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2013 HCPCS New Codes


A4435    Ostomy pouch, drainable, high output, with extended wear barrier (one-piece system), without filter, each

A9586   Florbetapir F18, diagnostic, per study dose, up to 10 millicuries

C9288   Injection, Centruroides (scorpion) Immune f(ab)2(equine), 1000 IU

C9289   Injection, asparaginase Erwinia chrysantheml, 1000 IU

C9290   Injection, bupivacaine liposome, 1 mg

C9291   Injection, aflibercept, 2mg vial

C9292   Injection, pertuzumab, 10 mg

C9293   Injection, glucarpidase, 10 units

C9294   Injection, taliglucerase alfa, 10 units

C9295   Injection, carfilzomib, 1 mg

C9296   Injection, ziv-aflibercept, 1 mg

C9368   Grafix core, per sq cm

C9369   Grafix prime, per sq cm

C9600   Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery of branch

C9601   Percutaneous transcatheter placement of drug- eluting intracoronary stents(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)

C9602   Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch

C9603   Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of major coronary artery (list separately in addition to code for primary procedure)

C9604   Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent atherectomy and angioplasty, including distal protection when performed; single vessel

C9605   Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug –eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; each additional branch subtended by the bypass graft (list separately in addition to code for primary procedure)

C9606   Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel

C9607   Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel

C9608   Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary artery, coronary artery branch, or bypass graft (list separately in addition to code for primary procedure)

C9733   Nonophthalmic fluorescent vascular angiography

E0670   Segmental pneumatic appliance for use with pneumatic compressor, integrated, 2 full legs and trunk

E2378   Power wheelchair component, actuator, replacement only

G0452   Molecular pathology procedure; physician interpretation and report

G0453   Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition to primary procedure)

G0454   Physician documentation of face-to-face visit for durable medical equipment determination performed by nurse practitioner, physician assistant or clinical nurse specialist

G0455   Preparation with instillation of fecal microbiota by any method including assessment of donor specimen

G0456   Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area less than or equal to 50 sq cm

G0457   Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area greater than 50 sq cm

G0458   Low dose rate (LDR) prostate brachytherapy service, composite rate

G8907   Patient documented not to have experienced any of the following events; a burn prior to discharge; a fall within the facility; wrong site/side/patient/procedure/implant event; or a hospital transfer or hospital admission upon discharge from the facility.

G8908   Patient document to have received a burn prior to discharge

G8909   Patient documented not to have received a burn prior to discharge.

G8910   Patient documented to have experienced a fall within ASC

G8911   Patient documented not to have experienced a fall within ambulatory surgery center.

G8912   Patient documented to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event.

G8913   Patient documented not to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event.

G8914   Patient documented to have experienced a hospital transfer or hospital admission upon discharge from ASC

G8915   Patient documented not to have experienced a hospital transfer or hospital admission upon discharge from ASC

G8916   Patient with preoperative order for IV antibiotic surgical site infection (SSI) prophylaxis, antibiotic initiated on time

G8917   Patient with preoperative order for IV antibiotic surgical site infection (SSI) prophylaxis, antibiotic not initiated on time

G8918   Patient without preoperative order for IV antibiotic surgical site infection (SSI) prophylaxis

G8919   Most recent systolic blood pressure < 140 mm Hg

G8920    Most recent systolic blood pressure >= 140 mm Hg

G8921    Most recent diastolic blood pressure < 90 mm Hg

G8922    Most recent diastolic blood pressure >= 90 mm Hg

G8923    Left ventricular ejection fraction (LVEF) < 40% or documentation of moderately or severely depressed left ventricular systolic function

G8924    Spirometry test results demonstrate FEVI/FVC < 60% with COPD symptoms (e.g. dyspnea, cough/sputum, wheezing)

G8925     Spirometry test results demonstrate FEVI/FVC >=60% or patient does not have COPD symptoms

G8926      Spirometry test not performed or documented, reason not given

G8927     Adjuvant chemotherapy referred, prescribed or previously received for AJCC stage III, colon cancer

G8928    Adjuvant chemotherapy not prescribed or previously received, reason given

G8929     Adjuvant chemotherapy not prescribed or previously received, reason not given

