UnitedHealth Premium Physician Designation Program Codes and Medications Demonstrating Compliance with Nationally Endorsed Quality Measures

UnitedHealth Premium Physician Designation Program s and Medications Demonstrating Compliance with Nationally Endorsed Quality Measures Introduction This document is a reference for use during the online UnitedHealth Premium designation program s reconsideration process to determine if a patient met the clinical standards for measures indicated as non-compliant. This document is specifically referenced within the Reconsideration Quality Worksheet and the online Quality tab screen for nationally endorsed quality measures. Refer to this document for codes and medications that demonstrate compliance with these measures. The document is organized alphabetically by condition and then by measure. Each measure includes a list and description of billing codes and/or medications that satisfy the compliance criteria. The list for each measure may include medications and the following code types as applicable: ICD-9 HCPCS LOINC RVNU POS Definition Current Procedural Terminology () is coding used to describe medical services and procedures. A three to five digit number code describing a diagnosis or medical procedure. The Healthcare Common Procedure Coding System (HCPCS) is a set of health care procedure codes based on the American Medical Association's Current Procedural Terminology (). Logical Observation Identifiers Names and s (LOINC) are a database and universal standard for identifying medical laboratory observations. s used to identify specific accommodations, ancillary services and billing calculations used by facilities as determined by the National Uniform Billing Committee. Place of Service (POS) s are two-digit codes placed on health care professional claims to indicate the setting in which a service was provided. Additional helpful definitions: Measure Source ID Symmetry EBM Connect Case ID or Symmetry Procedure Episode Group (PEG ) anchor category ID Rule ID Reference number for Symmetry EBM Connect rules. Note: You may also want to refer to the Evidence-Based Medicine (EBM) Synopses (Pathway: UnitedHealthcareOnline.com > UnitedHealth Premium > Premium Reconsideration > Reconsideration Resources.)

Table of Contents Acute Myocardial Infarction (AMI)...3 ADHD...4 Alcohol and Other Drug Dependence Treatment...15 Antidepressant Medical Management...29 Asthma...30 Avoidance of Antibiotic Treatment in adults with Acute Bronchitis...34 Breast Cancer Screening...35 Cardiovascular Disease...36 Cervical Cancer Screening...37 Chlamydia Screening.............................................40 Congestive Heart Failure...42 Coronary Artery Disease...47 Diabetes...50 Diabetes Mellitus...52 Diabetic Retinopathy (NS)...53 Glaucoma Screening...54 Medication Safety Monitoring...57 Migraine Headache...64 Osteoporosis Management...65 Pharyngitis...67 Pregnancy Management...68 Rheumatoid Arthritis...69 Upper Respiratory Infection (Pediatric)...70 Use of Appropriate Imaging for Back Pain...71 Table of Contents 2

Acute Myocardial Infarction (AMI) Measure Source (Case) ID: 203100 Measure: Medication Patient(s) hospitalized with an acute myocardial infarction (AMI) persistently taking a betablocker for six months after discharge. (Rule ID: 9000001) Acebutolol hydrochloride Atenolol Bendroflumethiazide-nadolol Betapace Betapace AF Betaxolol Blocadren Bystolic Cartrol Carvedilol Coreg Corgard Corzide Hydrochlorothiazide-metoprolol Hydrochlorothiazide-propranolol Inderal Inderide InnoPran XL Kerlone Levatol Lopressor Metoprolol succinate ER Metoprolol tartrate Nadolol Normodyne Pindolol Propranolol hydrochloride Sectral Sorine Sotalol hydrochloride Tenoretic Tenormin Timolide 10-25 Timolol maleate Toprol-XL Trandate Zebeta Ziac Acute Myocardial Infarction (AMI) 3

ADHD Measure Source (Case) ID: 200100 Measure: Measure: Patients who have an outpatient, intensive outpatient, or partial hospitalization follow-up visit with a prescribing provider within 30 days after the initial ADHD prescription. (Rule ID: 9000001) Patients who have an outpatient, intensive outpatient, or partial hospitalization follow-up visit with a prescribing provider within 30 days after the initial ADHD prescription AND two followup visits during the 31 days through 300 days after the initial. (Rule ID: 9000002) Description 90801 Psychiatric diagnostic interview examination 90802 Interactive psychiatric diagnostic interview examination using play equipment, physical devices, language interpreter, or other mechanisms of communication 90804 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient; 90805 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient; with medical evaluation and management services 90806 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient; 90807 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient; with medical evaluation and management services 90808 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient; 90809 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient; with medical evaluation and management services 90810 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient; 90811 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient; with medical evaluation and management services 90812 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient; 90813 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient; with medical evaluation and management services 90814 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient; ADHD 4

Description 90815 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient; with medical evaluation and management services 90816 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 20 to 30 minutes face-to-face with the patient; 90817 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 20 to 30 minutes face-to-face with the patient; with medical evaluation and management services 90818 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 45 to 50 minutes face-to-face with the patient; 90819 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 45 to 50 minutes face-to-face with the patient; with medical evaluation and management services 90821 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face-to-face with the patient; 90822 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face-to-face with the patient; with medical evaluation and management services 90823 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 20 to 30 minutes face-to-face with the patient; 90824 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 20 to 30 minutes face-to-face with the patient; with medical evaluation and management services 90826 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 45 to 50 minutes face-to-face with the patient; 90827 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 45 to 50 minutes face-to-face with the patient; with medical evaluation and management services 90828 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face-to-face with the patient; 90829 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face-to-face with the patient; with medical evaluation and management services 90845 Psychoanalysis 90847 Family psychotherapy (conjoint psychotherapy) (with patient present) 90849 Multiple-family group psychotherapy 90853 Group psychotherapy (other than of a multiple-family group) 90857 Interactive group psychotherapy ADHD 5

Description 90862 Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy 90875 Individual psychophysiological therapy incorporating biofeedback training by any modality (face-toface with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); approximately 20-30 minutes 90876 Individual psychophysiological therapy incorporating biofeedback training by any modality (face-toface with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); approximately 45-50 minutes 96150 Health and behavior assessment (eg, health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face-to-face with the patient; initial assessment 96151 Health and behavior assessment (eg, health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face-to-face with the patient; re-assessment 96152 Health and behavior intervention, each 15 minutes, face-to-face; individual 96153 Health and behavior intervention, each 15 minutes, face-to-face; group (two or more patients) 96154 Health and behavior intervention, each 15 minutes, face-to-face; family (with the patient present) 98960 Education and training for patient self-management by a qualified, non physician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/ family) each 30 minutes; individual patient 98961 Education and training for patient self-management by a qualified, non physician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/ family) each 30 minutes; two to four patients 98962 Education and training for patient self-management by a qualified, non physician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/ family) each 30 minutes; five to eight patients 99078 Physician educational services rendered to patients in a group setting (eg, prenatal, obesity, or diabetic instructions) 99201 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 10 minutes face-to-face with the patient and/or family. 99202 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 20 minutes face-to-face with the patient and/or family. 99203 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family. ADHD 6

Description 99204 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 45 minutes face-to-face with the patient and/or family. 99205 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 60 minutes faceto-face with the patient and/or family. 99211 Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services. 99212 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 10 minutes face-to-face with the patient and/or family. 99213 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 15 minutes face-to-face with the patient and/or family. 99214 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 25 minutes face-to-face with the patient and/or family. 99215 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 40 minutes face-to-face with the patient and/or family. 99217 Observation care discharge day management (This code is to be utilized by the physician to report all services provided to a patient on discharge from "observation status" if the discharge is on other than the initial date of "observation status." To report services to a patient designated as "observation status" or "inpatient status" and discharged on the same date, use the codes for Observation or Inpatient Care Services [including Admission and Discharge Services, 99234-99236 as appropriate.]) ADHD 7

Description 99218 Initial observation care, per day, for the evaluation and management of a patient which requires these three key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity. Counseling and/ or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission to "observation status" are of low severity. 99219 Initial observation care, per day, for the evaluation and management of a patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission to "observation status" are of moderate severity. 99220 Initial observation care, per day, for the evaluation and management of a patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission to "observation status" are of high severity. 99221 Initial hospital care, per day, for the evaluation and management of a patient, which requires these three key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of low severity. Physicians typically spend 30 minutes at the bedside and on the patient's hospital floor or unit. 99222 Initial hospital care, per day, for the evaluation and management of a patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of moderate severity. Physicians typically spend 50 minutes at the bedside and on the patient's hospital floor or unit. 99223 Initial hospital care, per day, for the evaluation and management of a patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of high severity. Physicians typically spend 70 minutes at the bedside and on the patient's hospital floor or unit. 99231 Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: A problem focused interval history; A problem focused examination; Medical decision making that is straightforward or of low complexity. Counseling and/ or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is stable, recovering or improving. Physicians typically spend 15 minutes at the bedside and on the patient's hospital floor or unit. 99232 Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Physicians typically spend 25 minutes at the bedside and on the patient's hospital floor or unit. ADHD 8

Description 99233 Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: A detailed interval history; A detailed examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant complication or a significant new problem. Physicians typically spend 35 minutes at the bedside and on the patient's hospital floor or unit. 99238 Hospital discharge day management; 30 minutes or less 99239 Hospital discharge day management; more than 30 minutes 99241 Office consultation for a new or established patient, which requires these three key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 15 minutes face-to-face with the patient and/or family. 99242 Office consultation for a new or established patient, which requires these three key components: An expanded problem focused history; An expanded problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family. 99243 Office consultation for a new or established patient, which requires these three key components: A detailed history; A detailed examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 40 minutes face-to-face with the patient and/or family. 99244 Office consultation for a new or established patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 60 minutes face-toface with the patient and/or family. 99245 Office consultation for a new or established patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 80 minutes face-to-face with the patient and/or family. 99251 Inpatient consultation for a new or established patient, which requires these three key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 20 minutes at the bedside and on the patient's hospital floor or unit. 99252 Inpatient consultation for a new or established patient, which requires these three key components: An expanded problem focused history; An expanded problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Physicians typically spend 40 minutes at the bedside and on the patient's hospital floor or unit. ADHD 9

Description 99253 Inpatient consultation for a new or established patient, which requires these three key components: A detailed history; A detailed examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 55 minutes at the bedside and on the patient's hospital floor or unit. 99254 Inpatient consultation for a new or established patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 80 minutes at the bedside and on the patient's hospital floor or unit. 99255 Inpatient consultation for a new or established patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 110 minutes at the bedside and on the patient's hospital floor or unit. 99261 Follow-up inpatient consult 99262 Follow-up inpatient consult 99263 Follow-up inpatient consult 99341 Home visit for the evaluation and management of a new patient, which requires these three key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Physicians typically spend 20 minutes face-to-face with the patient and/or family. 99342 Home visit for the evaluation and management of a new patient, which requires these three key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family. 99343 Home visit for the evaluation and management of a new patient, which requires these three key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 45 minutes face-toface with the patient and/or family. 99344 Home visit for the evaluation and management of a new patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity. Physicians typically spend 60 minutes face-to-face with the patient and/or family. ADHD 10

