HCPCS Service Codes - Medical care

HCPCS Codes for Medical care

• C9304

  Injection, marstacimab-hncq, 0.5 mg

• C9305

  Injection, nipocalimab-aahu, 3 mg

• C9306

  Injection, telisotuzumab vedotin-tllv, 1 mg

• C9307

  Injection, linvoseltamab-gcpt, 1 mg

• C9308

  Injection, carboplatin (avyxa), 1 mg

• C9309

  Injection, onasemnogene abeparvovec-brve, per treatment

• C9399

  Unclassified drugs or biologicals

• C9460

  Injection, cangrelor, 1 mg

• C9738

  Adjunctive blue light cystoscopy with fluorescent imaging agent (list separately in addition to code for primary procedure)

• C9757

  Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and excision of herniated intervertebral disc, and repair of annular defect with implantation of bone anchored annular closure device, including annular defect measurement, alignment and sizing assessment, and image guidance; 1 interspace, lumbar

• C9800

  Dermal injection procedure(s) for facial lipodystrophy syndrome (lds) and provision of radiesse or sculptra dermal filler, including all items and supplies

• C9898

  Radiolabeled product provided during a hospital inpatient stay

• C9899

  Implanted prosthetic device, payable only for inpatients who do not have inpatient coverage

• G0011

  Individual counseling for pre-exposure prophylaxis (prep) by physician or qualified health care professional (qhp) to prevent human immunodeficiency virus (hiv), includes hiv risk assessment (initial or continued assessment of risk), hiv risk reduction and medication adherence, 15-30 minutes

• G0012

  Injection of pre-exposure prophylaxis (prep) drug for hiv prevention, under skin or into muscle

• G0013

  Individual counseling for pre-exposure prophylaxis (prep) by clinical staff to prevent human immunodeficiency virus (hiv), includes: hiv risk assessment (initial or continued assessment of risk), hiv risk reduction and medication adherence

• G0017

  Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); first 60 minutes

• G0018

  Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); each additional 30 minutes (list separately in addition to code for primary service)

• G0019

  Community health integration services performed by certified or trained auxiliary personnel, including a community health worker, under the direction of a physician or other practitioner; 60 minutes per calendar month, in the following activities to address social determinants of health (sdoh) need(s) that are significantly limiting the ability to diagnose or treat problem(s) addressed in an initiating visit: person-centered assessment, performed to better understand the individualized context of the intersection between the sdoh need(s) and the problem(s) addressed in the initiating visit. ++ conducting a person-centered assessment to understand patient's life story, strengths, needs, goals, preferences and desired outcomes, including understanding cultural and linguistic factors and including unmet sdoh needs (that are not separately billed). ++ facilitating patient-driven goal-setting and establishing an action plan. ++ providing tailored support to the patient as needed to accomplish the practitioner's treatment plan. practitioner, home-, and community-based care coordination. ++ coordinating receipt of needed services from healthcare practitioners, providers, and facilities; and from home- and community-based service providers, social service providers, and caregiver (if applicable). ++ communication with practitioners, home- and community-based service providers, hospitals, and skilled nursing facilities (or other health care facilities) regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors. ++ coordination of care transitions between and among health care practitioners and settings, including transitions involving referral to other clinicians; follow-up after an emergency department visit; or follow-up after discharges from hospitals, skilled nursing facilities or other health care facilities. ++ facilitating access to community-based social services (e.g., housing, utilities, transportation, food assistance) to address the sdoh need(s). health education- helping the patient contextualize health education provided by the patient's treatment team with the patient's individual needs, goals, and preferences, in the context of the sdoh need(s), and educating the patient on how to best participate in medical decision-making. building patient self-advocacy skills, so that the patient can interact with members of the health care team and related community-based services addressing the sdoh need(s), in ways that are more likely to promote personalized and effective diagnosis or treatment. health care access / health system navigation. ++ helping the patient access healthcare, including identifying appropriate practitioners or providers for clinical care and helping secure appointments with them. facilitating behavioral change as necessary for meeting diagnosis and treatment goals, including promoting patient motivation to participate in care and reach person-centered diagnosis or treatment goals. facilitating and providing social and emotional support to help the patient cope with the problem(s) addressed in the initiating visit, the sdoh need(s), and adjust daily routines to better meet diagnosis and treatment goals. leveraging lived experience when applicable to provide support, mentorship, or inspiration to meet treatment goals

• G0022

  Community health integration services, each additional 30 minutes per calendar month (list separately in addition to g0019)