G8930     Assessment of depression severity not documented, reason not given

G8931    Assessment of depression severity not documented, reason not given

G8932    Suicide risk assessed at the initial evaluation

G8933     Suicide risk not assessed at the initial evaluation, reason not given  

G8934    Left ventricular ejection fraction (LVEF) < 40% or documentation of moderately or severely depressed left ventricular systolic function

G8935    Clinician prescribed angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy

G8936    Clinician documented that patient was not an eligible candidate for angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy

G8937     Clinician did not prescribe angiotension converting enzyme (ACE) inhibitor or angiotension receptor blocker (ARB) therapy, reason not given

G8938    BMI is calculated, but patient not eligible for follow-up plan

G8939    Pain assessment documented follow-up plan not documented, patient not eligible/appropriate

G8940     Screening for clinical depression documented, follow-up plan not documented, patient not eligible/appropriate

G8941     Elder maltreatment screen document, patient not eligible for follow-up

G8942     Documented functional outcomes assessment and care plan within the previous 30 days

G8943      LDL-C result not present or not with in 12 months prior

G8944     AJCC melanoma cancer stage 0 through IIC melanoma

G8945     Aneurysm minor diameter <=6cm for men

G8946     Minimally invasive biopsy method attempted but not diagnostic of breast cancer (e.g., high risk lesion of breast such as atypical ductal hyperplasia, lobular neoplasia, atypical lobular carcinoma in situ, atypical columnar hyperplasica, flat epithelial atypia, radial scar, complex sclerosing lesion, papillary lesion, or any lesion with spindle cells)

G8947     One or more neuropsychiatric symptoms

G8948     No neuropsychiatric symptoms

G8949     Documentation of patient reason(s) for patient not receiving counseling for diet and physical activity (e.g., patient is not willing to discuss diet or exercise interventions to help control blood pressure, or the patient said he/she refused to make these changes)

G8950     Prehypertensive or hypertensive blood pressure reading documented, indicated follow-up documented

G8951     Prehypertensive or hypertensive blood pressure reading documented, indicated follow-up not documented, patient not eligible/not appropriate

G8952     prehypertensive or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given

G8953     All quality action for the applicable measures in the oncology measures group have been performed for this patient

G8954     Complete and appropriate patient data were reported to a qualified clinical database registry

G8955     Most recent assessment of adequacy of volume management

G8956     patient receiving maintenance hemodialysis in an outpatient dialysis facility

G8957    patient not receiving maintenance hemodialysis in an outpatient dialysis facility

G8958    Assessment of adequacy of volume management not documented, reason not given

G8959    Clinician treating major depressive disorder communicates to clinician treating comorbid condition

G8960   Clinician treating major depressive disorder communicates to clinician treating comorbid condition, reason not given

G8961   Cardiac stress imaging test primarily on low-risk surgery patient for preoperative evaluation within 30 days

G8962    Cardiac stress imaging test performed on patient for any reason including those who did not have low risk surgery or test that was performed more then 30 days preceding low risk surgery

G8963    Cardiac stress imaging performed primarily for monitoring of asymptomaic patient who had PCI, within 2 years

G8964    Cardiac stress imaging test performed primarily for any other reason than monitoring or asymptomic patient who had PCI within 2 years (e.g., symptomatic patient, patient greater than 2 years since PCI, initial evaluation, etc.)

G8965    Cardiac stress imaging test primarily performed on low CHD risk patient for initial detection and risk assessment

G8966    Cardiac stress imaging test performed on symptomatic or higher than low CHD risk patient or for any reason other than initial detection and risk assessment

G8967    Warfarin or another oral anticoagulant that is FDA approved prescribed

G8968    Documentation of medical reason(s) for not prescribing warfarin or another oral anticoagulant that is FDA approved not prescribed (e.g., allergy, risk of bleeding, transient or reversible causes of atrial fibrillation, other medical reasons including, but not limited to pregnancy, mitral stenosis, prosthetic heart valve or patient is in the postoperative period)

G8969    Documentation of patient reason(s) for not prescribing warfarin or another oral anticoagulant that is FDA approved (e.g., economic, social, and/or religious impediments, noncompliance or patient refusal, other patient reasons)