Description 99345 Home visit for the evaluation and management of a new patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant new problem requiring immediate physician attention. Physicians typically spend 75 minutes face-to-face with the patient and/or family. 99347 Home visit for the evaluation and management of an established patient, which requires at least two of these three key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 15 minutes face-to-face with the patient and/or family. 99348 Home visit for the evaluation and management of an established patient, which requires at least two of these three key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 25 minutes face-to-face with the patient and/or family. 99349 Home visit for the evaluation and management of an established patient, which requires at least two of these three key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are moderate to high severity. Physicians typically spend 40 minutes face-to-face with the patient and/or family. 99350 Home visit for the evaluation and management of an established patient, which requires at least two of these three key components: A comprehensive interval history; A comprehensive examination; Medical decision making of moderate to high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/ or family's needs. Usually, the presenting problem(s) are of moderate to high severity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Physicians typically spend 60 minutes face-to-face with the patient and/or family. 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) 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) 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) 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) 99401 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes ADHD 11

Description 99402 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes 99403 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 45 minutes 99404 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes 99411 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 30 minutes 99412 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 60 minutes 99510 Home visit for individual, family, or marriage counseling HCPCS G0155 G0176 G0177 H0002 H0004 H0031 H0034 H0035 H0036 H0037 H0039 H0040 H2000 H2001 H2010 H2011 H2012 H2013 H2014 H2015 H2016 H2017 H2018 H2019 ADHD Description Services of clinical social worker in home health setting, each 15 minutes Activity therapy, such as music, dance, art or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more) Training and educational services related to the care and treatment of patient's disabling mental health problems per session (45 minutes or more) Behavioral health screening to determine eligibility for admission to treatment program Behavioral health counseling and therapy, per 15 minutes Mental health assessment, by non-physician Medication training and support, per 15 minutes Mental health partial hospitalization, treatment, less than 24 hours Community psychiatric supportive treatment, face-to-face, per 15 minutes Community psychiatric supportive treatment program, per diem Assertive community treatment, face-to-face, per 15 minutes Assertive community treatment program, per diem Comprehensive multidisciplinary evaluation Rehabilitation program, per 1/2 day Comprehensive medication services, per 15 minutes Crisis intervention service, per 15 minutes Behavioral health day treatment, per hour Psychiatric health facility service, per diem Skills training and development, per 15 minutes Comprehensive community support services, per 15 minutes Comprehensive community support services, per diem Psychosocial rehabilitation services, per 15 minutes Psychosocial rehabilitation services, per diem Therapeutic behavioral services, per 15 minutes 12

HCPCS H2020 M0064 S0201 S9480 S9484 S9485 Description Therapeutic behavioral services, per diem Brief office visit for the sole purpose of monitoring or changing drug prescriptions used in the treatment of mental psychoneurotic and personality disorders Partial hospitalization services, less than 24 hours, per diem Intensive outpatient psychiatric services, per diem Crisis intervention mental health services, per hour Crisis intervention mental health services, per diem Description RVNU 0510 Clinic-General 0513 Clinic-Psychiatric Clinic 0515 Clinic-Pediatric Clinic 0516 Clinic-Urgent Care Clinic 0517 Clinic-Family Practice Clinic 0519 Clinic-Other Clinic 0520 Freestanding Clinic-General 0521 Freestanding Clinic-Clinic visit by member to RHC/FQHC 0522 Freestanding Clinic-Home visit by RHC/FQHC Practitioner 0523 Freestanding Clinic-Family Practice Clinic 0526 Freestanding Clinic-Urgent Care Clinic 0527 Freestanding Clinic-Visiting Nurse Service (s) to a Member's Home When in a Home Health Shortage Area 0528 Freestanding Clinic-Visit by RHC/FQHC Practitioner to Other Non-RHC/FQHC Site (e.g. Scene of Accident) 0529 Freestanding Clinic-Other Freestanding Clinic 0770 Preventive Care Services-General 0771 Preventive Care Services-Vaccine Administration 0779 Preventive Care Services-Other Preventive Care Services 0900 Behavioral Health Treatments/Services (also see 091X, an extension of 090X)-General 0902 Behavioral Health Treatments/Services (also see 091X, an extension of 090X)-Milieu Therapy 0903 Behavioral Health Treatments/Services (also see 091X, an extension of 090X)-Play Therapy 0904 Behavioral Health Treatments/Services (also see 091X, an extension of 090X)-Activity Therapy 0905 Behavioral Health Treatments/Services (also see 091X, an extension of 090X)-Intensive Outpatient Services-Psychiatric 0907 Behavioral Health Treatments/Services (also see 091X, an extension of 090X)-Community Behavioral Health Program (Day Treatment) 0911 Behavioral Health Treatments/Services-Extension of 090X-Rehabilitation 0912 Behavioral Health Treatments/Services-Extension of 090X-Partial Hospitalization-Less Intensive ADHD 13

RVNU Description 0913 Behavioral Health Treatments/Services-Extension of 090X-Partial Hospitalization-Intensive 0914 Behavioral Health Treatments/Services-Extension of 090X-Individual Therapy 0915 Behavioral Health Treatments/Services-Extension of 090X-Group Therapy 0916 Behavioral Health Treatments/Services-Extension of 090X-Family Therapy 0917 Behavioral Health Treatments/Services-Extension of 090X-Bio Feedback 0919 Behavioral Health Treatments/Services-Extension of 090X-Other Behavioral Health Treatments/ Services 0982 Professional Fees (Extension of 096X and 097X)-Outpatient Services 0983 Professional Fees (Extension of 096X and 097X)-Clinic Description POS 03 Education Facility 05 Indian Health Service Free-Standing Facility 07 Tribal 638 Free-Standing Facility 09 Unassigned 11 Office 12 Home 13 Assisted Living Facility 14 Group Home 15 Mobile Unit 20 Urgent Care Facility 22 Outpatient Hospital 33 Custodial Care Facility 49 Independent Clinic 50 Federally Qualified Health Center 52 Psychiatric Facility Partial Hospitalization 53 Community Mental Health Center 71 State or Local Public Health Clinic 72 Rural Health Clinic ADHD 14

Alcohol and Other Drug Dependence Treatment Measure Source (Case) ID: 202700 Measure: Patients between the ages of 13 and 17 who initiated AOD treatment. (Rule ID: 9000002) Measure: Patient(s) between the ages of 13 and 17 who engaged in AOD treatment. (Rule ID: 9000008) Measure: Patient(s) age 18 years or older who initiated AOD treatment. (Rule ID: 9000013) Measure: Patient(s) age 18 years or older who engaged in AOD treatment. (Rule ID: 9000014) Description ICD-9 291 Alcohol-induced mental disorders 291.0 Alcohol withdrawal delirium 291.1 Alcohol-induced persisting amnestic disorder 291.2 Alcohol-induced persisting dementia 291.3 Alcohol-induced psychot disorder w/hallucination 291.4 Idiosyncratic alcohol intoxication 291.5 Alcohol-induced psychotic disorder w/delusions 291.8 Other specified alcohol-induced mental disorders 291.81 Alcohol withdrawal 291.82 Alcohol induced sleep disorders 291.89 Other specified alcohol-induced mental disorders 291.9 Unspecified alcohol-induced mental disorders 292 Drug-induced mental disorders 292.0 Drug withdrawal 292.1 Paranoid & or hallucinatory states induced drugs 292.11 Drug-induced psychotic disorder with delusions 292.12 Drug-induced psychotic disorder w/hallucinations 292.2 Pathological drug intoxication 292.8 Other specified drug-induced mental disorders 292.81 Drug-induced delirium 292.82 Drug-induced persisting dementia 292.83 Drug-induced persisting amnestic disorder 292.84 Drug-induced mood disorder 292.85 Drug induced sleep disorders 292.89 Other specified drug-induced mental disorder 292.9 Unspecified drug-induced mental disorder 303.00 Acute alcoholic intoxication unspec drunkenness 303.01 Acute alcoholic intoxication cont drunkenness Alcohol and Other Drug Dependence Treatment 15

Description ICD-9 303.02 Acut alcoholic intoxication episodic drunkenness 303.90 Oth & unspec alcohol dependence unspec drunkenness 303.91 Other & unspec alcohol dependence cont drunkenness 303.92 Oth & unspec alcohol depend episodic drunkenness 304.00 Opioid type dependence unspecified abuse 304.01 Opioid type dependence continuous abuse 304.02 Opioid type dependence episodic abuse 304.10 Sedative hypnotic/anxiolytic dependence unspec 304.11 Sedative hypnotic/anxiolytic dependence cont 304.12 Sedative hypnotic/anxiolytic dependence episodic 304.20 Cocaine dependence unspecified abuse 304.21 Cocaine dependence continuous abuse 304.22 Cocaine dependence, episodic abuse 304.30 Cannabis dependence unspecified abuse 304.31 Cannabis dependence continuous abuse 304.32 Cannabis dependence, episodic abuse 304.40 Amphet & oth psychostimulant dependence unspec abs 304.41 Amphet & oth psychostimulant dependence cont abs 304.42 Amphet & oth psychostimulant depend episodic abs 304.50 Hallucinogen dependence unspecified abuse 304.51 Hallucinogen dependence continuous abuse 304.52 Hallucinogen dependence episodic abuse 304.60 Other spec drug dependence unspec abuse 304.61 Other specified drug dependence continuous abuse 304.62 Other specified drug dependence episodic abuse 304.70 Comb opioid rx w/any oth rx depend unspec abs 304.71 Comb opioid drug w/any oth drug depend cont abs 304.72 Comb opioid rx w/any oth rx depend episodic abs 304.80 Comb drug depend excld opioid drug unspec abs 304.81 Comb drug depend excluding opioid drug cont abs 304.82 Comb drug depend excld opioid drug episodic abs 304.90 Unspecified drug dependence unspecified abuse 304.91 Unspecified drug dependence continuous abuse 304.92 Unspecified drug dependence episodic abuse 305.00 Nondependent alcohol abuse unspec drunkenness 305.01 Nondependent alcohol abuse cont drunkenness 305.02 Nondependent alcohol abuse episodic drunkenness Alcohol and Other Drug Dependence Treatment 16

