| G2 |
Urr reading of 60 to 64.9 |
Most recent urr reading of 60 to 64.9 |
| G2000 |
Blinded conv. tx mdd clin tr |
Blinded administration of convulsive therapy procedure, either electroconvulsive therapy (ect, current covered gold standard) or magnetic seizure therapy (mst, non-covered experimental therapy), performed in an approved ide-based clinical trial, per treatment session |
| G2001 |
Post d/c h vst new pt 20 m |
Brief (20 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2002 |
Post-d/c h vst new pt 30 m |
Limited (30 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2003 |
Post-d/c h vst new pt 45 m |
Moderate (45 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2004 |
Post-d/c h vst new pt 60 m |
Comprehensive (60 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2005 |
Post-d/c h vst new pt 75 m |
Extensive (75 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2006 |
Post-d/c h vst ext pt 20 m |
Brief (20 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2007 |
Post-d/c h vst ext pt 30 m |
Limited (30 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2008 |
Post-d/c h vst ext pt 45 m |
Moderate (45 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2009 |
Post-d/c h vst ext pt 60 m |
Comprehensive (60 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2010 |
Remot image submit by pt |
Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment |
| G2011 |
Alcohol/sub misuse assess |
Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention, 5-14 minutes |
| G2012 |
Brief check in by md/qhp |
Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion |
| G2013 |
Post-d/c h vst ext pt 75 m |
Extensive (75 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2014 |
Post-d/c care plan overs 30m |
Limited (30 minutes) care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.) |
| G2015 |
Post-d/c care plan overs 60m |
Comprehensive (60 mins) home care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility.) |
| G2020 |
Hi inten serv for sip model |
Services for high intensity clinical services associated with the initial engagement and outreach of beneficiaries assigned to the sip component of the pcf model (do not bill with chronic care management codes) |
| G2021 |
Hea care pract tx in place |
Health care practitioners rendering treatment in place (tip) |
| G2022 |
Benef refuses service, mod |
A model participant (ambulance supplier/provider), the beneficiary refuses services covered under the model (transport to an alternate destination/treatment in place) |
| G2023 |
Specimen collect covid-19 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
| G2024 |
Spec coll snf/lab covid-19 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) from an individual in a snf or by a laboratory on behalf of a hha, any specimen source |
| G2025 |
Dis site tele svcs rhc/fqhc |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
| G2058 |
Ccm add 20min |
Chronic care management services, each additional 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (list separately in addition to code for primary procedure). (do not report g2058 for care management services of less than 20 minutes additional to the first 20 minutes of chronic care management services during a calendar month). (use g2058 in conjunction with 99490). (do not report 99490, g2058 in the same calendar month as 99487, 99489, 99491)). |
| G2061 |
Qual nonmd est pt 5-10m |
Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 5-10 minutes |
| G2062 |
Qual nonmd est pt 11-20m |
Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11-20 minutes |
| G2063 |
Qual nonmd est pt 21>min |
Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes |
| G2064 |
Md mang high risk dx 30 |
Comprehensive care management services for a single high-risk disease, e.g., principal care management, at least 30 minutes of physician or other qualified health care professional time per calendar month with the following elements: one complex chronic condition lasting at least 3 months, which is the focus of the care plan, the condition is of sufficient severity to place patient at risk of hospitalization or have been the cause of a recent hospitalization, the condition requires development or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities |
| G2065 |
Clin mang h risk dx 30 |
Comprehensive care management for a single high-risk disease services, e.g. principal care management, at least 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month with the following elements: one complex chronic condition lasting at least 3 months, which is the focus of the care plan, the condition is of sufficient severity to place patient at risk of hospitalization or have been cause of a recent hospitalization, the condition requires development or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities |
| G2066 |
Inter devc remote 30d |
Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, implantable loop recorder system, or subcutaneous cardiac rhythm monitor system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results |
| G2067 |
Med assist tx meth wk |
Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a medicare-enrolled opioid treatment program) |
| G2068 |
Med assist tx bupre oral |
Medication assisted treatment, buprenorphine (oral); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) |
| G2069 |
Med assist tx inject |
