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HCPCS Level II

HCPCS Level II 2021 code changes

Every HCPCS Level II code whose CMS add date or termination date falls in 2021, grouped by effective date. Each code's own page carries its full record.

177
Added
204
Deleted

For HCPCS Level II, MedCoder records each code's CMS add date and termination date from the alpha-numeric file. A deletion is listed on the first day the code is no longer valid (the day after its CMS termination date). Description revisions between quarterly files are not recorded as changes.

Added effective January 1, 2021 (83)

  • A9591 — Fluoroestradiol f 18, diagnostic, 1 millicurie
  • C1052 — Hemostatic agent, gastrointestinal, topical
  • C1062 — Intravertebral body fracture augmentation with implant (e.g., metal, polymer)
  • C1825 — Generator, neurostimulator (implantable), non-rechargeable with carotid sinus baroreceptor stimulation lead(s)
  • C9068 — Copper cu-64, dotatate, diagnostic, 1 millicurie
  • C9069 — Injection, belantamab mafodontin-blmf, 0.5 mg
  • C9070 — Injection, tafasitamab-cxix, 2 mg
  • C9071 — Injection, viltolarsen, 10 mg
  • C9072 — Injection, immune globulin (asceniv), 500 mg
  • C9073 — Brexucabtagene autoleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
  • C9770 — Vitrectomy, mechanical, pars plana approach, with subretinal injection of pharmacologic/biologic agent
  • C9771 — Nasal/sinus endoscopy, cryoablation nasal tissue(s) and/or nerve(s), unilateral or bilateral
  • C9772 — Revascularization, endovascular, open or percutaneous, tibial/peroneal artery(ies), with intravascular lithotripsy, includes angioplasty within the same vessel (s), when performed
  • C9773 — Revascularization, endovascular, open or percutaneous, tibial/peroneal artery(ies); with intravascular lithotripsy, and transluminal stent placement(s), includes angioplasty within the same vessel(s), when performed
  • C9774 — Revascularization, endovascular, open or percutaneous, tibial/peroneal artery(ies); with intravascular lithotripsy and atherectomy, includes angioplasty within the same vessel (s), when performed
  • C9775 — Revascularization, endovascular, open or percutaneous, tibial/peroneal artery(ies); with intravascular lithotripsy and transluminal stent placement(s), and atherectomy, includes angioplasty within the same vessel (s), when performed
  • G0088 — Professional services, initial visit, for the administration of anti-infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy or other highly complex drug or biological) for each infusion drug administration calendar day in the individual's home, each 15 minutes
  • G0089 — Professional services, initial visit, for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes
  • G0090 — Professional services, initial visit, for the administration of intravenous chemotherapy or other highly complex infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes
  • G2173 — 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 episodes where the patient is taking antibiotics (table 1) in the 30 days prior to the episode date
  • G2175 — 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 — Outpatient, ed, or observation visits that result in an inpatient admission
  • G2177 — 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 — 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 — Clinician documented that patient had medical reason for not performing lower extremity neurological exam
  • G2180 — Clinician documented that patient was not an eligible candidate for evaluation of footwear as patient is bilateral lower extremity amputee
  • G2181 — Bmi not documented due to medical reason or patient refusal of height or weight measurement
  • G2182 — Patient receiving first-time biologic and/or immune response modifier therapy
  • G2183 — Documentation patient unable to communicate and informant not available
  • G2184 — Patient does not have a caregiver
  • G2185 — Documentation caregiver is trained and certified in dementia care
