Connection supplemental articles and policies - January 2010

CPT CODE

DESCRIPTION

0203T

SLEEP STUDY, UNATTENDED, SIMULTANEOUS RECORDING; HEART RATE, OXYGEN SATURATION, RESPIRATORY ANALYSIS (EG, BY AIRFLOW OR PERIPHERAL ARTERIAL TONE) AND SLEEP TIME

0204T

SLEEP STUDY, UNATTENDED, SIMULTANEOUS RECORDING; MINIMUM OF HEART RATE, OXYGEN SATURATION, AND RESPIRATORY ANALYSIS (EG, BY AIRFLOW OR PERIPHERAL ARTERIAL TONE)

0205T

INTRAVASCULAR CATHETER-BASED CORONARY VESSEL OR GRAFT SPECTROSCOPY (EG, INFRARED) DURING DIAGNOSTIC EVALUATION AND/OR THERAPEUTIC INTERVENTION INCLUDING IMAGING SUPERVISION, INTERPRETATION, AND REPORT, EACH VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

0206T

ALGORITHMIC ANALYSIS, REMOTE, OF ELECTROCARDIOGRAPHIC-DERIVED DATA WITH COMPUTER PROBABILITY ASSESSMENT, INCLUDING REPORT

0207T

EVACUATION OF MEIBOMIAN GLANDS, AUTOMATED, USING HEAT AND INTERMITTENT PRESSURE, UNILATERAL

0208T

PURE TONE AUDIOMETRY (THRESHOLD), AUTOMATED (INCLUDES USE OF COMPUTER-ASSISTED DEVICE); AIR ONLY

0209T

PURE TONE AUDIOMETRY (THRESHOLD), AUTOMATED (INCLUDES USE OF COMPUTER-ASSISTED DEVICE); AIR AND BONE

0210T

SPEECH AUDIOMETRY THRESHOLD, AUTOMATED (INCLUDES USE OF COMPUTER-ASSISTED DEVICE);

0211T

SPEECH AUDIOMETRY THRESHOLD, AUTOMATED (INCLUDES USE OF COMPUTER-ASSISTED DEVICE); WITH SPEECH RECOGNITION

0212T

COMPREHENSIVE AUDIOMETRY THRESHOLD EVALUATION AND SPEECH RECOGNITION (0209T, 0211T COMBINED), AUTOMATED (INCLUDES USE OF COMPUTER-ASSISTED DEVICE)

0213T

INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH ULTRASOUND GUIDANCE, CERVICAL OR THORACIC; SINGLE LEVEL

0214T

INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH ULTRASOUND GUIDANCE, CERVICAL OR THORACIC; SECOND LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

0215T

INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH ULTRASOUND GUIDANCE, CERVICAL OR THORACIC; THIRD AND ANY ADDITIONAL LEVEL(S) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

0216T

INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH ULTRASOUND GUIDANCE, LUMBAR OR SACRAL; SINGLE LEVEL

0217T

INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH ULTRASOUND GUIDANCE, LUMBAR OR SACRAL; SECOND LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

0218T

INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH ULTRASOUND GUIDANCE, LUMBAR OR SACRAL; THIRD AND ANY ADDITIONAL LEVEL(S). (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

0219T

PLACEMENT OF POSTERIOR INTRAFACET IMPLANT(S), UNILATERAL OR BILATERAL, INCLUDING IMAGING AND PLACEMENT OF BONE GRAFT(S) OR SYNTHETIC DEVICE(S), SINGLE LEVEL; CERVICAL

0220T

PLACEMENT OF POSTERIOR INTRAFACET IMPLANT(S), UNILATERAL OR BILATERAL, INCLUDING IMAGING AND PLACEMENT OF BONE GRAFT(S) OR SYNTHETIC DEVICE(S), SINGLE LEVEL; THORACIC

0221T

PLACEMENT OF POSTERIOR INTRAFACET IMPLANT(S), UNILATERAL OR BILATERAL, INCLUDING IMAGING AND PLACEMENT OF BONE GRAFT(S) OR SYNTHETIC DEVICE(S), SINGLE LEVEL; LUMBAR

0222T

PLACEMENT OF POSTERIOR INTRAFACET IMPLANT(S), UNILATERAL OR BILATERAL, INCLUDING IMAGING AND PLACEMENT OF BONE GRAFT(S) OR SYNTHETIC DEVICE(S), SINGLE LEVEL; EACH ADDITIONAL VERTEBRAL SEGMENT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

0545F

PLAN FOR FOLLOW-UP CARE FOR MAJOR DEPRESSIVE DISORDER, DOCUMENTED (MDD ADOL)

1200F

SEIZURE TYPE(S) AND CURRENT SEIZURE FREQUENCY(IES) DOCUMENTED (EPI)

1205F

ETIOLOGY OF EPILEPSY OR EPILEPSY SYNDROME(S) REVIEWED AND DOCUMENTED (EPI)

14301

ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA; DEFECT 30.1 SQ CM TO 60.0 SQ CM

14302

ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA; EACH ADDITIONAL 30.0 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

2060F

PATIENT INTERVIEWED DIRECTLY BY EVALUATING CLINICIAN ON OR BEFORE DATE OF DIAGNOSIS OF MAJOR DEPRESSIVE DISORDER (MDD ADOL)

21011

EXCISION, TUMOR, SOFT TISSUE OF FACE OR SCALP, SUBCUTANEOUS; LESS THAN 2 CM

21012

EXCISION, TUMOR, SOFT TISSUE OF FACE OR SCALP, SUBCUTANEOUS; 2 CM OR GREATER

21013

EXCISION, TUMOR, SOFT TISSUE OF FACE AND SCALP, SUBFASCIAL (EG, SUBGALEAL, INTRAMUSCULAR); LESS THAN 2 CM

21014

EXCISION, TUMOR, SOFT TISSUE OF FACE AND SCALP, SUBFASCIAL (EG, SUBGALEAL, INTRAMUSCULAR); 2 CM OR GREATER

21016

RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF FACE OR SCALP; 2 CM OR GREATER

