HCPCS G4012: Interventional Radiology MIPS Specialty Set - OpenPayer

Summary & Overview

HCPCS G4012: Interventional Radiology MIPS Specialty Set

HCPCS Level II code G4012 designates the Interventional Radiology MIPS specialty set, a quality reporting construct used to capture performance measures for interventional radiology clinicians. Nationally, specialty-specific MIPS sets like G4012 shape quality reporting, inform value-based payment adjustments, and support care-standardization efforts in image-guided, minimally invasive procedures.

Key payers referenced in standard analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare, which commonly use MIPS-derived performance data for payment and network decisions. Readers will find a concise overview of what G4012 represents, why it matters for interventional radiology practices, and what types of benchmarks and policy context typically accompany specialty-set codes. The publication summarizes common payer coverage considerations, implications for site-of-service reporting (hospital outpatient departments and ambulatory surgical centers), and the clinical context for interventional radiology quality measurement.

The report also outlines typical analytic elements readers can expect: national benchmarking of performance measures tied to the specialty set, relevant policy updates affecting MIPS reporting, and practical implications for coding and documentation workflows. Data not supplied in the input—such as specific measure lists, modifiers, taxonomies, or diagnosis mappings—is noted as unavailable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG4012HCPCS Level IIinterventional radiologyMIPSquality reportingperformance measureshospital outpatientambulatory surgical centervalue-based care

Billing Code Overview

HCPCS Level II code G4012 represents the Interventional Radiology MIPS specialty set. The code identifies a specialty-specific reporting set used for performance measurement within the Merit-based Incentive Payment System (MIPS) focused on interventional radiology.

Service type: Quality reporting / performance measurement

Typical site of service: Hospital outpatient departments and ambulatory surgical centers where interventional radiology services are furnished

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with known peripheral arterial disease and a symptomatic iliac artery stenosis is scheduled for an interventional radiology procedure performed by an interventional radiologist. The patient arrives to the hospital outpatient interventional suite after pre-procedure screening and informed consent. Vascular access is obtained under ultrasound guidance (common femoral artery), diagnostic angiography is performed to define lesion anatomy, and therapeutic interventions such as balloon angioplasty and stent placement are completed under fluoroscopic guidance. Conscious sedation or monitored anesthesia care is provided, and hemostasis is achieved with manual compression or closure device. The patient is observed in recovery for access-site bleeding, hemodynamic stability, and limb perfusion prior to discharge the same day or transfer to an inpatient bed if complications occur.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than typically required for the procedure (e.g., extensive additional maneuvers, prolonged fluoroscopy, complex anatomy).
`23`	Unusual anesthesia

HCPCS G2133: Frailty with Advanced Illness, Ages 66–80

HCPCS-G9710-HOSPICE-SERVICES-MEASUREMENT-PERIOD

HCPCS G9710: Patient Provided Hospice Services During Measurement Period

HCPCS-G9898-INSTITUTIONAL-SNP-LONG-TERM-CARE-RESIDENCY-90-DAYS

HCPCS G9898: Institutional SNP or Long-Term Care Residency, Age 66+

HCPCS-G8769-LIPID-PROFILE-NOT-PERFORMED

HCPCS G8769: Lipid Profile Not Performed, Reason Not Given

HCPCS-G8934-LEFT-VENTRICULAR-EJECTION-FRACTION-LVEF-40-OR-LESS

HCPCS G8934: Left Ventricular Ejection Fraction ≤40% or Moderately/Severely Depressed LV Function

HCPCS-G8663-SHOULDER-IMPAIRMENT-RESIDUAL-SCORE-CALCULATION

HCPCS G8663: Shoulder Impairment Residual Score

HCPCS-G2152-NECK-IMPAIRMENT-RESIDUAL-SCORE

HCPCS G2152: Residual Neck Impairment Score Calculated

HCPCS-G9906-TOBACCO-CESSATION-COUNSELING-PHARMACOTHERAPY

HCPCS G9906: Tobacco Cessation Counseling and/or Pharmacotherapy

HCPCS-G8500-HIV-AIDS-QUALITY-ACTIONS-COMPLETE

HCPCS G8500: Completion of HIV/AIDS Quality Measures

HCPCS-G2167-NECK-IMPAIRMENT-RESIDUAL-SCORE-NEGATIVE

HCPCS G2167: Neck Impairment Residual Score (< 0)

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`2086P0800X`	Interventional Radiology	Proceduralists who perform vascular and nonvascular image-guided interventions.
`207P00000X`	Diagnostic Radiology	Radiologists who perform diagnostic angiography and imaging guidance.
`2084P0800X`	Vascular Surgery	Vascular surgeons who may collaborate or perform endovascular interventions.
`367A00000X`	Anesthesiology	Anesthesia providers for monitored anesthesia care or general anesthesia.
`363A00000X`	Nurse Anesthetist	CRNAs providing anesthesia services in the IR suite.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.219`	Atherosclerosis of native arteries of extremities, unspecified, bilateral legs	Peripheral arterial disease is a primary indication for iliac or femoral angioplasty and stenting performed by interventional radiology.
`I70.213`	Atherosclerosis of native arteries of extremities with rest pain, bilateral legs	Critical limb ischemia presentations (rest pain) often prompt urgent endovascular intervention.
`I70.241`	Atherosclerosis of native arteries of extremities with intermittent claudication, right leg	Intermittent claudication due to focal iliac or femoropopliteal lesions is commonly treated with percutaneous angioplasty/stenting.
`I82.401`	Acute embolism and thrombosis of unspecified deep veins of lower extremity	Thrombotic disease may require catheter-directed thrombolysis or thrombectomy in the interventional suite.
`T82.898A`	Other complications of vascular prosthetic devices, implants and grafts, initial encounter	Complications related to prior vascular grafts or stents can necessitate image-guided interventions.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`37220`	Percutaneous transluminal angioplasty, initial vessel; iliac artery	Commonly performed therapeutic intervention in IR MIPS specialty set for iliac artery stenosis, often performed during the same session as diagnostic angiography.
`37221`	Percutaneous transluminal angioplasty, initial vessel; each additional contiguous vessel (eg, femoral, popliteal), when performed	Used when additional contiguous vessels are intervened on during the same procedure.
`37224`	Transcatheter placement of intravascular stent(s), each vessel; with angioplasty when performed	Used when stent placement accompanies angioplasty during endovascular treatment.
`36011`	Introduction of needle or intracatheter; cannulation of femoral artery for diagnostic angiography	Represents vascular access portion of the procedure; often billed with diagnostic angiography or as part of endovascular interventions.
`75710`	Angiography, extremity, unilateral, radiological supervision and interpretation	Diagnostic imaging code for extremity angiography that may precede or guide interventional therapy in the IR suite.

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