| Short Descr | Type 2 diab with mod nonp rtnop with macular edema, r eye |
| CMS-HCC v22 | 18 - Diabetes with Chronic Complications |
| CMS-HCC v24 | 18 - Diabetes with Chronic Complications |
| CMS-HCC v28 | 37 - Diabetes with Chronic Complications |
| ESRD-HCC v21 | 18 - Diabetes with Chronic Complications |
| ESRD-HCC v24 | 18 - Diabetes with Chronic Complications |
| HHS-HCC v07 | 20 - Diabetes with Chronic Complications |
| Rx-HCC v08 | 30 - Diabetes with Complications |
| Home Health Clinical Group | MMTA_ENDO |
| Home Health Comorbidity Subgroup | Neurological 11 |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2016-10-01 | Added | Code Added. |
|
Code
|
Description
|
|---|---|
| A4206 | Syringe with needle, sterile, 1 cc or less, each |
| A4207 | Syringe with needle, sterile 2 cc, each |
| A4208 | Syringe with needle, sterile 3 cc, each |
| A4209 | Syringe with needle, sterile 5 cc or greater, each |
| A4211 | Supplies for self-administered injections |
| A4212 | Non-coring needle or stylet with or without catheter |
| A4213 | Syringe, sterile, 20 cc or greater, each |
| A4215 | Needle, sterile, any size, each |
| A4221 | Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
| A4222 | Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
| A4226 | Supplies for maintenance of insulin infusion pump with dosage rate adjustment using therapeutic continuous glucose sensing, per week |
| A4230 | Infusion set for external insulin pump, non needle cannula type |
| A4231 | Infusion set for external insulin pump, needle type |
| A4232 | Syringe with needle for external insulin pump, sterile, 3 cc |
| A4233 | Replacement battery, alkaline (other than j cell), for use with medically necessary home blood glucose monitor owned by patient, each |
| A4234 | Replacement battery, alkaline, j cell, for use with medically necessary home blood glucose monitor owned by patient, each |
| A4235 | Replacement battery, lithium, for use with medically necessary home blood glucose monitor owned by patient, each |
| A4236 | Replacement battery, silver oxide, for use with medically necessary home blood glucose monitor owned by patient, each |
| A4238 | Supply allowance for adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
| A4239 | Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
| A4244 | Alcohol or peroxide, per pint |
| A4245 | Alcohol wipes, per box |
| A4246 | Betadine or phisohex solution, per pint |
| A4247 | Betadine or iodine swabs/wipes, per box |
| A4250 | Urine test or reagent strips or tablets (100 tablets or strips) |
| A4252 | Blood ketone test or reagent strip, each |
| A4253 | Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
| A4255 | Platforms for home blood glucose monitor, 50 per box |
| A4256 | Normal, low and high calibrator solution / chips |
| A4258 | Spring-powered device for lancet, each |
| A4259 | Lancets, per box of 100 |
| A9274 | External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories |
| A9275 | Home glucose disposable monitor, includes test strips |
| A9276 | Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
| A9277 | Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
| A9278 | Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
| C1767 | Generator, neurostimulator (implantable), non-rechargeable |
| C1778 | Lead, neurostimulator (implantable) |
| C9257 | Injection, bevacizumab, 0.25 mg |
| C9803 | Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source [deleted] |
| E0100 | Cane, includes canes of all materials, adjustable or fixed, with tip |
| E0105 | Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
| E0130 | Walker, rigid (pickup), adjustable or fixed height |
| E0135 | Walker, folding (pickup), adjustable or fixed height |
| E0140 | Walker, with trunk support, adjustable or fixed height, any type |
| E0141 | Walker, rigid, wheeled, adjustable or fixed height |
| E0143 | Walker, folding, wheeled, adjustable or fixed height |
| E0144 | Walker, enclosed, four sided framed, rigid or folding, wheeled with posterior seat |
| E0147 | Walker, heavy duty, multiple braking system, variable wheel resistance |
| E0148 | Walker, heavy duty, without wheels, rigid or folding, any type, each |
| E0149 | Walker, heavy duty, wheeled, rigid or folding, any type |
| E0163 | Commode chair, mobile or stationary, with fixed arms |
| E0165 | Commode chair, mobile or stationary, with detachable arms |
| E0167 | Pail or pan for use with commode chair, replacement only |
| E0168 | Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each |
| E0170 | Commode chair with integrated seat lift mechanism, electric, any type |