21552

EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBCUTANEOUS; 3 CM OR GREATER

21554

EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER

21558

RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF NECK OR ANTERIOR THORAX; 5 CM OR GREATER

21931

EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBCUTANEOUS; 3 CM OR GREATER

21932

EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5 CM

21933

EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER

21936

RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF BACK OR FLANK; 5 CM OR GREATER

22901

EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER

22902

EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBCUTANEOUS; LESS THAN 3 CM

22903

EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBCUTANEOUS; 3 CM OR GREATER

22904

RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF ABDOMINAL WALL; LESS THAN 5 CM

22905

RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF ABDOMINAL WALL; 5 CM OR GREATER

23071

EXCISION, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBCUTANEOUS; 3 CM OR GREATER

23073

EXCISION, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER

23078

RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF SHOULDER AREA; 5 CM OR GREATER

24071

EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOW AREA, SUBCUTANEOUS; 3 CM OR GREATER

24073

EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOW AREA, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER

24079

RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF UPPER ARM OR ELBOW AREA; 5 CM OR GREATER

25071

EXCISION, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST AREA, SUBCUTANEOUS; 3 CM OR GREATER

25073

EXCISION, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST AREA, SUBFASCIAL (EG, INTRAMUSCULAR); 3 CM OR GREATER

25078

RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF FOREARM AND/OR WRIST AREA; 3 CM OR GREATER

26111

EXCISION, TUMOR OR VASCULAR MALFORMATION, SOFT TISSUE OF HAND OR FINGER, SUBCUTANEOUS; 1.5 CM OR GREATER

26113

EXCISION, TUMOR, SOFT TISSUE, OR VASCULAR MALFORMATION, OF HAND OR FINGER, SUBFASCIAL (EG, INTRAMUSCULAR); 1.5 CM OR GREATER

26118

RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF HAND OR FINGER; 3 CM OR GREATER

27043

EXCISION, TUMOR, SOFT TISSUE OF PELVIS AND HIP AREA, SUBCUTANEOUS; 3 CM OR GREATER

27045

EXCISION, TUMOR, SOFT TISSUE OF PELVIS AND HIP AREA, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER

27059

RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF PELVIS AND HIP AREA; 5 CM OR GREATER

27337

EXCISION, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBCUTANEOUS; 3 CM OR GREATER

27339

EXCISION, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER

27364

RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF THIGH OR KNEE AREA; 5 CM OR GREATER

27616

RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF LEG OR ANKLE AREA; 5 CM OR GREATER

27632

EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA, SUBCUTANEOUS; 3 CM OR GREATER

27634

EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER

28039

EXCISION, TUMOR, SOFT TISSUE OF FOOT OR TOE, SUBCUTANEOUS; 1.5 CM OR GREATER

28041

EXCISION, TUMOR, SOFT TISSUE OF FOOT OR TOE, SUBFASCIAL (EG, INTRAMUSCULAR); 1.5 CM OR GREATER

28047

RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF FOOT OR TOE; 3 CM OR GREATER

29581

APPLICATION OF MULTI-LAYER VENOUS WOUND COMPRESSION SYSTEM, BELOW KNEE

3008F

BODY MASS INDEX (BMI), DOCUMENTED (PV)

3015F

CERVICAL CANCER SCREENING RESULTS DOCUMENTED AND REVIEWED (PV)

3038F

PULMONARY FUNCTION TEST PERFORMED WITHIN 12 MONTHS PRIOR TO SURGERY (LUNG/ESOP CX)

31626

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH PLACEMENT OF FIDUCIAL MARKERS, SINGLE OR MULTIPLE

31627

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH COMPUTER-ASSISTED, IMAGE-GUIDED NAVIGATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE[S])

32552

REMOVAL OF INDWELLING TUNNELED PLEURAL CATHETER WITH CUFF

32553

PLACEMENT OF INTERSTITIAL DEVICE(S) FOR RADIATION THERAPY GUIDANCE (EG, FIDUCIAL MARKERS, DOSIMETER), PERCUTANEOUS, INTRA-THORACIC, SINGLE OR MULTIPLE

32561

INSTILLATION(S), VIA CHEST TUBE/CATHETER, AGENT FOR FIBRINOLYSIS (EG, FIBRINOLYTIC AGENT FOR BREAK UP OF MULTILOCULATED EFFUSION); INITIAL DAY

32562

INSTILLATION(S), VIA CHEST TUBE/CATHETER, AGENT FOR FIBRINOLYSIS (EG, FIBRINOLYTIC AGENT FOR BREAK UP OF MULTILOCULATED EFFUSION); SUBSEQUENT DAY

3293F

ABO AND RH BLOOD TYPING DOCUMENTED AS PERFORMED (PRE-CR)

3294F

GROUP B STREPTOCOCCUS (GBS) SCREENING DOCUMENTED AS PERFORMED DURING WEEK 35-37 GESTATION (PRE-CR)

3323F

CLINICAL TUMOR, NODE AND METASTASES (TNM) STAGING DOCUMENTED AND REVIEWED PRIOR TO SURGERY (LUNG/ESOP CX)

3324F

MRI OR CT SCAN ORDERED, REVIEWED OR REQUESTED (EPI)

3328F

PERFORMANCE STATUS DOCUMENTED AND REVIEWED WITHIN 2 WEEKS PRIOR TO SURGERY(LUNG/ESOP CX)

33782

AORTIC ROOT TRANSLOCATION WITH VENTRICULAR SEPTAL DEFECT AND PULMONARY STENOSIS REPAIR (IE, NIKAIDOH PROCEDURE); WITHOUT CORONARY OSTIUM REIMPLANTATION

33783

AORTIC ROOT TRANSLOCATION WITH VENTRICULAR SEPTAL DEFECT AND PULMONARY STENOSIS REPAIR (IE, NIKAIDOH PROCEDURE); WITH REIMPLANTATION OF 1 OR BOTH CORONARY OSTIA

