HCPCS Service Codes - Medical care

HCPCS Service Code 1 for Medical care.

HCPCS Type of Service (TOS) code is an indicator that the contractor places on Form CMS-1500. The indicator is mainly used for data purposes, however in some instances, it affects payment. All HCPCS codes have a corresponding TOS indicator.

Below are all available HCPCS TOS codes. Find an HCPCS code based on the type of service.

HCPCS Codes for Medical care

  • G8853

    Positive airway pressure therapy not prescribed

  • G8854

    Documentation of reason(s) for not objectively reporting adherence to evidence-based therapy (e.g., patients who have been diagnosed with a terminal or advanced disease with an expected life span of less than 6 months, patients who decline therapy, patients who do not return for follow-up at least annually, patients unable to access/afford therapy, patient's insurance will not cover therapy)

  • G8855

    Adherence to therapy was not assessed at least annually through an objective informatics system or through self-reporting (if objective reporting is not available), reason not given

  • G8856

    Referral to a physician for an otologic evaluation performed

  • G8857

    Patient is not eligible for the referral for otologic evaluation measure (e.g., patients who are already under the care of a physician for acute or chronic dizziness)

  • G8858

    Referral to a physician for an otologic evaluation not performed, reason not given

  • G8859

    Patient receiving corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days

  • G8860

    Patients who have received dose of corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days

  • G8861

    Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) ordered and documented, review of systems and medication history or pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed

  • G8862

    Patients not receiving corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days

  • G8863

    Patients not assessed for risk of bone loss, reason not given

  • G8864

    Pneumococcal vaccine administered or previously received

  • G8865

    Documentation of medical reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient allergic reaction, potential adverse drug reaction)

  • G8866

    Documentation of patient reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient refusal)

  • G8867

    Pneumococcal vaccine not administered or previously received, reason not given

  • G8868

    Patients receiving a first course of anti-tnf therapy

  • G8869

    Patient has documented immunity to hepatitis b and initiating anti-tnf therapy

  • G8870

    Hepatitis b vaccine injection administered or previously received and is receiving a first course of anti-tnf therapy

  • G8871

    Patient not receiving a first course of anti-tnf therapy

  • G8872

    Excised tissue evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesion

  • G8873

    Patients with needle localization specimens which are not amenable to intraoperative imaging such as mri needle wire localization, or targets which are tentatively identified on mammogram or ultrasound which do not contain a biopsy marker but which can be verified on intraoperative inspection or pathology (e.g., needle biopsy site where the biopsy marker is remote from the actual biopsy site)

  • G8874

    Excised tissue not evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesion

  • G8875

    Clinician diagnosed breast cancer preoperatively by a minimally invasive biopsy method

  • G8876

    Documentation of reason(s) for not performing minimally invasive biopsy to diagnose breast cancer preoperatively (e.g., lesion too close to skin, implant, chest wall, etc., lesion could not be adequately visualized for needle biopsy, patient condition prevents needle biopsy [weight, breast thickness, etc.], duct excision without imaging abnormality, prophylactic mastectomy, reduction mammoplasty, excisional biopsy performed by another physician)

  • G8877

    Clinician did not attempt to achieve the diagnosis of breast cancer preoperatively by a minimally invasive biopsy method, reason not given

  • G8878

    Sentinel lymph node biopsy procedure performed

  • G8879

    Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer

  • G8880

    Documentation of reason(s) sentinel lymph node biopsy not performed (e.g., reasons could include but not limited to; non-invasive cancer, incidental discovery of breast cancer on prophylactic mastectomy, incidental discovery of breast cancer on reduction mammoplasty, pre-operative biopsy proven lymph node (ln) metastases, inflammatory carcinoma, stage 3 locally advanced cancer, recurrent invasive breast cancer, clinically node positive after neoadjuvant systemic therapy, patient refusal after informed consent, patient with significant age, comorbidities, or limited life expectancy and favorable tumor; adjuvant systemic therapy unlikely to change)

  • G8881

    Stage of breast cancer is greater than t1n0m0 or t2n0m0

  • G8882

    Sentinel lymph node biopsy procedure not performed, reason not given

  • G8883

    Biopsy results reviewed, communicated, tracked and documented

  • G8884

    Clinician documented reason that patient's biopsy results were not reviewed

  • G8885

    Biopsy results not reviewed, communicated, tracked or documented

  • G8886

    Most recent blood pressure under control

  • G8887

    Documentation of medical reason(s) for most recent blood pressure not being under control (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)

  • G8888

    Most recent blood pressure not under control, results documented and reviewed

  • G8889

    No documentation of blood pressure measurement, reason not given

  • G8890

    Most recent ldl-c under control, results documented and reviewed

  • G8891

    Documentation of medical reason(s) for most recent ldl-c not under control (e.g., patients with palliative goals for whom treatment of hypertension with standard treatment goals is not clinically appropriate)

  • G8892

    Documentation of medical reason(s) for not performing ldl-c test (e.g. patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)

  • G8893

    Most recent ldl-c not under control, results documented and reviewed

  • G8894

    Ldl-c not performed, reason not given

  • G8895

    Oral aspirin or other antithrombotic therapy prescribed

  • G8896

    Documentation of medical reason(s) for not prescribing oral aspirin or other antithrombotic therapy (e.g., patient documented to be low risk or patient with terminal illness or treatment of hypertension with standard treatment goals is not clinically appropriate, or for whom risk of aspirin or other antithrombotic therapy exceeds potential benefits such as for individuals whose blood pressure is poorly controlled)

  • G8897

    Oral aspirin or other antithrombotic therapy was not prescribed, reason not given

  • G8898

    I intend to report the chronic obstructive pulmonary disease (copd) measures group

  • G8899

    I intend to report the inflammatory bowel disease (ibd) measures group

  • G8900

    I intend to report the sleep apnea measures group

  • G8902

    I intend to report the dementia measures group

  • G8903

    I intend to report the parkinson's disease measures group