HCPCS Changes — 2025-Q1

352 new • 34 revised • 18 deleted

New Codes (352)

Code Description
G9402 Recd f/u w/in 30d disch
A4594 Neuromod adj rehab mouthpie
A9513 Lutetium lu 177 dotatat ther
A9515 Choline c-11
A9517 I131 iodide cap, rx
A9521 Tc99m exametazime
A9530 I131 iodide sol, rx
A9542 In111 ibritumomab, dx
A9543 Y90 ibritumomab, rx
A9547 In111 oxyquinoline
A9548 In111 pentetate
A9557 Tc99m bicisate
A9563 P32 na phosphate
A9568 Technetium tc99m arcitumomab
A9569 Technetium tc-99m auto wbc
A9570 Indium in-111 auto wbc
A9572 Indium in-111 pentetreotide
A9582 Iodine i-123 iobenguane
A9584 Iodine i-123 ioflupane
A9586 Florbetapir f18
A9587 Gallium ga-68
A9588 Fluciclovine f-18
A9591 Fluoroestradiol f 18
A9592 Copper cu 64 dotatate diag
A9593 Gallium ga-68 psma-11 ucsf
A9594 Gallium ga-68 psma-11, ucla
A9600 Sr89 strontium
A9604 Sm 153 lexidronam
A9606 Radium ra223 dichloride ther
A9607 Lutetium lu 177 vipivotide
A9615 Inj, pegulicianine, 1 mg
A9697 Inj, magtrace per study dose
C1735 Cath renal denerv radiofreq
C1736 Cath renal denerv ultrasnd
C1737 Si&pelvis fusn&fixn dev
C1738 Power endo us-guid bx dev
C7518 Cor/gft angio w/ ivus or oct
C7519 Cor/gft angio w/ flow resrv
C7546 Rep nph/urt cath w/dil stric
C7549 Chge urtr stent w/ dil stric
C7555 Rmvl thyrd w/autotran parath
C7558 Cor angio/vent w/drug admin
C7562 R&l hrt angio w/ffr & 3d map
C7563 Trluml ballo angiop all art
C7564 Vein mech throm w/intrvas us
C7565 Rpr aa hrn < 3 rdc w/ rmvl
C8000 Suprt dev, a-v fistula, imp
C8001 3d anat seg imaging preop
C8002 Prep skin cell susp, automtd
C8003 Imp extar knee shck absrb
C9067 Gallium ga-68 dotatoc
C9169 Inj, nogapendekin pmln 1 mcg
C9170 Inj, tarlatamab-dlle, 1 mg
C9171 Inj, pegulicianine, 1 mg
C9172 Inj, beqvez, per tx dose
C9290 Inj, bupivacaine liposome
C9610 Cath coronary drug-delivery
C9769 Cysto w/temp pros implant
C9786 Echo cad for hf preserved ef
C9794 Complex simulation w/pet-ct
C9795 Sbrt w/positron emission del
C9804 Pump elastomc non-opioid dev
C9806 Pump perist non-opioid dev
C9807 Nerve stim non-opioid dev
C9808 Cryo probe non-opioid dev
C9809 Cryo needle non-opioid dev
E0491 Oral dv nm mouthpc hw remote
E1800 Adjust elbow ext & flex dev
E1803 Adjust elbow extension dev
E1804 Adjust elbow flexion dev
E1805 Adjust wrist ext & flex dev
E1807 Adjust wrist extension dev
E1808 Adjust wrist flexion device
E1810 Adjust knee ext & flex dev
E1813 Adjust knee extension device
E1814 Adjust knee flexion device
E1815 Adjust ankle ext & flex dev
E1822 Adjust ankle extension dev
E1823 Adjust ankle flexion device
E1825 Adjust finger ext & flex dev
E1826 Adjust finger extension dev
E1827 Adjust finger flexion device