Medication assisted treatment, buprenorphine (injectable); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) |
| G2070 |
Med assist tx implant |
Medication assisted treatment, buprenorphine (implant insertion); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) |
| G2071 |
Med tx remove implant |
Medication assisted treatment, buprenorphine (implant removal); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) |
| G2072 |
Med tx insert/remove imp |
Medication assisted treatment, buprenorphine (implant insertion and removal); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) |
| G2073 |
Med tx naltrexone |
Medication assisted treatment, naltrexone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) |
| G2074 |
Med assist tx no drug |
Medication assisted treatment, weekly bundle not including the drug, including substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) |
| G2075 |
Med tx meds nos |
Medication assisted treatment, medication not otherwise specified; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a medicare-enrolled opioid treatment program) |
| G2076 |
Intake act w/med exam |
Intake activities, including initial medical examination that is a complete, fully documented physical evaluation and initial assessment by a program physician or a primary care physician, or an authorized healthcare professional under the supervision of a program physician qualified personnel that includes preparation of a treatment plan that includes the patient's short-term goals and the tasks the patient must perform to complete the short-term goals; the patient's requirements for education, vocational rehabilitation, and employment; and the medical, psycho- social, economic, legal, or other supportive services that a patient needs, conducted by qualified personnel (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure |
| G2077 |
Periodic assessment |
Periodic assessment; assessing periodically by qualified personnel to determine the most appropriate combination of services and treatment (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure |
| G2078 |
Take-home meth |
Take-home supply of methadone; up to 7 additional day supply (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure |
| G2079 |
Take-hom buprenorphine |
Take-home supply of buprenorphine (oral); up to 7 additional day supply (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure |
| G2080 |
Add 30 mins counsel |
Each additional 30 minutes of counseling in a week of medication assisted treatment, (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure |
| G2081 |
Pt 66+ snp or ltc pos > 90d |
Patients age 66 and older in institutional special needs plans (snp) or residing in long-term care with a pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period |
| G2082 |
Visit esketamine 56m or less |
Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of up to 56 mg of esketamine nasal self-administration, includes 2 hours post-administration observation |
| G2083 |
Visit esketamine, > 56m |
Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of greater than 56 mg esketamine nasal self-administration, includes 2 hours post-administration observation |
| G2086 |
Off base opioid tx 70min |
Office-based treatment for opioid use disorder, including development of the treatment plan, care coordination, individual therapy and group therapy and counseling; at least 70 minutes in the first calendar month |
| G2087 |
Off base opioid tx, 60 m |
Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; at least 60 minutes in a subsequent calendar month |
| G2088 |
Off base opioid tx, add30 |
Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; each additional 30 minutes beyond the first 120 minutes (list separately in addition to code for primary procedure) |
| G2089 |
A1c level 7 to 9% |
Most recent hemoglobin a1c (hba1c) level 7.0 to 9.0% |
| G2090 |
Pt 66+ frailty and med dem |
Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period |
| G2091 |
Pt 66+ frailty and adv ill |
Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period |
| G2092 |
Ace arb arni |
Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) or angiotensin receptor-neprilysin inhibitor (arni) therapy prescribed or currently being taken |
| G2093 |
Med doc rsn no ace arn arni |
Documentation of medical reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., hypotensive patients who are at immediate risk of cardiogenic shock, hospitalized patients who have experienced marked azotemia, allergy, intolerance, other medical reasons) |
| G2094 |
Pt rsn no ace arn arni |
Documentation of patient reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., patient declined, other patient reasons) |
| G2095 |
Sys rsn no ace arn arni |
Documentation of system reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., other system reasons) |
| G2096 |
No rsn ace arb arni |
Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) or angiotensin receptor-neprilysin inhibitor (arni) therapy was not prescribed, reason not given |
| G2097 |
Dx uri 3d after other dx |
Episodes where the patient had a competing diagnosis on or within three days after the episode date (e.g., intestinal infection, pertussis, bacterial infection, lyme disease, otitis media, acute sinusitis, chronic sinusitis, infection of the adenoids, prostatitis, cellulitis, mastoiditis, or bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia/gonococcal infections, venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis or uti) |
