Last Updated 4/13/2021

Services requiring Prior Authorization

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
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
A4421 OSTOMY SUPPLY MISC
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
A4649 SURGICAL SUPPLIES
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
A6512 COMPRES BURN GARMENT, NOC
A6549 G COMPRESSION STOCKING
A6550 NEG PRES WOUND THER DRSG SET
A7000 DISPOSABLE CANISTER FOR PUMP
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
A9900 SUPPLY/ACCESSORY/SERVICE
A9999 DME SUPPLY OR ACCESSORY, NOS
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
C1062 INTRAVERTEBRAL BODY FRACTURE AUGMENTATION W/IMPLANT
C1713 ANCHOR/SCREW BN/BN,TIS/BN
C1714 CATH, TRANS ATHERECTOMY, DIR
C1715 BRACHYTHERAPY NEEDLE
C1716 BRACHYTX, NON-STR, GOLD-198
C1717 BRACHYTX, NON-STR,HDR IR-192
C1719 BRACHYTX, NS, NON-HDRIR-192
C1721 AICD, DUAL CHAMBER
C1722 AICD, SINGLE CHAMBER
C1724 CATH, TRANS ATHEREC,ROTATION
C1725 CATH, TRANSLUMIN NON-LASER
C1726 CATH, BAL DIL, NON-VASCULAR
C1727 CATH, BAL TIS DIS, NON-VAS
C1728 CATH, BRACHYTX SEED ADM
C1750 CATH, HEMODIALYSIS,LONG-TERM
C1752 CATH,HEMODIALYSIS,SHORT-TERM
C1753 CATH, INTRAVAS ULTRASOUND
C1754 CATHETER, INTRADISCAL
C1755 CATHETER, INTRASPINAL
C1756 CATH, PACING, TRANSESOPH
C1757 CATH, THROMBECTOMY/EMBOLECT
C1758 CATHETER, URETERAL
C1759 CATH, INTRA ECHOCARDIOGRAPHY
C1762 CONN TISS, HUMAN(INC FASCIA)
C1763 CONN TISS, NON-HUMAN
C1764 EVENT RECORDER, CARDIAC
C1767 GENERATOR, NEURO NON-RECHARG
C1768 GRAFT, VASCULAR
C1772 INFUSION PUMP, PROGRAMMABLE
C1777 LEAD, AICD, ENDO SINGLE COIL
C1778 LEAD, NEUROSTIMULATOR
C1787 PATIENT PROGR, NEUROSTIM
C1789 PROSTHESIS, BREAST, IMP
C1813 PROSTHESIS, PENILE, INFLATAB
C1815 PROS, URINARY SPH, IMP
C1816 RECEIVER/TRANSMITTER, NEURO
C1817 SEPTAL DEFECT IMP SYS
C1820 GENERATOR NEURO RECHG BAT SY
C1822 GENERATOR, NEUROSTIMULATOR, HIGH FREQUENCY, WITH RECHARGEABLE BATTERY AND CHARGING SYSTEM
C1823 GENERATOR, NEUROSTIMULATOR, TRANSVENOUS SENSING/STIMULATION LEADS
C1874 STENT, COATED/COV W/DEL SYS
C1875 STENT, COATED/COV W/O DEL SY
C1876 STENT, NON-COA/NON-COV W/DEL
C1877 STENT, NON-COAT/COV W/O DEL
C1878 MATRL FOR VOCAL CORD
C1882 AICD, OTHER THAN SING/DUAL
C1883 ADAPT/EXT, PACING/NEURO LEAD
C1884 EMBOLIZATION PROTECT SYST
C1885 CATH, TRANSLUMIN ANGIO LASER
C1886 CATHETER, EXTRAVASCULAR TISSUE ABLATION, ANY MODALITY (INSERTABLE)
C1887 CATHETER, GUIDING
C1888 ENDOVAS NON-CARDIAC ABL CATH
C1889 IMPLANTABLE/INSERTABLE DEVICE FOR DEVICE INTENSIVE PROCEDURE, NOC
C1891 INFUSION PUMP,NON-PROG, PERM
C1895 LEAD, AICD, ENDO DUAL COIL
C1896 LEAD, AICD, NON SING/DUAL
C1897 LEAD, NEUROSTIM TEST KIT
C1899 LEAD, PMKR/AICD COMBINATION
C1900 LEAD, CORONARY VENOUS
C2616 BRACHYTX, NON-STR,YTTRIUM-90
C2617 STENT, NON-COR, TEM W/O DEL
C2623 CATHETER, TRANSLUMINAL ANGIOPLASTY, DRUG-COATED, NON-LASER
C2625 STENT, NON-COR, TEM W/DEL SY
C2626 INFUSION PUMP, NON-PROG,TEMP
C2630 CATH, EP, COOL-TIP
C2631 REP DEV, URINARY, W/O SLING
