HCPCS 2013 Code Changes
Oncology
| New | ||
| Code | Description | |
| G8928 | Adjuvant chemotherapy not prescribed or previously received, reason given | |
| G8929 | Adjuvant chemotherapy not prescribed or previously received, reason not given | |
| G8938 | Bmi is calculated, but patient not eligible for follow-up plan | |
| G8944 | Ajcc melanoma cancer stage 0 through iic melanoma | |
| G8946 | Minimally invasive biopsy method attempted but not diagnostic of breast cancer (e. G. , high risk lesion of breast such as atypical ductal hyperplasia, lobular neoplasia, atypical lobular carcinoma in situ, atypical columnar hyperplasica, flat epithelial atypia, radial scar, complex sclerosing lesion, papillary lesion, or any lesion with spindle cells) | |
| G8953 | All quality actions for the applicable measures in the oncology measures group have been performed for this patient | |
| G8973 | Most recent hemoglobin (hgb) level < 10 g/dl | |
| G8974 | Hemoglobin level measurement not documented, reason not given | |
| G8975 | Documentation of medical reason(s) for patient having a hemoglobin level < 10 g/dl (e. G. , patients who have non-renal etiologies of anemia [e. G. , sickle cell anemia or other hemoglobinopathies, hypersplenism, primary bone marrow disease, anemia related to chemotherapy for diagnosis of malignancy, postoperative bleeding, active bloodstream or peritoneal infection], other medical reasons) | |
| G8976 | Most recent hemoglobin (hgb) level >= 10 g/dl | |
| G8977 | I intend to report the oncology measures group | |
| J1741 | Injection, ibuprofen, 100 mg | |
| J2212 | Injection, methylnaltrexone, 0. 1 mg | |
| J7178 | Injection, human fibrinogen concentrate, 1 mg | |
| J7315 | Mitomycin, opthalmic, 0. 2 mg | |
| J7527 | Everolimus, oral, 0. 25 mg | |
| J9002 | Injection, doxorubicin hydrochloride, liposomal, doxil, 10 mg | |
| J9019 | Injection, asparaginase (erwinaze), 1,000 iu | |
| J9042 | Injection, brentuximab vedotin, 1 mg | |
| G9217 | Pcp prophylaxis was not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3, reason not given | |
| C9136 | Injection, factor viii, fc fusion protein, (recombinant), per i.u. | |
| G9364 | Sinusitis caused by, or presumed to be caused by, bacterial infection | |
| J7181 | Injection, factor xiii a-subunit, (recombinant), per iu | |
| J7182 | Injection, factor viii, (antihemophilic factor, recombinant), (novoeight), per iu | |
| J7200 | Injection, factor ix, (antihemophilic factor, recombinant), rixubis, per iu | |
| C2645 | Brachytherapy planar source, Palladium-103, per square millimeter | |
| G0296 | Counseling visit to discuss need for lung cancer screening (LDCT) using low dose CT scan (service is for eligibility determination and shared decision making) | |
| G0297 | Low dose CT scan (LDCT) for lung cancer screening | |
| G0476 | Infectious agent detection by nucleic acid (DNA or RNA); human papillomavirus (HPV), high-risk types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test | |
| G9496 | Documentation of reason for not detecting adenoma(s) or other neoplasm. (e.g., neoplasm detected is only diagnosed as traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma | |
| G9549 | Documentation of medical reason(s) that follow-up imaging is not indicated (e.g., patient has a known malignancy that can metastasize, other medical reason(s) | |
| G9619 | Documentation of reason(s) for not screening for uterine malignancy (e.g., prior hysterectomy) | |
| J0202 | Injection, alemtuzumab, 1 mg | |
| J1447 | Injection, tbo-filgrastim, 1 microgram | |
| J8655 | Netupitant 300 mg and palonosetron 0.5 mg | |
| J9032 | Injection, belinostat, 10 mg | |
| J9039 | Injection, blinatumomab, 1 microgram | |
| J9271 | Injection, pembrolizumab, 1 mg | |
| J9299 | Injection, nivolumab, 1 mg | |
| J9308 | Injection, ramucirumab, 5 mg | |
| Q5101 | Injection, filgrastim (G-CSF), biosimilar, 1 microgram | |
| G9678 | Oncology care model (ocm) monthly enhanced oncology services (meos) payment for ocm enhanced services. g9678 payments may only be made to ocm practitioners for ocm beneficiaries for the furnishment of enhanced services as defined in the ocm participation agreement | |
| G9704 | Ajcc breast cancer stage i: t1 mic or t1a documented | |
| G9705 | Ajcc breast cancer stage i: t1b (tumor > 0.5 cm but <= 1 cm in greatest dimension) documented | |
