canvas 0.63.0__py3-none-any.whl → 0.89.0__py3-none-any.whl

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Files changed (185) hide show
  1. {canvas-0.63.0.dist-info → canvas-0.89.0.dist-info}/METADATA +4 -1
  2. {canvas-0.63.0.dist-info → canvas-0.89.0.dist-info}/RECORD +184 -98
  3. {canvas-0.63.0.dist-info → canvas-0.89.0.dist-info}/WHEEL +1 -1
  4. canvas_cli/apps/emit/event_fixtures/UNKNOWN.ndjson +1 -0
  5. canvas_cli/apps/logs/logs.py +386 -22
  6. canvas_cli/main.py +3 -1
  7. canvas_cli/templates/plugins/default/{{ cookiecutter.__project_slug }}/tests/test_models.py +46 -4
  8. canvas_cli/utils/context/context.py +13 -13
  9. canvas_cli/utils/validators/manifest_schema.py +26 -1
  10. canvas_generated/messages/effects_pb2.py +5 -5
  11. canvas_generated/messages/effects_pb2.pyi +108 -2
  12. canvas_generated/messages/events_pb2.py +6 -6
  13. canvas_generated/messages/events_pb2.pyi +282 -2
  14. canvas_sdk/clients/__init__.py +1 -0
  15. canvas_sdk/clients/llms/__init__.py +17 -0
  16. canvas_sdk/clients/llms/libraries/__init__.py +11 -0
  17. canvas_sdk/clients/llms/libraries/llm_anthropic.py +87 -0
  18. canvas_sdk/clients/llms/libraries/llm_api.py +143 -0
  19. canvas_sdk/clients/llms/libraries/llm_google.py +92 -0
  20. canvas_sdk/clients/llms/libraries/llm_openai.py +98 -0
  21. canvas_sdk/clients/llms/structures/__init__.py +9 -0
  22. canvas_sdk/clients/llms/structures/llm_response.py +33 -0
  23. canvas_sdk/clients/llms/structures/llm_tokens.py +53 -0
  24. canvas_sdk/clients/llms/structures/llm_turn.py +47 -0
  25. canvas_sdk/clients/llms/structures/settings/__init__.py +13 -0
  26. canvas_sdk/clients/llms/structures/settings/llm_settings.py +27 -0
  27. canvas_sdk/clients/llms/structures/settings/llm_settings_anthropic.py +43 -0
  28. canvas_sdk/clients/llms/structures/settings/llm_settings_gemini.py +40 -0
  29. canvas_sdk/clients/llms/structures/settings/llm_settings_gpt4.py +40 -0
  30. canvas_sdk/clients/llms/structures/settings/llm_settings_gpt5.py +48 -0
  31. canvas_sdk/clients/third_party.py +3 -0
  32. canvas_sdk/commands/__init__.py +12 -0
  33. canvas_sdk/commands/base.py +33 -2
  34. canvas_sdk/commands/commands/adjust_prescription.py +4 -0
  35. canvas_sdk/commands/commands/custom_command.py +86 -0
  36. canvas_sdk/commands/commands/family_history.py +17 -1
  37. canvas_sdk/commands/commands/immunization_statement.py +42 -2
  38. canvas_sdk/commands/commands/medication_statement.py +16 -1
  39. canvas_sdk/commands/commands/past_surgical_history.py +16 -1
  40. canvas_sdk/commands/commands/perform.py +18 -1
  41. canvas_sdk/commands/commands/prescribe.py +8 -9
  42. canvas_sdk/commands/commands/refill.py +5 -5
  43. canvas_sdk/commands/commands/resolve_condition.py +5 -5
  44. canvas_sdk/commands/commands/review/__init__.py +3 -0
  45. canvas_sdk/commands/commands/review/base.py +72 -0
  46. canvas_sdk/commands/commands/review/imaging.py +13 -0
  47. canvas_sdk/commands/commands/review/lab.py +13 -0
  48. canvas_sdk/commands/commands/review/referral.py +13 -0
  49. canvas_sdk/commands/commands/review/uncategorized_document.py +13 -0
  50. canvas_sdk/commands/validation.py +43 -0
  51. canvas_sdk/effects/batch_originate.py +22 -0
  52. canvas_sdk/effects/calendar/__init__.py +13 -3
  53. canvas_sdk/effects/calendar/{create_calendar.py → calendar.py} +19 -5
  54. canvas_sdk/effects/calendar/event.py +172 -0
  55. canvas_sdk/effects/claim_label.py +93 -0
  56. canvas_sdk/effects/claim_line_item.py +47 -0
  57. canvas_sdk/effects/claim_queue.py +49 -0
  58. canvas_sdk/effects/fax/__init__.py +3 -0
  59. canvas_sdk/effects/fax/base.py +77 -0
  60. canvas_sdk/effects/fax/note.py +42 -0
  61. canvas_sdk/effects/metadata.py +15 -1
  62. canvas_sdk/effects/note/__init__.py +8 -1
  63. canvas_sdk/effects/note/appointment.py +135 -7
  64. canvas_sdk/effects/note/base.py +17 -0
  65. canvas_sdk/effects/note/message.py +22 -14
  66. canvas_sdk/effects/note/note.py +150 -1
  67. canvas_sdk/effects/observation/__init__.py +11 -0
  68. canvas_sdk/effects/observation/base.py +206 -0
  69. canvas_sdk/effects/patient/__init__.py +2 -0
  70. canvas_sdk/effects/patient/base.py +8 -0
  71. canvas_sdk/effects/payment/__init__.py +11 -0
  72. canvas_sdk/effects/payment/base.py +355 -0
  73. canvas_sdk/effects/payment/post_claim_payment.py +49 -0
  74. canvas_sdk/effects/send_contact_verification.py +42 -0
  75. canvas_sdk/effects/task/__init__.py +2 -1
  76. canvas_sdk/effects/task/task.py +30 -0
  77. canvas_sdk/effects/validation/__init__.py +3 -0
  78. canvas_sdk/effects/validation/base.py +92 -0
  79. canvas_sdk/events/base.py +15 -0
  80. canvas_sdk/handlers/application.py +7 -7
  81. canvas_sdk/handlers/simple_api/api.py +1 -4
  82. canvas_sdk/handlers/simple_api/websocket.py +1 -4
  83. canvas_sdk/handlers/utils.py +14 -0
  84. canvas_sdk/questionnaires/utils.py +1 -0
  85. canvas_sdk/templates/utils.py +17 -4
  86. canvas_sdk/test_utils/factories/FACTORY_GUIDE.md +362 -0
  87. canvas_sdk/test_utils/factories/__init__.py +115 -0
  88. canvas_sdk/test_utils/factories/calendar.py +24 -0
  89. canvas_sdk/test_utils/factories/claim.py +81 -0
  90. canvas_sdk/test_utils/factories/claim_diagnosis_code.py +16 -0
  91. canvas_sdk/test_utils/factories/coverage.py +17 -0
  92. canvas_sdk/test_utils/factories/imaging.py +74 -0
  93. canvas_sdk/test_utils/factories/lab.py +192 -0
  94. canvas_sdk/test_utils/factories/medication_history.py +75 -0
  95. canvas_sdk/test_utils/factories/note.py +52 -0
  96. canvas_sdk/test_utils/factories/organization.py +50 -0
  97. canvas_sdk/test_utils/factories/practicelocation.py +88 -0
  98. canvas_sdk/test_utils/factories/referral.py +81 -0
  99. canvas_sdk/test_utils/factories/staff.py +111 -0
  100. canvas_sdk/test_utils/factories/task.py +66 -0
  101. canvas_sdk/test_utils/factories/uncategorized_clinical_document.py +48 -0
  102. canvas_sdk/utils/metrics.py +4 -1
  103. canvas_sdk/v1/data/__init__.py +66 -7
  104. canvas_sdk/v1/data/allergy_intolerance.py +5 -11
  105. canvas_sdk/v1/data/appointment.py +18 -4
  106. canvas_sdk/v1/data/assessment.py +2 -12
  107. canvas_sdk/v1/data/banner_alert.py +2 -4
  108. canvas_sdk/v1/data/base.py +53 -14
  109. canvas_sdk/v1/data/billing.py +8 -11
  110. canvas_sdk/v1/data/calendar.py +64 -0
  111. canvas_sdk/v1/data/care_team.py +4 -10
  112. canvas_sdk/v1/data/claim.py +172 -66
  113. canvas_sdk/v1/data/claim_diagnosis_code.py +19 -0
  114. canvas_sdk/v1/data/claim_line_item.py +2 -5
  115. canvas_sdk/v1/data/coding.py +19 -0
  116. canvas_sdk/v1/data/command.py +2 -4
  117. canvas_sdk/v1/data/common.py +10 -0
  118. canvas_sdk/v1/data/compound_medication.py +3 -4
  119. canvas_sdk/v1/data/condition.py +4 -9
  120. canvas_sdk/v1/data/coverage.py +66 -26
  121. canvas_sdk/v1/data/detected_issue.py +20 -20
  122. canvas_sdk/v1/data/device.py +2 -14
  123. canvas_sdk/v1/data/discount.py +2 -5
  124. canvas_sdk/v1/data/encounter.py +44 -0
  125. canvas_sdk/v1/data/facility.py +1 -0
  126. canvas_sdk/v1/data/goal.py +2 -14
  127. canvas_sdk/v1/data/imaging.py +4 -30
  128. canvas_sdk/v1/data/immunization.py +7 -15
  129. canvas_sdk/v1/data/lab.py +12 -65
  130. canvas_sdk/v1/data/line_item_transaction.py +2 -5
  131. canvas_sdk/v1/data/medication.py +3 -8
  132. canvas_sdk/v1/data/medication_history.py +142 -0
  133. canvas_sdk/v1/data/medication_statement.py +41 -0
  134. canvas_sdk/v1/data/message.py +4 -8
  135. canvas_sdk/v1/data/note.py +37 -38
  136. canvas_sdk/v1/data/observation.py +9 -36
  137. canvas_sdk/v1/data/organization.py +70 -9
  138. canvas_sdk/v1/data/patient.py +8 -12
  139. canvas_sdk/v1/data/patient_consent.py +4 -14
  140. canvas_sdk/v1/data/payment_collection.py +2 -5
  141. canvas_sdk/v1/data/posting.py +3 -9
  142. canvas_sdk/v1/data/practicelocation.py +66 -7
  143. canvas_sdk/v1/data/protocol_override.py +3 -4
  144. canvas_sdk/v1/data/protocol_result.py +3 -3
  145. canvas_sdk/v1/data/questionnaire.py +10 -26
  146. canvas_sdk/v1/data/reason_for_visit.py +2 -6
  147. canvas_sdk/v1/data/referral.py +41 -17
  148. canvas_sdk/v1/data/staff.py +34 -26
  149. canvas_sdk/v1/data/stop_medication_event.py +27 -0
  150. canvas_sdk/v1/data/task.py +30 -11
  151. canvas_sdk/v1/data/team.py +2 -4
  152. canvas_sdk/v1/data/uncategorized_clinical_document.py +84 -0
  153. canvas_sdk/v1/data/user.py +14 -0
  154. canvas_sdk/v1/data/utils.py +5 -0
  155. canvas_sdk/value_set/v2026/__init__.py +1 -0
  156. canvas_sdk/value_set/v2026/adverse_event.py +157 -0
  157. canvas_sdk/value_set/v2026/allergy.py +116 -0
  158. canvas_sdk/value_set/v2026/assessment.py +466 -0
  159. canvas_sdk/value_set/v2026/communication.py +496 -0
  160. canvas_sdk/value_set/v2026/condition.py +52934 -0
  161. canvas_sdk/value_set/v2026/device.py +315 -0
  162. canvas_sdk/value_set/v2026/diagnostic_study.py +5243 -0
  163. canvas_sdk/value_set/v2026/encounter.py +2714 -0
  164. canvas_sdk/value_set/v2026/immunization.py +297 -0
  165. canvas_sdk/value_set/v2026/individual_characteristic.py +339 -0
  166. canvas_sdk/value_set/v2026/intervention.py +1703 -0
  167. canvas_sdk/value_set/v2026/laboratory_test.py +1831 -0
  168. canvas_sdk/value_set/v2026/medication.py +8218 -0
  169. canvas_sdk/value_set/v2026/no_qdm_category_assigned.py +26493 -0
  170. canvas_sdk/value_set/v2026/physical_exam.py +342 -0
  171. canvas_sdk/value_set/v2026/procedure.py +27869 -0
  172. canvas_sdk/value_set/v2026/symptom.py +625 -0
  173. logger/logger.py +30 -31
  174. logger/logstash.py +282 -0
  175. logger/pubsub.py +26 -0
  176. plugin_runner/allowed-module-imports.json +940 -9
  177. plugin_runner/generate_allowed_imports.py +1 -0
  178. plugin_runner/installation.py +2 -2
  179. plugin_runner/plugin_runner.py +21 -24
  180. plugin_runner/sandbox.py +34 -0
  181. protobufs/canvas_generated/messages/effects.proto +65 -0
  182. protobufs/canvas_generated/messages/events.proto +150 -51
  183. settings.py +27 -11
  184. canvas_sdk/effects/calendar/create_event.py +0 -43
  185. {canvas-0.63.0.dist-info → canvas-0.89.0.dist-info}/entry_points.txt +0 -0
@@ -0,0 +1,2714 @@
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+ from ..value_set import ValueSet
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+
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+
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+ class AnnualWellnessVisit(ValueSet):
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+ """
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+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for annual wellness visits.
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+
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+ **Data Element Scope:** This value set may use a model element related to Encounter.
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+
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+ **Inclusion Criteria:** Includes concepts that represent an encounter for a Medicare annual wellness visit.
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+
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+ **Exclusion Criteria:** No exclusions.
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+
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+ ** Used in:** CMS131v14
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+ """
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+
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+ VALUE_SET_NAME = "Annual Wellness Visit"
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+ OID = "2.16.840.1.113883.3.526.3.1240"
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+ DEFINITION_VERSION = "20190315"
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+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
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+
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+ HCPCSLEVELII = {
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+ "G0402", # Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
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+ "G0438", # Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
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+ "G0439", # Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
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+ }
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+
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+ SNOMEDCT = {
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+ "444971000124105", # Annual wellness visit (procedure)
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+ "456201000124103", # Medicare annual wellness visit (procedure)
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+ "86013001", # Periodic reevaluation and management of healthy individual (procedure)
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+ "866149003", # Annual visit (procedure)
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+ "90526000", # Initial evaluation and management of healthy individual (procedure)
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+ }
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+
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+
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+ class EncounterInpatient(ValueSet):
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+ """
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+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for inpatient hospitalizations encounters.
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+
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+ **Data Element Scope:** This value set may use a model element related to Encounter.
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+
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+ **Inclusion Criteria:** Includes concepts that represent an encounter for inpatient hospitalizations.
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+
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+ **Exclusion Criteria:** No exclusions.
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+
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+ ** Used in:** CMS131v14
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+ """
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+
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+ VALUE_SET_NAME = "Encounter Inpatient"
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+ OID = "2.16.840.1.113883.3.666.5.307"
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+ DEFINITION_VERSION = "20200307"
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+ EXPANSION_VERSION = "eCQM Update 2021-05-06"
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+
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+ SNOMEDCT = {
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+ "183452005", # Emergency hospital admission (procedure)
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+ "32485007", # Hospital admission (procedure)
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+ "8715000", # Hospital admission, elective (procedure)
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+ }
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+
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+
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+ class FrailtyEncounter(ValueSet):
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+ """
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+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for nursing care services provided to frail patients.
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+
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+ **Data Element Scope:** This value set may use a model element related to Encounter.
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+
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+ **Inclusion Criteria:** Includes concepts that represent an encounter for nursing care and home care services provided to frail patients.
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+
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+ **Exclusion Criteria:** No exclusions.
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+
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+ ** Used in:** CMS131v14
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+ """
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+
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+ VALUE_SET_NAME = "Frailty Encounter"
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+ OID = "2.16.840.1.113883.3.464.1003.101.12.1088"
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+ DEFINITION_VERSION = "20210224"
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+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
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+
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+ CPT = {
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+ "99504", # Home visit for mechanical ventilation care
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+ "99509", # Home visit for assistance with activities of daily living and personal care
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+ }
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+ HCPCSLEVELII = {
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+ "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)
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+ "G0299", # Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes
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+ "G0300", # Direct skilled nursing services of a licensed practical nurse (lpn) in the home health or hospice setting, each 15 minutes
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+ "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)
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+ "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)
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+ "S0271", # Physician management of patient home care, hospice monthly case rate (per 30 days)
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+ "S0311", # Comprehensive management and care coordination for advanced illness, per calendar month
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+ "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)
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+ "S9124", # Nursing care, in the home; by licensed practical nurse, per hour
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+ "T1000", # Private duty / independent nursing service(s) - licensed, up to 15 minutes
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+ "T1001", # Nursing assessment / evaluation
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+ "T1002", # Rn services, up to 15 minutes
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+ "T1003", # Lpn/lvn services, up to 15 minutes
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+ "T1004", # Services of a qualified nursing aide, up to 15 minutes
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+ "T1005", # Respite care services, up to 15 minutes
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+ "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)
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+ "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)
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+ "T1021", # Home health aide or certified nurse assistant, per visit
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+ "T1022", # Contracted home health agency services, all services provided under contract, per day
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+ "T1030", # Nursing care, in the home, by registered nurse, per diem
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+ "T1031", # Nursing care, in the home, by licensed practical nurse, per diem
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+ }
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+
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+
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+ class HomeHealthcareServices(ValueSet):
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+ """
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+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for home health visits.
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+
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+ **Data Element Scope:** This value set may use a model element related to Encounter.
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+
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+ **Inclusion Criteria:** Includes concepts that represent an encounter for a home health visit for the evaluation and management of a new or established patient.
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+
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+ **Exclusion Criteria:** No exclusions.
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+
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+ ** Used in:** CMS131v14
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+ """
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+
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+ VALUE_SET_NAME = "Home Healthcare Services"
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+ OID = "2.16.840.1.113883.3.464.1003.101.12.1016"
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+ DEFINITION_VERSION = "20240110"
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+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
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+
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+ CPT = {
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+ "99341", # Home/residence visit, new patient; straightforward MDM or 15+ minutes total time
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+ "99342", # Home/residence visit, new patient; low MDM or 30+ minutes total time
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+ "99344", # Home/residence visit, new patient; moderate MDM or 60+ minutes total time
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+ "99345", # Home/residence visit, new patient; high MDM or 75+ minutes total time
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+ "99347", # Home/residence visit, established patient; straightforward MDM or 20+ minutes total time
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+ "99348", # Home/residence visit, established patient; low MDM or 30+ minutes total time
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+ "99349", # Home/residence visit, established patient; moderate MDM or 40+ minutes total time
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+ "99350", # Home/residence visit, established patient; high MDM or 60+ minutes total time
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+ }
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+ SNOMEDCT = {
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+ "185460008", # Home visit request by patient (procedure)
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+ "185462000", # Home visit request by relative (procedure)
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+ "185466002", # Home visit for urgent condition (procedure)
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+ "185467006", # Home visit for acute condition (procedure)
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+ "185468001", # Home visit for chronic condition (procedure)
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+ "185470005", # Home visit elderly assessment (procedure)
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+ "225929007", # Joint home visit (procedure)
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+ "315205008", # Bank holiday home visit (procedure)
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+ "439708006", # Home visit (procedure)
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+ "698704008", # Home visit for rheumatology service (procedure)
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+ "704126008", # Home visit for anticoagulant drug monitoring (procedure)
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+ }
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+
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+
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+ class HospiceEncounter(ValueSet):
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+ """
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+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for hospice care services..
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+
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+ **Data Element Scope:** This value set may use a model element related to Encounter.
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+
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+ **Inclusion Criteria:** Includes concepts that represent hospice services in a hospice, home or inpatient setting.
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+
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+ **Exclusion Criteria:** Excludes concepts that represent palliative care or comfort measures.