E1828 Adjust toe extension device
E1829 Adjust toe flexion device
E1830 Adjust toe ext & flex device
G0106 Colon ca screen;barium enema
G0120 Colon ca scrn; barium enema
G0122 Colon ca scrn; barium enema
G0556 Adv prim care mgmt lvl 1
G0532 Take home supp nasal spray
G0533 Buprenorphone inj weekly
G0534 Coordinated care/or referral
G0535 Pt navigat svs direct/ref
G0536 Peer recover support svs
G0537 Risk ascvd tst once pr 12 mo
G0538 Ascvd rsk mng clin stf pr mo
G0539 Initial care training 30 m
G0540 Train for caregiver add 15
G0541 No pt prsnt train initial 30
G0542 No pt prsnt train add 15
G0543 Group train w/o patient
G0544 Post d/c phone follow up
G0545 Inherent visit to inpt
G0546 Phone/internet ehr assess
G0547 Phone/internet svs 11-20 m
G0548 Phone/inter svs 21-30 m
G0549 Phone/inter for treat>31m
G0550 Phone/inter for dx/treat >5m
G0551 Phn/intr svs fr dx treat 30m
G0552 Supply of digital device
G0553 Monthly tx for dmht 20mins
G0554 Add 20 m of monthly tx
G0555 Replacment pt electronic sys
G0557 Adv prim care mgmt lvl 2
G0558 Adv prim care mgmt lvl 3
G0559 Unrelat prac follow up visit
G0560 Safety plan interven
G0561 Temp tube delivery, unil
G0562 Complex simulation w/pet-ct
G0563 Sbrt w/positron emission del
G1001 Cdsm evicore
G1002 Cdsm medcurrent
G1003 Cdsm medicalis
G1004 Cdsm ndsc
G1007 Cdsm aim
G1008 Cdsm cranberry pk
G1010 Cdsm stanson
G1011 Cdsm qualified nos
G1012 Cdsm agilemd
G1013 Cdsm evidencecare
G1014 Cdsm inveniqa
G1015 Cdsm reliant
G1016 Cdsm speed of care
G1017 Cdsm healthhelp
G1018 Cdsm infinx
G1019 Cdsm logicnets
G1020 Cdsm curbside
G1021 Cdsm ehealthline
G1022 Cdsm intermountain
G1023 Cdsm persivia
G1024 Cdsm radrite
G2012 Brief check in by md/qhp
G2069 Med assist tx inject
G2070 Med assist tx implant
G2071 Med tx remove implant
G2072 Med tx insert/remove imp
G2091 Pt 66+ frailty and adv ill
G2099 Pt 66+ frailty and adv ill
G2101 Pt 66+ frailty and adv ill
G2107 Pt 66+ frailty and adv ill
G2116 Pt 66-80 frailty and adv ill
G2126 Pt 66-80 frailty and adv ill
G8482 Flu immunize order/admin
G8483 Flu imm no admin doc rea
G8484 Flu immunize no admin
G8577 Reop req bld grft oth
G8578 No reop req bld grft oth
G8694 Lvef <=40%
G8842 Ahi rdi rei doc win 2mo
G8843 Doc reas no ahi rdi rei
G8844 No ahi rdi rei ini dx no rsn
G8923 Lvef <= 40% or lvsd
G8934 Lvef <=40% or dep lv sys fcn
G8965 Csit perf on low chd rsk
G8966 Csit perf sx or high chd rsk
G9246 No enc or enc/vir ld 90days
G9247 2 enc enc/vir ld 90d
G9254 Doc pt dischg >2d
G9255 Pt dc home 2nd po day
G9321 Prev ct nuc med cnt doc 12mo
G9322 No cnt ct nuc med doc 12mo
G9403 Doc reas no 30 day f/u
G9404 No 30 day f/u
G9405 Recd f/u w/in 7d dc
G9406 Doc reas no 7d f/u
