NQF 0108: ADHD: Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication

 

Measure:

Record the percentage of children 6-12 years of age and newly dispensed a medication for attention-deficit/hyperactivity disorder (ADHD) who had appropriate follow-up care. Two rates are reported: 
a. Percentage of children who had one follow-up visit with a practitioner with prescribing authority during the 30-Day Initiation Phase.
b. Percentage of children who remained on ADHD medication for at least 210 days and who, in addition to the visit in the Initiation Phase, had at least two additional follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended.

 

 Numerator 1:

The number of patients who had at least one face-to-face visit with a practitioner with prescribing authority within 30 days after the IPSD.

 Numerator 2:

The number of patients who had at least one face-to-face visit with a practitioner with prescribing authority during the Initiation Phase, and at least two follow-up visits during the Continuation and Maintenance Phase. One of the two visits during the Continuation and Maintenance Phase may be a telephone visit with a practitioner.

Denominator 1:

Children 6-12 years of age who were dispensed an ADHD medication during the Intake Period and who had a visit during the measurement period.

Denominator 2:

Children 6-12 years of age who were dispensed an ADHD medication during the Intake Period and who remained on the medication for at least 210 days out of the 300 days following the IPSD, and who had a visit during the measurement period.

Denominator
Exclusion 1:

Patients diagnosed with narcolepsy at any point in their history or during the measurement period.

Exclude patients who had an acute inpatient stay with a principal diagnosis of mental health or substance abuse during the 30 days after the IPSD.

Exclude patients who were actively on an ADHD medication in the 120 days prior to the Index Prescription Start Date.

Denominator
Exclusion 2:

Patients diagnosed with narcolepsy at any point in their history or during the measurement period.

Exclude patients who had an acute inpatient stay with a principal diagnosis of mental health or substance abuse during the 300 days after the IPSD.

Exclude patients who were actively on an ADHD medication in the 120 days prior to the Index Prescription Start Date.

NQS Domain:

Effective Clinical Care

In ChartMaker Clinical:

In order to qualify for this measure, the provider must have seen the patient, ages 6-12 years, at least one time during the reporting period and have the appropriate information documented in the chart:

Required Data Elements for the Denominator*: 

• Office Visit Encounter or Face-to-Face Encounter Code during the measurement period
Valid Office Encounter Codes: 
CPT:   
Code Description
90791 Psychiatric diagnostic evaluation
90792 Psychiatric diagnostic evaluation with medical services
90832 Psychotherapy, 30 minutes with patient and/or family member
90834 Psychotherapy, 45 minutes with patient and/or family member
90837 Psychotherapy, 60 minutes with patient and/or family member
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)
90875 Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); 30 minutes
90876 Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); 45 minutes
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 (2 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, 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 or other qualified health care professional qualified by education, training, licensure/regulation (when applicable) educational services rendered to patients in a group setting (eg, prenatal, obesity, or diabetic instructions)
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 physicians, other qualified health care professionals, 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. Typically, 10 minutes are spent 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 physicians, other qualified health care professionals, 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. Typically, 20 minutes are spent 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 physicians, other qualified health care professionals, 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. Typically, 30 minutes are spent 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 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 45 minutes are spent 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 physicians, other qualified health care professionals, 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. Typically, 60 minutes are spent 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 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 10 minutes are spent 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 2 of these 3 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 physicians, other qualified health care professionals, 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. Typically, 15 minutes are spent 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 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 25 minutes are spent 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 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 40 minutes are spent face-to-face with the patient and/or family.
99217 Observation care discharge day management (This code is to be utilized 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.])
99241 Office consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 15 minutes are spent face-to-face with the patient and/or family.
99242 Office consultation for a new or established patient, which requires these 3 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 physicians, other qualified health care professionals, 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. Typically, 30 minutes are spent face-to-face with the patient and/or family.
99243 Office consultation for a new or established patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 40 minutes are spent face-to-face with the patient and/or family.
99244 Office consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 60 minutes are spent face-to-face with the patient and/or family.
99245 Office consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 80 minutes are spent face-to-face with the patient and/or family.
99341 Home visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 20 minutes are spent face-to-face with the patient and/or family.
99342 Home 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; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 30 minutes are spent face-to-face with the patient and/or family.
99343 Home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 45 minutes are spent face-to-face with the patient and/or family.
99344 Home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 60 minutes are spent face-to-face with the patient and/or family.
99345 Home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 75 minutes are spent 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 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 15 minutes are spent 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 2 of these 3 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 physicians, other qualified health care professionals, 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. Typically, 25 minutes are spent 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 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 40 minutes are spent 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 3 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 physicians, other qualified health care professionals, 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. Typically, 60 minutes are spent face-to-face with the patient and/or family.
99381 Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; infant (age younger than 1 year)
99382 Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; early childhood (age 1 through 4 years)
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)
99391 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; infant (age younger than 1 year)
99392 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; early childhood (age 1 through 4 years)
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
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

 

SNOMED:  
Code Description
12843005 Subsequent hospital visit by physician (procedure)
18170008 Subsequent nursing facility visit (procedure)
19681004 Nursing evaluation of patient and report (procedure)
87790002 Follow-up inpatient consultation visit (procedure)
90526000 Initial evaluation and management of healthy individual (procedure)
185349003 Encounter for "check-up" (procedure)
185463005 Visit out of hours (procedure)
185465003 Weekend visit (procedure)
207195004 History and physical examination with evaluation and management of nursing facility patient (procedure)
270427003 Patient-initiated encounter (procedure)
270430005 Provider-initiated encounter (procedure)
308335008 Patient encounter procedure (procedure)
390906007 Follow-up encounter (procedure)
406547006 Urgent follow-up (procedure)
439708006 Home visit (procedure)

Valid Face-to- Face Interaction Codes: 