33981

REPLACEMENT OF EXTRACORPOREAL VENTRICULAR ASSIST DEVICE, SINGLE OR BIVENTRICULAR, PUMP(S), SINGLE OR EACH PUMP

33982

REPLACEMENT OF VENTRICULAR ASSIST DEVICE PUMP(S); IMPLANTABLE INTRACORPOREAL, SINGLE VENTRICLE, WITHOUT CARDIOPULMONARY BYPASS

33983

REPLACEMENT OF VENTRICULAR ASSIST DEVICE PUMP(S); IMPLANTABLE INTRACORPOREAL, SINGLE VENTRICLE, WITH CARDIOPULMONARY BYPASS

36147

INTRODUCTION OF NEEDLE AND/OR CATHETER, ARTERIOVENOUS SHUNT CREATED FOR DIALYSIS (GRAFT/FISTULA); INITIAL ACCESS WITH COMPLETE RADIOLOGICAL EVALUATION OF DIALYSIS ACCESS, INCLUDING FLUOROSCOPY, IMAGE DOCUMENTATION AND REPORT (INCLUDES ACCESS OF SHUNT, INJECTION[S] OF CONTRAST, AND ALL NECESSARY IMAGING FROM THE ARTERIAL ANASTOMOSIS AND ADJACENT ARTERY THROUGH ENTIRE VENOUS OUTFLOW INCLUDING THE INFERIOR OR SUPERIOR VENA CAVA)

36148

INTRODUCTION OF NEEDLE AND/OR CATHETER, ARTERIOVENOUS SHUNT CREATED FOR DIALYSIS (GRAFT/FISTULA); ADDITIONAL ACCESS FOR THERAPEUTIC INTERVENTION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

3650F

ELECTROENCEPHALOGRAM (EEG) ORDERED, REVIEWED OR REQUESTED (EPI)

37761

LIGATION OF PERFORATOR VEIN(S), SUBFASCIAL, OPEN, INCLUDING ULTRASOUND GUIDANCE, WHEN PERFORMED, 1 LEG

4004F

PATIENT SCREENED FOR TOBACCO USE AND RECEIVED TOBACCO CESSATION COUNSELING, IF IDENTIFIED AS A TOBACCO USER (PV)

4063F

ANTIDEPRESSANT PHARMACOTHERAPY CONSIDERED AND NOT PRESCRIBED (MDD ADOL)

4255F

DURATION OF GENERAL OR NEURAXIAL ANESTHESIA 60 MINUTES OR LONGER, AS DOCUMENTED IN THE ANESTHESIA RECORD (CRIT)

4256F

DURATION OF GENERAL OR NEURAXIAL ANESTHESIA LESS THAN 60 MINUTES, AS DOCUMENTED IN THE ANESTHESIA RECORD (CRIT)

43281

LAPAROSCOPY, SURGICAL, REPAIR OF PARAESOPHAGEAL HERNIA, INCLUDES FUNDOPLASTY, WHEN PERFORMED; WITHOUT IMPLANTATION OF MESH

43282

LAPAROSCOPY, SURGICAL, REPAIR OF PARAESOPHAGEAL HERNIA, INCLUDES FUNDOPLASTY, WHEN PERFORMED; WITH IMPLANTATION OF MESH

4330F

COUNSELING ABOUT EPILEPSY SPECIFIC SAFETY ISSUES PROVIDED TO PATIENT (OR CAREGIVER (S)) (EPI)

4340F

COUNSELING FOR WOMEN OF CHILDBEARING POTENTIAL WITH EPILEPSY (EPI)

43775

LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; LONGITUDINAL GASTRECTOMY (IE, SLEEVE GASTRECTOMY)

45171

EXCISION OF RECTAL TUMOR, TRANSANAL APPROACH; NOT INCLUDING MUSCULARIS PROPRIA (IE, PARTIAL THICKNESS)

45172

EXCISION OF RECTAL TUMOR, TRANSANAL APPROACH; INCLUDING MUSCULARIS PROPRIA (IE, FULL THICKNESS)

46707

REPAIR OF ANORECTAL FISTULA WITH PLUG (EG, PORCINE SMALL INTESTINE SUBMUCOSA [SIS])

49411

PLACEMENT OF INTERSTITIAL DEVICE(S) FOR RADIATION THERAPY GUIDANCE (EG, FIDUCIAL MARKERS, DOSIMETER), PERCUTANEOUS, INTRA-ABDOMINAL, INTRA-PELVIC (EXCEPT PROSTATE), AND/OR RETROPERITONEUM, SINGLE OR MULTIPLE

51727

COMPLEX CYSTOMETROGRAM (IE, CALIBRATED ELECTRONIC EQUIPMENT); WITH URETHRAL PRESSURE PROFILE STUDIES (IE, URETHRAL CLOSURE PRESSURE PROFILE), ANY TECHNIQUE

51728

COMPLEX CYSTOMETROGRAM (IE, CALIBRATED ELECTRONIC EQUIPMENT); WITH VOIDING PRESSURE STUDIES (IE, BLADDER VOIDING PRESSURE), ANY TECHNIQUE

51729

COMPLEX CYSTOMETROGRAM (IE, CALIBRATED ELECTRONIC EQUIPMENT); WITH VOIDING PRESSURE STUDIES (IE, BLADDER VOIDING PRESSURE) AND URETHRAL PRESSURE PROFILE STUDIES (IE, URETHRAL CLOSURE PRESSURE PROFILE), ANY TECHNIQUE

5200F

CONSIDERATION OF REFERRAL FOR A NEUROLOGICAL EVALUATION OF APPROPRIATENESS FOR SURGICAL THERAPY FOR INTRACTABLE EPILEPSY WITHIN THE PAST 3 YEARS (EPI)

53855

INSERTION OF A TEMPORARY PROSTATIC URETHRAL STENT, INCLUDING URETHRAL MEASUREMENT

57426

REVISION (INCLUDING REMOVAL) OF PROSTHETIC VAGINAL GRAFT, LAPAROSCOPIC APPROACH

6070F

PATIENT QUERIED AND COUNSELED ABOUT ANTI-EPILEPTIC DRUG (AED) SIDE EFFECTS (EPI)