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+
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+ ** Used in:** CMS131v14
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+ """
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+
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+ VALUE_SET_NAME = "Hospice Encounter"
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+ OID = "2.16.840.1.113883.3.464.1003.1003"
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+ DEFINITION_VERSION = "20210820"
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+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
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+
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+ HCPCSLEVELII = {
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+ "G9473", # Services performed by chaplain in the hospice setting, each 15 minutes
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+ "G9474", # Services performed by dietary counselor in the hospice setting, each 15 minutes
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+ "G9475", # Services performed by other counselor in the hospice setting, each 15 minutes
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+ "G9476", # Services performed by volunteer in the hospice setting, each 15 minutes
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+ "G9477", # Services performed by care coordinator in the hospice setting, each 15 minutes
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+ "G9478", # Services performed by other qualified therapist in the hospice setting, each 15 minutes
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+ "G9479", # Services performed by qualified pharmacist in the hospice setting, each 15 minutes
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+ "Q5003", # Hospice care provided in nursing long term care facility (ltc) or non-skilled nursing facility (nf)
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+ "Q5004", # Hospice care provided in skilled nursing facility (snf)
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+ "Q5005", # Hospice care provided in inpatient hospital
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+ "Q5006", # Hospice care provided in inpatient hospice facility
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+ "Q5007", # Hospice care provided in long term care facility
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+ "Q5008", # Hospice care provided in inpatient psychiatric facility
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+ "Q5010", # Hospice home care provided in a hospice facility
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+ "S9126", # Hospice care, in the home, per diem
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+ "T2042", # Hospice routine home care; per diem
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+ "T2043", # Hospice continuous home care; per hour
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+ "T2044", # Hospice inpatient respite care; per diem
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+ "T2045", # Hospice general inpatient care; per diem
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+ "T2046", # Hospice long term care, room and board only; per diem
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+ }
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+
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+ SNOMEDCT = {
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+ "183919006", # Urgent admission to hospice (procedure)
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+ "183920000", # Routine admission to hospice (procedure)
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+ "183921001", # Admission to hospice for respite (procedure)
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+ "305336008", # Admission to hospice (procedure)
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+ "305911006", # Seen in hospice (finding)
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+ "385765002", # Hospice care management (procedure)
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+ }
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+
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+
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+ class OfficeVisit(ValueSet):
204
+ """
205
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for an outpatient visit.
206
+
207
+ **Data Element Scope:** This value set may use a model element related to Encounter.
208
+
209
+ **Inclusion Criteria:** Includes concepts that represent an encounter for the comprehensive history, evaluation, and management of a patient presenting with minor to high severity problems.
210
+
211
+ **Exclusion Criteria:** No exclusions.
212
+
213
+ ** Used in:** CMS135v10, CMS90v11, CMS249v4, CMS349v4, CMS142v10, CMS134v10, CMS177v10, CMS165v10, CMS143v10, CMS146v10, CMS157v10, CMS124v10, CMS50v10, CMS139v10, CMS154v10, CMS161v10, CMS56v10, CMS74v11, CMS645v5, CMS138v10, CMS137v10, CMS136v11, CMS128v10, CMS122v10, CMS153v10, CMS144v10, CMS66v10, CMS130v10, CMS646v2, CMS155v10, CMS127v10, CMS771v3, CMS117v10, CMS131v10, CMS149v10, CMS347v5, CMS156v10, CMS147v11, CMS125v10, CMS145v10
214
+ """
215
+
216
+ VALUE_SET_NAME = "Office Visit"
217
+ OID = "2.16.840.1.113883.3.464.1003.101.12.1001"
218
+ DEFINITION_VERSION = "20180310"
219
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
220
+
221
+ CPT = {
222
+ "99202", # Office or other outpatient visit for the evaluation and management of a new patient... 15 minutes or more
223
+ "99203", # Office or other outpatient visit for the evaluation and management of a new patient... 30 minutes or more
224
+ "99204", # Office or other outpatient visit for the evaluation and management of a new patient... 45 minutes or more
225
+ "99205", # Office or other outpatient visit for the evaluation and management of a new patient... 60 minutes or more
226
+ "99212", # Office or other outpatient visit for the evaluation and management of an established patient... 10 minutes or more
227
+ "99213", # Office or other outpatient visit for the evaluation and management of an established patient... 20 minutes or more
228
+ "99214", # Office or other outpatient visit for the evaluation and management of an established patient... 30 minutes or more
229
+ "99215", # Office or other outpatient visit for the evaluation and management of an established patient... 40 minutes or more
230
+ }
231
+
232
+ SNOMEDCT = {
233
+ "185349003", # Encounter for check up (procedure)
234
+ "185463005", # Visit out of hours (procedure)
235
+ "185464004", # Out of hours visit - not night visit (procedure)
236
+ "185465003", # Weekend visit (procedure)
237
+ "3391000175108", # Office visit for pediatric care and assessment (procedure)
238
+ "439740005", # Postoperative follow-up visit (procedure)
239
+ }
240
+
241
+
242
+ class PreventiveCareServicesEstablishedOfficeVisit18AndUp(ValueSet):
243
+ """
244
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for preventive care.
245
+
246
+ **Data Element Scope:** This value set may use a model element related to Encounter.
247
+
248
+ **Inclusion Criteria:** Includes concepts that represent an encounter for comprehensive preventive medicine reevaluation and management of an established patient 18 years of age or over.
249
+
250
+ **Exclusion Criteria:** Excludes initial visits for new patients.
251
+
252
+ ** Used in:** CMS131v14
253
+ """
254
+
255
+ VALUE_SET_NAME = "Preventive Care Services Established Office Visit, 18 and Up"
256
+ OID = "2.16.840.1.113883.3.464.1003.101.12.1025"
257
+ DEFINITION_VERSION = "20170504"
258
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
259
+
260
+ CPT = {
261
+ "99395", # Periodic comprehensive preventive medicine reevaluation and management, established patient; 18-39 years
262
+ "99396", # Periodic comprehensive preventive medicine reevaluation and management, established patient; 40-64 years
263
+ "99397", # Periodic comprehensive preventive medicine reevaluation and management, established patient; 65 years and older
264
+ "99385", # Initial comprehensive preventive medicine evaluation and management, new patient; 18-39 years
265
+ "99386", # Initial comprehensive preventive medicine evaluation and management, new patient; 40-64 years
266
+ "99387", # Initial comprehensive preventive medicine evaluation and management, new patient; 65 years and older
267
+ }
268
+
269
+
270
+ class OphthalmologicalServices(ValueSet):
271
+ """
272
+ **Clinical Focus:** The purpose of this value set is to represent concepts of encounters for ophthalmological visits.
273
+
274
+ **Data Element Scope:** This value set may use a model element related to Encounter.
275
+
276
+ **Inclusion Criteria:** Includes concepts that represent an encounter for a visit with an eye care professional.
277
+
278
+ **Exclusion Criteria:** No exclusions.
279
+
280
+ ** Used in:** CMS131v14
281
+ """
282
+
283
+ VALUE_SET_NAME = "Ophthalmological Services"
284
+ OID = "2.16.840.1.113883.3.526.3.1285"
285
+ DEFINITION_VERSION = "20210209"
286
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
287
+
288
+ CPT = {
289
+ "92002", # Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient
290
+ "92004", # Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits
291
+ "92012", # Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient
292
+ "92014", # Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, 1 or more visits
293
+ }
294
+ SNOMEDCT = {
295
+ "359960003", # Ophthalmologic examination and evaluation under general anesthesia, limited (procedure)
296
+ "36228007", # Ophthalmic examination and evaluation (procedure)
297
+ "66902005", # Ophthalmic examination and evaluation, follow-up (procedure)
298
+ "78831002", # Comprehensive eye examination (procedure)
299
+ }
300
+
301
+
302
+ class PalliativeCareEncounter(ValueSet):
303
+ """
304
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for palliative care services.
305
+
306
+ **Data Element Scope:** This value set may use a model element related to Encounter.
307
+
308
+ **Inclusion Criteria:** Includes concepts that represent an encounter for admission and management for palliative care services.
309
+
310
+ **Exclusion Criteria:** Excludes concepts that represent encounters for hospice and a referral to palliative care.
311
+
312
+ ** Used in:** CMS131v14
313
+ """
314
+
315
+ VALUE_SET_NAME = "Palliative Care Encounter"
316
+ OID = "2.16.840.1.113883.3.464.1003.101.12.1090"
317
+ DEFINITION_VERSION = "20210224"
318
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
319
+
320
+ HCPCSLEVELII = {
321
+ "G9054", # Oncology; primary focus of visit; supervising, coordinating or managing care of patient with terminal cancer or for whom other medical illness prevents further cancer treatment; includes symptom management, end-of-life care planning, management of palliative therapies (for use in a medicare-approved demonstration project)
322
+ }
323
+
324
+ SNOMEDCT = {
325
+ "305284002", # Admission by palliative care physician (procedure)
326
+ "305381007", # Admission to palliative care department (procedure)
327
+ "305686008", # Seen by palliative care physician (finding)
328
+ "305824005", # Seen by palliative care medicine service (finding)
329
+ "441874000", # Seen by palliative care service (finding)
330
+ "4901000124101", # Palliative care education (procedure)
331
+ "713281006", # Consultation for palliative care (procedure)
332
+ }
333
+
334
+ ICD10CM = {
335
+ "Z515", # Encounter for palliative care
336
+ }
337
+
338
+
339
+ class TelephoneVisits(ValueSet):
340
+ """
341
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for telephone visits.
342
+
343
+ **Data Element Scope:** This value set may use a model element related to Encounter.
344
+
345
+ **Inclusion Criteria:** Includes concepts that represent an encounter for assessment, evaluation and management services to a patient by telephone.
346
+
347
+ **Exclusion Criteria:** Excludes concepts that represent an encounter for telephone assessment, evaluation and management services that last for less than five minutes.
348
+
349
+ ** Used in:** CMS131v14
350
+ """
351
+
352
+ VALUE_SET_NAME = "Telephone Visits"
353
+ OID = "2.16.840.1.113883.3.464.1003.101.12.1080"
354
+ DEFINITION_VERSION = "20250205"
355
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
356
+
357
+ CPT = {
358
+ "99441", # MD/QHP telephone E/M, established patient; 5–10 minutes of medical discussion
359
+ "99442", # MD/QHP telephone E/M, established patient; 11–20 minutes of medical discussion
360
+ "99443", # MD/QHP telephone E/M, established patient; 21–30 minutes of medical discussion
361
+ "98008", # Audio-only E/M, new patient; straightforward MDM; >10 min, total time ≥15 min
362
+ "98009", # Audio-only E/M, new patient; low MDM; >10 min, total time ≥30 min
363
+ "98010", # Audio-only E/M, new patient; moderate MDM; >10 min, total time ≥45 min
364
+ "98011", # Audio-only E/M, new patient; high MDM; >10 min, total time ≥60 min
365
+ "98012", # Audio-only E/M, established patient; straightforward MDM; >10 min, time >10 min
366
+ "98013", # Audio-only E/M, established patient; low MDM; >10 min, total time ≥20 min
367
+ "98014", # Audio-only E/M, established patient; moderate MDM; >10 min, total time ≥30 min
368
+ "98015", # Audio-only E/M, established patient; high MDM; >10 min, total time ≥40 min
369
+ "98966", # Nonphysician telephone assessment/management, established pt; 5–10 min
370
+ "98967", # Nonphysician telephone assessment/management, established pt; 11–20 min
371
+ "98968", # Nonphysician telephone assessment/management, established pt; 21–30 min
372
+ }
373
+
374
+ SNOMEDCT = {
375
+ "185317003", # Telephone encounter (procedure)
376
+ "314849005", # Telephone contact by consultant (procedure)
377
+ "386472008", # Telephone consultation (procedure)
378
+ "386473003", # Telephone follow-up (procedure)
379
+ "401267002", # Telephone triage encounter (procedure)
380
+ }
381
+
382
+ class EmergencyDepartmentVisit(ValueSet):
383
+ """
384
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters in the emergency department (ED).
385
+
386
+ **Data Element Scope:** This value set may use a model element related to Encounter.
387
+
388
+ **Inclusion Criteria:** Includes concepts that represent an encounter ocurring in the emergency department (ED).
389
+
390
+ **Exclusion Criteria:** Excludes concepts that represent services not performed in the emergency department, including critical care and observation services.
391
+ """
392
+
393
+ VALUE_SET_NAME = "Emergency Department Visit"
394
+ OID = "2.16.840.1.113883.3.117.1.7.1.292"
395
+ DEFINITION_VERSION = "20210611"
396
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
397
+
398
+ SNOMEDCT = {
399
+ "4525004", # Emergency department patient visit (procedure)
400
+ }
401
+
402
+ class ObservationServices(ValueSet):
403
+ """
404
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for observation.
405
+
406
+ **Data Element Scope:** This value set may use a model element related to Encounter.
407
+
408
+ **Inclusion Criteria:** Includes concepts that represent an encounter for observation in the inpatient or outpatient setting.
409
+
410
+ **Exclusion Criteria:** No exclusions.
411
+ """
412
+
413
+ VALUE_SET_NAME = "Observation Services"
414
+ OID = "2.16.840.1.113762.1.4.1111.143"
415
+ DEFINITION_VERSION = "20210611"
416
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
417
+
418
+ SNOMEDCT = {
419
+ "448951000124107", # Admission to observation unit (procedure)
420
+ }
421
+
422
+ class EdVisitAndObTriage(ValueSet):
423
+ """
424
+ **Clinical Focus:** The purpose of this value set is to group concepts for encounters in the emergency department (ED) or OB triage represented as observation status.
425
+
426
+ **Data Element Scope:** This value set may use a model element related to Encounter.
427
+
428
+ **Inclusion Criteria:** Includes concepts that represent an encounter occurring in the emergency department (ED) or OB triage represented as observation status.
429
+
430
+ **Exclusion Criteria:** Excludes concepts that represent services not performed in the emergency department or OB triage represented as observation status.
431
+ """
432
+
433
+ VALUE_SET_NAME = "ED Visit and OB Triage"
434
+ OID = "2.16.840.1.113762.1.4.1029.369"
435
+ DEFINITION_VERSION = "20210611"
436
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
437
+
438
+ SNOMEDCT = {
439
+ "42102002", # Pre-admission observation, undelivered mother (procedure)
440
+ "4525004", # Emergency department patient visit (procedure)
441
+ }
442
+
443
+ class NonelectiveInpatientEncounter(ValueSet):
444
+ """
445
+ **Clinical Focus:** The purpose of this value set is to represent concepts of encounters for non-elective inpatient admission.
446
+
447
+ **Data Element Scope:** This value set may use a model element related to Encounter.
448
+
449
+ **Inclusion Criteria:** Includes concepts that represent an encounter for a non-elective inpatient admission.
450
+
451
+ **Exclusion Criteria:** Excludes concepts that represent an encounter for an elective inpatient admission.
452
+ """
453
+
454
+ VALUE_SET_NAME = "Nonelective Inpatient Encounter"
455
+ OID = "2.16.840.1.113883.3.117.1.7.1.424"
456
+ DEFINITION_VERSION = "20250206"
457
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
458
+
459
+ SNOMEDCT = {
460
+ "183452005", # Emergency hospital admission (procedure)
461
+ "32485007", # Hospital admission (procedure)
462
+ "442281000124108", # Emergency hospital admission from observation unit (procedure)
463
+ }
464
+
465
+ class OutpatientClinicalEncounters(ValueSet):
466
+ """
467
+ **Clinical Focus:** Office visit outpatient encounters for diabetes screening
468
+
469
+ **Data Element Scope:** Allowable outpatient encounters for diabetes screening
470
+
471
+ **Inclusion Criteria:** Office visits, outpatient visits, outpatient consultations, and telehealth services
472
+
473
+ **Exclusion Criteria:** None
474
+ """
475
+
476
+ VALUE_SET_NAME = "Outpatient Clinical Encounters"
477
+ OID = "2.16.840.1.113762.1.4.1160.24"
478
+ DEFINITION_VERSION = "20250301"
479
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
480
+
481
+ CPT = {
482
+ "98000", # Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
483
+ "98001", # Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
484
+ "98002", # Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
485
+ "98003", # Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
486
+ "98004", # Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.
487
+ "98005", # Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
488
+ "98006", # Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
489
+ "98007", # Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
490
+ "98008", # Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, straightforward medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
491
+ "98009", # Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, low medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
492
+ "98010", # Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, moderate medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
493
+ "98011", # Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, high medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
494
+ "98012", # Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, straightforward medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 10 minutes must be exceeded.
495
+ "98013", # Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, low medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
496
+ "98014", # Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, moderate medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
497
+ "98015", # Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, high medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
498
+ "99202", # Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
499
+ "99203", # Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
500
+ "99204", # Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
501
+ "99205", # Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
502
+ "99212", # Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.
503
+ "99213", # Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
504
+ "99214", # Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
505
+ "99215", # Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
506
+ "99242", # Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
507
+ "99243", # Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
508
+ "99244", # Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
509
+ "99245", # Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded.
510
+ "99341", # Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
511
+ "99342", # Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
512
+ "99344", # Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
513
+ "99345", # Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded.
514
+ "99347", # Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
515
+ "99348", # Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
516
+ "99349", # Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
517
+ "99350", # Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
518
+ }
519
+
520
+ HCPCSLEVELII = {
521
+ "G0463", # Hospital outpatient clinic visit for assessment and management of a patient
522
+ "T1015", # Clinic visit/encounter, all-inclusive
523
+ }
524
+
525
+ SNOMEDCT = {
526
+ "11429006", # Consultation (procedure)
527
+ "185463005", # Visit out of hours (procedure)
528
+ "185464004", # Out of hours visit - not night visit (procedure)
529
+ "185465003", # Weekend visit (procedure)
530
+ "281036007", # Follow-up consultation (procedure)
531
+ "3391000175108", # Office visit for pediatric care and assessment (procedure)
532
+ "371883000", # Outpatient procedure (procedure)
533
+ "439740005", # Postoperative follow-up visit (procedure)
534
+ "77406008", # Confirmatory medical consultation (procedure)
535
+ }
536
+
537
+ class PreventativeClinicalEncounters(ValueSet):
538
+ """
539
+ **Clinical Focus:** Preventative care outpatient encounters for diabetes screening
540
+
541
+ **Data Element Scope:** Allowable outpatient encounters for diabetes screening
542
+
543
+ **Inclusion Criteria:** Annual wellness visits, outpatient visits, and outpatient preventative care
544
+
545
+ **Exclusion Criteria:** None
546
+ """
547
+
548
+ VALUE_SET_NAME = "Preventative Clinical Encounters"
549
+ OID = "2.16.840.1.113762.1.4.1160.13"
550
+ DEFINITION_VERSION = "20250301"
551
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
552
+
553
+ CPT = {
554
+ "99385", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18-39 years
555
+ "99386", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 40-64 years
556
+ "99387", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 65 years and older
557
+ "99395", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 years
558
+ "99396", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years
559
+ "99397", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 65 years and older
560
+ "99401", # Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes
561
+ "99402", # Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes
562
+ "99403", # Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 45 minutes
563
+ "99404", # Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes
564
+ "99429", # Unlisted preventive medicine service
565
+ }
566
+
567
+ HCPCSLEVELII = {
568
+ "G0402", # Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
569
+ "G0438", # Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
570
+ "G0439", # Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
571
+ }
572
+
573
+ SNOMEDCT = {
574
+ "108219001", # Physician visit with evaluation AND/OR management service (procedure)
575
+ "108220007", # Evaluation AND/OR management - new patient (procedure)
576
+ "108221006", # Evaluation AND/OR management - established patient (procedure)
577
+ "108224003", # Preventive patient evaluation (procedure)
578
+ "14736009", # History and physical examination with evaluation and management of patient (procedure)
579
+ "185349003", # Encounter for check up (procedure)
580
+ "185389009", # Follow-up visit (procedure)
581
+ "270427003", # Patient-initiated encounter (procedure)
582
+ "270430005", # Provider-initiated encounter (procedure)
583
+ "308335008", # Patient encounter procedure (procedure)
584
+ "390906007", # Follow-up encounter (procedure)
585
+ "410187005", # Physical evaluation management (procedure)
586
+ "444971000124105", # Annual wellness visit (procedure)
587
+ "456201000124103", # Medicare annual wellness visit (procedure)
588
+ "78318003", # History and physical examination, annual for health maintenance (procedure)
589
+ "86013001", # Periodic reevaluation and management of healthy individual (procedure)
590
+ "90526000", # Initial evaluation and management of healthy individual (procedure)
591
+ }
592
+
593
+ class FaceToFaceInteraction(ValueSet):
594
+ """
595
+ **Clinical Focus:** This value set identifies patients who have had a face-to-face interaction with a member of their medical care team.