  • G2186 — Patient /caregiver dyad has been referred to appropriate resources and connection to those resources is confirmed
  • G2187 — Patients with clinical indications for imaging of the head: head trauma
  • G2188 — Patients with clinical indications for imaging of the head: new or change in headache above 50 years of age
  • G2189 — Patients with clinical indications for imaging of the head: abnormal neurologic exam
  • G2190 — Patients with clinical indications for imaging of the head: headache radiating to the neck
  • G2191 — Patients with clinical indications for imaging of the head: positional headaches
  • G2192 — Patients with clinical indications for imaging of the head: temporal headaches in patients over 55 years of age
  • G2193 — Patients with clinical indications for imaging of the head: new onset headache in pre-school children or younger (<6 years of age)
  • G2194 — 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 — Patients with clinical indications for imaging of the head: occipital headache in children
  • G2196 — Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method
  • G2197 — Patient screened for unhealthy alcohol use using a systematic screening method and not identified as an unhealthy alcohol user
  • G2198 — 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 — Patient not screened for unhealthy alcohol use using a systematic screening method
  • G2200 — Patient identified as an unhealthy alcohol user received brief counseling
  • G2201 — Documentation of medical reason(s) for not providing brief counseling (e.g., limited life expectancy, other medical reasons)
  • G2202 — Patient did not receive brief counseling if identified as an unhealthy alcohol user
  • G2203 — 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 — Patients between 45 and 85 years of age who received a screening colonoscopy during the performance period
  • G2205 — Patients with pregnancy during adjuvant treatment course
  • G2206 — Patient received adjuvant treatment course including both chemotherapy and her2-targeted therapy
  • G2207 — 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 — Patient did not receive adjuvant treatment course including both chemotherapy and her2-targeted therapy
  • G2209 — Patient refused to participate
  • G2210 — 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 — 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 home or residence or office/outpatient evaluation and management service, new or established)
  • G2212 — 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 — 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 — 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 — 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 — 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 — 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 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 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
  • J0693 — Injection, cefiderocol, 5 mg
  • J1823 — Injection, inebilizumab-cdon, 1 mg
  • J7212 — Factor viia (antihemophilic factor, recombinant)-jncw (sevenfact), 1 microgram
  • J7352 — Afamelanotide implant, 1 mg
  • J9144 — Injection, daratumumab, 10 mg and hyaluronidase-fihj
  • J9223 — Injection, lurbinectedin, 0.1 mg
  • J9281 — Mitomycin pyelocalyceal instillation, 1 mg
  • J9316 — Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg
  • J9317 — Injection, sacituzumab govitecan-hziy, 2.5 mg
  • M1145 — Most favored nation (mfn) model drug add-on amount, per dose, (do not bill with line items that have the jw modifier)
  • M1146 — Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record
  • M1147 — Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery
  • M1148 — Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown)
  • M1149 — Patient unable to complete the neck fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility, and an adequate proxy is not available
  • Q5122 — Injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mg
  • S0013 — Esketamine, nasal spray, 1 mg
  • U0005 — Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2