63661

REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODE PERCUTANEOUS ARRAY(S), INCLUDING FLUOROSCOPY, WHEN PERFORMED

63662

REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODE PLATE/PADDLE(S) PLACED VIA LAMINOTOMY OR LAMINECTOMY, INCLUDING FLUOROSCOPY, WHEN PERFORMED

63663

REVISION INCLUDING REPLACEMENT, WHEN PERFORMED, OF SPINAL NEUROSTIMULATOR ELECTRODE PERCUTANEOUS ARRAY(S), INCLUDING FLUOROSCOPY, WHEN PERFORMED

63664

REVISION INCLUDING REPLACEMENT, WHEN PERFORMED, OF SPINAL NEUROSTIMULATOR ELECTRODE PLATE/PADDLE(S) PLACED VIA LAMINOTOMY OR LAMINECTOMY, INCLUDING FLUOROSCOPY, WHEN PERFORMED

64490

INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; SINGLE LEVEL

64491

INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; SECOND LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

64492

INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; THIRD AND ANY ADDITIONAL LEVEL(S) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

64493

INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SINGLE LEVEL

64494

INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SECOND LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

64495

INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; THIRD AND ANY ADDITIONAL LEVEL(S) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

74261

COMPUTED TOMOGRAPHIC (CT) COLONOGRAPHY, DIAGNOSTIC, INCLUDING IMAGE POSTPROCESSING; WITHOUT CONTRAST MATERIAL

74262

COMPUTED TOMOGRAPHIC (CT) COLONOGRAPHY, DIAGNOSTIC, INCLUDING IMAGE POSTPROCESSING; WITH CONTRAST MATERIAL(S) INCLUDING NON-CONTRAST IMAGES, IF PERFORMED

74263

COMPUTED TOMOGRAPHIC (CT) COLONOGRAPHY, SCREENING, INCLUDING IMAGE POSTPROCESSING

75565

CARDIAC MAGNETIC RESONANCE IMAGING FOR VELOCITY FLOW MAPPING (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

75571

COMPUTED TOMOGRAPHY, HEART, WITHOUT CONTRAST MATERIAL, WITH QUANTITATIVE EVALUATION OF CORONARY CALCIUM

75572

COMPUTED TOMOGRAPHY, HEART, WITH CONTRAST MATERIAL, FOR EVALUATION OF CARDIAC STRUCTURE AND MORPHOLOGY (INCLUDING 3D IMAGE POSTPROCESSING, ASSESSMENT OF CARDIAC FUNCTION, AND EVALUATION OF VENOUS STRUCTURES, IF PERFORMED)

75573

COMPUTED TOMOGRAPHY, HEART, WITH CONTRAST MATERIAL, FOR EVALUATION OF CARDIAC STRUCTURE AND MORPHOLOGY IN THE SETTING OF CONGENITAL HEART DISEASE (INCLUDING 3D IMAGE POSTPROCESSING, ASSESSMENT OF LV CARDIAC FUNCTION, RV STRUCTURE AND FUNCTION AND EVALUATION OF VENOUS STRUCTURES, IF PERFORMED)

75574

COMPUTED TOMOGRAPHIC ANGIOGRAPHY, HEART, CORONARY ARTERIES AND BYPASS GRAFTS (WHEN PRESENT), WITH CONTRAST MATERIAL, INCLUDING 3D IMAGE POSTPROCESSING (INCLUDING EVALUATION OF CARDIAC STRUCTURE AND MORPHOLOGY, ASSESSMENT OF CARDIAC FUNCTION, AND EVALUATION OF VENOUS STRUCTURES, IF PERFORMED)

75791

ANGIOGRAPHY, ARTERIOVENOUS SHUNT (EG, DIALYSIS PATIENT FISTULA/GRAFT), COMPLETE EVALUATION OF DIALYSIS ACCESS, INCLUDING FLUOROSCOPY, IMAGE DOCUMENTATION AND REPORT (INCLUDES INJECTIONS OF CONTRAST AND ALL NECESSARY IMAGING FROM THE ARTERIAL ANASTOMOSIS AND ADJACENT ARTERY THROUGH ENTIRE VENOUS OUTFLOW INCLUDING THE INFERIOR OR SUPERIOR VENA CAVA), RADIOLOGICAL SUPERVISION AND INTERPRETATION

77338

MULTI-LEAF COLLIMATOR (MLC) DEVICE(S) FOR INTENSITY MODULATED RADIATION THERAPY (IMRT), DESIGN AND CONSTRUCTION PER IMRT PLAN

78451

MYOCARDIAL PERFUSION IMAGING, TOMOGRAPHIC (SPECT) (INCLUDING ATTENUATION CORRECTION, QUALITATIVE OR QUANTITATIVE WALL MOTION, EJECTION FRACTION BY FIRST PASS OR GATED TECHNIQUE, ADDITIONAL QUANTIFICATION, WHEN PERFORMED); SINGLE STUDY, AT REST OR STRESS (EXERCISE OR PHARMACOLOGIC)

78452

MYOCARDIAL PERFUSION IMAGING, TOMOGRAPHIC (SPECT) (INCLUDING ATTENUATION CORRECTION, QUALITATIVE OR QUANTITATIVE WALL MOTION, EJECTION FRACTION BY FIRST PASS OR GATED TECHNIQUE, ADDITIONAL QUANTIFICATION, WHEN PERFORMED); MULTIPLE STUDIES, AT REST AND/OR STRESS (EXERCISE OR PHARMACOLOGIC) AND/OR REDISTRIBUTION AND/OR REST REINJECTION

78453

MYOCARDIAL PERFUSION IMAGING, PLANAR (INCLUDING QUALITATIVE OR QUANTITATIVE WALL MOTION, EJECTION FRACTION BY FIRST PASS OR GATED TECHNIQUE, ADDITIONAL QUANTIFICATION, WHEN PERFORMED); SINGLE STUDY, AT REST OR STRESS (EXERCISE OR PHARMACOLOGIC)

