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HCPCS Level II

HCPCS Level II 2023 code changes

Every HCPCS Level II code whose CMS add date or termination date falls in 2023, grouped by effective date. Each code's own page carries its full record.

338
Added
70
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 A deletion is listed on the first day the code is no longer valid (the day after its CMS termination date).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, 2023 (184)

  • A4239 — Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service
  • C1747 — Endoscope, single-use (i.e. disposable), urinary tract, imaging/illumination device (insertable)
  • C1826 — Generator, neurostimulator (implantable), includes closed feedback loop leads and all implantable components, with rechargeable battery and charging system
  • C1827 — Generator, neurostimulator (implantable), non-rechargeable, with implantable stimulation lead and external paired stimulation controller
  • C7500 — Debridement, bone including epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed, first 20 sq cm or less with manual preparation and insertion of deep (e.g., subfacial) drug-delivery device(s)
  • C7501 — Percutaneous breast biopsies using stereotactic guidance, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, all lesions unilateral and bilateral (for single lesion biopsy, use appropriate code)
  • C7502 — Percutaneous breast biopsies using magnetic resonance guidance, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, all lesions unilateral or bilateral (for single lesion biopsy, use appropriate code)
  • C7503 — Open biopsy or excision of deep cervical node(s) with intraoperative identification (e.g., mapping) of sentinel lymph node(s) including injection of non-radioactive dye when performed
  • C7504 — Percutaneous vertebroplasties (bone biopsies included when performed), first cervicothoracic and any additional cervicothoracic or lumbosacral vertebral bodies, unilateral or bilateral injection, inclusive of all imaging guidance
  • C7505 — Percutaneous vertebroplasties (bone biopsies included when performed), first lumbosacral and any additional cervicothoracic or lumbosacral vertebral bodies, unilateral or bilateral injection, inclusive of all imaging guidance
  • C7506 — Arthrodesis, interphalangeal joints, with or without internal fixation
  • C7507 — Percutaneous vertebral augmentations, first thoracic and any additional thoracic or lumbar vertebral bodies, including cavity creations (fracture reductions and bone biopsies included when performed) using mechanical device (e.g., kyphoplasty), unilateral or bilateral cannulations, inclusive of all imaging guidance
  • C7508 — Percutaneous vertebral augmentations, first lumbar and any additional thoracic or lumbar vertebral bodies, including cavity creations (fracture reductions and bone biopsies included when performed) using mechanical device (e.g., kyphoplasty), unilateral or bilateral cannulations, inclusive of all imaging guidance
  • C7509 — Bronchoscopy, rigid or flexible, diagnostic with cell washing(s) when performed, with computer-assisted image-guided navigation, including fluoroscopic guidance when performed
  • C7510 — Bronchoscopy, rigid or flexible, with bronchial alveolar lavage(s), with computer-assisted image-guided navigation, including fluoroscopic guidance when performed
  • C7511 — Bronchoscopy, rigid or flexible, with single or multiple bronchial or endobronchial biopsy(ies), single or multiple sites, with computer-assisted image-guided navigation, including fluoroscopic guidance when performed
  • C7512 — Bronchoscopy, rigid or flexible, with single or multiple bronchial or endobronchial biopsy(ies), single or multiple sites, with transendoscopic endobronchial ultrasound (ebus) during bronchoscopic diagnostic or therapeutic intervention(s) for peripheral lesion(s), including fluoroscopic guidance when performed
  • C7513 — Dialysis circuit, introduction of needle(s) and/or catheter(s), with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, with transluminal balloon angioplasty of central dialysis segment, performed through dialysis circuit, including all required imaging, radiological supervision and interpretation, image documentation and report
  • C7514 — Dialysis circuit, introduction of needle(s) and/or catheter(s), with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, with all angioplasty in the central dialysis segment, and transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all required imaging, radiological supervision and interpretation, image documentation and report
  • C7515 — Dialysis circuit, introduction of needle(s) and/or catheter(s), with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, with dialysis circuit permanent endovascular embolization or occlusion of main circuit or any accessory veins, including all required imaging, radiological supervision and interpretation, image documentation and report
  • C7516 — Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report
  • C7517 — Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, with iliac and/or femoral artery angiography, non-selective, bilateral or ipsilateral to catheter insertion, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of the catheter in the distal aorta or ipsilateral femoral or iliac artery, injection of dye, production of permanent images, and radiologic supervision and interpretation
  • C7518 — Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging, supervision, interpretation and report
  • C7519 — Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress
  • C7520 — Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) includes intraprocedural injection(s) for bypass graft angiography with iliac and/or femoral artery angiography, non-selective, bilateral or ipsilateral to catheter insertion, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of the catheter in the distal aorta or ipsilateral femoral or iliac artery, injection of dye, production of permanent images, and radiologic supervision and interpretation
  • C7521 — Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography with right heart catheterization with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report
  • C7522 — Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation with right heart catheterization, with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress
  • C7523 — Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report
  • C7524 — Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress
  • C7525 — Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report
  • C7526 — Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress
  • C7527 — Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report
  • C7528 — Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress
  • C7529 — Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress
  • C7530 — Dialysis circuit, introduction of needle(s) and/or catheter(s), with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty and all angioplasty in the central dialysis segment, with transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all imaging, radiological supervision and interpretation, documentation and report
  • C7531 — Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(ies), unilateral, with transluminal angioplasty with intravascular ultrasound (initial noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation
  • C7532 — Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), initial artery, open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, with intravascular ultrasound (initial noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation
  • C7533 — Percutaneous transluminal coronary angioplasty, single major coronary artery or branch with transcatheter placement of radiation delivery device for subsequent coronary intravascular brachytherapy
  • C7534 — Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(ies), unilateral, with atherectomy, includes angioplasty within the same vessel, when performed with intravascular ultrasound (initial noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation
  • C7535 — Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(ies), unilateral, with transluminal stent placement(s), includes angioplasty within the same vessel, when performed, with intravascular ultrasound (initial noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation
  • C7537 — Insertion of new or replacement of permanent pacemaker with atrial transvenous electrode(s), with insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (e.g., for upgrade to dual chamber system)
  • C7538 — Insertion of new or replacement of permanent pacemaker with ventricular transvenous electrode(s), with insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (e.g., for upgrade to dual chamber system)
  • C7539 — Insertion of new or replacement of permanent pacemaker with atrial and ventricular transvenous electrode(s), with insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system)
  • C7540 — Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator, dual lead system, with insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system)
  • C7541 — Diagnostic endoscopic retrograde cholangiopancreatography (ercp), including collection of specimen(s) by brushing or washing, when performed, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s)
  • C7542 — Endoscopic retrograde cholangiopancreatography (ercp) with biopsy, single or multiple, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s)
  • C7543 — Endoscopic retrograde cholangiopancreatography (ercp) with sphincterotomy/papillotomy, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s)
  • C7544 — Endoscopic retrograde cholangiopancreatography (ercp) with removal of calculi/debris from biliary/pancreatic duct(s), with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s)
  • C7545 — Percutaneous exchange of biliary drainage catheter (eg, external, internal-external, or conversion of internal-external to external only), with removal of calculi/debris from biliary duct(s) and/or gallbladder, including destruction of calculi by any method (eg, mechanical, electrohydraulic, lithotripsy) when performed, including diagnostic cholangiography(ies) when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation
  • C7546 — Removal and replacement of externally accessible nephroureteral catheter (eg, external/internal stent) requiring fluoroscopic guidance, with ureteral stricture balloon dilation, including imaging guidance and all associated radiological supervision and interpretation
  • C7547 — Convert nephrostomy catheter to nephroureteral catheter, percutaneous via pre-existing nephrostomy tract, with ureteral stricture balloon dilation, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation
  • C7548 — Exchange nephrostomy catheter, percutaneous, with ureteral stricture balloon dilation, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation
  • C7549 — Change of ureterostomy tube or externally accessible ureteral stent via ileal conduit with ureteral stricture balloon dilation, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation
  • C7550 — Cystourethroscopy, with biopsy(ies) with adjunctive blue light cystoscopy with fluorescent imaging agent
  • C7551 — Excision of major peripheral nerve neuroma, except sciatic, with implantation of nerve end into bone or muscle
  • C7552 — Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography and right heart catheterization with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress, initial vessel
  • C7553 — Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography with pharmacologic agent administration (eg, inhaled nitric oxide, intravenous infusion of nitroprusside, dobutamine, milrinone, or other agent) including assessing hemodynamic measurements before, during, after and repeat pharmacologic agent administration, when performed
  • C7554 — Cystourethroscopy with adjunctive blue light cystoscopy with fluorescent imaging agent
  • C7555 — Thyroidectomy, total or complete with parathyroid autotransplantation
  • C7900 — Service for diagnosis, evaluation, or treatment of a mental health or substance use disorder, 15-29 minutes, provided remotely by hospital staff who are licensed to provide mental health services under applicable state law(s), when the patient is in their home, and there is no associated professional service
  • C7901 — Service for diagnosis, evaluation, or treatment of a mental health or substance use disorder, 30-60 minutes, provided remotely by hospital staff who are licensed to provided mental health services under applicable state law(s), when the patient is in their home, and there is no associated professional service
  • C7902 — Service for diagnosis, evaluation, or treatment of a mental health or substance use disorder, each additional 15 minutes, provided remotely by hospital staff who are licensed to provide mental health services under applicable state law(s), when the patient is in their home, and there is no associated professional service (list separately in addition to code for primary service)
  • C9143 — Cocaine hydrochloride nasal solution (numbrino), 1 mg
  • C9144 — Injection, bupivacaine (posimir), 1 mg
  • E2103 — Non-adjunctive, non-implanted continuous glucose monitor or receiver
  • G0316 — Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using 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 99223, 99233, and 99236 for hospital inpatient or observation care evaluation and management services). (do not report g0316 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99418, 99415, 99416). (do not report g0316 for any time unit less than 15 minutes)
  • G0317 — Prolonged nursing facility evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using 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 99306, 99310 for nursing facility evaluation and management services). (do not report g0317 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99418). (do not report g0317 for any time unit less than 15 minutes)
  • G0318 — Prolonged home or residence evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using 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 99345, 99350 for home or residence evaluation and management services). (do not report g0318 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99417). (do not report g0318 for any time unit less than 15 minutes)
  • G0320 — Home health services furnished using synchronous telemedicine rendered via a real-time two-way audio and video telecommunications system
