2024 CPT/HCPCS Codebook

eGuide

Enjoy our comprehensive codebook for 2024. Inside you’ll find all the CPT and HCPCS codes that are new, those that have been removed, and everything that’s been revised. You won’t find anything else like this for free. We simply want to help you improve your billing and coding.

Private practice healthcare billing and coding is always challenging. Keeping up with year-over-year changes can be just as daunting. Staying abreast of the medical codes for your specialty can have a big impact on your revenue cycle management and revenue collections performance. To help transform your billing and coding staff into financial rockstars, we compiled all the CPT and HCPCS code changes for 2024 and broke them down by specialty. We are offering this definitive 70-page billing and coding guide as a free, downloadable, and printable PDF.

Whether you are a practice with in-house billing staff or are an outsourced revenue cycle management company, this reference guide presents and explains what changes can impact you. It is organized and color-coded by specialty and code status. Get one free download of our exclusive 2024 billing and coding codebook emailed to your inbox. Bonus content added for requested specialties:

Occupational therapy
Psychiatry services and procedures
Evaluation and management coding (E&M)

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CPT/HCPCS

Codes 2024

Added | Revised | Deleted

BONUS: ICD-10 Codes for 2024

ADDED/REVISED/DELETED CPT/HCPCS & ICD-10 CODES DISCLAIMER

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THEIR PURPOSES. THIS INFORMATION IS NOT INTENDED TO BE A FINAL OR EXHAUSTIVE LIST OF ADDED, REVISED AND DELETED CODES FOR 2024, THE CPT/HCPCS CODES ARE FREQUENTLY REVISED AND ADVANCEDMD DISCLAIMS ALL RESPONSIBILITY FOR ADDED, REVISED AND DELETED CODES WHICH ARE LATER ADDED, REVISED, MODIFIED OR DELETED AT ANY TIME; NO INDEPENDENT VERIFICATION OF THE DATA IS CLAIMED OR IMPLIED.

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2024 CPT Codes

Below are the 2024 CPT code updates. This list includes new CPT codes, revised codes and deleted codes.

Added CPT Codes for 2024

Speciality

CPT Code

Description

Proprietary Laboratory Analyses

Proprietary Laboratory Analyses	0420U	Oncology (urothelial), mRNA expression profiling by real-time quantitative PCR of MDK, HOXA13, CDC2, IGFBP5, and CXCR2 in combination with droplet digital PCR (ddPCR) analysis of 6 single-nucleotide polymorphisms (SNPs) genes TERT and FGFR3, urine, algorithm reported as a risk score for urothelial carcinoma
Proprietary Laboratory Analyses	0421U	Oncology (colorectal) screening, quantitative real-time target and signal amplification of 8 RNA markers (GAPDH, SMAD4, ACY1, AREG, CDH1, KRAS, TNFRSF10B, EGLN2) and fecal hemoglobin, algorithm reported as a positive or negative for colorectal cancer risk
Proprietary Laboratory Analyses	0422U	Oncology (pan-solid tumor), analysis of DNA biomarker response to anti-cancer therapy using cell-free circulating DNA, biomarker comparison to a previous baseline pre-treatment cell-free circulating DNA analysis using next-generation sequencing, algorithm reported as a quantitative change from baseline, including specific alterations, if appropriate
Proprietary Laboratory Analyses	0423U	Psychiatry (eg, depression, anxiety), genomic analysis panel, including variant analysis of 26 genes, buccal swab, report including metabolizer status and risk of drug toxicity by condition
Proprietary Laboratory Analyses	0424U	Oncology (prostate), exosome-based analysis of 53 small noncoding RNAs (sncRNAs) by quantitative reverse transcription polymerase chain reaction (RT-qPCR), urine, reported as no molecular evidence, low-, moderate- or elevated-risk of prostate cancer
Proprietary Laboratory Analyses	0425U	Genome (eg, unexplained constitutional or heritable disorder or syndrome), rapid sequence analysis, each comparator genome (eg, parents, siblings)
Proprietary Laboratory Analyses	0426U	Genome (eg, unexplained constitutional or heritable disorder or syndrome), ultra-rapid sequence analysis
Proprietary Laboratory Analyses	0427U	Monocyte distribution width, whole blood (List separately in addition to code for primary procedure)
Proprietary Laboratory Analyses	0428U	Oncology (breast), targeted hybrid-capture genomic sequence analysis panel, circulating tumor DNA (ctDNA) analysis of 56 or more genes, interrogation for sequence variants, gene copy number amplifications, gene rearrangements, microsatellite instability, and tumor mutation burden
Proprietary Laboratory Analyses	0429U	Human papillomavirus (HPV), oropharyngeal swab, 14 high-risk types (ie, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68)
Proprietary Laboratory Analyses	0430U	Gastroenterology, malabsorption evaluation of alpha-1-antitrypsin, calprotectin, pancreatic elastase and reducing substances, feces, quantitative
Proprietary Laboratory Analyses	0431U	Glycine receptor alpha1 IgG, serum or cerebrospinal fluid (CSF), live cell-binding assay (LCBA), qualitative
Proprietary Laboratory Analyses	0432U	Kelch-like protein 11 (KLHL11) antibody, serum or cerebrospinal fluid (CSF), cell-binding assay, qualitative
Proprietary Laboratory Analyses	0433U	Oncology (prostate), 5 DNA regulatory markers by quantitative PCR, whole blood, algorithm, including prostate-specific antigen, reported as likelihood of cancer
Proprietary Laboratory Analyses	0434U	Drug metabolism (adverse drug reactions and drug response), genomic analysis panel, variant analysis of 25 genes with reported phenotypes
Proprietary Laboratory Analyses	0435U	Oncology, chemotherapeutic drug cytotoxicity assay of cancer stem cells (CSCs), from cultured CSCs and primary tumor cells, categorical drug response reported based on cytotoxicity percentage observed, minimum of 14 drugs or drug combinations
Proprietary Laboratory Analyses	0436U	Oncology (lung), plasma analysis of 388 proteins, using aptamer-based proteomics technology, predictive algorithm reported as clinical benefit from immune checkpoint inhibitor therapy
Proprietary Laboratory Analyses	0437U	Psychiatry (anxiety disorders), mRNA, gene expression profiling by RNA sequencing of 15 biomarkers, whole blood, algorithm reported as predictive risk score
Proprietary Laboratory Analyses	0438U	Drug metabolism (adverse drug reactions and drug response), buccal specimen, gene-drug interactions, variant analysis of 33 genes, including deletion/duplication analysis of CYP2D6, including reported phenotypes and impacted gene- drug interactions

Category III

Category III	0784T	Insertion or replacement of percutaneous electrode array, spinal, with integrated neurostimulator, including imaging guidance, when performed
Category III	0785T	Revision or removal of neurostimulator electrode array, spinal, with integrated neurostimulator
Category III	0786T	Insertion or replacement of percutaneous electrode array, sacral, with integrated neurostimulator, including imaging guidance, when performed
Category III	0787T	Revision or removal of neurostimulator electrode array, sacral, with integrated neurostimulator
Category III	0788T	Electronic analysis with simple programming of implanted integrated neurostimulation system (eg, electrode array and receiver), including contact group(s), amplitude, pulse width, frequency (Hz), on/off cycling, burst, dose lockout, patient-selectable parameters, responsive neurostimulation, detection algorithms, closed-loop parameters, and passive parameters, when performed by physician or other qualified health care professional, spinal cord or sacral nerve, 1-3 parameters

Speciality	CPT Code	Description
Category III	0789T	Electronic analysis with complex programming of implanted integrated neurostimulation system (eg, electrode array and receiver), including contact group(s), amplitude, pulse width, frequency (Hz), on/off cycling, burst, dose lockout, patient-selectable parameters, responsive neurostimulation, detection algorithms, closed-loop parameters, and passive parameters, when performed by physician or other qualified health care professional, spinal cord or sacral nerve, 4 or more parameters
Category III	0790T	Revision (eg, augmentation, division of tether), replacement, or removal of thoracolumbar or lumbar vertebral body tethering, including thoracoscopy, when performed
Category III	0811T	Remote multi-day complex uroflowmetry (eg, calibrated electronic equipment); set-up and patient education on use of equipment
Category III	0812T	Remote multi-day complex uroflowmetry (eg, calibrated electronic equipment); device supply with automated report generation, up to 10 days
Category III	0813T	Esophagogastroduodenoscopy, flexible, transoral, with volume adjustment of intragastric bariatric balloon
Category III	0814T	Percutaneous injection of calcium-based biodegradable osteoconductive material, proximal femur, including imaging guidance, unilateral
Category III	0815T	Ultrasound-based radiofrequency echographic multi-spectrometry (REMS), bone-density study and fracture-risk assessment, 1 or more sites, hips, pelvis, or spine
Category III	0816T	Open insertion or replacement of integrated neurostimulation system for bladder dysfunction including electrode(s) (eg, array or leadless), and pulse generator or receiver, including analysis, programming, and imaging guidance, when performed, posterior tibial nerve; subcutaneous
Category III	0817T	Open insertion or replacement of integrated neurostimulation system for bladder dysfunction including electrode(s) (eg, array or leadless), and pulse generator or receiver, including analysis, programming, and imaging guidance, when performed, posterior tibial nerve; subfascial
Category III	0818T	Revision or removal of integrated neurostimulation system for bladder dysfunction, including analysis, programming, and imaging, when performed, posterior tibial nerve; subcutaneous
Category III	0819T	Revision or removal of integrated neurostimulation system for bladder dysfunction, including analysis, programming, and imaging, when performed, posterior tibial nerve; subfascial
Category III	0820T	Continuous in-person monitoring and intervention (eg, psychotherapy, crisis intervention), as needed, during psychedelic medication therapy; first physician or other qualified health care professional, each hour
Category III	0821T	Continuous in-person monitoring and intervention (eg, psychotherapy, crisis intervention), as needed, during psychedelic medication therapy; second physician or other qualified health care professional, concurrent with first physician or other qualified health care professional, each hour (List separately in addition to code for primary procedure)
Category III	0822T	Continuous in-person monitoring and intervention (eg, psychotherapy, crisis intervention), as needed, during psychedelic medication therapy; clinical staff under the direction of a physician or other qualified health care professional, concurrent with first physician or other qualified health care professional, each hour (List separately in addition to code for primary procedure)
Category III	0823T	Transcatheter insertion of permanent single-chamber leadless pacemaker, right atrial, including imaging guidance (eg, fluoroscopy, venous ultrasound, right atrial angiography and/or right ventriculography, femoral venography, cavography) and device evaluation (eg, interrogation or programming), when performed
Category III	0824T	Transcatheter removal of permanent single-chamber leadless pacemaker, right atrial, including imaging guidance (eg, fluoroscopy, venous ultrasound, right atrial angiography and/or right ventriculography, femoral venography, cavography), when performed
Category III	0825T	Transcatheter removal and replacement of permanent single-chamber leadless pacemaker, right atrial, including imaging guidance (eg, fluoroscopy, venous ultrasound, right atrial angiography and/or right ventriculography, femoral venography, cavography) and device evaluation (eg, interrogation or programming), when performed
Category III	0826T	Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional, leadless pacemaker system in single-cardiac chamber
Category III	0827T	Digitization of glass microscope slides for cytopathology, fluids, washings, or brushings, except cervical or vaginal; smears with interpretation (List separately in addition to code for primary procedure)
Category III	0828T	Digitization of glass microscope slides for cytopathology, fluids, washings, or brushings, except cervical or vaginal; simple filter method with interpretation (List separately in addition to code for primary procedure)
Category III	0829T	Digitization of glass microscope slides for cytopathology, concentration technique, smears, and interpretation (eg, Saccomanno technique) (List separately in addition to code for primary procedure)
Category III	0830T	Digitization of glass microscope slides for cytopathology, selective-cellular enhancement technique with interpretation (eg, liquid-based slide preparation method), except cervical or vaginal (List separately in addition to code for primary procedure)
Category III	0831T	Digitization of glass microscope slides for cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physician (List separately in addition to code for primary procedure)
Category III	0832T	Digitization of glass microscope slides for cytopathology, smears, any other source; screening and interpretation (List separately in addition to code for primary procedure)
Category III	0833T	Digitization of glass microscope slides for cytopathology, smears, any other source; preparation, screening and interpretation (List separately in addition to code for primary procedure)

Speciality	CPT Code	Description
Category III	0834T	Digitization of glass microscope slides for cytopathology, smears, any other source; extended study involving over 5 slides and/or multiple stains (List separately in addition to code for primary procedure)
Category III	0835T	Digitization of glass microscope slides for cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, first evaluation episode, each site (List separately in addition to code for primary procedure)
Category III	0836T	Digitization of glass microscope slides for cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, each separate additional evaluation episode, same site (List separately in addition to code for primary procedure)
Category III	0837T	Digitization of glass microscope slides for cytopathology, evaluation of fine needle aspirate; interpretation and report (List separately in addition to code for primary procedure)
Category III	0838T	Digitization of glass microscope slides for consultation and report on referred slides prepared elsewhere (List separately in addition to code for primary procedure)
Category III	0839T	Digitization of glass microscope slides for consultation and report on referred material requiring preparation of slides (List separately in addition to code for primary procedure)
Category III	0840T	Digitization of glass microscope slides for consultation, comprehensive, with review of records and specimens, with report on referred material (List separately in addition to code for primary procedure)
Category III	0841T	Digitization of glass microscope slides for pathology consultation during surgery; first tissue block, with frozen section(s), single specimen (List separately in addition to code for primary procedure)
Category III	0842T	Digitization of glass microscope slides for pathology consultation during surgery; each additional tissue block with frozen section(s) (List separately in addition to code for primary procedure)
Category III	0843T	Digitization of glass microscope slides for pathology consultation during surgery; cytologic examination (eg, touch preparation, squash preparation), initial site (List separately in addition to code for primary procedure)
Category III	0844T	Digitization of glass microscope slides for pathology consultation during surgery; cytologic examination (eg, touch preparation, squash preparation), each additional site (List separately in addition to code for primary procedure)
Category III	0845T	Digitization of glass microscope slides for immunofluorescence, per specimen; initial single antibody stain procedure (List separately in addition to code for primary procedure)
Category III	0846T	Digitization of glass microscope slides for immunofluorescence, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure)
Category III	0847T	Digitization of glass microscope slides for examination and selection of retrieved archival (ie, previously diagnosed) tissue(s) for molecular analysis (eg, KRAS mutational analysis) (List separately in addition to code for primary procedure)
Category III	0848T	Digitization of glass microscope slides for in situ hybridization (eg, FISH), per specimen; initial single probe stain procedure (List separately in addition to code for primary procedure)
Category III	0849T	Digitization of glass microscope slides for in situ hybridization (eg, FISH), per specimen; each additional single probe stain procedure (List separately in addition to code for primary procedure)
Category III	0850T	Digitization of glass microscope slides for in situ hybridization (eg, FISH), per specimen; each multiplex probe stain procedure (List separately in addition to code for primary procedure)
Category III	0851T	Digitization of glass microscope slides for morphometric analysis, in situ hybridization (quantitative or semiquantitative), manual, per specimen; initial single probe stain procedure (List separately in addition to code for primary procedure)
Category III	0852T	Digitization of glass microscope slides for morphometric analysis, in situ hybridization (quantitative or semiquantitative), manual, per specimen; each additional single probe stain procedure (List separately in addition to code for primary procedure)
Category III	0853T	Digitization of glass microscope slides for morphometric analysis, in situ hybridization (quantitative or semiquantitative), manual, per specimen; each multiplex probe stain procedure (List separately in addition to code for primary procedure)
Category III	0854T	Digitization of glass microscope slides for blood smear, peripheral, interpretation by physician with written report (List separately in addition to code for primary procedure)
Category III	0855T	Digitization of glass microscope slides for bone marrow, smear interpretation (List separately in addition to code for primary procedure)
Category III	0856T	Digitization of glass microscope slides for electron microscopy, diagnostic (List separately in addition to code for primary procedure)
Category III	0857T	Opto-acoustic imaging, breast, unilateral, including axilla when performed, real-time with image documentation, augmentative analysis and report (List separately in addition to code for primary procedure)
Category III	0858T	Externally applied transcranial magnetic stimulation with concomitant measurement of evoked cortical potentials with automated report
Category III	0859T	Noncontact near-infrared spectroscopy (eg, for measurement of deoxyhemoglobin, oxyhemoglobin, and ratio of tissue oxygenation), other than for screening for peripheral arterial disease, image acquisition, interpretation, and report; each additional anatomic site (List separately in addition to code for primary procedure)
Category III	0860T	Noncontact near-infrared spectroscopy (eg, for measurement of deoxyhemoglobin, oxyhemoglobin, and ratio of tissue oxygenation), for screening for peripheral arterial disease, including provocative maneuvers, image acquisition, interpretation, and report, one or both lower extremities
Category III	0861T	Removal of pulse generator for wireless cardiac stimulator for left ventricular pacing; both components (battery and transmitter)
Category III	0862T	Relocation of pulse generator for wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming; battery component only

Speciality	CPT Code	Description
Category III	0863T	Relocation of pulse generator for wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming; transmitter component only
Category III	0864T	Low-intensity extracorporeal shock wave therapy involving corpus cavernosum, low energy
Category III	0865T	Quantitative magnetic resonance image (MRI) analysis of the brain with comparison to prior magnetic resonance (MR) study(ies), including lesion identification, characterization, and quantification, with brain volume(s) quantification and/ or severity score, when performed, data preparation and transmission, interpretation and report, obtained without diagnostic MRI examination of the brain during the same session
Category III	0866T	Quantitative magnetic resonance image (MRI) analysis of the brain with comparison to prior magnetic resonance (MR) study(ies), including lesion detection, characterization, and quantification, with brain volume(s) quantification and/or severity score, when performed, data preparation and transmission, interpretation and report, obtained with diagnostic MRI examination of the brain (List separately in addition to code for primary procedure)

Surgery

Surgery	22836	Anterior thoracic vertebral body tethering, including thoracoscopy, when performed; up to 7 vertebral segments
Surgery	22837	Anterior thoracic vertebral body tethering, including thoracoscopy, when performed; 8 or more vertebral segments
Surgery	22838	Revision (eg, augmentation, division of tether), replacement, or removal of thoracic vertebral body tethering, including thoracoscopy, when performed
Surgery	27278	Arthrodesis, sacroiliac joint, percutaneous, with image guidance, including placement of intra-articular implant(s) (eg, bone allograft[s], synthetic device[s]), without placement of transfixation device
Surgery	31242	Nasal/sinus endoscopy, surgical; with destruction by radiofrequency ablation, posterior nasal nerve
Surgery	31243	Nasal/sinus endoscopy, surgical; with destruction by cryoablation, posterior nasal nerve
Surgery	33276	Insertion of phrenic nerve stimulator system (pulse generator and stimulating lead[s]), including vessel catheterization, all imaging guidance, and pulse generator initial analysis with diagnostic mode activation, when performed
Surgery	33277	Insertion of phrenic nerve stimulator transvenous sensing lead (List separately in addition to code for primary procedure)
Surgery	33278	Removal of phrenic nerve stimulator, including vessel catheterization, all imaging guidance, and interrogation and programming, when performed; system, including pulse generator and lead(s)
Surgery	33279	Removal of phrenic nerve stimulator, including vessel catheterization, all imaging guidance, and interrogation and programming, when performed; transvenous stimulation or sensing lead(s) only
Surgery	33280	Removal of phrenic nerve stimulator, including vessel catheterization, all imaging guidance, and interrogation and programming, when performed; pulse generator only
Surgery	33281	Repositioning of phrenic nerve stimulator transvenous lead(s)
Surgery	33287	Removal and replacement of phrenic nerve stimulator, including vessel catheterization, all imaging guidance, and interrogation and programming, when performed; pulse generator
Surgery	33288	Removal and replacement of phrenic nerve stimulator, including vessel catheterization, all imaging guidance, and interrogation and programming, when performed; transvenous stimulation or sensing lead(s)
Surgery	52284	Cystourethroscopy, with mechanical urethral dilation and urethral therapeutic drug delivery by drug-coated balloon catheter for urethral stricture or stenosis, male, including fluoroscopy, when performed
Surgery	58580	Transcervical ablation of uterine fibroid(s), including intraoperative ultrasound guidance and monitoring, radiofrequency
Surgery	61889	Insertion of skull-mounted cranial neurostimulator pulse generator or receiver, including craniectomy or craniotomy, when performed, with direct or inductive coupling, with connection to depth and/or cortical strip electrode array(s)
Surgery	61891	Revision or replacement of skull-mounted cranial neurostimulator pulse generator or receiver with connection to depth and/or cortical strip electrode array(s)
Surgery	61892	Removal of skull-mounted cranial neurostimulator pulse generator or receiver with cranioplasty, when performed
Surgery	64596	Insertion or replacement of percutaneous electrode array, peripheral nerve, with integrated neurostimulator, including imaging guidance, when performed; initial electrode array
Surgery	64597	Insertion or replacement of percutaneous electrode array, peripheral nerve, with integrated neurostimulator, including imaging guidance, when performed; each additional electrode array (List separately in addition to code for primary procedure)
Surgery	64598	Revision or removal of neurostimulator electrode array, peripheral nerve, with integrated neurostimulator
Surgery	67516	Suprachoroidal space injection of pharmacologic agent (separate procedure)

Radiology

Radiology	75580	Noninvasive estimate of coronary fractional flow reserve (FFR) derived from augmentative software analysis of the data set from a coronary computed tomography angiography, with interpretation and report by a physician or other qualified health care professional
Radiology	76984	Ultrasound, intraoperative thoracic aorta (eg, epiaortic), diagnostic
Radiology	76987	Intraoperative epicardial cardiac ultrasound (ie, echocardiography) for congenital heart disease, diagnostic; including placement and manipulation of transducer, image acquisition, interpretation and report
Radiology	76988	Intraoperative epicardial cardiac ultrasound (ie, echocardiography) for congenital heart disease, diagnostic; placement, manipulation of transducer, and image acquisition only

Speciality	CPT Code	Description
Radiology	76989	Intraoperative epicardial cardiac ultrasound (ie, echocardiography) for congenital heart disease, diagnostic; interpretation and report only

Pathology and Laboratory

Pathology and Laboratory	81457	Solid organ neoplasm, genomic sequence analysis panel, interrogation for sequence variants; DNA analysis, microsatellite instability
Pathology and Laboratory	81458	Solid organ neoplasm, genomic sequence analysis panel, interrogation for sequence variants; DNA analysis, copy number variants and microsatellite instability
Pathology and Laboratory	81459	Solid organ neoplasm, genomic sequence analysis panel, interrogation for sequence variants; DNA analysis or combined DNA and RNA analysis, copy number variants, microsatellite instability, tumor mutation burden, and rearrangements
Pathology and Laboratory	81462	Solid organ neoplasm, genomic sequence analysis panel, cell-free nucleic acid (eg, plasma), interrogation for sequence variants; DNA analysis or combined DNA and RNA analysis, copy number variants and rearrangements
Pathology and Laboratory	81463	Solid organ neoplasm, genomic sequence analysis panel, cell-free nucleic acid (eg, plasma), interrogation for sequence variants; DNA analysis, copy number variants, and microsatellite instability
Pathology and Laboratory	81464	Solid organ neoplasm, genomic sequence analysis panel, cell-free nucleic acid (eg, plasma), interrogation for sequence variants; DNA analysis or combined DNA and RNA analysis, copy number variants, microsatellite instability, tumor mutation burden, and rearrangements
Pathology and Laboratory	81517	Liver disease, analysis of 3 biomarkers (hyaluronic acid [HA], procollagen III amino terminal peptide [PIIINP], tissue inhibitor of metalloproteinase 1 [TIMP-1]), using immunoassays, utilizing serum, prognostic algorithm reported as a risk score and risk of liver fibrosis and liver-related clinical events within 5 years
Pathology and Laboratory	82166	Anti-mullerian hormone (AMH)
Pathology and Laboratory	86041	Acetylcholine receptor (AChR); binding antibody
Pathology and Laboratory	86042	Acetylcholine receptor (AChR); blocking antibody
Pathology and Laboratory	86043	Acetylcholine receptor (AChR); modulating antibody
Pathology and Laboratory	86366	Muscle-specific kinase (MuSK) antibody
Pathology and Laboratory	87523	Infectious agent detection by nucleic acid (DNA or RNA); hepatitis D (delta), quantification, including reverse transcription, when performed

Medicine Services and Procedures

Medicine Services and Procedures	90589	Chikungunya virus vaccine, live attenuated, for intramuscular use
Medicine Services and Procedures	90623	Meningococcal pentavalent vaccine, conjugated Men A, C, W, Y- tetanus toxoid carrier, and Men B-FHbp, for intramuscular usew
Medicine Services and Procedures	90683	Respiratory syncytial virus vaccine, mRNA lipid nanoparticles, for intramuscular use
Medicine Services and Procedures	92622	Diagnostic analysis, programming, and verification of an auditory osseointegrated sound processor, any type; first 60 minutes
Medicine Services and Procedures	92623	Diagnostic analysis, programming, and verification of an auditory osseointegrated sound processor, any type; each additional 15 minutes (List separately in addition to code for primary procedure)
Medicine Services and Procedures	92972	Percutaneous transluminal coronary lithotripsy (List separately in addition to code for primary procedure)
Medicine Services and Procedures	93150	Therapy activation of implanted phrenic nerve stimulator system, including all interrogation and programming
Medicine Services and Procedures	93151	Interrogation and programming (minimum one parameter) of implanted phrenic nerve stimulator system
Medicine Services and Procedures	93152	Interrogation and programming of implanted phrenic nerve stimulator system during polysomnography
Medicine Services and Procedures	93153	Interrogation without programming of implanted phrenic nerve stimulator system
Medicine Services and Procedures	93584	Venography for congenital heart defect(s), including catheter placement, and radiological supervision and interpretation; anomalous or persistent superior vena cava when it exists as a second contralateral superior vena cava, with native drainage to heart (List separately in addition to code for primary procedure)
Medicine Services and Procedures	93585	Venography for congenital heart defect(s), including catheter placement, and radiological supervision and interpretation; azygos/hemiazygos venous system (List separately in addition to code for primary procedure)
Medicine Services and Procedures	93586	Venography for congenital heart defect(s), including catheter placement, and radiological supervision and interpretation; coronary sinus (List separately in addition to code for primary procedure)
Medicine Services and Procedures	93587	Venography for congenital heart defect(s), including catheter placement, and radiological supervision and interpretation; venovenous collaterals originating at or above the heart (eg, from innominate vein) (List separately in addition to code for primary procedure)
Medicine Services and Procedures	93588	Venography for congenital heart defect(s), including catheter placement, and radiological supervision and interpretation; venovenous collaterals originating below the heart (eg, from the inferior vena cava) (List separately in addition to code for primary procedure)
Medicine Services and Procedures	96547	Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) procedure, including separate incision(s) and closure, when performed; first 60 minutes (List separately in addition to code for primary procedure)
Medicine Services and Procedures	96548	Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) procedure, including separate incision(s) and closure, when performed; each additional 30 minutes (List separately in addition to code for primary procedure)

Speciality	CPT Code	Description
Medicine Services and Procedures	97037	Application of a modality to 1 or more areas; low-level laser therapy (ie, nonthermal and non-ablative) for post-operative pain reduction
Medicine Services and Procedures	97550	Caregiver training in strategies and techniques to facilitate the patient’s functional performance in the home or community (eg, activities of daily living [ADLs], instrumental ADLs [iADLs], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patient present), face to face; initial 30 minutes
Medicine Services and Procedures	97551	Caregiver training in strategies and techniques to facilitate the patient’s functional performance in the home or community (eg, activities of daily living [ADLs], instrumental ADLs [iADLs], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patient present), face to face; each additional 15 minutes (List separately in addition to code for primary service)
Medicine Services and Procedures	97552	Group caregiver training in strategies and techniques to facilitate the patient's functional performance in the home or community (eg, activities of daily living [ADLs], instrumental ADLs [iADLs], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patient present), face to face with multiple sets of caregivers

Evaluation and Management

99459

Pelvic examination (List separately in addition to code for primary procedure)

Speciality

CPT

Code

2024 Description

2023 Description

Proprietary Laboratory Analyses

0351U

Infectious disease (bacterial or viral), biochemical assays, tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), interferon gamma-induced protein-10 (IP-10), and C-reactive protein, serum, or venous whole blood, algorithm reported as likelihood of bacterial infection

Infectious disease (bacterial or viral), biochemical assays,

tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), interferon gamma-induced protein-10 (IP-10), and

C-reactive protein, serum, algorithm reported as likelihood of bacterial infection

Proprietary Laboratory Analyses

0356U

Oncology (oropharyngeal or anal), evaluation of 17 DNA biomarkers using droplet digital PCR (ddPCR), cell-free DNA, algorithm reported as a prognostic risk score for cancer recurrence

Oncology (oropharyngeal), evaluation of 17 DNA biomarkers using droplet digital PCR (ddPCR), cell-free DNA, algorithm reported as a prognostic risk score for cancer recurrence

Category III

Category III	0517T	Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming, and imaging supervision and interpretation, when performed; both components of pulse generator (battery and transmitter) only	Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming, and imaging supervision and interpretation, when performed; pulse generator component(s) (battery and/or transmitter) only
Category III	0518T	Removal of pulse generator for wireless cardiac stimulator for left ventricular pacing; battery component only	Removal of only pulse generator component(s) (battery and/ or transmitter) of wireless cardiac stimulator for left ventricular pacing
Category III	0519T	Removal and replacement of pulse generator for wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming; both components (battery and transmitter)	Removal and replacement of wireless cardiac stimulator for left ventricular pacing; pulse generator component(s) (battery and/ or transmitter)
Category III	0520T	Removal and replacement of pulse generator for wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming; battery component only	Removal and replacement of wireless cardiac stimulator for left ventricular pacing; pulse generator component(s) (battery and/or transmitter), including placement of a new electrode
Category III	0587T	Percutaneous implantation or replacement of integrated single device neurostimulation system for bladder dysfunction including electrode array and receiver or pulse generator, including analysis, programming, and imaging guidance when performed, posterior tibial nerve	Percutaneous implantation or replacement of integrated single device neurostimulation system including electrode array and receiver or pulse generator, including analysis, programming, and imaging guidance when performed, posterior tibial nerve
Category III	0588T	Revision or removal of percutaneously placed integrated single device neurostimulation system for bladder dysfunction including electrode array and receiver or pulse generator, including analysis, programming, and imaging guidance when performed, posterior tibial nerve	Revision or removal of integrated single device neurostimulation system including electrode array and receiver or pulse generator, including analysis, programming, and imaging guidance when performed, posterior tibial nerve
Category III	0589T	Electronic analysis with simple programming of implanted integrated neurostimulation system for bladder dysfunction (eg, electrode array and receiver), including contact group(s), amplitude, pulse width, frequency (Hz), on/off cycling, burst, dose lockout, patient-selectable parameters, responsive neurostimulation, detection algorithms, closed-loop parameters, and passive parameters, when performed by physician or other qualified health care professional, posterior tibial nerve, 1-3 parameters	Electronic analysis with simple programming of implanted integrated neurostimulation system (eg, electrode array and receiver), including contact group(s), amplitude, pulse width, frequency (Hz), on/off cycling, burst, dose lockout, patient- selectable parameters, responsive neurostimulation, detection algorithms, closed-loop parameters, and passive parameters, when performed by physician or other qualified health care professional, posterior tibial nerve, 1-3 parameters
Category III	0590T	Electronic analysis with complex programming of implanted integrated neurostimulation system for bladder dysfunction (eg, electrode array and receiver), including contact group(s), amplitude, pulse width, frequency (Hz), on/off cycling, burst, dose lockout, patient-selectable parameters, responsive neurostimulation, detection algorithms, closed-loop parameters, and passive parameters, when performed by physician or other qualified health care professional, posterior tibial nerve, 4 or more parameters	Electronic analysis with complex programming of implanted integrated neurostimulation system (eg, electrode array and receiver), including contact group(s), amplitude, pulse width, frequency (Hz), on/off cycling, burst, dose lockout, patient- selectable parameters, responsive neurostimulation, detection algorithms, closed-loop parameters, and passive parameters, when performed by physician or other qualified health care professional, posterior tibial nerve, 4 or more parameters
Category III	0640T	Noncontact near-infrared spectroscopy (eg, for measurement of deoxyhemoglobin, oxyhemoglobin, and ratio of tissue oxygenation), other than for screening for peripheral arterial disease, image acquisition, interpretation, and report; first anatomic site	Noncontact near-infrared spectroscopy studies of flap or wound (eg, for measurement of deoxyhemoglobin, oxyhemoglobin, and ratio of tissue oxygenation [StO2]); image acquisition, interpretation and report, each flap or wound
Category III	0656T	Anterior lumbar or thoracolumbar vertebral body tethering; up to 7 vertebral segments	Vertebral body tethering, anterior; up to 7 vertebral segments
Category III	0657T	Anterior lumbar or thoracolumbar vertebral body tethering; 8 or more vertebral segments	Vertebral body tethering, anterior; 8 or more vertebral segments
Category III	0766T	Transcutaneous magnetic stimulation by focused low-frequency electromagnetic pulse, peripheral nerve, with identification and marking of the treatment location, including noninvasive electroneurographic localization (nerve conduction localization), when performed; first nerve	Transcutaneous magnetic stimulation by focused low-frequency electromagnetic pulse, peripheral nerve, initial treatment, with identification and marking of the treatment location, including noninvasive electroneurographic localization (nerve conduction localization), when performed; first nerve

Speciality

CPT

Code

2024 Description

2023 Description

Category III

0767T

Transcutaneous magnetic stimulation by focused

low-frequency electromagnetic pulse, peripheral nerve, with identification and marking of the treatment location,

including noninvasive electroneurographic localization (nerve conduction localization), when performed; each additional nerve (List separately in addition to code for

primary procedure)

Transcutaneous magnetic stimulation by focused low-frequency electromagnetic pulse, peripheral nerve, initial treatment, with identification and marking of the treatment location, including noninvasive electroneurographic localization (nerve conduction localization), when performed; each additional nerve (List separately in addition to code for primary procedure)

Category II

Category II	1119F	Initial evaluation for condition (HEP C) (EPI, DSP)	Initial evaluation for condition (HEP C)(EPI, DSP)
Category II	1121F	Subsequent evaluation for condition (HEP C) (EPI)	Subsequent evaluation for condition (HEP C)(EPI)

Surgery

Radiology

Radiology	77402	Radiation treatment delivery, >=1 MeV; simple	Radiation treatment delivery, >/=1 MeV; simple
Radiology	77407	Radiation treatment delivery, >=1 MeV; intermediate	Radiation treatment delivery, >/=1 MeV; intermediate
Radiology	77412	Radiation treatment delivery, >=1 MeV; complex	Radiation treatment delivery, >/=1 MeV; complex

Speciality

CPT

Code

2024 Description

2023 Description

Pathology and Laboratory

81171

AFF2 (ALF transcription elongation factor 2 [FMR2]) (eg, fragile X intellectual disability 2 [FRAXE]) gene analysis; evaluation to detect abnormal (eg, expanded) alleles

AFF2 (AF4/FMR2 family, member 2 [FMR2]) (eg, fragile X mental retardation 2 [FRAXE]) gene analysis; evaluation to detect abnormal (eg, expanded) alleles+A32:C47+C36

Pathology and Laboratory

81172

AFF2 (ALF transcription elongation factor 2 [FMR2]) (eg, fragile X intellectual disability 2 [FRAXE]) gene analysis; characterization of alleles (eg, expanded size and methylation status)

AFF2 (AF4/FMR2 family, member 2 [FMR2]) (eg, fragile X mental retardation 2 [FRAXE]) gene analysis; characterization of alleles (eg, expanded size and methylation status)

Pathology and Laboratory

81243

FMR1 (fragile X messenger ribonucleoprotein 1) (eg, fragile X syndrome, X-linked intellectual disability [XLID]) gene analysis; evaluation to detect abnormal (eg, expanded) alleles

FMR1 (fragile X mental retardation 1) (eg, fragile X mental retardation) gene analysis; evaluation to detect abnormal (eg, expanded) alleles

Pathology and Laboratory

81244

FMR1 (fragile X messenger ribonucleoprotein 1) (eg, fragile X syndrome, X-linked intellectual disability [XLID]) gene analysis; characterization of alleles (eg, expanded size and promoter methylation status)

FMR1 (fragile X mental retardation 1) (eg, fragile X mental retardation) gene analysis; characterization of alleles (eg, expanded size and promoter methylation status)

Pathology and Laboratory

81403

Molecular pathology procedure, Level 4 (eg, analysis of single exon by DNA sequence analysis, analysis of >10 amplicons using multiplex PCR in 2 or more independent reactions, mutation scanning or duplication/deletion variants of 2-5 exons) ANG (angiogenin, ribonuclease, RNase A family, 5) (eg, amyotrophic lateral sclerosis), full gene sequence ARX (aristaless related homeobox) (eg, X-linked lissencephaly with ambiguous genitalia, X-linked intellectual disability), duplication/deletion analysis CEL (carboxyl ester lipase [bile salt-stimulated lipase]) (eg, maturity- onset diabetes of the young [MODY]), targeted sequence analysis of exon 11 (eg, c.1785delC, c.1686delT) CTNNB1 (catenin [cadherin-associated protein], beta 1, 88kDa) (eg, desmoid tumors), targeted sequence analysis (eg, exon 3) DAZ/SRY (deleted in azoospermia and sex determining region Y) (eg,

male infertility), common deletions (eg, AZFa, AZFb, AZFc, AZFd) DNMT3A (DNA [cytosine-5-]-methyltransferase 3 alpha) (eg, acute myeloid leukemia), targeted sequence analysis (eg, exon 23) EPCAM (epithelial cell adhesion molecule) (eg, Lynch syndrome), duplication/deletion analysis F8 (coagulation factor