Deleted effective January 1, 2021 (177)

  • C9060 — Fluoroestradiol f18, diagnostic, 1 mci
  • C9062 — Injection, daratumumab 10 mg and hyaluronidase-fihj
  • C9064 — Mitomycin pyelocalyceal instillation, 1 mg
  • C9066 — Injection, sacituzumab govitecan-hziy, 2.5 mg
  • C9745 — Nasal endoscopy, surgical; balloon dilation of eustachian tube
  • C9747 — Ablation of prostate, transrectal, high intensity focused ultrasound (hifu), including imaging guidance
  • C9749 — Repair of nasal vestibular lateral wall stenosis with implant(s)
  • G0297 — Low dose ct scan (ldct) for lung cancer screening
  • G1005 — Clinical decision support mechanism national imaging associates, as defined by the medicare appropriate use criteria program
  • G1006 — Clinical decision support mechanism test appropriate, as defined by the medicare appropriate use criteria program
  • G2058 — 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 — 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 — 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 — 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
  • G2089 — Most recent hemoglobin a1c (hba1c) level 7.0 to 9.0%
  • G2102 — Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed
  • G2103 — Seven standard field stereoscopic photos with interpretation by an ophthalmologist or optometrist documented and reviewed
  • G2104 — Eye imaging validated to match diagnosis from seven standard field stereoscopic photos results documented and reviewed
  • G2114 — 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
  • G2117 — 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
  • G2119 — Within the past 2 years, calcium and/or vitamin d optimization has been ordered or performed
  • G2120 — Within the past 2 years, calcium and/or vitamin d optimization has not been ordered or performed
  • G2123 — 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 — Patients 66-80 years of age and had at least one claim/encounter for frailty during the measurement period and a dispensed dementia medication
  • G2130 — 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 — Patients 81 years and older with a diagnosis of frailty
  • G2132 — 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 — 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 — 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 — 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
  • G2153 — In hospice or using hospice services during the measurement period
  • G2154 — 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 — 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 — 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 — 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 — Patient had prior pneumococcal vaccine adverse reaction any time during or before the measurement period
  • G2159 — 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 — 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 — Patient had prior adverse reaction caused by zoster vaccine or its components any time during or before the measurement period
  • G2162 — 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 — 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 — Patient had a prior influenza virus vaccine adverse reaction any time before or during the measurement period
  • G2165 — 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 — 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
  • G8398 — Dilated macular or fundus exam not performed
  • G8442 — Pain assessment not documented as being performed, documentation the patient is not eligible for a pain assessment using a standardized tool at the time of the encounter
  • G8509 — Pain assessment documented as positive using a standardized tool, follow-up plan not documented, reason not given
  • G8571 — Development of deep sternal wound infection/mediastinitis within 30 days postoperatively
  • G8572 — No deep sternal wound infection/mediastinitis
  • G8573 — Stroke following isolated cabg surgery
  • G8574 — No stroke following isolated cabg surgery
  • G8627 — 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)
  • G8628 — 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)
  • G8671 — 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)
  • G8672 — 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)
  • G8674 — Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs or other general orthopedic impairment not measured because the patient did not complete the general orthopedic fs prom at initial evaluation and/or near discharge, reason not given
  • G8730 — Pain assessment documented as positive using a standardized tool and a follow-up plan is documented
  • G8731 — Pain assessment using a standardized tool is documented as negative, no follow-up plan required
  • G8732 — No documentation of pain assessment, reason not given
  • G8809 — Rh-immunoglobulin (rhogam) ordered
  • G8810 — Rh-immunoglobulin (rhogam) not ordered for reasons documented by clinician (e.g., patient had prior documented receipt of rhogam within 12 weeks, patient refusal)
  • G8811 — Documentation rh-immunoglobulin (rhogam) was not ordered, reason not given
  • 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
  • G8939 — Pain assessment documented as positive, follow-up plan not documented, documentation the patient is not eligible at the time of the encounter
  • G8959 — Clinician treating major depressive disorder communicates to clinician treating comorbid condition
  • G8960 — Clinician treating major depressive disorder did not communicate to clinician treating comorbid condition, reason not given