  • G0321 — Home health services furnished using synchronous telemedicine rendered via telephone or other real-time interactive audio-only telecommunications system
  • G0322 — The collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency (i.e., remote patient monitoring)
  • G0323 — Care management services for behavioral health conditions, at least 20 minutes of clinical psychologist, clinical social worker, mental health counselor, or marriage and family therapist time, per calendar month. (these services include the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales; behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes; facilitating and coordinating treatment such as psychotherapy, coordination with and/or referral to physicians and practitioners who are authorized by medicare to prescribe medications and furnish e/m services, counseling and/or psychiatric consultation; and continuity of care with a designated member of the care team)
  • G0330 — Facility services for dental rehabilitation procedure(s) performed on a patient who requires monitored anesthesia (e.g., general, intravenous sedation (monitored anesthesia care) and use of an operating room
  • G3002 — Chronic pain management and treatment, monthly bundle including, diagnosis; assessment and monitoring; administration of a validated pain rating scale or tool; the development, implementation, revision, and/or maintenance of a person-centered care plan that includes strengths, goals, clinical needs, and desired outcomes; overall treatment management; facilitation and coordination of any necessary behavioral health treatment; medication management; pain and health literacy counseling; any necessary chronic pain related crisis care; and ongoing communication and care coordination between relevant practitioners furnishing care, e.g. physical therapy and occupational therapy, complementary and integrative approaches, and community-based care, as appropriate. required initial face-to-face visit at least 30 minutes provided by a physician or other qualified health professional; first 30 minutes personally provided by physician or other qualified health care professional, per calendar month. (when using g3002, 30 minutes must be met or exceeded.)
  • G3003 — Each additional 15 minutes of chronic pain management and treatment by a physician or other qualified health care professional, per calendar month. (list separately in addition to code for g3002. when using g3003, 15 minutes must be met or exceeded.)
  • J0134 — Injection, acetaminophen (fresenius kabi), not therapeutically equivalent to j0131, 10 mg
  • J0136 — Injection, acetaminophen (b braun), not therapeutically equivalent to j0131, 10 mg
  • J0173 — Injection, epinephrine (belcher), not therapeutically equivalent to j0171, 0.1 mg
  • J0225 — Injection, vutrisiran, 1 mg
  • J0283 — Injection, amiodarone hydrochloride (nexterone), 30 mg
  • J0611 — Injection, calcium gluconate (wg critical care), per 10 ml
  • J0689 — Injection, cefazolin sodium (baxter), not therapeutically equivalent to j0690, 500 mg
  • J0701 — Injection, cefepime hydrochloride (baxter), not therapeutically equivalent to maxipime, 500 mg
  • J0703 — Injection, cefepime hydrochloride (b braun), not therapeutically equivalent to maxipime, 500 mg
  • J0877 — Injection, daptomycin (hospira), not therapeutically equivalent to j0878, 1 mg
  • J0891 — Injection, argatroban (accord), not therapeutically equivalent to j0883, 1 mg (for non-esrd use)
  • J0892 — Injection, argatroban (accord), not therapeutically equivalent to j0884, 1 mg (for esrd on dialysis)
  • J0893 — Injection, decitabine (sun pharma), not therapeutically equivalent to j0894, 1 mg
  • J0898 — Injection, argatroban (auromedics), not therapeutically equivalent to j0883, 1 mg (for non-esrd use)
  • J0899 — Injection, argatroban (auromedics), not therapeutically equivalent to j0884, 1 mg (for esrd on dialysis)
  • J1456 — Injection, fosaprepitant (teva), not therapeutically equivalent to j1453, 1 mg
  • J1574 — Injection, ganciclovir sodium (exela), not therapeutically equivalent to j1570, 500 mg
  • J1611 — Injection, glucagon hydrochloride (fresenius kabi), not therapeutically equivalent to j1610, per 1 mg
  • J1643 — Injection, heparin sodium (pfizer), not therapeutically equivalent to j1644, per 1000 units
  • J1954 — Injection, leuprolide acetate for depot suspension (lutrate depot), 7.5 mg
  • J2021 — Injection, linezolid (hospira), not therapeutically equivalent to j2020, 200 mg
  • J2184 — Injection, meropenem (b. braun), not therapeutically equivalent to j2185, 100 mg
  • J2247 — Injection, micafungin sodium (par pharm) not thereapeutically equivalent to j2248, 1 mg
  • J2251 — Injection, midazolam in 0.9% sodium chloride, intravenous, not therapeutically equivalent to j2250, 1 mg
  • J2272 — Injection, morphine sulfate (fresenius kabi), not therapeutically equivalent to j2270, up to 10 mg
  • J2281 — Injection, moxifloxacin (fresenius kabi), not therapeutically equivalent to j2280, 100 mg
  • J2311 — Injection, naloxone hydrochloride (zimhi), 1 mg
  • J2327 — Injection, risankizumab-rzaa, intravenous, 1 mg
  • J2401 — Injection, chloroprocaine hydrochloride, per 1 mg
  • J2402 — Injection, chloroprocaine hydrochloride (clorotekal), per 1 mg
  • J3244 — Injection, tigecycline (accord), not therapeutically equivalent to j3243, 1 mg
  • J3371 — Injection, vancomycin hcl (mylan), not therapeutically equivalent to j3370, 500 mg
  • J3372 — Injection, vancomycin hcl (xellia), not therapeutically equivalent to j3370, 500 mg
  • J9046 — Injection, bortezomib (dr. reddy's), not therapeutically equivalent to j9041, 0.1 mg
  • J9048 — Injection, bortezomib (fresenius kabi), not therapeutically equivalent to j9041, 0.1 mg
  • J9049 — Injection, bortezomib (hospira), not therapeutically equivalent to j9041, 0.1 mg
  • J9314 — Injection, pemetrexed (teva), not therapeutically equivalent to j9305, 10 mg
  • J9393 — Injection, fulvestrant (teva), not therapeutically equivalent to j9395, 25 mg
  • J9394 — Injection, fulvestrant (fresenius kabi) not therapeutically equivalent to j9395, 25 mg
  • M0001 — Advancing cancer care mips value pathways
  • M0002 — Optimal care for kidney health mips value pathways
  • M0003 — Optimal care for patients with episodic neurological conditions mips value pathways
  • M0004 — Quality care for patients with neurological conditions mips value pathway
  • M0005 — Value in primary care mips value pathway
  • M1150 — Current or prior left ventricular ejection fraction (lvef) less than or equal to 40% or documentation of moderately or severely depressed left ventricular systolic function
  • M1151 — Patients with a history of heart transplant or with a left ventricular assist device (lvad)
  • M1152 — Patients with a history of heart transplant or with a left ventricular assist device (lvad)
  • M1153 — Patient with diagnosis of osteoporosis on date of encounter
  • M1154 — Hospice services provided to patient any time during the measurement period
  • M1155 — Patient had anaphylaxis due to the pneumococcal vaccine any time during or before the measurement period
  • M1156 — Patient received active chemotherapy any time during the measurement period
  • M1157 — Patient received bone marrow transplant any time during the measurement period
  • M1158 — Patient had history of immunocompromising conditions prior to or during the measurement period