| G2098 |
Pt 66+ frailty and med dem |
Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period |
| G2099 |
Pt 66+ frailty and adv ill |
Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period |
| G2100 |
Pt 66+ frailty and med dem |
Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period |
| G2101 |
Pt 66+ frailty and adv ill |
Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period |
| G2102 |
Dil retinal eye exam |
Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed |
| G2103 |
7 stereo photos interpret |
Seven standard field stereoscopic photos with interpretation by an ophthalmologist or optometrist documented and reviewed |
| G2104 |
Eye img valid w/7 stereo |
Eye imaging validated to match diagnosis from seven standard field stereoscopic photos results documented and reviewed |
| G2105 |
Pt 66+ snp or ltc pos > 90d |
Patient age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period |
| G2106 |
Pt 66+ frailty and med dem |
Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period |
| G2107 |
Pt 66+ frailty and adv ill |
Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period |
| G2108 |
Pt 66+ snp or ltc pos > 90d |
Patient age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period |
| G2109 |
Pt 66+ frailty and med dem |
Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period |
| G2110 |
Pt 66+ frailty and adv ill |
Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period |
| G2112 |
Pred<=5 mg ra glu <6m |
Patient receiving <=5 mg daily prednisone (or equivalent), or ra activity is worsening, or glucocorticoid use is for less than 6 months |
| G2113 |
Pred>5 mg >6m, no chg da |
Patient receiving >5 mg daily prednisone (or equivalent) for longer than 6 months, and improvement or no change in disease activity |
| G2114 |
Pt 66-80 frailty and med dem |
Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period |
| G2115 |
Pt 66-80 frailty and med dem |
Patients 66 - 80 years of age with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period |
| G2116 |
Pt 66-80 frailty and adv ill |
Patients 66 - 80 years of age with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period |
| G2117 |
Pt 66-80 frailty and adv ill |
Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period |
| G2118 |
Pt 81+ frailty |
Patients 81 years of age and older with at least one claim/encounter for frailty during the measurement period |
| G2119 |
Calc vitd opt |
Within the past 2 years, calcium and/or vitamin d optimization has been ordered or performed |
| G2120 |
No calc vitd opt |
Within the past 2 years, calcium and/or vitamin d optimization has not been ordered or performed |
| G2121 |
Psy dep anx ap and icd asse |
Depression, anxiety, apathy, and psychosis assessed |
| G2122 |
Psy/dep/anx/apandicd noasse |
Depression, anxiety, apathy, and psychosis not assessed |
| G2123 |
Pt 66-80 frailty med dem |
Patients 66-80 years of age and had at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period |
| G2124 |
Pt 66-80 frailty adv ill |
Patients 66-80 years of age and had at least one claim/encounter for frailty during the measurement period and a dispensed dementia medication |
| G2125 |
Pt 81+ frailty |
Patients 81 years of age and older with at least one claim/encounter for frailty during the six months prior to the measurement period through december 31 of the measurement period |
| G2126 |
Pt 66-80 frailty and adv ill |
Patients 66 - 80 years of age with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period |
| G2127 |
Pt 66-80 frailty and med dem |
Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period |
| G2128 |
No aspirin med rsn |
Documentation of medical reason(s) for not on a daily aspirin or other antiplatelet (e.g. history of gastrointestinal bleed, intra-cranial bleed, blood disorders, idiopathic thrombocytopenic purpura (itp), gastric bypass or documentation of active anticoagulant use during the measurement period) |
| G2129 |
No bp outpt |
Procedure-related bp's not taken during an outpatient visit. examples include same day surgery, ambulatory service center, g.i. lab, dialysis, infusion center, chemotherapy |
| G2130 |
Pt 66+ lt inst > 90 |
Patients age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 days during the measurement period |
| G2131 |
Pt 81+ frailty |
Patients 81 years and older with a diagnosis of frailty |
| G2132 |
Pt 66-80 frailty and med dem |
Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period |
| G2133 |
Pt 66-80 frailty and adv ill |
Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period |
| G2134 |
Pt 66+ frailty and med dem |
Patients 66 years of age or older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period |
| G2135 |
Pt 66+ frailty and adv ill |
Patients 66 years of age or older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period |
| G2136 |
Bk pain vas 6-20wk <= 3 |
Back pain measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively was less than or equal to 3.0 or back pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated an improvement of 5.0 points or greater |
| G2137 |
Bk pain vas 6-20wk > 3 |
Back pain measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively was greater than 3.0 and back pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated improvement of less than 5.0 points |
| G2138 |
Bk pain vas 9-15mo <= 3 |
