hcpcs codes annual update change report

HCPCS Codes 2021 Annual Update Change Report Prepared: 12/10/2020

New HCPCS Codes:

0001A – ADM SARSCOV2 30MCG/0.3ML 1ST Eff = 11/20/2020 Term = NONE

0002A – ADM SARSCOV2 30MCG/0.3ML 2ND Eff = 11/20/2020 Term = NONE

0003A – FEE COVID-19 VAC 1 BOOSTER Eff = 01/01/2021 Term = 01/01/2021

0004A – FEE COVID-19 VAC 1 RES Eff = 01/01/2021 Term = 01/01/2021

0011A – ADM SARSCOV2 100MCG/0.5ML1ST Eff = 11/30/2020 Term = NONE

0012A – ADM SARSCOV2 100MCG/0.5ML2ND Eff = 11/30/2020 Term = NONE



0014M – LIVER DS ALYS 3 BMRK SRM ALG Eff = 04/01/2020 Term = NONE

0015M – ADRNL CORTCL TUM BCHM ASY 25 Eff = 10/01/2020 Term = NONE

0016M – ONC BLADDER MRNA 209 GEN ALG Eff = 10/01/2020 Term = NONE

0021A – FEE COVID-19 VAC 3 DOSE 1 Eff = 01/01/2021 Term = 01/01/2021




































0163U – ONC CLRCT SCR 3 PRTN ALG Eff = 04/01/2020 Term = NONE

0164U – GI IBS IA ANTI-CDTB&VINCULIN Eff = 04/01/2020 Term = NONE

HCPCS Codes Annual Update Change Report (continued)

