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This document is intended only to provide information related to which CPT/HCPCs codes require prior authorization. It does not indicate/list codes which may be excluded from coverage or not covered for other reasons. In addition, inclusion on this list indicates, if covered the code would require prior authorization for coverage.
These lists are modified periodically with appropriate notice of these changes consistent with state and federal requirements. Inclusion of a procedure or device code(s) does not constitute or imply coverage nor does it imply or guarantee provider reimbursement. Coverage is determined by the member specific benefit plan document and any applicable laws regarding coverage of specific services. Providers should verify eligibility, benefits and whether prior authorization is required for all members prior to rendering services by contacting Health Plans at the following numbers:
- For Medicaid members: 801-213-4104; Toll Free 833-981-0212
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- For Individual Exchange members: 801-213-4111; Toll Free 833-981-0214
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- For Carson Tahoe members: 801-213-0150; Toll Free 833-661-3915
For pharmacy services and products, please consult the current Pharmacy Services and Products requiring Prior Authorization lists.
General Services Requiring Prior Authorization
The following services require prior authorization for elective circumstances; notification is required for urgent/emergent circumstances within 24 hours of admission or provision of the service.
Please note the search tool does not include pharmacy services and products. For pharmacy services and products, please consult the current lists: Pharmacy Services and Products requiring Prior Authorization
These include:
- Inpatient Acute Care Hospitals
- Long-Term Acute Care Hospitals
- Inpatient Behavioral Health and Substance Use
- Inpatient Hospice
- Acute Rehabilitation
- Skilled Nursing Facility
- Home Health/Outpatient Hospice Services
- Air Medical Transport
Search Codes Requiring Prior Authorization
Notice:
This website is intended only to provide information related to which CPT/HCPCs codes require prior authorization. It does not indicate/list codes which may be excluded from coverage or not covered for other reasons. Inclusion on this list indicates, if covered, the code would require prior authorization for coverage. Providers should verify eligibility, benefits and whether prior authorization is required for all members prior to rendering services.
Browse by Category
| AMBULANCE | |
|---|---|
| CODE | DESCRIPTION |
| A0428 | BLS |
| A0430 | FIXED WING AIR TRANSPORT |
| A0431 | ROTARY WING AIR TRANSPORT |
| A0435 | FIXED WING AIR MILEAGE |
| A0436 | ROTARY WING AIR MILEAGE |
| A0999 | UNLISTED AMBULANCE SERVICE |
| S9960 | AMB SERVICE AIR NONEMERGENCY 1 WAY FIXED WING |
| S9961 | AMB SERVICE AIR NONEMERGENCY 1 WAY ROTARY WING |
| ANESTHESIA | |
| CODE | DESCRIPTION |
| 00170 | ANESTH,PROCEDURE ON MOUTH |
| 00402 | ANESTH,SURG BREAST RECONSTRUCTIVE |
| 01999 | UNLISTED ANESTH PROCEDURE |
| DME & MEDICAL SUPPLIES | |
| CODE | DESCRIPTION |
| A4220 | INFUSION PUMP REFILL KIT |
| A4226 | SUPPLIES FOR INSULIN INFUSION PUMP, PER WEEK |
| A4290 | SACRAL NERVE STIM TEST LEAD |
| A4300 | CATH IMPL VASC ACCESS PORTAL |
| A4301 | IMPLANTABLE ACCESS SYST PERC |
| A4335 | INCONTINENCE SUPPLY |
| A4338 | INDWELLING CATHETER LATEX |
| A4340 | INDWELLING CATHETER SPECIAL |
| A4344 | CATH INDW FOLEY 2 WAY SILICN |
| A4349 | DISPOSABLE MALE EXTERNAL CAT |
| A4351 | STRAIGHT TIP URINE CATHETER |
| A4352 | COUDE TIP URINARY CATHETER |
| A4353 | INTERMITTENT URINARY CATH |
| A4354 | CATH INSERTION TRAY W/BAG |
| A4421 | OSTOMY SUPPLY MISC |
| T4537 | REUSABLE UNDERPAD BED SIZE |
| T4540 | REUSABLE UNDERPAD CHAIR SIZE |
| T4541 | LARGE DISPOSABLE UNDERPAD |
| T4542 | SMALL DISPOSABLE UNDERPAD |
| A4555 | ELECTRD /TRANSDUCR E-STIM DVC USED CA TX RPL ONLY |
| A4600 | SLEEVE, INTER LIMB COMP DEV |
| A4641 | RADIOPHARM DX AGENT NOC |
| A4642 | IN111 SATUMOMAB |
| A4913 | MISC DIALYSIS SUPPLIES NOC |
| A5500 | DIAB SHOE FOR DENSITY INSERT |
| A5501 | DIABETIC CUSTOM MOLDED SHOE |
| A5502 | DIABETIC SHOE DENSITY INSERT |
| A5503 | DIABETIC SHOE W/ROLLER/ROCKR |
| A5504 | DIABETIC SHOE WITH WEDGE |
| A5505 | DIAB SHOE W/METATARSAL BAR |
| A5506 | DIABETIC SHOE W/OFF SET HEEL |
| A5507 | MODIFICATION DIABETIC SHOE |
| A5508 | DIABETIC DELUXE SHOE |
| A5510 | COMPRESSION FORM SHOE INSERT |
| A5512 | MULTI DEN INSERT DIRECT FORM |
| A5513 | MULTI DEN INSERT CUSTOM MOLD |
| A5514 | DIABETIC PT MULTIPLE DENSITY INSERT TOTAL CONTACT W/FOOT |
| A6460 | SYNTHETIC RESORBABLE WOUND DRESSING <= 16 SQ IN, EA |
| A6461 | SYNTHETIC RESORBABLE WOUND DRESSING 16-48 SQ IN, EA |
| A6549 | G COMPRESSION STOCKING |
| A6550 | NEG PRES WOUND THER DRSG SET |
| A7001 | NONDISPOSABLE PUMP CANISTER |
| A7002 | TUBING USED W SUCTION PUMP |
| A7003 | NEBULIZER ADMINISTRATION SET |
| A7004 | DISPOSABLE NEBULIZER SML VOL |
| A7007 | LG VOL NEBULIZER DISPOSABLE |
| A7020 | INTERFACE, COUGH STIM DEVICE |
| A7025 | REPLACE CHEST COMPRESS VEST |
| A7026 | REPLACE CHST CMPRSS SYS HOSE |
| A8004 | REPL SOFT INTERFACE, HELMET |
| A9274 | EXT AMB INSULIN DELIVERY SYS |
| A9279 | MONITORING FEATURE/DEVICENOC |
| A9900 | SUPPLY/ACCESSORY/SERVICE |
| A9999 | DME SUPPLY OR ACCESSORY, NOS |
| B4035 | ENTERAL FEED SUPP PUMP PER D |
| B4102 | EF ADULT FLUIDS AND ELECTRO |
| B4103 | EF PED FLUID AND ELECTROLYTE |
| B4149 | EF BLENDERIZED FOODS |
| B4150 | EF COMPLET W/INTACT NUTRIENT |
| B4152 | EF CALORIE DENSE>/=1.5KCAL |
| B4153 | EF HYDROLYZED/AMINO ACIDS |
| B4154 | EF SPEC METABOLIC NONINHERIT |
| B4155 | EF INCOMPLETE/MODULAR |
| B4157 | EF SPECIAL METABOLIC INHERIT |
| B4158 | EF PED COMPLETE INTACT NUT |
| B4159 | EF PED COMPLETE SOY BASED |
| B4160 | EF PED CALORIC DENSE>/=0.7KC |
| B4161 | EF PED HYDROLYZED/AMINO ACID |
| B4162 | EF PED SPECMETABOLIC INHERIT |
| B9002 | ENTERAL INFUSION PUMP W/ ALA |
| B9998 | ENTERAL SUPP NOT OTHERWISE C |
| C1713 | ANCHOR/SCREW BN/BN,TIS/BN |
| C1776 | JOINT DEVICE (IMPLANTABLE) |
| C9063 | INJECTION, EPTINEZUMAB-JJMR, 1 MG |
| C9408 | IODINE I-131 IOBENGUANE, THERAPEUTIC, 1 MILLICURIE |
| E0181 | PRESS PAD ALTERNATING W/ PUM |
| E0182 | REPLACE PUMP, ALT PRESS PAD |
| E0184 | DRY PRESSURE MATTRESS |
| E0185 | GEL PRESSURE MATTRESS PAD |
| E0186 | AIR PRESSURE MATTRESS |
| E0187 | WATER PRESSURE MATTRESS |
| E0188 | SYNTHETIC SHEEPSKIN PAD |
| E0189 | LAMBSWOOL SHEEPSKIN PAD |
| E0190 | POSITIONING CUSHION |
| E0193 | POWERED AIR FLOTATION BED |
| E0194 | AIR FLUIDIZED BED |
| E0196 | GEL PRESSURE MATTRESS |
| E0197 | AIR PRESSURE PAD, MATTRESS |
| E0198 | WATER PRESSURE PAD FOR MATTR |
| E0199 | DRY PRESSURE PAD FOR MATTRES |
| E0202 | PHOTOTHERAPY LIGHT W/ PHOTOM |
| E0250 | HOSP BED FIXED HT W/ MATTRES |
| E0251 | HOSP BED FIXD HT W/O MATTRES |
| E0255 | HOSPITAL BED VAR HT W/ MATTR |
| E0256 | HOSPITAL BED VAR HT W/O MATT |
| E0260 | HOSP BED SEMI-ELECTR W/ MATT |
| E0261 | HOSP BED SEMI-ELECTR W/O MAT |
| E0265 | HOSP BED TOTAL ELECTR W/ MAT |
| E0266 | HOSP BED TOTAL ELEC W/O MATT |
| E0270 | HOSPITAL BED INSTITUTIONAL T |
| E0271 | MATTRESS INNERSPRING |
| E0277 | POWERED PRES-REDU AIR MATTRS |
| E0296 | HOSP BED TOTAL ELECT W/ MATT |
| E0297 | HOSP BED TOTAL ELECT W/O MAT |
| E0300 | ENCLOSED PED CRIB HOSP GRADE |
| E0301 | HD HOSP BED, 350-600 LBS |
| E0302 | EX HD HOSP BED > 600 LBS |
| E0303 | HOSP BED HVY DTY XTRA WIDE |
| E0304 | HOSP BED XTRA HVY DTY X WIDE |
| E0316 | BED SAFETY ENCLOSURE |
| E0371 | NONPOWER MATTRESS OVERLAY |
| E0372 | POWERED AIR MATTRESS OVERLAY |
| E0373 | NONPOWERED PRESSURE MATTRESS |
| E0424 | STATIONARY COMPRESSED GAS 02 |
| E0425 | GAS SYSTEM STATIONARY COMPRE |
| E0430 | OXYGEN SYSTEM GAS PORTABLE |
| E0431 | PORTABLE GASEOUS 02 |
| E0433 | PORTABLE LIQUID OXYGEN SYS |
| E0434 | PORTABLE LIQUID 02 |
| E0435 | OXYGEN SYSTEM LIQUID PORTABLE |
| E0439 | STATIONARY LIQUID 02 |
| E0440 | OXYGEN SYSTEM LIQUID STATION |
| E0441 | STATIONARY O2 CONTENTS, GAS |
| E0442 | STATIONARY O2 CONTENTS, LIQ |
| E0443 | PORTABLE 02 CONTENTS, GAS |
| E0444 | PORTABLE 02 CONTENTS, LIQUID |
| E0447 | PORTABLE OXYGEN, LIQUID, OVER 4 LPM, MONTH |
| E0455 | OXYGEN TENT EXCL CROUP/PED T |
| E0457 | CHEST SHELL |
| E0459 | CHEST WRAP |
| E0462 | ROCKING BED W/ OR W/O SIDE R |
| E0465 | HOME VENTILATOR, ANY TYPE, USED WITH INVASIVE INTERFACE |
| E0466 | HOME VENTILATOR, ANY TYPE, USED WITH NON-INVASIVE INTERFACE |
| E0467 | HOME VENTILATOR MULTI-FUNCTION RESPIRATORY DEVICE |
| E0470 | RAD W/O BACKUP NON-INV INTFC |
| E0471 | RAD W/BACKUP NON INV INTRFC |
| E0472 | RAD W BACKUP INVASIVE INTRFC |
| E0480 | PERCUSSOR ELECT/PNEUM HOME M |
| E0481 | INTRPULMNRY PERCUSS VENT SYS |
| E0482 | COUGH STIMULATING DEVICE |
| E0483 | CHEST COMPRESSION GEN SYSTEM |
| E0484 | NON-ELEC OSCILLATORY PEP DVC |
| E0486 | ORAL DEVICE/APPLIANCE CUSFAB |
| E0500 | IPPB ALL TYPES |
| E0565 | COMPRESSOR AIR POWER SOURCE |
| E0572 | AEROSOL COMPRESSOR ADJUST PR |
| E0574 | ULTRASONIC GENERATOR W SVNEB |
| E0575 | NEBULIZER ULTRASONIC |
| E0580 | NEBULIZER FOR USE W/ REGULAT |
| E0585 | NEBULIZER W/ COMPRESSOR & HE |
| E0600 | SUCTION PUMP PORTAB HOM MODL |
| E0601 | CONT AIRWAY PRESSURE DEVICE |
| E0604 | HOSP GRADE ELEC BREAST PUMP |
| E0610 | PACEMAKER MONITR AUDIBLE/VIS |
| E0615 | PACEMAKER MONITR DIGITAL/VIS |
| E0616 | CARDIAC EVENT RECORDER |
| E0617 | AUTOMATIC EXT DEFIBRILLATOR |
| E0618 | APNEA MONITOR |
| E0619 | APNEA MONITOR W RECORDER |
| E0621 | PATIENT LIFT SLING OR SEAT |
| E0629 | SEAT LIFT FOR PT FURN-NON-EL |
| E0630 | PATIENT LIFT HYDRAULIC |
| E0635 | PATIENT LIFT ELECTRIC |
| E0636 | PT SUPPORT & POSITIONING SYS |
| E0637 | COMBINATION SIT TO STAND SYS |
| E0638 | STANDING FRAME SYS |
| E0639 | MOVEABLE PATIENT LIFT SYSTEM |
| E0640 | FIXED PATIENT LIFT SYSTEM |
| E0641 | MULTI-POSITION STND FRAM SYS |
| E0642 | DYNAMIC STANDING FRAME |
| E0650 | PNEUMA COMPRESOR NON-SEGMENT |
| E0651 | PNEUM COMPRESSOR SEGMENTAL |
| E0652 | PNEUM COMPRES W/CAL PRESSURE |
| E0655 | PNEUMATIC APPLIANCE HALF ARM |
| E0656 | SEGMENTAL PNEUMATIC TRUNK |
| E0657 | SEGMENTAL PNEUMATIC CHEST |
| E0660 | PNEUMATIC APPLIANCE FULL LEG |
| E0665 | PNEUMATIC APPLIANCE FULL ARM |
| E0666 | PNEUMATIC APPLIANCE HALF LEG |
| E0667 | SEG PNEUMATIC APPL FULL LEG |
| E0668 | SEG PNEUMATIC APPL FULL ARM |
| E0669 | SEG PNEUMATIC APPLI HALF LEG |
| E0670 | SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, INTEGRATED, 2 |
| E0671 | PRESSURE PNEUM APPL FULL LEG |
| E0672 | PRESSURE PNEUM APPL FULL ARM |
| E0673 | PRESSURE PNEUM APPL HALF LEG |
| E0675 | PNEUMATIC COMPRESSION DEVICE |
| E0676 | INTER LIMB COMPRESS DEV NOS |
| E0691 | UVL PNL 2 SQ FT OR LESS |
| E0692 | UVL SYS PANEL 4 FT |
| E0693 | UVL SYS PANEL 6 FT |
| E0694 | UVL MD CABINET SYS 6 FT |
| E0730 | TENS, FOUR LEAD |
| E0731 | CONDUCTIVE GARMENT FOR TENS/ |
| E0747 | ELEC OSTEOGEN STIM NOT SPINE |
| E0748 | ELEC OSTEOGEN STIM SPINAL |
| E0749 | ELEC OSTEOGEN STIM IMPLANTED |
| E0760 | OSTEOGEN ULTRASOUND STIMLTOR |
| E0765 | NERVE STIMULATOR FOR TX N&V |
| E0766 | ELEC STIM DVC U CANCER TX INCL ALL ACC ANY TYPE |
| E0776 | IV POLE |
| E0782 | NON-PROGRAMBLE INFUSION PUMP |
| E0783 | PROGRAMMABLE INFUSION PUMP |
| E0784 | EXT AMB INFUSN PUMP INSULIN |
| E0785 | REPLACEMENT IMPL PUMP CATHET |
| E0787 | EXT AMB INF PUMP, INSULIN, W/CONT GLUCOSE SENSING |
| E0830 | AMBULATORY TRACTION DEVICE |
| E0910 | TRAPEZE BAR ATTACHED TO BED |
| E0911 | HD TRAPEZE BAR ATTACH TO BED |
| E0930 | FRACTURE FRAME FREE STANDING |
| E0946 | FRACTURE FRAME DUAL W CROSS |
| E0947 | FRACTURE FRAME ATTACHMNTS PE |
| E0948 | FRACTURE FRAME ATTACHMNTS CE |
| E0951 | LOOP HEEL |
| E0952 | TOE LOOP/HOLDER, EACH |
| E0953 | WHEELCHAIR ACCESSORY; LATERAL THIGH/KNEE SUPPORT, INCL FIXED MOUNTING HARDWARE, EA |
| E0954 | WHEELCHAIR ACCESSORY; FOOT BOX, ATTACHMENT AND MOUNTING HARDWARE, EACH FOOT |
| E0955 | CUSHIONED HEADREST |
| E0956 | W/C LATERAL TRUNK/HIP SUPPOR |
| E0957 | W/C MEDIAL THIGH SUPPORT |
| E0958 | WHLCHR ATT- CONV 1 ARM DRIVE |
| E0959 | AMPUTEE ADAPTER |
| E0960 | W/C SHOULDER HARNESS/STRAPS |
| E0961 | WHEELCHAIR BRAKE EXTENSION |
| E0966 | WHEELCHAIR HEAD REST EXTENSI |
| E0967 | MANUAL WC HAND RIM W PROJECT |
| E0968 | WHEELCHAIR COMMODE SEAT |
| E0969 | WHEELCHAIR NARROWING DEVICE |
| E0970 | WHEELCHAIR NO. 2 FOOTPLATES |
| E0971 | WHEELCHAIR ANTI-TIPPING DEVI |
| E0973 | W/CH ACCESS DET ADJ ARMREST |
| E0974 | W/CH ACCESS ANTI-ROLLBACK |
| E0978 | W/C ACC,SAF BELT PELV STRAP |
| E0980 | WHEELCHAIR SAFETY VEST |
| E0981 | SEAT UPHOLSTERY, REPLACEMENT |
| E0982 | BACK UPHOLSTERY, REPLACEMENT |
| E0983 | ADD PWR JOYSTICK |
| E0984 | ADD PWR TILLER |
| E0985 | W/C SEAT LIFT MECHANISM |
| E0986 | MAN W/C PUSH-RIM POW ASSIST |
| E0988 | MANUAL WHEELCHAIR ACCESSORY, LEVER-ACTIVATED, WHEEL DRIVE, PAIR |
| E0990 | WHEELCHAIR ELEVATING LEG RES |
| E0992 | WHEELCHAIR SOLID SEAT INSERT |
| E0994 | WHEELCHAIR ARM REST |
| E0995 | WHEELCHAIR CALF REST |
| E1002 | PWR SEAT TILT |
| E1003 | PWR SEAT RECLINE |
| E1004 | PWR SEAT RECLINE MECH |
| E1005 | PWR SEAT RECLINE PWR |
| E1006 | PWR SEAT COMBO W/O SHEAR |
| E1007 | PWR SEAT COMBO W/SHEAR |
| E1008 | PWR SEAT COMBO PWR SHEAR |
| E1009 | ADD MECH LEG ELEVATION |
| E1010 | ADD PWR LEG ELEVATION |
| E1011 | PED WC MODIFY WIDTH ADJUSTM |
| E1012 | WHEELCHAIR ACCESSORY, ADDITION TO POWER SEATING SYSTEM, CENTER MOUNT ELEVATING LEG REST/PLATFORM |
| E1014 | RECLINING BACK ADD PED W/C |
| E1015 | SHOCK ABSORBER FOR MAN W/C |
| E1016 | SHOCK ABSORBER FOR POWER W/C |
| E1017 | HD SHCK ABSRBR FOR HD MAN WC |
| E1018 | HD SHCK ABSRBER FOR HD POWWC |
| E1020 | RESIDUAL LIMB SUPPORT SYSTEM |
| E1028 | W/C MANUAL SWINGAWAY |
| E1029 | W/C VENT TRAY FIXED |
| E1030 | W/C VENT TRAY GIMBALED |
| E1035 | PATIENT TRANSFER SYSTEM <300 |
| E1036 | PATIENT TRANSFER SYSTEM >300 |
| E1037 | TRANSPORT CHAIR, PED SIZE |
| E1038 | TRANSPORT CHAIR PT WT<=300LB |
| E1039 | TRANSPORT CHAIR PT WT >300LB |
| E1050 | WHELCHR FXD FULL LENGTH ARMS |
| E1060 | WHEELCHAIR DETACHABLE ARMS |
| E1070 | WHEELCHAIR DETACHABLE FOOT R |
| E1083 | HEMI-WHEELCHAIR FIXED ARMS |
| E1084 | HEMI-WHEELCHAIR DETACHABLE A |
| E1085 | HEMI-WHEELCHAIR FIXED ARMS |
| E1086 | HEMI-WHEELCHAIR DETACHABLE A |
| E1087 | WHEELCHAIR LIGHTWT FIXED ARM |
| E1088 | WHEELCHAIR LIGHTWEIGHT DET A |
| E1089 | WHEELCHAIR LIGHTWT FIXED ARM |
| E1090 | WHEELCHAIR LIGHTWEIGHT DET A |
| E1092 | WHEELCHAIR WIDE W/ LEG RESTS |
| E1093 | WHEELCHAIR WIDE W/ FOOT REST |
| E1100 | WHCHR S-RECL FXD ARM LEG RES |
| E1110 | WHEELCHAIR SEMI-RECL DETACH |
| E1130 | WHLCHR STAND FXD ARM FT REST |
| E1140 | WHEELCHAIR STANDARD DETACH A |
| E1150 | WHEELCHAIR STANDARD W/ LEG R |
| E1160 | WHEELCHAIR FIXED ARMS |
| E1161 | MANUAL ADULT WC W TILTINSPAC |
| E1170 | WHLCHR AMPU FXD ARM LEG REST |
| E1171 | WHEELCHAIR AMPUTEE W/O LEG R |
| E1172 | WHEELCHAIR AMPUTEE DETACH AR |
| E1180 | WHEELCHAIR AMPUTEE W/ FOOT R |
| E1190 | WHEELCHAIR AMPUTEE W/ LEG RE |
| E1195 | WHEELCHAIR AMPUTEE HEAVY DUT |
| E1200 | WHEELCHAIR AMPUTEE FIXED ARM |
| E1220 | WHLCHR SPECIAL SIZE/CONSTRC |
| E1221 | WHEELCHAIR SPEC SIZE W FOOT |
| E1222 | WHEELCHAIR SPEC SIZE W/ LEG |
| E1223 | WHEELCHAIR SPEC SIZE W FOOT |
| E1224 | WHEELCHAIR SPEC SIZE W/ LEG |
| E1225 | MANUAL SEMI-RECLINING BACK |
| E1226 | MANUAL FULLY RECLINING BACK |
| E1227 | WHEELCHAIR SPEC SZ SPEC HT A |
| E1228 | WHEELCHAIR SPEC SZ SPEC HT B |
| E1229 | PEDIATRIC WHEELCHAIR NOS |
| E1230 | POWER OPERATED VEHICLE |
| E1231 | RIGID PED W/C TILT-IN-SPACE |
| E1232 | FOLDING PED WC TILT-IN-SPACE |
| E1233 | RIG PED WC TLTNSPC W/O SEAT |
| E1234 | FLD PED WC TLTNSPC W/O SEAT |
| E1235 | RIGID PED WC ADJUSTABLE |
| E1236 | FOLDING PED WC ADJUSTABLE |
| E1237 | RGD PED WC ADJSTABL W/O SEAT |
| E1238 | FLD PED WC ADJSTABL W/O SEAT |