VIII) (eg, hemophilia A), inversion analysis, intron 1 and intron 22A F12 (coagulation factor XII [Hageman factor]) (eg, angioedema, hereditary, type III; factor XII deficiency), targeted sequence analysis of exon 9 FGFR3 (fibroblast growth factor receptor 3) (eg, isolated craniosynostosis), targeted sequence analysis (eg, exon 7) (For targeted sequence analysis of multiple FGFR3 exons, use 81404) GJB1 (gap junction protein, beta 1) (eg, Charcot-Marie-Tooth X-linked), full gene sequence GNAQ (guanine nucleotide-binding protein G[q] subunit alpha) (eg, uveal melanoma), common variants (eg, R183, Q209) Human erythrocyte antigen gene analyses (eg, SLC14A1 [Kidd blood group], BCAM [Lutheran blood group], ICAM4 [Landsteiner-Wiener blood group], SLC4A1 [Diego blood group], AQP1 [Colton blood group], ERMAP [Scianna blood group], RHCE [Rh blood group, CcEe antigens], KEL [Kell blood group], DARC [Duffy blood group], GYPA, GYPB, GYPE [MNS blood group], ART4 [Dombrock blood group]) (eg, sickle-cell disease, thalassemia, hemolytic transfusion reactions, hemolytic disease of the fetus or newborn), common variants HRAS (v-Ha- ras Harvey rat sarcoma viral oncogene homolog) (eg, Costello syndrome), exon 2 sequence KCNC3 (potassium voltage-gated channel, Shaw-related subfamily, member 3) (eg, spinocerebellar ataxia), targeted sequence analysis (eg, exon 2) KCNJ2 (potassium inwardly-rectifying channel, subfamily J, member

2) (eg, Andersen-Tawil syndrome), full gene sequence KCNJ11 (potassium inwardly-rectifying channel, subfamily J, member 11) (eg, familial hyperinsulinism), full gene sequence Killer cell

immunoglobulin-like receptor (KIR) gene family (eg, hematopoietic stem cell transplantation), genotyping of KIR family genes Known familial variant not otherwise specified, for gene listed in Tier 1

or Tier 2, or identified during a genomic sequencing procedure, DNA sequence analysis, each variant exon (For a known familial variant that is considered a common variant, use specific common variant Tier 1 or Tier 2 code) MC4R (melanocortin 4 receptor) (eg, obesity), full gene sequence MICA (MHC class I polypeptide- related sequence A) (eg, solid organ transplantation), common variants (eg, *001, *002) MT-RNR1 (mitochondrially encoded 12S RNA) (eg, nonsyndromic hearing loss), full gene sequence MT- TS1 (mitochondrially encoded tRNA serine 1) (eg, nonsyndromic hearing loss), full gene sequence NDP (Norrie disease [pseudoglioma]) (eg, Norrie disease), duplication/deletion analysis NHLRC1 (NHL repeat containing 1) (eg, progressive myoclonus epilepsy), full gene sequence PHOX2B (paired-like homeobox 2b)

genitalia, X-linked mental retardation), duplication/deletion analysisCEL (carboxyl ester lipase [bile salt-stimulated lipase]) (eg, maturity-onset diabetes of the young [MODY]), targeted sequence analysis of exon 11 (eg, c.1785delC, c.1686delT) CTNNB1 (catenin [cadherin-associated protein], beta 1, 88kDa) (eg, desmoid tumors), targeted sequence analysis (eg, exon 3) DAZ/SRY (deleted in azoospermia and sex determining region Y) (eg, male infertility), common deletions (eg, AZFa, AZFb, AZFc, AZFd)DNMT3A (DNA [cytosine-5-]-methyltransferase 3 alpha) (eg, acute myeloid leukemia), targeted sequence analysis (eg, exon 23)EPCAM (epithelial cell adhesion molecule) (eg, Lynch syndrome), duplication/deletion analysisF8 (coagulation factor VIII) (eg, hemophilia A), inversion analysis, intron 1 and intron 22AF12 (coagulation factor XII [Hageman factor]) (eg, angioedema, hereditary, type III; factor XII deficiency), targeted sequence analysis of exon 9FGFR3 (fibroblast growth factor receptor 3) (eg, isolated craniosynostosis), targeted sequence analysis (eg, exon 7)(For targeted sequence analysis of multiple FGFR3 exons, use 81404)GJB1 (gap junction protein, beta 1)

(eg, Charcot-Marie-Tooth X-linked), full gene sequenceGNAQ (guanine nucleotide-binding protein G[q] subunit alpha) (eg, uveal melanoma), common variants (eg, R183, Q209)Human erythrocyte antigen gene analyses (eg, SLC14A1 [Kidd blood group], BCAM [Lutheran blood group], ICAM4 [Landsteiner-Wiener blood

group], SLC4A1 [Diego blood group], AQP1 [Colton blood group], ERMAP [Scianna blood group], RHCE [Rh blood group, CcEe antigens], KEL [Kell blood group], DARC [Duffy blood group], GYPA, GYPB, GYPE [MNS blood group], ART4 [Dombrock blood group]) (eg, sickle-cell disease, thalassemia, hemolytic transfusion reactions, hemolytic disease of the fetus or newborn), common variantsHRAS (v-Ha-ras Harvey rat sarcoma viral oncogene homolog) (eg, Costello syndrome), exon 2 sequenceKCNC3 (potassium voltage-gated channel, Shaw-related subfamily, member 3) (eg, spinocerebellar ataxia), targeted sequence analysis (eg, exon 2)KCNJ2 (potassium inwardly-rectifying channel, subfamily J, member 2) (eg, Andersen-Tawil syndrome), full gene sequenceKCNJ11 (potassium inwardly-rectifying channel, subfamily J, member 11) (eg, familial hyperinsulinism), full gene sequenceKiller cell immunoglobulin-like receptor (KIR) gene family (eg, hematopoietic stem cell transplantation), genotyping of KIR family genesKnown familial variant not otherwise specified, for gene listed in Tier 1 or Tier 2, or identified during a genomic sequencing procedure, DNA sequence analysis, each variant exon(For a known familial variant that is considered a common variant, use specific common variant Tier 1 or Tier 2 code)MC4R (melanocortin 4 receptor) (eg, obesity), full gene sequenceMICA (MHC class I polypeptide-related sequence A) (eg, solid organ transplantation), common variants (eg, *001, *002)MT-RNR1 (mitochondrially encoded 12S RNA) (eg, nonsyndromic hearing loss), full gene sequenceMT-TS1 (mitochondrially encoded tRNA serine 1) (eg, nonsyndromic hearing loss), full gene sequenceNDP (Norrie disease [pseudoglioma]) (eg, congenital central hypoventilation syndrome), duplication/deletion analysisPLN (phospholamban) (eg, dilated cardiomyopathy,

Speciality

CPT

Code

2024 Description

2023 Description

Pathology and Laboratory (continued)

81403

(eg, congenital central hypoventilation syndrome), duplication/ deletion analysis PLN (phospholamban) (eg, dilated cardiomyopathy, hypertrophic cardiomyopathy), full gene sequence RHD (Rh blood group, D antigen) (eg, hemolytic disease of the fetus and newborn, Rh maternal/fetal compatibility), deletion analysis (eg, exons 4, 5, and 7, pseudogene) RHD (Rh blood group, D antigen) (eg, hemolytic disease of the fetus and newborn, Rh maternal/fetal compatibility), deletion analysis (eg, exons 4, 5, and 7, pseudogene), performed on cell-free fetal DNA in maternal blood (For human erythrocyte gene analysis of RHD, use a separate unit of 81403) SH2D1A (SH2 domain containing

1A) (eg, X-linked lymphoproliferative syndrome), duplication/ deletion analysis TWIST1 (twist homolog 1 [Drosophila]) (eg, Saethre-Chotzen syndrome), duplication/deletion analysis UBA1 (ubiquitin-like modifier activating enzyme 1) (eg, spinal muscular atrophy, X-linked), targeted sequence analysis (eg, exon 15) VHL (von Hippel-Lindau tumor suppressor) (eg, von Hippel-Lindau familial cancer syndrome), deletion/duplication analysis VWF (von Willebrand factor) (eg, von Willebrand disease types 2A, 2B, 2M), targeted sequence analysis (eg, exon 28)

hypertrophic cardiomyopathy), full gene sequenceRHD (Rh blood group, D antigen) (eg, hemolytic disease of the fetus and newborn, Rh maternal/fetal compatibility), deletion analysis (eg, exons 4, 5, and 7, pseudogene)RHD (Rh blood group, D antigen) (eg, hemolytic disease of the fetus and newborn, Rh maternal/fetal compatibility), deletion analysis (eg, exons 4,

5, and 7, pseudogene), performed on cell-free fetal DNA in maternal blood(For human erythrocyte gene analysis of RHD, use a separate unit of 81403)SH2D1A (SH2 domain containing 1A) (eg, X-linked lymphoproliferative syndrome), duplication/ deletion analysisTWIST1 (twist homolog 1 [Drosophila]) (eg, Saethre-Chotzen syndrome), duplication/deletion analysisUBA1 (ubiquitin-like modifier activating enzyme 1) (eg, spinal muscular atrophy, X-linked), targeted sequence analysis (eg, exon 15)VHL (von Hippel-Lindau tumor suppressor) (eg, von Hippel-Lindau familial cancer syndrome), deletion/duplication analysisVWF (von Willebrand factor) (eg, von Willebrand disease types 2A, 2B, 2M), targeted sequence analysis (eg, exon 28)

Pathology and Laboratory

81404

Molecular pathology procedure, Level 5 (eg, analysis of 2-5 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 6-10 exons, or characterization of a dynamic mutation disorder/triplet repeat by Southern blot analysis) ACADS (acyl-CoA dehydrogenase, C-2 to C-3 short chain) (eg, short chain acyl-CoA dehydrogenase deficiency), targeted sequence analysis (eg, exons 5 and 6) AQP2 (aquaporin 2 [collecting duct]) (eg, nephrogenic diabetes insipidus), full gene sequence ARX (aristaless related homeobox) (eg, X-linked lissencephaly with ambiguous genitalia, X-linked intellectual disability), full gene sequence AVPR2 (arginine vasopressin receptor 2) (eg, nephrogenic diabetes insipidus), full gene sequence BBS10 (Bardet-Biedl syndrome 10) (eg, Bardet-Biedl syndrome), full gene sequence BTD (biotinidase) (eg, biotinidase deficiency), full gene sequence C10orf2 (chromosome 10 open reading frame 2) (eg, mitochondrial DNA depletion syndrome), full gene sequence CAV3 (caveolin 3) (eg, CAV3-related distal myopathy, limb-girdle muscular dystrophy type 1C), full gene sequence CD40LG (CD40 ligand) (eg,

CRX (cone-rod homeobox) (eg, cone-rod dystrophy 2, Leber congenital amaurosis), full gene sequence CYP1B1 (cytochrome P450, family

1, subfamily B, polypeptide 1) (eg, primary congenital glaucoma), full gene sequence EGR2 (early growth response 2) (eg, Charcot-

Marie-Tooth), full gene sequence EMD (emerin) (eg, Emery-Dreifuss muscular dystrophy), duplication/deletion analysis EPM2A (epilepsy, progressive myoclonus type 2A, Lafora disease [laforin]) (eg, progressive myoclonus epilepsy), full gene sequence FGF23 (fibroblast growth factor 23) (eg, hypophosphatemic rickets), full gene sequence FGFR2 (fibroblast growth factor receptor 2) (eg, craniosynostosis,

Apert syndrome, Crouzon syndrome), targeted sequence analysis (eg, exons 8, 10) FGFR3 (fibroblast growth factor receptor 3) (eg, achondroplasia, hypochondroplasia), targeted sequence analysis (eg, exons 8, 11, 12, 13) FHL1 (four and a half LIM domains 1) (eg, Emery-

Dreifuss muscular dystrophy), full gene sequence FKRP (fukutin related protein) (eg, congenital muscular dystrophy type 1C [MDC1C], limb- girdle muscular dystrophy [LGMD] type 2I), full gene sequence FOXG1 (forkhead box G1) (eg, Rett syndrome), full gene sequence FSHMD1A (facioscapulohumeral muscular dystrophy 1A) (eg, facioscapulohumeral muscular dystrophy), evaluation to detect abnormal (eg, deleted) alleles FSHMD1A (facioscapulohumeral muscular dystrophy 1A)

(eg, facioscapulohumeral muscular dystrophy), characterization of haplotype(s) (ie, chromosome 4A and 4B haplotypes) GH1 (growth hormone 1) (eg, growth hormone deficiency), full gene sequence GP1BB (glycoprotein Ib [platelet], beta polypeptide) (eg, Bernard- Soulier syndrome type B), full gene sequence (For common deletion variants of alpha globin 1 and alpha globin 2 genes, use 81257) HNF1B (HNF1 homeobox B) (eg, maturity-onset diabetes of the young [MODY]),duplication/deletion analysis HRAS (v-Ha-ras Harvey rat sarcoma viral oncogene homolog) (eg, Costello syndrome), full gene sequence HSD3B2 (hydroxy-delta-5-steroid dehydrogenase, 3 beta- and steroid delta-isomerase 2) (eg, 3-beta-hydroxysteroid dehydrogenase type II deficiency), full gene sequence HSD11B2 (hydroxysteroid [11-beta] dehydrogenase 2) (eg, mineralocorticoid excess syndrome), full gene sequence HSPB1 (heat shock 27kDa protein 1) (eg, Charcot-Marie-Tooth disease), full gene sequence INS (insulin) (eg, diabetes mellitus), full gene sequence KCNJ1

Molecular pathology procedure, Level 5 (eg, analysis of 2-5 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 6-10 exons, or characterization of a dynamic mutation disorder/triplet repeat by Southern blot analysis)ACADS (acyl-CoA dehydrogenase, C-2 to C-3 short chain) (eg, short chain acyl-CoA dehydrogenase deficiency), targeted sequence analysis (eg, exons 5 and 6)AQP2 (aquaporin 2 [collecting duct]) (eg, nephrogenic diabetes insipidus), full gene sequenceARX (aristaless related homeobox) (eg, X-linked lissencephaly with ambiguous genitalia, X-linked mental retardation), full gene sequenceAVPR2 (arginine vasopressin receptor 2) (eg, nephrogenic diabetes insipidus), full gene sequenceBBS10 (Bardet-Biedl syndrome 10) (eg, Bardet-Biedl syndrome), full gene sequenceBTD (biotinidase) (eg, biotinidase deficiency), full gene sequenceC10orf2 (chromosome 10 open reading frame 2) (eg, mitochondrial DNA depletion syndrome), full gene sequenceCAV3 (caveolin 3) (eg, CAV3-related distal myopathy, limb-girdle muscular dystrophy type 1C), full gene sequenceCD40LG (CD40 ligand) (eg,

X-linked hyper IgM syndrome), full gene sequenceCDKN2A (cyclin- dependent kinase inhibitor 2A) (eg, CDKN2A-related cutaneous malignant melanoma, familial atypical mole-malignant melanoma syndrome), full gene sequenceCLRN1 (clarin 1) (eg, Usher syndrome, type 3), full gene sequenceCOX6B1 (cytochrome c oxidase subunit VIb polypeptide 1) (eg, mitochondrial respiratory chain complex IV deficiency), full gene sequenceCPT2 (carnitine palmitoyltransferase 2) (eg, carnitine palmitoyltransferase II deficiency), full gene sequenceCRX (cone-rod homeobox) (eg, cone-rod dystrophy 2, Leber congenital amaurosis), full gene sequenceCYP1B1 (cytochrome P450, family 1, subfamily B, polypeptide 1) (eg, primary congenital glaucoma), full gene sequenceEGR2 (early growth response 2) (eg, Charcot-Marie-Tooth), full gene sequenceEMD (emerin) (eg, Emery- Dreifuss muscular dystrophy), duplication/deletion analysisEPM2A (epilepsy, progressive myoclonus type 2A, Lafora disease [laforin]) (eg, progressive myoclonus epilepsy), full gene sequenceFGF23 (fibroblast growth factor 23) (eg, hypophosphatemic rickets), full gene sequenceFGFR2 (fibroblast growth factor receptor 2) (eg, craniosynostosis, Apert syndrome, Crouzon syndrome), targeted sequence analysis (eg, exons 8, 10)FGFR3 (fibroblast growth factor receptor 3) (eg, achondroplasia, hypochondroplasia), targeted sequence analysis (eg, exons 8, 11, 12, 13)FHL1 (four and a half LIM domains 1) (eg, Emery-Dreifuss muscular dystrophy), full gene sequenceFKRP (fukutin related protein) (eg, congenital muscular dystrophy type 1C [MDC1C], limb-girdle muscular dystrophy [LGMD] type 2I), full gene sequenceFOXG1 (forkhead box G1) (eg, Rett syndrome), full gene sequenceFSHMD1A (facioscapulohumeral

muscular dystrophy 1A) (eg, facioscapulohumeral muscular dystrophy), evaluation to detect abnormal (eg, deleted) allelesFSHMD1A (facioscapulohumeral muscular dystrophy 1A) (eg, facioscapulohumeral muscular dystrophy), characterization of haplotype(s) (ie, chromosome 4A and 4B haplotypes)GH1 (growth hormone 1) (eg, growth hormone deficiency), full gene sequenceGP1BB (glycoprotein Ib [platelet],

beta polypeptide) (eg, Bernard-Soulier syndrome type B), full gene sequence(For common deletion variants of alpha globin 1 and alpha globin 2 genes, use 81257)HNF1B (HNF1 homeobox B) (eg, maturity-onset diabetes of the young [MODY]), duplication/deletion

analysisHRAS (v-Ha-ras Harvey rat sarcoma viral oncogene homolog) (eg, Costello syndrome), full gene sequenceHSD3B2 (hydroxy-delta- 5-steroid dehydrogenase, 3 beta- and steroid delta-isomerase 2) (eg, 3-beta-hydroxysteroid dehydrogenase type II deficiency), full gene sequenceHSD11B2 (hydroxysteroid [11-beta] dehydrogenase 2) (eg, mineralocorticoid excess syndrome), full gene sequenceHSPB1 (heat shock 27kDa protein 1) (eg, Charcot-Marie-Tooth disease), full gene

sequenceINS (insulin) (eg, diabetes mellitus), full gene sequenceKCNJ1

Speciality

CPT

Code

2024 Description

2023 Description

Pathology and Laboratory (continued)

81404

(potassium inwardly-rectifying channel, subfamily J, member 1) (eg, Bartter syndrome), full gene sequence KCNJ10 (potassium inwardly- rectifying channel, subfamily J, member 10) (eg, SeSAME syndrome, EAST syndrome, sensorineural hearing loss), full gene sequence LITAF (lipopolysaccharide-induced TNF factor) (eg, Charcot-Marie-Tooth), full gene sequence MEFV (Mediterranean fever) (eg, familial Mediterranean fever), full gene sequence MEN1 (multiple endocrine neoplasia I) (eg, multiple endocrine neoplasia type 1, Wermer syndrome), duplication/ deletion analysis MMACHC (methylmalonic aciduria [cobalamin deficiency] cblC type, with homocystinuria) (eg, methylmalonic acidemia and homocystinuria), full gene sequence MPV17 (MpV17 mitochondrial inner membrane protein) (eg, mitochondrial DNA depletion syndrome), duplication/deletion analysis NDP (Norrie disease [pseudoglioma]) (eg, Norrie disease), full gene sequence NDUFA1 (NADH dehydrogenase [ubiquinone] 1 alpha subcomplex, 1, 7.5kDa) (eg, Leigh syndrome, mitochondrial complex I deficiency), full gene sequence NDUFAF2 (NADH dehydrogenase [ubiquinone] 1 alpha subcomplex, assembly factor 2) (eg, Leigh syndrome, mitochondrial complex I deficiency), full gene sequence NDUFS4 (NADH dehydrogenase [ubiquinone] Fe-S protein 4, 18kDa [NADH-coenzyme Q reductase]) (eg, Leigh syndrome, mitochondrial complex I deficiency), full gene sequence NIPA1 (non- imprinted in Prader-Willi/Angelman syndrome 1) (eg, spastic paraplegia), full gene sequence NLGN4X (neuroligin 4, X-linked) (eg, autism spectrum disorders), duplication/deletion analysis NPC2 (Niemann-Pick disease, type C2 [epididymal secretory protein E1]) (eg, Niemann-Pick disease type C2), full gene sequence NR0B1 (nuclear receptor subfamily 0, group B, member 1) (eg, congenital adrenal hypoplasia), full gene sequence PDX1 (pancreatic and duodenal homeobox 1) (eg, maturity- onset diabetes of the young [MODY]), full gene sequence PHOX2B (paired-like homeobox 2b) (eg, congenital central hypoventilation syndrome), full gene sequence PLP1 (proteolipid protein 1) (eg, Pelizaeus- Merzbacher disease, spastic paraplegia), duplication/deletion analysis PQBP1 (polyglutamine binding protein 1) (eg, Renpenning syndrome), duplication/deletion analysis PRNP (prion protein) (eg, genetic prion disease), full gene sequence PROP1 (PROP paired-like homeobox 1) (eg, combined pituitary hormone deficiency), full gene sequence PRPH2 (peripherin 2 [retinal degeneration, slow]) (eg, retinitis pigmentosa), full gene sequence PRSS1 (protease, serine, 1 [trypsin 1]) (eg, hereditary pancreatitis), full gene sequence RAF1 (v-raf-1 murine leukemia viral oncogene homolog 1) (eg, LEOPARD syndrome), targeted sequence analysis (eg, exons 7, 12, 14, 17) RET (ret proto-oncogene) (eg, multiple endocrine neoplasia, type 2B and familial medullary thyroid carcinoma), common variants (eg, M918T, 2647_2648delinsTT, A883F) RHO (rhodopsin) (eg, retinitis pigmentosa), full gene sequence RP1 (retinitis pigmentosa 1) (eg, retinitis pigmentosa), full gene sequence SCN1B (sodium channel, voltage-gated, type I, beta) (eg, Brugada syndrome),

full gene sequence SCO2 (SCO cytochrome oxidase deficient homolog

2 [SCO1L]) (eg, mitochondrial respiratory chain complex IV deficiency), full gene sequence SDHC (succinate dehydrogenase complex, subunit C, integral membrane protein, 15kDa) (eg, hereditary paraganglioma- pheochromocytoma syndrome), duplication/deletion analysis SDHD (succinate dehydrogenase complex, subunit D, integral membrane protein) (eg, hereditary paraganglioma), full gene sequence SGCG (sarcoglycan, gamma [35kDa dystrophin-associated glycoprotein]) (eg, limb-girdle muscular dystrophy), duplication/deletion analysis SH2D1A (SH2 domain containing 1A) (eg, X-linked lymphoproliferative syndrome), full gene sequence SLC16A2 (solute carrier family 16, member 2 [thyroid hormone transporter]) (eg, specific thyroid hormone cell transporter deficiency, Allan-Herndon-Dudley syndrome), duplication/deletion analysis SLC25A20 (solute carrier family 25 [carnitine/acylcarnitine translocase], member 20) (eg, carnitine-acylcarnitine translocase deficiency), duplication/deletion analysis SLC25A4 (solute carrier family 25 [mitochondrial carrier; adenine nucleotide translocator], member 4) (eg, progressive external ophthalmoplegia), full gene sequence SOD1 (superoxide dismutase 1, soluble) (eg, amyotrophic lateral sclerosis), full gene sequence SPINK1 (serine peptidase inhibitor, Kazal type 1) (eg, hereditary pancreatitis), full gene sequence STK11 (serine/threonine kinase 11) (eg, Peutz-Jeghers syndrome), duplication/deletion analysis TACO1 (translational activator of mitochondrial encoded cytochrome c oxidase I) (eg, mitochondrial respiratory chain complex IV deficiency), full gene sequence THAP1 (THAP domain containing, apoptosis associated protein 1) (eg, torsion dystonia), full gene sequence TOR1A (torsin family 1, member A [torsin A]) (eg, torsion dystonia), full gene sequence TTPA (tocopherol [alpha] transfer protein) (eg, ataxia), full gene sequence

TTR (transthyretin) (eg, familial transthyretin amyloidosis), full gene sequence TWIST1 (twist homolog 1 [Drosophila]) (eg, Saethre-Chotzen syndrome), full gene sequence TYR (tyrosinase [oculocutaneous albinism IA]) (eg, oculocutaneous albinism IA), full gene sequence UGT1A1

(UDP glucuronosyltransferase 1 family, polypeptide A1) (eg, hereditary unconjugated hyperbilirubinemia [Crigler-Najjar syndrome]) full gene sequence USH1G (Usher syndrome 1G [autosomal recessive]) (eg, Usher syndrome, type 1), full gene sequence VHL (von Hippel-Lindau tumor suppressor) (eg, von Hippel-Lindau familial cancer syndrome), full gene sequence VWF (von Willebrand factor) (eg, von Willebrand disease type 1C), targeted sequence analysis (eg, exons 26, 27, 37) ZEB2 (zinc finger E-box binding homeobox 2) (eg, Mowat-Wilson syndrome), duplication/ deletion analysis ZNF41 (zinc finger protein 41) (eg, X-linked intellectual disability 89), full gene sequence

full gene sequenceNDUFS4 (NADH dehydrogenase [ubiquinone]

Fe-S protein 4, 18kDa [NADH-coenzyme Q reductase]) (eg, Leigh syndrome, mitochondrial complex I deficiency), full gene sequenceNIPA1 (non-imprinted in Prader-Willi/Angelman syndrome 1) (eg, spastic paraplegia), full gene sequenceNLGN4X (neuroligin 4, X-linked)

(eg, autism spectrum disorders), duplication/deletion analysisNPC2 (Niemann-Pick disease, type C2 [epididymal secretory protein E1]) (eg, Niemann-Pick disease type C2), full gene sequenceNR0B1 (nuclear receptor subfamily 0, group B, member 1) (eg, congenital adrenal hypoplasia), full gene sequencePDX1 (pancreatic and duodenal homeobox 1) (eg, maturity-onset diabetes of the young [MODY]), full gene sequencePHOX2B (paired-like homeobox 2b) (eg, congenital central hypoventilation syndrome), full gene sequencePLP1 (proteolipid protein 1) (eg, Pelizaeus-Merzbacher disease, spastic paraplegia), duplication/deletion analysisPQBP1 (polyglutamine binding protein 1) (eg, Renpenning syndrome), duplication/deletion analysisPRNP (prion protein) (eg, genetic prion disease), full gene sequencePROP1 (PROP paired-like homeobox 1) (eg, combined pituitary hormone deficiency), full gene sequencePRPH2 (peripherin 2 [retinal degeneration, slow]) (eg, retinitis pigmentosa), full gene sequencePRSS1 (protease, serine,

1 [trypsin 1]) (eg, hereditary pancreatitis), full gene sequenceRAF1

(v-raf-1 murine leukemia viral oncogene homolog 1) (eg, LEOPARD syndrome), targeted sequence analysis (eg, exons 7, 12, 14, 17)RET (ret proto-oncogene) (eg, multiple endocrine neoplasia, type 2B and familial medullary thyroid carcinoma), common variants (eg, M918T,

2647_2648delinsTT, A883F)RHO (rhodopsin) (eg, retinitis pigmentosa), full gene sequenceRP1 (retinitis pigmentosa 1) (eg, retinitis pigmentosa), full gene sequenceSCN1B (sodium channel, voltage-gated, type I, beta) (eg, Brugada syndrome), full gene sequenceSCO2 (SCO cytochrome oxidase deficient homolog 2 [SCO1L]) (eg, mitochondrial respiratory chain complex IV deficiency), full gene sequenceSDHC (succinate dehydrogenase complex, subunit C, integral membrane protein, 15kDa) (eg, hereditary paraganglioma-pheochromocytoma syndrome),

duplication/deletion analysisSDHD (succinate dehydrogenase complex,

subunit D, integral membrane protein) (eg, hereditary paraganglioma), full gene sequenceSGCG (sarcoglycan, gamma [35kDa dystrophin- associated glycoprotein]) (eg, limb-girdle muscular dystrophy), duplication/deletion analysisSH2D1A (SH2 domain containing 1A) (eg, X-linked lymphoproliferative syndrome), full gene sequenceSLC16A2 (solute carrier family 16, member 2 [thyroid hormone transporter]) (eg, specific thyroid hormone cell transporter deficiency, Allan-Herndon- Dudley syndrome), duplication/deletion analysisSLC25A20 (solute carrier family 25 [carnitine/acylcarnitine translocase], member 20) (eg, carnitine-acylcarnitine translocase deficiency), duplication/deletion analysisSLC25A4 (solute carrier family 25 [mitochondrial carrier; adenine nucleotide translocator], member 4) (eg, progressive external ophthalmoplegia), full gene sequenceSOD1 (superoxide dismutase 1, soluble) (eg, amyotrophic lateral sclerosis), full gene sequenceSPINK1

(serine peptidase inhibitor, Kazal type 1) (eg, hereditary pancreatitis), full

gene sequenceSTK11 (serine/threonine kinase 11) (eg, Peutz-Jeghers syndrome), duplication/deletion analysisTACO1 (translational activator of mitochondrial encoded cytochrome c oxidase I) (eg, mitochondrial respiratory chain complex IV deficiency), full gene sequenceTHAP1 (THAP domain containing, apoptosis associated protein 1) (eg, torsion dystonia), full gene sequenceTOR1A (torsin family 1, member A [torsin A]) (eg, torsion dystonia), full gene sequenceTTPA (tocopherol [alpha] transfer protein) (eg, ataxia), full gene sequenceTTR (transthyretin) (eg, familial transthyretin amyloidosis), full gene sequenceTWIST1 (twist homolog 1 [Drosophila]) (eg, Saethre-Chotzen syndrome),

full gene sequenceTYR (tyrosinase [oculocutaneous albinism IA])

(eg, oculocutaneous albinism IA), full gene sequenceUGT1A1 (UDP glucuronosyltransferase 1 family, polypeptide A1) (eg, hereditary unconjugated hyperbilirubinemia [Crigler-Najjar syndrome]) full gene sequenceUSH1G (Usher syndrome 1G [autosomal recessive]) (eg, Usher syndrome, type 1), full gene sequenceVHL (von Hippel-Lindau tumor suppressor) (eg, von Hippel-Lindau familial cancer syndrome), full gene sequenceVWF (von Willebrand factor) (eg, von Willebrand disease type 1C), targeted sequence analysis (eg, exons 26, 27, 37)ZEB2 (zinc finger E-box binding homeobox 2) (eg, Mowat-Wilson syndrome), duplication/ deletion analysisZNF41 (zinc finger protein 41) (eg, X-linked mental retardation 89), full gene sequence

Speciality

CPT

Code

2024 Description

2023 Description

Pathology and Laboratory

81405

Molecular pathology procedure, Level 6 (eg, analysis of 6-10 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 11-25 exons, regionally targeted cytogenomic array analysis) ABCD1 (ATP-binding cassette, sub- family D [ALD], member 1) (eg, adrenoleukodystrophy), full gene sequence ACADS (acyl-CoA dehydrogenase, C-2 to C-3 short chain) (eg, short chain acyl-CoA dehydrogenase deficiency), full gene sequence ACTA2 (actin, alpha 2, smooth muscle, aorta) (eg, thoracic aortic aneurysms and aortic dissections), full gene sequence ACTC1 (actin, alpha, cardiac muscle 1) (eg, familial hypertrophic cardiomyopathy), full gene sequence ANKRD1 (ankyrin repeat domain 1) (eg, dilated cardiomyopathy), full gene sequence APTX (aprataxin) (eg, ataxia with oculomotor apraxia 1), full gene sequence ARSA (arylsulfatase A) (eg, arylsulfatase A deficiency), full gene sequence BCKDHA (branched chain keto acid dehydrogenase E1, alpha polypeptide) (eg, maple syrup urine disease, type 1A), full gene sequence BCS1L (BCS1-like

(eg, early infantile epileptic encephalopathy), duplication/ deletion analysis CHRNA4 (cholinergic receptor, nicotinic, alpha 4) (eg, nocturnal frontal lobe epilepsy), full gene sequence CHRNB2 (cholinergic receptor, nicotinic, beta 2 [neuronal]) (eg, nocturnal frontal lobe epilepsy), full gene sequence COX10 (COX10 homolog, cytochrome c oxidase assembly protein)

(eg, mitochondrial respiratory chain complex IV deficiency), full gene sequence COX15 (COX15 homolog, cytochrome c oxidase assembly protein) (eg, mitochondrial respiratory chain complex IV deficiency), full gene sequence CPOX (coproporphyrinogen oxidase) (eg, hereditary coproporphyria), full gene sequence CTRC (chymotrypsin C) (eg, hereditary pancreatitis), full gene sequence CYP11B1 (cytochrome P450, family 11, subfamily B, polypeptide 1) (eg, congenital adrenal hyperplasia), full gene sequence CYP17A1 (cytochrome P450, family 17, subfamily A, polypeptide 1) (eg, congenital adrenal hyperplasia), full gene sequence CYP21A2 (cytochrome P450, family 21, subfamily A, polypeptide2) (eg, steroid 21-hydroxylase isoform, congenital adrenal hyperplasia), full gene sequence Cytogenomic constitutional targeted microarray analysis of chromosome 22q13 by interrogation of genomic regions for copy number and single nucleotide polymorphism (SNP) variants for chromosomal abnormalities (When performing cytogenomic [genome-wide] analysis for constitutional chromosomal abnormalities, see 81228, 81229, 81349) (Do not report analyte-specific molecular pathology procedures separately when the specific analytes are

included as part of the microarray analysis of chromosome 22q13) (Do not report 88271 when performing cytogenomic microarray analysis) DBT (dihydrolipoamide branched chain transacylase

E2) (eg, maple syrup urine disease, type 2), duplication/deletion analysis DCX (doublecortin) (eg, X-linked lissencephaly), full gene sequence DES (desmin) (eg, myofibrillar myopathy), full gene sequence DFNB59 (deafness, autosomal recessive 59) (eg, autosomal recessive nonsyndromic hearing impairment), full gene sequence DGUOK (deoxyguanosine kinase) (eg, hepatocerebral mitochondrial DNA depletion syndrome), full gene sequence DHCR7 (7-dehydrocholesterol reductase)

(eg, Smith-Lemli-Opitz syndrome), full gene sequence EIF2B2 (eukaryotic translation initiation factor 2B, subunit 2 beta, 39kDa) (eg, leukoencephalopathy with vanishing white matter), full

gene sequence EMD (emerin) (eg, Emery-Dreifuss muscular dystrophy), full gene sequence ENG (endoglin) (eg, hereditary hemorrhagic telangiectasia, type 1), duplication/deletion analysis EYA1 (eyes absent homolog 1 [Drosophila]) (eg, branchio-oto-renal [BOR] spectrum disorders), duplication/deletion analysis FGFR1 (fibroblast growth factor receptor 1) (eg, Kallmann syndrome 2), full gene sequence FH (fumarate hydratase) (eg, fumarate hydratase deficiency, hereditary leiomyomatosis with renal cell cancer),

full gene sequence FKTN (fukutin) (eg, limb-girdle muscular dystrophy [LGMD] type 2M or 2L), full gene sequence FTSJ1 (FtsJ RNA 2'-O-methyltransferase 1) (eg, X-linked intellectual disability 9), duplication/deletion analysis GABRG2 (gamma-aminobutyric acid [GABA] A receptor, gamma 2) (eg, generalized epilepsy with febrile seizures), full gene sequence GCH1 (GTP cyclohydrolase 1)

Molecular pathology procedure, Level 6 (eg, analysis of 6-10 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 11-25 exons, regionally targeted cytogenomic array analysis)ABCD1 (ATP-binding cassette, sub- family D [ALD], member 1) (eg, adrenoleukodystrophy), full gene sequenceACADS (acyl-CoA dehydrogenase, C-2 to C-3 short chain) (eg, short chain acyl-CoA dehydrogenase deficiency), full gene sequenceACTA2 (actin, alpha 2, smooth muscle, aorta) (eg, thoracic aortic aneurysms and aortic dissections), full gene sequenceACTC1 (actin, alpha, cardiac muscle 1) (eg, familial hypertrophic cardiomyopathy), full gene sequenceANKRD1 (ankyrin repeat domain 1) (eg, dilated cardiomyopathy), full gene sequenceAPTX (aprataxin) (eg, ataxia with oculomotor apraxia 1), full gene sequenceARSA (arylsulfatase A) (eg, arylsulfatase A deficiency), full gene sequenceBCKDHA (branched chain keto acid dehydrogenase E1, alpha polypeptide) (eg, maple syrup urine disease, type 1A), full gene sequenceBCS1L (BCS1-like

[S. cerevisiae]) (eg, Leigh syndrome, mitochondrial complex III deficiency, GRACILE syndrome), full gene sequenceBMPR2 (bone morphogenetic protein receptor, type II [serine/threonine kinase]) (eg, heritable pulmonary arterial hypertension), duplication/ deletion analysisCASQ2 (calsequestrin 2 [cardiac muscle]) (eg, catecholaminergic polymorphic ventricular tachycardia), full gene sequenceCASR (calcium-sensing receptor) (eg, hypocalcemia), full gene sequenceCDKL5 (cyclin-dependent kinase-like 5) (eg, early infantile epileptic encephalopathy), duplication/deletion analysisCHRNA4 (cholinergic receptor, nicotinic, alpha 4) (eg, nocturnal frontal lobe epilepsy), full gene sequenceCHRNB2 (cholinergic receptor, nicotinic, beta 2 [neuronal]) (eg, nocturnal frontal lobe epilepsy), full gene sequenceCOX10 (COX10 homolog, cytochrome c oxidase assembly protein) (eg, mitochondrial respiratory chain complex IV deficiency), full

gene sequenceCOX15 (COX15 homolog, cytochrome c oxidase assembly protein) (eg, mitochondrial respiratory chain complex IV deficiency), full gene sequenceCPOX (coproporphyrinogen oxidase) (eg, hereditary coproporphyria), full gene sequenceCTRC (chymotrypsin C) (eg, hereditary pancreatitis), full gene sequenceCYP11B1 (cytochrome P450, family 11, subfamily