| G9706 | Low (or very low) risk of recurrence, prostate cancer | |
| G9755 | Documentation of medical reason(s) that follow-up imaging is indicated (e.g., patient has a known malignancy that can metastasize, other medical reason(s) | |
| G9762 | Patient had at least three hpv vaccines on or between the patient's 9th and 13th birthdays | |
| G9763 | Patient did not have at least three hpv vaccines on or between the patient's 9th and 13th birthdays | |
| G9826 | Patient transferred to practice after initiation of chemotherapy | |
| G9827 | Her2-targeted therapies not administered during the initial course of treatment | |
| G9828 | Her2-targeted therapies administered during the initial course of treatment | |
| G9829 | Breast adjuvant chemotherapy administered | |
| G9830 | Her-2/neu positive | |
| G9831 | Ajcc stage at breast cancer diagnosis = ii or iii | |
| G9832 | Ajcc stage at breast cancer diagnosis = i (ia or ib) and t-stage at breast cancer diagnosis does not equal = t1, t1a, t1b | |
| G9833 | Patient transfer to practice after initiation of chemotherapy | |
| G9834 | Patient has metastatic disease at diagnosis | |
| G9835 | Trastuzumab administered within 12 months of diagnosis | |
| G9836 | Reason for not administering trastuzumab documented (e.g. patient declined, patient died, patient transferred, contraindication or other clinical exclusion, neoadjuvant chemotherapy or radiation not complete) | |
| G9837 | Trastuzumab not administered within 12 months of diagnosis | |
| G9838 | Patient has metastatic disease at diagnosis | |
| G9839 | Anti-egfr monoclonal antibody therapy | |
| G9840 | Kras gene mutation testing performed before initiation of anti-egfr moab | |
| G9841 | Kras gene mutation testing not performed before initiation of anti-egfr moab | |
| G9842 | Patient has metastatic disease at diagnosis | |
| G9843 | Kras gene mutation | |
| G9844 | Patient did not receive anti-egfr monoclonal antibody therapy | |
| G9845 | Patient received anti-egfr monoclonal antibody therapy | |
| G9847 | Patient received chemotherapy in the last 14 days of life | |
| G9848 | Patient did not receive chemotherapy in the last 14 days of life | |
| G9859 | Patients who died from cancer | |
| J8670 | Rolapitant, oral, 1 mg | |
| J9034 | Injection, bendamustine hcl (bendeka), 1 mg | |
| J9145 | Injection, daratumumab, 10 mg | |
| J9176 | Injection, elotuzumab, 1 mg | |
| J9205 | Injection, irinotecan liposome, 1 mg | |
| J9295 | Injection, necitumumab, 1 mg | |
| J9325 | Injection, talimogene laherparepvec, per 1 million plaque forming units | |
| J9352 | Injection, trabectedin, 0.1 mg | |
| C9024 | Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine | |
| C9028 | Injection, inotuzumab ozogamicin, 0.1 mg | |
| G9912 | Hepatitis b virus (hbv) status assessed and results interpreted prior to initiating anti-tnf (tumor necrosis factor) therapy | |
| G9913 | Hepatitis b virus (hbv) status not assessed and results interpreted prior to initiating anti-tnf (tumor necrosis factor) therapy, reason not given | |
| G9914 | Patient receiving an anti-tnf agent | |
| G9915 | No record of hbv results documented | |
| G9934 | Documentation that neoplasm detected is only diagnosed as traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma | |
| J7345 | Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg | |
| J9022 | Injection, atezolizumab, 10 mg | |
| J9023 | Injection, avelumab, 10 mg | |
| J9203 | Injection, gemtuzumab ozogamicin, 0.1 mg | |
| J9285 | Injection, olaratumab, 10 mg | |
| Q2040 | Tisagenlecleucel, up to 250 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per infusion | |
| Revised | |
| Code | Descriptor |
| J1561 | Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e. G. Liquid), 500 mg |
| J1569 | Injection, immune globulin, (gammagard liquid), non-lyophilized, (e. G. Liquid), 500 mg |
| J9020 | Injection, asparaginase, not otherwise specified, 10,000 units |
| J9280 | Injection, mitomycin, 5 mg |
| G8928 | Adjuvant chemotherapy not prescribed or previously received for documented reasons (e.g., medical co-morbidities, diagnosis date more than 5 years prior to the current visit date, patient's cancer has metastasized, medical contraindication/allergy, poor performance status, other medical reasons, patient refusal, other patient reasons, patient is currently enrolled in a clinical trial that precludes prescription of chemotherapy, other system reasons) |