0165U – PEANUT ALLG ASMT EPI Eff = 04/01/2020 Term = NONE

0166U – LIVER DS 10 BIOCHEM ASY SRM Eff = 04/01/2020 Term = NONE

0167U – CHORNC GONADOTROPIN HCG IA Eff = 04/01/2020 Term = NONE

0168U – FTL ANEUPLOIDY DNA SEQ ALYS Eff = 04/01/2020 Term = NONE

0169U – NUDT15&TPMT GENE COM VRNT Eff = 04/01/2020 Term = NONE

0170U – NEURO ASD RNA NEXT GEN SEQ Eff = 04/01/2020 Term = NONE

0171U – TRGT GEN SEQ ALYS PNL DNA 23 Eff = 04/01/2020 Term = NONE

0172U – ONC SLD TUM ALYS BRCA1 BRCA2 Eff = 07/01/2020 Term = NONE

0173U – PSYC GEN ALYS PANEL 14 GENES Eff = 07/01/2020 Term = NONE

0174U – ONC SOLID TUMOR 30 PRTN TRGT Eff = 07/01/2020 Term = NONE

0175U – PSYC GEN ALYS PANEL 15 GENES Eff = 07/01/2020 Term = NONE

0176U – CDTB&VINCULIN IGG ANTB IA Eff = 07/01/2020 Term = NONE

0177U – ONC BRST CA DNA PIK3CA 11 Eff = 07/01/2020 Term = NONE

0178U – PEANUT ALLG ASMT EPI CLIN RX Eff = 07/01/2020 Term = NONE

0179U – ONC NONSM CLL LNG CA ALYS 23 Eff = 07/01/2020 Term = NONE

0180U – ABO GNOTYP ABO 7 EXONS Eff = 07/01/2020 Term = NONE

0181U – CO GNOTYP AQP1 EXON 1 Eff = 07/01/2020 Term = NONE

0182U – CROM GNOTYP CD55 EXONS 1-10 Eff = 07/01/2020 Term = NONE

0183U – DI GNOTYP SLC4A1 EXON 19 Eff = 07/01/2020 Term = NONE

0184U – DO GNOTYP ART4 EXON 2 Eff = 07/01/2020 Term = NONE

0185U – FUT1 GNOTYP FUT1 EXON 4 Eff = 07/01/2020 Term = NONE

0186U – FUT2 GNOTYP FUT2 EXON 2 Eff = 07/01/2020 Term = NONE

0187U – FY GNOTYP ACKR1 EXONS 1-2 Eff = 07/01/2020 Term = NONE

0188U – GE GNOTYP GYPC EXONS 1-4 Eff = 07/01/2020 Term = NONE

0189U – GYPA GNOTYP NTRNS 1 5 EXON 2 Eff = 07/01/2020 Term = NONE

0190U – GYPB GNOTYP NTRNS 1 5 SEUX 3 Eff = 07/01/2020 Term = NONE

0191U – IN GNOTYP CD44 EXONS 2 3 6 Eff = 07/01/2020 Term = NONE

0192U – JK GNOTYP SLC14A1 EXON 9 Eff = 07/01/2020 Term = NONE

0193U – JR GNOTYP ABCG2 EXONS 2-26 Eff = 07/01/2020 Term = NONE

0194U – KEL GNOTYP KEL EXON 8 Eff = 07/01/2020 Term = NONE

0195U – KLF1 TARGETED SEQUENCING Eff = 07/01/2020 Term = NONE

0196U – LU GNOTYP BCAM EXON 3 Eff = 07/01/2020 Term = NONE

0197U – LW GNOTYP ICAM4 EXON 1 Eff = 07/01/2020 Term = NONE

0198U – RHD&RHCE GNTYP RHD1-10&RHCE5 Eff = 07/01/2020 Term = NONE

0199U – SC GNOTYP ERMAP EXONS 4 12 Eff = 07/01/2020 Term = NONE

0200U – XK GNOTYP XK EXONS 1-3 Eff = 07/01/2020 Term = NONE

0201U – YT GNOTYP ACHE EXON 2 Eff = 07/01/2020 Term = NONE

0202U – NFCT DS 22 TRGT SARS-COV-2 Eff = 05/20/2020 Term = NONE

0203U – AI IBD MRNA XPRSN PRFL 17 Eff = 10/01/2020 Term = NONE

0204U – ONC THYR MRNA XPRSN ALYS 593 Eff = 10/01/2020 Term = NONE

0205U – OPH AMD ALYS 3 GENE VARIANTS Eff = 10/01/2020 Term = NONE

0206U – NEURO ALZHEIMER CELL AGGREGJ Eff = 10/01/2020 Term = NONE

0207U – NEURO ALZHEIMER QUAN IMAGING Eff = 10/01/2020 Term = NONE

0208U – ONC MTC MRNA XPRSN ALYS 108 Eff = 10/01/2020 Term = NONE

0209U – CYTOG CONST ALYS INTERROG Eff = 10/01/2020 Term = NONE

0210U – SYPHILIS TST ANTB IA QUAN Eff = 10/01/2020 Term = NONE

0211U – ONC PAN-TUM DNA&RNA GNRJ SEQ Eff = 10/01/2020 Term = NONE

0212U – RARE DS GEN DNA ALYS PROBAND Eff = 10/01/2020 Term = NONE

0213U – RARE DS GEN DNA ALYS EA COMP Eff = 10/01/2020 Term = NONE

0214U – RARE DS XOM DNA ALYS PROBAND Eff = 10/01/2020 Term = NONE

0215U – RARE DS XOM DNA ALYS EA COMP Eff = 10/01/2020 Term = NONE

0216U – NEURO INH ATAXIA DNA 12 COM Eff = 10/01/2020 Term = NONE

0217U – NEURO INH ATAXIA DNA 51 GENE Eff = 10/01/2020 Term = NONE

0218U – NEURO MUSC DYS DMD SEQ ALYS Eff = 10/01/2020 Term = NONE

0219U – NFCT AGT HIV GNRJ SEQ ALYS Eff = 10/01/2020 Term = NONE

0220U – ONC BRST CA AI ASSMT 12 FEAT Eff = 10/01/2020 Term = NONE

0221U – ABO GNOTYP NEXT GNRJ SEQ ABO Eff = 10/01/2020 Term = NONE

0222U – RHD&RHCE GNTYP NEXT GNRJ SEQ Eff = 10/01/2020 Term = NONE

0223U – NFCT DS 22 TRGT SARS-COV-2 Eff = 06/25/2020 Term = NONE

0224U – ANTIBODY SARS-COV-2 TITER(S) Eff = 06/25/2020 Term = NONE

0225U – NFCT DS DNA&RNA 21 SARSCOV2 Eff = 08/10/2020 Term = NONE

0226U – SVNT SARSCOV2 ELISA PLSM SRM Eff = 08/10/2020 Term = NONE

0227U – RX ASY PRSMV 30+RX/METABLT Eff = 01/01/2021 Term = NONE

0228U – ONC PRST8 MA MOLEC PRFL ALG Eff = 01/01/2021 Term = NONE

0229U – BCAT1 PROMOTER MTHYLTN ALYS Eff = 01/01/2021 Term = NONE

0230U – AR FULL SEQUENCE ANALYSIS Eff = 01/01/2021 Term = NONE

0231U – CACNA1A FULL GENE ANALYSIS Eff = 01/01/2021 Term = NONE

0232U – CSTB FULL GENE ANALYSIS Eff = 01/01/2021 Term = NONE

0233U – FXN GENE ANALYSIS Eff = 01/01/2021 Term = NONE

0234U – MECP2 FULL GENE ANALYSIS Eff = 01/01/2021 Term = NONE

0235U – PTEN FULL GENE ANALYSIS Eff = 01/01/2021 Term = NONE

0236U – SMN1&SMN2 FULL GENE ANALYSIS Eff = 01/01/2021 Term = NONE

0237U – CAR ION CHNLPTHY GEN SEQ PNL Eff = 01/01/2021 Term = NONE

0238U – ONC LNCH SYN GEN DNA SEQ ALY Eff = 01/01/2021 Term = NONE

0239U – TRGT GEN SEQ ALYS PNL 311+ Eff = 01/01/2021 Term = NONE

0240U – NFCT DS VIR RESP RNA 3 TRGT Eff = 10/06/2020 Term = NONE

0241U – NFCT DS VIR RESP RNA 4 TRGT Eff = 10/06/2020 Term = NONE

0594T – OSTEOT HUM XTRNL LNGTH DEV Eff = 07/01/2020 Term = NONE

0596T – TEMP FML IU VLV-PMP 1ST INSJ Eff = 07/01/2020 Term = NONE

0597T – TEMP FML IU VALVE-PMP RPLCMT Eff = 07/01/2020 Term = NONE

0598T – NCNTC R-T FLUOR WND IMG 1ST Eff = 07/01/2020 Term = NONE

0599T – NCNTC R-T FLUOR WND IMG EA Eff = 07/01/2020 Term = NONE

0600T – IRE ABLTJ 1+TUM ORGAN PERQ Eff = 07/01/2020 Term = NONE

0601T – IRE ABLTJ 1+TUMORS OPEN Eff = 07/01/2020 Term = NONE

0602T – TRANSDERMAL GFR MEASUREMENTS Eff = 07/01/2020 Term = NONE

0603T – TRANSDERMAL GFR MONITORING Eff = 07/01/2020 Term = NONE

0604T – REM OCT RTA DEV SETUP&EDUCAJ Eff = 07/01/2020 Term = NONE

0605T – REM OCT RTA TECHL SPRT MIN 8 Eff = 07/01/2020 Term = NONE

0606T – REM OCT RTA PHYS/QHP EA 30D Eff = 07/01/2020 Term = NONE

0607T – REM MNTR PULM FLU MNTR SETUP Eff = 07/01/2020 Term = NONE

0608T – REM MNTR PULM FLU MNTR ALYS Eff = 07/01/2020 Term = NONE

0609T – MRS DISC PAIN ACQUISJ DATA Eff = 07/01/2020 Term = NONE

0610T – MRS DISC PAIN TRANSMIS DATA Eff = 07/01/2020 Term = NONE

0611T – MRS DISC PAIN ALG ALYS DATA Eff = 07/01/2020 Term = NONE

0612T – MRS DISCOGENIC PAIN I&R Eff = 07/01/2020 Term = NONE

0613T – PERQ TCAT INTRATRL SEPTL SHT Eff = 07/01/2020 Term = NONE

0614T – RMVL&RPLCMT SS IMPL DFB PG Eff = 07/01/2020 Term = NONE

0615T – EYE MVMT ALYS W/O CALBRJ I&R Eff = 07/01/2020 Term = NONE

0616T – INSERTION OF IRIS PROSTHESIS Eff = 07/01/2020 Term = NONE

0617T – INSJ IRIS PROSTH W/RMVL&INSJ Eff = 07/01/2020 Term = NONE

0618T – INSJ IRIS PROSTH SEC IO LENS Eff = 07/01/2020 Term = NONE

0619T – CYSTO W/PRST8 COMMISSUROTOMY Eff = 07/01/2020 Term = NONE

0620T – EVASC VEN ARTLZ TIBL/PRNL VN Eff = 01/01/2021 Term = NONE

0621T – TRABECULOSTOMY INTERNO LASER Eff = 01/01/2021 Term = NONE

0622T – TRABECULOSTOMY INT LSR W/SCP Eff = 01/01/2021 Term = NONE

0623T – AUTO QUANTIFICATION C PLAQUE Eff = 01/01/2021 Term = NONE


0624T – AUTO QUAN C PLAQ DATA PREP Eff = 01/01/2021 Term = NONE

0625T – AUTO QUAN C PLAQ CPTR ALYS Eff = 01/01/2021 Term = NONE

0626T – AUTO QUAN C PLAQ I&R Eff = 01/01/2021 Term = NONE

0627T – PERQ NJX ALGC FLUOR LMBR 1ST Eff = 01/01/2021 Term = NONE

0628T – PERQ NJX ALGC FLUOR LMBR EA Eff = 01/01/2021 Term = NONE

0629T – PERQ NJX ALGC CT LMBR 1ST Eff = 01/01/2021 Term = NONE

0630T – PERQ NJX ALGC CT LMBR EA Eff = 01/01/2021 Term = NONE

0631T – TC VIS LIT HYPERSPECTRAL IMG Eff = 01/01/2021 Term = NONE

0632T – PERQ TCAT US ABLTJ NRV P-ART Eff = 01/01/2021 Term = NONE

0633T – CT BREAST W/3D UNI C- Eff = 01/01/2021 Term = NONE

0634T – CT BREAST W/3D UNI C+ Eff = 01/01/2021 Term = NONE

0635T – CT BREAST W/3D UNI C-/C+ Eff = 01/01/2021 Term = NONE

0636T – CT BREAST W/3D BI C- Eff = 01/01/2021 Term = NONE

0637T – CT BREAST W/3D BI C+ Eff = 01/01/2021 Term = NONE

0638T – CT BREAST W/3D BI C-/C+ Eff = 01/01/2021 Term = NONE

0639T – WRLS SKN SNR ANISOTROPY MEAS Eff = 01/01/2021 Term = NONE

30468 – RPR NSL VLV COLLAPSE W/IMPLT Eff = 01/01/2021 Term = NONE

32408 – CORE NDL BX LNG/MED PERQ Eff = 01/01/2021 Term = NONE

33741 – TAS CONGENITAL CAR ANOMAL Eff = 01/01/2021 Term = NONE

33745 – TIS CGEN CAR ANOMAL 1ST SHNT Eff = 01/01/2021 Term = NONE

33746 – TIS CGEN CAR ANOMAL EA ADDL Eff = 01/01/2021 Term = NONE

33995 – INSJ PERQ VAD R HRT VENOUS Eff = 01/01/2021 Term = NONE

33997 – RMVL PERQ RIGHT HEART VAD Eff = 01/01/2021 Term = NONE

55880 – ABLTJ MAL PRST8 TISS HIFU Eff = 01/01/2021 Term = NONE

57465 – CAM CERVIX UTERI DRG COLP Eff = 01/01/2021 Term = NONE

69705 – NPS SURG DILAT EUST TUBE UNI Eff = 01/01/2021 Term = NONE

69706 – NPS SURG DILAT EUST TUBE BI Eff = 01/01/2021 Term = NONE

71271 – CT THORAX LUNG CANCER SCR C- Eff = 01/01/2021 Term = NONE

76145 – MED PHYSIC DOS EVAL RAD EXPS Eff = 01/01/2021 Term = NONE

80143 – DRUG ASSAY ACETAMINOPHEN Eff = 01/01/2021 Term = NONE

80151 – DRUG ASSAY AMIODARONE Eff = 01/01/2021 Term = NONE

80161 – ASY CARBAMAZEPIN 10,11-EPXID Eff = 01/01/2021 Term = NONE

80167 – DRUG ASSAY FELBAMATE Eff = 01/01/2021 Term = NONE

80179 – DRUG ASSAY SALICYLATE Eff = 01/01/2021 Term = NONE

80181 – DRUG ASSAY FLECAINIDE Eff = 01/01/2021 Term = NONE

80189 – DRUG ASSAY ITRACONZAOLE Eff = 01/01/2021 Term = NONE