| E1239 | PED POWER WHEELCHAIR NOS |
| E1240 | WHCHR LITWT DET ARM LEG REST |
| E1250 | WHEELCHAIR LIGHTWT FIXED ARM |
| E1260 | WHEELCHAIR LIGHTWT FOOT REST |
| E1270 | WHEELCHAIR LIGHTWEIGHT LEG R |
| E1280 | WHCHR H-DUTY DET ARM LEG RES |
| E1285 | WHEELCHAIR HEAVY DUTY FIXED |
| E1290 | WHEELCHAIR HVY DUTY DETACH A |
| E1295 | WHEELCHAIR HEAVY DUTY FIXED |
| E1296 | WHEELCHAIR SPECIAL SEAT HEIG |
| E1297 | WHEELCHAIR SPECIAL SEAT DEPT |
| E1298 | WHEELCHAIR SPEC SEAT DEPTH/W |
| E1352 | OXYGEN ACC FLOW REG CPBL POS INSPIRATORY PRESS |
| E1390 | OXYGEN CONCENTRATOR |
| E1391 | OXYGEN CONCENTRATOR, DUAL |
| E1392 | PORTABLE OXYGEN CONCENTRATOR |
| E1399 | DURABLE MEDICAL EQUIPMENT MI |
| E1405 | O2/WATER VAPOR ENRICH W/HEAT |
| E1406 | O2/WATER VAPOR ENRICH W/O HE |
| E1510 | KIDNEY DIALYSATE DELIVRY SYS |
| E1520 | HEPARIN INFUSION PUMP |
| E1530 | REPLACEMENT AIR BUBBLE DETEC |
| E1540 | REPLACEMENT PRESSURE ALARM |
| E1550 | BATH CONDUCTIVITY METER |
| E1560 | REPLACE BLOOD LEAK DETECTOR |
| E1570 | ADJUSTABLE CHAIR FOR ESRD PT |
| E1575 | TRANSDUCER PROTECT/FLD BAR |
| E1580 | UNIPUNCTURE CONTROL SYSTEM |
| E1590 | HEMODIALYSIS MACHINE |
| E1592 | AUTO INTERM PERITONEAL DIALY |
| E1594 | CYCLER DIALYSIS MACHINE |
| E1600 | DELI/INSTALL CHRG HEMO EQUIP |
| E1610 | REVERSE OSMOSIS H2O PURI SYS |
| E1620 | REPLACEMENT BLOOD PUMP |
| E1630 | RECIPROCATING PERITONEAL DIA |
| E1634 | PERITONEAL DIALYSIS CLAMP |
| E1635 | COMPACT TRAVEL HEMODIALYZER |
| E1636 | SORBENT CARTRIDGES PER 10 |
| E1637 | HEMOSTATS FOR DIALYSIS, EACH |
| E1699 | DIALYSIS EQUIPMENT NOC |
| E1800 | ADJUST ELBOW EXT/FLEX DEVICE |
| E1801 | SPS ELBOW DEVICE |
| E1802 | ADJST FOREARM PRO/SUP DEVICE |
| E1805 | ADJUST WRIST EXT/FLEX DEVICE |
| E1806 | SPS WRIST DEVICE |
| E1810 | ADJUST KNEE EXT/FLEX DEVICE |
| E1812 | KNEE EXT/FLEX W ACT RES CTRL |
| E1815 | ADJUST ANKLE EXT/FLEX DEVICE |
| E1816 | SPS ANKLE DEVICE |
| E1818 | SPS FOREARM DEVICE |
| E1820 | SOFT INTERFACE MATERIAL |
| E1821 | REPLACEMENT INTERFACE SPSD |
| E1825 | ADJUST FINGER EXT/FLEX DEVC |
| E1831 | STATIC STR TOE DEV EXT/FLEX |
| E1840 | ADJ SHOULDER EXT/FLEX DEVICE |
| E1841 | STATIC STR SHLDR DEV ROM ADJ |
| E2000 | GASTRIC SUCTION PUMP HME MDL |
| E2201 | MAN W/CH ACC SEAT W>=20"<24" |
| E2202 | SEAT WIDTH 24-27 IN |
| E2203 | FRAME DEPTH LESS THAN 22 IN |
| E2204 | FRAME DEPTH 22 TO 25 IN |
| E2205 | MANUAL WC ACCESSORY, HANDRIM |
| E2206 | COMPLETE WHEEL LOCK ASSEMBLY |
| E2207 | CRUTCH AND CANE HOLDER |
| E2208 | CYLINDER TANK CARRIER |
| E2209 | ARM TROUGH EACH |
| E2210 | WHEELCHAIR BEARINGS |
| E2211 | PNEUMATIC PROPULSION TIRE |
| E2212 | PNEUMATIC PROP TIRE TUBE |
| E2213 | PNEUMATIC PROP TIRE INSERT |
| E2214 | PNEUMATIC CASTER TIRE EACH |
| E2215 | PNEUMATIC CASTER TIRE TUBE |
| E2216 | FOAM FILLED PROPULSION TIRE |
| E2217 | FOAM FILLED CASTER TIRE EACH |
| E2218 | FOAM PROPULSION TIRE EACH |
| E2219 | FOAM CASTER TIRE ANY SIZE EA |
| E2222 | SOLID CASTER INTEGRATED WHL |
| E2227 | GEAR REDUCTION DRIVE WHEEL |
| E2228 | MWC ACC, WHEELCHAIR BRAKE |
| E2230 | MANUAL STANDING SYSTEM |
| E2231 | SOLID SEAT SUPPORT BASE |
| E2291 | PLANAR BACK FOR PED SIZE WC |
| E2292 | PLANAR SEAT FOR PED SIZE WC |
| E2294 | CONTOUR SEAT FOR PED SIZE WC |
| E2295 | PED DYNAMIC SEATING FRAME |
| E2300 | PWR SEAT ELEVATION SYS |
| E2301 | PWR STANDING |
| E2310 | ELECTRO CONNECT BTW CONTROL |
| E2311 | ELECTRO CONNECT BTW 2 SYS |
| E2312 | MINI-PROP REMOTE JOYSTICK |
| E2313 | PWC HARNESS, EXPAND CONTROL |
| E2321 | HAND INTERFACE JOYSTICK |
| E2322 | MULT MECH SWITCHES |
| E2323 | SPECIAL JOYSTICK HANDLE |
| E2324 | CHIN CUP INTERFACE |
| E2325 | SIP AND PUFF INTERFACE |
| E2326 | BREATH TUBE KIT |
| E2328 | HEAD/EXTREMITY CONTROL INTER |
| E2330 | HEAD CONTROL PROXIMITY SWITC |
| E2340 | W/C WDTH 20-23 IN SEAT FRAME |
| E2341 | W/C WDTH 24-27 IN SEAT FRAME |
| E2342 | W/C DPTH 20-21 IN SEAT FRAME |
| E2343 | W/C DPTH 22-25 IN SEAT FRAME |
| E2366 | BATTERY CHARGER, SINGLE MODE |
| E2370 | PWR WC MOTOR/GEAR BOX COMBO |
| E2373 | HAND/CHIN CTRL SPEC JOYSTICK |
| E2374 | HAND/CHIN CTRL STD JOYSTICK |
| E2375 | NON-EXPANDABLE CONTROLLER |
| E2376 | EXPANDABLE CONTROLLER, REPL |
| E2377 | EXPANDABLE CONTROLLER, INITL |
| E2381 | PNEUMATIC DRIVE WHEEL TIRE |
| E2382 | TUBE, PNEUMATIC DRIVE WHEEL TIRE |
| E2383 | INSERT, PNEUMATIC DRIVE WHEEL |
| E2384 | PNEUMATIC CASTER TIRE |
| E2385 | TUBE, PNEUMATIC CASTER TIRE |
| E2386 | FOAM FILLED DRIVE WHEEL TIRE |
| E2387 | FOAM FILLED CASTER TIRE |
| E2389 | FOAM CASTER TIRE |
| E2390 | SOLID DRIVE WHEEL TIRE |
| E2391 | SOLID CASTER TIRE |
| E2394 | DRIVE WHEEL EXCLUDES TIRE |
| E2402 | NEG PRESS WOUND THERAPY PUMP |
| E2601 | GEN W/C CUSHION WDTH < 22 IN |
| E2602 | GEN W/C CUSHION WDTH >=22 IN |
| E2603 | SKIN PROTECT WC CUS WD <22IN |
| E2604 | SKIN PROTECT WC CUS WD>=22IN |
| E2605 | POSITION WC CUSH WDTH <22 IN |
| E2606 | POSITION WC CUSH WDTH>=22 IN |
| E2607 | SKIN PRO/POS WC CUS WD <22IN |
| E2608 | SKIN PRO/POS WC CUS WD>=22IN |
| E2609 | CUSTOM FABRICATE W/C CUSHION |
| E2610 | POWERED W/C CUSHION |
| E2611 | GEN USE BACK CUSH WDTH <22IN |
| E2612 | GEN USE BACK CUSH WDTH>=22IN |
| E2613 | POSITION BACK CUSH WD <22IN |
| E2614 | POSITION BACK CUSH WD>=22IN |
| E2615 | POS BACK POST/LAT WDTH <22IN |
| E2616 | POS BACK POST/LAT WDTH>=22IN |
| E2617 | CUSTOM FAB W/C BACK CUSHION |
| E2619 | REPLACE COVER W/C SEAT CUSH |
| E2620 | WC PLANAR BACK CUSH WD <22IN |
| E2621 | WC PLANAR BACK CUSH WD>=22IN |
| E2622 | ADJ SKIN PRO W/C CUS WD<22IN |
| E2623 | ADJ SKIN PRO WC CUS WD>=22IN |
| E2624 | ADJ SKIN PRO/POS CUS<22IN |
| E2625 | ADJ SKIN PRO/POS WC CUS>=22 |
| E2626 | WHEELCHAIR ACCESSORY, SHOULDER ELBOW, MOBILE ARM SUPPORT ATTACHED TO |
| E2627 | WHEELCHAIR ACCESSORY, SHOULDER ELBOW, MOBILE ARM SUPPORT ATTACHED TO |
| E2628 | WHEELCHAIR ACCESSORY, SHOULDER ELBOW, MOBILE ARM SUPPORT ATTACHED TO |
| E2629 | WHEELCHAIR ACCESSORY, SHOULDER ELBOW, MOBILE ARM SUPPORT ATTACHED TO |
| E2630 | WHEELCHAIR ACCESSORY, SHOULDER ELBOW, MOBILE ARM SUPPORT, MONOSUSPENSION ARM |
| E2631 | WHEELCHAIR ACCESSORY, ADDITION TO MOBILE ARM SUPPORT, ELEVATING PROXIMAL ARM |
| E2632 | WHEELCHAIR ACCESSORY, ADDITION TO MOBILE ARM SUPPORT, OFFSET OR LATERAL ROCKER |
| E2633 | WHEELCHAIR ACCESSORY, ADDITION TO MOBILE ARM SUPPORT, SUPINATOR |
| E8000 | POSTERIOR GAIT TRAINER |
| E8001 | UPRIGHT GAIT TRAINER |
| E8002 | ANTERIOR GAIT TRAINER |
| K0001 | STANDARD WHEELCHAIR |
| K0002 | STND HEMI (LOW SEAT) WHLCHR |
| K0003 | LIGHTWEIGHT WHEELCHAIR |
| K0004 | HIGH STRENGTH LTWT WHLCHR |
| K0005 | ULTRALIGHTWEIGHT WHEELCHAIR |
| K0006 | HEAVY-DUTY WHEELCHAIR |
| K0007 | EXTRA HEAVY-DUTY WHEELCHAIR |
| K0008 | CUSTOM MANUAL WHEELCHAIR/BASE |
| K0009 | OTHER MANUAL WHEELCHAIR/BASE |
| K0010 | STND WT FRAME POWER WHLCHR |
| K0011 | STND WT PWR WHLCHR W CONTROL |
| K0012 | LTWT PORTBL POWER WHLCHR |
| K0013 | CUSTOM MOTORIZED/POWER WHEELCHAIR BASE |
| K0014 | OTHER POWER WHLCHR BASE |
| K0015 | DETACH NON-ADJUS HGHT ARMRST |
| K0017 | DETACH ADJUST ARMREST BASE |
| K0018 | DETACH ADJUST ARMRST UPPER |
| K0019 | ARM PAD EACH |
| K0020 | FIXED ADJUST ARMREST PAIR |
| K0037 | HIGH MOUNT FLIP-UP FOOTREST |
| K0038 | LEG STRAP EACH |
| K0039 | LEG STRAP H STYLE EACH |
| K0040 | ADJUSTABLE ANGLE FOOTPLATE |
| K0041 | LARGE SIZE FOOTPLATE EACH |
| K0042 | STANDARD SIZE FOOTPLATE EACH |
| K0043 | FTRST LOWER EXTENSION TUBE |
| K0044 | FTRST UPPER HANGER BRACKET |
| K0045 | FOOTREST,COMPLETE ASSEMBLY |
| K0046 | ELEVAT LEGRST LOW EXTENSION |
| K0047 | ELEVAT LEGRST UP HANGR BRACK |
| K0050 | RATCHET ASSEMBLY |
| K0051 | CAM RELEASE ASSEM FTRST/LGRST |
| K0052 | SWINGAWAY DETACH FOOTREST |
| K0053 | ELEVATE FOOTREST ARTICULATE |
| K0056 | SEAT HT <17 OR >=21 LTWT WC |
| K0065 | SPOKE PROTECTORS |
| K0069 | REAR WHL COMPLETE SOLID TIRE |
| K0070 | REAR WHL COMPL PNEUM TIRE |
| K0071 | FRONT CASTR COMPL PNEUM TIRE |
| K0072 | FRNT CSTR CMPL SEM-PNEUM TIR |
| K0073 | CASTER PIN LOCK EACH |
| K0077 | FRONT CASTER ASSEM COMPLETE |
| K0098 | DRIVE BELT POWER WHEELCHAIR |
| K0105 | IV HANGER |
| K0108 | W/C COMPONENT-ACCESSORY NOS |
| K0195 | ELEVATING WHLCHAIR LEG RESTS |
| K0462 | TEMPORARY REPLACEMENT EQPMNT |
| K0601 | REPL BATT SILVER OXIDE 1.5 V |
| K0602 | REPL BATT SILVER OXIDE 3 V |
| K0603 | REPL BATT ALKALINE 1.5 V |
| K0604 | REPL BATT LITHIUM 3.6 V |
| K0605 | REPL BATT LITHIUM 4.5 V |
| K0606 | AED GARMENT W ELEC ANALYSIS |
| K0607 | REPL BATT FOR AED |
| K0669 | SEAT/BACK CUS NO SADMERC VER |
| K0730 | CTRL DOSE INH DRUG DELIV SYS |
| K0733 | 12-24HR SEALED LEAD ACID |
| K0738 | PORTABLE GAS OXYGEN SYSTEM |
| K0739 | REPAIR/SVC DME NON-OXYGEN EQ |
| K0740 | REPAIR/SVC OXYGEN EQUIPMENT |
| K0743 | SUCTION PUMP, HOME MODEL, PORTABLE, FOR USE ON WOUNDS |
| K0744 | ABSORP WND DRSG FOR USE WITH SUCTION PUMP, PORT, PAD SIZE <= 16 SQ IN |
| K0745 | ABSORP WND DRSG FOR USE WITH SUCTION PUMP, PORT, PAD SIZE 16-48 SQ IN |
| K0746 | ABSORP WND DRSG FOR USE WITH SUCTION PUMP, PORT, PAD SIZE >48 SQ IN |
| K0800 | POV GROUP 1 STD UP TO 300LBS |
| K0801 | POV GROUP 1 HD 301-450 LBS |
| K0802 | POV GROUP 1 VHD 451-600 LBS |
| K0806 | POV GROUP 2 STD UP TO 300LBS |
| K0807 | POV GROUP 2 HD 301-450 LBS |
| K0808 | POV GROUP 2 VHD 451-600 LBS |
| K0812 | POWER OPERATED VEHICLE NOC |
| K0813 | PWC GP 1 STD PORT SEAT/BACK |
| K0814 | PWC GP 1 STD PORT CAP CHAIR |
| K0815 | PWC GP 1 STD SEAT/BACK |
| K0816 | PWC GP 1 STD CAP CHAIR |
| K0820 | PWC GP 2 STD PORT SEAT/BACK |
| K0821 | PWC GP 2 STD PORT CAP CHAIR |
| K0822 | PWC GP 2 STD SEAT/BACK |
| K0823 | PWC GP 2 STD CAP CHAIR |
| K0824 | PWC GP 2 HD SEAT/BACK |
| K0825 | PWC GP 2 HD CAP CHAIR |
| K0826 | PWC GP 2 VHD SEAT/BACK |
| K0827 | PWC GP VHD CAP CHAIR |
| K0828 | PWC GP 2 XTRA HD SEAT/BACK |
| K0829 | PWC GP 2 XTRA HD CAP CHAIR |
| K0830 | PWC GP2 STD SEAT ELEVATE S/B |
| K0831 | PWC GP2 STD SEAT ELEVATE CAP |
| K0835 | PWC GP2 STD SING POW OPT S/B |
| K0836 | PWC GP2 STD SING POW OPT CAP |
| K0837 | PWC GP 2 HD SING POW OPT S/B |
| K0838 | PWC GP 2 HD SING POW OPT CAP |
| K0839 | PWC GP2 VHD SING POW OPT S/B |
| K0840 | PWC GP2 XHD SING POW OPT S/B |
| K0841 | PWC GP2 STD MULT POW OPT S/B |
| K0842 | PWC GP2 STD MULT POW OPT CAP |
| K0843 | PWC GP2 HD MULT POW OPT S/B |
| K0848 | PWC GP 3 STD SEAT/BACK |
| K0849 | PWC GP 3 STD CAP CHAIR |
| K0850 | PWC GP 3 HD SEAT/BACK |
| K0851 | PWC GP 3 HD CAP CHAIR |
| K0852 | PWC GP 3 VHD SEAT/BACK |
| K0853 | PWC GP 3 VHD CAP CHAIR |
| K0854 | PWC GP 3 XHD SEAT/BACK |
| K0855 | PWC GP 3 XHD CAP CHAIR |
| K0856 | PWC GP3 STD SING POW OPT S/B |
| K0857 | PWC GP3 STD SING POW OPT CAP |
| K0858 | PWC GP3 HD SING POW OPT S/B |
| K0859 | PWC GP3 HD SING POW OPT CAP |
| K0860 | PWC GP3 VHD SING POW OPT S/B |
| K0861 | PWC GP3 STD MULT POW OPT S/B |
| K0862 | PWC GP3 HD MULT POW OPT S/B |
| K0863 | PWC GP3 VHD MULT POW OPT S/B |
| K0864 | PWC GP3 XHD MULT POW OPT S/B |
| K0868 | PWC GP 4 STD SEAT/BACK |
| K0869 | PWC GP 4 STD CAP CHAIR |
| K0870 | PWC GP 4 HD SEAT/BACK |
| K0871 | PWC GP 4 VHD SEAT/BACK |
| K0877 | PWC GP4 STD SING POW OPT S/B |
| K0878 | PWC GP4 STD SING POW OPT CAP |
| K0879 | PWC GP4 HD SING POW OPT S/B |
| K0880 | PWC GP4 VHD SING POW OPT S/B |
| K0884 | PWC GP4 STD MULT POW OPT S/B |
| K0885 | PWC GP4 STD MULT POW OPT CAP |
| K0886 | PWC GP4 HD MULT POW S/B |
| K0890 | PWC GP5 PED SING POW OPT S/B |
| K0891 | PWC GP5 PED MULT POW OPT S/B |
| K0898 | POWER WHEELCHAIR NOC |
| K0899 | POW MOBIL DEV NO SADMERC |
| K0900 | CUSTOMIZED DME OTHER THAN WHEELCHAIR |
| K1007 | BILATERAL HIP, KNEE, ANKLE, FOOT DEVICE, POWERED |
| K1009 | SPEECH VOLUME MODULATION SYSTEM, ANY TYPE |
| K1014 | ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, 4 BAR LINKAGE/MULTIAXIAL, FLUID SWING AND STANCE PHASE CONTROL |
| K1015 | FOOT, ADDUCTUS POSITION DEVICE, ADJUSTABLE |
| K1027 | Oral device/appliance used to reduce upper airway collapsibility, without fixed mechanical hinge, custom fabricated, includes fitting and adjustment |
| L0112 | CRANIAL CERVICAL ORTHOSIS |
| L0113 | CRANIAL CERVICAL TORTICOLLIS |
| L0120 | CERV FLEXIBLE NON-ADJUSTABLE |
| L0984 | PROTECTIVE BODY SOCK EACH |
| L0999 | Addition to spinal orthosis, not otherwise specified |
| L1300 | BODY JACKET MOLD TO PATIENT |
| K1030 | EXTERNAL RECHARGING SYS BATTERY FOR IMPLANTED CARDIAC CONTRACTILITY MOD GEN, REPL ONLY |
| K1031 | NON-PNEUMATIC COMPRESSION CONTROLLER W/O CALIBRATED GRADIENT PRESSURE |
| K1032 | NON-PNEUMATIC SEQUENTIAL COMPRESSION GARMENT, FULL LEG |
| K1033 | NON-PNEUMATIC SEQUENTIAL COMPRESSION GARMENT, HALF LEG |
| L1310 | POST-OPERATIVE BODY JACKET |
| L1499 | SPINAL ORTHOSIS,NOS |
| L1810 | KO ELASTIC WITH JOINTS |
| L1832 | KO ADJ JNT POS RIGID SUPPORT |
| L1840 | KO DEROT ANT CRUCIATE CUSTOM |
| L1843 | KO SINGLE UPRIGHT CUSTOM FIT |
| L1844 | KO W/ADJ JT ROT CNTRL MOLDED |
| L1847 | KO ADJUSTABLE W AIR CHAMBERS |
| L1848 | KNEE ORTHOSIS ADJUSTABLE JOINT AIR SUPP PREFAB |
| L1850 | KO SWEDISH TYPE |
| L1852 | KNEE ORTHOSIS, DOUBLE UPRIGHT, MEDIAL-LATERAL AND ROTATION CONTROL, PREFABRICATED, OFF-THE-SHELF |
| L1860 | KO SUPRACONDYLAR SOCKET MOLD |
| L2360 | EXTENDED STEEL SHANK |
| L2570 | HIP CLEVIS TYPE 2 POSIT JNT |
| L2600 | HIP CLEVIS/THRUST BEARING FR |
| L2610 | HIP CLEVIS/THRUST BEARING LO |
| L2620 | PELVIC CONTROL HIP HEAVY DUT |
| L2622 | HIP JOINT ADJUSTABLE FLEXION |
| L2624 | HIP ADJ FLEX EXT ABDUCT CONT |
| L2627 | PLASTIC MOLD RECIPRO HIP & C |
| L2628 | METAL FRAME RECIPRO HIP & CA |
| L2630 | PELVIC CONTROL BAND & BELT U |
| L2640 | PELVIC CONTROL BAND & BELT B |
| L2650 | PELV & THOR CONTROL GLUTEAL |
| L2660 | THORACIC CONTROL THORACIC BA |
| L2670 | THORAC CONT PARASPINAL UPRIG |
| L2680 | THORAC CONT LAT SUPPORT UPRI |
| L2795 | KNEE CONTROL FULL KNEECAP |
| L2999 | LOWER EXTREMITY ORTHOSIS NOS |
| L3000 | FT INSERT UCB BERKELEY SHELL |
| L3010 | FOOT LONGITUDINAL ARCH SUPPO |
| L3020 | FOOT LONGITUD/METATARSAL SUP |
| L3031 | FOOT LAMIN/PREPREG COMPOSITE |
| L3040 | FT ARCH SUPRT PREMOLD LONGIT |
| L3060 | FOOT ARCH SUPP LONGITUD/META |
| L3201 | OXFORD W SUPINAT/PRONAT INF |
| L3202 | OXFORD W/ SUPINAT/PRONATOR C |
| L3203 | OXFORD W/ SUPINATOR/PRONATOR |
| L3204 | HIGHTOP W/ SUPP/PRONATOR INF |
| L3206 | HIGHTOP W/ SUPP/PRONATOR CHI |
| L3207 | HIGHTOP W/ SUPP/PRONATOR JUN |
| L3224 | WOMAN SHOE OXFORD BRACE |
| L3225 | MAN SHOE OXFORD BRACE |
| L3253 | SHOE MOLDED PLASTAZOTE CUST |
| L3265 | PLASTAZOTE SANDAL EACH |
| L3332 | SHOE LIFTS TAPERED TO ONE-HA |
| L3334 | SHOE LIFTS ELEVATION HEEL /I |
| L3480 | SHOE HEEL PAD & DEPRESS FOR |
| L3967 | SEWHO AIRPLANE W/O JNTS CF |
| L3971 | SEWHO CAP DESIGN W/JNT(S) CF |
| L3999 | UPPER LIMB ORTHOSIS NOS |
| L4000 | REPL GIRDLE MILWAUKEE ORTH |
| L4002 | REPLACE STRAP, ANY ORTHOSIS |
| L4010 | REPLACE TRILATERAL SOCKET BR |
| L4020 | REPLACE QUADLAT SOCKET BRIM |
| L4030 | REPLACE SOCKET BRIM CUST FIT |
| L4040 | REPLACE MOLDED THIGH LACER |
| L4045 | REPLACE NON-MOLDED THIGH LAC |
| L4050 | REPLACE MOLDED CALF LACER |
| L4055 | REPLACE NON-MOLDED CALF LACE |
| L4060 | REPLACE HIGH ROLL CUFF |
| L4070 | REPLACE PROX & DIST UPRIGHT |
| L4080 | REPL MET BAND KAFO-AFO PROX |
| L4090 | REPL MET BAND KAFO-AFO CALF/ |
| L4100 | REPL LEATH CUFF KAFO PROX TH |
| L4110 | REPL LEATH CUFF KAFO-AFO CAL |
| L4130 | REPLACE PRETIBIAL SHELL |
| L4205 | ORTHO DVC REPAIR PER 15 MIN |
| L4210 | ORTH DEV REPAIR/REPL MINOR P |
| L4394 | REPLACE FOOT DROP SPINT |
| L4631 | AFO, WALK BOOT TYPE, CUS FAB |
| Q4050 | CAST SUPPLIES UNLISTED |
| Q4051 | SPLINT SUPPLIES, MISC |
| S1034 | ARTIF PANCREAS DEVC SYS THAT CMNCT W/ALL DEVC |
| S1035 | SENSOR; INVASV DSPBL USE ARTIF PANCREAS DEVC SYS |
| S8189 | TRACH SUPPLY NOC |
| S9435 | MEDICAL FOODS FOR INBORN ERR |
| T4521 | ADULT SIZE BRIEF/DIAPER SM |
| T4522 | ADULT SIZE BRIEF/DIAPER MED |
| T4523 | ADULT SIZE BRIEF/DIAPER LG |
| T4524 | ADULT SIZE BRIEF/DIAPER XL |
| T4525 | ADULT SIZE PULL-ON SM |
| T4526 | ADULT SIZE PULL-ON MED |