Description ICD-9 305.20 Nondependent cannabis abuse unspecified 305.21 Nondependent cannabis abuse continuous 305.22 Nondependent cannabis abuse episodic 305.30 Nondependent hallucinogen abuse unspecified 305.31 Nondependent hallucinogen abuse continuous 305.32 Nondependent hallucinogen abuse episodic 305.40 Nondepend sedative hypnot/anxiolytic abs unspec 305.41 Nondepend sedative hypnotic/anxiolytic abs cont 305.42 Nondepend sedat hypnot/anxiolytic abs episodic 305.50 Nondependent opioid abuse unspecified 305.51 Nondependent opioid abuse continuous 305.52 Nondependent opioid abuse, episodic 305.60 Nondependent cocaine abuse unspecified 305.61 Nondependent cocaine abuse continuous 305.62 Nondependent cocaine abuse episodic 305.70 Nondepend amphet/rel act sympathomimet abs uns 305.71 Nondepend amphet/rel act sympathomimet abs cont 305.72 Amphetamine/related drug abuse-episodic 305.80 Nondependent antidepressant type abuse unspec 305.81 Nondependent antidepressant type abuse cont 305.82 Nondependent antidepressant type abuse episodic 305.90 Oth mixed/unspec nondependent drug abuse unspec 305.91 Other mixed/unspec nondependent drug abuse cont 305.92 Oth mixed/unspec nondependent drug abs episodic 535.3 Alcoholic gastritis 535.30 Alcoholic gastritis without mention hemorrhage 535.31 Alcoholic gastritis with hemorrhage 571.1 Acute alcoholic hepatitis Description 90801 Psychiatric diagnostic interview examination 90802 Interactive psychiatric diagnostic interview examination using play equipment, physical devices, language interpreter, or other mechanisms of communication 90804 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient; 90805 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient; with medical evaluation and management services Alcohol and Other Drug Dependence Treatment 17

Description 90806 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient; 90807 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient; with medical evaluation and management services 90808 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient; 90809 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient; with medical evaluation and management services 90810 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient; 90811 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient; with medical evaluation and management services 90812 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient; 90813 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient; with medical evaluation and management services 90814 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient; 90815 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient; with medical evaluation and management services 90816 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 20 to 30 minutes face-to-face with the patient; 90817 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 20 to 30 minutes face-to-face with the patient; with medical evaluation and management services 90818 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 45 to 50 minutes face-to-face with the patient; 90819 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 45 to 50 minutes face-to-face with the patient; with medical evaluation and management services 90821 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face-to-face with the patient; 90822 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face-to-face with the patient; with medical evaluation and management services Alcohol and Other Drug Dependence Treatment 18

Description 90823 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 20 to 30 minutes face-to-face with the patient; 90824 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 20 to 30 minutes face-to-face with the patient; with medical evaluation and management services 90826 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 45 to 50 minutes face-to-face with the patient; 90827 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 45 to 50 minutes face-to-face with the patient; with medical evaluation and management services 90828 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face-to-face with the patient; 90829 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face-to-face with the patient; with medical evaluation and management services 90845 Psychoanalysis 90847 Family psychotherapy (conjoint psychotherapy) (with patient present) 90849 Multiple-family group psychotherapy 90853 Group psychotherapy (other than of a multiple-family group) 90857 Interactive group psychotherapy 90862 Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy 90875 Individual psychophysiological therapy incorporating biofeedback training by any modality (face-toface with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); approximately 20-30 minutes 90876 Individual psychophysiological therapy incorporating biofeedback training by any modality (face-toface with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); approximately 45-50 minutes 98960 Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/ family) each 30 minutes; individual patient 98961 Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/ family) each 30 minutes; 2-4 patients 98962 Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/ family) each 30 minutes; 5-8 patients 99078 Physician educational services rendered to patients in a group setting (eg, prenatal, obesity, or diabetic instructions) Alcohol and Other Drug Dependence Treatment 19

Description 99201 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 10 minutes face-to-face with the patient and/or family. 99202 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 20 minutes face-to-face with the patient and/or family. 99203 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family. 99204 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 45 minutes face-to-face with the patient and/or family. 99205 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 60 minutes face-to-face with the patient and/or family. 99211 Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically, five minutes are spent performing or supervising these services. 99212 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 10 minutes face-to-face with the patient and/or family. 99213 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 15 minutes face-to-face with the patient and/or family. 99214 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 25 minutes face-to-face with the patient and/or family. Alcohol and Other Drug Dependence Treatment 20

Description 99215 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 40 minutes face-to-face with the patient and/or family. 99217 Observation care discharge day management (This code is to be utilized by the physician to report all services provided to a patient on discharge from "observation status" if the discharge is on other than the initial date of "observation status." To report services to a patient designated as "observation status" or "inpatient status" and discharged on the same date, use the codes for Observation or Inpatient Care Services [including Admission and Discharge Services, 99234-99236 as appropriate.]) 99218 Initial observation care, per day, for the evaluation and management of a patient which requires these three key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity. Counseling and/ or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission to "observation status" are of low severity. 99219 Initial observation care, per day, for the evaluation and management of a patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission to "observation status" are of moderate severity. 99220 Initial observation care, per day, for the evaluation and management of a patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission to "observation status" are of high severity. 99221 Initial hospital care, per day, for the evaluation and management of a patient, which requires these three key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of low severity. Physicians typically spend 30 minutes at the bedside and on the patient's hospital floor or unit. 99222 Initial hospital care, per day, for the evaluation and management of a patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of moderate severity. Physicians typically spend 50 minutes at the bedside and on the patient's hospital floor or unit. 99223 Initial hospital care, per day, for the evaluation and management of a patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of high severity. Physicians typically spend 70 minutes at the bedside and on the patient's hospital floor or unit. Alcohol and Other Drug Dependence Treatment 21

Description 99231 Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: A problem focused interval history; A problem focused examination; Medical decision making that is straightforward or of low complexity. Counseling and/ or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is stable, recovering or improving. Physicians typically spend 15 minutes at the bedside and on the patient's hospital floor or unit. 99232 Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Physicians typically spend 25 minutes at the bedside and on the patient's hospital floor or unit. 99233 Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: A detailed interval history; A detailed examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant complication or a significant new problem. Physicians typically spend 35 minutes at the bedside and on the patient's hospital floor or unit. 99238 Hospital discharge day management; 30 minutes or less 99239 Hospital discharge day management; more than 30 minutes 99241 Office consultation for a new or established patient, which requires these three key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 15 minutes face-to-face with the patient and/or family. 99242 Office consultation for a new or established patient, which requires these three key components: An expanded problem focused history; An expanded problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family. 99243 Office consultation for a new or established patient, which requires these three key components: A detailed history; A detailed examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 40 minutes face-to-face with the patient and/or family. 99244 Office consultation for a new or established patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 60 minutes face-toface with the patient and/or family. Alcohol and Other Drug Dependence Treatment 22

Description 99245 Office consultation for a new or established patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 80 minutes face-to-face with the patient and/or family. 99251 Inpatient consultation for a new or established patient, which requires these three key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 20 minutes at the bedside and on the patient's hospital floor or unit. 99252 Inpatient consultation for a new or established patient, which requires these three key components: An expanded problem focused history; An expanded problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Physicians typically spend 40 minutes at the bedside and on the patient's hospital floor or unit. 99253 Inpatient consultation for a new or established patient, which requires these three key components: A detailed history; A detailed examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 55 minutes at the bedside and on the patient's hospital floor or unit. 99254 Inpatient consultation for a new or established patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 80 minutes at the bedside and on the patient's hospital floor or unit. 99255 Inpatient consultation for a new or established patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 110 minutes at the bedside and on the patient's hospital floor or unit. 99261 Follow-up inpatient consult 99262 Follow-up inpatient consult 99263 Follow-up inpatient consult 99341 Home visit for the evaluation and management of a new patient, which requires these three key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Physicians typically spend 20 minutes face-to-face with the patient and/or family. Alcohol and Other Drug Dependence Treatment 23

Description 99342 Home visit for the evaluation and management of a new patient, which requires these three key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family. 99343 Home visit for the evaluation and management of a new patient, which requires these three key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 45 minutes face-toface with the patient and/or family. 99344 Home visit for the evaluation and management of a new patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity. Physicians typically spend 60 minutes face-to-face with the patient and/or family. 99345 Home visit for the evaluation and management of a new patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant new problem requiring immediate physician attention. Physicians typically spend 75 minutes face-to-face with the patient and/or family. 99347 Home visit for the evaluation and management of an established patient, which requires at least two of these three key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 15 minutes face-to-face with the patient and/or family. 99348 Home visit for the evaluation and management of an established patient, which requires at least two of these three key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 25 minutes face-to-face with the patient and/or family. 99349 Home visit for the evaluation and management of an established patient, which requires at least 2 of these three key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are moderate to high severity. Physicians typically spend 40 minutes face-to-face with the patient and/or family. 99350 Home visit for the evaluation and management of an established patient, which requires at least 2 of these three key components: A comprehensive interval history; A comprehensive examination; Medical decision making of moderate to high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/ or family's needs. Usually, the presenting problem(s) are of moderate to high severity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Physicians typically spend 60 minutes face-to-face with the patient and/or family. Alcohol and Other Drug Dependence Treatment 24

Description 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) 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 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 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 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) 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 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 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 99401 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes 99402 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes 99403 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 45 minutes 99404 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes 99408 Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes 99409 Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; greater than 30 minutes 99411 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 30 minutes 99412 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 60 minutes 99510 Home visit for individual, family, or marriage counseling Alcohol and Other Drug Dependence Treatment 25

HCPCS G0155 G0176 G0177 G0396 G0397 H0001 H0002 H0004 H0005 H0007 Description Services of clinical social worker in home health setting, each 15 minutes Activity therapy, such as music, dance, art or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more) Training and educational services related to the care and treatment of patient's disabling mental health problems per session (45 minutes or more) Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT, DAST), and brief intervention 15 to 30 minutes Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT, DAST), and intervention, greater than 30 minutes Alcohol and/or drug assessment Behavioral health screening to determine eligibility for admission to treatment program Behavioral health counseling and therapy, per 15 minutes Alcohol and/or drug services; group counseling by a clinician Alcohol and/or drug services; crisis intervention (outpatient) H0015 Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least three days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education H0016 H0020 H0022 H0031 H0034 H0035 H0036 H0037 H0039 H0040 H2000 H2001 H2010 H2011 H2012 H2013 H2014 H2015 H2016 H2017 H2018 H2019 Alcohol and/or drug services; medical/somatic (medical intervention in ambulatory setting) Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) Alcohol and/or drug intervention service (planned facilitation) Mental health assessment, by nonphysician Medication training and support, per 15 minutes Mental health partial hospitalization, treatment, less than 24 hours Community psychiatric supportive treatment, face-to-face, per 15 minutes Community psychiatric supportive treatment program, per diem Assertive community treatment, face-to-face, per 15 minutes Assertive community treatment program, per diem Comprehensive multidisciplinary evaluation Rehabilitation program, per 1/2 day Comprehensive medication services, per 15 minutes Crisis intervention service, per 15 minutes Behavioral health day treatment, per hour Psychiatric health facility service, per diem Skills training and development, per 15 minutes Comprehensive community support services, per 15 minutes Comprehensive community support services, per diem Psychosocial rehabilitation services, per 15 minutes Psychosocial rehabilitation services, per diem Therapeutic behavioral services, per 15 minutes Alcohol and Other Drug Dependence Treatment 26

