HCPCS Codes Explained
Healthcare Common Procedure Coding System codes for medical procedures and services. Understand what each code means on your medical bills.
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Showing 41 of 41 HCPCS codes
G8752Documentation that your most recent systolic blood pressure reading was less than 140 mmHg
This code is used to document that your most recent systolic blood pressure measurement was below 140 mmHg. Systolic blood pressure is the top number in a blood pressure reading and measures the pressure in your arteries when your heart beats. A reading below 140 mmHg for the systolic pressure is generally considered within normal to slightly elevated ranges, depending on your overall health and other factors.
G8754Documentation that your most recent diastolic blood pressure reading was less than 90 mmHg
This code is used to document that your most recent diastolic blood pressure measurement was below 90 mmHg. Diastolic blood pressure is the bottom number in a blood pressure reading (like the '80' in '120/80') and represents the pressure in your arteries when your heart is resting between beats. A diastolic reading below 90 mmHg is generally considered within normal to high-normal range, depending on your overall blood pressure reading and individual health factors.
G8420Documentation that BMI (Body Mass Index) is within normal range with no follow-up needed
This code is used when a healthcare provider calculates and documents that a patient's Body Mass Index (BMI) falls within normal, healthy parameters. BMI is a measurement that uses height and weight to assess if someone is at a healthy weight for their height. When this code is used, it means your BMI is in the normal range and your healthcare provider has determined that no additional follow-up or intervention is required regarding your weight status.
G8950Documentation that elevated or high blood pressure was found and follow-up care was planned
This code indicates that your healthcare provider documented that you had elevated blood pressure (pre-hypertension) or high blood pressure (hypertension) during your visit, and they also documented what follow-up care or monitoring is needed. This is a tracking code used to show that your blood pressure reading was noted and that appropriate next steps were planned for your care.
G8427Documentation that your doctor reviewed your current medications
This code indicates that an eligible healthcare provider has documented in your medical record that they obtained, updated, or reviewed your current list of medications. This is an important safety measure to ensure your doctor has accurate information about all the medicines you're taking, including prescription drugs, over-the-counter medications, and supplements. This documentation helps prevent dangerous drug interactions and ensures appropriate treatment decisions.
G0476HPV DNA test for high-risk types used in cervical cancer screening (performed with Pap test)
This is a laboratory test that looks for the genetic material (DNA or RNA) of high-risk human papillomavirus (HPV) types that are most likely to cause cervical cancer. The test specifically checks for HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68. This test must be done along with a Pap test (not by itself) as part of cervical cancer screening. The combination of both tests helps doctors better detect early signs of cervical cancer or pre-cancerous changes.
G0145Cervical or vaginal cancer screening test using automated thin-layer preparation with computer and manual review
This is a screening test for cervical or vaginal cancer, commonly known as a Pap smear or Pap test. The sample is collected and preserved in a special fluid, then prepared using an automated thin-layer technique. The test involves two levels of review: first by an automated computer system, then by a trained professional under physician supervision to ensure accuracy. This screening helps detect abnormal cells that could indicate cancer or pre-cancerous conditions.
G8510Documentation that depression screening was negative and no follow-up plan is needed
This code is used by healthcare providers to document that a patient was screened for depression and the results were negative (meaning no signs of depression were found). Because the screening was negative, no follow-up treatment plan or additional care is required at this time. This is a documentation code that helps track that proper depression screening was performed and the results.
G0439Annual wellness visit (follow-up appointment) with personalized prevention plan
This code represents a follow-up annual wellness visit that includes creating or updating a personalized prevention plan of service (PPS). This is a subsequent visit, meaning it's not your first annual wellness visit. During this appointment, your healthcare provider will review your health status, update your prevention plan based on your current needs, and discuss preventive care services that may be appropriate for you. The personalized prevention plan is tailored to your individual health risks and helps guide your preventive care for the coming year.
G0101Cancer screening exam including pelvic exam and clinical breast exam
This code represents a preventive care service that combines screening for cervical or vaginal cancer (through a pelvic examination) with a clinical breast examination performed by a healthcare provider. This is a comprehensive women's health screening service that checks for signs of cancer in the reproductive organs and breasts. The pelvic exam may include visual inspection and manual examination of the cervix, vagina, and surrounding areas, while the clinical breast exam involves the healthcare provider checking the breasts and surrounding areas for any abnormalities.
