CPT Changes - New CPT Codes '2022

Glimpses of CPT Codes Updates - Effective from January 1st 2022

There are more than 400 codes are changes in 2022 from AMA. Total number codes are changed 405 and including of followings,

1. New Codes - 249 
2. Revised Codes - 93 
3. Deleted Codes - 63

More than 40% of the editorial changes are tried to new technology services described in Category III CPT codes and the continued expansion of the proprietary laboratory analyses section of the CPT code set.

Five new CPT codes are created for therapeutic remote monitoring codes 98975, 98976, 98977, 98980 and 98981 to increasingly important avenue of patient care especially during the COVID-19 pandemic.

Five new CPT codes are created for complex care management codes 99424, 99425, 99426, 99427 and 99437 and there are some changes in chronic care management CPT codes as well.

Six new CPT codes are created for Cardiac Catheterization codes 93593, 93594, 93595, 93596, 93597 and 93598 for congenital heart defects. Also, there are some changes in electrophysiology ablations CPT codes.

And major CPT codes are added in laboratory section. 

CPT Code CPT Code Description

01937 Anesthesia for percutaneous image-guided injection, drainage or aspiration procedures on the spine or spinal cord; cervical or thoracic

01938 Anesthesia for percutaneous image-guided injection, drainage or aspiration procedures on the spine or spinal cord; lumbar or sacral

01939 Anesthesia for percutaneous image-guided destruction procedures by neurolytic agent on the spine or spinal cord; cervical or thoracic

01940 Anesthesia for percutaneous image-guided destruction procedures by neurolytic agent on the spine or spinal cord; lumbar or sacral

01941 Anesthesia for percutaneous image-guided neuromodulation or intravertebral procedures (eg, kyphoplasty, vertebroplasty) on the spine or spinal cord; cervical or thoracic

01942 Anesthesia for percutaneous image-guided neuromodulation or intravertebral procedures (eg, kyphoplasty, vertebroplasty) on the spine or spinal cord; lumbar or sacral

0285U Oncology, response to radiation, cell-free DNA, quantitative branched chain DNA amplification, plasma, reported as a radiation toxicity score

0286U CEP72 (centrosomal protein, 72-KDa), NUDT15 (nudix hydrolase 15) and TPMT (thiopurine S-methyltransferase) (eg, drug metabolism) gene analysis, common variants

0287U Oncology (thyroid), DNA and mRNA, next generation sequencing analysis of 112 genes, fine needle aspirate or formalin fixed paraffin-embedded (FFPE) tissue, algorithmic prediction of cancer recurrence, reported as a categorical risk result (low, intermediate, high)

0288U Oncology (lung), mRNA, quantitative PCR analysis of 11 genes (BAG1, BRCA1, CDC6, CDK2AP1, ERBB3, FUT3, IL11, LCK, RND3, SH3BGR, WNT3A) and 3 reference genes (ESD, TBP, YAP1), formalin-fixed paraffin-embedded (FFPE) tumor tissue, algorithmic interpretation reported as a recurrence risk score

0289U Neurology (Alzheimer disease), mRNA, gene expression profiling by RNA sequencing of 24 genes, whole blood, algorithm reported as predictive risk score

0290U Pain management, mRNA, gene expression profiling by RNA sequencing of 36 genes, whole blood, algorithm reported as predictive risk score

0291U Psychiatry (mood disorders), mRNA, gene expression profiling by RNA sequencing of 144 genes, whole blood, algorithm reported as predictive risk score

0292U Psychiatry (stress disorders), mRNA, gene expression profiling by RNA sequencing of 72 genes, whole blood, algorithm reported as predictive risk score

0293U Psychiatry (suicidal ideation), mRNA, gene expression profiling by RNA sequencing of 54 genes, whole blood, algorithm reported as predictive risk score

0294U Longevity and mortality risk, mRNA, gene expression profiling by RNA sequencing of 18 genes, whole blood, algorithm reported as predictive risk score

0295U Oncology (breast ductal carcinoma in situ), protein expression profiling by immunohistochemistry of 7 proteins (COX2, FOXA1, HER2, Ki-67, p16, PR, SIAH2), with 4 clinicopathologic factors (size, age, margin status, palpability), utilizing formalin-fixed paraffin-embedded (FFPE) tissue, algorithm reported as a recurrence risk score

0296U Oncology (oral and/or oropharyngeal cancer), gene expression profiling by RNA sequencing at least 20 molecular features (eg, human and/or microbial mRNA), saliva, algorithm reported as positive or negative for signature associated with malignancy

0297U Oncology (pan tumor), whole genome sequencing of paired malignant and normal DNA specimens, fresh or formalin-fixed paraffin-embedded (FFPE) tissue, blood or bone marrow, comparative sequence analyses and variant identification

0298U Oncology (pan tumor), whole transcriptome sequencing of paired malignant and normal RNA specimens, fresh or formalin-fixed paraffin-embedded (FFPE) tissue, blood or bone marrow, comparative sequence analyses and expression level and chimeric transcript identification

0299U Oncology (pan tumor), whole genome optical genome mapping of paired malignant and normal DNA specimens, fresh frozen tissue, blood, or bone marrow, comparative structural variant identification

0300U Oncology (pan tumor), whole genome sequencing and optical genome mapping of paired malignant and normal DNA specimens, fresh tissue, blood, or bone marrow, comparative sequence analyses and variant identification

0301U Infectious agent detection by nucleic acid (DNA or RNA), Bartonella henselae and Bartonella quintana, droplet digital PCR (ddPCR);

0302U Infectious agent detection by nucleic acid (DNA or RNA), Bartonella henselae and Bartonella quintana, droplet digital PCR (ddPCR); following liquid enrichment

0303U Hematology, red blood cell (RBC) adhesion to endothelial/subendothelial adhesion molecules, functional assessment, whole blood, with algorithmic analysis and result reported as an RBC adhesion index; hypoxic

0304U Hematology, red blood cell (RBC) adhesion to endothelial/subendothelial adhesion molecules, functional assessment, whole blood, with algorithmic analysis and result reported as an RBC adhesion index; normoxic

0305U Hematology, red blood cell (RBC) functionality and deformity as a function of shear stress, whole blood, reported as a maximum elongation index

0671T Insertion of anterior segment aqueous drainage device into the trabecular meshwork, without external reservoir, and without concomitant cataract removal, one or more

0672T Endovaginal cryogen-cooled, monopolar radiofrequency remodeling of the tissues surrounding the female bladder neck and proximal urethra for urinary incontinence

0673T Ablation, benign thyroid nodule(s), percutaneous, laser, including imaging guidance

0674T Laparoscopic insertion of new or replacement of permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function, including an implantable pulse generator and diaphragmatic lead(s)

