Long Description: Patient has a valid reason for a head ct for trauma being ordered, regardless of indications (ie, ventricular shunt, brain tumor, coagulopathy, including thrombocytopenia)
HCPCS Code: G9596
Short Description: Hd inj >24h/gcs >15/no res
Long Description: Pediatric patient's head injury occurred greater than 24 hours before presentation to the emergency department, or has a gcs score less than 15, or had a head ct for trauma ordered by someone other than an emergency care provider, or was ordered for a reason other than trauma
HCPCS Code: G9597
Short Description: No low pecarn ped head traum
Long Description: Pediatric patient with minor blunt head trauma not classified as low risk according to the pecarn prediction rules
HCPCS Code: G9598
Short Description: Aor ane 5.5-5.9 cm max diam
Long Description: Aortic aneurysm 5.5 - 5.9 cm maximum diameter on centerline formatted ct or minor diameter on axial formatted ct
HCPCS Code: G9599
Short Description: Aor ane >=6.0 cm max diam
Long Description: Aortic aneurysm 6.0 cm or greater maximum diameter on centerline formatted ct or minor diameter on axial formatted ct
HCPCS Code: G9600
Short Description: Symp aaa urgent repair
Long Description: Symptomatic aaas that required urgent/emergent (non-elective) repair
HCPCS Code: G9601
Short Description: Pt dchg home post op day 7
Long Description: Patient discharge to home no later than post-operative day #7
HCPCS Code: G9602
Short Description: Pt no dchg home postop day 7
Long Description: Patient not discharged to home by post-operative day #7
HCPCS Code: G9603
Short Description: Pt surv improv bsline tx
Long Description: Patient survey score improved from baseline following treatment
HCPCS Code: G9604
Short Description: Pt surv results not avail
Long Description: Patient survey results not available
HCPCS Code: G9605
Short Description: Surv score no improv w/tx
Long Description: Patient survey score did not improve from baseline following treatment
HCPCS Code: G9606
Short Description: Intraop cyst eval trac inj
Long Description: Intraoperative cystoscopy performed to evaluate for lower tract injury
HCPCS Code: G9607
Short Description: Pt not elig
Long Description: Patient is not eligible (e.g., patient death during procedure, absent urethra or an otherwise inaccessible bladder)
HCPCS Code: G9608
Short Description: Intraop cyst eval not done
Long Description: Intraoperative cystoscopy not performed to evaluate for lower tract injury
HCPCS Code: G9609
Short Description: Doc order anti-plat or p2y12
Long Description: Documentation of an order for anti-platelet agents or p2y12 antagonists
HCPCS Code: G9610
Short Description: Doc md rsn no antipla/p2y12
Long Description: Documentation of medical reason(s) for not ordering anti-platelet agents or p2y12 antagonists (e.g., patients with known intolerance to anti-platelet agents such as aspirin or aspirin-like agents, or p2y12 antagonists, or those on or other intravenous anti-coagulants; patients with active bleeding or undergoing urgent or emergent operations or endarterectomy combined with cardiac surgery, other medical reason(s))
HCPCS Code: G9611
Short Description: No antipla/p2y12 ord, rs nos
Long Description: Order for anti-platelet agents or p2y12 antagonists was not documented, reason not otherwise specified
HCPCS Code: G9612
Short Description: Pho doc >1 cecal ldmk com ex
Long Description: Photodocumentation of one or more cecal landmarks to establish a complete examination
HCPCS Code: G9613
Short Description: Doc post surg anatomy
Long Description: Documentation of post-surgical anatomy (e.g., right hemicolectomy, ileocecal resection, etc.)