596
+
597
+ **Data Element Scope:** This value set was intended to map to the QDM data type of encounter.
598
+
599
+ **Inclusion Criteria:** Includes both initial and follow up visits. Includes home visits, inpatient and outpatient visits, and nursing facility visits.
600
+
601
+ **Exclusion Criteria:** Excludes visits that are not performed in-person, including telehealth services.
602
+ """
603
+
604
+ VALUE_SET_NAME = "Face to Face Interaction"
605
+ OID = "2.16.840.1.113762.1.4.1248.375"
606
+ DEFINITION_VERSION = "20250325"
607
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
608
+
609
+ SNOMEDCT = {
610
+ "12843005", # Subsequent hospital visit by physician (procedure)
611
+ "18170008", # Subsequent nursing facility visit (procedure)
612
+ "185349003", # Encounter for check up (procedure)
613
+ "185463005", # Visit out of hours (procedure)
614
+ "185465003", # Weekend visit (procedure)
615
+ "19681004", # Nursing evaluation of patient and report (procedure)
616
+ "207195004", # History and physical examination with evaluation and management of nursing facility patient (procedure)
617
+ "270427003", # Patient-initiated encounter (procedure)
618
+ "270430005", # Provider-initiated encounter (procedure)
619
+ "308335008", # Patient encounter procedure (procedure)
620
+ "390906007", # Follow-up encounter (procedure)
621
+ "406547006", # Urgent follow-up (procedure)
622
+ "439708006", # Home visit (procedure)
623
+ "87790002", # Follow-up inpatient consultation visit (procedure)
624
+ "90526000", # Initial evaluation and management of healthy individual (procedure)
625
+ }
626
+
627
+ class OutpatientConsultation(ValueSet):
628
+ """
629
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for outpatient interactions with a member of the medical care team.
630
+
631
+ **Data Element Scope:** This value set may use a model element related to Encounter.
632
+
633
+ **Inclusion Criteria:** Includes concepts that represent an encounter for the comprehensive history, evaluation, and management of a patient presenting with minor to high severity problems.
634
+
635
+ **Exclusion Criteria:** No exclusions.
636
+ """
637
+
638
+ VALUE_SET_NAME = "Outpatient Consultation"
639
+ OID = "2.16.840.1.113883.3.464.1003.101.12.1008"
640
+ DEFINITION_VERSION = "20240110"
641
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
642
+
643
+ CPT = {
644
+ "99242", # Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
645
+ "99243", # Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
646
+ "99244", # Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
647
+ "99245", # Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded.
648
+ }
649
+
650
+ SNOMEDCT = {
651
+ "281036007", # Follow-up consultation (procedure)
652
+ "77406008", # Confirmatory medical consultation (procedure)
653
+ }
654
+
655
+ class PreventiveCareServicesInitialOfficeVisit18AndUp(ValueSet):
656
+ """
657
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for preventive care.
658
+
659
+ **Data Element Scope:** This value set may use a model element related to Encounter.
660
+
661
+ **Inclusion Criteria:** Includes concepts that represent an encounter for comprehensive preventive medicine reevaluation and management of a new patient 18 years or over.
662
+
663
+ **Exclusion Criteria:** Excludes visits for established patients.
664
+ """
665
+
666
+ VALUE_SET_NAME = "Preventive Care Services Initial Office Visit, 18 and Up"
667
+ OID = "2.16.840.1.113883.3.464.1003.101.12.1023"
668
+ DEFINITION_VERSION = "20170504"
669
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
670
+
671
+ CPT = {
672
+ "99385", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18-39 years
673
+ "99386", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 40-64 years
674
+ "99387", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 65 years and older
675
+ }
676
+
677
+ class PreventiveCareServicesInitialOfficeVisit0To17(ValueSet):
678
+ """
679
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for preventive care.
680
+
681
+ **Data Element Scope:** This value set may use a model element related to Encounter.
682
+
683
+ **Inclusion Criteria:** Includes concepts that represent an encounter for comprehensive preventive medicine reevaluation and management of a new patient 0 to 17 years of age.
684
+
685
+ **Exclusion Criteria:** Excludes visits for established patients.
686
+ """
687
+
688
+ VALUE_SET_NAME = "Preventive Care Services, Initial Office Visit, 0 to 17"
689
+ OID = "2.16.840.1.113883.3.464.1003.101.12.1022"
690
+ DEFINITION_VERSION = "20170504"
691
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
692
+
693
+ CPT = {
694
+ "99381", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; infant (age younger than 1 year)
695
+ "99382", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; early childhood (age 1 through 4 years)
696
+ "99383", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; late childhood (age 5 through 11 years)
697
+ "99384", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; adolescent (age 12 through 17 years)
698
+ }
699
+
700
+ class PreventiveCareEstablishedOfficeVisit0To17(ValueSet):
701
+ """
702
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for preventative care.
703
+
704
+ **Data Element Scope:** This value set may use a model element related to Encounter.
705
+
706
+ **Inclusion Criteria:** Includes concepts that represent an encounter for comprehensive preventive medicine reevaluation and management of an established patient 0 to 17 years of age.
707
+
708
+ **Exclusion Criteria:** Excludes initial visits for new patients.
709
+ """
710
+
711
+ VALUE_SET_NAME = "Preventive Care, Established Office Visit, 0 to 17"
712
+ OID = "2.16.840.1.113883.3.464.1003.101.12.1024"
713
+ DEFINITION_VERSION = "20170504"
714
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
715
+
716
+ CPT = {
717
+ "99391", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; infant (age younger than 1 year)
718
+ "99392", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; early childhood (age 1 through 4 years)
719
+ "99393", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; late childhood (age 5 through 11 years)
720
+ "99394", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; adolescent (age 12 through 17 years)
721
+ }
722
+
723
+ class OutpatientEncounter(ValueSet):
724
+ """
725
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for outpatient visits.
726
+
727
+ **Data Element Scope:** This value set may use a model element related to Encounter.
728
+
729
+ **Inclusion Criteria:** Includes concepts that represent an encounter for comprehensive history, evaluation, and management of a patient in an outpatient setting.
730
+
731
+ **Exclusion Criteria:** No exclusions.
732
+ """
733
+
734
+ VALUE_SET_NAME = "Outpatient Encounter"
735
+ OID = "2.16.840.1.113883.3.464.1003.101.12.1087"
736
+ DEFINITION_VERSION = "20250328"
737
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
738
+
739
+ CPT = {
740
+ "99202", # Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
741
+ "99203", # Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
742
+ "99204", # Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
743
+ "99205", # Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
744
+ "99211", # Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional
745
+ "99212", # Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.
746
+ "99213", # Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
747
+ "99214", # Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
748
+ "99215", # Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
749
+ "99242", # Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
750
+ "99243", # Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
751
+ "99244", # Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
752
+ "99245", # Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded.
753
+ "99341", # Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
754
+ "99342", # Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
755
+ "99344", # Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
756
+ "99345", # Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded.
757
+ "99347", # Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
758
+ "99348", # Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
759
+ "99349", # Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
760
+ "99350", # Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
761
+ "99381", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; infant (age younger than 1 year)
762
+ "99382", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; early childhood (age 1 through 4 years)
763
+ "99383", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; late childhood (age 5 through 11 years)
764
+ "99384", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; adolescent (age 12 through 17 years)
765
+ "99385", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18-39 years
766
+ "99386", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 40-64 years
767
+ "99387", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 65 years and older
768
+ "99391", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; infant (age younger than 1 year)
769
+ "99392", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; early childhood (age 1 through 4 years)
770
+ "99393", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; late childhood (age 5 through 11 years)
771
+ "99394", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; adolescent (age 12 through 17 years)
772
+ "99395", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 years
773
+ "99396", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years
774
+ "99397", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 65 years and older
775
+ "99401", # Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes
776
+ "99402", # Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes
777
+ "99403", # Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 45 minutes
778
+ "99404", # Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes
779
+ "99411", # Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 30 minutes
780
+ "99412", # Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 60 minutes
781
+ "99429", # Unlisted preventive medicine service
782
+ "99455", # Work related or medical disability examination by the treating physician that includes: Completion of a medical history commensurate with the patient's condition; Performance of an examination commensurate with the patient's condition; Formulation of a diagnosis, assessment of capabilities and stability, and calculation of impairment; Development of future medical treatment plan; and Completion of necessary documentation/certificates and report.
783
+ "99456", # Work related or medical disability examination by other than the treating physician that includes: Completion of a medical history commensurate with the patient's condition; Performance of an examination commensurate with the patient's condition; Formulation of a diagnosis, assessment of capabilities and stability, and calculation of impairment; Development of future medical treatment plan; and Completion of necessary documentation/certificates and report.
784
+ "99483", # Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home, with all of the following required elements: Cognition-focused evaluation including a pertinent history and examination, Medical decision making of moderate or high complexity, Functional assessment (eg, basic and instrumental activities of daily living), including decision-making capacity, Use of standardized instruments for staging of dementia (eg, functional assessment staging test [FAST], clinical dementia rating [CDR]), Medication reconciliation and review for high-risk medications, Evaluation for neuropsychiatric and behavioral symptoms, including depression, including use of standardized screening instrument(s), Evaluation of safety (eg, home), including motor vehicle operation, Identification of caregiver(s), caregiver knowledge, caregiver needs, social supports, and the willingness of caregiver to take on caregiving tasks, Development, updating or revision, or review of an Advance Care Plan, Creation of a written care plan, including initial plans to address any neuropsychiatric symptoms, neuro-cognitive symptoms, functional limitations, and referral to community resources as needed (eg, rehabilitation services, adult day programs, support groups) shared with the patient and/or caregiver with initial education and support. Typically, 60 minutes of total time is spent on the date of the encounter.
785
+ }
786
+
787
+ HCPCSLEVELII = {
788
+ "G0402", # Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
789
+ "G0438", # Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
790
+ "G0439", # Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
791
+ "G0463", # Hospital outpatient clinic visit for assessment and management of a patient
792
+ "T1015", # Clinic visit/encounter, all-inclusive
793
+ }
794
+
795
+ SNOMEDCT = {
796
+ "185463005", # Visit out of hours (procedure)
797
+ "185464004", # Out of hours visit - not night visit (procedure)
798
+ "185465003", # Weekend visit (procedure)
799
+ "281036007", # Follow-up consultation (procedure)
800
+ "3391000175108", # Office visit for pediatric care and assessment (procedure)
801
+ "439740005", # Postoperative follow-up visit (procedure)
802
+ "444971000124105", # Annual wellness visit (procedure)
803
+ "77406008", # Confirmatory medical consultation (procedure)
804
+ "84251009", # Comprehensive consultation (procedure)
805
+ }
806
+
807
+ class VirtualEncounter(ValueSet):
808
+ """
809
+ **Clinical Focus:** Includes concepts that represent an encounter using online modalities.
810
+
811
+ **Data Element Scope:** This value set may use a model element related to Encounter.
812
+
813
+ **Inclusion Criteria:** Includes concepts that represent an encounter using online modalities.
814
+
815
+ **Exclusion Criteria:** Excludes concepts that represent encounters other than online.
816
+ """
817
+
818
+ VALUE_SET_NAME = "Virtual Encounter"
819
+ OID = "2.16.840.1.113883.3.464.1003.101.12.1089"
820
+ DEFINITION_VERSION = "20210224"
821
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
822
+
823
+ CPT = {
824
+ "98970", # Nonphysician qualified health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
825
+ "98971", # Nonphysician qualified health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes
826
+ "98972", # Nonphysician qualified health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes
827
+ "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
828
+ "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)
829
+ "99421", # Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
830
+ "99422", # Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes
831
+ "99423", # Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes
832
+ "99457", # Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes
833
+ "99458", # Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; each additional 20 minutes (List separately in addition to code for primary procedure)
834
+ }
835
+
836
+ HCPCSLEVELII = {
837
+ "G2012", # Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
838
+ "G0071", # Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only
839
+ "G2010", # Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment
840
+ "G2250", # Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment
841
+ "G2251", # Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of clinical discussion
842
+ "G2252", # Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion
843
+ }
844
+
845
+ class ElectiveInpatientEncounter(ValueSet):
846
+ """
847
+ **Clinical Focus:** The purpose of this value set is to represent concepts of elective inpatient encounters
848
+
849
+ **Data Element Scope:** Includes concepts that represent inpatient encounters
850
+
851
+ **Inclusion Criteria:** This value set may use a model element related to Encounter
852
+
853
+ **Exclusion Criteria:** N/A
854
+ """
855
+
856
+ VALUE_SET_NAME = "Elective Inpatient Encounter"
857
+ OID = "2.16.840.1.113762.1.4.1248.85"
858
+ DEFINITION_VERSION = "20230518"
859
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
860
+
861
+ SNOMEDCT = {
862
+ "112689000", # Hospital admission, elective, with complete pre-admission work-up (procedure)
863
+ "15584006", # Hospital admission, elective, with partial pre-admission work-up (procedure)
864
+ "81672003", # Hospital admission, elective, without pre-admission work-up (procedure)
865
+ "8715000", # Hospital admission, elective (procedure)
866
+ }
867
+
868
+ class OutpatientSurgeryService(ValueSet):
869
+ """
870
+ **Clinical Focus:** This value set contains concepts that are used to identify outpatient surgery encounter types.
871
+
872
+ **Data Element Scope:** This value set may use Quality Data Model (QDM) category related to Encounter, Performed. The intent of this data element is to identify patients who have had an outpatient surgery encounter.
873
+
874
+ **Inclusion Criteria:** Includes only relevant concepts associated with SNOMED codes identifying outpatient surgery encounters.
875
+
876
+ **Exclusion Criteria:** No exclusions.
877
+ """
878
+
879
+ VALUE_SET_NAME = "Outpatient Surgery Service"
880
+ OID = "2.16.840.1.113762.1.4.1110.38"
881
+ DEFINITION_VERSION = "20190426"
882
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
883
+
884
+ SNOMEDCT = {
885
+ "110468005", # Ambulatory surgery (procedure)
886
+ "709063003", # Admission to same day surgery center (procedure)
887
+ "711580002", # Minor ambulatory surgery (procedure)
888
+ }
889
+
890
+ class NutritionServices(ValueSet):
891
+ """
892
+ **Clinical Focus:** The purpose of this value set is to represent concepts for nutrition services.
893
+
894
+ **Data Element Scope:** This value set may use a model element related to Encounter.
895
+
896
+ **Inclusion Criteria:** Includes concepts that represent nutrition services.
897
+
898
+ **Exclusion Criteria:** Excludes concepts for nutrition services limited to a specific diagnosis.
899
+ """
900
+
901
+ VALUE_SET_NAME = "Nutrition Services"
902
+ OID = "2.16.840.1.113883.3.464.1003.1006"
903
+ DEFINITION_VERSION = "20210819"
904
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
905
+
906
+ CPT = {
907
+ "97802", # Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes
908
+ "97803", # Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes
909
+ "97804", # Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes
910
+ }
911
+
912
+ HCPCSLEVELII = {
913
+ "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
914
+ "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
915
+ "G0447", # Face-to-face behavioral counseling for obesity, 15 minutes
916
+ "S9449", # Weight management classes, non-physician provider, per session
917
+ "S9452", # Nutrition classes, non-physician provider, per session
918
+ "S9470", # Nutritional counseling, dietitian visit
919
+ }
920
+
921
+ SNOMEDCT = {
922
+ "11816003", # Diet education (procedure)
923
+ "14051000175103", # Dietary education for cardiovascular disorder (procedure)
924
+ "183059007", # High fiber diet education (procedure)
925
+ "183060002", # Low residue diet education (procedure)
926
+ "183061003", # Low fat diet education (procedure)
927
+ "183062005", # Low cholesterol diet education (procedure)
928
+ "183063000", # Low salt diet education (procedure)
929
+ "183065007", # Low carbohydrate diet education (procedure)
930
+ "183066008", # Low protein diet education (procedure)
931
+ "183067004", # High protein diet education (procedure)
932
+ "183070000", # Vegetarian diet education (procedure)
933
+ "183071001", # Vegan diet education (procedure)
934
+ "226067002", # Food hygiene education (procedure)
935
+ "266724001", # Weight-reducing diet education (procedure)
936
+ "275919002", # Weight loss advised (situation)
937
+ "281085002", # Sugar-free diet education (procedure)
938
+ "284352003", # Obesity diet education (procedure)
939
+ "305849009", # Seen by dietetics service (finding)
940
+ "305850009", # Seen by community-based dietetics service (finding)
941
+ "305851008", # Seen by hospital-based dietetics service (finding)
942
+ "306163007", # Referral to dietetics service (procedure)
943
+ "306164001", # Referral to community-based dietetics service (procedure)
944
+ "306165000", # Referral to hospital-based dietetics service (procedure)
945
+ "306626002", # Discharge from dietetics service (procedure)
946
+ "306627006", # Discharge from hospital dietetics service (procedure)
947
+ "306628001", # Discharge from community dietetics service (procedure)
948
+ "313210009", # Fluid intake education (procedure)
949
+ "370847001", # Dietary needs education (procedure)
950
+ "386464006", # Prescribed diet education (procedure)
951
+ "404923009", # Weight gain advised (situation)
952
+ "408910007", # Enteral feeding education (procedure)
953
+ "410171007", # Nutrition care education (procedure)
954
+ "410177006", # Special diet education (procedure)
955
+ "410200000", # Weight control education (procedure)
956
+ "428461000124101", # Referral to nutrition professional (procedure)
957
+ "428691000124107", # Vitamin K dietary intake education (procedure)
958
+ "429095004", # Dietary education for weight gain (procedure)
959
+ "431482008", # Dietary education for competitive athlete (procedure)
960
+ "441041000124100", # Counseling about nutrition (regime/therapy)
961
+ "441201000124108", # Counseling about nutrition using cognitive behavioral theoretical approach (regime/therapy)
962
+ "441231000124100", # Counseling about nutrition using health belief model (regime/therapy)
963
+ "441241000124105", # Counseling about nutrition using social learning theory approach (regime/therapy)
964
+ "441251000124107", # Counseling about nutrition using transtheoretical model and stages of change approach (regime/therapy)
965
+ "441261000124109", # Counseling about nutrition using motivational interviewing technique (regime/therapy)
966
+ "441271000124102", # Counseling about nutrition using goal setting strategy (regime/therapy)
967
+ "441281000124104", # Counseling about nutrition using self-monitoring strategy (regime/therapy)
968
+ "441291000124101", # Counseling about nutrition using problem solving strategy (regime/therapy)
969
+ "441301000124100", # Counseling about nutrition using social support strategy (regime/therapy)
970
+ "441311000124102", # Counseling about nutrition using stress management strategy (regime/therapy)
971
+ "441321000124105", # Counseling about nutrition using stimulus control strategy (regime/therapy)
972
+ "441331000124108", # Counseling about nutrition using cognitive restructuring strategy (regime/therapy)
973
+ "441341000124103", # Counseling about nutrition using relapse prevention strategy (regime/therapy)
974
+ "441351000124101", # Counseling about nutrition using rewards and contingency management strategy (regime/therapy)
975
+ "443288003", # Lifestyle education regarding diet (procedure)
976
+ "445291000124103", # Nutrition-related skill education (procedure)
977
+ "445301000124102", # Content-related nutrition education (procedure)
978
+ "445331000124105", # Nutrition-related laboratory result interpretation education (procedure)
979
+ "445641000124105", # Technical nutrition education (procedure)
980
+ "609104008", # Educated about weight management (situation)
981
+ "61310001", # Nutrition education (procedure)
982
+ "698471002", # Patient advised about weight management (situation)
983
+ "699827002", # Dietary education about fluid restriction (procedure)
984
+ "699829004", # High energy diet education (procedure)
985
+ "699830009", # Food fortification education (procedure)
986
+ "699849008", # Healthy eating education (procedure)
987
+ "700154005", # Seen in weight management clinic (finding)
988
+ "700258004", # Dietary education about vitamin intake (procedure)
989
+ "705060005", # Diet education about mineral intake (procedure)
990
+ "710881000", # Education about eating pattern (procedure)
991
+ }
992
+
993
+ class DecisionToAdmitToHospitalInpatient(ValueSet):
994
+ """
995
+ **Clinical Focus:** The purpose of this value set is to represent concepts of a decision to admit to hospital inpatient order.