  • M1159 — Hospice services provided to patient any time during the measurement period
  • M1160 — Patient had anaphylaxis due to the meningococcal vaccine any time on or before the patient's 13th birthday
  • M1161 — Patient had anaphylaxis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient's 13th birthday
  • M1162 — Patient had encephalitis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient's 13th birthday
  • M1163 — Patient had anaphylaxis due to the hpv vaccine any time on or before the patient's 13th birthday
  • M1164 — Patients with dementia any time during the patient's history through the end of the measurement period
  • M1165 — Patients who use hospice services any time during the measurement period
  • M1166 — Pathology report for tissue specimens produced from wide local excisions or re-excisions
  • M1167 — In hospice or using hospice services during the measurement period
  • M1168 — 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
  • M1169 — Documentation of medical reason(s) for not administering influenza vaccine (e.g., prior anaphylaxis due to the influenza vaccine)
  • M1170 — 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
  • M1171 — Patient received at least one td vaccine or one tdap vaccine between nine years prior to the encounter and the end of the measurement period
  • M1172 — Documentation of medical reason(s) for not administering td or tdap vaccine (e.g., prior anaphylaxis due to the td or tdap vaccine or history of encephalopathy within seven days after a previous dose of a td-containing vaccine)
  • M1173 — Patient did not receive at least one td vaccine or one tdap vaccine between nine years prior to the encounter and the end of the measurement period
  • M1174 — Patient received at least two doses of the herpes zoster recombinant vaccine (at least 28 days apart) on october 20, 2017, through the end of the measurement period
  • M1175 — Documentation of medical reason(s) for not administering zoster vaccine (e.g., prior anaphylaxis due to the zoster vaccine)
  • M1176 — Patient did not receive two doses of the herpes zoster recombinant vaccine (at least 28 days apart) on october 20, 2017, through the end of the measurement period
  • M1177 — Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period
  • M1178 — Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., prior anaphylaxis due to the pneumococcal vaccine)
  • M1179 — Patient did not receive any pneumococcal conjugate or polysaccharide vaccine, on or after their 19th birthday and before or during measurement period
  • M1180 — Patients on immune checkpoint inhibitor therapy
  • M1181 — Grade 2 or above diarrhea and/or grade 2 or above colitis
  • M1182 — Patients not eligible due to pre-existing inflammatory bowel disease (ibd) (e.g., ulcerative colitis, crohn's disease)
  • M1183 — Documentation of immune checkpoint inhibitor therapy held and corticosteroids or immunosuppressants prescribed or administered
  • M1184 — Documentation of medical reason(s) for not prescribing or administering corticosteroid or immunosuppressant treatment (e.g., allergy, intolerance, infectious etiology, pancreatic insufficiency, hyperthyroidism, prior bowel surgical interventions, celiac disease, receiving other medication, awaiting diagnostic workup results for alternative etiologies, other medical reasons/contraindication)
  • M1185 — Documentation of immune checkpoint inhibitor therapy not held and/or corticosteroids or immunosuppressants prescribed or administered was not performed, reason not given
  • M1186 — Patients who have an order for or are receiving hospice or palliative care
  • M1187 — Patients with a diagnosis of end stage renal disease (esrd)
  • M1188 — Patients with a diagnosis of chronic kidney disease (ckd) stage 5
  • M1189 — Documentation of a kidney health evaluation defined by an estimated glomerular filtration rate (egfr) and urine albumin-creatinine ratio (uacr) performed
  • M1190 — Documentation of a kidney health evaluation was not performed or defined by an estimated glomerular filtration rate (egfr) and urine albumin-creatinine ratio (uacr)
  • M1191 — Hospice services provided to patient any time during the measurement period
  • M1192 — Patients with an existing diagnosis of squamous cell carcinoma of the esophagus
  • M1193 — Surgical pathology reports that contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-based testing status, or both
  • M1194 — Documentation of medical reason(s) surgical pathology reports did not contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-based testing status, or both tests were not included (e.g., patient will not be treated with checkpoint inhibitor therapy, no residual carcinoma is present in the sample [tissue exhausted or status post neoadjuvant treatment], insufficient tumor for testing)
  • M1195 — Surgical pathology reports that do not contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-based testing status, or both, reason not given
  • M1196 — Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4
  • M1197 — Itch severity assessment score is reduced by 3 or more points from the initial (index) assessment score to the follow-up visit score
  • M1198 — Itch severity assessment score was not reduced by at least 3 points from initial (index) score to the follow-up visit score or assessment was not completed during the follow-up encounter
  • M1199 — Patients receiving rrt
  • M1200 — Ace inhibitor (ace-i) or arb therapy prescribed during the measurement period
  • M1201 — Documentation of medical reason(s) for not prescribing ace inhibitor (ace-i) or arb therapy during the measurement period (e.g., pregnancy, history of angioedema to ace-i, other allergy to ace-i and arb, hyperkalemia or history of hyperkalemia while on ace-i or arb therapy, acute kidney injury due to ace-i or arb therapy), other medical reasons)
  • M1202 — Documentation of patient reason(s) for not prescribing ace inhibitor or arb therapy during the measurement period, (e.g., patient declined, other patient reasons)
  • M1203 — Ace inhibitor or arb therapy not prescribed during the measurement period, reason not given
  • M1204 — Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4
  • M1205 — Itch severity assessment score is reduced by 3 or more points from the initial (index) assessment score to the follow-up visit score
  • M1206 — Itch severity assessment score was not reduced by at least 3 points from initial (index) score to the follow-up visit score or assessment was not completed during the follow-up encounter
  • M1207 — Patient is screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety
  • M1208 — Patient is not screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety
  • M1209 — At least two orders for high-risk medications from the same drug class, (table 4), without appropriate diagnoses
  • M1210 — At least two orders for high-risk medications from the same drug class, (table 4), not ordered
  • Q4262 — Dual layer impax membrane, per square centimeter (add-on, list separately in addition to primary procedure)
  • Q4263 — Surgraft tl, per square centimeter (add-on, list separately in addition to primary procedure)
  • Q4264 — Cocoon membrane, per square centimeter (add-on, list separately in addition to primary procedure)
  • Q5126 — Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg

Deleted effective January 1, 2023 (47)

  • C1841 — Retinal prosthesis, includes all internal and external components
  • C1842 — Retinal prosthesis, includes all internal and external components; add-on to c1841
  • C1849 — Skin substitute, synthetic, resorbable, per square centimeter
  • C9142 — Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg
  • G0028 — Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)
  • G0308 — Creation of subcutaneous pocket with insertion of 180 day implantable interstitial glucose sensor, including system activation and patient training
  • G0309 — Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and insertion of new 180 day implantable sensor, including system activation
  • G2095 — Documentation of system reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., other system reasons)
  • G2170 — 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 — 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
  • 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)
  • G2201 — Documentation of medical reason(s) for not providing brief counseling (e.g., limited life expectancy, other medical reasons)
  • 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)
  • G9196 — Documentation of medical reason(s) for not ordering a first or second generation cephalosporin for antimicrobial prophylaxis (e.g., patients enrolled in clinical trials, patients with documented infection prior to surgical procedure of interest, patients who were receiving antibiotics more than 24 hours prior to surgery [except colon surgery patients taking oral prophylactic antibiotics], patients who were receiving antibiotics within 24 hours prior to arrival [except colon surgery patients taking oral prophylactic antibiotics], other medical reason(s))
  • G9197 — Documentation of order for first or second generation cephalosporin for antimicrobial prophylaxis
  • G9198 — Order for first or second generation cephalosporin for antimicrobial prophylaxis was not documented, reason not given
  • G9250 — Documentation of patient pain brought to a comfortable level within 48 hours from initial assessment
  • G9251 — Documentation of patient with pain not brought to a comfortable level within 48 hours from initial assessment
  • G9359 — Documentation of negative or managed positive tb screen with further evidence that tb is not active prior to treatment with a biologic immune response modifier
  • G9360 — No documentation of negative or managed positive tb screen
  • G9506 — Biologic immune response modifier prescribed
  • G9618 — Documentation of screening for uterine malignancy or those that had an ultrasound and/or endometrial sampling of any kind
  • G9620 — Patient not screened for uterine malignancy, or those that have not had an ultrasound and/or endometrial sampling of any kind, reason not given
  • G9623 — Documentation of medical reason(s) for not screening for unhealthy alcohol use (e.g., limited life expectancy, other medical reasons)
  • G9631 — Patient sustained ureter injury at the time of surgery or discovered subsequently up to 30 days post-surgery
  • G9632 — Documented medical reasons for not reporting ureter injury (e.g., gynecologic or other pelvic malignancy documented, concurrent surgery involving bladder pathology, injury that occurs during a urinary incontinence procedure, patient death from non-medical causes not related to surgery, patient died during procedure without evidence of ureter injury)
  • G9633 — Patient did not sustain ureter injury at the time of surgery nor discovered subsequently up to 30 days post-surgery
  • G9718 — Hospice services for patient provided any time during the measurement period
  • G9774 — Patients who have had a hysterectomy
  • G9778 — Patients who have a diagnosis of pregnancy at any time during the measurement period
  • G9808 — Any patients who had no asthma controller medications dispensed during the measurement year
  • G9809 — Patients who use hospice services any time during the measurement period
  • G9810 — Patient achieved a pdc of at least 75% for their asthma controller medication
  • G9811 — Patient did not achieve a pdc of at least 75% for their asthma controller medication
  • G9904 — Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)
  • G9907 — Documentation of medical reason(s) for not providing tobacco cessation intervention on the date of the encounter or within the previous 12 months (e.g., limited life expectancy, other medical reason)
  • G9909 — Documentation of medical reason(s) for not providing tobacco cessation intervention on the date of the encounter or within the previous 12 months if identified as a tobacco user (e.g., limited life expectancy, other medical reason)
  • G9932 — Documentation of patient reason(s) for not having records of negative or managed positive tb screen (e.g., patient does not return for mantoux (ppd) skin test evaluation)
  • G9942 — Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminectomy
  • G9948 — Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminectomy
  • G9989 — Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., adverse reaction to vaccine)
  • J2400 — Injection, chloroprocaine hydrochloride, per 30 ml
  • J9044 — Injection, bortezomib, not otherwise specified, 0.1 mg
  • K0553 — Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service
  • K0554 — Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system
  • M1017 — Patient admitted to palliative care services
  • M1071 — Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminotomy

Added effective April 1, 2023 (44)

  • A2019 — Kerecis omega3 marigen shield, per square centimeter (add-on, list separately in addition to primary procedure)
  • A2020 — Ac5 advanced wound system (ac5)
  • A2021 — Neomatrix, per square centimeter (add-on, list separately in addition to primary procedure)
  • A4341 — Indwelling intraurethral drainage device with valve, patient inserted, replacement only, each
  • A4342 — Accessories for patient inserted indwelling intraurethral drainage device with valve, replacement only, each
  • A4560 — Neuromuscular electrical stimulator (nmes), disposable, replacement only
  • A6590 — External urinary catheters; disposable, with wicking material, for use with suction pump, per month
  • A6591 — External urinary catheter; non-disposable, for use with suction pump, per month
  • A7049 — Expiratory positive airway pressure intranasal resistance valve
  • C9145 — Injection, aprepitant, (aponvie), 1 mg
  • C9146 — Injection, mirvetuximab soravtansine-gynx, 1 mg
  • C9147 — Injection, tremelimumab-actl, 1 mg
  • C9148 — Injection, teclistamab-cqyv, 0.5 mg
  • C9149 — Injection, teplizumab-mzwv, 5 mcg
  • E0677 — Non-pneumatic sequential compression garment, trunk
  • E0711 — Upper extremity medical tubing/lines enclosure or covering device, restricts elbow range of motion
  • E1905 — Virtual reality cognitive behavioral therapy device (cbt), including pre-programmed therapy software
  • J0208 — Injection, sodium thiosulfate (pedmark), 100 mg
  • J0218 — Injection, olipudase alfa-rpcp, 1 mg
  • J0612 — Injection, calcium gluconate, not otherwise specified, 10 mg
  • J0613 — Injection, calcium gluconate (wg critical care), not therapeutically equivalent to j0612, 10 mg
  • J1411 — Injection, etranacogene dezaparvovec-drlb, per therapeutic dose
  • J1449 — Injection, eflapegrastim-xnst, 0.1 mg
  • J1747 — Injection, spesolimab-sbzo, 1 mg
  • J2403 — Chloroprocaine hcl ophthalmic, 3% gel, 1 mg
  • J9196 — Injection, gemcitabine hydrochloride (accord), not therapeutically equivalent to j9201, 200 mg
  • J9294 — Injection, pemetrexed (hospira), not therapeutically equivalent to j9305, 10 mg
  • J9296 — Injection, pemetrexed (accord), not therapeutically equivalent to j9305, 10 mg
  • J9297 — Injection, pemetrexed (sandoz), not therapeutically equivalent to j9305, 10 mg
  • K1035 — Molecular diagnostic test reader, nonprescription self-administered and self-collected use, fda approved, authorized or cleared
  • L8678 — Electrical stimulator supplies (external) for use with implantable neurostimulator, per month
  • M0010 — Enhancing oncology model (eom) monthly enhanced oncology services (meos) payment for eom enhanced services
  • Q4265 — Neostim tl, per square centimeter (add-on, list separately in addition to primary procedure)
  • Q4266 — Neostim membrane, per square centimeter (add-on, list separately in addition to primary procedure)
  • Q4267 — Neostim dl, per square centimeter (add-on, list separately in addition to primary procedure)
  • Q4268 — Surgraft ft, per square centimeter (add-on, list separately in addition to primary procedure)
  • Q4269 — Surgraft xt, per square centimeter (add-on, list separately in addition to primary procedure)
  • Q4270 — Complete sl, per square centimeter (add-on, list separately in addition to primary procedure)
  • Q4271 — Complete ft, per square centimeter (add-on, list separately in addition to primary procedure)
  • Q5127 — Injection, pegfilgrastim-fpgk (stimufend), biosimilar, 0.5 mg
  • Q5128 — Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg
  • Q5129 — Injection, bevacizumab-adcd (vegzelma), biosimilar, 10 mg
  • Q5130 — Injection, pegfilgrastim-pbbk (fylnetra), biosimilar, 0.5 mg
  • S9563 — Home injectable therapy, immunotherapy, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

Deleted effective April 1, 2023 (3)

  • C1834 — Pressure sensor system, includes all components (e.g., introducer, sensor), intramuscular (implantable), excludes mobile (wireless) software application
  • J0610 — Injection, calcium gluconate (fresenius kabi), per 10 ml
  • J0611 — Injection, calcium gluconate (wg critical care), per 10 ml

Deleted effective May 12, 2023 (5)

  • G2023 — Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source
  • G2024 — 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
  • U0003 — 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, making use of high throughput technologies as described by cms-2020-01-r
  • U0004 — 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by cms-2020-01-r
  • 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

Added effective July 1, 2023 (62)