HCPCS Code: G9614
Short Description: No photodoc cecal ldmk exam
Long Description: No photodocumentation of cecal landmarks to establish a complete examination
HCPCS Code: G9615
Short Description: Pre-op asst doc
Long Description: Preoperative assessment documented
HCPCS Code: G9616
Short Description: Doc rsn no preop assmt
Long Description: Documentation of reason(s) for not documenting a preoperative assessment (e.g., patient with a gynecologic or other pelvic malignancy noted at the time of surgery)
HCPCS Code: G9617
Short Description: Pre-op asst not doc, rng
Long Description: Preoperative assessment not documented, reason not given
HCPCS Code: G9618
Short Description: Doc scr uter mal or us/samp
Long Description: Documentation of screening for uterine malignancy or those that had an ultrasound and/or endometrial sampling of any kind
HCPCS Code: G9619
Short Description: Doc rsn no scr uter malig
Long Description: Documentation of reason(s) for not screening for uterine malignancy (e.g., prior hysterectomy)
HCPCS Code: G9620
Short Description: No scr utr malig/us/samp rng
Long Description: Patient not screened for uterine malignancy, or those that have not had an ultrasound and/or endometrial sampling of any kind, reason not given
HCPCS Code: G9621
Short Description: Scr unheal etoh w/counsel
Long Description: Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method and received brief counseling
HCPCS Code: G9622
Short Description: No unheal etoh user
Long Description: Patient not identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method
HCPCS Code: G9623
Short Description: Doc med rsn no scr etoh use
Long Description: Documentation of medical reason(s) for not screening for unhealthy alcohol use (e.g., limited life expectancy, other medical reasons)
HCPCS Code: G9624
Short Description: No etoh scr/no counc/nrg
Long Description: Patient not screened for unhealthy alcohol screening using a systematic screening method or patient did not receive brief counseling, reason not given
HCPCS Code: G9625
Short Description: Bld inj at surg/1mos post
Long Description: Patient sustained bladder injury at the time of surgery or subsequently up to 1 month post-surgery
HCPCS Code: G9626
Short Description: Pt not elig
Long Description: Patient is not eligible (e.g., gynecologic or other pelvic malignancy documented, concurrent surgery involving bladder neoplasia or otherwise to treat a bladder specific problem, patient death from other causes, etc.)
HCPCS Code: G9627
Short Description: No bld inj at surg/1mos post
Long Description: Patient did not sustained bladder injury at the time of surgery or subsequently up to 1 month post-surgery
HCPCS Code: G9628
Short Description: Vis inj at surg/1mos post
Long Description: Patient sustained major viscus injury at the time of surgery or subsequently up to 1 month post-surgery
HCPCS Code: G9629
Short Description: Pt not elig
Long Description: Patient is not eligible (e.g., gynecologic or other pelvic malignancy documented, concurrent surgery involving bladder neoplasia or otherwise to treat a bladder specific problem, patient death from other causes, etc.)
HCPCS Code: G9630
Short Description: No vis inj at surg/1mos post
Long Description: Patient did not sustain major viscus injury at the time of surgery or subsequently up to 1 month post-surgery
HCPCS Code: G9631
Short Description: Urtr inj at surg/1mos post
Long Description: Patient sustained ureter injury at the time of surgery or discovered subsequently up to 1 month post-surgery
HCPCS Code: G9632
Short Description: Pt not elig
Long Description: Patient is not eligible (e.g., gynecologic or other pelvic malignancy documented, concurrent surgery involving bladder neoplasia or otherwise to treat a bladder specific problem, patient death from other causes, etc.)