| T4527 | ADULT SIZE PULL-ON LG |
| T4528 | ADULT SIZE PULL-ON XL |
| T4529 | PED SIZE BRIEF/DIAPER SM/MED |
| T4530 | PED SIZE BRIEF/DIAPER LG |
| T4531 | PED SIZE PULL-ON SM/MED |
| T4532 | PED SIZE PULL-ON LG |
| T4533 | YOUTH SIZE BRIEF/DIAPER |
| T4534 | YOUTH SIZE PULL-ON |
| T4535 | DISPOSABLE LINER/SHIELD/PAD |
| T4543 | DISP BARIATRIC BRIEF/DIAPER |
| T4544 | ADULT SIZE DISPBL INCONT PULLUP ABVE EXTRA LG EA |
| V2199 | LENS SINGLE VISION NOT OTH C |
| V2797 | VIS ITEM/SVC IN OTHER CODE |
| A4596 | CRANIAL ELECTROTHERAPY STIMULATION (CES) SYSTEM SUPPLIES AND ACCESSORIES, PER MONTH |
| E0183 | POWERED PRESSURE REDUCING UNDERLAY/PAD, ALTERNATING, WITH PUMP, INCLUDES HEAVY DUTY |
| E2500 | Speech generating device, digitized speech, using prerecorded messages, less than or equal to eight minutes recording time |
| E2502 | Speech generating device, digitized speech, using prerecorded messages, greater than eight minutes but less than or equal to 20 minutes recording time |
| E2504 | Speech generating device, digitized speech, using prerecorded messages, greater than 20 minutes but less than or equal to 40 minutes recording time |
| E2506 | Speech generating device, digitized speech, using prerecorded messages, greater than 40 minutes recording time |
| E2508 | Speech generating device, synthesized speech, requiring message formulation by spelling and access by physical contact with the device |
| E2510 | Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access |
| E2511 | Speech generating software program, for personal computer or personal digital assistant |
| E2512 | Accessory for speech generating device, mounting system |
| E2599 | Accessory for speech generating device, not otherwise classified |
| V5030 | HEARING AID, MONAURAL, BODY WORN, AIR CONDUCTION |
| V5040 | HEARING AID, MONAURAL, BODY WORN, BONE CONDUCTION |
| V5050 | HEARING AID, MONAURAL, IN THE EAR |
| V5060 | HEARING AID, MONAURAL, BEHIND THE EAR |
| V5130 | BINAURAL, IN THE EAR |
| V5140 | BINAURAL, BEHIND THE EAR |
| V5336 | Repair/modification of augmentative communicative system or device (excludes adaptive hearing aid) |
| HOME HEALTH RELATED | |
| CODE | DESCRIPTION |
| 99377 | HOSPICE CARE SUPERVISION,15-29 MIN |
| 99378 | HOSPICE CARE SUPERVISION,30+ MIN |
| 99379 | NURSING FAC CARE SUPERVN,15-29 MIN |
| 99380 | NURSING FAC CARE SUPERVN,30+ MIN |
| 99500 | HOME VISIT, PRENATAL ASSESS |
| 99501 | HOME VISIT,POSTNATAL ASSESSMENT |
| 99502 | HOME VISIT,NEWBORN CARE,ASSESSMENT |
| 99504 | HOME VISIT,MECHANICAL VENTILATION CARE |
| 99505 | HOME VISIT,STOMA CARE |
| 99506 | HOME VISIT,IM INJECTIONS |
| 99507 | HOME VISIT,CATHETER CARE |
| 99507 | HOME VISIT,CATHETER CARE |
| 99509 | HOME VISIT,ADL ASSISTANCE |
| 99511 | HOME VISIT,FECAL IMP MGMT/ENEMA ADMIN |
| 99512 | HOME VISIT,HEMODIALYSIS |
| 99600 | UNLISTED HOME VISIT SERVICE/PROCEDURE |
| G0068 | ADMINISTRATION OF INFUSION DRUG(S) IN HOME, PER DAY, EA 15 MIN |
| G0069 | ADMINISTRATION OF IMMUNOTHERAPY DRUG(S) IN HOME, PER DAY, EA 15 MIN |
| G0070 | ADMINISTRATION OF CHEMOTHERAPY DRUG(S) IN HOME, PER DAY, EA 15 MIN |
| G0182 | HOSPICE CARE SUPERVISION |
| G0337 | HOSPICE EVALUATION PREELECTI |
| G0490 | FACE-TO-FACE HOME HEALTH NURSING VISIT BY RHC OR FQHC IN HOME HEALTH AGENCY SHORTAGE AREA |
| G0129 | OCCUP THERAPIST PARTIAL HOSP SERVICE |
| G0151 | HHCP-SERV OF PT,EA 15 MIN |
| G0152 | HHCP-SERV OF OT,EA 15 MIN |
| G0153 | HHCP-SVS OF S/L PATH,EA 15MN |
| G0155 | HHCP-SVS OF CSW,EA 15 MIN |
| G0156 | HHCP-SVS OF AIDE,EA 15 MIN |
| G0157 | HHC PT ASSISTANT EA 15 |
| G0158 | HHC OT ASSISTANT EA 15 |
| G0159 | HHC PT MAINT EA 15 MIN |
| G0160 | HHC OCCUP THERAPY EA 15 |
| G0161 | HHC OCCUP THERAPY EA 15 |
| G0162 | HHC RN E&M PLAN SVS, 15 MIN |
| G0299 | SKILLED NURSING SERVICES, RN, HOME HEALTH OR HOSPICE SETTING, EACH 15 MINUTES |
| G0300 | SKILLED NURSING SERVICES, LPN, HOME HEALTH OR HOSPICE SETTING, EACH 15 MINUTES |
| G0493 | RN SERVICES FOR OBSERVATION AND ASSESSMENT OF THE PATIENT'S CONDITION, EACH 15 MINUTES |
| G0494 | LPN SERVICES FOR THE OBSERVATION AND ASSESSMENT OF THE PATIENT'S CONDITION, EACH 15 MINUTES |
| G0495 | RN SERVICES FOR TRAINING/EDUCATION OF PT OR FAMILY MEMBER, HOME HEALTH OR HOSPICE SETTING, EA 15 MIN |
| G0496 | LPN SERVICES, FOR TRAINING/EDUCATION OF PT OR FAMILY MEMBER, HOME HLTH OR HOSPICE SETTING, EA 15 MIN |
| G2168 | SERVICES PERFORMED BY PHYSICAL THERAPIST ASSISTANT IN THE HOME HEALTH SETTING, EACH 15 MIN |
| G2169 | SERVICES PERFORMED BY OCCUPATIONAL THERAPIST ASSISTANT IN THE HOME HEALTH SETTING, EACH 15 MIN |
| H1004 | FOLLOW UP HOME VISIT/PRENTAL |
| Q5006 | HOSPICE IN HOSPICE FACILITY |
| S0271 | HOME HOSPICE CASE 30 DAYS |
| S0272 | HOME EPISODIC CASE 30 DAYS |
| S5108 | HOMECARE TRAIN PT 15 MIN |
| S5109 | HOMECARE TRAIN PT SESSION |
| S5110 | FAMILY HOMECARE TRAINING 15M |
| S5111 | FAMILY HOMECARE TRAIN/SESSIO |
| S5115 | NONFAMILY HOMECARE TRAIN/15M |
| S5116 | NONFAMILY HC TRAIN/SESSION |
| S5120 | CHORE SERVICES PER 15 MIN |
| S5180 | HH RESPIRATORY THRPY IN EVAL |
| S5181 | HH RESPIRATORY THRPY NOS/DAY |
| S9061 | MEDICAL SUPPLIES AND EQUIPME |
| S9097 | HOME VISIT WOUND CARE |
| S9098 | HOME PHOTOTHERAPY VISIT |
| S9122 | HOME HEALTH AIDE OR CERTIFIE |
| S9123 | NURSING CARE IN HOME RN |
| S9124 | NURSING CARE, IN THE HOME; B |
| S9126 | HOSPICE CARE, IN THE HOME, P |
| S9127 | SOCIAL WORK VISIT, IN THE HO |
| S9128 | SPEECH THERAPY, IN THE HOME, |
| S9129 | OCCUPATIONAL THERAPY, IN THE |
| S9131 | PT IN THE HOME PER DIEM |
| S9208 | HOME MGMT PRETERM LABOR |
| S9209 | HOME MGMT PPROM |
| S9211 | HOME MGMT GEST HYPERTENSION |
| S9212 | HM POSTPAR HYPER PER DIEM |
| S9213 | HM PREECLAMP PER DIEM |
| S9214 | HM GEST DM PER DIEM |
| S9335 | HT HEMODIALYSIS DIEM |
| S9339 | HIT PERITON DIALYSIS DIEM |
| S9340 | HIT ENTERAL PER DIEM |
| S9341 | HIT ENTERAL GRAV DIEM |
| S9342 | HIT ENTERAL PUMP DIEM |
| S9343 | HIT ENTERAL BOLUS NURS |
| S9460 | DIABETIC MANAGEMENT PROGRAM, |
| T1000 | PRIVATE DUTY/INDEPENDENT NSG |
| T1001 | NURSING ASSESSMENT/EVALUATN |
| T1002 | RN SERVICES UP TO 15 MINUTES |
| T1003 | LPN/LVN SERVICES UP TO 15MIN |
| T1004 | NSG AIDE SERVICE UP TO 15MIN |
| T1019 | PERSONAL CARE SER PER 15 MIN |
| T1021 | HH AIDE OR CN AIDE PER VISIT |
| T1022 | CONTRACTED SERVICES PER DAY |
| T1028 | HOME ENVIRONMENT ASSESSMENT |
| T1030 | RN HOME CARE PER DIEM |
| T1031 | LPN HOME CARE PER DIEM |
| T1502 | MEDICATION ADMIN VISIT |
| T2042 | HOSPICE ROUTINE HOME CARE |
| T2043 | HOSPICE CONTINUOUS HOME CARE |
| T2044 | HOSPICE RESPITE CARE |
| T2045 | HOSPICE GENERAL CARE |
| T2046 | HOSPICE LONG TERM CARE, R&B |
| Q5001 | HOSPICE IN PATIENT HOME |
| Q5002 | HOSPICE IN ASSISTED LIVING |
| Q5009 | HOSPICE CARE, NOS |
| MATERNITY | |
| CODE | DESCRIPTION |
| 59840 | INDUCED ABORTN BY D&C |
| 59841 | INDUCED ABORTN BY DIL/EVAC |
| 59850 | INDUCED ABORTN BY INTRA-AMNIOT INJ |
| 59851 | INDUCED AB BY INJECT+D&C/EVAC |
| 59852 | INDUCED AB BY INJECT+OPEN UTERUS |
| 59855 | INDUCED AB BY VAG SUPPOS |
| 59856 | INDUCED AB BY VAG SUPP+D&C/EVAC |
| 59857 | INDUCED AB BY VAG SUPP+OPEN UTERUS |
| 59897 | FETAL INVAS PX W/ US |
| 59898 | LAP,OB CARE/DELIV,UNLIST PROC |
| 59899 | MATERNITY CARE PROCEDURE UNLISTED |
| 59866 | MULTIFETAL PREGNANCY REDUCTION(S) (MPR) |
| MEDICAL DIAGNOSTIC | |
| CODE | DESCRIPTION |
| G0453 | CONTINUOUS INTRAOPERATIVE NEUROPHYSIOLOGY MONITORING, FROM OUTSIDE THE |
| MISCELLANEOUS MEDICAL | |
| CODE | DESCRIPTION |
| 90399 | IMMUNE GLOBULIN |
| 90749 | UNLISTED VACCINE/TOXOID |
| 90779 | UNLISTED IV/INTRA-ART INJ/INF |
| 90867 | TRANSCRANIAL MAGNETIC STIMULATION TREATMENT,PLANNING |
| 90868 | TRANSCRANIAL MAGNETIC STIMULATION TREATMENT,DELIVERY/MANAGEMENT |
| 90869 | REPET TMS TX SUBSEQ MOTR THRESHLD W/DELIV & MNGT |
| 90899 | PSYCHIATRIC SERVICE/THERAPY |
| 90935 | HEMODIALYSIS, ONE EVALUATION |
| 90937 | HEMODIALYSIS, REPEATED EVAL. |
| 90945 | DIALYSIS, NOT HEMO, 1 EVAL |
| 90947 | DIALYSIS, REPEATED EVAL. |
| 90951 | ESRD SERVICES, PER MONTH, <2 YR OLD, 4+ VISITS |
| 90952 | ESRD SERVICES, PER MONTH, <2 YR OLD, 2-3 VISITS |
| 90953 | ESRD SERVICES, PER MONTH, <2 YR OLD, 1 VISIT |
| 90954 | ESRD SERVICES, PER MONTH, 2-11 YR OLD, 4+ VISITS |
| 90955 | ESRD SERVICES, PER MONTH, 2-11 YR OLD, 2-3 VISITS |
| 90956 | ESRD SERVICES, PER MONTH, 2-11 YR OLD, 1 VISIT |
| 90957 | ESRD SERVICES, PER MONTH, 12-19 YR OLD, 4+ VISITS |
| 90959 | ESRD SERVICES, PER MONTH, 12-19 YR OLD, 1 VISIT |
| 90960 | ESRD SERVICES, PER MONTH, 20+ YR OLD, 4+ VISITS |
| 90961 | ESRD SERVICES, PER MONTH, 20+ YR OLD, 2-3 VISITS |
| 90962 | ESRD SERVICES, PER MONTH, 20+ YR OLD, 1 VISIT |
| 90963 | ESRD SERVICES, HOME DIALYSIS, PER MONTH, < 2 YR OLD |
| 90964 | ESRD SERVICES, HOME DIALYSIS, PER MONTH, 2-11 YR OLD |
| 90965 | ESRD SERVICES, HOME DIALYSIS, PER MONTH, 12-19 YR OLD |
| 90966 | ESRD SERVICES, HOME DIALYSIS, PER MONTH, 20+ YR OLD |
| 90967 | ESRD SERVICES, PER DAY, < 2 YR OLD |
| 90968 | ESRD SERVICES, PER DAY, 2-11 YR OLD |
| 90969 | ESRD SERVICES, PER DAY, 12-19 YR OLD |
| 90970 | ESRD SERVICES, PER DAY,20+ YR OLD |
| 90989 | DIALYSIS TRAINING/COMPLETE |
| 90993 | DIALYSIS TRAINING/INCOMPLETE |
| 90999 | DIALYSIS PROCEDURE |
| 91299 | GASTROENTEROLOGY PROCEDURE |
| 92311 | CONTACT LENS FIT,APHAKIA UNILAT |
| 92312 | CONTACT LENS FIT,APHAKIA BILAT |
| 92313 | CONTACT LENS FIT,CORNEOSCLERAL LENS |
| 92499 | EYE SERVICE OR PROCEDURE |
| 92507 | SPEECH/HEARING THERAPY, INDIVIDUAL |
| 92508 | SPEECH/HEARING THERAPY, GROUP |
| 92520 | LARYNGEAL FUNCTION STUDIES |
| 92524 | BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE |
| 92526 | ORAL FUNCTION THERAPY |
| 92606 | THER SRVC(S),NON-SPEECH GEN DEV, W/PROG |
| 92607 | EVAL,SPEECH-GEN AUG/ALT COMM DEV,1ST HR |
| 92608 | EVAL,SPEECH-GEN AUG/ALT COMM DEV,ADDL 30 |
| 92609 | THER SRVC,NON-SPEECH GEN DEV USE, W/PROG |
| 92618 | EVAL RX N-SP-GEN AUGMT ALT COMMUN DEV ADD 30 MIN |
| 92625 | TINNITUS ASSESSMENT |
| 92630 | AUDITORY REHAB, PRE-LINGUAL HEAR LOSS |
| 92633 | AUDITORY REHAB POST-LINGUAL HEAR LOSS |
| 92700 | UNLISTED OTORHINOLARYNG SERVICE/PROC |
| 93619 | ELECTROPHYS EV,R A-V PACE/REC,W/ INDUCT |
| 93620 | ELECTROPHYS EV,R A-V PACE/REC,W/O INDUCT |
| 93624 | ELECTROPHYSIOLOGIC F/U STUDY |
| 93650 | ABLATE AV NODE FUNCTION |
| 93653 | EPHYS EVAL W/ ABLATION SUPRAVENT ARRHYTHMIA |
| 93654 | EPHYS EVAL W/ ABLATION VENTRICULAR TACHYCARDIA |
| 93799 | CARDIOVASCULAR PROCEDURE UNLISTED |
| 94625 | PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR |
| 94626 | PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR |
| 94799 | PULMONARY SERVICE/PROCEDURE |
| 95199 | ALLERGY IMMUNOLOGY SERV,UNLISTED |
| 95700 | EEG CONT REC W/VIDEO BY TECH MIN 8 CHANNELS |
| 95705 | EEG W/O VIDEO BY TECH 2-12 HR UNMONITORED |
| 95706 | EEG W/O VIDEO BY TECH 2-12 HR INTERMITTENT MNTR |
| 95707 | EEG W/O VIDEO BY TECH 2-12HR CONTINUOUS R-T MNTR |
| 95708 | EEG W/O VID BY TECH EA INCR 12-26HR UNMONITORED |
| 95709 | EEG W/O VID BY TECH EA INCR 12-26 HR INTMT MNTR |
| 95710 | EEG W/O VID TECH EA INCR 12-26 HR CONT R-T MNTR |
| 95711 | VEEG BY TECH 2-12 HOURS UNMONITORED |
| 95712 | VEEG BY TECH 2-12 HR INTERMITTENT MONITORING |
| 95713 | VEEG BY TECH 2-12 HR CONTINUOUS R-T MONITORING |
| 95714 | VEEG BY TECH EA INCR 12-26 HR UNMONITORED |
| 95715 | VEEG BY TECH EA INCR 12-26 HR INTERMITTENT MNTR |
| 95716 | VEEG BY TECH EA INCR 12-26 HR CONT R-T MNTR |
| 95717 | EEG PHYS/QHP 2-12 HR WITHOUT VIDEO |
| 95718 | EEG PHYS/QHP 2-12 HR WITH VIDEO |
| 95719 | EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR WO VID |
| 95720 | EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR W/VEEG |
| 95721 | EEG COMPLETE STD PHYS/QHP>36 HR<60 HR W/O VIDEO |
| 95722 | EEG COMPLETE STD PHYS/QHP>36 HR<60 HR W/VEEG |
| 95723 | EEG COMPLETE STD PHYS/QHP>60 HR<84 HR W/O VIDEO |
| 95724 | EEG COMPLETE STD PHYS/QHP>60 HR<84 HR W/VEEG |
| 95725 | EEG COMPLETE STD PHYS/QHP>84 HR W/O VID |
| 95726 | EEG COMPLETE STD PHYS/QHP>84 HR W/VEEG |
| 95940 | IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES |
| 95941 | IONM REMOTE/NEARBY/>1 PATIENT IN OR PER HOUR |
| 95999 | NEUROLOGICAL PROCEDURE UNLISTED |
| 96110 | DEVELOPMENTAL TEST, LIM |
| 96549 | CHEMOTHERAPY, UNSPECIFIED PROCEDURE |
| 96999 | DERMATOLOGICAL PROCEDURE |
| 97010 | HOT OR COLD PACKS THERAPY |
| 97012 | MECHANICAL TRACTION THERAPY |
| 97014 | ELECTRIC STIMULATION THERAPY |
| 97016 | VASOPNEUMATIC DEVICE THERAPY |
| 97018 | PARAFFIN BATH THERAPY |
| 97022 | WHIRLPOOL THERAPY |
| 97024 | DIATHERMY TREATMENT |
| 97026 | INFRARED THERAPY |
| 97028 | ULTRAVIOLET THERAPY |
| 97032 | ELECTRICAL STIMULATION |
| 97033 | ELECTRIC CURRENT THERAPY |
| 97034 | CONTRAST BATH THERAPY |
| 97035 | ULTRASOUND THERAPY |
| 97036 | HYDROTHERAPY |
| 97039 | PHYSICAL THERAPY TREATMENT |
| 97110 | THERAPEUTIC EXERCISES |
| 97112 | NEUROMUSC REEDUCAT,1+ AREAS, EA 15 MIN |
| 97113 | AQUATIC THERAPY/EXERCISES |
| 97116 | GAIT TRAINING THERAPY |
| 97124 | MASSAGE THERAPY |
| 97129 | THER INTERVNTN COG FUNCTN DIR CONTACT 1ST 15 MINUTES |
| 97130 | THER INTERVNTN COG FUNCTN DIR CONTACT EA ADDL 15 MINUTES |
| 97139 | UNLISTED THERAPEUTIC PROCEDURE |
| 97140 | MANUAL THER TECH,1+REGIONS,EA 15 MIN |
| 97150 | GROUP THERAPEUTIC PROCEDURES |
| 97161 | PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS |
| 97162 | PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS |
| 97163 | PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS |
| 97164 | PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS |
| 97165 | OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS |
| 97166 | OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS |
| 97167 | OCCUPATIONAL THERAPY EVAL HIGH COMPLEX 60 MINS |
| 97168 | OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS |
| 97530 | THERAPEUTIC ACTIVITIES |
| 97533 | SENSORY INTEGRATIVE DEV, EA 15 MIN |
| 97535 | SELF CARE/HOME MGMT TRAIN,EA 15 MIN |
| 97537 | COMMUNITY/WORK REINTEGRATION |
| 97542 | WHEELCHAIR MNGEMENT TRAINING, EA 15 MIN |
| 97545 | WORK HARDENING/CONDN,0-2 HR |
| 97546 | WORK HARDENING/CONDN,EA ADDNL HR |
| 97605 | NEG PRESS WOUND TX, < 50 CM |
| 97606 | NEG PRESS WOUND TX, > 50 CM |
| 97607 | NEG PRESSURE WOUND THERAPY NON DME </= 50 SQ CM |
| 97608 | NEG PRESSURE WOUND THERAPY NON DME >50 SQ CM |
| 97750 | PHYSICAL PERFORMANCE TEST |
| 97755 | ASSISTIVE TECHNOLOGY ASSESS |
| 97760 | ORTHOTIC MGMT AND TRAINING, INITIAL ENCOUNTER, EACH 15 MIN |
| 97761 | PROSTHETIC TRAINING, INITIAL ENCOUNTER, EACH 15 MIN |
| 97763 | ORTHOTICS/PROSTH MGMT &/TRAINING SBSQ ENCTR 15 MIN |
| 97799 | UNLISTED PHYSICAL MED/RHAB SERVICE/ PROCED |
| 99183 | HYPERBARIC OXYGEN THERAPY |
| 99199 | SPECIAL SERVICE/PROC/REPORT |
| 99415 | PROLNG CLINCL STAFF SVC DURING O/P E/M 1ST HR |
| 99416 | PROLNG CLINCL STAFF SVC DURING O/P E/M EA 30 MIN |
| 99429 | UNLISTED PREVENTIVE SERVICE |
| 99499 | UNLISTED E/M SERVICE |
| 0780T | INSTLTN FECAL MICROBIOTA SSP RCT NMA LWR GI TRCT |
| G0277 | HYPERBARIC OXYGEN UNDER PRESSURE, FULL BODY CHAMBER, PER 30 MINUTES |
| G0283 | ELEC STIM OTHER THAN WOUND |
| G0410 | GRP PSYCH PARTIAL HOSP 45-50 |
| G0411 | INTER ACTIVE GRP PSYCH PARTI |
| G0455 | PREPARATION WITH INSTILLATION OF FECAL MICROBIOTA BY ANY METHOD, INCLUDING |
| S9474 | ENTEROSTOMAL THERAPY BY A RE |
| V2799 | MISCELLANEOUS VISION SERVICE |
| V5299 | HEARING SERVICE |
| V5362 | SPEECH SCREENING |
| V5363 | LANGUAGE SCREENING |
| V5364 | DYSPHAGIA SCREENING |
| OP PSYCH ALCOHOL DRUG ABUSE | |
| CODE | DESCRIPTION |
| H0005 | ALCOHOL AND/OR DRUG SERVICES |
| H0008 | ALCOHOL AND/OR DRUG SERVICES |
| H0009 | ALCOHOL AND/OR DRUG SERVICES |
| H0010 | ALCOHOL AND/OR DRUG SERVICES |
| H0011 | ALCOHOL AND/OR DRUG SERVICES |
| H0012 | ALCOHOL AND/OR DRUG SERVICES |
| H0013 | ALCOHOL AND/OR DRUG SERVICES |
| H0014 | ALCOHOL AND/OR DRUG SERVICES |
| H0015 | ALCOHOL AND/OR DRUG SERVICES |
| H0016 | ALCOHOL AND/OR DRUG SERVICES |
| H0017 | ALCOHOL AND/OR DRUG SERVICES |