B, polypeptide 1) (eg, congenital adrenal hyperplasia), full gene sequenceCYP17A1 (cytochrome P450, family 17, subfamily A, polypeptide 1) (eg, congenital adrenal hyperplasia), full gene sequenceCYP21A2 (cytochrome P450, family 21, subfamily A, polypeptide2) (eg, steroid 21-hydroxylase isoform, congenital adrenal hyperplasia), full gene sequenceCytogenomic constitutional targeted microarray analysis of chromosome 22q13 by interrogation of genomic regions for copy number and single nucleotide polymorphism (SNP) variants for chromosomal abnormalities(When performing cytogenomic [genome-wide]

analysis for constitutional chromosomal abnormalities, see 81228, 81229, 81349)(Do not report analyte-specific molecular pathology procedures separately when the specific analytes are included as part of the microarray analysis of chromosome 22q13)(Do

not report 88271 when performing cytogenomic microarray analysis)DBT (dihydrolipoamide branched chain transacylase E2) (eg, maple syrup urine disease, type 2), duplication/deletion analysisDCX (doublecortin) (eg, X-linked lissencephaly), full gene sequenceDES (desmin) (eg, myofibrillar myopathy), full gene sequenceDFNB59 (deafness, autosomal recessive 59) (eg, autosomal recessive nonsyndromic hearing impairment), full gene sequenceDGUOK (deoxyguanosine kinase) (eg, hepatocerebral mitochondrial DNA depletion syndrome), full gene sequenceDHCR7 (7-dehydrocholesterol reductase)

(eg, Smith-Lemli-Opitz syndrome), full gene sequenceEIF2B2 (eukaryotic translation initiation factor 2B, subunit 2 beta, 39kDa) (eg, leukoencephalopathy with vanishing white matter), full gene sequenceEMD (emerin) (eg, Emery-Dreifuss muscular dystrophy), full gene sequenceENG (endoglin) (eg, hereditary hemorrhagic telangiectasia, type 1), duplication/deletion analysisEYA1 (eyes absent homolog 1 [Drosophila]) (eg, branchio-oto-renal [BOR] spectrum disorders), duplication/deletion analysisFGFR1 (fibroblast growth factor receptor 1) (eg, Kallmann syndrome

2), full gene sequenceFH (fumarate hydratase) (eg, fumarate hydratase deficiency, hereditary leiomyomatosis with renal cell cancer), full gene sequenceFKTN (fukutin) (eg, limb- girdle muscular dystrophy [LGMD] type 2M or 2L), full gene sequenceFTSJ1 (FtsJ RNA methyltransferase homolog 1 [E. coli]) (eg, X-linked mental retardation 9), duplication/deletion

analysisGABRG2 (gamma-aminobutyric acid [GABA] A receptor, gamma 2) (eg, generalized epilepsy with febrile seizures), full

Speciality

CPT

Code

2024 Description

2023 Description

Pathology and Laboratory (continued)

81405

(eg, autosomal dominant dopa-responsive dystonia), full gene sequence GDAP1 (ganglioside-induced differentiation-

associated protein 1) (eg, Charcot-Marie-Tooth disease), full gene sequence GFAP (glial fibrillary acidic protein) (eg, Alexander disease), full gene sequence GHR (growth hormone receptor) (eg, Laron syndrome), full gene sequence GHRHR (growth hormone releasing hormone receptor) (eg, growth hormone deficiency), full gene sequence GLA (galactosidase, alpha) (eg, Fabry disease), full gene sequence HNF1A (HNF1 homeobox

A) (eg, maturity-onset diabetes of the young [MODY]), full gene sequence HNF1B (HNF1 homeobox B) (eg, maturity-onset diabetes of the young [MODY]), full gene sequence HTRA1 (HtrA serine peptidase 1) (eg, macular degeneration), full gene sequence

IDS (iduronate 2-sulfatase) (eg, mucopolysacchridosis, type II), full gene sequence IL2RG (interleukin 2 receptor, gamma) (eg, X-linked severe combined immunodeficiency), full gene sequence ISPD (isoprenoid synthase domain containing) (eg,

muscle-eye-brain disease, Walker-Warburg syndrome), full gene sequence KRAS (Kirsten rat sarcoma viral oncogene homolog) (eg, Noonan syndrome), full gene sequence LAMP2 (lysosomal- associated membrane protein 2) (eg, Danon disease), full

gene sequence LDLR (low density lipoprotein receptor) (eg, familial hypercholesterolemia), duplication/deletion analysis MEN1 (multiple endocrine neoplasia I) (eg, multiple endocrine neoplasia type 1, Wermer syndrome), full gene sequence MMAA (methylmalonic aciduria [cobalamine deficiency] type A) (eg, MMAA-related methylmalonic acidemia), full gene sequence MMAB (methylmalonic aciduria [cobalamine deficiency] type B) (eg, MMAA-related methylmalonic acidemia), full gene sequence MPI (mannose phosphate isomerase) (eg, congenital disorder of

glycosylation 1b), full gene sequence MPV17 (MpV17 mitochondrial inner membrane protein) (eg, mitochondrial DNA depletion syndrome), full gene sequence MPZ (myelin protein zero) (eg, Charcot-Marie-Tooth), full gene sequence MTM1 (myotubularin

1) (eg, X-linked centronuclear myopathy), duplication/deletion analysis MYL2 (myosin, light chain 2, regulatory, cardiac, slow) (eg, familial hypertrophic cardiomyopathy), full gene sequence MYL3 (myosin, light chain 3, alkali, ventricular, skeletal, slow) (eg, familial hypertrophic cardiomyopathy), full gene sequence MYOT (myotilin) (eg, limb-girdle muscular dystrophy), full gene sequence NDUFS7 (NADH dehydrogenase [ubiquinone] Fe-S protein 7, 20kDa [NADH-coenzyme Q reductase]) (eg, Leigh syndrome, mitochondrial complex I deficiency), full gene sequence

NDUFS8 (NADH dehydrogenase [ubiquinone] Fe-S protein 8, 23kDa [NADH-coenzyme Q reductase]) (eg, Leigh syndrome, mitochondrial complex I deficiency), full gene sequence NDUFV1 (NADH dehydrogenase [ubiquinone] flavoprotein 1, 51kDa)

(eg, Leigh syndrome, mitochondrial complex I deficiency), full gene sequence NEFL (neurofilament, light polypeptide) (eg, Charcot-Marie-Tooth), full gene sequence NF2 (neurofibromin 2 [merlin]) (eg, neurofibromatosis, type 2), duplication/deletion analysis NLGN3 (neuroligin 3) (eg, autism spectrum disorders), full gene sequence NLGN4X (neuroligin 4, X-linked) (eg, autism

spectrum disorders), full gene sequence NPHP1 (nephronophthisis 1 [juvenile]) (eg, Joubert syndrome), deletion analysis, and duplication analysis, if performed NPHS2 (nephrosis 2, idiopathic, steroid-resistant [podocin]) (eg, steroid-resistant nephrotic syndrome), full gene sequence NSD1 (nuclear receptor binding SET domain protein 1) (eg, Sotos syndrome), duplication/deletion analysis OTC (ornithine carbamoyltransferase) (eg, ornithine transcarbamylase deficiency), full gene sequence PAFAH1B1 (platelet-activating factor acetylhydrolase 1b, regulatory subunit 1 [45kDa]) (eg, lissencephaly, Miller-Dieker syndrome), duplication/ deletion analysis PARK2 (Parkinson protein 2, E3 ubiquitin protein ligase [parkin]) (eg, Parkinson disease), duplication/deletion analysis PCCA (propionyl CoA carboxylase, alpha polypeptide) (eg, propionic acidemia, type 1), duplication/deletion analysis PCDH19 (protocadherin 19) (eg, epileptic encephalopathy), full gene sequence PDHA1 (pyruvate dehydrogenase [lipoamide] alpha 1) (eg, lactic acidosis), duplication/deletion analysis PDHB (pyruvate dehydrogenase [lipoamide] beta) (eg, lactic acidosis), full gene sequence PINK1 (PTEN induced putative kinase 1)

(eg, Parkinson disease), full gene sequence PKLR (pyruvate kinase, liver and RBC) (eg, pyruvate kinase deficiency), full gene sequence PLP1 (proteolipid protein 1) (eg, Pelizaeus-Merzbacher disease, spastic paraplegia), full gene sequence POU1F1 (POU class 1 homeobox 1) (eg, combined pituitary hormone deficiency), full gene sequence PRX (periaxin) (eg, Charcot-Marie-Tooth disease), full gene sequence PQBP1 (polyglutamine binding

gene sequenceGCH1 (GTP cyclohydrolase 1) (eg, autosomal dominant dopa-responsive dystonia), full gene sequenceGDAP1 (ganglioside-induced differentiation-associated protein 1)

(eg, Charcot-Marie-Tooth disease), full gene sequenceGFAP (glial fibrillary acidic protein) (eg, Alexander disease), full gene sequenceGHR (growth hormone receptor) (eg, Laron syndrome), full gene sequenceGHRHR (growth hormone releasing

hormone receptor) (eg, growth hormone deficiency), full gene sequenceGLA (galactosidase, alpha) (eg, Fabry disease), full gene sequenceHNF1A (HNF1 homeobox A) (eg, maturity-onset diabetes of the young [MODY]), full gene sequenceHNF1B (HNF1 homeobox B) (eg, maturity-onset diabetes of the young [MODY]), full gene sequenceHTRA1 (HtrA serine peptidase 1) (eg, macular degeneration), full gene sequenceIDS (iduronate 2-sulfatase) (eg, mucopolysacchridosis, type II), full gene sequenceIL2RG (interleukin 2 receptor, gamma) (eg, X-linked severe combined immunodeficiency), full gene sequenceISPD (isoprenoid synthase domain containing) (eg, muscle-eye-brain disease,

Walker-Warburg syndrome), full gene sequenceKRAS (Kirsten rat sarcoma viral oncogene homolog) (eg, Noonan syndrome), full gene sequenceLAMP2 (lysosomal-associated membrane protein 2) (eg, Danon disease), full gene sequenceLDLR (low density lipoprotein receptor) (eg, familial hypercholesterolemia), duplication/deletion analysisMEN1 (multiple endocrine neoplasia I) (eg, multiple endocrine neoplasia type 1, Wermer syndrome), full gene sequenceMMAA (methylmalonic aciduria [cobalamine deficiency] type A) (eg, MMAA-related methylmalonic acidemia), full gene sequenceMMAB (methylmalonic aciduria [cobalamine deficiency] type B) (eg, MMAA-related methylmalonic

acidemia), full gene sequenceMPI (mannose phosphate isomerase) (eg, congenital disorder of glycosylation 1b), full gene sequenceMPV17 (MpV17 mitochondrial inner membrane protein) (eg, mitochondrial DNA depletion syndrome), full gene

sequenceMPZ (myelin protein zero) (eg, Charcot-Marie-Tooth), full gene sequenceMTM1 (myotubularin 1) (eg, X-linked centronuclear myopathy), duplication/deletion analysisMYL2 (myosin, light

chain 2, regulatory, cardiac, slow) (eg, familial hypertrophic cardiomyopathy), full gene sequenceMYL3 (myosin, light chain 3, alkali, ventricular, skeletal, slow) (eg, familial hypertrophic cardiomyopathy), full gene sequenceMYOT (myotilin) (eg, limb- girdle muscular dystrophy), full gene sequenceNDUFS7 (NADH dehydrogenase [ubiquinone] Fe-S protein 7, 20kDa [NADH- coenzyme Q reductase]) (eg, Leigh syndrome, mitochondrial complex I deficiency), full gene sequenceNDUFS8 (NADH dehydrogenase [ubiquinone] Fe-S protein 8, 23kDa [NADH- coenzyme Q reductase]) (eg, Leigh syndrome, mitochondrial complex I deficiency), full gene sequenceNDUFV1 (NADH dehydrogenase [ubiquinone] flavoprotein 1, 51kDa) (eg,

Leigh syndrome, mitochondrial complex I deficiency), full gene sequenceNEFL (neurofilament, light polypeptide) (eg, Charcot-Marie-Tooth), full gene sequenceNF2 (neurofibromin 2 [merlin]) (eg, neurofibromatosis, type 2), duplication/deletion analysisNLGN3 (neuroligin 3) (eg, autism spectrum disorders),

full gene sequenceNLGN4X (neuroligin 4, X-linked) (eg, autism spectrum disorders), full gene sequenceNPHP1 (nephronophthisis 1 [juvenile]) (eg, Joubert syndrome), deletion analysis, and duplication analysis, if performedNPHS2 (nephrosis 2, idiopathic, steroid-resistant [podocin]) (eg, steroid-resistant nephrotic syndrome), full gene sequenceNSD1 (nuclear receptor binding SET domain protein 1) (eg, Sotos syndrome), duplication/deletion analysisOTC (ornithine carbamoyltransferase) (eg, ornithine transcarbamylase deficiency), full gene sequencePAFAH1B1 (platelet-activating factor acetylhydrolase 1b, regulatory subunit 1 [45kDa]) (eg, lissencephaly, Miller-Dieker syndrome), duplication/ deletion analysisPARK2 (Parkinson protein 2, E3 ubiquitin

protein ligase [parkin]) (eg, Parkinson disease), duplication/ deletion analysisPCCA (propionyl CoA carboxylase, alpha polypeptide) (eg, propionic acidemia, type 1), duplication/ deletion analysisPCDH19 (protocadherin 19) (eg, epileptic encephalopathy), full gene sequencePDHA1 (pyruvate dehydrogenase [lipoamide] alpha 1) (eg, lactic acidosis), duplication/deletion analysisPDHB (pyruvate dehydrogenase [lipoamide] beta) (eg, lactic acidosis), full gene sequencePINK1 (PTEN induced putative kinase 1) (eg, Parkinson disease), full gene sequencePKLR (pyruvate kinase, liver and RBC) (eg, pyruvate kinase deficiency), full gene sequencePLP1 (proteolipid protein 1) (eg, Pelizaeus-Merzbacher disease, spastic paraplegia), full gene sequencePOU1F1 (POU class 1 homeobox 1) (eg, combined pituitary hormone deficiency), full gene sequencePRX

Speciality

CPT

Code

2024 Description

2023 Description

Pathology and Laboratory (continued)

81405

protein 1) (eg, Renpenning syndrome), full gene sequence PSEN1 (presenilin 1) (eg, Alzheimer disease), full gene sequence RAB7A (RAB7A, member RAS oncogene family) (eg, Charcot-Marie-Tooth disease), full gene sequence RAI1 (retinoic acid induced 1) (eg, Smith-Magenis syndrome), full gene sequence REEP1 (receptor accessory protein 1) (eg, spastic paraplegia), full gene sequence RET (ret proto-oncogene) (eg, multiple endocrine neoplasia,

type 2A and familial medullary thyroid carcinoma), targeted sequence analysis (eg, exons 10, 11, 13-16) RPS19 (ribosomal protein S19) (eg, Diamond-Blackfan anemia), full gene sequence RRM2B (ribonucleotide reductase M2 B [TP53 inducible]) (eg, mitochondrial DNA depletion), full gene sequence SCO1 (SCO cytochrome oxidase deficient homolog 1) (eg, mitochondrial

respiratory chain complex IV deficiency), full gene sequence SDHB (succinate dehydrogenase complex, subunit B, iron sulfur) (eg, hereditary paraganglioma), full gene sequence SDHC (succinate dehydrogenase complex, subunit C, integral membrane protein, 15kDa) (eg, hereditary paraganglioma-pheochromocytoma syndrome), full gene sequence SGCA (sarcoglycan, alpha [50kDa dystrophin-associated glycoprotein]) (eg, limb-girdle muscular dystrophy), full gene sequence SGCB (sarcoglycan, beta [43kDa dystrophin-associated glycoprotein]) (eg, limb-girdle muscular dystrophy), full gene sequence SGCD (sarcoglycan, delta [35kDa dystrophin-associated glycoprotein]) (eg, limb-girdle muscular dystrophy), full gene sequence SGCE (sarcoglycan, epsilon)

(eg, myoclonic dystonia), duplication/deletion analysis SGCG (sarcoglycan, gamma [35kDa dystrophin-associated glycoprotein]) (eg, limb-girdle muscular dystrophy), full gene sequence SHOC2 (soc-2 suppressor of clear homolog) (eg, Noonan-like syndrome with loose anagen hair), full gene sequence SHOX (short

stature homeobox) (eg, Langer mesomelic dysplasia), full gene sequence SIL1 (SIL1 homolog, endoplasmic reticulum chaperone [S. cerevisiae]) (eg, ataxia), full gene sequence SLC2A1 (solute carrier family 2 [facilitated glucose transporter], member 1) (eg, glucose transporter type 1 [GLUT 1] deficiency syndrome), full gene sequence SLC16A2 (solute carrier family 16, member 2 [thyroid

hormone transporter]) (eg, specific thyroid hormone cell transporter deficiency, Allan-Herndon-Dudley syndrome), full gene sequence SLC22A5 (solute carrier family 22 [organic cation/carnitine transporter], member 5) (eg, systemic primary carnitine deficiency), full gene sequence SLC25A20 (solute carrier family 25 [carnitine/ acylcarnitine translocase], member 20) (eg, carnitine-acylcarnitine translocase deficiency), full gene sequence SMAD4 (SMAD family member 4) (eg, hemorrhagic telangiectasia syndrome, juvenile polyposis), duplication/deletion analysis SPAST (spastin) (eg, spastic paraplegia), duplication/deletion analysis SPG7 (spastic paraplegia 7 [pure and complicated autosomal recessive])

(eg, spastic paraplegia), duplication/deletion analysis SPRED1 (sprouty-related, EVH1 domain containing 1) (eg, Legius syndrome), full gene sequence STAT3 (signal transducer and activator of transcription 3 [acute-phase response factor]) (eg, autosomal dominant hyper-IgE syndrome), targeted sequence analysis (eg, exons 12, 13, 14, 16, 17, 20, 21) STK11 (serine/threonine kinase 11) (eg, Peutz-Jeghers syndrome), full gene sequence SURF1 (surfeit 1) (eg, mitochondrial respiratory chain complex IV deficiency), full gene sequence TARDBP (TAR DNA binding protein) (eg, amyotrophic lateral sclerosis), full gene sequence TBX5 (T-box 5) (eg, Holt-Oram syndrome), full gene sequence TCF4 (transcription factor 4) (eg, Pitt-Hopkins syndrome), duplication/deletion analysis TGFBR1 (transforming growth factor, beta receptor 1) (eg, Marfan syndrome), full gene sequence TGFBR2 (transforming growth factor, beta receptor 2) (eg, Marfan syndrome), full gene sequence THRB (thyroid hormone receptor, beta) (eg, thyroid hormone resistance, thyroid hormone beta receptor deficiency), full gene sequence or targeted sequence analysis of >5 exons TK2 (thymidine kinase 2, mitochondrial) (eg, mitochondrial DNA depletion syndrome), full gene sequence TNNC1 (troponin C type 1 [slow]) (eg, hypertrophic cardiomyopathy or dilated cardiomyopathy), full gene sequence TNNI3 (troponin I, type 3 [cardiac]) (eg, familial hypertrophic cardiomyopathy), full gene sequence TPM1 (tropomyosin 1

[alpha]) (eg, familial hypertrophic cardiomyopathy), full gene sequence TSC1 (tuberous sclerosis 1) (eg, tuberous sclerosis), duplication/deletion analysis TYMP (thymidine phosphorylase) (eg, mitochondrial DNA depletion syndrome), full gene sequence VWF (von Willebrand factor) (eg, von Willebrand disease type 2N), targeted sequence analysis (eg, exons 18-20, 23-25) WT1 (Wilms tumor 1) (eg, Denys-Drash syndrome, familial Wilms tumor), full gene sequence ZEB2 (zinc finger E-box binding homeobox 2) (eg, Mowat-Wilson syndrome), full gene sequence

(periaxin) (eg, Charcot-Marie-Tooth disease), full gene sequencePQBP1 (polyglutamine binding protein 1) (eg, Renpenning syndrome), full gene sequencePSEN1 (presenilin 1) (eg, Alzheimer disease), full gene sequenceRAB7A (RAB7A, member RAS oncogene family) (eg, Charcot-Marie-Tooth disease), full gene sequenceRAI1 (retinoic acid induced 1) (eg, Smith-Magenis syndrome), full gene sequenceREEP1 (receptor accessory protein 1) (eg, spastic paraplegia), full gene sequenceRET (ret proto- oncogene) (eg, multiple endocrine neoplasia, type 2A and familial medullary thyroid carcinoma), targeted sequence analysis (eg, exons 10, 11, 13-16)RPS19 (ribosomal protein S19) (eg, Diamond- Blackfan anemia), full gene sequenceRRM2B (ribonucleotide reductase M2 B [TP53 inducible]) (eg, mitochondrial DNA depletion), full gene sequenceSCO1 (SCO cytochrome oxidase deficient homolog 1) (eg, mitochondrial respiratory chain complex

IV deficiency), full gene sequenceSDHB (succinate dehydrogenase

complex, subunit B, iron sulfur) (eg, hereditary paraganglioma), full gene sequenceSDHC (succinate dehydrogenase complex, subunit C, integral membrane protein, 15kDa) (eg, hereditary paraganglioma-pheochromocytoma syndrome), full gene

sequenceSGCA (sarcoglycan, alpha [50kDa dystrophin-associated glycoprotein]) (eg, limb-girdle muscular dystrophy), full gene sequenceSGCB (sarcoglycan, beta [43kDa dystrophin-associated glycoprotein]) (eg, limb-girdle muscular dystrophy), full gene sequenceSGCD (sarcoglycan, delta [35kDa dystrophin-associated glycoprotein]) (eg, limb-girdle muscular dystrophy), full gene sequenceSGCE (sarcoglycan, epsilon) (eg, myoclonic dystonia), duplication/deletion analysisSGCG (sarcoglycan, gamma [35kDa dystrophin-associated glycoprotein]) (eg, limb-girdle muscular dystrophy), full gene sequenceSHOC2 (soc-2 suppressor of clear homolog) (eg, Noonan-like syndrome with loose anagen hair),

full gene sequenceSHOX (short stature homeobox) (eg, Langer

mesomelic dysplasia), full gene sequenceSIL1 (SIL1 homolog, endoplasmic reticulum chaperone [S. cerevisiae]) (eg, ataxia), full gene sequenceSLC2A1 (solute carrier family 2 [facilitated glucose transporter], member 1) (eg, glucose transporter type 1 [GLUT 1] deficiency syndrome), full gene sequenceSLC16A2 (solute carrier family 16, member 2 [thyroid hormone transporter]) (eg, specific thyroid hormone cell transporter deficiency, Allan-Herndon-Dudley syndrome), full gene sequenceSLC22A5 (solute carrier family 22 [organic cation/carnitine transporter], member 5) (eg, systemic primary carnitine deficiency), full gene sequenceSLC25A20 (solute carrier family 25 [carnitine/acylcarnitine translocase], member

20) (eg, carnitine-acylcarnitine translocase deficiency), full gene

sequenceSMAD4 (SMAD family member 4) (eg, hemorrhagic telangiectasia syndrome, juvenile polyposis), duplication/ deletion analysisSPAST (spastin) (eg, spastic paraplegia), duplication/deletion analysisSPG7 (spastic paraplegia 7 [pure and complicated autosomal recessive]) (eg, spastic paraplegia),

duplication/deletion analysisSPRED1 (sprouty-related, EVH1 domain containing 1) (eg, Legius syndrome), full gene sequenceSTAT3 (signal transducer and activator of transcription 3 [acute-phase response factor]) (eg, autosomal dominant hyper-IgE syndrome), targeted sequence analysis (eg, exons 12, 13, 14, 16, 17, 20, 21) STK11 (serine/threonine kinase 11) (eg, Peutz-Jeghers syndrome), full gene sequenceSURF1 (surfeit 1) (eg, mitochondrial respiratory chain complex IV deficiency), full gene sequenceTARDBP (TAR DNA binding protein) (eg, amyotrophic lateral sclerosis), full gene sequenceTBX5 (T-box 5) (eg, Holt-Oram syndrome), full gene sequenceTCF4 (transcription factor 4) (eg, Pitt-Hopkins syndrome), duplication/deletion analysisTGFBR1 (transforming growth factor,

beta receptor 1) (eg, Marfan syndrome), full gene sequenceTGFBR2

(transforming growth factor, beta receptor 2) (eg, Marfan syndrome), full gene sequenceTHRB (thyroid hormone receptor, beta) (eg, thyroid hormone resistance, thyroid hormone beta receptor deficiency), full gene sequence or targeted sequence analysis of

>5 exonsTK2 (thymidine kinase 2, mitochondrial) (eg, mitochondrial DNA depletion syndrome), full gene sequenceTNNC1 (troponin

C type 1 [slow]) (eg, hypertrophic cardiomyopathy or dilated cardiomyopathy), full gene sequenceTNNI3 (troponin I, type 3 [cardiac]) (eg, familial hypertrophic cardiomyopathy), full gene sequenceTPM1 (tropomyosin 1 [alpha]) (eg, familial hypertrophic cardiomyopathy), full gene sequenceTSC1 (tuberous sclerosis 1) (eg, tuberous sclerosis), duplication/deletion analysisTYMP (thymidine phosphorylase) (eg, mitochondrial DNA depletion syndrome), full gene sequenceVWF (von Willebrand factor) (eg, von Willebrand disease type 2N), targeted sequence analysis (eg, exons 18-20,

23-25)WT1 (Wilms tumor 1) (eg, Denys-Drash syndrome, familial Wilms tumor), full gene sequenceZEB2 (zinc finger E-box binding homeobox 2) (eg, Mowat-Wilson syndrome), full gene sequence

Speciality

CPT

Code

2024 Description

2023 Description

Pathology and Laboratory

81406

Molecular pathology procedure, Level 7 (eg, analysis of 11- 25 exons by DNA sequence analysis, mutation scanning or

duplication/deletion variants of 26-50 exons) ACADVL (acyl-CoA dehydrogenase, very long chain) (eg, very long chain acyl- coenzyme A dehydrogenase deficiency), full gene sequence ACTN4 (actinin, alpha 4) (eg, focal segmental glomerulosclerosis), full gene sequence AFG3L2 (AFG3 ATPase family gene 3-like 2 [S. cerevisiae]) (eg, spinocerebellar ataxia), full gene sequence

AIRE (autoimmune regulator) (eg, autoimmune polyendocrinopathy syndrome type 1), full gene sequence ALDH7A1 (aldehyde dehydrogenase 7 family, member A1) (eg, pyridoxine-dependent epilepsy), full gene sequence ANO5 (anoctamin 5) (eg, limb-girdle muscular dystrophy), full gene sequence ANOS1 (anosmin-1) (eg, Kallmann syndrome 1), full gene sequence APP (amyloid beta [A4] precursor protein) (eg, Alzheimer disease), full gene sequence ASS1 (argininosuccinate synthase 1) (eg, citrullinemia type I), full gene sequence ATL1 (atlastin GTPase 1) (eg, spastic paraplegia), full gene sequence ATP1A2 (ATPase, Na+/K+ transporting, alpha 2 polypeptide) (eg, familial hemiplegic migraine), full gene sequence ATP7B (ATPase, Cu++ transporting, beta polypeptide) (eg, Wilson disease), full gene sequence BBS1 (Bardet-Biedl syndrome 1) (eg, Bardet-Biedl syndrome), full gene sequence BBS2 (Bardet-Biedl syndrome 2) (eg, Bardet-Biedl syndrome), full gene sequence BCKDHB (branched-chain keto acid dehydrogenase E1, beta polypeptide) (eg, maple syrup urine disease, type 1B), full gene sequence BEST1 (bestrophin 1) (eg, vitelliform macular dystrophy), full gene sequence BMPR2 (bone morphogenetic protein receptor, type II [serine/threonine kinase]) (eg, heritable pulmonary arterial hypertension), full gene sequence BRAF (B-Raf proto- oncogene, serine/threonine kinase) (eg, Noonan syndrome), full gene sequence BSCL2 (Berardinelli-Seip congenital lipodystrophy 2 [seipin]) (eg, Berardinelli-Seip congenital lipodystrophy), full gene sequence BTK (Bruton agammaglobulinemia tyrosine kinase)

(eg, X-linked agammaglobulinemia), full gene sequence CACNB2 (calcium channel, voltage-dependent, beta 2 subunit) (eg, Brugada syndrome), full gene sequence CAPN3 (calpain 3) (eg, limb-girdle muscular dystrophy [LGMD] type 2A, calpainopathy), full gene sequence CBS (cystathionine-beta-synthase) (eg, homocystinuria, cystathionine beta-synthase deficiency), full gene sequence CDH1 (cadherin 1, type 1, E-cadherin [epithelial]) (eg, hereditary diffuse gastric cancer), full gene sequence CDKL5 (cyclin-dependent kinase-like 5) (eg, early infantile epileptic encephalopathy), full gene sequence CLCN1 (chloride channel 1, skeletal muscle) (eg, myotonia congenita), full gene sequence CLCNKB (chloride channel, voltage-sensitive Kb) (eg, Bartter syndrome 3 and 4b),

full gene sequence CNTNAP2 (contactin-associated protein- like 2) (eg, Pitt-Hopkins-like syndrome 1), full gene sequence COL6A2 (collagen, type VI, alpha 2) (eg, collagen type VI- related disorders), duplication/deletion analysis CPT1A (carnitine palmitoyltransferase 1A [liver]) (eg, carnitine palmitoyltransferase

1A [CPT1A] deficiency), full gene sequence CRB1 (crumbs homolog 1 [Drosophila]) (eg, Leber congenital amaurosis), full gene sequence CREBBP (CREB binding protein) (eg, Rubinstein-Taybi syndrome), duplication/deletion analysis DBT (dihydrolipoamide branched chain transacylase E2) (eg, maple syrup urine

disease, type 2), full gene sequence DLAT (dihydrolipoamide

S-acetyltransferase) (eg, pyruvate dehydrogenase E2 deficiency), full gene sequence DLD (dihydrolipoamide dehydrogenase) (eg, maple syrup urine disease, type III), full gene sequence DSC2 (desmocollin) (eg, arrhythmogenic right ventricular dysplasia/ cardiomyopathy 11), full gene sequence DSG2 (desmoglein 2) (eg, arrhythmogenic right ventricular dysplasia/cardiomyopathy 10), full gene sequence DSP (desmoplakin) (eg, arrhythmogenic right ventricular dysplasia/cardiomyopathy 8), full gene sequence EFHC1 (EF-hand domain [C-terminal] containing 1) (eg, juvenile myoclonic epilepsy), full gene sequence EIF2B3 (eukaryotic translation initiation factor 2B, subunit 3 gamma, 58kDa) (eg, leukoencephalopathy with vanishing white matter), full gene sequence EIF2B4 (eukaryotic translation initiation factor 2B, subunit 4 delta, 67kDa) (eg, leukoencephalopathy with vanishing white matter), full gene sequence EIF2B5 (eukaryotic translation initiation factor 2B, subunit 5 epsilon, 82kDa) (eg, childhood ataxia with central nervous system hypomyelination/vanishing white matter), full gene sequence ENG (endoglin) (eg, hereditary hemorrhagic telangiectasia, type 1), full gene sequence EYA1 (eyes absent homolog 1 [Drosophila]) (eg, branchio-oto-renal [BOR] spectrum disorders), full gene sequence F8 (coagulation factor VIII) (eg, hemophilia A), duplication/deletion analysis FAH (fumarylacetoacetate hydrolase [fumarylacetoacetase]) (eg, tyrosinemia, type 1), full gene sequence FASTKD2

Molecular pathology procedure, Level 7 (eg, analysis of

11-25 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 26-50 exons)ACADVL (acyl-CoA dehydrogenase, very long chain) (eg, very long chain acyl-coenzyme A dehydrogenase deficiency), full gene sequenceACTN4 (actinin, alpha 4) (eg, focal segmental

glomerulosclerosis), full gene sequenceAFG3L2 (AFG3 ATPase family gene 3-like 2 [S. cerevisiae]) (eg, spinocerebellar

ataxia), full gene sequenceAIRE (autoimmune regulator) (eg, autoimmune polyendocrinopathy syndrome type 1), full gene sequenceALDH7A1 (aldehyde dehydrogenase 7 family, member A1) (eg, pyridoxine-dependent epilepsy), full gene sequenceANO5 (anoctamin 5) (eg, limb-girdle muscular dystrophy), full gene sequenceANOS1 (anosmin-1) (eg, Kallmann syndrome 1), full gene sequenceAPP (amyloid beta [A4] precursor protein) (eg, Alzheimer disease), full gene sequenceASS1 (argininosuccinate synthase

1) (eg, citrullinemia type I), full gene sequenceATL1 (atlastin GTPase 1) (eg, spastic paraplegia), full gene sequenceATP1A2 (ATPase, Na+/K+ transporting, alpha 2 polypeptide) (eg, familial hemiplegic migraine), full gene sequenceATP7B (ATPase, Cu++ transporting, beta polypeptide) (eg, Wilson disease), full gene sequenceBBS1 (Bardet-Biedl syndrome 1) (eg, Bardet-Biedl syndrome), full gene sequenceBBS2 (Bardet-Biedl syndrome 2) (eg, Bardet-Biedl syndrome), full gene sequenceBCKDHB

(branched-chain keto acid dehydrogenase E1, beta polypeptide) (eg, maple syrup urine disease, type 1B), full gene sequenceBEST1 (bestrophin 1) (eg, vitelliform macular dystrophy), full gene sequenceBMPR2 (bone morphogenetic protein receptor, type

II [serine/threonine kinase]) (eg, heritable pulmonary arterial hypertension), full gene sequenceBRAF (B-Raf proto-oncogene, serine/threonine kinase) (eg, Noonan syndrome), full gene sequenceBSCL2 (Berardinelli-Seip congenital lipodystrophy 2 [seipin]) (eg, Berardinelli-Seip congenital lipodystrophy), full gene sequenceBTK (Bruton agammaglobulinemia tyrosine kinase)

(eg, X-linked agammaglobulinemia), full gene sequenceCACNB2 (calcium channel, voltage-dependent, beta 2 subunit) (eg, Brugada syndrome), full gene sequenceCAPN3 (calpain 3) (eg, limb-girdle muscular dystrophy [LGMD] type 2A, calpainopathy), full gene sequenceCBS (cystathionine-beta-synthase) (eg, homocystinuria, cystathionine beta-synthase deficiency), full gene sequenceCDH1 (cadherin 1, type 1, E-cadherin [epithelial]) (eg, hereditary diffuse gastric cancer), full gene sequenceCDKL5 (cyclin-dependent kinase-like 5) (eg, early infantile epileptic encephalopathy), full gene sequenceCLCN1 (chloride channel 1, skeletal muscle) (eg, myotonia congenita), full gene sequenceCLCNKB (chloride channel, voltage-sensitive Kb) (eg, Bartter syndrome 3 and 4b),

full gene sequenceCNTNAP2 (contactin-associated protein-like 2) (eg, Pitt-Hopkins-like syndrome 1), full gene sequenceCOL6A2

(collagen, type VI, alpha 2) (eg, collagen type VI-related disorders), duplication/deletion analysisCPT1A (carnitine palmitoyltransferase 1A [liver]) (eg, carnitine palmitoyltransferase 1A [CPT1A] deficiency), full gene sequenceCRB1 (crumbs homolog 1 [Drosophila]) (eg, Leber congenital amaurosis), full gene sequenceCREBBP (CREB binding protein) (eg, Rubinstein-Taybi syndrome), duplication/ deletion analysisDBT (dihydrolipoamide branched chain transacylase E2) (eg, maple syrup urine disease, type 2), full

gene sequenceDLAT (dihydrolipoamide S-acetyltransferase) (eg, pyruvate dehydrogenase E2 deficiency), full gene sequenceDLD (dihydrolipoamide dehydrogenase) (eg, maple syrup urine disease, type III), full gene sequenceDSC2 (desmocollin) (eg, arrhythmogenic right ventricular dysplasia/cardiomyopathy 11), full gene sequenceDSG2 (desmoglein 2) (eg, arrhythmogenic right ventricular dysplasia/cardiomyopathy 10), full gene sequenceDSP (desmoplakin) (eg, arrhythmogenic right ventricular dysplasia/ cardiomyopathy 8), full gene sequenceEFHC1 (EF-hand domain [C-terminal] containing 1) (eg, juvenile myoclonic epilepsy),

full gene sequenceEIF2B3 (eukaryotic translation initiation factor 2B, subunit 3 gamma, 58kDa) (eg, leukoencephalopathy with vanishing white matter), full gene sequenceEIF2B4 (eukaryotic translation initiation factor 2B, subunit 4 delta, 67kDa) (eg, leukoencephalopathy with vanishing white matter), full gene sequenceEIF2B5 (eukaryotic translation initiation factor 2B, subunit 5 epsilon, 82kDa) (eg, childhood ataxia

with central nervous system hypomyelination/vanishing white matter), full gene sequenceENG (endoglin) (eg, hereditary hemorrhagic telangiectasia, type 1), full gene sequenceEYA1 (eyes absent homolog 1 [Drosophila]) (eg, branchio-oto-renal [BOR] spectrum disorders), full gene sequenceF8 (coagulation factor VIII) (eg, hemophilia A), duplication/deletion analysisFAH (fumarylacetoacetate hydrolase [fumarylacetoacetase]) (eg, tyrosinemia, type 1), full gene sequenceFASTKD2

Speciality

CPT

Code

2024 Description

2023 Description

Pathology and Laboratory (continued)