HCPCS H2020 H2035 H2036 M0064 S0201 S9480 S9484 S9485 T1006 T1012 Description Therapeutic behavioral services, per diem Alcohol and/or other drug treatment program, per hour Alcohol and/or other drug treatment program, per diem Brief office visit for the sole purpose of monitoring or changing drug prescriptions used in the treatment of mental psychoneurotic and personality disorders Partial hospitalization services, less than 24 hours, per diem Intensive outpatient psychiatric services, per diem Crisis intervention mental health services, per hour Crisis intervention mental health services, per diem Alcohol and/or substance abuse services, family/couple counseling Alcohol and/or substance abuse services, skills development Description RVNU 0510 Clinic-General 0513 Clinic-Psychiatric Clinic 0515 Clinic-Pediatric Clinic 0516 Clinic-Urgent Care Clinic 0517 Clinic-Family Practice Clinic 0519 Clinic-Other Clinic 0520 Freestanding Clinic-General 0521 Freestanding Clinic-Clinic visit by member to RHC/FQHC 0522 Freestanding Clinic-Home visit by RHC/FQHC Practitioner 0523 Freestanding Clinic-Family Practice Clinic 0526 Freestanding Clinic-Urgent Care Clinic 0527 Freestanding Clinic-Visiting Nurse Service (s) to a Member's Home When in a Home Health Shortage Area 0528 Freestanding Clinic-Visit by RHC/FQHC Practitioner to Other Non-RHC/FQHC Site (e.g. Scene of Accident) 0529 Freestanding Clinic-Other Freestanding Clinic 0770 Preventive Care Services-General 0771 Preventive Care Services-Vaccine Administration 0779 Preventive Care Services-Other Preventive Care Services 0900 Behavioral Health Treatments/Services (also see 091X, an extension of 090X)-General 0902 Behavioral Health Treatments/Services (also see 091X, an extension of 090X)-Milieu Therapy 0903 Behavioral Health Treatments/Services (also see 091X, an extension of 090X)-Play Therapy 0904 Behavioral Health Treatments/Services (also see 091X, an extension of 090X)-Activity Therapy 0905 Behavioral Health Treatments/Services (also see 091X, an extension of 090X)-Intensive Outpatient Services-Psychiatric Alcohol and Other Drug Dependence Treatment 27

RVNU Description 0906 Behavioral Health Treatments/Services (also see 091X, an extension of 090X)-Intensive Outpatient Services-Chemical Dependency 0907 Behavioral Health Treatments/Services (also see 091X, an extension of 090X)-Community Behavioral Health Program (Day Treatment) 0911 Behavioral Health Treatments/Services-Extension of 090X-Rehabilitation 0912 Behavioral Health Treatments/Services-Extension of 090X-Partial Hospitalization-Less Intensive 0913 Behavioral Health Treatments/Services-Extension of 090X-Partial Hospitalization-Intensive 0914 Behavioral Health Treatments/Services-Extension of 090X-Individual Therapy 0915 Behavioral Health Treatments/Services-Extension of 090X-Group Therapy 0916 Behavioral Health Treatments/Services-Extension of 090X-Family Therapy 0917 Behavioral Health Treatments/Services-Extension of 090X-Bio Feedback 0919 Behavioral Health Treatments/Services-Extension of 090X-Other Behavioral Health Treatments/ Services 0944 Other Therapeutic Services (see also 095X, an extension of 094X)-Drug Rehabilitation 0945 Other Therapeutic Services (see also 095X, an extension of 094X)-Alcohol Rehabilitation 0982 Professional Fees (Extension of 096X and 097X)-Outpatient Services 0983 Professional Fees (Extension of 096X and 097X)-Clinic Description POS 03 Education Facility 05 Indian Health Service Free-Standing Facility 07 Tribal 638 Free-Standing Facility 09 Unassigned 11 Office 12 Home 13 Assisted Living Facility 14 Group Home 15 Mobile Unit 20 Urgent Care Facility 22 Outpatient Hospital 33 Custodial Care Facility 49 Independent Clinic 50 Federally Qualified Health Center 52 Psychiatric Facility Partial Hospitalization 53 Community Mental Health Center 57 Non-residential Substance Abuse Treatment Facility 71 State or Local Public Health Clinic 72 Rural Health Clinic Alcohol and Other Drug Dependence Treatment 28

Antidepressant Medical Management Measure Source (Case) ID: 202000 Measure: Measure: Medication Patient(s) with a new episode of major depression that remained on an antidepressant medication during the initial 12-week acute treatment phase. (Rule ID: 9000002) Patients with a new episode of major depression that remained on an antidepressant medication during the 6 month acute treatment phase. (Rule ID: 9000003) Amitriptyline Hydrochloride Amitriptyline-Chlordiazepoxide Amitriptyline-Perphenazine Amoxapine Anafranil Aventyl HCl Budeprion SR Budeprion XL BuPROPion Hydrochloride BuPROPion Hydrochloride SR BuPROPion Hydrochloride XL Celexa Citalopram Hydrobromide ClomiPRAMINE Hydrochloride Cymbalta Desipramine Hydrochloride Desyrel Desyrel Dividose Doxepin Hydrochloride Duo-Vil 2-10 Duo-Vil 2-25 Duo-Vil 4-10 Effexor Effexor XR Elavil Emsam Etrafon 2-10 Etrafon 2-25 Etrafon Forte Fluoxetine Hydrochloride Fluvoxamine Maleate Imipramine Hydrochloride Imipramine Pamoate Lexapro Limbitrol Limbitrol DS Luvox Luvox CR Maprotiline Hydrochloride Marplan Mirtazapine Nardil Nefazodone Hydrochloride Norpramin Nortriptyline Hydrochloride Pamelor Parnate Paroxetine Hydrochloride Paroxetine Hydrochloride ER Paxil Paxil CR Pexeva Pristiq Protriptyline Hydrochloride Prozac Prozac Weekly Rapiflux Remeron Remeron SolTab Sarafem Selfemra Sertraline Hydrochloride Serzone Sinequan Surmontil Symbyax Tofranil Tofranil-PM Tranylcypromine Sulfate TraZODONE Hydrochloride Triavil Trimipramine Maleate Vanatrip Venlafaxine Hydrochloride Vivactil Wellbutrin Wellbutrin SR Wellbutrin XL Zoloft Antidepressant Medical Management 29

Asthma Measure Source (Case) ID: 100404 Measure: Patients 5-40 years of age with asthma who had frequency of daytime and nocturnal asthma symptoms assessed in the last 12 months. (Rule ID: 9000015) 1005F Description Asthma symptoms evaluated (includes physician documentation of numeric frequency of symptoms or patient completion of an asthma assessment tool/survey/questionnaire) (Asthma) 99201 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 10 minutes face-to-face with the patient and/or family. 99202 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 20 minutes face-to-face with the patient and/or family. 99203 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family. 99204 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 45 minutes face-to-face with the patient and/or family. 99205 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 60 minutes face-to-face with the patient and/or family. 99212 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 10 minutes face-to-face with the patient and/or family. Asthma 30

Description 99213 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 15 minutes face-to-face with the patient and/or family. 99214 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 25 minutes face-to-face with the patient and/or family. 99215 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 40 minutes face-to-face with the patient and/or family. 99241 Office consultation for a new or established patient, which requires these three key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 15 minutes face-to-face with the patient and/or family. 99242 Office consultation for a new or established patient, which requires these three key components: An expanded problem focused history; An expanded problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family. 99243 Office consultation for a new or established patient, which requires these three key components: A detailed history; A detailed examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 40 minutes face-to-face with the patient and/or family. 99244 Office consultation for a new or established patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 60 minutes face-toface with the patient and/or family. 99245 Office consultation for a new or established patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 80 minutes face-to-face with the patient and/or family. 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) Asthma 31

Description 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) 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 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 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) 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) 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 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 Asthma 32

Asthma Measure Source (Case) ID: 105500 Measure: Measure: Measure: Patient(s) between the ages of 5 and 9 with presumed persistent asthma using an inhaled corticosteroid or acceptable alternative. (Rule ID: 9000002) Patient(s) between the ages of 10 and 17 with presumed persistent asthma using an inhaled corticosteroid or acceptable alternative. (Rule ID: 9000003) Patient(s) between the ages of 18 and 56 with presumed persistent asthma using an inhaled corticosteroid or acceptable alternative. (Rule ID: 9000004) Medication Accolate Advair AeroBid AeroBid-M Aminophylline Asmanex Twisthaler Azmacort Beclovent Bronchial Choledyl SA Cromolyn sodium D-G Difil Dilex-G Dilor Dyfilin GG Dyflex-G Dy-G Dyline GG Dylix Dyphylline Dyphylline-Guaifenesin Dyphyllin-GG Dyphysin Ed-Bron G Elixophyllin Equibron G Flovent Intal Intal Inhaler Jay-Phyl Lufyllin Neothylline Panfil G Pulmicort Flexhaler Pulmicort Respules Pulmicort Turbuhaler Quibron Qvar Singulair Symbicort Theo-24 TheoCap Theochron Theo-Dur Theolair Theolate Theophylline Theo-Time Theo-X Tilade T-Phyl Truxophyllin Uni-Dur Uniphyl Vanceril Xolair Zyflo Asthma 33

Avoidance of Antibiotic Treatment in adults with Acute Bronchitis Measure Source (Case) ID: 201900 Measure: No compliance criteria Patients with diagnosis of Acute Bronchitis that did not receive a prescription for an antibiotic on or three days after the initiating visit. (Rule ID: 9000002) Avoidance of Antibiotic Treatment in adults with Acute Bronchitis 34

Breast Cancer Screening Measure Source (Case) ID: 300700 Measure: Patient(s) 42-69 years of age that had a screening mammogram in last 24 reported months. (Rule ID: 9000001) Description 76090 Mammogram, one breast 76091 Mammogram, both breasts 76092 Mammogram, screening 77055 Mammography; unilateral 77056 Mammography; bilateral 77057 Screening mammography, bilateral (view film study of each breast) Description ICD-9 87.36 Xerography of breast 87.37 Other mammography V76.11 Screening for Mammogram for High-Risk patient V76.12 Other Screening Mammogram HCPCS G0202 G0204 G0206 Description Screening mammography, producing direct digital image, bilateral, all views Diagnostic mammography, producing direct digital image, bilateral, all views Diagnostic mammography, producing direct digital image, unilateral, all views Description RVNU 401 Other Imaging Services-Diagnostic Mammography 403 Other Imaging Services-Screening Mammography Breast Cancer Screening 35