G9407 No 7d f/u
G9458 Tob user recd cess interv
G9459 Tob non-user
G9460 No tob assess or cess inter
G9659 >=86y scr colo nomed rsn
G9660 Doc med rsn colo pt >= 86y
G9707 Pt had hosp dur msmt per
G9751 Pt died w/in 24 mos rpt time
G9760 Pt w/hosp anytime msmt per
G9892 Doc pt rsn no dil mac exam
G9893 No mac exam
G9919 Scrn nd pos nd prov of rec
G9920 Scrning perf and negative
G9921 No or part scrn nd rng or os
G9974 Mac exam perf
G9975 Doc med rsn no dil mac exam
G9990 No pneum vax admin 19+
G9991 Pneum vax admin 19+
G9999 Doc sys rsn <3 colon
H0052 Mmip mental health and care
H0053 Ht mental health and care
J0135 Adalimumab injection
J0138 Inj acetaminoph 10mg/ibu 3mg
J0139 Inj, adalimumab, 1 mg
J0601 Sevelamer carbonate 20 mg
J0602 Sevelamer carbonate pdr 20mg
J0603 Sevelamer hydrochloride 20mg
J0605 Sucroferric oxyhydroxide 5mg
J0607 Lanthanum carbonate oral 5mg
J0608 Lanthanum carbonate pwdr 5mg
J0609 Ferric citrate orl 3 mg iron
J0615 Calcium acetate, oral, 23 mg
J0666 Inj, bupivacaine liposome
J0688 Inj cefazolin sodium, hikma
J0739 Hiv prep, inj, cabotegravir
J0750 Hiv prep, ftc/tdf 200/300mg
J0751 Hiv prep, ftc/taf 200/25mg
J0870 Injection, imetelstat, 1 mg
J0873 Inj daptomycin (xellia)
J0901 Vadadustat oral 1mg for esrd
J1010 Inj, methylpred acetate 1 mg
J1171 Inj, hydromorphone, 0.1 mg
J1307 Inj, crovalimab-akkz, 10 mg
J1414 Inj, beqvez, per tx dose
J1552 Inj, alyglo, 500 mg
J1596 Inj, glycopyrrolate, 0.1 mg
J1598 Inj glycopyrrolate fres kabi
J1885 Ketorolac tromethamine inj
J1939 Inj, bumetanide, 0.5 mg
J2002 Inj, lidocaine in d5w, 1 mg
J2183 Inj meropenem (wg crit care)
J2290 Inj, nafcillin sodium, 20 mg
J2373 Inj, immphentiv, 20 mcg
J2468 Inj, palonosetron (posfrea)
J2472 Inj, pantoprazole sodium chl
J2561 Inj, sezaby, 1 mg
J2679 Inj fluphenazine hcl 1.25 mg
J2796 Romiplostim injection
J2802 Inj, romiplostim 1 microgram
J2806 Inj sincalide, maia, 5 mcg
J2919 Inj, methylpred sod succ 5mg
J3392 Inj, exagamglogene autotem
J3425 Hydroxocobalamin im 10mcg
J7514 Mycophenol (myhibbin) 100 mg
J7601 Ensifentrine inh 3 mg
J8510 Oral busulfan
J8522 Capecitabine, oral, 50 mg
J9026 Inj, tarlatamab-dlle, 1 mg
J9028 Inj, nogapendekin pmln, 1mcg
J9033 Inj, bendamustine hcl, 1mg
J9056 Inj, vivimusta, 1 mg
J9058 Inj apotex/bendamustine 1 mg
J9059 Inj bendamustine, baxter 1mg
J9076 Inj, cyclophos (baxter) 5mg
J9259 Paclitaxel (american regent)
J9329 Inj, tislelizumab-jsgr
M0003 Opt care episod neuro mvp
M0004 Qual care neurologic cnd mvp
M0237 Intrav inf, toci, first dose
M0238 Intrav inf, toci, second dos
M1150 Lvef <=40% or mod/sev l vsf
M1154 Hospc serv dur meas pd
M1155 Pt anphx due to pneum
M1177 Pt recd pcv on/aft 19