| H0018 | ALCOHOL AND/OR DRUG SERVICES |
| H2036 | A/D TX PROGRAM, PER DIEM |
| S9480 | INTENSIVE OUTPATIENT PSYCHIATRIC SERVICES, PER DIEM |
| S9484 | CRISIS INTERVENTION PER HOUR |
| PATHOLOGY & LABORATORY | |
| CODE | DESCRIPTION |
| 80220 | DRUG ASSAY HYDROXYCHLOROQUINE |
| 80299 | QUANTITATIVE ASSAY, DRUG |
| 80503 | PATHOLOGY CLINICAL CONSULTATION SF MDM 5-20 MIN |
| 80504 | PATHOLOGY CLINICAL CONSULTATION MOD MDM 21-40MIN |
| 80505 | PATHOLOGY CLINICAL CONSULTATION HI MDM 41-60 MIN |
| 80506 | PATHOLOGY CLINICAL CONSLTN PROLNG SVC EA ADDL 30 |
| 81099 | URINALYSIS TEST PROCEDURE |
| 81105 | HPA-1 GENOTYPING GENE ANALYSIS COMMON VARIANT |
| 81106 | HPA-2 GENOTYPING GENE ANALYSIS COMMON VARIANT |
| 81107 | HPA-3 GENOTYPING GENE ANALYSIS COMMON VARIANT |
| 81108 | HPA-4 GENOTYPING GENE ANALYSIS COMMON VARIANT |
| 81109 | HPA-5 GENOTYPING GENE ANALYSIS COMMON VARIANT |
| 81110 | HPA-6 GENOTYPING GENE ANALYSIS COMMON VARIANT |
| 81111 | HPA-9 GENOTYPING GENE ANALYSIS COMMON VARIANT |
| 81112 | HPA-15 GENOTYPING GENE ANALYSIS COMMON VARIANT |
| 81120 | IDH1 COMMON VARIANTS |
| 81121 | IDH2 COMMON VARIANTS |
| 81161 | DMD DUPLICATION/DELETION ANALYSIS |
| 81162 | BRCA1 & BRCA2 FULL SEQ ANALYS/FULL DUP/DEL ANALYS |
| 81163 | BRCA1 BRCA2 GENE ANALYSIS FULL SEQUENCE ANALYSIS |
| 81164 | BRCA1 BRCA2 GENE ANALYSIS FULL DUP/DEL ANALYSIS |
| 81165 | BRCA1 GENE ANALYSIS FULL SEQUENCE ANALYSIS |
| 81166 | BRCA1 GENE ANALYSIS FULL DUP/DEL ANALYSIS |
| 81167 | BRCA2 GENE ANALYSIS FULL DUP/DEL ANALYSIS |
| 81168 | CCND1/IGH TRANSLOCATION ALYS MAJOR BP QUAL AND QUAN |
| 81170 | ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS |
| 81171 | AFF2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES |
| 81172 | AFF2 GENE ANALYSIS CHARACTERIZATION OF ALLELES |
| 81173 | AR GENE ANALYSIS FULL GENE SEQUENCE |
| 81174 | AR GENE ANALYSIS KNOWN FAMILIAL VARIANT |
| 81175 | ASXL1 GENE ANALYSIS FULL GENE SEQUENCE |
| 81176 | ASXL1 GENE ANALYSIS TARGETED SEQ ANALYSIS |
| 81187 | CNBP GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES |
| 81188 | CSTB GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES |
| 81189 | CSTB GENE ANALYSIS FULL GENE SEQUENCE |
| 81190 | CSTB GENE ANALYSIS KNOWN FAMILIAL VARIANTS |
| 81191 | NTRK1 TRANSLOCATION ANALYSIS |
| 81192 | NTRK2 TRANSLOCATION ANALYSIS |
| 81193 | NTRK3 TRANSLOCATION ANALYSIS |
| 81194 | NTRK TRANSLOCATION ANALYSIS |
| 81200 | ASPA GENE ANALYSIS COMMON VARIANTS |
| 81201 | APC GENE ANALYSIS FULL GENE SEQUENCE |
| 81202 | APC GENE ANALYSIS KNOWN FAMILIAL VARIANTS |
| 81203 | APC GENE ANALYSIS DUPLICATION/DELETION VARIANTS |
| 81204 | AR GENE ANALYSIS CHARACTERIZATION OF ALLELES |
| 81205 | BCKDHB GENE ANALYSIS COMMON VARIANTS |
| 81206 | BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE |
| 81207 | BCR/ABL1 MINOR BREAKPNT QUALITATIVE/QUANTITATIVE |
| 81208 | BCR/ABL1 OTHER BREAKPNT QUALITATIVE/QUANTITATIVE |
| 81209 | BLM GENE ANALYSIS 2281DEL6INS7 VARIANT |
| 81210 | BRAF GENE ANALYSIS V600E VARIANT |
| 81212 | BRCA1&BRCA2 ANAL 185DELAG5385INSC/6174DELT |
| 81215 | BRCA1 GENE ANALYSIS KNOWN FAMILIAL VARIANT |
| 81216 | BRCA2 GENE ANALYSIS FULL SEQUENCE ANALYSIS |
| 81217 | BRCA2 GENE ANALYSIS KNOWN FAMILIAL VARIANT |
| 81218 | CEBPA GENE ANALYSIS FULL GENE SEQUENCE |
| 81219 | CALR GENE ANALYSIS COMMON VARIANTS IN EXON 9 |
| 81220 | CFTR GENE ANALYSIS COMMON VARIANTS |
| 81221 | CFTR GENE ANALYSIS KNOWN FAMILIAL VARIANTS |
| 81222 | CFTR GENE ANALYSIS DUPLICATION/DELETION VARIANTS |
| 81223 | CFTR GENE ANALYSIS FULL GENE SEQUENCE |
| 81224 | CFTR GENE ANALYSIS INTRON 8 POLY-T ANALYSIS |
| 81227 | CYP2C9 GENE ANALYSIS COMMON VARIANTS |
| 81228 | CYTOGENOM CONST MICROARRAY COPY NUMBER VARIANTS |
| 81229 | CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR |
| 81234 | DMPK GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES |
| 81235 | EGFR GENE ANALYSIS COMMON VARIANTS |
| 81236 | EZH2 GENE ANALYSIS FULL GENE SEQUENCE |
| 81237 | EZH2 GENE ANALYSIS COMMON VARIANTS |
| 81238 | F9 FULL GENE SEQUENCE |
| 81239 | DMPK GENE ANALYSIS CHARACTERIZATION OF ALLELES |
| 81240 | F2 GENE ANALYSIS 20210G >A VARIANT |
| 81241 | F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT |
| 81242 | FANCC GENE ANALYSIS COMMON VARIANT |
| 81243 | FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES |
| 81244 | FMR1 GENE ANALYSIS CHARACTERIZATION OF ALLELES |
| 81245 | FLT3 GENE ANALYSIS INTERNAL TANDEM DUP VARIANTS |
| 81246 | FLT3 GENE ANLYS TYROSINE KINASE DOMAIN VARIANTS |
| 81250 | G6PC GENE ANALYSIS COMMON VARIANTS |
| 81251 | GBA GLUCOSIDASE/BETA/ACID ANAL COMM VARIANTS |
| 81252 | GJB2 GENE ANALYSIS FULL GENE SEQUENCE |
| 81253 | GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS |
| 81254 | GJB6 GENE ANALYSIS COMMON VARIANTS |
| 81255 | HEXA GENE ANALYSIS COMMON VARIANTS |
| 81256 | HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS |
| 81257 | HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT |
| 81258 | HBA1/HBA2 GENE ANALYSIS KNOWN FAMILIAL VARIANT |
| 81259 | HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE |
| 81260 | IKBKAP GENE ANALYSIS COMMON VARIANTS |
| 81261 | IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED |
| 81262 | IGH@ REARRANGE ABNORMAL CLONAL POP DIRECT PROBE |
| 81263 | IGH@ VARIABLE REGION SOMATIC MUTATION ANALYSIS |
| 81264 | IGK@ GENE REARRANGE DETECT ABNORMAL CLONAL POP |
| 81265 | COMPARATIVE ANAL STR MARKERS PATIENT&COMP SPEC |
| 81266 | COMPARATIVE ANAL STR MARKERS EA ADDL SPECIMEN |
| 81267 | CHIMERISM W/COMP TO BASELINE W/O CELL SELECTION |
| 81268 | CHIMERISM W/COMP TO BASELINE W/CELL SELECTION EA |
| 81269 | HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIANTS |
| 81270 | JAK2 GENE ANALYSIS P.VAL617PHE VARIANT |
| 81271 | HTT GENE ANALYSIS DETECT ABNORMAL ALLELES |
| 81272 | KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS |
| 81273 | KIT GENE ANALYSIS D816 VARIANT(S) |
| 81274 | HTT GENE ANALYSIS CHARACTERIZATION ALLELES |
| 81275 | KRAS GENE ANALYSIS VARIANTS IN CODONS 12 AND 13 |
| 81276 | KRAS GENE ANALYSIS ADDITIONAL VARIANT(S) |
| 81278 | IGH@/BCL2 TRANSLOCATION ALYS MBR AND MCR BP QUAL/QUAN |
| 81279 | JAK2 TARGETED SEQUENCE ANALYSIS |
| 81283 | IFNL3 GENE ANALYSIS RS12979860 VARIANT |
| 81287 | MGMT METHYLATION ANALYSIS |
| 81288 | MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS |
| 81290 | MCOLN1 MUCOLIPIN1 GENE ANALYSIS COMMON VARIANTS |
| 81292 | MLH1 GENE ANALYSIS FULL SEQUENCE ANALYSIS |
| 81293 | MLH1 GENE ANALYSIS KNOWN FAMILIAL VARIANTS |
| 81294 | MLH1 GENE ANALYSIS DUPLICATION/DELETION VARIANTS |
| 81295 | MSH2 GENE ANALYSIS FULL SEQUENCE ANALYSIS |
| 81296 | MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS |
| 81297 | MSH2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS |
| 81298 | MSH6 GENE ANALYSIS FULL SEQUENCE ANALYSIS |
| 81299 | MSH6 GENE ANALYSIS KNOWN FAMILIAL VARIANTS |
| 81300 | MSH6 GENE ANALYSIS DUPLICATION/DELETION VARIA |
| 81301 | MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF |
| 81302 | MECP2 GENE ANALYSIS FULL SEQUENCE |
| 81303 | MECP2 GENE ANALYSIS KNOWN FAMILIAL VARIANT |
| 81304 | MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT |
| 81305 | MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT |
| 81307 | PALB2 GENE ANALYSIS FULL GENE SEQUENCE |
| 81308 | PALB2 GENE ANALYSIS KNOWN FAMILIAL VARIANT |
| 81309 | PIK3CA GENE ANALYSIS TARGETED SEQUENCE ANALYSIS |
| 81310 | NPM1 NUCLEOPHOSMIN GENE ANAL EXON 12 VARIANTS |
| 81311 | NRAS GENE ANALYSIS VARIANTS IN EXON 2&3 |
| 81314 | PDGFRA GENE ANALYS TARGETED SEQUENCE ANALYS |
| 81315 | PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT |
| 81316 | PML/RARALPHA SINGLE BREAKPOINT QUAL/QUAN |
| 81317 | PMS2 GENE ANALYSIS FULL SEQUENCE |
| 81318 | PMS2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS |
| 81319 | PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS |
| 81320 | PLCG2 GENE ANALYSIS COMMON VARIANTS |
| 81321 | PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS |
| 81322 | PTEN GENE ANALYSIS KNOWN FAMILIAL VARIANT |
| 81323 | PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT |
| 81324 | PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS |
| 81325 | PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS |
| 81326 | PMP22 GENE ANALYSIS KNOWN FAMILIAL VARIANT |
| 81329 | SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS |
| 81330 | SMPD1 GENE ANALYSIS COMMON VARIANTS |
| 81331 | SNRPN/UBE3A METHYLATION ANALYSIS |
| 81332 | SERPINA1 GENE ANALYSIS COMMON VARIANTS |
| 81336 | SMN1 GENE ANALYSIS FULL GENE SEQUENCE |
| 81337 | SMN1 GENE ANALYSIS KNOWN FAMILIAL SEQ VARIANTS |
| 81338 | MPL GENE ANALYSIS COMMON VARIANTS |
| 81339 | MPL GENE ANALYSIS SEQUENCE ANALYSIS EXON 10 |
| 81340 | TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD |
| 81341 | TRB@ REARRANGEMENT ANAL DIRECT PROBE METHODOLOGY |
| 81342 | TRG@ GENE REARRANGEMENT ANALYSIS |
| 81343 | PPP2R2B GENE ANALYSIS EVAL DETC ABNORMAL ALLELES |
| 81344 | TBP GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES |
| 81345 | TERT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS |
| 81347 | SF3B1 GENE ANALYSIS COMMON VARIANTS |
| 81348 | SRSF2 GENE ANALYSIS COMMON VARIANTS |
| 81349 | CYTOG ALYS CHRMOML ABNOR LOW-PASS SEQ ALYS |
| 81350 | UGT1A1 GENE ANALYSIS COMMON VARIANTS |
| 81351 | TP53 GENE ANALYSIS FULL GENE SEQUENCE |
| 81352 | TP53 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS |
| 81353 | TP53 GENE ANALYSIS KNOWN FAMILIAL VARIANT |
| 81357 | U2AF1 GENE ANALYSIS COMMON VARIANTS |
| 81360 | ZRSR2 GENE ANALYSIS COMMON VARIANT(S) |
| 81361 | HBB COMMON VARIANTS |
| 81362 | HBB KNOWN FAMILIAL VARIANTS |
| 81363 | HBB DUPLICATION/DELETION VARIANTS |
| 81364 | HBB FULL GENE SEQUENCE |
| 81370 | HLA CLASS I&II LOW HLA-A -B -C -DRB1/3/4/5&-DQB1 |
| 81371 | HLA I&II LOW RESOLUTION HLA-A -B&-DRB1/3/4/5 |
| 81373 | HLA CLASS I TYPING LOW RESOLUTION ONE LOCUS EACH |
| 81375 | HLA II LOW RESOLUTION HLA-DRB1/3/4/5 AND -DQB1 |
| 81376 | HLA CLASS II TYPING LOW RESOLUTION ONE LOCUS EA |
| 81377 | HLA II LOW RESOLUTION ONE ANTIGEN EQUIVALENT EA |
| 81378 | HLA I&II HIGH RESOLUTION HLA-A -B -C AND -DRB1 |
| 81379 | HLA CLASS I TYPING HIGH RESOLUTION COMPLETE |
| 81380 | HLA CLASS I TYPING HIGH RESOLUTION ONE LOCUS EA |
| 81381 | HLA I TYPING HIGH RESOLUTION 1 ALLELE/ALLELE GRP |
| 81382 | HLA CLASS II TYPING HIGH RESOLUTION ONE LOCUS EA |
| 81383 | HLA II HIGH RESOLUTION 1 ALLELE/ALLELE GROUP |
| 81400 | MOLECULAR PATHOLOGY PROCEDURE LEVEL 1 |
| 81401 | MOLECULAR PATHOLOGY PROCEDURE LEVEL 2 |
| 81402 | MOLECULAR PATHOLOGY PROCEDURE LEVEL 3 |
| 81403 | MOLECULAR PATHOLOGY PROCEDURE LEVEL 4 |
| 81404 | MOLECULAR PATHOLOGY PROCEDURE LEVEL 5 |
| 81405 | MOLECULAR PATHOLOGY PROCEDURE LEVEL 6 |
| 81406 | MOLECULAR PATHOLOGY PROCEDURE LEVEL 7 |
| 81407 | MOLECULAR PATHOLOGY PROCEDURE LEVEL 8 |
| 81408 | MOLECULAR PATHOLOGY PROCEDURE LEVEL 9 |
| 81410 | AORTIC DYSFUNCTION/DILATION GENOMIC SEQ ANALYSIS |
| 81411 | AORTIC DYSFUNCTION/DILATION DUP/DEL ANALYSIS |
| 81412 | ASHKENAZI JEWISH ASSOC DSRDRS GEN SEQ ANAL 9 GEN |
| 81413 | CAR ION CHNNLPATH GENOMIC SEQ ALYS INC 10 GNS |
| 81414 | CAR ION CHNNLPATH DUP/DEL GN ALYS PANEL 2 GENES |
| 81415 | EXOME SEQUENCE ANALYSIS |
| 81416 | EXOME SEQUENCE ANALYSIS EACH COMPARATOR EXOME |
| 81417 | EXOME RE-EVAL OF PREVIOUSLY OBTAINED EXOME SEQ |
| 81419 | EPILEPSY GENOMIC SEQUENCE ANALYSIS PANEL |
| 81420 | FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS |
| 81430 | HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES |
| 81431 | HEARING LOSS DUP/DEL ANALYSIS |
| 81432 | HEREDITARY BRST CA-RELATED GEN SEQ ANALYS 14 GEN |
| 81433 | HEREDITARY BRST CA-RELATED DUP/DEL ANALYSIS |
| 81434 | HEREDITARY RETINAL DSRDRS GEN SEQ ANALYS 15 GEN |
| 81435 | HEREDITARY COLON CA GENOMIC SEQ ANALYS 7 GENES |
| 81436 | HEREDITARY COLON CA SYND DUP/DEL ANALYS 8 GENES |
| 81437 | HEREDTRY NURONDCRN TUM DSRDRS GEN SEQ ANAL 6 GEN |
| 81438 | HEREDTRY NURONDCRN TUM DSRDRS DUP/DEL ANALYSIS |
| 81439 | INHERIT CARDMYPTHY GENOMIC SEQ PANEL 5 GENES |
| 81440 | NUCLEAR MITOCHONDRIAL 100 GENE GENOMIC SEQ |
| 81442 | NOONAN SPECTRUM DISORDERS GEN SEQ ANALYS 12 GEN |
| 81443 | GENETIC TESTING FOR SEVERE INHERITED CONDITIONS |
| 81445 | TARGETED GENOMIC SEQ ANALYS DNA ANALYS 5-50 GENE |
| 81450 | GENOMIC SEQ ANALYS DNA&RNA ANALYS 5-50 GENE |
| 81455 | GENOMIC SEQ ANALYS DNA & RNA ANALYS 51/MORE GENES |
| 81479 | UNLISTED MOLELCULAR PATHOLOGY PROCEDURE |
| 81507 | FETAL ANEUPLOIDY 21 18 13 SEQ ANALY TRISOM RISK |
| 81518 | ONCOLOGY BREAST MRNA GENE EXPRESSION 11 GENES |
| 81519 | ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES |
| 81520 | ONC BREAST MRNA GENE EXPRSN PRFL HYBRID 58 GENES |
| 81521 | ONC BREAST MRNA MICROARRAY GENE EXPRSN PRFL 70 GENES |
| 81522 | ONCOLOGY BREAST MRNA GENE EXPRSN PRFL 12 GENES |
| 81523 | ONC BRST MRNA NEXT GNRTN SEQ GEN XPRSN 70 CNT AND 31 HSKPNG |
| 81540 | ONCOLOGY TUM UNKNOWN ORIGIN MRNA 92 GENES |
| 81541 | ONC PROSTATE MRNA GENE EXPRSN PRFL RT-PCR 46 GENES |
| 81546 | ONC THYR MRNA 10,196 GENES FINE NDL ASPIRATE ALG |
| 81554 | PULM DS IPF MRNA 190 GENE TRANSBRONCHIAL BX ALG |
| 81595 | CARDIOLOGY HRT TRNSPL MRNA GENE EXPRESS 20 GENES |
| 81599 | UNLISTED MULTIANALYTE ASSAY ALGORITHMIC ANALYSIS |
| 81560 | TRNSPLTN PED LVR AND BWL MES CD154+T CLL WHL PRPH BLD |
| 82653 | ELASTASE PANCREATIC FECAL QUANTITATIVE |
| 83521 | IMMUNOGLOBULIN LIGHT CHAINS FREE EACH |
| 83529 | ASSAY OF INTERLEUKIN-6 (IL-6) |
| 84999 | CLINICAL CHEMISTRY TEST |
| 85999 | HEMATOLOGY PROCEDURE |
| 86356 | MONONUCLEAR CELL ANTIGEN, QUANT |
| 86357 | NK CELLS, TOTAL COUNT |
| 86367 | STEM CELLS, TOTAL COUNT |
| 86486 | SKIN TEST UNLISTED ANTIGEN EACH |
| 86849 | IMMUNOLOGY PROCEDURE |
| 86999 | TRANSFUSION PROCEDURE |
| 87999 | MICROBIOLOGY PROCEDURE UNLISTED |
| 88099 | NECROPSY (AUTOPSY) UNLISTED |
| 88182 | CELL MARKER STUDY,DNA |
| 88199 | CYTOPATH PROCEDURE UNLISTED |
| 88245 | CHROMOSOME ANAL:BREAKGE,20-25 CELLS |
| 88248 | CHROMOSOME ANAL:BREAKGE,50-100 CELLS |
| 88249 | CHROMOSOME ANAL:BREAKGE,100 CELLS |
| 88261 | CHROMOSOME ANAL:5 CELLS,1 KARYOTYPE |
| 88262 | CHROMOSOME ANAL:15-20,2 KARYOTYPES |
| 88263 | CHROMOSOME ANAL:45 CELLS,MOSAICISM |
| 88264 | CHROMOSOME ANALYSIS:20-25 |
| 88267 | CHROMOSOME ANALY:PLACENTA |
| 88269 | CHROMOSOME ANALY:AMNIOTIC |
| 88271 | CYTOGENETICS, DNA PROBE |
| 88272 | CYTOGENETICS, 3-5 |
| 88273 | CYTOGENETICS, 10-30 |
| 88274 | CYTOGENETICS, 25-99 |
| 88275 | CYTOGENETICS, 100-300 |
| 88280 | CHROMOSOME KARYOTYPE STUDY |
| 88283 | CHROMOSOME BANDING STUDY |
| 88285 | CHROMOSOME COUNT:ADDN CELLS |
| 88289 | CHROMOSOME STUDY:ADDN HI RES |
| 88291 | CYTO/MOLECULAR REPORT |
| 88299 | CYTOGENETIC STUDY |
| 88399 | SURGICAL PATH PROCEDURE UNLISTED |
| 88749 | UNLISTED IN VIVO LAB SERVICE |
| 89240 | PATHOLOGY LAB PROCEDURE |
| 89398 | UNLISTED REPRODUCTIVE MEDICINE LAB PROCEDURE |
| G0452 | MOLECULAR PATHOLOGY PROCEDURE; PHYSICIAN INTERPRETATION AND REPORT |
| S3800 | GENETIC TESTING ALS |
| S3840 | DNA ANALYSIS RET-ONCOGENE |
| S3841 | GENE TEST RETINOBLASTOMA |
| S3842 | GENE TEST HIPPEL-LINDAU |
| S3853 | GENE TEST MYO MUSCLR DYST |
| S3861 | GENETIC TEST BRUGADA |
| S3870 | CGH TEST DEVELOPMENTAL DELAY |
| PROSTHETICS | |
| CODE | DESCRIPTION |
| L5050 | ANK SYMES MOLD SCKT SACH FT |
| L5060 | SYMES MET FR LEATH SOCKET AR |
| L5100 | MOLDED SOCKET SHIN SACH FOOT |
| L5105 | PLAST SOCKET JTS/THGH LACER |
| L5150 | MOLD SCKT EXT KNEE SHIN SACH |
| L5160 | MOLD SOCKET BENT KNEE SHIN S |
| L5200 | KNE SING AXIS FRIC SHIN SACH |
| L5210 | NO KNEE/ANKLE JOINTS W/ FT B |
| L5220 | NO KNEE JOINT WITH ARTIC ALI |
| L5230 | FEM FOCAL DEFIC CONSTANT FRI |
| L5250 | HIP CANAD SING AXI CONS FRIC |
| L5270 | TILT TABLE LOCKING HIP SING |
| L5280 | HEMIPELVECT CANAD SING AXIS |
| L5301 | BK MOLD SOCKET SACH FT ENDO |
| L5312 | KNEE DISARTICULATION (OR THROUGH KNEE), MOLDED SOCKET, SINGLE AXIS KNEE, PYLON, |
| L5321 | AK OPEN END SACH |