Cardiovascular Disease Measure Source (Case) ID: 105600 Measure: Patients with an LDL cholesterol test in the last 12 reported months. (Rule ID: 9000001) Description 3048F Most recent LDL-C less than 100 mg/dl (DM) 3049F Most recent LDL-C 100-129 mg/dl (DM) 3050F Most recent LDL-C greater than or equal to 130 mg/dl (DM) 80061 Lipid panel This panel must include the following: Cholesterol, serum, total (82465) Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718) Triglycerides (84478) 83700 Lipoprotein, blood; electrophoretic separation and quantitation 83701 Lipoprotein, blood; high resolution fractionation and quantitation of lipoproteins including lipoprotein subclasses when performed (eg, electrophoresis, ultracentrifugation) 83704 Lipoprotein, blood; quantitation of lipoprotein particle numbers and lipoprotein particle subclasses (eg, by nuclear magnetic resonance spectroscopy) 83721 Lipoprotein, direct measurement; LDL cholesterol Description LOINC 2089-1 Cholesterol.in LDL 12773-8 Cholesterol.in LDL 13457-7 Cholesterol.in LDL 18261-8 Cholesterol.in LDL 18262-6 Cholesterol.in LDL 22748-8 Cholesterol.in LDL 24331-1 Lipid HCFA 1996 panel 39469-2 Cholesterol.in LDL 49132-4 Cholesterol.in LDL Cardiovascular Disease 36

Cervical Cancer Screening Measure Source (Case) ID: 300600 Measure: Patient(s) that had a cervical cancer screening test in last 36 reported months. (Rule ID: 9000001) Description 88141 Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physician 88142 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision 88143 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with manual screening and rescreening under physician supervision 88147 Cytopathology smears, cervical or vaginal; screening by automated system under physician supervision 88148 Cytopathology smears, cervical or vaginal; screening by automated system with manual rescreening under physician supervision 88150 Cytopathology, slides, cervical or vaginal; manual screening under physician supervision 88152 Cytopathology, slides, cervical or vaginal; with manual screening and computer-assisted rescreening under physician supervision 88153 Cytopathology, slides, cervical or vaginal; with manual screening and rescreening under physician supervision 88154 Cytopathology, slides, cervical or vaginal; with manual screening and computer-assisted rescreening using cell selection and review under physician supervision 88155 Cytopathology, slides, cervical or vaginal, definitive hormonal evaluation (eg, maturation index, karyopyknotic index, estrogenic index) (List separately in addition to code[s] for other technical and interpretation services) 88164 Cytopathology, slides, cervical or vaginal (the Bethesda System); manual screening under physician supervision 88165 Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual screening and rescreening under physician supervision 88166 Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual screening and computerassisted rescreening under physician supervision 88167 Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual screening and computerassisted rescreening using cell selection and review under physician supervision 88174 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; screening by automated system, under physician supervision 88175 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with screening by automated system and manual rescreening or review, under physician supervision Cervical Cancer Screening 37

Description LOINC 10524-7 Microscopic observation 18500-9 Microscopic observation 19762-4 General categories 19764-0 Statement of adequacy 19765-7 Microscopic observation 19766-5 Microscopic observation 19774-9 Cytology study comment 33717-0 Study report 47527-7 Cytology report 47528-5 Cytology report Description ICD-9 91.46 Cell block and Papanicolaou smear of specimen from female genital tract V72.32 Encounter PAP Cerv Smer Confirm NL Ser FLWABN V76.2 Screening for Malignant Neoplasm of Cervix HCPCS G0123 G0124 G0141 G0143 G0144 G0145 G0147 G0148 P3000 Description Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under physician supervision Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervision Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening Screening Papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision Cervical Cancer Screening 38

HCPCS P3001 Q0091 Description Screening Papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory Description RVNU 0923 Other Diagnostic Services-Pap Smear Cervical Cancer Screening 39

Chlamydia Screening Measure Source (Case) ID: 300500 Measure: Measure: Patient(s) 16-20 years of age that had a chlamydia screening test in last 12 reported months. (Rule ID: 9000002) Patient(s) 21-24 years of age that had a chlamydia screening test in last 12 reported months. (Rule ID: 9000003 Description 87110 Culture, chlamydia, any source 87270 Infectious agent antigen detection by immunofluorescent technique; Chlamydia trachomatis 87320 Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Chlamydia trachomatis 87490 Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, direct probe technique 87491 Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique 87492 Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, quantification 87810 Infectious agent antigen detection by immunoassay with direct optical observation; Chlamydia trachomatis Description LOINC 557-9 Chlamydia sp identified 560-3 Chlamydia sp identified 4993-2 Chlamydia trachomatis rrna 6349-5 Chlamydia trachomatis 6354-5 Chlamydia trachomatis Ag 6355-2 Chlamydia trachomatis Ag 6356-0 Chlamydia trachomatis DNA 6357-8 Chlamydia trachomatis DNA 14463-4 Chlamydia trachomatis 14464-2 Chlamydia trachomatis 14467-5 Chlamydia trachomatis 14470-9 Chlamydia trachomatis Ag 14471-7 Chlamydia trachomatis Ag 14474-1 Chlamydia trachomatis Ag 14509-4 Chlamydia trachomatis Ag 14510-2 Chlamydia trachomatis Ag 14513-6 Chlamydia trachomatis Ag 16600-9 Chlamydia trachomatis rrna Chlamydia Screening 40

Description LOINC 16601-7 Chlamydia trachomatis rrna 21189-6 Chlamydia trachomatis DNA 21190-4 Chlamydia trachomatis DNA 21191-2 Chlamydia trachomatis DNA 21192-0 Chlamydia trachomatis rrna 21613-5 Chlamydia trachomatis DNA 23838-6 Chlamydia trachomatis rrna 31771-9 Chlamydia trachomatis Ag 31772-7 Chlamydia trachomatis Ag 31775-0 Chlamydia trachomatis Ag 31777-6 Chlamydia trachomatis Ag 36902-5 Chlamydia trachomatis+neisseria gonorrhoeae DNA 36903-3 Chlamydia trachomatis+neisseria gonorrhoeae DNA 42931-6 Chlamydia trachomatis rrna 43304-5 Chlamydia trachomatis rrna 43404-3 Chlamydia trachomatis DNA 43406-8 Chlamydia trachomatis+neisseria gonorrhoeae DNA 44806-8 Chlamydia trachomatis+neisseria gonorrhoeae DNA 44807-6 Chlamydia trachomatis+neisseria gonorrhoeae DNA 45067-6 Chlamydia trachomatis+neisseria gonorrhoeae rrna 45068-4 Chlamydia trachomatis+neisseria gonorrhoeae DNA 45069-2 Chlamydia trachomatis+neisseria gonorrhoeae rrna 45070-0 Chlamydia trachomatis+neisseria gonorrhoeae rrna 45074-2 Chlamydia trachomatis+neisseria gonorrhoeae rrna 45076-7 Chlamydia trachomatis+neisseria gonorrhoeae rrna 45078-3 Chlamydia trachomatis rrna 45080-9 Chlamydia trachomatis rrna 45084-1 Chlamydia trachomatis DNA 45091-6 Chlamydia trachomatis Ag 45095-7 Chlamydia trachomatis 45098-1 Chlamydia sp identified 45100-5 Chlamydia sp identified 47211-8 Chlamydia trachomatis L2 DNA 47212-6 Chlamydia trachomatis DNA 49096-1 Chlamydia trachomatis DNA 50387-0 Chlamydia trachomatis rrna Chlamydia Screening 41

Congestive Heart Failure Measure Source (Case) ID: 105700 Measure: 4009F Patient(s) prescribed ace-inhibitor or angiotensin II receptor antagonist therapy during the measurement year. (Rule ID: 9000001) Description Angiotensin converting enzyme (ACE) inhibitor or Angiotensin Receptor Blocker (ARB) therapy, prescribed (HF, CAD, CKD)1, (DM)2 Medication Amlodipine Benazepril Candesartan Capoten Captopril Enalapril Enalapril maleate Enalaprilat Enalpril Eprosartan Fosinopril Fosinopril Sodium Irbesartan Lisinopril Lorsartan Losartan Moexipril Olmesartan Perindopril Quinapril Quinaprol Ramipril Telmisartan Trandolapril Valsartan Measure: Patient(s) prescribed beta-blocker therapy during the measurement year. (Rule ID: 9000002) 4006F Description Beta-blocker therapy, prescribed (CAD, HF) Medication Acebutolol Atenolol Betapace Betaxolol Bisoprolol Blocadren Brevibloc Cartrol Coreg Corgard Corzide Esmolol Hydrochlorothiazide Inderal Inderide Innopran Kerlone Labetalol Labetolol Levatol Lopressor Metoprol Metoprolol Nadolol Normodyne Pindolol Propranolol Sectral Senormin Sorine Sotalol Tenoretic Tenormin Timolide Timolol Toprol Trandate Visken Zebeta Ziac Congestive Heart Failure 42

Measure: Patient(s) with CHF and atrial fibrillation currently taking warfarin. (Rule ID: 9000003) 4012F Description Warfarin therapy prescribed (HF) Medication Coufarin Coumadin Jantoven Panwarfin Sofarin Warfarin Measure: Patient(s) with LVF assessment during the measurement year. (Rule ID: 9000004) 3020F Description Left ventricular function (LVF) assessment (eg, echocardiography, nuclear test, or ventriculography) documented in the medical record (includes: quantitative or qualitative assessment results) (HF) Measure: Patient(s) with evidence of patient education during the measurement year. (Rule ID: 9000007) Description 4003F Patient education, written/oral, appropriate for patients with heart failure, performed (HF) 99201 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 10 minutes face-to-face with the patient and/or family. 99202 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 20 minutes face-to-face with the patient and/or family. 99203 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family. 99204 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 45 minutes face-to-face with the patient and/or family. Congestive Heart Failure 43

Description 99205 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 60 minutes face-to-face with the patient and/or family. 99212 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 10 minutes face-to-face with the patient and/or family. 99213 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 15 minutes face-to-face with the patient and/or family. 99214 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 25 minutes face-to-face with the patient and/or family. 99215 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 40 minutes face-to-face with the patient and/or family. 99241 Office consultation for a new or established patient, which requires these three key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 15 minutes face-to-face with the patient and/or family. 99242 Office consultation for a new or established patient, which requires these three key components: An expanded problem focused history; An expanded problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family. 99243 Office consultation for a new or established patient, which requires these three key components: A detailed history; A detailed examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 40 minutes face-to-face with the patient and/or family. Congestive Heart Failure 44