0675T Laparoscopic insertion of new or replacement of diaphragmatic lead(s), permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function, including connection to an existing pulse generator; first lead

0676T Laparoscopic insertion of new or replacement of diaphragmatic lead(s), permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function, including connection to an existing pulse generator; each additional lead (List separately in addition to code for primary procedure)

0677T Laparoscopic repositioning of diaphragmatic lead(s), permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function, including connection to an existing pulse generator; first repositioned lead

0678T Laparoscopic repositioning of diaphragmatic lead(s), permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function, including connection to an existing pulse generator; each additional repositioned lead (List separately in addition to code for primary procedure)

0679T Laparoscopic removal of diaphragmatic lead(s), permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function

0680T Insertion or replacement of pulse generator only, permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function, with connection to existing lead(s)

0681T Relocation of pulse generator only, permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function, with connection to existing dual leads

0682T Removal of pulse generator only, permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function

0683T 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, permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function

0684T Peri-procedural device evaluation (in-person) and programming of device system parameters before or after a surgery, procedure, or test with analysis, review, and report by a physician or other qualified health care professional, permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function

0685T Interrogation device evaluation (in-person) with analysis, review and report by a physician or other qualified health care professional, including connection, recording and disconnection per patient encounter, permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function

0686T Histotripsy (ie, non-thermal ablation via acoustic energy delivery) of malignant hepatocellular tissue, including image guidance

0687T Treatment of amblyopia using an online digital program; device supply, educational set-up, and initial session

0688T Treatment of amblyopia using an online digital program; assessment of patient performance and program data by physician or other qualified health care professional, with report, per calendar month

0689T Quantitative ultrasound tissue characterization (non-elastographic), including interpretation and report, obtained without diagnostic ultrasound examination of the same anatomy (eg, organ, gland, tissue, target structure)

0690T Quantitative ultrasound tissue characterization (non-elastographic), including interpretation and report, obtained with diagnostic ultrasound examination of the same anatomy (eg, organ, gland, tissue, target structure) (List separately in addition to code for primary procedure)

0691T Automated analysis of an existing computed tomography study for vertebral fracture(s), including assessment of bone density when performed, data preparation, interpretation, and report

0692T Therapeutic ultrafiltration

0693T Comprehensive full body computer-based markerless 3D kinematic and kinetic motion analysis and report

0694T 3-dimensional volumetric imaging and reconstruction of breast or axillary lymph node tissue, each excised specimen, 3-dimensional automatic specimen reorientation, interpretation and report, real-time intraoperative

0695T Body surface–activation mapping of pacemaker or pacing cardioverter-defibrillator lead(s) to optimize electrical synchrony, cardiac resynchronization therapy device, including connection, recording, disconnection, review, and report; at time of implant or replacement

0696T Body surface–activation mapping of pacemaker or pacing cardioverter-defibrillator lead(s) to optimize electrical synchrony, cardiac resynchronization therapy device, including connection, recording, disconnection, review, and report; at time of follow-up interrogation or programming device evaluation

0697T Quantitative magnetic resonance for analysis of tissue composition (eg, fat, iron, water content), including multiparametric data acquisition, data preparation and transmission, interpretation and report, obtained without diagnostic MRI examination of the same anatomy (eg, organ, gland, tissue, target structure) during the same session; multiple organs

0698T Quantitative magnetic resonance for analysis of tissue composition (eg, fat, iron, water content), including multiparametric data acquisition, data preparation and transmission, interpretation and report, obtained with diagnostic MRI examination of the same anatomy (eg, organ, gland, tissue, target structure); multiple organs (List separately in addition to code for primary procedure)

0699T Injection, posterior chamber of eye, medication

0700T Molecular fluorescent imaging of suspicious nevus; first lesion

0701T Molecular fluorescent imaging of suspicious nevus; each additional lesion (List separately in addition to code for primary procedure)

0702T Remote therapeutic monitoring of a standardized online digital cognitive behavioral therapy program ordered by a physician or other qualified health care professional; supply and technical support, per 30 days

0703T Remote therapeutic monitoring of a standardized online digital cognitive behavioral therapy program ordered by a physician or other qualified health care professional; management services by physician or other qualified health care professional, per calendar month

0704T Remote treatment of amblyopia using an eye tracking device; device supply with initial set-up and patient education on use of equipment

0705T Remote treatment of amblyopia using an eye tracking device; surveillance center technical support including data transmission with analysis, with a minimum of 18 training hours, each 30 days

0706T Remote treatment of amblyopia using an eye tracking device; interpretation and report by physician or other qualified health care professional, per calendar month

0707T Injection(s), bone-substitute material (eg, calcium phosphate) into subchondral bone defect (ie, bone marrow lesion, bone bruise, stress injury, microtrabecular fracture), including imaging guidance and arthroscopic assistance for joint visualization

0708T Intradermal cancer immunotherapy; preparation and initial injection

0709T Intradermal cancer immunotherapy; each additional injection (List separately in addition to code for primary procedure)

0710T Noninvasive arterial plaque analysis using software processing of data from non-coronary computerized tomography angiography; including data preparation and transmission, quantification of the structure and composition of the vessel wall and assessment for lipid-rich necrotic core plaque to assess atherosclerotic plaque stability, data review, interpretation and report

0711T Noninvasive arterial plaque analysis using software processing of data from non-coronary computerized tomography angiography; data preparation and transmission

0712T Noninvasive arterial plaque analysis using software processing of data from non-coronary computerized tomography angiography; quantification of the structure and composition of the vessel wall and assessment for lipid-rich necrotic core plaque to assess atherosclerotic plaque stability

0713T Noninvasive arterial plaque analysis using software processing of data from non-coronary computerized tomography angiography; data review, interpretation and report

33267 Exclusion of left atrial appendage, open, any method (eg, excision, isolation via stapling, oversewing, ligation, plication, clip)

33268 Exclusion of left atrial appendage, open, performed at the time of other sternotomy or thoracotomy procedure(s), any method (eg, excision, isolation via stapling, oversewing, ligation, plication, clip) (List separately in addition to code for primary procedure)

33269 Exclusion of left atrial appendage, thoracoscopic, any method (eg, excision, isolation via stapling, oversewing, ligation, plication, clip)

33370 Transcatheter placement and subsequent removal of cerebral embolic protection device(s), including arterial access, catheterization, imaging, and radiological supervision and interpretation, percutaneous (List separately in addition to code for primary procedure)

33509 Harvest of upper extremity artery, 1 segment, for coronary artery bypass procedure, endoscopic

33894 Endovascular stent repair of coarctation of the ascending, transverse, or descending thoracic or abdominal aorta, involving stent placement; across major side branches

33895 Endovascular stent repair of coarctation of the ascending, transverse, or descending thoracic or abdominal aorta, involving stent placement; not crossing major side branches