G0444Annual depression screening visit lasting 5 to 15 minutes
This code represents a yearly screening appointment specifically designed to check for signs of depression. During this 5 to 15 minute visit, your healthcare provider will ask you questions about your mood, feelings, and mental health to identify if you may be experiencing depression. This is a preventive service meant to catch depression early, even if you haven't reported feeling depressed.
G0382Level 3 emergency department visit at a Type B emergency department
This code represents a moderate complexity emergency department visit (Level 3 out of 5 levels) that takes place in a Type B emergency department. A Type B emergency department is a facility that meets specific requirements - it must be either licensed by the state as an emergency room, publicly advertised as providing urgent emergency care without appointments, or provide at least one-third of its outpatient visits for emergency conditions without requiring scheduled appointments. Level 3 visits typically involve moderately complex medical decision-making and evaluation of patients with multiple complaints or chronic conditions that require some diagnostic testing.
G0442Annual screening appointment to check for alcohol misuse problems
This is a yearly preventive health screening where a healthcare provider asks you questions about your alcohol use to identify potential drinking problems. The screening takes between 5 to 15 minutes and involves discussing your drinking habits, frequency, and any related concerns. This is a standard preventive care service designed to catch alcohol-related health issues early and provide appropriate guidance or treatment if needed.
Q0091Collection and preparation of a Pap smear sample for cervical cancer screening
This code covers the healthcare provider's work to collect a sample of cells from your cervix or vagina for a Pap smear test, prepare the sample properly, and send it to a laboratory for analysis. This is a routine screening test used to detect abnormal cells that could indicate cervical cancer or precancerous conditions. The code specifically covers the collection process and sample preparation, not the actual laboratory analysis of the cells.
G02793D mammography imaging (tomosynthesis) for breast cancer screening or diagnosis
Digital breast tomosynthesis is an advanced 3D mammography technique that takes multiple X-ray images of the breast from different angles to create a three-dimensional picture. This procedure can be performed on one breast (unilateral) or both breasts (bilateral). It provides clearer, more detailed images than traditional 2D mammography and is used as an additional imaging tool alongside standard mammography to help detect breast abnormalities, including cancer. The 3D images allow radiologists to examine breast tissue layer by layer, which can improve cancer detection and reduce false positives.
A9579Gadolinium-based MRI contrast agent injection (1 ml)
This code represents one milliliter of a gadolinium-based contrast agent that is injected during an MRI (magnetic resonance imaging) scan. Gadolinium is a special dye that helps make certain tissues, blood vessels, or abnormal areas show up more clearly on MRI images. The 'not otherwise specified' means this covers gadolinium contrast agents that don't fall into other specific categories. This contrast material is administered through an IV line during your MRI procedure to enhance the quality and detail of the images.
A7034Nasal mask or tube used with breathing assistance machines
This code covers nasal interface devices (either mask-style or cannula/tube-style) that connect to positive airway pressure machines like CPAP or BiPAP devices. These devices deliver pressurized air through your nose to help keep your airways open during sleep or breathing treatment. The interface may include a head strap to keep it securely in place.
G0467Visit to a Federally Qualified Health Center for an established patient
This code represents a face-to-face medical visit at a Federally Qualified Health Center (FQHC) for a patient who has been seen there before. FQHCs are community-based healthcare providers that serve medically underserved areas and populations. During this visit, you meet one-on-one with a healthcare practitioner who provides medically necessary services. The code covers a bundle of Medicare-covered services that are typically provided during a single day's visit to an FQHC.
P9604Travel fee for lab worker to collect blood sample at your home or nursing home (one-way trip)
This code covers the travel cost for a healthcare worker to come to your home or nursing home to collect a blood sample that's medically necessary. The fee is calculated based on the distance traveled and covers only one direction of the trip. This service is typically used when you cannot travel to a lab facility due to being homebound or residing in a nursing home. The actual blood draw and lab testing would be billed separately from this travel charge.
G0008Giving a flu shot (influenza vaccination)
This code covers the service of administering an influenza (flu) vaccine to a patient. This includes the healthcare provider's time and expertise in giving you the vaccination, but does not include the cost of the vaccine itself (which is billed separately). The flu shot is typically given as an injection in your upper arm and helps protect you from getting the flu during the upcoming flu season.
G0179Doctor's review and approval to continue Medicare home health services
This code represents when your doctor or other qualified healthcare provider reviews your progress and officially approves the continuation of your Medicare-covered home health services. During this process, your doctor doesn't need to see you in person, but they will communicate with your home health agency and review reports about your condition and progress. This review is required by Medicare to ensure that your home health care plan is still appropriate and necessary for your medical needs. Your doctor must confirm that the original treatment plan is being properly followed and that continued home health services are medically justified.