  • G8973 — Most recent hemoglobin (hgb) level < 10 g/dl
  • G8974 — Hemoglobin level measurement not documented, reason not given
  • G8975 — 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)
  • G8976 — Most recent hemoglobin (hgb) level >= 10 g/dl
  • G9232 — Clinician treating major depressive disorder did not communicate to clinician treating comorbid condition for specified patient reason (e.g., patient is unable to communicate the diagnosis of a comorbid condition; the patient is unwilling to communicate the diagnosis of a comorbid condition; or the patient is unaware of the comorbid condition, or any other specified patient reason)
  • G9239 — Documentation of reasons for patient initiating maintenance hemodialysis with a catheter as the mode of vascular access (e.g., patient has a maturing arteriovenous fistula (avf)/arteriovenous graft (avg), time-limited trial of hemodialysis, other medical reasons, patient declined avf/avg, other patient reasons, patient followed by reporting nephrologist for fewer than 90 days, other system reasons)
  • G9240 — Patient whose mode of vascular access is a catheter at the time maintenance hemodialysis is initiated
  • G9241 — Patient whose mode of vascular access is not a catheter at the time maintenance hemodialysis is initiated
  • G9256 — Documentation of patient death following cas
  • G9257 — Documentation of patient stroke following cas
  • G9258 — Documentation of patient stroke following cea
  • G9259 — Documentation of patient survival and absence of stroke following cas
  • G9260 — Documentation of patient death following cea
  • G9261 — Documentation of patient survival and absence of stroke following cea
  • G9262 — Documentation of patient death in the hospital following endovascular aaa repair
  • G9263 — Documentation of patient discharged alive following endovascular aaa repair
  • G9264 — Documentation of patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter for documented reasons (e.g., other medical reasons, patient declined arteriovenous fistula (avf)/arteriovenous graft (avg), other patient reasons)
  • G9265 — Patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter as the mode of vascular access
  • G9266 — Patient receiving maintenance hemodialysis for greater than or equal to 90 days without a catheter as the mode of vascular access
  • G9300 — 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)
  • G9301 — Patients who had the prophylactic antibiotic completely infused prior to the inflation of the proximal tourniquet
  • G9302 — Prophylactic antibiotic not completely infused prior to the inflation of the proximal tourniquet, reason not given
  • G9303 — 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
  • G9304 — 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
  • G9326 — Ct studies performed not reported to a radiation dose index registry that is capable of collecting at a minimum all necessary data elements, reason not given
  • G9327 — Ct studies performed reported to a radiation dose index registry that is capable of collecting at a minimum all necessary data elements
  • G9329 — 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
  • G9340 — 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
  • G9365 — One high-risk medication ordered
  • G9366 — One high-risk medication not ordered
  • G9389 — Unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery
  • G9390 — No unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery
  • G9469 — Patients who have received or are receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 90 or greater consecutive days or a single prescription equating to 900 mg prednisone or greater for all fills
  • G9503 — Patient taking tamsulosin hydrochloride
  • G9523 — Patient discontinued from hemodialysis or peritoneal dialysis
  • G9524 — Patient was referred to hospice care
  • G9525 — Documentation of patient reason(s) for not referring to hospice care (e.g., patient declined, other patient reasons)
  • G9526 — Patient was not referred to hospice care, reason not given
  • G9532 — Patient had a head ct for trauma ordered by someone other than an emergency care provider or was ordered for a reason other than trauma
  • G9558 — Patient treated with a beta-lactam antibiotic as definitive therapy
  • G9559 — Documentation of medical reason(s) for not prescribing a beta-lactam antibiotic (e.g., allergy, intolerance to beta-lactam antibiotics)
  • G9560 — Patient not treated with a beta-lactam antibiotic as definitive therapy, reason not given
  • G9573 — Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at six months as demonstrated by a six month (+/-60 days) phq-9 or phq-9m score of less than five
  • G9574 — Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at six months as demonstrated by a six month (+/-60 days) phq-9 or phq-9m score of less than five; either phq-9 or phq-9m score was not assessed or is greater than or equal to five
  • G9600 — Symptomatic aaas that required urgent/emergent (non-elective) repair
  • G9601 — Patient discharge to home no later than post-operative day #7
  • G9602 — Patient not discharged to home by post-operative day #7
  • G9615 — Preoperative assessment documented
  • G9616 — 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)
  • G9617 — Preoperative assessment not documented, reason not given
  • G9701 — Children who are taking antibiotics in the 30 days prior to the date of the encounter during which the diagnosis was established
  • G9738 — Patient refused to participate