HCPCS Code: G9633
Short Description: No urtr inj at surg/1ms post
Long Description: Patient did not sustain ureter injury at the time of surgery or subsequently up to 1 month post-surgery
HCPCS Code: G9634
Short Description: Qual life tool 2x same/impr
Long Description: Health-related quality of life assessed with tool during at least two visits and quality of life score remained the same or improved
HCPCS Code: G9635
Short Description: No doc rsn do qual life assm
Long Description: Health-related quality of life not assessed with tool for documented reason(s) (e.g., patient has a cognitive or neuropsychiatric impairment that impairs his/her ability to complete the hrqol survey, patient has the inability to read and/or write in order to complete the hrqol questionnaire)
HCPCS Code: G9636
Short Description: No life asst 2x same/decr
Long Description: Health-related quality of life not assessed with tool during at least two visits or quality of life score declined
HCPCS Code: G9637
Short Description: Doc >1 dose reduc tech
Long Description: Final reports with documentation of one or more dose reduction techniques (e.g., automated exposure control, adjustment of the ma and/or kv according to patient size, use of iterative reconstruction technique)
HCPCS Code: G9638
Short Description: No doc >1 dose reduc tech
Long Description: Final reports without documentation of one or more dose reduction techniques (e.g., automated exposure control, adjustment of the ma and/or kv according to patient size, use of iterative reconstruction technique)
HCPCS Code: G9639
Short Description: Amp no reqd in48h ieler proc
Long Description: Major amputation or open surgical bypass not required within 48 hours of the index endovascular lower extremity revascularization procedure
HCPCS Code: G9640
Short Description: Doc plan hybrid/stage proc
Long Description: Documentation of planned hybrid or staged procedure
HCPCS Code: G9641
Short Description: Amp reqd w/in 48h ieler proc
Long Description: Major amputation or open surgical bypass required within 48 hours of the index endovascular lower extremity revascularization procedure
HCPCS Code: G9642
Short Description: Current cig smoker
Long Description: Current cigarette smokers
HCPCS Code: G9643
Short Description: Elective surgery
Long Description: Elective surgery
HCPCS Code: G9644
Short Description: No smok b/4 anes day of surg
Long Description: Patients who abstained from smoking prior to anesthesia on the day of surgery or procedure
HCPCS Code: G9645
Short Description: Had smoke b/4 anes day surg
Long Description: Patients who did not abstain from smoking prior to anesthesia on the day of surgery or procedure
HCPCS Code: G9646
Short Description: Pt w/90d mrs 0-2
Long Description: Patients with 90 day mrs score of 0 to 2
HCPCS Code: G9647
Short Description: No mrs score in 90d followup
Long Description: Patients in whom mrs score could not be obtained at 90 day follow-up
HCPCS Code: G9648
Short Description: Pt w/90d mrs >2
Long Description: Patients with 90 day mrs score greater than 2
HCPCS Code: G9649
Short Description: Psori tool doc w/benchmk
Long Description: Psoriasis assessment tool documented meeting any one of the specified benchmarks (e.g., (pga; 6-point scale), body surface area (bsa), psoriasis area and severity index (pasi) and/or dermatology life quality index) (dlqi))
HCPCS Code: G9650
Short Description: Doc pt no ther chg or contra
Long Description: Documentation that the patient declined therapy change or has documented contraindications (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by pga, bsa, pasi, or dlqi
HCPCS Code: G9651
Short Description: Psori tool doc/no bnchmk met
Long Description: Psoriasis assessment tool documented not meeting any one of the specified benchmarks (e.g., (pga; 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
HCPCS Code: G9652
Short Description: Pt tx sys bio med psori 6mth
Long Description: Patient has been treated with a systemic or biologic medication for psoriasis for at least six months
HCPCS Code: G9653
Short Description: Pt no tx sys bio rx 6 mths
Long Description: Patient has not been treated with a systemic or biologic medication for psoriasis for at least six months
HCPCS Code: G9654
Short Description: Mon anesth care
Long Description: Monitored anesthesia care (mac)
HCPCS Code: G9655
Short Description: Toc tool incl key elem
Long Description: A transfer of care protocol or handoff tool/checklist that includes the required key handoff elements is used
HCPCS Code: G9656
Short Description: Pt direct anesth loc to pacu
Long Description: Patient transferred directly from anesthetizing location to pacu
HCPCS Code: G9657
Short Description: Toc dur aneth to icu
Long Description: Transfer of care during an anesthetic or to the intensive care unit
HCPCS Code: G9658