J0696Ceftriaxone antibiotic injection, billed per 250 mg dose
This code represents an injection of ceftriaxone sodium, a powerful antibiotic medication given through an IV or injection. Ceftriaxone is used to treat serious bacterial infections such as pneumonia, meningitis, sepsis, and other severe infections. The medication is measured and billed in 250 mg units, so multiple units may be used depending on your prescribed dose. This is typically administered in a hospital, clinic, or home healthcare setting by trained medical professionals.
G8482Flu vaccination given or documented as previously received
This code indicates that you either received a flu shot (influenza vaccination) during your visit, or your healthcare provider documented that you had already received your flu vaccination elsewhere. The flu vaccine helps protect you against seasonal influenza viruses and is typically recommended annually for most people 6 months and older. This code is used for billing and tracking purposes to show that your flu vaccination status was addressed during your care.
A4223Medical supplies for giving IV medications or fluids without using an electric pump
This code covers the disposable supplies needed to deliver intravenous (IV) medications or fluids directly into your bloodstream without using an automated infusion pump. These supplies typically include items like IV bags, tubing, connectors, and cassettes that allow healthcare providers to give you medications or fluids through a vein. The actual medications are billed separately from these supply items. This equipment is considered durable medical equipment because the delivery system can be reused, though individual supply components are replaced as needed.
G0180Doctor's certification and oversight of home health care services
This code represents when your doctor or other qualified healthcare provider certifies that you need Medicare-covered home health services and creates or reviews your home health care plan. This includes your doctor communicating with the home health agency, reviewing reports about your progress, and confirming that the home health care plan is appropriate for your medical needs. You don't need to be present during these administrative activities - your doctor handles this paperwork and coordination behind the scenes to ensure you receive proper home health care.
G8417Documentation that BMI is above normal range with follow-up plan recorded
This code indicates that a healthcare provider has calculated and documented that a patient's Body Mass Index (BMI) is above normal parameters (typically above 25, indicating overweight or obesity) and has also documented a specific follow-up plan to address this finding. BMI is a measurement that uses height and weight to estimate body fat. This code represents the administrative tracking that both the elevated BMI measurement and a plan for addressing it have been properly recorded in the medical record.
G0463Visit to a hospital's outpatient clinic for medical evaluation and treatment
This code represents a visit to a hospital's outpatient clinic where you receive medical care without being admitted as an inpatient. During this visit, a healthcare provider will assess your condition, review your symptoms, perform necessary examinations, and develop or adjust your treatment plan. This type of visit is for patients who need medical attention but don't require an overnight hospital stay. The visit may include consultation with specialists, diagnostic discussions, treatment planning, or follow-up care for ongoing conditions.
G0299Registered nurse care in your home or hospice, billed per 15-minute period
This code covers skilled nursing care provided by a registered nurse (RN) who comes to your home or hospice facility. The nurse provides direct, hands-on medical care that requires professional nursing skills and training. This might include wound care, medication management, monitoring your condition, patient education, or other medical treatments that can't be safely done by family members or non-medical caregivers. The service is billed in 15-minute increments, so if your nurse spends 30 minutes with you, it would be billed as two units of this code.
G0300Licensed practical nurse (LPN) home care services, billed per 15-minute period
This code covers skilled nursing care provided by a Licensed Practical Nurse (LPN) in your home or hospice setting. LPNs are trained healthcare professionals who can provide various nursing services under the supervision of a registered nurse or doctor. Services may include medication administration, wound care, monitoring vital signs, patient education, and other skilled nursing tasks. The care is billed in 15-minute increments, so if you receive 30 minutes of LPN care, it would be billed as 2 units of this code. This type of care allows you to receive professional nursing services in the comfort of your own home rather than in a hospital or clinic setting.
Q5001Healthcare services provided by hospice or home health agencies in your own home
This code represents healthcare services delivered by qualified hospice or home health care providers in your own home or residence. These services can include nursing care, therapy, medical equipment, and other supportive care provided by licensed healthcare professionals who come to your home. This type of care allows patients to receive necessary medical attention in the comfort and familiar environment of their own home rather than in a hospital or facility setting.