  • G9739 — Patient unable to complete the general orthopedic fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
  • G9747 — Patient is undergoing palliative dialysis with a catheter
  • G9748 — Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant
  • G9749 — Patient is undergoing palliative dialysis with a catheter
  • G9750 — Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant
  • G9759 — History of preoperative posterior capsule rupture
  • G9798 — Discharge(s) for ami between july 1 of the year prior measurement period to june 30 of the measurement period
  • G9799 — Patients with a medication dispensing event indicator of a history of asthma any time during the patient's history through the end of the measure period
  • G9800 — Patients who are identified as having an intolerance or allergy to beta-blocker therapy
  • G9801 — Hospitalizations in which the patient was transferred directly to a non-acute care facility for any diagnosis
  • G9802 — Patients who use hospice services any time during the measurement period
  • G9803 — Patient prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami
  • G9804 — Patient was not prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami
  • G9814 — Death occurring during the index acute care hospitalization
  • G9815 — Death did not occur during the index acute care hospitalization
  • G9816 — Death occurring after discharge from the hospital but within 30 days post procedure
  • G9817 — Death did not occur after discharge from the hospital within 30 days post procedure
  • G9825 — Her-2/neu negative or undocumented/unknown
  • G9826 — Patient transferred to practice after initiation of chemotherapy
  • G9827 — Her2-targeted therapies not administered during the initial course of treatment
  • G9828 — Her2-targeted therapies administered during the initial course of treatment
  • G9829 — Breast adjuvant chemotherapy administered
  • G9833 — Patient transfer to practice after initiation of chemotherapy
  • G9834 — Patient has metastatic disease at diagnosis
  • G9835 — Trastuzumab administered within 12 months of diagnosis
  • G9836 — Reason for not administering trastuzumab documented (e.g. patient declined, patient died, patient transferred, contraindication or other clinical exclusion, neoadjuvant chemotherapy or radiation not complete)
  • G9837 — Trastuzumab not administered within 12 months of diagnosis
  • G9849 — Patients who died from cancer
  • G9850 — Patient had more than one emergency department visit in the last 30 days of life
  • G9851 — Patient had one or less emergency department visits in the last 30 days of life
  • G9855 — Patients who died from cancer
  • G9856 — Patient was not admitted to hospice
  • G9857 — Patient admitted to hospice
  • G9924 — Documentation of medical reason(s) for not providing safety concerns screen or for not providing recommendations, orders or referrals for positive screen (e.g., patient in palliative care, other medical reason)
  • G9933 — Adenoma(s) or colorectal cancer detected during screening colonoscopy
  • G9934 — Documentation that neoplasm detected is only diagnosed as traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma
  • G9935 — Adenoma(s) or colorectal cancer not detected during screening colonoscopy
  • G9936 — Surveillance colonoscopy - personal history of colonic polyps, colon cancer, or other malignant neoplasm of rectum, rectosigmoid junction, and anus
  • G9937 — Diagnostic colonoscopy
  • G9966 — Children who were screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report
  • G9967 — Children who were not screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report
  • M1015 — Discharge/discontinuation of the episode of care documented in the medical record
  • M1023 — Adolescent patients 12 to 17 years of age with major depression or dysthymia who reached remission at six months as demonstrated by a six month (+/-60 days) phq-9 or phq-9m score of less than five
  • M1024 — Adolescent patients 12 to 17 years of age with major depression or dysthymia who did not reach remission at six months as demonstrated by a six month (+/-60 days) phq-9 or phq-9m score of less than five. either phq-9 or phq-9m score was not assessed or is greater than or equal to five
  • M1033 — Pharmacotherapy for oud initiated after june 30th of performance period
  • M1061 — Patient pregnancy
  • M1062 — Patient immunocompromised
  • M1063 — Patients receiving high doses of immunosuppressive therapy
  • M1064 — Shingrix vaccine documented as administered or previously received
  • M1065 — Shingrix vaccine was not administered for reasons documented by clinician (e.g. patient administered vaccine other than shingrix, patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons)
  • M1066 — Shingrix vaccine not documented as administered, reason not given
  • M1136 — The start of an episode of care documented in the medical record
  • M1137 — 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
  • M1138 — Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only)
  • M1139 — Ongoing care not indicated, patient self-discharged early and seen only 1-2 visits (e.g., financial or insurance reasons, transportation problems, or reason unknown)
  • M1140 — Ongoing care not indicated, patient discharged after only 1-2 visits due to specific medical events, documented in the medical record that make the treatment episode impossible such as the patient becomes hospitalized or scheduled for surgery for surgery or hospitalized
  • M1144 — Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only

