PT - 2020 Measure Value Set_Body Mass Index Assessment Numerator Value Set Name Code Definition Code System BMI Z68.1 [Z68.1] Body mass index (BMI) 19.9 or less, adult ICD10CM BMI Z68.20 [Z68.20] Body mass index (BMI) 20.0-20.9, adult ICD10CM BMI Z68.21 [Z68.21] Body mass index (BMI) 21.0-21.9, adult ICD10CM BMI Z68.22 [Z68.22] Body mass index (BMI) 22.0-22.9, adult ICD10CM BMI Z68.23 [Z68.23] Body mass index (BMI) 23.0-23.9, adult ICD10CM BMI Z68.24 [Z68.24] Body mass index (BMI) 24.0-24.9, adult ICD10CM BMI Z68.25 [Z68.25] Body mass index (BMI) 25.0-25.9, adult ICD10CM BMI Z68.26 [Z68.26] Body mass index (BMI) 26.0-26.9, adult ICD10CM BMI Z68.27 [Z68.27] Body mass index (BMI) 27.0-27.9, adult ICD10CM BMI Z68.28 [Z68.28] Body mass index (BMI) 28.0-28.9, adult ICD10CM BMI Z68.29 [Z68.29] Body mass index (BMI) 29.0-29.9, adult ICD10CM BMI Z68.30 [Z68.30] Body mass index (BMI) 30.0-30.9, adult ICD10CM BMI Z68.31 [Z68.31] Body mass index (BMI) 31.0-31.9, adult ICD10CM BMI Z68.32 [Z68.32] Body mass index (BMI) 32.0-32.9, adult ICD10CM BMI Z68.33 [Z68.33] Body mass index (BMI) 33.0-33.9, adult ICD10CM BMI Z68.34 [Z68.34] Body mass index (BMI) 34.0-34.9, adult ICD10CM BMI Z68.35 [Z68.35] Body mass index (BMI) 35.0-35.9, adult ICD10CM BMI Z68.36 [Z68.36] Body mass index (BMI) 36.0-36.9, adult ICD10CM BMI Z68.37 [Z68.37] Body mass index (BMI) 37.0-37.9, adult ICD10CM BMI Z68.38 [Z68.38] Body mass index (BMI) 38.0-38.9, adult ICD10CM BMI Z68.39 [Z68.39] Body mass index (BMI) 39.0-39.9, adult ICD10CM BMI Z68.41 [Z68.41] Body mass index (BMI) 40.0-44.9, adult ICD10CM BMI Z68.42 [Z68.42] Body mass index (BMI) 45.0-49.9, adult ICD10CM BMI Z68.43 [Z68.43] Body mass index (BMI) 50.0-59.9, adult ICD10CM BMI Z68.44 [Z68.44] Body mass index (BMI) 60.0-69.9, adult ICD10CM BMI Z68.45 [Z68.45] Body mass index (BMI) 70 or greater, adult ICD10CM BMI 39156-5 Body mass index (BMI) [Ratio] LOINC BMI 89270-3 Body mass index (BMI) [Ratio] Estimated LOINC BMI Percentile Z68.51 [Z68.51] Body mass index (BMI) pediatric, less than 5th percentile for age ICD10CM [Z68.52] Body mass index (BMI) pediatric, 5th percentile to less than 85th BMI Percentile Z68.52 ICD10CM percentile for age [Z68.53] Body mass index (BMI) pediatric, 85th percentile to less than 95th BMI Percentile Z68.53 ICD10CM percentile for age Page 1 of 275 November 2019 PT - 2020 Measure Value Set_Body Mass Index Assessment Numerator Value Set Name Code Definition Code System [Z68.54] Body mass index (BMI) pediatric, greater than or equal to 95th BMI Percentile Z68.54 ICD10CM percentile for age BMI Percentile 59574-4 Body mass index (BMI) [Percentile] LOINC BMI Percentile 59575-1 Body mass index (BMI) [Percentile] Per age LOINC BMI Percentile 59576-9 Body mass index (BMI) [Percentile] Per age and sex LOINC Page 2 of 275 November 2019 PT - 2020 Measure Value Set_Body Mass Index Assessment Denominator Value Set Name Code Definition Code System Outpatient 99201 CPT Outpatient 99202 CPT Outpatient 99203 CPT Outpatient 99204 CPT Outpatient 99205 CPT Outpatient 99211 CPT Outpatient 99212 CPT Outpatient 99213 CPT Outpatient 99214 CPT Outpatient 99215 CPT Outpatient 99241 CPT Outpatient 99242 CPT Outpatient 