| L5331 | HIP DISART CANADIAN SACH FT |
| L5341 | HEMIPELVECTOMY CANADIAN SACH |
| L5500 | INIT BK PTB PLASTER DIRECT |
| L5505 | INIT AK ISCHAL PLSTR DIRECT |
| L5520 | PERP BK PTB THERMOPLS DIRECT |
| L5530 | PREP BK PTB THERMOPLS MOLDED |
| L5535 | PREP BK PTB OPEN END SOCKET |
| L5540 | PREP BK PTB LAMINATED SOCKET |
| L5560 | PREP AK ISCHIAL PLAST MOLDED |
| L5570 | PREP AK ISCHIAL DIRECT FORM |
| L5580 | PREP AK ISCHIAL THERMO MOLD |
| L5585 | PREP AK ISCHIAL OPEN END |
| L5590 | PREP AK ISCHIAL LAMINATED |
| L5595 | HIP DISARTIC SACH THERMOPLS |
| L5600 | HIP DISART SACH LAMINAT MOLD |
| L5610 | ABOVE KNEE HYDRACADENCE |
| L5611 | AK 4 BAR LINK W/FRIC SWING |
| L5613 | AK 4 BAR LING W/HYDRAUL SWIG |
| L5614 | 4-BAR LINK ABOVE KNEE W/SWNG |
| L5616 | AK UNIV MULTIPLEX SYS FRICT |
| L5617 | AK/BK SELF-ALIGNING UNIT EA |
| L5618 | TEST SOCKET SYMES |
| L5620 | TEST SOCKET BELOW KNEE |
| L5622 | TEST SOCKET KNEE DISARTICULA |
| L5624 | TEST SOCKET ABOVE KNEE |
| L5626 | TEST SOCKET HIP DISARTICULAT |
| L5628 | TEST SOCKET HEMIPELVECTOMY |
| L5629 | BELOW KNEE ACRYLIC SOCKET |
| L5630 | SYME TYP EXPANDABL WALL SCKT |
| L5631 | AK/KNEE DISARTIC ACRYLIC SOC |
| L5632 | SYMES TYPE PTB BRIM DESIGN S |
| L5634 | SYMES TYPE POSTER OPENING SO |
| L5636 | SYMES TYPE MEDIAL OPENING SO |
| L5637 | BELOW KNEE TOTAL CONTACT |
| L5638 | BELOW KNEE LEATHER SOCKET |
| L5639 | BELOW KNEE WOOD SOCKET |
| L5640 | KNEE DISARTICULAT LEATHER SO |
| L5642 | ABOVE KNEE LEATHER SOCKET |
| L5643 | HIP FLEX INNER SOCKET EXT FR |
| L5644 | ABOVE KNEE WOOD SOCKET |
| L5645 | BK FLEX INNER SOCKET EXT FRA |
| L5646 | BELOW KNEE CUSHION SOCKET |
| L5647 | BELOW KNEE SUCTION SOCKET |
| L5648 | ABOVE KNEE CUSHION SOCKET |
| L5649 | ISCH CONTAINMT/NARROW M-L SO |
| L5650 | TOT CONTACT AK/KNEE DISART S |
| L5651 | AK FLEX INNER SOCKET EXT FRA |
| L5652 | SUCTION SUSP AK/KNEE DISART |
| L5653 | KNEE DISART EXPAND WALL SOCK |
| L5654 | SOCKET INSERT SYMES |
| L5655 | SOCKET INSERT BELOW KNEE |
| L5656 | SOCKET INSERT KNEE ARTICULAT |
| L5658 | SOCKET INSERT ABOVE KNEE |
| L5661 | MULTI-DUROMETER SYMES |
| L5665 | MULTI-DUROMETER BELOW KNEE |
| L5666 | BELOW KNEE CUFF SUSPENSION |
| L5668 | SOCKET INSERT W/O LOCK LOWER |
| L5670 | BK MOLDED SUPRACONDYLAR SUSP |
| L5671 | BK/AK LOCKING MECHANISM |
| L5672 | BK REMOVABLE MEDIAL BRIM SUS |
| L5673 | SOCKET INSERT W LOCK MECH |
| L5676 | BK KNEE JOINTS SINGLE AXIS P |
| L5677 | BK KNEE JOINTS POLYCENTRIC P |
| L5678 | BK JOINT COVERS PAIR |
| L5679 | SOCKET INSERT W/O LOCK MECH |
| L5680 | BK THIGH LACER NON-MOLDED |
| L5681 | INTL CUSTM CONG/LATYP INSERT |
| L5682 | BK THIGH LACER GLUT/ISCHIA M |
| L5683 | INITIAL CUSTOM SOCKET INSERT |
| L5684 | BK FORK STRAP |
| L5685 | BELOW KNEE SUS/SEAL SLEEVE |
| L5686 | BK BACK CHECK |
| L5688 | BK WAIST BELT WEBBING |
| L5690 | BK WAIST BELT PADDED AND LIN |
| L5692 | AK PELVIC CONTROL BELT LIGHT |
| L5694 | AK PELVIC CONTROL BELT PAD/L |
| L5695 | AK SLEEVE SUSP NEOPRENE/EQUA |
| L5696 | AK/KNEE DISARTIC PELVIC JOIN |
| L5697 | AK/KNEE DISARTIC PELVIC BAND |
| L5698 | AK/KNEE DISARTIC SILESIAN BA |
| L5699 | SHOULDER HARNESS |
| L5700 | REPLACE SOCKET BELOW KNEE |
| L5701 | REPLACE SOCKET ABOVE KNEE |
| L5702 | REPLACE SOCKET HIP |
| L5703 | SYMES ANKLE W/O (SACH) FOOT |
| L5704 | CUSTOM SHAPE COVER BK |
| L5705 | CUSTOM SHAPE COVER AK |
| L5706 | CUSTOM SHAPE CVR KNEE DISART |
| L5707 | CUSTOM SHAPE CVR HIP DISART |
| L5710 | KNE-SHIN EXO SNG AXI MNL LOC |
| L5711 | KNEE-SHIN EXO MNL LOCK ULTRA |
| L5712 | KNEE-SHIN EXO FRICT SWG & ST |
| L5714 | KNEE-SHIN EXO VARIABLE FRICT |
| L5716 | KNEE-SHIN EXO MECH STANCE PH |
| L5718 | KNEE-SHIN EXO FRCT SWG & STA |
| L5722 | KNEE-SHIN PNEUM SWG FRCT EXO |
| L5724 | KNEE-SHIN EXO FLUID SWING PH |
| L5726 | KNEE-SHIN EXT JNTS FLD SWG E |
| L5728 | KNEE-SHIN FLUID SWG & STANCE |
| L5780 | KNEE-SHIN PNEUM/HYDRA PNEUM |
| L5781 | LOWER LIMB PROS VACUUM PUMP |
| L5782 | HD LOW LIMB PROS VACUUM PUMP |
| L5785 | EXOSKELETAL BK ULTRALT MATER |
| L5790 | EXOSKELETAL AK ULTRA-LIGHT M |
| L5795 | EXOSKEL HIP ULTRA-LIGHT MATE |
| L5810 | ENDOSKEL KNEE-SHIN MNL LOCK |
| L5811 | ENDO KNEE-SHIN MNL LCK ULTRA |
| L5812 | ENDO KNEE-SHIN FRCT SWG & ST |
| L5814 | ENDO KNEE-SHIN HYDRAL SWG PH |
| L5816 | ENDO KNEE-SHIN POLYC MCH STA |
| L5818 | ENDO KNEE-SHIN FRCT SWG & ST |
| L5822 | ENDO KNEE-SHIN PNEUM SWG FRC |
| L5824 | ENDO KNEE-SHIN FLUID SWING P |
| L5826 | MINIATURE KNEE JOINT |
| L5828 | ENDO KNEE-SHIN FLUID SWG/STA |
| L5830 | ENDO KNEE-SHIN PNEUM/SWG PHA |
| L5840 | MULTI-AXIAL KNEE/SHIN SYSTEM |
| L5845 | KNEE-SHIN SYS STANCE FLEXION |
| L5848 | KNEE-SHIN SYS HYDRAUL STANCE |
| L5850 | ENDO AK/HIP KNEE EXTENS ASSI |
| L5855 | MECH HIP EXTENSION ASSIST |
| L5856 | ELEC KNEE-SHIN SWING/STANCE |
| L5857 | ELEC KNEE-SHIN SWING ONLY |
| L5858 | STANCE PHASE ONLY |
| L5859 | ADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL KNEE-SHIN SYSTEM, POWERED |
| L5910 | ENDO BELOW KNEE ALIGNABLE SY |
| L5920 | ENDO AK/HIP ALIGNABLE SYSTEM |
| L5925 | ABOVE KNEE MANUAL LOCK |
| L5930 | HIGH ACTIVITY KNEE FRAME |
| L5940 | ENDO BK ULTRA-LIGHT MATERIAL |
| L5950 | ENDO AK ULTRA-LIGHT MATERIAL |
| L5960 | ENDO HIP ULTRA-LIGHT MATERIA |
| L5961 | ENDO POLY HIP, PNEU/HYD/ROT |
| L5962 | BELOW KNEE FLEX COVER SYSTEM |
| L5964 | ABOVE KNEE FLEX COVER SYSTEM |
| L5966 | HIP FLEXIBLE COVER SYSTEM |
| L5968 | MULTIAXIAL ANKLE W DORSIFLEX |
| L5969 | ADDITION ENDOSKELETAL ANKLE-FOOT/ANK PWR ASSIST |
| L5970 | FOOT EXTERNAL KEEL SACH FOOT |
| L5971 | SACH FOOT, REPLACEMENT |
| L5972 | FLEXIBLE KEEL FOOT |
| L5973 | ANK-FOOT SYS DORS-PLANT FLEX |
| L5974 | FOOT SINGLE AXIS ANKLE/FOOT |
| L5975 | COMBO ANKLE/FOOT PROSTHESIS |
| L5976 | ENERGY STORING FOOT |
| L5978 | FT PROSTH MULTIAXIAL ANKL/FT |
| L5979 | MULTI-AXIAL ANKLE/FT PROSTH |
| L5980 | FLEX FOOT SYSTEM |
| L5981 | FLEX-WALK SYS LOW EXT PROSTH |
| L5982 | EXOSKELETAL AXIAL ROTATION U |
| L5984 | ENDOSKELETAL AXIAL ROTATION |
| L5985 | LWR EXT DYNAMIC PROSTH PYLON |
| L5986 | MULTI-AXIAL ROTATION UNIT |
| L5987 | SHANK FT W VERT LOAD PYLON |
| L5988 | VERTICAL SHOCK REDUCING PYLO |
| L5990 | USER ADJUSTABLE HEEL HEIGHT |
| L5999 | LOWR EXTREMITY PROSTHES NOS |
| L6000 | PAR HAND ROBIN-AIDS THUM REM |
| L6010 | HAND ROBIN-AIDS LITTLE/RING |
| L6020 | PART HAND ROBIN-AIDS NO FING |
| L6026 | TRANSCARPAL/METACARPAL OR PART HAND DISARTICULATION PROSTHESIS, EXT POWER, EXCL TERMINAL DEVICE(S) |
| L6050 | WRST MLD SCK FLX HNG TRI PAD |
| L6055 | WRST MOLD SOCK W/EXP INTERFA |
| L6100 | ELB MOLD SOCK FLEX HINGE PAD |
| L6110 | ELBOW MOLD SOCK SUSPENSION T |
| L6120 | ELBOW MOLD DOUB SPLT SOC STE |
| L6130 | ELBOW STUMP ACTIVATED LOCK H |
| L6200 | ELBOW MOLD OUTSID LOCK HINGE |
| L6205 | ELBOW MOLDED W/ EXPAND INTER |
| L6250 | ELBOW INTER LOC ELBOW FORARM |
| L6300 | SHLDER DISART INT LOCK ELBOW |
| L6310 | SHOULDER PASSIVE RESTOR COMP |
| L6320 | SHOULDER PASSIVE RESTOR CAP |
| L6350 | THORACIC INTERN LOCK ELBOW |
| L6360 | THORACIC PASSIVE RESTOR COMP |
| L6370 | THORACIC PASSIVE RESTOR CAP |
| L6380 | POSTOP DSG CAST CHG WRST/ELB |
| L6382 | POSTOP DSG CAST CHG ELB DIS/ |
| L6384 | POSTOP DSG CAST CHG SHLDER/T |
| L6386 | POSTOP EA CAST CHG & REALIGN |
| L6388 | POSTOP APPLICAT RIGID DSG ON |
| L6400 | BELOW ELBOW PROSTH TISS SHAP |
| L6450 | ELB DISART PROSTH TISS SHAP |
| L6500 | ABOVE ELBOW PROSTH TISS SHAP |
| L6550 | SHLDR DISAR PROSTH TISS SHAP |
| L6570 | SCAP THORAC PROSTH TISS SHAP |
| L6580 | WRIST/ELBOW BOWDEN CABLE MOL |
| L6582 | WRIST/ELBOW BOWDEN CBL DIR F |
| L6584 | ELBOW FAIR LEAD CABLE MOLDED |
| L6586 | ELBOW FAIR LEAD CABLE DIR FO |
| L6588 | SHDR FAIR LEAD CABLE MOLDED |
| L6590 | SHDR FAIR LEAD CABLE DIRECT |
| L6600 | POLYCENTRIC HINGE PAIR |
| L6605 | SINGLE PIVOT HINGE PAIR |
| L6610 | FLEXIBLE METAL HINGE PAIR |
| L6611 | ADDITIONAL SWITCH, EXT POWER |
| L6615 | DISCONNECT LOCKING WRIST UNI |
| L6616 | DISCONNECT INSERT LOCKING WR |
| L6620 | FLEXION/EXTENSION WRIST UNIT |
| L6621 | FLEX/EXT WRIST W/WO FRICTION |
| L6623 | SPRING-ASS ROT WRST W/ LATCH |
| L6624 | FLEX/EXT/ROTATION WRIST UNIT |
| L6625 | ROTATION WRST W/ CABLE LOCK |
| L6628 | QUICK DISCONN HOOK ADAPTER O |
| L6629 | LAMINATION COLLAR W/ COUPLIN |
| L6630 | STAINLESS STEEL ANY WRIST |
| L6632 | LATEX SUSPENSION SLEEVE EACH |
| L6635 | LIFT ASSIST FOR ELBOW |
| L6637 | NUDGE CONTROL ELBOW LOCK |
| L6638 | ELEC LOCK ON MANUAL PW ELBOW |
| L6640 | SHOULDER ABDUCTION JOINT PAI |
| L6641 | EXCURSION AMPLIFIER PULLEY T |
| L6642 | EXCURSION AMPLIFIER LEVER TY |
| L6645 | SHOULDER FLEXION-ABDUCTION J |
| L6646 | MULTIPO LOCKING SHOULDER JNT |
| L6647 | SHOULDER LOCK ACTUATOR |
| L6648 | EXT PWRD SHLDER LOCK/UNLOCK |
| L6650 | SHOULDER UNIVERSAL JOINT |
| L6655 | STANDARD CONTROL CABLE EXTRA |
| L6660 | HEAVY DUTY CONTROL CABLE |
| L6665 | TEFLON OR EQUAL CABLE LINING |
| L6670 | HOOK TO HAND CABLE ADAPTER |
| L6672 | HARNESS CHEST/SHLDER SADDLE |
| L6675 | HARNESS FIGURE OF 8 SING CON |
| L6676 | HARNESS FIGURE OF 8 DUAL CON |
| L6677 | UE TRIPLE CONTROL HARNESS |
| L6680 | TEST SOCK WRIST DISART/BEL E |
| L6682 | TEST SOCK ELBW DISART/ABOVE |
| L6684 | TEST SOCKET SHLDR DISART/THO |
| L6686 | SUCTION SOCKET |
| L6687 | FRAME TYP SOCKET BEL ELBOW/W |
| L6688 | FRAME TYP SOCK ABOVE ELB/DIS |
| L6689 | FRAME TYP SOCKET SHOULDER DI |
| L6690 | FRAME TYP SOCK INTERSCAP-THO |
| L6691 | REMOVABLE INSERT EACH |
| L6692 | SILICONE GEL INSERT OR EQUAL |
| L6693 | LOCKINGELBOW FOREARM CNTRBAL |
| L6694 | ELBOW SOCKET INS USE W/LOCK |
| L6695 | ELBOW SOCKET INS USE W/O LCK |
| L6696 | CUS ELBO SKT IN FOR CON/ATYP |
| L6697 | CUS ELBO SKT IN NOT CON/ATYP |
| L6698 | BELOW/ABOVE ELBOW LOCK MECH |
| L6703 | TERM DEV, PASSIVE HAND MITT |
| L6704 | TERM DEV, SPORT/REC/WORK ATT |
| L6706 | TERM DEV MECH HOOK VOL OPEN |
| L6707 | TERM DEV MECH HOOK VOL CLOSE |
| L6708 | TERM DEV MECH HAND VOL OPEN |
| L6709 | TERM DEV MECH HAND VOL CLOSE |
| L6711 | PED TERM DEV, HOOK, VOL OPEN |
| L6712 | PED TERM DEV, HOOK, VOL CLOS |
| L6713 | PED TERM DEV, HAND, VOL OPEN |
| L6714 | PED TERM DEV, HAND, VOL CLOS |
| L6715 | TERMINAL DEVICE, MULTIPLE ARTICULATING DIGIT, INCLUDES MOTOR(S), INITIAL ISSUE |
| L6721 | HOOK/HAND, HVY DTY, VOL OPEN |
| L6722 | HOOK/HAND, HVY DTY, VOL CLOS |
| L6805 | TERM DEV MODIFIER WRIST UNIT |
| L6810 | TERM DEV PRECISION PINCH DEV |
| L6880 | ELECTRIC HAND, SWITCH OR MYOLELECTRIC CONTROLLED, INDEPENDENTLY ARTICULATING |
| L6881 | TERM DEV AUTO GRASP FEATURE |
| L6882 | MICROPROCESSOR CONTROL UPLMB |
| L6883 | REPLC SOCKT BELOW E/W DISA |
| L6884 | REPLC SOCKT ABOVE ELBOW DISA |
| L6885 | REPLC SOCKT SHLDR DIS/INTERC |
| L6890 | PREFAB GLOVE FOR TERM DEVICE |
| L6895 | CUSTOM GLOVE FOR TERM DEVICE |
| L6900 | HAND RESTORAT THUMB/1 FINGER |
| L6905 | HAND RESTORATION MULTIPLE FI |
| L6910 | HAND RESTORATION NO FINGERS |
| L6915 | HAND RESTORATION REPLACMNT G |
| L6920 | WRIST DISARTICUL SWITCH CTRL |
| L6925 | WRIST DISART MYOELECTRONIC C |
| L6930 | BELOW ELBOW SWITCH CONTROL |
| L6935 | BELOW ELBOW MYOELECTRONIC CT |
| L6940 | ELBOW DISARTICULATION SWITCH |
| L6945 | ELBOW DISART MYOELECTRONIC C |
| L6950 | ABOVE ELBOW SWITCH CONTROL |
| L6955 | ABOVE ELBOW MYOELECTRONIC CT |
| L6960 | SHLDR DISARTIC SWITCH CONTRO |
| L6965 | SHLDR DISARTIC MYOELECTRONIC |
| L6970 | INTERSCAPULAR-THOR SWITCH CT |
| L6975 | INTERSCAP-THOR MYOELECTRONIC |
| L7007 | ADULT ELECTRIC HAND |
| L7008 | PEDIATRIC ELECTRIC HAND |
| L7009 | ADULT ELECTRIC HOOK |
| L7040 | PREHENSILE ACTUATOR |
| L7045 | PEDIATRIC ELECTRIC HOOK |
| L7170 | ELECTRONIC ELBOW HOSMER SWIT |
| L7180 | ELECTRONIC ELBOW SEQUENTIAL |
| L7181 | ELECTRONIC ELBO SIMULTANEOUS |
| L7185 | ELECTRON ELBOW ADOLESCENT SW |
| L7186 | ELECTRONIC ELBOW CHILD SWITCH |
| L7190 | ELBOW ADOLESCENT MYOELECTRON |
| L7191 | ELBOW CHILD MYOELECTRONIC CT |
| L7259 | ELECTRONIC WRIST ROTATOR, ANY TYPE |
| L7360 | SIX VOLT BAT OTTO BOCK/EQ EA |
| L7364 | TWELVE VOLT BATTERY UTAH/EQU |
| L7400 | ADD UE PROST BE/WD, ULTLITE |
| L7401 | ADD UE PROST A/E ULTLITE MAT |
| L7402 | ADD UE PROST S/D ULTLITE MAT |
| L7403 | ADD UE PROST B/E ACRYLIC |
| L7404 | ADD UE PROST A/E ACRYLIC |
| L7405 | ADD UE PROST S/D ACRYLIC |
| L7499 | UPPER EXTREMITY PROSTHES NOS |
| L7510 | PROSTHETIC DEVICE REPAIR REP |
| L7600 | PROSTHETIC DONNING SLEEVE |
| L7700 | GASKET OR SEAL, FOR USE WITH PROSTHETIC SOCKET INSERT, ANY TYPE, EACH |
| L8039 | BREAST PROSTHESIS, NOS |
| L8040 | NASAL PROSTHESIS |
| L8041 | MIDFACIAL PROSTHESIS |
| L8042 | ORBITAL PROSTHESIS |
| L8043 | UPPER FACIAL PROSTHESIS |
| L8044 | HEMI-FACIAL PROSTHESIS |
| L8045 | AURICULAR PROSTHESIS |
| L8046 | PARTIAL FACIAL PROSTHESIS |
| L8047 | NASAL SEPTAL PROSTHESIS |
| L8048 | UNSPEC MAXILLOFACIAL PROSTH |
| L8049 | REPAIR MAXILLOFACIAL PROSTH |
| L8400 | SHEATH BELOW KNEE |
| L8410 | SHEATH ABOVE KNEE |
| L8415 | SHEATH UPPER LIMB |
| L8417 | PROS SHEATH/SOCK W GEL CUSHN |
| L8420 | PROSTHETIC SOCK MULTI PLY BK |
| L8430 | PROSTHETIC SOCK MULTI PLY AK |
| L8435 | PROS SOCK MULTI PLY UPPER LM |
| L8440 | SHRINKER BELOW KNEE |
| L8460 | SHRINKER ABOVE KNEE |
| L8465 | SHRINKER UPPER LIMB |
| L8470 | PROS SOCK SINGLE PLY BK |
| L8480 | PROS SOCK SINGLE PLY AK |
| L8485 | PROS SOCK SINGLE PLY UPPER L |
| L8499 | UNLISTED MISC PROSTHETIC SER |
| L8500 | ARTIFICIAL LARYNX |
| L8501 | TRACHEOSTOMY SPEAKING VALVE |
| L8505 | ARTIFICIAL LARYNX, ACCESSORY |
| L8507 | TRACH-ESOPH VOICE PROS PT IN |
| L8509 | TRACH-ESOPH VOICE PROS MD IN |
| L8510 | VOICE AMPLIFIER |
| L8511 | INDWELLING TRACH INSERT |
| L8512 | GEL CAP FOR TRACH VOICE PROS |
| L8513 | TRACH PROS CLEANING DEVICE |
| L8514 | REPL TRACH PUNCTURE DILATOR |
| L8515 | GEL CAP APP DEVICE FOR TRACH |
| L8600 | IMPLANT BREAST SILICONE/EQ |
| L8603 | COLLAGEN IMP URINARY 2.5 ML |
| L8604 | DEXTRANOMER/HYALURONIC ACID |
| L8605 | INJECTABLE BULKING AGENT, DEXTRANOMER/HYALURONIC ACID COPOLYMER IMPLANT, ANAL |
| L8606 | SYNTHETIC IMPLNT URINARY 1ML |
| L8607 | INJECTABLE BULKING AGENT FOR VOCAL CORD MEDIALIZATION, 0.1 ML |
| L8609 | ARTIFICIAL CORNEA |
| L8612 | AQUEOUS SHUNT PROSTHESIS |
| L8613 | OSSICULAR IMPLANT |
| L8614 | COCHLEAR DEVICE |
| L8615 | COCH IMPLANT HEADSET REPLACE |
| L8616 | COCH IMPLANT MICROPHONE REPL |
| L8617 | COCH IMPLANT TRANS COIL REPL |
| L8618 | COCH IMPLANT TRAN CABLE REPL |
| L8619 | COCH IMP EXT PROC/CONTR RPLC |
| L8623 | LITH ION BATT CID,NON-EARLVL |
| L8624 | LITH ION BATT CID, EAR LEVEL |
| L8625 | EXTERNAL RECHARG SYS FOR COCHLEAR IMPLANT OR AUDITORY OSSEOINTEGRATED DEVICE BATTERY, REPL ONLY, EA |
| L8627 | CID EXT SPEECH PROCESS REPL |
| L8628 | CID EXT CONTROLLER REPL |
| L8629 | CID TRANSMIT COIL AND CABLE |
| L8631 | MCP JOINT REPL 2 PC OR MORE |
| L8641 | METATARSAL JOINT IMPLANT |
| L8642 | HALLUX IMPLANT |
| L8658 | INTERPHALANGEAL JOINT SPACER |
| L8659 | INTERPHALANGEAL JOINT REPL |
| L8670 | VASCULAR GRAFT, SYNTHETIC |
| L8679 | IMPLANTABLE NEUROSTIMULATOR PULSE GENERATOR ANY |
| L8680 | IMPLT NEUROSTIM ELCTR EACH |
| L8681 | PT PRGRM FOR IMPLT NEUROSTIM |
| L8682 | IMPLT NEUROSTIM RADIOFQ REC |
| L8683 | RADIOFQ TRSMTR FOR IMPLT NEU |
| L8684 | RADIOF TRSMTR IMPLT SCRL NEU |
| L8685 | IMPLT NROSTM PLS GEN SNG REC |
| L8686 | IMPLT NROSTM PLS GEN SNG NON |
| L8687 | IMPLT NROSTM PLS GEN DUA REC |
| L8688 | IMPLT NROSTM PLS GEN DUA NON |
| L8689 | EXTERNAL RECHARG SYS INTERN |
| L8690 | AUD OSSEO DEV, INT/EXT COMP |
| L8691 | OSSEOINTEGRATED SND PROC RPL |
| L8692 | NON-OSSEOINTEGRATED SND PROC |
| L8693 | AUD OSSEO DEV, ABUTMENT |
| L8694 | AUDITORY OSSEOINTEGRATED DEVICE, TRANSDUCER/ACTUATOR, REPLACEMENT ONLY, EA |
| L8695 | EXTERNAL RECHARG SYS EXTERN |
| L8696 | ANTENNA (EXTERNAL) FOR IMPL DIAPHRAGMATIC/PHRENIC NERVE STIM DEVICE, REPLACEMENT, EACH |
| L8698 | MISC COMP/SUPPLY/ACCESS USED WITH TOTAL ARTIFICIAL HEART SYSTEM |
| L8699 | PROSTHETIC IMPLANT,NOS |
| L9900 | O&P SUPPLY/ACCESSORY/SERVICE |
| RADIOLOGY-DIAGNOSTIC | |
| CODE | DESCRIPTION |
| 70540 | MRI, FACE, NECK |