M1179 No pcv recd
M1211 Gsa level>9.0%
M1212 Missing gsa not perf
M1219 Anphx due to vax
M1259 Pt stat doc <= 1 yr dialysis
M1260 Pt not doc <= 1 yr dialysis
M1264 Pts 75+ dialysis dt
M1267 Pt no act kid transplt wtlst
M1268 Pt ac stat kid trnsplt wtlst
M1272 Pts kid transplt wtlst
M1292 Pt 66+ frail inpt adv ill
M1343 Pt pam lvl 4 base or srt lin
M1344 No bsln/2nd pam score 4-12mo
M1345 Pt bsln pam, 2nd scr 4-12 mo
M1346 No pam inc 6 pts 4-12 mo
M1347 Pt pam incr 3 pt 4-12 mo
M1348 Pam incr 6 pt 4-12 mo
M1349 No pam inc 3 pts 4-12 mo
M1371 Mst rec gsa<7
M1372 Mst rec gsa >=7 and<8
M1373 Mst rec gsa >=8 and <=9
M1374 Ra dx enc 90 days dur per pd
M1375 Ra dx enc 90 days dur per pd
M1376 Ra dx enc 90 days dur per pd
M1377 Fu colscop 10 yr doc w/ disc
M1378 Med rsn no 10 yr fu colscope
M1379 10 yr fu no rec rsn not giv
M1380 2 rx in perf pd any com meds
M1381 Pt sec strk wthin 5 days
M1382 Enc dur perf pd pos 11
M1383 Acute pvd
M1384 Pt died dur perf pd
M1385 Pt rsn not seen 2nd pam
M1386 Exc sx melmn or mlnm is
M1387 Pt died dur perf pd
M1388 Pt doc exm rec melmn
M1390 Pt no doc exm for rec
M1391 All pt dx w/ rec mlnm
M1392 Pt rsn no exm or lst to fu
M1393 Pr no dx rec mlnm
M1394 Stg i-iii br ca
M1395 Init chemo w/def dur ec grp
M1396 Pt ther clin trial
M1397 Pt w/ recur/prog
M1398 Bslne and fu promis doc
M1399 Pt lve prac
M1400 Pt died dur perf pd
M1401 Stg i-iii br ca
M1402 Init chemo w/def dur ec grp
M1403 Bslne and fu promis doc
M1404 Pt ther clin trial
M1405 Pt w/ recur/prog
M1406 Pt lve prac
M1407 Pt died dur perf pd
M1408 Gmln brca bef dx ca
M1409 Recd gmln brca1/brca2 couns
M1410 No gmln brca1/brca2 couns
M1411 1st ln ici no chemo
M1412 Met nsclc w/ egfr alk oth ab
M1413 Pos pdl1 bef init ici tx
M1414 Med rsn no pdl1 bef 1st ther
M1415 No pos pdl1 bef ici ther
M1416 Pt rec hosp
M1417 Pt up to date cov
M1418 Med rsn not up to date cov
M1419 Pt not up to date cov
M1420 Complete ophthalmologic mvp
M1421 Dermatological care mvp
M1422 Gastroenterology care mvp
M1423 Opt care urologic cnd mvp
M1424 Pulmonology care mvp
M1425 Surgical care mvp
Q0155 Dronabinol (syndros) 0.1 mg
Q0237 Inj, tocilizumab-anoh, hospi
Q0516 Supply fee hiv prep oral 30
Q0517 Supply fee hiv prep oral 60
Q0518 Supply fee hiv prep oral 90
Q0519 Supply fee hiv prep inj 30
Q0520 Supply fee hiv prep inj 60
Q0521 Supply fee hiv prep fda appr
Q5131 Inj, idacio, 20 mg
Q5132 Inj, abrilada, 10 mg
Q5140 Inj adalimumab-fkjp, 1 mg
Q5141 Inj adalimumab-aaty, 1 mg
Q5142 Inj adalimumab-ryvk, 1 mg
Q5143 Inj adalimumab-adbm, 1 mg
Q5144 Inj, idacio, 1 mg
Q5145 Inj, abrilada, 1 mg
Q5146 Inj, hercessi, 10 mg
Q9982 Flutemetamol f18 diagnostic
Q9983 Florbetaben f18 diagnostic