Added effective February 9, 2021 (2)

  • M0245 — Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring
  • Q0245 — Injection, bamlanivimab and etesevimab, 2100 mg

Added effective April 1, 2021 (21)

  • A9592 — Copper cu-64, dotatate, diagnostic, 1 millicurie
  • C9074 — Injection, lumasiran, 0.5 mg
  • C9776 — Intraoperative near-infrared fluorescence imaging of major extra-hepatic bile duct(s) (e.g., cystic duct, common bile duct and common hepatic duct) with intravenous administration of indocyanine green (icg) (list separately in addition to code for primary procedure)
  • C9777 — Esophageal mucosal integrity testing by electrical impedance, transoral, includes esophagoscopy or esophagogastroduodenoscopy
  • G2020 — 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)
  • G2172 — All inclusive payment for services related to highly coordinated and integrated opioid use disorder (oud) treatment services furnished for the demonstration project
  • J1427 — Injection, viltolarsen, 10 mg
  • J1554 — Injection, immune globulin (asceniv), 500 mg
  • J7402 — Mometasone furoate sinus implant, (sinuva), 10 micrograms
  • J9037 — Injection, belantamab mafodotin-blmf, 0.5 mg
  • J9349 — Injection, tafasitamab-cxix, 2 mg
  • K1013 — Enema tube, with or without adapter, any type, replacement only, each
  • K1014 — Addition, endoskeletal knee-shin system, 4 bar linkage or multiaxial, fluid swing and stance phase control
  • K1015 — Foot, adductus positioning device, adjustable
  • K1016 — Transcutaneous electrical nerve stimulator for electrical stimulation of the trigeminal nerve
  • K1017 — Monthly supplies for use of device coded at k1016
  • K1018 — External upper limb tremor stimulator of the peripheral nerves of the wrist
  • K1019 — Supplies and accessories for external upper limb tremor stimulator of the peripheral nerves of the wrist
  • K1020 — Non-invasive vagus nerve stimulator
  • Q2053 — Brexucabtagene autoleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
  • S1091 — Stent, non-coronary, temporary, with delivery system (propel)

Deleted effective April 1, 2021 (12)

  • C9068 — Copper cu-64, dotatate, diagnostic, 1 millicurie
  • C9069 — Injection, belantamab mafodontin-blmf, 0.5 mg
  • C9070 — Injection, tafasitamab-cxix, 2 mg
  • C9071 — Injection, viltolarsen, 10 mg
  • C9072 — Injection, immune globulin (asceniv), 500 mg
  • C9073 — Brexucabtagene autoleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
  • C9122 — Mometasone furoate sinus implant, 10 micrograms (sinuva)
  • J7333 — Hyaluronan or derivative, visco-3, for intra-articular injection, per dose
  • J7401 — Mometasone furoate sinus implant, 10 micrograms
  • K1010 — Indwelling intraurethral drainage device with valve, patient inserted, replacement only, each
  • K1011 — Activation device for intraurethral drainage device with valve, replacement only, each
  • K1012 — Charger and base station for intraurethral activation device, replacement only

Added effective April 13, 2021 (1)

  • G0465 — Autologous platelet rich plasma (prp) or other blood-derived product for diabetic chronic wounds/ulcers, using an fda-cleared device for this indication, (includes as applicable administration, dressings, phlebotomy, centrifugation or mixing, and all other preparatory procedures, per treatment)

Deleted effective April 17, 2021 (2)

  • M0239 — Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring
  • Q0239 — Injection, bamlanivimab-xxxx, 700 mg