C2634 BRACHYTX, NON-STR, HA, I-125
C2635 BRACHYTX, NON-STR, HA, P-103
C2636 BRACHY LINEAR, NON-STR,P-103
C2637 BRACHY,NON-STR,YTTERBIUM-169
C2638 BRACHYTX, STRANDED, I-125
C2639 BRACHYTX, NON-STRANDED,I-125
C2640 BRACHYTX, STRANDED, P-103
C2641 BRACHYTX, NON-STRANDED,P-103
C2642 BRACHYTX, STRANDED, C-131
C2643 BRACHYTX, NON-STRANDED,C-131
C2644 BRACHYTHERAPY SRC CESIUM-131 CHLORID SOL PER MCI
C2645 BRACHYTHERAPY PLANAR SOURCE, PALLADIUM-103, PER SQUARE MILLIMETER
C2698 BRACHYTX, STRANDED, NOS
C2699 BRACHYTX, NON-STRANDED, NOS
C5271 APPL SKN GRFT TRUNK ARM LEG 100 CM; 1ST 25 CM/<
C5272 APPL SG TRNK ARMS LEGS AREA 100 CM; EA ADD 25 CM
C5273 APPL SG TRUNK ARM LEG AREA >/=100 CM;1ST 100 CM
C5274 APPL SG TRNK ARM LEG AREA>/=100 CM;EA ADD 100 CM
C5275 APPL SG FACE,SCALP,NECK,HANDS,FEET,GENIT,MLT DIGITS, AREA TO 100 CM; 1ST 25 CM/<
C5276 APPL SG FACE,SCALP,NECK,HANDS,FEET,GENIT,MLT DIGITS, AREA TO 100 CM;EA ADD 25 CM
C5277 APPL SG FACE,SCALP,NCK,HNDS,FEET,GEN,MLT DGTS TO >/=100 CM;1ST 100 CM/1% A CHLD
C5278 APPL SG FACE,SCALP,NCK,HNDS,FEET,GEN,MLT DGTS TO >/=100 CM;EA ADD 100 CM/1% CHL
C9061 INJECTION, TEPROTUMUMAB-TRBW, 10 MG
C9063 INJECTION, EPTINEZUMAB-JJMR, 1 MG
C9067 GALLIUM GA-68, DOTATOC, DIAGNOSTIC, 0.01 MCI
C9408 IODINE I-131 IOBENGUANE, THERAPEUTIC, 1 MILLICURIE
C9600 PERCUTANEOUS TRANSCATHETER PLACEMENT OF DRUG ELUTING INTRACORONARY STENT(S),
C9601 PERCUTANEOUS TRANSCATHETER PLACEMENT OF DRUG-ELUTING INTRACORONARY STENT(S),
C9602 PERCUTANEOUS TRANSLUMINAL CORONARY ATHERECTOMY, WITH DRUG ELUTING INTRACORONARY
C9603 PERCUTANEOUS TRANSLUMINAL CORONARY ATHERECTOMY, WITH DRUG-ELUTING INTRACORONARY
C9604 PERCUTANEOUS TRANSLUMINAL REVASCULARIZATION OF OR THROUGH CORONARY ARTERY
C9605 PERCUTANEOUS TRANSLUMINAL REVASCULARIZATION OF OR THROUGH CORONARY ARTERY
C9606 PERCUTANEOUS TRANSLUMINAL REVASCULARIZATION OF ACUTE TOTAL/SUBTOTAL OCCLUSION
C9607 PERCUTANEOUS TRANSLUMINAL REVASCULARIZATION OF CHRONIC TOTAL OCCLUSION,
C9608 PERCUTANEOUS TRANSLUMINAL REVASCULARIZATION OF CHRONIC TOTAL OCCLUSION,
C9728 PLACE DEVICE/MARKER, NON PRO
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
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
E0920 FRACTURE FRAME ATTACHED TO B
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
L0112 CRANIAL CERVICAL ORTHOSIS
L0113 CRANIAL CERVICAL TORTICOLLIS
L0120 CERV FLEXIBLE NON-ADJUSTABLE
L0984 PROTECTIVE BODY SOCK EACH
L1300 BODY JACKET MOLD TO PATIENT
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
L1845 KO W/ ADJ FLEX/EXT ROTAT CUS
L1846 KO W ADJ FLEX/EXT ROTAT MOLD
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
V2199 LENS SINGLE VISION NOT OTH C
V2797 VIS ITEM/SVC IN OTHER CODE
HOME HEALTH RELATED
CODE DESCRIPTION
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
99600 UNLISTED HOME VISIT SERVICE/PROCEDURE
99601 HOME INFUSION/VISIT, 2 HRS
99602 HOME INFUSION, EACH ADDTL HR
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
Q5001 HOSPICE IN PATIENT HOME
Q5002 HOSPICE IN ASSISTED LIVING
Q5009 HOSPICE CARE, NOS