  • C9150 — Xenon xe-129 hyperpolarized gas, diagnostic, per study dose
  • C9151 — Injection, pegcetacoplan, 1 mg
  • C9784 — Gastric restrictive procedure, endoscopic sleeve gastroplasty, with esophagogastroduodenoscopy and intraluminal tube insertion, if performed, including all system and tissue anchoring components
  • C9785 — Endoscopic outlet reduction, gastric pouch application, with endoscopy and intraluminal tube insertion, if performed, including all system and tissue anchoring components
  • C9786 — Echocardiography image post processing for computer aided detection of heart failure with preserved ejection fraction, including interpretation and report
  • C9787 — Gastric electrophysiology mapping with simultaneous patient symptom profiling
  • J0137 — Injection, acetaminophen (hikma), not therapeutically equivalent to j0131, 10 mg
  • J0206 — Injection, allopurinol sodium, 1 mg
  • J0216 — Injection, alfentanil hydrochloride, 500 micrograms
  • J0457 — Injection, aztreonam, 100 mg
  • J0665 — Injection, bupivicaine, not otherwise specified, 0.5 mg
  • J0736 — Injection, clindamycin phosphate, 300 mg
  • J0737 — Injection, clindamycin phosphate (baxter), not therapeutically equivalent to j0736, 300 mg
  • J1440 — Fecal microbiota, live - jslm, 1 ml
  • J1576 — Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg
  • J1805 — Injection, esmolol hydrochloride, 10 mg
  • J1806 — Injection, esmolol hydrochloride (wg critical care), not therapeutically equivalent to j1805, 10 mg
  • J1811 — Insulin (fiasp) for administration through dme (i.e., insulin pump) per 50 units
  • J1812 — Insulin (fiasp), per 5 units
  • J1813 — Insulin (lyumjev) for administration through dme (i.e., insulin pump) per 50 units
  • J1814 — Insulin (lyumjev), per 5 units
  • J1836 — Injection, metronidazole, 10 mg
  • J1920 — Injection, labetalol hydrochloride, 5 mg
  • J1921 — Injection, labetalol hydrochloride (hikma), not therapeutically equivalent to j1920, 5 mg
  • J1941 — Injection, furosemide (furoscix), 20 mg
  • J1961 — Injection, lenacapavir (only for use as hiv treatment), 1 mg
  • J2249 — Injection, remimazolam, 1 mg
  • J2305 — Injection, nitroglycerin, 5 mg
  • J2329 — Injection, ublituximab-xiiy, 1mg
  • J2371 — Injection, phenylephrine hydrochloride, 20 micrograms
  • J2372 — Injection, phenylephrine hydrochloride (biorphen), 20 micrograms
  • J2427 — Injection, paliperidone palmitate extended release (invega hafyera, or invega trinza), 1 mg
  • J2561 — Injection, phenobarbital sodium (sezaby), 1 mg
  • J2598 — Injection, vasopressin, 1 unit
  • J2599 — Injection, vasopressin (american regent), not therapeutically equivalent to j2598, 1 unit
  • J2806 — Injection, sincalide (maia), not therapeutically equivalent to j2805, 5 micrograms
  • J7213 — Injection, coagulation factor ix (recombinant), ixinity, 1 i.u.
  • J9029 — Intravesical instillation, nadofaragene firadenovec-vncg, per therapeutic dose
  • J9056 — Injection, bendamustine hydrochloride (vivimusta), 1 mg
  • J9058 — Injection, bendamustine hydrochloride (apotex), 1 mg
  • J9059 — Injection, bendamustine hydrochloride (baxter), 1 mg
  • J9063 — Injection, mirvetuximab soravtansine-gynx, 1 mg
  • J9259 — Injection, paclitaxel protein-bound particles (american regent), not therapeutically equivalent to j9264, 1 mg
  • J9322 — Injection, pemetrexed (bluepoint), not therapeutically equivalent to j9305, 10 mg
  • J9323 — Injection, pemetrexed ditromethamine, 10 mg
  • J9347 — Injection, tremelimumab-actl, 1 mg
  • J9350 — Injection, mosunetuzumab-axgb, 1 mg
  • J9380 — Injection, teclistamab-cqyv, 0.5 mg
  • J9381 — Injection, teplizumab-mzwv, 5 mcg
  • Q4272 — Esano a, per square centimeter (add-on, list separately in addition to primary procedure)
  • Q4273 — Esano aaa, per square centimeter (add-on, list separately in addition to primary procedure)
  • Q4274 — Esano ac, per square centimeter (add-on, list separately in addition to primary procedure)
  • Q4275 — Esano aca, per square centimeter (add-on, list separately in addition to primary procedure)
  • Q4276 — Orion, per square centimeter (add-on, list separately in addition to primary procedure)
  • Q4277 — Woundplus membrane or e-graft, per square centimeter
  • Q4278 — Epieffect, per square centimeter (add-on, list separately in addition to primary procedure)
  • Q4280 — Xcell amnio matrix, per square centimeter (add-on, list separately in addition to primary procedure)
  • Q4281 — Barrera sl or barrera dl, per square centimeter (add-on, list separately in addition to primary procedure)
  • Q4282 — Cygnus dual, per square centimeter (add-on, list separately in addition to primary procedure)
  • Q4283 — Biovance tri-layer or biovance 3l, per square centimeter (add-on, list separately in addition to primary procedure)
  • Q4284 — Dermabind sl, per square centimeter (add-on, list separately in addition to primary procedure)
  • Q5131 — Injection, adalimumab-aacf (idacio), biosimilar, 20 mg

Deleted effective July 1, 2023 (9)

