Summary & Overview
HCPCS G4010: Infectious Disease MIPS Specialty Set
HCPCS Level II code G4010 designates the Infectious Disease MIPS specialty set, a quality reporting construct used to capture specialty-specific performance measures for infectious disease clinicians within the Merit-based Incentive Payment System. This code is relevant nationally because specialty-set reporting influences clinician MIPS performance categories and potential payment adjustments tied to quality and improvement activities. It is used to identify reporting of multiple measures across clinical care, patient safety, and care coordination domains rather than a single clinical procedure.
Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how the code maps to specialty quality reporting, national implications for clinician performance measurement, and a summary of common reporting expectations tied to infectious disease practice. The report outlines benchmark considerations, implications for payer contract compliance, and the clinical contexts in which the specialty set is applied. Data not available in the input means the publication omits payer-specific reimbursement rates, associated ICD-10 diagnoses, provider taxonomies, and related billing codes.
Billing Code Overview
HCPCS Level II code G4010 represents the Infectious disease MIPS specialty set, a quality measure set designed for clinicians in infectious disease practice to report on performance under the Merit-based Incentive Payment System (MIPS). The code identifies services tied to specialty-specific quality reporting rather than a discrete clinical procedure.
Service Type: Quality reporting / specialty performance measurement
Typical Site of Service: Outpatient clinic or specialty practice setting where infectious disease clinicians provide ambulatory care and performance reporting activities
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult followed by an infectious disease specialist for management and outcomes reporting related to complex infections, antimicrobial stewardship, or long-term infectious disease care. The practice documents a MIPS specialty set submission using G4010 for reporting performance measures to the Centers for Medicare & Medicaid Services. A common workflow: the patient presents for an outpatient consult or follow-up visit; the clinician reviews history, microbiology, imaging, and antibiotic therapy; appropriate clinical actions (medication adjustments, diagnostic testing, care coordination) are documented; clinical quality measures are abstracted from the visit and submitted under the Infectious Disease MIPS specialty set. Encounters typically occur in ambulatory clinic settings, hospital outpatient departments, or academic specialty clinics where infectious disease physicians, physician assistants, or nurse practitioners deliver episodic and longitudinal infection care. Typical scenarios include management of complicated skin and soft tissue infections, prosthetic joint infections, endocarditis follow-up, or chronic viral hepatitis care where MIPS reporting captures quality and outcomes data.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required to reportable visit or service is substantially greater than typically required and documentation supports increased work |
23 | Unusual anesthesia | Use when an office or other outpatient procedure requires general anesthesia due to clinical condition |
52 | Reduced services | Use when a service is partially reduced or not completed at full scope |
53 | Discontinued procedure | Use when a procedure is started but discontinued due to patient condition or other unforeseen circumstances |
54 | Surgical care only | Use when the physician bills for surgical care only and another physician bills for postoperative care |
55 | Postoperative management only | Use when billing only for postoperative management following a surgical procedure |
56 | Preoperative management only | Use when billing only for preoperative management prior to a procedure |
62 | Two surgeons | Use when two surgeons of different specialties perform distinct operative work on the same patient |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | Use when an authorized nonphysician practitioner functions as the assistant at surgery |
QX | Service furnished under a contractual employer relationship (modifier QX) | Use when services are furnished under an employer relationship where required for billing compliance |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 2080P0206X | Infectious Disease | Board-certified infectious disease physicians primarily responsible for MIPS specialty set reporting |
| 208000000X | Internal Medicine | Hospital-based or clinic internists who co-manage infectious disease patients |
| 2083L0402X | Physician Assistant | PAs who provide outpatient infectious disease follow-up and assist in procedures |
| 363LP0201X | Nurse Practitioner | NPs providing longitudinal infectious disease clinic care |
| 2084P0800X | Infectious Disease Nurse Practitioner | Advanced practice providers specializing in infection management |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
B95.6 | Methicillin resistant Staphylococcus aureus infection as the cause of diseases classified elsewhere | MRSA is a common organism relevant to infectious disease quality measures and stewardship |
B96.89 | Other specified bacterial agents as the cause of diseases classified elsewhere | Used when a specific bacterial pathogen is identified and linked to the clinical problem |
A41.9 | Sepsis, unspecified organism | Severe infection scenario frequently managed by infectious disease specialists and captured by MIPS measures |
J15.9 | Bacterial pneumonia, unspecified | Community- or hospital-acquired pneumonias often require infectious disease consultation and outcome reporting |
B18.2 | Chronic viral hepatitis C | Longitudinal infection requiring specialty management and quality measure reporting |
K65.9 | Peritonitis, unspecified | Intra-abdominal infections managed in conjunction with infectious disease specialists |
T82.7XXA | Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter | Prosthetic device infections that commonly trigger infectious disease consultation and reporting |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
99213 | Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes | Common outpatient follow-up visit during which infectious disease MIPS measures are documented for G4010 reporting |
36415 | Collection of venous blood by venipuncture | Common diagnostic step for cultures or laboratory monitoring tied to infectious disease quality measures |
87070 | Culture, bacterial; any other source, except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates | Microbiology testing commonly ordered to guide therapy and quality reporting |
87077 | Antimicrobial susceptibility; organism not specified (e.g., disk diffusion) | Performed alongside cultures to direct antimicrobial management and support measure data |
87635 | Infectious agent detection by nucleic acid (DNA or RNA); SARS-CoV-2, amplified probe technique | Example molecular test often included in infectious disease workflows and quality tracking |