996
+
997
+ **Data Element Scope:** This value set may use a model element related to Encounter.
998
+
999
+ **Inclusion Criteria:** Includes concepts that represent an encounter of a decision to admit a patient to an inpatient hospital.
1000
+
1001
+ **Exclusion Criteria:** No exclusions
1002
+ """
1003
+
1004
+ VALUE_SET_NAME = "Decision to Admit to Hospital Inpatient"
1005
+ OID = "2.16.840.1.113883.3.117.1.7.1.294"
1006
+ DEFINITION_VERSION = "20210220"
1007
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1008
+
1009
+ SNOMEDCT = {
1010
+ "10378005", # Hospital admission, emergency, from emergency room, accidental injury (procedure)
1011
+ "19951005", # Hospital admission, emergency, from emergency room, medical nature (procedure)
1012
+ "432661000124104", # Hospital admission, transfer from emergency department (procedure)
1013
+ "73607007", # Hospital admission, emergency, from emergency room (procedure)
1014
+ }
1015
+
1016
+ class EmergencyDepartmentEvaluationAndManagementVisit(ValueSet):
1017
+ """
1018
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters in the emergency department.
1019
+
1020
+ **Data Element Scope:** This value set may use a model element related to Encounter.
1021
+
1022
+ **Inclusion Criteria:** Includes concepts that represent an encounter for care provided to new and established patients in the emergency department.
1023
+
1024
+ **Exclusion Criteria:** Excludes concepts that represent an encounter not representative of ED visits, including critical care and observation services.
1025
+ """
1026
+
1027
+ VALUE_SET_NAME = "Emergency Department Evaluation and Management Visit"
1028
+ OID = "2.16.840.1.113883.3.464.1003.101.12.1010"
1029
+ DEFINITION_VERSION = "20210928"
1030
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1031
+
1032
+ CPT = {
1033
+ "99281", # Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional
1034
+ "99282", # Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making
1035
+ "99283", # Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making
1036
+ "99284", # Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making
1037
+ "99285", # Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making
1038
+ }
1039
+
1040
+ SNOMEDCT = {
1041
+ "4525004", # Emergency department patient visit (procedure)
1042
+ }
1043
+
1044
+ class Triage(ValueSet):
1045
+ """
1046
+ **Clinical Focus:** The purpose of this value set is to represent concepts for nurse/non-billable encounters.
1047
+
1048
+ **Data Element Scope:** This value set may use the data element Encounter.
1049
+
1050
+ **Inclusion Criteria:** Includes concepts that represent nursing or non-billable encounters in the emergency department.
1051
+
1052
+ **Exclusion Criteria:** No exclusions.
1053
+ """
1054
+
1055
+ VALUE_SET_NAME = "Triage"
1056
+ OID = "2.16.840.1.113762.1.4.1046.279"
1057
+ DEFINITION_VERSION = "20250212"
1058
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1059
+
1060
+ SNOMEDCT = {
1061
+ "225390008", # Triage (procedure)
1062
+ "245581009", # Emergency examination for triage (procedure)
1063
+ "273887006", # Triage index (assessment scale)
1064
+ "314850005", # Seen by triage nurse (finding)
1065
+ "386478007", # Triage: emergency center (procedure)
1066
+ }
1067
+
1068
+ class DecisionToTransfer(ValueSet):
1069
+ """
1070
+ **Clinical Focus:** This value set contains concepts that represent procedures used to identify transfer from emergency department (ED) locations.
1071
+
1072
+ **Data Element Scope:** The intent of this data element is to identify patients transferred from emergency department (ED) locations.
1073
+
1074
+ **Inclusion Criteria:** Includes only relevant concepts associated with SNOMED CT codes that identify the environment hierarchy to define an emergency department.
1075
+
1076
+ **Exclusion Criteria:** No exclusions.
1077
+ """
1078
+
1079
+ VALUE_SET_NAME = "Decision to Transfer"
1080
+ OID = "2.16.840.1.113762.1.4.1046.286"
1081
+ DEFINITION_VERSION = "20240726"
1082
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1083
+
1084
+ SNOMEDCT = {
1085
+ "19712007", # Patient transfer, to another health care facility (procedure)
1086
+ "448551000124100", # Patient transfer to another hospital (procedure)
1087
+ }
1088
+
1089
+ class NursingFacilityVisit(ValueSet):
1090
+ """
1091
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters in a nursing facility.
1092
+
1093
+ **Data Element Scope:** This value set may use a model element related to Encounter.
1094
+
1095
+ **Inclusion Criteria:** Includes concepts that represent an encounter specific to a nursing facility, including skilled, intermediate and long term care facilities.
1096
+
1097
+ **Exclusion Criteria:** Excludes concepts that represent an encounter other than a nursing facility visits.
1098
+ """
1099
+
1100
+ VALUE_SET_NAME = "Nursing Facility Visit"
1101
+ OID = "2.16.840.1.113883.3.464.1003.101.12.1012"
1102
+ DEFINITION_VERSION = "20240110"
1103
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1104
+
1105
+ CPT = {
1106
+ "99304", # Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded.
1107
+ "99305", # Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded.
1108
+ "99306", # Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 50 minutes must be met or exceeded.
1109
+ "99307", # Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.
1110
+ "99308", # Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
1111
+ "99309", # Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
1112
+ "99310", # Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
1113
+ "99315", # Nursing facility discharge management; 30 minutes or less total time on the date of the encounter
1114
+ "99316", # Nursing facility discharge management; more than 30 minutes total time on the date of the encounter
1115
+ }
1116
+
1117
+ SNOMEDCT = {
1118
+ "18170008", # Subsequent nursing facility visit (procedure)
1119
+ "207195004", # History and physical examination with evaluation and management of nursing facility patient (procedure)
1120
+ }
1121
+
1122
+ class PsychVisitDiagnosticEvaluation(ValueSet):
1123
+ """
1124
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for diagnostic psychiatric evaluations.
1125
+
1126
+ **Data Element Scope:** This value set may use a model element related to Encounter.
1127
+
1128
+ **Inclusion Criteria:** Includes concepts that represent an encounter for psychiatric diagnostic evaluations.
1129
+
1130
+ **Exclusion Criteria:** Excludes concepts that represent an encounter for group psychotherapy or family psychotherapy visits.
1131
+ """
1132
+
1133
+ VALUE_SET_NAME = "Psych Visit Diagnostic Evaluation"
1134
+ OID = "2.16.840.1.113883.3.526.3.1492"
1135
+ DEFINITION_VERSION = "20190315"
1136
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1137
+
1138
+ CPT = {
1139
+ "90791", # Psychiatric diagnostic evaluation
1140
+ "90792", # Psychiatric diagnostic evaluation with medical services
1141
+ }
1142
+
1143
+ SNOMEDCT = {
1144
+ "10197000", # Psychiatric interview and evaluation (procedure)
1145
+ "165172002", # Diagnostic psychiatric interview (procedure)
1146
+ "68338001", # Interactive medical psychiatric diagnostic interview (procedure)
1147
+ "79094001", # Initial psychiatric interview with mental status and evaluation (procedure)
1148
+ }
1149
+
1150
+ class PsychVisitPsychotherapy(ValueSet):
1151
+ """
1152
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for psychotherapy visits.
1153
+
1154
+ **Data Element Scope:** This value set may use a model element related to Encounter.
1155
+
1156
+ **Inclusion Criteria:** Includes concepts that represent an encounter for individual psychotherapy services.
1157
+
1158
+ **Exclusion Criteria:** Excludes concepts that represent an encounter for group psychotherapy or family psychotherapy visits.
1159
+ """
1160
+
1161
+ VALUE_SET_NAME = "Psych Visit Psychotherapy"
1162
+ OID = "2.16.840.1.113883.3.526.3.1496"
1163
+ DEFINITION_VERSION = "20190315"
1164
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1165
+
1166
+ CPT = {
1167
+ "90832", # Psychotherapy, 30 minutes with patient
1168
+ "90834", # Psychotherapy, 45 minutes with patient
1169
+ "90837", # Psychotherapy, 60 minutes with patient
1170
+ }
1171
+
1172
+ SNOMEDCT = {
1173
+ "183381005", # General psychotherapy (regime/therapy)
1174
+ "183382003", # Psychotherapy - behavioral (regime/therapy)
1175
+ "183383008", # Psychotherapy - cognitive (regime/therapy)
1176
+ "18512000", # Individual psychotherapy (regime/therapy)
1177
+ "302242004", # Long-term psychodynamic psychotherapy (regime/therapy)
1178
+ "304820009", # Developmental psychodynamic psychotherapy (regime/therapy)
1179
+ "304822001", # Psychodynamic-interpersonal psychotherapy (regime/therapy)
1180
+ "314034001", # Psychodynamic psychotherapy (regime/therapy)
1181
+ "38678006", # Client-centered psychotherapy (regime/therapy)
1182
+ "401157001", # Brief solution focused psychotherapy (regime/therapy)
1183
+ "443730003", # Interpersonal psychotherapy (regime/therapy)
1184
+ "75516001", # Psychotherapy (regime/therapy)
1185
+ "90102008", # Social psychotherapy (regime/therapy)
1186
+ }
1187
+
1188
+ class CareServicesInLongTermResidentialFacility(ValueSet):
1189
+ """
1190
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for patients living in assisted living, domiciliary care or rest homes.
1191
+
1192
+ **Data Element Scope:** This value set may use a model element related to Encounter.
1193
+
1194
+ **Inclusion Criteria:** Includes concepts that represent an encounter for services provided to new and established patients living in assisted living, domiciliary care or rest home who have had an interaction with a member of their medical team.
1195
+
1196
+ **Exclusion Criteria:** Excludes concepts that represent an encounter for settings other than assisted living, domiciliary care, or rest homes.
1197
+ """
1198
+
1199
+ VALUE_SET_NAME = "Care Services in Long Term Residential Facility"
1200
+ OID = "2.16.840.1.113883.3.464.1003.101.12.1014"
1201
+ DEFINITION_VERSION = "20240203"
1202
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1203
+
1204
+ SNOMEDCT = {
1205
+ "209099002", # History and physical examination with management of domiciliary or rest home patient (procedure)
1206
+ "210098006", # Domiciliary or rest home patient evaluation and management (procedure)
1207
+ }
1208
+
1209
+ class PatientProviderInteraction(ValueSet):
1210
+ """
1211
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters or communications.
1212
+
1213
+ **Data Element Scope:** This value set may use a model element related to Encounter.
1214
+
1215
+ **Inclusion Criteria:** Includes concepts that represent an encounter in an office or care setting, as well as interactions that occur via virtual methods, such as telephone calls, emails, and letters.
1216
+
1217
+ **Exclusion Criteria:** No exclusions.
1218
+ """
1219
+
1220
+ VALUE_SET_NAME = "Patient Provider Interaction"
1221
+ OID = "2.16.840.1.113883.3.526.3.1012"
1222
+ DEFINITION_VERSION = "20170504"
1223
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1224
+
1225
+ SNOMEDCT = {
1226
+ "185316007", # Indirect encounter (procedure)
1227
+ "185317003", # Telephone encounter (procedure)
1228
+ "185318008", # Third party encounter (procedure)
1229
+ "185320006", # Encounter by computer link (procedure)
1230
+ "185321005", # Letter encounter to patient (procedure)
1231
+ "185349003", # Encounter for check up (procedure)
1232
+ "185463005", # Visit out of hours (procedure)
1233
+ "185465003", # Weekend visit (procedure)
1234
+ "270424005", # Letter encounter from patient (procedure)
1235
+ "270427003", # Patient-initiated encounter (procedure)
1236
+ "270430005", # Provider-initiated encounter (procedure)
1237
+ "308335008", # Patient encounter procedure (procedure)
1238
+ "308720009", # Letter encounter (procedure)
1239
+ "386473003", # Telephone follow-up (procedure)
1240
+ "390906007", # Follow-up encounter (procedure)
1241
+ "401267002", # Telephone triage encounter (procedure)
1242
+ "401271004", # Email sent to patient (procedure)
1243
+ "406547006", # Urgent follow-up (procedure)
1244
+ "438515009", # Email encounter from caregiver (procedure)
1245
+ "438516005", # Email encounter to caregiver (procedure)
1246
+ "445450000", # Encounter by short message service text messaging (procedure)
1247
+ "448337001", # Telemedicine consultation with patient (procedure)
1248
+ "87790002", # Follow-up inpatient consultation visit (procedure)
1249
+ "90526000", # Initial evaluation and management of healthy individual (procedure)
1250
+ }
1251
+
1252
+ class BehavioralHealthFollowUpVisit(ValueSet):
1253
+ """
1254
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for a behavioral health follow-up visit.
1255
+
1256
+ **Data Element Scope:** This value set may use a model element related to Encounter.
1257
+
1258
+ **Inclusion Criteria:** Includes concepts that represent an encounter for education and training for patient self-management by a qualified health care professional.
1259
+
1260
+ **Exclusion Criteria:** No exclusions.
1261
+ """
1262
+
1263
+ VALUE_SET_NAME = "Behavioral Health Follow up Visit"
1264
+ OID = "2.16.840.1.113883.3.464.1003.101.12.1054"
1265
+ DEFINITION_VERSION = "20170504"
1266
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1267
+
1268
+ CPT = {
1269
+ "98960", # Education and training for patient self-management by a nonphysician qualified health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient
1270
+ "98961", # Education and training for patient self-management by a nonphysician qualified health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; 2-4 patients
1271
+ "98962", # Education and training for patient self-management by a nonphysician qualified health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; 5-8 patients
1272
+ "99078", # Physician or other qualified health care professional qualified by education, training, licensure/regulation (when applicable) educational services rendered to patients in a group setting (eg, prenatal, obesity, or diabetic instructions)
1273
+ "99510", # Home visit for individual, family, or marriage counseling
1274
+ }
1275
+
1276
+ class PreventiveCareServicesGroupCounseling(ValueSet):
1277
+ """
1278
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for group counseling services.
1279
+
1280
+ **Data Element Scope:** This value set may use a model element related to Encounter.
1281
+
1282
+ **Inclusion Criteria:** Includes concepts that represent an encounter for preventive medicine counseling and/or risk factor reduction intervention(s) in a group setting.
1283
+
1284
+ **Exclusion Criteria:** No exclusions.
1285
+ """
1286
+
1287
+ VALUE_SET_NAME = "Preventive Care Services Group Counseling"
1288
+ OID = "2.16.840.1.113883.3.464.1003.101.12.1027"
1289
+ DEFINITION_VERSION = "20170504"
1290
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1291
+
1292
+ CPT = {
1293
+ "99411", # Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 30 minutes
1294
+ "99412", # Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 60 minutes
1295
+ }
1296
+
1297
+ class PreventiveCareServicesIndividualCounseling(ValueSet):
1298
+ """
1299
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for individual counseling services.
1300
+
1301
+ **Data Element Scope:** This value set may use a model element related to Encounter.
1302
+
1303
+ **Inclusion Criteria:** Includes concepts that represent an encounter for counseling, anticipatory guidance, and risk factor reduction interventions.
1304
+
1305
+ **Exclusion Criteria:** Excludes concepts that represent an encounter for services performed in the emergency department, including critical care and observation services.
1306
+ """
1307
+
1308
+ VALUE_SET_NAME = "Preventive Care Services Individual Counseling"
1309
+ OID = "2.16.840.1.113883.3.464.1003.101.12.1026"
1310
+ DEFINITION_VERSION = "20170504"
1311
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1312
+
1313
+ CPT = {
1314
+ "99401", # Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes
1315
+ "99402", # Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes
1316
+ "99403", # Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 45 minutes
1317
+ "99404", # Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes
1318
+ }
1319
+
1320
+ class PsychotherapyAndPharmacologicManagement(ValueSet):
1321
+ """
1322
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for psychotherapy services.
1323
+
1324
+ **Data Element Scope:** This value set may use a model element related to Encounter.
1325
+
1326
+ **Inclusion Criteria:** Includes concepts that represent an encounter for group or family psychotherapy services or individual psychophysiological therapy.
1327
+
1328
+ **Exclusion Criteria:** No exclusions.
1329
+ """
1330
+
1331
+ VALUE_SET_NAME = "Psychotherapy and Pharmacologic Management"
1332
+ OID = "2.16.840.1.113883.3.464.1003.101.12.1055"
1333
+ DEFINITION_VERSION = "20170504"
1334
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1335
+
1336
+ CPT = {
1337
+ "90845", # Psychoanalysis
1338
+ "90847", # Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes
1339
+ "90849", # Multiple-family group psychotherapy
1340
+ "90853", # Group psychotherapy (other than of a multiple-family group)
1341
+ "90875", # Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); 30 minutes
1342
+ "90876", # Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); 45 minutes
1343
+ }
1344
+
1345
+ class DetoxificationVisit(ValueSet):
1346
+ """
1347
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for detoxification visits.
1348
+
1349
+ **Data Element Scope:** This value set may use a model element related to Encounter.
1350
+
1351
+ **Inclusion Criteria:** Includes concepts that represent an encounter for alcohol and drug detoxification.
1352
+
1353
+ **Exclusion Criteria:** No exclusions.
1354
+ """
1355
+
1356
+ VALUE_SET_NAME = "Detoxification Visit"
1357
+ OID = "2.16.840.1.113883.3.464.1003.101.12.1059"
1358
+ DEFINITION_VERSION = "20170504"
1359
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1360
+
1361
+ SNOMEDCT = {
1362
+ "182969009", # Dependent drug detoxification (regime/therapy)
1363
+ "20093000", # Alcohol rehabilitation and detoxification (regime/therapy)
1364
+ "23915005", # Combined alcohol and drug rehabilitation and detoxification (regime/therapy)
1365
+ "414054004", # Drug dependence home detoxification (regime/therapy)
1366
+ "414056002", # Drug dependence self detoxification (regime/therapy)
1367
+ "56876005", # Drug rehabilitation and detoxification (regime/therapy)
1368
+ "61480009", # Drug detoxification (regime/therapy)
1369
+ "64297001", # Detoxication psychiatric therapy for alcoholism (regime/therapy)
1370
+ "67516001", # Detoxification therapy (regime/therapy)
1371
+ "827094004", # Alcohol detoxification (regime/therapy)
1372
+ "87106005", # Combined alcohol and drug detoxification (regime/therapy)
1373
+ }
1374
+
1375
+ class DischargeServicesHospitalInpatient(ValueSet):
1376
+ """
1377
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for inpatient hospital discharge services.
1378
+
1379
+ **Data Element Scope:** This value set may use a model element related to Encounter.
1380
+
1381
+ **Inclusion Criteria:** Includes concepts that represent an encounter for hospital discharge day management.
1382
+
1383
+ **Exclusion Criteria:** Excludes concepts that represent encounters other than inpatient hospital discharge services.
1384
+ """
1385
+
1386
+ VALUE_SET_NAME = "Discharge Services Hospital Inpatient"
1387
+ OID = "2.16.840.1.113883.3.464.1003.101.12.1007"
1388
+ DEFINITION_VERSION = "20170504"
1389
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1390
+
1391
+ CPT = {
1392
+ "99238", # Hospital inpatient or observation discharge day management; 30 minutes or less on the date of the encounter
1393
+ "99239", # Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter
1394
+ }
1395
+
1396
+ class DischargeServicesHospitalInpatientSameDayDischarge(ValueSet):
1397
+ """
1398
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for same day inpatient hospital discharge services.
1399
+
1400
+ **Data Element Scope:** This value set may use a model element related to Encounter.
1401
+
1402
+ **Inclusion Criteria:** Includes concepts that represent an encounter for the evaluation and management of a patient that results in discharge on the same date as admission.