80193 – DRUG ASSAY LEFLUNOMIDE Eff = 01/01/2021 Term = NONE

80204 – DRUG ASSAY METHOTREXATE Eff = 01/01/2021 Term = NONE

80210 – DRUG ASSAY RUFINAMIDE Eff = 01/01/2021 Term = NONE

81168 – CCND1/IGH TRANSLOCATION ALYS Eff = 01/01/2021 Term = NONE

81191 – NTRK1 TRANSLOCATION ANALYSIS Eff = 01/01/2021 Term = NONE



81194 – NTRK TRANSLOCATION ANALYSIS Eff = 01/01/2021 Term = NONE

81278 – IGH@/BCL2 TRANSLOCATION ALYS Eff = 01/01/2021 Term = NONE

81279 – JAK2 GENE TRGT SEQUENCE ALYS Eff = 01/01/2021 Term = NONE

81338 – MPL GENE COMMON VARIANTS Eff = 01/01/2021 Term = NONE

81339 – MPL GENE SEQ ALYS EXON 10 Eff = 01/01/2021 Term = NONE

81347 – SF3B1 GENE COMMON VARIANTS Eff = 01/01/2021 Term = NONE

81348 – SRSF2 GENE COMMON VARIANTS Eff = 01/01/2021 Term = NONE

81351 – TP53 GENE FULL GENE SEQUENCE Eff = 01/01/2021 Term = NONE

81352 – TP53 GENE TRGT SEQUENCE ALYS Eff = 01/01/2021 Term = NONE

81353 – TP53 GENE KNOWN FAMIL VRNT Eff = 01/01/2021 Term = NONE

81357 – U2AF1 GENE COMMON VARIANTS Eff = 01/01/2021 Term = NONE

81360 – ZRSR2 GENE COMMON VARIANTS Eff = 01/01/2021 Term = NONE

81419 – EPILEPSY GEN SEQ ALYS PANEL Eff = 01/01/2021 Term = NONE

81513 – NFCT DS BV RNA VAG FLU ALG Eff = 01/01/2021 Term = NONE

81514 – NFCT DS BV&VAGINITIS DNA ALG Eff = 01/01/2021 Term = NONE

81529 – ONC CUTAN MLNMA MRNA 31 GENE Eff = 01/01/2021 Term = NONE

81546 – ONC THYR MRNA 10,196 GEN ALG Eff = 01/01/2021 Term = NONE

81554 – PULM DS IPF MRNA 190 GEN ALG Eff = 01/01/2021 Term = NONE

82077 – ASSAY SPEC XCP UR&BREATH IA Eff = 01/01/2021 Term = NONE

82681 – ASSAY DIR MEAS FR ESTRADIOL Eff = 01/01/2021 Term = NONE

86328 – IA NFCT AB SARSCOV2 COVID19 Eff = 04/10/2020 Term = NONE

86408 – NEUTRLZG ANTB SARSCOV2 SCR Eff = 08/10/2020 Term = NONE

86409 – NEUTRLZG ANTB SARSCOV2 TITER Eff = 08/10/2020 Term = NONE

86413 – SARS-COV-2 ANTB QUANTITATIVE Eff = 09/08/2020 Term = NONE

86769 – SARS-COV-2 COVID-19 ANTIBODY Eff = 04/10/2020 Term = NONE

87426 – SARSCOV CORONAVIRUS AG IA Eff = 06/25/2020 Term = NONE

87428 – SARSCOV & INF VIR A&B AG IA Eff = 11/10/2020 Term = NONE

87635 – SARS-COV-2 COVID-19 AMP PRB Eff = 03/13/2020 Term = NONE

87636 – SARSCOV2 & INF A&B AMP PRB Eff = 10/06/2020 Term = NONE

87637 – SARSCOV2&INF A&B&RSV AMP PRB Eff = 10/06/2020 Term = NONE

87811 – SARS-COV-2 COVID19 W/OPTIC Eff = 10/06/2020 Term = NONE

90377 – RABIES IG HT&SOL HUMAN IM/SC Eff = 01/01/2021 Term = NONE

91300 – SARSCOV2 VAC 30MCG/0.3ML IM Eff = 11/20/2020 Term = NONE

91301 – SARSCOV2 VAC 100MCG/0.5ML IM Eff = 11/30/2020 Term = NONE

91302 – CORONAVIRUS VACCINE 3 Eff = 01/01/2021 Term = 01/01/2021









92229 – IMG RTA DETC/MNTR DS POC ALY Eff = 01/01/2021 Term = NONE

92517 – VEMP TEST I&R CERVICAL Eff = 01/01/2021 Term = NONE

92518 – VEMP TEST I&R OCULAR Eff = 01/01/2021 Term = NONE

92519 – VEMP TST I&R CERVICAL&OCULAR Eff = 01/01/2021 Term = NONE

92650 – AEP SCR AUDITORY POTENTIAL Eff = 01/01/2021 Term = NONE

92651 – AEP HEARING STATUS DETER I&R Eff = 01/01/2021 Term = NONE

92652 – AEP THRSHLD EST MLT FREQ I&R Eff = 01/01/2021 Term = NONE

92653 – AEP NEURODIAGNOSTIC I&R Eff = 01/01/2021 Term = NONE

93241 – EXT ECG>48HR<7D REC SCAN A/R Eff = 01/01/2021 Term = NONE

93242 – EXT ECG>48HR<7D RECORDING Eff = 01/01/2021 Term = NONE

93243 – EXT ECG>48HR<7D SCAN A/R Eff = 01/01/2021 Term = NONE

93244 – EXT ECG>48HR<7D REV&INTERPJ Eff = 01/01/2021 Term = NONE

93245 – EXT ECG>7D<15D REC SCAN A/R Eff = 01/01/2021 Term = NONE

93246 – EXT ECG>7D<15D RECORDING Eff = 01/01/2021 Term = NONE

93247 – EXT ECG>7D<15D SCAN A/R Eff = 01/01/2021 Term = NONE

93248 – EXT ECG>7D<15D REV&INTERPJ Eff = 01/01/2021 Term = NONE

94619 – EXERCISE TST BRNCSPSM WO ECG Eff = 01/01/2021 Term = NONE

99072 – ADDL SUPL MATRL&STAF TM PHE Eff = 09/08/2020 Term = NONE

99417 – PROLNG OFF/OP E/M EA 15 MIN Eff = 01/01/2021 Term = NONE

99439 – CHRNC CARE MGMT SVC EA ADDL Eff = 01/01/2021 Term = NONE


A9591 – FLUOROESTRADIOL F 18 Eff = 01/01/2021 Term = NONE

C1052 – HEMOSTATIC AGENT, GI, TOPIC Eff = 01/01/2021 Term = NONE

C1062 – INTRAVERTEBRAL FX AUG IMPL Eff = 01/01/2021 Term = NONE

C1748 – ENDOSCOPE, SINGLE, UGI Eff = 07/01/2020 Term = NONE

C1825 – GEN, NEURO, CAROT SINUS BARO Eff = 01/01/2021 Term = NONE

C1849 – SKIN SUBSTITUTE, SYNTHETIC Eff = 07/01/2020 Term = NONE

C9053 – INJ, CRIZANLIZUMAB-TMCA Eff = 04/01/2020 Term = 06/30/2020

C9056 – INJECTION, GIVOSIRAN Eff = 04/01/2020 Term = 06/30/2020

C9057 – INJ CETIRIZINE HYDROCHLORIDE Eff = 04/01/2020 Term = 06/30/2020

C9058 – INJECTION,PEGFILGRASTIM-BMEZ Eff = 11/15/2019 Term = 06/30/2020

C9059 – INJECTION, MELOXICAM Eff = 07/01/2020 Term = 09/30/2020

C9060 – FLUOROESTRADIOL F18 Eff = 10/01/2020 Term = 12/31/2020

C9061 – INJECTION, TEPROTUMUMAB-TRBW Eff = 07/01/2020 Term = 09/30/2020

C9062 – DARATUMUMAB HYALURONIDASE Eff = 10/01/2020 Term = 12/31/2020

C9063 – INJECTION, EPTINEZUMAB-JJMR Eff = 07/01/2020 Term = 09/30/2020

C9064 – MITOMYCIN PYELOCALYCEAL INST Eff = 10/01/2020 Term = 12/31/2020

C9065 – ROMIDEPSIN NON-LYOPHILIZED Eff = 10/01/2020 Term = NONE

C9066 – SACITUZUMAB GOVITECAN-HZIY Eff = 10/01/2020 Term = 12/31/2020

C9067 – GALLIUM GA-68 DOTATOC Eff = 10/01/2020 Term = NONE

C9068 – COPPER CU-64, DOTATATE, DX Eff = 01/01/2021 Term = NONE

C9069 – BELANTAMAB MAFODONTIN-BLMF Eff = 01/01/2021 Term = NONE

C9070 – INJECTION, TAFASITAMAB-CXIX Eff = 01/01/2021 Term = NONE

C9071 – INJECTION, VILTOLARSEN Eff = 01/01/2021 Term = NONE

C9072 – INJ, IMM GLOB ASCENIV Eff = 01/01/2021 Term = NONE

C9073 – BREXUCABTAGENE AUTOLEUCEL CA Eff = 01/01/2021 Term = NONE

C9122 – MOMETASONE FUROATE (SINUVA) Eff = 07/01/2020 Term = NONE

C9759 – TRANSCATH INTRAOP MICROINF Eff = 07/01/2020 Term = NONE

C9760 – NON-BLIND INTERATRIAL SHUNT Eff = 07/01/2020 Term = NONE

C9761 – CYSTO, LITHO, VACUUM KIDNEY Eff = 10/01/2020 Term = NONE

C9762 – CARDIAC MRI SEG DYS STRAIN Eff = 07/01/2020 Term = NONE

C9763 – CARDIAC MRI SEG DYS STRESS Eff = 07/01/2020 Term = NONE

C9764 – REVASC INTRAVASC LITHOTRIPSY Eff = 07/01/2020 Term = NONE

C9765 – REVASC INTRA LITHOTRIP-STENT Eff = 07/01/2020 Term = NONE

C9766 – REVASC INTRA LITHOTRIP-ATHER Eff = 07/01/2020 Term = NONE

C9767 – REVASC LITHOTRIP-STENT-ATHER Eff = 07/01/2020 Term = NONE

C9768 – ENDO US-GUIDE HEP PORTO GRAD Eff = 10/01/2020 Term = NONE

C9769 – CYSTO W/TEMP PROS IMPLANT Eff = 10/01/2020 Term = NONE

C9770 – VITREC/MECH PARS, SUBRET INJ Eff = 01/01/2021 Term = NONE

C9771 – NSL/SINS CRYO POST NASAL TIS Eff = 01/01/2021 Term = NONE

C9772 – REVASC LITHOTRIP TIBI/PERONE Eff = 01/01/2021 Term = NONE

C9773 – REVASC LITHOTR-STENT TIB/PER Eff = 01/01/2021 Term = NONE

C9774 – REVASC LITHOTR-ATHER TIB/PER Eff = 01/01/2021 Term = NONE

C9775 – REVASC LITH-STEN-ATH TIB/PER Eff = 01/01/2021 Term = NONE

C9803 – HOPD COVID-19 SPEC COLLECT Eff = 03/01/2020 Term = NONE

D0604 – ANTIGEN TEST PUB HLTH PATHOG Eff = 01/01/2021 Term = NONE

D0605 – ANTIBODY TEST PUB HLTH PATH Eff = 01/01/2021 Term = NONE

D0701 – PANO RADIO IMAGE Eff = 01/01/2021 Term = NONE

D0702 – 2D CEPHAL RADIO IMAGE Eff = 01/01/2021 Term = NONE

D0703 – 2D ORAL/FACIAL PHOTO IMAGE Eff = 01/01/2021 Term = NONE

D0704 – 3D PHOTO IMAGE CAPTURE ONLY Eff = 01/01/2021 Term = NONE

D0705 – EXTRA ORAL POST RADIO IMAGE Eff = 01/01/2021 Term = NONE

D0706 – INTRAORAL OCCLUS RADIO IMAGE Eff = 01/01/2021 Term = NONE

D0707 – INTRAORAL PERIAP RADIO IMAGE Eff = 01/01/2021 Term = NONE

D0708 – INTRAORAL BITE RADIO IMAGE Eff = 01/01/2021 Term = NONE

D0709 – INTRAORAL CMPLT RADIO IMAGES Eff = 01/01/2021 Term = NONE

D1321 – COUNS FOR HIGH RISK SUB USE Eff = 01/01/2021 Term = NONE

D1355 – CARIES MED APP PER TOOTH Eff = 01/01/2021 Term = NONE

D2928 – PREFAB PORC/CER CROWN PERM Eff = 01/01/2021 Term = NONE

D3471 – SURG REP ROOT RES ANTERIOR Eff = 01/01/2021 Term = NONE

D3472 – SURG REP ROOT RES PREMOLAR Eff = 01/01/2021 Term = NONE

D3473 – SURG REP ROOT RES MOLAR Eff = 01/01/2021 Term = NONE

D3501 – SURG EXP ROOT SURF ANTERIOR Eff = 01/01/2021 Term = NONE

D3502 – SURG EXP ROOT SURF PREMOLAR Eff = 01/01/2021 Term = NONE

D3503 – SURG EXP ROOT SURF MOLAR Eff = 01/01/2021 Term = NONE

D5995 – PERI MEDICAMENT W/SEAL, MAX Eff = 01/01/2021 Term = NONE

D5996 – PERI MEDICAMENT W/SEAL, MAND Eff = 01/01/2021 Term = NONE

D6191 – SEMI PRECISION ABUTMENT Eff = 01/01/2021 Term = NONE

D6192 – SEMI PRECISION ATTACHMENT Eff = 01/01/2021 Term = NONE

D7961 – BUCCAL/LABIAL FRENECTOMY Eff = 01/01/2021 Term = NONE

D7962 – LINGUAL FRENECTOMY Eff = 01/01/2021 Term = NONE

D7993 – SURG PLACE CRANIOFACIAL IMPL Eff = 01/01/2021 Term = NONE

D7994 – SURG PLACE ZYGOMATIC IMPL Eff = 01/01/2021 Term = NONE

G0088 – ADM IV DRUG 1ST HOME VISIT Eff = 01/01/2021 Term = NONE

G0089 – ADM SUBQ DRUG 1ST HOME VISIT Eff = 01/01/2021 Term = NONE

G0090 – ADM IV CHEMO 1ST HOME VISIT Eff = 01/01/2021 Term = NONE

G1012 – CDSM AGILEMD Eff = 04/01/2020 Term = NONE

G1013 – CDSM EVIDENCECARE Eff = 04/01/2020 Term = NONE

G1014 – CDSM INVENIQA Eff = 04/01/2020 Term = NONE

G1015 – CDSM RELIANT Eff = 04/01/2020 Term = NONE

G1016 – CDSM SPEED OF CARE Eff = 04/01/2020 Term = NONE

G1017 – CDSM HEALTHHELP Eff = 04/01/2020 Term = NONE

G1018 – CDSM INFINX Eff = 04/01/2020 Term = NONE