| G8929 | Adjuvant chemotherapy not prescribed or previously received, reason not specified |
| G0204 | Diagnostic mammography, producing direct 2-d digital image, bilateral, all views |
| G0206 | Diagnostic mammography, producing direct 2-d digital image, unilateral, all views |
| G8928 | Adjuvant chemotherapy not prescribed or previously received, for documented reasons (e.g., medical co-morbidities, diagnosis date more than 5 years prior to the current visit date, patient's diagnosis date is within 120 days of the end of the 12 month reporting period, patient's cancer has metastasized, medical contraindication/allergy, poor performance status, other medical reasons, patient refusal, other patient reasons, patient is currently enrolled in a clinical trial that precludes prescription of chemotherapy, other system reasons) |
| G8929 | Adjuvant chemotherapy not prescribed or previously received, reason not given |
| G9419 | Documentation of medical reason(s) for not including the histological type or NSCLC-NOS classification with an explanation (e.g., biopsy taken for other purposes in a patient with a history of primary non-small cell lung cancer or other documented medical reasons) |
| G9429 | Documentation of medical reason(s) for not including Pt category and a statement on thickness and ulceration and for pT1, mitotic rate (e.g., negative skin biopsies in a patient with a history of melanoma or other documented medical reasons) |
| J1442 | Injection, filgrastim (G-CSF), excludes biosimilars, 1 microgram |
| G0202 | Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (cad) when performed |
| G0204 | Diagnostic mammography, including computer-aided detection (cad) when performed; bilateral |
| G0206 | Diagnostic mammography, including computer-aided detection (cad) when performed; unilateral |
| G9549 | Documentation of medical reason(s) that follow-up imaging is indicated (e.g., patient has a known malignancy that can metastasize, other medical reason(s) such as fever in an immunocompromised patient) |
| J9033 | Injection, bendamustine hcl (treanda), 1 mg |
| G8869 | Patient has documented immunity to hepatitis b and initiating anti-tnf therapy |
| G8880 | Documentation of reason(s) sentinel lymph node biopsy not performed (e.g., reasons could include but not limited to; non-invasive cancer, incidental discovery of breast cancer on prophylactic mastectomy, incidental discovery of breast cancer on reduction mammoplasty, pre-operative biopsy proven lymph node (ln) metastases, inflammatory carcinoma, stage 3 locally advanced cancer, recurrent invasive breast cancer, clinically node positive after neoadjuvant systemic therapy, patient refusal after informed consent) |
| G9504 | Documented reason for not assessing hepatitis b virus (hbv) status (e.g., patient not initiating anti-tnf therapy, patient declined) prior to initiating anti-tnf therapy |
| G9785 | Pathology report diagnosing cutaneous basal cell carcinoma or squamous cell carcinoma (to include in situ disease) sent from the pathologist/dermatopathologist to the biopsying clinician for review within 7 days from the time when the tissue specimen was received by the pathologist |
| G9786 | Pathology report diagnosing cutaneous basal cell carcinoma or squamous cell carcinoma (to include in situ disease) was not sent from the pathologist/dermatopathologist to the biopsying clinician for review within 7 days from the time when the tissue specimen was received by the pathologist |
| G9840 | Ras (kras and nras) gene mutation testing performed before initiation of anti-egfr moab |
| G9841 | Ras (kras and nras) gene mutation testing not performed before initiation of anti-egfr moab |
| G9843 | Ras (kras or nras) gene mutation |
| Deleted | |
| Code | Descriptor |
| C9279 | Injection, ibuprofen, 100 mg |
| C9287 | Injection, brentuximab vedotin, 1 mg |
| J1680 | Injection, human fibrinogen concentrate, 100 mg |
| J8561 | Everolimus, oral, 0. 25 mg |
| J9001 | Injection, doxorubicin hydrochloride, all lipid formulations, 10 mg |
| Q2045 | Injection, human fibrinogen concentrate, 1 mg |
| Q2048 | Injection, doxorubicin hydrochloride, liposomal, doxil, 10 mg |
| C9021 | Injection, obinutuzumab, 10 mg |
| C9133 | Factor ix (antihemophilic factor, recombinant), rixubis, per i.u. |