| 70542 | MRI, FACE, NECK W/CONTRAST |
| 70543 | MRI, FACE, NECK, COMBO |
| 70544 | MR ANGIO, HEAD |
| 70545 | MR ANGIO, HEAD W/CONTRAST |
| 70546 | MR ANGIO, HEAD, COMBO |
| 70547 | MR ANGIO, NECK |
| 70548 | MR ANGIO, NECK W/CONTRAST |
| 70549 | MR ANGIO, NECK, COMBO |
| 70551 | MRI BRAIN |
| 70552 | MRI BRAIN CONTRAST |
| 70553 | MRI BRAIN COMBO |
| 70554 | FUNCTIONAL MRI BRAIN BY TECH |
| 70555 | FUNCTIONAL MRI BRAIN BY PHYS/PSYCH |
| 71550 | MRI, CHEST |
| 71551 | MRI, CHEST, W/CONTRAST |
| 71552 | MRI, CHEST, COMBO |
| 71555 | MR ANGIO CHEST (MRA) |
| 72141 | MRI, CERV SPINE |
| 72142 | MRI, CERV SPINE CONTRAST |
| 72146 | MRI, DORSAL SPINE |
| 72147 | MRI, DORSAL SPINE CONTRAST |
| 72148 | MRI, LUMBAR SPINE |
| 72149 | MRI, LUMBAR SPINE CONTRAST |
| 72156 | MRI, CERV SPINE COMBO |
| 72157 | MRI, DORSAL SPINE COMBO |
| 72158 | MRI, LUMBAR SPINE COMBO |
| 72159 | MR ANGIO SPINE (MRA) |
| 72195 | MRI, PELVIS, W/O CONTRAST |
| 72196 | MRI, PELVIS W/CONTRAST |
| 72197 | MRI, PELVIS, COMBO |
| 72198 | MR ANGIO PELVIS(MRA) |
| 73218 | MRI, UPPER EXTREM |
| 73219 | MRI, UPPER EXTREM W/CONTRAST |
| 73220 | MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS |
| 73221 | MRI, JOINT UPPER EXTREM |
| 73222 | MRI, JOINT UPPER EXTREM W/CONTRAST |
| 73223 | MRI, JOINT UPPER EXTREM COMBO |
| 73225 | MR ANGIO UPPER EXTREM |
| 73718 | MRI, LOWER EXTREM |
| 73719 | MRI, LOWER EXTREM W/CONTRAST |
| 73720 | MRI, LOWER EXTR, W/O CONTRAST F/U BY CONTRAST |
| 73721 | MRI LOWER EXTREM JT, W/O CONTRAST |
| 73722 | MRI, JOINT OF LEG W/CONTRAST |
| 73723 | MRI, JOINT OF LEG. COMBO |
| 73725 | MR ANGIO LOWER EXTREM (MRA) |
| 74181 | MRI, ABDOMEN (MRI) |
| 74182 | MRI, ABDOMEN W/CONTRAST |
| 74183 | MRI, ABDOMEN, COMBO |
| 74185 | MR ANGIO ABDOMEN (MRA) |
| 74712 | FETAL MRI W/PLACNTL MATRNL PLVC IMG SING/1ST GES |
| 74713 | FETAL MRI W/PLACNTL MATRNL PLVC IMG EA ADDL GES |
| 75894 | TRANSCATHETER RX EMBOLIZATN |
| 76390 | MRI SPECTROSCOPY |
| 76391 | MAGNETIC RESONANCE ELASTOGRAPHY |
| 76496 | UNLISTED FLUOROSCOPIC PROCEDURE |
| 76497 | UNLISTED CT PROCEDURE |
| 76498 | UNLISTED MRI PROCEDURE |
| 76499 | UNLISTED DX RADIOGRAPHIC PROCEDURE |
| 76999 | UNLISTED ULTRASOUND PROCEDURE |
| 77013 | CT GUIDANCE TISSUE ABLATION |
| 77046 | MRI BREAST WITHOUT CONTRAST MATERIAL UNILATERAL |
| 77047 | MRI BREAST WITHOUT CONTRAST MATERIAL BILATERAL |
| 77048 | MRI BREAST W/OUT&WITH CONTRAST W/CAD UNILATERAL |
| 77049 | MRI BREAST WITHOUT&WITH CONTRAST W/CAD BILATERAL |
| 77078 | CT BONE DENS STUDY, 1+ SITE,AXIAL |
| 77084 | MRI, BONE MARROW |
| 77089 | TBS DXA/OTHER IMG CALCULATION W/INTERP AND RPT FX RISK |
| 77090 | TBS TECHL PREP AND TRANSMIS DATA ALYS PFRMD ELSEWHR |
| 77091 | TBS TECHNICAL CALCULATION ONLY |
| 77092 | TBS INTERPRETATION AND REPORT FX RISK BY OTHER QHP |
| 78099 | ENDOCRINE NUCLEAR PROCEDURE |
| 78199 | BLOOD/LYMPH NUCLEAR EXAM UNLISTED |
| 78299 | GI NUCLEAR PROCEDURE UNLISTED |
| 78399 | MUSCULOSKELETAL NUCLEAR EXAM |
| 78429 | MYOCRD IMG PET METAB EVAL SINGLE STUDY CNCRNT CT |
| 78430 | MYOCRD IMG PET PRFUSN 1 STD REST/STRESS CNCRNT CT |
| 78431 | MYOCRD IMG PET PRFUSN MLT STD RST AND STRS CNCRNT CT |
| 78432 | MYOCRD IMG PET PRFUSN W/METAB DUAL RADIOTRACER |
| 78433 | MYOCRD IMG PET PRFUSN W/METAB 2RTRACER CNCRNT CT |
| 78451 | MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS |
| 78459 | HEART MUSCLE IMAGING (PET) |
| 78472 | GATED HEART, PLANAR SINGLE |
| 78473 | GATED HEART, MULTIPLE |
| 78481 | HEART FIRST PASS SINGLE,PLANAR |
| 78483 | HEART FIRST PASS MULTIPLE,PLANAR |
| 78491 | HEART IMAGE (PET) SINGLE |
| 78492 | HEART IMAGE (PET) MULTIPLE |
| 78494 | HEART IMAGE, SPECT |
| 78496 | HEART FIRST PASS ADD-ON |
| 78499 | CARDIOVASC NUCL EXAM UNLISTED |
| 78599 | RESP NUCLEAR EXAM UNLISTED |
| 78608 | BRAIN IMAGING PET METABOLIC |
| 78609 | BRAIN IMAGING PET PERFUSION |
| 78699 | NERV SYS NUCL EXAM UNLISTED |
| 78799 | GU NUCLEAR EXAM UNLISTED |
| 78811 | PET IMAGING LIMITED AREA CHEST HEAD/NECK |
| 78812 | PET IMAGING SKULL BASE TO MID-THIGH |
| 78813 | PET IMAGING WHOLE BODY |
| 78814 | PET IMAGING CT FOR ATTENUATION LIMITED AREA |
| 78816 | PET IMAGING FOR CT ATTENUATION WHOLE BODY |
| 78999 | NUCLEAR DIAGNOSTIC EXAM UNLISTED |
| 79445 | NUCLEAR THERAPY, INTRA-ARTERIAL |
| 79999 | NUCLEAR THERAPY, UNLISTED |
| G0235 | PET NOT OTHERWISE SPECIFIED |
| 75561 | CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY AND FUNCTION WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES |
| RADIOLOGY-THERAPUTIC | |
| CODE | DESCRIPTION |
| 77299 | RADN THERAPY PLANNING UNLISTED |
| 77371 | RADIATION DELIVERY STEREOTACTIC CRANIAL COBALT |
| 77372 | RADIATION DELIVERY STEREOTACTIC CRANIAL LINEAR |
| 77373 | RADN RX DELIV,BODY, EACH FRACTION |
| 77387 | GUIDANCE FOR LOC OF TARGET VOL RADIAJ TX DLVR |
| 77399 | RADIATION DOSIMETRY UNLISTED |
| 77432 | STEREOTACTIC RADIATION TX MANAGEMENT CRANIAL LESION |
| 77435 | RADN RX DELIV,BODY, MANAGEMENT, PER COURSE |
| 77499 | RADIATION,MANGEMENT,THERAP-OTH |
| 77520 | PROTON BEAM DEL,SIMPLE |
| 77522 | PROTON BEAM DEL,SINGLE, W/COMPENSAT |
| 77523 | PROTON,BEAM DEL,INTERMED |
| 77525 | PROTON BEAM DEL,MULTIPLE,COMPLEX |
| 77610 | HYPERTHERMIA INTERN =<5 APPL |
| 77615 | HYPERTHERMIA INTERN >5 APPL |
| 77620 | HYPERTHERMIA RX INTRACAV PROBE |
| 77799 | RADIUM/RADIOISOTOPE THERAPY UNLIST |
| G0339 | ROBOT LIN-RADSURG COM, FIRST |
| G0340 | ROBT LIN-RADSURG FRACTX 2-5 |
| G6016 | COMPENSATOR-BASED BEAM MOD TX DEL OF INVERSE PLANNED TX, PER SESSION |
| 0398T | MRGFUS STEREOTACTIC ABLATION LESION INTRACRANIAL |
| SURGERY-AUDITORY-SYSTEM | |
| CODE | DESCRIPTION |
| 69300 | REVISE EXTERNAL EAR |
| 69399 | OUTER EAR SURGERY PROC UNLISTED |
| 69711 | REMOVE/REPAIR HEAR AID,TEMP BONE |
| 69714 | IMPLNT,TEMPORAL BONE,W/EXTRN STIM |
| 69716 | IMPLTN OI IMPLT SKULL MAG TC ATTACHMENT ESP |
| 69717 | REPLCE IMPLNT,TEMPORAL BONE,W/EXTRN STIM |
| 69719 | REVSN/RPLCMT OI IMPLT SKULL MAG TC ATTACHMENT ESP |
| 69726 | REMOVAL OI IMPLT SKULL PERQ ATTACHMENT ESP |
| 69727 | REMOVAL OI IMPLT SKULL MAG TC ATTACHMENT ESP |
| 69728 | RMVL ENTIRE OI IMPLT SKL MAG TC ATTCH ESP >=100 |
| 69729 | IMPL OI IMPLT SKULL MAG TC ATTACHMENT ESP>=100 |
| 69730 | RPLCMT OI IMPLT SKULL MAG TC ATTACHMENT ESP>=100 |
| 69799 | MIDDLE EAR SURGERY PROC UNLISTED |
| 69930 | IMPLANT COCHLEAR DEVICE |
| 69949 | INNER EAR SURGERY PROC UNLISTED |
| 69979 | TEMPORAL BONE,MIDDLE,SURG UNLISTED |
| SURGERY-CARDIOVASCULAR-SYSTEM | |
| CODE | DESCRIPTION |
| 33230 | INS PACNG CVDFB PLS GEN ONLY W/EXIST DUAL LEADS |
| 33231 | INS PACNG CVDFB PLS GEN ONLY W/EXIST MULTI LEADS |
| 33240 | INSERT PULSE GEN,SNGL/DUAL |
| 33249 | INSERT ELECTRD LEADS/REPOSTION |
| 33267 | EXCLUSION LEFT ATRIAL APPENDAGE OPEN ANY METHOD |
| 33268 | EXCLUSION LAA OPEN TM STRNT/THRCM ANY METHOD |
| 33270 | INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD |
| 33361 | REPLACE AORTIC VALVE PERQ FEMORAL ARTRY APPROACH |
| 33362 | REPLACE AORTIC VALVE OPENFEMORAL ARTERY APPROACH |
| 33363 | REPLACE AORTIC VALVE OPEN AXILLRY ARTRY APPROACH |
| 33364 | REPLACE AORTIC VALVE OPEN ILIAC ARTERY APPROACH |
| 33365 | REPLACE AORTIC VALVE OPEN TRANSAORTIC APPROACH |
| 33366 | TRANSCATHETER TRANSAPICAL REPLACEMT AORTIC VALVE |
| 33367 | REPLACE AORTIC VALVE W/BYP PRQ ART/VENOUS APPRCH |
| 33368 | REPLACE AORTIC VALVE W/BYP OPEN ART/VENOUS APRCH |
| 33369 | REPLACE AORTA VALVE W/BYP CNTRL ART/VENOUS APRCH |
| 33370 | INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD |
| 33405 | REPLACE AORT VALV,PROSTH VALV |
| 33406 | REPLACE AORT VALVE W/ALLOGRAFT VALVE |
| 33411 | REPLAC AORT VALV W ANNULU ENLRG |
| 33412 | REPLAC AO VALV XVENT AO ANNUL ENLG |
| 33413 | REPL AORT VALVE,TRANSLOC AUTOL PULM VALV |
| 33418 | TCAT MITRAL VALVE REPAIR INITIAL PROSTHESIS |
| 33419 | TCAT MITRAL VALVE REPAIR ADDL PROSTHESIS |
| 33465 | REPLACE TRICUSPID W CP BYPASS |
| 33475 | REPLACEMENT, PULMONARY VALVE |
| 33477 | TCAT PULMONARY VALVE IMPLANTATION PRQ APPROACH |
| 33894 | EVASC ST RPR COARC THRC/AA ACRS MAJ SIDE BRNCH |
| 33895 | EVASC ST RPR COARC THRC/AA XCRSG MAJ SIDE BRNCH |
| 33897 | PERQ TRANSLUMINAL ANGIOPLASTY NATIVE/RECR COA |
| 33900 | PERQ P-ART REVSC ST 1ST NML NATIVE CONNECTN UNI |
| 33901 | PERQ P-ART REVSC ST 1ST NML NATIVE CONNECTN BI |
| 33902 | PERQ P-ART REVSC ST 1ST ABNOR CONNECTN UNILATERAL |
| 33903 | PERQ P-ART REVSC ST 1ST ABNORMAL CONNECTN BILATERAL |
| 33904 | PERQ P-ART REVSC ST EA ADDL VSL/SEP LES NM/ABNL |
| 33927 | IMPLT TOTAL RPLCMT HEART SYS W/RECIPIENT CARDIECTOMY |
| 33928 | REMOVAL & RPLCMT TOTAL RPLCMT HEART SYS |
| 33930 | REMOVAL OF DONOR HEART/LUNG |
| 33933 | TRANSPLANT,PREP DONOR HEART/LUNG |
| 33935 | TRANSPLANTATION, HEART/LUNG |
| 33940 | REMOVAL OF DONOR HEART |
| 33944 | TRANSPLANT,PREP DONOR HEART |
| 33945 | TRANSPLANTATION OF HEART |
| 33975 | INSERT VENT ASST DEVICE,SINGLE VENTRICLE |
| 33976 | INSERT VENT ASST DEVICE,BIVENTRICULAR |
| 33979 | INSERT VENT ASST DEV,IMPLANT,SINGLE VENT |
| 33995 | INSERTION PERQ VAD W/RAD SUP AND INTERP RIGHT HEART VENOUS ACCESS ONLY |
| 33999 | CARDIAC SURG PROCEDURE UNLIST |
| 34701 | ENDOVASC REPAIR DEPLOYMENT AORTO-AORTIC ENDOGRAFT |
| 34702 | ENDOVASC REPAIR DEPLOYMENT AORTO-AORTIC ENDOGRAFT RUPTURE |
| 34703 | ENDOVASC REPAIR DEPLOYMENT AORTO-UN-ILIAC ENDOGRAFT |
| 34704 | ENDOVASC REPAIR DEPLOYMENT AORTO-UN-ILIAC ENDOGRAFT RUPTURE |
| 34705 | ENDOVASC REPAIR DEPLOYMENT AORTO-BI-ILIAC ENDOGRAFT |
| 34706 | EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT |
| 34707 | EVASC RPR DPLMNT ILIO-ILIAC NDGFT |
| 34708 | ENDOVASC REPAIR DEPLOYMENT ILIO-ILIAC ENDOGRAFT RUPTURE, UNILAT |
| 34709 | PLACEMENT EXTENSION PROSTH FOR ENDOVASCULAR REPAIR |
| 34710 | DELAYED PLACEMENT EXTENSION PROSTH FOR ENDOVASC REPAIR, FIRST VESSEL |
| 34711 | DELAYED PLACEMENT EXTENSION PROSTH FOR ENDOVASC REPAIR, EA ADDL |
| 34712 | TRANSCATHETER DELIVERY ENHANCED FIXATION DEVICES RS&I |
| 34713 | PERQ ACCESS & CLOSURE FEMORAL ARTERY FOR DELIVERY ENDOGRAFT |
| 34714 | OPEN FEMORAL ARTERY EXPOSURE W/CONDUIT CREATION DELIVERY ENDOVASC PROSTH, UNILAT |
| 34715 | OPEN AXILLARY/SUBCLAVIAN ARTERY EXPOSURE DELIVERY ENDOVASC PROSTH, UNILAT |
| 34716 | OPEN AXILLARY/SUBCLAVIAN ARTERY EXPOSURE W/CONDUIT CREATION |
| 35601 | BYPASS GRAFT OTHR,CAROTID |
| 35606 | BYPASS GRAFT OTHR,CAROT-SUBCL |
| 35612 | BYPASS GRAFT OTHR,SUBCL-SUBCL |
| 35616 | BYPASS GRAFT OTHR,SUBCL-AXILL |
| 35621 | BYPASS GRAFT OTHR,AXILL-FEM |
| 35623 | BYPASS GRAFT OTHR,AXILL-POP |
| 35626 | BYPASS GRAFT OTHR,AORTO-SUBCL |
| 35631 | BYPASS GRAFT OTHR,AORTO-MESENTER |
| 35632 | BYPASS GRAFT OTHR, ILIO-CELIAC |
| 35633 | BYPASS GRAFT OTHR,ILIO-MESENTERIC |
| 35634 | BYPASS GRAFT OTHR, ILIORENAL |
| 35636 | BYPASS GRAFT OTHR,SPLENO-RENAL |
| 35637 | BYPASS GRAFT OTHR,AORTOILIAC |
| 35638 | BYPASS GRAFT OTHR,AORTOBI-ILIAC |
| 35642 | BYPASS GRAFT OTHR,CAROT-VERT |
| 35645 | BYPASS GRAFT OTHR,SUBCL-VERT |
| 35646 | BYPASS GRAFT OTHR,AORTOBIFEMORAL |
| 35647 | BYPASS GRAFT OTHR,AORTOFEMORAL |
| 35650 | BYPASS GRAFT OTHR,AXILL-AXILL |
| 35654 | BYPASS GRAFT OTHR,AXILL-FEM-FEM |
| 35663 | BYPASS GRAFT OTHR,ILIOILIAC |
| 36299 | VESSEL INJECTION PROCEDURE UNLISTED |
| 36465 | INJ NONCMPND SCLEROSANT SINGLE INCOMPETENT VEIN |
| 36466 | INJ NONCMPND SCLEROSANT MULTIPLE INCOMPETENT VEINS |
| 36470 | INJECTION THERAPY VEIN,ONE VEIN |
| 36471 | INJECTION THERAPY VEIN,MULT VEINS |
| 36473 | ENDOVEN ABLTN INCMPTNT VEIN MCHNCHEM 1ST VEIN |
| 36474 | ENDOVEN ABLTN INCMPTNT VEIN MCHNCHEM SBSQ VEINS |
| 36475 | ENDOVENOUS RF, 1ST VEIN |
| 36476 | ENDOVENOUS RF, VEIN ADD-ON |
| 36478 | ENDOVENOUS LASER, 1ST VEIN |
| 36479 | ENDOVENOUS LASER VEIN ADDON |
| 36482 | ENDOVENOUS ABLATION THER CHEM ADHESIVE 1ST VEIN |
| 36483 | ENDOVENOUS ABLATION THER CHEM ADHESIVE SBSQ VEIN |
| 36836 | PERQ AV FISTULA CREATION UXTR SINGLE ACCESS |
| 36837 | PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES |
| 37215 | TRANSCATH STENT, CCA W/EPS |
| 37216 | TRANSCATH STENT, CCA W/O EPS |
| 37217 | TCATH STENT PLACEMT RETROGRAD CAROTID/INNOMINATE |
| 37238 | OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST |
| 37239 | OPEN/PERQ PLACEMT INTRAVASC STENT SAME EA ADDL |
| 37241 | VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I |
| 37243 | VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT |
| 37246 | TRLML BALO ANGIOP OPEN/PERQ IMG S&I 1ST ART |
| 37247 | TRLML BALO ANGIOP OPEN/PERQ IMG S&I EA ADDL ART |
| 37248 | TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I 1ST VEIN |
| 37249 | TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I ADDL VEIN |
| 37501 | UNLISTED VASCULAR ENDOSCOPY PROC |
| 37700 | LIGATN LONG SAPHENOUS VEIN AT SEPH-FEM JUNC |
| 37718 | LIGATE/STRIP SHORT SAPEHNOUS VEIN |
| 37722 | LIGATE/STRIP LONG SAPH VEIN BELW SEP-FEM JUNC |
| 37735 | REMOVAL OF LEG VEINS/ULCER |
| 37760 | LIGATN PERFORATORS,SUBFASC,RADICAL,OPEN |
| 37761 | LIGATN PERFORATORS,SUBFASC,OPEN, INCL U/S, 1 LEG |
| 37765 | PHLEB VEINS - EXTREM - TO 20 |
| 37766 | PHLEB VEINS - EXTREM 20+ |
| 37780 | LIGATN SHORT SAPHEN |
| 37785 | REVISE SECONDARY VARICOSITY |
| 37799 | VASCULAR SURGERY PROCEDURE UNLIST |
| SURGERY - DIGESTIVE SYSTEM | |
| CODE | DESCRIPTION |
| 40799 | LIP SURGERY PROC UNLISTED |
| 40899 | MOUTH SURGERY PROC UNLISTED |
| 41019 | PLACEMENT NEEDLE HEAD/NECK RADIOELEMENT APPLICAT |
| 41120 | PART REMOVAL TONGUE,<1/2 |
| 41512 | TONGUE BASE SUSPENSION, PERM SUTURE |
| 41599 | TONGUE AND MOUTH SURG UNLISTED |
| 41899 | DENTAL SURGERY PROCEDURE |
| 42140 | EXCISION OF UVULA |
| 42145 | PALATOPHAYNGOPLASTY |
| 42160 | DESTRUC LESN PALATE/UVULA |
| 42299 | PALATE/UVULA SURGERY UNLISTED |
| 42699 | SALIVARY SURG UNLISTED PROC |
| 42999 | THROAT SURGERY PROCEDURE UNLISTED |
| 43253 | EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER |
| 43279 | LAP, ESOPHAGOMYOTOMY W FUNDOPLASTY |
| 43289 | LAP,ESOPHAGUS,OTHER PROC |
| 43499 | ESOPHAGUS SURG PROCEDURE UNLISTED |
| 43633 | REMV STOMACH,PART,DISTAL,ROUX-EN-Y |
| 43644 | LAP GASTRIC BYPASS/ROUX-EN-Y |
| 43645 | LAP GASTR BYPASS INCL SMLL INT RECON |
| 43647 | LAP IMPLANT/ REPLACE GASTRIC NEUROSTIM ANTRUM |
| 43648 | LAP REVISE/REMOVE GASTRIC NEUROSTIM ANTRUM |
| 43659 | UNLISTED LAPAROSCOPIC PROCEDURE, STOMACH |
| 43775 | LAP, GAST RESTRICT PROC, LONGITUDINAL GASTRECTOMY |
| 43845 | GASTROPLASTY DUODENAL SWITCH |
| 43846 | GASTRIC BYPASS,OBESE<100CM ROUX-EN-Y |
| 43848 | REVISION GASTROPLASTY,OBESITY, NON-GAST RESTRICT DEVICE |
| 43860 | REVISE,GASTROJEJUN ANAST,W/O VAGOTOMY |
| 43865 | REVISE GASTROJEJUN ANAST,W VAGOTOMY |
| 43886 | REVISE GASTRIC PORT, OPEN |
| 43887 | REMOVE GASTRIC PORT, OPEN |
| 43999 | STOMACH SURGERY PROCEDURE UNLISTED |
| 44135 | ALLOTRANSPLANT,INTESTINE,CADAVER DNR |
| 44136 | ALLOTRANSPLANT,INTESTINE,LIVING DONOR |
| 44238 | UNLISTED LAPAROSCOPY PROC,INTESTINE |
| 44705 | PREPARE FECAL MICROBIOTA FOR INSTILLATION |
| 44799 | INTESTINE SURG PROCEDURE UNLISTED |
| 44899 | UNLISTED PROC,MECKEL/MESENTERY |
| 44979 | LAP,APPENDIX UNLISTED PROCED |
| 45399 | UNLISTED PROCEDURE COLON |
| 45499 | UNLISTED LAP PROCEDURE, RECTUM |
| 45999 | RECTUM SURGERY PROCEDURE UNLISTED |
| 46999 | ANUS SURGERY PROCEDURE UNLISTED |
| 47135 | TRANSPLANT LIVER,ALLOTRANSPLANT |
| 47143 | TRANSPLANT,PREP DONOR LIVER, WHOLE |
| 47144 | TRANSPLANT,PREP DONOR LIVER, 3-SEGMENT |
| 47145 | TRANSPLANT,PREP DONOR LIVER, LOBE SPLIT |
| 47146 | TRANSPLANT,PREP DONOR LIVER/VENOUS |
| 47147 | TRANSPLANT,PREP DONOR LIVER/ARTERIAL |
| 47370 | LAP,ABLAT 1+ LIVER TUMOR(S),RADIOFREQ |
| 47371 | LAP,ABLAT 1+ LIVER TUMOR(S),CRYO |
| 47379 | UNLISTED LAPAROSCOPIC PROC, LIVER |
| 47380 | ABLAT,OPEN,1+ LIVER TUMOR(S),RADIOFREQ |
| 47381 | ABLAT,OPEN,1+ LIVER TUMOR(S),CRYO |
| 47382 | ABLAT,OPEN,1+ LIVER TUMOR(S),PERCUT RF |
| 47383 | ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION |
| 47399 | LIVER SURGERY PROCEDURE UNLISTED |
| 47579 | LAP,BILIARY TRACT,UNLISTED |
| 47999 | BILE TRACT SURG PROC, UNLISTED |
| 48160 | PANCREATECTOMY,W/AUTOLOGOUS TRANSPLANT |