G1019 – CDSM LOGICNETS Eff = 04/01/2020 Term = NONE

G1020 – CDSM CURBSIDE Eff = 10/01/2020 Term = NONE

G1021 – CDSM EHEALTHLINE Eff = 10/01/2020 Term = NONE

G1022 – CDSM INTERMOUNTAIN Eff = 10/01/2020 Term = NONE

G1023 – CDSM PERSIVIA Eff = 10/01/2020 Term = NONE

G2023 – SPECIMEN COLLECT COVID-19 Eff = 03/01/2020 Term = NONE

G2024 – SPEC COLL SNF/LAB COVID-19 Eff = 03/01/2020 Term = NONE

G2025 – DIS SITE TELE SVCS RHC/FQHC Eff = 01/27/2020 Term = NONE

G2168 – SVS BY PT IN HOME HEALTH Eff = 01/01/2020 Term = NONE

G2169 – SVS BY OT IN HOME HEALTH Eff = 01/01/2020 Term = NONE

G2170 – AVF BY TISSUE W THERMAL E Eff = 07/01/2020 Term = NONE

G2171 – AVF USE MAGNETIC/ART/VEN Eff = 07/01/2020 Term = NONE

G2173 – URI W COMORB 12M OTH DX Eff = 01/01/2021 Term = NONE

G2174 – URI NEW RX ANTIBIOTIC 30D Eff = 01/01/2021 Term = NONE

G2175 – PT COMORB DX 12M OF EPI Eff = 01/01/2021 Term = NONE

G2176 – OUTPT ED OBS W INPT ADMIT Eff = 01/01/2021 Term = NONE

G2177 – BRONCH W RX ANTIBX 30D Eff = 01/01/2021 Term = NONE

G2178 – PT NOT ELIG LOW NEURO EX Eff = 01/01/2021 Term = NONE

G2179 – MED DOC RSN NO LOW EX Eff = 01/01/2021 Term = NONE

G2180 – INELIG FOOTWR EVAL Eff = 01/01/2021 Term = NONE

G2181 – BMI NOT DOC MEDRSN PTREF Eff = 01/01/2021 Term = NONE

G2182 – PT 1ST BIOLOG ANTIRHEUM Eff = 01/01/2021 Term = NONE

G2183 – DOC PT UNABLE COMM Eff = 01/01/2021 Term = NONE

G2184 – NO CAREGIVER Eff = 01/01/2021 Term = NONE


G2185 – CAREGIVER DEM TRAINED Eff = 01/01/2021 Term = NONE

G2186 – PT REF APP RSRCS Eff = 01/01/2021 Term = NONE

G2187 – CLIN IND IMG HD TRAUMA Eff = 01/01/2021 Term = NONE

G2188 – PT 50 YRS W/CLIN IND HD Eff = 01/01/2021 Term = NONE

G2189 – IMG HD ABNML NEURO EXAM Eff = 01/01/2021 Term = NONE

G2190 – IND IMG HD RAD NECK Eff = 01/01/2021 Term = NONE

G2191 – IND IMG HD POS HD ACHE Eff = 01/01/2021 Term = NONE

G2192 - >55 YRS TEMP HD ACHE Eff = 01/01/2021 Term = NONE

G2193 - <6YR NEW ONSET HD ACHE Eff = 01/01/2021 Term = NONE

G2194 – NEW HDACHE PED PT DIS Eff = 01/01/2021 Term = NONE

G2195 – OCCIP HDACHE CHILD Eff = 01/01/2021 Term = NONE

G2196 – SCREEN UNHLTHY ETOH USE Eff = 01/01/2021 Term = NONE

G2197 – SCREEN HLTHY ETOH USE Eff = 01/01/2021 Term = NONE

G2198 – MED RSN NO UNHLTHY ETOH Eff = 01/01/2021 Term = NONE

G2199 – NOT SCRN ETOH NO RSN Eff = 01/01/2021 Term = NONE

G2200 – UNHLTHY ETOH RCVD COUNS Eff = 01/01/2021 Term = NONE

G2201 – MED RSN NO BRIEF COUNS Eff = 01/01/2021 Term = NONE

G2202 – NO RSN NO BRIEF COUNS Eff = 01/01/2021 Term = NONE

G2203 – MED RSN NO ETOH COUNS Eff = 01/01/2021 Term = NONE

G2204 – PT 50-85 W/ SCOPE Eff = 01/01/2021 Term = NONE

G2205 – PREG DRNG ADJV TRTMT Eff = 01/01/2021 Term = NONE

G2206 – ADJV TRTMT CHEMO HER2 Eff = 01/01/2021 Term = NONE

G2207 – RSN NO TRTMT CHEM HER2 Eff = 01/01/2021 Term = NONE

G2208 – NO TRTMT CHEMO AND HER2 Eff = 01/01/2021 Term = NONE

G2209 – REFUSED TO PARTICIPATE Eff = 01/01/2021 Term = NONE

G2210 – NO NECK FS PROM NO RSN Eff = 01/01/2021 Term = NONE

G2211 – COMPLEX E/M VISIT ADD ON Eff = 01/01/2021 Term = NONE

G2212 – PROLONG OUTPT/OFFICE VIS Eff = 01/01/2021 Term = NONE

G2213 – INITIAT MED ASSIST TX IN ER Eff = 01/01/2021 Term = NONE

G2214 – INIT/SUB PSYCH CARE M 1ST 30 Eff = 01/01/2021 Term = NONE

G2215 – HOME SUPPLY NASAL NALOXONE Eff = 01/01/2021 Term = NONE

G2216 – HOME SUPPLY INJECT NALOXON Eff = 01/01/2021 Term = NONE

G2250 – REMOT IMG SUB BY PT, NON E/M Eff = 01/01/2021 Term = NONE

G2251 – BRIEF CHKIN, 5-10, NON-E/M Eff = 01/01/2021 Term = NONE

G2252 – BRIEF CHKIN BY MD/QHP, 11-20 Eff = 01/01/2021 Term = NONE

J0223 – INJ GIVOSIRAN 0.5 MG Eff = 07/01/2020 Term = NONE

J0591 – INJ DEOXYCHOLIC ACID, 1 MG Eff = 07/01/2020 Term = NONE

J0691 – INJ LEFAMULIN 1 MG Eff = 07/01/2020 Term = NONE

J0693 – INJ., CEFIDEROCOL, 5 MG Eff = 01/01/2021 Term = NONE

J0742 – INJ IMIP 4 CILAS 4 RELEB 2MG Eff = 07/01/2020 Term = NONE

J0791 – INJ CRIZANLIZUMAB-TMCA 5MG Eff = 07/01/2020 Term = NONE

J0896 – INJ LUSPATERCEPT-AAMT 0.25MG Eff = 07/01/2020 Term = NONE

J1201 – INJ. CETIRIZINE HCL 0.5MG Eff = 07/01/2020 Term = NONE

J1429 – INJ GOLODIRSEN 10 MG Eff = 07/01/2020 Term = NONE

J1437 – INJ. FE DERISOMALTOSE 10 MG Eff = 10/01/2020 Term = NONE

J1558 – INJ. XEMBIFY, 100 MG Eff = 07/01/2020 Term = NONE

J1632 – INJ., BREXANOLONE, 1 MG Eff = 10/01/2020 Term = NONE

J1738 – INJ. MELOXICAM 1 MG Eff = 10/01/2020 Term = NONE

J1823 – INJ. INEBILIZUMAB-CDON, 1 MG Eff = 01/01/2021 Term = NONE

J3032 – INJ. EPTINEZUMAB-JJMR 1 MG Eff = 10/01/2020 Term = NONE

J3241 – INJ. TEPROTUMUMAB-TRBW 10 MG Eff = 10/01/2020 Term = NONE

J3399 – INJ ONASE ABEPAR-XIOI TREAT Eff = 07/01/2020 Term = NONE

J7169 – INJ ANDEXXA, 10 MG Eff = 07/01/2020 Term = NONE

J7204 – INJ RECOMBIN ESPEROCT PER IU Eff = 07/01/2020 Term = NONE

J7212 – FACTOR VIIA RECOMB SEVENFACT Eff = 01/01/2021 Term = NONE

J7333 – VISCO-3 INJ DOSE Eff = 07/01/2020 Term = NONE

J7351 – INJ BIMATOPROST ITC IMP1MCG Eff = 10/01/2020 Term = NONE

J7352 – AFAMELANOTIDE IMPLANT, 1 MG Eff = 01/01/2021 Term = NONE

J9144 – DARATUMUMAB, HYALURONIDASE Eff = 01/01/2021 Term = NONE

J9177 – INJ ENFORT VEDO-EJFV 0.25MG Eff = 07/01/2020 Term = NONE

J9198 – INJ. INFUGEM, 100 MG Eff = 07/01/2020 Term = NONE

J9223 – INJ. LURBINECTEDIN, 0.1 MG Eff = 01/01/2021 Term = NONE

J9227 – INJ. ISATUXIMAB-IRFC 10 MG Eff = 10/01/2020 Term = NONE

J9246 – INJ., EVOMELA, 1 MG Eff = 07/01/2020 Term = NONE

J9281 – MITOMYCIN INSTILLATION Eff = 01/01/2021 Term = NONE

J9304 – INJ. PEMETREXED, 10 MG Eff = 10/01/2020 Term = NONE

J9316 – PERTUZU, TRASTUZU, 10 MG Eff = 01/01/2021 Term = NONE

J9317 – SACITUZUMAB GOVITECAN-HZIY Eff = 01/01/2021 Term = NONE

J9358 – INJ FAM-TRASTU DERU-NXKI 1MG Eff = 07/01/2020 Term = NONE

K1006 – SUCT PUM EXT URINE MGMT SYS Eff = 10/01/2020 Term = NONE

K1007 – BIL HKAF PC S/D MICRO SENSOR Eff = 10/01/2020 Term = NONE

K1009 – SPEECH VOLUME MODULATION SYS Eff = 10/01/2020 Term = NONE

K1010 – INTRAURETHRAL DRAINAG DEVICE Eff = 10/01/2020 Term = NONE

K1011 – ACTI INTRAURETHRAL DRAINAGE Eff = 10/01/2020 Term = NONE

K1012 – CHARGER BASE STATION INTRAUR Eff = 10/01/2020 Term = NONE

M0239 – BAMLANIVIMAB-XXXX INFUSION Eff = 11/09/2020 Term = NONE

M0243 – CASIRIVI AND IMDEVI INFUSION Eff = 11/21/2020 Term = NONE

M1145 – MFN DRUG ADD-ON, PER DOSE Eff = 01/01/2021 Term = NONE

M1146 – ONGOING CARE NOT IND Eff = 01/01/2021 Term = NONE

M1147 – CARE NOT POSS MED RSN Eff = 01/01/2021 Term = NONE

M1148 – PT SELF DSCHG Eff = 01/01/2021 Term = NONE

M1149 – NO NECK FS PROM INCAP Eff = 01/01/2021 Term = NONE

Q0239 – BAMLANIVIMAB-XXXX Eff = 11/09/2020 Term = NONE

Q0243 – CASIRIVIMAB AND IMDEVIMAB Eff = 11/21/2020 Term = NONE

Q4227 – AMNIOCORE PER SQ CM Eff = 07/01/2020 Term = NONE

Q4228 – BIONEXTPATCH, PER SQ CM Eff = 07/01/2020 Term = NONE

Q4229 – COGENEX AMNIO MEMB PER SQ CM Eff = 07/01/2020 Term = NONE

Q4230 – COGENEX FLOW AMNION 0.5 CC Eff = 07/01/2020 Term = NONE

Q4231 – CORPLEX P, PER CC Eff = 07/01/2020 Term = NONE

Q4232 – CORPLEX, PER SQ CM Eff = 07/01/2020 Term = NONE

Q4233 – SURFACTOR /NUDYN PER 0.5 CC Eff = 07/01/2020 Term = NONE

Q4234 – XCELLERATE, PER SQ CM Eff = 07/01/2020 Term = NONE

Q4235 – AMNIOREPAIR OR ALTIPLY SQ CM Eff = 07/01/2020 Term = NONE

Q4236 – CAREPATCH PER SQ CM Eff = 07/01/2020 Term = NONE

Q4237 – CRYO-CORD, PER SQ CM Eff = 07/01/2020 Term = NONE

Q4238 – DERM-MAXX, PER SQ CM Eff = 07/01/2020 Term = NONE

Q4239 – AMNIO-MAXX OR LITE PER SQ CM Eff = 07/01/2020 Term = NONE

Q4240 – CORECYTE TOPICAL ONLY 0.5 CC Eff = 07/01/2020 Term = NONE

Q4241 – POLYCYTE, TOPICAL ONLY 0.5CC Eff = 07/01/2020 Term = NONE

Q4242 – AMNIOCYTE PLUS, PER 0.5 CC Eff = 07/01/2020 Term = NONE

Q4244 – PROCENTA, PER 200 MG Eff = 07/01/2020 Term = NONE

Q4245 – AMNIOTEXT, PER CC Eff = 07/01/2020 Term = NONE

Q4246 – CORETEXT OR PROTEXT, PER CC Eff = 07/01/2020 Term = NONE

Q4247 – AMNIOTEXT PATCH, PER SQ CM Eff = 07/01/2020 Term = NONE

Q4248 – DERMACYTE AMN MEM ALLO SQ CM Eff = 07/01/2020 Term = NONE

Q4249 – AMNIPLY, PER SQ CM Eff = 10/01/2020 Term = NONE


Q4250 – AMNIOAMP-MP PER SQ CM Eff = 10/01/2020 Term = NONE

Q4254 – NOVAFIX DL PER SQ CM Eff = 10/01/2020 Term = NONE

Q4255 – REGUARD, TOPICAL USE PER SQ Eff = 10/01/2020 Term = NONE

Q5119 – INJ RUXIENCE, 10 MG Eff = 07/01/2020 Term = NONE

Q5120 – INJ PEGFILGRASTIM-BMEZ 0.5MG Eff = 07/01/2020 Term = NONE

Q5121 – INJ. AVSOLA, 10 MG Eff = 07/01/2020 Term = NONE

Q5122 – INJ, NYVEPRIA Eff = 01/01/2021 Term = NONE

Q9001 – VA CHAPLAIN ASSESSMENT Eff = 10/01/2020 Term = NONE

Q9002 – VA CHAPLAIN COUNSEL INDIVIDU Eff = 10/01/2020 Term = NONE

Q9003 – VA CHAPLAIN COUNSEL GROUP Eff = 10/01/2020 Term = NONE

S0013 – ESKETAMINE, NASAL SPRAY Eff = 01/01/2021 Term = NONE

T2047 – HAB PREVO WAIVER PER 15 Eff = 10/01/2020 Term = NONE

U0001 – 2019-NCOV DIAGNOSTIC P Eff = 02/04/2020 Term = NONE

U0002 – COVID-19 LAB TEST NON-CDC Eff = 02/04/2020 Term = NONE

U0003 – COV-19 AMP PRB HGH THRUPUT Eff = 04/14/2020 Term = NONE

U0004 – COV-19 TEST NON-CDC HGH THRU Eff = 04/14/2020 Term = NONE

U0005 – INFEC AGEN DETEC AMPLI PROBE Eff = 01/01/2021 Term = NONE

V2524 – CNTCT LENS HYDROPHIL PHOTOCH Eff = 10/01/2020 Term = NONE

New HCPCS Code Count = 491

Deleted HCPCS Codes:

Deleted HCPCS Code Count = 0

Modified HCPCS Codes (changes only shown on second line):

0006U – DETC IA MEDS 120+ ANALYTES Eff = 08/01/2017 Term = NONE

Term = 03/31/2020

0058T – CRYOPRESERVATION OVARY TISS Eff = 12/31/2008 Term = NONE

Term = 12/31/2020

0085T – BREATH TEST HEART REJECT Eff = 01/01/2005 Term = NONE

Term = 12/31/2020

0111T – RBC MEMBRANES FATTY ACIDS Eff = 01/01/2006 Term = NONE

Term = 12/31/2020

0124U – FTL CGEN ABNOR 3 ANALYTES Eff = 10/01/2019 Term = NONE

Term = 06/30/2020

0125U – FTL CGEN ABNOR PRNT COMP 5 Eff = 10/01/2019 Term = NONE

Term = 06/30/2020

0126T – CHD RISK IMT STUDY Eff = 01/01/2006 Term = NONE

Term = 12/31/2020

0126U – FTL CGEN ABNOR PRNT COMP 5 Y Eff = 10/01/2019 Term = NONE

Term = 06/30/2020

0127U – OB PE 3 ANALYTES Eff = 10/01/2019 Term = NONE

Term = 06/30/2020

0128U – OB PE 3 ANALYTES Y CHRMSM Eff = 10/01/2019 Term = NONE

Term = 06/30/2020

0152U – NFCT BCT FNG PRST DNA >1000 Eff = 01/01/2020 Term = NONE

NFCT DS DNA UNTRGT NGNRJ SEQ

0154U – FGFR3 GENE ANALYSIS Eff = 01/01/2020 Term = NONE

ONC URTHL CA RNA FGFR3 GENE

0155U – PIK3CA GENE ANALYSIS Eff = 01/01/2020 Term = NONE

ONC BRST CA DNA PIK3CA GENE

0228T – NJX TFRML EPRL W/US CER/THOR Eff = 07/01/2010 Term = NONE

Term = 12/31/2020

0229T – NJX TFRML EPRL W/US CER/THOR Eff = 07/01/2010 Term = NONE

Term = 12/31/2020

0230T – NJX TFRML EPRL W/US LUMB/SAC Eff = 07/01/2010 Term = NONE

Term = 12/31/2020

0231T – NJX TFRML EPRL W/US LUMB/SAC Eff = 07/01/2010 Term = NONE

Term = 12/31/2020

0295T – EXT ECG COMPLETE Eff = 01/01/2012 Term = NONE

Term = 12/31/2020

0296T – EXT ECG RECORDING Eff = 01/01/2012 Term = NONE

Term = 12/31/2020

0297T – EXT ECG SCAN W/REPORT Eff = 01/01/2012 Term = NONE

Term = 12/31/2020

0298T – EXT ECG REVIEW AND INTERP Eff = 01/01/2012 Term = NONE

Term = 12/31/2020

0381T – EXT H RATE EPI SZ 14 DAYS Eff = 01/01/2015 Term = NONE

Term = 12/31/2020

0382T – EXT H RATE SZ 14 DAY RI ONLY Eff = 01/01/2015 Term = NONE

Term = 12/31/2020

0383T – EXT H RATE SZ UP TO 30 DAYS Eff = 01/01/2015 Term = NONE

Term = 12/31/2020

0384T – EX H RATE SZ 30 DAY RI ONLY Eff = 01/01/2015 Term = NONE

Term = 12/31/2020

0385T – EX H RATE FOR SZ OVR 30 DAY Eff = 01/01/2015 Term = NONE

Term = 12/31/2020

0386T – EX H RATE SZ 30+ DAY RI ONLY Eff = 01/01/2015 Term = NONE

Term = 12/31/2020

0396T – INTRAOP KINETIC BALNCE SENSR Eff = 01/01/2016 Term = NONE

Term = 12/31/2020

0400T – MLTISPECTRL DIGITAL LES ALYS Eff = 01/01/2016 Term = NONE

Term = 12/31/2020

0401T – MLTISPECTRL DIGITAL LES ALYS Eff = 01/01/2016 Term = NONE

Term = 12/31/2020

0405T – OVRSGHT XTRCORP LIV ASST PAT Eff = 01/01/2016 Term = NONE

Term = 12/31/2020

11970 – REPLACE TISSUE EXPANDER Eff = 01/01/1985 Term = NONE

RPLCMT TISS XPNDR PERM IMPLT

11971 – REMOVE TISSUE EXPANDER(S) Eff = 01/01/1988 Term = NONE

RMVL TIS XPNDR WO INSJ IMPLT

19318 – REDUCTION OF LARGE BREAST Eff = 01/01/1984 Term = NONE

BREAST REDUCTION

19324 – ENLARGE BREAST Eff = 01/01/1984 Term = NONE

Term = 12/31/2020

19325 – ENLARGE BREAST WITH IMPLANT Eff = 01/01/1984 Term = NONE

BREAST AUGMENTATION W/IMPLT

19328 – REMOVAL OF BREAST IMPLANT Eff = 01/01/1984 Term = NONE

RMVL INTACT BREAST IMPLANT

19330 – REMOVAL OF IMPLANT MATERIAL Eff = 01/01/1982 Term = NONE

RMVL RUPTURED BREAST IMPLANT

19340 – IMMEDIATE BREAST PROSTHESIS Eff = 01/01/1984 Term = NONE

INSJ BREAST IMPLT SM D MAST

19342 – DELAYED BREAST PROSTHESIS Eff = 01/01/1984 Term = NONE

INSJ/RPLCMT BRST IMPLT SEP D

19357 – BREAST RECONSTRUCTION Eff = 01/01/1992 Term = NONE

TISS XPNDR PLMT BRST RCNSTJ


19361 – BREAST RECONSTR W/LAT FLAP Eff = 01/01/1992 Term = NONE

BRST RCNSTJ LATSMS DRSI FLAP


BRST RCNSTJ FREE FLAP


Term = 12/31/2020


BRST RCNSTJ 1 PDCL TRAM FLAP


BRST RCNSTJ 1PDCL TRAM ANAST


BRST RCNSTJ 2 PDCL TRAM FLAP

19370 – SURGERY OF BREAST CAPSULE Eff = 01/01/1984 Term = NONE

REVJ PERI-IMPLT CAPSULE BRST

19371 – REMOVAL OF BREAST CAPSULE Eff = 01/01/1984 Term = NONE

PERI-IMPLT CAPSLC BRST COMPL

19380 – REVISE BREAST RECONSTRUCTION Eff = 01/01/1984 Term = NONE

REVJ RECONSTRUCTED BREAST

29805 – SHOULDER ARTHROSCOPY DX Eff = 01/01/2002 Term = NONE

SHO ARTHRS DX +- SYNOVIAL BX

29806 – SHOULDER ARTHROSCOPY/SURGERY Eff = 01/01/2002 Term = NONE

SHO ARTHRS SRG CAPSULORPAPHY


SHO ARTHRS SRG RPR SLAP LES


SHO ARTHRS SRG RMVL LOOSE/FB


SHO ARTHRS SRG PRTL SYNVCT


SHO ARTHRS SRG COMPL SYNVCT


SHO ARTHRS SRG LMTD DBRDMT


SHO ARTHRS SRG XTNSV DBRDMT


SHO ARTHRS SRG DSTL CLAVICLC


SHO ARTHRS SRG LSS&RESCJ ADS


SHO ARTHRS SRG DECOMPRESSION

29827 – ARTHROSCOP ROTATOR CUFF REPR Eff = 01/01/2003 Term = NONE

SHO ARTHRS SRG RT8TR CUF RPR

29828 – ARTHROSCOPY BICEPS TENODESIS Eff = 01/01/2008 Term = NONE

SHO ARTHRS SRG BICP TENODSIS

3051F – HG A1C>EQUAL 7.0%<8.0% Eff = 10/01/2019 Term = NONE

Eff = 01/01/2020

3052F – HG A1C>EQUAL 8.0%<EQUAL 9.0% Eff = 10/01/2019 Term = NONE

Eff = 01/01/2020

3170F – FLOW CYTO DONE B/4 TX Eff = 07/01/2007 Term = NONE

BASELIN FLO CYTOMETRY B/4 TX

32405 – PERCUT BX LUNG/MEDIASTINUM Eff = 01/01/1984 Term = NONE

Term = 12/31/2020

33990 – INSERT VAD ARTERY ACCESS Eff = 01/01/2013 Term = NONE

INSJ PERQ VAD L HRT ARTERIAL

33991 – INSERT VAD ART&VEIN ACCESS Eff = 01/01/2013 Term = NONE

INSJ PERQ VAD L HRT ARTL&VEN

33992 – REMOVE VAD DIFFERENT SESSION Eff = 01/01/2013 Term = NONE

RMVL PERQ LEFT HEART VAD

33993 – REPOSITION VAD DIFF SESSION Eff = 01/01/2013 Term = NONE

REPOSG PERQ R/L HRT VAD

49220 – MULTIPLE SURGERY ABDOMEN Eff = 01/01/1984 Term = NONE

Term = 12/31/2020

57112 – VAGINECTOMY W/NODES COMPL Eff = 01/01/1999 Term = NONE

Term = 12/31/2020

58293 – VAG HYST W/URO REPAIR COMPL Eff = 01/01/2003 Term = NONE

Term = 12/31/2020

61870 – IMPLANT NEUROELECTRODES Eff = 01/01/1982 Term = NONE

Term = 12/31/2020

62163 – ZNEUROENDOSCOPY W/FB REMOVAL Eff = 01/01/2003 Term = NONE

Term = 12/31/2020

63180 – REVISE SPINAL CORD LIGAMENTS Eff = 01/01/1984 Term = NONE

Term = 12/31/2020

63182 – REVISE SPINAL CORD LIGAMENTS Eff = 01/01/1984 Term = NONE

Term = 12/31/2020

64455 – N BLOCK INJ PLANTAR DIGIT Eff = 01/01/2009 Term = NONE

NJX AA&/STRD PLTR COM DG NRV

64479 – INJ FORAMEN EPIDURAL C/T Eff = 01/01/2000 Term = NONE

NJX AA&/STRD TFRM EPI C/T 1

64480 – INJ FORAMEN EPIDURAL ADD-ON Eff = 01/01/2000 Term = NONE

NJX AA&/STRD TFRM EPI C/T EA

64483 – INJ FORAMEN EPIDURAL L/S Eff = 01/01/2000 Term = NONE

NJX AA&/STRD TFRM EPI L/S 1

64484 – INJ FORAMEN EPIDURAL ADD-ON Eff = 01/01/2000 Term = NONE

NJX AA&/STRD TFRM EPI L/S EA

69605 – MASTOID SURGERY REVISION Eff = 01/01/1984 Term = NONE

Term = 12/31/2020

71250 – CT THORAX W/O DYE Eff = 01/01/1984 Term = NONE

CT THORAX DX C-

71260 – CT THORAX W/DYE Eff = 01/01/1984 Term = NONE

CT THORAX DX C+

71270 – CT THORAX W/O & W/DYE Eff = 01/01/1984 Term = NONE

CT THORAX DX C-/C+

74400 – CONTRST X-RAY URINARY TRACT Eff = 01/01/1986 Term = NONE

UROGRAPHY IV +-KUB TOMOG


UROGRAPHY NFS DRIP&/BOLUS


UROGRAPHY NFS DRIP&/BLS W/NF


UROGRAPHY RTRGR +-KUB


UROGRAPHY ANTEGRADE RS&I

76510 – OPHTH US B & QUANT A Eff = 01/01/2005 Term = NONE