G8970     No risk factors or one moderate risk factor for thromboembolism

G8971     Warfarin or another oral anticoagulant that is FDA approved not prescribed, reason not given

G8972     One or more high risk factors for thromboembolism or more than one moderate risk factor for thromboembolism

G8973      Most recent hemoglobin (HgB) level < 10 g/dl

G8974     Hemoglobin level measurement not documented, reason not given

G8975     Documentation of medical reason(s) for patient having a hemoglobin level < 10 g/dl (e.g., patient who have nonrenal etiologies of anemia [e.g., sickle cell anemia or other hemoglobinopathies, hypersplenism, primary bone marrow disease, anemia related to chemotherapy for diagnosis of malignancy, postoperative bleeding, active bloodstream or peritoneal infection], other medical reasons)

G8976      Most recent hemoglobin (HgB) level >= 10 g/dl

G8977     I intend to report the oncology measures group

G8978     Mobility: walking and moving around functional limitation, current status, at therapy episode outset ant at reporting intervals

G8979     Mobility: walking and moving around function limitation, project goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting

G8980     Mobility: walking and moving around functional limitation, discharge status, at discharge from therapy or to end reporting

G8981     Changing and maintaining body position functional limitation, current status, at therapy episode outset and at reporting intervals

G8982     Changing and maintaining body position functional limitation, project goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting

G9083     Changing and maintaining body position functional limitation, discharge status, at discharge from therapy or to end reporting

G8984    Carrying, moving and handing object functional limitation, current status, at therapy episode outset and at reporting intervals

G8985    Carrying, moving and handing object functional limitation, current status, at therapy episode outset and at reporting intervals

G8986     Carrying, moving and handing objects functional limitation, discharge status, at discharge from therapy or to end reporting

G8987     Self care functional limitation, current status, at therapy episode outset and at reporting intervals

G8988    Self care functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting

G8989    Self care functional limitation, discharge status, at discharge from therapy or to end reporting

G8990    Other physical or occupational primary functional limitation, current status, at therapy episode outset and at reporting intervals

G8991    Other physical or occupational primary functional limitation, project goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting

G8992    Other physical or occupational primary functional limitation, discharge status, at discharge from therapy or to end reporting

G8993    Other physical or occupational subsequent functional limitation, current status, at therapy episode outset and at reporting intervals

G8994    Other physical or occupational subsequent functional limitation, project goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting

G8995    Other physical or occupation subsequent functional limitation, discharge status, at discharge from therapy or to end reporting

G8996    Swallowing functional limitation, current status at time of initial therapy treatment/episode outset and reporting intervals

G8997     Swallowing functional limitation, projected goal status, at initial therapy treatment/outset and at discharge from therapy

G8998     Swallowing functional limitation, discharge status, at discharge from therapy/end of reporting on limitation

G8999      Motor speech functional limitation, current status at time of initial therapy treatment/episode outset and reporting intervals

G9148     National committee for Quality Assurance-Level 1 medical home

G9149     National committee for Quality Assurance-Level 2 medical home

G9150     National committee for Quality assurance-Level 3 medical home

G9151     MAPCP Demonstration-state provided services

G9152     MAPCP Demonstration—Community Health Teams

G9153     MAPCP Demonstration-Physician Incentive Pool

G9157     Transesophageal Doppler used for cardiac monitoring

G9158      Motor speech functional limitation, discharge status at discharge from therapy/end of reporting on limitation

G9159     Spoken language comprehension functional limitation, current status at time of initial therapy treatment/episode outset and reporting intervals

G9160     Spoken language comprehension functional limitation, project goal status at initial therapy treatment/outset and at discharge from therapy 

G9161     Spoken language comprehension functional limitation, discharge status at discharge from therapy/end of reporting on limitation

G9162     Spoken language expression functional limitation, current status at time of initial therapy treatment/episode outset and reporting intervals

G9163     Spoken language expression functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy

G9164     Spoken language expression functional limitation, discharge status at discharge from therapy/end of reporting on limitation

G9165     Attention functional limitation, current status at time of initial therapy treatment/episode outset and reporting intervals