81406

(FAST kinase domains 2) (eg, mitochondrial respiratory chain complex IV deficiency), full gene sequence FIG4 (FIG4 homolog, SAC1 lipid phosphatase domain containing [S. cerevisiae]) (eg, Charcot-Marie-Tooth disease), full gene sequence FTSJ1 (FtsJ RNA 2’-O-methyltransferase 1) (eg, X-linked intellectual disability 9), full gene sequence FUS (fused in sarcoma) (eg, amyotrophic lateral sclerosis), full gene sequence GAA (glucosidase, alpha; acid) (eg, glycogen storage disease type II [Pompe disease]),

full gene sequence GALC (galactosylceramidase) (eg, Krabbe disease), full gene sequence GALT (galactose-1-phosphate uridylyltransferase) (eg, galactosemia), full gene sequence GARS (glycyl-tRNA synthetase) (eg, Charcot-Marie-Tooth disease),

full gene sequence GCDH (glutaryl-CoA dehydrogenase) (eg, glutaricacidemia type 1), full gene sequence GCK (glucokinase [hexokinase 4]) (eg, maturity-onset diabetes of the young [MODY]), full gene sequence GLUD1 (glutamate dehydrogenase 1) (eg, familial hyperinsulinism), full gene sequence GNE (glucosamine [UDP-N-acetyl]-2-epimerase/N-acetylmannosamine kinase) (eg, inclusion body myopathy 2 [IBM2], Nonaka myopathy), full gene sequence GRN (granulin) (eg, frontotemporal dementia), full

gene sequence HADHA (hydroxyacyl-CoA dehydrogenase/3- ketoacyl-CoA thiolase/enoyl-CoA hydratase [trifunctional protein] alpha subunit) (eg, long chain acyl-coenzyme A dehydrogenase deficiency), full gene sequence HADHB (hydroxyacyl-CoA dehydrogenase/3-ketoacyl-CoA thiolase/ enoyl-CoA hydratase [trifunctional protein], beta subunit) (eg, trifunctional protein deficiency), full gene sequence HEXA (hexosaminidase A, alpha polypeptide) (eg, Tay-Sachs disease), full gene sequence HLCS (HLCS holocarboxylase synthetase) (eg, holocarboxylase synthetase deficiency), full gene sequence HMBS (hydroxymethylbilane synthase) (eg, acute intermittent porphyria), full gene sequence HNF4A (hepatocyte nuclear factor 4, alpha) (eg, maturity-onset diabetes of the young [MODY]), full gene sequence IDUA (iduronidase, alpha-L-) (eg,

mucopolysaccharidosis type I), full gene sequence INF2 (inverted formin, FH2 and WH2 domain containing) (eg, focal segmental glomerulosclerosis), full gene sequence IVD (isovaleryl-CoA dehydrogenase) (eg, isovaleric acidemia), full gene sequence JAG1 (jagged 1) (eg, Alagille syndrome), duplication/deletion analysis JUP (junction plakoglobin) (eg, arrhythmogenic right ventricular dysplasia/cardiomyopathy 11), full gene sequence KCNH2 (potassium voltage-gated channel, subfamily H [eag- related], member 2) (eg, short QT syndrome, long QT syndrome), full gene sequence KCNQ1 (potassium voltage-gated channel, KQT-like subfamily, member 1) (eg, short QT syndrome, long QT syndrome), full gene sequence KCNQ2 (potassium voltage- gated channel, KQT-like subfamily, member 2) (eg, epileptic encephalopathy), full gene sequence LDB3 (LIM domain binding 3) (eg, familial dilated cardiomyopathy, myofibrillar myopathy),

full gene sequence LDLR (low density lipoprotein receptor) (eg, familial hypercholesterolemia), full gene sequence LEPR (leptin receptor) (eg, obesity with hypogonadism), full gene sequence LHCGR (luteinizing hormone/choriogonadotropin receptor) (eg, precocious male puberty), full gene sequence LMNA (lamin A/C) (eg, Emery-Dreifuss muscular dystrophy [EDMD1, 2 and 3] limb- girdle muscular dystrophy [LGMD] type 1B, dilated cardiomyopathy [CMD1A], familial partial lipodystrophy [FPLD2]), full gene sequence LRP5 (low density lipoprotein receptor-related protein 5) (eg, osteopetrosis), full gene sequence MAP2K1 (mitogen- activated protein kinase 1) (eg, cardiofaciocutaneous syndrome), full gene sequence MAP2K2 (mitogen-activated protein kinase

2) (eg, cardiofaciocutaneous syndrome), full gene sequence MAPT (microtubule-associated protein tau) (eg, frontotemporal dementia), full gene sequence MCCC1 (methylcrotonoyl-CoA carboxylase 1 [alpha]) (eg, 3-methylcrotonyl-CoA carboxylase deficiency), full gene sequence MCCC2 (methylcrotonoyl-

CoA carboxylase 2 [beta]) (eg, 3-methylcrotonyl carboxylase deficiency), full gene sequence MFN2 (mitofusin 2) (eg, Charcot- Marie-Tooth disease), full gene sequence MTM1 (myotubularin 1) (eg, X-linked centronuclear myopathy), full gene sequence MUT (methylmalonyl CoA mutase) (eg, methylmalonic acidemia), full gene sequence MUTYH (mutY homolog [E. coli]) (eg, MYH- associated polyposis), full gene sequence NDUFS1 (NADH dehydrogenase [ubiquinone] Fe-S protein 1, 75kDa [NADH- coenzyme Q reductase]) (eg, Leigh syndrome, mitochondrial complex I deficiency), full gene sequence NF2 (neurofibromin

2 [merlin]) (eg, neurofibromatosis, type 2), full gene sequence NOTCH3 (notch 3) (eg, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy [CADASIL]),

(FAST kinase domains 2) (eg, mitochondrial respiratory chain complex IV deficiency), full gene sequenceFIG4 (FIG4 homolog, SAC1 lipid phosphatase domain containing [S. cerevisiae]) (eg, Charcot-Marie-Tooth disease), full gene sequenceFTSJ1 (FtsJ RNA methyltransferase homolog 1 [E. coli]) (eg, X-linked mental retardation 9), full gene sequenceFUS (fused in sarcoma)

(eg, amyotrophic lateral sclerosis), full gene sequenceGAA (glucosidase, alpha; acid) (eg, glycogen storage disease type II [Pompe disease]), full gene sequenceGALC (galactosylceramidase) (eg, Krabbe disease), full gene sequenceGALT (galactose-1- phosphate uridylyltransferase) (eg, galactosemia), full gene sequenceGARS (glycyl-tRNA synthetase) (eg, Charcot-Marie-Tooth disease), full gene sequenceGCDH (glutaryl-CoA dehydrogenase) (eg, glutaricacidemia type 1), full gene sequenceGCK (glucokinase [hexokinase 4]) (eg, maturity-onset diabetes of the young [MODY]), full gene sequenceGLUD1 (glutamate dehydrogenase 1) (eg, familial hyperinsulinism), full gene sequenceGNE (glucosamine [UDP-N-acetyl]-2-epimerase/N-acetylmannosamine kinase) (eg, inclusion body myopathy 2 [IBM2], Nonaka myopathy), full gene sequenceGRN (granulin) (eg, frontotemporal dementia), full

gene sequenceHADHA (hydroxyacyl-CoA dehydrogenase/3-

ketoacyl-CoA thiolase/enoyl-CoA hydratase [trifunctional protein] alpha subunit) (eg, long chain acyl-coenzyme A dehydrogenase deficiency), full gene sequenceHADHB (hydroxyacyl-CoA dehydrogenase/3-ketoacyl-CoA thiolase/ enoyl-CoA hydratase [trifunctional protein], beta subunit) (eg, trifunctional protein deficiency), full gene sequenceHEXA (hexosaminidase A, alpha polypeptide) (eg, Tay-Sachs disease),

full gene sequenceHLCS (HLCS holocarboxylase synthetase) (eg, holocarboxylase synthetase deficiency), full gene sequenceHMBS (hydroxymethylbilane synthase) (eg, acute intermittent porphyria), full gene sequenceHNF4A (hepatocyte nuclear factor 4, alpha) (eg, maturity-onset diabetes of the young [MODY]), full gene sequenceIDUA (iduronidase, alpha-L-) (eg, mucopolysaccharidosis type I), full gene sequenceINF2 (inverted formin, FH2 and WH2 domain containing) (eg, focal segmental glomerulosclerosis),

full gene sequenceIVD (isovaleryl-CoA dehydrogenase) (eg, isovaleric acidemia), full gene sequenceJAG1 (jagged 1) (eg, Alagille syndrome), duplication/deletion analysisJUP (junction plakoglobin) (eg, arrhythmogenic right ventricular dysplasia/cardiomyopathy

11), full gene sequenceKCNH2 (potassium voltage-gated channel, subfamily H [eag-related], member 2) (eg, short QT syndrome, long QT syndrome), full gene sequenceKCNQ1 (potassium voltage-gated channel, KQT-like subfamily, member 1) (eg, short QT syndrome, long QT syndrome), full gene sequenceKCNQ2 (potassium

voltage-gated channel, KQT-like subfamily, member 2) (eg, epileptic encephalopathy), full gene sequenceLDB3 (LIM domain binding

3) (eg, familial dilated cardiomyopathy, myofibrillar myopathy), full gene sequenceLDLR (low density lipoprotein receptor) (eg, familial hypercholesterolemia), full gene sequenceLEPR (leptin receptor) (eg, obesity with hypogonadism), full gene sequenceLHCGR (luteinizing hormone/choriogonadotropin

receptor) (eg, precocious male puberty), full gene sequenceLMNA (lamin A/C) (eg, Emery-Dreifuss muscular dystrophy [EDMD1, 2

and 3] limb-girdle muscular dystrophy [LGMD] type 1B, dilated cardiomyopathy [CMD1A], familial partial lipodystrophy [FPLD2]), full gene sequenceLRP5 (low density lipoprotein receptor-related

protein 5) (eg, osteopetrosis), full gene sequenceMAP2K1 (mitogen- activated protein kinase 1) (eg, cardiofaciocutaneous syndrome), full gene sequenceMAP2K2 (mitogen-activated protein kinase 2) (eg, cardiofaciocutaneous syndrome), full gene sequenceMAPT (microtubule-associated protein tau) (eg, frontotemporal dementia), full gene sequenceMCCC1 (methylcrotonoyl-CoA carboxylase 1 [alpha]) (eg, 3-methylcrotonyl-CoA carboxylase deficiency), full gene sequenceMCCC2 (methylcrotonoyl-CoA carboxylase 2 [beta]) (eg, 3-methylcrotonyl carboxylase deficiency), full gene sequenceMFN2 (mitofusin 2) (eg, Charcot-Marie-Tooth disease), full gene sequenceMTM1 (myotubularin 1) (eg, X-linked centronuclear myopathy), full gene sequenceMUT (methylmalonyl CoA mutase) (eg, methylmalonic acidemia), full gene sequenceMUTYH

(mutY homolog [E. coli]) (eg, MYH-associated polyposis), full

gene sequenceNDUFS1 (NADH dehydrogenase [ubiquinone] Fe-S protein 1, 75kDa [NADH-coenzyme Q reductase]) (eg, Leigh syndrome, mitochondrial complex I deficiency), full gene sequenceNF2 (neurofibromin 2 [merlin]) (eg, neurofibromatosis, type 2), full gene sequenceNOTCH3 (notch 3) (eg, cerebral autosomal dominant arteriopathy with subcortical infarcts and

leukoencephalopathy [CADASIL]), targeted sequence analysis (eg, exons 1-23)NPC1 (Niemann-Pick disease, type C1) (eg, Niemann-Pick disease), full gene sequenceNPHP1 (nephronophthisis 1 [juvenile]) (eg, Joubert syndrome), full gene sequenceNSD1

Speciality

CPT

Code

2024 Description

2023 Description

Pathology and Laboratory (continued)

81406

targeted sequence analysis (eg, exons 1-23) NPC1 (Niemann-Pick disease, type C1) (eg, Niemann-Pick disease), full gene sequence NPHP1

(nephronophthisis 1 [juvenile]) (eg, Joubert syndrome), full gene sequence NSD1 (nuclear receptor binding SET domain protein 1) (eg, Sotos syndrome), full gene sequence OPA1 (optic atrophy 1) (eg, optic atrophy), duplication/ deletion analysis OPTN (optineurin) (eg, amyotrophic lateral sclerosis), full gene sequence PAFAH1B1 (platelet-activating factor acetylhydrolase 1b, regulatory subunit 1 [45kDa]) (eg, lissencephaly, Miller-Dieker syndrome),

full gene sequence PAH (phenylalanine hydroxylase) (eg, phenylketonuria), full gene sequence PARK2 (Parkinson protein 2, E3 ubiquitin protein

ligase [parkin]) (eg, Parkinson disease), full gene sequence PAX2 (paired box 2) (eg, renal coloboma syndrome), full gene sequence PC (pyruvate carboxylase) (eg, pyruvate carboxylase deficiency), full gene sequence PCCA (propionyl CoA carboxylase, alpha polypeptide) (eg, propionic acidemia, type 1), full gene sequence PCCB (propionyl CoA carboxylase, beta polypeptide) (eg, propionic acidemia), full gene sequence PCDH15 (protocadherin-related 15) (eg, Usher syndrome type 1F), duplication/ deletion analysis PCSK9 (proprotein convertase subtilisin/kexin type 9) (eg, familial hypercholesterolemia), full gene sequence PDHA1 (pyruvate

dehydrogenase [lipoamide] alpha 1) (eg, lactic acidosis), full gene sequence PDHX (pyruvate dehydrogenase complex, component X) (eg, lactic acidosis), full gene sequence PHEX (phosphate-regulating endopeptidase homolog,

X-linked) (eg, hypophosphatemic rickets), full gene sequence PKD2 (polycystic kidney disease 2 [autosomal dominant]) (eg, polycystic kidney disease), full gene sequence PKP2 (plakophilin 2) (eg, arrhythmogenic right ventricular dysplasia/cardiomyopathy 9), full gene sequence PNKD (paroxysmal nonkinesigenic dyskinesia) (eg, paroxysmal nonkinesigenic

dyskinesia), full gene sequence POLG (polymerase [DNA directed], gamma) (eg, Alpers-Huttenlocher syndrome, autosomal dominant progressive external ophthalmoplegia), full gene sequence POMGNT1 (protein O-linked mannose beta1,2-N acetylglucosaminyltransferase) (eg, muscle-eye-brain disease, Walker-Warburg syndrome), full gene sequence POMT1 (protein- O-mannosyltransferase 1) (eg, limb-girdle muscular dystrophy [LGMD] type 2K, Walker-Warburg syndrome), full gene sequence POMT2 (protein-O-

mannosyltransferase 2) (eg, limb-girdle muscular dystrophy [LGMD] type 2N, Walker-Warburg syndrome), full gene sequence PPOX (protoporphyrinogen oxidase) (eg, variegate porphyria), full gene sequence PRKAG2 (protein kinase, AMP-activated, gamma 2 non-catalytic subunit) (eg, familial hypertrophic cardiomyopathy with Wolff-Parkinson-White syndrome, lethal congenital glycogen storage disease of heart), full gene sequence PRKCG (protein kinase C, gamma) (eg, spinocerebellar ataxia), full gene sequence PSEN2 (presenilin 2 [Alzheimer disease 4]) (eg, Alzheimer disease), full gene sequence PTPN11 (protein tyrosine phosphatase, non-receptor type

11) (eg, Noonan syndrome, LEOPARD syndrome), full gene sequence PYGM (phosphorylase, glycogen, muscle) (eg, glycogen storage disease type V, McArdle disease), full gene sequence RAF1 (v-raf-1 murine leukemia viral oncogene homolog 1) (eg, LEOPARD syndrome), full gene sequence RET (ret proto-oncogene) (eg, Hirschsprung disease), full gene sequence RPE65 (retinal pigment epithelium-specific protein 65kDa) (eg, retinitis pigmentosa, Leber congenital amaurosis), full gene sequence RYR1 (ryanodine receptor 1, skeletal) (eg, malignant hyperthermia), targeted sequence analysis of exons with functionally-confirmed mutations SCN4A (sodium channel, voltage- gated, type IV, alpha subunit) (eg, hyperkalemic periodic paralysis), full

gene sequence SCNN1A (sodium channel, nonvoltage-gated 1 alpha) (eg, pseudohypoaldosteronism), full gene sequence SCNN1B (sodium channel, nonvoltage-gated 1, beta) (eg, Liddle syndrome, pseudohypoaldosteronism), full gene sequence SCNN1G (sodium channel, nonvoltage-gated 1, gamma) (eg, Liddle syndrome, pseudohypoaldosteronism), full gene sequence SDHA (succinate dehydrogenase complex, subunit A, flavoprotein [Fp]) (eg, Leigh syndrome, mitochondrial complex II deficiency), full gene sequence SETX (senataxin) (eg, ataxia), full gene sequence SGCE (sarcoglycan, epsilon)

(eg, myoclonic dystonia), full gene sequence SH3TC2 (SH3 domain and tetratricopeptide repeats 2) (eg, Charcot-Marie-Tooth disease), full gene sequence SLC9A6 (solute carrier family 9 [sodium/hydrogen exchanger], member 6) (eg, Christianson syndrome), full gene sequence SLC26A4 (solute carrier family 26, member 4) (eg, Pendred syndrome), full gene sequence SLC37A4 (solute carrier family 37 [glucose-6-phosphate transporter], member 4) (eg, glycogen storage disease type Ib), full gene sequence SMAD4

(SMAD family member 4) (eg, hemorrhagic telangiectasia syndrome, juvenile polyposis), full gene sequence SOS1 (son of sevenless homolog 1) (eg, Noonan syndrome, gingival fibromatosis), full gene sequence SPAST (spastin) (eg, spastic paraplegia), full gene sequence SPG7 (spastic paraplegia 7 [pure and complicated autosomal recessive]) (eg, spastic paraplegia), full gene sequence STXBP1 (syntaxin-binding protein 1) (eg, epileptic encephalopathy), full gene sequence TAZ (tafazzin) (eg, methylglutaconic aciduria type 2, Barth syndrome), full gene sequence TCF4 (transcription factor 4) (eg, Pitt-Hopkins syndrome), full gene sequence TH (tyrosine hydroxylase) (eg, Segawa syndrome), full gene sequence TMEM43 (transmembrane protein 43) (eg, arrhythmogenic right ventricular cardiomyopathy), full gene sequence TNNT2 (troponin T, type 2 [cardiac]) (eg, familial hypertrophic cardiomyopathy),

full gene sequence TRPC6 (transient receptor potential cation channel, subfamily C, member 6) (eg, focal segmental glomerulosclerosis), full gene sequence TSC1 (tuberous sclerosis 1) (eg, tuberous sclerosis), full gene sequence TSC2 (tuberous sclerosis 2) (eg, tuberous sclerosis), duplication/ deletion analysis UBE3A (ubiquitin protein ligase E3A) (eg, Angelman syndrome), full gene sequence UMOD (uromodulin) (eg, glomerulocystic kidney disease with hyperuricemia and isosthenuria), full gene sequence VWF (von Willebrand factor) (von Willebrand disease type 2A), extended targeted sequence analysis (eg, exons 11-16, 24-26, 51, 52) WAS (Wiskott- Aldrich syndrome [eczema-thrombocytopenia]) (eg, Wiskott-Aldrich syndrome), full gene sequence

(nuclear receptor binding SET domain protein 1) (eg, Sotos syndrome), full gene sequenceOPA1 (optic atrophy 1) (eg, optic atrophy), duplication/ deletion analysisOPTN (optineurin) (eg, amyotrophic lateral sclerosis), full gene sequencePAFAH1B1 (platelet-activating factor acetylhydrolase 1b, regulatory subunit 1 [45kDa]) (eg, lissencephaly, Miller-Dieker syndrome),

full gene sequencePAH (phenylalanine hydroxylase) (eg, phenylketonuria), full gene sequencePARK2 (Parkinson protein 2, E3 ubiquitin protein ligase [parkin]) (eg, Parkinson disease), full gene sequencePAX2 (paired box 2) (eg, renal coloboma syndrome), full gene sequencePC (pyruvate carboxylase) (eg, pyruvate carboxylase deficiency), full gene sequencePCCA (propionyl CoA carboxylase, alpha polypeptide) (eg, propionic acidemia, type 1), full gene sequencePCCB (propionyl CoA carboxylase, beta polypeptide)

(eg, propionic acidemia), full gene sequencePCDH15 (protocadherin- related 15) (eg, Usher syndrome type 1F), duplication/deletion analysisPCSK9 (proprotein convertase subtilisin/kexin type 9) (eg, familial hypercholesterolemia), full gene sequencePDHA1 (pyruvate dehydrogenase [lipoamide] alpha 1) (eg, lactic acidosis), full gene sequencePDHX

(pyruvate dehydrogenase complex, component X) (eg, lactic acidosis), full gene sequencePHEX (phosphate-regulating endopeptidase homolog,

X-linked) (eg, hypophosphatemic rickets), full gene sequencePKD2 (polycystic kidney disease 2 [autosomal dominant]) (eg, polycystic kidney disease), full gene sequencePKP2 (plakophilin 2) (eg, arrhythmogenic right ventricular dysplasia/cardiomyopathy 9), full gene sequencePNKD (paroxysmal nonkinesigenic dyskinesia) (eg, paroxysmal nonkinesigenic

dyskinesia), full gene sequencePOLG (polymerase [DNA directed], gamma) (eg, Alpers-Huttenlocher syndrome, autosomal dominant progressive external ophthalmoplegia), full gene sequencePOMGNT1 (protein O-linked mannose beta1,2-N acetylglucosaminyltransferase) (eg, muscle-eye-brain disease, Walker-Warburg syndrome), full gene sequencePOMT1 (protein- O-mannosyltransferase 1) (eg, limb-girdle muscular dystrophy [LGMD] type 2K, Walker-Warburg syndrome), full gene sequencePOMT2 (protein-O-

mannosyltransferase 2) (eg, limb-girdle muscular dystrophy [LGMD] type 2N, Walker-Warburg syndrome), full gene sequencePPOX (protoporphyrinogen oxidase) (eg, variegate porphyria), full gene sequencePRKAG2 (protein kinase, AMP-activated, gamma 2 non-catalytic subunit) (eg, familial hypertrophic cardiomyopathy with Wolff-Parkinson-White syndrome, lethal congenital glycogen storage disease of heart), full gene sequencePRKCG (protein kinase C, gamma) (eg, spinocerebellar ataxia), full gene sequencePSEN2 (presenilin 2 [Alzheimer disease 4]) (eg, Alzheimer disease), full gene sequencePTPN11 (protein tyrosine phosphatase,

non-receptor type 11) (eg, Noonan syndrome, LEOPARD syndrome), full gene sequencePYGM (phosphorylase, glycogen, muscle) (eg, glycogen storage disease type V, McArdle disease), full gene sequenceRAF1 (v-raf-1 murine leukemia viral oncogene homolog 1) (eg, LEOPARD syndrome),

full gene sequenceRET (ret proto-oncogene) (eg, Hirschsprung disease), full gene sequenceRPE65 (retinal pigment epithelium-specific protein 65kDa) (eg, retinitis pigmentosa, Leber congenital amaurosis), full gene sequenceRYR1 (ryanodine receptor 1, skeletal) (eg, malignant hyperthermia), targeted sequence analysis of exons with functionally-confirmed mutationsSCN4A (sodium channel, voltage-gated, type IV, alpha subunit) (eg, hyperkalemic periodic paralysis), full gene sequenceSCNN1A (sodium channel, nonvoltage-gated 1 alpha) (eg, pseudohypoaldosteronism), full gene sequenceSCNN1B (sodium channel, nonvoltage-gated 1, beta) (eg, Liddle syndrome, pseudohypoaldosteronism), full gene sequenceSCNN1G (sodium channel, nonvoltage-gated 1, gamma) (eg, Liddle syndrome, pseudohypoaldosteronism), full gene sequenceSDHA (succinate dehydrogenase complex, subunit A, flavoprotein [Fp]) (eg, Leigh syndrome, mitochondrial complex II deficiency), full gene sequenceSETX (senataxin) (eg, ataxia), full gene sequenceSGCE (sarcoglycan, epsilon) (eg, myoclonic dystonia), full gene sequenceSH3TC2 (SH3 domain and tetratricopeptide repeats 2) (eg, Charcot-Marie-Tooth disease), full gene sequenceSLC9A6 (solute carrier family 9 [sodium/hydrogen exchanger], member 6) (eg, Christianson syndrome), full gene sequenceSLC26A4 (solute carrier family 26, member 4) (eg, Pendred syndrome), full gene sequenceSLC37A4 (solute carrier family 37 [glucose-6-phosphate transporter], member 4) (eg,

glycogen storage disease type Ib), full gene sequenceSMAD4 (SMAD family member 4) (eg, hemorrhagic telangiectasia syndrome, juvenile polyposis), full gene sequenceSOS1 (son of sevenless homolog 1) (eg, Noonan syndrome, gingival fibromatosis), full gene sequenceSPAST (spastin) (eg, spastic paraplegia), full gene sequenceSPG7 (spastic paraplegia 7 [pure and complicated autosomal recessive]) (eg, spastic paraplegia), full gene

sequenceSTXBP1 (syntaxin-binding protein 1) (eg, epileptic encephalopathy), full gene sequenceTAZ (tafazzin) (eg, methylglutaconic aciduria type 2, Barth syndrome), full gene sequenceTCF4 (transcription factor 4) (eg, Pitt-Hopkins syndrome), full gene sequenceTH (tyrosine hydroxylase) (eg, Segawa syndrome), full gene sequenceTMEM43 (transmembrane protein 43) (eg, arrhythmogenic right ventricular cardiomyopathy), full gene sequenceTNNT2 (troponin T, type 2 [cardiac]) (eg, familial hypertrophic cardiomyopathy),

full gene sequenceTRPC6 (transient receptor potential cation channel, subfamily C, member 6) (eg, focal segmental glomerulosclerosis), full gene sequenceTSC1 (tuberous sclerosis 1) (eg, tuberous sclerosis), full gene sequenceTSC2 (tuberous sclerosis 2) (eg, tuberous sclerosis), duplication/ deletion analysisUBE3A (ubiquitin protein ligase E3A) (eg, Angelman syndrome), full gene sequenceUMOD (uromodulin) (eg, glomerulocystic kidney disease with hyperuricemia and isosthenuria), full gene sequenceVWF (von Willebrand factor) (von Willebrand disease type 2A), extended targeted sequence analysis (eg, exons 11-16, 24-26, 51, 52)WAS (Wiskott-Aldrich syndrome [eczema-thrombocytopenia]) (eg, Wiskott-Aldrich syndrome), full gene sequence

Speciality

CPT

Code

2024 Description

2023 Description

Pathology and Laboratory

81407

Molecular pathology procedure, Level 8 (eg, analysis of 26- 50 exons by DNA sequence analysis, mutation scanning or

duplication/deletion variants of >50 exons, sequence analysis of multiple genes on one platform) ABCC8 (ATP-binding cassette, sub-family C [CFTR/MRP], member 8) (eg, familial hyperinsulinism), full gene sequence AGL (amylo-alpha-1, 6-glucosidase, 4-alpha- glucanotransferase) (eg, glycogen storage disease type III), full gene sequence AHI1 (Abelson helper integration site 1) (eg, Joubert syndrome), full gene sequence APOB (apolipoprotein

B) (eg, familial hypercholesterolemia type B) full gene sequence ASPM (asp [abnormal spindle] homolog, microcephaly associated [Drosophila]) (eg, primary microcephaly), full gene sequence CHD7 (chromodomain helicase DNA binding protein 7) (eg, CHARGE syndrome), full gene sequence COL4A4 (collagen, type IV, alpha 4) (eg, Alport syndrome), full gene sequence COL4A5 (collagen, type IV, alpha 5) (eg, Alport syndrome), duplication/ deletion analysis COL6A1 (collagen, type VI, alpha 1) (eg, collagen type VI-related disorders), full gene sequence COL6A2 (collagen, type VI, alpha 2) (eg, collagen type VI-related disorders), full gene sequence COL6A3 (collagen, type VI, alpha 3) (eg, collagen type VI-related disorders), full gene sequence CREBBP (CREB binding protein) (eg, Rubinstein-Taybi syndrome), full gene sequence F8 (coagulation factor VIII) (eg, hemophilia A), full gene sequence JAG1 (jagged 1) (eg, Alagille syndrome), full gene sequence KDM5C (lysine demethylase 5C) (eg, X-linked intellectual disability), full gene sequence KIAA0196 (KIAA0196) (eg, spastic paraplegia), full gene sequence L1CAM (L1 cell adhesion molecule) (eg, MASA syndrome, X-linked hydrocephaly), full gene sequence LAMB2 (laminin, beta 2 [laminin S]) (eg, Pierson syndrome), full gene sequence MYBPC3 (myosin binding protein C, cardiac) (eg, familial hypertrophic cardiomyopathy), full gene sequence MYH6 (myosin, heavy chain 6, cardiac muscle, alpha) (eg, familial dilated cardiomyopathy), full gene sequence MYH7 (myosin, heavy chain 7, cardiac muscle, beta) (eg, familial hypertrophic cardiomyopathy, Liang distal myopathy), full gene sequence MYO7A (myosin

VIIA) (eg, Usher syndrome, type 1), full gene sequence NOTCH1 (notch 1) (eg, aortic valve disease), full gene sequence NPHS1 (nephrosis 1, congenital, Finnish type [nephrin]) (eg, congenital Finnish nephrosis), full gene sequence OPA1 (optic atrophy 1) (eg, optic atrophy), full gene sequence PCDH15 (protocadherin-

related 15) (eg, Usher syndrome, type 1), full gene sequence PKD1 (polycystic kidney disease 1 [autosomal dominant]) (eg, polycystic kidney disease), full gene sequence PLCE1 (phospholipase C, epsilon 1) (eg, nephrotic syndrome type 3), full gene sequence SCN1A (sodium channel, voltage-gated, type 1, alpha subunit) (eg, generalized epilepsy with febrile seizures), full gene sequence SCN5A (sodium channel, voltage-gated, type V, alpha subunit) (eg, familial dilated cardiomyopathy), full gene sequence SLC12A1 (solute carrier family 12 [sodium/potassium/chloride transporters], member 1) (eg, Bartter syndrome), full gene sequence SLC12A3 (solute carrier family 12 [sodium/chloride transporters], member

3) (eg, Gitelman syndrome), full gene sequence SPG11 (spastic paraplegia 11 [autosomal recessive]) (eg, spastic paraplegia), full gene sequence SPTBN2

(spectrin, beta, non-erythrocytic 2) (eg, spinocerebellar ataxia), full gene sequence TMEM67 (transmembrane protein 67) (eg, Joubert syndrome), full gene sequence TSC2

(tuberous sclerosis 2) (eg, tuberous sclerosis), full gene sequence USH1C (Usher syndrome 1C [autosomal recessive, severe]) (eg, Usher syndrome, type 1), full gene sequence VPS13B (vacuolar protein sorting 13 homolog B [yeast]) (eg, Cohen syndrome), duplication/deletion analysis WDR62 (WD repeat domain 62) (eg, primary autosomal recessive microcephaly), full gene sequence

Molecular pathology procedure, Level 8 (eg, analysis of 26- 50 exons by DNA sequence analysis, mutation scanning or

4-alpha-glucanotransferase) (eg, glycogen storage disease type III), full gene sequenceAHI1 (Abelson helper integration site 1) (eg, Joubert syndrome), full gene sequenceAPOB (apolipoprotein B) (eg, familial hypercholesterolemia type B) full gene sequenceASPM (asp [abnormal spindle] homolog,

microcephaly associated [Drosophila]) (eg, primary microcephaly), full gene sequenceCHD7 (chromodomain helicase DNA binding protein 7) (eg, CHARGE syndrome), full gene sequenceCOL4A4 (collagen, type IV, alpha 4) (eg, Alport syndrome), full gene sequenceCOL4A5 (collagen, type IV, alpha 5) (eg, Alport syndrome), duplication/deletion analysisCOL6A1 (collagen, type VI, alpha 1) (eg, collagen type VI-related disorders), full gene sequenceCOL6A2 (collagen, type VI, alpha 2) (eg, collagen type VI-related disorders), full gene sequenceCOL6A3 (collagen, type VI, alpha 3) (eg, collagen type VI-related disorders), full gene sequenceCREBBP (CREB binding protein) (eg, Rubinstein-Taybi syndrome), full gene sequenceF8 (coagulation factor VIII) (eg, hemophilia A), full gene sequenceJAG1 (jagged 1) (eg, Alagille syndrome), full gene sequenceKDM5C (lysine [K]-specific demethylase 5C) (eg, X-linked mental retardation), full gene sequenceKIAA0196 (KIAA0196) (eg, spastic paraplegia), full

gene sequenceL1CAM (L1 cell adhesion molecule) (eg, MASA syndrome, X-linked hydrocephaly), full gene sequenceLAMB2 (laminin, beta 2 [laminin S]) (eg, Pierson syndrome), full gene sequenceMYBPC3 (myosin binding protein C, cardiac) (eg, familial hypertrophic cardiomyopathy), full gene sequenceMYH6 (myosin, heavy chain 6, cardiac muscle, alpha) (eg, familial dilated cardiomyopathy), full gene sequenceMYH7 (myosin, heavy chain 7, cardiac muscle, beta) (eg, familial hypertrophic cardiomyopathy, Liang distal myopathy), full gene sequenceMYO7A (myosin

VIIA) (eg, Usher syndrome, type 1), full gene sequenceNOTCH1 (notch 1) (eg, aortic valve disease), full gene sequenceNPHS1 (nephrosis 1, congenital, Finnish type [nephrin]) (eg, congenital Finnish nephrosis), full gene sequenceOPA1 (optic atrophy 1) (eg, optic atrophy), full gene sequencePCDH15 (protocadherin-

related 15) (eg, Usher syndrome, type 1), full gene sequencePKD1 (polycystic kidney disease 1 [autosomal dominant]) (eg, polycystic kidney disease), full gene sequencePLCE1 (phospholipase

C, epsilon 1) (eg, nephrotic syndrome type 3), full gene sequenceSCN1A (sodium channel, voltage-gated, type 1, alpha subunit) (eg, generalized epilepsy with febrile seizures), full gene sequenceSCN5A (sodium channel, voltage-gated, type V, alpha subunit) (eg, familial dilated cardiomyopathy), full gene sequenceSLC12A1 (solute carrier family 12 [sodium/potassium/ chloride transporters], member 1) (eg, Bartter syndrome), full

gene sequenceSLC12A3 (solute carrier family 12 [sodium/chloride transporters], member 3) (eg, Gitelman syndrome), full gene sequenceSPG11 (spastic paraplegia 11 [autosomal recessive])

(eg, spastic paraplegia), full gene sequenceSPTBN2 (spectrin, beta, non-erythrocytic 2) (eg, spinocerebellar ataxia), full gene sequenceTMEM67 (transmembrane protein 67) (eg, Joubert syndrome), full gene sequenceTSC2

(tuberous sclerosis 2) (eg, tuberous sclerosis), full gene sequenceUSH1C (Usher syndrome 1C [autosomal recessive, severe]) (eg, Usher syndrome, type 1), full gene sequenceVPS13B (vacuolar protein sorting 13 homolog B [yeast]) (eg, Cohen syndrome), duplication/deletion analysisWDR62 (WD repeat domain 62) (eg, primary autosomal recessive microcephaly), full gene sequence

Pathology and Laboratory

81445

Solid organ neoplasm, genomic sequence analysis panel, 5-50 genes, interrogation for sequence variants and copy number variants or rearrangements, if performed; DNA analysis or combined DNA and RNA analysis

Targeted genomic sequence analysis panel, solid organ neoplasm, 5-50 genes (eg, ALK, BRAF, CDKN2A, EGFR, ERBB2, KIT, KRAS, MET, NRAS, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN,

RET), interrogation for sequence variants and copy number variants or rearrangements, if performed; DNA analysis or combined DNA and RNA analysis

Pathology and Laboratory

81449

Solid organ neoplasm, genomic sequence analysis panel, 5-50 genes, interrogation for sequence variants and copy number variants or rearrangements, if performed; RNA analysis

Targeted genomic sequence analysis panel, solid organ neoplasm, 5-50 genes (eg, ALK, BRAF, CDKN2A, EGFR, ERBB2, KIT, KRAS, MET,

NRAS, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for

sequence variants and copy number variants or rearrangements, if performed; RNA analysis

Speciality

CPT

Code

2024 Description

2023 Description

Pathology and Laboratory

81450

Hematolymphoid neoplasm or disorder, genomic sequence analysis panel, 5-50 genes, interrogation for sequence variants, and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; DNA analysis or combined DNA and RNA analysis

Targeted genomic sequence analysis panel, hematolymphoid neoplasm or disorder, 5-50 genes (eg, BRAF, CEBPA, DNMT3A, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MLL, NOTCH1, NPM1,

NRAS), interrogation for sequence variants, and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; DNA analysis or combined DNA and RNA analysis

Pathology and Laboratory

81451

Targeted genomic sequence analysis panel, hematolymphoid neoplasm or disorder, 5-50 genes (eg, BRAF, CEBPA, DNMT3A, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MLL, NOTCH1, NPM1,

NRAS), interrogation for sequence variants, and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; RNA analysis

Pathology and Laboratory

81455

Solid organ or hematolymphoid neoplasm or disorder, 51 or greater genes, genomic sequence analysis panel, interrogation for sequence variants and copy number

variants or rearrangements, or isoform expression or mRNA expression levels, if performed; DNA analysis or combined DNA and RNA analysis

Targeted genomic sequence analysis panel, solid organ or hematolymphoid neoplasm or disorder, 51 or greater

genes (eg, ALK, BRAF, CDKN2A, CEBPA, DNMT3A, EGFR, ERBB2, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MET, MLL, NOTCH1, NPM1, NRAS, PDGFRA, PDGFRB, PGR, PIK3CA,

PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; DNA analysis or combined DNA and RNA analysis

Pathology and Laboratory

81456

Solid organ or hematolymphoid neoplasm or disorder, 51 or greater genes, genomic sequence analysis panel,

interrogation for sequence variants and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; RNA analysis

Targeted genomic sequence analysis panel, solid organ or hematolymphoid neoplasm or disorder, 51 or greater genes (eg, ALK, BRAF, CDKN2A, CEBPA, DNMT3A, EGFR, ERBB2, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MET, MLL, NOTCH1, NPM1, NRAS, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET),

interrogation for sequence variants and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; RNA analysis

Pathology and Laboratory

87467

Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [EIA], enzyme-linked

immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]),

qualitative or semiquantitative; hepatitis B surface antigen (HBsAg), quantitative

Hepatitis B surface antigen (HBsAg), quantitative

Medicine Services and Procedures

Medicine Services and Procedures	91304	Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, 5 mcg/0.5 mL dosage, for intramuscular use	Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, 5 mcg/0.5 mL dosage, for intramuscular use
Medicine Services and Procedures	96446	Chemotherapy administration into the peritoneal cavity via implanted port or catheter	Chemotherapy administration into the peritoneal cavity via indwelling port or catheter
Medicine Services and Procedures	96920	Excimer laser treatment for psoriasis; total area less than 250 sq cm	Laser treatment for inflammatory skin disease (psoriasis); total area less than 250 sq cm
Medicine Services and Procedures	96921	Excimer laser treatment for psoriasis; 250 sq cm to 500 sq cm	Laser treatment for inflammatory skin disease (psoriasis); 250 sq cm to 500 sq cm
Medicine Services and Procedures	96922	Excimer laser treatment for psoriasis; over 500 sq cm	Laser treatment for inflammatory skin disease (psoriasis); over 500 sq cm

Evaluation and Management

99202

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter.