| 48551 | TRANSPLANT,PREP DONOR PANCREAS |
| 48552 | TRANSPLANT,PREP DONOR PANCREAS/VENOUS |
| 48554 | TRANSPLANT ALLOGRAFT PANCREAS |
| 48999 | PANCREAS SURGERY PROC UNLISTED |
| 49329 | LAP,ABD/PERIT/OMENTUM,UNLIST |
| 49591 | RPR AA HERNIA 1ST < 3 CM REDUCIBLE |
| 49592 | RPR AA HERNIA 1ST < 3 CM INCRCRATED/STRANGULATED |
| 49593 | RPR AA HERNIA 1ST 3-10 CM REDUCIBLE |
| 49594 | RPR AA HERNIA 1ST 3-10 CM INCRCRATED/STRANGULATED |
| 49595 | RPR AA HERNIA 1ST > 10 CM REDUCIBLE |
| 49596 | RPR AA HERNIA 1ST > 10 CM INCRCRATED/STRANGULATED |
| 49613 | RPR AA HERNIA RECR < 3 CM REDUCIBLE |
| 49614 | RPR AA HERNIA RECR < 3 CM INCRCRATED/STRANGULATED |
| 49615 | RPR AA HERNIA RECR 3-10 CM REDUCIBLE |
| 49616 | RPR AA HERNIA RECR 3-10 CM INCRCRATED/STRANGULATED |
| 49617 | RPR AA HERNIA RECR > 10 CM REDUCIBLE |
| 49618 | RPR AA HERNIA RECR > 10 CM INCRCRATED/STRANGULATED |
| 49659 | LAP,HERNIA REPAIR PROC,UNLIST |
| 49999 | ABDOMEN SURGERY PROC UNLISTED |
| SURGERY - EYE & OCULAR ADNEXA | |
| CODE | DESCRIPTION |
| 0402T | COLLAGEN CROSS-LINKING OF CORNEA |
| 0671T | INSRTN ANT SGM DRG DEV TRAB MW W/O RES AND CTRC RMVL 1+ |
| 0707T | INJ BONE SUB MATRL INTO SUBCHONDRAL BONE DEFECT |
| 65785 | IMPLANTATION INTRASTROMAL CORNEAL RING SEGMENTS |
| 66179 | AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT |
| 66180 | WATER SHUNT-EXTRAOCUL RESERV |
| 66183 | INSERT ANTER DRAINAGE DEV W/O EXTRAOC RESERVOIR |
| 66184 | REVJ SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT |
| 66185 | REVISE EYE SHUNT |
| 66989 | XCAPSL CTRC RMVL INSRTN IO LENS PRSTH CPLX INSRTN 1+ |
| 66991 | XCAPSL CTRC RMVL INSJ IO LENS PROSTH INSRTN 1+ |
| 66999 | EYE SURG ANT SGMT PROC UNLISTED |
| 67299 | EYE SURG POST SGMT PROC UNLISTED |
| 67399 | EYE MUSCLE SURG PROC UNLISTED |
| 67599 | ORBIT SURGERY PROC UNLISTED |
| 67900 | REPAIR BROW PTOSIS |
| 67901 | FIX LID PTOSIS,FRONTALIS MUSC,SUT |
| 67902 | FIX LID PTOSIS,FRONT MUSC,FAS SLNG |
| 67903 | FIX LID PTOSIS,LEVATR RESEC,INTERN |
| 67904 | FIX LID PTOSIS,LEVATR RESEC,EXTERN |
| 67906 | FIX LID PTOSIS,SUPER RECTUS TECH |
| 67908 | FIX LID PTOSIS,FASANELLA-SERVAT |
| 67909 | REDN OVERCORRECTN OF LID PTOSIS |
| 67950 | CANTHOPLASTY |
| 67999 | REVISION EYELID UNLISTED |
| 68399 | CONJUNCTIVAL SURGERY UNLISTED |
| 68841 | INSRTN RX ELUTING IMPLT PUNCTAL DILAT LAC CANAL EA |
| 68899 | TEAR DUCT SYSTEM SURG UNLISTED |
| SURGERY - FEMALE GENITAL SYSTEM | |
| CODE | DESCRIPTION |
| 56625 | COMPLETE SIMPLE REMV VULVA |
| 56800 | PLASTIC REPAIR INTROITUS |
| 56805 | REPAIR CLITORIS |
| 57110 | COMPLETE REMOVAL OF VAGINA WALL |
| 57291 | CONSTRUCTION ARTIFIC VAGINA |
| 57292 | CONSTRUCT ARTIFIC VAGINA W GRAFT |
| 57335 | REVISE VAGINA FOR INTERSEC STATE |
| 58140 | MYOMECTOMY 1-4,W/TOT 250GMS/<,ABD APPRCH |
| 58145 | EXCIS UTERINE FIBROID,VAG APPRCH |
| 58146 | MYOMECTOMY 5/>,TOT>250 GMS,ABD APPRCH |
| 58150 | TOTAL ABDOM HYSTERECTOMY |
| 58152 | TOTAL ABD HYSTERECTOMY+BLAD REPR |
| 58180 | SUPRACERV ABD HYSTERECTOMY |
| 58260 | VAGINAL HYSTERECTOMY,UTERUS 250 GMS/< |
| 58262 | VAG HYST,RMV TUBE/OVARY |
| 58263 | VAG HYST,RMV TUBE/OVARY,FIX ENTEROCE |
| 58267 | VAG HYST,REV VAG/URETHRA |
| 58270 | VAG HYST,REV VAG/URETHR,FIX ENTEROCE |
| 58275 | VAG HYST, W/VAGINECTOMY |
| 58280 | VAG HYST,RMV VAG,FIX ENTEROCELE |
| 58285 | VAG HYST RADICAL |
| 58290 | VAG HYST,UTERUS >250 GMS |
| 58291 | VAG HYST,UTERUS >250 GMS,REM TUBE/OVARY |
| 58292 | VAG HYST,>250 GMS,SOOPH,REENTEROCELE |
| 58294 | VAG HYST,>250 GMS,REENTEROCELE |
| 58350 | REOPEN FALLOPIAN TUBE,CHROMOTUBATION |
| 58540 | REVISION OF UTERINE ANOMALY |
| 58541 | LAP, SUPRACERVIAL HYSTERECTOMY, <250G |
| 58542 | LAP, SUPRACERVIAL HYSTERECTOMY W/ TUBE&OV, <250G |
| 58543 | LAP, SUPRACERVIAL HYSTERECTOMY, >250G |
| 58544 | LAP, SUPRACERVIAL HYSTERECTOMY W/ TUBE&OV, >250G |
| 58545 | LAP,MYOMECTOMY 1-4,TOT WT 250 GMS |
| 58546 | LAP,MYOMECTOMY 5/>,TOTAL WT >250 GMS |
| 58550 | LAP,VAG HYST,UTERUS 250GMS/< |
| 58552 | LAP,VAG HYST,UTERUS 250GMS/<,SALP-OOPH |
| 58553 | LAP,VAG HYST,UTERUS >250GMS |
| 58554 | LAP,VAG HYST,UTERUS >250GMS,SALP-OOPH |
| 58563 | HYSTEROSCOPY,W/ENDOMETRIAL ABLATION |
| 58570 | LAPAROSCOPY W TOT HYSTERECT UTERUS 250 GRAM OR LESS |
| 58571 | LAPAROSCOPY W TOT HYSTERECTUTERUS <=250 GRAM W TUBE/OVARY |
| 58572 | LAPAROSCOPY TOTAL HYSTERECTOMY UTERUS > 250 GRAM |
| 58573 | LAPAROSCOPY TOT HYSTERECTOMY UTERUS >250 GRAM W TUBE/OVARY |
| 58578 | LAP,UTERUS,UNLISTED PROCEDURE |
| 58579 | HYSTEROSCOPY,UTERUS,UNL PROC |
| 58660 | LAP,LYSIS OF ADHESIONS |
| 58661 | LAP,RMV ADNEXAL STRUCTURE |
| 58673 | LAP,SALPINGOSTOMY |
| 58679 | LAP,OVIDUCT/OVARY,UNLIST PROC |
| 58700 | REMOVAL OF FALLOPIAN TUBE |
| 58720 | REMOVAL OF OVARY/TUBE(S) |
| 58740 | LYSIS ADNEXAL ADHESIONS |
| 58760 | FIMBRIOPLASTY |
| 58770 | CREATE NEW TUBAL OPENING |
| 58920 | PARTIAL REMOVAL OF OVARY(S) |
| 58940 | REMOVAL OF OVARY(S) |
| 58999 | GENITAL SURG PROC, FEMALE UNLISTED |
| 38129 | LAP PROC,SPLEEN,UNLISTED |
| SURGERY - HEMIC & LYMPHATIC | |
| CODE | DESCRIPTION |
| 38205 | PROG CELL HARVEST,TRANSPLANT,ALLOGENIC |
| 38206 | PROG CELL HARVEST,TRANSPLANT,AUTOLOGOUS |
| 38230 | BONE MARROW COLLECTION |
| 38232 | BONE MARROW HARVEST TRANSPLANTATION AUTOLOGOUS |
| 38240 | BONE MARROW/STEM XPLANT,ALLOGENIC |
| 38241 | BONE MARROW/STEM XPLANT,AUTOLOGOUS |
| 38242 | BONE MAR/STEM XPLANT,ALLOG DON LYMPH INF |
| 38243 | TRNSPLJ HEMATOPOIETIC CELL BOOST |
| 38589 | LAP,LYMPHATIC SYSTEM,OTHER PROC |
| 38999 | BLOOD/LYMPH SYSTEM PROCEDURE |
| SURGERY - INTEGUMENTARY | |
| CODE | DESCRIPTION |
| 11950 | FILL CONTOUR DEFCT <1CC |
| 11951 | FILL CONTOUR DEFCT 1.1-5CC |
| 11952 | FILL CONTOUR DEFCT 5.1-10CC |
| 11954 | FILL CONTOUR DEFCT >10CC |
| 15115 | EPI AUTOGRFT FACE/NCK/HND/FT/GEN <100 SQCM |
| 15116 | EPI AUTOGRFT FACE/NCK/HND/FT/GEN , EA 100 SQCM |
| 15120 | SPLIT GRFT,HEAD,FAC,HAND,FEET <100CM |
| 15121 | SPLIT GRFT,HEAD,FAC,HAND,FET EA100CM |
| 15135 | DERM AUTOGRAFT FACE/NCK/HND/FT/GEN <100 SQCM |
| 15136 | DERM AUTOGRAFT FACE/NCK/HND/FT/GEN, EA 100 SQCM |
| 15155 | CULT EPIDRM AUTOGRFT,FACE/NCK/HND/FT/GEN <26 SQCM |
| 15156 | CULT EPID AUTOGRFT FACE/NCK/HND/FT/GEN 26-75 SQCM |
| 15157 | CULT EPID AUTOGFT FACE/NCK/HND/FT/GEN EA 100 SQCM |
| 15220 | FULL THICK GRFT SCALP,ARM,LEG <20SQC |
| 15221 | FULL THICK GRFT SCALP,ARM ADD 20SQCM |
| 15275 | SUB GRFT F/S/N/H/F/G/M/D /<100SCM /<1ST 25 SCM |
| 15276 | SUB GRFT F/S/N/H/F/G/M/D /<100SCM EA ADL 25SCM |
| 15277 | SUB GRFT F/S/N/H/F/G/M/D />100SCM 1ST 100SCM |
| 15278 | SUB GRFT F/S/N/H/F/G/M/D />100SCM ADL 100SCM |
| 15734 | MUSCLE-SKIN FLAP,TRUNK |
| 15769 | GRAFTING OF AUTOLOGOUS SOFT TISS BY DIRECT EXCISION |
| 15771 | GRAFTING OF AUTOLOGOUS FAT BY LIPO 50 CC OR LESS |
| 15772 | GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 50 CC |
| 15773 | GRAFTING OF AUTOLOGOUS FAT BY LIPO 25 CC OR LESS |
| 15774 | GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 25 CC |
| 15777 | IMPLNT BIO IMPLNT FOR SOFT TISSUE REINFORCEMENT |
| 15820 | REVISION OF LOWER EYELID |
| 15821 | REV LOWER EYELID EXTEN FAT PAD |
| 15822 | REVISION OF UPPER EYELID |
| 15823 | REV UPPER EYELID W EXCESS SKIN |
| 15830 | EXCISE EXCESS SKIN TISSUE,ABDOMEN |
| 15847 | EXCISE EXCESS SKIN TISSUE,ABDOMEN, ADD-ON |
| 17106 | DESTRUC CUT/VASC <10SQ CM |
| 17107 | DESTRUC CUT/VASC 10-50 SQ CM |
| 17108 | DESTRUC CUT/VASC >50 SQ CM |
| 17999 | SKIN TISSUE PROCEDURE UNLISTED |
| 19296 | PLACE POSTOP BREAST CATH FOR RAD |
| 19297 | PLACE INTRAOP BREAST CATH FOR RAD |
| 19298 | PLACE BREAST RAD TUBE/CATHS |
| 19300 | MASTECTOMY FOR GYNECOMASTIA |
| 19303 | MASTECTOMY, SIMPLE, COMPLETE |
| 19316 | SUSPENSION OF BREAST |
| 19318 | REDUCTION OF LARGE BREAST |
| 19325 | ENLARGE BREAST WITH IMPLANT |
| 19328 | REMOVAL OF BREAST IMPLANT |
| 19330 | REMOVAL OF IMPLANT MATERIAL |
| 19340 | INSERT BREAST PROS IMMED AFTER EXCIS |
| 19342 | DELAY BREAST PROS AFTER BREAST SURG |
| 19350 | NIPPLE/AREOLA RECONSTRUCTION |
| 19355 | CORRECT INVERTED NIPPLE(S) |
| 19357 | BREAST RECONSTRUC W TISS EXPANDR |
| 19361 | BREAST RECONSTRUC W LAT DORSI FLAP |
| 19364 | BREAST RECONSTRUC W FREE FLAP |
| 19367 | BREAST RECONSTRUCT W TRAM 1 PEDICL |
| 19368 | BREAST RECONSTRUCT W TRAM UVASC ANAS |
| 19369 | BREAST RECONSTRUCT W TRAM 2 PEDICL |
| 19370 | SURGERY OF BREAST CAPSULE |
| 19371 | REMOVAL OF BREAST CAPSULE |
| 19380 | REVISE BREAST RECONSTRUCTION |
| 19396 | DESIGN CUSTOM BREAST IMPLANT |
| 19499 | BREAST SURGERY PROCEDURE UNLISTED |
| 0479T | FRACTIONAL ABLATIVE LASER FENESTRATION, FIRST 100 SQ CM |
| 0480T | FRACTIONAL ABLATIVE LASER FENESTRATION, EA ADDL 100 SQ CM |
| 17380 | ELECTROLYSIS EPILATION, EACH 30 MINUTES |
| SURGERY - MALE GENITAL SYSTEM | |
| CODE | DESCRIPTION |
| 54125 | REMOVAL PENIS,TOTAL |
| 54400 | INSERT SEMI-RIGID PENILE PROSTHESIS |
| 54401 | INSERT SELF-CONTD PENILE PROSTHESIS |
| 54520 | REMOVAL TESTIS,SIMPLE |
| 54660 | INSERT TESTICULAR PROSTHESIS |
| 54690 | LAP,ORCHIECTOMY |
| 54699 | LAP,TESTIS PROCEDURE,UNLISTED |
| 55150 | REMOVAL OF SCROTUM |
| 55175 | REVISION OF SCROTUM,SIMPLE |
| 55180 | REVISION OF SCROTUM,COMPLICATED |
| 55500 | REMV HYDROCELE,SPERM CORD,UNILAT |
| 55530 | EXCISE VARICOCELE |
| 55535 | EXCISE VARICOCELE,ABD APPROACH |
| 55550 | LAP,LIGATION SPERMATIC VEINS |
| 55559 | LAP,SPERMATIC CORD PROC,UNLIST |
| 55899 | GENITAL SURG PROC,MALE UNLISTED |
| SURGERY-MUSCULOSKELETAL | |
| CODE | DESCRIPTION |
| 20700 | MANUAL PREP AND INSERTION DEEP DRUG DELIVERY DEV |
| 20701 | REMOVAL DEEP DRUG DELIVERY DEVICE |
| 20932 | OSTEOARTICULAR ALLOGRAFT W/ARTICULAR SURF & BONE |
| 20933 | HEMICORTICAL INTERCALARY ALLOGRAFT PARTIAL |
| 20934 | INTERCALARY ALLOGRAFT COMPLETE |
| 20982 | ABLATE, BONE TUMOR(S) PERQ |
| 20999 | MUSCULOSKELETAL SURGERY UNLISTED |
| 21010 | INCISION OF JAW JOINT |
| 21050 | REMV JAW JOINT |
| 21081 | PREP FACE/ORAL PROST MANDIBULAR |
| 21085 | PREP FACE/ORAL PROST ORAL SPLINT |
| 21089 | PREP FACE/ORAL PROST UNLISTED |
| 21110 | INTERDENTAL FIXATION |
| 21120 | RECONST CHIN AUGMENT |
| 21121 | RECONST CHIN SLIDE SINGL OSTEOTOMY |
| 21122 | RECONST CHIN SLIDE MULTIP OSTEOTMY |
| 21123 | RECONST CHIN SLIDE INTERPOS GRFT |
| 21125 | AUGMENT LOWER JAW BONE,PROSTHETIC |
| 21127 | AUGMENT LOWER JAW BONE,BONE GRAFT |
| 21137 | REDUC FOREHEAD,CONTOURING |
| 21138 | REDUC FOREHEAD,CONTOUR+GRAFT |
| 21139 | REDUC FOREHEAD,CONTOUR+SETBACK |
| 21141 | RECONST FACE,LEFORT I,1 PIECE |
| 21142 | RECONST FACE,LEFORT I,2 PIECES |
| 21143 | RECONST FACE,LEFORT I,3+ PIECES |
| 21145 | RECONST FACE,LEFORT I,1 PIECE+GRFT |
| 21146 | RECONST FACE,LEFORT I,2 PIECES+GRFT |
| 21147 | RECONST FACE,LEFORT I,3+PIECES+GRFT |
| 21150 | RECONST FACE,LEFORT II |
| 21151 | RECONST FACE,LEFORT II+GRAFT |
| 21154 | RECONST FACE,LEFORT III |
| 21155 | RECONST FACE,LEFORT III+LEFORT I |
| 21159 | RECONST FACE,LEFORT III COMPLEX |
| 21160 | RECONST FACE,LEFORT III+I COMPLX |
| 21188 | RECONST MIDFACE |
| 21193 | RECONST MANDIBLE,C/L OSTEOTOMY |
| 21194 | RECONST MANDIBLE,C/L OSTEO+GRFT |
| 21195 | RECONST MANDIBLE,SAG SPLIT |
| 21196 | RECONST MANDIBLE,SAG SPLIT+FIXATN |
| 21198 | OSTEOTOMY, MANDIBLE |
| 21199 | RECONST MANDIBLE,GLOSSAL ADVANCEMT |
| 21206 | RECONST MAXILLA,SEGMENTAL |
| 21208 | AUGMENT FACIAL BONES |
| 21209 | REDUCTION OF FACIAL BONES |
| 21210 | NASAL,MAXILLA,MALAR BONE GRAFT |
| 21215 | MANDIBLE GRAFT |
| 21230 | RIB CARTILAGE GRAFT TO FACE |
| 21235 | EAR CARTILAGE GRAFT TO FACE |
| 21240 | ARTHROPLASTY TMJ |
| 21242 | ARTHROPLASTY TMJ+ALLOGRAFT |
| 21243 | ARTHROPLASTY TMJ+PROSTHESIS |
| 21244 | RECONSTR MANDIBLE,BONE PLATE |
| 21245 | RECONSTR JAW,PART-SUB IMPLNT |
| 21246 | RECONSTR JAW,FULL-SUB IMPLNT |
| 21247 | RECONSTR MANDIB CONDYLE |
| 21248 | RECONSTR JAW,PART-ENDO IMPLNT |
| 21249 | RECONSTR JAW,FULL,ENDO IMPLNT |
| 21255 | RECONSTR ZYGOMA/GLENOID FOSSA |
| 21275 | REVISION ORBITOFACIAL BONES |
| 21295 | REVISN JAW MUSCLE/BONE,EXTRAORAL |
| 21296 | REVISN JAW MUSCLE/BONE,INTRAORAL |
| 21299 | CRANIO/MAXILLOFACIAL SURG UNLISTED |
| 21499 | HEAD SURGERY PROC UNLISTED |
| 21685 | HYOID MYOTOMY & SUSPENSION |
| 21899 | NECK/CHEST PROCEDURE UNLISTED |
| 22206 | OSTEOTOMY SPINE POSTERIOR 3 COLUMN THORACIC |
| 22207 | OSTEOTOMY SPINE POSTERIOR 3 COLUMN LUMBAR |
| 22210 | OSTEOTOMY CERV SP,POST,1 LVL |
| 22212 | OSTEOTOMY THOR SP,POST,1 LVL |
| 22214 | OSTEOTOMY LUMB SP,POST,1 LVL |
| 22220 | OSTEOTOMY CERV SP,ANT,REMV DISK |
| 22224 | OSTEOTOMY LUMB SP,ANT,REMV DISK |
| 22510 | PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC |
| 22511 | PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL |
| 22512 | VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL |
| 22513 | PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION |
| 22514 | PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR |
| 22515 | PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH |
| 22527 | PERC INTRADISC ELECTRO ANNULOPLASTY, 1 OR MORE ADD |
| 22532 | LAT THORAX SPINE FUSION |
| 22533 | LAT LUMBAR SPINE FUSION |
| 22534 | LAT THOR/LUMB, ADDÆL SEG |
| 22548 | CERV SPINE FUSN,ANTER,CLIVUS-C1-C2 |
| 22551 | ARTHRODESIS ANT INTERBODY INC DISCECTOMY, CERVICAL BELOW C2 |
| 22552 | ARTHRODESIS ANT INTERBODY INC DISCECTOMY, CERVICAL BELOW C2 EACH ADDL |
| 22554 | CERV SPINE FUSN,ANTER,BELOW C2 |
| 22556 | THORAX SPINE FUSION,ANTER APPRCH |
| 22558 | LUMBAR SPINE FUSION,ANTER APPRCH |
| 22585 | SPINAL FUSION,ANT,EA ADNL LEVEL |
| 22586 | ARTHRODESIS PRESACRAL INTRBDY W/INSTRUMENT L5/S1 |
| 22590 | CRANIOCERV FUSN,POST TECHNIQUE |
| 22595 | CERV C1-2 FUSN,POSTER TECH |
| 22600 | CERV FUSN,BELOW C2,POST TECH |
| 22610 | THORAX SPINE FUSN,POST TECH |
| 22612 | LUMBAR SPINE FUSN,POST TECH |
| 22614 | SPINE FUSN,POST TECH,EA ADDNL SGMT |
| 22630 | LUMBAR SPINE FUSN,POST INTERBODY |
| 22632 | LUMB SP FUSN,POST INTERBDY,EA ADDNL |
| 22633 | ARTHDSIS POST/POSTEROLATRL/POSTINTERBODY LUMBAR |
| 22634 | ARTHDSIS POST/POSTERLATRL/POSTINTRBDYADL SPC/SEG |
| 22800 | SPINE FUSN,POSTER,UP TO 6 SGMTS |
| 22802 | SPINE FUSION,POSTER,7-12 SGMTS |
| 22804 | SPINE FUSION,POSTER,13+ SGMTS |
| 22808 | SPINE FUSION,ANTER,3 SGMTS |
| 22810 | SPINE FUSION,ANTER,4-7 SGMTS |
| 22812 | SPINE FUSION,ANTER,8+ SGMTS |
| 22818 | KYPHECTOMY, 1-2 SEGMENTS |
| 22819 | KYPHECTOMY, 3 & MORE SEGMENT |
| 22830 | EXPLORATION OF SPINAL FUSION |
| 22840 | POSTERIOR NON-SEGMENTAL INSTRUMENTATION |
| 22841 | INTERNAL SPINAL FIXATION WIRING SPINOUS PROCESS |
| 22842 | POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG |
| 22843 | POSTERIOR SEGMENTAL INSTRUMENTATION 7-12 VRT SEG |
| 22844 | POSTERIOR SEGMENTAL INSTRUMENTATION 13/> VRT SEG |
| 22845 | ANTERIOR INSTRUMENTATION 2-3 VERTEBRAL SEGMENTS |
| 22846 | ANTERIOR INSTRUMENTATION 4-7 VERTEBRAL SEGMENTS |
| 22847 | ANTERIOR INSTRUMENTATION 8/> VERTEBRAL SEGMENTS |
| 22848 | PELVIC FIXATION OTHER THAN SACRUM |
| 22849 | REINSERT SPINAL FIXATION |
| 22850 | REMOVE SPINE FIX DEV,HARRINGTON |
| 22852 | REMOVE SPINE FIX DEV,POST SGMTAL |
| 22853 | INSERT BIOMCHN DEV INTERVERTEBRAL DSC SPC W/ARTHRD |
| 22854 | INSERT BIOMCHN DEV VRT CORPECTOMY DEFECT W/ARTHRD |
| 22855 | REMOVE SPINE FIX DEV,ANTERIOR |
| 22856 | TOTAL DISC ARTHROPLASTY, CERVICAL, SINGLE |
| 22857 | TOTAL DISC ARTHROPLASTY, LUMBAR, SINGLE |
| 22858 | TOT DISC ARTHRP ANT APPR DISC 2ND LEVEL CERVICAL |
| 22859 | INSRTN BIOMCHN DEV NTRVRT DISC SPACE W/O ARTHRD |
| 22860 | TOTAL DISC ARTHRP ANT SECOND INTERSPACE LUMBAR |
| 22861 | REVISION TOTAL DISC ARTHROPLASTY, CERVICAL, SINGLE |
| 22862 | REVISION TOTAL DISC ARTHROPLASTY, LUMBAR, SINGLE |
| 22864 | REMOVE TOTAL DISC ARTHROPLASTY, CERVICAL, SINGLE |
| 22865 | REMOVE TOTAL DISC ARTHROPLASTY, LUMBAR, SINGLE |
| 22899 | Unlisted procedure, spine |
| 22999 | Unlisted procedure, abdomen, musculoskeletal system |
| 23470 | RECONSTRUCT PROX HUMERAL IMPLANT |
| 23472 | RECONSTR TOTAL SHOULDER IMPLANT |
| 23473 | REVIS SHOULDER ARTHRPLSTY HUMERAL/GLENOID COMPNT |
| 23474 | REVIS SHOULDER ARTHRPLSTY HUMERAL&GLENOID COMPNT |