S9340 HIT ENTERAL PER DIEM
S9341 HIT ENTERAL GRAV DIEM
S9342 HIT ENTERAL PUMP DIEM
S9343 HIT ENTERAL BOLUS NURS
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
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
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
92521 EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER)
92522 EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE
92523 EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION
92524 BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE
92526 ORAL FUNCTION THERAPY
92606 THER SRVC(S),NON-SPEECH GEN DEV, W/PROG
92609 THER SRVC,NON-SPEECH GEN DEV USE, W/PROG
92630 AUDITORY REHAB, PRE-LINGUAL HEAR LOSS
92633 AUDITORY REHAB POST-LINGUAL HEAR LOSS
92700 UNLISTED OTORHINOLARYNG SERVICE/PROC
92928 PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH
92929 PRQ TRLUML CORONARY STENT W/ANGIO ADDL ART/BRNCH
93619 ELECTROPHYS EV,R A-V PACE/REC,W/ INDUCT
93620 ELECTROPHYS EV,R A-V PACE/REC,W/O INDUCT
93621 ELECTROPHYS EV,L A-V PACE/REC,W/ INDUCT
93622 ELECTROPHYS EV,L 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
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
97153 ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN
97154 GROUP ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN
97155 ADAPT BEHAVIOR TX PRTCL MODIFICATION BY PHYS/QHP EA 15 MIN
97156 FAMILY ADAPTIVE BEHAVIOR TX GUIDANCE BY PHYS/QHP EA 15 MIN
97157 MULTIPLE FAM GROUP BEHAVIOR TX GUIDANCE BY PHYS/QHP EA 15 MIN
97158 GROUP ADAPTIVE BEHAVIOR TX PROTOCOL MODIFICATION BY PHYS/QHP EA 15 MIN
97164 PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 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
99429 UNLISTED PREVENTIVE SERVICE
99499 UNLISTED E/M SERVICE
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
V2799 MISCELLANEOUS VISION SERVICE
V5299 HEARING SERVICE
V5362 SPEECH SCREENING
V5363 LANGUAGE SCREENING
V5364 DYSPHAGIA SCREENING
OP PSHYCH 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
PATHOLOGY & LABORATORY
CODE DESCRIPTION
80299 QUANTITATIVE ASSAY, DRUG
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
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
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
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
84999 CLINICAL CHEMISTRY TEST
85999 HEMATOLOGY PROCEDURE
86355 B CELLS, TOTAL COUNT
86356 MONONUCLEAR CELL ANTIGEN, QUANT
86357 NK CELLS, TOTAL COUNT
86359 T CELLS, TOTAL COUNT
86360 T CELL ABSOLUTE COUNT/RATIO
86361 T CELL ABSOLUTE 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
L8000 MASTECTOMY BRA
L8001 BREAST PROSTHESIS BRA & FORM
L8002 BRST PRSTH BRA & BILAT FORM
L8015 EXT BREASTPROSTHESIS GARMENT
L8020 MASTECTOMY FORM
L8030 BREAST PROSTHES W/O ADHESIVE
L8031 BREAST PROSTHESIS W ADHESIVE
L8032 REUSABLE NIPPLE PROSTHESIS
L8035 CUSTOM BREAST PROSTHESIS
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-THERAPUTIC
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