| C9134 | Factor xiii (antihemophilic factor, recombinant), tretten, per 10 i.u. |
| C9135 | Factor ix (antihemophilic factor, recombinant), alprolix, per i.u. |
| C9025 | Injection, ramucirumab, 5 mg |
| C9027 | Injection, pembrolizumab, 1 mg |
| C9442 | Injection, belinostat, 10 mg |
| C9448 | Netupitant 300 mg and palonosetron 0.5 mg, oral |
| C9449 | Injection, blinatumomab, 1 mcg |
| C9453 | Injection, nivolumab, 1 mg |
| G9320 | Documentation of medical reason(s) for not naming CT studies according to a standardized nomenclature provided (e.g., CT studies performed for radiation treatment planning or image-guided radiation treatment delivery) |
| G9323 | Documentation of medical reason(s) for not counting previous ct and cardiac nuclear medicine (myocardial perfusion) studies (e.g., CT studies performed for radiation treatment planning or image-guided radiation treatment delivery) |
| G9325 | CT studies not reported to a radiation dose index registry due to medical reasons (e.g., CT studies performed for radiation treatment planning or image-guided radiation treatment delivery) |
| G9328 | Dicom format image data availability not documented in final report due to medical reasons (e.g., CT studies performed for radiation treatment planning or image-guided radiation treatment delivery) |
| G9343 | Due to medical reasons, search not conducted for dicom format images for ?prior patient CT imaging studies completed at non-affiliated external healthcare facilities or entities within the past 12 months that are available through a secure, authorized, media-free, shared archive (e.g., CT?studies performed for radiation treatment planning or image-guided radiation treatment delivery) |
| G9346 | Follow-up recommendations not documented according to recommended guidelines for incidentally detected puc nodules due to medical reasons (e.g., patients with known malignant disease, patients with unexplained fever, CT studies performed for radiation treatment planning or image-guided radiation treatment delivery) |
| J1446 | Injection, TBO-filgrastim, ?5 micrograms |
| Q9978 | Netupitant 300 mg and palonosetron 0.5 mg |
| S3721 | Prostate cancer antigen 3 (PCA3) testing |
| S3854 | Gene expression profiling panel for use in the management of breast cancer treatment |
| S3890 | DNA analysis, fecal, for colorectal cancer screening |
| A9544 | Iodine i-131 tositumomab, diagnostic, per study dose |
| A9545 | Iodine i-131 tositumomab, therapeutic, per treatment dose |
| C9476 | Injection, daratumumab, 10 mg |
| C9477 | Injection, elotuzumab, 1 mg |
| C9480 | Injection, trabectedin, 0.1 mg |
| G3001 | Administration and supply of tositumomab, 450 mg |
| G8928 | Adjuvant chemotherapy not prescribed or previously received, for documented reasons (e.g., medical co-morbidities, diagnosis date more than 5 years prior to the current visit date, patient's diagnosis date is within 120 days of the end of the 12 month reporting period, patient's cancer has metastasized, medical contraindication/allergy, poor performance status, other medical reasons, patient refusal, other patient reasons, patient is currently enrolled in a clinical trial that precludes prescription of chemotherapy, other system reasons) |
| G8929 | Adjuvant chemotherapy not prescribed or previously received, reason not given |
| G8953 | All quality actions for the applicable measures in the oncology measures group have been performed for this patient |
| G8977 | I intend to report the oncology measures group |
| G9217 | Pcp prophylaxis was not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3, reason not given |
| G9619 | Documentation of reason(s) for not screening for uterine malignancy (e.g., prior hysterectomy) |
| C9483 | Injection, atezolizumab, 10 mg |
| G0202 | Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (cad) when performed |
| G0204 | Diagnostic mammography, including computer-aided detection (cad) when performed; bilateral |
| G0206 | Diagnostic mammography, including computer-aided detection (cad) when performed; unilateral |
| G8879 | Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer |
| G9496 | Documentation of reason for not detecting adenoma(s) or other neoplasm. (e.g., neoplasm detected is only diagnosed as traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma |
| J9300 | Injection, gemtuzumab ozogamicin, 5 mg |