• ADHD Medication started within 90 days prior to or within 60 days after the start of the measurement period
  • {10 (12 HR Clonidine Hydrochloride 0.1 MG Extended Release       Oral Tablet) / 10 (12 HR Clonidine Hydrochloride 0.2   MG Extended Release Oral Tablet) } Pack
  • {5 (atomoxetine 10 MG Oral Capsule) / 5 (atomoxetine 18 MG       Oral Capsule) / 5 (atomoxetine 25 MG Oral Capsule) / 15 (atomoxetine 40 MG Oral Capsule) } Pack
  • {5 (atomoxetine 18 MG Oral Capsule) / 5 (atomoxetine 25 MG       Oral Capsule) / 5 (atomoxetine 40 MG Oral Capsule) / 15 (atomoxetine 60 MG Oral Capsule) } Pack
  • {5 (atomoxetine 25 MG Oral Capsule) / 5 (atomoxetine 40 MG        Oral Capsule) / 5 (atomoxetine 60 MG Oral Capsule) / 15 (atomoxetine 80 MG Oral Capsule) } Pack
  • {7 (24 HR Guanfacine 1 MG Extended Release Oral Tablet) / 7        (24 HR Guanfacine 2 MG Extended Release Oral Tablet) } Pack
  • 12 HR Clonidine Hydrochloride 0.1 MG Extended Release Oral
    Tablet
  • 12 HR Clonidine Hydrochloride 0.2 MG Extended Release Oral
    Tablet
  • 168 HR Clonidine 0.00417 MG/HR Transdermal Patch
  • 168 HR Clonidine 0.00833 MG/HR Transdermal Patch
  • 168 HR Clonidine 0.0125 MG/HR Transdermal Patch
  • 24 HR Amphetamine aspartate 1.25 MG / Amphetamine
    Sulfate 1.25 MG / Dextroamphetamine saccharate 1.25 MG /
    Dextroamphetamine Sulfate 1.25 MG Extended Release Oral
    Capsule
  • 24 HR Amphetamine aspartate 2.5 MG / Amphetamine Sulfate
    2.5 MG / Dextroamphetamine saccharate 2.5 MG /
    Dextroamphetamine Sulfate 2.5 MG Extended Release Oral
    Capsule
  • 24 HR Amphetamine aspartate 3.75 MG / Amphetamine
    Sulfate 3.75 MG / Dextroamphetamine saccharate 3.75 MG /
    Dextroamphetamine Sulfate 3.75 MG Extended Release Oral
    Capsule
  • 24 HR Amphetamine aspartate 5 MG / Amphetamine Sulfate 5
    MG / Dextroamphetamine saccharate 5 MG /
    Dextroamphetamine Sulfate 5 MG Extended Release Oral
    Capsule
  • 24 HR Amphetamine aspartate 6.25 MG / Amphetamine
    Sulfate 6.25 MG / Dextroamphetamine saccharate 6.25 MG
    / Dextroamphetamine Sulfate 6.25 MG Extended Release
    Oral Capsule
  • 24 HR Amphetamine aspartate 7.5 MG / Amphetamine Sulfate
    7.5 MG / Dextroamphetamine saccharate 7.5 MG /
    Dextroamphetamine Sulfate 7.5 MG Extended Release Oral
    Capsule
  • 24 HR Clonidine Hydrochloride 0.1 MG/ML Extended Release
    Suspension
  • 24 HR Clonidine Hydrochloride 0.17 MG Extended Release Oral
    Tablet
  • 24 HR Clonidine Hydrochloride 0.2 MG Extended Release Oral
    Tablet
  • 24 HR Clonidine Hydrochloride 0.3 MG Extended Release Oral
    Tablet
  • 24 HR dexmethylphenidate hydrochloride 10 MG Extended
    Release Oral Capsule
  • 24 HR dexmethylphenidate hydrochloride 15 MG Extended
    Release Oral Capsule
  • 24 HR dexmethylphenidate hydrochloride 20 MG Extended
    Release Oral Capsule
  • 24 HR dexmethylphenidate hydrochloride 25 MG Extended
    Release Oral Capsule
  • 24 HR dexmethylphenidate hydrochloride 30 MG Extended
    Release Oral Capsule
  • 24 HR dexmethylphenidate hydrochloride 35 MG Extended
    Release Oral Capsule
  • 24 HR dexmethylphenidate hydrochloride 40 MG Extended
    Release Oral Capsule
  • 24 HR dexmethylphenidate hydrochloride 5 MG Extended
    Release Oral Capsule
  • 24 HR Guanfacine 1 MG Extended Release Oral Tablet
  • 24 HR Guanfacine 2 MG Extended Release Oral Tablet
  • 24 HR Guanfacine 3 MG Extended Release Oral Tablet
  • 24 HR Guanfacine 4 MG Extended Release Oral Tablet
  • 24 HR Methylphenidate Hydrochloride 10 MG Extended
    Release Oral Capsule
  • 24 HR Methylphenidate Hydrochloride 18 MG Extended Release Oral Tablet
  • 24 HR Methylphenidate Hydrochloride 20 MG Extended
    Release Oral Capsule
  • 24 HR Methylphenidate Hydrochloride 27 MG Extended
    Release Oral Tablet
  • 24 HR Methylphenidate Hydrochloride 30 MG Extended
    Release Oral Capsule
  • 24 HR Methylphenidate Hydrochloride 36 MG Extended
    Release Oral Tablet
  • 24 HR Methylphenidate Hydrochloride 40 MG Extended
    Release Oral Capsule
  • 24 HR Methylphenidate Hydrochloride 5 MG/ML Extended
    Release Suspension
  • 24 HR Methylphenidate Hydrochloride 50 MG Extended
    Release Oral Capsule
  • 24 HR Methylphenidate Hydrochloride 54 MG Extended
    Release Oral Tablet
  • 24 HR Methylphenidate Hydrochloride 60 MG Extended
    Release Oral Capsule
  • 8 HR Methylphenidate Hydrochloride 10 MG Extended Release
    Oral Tablet
  • 8 HR Methylphenidate Hydrochloride 20 MG Extended Release
    Oral Tablet
  • 9 HR Methylphenidate 1.11 MG/HR Transdermal Patch
  • 9 HR Methylphenidate 1.67 MG/HR Transdermal Patch
  • 9 HR Methylphenidate 2.22 MG/HR Transdermal Patch
  • 9 HR Methylphenidate 3.33 MG/HR Transdermal Patch
  • Amphetamine aspartate 1.25 MG / Amphetamine Sulfate 1.25
    MG / Dextroamphetamine saccharate 1.25 MG /
    Dextroamphetamine Sulfate 1.25 MG Oral Tablet
  • Amphetamine aspartate 1.875 MG / Amphetamine Sulfate
    1.875 MG / Dextroamphetamine saccharate 1.875 MG /
    Dextroamphetamine Sulfate 1.875 MG Oral Tablet
  • Amphetamine aspartate 2.5 MG / Amphetamine Sulfate 2.5
    MG / Dextroamphetamine saccharate 5 MG /
    Dextroamphetamine Sulfate 2.5 MG Oral Tablet
  • Amphetamine aspartate 3.125 MG / Amphetamine Sulfate
    3.125 MG / Dextroamphetamine saccharate 3.125 MG /
    Dextroamphetamine Sulfate 3.125 MG Oral Tablet
  • Amphetamine aspartate 3.75 MG / Amphetamine Sulfate 3.75
    MG / Dextroamphetamine saccharate 3.75 MG /
    Dextroamphetamine Sulfate 3.75 MG Oral Tablet
  • Amphetamine aspartate 5 MG / Amphetamine Sulfate 5 MG /
    Dextroamphetamine saccharate 5 MG /
    Dextroamphetamine Sulfate 5 MG Oral Tablet
  • Amphetamine aspartate 7.5 MG / Amphetamine Sulfate 7.5 MG
    / Dextroamphetamine saccharate 5 MG /
    Dextroamphetamine Sulfate 7.5 MG Oral Tablet
  • atomoxetine 10 MG Oral Capsule
  • atomoxetine 100 MG Oral Capsule
  • atomoxetine 18 MG Oral Capsule
  • atomoxetine 25 MG Oral Capsule
  • atomoxetine 40 MG Oral Capsule
  • atomoxetine 5 MG Oral Capsule
  • atomoxetine 60 MG Oral Capsule
  • atomoxetine 80 MG Oral Capsule
  • Butabarbital sodium 30 MG / Methamphetamine
    Hydrochloride 10 MG Extended Release Oral Tablet
  • Chlorthalidone 15 MG / Clonidine Hydrochloride 0.1 MG Oral
    Tablet
  • Chlorthalidone 15 MG / Clonidine Hydrochloride 0.2 MG Oral
    Tablet
  • Chlorthalidone 15 MG / Clonidine Hydrochloride 0.3 MG Oral
    Tablet
  • Clonidine Hydrochloride 0.025 MG Oral Tablet
  • Clonidine Hydrochloride 0.1 MG Oral Tablet
  • Clonidine Hydrochloride 0.1 MG/ML Injectable Solution
  • Clonidine Hydrochloride 0.15 MG Oral Tablet
  • Clonidine Hydrochloride 0.2 MG Oral Tablet
  • Clonidine Hydrochloride 0.3 MG Oral Tablet
  • Clonidine Hydrochloride 0.5 MG/ML Injectable Solution
  • dexmethylphenidate hydrochloride 10 MG Oral Tablet
  • dexmethylphenidate hydrochloride 2.5 MG Oral Tablet
  • dexmethylphenidate hydrochloride 5 MG Oral Tablet
  • Dextroamphetamine Sulfate 1 MG/ML Oral Solution
  • Dextroamphetamine Sulfate 10 MG Extended Release Oral
    Capsule
  • Dextroamphetamine Sulfate 10 MG Oral Tablet
  • Dextroamphetamine Sulfate 15 MG Extended Release Oral
    Capsule
  • Dextroamphetamine Sulfate 15 MG Oral Capsule
  • Dextroamphetamine Sulfate 15 MG Oral Tablet
  • Dextroamphetamine Sulfate 2.5 MG Oral Tablet
  • Dextroamphetamine Sulfate 5 MG Extended Release Oral
    Capsule
  • Dextroamphetamine Sulfate 5 MG Oral Tablet
  • Dextroamphetamine Sulfate 7.5 MG Oral Tablet
  • Guanfacine 1 MG Oral Tablet
  • Guanfacine 2 MG Oral Tablet
  • lisdexamfetamine dimesylate 20 MG Oral Capsule
  • lisdexamfetamine dimesylate 30 MG Oral Capsule
  • lisdexamfetamine dimesylate 40 MG Oral Capsule
  • lisdexamfetamine dimesylate 50 MG Oral Capsule
  • lisdexamfetamine dimesylate 60 MG Oral Capsule
  • lisdexamfetamine dimesylate 70 MG Oral Capsule
  • Methamphetamine Hydrochloride 10 MG Extended Release
    Oral Tablet
  • Methamphetamine Hydrochloride 15 MG Extended Release
    Oral Tablet
  • Methamphetamine Hydrochloride 5 MG Extended Release Oral
    Tablet
  • Methamphetamine Hydrochloride 5 MG Oral Tablet
  • Methylphenidate Hydrochloride 1 MG/ML Oral Solution
  • Methylphenidate Hydrochloride 10 MG Chewable Tablet
  • Methylphenidate Hydrochloride 10 MG Oral Tablet
  • Methylphenidate Hydrochloride 2 MG/ML Oral Solution
  • Methylphenidate Hydrochloride 2.5 MG Chewable Tablet
  • Methylphenidate Hydrochloride 20 MG Oral Tablet
  • Methylphenidate Hydrochloride 5 MG Chewable Tablet
  • Methylphenidate Hydrochloride 5 MG Oral Tablet
  • Required Data Elements for the Numerator 1*: 