• G0023

  Principal illness navigation services by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a patient navigator; 60 minutes per calendar month, in the following activities: person-centered assessment, performed to better understand the individual context of the serious, high-risk condition. ++ conducting a person-centered assessment to understand the patient's life story, strengths, needs, goals, preferences, and desired outcomes, including understanding cultural and linguistic factors and including unmet sdoh needs (that are not separately billed). ++ facilitating patient-driven goal setting and establishing an action plan. ++ providing tailored support as needed to accomplish the practitioner's treatment plan. identifying or referring patient (and caregiver or family, if applicable) to appropriate supportive services. practitioner, home, and community-based care coordination. ++ coordinating receipt of needed services from healthcare practitioners, providers, and facilities; home- and community-based service providers; and caregiver (if applicable). ++ communication with practitioners, home-, and community-based service providers, hospitals, and skilled nursing facilities (or other health care facilities) regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors. ++ coordination of care transitions between and among health care practitioners and settings, including transitions involving referral to other clinicians; follow-up after an emergency department visit; or follow-up after discharges from hospitals, skilled nursing facilities or other health care facilities. ++ facilitating access to community-based social services (e.g., housing, utilities, transportation, food assistance) as needed to address sdoh need(s). health education- helping the patient contextualize health education provided by the patient's treatment team with the patient's individual needs, goals, preferences, and sdoh need(s), and educating the patient (and caregiver if applicable) on how to best participate in medical decision-making. building patient self-advocacy skills, so that the patient can interact with members of the health care team and related community-based services (as needed), in ways that are more likely to promote personalized and effective treatment of their condition. health care access / health system navigation. ++ helping the patient access healthcare, including identifying appropriate practitioners or providers for clinical care, and helping secure appointments with them. ++ providing the patient with information/resources to consider participation in clinical trials or clinical research as applicable. facilitating behavioral change as necessary for meeting diagnosis and treatment goals, including promoting patient motivation to participate in care and reach person-centered diagnosis or treatment goals. facilitating and providing social and emotional support to help the patient cope with the condition, sdoh need(s), and adjust daily routines to better meet diagnosis and treatment goals. leverage knowledge of the serious, high-risk condition and/or lived experience when applicable to provide support, mentorship, or inspiration to meet treatment goals

• G0024

  Principal illness navigation services, additional 30 minutes per calendar month (list separately in addition to g0023)

• G0028

  Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)

• G0029

  Tobacco screening not performed or tobacco cessation intervention not provided during the measurement period or in the six months prior to the measurement period

• G0030

  Patient screened for tobacco use and received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling, pharmacotherapy, or both), if identified as a tobacco user

• G0031

  Palliative care services given to patient any time during the measurement period

• G0032

  Two or more antipsychotic prescriptions ordered for patients who had a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between january 1 of the year prior to the measurement period and the index prescription start date (ipsd) for antipsychotics

• G0033

  Two or more benzodiazepine prescriptions ordered for patients who had a diagnosis of seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, or severe generalized anxiety disorder on or between january 1 of the year prior to the measurement period and the ipsd for benzodiazepines

• G0034

  Patients receiving palliative care during the measurement period

• G0035

  Patient has any emergency department encounter during the performance period with place of service indicator 23

• G0036

  Patient or care partner decline assessment

• G0037

  On date of encounter, patient is not able to participate in assessment or screening, including non-verbal patients, delirious, severely aphasic, severely developmentally delayed, severe visual or hearing impairment and for those patients, no knowledgeable informant available

• G0038

  Clinician determines patient does not require referral

• G0039

  Patient not referred, reason not otherwise specified

• G0040

  Patient already receiving physical/occupational/speech/recreational therapy during the measurement period

• G0041

  Patient and/or care partner decline referral

• G0042

  Referral to physical, occupational, speech, or recreational therapy

• G0043

  Patients with mechanical prosthetic heart valve

• G0044

  Patients with moderate or severe mitral stenosis

• G0045

  Clinical follow-up and mrs score assessed at 90 days following endovascular stroke intervention

• G0046

  Clinical follow-up and mrs score not assessed at 90 days following endovascular stroke intervention

• G0047

  Pediatric patient with minor blunt head trauma and pecarn prediction criteria are not assessed

• G0048

  Patients who receive palliative care services any time during the intake period through the end of the measurement year

• G0049

  With maintenance hemodialysis (in-center and home hd) for the complete reporting month

• G0050

  Patients with a catheter that have limited life expectancy

• G0051

  Patients under hospice care in the current reporting month

• G0052

  Patients on peritoneal dialysis for any portion of the reporting month

• G0053

  Advancing rheumatology patient care mips value pathways

• G0054

  Coordinating stroke care to promote prevention and cultivate positive outcomes mips value pathways

• G0055

  Advancing care for heart disease mips value pathways