33897 Percutaneous transluminal angioplasty of native or recurrent coarctation of the aorta

42975 Drug-induced sleep endoscopy, with dynamic evaluation of velum, pharynx, tongue base, and larynx for evaluation of sleep-disordered breathing, flexible, diagnostic

43497 Lower esophageal myotomy, transoral (ie, peroral endoscopic myotomy [POEM])

53451 Periurethral transperineal adjustable balloon continence device; bilateral insertion, including cystourethroscopy and imaging guidance

53452 Periurethral transperineal adjustable balloon continence device; unilateral insertion, including cystourethroscopy and imaging guidance

53453 Periurethral transperineal adjustable balloon continence device; removal, each balloon

53454 Periurethral transperineal adjustable balloon continence device; percutaneous adjustment of balloon(s) fluid volume

61736 Laser interstitial thermal therapy (LITT) of lesion, intracranial, including burr hole(s), with magnetic resonance imaging guidance, when performed; single trajectory for 1 simple lesion

61737 Laser interstitial thermal therapy (LITT) of lesion, intracranial, including burr hole(s), with magnetic resonance imaging guidance, when performed; multiple trajectories for multiple or complex lesion(s)

63052 Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s] [eg, spinal or lateral recess stenosis]), during posterior interbody arthrodesis, lumbar; single vertebral segment (List separately in addition to code for primary procedure)

63053 Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s] [eg, spinal or lateral recess stenosis]), during posterior interbody arthrodesis, lumbar; each additional segment (List separately in addition to code for primary procedure)

64582 Open implantation of hypoglossal nerve neurostimulator array, pulse generator, and distal respiratory sensor electrode or electrode array

64583 Revision or replacement of hypoglossal nerve neurostimulator array and distal respiratory sensor electrode or electrode array, including connection to existing pulse generator

64584 Removal of hypoglossal nerve neurostimulator array, pulse generator, and distal respiratory sensor electrode or electrode array

64628 Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; first 2 vertebral bodies, lumbar or sacral

64629 Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; each additional vertebral body, lumbar or sacral (List separately in addition to code for primary procedure)

66989 Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; with insertion of intraocular (eg, trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more

66991 Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); with insertion of intraocular (eg, trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more

68841 Insertion of drug-eluting implant, including punctal dilation when performed, into lacrimal canaliculus, each

69716 Implantation, osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor

69719 Revision or replacement (including removal of existing device), osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor

69726 Removal, osseointegrated implant, skull; with percutaneous attachment to external speech processor

69727 Removal, osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor

77089 Trabecular bone score (TBS), structural condition of the bone microarchitecture; using dual X-ray absorptiometry (DXA) or other imaging data on gray-scale variogram, calculation, with interpretation and report on fracture-risk

77090 Trabecular bone score (TBS), structural condition of the bone microarchitecture; technical preparation and transmission of data for analysis to be performed elsewhere

77091 Trabecular bone score (TBS), structural condition of the bone microarchitecture; technical calculation only

77092 Trabecular bone score (TBS), structural condition of the bone microarchitecture; interpretation and report on fracture-risk only by other qualified health care professional

80220 Hydroxychloroquine

80503 Pathology clinical consultation; for a clinical problem, with limited review of patient's history and medical records and straightforward medical decision making When using time for code selection, 5-20 minutes of total time is spent on the date of the consultation.

80504 Pathology clinical consultation; for a moderately complex clinical problem, with review of patient's history and medical records and moderate level of medical decision making When using time for code selection, 21-40 minutes of total time is spent on the date of the consultation.

80505 Pathology clinical consultation; for a highly complex clinical problem, with comprehensive review of patient's history and medical records and high level of medical decision making When using time for code selection, 41-60 minutes of total time is spent on the date of the consultation.

80506 Pathology clinical consultation; prolonged service, each additional 30 minutes (List separately in addition to code for primary procedure)

81349 Cytogenomic (genome-wide) analysis for constitutional chromosomal abnormalities; interrogation of genomic regions for copy number and loss-of-heterozygosity variants, low-pass sequencing analysis

81523 Oncology (breast), mRNA, next-generation sequencing gene expression profiling of 70 content genes and 31 housekeeping genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as index related to risk to distant metastasis

81560 Transplantation medicine (allograft rejection, pediatric liver and small bowel), measurement of donor and third-party-induced CD154+T-cytotoxic memory cells, utilizing whole peripheral blood, algorithm reported as a rejection risk score

82653 Elastase, pancreatic (EL-1), fecal; quantitative

83521 Immunoglobulin light chains (ie, kappa, lambda), free, each

83529 Interleukin-6 (IL-6)

86015 Actin (smooth muscle) antibody (ASMA), each

86036 Antineutrophil cytoplasmic antibody (ANCA); screen, each antibody

86037 Antineutrophil cytoplasmic antibody (ANCA); titer, each antibody

86051 Aquaporin-4 (neuromyelitis optica [NMO]) antibody; enzyme-linked immunosorbent immunoassay (ELISA)

86052 Aquaporin-4 (neuromyelitis optica [NMO]) antibody; cell-based immunofluorescence assay (CBA), each

86053 Aquaporin-4 (neuromyelitis optica [NMO]) antibody; flow cytometry (ie, fluorescence-activated cell sorting [FACS]), each

86231 Endomysial antibody (EMA), each immunoglobulin (Ig) class

86258 Gliadin (deamidated) (DGP) antibody, each immunoglobulin (Ig) class

86362 Myelin oligodendrocyte glycoprotein (MOG-IgG1) antibody; cell-based immunofluorescence assay (CBA), each

86363 Myelin oligodendrocyte glycoprotein (MOG-IgG1) antibody; flow cytometry (ie, fluorescence-activated cell sorting [FACS]), each

86364 Tissue transglutaminase, each immunoglobulin (Ig) class

86381 Mitochondrial antibody (eg, M2), each

86596 Voltage-gated calcium channel antibody, each

87154 Culture, typing; identification of blood pathogen and resistance typing, when performed, by nucleic acid (DNA or RNA) probe, multiplexed amplified probe technique including multiplex reverse transcription, when performed, per culture or isolate, 6 or more targets

90759 Hepatitis B vaccine (HepB), 3-antigen (S, Pre-S1, Pre-S2), 10 mcg dosage, 3 dose schedule, for intramuscular use

91113 Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), colon, with interpretation and report

93319 3D echocardiographic imaging and postprocessing during transesophageal echocardiography, or during transthoracic echocardiography for congenital cardiac anomalies, for the assessment of cardiac structure(s) (eg, cardiac chambers and valves, left atrial appendage, interatrial septum, interventricular septum) and function, when performed (List separately in addition to code for echocardiographic imaging)

93593 Right heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone; normal native connections

93594 Right heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone; abnormal native connections

93595 Left heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone, normal or abnormal native connections

93596 Right and left heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone(s); normal native connections

93597 Right and left heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone(s); abnormal native connections

93598 Cardiac output measurement(s), thermodilution or other indicator dilution method, performed during cardiac catheterization for the evaluation of congenital heart defects (List separately in addition to code for primary procedure)

94625 Physician or other qualified health care professional services for outpatient pulmonary rehabilitation; without continuous oximetry monitoring (per session)

94626 Physician or other qualified health care professional services for outpatient pulmonary rehabilitation; with continuous oximetry monitoring (per session)

98975 Remote therapeutic monitoring (eg, respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on use of equipment

98976 Remote therapeutic monitoring (eg, respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (eg, daily) recording(s) and/or programmed alert(s) transmission to monitor respiratory system, each 30 days

98977 Remote therapeutic monitoring (eg, respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (eg, daily) recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system, each 30 days

98980 Remote therapeutic monitoring treatment management services, physician or other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient or caregiver during the calendar month; first 20 minutes

98981 Remote therapeutic monitoring treatment management services, physician or other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient or caregiver during the calendar month; each additional 20 minutes (List separately in addition to code for primary procedure)

99424 "Principal care management services, for a single high-risk disease, with the following required elements:

• One complex chronic condition expected to last at least 3 months, and that places the patient at significant risk of hospitalization, acute exacerbation/decompensation, functional decline, or death,
• The condition requires development, monitoring, or revision of disease-specific care plan,
• The condition requires frequent adjustments in the medication regimen and/or the management of the condition is unusually complex due to comorbidities,
• Ongoing communication and care coordination between relevant practitioners furnishing care; first 30 minutes provided personally by a physician or other qualified health care professional, per calendar month."

99425 "Principal care management services, for a single high-risk disease, with the following required elements:

• One complex chronic condition expected to last at least 3 months, and that places the patient at significant risk of hospitalization, acute exacerbation/decompensation, functional decline, or death,
• The condition requires development, monitoring, or revision of disease-specific care plan,
• The condition requires frequent adjustments in the medication regimen and/or the management of the condition is unusually complex due to comorbidities,
• Ongoing communication and care coordination between relevant practitioners furnishing care; each additional 30 minutes provided personally by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure)"

99426 "Principal care management services, for a single high-risk disease, with the following required elements:

• One complex chronic condition expected to last at least 3 months, and that places the patient at significant risk of hospitalization, acute exacerbation/decompensation, functional decline, or death,
• The condition requires development, monitoring, or revision of disease-specific care plan,
• The condition requires frequent adjustments in the medication regimen and/or the management of the condition is unusually complex due to comorbidities,
• Ongoing communication and care coordination between relevant practitioners furnishing care; first 30 minutes of clinical staff time directed by physician or other qualified health care professional, per calendar month."

99427 "Principal care management services, for a single high-risk disease, with the following required elements:

• One complex chronic condition expected to last at least 3 months, and that places the patient at significant risk of hospitalization, acute exacerbation/decompensation, functional decline, or death,
• The condition requires development, monitoring, or revision of disease-specific care plan,
• The condition requires frequent adjustments in the medication regimen and/or the management of the condition is unusually complex due to comorbidities,
• Ongoing communication and care coordination between relevant practitioners furnishing care; each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure)"

99437 "Chronic care management services with the following required elements:

• Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient,
• Chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline,
• Comprehensive care plan established, implemented, revised, or monitored; each additional 30 minutes by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure)"

See also Revised Codes

 

Check Outdated Codes'2022

Pneumococcal Vaccine and Administration

HCPCS/CPT Codes

• 90670 – Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use
• 90732 – Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use
• G0009 – Pneumococcal Administration

ICD-10 Codes

The specified below ICD codes are covered for CPT G0102 and G0103 but may not be limited and some private payers having specific guidelines.

• Z23  Encounter for immunization
• Z71.84 Encounter for health counseling related to travel

Who Is Covered

• All Medicare beneficiaries

Fee Value and MUE Edits

      CPT         Dosage   Fee    MUE
      90670 0.5 ml $241.383      1
      90732 0.5 ml $125.918     1

Frequency

• An initial pneumococcal vaccine to Medicare beneficiaries who never received the vaccine under Medicare Part B
• A different, second pneumococcal vaccine 1 year after the first vaccine was administered

Medicare Beneficiary Pays

• Co-payment/coinsurance waived
• Deductible waived

Prostate Cancer Screening CPT G0102 and G0103

HCPCS/CPT Codes

G0102 – Prostate cancer screening; digital rectal examination

• The Physician performs a prostate cancer screening in which he performs a digital rectal examination to assess the male patient’s prostate. 
• To examine the prostate the provider inserts a gloved and lubricated finger into the rectum and checks for hardness, lumps, or any abnormalities. 
• This examination helps detect prostate cancer in its early stages. The provider typically performs this test for the first time at the age of 40 for men at risk of having prostate cancer such as those men with a family history of cancer
• Medicare provides coverage for an annual prostate cancer screening digital rectal examination for men at the age of 50.  

G0103 – Prostate cancer screening; prostate specific antigen test (PSA)

• The Prostate screening examination, the Physician detects the prostate specific antigen, or PSA, level in a patient’s blood. PSA is a protein the prostate gland produces, and he/she may use PSA levels to screen for prostate cancer
• This protein is considered as an indicator for prostate cancer. The Physician collects the blood sample through a venipuncture. This test helps to detect prostate cancer in its early stages. 
• A normal level of PSA in blood level as specified below, 
• For below 50 years of age is less than 2.5
• For age 50 to 60 it is less than 3.5, 
• For age 60 to 70 it is less than 4.5 
• For age above 70 it is 6.6.  
• Medicare provides coverage for an annual prostate cancer screening, or PSA, test for men at the age of 50.

ICD-10 Codes

The specified below ICD codes are covered for CPT G0102 and G0103 but may not be limited and some private payers having specific guidelines.

• D07.5 Carcinoma in situ of prostate
• D29.1 Benign neoplasm of prostate
• D40.0 Neoplasm of uncertain behavior of prostate
• R97.20 Elevated prostate specific antigen [PSA]
• R97.21 Rising PSA following treatment for malignant neoplasm of prostate
• Z12.5 Encounter for screening for malignant neoplasm of prostate
• Z15.03 Genetic susceptibility to malignant neoplasm of prostate
• Z71.84 Encounter for health counseling related to travel
• Z80.42 Family history of malignant neoplasm of prostate
• Z85.46 Personal history of malignant neoplasm of prostate

Who Is Covered

• All male Medicare beneficiaries aged 50 and older (coverage begins the day after their 50th birthday)

Frequency

• Annually for covered Medicare beneficiaries
• Medicare Beneficiary Pays

G0102:

• Co-payment/coinsurance applies
• Deductible applies

G0103:

• Co-payment/coinsurance waived
• Deductible waived

Initial Preventive Physical Examination with EKG (IPPE)

Welcome to Medicare Preventive Visit

HCPCS/CPT Codes

• G0402 – Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment

• G0403 – Electrocardiogram, routine ECG with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report

• G0404 – Electrocardiogram, routine ECG with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination

• G0405 – Electrocardiogram, routine ECG with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination

Who Is Covered

• All new Medicare beneficiaries who are within the first 12 months of their first Medicare Part B coverage period

Frequency

• Once in a lifetime
• Must furnish no later than 12 months after the effective date of the first Medicare Part B coverage period

Covered ICD-10 Codes for CPT G0402

The specified below ICD codes are covered for CPT G0402 but may not be limited and some private payers having specific guidelines.

• R93.811 Abnormal radiologic findings on diagnostic imaging of right testicle
• R93.812 Abnormal radiologic findings on diagnostic imaging of left testicle
• R93.813 Abnormal radiologic findings on diagnostic imaging of testicles, bilateral
• R93.819 Abnormal radiologic findings on diagnostic imaging of unspecified testicle
• R93.89 Abnormal findings on diagnostic imaging of other specified body structures
• Z00.00 Encounter for general adult medical examination without abnormal findings
• Z00.01 Encounter for general adult medical examination with abnormal findings
• Z00.8 Encounter for other general examination
• Z01.00 Encounter for examination of eyes and vision without abnormal findings
• Z01.01 Encounter for examination of eyes and vision with abnormal findings
• Z01.020 Encounter for examination of eyes and vision following failed vision screening without abnormal findings
• Z01.021 Encounter for examination of eyes and vision following failed vision screening with abnormal findings
• Z01.10 Encounter for examination of ears and hearing without abnormal findings
• Z01.110 Encounter for hearing examination following failed hearing screening
• Z01.118 Encounter for examination of ears and hearing with other abnormal findings
• Z68.1 Body mass index [BMI] 19.9 or less, adult
• Z68.20 Body mass index [BMI] 20.0-20.9, adult
• Z68.21 Body mass index [BMI] 21.0-21.9, adult
• Z68.22 Body mass index [BMI] 22.0-22.9, adult
• Z68.23 Body mass index [BMI] 23.0-23.9, adult
• Z68.24 Body mass index [BMI] 24.0-24.9, adult
• Z68.25 Body mass index [BMI] 25.0-25.9, adult
• Z68.26 Body mass index [BMI] 26.0-26.9, adult
• Z68.27 Body mass index [BMI] 27.0-27.9, adult
• Z68.28 Body mass index [BMI] 28.0-28.9, adult
• Z68.29 Body mass index [BMI] 29.0-29.9, adult
• Z68.30 Body mass index [BMI] 30.0-30.9, adult
• Z68.31 Body mass index [BMI] 31.0-31.9, adult
• Z68.32 Body mass index [BMI] 32.0-32.9, adult
• Z68.33 Body mass index [BMI] 33.0-33.9, adult
• Z68.34 Body mass index [BMI] 34.0-34.9, adult
• Z68.35 Body mass index [BMI] 35.0-35.9, adult
• Z68.36 Body mass index [BMI] 36.0-36.9, adult
• Z68.37 Body mass index [BMI] 37.0-37.9, adult
• Z68.38 Body mass index [BMI] 38.0-38.9, adult
• Z68.39 Body mass index [BMI] 39.0-39.9, adult
• Z68.41 Body mass index [BMI] 40.0-44.9, adult
• Z68.42 Body mass index [BMI] 45.0-49.9, adult
• Z68.43 Body mass index [BMI] 50.0-59.9, adult
• Z68.44 Body mass index [BMI] 60.0-69.9, adult
• Z68.45 Body mass index [BMI] 70 or greater, adult
• Z71.84 Encounter for health counseling related to travel

Covered ICD-10 Codes for CPT G0403, G0404, G0405

The specified below ICD codes are covered for CPT G0403, G0404, G0405 but may not be limited and some private payers having specific guidelines.

• R00.0 Tachycardia, unspecified
• R00.1 Bradycardia, unspecified
• R00.2 Palpitations
• R00.8 Other abnormalities of heart beat
• R00.9 Unspecified abnormalities of heart beat
• R01.0 Benign and innocent cardiac murmurs
• R01.1 Cardiac murmur, unspecified
• R01.2 Other cardiac sounds
• R03.0 Elevated blood-pressure reading, without diagnosis of hypertension
• R07.1 Chest pain on breathing
• R07.2 Precordial pain
• R07.81 Pleurodynia
• R07.82 Intercostal pain
• R07.89 Other chest pain
• R07.9 Chest pain, unspecified
• R94.31 Abnormal electrocardiogram [ECG] [EKG]
• Z13.30 Encounter for screening examination for mental health and behavioral disorders, unspecified
• Z13.31 Encounter for screening for depression
• Z13.32 Encounter for screening for maternal depression
• Z13.39 Encounter for screening examination for other mental health and behavioral disorders
• Z13.6 Encounter for screening for cardiovascular disorders
• Z82.41 Family history of sudden cardiac death
• Z82.49 Family history of ischemic heart disease and other diseases of the circulatory system

Medicare Beneficiary Pays as below,

G0402,

• Co-payment/coinsurance waived
• Deductible waived

G0403, G0404, and G0405,

• Co-payment/coinsurance applies
• Deductible applies

Screening for Cervical Cancer with Human Papillomavirus (HPV) Tests

Human Papillomavirus 

The lab analyst performs the technical steps to detect human papillomavirus through nucleic acid detection and the Nucleic acid probes permit identification of microorganisms based on their DNA or RNA. 

The Nucleic acid quantitation allows assessment of treatment response and the Quantitation refers to measuring the exact amount of a substance. The lab analyst performs this procedure for detection of high risk types of human papillomavirus.

HCPCS/CPT Codes

• 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 

ICD-10 Codes

The specified below ICD codes are covered for CPT G0476 but may not be limited and some private payers having specific guidelines.

• B97.7 Papillomavirus as the cause of diseases classified elsewhere
• R85.81 Anal high risk human papillomavirus (HPV) DNA test positive
• R85.82 Anal low risk human papillomavirus (HPV) DNA test positive
• R87.810 Cervical high risk human papillomavirus (HPV) DNA test positive
• R87.811 Vaginal high risk human papillomavirus (HPV) DNA test positive
• R87.820 Cervical low risk human papillomavirus (HPV) DNA test positive
• R87.821 Vaginal low risk human papillomavirus (HPV) DNA test positive
• Z01.411 Encounter for gynecological examination (general) (routine) with abnormal findings
• Z01.419 Encounter for gynecological examination (general) (routine) without abnormal findings
• Z01.42 Encounter for cervical smear to confirm findings of recent normal smear following initial abnormal smear
• Z11.51 Encounter for screening for human papillomavirus (HPV)
• Z86.002 Personal history of in-situ neoplasm of other and unspecified genital organs

Who Is Covered

• All asymptomatic female Medicare beneficiaries aged 30 to 65 years

Frequency

• Once every 5 years

Medicare Beneficiary Pays

• Co-payment/coinsurance waived
• Deductible waived

Intensive Behavioral Therapy (IBT) - CPT G0446

Intensive Behavioral Therapy (IBT) for Cardiovascular Disease (CVD)

• Also known as a CVD risk reduction visit

HCPCS/CPT Codes

• G0446 – Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes

Covered ICD Codes

The specified below ICD  codes are covered for CPT G0446 but may not be limited and some private payers having specific guidelines.

• F53.0    Postpartum depression
• F53.1    Puerperal psychosis 
• F68.A    Factitious disorder imposed on another
• I01.0 Acute rheumatic pericarditis
• I01.1 Acute rheumatic endocarditis
• I01.2 Acute rheumatic myocarditis
• I01.8 Other acute rheumatic heart disease
• I01.9 Acute rheumatic heart disease, unspecified
• I02.0 Rheumatic chorea with heart involvement
• I02.9 Rheumatic chorea without heart involvement
• I05.0 Rheumatic mitral stenosis
• I05.1 Rheumatic mitral insufficiency
• I05.2 Rheumatic mitral stenosis with insufficiency
• I05.8 Other rheumatic mitral valve diseases
• I05.9 Rheumatic mitral valve disease, unspecified
• I06.0 Rheumatic aortic stenosis
• I06.1 Rheumatic aortic insufficiency
• I06.2 Rheumatic aortic stenosis with insufficiency
• I06.8 Other rheumatic aortic valve diseases
• I06.9 Rheumatic aortic valve disease, unspecified
• I07.0 Rheumatic tricuspid stenosis
• I07.1 Rheumatic tricuspid insufficiency
• I07.2 Rheumatic tricuspid stenosis and insufficiency
• I07.8 Other rheumatic tricuspid valve diseases
• I07.9 Rheumatic tricuspid valve disease, unspecified
• I08.0 Rheumatic disorders of both mitral and aortic valves
• I08.1 Rheumatic disorders of both mitral and tricuspid valves
• I08.2 Rheumatic disorders of both aortic and tricuspid valves
• I08.3 Combined rheumatic disorders of mitral, aortic and tricuspid valves
• I08.8 Other rheumatic multiple valve diseases
• I08.9 Rheumatic multiple valve disease, unspecified
• I09.0 Rheumatic myocarditis
• I09.1 Rheumatic diseases of endocardium, valve unspecified
• I09.2 Chronic rheumatic pericarditis
• I09.81 Rheumatic heart failure
• I09.89 Other specified rheumatic heart diseases
• I09.9 Rheumatic heart disease, unspecified
• I10         Essential (primary) hypertension
• I11.0 Hypertensive heart disease with heart failure
• I11.9 Hypertensive heart disease without heart failure
• I12.0 Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease
• I12.9 Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
• I13.0 Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
• I13.10 Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
• I13.11 Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease
• I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease
• I15.0 Reno vascular hypertension
• I15.1 Hypertension secondary to other renal disorders
• I15.2 Hypertension secondary to endocrine disorders
• I15.8 Other secondary hypertension
• I15.9 Secondary hypertension, unspecified
• I16.0 Hypertensive urgency
• I16.1 Hypertensive emergency
• I16.9 Hypertensive crisis, unspecified
• I20.0 Unstable angina
• I20.1 Angina pectoris with documented spasm
• I20.8 Other forms of angina pectoris
• I20.9 Angina pectoris, unspecified
• I21.01 ST elevation (STEMI) myocardial infarction involving left main coronary artery
• I21.02 ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery
• I21.09 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall
• I21.11 ST elevation (STEMI) myocardial infarction involving right coronary artery
• I21.19 ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall
• I21.21 ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery
• I21.29 ST elevation (STEMI) myocardial infarction involving other sites
• I21.3 ST elevation (STEMI) myocardial infarction of unspecified site
• I21.4 Non-ST elevation (NSTEMI) myocardial infarction
• I22.0 Subsequent ST elevation (STEMI) myocardial infarction of anterior wall
• I22.1 Subsequent ST elevation (STEMI) myocardial infarction of inferior wall
• I22.2 Subsequent non-ST elevation (NSTEMI) myocardial infarction
• I22.8 Subsequent ST elevation (STEMI) myocardial infarction of other sites
• I22.9 Subsequent ST elevation (STEMI) myocardial infarction of unspecified site
• I23.0 Hemopericardium as current complication following acute myocardial infarction
• I23.1 Atrial septal defect as current complication following acute myocardial infarction
• I23.2 Ventricular septal defect as current complication following acute myocardial infarction
• I23.3 Rupture of cardiac wall without hemopericardium as current complication following acute myocardial infarction
• I23.4 Rupture of chordae tendineae as current complication following acute myocardial infarction
• I23.5 Rupture of papillary muscle as current complication following acute myocardial infarction
• I23.6 Thrombosis of atrium, auricular appendage, and ventricle as current complications following acute myocardial infarction
• I23.7 Postinfarction angina
• I23.8 Other current complications following acute myocardial infarction
• I24.0 Acute coronary thrombosis not resulting in myocardial infarction
• I24.1 Dressler's syndrome
• I24.8 Other forms of acute ischemic heart disease
• I24.9 Acute ischemic heart disease, unspecified
• I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris
• I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina pectoris
• I25.111 Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm
• I25.118 Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris
• I25.119 Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris
• I25.2 Old myocardial infarction
• I25.3 Aneurysm of heart
• I25.41 Coronary artery aneurysm
• I25.42 Coronary artery dissection
• I25.5 Ischemic cardiomyopathy
• I25.6 Silent myocardial ischemia
• I25.700 Atherosclerosis of coronary artery bypass graft(s), unspecified, with unstable angina pectoris
• I25.701 Atherosclerosis of coronary artery bypass graft(s), unspecified, with angina pectoris with documented spasm
• I25.708 Atherosclerosis of coronary artery bypass graft(s), unspecified, with other forms of angina pectoris
• I25.709 Atherosclerosis of coronary artery bypass graft(s), unspecified, with unspecified angina pectoris
• I25.710 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris
• I25.711 Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris with documented spasm
• I25.718 Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectoris
• I25.719 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unspecified angina pectoris
• I25.720 Atherosclerosis of autologous artery coronary artery bypass graft(s) with unstable angina pectoris
• I25.721 Atherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris with documented spasm
• I25.728 Atherosclerosis of autologous artery coronary artery bypass graft(s) with other forms of angina pectoris
• I25.729 Atherosclerosis of autologous artery coronary artery bypass graft(s) with unspecified angina pectoris
• I25.730 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina pectoris
• I25.731 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with angina pectoris with documented spasm
• I25.738 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with other forms of angina pectoris
• I25.739 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unspecified angina pectoris
• I25.750 Atherosclerosis of native coronary artery of transplanted heart with unstable angina
• I25.751 Atherosclerosis of native coronary artery of transplanted heart with angina pectoris with documented spasm
• I25.758 Atherosclerosis of native coronary artery of transplanted heart with other forms of angina pectoris
• I25.759 Atherosclerosis of native coronary artery of transplanted heart with unspecified angina pectoris
• I25.760 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unstable angina
• I25.761 Atherosclerosis of bypass graft of coronary artery of transplanted heart with angina pectoris with documented spasm
• I25.768 Atherosclerosis of bypass graft of coronary artery of transplanted heart with other forms of angina pectoris
• I25.769 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unspecified angina pectoris
• I25.790 Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris
• I25.791 Atherosclerosis of other coronary artery bypass graft(s) with angina pectoris with documented spasm
• I25.798 Atherosclerosis of other coronary artery bypass graft(s) with other forms of angina pectoris
• I25.799 Atherosclerosis of other coronary artery bypass graft(s) with unspecified angina pectoris
• I25.810 Atherosclerosis of coronary artery bypass graft(s) without angina pectoris
• I25.811 Atherosclerosis of native coronary artery of transplanted heart without angina pectoris
• I25.812 Atherosclerosis of bypass graft of coronary artery of transplanted heart without angina pectoris
• I25.82 Chronic total occlusion of coronary artery
• I25.83 Coronary atherosclerosis due to lipid rich plaque
• I25.84 Coronary atherosclerosis due to calcified coronary lesion
• I25.89 Other forms of chronic ischemic heart disease
• I25.9 Chronic ischemic heart disease, unspecified
• I26.01 Septic pulmonary embolism with acute cor pulmonale
• I26.02 Saddle embolus of pulmonary artery with acute cor pulmonale
• I26.09 Other pulmonary embolism with acute cor pulmonale
• I26.90 Septic pulmonary embolism without acute cor pulmonale
• I26.92 Saddle embolus of pulmonary artery without acute cor pulmonale
• I26.93 Single subsegmental pulmonary embolism without acute cor pulmonale
• I26.94 Multiple subsegmental pulmonary emboli without acute cor pulmonale
• I26.99 Other pulmonary embolism without acute cor pulmonale
• I27.0 Primary pulmonary hypertension
• I27.1 Kyphoscoliotic heart disease
• I27.81 Cor pulmonale (chronic)
• I27.82 Chronic pulmonary embolism
• I27.89 Other specified pulmonary heart diseases
• I27.9 Pulmonary heart disease, unspecified
• I28.0 Arteriovenous fistula of pulmonary vessels
• I28.1 Aneurysm of pulmonary artery
• I28.8 Other diseases of pulmonary vessels
• I28.9 Disease of pulmonary vessels, unspecified
• I30.0 Acute nonspecific idiopathic pericarditis
• I30.1 Infective pericarditis
• I30.8 Other forms of acute pericarditis
• I30.9 Acute pericarditis, unspecified
• I31.0 Chronic adhesive pericarditis
• I31.1 Chronic constrictive pericarditis
• I31.2 Hemopericardium, not elsewhere classified
• I31.3 Pericardial effusion (noninflammatory)
• I31.4 Cardiac tamponade
• I31.8 Other specified diseases of pericardium
• I31.9 Disease of pericardium, unspecified
• I32         Pericarditis in diseases classified elsewhere
• I33.0 Acute and subacute infective endocarditis
• I33.9 Acute and subacute endocarditis, unspecified 
• I34.0 Nonrheumatic mitral (valve) insufficiency
• I34.1 Nonrheumatic mitral (valve) prolapse
• I34.2 Nonrheumatic mitral (valve) stenosis
• I34.8 Other nonrheumatic mitral valve disorders
• I34.9 Nonrheumatic mitral valve disorder, unspecified
• I35.0 Nonrheumatic aortic (valve) stenosis
• I35.1 Nonrheumatic aortic (valve) insufficiency
• I35.2 Nonrheumatic aortic (valve) stenosis with insufficiency
• I35.8 Other nonrheumatic aortic valve disorders
• I35.9 Nonrheumatic aortic valve disorder, unspecified
• I36.0 Nonrheumatic tricuspid (valve) stenosis
• I36.1 Nonrheumatic tricuspid (valve) insufficiency
• I36.2 Nonrheumatic tricuspid (valve) stenosis with insufficiency
• I36.8 Other nonrheumatic tricuspid valve disorders
• I36.9 Nonrheumatic tricuspid valve disorder, unspecified
• I37.0 Nonrheumatic pulmonary valve stenosis
• I37.1 Nonrheumatic pulmonary valve insufficiency
• I37.2 Nonrheumatic pulmonary valve stenosis with insufficiency
• I37.8 Other nonrheumatic pulmonary valve disorders
• I37.9 Nonrheumatic pulmonary valve disorder, unspecified
• I38         Endocarditis, valve unspecified
• I39         Endocarditis and heart valve disorders in diseases classified elsewhere
• I40.0 Infective myocarditis
• I40.1 Isolated myocarditis
• I40.8 Other acute myocarditis
• I40.9 Acute myocarditis, unspecified
• I41         Myocarditis in diseases classified elsewhere
• I42.0 Dilated cardiomyopathy
• I42.1 Obstructive hypertrophic cardiomyopathy
• I42.2 Other hypertrophic cardiomyopathy
• I42.3 Endomyocardial (eosinophilic) disease
• I42.4 Endocardial fibroelastosis
• I42.5 Other restrictive cardiomyopathy
• I42.6 Alcoholic cardiomyopathy
• I42.7 Cardiomyopathy due to drug and external agent
• I42.8 Other cardiomyopathies
• I42.9 Cardiomyopathy, unspecified
• I43         Cardiomyopathy in diseases classified elsewhere
• I44.0 Atrioventricular block, first degree
• I44.1 Atrioventricular block, second degree
• I44.2 Atrioventricular block, complete
• I44.30 Unspecified atrioventricular block
• I44.39 Other atrioventricular block
• I44.4 Left anterior fascicular block
• I44.5 Left posterior fascicular block
• I44.60 Unspecified fascicular block
• I44.69 Other fascicular block
• I44.7 Left bundle-branch block, unspecified
• I45.0 Right fascicular block
• I45.10 Unspecified right bundle-branch block
• I45.19 Other right bundle-branch block
• I45.2 Bifascicular block
• I45.3 Trifascicular block
• I45.4 Nonspecific intraventricular block
• I45.5 Other specified heart block
• I45.6 Pre-excitation syndrome
• I45.81 Long QT syndrome
• I45.89 Other specified conduction disorders
• I45.9 Conduction disorder, unspecified
• I46.2 Cardiac arrest due to underlying cardiac condition
• I46.8 Cardiac arrest due to other underlying condition
• I46.9 Cardiac arrest, cause unspecified
• I47.0 Re-entry ventricular arrhythmia
• I47.1 Supraventricular tachycardia
• I47.2 Ventricular tachycardia
• I47.9 Paroxysmal tachycardia, unspecified
• I48.0 Paroxysmal atrial fibrillation
• I48.11 Longstanding persistent atrial fibrillation
• I48.19 Other persistent atrial fibrillation
• I48.20 Chronic atrial fibrillation, unspecified
• I48.21 Permanent atrial fibrillation
• I48.3 Typical atrial flutter
• I48.4 Atypical atrial flutter
• I48.91 Unspecified atrial fibrillation
• I48.92 Unspecified atrial flutter
• I49.01 Ventricular fibrillation
• I49.02 Ventricular flutter
• I49.1 Atrial premature depolarization
• I49.2 Junctional premature depolarization
• I49.3 Ventricular premature depolarization
• I49.40 Unspecified premature depolarization
• I49.49 Other premature depolarization
• I49.5 Sick sinus syndrome
• I49.8 Other specified cardiac arrhythmias
• I49.9 Cardiac arrhythmia, unspecified
• I50.1 Left ventricular failure, unspecified
• I50.20 Unspecified systolic (congestive) heart failure
• I50.21 Acute systolic (congestive) heart failure
• I50.22 Chronic systolic (congestive) heart failure
• I50.23 Acute on chronic systolic (congestive) heart failure
• I50.30 Unspecified diastolic (congestive) heart failure
• I50.31 Acute diastolic (congestive) heart failure
• I50.32 Chronic diastolic (congestive) heart failure
• I50.33 Acute on chronic diastolic (congestive) heart failure
• I50.40 Unspecified combined systolic (congestive) and diastolic (congestive) heart failure
• I50.41 Acute combined systolic (congestive) and diastolic (congestive) heart failure
• I50.42 Chronic combined systolic (congestive) and diastolic (congestive) heart failure
• I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
• I50.9 Heart failure, unspecified
• I51.0 Cardiac septal defect, acquired
• I51.1 Rupture of chordae tendineae, not elsewhere classified
• I51.2 Rupture of papillary muscle, not elsewhere classified
• I51.3 Intracardiac thrombosis, not elsewhere classified
• I51.4 Myocarditis, unspecified
• I51.5 Myocardial degeneration
• I51.7 Cardiomegaly
• I51.81 Takotsubo syndrome
• I51.89 Other ill-defined heart diseases
• I51.9 Heart disease, unspecified
• I52         Other heart disorders in diseases classified elsewhere
• Z13.30 Encounter for screening examination for mental health and behavioral disorders, unspecified
• Z13.31 Encounter for screening for depression
• Z13.32 Encounter for screening for maternal depression
• Z13.39 Encounter for screening examination for other mental health and behavioral disorders