    • Office Visit Encounter or Face-to-Face Encounter Code that occurs within 30 days after the start of the ADHD medication
    Valid Office Encounter Codes: 
    CPT:  
    CodeDescription
    90791Psychiatric diagnostic evaluation
    90792Psychiatric diagnostic evaluation with medical services
    90832Psychotherapy, 30 minutes with patient and/or family member
    90834Psychotherapy, 45 minutes with patient and/or family member
    90837Psychotherapy, 60 minutes with patient and/or family member
    90845Psychoanalysis
    90847Family psychotherapy (conjoint psychotherapy) (with patient present)
    90849Multiple-family group psychotherapy
    90853Group psychotherapy (other than of a multiple-family group)
    90875Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); 30 minutes
    90876Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); 45 minutes
    96150Health 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
    96151Health 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
    96152Health and behavior intervention, each 15 minutes, face-to-face; individual
    96153Health and behavior intervention, each 15 minutes, face-to-face; group (2 or more patients)
    96154Health and behavior intervention, each 15 minutes, face-to-face; family (with the patient present)
    98960Education 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
    98961Education 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
    98962Education 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
    98966Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
    98967Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion
    98968Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion
    99078Physician or other qualified health care professional qualified by education, training, licensure/regulation (when applicable) educational services rendered to patients in a group setting (eg, prenatal, obesity, or diabetic instructions)
    99201Office 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 physicians, other qualified health care professionals, 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. Typically, 10 minutes are spent face-to-face with the patient and/or family.
    99202Office 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 physicians, other qualified health care professionals, 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. Typically, 20 minutes are spent face-to-face with the patient and/or family.
    99203Office 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 physicians, other qualified health care professionals, 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. Typically, 30 minutes are spent face-to-face with the patient and/or family.
    99204Office 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 physicians, other qualified health care professionals, 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. Typically, 45 minutes are spent face-to-face with the patient and/or family.
    99205Office 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 physicians, other qualified health care professionals, 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. Typically, 60 minutes are spent face-to-face with the patient and/or family.
    99212Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 10 minutes are spent face-to-face with the patient and/or family.
    99213Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 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 physicians, other qualified health care professionals, 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. Typically, 15 minutes are spent face-to-face with the patient and/or family.
    99214Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 25 minutes are spent face-to-face with the patient and/or family.
    99215Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 40 minutes are spent face-to-face with the patient and/or family.
    99217Observation care discharge day management (This code is to be utilized 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.])
    99241Office consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 15 minutes are spent face-to-face with the patient and/or family.
    99242Office consultation for a new or established patient, which requires these 3 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 physicians, other qualified health care professionals, 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. Typically, 30 minutes are spent face-to-face with the patient and/or family.
    99243Office consultation for a new or established patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 40 minutes are spent face-to-face with the patient and/or family.
    99244Office consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 60 minutes are spent face-to-face with the patient and/or family.
    99245Office consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 80 minutes are spent face-to-face with the patient and/or family.
    99341Home visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 20 minutes are spent face-to-face with the patient and/or family.
    99342Home 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; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 30 minutes are spent face-to-face with the patient and/or family.
    99343Home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 45 minutes are spent face-to-face with the patient and/or family.
    99344Home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 60 minutes are spent face-to-face with the patient and/or family.
    99345Home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 75 minutes are spent face-to-face with the patient and/or family.
    99347Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 15 minutes are spent face-to-face with the patient and/or family.
    99348Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 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 physicians, other qualified health care professionals, 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. Typically, 25 minutes are spent face-to-face with the patient and/or family.
    99349Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 40 minutes are spent face-to-face with the patient and/or family.
    99350Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 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 physicians, other qualified health care professionals, 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. Typically, 60 minutes are spent face-to-face with the patient and/or family.
    99381Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; infant (age younger than 1 year)
    99382Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; early childhood (age 1 through 4 years)
    99383Initial 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)
    99384Initial 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)
    99391Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; infant (age younger than 1 year)
    99392Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; early childhood (age 1 through 4 years)
    99393Periodic 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)
    99394Periodic 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)
    99401Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes
    99402Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes
    99403Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 45 minutes
    99404Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes
    99411Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 30 minutes
    99412Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 60 minutes
    99441Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
    99442Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion
    99443Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion
    99444Online evaluation and management service provided by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient or guardian, not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network
    99510Home visit for individual, family, or marriage counseling