Description 99244 Office consultation for a new or established patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 60 minutes face-toface with the patient and/or family. 99245 Office consultation for a new or established patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 80 minutes face-to-face with the patient and/or family. 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 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 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 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 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 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 Description ICD-9 402.01 Malig hypertensive heart disease w/heart failure 402.11 Ben hypertensive heart disease w/heart failure 402.91 Hypertensive heart disease unspec w/heart fail 404.01 Htn hrt & ckd mal w/hf & w/ckd stage 1-iv/uns 404.03 Htn hrt & ckd malig w/hf & w/ckd stage v/esrd 404.11 Htn hrt & ckd ben w/hf & w/ckd stage i-iv/uns 404.13 Htn heart & ckd ben w/hf & ckd stage v/esrd 404.91 Htn hrt & ckd uns w/hf & w/ckd stage i - iv/uns 404.93 Htn heart & ckd unspec w/hf & ckd stage v/esrd Congestive Heart Failure 45

Description ICD-9 428.0 Congestive heart failure unspecified 428.1 Left heart failure 428.20 Unspecified systolic heart failure 428.21 Acute systolic heart failure 428.22 Chronic systolic heart failure 428.23 Acute on chronic systolic heart failure 428.30 Unspecified diastolic heart failure 428.31 Acute diastolic heart failure 428.32 Chronic diastolic heart failure 428.33 Acute on chronic diastolic heart failure 428.40 Unspec combined systolic & diastolic heart failure 428.41 Acute combined systolic & diastolic heart failure 428.42 Chronic comb systolic & diastolic heart failure 428.43 Acute chronic comb systolic&diastolic heart fail 428.9 Unspecified heart failure Footer 46

Coronary Artery Disease Measure Source (Case) ID: 105700 Measure: Patient(s) prescribed lipid-lowering therapy during the measurement year. (Rule ID: 9000001) 4002F Description Statin therapy, prescribed (CAD) Medication Advicor Altocor Altoprev Antara Atromid-S B-3-50 B3-500-Gr Caduet Cholestin Cholestyramine Choloxin Clofibrate Colestid Crestor Eck Niacin Endur-Acin Fenofibrate Gemfibrozil Lescol Lescol Xl Lipidil Supra Lipitor Locholest Lofibra Lopid Lovastatin Mevacor Niacin Niacinol Niacor Niadelay Niaspan Nico-400 Nicobid Tempules Nicolar Nicotinex Nicotinic Acid Pravachol Pravigard Pac Prevalite Probucol Questran Slo-Niacin Tricor Triglide Vytorin Welchol Zetia Zocor Measure: 4006F Patient(s) with a prior myocardial infarction prescribed beta-blocker therapy during the measurement year. (Rule ID: 9000002)) Description Beta-blocker therapy, prescribed (CAD, HF) Medication Acebutolol Atenolol Betapace Betaxolol Bisoprolol Blocadren Brevibloc Cartrol Coreg Corgard Corzide Esmolol Hydrochlorothiazide Inderal Inderide Innopran Kerlone Labetalol Labetolol Levatol Lopressor Metoprol Metoprolol Nadolol Normodyne Pindolol Propranolol Sectral Senormin Sorine Sotalol Tenoretic Tenormin Timolide Timolol Toprol Trandate Visken Zebeta Ziac Coronary Artery Disease 47

Measure: 4009F Patient(s) with CAD and diabetes and/or CHF prescribed ace-inhibitor or angiotensin II receptor antagonist therapy during the measurement year. (Rule ID: 9000004) Description Angiotensin converting enzyme (ACE) inhibitor or Angiotensin Receptor Blocker (ARB) therapy, prescribed (HF, CAD, CKD)1, (DM)2 Medication Amlodipine Benazepril Candesartan Capoten Captopril Enalapril Enalapril maleate Enalaprilat Enalpril Eprosartan Fosinopril Irbesantan Lisinopril Lorsartan Moexipril Olmesartan Perindopril Quinapril Quinaprol Ramipril Telmisartan Trandolapril Valsartan Measure: Patient(s) prescribed antiplatelet therapy during the measurement year. (Rule ID: 9000005) 4011F Description Oral antiplatelet therapy prescribed (eg, aspirin, clopidogrel/plavix, or combination of aspirin and dipyridamole/aggrenox) (CAD) Medication Acetaminophen Aggrenox Anacin Analgesic Antacid Pain Reliever Arthritis bc Powder Packet Arthritis Pain Relief ASA/Caffeine AS-caff Aspidrox Aspirbar Tablet Aspircaf Aspirin Aspirin/Apap/Cafeine Aspirin/Butalbital/ Caffeine Aspir-mox Aspirtab Aspirtal Aspridrox Asprimox Bayer Plus BC Powder BC Tablet BL eff Pain Relief Buffered Aspirin Bufferin Buffex Butalbital Compound Cama Arthritis Clopidogrel Coat-A-Prin ECK Effervescent Pain Relief Ecofair Ecpirin Effer Pain Relief Efferv Antacid Pain Relief Effervescent Pain/ Antacid Encaprin EQ Effervescent Antacid EQL Antacid & Pain Relief Extraprin Fiorinal Fiormor Fiortal Fortabs Gelpirin Tablet Gemnisyn Genace Gensan GNP Tri-Buffered Aspirin Headache Relief HM Aspridox Idenal Isolin Isollyl Laniroif Lanorinal Magnaprin Medi-Seltzer Efferves Migraine Relief Osco Aspercin P-A-C Pain Relief Efferv Pain Relief Tablet Painaid Pain-Off Pravigard RA Pain Effervescent Saleto Stanback Analgesic Supac Therapy Bayer Valesin Valomag Valumag w/aspirin Vanquish Coronary Artery Disease 48

Measure: 1002F Patient(s) assessed for activity and anginal symptoms during the measurement year. (Rule ID: 9000006) Description Anginal symptoms and level of activity assessed (CAD)1 Coronary Artery Disease 49

Diabetes Measure Source (Case) ID: 105200 Measure: Measure: Patient(s) 18-75 years of age that had a HbA1c test in last 12 reported months. (Rule ID: 9000001) Patient(s) 5-17 years of age that had a HbA1c test in last 12 reported months. (Rule ID: 9000009) Description 3044F Most recent hemoglobin A A1C (Hb A1C) level less than 7.0% (DM) 3045F Most recent hemoglobin A1C (Hb A1C) level 7.0-9.0 % (DM) 3046F Most recent hemoglobin A1C level greater than 9.0% (DM) 3047F Most recent hemoglobin A1C level <= 9.0% 83036 Hemoglobin; glycosylated (A1C) 83037 Hemoglobin; glycosylated (A1C) by device cleared by FDA for home use Description LOINC 4548-4 Hemoglobin A1C /Hemoglobin.total 4549-2 Hemoglobin A1C /Hemoglobin.total 17856-6 Hemoglobin A1C /Hemoglobin.total Measure: Patient(s) 18-75 years of age with a LDL cholesterol in last 12 months. (Rule ID: 9000003) Description 3048F Most recent LDL-C less than 100 mg/dl (DM) 3049F Most recent LDL-C 100-129 mg/dl (DM) 3050F Most recent LDL-C greater than or equal to 130 mg/dl (DM) 80061 Lipid panel. This panel must include the following: Cholesterol, serum, total (82465) Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718), Triglycerides (84478) 83700 Lipoprotein, blood; electrophoretic separation and quantitation 83701 Lipoprotein, blood; high resolution fractionation and quantitation of lipoproteins including lipoprotein subclasses when performed (eg, electrophoresis, ultracentrifugation) 83704 Lipoprotein, blood; quantitation of lipoprotein particle numbers and lipoprotein particle subclasses (eg, by nuclear magnetic resonance spectroscopy) 83721 Lipoprotein, direct measurement; LDL cholesterol Diabetes 50

Description LOINC 2089-1 Cholesterol.in LDL 12773-8 Cholesterol.in LDL 13457-7 Cholesterol.in LDL 18261-8 Cholesterol.in LDL 18262-6 Cholesterol.in LDL 22748-8 Cholesterol.in LDL 24331-1 Lipid HCFA 1996 panel 39469-2 Cholesterol.in LDL 49132-4 Cholesterol.in LDL Diabetes 51

Diabetes Mellitus Measure Source (Case) ID: 100311 Measure: 3074F 3075F 3077F 3078F 3079F 3080F Adult(s) aged 18-75 years with diabetes who had their blood pressure documented in the past year less than 140/80 mm/hg (Rule ID: 9000047) Description Most recent systolic blood pressure less than 130 mm Hg (DM) (HTN, CKD) Most recent systolic blood pressure 130 to 139 mm Hg (DM) (HTN, CKD) Most recent systolic blood pressure >= 140 mm Hg (DM)(HTN, CKD) Most recent diastolic blood pressure < 80 mm Hg (DM) (HTN, CKD) Most recent diastolic blood pressure 80-89 mm Hg (DM) (HTN, CKD) Most recent diastolic blood pressure >= 90 mm Hg (DM) (HTN, CKD) Diabetes Mellitus 52

Diabetic Retinopathy (NS) Measure Source (Case) ID: 105800 Measure: Adult(s) with diabetic retinopathy and a dilated macular or fundus exam who had level of severity of retinopathy and presence of macular edema documented. (Rule ID: 900001) Modifier Description 2021F Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema AND level of severity of retinopathy (EC) 2021F 1P Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema AND level of severity of retinopathy (EC) 2021F 2P Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema AND level of severity of retinopathy (EC) 2021F 3P Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema AND level of severity of retinopathy (EC) 2021F 8P Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema AND level of severity of retinopathy (EC) Diabetic Retinopathy (NS) 53

Glaucoma Screening Measure Source (Case) ID: 300400 Measure: Patient(s) 67 years of age and older that had an eye exam for glaucoma in the last 24 reported months. (Rule ID: 9000001) 1 Description 92002 Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient 92004 Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, one or more visits 92012 Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient 92014 Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, one or more visits 92081 Visual field examination, unilateral or bilateral, with interpretation and report; limited examination (eg, tangent screen, Autoplot, arc perimeter, or single stimulus level automated test, such as Octopus three or seven equivalent) 92082 Visual field examination, unilateral or bilateral, with interpretation and report; intermediate examination (eg, at least two isopters on Goldmann perimeter, or semiquantitative, automated suprathreshold screening program, Humphrey suprathreshold automatic diagnostic test, Octopus program 33) 92083 Visual field examination, unilateral or bilateral, with interpretation and report; extended examination (eg, Goldmann visual fields with at least three isopters plotted and static determination within the central 30 degrees, or quantitative, automated threshold perimetry, Octopus program G-1, 32 or 42, Humphrey visual field analyzer full threshold programs 30-2, 24-2, or 30/60-2) 92135 Scanning computerized ophthalmic diagnostic imaging, posterior segment, (eg, scanning laser) with interpretation and report, unilateral 92140 Provocative tests for glaucoma, with interpretation and report, without tonography 99202 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 20 minutes face-to-face with the patient and/or family. 99203 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family. 99204 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 45 minutes face-to-face with the patient and/or family. Glaucoma Screening 54