Added effective May 6, 2021 (2)

  • M0244 — Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency
  • M0246 — Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider based to the hospital during the covid 19 public health emergency

Added effective May 26, 2021 (3)

  • M0247 — Intravenous infusion, sotrovimab, includes infusion and post administration monitoring
  • M0248 — Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency
  • Q0247 — Injection, sotrovimab, 500 mg

Added effective June 3, 2021 (1)

  • Q0244 — Injection, casirivimab and imdevimab, 1200 mg

Added effective June 8, 2021 (1)

  • M0201 — Administration of pneumococcal, influenza, hepatitis b, and/or covid-19 vaccine inside a patient's home; reported only once per individual home per date of service when such vaccine administration(s) are performed at the patient's home

Added effective June 24, 2021 (3)

  • M0249 — Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, first dose
  • M0250 — Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, second dose
  • Q0249 — Injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, 1 mg

Added effective July 1, 2021 (17)

  • A9593 — Gallium ga-68 psma-11, diagnostic, (ucsf), 1 millicurie
  • A9594 — Gallium ga-68 psma-11, diagnostic, (ucla), 1 millicurie
  • C1761 — Catheter, transluminal intravascular lithotripsy, coronary
  • C9075 — Injection, casimersen, 10 mg
  • C9076 — Lisocabtagene maraleucel, up to 110 million autologous anti-cd19 car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
  • C9077 — Injection, cabotegravir and rilpivirine, 2mg/3mg
  • C9078 — Injection, trilaciclib, 1 mg
  • C9079 — Injection, evinacumab-dgnb, 5 mg
  • C9080 — Injection, melphalan flufenamide hydrochloride, 1 mg
  • C9778 — Colpopexy, vaginal; minimally invasive extra-peritoneal approach (sacrospinous)
  • G0327 — Colorectal cancer screening; blood-based biomarker
  • J0224 — Injection, lumasiran, 0.5 mg
  • J1951 — Injection, leuprolide acetate for depot suspension (fensolvi), 0.25 mg
  • J7168 — Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity
  • J9348 — Injection, naxitamab-gqgk, 1 mg
  • J9353 — Injection, margetuximab-cmkb, 5 mg
  • Q5123 — Injection, rituximab-arrx, biosimilar, (riabni), 10 mg

Deleted effective July 1, 2021 (2)

  • C9074 — Injection, lumasiran, 0.5 mg
  • C9132 — Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity

Added effective July 30, 2021 (3)

  • M0240 — Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses
  • M0241 — Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency, subsequent repeat doses
  • Q0240 — Injection, casirivimab and imdevimab, 600 mg

Added effective October 1, 2021 (35)