OPH US DX B-SCAN&QUAN A-SCAN

76511 – OPHTH US QUANT A ONLY Eff = 01/01/1982 Term = NONE

OPH US DX QUAN A-SCAN ONLY


76512 – OPHTH US B W/NON-QUANT A Eff = 01/01/1982 Term = NONE

OPH US DX B-SCAN

76513 – ECHO EXAM OF EYE WATER BATH Eff = 01/01/1988 Term = NONE

OPH US DX ANT SGM US UNI/BI

76970 – ULTRASOUND EXAM FOLLOW-UP Eff = 01/01/1986 Term = NONE

Term = 12/31/2020

78135 – RED CELL SURVIVAL KINETICS Eff = 01/01/1984 Term = NONE

Term = 12/31/2020

80414 – TESTOSTERONE RESPONSE Eff = 01/01/1994 Term = NONE

TESTOSTERONE RESPONSE PANEL

80415 – ESTRADIOL RESPONSE PANEL Eff = 01/01/1994 Term = NONE

TOT ESTRADIOL RESPONSE PANEL

81545 – ONCOLOGY THYROID Eff = 01/01/2016 Term = NONE

Term = 12/31/2020

82670 – ASSAY OF ESTRADIOL Eff = 01/01/1984 Term = NONE

ASSAY OF TOTAL ESTRADIOL

86318 – IMMUNOASSAY INFECTIOUS AGENT Eff = 01/01/1989 Term = NONE

IA INFECTIOUS AGENT ANTIBODY

87338 – HPYLORI STOOL IA Eff = 01/01/2000 Term = NONE

HPYLORI STOOL AG IA

87380 – HEPATITIS DELTA AG IA Eff = 01/01/1998 Term = NONE

HEPATITIS DELTA AGENT AG IA

87389 – HIV-1 AG W/HIV-1 & HIV-2 AB Eff = 01/01/2012 Term = NONE

HIV-1 AG W/HIV-1&2 AB AG IA

87400 – INFLUENZA A/B AG IA Eff = 01/01/2001 Term = NONE

INFLUENZA A/B EACH AG IA

87420 – RESP SYNCYTIAL AG IA Eff = 01/01/1998 Term = NONE

RESP SYNCYTIAL VIRUS AG IA

87449 – AG DETECT NOS IA MULT Eff = 01/01/1998 Term = NONE

NOS EACH ORGANISM AG IA

87450 – AG DETECT NOS IA SINGLE Eff = 01/01/1998 Term = NONE

Term = 10/05/2020

87451 – AG DETECT POLYVAL IA MULT Eff = 01/01/2001 Term = NONE

POLYVALENT MULT ORG EA AG IA

87806 – HIV ANTIGEN W/HIV ANTIBODIES Eff = 01/01/2015 Term = NONE

HIV W/HIV1&2 ANTB W/OPTIC

90619 – MENACWY-TT VACCINE IM Eff = 01/01/2020 Term = NONE

Eff = 07/01/2019

92227 – REMOTE DX RETINAL IMAGING Eff = 01/01/2011 Term = NONE

IMG RTA DETCJ/MNTR DS STAFF

92228 – REMOTE RETINAL IMAGING MGMT Eff = 01/01/2011 Term = NONE

IMG RTA DETC/MNTR DS PHY/QHP

92585 – AUDITOR EVOKE POTENT COMPRE Eff = 01/01/1982 Term = NONE

Term = 12/31/2020

92586 – AUDITOR EVOKE POTENT LIMIT Eff = 01/01/2001 Term = NONE

Term = 12/31/2020

92992 – REVISION OF HEART CHAMBER Eff = 01/01/1994 Term = NONE

Term = 12/31/2020

92993 – REVISION OF HEART CHAMBER Eff = 01/01/1994 Term = NONE

Term = 12/31/2020

94250 – EXPIRED GAS COLLECTION Eff = 01/01/1984 Term = NONE

Term = 12/31/2020

94400 – CO2 BREATHING RESPONSE CURVE Eff = 01/01/1984 Term = NONE

Term = 12/31/2020

94617 – EXERCISE TST BRNCSPSM Eff = 01/01/2018 Term = NONE

EXERCISE TST BRNCSPSM W/ECG

94750 – PULMONARY COMPLIANCE STUDY Eff = 01/01/1984 Term = NONE

Term = 12/31/2020

94770 – EXHALED CARBON DIOXIDE TEST Eff = 01/01/1984 Term = NONE

Term = 12/31/2020

95071 – BRONCHIAL ALLERGY TESTS Eff = 01/01/1985 Term = NONE

Term = 12/31/2020

98970 – QNHP OL DIG E/M SVC 5-10MIN Eff = 01/01/2020 Term = NONE

QNHP OL DIG ASSMT&MGMT 5-10

98971 – QNHP OL DIG EM SVC 11-20MIN Eff = 01/01/2020 Term = NONE

QNHP OL DIG ASSMT&MGMT 11-20

98972 – QNHP OL DIG E/M SVC 21+ MIN Eff = 01/01/2020 Term = NONE

QNHP OL DIG ASSMT&MGMT 21+

99201 – OFFICE/OUTPATIENT VISIT NEW Eff = 01/01/1992 Term = NONE

Term = 12/31/2020


OFFICE O/P NEW SF 15-29 MIN


OFFICE O/P NEW LOW 30-44 MIN


OFFICE O/P NEW MOD 45-59 MIN


OFFICE O/P NEW HI 60-74 MIN

99211 – OFFICE/OUTPATIENT VISIT EST Eff = 01/01/1992 Term = NONE

OFFICE O/P EST MINIMAL PROB


OFFICE O/P EST SF 10-19 MIN


OFFICE O/P EST LOW 20-29 MIN


OFFICE O/P EST MOD 30-39 MIN


OFFICE O/P EST HI 40-54 MIN

99354 – PROLONG E&M/PSYCTX SERV O/P Eff = 01/01/1994 Term = NONE

PROLNG SVC O/P 1ST HOUR

99355 – PROLONG E&M/PSYCTX SERV O/P Eff = 01/01/1994 Term = NONE

PROLNG SVC O/P EA ADDL 30

99356 – PROLONGED SERVICE INPATIENT Eff = 01/01/1994 Term = NONE

PROLNG SVC I/P/OBS 1ST HOUR

99357 – PROLONGED SERVICE INPATIENT Eff = 01/01/1994 Term = NONE

PROLNG SVC I/P/OBS EA ADDL

99415 – PROLONG CLINCL STAFF SVC Eff = 01/01/2016 Term = NONE

PROLNG CLIN STAFF SVC 1ST HR

99416 – PROLONG CLINCL STAFF SVC ADD Eff = 01/01/2016 Term = NONE

PROLNG CLIN STAFF SVC EA ADD

99487 – CMPLX CHRON CARE W/O PT VSIT Eff = 01/01/2013 Term = NONE

CPLX CHRNC CARE 1ST 60 MIN

99489 – CMPLX CHRON CARE ADDL 30 MIN Eff = 01/01/2013 Term = NONE

CPLX CHRNC CARE EA ADDL 30

99490 – CHRON CARE MGMT SRVC 20 MIN Eff = 01/01/2015 Term = NONE

CHRNC CARE MGMT SVC 1ST 20


C9041 – INJ, COAGULATION FACTOR XA Eff = 04/01/2019 Term = NONE

Term = 06/30/2020

C9054 – INJECTION, LEFAMULIN Eff = 01/01/2020 Term = NONE

Term = 06/30/2020

C9055 – INJ, BREXANOLONE Eff = 01/01/2020 Term = NONE

Term = 09/30/2020

C9745 – NASAL ENDO EUSTACHIAN TUBE Eff = 07/01/2017 Term = NONE

Term = 12/31/2020

C9747 – ABLATION, HIFU, PROSTATE Eff = 07/01/2017 Term = NONE

Term = 12/31/2020

C9749 – REPAIR NASAL STENOSIS W/IMP Eff = 04/01/2018 Term = NONE

Term = 12/31/2020

C9754 – PERC AV FISTULA, DIRECT Eff = 01/01/2019 Term = NONE

Term = 06/30/2020

C9755 – RF MAGNETIC-GUIDE AV FISTULA Eff = 01/01/2019 Term = NONE

Term = 06/30/2020

C9758 – INTERATRIAL SHUNT IDE Eff = 01/01/2020 Term = NONE

BLIND INTERATRIAL SHUNT IDE

D2960 – LAMINATE LABIAL VENEER Eff = 01/01/1985 Term = NONE

LABIAL VENEER RESIN DIRECT

D2961 – LAB LABIAL VENEER RESIN Eff = 01/01/1992 Term = NONE

LABIAL VENEER RESIN INDIRECT

D2962 – LAB LABIAL VENEER PORCELAIN Eff = 01/01/1992 Term = NONE

LABIAL VENEER PORC INDIRECT

D3427 – PERIRADICULAR SURGERY Eff = 01/01/2014 Term = NONE

Term = 12/31/2020

D5730 – DENTURE RELN CMPLT MAXIL CH Eff = 01/01/1984 Term = NONE

DENTURE RELN CMPLT MAX DIR

D5731 – DENTURE RELN CMPLT MAND CHR Eff = 01/01/1986 Term = NONE

DENTURE RELN CMPLT MAND DIR

D5740 – DENTURE RELN PART MAXIL CHR Eff = 01/01/1984 Term = NONE

DENTURE RELN PART MAX DIR

D5741 – DENTURE RELN PART MAND CHR Eff = 01/01/1986 Term = NONE

DENTURE RELN PART MAND DIR

D5750 – DENTURE RELN CMPLT MAX LAB Eff = 01/01/1984 Term = NONE

DENTURE RELN CMPLT MAX INDIR

D5751 – DENTURE RELN CMPLT MAND LAB Eff = 01/01/1986 Term = NONE

DENTURE RELN CMPLT MAND IND

D5760 – DENTURE RELN PART MAXIL LAB Eff = 01/01/1984 Term = NONE

DENTURE RELN PART MAX INDIR

D5761 – DENTURE RELN PART MAND LAB Eff = 01/01/1986 Term = NONE

DENTURE RELN PART MAND INDIR

D5994 – PERIDONTAL MEDICAMENT Eff = 01/01/2014 Term = NONE

Term = 12/31/2020

D6052 – SEMI PRECISION ATTACH ABUT Eff = 01/01/2014 Term = NONE

Term = 12/31/2020

D7960 – FRENULECTOMY/FRENECTOMY Eff = 01/01/1984 Term = NONE

Term = 12/31/2020

D9971 – ODONTOPLASTY 1-2 TEETH Eff = 01/01/2000 Term = NONE

ODONTOPLASTY PER TOOTH

G0068 – ADM OF INFUSION DRUG IN HOME Eff = 01/01/2019 Term = NONE

ADM IV INFUSION DRUG IN HOME

G0069 – ADM OF IMMUNE DRUG IN HOME Eff = 01/01/2019 Term = NONE

ADM SQ INFUSION DRUG IN HOME

G0297 – LDCT FOR LUNG CA SCREEN Eff = 02/05/2015 Term = NONE

Term = 12/31/2020

G1000 – CDSM APPLIED PATHWAYS Eff = 01/01/2020 Term = NONE

Term = 03/31/2020

G1005 – CDSM NIA Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G1006 – CDSM TEST APPROP Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G2011 – ALCOHOL/SUB ABUSE ASSESS Eff = 01/01/2019 Term = NONE