A9270Administrative code indicating a medical item or service is not covered by insurance
This is an administrative billing code used by healthcare providers to indicate that a specific medical item, service, or procedure is not covered by your insurance plan or Medicare/Medicaid. When you see this code on a medical bill or explanation of benefits, it means the insurance company has determined that the particular item or service does not qualify for coverage under your current benefits. This could be due to various reasons such as the service being considered experimental, cosmetic, not medically necessary, or simply not included in your plan's covered benefits. You would typically be responsible for paying the full cost of any items or services assigned this code.
J3301Injection of triamcinolone acetonide, 10 mg dose
This code represents a 10-milligram injection of triamcinolone acetonide, which is a corticosteroid medication given by injection. The 'not otherwise specified' (nos) designation means this code is used when the specific brand or formulation of triamcinolone acetonide doesn't have its own unique code. Triamcinolone acetonide is an anti-inflammatory medication that can be injected into joints, muscles, or other areas of the body to reduce inflammation and pain.
A7035Headgear component for sleep apnea breathing machine
This code covers the headgear (straps and frame) that holds a mask in place for patients using a positive airway pressure (PAP) device. PAP devices, such as CPAP or BiPAP machines, help people with sleep apnea breathe properly during sleep by delivering pressurized air through a mask. The headgear is an essential component that secures the mask to your head and face to ensure proper fit and prevent air leaks during treatment.
A7038Disposable filter for positive airway pressure (PAP) devices like CPAP machines
This code represents a disposable filter that is used with positive airway pressure devices, commonly known as CPAP, BiPAP, or other PAP machines. These filters help keep the air clean by removing dust, pollen, and other particles before the air reaches your airways during sleep therapy treatment. The filter is designed to be replaced regularly as part of maintaining your PAP equipment.
G8783Documentation of normal blood pressure reading with no follow-up needed
This code is used when a healthcare provider documents that your blood pressure reading was normal and within healthy ranges. Because your blood pressure was normal, no additional follow-up appointments or monitoring are required at this time. This is a positive finding that indicates your blood pressure is well-controlled and healthy.
A4604Heated tubing for sleep apnea machines
This is specialized tubing that has a built-in heating element designed to work with positive airway pressure (PAP) devices, commonly used to treat sleep apnea. The heating element helps prevent condensation from forming inside the tubing by keeping the air warm as it travels from the machine to your mask. This heated tubing helps maintain comfortable humidity levels and prevents water droplets from collecting in the tube, which can disrupt your sleep therapy.
A7032Replacement cushion part for nasal mask breathing equipment
This code covers a replacement cushion that fits on a nasal mask interface. The cushion is the soft part that sits against your nose to create a seal when using breathing equipment like CPAP machines or other respiratory devices. This is for replacing worn or damaged cushions only - each individual cushion is covered under this code.
A7046Replacement water chamber for CPAP/BiPAP humidifier
This code covers the cost of a replacement water chamber (tank) that is part of a humidifier system used with positive airway pressure devices like CPAP or BiPAP machines. The water chamber holds water that gets heated to add moisture to the air you breathe through your sleep apnea device, making therapy more comfortable. This is a single replacement unit when your current water chamber needs to be replaced due to wear, damage, or medical necessity.
G0446Annual face-to-face behavioral therapy session for heart disease prevention (15 minutes)
This code represents a 15-minute, one-on-one counseling session with a healthcare provider focused on behavioral therapy for cardiovascular (heart) disease prevention. This is an annual service where you meet face-to-face with a qualified healthcare professional who helps you develop and maintain healthy behaviors to reduce your risk of heart disease. The session typically covers topics like diet modification, exercise planning, stress management, smoking cessation, and other lifestyle changes that can improve your heart health.
G9903Screening for tobacco use - patient identified as non-tobacco user
This code indicates that you were screened (asked questions) about your tobacco use during your medical visit, and you were identified as someone who does not use tobacco products. This is a routine health screening that healthcare providers perform to assess risk factors and provide appropriate preventive care. Being identified as a non-tobacco user is positive for your health status and may influence your treatment recommendations and health risk assessments.
J2704Propofol injection (10 mg dose) - a sedative medication given through IV
This code represents a 10 milligram dose of propofol given by injection, typically through an IV line. Propofol is a powerful sedative medication commonly used to help patients relax or sleep during medical procedures, surgeries, or while on a ventilator. It works quickly to induce sedation and wears off relatively fast once stopped. This medication is always administered by trained medical professionals in controlled healthcare settings due to its potent effects on breathing and blood pressure.
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