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CMS125v6 Code List

Code List: CMS125v6, Breast Cancer Screening

MicroMD uses the following code lists to determine a patient’s inclusion in this measure.  To search for your code, simply press Ctrl + F on your keyboard, enter your code in the search field and press Enter on your keyboard.

This user-friendly code list is provided as a courtesy to our MicroMD users.  For more in-depth information about codes and/or criteria or to compare version changes, visit the CMS eCQI Resource Center at https://ecqi.healthit.gov/ (no user account required) or the United States Health Information Knowledgebase at https://ushik.ahrq.gov/mdr/portals (requires a free user account to view codes).

Item Codes
Encounter Codes
Encounter, Performed: Annual Wellness Visit: HCPCS G0438, G0439
Encounter, Performed: Face-to-Face Interaction: SNOMED 12843005, 18170008, 185349003, 185463005, 185465003, 19681004, 207195004, 270427003, 270430005, 308335008, 390906007, 406547006, 439708006, 87790002, 90526000
Encounter, Performed: Home Healthcare Services: CPT 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350
Encounter, Performed: Office Visit: CPT 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215
Encounter, Performed: Preventive Care Services – Established Office Visit, 18 and Up: CPT 99395, 99396, 99397
Encounter, Performed: Preventive Care Services-Initial Office Visit, 18 and Up: CPT 99385, 99386, 99387
Mammography Codes
Diagnostic Study, Performed: Mammography: HCPCS G0202, G0204, G0206
Diagnostic Study, Performed: Mammography: LOINC 24605-8, 24606-6, 24610-8, 24604-1, 26176-8, 26177-6, 26175-0, 26289-9, 26287-3, 26291-5, 26346-7, 26350-9, 26347-5, 26351-7, 26348-3, 26349-1, 36319-2, 36627-8, 36625-2, 36626-0, 36642-7, 36962-9, 37005-6, 37006-4, 37016-3, 37017-1, 37028-8, 37029-6, 37030-4, 37037-9, 37038-7, 37052-8, 37053-6, 37542-8, 37539-4, 37543-6, 37551-9, 37552-7, 37553-5, 37554-3, 37768-9, 37769-7, 37773-9, 37770-5, 37774-7, 37771-3, 37772-1, 37775-4, 38070-9, 38067-5, 38071-7, 38072-5, 38090-7, 38091-5, 38807-4, 38820-7, 38854-6, 38855-3, 39150-8, 39152-4, 39153-2, 39154-0, 42168-5, 42169-3, 42174-3, 42416-8, 42415-0, 46335-6, 46339-8, 46336-4, 46337-2, 46338-0, 46342-2, 46350-5, 46354-7, 46351-3, 46355-4, 46356-2, 46380-2, 48475-8, 48492-3, 69150-1, 69251-7, 69259-0
Exclusion Diagnosis Codes
Diagnosis: History of bilateral mastectomy: SNOMED 428529004
Diagnosis: History of bilateral mastectomy: ICD-10 Z90.13
Diagnosis: Status Post Left Mastectomy: SNOMED 429009003
Diagnosis: Status Post Left Mastectomy: ICD-10 Z90.12
Diagnosis: Status Post Right Mastectomy: SNOMED 429242008
Diagnosis: Status Post Right Mastectomy: ICD-10 Z90.11
Diagnosis: Unilateral Mastectomy, Unspecified Laterality: SNOMED 22964006, 248802009, 72269009, 73359007, 8115005, 88764002
Diagnosis: Unilateral Mastectomy, Unspecified Laterality: ICD-9 V45.71
Diagnosis: Unilateral Mastectomy, Unspecified Laterality: ICD-10 Z90.10
Exclusion Procedure Codes
Procedure, Performed: Bilateral Mastectomy: SNOMED 14693006, 14714006, 17086001, 22418005, 27865001, 456903003, 52314009, 60633004, 76468001
Procedure, Performed: Unilateral Mastectomy: CPT 19180, 19200, 19220, 19240, 19303, 19304, 19305, 19306, 19307
Procedure, Performed: Unilateral Mastectomy: SNOMED 172043006, 237367009, 237368004, 274957008, 287653007, 287654001, 318190001, 359728003, 359731002, 359734005, 359740003, 384723003, 395702000, 406505007, 428564008, 428571003, 429400009, 446109005, 446420001, 447135002, 447421006, 66398006, 70183006
Anatomical location site: Left (attribute) 419161000 (Unilateral left), 7771000 (Left)
Anatomical location site: Right (attribute) 419465000 (Unilateral right), 24028007 (Right)
Hospice Exclusion Codes
Encounter, Performed: Encounter Inpatient 183452005, 32485007, 8715000
Intervention, Order: Hospice Care 385763009, 385765002
Discharge Codes to Health Care Facility for Hospice Care 428371000124100
Discharge Codes to Home for Hospice Care 428361000124107

Last updated: June 11, 2018 at 3:01 pm