78454

MYOCARDIAL PERFUSION IMAGING, PLANAR (INCLUDING QUALITATIVE OR QUANTITATIVE WALL MOTION, EJECTION FRACTION BY FIRST PASS OR GATED TECHNIQUE, ADDITIONAL QUANTIFICATION, WHEN PERFORMED); MULTIPLE STUDIES, AT REST AND/OR STRESS (EXERCISE OR PHARMACOLOGIC) AND/OR REDISTRIBUTION AND/OR REST REINJECTION

83987

PH; EXHALED BREATH CONDENSATE

84145

PROCALCITONIN (PCT)

84431

THROMBOXANE METABOLITE(S), INCLUDING THROMBOXANE IF PERFORMED, URINE

86305

HUMAN EPIDIDYMIS PROTEIN 4 (HE4)

86352

CELLULAR FUNCTION ASSAY INVOLVING STIMULATION (EG, MITOGEN OR ANTIGEN) AND DETECTION OF BIOMARKER (EG, ATP)

86780

ANTIBODY; TREPONEMA PALLIDUM

86825

HUMAN LEUKOCYTE ANTIGEN (HLA) CROSSMATCH, NON-CYTOTOXIC (EG, USING FLOW CYTOMETRY); FIRST SERUM SAMPLE OR DILUTION

86826

HUMAN LEUKOCYTE ANTIGEN (HLA) CROSSMATCH, NON-CYTOTOXIC (EG, USING FLOW CYTOMETRY); EACH ADDITIONAL SERUM SAMPLE OR SAMPLE DILUTION (LIST SEPARATELY IN ADDITION TO PRIMARY PROCEDURE)

87150

CULTURE, TYPING; IDENTIFICATION BY NUCLEIC ACID (DNA OR RNA) PROBE, AMPLIFIED PROBE TECHNIQUE, PER CULTURE OR ISOLATE, EACH ORGANISM PROBED

87153

CULTURE, TYPING; IDENTIFICATION BY NUCLEIC ACID SEQUENCING METHOD, EACH ISOLATE (EG, SEQUENCING OF THE 16S RRNA GENE)

87493

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CLOSTRIDIUM DIFFICILE, TOXIN GENE(S), AMPLIFIED PROBE TECHNIQUE

88387

MACROSCOPIC EXAMINATION, DISSECTION, AND PREPARATION OF TISSUE FOR NON-MICROSCOPIC ANALYTICAL STUDIES (EG, NUCLEIC ACID-BASED MOLECULAR STUDIES); EACH TISSUE PREPARATION (EG, A SINGLE LYMPH NODE)

88388

MACROSCOPIC EXAMINATION, DISSECTION, AND PREPARATION OF TISSUE FOR NON-MICROSCOPIC ANALYTICAL STUDIES (EG, NUCLEIC ACID-BASED MOLECULAR STUDIES); IN CONJUNCTION WITH A TOUCH IMPRINT, INTRAOPERATIVE CONSULTATION, OR FROZEN SECTION, EACH TISSUE PREPARATION (EG, A SINGLE LYMPH NODE) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

88738

HEMOGLOBIN (HGB), QUANTITATIVE, TRANSCUTANEOUS

89398

UNLISTED REPRODUCTIVE MEDICINE LABORATORY PROCEDURE

90644

MENINGOCOCCAL CONJUGATE VACCINE, SEROGROUPS C & Y AND HEMOPHILUS INFLUENZA B VACCINE, TETANUS TOXOID CONJUGATE (HIB-MENCY-TT), 4-DOSE SCHEDULE, WHEN ADMINISTERED TO CHILDREN 2-15 MONTHS OF AGE, FOR INTRAMUSCULAR USE

92540

BASIC VESTIBULAR EVALUATION, INCLUDES SPONTANEOUS NYSTAGMUS TEST WITH ECCENTRIC GAZE FIXATION NYSTAGMUS, WITH RECORDING, POSITIONAL NYSTAGMUS TEST, MINIMUM OF 4 POSITIONS, WITH RECORDING, OPTOKINETIC NYSTAGMUS TEST, BIDIRECTIONAL FOVEAL AND PERIPHERAL STIMULATION, WITH RECORDING, AND OSCILLATING TRACKING TEST, WITH RECORDING

92550

TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS

92570

ACOUSTIC IMMITTANCE TESTING, INCLUDES TYMPANOMETRY (IMPEDANCE TESTING), ACOUSTIC REFLEX THRESHOLD TESTING, AND ACOUSTIC REFLEX DECAY TESTING

93750

INTERROGATION OF VENTRICULAR ASSIST DEVICE (VAD), IN PERSON, WITH PHYSICIAN ANALYSIS OF DEVICE PARAMETERS (EG, DRIVELINES, ALARMS, POWER SURGES), REVIEW OF DEVICE FUNCTION (EG, FLOW AND VOLUME STATUS, SEPTUM STATUS, RECOVERY), WITH PROGRAMMING, IF PERFORMED, AND REPORT

94011

MEASUREMENT OF SPIROMETRIC FORCED EXPIRATORY FLOWS IN AN INFANT OR CHILD THROUGH 2 YEARS OF AGE

94012

MEASUREMENT OF SPIROMETRIC FORCED EXPIRATORY FLOWS, BEFORE AND AFTER BRONCHODILATOR, IN AN INFANT OR CHILD THROUGH 2 YEARS OF AGE

94013

MEASUREMENT OF LUNG VOLUMES (IE, FUNCTIONAL RESIDUAL CAPACITY [FRC], FORCED VITAL CAPACITY [FVC], AND EXPIRATORY RESERVE VOLUME [ERV]) IN AN INFANT OR CHILD THROUGH 2 YEARS OF AGE

95905

MOTOR AND/OR SENSORY NERVE CONDUCTION, USING PRECONFIGURED ELECTRODE ARRAY(S), AMPLITUDE AND LATENCY/VELOCITY STUDY, EACH LIMB, INCLUDES F-WAVE STUDY WHEN PERFORMED, WITH INTERPRETATION AND REPORT

HCPCS Code

Description

A4264

Permanent implantable contraceptive intratubal occlusion device(s) and delivery system

A4336

Incontinence supply, urethral insert, any type, each

A4360

Disposable external urethral clamp or compression device, with pad and/or pouch, each