Evaluation and Management

99203

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making.

When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 30-44 minutes of total time is spent on the date of the encounter.

Evaluation and Management

99204

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 45-59 minutes of total time is spent on the date of the encounter.

Speciality

CPT

Code

2024 Description

2023 Description

Evaluation and Management

99205

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making.

When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 60-74 minutes of total time is spent on the date of the encounter.

Evaluation and Management

99212

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and

straightforward medical decision making. When using time for code selection, 10-19 minutes of total time is spent on the date of the encounter.

Evaluation and Management

99213

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter.

Evaluation and Management

99214

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter.

Evaluation and Management

99215

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.

Evaluation and Management

99306

Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 50 minutes must be met or exceeded.

Evaluation and Management

99308

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.

Speciality

CPT Code

Description

Multianalyte Assay

0014M

Liver disease, analysis of 3 biomarkers (hyaluronic acid [HA], procollagen III amino terminal peptide [PIIINP], tissue inhibitor of metalloproteinase 1 [TIMP-1]), using immunoassays, utilizing serum, prognostic algorithm reported as a risk score and risk of liver fibrosis and liver-related clinical events within 5 years

Category III

Category III	0404T	Transcervical uterine fibroid(s) ablation with ultrasound guidance, radiofrequency
Category III	0424T	Insertion or replacement of neurostimulator system for treatment of central sleep apnea; complete system (transvenous placement of right or left stimulation lead, sensing lead, implantable pulse generator)
Category III	0425T	Insertion or replacement of neurostimulator system for treatment of central sleep apnea; sensing lead only
Category III	0426T	Insertion or replacement of neurostimulator system for treatment of central sleep apnea; stimulation lead only
Category III	0427T	Insertion or replacement of neurostimulator system for treatment of central sleep apnea; pulse generator only
Category III	0428T	Removal of neurostimulator system for treatment of central sleep apnea; pulse generator only
Category III	0429T	Removal of neurostimulator system for treatment of central sleep apnea; sensing lead only
Category III	0430T	Removal of neurostimulator system for treatment of central sleep apnea; stimulation lead only
Category III	0431T	Removal and replacement of neurostimulator system for treatment of central sleep apnea, pulse generator only
Category III	0432T	Repositioning of neurostimulator system for treatment of central sleep apnea; stimulation lead only
Category III	0433T	Repositioning of neurostimulator system for treatment of central sleep apnea; sensing lead only
Category III	0434T	Interrogation device evaluation implanted neurostimulator pulse generator system for central sleep apnea
Category III	0435T	Programming device evaluation of implanted neurostimulator pulse generator system for central sleep apnea; single session
Category III	0436T	Programming device evaluation of implanted neurostimulator pulse generator system for central sleep apnea; during sleep study
Category III	0465T	Suprachoroidal injection of a pharmacologic agent (does not include supply of medication)
Category III	0499T	Cystourethroscopy, with mechanical dilation and urethral therapeutic drug delivery for urethral stricture or stenosis, including fluoroscopy, when performed
Category III	0501T	Noninvasive estimated coronary fractional flow reserve (FFR) derived from coronary computed tomography angiography data using computation fluid dynamics physiologic simulation software analysis of functional data to assess the severity of coronary artery disease; data preparation and transmission, analysis of fluid dynamics and simulated maximal coronary hyperemia, generation of estimated FFR model, with anatomical data review in comparison with estimated FFR model to reconcile discordant data, interpretation and report
Category III	0502T	Noninvasive estimated coronary fractional flow reserve (FFR) derived from coronary computed tomography angiography data using computation fluid dynamics physiologic simulation software analysis of functional data to assess the severity of coronary artery disease; data preparation and transmission
Category III	0503T	Noninvasive estimated coronary fractional flow reserve (FFR) derived from coronary computed tomography angiography data using computation fluid dynamics physiologic simulation software analysis of functional data to assess the severity of coronary artery disease; analysis of fluid dynamics and simulated maximal coronary hyperemia, and generation of estimated FFR model
Category III	0504T	Noninvasive estimated coronary fractional flow reserve (FFR) derived from coronary computed tomography angiography data using computation fluid dynamics physiologic simulation software analysis of functional data to assess the severity of coronary artery disease; anatomical data review in comparison with estimated FFR model to reconcile discordant data, interpretation and report
Category III	0508T	Pulse-echo ultrasound bone density measurement resulting in indicator of axial bone mineral density, tibia
Category III	0533T	Continuous recording of movement disorder symptoms, including bradykinesia, dyskinesia, and tremor for 6 days up to 10 days; includes set-up, patient training, configuration of monitor, data upload, analysis and initial report configuration, download review, interpretation and report
Category III	0534T	Continuous recording of movement disorder symptoms, including bradykinesia, dyskinesia, and tremor for 6 days up to 10 days; set-up, patient training, configuration of monitor
Category III	0535T	Continuous recording of movement disorder symptoms, including bradykinesia, dyskinesia, and tremor for 6 days up to 10 days; data upload, analysis and initial report configuration
Category III	0536T	Continuous recording of movement disorder symptoms, including bradykinesia, dyskinesia, and tremor for 6 days up to 10 days; download review, interpretation and report
Category III	0641T	Noncontact near-infrared spectroscopy studies of flap or wound (eg, for measurement of deoxyhemoglobin, oxyhemoglobin, and ratio of tissue oxygenation [StO2]); image acquisition only, each flap or wound
Category III	0642T	Noncontact near-infrared spectroscopy studies of flap or wound (eg, for measurement of deoxyhemoglobin, oxyhemoglobin, and ratio of tissue oxygenation [StO2]); interpretation and report only, each flap or wound
Category III	0715T	Percutaneous transluminal coronary lithotripsy (List separately in addition to code for primary procedure)
Category III	0768T	Transcutaneous magnetic stimulation by focused low-frequency electromagnetic pulse, peripheral nerve, subsequent treatment, including noninvasive electroneurographic localization (nerve conduction localization), when performed; first nerve
Category III	0769T	Transcutaneous magnetic stimulation by focused low-frequency electromagnetic pulse, peripheral nerve, subsequent treatment, including noninvasive electroneurographic localization (nerve conduction localization), when performed; each additional nerve (List separately in addition to code for primary procedure)

Speciality	CPT Code	Description
Category III	0775T	Arthrodesis, sacroiliac joint, percutaneous, with image guidance, includes placement of intra-articular implant(s) (eg, bone allograft[s], synthetic device[s])
Category III	0809T	Arthrodesis, sacroiliac joint, percutaneous or minimally invasive (indirect visualization), with image guidance, placement of transfixing device(s) and intra-articular implant(s), including allograft or synthetic device(s)

Radiology

74710

Pelvimetry, with or without placental localization

2024 HCPCS Codes

Below are the 2024 HCPCS code updates. This list includes new HCPCS codes, revised codes and deleted codes.

Added HCPCS Codes for 2024

Speciality

HCPCS Code

Description

Medical And Surgical Supplies

Medical and Surgical Supplies	A4287	Disposable collection and storage bag for breast milk, any size, any type, each
Medical and Surgical Supplies	A4457	Enema tube, with or without adapter, any type, replacement only, each
Medical and Surgical Supplies	A4468	Exsufflation belt, includes all supplies and accessories
Medical and Surgical Supplies	A4540	Distal transcutaneous electrical nerve stimulator, stimulates peripheral nerves of the upper arm
Medical and Surgical Supplies	A4541	Monthly supplies for use of device coded at e0733
Medical and Surgical Supplies	A4542	Supplies and accessories for external upper limb tremor stimulator of the peripheral nerves of the wrist
Medical and Surgical Supplies	A6520	Gradient compression garment, glove, padded, for nighttime use, each
Medical and Surgical Supplies	A6521	Gradient compression garment, glove, padded, for nighttime use, custom, each
Medical and Surgical Supplies	A6522	Gradient compression garment, arm, padded, for nighttime use, each
Medical and Surgical Supplies	A6523	Gradient compression garment, arm, padded, for nighttime use, custom, each
Medical and Surgical Supplies	A6524	Gradient compression garment, lower leg and foot, padded, for nighttime use, each
Medical and Surgical Supplies	A6525	Gradient compression garment, lower leg and foot, padded, for nighttime use, custom, each
Medical and Surgical Supplies	A6526	Gradient compression garment, full leg and foot, padded, for nighttime use, each
Medical and Surgical Supplies	A6527	Gradient compression garment, full leg and foot, padded, for nighttime use, custom, each
Medical and Surgical Supplies	A6528	Gradient compression garment, bra, for nighttime use, each
Medical and Surgical Supplies	A6529	Gradient compression garment, bra, for nighttime use, custom, each
Medical and Surgical Supplies	A6552	Gradient compression stocking, below knee, 30-40 mmhg, each
Medical and Surgical Supplies	A6553	Gradient compression stocking, below knee, 30-40 mmhg, custom, each
Medical and Surgical Supplies	A6554	Gradient compression stocking, below knee, 40 mmhg or greater, each
Medical and Surgical Supplies	A6555	Gradient compression stocking, below knee, 40 mmhg or greater, custom, each
Medical and Surgical Supplies	A6556	Gradient compression stocking, thigh length, 18-30 mmhg, custom, each
Medical and Surgical Supplies	A6557	Gradient compression stocking, thigh length, 30-40 mmhg, custom, each
Medical and Surgical Supplies	A6558	Gradient compression stocking, thigh length, 40 mmhg or greater, custom, each
Medical and Surgical Supplies	A6559	Gradient compression stocking, full length/chap style, 18-30 mmhg, custom, each
Medical and Surgical Supplies	A6560	Gradient compression stocking, full length/chap style, 30-40 mmhg, custom, each
Medical and Surgical Supplies	A6561	Gradient compression stocking, full length/chap style, 40 mmhg or greater, custom, each
Medical and Surgical Supplies	A6562	Gradient compression stocking, waist length, 18-30 mmhg, custom, each
Medical and Surgical Supplies	A6563	Gradient compression stocking, waist length, 30-40 mmhg, custom, each
Medical and Surgical Supplies	A6564	Gradient compression stocking, waist length, 40 mmhg or greater, custom, each
Medical and Surgical Supplies	A6565	Gradient compression gauntlet, custom, each
Medical and Surgical Supplies	A6566	Gradient compression garment, neck/head, each
Medical and Surgical Supplies	A6567	Gradient compression garment, neck/head, custom, each
Medical and Surgical Supplies	A6568	Gradient compression garment, torso and shoulder, each
Medical and Surgical Supplies	A6569	Gradient compression garment, torso/shoulder, custom, each
Medical and Surgical Supplies	A6570	Gradient compression garment, genital region, each
Medical and Surgical Supplies	A6571	Gradient compression garment, genital region, custom, each
Medical and Surgical Supplies	A6572	Gradient compression garment, toe caps, each
Medical and Surgical Supplies	A6573	Gradient compression garment, toe caps, custom, each
Medical and Surgical Supplies	A6574	Gradient compression arm sleeve and glove combination, custom, each
Medical and Surgical Supplies	A6575	Gradient compression arm sleeve and glove combination, each
Medical and Surgical Supplies	A6576	Gradient compression arm sleeve, custom, medium weight, each
Medical and Surgical Supplies	A6577	Gradient compression arm sleeve, custom, heavy weight, each
Medical and Surgical Supplies	A6578	Gradient compression arm sleeve, each
Medical and Surgical Supplies	A6579	Gradient compression glove, custom, medium weight, each

Speciality	HCPCS Code	Description
Medical and Surgical Supplies	A6580	Gradient compression glove, custom, heavy weight, each
Medical and Surgical Supplies	A6581	Gradient compression glove, each
Medical and Surgical Supplies	A6582	Gradient compression gauntlet, each
Medical and Surgical Supplies	A6583	Gradient compression wrap with adjustable straps, below knee, 30-50 mmhg, each
Medical and Surgical Supplies	A6584	Gradient compression wrap with adjustable straps, not otherwise specified
Medical and Surgical Supplies	A6585	Gradient pressure wrap with adjustable straps, above knee, each
Medical and Surgical Supplies	A6586	Gradient pressure wrap with adjustable straps, full leg, each
Medical and Surgical Supplies	A6587	Gradient pressure wrap with adjustable straps, foot, each
Medical and Surgical Supplies	A6588	Gradient pressure wrap with adjustable straps, arm, each
Medical and Surgical Supplies	A6589	Gradient pressure wrap with adjustable straps, bra, each
Medical and Surgical Supplies	A6593	Accessory for gradient compression garment or wrap with adjustable straps, non-otherwise specified
Medical and Surgical Supplies	A6594	Gradient compression bandaging supply, bandage liner, lower extremity, any size or length, each
Medical and Surgical Supplies	A6595	Gradient compression bandaging supply, bandage liner, upper extremity, any size or length, each
Medical and Surgical Supplies	A6596	Gradient compression bandaging supply, conforming gauze, per linear yard, any width, each
Medical and Surgical Supplies	A6597	Gradient compression bandage roll, elastic long stretch, linear yard, any width, each
Medical and Surgical Supplies	A6598	Gradient compression bandage roll, elastic medium stretch, per linear yard, any width, each
Medical and Surgical Supplies	A6599	Gradient compression bandage roll, inelastic short stretch, per linear yard, any width, each
Medical and Surgical Supplies	A6600	Gradient compression bandaging supply, high density foam sheet, per 250 square centimeters, each
Medical and Surgical Supplies	A6601	Gradient compression bandaging supply, high density foam pad, any size or shape, each
Medical and Surgical Supplies	A6602	Gradient compression bandaging supply, high density foam roll for bandage, per linear yard, any width, each
Medical and Surgical Supplies	A6603	Gradient compression bandaging supply, low density channel foam sheet, per 250 square centimeters, each
Medical and Surgical Supplies	A6604	Gradient compression bandaging supply, low density flat foam sheet, per 250 square centimeters, each
Medical and Surgical Supplies	A6605	Gradient compression bandaging supply, padded foam, per linear yard, any width, each
Medical and Surgical Supplies	A6606	Gradient compression bandaging supply, padded textile, per linear yard, any width, each
Medical and Surgical Supplies	A6607	Gradient compression bandaging supply, tubular protective absorption layer, per linear yard, any width, each
Medical and Surgical Supplies	A6608	Gradient compression bandaging supply, tubular protective absorption padded layer, per linear yard, any width, each
Medical and Surgical Supplies	A6609	Gradient compression bandaging supply, not otherwise specified
Medical and Surgical Supplies	A6610	Gradient compression stocking, below knee, 18-30 mmhg, custom, each
Medical and Surgical Supplies	A7023	Mechanical allergen particle barrier/inhalation filter, cream, nasal, topical

Administrative, Miscellaneous and Investigational

Administrative, Miscellaneous and Investigational	A9608	Flotufolastat f 18, diagnostic, 1 millicurie
Administrative, Miscellaneous and Investigational	A9609	Fludeoxyglucose f18 up to 15 millicuries

Outpatient PPS

Outpatient PPS	C1600	Catheter, transluminal intravascular lesion preparation device, bladed, sheathed (insertable)
Outpatient PPS	C1601	Endoscope, single-use (i.e. disposable), pulmonary, imaging/illumination device (insertable)
Outpatient PPS	C1602	Orthopedic/device/drug matrix/absorbable bone void filler, antimicrobial-eluting (implantable)
Outpatient PPS	C1603	Retrieval device, insertable, laser (used to retrieve intravascular inferior vena cava filter)
Outpatient PPS	C1604	Graft, transmural transvenous arterial bypass (implantable), with all delivery system components
Outpatient PPS	C7556	Bronchoscopy, rigid or flexible, with bronchial alveolar lavage and transendoscopic endobronchial ultrasound (ebus) during bronchoscopic diagnostic or therapeutic intervention(s) for peripheral lesion(s), including fluoroscopic guidance, when performed
Outpatient PPS	C7557	Catheter placement in coronary artery(s) 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 and intraprocedural coronary fractional flow reserve (ffr) with 3d functional mapping of color-coded ffr values for the coronary tree, derived from coronary angiogram data, for real-time review and interpretation of possible atherosclerotic stenosis(es) intervention
Outpatient PPS	C7558	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

Speciality	HCPCS Code	Description
Outpatient PPS	C7560	Endoscopic retrograde cholangiopancreatography (ercp) with removal of foreign body(s) or stent(s) from biliary/ pancreatic duct(s) and endoscopic cannulation of papilla with direct visualization of pancreatic/common bile duct(s)
Outpatient PPS	C7561	Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less with manual preparation and insertion of drug-delivery device(s), deep (e.g., subfascial)
Outpatient PPS	C7903	Group psychotherapy service for diagnosis, evaluation, or treatment of a mental health or substance use disorder 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
Outpatient PPS	C9159	Injection, prothrombin complex concentrate (human), balfaxar, per i.u. of factor ix activity
Outpatient PPS	C9160	Injection, daxibotulinumtoxina-lanm, 1 unit
Outpatient PPS	C9161	Injection, aflibercept hd, 1 mg
Outpatient PPS	C9162	Injection, avacincaptad pegol, 0.1 mg
Outpatient PPS	C9163	Injection, talquetamab-tgvs, 0.25 mg
Outpatient PPS	C9164	Cantharidin for topical administration, 0.7%, single unit dose applicator (3.2 mg)
Outpatient PPS	C9165	Injection, elranatamab-bcmm, 1 mg
Outpatient PPS	C9793	3d predictive model generation for pre-planning of a cardiac procedure, using data from cardiac computed tomographic angiography with report
Outpatient PPS	C9794	Therapeutic radiology simulation-aided field setting; complex, including acquisition of pet and ct imaging data required for radiopharmaceutical-directed radiation therapy treatment planning (i.e., modeling)
Outpatient PPS	C9795	Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance and real-time positron emissions-based delivery adjustments to 1 or more lesions, entire course not to exceed 5 fractions

Durable Medical Equipment

Durable Medical Equipment	E0492	Power source and control electronics unit for oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, controlled by phone application
Durable Medical Equipment	E0493	Oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, used in conjunction with the power source and control electronics unit, controlled by phone application, 90-day supply
Durable Medical Equipment	E0530	Electronic positional obstructive sleep apnea treatment, with sensor, includes all components and accessories, any type
Durable Medical Equipment	E0678	Non-pneumatic sequential compression garment, full leg
Durable Medical Equipment	E0679	Non-pneumatic sequential compression garment, half leg
Durable Medical Equipment	E0680	Non-pneumatic compression controller with sequential calibrated gradient pressure
Durable Medical Equipment	E0681	Non-pneumatic compression controller without calibrated gradient pressure
Durable Medical Equipment	E0682	Non-pneumatic sequential compression garment, full arm
Durable Medical Equipment	E0732	Cranial electrotherapy stimulation (ces) system, any type
Durable Medical Equipment	E0733	Transcutaneous electrical nerve stimulator for electrical stimulation of the trigeminal nerve
Durable Medical Equipment	E0734	External upper limb tremor stimulator of the peripheral nerves of the wrist
Durable Medical Equipment	E0735	Non-invasive vagus nerve stimulator
Durable Medical Equipment	E1301	Whirlpool tub, walk-in, portable
Durable Medical Equipment	E2001	Suction pump, home model, portable or stationary, electric, any type, for use with external urine management system
Durable Medical Equipment	E3000	Speech volume modulation system, any type, including all components and accessories

Procedures / Professional Services

Procedures / Professional Svc	G0011	Individual counseling for pre-exposure prophylaxis (prep) by physician or qualified health care professional (qhp )to prevent human immunodeficiency virus (hiv), includes hiv risk assessment (initial or continued assessment of risk), hiv risk reduction and medication adherence, 15-30 minutes
Procedures / Professional Svc	G0012	Injection of pre-exposure prophylaxis (prep) drug for hiv prevention, under skin or into muscle
Procedures / Professional Svc	G0013	Individual counseling for pre-exposure prophylaxis (prep) by clinical staff to prevent human immunodeficiency virus (hiv), includes: hiv risk assessment (initial or continued assessment of risk), hiv risk reduction and medication adherence
Procedures / Professional Svc	G0017	Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); first 60 minutes
Procedures / Professional Svc	G0018	Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); each additional 30 minutes (list separately in addition to code for primary service)

Speciality	HCPCS Code	Description
Procedures / Professional Svc	G0019	Community health integration services performed by certified or trained auxiliary personnel, including a community health worker, under the direction of a physician or other practitioner; 60 minutes per calendar month, in the following activities to address social determinants of health (sdoh) need(s) that are significantly limiting the ability to diagnose or treat problem(s) addressed in an initiating visit: person-centered assessment, performed to better understand the individualized context of the intersection between the sdoh need(s) and the problem(s) addressed in the initiating visit. ++ conducting a person-centered assessment to understand patient's life story, strengths, needs, goals, preferences and desired outcomes, including understanding cultural and linguistic factors and including unmet sdoh needs (that are not separately billed). ++ facilitating patient-driven goal-setting and establishing an action plan. ++ providing tailored support to the patient as needed to accomplish the practitioner's treatment plan. practitioner, home-, and community- based care coordination. ++ coordinating receipt of needed services from healthcare practitioners, providers, and facilities; and from home- and community-based service providers, social service providers, and caregiver (if applicable). ++ communication with practitioners, home- and community-based service providers, hospitals, and skilled nursing facilities (or other health care facilities) regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors. ++ coordination of care transitions between and among health care practitioners and settings, including transitions involving referral to other clinicians; follow-up after an emergency department visit; or follow-up after discharges from hospitals, skilled nursing facilities or other health care facilities. ++ facilitating access to community-based social services (e.g., housing, utilities, transportation, food assistance) to address the sdoh need(s). health education- helping the patient contextualize health education provided by the patient's treatment team with the patient's individual needs, goals, and preferences, in the context of the sdoh need(s), and educating the patient on how to best participate in medical decision-making. building patient self-advocacy skills, so that the patient can interact with members of the health care team and related community-based services addressing the sdoh need(s), in ways that are more likely to promote personalized and effective diagnosis or treatment. health care access / health system navigation. ++ helping the patient access healthcare, including identifying appropriate practitioners or providers for clinical care and helping secure appointments with them. facilitating behavioral change as necessary for meeting diagnosis and treatment goals, including promoting patient motivation to participate in care and reach person-centered diagnosis or treatment goals. facilitating and providing social and emotional support to help the patient cope with the problem(s) addressed in the initiating visit, the sdoh need(s), and adjust daily routines to better meet diagnosis and treatment goals. leveraging lived experience when applicable to provide support, mentorship, or inspiration to meet treatment goals
Procedures / Professional Svc	G0022	Community health integration services, each additional 30 minutes per calendar month (list separately in addition to g0019)
Procedures / Professional Svc	G0023	Principal illness navigation services by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a patient navigator; 60 minutes per calendar month, in the following activities: person- centered assessment, performed to better understand the individual context of the serious, high-risk condition. ++ conducting a person-centered assessment to understand the patient's life story, strengths, needs, goals, preferences, and desired outcomes, including understanding cultural and linguistic factors and including unmet sdoh needs (that are not separately billed). ++ facilitating patient-driven goal setting and establishing an action plan. ++ providing tailored support as needed to accomplish the practitioner's treatment plan. identifying or referring patient (and caregiver or family, if applicable) to appropriate supportive services. practitioner, home, and community-based care coordination. ++ coordinating receipt of needed services from healthcare practitioners, providers, and facilities; home- and community- based service providers; and caregiver (if applicable). ++ communication with practitioners, home-, and community- based service providers, hospitals, and skilled nursing facilities (or other health care facilities) regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors. ++ coordination of care transitions between and among health care practitioners and settings, including transitions involving referral to other clinicians; follow-up after an emergency department visit; or follow- up after discharges from hospitals, skilled nursing facilities or other health care facilities. ++ facilitating access to community-based social services (e.g., housing, utilities, transportation, likely to promote personalized and effective treatment of their condition. health care access / health system navigation. ++ helping the patient access healthcare, including identifying appropriate practitioners or providers for clinical care, and helping secure appointments with them. ++ providing the patient with information/resources to consider participation in clinical trials or clinical research as applicable. facilitating behavioral change as necessary for meeting diagnosis and treatment goals, including promoting patient motivation to participate in care and reach person-centered diagnosis or treatment goals. facilitating and providing social and emotional support to help the patient cope with the condition, sdoh need(s), and adjust daily routines to better meet diagnosis and treatment goals. leverage knowledge of the serious, high-risk condition and/or lived experience when applicable to provide support, mentorship, or inspiration to meet treatment goals
Procedures / Professional Svc	G0024	Principal illness navigation services, additional 30 minutes per calendar month (list separately in addition to g0023)
Procedures / Professional Svc	G0136	Administration of a standardized, evidence-based social determinants of health risk assessment tool, 5-15 minutes
Procedures / Professional Svc	G0137	Intensive outpatient services; weekly bundle, minimum of 9 services over a 7 contiguous day period, which can include individual and group therapy with physicians or psychologists (or other mental health professionals to the extent authorized under state law); occupational therapy requiring the skills of a qualified occupational therapist; services of social workers, trained psychiatric nurses, and other staff trained to work with psychiatric patients; individualized activity therapies that are not primarily recreational or diversionary; family counseling (the primary purpose of which is treatment of the individual's condition); patient training and education (to the extent that training and educational activities are closely and clearly related to individual's care and treatment); diagnostic services; and such other items and services (excluding meals and transportation) that are reasonable and necessary for the diagnosis or active treatment of the individual's condition, reasonably expected to improve or maintain the individual's condition and functional level and to prevent relapse or hospitalization, and furnished pursuant to such guidelines relating to frequency and duration of services in accordance with a physician certification and plan of treatment (provision of the services by a medicare- enrolled opioid treatment program); list separately in addition to code for primary procedure

Speciality

HCPCS Code

Description

Procedures / Professional Svc

G0140

Principal illness navigation – peer support by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a certified peer specialist; 60 minutes per calendar month, in the following activities: person-centered interview, performed to better understand the individual context of the serious, high-risk condition. ++ conducting a person-centered interview to understand the patient's life story, strengths, needs, goals, preferences, and desired outcomes, including understanding cultural and linguistic factors, and including unmet sdoh needs (that are not

billed separately). ++ facilitating patient-driven goal setting and establishing an action plan. ++ providing tailored support as needed to accomplish the person-centered goals in the practitioner's treatment plan. identifying or referring patient (and caregiver or family, if applicable) to appropriate supportive services. practitioner, home, and community-based care communication. ++ assist the patient in communicating with their practitioners, home-, and community-based service providers, hospitals, and skilled nursing facilities (or other health care facilities) regarding the patient's psychosocial strengths and needs, goals, preferences, and desired outcomes, including cultural and linguistic factors. ++ facilitating access to community-based social services (e.g., housing, utilities, transportation, food assistance) as needed to address sdoh need(s). health education. helping the patient contextualize health education provided by the patient's treatment team with the patient's individual needs, goals, preferences, and sdoh need(s), and educating the patient (and caregiver if applicable) on how to best participate in medical decision-making. building patient self-advocacy skills, so that the patient can interact with members of the health care team and related community-based services (as needed), in ways that are more likely to promote personalized and effective treatment of their condition. developing and proposing strategies to help meet person-centered treatment goals and supporting the patient in using chosen strategies to reach person-centered treatment goals. facilitating and providing social and emotional support to help the patient cope with the condition, sdoh need(s), and adjust daily routines to better meet person-centered diagnosis and treatment goals. leverage knowledge of the serious, high-risk condition and/or lived experience when applicable to provide support, mentorship, or inspiration to meet treatment goals

Procedures / Professional Svc

G0146

Principal illness navigation – peer support, additional 30 minutes per calendar month (list separately in addition to g0140)

Drugs Administered Other than Oral Method

Drugs Administered Other than Oral Method	J0184	Injection, amisulpride, 1 mg
Drugs Administered Other than Oral Method	J0217	Injection, velmanase alfa-tycv, 1 mg
Drugs Administered Other than Oral Method	J0391	Injection, artesunate, 1 mg
Drugs Administered Other than Oral Method	J0402	Injection, aripiprazole (abilify asimtufii), 1 mg
Drugs Administered Other than Oral Method	J0576	Injection, buprenorphine extended-release (brixadi), 1 mg
Drugs Administered Other than Oral Method	J0688	Injection, cefazolin sodium (hikma), not therapeutically equivalent to j0690, 500 mg
Drugs Administered Other than Oral Method	J0750	Emtricitabine 200mg and tenofovir disoproxil fumarate 300mg, oral, fda approved prescription, only for use as hiv pre- exposure prophylaxis (not for use as treatment of hiv)
Drugs Administered Other than Oral Method	J0751	Emtricitabine 200mg and tenofovir alafenamide 25mg, oral, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment of hiv)
Drugs Administered Other than Oral Method	J0799	Fda approved prescription drug, only for use as hiv pre-exposure prophylaxis (not for use as treatment of hiv), not otherwise classified
Drugs Administered Other than Oral Method	J0873	Injection, daptomycin (xellia) not therapeutically equivalent to j0878, 1 mg
Drugs Administered Other than Oral Method	J1105	Dexmedetomidine, oral, 1 mcg
Drugs Administered Other than Oral Method	J1246	Injection, dinutuximab, 0.1 mg
Drugs Administered Other than Oral Method	J1304	Injection, tofersen, 1 mg
Drugs Administered Other than Oral Method	J1412	Injection, valoctocogene roxaparvovec-rvox, per ml, containing nominal 2 x 10^13 vector genomes
Drugs Administered Other than Oral Method	J1413	Injection, delandistrogene moxeparvovec-rokl, per therapeutic dose
Drugs Administered Other than Oral Method	J1596	Injection, glycopyrrolate, 0.1 mg
Drugs Administered Other than Oral Method	J1939	Injection, bumetanide, 0.5 mg
Drugs Administered Other than Oral Method	J2404	Injection, nicardipine, 0.1 mg
Drugs Administered Other than Oral Method	J2508	Injection, pegunigalsidase alfa-iwxj, 1 mg
Drugs Administered Other than Oral Method	J2679	Injection, fluphenazine hcl, 1.25 mg

Speciality	HCPCS Code	Description
Drugs Administered Other than Oral Method	J2799	Injection, risperidone (uzedy), 1 mg
Drugs Administered Other than Oral Method	J3401	Beremagene geperpavec-svdt for topical administration, containing nominal 5 x 10^9 pfu/ml vector genomes, per 0.1 ml
Drugs Administered Other than Oral Method	J3425	Injection, hydroxocobalamin, 10 mcg

Chemotherapy Drugs

Chemotherapy Drugs	J9052	Injection, carmustine (accord), not therapeutically equivalent to j9050, 100 mg
Chemotherapy Drugs	J9072	Injection, cyclophosphamide, (dr. reddy's), 5 mg
Chemotherapy Drugs	J9172	Injection, docetaxel (ingenus) not therapeutically equivalent to j9171, 1 mg
Chemotherapy Drugs	J9255	Injection, methotrexate (accord) not therapeutically equivalent to j9250 and j9260, 50 mg
Chemotherapy Drugs	J9258	Injection, paclitaxel protein-bound particles (teva) not therapeutically equivalent to j9264, 1 mg
Chemotherapy Drugs	J9286	Injection, glofitamab-gxbm, 2.5 mg
Chemotherapy Drugs	J9321	Injection, epcoritamab-bysp, 0.16 mg
Chemotherapy Drugs	J9324	Injection, pemetrexed (pemrydi rtu), 10 mg
Chemotherapy Drugs	J9333	Injection, rozanolixizumab-noli, 1 mg
Chemotherapy Drugs	J9334	Injection, efgartigimod alfa, 2 mg and hyaluronidase-qvfc

Orthotic Procedures and Services

Orthotic Procedures and services

L3161

Foot, adductus positioning device, adjustable

Prosthetic Procedures

Prosthetic Procedures	L5615	Addition, endoskeletal knee-shin system, 4 bar linkage or multiaxial, fluid swing and stance phase control
Prosthetic Procedures	L5926	Addition to lower extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type

Other Services

Other Services	M1211	Most recent hemoglobin a1c level > 9.0%
Other Services	M1212	Hemoglobin a1c level is missing, or was not performed during the measurement period (12 months)
Other Services	M1213	No history of spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) and present spirometry is >= 70%
Other Services	M1214	Spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) documented and reviewed
Other Services	M1215	Documentation of medical reason(s) for not documenting and reviewing spirometry results (e.g., patients with dementia or tracheostomy)
Other Services	M1216	No spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) documented and/or no spirometry performed with results documented during the encounter
Other Services	M1217	Documentation of system reason(s) for not documenting and reviewing spirometry results (e.g., spirometry equipment not available at the time of the encounter)
Other Services	M1218	Patient has copd symptoms (e.g., dyspnea, cough/sputum, wheezing)
Other Services	M1219	Anaphylaxis due to the vaccine on or before the date of the encounter
Other Services	M1220	Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; with evidence of retinopathy
Other Services	M1221	Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; without evidence of retinopathy
Other Services	M1222	Glaucoma plan of care not documented, reason not otherwise specified
Other Services	M1223	Glaucoma plan of care documented
Other Services	M1224	Intraocular pressure (iop) reduced by a value less than 20% from the pre-intervention level
Other Services	M1225	Intraocular pressure (iop) reduced by a value of greater than or equal to 20% from the pre-intervention level
Other Services	M1226	Iop measurement not documented, reason not otherwise specified
Other Services	M1227	Evidence-based therapy was prescribed
Other Services	M1228	Patient, who has a reactive hcv antibody test, and has a follow up hcv viral test that detected hcv viremia, has hcv treatment initiated within 3 months of the reactive hcv antibody test
Other Services	M1229	Patient, who has a reactive hcv antibody test, and has a follow up hcv viral test that detected hcv viremia, is referred within 1 month of the reactive hcv antibody test to a clinician who treats hcv infection

Speciality	HCPCS Code	Description
Other Services	M1230	Patient has a reactive hcv antibody test and does not have a follow up hcv viral test, or patient has a reactive hcv antibody test and has a follow up hcv viral test that detects hcv viremia and is not referred to a clinician who treats hcv infection within 1 month and does not have hcv treatment initiated within 3 months of the reactive hcv antibody test, reason not given
Other Services	M1231	Patient receives hcv antibody test with nonreactive result
Other Services	M1232	Patient receives hcv antibody test with reactive result
Other Services	M1233	Patient does not receive hcv antibody test or patient does receive hcv antibody test but results not documented, reason not given
Other Services	M1234	Patient has a reactive hcv antibody test, and has a follow up hcv viral test that does not detect hcv viremia
Other Services	M1235	Documentation or patient report of hcv antibody test or hcv rna test which occurred prior to the performance period
Other Services	M1236	Baseline mrs > 2
Other Services	M1237	Patient reason for not screening for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety (e.g., patient declined or other patient reasons)
Other Services	M1238	Documentation that administration of second recombinant zoster vaccine could not occur during the performance period due to the recommended 2-6 month interval between doses (i.e, first dose received after october 31)
Other Services	M1239	Patient did not respond to the question of patient felt heard and understood by this provider and team
Other Services	M1240	Patient did not respond to the question of patient felt this provider and team put my best interests first when making recommendations about my care
Other Services	M1241	Patient did not respond to the question of patient felt this provider and team saw me as a person, not just someone with a medical problem
Other Services	M1242	Patient did not respond to the question of patient felt this provider and team understood what is important to me in my life
Other Services	M1243	Patient provided a response other than "completely true" for the question of patient felt heard and understood by this provider and team
Other Services	M1244	Patient provided a response other than "completely true" for the question of patient felt this provider and team put my best interests first when making recommendations about my care
Other Services	M1245	Patient provided a response other than "completely true" for the question of patient felt this provider and team saw me as a person, not just someone with a medical problem
Other Services	M1246	Patient provided a response other than "completely true" for the question of patient felt this provider and team understood what is important to me in my life
Other Services	M1247	Patient responded "completely true" for the question of patient felt this provider and team put my best interests first when making recommendations about my care
Other Services	M1248	Patient responded "completely true" for the question of patient felt this provider and team saw me as a person, not just someone with a medical problem
Other Services	M1249	Patient responded "completely true" for the question of patient felt this provider and team understood what is important to me in my life
Other Services	M1250	Patient responded as "completely true" for the question of patient felt heard and understood by this provider and team
Other Services	M1251	Patients for whom a proxy completed the entire hu survey on their behalf for any reason (no patient involvement)
Other Services	M1252	Patients who did not complete at least one of the four patient experience hu survey items and return the hu survey within 60 days of the ambulatory palliative care visit
Other Services	M1253	Patients who respond on the patient experience hu survey that they did not receive care by the listed ambulatory palliative care provider in the last 60 days (disavowal)
Other Services	M1254	Patients who were deceased when the hu survey reached them
Other Services	M1255	Patients who have another reason for visiting the clinic [not prenatal or postpartum care] and have a positive pregnancy test but have not established the clinic as an ob provider (e.g., plan to terminate the pregnancy or seek prenatal services elsewhere)
Other Services	M1256	Prior history of known cvd
Other Services	M1257	Cvd risk assessment not performed or incomplete (e.g., cvd risk assessment was not documented), reason not otherwise specified
Other Services	M1258	Cvd risk assessment performed, have a documented calculated risk score
Other Services	M1259	Patients listed on the kidney-pancreas transplant waitlist or who received a living donor transplant within the first year following initiation of dialysis
Other Services	M1260	Patients who were not listed on the kidney-pancreas transplant waitlist or patients who did not receive a living donor transplant within the first year following initiation of dialysis
Other Services	M1261	Patients that were on the kidney or kidney-pancreas waitlist prior to initiation of dialysis
Other Services	M1262	Patients who had a transplant prior to initiation of dialysis
Other Services	M1263	Patients in hospice on their initiation of dialysis date or during the month of evaluation
Other Services	M1264	Patients age 75 or older on their initiation of dialysis date