99243 CPT Outpatient 99244 CPT Outpatient 99245 CPT Outpatient 99341 CPT Outpatient 99342 CPT Outpatient 99343 CPT Outpatient 99344 CPT Outpatient 99345 CPT Outpatient 99347 CPT Outpatient 99348 CPT Outpatient 99349 CPT Outpatient 99350 CPT Outpatient 99381 CPT Outpatient 99382 CPT Outpatient 99383 CPT Outpatient 99384 CPT Outpatient 99385 CPT Outpatient 99386 CPT Outpatient 99387 CPT Outpatient 99391 CPT Outpatient 99392 CPT November 2019 3 of 275 PT - 2020 Measure Value Set_Body Mass Index Assessment Denominator Value Set Name Code Definition Code System Outpatient 99393 CPT Outpatient 99394 CPT Outpatient 99395 CPT Outpatient 99396 CPT Outpatient 99397 CPT Outpatient 99401 CPT Outpatient 99402 CPT Outpatient 99403 CPT Outpatient 99404 CPT Outpatient 99411 CPT Outpatient 99412 CPT Outpatient 99429 CPT Outpatient 99455 CPT Outpatient 99456 CPT Outpatient 99483 CPT Initial preventive physical examination; face-to-face visit, services limited to new Outpatient G0402 HCPCS beneficiary during the first 12 months of medicare enrollment (G0402) Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit Outpatient G0438 HCPCS (G0438) Annual wellness visit, includes a personalized prevention plan of service (pps), Outpatient G0439 HCPCS subsequent visit (G0439) Outpatient G0463 Hospital outpatient clinic visit for assessment and management of a patient (G0463) HCPCS Outpatient T1015 Clinic visit/encounter, all-inclusive (T1015) HCPCS Outpatient 17436001 Medical consultation with outpatient (procedure) SNOMED CT US Edition Evaluation and management of established outpatient in office or other outpatient Outpatient 30346009 SNOMED CT US Edition facility (procedure) Evaluation and management of new outpatient in office or other outpatient facility Outpatient 37894004 SNOMED CT US Edition (procedure) Outpatient 77406008 Confirmatory medical consultation (procedure) SNOMED CT US Edition Outpatient 84251009 Comprehensive consultation (procedure) SNOMED CT US Edition Outpatient 185463005 Visit out of hours (procedure) SNOMED CT US Edition November 2019 4 of 275 PT - 2020 Measure Value Set_Body Mass Index Assessment Denominator Value Set Name Code Definition Code System Outpatient 185464004 Out of hours visit - not night visit (procedure) SNOMED CT US Edition Outpatient 185465003 Weekend visit (procedure) SNOMED CT US Edition Outpatient 281036007 Follow-up consultation (procedure) SNOMED CT US Edition Outpatient 439740005 Postoperative follow-up visit (procedure) SNOMED CT US Edition 3391000175 Outpatient Office visit for pediatric care and assessment (procedure) SNOMED CT US Edition 108 4449710001 Outpatient Annual wellness visit (procedure) SNOMED CT US Edition 24105 Outpatient 0510 UBREV Outpatient 0511 UBREV Outpatient 0512 UBREV Outpatient 0513 UBREV Outpatient 0514 UBREV Outpatient 0515 UBREV Outpatient 0516 UBREV Outpatient 0517 UBREV Outpatient 0519 UBREV Outpatient 0520 UBREV Outpatient 0521 UBREV Outpatient 0522 UBREV Outpatient 0523 UBREV Outpatient 0526 UBREV Outpatient 0527 UBREV Outpatient 0528 UBREV Outpatient 0529 UBREV Outpatient 0982 UBREV Outpatient 0983 UBREV November 2019 5 of 275 PT - 2020 Measure Value Set_Body Mass Index