A4456

Adhesive remover, wipes, any type, each

A4466

Garment, belt, sleeve or other covering, elastic or similar stretchable material, any type, each

A9581

Injection, gadoxetate disodium, 1 ml

A9582

Iodine I-123 iobenguane, diagnostic, per study dose, up to 15 millicuries

A9583

Injection, gadofosveset trisodium, 1 ml

A9604

Samarium SM-153 lexidronam, therapeutic, per treatment dose, up to 150 millicuries

C9254

Injection, lacosamide, 1 mg

C9255

Injection, paliperidone palmitate, 1 mg

C9256

Injection, dexamethasone intravitreal implant, 0.1 mg

C9257

Injection, bevacizumab, 0.25 mg

E0433

Portable liquid oxygen system, rental; home liquefier used to fill portable liquid oxygen containers, includes portable containers, regulator, flowmeter, humidifier, cannula or mask and tubing, with or without supply reservoir and contents gauge

E1036

Multi-positional patient transfer system, extra-wide, with integrated seat, operated by caregiver, patient weight capacity greater than 300 lbs

G0420

Face-to-face educational services related to the care of chronic kidney disease; individual, per session, per one hour

G0421

Face-to-face educational services related to the care of chronic kidney disease; group, per session, per one hour

G0422

Intensive cardiac rehabilitation; with or without continuous ECG monitoring with exercise, per session

G0423

Intensive cardiac rehabilitation; with or without continuous ECG monitoring; without exercise, per session

G0424

Pulmonary rehabilitation, including exercise (includes monitoring), one hour, per session, up to two sessions per day

G0425

Initial inpatient telehealth consultation, typically 30 minutes communicating with the patient via telehealth

G0426

Initial inpatient telehealth consultation, typically 50 minutes communicating with the patient via telehealth

G0427

Initial inpatient telehealth consultation, typically 70 minutes or more communicating with the patient via telehealth

G0430

Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure

G0431

Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class

G8545

I intend to report the hepatitis C measures group

G8546

I intend to report the community-acquired pneumonia (CAP) measures group

G8547

I intend to report the ischemic vascular disease (IVD) measures group

G8548

I intend to report the heart failure (HF) measures group

G8549

All quality actions for the applicable measures in the hepatitis C measures group have been performed for this patient

G8550

All quality actions for the applicable measures in the community-acquired pneumonia (CAP) measures group have been performed for this patient

G8551

All quality actions for the applicable measures in the heart failure (HF)measures group have been performed for this patient

G8552

All quality actions for the applicable measures in the ischemic vascular disease (IVD) measures group have been performed for this patient

G8553

At least one prescription created during the encounter was generated and transmitted electronically using a qualified ERX system

G8556

Referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation

G8557

Patient is not eligible for the referral for otologic evaluation measure

G8558

Not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not specified

G8559

Patient referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation

G8560

Patient has a history of active drainage from the ear within the previous 90 days

G8561

Patient is not eligible for the referral for otologic evaluation for patients with a history of active drainage measure

G8562

Patient does not have a history of active drainage from the ear within the previous 90 days

G8563

Patient not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not specified

G8564

Patient was referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not specified)

G8565

Verification and documentation of sudden or rapidly progressive hearing loss

G8566

Patient is not eligible for the "referral for otologic evaluation for sudden or rapidly progressive hearing loss" measure

G8567

Patient does not have verification and documentation of sudden or rapidly progressive hearing loss

G8568

Patient was not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not specified)

G8569

Prolonged intubation (>24 hrs) required

G8570

Prolonged intubation (>24 hrs) not required

G8571

Development of deep sternal wound infection within 30 days postoperatively

G8572

No deep sternal wound infection

G8573

Stroke/CBA following isolated CABG surgery

G8574

No stroke/CVA following isolated CABG surgery

G8575

Developed postoperative renal insufficiency or required dialysis

G8576

No postoperative renal insufficiency/dialysis not required

G8577

Reoperation required due to bleeding/tamponade, graft occlusion or other cardiac reason

G8578

Reoperation not required due to bleeding/tamponade, graft occlusion or other cardiac reason

G8579

Antiplatelet medication at discharge

G8580

Antiplatelet medication contraindicated/not indicated

G8581

No antiplatelet medication at discharge

G8582

Beta-blocker at discharge

G8583

Beta-blocker contraindicated/not indicated

G8584

No beta-blocker at discharge

G8585

Anti-lipid treatment at discharge

G8586

Anti-lipid treatment contraindicated/not indicated

G8587

No anti-lipid treatment at discharge

G8588

Most recent systolic blood pressure < 140 mmhg

G8589

Most recent systolic blood pressure >= 140 mmhg

G8590

Most recent diastolic blood pressure < 90 mmhg

G8591

Most recent diastolic blood pressure >= 90 mmhg

G8592

No documentation of blood pressure measurement

G8593

Lipid profile results documented and reviewed (must include total cholesterol, HDL-C, triglycerides and calculated LDL-C)

G8594

Lipid profile not performed, reason not otherwise specified

G8595

Most recent LDL-C < 100 mg/dl

G8596

LDL-C was not performed

G8597

Most recent LDL-C >= 100 mg/dl

G8598

Aspirin or another antithrombotic therapy used

G8599

Aspirin or another antithrombotic therapy not used, reason not otherwise specified

G8600

IV t-PA initiated within three hours (<= 180 minutes) of time last known well

G8601

IV t-PA not initiated within three hours (<= 180 minutes) of time last known well for reasons documented by clinician

G8602

IV t-PA not initiated within three hours (<= 180 minutes) of time last known well, reason not specified

G8603

Score on the spoken language comprehension functional communication measure at discharge was higher than at admission

G8604

Score on the spoken language comprehension functional communication measure at discharge was not higher than at admission, reason not specified

G8605

Patient was not scored on the spoken language comprehension functional communication measure either at admission or at discharge

G8606

Score on the attention functional communication measure at discharge was higher than at admission

G8607

Score on the attention functional communication measure at discharge was not higher than at admission, reason not specified