Speciality	HCPCS Code	Description
Other Services	M1265	Cms medical evidence form 2728 for dialysis patients: initial form completed
Other Services	M1266	Patients admitted to a skilled nursing facility (snf)
Other Services	M1267	Patients not on any kidney or kidney-pancreas transplant waitlist or is not in active status on any kidney or kidney- pancreas transplant waitlist as of the last day of each month during the measurement period
Other Services	M1268	Patients on active status on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period
Other Services	M1269	Receiving esrd mcp dialysis services by the provider on the last day of the reporting month
Other Services	M1270	Patients not on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period
Other Services	M1271	Patients with dementia at any time prior to or during the month
Other Services	M1272	Patients on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period
Other Services	M1273	Patients who were admitted to a skilled nursing facility (snf) within one year of dialysis initiation according to the cms-2728 form
Other Services	M1274	Patients who were admitted to a skilled nursing facility (snf) during the month of evaluation were excluded from that month
Other Services	M1275	Patients determined to be in hospice were excluded from month of evaluation and the remainder of reporting period
Other Services	M1276	Bmi documented outside normal parameters, no follow-up plan documented, no reason given
Other Services	M1277	Colorectal cancer screening results documented and reviewed
Other Services	M1278	Elevated or hypertensive blood pressure reading documented, and the indicated follow-up is documented
Other Services	M1279	Elevated or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given
Other Services	M1280	Women who had a bilateral mastectomy or who have a history of a bilateral mastectomy or for whom there is evidence of a right and a left unilateral mastectomy
Other Services	M1281	Blood pressure reading not documented, reason not given
Other Services	M1282	Patient screened for tobacco use and identified as a tobacco non-user
Other Services	M1283	Patient screened for tobacco use and identified as a tobacco user
Other Services	M1284	Patients age 66 or older in institutional special needs plans (snp) or residing in long term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the measurement period
Other Services	M1285	Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results were not documented and reviewed, reason not otherwise specified
Other Services	M1286	Bmi is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reason
Other Services	M1287	Bmi is documented below normal parameters and a follow-up plan is documented
Other Services	M1288	Documented reason for not screening or recommending a follow-up for high blood pressure
Other Services	M1289	Patient identified as tobacco user did not receive tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy)
Other Services	M1290	Patient not eligible due to active diagnosis of hypertension
Other Services	M1291	Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
Other Services	M1292	Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period
Other Services	M1293	Bmi is documented above normal parameters and a follow-up plan is documented
Other Services	M1294	Normal blood pressure reading documented, follow-up not required
Other Services	M1295	Patients with a diagnosis or past history of total colectomy or colorectal cancer
Other Services	M1296	Bmi is documented within normal parameters and no follow-up plan is required
Other Services	M1297	Bmi not documented due to medical reason or patient refusal of height or weight measurement
Other Services	M1298	Documentation of patient pregnancy anytime during the measurement period prior to and including the current encounter
Other Services	M1299	Influenza immunization administered or previously received
Other Services	M1300	Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons)
Other Services	M1301	Patient identified as a tobacco user received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy)
Other Services	M1302	Screening, diagnostic, film digital or digital breast tomosynthesis (3d) mammography results documented and reviewed
Other Services	M1303	Hospice services provided to patient any time during the measurement period

Speciality	HCPCS Code	Description
Other Services	M1304	Patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period
Other Services	M1305	Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period
Other Services	M1306	Patient had anaphylaxis due to the pneumococcal vaccine any time during or before the measurement period
Other Services	M1307	Documentation stating the patient has received or is currently receiving palliative or hospice care
Other Services	M1308	Influenza immunization was not administered, reason not given
Other Services	M1309	Palliative care services provided to patient any time during the measurement period
Other Services	M1310	Patient screened for tobacco use and received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling, pharmacotherapy, or both), if identified as a tobacco user
Other Services	M1311	Anaphylaxis due to the vaccine on or before the date of the encounter
Other Services	M1312	Patient not screened for tobacco use
Other Services	M1313	Tobacco screening not performed or tobacco cessation intervention not provided during the measurement period or in the six months prior to the measurement period
Other Services	M1314	Bmi not documented and no reason is given
Other Services	M1315	Colorectal cancer screening results were not documented and reviewed; reason not otherwise specified
Other Services	M1316	Current tobacco non-user
Other Services	M1317	Patients who are counseled on connection with a csp and explicitly opt out
Other Services	M1318	Patients who did not have documented contact with a csp for at least one of their screened positive hrsns within 60 days after screening or documentation that there was no contact with a csp
Other Services	M1319	Patients who had documented contact with a csp for at least one of their screened positive hrsns within 60 days after screening
Other Services	M1320	Patients who screened positive for at least 1 of the 5 hrsns
Other Services	M1321	Patients who were not seen within 7 weeks following the date of injection for follow up or who did not have a documented iop or no plan of care documented if the iop was >25 mm hg
Other Services	M1322	Patients seen within 7 weeks following the date of injection and are screened for elevated intraocular pressure (iop) with tonometry with documented iop =<25 mm hg for injected eye
Other Services	M1323	Patients seen within 7 weeks following the date of injection and are screened for elevated intraocular pressure (iop) with tonometry with documented iop >25 mm hg and a plan of care was documented
Other Services	M1324	Patients who had an intravitreal or periocular corticosteroid injection (e.g., triamcinolone, preservative-free triamcinolone, dexamethasone, dexamethasone intravitreal implant, or fluocinolone intravitreal implant)
Other Services	M1325	Patients who were not seen for reasons documented by clinician for patient or medical reasons (e.g., inadequate time for follow-up, patients who received a prior intravitreal or periocular steroid injection within the last six (6) months and had a subsequent iop evaluation with iop <25mm hg within seven (7) weeks of treatment)
Other Services	M1326	Patients with a diagnosis of hypotony
Other Services	M1327	Patients who were not appropriately evaluated during the initial exam and/or who were not re-evaluated within 8 weeks
Other Services	M1328	Patients with a diagnosis of acute vitreous hemorrhage
Other Services	M1329	Patients with a post-operative encounter of the eye with the acute pvd within 2 weeks before the initial encounter or 8 weeks after initial acute pvd encounter
Other Services	M1330	Documentation of patient reason(s) for not having a follow up exam (e.g., inadequate time for follow up)
Other Services	M1331	Patients who were appropriately evaluated during the initial exam and were re-evaluated no later than 8 weeks from initial exam
Other Services	M1332	Patients who were not appropriately evaluated during the initial exam and/or who were not re-evaluated within 2 weeks
Other Services	M1333	Acute vitreous hemorrhage
Other Services	M1334	Patients with a post-operative encounter of the eye with the acute pvd within 2 weeks before the initial encounter or 2 weeks after initial acute pvd encounter
Other Services	M1335	Documentation of patient reason(s) for not having a follow up exam (e.g., inadequate time for follow up)
Other Services	M1336	Patients who were appropriately evaluated during the initial exam and were re-evaluated no later than 2 weeks
Other Services	M1337	Acute pvd
Other Services	M1338	Patients who had follow-up assessment 30 to 180 days after the index assessment who did not demonstrate positive improvement or maintenance of functioning scores during the performance period
Other Services	M1339	Patients who had follow-up assessment 30 to 180 days after the index assessment who demonstrated positive improvement or maintenance of functioning scores during the performance period
Other Services	M1340	Index assessment completed using the 12-item whodas 2.0 or sds during the denominator identification period

Speciality	HCPCS Code	Description
Other Services	M1341	Patients who did not have a follow-up assessment or did not have an assessment within 30 to 180 days after the index assessment during the performance period
Other Services	M1342	Patients who died during the performance period
Other Services	M1343	Patients who are at pam level 4 at baseline or patients who are flagged with extreme straight line response sets on the pam
Other Services	M1344	Patients who did not have a baseline pam score and/or a second score within 6 to 12 month of baseline pam score
Other Services	M1345	Patients who had a baseline pam score and a second score within 6 to 12 month of baseline pam score
Other Services	M1346	Patients who did not have a net increase in pam score of at least 6 points within a 6 to 12 month period
Other Services	M1347	Patients who achieved a net increase in pam score of at least 3 points in a 6 to 12 month period (passing)
Other Services	M1348	Patients who achieved a net increase in pam score of at least 6-points in a 6 to 12 month period (excellent)
Other Services	M1349	Patients who did not have a net increase in pam score of at least 3 points within 6 to 12 month period
Other Services	M1350	Patients who had a completed suicide safety plan initiated, reviewed or updated in collaboration with their clinician (concurrent or within 24 hours) of the index clinical encounter
Other Services	M1351	Patients who had a suicide safety plan initiated, reviewed, or updated and reviewed and updated in collaboration with the patient and their clinician concurrent or within 24 hours of clinical encounter and within 120 days after initiation
Other Services	M1352	Suicidal ideation and/or behavior symptoms based on the c-ssrs or equivalent assessment
Other Services	M1353	Patients who did not have a completed suicide safety plan initiated, reviewed or updated in collaboration with their clinician (concurrent or within 24 hours) of the index clinical encounter
Other Services	M1354	Patients who did not have a suicide safety plan initiated, reviewed, or updated or reviewed and updated in collaboration with the patient and their clinician concurrent or within 24 hours of clinical encounter and within 120 days after initiation
Other Services	M1355	Suicide risk based on their clinician's evaluation or a clinician-rated tool
Other Services	M1356	Patients who died during the measurement period
Other Services	M1357	Patients who had a reduction in suicidal ideation and/or behavior upon follow-up assessment within 120 days of index assessment
Other Services	M1358	Patients who did not have a reduction in suicidal ideation and/or behavior upon follow-up assessment within 120 days of index assessment
Other Services	M1359	Index assessment during the denominator period when the suicidal ideation and/or behavior symptoms or increased suicide risk by clinician determination occurs and a non-zero c-ssrs score is obtained
Other Services	M1360	Suicidal ideation and/or behavior symptoms based on the c-ssrs
Other Services	M1361	Suicide risk based on their clinician's evaluation or a clinician-rated tool
Other Services	M1362	Patients who died during the measurement period
Other Services	M1363	Patients who did not have a follow-up assessment within 120 days of the index assessment
Other Services	M1364	Calculated 10-year ascvd risk score of = 20 percent during the performance period
Other Services	M1365	Patient encounter during the performance period with hospice and palliative care specialty code 17
Other Services	M1366	Focusing on women's health mips value pathway
Other Services	M1367	Quality care for the treatment of ear, nose, and throat disorders mips value pathway
Other Services	M1368	Prevention and treatment of infectious disorders including hepatitis c and hiv mips value pathway
Other Services	M1369	Quality care in mental health and substance use disorders mips value pathway
Other Services	M1370	Rehabilitative support for musculoskeletal care mips value pathway

Temporary Codes

Temporary Codes	Q0516	Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription drug, per 30-days
Temporary Codes	Q0517	Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription drug, per 60-days
Temporary Codes	Q0518	Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription drug, per 90-days
Temporary Codes	Q4279	Vendaje ac, per square centimeter
Temporary Codes	Q4287	Dermabind dl, per square centimeter
Temporary Codes	Q4288	Dermabind ch, per square centimeter
Temporary Codes	Q4289	Revoshield + amniotic barrier, per square centimeter
Temporary Codes	Q4290	Membrane wrap-hydro, per square centimeter
Temporary Codes	Q4291	Lamellas xt, per square centimeter
Temporary Codes	Q4292	Lamellas, per square centimeter
Temporary Codes	Q4293	Acesso dl, per square centimeter
Temporary Codes	Q4294	Amnio quad-core, per square centimeter

Speciality	HCPCS Code	Description
Temporary Codes	Q4295	Amnio tri-core amniotic, per square centimeter
Temporary Codes	Q4296	Rebound matrix, per square centimeter
Temporary Codes	Q4297	Emerge matrix, per square centimeter
Temporary Codes	Q4298	Amniocore pro, per square centimeter
Temporary Codes	Q4299	Amniocore pro+, per square centimeter
Temporary Codes	Q4300	Acesso tl, per square centimeter
Temporary Codes	Q4301	Activate matrix, per square centimeter
Temporary Codes	Q4302	Complete aca, per square centimeter
Temporary Codes	Q4303	Complete aa, per square centimeter
Temporary Codes	Q4304	Grafix plus, per square centimeter
Temporary Codes	Q5132	Injection, adalimumab-afzb (abrilada), biosimilar, 10 mg

Speciality

HCPCS

Code

2024 Description

2023 Description

Medical and Surgical Supplies

Medical and Surgical Supplies	A6531	Gradient compression stocking, below knee, 30-40 mmhg, used as a surgical dressing, each	Gradient compression stocking, below knee, 30-40 mmHg, each
Medical and Surgical Supplies	A6532	Gradient compression stocking, below knee, 40-50 mmhg, used as a surgical dressing, each	Gradient compression stocking, below knee, 40-50 mmHg, each
Medical and Surgical Supplies	A6535	Gradient compression stocking, thigh length, 40 mmhg or greater, each	Gradient compression stocking, thigh length, 40-50 mmHg, each
Medical and Surgical Supplies	A6538	Gradient compression stocking, full length/chap style, 40 mmhg or greater, each	Gradient compression stocking, full length/chap style, 40-50 mmHg, each
Medical and Surgical Supplies	A6541	Gradient compression stocking, waist length, 40 mmhg or greater, each	Gradient compression stocking, waist length, 40-50 mmHg, each
Medical and Surgical Supplies	A6545	Gradient compression wrap, non-elastic, below knee, 30-50 mmhg, used as a surgical dressing, each	Gradient compression wrap, non-elastic, below knee, 30-50 mmHg, each
Medical and Surgical Supplies	A6549	Gradient compression garment, not otherwise specified	Gradient compression stocking/sleeve, not otherwise specified

Procedures / Professional Services

Procedures / Professional Svc

G0129

Occupational therapy services requiring the skills of a qualified occupational therapist, furnished as a component of a partial hospitalization or intensive outpatient treatment program, per session (45 minutes or more)

Occupational therapy services requiring the skills of a qualified occupational therapist, furnished as a component of a partial hospitalization treatment program, per session (45 minutes or more)

Procedures / Professional Svc

G0410

Group psychotherapy other than of a multiple-family group, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes

Group psychotherapy other than of a multiple-family group, in a partial hospitalization setting, approximately 45 to 50 minutes

Procedures / Professional Svc

G0411

Interactive group psychotherapy, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes

Interactive group psychotherapy, in a partial hospitalization setting, approximately 45 to 50 minutes

Procedures / Professional Svc

G2137

pain scale within three months preoperatively and at three months (6 – 20 weeks) postoperatively demonstrated improvement of less than 5.0 points

Back pain measured by the visual analog scale (vas) or numeric pain scale at three months (6 – 20 weeks) postoperatively was greater than 3.0 and back pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at three months (6 – 20 weeks) postoperatively demonstrated less than an improvement of 5.0 points

Procedures / Professional Svc

G2139

Back pain measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively was greater than 3.0 and back pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated improvement of less than 5.0 points

Procedures / Professional Svc

G2141

Leg pain measured by the visual analog scale (vas) or numeric pain scale at three months (6 – 20 weeks) postoperatively was greater than 3.0 and leg pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at three months (6 – 20 weeks) postoperatively demonstrated improvement of less than 5.0 points

Procedures / Professional Svc

G2147

Leg pain measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively

was greater than 3.0 and leg pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated improvement of less than 5.0 points

Leg pain measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively

Procedures / Professional Svc

G2174

Uri episodes where the patient is taking antibiotics (table 1) in the 30 days prior to the episode date

Uri episodes when the patient had an active prescription of antibiotics in the 30 days prior to the episode date or is still active the same day of the encounter

Procedures / Professional Svc

G8474

Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy not prescribed for reasons documented by the clinician (e.g., allergy, intolerance, pregnancy, renal failure due to ace inhibitor, diseases of the aortic or mitral valve, other medical reasons) or (e.g., patient declined, other patient reasons)

Angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy not prescribed for reasons documented by the clinician (e.g., allergy, intolerance, pregnancy, renal failure due to ACE inhibitor, diseases of the aortic or mitral valve, other medical reasons) or (e.g., patient declined, other patient reasons) or (e.g., lack of drug availability, other reasons attributable to the health care system)

Speciality

HCPCS

Code

2024 Description

2023 Description

Procedures / Professional Svc

G8535

Elder maltreatment screen not documented; documentation that patient is not eligible for the elder maltreatment screen at the time of the encounter related to one of the following reasons: (1) patient refuses to participate in the screening and has reasonable decisional capacity for self-protection, or (2) patient is in an urgent or emergent situation where time is of the essence and to delay treatment to perform the screening would jeopardize the patient's health status

Elder maltreatment screen not documented; documentation that patient is not eligible for the elder maltreatment screen at the time of the encounter

Procedures / Professional Svc

G8601

Iv thrombolytic therapy not initiated within 4.5 hours (<= 270 minutes) of time last known well for reasons documented by clinician (e.g. patient enrolled in clinical trial for stroke, patient admitted for elective carotid intervention)

Iv thrombolytic therapy not initiated within 4.5 hours (= 270 minutes) of time last known well for reasons documented by clinician (e.g. patient enrolled in clinical trial for stroke, patient admitted for elective carotid intervention, patient received tenecteplase (tnk))

Procedures / Professional Svc

G8807

Trans-abdominal or trans-vaginal ultrasound not performed for reasons documented by clinician (e.g., patient has a documented intrauterine pregnancy [iup])

Trans-abdominal or trans-vaginal ultrasound not performed for reasons documented by clinician (e.g., patient has visited the ED multiple times within 72 hours, patient has a documented intrauterine pregnancy [IUP])

Procedures / Professional Svc

G8851

Adherence to therapy was assessed at least annually through an objective informatics system or through self-reporting (if objective reporting is not available, documented)

Objective measurement of adherence to positive airway pressure therapy, documented

Procedures / Professional Svc

G8854

Documentation of reason(s) for not objectively reporting adherence to evidence-based therapy (e.g., patients who have been diagnosed with a terminal or advanced disease with an expected life span of less than 6 months, patients who decline therapy, patients who do not return for follow-up at least annually, patients unable to access/afford therapy, patient's insurance will not cover therapy)

Documentation of reason(s) for not objectively measuring adherence to positive airway pressure therapy (e.g., patient didn't bring data from continuous positive airway pressure [cpap], therapy not yet initiated, not available on machine)

Procedures / Professional Svc

G8855

Adherence to therapy was not assessed at least annually through an objective informatics system or

through self-reporting (if objective reporting is not available), reason not given

Objective measurement of adherence to positive airway pressure therapy not performed, reason not given

Procedures / Professional Svc

G8924

Spirometry results documented (fev1/fvc < 70%)

Spirometry test results demonstrate fev1/fvc < 70%, fev1 < 60% predicted and patient has copd symptoms (e.g., dyspnea, cough/ sputum, wheezing)

Procedures / Professional Svc

G8936

Clinician documented that patient was not an eligible candidate for angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy (eg, allergy, intolerance, pregnancy, renal failure due to ace inhibitor, diseases of the aortic or mitral valve, other medical reasons) or (eg, patient declined, other patient reasons)

Clinician documented that patient was not an eligible candidate for angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy (e.g., allergy, intolerance, pregnancy, renal failure due to ACE inhibitor, diseases of the aortic or mitral valve, other medical reasons) or (e.g., patient declined, other patient reasons) or

(e.g., lack of drug availability, other reasons attributable to the health care system)

Procedures / Professional Svc

G8942

Functional outcome assessment using a standardized tool is documented within the previous 30 days and a care plan, based on identified deficiencies is documented within two days of the functional outcome assessment

Functional outcomes assessment using a standardized tool is documented within the previous 30 days and care plan, based on identified deficiencies is documented within two days of the functional outcome assessment

Procedures / Professional Svc

G8968

Documentation of medical reason(s) for not prescribing an fda-approved anticoagulant (e.g., present or planned atrial appendage occlusion or ligation or patient being currently enrolled in a clinical trial related to af/atrial flutter treatment)

Documentation of medical reason(s) for not prescribing an fda-approved anticoagulant (e.g., present or planned atrial appendage occlusion or ligation)

Procedures / Professional Svc

G9380

Patient offered assistance with end of life issues or existing end of life plan was reviewed or updated during the measurement period

Patient offered assistance with end of life issues during the measurement period

Procedures / Professional Svc

G9382

Patient not offered assistance with end of life issues or existing end of life plan was not reviewed or updated during the measurement period

Patient not offered assistance with end of life issues during the measurement period

Procedures / Professional Svc

G9452

Documentation of medical reason(s) for not receiving hcv antibody test due to limited life expectancy

Documentation of medical reason(s) for not receiving one-time screening for HCV infection (e.g., decompensated cirrhosis indicating advanced disease [ie, ascites, esophageal variceal bleeding, hepatic encephalopathy], hepatocellular carcinoma, waitlist for organ transplant, limited life expectancy, other medical reasons)

Procedures / Professional Svc

G9696

Documentation of medical reason(s) for not prescribing a long-acting inhaled bronchodilator (e.g., patient intolerance or history of side effects)

Documentation of medical reason(s) for not prescribing a long-acting inhaled bronchodilator

Procedures / Professional Svc

G9698

Documentation of system reason(s) for not prescribing a long-acting inhaled bronchodilator (e.g., cost of treatment or lack of insurance)

Documentation of system reason(s) for not prescribing a long-acting inhaled bronchodilator

Procedures / Professional Svc

G9703

Episodes where the patient is taking antibiotics (table 1) in the 30 days prior to the episode date

Episodes where the patient is taking antibiotics (table 1) in the

30 days prior to the episode date, or had an active prescription on the episode date

Speciality	HCPCS Code	2024 Description	2023 Description
Procedures / Professional Svc	G9717	Documentation stating the patient has had a diagnosis of bipolar disorder	Documentation stating the patient has had a diagnosis of depression or has had a diagnosis of bipolar disorder
Procedures / Professional Svc	G9771	At least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) achieved within the 30 minutes immediately before or 15 minutes immediately after anesthesia end time	At least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) achieved within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time
Procedures / Professional Svc	G9772	Documentation of medical reason(s) for not achieving at least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) within the 30 minutes immediately before or 15 minutes immediately after anesthesia end time (e.g., emergency cases, intentional hypothermia, etc.)	Documentation of medical reason(s) for not achieving at least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time (e.g., emergency cases, intentional hypothermia, etc.)
Procedures / Professional Svc	G9773	At least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) not achieved within the 30 minutes immediately before or 15 minutes immediately after anesthesia end time, reason not given	At least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) not achieved within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time, reason not given
Procedures / Professional Svc	G9779	Patients who are breastfeeding at any time during the performance period	Patients who are breastfeeding at any time during the measurement period
Procedures / Professional Svc	G9780	Patients who have a diagnosis of rhabdomyolysis at any time during the performance period	Patients who have a diagnosis of rhabdomyolysis at any time during the measurement period
Procedures / Professional Svc	G9914	Patient initiated an anti-tnf agent	Patient receiving an anti-TNF agent
Procedures / Professional Svc	G9938	Patients aged 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the six months prior to the measurement period through december 31 of the measurement period	Patients age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the six months prior to the measurement period through december 31 of the measurement period
Procedures / Professional Svc	G9990	Patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period	Patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 60th birthday and before the end of the measurement period
Procedures / Professional Svc	G9991	Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period	Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 60th birthday and before the end of the measurement period
Procedures / Professional Svc	G9998	Documentation of medical reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., last colonoscopy incomplete, last colonoscopy had inadequate prep, piecemeal removal of adenomas, or sessile serrated polyps >= 20 mm in size, last colonoscopy found greater than 10 adenomas, lower gastrointestinal bleeding, or patient at high risk for colon cancer due to underlying medical history ([i.e. crohn's disease, ulcerative colitis, personal or family history of colon cancer, hereditary colorectal cancer syndromes])	Documentation of medical reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., last colonoscopy incomplete, last colonoscopy had inadequate prep, piecemeal removal of adenomas, last colonoscopy found greater than 10 adenomas, or patient at high risk for colon cancer [crohn's disease, ulcerative colitis, lower gastrointestinal bleeding, personal or family history of colon cancer, hereditary colorectal cancer syndromes])

Drugs Administered Other than Oral Method

J0739

Injection, cabotegravir, 1mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)

Injection, cabotegravir, 1 mg

MIPS Value Pathways

M0005

Value in primary care mips value pathway

Promoting wellness mips value pathways

Miscellaneous Medical Services

M0201

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

Covid-19 vaccine administration inside a patient's home; reported only once per individual home per date of service when only covid-19 vaccine administration is performed at the patient's home

MIPS Value Pathways Miscellaneous Medical Services

Other Services

M1174

Patient received at least two doses of the herpes zoster recombinant vaccine (at least 28 days apart) anytime on or after the patient's 50th birthday before or during the measurement period

Patient received at least one dose of the herpes zoster live vaccine or two doses of the herpes zoster recombinant vaccine (at least 28 days apart) anytime on or after the patient's 50th birthday before or during the measurement period

Other Services

M1176

Patient did not receive at least two doses of the herpes zoster recombinant vaccine (at least 28 days apart) anytime on or after the patient's 50th birthday before or during the measurement period

Patient did not receive at least one dose of the herpes zoster live vaccine or two doses of the herpes zoster recombinant vaccine (at least 28 days apart) anytime on or after the patient's 50th birthday before or during the measurement period

Speciality

HCPCS

Code

2024 Description

2023 Description

Other Services

M1197

Itch severity assessment score is reduced by 3 or more

points from the initial (index) assessment score to the follow-up visit score

Itch severity assessment score is reduced by 2 or more

points from the initial (index) assessment score to the follow-up visit score

Other Services

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

Itch severity assessment score was not reduced by at least 2 points from initial (index) score to the follow-up visit score or assessment was not completed during the follow-up encounter

Other Services

M1205

Itch severity assessment score is reduced by 3 or more

points from the initial (index) assessment score to the follow-up visit score

Itch severity assessment score is reduced by 2 or more

points from the initial (index) assessment score to the follow-up visit score

Other Services

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

Itch severity assessment score was not reduced by at least 2 points from initial (index) score to the follow-up visit score or assessment was not completed during the follow-up encounter

Other Services

M1207

Patient is screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety

Number of patients screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety

Other Services

M1208

Patient is not screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety

Number of patients not screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety

National Codes Established for State Medicaid Agencies

T1026

Intensive, extended multidisciplinary services provided in a clinic setting to children with complex medical, physical, mental and psychosocial impairments, per hour

Intensive, extended multidisciplinary services provided in a clinic setting to children with complex medical, physical, medical and psychosocial impairments, per hour

Temporary Codes

Q4225

Amniobind or dermabind tl, per square centimeter

Amniobind, per square centimeter

Speciality

HCPCS

Code

Description

Outpatient PPS

Outpatient PPS	C9152	Injection, aripiprazole, (abilify asimtufii), 1 mg
Outpatient PPS	C9153	Injection, amisulpride, 1 mg
Outpatient PPS	C9154	Injection, buprenorphine extended-release (brixadi), 1 mg
Outpatient PPS	C9155	Injection, epcoritamab-bysp, 0.16 mg
Outpatient PPS	C9156	Flotufolastat f 18, diagnostic, 1 millicurie
Outpatient PPS	C9157	Injection, tofersen, 1 mg
Outpatient PPS	C9158	Injection, risperidone, (uzedy), 1 mg
Outpatient PPS	C9770	Vitrectomy, mechanical, pars plana approach, with subretinal injection of pharmacologic/biologic agent
Outpatient PPS	C9771	Nasal/sinus endoscopy, cryoablation nasal tissue(s) and/or nerve(s), unilateral or bilateral
Outpatient PPS	C9788	Opto-acoustic imaging, breast (including axilla when performed), unilateral, with image documentation, analysis and report, obtained with ultrasound examination
Outpatient PPS	C9803	Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source

Procedures / Professional Svc

Procedures / Professional Svc	G0056+ A42:B65	Optimizing chronic disease management mips value pathways
Procedures / Professional Svc	G2066	Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, implantable loop recorder system, or subcutaneous cardiac rhythm monitor system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results
Procedures / Professional Svc	G2108	Patient age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period
Procedures / Professional Svc	G2109	Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
Procedures / Professional Svc	G2110	Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period
Procedures / Professional Svc	G8506	Patient receiving angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy
Procedures / Professional Svc	G8818	Patient discharge to home no later than post-operative day #7
Procedures / Professional Svc	G8825	Patient not discharged to home by post-operative day #7
Procedures / Professional Svc	G8852	Positive airway pressure therapy was prescribed
Procedures / Professional Svc	G8883	Biopsy results reviewed, communicated, tracked and documented
Procedures / Professional Svc	G8884	Clinician documented reason that patient's biopsy results were not reviewed
Procedures / Professional Svc	G8885	Biopsy results not reviewed, communicated, tracked or documented
Procedures / Professional Svc	G8941	Elder maltreatment screen documented as positive, follow-up plan not documented, documentation the patient is not eligible for follow-up plan at the time of the encounter
Procedures / Professional Svc	G8963	Cardiac stress imaging performed primarily for monitoring of asymptomatic patient who had pci within 2 years
Procedures / Professional Svc	G8964	Cardiac stress imaging test performed primarily for any other reason than monitoring of asymptomatic patient who had pci within 2 years (e.g., symptomatic patient, patient greater than 2 years since pci, initial evaluation, etc)
Procedures / Professional Svc	G9192	Documentation of system reason(s) for not prescribing beta-blocker therapy (eg, other reasons attributable to the health care system)
Procedures / Professional Svc	G9229	Chlamydia, gonorrhea, and syphilis screening results not documented (patient refusal is the only allowed exception)
Procedures / Professional Svc	G9451	Patient received one-time screening for hcv infection
Procedures / Professional Svc	G9453	Documentation of patient reason(s) for not receiving one-time screening for hcv infection (e.g., patient declined, other patient reasons)
Procedures / Professional Svc	G9454	One-time screening for hcv infection not received within 12-month reporting period and no documentation of prior screening for hcv infection, reason not given
Procedures / Professional Svc	G9596	Pediatric patient had a head ct for trauma ordered by someone other than an emergency care provider or was ordered for a reason other than trauma
Procedures / Professional Svc	G9612	Photodocumentation of two or more cecal landmarks to establish a complete examination
Procedures / Professional Svc	G9613	Documentation of post-surgical anatomy (e.g., right hemicolectomy, ileocecal resection, etc.)
Procedures / Professional Svc	G9614	Photodocumentation of less than two cecal landmarks (i.e., no cecal landmarks or only one cecal landmark) to establish a complete examination
Procedures / Professional Svc	G9697	Documentation of patient reason(s) for not prescribing a long-acting inhaled bronchodilator

Speciality Speciality	HCPCS Code	Description
Procedures / Professional Svc	G9715	Patients who use hospice services any time during the measurement period
Procedures / Professional Svc	G9725	Patients who use hospice services any time during the measurement period
Procedures / Professional Svc	G9852	Patients who died from cancer
Procedures / Professional Svc	G9853	Patient admitted to the icu in the last 30 days of life
Procedures / Professional Svc	G9854	Patient was not admitted to the icu in the last 30 days of life
Procedures / Professional Svc	G9927	Documentation of system reason(s) for not prescribing an fda-approved anticoagulation due to patient being currently enrolled in a clinical trial related to af/atrial flutter treatment
Procedures / Professional Svc	G9995	Patients who use palliative care services any time during the measurement period

Chemotherapy Drugs

J9160

Injection, denileukin diftitox, 300 micrograms

Components, Accessories and Supplies

Components, Accessories and Supplies	K1001	Electronic positional obstructive sleep apnea treatment, with sensor, includes all components and accessories, any type
Components, Accessories and Supplies	K1002	Cranial electrotherapy stimulation (ces) system, any type
Components, Accessories and Supplies	K1003	Whirlpool tub, walk-in, portable
Components, Accessories and Supplies	K1005	Disposable collection and storage bag for breast milk, any size, any type, each
Components, Accessories and Supplies	K1006	Suction pump, home model, portable or stationary, electric, any type, for use with external urine management system
Components, Accessories and Supplies	K1009	Speech volume modulation system, any type, including all components and accessories
Components, Accessories and Supplies	K1013	Enema tube, with or without adapter, any type, replacement only, each
Components, Accessories and Supplies	K1014	Addition, endoskeletal knee-shin system, 4 bar linkage or multiaxial, fluid swing and stance phase control
Components, Accessories and Supplies	K1015	Foot, adductus positioning device, adjustable
Components, Accessories and Supplies	K1016	Transcutaneous electrical nerve stimulator for electrical stimulation of the trigeminal nerve
Components, Accessories and Supplies	K1017	Monthly supplies for use of device coded at k1016
Components, Accessories and Supplies	K1018	External upper limb tremor stimulator of the peripheral nerves of the wrist
Components, Accessories and Supplies	K1019	Supplies and accessories for external upper limb tremor stimulator of the peripheral nerves of the wrist
Components, Accessories and Supplies	K1020	Non-invasive vagus nerve stimulator
Components, Accessories and Supplies	K1021	Exsufflation belt, includes all supplies and accessories
Components, Accessories and Supplies	K1022	Addition to lower extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type
Components, Accessories and Supplies	K1023	Distal transcutaneous electrical nerve stimulator, stimulates peripheral nerves of the upper arm
Components, Accessories and Supplies	K1024	Non-pneumatic compression controller with sequential calibrated gradient pressure
Components, Accessories and Supplies	K1025	Non-pneumatic sequential compression garment, full arm
Components, Accessories and Supplies	K1026	Mechanical allergen particle barrier/inhalation filter, cream, nasal, topical
Components, Accessories and Supplies	K1028	Power source and control electronics unit for oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, controlled by phone application
Components, Accessories and Supplies	K1029	Oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, used in conjunction with the power source and control electronics unit, controlled by phone application, 90-day supply
Components, Accessories and Supplies	K1031	Non-pneumatic compression controller without calibrated gradient pressure

Speciality

HCPCS

Code

Description

Components, Accessories and Supplies

K1032

Non-pneumatic sequential compression garment, full leg

Components, Accessories and Supplies

K1033

Non-pneumatic sequential compression garment, half leg

Other Services

Other Services	M1156	Patient received active chemotherapy any time during the measurement period
Other Services	M1157	Patient received bone marrow transplant any time during the measurement period
Other Services	M1158	Patient had history of immunocompromising conditions prior to or during the measurement period

Temporary National Codes (Non-Medicare)

S0171

Injection, bumetanide, 0.5 mg

BONUS: ICD-10 Codes for 2024

Below are the ICD-10 code updates. This list includes replacement codes, new codes and deleted codes.

Replacement ICD-10 Codes for 2024

ICD-10 Code

Description

Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism

Delete	D139	Benign neoplasm of ill-defined sites within the digestive system
Replacement	D1391	Familial adenomatous polyposis
Replacement	D1399	Benign neoplasm of ill-defined sites within the digestive system
Delete	D481	Neoplasm of uncertain behavior of connective and other soft tissue
Replacement	D48110	Desmoid tumor of head and neck
Replacement	D48111	Desmoid tumor of chest wall
Replacement	D48112	Desmoid tumor, intrathoracic
Replacement	D48113	Desmoid tumor of abdominal wall
Replacement	D48114	Desmoid tumor, intraabdominal
Replacement	D48115	Desmoid tumor of upper extremity and shoulder girdle
Replacement	D48116	Desmoid tumor of lower extremity and pelvic girdle
Replacement	D48117	Desmoid tumor of back
Replacement	D48118	Desmoid tumor of other site
Replacement	D48119	Desmoid tumor of unspecified site
Replacement	D4819	Other specified neoplasm of uncertain behavior of connective and other soft tissue

Endocrine, nutritional and metabolic diseases

Delete	E208	Other hypoparathyroidism
Replacement	E20810	Autosomal dominant hypocalcemia
Replacement	E20811	Secondary hypoparathyroidism in diseases classified elsewhere
Replacement	E20812	Autoimmune hypoparathyroidism
Replacement	E20818	Other specified hypoparathyroidism due to impaired parathyroid hormone secretion
Replacement	E20819	Hypoparathyroidism due to impaired parathyroid hormone secretion, unspecified
Replacement	E2089	Other specified hypoparathyroidism
Delete	E798	Other disorders of purine and pyrimidine metabolism
Replacement	E7981	Aicardi-Goutieres syndrome
Replacement	E7982	Hereditary xanthinuria
Replacement	E7989	Other specified disorders of purine and pyrimidine metabolism
Delete	E8881	Metabolic syndrome
Replacement	E88810	Metabolic syndrome
Replacement	E88811	Insulin resistance syndrome, Type A
Replacement	E88818	Other insulin resistance
Replacement	E88819	Insulin resistance, unspecified
Replacement	E88A	Wasting disease (syndrome) due to underlying condition

Diseases of the nervous system

Delete	G20	Parkinson’s disease
Replacement	G20A1	Parkinson's disease without dyskinesia, without mention of fluctuations
Replacement	G20A2	Parkinson's disease without dyskinesia, with fluctuations
Replacement	G20B1	Parkinson's disease with dyskinesia, without mention of fluctuations
Replacement	G20B2	Parkinson's disease with dyskinesia, with fluctuations

ICD-10 Code

Description

Diseases of the nervous system

Delete	G20	Parkinson’s disease
Replacement	G20C	Parkinsonism, unspecified
Delete	G378	Other specified demyelinating diseases of central nervous system
Replacement	G3781	Myelin oligodendrocyte glycoprotein antibody disease
Replacement	G3789	Other specified demyelinating diseases of central nervous system

Diseases of the eye and adnexa

Delete	H36	Retinal disorders in diseases classified elsewhere
Replacement	H36811	Nonproliferative sickle-cell retinopathy, right eye
Replacement	H36812	Nonproliferative sickle-cell retinopathy, left eye
Replacement	H36813	Nonproliferative sickle-cell retinopathy, bilateral
Replacement	H36819	Nonproliferative sickle-cell retinopathy, unspecified eye
Replacement	H36821	Proliferative sickle-cell retinopathy, right eye
Replacement	H36822	Proliferative sickle-cell retinopathy, left eye
Replacement	H36823	Proliferative sickle-cell retinopathy, bilateral
Replacement	H36829	Proliferative sickle-cell retinopathy, unspecified eye
Replacement	H3689	Other retinal disorders in diseases classified elsewhere

Diseases of the circulatory system

Delete	I208	Other forms of angina pectoris
Replacement	I2081	Angina pectoris with coronary microvascular dysfunction
Replacement	I2089	Other forms of angina pectoris
Replacement	I21B	Myocardial infarction with coronary microvascular dysfunction
Delete	I248	Other forms of acute ischemic heart disease
Replacement	I2481	Acute coronary microvascular dysfunction
Replacement	I2489	Other forms of acute ischemic heart disease
Delete	I471	Supraventricular tachycardia
Replacement	I4710	Supraventricular tachycardia, unspecified
Replacement	I4711	Inappropriate sinus tachycardia, so stated
Replacement	I4719	Other supraventricular tachycardia

Diseases of the respiratory system

Delete	J156	Pneumonia due to other Gram-negative bacteria
Replacement	J1561	Pneumonia due to Acinetobacter baumannii
Replacement	J1569	Pneumonia due to other Gram-negative bacteria

Diseases of the digestive system

Delete	K3520	Acute appendicitis with generalized peritonitis, without abscess
Replacement	K35200	Acute appendicitis with generalized peritonitis, without perforation or abscess
Replacement	K35201	Acute appendicitis with generalized peritonitis, with perforation, without abscess
Replacement	K35209	Acute appendicitis with generalized peritonitis, without abscess, unspecified as to perforation
Delete	K3521	Acute appendicitis with generalized peritonitis, with abscess
Replacement	K35210	Acute appendicitis with generalized peritonitis, without perforation, with abscess
Replacement	K35211	Acute appendicitis with generalized peritonitis, with perforation and abscess
Replacement	K35219	Acute appendicitis with generalized peritonitis, with abscess, unspecified as to perforation

ICD-10 Code

Description

Diseases of the genitourinary system

Delete	N042	Nephrotic syndrome with diffuse membranous glomerulonephritis
Replacement	N0420	Nephrotic syndrome with diffuse membranous glomerulonephritis, unspecified
Replacement	N0421	Primary membranous nephropathy with nephrotic syndrome
Replacement	N0422	Seconday membranous nephropathy with nephrotic syndrome
Replacement	N0429	Other nephrotic syndrome with diffuse membranous glomerulonephritis
Delete	N062	Isolated proteinuria with diffuse membranous glomerulonephritis
Replacement	N0620	Isolated proteinuria with diffuse membranous glomerulonephritis, unspecified
Replacement	N0621	Primary membranous nephropathy with isolated proteinuria
Replacement	N0622	Seconday membranous nephropathy with isolated proteinuria
Replacement	N0629	Other isolated proteinuria with diffuse membranous glomerulonephritis

Pregnancy, childbirth and the puerperium

Delete	O904	Postpartum acute kidney failure
Replacement	O9041	Hepatorenal syndrome following labor and delivery
Replacement	O9049	Other postpartum acute kidney failure

Congenital malformations, deformations and chromosomal abnormalities

Delete	Q447	Other congenital malformations of liver
Replacement	Q4470	Other congenital malformation of liver, unspecified
Replacement	Q4471	Alagille syndrome
Replacement	Q4479	Other congenital malformations of liver
Delete	Q750	Craniosynostosis
Replacement	Q75001	Craniosynostosis unspecified, unilateral
Replacement	Q75002	Craniosynostosis unspecified, bilateral
Replacement	Q75009	Craniosynostosis unspecified
Replacement	Q7501	Sagittal craniosynostosis
Replacement	Q75021	Coronal craniosynostosis unilateral
Replacement	Q75022	Coronal craniosynostosis bilateral
Replacement	Q75029	Coronal craniosynostosis unspecified
Replacement	Q7503	Metopic craniosynostosis
Replacement	Q75041	Lambdoid craniosynostosis, unilateral
Replacement	Q75042	Lambdoid craniosynostosis, bilateral
Replacement	Q75049	Lambdoid craniosynostosis, unspecified
Replacement	Q75051	Cloverleaf skull
Replacement	Q75052	Pansynostosis
Replacement	Q75058	Other multi-suture craniosynostosis
Replacement	Q7508	Other single-suture craniosynostosis
Replacement	I2489	Other forms of acute ischemic heart disease
Replacement	I4710	Supraventricular tachycardia, unspecified
Replacement	I4711	Inappropriate sinus tachycardia, so stated
Replacement	I4719	Other supraventricular tachycardia
Replacement	J1561	Pneumonia due to Acinetobacter baumannii
Replacement	J1569	Pneumonia due to other Gram-negative bacteria

ICD-10 Code

Description

Factors influencing health status and contact with health services

Delete	Z058	Observation and evaluation of newborn for other specified suspected condition ruled out
Replacement	Z0581	Observation and evaluation of newborn for suspected condition related to home physiologic monitoring device ruled out
Replacement	Z0589	Observation and evaluation of newborn for other specified suspected condition ruled out
Delete	Z298	Encounter for other specified prophylactic measures
Replacement	Z2981	Encounter for HIV pre-exposure prophylaxis
Replacement	Z2989	Encounter for other specified prophylactic measures
Delete	Z8371	Family history of colonic polyps
Replacement	Z83710	Family history of adenomatous and serrated polyps
Replacement	Z83711	Family history of hyperplastic colon polyps
Replacement	Z83718	Other family history of colon polyps
Replacement	Z83719	Family history of colon polyps, unspecified
Delete	Z91A4	Caregiver’s other noncompliance with patient’s medication regimen
Replacement	Z91A41	Caregiver's other noncompliance with patient's medication regimen due to financial hardship
Replacement	Z91A48	Caregiver's other noncompliance with patient's medication regimen for other reason
Delete	Z91A5	Caregiver’s noncompliance with patient’s renal dialysis
Replacement	Z91A51	Caregiver's noncompliance with patient's renal dialysis due to financial hardship
Replacement	Z91A58	Caregiver's noncompliance with patient's renal dialysis for other reason
Delete	Z91A9	Caregiver’s noncompliance with patient’s other medical treatment and regimen
Replacement	Z91A91	Caregiver's noncompliance with patient's other medical treatment and regimen due to financial hardship
Replacement	Z91A98	Caregiver's noncompliance with patient's other medical treatment and regimen for other reason

System

ICD-10 Code

Description

Certain infectious and parasitic diseases

Certain infectious and parasitic diseases	A4154	Sepsis due to Acinetobacter baumannii
Certain infectious and parasitic diseases	B9683	Acinetobacter baumannii as the cause of diseases classified elsewhere

Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism

Diseases of the blood and blood-forming organs	D5704	Hb-SS disease with dactylitis
Diseases of the blood and blood-forming organs	D57214	Sickle-cell/Hb-C disease with dactylitis
Diseases of the blood and blood-forming organs	D57414	Sickle-cell thalassemia, unspecified, with dactylitis
Diseases of the blood and blood-forming organs	D57434	Sickle-cell thalassemia beta zero with dactylitis
Diseases of the blood and blood-forming organs	D57454	Sickle-cell thalassemia beta plus with dactylitis
Diseases of the blood and blood-forming organs	D57814	Other sickle-cell disorders with dactylitis
Diseases of the blood and blood-forming organs	D6102	Shwachman-Diamond syndrome
Diseases of the blood and blood-forming organs	D8984	IgG4-related disease

Endocrine, nutritional and metabolic diseases

Endocrine, nutritional and metabolic diseases	E7405	Lysosome-associated membrane protein 2 [LAMP2] deficiency
Endocrine, nutritional and metabolic diseases	E7527	Pelizaeus-Merzbacher disease
Endocrine, nutritional and metabolic diseases	E7528	Canavan disease
Endocrine, nutritional and metabolic diseases	E8843	Disorders of mitochondrial tRNA synthetases

Diseases of the nervous system

Diseases of the nervous system	G115	Hypomyelination – hypogonadotropic hypogonadism – hypodontia
Diseases of the nervous system	G116	Leukodystrophy with vanishing white matter disease
Diseases of the nervous system	G233	Hypomyelination with atrophy of the basal ganglia and cerebellum
Diseases of the nervous system	G3180	Leukodystrophy, unspecified
Diseases of the nervous system	G3186	Alexander disease
Diseases of the nervous system	G40C01	Lafora progressive myoclonus epilepsy, not intractable, with status epilepticus
Diseases of the nervous system	G40C09	Lafora progressive myoclonus epilepsy, not intractable, without status epilepticus
Diseases of the nervous system	G40C11	Lafora progressive myoclonus epilepsy, intractable, with status epilepticus
Diseases of the nervous system	G40C19	Lafora progressive myoclonus epilepsy, intractable, without status epilepticus
Diseases of the nervous system	G43E01	Chronic migraine with aura, not intractable, with status migrainosus
Diseases of the nervous system	G43E09	Chronic migraine with aura, not intractable, without status migrainosus
Diseases of the nervous system	G43E11	Chronic migraine with aura, intractable, with status migrainosus
Diseases of the nervous system	G43E19	Chronic migraine with aura, intractable, without status migrainosus
Diseases of the nervous system	G90B	LMNB1-related autosomal dominant leukodystrophy
Diseases of the nervous system	G9342	Megaloencephalic leukoencephalopathy with subcortical cysts
Diseases of the nervous system	G9343	Leukoencephalopathy with calcifications and cysts
Diseases of the nervous system	G9344	Adult-onset leukodystrophy with axonal spheroids

Diseases of the eye and adnexa

Diseases of the eye and adnexa	H50621	Inferior oblique muscle entrapment, right eye
Diseases of the eye and adnexa	H50622	Inferior oblique muscle entrapment, left eye
Diseases of the eye and adnexa	H50629	Inferior oblique muscle entrapment, unspecified eye
Diseases of the eye and adnexa	H50631	Inferior rectus muscle entrapment, right eye
Diseases of the eye and adnexa	H50632	Inferior rectus muscle entrapment, left eye
Diseases of the eye and adnexa	H50639	Inferior rectus muscle entrapment, unspecified eye
Diseases of the eye and adnexa	H50641	Lateral rectus muscle entrapment, right eye
Diseases of the eye and adnexa	H50642	Lateral rectus muscle entrapment, left eye
Diseases of the eye and adnexa	H50649	Lateral rectus muscle entrapment, unspecified eye
Diseases of the eye and adnexa	H50651	Medial rectus muscle entrapment, right eye
Diseases of the eye and adnexa	H50652	Medial rectus muscle entrapment, left eye

System	ICD-10 Code	Description
Diseases of the eye and adnexa	H50659	Medial rectus muscle entrapment, unspecified eye
Diseases of the eye and adnexa	H50661	Superior oblique muscle entrapment, right eye
Diseases of the eye and adnexa	H50662	Superior oblique muscle entrapment, left eye
Diseases of the eye and adnexa	H50669	Superior oblique muscle entrapment, unspecified eye
Diseases of the eye and adnexa	H50671	Superior rectus muscle entrapment, right eye
Diseases of the eye and adnexa	H50672	Superior rectus muscle entrapment, left eye
Diseases of the eye and adnexa	H50679	Superior rectus muscle entrapment, unspecified eye
Diseases of the eye and adnexa	H50681	Extraocular muscle entrapment, unspecified, right eye
Diseases of the eye and adnexa	H50682	Extraocular muscle entrapment, unspecified, left eye
Diseases of the eye and adnexa	H50689	Extraocular muscle entrapment, unspecified, unspecified eye
Diseases of the eye and adnexa	H578A1	Foreign body sensation, right eye
Diseases of the eye and adnexa	H578A2	Foreign body sensation, left eye
Diseases of the eye and adnexa	H578A3	Foreign body sensation, bilateral eyes
Diseases of the eye and adnexa	H578A9	Foreign body sensation, unspecified eye

Diseases of the circulatory system

Diseases of the circulatory system	I1A0	Resistant hypertension
Diseases of the circulatory system	I2585	Chronic coronary microvascular dysfunction

Diseases of the respiratory system

Diseases of the respiratory system	J4481	Bronchiolitis obliterans and bronchiolitis obliterans syndrome
Diseases of the circulatory system	J4489	Other specified chronic obstructive pulmonary disease
Diseases of the circulatory system	J4A0	Restrictive allograft syndrome
Diseases of the circulatory system	J4A8	Other chronic lung allograft dysfunction
Diseases of the circulatory system	J4A9	Chronic lung allograft dysfunction, unspecified

Diseases of the digestive system

Diseases of the digestive system	K638211	Small intestinal bacterial overgrowth, hydrogen-subtype
Diseases of the digestive system	K638212	Small intestinal bacterial overgrowth, hydrogen sulfide-subtype
Diseases of the digestive system	K638219	Small intestinal bacterial overgrowth, unspecified
Diseases of the digestive system	K63822	Small intestinal fungal overgrowth
Diseases of the digestive system	K63829	Intestinal methanogen overgrowth, unspecified
Diseases of the digestive system	K682	Retroperitoneal fibrosis
Diseases of the digestive system	K683	Retroperitoneal hematoma
Diseases of the digestive system	K90821	Short bowel syndrome with colon in continuity
Diseases of the digestive system	K90822	Short bowel syndrome without colon in continuity
Diseases of the digestive system	K90829	Short bowel syndrome, unspecified
Diseases of the digestive system	K9083	Intestinal failure

Diseases of the musculoskeletal system and connective tissue

Diseases of the musculoskeletal system and connective tissue	M800B1A	Age-related osteoporosis with current pathological fracture, right pelvis, initial encounter for fracture
Diseases of the musculoskeletal system and connective tissue	M800B1D	Age-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with routine healing
Diseases of the musculoskeletal system and connective tissue	M800B1G	Age-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with delayed healing
Diseases of the musculoskeletal system and connective tissue	M800B1K	Age-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with nonunion
Diseases of the musculoskeletal system and connective tissue	M800B1P	Age-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with malunion
Diseases of the musculoskeletal system and connective tissue	M800B1S	Age-related osteoporosis with current pathological fracture, right pelvis, sequela
Diseases of the musculoskeletal system and connective tissue	M800B2A	Age-related osteoporosis with current pathological fracture, left pelvis, initial encounter for fracture

System	ICD-10 Code	Description
Diseases of the musculoskeletal system and connective tissue	M800B2D	Age-related osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with routine healing
Diseases of the musculoskeletal system and connective tissue	M800B2G	Age-related osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with delayed healing
Diseases of the musculoskeletal system and connective tissue	M800B2K	Age-related osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with nonunion
Diseases of the musculoskeletal system and connective tissue	M800B2P	Age-related osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with malunion
Diseases of the musculoskeletal system and connective tissue	M800B2S	Age-related osteoporosis with current pathological fracture, left pelvis, sequela
Diseases of the musculoskeletal system and connective tissue	M800B9A	Age-related osteoporosis with current pathological fracture, unspecified pelvis, initial encounter for fracture
Diseases of the musculoskeletal system and connective tissue	M800B9D	Age-related osteoporosis with current pathological fracture, unspecified pelvis, subsequent encounter for fracture with routine healing
Diseases of the musculoskeletal system and connective tissue	M800B9G	Age-related osteoporosis with current pathological fracture, unspecified pelvis, subsequent encounter for fracture with delayed healing
Diseases of the musculoskeletal system and connective tissue	M800B9K	Age-related osteoporosis with current pathological fracture, unspecified pelvis, subsequent encounter for fracture with nonunion
Diseases of the musculoskeletal system and connective tissue	M800B9P	Age-related osteoporosis with current pathological fracture, unspecified pelvis, subsequent encounter for fracture with malunion
Diseases of the musculoskeletal system and connective tissue	M800B9S	Age-related osteoporosis with current pathological fracture, unspecified pelvis, sequela
Diseases of the musculoskeletal system and connective tissue	M808B1A	Other osteoporosis with current pathological fracture, right pelvis, initial encounter for fracture
Diseases of the musculoskeletal system and connective tissue	M808B1D	Other osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with routine healing
Diseases of the musculoskeletal system and connective tissue	M808B1G	Other osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with delayed healing
Diseases of the musculoskeletal system and connective tissue	M808B1K	Other osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with nonunion
Diseases of the musculoskeletal system and connective tissue	M808B1P	Other osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with malunion
Diseases of the musculoskeletal system and connective tissue	M808B1S	Other osteoporosis with current pathological fracture, right pelvis, sequela
Diseases of the musculoskeletal system and connective tissue	M808B2A	Other osteoporosis with current pathological fracture, left pelvis, initial encounter for fracture
Diseases of the musculoskeletal system and connective tissue	M808B2D	Other osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with routine healing
Diseases of the musculoskeletal system and connective tissue	M808B2G	Other osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with delayed healing
Diseases of the musculoskeletal system and connective tissue	M808B2K	Other osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with nonunion
Diseases of the musculoskeletal system and connective tissue	M808B2P	Other osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with malunion
Diseases of the musculoskeletal system and connective tissue	M808B2S	Other osteoporosis with current pathological fracture, left pelvis, sequela
Diseases of the musculoskeletal system and connective tissue	M808B9A	Other osteoporosis with current pathological fracture, unspecified pelvis, initial encounter for fracture
Diseases of the musculoskeletal system and connective tissue	M808B9D	Other osteoporosis with current pathological fracture, unspecified pelvis, subsequent encounter for fracture with routine healing
Diseases of the musculoskeletal system and connective tissue	M808B9G	Other osteoporosis with current pathological fracture, unspecified pelvis, subsequent encounter for fracture with delayed healing
Diseases of the musculoskeletal system and connective tissue	M808B9K	Other osteoporosis with current pathological fracture, unspecified pelvis, subsequent encounter for fracture with nonunion
Diseases of the musculoskeletal system and connective tissue	M808B9P	Other osteoporosis with current pathological fracture, unspecified pelvis, subsequent encounter for fracture with malunion
Diseases of the musculoskeletal system and connective tissue	M808B9S	Other osteoporosis with current pathological fracture, unspecified pelvis, sequela

Diseases of the genitourinary system

N02B1

Recurrent and persistent immunoglobulin A nephropathy with glomerular lesion

System	ICD-10 Code	Description
Diseases of the genitourinary system	N02B2	Recurrent and persistent immunoglobulin A nephropathy with focal and segmental glomerular lesion
Diseases of the genitourinary system	N02B3	Recurrent and persistent immunoglobulin A nephropathy with diffuse membranoproliferative glomerulonephritis
Diseases of the genitourinary system	N02B4	Recurrent and persistent immunoglobulin A nephropathy with diffuse membranous glomerulonephritis
Diseases of the genitourinary system	N02B5	Recurrent and persistent immunoglobulin A nephropathy with diffuse mesangial proliferative glomerulonephritis
Diseases of the genitourinary system	N02B6	Recurrent and persistent immunoglobulin A nephropathy with diffuse mesangiocapillary glomerulonephritis
Diseases of the genitourinary system	N02B9	Other recurrent and persistent immunoglobulin A nephropathy

Congenital malformations, deformations and chromosomal abnormalities

Congenital malformations, deformations and chromosomal abnormalities	Q8783	Bardet-Biedl syndrome
Congenital malformations, deformations and chromosomal abnormalities	Q8784	Laurence-Moon syndrome
Congenital malformations, deformations and chromosomal abnormalities	Q8785	MED13L syndrome
Congenital malformations, deformations and chromosomal abnormalities	Q9352	Phelan-McDermid syndrome

Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified

Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified	R09A0	Foreign body sensation, unspecified
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified	R09A1	Foreign body sensation, nose
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified	R09A2	Foreign body sensation, throat
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified	R09A9	Foreign body sensation, other site
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified	R402A	Nontraumatic coma due to underlying condition
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified	R9230	Dense breasts, unspecified
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified	R92311	Mammographic fatty tissue density, right breast
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified	R92312	Mammographic fatty tissue density, left breast
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified	R92313	Mammographic fatty tissue density, bilateral breasts
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified	R92321	Mammographic fibroglandular density, right breast
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified	R92322	Mammographic fibroglandular density, left breast
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified	R92323	Mammographic fibroglandular density, bilateral breasts
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified	R92331	Mammographic heterogeneous density, right breast
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified	R92332	Mammographic heterogeneous density, left breast
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified	R92333	Mammographic heterogeneous density, bilateral breasts
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified	R92341	Mammographic extreme density, right breast
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified	R92342	Mammographic extreme density, left breast
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified	R92343	Mammographic extreme density, bilateral breasts

Injury, poisoning and certain other consequences of external causes

T56821A

Toxic effect of gadolinium, accidental (unintentional), initial encounter

System	ICD-10 Code	Description
Injury, poisoning and certain other consequences of external causes	T56821D	Toxic effect of gadolinium, accidental (unintentional), subsequent encounter
Injury, poisoning and certain other consequences of external causes	T56821S	Toxic effect of gadolinium, accidental (unintentional), sequela
Injury, poisoning and certain other consequences of external causes	T56822A	Toxic effect of gadolinium, intentional self-harm, initial encounter
Injury, poisoning and certain other consequences of external causes	T56822D	Toxic effect of gadolinium, intentional self-harm, subsequent encounter
Injury, poisoning and certain other consequences of external causes	T56822S	Toxic effect of gadolinium, intentional self-harm, sequela
Injury, poisoning and certain other consequences of external causes	T56823A	Toxic effect of gadolinium, assault, initial encounter
Injury, poisoning and certain other consequences of external causes	T56823D	Toxic effect of gadolinium, assault, subsequent encounter
Injury, poisoning and certain other consequences of external causes	T56823S	Toxic effect of gadolinium, assault, sequela
Injury, poisoning and certain other consequences of external causes	T56824A	Toxic effect of gadolinium, undetermined, initial encounter
Injury, poisoning and certain other consequences of external causes	T56824D	Toxic effect of gadolinium, undetermined, subsequent encounter
Injury, poisoning and certain other consequences of external causes	T56824S	Toxic effect of gadolinium, undetermined, sequela

External causes of morbidity

External causes of morbidity	W448XXA	Other foreign body entering into or through a natural orifice, initial encounter
External causes of morbidity	W448XXD	Other foreign body entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W448XXS	Other foreign body entering into or through a natural orifice, sequela
External causes of morbidity	W449XXA	Unspecified foreign body entering into or through a natural orifice, initial encounter
External causes of morbidity	W449XXD	Unspecified foreign body entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W449XXS	Unspecified foreign body entering into or through a natural orifice, sequela
External causes of morbidity	W44A0XA	Battery unspecified, entering into or through a natural orifice, initial encounter
External causes of morbidity	W44A0XD	Battery unspecified, entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44A0XS	Battery unspecified, entering into or through a natural orifice, sequela
External causes of morbidity	W44A1XA	Button battery entering into or through a natural orifice, initial encounter
External causes of morbidity	W44A1XD	Button battery entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44A1XS	Button battery entering into or through a natural orifice, sequela
External causes of morbidity	W44A9XA	Other batteries entering into or through a natural orifice, initial encounter
External causes of morbidity	W44A9XD	Other batteries entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44A9XS	Other batteries entering into or through a natural orifice, sequela
External causes of morbidity	W44B0XA	Plastic object unspecified, entering into or through a natural orifice, initial encounter
External causes of morbidity	W44B0XD	Plastic object unspecified, entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44B0XS	Plastic object unspecified, entering into or through a natural orifice, sequela
External causes of morbidity	W44B1XA	Plastic bead entering into or through a natural orifice, initial encounter
External causes of morbidity	W44B1XD	Plastic bead entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44B1XS	Plastic bead entering into or through a natural orifice, sequela
External causes of morbidity	W44B2XA	Plastic coin entering into or through a natural orifice, initial encounter
External causes of morbidity	W44B2XD	Plastic coin entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44B2XS	Plastic coin entering into or through a natural orifice, sequela
External causes of morbidity	W44B3XA	Plastic toy and toy part entering into or through a natural orifice, initial encounter
External causes of morbidity	W44B3XD	Plastic toy and toy part entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44B3XS	Plastic toy and toy part entering into or through a natural orifice, sequela
External causes of morbidity	W44B4XA	Plastic jewelry entering into or through a natural orifice, initial encounter
External causes of morbidity	W44B4XD	Plastic jewelry entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44B4XS	Plastic jewelry entering into or through a natural orifice, sequela

System	ICD-10 Code	Description
External causes of morbidity	W44B5XA	Plastic bottle entering into or through a natural orifice, initial encounter
External causes of morbidity	W44B5XD	Plastic bottle entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44B5XS	Plastic bottle entering into or through a natural orifice, sequela
External causes of morbidity	W44B9XA	Other plastic object entering into or through a natural orifice, initial encounter
External causes of morbidity	W44B9XD	Other plastic object entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44B9XS	Other plastic object entering into or through a natural orifice, sequela
External causes of morbidity	W44C0XA	Glass unspecified, entering into or through a natural orifice, initial encounter
External causes of morbidity	W44C0XD	Glass unspecified, entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44C0XS	Glass unspecified, entering into or through a natural orifice, sequela
External causes of morbidity	W44C1XA	Sharp glass entering into or through a natural orifice, initial encounter
External causes of morbidity	W44C1XD	Sharp glass entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44C1XS	Sharp glass entering into or through a natural orifice, sequela
External causes of morbidity	W44C2XA	Intact glass entering into or through a natural orifice, initial encounter
External causes of morbidity	W44C2XD	Intact glass entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44C2XS	Intact glass entering into or through a natural orifice, sequela
External causes of morbidity	W44D0XA	Magnetic metal object unspecified, entering into or through a natural orifice, initial encounter
External causes of morbidity	W44D0XD	Magnetic metal object unspecified, entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44D0XS	Magnetic metal object unspecified, entering into or through a natural orifice, sequela
External causes of morbidity	W44D1XA	Magnetic metal bead entering into or through a natural orifice, initial encounter
External causes of morbidity	W44D1XD	Magnetic metal bead entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44D1XS	Magnetic metal bead entering into or through a natural orifice, sequela
External causes of morbidity	W44D2XA	Magnetic metal coin entering into or through a natural orifice, initial encounter
External causes of morbidity	W44D2XD	Magnetic metal coin entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44D2XS	Magnetic metal coin entering into or through a natural orifice, sequela
External causes of morbidity	W44D3XA	Magnetic metal toy entering into or through a natural orifice, initial encounter
External causes of morbidity	W44D3XD	Magnetic metal toy entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44D3XS	Magnetic metal toy entering into or through a natural orifice, sequela
External causes of morbidity	W44D4XA	Magnetic metal jewelry entering into or through a natural orifice, initial encounter
External causes of morbidity	W44D4XD	Magnetic metal jewelry entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44D4XS	Magnetic metal jewelry entering into or through a natural orifice, sequela
External causes of morbidity	W44D9XA	Other magnetic metal objects entering into or through a natural orifice, initial encounter
External causes of morbidity	W44D9XD	Other magnetic metal objects entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44D9XS	Other magnetic metal objects entering into or through a natural orifice, sequela
External causes of morbidity	W44E0XA	Non-magnetic metal object unspecified, entering into or through a natural orifice, initial encounter
External causes of morbidity	W44E0XD	Non-magnetic metal object unspecified, entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44E0XS	Non-magnetic metal object unspecified, entering into or through a natural orifice, sequela
External causes of morbidity	W44E1XA	Non-magnetic metal bead entering into or through a natural orifice, initial encounter
External causes of morbidity	W44E1XD	Non-magnetic metal bead entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44E1XS	Non-magnetic metal bead entering into or through a natural orifice, sequela
External causes of morbidity	W44E2XA	Non-magnetic metal coin entering into or through a natural orifice, initial encounter
External causes of morbidity	W44E2XD	Non-magnetic metal coin entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44E2XS	Non-magnetic metal coin entering into or through a natural orifice, sequela
External causes of morbidity	W44E3XA	Non-magnetic metal toy entering into or through a natural orifice, initial encounter
External causes of morbidity	W44E3XD	Non-magnetic metal toy entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44E3XS	Non-magnetic metal toy entering into or through a natural orifice, sequela
External causes of morbidity	W44E4XA	Non-magnetic metal jewelry entering into or through a natural orifice, initial encounter
External causes of morbidity	W44E4XD	Non-magnetic metal jewelry entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44E4XS	Non-magnetic metal jewelry entering into or through a natural orifice, sequela
External causes of morbidity	W44E9XA	Other non-magnetic metal objects entering into or through a natural orifice, initial encounter

System	ICD-10 Code	Description
External causes of morbidity	W44E9XD	Other non-magnetic metal objects entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44E9XS	Other non-magnetic metal objects entering into or through a natural orifice, sequela
External causes of morbidity	W44F0XA	Objects of natural or organic material unspecified, entering into or through a natural orifice, initial encounter
External causes of morbidity	W44F0XD	Objects of natural or organic material unspecified, entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44F0XS	Objects of natural or organic material unspecified, entering into or through a natural orifice, sequela
External causes of morbidity	W44F1XA	Bezoar entering into or through a natural orifice, initial encounter
External causes of morbidity	W44F1XD	Bezoar entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44F1XS	Bezoar entering into or through a natural orifice, sequela
External causes of morbidity	W44F2XA	Rubber band entering into or through a natural orifice, initial encounter
External causes of morbidity	W44F2XD	Rubber band entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44F2XS	Rubber band entering into or through a natural orifice, sequela
External causes of morbidity	W44F3XA	Food entering into or through a natural orifice, initial encounter
External causes of morbidity	W44F3XD	Food entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44F3XS	Food entering into or through a natural orifice, sequela
External causes of morbidity	W44F4XA	Insect entering into or through a natural orifice, initial encounter
External causes of morbidity	W44F4XD	Insect entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44F4XS	Insect entering into or through a natural orifice, sequela
External causes of morbidity	W44F9XA	Other object of natural or organic material, entering into or through a natural orifice, initial encounter
External causes of morbidity	W44F9XD	Other object of natural or organic material, entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44F9XS	Other object of natural or organic material, entering into or through a natural orifice, sequela
External causes of morbidity	W44G0XA	Other non-organic objects unspecified, entering into or through a natural orifice, initial encounter
External causes of morbidity	W44G0XD	Other non-organic objects unspecified, entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44G0XS	Other non-organic objects unspecified, entering into or through a natural orifice, sequela
External causes of morbidity	W44G1XA	Audio device entering into or through a natural orifice, initial encounter
External causes of morbidity	W44G1XD	Audio device entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44G1XS	Audio device entering into or through a natural orifice, sequela
External causes of morbidity	W44G2XA	Combination metal and plastic toy and toy part entering into or through natural orifice, initial encounter
External causes of morbidity	W44G2XD	Combination metal and plastic toy and toy part entering into or through natural orifice, subsequent encounter
External causes of morbidity	W44G2XS	Combination metal and plastic toy and toy part entering into or through natural orifice, sequela
External causes of morbidity	W44G3XA	Combination metal and plastic jewelry entering into or through a natural orifice, initial encounter
External causes of morbidity	W44G3XD	Combination metal and plastic jewelry entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44G3XS	Combination metal and plastic jewelry entering into or through a natural orifice, sequela
External causes of morbidity	W44G9XA	Other non-organic objects entering into or through a natural orifice, initial encounter
External causes of morbidity	W44G9XD	Other non-organic objects entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44G9XS	Other non-organic objects entering into or through a natural orifice, sequela
External causes of morbidity	W44H0XA	Other sharp object unspecified, entering into or through a natural orifice, initial encounter
External causes of morbidity	W44H0XD	Other sharp object unspecified, entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44H0XS	Other sharp object unspecified, entering into or through a natural orifice, sequela
External causes of morbidity	W44H1XA	Needle entering into or through a natural orifice, initial encounter
External causes of morbidity	W44H1XD	Needle entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44H1XS	Needle entering into or through a natural orifice, sequela
External causes of morbidity	W44H2XA	Knife, sword or dagger entering into or through a natural orifice, initial encounter
External causes of morbidity	W44H2XD	Knife, sword or dagger entering into or through a natural orifice, subsequent encounter
External causes of morbidity	W44H2XS	Knife, sword or dagger entering into or through a natural orifice, sequela

Factors influencing health status and contact with health services

Z0284

Encounter for child welfare exam

System	ICD-10 Code	Description
Factors influencing health status and contact with health services	Z1613	Resistance to carbapenem
Factors influencing health status and contact with health services	Z22340	Carrier of carbapenem-resistant Acinetobacter baumannii
Factors influencing health status and contact with health services	Z22341	Carrier of carbapenem-sensitive Acinetobacter baumannii
Factors influencing health status and contact with health services	Z22349	Carrier of Acinetobacter baumannii, unspecified
Factors influencing health status and contact with health services	Z22350	Carrier of carbapenem-resistant Enterobacterales
Factors influencing health status and contact with health services	Z22358	Carrier of other Enterobacterales
Factors influencing health status and contact with health services	Z22359	Carrier of Enterobacterales, unspecified
Factors influencing health status and contact with health services	Z6223	Child in custody of non-parental relative
Factors influencing health status and contact with health services	Z6224	Child in custody of non-relative guardian
Factors influencing health status and contact with health services	Z62823	Parent-step child conflict
Factors influencing health status and contact with health services	Z62831	Non-parental relative-child conflict
Factors influencing health status and contact with health services	Z62832	Non-relative guardian-child conflict
Factors influencing health status and contact with health services	Z62833	Group home staff-child conflict
Factors influencing health status and contact with health services	Z62892	Runaway [from current living environment]
Factors influencing health status and contact with health services	Z9185	Personal history of military service

System

ICD-10 Code

Description

Neoplasms

Neoplasms	D139	Benign neoplasm of ill-defined sites within the digestive system
Neoplasms	D481	Neoplasm of uncertain behavior of connective and other soft tissue

Endocrine, nutritional and metabolic diseases

Endocrine, nutritional and metabolic diseases	E208	Other hypoparathyroidism
Endocrine, nutritional and metabolic diseases	E798	Other disorders of purine and pyrimidine metabolism
Endocrine, nutritional and metabolic diseases	E8881	Metabolic syndrome

Diseases of the nervous system

Diseases of the nervous system	G20	Parkinson's disease
Diseases of the nervous system	G378	Other specified demyelinating diseases of central nervous system

Diseases of the eye and adnexa

H36

Retinal disorders in diseases classified elsewhere

Diseases of the circulatory system	I208	Other forms of angina pectoris
Diseases of the circulatory system	I248	Other forms of acute ischemic heart disease
Diseases of the circulatory system	I471	Supraventricular tachycardia

Diseases of the eye and adnexa Diseases of the circulatory system

Diseases of the respiratory system

J156

Pneumonia due to other Gram-negative bacteria

Diseases of the digestive system	K3520	Acute appendicitis with generalized peritonitis, without abscess
Diseases of the digestive system	K3521	Acute appendicitis with generalized peritonitis, with abscess

Diseases of the respiratory system Diseases of the digestive system

Diseases of the genitourinary system

Diseases of the genitourinary system	N042	Nephrotic syndrome with diffuse membranous glomerulonephritis
Diseases of the genitourinary system	N062	Isolated proteinuria with diffuse membranous glomerulonephritis

Pregnancy, childbirth and the puerperium

O904

Postpartum acute kidney failure

Congenital malformations, deformations and chromosomal abnormalities

Congenital malformations, deformations and chromosomal abnormalities	Q447	Other congenital malformations of liver
Congenital malformations, deformations and chromosomal abnormalities	Q750	Craniosynostosis

Factors influencing health status and contact with health services

Factors influencing health status and contact with health services	Z058	Observation and evaluation of newborn for other specified suspected condition ruled out
Factors influencing health status and contact with health services	Z298	Encounter for other specified prophylactic measures
Factors influencing health status and contact with health services	Z8371	Family history of colonic polyps
Factors influencing health status and contact with health services	Z91A4	Caregiver's other noncompliance with patient's medication regimen
Factors influencing health status and contact with health services	Z91A5	Caregiver's noncompliance with patient's renal dialysis
Factors influencing health status and contact with health services	Z91A9	Caregiver's noncompliance with patient's other medical treatment and regimen

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EVALUATION AND MANAGEMENT ADDED/REVISED/DELETED CPT CODES DISCLAIMER

ADVANCEDMD IS PROVIDING THIS EVALUATION AND MANAGEMENT CPT LIST OF ADDED, REVISED AND DELETED CODES FOR 2024 “AS IS” WITHOUT WARRANTY OF ANY KIND, INCLUDING BUT NOT LIMITED TO ANY EXPRESSED OR IMPLIED WARRANTIES OR WARRANTIES FOR FITNESS FOR A PARTICULAR PURPOSE OR MERCHANTABILITY. ADVANCEDMD DISCLAIMS RESPONSIBILITY FOR ANY ERRORS OR OMISSIONS CONTAINED WITHIN THE ADDED, REVISED AND DELETED CPT CODES LIST INCLUDING

IN CONJUNCTION WITH ITS USE WITH ANY SOFTWARE AND/OR HARDWARE SYSTEM. ADVANCEDMD DISCLAIMS RESPONSIBILITY FOR ANY CONSEQUENCES OR LIABILITY WHICH MAY BE ATTRIBUTED TO OR RELATED IN ANY WAY TO THE USE, NON-USE OR INTERPRETATION OF THE INFORMATION PROVIDED OR NOT PROVIDED WITHIN THIS DOCUMENT. THE INFORMATION PROVIDED WITHIN THIS DOCUMENT IS SOLELY AS A SERVICE TO ADVANCEDMD CLIENTS AND IS NOT A GUARANTEE OF ANY TYPE AS TO THE ACCURACY OR COMPLETENESS OF THE INFORMATION. WE CANNOT GUARANTEE THE ACCURACY OF THE INFORMATION PRINTED HEREIN AND ARE NOT RESPONSIBLE FOR CLAIMS OR LIABILITY THAT MAY RESULT FROM THE USE OF THIS INFORMATION.