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
78815 PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH
78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY
78999 NUCLEAR DIAGNOSTIC EXAM UNLISTED
79445 NUCLEAR THERAPY, INTRA-ARTERIAL
79999 NUCLEAR THERAPY, UNLISTED
C9762 CARDIAC MRI FOR MORPHOLOGY AND FUNCTION, QUANT SEGMENTAL DYSFUNCTION; WITH STRAIN IMAGING
C9763 CARDIAC MRI FOR MORPHOLOGY AND FUNCTION, QUANT SEGMENTAL DYSFUNCTION; WITH STRESS IMAGING
G0235 PET NOT OTHERWISE SPECIFIED
G0297 LOW DOSE CT SCAN (LDCT) FOR LUNG CANCER SCREENING
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
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
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
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
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
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
43236 UPPER GI ENDOSCOPY,W/DIR SUBMUC INJ
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
49560 REPAIR INCISIONAL HERNIA,REDUCIBLE
49565 REPAIR RECURR INCIS HERNIA,REDUC
49652 LAP, VENTRAL HERNIA REPAIR,REDUCIBLE
49654 LAP, INCISIONAL HERNIA REPAIR,REDUCIBLE
49656 LAP, RECURRENT INCISIONAL HERNIA REPAIR,REDUCIBLE
49659 LAP,HERNIA REPAIR PROC,UNLIST
49999 ABDOMEN SURGERY PROC UNLISTED
SURGERY - EYE & OCULAR ADNEXA
CODE DESCRIPTION
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
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
68899 TEAR DUCT SYSTEM SURG UNLISTED
0191T INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPROACH
0402T COLLAGEN CROSS-LINKING OF CORNEA
C9770 VITRECTOMY, MECH, PARS PLANA APPROACH, W/SUBRETINAL INJ PHARM/BIOLOGIC AGENT
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
11980 IMPLANT,HORMONE,SUBCUTANEOUS
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
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
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
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
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
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
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
63194 INCIS 1 SPINOTHAL,CERV,1 STAGE
63195 INCIS 1 SPINOTHAL,THOR,1 STAGE
63196 INCIS BOTH SPINOTHAL,CERV,1 STAGE
63197 INCIS BOTH SPINOTHAL,THOR,1 STAGE
63198 INCIS BOTH SPINOTHAL,CERV,2 STAGES
63199 INCIS BOTH SPINOTHAL,THOR,2 STAGES
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
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
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
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
53899 UROLOGY SURGERY PROCEDURE UNLISTED
C9739 CYSTOURETHROSCOPY, WITH INSERT TRANSPROSTATIC IMPLANT; 1 TO 3 IMPLANTS
C9740 CYSTOURETHROSCOPY, WITH INSERT TRANSPROSTATIC IMPLANT; 4 OR MORE IMPLANTS
0491T ABLATIVE LASER TX OPEN WOUND, PER DAY, 1ST 20 SQCM OR LESS
0492T ABLATIVE LASER TX OPEN WOUND, PER DAY, ADDL 20 SQCM
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

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