Q9996 Ustekinumab- ttwe sub cu inj
Q9997 Ustekinumab-ttwe iv inj 1 mg

Revised Codes (34)

Code Old Description New Description
E1800 Adjust elbow ext/flex device Adjust elbow ext & flex dev
E1805 Adjust wrist ext/flex device Adjust wrist ext & flex dev
E1810 Adjust knee ext/flex device Adjust knee ext & flex dev
E1815 Adjust ankle ext/flex device Adjust ankle ext & flex dev
E1825 Adjust finger ext/flex devc Adjust finger ext & flex dev
E1830 Adjust toe ext/flex device Adjust toe ext & flex device
G8842 Ahi or rdi initial dx Ahi rdi rei doc win 2mo
G8843 Doc reas no ahi or rdi Doc reas no ahi rdi rei
G8844 No ahi or rdi initial dx No ahi rdi rei ini dx no rsn
G9246 No med visit in 24mo No enc or enc/vir ld 90days
G9247 1 med visit in 24mo 2 enc enc/vir ld 90d
G9255 Doc pt dischg <=2d Pt dc home 2nd po day
G9321 Doc count of ct in 12mo Prev ct nuc med cnt doc 12mo
G9322 No doc count of ct in 12mo No cnt ct nuc med doc 12mo
G9659 >=86y no hx colo ca/rsn scop >=86y scr colo nomed rsn
G9660 Doc med rsn scope pt >= 86y Doc med rsn colo pt >= 86y
J0138 Injection, acetaminoph 10 mg Inj acetaminoph 10mg/ibu 3mg
J2468 Inj, palonosetron (avyxa) Inj, palonosetron (posfrea)
J9033 Inj., treanda 1 mg Inj, bendamustine hcl, 1mg
J9056 Inj, bendamustine, 1 mg Inj, vivimusta, 1 mg
J9072 Inj cyclophos dr.reddy's 5mg Inj cyclophos avyxa 5mg
M0004 Support care neur cond mvp Qual care neurologic cnd mvp
M1176 Pt w/o hzv on/aft age 50 No 2 hzv on/aft age 50
M1177 Pt recd pcv on/aft 60 Pt recd pcv on/aft 19
M1211 Hemoglobin a1c level >9.0% Gsa level>9.0%
M1212 Missing hb a1c level Missing gsa not perf
M1259 Pt kid transplt wtlst lv don Pt stat doc <= 1 yr dialysis
M1260 Pt no kd trnsplt wtlst lv do Pt not doc <= 1 yr dialysis
M1344 Pts no bsln or 2nd pam score No bsln/2nd pam score 4-12mo
M1345 Pt bsln pam, 2nd scr 6-12 mo Pt bsln pam, 2nd scr 4-12 mo
M1346 Pts no pam 6 pts 6-12 mo No pam inc 6 pts 4-12 mo
M1347 Pt pam incr 3 pt 6-12 mo Pt pam incr 3 pt 4-12 mo
M1348 Pt pam incr 6 pt 6-12 mo Pam incr 6 pt 4-12 mo
M1349 Pt no pam 3 pts 6-12 mo No pam inc 3 pts 4-12 mo

Deleted Codes (18)

Code Description
A9155 Artificial saliva
G0564 365 d implant glucose sensor
G0565 Rem/ins glu snsr 365 dif sit
J1094 Inj dexamethasone acetate
J1300 Eculizumab injection
J1810 Droperidol/fentanyl inj
J1890 Cephalothin sodium injection
J1940 Furosemide injection
J9037 Inj belantamab mafodot blmf
J9247 Inj, melphalan flufenami 1mg
L8010 Mastectomy sleeve
Q4231 Corplex p, per cc
Q5139 Inj, eculizumab-aeeb, 10 mg
S0017 Injection, aminocaproic acid
S0028 Injection, famotidine, 20 mg
S0032 Injection, nafcillin sodium
S0039 Injection, sulfamethoxazole
S4988 Penile contractur devic manu