Short Description: Toc tool incl elem not used
Long Description: A transfer of care protocol or handoff tool/checklist that includes the required key handoff elements is not used
HCPCS Code: G9659
Short Description: >85y no hx colo ca/rsn scope
Long Description: Patients greater than 85 years of age who did not have a history of colorectal cancer or valid medical reason for the colonoscopy, including: iron deficiency anemia, lower gastrointestinal bleeding, crohn's disease (i.e., regional enteritis), familial adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease, ulcerative colitis, abnormal finding of gastrointestinal tract, or changes in bowel habits
HCPCS Code: G9660
Short Description: Doc med rsn scope pt >85y
Long Description: Documentation of medical reason(s) for a colonoscopy performed on a patient greater than 85 years of age (eg., last colonoscopy incomplete, last colonoscopy had inadequate prep, iron deficiency anemia, lower gastrointestinal bleeding, crohn's disease (i.e., regional enteritis), familial history of adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease, ulcerative colitis, abnormal finding of gastrointestinal tract, or changes in bowel habits)
HCPCS Code: G9661
Short Description: >85y scope othr rsn
Long Description: Patients greater than 85 years of age who received a routine colonoscopy for a reason other than the following: an assessment of signs/symptoms of gi tract illness, and/or the patient is considered high risk, and/or to follow-up on previously diagnoses advance lesions
HCPCS Code: G9662
Short Description: Prior dx/active clin ascvd
Long Description: Previously diagnosed or have an active diagnosis of clinical ascvd
HCPCS Code: G9663
Short Description: Fast/dir ldl = 190 mg/dl
Long Description: Any fasting or direct ldl-c laboratory test result = 190 mg/dl
HCPCS Code: G9664
Short Description: Taking statin or rec'd order
Long Description: Patients who are currently statin therapy users or received an order (prescription) for statin therapy
HCPCS Code: G9665
Short Description: No statin/no order statin
Long Description: Patients who are not currently statin therapy users or did not receive an order (prescription) for statin therapy
HCPCS Code: G9666
Short Description: Fas/dir ldl 70-189mg/dl mst
Long Description: The highest fasting or direct ldl-c laboratory test result of 70?189 mg/dl in the measurement period or two years prior to the beginning of the measurement period
HCPCS Code: G9667
Short Description: Doc med rsn no stat tx/presc
Long Description: Documentation of medical reason (s) for not currently being a statin therapy user or receive an order (prescription) for statin therapy (e.g., patient with adverse effect, allergy or intolerance to statin medication therapy, patients who have an active diagnosis of pregnancy or who are breastfeeding, patients who are receiving palliative care, patients with active liver disease or hepatic disease or insufficiency, patients with end stage renal disease (esrd), and patients with diabetes who have a fasting or direct ldl-c laboratory test result < 70 mg/dl and are not taking statin therapy)
HCPCS Code: G9668
Short Description: Doc med rsn no stat tx/presc
Long Description: Documentation of medical reason (s) for not currently being a statin therapy user or receive an order (prescription) for statin therapy (e.g., patient with adverse effect, allergy or intolerance to statin medication therapy, patients who have an active diagnosis of pregnancy or who are breastfeeding, patients who are receiving palliative care, patients with active liver disease or hepatic disease or insufficiency, patients with end stage renal disease (esrd), and patients with diabetes who have a fasting or direct ldl-c laboratory test result < 70 mg/dl and are not taking statin therapy)
HCPCS Code: G9669
Short Description: Intend rpt mult chr msr grp
Long Description: I intend to report the multiple chronic conditions measures group
HCPCS Code: G9670
Short Description: Qty act mcc mg perf
Long Description: All quality actions for the applicable measures in the multiple chronic conditions measures group have been performed for this patient
HCPCS Code: G9671
Short Description: Intend rpt dia retin msr grp
Long Description: I intend to report the diabetic retinopathy measures group
HCPCS Code: G9672
Short Description: Qty act diab retin mg perf
Long Description: All quality actions for the applicable measures in the diabetic retinopathy measures group have been performed for this patient
HCPCS Code: G9673
Short Description: Intend rpt card prev msr grp
Long Description: I intend to report the cardiovascular prevention measures group
HCPCS Code: G9674
Short Description: Pt w/clin ascvd dx
Long Description: Patients with clinical ascvd diagnosis
HCPCS Code: G9675
Short Description: Pt w/fast/dir lab ldl-c >190