  • A4453 — Rectal catheter with or without balloon, for use with any type transanal irrigation system, each
  • C1831 — Interbody cage, anterior, lateral or posterior, personalized (implantable)
  • C9081 — Idecabtagene vicleucel, up to 460 million autologous anti-bcma car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
  • C9082 — Injection, dostarlimab-gxly, 100 mg
  • C9083 — Injection, amivantamab-vmjw, 10 mg
  • C9084 — Injection, loncastuximab tesirine-lpyl, 0.1 mg
  • C9779 — Endoscopic submucosal dissection (esd), including endoscopy or colonoscopy, mucosal closure, when performed
  • C9780 — Insertion of central venous catheter through central venous occlusion via inferior and superior approaches (e.g., inside-out technique), including imaging guidance
  • J0699 — Injection, cefiderocol, 10 mg
  • J0741 — Injection, cabotegravir and rilpivirine, 2mg/3mg
  • J1305 — Injection, evinacumab-dgnb, 5mg
  • J1426 — Injection, casimersen, 10 mg
  • J1445 — Injection, ferric pyrophosphate citrate solution (triferic avnu), 0.1 mg of iron
  • J1448 — Injection, trilaciclib, 1mg
  • J2406 — Injection, oritavancin (kimyrsa), 10 mg
  • J7294 — Segesterone acetate and ethinyl estradiol 0.15mg, 0.013mg per 24 hours; yearly vaginal system, each
  • J7295 — Ethinyl estradiol and etonogestrel 0.015mg, 0.12mg per 24 hours; monthly vaginal ring, each
  • J9247 — Injection, melphalan flufenamide, 1mg
  • J9318 — Injection, romidepsin, non-lyophilized, 0.1 mg
  • J9319 — Injection, romidepsin, lyophilized, 0.1 mg
  • K1021 — Exsufflation belt, includes all supplies and accessories
  • K1022 — Addition to lower extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type
  • K1023 — Distal transcutaneous electrical nerve stimulator, stimulates peripheral nerves of the upper arm
  • K1024 — Non-pneumatic compression controller with sequential calibrated gradient pressure
  • K1025 — Non-pneumatic sequential compression garment, full arm
  • K1026 — Mechanical allergen particle barrier/inhalation filter, cream, nasal, topical
  • K1027 — Oral device/appliance used to reduce upper airway collapsibility, without fixed mechanical hinge, custom fabricated, includes fitting and adjustment
  • P9025 — Plasma, cryoprecipitate reduced, pathogen reduced, each unit
  • P9026 — Cryoprecipitated fibrinogen complex, pathogen reduced, each unit
  • Q2054 — Lisocabtagene maraleucel, up to 110 million autologous anti-cd19 car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
  • Q4251 — Vim, per square centimeter (add-on, list separately in addition to primary procedure)
  • Q4252 — Vendaje, per square centimeter (add-on, list separately in addition to primary procedure)
  • Q4253 — Zenith amniotic membrane, per square centimeter (add-on, list separately in addition to primary procedure)
  • Q9004 — Department of veterans affairs whole health partner services
  • S9432 — Medical foods for non-inborn errors of metabolism

Deleted effective October 1, 2021 (11)

  • C9065 — Injection, romidepsin, non-lyophilized (e.g. liquid), 1mg
  • C9075 — Injection, casimersen, 10 mg
  • C9076 — Lisocabtagene maraleucel, up to 110 million autologous anti-cd19 car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
  • C9077 — Injection, cabotegravir and rilpivirine, 2mg/3mg
  • C9078 — Injection, trilaciclib, 1 mg
  • C9079 — Injection, evinacumab-dgnb, 5 mg
  • C9080 — Injection, melphalan flufenamide hydrochloride, 1 mg
  • J0693 — Injection, cefiderocol, 5 mg
  • J7303 — Contraceptive supply, hormone containing vaginal ring, each
  • J9315 — Injection, romidepsin, 1 mg
  • Q4228 — Bionextpatch, per square centimeter

Added effective December 8, 2021 (3)

  • M0220 — Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring
  • M0221 — Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency
  • Q0220 — Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 300 mg

Added effective December 23, 2021 (1)

  • J0248 — Injection, remdesivir, 1 mg

Added effective December 28, 2021 (1)

  • C9507 — Plasma, high titer covid-19 convalescent, each unit

Source: CMS HCPCS Level II alpha-numeric file (add and termination dates).

Source data

Source organization
CMS
Source release
HCPCS Level II October 2026 alpha-numeric file
Source file
october-2026-alpha-numeric-hcpcs-file.zip
File checksum (SHA-256)
c25240c63108756d4ba6c0ea785c517117d83bfed9526c51da8acf123de1feb6
Data read date
Data not available in the current MedCoder release record.
Effective date
CMS effective dates within 2021
Release type
Quarterly (January, April, July, October), with occasional mid-quarter additions
Methodology
Each code's add date and termination date are read from the alpha-numeric file. A deletion is dated the first day the code is no longer valid, the day after its termination date. Description revisions are not recorded as changes.

These changes are based on recorded release data. MedCoder does not generate coding changes with AI.

All releases in the Change Ledger