HEDIS Outpatient Value Set

{
  "compose" : {
    "exclude" : [ ],
    "include" : [ {
      "valueSet" : [ "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1195.294" ]
    }, {
      "valueSet" : [ "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1195.295" ]
    } ]
  },
  "date" : "2019-01-29T01:00:02-05:00",
  "meta" : {
    "versionId" : "5",
    "lastUpdated" : "2023-12-21T17:43:03.000-05:00",
    "profile" : [ "http://hl7.org/fhir/StructureDefinition/shareablevalueset", "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-valueset-cqfm", "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-valueset-cqfm" ]
  },
  "publisher" : "NJII Steward",
  "jurisdiction" : [ {
    "coding" : [ {
      "system" : "urn:iso:std:iso:3166",
      "code" : "US"
    } ]
  } ],
  "purpose" : "(Clinical Focus: Denominator and Numerator criteria for Osteoporosis Management in Women STARSC12-HEDISOMW.),(Data Element Scope: CPT, HCPCS Codes),(Inclusion Criteria: As Defined within STARSC12-HEDISOMW.),(Exclusion Criteria: As Defined within STARSC12-HEDISOMW.)",
  "name" : "HEDISOutpatientValueSet",
  "experimental" : false,
  "resourceType" : "ValueSet",
  "expansion" : {
    "contains" : [ {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99202",
      "display" : "Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99203",
      "display" : "Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99204",
      "display" : "Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99205",
      "display" : "Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99211",
      "display" : "Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99212",
      "display" : "Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99213",
      "display" : "Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99214",
      "display" : "Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99215",
      "display" : "Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99242",
      "display" : "Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99243",
      "display" : "Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99244",
      "display" : "Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99245",
      "display" : "Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded.",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99341",
      "display" : "Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99342",
      "display" : "Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99344",
      "display" : "Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99345",
      "display" : "Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded.",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99347",
      "display" : "Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99348",
      "display" : "Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99349",
      "display" : "Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99350",
      "display" : "Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99381",
      "display" : "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)",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99382",
      "display" : "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)",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99383",
      "display" : "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)",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99384",
      "display" : "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)",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99385",
      "display" : "Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18-39 years",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99386",
      "display" : "Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 40-64 years",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99387",
      "display" : "Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 65 years and older",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99391",
      "display" : "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)",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99392",
      "display" : "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)",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99393",
      "display" : "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)",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99394",
      "display" : "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)",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99395",
      "display" : "Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 years",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99396",
      "display" : "Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99397",
      "display" : "Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 65 years and older",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99401",
      "display" : "Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99402",
      "display" : "Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99403",
      "display" : "Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 45 minutes",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99404",
      "display" : "Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99411",
      "display" : "Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 30 minutes",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99412",
      "display" : "Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 60 minutes",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99429",
      "display" : "Unlisted preventive medicine service",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99455",
      "display" : "Work related or medical disability examination by the treating physician that includes: Completion of a medical history commensurate with the patient's condition; Performance of an examination commensurate with the patient's condition; Formulation of a diagnosis, assessment of capabilities and stability, and calculation of impairment; Development of future medical treatment plan; and Completion of necessary documentation/certificates and report.",
      "version" : "2024"
    }, {
      "system" : "http://www.ama-assn.org/go/cpt",
      "code" : "99456",
      "display" : "Work related or medical disability examination by other than the treating physician that includes: Completion of a medical history commensurate with the patient's condition; Performance of an examination commensurate with the patient's condition; Formulation of a diagnosis, assessment of capabilities and stability, and calculation of impairment; Development of future medical treatment plan; and Completion of necessary documentation/certificates and report.",
      "version" : "2024"
    }, {
      "system" : "http://www.nlm.nih.gov/research/umls/hcpcs",
      "code" : "G0402",
      "display" : "Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment",
      "version" : "2024"
    }, {
      "system" : "http://www.nlm.nih.gov/research/umls/hcpcs",
      "code" : "G0438",
      "display" : "Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit",
      "version" : "2024"
    }, {
      "system" : "http://www.nlm.nih.gov/research/umls/hcpcs",
      "code" : "G0439",
      "display" : "Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit",
      "version" : "2024"
    }, {
      "system" : "http://www.nlm.nih.gov/research/umls/hcpcs",
      "code" : "G0463",
      "display" : "Hospital outpatient clinic visit for assessment and management of a patient",
      "version" : "2024"
    }, {
      "system" : "http://www.nlm.nih.gov/research/umls/hcpcs",
      "code" : "T1015",
      "display" : "Clinic visit/encounter, all-inclusive",
      "version" : "2024"
    } ],
    "total" : 49,
    "identifier" : "urn:uuid:d87900db-a26e-4b22-bd08-1e5541b189cf",
    "timestamp" : "2024-04-23T10:49:22-04:00"
  },
  "title" : "HEDIS Outpatient Value Set",
  "extension" : [ {
    "valueString" : "NJII Author",
    "url" : "http://hl7.org/fhir/StructureDefinition/valueset-author"
  }, {
    "valueDate" : "2022-12-15",
    "url" : "http://hl7.org/fhir/StructureDefinition/resource-lastReviewDate"
  }, {
    "valueDate" : "2019-01-29",
    "url" : "http://hl7.org/fhir/StructureDefinition/valueset-effectiveDate"
  }, {
    "url" : "http://health-samurai.io/extensions/source",
    "valueCode" : "db"
  } ],
  "status" : "active",
  "id" : "3812c915-4566-419b-ae36-6e562ebd5479",
  "url" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1195.296",
  "identifier" : [ {
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:oid:2.16.840.1.113762.1.4.1195.296"
  } ],
  "version" : "20190129"
}