    Valid Face-to- Face Interaction Codes: 

    SNOMED: 
    CodeDescription
    12843005Subsequent hospital visit by physician (procedure)
    18170008Subsequent nursing facility visit (procedure)
    19681004Nursing evaluation of patient and report (procedure)
    87790002Follow-up inpatient consultation visit (procedure)
    90526000Initial evaluation and management of healthy individual (procedure)
    185349003Encounter for "check-up" (procedure)
    185463005Visit out of hours (procedure)
    185465003Weekend visit (procedure)
    207195004History and physical examination with evaluation and management of nursing facility patient (procedure)
    270427003Patient-initiated encounter (procedure)
    270430005Provider-initiated encounter (procedure)
    308335008Patient encounter procedure (procedure)
    390906007Follow-up encounter (procedure)
    406547006Urgent follow-up (procedure)
    439708006Home visit (procedure)

    Required Data Elements for the Numerator 2*: 

    • Office Visit Encounter or Face-to-Face Encounter Code that occurs within 30 days after the start of the ADHD medication
    Valid Office Encounter Codes: 
    CPT:  
    CodeDescription
    90791Psychiatric diagnostic evaluation
    90792Psychiatric diagnostic evaluation with medical services
    90832Psychotherapy, 30 minutes with patient and/or family member
    90834Psychotherapy, 45 minutes with patient and/or family member
    90837Psychotherapy, 60 minutes with patient and/or family member
    90845Psychoanalysis
    90847Family psychotherapy (conjoint psychotherapy) (with patient present)
    90849Multiple-family group psychotherapy
    90853Group psychotherapy (other than of a multiple-family group)
    90875Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); 30 minutes
    90876Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); 45 minutes
    96150Health 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
    96151Health 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
    96152Health and behavior intervention, each 15 minutes, face-to-face; individual
    96153Health and behavior intervention, each 15 minutes, face-to-face; group (2 or more patients)
    96154Health and behavior intervention, each 15 minutes, face-to-face; family (with the patient present)
    98960Education 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
    98961Education 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
    98962Education 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
    99078Physician or other qualified health care professional qualified by education, training, licensure/regulation (when applicable) educational services rendered to patients in a group setting (eg, prenatal, obesity, or diabetic instructions)
    99201Office 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 physicians, other qualified health care professionals, 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. Typically, 10 minutes are spent face-to-face with the patient and/or family.
    99202Office 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 physicians, other qualified health care professionals, 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. Typically, 20 minutes are spent face-to-face with the patient and/or family.
    99203Office 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 physicians, other qualified health care professionals, 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. Typically, 30 minutes are spent face-to-face with the patient and/or family.
    99204Office 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 physicians, other qualified health care professionals, 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. Typically, 45 minutes are spent face-to-face with the patient and/or family.
    99205Office 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 physicians, other qualified health care professionals, 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. Typically, 60 minutes are spent face-to-face with the patient and/or family.
    99212Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 10 minutes are spent face-to-face with the patient and/or family.
    99213Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 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 physicians, other qualified health care professionals, 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. Typically, 15 minutes are spent face-to-face with the patient and/or family.
    99214Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 25 minutes are spent face-to-face with the patient and/or family.
    99215Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 40 minutes are spent face-to-face with the patient and/or family.
    99217Observation care discharge day management (This code is to be utilized 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.])
    99241Office consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 15 minutes are spent face-to-face with the patient and/or family.
    99242Office consultation for a new or established patient, which requires these 3 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 physicians, other qualified health care professionals, 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. Typically, 30 minutes are spent face-to-face with the patient and/or family.
    99243Office consultation for a new or established patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 40 minutes are spent face-to-face with the patient and/or family.
    99244Office consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 60 minutes are spent face-to-face with the patient and/or family.
    99245Office consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 80 minutes are spent face-to-face with the patient and/or family.
    99341Home visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 20 minutes are spent face-to-face with the patient and/or family.
    99342Home 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; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 30 minutes are spent face-to-face with the patient and/or family.
    99343Home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 45 minutes are spent face-to-face with the patient and/or family.
    99344Home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 60 minutes are spent face-to-face with the patient and/or family.
    99345Home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 75 minutes are spent face-to-face with the patient and/or family.
    99347Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 15 minutes are spent face-to-face with the patient and/or family.
    99348Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 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 physicians, other qualified health care professionals, 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. Typically, 25 minutes are spent face-to-face with the patient and/or family.
    99349Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 40 minutes are spent face-to-face with the patient and/or family.
    99350Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 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 physicians, other qualified health care professionals, 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. Typically, 60 minutes are spent face-to-face with the patient and/or family.
    99381Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; infant (age younger than 1 year)
    99382Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; early childhood (age 1 through 4 years)
    99383Initial 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)
    99384Initial 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)
    99391Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; infant (age younger than 1 year)
    99392Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; early childhood (age 1 through 4 years)
    99393Periodic 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)
    99394Periodic 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)
    99401Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes
    99402Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes
    99403Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 45 minutes
    99404Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes
    99411Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 30 minutes
    99412Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 60 minutes
    99510Home visit for individual, family, or marriage counseling

     

    Valid Face-to- Face Interaction Codes: 

    SNOMED: 
    CodeDescription
    12843005Subsequent hospital visit by physician (procedure)
    18170008Subsequent nursing facility visit (procedure)
    19681004Nursing evaluation of patient and report (procedure)
    87790002Follow-up inpatient consultation visit (procedure)
    90526000Initial evaluation and management of healthy individual (procedure)
    185349003Encounter for "check-up" (procedure)
    185463005Visit out of hours (procedure)
    185465003Weekend visit (procedure)
    207195004History and physical examination with evaluation and management of nursing facility patient (procedure)
    270427003Patient-initiated encounter (procedure)
    270430005Provider-initiated encounter (procedure)
    308335008Patient encounter procedure (procedure)
    390906007Follow-up encounter (procedure)
    406547006Urgent follow-up (procedure)
    439708006Home visit (procedure)

     