1 Description 99205 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 60 minutes face-to-face with the patient and/or family. 99213 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 15 minutes face-to-face with the patient and/or family. 99214 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 25 minutes face-to-face with the patient and/or family. 99215 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 40 minutes face-to-face with the patient and/or family. 99242 Office consultation for a new or established patient, which requires these three key components: An expanded problem focused history; An expanded problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family. 99243 Office consultation for a new or established patient, which requires these three key components: A detailed history; A detailed examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 40 minutes face-to-face with the patient and/or family. 99244 Office consultation for a new or established patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 60 minutes face-toface with the patient and/or family. 99245 Office consultation for a new or established patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 80 minutes face-to-face with the patient and/or family. Glaucoma Screening 55

Description ICD-9 1 V80.1 Screening for Glaucoma 95.02 Comprehensive eye examination 95.03 Extended ophthalmologic work-up 95.26 Tonography, provocative tests, and other glaucoma testing HCPCS G0117 G0118 S0620 S0621 Description Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist Routine ophthalmological examination including refraction; new patient Routine ophthalmological examination including refraction; established patient 1 Requires code must be submitted by an Optometrist, Ophthalmologist, or Pediatric Opthalmologist Glaucoma Screening 56

Medication Safety Monitoring Measure Source (Case) ID: 0 Measure: Patients on ARB/ACE therapy who have a serum potassium and either a creatinine OR BUN in the last 12 reported months. (Rule ID: 9180001) Measure: Patients on digoxin who have a serum potassium and either a creatinine OR BUN in the last 12 reported months. (Rule ID: 9180002) Measure: Patients on a diuretic who have a serum potassium and either a creatinine OR BUN in the last 12 reported months. (Rule ID: 9180003) Description 80047 Basic metabolic panel (Calcium, ionized). This panel must include the following: Calcium, ionized (82330) Carbon dioxide (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Potassium (84132) Sodium (84295) Urea Nitrogen (BUN) (84520) 80048 Basic metabolic panel (Calcium, total). This panel must include the following: Calcium, total (82310) Carbon dioxide (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Potassium (84132) Sodium (84295) Urea nitrogen (BUN) (84520) 80050 General health panel. This panel must include the following: Comprehensive metabolic panel (80053) Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009) Thyroid stimulating hormone (TSH) (84443) 80051 Electrolyte panel. This panel must include the following: Carbon dioxide (82374) Chloride (82435) Potassium (84132) Sodium (84295) 80053 Comprehensive metabolic panel. This panel must include the following: Albumin (82040) Bilirubin, total (82247) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphatase, alkaline (84075) Potassium (84132) Protein, total (84155) Sodium (84295) Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate amino (AST) (SGOT) (84450) Urea nitrogen (BUN) (84520) 80069 Renal function panel. This panel must include the following: Albumin (82040) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphorus inorganic (phosphate) (84100) Potassium (84132) Sodium (84295) Urea nitrogen (BUN) (84520) 82565 Creatinine; blood 82575 Creatinine; clearance 84132 Potassium; serum, plasma or whole blood 84520 Urea nitrogen; quantitative 84525 Urea nitrogen; semiquantitative (eg, reagent strip test) Medication Safety Monitoring 57

Description LOINC 2160-0 Creatinine 2163-4 Creatinine renal clearance 2164-2 Creatinine renal clearance 2823-3 Potassium 2824-1 Potassium 3094-0 Urea nitrogen 6298-4 Potassium 6299-2 Urea nitrogen 11041-1 Creatinine^post dialysis 11042-9 Creatinine^pre dialysis 11064-3 Urea nitrogen^post dialysis 11065-0 Urea nitrogen^pre dialysis 12195-4 Creatinine renal clearance/1.73 sq M 12812-4 Potassium^2nd specimen 12813-2 Potassium^3rd specimen 12964-3 Urea nitrogen^baseline 12965-0 Urea nitrogen^70m specimen 12966-8 Urea nitrogen^2h specimen 13441-1 Creatinine renal clearance 13442-9 Creatinine renal clearance 13443-7 Creatinine renal clearance 13446-0 Creatinine renal clearance/1.73 sq M 13447-8 Creatinine renal clearance/1.73 sq M 13449-4 Creatinine renal clearance/1.73 sq M 13450-2 Creatinine renal clearance/1.73 sq M 14682-9 Creatinine 14937-7 Urea nitrogen 16188-5 Creatinine^2H specimen 16189-3 Creatinine^4H specimen 21232-4 Creatinine 22760-3 Potassium 24320-4 Basic metabolic HCFA 1998 panel 24321-2 Basic metabolic HCFA 2000 panel 24322-0 Comprehensive metabolic HCFA 1998 panel 24323-8 Comprehensive metabolic HCFA 2000 panel 24326-1 Electrolytes HCFA 1998 panel 24362-6 Renal function HCFA 2000 panel Medication Safety Monitoring 58

Description 26752-6 Creatinine renal clearance 29349-8 Potassium^post dialysis 31045-8 Creatinine/Urea nitrogen 32713-0 Potassium 33558-8 Creatinine renal clearance 34548-8 Sodium & Potassium panel 34554-6 Electrolytes HCFA 1998 & Venous ph panel 34555-3 Creatinine renal clearance panel 35203-9 Creatinine 35591-7 Creatinine renal clearance.predicted 35592-5 Creatinine renal clearance/1.73 sq M.predicted 35593-3 Creatinine renal clearance/1.73 sq M 35594-1 Creatinine renal clearance/1.73 sq M 38483-4 Creatinine 39789-3 Potassium 39790-1 Potassium 39955-0 Creatinine^pre XXX challenge 39956-8 Creatinine^1.5H pre XXX challenge 39957-6 Creatinine^1H pre XXX challenge 39958-4 Creatinine^45M pre XXX challenge 39959-2 Creatinine^30M pre XXX challenge 39960-0 Creatinine^45M post XXX challenge 39961-8 Creatinine^3.5H post XXX challenge 39962-6 Creatinine^3.75H post XXX challenge 39963-4 Creatinine^4H post XXX challenge 39964-2 Creatinine^4.5H post XXX challenge 39965-9 Creatinine^5.25H post XXX challenge 39966-7 Creatinine^5.5H post XXX challenge 39967-5 Creatinine^6.5H post XXX challenge 39968-3 Creatinine^8H post XXX challenge 39969-1 Creatinine^9H post XXX challenge 39970-9 Creatinine^10H post XXX challenge 39971-7 Creatinine^12H post XXX challenge 39972-5 Creatinine^16H post XXX challenge 39973-3 Creatinine^18H post XXX challenge 39974-1 Creatinine^2D post XXX challenge Medication Safety Monitoring 59

Description LOINC 39975-8 Creatinine^4D post XXX challenge 39976-6 Creatinine^7D post XXX challenge 40112-5 Creatinine^pre XXX challenge 40113-3 Creatinine^1.5H pre XXX challenge 40114-1 Creatinine^1H pre XXX challenge 40115-8 Creatinine^45M pre XXX challenge 40116-6 Creatinine^30M pre XXX challenge 40117-4 Creatinine^45M post XXX challenge 40118-2 Creatinine^3.5H post XXX challenge 40119-0 Creatinine^4H post XXX challenge 40120-8 Creatinine^8H post XXX challenge 40121-6 Creatinine^9H post XXX challenge 40122-4 Creatinine^10H post XXX challenge 40123-2 Creatinine^12H post XXX challenge 40124-0 Creatinine^16H post XXX challenge 40125-7 Creatinine^18H post XXX challenge 40126-5 Creatinine^2D post XXX challenge 40127-3 Creatinine^4D post XXX challenge 40128-1 Creatinine^7D post XXX challenge 40248-7 Creatinine^baseline 40249-5 Creatinine^30M post XXX challenge 40250-3 Creatinine^1H post XXX challenge 40251-1 Creatinine^1.5H post XXX challenge 40252-9 Creatinine^2H post XXX challenge 40253-7 Creatinine^2.25H post XXX challenge 40254-5 Creatinine^2.5H post XXX challenge 40255-2 Creatinine^3H post XXX challenge 40256-0 Creatinine^5H post XXX challenge 40257-8 Creatinine^6H post XXX challenge 40258-6 Creatinine^1D post XXX challenge 40264-4 Creatinine^baseline 40265-1 Creatinine^30M post XXX challenge 40266-9 Creatinine^1H post XXX challenge 40267-7 Creatinine^1.5H post XXX challenge 40268-5 Creatinine^2H post XXX challenge 40269-3 Creatinine^2.5H post XXX challenge Medication Safety Monitoring 60

Description LOINC 40270-1 Creatinine^3H post XXX challenge 40271-9 Creatinine^5H post XXX challenge 40272-7 Creatinine^6H post XXX challenge 40273-5 Creatinine^1D post XXX challenge 41656-0 Potassium 44734-2 Urea nitrogen/creatinine 44784-7 Creatinine 45064-3 Basic metabolic panel & Glomerular filtration rate.predicted 45065-0 Comprehensive metabolic panel & Glomerular filtration rate.predicted 45066-8 Creatinine & Glomerular filtration rate.predicted panel 49071-4 Urea nitrogen^post dialysis/urea nitrogen^pre dialysis 50261-7 Renal function panel & Glomerular filtration rate.predicted 50380-5 Creatinine renal clearance/1.73 sq M.predicted.female 50381-3 Creatinine renal clearance/1.73 sq M.predicted.male 51618-7 Potassium^pre dialysis 51619-5 Creatinine^pre dialysis 51620-3 Creatinine^post dialysis Measure: Patients on a phenobarbital-containing drug who have a phenobarbital level in the last 12 reported months. (Rule ID: 9180004) Description 80184 Phenobarbital Description LOINC 3951-1 Phenobarbital.free 3948-7 Phenobarbital 10547-8 Primidone+Phenobarbital 14874-2 Phenobarbital 34365-7 Primidone+Phenobarbital Medication Safety Monitoring 61

Measure: Adult patients persistently taking phenytoin medication who received a drug serum concentration test for phenytoin within the last 12 reported months (HEDIS criteria). (Rule ID: 9180005) Description 80185 Phenytoin; total 80186 Phenytoin; free Description LOINC 3968-5 Phenytoin 3969-3 Phenytoin.free 14877-5 Phenytoin 32109-1 Phenytoin.free 34540-5 Phenytoin free & total panel 40460-8 Phenytoin.bound Measure: Adult patients persistently taking valproic acid/valproate (dipropylacetic acid) medication who received a drug serum concentration test for valproic acid within the last 12 reported months Description 80164 Dipropylacetic acid (valproic acid) Description LOINC 4086-5 Valproate 4087-3 Valproate.free 4088-1 Valproate^trough 14946-8 Valproate 18489-5 Valproate.protein bound 21590-5 Valproate.bound/Valproate.total 32119-0 Valproate.free 32283-4 Valproate.free/Valproate.total Medication Safety Monitoring 62

Measure: Patients on a carbamazepine-containing drug who have a carbamazepine level in the last 12 reported months. (Rule ID: 9180007) Description 80156 Carbamazepine; total 80157 Carbamazepine; free Description LOINC 3432-2 Carbamazepine 3433-0 Carbamazepine.free 9415-1 Carbamazepine 10,11-Epoxide 14056-6 Carbamazepine 10,11-Epoxide.free 14639-9 Carbamazepine 18270-9 Carbamazepine 10,11-Epoxide 29147-6 Carbamazepine 10,11-Epoxide.bound 29148-4 Carbamazepine.bound 32058-0 Carbamazepine.free 32852-6 Carbamazepine.free/Carbamazepine.total 34545-4 Carbamazepine free & total panel 47097-1 Carbamazepine 10,11-Epoxide.free Measure: No compliance criteria Patients 65 years of age and older that received one or more high risk medications in the elderly in the last 12 reported months (HEDIS criteria). (Rule ID: 9181001) Medication Safety Monitoring 63

Migraine Headache Measure Source (Case) ID: 104000 Measure: Adult patient(s) with frequent use of acute medications that also received prophylactic medications. (Rule ID: 9000006) Medication Acebutolol Amitriptyline Amitriptyline Amlodipine besylate Amoxapine Atenolol Benazepril Bepridil Betaxolol Bisoprolol Bisoprolol fumarate Carbamazepine Carteolol Carvedilol Chlordiazepoxide Clevidipine butyrate Clevidipine butyrate Clomipramine Desipramine Diltiazem Divalproex sodium Doxepin Enalapril Esmolol Ethosuximide Ethotoin Felbamate Felodipine Gabapentin Imipramine Imipramine Imipramine Isradipine Labetalol hydrochloride Lacosamide Lamotrigine Levetiracetam Maprotiline Mephenytoin Methsuximide Metoprolol Mibefradil Nadolol Nebivolol Nicardipine Nifedipine Nimodipine Nisoldipine Nortriptyline hydrochloride Olmesartan Oxcarbazepine Paramethadione Penbutolol Perphenazine Phenacemide Phensuximide Phenytoin Pindolol Primidone Propranolol Propranolol Protriptyline hydrochloride Rufinamide Sotalol Tiagabine Timolol Topiramate Trandolapril Trimethadione Trimipramine maleate Valproic acid Valsartan Verapamil Zonisamide Migraine Headache 64

Osteoporosis Management Measure Source (Case) ID: 202400 Measure: Women 67 years of age or older who were treated or tested for osteoporosis within six months of a fracture. (Rule ID: 9000001) Description 76070 CT scan, bone density study 76071 Computed tomography, appendicular skeleton 76075 Dual energy x-ray study 76076 Dual energy x-ray study 76077 Dxa bn dnsity stdy 1/>site; vert fx 76078 Photodensitometry 76977 Ultrasound bone density measurement and interpretation, peripheral site(s), any method 77078 Computed tomography, bone mineral density study, one or more sites; axial skeleton (eg, hips, pelvis, spine) 77079 Computed tomography, bone mineral density study, one or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel) 77080 Dual-energy X-ray absorptiometry (DXA), bone density study, one or more sites; axial skeleton (eg, hips, pelvis, spine) 77081 Dual-energy X-ray absorptiometry (DXA), bone density study, one or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel) 77082 Dual-energy X-ray absorptiometry (DXA), bone density study, one or more sites; vertebral fracture assessment 77083 Radiographic absorptiometry (eg, photodensitometry, radiogrammetry), one or more sites 78350 Bone density (bone mineral content) study, one or more sites; single photon absorptiometry 78351 Bone density (bone mineral content) study, one or more sites; dual photon absorptiometry, one or more sites Description ICD-9 88.98 Bone mineral density studies V82.81 Special screening for Osteoporosis HCPCS G0130 Description Single energy x-ray absorptiometry (SEXA) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel) Osteoporosis Management 65

Medication Activella Actonel Alendronate Alora Boniva Calcitonin, Salmon Cenestin Climara Clinagen LA 40 Combipatch Delestrogen Dep gynogen Depo-Estradiol Depogen Divigel Elestrin Enjuvia Esclim Estrace Estraderm Estradiol Estradiol Cypionate Estradiol Estradiol-Norethindrone Acetate Estragyn LA 5 Estrasorb Estratab Estro-Cyp Estrogel Estropipate Evamist Evista Femhrt Femring Femtrace Forteo Fortical Fosamax Gynodiol Gynogen LA 20 Menaval-20 Menest Menostar Miacalcin Norinyl 1/35 Ogen Ortho-Est Premarin Premphase Prempro Reclast Valergen Osteoporosis Management 66

Pharyngitis Measure Source (Case) ID: 201100 Measure: Patient(s) treated with an antibiotic for pharyngitis that had a group a streptococcus test. (Rule ID: 9000001) Description 87070 Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates 87071 Culture, bacterial; quantitative, aerobic with isolation and presumptive identification of isolates, any source except urine, blood or stool 87081 Culture, presumptive, pathogenic organisms, screening only; 87430 Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Streptococcus, group A 87650 Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, direct probe technique 87651 Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, amplified probe technique 87652 Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, quantification 87880 Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group A Description LOINC 11268-0 Streptococcus pyogenes 17656-0 Streptococcus pyogenes identified 18481-2 Streptococcus pyogenes Ag 31971-5 Streptococcus pyogenes Ag 49610-9 Streptococcus pyogenes DNA 5036-9 Streptococcus pyogenes rrna 626-2 Bacteria identified 6556-5 Streptococcus pyogenes Ag 6557-3 Streptococcus pyogenes Ag 6558-1 Streptococcus pyogenes Ag 6559-9 Streptococcus pyogenes Ag Pharyngitis 67

Pregnancy Management Measure Source (Case) ID: 201500 Measure: Pregnant women that had HIV testing. (Rule ID: 9000001) Description 3292F HIV testing ordered or documented and reviewed during the first or second prenatal visit (PRENATAL) 86689 Antibody; HTLV or HIV antibody, confirmatory test (eg, Western Blot) 86701 Antibody; HIV-1 86702 Antibody; HIV-2 86703 Antibody; HIV-1 and HIV-2, single assay 87390 Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; HIV-1 87391 Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; HIV-2 87534 Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, direct probe technique 87535 Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, amplified probe technique 87536 Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, quantification 87537 Infectious agent detection by nucleic acid (DNA or RNA); HIV-2, direct probe technique 87538 Infectious agent detection by nucleic acid (DNA or RNA); HIV-2, amplified probe technique 87539 Infectious agent detection by nucleic acid (DNA or RNA); HIV-2, quantification Description LOINC 7918 HIV Test 7917 HIV Test 5222 HIV Test 5221 HIV Test 31201 HIV Test 29893 HIV Test 24012 HIV Test 14092 HIV Test Pregnancy Management 68

Rheumatoid Arthritis Measure Source (Case) ID: 101802 Measure: Patient(s) who had a prescription dispensed for a disease modifying anti-rheumatic drug (DMRAD) during the report period. (Rule ID: 9000027) HCPCS J0129 J0135 J1438 J1600 J1745 J7502 J7515 J7516 J9250 J9260 Description Injection, abatacept, 10 mg Injection, adalimumab, 20 mg Injection, etanercept, 25 mg (code may be used for Medicare when drug administered under the direct supervision of a physician, not for use when drug is self-administered) Injection, gold sodium thiomalate, up to 50 mg Injection infliximab, 10 mg Cyclosporine, oral, 100 mg Cyclosporine, oral, 25 mg Cyclosporine, parenteral, 250 mg Methotrexate sodium, 5 mg Methotrexate sodium, 50 mg Medication Arava Azasan Azathioprine Azulfidine Cuprimine Cyclophosphamide CycloSPORINE Cytoxan Depen Dynacin Enbrel Enbrel Prefilled Syringe Enbrel SureClick Gengraf Gold sodium thiomalate Humira Hydroxychloroquine sulfate Imuran Kineret Leflunomide Methotrexate Minocin Minocycline hydrochloride Myochrysine Myrac Neoral Neosar Orencia Plaquenil Sulfate Remicade Rheumatrex Dose Pack Ridaura Rituxan Sandimmune Solganal Solodyn Sulfasalazine Sulfazine Trexall Vectrin Rheumatoid Arthritis 69

Upper Respiratory Infection (Pediatric) Measure Source (Case) ID: 201800 Measure: Patients with diagnosis of upper respiratory infection (URI) that did not have a prescription for an antibiotic on or three days after the initiating visit. (Rule ID: 9000001) No compliance criteria Upper Respiratory Infection (Pediatric) 70

Use of Appropriate Imaging for Back Pain Measure Source (Case) ID: 201000 Measure: Patients with uncomplicated low back pain that did not have imaging studies (Rule ID: 9000001) No compliance criteria Use of Appropriate Imaging for Back Pain 71

Important notes about the UnitedHealth Premium Physician Designation Program The information from the Premium physician designation program is not an endorsement of a particular physician or health care professional s suitability for the health care needs of any particular member. UnitedHealthcare does not practice medicine nor provide health care services. Physicians are solely responsible for medical judgments and treatments supplied. The quality and/or cost efficiency designation of a physician does not guarantee the quality of health care services members will receive from a doctor and does not guarantee the outcome of any health care services members will receive. Likewise, the fact that a physician may not be designated by this program does not mean that the physician does not provide quality health care services. All physicians in the UnitedHealthcare Network have met certain minimum credentialing requirements. Regardless of whether a physician has received a designation, members have access to all physicians in the UnitedHealthcare Network, as further described under the member s benefit plan. UnitedHealthcare informs members that designations are intended only as a guide when choosing a physician and should not be the sole factor in selecting a physician. As with all programs that evaluate performance based on analysis of a sample, there is a risk of error. There is a risk of error in the claims data used in the evaluation, in the calculations used in the evaluation, and in the way the program determined that an individual physician was responsible for the treatment of the patient s condition. Physicians have the opportunity to review this data and submit a reconsideration request. UnitedHealthcare uses statistical testing to compare a physician s results to expected or normative results. There is a risk of error in statistical tests when applied to the data and a result based on statistical testing is not a guarantee of correct inference or classification. We inform members that it is important that they consider many factors and information from as many sources as possible when selecting a physician. We also inform our members that they may wish to discuss designations with a physician before choosing him or her, or confer with their current physician for advice on selecting other physicians. The information contained in this s and Medications document is subject to change. M49328 11/11 ET122 112211 2011 United HealthCare Services, Inc.