1403
+
1404
+ **Exclusion Criteria:** Excludes concepts that represent encounters other than same day inpatient hospital discharge services.
1405
+ """
1406
+
1407
+ VALUE_SET_NAME = "Discharge Services Hospital Inpatient Same Day Discharge"
1408
+ OID = "2.16.840.1.113883.3.464.1003.101.12.1006"
1409
+ DEFINITION_VERSION = "20170504"
1410
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1411
+
1412
+ CPT = {
1413
+ "99234", # Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
1414
+ "99235", # Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 70 minutes must be met or exceeded.
1415
+ "99236", # Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 85 minutes must be met or exceeded.
1416
+ }
1417
+
1418
+ class InitialHospitalInpatientVisit(ValueSet):
1419
+ """
1420
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for inpatient hospital care.
1421
+
1422
+ **Data Element Scope:** This value set may use a model element related to Encounter.
1423
+
1424
+ **Inclusion Criteria:** Includes concepts that represent an encounter for initial hospital care for the evaluation and management of a patient.
1425
+
1426
+ **Exclusion Criteria:** No exclusions.
1427
+ """
1428
+
1429
+ VALUE_SET_NAME = "Initial Hospital Inpatient Visit"
1430
+ OID = "2.16.840.1.113883.3.464.1003.101.12.1004"
1431
+ DEFINITION_VERSION = "20170504"
1432
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1433
+
1434
+ CPT = {
1435
+ "99221", # Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
1436
+ "99222", # Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded.
1437
+ "99223", # Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded.
1438
+ }
1439
+
1440
+ class OccupationalTherapyEvaluation(ValueSet):
1441
+ """
1442
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for assessment, management, and evaluation for occupational therapy.
1443
+
1444
+ **Data Element Scope:** This value set may use a model element related to Encounter.
1445
+
1446
+ **Inclusion Criteria:** Includes concepts that represent an encounter for assessment, management, and evaluation for occupational therapy.
1447
+
1448
+ **Exclusion Criteria:** No exclusions.
1449
+ """
1450
+
1451
+ VALUE_SET_NAME = "Occupational Therapy Evaluation"
1452
+ OID = "2.16.840.1.113883.3.526.3.1011"
1453
+ DEFINITION_VERSION = "20190315"
1454
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1455
+
1456
+ CPT = {
1457
+ "97165", # Occupational therapy evaluation, low complexity, requiring these components: An occupational profile and medical and therapy history, which includes a brief history including review of medical and/or therapy records relating to the presenting problem; An assessment(s) that identifies 1-3 performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of low complexity, which includes an analysis of the occupational profile, analysis of data from problem-focused assessment(s), and consideration of a limited number of treatment options. Patient presents with no comorbidities that affect occupational performance. Modification of tasks or assistance (eg, physical or verbal) with assessment(s) is not necessary to enable completion of evaluation component. Typically, 30 minutes are spent face-to-face with the patient and/or family.
1458
+ "97166", # Occupational therapy evaluation, moderate complexity, requiring these components: An occupational profile and medical and therapy history, which includes an expanded review of medical and/or therapy records and additional review of physical, cognitive, or psychosocial history related to current functional performance; An assessment(s) that identifies 3-5 performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of moderate analytic complexity, which includes an analysis of the occupational profile, analysis of data from detailed assessment(s), and consideration of several treatment options. Patient may present with comorbidities that affect occupational performance. Minimal to moderate modification of tasks or assistance (eg, physical or verbal) with assessment(s) is necessary to enable patient to complete evaluation component. Typically, 45 minutes are spent face-to-face with the patient and/or family.
1459
+ "97167", # Occupational therapy evaluation, high complexity, requiring these components: An occupational profile and medical and therapy history, which includes review of medical and/or therapy records and extensive additional review of physical, cognitive, or psychosocial history related to current functional performance; An assessment(s) that identifies 5 or more performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of high analytic complexity, which includes an analysis of the patient profile, analysis of data from comprehensive assessment(s), and consideration of multiple treatment options. Patient presents with comorbidities that affect occupational performance. Significant modification of tasks or assistance (eg, physical or verbal) with assessment(s) is necessary to enable patient to complete evaluation component. Typically, 60 minutes are spent face-to-face with the patient and/or family.
1460
+ "97168", # Re-evaluation of occupational therapy established plan of care, requiring these components: An assessment of changes in patient functional or medical status with revised plan of care; An update to the initial occupational profile to reflect changes in condition or environment that affect future interventions and/or goals; and A revised plan of care. A formal reevaluation is performed when there is a documented change in functional status or a significant change to the plan of care is required. Typically, 30 minutes are spent face-to-face with the patient and/or family.
1461
+ }
1462
+
1463
+ SNOMEDCT = {
1464
+ "228653003", # Occupational therapy home visit (regime/therapy)
1465
+ "410155007", # Occupational therapy assessment (procedure)
1466
+ "410156008", # Occupational therapy education (procedure)
1467
+ "410157004", # Occupational therapy management (procedure)
1468
+ "423602000", # Occupational therapy surveillance (regime/therapy)
1469
+ "424574000", # Occupational therapy education, guidance, counseling (procedure)
1470
+ "59694001", # Occupational social therapy (regime/therapy)
1471
+ "84478008", # Occupational therapy (regime/therapy)
1472
+ }
1473
+
1474
+ class PhysicalTherapyEvaluation(ValueSet):
1475
+ """
1476
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for a physical therapy evaluation.
1477
+
1478
+ **Data Element Scope:** This value set may use a model element related to Encounter.
1479
+
1480
+ **Inclusion Criteria:** Includes concepts that represent an encounter for a physical therapy evaluation.
1481
+
1482
+ **Exclusion Criteria:** No exclusions.
1483
+ """
1484
+
1485
+ VALUE_SET_NAME = "Physical Therapy Evaluation"
1486
+ OID = "2.16.840.1.113883.3.526.3.1022"
1487
+ DEFINITION_VERSION = "20200306"
1488
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1489
+
1490
+ CPT = {
1491
+ "97161", # Physical therapy evaluation: low complexity, requiring these components: A history with no personal factors and/or comorbidities that impact the plan of care; An examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with stable and/or uncomplicated characteristics; and Clinical decision making of low complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 20 minutes are spent face-to-face with the patient and/or family.
1492
+ "97162", # Physical therapy evaluation: moderate complexity, requiring these components: A history of present problem with 1-2 personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures in addressing a total of 3 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; An evolving clinical presentation with changing characteristics; and Clinical decision making of moderate complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 30 minutes are spent face-to-face with the patient and/or family.
1493
+ "97163", # Physical therapy evaluation: high complexity, requiring these components: A history of present problem with 3 or more personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures addressing a total of 4 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with unstable and unpredictable characteristics; and Clinical decision making of high complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 45 minutes are spent face-to-face with the patient and/or family.
1494
+ "97164", # Re-evaluation of physical therapy established plan of care, requiring these components: An examination including a review of history and use of standardized tests and measures is required; and Revised plan of care using a standardized patient assessment instrument and/or measurable assessment of functional outcome Typically, 20 minutes are spent face-to-face with the patient and/or family.
1495
+ }
1496
+
1497
+ SNOMEDCT = {
1498
+ "183326003", # Combined physical therapy (regime/therapy)
1499
+ "410158009", # Physical therapy assessment (procedure)
1500
+ "410159001", # Physical therapy education (procedure)
1501
+ "410160006", # Physical therapy management (procedure)
1502
+ "424203006", # Physical therapy education, guidance and counseling (procedure)
1503
+ "424291000", # Physical therapy surveillance (regime/therapy)
1504
+ }
1505
+
1506
+ class Psychoanalysis(ValueSet):
1507
+ """
1508
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for psychoanalysis.
1509
+
1510
+ **Data Element Scope:** This value set may use a model element related to Encounter.
1511
+
1512
+ **Inclusion Criteria:** Includes concepts that represent an encounter for psychoanalysis.
1513
+
1514
+ **Exclusion Criteria:** No exclusions.
1515
+ """
1516
+
1517
+ VALUE_SET_NAME = "Psychoanalysis"
1518
+ OID = "2.16.840.1.113883.3.526.3.1141"
1519
+ DEFINITION_VERSION = "20190315"
1520
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1521
+
1522
+ CPT = {
1523
+ "90845", # Psychoanalysis
1524
+ }
1525
+
1526
+ SNOMEDCT = {
1527
+ "28988002", # Psychoanalysis in depth (procedure)
1528
+ "61436009", # Psychoanalysis (procedure)
1529
+ }
1530
+
1531
+ class SpeechAndHearingEvaluation(ValueSet):
1532
+ """
1533
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for speech or hearing evaluation.
1534
+
1535
+ **Data Element Scope:** This value set may use a model element related to Encounter.
1536
+
1537
+ **Inclusion Criteria:** Includes concepts that represent an encounter for the evaluation of speech and/or hearing related abilities.
1538
+
1539
+ **Exclusion Criteria:** No exclusions.
1540
+ """
1541
+
1542
+ VALUE_SET_NAME = "Speech and Hearing Evaluation"
1543
+ OID = "2.16.840.1.113883.3.526.3.1530"
1544
+ DEFINITION_VERSION = "20190315"
1545
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1546
+
1547
+ CPT = {
1548
+ "92521", # Evaluation of speech fluency (eg, stuttering, cluttering)
1549
+ "92522", # Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria)
1550
+ "92523", # Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language)
1551
+ "92524", # Behavioral and qualitative analysis of voice and resonance
1552
+ "92540", # Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and oscillating tracking test, with recording
1553
+ "92557", # Comprehensive audiometry threshold evaluation and speech recognition (92553 and 92556 combined)
1554
+ "92625", # Assessment of tinnitus (includes pitch, loudness matching, and masking)
1555
+ }
1556
+
1557
+ SNOMEDCT = {
1558
+ "26342005", # Medical evaluation for speech, language and/or hearing problems (regime/therapy)
1559
+ "41375007", # Medical evaluation of hearing problem (procedure)
1560
+ "77837000", # Medical evaluation of speech, language and hearing problem (procedure)
1561
+ "91515000", # Special audiologic evaluation for functional hearing loss (procedure)
1562
+ }
1563
+
1564
+ class AudiologyVisit(ValueSet):
1565
+ """
1566
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters with nystagmus testing.
1567
+
1568
+ **Data Element Scope:** This value set may use a model element related to Encounter.
1569
+
1570
+ **Inclusion Criteria:** Includes concepts that represent an encounter for a hearing assessment to quantify hearing such as basic vestibular evaluation, spontaneous and positional nystagmus testing, and computerized dynamic posturography
1571
+
1572
+ **Exclusion Criteria:** No exclusions.
1573
+ """
1574
+
1575
+ VALUE_SET_NAME = "Audiology Visit"
1576
+ OID = "2.16.840.1.113883.3.464.1003.101.12.1066"
1577
+ DEFINITION_VERSION = "20170504"
1578
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1579
+
1580
+ CPT = {
1581
+ "92540", # Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and oscillating tracking test, with recording
1582
+ "92541", # Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording
1583
+ "92542", # Positional nystagmus test, minimum of 4 positions, with recording
1584
+ "92548", # Computerized dynamic posturography sensory organization test (CDP-SOT), 6 conditions (ie, eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway), including interpretation and report
1585
+ }
1586
+
1587
+ class DischargeServicesNursingFacility(ValueSet):
1588
+ """
1589
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for discharges from a nursing facility.
1590
+
1591
+ **Data Element Scope:** This value set may use a model element related to Encounter.
1592
+
1593
+ **Inclusion Criteria:** Includes concepts that represent an encounter for nursing facility discharge.
1594
+
1595
+ **Exclusion Criteria:** Excludes concepts that represent discharges from settings other than a nursing facility.
1596
+ """
1597
+
1598
+ VALUE_SET_NAME = "Discharge Services Nursing Facility"
1599
+ OID = "2.16.840.1.113883.3.464.1003.101.12.1013"
1600
+ DEFINITION_VERSION = "20170504"
1601
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1602
+
1603
+ CPT = {
1604
+ "99315", # Nursing facility discharge management; 30 minutes or less total time on the date of the encounter
1605
+ "99316", # Nursing facility discharge management; more than 30 minutes total time on the date of the encounter
1606
+ }
1607
+
1608
+ class MedicalDisabilityExam(ValueSet):
1609
+ """
1610
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for work related or medical disability examinations
1611
+
1612
+ **Data Element Scope:** This value set may use a model element related to Encounter.
1613
+
1614
+ **Inclusion Criteria:** Includes concepts that represent an encounter for work related or medical disability examinations.
1615
+
1616
+ **Exclusion Criteria:** No exclusions.
1617
+ """
1618
+
1619
+ VALUE_SET_NAME = "Medical Disability Exam"
1620
+ OID = "2.16.840.1.113883.3.464.1003.101.12.1073"
1621
+ DEFINITION_VERSION = "20210306"
1622
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1623
+
1624
+ CPT = {
1625
+ "99455", # Work related or medical disability examination by the treating physician that includes: Completion of a medical history commensurate with the patient's condition; Performance of an examination commensurate with the patient's condition; Formulation of a diagnosis, assessment of capabilities and stability, and calculation of impairment; Development of future medical treatment plan; and Completion of necessary documentation/certificates and report.
1626
+ "99456", # Work related or medical disability examination by other than the treating physician that includes: Completion of a medical history commensurate with the patient's condition; Performance of an examination commensurate with the patient's condition; Formulation of a diagnosis, assessment of capabilities and stability, and calculation of impairment; Development of future medical treatment plan; and Completion of necessary documentation/certificates and report.
1627
+ }
1628
+
1629
+ class BehavioralOrNeuropsychAssessment(ValueSet):
1630
+ """
1631
+ **Clinical Focus:** The purpose of this value set is to represent concepts of encounters for neuropsychological assessments.
1632
+
1633
+ **Data Element Scope:** This value set may use a model element related to Encounter.
1634
+
1635
+ **Inclusion Criteria:** Includes concepts that describe an assessment for applicable neuropsychological assessments for behavioral health.
1636
+
1637
+ **Exclusion Criteria:** No exclusions.
1638
+ """
1639
+
1640
+ VALUE_SET_NAME = "Behavioral or Neuropsych Assessment"
1641
+ OID = "2.16.840.1.113883.3.526.3.1023"
1642
+ DEFINITION_VERSION = "20190315"
1643
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1644
+
1645
+ CPT = {
1646
+ "96116", # Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, [eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities]), by physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; first hour
1647
+ }
1648
+
1649
+ SNOMEDCT = {
1650
+ "307808008", # Neuropsychological testing (procedure)
1651
+ }
1652
+
1653
+ class AudioVisualTelehealthEncounter(ValueSet):
1654
+ """
1655
+ **Clinical Focus:** This value set contains concepts that represent telehealth encounters using audio-visual platforms.
1656
+
1657
+ **Data Element Scope:** This value set may use the Quality Data Model (QDM) category related to Encounter.
1658
+
1659
+ **Inclusion Criteria:** Includes only telehealth codes for encounters involving real-time two-way communication using audio-visual platforms.
1660
+
1661
+ **Exclusion Criteria:** No exclusions.
1662
+ """
1663
+
1664
+ VALUE_SET_NAME = "Audio Visual Telehealth Encounter"
1665
+ OID = "2.16.840.1.113883.3.1444.5.215"
1666
+ DEFINITION_VERSION = "20250201"
1667
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1668
+
1669
+ CPT = {
1670
+ "98000", # Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
1671
+ "98001", # Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
1672
+ "98002", # Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
1673
+ "98003", # Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
1674
+ "98004", # Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.
1675
+ "98005", # Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
1676
+ "98006", # Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
1677
+ "98007", # Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
1678
+ }
1679
+
1680
+ SNOMEDCT = {
1681
+ "448337001", # Telemedicine consultation with patient (procedure)
1682
+ "453131000124105", # Videotelephony encounter (procedure)
1683
+ "763184009", # Telepractice consultation (procedure)
1684
+ }
1685
+
1686
+ class RadiationTreatmentManagement(ValueSet):
1687
+ """
1688
+ **Clinical Focus:** The purpose of this value set is to represent concepts for the procedure of radiation management.
1689
+
1690
+ **Data Element Scope:** This value set may use a model element related to Procedure.
1691
+
1692
+ **Inclusion Criteria:** Includes concepts that represent a procedure for radiation treatment management.
1693
+
1694
+ **Exclusion Criteria:** No exclusions.
1695
+ """
1696
+
1697
+ VALUE_SET_NAME = "Radiation Treatment Management"
1698
+ OID = "2.16.840.1.113883.3.526.3.1026"
1699
+ DEFINITION_VERSION = "20170504"
1700
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1701
+
1702
+ CPT = {
1703
+ "77427", # Radiation treatment management, 5 treatments
1704
+ "77431", # Radiation therapy management with complete course of therapy consisting of 1 or 2 fractions only
1705
+ "77432", # Stereotactic radiation treatment management of cranial lesion(s) (complete course of treatment consisting of 1 session)
1706
+ "77435", # Stereotactic body radiation therapy, treatment management, per treatment course, to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions
1707
+ }
1708
+
1709
+ SNOMEDCT = {
1710
+ "84755001", # Radiation therapy treatment management (procedure)
1711
+ }
1712
+
1713
+ class ContactOrOfficeVisit(ValueSet):
1714
+ """
1715
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for office visits and outpatient contacts to evaluate for depression.
1716
+
1717
+ **Data Element Scope:** This value set may use a model element related to Encounter.
1718
+
1719
+ **Inclusion Criteria:** Includes concepts that represent an encounter for outpatient contact and office visits in which a patient may be evaluated for depression.
1720
+
1721
+ **Exclusion Criteria:** Excludes concepts that represent an encounter for inpatient visits, except for psychiatry and psychotherapy visits, which are not specific to setting.
1722
+ """
1723
+
1724
+ VALUE_SET_NAME = "Contact or Office Visit"
1725
+ OID = "2.16.840.1.113762.1.4.1080.5"
1726
+ DEFINITION_VERSION = "20220219"
1727
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1728
+
1729
+ CPT = {
1730
+ "90791", # Psychiatric diagnostic evaluation
1731
+ "90792", # Psychiatric diagnostic evaluation with medical services
1732
+ "90832", # Psychotherapy, 30 minutes with patient
1733
+ "90834", # Psychotherapy, 45 minutes with patient
1734
+ "90837", # Psychotherapy, 60 minutes with patient
1735
+ "90839", # Psychotherapy for crisis; first 60 minutes
1736
+ "96156", # Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making)
1737
+ "96158", # Health behavior intervention, individual, face-to-face; initial 30 minutes
1738
+ "96159", # Health behavior intervention, individual, face-to-face; each additional 15 minutes (List separately in addition to code for primary service)
1739
+ "98008", # Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, straightforward medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
1740
+ "98009", # Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, low medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
1741
+ "98010", # Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, moderate medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
1742
+ "98011", # Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, high medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
1743
+ "98012", # Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, straightforward medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 10 minutes must be exceeded.
1744
+ "98013", # Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, low medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
1745
+ "98014", # Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, moderate medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
1746
+ "98015", # Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, high medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
1747
+ "99202", # Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
1748
+ "99203", # Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
1749
+ "99204", # Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
1750
+ "99205", # Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
1751
+ "99211", # Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional
1752
+ "99212", # Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.
1753
+ "99213", # Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
1754
+ "99214", # Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
1755
+ "99215", # Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
1756
+ "99384", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; adolescent (age 12 through 17 years)
1757
+ "99385", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18-39 years
1758
+ "99386", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 40-64 years
1759
+ "99387", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 65 years and older
1760
+ "99394", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; adolescent (age 12 through 17 years)
1761
+ "99395", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 years
1762
+ "99396", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years
1763
+ "99397", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 65 years and older
1764
+ "99421", # Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
1765
+ "99422", # Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes
1766
+ "99423", # Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes
1767
+ }
1768
+
1769
+ HCPCSLEVELII = {
1770
+ "G0402", # Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
1771
+ "G0438", # Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
1772
+ "G0439", # Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
1773
+ }
1774
+
1775
+ class EsrdMonthlyOutpatientServices(ValueSet):
1776
+ """
1777
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for end-stage renal disease (ESRD) outpatient services.