Long Description: Patients who have ever had a fasting or direct laboratory result of ldl-c = 190 mg/dl
HCPCS Code: G9676
Short Description: 40-75y w/type 1/2 w/ldl-c rs
Long Description: Patients aged 40 to 75 years at the beginning of the measurement period with type 1 or type 2 diabetes and with an ldl-c result of 70?189 mg/dl recorded as the highest fasting or direct laboratory test result in the measurement year or during the two years prior to the beginning of the measurement period
HCPCS Code: G9677
Short Description: Qty act card prev mg perf
Long Description: All quality actions for the applicable measures in the cardiovascular prevention measures group have been performed for this patient
HCPCS Code: GA
Short Description: Liability waiver ind case
Long Description: Waiver of liability statement issued as required by payer policy, individual case
HCPCS Code: GB
Short Description: Claim resubmitted
Long Description: Claim being re-submitted for payment because it is no longer covered under a global payment demonstration
HCPCS Code: GC
Short Description: Resident/teaching phys serv
Long Description: This service has been performed in part by a resident under the direction of a teaching physician
HCPCS Code: GD
Short Description: Unit of service > mue value
Long Description: Units of service exceeds medically unlikely edit value and represents reasonable and necessary services
HCPCS Code: GE
Short Description: Resident prim care exception
Long Description: This service has been performed by a resident without the presence of a teaching physician under the primary care exception
HCPCS Code: GF
Short Description: Nonphysician serv c a hosp
Long Description: Non-physician (e.g. nurse practitioner (np), certified registered nurse anesthetist (crna), certified registered nurse (crn), clinical nurse specialist (cns), physician assistant (pa)) services in a critical access hospital
HCPCS Code: GG
Short Description: Payment screen mam + diagmam
Long Description: Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day
HCPCS Code: GH
Short Description: Diag mammo to screening mamo
Long Description: Diagnostic mammogram converted from screening mammogram on same day
HCPCS Code: GJ
Short Description: Opt out provider of er srvc
Long Description: "opt out" physician or practitioner emergency or urgent service
HCPCS Code: GK
Short Description: Actual item/service ordered
Long Description: Reasonable and necessary item/service associated with a ga or gz modifier
HCPCS Code: GL
Short Description: Upgraded item, no charge
Long Description: Medically unnecessary upgrade provided instead of non-upgraded item, no charge, no advance beneficiary notice (abn)
HCPCS Code: GM
Short Description: Multiple transports
Long Description: Multiple patients on one ambulance trip
HCPCS Code: GN
Short Description: Op speech language service
Long Description: Services delivered under an outpatient speech language pathology plan of care
HCPCS Code: GO
Short Description: Op occupational therapy serv
Long Description: Services delivered under an outpatient occupational therapy plan of care
HCPCS Code: GP
Short Description: Op pt services
Long Description: Services delivered under an outpatient physical therapy plan of care
HCPCS Code: GQ
Short Description: Telehealth store and forward
Long Description: Via asynchronous telecommunications system
HCPCS Code: GR
Short Description: Service by va resident
Long Description: This service was performed in whole or in part by a resident in a department of veterans affairs medical center or clinic, supervised in accordance with va policy
HCPCS Code: GS
Short Description: Epo/darbepoietin reduced 25%
Long Description: Dosage of erythropoietin stimulating agent has been reduced and maintained in response to hematocrit or hemoglobin level
HCPCS Code: GT
Short Description: Interactivetelecommunication
Long Description: Via interactive audio and video telecommunication systems
HCPCS Code: GU
Short Description: Liability waiver rout notice
Long Description: Waiver of liability statement issued as required by payer policy, routine notice
HCPCS Code: GV
Short Description: Attending phys not hospice
Long Description: Attending physician not employed or paid under arrangement by the patient's hospice provider
HCPCS Code: GW
Short Description: Service unrelated to term co
Long Description: Service not related to the hospice patient's terminal condition
HCPCS Code: GX
Short Description: Voluntary liability notice
Long Description: Notice of liability issued, voluntary under payer policy
HCPCS Code: GY
Short Description: Statutorily excluded
Long Description: Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
HCPCS Code: GZ
Short Description: Not reasonable and necessary
Long Description: Item or service expected to be denied as not reasonable and necessary