ALCOHOL/SUB MISUSE ASSESS

G2058 – CCM ADD 20MIN Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G2089 – A1C LEVEL 7 TO 9% Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G2097 – CHILD DX URI 3D OF OTHER DX Eff = 01/01/2020 Term = NONE

DX URI 3D AFTER OTHER DX

G2102 – DIL RETINAL EYE EXAM Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G2103 – 7 STEREO PHOTOS INTERPRET Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G2104 – EYE IMG VALID W/7 STEREO Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G2105 – PT 66+ LT INTS > 90 Eff = 01/01/2020 Term = NONE

PT 66+ SNP OR LTC POS > 90D

G2108 – PT 66+ LT INTS > 90 Eff = 01/01/2020 Term = NONE


G2114 – PT 66-80 FRAILTY AND MED DEM Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G2115 – PT 66+ FRAILTY AND MED DEM Eff = 01/01/2020 Term = NONE

PT 66-80 FRAILTY AND MED DEM

G2116 – PT 66+ FRAILTY AND ADV ILL Eff = 01/01/2020 Term = NONE

PT 66-80 FRAILTY AND ADV ILL

G2117 – PT 66-80 FRAILTY AND ADV ILL Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G2119 – CALC VITD OPT Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G2120 – NO CALC VITD OPT Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G2123 – PT 66-80 FRAILTY MED DEM Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G2124 – PT 66-80 FRAILTY ADV ILL Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G2126 – PT 66+ FRAILTY ADV ILL Eff = 01/01/2020 Term = NONE

PT 66-80 FRAILTY AND ADV ILL

G2127 – PT 66+ FRAILTY MED DEM Eff = 01/01/2020 Term = NONE

PT 66-80 FRAILTY AND MED DEM

G2130 – PT 66+ LT INST > 90 Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G2131 – PT 81+ FRAILTY Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G2132 – PT 66-80 FRAILTY AND MED DEM Eff = 01/01/2020 Term = NONE

Term = 12/31/2020


G2133 – PT 66-80 FRAILTY AND ADV ILL Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G2134 – PT 66+ FRAILTY AND MED DEM Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G2135 – PT 66+ FRAILTY AND ADV ILL Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G2136 – BK PAIN VAS 6-20WK = 3 Eff = 01/01/2020 Term = NONE

BK PAIN VAS 6-20WK <= 3

G2138 – BK PAIN VAS 9-15MO = 3 Eff = 01/01/2020 Term = NONE

BK PAIN VAS 9-15MO <= 3

G2140 – LEG PAIN VAS 6-20WK = 3 Eff = 01/01/2020 Term = NONE

LEG PAIN VAS 6-20WK <= 3

G2144 – FS ODI 6-20WK POSTOP > 22 Eff = 01/01/2020 Term = NONE

FS ODI 6-20WK POSTOP <= 22

G2152 – RES CHANGE SC =0 Eff = 01/01/2020 Term = NONE

RES CHANGE SC >=0

G2153 – HOSP DUR MEAS PD Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G2154 – TD 9 YRS START END MEAS Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G2155 – HIST CONTRAINDICATIONS Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G2156 – NO PRIOR TD OR HX CONTRA Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G2157 – PNEUM VACC 12 MO 60+ Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G2158 – PNEUM VACC ADV RX Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G2159 – NO PNEUM VACC 12 MO 60+ Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G2160 – HERPZOS 50+ Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G2161 – ADV RX ZOS Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G2162 – NO HERPZOS 50+ Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G2163 – INFL VACC 07/01 TO 06/30 Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G2164 – ADV RX INFL VACC Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G2165 – NO INFL VACC 07/01 TO 06/30 Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G2166 – NO PT ADM DX NO NECK FS PROM Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