G8608

Patient was not scored on the attention functional communication measure either at admission or at discharge

G8609

Score on the memory functional communication measure at discharge was higher than at admission

G8610

Score on the memory functional communication measure at discharge was not higher than at admission, reason not specified

G8611

Patient was not scored on the memory functional communication measure at either admission or at discharge

G8612

Score on the motor speech functional communication measure at discharge was higher than at admission

G8613

Score on the motor speech functional communication measure at discharge was not higher than at admission, reason not specified

G8614

Patient was not scored on the motor speech functional communication measure either at admission or at discharge

G8615

Score on the reading functional communication measure at discharge was higher than at admission

G8616

Score on the reading functional communication measure at discharge was not higher than at admission, reason not specified

G8617

Patient was not scored on the reading functional communication measure either at admission or at discharge

G8618

Score on the spoken language expression functional communication measure at discharge was higher than at admission

G8619

Score on the spoken language expression functional communication measure at discharge was not higher than at admission, reason not specified

G8620

Patient was not scored on the spoken language expression functional communication measure either at admission or at discharge

G8621

Score on the writing functional communication measure at discharge was higher than at admission

G8622

Score on the writing functional communication measure at discharge was not higher than at admission, reason not specified

G8623

Patient was not scored on the writing functional communication measure either at admission or at discharge

G8624

Score on the swallowing functional communication measure at discharge was higher than at admission

G8625

Score on the swallowing functional communication measure at discharge was not higher than at admission, reason not specified

G8626

Patient was not scored on the swallowing functional communication measure at admission or at discharge

G8627

Surgical procedure performed within 30 days following cataract surgery for major complications (e.g. retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscence)

G8628

Surgical procedure not performed within 30 days following cataract surgery for major complications (e.g. retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscence)

J0461

Injection, atropine sulfate, 0.01 mg

J0559

Injection, penicillin G benzathine and penicillin G procaine, 2500 units

J0586

Injection, abobotulinumtoxina, 5 units

J0598

Injection, C1 esterase inhibitor (human), 10 units

J0718

Injection, certolizumab pegol, 1 mg

J0833

Injection, cosyntropin, not otherwise specified, 0.25 mg

J0834

Injection, cosyntropin (Cortrosyn), 0.25 mg

J1680

Injection, human fibrinogen concentrate, 100 mg

J2562

Injection, plerixafor, 1 mg

J2793

Injection, rilonacept, 1 mg

J2796

Injection, romiplostim, 10 micrograms

J7185

Injection, factor VIII (antihemophilic factor, recombinant) (Xyntha), per i.u.

J7325

Hyaluronan or derivative, Synvisc or Synvisc-One, for intra-articular injection, 1 mg

J9155

Injection, degarelix, 1 mg

J9171

Injection, docetaxel, 1 mg

J9328

Injection, temozolomide, 1 mg

L2861

Addition to lower extremity joint, knee or ankle, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each

L3891

Addition to upper extremity joint, wrist or elbow, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each

L5973

Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion and/or plantar flexion control, includes power source

L8031

Breast prosthesis, silicone or equal, with integral adhesive

L8032

Nipple prosthesis, reusable, any type, each

L8627

Cochlear implant, external speech processor, component, replacement

L8628

Cochlear implant, external controller component, replacement

L8629

Transmitting coil and cable, integrated, for use with cochlear implant device, replacement

L8692

Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment

Q0138

Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-ESRD use)

Q0139

Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (for ESRD on dialysis)

Q0506

Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only

Q4074

Iloprost, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose form, up to 20 micrograms

Q9968

Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg

S0280

Medical home program, comprehensive care coordination and planning, initial plan

S0281

Medical home program, comprehensive care coordination and planning, maintenance of plan

L3160

Foot, adjustable shoe -styled positioning device

CODE

DESCRIPTION

0171T

Insertion of posterior spinous process distraction device (including necessary removal of bone or ligament for insertion and imaging guidance), lumbar; single level

0172T

Insertion of posterior spinous process distraction device (including necessary removal of bone or ligament for insertion of imaging guidance),lumbar;each additional level (list separately in addition to primary procedure)

0200T

Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device (if utilized), one or more needles

0201T

Percutaneous sacral augmentation (sacroplasty), bilateral injections, including the use of a balloon or mechanical device (if utilized), two or more needles

22520

Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic

22521

Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; lumbar

22522

Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure)

22523

Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, one vertebral body, unilateral or bilateral cannulation (eg, kyphoplasty); thoracic

22524

Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, one vertebral body, unilateral or bilateral cannulation (eg, kyphoplasty); lumbar

22525

Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, one vertebral body, unilateral or bilateral cannulation (eg, kyphoplasty); each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure)

43257

Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with delivery of thermal energy to the muscle of lower esophageal sphincter and/or gastric cardia, for treatment of gastroesophageal reflux disease

83037

Hemoglobin; glycosylated (A1C) by device cleared by FDA for home use

86890

Autologous blood or component, collection processing and storage; predeposited

93025

Microvolt T-wave alternans for assessment of ventricular arrhythmias

95250

Glucose monitoring for up to 72 hours by continuous recording and storage of glucose values from interstitial tissue fluid via a subcutaneous sensor (includes hook-up, calibration, patient initiation and training, recording, disconnection, downloading with printout of data)

95251

Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for up to 72 hours; physician interpretation and report

95965

Magnetoencephalography (MEG), recording and analysis; for spontaneous brain magnetic activity (eg, epileptic cerebral cortex localization)

95966

Magnetoencephalography (MEG), recording and analysis; for evoked magnetic fields, single modality (eg, sensory, motor, language, or visual cortex localization)

95967

Magnetoencephalography (MEG), recording and analysis; for evoked magnetic fields, each additional modality (eg, sensory, motor, language, or visual cortex localization) (List separately in addition to code for primary procedure)

96000

Comprehensive computer-based motion analysis by video-taping and 3-D kinematics;

96001

Comprehensive computer-based motion analysis by video-taping and 3-D kinematics; with dynamic plantar pressure measurements during walking

96002

Dynamic surface electromyography, during walking or other functional activities, 1-12 muscles