  • C9146 — Injection, mirvetuximab soravtansine-gynx, 1 mg
  • C9147 — Injection, tremelimumab-actl, 1 mg
  • C9148 — Injection, teclistamab-cqyv, 0.5 mg
  • C9149 — Injection, teplizumab-mzwv, 5 mcg
  • J2370 — Injection, phenylephrine hcl, up to 1 ml
  • S0020 — Injection, bupivicaine hydrochloride, 30 ml
  • S0030 — Injection, metronidazole, 500 mg
  • S0073 — Injection, aztreonam, 500 mg
  • S0077 — Injection, clindamycin phosphate, 300 mg

Added effective July 6, 2023 (1)

  • J0174 — Lecanemab-irmb, for intravenous injection, 1 mg

Added effective October 1, 2023 (47)

  • A2022 — Innovaburn or innovamatrix xl, per square centimeter (add-on, list separately in addition to primary procedure)
  • A2023 — Innovamatrix pd, 1 mg
  • A2024 — Resolve matrix or xenopatch, per square centimeter (add-on, list separately in addition to primary procedure)
  • A2025 — Miro3d, per cubic centimeter (add-on, list separately in addition to primary procedure)
  • A9156 — Oral mucoadhesive, any type (liquid, gel, paste, etc.), per 1 ml
  • A9268 — Programmer for transient, orally ingested capsule
  • A9269 — Programable, transient, orally ingested capsule, for use with external programmer, per month
  • A9292 — Prescription digital visual therapy, software-only, fda cleared, per course of treatment
  • A9573 — Injection, gadopiclenol, 1 ml
  • A9603 — Injection, pafolacianine, 0.1 mg
  • A9697 — Injection, carboxydextran-coated superparamagnetic iron oxide, per study dose
  • B4148 — Enteral feeding supply kit; elastomeric control fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape
  • C9152 — Injection, aripiprazole, (abilify asimtufii), 1 mg
  • C9153 — Injection, amisulpride, 1 mg
  • C9154 — Injection, buprenorphine extended-release (brixadi), 1 mg
  • C9155 — Injection, epcoritamab-bysp, 0.16 mg
  • C9156 — Flotufolastat f 18, diagnostic, 1 millicurie
  • C9157 — Injection, tofersen, 1 mg
  • C9158 — Injection, risperidone, (uzedy), 1 mg
  • C9788 — Opto-acoustic imaging, breast (including axilla when performed), unilateral, with image documentation, analysis and report, obtained with ultrasound examination
  • C9789 — Instillation of anti-neoplastic pharmacologic/biologic agent into renal pelvis, any method, including all imaging guidance, including volumetric measurement if performed
  • C9790 — Histotripsy (i.e., non-thermal ablation via acoustic energy delivery) of malignant renal tissue, including image guidance
  • C9791 — Magnetic resonance imaging with inhaled hyperpolarized xenon-129 contrast agent, chest, including preparation and administration of agent
  • C9792 — Blinded or nonblinded procedure for symptomatic new york heart association (nyha) class ii, iii, iva heart failure; transcatheter implantation of left atrial to coronary sinus shunt using jugular vein access, including all imaging necessary to intra procedurally map the coronary sinus for optimal shunt placement (e.g., tee or ice ultrasound, fluoroscopy), performed under general anesthesia in an approved investigational device exemption (ide) study)
  • E0490 — Power source and control electronics unit for oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, controlled by hardware remote
  • E0491 — Oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, used in conjunction with the power source and control electronics unit, controlled by hardware remote, 90-day supply
  • H2040 — Coordinated specialty care, team-based, for first episode psychosis, per month
  • H2041 — Coordinated specialty care, team-based, for first episode psychosis, per encounter
  • J0349 — Injection, rezafungin, 1 mg
  • J0801 — Injection, corticotropin (acthar gel), up to 40 units
  • J0802 — Injection, corticotropin (ani), up to 40 units
  • J0874 — Injection, daptomycin (baxter), not therapeutically equivalent to j0878, 1 mg
  • J0889 — Daprodustat, oral, 1 mg, (for esrd on dialysis)
  • J2359 — Injection, olanzapine, 0.5 mg
  • J2781 — Injection, pegcetacoplan, intravitreal, 1 mg
  • J7214 — Injection, factor viii/von willebrand factor complex, recombinant (altuviiio), per factor viii i.u.
  • J7353 — Anacaulase-bcdb, 8.8% gel, 1 gram
  • J7519 — Injection, mycophenolate mofetil, 10 mg
  • J9051 — Injection, bortezomib (maia), not therapeutically equivalent to j9041, 0.1 mg
  • J9064 — Injection, cabazitaxel (sandoz), not therapeutically equivalent to j9043, 1 mg
  • J9345 — Injection, retifanlimab-dlwr, 1 mg
  • K1036 — Supplies and accessories (e.g., transducer) for low frequency ultrasonic diathermy treatment device, per month
  • L1681 — Hip orthosis, bilateral hip joints and thigh cuffs, adjustable flexion, extension, abduction control of hip joint, postoperative hip abduction type, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
  • L5991 — Addition to lower extremity prostheses, osseointegrated external prosthetic connector
  • Q4285 — Nudyn dl or nudyn dl mesh, per square centimeter (add-on, list separately in addition to primary procedure)
  • Q4286 — Nudyn sl or nudyn slw, per square centimeter (add-on, list separately in addition to primary procedure)
  • V2526 — Contact lens, hydrophilic, with blue-violet filter, per lens

Deleted effective October 1, 2023 (3)

  • C9151 — Injection, pegcetacoplan, 1 mg
  • J0800 — Injection, corticotropin, up to 40 units
  • S0166 — Injection, olanzapine, 2.5 mg

Deleted effective December 14, 2023 (3)

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

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 2023
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