G8398 – DIL MACULAR/FUNDUS NOT PERFO Eff = 01/01/2008 Term = NONE

Term = 12/31/2020

G8430 – EC AT DOC MEDREC PT NOT ELIG Eff = 01/01/2008 Term = NONE

DOC MED RSN NO MEDREC

G8442 – DOC PAIN AS NT PERF, NOT ELG Eff = 01/01/2008 Term = NONE

Term = 12/31/2020

G8509 – POS PAIN ASSESS NO F/U DOC Eff = 01/01/2009 Term = NONE

Term = 12/31/2020

G8571 – STER WD IFX 30 D POSTOP Eff = 01/01/2010 Term = NONE

Term = 12/31/2020

G8572 – NO STER WD IFX Eff = 01/01/2010 Term = NONE

Term = 12/31/2020

G8573 – STK CABG Eff = 01/01/2010 Term = NONE

Term = 12/31/2020

G8574 – NO STRK CABG Eff = 01/01/2010 Term = NONE

Term = 12/31/2020

G8627 – SURG PROC W/IN 30 DAYS Eff = 01/01/2010 Term = NONE

Term = 12/31/2020

G8628 – NO SURG PROC W/IN 30 DAYS Eff = 01/01/2010 Term = NONE

Term = 12/31/2020

G8650 – RAFS CRS KI NO SCOR NO SURV Eff = 01/01/2011 Term = NONE

RAFS CRS KI NO SCOR NO RSN

G8671 – RAFSCRS GOI SCOR >= 0 Eff = 01/01/2011 Term = NONE

Term = 12/31/2020

G8672 – RAFSCRS GOI SCOR < 0 Eff = 01/01/2011 Term = NONE

Term = 12/31/2020

G8674 – RAFSCRS NECK, NO MSR/NO FOTO Eff = 01/01/2011 Term = NONE

Term = 12/31/2020

G8709 – PT PRESC DOC MED RSN ID URI Eff = 01/01/2012 Term = NONE

URI EP COMPETE DIAG

G8730 – PAIN DOC POS AND PLAN Eff = 01/01/2012 Term = NONE

Term = 12/31/2020

G8731 – PAIN NEG NO PLAN Eff = 01/01/2012 Term = NONE

Term = 12/31/2020

G8732 – NO DOC OF PAIN Eff = 01/01/2012 Term = NONE

Term = 12/31/2020

G8809 – RH-IMMUNOGLOBULIN ORDER Eff = 01/01/2012 Term = NONE

Term = 12/31/2020

G8810 – DOC REAS NO RH-IMMUNO Eff = 01/01/2012 Term = NONE

Term = 12/31/2020

G8811 – NO RH-IMMUNOGLOBULIN ORDER Eff = 01/01/2012 Term = NONE

Term = 12/31/2020

G8872 – INTRAOP IMAGE CONFIRM EXCISE Eff = 01/01/2012 Term = NONE

Term = 12/31/2020

G8873 – SPECIMEN NOT INTRAOP IMAGE Eff = 01/01/2012 Term = NONE

Term = 12/31/2020

G8874 – TISSUE NOT IMAGE INTRAOP Eff = 01/01/2012 Term = NONE

Term = 12/31/2020

G8939 – PAIN AS DOC POSITIVE, NO F/U Eff = 01/01/2013 Term = NONE

Term = 12/31/2020

G8959 – CLIN TX MDD COMM TO TX CLIN Eff = 01/01/2013 Term = NONE

Term = 12/31/2020

G8960 – CLIN TX MDD NOT COMM Eff = 01/01/2013 Term = NONE

Term = 12/31/2020

G8973 – MST RCNT HBB < 10G/DL Eff = 01/01/2013 Term = NONE

Term = 12/31/2020

G8974 – HGB NOT DOC RNS NOT GVN Eff = 01/01/2013 Term = NONE

Term = 12/31/2020

G8975 – HGB <10G/DL, MED RSN Eff = 01/01/2013 Term = NONE

Term = 12/31/2020

G8976 – HGB >= 10 G/DL Eff = 01/01/2013 Term = NONE

Term = 12/31/2020


G9232 – PTRSN NO COMM COMORBID Eff = 01/01/2014 Term = NONE

Term = 12/31/2020

G9239 – DOC RSN HEMOD & CATH ACC Eff = 01/01/2014 Term = NONE

Term = 12/31/2020

G9240 – DOC PT W CATH MAINT DIA Eff = 01/01/2014 Term = NONE

Term = 12/31/2020

G9241 – DOC PT W OUT CATH MAINT DIA Eff = 01/01/2014 Term = NONE

Term = 12/31/2020

G9256 – DOC OF PAT DEATH AFTER CAS Eff = 01/01/2014 Term = NONE

Term = 12/31/2020

G9257 – DOC OF PAT STROKE AFTER CAS Eff = 01/01/2014 Term = NONE

Term = 12/31/2020

G9258 – DOC OF PAT STROKE AFTER CEA Eff = 01/01/2014 Term = NONE

Term = 12/31/2020

G9259 – SURVIVE/NO STROKE POST CAS Eff = 01/01/2014 Term = NONE

Term = 12/31/2020

G9260 – DOC OF PAT DEATH AFTER CEA Eff = 01/01/2014 Term = NONE

Term = 12/31/2020

G9261 – SURVIVE/NO STROKE POST CEA Eff = 01/01/2014 Term = NONE

Term = 12/31/2020

G9262 – DOC OF DEATH POST-AAA REPAIR Eff = 01/01/2014 Term = NONE

Term = 12/31/2020

G9263 – DOC OF DISCH POST-AAA REPAIR Eff = 01/01/2014 Term = NONE

Term = 12/31/2020

G9264 – DOC RSN HEMOD W/CATH >=90D Eff = 01/01/2014 Term = NONE

Term = 12/31/2020

G9265 – DOC CATH >90D FOR MAINT DIA Eff = 01/01/2014 Term = NONE

Term = 12/31/2020

G9266 – NORSN PT CATH >=90D Eff = 01/01/2014 Term = NONE

Term = 12/31/2020

G9299 – NO EVAL RISKK VTE CARD PRIOR Eff = 01/01/2014 Term = NONE

NO EVAL RISK VTE CARD PRIOR

G9300 – DOC MEDRSN NO COMPL ANTIBIO Eff = 01/01/2014 Term = NONE

Term = 12/31/2020

G9301 – DOC COMPL INF ANTIBIO Eff = 01/01/2014 Term = NONE

Term = 12/31/2020

G9302 – NORSN INCOMP INF ANTIBIO Eff = 01/01/2014 Term = NONE

Term = 12/31/2020

G9303 – NORSN NO PROS INFO OP RPT Eff = 01/01/2014 Term = NONE

Term = 12/31/2020

G9304 – PROS INFO OP RPT Eff = 01/01/2014 Term = NONE

Term = 12/31/2020

G9326 – CT DONE NO RAD DS INDEX, NRG Eff = 01/01/2014 Term = NONE

Term = 12/31/2020

G9327 – CT DONE RAD DS INDEX Eff = 01/01/2014 Term = NONE

Term = 12/31/2020

G9329 – NORSN NO DICOM FORMAT DOC Eff = 01/01/2014 Term = NONE

Term = 12/31/2020

G9340 – DICOM FORMAT DOC ON RPT Eff = 01/01/2014 Term = NONE

Term = 12/31/2020

G9365 – 1HIGH RISK MED ORD Eff = 01/01/2015 Term = NONE

Term = 12/31/2020

G9366 – 1HIGH RISK NO ORD Eff = 01/01/2015 Term = NONE

Term = 12/31/2020

G9389 – UNPLN RUP POST CAP Eff = 01/01/2015 Term = NONE

Term = 12/31/2020

G9390 – NO UNPLN RUP POST CAP Eff = 01/01/2015 Term = NONE

Term = 12/31/2020

G9469 – REC CORTICO>90D OR 1RX 900MG Eff = 01/01/2015 Term = NONE

Term = 12/31/2020

G9503 – PT TK TAMS HCL Eff = 01/01/2016 Term = NONE

Term = 12/31/2020

G9523 – D/C HEMO OR PERIT DIALYSIS Eff = 01/01/2016 Term = NONE

Term = 12/31/2020

G9524 – REFER TO HOSPICE Eff = 01/01/2016 Term = NONE

Term = 12/31/2020

G9525 – DOC PT REAS NO HOSPICE REFER Eff = 01/01/2016 Term = NONE

Term = 12/31/2020

G9526 – NO REASON, NO REFER HOSPICE Eff = 01/01/2016 Term = NONE

Term = 12/31/2020

G9532 – PT HD CT ORD Eff = 01/01/2016 Term = NONE

Term = 12/31/2020

G9537 – DOC SYSM RSN IMG HD Eff = 01/01/2016 Term = NONE

IMG HD CLIN TRIAL

G9558 – TX BETA-LACTAM ABX THERAPY Eff = 01/01/2016 Term = NONE

Term = 12/31/2020

G9559 – DOC MED REAS NO ABX THERAPY Eff = 01/01/2016 Term = NONE

Term = 12/31/2020

G9560 – NO BETA-LACTAM ABX THER, RNG Eff = 01/01/2016 Term = NONE

Term = 12/31/2020

G9573 – ADL PT MD OR DYS REM 6 MON Eff = 01/01/2016 Term = NONE

Term = 12/31/2020

G9574 – ADL PT MD DYS NO REM 6 MON Eff = 01/01/2016 Term = NONE

Term = 12/31/2020

G9600 – SYMP AAA URGENT REPAIR Eff = 01/01/2016 Term = NONE

Term = 12/31/2020

G9601 – PT DCHG HOME POST OP DAY 7 Eff = 01/01/2016 Term = NONE

Term = 12/31/2020

G9602 – PT NO DCHG HOME POSTOP DAY 7 Eff = 01/01/2016 Term = NONE

Term = 12/31/2020

G9615 – PRE-OP ASST DOC Eff = 01/01/2016 Term = NONE

Term = 12/31/2020

G9616 – DOC RSN NO PREOP ASSMT Eff = 01/01/2016 Term = NONE

Term = 12/31/2020

G9617 – PRE-OP ASST NOT DOC, RNG Eff = 01/01/2016 Term = NONE

Term = 12/31/2020

G9659 - >85Y NO HX COLO CA/RSN SCOPE Eff = 01/01/2016 Term = NONE

>=86Y NO HX COLO CA/RSN SCOP

G9660 – DOC MED RSN SCOPE PT >85Y Eff = 01/01/2016 Term = NONE

DOC MED RSN SCOPE PT >= 86Y

G9661 - >85Y SCOPE OTHR RSN Eff = 01/01/2016 Term = NONE

PT >= 86 W/ HI RISK

G9663 – FAST/DIR LDL <= 190 MG/DL Eff = 01/01/2016 Term = NONE

FAST/DIR LDL >= 190 MG/DL

G9701 – CHILD ANBX 30 PRIOR DX ESTAB Eff = 01/01/2017 Term = NONE

Term = 12/31/2020


G9703 – CHILD ANBX 30 PRIOR DX PHARY Eff = 01/01/2017 Term = NONE

ANBX 30 PRIOR TO EPISODE

G9717 – DOC PT DX DEP/BP F/U NT REQ Eff = 01/01/2017 Term = NONE

DOC PT DX DEP/BIPOL

G9722 – DOC HX RENAL FAIL OR CR+ >4 Eff = 01/01/2017 Term = NONE

DOC HX RENAL FAIL OR CR+ >=4

G9727 – PT UNABLE CMPLT KNEE FS PROM Eff = 01/01/2017 Term = NONE

PT UNABLE CMPLT LEPF PROM

G9729 – PT UNBL CMPLT HIP FS PROM Eff = 01/01/2017 Term = NONE

PT UNBL CMPLT LEPF PROM

G9731 – PT UNBL CMPLT FT/ANK FS PROM Eff = 01/01/2017 Term = NONE

PT UNBL CMPLT LEPF PROM

G9738 – REFUSED TO PARTICIPATE Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9739 – PT UNBL CMPLT GO FS PROM Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9747 – PALL DIALYSIS WITH CATHETER Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9748 – APP TRANSPL LVG KIDNEY DONOR Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9749 – PALL DIALYSIS WITH CATHETER Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9750 – APP TRANSPL LVG KIDNEY DONOR Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9759 – HX PREOP POST CAP RUP Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9798 – D/C AMI BTW 7/1-6/30 MEAS PD Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9799 – MED DISP EVT INDIC HX ASTH Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9800 – PT ID INTOL/ALLEG BETA-BLOCK Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9801 – NONACUT TRANSF FROM INPT Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9802 – PT W/HOSP ANYTIME MSMT PER Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9803 – PT PRESC 135 DAY TRMT Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9804 – PT NOT PRESC 135 DAY TRMT Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9814 – DEATH DURING INDEX HOSP Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9815 – DEATH NOT DURING INDEX HOSP Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9816 – DEATH <30 DAY POST DISCHARGE Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9817 – NO DEATH 30-DAYS POST-DISCH Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9825 – HER-2 NEG,UNDOC/UNKN Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9826 – TRANSF PRACT AFT INIT CHEMO Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9827 – HER-2 TARG THER NO INIT TX Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9828 – HER-2 TARG THER DUR INIT TX Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9829 – BREAST ADJ CHEMO ADMIN Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9833 – TRANSF PRACT AFT INIT CHEMO Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9834 – PT MET DIS AT DX Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9835 – TRASTUZ GIVEN W/IN 12 MOS DX Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9836 – RSN NO TRAST GIVEN DOC Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9837 – TRASTUZ NOT IN 12 MOS DX Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9849 – PT DIED FROM CANCER Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9850 – 1/MORE ED LAST 30D LIFE Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9851 – 1/NO ED VISIT LAST 30D LIFE Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9855 – PT DIED FROM CANCER Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9856 – PT NO HOSPICE Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9857 – PT ADMIT HOSPICE Eff = 01/01/2017 Term = NONE

Term = 12/31/2020

G9898 – PT 66+ SNP OR LTC POS Eff = 01/01/2018 Term = NONE






G9924 – DOC MED RSN NO SCRN OR RECS Eff = 01/01/2018 Term = NONE

Term = 12/31/2020

G9933 – CANC DETECTD DURING COL SCRN Eff = 01/01/2018 Term = NONE

Term = 12/31/2020

G9934 – DOC RSN NOT DETECTING CANCER Eff = 01/01/2018 Term = NONE

Term = 12/31/2020

G9935 – CANC NOT DETECTD DURING SRCN Eff = 01/01/2018 Term = NONE

Term = 12/31/2020

G9936 – PMH PLYP/NEO CO/RECT/JUN/ANS Eff = 01/01/2018 Term = NONE

Term = 12/31/2020

G9937 – DIG OR SURV COLSCO Eff = 01/01/2018 Term = NONE

Term = 12/31/2020



G9945 – PT W/CANCER SCOLIOSIS Eff = 01/01/2018 Term = NONE

PT W/CANCER SCOLIOSIS

G9966 – SCRN, INTER, REPORT CHILD Eff = 01/01/2018 Term = NONE

Term = 12/31/2020

G9967 – NO SCRN, INTER, REPRT CHILD Eff = 01/01/2018 Term = NONE

Term = 12/31/2020


J7189 – FACTOR VIIA Eff = 01/01/2006 Term = NONE

FACTOR VIIA RECOMB NOVOSEVEN

J7321 – HYALGAN SUPARTZ VISCO-3 DOSE Eff = 01/01/2008 Term = NONE

HYALGAN OR SUPARTZ INJ DOSE

J9199 – INJECTION, INFUGEM, 200 MG Eff = 01/01/2020 Term = NONE

Term = 06/30/2020

J9245 – INJ MELPHALAN HYDROCHL 50 MG Eff = 01/01/1995 Term = NONE

INJ MELPHA HYDROCH NOS 50 MG

J9305 – PEMETREXED INJECTION Eff = 01/01/2005 Term = NONE

INJ. PEMETREXED NOS 10MG

L8701 – POW UE ROM DEV EWH UPRT CUST Eff = 01/01/2019 Term = NONE

EWH S/D UPRT MICRO SENSOR

L8702 – POW UE ROM DEV EWHF UPRT CUS Eff = 01/01/2019 Term = NONE

EWHF S/D UPRT MICRO SENSOR

M1015 – DC EOC DOC MED REC Eff = 01/01/2019 Term = NONE

Term = 12/31/2020

M1023 – ADL PT MJ DEP DS RS 6 PHQ<5 Eff = 01/01/2019 Term = NONE

Term = 12/31/2020

M1024 – ADL PT MJ DEP DS NO RS 6 MO Eff = 01/01/2019 Term = NONE

Term = 12/31/2020

M1033 – PHARMTHRY FOR OUD AFR 6.30 Eff = 01/01/2019 Term = NONE

Term = 12/31/2020

M1045 – FS OKS 9-15MO = 37 Eff = 01/01/2019 Term = NONE

FS OKS 9-15MO >= 37 >= 71

M1046 – FS OKS 9-15MO = 37 Eff = 01/01/2019 Term = NONE

FS OKS 9-15MO < 37 < 71

M1061 – PT PREG Eff = 01/01/2019 Term = NONE

Term = 12/31/2020

M1062 – PT IMCOMPRMD Eff = 01/01/2019 Term = NONE

Term = 12/31/2020

M1063 – PT REC HG DOS IMSUP THPY Eff = 01/01/2019 Term = NONE

Term = 12/31/2020

M1064 – SHING VAC DOC ADM OR PV REC Eff = 01/01/2019 Term = NONE

Term = 12/31/2020

M1065 – SHING VAC NO ADM CLINC RSN Eff = 01/01/2019 Term = NONE

Term = 12/31/2020

M1066 – SHING VAC NO DOC NO RSN Eff = 01/01/2019 Term = NONE

Term = 12/31/2020

M1108 – OC NI PT 1-2 VIS Eff = 01/01/2020 Term = NONE

OC NI PT HOME PROG

M1109 – OC NI PT DC 1-2 VIS Eff = 01/01/2020 Term = NONE

OC NI PT DC

M1110 – OC NI PT SELFDC 1-2 VIS Eff = 01/01/2020 Term = NONE

OC NOT P PT SELFDC


OC NI PT HOME PROG


OC NI PT DC


OC NI PT SELFDC


OC NI PT HOME PROG


OC NI PT DC


OC NI PT SELFDC


OC NI PT HOME PROG


OC NI PT HOME PROG


OC NI PT DC

M1130 – OC NI PT SELF DC 1-2 VIS Eff = 01/01/2020 Term = NONE

OC NI PT SELFDC


OC NI PT HOME PROG


OC NI PT DC


OC NI PT SELFDC

M1136 – START EOC DOC MED REC Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

M1137 – DOCU DX DEGEN NEURO Eff = 01/01/2020 Term = NONE

Term = 12/31/2020


Term = 12/31/2020


Term = 12/31/2020


Term = 12/31/2020

M1144 – OC NO IND PT 1-2 VIS Eff = 01/01/2020 Term = NONE

Term = 12/31/2020

Q4176 – NEOPATCH, PER SQ CENTIMETER Eff = 01/01/2018 Term = NONE

NEOPATCH OR THERION, 1 SQ CM

Modified HCPCS Code Count = 401

New HCPCS Modifiers:

J5 - DMEPOS COMP BID FUR BY PT/OT Eff = 10/01/2020 Term = NONE

V4 - DEMONSTRATION MODIFIER 4 Eff = 10/01/2020 Term = NONE

New HCPCS Modifiers Count = 2

Deleted HCPCS Modifiers:

Deleted HCPCS Modifiers Count = 0

Modified HCPCS Modifiers (changes only shown on second line):

CS - GULF OIL 2010 SPILL RELATED Eff = 01/01/2011 Term = NONE

COST SHARE WAIVER COVID-19

Modified HCPCS Modifiers Count = 1

End of Report

hcpcs codes annual update change report

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