G9166      Attention functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy

G9167     Attention functional limitation, discharge status at discharge from therapy/end of recording on limitation

G9168     Memory functional limitation, current status at time of initial therapy treatment/episode outset and recording intervals

G9169     Memory functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy

G9170     Memory functional limitation, discharge status at discharge from therapy/end of recording on limitation

G9171     Memory functional limitation, current status at time of initial therapy treatment/episode outset and recording intervals

G9172     Voice functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy

G9173     Voice functional limitation, discharge status at discharge from therapy/end of recording on limitation

G9174     Other speech language pathology functional limitation, current status at time of initial therapy treatment/episode outset and reporting intervals

G9175      Other speech language pathology functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy

G9176      Other speech language pathology functional limitation, discharge status at discharge from therapy/end of recording of limitation

G9186      Motor speech functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy

J0178       Injection, aflibercept, 1 mg

J0485       Injection, belatacept, 1 mg

J0716       Injection, centruroides immune f(ab)2, up to 120 mg

J0890       Injection, peginesatide, 0.1 mg (for ESRD on dialysis)

J1050       Injection, medroxyprogesterone acetate, 1 mg

J1741       Injection, ibuprofen, 100 mg

J1744        Injection, icatibant, 1 mg

J2212        Injection, methylnaltrexone, 0.1 mg

J7178        Injection, human fibrinogen concentrate, 1 mg

J7315         Mitomycin ophthalmic, 0.2 mg

J7527         Everolimus, oral, 0.25 mg

J9002         Injection, doxorubicin hydrochloride, liposomal, Doxil, 10 mg

J9019         Injection, asparaginase (Erwinaze), 1,000 IU

J9042         Injection, brentuximab vedotin, 1 mg

L5859        Addition to lower extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/extension assistant control, includes any type motor(s)

L7902       Tension ring, for vaaum erection device, any type, replacement only, each

L8605       Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, anal canal, 1 ml, includes shipping and necessary supplies

Q2034     Inluenza virs vaccine, split virus, for intramuscular use (Agriflu)

Q2045     Injection, human fibrinogen concentrate, 1 mg

Q2046      Injection, afibercept, 1 mg

Q2047      Injection, peginesatide, 0.1 mg (ESRD on dialysis)

Q2048      Injection, doxorubicin hydrochloride, liposomal, DOXIL, 10 mg

Q2049      Injection, doxorubicin hydrochloride, liposomal, imported Lipodox, 10 mg

Q4131      EpiFix, per sq cm

Q4132       Grafix core, per sq cm

Q4133      Grafix prime, per sq cm

Q4134      hMatrix, per sq cm

Q4135      Mediskin, per sq cm

Q4136      E-Z Derm, per sq cm

Q9969     Tc-99m from nonhighly enriched uranium source, full cost recovery add-on, per study dose

S0353      Treatment planning and care coordination management for cancer initial treatment

S0354      Treatment planning and care coordination management for cancer established patient with a change of regimen

S0596      Phakic intraocular lens for correction of refractive error

S1090      Mometasone furoate sinus imolant, 370 micrograms

S3721      Prostate cancer antigen 3 (PCA3) testing

S8930       Electrical stimulation of auricular acupuncture points; each 15 minutes of personal one-on-one contact with patient

S9110      Telemointoring of patient in their home, including all necessary equipment; computer system, connections, and software; maintenance; patient education and support; per month

V5281     Assistive listening device, personal FM/DM system, monaural (1 receiver, transmitter, microphone), any type

V5282     Assistive listening device, personal FM/FD system, binaural (2 receivers, transmitter, microphone), any type

V5283     Assistive listening device, personal FM/DM neck, loop induction receiver

V5284     Assistive listening device, personal FM/DM, ear level receiver

V5285     Assistive listening device, personal FM/DM, direct audio input receiver

V5286     Assistive listening device, personal blue tooth FM/DM receiver

V5287     Assistive listening device, personal FM/DM receiver, not otherwise specified

V5288     Assistive listening device, personal FM/DM transmitter assistive listening device

V5289     Assistive listening device, personal FM/DM adapter/boot coupling device for receiver, any type

V5290     Assistive listening device, transmitter microphone, any type

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