THIS DOCUMENT. THIS INFORMATION IS NOT INTENDED TO BE NOR SHOULD BE CONSTRUED AS LEGAL ADVICE OR GUIDANCE IN ANY MANNER OR CAPACITY, CLIENTS ARE RESPONSIBLE FOR DETERMINING WHETHER THE INFORMATION CONTAINED WITHIN THIS DOCUMENT IS USEFUL OR APPLICABLE FOR THEIR PURPOSES. THIS INFORMATION IS NOT INTENDED TO BE A FINAL OR EXHAUSTIVE LIST OF ADDED, REVISED AND DELETED CODES FOR 2024, THE CPT CODES ARE FREQUENTLY REVISED AND ADVANCEDMD DISCLAIMS ALL RESPONSIBILITY FOR ADDED, REVISED AND DELETED CODES WHICH ARE LATER ADDED, REVISED, MODIFIED OR DELETED AT ANY TIME; NO INDEPENDENT VERIFICATION OF THE DATA IS CLAIMED OR IMPLIED.

FURTHERMORE, PLEASE NOTE THAT ADVANCEDMD IS PROVIDING THIS INFORMATION WITHIN ITS LIMITED LICENSE WITH THE AMERICAN MEDICAL ASSOCIATION (AMA) AND THAT ANY QUESTIONS PERTAINING TO LICENSE OR USE OF THE CPT MUST BE ADDRESSED TO THE AMA AS THE SCOPE OF ADVANCEDMD’S LICENSE IS DETERMINED BY THE AMA, THE COPYRIGHT HOLDER. CLIENTS DO NOT ACT FOR OR ON BEHALF OF ADVANCEDMD AND ADVANCEDMD SPECIFICALLY DISCLAIMS REASONABILITY FOR ANY LIABILITY ATTRIBUTABLE TO THE CLIENT’S USE OF THE CPT CODES. IN NO EVENT SHALL ADVANCEDMD BE LIABLE FOR DIRECT, INDIRECT, SPECIAL, INCIDENTAL, OR CONSEQUENTIAL DAMAGES ARISING OUT OF THE USE OF SUCH INFORMATION OR MATERIAL.

2024 – Evaluation & Management Code changes overview

Three major changes that are set to go into effect Jan. 1, 2024:

Time ranges removed from office visit codes. The codes’ time ranges will be replaced with threshold times, which will bring them in line with the rest of the level-based code.
Revised guidelines for split/shared visits. The changes will only apply to facility-based visits, The new guidelines will align with Medicare’s current definition of substantive portion and address split/shared visits based on time and medical decision-making (MDM).
More guidance for how to report same-day services and inpatient/observation services. The update will include a chart that clarifies how to report inpatient and observation stays based on the length of the stay.

Split or shared visits

The CPT guidelines adopt the concept of calculating the substantive portion to determine which team member reports the visit.

If a practice codes a visit based on time, the practitioner who spends the majority of the face-to-face or non-face-to-face time on the date of the encounter reports the service.

For example:

Physician A and Physician B are involved in the case. Physician A spent 40 minutes during encounter while physician B spent 10 minutes. In this case service will be reported by physician A as majority of the time is spent by physician A

Multiple Evaluation and Management Services on the Same Date

The following guidelines apply to services that a patient may receive for hospital inpatient care, observation care, or nursing facility care.

The guidelines for multiple E/M services on the same date address circumstances in which the patient has received multiple visits or services from the same physician or other QHP or another physician or other QHP of the exact same specialty and subspecialty who belongs to the same group practice.

Per day: When multiple visits occur over the course of a single calendar date in the same setting, a single service is reported.
Multiple encounters in different settings or facilities: Can bill one E/M service for each setting or facility.

Discharge services

Discharge services and services in other facilities: Each service may be reported separately as long as any time spent on the discharge service is not counted towards the total time of a subsequent service

Discharge services and services in the same facility: If the patient is discharged and readmitted to the same facility on the same calendar date, report a subsequent care service instead of a discharge or initial service. For the purpose of E/M reporting, this is a single stay.

Discharge services and services in a different facility: Discharge and initial services may be reported as long as time spent on the discharge service is not counted towards the total time of the subsequent service reported when code level selection is based on time.

Transitions between office or other outpatient, home or residence, or emergency department and hospital inpatient or observation or nursing facility: When the patient is admitted to the hospital as an inpatient or to observation status in the course of an encounter in

another site of service (eg, hospital emergency department, office, nursing facility), the services in the initial site may be separately reported by appending modifier 25.

Hospital inpatient or observation care services for 8-hour rule

Below guidelines are added for hospital inpatient or observation care services for 8-hour rule.

Length of Stay	Discharged On	Report Codes
<8 hours	Same calendar date as initial hospital inpatient or observation care service	99221, 99222, 99223
8 or more hours	Same calendar date as initial hospital inpatient or observation care service	99234, 99235, 99236
<8 hours	Different calendar date as initial hospital inpatient or observation care service	99221, 99222, 99223
8 or more hours	Different calendar date as initial hospital inpatient or observation care service	99221, 99222, 99223 and 99238, 99239

Below are the 2024 CPT code updates for Evaluation & Management. This list includes new CPT codes, revised codes and deleted codes.

New and revised CPT Codes for 2024

Code	Description

#+● 99459

Pelvic examination (List separately in addition to code for primary procedure)

★▲ 99202

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making.

When using total time on the date of the encounter for code selection, ~~15-29 minutes of total time is spent on the date of the encounter~~ minutes must be met or exceeded.

★▲ 99203

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making.

When using total time on the date of the encounter for code selection, ~~30-44 minutes of total time is spent on the date of the encounter~~ minutes must be met or exceeded.

★▲ 99204

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate medical decision making.

When using total time on the date of the encounter for code selection, ~~45-59 minutes of total time is spent on the date of the encounter~~ minutes must be met or exceeded.

★▲ 99205

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making.

When using total time on the date of the encounter for code selection, ~~60-74 minutes of total time is spent on the date of the encounter~~ minutes must be met or exceeded.

★▲ 99212

When using total time on the date of the encounter for code selection, ~~10-19 minutes of total time is spent on the date of the encounter~~ minutes must be met or exceeded.

★▲ 99213

When using total time on the date of the encounter for code selection, ~~20-29 minutes of total time is spent on the date of the encounter~~ minutes must be met or exceeded.

★▲ 99214

When using total time on the date of the encounter for code selection, 30-39 minutes of total time is spent on the date of the encounter minutes must be met or exceeded.

★▲ 99215

When using total time on the date of the encounter for code selection, ~~40-54 minutes of total time is spent on the date of the encounter~~ minutes must be met or exceeded.

▲ 99306

Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making.

When using total time on the date of the encounter for code selection, 4550 minutes must be met or exceeded.

★▲ 99308

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making.

When using total time on the date of the encounter for code selection, 1520 minutes must be met or exceeded.

New codes Revised codes

● = New Code

▲ = Revised Code

+ = Add on code

# = Resequenced code

★ = Telemed code

PSYCHIATRY SERVICES AND PROCEDURES CPT CODES DISCLAIMER

ADVANCEDMD IS PROVIDING THIS PSYCHIATRY SERVICES AND PROCEDURES CPT LIST OF CODES FOR 2024 “AS IS” WITHOUT WARRANTY OF ANY KIND, INCLUDING BUT NOT LIMITED TO ANY EXPRESSED OR IMPLIED WARRANTIES OR WARRANTIES FOR FITNESS FOR A PARTICULAR

PURPOSE OR MERCHANTABILITY. ADVANCEDMD DISCLAIMS RESPONSIBILITY FOR ANY ERRORS OR OMISSIONS CONTAINED WITHIN THE ADDED, REVISED AND DELETED CPT CODES LIST INCLUDING IN CONJUNCTION WITH ITS USE WITH ANY SOFTWARE AND/OR HARDWARE SYSTEM. ADVANCEDMD DISCLAIMS RESPONSIBILITY FOR ANY CONSEQUENCES OR LIABILITY WHICH MAY BE ATTRIBUTED TO OR RELATED IN ANY WAY TO THE USE, NON-USE OR INTERPRETATION OF THE INFORMATION PROVIDED OR NOT PROVIDED WITHIN THIS DOCUMENT. THE INFORMATION PROVIDED WITHIN THIS DOCUMENT IS SOLELY AS A SERVICE TO ADVANCEDMD CLIENTS AND IS NOT A GUARANTEE OF ANY TYPE AS TO THE ACCURACY OR COMPLETENESS OF THE INFORMATION. WE CANNOT GUARANTEE

THE ACCURACY OF THE INFORMATION PRINTED HEREIN AND ARE NOT RESPONSIBLE FOR CLAIMS OR LIABILITY THAT MAY RESULT FROM THE USE OF THIS INFORMATION.

ADVANCEDMD NEITHER REPRESENTS NOR GUARANTEES THAT ANY OF THE LIST OF CPT CODES INFORMATION CONTAINED HEREIN IS COMPLETE, ACCURATE OR APPLICABLE TO ANY SPECIFIC CLIENT OR THEIR PRACTICE OR PATIENT(S) AND ADVANCEDMD DISCLAIMS ALL LIABILITY FOR ANY CONSEQUENCES WHICH MAY RESULT FROM RELIANCE ON THE INFORMATION CONTAINED WITHIN THIS DOCUMENT. THIS INFORMATION IS NOT INTENDED TO BE NOR SHOULD BE CONSTRUED AS LEGAL ADVICE OR GUIDANCE IN ANY MANNER OR CAPACITY, CLIENTS ARE RESPONSIBLE FOR DETERMINING WHETHER THE INFORMATION CONTAINED WITHIN THIS DOCUMENT IS USEFUL

OR APPLICABLE FOR THEIR PURPOSES. THIS INFORMATION IS NOT INTENDED TO BE A FINAL OR EXHAUSTIVE LIST OF ADDED, REVISED AND DELETED CODES FOR 2024, THE CPT CODES ARE FREQUENTLY REVISED AND ADVANCEDMD DISCLAIMS ALL RESPONSIBILITY FOR ADDED, REVISED AND DELETED CODES WHICH ARE LATER ADDED, REVISED, MODIFIED OR DELETED AT ANY TIME; NO INDEPENDENT VERIFICATION OF THE DATA IS CLAIMED OR IMPLIED.

IN NO EVENT SHALL ADVANCEDMD BE LIABLE FOR DIRECT, INDIRECT, SPECIAL, INCIDENTAL, OR CONSEQUENTIAL DAMAGES ARISING OUT OF THE USE OF SUCH INFORMATION OR MATERIAL.

2024 Psychiatry Services & Procedures Code Updates

Psychiatry services

Psychiatry services include diagnostic services, psychotherapy, and other services to an individual, family, or group. Patient condition, characteristics, or situational factors may require services described as being with interactive complexity. Services may be provided to a patient in crisis. Services are provided in all settings of care and psychiatry services codes are reported without regard to setting. Services may be provided by a physician or other qualified health care professional. Some psychiatry services may be reported with evaluation and management services (99202-99255, 99281-99285, 99304-99316, 99341- 99350) or other services when performed. Evaluation and management services (99202-99285, 99304-99316, 99341-99350) may be reported for treatment of psychiatric conditions, rather than using psychiatry services codes, when appropriate.

Hospital inpatient or observation care in treating a psychiatric inpatient or partial hospitalization may be initial or subsequent in nature (see 99221-99233).

Some patients receive hospital evaluation and management services only and others receive hospital evaluation and management services and other procedures. If other procedures such as electroconvulsive therapy or psychotherapy are rendered in addition to hospital evaluation and management services, these may be listed separately (eg, hospital inpatient or observation care services [99221-99223, 99231-99233] plus electroconvulsive therapy [90870]), or when psychotherapy is done, with appropriate code(s) defining psychotherapy services.

Consultation for psychiatric evaluation

Consultation for psychiatric evaluation of a patient includes examination of a patient and exchange of information with the primary physician and other informants such as nurses or family members, and preparation of a report. These services may be reported using consultation codes (see Consultations).

(Do not report 90785-90899 in conjunction with 90839, 90840, 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T)

Interactive Complexity

Code 90785 is an add-on code for interactive complexity to be reported in conjunction with codes for diagnostic psychiatric evaluation (90791, 90792), psychotherapy (90832, 90833, 90834, 90836, 90837, 90838), and group psychotherapy (90853).

Interactive complexity refers to specific communication factors that complicate the delivery of a psychiatric procedure. Common factors include more difficult communication with discordant or emotional family members and engagement of young and verbally undeveloped or impaired patients. Typical patients are those who have third parties, such as parents, guardians, other family members, agencies, court officers, or schools involved in their psychiatric care.

Psychiatric Interactive complexity

Psychiatric procedures may be reported “with interactive complexity” when at least one of the following is present:

The need to manage maladaptive communication (related to, eg, high anxiety, high reactivity, repeated questions, or disagreement) among participants that complicates delivery of care.
Caregiver emotions or behavior that interferes with the caregiver’s understanding and ability to assist in the implementation of the treatment plan.
Evidence or disclosure of a sentinel event and mandated report to third party (eg, abuse or neglect with report to state agency) with initiation of discussion of the sentinel event and/or report with patient and other visit participants.
Use of play equipment or other physical devices to communicate with the patient to overcome barriers to therapeutic or diagnostic interaction between the physician or other qualified health care professional and a patient who has not developed, or has lost, either the expressive language communication skills to explain his/her symptoms and response to treatment, or the receptive communication skills to understand the physician or other qualified health care professional if he/she were to use typical language for communication.

Interactive complexity must be reported in conjunction with an appropriate psychiatric diagnostic evaluation or psychotherapy service, for the purpose of reporting increased complexity of the service due to specific communication factors which can result in barriers to diagnostic or therapeutic interaction with the patient.

When provided in conjunction with the psychotherapy services (90832-90838), the amount of time spent by a physician or other qualified health care professional providing interactive complexity services should be reflected in the timed service code for psychotherapy (90832, 90834, 90837) or the psychotherapy add-on code (90833, 90836, 90838) performed with an evaluation and management service and must relate to the psychotherapy service only. Interactive complexity is not a service associated with evaluation and management services when provided without psychotherapy.

★+ 90785

Interactive complexity (List separately in addition to the code for primary procedure)

CPT Changes: An Insider’s View 2013

CPT Assistant May 13:12, Jun 13:3, Apr 14:6, Nov 18:3, Jan 22:8

(Use 90785 in conjunction with codes for diagnostic psychiatric evaluation [90791, 90792], psychotherapy [90832, 90833, 90834,

90836, 90837, 90838], and group psychotherapy [90853])

(Use 90785 in conjunction with 90853 for the specified patient when group psychotherapy includes interactive complexity)

(Do not report 90785 in conjunction with psychological and neuropsychological testing [96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, 96146], or E/M services when no psychotherapy service is also reported)

(Do not report 90785 in conjunction with 90839, 90840, 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T)

Psychiatric Diagnostic Procedures

Psychiatric diagnostic evaluation is an integrated biopsychosocial assessment, including history, mental status, and recommendations. The evaluation may include communication with family or other sources and review and ordering of diagnostic studies.

Psychiatric diagnostic evaluation with medical services is an integrated biopsychosocial and medical assessment, including history, mental status, other physical examination elements as indicated, and recommendations. The evaluation may include communication with family or other sources, prescription of medications, and review and ordering of laboratory or other diagnostic studies.

In certain circumstances one or more other informants (family members, guardians, or significant others) may be seen in lieu of the patient. Codes 90791, 90792 may be reported more than once for the patient when separate diagnostic evaluations are conducted with the patient and other informants. Report services as being provided to the patient and not the informant or other party in such circumstances. Codes 90791, 90792 may be reported once per day and not on the same day as an evaluation and management service performed by the same individual for the same patient.

The psychiatric diagnostic evaluation may include interactive complexity services when factors exist that complicate the delivery of the psychiatric procedure. These services should be reported with add-on code 90785 used in conjunction with the diagnostic psychiatric evaluation codes 90791, 90792.

Codes 90791, 90792 are used for the diagnostic assessment(s) or reassessment(s), if required, and do not include psychotherapeutic services. Psychotherapy services, including for crisis, may not be reported on the same day.

(Do not report 90791-90899 in conjunction with 90839, 90840, 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T)

★ 90791

Psychiatric diagnostic evaluation

CPT Changes: An Insider’s View 2013, 2017

CPT Assistant May 13:12, Jun 13:3, Dec 13:18, Jun 14:3, Nov 17:3, Nov 18:3, Oct 20:15, Aug 22:13

★ 90792

Psychiatric diagnostic evaluation with medical services

CPT Changes: An Insider’s View 2013, 2017

CPT Assistant Jun 13:3, Dec 13:18, Jun 14:3, Nov 17:3, Nov 18:3, Dec 19:15, Oct 20:154

(Do not report 90791 or 90792 in conjunction with 99202-99316, 99341-99350, 99366-99368, 99401-99443, 97151, 97152, 97153,

97154, 97155, 97156, 97157, 97158, 0362T, 0373T)

(Use 90785 in conjunction with 90791, 90792 when the diagnostic evaluation includes interactive complexity services)

Psychotherapy

Psychotherapy is the treatment of mental illness and behavioral disturbances in which the physician or other qualified health care professional, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development.

The psychotherapy service codes 90832-90838 include ongoing assessment and adjustment of psychotherapeutic interventions, and may include involvement of informants in the treatment process.

Codes 90832, 90833, 90834, 90836, 90837, 90838 describe psychotherapy for the individual patient, although times are for face-to-face services with patient and may include informant(s). The patient must be present for all or a majority of the service.

See codes 90846, 90847 when utilizing family psychotherapy techniques, such as focusing on family dynamics. Do not report 90846, 90847 for family psychotherapy services less than 26 minutes. Codes 90832, 90833, 90834, 90836, 90837, 90838 may be reported on the same day as codes 90846, 90847, when the services are separate and distinct.

In reporting, choose the code closest to the actual time (ie, 16-37 minutes for 90832 and 90833, 38-52 minutes for 90834 and 90836, and 53 or more minutes for 90837 and 90838). Do not report psychotherapy of less than 16 minutes duration. (See instructions for the usage of time in the Introduction of the CPT code set.)

Psychotherapy provided to a patient in a crisis state is reported with codes 90839 and 90840 and cannot be reported in addition to the psychotherapy codes 90832-90838. For psychotherapy for crisis, see “Other Psychotherapy.”

Code 90785 is an add-on code to report interactive complexity services when provided in conjunction with the psychotherapy codes 90832-90838. For family psychotherapy, see 90846, 90847. The amount of time spent by a physician or other qualified health care professional providing interactive complexity services should be reflected in the timed service code for psychotherapy (90832, 90834, 90837) or the psychotherapy add-on code performed with an evaluation and management service (90833, 90836, 90838).

Some psychiatric patients receive a medical evaluation and management (E/M) service on the same day as a psychotherapy service by the same physician or other qualified health care professional. To report both E/M and psychotherapy, the two services must be significant and separately identifiable. These services are reported by using codes specific for psychotherapy when performed with evaluation and management services (90833, 90836, 90838) as add- on codes to the evaluation and management service.

Medical symptoms and disorders inform treatment choices of psychotherapeutic interventions, and data from therapeutic communication are used to evaluate the presence, type, and severity of medical symptoms and disorders. For the purposes of reporting, the medical and psychotherapeutic components of the service may be separately identified as follows:

The type and level of E/M service is selected based on medical decision making.
Time spent on the activities of the E/M service is not included in the time used for reporting the psychotherapy service. Time may not be used as the basis of E/M code selection and prolonged services may not be reported when psychotherapy with E/M (90833, 90836, 90838) are reported.
A separate diagnosis is not required for the reporting of E/M and psychotherapy on the same date of service.

★ 90832

Psychotherapy, 30 minutes with patient

CPT Changes: An Insider’s View 2013, 2017

CPT Assistant Jan 13:3, May 13:12, Jun 13:3, Aug 13:14, Feb 14:3, Aug 14:5, Oct 15:9, Dec 16:11, Sep 17:12, Nov 18:3, Dec 20:14, Apr 22:10

★+ 90833

Psychotherapy, 30 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure)

CPT Changes: An Insider’s View 2013, 2017

CPT Assistant Jan 13:3, May 13:12, Jun 13:3, Aug 13:14, Aug 14:5, Oct 15:9, Dec 16:11, Nov 18:3, Dec 20:14, Apr 22:10, Aug 22:19

(Use 90833 in conjunction with 99202-99255, 99304-99316, 99341-99350)

★ 90834

Psychotherapy, 45 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure)

CPT Changes: An Insider’s View 2013, 2017

CPT Assistant Jan 13:3, May 13:12, Jun 13:3, Aug 13:14, Oct 15:9, Dec 16:11, Nov 18:3, Dec 20:14, Apr 22:10, Aug 22:19

(Use 90836 in conjunction with 99202-99255, 99304-99316, 99341-99350)

★+ 90836

Psychotherapy, 45 minutes with patient

CPT Changes: An Insider’s View 2013, 2017

CPT Assistant Jun 13:3, Dec 13:18, Jun 14:3, Nov 17:3, Nov 18:3, Dec 19:15, Oct 20:154

(Do not report 90791 or 90792 in conjunction with 99202-99316, 99341-99350, 99366-99368, 99401-99443, 97151, 97152, 97153,

97154, 97155, 97156, 97157, 97158, 0362T, 0373T)

(Use 90785 in conjunction with 90791, 90792 when the diagnostic evaluation includes interactive complexity services)

★ 90837

Psychotherapy, 60 minutes with patient

CPT Changes: An Insider’s View 2013, 2017

CPT Assistant Jan 13:3, May 13:12, Jun 13:3, Aug 13:14, Apr 14:6, Oct 15:3, 9, Dec 16:11, Nov 18:3, Dec 20:14, Apr 22:10, Jan 23:33

★+ 90838

Psychotherapy, 60 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure)

CPT Changes: An Insider’s View 2013, 2017

CPT Assistant Jan 13:3, May 13:12, Jun 13:3, Aug 13:14, Feb 14:3, Apr 14:6, Oct 15:9, Dec 16:11, Nov 18:3, Dec 20:14, Apr 22:10, Aug 22:19

(Use 90838 in conjunction with 99202-99255, 99304-99316, 99341-99350)

(Use 90785 in conjunction with 90832, 90833, 90834, 90836, 90837, 90838 when psychotherapy includes interactive

complexity services)

Psychotherapy Crisis

Psychotherapy for crisis is an urgent assessment and history of a crisis state, a mental status exam, and a disposition. The treatment includes psychotherapy, mobilization of resources to defuse the crisis and restore safety, and implementation of psychotherapeutic interventions to minimize the potential for psychological trauma. The presenting problem is typically life threatening or complex and requires immediate attention to a patient in high distress.

Codes 90839, 90840 are used to report the total duration of time face-to-face with the patient and/or family spent by the physician or other qualified health care professional providing psychotherapy for crisis, even if the time spent on that date is not continuous. For any given period of time spent providing psychotherapy for crisis state, the physician or other qualified health care professional must devote his or her full attention to the patient and, therefore, cannot provide services to any other patient during the same time period. The patient must be present for all or some of the service. Do not report with 90791 or 90792.

Code 90839 is used to report the first 30-74 minutes of psychotherapy for crisis on a given date. It should be used only once per date even if the time spent by the physician or other health care professional is not continuous on that date. Psychotherapy for crisis of less than 30 minutes total duration on a given date should be reported with 90832 or 90833 (when provided with evaluation and management services).

Code 90840 is used to report additional block(s) of time, of up to 30 minutes each beyond the first 74 minutes

★ 90839

Psychotherapy for crisis; first 60 minutes

CPT Changes: An Insider’s View 2013

CPT Assistant Jun 13:3, Aug 14:5, Oct 15:9, Nov 18:3

★+ 90840

Psychotherapy for crisis; each additional 30 minutes (List separately in addition to code for primary service)

CPT Changes: An Insider’s View 2013

CPT Assistant Jun 13:3, Aug 14:5, Oct 15:9, Nov 18:3

(Use 90840 in conjunction with 90839)

(Do not report 90839, 90840 in conjunction with 90791, 90792, psychotherapy codes 90832-90838 or other psychiatric

services, or 90785-90899)

★ 90845

Psychoanalysis

CPT Changes: An Insider’s View 2017

CPT Assistant Summer 92:15, Nov 97:40-41, Mar 01:8, Mar 02:4, May 05:1, Feb 06:15, Mar 10:6, Oct 15:9, Nov 18:3

★ 90846

Family psychotherapy (without the patient present), 50 minutes

CPT Changes: An Insider’s View 2017

CPT Assistant Summer 92:15, Nov 97:40-41, Mar 01:8, Mar 02:4, May 05:1, Sep 09:11, Mar 10:6, Jun 13:3, Dec 13:18, Oct 15:9, Dec 16:11,

Mar 17:11, Nov 18:3

★ 90847

Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes

CPT Changes: An Insider’s View 2017

CPT Assistant Summer 92:15, Nov 97:40-41, Mar 01:5, Mar 02:4, May 05:1, Mar 10:6, Jun 13:3, Dec 13:18, Oct 15:9, Dec 16:11, Nov 18:3 (Do not report 90846, 90847 for family psychotherapy services less than 26 minutes)

(Do not report 90846, 90847 in conjunction with 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T)

90849

Multiple-family group psychotherapy

CPT Assistant Summer 92:15, Nov 97:40-41, Mar 01:5, Mar 02:4, May 05:1, Mar 10:6, Aug 14:15, Oct 15:9, Nov 18:3

90853

Group psychotherapy (other than of a multiple-family group)

CPT Assistant Summer 92:15, Nov 97:40-41, Mar 01:8, Mar 02:4, May 05:1, Mar 10:6, Jun 13:3, Jun 14:3, Aug 14:15, Oct 15:9, Mar 17:11,

Nov 18:3, Apr 22:10, Oct 22:7

(Use 90853 in conjunction with 90785 for the specified patient when group psychotherapy includes interactive complexity)

(Do not report 90853 in conjunction with 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T)

Other Psychotherapy Services or Procedures

For electronic analysis with programming, when performed, of vagal nerve neurostimulators, see 95970, 95976, 95977)

★+ 90863

Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services (List separately in addition to the code for primary procedure)

CPT Changes: An Insider’s View 2013, 2017 CPT Assistant Jun 13:3, Nov 18:3

(Use 90863 in conjunction with 90832, 90834, 90837)

(For pharmacologic management with psychotherapy services performed by a physician or other qualified health care professional who may report evaluation and management codes, use the appropriate evaluation and management codes 99202-99255, 99281- 99285, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99341-99350 and the appropriate psychotherapy with evaluation and

management service 90833, 90836, 90838)

(Do not count time spent on providing pharmacologic management services in the time used for selection of the psychotherapy service)

90865

Narcosynthesis for psychiatric diagnostic and therapeutic purposes (eg, sodium amobarbital (Amytal) interview)

CPT Changes: An Insider’s View 2017

CPT Assistant Summer 92:15, Nov 97:40-41, Mar 01:8, Mar 02:4, May 05:1, Sep 09:11, Mar 10:6, Jun 13:3, Dec 13:18, Oct 15:9, Dec 16:11,

Mar 17:11, Nov 18:3

90867

Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management

CPT Changes: An Insider’s View 2011, 2012 CPT Assistant Nov 18:3

(Report only once per course of treatment)

(Do not report 90867 in conjunction with 90868, 90869, 95860, 95870, 95928, 95929, 95939) (For peripheral nerve transcutaneous magnetic stimulation, see 0766T, 0767T)

90868

Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session

CPT Changes: An Insider’s View 2011, 2012 CPT Assistant Nov 18:3

90869

Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re- determination with delivery and management

CPT Changes: An Insider’s View 2012 CPT Assistant Nov 18:3

(Do not report 90869 in conjunction with 90867, 90868, 95860-95870, 95928, 95929, 95939)

(If a significant, separately identifiable evaluation and management, medication management, or psychotherapy service is performed, the appropriate E/M or psychotherapy code may be reported in addition to 90867-90869. Evaluation and management activities

directly related to cortical mapping, motor threshold determination, delivery and management of TMS are not separately reported)

90870

Electroconvulsive therapy (includes necessary monitoring)

CPT Changes: An Insider’s View 2006

CPT Assistant Summer 92:16, Mar 01:5, Mar 02:4, May 05:1, Mar 10:6, Feb 13:3, Nov 18:3

90875

Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); 30 minutes

CPT Changes: An Insider’s View 2013

CPT Assistant Nov 96:15, Sep 97:11, Nov 97:41, Apr 98:14, Jun 99:5, Mar 01:5, Mar 02:4, Mar 05:16, May 05:1, Nov 18:3

90876

CPT Changes: An Insider’s View 2013

90880

Hypnotherapy

CPT Assistant Summer 92:16, Nov 97:41, Mar 01:5, Mar 02:4, May 05:1, Nov 18:3

90882

Environmental intervention for medical management purposes on a psychiatric patient’s behalf with agencies, employers, or institutions

90885

Psychiatric evaluation of hospital records, other psychiatric reports, psychometric and/or projective tests, and other accumulated data for medical diagnostic purposes

90887

Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient

(Do not report 90887 in conjunction with 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T)

90889

Preparation of report of patient’s psychiatric status, history, treatment, or progress (other than for legal or consultative purposes) for other individuals, agencies, or insurance carriers

CPT Changes: An Insider’s View 2013

CPT Assistant Summer 92:17, Mar 01:5, Mar 02:4, May 05:1, Nov 18:3, Dec 22:18

90899

Unlisted psychiatric service or procedure

CPT Assistant Mar 01:5, Mar 02:4, May 05:1, Jan 10:11, Apr 14:6, Nov 18:3, Jan 22:8

+ = Add on code

★ = Telemed code

OCCUPATINAL THERAPY ADDED/REVISED/DELETED CPT CODES DISCLAIMER

ADVANCEDMD IS PROVIDING THIS OCCUPATIONAL THERAPY CPT LIST OF ADDED, REVISED AND DELETED CODES FOR 2024 “AS IS” WITHOUT WARRANTY OF ANY KIND, INCLUDING BUT NOT LIMITED TO ANY EXPRESSED OR IMPLIED WARRANTIES OR WARRANTIES FOR FITNESS FOR A PARTICULAR PURPOSE OR MERCHANTABILITY. ADVANCEDMD DISCLAIMS RESPONSIBILITY FOR ANY ERRORS OR OMISSIONS CONTAINED WITHIN THE ADDED, REVISED AND DELETED CPT CODES LIST INCLUDING

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IN NO EVENT SHALL ADVANCEDMD BE LIABLE FOR DIRECT, INDIRECT, SPECIAL, INCIDENTAL, OR CONSEQUENTIAL DAMAGES ARISING OUT OF THE USE OF SUCH INFORMATION OR MATERIAL.

OCCUPATINAL THERAPY ADDED/REVISED/DELETED CPT CODES DISCLAIMER

THE ACCURACY OF THE INFORMATION PRINTED HEREIN AND ARE NOT RESPONSIBLE FOR CLAIMS OR LIABILITY THAT MAY RESULT FROM THE USE OF THIS INFORMATION.

IN NO EVENT SHALL ADVANCEDMD BE LIABLE FOR DIRECT, INDIRECT, SPECIAL, INCIDENTAL, OR CONSEQUENTIAL DAMAGES ARISING OUT OF THE USE OF SUCH INFORMATION OR MATERIAL.

2024 Occupational Therapy Code Updates

Occupational Therapy Evaluations

Occupational therapy evaluations include an occupational profile, medical and therapy history, relevant assessments, and development of a plan of care, which reflects the therapist’s clinical reasoning and interpretation of the data.

Coordination, consultation, and collaboration of care with physicians, other qualified health care professionals, or agencies is provided consistent with the nature of the problem(s) and the needs of the patient, family and/or other caregivers.

At a minimum, each of the following components noted in the code descriptors must be documented, in order to report the selected level of occupational therapy evaluation.

Occupational therapy evaluations include the following components:

Occupational profile and client history (medical and therapy)
Assessments of occupational performance
Clinical decision making
Development of plan of care

Report 97168 for performance of a re-evaluation that is based on an established and ongoing plan of care.

Definitions

The level of the occupational therapy evaluation performed is determined by patient condition, complexity of clinical decision making, and the scope and nature of the patient’s performance deficits relating to physical, cognitive, or psychosocial skills to be assessed. The patient’s plan of treatment should reflect assessment of each of the identified performance deficits.

Occupational Therapy

Performance deficits: performance deficits refer to the inability to complete activities due to the lack of skills in one or more of the categories below (ie, relating to physical, cognitive, or psychosocial skills):

Physical skills: Physical skills refer to impairments of body structure or body function (eg, balance, mobility, strength, endurance, fine or gross motor coordination, sensation, dexterity).
Cognitive skills: Cognitive skills refer to the ability to attend, perceive, think, understand, problem solve, mentally sequence, learn, and remember resulting in the ability to organize occupational performance in a timely and safe manner. These skills are observed when: (1) a person attends to and selects, interacts with, and uses task tools and materials; (2) carries out individual actions and steps; and (3) modifies performance when problems are encountered.
Psychosocial skills: Psychosocial skills refer to interpersonal interactions, habits, routines and behaviors, active use of coping strategies, and/or environmental adaptations to develop skills necessary to successfully and appropriately participate in everyday tasks and social situations.

#★ 97165

Occupational therapy evaluation, low complexity, requiring these components:

An occupational profile and medical and therapy history, which includes a brief history including review of medical and/ or therapy records relating to the presenting problem;
An assessment(s) that identifies 1-3 performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and
Clinical decision making of low complexity, which includes an analysis of the occupational profile, analysis of data from problem-focused assessment(s), and consideration of a limited number of treatment options. Patient presents with no comorbidities that affect occupational performance. Modification of tasks or assistance (eg, physical or verbal) with assessment(s) is not necessary to enable completion of evaluation component.

Typically, 30 minutes are spent face-to-face with the patient and/or family.

#★ 97166

Occupational therapy evaluation, moderate complexity, requiring these components:

An occupational profile and medical and therapy history, which includes an expanded review of medical and/or therapy records and additional review of physical, cognitive, or psychosocial history related to current functional performance;
An assessment(s) that identifies 3-5 performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and
Clinical decision making of moderate analytic complexity, which includes an analysis of the occupational profile, analysis of data from detailed assessment(s), and consideration of several treatment options. Patient may present with

comorbidities that affect occupational performance. Minimal to moderate modification of tasks or assistance (eg, physical or verbal) with assessment(s) is necessary to enable patient to complete evaluation component.

Typically, 45 minutes are spent face-to-face with the patient and/or family.

Occupational Therapy (continued)

#★ 97167

Occupational therapy evaluation, high complexity, requiring these components:

An occupational profile and medical and therapy history, which includes review of medical and/or therapy records and extensive additional review of physical, cognitive, or psychosocial history related to current functional performance;
An assessment(s) that identifies 5 or more performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and
Clinical decision making of high analytic complexity, which includes an analysis of the patient profile, analysis of data from comprehensive assessment(s), and consideration of multiple treatment options. Patient presents with comorbidities that affect occupational performance. Significant modification of tasks or assistance (eg, physical or verbal) with assessment(s) is necessary to enable patient to complete evaluation component.

Typically, 60 minutes are spent face-to-face with the patient and/or family.

#★ 97168

Re-evaluation of occupational therapy established plan of care, requiring these components:

An assessment of changes in patient functional or medical status with revised plan of care;
An update to the initial occupational profile to reflect changes in condition or environment that affect future interventions and/or goals; and
A revised plan of care. A formal reevaluation is performed when there is a documented change in functional status or a significant change to the plan of care is required.

Typically, 30 minutes are spent face-to-face with the patient and/or family. CPT Changes: An Insider’s View 2017

CPT Assistant Feb 17:3, May 18:5

+ = Add on code

# = Resequenced code

★ = Telemed code

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2024 CPT/HCPCS Codebook

eGuide

BONUS: ICD-10 Codes for 2024

Time ranges removed from office visit codes. The codes’ time ranges will be replaced with threshold times, which will bring them in line with the rest of the level-based code.

Revised guidelines for split/shared visits. The changes will only apply to facility-based visits, The new guidelines will align with Medicare’s current definition of substantive portion and address split/shared visits based on time and medical decision-making (MDM).

More guidance for how to report same-day services and inpatient/observation services. The update will include a chart that clarifies how to report inpatient and observation stays based on the length of the stay.

For example:

Per day: When multiple visits occur over the course of a single calendar date in the same setting, a single service is reported.

Multiple encounters in different settings or facilities: Can bill one E/M service for each setting or facility.

Discharge services and services in other facilities: Each service may be reported separately as long as any time spent on the discharge service is not counted towards the total time of a subsequent service

Discharge services and services in the same facility: If the patient is discharged and readmitted to the same facility on the same calendar date, report a subsequent care service instead of a discharge or initial service. For the purpose of E/M reporting, this is a single stay.

Discharge services and services in a different facility: Discharge and initial services may be reported as long as time spent on the discharge service is not counted towards the total time of the subsequent service reported when code level selection is based on time.

Transitions between office or other outpatient, home or residence, or emergency department and hospital inpatient or observation or nursing facility: When the patient is admitted to the hospital as an inpatient or to observation status in the course of an encounter in

Interactive Complexity

Psychiatric procedures may be reported “with interactive complexity” when at least one of the following is present:

Definitions

Physical skills: Physical skills refer to impairments of body structure or body function (eg, balance, mobility, strength, endurance, fine or gross motor coordination, sensation, dexterity).

Psychosocial skills: Psychosocial skills refer to interpersonal interactions, habits, routines and behaviors, active use of coping strategies, and/or environmental adaptations to develop skills necessary to successfully and appropriately participate in everyday tasks and social situations.

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