1778
+
1779
+ **Data Element Scope:** This value set may use a model element related to Encounter.
1780
+
1781
+ **Inclusion Criteria:** Includes concepts that represent an encounter for ESRD outpatients services.
1782
+
1783
+ **Exclusion Criteria:** No exclusions.
1784
+ """
1785
+
1786
+ VALUE_SET_NAME = "ESRD Monthly Outpatient Services"
1787
+ OID = "2.16.840.1.113883.3.464.1003.109.12.1014"
1788
+ DEFINITION_VERSION = "20170504"
1789
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1790
+
1791
+ CPT = {
1792
+ "90951", # End-stage renal disease (ESRD) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face visits by a physician or other qualified health care professional per month
1793
+ "90952", # End-stage renal disease (ESRD) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 2-3 face-to-face visits by a physician or other qualified health care professional per month
1794
+ "90953", # End-stage renal disease (ESRD) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 1 face-to-face visit by a physician or other qualified health care professional per month
1795
+ "90954", # End-stage renal disease (ESRD) related services monthly, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face visits by a physician or other qualified health care professional per month
1796
+ "90955", # End-stage renal disease (ESRD) related services monthly, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 2-3 face-to-face visits by a physician or other qualified health care professional per month
1797
+ "90956", # End-stage renal disease (ESRD) related services monthly, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 1 face-to-face visit by a physician or other qualified health care professional per month
1798
+ "90957", # End-stage renal disease (ESRD) related services monthly, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face visits by a physician or other qualified health care professional per month
1799
+ "90958", # End-stage renal disease (ESRD) related services monthly, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 2-3 face-to-face visits by a physician or other qualified health care professional per month
1800
+ "90959", # End-stage renal disease (ESRD) related services monthly, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 1 face-to-face visit by a physician or other qualified health care professional per month
1801
+ "90960", # End-stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 4 or more face-to-face visits by a physician or other qualified health care professional per month
1802
+ "90961", # End-stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 2-3 face-to-face visits by a physician or other qualified health care professional per month
1803
+ "90962", # End-stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 1 face-to-face visit by a physician or other qualified health care professional per month
1804
+ "90963", # End-stage renal disease (ESRD) related services for home dialysis per full month, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents
1805
+ "90964", # End-stage renal disease (ESRD) related services for home dialysis per full month, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents
1806
+ "90965", # End-stage renal disease (ESRD) related services for home dialysis per full month, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents
1807
+ "90966", # End-stage renal disease (ESRD) related services for home dialysis per full month, for patients 20 years of age and older
1808
+ "90967", # End-stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients younger than 2 years of age
1809
+ "90968", # End-stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients 2-11 years of age
1810
+ "90969", # End-stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients 12-19 years of age
1811
+ "90970", # End-stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients 20 years of age and older
1812
+ "90989", # Dialysis training, patient, including helper where applicable, any mode, completed course
1813
+ "90993", # Dialysis training, patient, including helper where applicable, any mode, course not completed, per training session
1814
+ "90997", # Hemoperfusion (eg, with activated charcoal or resin)
1815
+ "90999", # Unlisted dialysis procedure, inpatient or outpatient
1816
+ "99512", # Home visit for hemodialysis
1817
+ }
1818
+
1819
+ class GroupPsychotherapy(ValueSet):
1820
+ """
1821
+ **Clinical Focus:** The purpose of this value set is to represent concepts for group psychotherapy.
1822
+
1823
+ **Data Element Scope:** This value set may use a model element related to Encounter or Procedure.
1824
+
1825
+ **Inclusion Criteria:** Includes concepts that represent group psychotherapy.
1826
+
1827
+ **Exclusion Criteria:** Excludes concepts that represent family psychotherapy or individual psychotherapy.
1828
+ """
1829
+
1830
+ VALUE_SET_NAME = "Group Psychotherapy"
1831
+ OID = "2.16.840.1.113883.3.526.3.1187"
1832
+ DEFINITION_VERSION = "20210220"
1833
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1834
+
1835
+ CPT = {
1836
+ "90853", # Group psychotherapy (other than of a multiple-family group)
1837
+ }
1838
+
1839
+ SNOMEDCT = {
1840
+ "1555005", # Brief group psychotherapy (regime/therapy)
1841
+ "27591006", # Group analytical psychotherapy (regime/therapy)
1842
+ "28868002", # Interactive group medical psychotherapy (regime/therapy)
1843
+ "76168009", # Group psychotherapy (regime/therapy)
1844
+ }
1845
+
1846
+ class PsychVisitForFamilyPsychotherapy(ValueSet):
1847
+ """
1848
+ **Clinical Focus:** The purpose of this value set is to represent concepts for family psychotherapy.
1849
+
1850
+ **Data Element Scope:** This value set may use a model element related to Encounter.
1851
+
1852
+ **Inclusion Criteria:** Includes concepts that represent family psychotherapy.
1853
+
1854
+ **Exclusion Criteria:** Excludes concepts for group psychotherapy or individual psychotherapy.
1855
+ """
1856
+
1857
+ VALUE_SET_NAME = "Psych Visit for Family Psychotherapy"
1858
+ OID = "2.16.840.1.113883.3.526.3.1018"
1859
+ DEFINITION_VERSION = "20210220"
1860
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1861
+
1862
+ CPT = {
1863
+ "90846", # Family psychotherapy (without the patient present), 50 minutes
1864
+ "90847", # Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes
1865
+ }
1866
+
1867
+ SNOMEDCT = {
1868
+ "108313002", # Family psychotherapy procedure (regime/therapy)
1869
+ "302247005", # Narrative family psychotherapy (regime/therapy)
1870
+ "361229007", # Structural family psychotherapy (regime/therapy)
1871
+ }
1872
+
1873
+ class EncounterToScreenForBloodPressure(ValueSet):
1874
+ """
1875
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters where blood pressure would be recorded.
1876
+
1877
+ **Data Element Scope:** This value set may use a model element related to Encounter.
1878
+
1879
+ **Inclusion Criteria:** Includes concepts that represent an encounter where blood pressure is recorded.
1880
+
1881
+ **Exclusion Criteria:** No exclusions.
1882
+ """
1883
+
1884
+ VALUE_SET_NAME = "Encounter to Screen for Blood Pressure"
1885
+ OID = "2.16.840.1.113883.3.600.1920"
1886
+ DEFINITION_VERSION = "20210220"
1887
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
1888
+
1889
+ CDT = {
1890
+ "D3921", # decoronation or submergence of an erupted tooth
1891
+ "D7111", # extraction, coronal remnants - primary tooth
1892
+ "D7140", # extraction, erupted tooth or exposed root (elevation and/or forceps removal)
1893
+ "D7210", # extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated
1894
+ "D7220", # removal of impacted tooth - soft tissue
1895
+ "D7230", # removal of impacted tooth - partially bony
1896
+ "D7240", # removal of impacted tooth - completely bony
1897
+ "D7241", # removal of impacted tooth - completely bony, with unusual surgical complications
1898
+ "D7250", # removal of residual tooth roots (cutting procedure)
1899
+ "D7251", # coronectomy - intentional partial tooth removal, impacted teeth only
1900
+ }
1901
+
1902
+ CPT = {
1903
+ "90791", # Psychiatric diagnostic evaluation
1904
+ "90792", # Psychiatric diagnostic evaluation with medical services
1905
+ "92002", # Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient
1906
+ "92004", # Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits
1907
+ "92012", # Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient
1908
+ "92014", # Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, 1 or more visits
1909
+ "92532", # Positional nystagmus test
1910
+ "92534", # Optokinetic nystagmus test
1911
+ "92537", # Caloric vestibular test with recording, bilateral; bithermal (ie, one warm and one cool irrigation in each ear for a total of four irrigations)
1912
+ "92538", # Caloric vestibular test with recording, bilateral; monothermal (ie, one irrigation in each ear for a total of two irrigations)
1913
+ "92540", # Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and oscillating tracking test, with recording
1914
+ "92541", # Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording
1915
+ "92542", # Positional nystagmus test, minimum of 4 positions, with recording
1916
+ "92544", # Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording
1917
+ "92545", # Oscillating tracking test, with recording
1918
+ "92546", # Sinusoidal vertical axis rotational testing
1919
+ "92622", # Diagnostic analysis, programming, and verification of an auditory osseointegrated sound processor, any type; first 60 minutes
1920
+ "92625", # Assessment of tinnitus (includes pitch, loudness matching, and masking)
1921
+ "97802", # Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes
1922
+ "97803", # Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes
1923
+ "99202", # Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
1924
+ "99203", # Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
1925
+ "99204", # Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
1926
+ "99205", # Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
1927
+ "99212", # Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.
1928
+ "99213", # Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
1929
+ "99214", # Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
1930
+ "99215", # Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
1931
+ "99236", # Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 85 minutes must be met or exceeded.
1932
+ "99242", # Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
1933
+ "99243", # Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
1934
+ "99244", # Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
1935
+ "99245", # Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded.
1936
+ "99281", # Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional
1937
+ "99282", # Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making
1938
+ "99283", # Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making
1939
+ "99284", # Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making
1940
+ "99285", # Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making
1941
+ "99304", # Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded.
1942
+ "99305", # Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded.
1943
+ "99306", # Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 50 minutes must be met or exceeded.
1944
+ "99307", # Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.
1945
+ "99308", # Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
1946
+ "99309", # Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
1947
+ "99310", # Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
1948
+ "99315", # Nursing facility discharge management; 30 minutes or less total time on the date of the encounter
1949
+ "99316", # Nursing facility discharge management; more than 30 minutes total time on the date of the encounter
1950
+ "99341", # Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
1951
+ "99342", # Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
1952
+ "99344", # Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
1953
+ "99345", # Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded.
1954
+ "99347", # Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
1955
+ "99348", # Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
1956
+ "99349", # Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
1957
+ "99350", # Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
1958
+ "99385", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18-39 years
1959
+ "99386", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 40-64 years
1960
+ "99387", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 65 years and older
1961
+ "99395", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 years
1962
+ "99396", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years
1963
+ "99397", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 65 years and older
1964
+ "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.
1965
+ "99491", # 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; first 30 minutes provided personally by a physician or other qualified health care professional, per calendar month.
1966
+ }
1967
+
1968
+ HCPCSLEVELII = {
1969
+ "G0101", # Cervical or vaginal cancer screening; pelvic and clinical breast examination
1970
+ "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
1971
+ "G0402", # Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
1972
+ "G0438", # Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
1973
+ "G0439", # Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
1974
+ }
1975
+
1976
+ SNOMEDCT = {
1977
+ "103705002", # Patient status observation (procedure)
1978
+ "108220007", # Evaluation AND/OR management - new patient (procedure)
1979
+ "108221006", # Evaluation AND/OR management - established patient (procedure)
1980
+ "108224003", # Preventive patient evaluation (procedure)
1981
+ "12843005", # Subsequent hospital visit by physician (procedure)
1982
+ "13607009", # Manual examination of breast (procedure)
1983
+ "14736009", # History and physical examination with evaluation and management of patient (procedure)
1984
+ "1759002", # Assessment of nutritional status (procedure)
1985
+ "18170008", # Subsequent nursing facility visit (procedure)
1986
+ "185349003", # Encounter for check up (procedure)
1987
+ "185463005", # Visit out of hours (procedure)
1988
+ "185465003", # Weekend visit (procedure)
1989
+ "207195004", # History and physical examination with evaluation and management of nursing facility patient (procedure)
1990
+ "209099002", # History and physical examination with management of domiciliary or rest home patient (procedure)
1991
+ "210098006", # Domiciliary or rest home patient evaluation and management (procedure)
1992
+ "270427003", # Patient-initiated encounter (procedure)
1993
+ "270430005", # Provider-initiated encounter (procedure)
1994
+ "306677009", # Discharge from day hospital (procedure)
1995
+ "308335008", # Patient encounter procedure (procedure)
1996
+ "310243009", # Nutritional assessment (procedure)
1997
+ "35025007", # Manual pelvic examination (procedure)
1998
+ "390906007", # Follow-up encounter (procedure)
1999
+ "406547006", # Urgent follow-up (procedure)
2000
+ "410172000", # Nutrition care management (procedure)
2001
+ "439708006", # Home visit (procedure)
2002
+ "4525004", # Emergency department patient visit (procedure)
2003
+ "46662001", # Examination of breast (procedure)
2004
+ "50357006", # Evaluation and management of patient at home (procedure)
2005
+ "76464004", # Hospital admission, for observation (procedure)
2006
+ "78318003", # History and physical examination, annual for health maintenance (procedure)
2007
+ "83607001", # Gynecologic examination (procedure)
2008
+ "86013001", # Periodic reevaluation and management of healthy individual (procedure)
2009
+ "90526000", # Initial evaluation and management of healthy individual (procedure)
2010
+ }
2011
+
2012
+ class EncounterToScreenForDepression(ValueSet):
2013
+ """
2014
+ **Clinical Focus:** The purpose of this value set is to represent concepts of encounters for depression screening.
2015
+
2016
+ **Data Element Scope:** This value set may use a model element related to Encounter.
2017
+
2018
+ **Inclusion Criteria:** Includes concepts that represent wellness visits, annual visits, therapy evaluations, or primary or specialist physician office visits where a depression screen could be conducted.
2019
+
2020
+ **Exclusion Criteria:** No exclusions.
2021
+ """
2022
+
2023
+ VALUE_SET_NAME = "Encounter to Screen for Depression"
2024
+ OID = "2.16.840.1.113883.3.600.1916"
2025
+ DEFINITION_VERSION = "20210220"
2026
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
2027
+
2028
+ CPT = {
2029
+ "59400", # Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care
2030
+ "59425", # Antepartum care only; 4-6 visits
2031
+ "59426", # Antepartum care only; 7 or more visits
2032
+ "59510", # Routine obstetric care including antepartum care, cesarean delivery, and postpartum care
2033
+ "59610", # Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, after previous cesarean delivery
2034
+ "59618", # Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous cesarean delivery
2035
+ "90791", # Psychiatric diagnostic evaluation
2036
+ "90792", # Psychiatric diagnostic evaluation with medical services
2037
+ "90832", # Psychotherapy, 30 minutes with patient
2038
+ "90834", # Psychotherapy, 45 minutes with patient
2039
+ "90837", # Psychotherapy, 60 minutes with patient
2040
+ "92622", # Diagnostic analysis, programming, and verification of an auditory osseointegrated sound processor, any type; first 60 minutes
2041
+ "92625", # Assessment of tinnitus (includes pitch, loudness matching, and masking)
2042
+ "96105", # Assessment of aphasia (includes assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, writing, eg, by Boston Diagnostic Aphasia Examination) with interpretation and report, per hour
2043
+ "96110", # Developmental screening (eg, developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument
2044
+ "96112", # Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour
2045
+ "96116", # Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, [eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities]), by physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; first hour
2046
+ "96125", # Standardized cognitive performance testing (eg, Ross Information Processing Assessment) per hour of a qualified health care professional's time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report
2047
+ "96136", # Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes
2048
+ "96138", # Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes
2049
+ "96156", # Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making)
2050
+ "96158", # Health behavior intervention, individual, face-to-face; initial 30 minutes
2051
+ "97161", # Physical therapy evaluation: low complexity, requiring these components: A history with no personal factors and/or comorbidities that impact the plan of care; An examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with stable and/or uncomplicated characteristics; and Clinical decision making of low complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 20 minutes are spent face-to-face with the patient and/or family.
2052
+ "97162", # Physical therapy evaluation: moderate complexity, requiring these components: A history of present problem with 1-2 personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures in addressing a total of 3 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; An evolving clinical presentation with changing characteristics; and Clinical decision making of moderate complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 30 minutes are spent face-to-face with the patient and/or family.
2053
+ "97163", # Physical therapy evaluation: high complexity, requiring these components: A history of present problem with 3 or more personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures addressing a total of 4 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with unstable and unpredictable characteristics; and Clinical decision making of high complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 45 minutes are spent face-to-face with the patient and/or family.
2054
+ "97164", # Re-evaluation of physical therapy established plan of care, requiring these components: An examination including a review of history and use of standardized tests and measures is required; and Revised plan of care using a standardized patient assessment instrument and/or measurable assessment of functional outcome Typically, 20 minutes are spent face-to-face with the patient and/or family.
2055
+ "97165", # Occupational therapy evaluation, low complexity, requiring these components: An occupational profile and medical and therapy history, which includes a brief history including review of medical and/or therapy records relating to the presenting problem; An assessment(s) that identifies 1-3 performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of low complexity, which includes an analysis of the occupational profile, analysis of data from problem-focused assessment(s), and consideration of a limited number of treatment options. Patient presents with no comorbidities that affect occupational performance. Modification of tasks or assistance (eg, physical or verbal) with assessment(s) is not necessary to enable completion of evaluation component. Typically, 30 minutes are spent face-to-face with the patient and/or family.
2056
+ "97166", # Occupational therapy evaluation, moderate complexity, requiring these components: An occupational profile and medical and therapy history, which includes an expanded review of medical and/or therapy records and additional review of physical, cognitive, or psychosocial history related to current functional performance; An assessment(s) that identifies 3-5 performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of moderate analytic complexity, which includes an analysis of the occupational profile, analysis of data from detailed assessment(s), and consideration of several treatment options. Patient may present with comorbidities that affect occupational performance. Minimal to moderate modification of tasks or assistance (eg, physical or verbal) with assessment(s) is necessary to enable patient to complete evaluation component. Typically, 45 minutes are spent face-to-face with the patient and/or family.
2057
+ "97167", # Occupational therapy evaluation, high complexity, requiring these components: An occupational profile and medical and therapy history, which includes review of medical and/or therapy records and extensive additional review of physical, cognitive, or psychosocial history related to current functional performance; An assessment(s) that identifies 5 or more performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of high analytic complexity, which includes an analysis of the patient profile, analysis of data from comprehensive assessment(s), and consideration of multiple treatment options. Patient presents with comorbidities that affect occupational performance. Significant modification of tasks or assistance (eg, physical or verbal) with assessment(s) is necessary to enable patient to complete evaluation component. Typically, 60 minutes are spent face-to-face with the patient and/or family.
2058
+ "97802", # Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes
2059
+ "97803", # Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes
2060
+ "98000", # Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
2061
+ "98001", # Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
2062
+ "98002", # Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
2063
+ "98003", # Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
2064
+ "98004", # Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.
2065
+ "98005", # Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
2066
+ "98006", # Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
2067
+ "98007", # Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
2068
+ "98008", # Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, straightforward medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
2069
+ "98009", # Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, low medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
2070
+ "98010", # Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, moderate medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
2071
+ "98011", # Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, high medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
2072
+ "98012", # Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, straightforward medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 10 minutes must be exceeded.
2073
+ "98013", # Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, low medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
2074
+ "98014", # Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, moderate medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
2075
+ "98015", # Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, high medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
2076
+ "98016", # Brief communication technology-based service (eg, virtual check-in) by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related evaluation and management service provided within the previous 7 days nor leading to an evaluation and management service or procedure within the next 24 hours or soonest available appointment, 5-10 minutes of medical discussion
2077
+ "98966", # Telephone assessment and management service provided by a nonphysician qualified health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
2078
+ "98967", # Telephone assessment and management service provided by a nonphysician qualified health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion
2079
+ "98968", # Telephone assessment and management service provided by a nonphysician qualified health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion
2080
+ "99078", # Physician or other qualified health care professional qualified by education, training, licensure/regulation (when applicable) educational services rendered to patients in a group setting (eg, prenatal, obesity, or diabetic instructions)
2081
+ "99202", # Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
2082
+ "99203", # Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
2083
+ "99204", # Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
2084
+ "99205", # Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
2085
+ "99212", # Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.
2086
+ "99213", # Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
2087
+ "99214", # Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
2088
+ "99215", # Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
2089
+ "99304", # Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded.
2090
+ "99305", # Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded.
2091
+ "99306", # Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 50 minutes must be met or exceeded.
2092
+ "99307", # Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.