| E0171 | Commode chair with integrated seat lift mechanism, non-electric, any type |
| E0250 | Hospital bed, fixed height, with any type side rails, with mattress |
| E0251 | Hospital bed, fixed height, with any type side rails, without mattress |
| E0255 | Hospital bed, variable height, hi-lo, with any type side rails, with mattress |
| E0256 | Hospital bed, variable height, hi-lo, with any type side rails, without mattress |
| E0260 | Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
| E0261 | Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
| E0265 | Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress |
| E0266 | Hospital bed, total electric (head, foot and height adjustments), with any type side rails, without mattress |
| E0270 | Hospital bed, institutional type includes: oscillating, circulating and stryker frame, with mattress |
| E0290 | Hospital bed, fixed height, without side rails, with mattress |
| E0291 | Hospital bed, fixed height, without side rails, without mattress |
| E0292 | Hospital bed, variable height, hi-lo, without side rails, with mattress |
| E0293 | Hospital bed, variable height, hi-lo, without side rails, without mattress |
| E0294 | Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress |
| E0295 | Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
| E0296 | Hospital bed, total electric (head, foot and height adjustments), without side rails, with mattress |
| E0297 | Hospital bed, total electric (head, foot and height adjustments), without side rails, without mattress |
| E0301 | Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, without mattress |
| E0302 | Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, without mattress |
| E0303 | Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
| E0304 | Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, with mattress |
| E0424 | Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
| E0425 | Stationary compressed gas system, purchase; includes regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
| E0430 | Portable gaseous oxygen system, purchase; includes regulator, flowmeter, humidifier, cannula or mask, and tubing |
| E0431 | Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
| E0433 | Portable liquid oxygen system, rental; home liquefier used to fill portable liquid oxygen containers, includes portable containers, regulator, flowmeter, humidifier, cannula or mask and tubing, with or without supply reservoir and contents gauge |
| E0434 | Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
| E0435 | Portable liquid oxygen system, purchase; includes portable container, supply reservoir, flowmeter, humidifier, contents gauge, cannula or mask, tubing and refill adaptor |
| E0439 | Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing |
| E0440 | Stationary liquid oxygen system, purchase; includes use of reservoir, contents indicator, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
| E0441 | Stationary oxygen contents, gaseous, 1 month's supply = 1 unit |
| E0442 | Stationary oxygen contents, liquid, 1 month's supply = 1 unit |
| E0443 | Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
| E0444 | Portable oxygen contents, liquid, 1 month's supply = 1 unit |
| E0462 | Rocking bed with or without side rails |
| E0465 | Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
| E0466 | Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
| E0470 | Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
| E0471 | Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
| E0472 | Respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, e.g., tracheostomy tube (intermittent assist device with continuous positive airway pressure device) |
| E0561 | Humidifier, non-heated, used with positive airway pressure device |
| E0562 | Humidifier, heated, used with positive airway pressure device |
| E0607 | Home blood glucose monitor |
| E0784 | External ambulatory infusion pump, insulin |
| E0787 | External ambulatory infusion pump, insulin, dosage rate adjustment using therapeutic continuous glucose sensing |
| E1130 | Standard wheelchair, fixed full length arms, fixed or swing away detachable footrests |
| E1140 | Wheelchair, detachable arms, desk or full length, swing away detachable footrests |
| E1150 | Wheelchair, detachable arms, desk or full length swing away detachable elevating legrests |
| E1160 | Wheelchair, fixed full length arms, swing away detachable elevating legrests |
| E1161 | Manual adult size wheelchair, includes tilt in space |
| E1240 | Lightweight wheelchair, detachable arms, (desk or full length) swing away detachable, elevating legrest |
| E1250 | Lightweight wheelchair, fixed full length arms, swing away detachable footrest |