| 23929 | SHOULDER SURG PROC UNLISTED |
| 24360 | ARTHROPLASTY,ELBOW,W MEMBRANE |
| 24361 | ARTHROPLASTY,ELBOW,DIST HUMER PROSTH |
| 24362 | ARTHROPLASTY,ELBOW,IMPLNT/RECONSTRUC |
| 24363 | ARTHROPLASTY,ELBOW,TOTAL PROSTH REPL |
| 24370 | REVIS ELBOW ARTHRPLSTY HUMERAL/ULNA COMPNT |
| 24371 | REVIS ELBOW ARTHRPLSTY HUMERAL&ULNA COMPNT |
| 24999 | UPPER ARM/ELBOW SURGERY UNLISTED |
| 25332 | ARTHROPLASTY WRIST JT |
| 25441 | RECONSTRUCT DIST RADIUS W PROSTH |
| 25442 | RECONSTRUCT DIST ULNA W PROSTHESIS |
| 25443 | RECONSTRUCT SCAPHOID CARPAL W PROSTHESIS |
| 25444 | RECONSTRUCT LUNATE W PROSTHESIS |
| 25445 | RECONSTRUCT TRAPEZIUM W PROSTHESIS |
| 25446 | TOTAL WRIST REPLACEMENT |
| 25447 | REPAIR INTERCARP/CARP-METACARP JT |
| 25449 | REMOVE WRIST JOINT IMPLANT |
| 25999 | FOREARM/WRIST SURGERY UNLISTED |
| 26530 | ARTHROPLASTY MC-P JT,SINGLE |
| 26531 | ARTHROPLASTY MC-P JT,IMPLANT |
| 26536 | ARTHROPLASTY I-P JT,IMPLANT |
| 26989 | HAND/FINGER SURGERY UNLISTED |
| 27125 | PARTIAL HIP REPLACEMENT |
| 27130 | TOTAL HIP ARTHROPLASTY |
| 27132 | CONV PREV HIP SURG TO TOT HIP ARTHROPLAS |
| 27134 | REVISE TOTAL HIP REPLACEMENT |
| 27137 | REVISE ACETABULAR PART OF TOTAL HIP |
| 27138 | REVISE FEM PART OFTOTAL HIP |
| 27279 | ARTHRODESIS SACROILIAC JOINT PERCUTANEOUS |
| 27280 | FUSION OF SACROILIAC JOINT |
| 27299 | PELVIS/HIP JOINT SURGERY UNLISTED |
| 27412 | AUTOCHONDROCYTE IMPLANT KNEE |
| 27437 | ARTHROPLASTY PATELLA |
| 27438 | ARTHROPLASTY PATELLA WITH IMPLANT |
| 27440 | ARTHROPLASTY TIBIAL PLATEAU |
| 27441 | PLASTY TIBIAL PLATEAU+DEBRIDE |
| 27442 | PLASTY TIB PLAT OR FEM CONDYLES |
| 27443 | PLASTY TIB PLAT/FEM CONDY+DEBRIDE |
| 27445 | PLASTY KNEE,CONSTRAINED PROSTHESIS |
| 27446 | PLASTY KNEE,MED OR LAT COMPARTMT |
| 27447 | TOTAL KNEE ARTHROPLASTY |
| 27486 | REVISE KNEE JOINT REPLACE,1 PART |
| 27487 | REVISE KNEE JOINT REPLACE,ALL PARTS |
| 27488 | REMOVAL OF KNEE PROSTHESIS |
| 27580 | FUSION OF KNEE |
| 27599 | FEMUR/KNEE SURG UNLISTED |
| 27700 | ARTHROPLASTY ANKLE JOINT |
| 27702 | TOTAL ANKLE REPLACEMENT |
| 27703 | SECONDARY RECONSTRUCTION,ANKLE JOINT |
| 27899 | LEG/ANKLE SURGERY PROC UNLISTED |
| 28008 | INCISION OF FOOT/TOE FASCIA |
| 28250 | DIVISN PLANTAR FASCIA/MUSCLE |
| 28308 | OSTEOTOMY METATARSAL (NOT 1ST) |
| 28725 | FUSION FOOT BONES,SUBTALAR |
| 28899 | FOOT/TOES SURGERY PROC UNLISTED |
| 29799 | CAST/STRAP PROCEDURE UNLISTED |
| 29800 | TMJ ARTHROSCOPY/DIAGNOSTIC |
| 29804 | TMJ ARTHROSCOPY/SURGERY |
| 29806 | SHLDR ARTHROSCOP,SURG,CAPSULORRHAPHY |
| 29807 | SHLDR ARTHROSCOP,SURG,REPAIR,SLAP LESION |
| 29819 | SHLDR ARTHROSCOP,SURG,W/REMOVAL,LOOSE/FB |
| 29820 | SHLDR ARTHROSCOP,PART SYNOVECT |
| 29821 | SHLDR ARTHROSCOP,FULL SYNOVECT |
| 29822 | SHLDR ARTHROSCOP,PART DEBRIDE |
| 29823 | SHLDR ARTHROSCOP,EXTEN DEBRIDE |
| 29824 | SHLDR ARTHROSCOP,SURG,DIS CLAVICULECTOMY |
| 29825 | SHLDR ARTHROSCOP,LYSE ADHESNS |
| 29826 | SHLDR ARTHROSCOP,PART ACROMIOPLAS |
| 29827 | SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR |
| 29828 | ARTHROSCOPY SHOULDER SURGICAL BICEPS TENODESIS |
| 29834 | ELBOW ARTHROSCOP,REMV LOOSE BODY |
| 29835 | ELBOW ARTHROSCOP,PART SYNOVECT |
| 29836 | ELBOW ARTHROSCOP,FULL SYNOVECT |
| 29837 | ELBOW ARTHROSCOP,PART DEBRIDE |
| 29838 | ELBOW ARTHROSCOP,EXTEN DEBRIDE |
| 29843 | WRIST ARTHROSCOP,CLEAN/DRAIN |
| 29844 | WRIST ARTHROSCOP,PART SYNOVECT |
| 29845 | WRIST ARTHROSCOP,FULL SYNOVECT |
| 29846 | WRIST ARTHROSCOP,EXCIS TRIANG CART |
| 29847 | WRIST ARTHROSCOP,INTERN FIXATN |
| 29848 | WRIST ARTHROSCOP,RELEASE XVERS LIG |
| 29861 | HIP SCOPE/REMOV LOOSE/FOREIGN BODY |
| 29862 | HIP SCOPE/REMV BODY,PLASTY/RESECTN |
| 29863 | HIP SCOPE/REMV BODY,SYNOVECTOMY |
| 29866 | KNEE SCOPE, AUTOGRAFT IMPANT |
| 29867 | KNEE SCOPE, ALLOGRAFT IMPANT |
| 29868 | KNEE SCOPE, MENISC TRANSPLANT |
| 29871 | KNEE SCOPE,CLEAN/DRAIN |
| 29873 | KNEE SCOPE, W/LATERAL RELEASE |
| 29874 | KNEE SCOPE,REMV LOOSE BODY |
| 29875 | KNEE SCOPE,PART SYNOVECT |
| 29876 | KNEE SCOPE,FULL SYNOVECT |
| 29877 | KNEE SCOPE,SHAVE ARTICULAR CART |
| 29879 | KNEE SCOPE,ABRASN ARTHROPLASTY |
| 29880 | KNEE SCOPE,SINGLE MENISECTOMY |
| 29881 | KNEE SCOPE,MED/LAT MENISECTOMY |
| 29882 | KNEE SCOPE,MED OR LAT MENIS REPAIR |
| 29883 | KNEE SCOPE,MED+LAT MENIS REPAIR |
| 29884 | KNEE SCOPE,LYSIS OF ADHESNS |
| 29885 | KNEE SCOPE,DRILL OSTE DISSEC+GRFT |
| 29886 | KNEE SCOPE,DRILL OSTEIT DISSEC |
| 29887 | KNEE SCOPE,DRILL OSTE DISS+INT FIX |
| 29888 | KNEE SCOPE,AID ANT CRUCIATE REPAIR |
| 29889 | KNEE SCOPE,AID POST CRUC REPAIR |
| 29891 | ANKLE SCOPE,EXCIS OSTEOCHON DEFCT |
| 29892 | ANKLE SCOPE,AID REPAIR FX,BONE DEFCT |
| 29893 | ANKLE SCOPE,PLANTAR FASCIOTOMY |
| 29894 | ANKLE SCOPE,REMVL LOOSE BODY |
| 29895 | ANKLE SCOPE,PART SYNOVECTOMY |
| 29897 | ANKLE SCOPE,PART DEBRIDEMENT |
| 29898 | ANKLE SCOPE,EXTENS DEBRIDEMNT |
| 29899 | ANKLE SCOPE,W/ANKLE ARTHRODESIS |
| 29904 | ARTHROSCOPY SUBTALAR JOINT REMOVE LOOSE/FOREIGN BODY |
| 29905 | ARTHROSCOPY SUBTALAR JOINT WITH SYNOVECTOMY |
| 29906 | ARTHROSCOPY SUBTALAR JOINT WITH DEBRIDEMENT |
| 29907 | ARTHROSCOPY SUBTALAR JOINT SUBTALAR ARTHRODESIS |
| 29914 | ARTHROSCOPY HIP W/FEMOROPLASTY |
| 29915 | ARTHROSCOPY HIP W/ACETABULOPLASTY |
| 29916 | ARTHROSCOPY HIP W/LABRAL REPAIR |
| 29999 | UNLISTED PROC, ARTHROSCOPY |
| G0289 | ARTHRO, LOOSE BODY + CHONDRO |
| S2112 | KNEE ARTHROSCP HARV |
| S2118 | TOTAL HIP RESURFACING |
| 29870 | ARTHROSCOPY, KNEE, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE) |
| SURGERY-NERVOUS-SYSTEM | |
| CODE | DESCRIPTION |
| 61796 | STEREOTACTIC RADIOSURGERY, CRANIAL,SIMPLE,SINGLE |
| 61797 | STEREOTACTIC RADIOSURGERY, CRANIAL,SIMPLE,EA ADD |
| 61798 | STEREOTACTIC RADIOSURGERY, CRANIAL,COMPLEX,SINGLE |
| 61799 | STEREOTACTIC RADIOSURGERY, CRANIAL,COMPLEX,EA ADD |
| 61800 | APPLY STEREOTACTIC HEADFRAME FOR RADIOSURGERY |
| 61850 | IMP ELECTRDS,CORT,DRILL,BURR |
| 61860 | IMP ELECTRD,CRANIECTMY/CRANIOTMY |
| 61863 | IMPLANT NEUROELECTRODE W/O RECORDING |
| 61864 | IMPLANT NEUROELECTRDE, ADD'L |
| 61867 | IMPLANT NEUROELECTRODE W/ RECORDING |
| 61868 | IMPLANT NEUROELECTRDE, ADDÆL |
| 61880 | REVISE/REMOVE INTRACRAN NEUROELEC |
| 61885 | IMP STIM,CRANIAL,SUBQ,1 ARRAY |
| 61886 | IMP STIM,CRANIAL,SUBQ,>1 ARRAY |
| 61888 | REVIS/REMOV CRANIAL NEURORCVR |
| 62350 | IMP SPINAL CANAL CATH |
| 62351 | IMPLANT SPINAL CATH W LAMINECT |
| 62355 | REMOVE SPINAL CANAL CATHETER |
| 62360 | INSERT SPINE INFUSN DEVICE,SUBCUT |
| 62361 | INSERT/ PREPLACE INFUSN PUMP,NONPROGRAM |
| 62362 | INSERT/ REPLACE INFUSN PUMP,PROGRAMMABLE |
| 62365 | REMOVE INFUSN DEVICE/PUMP |
| 63001 | LAM W/O FACETEC FORAMOT/DSKC 1/2 VRT SEG, CERVICAL |
| 63003 | LAM W/O FACETEC FORAMOT/DSKC 1/2 VRT SEG, THORACIC |
| 63005 | LAM W/O FACETEC FORAMOT/DSKC 1/2 VRT SEG, LUMBAR |
| 63011 | LAM W/O FACETEC FORAMOT/DSKC 1/2 VRT SEG, SACRAL |
| 63012 | LAMINECTOMY,FACETECTOMY,LUMBAR |
| 63015 | LAMINECTOMY,>2 SGMT,CERVICAL |
| 63016 | LAMINECTOMY,>2 SGMT,THORACIC |
| 63017 | LAMINECTOMY,>2 SGMT,LUMBAR |
| 63020 | EXCIS CERV DISK,ONE LEVEL |
| 63030 | LAMINOTOMY,LUMBAR DISK,1 INTRSP |
| 63035 | EXCIS EACH ADDNL SPINAL DISK |
| 63040 | LAMINOTOMY |
| 63042 | REDO EXCIS LUMBAR DISK |
| 63043 | REDO EXCIS CERV DISK, ADDN CERV INTERSPC |
| 63044 | REDO EXCIS CERV DISK, ADDN LUMB INTERSPC |
| 63045 | LAMINEC/FACETECT/FORAMIN,CERVICAL 1 SEG |
| 63046 | LAMINEC/FACETECT/FORAMIN,THORACIC 1 SEG |
| 63047 | LAMINEC/FACETECT/FORAMIN,LUMBAR 1 SEG |
| 63048 | LAMINEC/FACETECT/FORAMIN,EACH ADDNL |
| 63050 | C- LAMINOPLASTY, 2 OR MORE |
| 63051 | C-LAMINOPLASTY W/GRAFT/PLATE, 2 OR MORE |
| 63052 | LAM FACETEC/FORAMOT DRG ARTHRD LUMBAR 1 VRT SGM |
| 63053 | LAM FACETEC/FORAMOT DRG ARTHRD LMBR EA ADDL SGM |
| 63055 | XPEDICUL DECOMPRESS THROACIC CORD |
| 63056 | DECOMPRESS SPINAL CORD,1 SEG |
| 63057 | XPEDICUL DECOMPRESS CORD,ADDNL SGMT |
| 63064 | COSTOVERT DECOMPRESS THORACIC CORD |
| 63066 | COSTOVERT DECOMP THOR CORD,EACH ADDN |
| 63075 | DISK SURG,ANTER,CERVICAL,SINGLE LVL |
| 63076 | DISK SURG,ANTER,CERV,EA ADDNL LVL |
| 63077 | DISK SURG,THORAX,SINGLE LEVEL |
| 63078 | DISK SURG,THORAX,EA ADDNL LEVEL |
| 63081 | REMV VERT BODY,CERV,ONE SGMT |
| 63082 | REMV VERT BODY,CERV,EACH ADDNL SGMT |
| 63085 | REMV VERT BODY,THOR,ONE SGMT |
| 63086 | REMV VERT BODY,THOR,EACH ADDNL SGMT |
| 63087 | REMV VERT BODY,LO THOR/LUMB,ONE |
| 63088 | REMV VERT BODY,LO THOR/LUMB,EA ADDNL |
| 63090 | REMV VERT BODY,LOWER,RETROPER,ONE |
| 63091 | REMV VERT BODY,LOWR,RETROPER,EA ADDN |
| 63101 | REMV VERT BODY, LATERAL, THORACIC |
| 63102 | REMV VERT BODY, LATERAL, LUMBAR |
| 63103 | REMOVE VERTEBRAL BODY ADD-ON |
| 63170 | INCISE SPINAL CORD TRACT(S) |
| 63172 | DRAIN INTRAMEDULLARY->SUBARACH |
| 63173 | DRAIN INTRAMEDULLARY->PERITONEAL |
| 63185 | INCISE SP COLUMN/NERVES,ONE/TWO LVL |
| 63190 | INCISE SP COLUMN/NERVES,>2 LVL |
| 63191 | INCISE SPINAL ACCESS NERVE |
| 63197 | INCIS BOTH SPINOTHAL,THOR,1 STAGE |
| 63200 | RELEASE TETHERED SPINAL CORD,LUMBR |
| 63250 | EXCIS/OCCLUD CORD AVM,CERVICAL |
| 63251 | EXCIS/OCCLUD CORD AVM,THORACIC |
| 63252 | EXCIS/OCCLUD CORD AVM,THORCOLUMBAR |
| 63265 | EXCIS INTRASP LESN,XDURAL,CERVICAL |
| 63266 | EXCIS INTRASP LESN,XDURAL,THORACIC |
| 63267 | EXCIS INTRASP LESN,XDURAL,LUMBAR |
| 63268 | EXCIS INTRASP LESN,XDURAL,SACRAL |
| 63270 | EXCIS INTRASP LESN,INTRADUR,CERV |
| 63271 | EXCIS INTRASP LESN,INTRADUR,THOR |
| 63272 | EXCIS INTRASP LESN,INTRADUR,LUMB |
| 63273 | EXCIS INTRASP LESN,INTRADUR,SACRAL |
| 63300 | REMV VERT,EXDUR,CERV TUMOR |
| 63301 | REMV VERT,EXUDR,XTHOR,THOR TUMOR |
| 63302 | REMV VERT,EXDUR,THORLUM,THOR TUMOR |
| 63303 | REMV VERT,EXDUR,LUMB/SACR TUMOR |
| 63304 | REMV VERT,INDURAL,CERV TUMOR |
| 63305 | REMV VERT,INDURAL,XTHOR,THOR TUMOR |
| 63306 | REMV VERT,INDURAL,THORLUM,THOR TUMOR |
| 63307 | REMV VERT,INDURAL,LUMB/SACR TUMOR |
| 63308 | REMV VERT,EACH ADDNL SEGMENT |
| 63620 | STEREOTACTIC RADIOSURGERY, SPINAL, SINGLE LESION |
| 63621 | STEREOTACTIC RADIOSURGERY, SPINAL, EA ADD LESION |
| 63650 | PERCUT IMPLNT NEUROELECT,EPIDURAL |
| 63655 | SURG IMPLNT NEUROELECT,EPIDURAL |
| 63685 | IMPLANT SPINAL NEUROSTIM/RECEIVER |
| 63688 | REVISE/REMOVE SPINAL NEUROSTIM/RECEIVER |
| 64451 | INJECTION ANES AGNT/STEROID NERVES NRVTG SI JOINT W/IMG GUID |
| 64553 | PERCUT IMPLNT NEUROELEC,CRANIAL |
| 64555 | PERCUT IMPLANT,NEUROELEC,PERIPH NERVE |
| 64561 | PERCUT IMPLANT,NEUROELEC,SACRAL NERVE |
| 64566 | POST TIBIAL NEUROSTIMULATION,PERC NEEDLE ELECTRODE |
| 64568 | INCISION IMPLANT CRANIAL NERVE STIM ELECTRODE/PULSE GEN |
| 64575 | INCISION,IMPLANT,NEUROELEC,PERIPH NERVE |
| 64581 | INCISION,IMPLANT,NEUROELEC,SACRAL NERVE |
| 64582 | OPEN IMPLTN HPGLSL NRV NSTIM RA PG AND RESPIR SENSOR |
| 64583 | REVSN/RPLCMT HPGLSL NERVE NSTIM RA PG AND RESPIR SNR |
| 64584 | REMOVAL HYPOGLOSSAL NERVE NSTIM RA PG AND RESPIR SNR |
| 64585 | REVISE/REMOVE PERIPHERAL NEUROELECTRODE |
| 64590 | IMPLANT PERIPH/GASTRIC NEUROSTIM/RECEIVER |
| 64595 | REVISE/REMOVE PERIPH/GASTRIC NEUROSTIM/RECEIVER |
| 64650 | CHEMODENERV ECCRINE GLANDS BOTH AXILLAE |
| 64653 | CHEMODENERV ECCRINE GLANDS, NON-AXILLARY |
| 64719 | REVISE ULNAR NERVE AT WRIST |
| 64721 | CARPAL TUNNEL SURGERY |
| 64818 | SYMPATHECTOMY,LUMBAR |
| 64999 | NERVOUS SYSTEM SURGERY UNLISTED |
| SURGERY - OTHER | |
| CODE | DESCRIPTION |
| 39499 | MEDIASTINAL PROCEDURE UNLIST |
| 39599 | DIAPHRAGM SURG PROC UNLISTED |
| 55970 | SEX TRANSFORMATION, M TO F |
| 55980 | SEX TRANSFORMATION, F TO M |
| 60659 | LAP,ENDOCRINE SYSTEM,UNLISTED |
| 60699 | ENDOCRINE SURGERY PROC UNLISTED |
| 93998 | Unlisted noninvasive vascular diagnostic study |
| S2080 | LAUP |
| S2095 | TRANSCATH EMBOLIZ MICROSPHER |
| S2202 | ECHOSCLEROTHERAPY |
| SURGERY - RESPIRATORY SYSTEM | |
| CODE | DESCRIPTION |
| 30120 | EXCISION SKIN OF NOSE |
| 30400 | RECONSTR NOSE |
| 30410 | RECONSTR NOSE,COMPLETE+EXTERNAL |
| 30420 | RECONSTR NOSE+MAJ SEPTAL REPAIR |
| 30430 | REVIS NOSE,SECONDARY,MINOR |
| 30435 | REVIS NOSE,SECONDARY,INTERMEDIATE |
| 30450 | REVIS NOSE,SECONDARY,MAJOR |
| 30460 | REVIS NOSE/CLEFT LIP/TIP |
| 30462 | REVIS NOSE/CLEFT LIP/TIP,SEPTUM |
| 30465 | REPAIR NASAL CAVITY STENOSIS |
| 30468 | RPR NSL VLV COLLAPSE SUBQ/SBMCSL LAT WALL IMPLT |
| 30469 | RPR NSL VLV COLLAPSE LW NRG SUBQ/SBMCSL RMDLG |
| 30520 | REPAIR OF NASAL SEPTUM |
| 30620 | INTRANASAL RECONSTRUCTION |
| 30801 | CAUTER TURBINATE MUCOSA,SUPERFICIAL |
| 30802 | CAUTER TURBINATE MUCOSA,INTRAMURAL |
| 30999 | NASAL SURG PROC UNLISTED |
| 31253 | NASAL/SINUS ENDOSCOPY TOT W/FRONTAL SINUS EXPL TISS REMOVAL |
| 31254 | NASAL SCOPY,REMV PART ETHMOID |
| 31255 | NASAL SCOPY,REMV TOTL ETHMOID |
| 31256 | NASAL SCOPY,OPEN MAXILL SINUS |
| 31257 | NASAL/SINUS ENDOSCOPY TOTAL WITH SPHENOIDOTOMY |
| 31259 | NASAL/SINUS ENDOSCOPY TOT W/ETHMOIDECTOMY W/SPHENOID TISSUE REMOVAL |
| 31267 | NASAL SCOPY,RMV TISS MAXILL SINUS |
| 31276 | NASAL SCOPY,EXPLOR FRONTAL SINUS |
| 31287 | NASAL SCOPY,SPHENOIDOTOMY |
| 31288 | NASAL SCOPY,REMV TISS SPHENOID |
| 31295 | NASAL/SINUS ENDOSCOPY,W/DILAT MAXILLARY SINUS OSTIUM |
| 31296 | NASAL/SINUS ENDOSCOPY,W/DILAT FRONTAL SINUS OSTIUM |
| 31297 | NASAL/SINUS ENDOSCOPY,W/DILAT SPHENOID SINUS OSTIUM |
| 31298 | NASAL/SINUS ENDOSCOPY W/FRONTAL & SPHENOID SINUS DILATION |
| 31299 | SINUS SURGERY PROC UNLISTED |
| 31599 | LARYNX SURG PROC UNLISTED |
| 31899 | AIRWAYS SURGICAL PROCEDURE UNLISTED |
| 32664 | THORACOSCOPY SURG THOR SYMPATHECT |
| 32701 | THORAX STEREOTACTIC RADIATION TARGET W/TX COURSE |
| 32850 | DONOR PNEUMONECTOMY |
| 32851 | LUNG TRANSPLANT,SINGLE |
| 32852 | LUNG TRANSPLANT,SINGL W CP BYPASS |
| 32853 | LUNG TRANSPLANT,DOUBLE |
| 32854 | LUNG TRANSPLANT,DBL W CP BYPASS |
| 32855 | TRANSPLANT,PREP DONOR LUNG, SINGLE |
| 32856 | TRANSPLANT,PREP DONOR LUNG, DOUBLE |
| 32994 | ABLATION THER 1+ PULM TUMORS PERQ CRYOABLATION |
| 32998 | PERQ RADIOFREQ ABLATION TX, PUL TUMOR |
| 32999 | CHEST SURGERY PROCEDURE UNLISTED |
| SURGERY - TRANSPLANT | |
| CODE | DESCRIPTION |
| 50323 | TRANSPLANT,PREP CADAVER RENAL GRAFT |
| 50325 | TRANSPLANT,PREP LIVING RENAL GRAFT |
| 50327 | TRANSPLANT,PREP RENAL GRAFT/VENOUS |
| 50328 | TRANSPLANT,PREP RENAL GRAFT/ARTERIAL |
| 50329 | TRANSPLANT,PREP RENAL GRAFT/URETERAL |
| 50340 | REMOVAL OF RECIPIENT KIDNEY |
| 50360 | TRANSPLANTATION OF KIDNEY |
| 50365 | TRANSPLANT KIDNEY+RECIP NEPHREC |
| 50380 | REIMPLANTATION OF KIDNEY |
| 0584T | PERCUTANEOUS ISLET CELL TRANSPLANT |
| 0585T | LAPAROSCOPIC ISLET CELL TRANSPLANT |
| 0586T | OPEN ISLET CELL TRANSPLANT |
| S2053 | TRANSPLANTATION OF SMALL INT |
| S2054 | TRANSPLANTATION OF MULTIVISC |
| S2060 | LOBAR LUNG TRANSPLANTATION |
| S2065 | SIMULT PANC KIDN TRANS |
| S2102 | ISLET CELL TISSUE TRANSPLANT |
| S2140 | CORD BLOOD HARVESTING |
| S2142 | CORD BLOOD-DERIVED STEM-CELL |
| S2150 | BMT HARV/TRANSPL 28D PKG |
| S2152 | SOLID ORGAN TRANSPL PKG |
| SURGERY - URINARY SYSTEM | |
| CODE | DESCRIPTION |
| 50542 | LAP,ABLATION, RENAL MASS LESION(S) |
| 50549 | LAP,RENAL PROCEDURE,UNLISTED |
| 50593 | ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY |
| 50949 | UNLISTED LAPAROSCOPY PROC, URETER |
| 51999 | LAP PROCEDURE, UNLISTED, BLADDER |
| 53430 | RECONSTRUC FEMALE URETHRA |
| 52441 | CYSTO INSERTION TRANSPROSTATIC IMPLANT SINGLE |
| 52442 | CYSTO INSERTION TRANSPROSTATIC IMPLANT EA ADDL |
| 53899 | UROLOGY SURGERY PROCEDURE UNLISTED |
| 0571T | INSRTN/RPLCMT ICDS W/SUBSTERNAL ELECTRODE |
| 0572T | INSRTN SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD |
| 0573T | RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD |
| 0574T | REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD |
| 0575T | PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON |
| 0576T | INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON |
| 0577T | ELECTROPHYSIOLOGICAL EVAL ICDS W/SS ELECTRODE |
| 0578T | REM INTERROG DEV EVAL SS LD ICDS <90D PHY/QHP |
| 0579T | REM INTERROG DEV EVAL SS LD ICDS < 90D TECH |
| 0580T | RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY |
