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

  • G9980

    Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a detailed history; a detailed examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate severity. typically, 30 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology

  • G9981

    Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 45 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology

  • G9982

    Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 60 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology

  • G9983

    Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology

  • G9984

    Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 15 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology

  • G9985

    Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 25 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology

  • G9986

    Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 40 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology

  • G9987

    Bundled payments for care improvement advanced (bpci advanced) model home visit for patient assessment performed by clinical staff for an individual not considered homebound, including, but not necessarily limited to patient assessment of clinical status, safety/fall prevention, functional status/ambulation, medication reconciliation/management, compliance with orders/plan of care, performance of activities of daily living, and ensuring beneficiary connections to community and other services; for use only for a bpci advanced model episode of care; may not be billed for a 30-day period covered by a transitional care management code

  • G9988

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

  • G9989

    Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., adverse reaction to vaccine)

  • G9990

    Patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period

  • G9991

    Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period

  • G9992

    Palliative care services used by patient any time during the measurement period

  • G9993

    Patient was provided palliative care services any time during the measurement period

  • G9994

    Patient is using palliative care services any time during the measurement period

  • G9995

    Patients who use palliative care services any time during the measurement period

  • G9996

    Documentation stating the patient has received or is currently receiving palliative or hospice care

  • G9997

    Documentation of patient pregnancy anytime during the measurement period prior to and including the current encounter

  • G9998

    Documentation of medical reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., last colonoscopy incomplete, last colonoscopy had inadequate prep, piecemeal removal of adenomas, or sessile serrated polyps >= 20 mm in size, last colonoscopy found greater than 10 adenomas, lower gastrointestinal bleeding, or patient at high risk for colon cancer due to underlying medical history ([i.e. crohn's disease, ulcerative colitis, personal or family history of colon cancer, hereditary colorectal cancer syndromes])

  • G9999

    Documentation of system reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., unable to locate previous colonoscopy report, patient cannot provide precise date or details from previous colonoscopy, previous colonoscopy report was incomplete)

  • J0013

    Esketamine, nasal spray, 1 mg

  • J0120

    Injection, tetracycline, up to 250 mg

  • J0121

    Injection, omadacycline, 1 mg

  • J0122

    Injection, eravacycline, 1 mg

  • J0129

    Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)

  • J0130

    Injection abciximab, 10 mg

  • J0131

    Injection, acetaminophen, not otherwise specified,10 mg

  • J0132

    Injection, acetylcysteine, 100 mg

  • J0133

    Injection, acyclovir, 5 mg

  • J0134

    Injection, acetaminophen (fresenius kabi), not therapeutically equivalent to j0131, 10 mg

  • J0135

    Injection, adalimumab, 20 mg

  • J0136

    Injection, acetaminophen (b braun), not therapeutically equivalent to j0131, 10 mg

  • J0137

    Injection, acetaminophen (hikma), not therapeutically equivalent to j0131, 10 mg

  • J0138

    Injection, acetaminophen 10 mg and ibuprofen 3 mg

  • J0139

    Injection, adalimumab, 1 mg

  • J0150

    Injection, adenosine for therapeutic use, 6 mg (not to be used to report any adenosine phosphate compounds, instead use a9270)

  • J0151

    Injection, adenosine for diagnostic use, 1 mg (not to be used to report any adenosine phosphate compounds, instead use a9270)

  • J0153

    Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)

  • J0162

    Injection, epinephrine (fresenius), not therapeutically equivalent to j0165, 0.1 mg

  • J0163

    Injection, epinephrine in sodium chloride (endo), 0.1 mg

  • J0164

    Injection, epinephrine in sodium chloride (baxter), 0.1 mg

  • J0165

    Injection, epinephrine, not otherwise specified, 0.1 mg

  • J0166

    Injection, epinephrine (bpi), not therapeutically equivalent to j0165, 0.1 mg

  • J0167

    Injection, epinephrine (hospira), not therapeutically equivalent to j0165, 0.1 mg

  • J0168

    Injection, epinephrine (international medication systems), not therapeutically equivalent to j0165, 0.1 mg

  • J0169

    Injection, epinephrine (adrenalin), not therapeutically equivalent to j0165, 0.1 mg

  • J0171

    Injection, adrenalin, epinephrine, 0.1 mg

  • J0172

    Injection, aducanumab-avwa, 2 mg

  • J0173

    Injection, epinephrine (belcher), not therapeutically equivalent to j0171, 0.1 mg

  • J0174

    Lecanemab-irmb, for intravenous injection, 1 mg