| E1260 | Lightweight wheelchair, detachable arms (desk or full length) swing away detachable footrest |
| E1270 | Lightweight wheelchair, fixed full length arms, swing away detachable elevating legrests |
| E1280 | Heavy duty wheelchair, detachable arms (desk or full length) elevating legrests |
| E1285 | Heavy duty wheelchair, fixed full length arms, swing away detachable footrest |
| E1290 | Heavy duty wheelchair, detachable arms (desk or full length) swing away detachable footrest |
| E1295 | Heavy duty wheelchair, fixed full length arms, elevating legrest |
| E1296 | Special wheelchair seat height from floor |
| E1297 | Special wheelchair seat depth, by upholstery |
| E1298 | Special wheelchair seat depth and/or width, by construction |
| E1399 | Durable medical equipment, miscellaneous |
| E2101 | Blood glucose monitor with integrated lancing/blood sample |
| E2102 | Adjunctive, non-implanted continuous glucose monitor or receiver |
| E2103 | Non-adjunctive, non-implanted continuous glucose monitor or receiver |
| G0108 | Diabetes outpatient self-management training services, individual, per 30 minutes |
| G0109 | Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes |
| G0127 | Trimming of dystrophic nails, any number |
| G0162 | Skilled services by a registered nurse (rn) for management and evaluation of the plan of care; each 15 minutes (the patient's underlying condition or complication requires an rn to ensure that essential non-skilled care achieves its purpose in the home health or hospice setting) |
| G0270 | Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes |
| G0271 | Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes |
| G0299 | Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes |
| G0300 | Direct skilled nursing services of a licensed practical nurse (lpn) in the home health or hospice setting, each 15 minutes |
| G0308 | Creation of subcutaneous pocket with insertion of 180 day implantable interstitial glucose sensor, including system activation and patient training [deleted] |
| G0309 | Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and insertion of new 180 day implantable sensor, including system activation [deleted] |
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
| G0446 | Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes |
| G0447 | Face-to-face behavioral counseling for obesity, 15 minutes |
| G0473 | Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes |
| G0493 | Skilled services of a registered nurse (rn) for the observation and assessment of the patient's condition, each 15 minutes (the change in the patient's condition requires skilled nursing personnel to identify and evaluate the patient's need for possible modification of treatment in the home health or hospice setting) |
| G0494 | Skilled services of a licensed practical nurse (lpn) for the observation and assessment of the patient's condition, each 15 minutes (the change in the patient's condition requires skilled nursing personnel to identify and evaluate the patient's need for possible modification of treatment in the home health or hospice setting) |
| G0564 | Creation of subcutaneous pocket with insertion of 365 day implantable interstitial glucose sensor, including system activation and patient training |
| G0565 | Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and insertion of new 365 day implantable sensor, including system activation |
| G2023 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source [deleted] |
| G2024 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) from an individual in a snf or by a laboratory on behalf of a hha, any specimen source [deleted] |
| G2025 | Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
| G2081 | Patients age 66 and older in institutional special needs plans (snp) or residing in long-term care with a pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period |
| G2090 | Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period |
| G2091 | Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period |
| G2105 | Patient age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period |
| G2106 | Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period |
| G2107 | Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period |
| G9687 | Hospice services provided to patient any time during the measurement period |
| G9714 | Patient is using hospice services any time during the measurement period |
| J0135 | Injection, adalimumab, 20 mg [deleted] |
| J0178 | Injection, aflibercept, 1 mg |
| J1438 | Injection, etanercept, 25 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg |
| J1815 | Injection, insulin, per 5 units |
| J1817 | Insulin for administration through dme (i.e., insulin pump) per 50 units |
| J2503 | Injection, pegaptanib sodium, 0.3 mg |
| J2778 | Injection, ranibizumab, 0.1 mg |
| J3590 | Unclassified biologics |
| K0553 | Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service [deleted] |
| K0554 | Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system [deleted] |
| L8679 | Implantable neurostimulator, pulse generator, any type |
| L8680 | Implantable neurostimulator electrode, each |
| L8688 | Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension |
| Q5103 | Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg |
| Q5104 | Injection, infliximab-abda, biosimilar, (renflexis), 10 mg |
| Q5109 | Injection, infliximab-qbtx, biosimilar, (ixifi), 10 mg |
| S0271 | Physician management of patient home care, hospice monthly case rate (per 30 days) |
| S0311 | Comprehensive management and care coordination for advanced illness, per calendar month |
| S1030 | Continuous noninvasive glucose monitoring device, purchase (for physician interpretation of data, use cpt code) |
| S1031 | Continuous noninvasive glucose monitoring device, rental, including sensor, sensor replacement, and download to monitor (for physician interpretation of data, use cpt code) |
| S1034 | Artificial pancreas device system (e.g., low glucose suspend (lgs) feature) including continuous glucose monitor, blood glucose device, insulin pump and computer algorithm that communicates with all of the devices |
| S1035 | Sensor; invasive (e.g., subcutaneous), disposable, for use with artificial pancreas device system |
| S1036 | Transmitter; external, for use with artificial pancreas device system |
| S1037 | Receiver (monitor); external, for use with artificial pancreas device system |
| S5550 | Insulin, rapid onset, 5 units |
| S5551 | Insulin, most rapid onset (lispro or aspart); 5 units |
| S5552 | Insulin, intermediate acting (nph or lente); 5 units |
| S5553 | Insulin, long acting; 5 units |
| S5560 | Insulin delivery device, reusable pen; 1.5 ml size |
| S5561 | Insulin delivery device, reusable pen; 3 ml size |
| S5565 | Insulin cartridge for use in insulin delivery device other than pump; 150 units |
| S5566 | Insulin cartridge for use in insulin delivery device other than pump; 300 units |
| S5570 | Insulin delivery device, disposable pen (including insulin); 1.5 ml size |
| S5571 | Insulin delivery device, disposable pen (including insulin); 3 ml size |
| S8490 | Insulin syringes (100 syringes, any size) |
| S9123 | Nursing care, in the home; by registered nurse, per hour (use for general nursing care only, not to be used when cpt codes 99500-99602 can be used) |
| S9124 | Nursing care, in the home; by licensed practical nurse, per hour |
| S9140 | Diabetic management program, follow-up visit to non-md provider |
| S9141 | Diabetic management program, follow-up visit to md provider |
| S9145 | Insulin pump initiation, instruction in initial use of pump (pump not included) |
| S9353 | Home infusion therapy, continuous insulin infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
| S9359 | Home infusion therapy, anti-tumor necrosis factor intravenous therapy; (e.g., infliximab); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
| S9455 | Diabetic management program, group session |
| S9460 | Diabetic management program, nurse visit |
| S9465 | Diabetic management program, dietitian visit |
| S9470 | Nutritional counseling, dietitian visit |
| T1000 | Private duty / independent nursing service(s) - licensed, up to 15 minutes |
| T1001 | Nursing assessment / evaluation |
| T1002 | Rn services, up to 15 minutes |
| T1003 | Lpn/lvn services, up to 15 minutes |
| T1004 | Services of a qualified nursing aide, up to 15 minutes |
| T1005 | Respite care services, up to 15 minutes |
| T1019 | Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify services provided by home health aide or certified nurse assistant) |
| T1020 | Personal care services, per diem, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify services provided by home health aide or certified nurse assistant) |
| T1021 | Home health aide or certified nurse assistant, per visit |
| T1022 | Contracted home health agency services, all services provided under contract, per day |
| T1030 | Nursing care, in the home, by registered nurse, per diem |
| T1031 | Nursing care, in the home, by licensed practical nurse, per diem |
| V2744 | Tint, photochromatic, per lens |
| V2745 | Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
| V2755 | U-v lens, per lens |
| No matching codes found | |