2093
+ "99308", # Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
2094
+ "99309", # Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
2095
+ "99310", # Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
2096
+ "99315", # Nursing facility discharge management; 30 minutes or less total time on the date of the encounter
2097
+ "99316", # Nursing facility discharge management; more than 30 minutes total time on the date of the encounter
2098
+ "99341", # Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
2099
+ "99342", # Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
2100
+ "99344", # Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
2101
+ "99345", # Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded.
2102
+ "99347", # Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
2103
+ "99348", # Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
2104
+ "99349", # Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
2105
+ "99350", # Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
2106
+ "99384", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; adolescent (age 12 through 17 years)
2107
+ "99385", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18-39 years
2108
+ "99386", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 40-64 years
2109
+ "99387", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 65 years and older
2110
+ "99394", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; adolescent (age 12 through 17 years)
2111
+ "99395", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 years
2112
+ "99396", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years
2113
+ "99397", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 65 years and older
2114
+ "99401", # Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes
2115
+ "99402", # Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes
2116
+ "99403", # Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 45 minutes
2117
+ "99404", # Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes
2118
+ "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.
2119
+ "99483", # Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home, with all of the following required elements: Cognition-focused evaluation including a pertinent history and examination, Medical decision making of moderate or high complexity, Functional assessment (eg, basic and instrumental activities of daily living), including decision-making capacity, Use of standardized instruments for staging of dementia (eg, functional assessment staging test [FAST], clinical dementia rating [CDR]), Medication reconciliation and review for high-risk medications, Evaluation for neuropsychiatric and behavioral symptoms, including depression, including use of standardized screening instrument(s), Evaluation of safety (eg, home), including motor vehicle operation, Identification of caregiver(s), caregiver knowledge, caregiver needs, social supports, and the willingness of caregiver to take on caregiving tasks, Development, updating or revision, or review of an Advance Care Plan, Creation of a written care plan, including initial plans to address any neuropsychiatric symptoms, neuro-cognitive symptoms, functional limitations, and referral to community resources as needed (eg, rehabilitation services, adult day programs, support groups) shared with the patient and/or caregiver with initial education and support. Typically, 60 minutes of total time is spent on the date of the encounter.
2120
+ "99484", # Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month, with the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales, behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes, facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation, and continuity of care with a designated member of the care team.
2121
+ "99491", # 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; first 30 minutes provided personally by a physician or other qualified health care professional, per calendar month.
2122
+ "99492", # Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: outreach to and engagement in treatment of a patient directed by the treating physician or other qualified health care professional, initial assessment of the patient, including administration of validated rating scales, with the development of an individualized treatment plan, review by the psychiatric consultant with modifications of the plan if recommended, entering patient in a registry and tracking patient follow-up and progress using the registry, with appropriate documentation, and participation in weekly caseload consultation with the psychiatric consultant, and provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies.
2123
+ "99493", # Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: tracking patient follow-up and progress using the registry, with appropriate documentation, participation in weekly caseload consultation with the psychiatric consultant, ongoing collaboration with and coordination of the patient's mental health care with the treating physician or other qualified health care professional and any other treating mental health providers, additional review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations provided by the psychiatric consultant, provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies, monitoring of patient outcomes using validated rating scales, and relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharge from active treatment.
2124
+ }
2125
+
2126
+ HCPCSLEVELII = {
2127
+ "G0101", # Cervical or vaginal cancer screening; pelvic and clinical breast examination
2128
+ "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
2129
+ "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
2130
+ "G0402", # Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
2131
+ "G0438", # Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
2132
+ "G0439", # Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
2133
+ "G0444", # Annual depression screening, 5 to 15 minutes
2134
+ }
2135
+
2136
+ SNOMEDCT = {
2137
+ "10197000", # Psychiatric interview and evaluation (procedure)
2138
+ "108220007", # Evaluation AND/OR management - new patient (procedure)
2139
+ "108221006", # Evaluation AND/OR management - established patient (procedure)
2140
+ "108224003", # Preventive patient evaluation (procedure)
2141
+ "108311000", # Psychiatric procedure, interview AND/OR consultation (procedure)
2142
+ "13607009", # Manual examination of breast (procedure)
2143
+ "14736009", # History and physical examination with evaluation and management of patient (procedure)
2144
+ "165171009", # Initial psychiatric evaluation (procedure)
2145
+ "171207006", # Depression screening (procedure)
2146
+ "18512000", # Individual psychotherapy (regime/therapy)
2147
+ "185349003", # Encounter for check up (procedure)
2148
+ "185463005", # Visit out of hours (procedure)
2149
+ "185465003", # Weekend visit (procedure)
2150
+ "252603000", # Tinnitus assessment (procedure)
2151
+ "270427003", # Patient-initiated encounter (procedure)
2152
+ "270430005", # Provider-initiated encounter (procedure)
2153
+ "302440009", # Psychiatric pharmacologic management (procedure)
2154
+ "308335008", # Patient encounter procedure (procedure)
2155
+ "35025007", # Manual pelvic examination (procedure)
2156
+ "370803007", # Evaluation of psychosocial impact on plan of care (procedure)
2157
+ "390906007", # Follow-up encounter (procedure)
2158
+ "406547006", # Urgent follow-up (procedure)
2159
+ "410155007", # Occupational therapy assessment (procedure)
2160
+ "410157004", # Occupational therapy management (procedure)
2161
+ "46662001", # Examination of breast (procedure)
2162
+ "53555003", # Basic comprehensive audiometry testing (procedure)
2163
+ "78318003", # History and physical examination, annual for health maintenance (procedure)
2164
+ "83607001", # Gynecologic examination (procedure)
2165
+ "8411005", # Interactive individual medical psychotherapy (regime/therapy)
2166
+ "86013001", # Periodic reevaluation and management of healthy individual (procedure)
2167
+ "90526000", # Initial evaluation and management of healthy individual (procedure)
2168
+ }
2169
+
2170
+ class OutpatientEncountersForPreventiveCare(ValueSet):
2171
+ """
2172
+ **Clinical Focus:** The purpose of this value set is to represent concepts of an encounter for outpatient visits.
2173
+
2174
+ **Data Element Scope:** This value set may use a model element related to Medication.
2175
+
2176
+ **Inclusion Criteria:** Includes concepts that represent outpatient encounters for annual visit, preventive evaluation, follow-up, or periodic re-evaluations.
2177
+
2178
+ **Exclusion Criteria:** No exclusions.
2179
+ """
2180
+
2181
+ VALUE_SET_NAME = "Outpatient Encounters for Preventive Care"
2182
+ OID = "2.16.840.1.113883.3.526.3.1576"
2183
+ DEFINITION_VERSION = "20200307"
2184
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
2185
+
2186
+ SNOMEDCT = {
2187
+ "108219001", # Physician visit with evaluation AND/OR management service (procedure)
2188
+ "108220007", # Evaluation AND/OR management - new patient (procedure)
2189
+ "108221006", # Evaluation AND/OR management - established patient (procedure)
2190
+ "108224003", # Preventive patient evaluation (procedure)
2191
+ "14736009", # History and physical examination with evaluation and management of patient (procedure)
2192
+ "185349003", # Encounter for check up (procedure)
2193
+ "185389009", # Follow-up visit (procedure)
2194
+ "270427003", # Patient-initiated encounter (procedure)
2195
+ "270430005", # Provider-initiated encounter (procedure)
2196
+ "281036007", # Follow-up consultation (procedure)
2197
+ "308335008", # Patient encounter procedure (procedure)
2198
+ "390906007", # Follow-up encounter (procedure)
2199
+ "410187005", # Physical evaluation management (procedure)
2200
+ "78318003", # History and physical examination, annual for health maintenance (procedure)
2201
+ "86013001", # Periodic reevaluation and management of healthy individual (procedure)
2202
+ "90526000", # Initial evaluation and management of healthy individual (procedure)
2203
+ }
2204
+
2205
+ class TelemedicineServices(ValueSet):
2206
+ """
2207
+ **Clinical Focus:** The purpose of this value set is to represent concepts for telemedicine or virtual encounters.
2208
+
2209
+ **Data Element Scope:** This value set may use a model element related to Encounter.
2210
+
2211
+ **Inclusion Criteria:** Includes concepts that represent a telemedicine or virtual encounter.
2212
+
2213
+ **Exclusion Criteria:** No exclusions.
2214
+ """
2215
+
2216
+ VALUE_SET_NAME = "Telemedicine Services"
2217
+ OID = "2.16.840.1.113762.1.4.1248.276"
2218
+ DEFINITION_VERSION = "20250124"
2219
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
2220
+
2221
+ CPT = {
2222
+ "98000", # Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
2223
+ "98001", # Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
2224
+ "98002", # Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
2225
+ "98003", # Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
2226
+ "98004", # Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.
2227
+ "98005", # Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
2228
+ "98006", # Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
2229
+ "98007", # Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
2230
+ "98008", # Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, straightforward medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
2231
+ "98009", # Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, low medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
2232
+ "98010", # Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, moderate medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
2233
+ "98011", # Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, high medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
2234
+ "98012", # Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, straightforward medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 10 minutes must be exceeded.
2235
+ "98013", # Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, low medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
2236
+ "98014", # Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, moderate medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
2237
+ "98015", # Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, high medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
2238
+ "98016", # Brief communication technology-based service (eg, virtual check-in) by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related evaluation and management service provided within the previous 7 days nor leading to an evaluation and management service or procedure within the next 24 hours or soonest available appointment, 5-10 minutes of medical discussion
2239
+ }
2240
+
2241
+ class EncounterToDocumentMedications(ValueSet):
2242
+ """
2243
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters that include documentation of current medications.
2244
+
2245
+ **Data Element Scope:** This value set may use a model element related to Encounter.
2246
+
2247
+ **Inclusion Criteria:** Includes concepts that identify an encounter that includes documentation of medications reviewed, updated or transcribed as the current medication list.
2248
+
2249
+ **Exclusion Criteria:** No exclusions.
2250
+ """
2251
+
2252
+ VALUE_SET_NAME = "Encounter to Document Medications"
2253
+ OID = "2.16.840.1.113883.3.600.1.1834"
2254
+ DEFINITION_VERSION = "20210220"
2255
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
2256
+
2257
+ CPT = {
2258
+ "59400", # Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care
2259
+ "59510", # Routine obstetric care including antepartum care, cesarean delivery, and postpartum care
2260
+ "59610", # Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, after previous cesarean delivery
2261
+ "59618", # Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous cesarean delivery
2262
+ "90791", # Psychiatric diagnostic evaluation
2263
+ "90792", # Psychiatric diagnostic evaluation with medical services
2264
+ "90832", # Psychotherapy, 30 minutes with patient
2265
+ "90834", # Psychotherapy, 45 minutes with patient
2266
+ "90837", # Psychotherapy, 60 minutes with patient
2267
+ "90839", # Psychotherapy for crisis; first 60 minutes
2268
+ "92002", # Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient
2269
+ "92004", # Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits
2270
+ "92012", # Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient
2271
+ "92014", # Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, 1 or more visits
2272
+ "92507", # Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
2273
+ "92508", # Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
2274
+ "92526", # Treatment of swallowing dysfunction and/or oral function for feeding
2275
+ "92537", # Caloric vestibular test with recording, bilateral; bithermal (ie, one warm and one cool irrigation in each ear for a total of four irrigations)
2276
+ "92538", # Caloric vestibular test with recording, bilateral; monothermal (ie, one irrigation in each ear for a total of two irrigations)
2277
+ "92540", # Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and oscillating tracking test, with recording
2278
+ "92541", # Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording
2279
+ "92542", # Positional nystagmus test, minimum of 4 positions, with recording
2280
+ "92544", # Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording
2281
+ "92545", # Oscillating tracking test, with recording
2282
+ "92547", # Use of vertical electrodes (List separately in addition to code for primary procedure)
2283
+ "92548", # Computerized dynamic posturography sensory organization test (CDP-SOT), 6 conditions (ie, eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway), including interpretation and report
2284
+ "92549", # Computerized dynamic posturography sensory organization test (CDP-SOT), 6 conditions (ie, eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway), including interpretation and report; with motor control test (MCT) and adaptation test (ADT)
2285
+ "92550", # Tympanometry and reflex threshold measurements
2286
+ "92557", # Comprehensive audiometry threshold evaluation and speech recognition (92553 and 92556 combined)
2287
+ "92567", # Tympanometry (impedance testing)
2288
+ "92568", # Acoustic reflex testing, threshold
2289
+ "92570", # Acoustic immittance testing, includes tympanometry (impedance testing), acoustic reflex threshold testing, and acoustic reflex decay testing
2290
+ "92588", # Distortion product evoked otoacoustic emissions; comprehensive diagnostic evaluation (quantitative analysis of outer hair cell function by cochlear mapping, minimum of 12 frequencies), with interpretation and report
2291
+ "92626", # Evaluation of auditory function for surgically implanted device(s) candidacy or postoperative status of a surgically implanted device(s); first hour
2292
+ "92650", # Auditory evoked potentials; screening of auditory potential with broadband stimuli, automated analysis
2293
+ "92651", # Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report
2294
+ "92652", # Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report
2295
+ "92653", # Auditory evoked potentials; neurodiagnostic, with interpretation and report
2296
+ "96116", # Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, [eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities]), by physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; first hour
2297
+ "96156", # Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making)
2298
+ "96158", # Health behavior intervention, individual, face-to-face; initial 30 minutes
2299
+ "97129", # Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes
2300
+ "97161", # Physical therapy evaluation: low complexity, requiring these components: A history with no personal factors and/or comorbidities that impact the plan of care; An examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with stable and/or uncomplicated characteristics; and Clinical decision making of low complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 20 minutes are spent face-to-face with the patient and/or family.
2301
+ "97162", # Physical therapy evaluation: moderate complexity, requiring these components: A history of present problem with 1-2 personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures in addressing a total of 3 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; An evolving clinical presentation with changing characteristics; and Clinical decision making of moderate complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 30 minutes are spent face-to-face with the patient and/or family.
2302
+ "97163", # Physical therapy evaluation: high complexity, requiring these components: A history of present problem with 3 or more personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures addressing a total of 4 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with unstable and unpredictable characteristics; and Clinical decision making of high complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 45 minutes are spent face-to-face with the patient and/or family.
2303
+ "97164", # Re-evaluation of physical therapy established plan of care, requiring these components: An examination including a review of history and use of standardized tests and measures is required; and Revised plan of care using a standardized patient assessment instrument and/or measurable assessment of functional outcome Typically, 20 minutes are spent face-to-face with the patient and/or family.
2304
+ "97165", # Occupational therapy evaluation, low complexity, requiring these components: An occupational profile and medical and therapy history, which includes a brief history including review of medical and/or therapy records relating to the presenting problem; An assessment(s) that identifies 1-3 performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of low complexity, which includes an analysis of the occupational profile, analysis of data from problem-focused assessment(s), and consideration of a limited number of treatment options. Patient presents with no comorbidities that affect occupational performance. Modification of tasks or assistance (eg, physical or verbal) with assessment(s) is not necessary to enable completion of evaluation component. Typically, 30 minutes are spent face-to-face with the patient and/or family.
2305
+ "97166", # Occupational therapy evaluation, moderate complexity, requiring these components: An occupational profile and medical and therapy history, which includes an expanded review of medical and/or therapy records and additional review of physical, cognitive, or psychosocial history related to current functional performance; An assessment(s) that identifies 3-5 performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of moderate analytic complexity, which includes an analysis of the occupational profile, analysis of data from detailed assessment(s), and consideration of several treatment options. Patient may present with comorbidities that affect occupational performance. Minimal to moderate modification of tasks or assistance (eg, physical or verbal) with assessment(s) is necessary to enable patient to complete evaluation component. Typically, 45 minutes are spent face-to-face with the patient and/or family.
2306
+ "97167", # Occupational therapy evaluation, high complexity, requiring these components: An occupational profile and medical and therapy history, which includes review of medical and/or therapy records and extensive additional review of physical, cognitive, or psychosocial history related to current functional performance; An assessment(s) that identifies 5 or more performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of high analytic complexity, which includes an analysis of the patient profile, analysis of data from comprehensive assessment(s), and consideration of multiple treatment options. Patient presents with comorbidities that affect occupational performance. Significant modification of tasks or assistance (eg, physical or verbal) with assessment(s) is necessary to enable patient to complete evaluation component. Typically, 60 minutes are spent face-to-face with the patient and/or family.
2307
+ "97168", # Re-evaluation of occupational therapy established plan of care, requiring these components: An assessment of changes in patient functional or medical status with revised plan of care; An update to the initial occupational profile to reflect changes in condition or environment that affect future interventions and/or goals; and A revised plan of care. A formal reevaluation is performed when there is a documented change in functional status or a significant change to the plan of care is required. Typically, 30 minutes are spent face-to-face with the patient and/or family.
2308
+ "97802", # Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes
2309
+ "97803", # Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes
2310
+ "97804", # Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes
2311
+ "98000", # Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
2312
+ "98001", # Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
2313
+ "98002", # Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
2314
+ "98003", # Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
2315
+ "98004", # Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.
2316
+ "98005", # Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
2317
+ "98006", # Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
2318
+ "98007", # Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
2319
+ "98008", # Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, straightforward medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
2320
+ "98009", # Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, low medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
2321
+ "98010", # Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, moderate medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
2322
+ "98011", # Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, high medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
2323
+ "98012", # Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, straightforward medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 10 minutes must be exceeded.
2324
+ "98013", # Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, low medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
2325
+ "98014", # Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, moderate medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
2326
+ "98015", # Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, high medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
2327
+ "98016", # Brief communication technology-based service (eg, virtual check-in) by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related evaluation and management service provided within the previous 7 days nor leading to an evaluation and management service or procedure within the next 24 hours or soonest available appointment, 5-10 minutes of medical discussion
2328
+ "98960", # Education and training for patient self-management by a nonphysician qualified health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient
2329
+ "98961", # Education and training for patient self-management by a nonphysician qualified health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; 2-4 patients
2330
+ "98962", # Education and training for patient self-management by a nonphysician qualified health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; 5-8 patients
2331
+ "99202", # Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
2332
+ "99203", # Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
2333
+ "99204", # Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
2334
+ "99205", # Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
2335
+ "99211", # Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional
2336
+ "99212", # Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.
2337
+ "99213", # Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
2338
+ "99214", # Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
2339
+ "99215", # Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
2340
+ "99221", # Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
2341
+ "99222", # Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded.
2342
+ "99223", # Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded.
2343
+ "99236", # Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 85 minutes must be met or exceeded.
2344
+ "99281", # Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional
2345
+ "99282", # Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making
2346
+ "99283", # Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making
2347
+ "99284", # Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making
2348
+ "99285", # Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making
2349
+ "99304", # Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded.
2350
+ "99305", # Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded.
2351
+ "99306", # Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 50 minutes must be met or exceeded.
2352
+ "99307", # Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.
2353
+ "99308", # Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
2354
+ "99309", # Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
2355
+ "99310", # Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
2356
+ "99315", # Nursing facility discharge management; 30 minutes or less total time on the date of the encounter
2357
+ "99316", # Nursing facility discharge management; more than 30 minutes total time on the date of the encounter
2358
+ "99341", # Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
2359
+ "99342", # Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
2360
+ "99344", # Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
2361
+ "99345", # Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded.
2362
+ "99347", # Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
2363
+ "99348", # Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
2364
+ "99349", # Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
2365
+ "99350", # Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
2366
+ "99385", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18-39 years
2367
+ "99386", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 40-64 years
2368
+ "99387", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 65 years and older
2369
+ "99395", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 years
2370
+ "99396", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years
2371
+ "99397", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 65 years and older
2372
+ "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.
2373
+ "99491", # 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; first 30 minutes provided personally by a physician or other qualified health care professional, per calendar month.