Who Is Covered

All Medicare beneficiaries covered when following criteria are met,

• Competent and alert at the time counseling is provided
• Furnished counseling by a qualified primary care physician or other primary care practitioner and in a primary care setting

Frequency

• Annually for covered Medicare beneficiaries

Medicare Beneficiary Pays

• Co-payment/coinsurance waived
• Deductible waived

Intensive Behavioral Therapy (IBT) for Obesity

HCPCS/CPT Codes

• G0447 – Face-to-face behavioral counseling for obesity, 15 minutes
• G0473 – Face-to-face behavioral counseling for obesity, group (2–10), 30 minutes

Covered ICD-10 Codes for CPT G0447 & G0473

The specified below ICD codes are covered for CPT G0472 and may not be limited and some private payers have own specific guidelines,

• Z68.30 - Body mass index [BMI] 30.0-30.9, adult
• Z68.31  -Body mass index [BMI] 31.0-31.9, adult
• Z68.32 - Body mass index [BMI] 32.0-32.9, adult
• Z68.33 - Body mass index [BMI] 33.0-33.9, adult
• Z68.34 - Body mass index [BMI] 34.0-34.9, adult
• Z68.35 - Body mass index [BMI] 35.0-35.9, adult
• Z68.36 - Body mass index [BMI] 36.0-36.9, adult
• Z68.37 - Body mass index [BMI] 37.0-37.9, adult
• Z68.38 - Body mass index [BMI] 38.0-38.9, adult
• Z68.39 - Body mass index [BMI] 39.0-39.9, adult
• Z68.41 - Body mass index [BMI] 40.0-44.9, adult
• Z68.42 - Body mass index [BMI] 45.0-49.9, adult
• Z68.43 - Body mass index [BMI] 50.0-59.9, adult
• Z68.44 - Body mass index [BMI] 60.0-69.9, adult
• Z68.45 - Body mass index [BMI] 70 or greater, adult

Require primary ICD Codes for above diagnosis,

• E66.9 - Obesity, unspecified
• E66.8 - Other obesity
• E66.3 - Overweight
• E66.2 - Morbid (severe) obesity with alveolar hypoventilation
• E66.1 - Drug-induced obesity
• E66.09 - Other obesity due to excess calories
• E66.01 - Morbid (severe) obesity due to excess calories

Who Is Covered

The Medicare beneficiaries requires the following information to meat the medical necessity 

• Obesity (Body Mass Index [BMI] ≥ 30 kilograms [kg] per meter squared)
• Competent and alert at the time counseling is provided
• Counseling furnished by a qualified primary care physician or other primary care practitioner in a primary care setting

Frequency

• First month: one face-to-face visit every week
• Months 2–6: one face-to-face visit every other week
• Months 7–12: one face-to-face visit every month if certain requirements are met.

At the 6-month visit, a reassessment of obesity and a determination of the amount of weight loss must be performed.

To be eligible for additional face-to-face visits occurring once a month for an additional 6 months, Medicare beneficiaries must have lost at least 3 kg.

For Medicare beneficiaries who do not achieve a weight loss of at least 3 kg during the first 6 months, a reassessment of their readiness to change and BMI is appropriate after an additional 6-month period.

Medicare Beneficiary Pays

• Co-payment/coinsurance waived
• Deductible waived