96003

Dynamic fine wire electromyography, during walking or other functional activities, 1 muscle

96004

Physician review and interpretation of comprehensive computer based motion analysis, dynamic plantar pressure measurements, dynamic surface electromyography during walking or other functional activities, and dynamic fine wire electromyography, with written report

96920

Laser treatment for inflammatory skin disease (psoriasis); total area less than 250 sq cm

96921

Laser treatment for inflammatory skin disease (psoriasis); 250 sq cm to 500 sq cm

96922

Laser treatment for inflammatory skin disease (psoriasis); over 500 sq cm

97124

Therapeutic procedure, one or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion)

C1821

Interspinous process distraction device (implantable)

E0617

External defibrillator with integrated electrocardiogram analysis

E0676

Intermittent limb compression device (includes all accessories), not otherwise specified

E0762

Transcutaneous electrical joint stimulation device system, includes all accessories

G0166

External counterpulsation, per treatment session

G0281

Electrical stimulation, (unattended), to one or more areas, for chronic Stage III and Stage IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of care

G0332

Service for intravenous infusion of immunoglobulin prior to administration, per infusion encounter (ths service is to be billed in conjunction with administration of immunoglobulin).

G0402

Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment

G0403

Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report

G0404

Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination

G0405

Electrocardiogram, routine ecg with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination

G0406

Follow-up inpatient telehealth consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth

G0407

Follow-up inpatient telehealth consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth

G0408

Follow-up inpatient telehealth consultation, complex, physicians typically spend 35 minutes or more communicating with the patient via telehealth

CODE

DESCRIPTION

69714

Implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; without mastoidectomy

69715

Implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; with mastoidectomy

69717

Replacement (including removal of existing device), osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; without mastoidectomy

69718

Replacement (including removal of existing device), osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; with mastoidectomy

99406

Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes

99407

Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes

L8690

Auditory osseointegrated device, includes all internal and external components

L8691

Auditory osseointegrated device, external sound processor, replacement

CODE

DESCRIPTION

A4606

Oxygen probe for use with oximeter device, replacement

E0445

Oximeter device for measuring blood oxygen levels non-invasively

S0302

Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service)

T4521

Adult sized disposable incontinence product, brief/diaper, small, each

T4522

Adult sized disposable incontinence product, brief/diaper, medium, each

T4523

Adult sized disposable incontinence product, brief/diaper, large, each

T4524

Adult sized disposable incontinence product, brief/diaper, extra large, each

T4525

Adult sized disposable incontinence product, protective underwear/pull-on, small size, each

T4526

Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each

T4527

Adult sized disposable incontinence product, protective underwear/pull-on, large size, each

T4528

Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each

T4529

Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each

T4530

Pediatric sized disposable incontinence product, brief/diaper, large size, each

T4531

Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each

T4532

Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each

T4533

Youth sized disposable incontinence product, brief/diaper, each

T4534

Youth sized disposable incontinence product, protective underwear/pull-on, each

T4535

Disposable liner/shield/guard/pad/undergarment, for incontinence, each

T4536

Incontinence product, protective underwear/pull-on, reusable, any size, each

T4537

Incontinence product, protective underpad, reusable, bed size, each

T4538

Diaper service, reusable diaper, each diaper

T4539

Incontinence product, diaper/brief, reusable, any size, each

T4540

Incontinence product, protective underpad, reusable, chair size, each

T4541

Incontinence product, disposable underpad, large, each

T4542

Incontinence product, disposable underpad, small size, each

CODE

DESCRIPTION

A0110

Nonemergency transportation and bus, intra- or interstate carrier

A0120

Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems

A0210

Nonemergency transportation: ancillary: meals - escort

D2920

Recement crown

D2940

Sedative filling

D5225

Maxillary partial denture - flexible base (including any clasps, rests and teeth)

D5226

Mandibular partial denture - flexible base (including any clasps, rests and teeth)

D5510

Repair broken complete denture base

D5650

Add tooth to existing partial denture

D5750

Reline complete maxillary denture (laboratory)

D5751

Reline complete mandibular denture (laboratory)

D5760

Reline maxillary partial denture (laboratory)

E0247

Transfer bench for tub or toilet with or without commode opening

S5100

Day care services, adult; per 15 minutes

S5101

Day care services, adult; per half day

S5102

Day care services, adult; per diem

S5105

Day care services, center-based; services not included in program fee, per diem

S5108

Home care training to home care client, per 15 minutes

S5109

Home care training to home care client, per session

S5110

Home care training, family; per 15 minutes

S5111

Home care training, family; per session

S5115

Home care training, non-family; per 15 minutes

S5116

Home care training, non-family; per session

S5120

Chore services; per 15 minutes

S5121

Chore services; per diem

S5125

Attendant care services; per 15 minutes

S5126

Attendant care services; per diem

S5130

Homemaker service, NOS; per 15 minutes

S5131

Homemaker service, NOS; per diem

S5135

Companion care, adult (e.g., IADL/ADL); per 15 minutes

S5136

Companion care, adult (e.g. iadl/adl); per diem

S5140

Foster care, adult; per diem

S5141

Foster care, adult; per month

S5150

Unskilled respite care, not hospice; per 15 minutes

S5151

Unskilled respite care, not hospice; per diem

S5165

Home modifications; per service

S5170

Home delivered meals, including preparation; per meal

S5175

Laundry service, external, professional; per order

S5185

Medication reminder services, non-face-to-face; per month

S9977

Meals, per diem not otherwise specified

CODE

DESCRIPTION

S5160

Emergency response system; installation and testing

S5161

Emergency response system; service fee, per month (excludes installation and testing)

S5162

Emergency response system; purchase only

CODE

DESCRIPTION

T1019

Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, ICF/MR or IMD, part of the individualized plan of treatment (code may not be used to identify services provided by home health aide or certified nurse assistant)

T1020

Personal care services, per diem, not for an inpatient or resident of a hospital, nursing facility, ICF/MR or IMD, part of the individualized plan of treatment (code may not be used to identify services provided by home health aide or certified nurse assistant)

T2003

Non-emergency transportation; encounter/trip