2374
+ "99495", # Transitional care management services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge At least moderate level of medical decision making during the service period Face-to-face visit, within 14 calendar days of discharge
2375
+ "99496", # Transitional care management services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge High level of medical decision making during the service period Face-to-face visit, within 7 calendar days of discharge
2376
+ }
2377
+
2378
+ HCPCSLEVELII = {
2379
+ "G0101", # Cervical or vaginal cancer screening; pelvic and clinical breast examination
2380
+ "G0108", # Diabetes outpatient self-management training services, individual, per 30 minutes
2381
+ "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
2382
+ "G0402", # Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
2383
+ "G0438", # Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
2384
+ "G0439", # Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
2385
+ }
2386
+
2387
+ SNOMEDCT = {
2388
+ "10197000", # Psychiatric interview and evaluation (procedure)
2389
+ "108220007", # Evaluation AND/OR management - new patient (procedure)
2390
+ "108221006", # Evaluation AND/OR management - established patient (procedure)
2391
+ "108224003", # Preventive patient evaluation (procedure)
2392
+ "108311000", # Psychiatric procedure, interview AND/OR consultation (procedure)
2393
+ "13607009", # Manual examination of breast (procedure)
2394
+ "14736009", # History and physical examination with evaluation and management of patient (procedure)
2395
+ "163497009", # Obstetric examination (procedure)
2396
+ "165171009", # Initial psychiatric evaluation (procedure)
2397
+ "169762003", # Postnatal visit (regime/therapy)
2398
+ "18091003", # Electronystagmography with vertical electrodes (procedure)
2399
+ "18114009", # Prenatal examination and care of mother (procedure)
2400
+ "183382003", # Psychotherapy - behavioral (regime/therapy)
2401
+ "183383008", # Psychotherapy - cognitive (regime/therapy)
2402
+ "18512000", # Individual psychotherapy (regime/therapy)
2403
+ "185349003", # Encounter for check up (procedure)
2404
+ "185463005", # Visit out of hours (procedure)
2405
+ "185465003", # Weekend visit (procedure)
2406
+ "209099002", # History and physical examination with management of domiciliary or rest home patient (procedure)
2407
+ "210098006", # Domiciliary or rest home patient evaluation and management (procedure)
2408
+ "225967005", # Self-care patient education (procedure)
2409
+ "252592009", # Speech audiometry (procedure)
2410
+ "252624005", # Evoked oto-acoustic emission measurement (procedure)
2411
+ "270427003", # Patient-initiated encounter (procedure)
2412
+ "270430005", # Provider-initiated encounter (procedure)
2413
+ "274803000", # Examination of tympanic membrane (procedure)
2414
+ "277404009", # High frequency tympanometry (procedure)
2415
+ "284015009", # Auditory evoked potentials monitoring (regime/therapy)
2416
+ "308335008", # Patient encounter procedure (procedure)
2417
+ "34651001", # Optokinetic nystagmus test, bidirectional, with recording (procedure)
2418
+ "35025007", # Manual pelvic examination (procedure)
2419
+ "36228007", # Ophthalmic examination and evaluation (procedure)
2420
+ "370803007", # Evaluation of psychosocial impact on plan of care (procedure)
2421
+ "386372009", # Nutrition management (regime/therapy)
2422
+ "390906007", # Follow-up encounter (procedure)
2423
+ "406547006", # Urgent follow-up (procedure)
2424
+ "408983003", # Renal care management (procedure)
2425
+ "410155007", # Occupational therapy assessment (procedure)
2426
+ "410157004", # Occupational therapy management (procedure)
2427
+ "410158009", # Physical therapy assessment (procedure)
2428
+ "410160006", # Physical therapy management (procedure)
2429
+ "410170008", # Nutrition care assessment (procedure)
2430
+ "439708006", # Home visit (procedure)
2431
+ "439952009", # Evaluation of auditory rehabilitation (procedure)
2432
+ "440524004", # Oscillating tracking test with recording (procedure)
2433
+ "46662001", # Examination of breast (procedure)
2434
+ "48423005", # Acoustic reflex testing (procedure)
2435
+ "50357006", # Evaluation and management of patient at home (procedure)
2436
+ "53555003", # Basic comprehensive audiometry testing (procedure)
2437
+ "54290001", # Positional nystagmus test with recording (procedure)
2438
+ "63547008", # Caloric vestibular test with recording (procedure)
2439
+ "66902005", # Ophthalmic examination and evaluation, follow-up (procedure)
2440
+ "698610002", # Education about self management of diabetes (procedure)
2441
+ "78318003", # History and physical examination, annual for health maintenance (procedure)
2442
+ "83607001", # Gynecologic examination (procedure)
2443
+ "8411005", # Interactive individual medical psychotherapy (regime/therapy)
2444
+ "86013001", # Periodic reevaluation and management of healthy individual (procedure)
2445
+ "870422002", # Assessment of self management of diabetes mellitus (procedure)
2446
+ "90526000", # Initial evaluation and management of healthy individual (procedure)
2447
+ "91573000", # Tympanometry testing (procedure)
2448
+ }
2449
+
2450
+ class EncounterToEvaluateBmi(ValueSet):
2451
+ """
2452
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters where body mass index (BMI) could be assessed.
2453
+
2454
+ **Data Element Scope:** This value set may use a model element related to Encounter.
2455
+
2456
+ **Inclusion Criteria:** Includes concepts for encounters where body mass index (BMI) could be assessed.
2457
+
2458
+ **Exclusion Criteria:** No exclusions.
2459
+ """
2460
+
2461
+ VALUE_SET_NAME = "Encounter to Evaluate BMI"
2462
+ OID = "2.16.840.1.113883.3.600.1.1751"
2463
+ DEFINITION_VERSION = "20210220"
2464
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
2465
+
2466
+ CDT = {
2467
+ "D3921", # decoronation or submergence of an erupted tooth
2468
+ "D7111", # extraction, coronal remnants - primary tooth
2469
+ "D7140", # extraction, erupted tooth or exposed root (elevation and/or forceps removal)
2470
+ "D7210", # extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated
2471
+ "D7220", # removal of impacted tooth - soft tissue
2472
+ "D7230", # removal of impacted tooth - partially bony
2473
+ "D7240", # removal of impacted tooth - completely bony
2474
+ "D7241", # removal of impacted tooth - completely bony, with unusual surgical complications
2475
+ "D7250", # removal of residual tooth roots (cutting procedure)
2476
+ "D7251", # coronectomy - intentional partial tooth removal, impacted teeth only
2477
+ }
2478
+
2479
+ CPT = {
2480
+ "90791", # Psychiatric diagnostic evaluation
2481
+ "90792", # Psychiatric diagnostic evaluation with medical services
2482
+ "90832", # Psychotherapy, 30 minutes with patient
2483
+ "90834", # Psychotherapy, 45 minutes with patient
2484
+ "90837", # Psychotherapy, 60 minutes with patient
2485
+ "96156", # Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making)
2486
+ "96158", # Health behavior intervention, individual, face-to-face; initial 30 minutes
2487
+ "96159", # Health behavior intervention, individual, face-to-face; each additional 15 minutes (List separately in addition to code for primary service)
2488
+ "97161", # Physical therapy evaluation: low complexity, requiring these components: A history with no personal factors and/or comorbidities that impact the plan of care; An examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with stable and/or uncomplicated characteristics; and Clinical decision making of low complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 20 minutes are spent face-to-face with the patient and/or family.
2489
+ "97162", # Physical therapy evaluation: moderate complexity, requiring these components: A history of present problem with 1-2 personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures in addressing a total of 3 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; An evolving clinical presentation with changing characteristics; and Clinical decision making of moderate complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 30 minutes are spent face-to-face with the patient and/or family.
2490
+ "97163", # Physical therapy evaluation: high complexity, requiring these components: A history of present problem with 3 or more personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures addressing a total of 4 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with unstable and unpredictable characteristics; and Clinical decision making of high complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 45 minutes are spent face-to-face with the patient and/or family.
2491
+ "97165", # Occupational therapy evaluation, low complexity, requiring these components: An occupational profile and medical and therapy history, which includes a brief history including review of medical and/or therapy records relating to the presenting problem; An assessment(s) that identifies 1-3 performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of low complexity, which includes an analysis of the occupational profile, analysis of data from problem-focused assessment(s), and consideration of a limited number of treatment options. Patient presents with no comorbidities that affect occupational performance. Modification of tasks or assistance (eg, physical or verbal) with assessment(s) is not necessary to enable completion of evaluation component. Typically, 30 minutes are spent face-to-face with the patient and/or family.
2492
+ "97166", # Occupational therapy evaluation, moderate complexity, requiring these components: An occupational profile and medical and therapy history, which includes an expanded review of medical and/or therapy records and additional review of physical, cognitive, or psychosocial history related to current functional performance; An assessment(s) that identifies 3-5 performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of moderate analytic complexity, which includes an analysis of the occupational profile, analysis of data from detailed assessment(s), and consideration of several treatment options. Patient may present with comorbidities that affect occupational performance. Minimal to moderate modification of tasks or assistance (eg, physical or verbal) with assessment(s) is necessary to enable patient to complete evaluation component. Typically, 45 minutes are spent face-to-face with the patient and/or family.
2493
+ "97167", # Occupational therapy evaluation, high complexity, requiring these components: An occupational profile and medical and therapy history, which includes review of medical and/or therapy records and extensive additional review of physical, cognitive, or psychosocial history related to current functional performance; An assessment(s) that identifies 5 or more performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of high analytic complexity, which includes an analysis of the patient profile, analysis of data from comprehensive assessment(s), and consideration of multiple treatment options. Patient presents with comorbidities that affect occupational performance. Significant modification of tasks or assistance (eg, physical or verbal) with assessment(s) is necessary to enable patient to complete evaluation component. Typically, 60 minutes are spent face-to-face with the patient and/or family.
2494
+ "97802", # Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes
2495
+ "97803", # Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes
2496
+ "99202", # Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
2497
+ "99203", # Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
2498
+ "99204", # Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
2499
+ "99205", # Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
2500
+ "99212", # Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.
2501
+ "99213", # Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
2502
+ "99214", # Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
2503
+ "99215", # Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
2504
+ "99242", # Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
2505
+ "99243", # Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
2506
+ "99244", # Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
2507
+ "99245", # Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded.
2508
+ "99304", # Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded.
2509
+ "99305", # Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded.
2510
+ "99306", # Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 50 minutes must be met or exceeded.
2511
+ "99307", # Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.
2512
+ "99308", # Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
2513
+ "99309", # Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
2514
+ "99310", # Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
2515
+ "99315", # Nursing facility discharge management; 30 minutes or less total time on the date of the encounter
2516
+ "99316", # Nursing facility discharge management; more than 30 minutes total time on the date of the encounter
2517
+ "99341", # Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
2518
+ "99342", # Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
2519
+ "99344", # Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
2520
+ "99345", # Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded.
2521
+ "99347", # Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
2522
+ "99348", # Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
2523
+ "99349", # Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
2524
+ "99350", # Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
2525
+ "99385", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18-39 years
2526
+ "99386", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 40-64 years
2527
+ "99387", # Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 65 years and older
2528
+ "99395", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 years
2529
+ "99396", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years
2530
+ "99397", # Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 65 years and older
2531
+ "99401", # Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes
2532
+ "99402", # Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes
2533
+ "99491", # 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; first 30 minutes provided personally by a physician or other qualified health care professional, per calendar month.
2534
+ }
2535
+
2536
+ HCPCSLEVELII = {
2537
+ "G0101", # Cervical or vaginal cancer screening; pelvic and clinical breast examination
2538
+ "G0108", # Diabetes outpatient self-management training services, individual, per 30 minutes
2539
+ "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
2540
+ "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
2541
+ "G0402", # Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
2542
+ "G0438", # Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
2543
+ "G0439", # Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
2544
+ "G0447", # Face-to-face behavioral counseling for obesity, 15 minutes
2545
+ "G0473", # Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes
2546
+ }
2547
+
2548
+ SNOMEDCT = {
2549
+ "10197000", # Psychiatric interview and evaluation (procedure)
2550
+ "108220007", # Evaluation AND/OR management - new patient (procedure)
2551
+ "108221006", # Evaluation AND/OR management - established patient (procedure)
2552
+ "108224003", # Preventive patient evaluation (procedure)
2553
+ "108311000", # Psychiatric procedure, interview AND/OR consultation (procedure)
2554
+ "13607009", # Manual examination of breast (procedure)
2555
+ "14736009", # History and physical examination with evaluation and management of patient (procedure)
2556
+ "165171009", # Initial psychiatric evaluation (procedure)
2557
+ "18512000", # Individual psychotherapy (regime/therapy)
2558
+ "185349003", # Encounter for check up (procedure)
2559
+ "185463005", # Visit out of hours (procedure)
2560
+ "185465003", # Weekend visit (procedure)
2561
+ "209099002", # History and physical examination with management of domiciliary or rest home patient (procedure)
2562
+ "210098006", # Domiciliary or rest home patient evaluation and management (procedure)
2563
+ "225967005", # Self-care patient education (procedure)
2564
+ "270427003", # Patient-initiated encounter (procedure)
2565
+ "270430005", # Provider-initiated encounter (procedure)
2566
+ "308335008", # Patient encounter procedure (procedure)
2567
+ "35025007", # Manual pelvic examination (procedure)
2568
+ "386372009", # Nutrition management (regime/therapy)
2569
+ "390906007", # Follow-up encounter (procedure)
2570
+ "406547006", # Urgent follow-up (procedure)
2571
+ "410155007", # Occupational therapy assessment (procedure)
2572
+ "410157004", # Occupational therapy management (procedure)
2573
+ "410158009", # Physical therapy assessment (procedure)
2574
+ "410160006", # Physical therapy management (procedure)
2575
+ "410170008", # Nutrition care assessment (procedure)
2576
+ "410172000", # Nutrition care management (procedure)
2577
+ "46662001", # Examination of breast (procedure)
2578
+ "55162003", # Tooth extraction (procedure)
2579
+ "68381003", # Surgical removal of erupted tooth requiring elevation of mucoperiosteal flap and removal of bone and/or section of tooth (procedure)
2580
+ "78318003", # History and physical examination, annual for health maintenance (procedure)
2581
+ "83607001", # Gynecologic examination (procedure)
2582
+ "8411005", # Interactive individual medical psychotherapy (regime/therapy)
2583
+ "86013001", # Periodic reevaluation and management of healthy individual (procedure)
2584
+ "90526000", # Initial evaluation and management of healthy individual (procedure)
2585
+ }
2586
+
2587
+ class ClinicalOralEvaluation(ValueSet):
2588
+ """
2589
+ **Clinical Focus:** The purpose of this value set is to represent concepts for encounters for clinical oral evaluations.
2590
+
2591
+ **Data Element Scope:** This value set may use a model element related to Encounter.
2592
+
2593
+ **Inclusion Criteria:** Includes concepts that represent an encounter for periodic or limited (problem focused) or comprehensive oral evaluations and re-evaluations.
2594
+
2595
+ **Exclusion Criteria:** No exclusions.
2596
+ """
2597
+
2598
+ VALUE_SET_NAME = "Clinical Oral Evaluation"
2599
+ OID = "2.16.840.1.113883.3.464.1003.125.12.1003"
2600
+ DEFINITION_VERSION = "20170504"
2601
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
2602
+
2603
+ CDT = {
2604
+ "D0120", # periodic oral evaluation - established patient
2605
+ "D0140", # limited oral evaluation - problem focused
2606
+ "D0145", # oral evaluation for a patient under three years of age and counseling with primary caregiver
2607
+ "D0150", # comprehensive oral evaluation - new or established patient
2608
+ "D0160", # detailed and extensive oral evaluation - problem focused, by report
2609
+ "D0170", # re-evaluation - limited, problem focused (established patient; not post-operative visit)
2610
+ "D0180", # comprehensive periodontal evaluation - new or established patient
2611
+ }
2612
+
2613
+ class HospitalServicesForUrologyCare(ValueSet):
2614
+ """
2615
+ **Clinical Focus:** The purpose of this value set is to represent concepts of encounters identifying hospital services for urology care.
2616
+
2617
+ **Data Element Scope:** This value set may use a model element related to Encounter.
2618
+
2619
+ **Inclusion Criteria:** Includes concepts that represent an encounter specific to hospital services for urology care.
2620
+
2621
+ **Exclusion Criteria:** .No exclusions.
2622
+ """
2623
+
2624
+ VALUE_SET_NAME = "Hospital Services for Urology Care"
2625
+ OID = "2.16.840.1.113762.1.4.1248.360"
2626
+ DEFINITION_VERSION = "20250312"
2627
+ EXPANSION_VERSION = "eCQM Update 2025-05-08"
2628
+
2629
+ CPT = {
2630
+ "99221", # Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
2631
+ "99222", # Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded.
2632
+ "99223", # Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded.
2633
+ "99231", # Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded.
2634
+ "99232", # Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded.
2635
+ "99233", # Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 50 minutes must be met or exceeded.
2636
+ "99234", # Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
2637
+ "99235", # Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 70 minutes must be met or exceeded.
2638
+ "99236", # Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 85 minutes must be met or exceeded.
2639
+ "99238", # Hospital inpatient or observation discharge day management; 30 minutes or less on the date of the encounter
2640
+ "99239", # Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter
2641
+ "99281", # Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional
2642
+ "99282", # Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making
2643
+ "99283", # Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making
2644
+ "99284", # Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making
2645
+ "99285", # Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making
2646
+ }
2647
+
2648
+ __exports__ = (
2649
+ "AnnualWellnessVisit",
2650
+ "EncounterInpatient",
2651
+ "FrailtyEncounter",
2652
+ "HomeHealthcareServices",
2653
+ "HospiceEncounter",
2654
+ "OfficeVisit",
2655
+ "PreventiveCareServicesEstablishedOfficeVisit18AndUp",
2656
+ "OphthalmologicalServices",
2657
+ "PalliativeCareEncounter",
2658
+ "TelephoneVisits",
2659
+ "EmergencyDepartmentVisit",
2660
+ "ObservationServices",
2661
+ "EdVisitAndObTriage",
2662
+ "NonelectiveInpatientEncounter",
2663
+ "OutpatientClinicalEncounters",
2664
+ "PreventativeClinicalEncounters",
2665
+ "FaceToFaceInteraction",
2666
+ "OutpatientConsultation",
2667
+ "PreventiveCareServicesInitialOfficeVisit18AndUp",
2668
+ "PreventiveCareServicesInitialOfficeVisit0To17",
2669
+ "PreventiveCareEstablishedOfficeVisit0To17",
2670
+ "OutpatientEncounter",
2671
+ "VirtualEncounter",
2672
+ "ElectiveInpatientEncounter",
2673
+ "OutpatientSurgeryService",
2674
+ "NutritionServices",
2675
+ "DecisionToAdmitToHospitalInpatient",
2676
+ "EmergencyDepartmentEvaluationAndManagementVisit",
2677
+ "Triage",
2678
+ "DecisionToTransfer",
2679
+ "NursingFacilityVisit",
2680
+ "PsychVisitDiagnosticEvaluation",
2681
+ "PsychVisitPsychotherapy",
2682
+ "CareServicesInLongTermResidentialFacility",
2683
+ "PatientProviderInteraction",
2684
+ "BehavioralHealthFollowUpVisit",
2685
+ "PreventiveCareServicesGroupCounseling",
2686
+ "PreventiveCareServicesIndividualCounseling",
2687
+ "PsychotherapyAndPharmacologicManagement",
2688
+ "DetoxificationVisit",
2689
+ "DischargeServicesHospitalInpatient",
2690
+ "DischargeServicesHospitalInpatientSameDayDischarge",
2691
+ "InitialHospitalInpatientVisit",
2692
+ "OccupationalTherapyEvaluation",
2693
+ "PhysicalTherapyEvaluation",
2694
+ "Psychoanalysis",
2695
+ "SpeechAndHearingEvaluation",
2696
+ "AudiologyVisit",
2697
+ "DischargeServicesNursingFacility",
2698
+ "MedicalDisabilityExam",
2699
+ "BehavioralOrNeuropsychAssessment",
2700
+ "AudioVisualTelehealthEncounter",
2701
+ "RadiationTreatmentManagement",
2702
+ "ContactOrOfficeVisit",
2703
+ "EsrdMonthlyOutpatientServices",
2704
+ "GroupPsychotherapy",
2705
+ "PsychVisitForFamilyPsychotherapy",
2706
+ "EncounterToScreenForBloodPressure",
2707
+ "EncounterToScreenForDepression",
2708
+ "OutpatientEncountersForPreventiveCare",
2709
+ "TelemedicineServices",
2710
+ "EncounterToDocumentMedications",
2711
+ "EncounterToEvaluateBmi",
2712
+ "ClinicalOralEvaluation",
2713
+ "HospitalServicesForUrologyCare",
2714
+ )