Assessment Exclusions Value Set Name Code Definition Code System Pregnancy O00.0 [O00.0] Abdominal pregnancy ICD10CM Pregnancy O00.00 [O00.00] Abdominal pregnancy without intrauterine pregnancy ICD10CM Pregnancy O00.01 [O00.01] Abdominal pregnancy with intrauterine pregnancy ICD10CM Pregnancy O00.1 [O00.1] Tubal pregnancy ICD10CM Pregnancy O00.10 [O00.10] Tubal pregnancy without intrauterine pregnancy ICD10CM Pregnancy O00.101 [O00.101] Right tubal pregnancy without intrauterine pregnancy ICD10CM Pregnancy O00.102 [O00.102] Left tubal pregnancy without intrauterine pregnancy ICD10CM Pregnancy O00.109 [O00.109] Unspecified tubal pregnancy without intrauterine pregnancy ICD10CM Pregnancy O00.11 [O00.11] Tubal pregnancy with intrauterine pregnancy ICD10CM Pregnancy O00.111 [O00.111] Right tubal pregnancy with intrauterine pregnancy ICD10CM Pregnancy O00.112 [O00.112] Left tubal pregnancy with intrauterine pregnancy ICD10CM Pregnancy O00.119 [O00.119] Unspecified tubal pregnancy with intrauterine pregnancy ICD10CM Pregnancy O00.2 [O00.2] Ovarian pregnancy ICD10CM Pregnancy O00.20 [O00.20] Ovarian pregnancy without intrauterine pregnancy ICD10CM Pregnancy O00.201 [O00.201] Right ovarian pregnancy without intrauterine pregnancy ICD10CM Pregnancy O00.202 [O00.202] Left ovarian pregnancy without intrauterine pregnancy ICD10CM Pregnancy O00.209 [O00.209] Unspecified ovarian pregnancy without intrauterine pregnancy ICD10CM Pregnancy O00.21 [O00.21] Ovarian pregnancy with intrauterine pregnancy ICD10CM Pregnancy O00.211 [O00.211] Right ovarian pregnancy with intrauterine pregnancy ICD10CM 6 of 275 November 2019 PT - 2020 Measure Value Set_Body Mass Index Assessment Exclusions Value Set Name Code Definition Code System Pregnancy O00.212 [O00.212] Left ovarian pregnancy with intrauterine pregnancy ICD10CM Pregnancy O00.219 [O00.219] Unspecified ovarian pregnancy with intrauterine pregnancy ICD10CM Pregnancy O00.8 [O00.8] Other ectopic pregnancy ICD10CM Pregnancy O00.80 [O00.80] Other ectopic pregnancy without intrauterine pregnancy ICD10CM Pregnancy O00.81 [O00.81] Other ectopic pregnancy with intrauterine pregnancy ICD10CM Pregnancy O00.9 [O00.9] Ectopic pregnancy, unspecified ICD10CM Pregnancy O00.90 [O00.90] Unspecified ectopic pregnancy without intrauterine pregnancy ICD10CM Pregnancy O00.91 [O00.91] Unspecified ectopic pregnancy with intrauterine pregnancy ICD10CM Pregnancy O01.0 [O01.0] Classical hydatidiform mole ICD10CM Pregnancy O01.1 [O01.1] Incomplete and partial hydatidiform mole ICD10CM Pregnancy O01.9 [O01.9] Hydatidiform mole, unspecified ICD10CM Pregnancy O02.0 [O02.0] Blighted ovum and nonhydatidiform mole ICD10CM Pregnancy O02.1 [O02.1] Missed abortion ICD10CM Pregnancy O02.81 [O02.81] Inappropriate change in quantitative human chorionic gonadotropin (hCG) in early pregnancy ICD10CM Pregnancy O02.89 [O02.89] Other abnormal products of conception ICD10CM Pregnancy O02.9 [O02.9] Abnormal product of conception, unspecified ICD10CM Pregnancy O03.0 [O03.0] Genital tract and pelvic infection following incomplete spontaneous abortion ICD10CM Pregnancy O03.1 [O03.1] Delayed or excessive hemorrhage following incomplete spontaneous abortion