    • Office Visit Encounter or Face-to-Face Encounter Code (including Telephone visits) that occurs between 31 and 300 days after the start of the ADHD medication
    Valid Office Encounter Codes: 
    CPT:  
    CodeDescription
    90791Psychiatric diagnostic evaluation
    90792Psychiatric diagnostic evaluation with medical services
    90832Psychotherapy, 30 minutes with patient and/or family member
    90834Psychotherapy, 45 minutes with patient and/or family member
    90837Psychotherapy, 60 minutes with patient and/or family member
    90845Psychoanalysis
    90847Family psychotherapy (conjoint psychotherapy) (with patient present)
    90849Multiple-family group psychotherapy
    90853Group psychotherapy (other than of a multiple-family group)
    90875Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); 30 minutes
    90876Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); 45 minutes
    96150Health 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
    96151Health 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
    96152Health and behavior intervention, each 15 minutes, face-to-face; individual
    96153Health and behavior intervention, each 15 minutes, face-to-face; group (2 or more patients)
    96154Health and behavior intervention, each 15 minutes, face-to-face; family (with the patient present)
    98960Education 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
    98961Education 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
    98962Education 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
    98966Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
    98967Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion
    98968Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion
    99078Physician or other qualified health care professional qualified by education, training, licensure/regulation (when applicable) educational services rendered to patients in a group setting (eg, prenatal, obesity, or diabetic instructions)
    99201Office 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 physicians, other qualified health care professionals, 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. Typically, 10 minutes are spent face-to-face with the patient and/or family.
    99202Office 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 physicians, other qualified health care professionals, 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. Typically, 20 minutes are spent face-to-face with the patient and/or family.
    99203Office 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 physicians, other qualified health care professionals, 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. Typically, 30 minutes are spent face-to-face with the patient and/or family.
    99204Office 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 physicians, other qualified health care professionals, 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. Typically, 45 minutes are spent face-to-face with the patient and/or family.
    99205Office 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 physicians, other qualified health care professionals, 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. Typically, 60 minutes are spent face-to-face with the patient and/or family.
    99212Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 10 minutes are spent face-to-face with the patient and/or family.
    99213Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 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 physicians, other qualified health care professionals, 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. Typically, 15 minutes are spent face-to-face with the patient and/or family.
    99214Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 25 minutes are spent face-to-face with the patient and/or family.
    99215Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 40 minutes are spent face-to-face with the patient and/or family.
    99217Observation care discharge day management (This code is to be utilized 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.])
    99241Office consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 15 minutes are spent face-to-face with the patient and/or family.
    99242Office consultation for a new or established patient, which requires these 3 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 physicians, other qualified health care professionals, 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. Typically, 30 minutes are spent face-to-face with the patient and/or family.
    99243Office consultation for a new or established patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 40 minutes are spent face-to-face with the patient and/or family.
    99244Office consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 60 minutes are spent face-to-face with the patient and/or family.
    99245Office consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 80 minutes are spent face-to-face with the patient and/or family.
    99341Home visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 20 minutes are spent face-to-face with the patient and/or family.
    99342Home 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; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 30 minutes are spent face-to-face with the patient and/or family.
    99343Home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 45 minutes are spent face-to-face with the patient and/or family.
    99344Home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 60 minutes are spent face-to-face with the patient and/or family.
    99345Home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 75 minutes are spent face-to-face with the patient and/or family.
    99347Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 15 minutes are spent face-to-face with the patient and/or family.
    99348Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 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 physicians, other qualified health care professionals, 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. Typically, 25 minutes are spent face-to-face with the patient and/or family.
    99349Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 40 minutes are spent face-to-face with the patient and/or family.
    99350Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 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 physicians, other qualified health care professionals, 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. Typically, 60 minutes are spent face-to-face with the patient and/or family.
    99381Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; infant (age younger than 1 year)
    99382Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; early childhood (age 1 through 4 years)
    99383Initial 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)
    99384Initial 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)
    99391Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; infant (age younger than 1 year)
    99392Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; early childhood (age 1 through 4 years)
    99393Periodic 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)
    99394Periodic 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)
    99401Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes
    99402Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes
    99403Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 45 minutes
    99404Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes
    99411Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 30 minutes
    99412Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 60 minutes
    99441Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
    99442Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion
    99443Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion
    99444Online evaluation and management service provided by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient or guardian, not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network
    99510Home visit for individual, family, or marriage counseling

    Valid Face-to- Face Interaction Codes: 

    SNOMED: 
    CodeDescription
    12843005Subsequent hospital visit by physician (procedure)
    18170008Subsequent nursing facility visit (procedure)
    19681004Nursing evaluation of patient and report (procedure)
    87790002Follow-up inpatient consultation visit (procedure)
    90526000Initial evaluation and management of healthy individual (procedure)
    185349003Encounter for "check-up" (procedure)
    185463005Visit out of hours (procedure)
    185465003Weekend visit (procedure)
    207195004History and physical examination with evaluation and management of nursing facility patient (procedure)
    270427003Patient-initiated encounter (procedure)
    270430005Provider-initiated encounter (procedure)
    308335008Patient encounter procedure (procedure)
    390906007Follow-up encounter (procedure)
    406547006Urgent follow-up (procedure)
    439708006Home visit (procedure)

    EXCLUSION DETAILS: 

    This measure makes an exclusion for each denominator:

    Denominator 1 Exclusion*:  Patients are excluded who have a historic, current, or new diagnosis of narcolespy;  who had an acute inpatient stay that was with a primary diagnosis of mental health or substance abuse during the 30 days after Index Prescription Start Date (IPSD); who had an active ADHD medication in the 120 days prior to the IPSD.  In order to meet the requirements for this exclusion, the appropriate information must be documented in the chart:

    At least one of the following:

    • Narcolepsy Diagnosis Code (with attached SNOMED) that occurs before or during the measurement period
    ICD-9: 
    CodeDescription
    347Narcolepsy, without cataplexy
    347.01Narcolepsy, with cataplexy
    347.1Narcolepsy in conditions classified elsewhere, without cataplexy
    347.11Narcolepsy in conditions classified elsewhere, with cataplexy
    ICD-10: 
    CodeDescription
    G47.411Narcolepsy with cataplexy
    G47.419Narcolepsy without cataplexy
    G47.421Narcolepsy in conditions classified elsewhere with cataplexy
    G47.429Narcolepsy in conditions classified elsewhere without cataplexy
    SNOMED: 
    CodeDescription
    60380001Narcolepsy (disorder)
    193042000Cataplexy and narcolepsy (disorder)
    91521000119104Narcolepsy without cataplexy (disorder)
    434241000124107Secondary narcolepsy (disorder)
    434251000124109Secondary narcolepsy without cataplexy (disorder)
    434261000124106Secondary narcolepsy with cataplexy (disorder)
    • Active ADHD Medication 120 days prior to the start of the index ADHD medication (listed in the denominator section above)
  • {10 (12 HR Clonidine Hydrochloride 0.1 MG Extended Release Oral Tablet) / 10 (12 HR Clonidine Hydrochloride 0.2 MG Extended Release Oral Tablet) } Pack
  • {7 (24 HR Guanfacine 1 MG Extended Release Oral Tablet) / 7 (24 HR Guanfacine 2 MG Extended Release Oral Tablet) } Pack
  • 12 HR Clonidine Hydrochloride 0.1 MG Extended Release Oral Tablet
  • 12 HR Clonidine Hydrochloride 0.2 MG Extended Release Oral Tablet
  • 24 HR Clonidine Hydrochloride 0.17 MG Extended Release Oral Tablet
  • 24 HR dexmethylphenidate hydrochloride 25 MG Extended Release Oral Capsule
  • 24 HR dexmethylphenidate hydrochloride 35 MG Extended Release Oral Capsule
  • 24 HR dexmethylphenidate hydrochloride 40 MG Extended Release Oral Capsule
  • 24 HR Methylphenidate Hydrochloride 10 MG Extended Release Oral Capsule
  • 24 HR Methylphenidate Hydrochloride 18 MG Extended Release Oral Tablet
  • 24 HR Methylphenidate Hydrochloride 20 MG Extended Release Oral Capsule
  • 24 HR Methylphenidate Hydrochloride 27 MG Extended Release Oral Tablet
  • 24 HR Methylphenidate Hydrochloride 30 MG Extended Release Oral Capsule
  • 24 HR Methylphenidate Hydrochloride 36 MG Extended Release Oral Tablet
  • 24 HR Methylphenidate Hydrochloride 40 MG Extended Release Oral Capsule
  • 24 HR Methylphenidate Hydrochloride 5 MG/ML Extended Release Suspension
  • 24 HR Methylphenidate Hydrochloride 50 MG Extended Release Oral Capsule
  • 24 HR Methylphenidate Hydrochloride 54 MG Extended Release Oral Tablet
  • 24 HR Methylphenidate Hydrochloride 60 MG Extended Release Oral Capsule
  • 8 HR Methylphenidate Hydrochloride 10 MG Extended Release Oral Tablet
  • 8 HR Methylphenidate Hydrochloride 20 MG Extended Release Oral Tablet
  • 9 HR Methylphenidate 1.11 MG/HR Transdermal Patch
  • 9 HR Methylphenidate 1.67 MG/HR Transdermal Patch
  • 9 HR Methylphenidate 2.22 MG/HR Transdermal Patch
  • 9 HR Methylphenidate 3.33 MG/HR Transdermal Patch
  • Amphetamine aspartate 1.25 MG / Amphetamine Sulfate 1.25 MG / Dextroamphetamine saccharate 1.25 MG / Dextroamphetamine Sulfate 1.25 MG Oral Tablet
  • Amphetamine aspartate 1.875 MG / Amphetamine Sulfate 1.875 MG / Dextroamphetamine saccharate 1.875 MG / Dextroamphetamine Sulfate 1.875 MG Oral Tablet
  • Amphetamine aspartate 2.5 MG / Amphetamine Sulfate 2.5 MG / Dextroamphetamine saccharate 2.5 MG / Dextroamphetamine Sulfate 2.5 MG Oral Tablet
  • Amphetamine aspartate 3.125 MG / Amphetamine Sulfate 3.125 MG / Dextroamphetamine saccharate 3.125 MG / Dextroamphetamine Sulfate 3.125 MG Oral Tablet
  • Amphetamine aspartate 3.75 MG / Amphetamine Sulfate 3.75 MG / Dextroamphetamine saccharate 3.75 MG / Dextroamphetamine Sulfate 3.75 MG Oral Tablet
  • Amphetamine aspartate 5 MG / Amphetamine Sulfate 5 MG / Dextroamphetamine saccharate 5 MG / Dextroamphetamine Sulfate 5 MG Oral Tablet
  • Amphetamine aspartate 7.5 MG / Amphetamine Sulfate 7.5 MG / Dextroamphetamine saccharate 7.5 MG / Dextroamphetamine Sulfate 7.5 MG Oral Tablet
  • atomoxetine 10 MG Oral Capsule
  • atomoxetine 100 MG Oral Capsule
  • atomoxetine 18 MG Oral Capsule
  • atomoxetine 25 MG Oral Capsule
  • atomoxetine 40 MG Oral Capsule
  • atomoxetine 5 MG Oral Capsule
  • atomoxetine 60 MG Oral Capsule
  • atomoxetine 80 MG Oral Capsule
  • Butabarbital sodium 30 MG / Methamphetamine Hydrochloride 10 MG Extended Release Oral Tablet
  • Clonidine Hydrochloride 0.15 MG Oral Tablet
  • Dextroamphetamine Sulfate 2.5 MG Oral Tablet
  • Dextroamphetamine Sulfate 7.5 MG Oral Tablet
  • Guanfacine 1 MG Oral Tablet
  • Guanfacine 2 MG Oral Tablet
  • lisdexamfetamine dimesylate 20 MG Oral Capsule
  • lisdexamfetamine dimesylate 30 MG Oral Capsule
  • lisdexamfetamine dimesylate 40 MG Oral Capsule
  • lisdexamfetamine dimesylate 50 MG Oral Capsule
  • lisdexamfetamine dimesylate 60 MG Oral Capsule
  • lisdexamfetamine dimesylate 70 MG Oral Capsule
  • Methylphenidate Hydrochloride 1 MG/ML Oral Solution
  • Methylphenidate Hydrochloride 10 MG Chewable Tablet
  • Methylphenidate Hydrochloride 10 MG Oral Tablet
  • Methylphenidate Hydrochloride 2 MG/ML Oral Solution
  • Methylphenidate Hydrochloride 2.5 MG Chewable Tablet
  • Methylphenidate Hydrochloride 20 MG Oral Tablet
  • Methylphenidate Hydrochloride 5 MG Chewable Tablet
  • Methylphenidate Hydrochloride 5 MG Oral Tablet
  • • Inpatient Encounter (SNOMED) Code that occurs within 30 days after the start of the Index ADHD medication
    SNOMED:  
    CodeDescription
    304568006Admission for respite care (procedure)
    305348006Admission to care of the elderly day hospital (procedure)
    305337004Admission to community hospital (procedure)
    305344008Admission to day hospital (procedure)
    305343002Admission to day ward (procedure)
    305347001Admission to elderly severely mentally ill day hospital (procedure)
    305335007Admission to establishment (procedure)
    305338009Admission to general practice hospital (procedure)
    305340004Admission to long stay hospital (procedure)
    305339001Admission to private hospital (procedure)
    305345009Admission to psychiatric day hospital (procedure)
    305346005Admission to psychogeriatric day hospital (procedure)
    305341000Admission to tertiary referral hospital (procedure)
    305342007Admission to ward (procedure)
    183477006Admit cardiothoracic emergency (procedure)
    183466000Admit dermatology emergency (procedure)
    183472000Admit diabetic emergency (procedure)
    183462003Admit ear, nose and throat emergency (procedure)
    183457004Admit geriatric emergency (procedure)
    183459001Admit gynecological emergency (procedure)
    183470008Admit hematology emergency (procedure)
    183467009Admit neurology emergency (procedure)
    183476002Admit neurosurgical emergency (procedure)
    183460006Admit obstetric emergency (procedure)
    183464002Admit ophthalmological emergency (procedure)
    183473005Admit oral surgical emergency (procedure)
    183461005Admit orthopedic emergency (procedure)
    183458009Admit pediatric emergency (procedure)
    183471007Admit plastic surgery emergency (procedure)
    183455007Admit psychiatric emergency (procedure)
    183474004Admit psychogeriatric emergency (procedure)
    183469007Admit radiotherapy emergency (procedure)
    183475003Admit renal medicine emergency (procedure)
    183465001Admit rheumatology emergency (procedure)
    183463008Admit trauma emergency (procedure)
    183468004Admit urology emergency (procedure)
    183478001Emergency admission, asthma (procedure)
    183452005Emergency hospital admission (procedure)
    32485007Hospital admission (procedure)
    1505002Hospital admission for isolation (procedure)
    82942009Hospital admission, blood donor (procedure)
    112690009Hospital admission, boarder, for social reasons (procedure)
    70755000Hospital admission, by legal authority (commitment) (procedure)
    51032003Hospital admission, donor for transplant organ (procedure)
    8715000Hospital admission, elective (procedure)
    112689000Hospital admission, elective, with complete pre-admission work-up (procedure)
    15584006Hospital admission, elective, with partial pre-admission work-up (procedure)
    81672003Hospital admission, elective, without pre-admission work-up (procedure)
    18083007Hospital admission, emergency, indirect (procedure)
    55402005Hospital admission, for laboratory work-up, radiography, etc. (procedure)
    76464004Hospital admission, for observation (procedure)
    23473000Hospital admission, for research investigation (procedure)
    63551005Hospital admission, from remote area, by means of special transportation (procedure)
    60059000Hospital admission, infant, for observation, delivered outside of hospital (procedure)
    52748007Hospital admission, involuntary (procedure)
    71290004Hospital admission, limited to designated procedures (procedure)
    47348005Hospital admission, mother, for observation, delivered outside of hospital (procedure)
    51501005Hospital admission, parent, for in-hospital child care (procedure)
    45702004Hospital admission, precertified by medical audit action (procedure)
    36723004Hospital admission, pre-nursing home placement (procedure)
    50699000Hospital admission, short-term (procedure)
    74857009Hospital admission, short-term, 24 hours (procedure)
    65043002Hospital admission, short-term, day care (procedure)
    48183000Hospital admission, special (procedure)
    432621000124105Hospital admission, transfer from dialysis facility (procedure)
    432661000124104Hospital admission, transfer from emergency department (procedure)
    4563007Hospital admission, transfer from other hospital or health care facility (procedure)
    2876009Hospital admission, type unclassified, explain by report (procedure)
    25986004Hospital admission, under police custody (procedure)
    2252009Hospital admission, urgent, 48 hours (procedure)
    417005Hospital re-admission (procedure)
    183481006Non-urgent hospital admission (procedure)
    183497001Non-urgent trauma admission (procedure)
    405614004Unexpected hospital admission (procedure)

    If an Inpatient Encounter is documented, at least one of the following must be documented as well:

    • Mental Health Diagnosis Code (with attached SNOMED) that occurs before or during the Inpatient Encounter
    • Substance Abuse Diagnosis Code (with attached SNOMED) that occurs before or during the Inpatient Encounter

    Denominator 2 Exclusion*:  Patients are excluded who have a historic, current, or new diagnosis of narcolespy;  who had an acute inpatient stay that was with a principal diagnosis of mental health or substance abuse during the 300 days after Index Prescription Start Date (IPSD); who had an active ADHD medication in the 120 days prior to the IPSD.  In order to meet the requirements for this exclusion, the appropriate information must be documented in the chart:

    At least one of the following:

    • Narcolepsy Diagnosis Code (with attached SNOMED) that occurs before or during the measurement period
    ICD-9: 
    CodeDescription
    347Narcolepsy, without cataplexy
    347.01Narcolepsy, with cataplexy
    347.1Narcolepsy in conditions classified elsewhere, without cataplexy
    347.11Narcolepsy in conditions classified elsewhere, with cataplexy
    ICD-10: 
    CodeDescription
    G47.411Narcolepsy with cataplexy
    G47.419Narcolepsy without cataplexy
    G47.421Narcolepsy in conditions classified elsewhere with cataplexy
    G47.429Narcolepsy in conditions classified elsewhere without cataplexy
    SNOMED: 
    CodeDescription
    60380001Narcolepsy (disorder)
    193042000Cataplexy and narcolepsy (disorder)
    91521000119104Narcolepsy without cataplexy (disorder)
    434241000124107Secondary narcolepsy (disorder)
    434251000124109Secondary narcolepsy without cataplexy (disorder)
    434261000124106Secondary narcolepsy with cataplexy (disorder)
    • Active ADHD Medication 120 days prior to the start of the index ADHD medication (listed in the denominator section above)
  • {10 (12 HR Clonidine Hydrochloride 0.1 MG Extended Release Oral Tablet) / 10 (12 HR Clonidine Hydrochloride 0.2 MG Extended Release Oral Tablet) } Pack
  • {7 (24 HR Guanfacine 1 MG Extended Release Oral Tablet) / 7 (24 HR Guanfacine 2 MG Extended Release Oral Tablet) } Pack
  • 12 HR Clonidine Hydrochloride 0.1 MG Extended Release Oral Tablet
  • 12 HR Clonidine Hydrochloride 0.2 MG Extended Release Oral Tablet
  • 24 HR Clonidine Hydrochloride 0.17 MG Extended Release Oral Tablet
  • 24 HR dexmethylphenidate hydrochloride 25 MG Extended Release Oral Capsule
  • 24 HR dexmethylphenidate hydrochloride 35 MG Extended Release Oral Capsule
  • 24 HR dexmethylphenidate hydrochloride 40 MG Extended Release Oral Capsule
  • 24 HR Methylphenidate Hydrochloride 10 MG Extended Release Oral Capsule
  • 24 HR Methylphenidate Hydrochloride 18 MG Extended Release Oral Tablet
  • 24 HR Methylphenidate Hydrochloride 20 MG Extended Release Oral Capsule
  • 24 HR Methylphenidate Hydrochloride 27 MG Extended Release Oral Tablet
  • 24 HR Methylphenidate Hydrochloride 30 MG Extended Release Oral Capsule
  • 24 HR Methylphenidate Hydrochloride 36 MG Extended Release Oral Tablet
  • 24 HR Methylphenidate Hydrochloride 40 MG Extended Release Oral Capsule
  • 24 HR Methylphenidate Hydrochloride 5 MG/ML Extended Release Suspension
  • 24 HR Methylphenidate Hydrochloride 50 MG Extended Release Oral Capsule
  • 24 HR Methylphenidate Hydrochloride 54 MG Extended Release Oral Tablet
  • 24 HR Methylphenidate Hydrochloride 60 MG Extended Release Oral Capsule
  • 8 HR Methylphenidate Hydrochloride 10 MG Extended Release Oral Tablet
  • 8 HR Methylphenidate Hydrochloride 20 MG Extended Release Oral Tablet
  • 9 HR Methylphenidate 1.11 MG/HR Transdermal Patch
  • 9 HR Methylphenidate 1.67 MG/HR Transdermal Patch
  • 9 HR Methylphenidate 2.22 MG/HR Transdermal Patch
  • 9 HR Methylphenidate 3.33 MG/HR Transdermal Patch
  • Amphetamine aspartate 1.25 MG / Amphetamine Sulfate 1.25 MG / Dextroamphetamine saccharate 1.25 MG / Dextroamphetamine Sulfate 1.25 MG Oral Tablet
  • Amphetamine aspartate 1.875 MG / Amphetamine Sulfate 1.875 MG / Dextroamphetamine saccharate 1.875 MG / Dextroamphetamine Sulfate 1.875 MG Oral Tablet
  • Amphetamine aspartate 2.5 MG / Amphetamine Sulfate 2.5 MG / Dextroamphetamine saccharate 2.5 MG / Dextroamphetamine Sulfate 2.5 MG Oral Tablet
  • Amphetamine aspartate 3.125 MG / Amphetamine Sulfate 3.125 MG / Dextroamphetamine saccharate 3.125 MG / Dextroamphetamine Sulfate 3.125 MG Oral Tablet
  • Amphetamine aspartate 3.75 MG / Amphetamine Sulfate 3.75 MG / Dextroamphetamine saccharate 3.75 MG / Dextroamphetamine Sulfate 3.75 MG Oral Tablet
  • Amphetamine aspartate 5 MG / Amphetamine Sulfate 5 MG / Dextroamphetamine saccharate 5 MG / Dextroamphetamine Sulfate 5 MG Oral Tablet
  • Amphetamine aspartate 7.5 MG / Amphetamine Sulfate 7.5 MG / Dextroamphetamine saccharate 7.5 MG / Dextroamphetamine Sulfate 7.5 MG Oral Tablet
  • atomoxetine 10 MG Oral Capsule
  • atomoxetine 100 MG Oral Capsule
  • atomoxetine 18 MG Oral Capsule
  • atomoxetine 25 MG Oral Capsule
  • atomoxetine 40 MG Oral Capsule
  • atomoxetine 5 MG Oral Capsule
  • atomoxetine 60 MG Oral Capsule
  • atomoxetine 80 MG Oral Capsule
  • Butabarbital sodium 30 MG / Methamphetamine Hydrochloride 10 MG Extended Release Oral Tablet
  • Clonidine Hydrochloride 0.15 MG Oral Tablet
  • Dextroamphetamine Sulfate 2.5 MG Oral Tablet
  • Dextroamphetamine Sulfate 7.5 MG Oral Tablet
  • Guanfacine 1 MG Oral Tablet
  • Guanfacine 2 MG Oral Tablet
  • lisdexamfetamine dimesylate 20 MG Oral Capsule
  • lisdexamfetamine dimesylate 30 MG Oral Capsule
  • lisdexamfetamine dimesylate 40 MG Oral Capsule
  • lisdexamfetamine dimesylate 50 MG Oral Capsule
  • lisdexamfetamine dimesylate 60 MG Oral Capsule
  • lisdexamfetamine dimesylate 70 MG Oral Capsule
  • Methylphenidate Hydrochloride 1 MG/ML Oral Solution
  • Methylphenidate Hydrochloride 10 MG Chewable Tablet
  • Methylphenidate Hydrochloride 10 MG Oral Tablet
  • Methylphenidate Hydrochloride 2 MG/ML Oral Solution
  • Methylphenidate Hydrochloride 2.5 MG Chewable Tablet
  • Methylphenidate Hydrochloride 20 MG Oral Tablet
  • Methylphenidate Hydrochloride 5 MG Chewable Tablet
  • Methylphenidate Hydrochloride 5 MG Oral Tablet
  • • Inpatient Encounter (SNOMED) Code that occurs within 300 days after the start of the Index ADHD medication
    SNOMED:  
    CodeDescription
    304568006Admission for respite care (procedure)
    305348006Admission to care of the elderly day hospital (procedure)
    305337004Admission to community hospital (procedure)
    305344008Admission to day hospital (procedure)
    305343002Admission to day ward (procedure)
    305347001Admission to elderly severely mentally ill day hospital (procedure)
    305335007Admission to establishment (procedure)
    305338009Admission to general practice hospital (procedure)
    305340004Admission to long stay hospital (procedure)
    305339001Admission to private hospital (procedure)
    305345009Admission to psychiatric day hospital (procedure)
    305346005Admission to psychogeriatric day hospital (procedure)
    305341000Admission to tertiary referral hospital (procedure)
    305342007Admission to ward (procedure)
    183477006Admit cardiothoracic emergency (procedure)
    183466000Admit dermatology emergency (procedure)
    183472000Admit diabetic emergency (procedure)
    183462003Admit ear, nose and throat emergency (procedure)
    183457004Admit geriatric emergency (procedure)
    183459001Admit gynecological emergency (procedure)
    183470008Admit hematology emergency (procedure)
    183467009Admit neurology emergency (procedure)
    183476002Admit neurosurgical emergency (procedure)
    183460006Admit obstetric emergency (procedure)
    183464002Admit ophthalmological emergency (procedure)
    183473005Admit oral surgical emergency (procedure)
    183461005Admit orthopedic emergency (procedure)
    183458009Admit pediatric emergency (procedure)
    183471007Admit plastic surgery emergency (procedure)
    183455007Admit psychiatric emergency (procedure)
    183474004Admit psychogeriatric emergency (procedure)
    183469007Admit radiotherapy emergency (procedure)
    183475003Admit renal medicine emergency (procedure)
    183465001Admit rheumatology emergency (procedure)
    183463008Admit trauma emergency (procedure)
    183468004Admit urology emergency (procedure)
    183478001Emergency admission, asthma (procedure)
    183452005Emergency hospital admission (procedure)
    32485007Hospital admission (procedure)
    1505002Hospital admission for isolation (procedure)
    82942009Hospital admission, blood donor (procedure)
    112690009Hospital admission, boarder, for social reasons (procedure)
    70755000Hospital admission, by legal authority (commitment) (procedure)
    51032003Hospital admission, donor for transplant organ (procedure)
    8715000Hospital admission, elective (procedure)
    112689000Hospital admission, elective, with complete pre-admission work-up (procedure)
    15584006Hospital admission, elective, with partial pre-admission work-up (procedure)
    81672003Hospital admission, elective, without pre-admission work-up (procedure)
    18083007Hospital admission, emergency, indirect (procedure)
    55402005Hospital admission, for laboratory work-up, radiography, etc. (procedure)
    76464004Hospital admission, for observation (procedure)
    23473000Hospital admission, for research investigation (procedure)
    63551005Hospital admission, from remote area, by means of special transportation (procedure)
    60059000Hospital admission, infant, for observation, delivered outside of hospital (procedure)
    52748007Hospital admission, involuntary (procedure)
    71290004Hospital admission, limited to designated procedures (procedure)
    47348005Hospital admission, mother, for observation, delivered outside of hospital (procedure)
    51501005Hospital admission, parent, for in-hospital child care (procedure)
    45702004Hospital admission, precertified by medical audit action (procedure)
    36723004Hospital admission, pre-nursing home placement (procedure)
    50699000Hospital admission, short-term (procedure)
    74857009Hospital admission, short-term, 24 hours (procedure)
    65043002Hospital admission, short-term, day care (procedure)
    48183000Hospital admission, special (procedure)
    432621000124105Hospital admission, transfer from dialysis facility (procedure)
    432661000124104Hospital admission, transfer from emergency department (procedure)
    4563007Hospital admission, transfer from other hospital or health care facility (procedure)
    2876009Hospital admission, type unclassified, explain by report (procedure)
    25986004Hospital admission, under police custody (procedure)
    2252009Hospital admission, urgent, 48 hours (procedure)
    417005Hospital re-admission (procedure)
    183481006Non-urgent hospital admission (procedure)
    183497001Non-urgent trauma admission (procedure)
    405614004Unexpected hospital admission (procedure)

    If an Inpatient Encounter is documented, at least one of the following must be documented as well:

    • Mental Health Diagnosis Code (with attached SNOMED) that occurs before or during the Inpatient Encounter
    • Substance Abuse Diagnosis Code (with attached SNOMED) that occurs before or during the Inpatient Encounter

    *ADDITIONAL INFORMATION:

    •  The patient must be at least 6 years old and under 12 prior to the start of the measurement period.

    •  The Inpatient SNOMED code must be attached a procedure code (not the office visit code).  The procedure code must be documented with the correct inpatient date.  Any diagnosis codes that occurred during the inpatient encounter must be entered using the same date.

    •  The only data used to determine the denominator is data from the ChartMaker Clinical Module. If a patient encounter was not entered into the ChartMaker Clinical Module, that encounter is not included in the denominator for the statistical calculations on the Meaningful Use Dashboard. Please add these additional patients to the denominator and recalculate the percentage for Attestation purposes.

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