Back pain as measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively was less than or equal to 3.0 or back pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of 5.0 points or greater |
| G2139 |
Bk pain vas 9-15mo > 3 |
Back pain measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively was greater than 3.0 and back pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated improvement of less than 5.0 points |
| G2140 |
Leg pain vas 6-20wk <= 3 |
Leg pain measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively was less than or equal to 3.0 or leg pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated an improvement of 5.0 points or greater |
| G2141 |
Leg pain vas 6-20wk > 3 |
Leg pain measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively was greater than 3.0 and leg pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated improvement of less than 5.0 points |
| G2142 |
Fs odi 9-15mo postop<= 22 |
Functional status measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively was less than or equal to 22 or functional status measured by the odi version 2.1a within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of 30 points or greater |
| G2143 |
Fs odi 9-15mo > 22 |
Functional status measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively was greater than 22 and functional status measured by the odi version 2.1a within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of less than 30 points |
| G2144 |
Fs odi 6-20wk postop <= 22 |
Functional status measured by the oswestry disability index (odi version 2.1a) at three months (6-20 weeks) postoperatively was less than or equal to 22 or functional status measured by the odi version 2.1a within three months preoperatively and at three months (6-20 weeks) postoperatively demonstrated an improvement of 30 points or greater |
| G2145 |
Fsodi 6-20wk >22 or chg 30pt |
Functional status measured by the oswestry disability index (odi version 2.1a) at three months (6 - 20 weeks) postoperatively was greater than 22 and functional status measured by the odi version 2.1a within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated an improvement of less than 30 points |
| G2146 |
Leg pain vas 9-15mo <= 3 |
Leg pain as measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively was less than or equal to 3.0 or leg pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of 5.0 points or greater |
| G2147 |
Leg pain vas 9-15mo > 3 |
Leg pain measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively was greater than 3.0 and leg pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated improvement of less than 5.0 points |
| G2148 |
Mpm used |
Multimodal pain management was used |
| G2149 |
No mpm med rsn |
Documentation of medical reason(s) for not using multimodal pain management (e.g., allergy to multiple classes of analgesics, intubated patient, hepatic failure, patient reports no pain during pacu stay, other medical reason(s)) |
| G2150 |
No mpm |
Multimodal pain management was not used |
| G2151 |
Dx degen neuro |
Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time before or during the episode of care |
| G2152 |
Res change sc >=0 |
Residual score for the neck impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) |
| G2153 |
Hosp dur meas pd |
In hospice or using hospice services during the measurement period |
| G2154 |
Td 9 yrs start end meas |
Patient received at least one td vaccine or one tdap vaccine between nine years prior to the start of the measurement period and the end of the measurement period |
| G2155 |
Hist contraindications |
Patient had history of at least one of the following contraindications any time during or before the measurement period: anaphylaxis due to tdap vaccine, anaphylaxis due to td vaccine or its components; encephalopathy due to tdap or td vaccination (post tetanus vaccination encephalitis, post diphtheria vaccination encephalitis or post pertussis vaccination encephalitis.) |
| G2156 |
No prior td or hx contra |
Patient did not receive at least one td vaccine or one tdap vaccine between nine years prior to the start of the measurement period and the end of the measurement period; or have history of at least one of the following contraindications any time during or before the measurement period: anaphylaxis due to tdap vaccine, anaphylaxis due to td vaccine or its components; encephalopathy due to tdap or td vaccination (post tetanus vaccination encephalitis, post diphtheria vaccination encephalitis or post pertussis vaccination encephalitis.) |
| G2157 |
Pneum vacc 12 mo 60+ |
Patients received both the 13-valent pneumococcal conjugate vaccine and the 23-valent pneumococcal polysaccharide vaccine at least 12 months apart, with the first occurrence after the age of 60 before or during the measurement period |
| G2158 |
Pneum vacc adv rx |
Patient had prior pneumococcal vaccine adverse reaction any time during or before the measurement period |
| G2159 |
No pneum vacc 12 mo 60+ |
Patient did not receive both the 13-valent pneumococcal conjugate vaccine and the 23-valent pneumococcal polysaccharide vaccine at least 12 months apart, with the first occurrence after the age of 60 before or during measurement period; or have prior pneumococcal vaccine adverse reaction any time during or before the measurement period |
| G2160 |
Herpzos 50+ |
Patient received at least one dose of the herpes zoster live vaccine or two doses of the herpes zoster recombinant vaccine (at least 28 days apart) anytime on or after the patient's 50th birthday before or during the measurement period |
| G2161 |
Adv rx zos |
Patient had prior adverse reaction caused by zoster vaccine or its components any time during or before the measurement period |
| G2162 |
No herpzos 50+ |
Patient did not receive at least one dose of the herpes zoster live vaccine or two doses of the herpes zoster recombinant vaccine (at least 28 days apart) anytime on or after the patient's 50th birthday before or during the measurement period; or have prior adverse reaction caused by zoster vaccine or its components any time during or before the measurement period |
| G2163 |
Infl vacc 07/01 to 06/30 |
Patient received an influenza vaccine on or between july 1 of the year prior to the measurement period and june 30 of the measurement period |
| G2164 |
Adv rx infl vacc |
Patient had a prior influenza virus vaccine adverse reaction any time before or during the measurement period |
| G2165 |
No infl vacc 07/01 to 06/30 |
Patient did not receive an influenza vaccine on or between july 1 of the year prior to the measurement period and june 30 of the measurement period; or did not have a prior influenza virus vaccine adverse reaction any time before or during the measurement period |
| G2166 |
No pt adm dx no neck fs prom |
Patient refused to participate at admission and/or discharge; patient unable to complete the neck fs prom at admission or discharge due to cognitive deficit, visual deficit, motor deficit, language barrier, or low reading level, and a suitable proxy/recorder is not available; patient self-discharged early; medical reason |
| G2167 |
Res change sc < 0 |
Residual score for the neck impairment successfully calculated and the score was less than zero (< 0) |
| G2168 |
Svs by pt in home health |
Services performed by a physical therapist assistant in the home health setting in the delivery of a safe and effective physical therapy maintenance program, each 15 minutes |
| G2169 |
Svs by ot in home health |
Services performed by an occupational therapist assistant in the home health setting in the delivery of a safe and effective occupational therapy maintenance program, each 15 minutes |
| G2170 |
Avf by tissue w thermal e |
Percutaneous arteriovenous fistula creation (avf), direct, any site, by tissue approximation using thermal resistance energy, and secondary procedures to redirect blood flow (e.g., transluminal balloon angioplasty, coil embolization) when performed, and includes all imaging and radiologic guidance, supervision and interpretation, when performed |
| G2171 |
Avf use magnetic/art/ven |
Percutaneous arteriovenous fistula creation (avf), direct, any site, using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, wen performed) and fistulogram(s), angiography, enography, and/or ultrasound, with radiologic supervision and interpretation, when performed |
| G2172 |
Tx for opioid use demo proj |
All inclusive payment for services related to highly coordinated and integrated opioid use disorder (oud) treatment services furnished for the demonstration project |
| G2173 |
Uri w comorb 12m oth dx |
Uri episodes where the patient had a comorbid condition during the 12 months prior to or on the episode date (e.g., tuberculosis, neutropenia, cystic fibrosis, chronic bronchitis, pulmonary edema, respiratory failure, rheumatoid lung disease) |
| G2174 |
Uri new rx antibiotic 30d |
Uri episodes where the patient is taking antibiotics (table 1) in the 30 days prior to the episode date |
| G2175 |
Pt comorb dx 12m of epi |
Episodes where the patient had a comorbid condition during the 12 months prior to or on the episode date (e.g., tuberculosis, neutropenia, cystic fibrosis, chronic bronchitis, pulmonary edema, respiratory failure, rheumatoid lung disease) |
| G2176 |
Outpt ed obs w inpt admit |
Outpatient, ed, or observation visits that result in an inpatient admission |
| G2177 |
Bronch w rx antibx 30d |
Acute bronchitis/bronchiolitis episodes when the patient had a new or refill prescription of antibiotics (table 1) in the 30 days prior to the episode date |
| G2178 |
Pt not elig low neuro ex |
Clinician documented that patient was not an eligible candidate for lower extremity neurological exam measure, for example patient bilateral amputee; patient has condition that would not allow them to accurately respond to a neurological exam (dementia, alzheimer's, etc.); patient has previously documented diabetic peripheral neuropathy with loss of protective sensation |
| G2179 |
Med doc rsn no low ex |
Clinician documented that patient had medical reason for not performing lower extremity neurological exam |
| G2180 |
Inelig footwr eval |
Clinician documented that patient was not an eligible candidate for evaluation of footwear as patient is bilateral lower extremity amputee |
| G2181 |
Bmi not doc medrsn ptref |
Bmi not documented due to medical reason or patient refusal of height or weight measurement |
| G2182 |
Pt 1st biolog antirheum |
Patient receiving first-time biologic and/or immune response modifier therapy |
| G2183 |
Doc pt unable comm |
Documentation patient unable to communicate and informant not available |
| G2184 |
No caregiver |
Patient does not have a caregiver |
| G2185 |
Caregiver dem trained |
Documentation caregiver is trained and certified in dementia care |
| G2186 |
Pt ref app rsrcs |
Patient /caregiver dyad has been referred to appropriate resources and connection to those resources is confirmed |
| G2187 |
Clin ind img hd trauma |
Patients with clinical indications for imaging of the head: head trauma |
| G2188 |
Pt 50 yrs w/clin ind hd |
Patients with clinical indications for imaging of the head: new or change in headache above 50 years of age |
| G2189 |
Img hd abnml neuro exam |
Patients with clinical indications for imaging of the head: abnormal neurologic exam |
| G2190 |
Ind img hd rad neck |
Patients with clinical indications for imaging of the head: headache radiating to the neck |
| G2191 |
Ind img hd pos hd ache |
Patients with clinical indications for imaging of the head: positional headaches |
| G2192 |
>55 yrs temp hd ache |
Patients with clinical indications for imaging of the head: temporal headaches in patients over 55 years of age |
| G2193 |
<6yr new onset hd ache |
Patients with clinical indications for imaging of the head: new onset headache in pre-school children or younger (<6 years of age) |
| G2194 |
New hdache ped pt dis |
Patients with clinical indications for imaging of the head: new onset headache in pediatric patients with disabilities for which headache is a concern as inferred from behavior |
| G2195 |
Occip hdache child |
Patients with clinical indications for imaging of the head: occipital headache in children |
| G2196 |
Screen unhlthy etoh use |
Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method |
| G2197 |
Screen hlthy etoh use |
Patient screened for unhealthy alcohol use using a systematic screening method and not identified as an unhealthy alcohol user |
| G2198 |
Med rsn no unhlthy etoh |
Documentation of medical reason(s) for not screening for unhealthy alcohol use using a systematic screening method (e.g., limited life expectancy, other medical reasons) |
| G2199 |
Not scrn etoh no rsn |
Patient not screened for unhealthy alcohol use using a systematic screening method |
| G2200 |
Unhlthy etoh rcvd couns |
Patient identified as an unhealthy alcohol user received brief counseling |
| G2201 |
Med rsn no brief couns |
Documentation of medical reason(s) for not providing brief counseling (e.g., limited life expectancy, other medical reasons) |
| G2202 |
No rsn no brief couns |
Patient did not receive brief counseling if identified as an unhealthy alcohol user |
| G2203 |
Med rsn no etoh couns |
Documentation of medical reason(s) for not providing brief counseling if identified as an unhealthy alcohol user (e.g., limited life expectancy, other medical reasons) |
| G2204 |
Pt 45-85 w/ scope |
Patients between 45 and 85 years of age who received a screening colonoscopy during the performance period |
| G2205 |
Preg drng adjv trtmt |
Patients with pregnancy during adjuvant treatment course |
| G2206 |
Adjv trtmt chemo her2 |
Patient received adjuvant treatment course including both chemotherapy and her2-targeted therapy |
| G2207 |
Rsn no trtmt chem her2 |
Reason for not administering adjuvant treatment course including both chemotherapy and her2-targeted therapy (e.g. poor performance status (ecog 3-4; karnofsky <=50), cardiac contraindications, insufficient renal function, insufficient hepatic function, other active or secondary cancer diagnoses, other medical contraindications, patients who died during initial treatment course or transferred during or after initial treatment course) |
| G2208 |
No trtmt chemo and her2 |
Patient did not receive adjuvant treatment course including both chemotherapy and her2-targeted therapy |
| G2209 |
Refused to participate |
Patient refused to participate |
| G2210 |
No neck fs prom no rsn |
Residual score for the neck impairment not measured because the patient did not complete the neck fs prom at initial evaluation and/or near discharge, reason not given |
| G2211 |
Complex e/m visit add on |
Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established) |
| G2212 |
Prolong outpt/office vis |
Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99205, 99215, 99483 for office or other outpatient evaluation and management services) (do not report g2212 on the same date of service as 99358, 99359, 99415, 99416). (do not report g2212 for any time unit less than 15 minutes) |
| G2213 |
Initiat med assist tx in er |
Initiation of medication for the treatment of opioid use disorder in the emergency department setting, including assessment, referral to ongoing care, and arranging access to supportive services (list separately in addition to code for primary procedure) |
| G2214 |
Init/sub psych care m 1st 30 |
Initial or subsequent psychiatric collaborative care management, first 30 minutes in a month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional |
| G2215 |
Home supply nasal naloxone |
Take-home supply of nasal naloxone; 2-pack of 4mg per 0.1 ml nasal spray (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure |
| G2216 |
Home supply inject naloxon |
Take-home supply of injectable naloxone (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure |
| G2250 |
Remot img sub by pt, non e/m |
Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment |
| G2251 |
Brief chkin, 5-10, non-e/m |
Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of clinical discussion |
| G2252 |
Brief chkin by md/qhp, 11-20 |
Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion |
