114 CMR 40.06 - Fees

(1) Acupuncture.

Code

Fee

40.06(1) Acupuncture Description

97039

9.53

Unlisted modality (specify type and time if constant attendance)

97124

18.73

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

97139

13.17

Unlisted therapeutic procedure (specify)

97810

27.01

Acupuncture, one or more needles; without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient

97811

20.33

Acupuncture, one or more needles; without electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure)

97813

28.63

Acupuncture, one or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient

97814

22.98

Acupuncture, one or more needles; with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure)

99080

26.09

Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form

99201

30.72

Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a problem focused history; a problem focused

examination; straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the presenting problems are self limited or minor. Physicians typically spend ten minutes face-to-face with the patient and/or family

99202

53.39

Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: an expanded problem focused history; an expanded problem focused examination; straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the presenting problems are of low to moderate severity. Physicians typically spend 20 minutes face-to-face with the patient and/or family

99203

79.92

Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a detailed history; a detailed examination; medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the presenting problems are of moderate severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family

99204

112.90

Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a comprehensive history; a comprehensive examination; medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the presenting problems are of moderate to high severity. Physicians typically spend 45 minutes face-to-face with the patient and/or family

99211

17.60

Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically, five minutes are spent performing or supervising these services

99212

31.79

Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a problem focused history; a problem focused examination; straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the presenting problem(s) are self limited or minor. Physicians typically spend ten minutes face-to-face with the patient and/or family.

99213

49.73

Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the presenting problem(s) are of low to moderate complexity. Physicians typically spend 15 minutes face-to-face with the patient and/or family.

99214

74.00

Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a detailed history; a detailed examination; medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the presenting problem(s) are of moderate to high severity. Physicians typically spend 25 minutes face-to-face with the patient and/or family.
(2) Anesthesia.

PAYMENT EQUALS : (TIME UNITS + BASE UNITS + MODIFYING UNITS) TIMES $39.00 (Rate per UNIT)

Code

2008 Base Unit

40.06(2) - Anesthesia Description

00100

5

Anesthesia for procedures on salivary glands, including biopsy

00102

6

Anesthesia for procedures involving plastic repair of cleft lip

00103

5

Anesthesia for reconstructive procedures of eyelid (eg, blepharoplasty, ptosis surgery)

00104

4

Anesthesia for electroconvulsive therapy

00120

5

Anesthesia for procedures on external, middle, and inner ear including biopsy; not otherwise specified

00124

4

Anesthesia for procedures on external, middle, and inner ear including biopsy; otoscopy

00126

4

Anesthesia for procedures on external, middle, and inner ear including biopsy; tympanotomy

00140

5

Anesthesia for procedures on eye; not otherwise specified

00142

4

Anesthesia for procedures on eye; lens surgery

00144

6

Anesthesia for procedures on eye; corneal transplant

00145

6

Anesthesia for procedures on eye; vitreoretinal surgery

00147

4

Anesthesia for procedures on eye; iridectomy

00148

4

Anesthesia for procedures on eye; ophthalmoscopy

00160

5

Anesthesia for procedures on nose and accessory sinuses; not otherwise specified

00162

7

Anesthesia for procedures on nose and accessory sinuses; radical surgery

00164

4

Anesthesia for procedures on nose and accessory sinuses; biopsy, soft tissue

00170

5

Anesthesia for intraoral procedures, including biopsy; not otherwise specified

00172

6

Anesthesia for intraoral procedures, including biopsy; repair of cleft palate

00174

6

Anesthesia for intraoral procedures, including biopsy; excision of retropharyngeal tumor

00176

7

Anesthesia for intraoral procedures, including biopsy; radical surgery

00190

5

Anesthesia for procedures on facial bones or skull; not otherwise specified

00192

7

Anesthesia for procedures on facial bones or skull; radical surgery (including prognathism)

00210

11

Anesthesia for intracranial procedures; not otherwise specified

00212

5

Anesthesia for intracranial procedures; subdural taps

00214

9

Anesthesia for intracranial procedures; burr holes, including ventriculography

00215

9

Anesthesia for intracranial procedures; cranioplasty or elevation of depressed skull fracture, extradural (simple or compound)

00216

15

Anesthesia for intracranial procedures; vascular procedures

00218

13

Anesthesia for intracranial procedures; procedures in sitting position

00220

10

Anesthesia for intracranial procedures; cerebrospinal fluid shunting procedures

00222

6

Anesthesia for intracranial procedures; electrocoagulation of intracranial nerve

00300

5

Anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck, and posterior trunk, not otherwise specified

00320

6

Anesthesia for all procedures on esophagus, thyroid, larynx, trachea and lymphatic system of neck; not otherwise specified, age 1 year or older

00322

3

Anesthesia for all procedures on esophagus, thyroid, larynx, trachea and lymphatic system of neck; needle biopsy of thyroid

00350

10

Anesthesia for procedures on major vessels of neck; not otherwise specified

00352

5

Anesthesia for procedures on major vessels of neck; simple ligation

00400

3

Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified

00402

5

Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; reconstructive procedures on breast (eg, reduction or augmentation mammoplasty, muscle flaps)

00404

5

Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; radical or modified radical procedures on breast

00406

13

Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; radical or modified radical procedures on breast with internal mammary node dissection

00410

4

Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; electrical conversion of arrhythmias

00450

5

Anesthesia for procedures on clavicle and scapula; not otherwise specified

00452

6

Anesthesia for procedures on clavicle and scapula; radical surgery

00454

3

Anesthesia for procedures on clavicle and scapula; biopsy of clavicle

00470

6

Anesthesia for partial rib resection; not otherwise specified

00472

10

Anesthesia for partial rib resection; thoracoplasty (any type)

00474

13

Anesthesia for partial rib resection; radical procedures (eg, pectus excavatum)

00500

15

Anesthesia for all procedures on esophagus

00520

6

Anesthesia for closed chest procedures; (including bronchoscopy) not otherwise specified

00522

4

Anesthesia for closed chest procedures; needle biopsy of pleura

00524

4

Anesthesia for closed chest procedures; pneumocentesis

00528

8

Anesthesia for closed chest procedures; mediastinoscopy and diagnostic thoracoscopy not utilizing one lung ventilation

00529

11

Anesthesia for closed chest procedures; mediastinoscopy and diagnostic thoracoscopy utilizing one lung ventilation

00530

4

Anesthesia for permanent transvenous pacemaker insertion

00532

4

Anesthesia for access to central venous circulation

00534

7

Anesthesia for transvenous insertion or replacement of pacing cardioverter-defibrillator

00537

7

Anesthesia for cardiac electrophysiologic procedures including radiofrequency ablation

00539

18

Anesthesia for tracheobronchial reconstruction

00540

12

Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, and mediastinum (including surgical thoracoscopy); not otherwise specified

00542

15

Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, and mediastinum (including surgical thoracoscopy); decortication

00541

15

Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, and mediastinum (including surgical thoracoscopy); utilizing one lung ventilation

00546

15

Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, and mediastinum (including surgical thoracoscopy); pulmonary resection with thoracoplasty

00548

17

Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, and mediastinum (including surgical thoracoscopy); intrathoracic procedures on the trachea and bronchi

00550

10

Anesthesia for sternal debridement

00560

15

Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; without pump oxygenator

00562

20

Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator

00563

25

Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator with hypothermic circulatory arrest

00566

25

Anesthesia for direct coronary artery bypass grafting without pump oxygenator

00580

20

Anesthesia for heart transplant or heart/lung transplant

00600

10

Anesthesia for procedures on cervical spine and cord; not otherwise specified

00604

13

Anesthesia for procedures on cervical spine and cord; procedures with patient in the sitting position

00620

10

Anesthesia for procedures on thoracic spine and cord; not otherwise specified

00622

13

Anesthesia for procedures on thoracic spine and cord; thoracolumbar sympathectomy

00625

13

Anesthesia for procedures on the thoracic spine and cord, via an anterior transthoracic approach; not utilizing one lung ventilation

00626

15

Anesthesia for procedures on the thoracic spine and cord, via an anterior transthoracic approach; utilizing one lung ventilation

00630

8

Anesthesia for procedures in lumbar region; not otherwise specified

00632

7

Anesthesia for procedures in lumbar region; lumbar sympathectomy

00634

10

Anesthesia for procedures in lumbar region; chemonucleolysis

00635

4

Anesthesia for procedures in lumbar region; diagnostic or therapeutic lumbar puncture

00640

3

Anesthesia for manipulation of the spine or for closed procedures on the cervical, thoracic or lumbar spine

00670

13

Anesthesia for extensive spine and spinal cord procedures (eg, spinal instrumentation or vascular procedures)

00700

4

Anesthesia for procedures on upper anterior abdominal wall; not otherwise specified

00702

4

Anesthesia for procedures on upper anterior abdominal wall; percutaneous liver biopsy

00730

5

Anesthesia for procedures on upper posterior abdominal wall

00740

5

Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum

00750

4

Anesthesia for hernia repairs in upper abdomen; not otherwise specified

00752

6

Anesthesia for hernia repairs in upper abdomen; lumbar and ventral (incisional) hernias and/or wound dehiscence

00754

7

Anesthesia for hernia repairs in upper abdomen; omphalocele

00756

7

Anesthesia for hernia repairs in upper abdomen; transabdominal repair of diaphragmatic hernia

00770

15

Anesthesia for all procedures on major abdominal blood vessels

00790

7

Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; not otherwise specified

00792

13

Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; partial hepatectomy or management of liver hemorrhage (excluding liver biopsy)

00794

8

Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; pancreatectomy, partial or total (eg, Whipple procedure)

00796

30

Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; liver transplant (recipient)

00797

11

Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; gastric restrictive procedure for morbid obesity

00800

4

Anesthesia for procedures on lower anterior abdominal wall; not otherwise specified

00802

5

Anesthesia for procedures on lower anterior abdominal wall; panniculectomy

00810

5

Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum

00820

5

Anesthesia for procedures on lower posterior abdominal wall

00830

4

Anesthesia for hernia repairs in lower abdomen; not otherwise specified

00832

6

Anesthesia for hernia repairs in lower abdomen; ventral and incisional hernias

00840

6

Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; not otherwise specified

00842

4

Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; amniocentesis

00844

7

Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; abdominoperineal resection

00846

8

Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; radical hysterectomy

00848

8

Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; pelvic exenteration

00851

6

Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; tubal ligation/transection

00860

6

Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; not otherwise specified

00862

7

Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; renal procedures, including upper one-third of ureter, or donor nephrectomy

00864

8

Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; total cystectomy

00865

7

Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; radical prostatectomy (suprapubic, retropubic)

00866

10

Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; adrenalectomy

00868

10

Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; renal transplant (recipient)

00870

5

Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; cystolithotomy

00872

7

Anesthesia for lithotripsy, extracorporeal shock wave; with water bath

00873

5

Anesthesia for lithotripsy, extracorporeal shock wave; without water bath

00880

15

Anesthesia for procedures on major lower abdominal vessels; not otherwise specified

00882

10

Anesthesia for procedures on major lower abdominal vessels; inferior vena cava ligation

00902

5

Anesthesia for; anorectal procedure

00904

7

Anesthesia for; radical perineal procedure

00906

4

Anesthesia for; vulvectomy

00908

6

Anesthesia for; perineal prostatectomy

00910

3

Anesthesia for transurethral procedures (including urethrocystoscopy); not otherwise specified

00912

5

Anesthesia for transurethral procedures (including urethrocystoscopy); transurethral resection of bladder tumor(s)

00914

5

Anesthesia for transurethral procedures (including urethrocystoscopy); transurethral resection of prostate

00916

5

Anesthesia for transurethral procedures (including urethrocystoscopy); post-transurethral resection bleeding

00918

5

Anesthesia for transurethral procedures (including urethrocystoscopy); with fragmentation, manipulation and/or removal of ureteral calculus

00920

3

Anesthesia for procedures on male genitalia (including open urethral procedures); not otherwise specified

00921

3

Anesthesia for procedures on male genitalia (including open urethral procedures); vasectomy, unilateral or bilateral

00922

6

Anesthesia for procedures on male genitalia (including open urethral procedures); seminal vesicles

00924

4

Anesthesia for procedures on male genitalia (including open urethral procedures); undescended testis, unilateral or bilateral

00926

4

Anesthesia for procedures on male genitalia (including open urethral procedures); radical orchiectomy, inguinal

00928

6

Anesthesia for procedures on male genitalia (including open urethral procedures); radical orchiectomy, abdominal

00930

4

Anesthesia for procedures on male genitalia (including open urethral procedures); orchiopexy, unilateral or bilateral

00932

4

Anesthesia for procedures on male genitalia (including open urethral procedures); complete amputation of penis

00934

6

Anesthesia for procedures on male genitalia (including open urethral procedures); radical amputation of penis with bilateral inguinal lymphadenectomy

00936

8

Anesthesia for procedures on male genitalia (including open urethral procedures); radical amputation of penis with bilateral inguinal and iliac lymphadenectomy

00938

4

Anesthesia for procedures on male genitalia (including open urethral procedures); insertion of penile prosthesis (perineal approach)

00940

3

Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); not otherwise specified

00942

4

Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); colpotomy, vaginectomy, colporrhaphy, and open urethral procedures

00944

6

Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); vaginal hysterectomy

00948

4

Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); cervical cerclage

00950

5

Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); culdoscopy

00952

4

Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); hysteroscopy and/or hysterosalpingography

01112

5

Anesthesia for bone marrow aspiration and/or biopsy, anterior or posterior iliac crest

01120

6

Anesthesia for procedures on bony pelvis

01130

3

Anesthesia for body cast application or revision

01140

15

Anesthesia for interpelviabdominal (hindquarter) amputation

01150

10

Anesthesia for radical procedures for tumor of pelvis, except hindquarter amputation

01160

4

Anesthesia for closed procedures involving symphysis pubis or sacroiliac joint

01170

8

Anesthesia for open procedures involving symphysis pubis or sacroiliac joint

01173

12

Anesthesia for open repair of fracture disruption of pelvis or column fracture involving acetabulum

01180

3

Anesthesia for obturator neurectomy; extrapelvic

01190

4

Anesthesia for obturator neurectomy; intrapelvic

01200

4

Anesthesia for all closed procedures involving hip joint

01202

4

Anesthesia for arthroscopic procedures of hip joint

01210

6

Anesthesia for open procedures involving hip joint; not otherwise specified

01212

10

Anesthesia for open procedures involving hip joint; hip disarticulation

01214

8

Anesthesia for open procedures involving hip joint; total hip arthroplasty

01215

10

Anesthesia for open procedures involving hip joint; revision of total hip arthroplasty

01220

4

Anesthesia for all closed procedures involving upper two-thirds of femur

01230

6

Anesthesia for open procedures involving upper two-thirds of femur; not otherwise specified

01232

5

Anesthesia for open procedures involving upper two-thirds of femur; amputation

01234

8

Anesthesia for open procedures involving upper two-thirds of femur; radical resection

01250

4

Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of upper leg

01260

3

Anesthesia for all procedures involving veins of upper leg, including exploration

01270

8

Anesthesia for procedures involving arteries of upper leg, including bypass graft; not otherwise specified

01272

4

Anesthesia for procedures involving arteries of upper leg, including bypass graft; femoral artery ligation

01274

6

Anesthesia for procedures involving arteries of upper leg, including bypass graft; femoral artery embolectomy

01320

4

Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of knee and/or popliteal area

01340

4

Anesthesia for all closed procedures on lower one-third of femur

01360

5

Anesthesia for all open procedures on lower one-third of femur

01380

3

Anesthesia for all closed procedures on knee joint

01382

3

Anesthesia for diagnostic arthroscopic procedures of knee joint

01390

3

Anesthesia for all closed procedures on upper ends of tibia, fibula, and/or patella

01392

4

Anesthesia for all open procedures on upper ends of tibia, fibula, and/or patella

01400

4

Anesthesia for open or surgical arthroscopic procedures on knee joint; not otherwise specified

01402

7

Anesthesia for open or surgical arthroscopic procedures on knee joint; total knee arthroplasty

01404

5

Anesthesia for open or surgical arthroscopic procedures on knee joint; disarticulation at knee

01420

3

Anesthesia for all cast applications, removal, or repair involving knee joint

01430

3

Anesthesia for procedures on veins of knee and popliteal area; not otherwise specified

01432

6

Anesthesia for procedures on veins of knee and popliteal area; arteriovenous fistula

01440

8

Anesthesia for procedures on arteries of knee and popliteal area; not otherwise specified

01442

8

Anesthesia for procedures on arteries of knee and popliteal area; popliteal thromboendarterectomy, with or without patch graft

01444

8

Anesthesia for procedures on arteries of knee and popliteal area; popliteal excision and graft or repair for occlusion or aneurysm

01462

3

Anesthesia for all closed procedures on lower leg, ankle, and foot

01464

3

Anesthesia for arthroscopic procedures of ankle and/or foot

01470

3

Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; not otherwise specified

01472

5

Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; repair of ruptured Achilles tendon, with or without graft

01474

5

Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; gastrocnemius recession (eg, Strayer procedure)

01480

3

Anesthesia for open procedures on bones of lower leg, ankle, and foot; not otherwise specified

01482

4

Anesthesia for open procedures on bones of lower leg, ankle, and foot; radical resection (including below knee amputation)

01484

4

Anesthesia for open procedures on bones of lower leg, ankle, and foot; osteotomy or osteoplasty of tibia and/or fibula

01486

7

Anesthesia for open procedures on bones of lower leg, ankle, and foot; total ankle replacement

01490

3

Anesthesia for lower leg cast application, removal, or repair

01500

8

Anesthesia for procedures on arteries of lower leg, including bypass graft; not otherwise specified

01502

6

Anesthesia for procedures on arteries of lower leg, including bypass graft; embolectomy, direct or with catheter

01520

3

Anesthesia for procedures on veins of lower leg; not otherwise specified

01522

5

Anesthesia for procedures on veins of lower leg; venous thrombectomy, direct or with catheter

01610

5

Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of shoulder and axilla

01620

4

Anesthesia for all closed procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint

01622

4

Anesthesia for diagnostic arthroscopic procedures of shoulder joint

01630

5

Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; not otherwise specified

01632

6

Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; radical resection

01634

9

Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; shoulder disarticulation

01636

15

Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; interthoracoscapular (forequarter) amputation

01638

10

Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; total shoulder replacement

01650

6

Anesthesia for procedures on arteries of shoulder and axilla; not otherwise specified

01652

10

Anesthesia for procedures on arteries of shoulder and axilla; axillary-brachial aneurysm

01654

8

Anesthesia for procedures on arteries of shoulder and axilla; bypass graft

01656

10

Anesthesia for procedures on arteries of shoulder and axilla; axillary-femoral bypass graft

01670

4

Anesthesia for all procedures on veins of shoulder and axilla

01680

3

Anesthesia for shoulder cast application, removal or repair; not otherwise specified

01682

4

Anesthesia for shoulder cast application, removal or repair; shoulder spica

01710

3

Anesthesia for procedures on nerves, muscles, tendons, fascia, and bursae of upper arm and elbow; not otherwise specified

01712

5

Anesthesia for procedures on nerves, muscles, tendons, fascia, and bursae of upper arm and elbow; tenotomy, elbow to shoulder, open

01714

5

Anesthesia for procedures on nerves, muscles, tendons, fascia, and bursae of upper arm and elbow; tenoplasty, elbow to shoulder

01716

5

Anesthesia for procedures on nerves, muscles, tendons, fascia, and bursae of upper arm and elbow; tenodesis, rupture of long tendon of biceps

01730

3

Anesthesia for all closed procedures on humerus and elbow

01732

3

Anesthesia for diagnostic arthroscopic procedures of elbow joint

01740

4

Anesthesia for open or surgical arthroscopic procedures of the elbow; not otherwise specified

01742

5

Anesthesia for open or surgical arthroscopic procedures of the elbow; osteotomy of humerus

01744

5

Anesthesia for open or surgical arthroscopic procedures of the elbow; repair of nonunion or malunion of humerus

01756

6

Anesthesia for open or surgical arthroscopic procedures of the elbow; radical procedures

01758

5

Anesthesia for open or surgical arthroscopic procedures of the elbow; excision of cyst or tumor of humerus

01760

7

Anesthesia for open or surgical arthroscopic procedures of the elbow; total elbow replacement

01770

6

Anesthesia for procedures on arteries of upper arm and elbow; not otherwise specified

01772

6

Anesthesia for procedures on arteries of upper arm and elbow; embolectomy

01780

3

Anesthesia for procedures on veins of upper arm and elbow; not otherwise specified

01782

4

Anesthesia for procedures on veins of upper arm and elbow; phleborrhaphy

01810

3

Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of forearm, wrist, and hand

01820

3

Anesthesia for all closed procedures on radius, ulna, wrist, or hand bones

01829

3

Anesthesia for diagnostic arthroscopic procedures on the wrist

01830

3

Anesthesia for open or surgical arthroscopic/endoscopic procedures on distal radius, distal ulna, wrist, or hand joints; not otherwise specified

01832

6

Anesthesia for open or surgical arthroscopic/endoscopic procedures on distal radius, distal ulna, wrist, or hand joints; total wrist replacement

01840

6

Anesthesia for procedures on arteries of forearm, wrist, and hand; not otherwise specified

01842

6

Anesthesia for procedures on arteries of forearm, wrist, and hand; embolectomy

01844

6

Anesthesia for vascular shunt, or shunt revision, any type (eg, dialysis)

01850

3

Anesthesia for procedures on veins of forearm, wrist, and hand; not otherwise specified

01852

4

Anesthesia for procedures on veins of forearm, wrist, and hand; phleborrhaphy

01860

3

Anesthesia for forearm, wrist, or hand cast application, removal, or repair

01916

5

Anesthesia for diagnostic arteriography/venography

01920

7

Anesthesia for cardiac catheterization including coronary angiography and ventriculography (not to include Swan-Ganz catheter)

01922

7

Anesthesia for non-invasive imaging or radiation therapy

01924

5

Anesthesia for therapeutic interventional radiological procedures involving the arterial system; not otherwise specified

01925

7

Anesthesia for therapeutic interventional radiological procedures involving the arterial system; carotid or coronary

01926

8

Anesthesia for therapeutic interventional radiological procedures involving the arterial system; intracranial, intracardiac, or aortic

01930

5

Anesthesia for therapeutic interventional radiological procedures involving the venous/lymphatic system (not to include access to the central circulation); not otherwise specified

01931

7

Anesthesia for therapeutic interventional radiological procedures involving the venous/lymphatic system (not to include access to the central circulation); intrahepatic or portal circulation (eg, transvenous intrahepatic portosystemic shunt[s] [TIPS])

01932

6

Anesthesia for therapeutic interventional radiological procedures involving the venous/lymphatic system (not to include access to the central circulation); intrathoracic or jugular

01933

7

Anesthesia for therapeutic interventional radiological procedures involving the venous/lymphatic system (not to include access to the central circulation); intracranial

01935

5

Anesthesia for percutaneous image guided procedures on the spine and spinal cord; diagnostic

01936

5

Anesthesia for percutaneous image guided procedures on the spine and spinal cord; therapeutic

01951

3

Anesthesia for second- and third-degree burn excision or debridement with or without skin grafting, any site, for total body surface area (TBSA) treated during anesthesia and surgery; less than 4% total body surface area

01952

5

Anesthesia for second- and third-degree burn excision or debridement with or without skin grafting, any site, for total body surface area (TBSA) treated during anesthesia and surgery; between 4% and 9% of total body surface area

01953

1

Anesthesia for second- and third-degree burn excision or debridement with or without skin grafting, any site, for total body surface area (TBSA) treated during anesthesia and surgery; each additional 9% total body surface area or part thereof (List separately in addition to code for primary procedure performed)

01958

5

Anesthesia for external cephalic version procedure

01960

5

Anesthesia for vaginal delivery only

01961

7

Anesthesia for cesarean delivery only

01962

8

Anesthesia for urgent hysterectomy following delivery

01963

8

Anesthesia for cesarean hysterectomy without any labor analgesia/anesthesia care

01965

4

Anesthesia for incomplete or missed abortion procedures

01966

4

Anesthesia for induced abortion procedures

01967

5

Neuraxial labor analgesia/anesthesia for planned vaginal delivery (this includes any repeat subarachnoid needle placement and drug injection and/or any necessary replacement of an epidural catheter during labor)

01968

2

Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia (List separately in addition to code for primary procedure performed)

01969

5

Anesthesia for cesarean hysterectomy following neuraxial labor analgesia/anesthesia (List separately in addition to code for primary procedure performed)

01990

7

Physiological support for harvesting of organ(s) from brain-dead patient

01991

3

Anesthesia for diagnostic or therapeutic nerve blocks and injections (when block or injection is performed by a different provider); other than the prone position

01992

5

Anesthesia for diagnostic or therapeutic nerve blocks and injections (when block or injection is performed by a different provider); prone position

01996

3

Daily hospital management of epidural or subarachnoid continuous drug administration

01999

0

Unlisted anesthesia procedure(s)
(3) Chiropractors.

Code

Fee

40.06(3) - Chiropractic Description

98940

29.79

Chiropractic manipulative treatment (CMT); spinal, one to two regions

98941

38.54

Chiropractic manipulative treatment (CMT); spinal, three to four regions

98942

47.66

Chiropractic manipulative treatment (CMT); spinal, five regions

98943

28.60

Chiropractic manipulative treatment (CMT); extraspinal, one or more regions

99201

30.10

Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend ten minutes face-to-face with the patient and/or family.

99202

51.54

Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 20 minutes face-to-face with the patient and/or family.

99203

76.11

Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family.

99204

112.85

Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 45 minutes face-to-face with the patient and/or family.

9921 1

17.97

Office or other outpatient visit for the evaluation and management of an established patien that may not require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically, five minutes are spent performing or supervising these services.

99212

31.13

Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend ten minutes face-to-face with the patient and/or family.

99213

49.35

Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 15 minutes face-to-face with the patient and/or family.

99214

73.96

Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 25 minutes face-to-face with the patient and/or family.

99358

73.29

Prolonged evaluation and management service before and/or after direct (face-to-face) patient care (eg, review of extensive records and tests, communication with other professionals and/or the patient/family); first hour (List separately in addition to code for other physician service(s) and/or inpatient or outpatient Evaluation and Management service)

99359

35.43

Prolonged evaluation and management service before and/or after direct (face-to-face) patient care (eg, review of extensive records and tests, communication with other professionals and/or the patient/family); each additional 30 minutes (List separately in addition to code for prolonged physician service)

99368

24.60

Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more; participation by nonphysician qualified health care professional

80047

30.51

Basic metabolic panel (Calcium, ionized) This panel must include the following: Calcium, ionized (82330) Carbon dioxide (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Potassium (84132) Sodium (84295) Urea Nitrogen (BUN) (84520)

80048

11.83

Basic metabolic panel (Calcium, total) This panel must include the following: Calcium (82310) Carbon dioxide (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Potassium (84132) Sodium (84295) Urea nitrogen (BUN) (84520)

80051

9.80

Electrolyte panel This panel must include the following: Carbon dioxide (82374) Chloride (82435) Potassium (84132) Sodium (84295)

80053

14.77

Comprehensive metabolic panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Calcium (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphatase, alkaline (84075) Potassium (84132) Protein, total (84155) Sodium (84295) Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate amino (AST) (SGOT) (84450)

80061

18.72

Lipid panel This panel must include the following: Cholesterol, serum, total (82465)

Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718)

Triglycerides (84478)

80069

12.13

Renal function panel This panel must include the following: Albumin (82040) Calcium (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphorus inorganic (phosphate) (84100) Potassium (84132) Sodium (84295)

80074

62.84

Acute hepatitis panel This panel must include the following: Hepatitis A antibody (HAAb), IgM antibody (86709) Hepatitis B core antibody (HBcAb), IgM antibody (86705) Hepatitis B surface antigen (HBsAg) (87340) Hepatitis C antibody (86803)

80076

11.42

Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155) Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate amino (AST) (SGOT) (84450)

80100

16.32

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

80101

19.24

Drug screen, qualitative; single drug class method (eg, immunoassay, enzyme assay), each drug class

80102

18.51

Drug confirmation, each procedure

80150

21.06

Amikacin

80152

25.01

Amitriptyline

80154

25.84

Benzodiazepines

80156

20.34

Carbamazepine; total

80157

18.52

Carbamazepine; free

80158

25.23

Cyclosporine

80160

24.05

Desipramine

80162

18.55

Digoxin

80164

18.93

Dipropylacetic acid (valproic acid)

80166

21.66

Doxepin

80168

22.83

Ethosuximide

80170

22.90

Gentamicin

80172

22.76

Gold

80173

20.34

Haloperidol

80174

24.05

Imipramine

80176

20.52

Lidocaine

80178

9.24

Lithium

80182

18.93

Nortriptyline

80184

16.01

Phenobarbital

80185

18.52

Phenytoin; total

80186

19.23

Phenytoin; free

80188

23.18

Primidone

80190

23.41

Procainamide;

80192

23.41

Procainamide; with metabolites (eg, n-acetyl procainamide)

80194

20.39

Quinidine

80195

10.18

Sirolimus

80196

9.92

Salicylate

80197

10.18

Tacrolimus

80198

19.77

Theophylline

80200

22.52

Tobramycin

80201

16.66

Topiramate

80202

18.93

Vancomycin

80299

19.13

Quantitation of drug, not elsewhere specified

80400

45.56

ACTH stimulation panel; for adrenal insufficiency This panel must include the following: Cortisol (82533 x 2)

80402

121.46

ACTH stimulation panel; for 21 hydroxylase deficiency This panel must include the following: Cortisol (82533 x 2) 17 hydroxyprogesterone (83498 x 2)

80406

106.06

ACTH stimulation panel; for 3 beta-hydroxydehydrogenase deficiency This panel must include the following: Cortisol (82533 x 2) 17 hydroxypregnenolone (84143 x 2)

80408

175.34

Aldosterone suppression evaluation panel (eg, saline infusion) This panel must include the following: Aldosterone (82088 x 2) Renin (84244 x 2)

80410

112.23

Calcitonin stimulation panel (eg, calcium, pentagastrin) This panel must include the following: Calcitonin (82308 x 3)

80412

460.50

Corticotropic releasing hormone (CRH) stimulation panel This panel must include the following: Cortisol (82533 x 6) Adrenocorticotropic hormone (ACTH) (82024 x 6)

80414

72.16

Chorionic gonadotropin stimulation panel; testosterone response This panel must include the following: Testosterone (84403 x 2 on three pooled blood samples)

80415

78.08

Chorionic gonadotropin stimulation panel; estradiol response This panel must include the following: Estradiol (82670 x 2 on three pooled blood samples)

80416

184.38

Renal vein renin stimulation panel (eg, captopril) This panel must include the following: Renin (84244 x 6)

80417

61.46

Peripheral vein renin stimulation panel (eg, captopril) This panel must include the following: Renin (84244 x 2)

80418

809.76

Combined rapid anterior pituitary evaluation panel This panel must include the following: Adrenocorticotropic hormone (ACTH) (82024 x 4) Luteinizing hormone (LH) (83002 x 4) Follicle stimulating hormone (FSH) (83001 x 4) Prolactin (84146 x 4) Human growth hormone (HGH) (93003x4) Cortisol (82533 x 4) Thyroid stimulating hormone (TSH) (84443 x 4)

80420

100.64

Dexamethasone suppression panel, 48 hour This panel must include the following: Free cortisol, urine (82530 x 2) Cortisol (82533 x 2) Volume measurement for timed collection (81050 x 2)

80422

64.38

Glucagon tolerance panel; for insulinoma This panel must include the following: Glucose (82947 x 3) Insulin (83525 x 3)

80424

70.56

Glucagon tolerance panel; for pheochromocytoma This panel must include the following: Catecholamines, fractionated (82384 x 2)

80426

207.40

Gonadotropin releasing hormone stimulation panel This panel must include the following: Follicle stimulating hormone (FSH) (83001 x 4) Luteinizing hormone (LH) (83002 x 4)

80428

93.16

Growth hormone stimulation panel (eg, arginine infusion, l-dopa administration) This panel must include the following: Human growth hormone (HGH) (83003 x 4)

80430

109.60

Growth hormone suppression panel (glucose administration) This panel must include the following: Glucose (82947 x 3) Human growth hormone (HGH) (83003 x 4)

80432

188.73

Insulin-induced C-peptide suppression panel This panel must include the following: Insulin (83525) C-peptide (84681 x 5) Glucose (82947 x 5)

80434

141.30

Insulin tolerance panel; for ACTH insufficiency This panel must include the following: Cortisol (82533 x 5) Glucose (82947 x 5)

80435

143.85

Insulin tolerance panel; for growth hormone deficiency This panel must include the following: Glucose (82947 x 5) Human growth hormone (HGH) (83003 x 5)

80436

127.36

Metyrapone panel This panel must include the following: Cortisol (82533 x 2) 11 deoxycortisol (82634 x 2)

80438

70.41

Thyrotropin releasing hormone (TRH) stimulation panel; one hour This panel must include the following: Thyroid stimulating hormone (TSH) (84443 x 3)

80439

93.88

Thyrotropin releasing hormone (TRH) stimulation panel; two hour This panel must include the following: Thyroid stimulating hormone (TSH) (84443 x 4)

80440

81.24

Thyrotropin releasing hormone (TRH) stimulation panel; for hyperprolactinemia This panel must include the following: Prolactin (84146 x 3)

81000

4.43

Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, with microscopy

81001

4.43

Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, with microscopy

81002

3.57

Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, without microscopy

81003

3.14

Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, without microscopy

81005

3.03

Urinalysis; qualitative or semiquantitative, except immunoassays

81007

3.59

Urinalysis; bacteriuria screen, except by culture or dipstick

81015

4.24

Urinalysis; microscopic only

81020

5.15

Urinalysis; two or three glass test

81025

8.84

Urine pregnancy test, by visual color comparison methods

81050

4.19

Volume measurement for timed collection, each

82000

17.31

Acetaldehyde, blood

82003

28.28

Acetaminophen

82009

6.31

Acetone or other ketone bodies, serum; qualitative

82010

11.42

Acetone or other ketone bodies, serum; quantitative

82013

15.61

Acetylcholinesterase

82016

19.37

Acylcarnitines; qualitative, each specimen

82017

14.94

Acylcarnitines; quantitative, each specimen

82024

53.97

Adrenocorticotropic hormone (ACTH)

82030

36.05

Adenosine, 5-monophosphate, cyclic (cyclic AMP)

82040

6.92

Albumin; serum

82042

7.23

Albumin; urine or other source, quantitative, each specimen

82043

7.56

Albumin; urine, microalbumin, quantitative

82044

6.39

Albumin; urine, microalbumin, semiquantitative (eg, reagent strip assay)

82045

47.43

Albumin; ischemia modified

82055

15.10

Alcohol (ethanol); any specimen except breath

82075

16.84

Alcohol (ethanol); breath

82085

13.56

Aldolase

82088

56.94

Aldosterone

82101

38.96

Alkaloids, urine, quantitative

82103

18.77

Alpha-1-antitrypsin; total

82104

20.20

Alpha-1-antitrypsin; phenotype

82105

23.44

Alpha-fetoprotein (AFP); serum

82106

23.44

Alpha-fetoprotein (AFP); amniotic fluid

82107

89.99

Alpha-fetoprotein (AFP); AFP-L3 fraction isoform and total AFP (including ratio)

82108

35.60

Aluminum

82120

5.25

Amines, vaginal fluid, qualitative

82127

19.37

Amino acids; single, qualitative, each specimen

82128

19.37

Amino acids; multiple, qualitative, each specimen

82131

23.57

Amino acids; single, quantitative, each specimen

82135

23.00

Aminolevulinic acid, delta (ALA)

82136

14.94

Amino acids, two to five amino acids, quantitative, each specimen

82139

14.94

Amino acids, six or more amino acids, quantitative, each specimen

82140

20.36

Ammonia

82143

9.61

Amniotic fluid scan (spectrophotometric)

82145

21.72

Amphetamine or methamphetamine

82150

9.06

Amylase

82154

40.29

Androstanediol glucuronide

82157

40.90

Androstenedione

82160

34.94

Androsterone

82163

25.16

Angiotensin II

82164

20.39

Angiotensin I - converting enzyme (ACE)

82172

21.65

Apolipoprotein, each

82175

26.51

Arsenic

82180

13.81

Ascorbic acid (Vitamin C), blood

82190

7.61

Atomic absorption spectroscopy, each analyte

82205

16.01

Barbiturates, not elsewhere specified

82232

22.61

Beta-2 microglobulin

82239

23.94

Bile acids; total

82240

37.13

Bile acids; cholylglycine

82247

7.02

Bilirubin; total

82248

7.02

Bilirubin; direct

82252

6.35

Bilirubin; feces, qualitative

82261

14.94

Biotinidase, each specimen

82270

4.54

Blood, occult, by peroxidase activity (eg, guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (ie, patient was provided three cards or single triple card for consecutive collection)

82271

4.54

Blood, occult, by peroxidase activity (eg, guaiac), qualitative; other sources

82272

4.54

Blood, occult, by peroxidase activity (eg, guaiac), qualitative, feces, one-three simultaneous determinations, performed for other than colorectal neoplasm screening

82274

20.70

Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, one-three simultaneous determinations

82286

9.62

Bradykinin

82300

32.33

Cadmium

82306

41.36

Calcifediol (25-OH Vitamin D-3)

82307

45.02

Calciferol (Vitamin D)

82308

37.41

Calcitonin

82310

7.20

Calcium; total

82330

19.09

Calcium; ionized

82331

7.23

Calcium; after calcium infusion test

82340

8.43

Calcium; urine quantitative, timed specimen

82355

16.17

Calculus; qualitative analysis

82360

17.99

Calculus; quantitative analysis, chemical

82365

18.01

Calculus; infrared spectroscopy

82370

17.51

Calculus; X-ray diffraction

82373

25.23

Carbohydrate deficient transferrin

82374

6.83

Carbon dioxide (bicarbonate)

82375

17.22

Carbon monoxide (carboxyhemoglobin); quantitative

82376

8.37

Carbon monoxide (carboxyhemoglobin); qualitative

82378

26.51

Carcinoembryonic antigen (CEA)

82379

14.94

Carnitine (total and free), quantitative, each specimen

82380

12.89

Carotene

82382

24.02

Catecholamines; total urine

82383

35.01

Catecholamines; blood

82384

35.28

Catecholamines; fractionated

82387

29.07

Cathepsin-D

82390

15.01

Ceruloplasmin

82397

14.94

Chemiluminescent assay

82415

17.70

Chloramphenicol

82435

6.42

Chloride; blood

82436

7.02

Chloride; urine

82438

6.83

Chloride; other source

82441

8.38

Chlorinated hydrocarbons, screen

82465

6.08

Cholesterol, serum or whole blood, total

82480

11.01

Cholinesterase; serum

82482

10.74

Cholinesterase; RBC

82485

28.85

Chondroitin B sulfate, quantitative

82486

25.23

Chromatography, qualitative; column (eg, gas liquid or HPLC), analyte not elsewhere specified

82487

22.30

Chromatography, qualitative; paper, 1-dimensional, analyte not elsewhere specified

82488

29.85

Chromatography, qualitative; paper, 2-dimensional, analyte not elsewhere specified

82489

25.84

Chromatography, qualitative; thin layer, analyte not elsewhere specified

82491

25.23

Chromatography, quantitative, column (eg, gas liquid or HPLC); single analyte not elsewhere specified, single stationary and mobile phase

82492

25.23

Chromatography, quantitative, column (eg, gas liquid or HPLC); multiple analytes, single stationary and mobile phase

82495

28.34

Chromium

82507

38.85

Citrate

82520

21.17

Cocaine or metabolite

82523

17.81

Collagen cross links, any method

82525

17.34

Copper

82528

31.45

Corticosterone

82530

23.35

Cortisol; free

82533

22.78

Cortisol; total

82540

6.48

Creatine

82541

25.23

Column chromatography/mass spectrometry (eg, GC/MS, or HPLC/MS), analyte not elsewhere specified; qualitative, single stationary and mobile phase

82542

25.23

Column chromatography/mass spectrometry (eg, GC/MS, or HPLC/MS), analyte not elsewhere specified; quantitative, single stationary and mobile phase

82543

25.23

Column chromatography/mass spectrometry (eg, GC/MS, or HPLC/MS), analyte not elsewhere specified; stable isotope dilution, single analyte, quantitative, single stationary and mobile phase

82544

25.23

Column chromatography/mass spectrometry (eg, GC/MS, or HPLC/MS), analyte not elsewhere specified; stable isotope dilution, multiple analytes, quantitative, single stationary and mobile phase

82550

9.10

Creatine kinase (CK), (CPK); total

82552

18.71

Creatine kinase (CK), (CPK); isoenzymes

82553

10.83

Creatine kinase (CK), (CPK); MB fraction only

82554

10.68

Creatine kinase (CK), (CPK); isoforms

82565

7.16

Creatinine; blood

82570

7.23

Creatinine; other source

82575

13.20

Creatinine; clearance

82585

8.11

Cryofibrinogen

82595

9.04

Cryoglobulin, qualitative or semi-quantitative (eg, cryocrit)

82600

27.11

Cyanide

82607

20.91

Cyanocobalamin (Vitamin B-12);

82608

20.01

Cyanocobalamin (Vitamin B-12); unsaturated binding capacity

82610

15.86

Cystatin C

82615

11.41

Cystine and homocystine, urine, qualitative

82626

35.31

Dehydroepiandrosterone (DHEA)

82627

31.07

Dehydroepiandrosterone-sulfate (DHEA-S)

82633

43.28

Desoxycorticosterone, 11-

82634

40.90

Deoxycortisol, 11-

82638

17.11

Dibucaine number

82646

28.85

Dihydrocodeinone

82649

35.91

Dihydromorphinone

82651

36.07

Dihydrotestosterone (DHT)

82652

53.78

Dihydroxyvitamin D, 1,25-

82654

19.34

Dimethadione

82656

16.01

Elastase, pancreatic (EL-1), fecal, qualitative or semi-quantitative

82657

25.23

Enzyme activity in blood cells, cultured cells, or tissue, not elsewhere specified; nonradioactive substrate, each specimen

82658

25.23

Enzyme activity in blood cells, cultured cells, or tissue, not elsewhere specified; radioactive substrate, each specimen

82664

48.00

Electrophoretic technique, not elsewhere specified

82666

29.50

Epiandrosterone

82668

26.26

Erythropoietin

82670

39.04

Estradiol

82671

45.13

Estrogens; fractionated

82672

30.30

Estrogens; total

82677

25.91

Estriol

82679

34.88

Estrone

82690

24.15

Ethchlorvynol

82693

20.82

Ethylene glycol

82696

32.95

Etiocholanolone

82705

7.11

Fat or lipids, feces; qualitative

82710

23.47

Fat or lipids, feces; quantitative

82715

24.05

Fat differential, feces, quantitative

82725

18.60

Fatty acids, nonesterified

82726

25.23

Very long chain fatty acids

82728

19.03

Ferritin

82731

89.99

Fetal fibronectin, cervicovaginal secretions, semi-quantitative

82735

25.91

Fluoride

82742

27.66

Flurazepam

82746

20.54

Folic acid; serum

82747

21.91

Folic acid; RBC

82757

24.24

Fructose, semen

82759

30.01

Galactokinase, RBC

82760

15.64

Galactose

82775

29.43

Galactose-1-phosphate uridyl transferase; quantitative

82776

11.71

Galactose-1-phosphate uridyl transferase; screen

82784

10.39

Gammaglobulin; IgA, IgD, IgG, IgM, each

82785

23.01

Gammaglobulin; IgE

82787

5.15

Gammaglobulin; immunoglobulin subclasses (IgG1, 2, 3, or 4), each

82800

11.83

Gases, blood, pH only

82803

27.04

Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation);

82805

39.65

Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation); with O2 saturation, by direct measurement, except pulse oximetry

82810

12.20

Gases, blood, O2 saturation only, by direct measurement, except pulse oximetry

82820

10.76

Hemoglobin-oxygen affinity (pO2 for 50% hemoglobin saturation with oxygen)

82926

7.61

Gastric acid, free and total, each specimen

82928

9.15

Gastric acid, free or total, each specimen

82938

24.72

Gastrin after secretin stimulation

82941

24.64

Gastrin

82943

19.97

Glucagon

82945

5.48

Glucose, body fluid, other than blood

82946

21.06

Glucagon tolerance test

82947

5.48

Glucose; quantitative, blood (except reagent strip)

82948

3.57

Glucose; blood, reagent strip

82950

6.64

Glucose; post glucose dose (includes glucose)

82951

17.99

Glucose; tolerance test (GTT), three specimens (includes glucose)

82952

4.02

Glucose; tolerance test, each additional beyond three specimens

82953

21.16

Glucose; tolbutamide tolerance test

82955

12.47

Glucose-6-phosphate dehydrogenase (G6PD); quantitative

82960

8.11

Glucose-6-phosphate dehydrogenase (G6PD); screen

82962

3.27

Glucose, blood by glucose monitoring device(s) cleared by the FDA specifically for home use

82963

30.01

Glucosidase, beta

82965

10.80

Glutamate dehydrogenase

82975

22.13

Glutamine (glutamic acid amide)

82977

10.06

Glutamyltransferase, gamma (GGT)

82978

19.91

Glutathione

82979

9.62

Glutathione reductase, RBC

82980

25.60

Glutethimide

82985

21.06

Glycated protein

83001

25.97

Gonadotropin; follicle stimulating hormone (FSH)

83002

25.88

Gonadotropin; luteinizing hormone (LH)

83003

23.29

Growth hormone, human (HGH) (somatotropin)

83008

23.45

Guanosine monophosphate (GMP), cyclic

83009

94.11

Helicobacter pylori, blood test analysis for urease activity, non-radioactive isotope (eg, C-13)

83010

17.58

Haptoglobin; quantitative

83012

24.02

Haptoglobin; phenotypes

83013

94.11

Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)

83014

10.98

Helicobacter pylori; drug administration

83015

26.31

Heavy metal (eg, arsenic, barium, beryllium, bismuth, antimony, mercury); screen

83018

30.68

Heavy metal (eg, arsenic, barium, beryllium, bismuth, antimony, mercury); quantitative, each

83020

17.99

Hemoglobin fractionation and quantitation; electrophoresis (eg, A2, S, C, and/or F)

83021

25.23

Hemoglobin fractionation and quantitation; chromatography (eg, A2, S, C, and/or F)

83026

3.30

Hemoglobin; by copper sulfate method, non-automated

83030

11.56

Hemoglobin; F (fetal), chemical

83033

8.33

Hemoglobin; F (fetal), qualitative

83036

13.56

Hemoglobin; glycosylated (A1C)

83037

21.06

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

83045

6.93

Hemoglobin; methemoglobin, qualitative

83050

10.23

Hemoglobin; methemoglobin, quantitative

83051

10.21

Hemoglobin; plasma

83055

6.87

Hemoglobin; sulfhemoglobin, qualitative

83060

11.56

Hemoglobin; sulfhemoglobin, quantitative

83065

9.62

Hemoglobin; thermolabile

83068

11.83

Hemoglobin; unstable, screen

83069

5.51

Hemoglobin; urine

83070

6.64

Hemosiderin; qualitative

83071

9.61

Hemosiderin; quantitative

83080

14.94

b-Hexosaminidase, each assay

83088

41.26

Histamine

83090

23.57

Homocysteine

83150

27.04

Homovanillic acid (HVA)

83491

24.47

Hydroxycorticosteroids, 17- (17-OHCS)

83497

18.01

Hydroxyindolacetic acid, 5-(HIAA)

83498

37.95

Hydroxyprogesterone, 17-d

83499

35.22

Hydroxyprogesterone, 20-

83500

31.65

Hydroxyproline; free

83505

33.96

Hydroxyproline; total

83516

16.01

Immunoassay for analyte other than infectious agent antibody or infectious agent antigen, qualitative or semiquantitative; multiple step method

83518

10.68

Immunoassay for analyte other than infectious agent antibody or infectious agent antigen, qualitative or semiquantitative; single step method (eg, reagent strip)

83519

18.88

Immunoassay, analyte, quantitative; by radiopharmaceutical technique (eg, RIA)

83520

18.09

Immunoassay, analyte, quantitative; not otherwise specified

83525

15.98

Insulin; total

83527

17.68

Insulin; free

83528

22.22

Intrinsic factor

83540

9.05

Iron

83550

12.21

Iron binding capacity

83570

9.61

Isocitric dehydrogenase (IDH)

83582

19.8

Ketogenic steroids, fractionation

83586

17.89

Ketosteroids, 17- (17-KS); total

83593

36.75

Ketosteroids, 17- (17-KS); fractionation

83605

14.92

Lactate (lactic acid)

83615

8.44

Lactate dehydrogenase (LD), (LDH);

83625

17.88

Lactate dehydrogenase (LD), (LDH); isoenzymes, separation and quantitation

83630

27.42

Lactoferrin, fecal; qualitative

83631

27.42

Lactoferrin, fecal; quantitative

83632

28.24

Lactogen, human placental (HPL) human chorionic somatomammotropin

83633

7.69

Lactose, urine; qualitative

83634

16.10

Lactose, urine; quantitative

83655

16.91

Lead

83661

30.71

Fetal lung maturity assessment; lecithin sphingomyelin (L/S) ratio

83662

26.43

Fetal lung maturity assessment; foam stability test

83663

26.43

Fetal lung maturity assessment; fluorescence polarization

83664

26.43

Fetal lung maturity assessment; lamellar body density

83670

11.77

Leucine aminopeptidase (LAP)

83690

9.62

Lipase

83695

18.09

Lipoprotein (a)

83698

47.43

Lipoprotein-associated phospholipase A2 (Lp-PLA2)

83700

15.73

Lipoprotein, blood; electrophoretic separation and quantitation

83701

34.68

Lipoprotein, blood; high resolution fractionation and quantitation of lipoproteins including lipoprotein subclasses when performed (eg, electrophoresis, ultracentrifugation)

83704

44.08

Lipoprotein, blood; quantitation of lipoprotein particle numbers and lipoprotein particle subclasses (eg, by nuclear magnetic resonance spectroscopy)

83718

11.44

Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol)

83719

16.26

Lipoprotein, direct measurement; VLDL cholesterol

83721

12.81

Lipoprotein, direct measurement; LDL cholesterol

83727

24.02

Luteinizing releasing factor (LRH)

83735

9.36

Magnesium

83775

9.75

Malate dehydrogenase

83785

34.36

Manganese

83788

25.23

Mass spectrometry and tandem mass spectrometry (MS, MS/MS), analyte not elsewhere specified; qualitative, each specimen

83789

25.23

Mass spectrometry and tandem mass spectrometry (MS, MS/MS), analyte not elsewhere specified; quantitative, each specimen

83805

24.63

Meprobamate

83825

22.72

Mercury, quantitative

83835

23.67

Metanephrines

83840

22.81

Methadone

83857

10.97

Methemalbumin

83858

20.71

Methsuximide

83864

27.82

Mucopolysaccharides, acid; quantitative

83866

13.76

Mucopolysaccharides, acid; screen

83872

8.19

Mucin, synovial fluid (Ropes test)

83873

24.04

Myelin basic protein, cerebrospinal fluid

83874

18.04

Myoglobin

83880

47.43

Natriuretic peptide

83883

15.86

Nephelometry, each analyte not elsewhere specified

83885

34.23

Nickel

83887

33.09

Nicotine

83890

5.60

Molecular diagnostics; molecular isolation or extraction

83891

5.60

Molecular diagnostics; isolation or extraction of highly purified nucleic acid

83892

5.60

Molecular diagnostics; enzymatic digestion

83893

5.60

Molecular diagnostics; dot/slot blot production

83894

5.60

Molecular diagnostics; separation by gel electrophoresis (eg, agarose, polyacrylamide)

83896

5.60

Molecular diagnostics; nucleic acid probe, each

83897

5.60

Molecular diagnostics; nucleic acid transfer (eg, Southern, Northern)

83898

6.10

Molecular diagnostics; amplification, target, each nucleic acid sequence

83900

12.20

Molecular diagnostics; amplification, target, multiplex, first two nucleic acid sequences

83901

6.10

Molecular diagnostics; amplification, target, multiplex, each additional nucleic acid sequence beyond two (List separately in addition to code for primary procedure)

83902

5.75

Molecular diagnostics; reverse transcription

83903

6.10

Molecular diagnostics; mutation scanning, by physical properties (eg, single strand conformational polymorphisms (SSCP), heteroduplex, denaturing gradient gel electrophoresis (DGGE), RNA'ase A), single segment, each

83904

6.10

Molecular diagnostics; mutation identification by sequencing, single segment, each segment

83905

6.10

Molecular diagnostics; mutation identification by allele specific transcription, single segment, each segment

83906

6.10

Molecular diagnostics; mutation identification by allele specific translation, single segment, each segment

83907

18.66

Molecular diagnostics; lysis of cells prior to nucleic acid extraction (eg, stool specimens, paraffin embedded tissue)

83908

6.10

Molecular diagnostics; amplification, signal, each nucleic acid sequence

83909

6.10

Molecular diagnostics; separation and identification by high resolution technique (eg, capillary electrophoresis)

83912

5.60

Molecular diagnostics; interpretation and report

83913

18.66

Molecular diagnostics; RNA stabilization

83914

6.10

Mutation identification by enzymatic ligation or primer extension, single segment, each segment (eg, oligonucleotide ligation assay (OLA), single base chain extension (SBCE), or allele-specific primer extension (ASPE))

83915

15.58

Nucleotidase 5'-

83916

28.09

Oligoclonal immune (oligoclonal bands)

83918

23.00

Organic acids; total, quantitative, each specimen

83919

23.00

Organic acids; qualitative, each specimen

83921

23.00

Organic acid, single, quantitative

83925

27.19

Opiates (eg, morphine, meperidine)

83930

9.24

Osmolality; blood

83935

9.52

Osmolality; urine

83937

41.71

Osteocalcin (bone g1a protein)

83945

17.99

Oxalate

83950

89.99

Oncoprotein, HER-2/neu

83970

57.67

Parathormone (parathyroid hormone)

83986

5.00

pH, body fluid, except blood

83992

20.54

Phencyclidine (PCP)

83993

27.42

Calprotectin, fecal

84022

21.76

Phenothiazine

84030

7.69

Phenylalanine (PKU), blood

84035

5.11

Phenylketones, qualitative

84060

10.32

Phosphatase, acid; total

84061

10.39

Phosphatase, acid; forensic examination

84066

13.50

Phosphatase, acid; prostatic

84075

7.23

Phosphatase, alkaline;

84078

10.20

Phosphatase, alkaline; heat stable (total not included)

84080

20.66

Phosphatase, alkaline; isoenzymes

84081

23.09

Phosphatidylglycerol

84085

9.42

Phosphogluconate, 6-, dehydrogenase, RBC

84087

14.42

Phosphohexose isomerase

84100

6.63

Phosphorus inorganic (phosphate);

84105

7.23

Phosphorus inorganic (phosphate); urine

84106

5.99

Porphobilinogen, urine; qualitative

84110

11.80

Porphobilinogen, urine; quantitative

84119

10.60

Porphyrins, urine; qualitative

84120

20.55

Porphyrins, urine; quantitation and fractionation

84126

35.59

Porphyrins, feces; quantitative

84127

10.60

Porphyrins, feces; qualitative

84132

6.42

Potassium; serum

84133

6.01

Potassium; urine

84134

20.38

Prealbumin

84135

26.73

Pregnanediol

84138

26.46

Pregnanetriol

84140

28.89

Pregnenolone

84143

30.25

17-hydroxypregnenolone

84144

29.15

Progesterone

84146

27.08

Prolactin

84150

34.88

Prostaglandin, each

84152

25.70

Prostate specific antigen (PSA); complexed (direct measurement)

84153

25.70

Prostate specific antigen (PSA); total

84154

25.70

Prostate specific antigen (PSA); free

84155

5.12

Protein, total, except by refractometry; serum

84156

5.12

Protein, total, except by refractometry; urine

84157

5.12

Protein, total, except by refractometry; other source (eg, synovial fluid, cerebrospinal fluid)

84160

7.23

Protein, total, by refractometry, any source

84163

21.03

Pregnancy-associated plasma protein-A (PAPP-A)

84165

15.01

Protein; electrophoretic fractionation and quantitation, serum

84166

24.92

Protein; electrophoretic fractionation and quantitation, other fluids with concentration (eg, urine, CSF)

84181

23.80

Protein; Western Blot, with interpretation and report, blood or other body fluid

84182

25.15

Protein; Western Blot, with interpretation and report, blood or other body fluid, immunological probe for band identification, each

84202

20.05

Protoporphyrin, RBC; quantitative

84203

12.03

Protoporphyrin, RBC; screen

84206

24.89

Proinsulin

84207

37.96

Pyridoxal phosphate (Vitamin B-6)

84210

15.17

Pyruvate

84220

13.18

Pyruvate kinase

84228

16.26

Quinine

84233

89.99

Receptor assay; estrogen

84234

90.64

Receptor assay; progesterone

84235

73.12

Receptor assay; endocrine, other than estrogen or progesterone (specify hormone)

84238

51.09

Receptor assay; non-endocrine (specify receptor)

84244

30.73

Renin

84252

28.28

Riboflavin (Vitamin B-2)

84255

35.67

Selenium

84260

43.28

Serotonin

84270

30.36

Sex hormone binding globulin (SHBG)

84275

18.77

Sialic acid

84285

32.90

Silica

84295

6.72

Sodium; serum

84300

6.79

Sodium; urine

84302

6.79

Sodium; other source

84305

23.62

Somatomedin

84307

23.62

Somatostatin

84311

9.03

Spectrophotometry, analyte not elsewhere specified

84315

3.50

Specific gravity (except urine)

84375

27.39

Sugars, chromatographic, TLC or paper chromatography

84376

7.69

Sugars (mono-, di-, and oligosaccharides); single qualitative, each specimen

84377

7.69

Sugars (mono-, di-, and oligosaccharides); multiple qualitative, each specimen

84378

16.10

Sugars (mono-, di-, and oligosaccharides); single quantitative, each specimen

84379

16.10

Sugars (mono-, di-, and oligosaccharides); multiple quantitative, each specimen

84392

6.64

Sulfate, urine

84402

35.57

Testosterone; free

84403

36.08

Testosterone; total

84425

29.67

Thiamine (Vitamin B-1)

84430

16.26

Thiocyanate

84432

22.44

Thyroglobulin

84436

9.61

Thyroxine; total

84437

9.04

Thyroxine; requiring elution (eg, neonatal)

84439

12.60

Thyroxine; free

84442

20.66

Thyroxine binding globulin (TBG)

84443

23.47

Thyroid stimulating hormone (TSH)

84445

71.05

Thyroid stimulating immune globulins (TSI)

84446

19.81

Tocopherol alpha (Vitamin E)

84449

24.57

Transcortin (cortisol binding globulin)

84450

7.22

Transferase; aspartate amino (AST) (SGOT)

84460

7.40

Transferase; alanine amino (ALT) (SGPT)

84466

17.84

Transferrin

84478

8.04

Triglycerides

84479

9.04

Thyroid hormone (T3 or T4) uptake or thyroid hormone binding ratio (THBR)

84480

19.81

Triiodothyronine T3; total (TT-3)

84481

23.67

Triiodothyronine T3; free

84482

21.27

Triiodothyronine T3; reverse

84484

13.75

Troponin, quantitative

84485

10.49

Trypsin; duodenal fluid

84488

9.61

Trypsin; feces, qualitative

84490

10.63

Trypsin; feces, quantitative, 24-hour collection

84510

14.53

Tyrosine

84512

10.31

Troponin, qualitative

84520

5.51

Urea nitrogen; quantitative

84525

5.25

Urea nitrogen; semiquantitative (eg, reagent strip test)

84540

6.64

Urea nitrogen, urine

84545

9.23

Urea nitrogen, clearance

84550

6.31

Uric acid; blood

84560

6.64

Uric acid; other source

84577

17.43

Urobilinogen, feces, quantitative

84578

4.54

Urobilinogen, urine; qualitative

84580

8.92

Urobilinogen, urine; quantitative, timed specimen

84583

7.02

Urobilinogen, urine; semiquantitative

84585

21.66

Vanillylmandelic acid (VMA), urine

84586

26.68

Vasoactive intestinal peptide (VIP)

84588

47.43

Vasopressin (antidiuretic hormone, ADH)

84590

16.20

Vitamin A

84591

16.20

Vitamin, not otherwise specified

84597

19.15

Vitamin K

84600

22.45

Volatiles (eg, acetic anhydride, carbon tetrachloride, dichloroethane, dichloromethane, diethylether, isopropyl alcohol, methanol)

84620

16.55

Xylose absorption test, blood and/or urine

84630

15.91

Zinc

84681

29.07

C-peptide

84702

21.03

Gonadotropin, chorionic (hCG); quantitative

84703

10.49

Gonadotropin, chorionic (hCG); qualitative

84704

21.03

Gonadotropin, chorionic (hCG); free beta chain

84830

14.02

Ovulation tests, by visual color comparison methods for human luteinizing hormone

85002

6.29

Bleeding time

85004

9.04

Blood count; automated differential WBC count

85007

4.81

Blood count; blood smear, microscopic examination with manual differential WBC count

85008

4.81

Blood count; blood smear, microscopic examination without manual differential WBC count

85009

5.19

Blood count; manual differential WBC count, buffy coat

85013

3.31

Blood count; spun microhematocrit

85014

3.31

Blood count; hematocrit (Hct)

85018

3.31

Blood count; hemoglobin (Hgb)

85025

10.86

Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count

85027

9.04

Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)

85032

6.01

Blood count; manual cell count (erythrocyte, leukocyte, or platelet) each

85041

4.05

Blood count; red blood cell (RBC), automated

85044

6.01

Blood count; reticulocyte, manual

85045

5.59

Blood count; reticulocyte, automated

85046

7.80

Blood count; reticulocytes, automated, including one or more cellular parameters (eg, reticulocyte hemoglobin content (CHr), immature reticulocyte fraction (IRF), reticulocyte volume (MRV), RNA content), direct measurement

85048

3.55

Blood count; leukocyte (WBC), automated

85049

6.25

Blood count; platelet, automated

85055

15.37

Reticulated platelet assay

85130

10.68

Chromogenic substrate assay

85170

5.05

Clot retraction

85175

5.41

Clot lysis time, whole blood dilution

85210

18.14

Clotting; factor II, prothrombin, specific

85220

24.66

Clotting; factor V (AcG or proaccelerin), labile factor

85230

25.02

Clotting; factor VII (proconvertin, stable factor)

85240

25.02

Clotting; factor VIII (AHG), one stage

85244

28.53

Clotting; factor VIII related antigen

85245

32.06

Clotting; factor VIII, VW factor, ristocetin cofactor

85246

32.06

Clotting; factor VIII, VW factor antigen

85247

32.06

Clotting; factor VIII, von Willebrand factor, multimetric analysis

85250

26.60

Clotting; factor IX (PTC or Christmas)

85260

25.02

Clotting; factor X (Stuart-Prower)

85270

25.02

Clotting; factor XI (PTA)

85280

27.04

Clotting; factor XII (Hageman)

85290

22.83

Clotting; factor XIII (fibrin stabilizing)

85291

12.42

Clotting; factor XIII (fibrin stabilizing), screen solubility

85292

26.46

Clotting; prekallikrein assay (Fletcher factor assay)

85293

26.46

Clotting; high molecular weight kininogen assay (Fitzgerald factor assay)

85300

16.55

Clotting inhibitors or anticoagulants; antithrombin III, activity

85301

15.11

Clotting inhibitors or anticoagulants; antithrombin III, antigen assay

85302

16.80

Clotting inhibitors or anticoagulants; protein C, antigen

85303

17.81

Clotting inhibitors or anticoagulants; protein C, activity

85305

16.20

Clotting inhibitors or anticoagulants; protein S, total

85306

19.97

Clotting inhibitors or anticoagulants; protein S, free

85307

19.97

Activated Protein C (APC) resistance assay

85335

17.99

Factor inhibitor test

85337

14.56

Thrombomodulin

85345

6.01

Coagulation time; Lee and White

85347

5.95

Coagulation time; activated

85348

5.20

Coagulation time; other methods

85360

11.74

Euglobulin lysis

85362

9.62

Fibrin(ogen) degradation (split) products (FDP) (FSP); agglutination slide, semiquantitative

85366

10.54

Fibrin(ogen) degradation (split) products (FDP) (FSP); paracoagulation

85370

9.60

Fibrin(ogen) degradation (split) products (FDP) (FSP); quantitative

85378

9.97

Fibrin degradation products, D-dimer; qualitative or semiquantitative

85379

14.22

Fibrin degradation products, D-dimer; quantitative

85380

14.22

Fibrin degradation products, D-dimer; ultrasensitive (eg, for evaluation for venous thromboembolism), qualitative or semiquantitative

85384

11.87

Fibrinogen; activity

85385

11.87

Fibrinogen; antigen

85390

7.22

Fibrinolysins or coagulopathy screen, interpretation and report

85400

12.36

Fibrinolytic factors and inhibitors; plasmin

85410

10.77

Fibrinolytic factors and inhibitors; alpha-2 antiplasmin

85415

24.02

Fibrinolytic factors and inhibitors; plasminogen activator

85420

9.13

Fibrinolytic factors and inhibitors; plasminogen, except antigenic assay

85421

14.23

Fibrinolytic factors and inhibitors; plasminogen, antigenic assay

85441

5.88

Heinz bodies; direct

85445

9.52

Heinz bodies; induced, acetyl phenylhydrazine

85460

8.11

Hemoglobin or RBCs, fetal, for fetomaternal hemorrhage; differential lysis (Kleihauer-Betke)

85461

9.26

Hemoglobin or RBCs, fetal, for fetomaternal hemorrhage; rosette

85475

12.40

Hemolysin, acid

85520

18.29

Heparin assay

85525

16.55

Heparin neutralization

85530

19.81

Heparin-protamine tolerance test

85536

9.04

Iron stain, peripheral blood

85540

12.02

Leukocyte alkaline phosphatase with count

85547

8.92

Mechanical fragility, RBC

85549

26.21

Muramidase

85555

9.34

Osmotic fragility, RBC; unincubated

85557

11.36

Osmotic fragility, RBC; incubated

85576

30.01

Platelet, aggregation (in vitro), each agent

85576

30.01

Platelet, aggregation (in vitro), each agent

85597

6.53

Platelet neutralization

85610

5.49

Prothrombin time;

85611

5.51

Prothrombin time; substitution, plasma fractions, each

85612

8.38

Russell viper venom time (includes venom); undiluted

85613

8.38

Russell viper venom time (includes venom); diluted

85635

13.76

Reptilase test

85651

4.96

Sedimentation rate, erythrocyte; non-automated

85652

3.77

Sedimentation rate, erythrocyte; automated

85660

7.71

Sickling of RBC, reduction

85670

8.07

Thrombin time; plasma

85675

9.58

Thrombin time; titer

85705

9.77

Thromboplastin inhibition, tissue

85730

8.38

Thromboplastin time, partial (PTT); plasma or whole blood

85732

9.04

Thromboplastin time, partial (PTT); substitution, plasma fractions, each

85810

16.32

Viscosity

86000

9.75

Agglutinins, febrile (eg, Brucella, Francisella, Murine typhus, Q fever, Rocky Mountain spotted fever, scrub typhus), each antigen

86001

7.30

Allergen specific IgG quantitative or semiquantitative, each allergen

86003

7.30

Allergen specific IgE; quantitative or semiquantitative, each allergen

86005

11.14

Allergen specific IgE; qualitative, multiallergen screen (dipstick, paddle, or disk)

86021

21.03

Antibody identification; leukocyte antibodies

86022

25.66

Antibody identification; platelet antibodies

86023

17.40

Antibody identification; platelet associated immunoglobulin assay

86038

16.89

Antinuclear antibodies (ANA);

86039

15.60

Antinuclear antibodies (ANA); titer

86060

10.20

Antistreptolysin 0; titer

86063

8.07

Antistreptolysin 0; screen

86140

7.23

C-reactive protein;

86141

18.09

C-reactive protein; high sensitivity (hsCRP)

86146

19.21

Beta 2 Glycoprotein I antibody, each

86147

19.21

Cardiolipin (phospholipid) antibody, each Ig class

86148

19.21

Anti-phosphatidylserine (phospholipid) antibody

86155

22.33

Chemotaxis assay, specify method

86156

8.91

Cold agglutinin; screen

86157

11.27

Cold agglutinin; titer

86160

16.78

Complement; antigen, each component

86161

16.78

Complement; functional activity, each component

86162

28.39

Complement; total hemolytic (CH50)

86171

12.16

Complement fixation tests, each antigen

86185

12.50

Counterimmunoelectrophoresis, each antigen

86200

18.09

Cyclic citrullinated peptide (CCP), antibody

86215

18.51

Deoxyribonuclease, antibody

86225

19.20

Deoxyribonucleic acid (DNA) antibody; native or double stranded

86226

16.92

Deoxyribonucleic acid (DNA) antibody; single stranded

86235

25.06

Extractable nuclear antigen, antibody to, any method (eg, nRNP, SS-A, SS-B, Sm, RNP, Sc170, J01), each antibody

86243

28.68

Fc receptor

86255

12.16

Fluorescent noninfectious agent antibody; screen, each antibody

86256

16.84

Fluorescent noninfectious agent antibody; titer, each antibody

86277

21.99

Growth hormone, human (HGH), antibody

86280

11.44

Hemagglutination inhibition test (HAI)

86294

27.41

Immunoassay for tumor antigen, qualitative or semiquantitative (eg, bladder tumor antigen)

86300

29.07

Immunoassay for tumor antigen, quantitative; CA 15-3 (27.29)

86301

29.07

Immunoassay for tumor antigen, quantitative; CA 19-9

86304

29.07

Immunoassay for tumor antigen, quantitative; CA 125

86308

7.23

Heterophile antibodies; screening

86309

9.04

Heterophile antibodies; titer

86310

10.30

Heterophile antibodies; titers after absorption with beef cells and guinea pig kidney

86316

29.07

Immunoassay for tumor antigen, other antigen, quantitative (eg, CA 50, 72-4, 549), each

86317

20.95

Immunoassay for infectious agent antibody, quantitative, not otherwise specified

86318

18.09

Immunoassay for infectious agent antibody, qualitative or semiquantitative, single step method (eg, reagent strip)

86320

31.32

Immunoelectrophoresis; serum

86325

31.24

Immunoelectrophoresis; other fluids (eg, urine, cerebrospinal fluid) with concentration

86327

31.70

Immunoelectrophoresis; crossed (2-dimensional assay)

86329

19.62

Immunodiffusion; not elsewhere specified

86331

16.75

Immunodiffusion; gel diffusion, qualitative (Ouchterlony), each antigen or antibody

86332

34.05

Immune complex assay

86334

31.21

Immunofixation electrophoresis; serum

86335

41.00

Immunofixation electrophoresis; other fluids with concentration (eg, urine, CSF)

86336

21.77

Inhibin A

86337

29.92

Insulin antibodies

86340

21.06

Intrinsic factor antibodies

86341

27.65

Islet cell antibody

86343

17.41

Leukocyte histamine release test (LHR)

86344

11.16

Leukocyte phagocytosis

86353

68.49

Lymphocyte transformation, mitogen (phytomitogen) or antigen induced blastogenesis

86355

16.01

B cells, total count

86356

15.37

Mononuclear cell antigen, quantitative (eg, flow cytometry), not otherwise specified, each antigen

86357

16.01

Natural killer (NK) cells, total count

86359

16.01

T cells; total count

86360

19.21

T cells; absolute CD4 and CD8 count, including ratio

86361

15.37

T cells; absolute CD4 count

86367

16.01

Stem cells (ie, CD34), total count

86376

20.33

Microsomal antibodies (eg, thyroid or liver-kidney), each

86378

27.51

Migration inhibitory factor test (MIF)

86382

23.62

Neutralization test, viral

86384

15.91

Nitroblue tetrazolium dye test (NTD)

86403

14.24

Particle agglutination; screen, each antibody

86406

14.87

Particle agglutination; titer, each antibody

86430

7.93

Rheumatoid factor; qualitative

86431

7.93

Rheumatoid factor; quantitative

86480

86.59

Tuberculosis test, cell mediated immunity measurement of gamma interferon antigen response

86590

15.41

Streptokinase, antibody

86592

5.96

Syphilis test; qualitative (eg, VDRL, RPR, ART)

86593

6.16

Syphilis test; quantitative

86602

13.64

Antibody; actinomyces

86603

14.58

Antibody; adenovirus

86606

20.59

Antibody; Aspergillus

86609

13.64

Antibody; bacterium, not elsewhere specified

86611

13.64

Antibody; Bartonella

86612

18.03

Antibody; Blastomyces

86615

18.43

Antibody; Bordetella

86617

21.64

Antibody; Borrelia burgdorferi (Lyme disease) confirmatory test (eg, Western Blot or immunoblot)

86618

19.97

Antibody; Borrelia burgdorferi (Lyme disease)

86619

18.69

Antibody; Borrelia (relapsing fever)

86622

12.14

Antibody; Brucella

86625

13.64

Antibody; Campylobacter

86628

16.78

Antibody; Candida

86631

16.52

Antibody; Chlamydia

86632

17.74

Antibody; Chlamydia, IgM

86635

16.03

Antibody; Coccidioides

86638

16.94

Antibody; Coxiella burnetii (Q fever)

86641

12.14

Antibody; Cryptococcus

86644

20.11

Antibody; cytomegalovirus (CMV)

86645

19.97

Antibody; cytomegalovirus (CMV), IgM

86648

13.64

Antibody; Diphtheria

86651

18.43

Antibody; encephalitis, California (La Crosse)

86652

18.43

Antibody; encephalitis, Eastern equine

86653

18.43

Antibody; encephalitis, St. Louis

86654

18.43

Antibody; encephalitis, Western equine

86658

14.58

Antibody; enterovirus (eg, coxsackie, echo, polio)

86663

18.33

Antibody; Epstein-Barr (EB) virus, early antigen (EA)

86664

19.97

Antibody; Epstein-Barr (EB) virus, nuclear antigen (EBNA)

86665

19.97

Antibody; Epstein-Barr (EB) virus, viral capsid (VCA)

86666

13.64

Antibody; Ehrlichia

86668

12.14

Antibody; Francisella tularensis

86671

13.64

Antibody; fungus, not elsewhere specified

86674

19.97

Antibody; Giardia lamblia

86677

20.28

Antibody; Helicobacter pylori

86682

13.64

Antibody; helminth, not elsewhere specified

86684

13.64

Antibody; Haemophilus influenza

86687

11.72

Antibody; HTLV-I

86688

13.94

Antibody; HTLV-II

86689

27.05

Antibody; HTLV or HIV antibody, confirmatory test (eg, Western Blot)

86692

23.62

Antibody; hepatitis, delta agent

86694

20.11

Antibody; herpes simplex, non-specific type test

86695

18.43

Antibody; herpes simplex, type 1

86696

27.05

Antibody; herpes simplex, type 2

86698

17.46

Antibody; histoplasma

86701

12.41

Antibody; HIV-1

86702

14.75

Antibody; HIV-2

86703

14.75

Antibody; HIV-1 and HIV-2, single assay

86704

16.84

Hepatitis B core antibody (HBcAb); total

86705

16.44

Hepatitis B core antibody (HBcAb); IgM antibody

86706

14.61

Hepatitis B surface antibody (HBsAb)

86707

16.16

Hepatitis Be antibody (HBeAb)

86708

16.24

Hepatitis A antibody (HAAb); total

86709

15.73

Hepatitis A antibody (HAAb); IgM antibody

86710

14.58

Antibody; influenza virus

86713

21.39

Antibody; Legionella

86717

13.00

Antibody; Leishmania

86720

12.14

Antibody; Leptospira

86723

13.00

Antibody; Listeria monocytogenes

86727

14.58

Antibody; lymphocytic choriomeningitis

86729

16.69

Antibody; lymphogranuloma venereum

86732

13.00

Antibody; mucormycosis

86735

18.23

Antibody; mumps

86738

14.58

Antibody; mycoplasma

86741

13.00

Antibody; Neisseria meningitides

86744

13.00

Antibody; Nocardia

86747

13.00

Antibody; parvovirus

86750

13.00

Antibody; Plasmodium (malaria)

86753

13.00

Antibody; protozoa, not elsewhere specified

86756

18.01

Antibody; respiratory syncytial virus

86757

27.05

Antibody; Rickettsia

86759

18.43

Antibody; rotavirus

86762

20.11

Antibody; rubella

86765

18.00

Antibody; rubeola

86768

13.00

Antibody; Salmonella

86771

13.00

Antibody; Shigella

86774

13.00

Antibody; tetanus

86777

20.11

Antibody; Toxoplasma

86778

20.12

Antibody; Toxoplasma, IgM

86781

18.50

Antibody; Treponema pallidum, confirmatory test (eg, FTA-abs)

86784

17.55

Antibody; Trichinella

86787

18.00

Antibody; varicella-zoster

86788

19.97

Antibody; West Nile virus, IgM

86789

20.11

Antibody; West Nile virus

86790

13.00

Antibody; virus, not elsewhere specified

86793

13.00

Antibody; Yersinia

86800

20.70

Thyroglobulin antibody

86803

16.24

Hepatitis C antibody;

86804

21.64

Hepatitis C antibody; confirmatory test (eg, immunoblot)

86805

73.05

Lymphocytotoxicity assay, visual crossmatch; with titration

86806

66.49

Lymphocytotoxicity assay, visual crossmatch; without titration

86807

55.29

Serum screening for cytotoxic percent reactive antibody (PRA); standard method

86808

41.47

Serum screening for cytotoxic percent reactive antibody (PRA); quick method

86812

36.06

HLA typing; A, B, or C (eg, A10, B7, B27), single antigen

86813

81.02

HLA typing; A, B, or C, multiple antigens

86816

38.92

HLA typing; DR/DQ, single antigen

86817

89.95

HLA typing; DR/DQ, multiple antigens

86821

78.88

HLA typing; lymphocyte culture, mixed (MLC)

86822

51.07

HLA typing; lymphocyte culture, primed (PLC)

86880

7.50

Antihuman globulin test (Coombs test); direct, each antiserum

86885

7.99

Antihuman globulin test (Coombs test); indirect, qualitative, each reagent red cell

86886

7.23

Antihuman globulin test (Coombs test); indirect, each antibody titer

86900

4.17

Blood typing; ABO

86901

4.17

Blood typing; Rh (D)

86903

13.19

Blood typing; antigen screening for compatible blood unit using reagent serum, per unit screened

86904

13.28

Blood typing; antigen screening for compatible unit using patient serum, per unit screened

86905

5.34

Blood typing; RBC antigens, other than ABO or Rh (D), each

86906

10.83

Blood typing; Rh phenotyping, complete

86940

11.46

Hemolysins and agglutinins; auto, screen, each

86941

16.92

Hemolysins and agglutinins; incubated

87001

6.88

Animal inoculation, small animal; with observation

87003

23.52

Animal inoculation, small animal; with observation and dissection

87015

9.33

Concentration (any type), for infectious agents

87040

14.42

Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates (includes anaerobic culture, if appropriate)

87045

13.18

Culture, bacterial; stool, aerobic, with isolation and preliminary examination (eg, KIA, LIA), Salmonella and Shigella species

87046

13.18

Culture, bacterial; stool, aerobic, additional pathogens, isolation and presumptive identification of isolates, each plate

87070

12.03

Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates

87071

13.18

Culture, bacterial; quantitative, aerobic with isolation and presumptive identification of isolates, any source except urine, blood or stool

87073

13.18

Culture, bacterial; quantitative, anaerobic with isolation and presumptive identification of isolates, any source except urine, blood or stool

87075

13.22

Culture, bacterial; any source, except blood, anaerobic with isolation and presumptive identification of isolates

87076

7.30

Culture, bacterial; anaerobic isolate, additional methods required for definitive identification, each isolate

87077

7.30

Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate

87081

9.26

Culture, presumptive, pathogenic organisms, screening only;

87084

9.75

Culture, presumptive, pathogenic organisms, screening only; with colony estimation from density chart

87086

11.28

Culture, bacterial; quantitative colony count, urine

87088

11.31

Culture, bacterial; with isolation and presumptive identification of each isolate, urine

87101

10.77

Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; skin, hair, or nail

87102

11.74

Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; other source (except blood)

87103

12.60

Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; blood

87106

14.42

Culture, fungi, definitive identification, each organism; yeast

87107

14.42

Culture, fungi, definitive identification, each organism; mold

87109

21.50

Culture, mycoplasma, any source

87110

27.37

Culture, chlamydia, any source

87116

15.10

Culture, tubercle or other acid-fast bacilli (eg, TB, AFB, mycobacteria) any source, with isolation and presumptive identification of isolates

87118

15.29

Culture, mycobacterial, definitive identification, each isolate

87140

7.79

Culture, typing; immunofluorescent method, each antiserum

87143

17.51

Culture, typing; gas liquid chromatography (GLC) or high pressure liquid chromatography (HPLC) method

87147

7.23

Culture, typing; immunologic method, other than immunofluoresence (eg, agglutination grouping), per antiserum

87149

28.02

Culture, typing; identification by nucleic acid probe

87152

7.31

Culture, typing; identification by pulse field gel typing

87158

7.31

Culture, typing; other methods

87164

8.11

Dark field examination, any source (eg, penile, vaginal, oral, skin); includes specimen collection

87166

8.11

Dark field examination, any source (eg, penile, vaginal, oral, skin); without collection

87168

5.96

Macroscopic examination; arthropod

87169

5.96

Macroscopic examination; parasite

87172

5.96

Pinworm exam (eg, cellophane tape prep)

87176

8.22

Homogenization, tissue, for culture

87177

12.43

Ova and parasites, direct smears, concentration and identification

87181

6.64

Susceptibility studies, antimicrobial agent; agar dilution method, per agent (eg, antibiotic gradient strip)

87184

9.63

Susceptibility studies, antimicrobial agent; disk method, per plate (12 or fewer agents)

87185

6.64

Susceptibility studies, antimicrobial agent; enzyme detection (eg, beta lactamase), per enzyme

87186

12.08

Susceptibility studies, antimicrobial agent; microdilution or agar dilution (minimum inhibitory concentration (MIC) or breakpoint), each multi-antimicrobial, per plate

87187

14.48

Susceptibility studies, antimicrobial agent; microdilution or agar dilution, minimum lethal concentration (MLC), each plate (List separately in addition to code for primary procedure)

87188

9.27

Susceptibility studies, antimicrobial agent; macrobroth dilution method, each agent

87190

6.88

Susceptibility studies, antimicrobial agent; mycobacteria, proportion method, each agent

87197

20.99

Serum bactericidal titer (Schlicter test)

87205

5.96

Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types

87206

7.50

Smear, primary source with interpretation; fluorescent and/or acid fast stain for bacteria, fungi, parasites, viruses or cell types

87207

8.37

Smear, primary source with interpretation; special stain for inclusion bodies or parasites (eg, malaria, coccidia, microsporidia, trypanosomes, herpes viruses)

87209

25.11

Smear, primary source with interpretation; complex special stain (eg, trichrome, iron hemotoxylin) for ova and parasites

87210

5.96

Smear, primary source with interpretation; wet mount for infectious agents (eg, saline, India ink, KOH preps)

87220

5.96

Tissue examination by KOH slide of samples from skin, hair, or nails for fungi or ectoparasite ova or mites (eg, scabies)

87230

27.30

Toxin or antitoxin assay, tissue culture (eg, Clostridium difficile toxin)

87250

27.32

Virus isolation; inoculation of embryonated eggs, or small animal, includes observation and dissection

87252

36.42

Virus isolation; tissue culture inoculation, observation, and presumptive identification by cytopathic effect

87253

28.22

Virus isolation; tissue culture, additional studies or definitive identification (eg, hemabsorption, neutralization, immunofluoresence stain), each isolate

87254

27.32

Virus isolation; centrifuge enhanced (shell vial) technique, includes identification with immunofluorescence stain, each virus

87255

47.31

Virus isolation; including identification by non-immunologic method, other than by cytopathic effect (eg, virus specific enzymatic activity)

87260

16.01

Infectious agent antigen detection by immunofluorescent technique; adenovirus

87265

16.01

Infectious agent antigen detection by immunofluorescent technique; Bordetella pertussis/parapertussis

87267

16.01

Infectious agent antigen detection by immunofluorescent technique; Enterovirus, direct fluorescent antibody (DFA)

87269

16.01

Infectious agent antigen detection by immunofluorescent technique; giardia

87270

16.01

Infectious agent antigen detection by immunofluorescent technique; Chlamydia trachomatis

87271

16.01

Infectious agent antigen detection by immunofluorescent technique; Cytomegalovirus, direct fluorescent antibody (DFA)

87272

16.01

Infectious agent antigen detection by immunofluorescent technique; cryptosporidium

87273

16.01

Infectious agent antigen detection by immunofluorescent technique; Herpes simplex virus type 2

87274

16.01

Infectious agent antigen detection by immunofluorescent technique; Herpes simplex virus type 1

87275

16.01

Infectious agent antigen detection by immunofluorescent technique; influenza B virus

87276

16.01

Infectious agent antigen detection by immunofluorescent technique; influenza A virus

87277

16.01

Infectious agent antigen detection by immunofluorescent technique; Legionella micdadei

87278

16.01

Infectious agent antigen detection by immunofluorescent technique; Legionella pneumophila

87279

16.01

Infectious agent antigen detection by immunofluorescent technique; Parainfluenza virus, each type

87280

16.01

Infectious agent antigen detection by immunofluorescent technique; respiratory syncytial virus

87281

16.01

Infectious agent antigen detection by immunofluorescent technique; Pneumocystis carinii

87283

16.01

Infectious agent antigen detection by immunofluorescent technique; Rubeola

87285

16.01

Infectious agent antigen detection by immunofluorescent technique; Treponema pallidum

87290

16.01

Infectious agent antigen detection by immunofluorescent technique; Varicella zoster virus

87299

16.01

Infectious agent antigen detection by immunofluorescent technique; not otherwise specified, each organism

87300

16.01

Infectious agent antigen detection by immunofluorescent technique, polyvalent for multiple organisms, each polyvalent antiserum

87301

16.01

Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; adenovirus enteric types 40/41

87305

16.01

Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Aspergillus

87320

16.01

Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Chlamydia trachomatis

87324

16.01

Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Clostridium difficile toxin(s)

87327

16.01

Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Cryptococcus neoformans

87328

16.01

Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; cryptosporidium

87329

16.01

Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; giardia

87332

16.01

Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; cytomegalovirus

87335

16.01

Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Escherichia coli 0157

87336

16.01

Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Entamoeba histolytica dispar group

87337

16.01

Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Entamoeba histolytica group

87338

16.04

Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool

87339

16.01

Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Helicobacter pylori

87340

14.43

Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg)

87341

14.43

Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg) neutralization

87350

16.10

Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; hepatitis Be antigen (HBeAg)

87380

15.54

Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; hepatitis, delta agent

87385

16.01

Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Histoplasma capsulatum

87390

24.65

Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; HIV-1

87391

24.65

Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; HIV-2

87400

16.01

Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Influenza, A or B, each

87420

16.01

Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; respiratory syncytial virus

87425

16.01

Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; rotavirus

87427

16.01

Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Shiga-like toxin

87430

16.01

Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Streptococcus, group A

87449

16.01

Infectious agent antigen detection by enzyme immunoassay technique qualitative or semiquantitative; multiple step method, not otherwise specified, each organism

87450

10.68

Infectious agent antigen detection by enzyme immunoassay technique qualitative or semiquantitative; single step method, not otherwise specified, each organism

87451

10.68

Infectious agent antigen detection by enzyme immunoassay technique qualitative or semiquantitative; multiple step method, polyvalent for multiple organisms, each polyvalent antiserum

87470

28.02

Infectious agent detection by nucleic acid (DNA or RNA); Bartonella henselae and Bartonella quintana, direct probe technique

87471

36.39

Infectious agent detection by nucleic acid (DNA or RNA); Bartonella henselae and Bartonella quintana, amplified probe technique

87472

59.85

Infectious agent detection by nucleic acid (DNA or RNA); Bartonella henselae and Bartonella quintana, quantification

87475

28.02

Infectious agent detection by nucleic acid (DNA or RNA); Borrelia burgdorferi, direct probe technique

87476

36.39

Infectious agent detection by nucleic acid (DNA or RNA); Borrelia burgdorferi, amplified probe technique

87477

59.85

Infectious agent detection by nucleic acid (DNA or RNA); Borrelia burgdorferi, quantification

87480

28.02

Infectious agent detection by nucleic acid (DNA or RNA); Candida species, direct probe technique

87481

36.39

Infectious agent detection by nucleic acid (DNA or RNA); Candida species, amplified probe technique

87482

58.33

Infectious agent detection by nucleic acid (DNA or RNA); Candida species, quantification

87485

28.02

Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia pneumoniae, direct probe technique

87486

36.39

Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia pneumoniae, amplified probe technique

87487

59.85

Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia pneumoniae, quantification

87490

28.02

Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, direct probe technique

87491

36.39

Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique

87492

22.93

Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, quantification

87495

28.02

Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus, direct probe technique

87496

36.39

Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus, amplified probe technique

87497

59.85

Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus, quantification

87498

36.39

Infectious agent detection by nucleic acid (DNA or RNA); enterovirus, amplified probe technique

87500

36.39

Infectious agent detection by nucleic acid (DNA or RNA); vancomycin resistance (eg, enterococcus species van A, van B), amplified probe technique

87510

28.02

Infectious agent detection by nucleic acid (DNA or RNA); Gardnerella vaginalis, direct probe technique

87511

36.39

Infectious agent detection by nucleic acid (DNA or RNA); Gardnerella vaginalis, amplified probe technique

87512

58.33

Infectious agent detection by nucleic acid (DNA or RNA); Gardnerella vaginalis, quantification

87515

28.02

Infectious agent detection by nucleic acid (DNA or RNA); hepatitis B virus, direct probe technique

87516

36.39

Infectious agent detection by nucleic acid (DNA or RNA); hepatitis B virus, amplified probe technique

87517

59.85

Infectious agent detection by nucleic acid (DNA or RNA); hepatitis B virus, quantification

87520

28.02

Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, direct probe technique

87521

36.39

Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, amplified probe technique

87522

59.85

Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification

87525

28.02

Infectious agent detection by nucleic acid (DNA or RNA); hepatitis G, direct probe technique

87526

36.39

Infectious agent detection by nucleic acid (DNA or RNA); hepatitis G, amplified probe technique

87527

58.33

Infectious agent detection by nucleic acid (DNA or RNA); hepatitis G, quantification

87528

28.02

Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus, direct probe technique

87529

36.39

Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus, amplified probe technique

87530

59.85

Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus, quantification

87531

28.02

Infectious agent detection by nucleic acid (DNA or RNA); Herpes virus-6, direct probe technique

87532

36.39

Infectious agent detection by nucleic acid (DNA or RNA); Herpes virus-6, amplified probe technique

87533

58.33

Infectious agent detection by nucleic acid (DNA or RNA); Herpes virus-6, quantification

87534

28.02

Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, direct probe technique

87535

36.39

Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, amplified probe technique

87536

78.52

Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, quantification

87537

28.02

Infectious agent detection by nucleic acid (DNA or RNA); HIV-2, direct probe technique

87538

36.39

Infectious agent detection by nucleic acid (DNA or RNA); HIV-2, amplified probe technique

87539

59.85

Infectious agent detection by nucleic acid (DNA or RNA); HIV-2, quantification

87540

28.02

Infectious agent detection by nucleic acid (DNA or RNA); Legionella pneumophila, direct probe technique

87541

36.39

Infectious agent detection by nucleic acid (DNA or RNA); Legionella pneumophila, amplified probe technique

87542

58.33

Infectious agent detection by nucleic acid (DNA or RNA); Legionella pneumophila, quantification

87550

28.02

Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria species, direct probe technique

87551

36.39

Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria species, amplified probe technique

87552

59.85

Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria species, quantification

87555

28.02

Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria tuberculosis, direct probe technique

87556

36.39

Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria tuberculosis, amplified probe technique

87557

59.85

Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria tuberculosis, quantification

87560

28.02

Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria avium-intracellulare, direct probe technique

87561

36.39

Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria avium-intracellulare, amplified probe technique

87562

59.85

Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria avium-intracellulare, quantification

87580

28.02

Infectious agent detection by nucleic acid (DNA or RNA); Mycoplasma pneumoniae, direct probe technique

87581

36.39

Infectious agent detection by nucleic acid (DNA or RNA); Mycoplasma pneumoniae, amplified probe technique

87582

58.33

Infectious agent detection by nucleic acid (DNA or RNA); Mycoplasma pneumoniae, quantification

87590

28.02

Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, direct probe technique

87591

36.39

Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique

87592

59.85

Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, quantification

87620

28.02

Infectious agent detection by nucleic acid (DNA or RNA); papillomavirus, human, direct probe technique

87621

36.39

Infectious agent detection by nucleic acid (DNA or RNA); papillomavirus, human, amplified probe technique

87622

58.33

Infectious agent detection by nucleic acid (DNA or RNA); papillomavirus, human, quantification

87640

36.39

Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, amplified probe technique

87641

36.39

Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, methicillin resistant, amplified probe technique

87650

28.02

Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, direct probe technique

87651

36.39

Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, amplified probe technique

87652

58.33

Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, quantification

87653

36.39

Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group B, amplified probe technique

87660

28.02

Infectious agent detection by nucleic acid (DNA or RNA); Trichomonas vaginalis, direct probe technique

87797

28.02

Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; direct probe technique, each organism

87798

36.39

Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism

87799

59.85

Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; quantification, each organism

87800

56.03

Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; direct probe(s) technique

87801

72.78

Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique

87802

16.01

Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group B

87803

16.01

Infectious agent antigen detection by immunoassay with direct optical observation; Clostridium difficile toxin A

87804

16.01

Infectious agent antigen detection by immunoassay with direct optical observation; Influenza

87804

16.01

Infectious agent antigen detection by immunoassay with direct optical observation; Influenza

87807

16.01

Infectious agent antigen detection by immunoassay with direct optical observation; respiratory syncytial virus

87808

16.01

Infectious agent antigen detection by immunoassay with direct optical observation; Trichomonas vaginalis

87809

16.01

Infectious agent antigen detection by immunoassay with direct optical observation; adenovirus

87810

16.01

Infectious agent detection by immunoassay with direct optical observation; Chlamydia trachomatis

87850

16.01

Infectious agent detection by immunoassay with direct optical observation; Neisseria gonorrhoeae

87880

16.01

Infectious agent detection by immunoassay with direct optical observation; Streptococcus, group A

87899

16.01

Infectious agent detection by immunoassay with direct optical observation; not otherwise specified

87900

182.11

Infectious agent drug susceptibility phenotype prediction using regularly updated genotypic bioinformatics

87901

114.95

Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV 1, reverse transcriptase and protease

87902

114.95

Infectious agent genotype analysis by nucleic acid (DNA or RNA); Hepatitis C virus

87903

682.72

Infectious agent phenotype analysis by nucleic acid (DNA or RNA) with drug resistance tissue culture analysis, HIV 1; first through ten drugs tested

87904

36.42

Infectious agent phenotype analysis by nucleic acid (DNA or RNA) with drug resistance tissue culture analysis, HIV 1; each additional drug tested (List separately in addition to code for primary procedure)

88130

21.02

Sex chromatin identification; Barr bodies

88140

11.17

Sex chromatin identification; peripheral blood smear, polymorphonuclear drumsticks

88142

28.31

Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision

88143

28.31

Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with manual screening and rescreening under physician supervision

88147

15.90

Cytopathology smears, cervical or vaginal; screening by automated system under physician supervision

88148

21.23

Cytopathology smears, cervical or vaginal; screening by automated system with manual rescreening under physician supervision

88150

14.76

Cytopathology, slides, cervical or vaginal; manual screening under physician supervision

88152

14.76

Cytopathology, slides, cervical or vaginal; with manual screening and computer-assisted rescreening under physician supervision

88153

14.76

Cytopathology, slides, cervical or vaginal; with manual screening and rescreening under physician supervision

88154

14.76

Cytopathology, slides, cervical or vaginal; with manual screening and computer-assisted rescreening using cell selection and review under physician supervision

88155

8.37

Cytopathology, slides, cervical or vaginal, definitive hormonal evaluation (eg, maturation index, karyopyknotic index, estrogenic index) (List separately in addition to code(s) for other technical and interpretation services)

88164

14.76

Cytopathology, slides, cervical or vaginal (the Bethesda System); manual screening under physician supervision

88165

14.76

Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual screening and rescreening under physician supervision

88166

14.76

Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual screening and computer-assisted rescreening under physician supervision

88167

14.76

Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual screening and computer-assisted rescreening using cell selection and review under physician supervision

88174

29.85

Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; screening by automated system, under physician supervision

88175

37.01

Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with screening by automated system and manual rescreening or review, under physician supervision

88230

48.38

Tissue culture for non-neoplastic disorders; lymphocyte

88233

122.81

Tissue culture for non-neoplastic disorders; skin or other solid tissue biopsy

88235

122.81

Tissue culture for non-neoplastic disorders; amniotic fluid or chorionic villus cells

88237

55.83

Tissue culture for neoplastic disorders; bone marrow, blood cells

88239

206.12

Tissue culture for neoplastic disorders; solid tumor

88240

14.11

Cryopreservation, freezing and storage of cells, each cell line

88241

14.11

Thawing and expansion of frozen cells, each aliquot

88245

207.98

Chromosome analysis for breakage syndromes; baseline Sister Chromatid Exchange (SCE), 20-25 cells

88248

241.96

Chromosome analysis for breakage syndromes; baseline breakage, score 50-100 cells, count 20 cells, two karyotypes (eg, for ataxia telangiectasia, Fanconi anemia, fragile X)

88249

241.96

Chromosome analysis for breakage syndromes; score 100 cells, clastogen stress (eg, diepoxybutane, mitomycin C, ionizing radiation, UV radiation)

88261

246.93

Chromosome analysis; count five cells, one karyotype, with banding

88262

174.14

Chromosome analysis; count 15-20 cells, two karyotypes, with banding

88263

204.68

Chromosome analysis; count 45 cells for mosaicism, two karyotypes, with banding

88264

174.14

Chromosome analysis; analyze 20-25 cells

88267

251.17

Chromosome analysis, amniotic fluid or chorionic villus, count 15 cells, one karyotype, with banding

88269

232.38

Chromosome analysis, in situ for amniotic fluid cells, count cells from six-12 colonies, one karyotype, with banding

88271

29.93

Molecular cytogenetics; DNA probe, each (eg, FISH)

88272

37.41

Molecular cytogenetics; chromosomal in situ hybridization, analyze three-five cells (eg, for derivatives and markers)

88273

44.89

Molecular cytogenetics; chromosomal in situ hybridization, analyze ten-30 cells (eg, for microdeletions)

88274

48.63

Molecular cytogenetics; interphase in situ hybridization, analyze 25-99 cells

88275

56.11

Molecular cytogenetics; interphase in situ hybridization, analyze 100-300 cells

88280

35.07

Chromosome analysis; additional karyotypes, each study

88283

95.84

Chromosome analysis; additional specialized banding technique (eg, NOR, C-banding)

88285

26.54

Chromosome analysis; additional cells counted, each study

88289

48.11

Chromosome analysis; additional high resolution study

88371

31.05

Protein analysis of tissue by Western Blot, with interpretation and report;

88372

31.79

Protein analysis of tissue by Western Blot, with interpretation and report; immunological probe for band identification, each

88400

7.02

Bilirubin, total, transcutaneous

89050

6.61

Cell count, miscellaneous body fluids (eg, cerebrospinal fluid, joint fluid), except blood;

89051

7.70

Cell count, miscellaneous body fluids (eg, cerebrospinal fluid, joint fluid), except blood; with differential count

89055

5.96

Leukocyte assessment, fecal, qualitative or semiquantitative

89060

9.99

Crystal identification by light microscopy with or without polarizing lens analysis, tissue or any body fluid (except urine)

89125

6.03

Fat stain, feces, urine, or respiratory secretions

89160

5.15

Meat fibers, feces

89190

6.64

Nasal smear for eosinophils

89225

4.67

Starch granules, feces

89235

7.69

Water load test

89300

9.77

Semen analysis; presence and/or motility of sperm including Huhner test (post coital)

89310

12.03

Semen analysis; motility and count (not including Huhner test)

89320

16.84

Semen analysis; volume, count, motility, and differential

89321

16.84

Semen analysis; sperm presence and motility of sperm, if performed

89322

21.65

Semen analysis; volume, count, motility, and differential using strict morphologic criteria (eg, Kruger)

89325

14.91

Sperm antibodies

89329

29.30

Sperm evaluation; hamster penetration test

89330

13.83

Sperm evaluation; cervical mucus penetration test, with or without spinnbarkeit test

89331

27.37

Sperm evaluation, for retrograde ejaculation, urine (sperm concentration, motility, and morphology, as indicated)
(5) Dental Services.

Code

Fee

40.06(5) - Dental Service Description

D0120

30.40

Periodic oral evaluation - established patient

D0140

60.00

Limited oral evaluation - problem focused

D0150

60.00

Comprehensive oral evaluation - new or established patient

D0160

80.00

Detailed and extensive oral evaluation - problem focused, by report

D0170

53.60

Re-evaluation - limited, problem focused (established patient; not postoperative visit)

D0180

79.20

Comprehensive periodontal evaluation - new or established patient

D0210

100.00

Intraoral - complete series (including bitewings)

D0220

20.00

Intraoral - periapical, first film

D0230

16.00

Intraoral - periapical, each additional film

D0240

30.40

Intraoral - occlusal film

D0250

32.00

Extraoral - first film

D0260

28.00

Extraoral - each additional film

D0270

20.00

Bitewing - single film

D0272

32.00

Bitewings - two films

D0273

40.00

Bitewings - three films

D0274

48.00

Bitewings - four films

D0277

72.80

Vertical bitewings - seven to eight films

D0290

66.40

Posterior-anterior or lateral skull and facial bone survey film

D0310

132.00

Sialography

D0321

104.00

Other temporomandibular joint films, by report

D0322

220.00

Tomographic survey

D0330

88.00

Panoramic film

D0340

92.00

Cephalometric film

D0350

36.00

Oral/facial photographic images

D0460

40.00

Pulp vitality tests

D0470

76.80

Diagnostic casts

D0472

112.00

Accession of tissue, gross examination, preparation, and transmission of written report

D0473

264.00

Accession of tissue, gross and microscopic examination, preparation and transmission of written report

D0474

12.00

Accession of tissue, gross and microscopic examination, including assessment of surgical margins for presence of disease, preparation and transmission of written report

D0480

12.00

Accession of exfoliative cytologic smears, microscopic examination, preparation and transmission of written report

D1110

69.60

Prophylaxis - adult

D1204

26.40

Topical application of fluoride (prophylaxis not included) - adult

D1206

28.80

Topical fluoride varnish; therapeutic application for moderate to high caries risk patients

D1351

41.60

Sealant - per tooth

D1510

280.00

Space maintainer - fixed-unilateral

D1515

424.00

Space maintainer - fixed-bilateral

D1520

128.00

Space maintainer - removable-unilateral

D1525

180.00

Space maintainer - removable-bilateral

D1550

80.00

Recementation of space maintainer

D1555

44.00

Removal of fixed space maintainer

D2140

88.00

Amalgam-one surface, primary or permanent

D2150

110.40

Amalgam-two surfaces, primary or permanent

D2160

132.00

Amalgam-three surfaces, primary or permanent

D2161

156.00

Amalgam-four or more surfaces, primary or permanent

D2330

104.00

Resin - one surface, anterior

D2331

129.60

Resin - two surfaces, anterior

D2332

157.60

Resin - three surfaces, anterior

D2335

200.00

Resin - four or more surfaces or involving incisal angle (anterior)

D2390

176.80

Resin-based composite crown, anterior

D2391

116.00

Resin-based composite - one surface, posterior

D2392

151.20

Resin-based composite - two surfaces, posterior

D2393

184.00

Resin-based composite - three surfaces, posterior

D2394

216.00

Resin-based composite - four or more surfaces, posterior

D2510

240.00

Inlay - metallic -one surface

D2520

680.00

Inlay - metallic - two surfaces

D2530

756.00

Inlay - metallic - three or more surfaces

D2542

720.00

Onlay - metallic - two surfaces

D2543

772.00

Onlay - metallic - three surfaces

D2544

880.00

Onlay - metallic - four or more surfaces

D2610

288.00

Inlay - porcelain/ceramic - one surface

D2620

389.60

Inlay - porcelain/ceramic - two surfaces

D2630

632.00

Inlay - porcelain/ceramic - three or more surfaces

D2642

748.00

Onlay - porcelain/ceramic - two surfaces

D2643

796.00

Onlay - porcelain/ceramic - three surfaces

D2644

912.00

Onlay - porcelain/ceramic - four or more surfaces

D2662

1,016.00

Onlay - resin-based composite - two surfaces

D2663

960.00

Onlay - resin-based composite - three surfaces

D2664

1,016.00

Onlay - resin-based composite - four or more surfaces

D2710

240.00

Crown - resin-based composite (indirect)

D2712

300.00

Crown - ¾ resin-based composite (indirect)

D2720

1,120.00

Crown - resin with high noble metal

D2721

640.00

Crown - resin with predominantly base metal

D2740

960.00

Crown - porcelain/ceramic substrate

D2750

880.00

Crown - porcelain fused to high noble metal

D2751

796.00

Crown - porcelain fused to predominantly base metal

D2752

800.00

Crown - porcelain fused to noble metal

D2780

920.00

Crown - ¾ cast high noble metal

D2782

1,100.00

Crown - ¾ cast noble metal

D2783

1,005.60

Crown - 3/4 porcelain/ceramic

D2790

918.40

Crown - full cast high noble metal

D2791

744.00

Crown - full cast predominantly base metal

D2792

856.00

Crown - full cast noble metal

D2794

1,120.00

Crown - titanium

D2799

200.00

Provisional crown

D2910

75.20

Recement inlay, onlay or partial coverage restoration

D2915

72.00

Recement cast or prefabricated post and core

D2920

76.00

Recement crown

D2930

208.00

Prefabricated stainless steel crown - primary tooth

D2931

240.00

Prefabricated stainless steel crown - permanent tooth

D2932

200.00

Prefabricated resin crown

D2934

232.00

Stainless steel crown - primary

D2940

80.00

Sedative filling

D2950

227.20

Core buildup, including any pins

D2951

36.00

Pin retention - per tooth, in addition to restoration

D2952

316.00

Post and core in addition to crown, indirectly fabricated

D2954

256.00

Prefabricated post and core in addition to crown

D2970

224.80

Temporary crown (fractured tooth)

D2971

224.80

Additional procedures to construct new crown under existing partial denture framework

D2980

150.40

Crown repair, by report

D3110

48.00

Pulp cap - direct (excluding final restoration)

D3120

56.00

Pulp cap - indirect (excluding final restoration)

D3220

132.00

Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction and application of medicament

D3221

145.60

Pulpal debridement, primary and permanent teeth

D3310

560.00

Anterior (excluding final restoration)

D3320

660.00 Bicuspid (excluding final restoration)

D3330

840.00

Molar (excluding final restoration)

D3332

260.00

Incomplete endodontic therapy; inoperable, unrestorable or fractured tooth

D3333

312.00

Internal root repair of perforation defects

D3346

640.00

Retreatment of previous root canal therapy - anterior

D3347

760.00

Retreatment of previous root canal therapy - bicuspid

D3348

921.60

Retreatment of previous root canal therapy - molar

D3351

156.00

Apexification/recalcification - initial visit (apical closure/calcific repair of perforations, root resorption, etc.)

D3352

169.60

Apexification/recalcification - interim medication replacement (apical closure/calcific repair of perforations, root resorption, etc.)

D3410

639.20

Apicoectomy/periradicular surgery - anterior

D3421

560.00

Apicoectomy/periradicular surgery - bicuspid (first root)

D3425

656.00

Apicoectomy/periradicular surgery - molar (first root)

D3430

120.00

Retrograde filling - per root

D3450

420.00

Root amputation - per root

D3920

313.60

Hemisection (including any root removal), not including root canal therapy

D4210

304.00

Gingivectomy or gingivoplasty - Four or more contiguous teeth or bounded teeth spaces per quadrant

D4211

140.00

Gingivectomy or gingivoplasty - one to three contiguous teeth or bounded teeth spaces per quadrant

D4240

560.00

Gingival flap procedure, including root planing - four or more contiguous teeth or bounded teeth spaces per quadrant

D4241

240.00

Gingival flap procedure, including root planing - one to three contiguous teeth or bounded teeth spaces per quadrant

D4249

625.60

Clinical crown lengthening - hard tissue

D4260

880.00

Osseous surgery (including flap entry and closure) - four or more contiguous teeth or bounded teeth spaces per quadrant

D4261

760.00

Osseous surgery (including flap entry and closure) - one to three contiguous teeth or bounded teeth spaces per quadrant

D4263

269.60

Bone replacement graft - first site in quadrant

D4264

180.00

Bone replacement graft - each additional site in quadrant

D4265

236.00

Biologic materials to aid in soft and osseous tissue regeneration

D4266

360.00

Guided tissue regeneration - resorbable barrier, per site

D4270

743.20

Pedicle soft tissue graft procedure

D4271

718.40

Free soft tissue graft procedure (including donor site surgery)

D4273

928.00

Subepithelial connective tissue graft procedures, per tooth

D4274

460.00

Distal or proximal wedge procedure (when not performed in conjunction with surgical procedures in the same anatomical area)

D4275

780.00

Soft tissue allograft

D4341

180.00

Periodontal scaling and root planing - four or more teeth per quadrant

D4342

124.00

Periodontal scaling and root planing - one to three teeth, per quadrant

D4355

116.00

Full mouth debridement to enable comprehensive evaluation and diagnosis

D4381

29.60

Localized delivery of antimicrobial agents via a controlled release vehicle into diseased crevicular tissue, per tooth, by report

D4910

96.00

Periodontal maintenance

D4920

88.00

Unscheduled dressing change (by someone other than treating dentist)

D5110

960.00

Complete denture - maxillary

D5120

960.00

Complete denture - mandibular

D5130

1,040.00

Immediate denture - maxillary

D5140

1,040.00

Immediate denture - mandibular

D5211

760.00

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

D5212

780.00

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

D5213

1,040.00

Maxillary partial denture - cast metal framework with resin denture bases (including any conventional clasps, rests and teeth)

D5214

1,040.00

Mandibular partial denture - cast metal framework with resin denture bases (including any conventional clasps, rests and teeth)

D5225

1,000.00

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

D5226

960.00

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

D5281

520.00

Removable unilateral partial denture - one piece cast metal (including clasps and teeth)

D5410

60.00

Adjust complete denture - maxillary

D5411

36.00

Adjust complete denture - mandibular

D5421

68.00

Adjust partial denture - maxillary

D5422

60.00

Adjust partial denture - mandibular

D5510

132.00

Repair broken complete denture base

D5520

116.00

Replace missing or broken teeth - complete denture (each tooth)

D5610

124.00

Repair resin denture base

D5620

168.00

Repair cast framework

D5630

140.00

Repair or replace broken clasp

D5640

112.00

Replace broken teeth - per tooth

D5650

128.00

Add tooth to existing partial denture

D5660

132.80

Add clasp to existing partial denture

D5670

340.00

Replace all teeth and acrylic on cast metal framework (maxillary)

D5671

480.00

Replace all teeth and acrylic on cast metal framework (mandibular)

D5710

280.00

Rebase complete maxillary denture

D5711

378.40

Rebase complete mandibular denture

D5720

320.00

Rebase maxillary partial denture

D5721

316.00

Rebase mandibular partial denture

D5730

240.00

Reline complete maxillary denture (chairside)

D5731

211.20

Reline lower complete mandibular denture (chairside)

D5740

180.00

Reline maxillary partial denture (chairside)

D5741

200.00

Reline mandibular partial denture (chairside)

D5750

285.60

Reline complete maxillary denture (laboratory)

D5751

300.00

Reline complete mandibular denture (laboratory)

D5760

285.60

Reline maxillary partial denture (laboratory)

D5761

267.20

Reline mandibular partial denture (laboratory)

D5820

380.00

Interim partial denture (maxillary)

D5821

428.00

Interim partial denture (mandibular)

D5850

110.40

Tissue conditioning, maxillary

D5851

134.40

Tissue conditioning, mandibular

D5862

360.00

Precision attachment, by report

D6010

1,560.00

Surgical placement of implant body: endosteal implant

D6040

1,200.00

Surgical placement: eposteal implant

D6050

360.00

Surgical placement: transosteal implant

D6055

1,040.00

Dental implant supported connecting bar

D6056

420.00

Prefabricated abutment - includes placement

D6057

560.00

Custom abutment - includes placement

D6058

1,000.00

Abutment supported porcelain/ceramic crown

D6059

1,036.00

Abutment supported porcelain fused to metal crown (high noble metal)

D6060

960.00

Abutment supported porcelain fused to metal crown (predominantly base metal)

D6061

920.00

Abutment supported porcelain fused to metal crown (noble metal)

D6062

1,050.40

Abutment supported cast metal crown (high noble metal)

D6063

360.00

Abutment supported cast metal crown (predominantly base metal)

D6064

820.00

Abutment supported cast metal crown (noble metal)

D6065

1,040.00

Implant supported porcelain/ceramic crown

D6066

1,120.00

Implant supported porcelain fused to metal crown (titanium, titanium alloy, high noble metal)

D6067

1,480.00

Implant supported metal crown (titanium, titanium alloy, high noble metal)

D6068

480.00

Abutment supported retainer for porcelain/ceramic FPD

D6069

960.00

Abutment supported retainer for porcelain fused to metal FPD (high noble metal)

D6071

528.80

Abutment supported retainer for porcelain fused to metal FPD (noble metal)

D6072

1,360.00

Abutment supported retainer for cast metal FPD (high noble metal)

D6077

1,120.00

Implant supported retainer for cast metal FPD (titanium, titanium alloy, or high noble metal)

D6092

88.00

Recement implant/abutment supported crown

D6093

60.00

Recement implant/abutment supported fixed partial denture

D6205

240.00

Pontic - indirect resin based composite

D6210

880.00

Pontic - cast high noble metal

D6211

520.00

Pontic - cast predominantly base metal

D6212

704.00

Pontic - cast noble metal

D6240

872.00

Pontic - porcelain fused to high noble metal

D6241

760.00

Pontic - porcelain fused to predominantly base metal

D6242

798.40

Pontic - porcelain fused to noble metal

D6250

904.00

Pontic - resin with high noble metal

D6251

616.00

Pontic - resin with predominantly base metal

D6252

480.00

Pontic - resin with noble metal

D6253

240.00

Provisional pontic

D6545

320.00

Retainer - cast metal for resin bonded fixed prosthesis

D6602

676.00

Inlay - cast high noble metal, two surfaces

D6606

600.00

Inlay - cast noble metal, two surfaces

D6610

720.00

Onlay - cast high noble metal, two surfaces

D6611

860.00

Onlay - cast high noble metal, three or more surfaces

D6615

920.00

Onlay - cast noble metal, three or more surfaces

D6710

276.00

Crown - indirect resin based composite

D6720

764.00

Crown - resin with high noble metal

D6721

604.00

Crown - resin with predominantly base metal

D6722

640.00

Crown - resin with noble metal

D6750

877.60

Crown - porcelain fused to high noble metal

D6751

756.80

Crown - porcelain fused to predominantly base metal

D6752

800.00

Crown - porcelain fused to noble metal

D6780

800.00

Crown - ¾ cast high noble metal

D6782

840.00

Crown - ¾ noble metal

D6790

864.00

Crown - full cast high noble metal

D6791

560.00

Crown - full cast predominantly base metal

D6792

680.00

Crown - full cast noble metal

D6793

240.00

Provisional retainer crown

D6930

100.00

Recement bridge

D6950

360.00

Precision attachment

D6970

200.00

Post and core in addition to fixed partial denture retainer, indirectly fabricated

D6972

280.00

Prefabricated post and core in addition to bridge retainer

D6973

216.00

Core build up for retainer, including any pins

D6980

168.80

Bridge repair, by report

D7111

80.00

Extraction, coronal remnants - deciduous tooth

D7140

112.00

Extraction, erupted tooth or exposed root (elevation and/or forceps removal)

D7210

200.00

Surgical removal of erupted tooth requiring elevation of mucoperiosteal flap and removal of bone and/or section of tooth

D7220

247.20

Removal of impacted tooth - soft tissue

D7230

320.00

Removal of impacted tooth - partially bony

D7240

400.00

Removal of impacted tooth - completely bony

D7241

476.00

Removal of impacted tooth - completely bony, with unusual surgical complications

D7250

214.40

Surgical removal of residual tooth roots (cutting procedure)

D7261

460.00

Primary closure of a sinus perforation

D7280

320.00

Surgical access of an unerupted tooth

D7283

120.00

Placement of device to facilitate eruption of impacted tooth

D7285

312.00

Biopsy of oral tissue - hard (bone, tooth)

D7286

277.60

Biopsy of oral tissue - soft

D7287

72.00

Exfoliative cytological sample collection

D7288

104.00

Brush biopsy - transepithelial sample collection

D7291

171.20

Transseptal fiberotomy/supra crestal fiberotomy, by report

D7310

200.00

Alveoloplasty in conjunction with extractions-four or more teeth or tooth spaces, per quadrant

D7311

224.00

Alveoloplasty in conjunction with extractions - one to three teeth or tooth spaces, per quadrant

D7320

200.00

Alveoloplasty not in conjunction with extractions-four or more teeth or tooth spaces, per quadrant

D7321

160.80

Alveoloplasty not in conjunction with extractions - one to three teeth or tooth spaces, per quadrant

D7340

357.60

Vestibuloplasty - ridge extension (second epithelialization)

D7350

1,760.00

Vestibuloplasty - ridge extension (including soft tissue grafts, muscle reattachments, revision of soft tissue attachment and management of hytrophied and hyperplastic tissue

D7410

200.00

Excision of benign lesion up to 1.25 cm

D7411

400.80

Excision of benign lesion greater than 1.25 cm

D7465

56.00

Destruction of lesion(s) by physical or chemical method, by report

D7471

236.00

Removal of lateral exostosis (maxilla or mandible)

D7473

400.00

Removal of torus mandibularis

D7510

148.00

Incision and drainage of abscess - intraoral soft tissue

D7511

236.00

Incision and drainage of abscess - intraoral soft tissue - complicated (includes drainage of multiple fascial spaces)

D7520

80.00

Incision and drainage of abscess - extraoral soft tissue

D7530

60.00

Removal of foreign body from mucosa, skin, or subcutaneous alveolar tissue

D7550

244.00

Partial ostectomy/sequestrectomy for removal of nonvital bone

D7670

80.00

Alveolus-closed reduction, may include stabilization of teeth

D7740

796.00

Mandible-closed reduction

D7820

192.00

Closed reduction of dislocation

D7830

960.00

Manipulation under anesthesia

D7880

356.00

Occlusal orthotic appliance

D7881

380.00

TMD therapy

D7911

12.00

Complicated suture - up to 5 cm

D7960

380.00

Frenulectomy (frenectomy or frenotomy) - separate procedure

D7963

557.60

Frenuloplasty

D8010

243.20

Limited orthodontic treatment of the primary dentition

D8020

353.60

Limited orthodontic treatment of the transitional dentition

D8030

200.00

Limited orthodontic treatment of the adolescent dentition

D8040

333.60

Limited orthodontic treatment of the adult dentition

D8050

333.60

Interceptive orthodontic treatment of the primary dentition

D8060

373.60

Interceptive orthodontic treatment of the transitional dentition

D8070

316.80

Comprehensive orthodontic treatment of the transitional dentition

D8080

323.20

Comprehensive orthodontic treatment of the adolescent dentition

D8090

323.20

Comprehensive orthodontic treatment of the adult dentition

D8210

280.00

Removable appliance therapy

D8220

360.00

Fixed appliance therapy

D8660

244.00

Preorthodontic treatment visit

D8670

300.00

Periodic orthodontic treatment visit (as part of contract)

D8680

308.00

Orthodontic retention (removal of appliances, construction and placement of retainer(s))

D8690

200.00

Orthodontic treatment (alternative billing to a contract fee)

D8691

76.00

Repair of orthodontic appliance

D8692

200.00

Replacement of lost or broken retainer

D9110

75.20

Palliative (emergency) treatment of dental pain - minor procedure

D9120

120.00

Fixed partial denture sectioning

D9220

248.00

Deep sedation/general anesthesia - first 30 minutes

D9221

132.00

Deep sedation/general anesthesia - each additional 15 minutes

D9230

52.00

Analgesia, anxiolysis, inhalation of nitrous oxide

D9241

240.00

Intravenous conscious sedation/analgesia - first 30 minutes

D9242

116.00

Intravenous conscious sedation/analgesia - each additional 15 minutes

D9310

64.00

Consultation-diagnostic service provided by dentist or physician other than requesting dentist or physician

D9910

27.20

Application of desensitizing medicament

D9940

333.60

Occlusal guards, by report

D9942

100.00

Repair and/or reline of occlusal guard

D9952

220.00

Occlusal adjustment - complete
(6) Durable Medical Equipment, Prosthetics/Orthotics, and Supplies.

Code

Fee Nu

Fee Ue

Fee RR

114.3 CMR 40.06(6) - DMEPOS Description

A4216

0.45

Sterile water, saline and/or dextrose, diluent/flush, 10 ml

A4217

2.66

Sterile water/saline, 500 ml

A4221

22.64

Supplies for maintenance of drug infusion catheter, per week (list drug separately)

A4222

46.73

Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately)

A4233

0.80

Replacement battery, alkaline (other than J cell), for use with medically necessary home blood glucose monitor owned by patient, each

A4234

3.63

Replacement battery, alkaline, J cell, for use with medically necessary home blood glucose monitor owned by patient, each

A4235

2.34

Replacement battery, lithium, for use with medically necessary home blood glucose monitor owned by patient, each

A4236

1.68

Replacement battery, silver oxide, for use with medically necessary home blood glucose monitor owned by patient, each

A4253

36.94

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips

A4255

3.91

Platforms for home blood glucose monitor, 50 per box

A4256

11.44

Normal, low, and high calibrator solution/chips

A4257

12.75

Replacement lens shield cartridge for use with laser skin piercing device, each

A4258

18.05

Spring-powered device for lancet, each

A4259

10.83

Lancets, per box of 100

A4265

3.39

Paraffin, per pound

A4280

5.45

Adhesive skin support attachment for use with external breast prosthesis, each

A4310

7.72

Insertion tray without drainage bag and without catheter (accessories only)

A4311

13.97

Insertion tray without drainage bag with indwelling catheter, Foley type, two-way latex with coating (Teflon, silicone, silicone elastomer or hydrophilic, etc.)

A4312

15.33

Insertion tray without drainage bag with indwelling catheter, Foley type, two-way, all silicone

A4313

15.74

Insertion tray without drainage bag with indwelling catheter, Foley type, three-way, for continuous irrigation

A4314

21.50

Insertion tray with drainage bag with indwelling catheter, Foley type, two-way latex with coating (Teflon, silicone, silicone elastomer or hydrophilic, etc.)

A4315

22.43

Insertion tray with drainage bag with indwelling catheter, Foley type, two-way, all silicone

A4316

28.40

Insertion tray with drainage bag with indwelling catheter, Foley type, three-way, for continuous irrigation

A4320

5.33

Irrigation tray with bulb or piston syringe, any purpose

A4321

I.C

Therapeutic agent for urinary catheter irrigation

A4322

3.04

Irrigation syringe, bulb or piston, each

A4326

10.37

Male external catheter with integral collection chamber, any type, each

A4327

42.27

Female external urinary collection device; meatal cup, each

A4328

8.88

Female external urinary collection device; pouch, each

A4330

7.15

Perianal fecal collection pouch with adhesive, each

A4331

3.18

Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each

A4332

0.12

Lubricant, individual sterile packet, each

A4333

2.20

Urinary catheter anchoring device, adhesive skin attachment, each

A4334

4.93

Urinary catheter anchoring device, leg strap, each

A4338

12.26

Indwelling catheter; Foley type, two-way latex with coating (Teflon, silicone, silicone elastomer, or hydrophilic, etc.), each

A4340

31.75

Indwelling catheter; specialty type, (eg, Coude, mushroom, wing, etc.), each

A4344

15.20

Indwelling catheter, Foley type, two-way, all silicone, each

A4346

19.59

Indwelling catheter; Foley type, three-way for continuous irrigation, each

A4349

2.02

Male external catheter, with or without adhesive, disposable, each

A4351

1.81

Intermittent urinary catheter; straight tip, with or without coating (Teflon, silicone, silicone elastomer, or hydrophilic, etc.), each

A4352

6.42

Intermittent urinary catheter; Coude (curved) tip, with or without coating (Teflon, silicone, silicone elastomeric, or hydrophilic, etc.), each

A4353

6.99

Intermittent urinary catheter, with insertion supplies

A4354

11.80

Insertion tray with drainage bag but without catheter

A4355

7.57

Irrigation tubing set for continuous bladder irrigation through a three-way indwelling Foley catheter, each

A4356

38.79

External urethral clamp or compression device (not to be used for catheter clamp), each

A4357

8.25

Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each

A4358

6.63

Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each

A4361

17.83

Ostomy faceplate, each

A4362

2.94

Skin barrier; solid, 4 x 4 or equivalent; each

A4363

2.36

Ostomy clamp, any type, replacement only, each

A4364

2.89

Adhesive, liquid, or equal, any type, per oz.

A4365

11.32

Adhesive remover wipes, any type, per 50

A4366

1.30

Ostomy vent, any type, each

A4367

6.62

Ostomy belt, each

A4368

0.26

Ostomy filter, any type, each

A4369

2.42

Ostomy skin barrier, liquid (spray, brush, etc.), per oz.

A4371

3.65

Ostomy skin barrier, powder, per oz.

A4372

4.18

Ostomy skin barrier, solid 4 x 4 or equivalent, standard wear, with built-in convexity, each

A4373

6.28

Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each

A4375

17.18

Ostomy pouch, drainable, with faceplate attached, plastic, each

A4376

47.58

Ostomy pouch, drainable, with faceplate attached, rubber, each

A4377

4.29

Ostomy pouch, drainable, for use on faceplate, plastic, each

A4378

30.75

Ostomy pouch, drainable, for use on faceplate, rubber, each

A4379

15.02

Ostomy pouch, urinary, with faceplate attached, plastic, each

A4380

37.33

Ostomy pouch, urinary, with faceplate attached, rubber, each

A4381

4.61

Ostomy pouch, urinary, for use on faceplate, plastic, each

A4382

24.62

Ostomy pouch, urinary, for use on faceplate, heavy plastic, each

A4383

28.19

Ostomy pouch, urinary, for use on faceplate, rubber, each

A4384

9.62

Ostomy faceplate equivalent, silicone ring, each

A4385

5.10

Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each

A4387

I.C

Ostomy pouch, closed, with barrier attached, with built-in convexity (one piece), each

A4388

4.36

Ostomy pouch, drainable, with extended wear barrier attached, (one piece), each

A4389

6.22

Ostomy pouch, drainable, with barrier attached, with built-in convexity (one piece), each

A4390

9.61

Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (one piece), each

A4391

7.07

Ostomy pouch, urinary, with extended wear barrier attached (one piece), each

A4392

8.18

Ostomy pouch, urinary, with standard wear barrier attached, with built-in convexity (one piece), each

A4393

9.04

Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (one piece), each

A4394

2.58

Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce

A4395

0.05

Ostomy deodorant for use in ostomy pouch, solid, per tablet

A4396

40.48

Ostomy belt with peristomal hernia support

A4397

4.07

Irrigation supply; sleeve, each

A4398

13.56

Ostomy irrigation supply; bag, each

A4399

12.26

Ostomy irrigation supply; cone/catheter, including brush

A4400

48.87

Ostomy irrigation set

A4402

1.36

Lubricant, per oz.

A4404

1.69

Ostomy ring, each

A4405

3.40

Ostomy skin barrier, nonpectin-based, paste, per oz.

A4406

5.74

Ostomy skin barrier, pectin-based, paste, per oz.

A4407

8.76

Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 in. or smaller, each

A4408

9.87

Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, with built-in convexity, larger than 4 x 4 in., each

A4409

6.22

Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 in. or smaller, each

A4410

9.04

Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 in., each

A4411

5.10

Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each

A4412

2.70

Ostomy pouch, drainable, high output, for use on a barrier with flange (two piece system), without filter, each

A4413

5.50

Ostomy pouch, drainable, high output, for use on a barrier with flange (two piece system), with filter, each

A4414

4.93

Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 in. or smaller, each

A4415

6.00

Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 in., each

A4416

A4417

2.75

3.72

Ostomy pouch, closed, with barrier attached, with filter (one piece), each Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (one piece), each

A4418

1.81

Ostomy pouch, closed; without barrier attached, with filter (one piece), each

A4419

1.74

Ostomy pouch, closed; for use on barrier with

nonlocking flange, with filter (two piece), each

A4420

I.C

Ostomy pouch, closed; for use on barrier with locking

flange (two piece), each

A4422

0.12

Ostomy absorbent material (sheet/pad/crystal packet)

for use in ostomy pouch to thicken liquid stomal

output, each

A4423

1.86

Ostomy pouch, closed; for use on barrier with locking

A4424

4.75

flange, with filter (two piece), each Ostomy pouch, drainable, with barrier attached, with

A4425

3.58

filter (one piece), each Ostomy pouch, drainable; for use on barrier with

A4426

2.73

nonlocking flange, with filter (two piece system), each Ostomy pouch, drainable; for use on barrier with

A4427

2.78

locking flange (two piece system), each Ostomy pouch, drainable; for use on barrier with

A4428

6.51

locking flange, with filter (two piece system), each Ostomy pouch, urinary, with extended wear barrier

attached, with faucet-type tap with valve (one piece), each

A4429

8.25

Ostomy pouch, urinary, with barrier attached, with built-in convexity, with faucet-type tap with valve

A4430

8.52

(one piece), each Ostomy pouch, urinary, with extended wear barrier

attached, with built-in convexity, with faucet-type tap with valve (one piece), each

A4431

6.22

Ostomy pouch, urinary; with barrier attached, with faucet-type tap with valve (one piece), each

A4432

3.59

Ostomy pouch, urinary; for use on barrier with nonlocking flange, with faucet-type tap with valve

A4433

3.34

(two piece), each Ostomy pouch, urinary; for use on barrier with

A4434

3.76

locking flange (two piece), each Ostomy pouch, urinary; for use on barrier with

locking flange, with faucet-type tap with valve (two piece), each

A4455

1.43

Adhesive remover or solvent (for tape, cement or other adhesive), per oz.

A4461

A4463

3.29

13.31

Surgical dressing holder, nonreusable, each Surgical dressing holder, reusable, each

A4481

A4483

0.37 I.C

Tracheostoma filter, any type, any size, each Moisture exchanger, disposable, for use with invasive

A4556

10.32

mechanical ventilation Electrodes (eg, apnea monitor), per pair

A4557

A4558

21.10

4.63

Lead wires (eg, apnea monitor), per pair Conductive gel or paste, for use with electrical device

A4559

0.10

(eg, TENS, NMES), per oz.

Coupling gel or paste, for use with ultrasound device,

A4561

19.95

per oz.

Pessary, rubber, any type

A4562

49.68

Pessary, nonrubber, any type

A4595

28.81

Electrical stimulator supplies, two lead, per month, (eg, TENS, NMES)

A4604

66.81

Tubing with integrated heating element for use with positive airway pressure device

A4605

16.40

Tracheal suction catheter, closed system, each

A4608

58.15

Transtracheal oxygen catheter, each

A4611

196.45

147.34

20.37

Battery, heavy duty; replacement for patient-owned ventilator

A4612

79.93

60.95

8.14

Battery cables; replacement for patient-owned ventilator

A4613

122.58

88.65

12.27

Battery charger; replacement for patient-owned ventilator

A4614

23.78

Peak expiratory flow rate meter, hand held

A4615

0.83

Cannula, nasal

A4616

0.08

Tubing (oxygen), per foot

A4617

3.59

Mouthpiece

A4618

8.89

6.67

1.02

Breathing circuits

A4619

1.21

Face tent

A4620

0.69

Variable concentration mask

A4623

6.55

Tracheostomy, inner cannula

A4624

2.24

Tracheal suction catheter, any type other than closed system, each

A4625

5.89

Tracheostomy care kit for new tracheostomy

A4626

3.19

Tracheostomy cleaning brush, each

A4628

3.74

Oropharyngeal suction catheter, each

A4629

4.63

Tracheostomy care kit for established tracheostomy

A4630

6.25

Replacement batteries, medically necessary,

transcutaneous electrical stimulator, owned by patient

A4633

41.04

Replacement bulb/lamp for ultraviolet light therapy system, each

A4635

5.12

3.39

0.69

Underarm pad, crutch, replacement, each

A4636

4.21

3.07

0.43

Replacement, handgrip, cane, crutch, or walker, each

A4637

2.13

1.61

0.30

Replacement, tip, cane, crutch, walker, each

A4638

I.C

I.C

I.C

Replacement battery for patient-owned ear pulse generator, each

A4639

287.21

Replacement pad for infrared heating pad system, each

A4640

63.32

44.86

6.45

Replacement pad for use with medically necessary alternating pressure pad owned by patient

A5051

2.07

Ostomy pouch, closed; with barrier attached (one piece), each

A5052

1.49

Ostomy pouch, closed; without barrier attached (one piece), each

A5053

1.49

Ostomy pouch, closed; for use on faceplate, each

A5054

1.79

Ostomy pouch, closed; for use on barrier with flange (two piece), each

A5055

1.44

Stoma cap

A5061

3.52

Ostomy pouch, drainable; with barrier attached, (one piece), each

A5062

2.22

Ostomy pouch, drainable; without barrier attached (one piece), each

A5063

2.70

Ostomy pouch, drainable; for use on barrier with flange (two piece system), each

A5071

6.01

Ostomy pouch, urinary; with barrier attached (one piece), each

A5072

3.52

Ostomy pouch, urinary; without barrier attached (one piece), each

A5073

3.18

Ostomy pouch, urinary; for use on barrier with flange (two piece), each

A5081

3.30

Continent device; plug for continent stoma

A5082

11.89

Continent device; catheter for continent stoma

A5083

I.C.

Continent device, stoma absorptive cover for continent stoma

A5093

1.95

Ostomy accessory; convex insert

A5102

22.42

Bedside drainage bottle, with or without tubing, rigid or expandable, each

A5105

34.65

Urinary suspensory with leg bag, with or without tube, each

A5112

29.93

Urinary leg bag; latex

A5113

4.47

Leg strap; latex, replacement only, per set

A5114

A5121

7.60

7.39

Leg strap; foam or fabric, replacement only, per set Skin barrier; solid, 6 x 6 or equivalent, each

A5122

10.92

Skin barrier; solid, 8 x 8 or equivalent, each

A5126

1.32

Adhesive or nonadhesive; disk or foam pad

A5131

15.86

Appliance cleaner, incontinence and ostomy appliances, per 16 oz.

A5200

11.30

Percutaneous catheter/tube anchoring device, adhesive skin attachment

A5500

63.58

For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe

A5501

190.71

For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from cast(s) of patient's foot (custom molded shoe), per shoe

A5503

28.28

For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe with roller or rigid rocker bottom, per shoe

A5504

28.28

For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe with wedge(s), per shoe

A5505

28.28

For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe with metatarsal bar, per shoe

A5506

28.28

For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe with off-set heel(s), per shoe

A5507

28.28

For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe, per shoe

A5512

25.94

For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees Fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of ¼ inch material of shore a 35 durometer or 3/16 inch material

A5513

38.71

For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer or higher, includes arch filler and other shaping

A6010

30.96

Collagen based wound filler, dry form, per gram of collagen

A6011

2.28

Collagen based wound filler, gel/paste, per gram of collagen

A6021

21.02

Collagen dressing, pad size 16 sq. in. or less, each

A6022

21.02

Collagen dressing, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each

A6023

190.30

Collagen dressing, pad size more than 48 square inches, each

A6024

6.19

Collagen dressing wound filler, per 6 in.

A6154

14.38

Wound pouch, each

A6196

7.35

Alginate or other fiber gelling dressing, wound cover, pad size 16 sq. in. or less, each dressing

A6197

16.44

Alginate or other fiber gelling dressing, wound cover, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing

A6199

5.29

Alginate or other fiber gelling dressing, wound filler, per 6 in.

A6203

3.35

Composite dressing, pad size 16 sq. in. or less, with any size adhesive border, each dressing

A6204

6.23

Composite dressing, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing

A6207

7.34

Contact layer, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing

A6209

7.48

Foam dressing, wound cover, pad size 16 sq. in. or less, without adhesive border, each dressing

A6210

19.92

Foam dressing, wound cover, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing

A6211

29.37

Foam dressing, wound cover, pad size more then 48 sq. in., without adhesive border, each dressing

A6212

9.70

Foam dressing, wound cover, pad size 16 sq. in. or less, with any size adhesive border, each dressing

A6214

10.29

Foam dressing, wound cover, pad size more than 48 sq. in., with any size adhesive border, each dressing

A6216

0.05

Gauze, nonimpregnated, nonsterile, pad size 16 sq. in. or less, without adhesive border, each dressing

A6217

I.C.

Gauze, nonimpregnated, nonsterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing

A6219

0.95

Gauze, nonimpregnated, pad size 16 sq. in. or less, with any size adhesive border, each dressing

A6220

2.58

Gauze, nonimpregnated, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing

A6222

2.13

Gauze, impregnated with other than water, normal saline, or hydrogel, pad size 16 sq. in. or less, without adhesive border, each dressing

A6223

2.42

Gauze, impregnated with other than water, normal saline, or hydrogel, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing

A6224

3.61

Gauze, impregnated with other than water, normal saline, or hydrogel, pad size more than 48 sq. in., without adhesive border, each dressing

A6229

3.61

Gauze, impregnated, water or normal saline, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing

A6231

4.66

Gauze, impregnated, hydrogel, for direct wound contact, pad size 16 sq. in. or less, each dressing

A6232

6.88

Gauze, impregnated, hydrogel, for direct wound contact, pad size greater than 16 sq. in., but less than or equal to 48 sq. in., each dressing

A6233

19.19

Gauze, impregnated, hydrogel for direct wound contact, pad size more than 48 sq. in., each dressing

A6234

6.54

Hydrocolloid dressing, wound cover, pad size 16 sq. in. or less, without adhesive border, each dressing

A6235

16.82

Hydrocolloid dressing, wound cover, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing

A6236

27.25

Hydrocolloid dressing, wound cover, pad size more than 48 sq. in., without adhesive border, each dressing

A6237

7.91

Hydrocolloid dressing, wound cover, pad size 16 sq. in. or less, with any size adhesive border, each dressing

A6238

22.79

Hydrocolloid dressing, wound cover, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing

A6240

12.24

Hydrocolloid dressing, wound filler, paste, per fl. oz.

A6241

2.57

Hydrocolloid dressing, wound filler, dry form, per gm

A6242

6.07

Hydrogel dressing, wound cover, pad size 16 sq. in. or less, without adhesive border, each dressing

A6243

12.31

Hydrogel dressing, wound cover, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing

A6244

39.28

Hydrogel dressing, wound cover, pad size more than 48 sq. in., without adhesive border, each dressing

A6245

7.27

Hydrogel dressing, wound cover, pad size 16 sq. in. or less, with any size adhesive border, each dressing

A6246

9.92

Hydrogel dressing, wound cover, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing

A6247

23.78

Hydrogel dressing, wound cover, pad size more than 48 sq. in., with any size adhesive border, each dressing

A6248

16.24

Hydrogel dressing, wound filler, gel, per fl. oz.

A6251

1.99

Specialty absorptive dressing, wound cover, pad size 16 sq. in. or less, without adhesive border, each dressing

A6252

3.25

Specialty absorptive dressing, wound cover, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing

A6253

6.34

Specialty absorptive dressing, wound cover, pad size more than 48 sq. in., without adhesive border, each dressing

A6254

1.21

Specialty absorptive dressing, wound cover, pad size 16 sq. in. or less, with any size adhesive border, each dressing

A6255

3.03

Specialty absorptive dressing, wound cover, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing

A6257

1.53

Transparent film, 16 sq. in. or less, each dressing

A6258

4.30

Transparent film, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing

A6259

10.94

Transparent film, more than 48 sq. in., each dressing

A6266

1.92

Gauze, impregnated, other than water, normal saline, or zinc paste, any width, per linear yd.

A6402

0.12

Gauze, nonimpregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing

A6403

0.43

Gauze, nonimpregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing

A6407

1.88

Packing strips, nonimpregnated, up to two in. in width, per linear yd.

A6410

0.39

Eye pad, sterile, each

A6411

I.C.

Eye pad, non-sterile, each

A6441

0.67

Padding bandage, nonelastic, nonwoven/nonknitted, width greater than or equal to three in. and less than five in., per yd.

A6442

0.17

Conforming bandage, nonelastic, knitted/woven, nonsterile, width less than three in., per yd.

A6443

0.29

Conforming bandage, nonelastic, knitted/woven, nonsterile, width greater than or equal to three in. and less than five in., per yd.

A6444

0.56

Conforming bandage, nonelastic, knitted/woven, nonsterile, width greater than or equal to five in., per yd.

A6445

0.32

Conforming bandage, nonelastic, knitted/woven, sterile, width less than three in., per yd.

A6446

0.41

Conforming bandage, nonelastic, knitted/woven, sterile, width greater than or equal to three in. and less than five in., per yd.

A6447

0.67

Conforming bandage, nonelastic, knitted/woven, sterile, width greater than or equal to five in., per yd.

A6448

1.16

Light compression bandage, elastic, knitted/woven, width less than three in., per yd.

A6449

1.75

Light compression bandage, elastic, knitted/woven, width greater than or equal to three in. and less than five in., per yd.

A6450

I.C.

Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard

A6451

I.C.

Moderate compression bandage, elastic,

knitted/woven, load resistance of 1.25 to 1.34 foot pounds at 50% maximum stretch, width greater than or equal to three in. and less than five in., per yd.

A6452

5.91

High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three in. and less than five in., per yd.

A6453

0.61

Self-adherent bandage, elastic, nonknitted/nonwoven, width less than three in., per yd.

A6454

0.77

Self-adherent bandage, elastic, nonknitted/nonwoven, width greater than or equal to three in. and less than five in., per yard

A6455

1.39

Self-adherent bandage, elastic, nonknitted/nonwoven, width greater than or equal to five in., per yd.

A6456

1.28

Zinc paste impregnated bandage, nonelastic, knitted/woven, width greater than or equal to 3 in. and less than 5 in., per yd.

A6457

1.14

Tubular dressing with or without elastic, any width, per linear yard

A6501

AI +20%

Compression burn garment, bodysuit (head to foot), custom fabricated

A6502

AI +20%

Compression burn garment, chin strap, custom fabricated

A6503

AI +20%

Compression burn garment, facial hood, custom fabricated

A6504

AI +20%

Compression burn garment, glove to wrist, custom fabricated

A6505

AI +20%

Compression burn garment, glove to elbow, custom fabricated

A6506

AI +20%

Compression burn garment, glove to axilla, custom fabricated

A6507

AI +20%

Compression burn garment, foot to knee length, custom fabricated

A6508

AI +20%

Compression burn garment, foot to thigh length, custom fabricated

A6509

AI +20%

Compression burn garment, upper trunk to waist including arm openings (vest), custom fabricated

A6510

AI +20%

Compression burn garment, trunk, including arms down to leg openings (leotard), custom fabricated

A6511

AI +20%

Compression burn garment, lower trunk including leg openings (panty), custom fabricated

A6513

AI +20%

Compression burn mask, face and/or neck, plastic or equal, custom fabricated

A6531

43.27

Gradient compression stocking, below knee, 30-40 mm Hg, each

A6532

60.96

Gradient compression stocking, below knee, 40-50 mm Hg, each

A6550

27.42

Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories

A7000

8.75

Canister, disposable, used with suction pump, each

A7001

31.30

Canister, nondisposable, used with suction pump, each

A7002

3.63

Tubing, used with suction pump, each

A7003

2.74

Administration set, with small volume nonfiltered pneumatic nebulizer, disposable

A7004

1.55

Small volume nonfiltered pneumatic nebulizer, disposable

A7005

29.20

Administration set, with small volume nonfiltered pneumatic nebulizer, nondisposable

A7006

8.54

Administration set, with small volume filtered pneumatic nebulizer

A7007

4.18

Large volume nebulizer, disposable, unfilled, used with aerosol compressor

A7008

11.00

Large volume nebulizer, disposable, prefilled, used with aerosol compressor

A7009

39.79

Reservoir bottle, nondisposable, used with large volume ultrasonic nebulizer

A7010

23.59

Corrugated tubing, disposable, used with large volume nebulizer, 100 ft.

A7012

3.76

Water collection device, used with large volume nebulizer

A7013

0.78

Filter, disposable, used with aerosol compressor

A7014

4.24

Filter, nondisposable, used with aerosol compressor or

ultrasonic generator

A7015

1.72

Aerosol mask, used with DME nebulizer

A7016

6.85

Dome and mouthpiece, used with small volume

ultrasonic nebulizer

A7017

134.04

100.52

13.40

Nebulizer, durable, glass or autoclavable plastic,

bottle type, not used with oxygen

A7018

0.38

Water, distilled, used with large volume nebulizer,

1000 ml

A7025

434.94

High frequency chest wall oscillation system vest,

replacement for use with patient owned equipment,

each

A7026

28.75

High frequency chest wall oscillation system hose,

replacement for use with patient owned equipment,

each

A7027

179.35

Combination oral/nasal mask, used with continuous

positive airway pressure device, each

A7028

49.54

Oral cushion for combination oral/nasal mask,

replacement only, each

A7029

20.24

Nasal pillows for combination oral/nasal mask,

replacement only, pair

A7030

188.64

Full face mask used with positive airway pressure

device, each

A7031

69.77

Face mask interface, replacement for full face mask,

each

A7032

40.53

Cushion for use on nasal mask interface, replacement

only, each

A7033

28.41

Pillow for use on nasal cannula type interface,

replacement only, pair

A7034

117.64

Nasal interface (mask or cannula type) used with

positive airway pressure device, with or without head

strap

A7035

37.16

Headgear used with positive airway pressure device

A7036

18.20

Chinstrap used with positive airway pressure device

A7037

41.02

Tubing used with positive airway pressure device

A7038

4.58

Filter, disposable, used with positive airway pressure

device

A7039

15.33

Filter, nondisposable, used with positive airway

pressure device

A7040

39.48

One way chest drain valve

A7041

74.19

Water seal drainage container and tubing for use with

implanted chest tube

A7042

177.41

Implanted pleural catheter, each

A7043

28.11

Vacuum drainage bottle and tubing for use with

implanted catheter

A7044

120.91

Oral interface used with positive airway pressure

device, each

A7045

19.47

14.60

1.95

Exhalation port with or without swivel used with

accessories for positive airway devices, replacement

only

A7046

19.51

Water chamber for humidifier, used with positive

airway pressure device, replacement, each

A7501

105.03

Tracheostoma valve, including diaphragm, each

A7502

49.91

Replacement diaphragm/faceplate for tracheostoma

valve, each

A7503

11.33

Filter holder or filter cap, reusable, for use in a tracheostoma heat and moisture exchange system, each

A7504

0.67

Filter for use in a tracheostoma heat and moisture exchange system, each

A7505

4.68

Housing, reusable without adhesive, for use in a heat and moisture exchange system and/or with a tracheostoma valve, each

A7506

0.33

Adhesive disc for use in a heat and moisture exchange system and/or with tracheostoma valve, any type each

A7507

2.49

Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each

A7508

2.87

Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each

A7509

1.41

Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, each

A7520

47.48

Tracheostomy/laryngectomy tube, noncuffed, polyvinylchloride (PVC), silicone or equal, each

A7521

47.05

Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (PVC), silicone or equal, each

A7522

45.16

Tracheostomy/laryngectomy tube, stainless steel or equal (sterilizable and reusable), each

A7524

77.40

Tracheostoma stent/stud/button, each

A7525

2.07

Tracheostomy mask, each

A7526

3.37

Tracheostomy tube collar/holder, each

A7527

3.58

Tracheostomy/laryngectomy tube plug/stop, each

A8000

153.35

115.03

15.33

Helmet, protective, soft, prefabricated, includes all components and accessories

A8001

153.35

115.03

15.33

Helmet, protective, hard, prefabricated, includes all components and accessories

A8002

AI +70%

Helmet, protective, soft, custom fabricated, includes all components and accessories

A8003

AI +70%

Helmet, protective, hard, custom fabricated, includes all components and accessories

A8004

I.C.

I.C.

I.C.

Soft interface for helmet, replacement only

E0100

20.29

15.20

5.31

Cane, includes canes of all materials, adjustable or fixed, with tip

E0105

48.46

36.35

7.53

Cane, quad or three-prong, includes canes of all materials, adjustable or fixed, with tips

E0110

77.59

58.18

15.99

Crutches, forearm, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips

E0111

53.26

41.10

8.43

Crutch, forearm, includes crutches of various materials, adjustable or fixed, each, with tip and handgrip

E0112

31.45

24.00

8.44

Crutches, underarm, wood, adjustable or fixed, pair, with pads, tips and handgrips

E0113

21.13

15.86

5.15

Crutch, underarm, wood, adjustable or fixed, each, with pad, tip and handgrip

E0114

40.11

30.32

7.28

Crutches, underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips

E0116

27.74

20.88

4.59

Crutch, underarm, other than wood, adjustable or fixed, with pad, tip, handgrip, with or without shock absorber, each

E0117

192.71

144.55

19.26

Crutch, underarm, articulating, spring assisted, each

E0130

64.70

48.52

14.30

Walker, rigid (pickup), adjustable or fixed height

E0135

83.84

64.32

14.67

Walker, folding (pickup), adjustable or fixed height

E0140

360.71

270.54

36.08

Walker, with trunk support, adjustable or fixed height, any type

E0141

114.09

85.57

19.01

Walker, rigid, wheeled, adjustable or fixed height

E0143

120.23

89.98

18.35

Walker, folding, wheeled, adjustable or fixed height

E0144

318.45

203.01

27.08

Walker, enclosed, four sided framed, rigid or folding, wheeled with posterior seat

E0147

574.81

431.13

57.48

Walker, heavy duty, multiple braking system, variable wheel resistance

E0148

127.05

95.28

12.72

Walker, heavy duty, without wheels, rigid or folding, any type, each

E0149

223.20

167.39

22.32

Walker, heavy duty, wheeled, rigid or folding, any type

E0153

58.97

44.23

6.66

Platform attachment, forearm crutch, each

E0154

65.40

49.06

7.28

Platform attachment, walker, each

E0155

31.56

24.05

3.85

Wheel attachment, rigid pick-up walker, per pair

E0156

26.43

19.85

3.38

Seat attachment, walker

E0157

81.92

61.45

8.99

Crutch attachment, walker, each

E0158

32.18

24.12

3.55

Leg extensions for walker, per set of four

E0159

17.81

13.38

1.80

Brake attachment for wheeled walker, replacement, each

E0160

33.06

24.77

3.96

Sitz type bath or equipment, portable, used with or without commode

E0161

22.30

16.69

3.57

Sitz type bath or equipment, portable, used with or without commode, with faucet attachment(s)

E0162

145.70

113.00

15.29

Sitz bath chair

E0163

102.25

76.67

20.77

Commode chair, mobile or stationary, with fixed arms

E0165

15.79

Commode chair, mobile or stationary, with detachable

arms

E0167

12.00

9.04

1.07

Pail or pan for use with commode chair, replacement only

E0168

150.92

113.18

15.17

Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each

E0170

160.72

Commode chair with integrated seat lift mechanism, electric, any type

E0171

28.92

Commode chair with integrated seat lift mechanism, non-electric, any type

E0175

64.98

48.74

6.51

Foot rest, for use with commode chair, each

E0181

26.06

Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty

E0182

22.25

Pump for alternating pressure pad, for replacement only

E0184

194.70

149.32

23.78

Dry pressure mattress

E0185

319.86

245.48

44.94

Gel or gel-like pressure pad for mattress, standard mattress length and width

E0186

17.26

Air pressure mattress

E0187

19.73

Water pressure mattress

E0188

22.47

16.87

2.64

Synthetic sheepskin pad

E0189

51.96

38.98

5.31

Lambswool sheepskin pad, any size

E0191

9.99

7.46

1.02

Heel or elbow protector, each

E0193

903.46

Powered air flotation bed (low air loss therapy)

E0194

3,254.34

Air fluidized bed

E0196

27.62

Gel pressure mattress

E0197

188.34

165.44

25.98

Air pressure pad for mattress, standard mattress length and width

E0198

188.34

142.92

19.51

Water pressure pad for mattress, standard mattress length and width

E0199

28.30

21.21

2.82

Dry pressure pad for mattress, standard mattress length and width

E0200

67.39

50.57

9.15

Heat lamp, without stand (table model), includes bulb, or infrared element

E0202

60.28

Phototherapy (bilirubin) light with photometer

E0205

164.95

123.71

18.14

Heat lamp, with stand, includes bulb, or infrared element

E0210

32.64

24.48

2.66

Electric heat pad, standard

E0215

60.21

45.17

6.30

Electric heat pad, moist

E0217

496.47

372.32

55.28

Water circulating heat pad with pump

E0220

7.20

5.38

0.76

Hot water bottle

E0225

330.35

247.76

32.56

Hydrocollator unit, includes pads

E0230

7.21

5.39

0.81

Ice cap or collar

E0235

15.76

Paraffin bath unit, portable (see medical supply code A4265 for paraffin)

E0236

44.25

Pump for water circulating pad

E0238

22.98

16.90

2.61

Nonelectric heat pad, moist

E0239

449.83

337.39

44.99

Hydrocollator unit, portable

E0249

99.60

74.70

10.95

Pad for water circulating heat unit

E0250

97.76

Hospital bed, fixed height, with any type side rails, with mattress

E0251

74.08

Hospital bed, fixed height, with any type side rails, without mattress

E0255

117.48

Hospital bed, variable height, hi-lo, with any type side rails, with mattress

E0256

83.35

Hospital bed, variable height, hi-lo, with any type side rails, without mattress

E0260

140.46

Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress

E0261

136.94

Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress

E0265

199.88

Hospital bed, total electric (head, foot, and height adjustments), with any type side rails, with mattress

E0266

177.59

Hospital bed, total electric (head, foot, and height adjustments), with any type side rails, without

mattress

E0271

222.04

173.46

23.06

Mattress, innerspring

E0272

202.37

151.05

21.13

Mattress, foam rubber

E0275

14.57

10.94

1.46

Bed pan, standard, metal or plastic

E0276

11.31

8.94

1.51

Bed pan, fracture, metal or plastic

E0277

703.47

Powered pressure-reducing air mattress

E0280

36.58

27.42

3.65

Bed cradle, any type

E0290

74.74

Hospital bed, fixed height, without side rails, with mattress

E0291

54.30

Hospital bed, fixed height, without side rails, without mattress

E0292

84.04

Hospital bed, variable height, hi-lo, without side rails, with mattress

E0293

71.51

Hospital bed, variable height, hi-lo, without side rails, without mattress

E0294

130.65

Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress

E0295

127.35

Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress

E0296

164.20

Hospital bed, total electric (head, foot, and height adjustments), without side rails, with mattress

E0297

140.67

Hospital bed, total electric (head, foot, and height adjustments), without side rails, without mattress

E0300

2,838.62

2,128.96

283.86

Pediatric crib, hospital grade, fully enclosed

E0301

270.72

Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, without

mattress

E0302

715.44

Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, without mattress

E0303

303.98

Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with

mattress

E0304

770.67

Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, with mattress

E0305

17.79

Bedside rails, half-length

E0310

185.02

138.77

22.76

Bedside rails, full-length

E0316

211.28

Safety enclosure frame/canopy for use with hospital bed, any type

E0325

10.11

6.69

1.51

Urinal; male, jug-type, any material

E0326

10.50

7.87

1.19

Urinal; female, jug-type, any material

E0371

444.48

Nonpowered advanced pressure reducing overlay for mattress, standard mattress length and width

E0372

539.34

Powered air overlay for mattress, standard mattress length and width

E0373

614.47

Nonpowered advanced pressure reducing mattress

E0424

199.28

Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing

E0431

31.79

Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing

E0434

31.79

Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing

E0439

199.28

Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing

E0441

77.45

Oxygen contents, gaseous (for use with owned gaseous stationary systems or when both a stationary and portable gaseous system are owned), one month's supply = 1 unit

E0442

77.45

Oxygen contents, liquid (for use with owned liquid stationary systems or when both a stationary and portable liquid system are owned), one month's supply = 1 unit

E0443

77.45

Portable oxygen contents, gaseous (for use only with portable gaseous systems when no stationary gas or liquid system is used), one month's supply = 1 unit

E0444

77.45

Portable oxygen contents, liquid (for use only with portable liquid systems when no stationary gas or liquid system is used), one month's supply = 1 unit

E0450

954.52

Volume control ventilator, without pressure support mode, may include pressure control mode, used with invasive interface (eg, tracheostomy tube)

E0457

614.51

460.85

61.45

Chest shell (cuirass)

E0459

50.89

Chest wrap

E0460

623.53

Negative pressure ventilator; portable or stationary

E0462

247.69

Rocking bed, with or without side rails

E0463

1,406.38

Pressure support ventilator with volume control mode, may include pressure control mode, used with invasive interface (eg, tracheostomy tube)

E0464

1,406.38

Pressure support ventilator with volume control mode, may include pressure control mode, used with noninvasive interface (eg, mask)

E0470

231.77

Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, eg, nasal or facial mask (intermittent assist device with continuous positive airway pressure device)

E0471

642.17

Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, eg, nasal or facial mask (intermittent assist device with continuous positive airway pressure device)

E0472

642.17

Respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, eg, tracheostomy tube (intermittent assist device with continuous positive airway pressure device)

E0480

43.94

Percussor, electric or pneumatic, home model

E0482

430.02

Cough stimulating device, alternating positive and negative airway pressure

E0483

1,063.13

High frequency chest wall oscillation air-pulse generator system, (includes hoses and vest), each

E0484

36.92

27.70

3.69

Oscillatory positive expiratory pressure device,

nonelectric, any type, each

E0485

AI + 50%

Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, prefabricated, includes fitting and adjustment

E0486

AI + 70%

Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment

E0486

AI + 70%

Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment

E0486

AI + 70%

Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment

E0500

109.77

IPPB machine, all types, with built-in nebulization; manual or automatic valves; internal or external power source

E0550

42.61

Humidifier, durable for extensive supplemental humidification during IPPB treatments or oxygen delivery

E0560

171.52

128.64

20.10

Humidifier, durable for supplemental humidification during IPPB treatment or oxygen delivery

E0561

107.00

80.24

10.69

Humidifier, nonheated, used with positive airway pressure device

E0562

301.22

225.91

30.11

Humidifier, heated, used with positive airway pressure device

E0565

61.01

Compressor, air power source for equipment which is not self-contained or cylinder driven

E0570

16.11

Nebulizer, with compressor

E0571

29.97

Aerosol compressor, battery powered, for use with small volume nebulizer

E0572

38.09

Aerosol compressor, adjustable pressure, light duty for intermittent use

E0574

40.26

Ultrasonic/electronic aerosol generator with small volume nebulizer

E0575

102.78

Nebulizer, ultrasonic, large volume

E0580

134.04

100.52

13.40

Nebulizer, durable, glass or autoclavable plastic, bottle type, for use with regulator or flowmeter

E0585

29.81

Nebulizer, with compressor and heater

E0600

45.79

Respiratory suction pump, home model, portable or stationary, electric

E0601

96.99

Continuous airway pressure (CPAP) device

E0602

29.52

22.14

2.96

Breast pump, manual, any type

E0605

26.43

19.85

2.66

Vaporizer, room type

E0606

22.94

Postural drainage board

E0607

66.82

50.10

6.68

Home blood glucose monitor

E0610

202.18

151.66

21.33

Pacemaker monitor, self-contained, (checks battery depletion, includes audible and visible check systems)

E0615

478.82

359.12

58.50

Pacemaker monitor, self-contained, checks battery depletion and other pacemaker components, includes digital/visible check systems

E0617

304.05

External defibrillator with integrated electrocardiogram analysis

E0617

337.57

External defibrillator with integrated electrocardiogram analysis

E0618

280.35

Apnea monitor, without recording feature

E0619

I.C.

Apnea monitor, with recording feature

E0620

874.39

655.79

87.43

Skin piercing device for collection of capillary blood, laser, each

E0621

95.99

72.36

9.25

Sling or seat, patient lift, canvas or nylon

E0627

337.32

253.00

33.74

Seat lift mechanism incorporated into a combination lift-chair mechanism

E0628

337.32

253.00

33.74

Separate seat lift mechanism for use with patient owned furniture - electric

E0629

330.71

248.01

33.08

Separate seat lift mechanism for use with patient owned furniture - nonelectric

E0630

101.89

Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s), or pad(s)

E0635

122.36

Patient lift, electric, with seat or sling

E0636

1,054.56

Multipositional patient support system, with integrated lift, patient accessible controls

E0650

720.22

540.16

88.87

Pneumatic compressor, nonsegmental home model

E0651

780.66

585.50

92.49

Pneumatic compressor, segmental home model without calibrated gradient pressure

E0652

5,301.45

3,972.53

445.36

Pneumatic compressor, segmental home model with calibrated gradient pressure

E0655

101.75

76.30

10.78

Nonsegmental pneumatic appliance for use with pneumatic compressor, half arm

E0660

158.24

118.68

14.14

Nonsegmental pneumatic appliance for use with pneumatic compressor, full leg

E0665

136.99

102.88

13.22

Nonsegmental pneumatic appliance for use with pneumatic compressor, full arm

E0666

138.08

103.59

14.23

Nonsegmental pneumatic appliance for use with pneumatic compressor, half leg

E0667

275.20

206.41

36.56

Segmental pneumatic appliance for use with pneumatic compressor, full leg

E0668

441.88

331.42

43.61

Segmental pneumatic appliance for use with pneumatic compressor, full arm

E0669

174.06

130.56

17.41

Segmental pneumatic appliance for use with pneumatic compressor, half leg

E0671

415.35

311.50

41.54

Segmental gradient pressure pneumatic appliance, full leg

E0672

322.73

242.06

32.28

Segmental gradient pressure pneumatic appliance, full arm

E0673

268.17

201.15

26.82

Segmental gradient pressure pneumatic appliance, half leg

E0675

384.55

Pneumatic compression device, high pressure, rapid inflation/deflation cycle, for arterial insufficiency (unilateral or bilateral system)

E0691

898.59

673.94

89.86

Ultraviolet light therapy system panel, includes bulbs/lamps, timer, and eye protection; treatment area 2 sq. ft. or less

E0692

1,128.37

846.29

112.83

Ultraviolet light therapy system panel, includes bulbs/lamps, timer, and eye protection, 4 ft. panel

E0693

1,390.98

1,043.24

139.10

Ultraviolet light therapy system panel, includes bulbs/lamps, timer, and eye protection, 6 ft. panel

E0694

4,427.34

3,320.53

442.73

Ultraviolet multidirectional light therapy system in 6 ft. cabinet, includes bulbs/lamps, timer, and eye protection

E0705

54.89

40.36

5.61

Transfer device, any type, each

E0720

367.58

Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation

E0730

370.56

Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation

E0731

303.19

Form-fitting conductive garment for delivery of TENS or NMES (with conductive fibers separated from the patient's skin by layers of fabric)

E0740

522.87

392.18

52.29

Incontinence treatment system, pelvic floor stimulator, monitor, sensor, and/or trainer

E0744

91.57

Neuromuscular stimulator for scoliosis

E0745

89.51

Neuromuscular stimulator, electronic shock unit

E0747

3,328.66

2,473.13

330.78

Osteogenesis stimulator, electrical, noninvasive, other than spinal applications

E0748

3,890.70

2,918.04

389.07

Osteogenesis stimulator, electrical, noninvasive, spinal applications

E0749

284.37

Osteogenesis stimulator, electrical, surgically implanted

E0760

3,233.10

2,424.83

323.32

Osteogenesis stimulator, low intensity ultrasound,

noninvasive

E0762

934.63

700.95

93.47

Transcutaneous electrical joint stimulation device system, includes all accessories

E0764

11,066.82

8,300.12

1,106.67

Functional neuromuscular stimulator, transcutaneous stimulation of muscles of ambulation with computer control, used for walking by spinal cord injured, entire system, after completion of training program

E0765

84.13

63.12

8.43

FDA approved nerve stimulator, with replaceable batteries, for treatment of nausea and vomiting

E0776

143.16

105.33

18.65

IV pole

E0779

16.73

Ambulatory infusion pump, mechanical, reusable, for infusion eight hours or greater

E0780

10.37

Ambulatory infusion pump, mechanical, reusable, for infusion less than eight hours

E0781

225.14

Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient

E0782

3,649.40

2,737.06

364.96

Infusion pump, implantable, non-programmable (includes all components, eg, pump, catheter, connectors, etc.)

E0783

8,186.91

6,140.19

818.70

Infusion pump system, implantable, programmable (includes all components, eg, pump, catheter, connectors, etc.)

E0784

417.57

External ambulatory infusion pump, insulin

E0785

472.50

Implantable intraspinal (epidural/intrathecal) catheter used with implantable infusion pump, replacement

E0786

7,697.60

5,773.22

769.76

Implantable programmable infusion pump,

replacement (excludes implantable intraspinal catheter)

E0791

316.20

Parenteral infusion pump, stationary, single, or multi-channel

E0840

73.28

54.93

14.53

Traction frame, attached to headboard, cervical traction

E0849

515.31

386.46

51.53

Traction equipment, cervical, free-standing stand/frame, pneumatic, applying traction force to other than mandible

E0850

105.06

78.80

12.27

Traction stand, freestanding, cervical traction

E0855

502.63

376.96

50.26

Cervical traction equipment not requiring additional stand or frame

E0856

I.C.

I.C.

I.C.

Cervical traction device, cervical collar with inflatable air bladder

E0860

38.53

29.51

6.51

Traction equipment, overdoor, cervical

E0870

116.31

87.62

13.40

Traction frame, attached to footboard, extremity traction (eg, Buck's)

E0880

125.54

95.02

19.71

Traction stand, freestanding, extremity traction (eg, Buck's)

E0890

120.41

96.99

32.83

Traction frame, attached to footboard, pelvic traction

E0900

128.12

96.12

27.62

Traction stand, freestanding, pelvic traction (eg, Buck's)

E0910

20.00

Trapeze bars, also known as Patient Helper, attached to bed, with grab bar

E0911

49.85

Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, attached to bed, with grab bar

E0912

114.47

Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, free standing, complete with grab bar

E0920

46.14

Fracture frame, attached to bed, includes weights

E0930

45.69

Fracture frame, freestanding, includes weights

E0935

22.73

Continuous passive motion exercise device for use on knee only

E0940

34.77

Trapeze bar, freestanding, complete with grab bar

E0941

36.90

Gravity assisted traction device, any type

E0942

19.85

14.88

1.99

Cervical head harness/halter

E0944

45.88

34.40

3.97

Pelvic belt/harness/boot

E0945

44.32

34.31

3.77

Extremity belt/harness

E0946

59.16

Fracture frame, dual with cross bars, attached to bed (eg, Balken, Four Poster)

E0947

606.46

454.84

62.89

Fracture frame, attachments for complex pelvic traction

E0948

586.59

413.70

58.64

Fracture frame, attachments for complex cervical traction

E0950

88.36

66.27

8.85

Wheelchair accessory, tray, each

E0951

17.08

12.80

1.96

Heel loop/holder, any type, with or without ankle strap, each

E0952

16.89

12.66

1.96

Toe loop/holder, any type, each

E0955

202.18

151.63

20.23

Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each

E0956

98.58

73.93

9.87

Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each

E0957

137.93

103.45

13.79

Wheelchair accessory, medial thigh support, any type, including fixed mounting hardware, each

E0958

37.09

Manual wheelchair accessory, one-arm drive attachment, each

E0959

44.21

33.46

3.91

Manual wheelchair accessory, adapter for amputee, each

E0960

90.98

68.24

9.10

Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware

E0961

29.74

12.63

2.64

Manual wheelchair accessory, wheel lock brake extension (handle), each

E0966

71.37

53.52

6.62

Manual wheelchair accessory, headrest extension, each

E0967

65.69

49.25

6.57

Manual wheelchair accessory, hand rim with projections, any type, each

E0968

16.94

Commode seat, wheelchair

E0969

156.63

117.48

13.22

Narrowing device, wheelchair

E0971

43.39

32.56

4.34

Manual wheelchair accessory, anti-tipping device, each

E0973

114.97

86.23

9.31

Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each

E0974

74.07

55.54

7.06

Manual wheelchair accessory, anti-rollback device, each

E0978

42.70

31.66

4.28

Wheelchair accessory, positioning belt/safety belt/pelvic strap, each

E0980

33.06

24.66

3.30

Safety vest, wheelchair

E0981

47.15

35.70

4.08

Wheelchair accessory, seat upholstery, replacement only, each

E0982

51.53

38.64

4.38

Wheelchair accessory, back upholstery, replacement only, each

E0983

249.93

Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, joystick control

E0984

1,760.94

1,320.70

176.09

Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, tiller control

E0985

202.85

152.12

20.30

Wheelchair accessory, seat lift mechanism

E0986

4,864.24

3,648.20

486.43

Manual wheelchair accessory, push activated power assist, each

E0990

117.43

91.75

13.22

Wheelchair accessory, elevating leg rest, complete assembly, each

E0992

95.15

71.37

7.92

Manual wheelchair accessory, solid seat insert

E0994

17.63

13.23

1.78

Armrest, each

E0995

25.84

19.36

2.66

Wheelchair accessory, calf rest/pad, each

E1002

4,053.21

3,039.90

405.32

Wheelchair accessory, power seating system, tilt only

E1003

4,391.30

3,293.48

439.14

Wheelchair accessory, power seating system, recline only, without shear reduction

E1004

4,869.05

3,651.77

486.90

Wheelchair accessory, power seating system, recline only, with mechanical shear reduction

E1005

5,270.36

3,952.78

527.03

Wheelchair accessory, power seatng System, recline only, with power shear reduction

E1006

6,455.70

4,841.78

645.55

Wheelchair accessory, power seating system, combination tilt and recline, without shear reduction

E1007

8,741.27

6,555.94

874.13

Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction

E1008

8,742.05

6,556.55

874.20

Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction

E1009

AI + 35%

I.C.

I.C.

Wheelchair accessory, addition to power seating system, mechanically linked leg elevation system, including pushrod and leg rest, each

E1010

1,143.79

857.86

114.38

Wheelchair accessory, addition to power seating system, power leg elevation system, including leg rest, pair

E1011

I.C.

I.C.

I.C.

Modification to pediatric size wheelchair, width adjustment package (not to be dispensed with initial chair)

E1014

365.14

273.85

36.52

Reclining back, addition to pediatric size wheelchair

E1015

114.70

86.02

11.46

Shock absorber for manual wheelchair, each

E1016

131.31

98.48

13.14

Shock absorber for power wheelchair, each

E1017

AI + 35%

I.C.

I.C.

Heavy duty shock absorber for heavy duty or extra heavy duty manual wheelchair, each

E1018

AI + 35%

I.C.

I.C.

Heavy duty shock absorber for heavy duty or extra heavy duty power wheelchair, each

E1020

243.41

182.55

24.32

Residual limb support system for wheelchair

E1028

206.54

154.89

20.65

Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for joystick, other control interface or positioning accessory

E1029

369.54

277.15

36.95

Wheelchair accessory, ventilator tray, fixed

E1030

1,165.27

873.96

116.53

Wheelchair accessory, ventilator tray, gimbaled

E1031

49.09

Rollabout chair, any and all types with castors five in. or greater

E1035

613.20

Multi-positional patient transfer system, with integrated seat, operated by care giver

E1037

108.49

Transport chair, pediatric size

E1038

18.03

Transport chair, adult size, patient weight capacity up to and including 300 pounds

E1039

34.20

Transport chair, adult size, heavy duty, patient weight capacity greater than 300 pounds

E1050

86.56

Fully reclining wheelchair; fixed full-length arms, swing-away, detachable, elevating legrests

E1060

126.07

Fully reclining wheelchair; detachable arms, desk, or full-length, swing-away, detachable, elevating leg rests

E1070

109.53

Fully reclining wheelchair; detachable arms, desk or full-length, swing-away, detachable footrests

E1083

72.72

Hemi-wheelchair; fixed full-length arms, swing-away, detachable, elevating legrests

E1084

96.57

Hemi-wheelchair; detachable arms, desk, or full-length, swing-away, detachable, elevating leg rests

E1087

126.51

High-strength lightweight wheelchair; fixed full-length arms, swing-away, detachable, elevating legrests

E1088

150.77

High strength lightweight wheelchair, detachable arms desk or full length, swing away detachable elevating leg rests

E1092

109.23

Wide heavy duty wheel chair, detachable arms (desk or full length), swing away detachable elevating leg rests

E1093

93.94

Wide, heavy-duty wheelchair; detachable arms, desk or full-length arms, swing-away, detachable footrests

E1100

103.81

Semi-reclining wheelchair, fixed full-length arms, swing away detachable elevating leg rests

E1110

101.66

Semi-reclining wheelchair; detachable arms, desk or full-length, elevating legrest

E1150

81.58

Wheelchair, detachable arms, desk or full-length swing away detachable elevating leg rests

E1160

62.50

Wheelchair, fixed full-length arms, swing away detachable elevating leg rests

E1161

2,366.09

1,774.57

236.61

Manual adult size wheelchair, includes tilt in space

E1170

89.31

Amputee wheelchair, fixed full-length arms, swing away detachable elevating leg rests

E1171

80.15

Amputee wheelchair, fixed full-length arms, without footrests or leg rest

E1172

97.95

Amputee wheelchair, detachable arms (desk or full-length) without footrests or leg rest

E1180

101.34

Amputee wheelchair, detachable arms (desk or full-length) swing away detachable foot rests

E1190

107.92

Amputee wheelchair, detachable arms (desk or full-length) swing away detachable elevating leg rests

E1195

125.63

Heavy duty wheelchair, fixed full-length arms, swing away detachable elevating leg rests

E1200

87.01

Amputee wheelchair, fixed full-length arms, swing away detachable footrest

E1221

47.51

Wheelchair with fixed arm, footrests

E1222

67.79

Wheelchair with fixed arm, elevating leg rests

E1223

74.02

Wheelchair with detachable arms, footrests

E1224

81.15

Wheelchair with detachable arms, elevating leg rests

E1225

38.42

Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each

E1226

463.80

347.82

47.74

Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each

E1227

E1228

235.88

176.93

23.59

28.02

Special height arms for wheelchair Special back height for wheelchair

E1230

2,261.79

1,788.81

222.45

Power operated vehicle (three- or four-wheel nonhighway), specify brand name and model number

E1240

103.02

Lightweight wheelchair, detachable arms, (desk or full length) swing away detachable, elevating leg rest

E1270

78.94

Lightweight wheelchair, fixed full length arms, swing away detachable elevating leg rests

E1280

131.26

Heavy duty wheelchair, detachable arms (desk or full length) elevating leg rests

E1295

121.47

Heavy duty wheelchair, fixed full length arms, elevating leg rest

E1296

491.67

368.75

49.94

Special wheelchair seat height from floor

E1297

88.92

66.68

9.88

Special wheelchair seat depth, by upholstery

E1298

360.10

270.07

36.85

Special wheelchair seat depth and/or width, by construction

E1310

1,825.29

1,368.97

156.12

Whirlpool, nonportable (built-in type)

E1353

32.87

Regulator

E1355

24.75

Stand/rack

E1372

163.03

120.68

23.69

Immersion external heater for nebulizer

E1390

199.28

Oxygen concentrator, single delivery port, capable of delivering 85% or greater oxygen concentration at the prescribed flow rate

E1391

199.28

Oxygen concentrator, dual delivery port, capable of delivering 85% or greater oxygen concentration at the prescribed flow rate, each

E1392

51.63

Portable oxygen concentrator, rental

E1405

229.09

Oxygen and water vapor enriching system with heated delivery

E1406

215.39

Oxygen and water vapor enriching system without heated delivery

E1700

312.39

234.31

31.23

Jaw motion rehabilitation system

E1701

10.37

Replacement cushions for jaw motion rehabilitation system, package of six

E1702

22.57

Replacement measuring scales for jaw motion rehabilitation system, package of 200

E1800

104.13

Dynamic adjustable elbow extension/flexion device, includes soft interface material

E1801

129.00

Static progressive stretch elbow device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories

E1802

326.80

Dynamic adjustable forearm pronation/supination device, includes soft interface material

E1805

126.34

Dynamic adjustable wrist extension/flexion device, includes soft interface material

E1806

105.91

Static progressive stretch wrist device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories

E1810

105.89

Dynamic adjustable knee extension/flexion device, includes soft interface material

E1811

134.12

Static progressive stretch knee device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories

E1812

85.99

Dynamic knee, extension/flexion device with active resistance control

E1815

126.34

Dynamic adjustable ankle extension/flexion device, includes soft interface material

E1816

136.24

Static progressive stretch ankle device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories

E1818

139.09

Static progressive stretch forearm pronation/supination device, with or without range of motion adjustment, includes all components and accessories

E1820

81.74

61.31

8.17

Replacement soft interface material, dynamic adjustable extension/flexion device

E1821

105.25

78.95

10.51

Replacement soft interface material/cuffs for bi-directional static progressive stretch device

E1825

126.34

Dynamic adjustable finger extension/flexion device, includes soft interface material

E1830

126.34

Dynamic adjustable toe extension/flexion device, includes soft interface material

E1840

382.71

Dynamic adjustable shoulder flexion/abduction/ rotation device, includes soft interface material

E1841

453.00

Static progressive stretch shoulder device, with or without range of motion adjustment, includes all components and accessories

E2000

51.83

Gastric suction pump, home model, portable or stationary, electric

E2100

643.19

482.40

64.32

Blood glucose monitor with integrated voice synthesizer

E2101

188.56

141.42

18.86

Blood glucose monitor with integrated lancing/blood sample

E2120

283.52

Pulse generator system for tympanic treatment of inner ear endolymphatic fluid

E2201

373.10

279.83

37.31

Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches

E2202

473.98

355.50

47.40

Manual wheelchair accessory, nonstandard seat frame width, 24-27 in.

E2203

479.05

359.28

47.89

Manual wheelchair accessory, nonstandard seat frame depth, 20 to less than 22 inches

E2204

813.40

610.05

81.35

Manual wheelchair accessory, nonstandard seat frame depth, 22 to 25 inches

E2205

32.67

24.52

3.25

Manual wheelchair accessory, handrim without projections (includes ergonomic or contoured), any type, replacement only, each

E2206

40.68

30.50

4.06

Manual wheelchair accessory, wheel Lock assembly, complete, each

E2207

43.35

32.51

4.34

Wheelchair accessory, crutch and cane holder, each

E2208

118.78

89.09

11.87

Wheelchair accessory, cylinder tank carrier, each

E2209

107.16

80.38

10.74

Accessory, arm trough, with or without hand support, each

E2210

6.55

4.92

0.56

Wheelchair accessory, bearings, any type, replacement only, each

E2211

40.91

29.30

3.96

Manual wheelchair accessory, pneumatic propulsion tire, any size, each

E2212

5.88

4.42

0.61

Manual wheelchair accessory, tube for pneumatic propulsion tire, any size, each

E2213

30.41

22.79

3.05

Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each

E2214

36.00

26.99

3.96

Manual wheelchair accessory, pneumatic caster tire, any size, each

E2215

9.60

7.18

0.95

Manual wheelchair accessory, tube for pneumatic caster tire, any size, each

E2216

AI + 30%

I.C.

I.C.

Manual wheelchair accessory, foam filled propulsion tire, any size, each

E2217

AI + 30%

I.C.

I.C.

Manual wheelchair accessory, foam filled caster tire, any size, each

E2218

AI + 30%

I.C.

I.C.

Manual wheelchair accessory, foam propulsion tire, any size, each

E2219

40.31

30.24

4.01

Manual wheelchair accessory, foam caster tire, any size, each

E2220

28.52

21.81

2.75

Manual wheelchair accessory, solid (rubber/plastic) propulsion tire, any size, each

E2221

25.55

19.18

2.58

Manual wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, each

E2222

21.06

15.81

2.09

Manual wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, each

E2223

5.61

4.21

0.56

Manual wheelchair accessory, valve, any type, replacement only, each

E2224

98.06

73.55

10.29

Manual wheelchair accessory, propulsion wheel excludes tire, any size, each

E2225

17.40

13.04

1.74

Manual wheelchair accessory, caster wheel excludes tire, any size, replacement only, each

E2226

37.94

28.46

3.79

Manual wheelchair accessory, caster fork, any size, replacement only, each

E2227

AI + 35%

I.C.

I.C.

Manual wheelchair accessory, gear reduction drive wheel, each

E2228

AI + 35%

I.C.

I.C.

Manual wheelchair accessory, wheel braking system and lock, complete, each

E2310

1,170.24

877.68

117.02

Power wheelchair accessory, electronic connection between wheelchair controller and one power seating system motor, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware

E2311

2,369.20

1,776.90

236.93

Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware

E2312

2,473.18

1,454.36

193.92

Power wheelchair accessory, hand or chin control interface, mini-proportional remote joystick, proportional, including fixed mounting hardware

E2312

1,939.18

1,854.88

193.92

Power wheelchair accessory, hand or chin control interface, mini-proportional remote joystick, proportional, including fixed mounting hardware

E2313

307.93

230.95

30.81

Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each

E2321

2,231.00

1,673.25

223.10

Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware

E2322

1,410.36

1,771.94

236.26

Power wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware

E2323

69.16

51.87

6.92

Power wheelchair accessory, specialty joystick handle for hand control interface, prefabricated

E2323

69.16

51.87

6.92

Power wheelchair accessory, specialty joystick handle for hand control interface, prefabricated

E2323

69.16

51.87

6.92

Power wheelchair accessory, specialty joystick handle for hand control interface, prefabricated

E2324

43.82

32.87

4.37

Power wheelchair accessory, chin cup for chin control interface

E2324

43.82

32.87

4.37

Power wheelchair accessory, chin cup for chin control interface

E2324

43.82

32.87

4.37

Power wheelchair accessory, chin cup for chin control interface

E2325

1,346.83

1,010.13

134.70

Power wheelchair accessory, sip and puff interface, nonproportional, including all related electronics, mechanical stop switch, and manual swingaway mounting hardware

E2325

1,346.83

1,010.13

134.70

Power wheelchair accessory, sip and puff interface, nonproportional, including all related electronics, mechanical stop switch, and manual swingaway mounting hardware

E2325

1,346.83

1,010.13

134.70

Power wheelchair accessory, sip and puff interface, nonproportional, including all related electronics, mechanical stop switch, and manual swingaway mounting hardware

E2326

347.14

260.34

34.73

Power wheelchair accessory, breath tube kit for sip and puff interface

E2326

347.14

260.34

34.73

Power wheelchair accessory, breath tube kit for sip and puff interface

E2326

347.14

260.34

34.73

Power wheelchair accessory, breath tube kit for sip and puff interface

E2327

3,420.77

2,565.57

342.08

Power wheelchair accessory, head control interface, mechanical, proportional, including all related electronics, mechanical direction change switch, and fixed mounting hardware

E2328

4,955.32

3,716.50

495.52

Power wheelchair accessory, head control or extremity control interface, electronic, proportional, including all related electronics and fixed mounting hardware

E2329

1,766.13

1,324.60

176.61

Power wheelchair accessory, head control interface, contact switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware

E2330

3,422.09

2,566.58

342.20

Power wheelchair accessory, head control interface, proximity switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware

E2340

358.36

268.79

35.85

Power wheelchair accessory, nonstandard seat frame width, 20-23 in.

E2341

537.58

403.19

53.76

Power wheelchair accessory, nonstandard seat frame width, 24-27 in.

E2342

447.98

335.99

44.80

Power wheelchair accessory, nonstandard seat frame depth, 20 or 21 in.

E2343

716.78

537.58

71.67

Power wheelchair accessory, nonstandard seat frame depth, 22-25 in.

E2351

698.63

523.96

69.88

Power wheelchair accessory, electronic interface to operate speech generating device using power wheelchair control interface

E2360

112.34

84.26

11.29

Power wheelchair accessory, 22 NF nonsealed lead acid battery, each

E2361

139.47

104.62

13.95

Power wheelchair accessory, 22 NF sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat)

E2362

91.98

68.98

9.20

Power wheelchair accessory, group 24 nonsealed lead acid battery, each

E2363

186.00

139.50

18.61

Power wheelchair accessory, group 24 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat)

E2364

112.34

84.26

11.29

Power wheelchair accessory, U-1 nonsealed lead acid battery, each

E2365

112.17

84.15

11.22

Power wheelchair accessory, U-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat)

E2366

263.62

197.72

26.43

Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each

E2367

419.08

314.31

41.91

Power wheelchair accessory, battery charger, dual mode, for use with either battery type, sealed or nonsealed, each

E2368

516.57

387.44

51.67

Power wheelchair component, motor, replacement only

E2369

449.94

337.45

45.00

Power wheelchair component, gear box, replacement only

E2370

802.84

602.12

80.29

Power wheelchair component, motor and gear box combination, replacement only

E2371

150.74

113.06

15.08

Power wheelchair accessory, group 27 sealed lead acid battery, (e.g., gel cell, absorbed glassmat), each

E2372

AI + 35%

I.C.

I.C.

Power wheelchair accessory, group 27 nonsealed lead acid battery, each

E2373

1,209.93

907.47

121.00

Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware

E2374

534.02

400.53

53.40

Power wheelchair accessory, hand or chin control interface, standard remote joystick (not including controller), proportional, including all related electronics and fixed mounting hardware, replacement only

E2375

856.56

642.40

85.65

Power wheelchair accessory, nonexpandable controller, including all related electronics and mounting hardware, replacement only

E2376

1,342.27

1,006.72

134.23

Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, replacement only

E2377

485.71

364.30

48.56

Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue

E2381

76.18

57.14

7.63

Power wheelchair accessory, pneumatic drive wheel tire, any size, replacement only, each

E2382

20.77

15.57

2.07

Power wheelchair accessory, tube for pneumatic drive wheel tire, any size, replacement only, each

E2383

151.88

113.91

15.19

Power wheelchair accessory, insert for pneumatic drive wheel tire (removable), any type, any size, replacement only, each

E2384

80.91

60.68

8.11

Power wheelchair accessory, pneumatic caster tire, any size, replacement only, each

E2385

49.50

37.11

4.96

Power wheelchair accessory, tube for pneumatic caster tire, any size, replacement only, each

E2386

150.51

112.87

15.05

Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each

E2387

67.49

50.65

6.75

Power wheelchair accessory, foam filled caster tire, any size, replacement only, each

E2388

50.39

37.80

5.04

Power wheelchair accessory, foam drive wheel tire, any size, replacement only, each

E2389

27.36

20.51

2.74

Power wheelchair accessory, foam caster tire, any size, replacement only, each

E2390

42.79

32.07

4.28

Power wheelchair accessory, solid (rubber/plastic) drive wheel tire, any size, replacement only, each

E2391

20.50

15.38

2.05

Power wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each

E2392

53.88

40.41

5.40

Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each

E2393

AI + 35%

I.C

I.C

Power wheelchair accessory, valve for pneumatic tire tube, any type, replacement only, each

E2394

76.75

57.57

7.69

Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each

E2395

54.55

40.93

5.46

Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each

E2396

64.07

48.07

7.13

Power wheelchair accessory, caster fork, any size, replacement only, each

E2397

E2402

AI + 35%

I.C

I.C

1,716.46

Power wheelchair accessory, lithium-based battery, each Negative pressure wound therapy electrical pump, stationary or portable

E2500

391.06

293.29

39.11

Speech generating device, digitized speech, using pre-recorded messages, less than or equal to eight minutes recording time

E2502

1,195.80

896.86

119.59

Speech generating device, digitized speech, using prerecorded messages, greater than eight minutes but less than or equal to 20 minutes recording time

E2504

1,577.42

1,183.05

157.76

Speech generating device, digitized speech, using prerecorded messages, greater than 20 minutes but less than or equal to 40 minutes recording time

E2506

2,312.96

1,734.69

231.29

Speech generating device, digitized speech, using prerecorded messages, greater than 40 minutes recording time

E2508

3,576.61

2,682.47

357.67

Speech generating device, synthesized speech, requiring message formulation by spelling and access by physical contact with the device

E2510

6,768.25

5,076.18

676.82

Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access

E2511

AI + 30%

I.C

I.C

Speech generating software program, for personal computer or personal digital assistant

E2512

AI + 30%

I.C

I.C

Accessory for speech generating device, mounting system

E2601

61.16

45.87

6.13

General use wheelchair seat cushion, width less than 22 in., any depth

E2602

119.40

89.55

11.94

General use wheelchair seat cushion, width 22 in. or greater, any depth

E2603

151.59

113.69

15.17

Skin protection wheelchair seat cushion, width less than 22 in., any depth

E2604

188.41

141.33

18.83

Skin protection wheelchair seat cushion, width 22 in. or greater, any depth

E2605

269.17

201.91

26.93

Positioning wheelchair seat cushion, width less than 22 in., any depth

E2606

419.93

314.94

42.01

Positioning wheelchair seat cushion, width 22 in. or greater, any depth

E2607

289.85

217.39

28.99

Skin protection and positioning wheelchair seat cushion, width less than 22 in., any depth

E2608

348.09

261.07

34.80

Skin protection and positioning wheelchair seat cushion, width 22 in. or greater, any depth

E2611

312.35

234.29

31.23

General use wheelchair back cushion, width less than 22 in., any height, including any type mounting hardware

E2612

422.54

316.89

42.25

General use wheelchair back cushion, width 22 in. or greater, any height, including any type mounting hardware

E2613

393.04

294.78

39.31

Positioning wheelchair back cushion, posterior, width less than 22 in., any height, including any type mounting hardware

E2614

543.93

407.97

54.40

Positioning wheelchair back cushion, posterior, width 22 in. or greater, any height, including any type mounting hardware

E2615

452.32

339.23

45.24

Positioning wheelchair back cushion, posterior-lateral, width less than 22 in., any height, including any type mounting hardware

E2616

608.58

456.45

60.86

Positioning wheelchair back cushion, posterior-lateral, width 22 in. or greater, any height, including any type mounting hardware

E2619

51.32

38.51

5.13

Replacement cover for wheelchair seat cushion or back cushion, each

E2620

547.70

410.79

54.77

Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 in., any height, including any type mounting hardware

E2621

574.76

431.08

57.47

Positioning wheelchair back cushion, planar back with lateral supports, width 22 in. or greater, any height, including any type mounting hardware

L0112

1,178.03

Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated

L0120

21.39

Cervical, flexible, nonadjustable (foam collar)

L0130

137.29

Cervical, flexible, thermoplastic collar, molded to patient

L0140

66.73

Cervical, semi-rigid, adjustable (plastic collar)

L0150

99.40

Cervical, semi-rigid, adjustable molded chin cup (plastic collar with mandibular/occipital piece)

L0160

168.38

Cervical, semi-rigid, wire frame occipital/mandibular support

L0170

663.10

Cervical, collar, molded to patient model

L0172

102.37

Cervical, collar, semi-rigid thermoplastic foam, two piece

L0174

295.33

Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension

L0180

398.35

Cervical, multiple post collar, occipital/mandibular supports, adjustable

L0190

482.75

Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars (SOMI, Guilford, Taylor types)

L0200

452.73

Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars, and thoracic extension

L0210

39.84

Thoracic, rib belt

L0220

107.26

Thoracic, rib belt, custom fabricated

L0430

1,135.00

Spinal orthosis, anterior-posterior-lateral control, with interface material, custom fitted (DeWall Posture Protector only)

L0450

186.85

TLSO, flexible, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, includes fitting and adjustment

L0452

AI + 70%.

TLSO, flexible, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, custom fabricated

L0454

291.91

TLSO flexible, provides trunk support, extends from sacrococcygeal junction to above T-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder

L0456

837.12

TLSO, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary

L0458

750.63

TLSO, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment

L0460

844.88

TLSO, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment

L0462

1,050.90

TLSO, triplanar control, modular segmented spinal system, three rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment

L0464

1,251.08

TLSO, triplanar control, modular segmented spinal system, four rigid plastic shells, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment

L0466

347.54

TLSO, sagittal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, restricts gross trunk motion in sagittal plane, produces intracavitary pressure to reduce load on intervertebral disks, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment

L0468

449.08

TLSO, sagittal-coronal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction over scapulae, lateral strength provided by pelvic, thoracic, and lateral frame pieces, restricts gross trunk motion in sagittal, and coronal planes, produces intracavitary pressure to reduce load on intravertebral disks, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment

L0470

637.80

TLSO, triplanar control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction to scapula, lateral strength provided by pelvic, thoracic, and lateral frame pieces, rotational strength provided by subclavicular extensions, restricts gross trunk motion in the sagittal, coronal, and transverse planes, produces intracavitary pressure to reduce load on intravertebral disks, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment

L0472

388.61

TLSO, triplanar control, hyperextension, rigid anterior and lateral frame extends from symphysis pubis to sternal notch with two anterior components (one pubic and one sternal), posterior and lateral pads with straps and closures, limits spinal flexion, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment

L0480

1,342.86

TLSO, triplanar control, one piece rigid plastic shell without interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes a carved plaster or CAD-CAM model, custom fabricated

L0482

1,401.23

TLSO, triplanar control, one piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes a carved plaster or CAD-CAM model, custom fabricated

L0484

1,910.59

TLSO, triplanar control, two piece rigid plastic shell without interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes a carved plaster or CAD-CAM model, custom fabricated

L0486

2,027.03

TLSO, triplanar control, two piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes a carved plaster or CAD-CAM model, custom fabricated

L0488

844.88

TLSO, triplanar control, one piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, prefabricated, includes fitting and adjustment

L0490

238.10

TLSO, sagittal-coronal control, one piece rigid plastic shell, with overlapping reinforced anterior, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates at or before the T-9 vertebra, anterior extends from symphysis pubis to xiphoid, anterior opening, restricts gross trunk motion in sagittal and coronal planes, prefabricated, includes fitting and adjustment

L0491

646.42

TLSO, sagittal-coronal control, modular segmented spinal System, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal and coronal planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment

L0492

425.36

TLSO, sagittal-coronal control, modular segmented spinal system, three rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal and coronal planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment

L0621

87.11

Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, includes fitting and adjustment

L0622

277.74

Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated

L0623

AI + 50%.

Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, includes fitting and adjustment

L0624

AI + 70%

Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels placed over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated

L0625

46.35

Lumbar orthosis, flexible, provides lumbar support, posterior extends from L-1 to below L-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include pendulous abdomen design, shoulder straps, stays, prefabricated, includes fitting and adjustment

L0626

65.60

Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior extends from L-1 to below L-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder

L0627

345.97

Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from L-1 to below L-5 vertebra, produces intracavitarypressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, includes fitting and adjustment

L0628

70.61

Lumbar-sacral orthosis, flexible, provides lumbosacral support, posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, prefabricated, includes fitting and adjustment

L0629

AI + 70%

Lumbar-sacral orthosis, flexible, provides lumbosacral support, posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, custom fabricated

L0630

136.31

Lumbar-sacral orthosis, sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, includes fitting and adjustment

L0631

864.05

Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, includes fitting and adjustment

L0632

AI + 70%.

LSO, sagittal control, with rigid anterior and posterio panels, posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, custom fabricated

L0633

241.35

LSO, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, includes fitting and adjustment

L0634

AI + 70%.

LSO, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, custom

L0635

788.67

LSO, sagittal-coronal control, lumbar flexion, rigid posterior frame/panel(s), lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, anterior panel, pendulous abdomen design, prefabricated, includes fitting and adjustment

L0636

1,270.32

LSO, sagittal-coronal control, lumbar flexion, rigid posterior frame/panels, lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, anterior panel, pendulous abdomen design, custom fabricated

L0637

985.53

LSO, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, includes fitting and adjustment

L0638

1,110.09

LSO, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, custom fabricated

L0639

985.53

LSO, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, prefabricated, includes fitting and adjustment

L0640

880.72

LSO, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, custom fabricated

L0700

1,811.11

CTLSO, anterior-posterior-lateral control, molded to patient model (Minerva type)

L0710

1,954.07

CTLSO, anterior-posterior-lateral control, molded to patient model, with interface material (Minerva type)

L0810

2,726.96

Halo procedure, cervical halo incorporated into jacket

L0820

2,322.30

Halo procedure, cervical halo incorporated into plaster body jacket

L0830

3,020.24

Halo procedure, cervical halo incorporated into Milwaukee type orthosis

L0859

1,043.56

Addition to halo procedure, magnetic resonance image compatible systems, rings and pins, any material

L0861

181.41

Addition to halo procedure, replacement liner/interface material

L0970

92.15

TLSO, corset front

L0972

82.98

LSO, corset front

L0974

181.90

TLSO, full corset

L0976

137.81

LSO, full corset

L0978

166.92

Axillary crutch extension

L0980

18.77

Peroneal straps, pair

L0982

17.50

Stocking supporter grips, set of four

L0984

55.14

Protective body sock, each

L1000

2,065.61

CTLSO (Milwaukee), inclusive of furnishing initial orthosis, including model

L1005

2,693.89

Tension based scoliosis orthosis and accessory pads, includes fitting and adjustment

L1010

59.72

Addition to CTLSO or scoliosis orthosis, axilla sling

L1020

69.69

Addition to CTLSO or scoliosis orthosis, kyphosis pad

L1025

107.97

Addition to CTLSO or scoliosis orthosis, kyphosis pad, floating

L1030

51.29

Addition to CTLSO or scoliosis orthosis, lumbar bolster pad

L1040

62.90

Addition to CTLSO or scoliosis orthosis, lumbar or lumbar rib pad

L1050

67.13

Addition to CTLSO or scoliosis orthosis, sternal pad

L1060

80.17

Addition to CTLSO or scoliosis orthosis, thoracic pad

L1070

72.55

Addition to CTLSO or scoliosis orthosis, trapezius sling

L1080

47.50

Addition to CTLSO or scoliosis orthosis, outrigger

L1085

124.11

Addition to CTLSO or scoliosis orthosis, outrigger, bilateral with vertical extensions

L1090

73.91

Addition to CTLSO or scoliosis orthosis, lumbar sling

L1100

155.95

Addition to CTLSO or scoliosis orthosis, ring flange, plastic or leather

L1110

243.03

Addition to CTLSO or scoliosis orthosis, ring flange, plastic or leather, molded to patient model

L1120

32.02

Addition to CTLSO, scoliosis orthosis, cover for upright, each

L1200

1,499.67

TLSO, inclusive of furnishing initial orthosis only

L1210

210.98

Addition to TLSO, (low profile), lateral thoracic extension

L1220

178.63

Addition to TLSO, (low profile), anterior thoracic extension

L1230

515.39

Addition to TLSO, (low profile), Milwaukee type superstructure

L1240

68.06

Addition to TLSO, (low profile), lumbar derotation pad

L1250

68.02

Addition to TLSO, (low profile), anterior ASIS pad

L1260

68.06

Addition to TLSO, (low profile), anterior thoracic derotation pad

L1270

68.06

Addition to TLSO, (low profile), abdominal pad

L1280

92.74

Addition to TLSO, (low profile), rib gusset (elastic), each

L1290

68.06

Addition to TLSO, (low profile), lateral trochanteric pad

L1300

1,432.76

Other scoliosis procedure, body jacket molded to patient model

L1310

1,542.02

Other scoliosis procedure, postoperative body jacket

L1500

2,015.56

THKAO, mobility frame (Newington, Parapodium types)

L1510

1,191.06

THKAO, standing frame, with or without tray and accessories

L1520

1,998.13

THKAO, swivel walker

L1600

124.86

HO, abduction control of hip joints, flexible, Frejka type with cover, prefabricated, includes fitting and adjustment

L1610

38.26

HO, abduction control of hip joints, flexible, (Frejka cover only), prefabricated, includes fitting and adjustment

L1620

127.09

HO, abduction control of hip joints, flexible, (Pavlik harness), prefabricated, includes fitting and adjustment

L1630

182.18

HO, abduction control of hip joints, semi-flexible (Von Rosen type), custom fabricated

L1640

496.08

HO, abduction control of hip joints, static, pelvic band or spreader bar, thigh cuffs, custom fabricated

L1650

246.94

HO, abduction control of hip joints, static, adjustable (Ilfled type), prefabricated, includes fitting and adjustment

L1652

300.03

Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated, includes fitting and adjustment, any type

L1660

169.65

HO, abduction control of hip joints, static, plastic, prefabricated, includes fitting and adjustment

L1680

982.44

HO, abduction control of hip joints, dynamic, pelvic control, adjustable hip motion control, thigh cuffs (Rancho hip action type), custom fabricated

L1685

1,278.81

HO, abduction control of hip joint, postoperative hip abduction type, custom fabricated

L1686

810.92

HO, abduction control of hip joint, postoperative hip abduction type, prefabricated, includes fitting and adjustments

L1690

1,627.58

Combination, bilateral, lumbo-sacral, hip, femur orthosis providing adduction and internal rotation control, prefabricated, includes fitting and adjustment

L1700

1,564.68

Legg Perthes orthosis, (Toronto type), custom fabricated

L1710

1,921.90

Legg Perthes orthosis, (Newington type), custom fabricated

L1720

1,086.86

Legg Perthes orthosis, trilateral, (Tachdijan type), custom fabricated

L1730

1,142.67

Legg Perthes orthosis, (Scottish Rite type), custom fabricated

L1755

1,702.14

Legg Perthes orthosis, (Patten bottom type), custom fabricated

L1800

53.64

KO, elastic with stays, prefabricated, includes fitting and adjustment

L1810

83.35

KO, elastic with joints, prefabricated, includes fitting and adjustment

L1815

104.15

KO, elastic or other elastic type material with condylar pad(s), prefabricated, includes fitting and adjustment

L1820

122.74

Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated, includes fitting and adjustment

L1825

57.52

KO, elastic knee cap, prefabricated, includes fitting and adjustment

L1830

70.54

KO, immobilizer, canvas longitudinal, prefabricated, includes fitting and adjustment

L1831

247.71

Knee orthosis, locking knee joint(s), positional orthosis, prefabricated, includes fitting and adjustment

L1832

640.07

Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, includes fitting and adjustment

L1834

834.56

KO, without knee joint, rigid, custom fabricated

L1836

112.30

Knee orthosis, rigid, without joint(s), includes soft interface material, prefabricated, includes fitting and adjustment

L1840

786.51

KO, derotation, medial-lateral, anterior cruciate ligament, custom fabricated

L1843

755.20

Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, includes fitting and adjustment

L1844

1,377.12

Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated

L1845

702.24

Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, includes fitting and adjustment

L1846

1,045.16

Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated

L1847

484.10

KO, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated, includes fitting and adjustment

L1850

285.45

KO, Swedish type, prefabricated, includes fitting and adjustment

L1860

914.78

KO, modification of supracondylar prosthetic socket, custom fabricated (SK)

L1900

256.10

AFO, spring wire, dorsiflexion assist calf band, custom fabricated

L1901

14.90

Ankle orthosis, elastic, prefabricated, includes fitting and adjustment (e.g., neoprene, Lycra)

L1902

74.14

AFO, ankle gauntlet, prefabricated, includes fitting and adjustment

L1904

505.56

AFO, molded ankle gauntlet, custom fabricated

L1906

108.58

AFO, multiligamentus ankle support, prefabricated, includes fitting and adjustment

L1907

473.60

AFO, supramalleolar with straps, with or without interface/pads, custom fabricated

L1910

255.64

AFO, posterior, single bar, clasp attachment to shoe counter, prefabricated, includes fitting and adjustment

L1920

374.64

AFO, single upright with static or adjustable stop (Phelps or Perlstein type), custom fabricated

L1930

220.14

AFO, plastic or other material, prefabricated, includes fitting and adjustment

L1932

751.08

AFO, rigid anterior tibial section, total carbon fiber or equal material, prefabricated, includes fitting and adjustment

L1940

531.69

AFO, plastic or other material, custom-fabricated

L1945

995.21

AFO, molded to patient model, plastic, rigid anterior tibial section (floor reaction), custom fabricated

L1950

768.97

AFO, spiral, (Institute of Rehabilitative Medicine type), plastic, custom fabricated

L1951

706.87

AFO, spiral, (Institute of Rehabilitative Medicine type), plastic or other material, prefabricated, includes fitting and adjustment

L1960

595.91

AFO, posterior solid ankle, plastic, custom fabricated

L1970

765.00

AFO, plastic, with ankle joint, custom fabricated

L1971

394.51

AFO, plastic or other material with ankle joint, prefabricated, includes fitting and adjustment

L1980

382.79

AFO, single upright free plantar dorsiflexion, solid stirrup, calf band/cuff (single bar BK orthosis), custom fabricated

L1990

455.40

AFO, double upright free plantar dorsiflexion, solid stirrup, calf band/cuff (double bar BK orthosis), custom fabricated

L2000

928.46

KAFO, single upright, free knee, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar AK orthosis), custom fabricated

L2005

3,448.94

Knee ankle foot orthosis, any material, single or double upright, stance control, automatic lock and swing phase release, mechanical activation, includes ankle joint, any type, custom fabricated

L2010

843.90

KAFO, single upright, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar AK orthosis), without knee joint, custom fabricated

L2020

1,197.45

KAFO, double upright, free knee, free ankle, solid stirrup, thigh and calf bands/cuffs (double bar AK orthosis), custom fabricated

L2030

971.19

KAFO, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs, (double bar AK orthosis), without knee joint, custom fabricated

L2034

1,684.16

Knee ankle foot orthosis, full plastic, single upright, with or without free motion knee, medial lateral rotation control, with or without free motion ankle, custom fabricated

L2035

148.30

Knee ankle foot orthosis, full plastic, static (pediatric size), without free motion ankle, prefabricated, includes fitting and adjustment

L2036

1,994.65

Knee ankle foot orthosis, full plastic, double upright, with or without free motion knee, with or without free motion ankle, custom fabricated

L2037

1,790.67

Knee ankle foot orthosis, full plastic, single upright, with or without free motion knee, with or without free motion ankle, custom fabricated

L2038

1,537.10

Knee ankle foot orthosis, full plastic, with or without free motion knee, multi-axis ankle, custom fabricated

L2040

183.03

HKAFO, torsion control, bilateral rotation straps, pelvic band/belt, custom fabricated

L2050

512.14

HKAFO, torsion control, bilateral torsion cables, hip joint, pelvic band/belt, custom fabricated

L2060

521.33

HKAFO, torsion control, bilateral torsion cables, ball bearing hip joint, pelvic band/ belt, custom fabricated

L2070

125.86

HKAFO, torsion control, unilateral rotation straps, pelvic band/belt, custom fabricated

L2080

386.69

HKAFO, torsion control, unilateral torsion cable, hip joint, pelvic band/belt, custom fabricated

L2090

371.63

HKAFO, torsion control, unilateral torsion cable, ball bearing hip joint, pelvic band/belt, custom fabricated

L2106

730.97

AFO, fracture orthosis, tibial fracture cast orthosis, thermoplastic type casting material, custom fabricated

L2108

1,110.45

AFO, fracture orthosis, tibial fracture cast orthosis, custom fabricated

L2112

455.80

AFO, fracture orthosis, tibial fracture orthosis, soft, prefabricated, includes fitting and adjustment

L2114

550.54

AFO, fracture orthosis, tibial fracture orthosis, semi-rigid, prefabricated, includes fitting and adjustment

L2116

707.02

AFO, fracture orthosis, tibial fracture orthosis, rigid, prefabricated, includes fitting and adjustment

L2126

1,157.86

KAFO, fracture orthosis, femoral fracture cast orthosis, thermoplastic type casting material, custom fabricated

L2128

1,843.50

KAFO, fracture orthosis, femoral fracture cast orthosis, custom fabricated

L2132

681.12

Knee ankle foot orthosis (KAFO), fracture orthosis, femoral fracture cast orthosis, soft, prefabricated, includes fitting and adjustment

L2134

958.80

Knee ankle foot orthosis (KAFO), fracture orthosis, femoral fracture cast orthosis, semi-rigid, prefabricated, includes fitting and adjustment

L2136

1,071.71

KAFO, fracture orthosis, femoral fracture cast orthosis, rigid, prefabricated, includes fitting and adjustment

L2180

111.39

Addition to lower extremity fracture orthosis, plastic shoe insert with ankle joints

L2182

98.49

Addition to lower extremity fracture orthosis, drop lock knee joint

L2184

103.39

Addition to lower extremity fracture orthosis, limited motion knee joint

L2186

124.80

Addition to lower extremity fracture orthosis, adjustable motion knee joint, Lerman type

L2188

302.99

Addition to lower extremity fracture orthosis, quadrilateral brim

L2190

93.89

Addition to lower extremity fracture orthosis, waist belt

L2192

347.28

Addition to lower extremity fracture orthosis, hip joint, pelvic band, thigh flange, and pelvic belt

L2200

38.34

Addition to lower extremity, limited ankle motion, each joint

L2210

54.20

Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint

L2220

66.03

Addition to lower extremity, dorsiflexion and plantar flexion assist/resist, each joint

L2230

61.87

Addition to lower extremity, split flat caliper stirrups and plate attachment

L2232

83.76

Addition to lower extremity orthosis, rocker bottom for total contact ankle foot orthosis, for custom fabricated orthosis only

L2240

82.97

Addition to lower extremity, round caliper and plate attachment

L2250

286.51

Addition to lower extremity, foot plate, molded to patient model, stirrup attachment

L2260

161.64

Addition to lower extremity, reinforced solid stirrup (Scott-Craig type)

L2265

126.61

Addition to lower extremity, long tongue stirrup

L2270

50.63

Addition to lower extremity, varus/valgus correction (T) strap, padded/lined or malleolus pad

L2275

106.16

Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined

L2280

402.85

Addition to lower extremity, molded inner boot

L2300

217.09

Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable

L2310

99.19

Addition to lower extremity, abduction bar, straight

L2320

203.36

Addition to lower extremity, non-molded lacer, for custom fabricated orthosis only

L2330

354.30

Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only

L2335

242.04

Addition to lower extremity, anterior swing band

L2340

360.37

Addition to lower extremity, pretibial shell, molded to patient model

L2350

718.47

Addition to lower extremity, prosthetic type, (BK) socket, molded to patient model, (used for PTB, AFO orthoses)

L2360

41.72

Addition to lower extremity, extended steel shank

L2370

206.99

Addition to lower extremity, Patten bottom

L2375

97.58

Addition to lower extremity, torsion control, ankle joint and half solid stirrup

L2380

99.27

Addition to lower extremity, torsion control, straight knee joint, each joint

L2385

137.66

Addition to lower extremity, straight knee joint, heavy duty, each joint

L2387

177.92

Addition to lower extremity, polycentric knee joint, for custom fabricated knee ankle foot orthosis, each joint

L2390

117.68

Addition to lower extremity, offset knee joint, each joint

L2395

168.21

Addition to lower extremity, offset knee joint, heavy duty, each joint

L2397

99.42

Addition to lower extremity orthosis, suspension sleeve

L2405

73.38

Addition to knee joint, drop lock, each

L2415

102.22

Addition to knee lock with integrated release mechanism (bail, cable, or equal), any material, each joint

L2425

120.65

Addition to knee joint, disc or dial lock for adjustable knee flexion, each joint

L2430

120.65

Addition to knee joint, ratchet lock for active and progressive knee extension, each joint

L2492

95.65

Addition to knee joint, lift loop for drop lock ring

L2500

339.17

Addition to lower extremity, thigh/weight bearing, gluteal/ischial weight bearing, ring

L2510

652.26

Addition to lower extremity, thigh/weight bearing, quadri-lateral brim, molded to patient model

L2520

480.46

Addition to lower extremity, thigh/weight bearing, quadri-lateral brim, custom fitted

L2525

1,310.53

Addition to lower extremity, thigh/weight bearing, ischial containment/narrow M-L brim molded to patient model

L2526

712.20

Addition to lower extremity, thigh/weight bearing, ischial containment/narrow M-L brim, custom fitted

L2530

214.87

Addition to lower extremity, thigh/weight bearing, lacer, nonmolded

L2540

454.53

Addition to lower extremity, thigh/weight bearing, lacer, molded to patient model

L2550

231.58

Addition to lower extremity, thigh/weight bearing, high roll cuff

L2570

384.06

Addition to lower extremity, pelvic control, hip joint, Clevis type, two position joint, each

L2580

417.55

Addition to lower extremity, pelvic control, pelvic sling

L2600

165.60

Addition to lower extremity, pelvic control, hip joint, Clevis type, or thrust bearing, free, each

L2610

195.82

Addition to lower extremity, pelvic control, hip joint, Clevis or thrust bearing, lock, each

L2620

287.46

Addition to lower extremity, pelvic control, hip joint, heavy-duty, each

L2622

329.52

Addition to lower extremity, pelvic control, hip joint, adjustable flexion, each

L2624

267.01

Addition to lower extremity, pelvic control, hip joint, adjustable flexion, extension, abduction control, each

L2627

1,843.03

Addition to lower extremity, pelvic control, plastic, molded to patient model, reciprocating hip joint and cables

L2628

1,575.36

Addition to lower extremity, pelvic control, metal frame, reciprocating hip joint and cables

L2630

247.55

Addition to lower extremity, pelvic control, band and belt, unilateral

L2640

354.83

Addition to lower extremity, pelvic control, band and belt, bilateral

L2650

97.02

Addition to lower extremity, pelvic and thoracic control, gluteal pad, each

L2660

200.12

Addition to lower extremity, thoracic control, thoracic band

L2670

137.54

Addition to lower extremity, thoracic control, paraspinal uprights

L2680

126.18

Addition to lower extremity, thoracic control, lateral support uprights

L2750

89.86

Addition to lower extremity orthosis, plating chrome or nickel, per bar

L2755

109.94

Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only

L2760

48.99

Addition to lower extremity orthosis, extension, per extension, per bar (for lineal adjustment for growth)

L2768

109.66

Orthotic side bar disconnect device, per bar

L2770

49.79

Addition to lower extremity orthosis, any material, per bar or joint

L2780

72.76

Addition to lower extremity orthosis, noncorrosive finish, per bar

L2785

27.64

Addition to lower extremity orthosis, drop lock retainer, each

L2795

91.35

Addition to lower extremity orthosis, knee control, full kneecap

L2800

114.67

Addition to lower extremity orthosis, knee control, knee cap, medial or lateral pull, for use with custom fabricated orthosis only

L2810

83.97

Addition to lower extremity orthosis, knee control, condylar pad

L2820

92.97

Addition to lower extremity orthosis, soft interface for molded plastic, below knee section

L2830

101.01

Addition to lower extremity orthosis, soft interface for molded plastic, above knee section

L2840

35.36

Addition to lower extremity orthosis, tibial length sock, fracture or equal, each

L2850

63.93

Addition to lower extremity orthosis, femoral length sock, fracture or equal, each

L2999

A.I. + 50%

Unlisted procedure for lower extremity orthosis

L3000

264.39

Foot insert, removable, molded to patient model, UCB type, Berkeley shell, each

L3001

111.32

Foot insert, removable, molded to patient model, Spenco, each

L3002

135.93

Foot insert, removable, molded to patient model, Plastazote or equal, each

L3003

146.67

Foot insert, removable, molded to patient model, silicone gel, each

L3010

146.67

Foot insert, removable, molded to patient model, longitudinal arch support, each

L3020

167.00

Foot insert, removable, molded to patient model, longitudinal/metatarsal support, each

L3030

64.24

Foot insert, removable, formed to patient foot, each

L3031

130.00

Foot, insert/plate, removable, addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, each

L3040

39.60

Foot, arch support, removable, premolded,

longitudinal, each

L3050

39.60

Foot, arch support, removable, premolded, metatarsal, each

L3060

62.09

Foot, arch support, removable, premolded,

longitudinal/metatarsal, each

L3070

26.73

Foot, arch support, nonremovable, attached to shoe, longitudinal, each

L3080

26.73

Foot, arch support, nonremovable, attached to shoe, metatarsal, each

L3090

34.27

Foot, arch support, nonremovable, attached to shoe, longitudinal/metatarsal, each

L3100

36.39

Hallus-valgus night dynamic splint

L3140

74.94

Foot, abduction rotation bar, including shoes

L3150

68.51

Foot, abduction rotation bar, without shoes

L3160

AI + 50%

Foot, adjustable shoe style positioning device

L3170

42.84

Foot, plastic, silicone, or equal, heel stabilizer, each

L3203

58.03

Orthopedic shoe, oxford wit supinator or pronator, junior

L3207

AI + 50%

Orthopedic shoe, hightop with supinator or pronator, junior

L3211

70.56

Surgical boot, each, junior

L3214

AI + 50%

Benesch boot, pair, junior

L3215

89.99

Orthopedic footwear, ladies shoes, oxford, "each"

L3216

115.06

Orthopedic footwear, ladies shoes, depth inlay "each"

L3217

AI + 50%

Orthopedic footwear, ladies shoes, hightop, depth inlay "each"

L3219

137.00

Orthopedic footwear, mens shoes, oxford, "each"

L3221

139.94

Orthopedic footwear, mens shoes, depth inlay "each"

L3222

175.00

Orthopedic footwear, mens shoes, hightop, depth inlay "each"

L3224

60.09

Orthopedic footwear, woman's shoe, oxford, used as an integral part of a brace (orthosis)

L3225

72.73

Orthopedic footwear, man's shoe, oxford, used as an integral part of a brace (orthosis)

L3230

303.97

Orthopedic footwear, custom shoes, depth inlay "each"

L3250

399.89

Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each

L3251

Foot, shoe molded to patient model, silicone shoe, each

L3252

300.08

Foot, shoe molded to patient model, plastazote (or similar), custom fabricated, each

L3253

80.02

Foot, molded shoe, plastazote (or similar) custom fitted, each

L3254

28.00

Non-standard size or width

L3255

AI + 70%

Non-standard size or length

L3257

54.99

Orthopedic footware, additional charge for split size

L3260

30.00

Ambulatory surgical boot, each

L3265

24.99

Plastazote sandal, each

L3300

43.88

Lift, elevation, heel, tapered to metatarsals, per inch

L3310

68.51

Lift, elevation, heel and sole, neoprene, per inch

L3330

476.34

Lift, elevation, metal extension (skate)

L3332

62.09

Lift, elevation, inside shoe, tapered, up to one-half in.

L3334

32.11

Lift, elevation, heel, per in.

L3340

71.73

Heel wedge, SACH

L3350

19.28

Heel wedge

L3360

29.97

Sole wedge, outside sole

L3370

41.72

Sole wedge, between sole

L3380

41.72

Clubfoot wedge

L3390

41.72

Outflare wedge

L3400

34.27

Metatarsal bar wedge, rocker

L3410

78.13

Metatarsal bar wedge, between sole

L3420

46.03

Full sole and heel wedge, between sole

L3430

134.88

Heel, counter, plastic reinforced

L3440

64.24

Heel, counter, leather reinforced

L3450

88.85

Heel, SACH cushion type

L3455

34.27

Heel, new leather, standard

L3460

28.89

Heel, new rubber, standard

L3465

49.25

Heel, Thomas with wedge

L3470

52.45

Heel, Thomas extended to ball

L3480

52.45

Heel, pad and depression for spur

L3485

28.50

Heel, pad-removeable for spur

L3500

24.62

Orthopedic shoe addition, insole, leather

L3510

24.62

Orthopedic shoe addition, insole, rubber

L3520

26.73

Orthopedic shoe addition, insole, felt covered with leather

L3530

26.73

Orthopedic shoe addition, sole, half

L3540

42.84

Orthopedic shoe addition, sole, full

L3550

7.48

Orthopedic shoe addition, toe tap, standard

L3560

19.28

Orthopedic shoe addition, toe tap, horseshoe

L3570

71.73

Orthopedic shoe addition, special extension to instep (leather with eyelets)

L3580

54.59

Orthopedic shoe addition, convert instep to Velcro closure

L3590

44.95

Orthopedic shoe addition, convert firm shoe counter to soft counter

L3595

35.32

Orthopedic shoe addition, March bar

L3600

64.24

Transfer of an orthosis from one shoe to another, caliper plate, existing

L3610

84.55

Transfer of an orthosis from one shoe to another, caliper plate, new

L3620

64.24

Transfer of an orthosis from one shoe to another, solid stirrup, existing

L3630

84.55

Transfer of an orthosis from one shoe to another, solid stirrup, new

L3640

36.39

Transfer of an orthosis from one shoe to another, Dennis Browne splint (Riveton), both shoes

L3649

AI + 70%

Orthopedic shoe modification, addition or transfer not otherwise specified

L3650

58.00

SO, figure of eight design abduction restrainer, prefabricated, includes fitting and adjustment

L3651

50.44

SO, single shoulder, elastic, prefabricated, includes fitting and adjustment (e.g., neoprene, Lycra)

L3652

152.00

SO, double shoulder, elastic, prefabricated, includes fitting and adjustment (e.g., neoprene, Lycra)

L3660

108.13

SO, figure of eight design abduction restrainer, canvas and webbing, prefabricated, includes fitting and adjustment

L3670

89.22

SO, acromio/clavicular (canvas and webbing type), prefabricated, includes fitting and adjustment

L3671

690.23

Shoulder orthosis (SO), shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

L3672

858.34

SO, abduction positioning (airplane design), thoracic component and support bar, without joints, may inlcude soft interface, straps, custom fabricated, includes fitting and adjustment

L3673

935.49

Shoulder orthosis (SO), abduction positioning (airplane design), thoracic component and support bar, includes nontorsion joint/turnbuckle, may include soft interface, straps, custom fabricated, includes fitting and adjustment

L3675

134.42

SO, vest type abduction restrainer, canvas webbing type, or equal, prefabricated, includes fitting and adjustment

L3700

55.08

EO, elastic with stays, prefabricated, includes fitting and adjustment

L3701

15.60

Elbow orthosis (EO), elastic, prefabricated, includes fitting and adjustment (e.g., neoprene, Lycra)

L3702

221.18

Elbow orthosis (EO), without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

L3710

122.49

EO, elastic with metal joints, prefabricated, includes fitting and adjustment

L3720

516.08

Elbow orthosis (EO), double upright with forearm/arm cuffs, free motion, custom fabricated

L3730

948.36

EO, double upright with forearm/arm cuffs, extension/flexion assist, custom fabricated

L3740

1,124.36

Elbow orthosis (EO), double upright with forearm/arm cuffs, adjustable position Lock with active control, custom fabricated

L3760

383.07

Elbow orthosis (EO), with adjustable position locking joint(s), prefabricated, includes fitting and adjustments, any type

L3762

82.37

Elbow orthosis (EO), rigid, without joints, includes soft interface material, prefabricated, includes fitting and adjustment

L3763

557.35

Elbow wrist hand orthosis (EWHO), rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

L3764

728.30

Elbow wrist hand orthosis (EWHO), includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

L3765

982.19

Elbow wrist hand finger orthosis (EWHFO), rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

L3766

1,040.07

Elbow wrist hand finger orthosis (EWHFO), includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

L3806

347.95

WHFO, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment

L3807

191.54

Wrist hand finger orthosis (WHFO), without joint(s), prefabricated, includes fitting and adjustments, any type

L3808

323.61

Wrist hand finger orthosis (WHFO), rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment

L3900

1,026.53

WHFO, dynamic flexor hinge, reciprocal wrist extension/flexion, finger flexion/extension, wrist or finger driven, custom fabricated

L3901

1,267.98

WHFO, dynamic flexor hinge, reciprocal wrist extension/flexion, finger flexion/extension, cable driven, custom fabricated

L3904

2,431.38

WHFO, external powered, electric, custom fabricated

L3905

759.66

Wrist hand finger orthosis (WHFO), includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

L3906

370.14

Wrist hand orthosis (WHO), without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

L3908

63.03

WHO, wrist extension control cock-up, nonmolded, prefabricated, includes fitting and adjustment

L3909

10.80

WO, elastic, prefabricated, includes fitting and adjustment (e.g., neoprene, Lycra)

L3911

18.97

Wrist hand finger orthosis (WHFO), elastic, prefabricated, includes fitting and adjustment (e.g., neoprene, Lycra)

L3912

74.83

HFO, flexion glove with elastic finger control, prefabricated, includes fitting and adjustment

L3913

207.47

Hand finger orthosis (HFO), without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

L3915

407.17

Wrist hand orthosis (WHO), includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, includes fitting and adjustment

L3917

80.92

Hand orthosis (HO), metacarpal fracture orthosis, prefabricated, includes fitting and adjustment

L3919

207.47

Hand orthosis (HO), without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

L3921

246.06

Hand finger orthosis (HFO), includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

L3923

91.52

Hand finger orthosis (HFO), without joints, may include soft interface, straps, prefabricated, includes fitting and adjustment

L3925

41.16

FO, proximal interphalangeal (PIP)/distal interphalangeal (DIP), nontorsion joint/spring, extension/flexion, may include soft interface material, prefabricated, includes fitting and adjustment

L3927

AI + 50%

FO, proximal interphalangeal (PIP)/distal interphalangeal (DIP), without joint/spring, extension/flexion (e.g., static or ring type), may include soft interface material, prefabricated, includes fitting and adjustment

L3929

61.68

HFO, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated, includes fitting and adjustment

L3931

162.84

WHFO, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated, includes fitting and adjustment

L3933

163.44

Finger orthosis (FO), without joints, may include soft interface, custom fabricated, includes fitting and adjustment

L3935

169.22

Finger orthosis, nontorsion joint, may include soft interface, custom fabricated, includes fitting and adjustment

L3956

I.C.

Addition of joint to upper extremity orthosis, any material; per joint

L3960

688.97

SEWHO, abduction positioning, airplane design, prefabricated, includes fitting and adjustment

L3961

1,286.96

Shoulder elbow wrist hand orthosis (SEWHO), shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

L3962

754.83

SEWHO, abduction positioning, Erb's palsy design, prefabricated, includes fitting and adjustment

L3964

621.11

465.80

62.10

SEO, mobile arm support attached to wheelchair, balanced, adjustable, prefabricated, includes fitting and adjustment

L3964

621.11

465.80

62.10

SEO, mobile arm support attached to wheelchair, balanced, adjustable, prefabricated, includes fitting and adjustment

L3964

621.11

465.80

62.10

SEO, mobile arm support attached to wheelchair, balanced, adjustable, prefabricated, includes fitting and adjustment

L3965

991.11

743.33

99.13

SEO, mobile arm support attached to wheelchair, balanced, adjustable Rancho type, prefabricated, includes fitting and adjustment

L3965

991.11

743.33

99.13

SEO, mobile arm support attached to wheelchair, balanced, adjustable Rancho type, prefabricated, includes fitting and adjustment

L3965

991.11

743.33

99.13

SEO, mobile arm support attached to wheelchair, balanced, adjustable Rancho type, prefabricated, includes fitting and adjustment

L3966

746.64

559.98

74.67

SEO, mobile arm support attached to wheelchair, balanced, reclining, prefabricated, includes fitting and adjustment

L3966

746.64

559.98

74.67

SEO, mobile arm support attached to wheelchair, balanced, reclining, prefabricated, includes fitting and adjustment

L3966

746.64

559.98

74.67

SEO, mobile arm support attached to wheelchair, balanced, reclining, prefabricated, includes fitting and adjustment

L3967

1,519.48

Shoulder elbow wrist hand orthosis (SEWHO), abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

L3968

858.96

644.22

85.89

SEO, mobile arm support attached to wheelchair, balanced, friction arm support (friction dampening to proximal and distal joints), prefabricated, includes fitting and adjustment

L3968

858.96

644.22

85.89

SEO, mobile arm support attached to wheelchair, balanced, friction arm support (friction dampening to proximal and distal joints), prefabricated, includes fitting and adjustment

L3968

858.96

644.22

85.89

SEO, mobile arm support attached to wheelchair, balanced, friction arm support (friction dampening to proximal and distal joints), prefabricated, includes fitting and adjustment

L3969

660.74

495.54

66.08

SEO, mobile arm support, monosuspension arm and hand support, overhead elbow forearm hand sling support, yoke type arm suspension support, prefabricated, includes fitting and adjustment

L3969

660.74

495.54

66.08

SEO, mobile arm support, monosuspension arm and hand support, overhead elbow forearm hand sling support, yoke type arm suspension support, prefabricated, includes fitting and adjustment

L3969

660.74

495.54

66.08

SEO, mobile arm support, monosuspension arm and hand support, overhead elbow forearm hand sling support, yoke type arm suspension support, prefabricated, includes fitting and adjustment

L3970

224.66

168.50

22.47

Shoulder elbow orthosis (SEO), addition to mobile arm support, elevating proximal arm

L3970

224.66

168.50

22.47

Shoulder elbow orthosis (SEO), addition to mobile arm support, elevating proximal arm

L3970

224.66

168.50

22.47

Shoulder elbow orthosis (SEO), addition to mobile arm support, elevating proximal arm

L3971

1,442.33

Shoulder elbow wrist hand orthosis (SEWHO), shoulder cap design, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

L3972

168.07

126.05

16.81

Shoulder elbow orthosis (SEO), addition to mobile arm support, offset or lateral rocker arm with elastic balance control

L3972

168.07

126.05

16.81

Shoulder elbow orthosis (SEO), addition to mobile arm support, offset or lateral rocker arm with elastic balance control

L3972

168.07

126.05

16.81

Shoulder elbow orthosis (SEO), addition to mobile arm support, offset or lateral rocker arm with elastic balance control

L3973

1,519.48

Shoulder elbow wrist hand orthosis (SEWHO), abduction positioning (airplane design), thoracic component and support bar, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

L3974

142.55

106.91

14.27

Shoulder elbow orthosis (SEO), addition to mobile arm support, supinator

L3974

142.55

106.91

14.27

Shoulder elbow orthosis (SEO), addition to mobile arm support, supinator

L3974

142.55

106.91

14.27

Shoulder elbow orthosis (SEO), addition to mobile arm support, supinator

L3975

1,286.96

Shoulder elbow wrist hand finger orthosis (SEWHO), shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

L3976

1,286.96

Shoulder elbow wrist hand finger orthosis (SEWHO), abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

L3977

1,442.33

Shoulder elbow wrist hand finger orthosis (SEWHO), shoulder cap design, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

L3978

1,519.48

Shoulder elbow wrist hand finger orthosis (SEWHO), abduction positioning (airplane design), thoracic component and support bar, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, incl

L3980

325.24

Upper extremity fracture orthosis, humeral,

prefabricated, includes fitting and adjustment

L3982

342.79

Upper extremity fracture orthosis, radius/ulnar, prefabricated, includes fitting and adjustment

L3984

341.01

Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment

L3995

34.40

Addition to upper extremity orthosis, sock, fracture or equal, each

L4000

1,232.35

Replace girdle for spinal orthosis (CTLSO or SO)

L4002

AI + 70%

Replacement strap, any orthosis, includes all components, any length, any type

L4010

541.14

Replace trilateral socket brim

L4020

701.52

Replace quadrilateral socket brim, molded to patient model

L4030

407.10

Replace quadrilateral socket brim, custom fitted

L4040

360.36

Replace molded thigh lacer, for custom fabricated orthosis only

L4045

352.66

Replace non-molded thigh lacer, for custom fabricated orthosis only

L4050

405.45

Replace molded calf lacer, for custom fabricated orthosis only

L4055

287.40

Replace non-molded calf lacer, for custom fabricated orthosis only

L4060

268.36

Replace high roll cuff

L4070

254.04

Replace proximal and distal upright for KAFO

L4080

108.74

Replace metal bands KAFO, proximal thigh

L4090

84.70

Replace metal bands KAFO-AFO, calf or distal thigh

L4100

95.17

Replace leather cuff KAFO, proximal thigh

L4110

81.81

Replace leather cuff KAFO-AFO, calf or distal thigh

L4130

400.04

Replace pretibial shell

L4350

83.72

Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, includes fitting and adjustment

L4360

297.68

Walking boot, pneumatic, with or without joints, with or without interface material, prefabricated, includes fitting and adjustment

L4370

202.97

Pneumatic full leg splint, prefabricated, includes fitting and adjustment

L4380

115.48

Pneumatic knee splint, prefabricated, includes fitting and adjustment

L4386

133.45

Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, includes fitting and adjustment

L4392

20.68

Replacement, soft interface material, static AFO

L4394

15.10

Replace soft interface material, foot drop splint

L4396

147.55

Static ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, pressure reduction, may be used for minimal ambulation, prefabricated, includes fitting and adjustment

L4398

67.93

Foot drop splint, recumbent positioning device, prefabricated, includes fitting and adjustment

L5000

434.04

Partial foot, shoe insert with longitudinal arch, toe filler

L5010

1,052.05

Partial foot, molded socket, ankle height, with toe filler

L5020

1,789.88

Partial foot, molded socket, tibial tubercle height, with toe filler

L5050

2,340.34

Ankle, Symes, molded socket, SACH foot

L5060

2,372.67

Ankle, Symes, metal frame, molded leather socket, articulated ankle/foot

L5100

2,399.82

Below knee, molded socket, shin, SACH foot

L5105

3,655.13

Below knee, plastic socket, joints and thigh lacer, SACH foot

L5150

3,085.81

Knee disarticulation (or through knee), molded socket, external knee joints, shin, SACH foot

L5160

3,618.72

Knee disarticulation (or through knee), molded socket, bent knee configuration, external knee joints, shin, SACH foot

L5200

3,598.61

Above knee, molded socket, single axis constant friction knee, shin, SACH foot

L5210

2,265.99

Above knee, short prosthesis, no knee joint (stubbies), with foot blocks, no ankle joints, each

L5220

2,432.04

Above knee, short prosthesis, no knee joint (stubbies), with articulated ankle/foot, dynamically aligned, each

L5230

3,428.72

Above knee, for proximal femoral focal deficiency, constant friction knee, shin, SACH foot

L5250

4,786.21

Hip disarticulation, Canadian type; molded socket, hip joint, single axis constant friction knee, shin, SACH foot

L5270

5,138.59

Hip disarticulation, tilt table type; molded socket, locking hip joint, single axis constant friction knee, shin, SACH foot

L5280

5,147.34

Hemipelvectomy, Canadian type; molded socket, hip joint, single axis constant friction knee, shin, SACH foot

L5301

2,107.24

Below knee, molded socket, shin, SACH foot, endoskeletal system

L5311

2,833.53

Knee disarticulation (or through knee), molded socket, external knee joints, shin, SACH foot, endoskeletal system

L5321

2,972.75

Above knee, molded socket, open end, SACH foot, endoskeletal system, single axis knee

L5331

4,429.79

Hip disarticulation, Canadian type, molded socket, endoskeletal system, hip joint, single axis knee, SACH foot

L5341

4,341.54

Hemipelvectomy, Canadian type, molded socket, endoskeletal system, hip joint, single axis knee, SACH foot

L5400

1,033.89

Immediate postsurgical or early fitting, application of initial rigid dressing, including fitting, alignment, suspension, and one cast change, below knee

L5410

394.79

Immediate postsurgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension, below knee, each additional cast change and realignment

L5420

1,305.75

Immediate postsurgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension and one cast change AK or knee disarticulation

L5430

452.26

Immediate postsurgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension, AK or knee disarticulation, each additional cast change and realignment

L5450

349.98

Immediate postsurgical or early fitting, application of nonweight bearing rigid dressing, below knee

L5460

514.57

Immediate postsurgical or early fitting, application of nonweight bearing rigid dressing, above knee

L5500

1,256.53

Initial, below knee PTB type socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, direct formed

L5505

1,758.90

Initial, above knee - knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot plaster socket, direct formed

L5510

1,566.55

Preparatory, below knee PTB type socket,

nonalignable system, pylon, no cover, SACH foot, plaster socket, molded to model

L5520

1,640.70

Preparatory, below knee PTB type socket,

nonalignable system, pylon, no cover, SACH foot, thermoplastic or equal, direct formed

L5530

1,787.90

Preparatory, below knee PTB type socket,

nonalignable system, pylon, no cover, SACH foot, thermoplastic or equal, molded to model

L5535

1,865.14

Preparatory, below knee PTB type socket,

nonalignable system, pylon, no cover, SACH foot, prefabricated, adjustable open end socket

L5540

1,773.42

Preparatory, below knee PTB type socket,

nonalignable system, pylon, no cover, SACH foot, laminated socket, molded to model

L5560

1,689.04

Preparatory, above knee - knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, molded to model

L5570

2,037.01

Preparatory, above knee - knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, thermoplastic or equal, direct formed

L5580

2,112.61

Preparatory, above knee - knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, thermoplastic or equal, molded to model

L5585

2,364.77

Preparatory, above knee - knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, prefabricated adjustable open end socket

L5590

2,382.30

Preparatory, above knee - knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, laminated socket, molded to model

L5595

4,248.26

Preparatory, hip disarticulation - hemipelvectomy, pylon, no cover, SACH foot, thermoplastic or equal, molded to patient model

L5600

5,023.42

Preparatory, hip disarticulation - hemipelvectomy, pylon, no cover, SACH foot, laminated socket, molded to patient model

L5610

2,125.16

Addition to lower extremity, endoskeletal system, above knee, hydracadence system

L5611

1,845.41

Addition to lower extremity, endoskeletal system, above knee - knee disarticulation, 4-bar linkage, with friction swing phase control

L5613

2,806.98

Addition to lower extremity, endoskeletal system, above knee - knee disarticulation, 4-bar linkage, with hydraulic swing phase control

L5614

1,423.05

Addition to lower extremity, endoskeletal system, above knee - knee disarticulation, 4-bar linkage, with pneumatic swing phase control

L5616

1,317.12

Addition to lower extremity, endoskeletal system, above knee, universal multiplex system, friction swing phase control

L5617

495.65

Addition to lower extremity, quick change self-aligning unit, above or below knee, each

L5618

322.12

Addition to lower extremity, test socket, Symes

L5620

318.43

Addition to lower extremity, test socket, below knee

L5622

388.19

Addition to lower extremity, test socket, knee disarticulation

L5624

416.41

Addition to lower extremity, test socket, above knee

L5626

495.90

Addition to lower extremity, test socket, hip disarticulation

L5628

469.85

Addition to lower extremity, test socket,

hemipelvectomy

L5629

364.00

Addition to lower extremity, below knee, acrylic socket

L5630

439.02

Addition to lower extremity, Symes type, expandable wall socket

L5631

503.26

Addition to lower extremity, above knee or knee disarticulation, acrylic socket

L5632

217.40

Addition to lower extremity, Symes type, PTB brim design socket

L5634

339.98

Addition to lower extremity, Symes type, posterior opening (Canadian) socket

L5636

291.85

Addition to lower extremity, Symes type, medial opening socket

L5637

285.72

Addition to lower extremity, below knee, total contact

L5638

418.06

Addition to lower extremity, below knee, leather socket

L5639

1,284.18

Addition to lower extremity, below knee, wood socket

L5640

549.30

Addition to lower extremity, knee disarticulation, leather socket

L5642

532.23

Addition to lower extremity, above knee, leather socket

L5643

1,782.72

Addition to lower extremity, hip disarticulation, flexible inner socket, external frame

L5644

665.79

Addition to lower extremity, above knee, wood socket

L5645

763.36

Addition to lower extremity, below knee, flexible inner socket, external frame

L5646

627.57

Addition to lower extremity, below knee, air, fluid, gel or equal, cushion socket

L5647

911.10

Addition to lower extremity, below knee, suction socket

L5648

565.57

Addition to lower extremity, above knee, air, fluid, gel or equal, cushion socket

L5649

1,635.55

Addition to lower extremity, ischial containment/narrow M-L socket

L5650

419.37

Addition to lower extremity, total contact, above knee or knee disarticulation socket

L5651

1,375.51

Addition to lower extremity, above knee, flexible inner socket, external frame

L5652

462.76

Addition to lower extremity, suction suspension, above knee or knee disarticulation socket

L5653

523.53

Addition to lower extremity, knee disarticulation, expandable wall socket

L5654

379.85

Addition to lower extremity, socket insert, Symes (Kemblo, Pelite, Aliplast, Plastazote or equal)

L5655

271.16

Addition to lower extremity, socket insert, below knee (Kemblo, Pelite, Aliplast, Plastazote or equal)

L5656

321.75

Addition to lower extremity, socket insert, knee disarticulation (Kemblo, Pelite, Aliplast, Plastazote or equal)

L5658

363.21

Addition to lower extremity, socket insert, above knee (Kemblo, Pelite, Aliplast, Plastazote or equal)

L5661

697.01

Addition to lower extremity, socket insert, multidurometer, Symes

L5665

586.46

Addition to lower extremity, socket insert,

multidurometer, below knee

L5666

73.41

Addition to lower extremity, below knee, cuff suspension

L5668

106.43

Addition to lower extremity, below knee, molded distal cushion

L5670

247.58

Addition to lower extremity, below knee, molded supracondylar suspension (PTS or similar)

L5671

427.29

Addition to lower extremity, below knee/above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert

L5672

301.18

Addition to lower extremity, below knee, removable medial brim suspension

L5673

677.72

Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism

L5676

407.76

Addition to lower extremity, below knee, knee joints, single axis, pair

L5677

564.74

Addition to lower extremity, below knee, knee joints, polycentric, pair

L5678

34.11

Addition to lower extremity, below knee joint covers, pair

L5679

564.73

Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism

L5680

296.84

Addition to lower extremity, below knee, thigh lacer, nonmolded

L5681

1,109.28

Addition to lower extremity, below knee/above knee, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code L5673 or L5679)

L5682

716.31

Addition to lower extremity, below knee, thigh lacer, gluteal/ischial, molded

L5683

1,109.28

Addition to lower extremity, below knee/above knee, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code L5673 or L5679)

L5684

51.79

Addition to lower extremity, below knee, fork strap

L5685

108.01

Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each

L5686

51.73

Addition to lower extremity, below knee, back check (extension control)

L5688

61.00

Addition to lower extremity, below knee, waist belt, webbing

L5690

112.08

Addition to lower extremity, below knee, waist belt, padded and lined

L5692

135.02

Addition to lower extremity, above knee, pelvic control belt, light

L5694

207.79

Addition to lower extremity, above knee, pelvic control belt, padded and lined

L5695

157.73

Addition to lower extremity, above knee, pelvic control, sleeve suspension, neoprene or equal, each

L5696

203.68

Addition to lower extremity, above knee or knee disarticulation, pelvic joint

L5697

91.95

Addition to lower extremity, above knee or knee disarticulation, pelvic band

L5698

103.21

Addition to lower extremity, above knee or knee disarticulation, Silesian bandage

L5699

207.21

All lower extremity prostheses, shoulder harness

L5700

2,503.15

Replacement, socket, below knee, molded to patient model

L5701

3,105.38

Replacement, socket, above knee/knee disarticulation, including attachment plate, molded to patient model

L5702

3,913.86

Replacement, socket, hip disarticulation, including hip joint, molded to patient model

L5703

2,030.95

Ankle, Symes, molded to patient model, socket without solid ankle cushion heel (SACH) foot, replacement only

L5704

510.40

Custom shaped protective cover, below knee

L5705

935.70

Custom shaped protective cover, above knee

L5706

912.68

Custom shaped protective cover, knee disarticulation

L5707

1,226.17

Custom shaped protective cover, hip disarticulation

L5710

348.86

Addition, exoskeletal knee-shin system, single axis, manual lock

L5711

585.21

Addition, exoskeletal knee-shin system, single axis, manual lock, ultra-light material

L5712

464.98

Addition, exoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee)

L5714

418.64

Addition, exoskeletal knee-shin system, single axis, variable friction swing phase control

L5716

752.15

Addition, exoskeletal knee-shin system, polycentric, mechanical stance phase lock

L5718

903.46

Addition, exoskeletal knee-shin system, polycentric, friction swing and stance phase control

L5722

847.65

Addition, exoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control

L5724

1,559.20

Addition, exoskeletal knee-shin system, single axis, fluid swing phase control

L5726

1,936.91

Addition, exoskeletal knee-shin system, single axis, external joints, fluid swing phase control

L5728

2,725.43

Addition, exoskeletal knee-shin system, single axis, fluid swing and stance phase control

L5780

1,048.19

Addition, exoskeletal knee-shin system, single axis, pneumatic/hydra pneumatic swing phase control

L5781

3,374.24

Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system

L5782

3,557.22

Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy duty

L5785

595.08

Addition, exoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal)

L5790

823.56

Addition, exoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal)

L5795

1,229.79

Addition, exoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)

L5810

557.65

Addition, endoskeletal knee-shin system, single axis, manual lock

L5811

835.34

Addition, endoskeletal knee-shin system, single axis, manual lock, ultra-light material

L5812

631.92

Addition, endoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee)

L5814

3,131.94

Addition, endoskeletal knee-shin system, polycentric, hydraulic swing phase control, mechanical stance phase lock

L5816

787.77

Addition, endoskeletal knee-shin system, polycentric, mechanical stance phase lock

L5818

1,099.94

Addition, endoskeletal knee-shin system, polycentric, friction swing and stance phase control

L5822

1,950.47

Addition, endoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control

L5824

1,530.65

Addition, endoskeletal knee-shin system, single axis, fluid swing phase control

L5826

2,678.39

Addition, endoskeletal knee-shin system, single axis, hydraulic swing phase control, with miniature high activity frame

L5828

3,234.48

Addition, endoskeletal knee-shin system, single axis, fluid swing and stance phase control

L5830

2,173.40

Addition, endoskeletal knee-shin system, single axis, pneumatic/swing phase control

L5840

3,182.45

Addition, endoskeletal knee-shin system, 4-bar linkage or multiaxial, pneumatic swing phase control

L5845

1,511.53

Addition, endoskeletal knee-shin system, stance flexion feature, adjustable

L5848

906.84

Addition to endoskeletal knee-shin system, fluid stance extension, dampening feature, with or without adjustability

L5850

109.89

Addition, endoskeletal system, above knee or hip disarticulation, knee extension assist

L5855

265.30

Addition, endoskeletal system, hip disarticulation, mechanical hip extension assist

L5856

20,475.22

Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type

L5857

7,414.22

Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type

L5858

15,673.19

Addition to lower extremity prosthesis, endoskeletal knee shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type

L5910

414.83

Addition, endoskeletal system, below knee, alignable system

L5920

607.73

Addition, endoskeletal system, above knee or hip disarticulation, alignable system

L5925

288.64

Addition, endoskeletal system, above knee, knee disarticulation or hip disarticulation, manual lock

L5930

2,981.78

Addition, endoskeletal system, high activity knee control frame

L5940

430.90

Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal)

L5950

839.16

Addition, endoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal)

L5960

923.06

Addition, endoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)

L5962

504.94

Addition, endoskeletal system, below knee, flexible protective outer surface covering system

L5964

914.80

Addition, endoskeletal system, above knee, flexible protective outer surface covering system

L5966

1,178.41

Addition, endoskeletal system, hip disarticulation, flexible protective outer surface covering system

L5968

3,064.55

Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature

L5970

232.62

All lower extremity prostheses, foot, external keel, SACH foot

L5971

232.62

All lower extremity prosthesis, solid ankle cushion heel (SACH) foot, replacement only

L5972

352.92

All lower extremity prostheses, flexible keel foot (SAFE, STEN, Bock Dynamic or equal)

L5974

260.97

All lower extremity prostheses, foot, single axis ankle/foot

L5975

390.95

All lower extremity prosthesis, combination single axis ankle and flexible keel foot

L5976

590.25

All lower extremity prostheses, energy storing foot (Seattle Carbon Copy II or equal)

L5978

319.08

All lower extremity prostheses, foot, multiaxial ankle/foot

L5979

2,034.66

All lower extremity prostheses, multiaxial ankle, dynamic response foot, one piece system

L5980

3,739.01

All lower extremity prostheses, flex-foot system

L5981

2,784.58

All lower extremity prostheses, flex-walk system or equal

L5982

659.38

All exoskeletal lower extremity prostheses, axial rotation unit

L5984

594.67

All endoskeletal lower extremity prosthesis, axial rotation unit, with or without adjustability

L5985

250.14

All endoskeletal lower extremity prostheses, dynamic prosthetic pylon

L5986

557.24

All lower extremity prostheses, multiaxial rotation unit (MCP or equal)

L5987

6,066.57

All lower extremity prosthesis, shank foot system with vertical loading pylon

L5988

1,684.70

Addition to lower limb prosthesis, vertical shock reducing pylon feature

L5990

1,529.95

Addition to lower extremity prosthesis, user adjustable heel height

L5993

AI + 70%

Addition to lower extremity prosthesis, heavy duty feature, foot only, (for patient weight greater than 300 lbs)

L5994

AI + 70%

Addition to lower extremity prosthesis, heavy duty feature, knee only, (for patient weight greater than 300 lbs)

L5995

AI + 70%

Addition to lower extremity prosthesis, heavy duty feature, other than foot or knee, (for patient weight greater than 300 lbs)

L6000

1,141.39

Partial hand, Robin-Aids, thumb remaining (or equal)

L6010

1,270.18

Partial hand, Robin-Aids, little and/or ring finger remaining (or equal)

L6020

1,184.25

Partial hand, Robin-Aids, no finger remaining (or equal)

L6025

6,748.54

Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectric control of terminal device

L6050

1,807.84

Wrist disarticulation, molded socket, flexible elbow hinges, triceps pad

L6055

2,854.00

Wrist disarticulation, molded socket with expandable interface, flexible elbow hinges, triceps pad

L6100

1,819.17

Below elbow, molded socket, flexible elbow hinge, triceps pad

L6110

1,816.09

Below elbow, molded socket (Muenster or Northwestern suspension types)

L6120

2,295.01

Below elbow, molded double wall split socket, step-up hinges, half cuff

L6130

2,494.19

Below elbow, molded double wall split socket, stump activated locking hinge, half cuff

L6200

2,855.32

Elbow disarticulation, molded socket, outside locking hinge, forearm

L6205

3,958.13

Elbow disarticulation, molded socket with expandable interface, outside locking hinges, forearm

L6250

2,366.60

Above elbow, molded double wall socket, internal locking elbow, forearm

L6300

4,264.68

Shoulder disarticulation, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm

L6310

2,606.83

Shoulder disarticulation, passive restoration (complete prosthesis)

L6320

1,474.80

Shoulder disarticulation, passive restoration (shoulder cap only)

L6350

3,364.78

Interscapular thoracic, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm

L6360

2,736.19

Interscapular thoracic, passive restoration (complete prosthesis)

L6370

1,799.79

Interscapular thoracic, passive restoration (shoulder cap only)

L6380

1,007.86

Immediate postsurgical or early fitting, application of initial rigid dressing, including fitting alignment and suspension of components, and one cast change, wrist disarticulation or below elbow

L6382

1,313.50

Immediate postsurgical or early fitting, application of initial rigid dressing including fitting alignment and suspension of components, and one cast change, elbow disarticulation or above elbow

L6384

1,637.85

Immediate postsurgical or early fitting, application of initial rigid dressing including fitting alignment and suspension of components, and one cast change, shoulder disarticulation or interscapular thoracic

L6386

388.51

Immediate postsurgical or early fitting, each additional cast change and realignment

L6388

503.54

Immediate postsurgical or early fitting, application of rigid dressing only

L6400

1,993.31

Below elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping

L6450

3,468.52

Elbow disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping

L6500

2,989.76

Above elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping

L6550

3,515.90

Shoulder disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping

L6570

4,775.34

Interscapular thoracic, molded socket, endoskeletal system, including soft prosthetic tissue shaping

L6580

1,393.42

Preparatory, wrist disarticulation or below elbow, single wall plastic socket, friction wrist, flexible elbow hinges, figure of eight harness, humeral cuff, Bowden cable control, USMC or equal pylon, no cover, molded to patient model

L6582

1,233.06

Preparatory, wrist disarticulation or below elbow, single wall socket, friction wrist, flexible elbow hinges, figure of eight harness, humeral cuff, Bowden cable control, USMC or equal pylon, no cover, direct formed

L6584

2,039.35

Preparatory, elbow disarticulation or above elbow, single wall plastic socket, friction wrist, locking elbow, figure of eight harness, fair lead cable control, USMC or equal pylon, no cover, molded to patient model

L6586

1,782.69

Preparatory, elbow disarticulation or above elbow, single wall socket, friction wrist, locking elbow, figure of eight harness, fair lead cable control, USMC or equal pylon, no cover, direct formed

L6588

2,998.33

Preparatory, shoulder disarticulation or interscapular thoracic, single wall plastic socket, shoulder joint, locking elbow, friction wrist, chest strap, fair lead cable control, USMC or equal pylon, no cover, molded to patient model

L6590

2,647.08

Preparatory, shoulder disarticulation or interscapular thoracic, single wall socket, shoulder joint, locking elbow, friction wrist, chest strap, fair lead cable control, USMC or equal pylon, no cover, direct formed

L6600

161.14

Upper extremity additions, polycentric hinge, pair

L6605

159.10

Upper extremity additions, single pivot hinge, pair

L6610

143.02

Upper extremity additions, flexible metal hinge, pair

L6611

347.22

Addition to upper extremity prosthesis, external powered, additional switch, any type

L6615

149.23

Upper extremity addition, disconnect locking wrist unit

L6616

61.66

Upper extremity addition, additional disconnect insert for locking wrist unit, each

L6620

276.73

Upper extremity addition, flexion/extension wrist unit, with or without friction

L6621

1,928.92

Upper extremity prosthesis addition, flexion/extension wrist with or without friction, for use with external powered terminal device

L6623

605.94

Upper extremity addition, spring assisted rotational wrist unit with latch release

L6624

3,176.01

Upper extremity addition, flexion/extension and rotation wrist unit

L6625

609.18

Upper extremity addition, rotation wrist unit with cable lock

L6628

488.66

Upper extremity addition, quick disconnect hook adapter, Otto Bock or equal

L6629

129.79

Upper extremity addition, quick disconnect lamination collar with coupling piece, Otto Bock or equal

L6630

246.85

Upper extremity addition, stainless steel, any wrist

L6632

60.00

Upper extremity addition, latex suspension sleeve, each

L6635

154.79

Upper extremity addition, lift assist for elbow

L6637

420.57

Upper extremity addition, nudge control elbow lock

L6638

2,108.91

Upper extremity addition to prosthesis, electric locking feature, only for use with manually powered elbow

L6639

1,286.19

Upper extremity addition, heavy duty feature, any elbow

L6640

240.63

Upper extremity additions, shoulder abduction joint, pair

L6641

163.33

Upper extremity addition, excursion amplifier, pulley type

L6642

228.47

Upper extremity addition, excursion amplifier, lever type

L6645

274.23

Upper extremity addition, shoulder flexion-abduction joint, each

L6646

2,659.81

Upper extremity addition, shoulder joint,

multipositional locking, flexion, adjustable abduction friction control, for use with body powered or external powered system

L6647

437.88

Upper extremity addition, shoulder lock mechanism, body powered actuator

L6648

2,743.22

Upper extremity addition, shoulder lock mechanism, external powered actuator

L6650

317.09

Upper extremity addition, shoulder universal joint, each

L6655

70.61

Upper extremity addition, standard control cable, extra

L6660

100.03

Upper extremity addition, heavy duty control cable

L6665

48.10

Upper extremity addition, Teflon, or equal, cable lining

L6670

43.99

Upper extremity addition, hook to hand, cable adapter

L6672

144.85

Upper extremity addition, harness, chest or shoulder, saddle type

L6675

137.55

Upper extremity addition, harness, (e.g. figure of eight type), single cable design

L6676

108.97

Upper extremity addition, harness, (e.g. figure of eight type), dual cable design

L6677

250.16

Upper extremity addition, harness, triple control, simultaneous operation of terminal device and elbow

L6680

202.80

Upper extremity addition, test socket, wrist disarticulation or below elbow

L6682

246.79

Upper extremity addition, test socket, elbow disarticulation or above elbow

L6684

369.09

Upper extremity addition, test socket, shoulder disarticulation or interscapular thoracic

L6686

676.20

Upper extremity addition, suction socket

L6687

495.50

Upper extremity addition, frame type socket, below elbow or wrist disarticulation

L6688

480.92

Upper extremity addition, frame type socket, above elbow or elbow disarticulation

L6689

591.48

Upper extremity addition, frame type socket, shoulder disarticulation

L6690

620.28

Upper extremity addition, frame type socket, interscapular-thoracic

L6691

395.37

Upper extremity addition, removable insert, each

L6692

534.94

Upper extremity addition, silicone gel insert or equal, each

L6693

2,394.18

Upper extremity addition, locking elbow, forearm counterbalance

L6694

677.72

Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism

L6695

564.73

Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism

L6696

1,109.28

Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code L6694 or L6695)

L6697

1,109.28

Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code L6694 or L6695)

L6698

427.29

Addition to upper extremity prosthesis, below elbow/above elbow, lock mechanism, excludes socket insert

L6703

332.40

Terminal device, passive hand/mitt, any material, any size

L6704

503.08

Terminal device, sport/recreational/work attachment, any material, any size

L6706

343.57

Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined

L6707

1,237.49

Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined

L6708

744.38

Terminal device, hand, mechanical, voluntary opening, any material, any size

L6709

1,040.75

Terminal device, hand, mechanical, voluntary closing, any material, any size

L6805

310.65

Addition to terminal device, modifier wrist unit

L6810

160.41

Addition to terminal device, precision pinch device

L6881

3,447.69

Automatic grasp feature, addition to upper limb electric prosthetic terminal device

L6882

2,615.22

Microprocessor control feature, addition to upper limb prosthetic terminal device

L6883

1,363.19

Replacement socket, below elbow/wrist disarticulation, molded to patient model, for use with or without external power

L6884

1,934.38

Replacement socket, above elbow/elbow disarticulation, molded to patient model, for use with or without external power

L6885

2,736.19

Replacement socket, shoulder disarticulation/

interscapular thoracic, molded to patient model, for use with or without external power

L6890

161.57

Addition to upper extremity prosthesis, glove for terminal device, any material, prefabricated, includes fitting and adjustment

L6895

639.57

Addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated

L6900

1,297.54

Hand restoration (casts, shading and measurements included), partial hand, with glove, thumb or one finger remaining

L6905

1,261.25

Hand restoration (casts, shading and measurements included), partial hand, with glove, multiple fingers remaining

L6910

1,228.71

Hand restoration (casts, shading and measurements included), partial hand, with glove, no fingers remaining

L6915

577.34

Hand restoration (shading and measurements included), replacement glove for above

L6920

6,551.88

Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, Otto Bock or equal switch, cables, two batteries and one charger, switch control of terminal device

L6925

7,617.30

Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, Otto Bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device

L6930

6,388.01

Below elbow, external power, self-suspended inner socket, removable forearm shell, Otto Bock or equal switch, cables, two batteries and one charger, switch control of terminal device

L6935

7,437.03

Below elbow, external power, self-suspended inner socket, removable forearm shell, Otto Bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device

L6940

8,153.41

Elbow disarticulation, external power, molded inner socket, removable humeral shell, outside locking hinges, forearm, Otto Bock or equal switch, cables, two batteries and one charger, switch control of terminal device

L6945

9,280.46

Elbow disarticulation, external power, molded inner socket, removable humeral shell, outside locking hinges, forearm, Otto Bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device

L6950

8,572.50

Above elbow, external power, molded inner socket, removable humeral shell, internal locking elbow, forearm, Otto Bock or equal switch, cables, two batteries and one charger, switch control of terminal device

L6955

10,378.59

Above elbow, external power, molded inner socket, removable humeral shell, internal locking elbow, forearm, Otto Bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device

L6960

11,439.98

Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, Otto Bock or equal switch, cables, two batteries and one charger, switch control of terminal device

L6965

13,422.59

Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, Otto Bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device

L6970

14,367.62

Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, Otto Bock or equal switch, cables, two batteries and one charger, switch control of terminal device

L6975

16,193.97

Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, Otto Bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device

L7007

3,114.32

Electric hand, switch or myoelectric controlled, adult

L7008

5,262.22

Electric hand, switch or myoelectric, controlled, pediatric

L7009

3,264.81

Electric hook, switch or myoelectric controlled, adult

L7040

2,495.91

Prehensile actuator, switch controlled

L7045

1,388.49

Electric hook, switch or myoelectric controlled, pediatric

L7170

5,085.91

Electronic elbow, Hosmer or equal, switch controlled

L7180

32,334.77

Electronic elbow, microprocessor sequential control of elbow and terminal device

L7181

33,790.06

Electronic elbow, microprocessor simultaneous control of elbow and terminal device

L7185

5,297.57

Electronic elbow, adolescent, Variety Village or equal, switch controlled

L7186

8,360.17

Electronic elbow, child, Variety Village or equal, switch controlled

L7190

7,099.57

Electronic elbow, adolescent, Variety Village or equal, myoelectronically controlled

L7191

8,801.11

Electronic elbow, child, Variety Village or equal, myoelectronically controlled

L7260

2,245.57

Electronic wrist rotator, Otto Bock or equal

L7261

4,056.39

Electronic wrist rotator, for Utah arm

L7266

850.51

Servo control, Steeper or equal

L7272

1,891.14

Analogue control, UNB or equal

L7274

6,108.88

Proportional control, six-12 volt, Liberty, Utah or equal

L7360

231.27

Six volt battery, each

L7362

239.02

Battery charger, six volt, each

L7364

432.51

Twelve volt battery, each

L7366

588.81

Battery charger, twelve volt, each

L7367

328.32

Lithium ion battery, replacement

L7368

425.62

Lithium ion battery charger

L7400

258.47

Addition to upper extremity prosthesis, below elbow/wrist disarticulation, ultralight material (titanium, carbon fiber or equal)

L7401

289.35

Addition to upper extremity prosthesis, above elbow disarticulation, ultralight material (titanium, carbon fiber or equal)

L7402

312.48

Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, ultralight material (titanium, carbon fiber or equal)

L7403

310.56

Addition to upper extremity prosthesis, below elbow/wrist disarticulation, acrylic material

L7404

468.72

Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material

L7405

613.03

Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, acrylic material

L7621

I.C.

Terminal device, hook or hand, heavy duty, mechanical, voluntary opening, any material, any size, lined or unlined

L7622

I.C.

Terminal device, hook or hand, heavy duty, mechanical, voluntary closing, any material, any size, lined or unlined

L7900

462.85

Male vacuum erection system

L8000

31.94

Breast prosthesis, mastectomy bra

L8001

105.77

Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral

L8002

139.12

Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral

L8015

50.55

External breast prosthesis garment, with mastectomy form, post-mastectomy

L8020

172.33

Breast prosthesis, mastectomy form

L8030

361.35

Breast prosthesis, silicone or equal

L8035

3,089.60

Custom breast prosthesis, post mastectomy, molded to patient model

L8040

2,256.97

Nasal prosthesis, provided by a nonphysician

L8040

2,256.97

Nasal prosthesis, provided by a nonphysician

L8040

2,256.97

Nasal prosthesis, provided by a nonphysician

L8041

2,720.52

Midfacial prosthesis, provided by a nonphysician

L8041

2,720.52

Midfacial prosthesis, provided by a nonphysician

L8041

2,720.52

Midfacial prosthesis, provided by a nonphysician

L8042

3,056.77

Orbital prosthesis, provided by a nonphysician

L8042

3,056.77

Orbital prosthesis, provided by a nonphysician

L8042

3,056.77

Orbital prosthesis, provided by a nonphysician

L8043

3,423.59

Upper facial prosthesis, provided by a nonphysician

L8043

3,423.59

Upper facial prosthesis, provided by a nonphysician

L8043

3,423.59

Upper facial prosthesis, provided by a nonphysician

L8044

3,790.39

Hemi-facial prosthesis, provided by a nonphysician

L8044

3,790.39

Hemi-facial prosthesis, provided by a nonphysician

L8044

3,790.39

Hemi-facial prosthesis, provided by a nonphysician

L8045

2,382.92

Auricular prosthesis, provided by a nonphysician

L8045

2,382.92

Auricular prosthesis, provided by a nonphysician

L8045

2,382.92

Auricular prosthesis, provided by a nonphysician

L8046

2,445.42

Partial facial prosthesis, provided by a nonphysician

L8046

2,445.42

Partial facial prosthesis, provided by a nonphysician

L8046

2,445.42

Partial facial prosthesis, provided by a nonphysician

L8047

1,253.28

Nasal septal prosthesis, provided by a nonphysician

L8047

1,253.28

Nasal septal prosthesis, provided by a nonphysician

L8047

1,253.28

Nasal septal prosthesis, provided by a nonphysician

L8300

72.46

Truss, single with standard pad

L8310

114.41

Truss, double with standard pads

L8320

60.83

Truss, addition to standard pad, water pad

L8330

56.55

Truss, addition to standard pad, scrotal pad

L8400

15.39

Prosthetic sheath, below knee, each

L8410

23.73

Prosthetic sheath, above knee, each

L8415

24.55

Prosthetic sheath, upper limb, each

L8417

63.32

Prosthetic sheath/sock, including a gel cushion layer, below knee or above knee, each

L8420

17.87

Prosthetic sock, multiple ply, below knee, each

L8430

20.90

Prosthetic sock, multiple ply, above knee, each

L8435

23.31

Prosthetic sock, multiple ply, upper limb, each

L8440

40.40

Prosthetic shrinker, below knee, each

L8460

65.87

Prosthetic shrinker, above knee, each

L8465

44.03

Prosthetic shrinker, upper limb, each

L8470

5.74

Prosthetic sock, single ply, fitting, below knee, each

L8480

10.02

Prosthetic sock, single ply, fitting, above knee, each

L8485

10.04

Prosthetic sock, single ply, fitting, upper limb, each

L8500

638.30

Artificial larynx, any type

L8501

138.36

Tracheostomy speaking valve

L8507

35.33

Tracheo-esophageal voice prosthesis, patient inserted, any type, each

L8509

92.10

Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type

L8510

213.09

Voice amplifier

L8511

61.33

Insert for indwelling tracheoesophageal prosthesis, with or without valve, replacement only, each

L8512

1.82

Gelatin capsules or equivalent, for use with tracheoesophageal voice prosthesis, replacement only, per ten

L8513

4.38

Cleaning device used with tracheoesophageal voice prosthesis, pipet, brush, or equal, replacement only, each

L8514

79.52

Tracheoesophageal puncture dilator, replacement only, each

L8515

53.23

Gelatin capsule, application device for use with tracheoesophageal voice prosthesis, each

L8600

541.09

Implantable breast prosthesis, silicone or equal

L8603

376.16

Injectable bulking agent, collagen implant, urinary tract, 2.5 ml syringe, includes shipping and necessary supplies

L8606

184.87

Injectable bulking agent, synthetic implant, urinary tract, 1 ml syringe, includes shipping and necessary supplies

L8609

5,494.58

Artificial cornea

L8610

502.81

Ocular implant

L8612

616.35

Aqueous shunt

L8613

268.38

Ossicula implant

L8614

16,447.22

Cochlear device, includes all internal and external components

L8615

380.34

Headset/headpiece for use with cochlear implant device, replacement

L8616

88.59

Microphone for use with cochlear implant device, replacement

L8617

77.37

Transmitting coil for use with cochlear implant device, replacement

L8618

22.11

Transmitter cable for use with cochlear implant device, replacement

L8619

7,060.69

Cochlear implant external speech processor, replacement

L8621

0.52

Zinc air battery for use with cochlear implant device, replacement, each

L8622

0.28

Alkaline battery for use with cochlear implant device, any size, replacement, each

L8623

54.55

Lithium ion battery for use with cochlear implant device speech processor, other than ear level, replacement, each

L8624

136.00

Lithium ion battery for use with cochlear implant device speech processor, ear level, replacement, each

L8630

385.88

Metacarpophalangeal joint implant

L8631

1,881.80

Metacarpal phalangeal joint replacement, two or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon), for surgical implantation (all sizes, includes entire system)

L8641

400.93

Metatarsal joint implant

L8642

243.90

Hallux implant

L8658

349.58

Interphalangeal joint spacer, silicone or equal, each

L8659

1,627.34

Interphalangeal finger joint replacement, two or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon) for surgical implantation, any size

L8670

478.18

Vascular graft material, synthetic, implant

L8680

387.36

Implantable neurostimulator electrode, each

L8681

926.72

Patient programmer (external) for use with implantable programmable neurostimulator pulse generator

L8682

5,027.57

Implantable neurostimulator radiofrequency receiver

L8683

4,425.41

Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver

L8684

584.96

Radiofrequency transmitter (external) for use with implantable sacral root neurostimulator receiver for bowel and bladder management, replacement

L8685

11,027.88

Implantable neurostimulator pulse generator, single array, rechargeable, includes extension

L8686

7,036.64

Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension

L8687

14,351.67

Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension

L8688

9,157.52

Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension

L8689

1,454.68

External recharging system for battery (internal) for use with implantable neurostimulator

L8690

4,011.80

Auditory osseointegrated device, includes all internal and external components

L8691

2,248.74

Auditory osseointegrated device, external sound processor, replacement

L8695

14.04

External recharging system for battery (external) for use with implantable neurostimulator

L7614

I.C.

Terminal device, hand, mechanical, voluntary closing, any material, any size, pediatric

L7621

I.C.

Terminal device, hook or hand, heavy duty, mechanical, voluntary opening, any material, any size, lined or unlined

L7622

I.C.

Terminal device, hook or hand, heavy duty, mechanical, voluntary closing, any material, any size, lined or unlined

L7900

462.85

Male vacuum erection system

L8000

31.94

Breast prosthesis, mastectomy bra

L8001

105.77

Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral

L8002

139.12

Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral

L8015

50.55

External breast prosthesis garment, with mastectomy form, post-mastectomy

L8020

172.33

Breast prosthesis, mastectomy form

L8030

361.35

Breast prosthesis, silicone or equal

L8035

3,089.60

Custom breast prosthesis, post mastectomy, molded to patient model

L8040

2,256.97

Nasal prosthesis, provided by a nonphysician

L8041

2,720.52

Midfacial prosthesis, provided by a nonphysician

L8042

3,056.77

Orbital prosthesis, provided by a nonphysician

L8043

3,423.59

Upper facial prosthesis, provided by a nonphysician

L8044

3,790.39

Hemi-facial prosthesis, provided by a nonphysician

L8045

2,382.92

Auricular prosthesis, provided by a nonphysician

L8046

2,445.42

Partial facial prosthesis, provided by a nonphysician

L8047

1,253.28

Nasal septal prosthesis, provided by a nonphysician

L8300

72.46

Truss, single with standard pad

L8310

114.41

Truss, double with standard pads

L8320

60.83

Truss, addition to standard pad, water pad

L8330

56.55

Truss, addition to standard pad, scrotal pad

L8400

15.39

Prosthetic sheath, below knee, each

L8410

23.73

Prosthetic sheath, above knee, each

L8415

24.55

Prosthetic sheath, upper limb, each

L8417

63.32

Prosthetic sheath/sock, including a gel cushion layer, below knee or above knee, each

L8420

17.87

Prosthetic sock, multiple ply, below knee, each

L8430

20.90

Prosthetic sock, multiple ply, above knee, each

L8435

23.31

Prosthetic sock, multiple ply, upper limb, each

L8440

40.40

Prosthetic shrinker, below knee, each

L8460

65.87

Prosthetic shrinker, above knee, each

L8465

44.03

Prosthetic shrinker, upper limb, each

L8470

5.74

Prosthetic sock, single ply, fitting, below knee, each

L8480

10.02

Prosthetic sock, single ply, fitting, above knee, each

L8485

10.04

Prosthetic sock, single ply, fitting, upper limb, each

L8500

638.30

Artificial larynx, any type

L8501

138.36

Tracheostomy speaking valve

L8507

35.33

Tracheo-esophageal voice prosthesis, patient inserted, any type, each

L8509

92.10

Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type

L8510

213.09

Voice amplifier

L8511

61.33

Insert for indwelling tracheoesophageal prosthesis, with or without valve, replacement only, each

L8512

1.82

Gelatin capsules or equivalent, for use with tracheoesophageal voice prosthesis, replacement only, per ten

L8513

4.38

Cleaning device used with tracheoesophageal voice prosthesis, pipet, brush, or equal, replacement only, each

L8514

79.52

Tracheoesophageal puncture dilator, replacement only, each

L8515

53.23

Gelatin capsule, application device for use with tracheoesophageal voice prosthesis, each

L8600

541.09

Implantable breast prosthesis, silicone or equal

L8603

376.16

Injectable bulking agent, collagen implant, urinary tract, 2.5 ml syringe, includes shipping and necessary supplies

L8606

184.87

Injectable bulking agent, synthetic implant, urinary tract, 1 ml syringe, includes shipping and necessary supplies

L8609

5,494.58

Artificial cornea

L8610

502.81

Ocular implant

L8612

616.35

Aqueous shunt

L8613

268.38

Ossicula implant

L8614

16,447.22

Cochlear device, includes all internal and external components

L8615

380.34

Headset/headpiece for use with cochlear implant device, replacement

L8616

88.59

Microphone for use with cochlear implant device, replacement

L8617

77.37

Transmitting coil for use with cochlear implant device, replacement

L8618

22.11

Transmitter cable for use with cochlear implant device, replacement

L8619

7,060.69

Cochlear implant external speech processor, replacement

L8621

0.52

Zinc air battery for use with cochlear implant device, replacement, each

L8622

0.28

Alkaline battery for use with cochlear implant device, any size, replacement, each

L8623

54.55

Lithium ion battery for use with cochlear implant device speech processor, other than ear level, replacement, each

L8624

136.00

Lithium ion battery for use with cochlear implant device speech processor, ear level, replacement, each

L8630

385.88

Metacarpophalangeal joint implant

L8631

1,881.80

Metacarpal phalangeal joint replacement, two or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon), for surgical implantation (all sizes, includes entire system)

L8641

400.93

Metatarsal joint implant

L8642

243.90

Hallux implant

L8658

349.58

Interphalangeal joint spacer, silicone or equal, each

L8659

1,627.34

Interphalangeal finger joint replacement, two or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon) for surgical implantation, any size

L8670

478.18

Vascular graft material, synthetic, implant

L8680

387.36

Implantable neurostimulator electrode, each

L8681

926.72

Patient programmer (external) for use with implantable programmable neurostimulator pulse generator

L8682

5,027.57

Implantable neurostimulator radiofrequency receiver

L8683

4,425.41

Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver

L8684

584.96

Radiofrequency transmitter (external) for use with implantable sacral root neurostimulator receiver for bowel and bladder management, replacement

L8685

11,027.88

Implantable neurostimulator pulse generator, single array, rechargeable, includes extension

L8686

7,036.64

Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension

L8687

14,351.67

Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension

L8688

9,157.52

Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension

L8689

1,454.68

External recharging system for battery (internal) for use with implantable neurostimulator

L8690

4,011.80

Auditory osseointegrated device, includes all internal and external components

L8691

2,248.74

Auditory osseointegrated device, external sound processor, replacement

L8695

14.04

External recharging system for battery (external) for use with implantable neurostimulator
(7) Freestanding Diagnostic Facilities/Radiology.

Code

Global

PC

TC

40.06(7) - Radiologic Service Description

70010

222.25

60.54

161.71

Myelography, posterior fossa, radiological supervision and interpretation

70015

152.67

61.90

90.77

Cisternography, positive contrast, radiological supervision and interpretation

70030

31.56

8.87

22.69

Radiologic examination, eye, for detection of foreign body

70100

35.12

9.21

25.91

Radiologic examination, mandible; partial, less than four views

70110

44.56

12.52

32.04

Radiologic examination, mandible; complete, minimum of four views

70120

39.40

9.21

30.20

Radiologic examination, mastoids; less than three views per side

70130

60.66

17.27

43.38

Radiologic examination, mastoids; complete, minimum of three views per side

70134

53.75

17.27

36.48

Radiologic examination, internal auditory meati, complete

70140

36.52

9.55

26.97

Radiologic examination, facial bones; less than three views

70150

49.80

12.86

36.94

Radiologic examination, facial bones; complete, minimum of three views

70160

36.16

8.87

27.30

Radiologic examination, nasal bones, complete, minimum of three views

70170

I.C.

15.15

I.C.

Dacryocystography, nasolacrimal duct, radiological supervision and interpretation

70190

41.35

10.69

30.66

Radiologic examination; optic foramina

70200

51.40

14.00

37.40

Radiologic examination; orbits, complete, minimum of four views

70210

35.84

8.41

27.44

Radiologic examination, sinuses, paranasal, less than three views

70220

47.16

12.52

34.64

Radiologic examination, sinuses, paranasal, complete, minimum of three views

70240

32.24

9.55

22.69

Radiologic examination, sella turcica

70250

41.45

11.72

29.74

Radiologic examination, skull; less than four views

70260

57.27

17.27

40.00

Radiologic examination, skull; complete, minimum of four views

70300

16.74

5.56

11.19

Radiologic examination, teeth; single view

70310

36.28

8.52

27.76

Radiologic examination, teeth; partial examination, less than full mouth

70320

53.96

11.49

42.46

Radiologic examination, teeth; complete, full mouth

70328

34.20

9.21

24.99

Radiologic examination, temporomandibular joint, open and closed mouth; unilateral

70330

54.18

12.18

42.00

Radiologic examination, temporomandibular joint, open and closed mouth; bilateral

70332

109.17

27.32

81.84

Temporomandibular joint arthrography, radiological supervision and interpretation

70336

619.89

75.64

544.25

Magnetic resonance (eg, proton) imaging, temporomandibular joint(s)

70350

24.65

8.87

15.79

Cephalogram, orthodontic

70355

29.96

10.35

19.61

Orthopantogram

70360

30.64

8.87

21.77

Radiologic examination; neck, soft tissue

70370

83.75

15.83

67.92

Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique

70371

122.31

42.31

80.00

Complex dynamic pharyngeal and speech evaluation by cine or video recording

70373

99.93

21.61

78.32

Laryngography, contrast, radiological supervision and interpretation

70380

43.21

8.87

34.34

Radiologic examination, salivary gland for calculus

70390

114.91

19.56

95.35

Sialography, radiological supervision and interpretation

70450

266.01

43.57

222.45

Computed tomography, head or brain; without contrast material

70460

338.13

58.03

280.10

Computed tomography, head or brain; with contrast material(s)

70470

411.13

64.95

346.18

Computed tomography, head or brain; without contrast material, followed by contrast material(s) and further sections

70480

366.45

65.29

301.15

Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material

70481

428.43

70.55

357.89

Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s)

70482

498.74

73.86

424.88

Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material, followed by contrast material(s) and further sections

70486

321.32

57.91

263.41

Computed tomography, maxillofacial area; without contrast material

70487

387.96

66.90

321.06

Computed tomography, maxillofacial area; with contrast material(s)

70488

474.24

72.38

401.87

Computed tomography, maxillofacial area; without contrast material, followed by contrast material(s) and further sections

70490

320.88

65.75

255.13

Computed tomography, soft tissue neck; without contrast material

70491

383.79

70.55

313.24

Computed tomography, soft tissue neck; with contrast material(s)

70492

466.98

73.86

393.12

Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections

70496

730.37

89.77

640.61

Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing

70498

733.59

90.23

643.37

Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and image postprocessing

70540

653.81

68.60

585.20

Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s)

70542

745.35

82.73

662.62

Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s)

70543

1,122.49

109.55

1,012.94

Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s), followed by contrast material(s) and further sequences

70544

692.12

61.34

630.78

Magnetic resonance angiography, head; without contrast material(s)

70545

689.36

61.34

628.02

Magnetic resonance angiography, head; with contrast material(s)

70546

1,164.58

91.93

1,072.65

Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further sequences

70547

690.28

60.88

629.40

Magnetic resonance angiography, neck; without contrast material(s)

70548

710.53

61.34

649.19

Magnetic resonance angiography, neck; with contrast material(s)

70549

1,164.58

91.93

1,072.65

Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further sequences

70551

671.90

75.64

596.26

Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material

70552

766.29

91.25

675.04

Magnetic resonance (eg, proton) imaging, brain (including brain stem); with contrast material(s)

70553

1,129.94

120.40

1,009.54

Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences

70554

809.37

106.80

702.57

Magnetic resonance imaging, brain, functional MRI; including test selection and administration of repetitive body part movement and/or visual stimulation, not requiring physician or psychologist administration

70555

I.C.

131.45

I.C.

Magnetic resonance imaging, brain, functional MRI; requiring physician or psychologist administration of entire neurofunctional testing

70557

I.C.

151.12

I.C.

Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial procedure (eg, to assess for residual tumor or residual vascular malformation); without contrast material

70558

I.C.

166.11

I.C.

Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial procedure (eg, to assess for residual tumor or residual vascular malformation); with contrast material(s)

70559

I.C.

167.63

I.C.

Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial procedure (eg, to assess for residual tumor or residual vascular malformation); without contrast material(s), followed by contrast material(s) and further sequences

71010

29.14

9.21

19.93

Radiologic examination, chest; single view, frontal

71015

34.77

10.69

24.07

Radiologic examination, chest; stereo, frontal

71020

38.01

11.03

26.97

Radiologic examination, chest, two views, frontal and lateral;

71021

46.46

13.66

32.80

Radiologic examination, chest, two views, frontal and lateral; with apical lordotic procedure

71022

51.97

15.49

36.48

Radiologic examination, chest, two views, frontal and lateral; with oblique projections

71023

71.39

19.72

51.67

Radiologic examination, chest, two views, frontal and lateral; with fluoroscopy

71030

53.81

15.49

38.32

Radiologic examination, chest, complete, minimum of four views;

71034

103.86

24.59

79.26

Radiologic examination, chest, complete, minimum of four views; with fluoroscopy

71035

38.34

9.21

29.14

Radiologic examination, chest, special views (eg, lateral decubitus, Bucky studies)

71040

108.25

28.99

79.26

Bronchography, unilateral, radiological supervision and interpretation

71060

158.02

37.67

120.35

Bronchography, bilateral, radiological supervision and interpretation

71090

I.C.

30.08

I.C.

Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation

71100

38.01

11.03

26.97

Radiologic examination, ribs, unilateral; two views

71101

45.70

13.66

32.04

Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of three views

71110

48.76

13.66

35.10

Radiologic examination, ribs, bilateral; three views

71111

60.43

15.83

44.60

Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of four views

71120

39.63

10.35

29.28

Radiologic examination; sternum, minimum of two

views

71130

43.99

11.03

32.96

Radiologic examination; sternoclavicular joint or joints, minimum of three views

71250

343.60

59.06

284.54

Computed tomography, thorax; without contrast material

71260

411.18

63.17

348.02

Computed tomography, thorax; with contrast material(s)

71270

508.26

70.55

437.71

Computed tomography, thorax; without contrast material, followed by contrast material(s) and further sections

71275

650.23

98.63

551.60

Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing

71550

710.91

74.20

636.71

Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast material(s)

71551

812.12

88.16

723.96

Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); with contrast material(s)

71552

1,209.82

115.60

1,094.22

Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast material(s), followed by contrast material(s) and further sequences

71555

706.02

93.19

612.83

Magnetic resonance angiography, chest (excluding myocardium), with or without contrast material(s)

72010

77.60

22.41

55.19

Radiologic examination, spine, entire, survey study, anteroposterior and lateral

72020

27.65

7.72

19.93

Radiologic examination, spine, single view, specify level

72040

42.15

11.03

31.12

Radiologic examination, spine, cervical; two or three views

72050

60.09

15.49

44.60

Radiologic examination, spine, cervical; minimum of four views

72052

75.45

18.41

57.03

Radiologic examination, spine, cervical; complete, including oblique and flexion and/or extension studies

72069

38.79

11.49

27.30

Radiologic examination, spine, thoracolumbar, standing (scoliosis)

72070

40.31

11.03

29.28

Radiologic examination, spine; thoracic, two views

72072

45.21

11.03

34.18

Radiologic examination, spine; thoracic, three views

72074

53.80

11.03

42.76

Radiologic examination, spine; thoracic, minimum of four views

72080

41.69

11.03

30.66

Radiologic examination, spine; thoracolumbar, two views

72090

52.02

14.46

37.56

Radiologic examination, spine; scoliosis study, including supine and erect studies

72100

44.45

11.03

33.42

Radiologic examination, spine, lumbosacral; two or three views

72110

61.93

15.49

46.45

Radiologic examination, spine, lumbosacral; minimum of four views

72114

80.51

18.41

62.10

Radiologic examination, spine, lumbosacral; complete, including bending views

72120

56.10

11.03

45.06

Radiologic examination, spine, lumbosacral, bending views only, minimum of four views

72125

344.06

59.06

285.00

Computed tomography, cervical spine; without contrast material

72126

410.04

62.02

348.02

Computed tomography, cervical spine; with contrast material

72127

503.58

64.95

438.63

Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections

72128

343.60

59.06

284.54

Computed tomography, thoracic spine; without contrast material

72129

410.50

62.49

348.02

Computed tomography, thoracic spine; with contrast material

72130

502.20

64.95

437.25

Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections

72131

343.14

59.06

284.08

Computed tomography, lumbar spine; without contrast material

72132

409.58

62.02

347.56

Computed tomography, lumbar spine; with contrast material

72133

503.12

64.95

438.17

Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections

72141

631.35

81.58

549.77

Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material

72142

772.75

98.17

674.58

Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; with contrast material(s)

72146

661.85

81.58

580.27

Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; without contrast material

72147

725.80

98.17

627.63

Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; with contrast material(s)

72148

655.45

75.64

579.81

Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material

72149

764.91

91.25

673.66

Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; with contrast material(s)

72156

1,132.34

131.09

1,001.25

Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; cervical

72157

1,095.98

131.09

964.89

Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; thoracic

72158

1,121.19

120.40

1,000.79

Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; lumbar

72159

718.83

89.77

629.06

Magnetic resonance angiography, spinal canal and contents, with or without contrast material(s)

72170

31.56

8.87

22.69

Radiologic examination, pelvis; one or two views

72190

45.03

10.69

34.34

Radiologic examination, pelvis; complete, minimum of three views

72191

627.76

93.19

534.57

Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing

72192

331.08

55.75

275.33

Computed tomography, pelvis; without contrast material

72193

392.04

59.52

332.53

Computed tomography, pelvis; with contrast material(s)

72194

493.77

62.02

431.75

Computed tomography, pelvis; without contrast material, followed by contrast material(s) and further sections

72195

666.26

74.20

592.06

Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s)

72196

757.35

88.62

668.73

Magnetic resonance (eg, proton) imaging, pelvis; with contrast material(s)

72197

1,134.16

115.14

1,019.02

Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s), followed by contrast material(s) and further sequences

72198

700.16

91.93

608.23

Magnetic resonance angiography, pelvis, with or without contrast material(s)

72200

33.86

8.87

24.99

Radiologic examination, sacroiliac joints; less than three views

72202

40.67

9.55

31.12

Radiologic examination, sacroiliac joints; three or

more views

72220

35.38

8.87

26.51

Radiologic examination, sacrum and coccyx, minimum of two views

72240

214.67

46.08

168.59

Myelography, cervical, radiological supervision and interpretation

72255

196.74

45.16

151.58

Myelography, thoracic, radiological supervision and interpretation

72265

194.01

41.97

152.04

Myelography, lumbosacral, radiological supervision and interpretation

72270

299.67

67.92

231.75

Myelography, two or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical), radiological supervision and interpretation

72275

126.72

36.35

90.37

Epidurography, radiological supervision and interpretation

72285

288.88

56.89

231.98

Discography, cervical or thoracic, radiological supervision and interpretation

72291

I.C.

69.36

I.C.

Radiological supervision and interpretation, percutaneous vertebroplasty or vertebral augmentation including cavity creation, per vertebral body; under fluoroscopic guidance

72292

I.C.

71.77

I.C.

Radiological supervision and interpretation, percutaneous vertebroplasty or vertebral augmentation including cavity creation, per vertebral body; under CT guidance

72295

263.06

42.10

220.96

Discography, lumbar, radiological supervision and interpretation

73000

32.14

8.06

24.07

Radiologic examination; clavicle, complete

73010

33.40

8.87

24.53

Radiologic examination; scapula, complete

73020

28.11

7.72

20.39

Radiologic examination, shoulder; one view

73030

35.26

9.21

26.05

Radiologic examination, shoulder; complete, minimum of two views

73040

127.12

27.78

99.34

Radiologic examination, shoulder, arthrography, radiological supervision and interpretation

73050

41.93

10.35

31.58

Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction

73060

34.92

8.87

26.05

Radiologic examination; humerus, minimum of two views

73070

31.80

7.72

24.07

Radiologic examination, elbow; two views

73080

39.06

8.87

30.20

Radiologic examination, elbow; complete, minimum of three views

73085

117.91

27.78

90.13

Radiologic examination, elbow, arthrography, radiological supervision and interpretation

73090

32.14

8.06

24.07

Radiologic examination; forearm, two views

73092

32.14

8.06

24.07

Radiologic examination; upper extremity, infant, minimum of two views

73100

32.60

8.06

24.53

Radiologic examination, wrist; two views

73110

38.00

8.87

29.14

Radiologic examination, wrist; complete, minimum of three views

73115

115.93

27.32

88.61

Radiologic examination, wrist, arthrography, radiological supervision and interpretation

73120

31.68

8.06

23.61

Radiologic examination, hand; two views

73130

35.70

8.87

26.84

Radiologic examination, hand; minimum of three views

73140

31.57

6.58

24.99

Radiologic examination, finger(s), minimum of two

views

73200

315.93

55.75

260.19

Computed tomography, upper extremity; without contrast material

73201

377.20

59.06

318.14

Computed tomography, upper extremity; with contrast material(s)

73202

477.84

62.02

415.82

Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections

73206

593.24

93.19

500.05

Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing

73218

664.85

68.60

596.25

Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s)

73219

748.11

82.73

665.39

Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s)

73220

1,129.39

110.01

1,019.39

Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by contrast material(s) and further sequences

73221

639.54

68.60

570.93

Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s)

73222

722.80

82.73

640.07

Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s)

73223

1,095.33

109.55

985.79

Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s), followed by contrast material(s) and further sequences

73225

685.48

86.46

599.02

Magnetic resonance angiography, upper extremity, with or without contrast material(s)

73500

30.18

8.87

21.31

Radiologic examination, hip, unilateral; one view

73510

41.35

10.69

30.66

Radiologic examination, hip, unilateral; complete, minimum of two views

73520

45.82

13.32

32.50

Radiologic examination, hips, bilateral, minimum of two views of each hip, including anteroposterior view of pelvis

73525

117.75

27.62

90.13

Radiologic examination, hip, arthrography, radiological supervision and interpretation

73530

I.C.

14.80

I.C.

Radiologic examination, hip, during operative procedure

73540

41.47

10.35

31.12

Radiologic examination, pelvis and hips, infant or child, minimum of two views

73542

102.89

27.95

74.94

Radiological examination, sacroiliac joint arthrography, radiological supervision and interpretation

73550

34.46

8.87

25.59

Radiologic examination, femur, two views

73560

33.40

8.87

24.53

Radiologic examination, knee; one or two views

73562

38.94

9.21

29.74

Radiologic examination, knee; three views

73564

44.45

11.03

33.42

Radiologic examination, knee; complete, four or more

views

73565

34.32

8.87

25.45

Radiologic examination, knee; both knees, standing, anteroposterior

73580

146.89

27.62

119.27

Radiologic examination, knee, arthrography, radiological supervision and interpretation

73590

32.48

8.87

23.61

Radiologic examination; tibia and fibula, two views

73592

32.14

8.06

24.07

Radiologic examination; lower extremity, infant, minimum of two views

73600

31.68

8.06

23.61

Radiologic examination, ankle; two views

73610

35.70

8.87

26.84

Radiologic examination, ankle; complete, minimum of three views

73615

121.43

27.62

93.81

Radiologic examination, ankle, arthrography, radiological supervision and interpretation

73620

31.22

8.06

23.15

Radiologic examination, foot; two views

73630

35.70

8.87

26.84

Radiologic examination, foot; complete, minimum of three views

73650

30.76

8.06

22.69

Radiologic examination; calcaneus, minimum of two

views

73660

30.65

6.58

24.07

Radiologic examination; toe(s), minimum of two views

73700

315.93

55.75

260.19

Computed tomography, lower extremity; without contrast material

73701

379.04

59.52

319.52

Computed tomography, lower extremity; with contrast material(s)

73702

481.98

62.49

419.50

Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections

73706

629.92

98.11

531.81

Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing

73718

656.11

68.60

587.50

Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s)

73719

748.11

82.73

665.39

Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s)

73720

1,127.55

109.55

1,018.01

Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by contrast material(s) and further sequences

73721

646.90

68.60

578.30

Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material

73722

726.94

82.73

644.21

Magnetic resonance (eg, proton) imaging, any joint of lower extremity; with contrast material(s)

73723

1,095.33

110.01

985.33

Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by contrast material(s) and further sequences

73725

702.22

93.08

609.15

Magnetic resonance angiography, lower extremity, with or without contrast material(s)

74000

30.98

9.21

21.77

Radiologic examination, abdomen; single anteroposterior view

74010

42.49

11.83

30.66

Radiologic examination, abdomen; anteroposterior and additional oblique and cone views

74020

45.70

13.66

32.04

Radiologic examination, abdomen; complete, including decubitus and/or erect views

74022

54.61

16.29

38.32

Radiologic examination, abdomen; complete acute abdomen series, including supine, erect, and/or decubitus views, single view chest

74150

330.51

61.00

269.51

Computed tomography, abdomen; without contrast material

74160

426.48

65.41

361.06

Computed tomography, abdomen; with contrast material(s)

74170

549.01

71.69

477.31

Computed tomography, abdomen; without contrast material, followed by contrast material(s) and further sections

74175

652.47

97.19

555.28

Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and image postprocessing

74181

620.70

74.66

546.03

Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s)

74182

801.54

88.62

712.91

Magnetic resonance (eg, proton) imaging, abdomen; with contrast material(s)

74183

1,134.63

115.14

1,019.48

Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s), followed by with contrast material(s) and further sequences

74185

700.16

91.93

608.23

Magnetic resonance angiography, abdomen, with or without contrast material(s)

74190

I.C.

24.35

I.C.

Peritoneogram (eg, after injection of air or contrast), radiological supervision and interpretation

74210

85.57

18.41

67.16

Radiologic examination; pharynx and/or cervical esophagus

74220

95.43

23.67

71.76

Radiologic examination; esophagus

74230

99.96

26.98

72.98

Swallowing function, with cineradiography/ videoradiography

74235

I.C.

61.92

I.C.

Removal of foreign body(s), esophageal, with use of balloon catheter, radiological supervision and interpretation

74240

118.91

35.50

83.41

Radiologic examination, gastrointestinal tract, upper; with or without delayed films, without KUB

74241

125.36

35.04

90.31

Radiologic examination, gastrointestinal tract, upper; with or without delayed films, with KUB

74245

188.98

46.54

142.44

Radiologic examination, gastrointestinal tract, upper; with small intestine, includes multiple serial films

74246

135.16

35.50

99.66

Radiological examination, gastrointestinal tract, upper, air contrast, with specific high density barium, effervescent agent, with or without glucagon; with or without delayed films, without KUB

74247

146.05

35.50

110.54

Radiological examination, gastrointestinal tract, upper, air contrast, with specific high density barium, effervescent agent, with or without glucagon; with or without delayed films, with KUB

74249

202.63

46.54

156.09

Radiological examination, gastrointestinal tract, upper, air contrast, with specific high density barium, effervescent agent, with or without glucagon; with small intestine follow-through

74250

109.42

24.01

85.41

Radiologic examination, small intestine, includes multiple serial films;

74251

292.60

35.50

257.09

Radiologic examination, small intestine, includes multiple serial films; via enteroclysis tube

74260

249.29

25.50

223.79

Duodenography, hypotonic

74270

154.79

35.50

119.29

Radiologic examination, colon; barium enema, with or without KUB

74280

211.50

50.19

161.31

Radiologic examination, colon; air contrast with specific high density barium, with or without glucagon

74283

230.06

102.51

127.55

Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium ileus)

74290

68.42

16.29

52.13

Cholecystography, oral contrast;

74291

54.68

10.35

44.33

Cholecystography, oral contrast; additional or repeat examination or multiple day examination

74300

I.C.

18.41

I.C.

Cholangiography and/or pancreatography; intraoperative, radiological supervision and interpretation

74301

I.C.

10.69

I.C.

Cholangiography and/or pancreatography; additional set intraoperative, radiological supervision and interpretation (List separately in addition to code for primary procedure)

74305

I.C.

21.84

I.C.

Cholangiography and/or pancreatography; through existing catheter, radiological supervision and interpretation

74320

149.79

27.78

122.01

Cholangiography, percutaneous, transhepatic, radiological supervision and interpretation

74327

142.25

35.85

106.40

Postoperative biliary duct calculus removal, percutaneous via T-tube tract, basket, or snare (eg, Burhenne technique), radiological supervision and interpretation

74328

I.C.

36.31

I.C.

Endoscopic catheterization of the biliary ductal system, radiological supervision and interpretation

74329

I.C.

36.31

I.C.

Endoscopic catheterization of the pancreatic ductal system, radiological supervision and interpretation

74330

I.C.

46.20

I.C.

Combined endoscopic catheterization of the biliary and pancreatic ductal systems, radiological supervision and interpretation

74340

I.C.

27.78

I.C.

Introduction of long gastrointestinal tube (eg, Miller-Abbott), including multiple fluoroscopies and films, radiological supervision and interpretation

74355

I.C.

38.82

I.C.

Percutaneous placement of enteroclysis tube, radiological supervision and interpretation

74360

I.C.

28.70

I.C.

Intraluminal dilation of strictures and/or obstructions (eg, esophagus), radiological supervision and interpretation

74363

I.C.

45.05

I.C.

Percutaneous transhepatic dilation of biliary duct stricture with or without placement of stent, radiological supervision and interpretation

74400

122.81

25.15

97.65

Urography (pyelography), intravenous, with or without KUB, with or without tomography

74410

131.09

25.15

105.94

Urography, infusion, drip technique and/or bolus technique;

74415

148.88

25.15

123.73

Urography, infusion, drip technique and/or bolus technique; with nephrotomography

74420

I.C.

18.87

I.C.

Urography, retrograde, with or without KUB

74425

I.C.

18.87

I.C.

Urography, antegrade (pyelostogram, nephrostogram,

loopogram), radiological supervision and interpretation

74430

85.13

16.59

68.54

Cystography, minimum of thee views, radiological supervision and interpretation

74440

92.70

19.56

73.14

Vasography, vesiculography, or epididymography, radiological supervision and interpretation

74445

I.C.

59.89

I.C.

Corpora cavernosography, radiological supervision and interpretation

74450

I.C.

17.39

I.C.

Urethrocystography, retrograde, radiological supervision and interpretation

74455

104.16

17.39

86.77

Urethrocystography, voiding, radiological supervision and interpretation

74470

I.C.

27.32

I.C.

Radiologic examination, renal cyst study, translumbar, contrast visualization, radiological supervision and interpretation

74475

172.46

27.78

144.68

Introduction of intracatheter or catheter into renal pelvis for drainage and/or injection, percutaneous, radiological supervision and interpretation

74480

172.46

27.78

144.68

Introduction of ureteral catheter or stent into ureter through renal pelvis for drainage and/or injection, percutaneous, radiological supervision and interpretation

74485

153.31

28.08

125.23

Dilation of nephrostomy, ureters, or urethra, radiological supervision and interpretation

74710

55.43

17.27

38.16

Pelvimetry, with or without placental localization

74740

89.32

19.56

69.76

Hysterosalpingography, radiological supervision and interpretation

74742

I.C.

30.93

I.C.

Transcervical catheterization of fallopian tube, radiological supervision and interpretation

74775

I.C.

31.73

I.C.

Perineogram (eg, vaginogram, for sex determination or extent of anomalies)

75557

628.05

126.50

501.55

Cardiac magnetic resonance imaging for morphology and function without contrast material;

75558

691.13

119.69

571.45

Cardiac magnetic resonance imaging for morphology and function without contrast material; with flow/velocity quantification

75559

924.24

162.18

762.07

Cardiac magnetic resonance imaging for morphology and function without contrast material; with stress imaging

75560

907.52

137.49

770.03

Cardiac magnetic resonance imaging for morphology and function without contrast material; with flow/velocity quantification and stress

75561

856.37

139.94

716.44

Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences;

75562

900.41

131.33

769.09

Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; with flow/velocity quantification

75563

1,065.49

169.25

896.25

Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; with stress imaging

75564

1,058.78

153.72

905.07

Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; with flow/velocity quantification and stress

75600

479.60

27.46

452.15

Aortography, thoracic, without serialography, radiological supervision and interpretation

75605

441.02

60.67

380.34

Aortography, thoracic, by serialography, radiological supervision and interpretation

75625

436.25

59.13

377.12

Aortography, abdominal, by serialography, radiological supervision and interpretation

75630

488.30

94.79

393.51

Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation

75635

779.07

124.36

654.70

Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast material(s), including noncontrast images, if performed, and image postprocessing

75650

454.95

77.37

377.58

Angiography, cervicocerebral, catheter, including vessel origin, radiological supervision and interpretation

75658

453.41

68.00

385.41

Angiography, brachial, retrograde, radiological supervision and interpretation

75660

455.87

68.16

387.71

Angiography, external carotid, unilateral, selective, radiological supervision and interpretation

75662

497.28

88.39

408.88

Angiography, external carotid, bilateral, selective, radiological supervision and interpretation

75665

461.83

68.60

393.23

Angiography, carotid, cerebral, unilateral, radiological supervision and interpretation

75671

498.50

85.93

412.56

Angiography, carotid, cerebral, bilateral, radiological supervision and interpretation

75676

455.71

68.00

387.71

Angiography, carotid, cervical, unilateral, radiological supervision and interpretation

75680

486.99

86.39

400.60

Angiography, carotid, cervical, bilateral, radiological supervision and interpretation

75685

455.87

68.16

387.71

Angiography, vertebral, cervical, and/or intracranial, radiological supervision and interpretation

75705

500.56

113.31

387.25

Angiography, spinal, selective, radiological supervision and interpretation

75710

450.82

59.89

390.93

Angiography, extremity, unilateral, radiological supervision and interpretation

75716

479.64

68.00

411.64

Angiography, extremity, bilateral, radiological supervision and interpretation

75722

447.92

60.67

387.25

Angiography, renal, unilateral, selective (including flush aortogram), radiological supervision and interpretation

75724

493.01

82.29

410.72

Angiography, renal, bilateral, selective (including flush aortogram), radiological supervision and interpretation

75726

445.16

58.37

386.79

Angiography, visceral, selective or supraselective (with or without flush aortogram), radiological supervision and interpretation

75731

453.29

60.97

392.31

Angiography, adrenal, unilateral, selective, radiological supervision and interpretation

75733

492.23

71.84

420.39

Angiography, adrenal, bilateral, selective, radiological supervision and interpretation

75736

448.68

59.59

389.09

Angiography, pelvic, selective or supraselective, radiological supervision and interpretation

75741

439.30

67.70

371.60

Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation

75743

463.05

85.47

377.58

Angiography, pulmonary, bilateral, selective, radiological supervision and interpretation

75746

440.10

58.37

381.72

Angiography, pulmonary, by nonselective catheter or venous injection, radiological supervision and interpretation

75756

460.05

63.60

396.45

Angiography, internal mammary, radiological supervision and interpretation

75774

383.11

18.87

364.23

Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation (List separately in addition to code for primary procedure)

75790

184.83

93.14

91.69

Angiography, arteriovenous shunt (eg, dialysis patient), radiological supervision and interpretation

75801

I.C.

41.56

I.C.

Lymphangiography, extremity only, unilateral, radiological supervision and interpretation

75803

I.C.

59.40

I.C.

Lymphangiography, extremity only, bilateral, radiological supervision and interpretation

75805

I.C.

41.58

I.C.

Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and interpretation

75807

I.C.

59.40

I.C.

Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation

75809

89.03

23.55

65.48

Shuntogram for investigation of previously placed indwelling nonvascular shunt (eg, LeVeen shunt, ventriculoperitoneal shunt, indwelling infusion pump), radiological supervision and interpretation

75810

I.C.

57.91

I.C.

Splenoportography, radiological supervision and interpretation

75820

122.80

36.77

86.03

Venography, extremity, unilateral, radiological supervision and interpretation

75822

155.16

54.26

100.90

Venography, extremity, bilateral, radiological supervision and interpretation

75825

426.89

58.51

368.38

Venography, caval, inferior, with serialography, radiological supervision and interpretation

75827

426.75

57.45

369.30

Venography, caval, superior, with serialography, radiological supervision and interpretation

75831

428.89

57.75

371.14

Venography, renal, unilateral, selective, radiological supervision and interpretation

75833

459.23

76.59

382.65

Venography, renal, bilateral, selective, radiological supervision and interpretation

75840

427.81

58.05

369.76

Venography, adrenal, unilateral, selective, radiological supervision and interpretation

75842

460.01

76.45

383.57

Venography, adrenal, bilateral, selective, radiological supervision and interpretation

75860

437.04

60.37

376.66

Venography, venous sinus (eg, petrosal and inferior sagittal) or jugular, catheter, radiological supervision and interpretation

75870

435.03

58.83

376.20

Venography, superior sagittal sinus, radiological supervision and interpretation

75872

454.76

61.99

392.77

Venography, epidural, radiological supervision and interpretation

75880

127.86

36.31

91.55

Venography, orbital, radiological supervision and interpretation

75885

444.66

73.52

371.14

Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation

75887

450.18

74.90

375.28

Percutaneous transhepatic portography without hemodynamic evaluation, radiological supervision and interpretation

75889

429.51

58.37

371.14

Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation

75891

429.05

58.37

370.68

Hepatic venography, wedged or free, without hemodynamic evaluation, radiological supervision and interpretation

75893

398.92

27.78

371.14

Venous sampling through catheter, with or without angiography (eg, for parathyroid hormone, renin), radiological supervision and interpretation

75894

I.C.

67.38

I.C.

Transcatheter therapy, embolization, any method, radiological supervision and interpretation

75896

I.C.

68.32

I.C.

Transcatheter therapy, infusion, any method (eg, thrombolysis other than coronary), radiological supervision and interpretation

75898

I.C.

85.59

I.C.

Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion

75900

I.C.

24.99

I.C.

Exchange of a previously placed intravascular catheter during thrombolytic therapy with contrast monitoring, radiological supervision and interpretation

75901

171.55

25.15

146.39

Mechanical removal of pericatheter obstructive material (eg, fibrin sheath) from central venous device via separate venous access, radiologic supervision and interpretation

75902

109.22

19.90

89.32

Mechanical removal of intraluminal (intracatheter) obstructive material from central venous device through device lumen, radiologic supervision and interpretation

75940

I.C.

27.92

I.C.

Percutaneous placement of IVC filter, radiological supervision and interpretation

75945

I.C.

21.30

I.C.

Intravascular ultrasound (non-coronary vessel), radiological supervision and interpretation; initial vessel

75946

I.C.

21.14

I.C.

Intravascular ultrasound (non-coronary vessel), radiological supervision and interpretation; each additional non-coronary vessel (List separately in addition to code for primary procedure)

75952

I.C.

230.17

I.C.

Endovascular repair of infrarenal abdominal aortic aneurysm or dissection, radiological supervision and interpretation

75953

I.C.

69.66

I.C.

Placement of proximal or distal extension prosthesis for endovascular repair of infrarenal aortic or iliac artery aneurysm, pseudoaneurysm, or dissection, radiological supervision and interpretation

75954

I.C.

113.54

I.C.

Endovascular repair of iliac artery aneurysm, pseudoaneurysm, arteriovenous malformation, or trauma, radiological supervision and interpretation

75956

I.C.

365.09

I.C.

Endovascular repair of descending thoracic aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption); involving coverage of left subclavian artery origin, initial endoprosthesis plus descending thoracic aortic extension(s), if required, to level of celiac artery origin, radiological supervision and interpretation

75957

I.C.

313.22

I.C.

Endovascular repair of descending thoracic aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption); not involving coverage of left subclavian artery origin, initial endoprosthesis plus descending thoracic aortic extension(s), if required, to level of celiac artery origin, radiological supervision and interpretation

75958

I.C.

208.10

I.C.

Placement of proximal extension prosthesis for endovascular repair of descending thoracic aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption), radiological supervision and interpretation

75959

I.C.

182.16

I.C.

Placement of distal extension prosthesis(s) (delayed) after endovascular repair of descending thoracic aorta, as needed, to level of celiac origin, radiological supervision and interpretation

75960

464.53

43.30

421.22

Transcatheter introduction of intravascular stent(s) (except coronary, carotid, and vertebral vessel), percutaneous and/or open, radiological supervision and interpretation, each vessel

75961

548.22

216.44

331.78

Transcatheter retrieval, percutaneous, of intravascular foreign body (eg, fractured venous or arterial catheter), radiological supervision and interpretation

75962

491.61

28.08

463.53

Transluminal balloon angioplasty, peripheral artery, radiological supervision and interpretation

75964

276.01

18.71

257.30

Transluminal balloon angioplasty, each additional peripheral artery, radiological supervision and interpretation (List separately in addition to code for primary procedure)

75966

540.43

70.00

470.43

Transluminal balloon angioplasty, renal or other visceral artery, radiological supervision and interpretation

75968

277.09

19.33

257.76

Transluminal balloon angioplasty, each additional visceral artery, radiological supervision and interpretation (List separately in addition to code for primary procedure)

75970

I.C.

42.89

I.C.

Transcatheter biopsy, radiological supervision and interpretation

75978

485.79

27.32

458.46

Transluminal balloon angioplasty, venous (eg, subclavian stenosis), radiological supervision and interpretation

75980

I.C.

73.98

I.C.

Percutaneous transhepatic biliary drainage with contrast monitoring, radiological supervision and interpretation

75982

I.C.

73.98

I.C.

Percutaneous placement of drainage catheter for combined internal and external biliary drainage or of a drainage stent for internal biliary drainage in patients with an inoperable mechanical biliary obstruction, radiological supervision and interpretation

75984

131.88

36.53

95.35

Change of percutaneous tube or drainage catheter with contrast monitoring (eg, genitourinary system, abscess), radiological supervision and interpretation

75989

180.71

61.00

119.71

Radiological guidance (ie, fluoroscopy, ultrasound, or computed tomography), for percutaneous drainage (eg, abscess, specimen collection), with placement of catheter, radiological supervision and interpretation

75992

I.C.

29.00

I.C.

Transluminal atherectomy, peripheral artery, radiological supervision and interpretation

75993

I.C.

18.87

I.C.

Transluminal atherectomy, each additional peripheral artery, radiological supervision and interpretation (List separately in addition to code for primary procedure)

75994

I.C.

69.84

I.C.

Transluminal atherectomy, renal, radiological supervision and interpretation

75995

I.C.

67.86

I.C.

Transluminal atherectomy, visceral, radiological supervision and interpretation

75996

I.C.

18.41

I.C.

Transluminal atherectomy, each additional visceral artery, radiological supervision and interpretation (List separately in addition to code for primary procedure)

76000

103.02

8.41

94.61

Fluoroscopy (separate procedure), up to one hour physician time, other than 71023 or 71034 (eg, cardiac fluoroscopy)

76001

I.C.

34.96

I.C.

Fluoroscopy, physician time more than one hour, assisting a nonradiologic physician (eg, nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy)

76010

32.82

9.21

23.61

Radiologic examination from nose to rectum for foreign body, single view, child

76080

74.23

27.78

46.45

Radiologic examination, abscess, fistula or sinus tract study, radiological supervision and interpretation

76098

24.31

8.06

16.25

Radiological examination, surgical specimen

76100

137.87

29.91

107.96

Radiologic examination, single plane body section (eg, tomography), other than with urography

76101

186.04

29.45

156.59

Radiologic examination, complex motion (ie, hypercycloidal) body section (eg, mastoid polytomography), other than with urography; unilateral

76102

244.01

28.99

215.03

Radiologic examination, complex motion (ie, hypercycloidal) body section (eg, mastoid polytomography), other than with urography; bilateral

76120

85.80

19.56

66.24

Cineradiography/videoradiography, except where specifically included

76125

I.C.

14.58

I.C.

Cineradiography/videoradiography to complement routine examination (List separately in addition to code for primary procedure)

76140

I.C.

I.C.

I.C.

Consultation on X-ray examination made elsewhere, written report

76150

25.91

I.C.

I.C.

Xeroradiography

76350

I.C.

I.C.

I.C.

Subtraction in conjunction with contrast studies

76376

122.60

10.65

111.94

3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; not requiring image postprocessing on an independent workstation

76377

155.57

41.80

113.78

3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; requiring image postprocessing on an independent workstation

76380

236.59

49.85

186.75

Computed tomography, limited or localized follow-up study

76390

549.04

68.31

480.73

Magnetic resonance spectroscopy

76496

I.C.

I.C.

I.C.

Unlisted fluoroscopic procedure (eg, diagnostic, interventional)

76497

I.C.

I.C.

I.C.

Unlisted computed tomography procedure (eg, diagnostic, interventional)

76498

I.C.

I.C.

I.C.

Unlisted magnetic resonance procedure (eg, diagnostic, interventional)

76499

I.C.

I.C.

I.C.

Unlisted diagnostic radiographic procedure

76506

127.43

33.43

93.99

Echoencephalography, real time with image documentation (gray scale) (for determination of ventricular size, delineation of cerebral contents, and detection of fluid masses or other intracranial abnormalities), including A-mode encephalography as secondary component where indicated

76510

173.29

81.90

91.39

Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter

76511

122.09

49.56

72.52

Ophthalmic ultrasound, diagnostic; quantitative A-scan only

76512

113.48

49.72

63.75

Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan)

76513

103.00

35.10

67.90

Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution biomicroscopy

76514

13.31

9.33

3.98

Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)

76516

81.13

28.40

52.73

Ophthalmic biometry by ultrasound echography, A-scan;

76519

86.20

28.86

57.33

Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation

76529

80.45

30.19

50.27

Ophthalmic ultrasonic foreign body localization

76536

120.62

28.00

92.61

Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation

76604

97.88

28.12

69.76

Ultrasound, chest (includes mediastinum), real time with image documentation

76645

97.70

27.32

70.38

Ultrasound, breast(s) (unilateral or bilateral), real time with image documentation

76700

153.21

41.28

111.92

Ultrasound, abdominal, real time with image documentation; complete

76705

114.58

30.25

84.33

Ultrasound, abdominal, real time with image documentation; limited (eg, single organ, quadrant, follow-up)

76770

147.75

37.67

110.08

Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete

76775

115.62

29.91

85.71

Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; limited

76776

160.40

38.82

121.59

Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation

76800

135.92

54.35

81.57

Ultrasound, spinal canal and contents

76801

151.37

49.73

101.64

Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; single or first gestation

76802

86.53

42.43

44.10

Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; each additional gestation (List separately in addition to code for primary procedure)

76805

164.71

49.73

114.99

Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days),

transabdominal approach; single or first gestation

76810

111.22

49.39

61.83

Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; each additional gestation (List separately in addition to code for primary procedure)

76811

248.00

96.11

151.89

Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation

76812

206.18

89.87

116.31

Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; each additional gestation (List separately in addition to code for primary procedure)

76813

147.71

60.20

87.51

Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; single or first gestation

76814

92.43

48.65

43.78

Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; each additional gestation (List separately in addition to code for primary procedure)

76815

104.66

32.76

71.90

Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), one or more fetuses

76816

119.47

43.11

76.36

Ultrasound, pregnant uterus, real time with image documentation, follow-up (eg, re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ system(s) suspected or confirmed to be abnormal on a previous scan), transabdominal approach, per fetus

76817

115.30

37.55

77.74

Ultrasound, pregnant uterus, real time with image documentation, transvaginal

76818

137.47

53.46

84.01

Fetal biophysical profile; with non-stress testing

76819

111.20

39.16

72.04

Fetal biophysical profile; without non-stress testing

76820

75.88

25.80

50.09

Doppler velocimetry, fetal; umbilical artery

76821

114.93

35.85

79.08

Doppler velocimetry, fetal; middle cerebral artery

76825

222.13

84.43

137.70

Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode recording;

76826

117.27

41.67

75.60

Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode recording; follow-up or repeat study

76827

93.04

29.15

63.89

Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete

76828

67.52

28.76

38.76

Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study

76830

131.48

35.04

96.43

Ultrasound, transvaginal

76831

132.04

36.07

95.97

Saline infusion sonohysterography (SIS), including color flow Doppler, when performed

76856

131.94

35.04

96.89

Ultrasound, pelvic (nonobstetric), real time with image documentation; complete

76857

114.79

19.56

95.24

Ultrasound, pelvic (nonobstetric), real time with image documentation; limited or follow-up (eg, for follicles)

76870

130.69

32.88

97.82

Ultrasound, scrotum and contents

76872

157.55

35.80

121.75

Ultrasound, transrectal;

76873

198.50

79.55

118.95

Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure)

76880

133.91

29.79

104.12

Ultrasound, extremity, nonvascular, real time with image documentation

76885

144.23

37.21

107.02

Ultrasound, infant hips, real time with imaging documentation; dynamic (requiring physician manipulation)

76886

114.22

31.73

82.49

Ultrasound, infant hips, real time with imaging documentation; limited, static (not requiring physician manipulation)

76930

114.85

36.82

78.02

Ultrasonic guidance for pericardiocentesis, imaging supervision and interpretation

76932

I.C.

37.28

I.C.

Ultrasonic guidance for endomyocardial biopsy, imaging supervision and interpretation

76936

383.52

103.60

279.92

Ultrasound guided compression repair of arterial pseudoaneurysm or arteriovenous fistulae (includes diagnostic ultrasound evaluation, compression of lesion and imaging)

76937

39.46

15.74

23.71

Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting (List separately in addition to code for primary procedure)

76940

I.C.

107.50

I.C.

Ultrasound guidance for, and monitoring of, parenchymal tissue ablation

76941

I.C.

67.64

I.C.

Ultrasonic guidance for intrauterine fetal transfusion or cordocentesis, imaging supervision and interpretation

76942

206.74

34.36

172.38

Ultrasonic guidance for needle placement (eg, biopsy aspiration, injection, localization device), imaging supervision and interpretation

76945

I.C.

33.44

I.C.

Ultrasonic guidance for chorionic villus sampling, imaging supervision and interpretation

76946

64.90

19.10

45.80

Ultrasonic guidance for amniocentesis, imaging supervision and interpretation

76948

64.44

18.64

45.80

Ultrasonic guidance for aspiration of ova, imaging supervision and interpretation

76950

84.94

29.45

55.49

Ultrasonic guidance for placement of radiation therapy fields

76965

222.54

69.32

153.22

Ultrasonic guidance for interstitial radioelement application

76970

88.78

19.78

69.00

Ultrasound study follow-up (specify)

76975

I.C.

42.20

I.C.

Gastrointestinal endoscopic ultrasound, supervision and interpretation

76977

25.60

2.93

22.67

Ultrasound bone density measurement and interpretation, peripheral site(s), any method

76998

I.C.

62.36

I.C.

Ultrasonic guidance, intraoperative

76999

I.C.

I.C.

I.C.

Unlisted ultrasound procedure (eg, diagnostic, interventional)

77001

112.01

19.26

92.75

Fluoroscopic guidance for central venous access device placement, replacement (catheter only or complete), or removal (includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venographyradiologic supervision and interpretation, and radiographic documentation of final catheter position) (List separately in addition to code for primary procedure)

77002

83.27

26.40

56.87

Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device)

77003

74.57

28.29

46.29

Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve, or sacroiliac joint), including neurolytic agent destruction

77011

721.43

61.22

660.21

Computed tomography guidance for stereotactic localization

77012

306.39

59.52

246.87

Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation

77013

I.C.

204.22

I.C.

Computed tomography guidance for, and monitoring of, parenchymal tissue ablation

77014

212.69

43.11

169.58

Computed tomography guidance for placement of radiation therapy fields

77021

563.36

77.39

485.97

Magnetic resonance guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation

77022

I.C.

218.70

I.C.

Magnetic resonance guidance for, and monitoring of, parenchymal tissue ablation

77031

288.09

81.38

206.71

Stereotactic localization guidance for breast biopsy or needle placement (eg, for wire localization or for injection), each lesion, radiological supervision and interpretation

77032

75.67

28.46

47.21

Mammographic guidance for needle placement, breast (eg, for wire localization or for injection), each lesion, radiological supervision and interpretation

77051

17.38

3.27

14.11

Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images; diagnostic mammography (List separately in addition to code for primary procedure)

77052

17.38

3.27

14.11

Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images; screening mammography (List separately in addition to code for primary procedure)

77053

108.68

18.41

90.27

Mammary ductogram or galactogram, single duct, radiological supervision and interpretation

77054

147.78

22.87

124.91

Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation

77055

93.80

35.85

57.95

Mammography; unilateral

77056

118.61

44.25

74.36

Mammography; bilateral

77057

94.10

35.85

58.25

Screening mammography, bilateral (2-view film study of each breast)

77058

1,001.75

83.07

918.68

Magnetic resonance imaging, breast, without and/or with contrast material(s); unilateral

77059

1,154.49

83.07

1,071.42

Magnetic resonance imaging, breast, without and/or with contrast material(s); bilateral

77071

37.89

I.C.

I.C.

Manual application of stress performed by physician for joint radiography, including contralateral joint if indicated

77072

26.72

9.55

17.17

Bone age studies

77073

46.92

14.12

32.80

Bone length studies (orthoroentgenogram, scanogram)

77074

77.60

23.33

54.27

Radiologic examination, osseous survey; limited (eg, for metastases)

77075

111.65

27.78

83.87

Radiologic examination, osseous survey; complete (axial and appendicular skeleton)

77076

97.64

35.39

62.26

Radiologic examination, osseous survey, infant

77077

55.79

15.79

40.00

Joint survey, single view, two or more joints (specify)

77078

192.22

12.52

179.70

Computed tomography, bone mineral density study, one or more sites; axial skeleton (eg, hips, pelvis, spine)

77079

97.68

11.03

86.65

Computed tomography, bone mineral density study, one or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel)

77080

111.18

10.81

100.37

Dual-energy X-ray absorptiometry (DXA), bone density study, one or more sites; axial skeleton (eg, hips, pelvis, spine)

77081

39.23

11.03

28.20

Dual-energy X-ray absorptiometry (DXA), bone density study, one or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel)

77082

37.98

8.41

29.58

Dual-energy X-ray absorptiometry (DXA), bone density study, one or more sites; vertebral fracture assessment

77083

35.78

9.89

25.89

Radiographic absorptiometry (eg, photodensitometry, radiogrammetry), one or more sites

77084

656.67

80.66

576.01

Magnetic resonance (eg, proton) imaging, bone marrow blood supply

77261

72.11

I.C.

I.C.

Therapeutic radiology treatment planning; simple

77262

108.48

I.C.

I.C.

Therapeutic radiology treatment planning; intermediate

77263

161.26

I.C.

I.C.

Therapeutic radiology treatment planning; complex

77280

217.83

35.69

182.14

Therapeutic radiology simulation-aided field setting; simple

77285

367.16

53.00

314.16

Therapeutic radiology simulation-aided field setting; intermediate

77290

536.56

78.68

457.88

Therapeutic radiology simulation-aided field setting; complex

77295

1,055.25

230.71

824.54

Therapeutic radiology simulation-aided field setting; 3-dimensional

77299

I.C.

I.C.

I.C.

Unlisted procedure, therapeutic radiology clinical treatment planning

77300

86.76

31.27

55.49

Basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of non-ionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician

77301

2,353.93

404.01

1,949.93

Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications

77305

97.44

35.69

61.75

Teletherapy, isodose plan (whether hand or computer calculated); simple (one or two parallel opposed unmodified ports directed to a single area of interest)

77310

131.46

53.00

78.46

Teletherapy, isodose plan (whether hand or computer calculated); intermediate (three or more treatment ports directed to a single area of interest)

77315

180.45

78.68

101.78

Teletherapy, isodose plan (whether hand or computer calculated); complex (mantle or inverted Y, tangential ports, the use of wedges, compensators, complex blocking, rotational beam, or special beam considerations)

77321

175.09

48.20

126.89

Special teletherapy port plan, particles, hemibody, total body

77326

166.95

47.06

119.89

Brachytherapy isodose plan; simple (calculation made from single plane, one to four sources/ribbon application, remote afterloading brachytherapy, one to eight sources)

77327

239.53

70.27

169.26

Brachytherapy isodose plan; intermediate (multiplane dosage calculations, application involving five to ten sources/ribbons, remote afterloading brachytherapy, nine to 12 sources)

77328

332.54

105.96

226.59

Brachytherapy isodose plan; complex (multiplane isodose plan, volume implant calculations, over ten sources/ribbons used, special spatial reconstruction, remote afterloading brachytherapy, over 12 sources)

77331

67.87

43.79

24.07

Special dosimetry (eg, TLD, microdosimetry) (specify), only when prescribed by the treating physician

77332

91.86

27.16

64.70

Treatment devices, design and construction; simple (simple block, simple bolus)

77333

94.85

42.31

52.55

Treatment devices, design and construction;

intermediate (multiple blocks, stents, bite blocks, special bolus)

77373

1,967.92

Stereotactic body radiation therapy, treatment delivery, per fraction to one or more lesions, including image guidance, entire course not to exceed five fractions

77399

I.C.

Unlisted procedure, medical radiation physics, dosimetry and treatment devices, and special services

77401

54.85

Radiation treatment delivery, superficial and/or ortho voltage

77402

144.14

Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks; up to 5 MeV

77403

130.80

Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks; 6-10 MeV

77404

140.92

Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks; 11-19 MeV

77406

141.84

Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks; 20 MeV or greater

77407

184.95

Radiation treatment delivery, two separate treatment areas, three or more ports on a single treatment area, use of multiple blocks; up to 5 MeV

77408

171.14

Radiation treatment delivery, two separate treatment areas, three or more ports on a single treatment area, use of multiple blocks; 6-10 MeV

77409

184.49

Radiation treatment delivery, two separate treatment areas, three or more ports on a single treatment area, use of multiple blocks; 11-19 MeV

77411

184.03

Radiation treatment delivery, two separate treatment areas, three or more ports on a single treatment area, use of multiple blocks; 20 MeV or greater

77412

213.78

Radiation treatment delivery, three or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; up to 5 MeV

77413

215.63

Radiation treatment delivery, three or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 6-10 MeV

77414

235.42

Radiation treatment delivery, three or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 11-19 MeV

77416

235.42

Radiation treatment delivery, three or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 20 MeV or greater

77417

23.29

Therapeutic radiology port film(s)

77418

721.94

Intensity modulated treatment delivery, single or multiple fields/arcs, via narrow spatially and temporally modulated beams, binary, dynamic MLC, per treatment session

77421

151.78

19.90

131.88

Stereoscopic X-ray guidance for localization of target volume for the delivery of radiation therapy

77422

166.38

High energy neutron radiation treatment delivery; single treatment area using a single port or parallel-opposed ports with no blocks or simple blocking

77423

227.59

High energy neutron radiation treatment delivery; one or more isocenter(s) with coplanar or non-coplanar geometry with blocking and/or wedge, and/or compensator(s)

77427

187.58

Radiation treatment management, five treatments

77431

98.10

Radiation therapy management with complete course of therapy consisting of one or two fractions only

77432

409.28

Stereotactic radiation treatment management of cranial lesion(s) (complete course of treatment consisting of one session)

77435

683.04

Stereotactic body radiation therapy, treatment management, per treatment course, to one or more lesions, including image guidance, entire course not to exceed five fractions

77470

409.01

105.96

303.06

Special treatment procedure (eg, total body irradiation, hemibody radiation, per oral, endocavitary or intraoperative cone irradiation)

77499

I.C.

I.C.

I.C.

Unlisted procedure, therapeutic radiology treatment management

77520

I.C.

Proton treatment delivery; simple, without compensation

77522

I.C.

Proton treatment delivery; simple, with compensation

77523

I.C.

Proton treatment delivery; intermediate

77525

I.C.

Proton treatment delivery; complex

77600

378.05

78.68

299.38

Hyperthermia, externally generated; superficial (ie, heating to a depth of 4 cm or less)

77605

616.68

103.77

512.90

Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm)

77610

555.26

75.45

479.81

Hyperthermia generated by interstitial probe(s); five or fewer interstitial applicators

77615

786.40

104.57

681.83

Hyperthermia generated by interstitial probe(s); more than five interstitial applicators

77620

388.09

80.43

307.66

Hyperthermia generated by intracavitary probe(s)

77750

349.94

249.81

100.14

Infusion or instillation of radioelement solution (includes three months follow-up care)

77761

369.08

189.97

179.10

Intracavitary radiation source application; simple

77762

511.05

289.95

221.11

Intracavitary radiation source application; intermediate

77763

718.00

434.48

283.52

Intracavitary radiation source application; complex

77776

420.48

232.93

187.55

Interstitial radiation source application; simple

77777

608.18

378.35

229.83

Interstitial radiation source application; intermediate

77778

869.35

567.59

301.75

Interstitial radiation source application; complex

77781

656.36

64.88

591.48

Remote afterloading high intensity brachytherapy; one - four source positions or catheters

77782

876.75

107.15

769.60

Remote afterloading high intensity brachytherapy; five - eight source positions or catheters

77783

1,201.32

169.35

1,031.96

Remote afterloading high intensity brachytherapy; nine-12 source positions or catheters

77784

1,777.12

264.62

1,512.50

Remote afterloading high intensity brachytherapy; over 12 source positions or catheters

77789

106.68

58.21

48.47

Surface application of radiation source

77790

90.88

53.00

37.88

Supervision, handling, loading of radiation source

77799

I.C.

I.C.

I.C.

Unlisted procedure, clinical brachytherapy

78000

74.87

9.55

65.32

Thyroid uptake; single determination

78001

96.43

13.32

83.11

Thyroid uptake; multiple determinations

78003

82.41

16.63

65.78

Thyroid uptake; stimulation, suppression or discharge (not including initial uptake studies)

78006

222.83

24.69

198.14

Thyroid imaging, with uptake; single determination

78007

155.35

25.50

129.85

Thyroid imaging, with uptake; multiple determinations

78010

158.52

19.90

138.62

Thyroid imaging; only

78011

183.26

22.87

160.39

Thyroid imaging; with vascular flow

78015

215.77

34.36

181.40

Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only)

78016

317.37

41.78

275.58

Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery)

78018

353.63

44.37

309.26

Thyroid carcinoma metastases imaging; whole body

78020

101.69

30.75

70.94

Thyroid carcinoma metastases uptake (List separately in addition to code for primary procedure)

78070

217.53

42.08

175.44

Parathyroid imaging

78075

433.00

37.67

395.33

Adrenal imaging, cortex and/or medulla

78099

I.C.

I.C.

I.C.

Unlisted endocrine procedure, diagnostic nuclear medicine

78102

170.73

28.12

142.60

Bone marrow imaging; limited area

78103

235.97

38.47

197.49

Bone marrow imaging; multiple areas

78104

278.30

41.10

237.20

Bone marrow imaging; whole body

78110

81.31

10.01

71.30

Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling

78111

122.48

11.49

110.98

Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); multiple samplings

78120

101.67

11.83

89.83

Red cell volume determination (separate procedure); single sampling

78121

136.02

16.29

119.73

Red cell volume determination (separate procedure); multiple samplings

78122

184.72

23.33

161.39

Whole blood volume determination, including separate measurement of plasma volume and red cell volume (radiopharmaceutical volume-dilution technique)

78130

176.90

31.39

145.50

Red cell survival study;

78135

347.38

32.88

314.50

Red cell survival study; differential organ/tissue kinetics (eg, splenic and/or hepatic sequestration)

78140

190.96

31.39

159.57

Labeled red cell sequestration, differential organ/tissue (eg, splenic and/or hepatic)

78185

195.36

20.70

174.66

Spleen imaging only, with or without vascular flow

78190

381.85

54.34

327.51

Kinetics, study of platelet survival, with or without differential organ/tissue localization

78191

287.35

31.39

255.96

Platelet survival study

78195

352.23

61.64

290.59

Lymphatics and lymph nodes imaging

78199

I.C.

I.C.

I.C.

Unlisted hematopoietic, reticuloendothelial and lymphatic procedure, diagnostic nuclear medicine

78201

183.38

22.07

161.31

Liver imaging; static only

78202

215.53

25.84

189.69

Liver imaging; with vascular flow

78205

297.25

36.19

261.07

Liver imaging (SPECT);

78206

378.80

49.17

329.64

Liver imaging (SPECT); with vascular flow

78215

204.26

25.15

179.10

Liver and spleen imaging; static only

78216

175.51

28.81

146.70

Liver and spleen imaging; with vascular flow

78220

183.20

24.69

158.51

Liver function study with hepatobiliary agents, with serial images

78223

322.33

43.23

279.10

Hepatobiliary ductal system imaging, including gallbladder, with or without pharmacologic intervention, with or without quantitative measurement of gallbladder function

78230

169.45

22.87

146.58

Salivary gland imaging;

78231

164.76

26.18

138.58

Salivary gland imaging; with serial images

78232

171.17

24.01

147.16

Salivary gland function study

78258

229.66

38.13

191.53

Esophageal motility

78261

269.02

35.50

233.51

Gastric mucosa imaging

78262

270.98

34.24

236.74

Gastroesophageal reflux study

78264

300.17

39.96

260.21

Gastric emptying study

78267

I.C.

Urea breath test, C-14 (isotopic); acquisition for analysis

78268

I.C.

Urea breath test, C-14 (isotopic); analysis

78270

92.06

10.35

81.71

Vitamin B-12 absorption study (eg, Schilling test); without intrinsic factor

78271

92.98

9.89

83.09

Vitamin B-12 absorption study (eg, Schilling test); with intrinsic factor

78272

116.52

13.20

103.32

Vitamin B-12 absorption studies combined, with and without intrinsic factor

78278

360.55

50.65

309.90

Acute gastrointestinal blood loss imaging

78282

I.C.

19.56

I.C.

Gastrointestinal protein loss

78290

300.94

35.16

265.78

Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus)

78291

255.13

45.05

210.08

Peritoneal-venous shunt patency test (eg, for LeVeen, Denver shunt)

78299

I.C.

I.C.

I.C.

Unlisted gastrointestinal procedure, diagnostic nuclea medicine

78300

185.52

31.73

153.79

Bone and/or joint imaging; limited area

78305

252.03

42.43

209.60

Bone and/or joint imaging; multiple areas

78306

282.03

44.37

237.66

Bone and/or joint imaging; whole body

78315

359.27

52.13

307.14

Bone and/or joint imaging; three phase study

78320

313.88

53.28

260.61

Bone and/or joint imaging; tomographic (SPECT)

78350

40.15

10.57

29.58

Bone density (bone mineral content) study, one or more sites; single photon absorptiometry

78351

14.69

Bone density (bone mineral content) study, one or more sites; dual photon absorptiometry, one or more sites

78399

I.C.

I.C.

I.C.

Unlisted musculoskeletal procedure, diagnostic nuclear medicine

78414

I.C.

23.79

I.C.

Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without pharmacologic intervention or exercise, single or multiple determinations

78428

210.94

42.26

168.68

Cardiac shunt detection

78445

170.68

25.15

145.52

Non-cardiac vascular flow imaging (ie, angiography, venography)

78456

346.44

51.91

294.53

Acute venous thrombosis imaging, peptide

78457

205.83

38.70

167.14

Venous thrombosis imaging, venogram; unilateral

78458

242.13

46.20

195.93

Venous thrombosis imaging, venogram; bilateral

78459

I.C.

79.87

I.C.

Myocardial imaging, positron emission tomography (PET), metabolic evaluation

78460

202.46

44.37

158.09

Myocardial perfusion imaging; (planar) single study, at rest or stress (exercise and/or pharmacologic), with or without quantification

78461

263.18

63.75

199.43

Myocardial perfusion imaging; multiple studies (planar), at rest and/or stress (exercise and/or pharmacologic), and redistribution and/or rest injection, with or without quantification

78464

356.05

58.67

297.39

Myocardial perfusion imaging; tomographic (SPECT), single study (including attenuation correction when performed), at rest or stress (exercise and/or pharmacologic), with or without quantification

78465

616.75

79.42

537.32

Myocardial perfusion imaging; tomographic (SPECT), multiple studies (including attenuation correction when performed), at rest and/or stress (exercise and/or pharmacologic) and redistribution and/or rest injection, with or without quantification

78466

199.88

36.43

163.45

Myocardial imaging, infarct avid, planar; qualitative or quantitative

78468

259.45

43.40

216.04

Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique

78469

313.19

49.80

263.39

Myocardial imaging, infarct avid, planar; tomographic SPECT with or without quantification

78472

317.06

51.69

265.37

Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without additional quantitative processing

78473

445.23

78.69

366.55

Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and stress (exercise and/or pharmacologic), with or without additional quantification

78478

80.51

28.72

51.79

Myocardial perfusion study with wall motion, qualitative or quantitative study (List separately in addition to code for primary procedure)

78480

70.91

19.13

51.79

Myocardial perfusion study with ejection fraction (List separately in addition to code for primary procedure)

78481

288.08

54.15

233.93

Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without quantification

78483

415.63

82.07

333.57

Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (exercise and/ or pharmacologic), wall motion study plus ejection fraction, with or without quantification

78491

I.C.

81.09

I.C.

Myocardial imaging, positron emission tomography (PET), perfusion; single study at rest or stress

78492

I.C.

103.69

I.C.

Myocardial imaging, positron emission tomography (PET), perfusion; multiple studies at rest and/or stress

78494

366.87

64.22

302.65

Cardiac blood pool imaging, gated equilibrium, SPECT, at rest, wall motion study plus ejection fraction, with or without quantitative processing

78496

213.54

26.88

186.66

Cardiac blood pool imaging, gated equilibrium, single study, at rest, with right ventricular ejection fraction by first pass technique (List separately in addition to code for primary procedure)

78499

I.C.

I.C.

I.C.

Unlisted cardiovascular procedure, diagnostic nuclea medicine

78580

234.54

38.13

196.41

Pulmonary perfusion imaging, particulate

78584

191.07

50.65

140.42

Pulmonary perfusion imaging, particulate, with ventilation; single breath

78585

384.63

55.75

328.89

Pulmonary perfusion imaging, particulate, with ventilation; rebreathing and washout, with or without single breath

78586

176.79

20.24

156.55

Pulmonary ventilation imaging, aerosol; single projection

78587

215.30

25.15

190.15

Pulmonary ventilation imaging, aerosol; multiple projections (eg, anterior, posterior, lateral views)

78588

325.34

55.75

269.60

Pulmonary perfusion imaging, particulate, with ventilation imaging, aerosol, one or multiple projections

78591

183.23

20.70

162.53

Pulmonary ventilation imaging, gaseous, single breath, single projection

78593

216.50

24.69

191.81

Pulmonary ventilation imaging, gaseous, with rebreathing and washout with or without single breath; single projection

78594

266.92

26.98

239.94

Pulmonary ventilation imaging, gaseous, with rebreathing and washout with or without single breath; multiple projections (eg, anterior, posterior, lateral views)

78596

428.32

63.73

364.59

Pulmonary quantitative differential function (ventilation/perfusion) study

78599

I.C.

I.C.

I.C.

Unlisted respiratory procedure, diagnostic nuclear medicine

78600

190.58

22.53

168.06

Brain imaging, less than four static views;

78601

229.15

25.84

203.32

Brain imaging, less than four static views; with vascular flow

78605

218.33

27.44

190.89

Brain imaging, minimum four static views;

78606

319.48

32.42

287.07

Brain imaging, minimum four static views; with vascular flow

78607

413.47

62.83

350.64

Brain imaging, tomographic (SPECT)

78608

I.C.

76.03

I.C.

Brain imaging, positron emission tomography (PET) metabolic evaluation

78609

75.57

75.57

I.C.

Brain imaging, positron emission tomography (PET); perfusion evaluation

78610

208.70

16.53

192.17

Brain imaging, vascular flow only

78630

352.57

34.70

317.86

Cerebrospinal fluid flow, imaging (not including introduction of material); cisternography

78635

292.13

31.55

260.57

Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography

78645

303.93

28.81

275.12

Cerebrospinal fluid flow, imaging (not including introduction of material); shunt evaluation

78647

380.91

45.74

335.17

Cerebrospinal fluid flow, imaging (not including introduction of material); tomographic (SPECT)

78650

337.77

31.39

306.38

Cerebrospinal fluid leakage detection and localization

78660

173.26

26.98

146.28

Radiopharmaceutical dacryocystography

78699

I.C.

I.C.

I.C.

Unlisted nervous system procedure, diagnostic nuclea medicine

78700

195.67

23.33

172.34

Kidney imaging morphology;

78701

232.61

25.15

207.46

Kidney imaging morphology; with vascular flow

78707

277.46

49.17

228.29

Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention

78708

242.10

62.14

179.96

Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg, angiotensin converting enzyme inhibitor and/or diuretic)

78709

374.89

72.03

302.86

Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological intervention (eg, angiotensin converting enzyme inhibitor and/or diuretic)

78710

295.55

33.56

261.99

Kidney imaging morphology; tomographic (SPECT)

78725

115.37

19.56

95.81

Kidneyfunction study, non-imaging radioisotopic study

78730

90.05

9.86

80.19

Urinary bladder residual study (List separately in addition to code for primary procedure)

78740

207.15

29.11

178.04

Ureteral reflux study (radiopharmaceutical voiding cystogram)

78761

225.40

36.19

189.21

Testicular imaging with vascular flow

78799

I.C.

I.C.

I.C.

Unlisted genitourinary procedure, diagnostic nuclear medicine

78800

212.78

33.86

178.92

Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent(s); limited

area

78801

277.63

40.90

236.74

Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent(s); multiple

areas

78802

360.83

43.91

316.92

Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent(s); whole body, single day imaging

78803

405.46

56.21

349.26

Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent(s); tomographic (SPECT)

78804

651.53

54.76

596.77

Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent(s); whole body, requiring two or more days imaging

78805

212.57

37.33

175.24

Radiopharmaceutical localization of inflammatory process; limited area

78806

388.11

43.91

344.20

Radiopharmaceutical localization of inflammatory process; whole body

78807

404.70

55.91

348.80

Radiopharmaceutical localization of inflammatory process; tomographic (SPECT)

78811

I.C.

80.27

I.C.

Positron emission tomography (PET) imaging; limited area (eg, chest, head/neck)

78812

I.C.

99.57

I.C.

Positron emission tomography (PET) imaging; skull base to mid-thigh

78813

I.C.

103.34

I.C.

Positron emission tomography (PET) imaging; whole body

78814

I.C.

112.93

I.C.

Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; limited area (eg, chest, head/neck)

78815

I.C.

125.27

I.C.

Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; skull base to mid-thigh

78816

I.C.

128.24

I.C.

Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; whole body

78890

43.39

2.93

40.46

Generation of automated data: interactive process involving nuclear physician and/or allied health professional personnel; simple manipulations and interpretation, not to exceed 30 minutes

78891

89.08

5.09

83.99

Generation of automated data: interactive process involving nuclear physician and/or allied health professional personnel; complex manipulations and interpretation, exceeding 30 minutes

78999

I.C.

I.C.

I.C.

Unlisted miscellaneous procedure, diagnostic nuclear medicine

79005

184.96

91.01

93.95

Radiopharmaceutical therapy, by oral administration

79101

199.17

101.54

97.63

Radiopharmaceutical therapy, by intravenous administration

79200

202.34

101.48

100.86

Radiopharmaceutical therapy, by intracavitary administration

79300

I.C.

83.84

I.C.

Radiopharmaceutical therapy, by interstitial radioactive colloid administration

79403

269.97

117.56

152.41

Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion

79440

193.75

102.56

91.19

Radiopharmaceutical therapy, by intra-articular administration

79445

I.C.

123.74

I.C.

Radiopharmaceutical therapy, by intra-arterial particulate administration

79999

I.C.

I.C.

I.C.

Radiopharmaceutical therapy, unlisted procedure

(8) Freestanding Ambulatory Surgical Services / Surgery.

Code

ASC

Rate

Incl

GL Fee

PC

Fee

TC

Fee

40.06(8) - Surgical Services Description

10021

49.59

146.24

Fine needle aspiration; without imaging guidance

10022

193.36

153.93

Fine needle aspiration; with imaging guidance

10040

35.44

95.98

Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules)

10060

49.64

106.83

Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single

10061

62.85

180.17

Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple

10080

62.85

176.95

Incision and drainage of pilonidal cyst; simple

10081

138.64

265.51

Incision and drainage of pilonidal cyst; complicated

10120

62.85

140.41

Incision and removal of foreign body, subcutaneous tissues; simple

10121

719.48

263.98

Incision and removal of foreign body, subcutaneous tissues; complicated

10140

73.92

151.59

Incision and drainage of hematoma, seroma or fluid collection

10160

63.25

125.02

Puncture aspiration of abscess, hematoma, bulla, or cyst

10180

818.67

231.60

Incision and drainage, complex, postoperative wound infection

11000

23.90

52.50

Debridement of extensive eczematous or infected skin; up to 10% of body surface

11001

8.46

22.03

Debridement of extensive eczematous or infected skin; each additional 10% of the body surface (List separately in addition to code for primary procedure)

11004

552.23

Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; external genitalia and perineum

11005

729.92

Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; abdominal wall, with or without fascial closure

11006

688.17

Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; external genitalia, perineum and abdominal wall, with or without fascial closure

11008

265.41

Removal of prosthetic material or mesh, abdominal wall for infection (eg, for chronic or recurrent mesh infection or necrotizing soft tissue infection) (List separately in addition to code for primary procedure)

11010

192.34

477.68

Debridement including removal of foreign material associated with open fracture(s) and/or dislocation(s); skin and subcutaneous tissues

11011

192.34

540.66

Debridement including removal of foreign material associated with open fracture(s) and/or dislocation(s); skin, subcutaneous tissue, muscle fascia, and muscle

11012

192.34

755.39

Debridement including removal of foreign material associated with open fracture(s) and/or dislocation(s); skin, subcutaneous tissue, muscle fascia, muscle, and bone

11040

22.06

46.49

Debridement; skin, partial thickness

11041

25.38

55.24

Debridement; skin, full thickness

11042

118.89

75.40

Debridement; skin, and subcutaneous tissue

11043

118.89

271.72

Debridement; skin, subcutaneous tissue, and muscle

11044

307.53

367.25

Debridement; skin, subcutaneous tissue, muscle, and bone

11055

25.01

47.48

Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion

11056

27.95

57.91

Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); two to four lesions

11057

31.63

69.55

Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); more than four lesions

11100

35.44

100.36

Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; single lesion

11101

13.61

31.63

Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; each separate/additional lesion (List separately in addition to code for primary procedure)

11200

35.44

80.18

Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions

11201

5.88

17.87

Removal of skin tags, multiple fibrocutaneous tags, any area; each additional ten lesions (List separately in addition to code for primary procedure)

11300

35.44

68.48

Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less

11301

35.44

90.52

Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm

11302

35.44

107.77

Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm

11303

66.19

127.75

Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm

11305

35.31

69.16

Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less

11306

35.44

93.90

Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm

11307

35.44

109.60

Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm

11308

35.44

124.76

Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm

11310

35.44

83.66

Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less

11311

35.44

103.17

Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm

11312

35.44

119.64

Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm

11313

35.44

150.37

Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm

11400

71.34

120.80

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less

11401

77.95

143.26

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.6 to 1.0 cm

11402

84.95

158.70

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 1.1 to 2.0 cm

11403

90.83

181.04

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 2.1 to 3.0 cm

11404

719.48

205.27

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 3.1 to 4.0 cm

11406

719.48

279.96

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter over 4.0 cm

11420

65.82

119.69

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less

11421

78.70

151.56

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm

11422

86.05

169.30

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm

11423

96.35

196.36

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm

11424

719.48

224.17

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm

11426

943.36

314.07

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm

11440

77.22

133.88

Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less

11441

86.42

163.74

Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.6 to 1.0 cm

11442

95.25

183.42

Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 1.1 to 2.0 cm

11443

106.64

218.95

Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 2.1 to 3.0 cm

11444

388.12

273.38

Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 3.1 to 4.0 cm

11446

943.36

362.40

Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm

11450

943.36

351.22

Excision of skin and subcutaneous tissue for hidradenitis, axillary; with simple or intermediate repair

11451

943.36

463.13

Excision of skin and subcutaneous tissue for hidradenitis, axillary; with complex repair

11462

943.36

349.56

Excision of skin and subcutaneous tissue for hidradenitis, inguinal; with simple or intermediate repair

11463

943.36

472.18

Excision of skin and subcutaneous tissue for hidradenitis, inguinal; with complex repair

11470

943.36

379.52

Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or umbilical; with simple or intermediate repair

11471

943.36

485.86

Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or umbilical; with complex repair

11600

98.92

180.76

Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.5 cm or less

11601

112.89

213.87

Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.6 to 1.0 cm

11602

122.46

233.13

Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 1.1 to 2.0 cm

11603

130.91

263.23

Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 2.1 to 3.0 cm

11604

388.12

290.19

Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 3.1 to 4.0 cm

11606

719.48

400.50

Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter over 4.0 cm

11620

100.03

182.18

Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less

11621

114.00

215.59

Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm

11622

126.13

242.65

Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm

11623

136.79

282.16

Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm

11624

719.48

318.24

Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm

11626

943.36

390.12

Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm

11640

104.80

190.25

Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0.5 cm or less

11641

122.46

230.45

Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0.6 to 1.0 cm

11642

136.79

264.67

Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 1.1 to 2.0 cm

11643

148.57

308.81

Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 2.1 to 3.0 cm

11644

719.48

382.18

Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 3.1 to 4.0 cm

11646

943.36

498.66

Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter over 4.0 cm

11719

11.40

20.67

Trimming of nondystrophic nails, any number

11720

14.71

30.54

Debridement of nail(s) by any method(s); one to five

11721

18.02

43.09

Debridement of nail(s) by any method(s); six or more

11730

35.44

96.07

Avulsion of nail plate, partial or complete, simple; single

11732

18.02

44.11

Avulsion of nail plate, partial or complete, simple; each additional nail plate (List separately in addition to code for primary procedure)

11740

13.24

44.67

Evacuation of subungual hematoma

11750

94.13

206.37

Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal;

11752

129.44

291.79

Excision of nail and nail matrix, partial or complete

(eg, ingrown or deformed nail), for permanent removal; with amputation of tuft of distal phalanx

11755

65.82

131.77

Biopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure)

11760

94.07

199.47

Repair of nail bed

11762

120.98

261.58

Reconstruction of nail bed with graft

11765

65.22

129.28

Wedge excision of skin of nail fold (eg, for ingrown toenail)

11770

943.36

259.41

Excision of pilonidal cyst or sinus; simple

11771

943.36

508.97

Excision of pilonidal cyst or sinus; extensive

11772

943.36

631.17

Excision of pilonidal cyst or sinus; complicated

11900

28.68

54.26

Injection, intralesional; up to and including seven lesions

11901

30.53

66.42

Injection, intralesional; more than seven lesions

11920

94.07

201.17

Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.0 sq cm or less

11921

94.07

226.94

Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm

11922

37.88

66.24

Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm (List separately in addition to code for primary procedure)

11950

37.14

76.97

Subcutaneous injection of filling material (eg, collagen); 1 cc or less

11951

43.76

99.16

Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc

11952

57.17

142.59

Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc

11954

57.17

168.24

Subcutaneous injection of filling material (eg, collagen); over 10.0 cc

11960

903.02

898.02

Insertion of tissue expander(s) for other than breast, including subsequent expansion

119701,920.92

582.91

Replacement of tissue expander with permanent prosthesis

11971

943.36

499.38

Removal of tissue expander(s) without insertion of prosthesis

11980

28.19

104.14

Subcutaneous hormone pellet implantation (implantation of estradiol and/or testosterone pellets beneath the skin)

11981

28.19

136.98

Insertion, non-biodegradable drug delivery implant

11982

28.19

157.01

Removal, non-biodegradable drug delivery implant

11983

28.19

232.80

Removal with reinsertion, non-biodegradable drug delivery implant

12001

57.17

148.83

Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less

12002

57.17

157.66

Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities

(including hands and feet); 2.6 cm to 7.5 cm

12004

57.17

184.72

Simple repair of superficial wounds of scalp, neck,

axillae, external genitalia, trunk and/or extremities (including hands and feet); 7.6 cm to 12.5 cm

12005

57.17

229.32

Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 12.6 cm to 20.0 cm

12006

57.17

284.81

Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 20.1 cm to 30.0 cm

12007

57.17

319.74

Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); over 30.0 cm

12011

57.17

158.55

Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less

12013

57.17

173.90

Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm

12014

57.17

203.42

Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm

12015

57.17

254.54

Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm

12016

57.17

300.27

Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 12.6 cm to 20.0 cm

12017

57.17

253.95

Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 20.1 cm to 30.0 cm

12018

57.17

304.54

Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; over 30.0 cm

12020

202.27

272.20

Treatment of superficial wound dehiscence; simple closure

12021

202.27

155.39

Treatment of superficial wound dehiscence; with packing

12031

94.07

221.41

Layer closure of wounds of scalp, axillae, trunk and/o extremities (excluding hands and feet); 2.5 cm or less

12032

94.07

298.32

Layer closure of wounds of scalp, axillae, trunk and/o extremities (excluding hands and feet); 2.6 cm to 7.5 cm

12034

94.07

287.38

Layer closure of wounds of scalp, axillae, trunk and/o extremities (excluding hands and feet); 7.6 cm to 12.5 cm

12035

94.07

370.79

Layer closure of wounds of scalp, axillae, trunk and/o extremities (excluding hands and feet); 12.6 cm to 20.0 cm

12036

94.07

407.34

Layer closure of wounds of scalp, axillae, trunk and/o extremities (excluding hands and feet); 20.1 cm to 30.0 cm

12037

94.07

457.58

Layer closure of wounds of scalp, axillae, trunk and/o extremities (excluding hands and feet); over 30.0 cm

12041

94.07

235.05

Layer closure of wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less

12042

94.07

277.92

Layer closure of wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm

12044

94.07

314.37

Layer closure of wounds of neck, hands, feet and/or external genitalia; 7.6 cm to 12.5 cm

12045

94.07

373.96

Layer closure of wounds of neck, hands, feet and/or external genitalia; 12.6 cm to 20.0 cm

12046

94.07

441.49

Layer closure of wounds of neck, hands, feet and/or external genitalia; 20.1 cm to 30.0 cm

12047

94.07

471.99

Layer closure of wounds of neck, hands, feet and/or external genitalia; over 30.0 cm

12051

94.07

260.86

Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less

12052

94.07

286.99

Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm

12053

94.07

312.95

Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm

12054

94.07

334.60

Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm

12055

94.07

406.73

Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 12.6 cm to 20.0 cm

12056

94.07

503.48

Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 20.1 cm to 30.0 cm

12057

94.07

540.52

Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; over 30.0 cm

13100

202.27

310.16

Repair, complex, trunk; 1.1 cm to 2.5 cm

13101

202.27

385.92

Repair, complex, trunk; 2.6 cm to 7.5 cm

13102

202.27

104.23

Repair, complex, trunk; each additional 5 cm or less (List separately in addition to code for primary procedure)

13120

94.07

321.83

Repair, complex, scalp, arms, and/or legs; 1.1 cm to 2.5 cm

13121

202.27

422.40

Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm

13122

94.07

119.94

Repair, complex, scalp, arms, and/or legs; each additional 5 cm or less (List separately in addition to code for primary procedure)

13131

202.27

353.41

Repair, complex, forehead, cheeks, chin, mouth, neck axillae, genitalia, hands and/or feet; 1.1 cm to 2.5 cm

13132

202.27

548.43

Repair, complex, forehead, cheeks, chin, mouth, neck axillae, genitalia, hands and/or feet; 2.6 cm to 7.5 cm

13133

202.27

161.64

Repair, complex, forehead, cheeks, chin, mouth, neck axillae, genitalia, hands and/or feet; each additional 5 cm or less (List separately in addition to code for primary procedure)

13150

202.27

361.55

Repair, complex, eyelids, nose, ears and/or lips; 1.0 cm or less

13151

202.27

399.08

Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm

13152

202.27

540.99

Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm

13153

94.07

180.05

Repair, complex, eyelids, nose, ears and/or lips; each additional 5 cm or less (List separately in addition to code for primary procedure)

13160

903.02

776.75

Secondary closure of surgical wound or dehiscence, extensive or complicated

14000

672.37

637.52

Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less

14001

672.37

822.76

Adjacent tissue transfer or rearrangement, trunk; defect 10.1 sq cm to 30.0 sq cm

14020

672.37

709.70

Adjacent tissue transfer or rearrangement, scalp, arm and/or legs; defect 10 sq cm or less

14021

672.37

922.90

Adjacent tissue transfer or rearrangement, scalp, arm and/or legs; defect 10.1 sq cm to 30.0 sq cm

14040

672.37

744.02

Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less

14041

672.37

1,010.95

Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10.1 sq cm to 30.0 sq cm

14060

672.37

755.36

Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less

14061

672.37

1,098.01

Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10.1 sq cm to 30.0 sq cm

14300

903.02

1,055.04

Adjacent tissue transfer or rearrangement, more than 30 sq cm, unusual or complicated, any area

14350

903.02

732.71

Filleted finger or toe flap, including preparation of recipient site

15040

94.07

271.10

Harvest of skin for tissue cultured skin autograft, 100 sq cm or less

15050

202.27

535.06

Pinch graft, single or multiple, to cover small ulcer, tip of digit, or other minimal open area (except on face), up to defect size 2 cm diameter

15150

202.27

708.42

Tissue cultured epidermal autograft, trunk, arms, legs first 25 sq cm or less

15151

202.27

126.85

Tissue cultured epidermal autograft, trunk, arms, legs additional 1 sq cm to 75 sq cm (List separately in addition to code for primary procedure)

15155

202.27

730.87

Tissue cultured epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 25 sq cm or less

15156

202.27

166.82

Tissue cultured epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; additional 1 sq cm to 75 sq cm (List separately in addition to code for primary procedure)

15200

672.37

780.27

Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less

15201

672.37

156.17

Full thickness graft, free, including direct closure of donor site, trunk; each additional 20 sq cm (List separately in addition to code for primary procedure)

15220

672.37

749.07

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less

15221

202.27

144.85

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm (List separately in addition to code for primary procedure)

15240

672.37

885.96

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less

15241

202.27

185.01

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; each additional 20 sq cm (List separately in addition to code for primary procedure)

15260

672.37

944.42

Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less

15261

672.37

213.15

Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; each additional 20 sq cm (List separately in addition to code for primary procedure)

15340

94.07

317.42

Tissue cultured allogeneic skin substitute; first 25 sq cm or less

15341

94.07

47.41

Tissue cultured allogeneic skin substitute; each additional 25 sq cm

15570

903.02

874.10

Formation of direct or tubed pedicle, with or without transfer; trunk

15572

903.02

819.06

Formation of direct or tubed pedicle, with or without transfer; scalp, arms, or legs

15574

903.02

883.97

Formation of direct or tubed pedicle, with or without transfer; forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands or feet

15576

903.02

788.95

Formation of direct or tubed pedicle, with or without transfer; eyelids, nose, ears, lips, or intraoral

15600

903.02

372.01

Delay of flap or sectioning of flap (division and inset) at trunk

15610

903.02

330.61

Delay of flap or sectioning of flap (division and inset) at scalp, arms, or legs

15620

903.02

462.27

Delay of flap or sectioning of flap (division and inset) at forehead, cheeks, chin, neck, axillae, genitalia, hands, or feet

15630

903.02

470.02

Delay of flap or sectioning of flap (division and inset) at eyelids, nose, ears, or lips

15650

903.02

502.88

Transfer, intermediate, of any pedicle flap (eg, abdomen to wrist, Walking tube), any location

15731

903.02

1,068.20

Forehead flap with preservation of vascular pedicle (eg, axial pattern flap, paramedian forehead flap)

15732

903.02

1,485.59

Muscle, myocutaneous, or fasciocutaneous flap; head and neck (eg, temporalis, masseter muscle, sternocleidomastoid, levator scapulae)

15734

903.02

1,526.76

Muscle, myocutaneous, or fasciocutaneous flap; trun

15736

903.02

1,379.60

Muscle, myocutaneous, or fasciocutaneous flap; uppe extremity

15738

903.02

1,456.65

Muscle, myocutaneous, or fasciocutaneous flap; lowe extremity

15740

672.37

959.81

Flap; island pedicle

15750

903.02

889.16

Flap; neurovascular pedicle

15756

2,293.67

Free muscle or myocutaneous flap with microvascula anastomosis

15757

2,287.08

Free skin flap with microvascular anastomosis

15758

2,281.38

Free fascial flap with microvascular anastomosis

15760

903.02

826.85

Graft; composite (eg, full thickness of external ear or nasal ala), including primary closure, donor area

15770

903.02

636.09

Graft; derma-fat-fascia

15775

903.02

314.31

Punch graft for hair transplant; one to 15 punch grafts

15776

903.02

445.60

Punch graft for hair transplant; more than 15 punch grafts

15780

903.02

834.10

Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis)

15781

903.02

536.85

Dermabrasion; segmental, face

15782

903.02

586.66

Dermabrasion; regional, other than face

15783

903.02

496.84

Dermabrasion; superficial, any site (eg, tattoo removal

15786

903.02

240.37

Abrasion; single lesion (eg, keratosis, scar)

15787

903.02

56.65

Abrasion; each additional four lesions or less (List separately in addition to code for primary procedure)

15788

903.02

447.02

Chemical peel, facial; epidermal

15789

903.02

576.84

Chemical peel, facial; dermal

15792

903.02

437.47

Chemical peel, nonfacial; epidermal

15793

903.02

467.52

Chemical peel, nonfacial; dermal

15819

903.02

704.85

Cervicoplasty

15820

903.02

527.39

Blepharoplasty, lower eyelid;

15821

903.02

561.24

Blepharoplasty, lower eyelid; with extensive herniate fat pad

15822

903.02

419.61

Blepharoplasty, upper eyelid;

15823

903.02

642.96

Blepharoplasty, upper eyelid; with excessive skin weighting down lid

15824

903.02

I.C.

Rhytidectomy; forehead

15825

903.02

I.C.

Rhytidectomy; neck with platysmal tightening (platysmal flap, P-flap)

15826

903.02

I.C.

Rhytidectomy; glabellar frown lines

15828

903.02

I.C.

Rhytidectomy; cheek, chin, and neck

15829

903.02

I.C.

Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap

15830

903.02

1,116.84

Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy

15832

903.02

864.16

Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh

15833

903.02

805.92

Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg

15834

57.17

821.96

Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip

15835

57.17

839.07

Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock

15836

418.12

709.05

Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm

15837

192.34

752.05

Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand

15838

192.34

558.04

Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad

15839

118.89

816.99

Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area

15840

35.44

978.48

Graft for facial nerve paralysis; free fascia graft (including obtaining fascia)

15841

35.31

1,610.39

Graft for facial nerve paralysis; free muscle graft (including obtaining graft)

15842

35.44

2,545.49

Graft for facial nerve paralysis; free muscle flap by microsurgical technique

15845

65.22

910.54

Graft for facial nerve paralysis; regional muscle transfer

15847

65.22

I.C.

Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty)

15850

35.44

91.65

(includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure)

Removal of sutures under anesthesia (other than

15851

94.07

100.66

local), same surgeon Removal of sutures under anesthesia (other than

15852

903.02

45.41

local), other surgeon Dressing change (for other than burns) under

15860

903.02

107.35

anesthesia (other than local)

Intravenous injection of agent (eg, fluorescein) to test

15876

903.02

I.C.

vascular flow in flap or graft Suction assisted lipectomy; head and neck

15877

903.02

I.C.

Suction assisted lipectomy; trunk

15878

903.02

I.C.

Suction assisted lipectomy; upper extremity

15879

903.02

I.C.

Suction assisted lipectomy; lower extremity

15920

903.02

560.29

Excision, coccygeal pressure ulcer, with

15922

903.02

722.79

coccygectomy; with primary suture Excision, coccygeal pressure ulcer, with

15931

903.02

636.67

coccygectomy; with flap closure Excision, sacral pressure ulcer, with primary suture;

15933

943.36

790.51

Excision, sacral pressure ulcer, with primary suture;

15934

943.36

878.65

with ostectomy Excision, sacral pressure ulcer, with skin flap closure

15935

943.36

1,043.67

Excision, sacral pressure ulcer, with skin flap closure

15936

943.36

858.22

with ostectomy Excision, sacral pressure ulcer, in preparation for

15937

943.36

1,005.94

muscle or myocutaneous flap or skin graft closure;

Excision, sacral pressure ulcer, in preparation for

15940

719.48

660.16

muscle or myocutaneous flap or skin graft closure; with ostectomy Excision, ischial pressure ulcer, with primary suture;

15941

719.48

879.16

Excision, ischial pressure ulcer, with primary suture;

15944

719.48

853.65

with ostectomy (ischiectomy)

Excision, ischial pressure ulcer, with skin flap closure

15945

719.48

943.61

Excision, ischial pressure ulcer, with skin flap

15946

903.02

1,553.86

closure; with ostectomy Excision, ischial pressure ulcer, with ostectomy, in

15950

903.02

550.26

preparation for muscle or myocutaneous flap or skin graft closure Excision, trochanteric pressure ulcer, with primary

15951

903.02

784.05

suture;

Excision, trochanteric pressure ulcer, with primary

15952

903.02

812.73

suture; with ostectomy Excision, trochanteric pressure ulcer, with skin flap

15953

943.36

907.89

closure;

Excision, trochanteric pressure ulcer, with skin flap

15956

118.89

1,100.62

closure; with ostectomy Excision, trochanteric pressure ulcer, in preparation

15958

55.16

1,127.15

for muscle or myocutaneous flap or skin graft closure; Excision, trochanteric pressure ulcer, in preparation

15999

I.C.

for muscle or myocutaneous flap or skin graft closure;

with ostectomy Unlisted procedure, excision pressure ulcer

16000

28.19

69.15

Initial treatment, first degree burn, when no more tha local treatment is required

16020

903.02

84.95

Dressings and/or debridement of partial-thickness burns, initial or subsequent; small (less than 5% total body surface area)

16025

903.02

145.73

Dressings and/or debridement of partial-thickness burns, initial or subsequent; medium (eg, whole face or whole extremity, or 5% to 10% total body surface area)

16030

903.02

176.25

Dressings and/or debridement of partial-thickness burns, initial or subsequent; large (eg, more than one extremity, or greater than 10% total body surface area)

16035

903.02

205.92

Escharotomy; initial incision

16036

81.60

Escharotomy; each additional incision (List separatel in addition to code for primary procedure)

17000

35.44

76.84

Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion

17003

4.05

7.75

Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion)

17004

87.15

174.52

Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions

17106

118.89

382.26

Destruction of cutaneous vascular proliferative lesion (eg, laser technique); less than 10 sq cm

17107

118.89

659.00

Destruction of cutaneous vascular proliferative lesion (eg, laser technique); 10.0 to 50.0 sq cm

17108

118.89

885.03

Destruction of cutaneous vascular proliferative lesion (eg, laser technique); over 50.0 sq cm

17110

35.44

102.62

Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions

17111

65.22

123.81

Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions

17250

46.71

77.33

Chemical cauterization of granulation tissue (proud flesh, sinus or fistula)

17260

49.27

94.63

Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less

17261

65.22

136.49

Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm

17262

65.22

165.05

Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm

17263

65.22

181.73

Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm

17264

65.22

195.90

Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm

17266

110.31

221.36

Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm

17270

65.22

142.53

Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less

17271

65.22

155.54

Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm

17272

65.22

177.82

Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm

17273

99.65

197.81

Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm

17274

113.26

234.34

Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm

17276

118.89

272.15

Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm

17280

65.22

133.73

Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less

17281

85.32

168.29

Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm

17282

97.08

194.71

Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm

17283

112.16

234.50

Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm

17284

118.89

272.98

Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm

17286

118.89

345.71

Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm

17311

162.31

711.84

Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (eg, hematoxylin and eosin, toluidine blue), head, neck, hands, feet, genitalia, or any location with surgery directly involving muscle, cartilage, bone, tendon, major nerves, or vessels; first stage, up to five tissue blocks

17312

162.31

433.70

Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (eg, hematoxylin and eosin, toluidine blue), head, neck, hands, feet, genitalia, or any location with surgery directly involving muscle, cartilage, bone, tendon, major nerves, or vessels; each additional stage after the first stage, up to five tissue blocks (List separately in addition to code for primary procedure)

17313

162.31

651.19

Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (eg, hematoxylin and eosin, toluidine blue), of the trunk, arms, or legs; first stage, up to five tissue blocks

17314

162.31

401.27

Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (eg, hematoxylin and eosin, toluidine blue), of the trunk, arms, or legs; each additional stage after the first stage, up to five tissue blocks (List separately in addition to code for primary procedure)

17315

41.92

83.08

Mohs micrographic technique, including removal of

all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (eg, hematoxylin and eosin, toluidine blue), each additional block after the first five tissue blocks, any stage (List separately in addition to code for primary procedure)

17340

13.23

44.02

Cryotherapy (CO2 slush, liquid N2) for acne

17360

35.44

126.91

Chemical exfoliation for acne (eg, acne paste, acid)

17380

35.44

I.C.

Electrolysis epilation, each 30 minutes

17999

I.C.

Unlisted procedure, skin, mucous membrane and subcutaneous tissue

19000

71.70

120.83

Puncture aspiration of cyst of breast;

19001

71.70

27.05

Puncture aspiration of cyst of breast; each additional cyst (List separately in addition to code for primary procedure)

19020

71.70

439.45

Mastotomy with exploration or drainage of abscess, deep

19030

182.43

Injection procedure only for mammary ductogram or galactogram

19100

193.36

143.90

Biopsy of breast; percutaneous, needle core, not using imaging guidance (separate procedure)

19101

922.44

325.31

Biopsy of breast; open, incisional

19102

317.95

240.49

Biopsy of breast; percutaneous, needle core, using imaging guidance

19103

606.71

632.08

Biopsy of breast; percutaneous, automated vacuum assisted or rotating biopsy device, using imaging guidance

19105

1,417.2

2

2,27

5.75

Ablation, cryosurgical, of fibroadenoma, including ultrasound guidance, each fibroadenoma

19110

922.44

438.55

Nipple exploration, with or without excision of a solitary lactiferous duct or a papilloma lactiferous duct

19112

922.44

424.47

Excision of lactiferous duct fistula

19120

922.44

442.67

Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, one or more lesions

19125

922.44

486.95

Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion

19126

922.44

151.47

Excision of breast lesion identified by preoperative placement of radiological marker, open; each additional lesion separately identified by a preoperative radiological marker (List separately in addition to code for primary procedure)

19260

1,155.26

Excision of chest wall tumor including ribs

19271

1,603.08

Excision of chest wall tumor involving ribs, with plastic reconstruction; without mediastinal lymphadenectomy

19272

1,763.56

Excision of chest wall tumor involving ribs, with plastic reconstruction; with mediastinal lymphadenectomy

19290

177.56

Preoperative placement of needle localization wire, breast;

19291

76.56

Preoperative placement of needle localization wire, breast; each additional lesion (List separately in addition to code for primary procedure)

19295

114.91

Image guided placement, metallic localization clip, percutaneous, during breast biopsy (List separately in addition to code for primary procedure)

19296

2,528.34

5,002.21

Placement of radiotherapy afterloading balloon catheter into the breast for interstitial radioelement application following partial mastectomy, includes imaging guidance; on date separate from partial mastectomy

19297

2,528.34

88.68

Placement of radiotherapy afterloading balloon catheter into the breast for interstitial radioelement application following partial mastectomy, includes imaging guidance; concurrent with partial mastectomy (List separately in addition to code for primary procedure)

19298

2,528.34

1,695.25

Placement of radiotherapy afterloading brachytherapy catheters (multiple tube and button type) into the breast for interstitial radioelement application following (at the time of or subsequent to) partial mastectomy, includes imaging guidance

19300

2,528.34

548.04

Mastectomy for gynecomastia

19301

2,528.34

550.14

Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy);

19302

2,528.34

815.08

Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymphadenectomy

19303

2,528.34

847.02

Mastectomy, simple, complete

19304

2,528.34

521.07

Mastectomy, subcutaneous

19305

1,016.20

Mastectomy, radical, including pectoral muscles, axillary lymph nodes

19306

1,062.12

Mastectomy, radical, including pectoral muscles, axillary and internal mammary lymph nodes (Urban type operation)

19307

1,067.49

Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle

19316

1,417.22

756.83

Mastopexy

19318

1,779.44

1,116.18

Reduction mammaplasty

19324

1,779.44

467.64

Mammaplasty, augmentation; without prosthetic implant

19325

2,528.34

628.57

Mammaplasty, augmentation; with prosthetic implan

19328

1,417.22

474.69

Removal of intact mammary implant

19330

1,417.22

600.40

Removal of mammary implant material

19340

1,779.44

383.80

Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction

19342

2,528.34

889.56

Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction

19350

922.44

895.56

Nipple/areola reconstruction

19357

2,528.34

1,504.35

Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion

19361

1,551.85

Breast reconstruction with latissimus dorsi flap, without prosthetic implant

19364

2,687.37

Breast reconstruction with free flap

19366

1,417.22

1,333.13

Breast reconstruction with other technique

19367

1,763.11

Breast reconstruction with transverse rectus abdominis myocutaneous flap (TRAM), single pedicle, including closure of donor site;

19368

2,164.21

Breast reconstruction with transverse rectus abdominis myocutaneous flap (TRAM), single pedicle, including closure of donor site; with microvascular anastomosis (supercharging)

19369

1,993.81

Breast reconstruction with transverse rectus abdominis myocutaneous flap (TRAM), double pedicle, including closure of donor site

19370

1,417.22

660.91

Open periprosthetic capsulotomy, breast

19371

1,417.22

761.51

Periprosthetic capsulectomy, breast

19380

1,779.44

744.34

Revision of reconstructed breast

19396

1,417.22

212.42

Preparation of moulage for custom breast implant

19499

I.C.

Unlisted procedure, breast

20000

62.85

206.68

Incision of soft tissue abscess (eg, secondary to osteomyelitis); superficial

20005

950.47

299.78

Incision of soft tissue abscess (eg, secondary to osteomyelitis); deep or complicated

20100

574.00

Exploration of penetrating wound (separate procedure); neck

20101

411.27

Exploration of penetrating wound (separate procedure); chest

20102

481.42

Exploration of penetrating wound (separate procedure); abdomen/flank/back

20103

430.53

581.21

Exploration of penetrating wound (separate procedure); extremity

20150

1,920.92

897.48

Excision of epiphyseal bar, with or without autogenous soft tissue graft obtained through same fascial incision

20200

719.48

197.59

Biopsy, muscle; superficial

20205

719.48

267.80

Biopsy, muscle; deep

20206

317.95

305.62

Biopsy, muscle, percutaneous needle

20220

388.12

212.84

Biopsy, bone, trocar, or needle; superficial (eg, ilium sternum, spinous process, ribs)

20225

388.12

909.54

Biopsy, bone, trocar, or needle; deep (eg, vertebral body, femur)

20240

943.36

229.56

Biopsy, bone, open; superficial (eg, ilium, sternum, spinous process, ribs, trochanter of femur)

20245

943.36

622.24

Biopsy, bone, open; deep (eg, humerus, ischium, femur

20250

950.47

371.07

Biopsy, vertebral body, open; thoracic

20251

950.47

412.86

Biopsy, vertebral body, open; lumbar or cervical

20500

66.19

129.13

Injection of sinus tract; therapeutic (separate procedure

20501

148.66

Injection of sinus tract; diagnostic (sinogram)

20520

101.50

197.18

Removal of foreign body in muscle or tendon sheath; simple

20525

943.36

509.34

Removal of foreign body in muscle or tendon sheath; deep or complicated

20526

32.73

76.96

Injection, therapeutic (eg, local anesthetic, corticosteroid), carpal tunnel

20550

24.64

59.14

Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia")

20551

24.28

58.38

Injection(s); single tendon origin/insertion

20552

23.90

53.95

Injection(s); single or multiple trigger point(s), one o two muscle(s)

20553

26.84

60.41

Injection(s); single or multiple trigger point(s), three or more muscle(s)

20555

1,304.45

318.09

Placement of needles or catheters into muscle and/or soft tissue for subsequent interstitial radioelement application (at the time of or subsequent to the procedure)

20600

24.28

55.31

Arthrocentesis, aspiration and/or injection; small join or bursa (eg, fingers, toes)

20605

27.58

60.14

Arthrocentesis, aspiration and/or injection; intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa)

20610

37.14

76.76

Arthrocentesis, aspiration and/or injection; major join or bursa (eg, shoulder, hip, knee joint, subacromial bursa)

20612

25.74

59.12

Aspiration and/or injection of ganglion cyst(s) any location

20615

114.36

227.67

Aspiration and injection for treatment of bone cyst

20650

950.47

197.04

Insertion of wire or pin with application of skeletal traction, including removal (separate procedure)

20660

259.20

Application of cranial tongs, caliper, or stereotactic frame, including removal (separate procedure)

20661

461.90

Application of halo, including removal; cranial

20662

950.47

468.49

Application of halo, including removal; pelvic

20663

950.47

442.84

Application of halo, including removal; femoral

20664

731.10

Application of halo, including removal, cranial, 6 or more pins placed, for thin skull osteology (eg, pediatric patients, hydrocephalus, osteogenesis imperfecta), requiring general anesthesia

20665

28.19

132.12

Removal of tongs or halo applied by another physicia

20670

719.48

486.42

Removal of implant; superficial (eg, buried wire, pin or rod) (separate procedure)

20680

943.36

608.09

Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)

20690

1,304.45

483.79

Application of a uniplane (pins or wires in one plane), unilateral, external fixation system

20692

1,304.45

890.29

Application of a multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)

20693

950.47

461.97

Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))

20694

950.47

451.44

Removal, under anesthesia, of external fixation system

20802

2,345.84

Replantation, arm (includes surgical neck of humerus through elbow joint), complete amputation

20805

3,095.55

Replantation, forearm (includes radius and ulna to radial carpal joint), complete amputation

20808

4,019.75

Replantation, hand (includes hand through metacarpophalangeal joints), complete amputation

20816

2,466.39

Replantation, digit, excluding thumb (includes metacarpophalangeal joint to insertion of flexor sublimis tendon), complete amputation

20822

1,175.77

2,170.99

Replantation, digit, excluding thumb (includes distal tip to sublimis tendon insertion), complete amputation

20824

2,436.87

Replantation, thumb (includes carpometacarpal joint to MP joint), complete amputation

20827

2,219.31

Replantation, thumb (includes distal tip to MP joint), complete amputation

20838

2,322.57

Replantation, foot, complete amputation

20900

1,304.45

631.61

Bone graft, any donor area; minor or small (eg, dowel or button)

20902

1,304.45

607.39

Bone graft, any donor area; major or large

20910

903.02

430.61

Cartilage graft; costochondral

20912

903.02

487.05

Cartilage graft; nasal septum

20920

672.37

401.84

Fascia lata graft; by stripper

20922

672.37

602.03

Fascia lata graft; by incision and area exposure, complex or sheet

20924

1,304.45

506.11

Tendon graft, from a distance (eg, palmaris, toe extensor, plantaris)

20926

202.27

433.34

Tissue grafts, other (eg, paratenon, fat, dermis)

20930

I.C.

Allograft for spine surgery only; morselized (List separately in addition to code for primary procedure)

20931

111.51

Allograft for spine surgery only; structural (List separately in addition to code for primary procedure)

20936

I.C.

Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision (List separately in addition to code for primary procedure)

20937

169.44

Autograft for spine surgery only (includes harvesting the graft); morselized (through separate skin or fascial incision) (List separately in addition to code for primary procedure)

20938

184.43

Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate skin or fascial incision) (List separately in addition to code for primary procedure)

20950

62.85

304.01

Monitoring of interstitial fluid pressure (includes insertion of device, eg, wick catheter technique, needle manometer technique) in detection of muscle compartment syndrome

20955

2,499.21

Bone graft with microvascular anastomosis; fibula

20956

2,646.13

Bone graft with microvascular anastomosis; iliac cres

20957

2,459.01

Bone graft with microvascular anastomosis; metatarsa

20962

2,637.14

Bone graft with microvascular anastomosis; other than fibula, iliac crest, or metatarsal

20969

2,783.23

Free osteocutaneous flap with microvascular anastomosis; other than iliac crest, metatarsal, or great

toe

20970

2,775.62

Free osteocutaneous flap with microvascular anastomosis; iliac crest

20972

1,978.29

2,485.71

Free osteocutaneous flap with microvascular anastomosis; metatarsal

20973

1,978.29

2,675.05

Free osteocutaneous flap with microvascular anastomosis; great toe with web space

20974

62.67

Electrical stimulation to aid bone healing; noninvasiv (nonoperative)

20975

176.78

Electrical stimulation to aid bone healing; invasive (operative)

20979

26.11

56.55

Low intensity ultrasound stimulation to aid bone healing, noninvasive (nonoperative)

20982

1,920.92

4,634.67

Ablation, bone tumor(s) (eg, osteoid osteoma, metastasis) radiofrequency, percutaneous, including computed tomographic guidance

20985

145.31

Computer-assisted surgical navigational procedure fo musculoskeletal procedures; image-less (List separately in addition to code for primary procedure)

20986

I.C.

Computer-assisted surgical navigational procedure for musculoskeletal procedures; with image guidance based on intraoperatively obtained images (eg, fluoroscopy, ultrasound) (List separately in addition to code for primary procedure)

20987

I.C.

Computer-assisted surgical navigational procedure for musculoskeletal procedures; with image guidance based on preoperative images (List separately in addition to code for primary procedure)

20999

I.C.

Unlisted procedure, musculoskeletal system, general

21010

1,071.47

713.36

Arthrotomy, temporomandibular joint

21015

729.71

426.33

Radical resection of tumor (eg, malignant neoplasm), soft tissue of face or scalp

21025

1,782.06

988.28

Excision of bone (eg, for osteomyelitis or bone abscess); mandible

21026

1,782.06

591.47

Excision of bone (eg, for osteomyelitis or bone abscess); facial bone(s)

21029

1,782.06

746.08

Removal by contouring of benign tumor of facial bone (eg, fibrous dysplasia)

21030

248.59

491.22

Excision of benign tumor or cyst of maxilla or zygoma by enucleation and curettage

21031

203.73

380.69

Excision of torus mandibularis

21032

209.24

388.44

Excision of maxillary torus palatinus

21034

1,782.06

1,325.45

Excision of malignant tumor of maxilla or zygoma

21040

1,071.47

493.06

Excision of benign tumor or cyst of mandible, by enucleation and/or curettage

21044

1,782.06

866.40

Excision of malignant tumor of mandible;

21045

1,197.58

Excision of malignant tumor of mandible; radical resection

21046

1,782.06

1,071.26

Excision of benign tumor or cyst of mandible; requiring intra-oral osteotomy (eg, locally aggressive or destructive lesion(s))

21047

1,782.06

1,285.42

Excision of benign tumor or cyst of mandible; requiring extra-oral osteotomy and partial mandibulectomy (eg, locally aggressive or destructive lesion(s))

21048

1,782.06

1,088.86

Excision of benign tumor or cyst of maxilla; requiring intra-oral osteotomy (eg, locally aggressive or destructive lesion(s))

21049

1,235.80

Excision of benign tumor or cyst of maxilla; requiring extra-oral osteotomy and partial maxillectomy (eg, locally aggressive or destructive lesion(s))

21050

1,782.06

844.50

Condylectomy, temporomandibular joint (separate procedure)

21060

1,782.06

777.49

Meniscectomy, partial or complete, temporomandibular joint (separate procedure)

21070

1,782.06

636.21

Coronoidectomy (separate procedure)

21073

202.26

379.74

Manipulation of temporomandibular joint(s) (TMJ), therapeutic, requiring an anesthesia service (ie, general or monitored anesthesia care)

21076

374.35

986.49

Impression and custom preparation; surgical obturato prosthesis

21077

914.19

2,432.95

Impression and custom preparation; orbital prosthesis

21079

651.62

1,672.99

Impression and custom preparation; interim obturator prosthesis

21080

746.87

1,903.78

Impression and custom preparation; definitive obturator prosthesis

21081

685.82

1,735.73

Impression and custom preparation; mandibular resection prosthesis

21082

629.19

1,593.53

Impression and custom preparation; palatal augmentation prosthesis

21083

618.90

1,520.60

Impression and custom preparation; palatal lift prosthesis

21084

721.86

1,737.63

Impression and custom preparation; speech aid prosthesis

21085

279.48

695.29

Impression and custom preparation; oral surgical splint

21086

673.32

1,805.14

Impression and custom preparation; auricular prosthesis

21087

667.44

1,789.22

Impression and custom preparation; nasal prosthesis

21088

1,782.06

I.C.

Impression and custom preparation; facial prosthesis

21089

I.C.

Unlisted maxillofacial prosthetic procedure

21100

1,782.06

773.46

Application of halo type appliance for maxillofacial fixation, includes removal (separate procedure)

21110

332.81

740.19

Application of interdental fixation device for conditions other than fracture or dislocation, includes removal

21116

186.87

Injection procedure for temporomandibular joint arthrography

21120

1,071.47

654.16

Genioplasty; augmentation (autograft, allograft, prosthetic material)

21121

1,071.47

758.91

Genioplasty; sliding osteotomy, single piece

21122

1,071.47

718.44

Genioplasty; sliding osteotomies, two or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin)

21123

1,071.47

835.62

Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts)

21125

1,071.47

3,132.9

9

Augmentation, mandibular body or angle; prosthetic material

21127

1,782.06

3,406.0

5

Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft)

21137

1,071.47

734.45

Reduction forehead; contouring only

21138

1,782.06

885.70

Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft)

21139

1,782.06

959.74

Reduction forehead; contouring and setback of anterior frontal sinus wall

21141

1,316.00

Reconstruction midface, LeFort I; single piece, segment movement in any direction (eg, for Long Face Syndrome), without bone graft

21142

1,281.30

Reconstruction midface, LeFort I; two pieces, segment movement in any direction, without bone graft

21143

1,359.35

Reconstruction midface, LeFort I; three or more pieces, segment movement in any direction, without bone graft

21145

1,511.19

Reconstruction midface, LeFort I; single piece, segment movement in any direction, requiring bone grafts (includes obtaining autografts)

21146

1,495.10

Reconstruction midface, LeFort I; two pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted unilateral alveolar cleft)

21147

1,623.65

Reconstruction midface, LeFort I; three or more pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted bilateral alveolar cleft or multiple osteotomies)

21150

1,782.06

1,732.52

Reconstruction midface, LeFort II; anterior intrusion (eg, Treacher-Collins Syndrome)

21151

1,849.76

Reconstruction midface, LeFort II; any direction, requiring bone grafts (includes obtaining autografts)

21154

2,079.28

Reconstruction midface, LeFort III (extracranial), an type, requiring bone grafts (includes obtaining autografts); without LeFort I

21155

2,362.39

Reconstruction midface, LeFort III (extracranial), an type, requiring bone grafts (includes obtaining autografts); with LeFort I

21159

2,728.67

Reconstruction midface, LeFort III (extra and intracranial) with forehead advancement (eg, mono bloc), requiring bone grafts (includes obtaining autografts); without LeFort I

21160

2,894.85

Reconstruction midface, LeFort III (extra and intracranial) with forehead advancement (eg, mono bloc), requiring bone grafts (includes obtaining autografts); with LeFort I

21172

1,697.99

Reconstruction superior-lateral orbital rim and lower forehead, advancement or alteration, with or without grafts (includes obtaining autografts)

21175

2,007.74

Reconstruction, bifrontal, superior-lateral orbital rim and lower forehead, advancement or alteration (eg, plagiocephaly, trigonocephaly, brachycephaly), with or without grafts (includes obtaining autografts)

21179

1,437.11

Reconstruction, entire or majority of forehead and/or supraorbital rims; with grafts (allograft or prosthetic material)

21180

1,627.03

Reconstruction, entire or majority of forehead and/or supraorbital rims; with autograft (includes obtaining grafts)

21181

1,071.47

716.24

Reconstruction by contouring of benign tumor of cranial bones (eg, fibrous dysplasia), extracranial

21182

1,983.86

Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following intra-and extracranial excision of benign tumor of cranial bone (eg, fibrous dysplasia), with multiple autografts (includes obtaining grafts); total area of bone grafting less than 40 sq cm

21183

2,270.70

Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following intra- and extracranial excision of benign tumor of cranial bone (eg, fibrous dysplasia), with multiple autografts (includes obtaining grafts); total area of bone grafting greater than 40 sq cm but less than 80 sq cm

21184

2,350.49

Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following intra- and extracranial excision of benign tumor of cranial bone (eg, fibrous dysplasia), with multiple autografts (includes obtaining grafts); total area of bone grafting greater than 80 sq cm

21188

21193

1,630.13

1,221.27

Reconstruction midface, osteotomies (other than LeFort type) and bone grafts (includes obtaining autografts)

Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; without bone graft

21194

1,392.36

Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; with bone graft (includes obtaining graft)

21195

21196

1,335.87

1,446.59

Reconstruction of mandibular rami and/or body, sagittal split; without internal rigid fixation Reconstruction of mandibular rami and/or body, sagittal split; with internal rigid fixation

21198

1,782.06

1,137.84

Osteotomy, mandible, segmental;

21199

1,782.06

993.46

Osteotomy, mandible, segmental; with genioglossus advancement

21206

1,782.06

1,106.06

Osteotomy, maxilla, segmental (eg, Wassmund or Schuchard)

21208

1,782.06

1,691.11

Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant)

21209

1,782.06

815.11

Osteoplasty, facial bones; reduction

21210

1,782.06

2,001.90

Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)

21215

1,782.06

3,400.25

Graft, bone; mandible (includes obtaining graft)

21230

1,782.06

762.88

Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft)

21235

1,071.47

727.23

Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft)

21240

1,782.06

1,100.68

Arthroplasty, temporomandibular joint, with or without autograft (includes obtaining graft)

21242

1,782.06

1,015.29

Arthroplasty, temporomandibular joint, with allograf

21243

1,782.06

1,645.42

Arthroplasty, temporomandibular joint, with prosthetic joint replacement

21244

1,782.06

1,036.87

Reconstruction of mandible, extraoral, with transosteal bone plate (eg, mandibular staple bone plate)

21245

1,782.06

1,134.10

Reconstruction of mandible or maxilla, subperiosteal implant; partial

21246

1,782.06

856.09

Reconstruction of mandible or maxilla, subperiosteal implant; complete

21247

1,598.07

Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)

21248

1,782.06

1,044.44

Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partial

21249

1,782.06

1,456.17

Reconstruction of mandible or maxilla, endosteal

implant (eg, blade, cylinder); complete

21255

1,386.02

Reconstruction of zygomatic arch and glenoid fossa with bone and cartilage (includes obtaining autografts)

21256

1,132.24

Reconstruction of orbit with osteotomies (extracranial) and with bone grafts (includes obtaining autografts) (eg, micro-ophthalmia)

21260

1,782.06

1,227.16

Periorbital osteotomies for orbital hypertelorism, with bone grafts; extracranial approach

21261

2,153.72

Periorbital osteotomies for orbital hypertelorism, wit bone grafts; combined intra- and extracranial approach

21263

1,890.40

Periorbital osteotomies for orbital hypertelorism, wit bone grafts; with forehead advancement

21267

21268

1,782.06

1,791.81

1,574.31

Orbital repositioning, periorbital osteotomies, unilateral, with bone grafts; extracranial approach Orbital repositioning, periorbital osteotomies, unilateral, with bone grafts; combined intra- and extracranial approach

21270

1,782.06

905.95

Malar augmentation, prosthetic material

21275

1,782.06

789.01

Secondary revision of orbitocraniofacial reconstruction

21280

1,782.06

515.36

Medial canthopexy (separate procedure)

21282

729.71

346.96

Lateral canthopexy

21295

332.81

176.48

Reduction of masseter muscle and bone (eg, for treatment of benign masseteric hypertrophy); extraoral approach

21296

21299

1,071.47

I.C.

407.61

Reduction of masseter muscle and bone (eg, for treatment of benign masseteric hypertrophy); intraoral approach Unlisted craniofacial and maxillofacial procedure

21310

111.73

119.80

Closed treatment of nasal bone fracture without manipulation

21315

111.73

271.18

Closed treatment of nasal bone fracture; without stabilization

21320

729.71

258.08

Closed treatment of nasal bone fracture; with stabilization

21325

1,071.47

507.27

Open treatment of nasal fracture; uncomplicated

21330

1,071.47

609.78

Open treatment of nasal fracture; complicated, with internal and/or external skeletal fixation

21335

1,071.47

742.95

Open treatment of nasal fracture; with concomitant open treatment of fractured septum

21336

1,169.01

661.16

Open treatment of nasal septal fracture, with or without stabilization

21337

729.71

402.31

Closed treatment of nasal septal fracture, with or without stabilization

21338

1,071.47

806.80

Open treatment of nasoethmoid fracture; without external fixation

21339

1,071.47

861.59

Open treatment of nasoethmoid fracture; with externa fixation

21340

1,782.06

781.71

Percutaneous treatment of nasoethmoid complex fracture, with splint, wire or headcap fixation, including repair of canthal ligaments and/or the nasolacrimal apparatus

21343

1,176.66

Open treatment of depressed frontal sinus fracture

21344

1,483.19

Open treatment of complicated (eg, comminuted or involving posterior wall) frontal sinus fracture, via coronal or multiple approaches

21345

1,071.47

798.53

Closed treatment of nasomaxillary complex fracture (LeFort II type), with interdental wire fixation or fixation of denture or splint

21346

951.99

Open treatment of nasomaxillary complex fracture (LeFort II type); with wiring and/or local fixation

21347

1,143.57

Open treatment of nasomaxillary complex fracture (LeFort II type); requiring multiple open approaches

21348

1,176.43

Open treatment of nasomaxillary complex fracture (LeFort II type); with bone grafting (includes obtaining graft)

21355

1,782.06

437.08

Percutaneous treatment of fracture of malar area, including zygomatic arch and malar tripod, with manipulation

21356

1,071.47

498.76

Open treatment of depressed zygomatic arch fracture (eg, Gillies approach)

21360

1,071.47

523.19

Open treatment of depressed malar fracture, including zygomatic arch and malar tripod

21365

1,073.90

Open treatment of complicated (eg, comminuted or involving cranial nerve foramina) fracture(s) of malar area, including zygomatic arch and malar tripod; with internal fixation and multiple surgical approaches

21366

1,207.16

Open treatment of complicated (eg, comminuted or involving cranial nerve foramina) fracture(s) of malar area, including zygomatic arch and malar tripod; with bone grafting (includes obtaining graft)

21385

21386

706.95

653.09

Open treatment of orbital floor blowout fracture; transantral approach (Caldwell-Luc type operation) Open treatment of orbital floor blowout fracture; periorbital approach

21387

751.69

Open treatment of orbital floor blowout fracture; combined approach

21390

21395

1,782.06

942.32

746.01

Open treatment of orbital floor blowout fracture; periorbital approach, with alloplastic or other implant Open treatment of orbital floor blowout fracture; periorbital approach with bone graft (includes obtaining graft)

21400

332.81

176.10

Closed treatment of fracture of orbit, except blowout; without manipulation

21401

729.71

479.41

Closed treatment of fracture of orbit, except blowout; with manipulation

21406

1,782.06

533.37

Open treatment of fracture of orbit, except blowout; without implant

21407

1,782.06

626.51

Open treatment of fracture of orbit, except blowout; with implant

21408

851.81

Open treatment of fracture of orbit, except blowout; with bone grafting (includes obtaining graft)

21421

1,071.47

721.62

Closed treatment of palatal or maxillary fracture (LeFort I type), with interdental wire fixation or fixation of denture or splint

21422

671.96

Open treatment of palatal or maxillary fracture (LeFort I type);

21423

789.00

Open treatment of palatal or maxillary fracture (LeFort I type); complicated (comminuted or involving cranial nerve foramina), multiple approaches

21431

754.28

Closed treatment of craniofacial separation (LeFort II type) using interdental wire fixation of denture or splint

21432

665.82

Open treatment of craniofacial separation (LeFort III type); with wiring and/or internal fixation

21433

1,633.07

Open treatment of craniofacial separation (LeFort III type); complicated (eg, comminuted or involving cranial nerve foramina), multiple surgical approaches

21435

1,290.93

Open treatment of craniofacial separation (LeFort III type); complicated, utilizing internal and/or external fixation techniques (eg, head cap, halo device, and/or intermaxillary fixation)

21436

1,839.74

Open treatment of craniofacial separation (LeFort III type); complicated, multiple surgical approaches, internal fixation, with bone grafting (includes obtaining graft)

21440

315.52

518.76

Closed treatment of mandibular or maxillary alveolar ridge fracture (separate procedure)

21445

1,071.47

736.83

Open treatment of mandibular or maxillary alveolar ridge fracture (separate procedure)

21450

111.73

543.05

Closed treatment of mandibular fracture; without manipulation

21451

332.81

719.44

Closed treatment of mandibular fracture; with manipulation

21452

729.71

663.47

Percutaneous treatment of mandibular fracture, with external fixation

21453

1,782.06

828.94

Closed treatment of mandibular fracture with interdental fixation

21454

1,071.47

545.55

Open treatment of mandibular fracture with external fixation

21461

1,782.06

1,862.58

Open treatment of mandibular fracture; without interdental fixation

21462

1,782.06

2,031.50

Open treatment of mandibular fracture; with interdental fixation

21465

1,782.06

897.60

Open treatment of mandibular condylar fracture

21470

1,158.59

Open treatment of complicated mandibular fracture b multiple surgical approaches including internal fixation, interdental fixation, and/or wiring of dentures or splints

21480

111.73

98.57

Closed treatment of temporomandibular dislocation; initial or subsequent

21485

729.71

639.31

Closed treatment of temporomandibular dislocation; complicated (eg, recurrent requiring intermaxillary fixation or splinting), initial or subsequent

21490

1,782.06

903.12

Open treatment of temporomandibular dislocation

21495

729.71

672.39

Open treatment of hyoid fracture

21497

729.71

642.86

Interdental wiring, for condition other than fracture

21499

I.C.

Unlisted musculoskeletal procedure, head

21501

818.67

443.75

Incision and drainage, deep abscess or hematoma, sof tissues of neck or thorax;

21502

950.47

517.50

Incision and drainage, deep abscess or hematoma, sof tissues of neck or thorax; with partial rib ostectomy

21510

472.07

Incision, deep, with opening of bone cortex (eg, for osteomyelitis or bone abscess), thorax

21550

388.12

258.55

Biopsy, soft tissue of neck or thorax

21555

943.36

427.07

Excision tumor, soft tissue of neck or thorax; subcutaneous

21556

943.36

401.35

Excision tumor, soft tissue of neck or thorax; deep, subfascial, intramuscular

21557

943.36

563.97

Radical resection of tumor (eg, malignant neoplasm), soft tissue of neck or thorax

21600

1,304.45

542.72

Excision of rib, partial

21610

1,304.45

1,039.61

Costotransversectomy (separate procedure)

21615

668.43

Excision first and/or cervical rib;

21616

818.83

Excision first and/or cervical rib; with sympathectom

21620

521.01

Ostectomy of sternum, partial

21627

548.67

Sternal debridement

21630

1,237.61

Radical resection of sternum;

21632

1,218.57

Radical resection of sternum; with mediastinal lymphadenectomy

21685

332.81

971.45

Hyoid myotomy and suspension

21700

950.47

425.75

Division of scalenus anticus; without resection of cervical rib

21705

607.25

Division of scalenus anticus; with resection of cervical rib

21720

950.47

374.01

Division of sternocleidomastoid for torticollis, open operation; without cast application

21725

62.85

522.63

Division of sternocleidomastoid for torticollis, open operation; with cast application

21740

1,052.32

Reconstructive repair of pectus excavatum or carinatum; open

21742

I.C.

Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy

21743

I.C.

Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy

21750

699.66

Closure of median sternotomy separation with or without debridement (separate procedure)

21800

79.02

98.30

Closed treatment of rib fracture, uncomplicated, each

21805

1,169.01

256.12

Open treatment of rib fracture without fixation, each

21810

502.41

Treatment of rib fracture requiring external fixation (flail chest)

21820

79.02

133.75

Closed treatment of sternum fracture

21825

565.57

Open treatment of sternum fracture with or without skeletal fixation

21899

I.C.

Unlisted procedure, neck or thorax

21920

141.94

252.88

Biopsy, soft tissue of back or flank; superficial

21925

943.36

415.10

Biopsy, soft tissue of back or flank; deep

21930

943.36

463.19

Excision, tumor, soft tissue of back or flank

21935

943.36

1,117.98

Radical resection of tumor (eg, malignant neoplasm), soft tissue of back or flank

22010

878.10

Incision and drainage, open, of deep abscess (subfascial), posterior spine; cervical, thoracic, or cervicothoracic

22015

872.36

Incision and drainage, open, of deep abscess (subfascial), posterior spine; lumbar, sacral, or lumbosacral

22100

795.13

Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; cervical

22101

794.19

Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; thoracic

22102

2,090.17

796.97

Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; lumbar

22103

2,090.17

141.41

Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; each additional segment (List separately in addition to code for primary procedure)

22110

975.36

Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; cervical

22112

971.02

Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; thoracic

22114

973.39

Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; lumbar

22116

141.61

Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; each additional vertebral segment (List separately in addition to code for primary procedure)

22206

2,266.12

Osteotomy of spine, posterior or posterolateral approach, three columns, one vertebral segment (eg, pedicle/vertebral body subtraction); thoracic

22207

2,238.72

Osteotomy of spine, posterior or posterolateral approach, three columns, one vertebral segment (eg, pedicle/vertebral body subtraction); lumbar

22208

563.55

Osteotomy of spine, posterior or posterolateral approach, three columns, one vertebral segment (eg, pedicle/vertebral body subtraction); each additional vertebral segment (List separately in addition to code for primary procedure)

22210

1,711.64

Osteotomy of spine, posterior or posterolateral approach, one vertebral segment; cervical

22212

1,417.71

Osteotomy of spine, posterior or posterolateral approach, one vertebral segment; thoracic

22214

1,433.30

Osteotomy of spine, posterior or posterolateral approach, one vertebral segment; lumbar

22216

370.21

Osteotomy of spine, posterior or posterolateral approach, one vertebral segment; each additional vertebral segment (List separately in addition to primary procedure)

22220

1,548.36

Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; cervical

22222

1,400.73

Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; thoracic

22224

1,530.02

Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; lumbar

22226

368.37

Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; each additional vertebral segment (List separately in addition to code for primary procedure)

22305

79.02

185.35

Closed treatment of vertebral process fracture(s)

22310

79.02

274.46

Closed treatment of vertebral body fracture(s), without manipulation, requiring and including casting or bracing

22315

79.02

844.73

Closed treatment of vertebral fracture(s) and/or dislocation(s) requiring casting or bracing, with and including casting and/or bracing, with or without anesthesia, by manipulation or traction

22318

1,542.01

Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), anterior approach, including placement of internal fixation; without grafting

22319

1,688.58

Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), anterior approach, including placement of internal fixation; with grafting

22325

1,344.05

Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, one fractured vertebra or dislocated segment; lumbar

22326

1,406.87

Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, one fractured vertebra or dislocated segment; cervical

22327

1,389.12

Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, one fractured vertebra or dislocated segment; thoracic

22328

277.75

Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, one fractured vertebra or dislocated segment; each additional fractured vertebra or dislocated segment (List separately in addition to code for primary procedure)

22505

659.86

121.59

Manipulation of spine requiring anesthesia, any region

22520

1,304.45

2,793.55

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

22521

1,304.45

2,666.47

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

22522

1,304.45

244.58

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

3,549.34

609.50

Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included

22524

3,549.34

583.96

when performed) using mechanical device, one vertebral body, unilateral or bilateral cannulation (eg, kyphoplasty); thoracic Percutaneous vertebral augmentation, including cavity

22525

3,549.34

268.33

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

22526

1,304.45

2,392.91

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)

Percutaneous intradiscal electrothermal annuloplasty,

22527

1,304.45

1,980.38

unilateral or bilateral including fluoroscopic guidance;

single level Percutaneous intradiscal electrothermal annuloplasty,

unilateral or bilateral including fluoroscopic guidance; one or more additional levels (List separately in addition to code for primary procedure)

22532

1,670.29

Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic

22533

1,560.50

Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar

22534

364.42

Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic or lumbar, each additional vertebral segment (List separately in addition to code for primary procedure)

22548

1,793.15

Arthrodesis, anterior transoral or extraoral technique, clivus-C1-C2 (atlas-axis), with or without excision of odontoid process

22554

1,261.88

Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); cervical below C2

22556

1,604.39

Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic

22558

1,460.65

Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar

22585

I

1,259.20

Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); each additional interspace (List separately in addition to code for primary procedure)

22590

1,487.74

Arthrodesis, posterior technique, craniocervical (occiput-C2)

22595

1,416.93

Arthrodesis, posterior technique, atlas-axis (C1-C2)

22600

1,214.58

Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment

22610

1,200.81

Arthrodesis, posterior or posterolateral technique, single level; thoracic (with or without lateral transverse technique)

22612

I

3,883.08

Arthrodesis, posterior or posterolateral technique, single level; lumbar (with or without lateral transverse technique)

22614

394.39

Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately in addition to code for primary procedure)

22630

1,491.22

Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; lumbar

22632

320.24

Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; each additional interspace (List separately in addition to code for primary procedure)

22800

1,322.62

Arthrodesis, posterior, for spinal deformity, with or without cast; up to six vertebral segments

22802

2,093.75

Arthrodesis, posterior, for spinal deformity, with or without cast; seven to 12 vertebral segments

22804

2,423.25

Arthrodesis, posterior, for spinal deformity, with or without cast; 13 or more vertebral segments

22808

1,779.39

Arthrodesis, anterior, for spinal deformity, with or without cast; two to three vertebral segments

22810

1,988.96

Arthrodesis, anterior, for spinal deformity, with or without cast; four to seven vertebral segments

22812

2,181.84

Arthrodesis, anterior, for spinal deformity, with or without cast; eight or more vertebral segments

22818

2,177.95

Kyphectomy, circumferential exposure of spine and resection of vertebral segment(s) (including body and posterior elements); single or two segments

22819

2,463.80

Kyphectomy, circumferential exposure of spine and resection of vertebral segment(s) (including body and posterior elements); three or more segments

22830

794.63

Exploration of spinal fusion

22840

I

2,245.41

Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across one interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure)

22841

I.C.

Internal spinal fixation by wiring of spinous processe (List separately in addition to code for primary procedure)

22842

I

2,856.09

Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); three to six vertebral segments (List separately in addition to code for primary procedure)

22843

815.26

Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); seven to 12 vertebral segments (List separately in addition to code for primary procedure)

22844

1,005.14

Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 13 or more vertebral segments (List separately in addition to code for primary procedure)

22845

I

1,844.78

Anterior instrumentation; two to three vertebral segments (List separately in addition to code for

primary procedure)

22846

765.25

Anterior instrumentation; four to seven vertebral segments (List separately in addition to code for

primary procedure)

22847

841.65

Anterior instrumentation; eight or more vertebral segments (List separately in addition to code for primary procedure)

22848

366.03

Pelvic fixation (attachment of caudal end of instrumentation to pelvic bony structures) other than sacrum (List separately in addition to code for primary procedure)

22849

1,272.36

Reinsertion of spinal fixation device

22850

702.39

Removal of posterior nonsegmental instrumentation (eg, Harrington rod)

22851

I

1,827.17

Application of intervertebral biomechanical device(s) (eg, synthetic cage(s), threaded bone dowel(s), methylmethacrylate) to vertebral defect or interspace (List separately in addition to code for primary procedure)

22852

672.86

Removal of posterior segmental instrumentation

22855

1,077.99

Removal of anterior instrumentation

22857

1,708.32

Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), lumbar, single interspace

22862

2,008.52

Revision including replacement of total disc arthroplasty (artificial disc) anterior approach, lumbar, single interspace

22865

1,956.97

Removal of total disc arthroplasty (artificial disc), anterior approach, lumbar, single interspace

22899

I.C.

Unlisted procedure, spine

22900

943.36

387.99

Excision, abdominal wall tumor, subfascial (eg, desmoid)

22999

I.C.

Unlisted procedure, abdomen, musculoskeletal system

23000

23020

719.48

1,920.92

548.50

684.76

Removal of subdeltoid calcareous deposits, open Capsular contracture release (eg, Sever type procedure)

23030

818.67

449.37

Incision and drainage, shoulder area; deep abscess or hematoma

23031

818.67

438.97

Incision and drainage, shoulder area; infected bursa

23035

950.47

691.48

Incision, bone cortex (eg, osteomyelitis or bone abscess), shoulder area

23040

1,304.45

713.22

Arthrotomy, glenohumeral joint, including exploration, drainage, or removal of foreign body

23044

1,304.45

567.81

Arthrotomy, acromioclavicular, sternoclavicular joint, including exploration, drainage, or removal of foreign body

23065

100.03

209.04

Biopsy, soft tissue of shoulder area; superficial

23066

943.36

517.96

Biopsy, soft tissue of shoulder area; deep

23075

719.48

261.86

Excision, soft tissue tumor, shoulder area; subcutaneous

23076

943.36

549.56

Excision, soft tissue tumor, shoulder area; deep, subfascial, or intramuscular

23077

943.36

1,144.05

Radical resection of tumor (eg, malignant neoplasm), soft tissue of shoulder area

23100

950.47

484.44

Arthrotomy, glenohumeral joint, including biopsy

23101

1,304.45

448.38

Arthrotomy, acromioclavicular joint or sternoclavicular joint, including biopsy and/or excision of torn cartilage

23105

1,304.45

632.25

Arthrotomy; glenohumeral joint, with synovectomy, with or without biopsy

23106

1,304.45

476.86

Arthrotomy; sternoclavicular joint, with synovectomy, with or without biopsy

23107

1,304.45

657.79

Arthrotomy, glenohumeral joint, with joint exploration, with or without removal of loose or foreign body

23120

1,304.45

558.51

Claviculectomy; partial

23125

1,304.45

694.88

Claviculectomy; total

23130

1,920.92

603.72

Acromioplasty or acromionectomy, partial, with or without coracoacromial ligament release

23140

950.47

505.08

Excision or curettage of bone cyst or benign tumor of clavicle or scapula;

23145

1,304.45

682.33

Excision or curettage of bone cyst or benign tumor of clavicle or scapula; with autograft (includes obtaining graft)

23146

1,304.45

612.35

Excision or curettage of bone cyst or benign tumor of clavicle or scapula; with allograft

23150

1,304.45

643.01

Excision or curettage of bone cyst or benign tumor of proximal humerus;

23155

1,304.45

778.83

Excision or curettage of bone cyst or benign tumor of proximal humerus; with autograft (includes obtaining graft)

23156

1,304.45

666.74

Excision or curettage of bone cyst or benign tumor of proximal humerus; with allograft

23170

1,304.45

529.60

Sequestrectomy (eg, for osteomyelitis or bone abscess), clavicle

23172

1,304.45

547.67

Sequestrectomy (eg, for osteomyelitis or bone abscess), scapula

23174

1,304.45

745.11

Sequestrectomy (eg, for osteomyelitis or bone abscess), humeral head to surgical neck

23180

1,304.45

701.11

Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), clavicle

23182

1,304.45

675.01

Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), scapula

23184

1,304.45

755.84

Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), proximal humerus

23190

1,304.45

550.57

Ostectomy of scapula, partial (eg, superior medial angle)

23195

1,304.45

738.27

Resection, humeral head

23200

855.97

Radical resection for tumor; clavicle

23210

897.27

Radical resection for tumor; scapula

23220

1,058.90

Radical resection of bone tumor, proximal humerus;

23221

1,234.43

Radical resection of bone tumor, proximal humerus; with autograft (includes obtaining graft)

23222

1,657.63

Radical resection of bone tumor, proximal humerus; with prosthetic replacement

23330

388.12

233.06

Removal of foreign body, shoulder; subcutaneous

23331

943.36

585.38

Removal of foreign body, shoulder; deep (eg, Neer hemiarthroplasty removal)

23332

876.56

Removal of foreign body, shoulder; complicated (eg, total shoulder)

23350

178.63

Injection procedure for shoulder arthrography or enhanced CT/MRI shoulder arthrography

23395

1,920.92

1,266.78

Muscle transfer, any type, shoulder or upper arm; single

23397

3,549.34

1,131.50

Muscle transfer, any type, shoulder or upper arm; multiple

23400

1,304.45

966.25

Scapulopexy (eg, Sprengels deformity or for paralysis)

23405

1,304.45

626.79

Tenotomy, shoulder area; single tendon

23406

1,304.45

779.71

Tenotomy, shoulder area; multiple tendons through

same incision

23410

1,920.92

892.11

Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; acute

23412

1,920.92

I

2,271.64

Repair of ruptured musculotendinous cuff (eg, rotato cuff) open; chronic

23415

1,920.92

732.20

Coracoacromial ligament release, with or without acromioplasty

23420

1,920.92

I

2,118.74

Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty)

23430

1,920.92

737.74

Tenodesis of long tendon of biceps

23440

1,920.92

760.51

Resection or transplantation of long tendon of biceps

23450

3,549.34

948.68

Capsulorrhaphy, anterior; Putti-Platt procedure or Magnuson type operation

23455

3,549.34

1,008.99

Capsulorrhaphy, anterior; with labral repair (eg, Bankart procedure)

23460

3,549.34

1,092.71

Capsulorrhaphy, anterior, any type; with bone block

23462

1,920.92

1,067.17

Capsulorrhaphy, anterior, any type; with coracoid process transfer

23465

3,549.34

1,110.71

Capsulorrhaphy, glenohumeral joint, posterior, with or without bone block

23466

1,920.92

1,097.00

Capsulorrhaphy, glenohumeral joint, any type multi-directional instability

23470

1,210.72

Arthroplasty, glenohumeral joint; hemiarthroplasty

23472

1,488.46

Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement (eg, total shoulder))

23480

1,920.92

818.43

Osteotomy, clavicle, with or without internal fixation

23485

3,549.34

957.53

Osteotomy, clavicle, with or without internal fixation with bone graft for nonunion or malunion (includes obtaining graft and/or necessary fixation)

23490

1,920.92

810.94

Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; clavicle

23491

3,549.34

1,013.09

Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; proximal humerus

23500

79.02

208.75

Closed treatment of clavicular fracture; without manipulation

23505

79.02

339.76

Closed treatment of clavicular fracture; with manipulation

23515

2,646.58

675.82

Open treatment of clavicular fracture, includes internal fixation, when performed

23520

79.02

214.99

Closed treatment of sternoclavicular dislocation; without manipulation

23525

79.02

339.32

Closed treatment of sternoclavicular dislocation; with manipulation

23530

1,837.10

546.28

Open treatment of sternoclavicular dislocation, acute or chronic;

23532

1,169.01

616.42

Open treatment of sternoclavicular dislocation, acute or chronic; with fascial graft (includes obtaining graft)

23540

79.02

214.04

Closed treatment of acromioclavicular dislocation; without manipulation

23545

79.02

306.58

Closed treatment of acromioclavicular dislocation; with manipulation

23550

1,837.10

567.19

Open treatment of acromioclavicular dislocation, acute or chronic;

23552

1,837.10

653.34

Open treatment of acromioclavicular dislocation, acute or chronic; with fascial graft (includes obtaining graft)

23570

79.02

222.12

Closed treatment of scapular fracture; without manipulation

23575

79.02

376.53

Closed treatment of scapular fracture; with manipulation, with or without skeletal traction (with or without shoulder joint involvement)

23585

2,646.58

898.46

Open treatment of scapular fracture (body, glenoid or acromion) with or without internal fixation

23600

79.02

315.20

Closed treatment of proximal humeral (surgical or anatomical neck) fracture; without manipulation

23605

79.02

459.43

Closed treatment of proximal humeral (surgical or anatomical neck) fracture; with manipulation, with or without skeletal traction

23615

2,646.58

851.31

Open treatment of proximal humeral (surgical or anatomical neck) fracture, includes internal fixation, when performed, includes repair of tuberosity(s), when performed;

23616

2,646.58

1,298.12

Open treatment of proximal humeral (surgical or anatomical neck) fracture, includes internal fixation, when performed, includes repair of tuberosity(s), when performed; with proximal humeral prosthetic replacement

23620

79.02

257.54

Closed treatment of greater humeral tuberosity fracture; without manipulation

23625

79.02

372.19

Closed treatment of greater humeral tuberosity fracture; with manipulation

23630

2,646.58

715.01

Open treatment of greater humeral tuberosity fracture, includes internal fixation, when performed

23650

79.02

288.92

Closed treatment of shoulder dislocation, with manipulation; without anesthesia

23655

659.86

370.58

Closed treatment of shoulder dislocation, with manipulation; requiring anesthesia

23660

1,837.10

574.46

Open treatment of acute shoulder dislocation

23665

79.02

410.57

Closed treatment of shoulder dislocation, with fracture of greater humeral tuberosity, with manipulation

23670

2,646.58

794.27

Open treatment of shoulder dislocation, with fracture of greater humeral tuberosity, includes internal fixation, when performed

23675

79.02

537.83

Closed treatment of shoulder dislocation, with surgical or anatomical neck fracture, with manipulation

23680

1,837.10

872.32

Open treatment of shoulder dislocation, with surgical or anatomical neck fracture, includes internal fixation, when performed

23700

659.86

193.81

Manipulation under anesthesia, shoulder joint, including application of fixation apparatus (dislocation excluded)

23800

3,549.34

1,012.60

Arthrodesis, glenohumeral joint;

23802

1,920.92

1,194.11

Arthrodesis, glenohumeral joint; with autogenous graft (includes obtaining graft)

23900

1,307.47

Interthoracoscapular amputation (forequarter)

23920

1,062.30

Disarticulation of shoulder;

23921

672.37

443.68

Disarticulation of shoulder; secondary closure or scar

revision

23929

I.C.

Unlisted procedure, shoulder

23930

818.67

374.01

Incision and drainage, upper arm or elbow area; deep abscess or hematoma

23931

818.67

306.78

Incision and drainage, upper arm or elbow area; bursa

23935

950.47

499.17

Incision, deep, with opening of bone cortex (eg, for osteomyelitis or bone abscess), humerus or elbow

24000

1,304.45

467.42

Arthrotomy, elbow, including exploration, drainage, or removal of foreign body

24006

1,304.45

703.90

Arthrotomy of the elbow, with capsular excision for capsular release (separate procedure)

24065

135.32

246.18

Biopsy, soft tissue of upper arm or elbow area; superficial

24066

719.48

599.87

Biopsy, soft tissue of upper arm or elbow area; deep (subfascial or intramuscular)

24075

719.48

486.62

Excision, tumor, soft tissue of upper arm or elbow area; subcutaneous

24076

943.36

462.88

Excision, tumor, soft tissue of upper arm or elbow area; deep (subfascial or intramuscular)

24077

943.36

795.87

Radical resection of tumor (eg, malignant neoplasm), soft tissue of upper arm or elbow area

24100

950.47

393.89

Arthrotomy, elbow; with synovial biopsy only

24101

1,304.45

494.91

Arthrotomy, elbow; with joint exploration, with or without biopsy, with or without removal of loose or foreign body

24102

1,304.45

609.95

Arthrotomy, elbow; with synovectomy

24105

950.47

337.37

Excision, olecranon bursa

24110

950.47

576.61

Excision or curettage of bone cyst or benign tumor, humerus;

24115

1,304.45

657.37

Excision or curettage of bone cyst or benign tumor, humerus; with autograft (includes obtaining graft)

24116

1,304.45

860.94

Excision or curettage of bone cyst or benign tumor, humerus; with allograft

24120

950.47

517.53

Excision or curettage of bone cyst or benign tumor of head or neck of radius or olecranon process;

24125

1,304.45

585.45

Excision or curettage of bone cyst or benign tumor of head or neck of radius or olecranon process; with autograft (includes obtaining graft)

24126

1,304.45

625.09

Excision or curettage of bone cyst or benign tumor of head or neck of radius or olecranon process; with allograft

24130

1,304.45

503.45

Excision, radial head

24134

1,304.45

756.71

Sequestrectomy (eg, for osteomyelitis or bone abscess), shaft or distal humerus

24136

1,304.45

623.59

Sequestrectomy (eg, for osteomyelitis or bone abscess), radial head or neck

24138

1,304.45

653.22

Sequestrectomy (eg, for osteomyelitis or bone abscess), olecranon process

24140

1,304.45

728.09

Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), humerus

24145

1,304.45

615.66

Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), radial head or neck

24147

1,304.45

643.98

Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), olecranon

process

24149

1,304.45

1,129.51

Radical resection of capsule, soft tissue, and heterotopic bone, elbow, with contracture release (separate procedure)

24150

963.36

Radical resection for tumor, shaft or distal humerus;

24151

1,115.31

Radical resection for tumor, shaft or distal humerus; with autograft (includes obtaining graft)

24152

1,920.92

713.88

Radical resection for tumor, radial head or neck;

24153

3,549.34

662.95

Radical resection for tumor, radial head or neck; with autograft (includes obtaining graft)

24155

1,920.92

830.63

Resection of elbow joint (arthrectomy)

24160

1,304.45

601.10

Implant removal; elbow joint

24164

1,304.45

493.13

Implant removal; radial head

24200

112.89

208.54

Removal of foreign body, upper arm or elbow area; subcutaneous

24201

719.48

584.49

Removal of foreign body, upper arm or elbow area; deep (subfascial or intramuscular)

24220

192.11

Injection procedure for elbow arthrography

24300

659.86

401.67

Manipulation, elbow, under anesthesia

24301

1,304.45

745.74

Muscle or tendon transfer, any type, upper arm or elbow, single (excluding 24320-24331)

24305

1,304.45

575.80

Tendon lengthening, upper arm or elbow, each tendon

24310

950.47

472.16

Tenotomy, open, elbow to shoulder, each tendon

24320

1,920.92

753.94

Tenoplasty, with muscle transfer, with or without free graft, elbow to shoulder, single (Seddon-Brookes type procedure)

24330

3,549.34

712.29

Flexor-plasty, elbow (eg, Steindler type advancement);

24331

1,920.92

783.06

Flexor-plasty, elbow (eg, Steindler type advancement); with extensor advancement

24332

950.47

594.44

Tenolysis, triceps

24340

1,920.92

610.35

Tenodesis of biceps tendon at elbow (separate procedure)

24341

1,920.92

711.58

Repair, tendon or muscle, upper arm or elbow, each tendon or muscle, primary or secondary (excludes rotator cuff)

24342

1,920.92

781.01

Reinsertion of ruptured biceps or triceps tendon, distal, with or without tendon graft

24343

1,304.45

698.24

Repair lateral collateral ligament, elbow, with local tissue

24344

3,549.34

1,076.50

Reconstruction lateral collateral ligament, elbow, with tendon graft (includes harvesting of graft)

24345

1,304.45

694.40

Repair medial collateral ligament, elbow, with local tissue

24346

1,920.92

1,073.30

Reconstruction medial collateral ligament, elbow, with tendon graft (includes harvesting of graft)

24357

1,304.45

444.76

Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer's elbow); percutaneous

24358

1,304.45

519.11

Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer's elbow); debridement, soft tissue and/or bone, open

24359

1,304.45

630.15

Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer's elbow); debridement, soft tissue and/or bone, open with tendon repair or reattachment

24360

1,604.48

888.16

Arthroplasty, elbow; with membrane (eg, fascial)

24361

5,461.16

997.96

Arthroplasty, elbow; with distal humeral prosthetic replacement

24362

2,274.08

959.69

Arthroplasty, elbow; with implant and fascia lata ligament reconstruction

24363

5,461.16

1,453.78

Arthroplasty, elbow; with distal humerus and proximal ulnar prosthetic replacement (eg, total elbow)

24365

1,604.48

636.15

Arthroplasty, radial head;

24366

5,461.16

680.36

Arthroplasty, radial head; with implant

24400

1,304.45

816.42

Osteotomy, humerus, with or without internal fixation

24410

1,304.45

1,038.27

Multiple osteotomies with realignment on intramedullary rod, humeral shaft (Sofield type procedure)

24420

1,920.92

967.66

Osteoplasty, humerus (eg, shortening or lengthening) (excluding 64876)

24430

3,549.34

1,017.89

Repair of nonunion or malunion, humerus; without graft (eg, compression technique)

24435

3,549.34

1,048.00

Repair of nonunion or malunion, humerus; with iliac or other autograft (includes obtaining graft)

24470

1,920.92

653.09

Hemiepiphyseal arrest (eg, cubitus varus or valgus, distal humerus)

24495

1,304.45

667.65

Decompression fasciotomy, forearm, with brachial artery exploration

24498

3,549.34

867.09

Prophylactic treatment (nailing, pinning, plating or wiring), with or without methylmethacrylate, humeral shaft

24500

79.02

341.35

Closed treatment of humeral shaft fracture; without manipulation

24505

79.02

492.22

Closed treatment of humeral shaft fracture; with manipulation, with or without skeletal traction

24515

2,646.58

870.91

Open treatment of humeral shaft fracture with plate/screws, with or without cerclage

24516

2,646.58

858.67

Treatment of humeral shaft fracture, with insertion of intramedullary implant, with or without cerclage and/or locking screws

24530

79.02

367.74

Closed treatment of supracondylar or transcondylar humeral fracture, with or without intercondylar extension; without manipulation

24535

79.02

610.39

Closed treatment of supracondylar or transcondylar humeral fracture, with or without intercondylar extension; with manipulation, with or without skin or skeletal traction

24538

1,169.01

743.88

Percutaneous skeletal fixation of supracondylar or transcondylar humeral fracture, with or without intercondylar extension

24545

2,646.58

883.63

Open treatment of humeral supracondylar or transcondylar fracture, includes internal fixation, when performed; without intercondylar extension

24546

2,646.58

1,055.47

Open treatment of humeral supracondylar or transcondylar fracture, includes internal fixation, when performed; with intercondylar extension

24560

79.02

309.10

Closed treatment of humeral epicondylar fracture, medial or lateral; without manipulation

24565

79.02

509.50

Closed treatment of humeral epicondylar fracture, medial or lateral; with manipulation

24566

1,169.01

685.77

Percutaneous skeletal fixation of humeral epicondylar fracture, medial or lateral, with manipulation

24575

2,646.58

735.39

Open treatment of humeral epicondylar fracture, medial or lateral, includes internal fixation, when performed

24576

79.02

325.44

Closed treatment of humeral condylar fracture, medial or lateral; without manipulation

24577

79.02

527.62

Closed treatment of humeral condylar fracture, medial or lateral; with manipulation

24579

2,646.58

826.87

Open treatment of humeral condylar fracture, medial or lateral, includes internal fixation, when performed

24582

1,169.01

780.18

Percutaneous skeletal fixation of humeral condylar fracture, medial or lateral, with manipulation

24586

2,646.58

1,086.60

Open treatment of periarticular fracture and/or dislocation of the elbow (fracture distal humerus and proximal ulna and/or proximal radius);

24587

2,646.58

1,078.28

Open treatment of periarticular fracture and/or dislocation of the elbow (fracture distal humerus and proximal ulna and/or proximal radius); with implant arthroplasty

24600

79.02

361.80

Treatment of closed elbow dislocation; without anesthesia

24605

659.86

451.05

Treatment of closed elbow dislocation; requiring anesthesia

24615

2,646.58

710.77

Open treatment of acute or chronic elbow dislocation

24620

79.02

543.65

Closed treatment of Monteggia type of fracture dislocation at elbow (fracture proximal end of ulna with dislocation of radial head), with manipulation

24635

2,646.58

838.19

Open treatment of Monteggia type of fracture dislocation at elbow (fracture proximal end of ulna with dislocation of radial head), includes internal fixation, when performed

24640

61.77

123.04

Closed treatment of radial head subluxation in child, nursemaid elbow, with manipulation

24650

79.02

251.99

Closed treatment of radial head or neck fracture; without manipulation

24655

79.02

430.32

Closed treatment of radial head or neck fracture; with manipulation

24665

1,837.10

645.58

Open treatment of radial head or neck fracture, includes internal fixation or radial head excision, when performed;

24666

2,646.58

726.78

Open treatment of radial head or neck fracture, includes internal fixation or radial head excision, when performed; with radial head prosthetic replacement

24670

79.02

281.49

Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process[es]); without manipulation

24675

79.02

449.72

Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process[es]); with manipulation

24685

1,837.10

648.99

Open treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process[es]), includes internal fixation, when performed

24800

1,920.92

793.59

Arthrodesis, elbow joint; local

24802

1,920.92

979.41

Arthrodesis, elbow joint; with autogenous graft (includes obtaining graft)

24900

698.89

Amputation, arm through humerus; with primary closure

24920

689.10

Amputation, arm through humerus; open, circular (guillotine)

24925

950.47

533.74

Amputation, arm through humerus; secondary closure or scar revision

24930

725.68

Amputation, arm through humerus; re-amputation

24931

760.29

Amputation, arm through humerus; with implant

24935

1,046.44

Stump elongation, upper extremity

24940

I.C.

Cineplasty, upper extremity, complete procedure

24999

I.C.

Unlisted procedure, humerus or elbow

25000

950.47

383.87

Incision, extensor tendon sheath, wrist (eg, deQuervains disease)

25001

950.47

330.39

Incision, flexor tendon sheath, wrist (eg, flexor carpi radialis)

25020

950.47

611.90

Decompression fasciotomy, forearm and/or wrist, flexor OR extensor compartment; without debridement of nonviable muscle and/or nerve

25023

1,304.45

1,133.38

Decompression fasciotomy, forearm and/or wrist, flexor OR extensor compartment; with debridement of nonviable muscle and/or nerve

25024

1,304.45

738.45

Decompression fasciotomy, forearm and/or wrist, flexor AND extensor compartment; without debridement of nonviable muscle and/or nerve

25025

1,304.45

1,114.49

Decompression fasciotomy, forearm and/or wrist, flexor AND extensor compartment; with debridement of nonviable muscle and/or nerve

25028

950.47

535.72

Incision and drainage, forearm and/or wrist; deep abscess or hematoma

25031

950.47

424.42

Incision and drainage, forearm and/or wrist; bursa

25035

950.47

736.94

Incision, deep, bone cortex, forearm and/or wrist (eg, osteomyelitis or bone abscess)

25040

1,304.45

579.75

Arthrotomy, radiocarpal or midcarpal joint, with exploration, drainage, or removal of foreign body

25065

138.64

247.11

Biopsy, soft tissue of forearm and/or wrist; superficial

25066

943.36

412.76

Biopsy, soft tissue of forearm and/or wrist; deep (subfascial or intramuscular)

25075

719.48

357.28

Excision, tumor, soft tissue of forearm and/or wrist area; subcutaneous

25076

943.36

506.24

Excision, tumor, soft tissue of forearm and/or wrist area; deep (subfascial or intramuscular)

25077

943.36

801.28

Radical resection of tumor (eg, malignant neoplasm), soft tissue of forearm and/or wrist area

25085

950.47

485.16

Capsulotomy, wrist (eg, contracture)

25100

950.47

360.72

Arthrotomy, wrist joint; with biopsy

25101

1,304.45

419.98

Arthrotomy, wrist joint; with joint exploration, with or without biopsy, with or without removal of loose or foreign body

25105

1,304.45

511.98

Arthrotomy, wrist joint; with synovectomy

25107

1,304.45

621.29

Arthrotomy, distal radioulnar joint including repair of triangular cartilage, complex

25109

950.47

502.48

Excision of tendon, forearm and/or wrist, flexor or extensor, each

25110

950.47

399.58

Excision, lesion of tendon sheath, forearm and/or wrist

25111

735.73

324.82

Excision of ganglion, wrist (dorsal or volar); primary

25112

735.73

392.31

Excision of ganglion, wrist (dorsal or volar); recurrent

25115

950.47

868.98

Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (eg, tenosynovitis, fungus, Tbc, or other granulomas, rheumatoid arthritis); flexors

25116

950.47

730.34

Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (eg, tenosynovitis, fungus, Tbc, or other granulomas, rheumatoid arthritis); extensors, with or without transposition of dorsal retinaculum

25118

1,304.45

399.13

Synovectomy, extensor tendon sheath, wrist, single compartment;

25119

1,304.45

528.41

Synovectomy, extensor tendon sheath, wrist, single compartment; with resection of distal ulna

25120

1,304.45

636.14

Excision or curettage of bone cyst or benign tumor of radius or ulna (excluding head or neck of radius and olecranon process);

25125

1,304.45

716.23

Excision or curettage of bone cyst or benign tumor of radius or ulna (excluding head or neck of radius and olecranon process); with autograft (includes obtaining graft)

25126

1,304.45

732.74

Excision or curettage of bone cyst or benign tumor of radius or ulna (excluding head or neck of radius and olecranon process); with allograft

25130

1,304.45

462.46

Excision or curettage of bone cyst or benign tumor of carpal bones;

25135

1,304.45

570.61

Excision or curettage of bone cyst or benign tumor of carpal bones; with autograft (includes obtaining graft)

25136

1,304.45

506.02

Excision or curettage of bone cyst or benign tumor of carpal bones; with allograft

25145

1,304.45

647.50

Sequestrectomy (eg, for osteomyelitis or bone abscess), forearm and/or wrist

25150

1,304.45

598.60

Partial excision (craterization, saucerization, or diaphysectomy) of bone (eg, for osteomyelitis); ulna

25151

1,304.45

716.83

Partial excision (craterization, saucerization, or diaphysectomy) of bone (eg, for osteomyelitis); radius

25170

958.81

Radical resection for tumor, radius or ulna

25210

1,175.77

504.06

Carpectomy; one bone

25215

1,175.77

650.11

Carpectomy; all bones of proximal row

25230

1,304.45

448.83

Radial styloidectomy (separate procedure)

25240

1,304.45

465.33

Excision distal ulna partial or complete (eg, Darrach type or matched resection)

25246

194.43

Injection procedure for wrist arthrography

25248

950.47

488.64

Exploration with removal of deep foreign body, forearm or wrist

25250

1,304.45

519.57

Removal of wrist prosthesis; (separate procedure)

25251

1,304.45

706.34

Removal of wrist prosthesis; complicated, including total wrist

25259

79.02

400.77

Manipulation, wrist, under anesthesia

25260

1,304.45

758.44

Repair, tendon or muscle, flexor, forearm and/or wrist; primary, single, each tendon or muscle

25263

1,304.45

750.65

Repair, tendon or muscle, flexor, forearm and/or wrist; secondary, single, each tendon or muscle

25265

1,304.45

877.09

Repair, tendon or muscle, flexor, forearm and/or wrist; secondary, with free graft (includes obtaining graft), each tendon or muscle

25270

1,304.45

626.62

Repair, tendon or muscle, extensor, forearm and/or wrist; primary, single, each tendon or muscle

25272

1,304.45

696.39

Repair, tendon or muscle, extensor, forearm and/or wrist; secondary, single, each tendon or muscle

25274

1,304.45

802.19

Repair, tendon or muscle, extensor, forearm and/or wrist; secondary, with free graft (includes obtaining graft), each tendon or muscle

25275

1,304.45

663.99

Repair, tendon sheath, extensor, forearm and/or wrist, with free graft (includes obtaining graft) (eg, for extensor carpi ulnaris subluxation)

25280

1,304.45

699.79

Lengthening or shortening of flexor or extensor tendon, forearm and/or wrist, single, each tendon

25290

1,304.45

655.68

Tenotomy, open, flexor or extensor tendon, forearm and/or wrist, single, each tendon

25295

950.47

657.49

Tenolysis, flexor or extensor tendon, forearm and/or wrist, single, each tendon

25300

1,304.45

688.93

Tenodesis at wrist; flexors of fingers

25301

1,304.45

656.04

Tenodesis at wrist; extensors of fingers

25310

1,920.92

755.10

Tendon transplantation or transfer, flexor or extensor, forearm and/or wrist, single; each tendon

25312

1,920.92

848.92

Tendon transplantation or transfer, flexor or extensor, forearm and/or wrist, single; with tendon graft(s) (includes obtaining graft), each tendon

25315

1,920.92

903.17

Flexor origin slide (eg, for cerebral palsy, Volkmann contracture), forearm and/or wrist;

25316

3,549.34

1,041.84

Flexor origin slide (eg, for cerebral palsy, Volkmann contracture), forearm and/or wrist; with tendon(s) transfer

25320

1,920.92

960.23

Capsulorrhaphy or reconstruction, wrist, open (eg, capsulodesis, ligament repair, tendon transfer or graft) (includes synovectomy, capsulotomy and open reduction) for carpal instability

25332

1,604.48

837.85

Arthroplasty, wrist, with or without interposition, with or without external or internal fixation

25335

1,920.92

968.23

Centralization of wrist on ulna (eg, radial club hand)

25337

1,920.92

892.69

Reconstruction for stabilization of unstable distal ulna or distal radioulnar joint, secondary by soft tissue stabilization (eg, tendon transfer, tendon graft or weave, or tenodesis) with or without open reduction of distal radioulnar joint

25350

3,549.34

818.13

Osteotomy, radius; distal third

25355

1,920.92

899.17

Osteotomy, radius; middle or proximal third

25360

1,304.45

799.62

Osteotomy; ulna

25365

1,304.45

1,049.41

Osteotomy; radius AND ulna

25370

1,920.92

1,121.91

Multiple osteotomies, with realignment on intramedullary rod (Sofield type procedure); radius OR ulna

25375

1,920.92

1,096.65

Multiple osteotomies, with realignment on intramedullary rod (Sofield type procedure); radius AND ulna

25390

1,304.45

909.18

Osteoplasty, radius OR ulna; shortening

25391

1,920.92

1,130.20

Osteoplasty, radius OR ulna; lengthening with autograft

25392

1,304.45

1,128.86

Osteoplasty, radius AND ulna; shortening (excluding 64876)

25393

1,920.92

1,268.72

Osteoplasty, radius AND ulna; lengthening with autograft

25394

735.73

759.00

Osteoplasty, carpal bone, shortening

25400

3,549.34

952.79

Repair of nonunion or malunion, radius OR ulna; without graft (eg, compression technique)

25405

3,549.34

1,180.98

Repair of nonunion or malunion, radius OR ulna; with autograft (includes obtaining graft)

25415

3,549.34

1,114.46

Repair of nonunion or malunion, radius AND ulna; without graft (eg, compression technique)

25420

3,549.34

1,304.67

Repair of nonunion or malunion, radius AND ulna; with autograft (includes obtaining graft)

25425

1,920.92

1,213.97

Repair of defect with autograft; radius OR ulna

25426

1,920.92

1,226.15

Repair of defect with autograft; radius AND ulna

25430

1,175.77

695.76

Insertion of vascular pedicle into carpal bone (eg, Hori procedure)

25431

1,175.77

782.39

Repair of nonunion of carpal bone (excluding carpal scaphoid (navicular)) (includes obtaining graft and necessary fixation), each bone

25440

3,549.34

784.54

Repair of nonunion, scaphoid carpal (navicular) bone with or without radial styloidectomy (includes obtaining graft and necessary fixation)

25441

5,461.16

928.34

Arthroplastywith prosthetic replacement; distal radius

25442

5,461.16

798.18

Arthroplasty with prosthetic replacement; distal ulna

25443

2,274.08

768.48

Arthroplasty with prosthetic replacement; scaphoid carpal (navicular)

25444

2,274.08

815.96

Arthroplasty with prosthetic replacement; lunate

25445

2,274.08

718.00

Arthroplasty with prosthetic replacement; trapezium

25446

5,461.16

1,164.70

Arthroplastywith prosthetic replacement; distal radius and partial or entire carpus (total wrist)

25447

1,604.48

802.78

Arthroplasty, interposition, intercarpal or carpometacarpal joints

25449

1,604.48

1,023.86

Revision of arthroplasty, including removal of implant, wrist joint

25450

1,920.92

634.98

Epiphyseal arrest by epiphysiodesis or stapling; distal radius OR ulna

25455

1,920.92

763.33

Epiphyseal arrest by epiphysiodesis or stapling; distal radius AND ulna

25490

1,920.92

838.62

Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; radius

25491

1,920.92

879.69

Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; ulna

25492

1,920.92

1,035.97

Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; radius AND ulna

25500

79.02

254.53

Closed treatment of radial shaft fracture; without manipulation

25505

79.02

492.85

Closed treatment of radial shaft fracture; with manipulation

25515

1,837.10

663.47

Open treatment of radial shaft fracture, includes internal fixation, when performed

25520

79.02

538.24

Closed treatment of radial shaft fracture and closed treatment of dislocation of distal radioulnar joint (Galeazzi fracture/dislocation)

25525

1,837.10

818.81

Open treatment of radial shaft fracture, includes internal fixation, when performed, and closed treatment of distal radioulnar joint dislocation (Galeazzi fracture/ dislocation), includes percutaneous skeletal fixation, when performed

25526

1,837.10

1,019.35

Open treatment of radial shaft fracture, includes internal fixation, when performed, and open treatment of distal radioulnar joint dislocation (Galeazzi fracture/ dislocation), includes internal fixation, when performed, includes repair of triangular fibrocartilage complex

25530

79.02

250.22

Closed treatment of ulnar shaft fracture; without manipulation

25535

79.02

471.41

Closed treatment of ulnar shaft fracture; with manipulation

25545

1,837.10

631.39

Open treatment of ulnar shaft fracture, includes internal fixation, when performed

25560

79.02

258.33

Closed treatment of radial and ulnar shaft fractures; without manipulation

25565

79.02

513.27

Closed treatment of radial and ulnar shaft fractures; with manipulation

25574

2,646.58

647.94

Open treatment of radial AND ulnar shaft fractures, with internal fixation, when performed; of radius OR ulna

25575

2,646.58

879.18

Open treatment of radial AND ulnar shaft fractures, with internal fixation, when performed; of radius AND ulna

25600

79.02

283.48

Closed treatment of distal radial fracture (eg, Colles o Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; without manipulation

25605

79.02

594.16

Closed treatment of distal radial fracture (eg, Colles o Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; with manipulation

25606

1,169.01

674.73

Percutaneous skeletal fixation of distal radial fracture or epiphyseal separation

25607

2,646.58

691.41

Open treatment of distal radial extra-articular fracture or epiphyseal separation, with internal fixation

25608

2,646.58

784.97

Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 2 fragments

25609

2,646.58

998.07

Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 3 or more fragments

25622

79.02

292.05

Closed treatment of carpal scaphoid (navicular) fracture; without manipulation

25624

79.02

455.31

Closed treatment of carpal scaphoid (navicular) fracture; with manipulation

25628

1,837.10

703.61

Open treatment of carpal scaphoid (navicular) fracture, includes internal fixation, when performed

25630

79.02

296.60

Closed treatment of carpal bone fracture (excluding carpal scaphoid (navicular)); without manipulation, each bone

25635

79.02

429.34

Closed treatment of carpal bone fracture (excluding carpal scaphoid (navicular)); with manipulation, each bone

25645

1,837.10

566.33

Open treatment of carpal bone fracture (other than carpal scaphoid (navicular)), each bone

25650

79.02

307.81

Closed treatment of ulnar styloid fracture

25651

1,169.01

464.58

Percutaneous skeletal fixation of ulnar styloid fracture

25652

1,837.10

609.55

Open treatment of ulnar styloid fracture

25660

79.02

390.69

Closed treatment of radiocarpal or intercarpal dislocation, one or more bones, with manipulation

25670

1,169.01

605.87

Open treatment of radiocarpal or intercarpal dislocation, one or more bones

25671

1,169.01

515.02

Percutaneous skeletal fixation of distal radioulnar dislocation

25675

79.02

419.65

Closed treatment of distal radioulnar dislocation with manipulation

25676

1,169.01

628.42

Open treatment of distal radioulnar dislocation, acute or chronic

25680

79.02

440.86

Closed treatment of trans-scaphoperilunar type of fracture dislocation, with manipulation

25685

1,169.01

720.23

Open treatment of trans-scaphoperilunar type of fracture dislocation

25690

79.02

455.32

Closed treatment of lunate dislocation, with manipulation

25695

1,169.01

627.85

Open treatment of lunate dislocation

25800

3,549.34

752.71

Arthrodesis, wrist; complete, without bone graft (includes radiocarpal and/or intercarpal and/or carpometacarpal joints)

25805

1,920.92

862.84

Arthrodesis, wrist; with sliding graft

25810

3,549.34

864.87

Arthrodesis, wrist; with iliac or other autograft (includes obtaining graft)

25820

735.73

621.51

Arthrodesis, wrist; limited, without bone graft (eg, intercarpal or radiocarpal)

25825

3,549.34

756.93

Arthrodesis, wrist; with autograft (includes obtaining graft)

25830

3,549.34

986.80

Arthrodesis, distal radioulnar joint with segmental resection of ulna, with or without bone graft (eg, Sauve-Kapandji procedure)

25900

806.59

Amputation, forearm, through radius and ulna;

25905

788.64

Amputation, forearm, through radius and ulna; open, circular (guillotine)

25907

950.47

709.10

Amputation, forearm, through radius and ulna; secondary closure or scar revision

25909

785.80

Amputation, forearm, through radius and ulna; re-amputation

25915

1,253.6

Krukenberg procedure

25920

677.35

Disarticulation through wrist;

25922

950.47

598.02

Disarticulation through wrist; secondary closure or scar revision

25924

663.87

Disarticulation through wrist; re-amputation

25927

812.78

Transmetacarpal amputation;

25929

672.37

563.00

Transmetacarpal amputation; secondary closure or scar revision

25931

25999

950.47

760.90 I.C.

Transmetacarpal amputation; re-amputation Unlisted procedure, forearm or wrist

26010

62.85

280.05

Drainage of finger abscess; simple

26011

516.57

432.40

Drainage of finger abscess; complicated (eg, felon)

26020

735.73

424.01

Drainage of tendon sheath, digit and/or palm, each

26025

735.73

413.63

Drainage of palmar bursa; single, bursa

26030

735.73

484.61

Drainage of palmar bursa; multiple bursa

26034

735.73

526.65

Incision, bone cortex, hand or finger (eg,

osteomyelitis or bone abscess)

26035

735.73

792.64

Decompression fingers and/or hand, injection injury (eg, grease gun)

26037

561.29

Decompressive fasciotomy, hand (excludes 26035)

26040

1,175.77

307.58

Fasciotomy, palmar (eg, Dupuytren's contracture); percutaneous

26045

1,175.77

462.33

Fasciotomy, palmar (eg, Dupuytren's contracture); open, partial

26055

735.73

653.85

Tendon sheath incision (eg, for trigger finger)

26060

735.73

261.77

Tenotomy, percutaneous, single, each digit

26070

735.73

289.49

Arthrotomy, with exploration, drainage, or removal of loose or foreign body; carpometacarpal joint

26075

735.73

311.44

Arthrotomy, with exploration, drainage, or removal of loose or foreign body; metacarpophalangeal joint, each

26080

735.73

379.92

Arthrotomy, with exploration, drainage, or removal of loose or foreign body; interphalangeal joint, each

26100

735.73

322.37

Arthrotomy with biopsy; carpometacarpal joint, each

26105

735.73

327.99

Arthrotomy with biopsy; metacarpophalangeal joint, each

26110

735.73

314.07

Arthrotomy with biopsy; interphalangeal joint, each

26115

943.36

679.47

Excision, tumor or vascular malformation, soft tissue of hand or finger; subcutaneous

26116

943.36

477.24

Excision, tumor or vascular malformation, soft tissue of hand or finger; deep (subfascial or intramuscular)

26117

943.36

637.25

Radical resection of tumor (eg, malignant neoplasm), soft tissue of hand or finger

26121

1,175.77

591.78

Fasciectomy, palm only, with or without Z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft)

26123

1,175.77

798.89

Fasciectomy, partial palmar with release of single digit including proximal interphalangeal joint, with or without Z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft);

26125

735.73

277.46

Fasciectomy, partial palmar with release of single digit including proximal interphalangeal joint, with or without Z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft); each additional digit (List separately in addition to code for primary procedure)

26130

735.73

450.94

Synovectomy, carpometacarpal joint

26135

1,175.77

546.55

Synovectomy, metacarpophalangeal joint including intrinsic release and extensor hood reconstruction, each digit

26140

735.73

498.51

Synovectomy, proximal interphalangeal joint, including extensor reconstruction, each interphalangeal joint

26145

735.73

505.59

Synovectomy, tendon sheath, radical (tenosynovectomy), flexor tendon, palm and/or finger, each tendon

26160

735.73

625.78

Excision of lesion of tendon sheath or joint capsule (eg, cyst, mucous cyst, or ganglion), hand or finger

26170

735.73

399.74

Excision of tendon, palm, flexor or extensor, single, each tendon

26180

735.73

435.19

Excision of tendon, finger, flexor or extensor, each tendon

26185

735.73

511.17

Sesamoidectomy, thumb or finger (separate procedure)

26200

735.73

444.51

Excision or curettage of bone cyst or benign tumor of metacarpal;

26205

1,175.77

596.17

Excision or curettage of bone cyst or benign tumor of metacarpal; with autograft (includes obtaining graft)

26210

735.73

435.39

Excision or curettage of bone cyst or benign tumor of proximal, middle, or distal phalanx of finger;

26215

735.73

546.79

Excision or curettage of bone cyst or benign tumor of proximal, middle, or distal phalanx of finger; with autograft (includes obtaining graft)

26230

735.73

498.04

Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); metacarpal

26235

735.73

489.16

Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); proximal or middle phalanx of finger

26236

735.73

435.47

Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); distal phalanx of finger

26250

735.73

571.75

Radical resection, metacarpal (eg, tumor);

26255

1,175.77

894.12

Radical resection, metacarpal (eg, tumor); with autograft (includes obtaining graft)

26260

735.73

540.69

Radical resection, proximal or middle phalanx of finger (eg, tumor);

26261

735.73

647.90

Radical resection, proximal or middle phalanx of finger (eg, tumor); with autograft (includes obtaining graft)

26262

735.73

453.66

Radical resection, distal phalanx of finger (eg, tumor)

26320

719.48

341.35

Removal of implant from finger or hand

26340

79.02

319.32

Manipulation, finger joint, under anesthesia, each joint

26350

1,175.77

791.14

Repair or advancement, flexor tendon, not in zone 2 digital flexor tendon sheath (eg, no man's land); primary or secondary without free graft, each tendon

26352

1,175.77

883.96

Repair or advancement, flexor tendon, not in zone 2 digital flexor tendon sheath (eg, no man's land); secondary with free graft (includes obtaining graft), each tendon

26356

1,175.77

1,123.96

Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no man's land); primary, without free graft, each tendon

26357

1,175.77

933.57

Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no man's land); secondary, without free graft, each tendon

26358

1,175.77

991.81

Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no man's land); secondary, with free graft (includes obtaining graft), each tendon

26370

1,175.77

844.98

Repair or advancement of profundus tendon, with intact superficialis tendon; primary, each tendon

26372

1,175.77

968.72

Repair or advancement of profundus tendon, with intact superficialis tendon; secondary with free graft (includes obtaining graft), each tendon

26373

1,175.77

923.34

Repair or advancement of profundus tendon, with intact superficialis tendon; secondary without free graft, each tendon

26390

1,175.77

877.65

Excision flexor tendon, with implantation of synthetic rod for delayed tendon graft, hand or finger, each rod

26392

1,175.77

1,043.56

Removal of synthetic rod and insertion of flexor tendon graft, hand or finger (includes obtaining graft), each rod

26410

735.73

632.29

Repair, extensor tendon, hand, primary or secondary; without free graft, each tendon

26412

1,175.77

750.58

Repair, extensor tendon, hand, primary or secondary; with free graft (includes obtaining graft), each tendon

26415

1,175.77

759.43

Excision of extensor tendon, with implantation of synthetic rod for delayed tendon graft, hand or finger, each rod

26416

1,175.77

890.50

Removal of synthetic rod and insertion of extensor tendon graft (includes obtaining graft), hand or finger, each rod

26418

735.73

639.25

Repair, extensor tendon, finger, primary or secondary; without free graft, each tendon

26420

1,175.77

781.71

Repair, extensor tendon, finger, primary or secondary; with free graft (includes obtaining graft) each tendon

26426

1,175.77

661.20

Repair of extensor tendon, central slip, secondary (eg,

boutonniere deformity); using local tissue(s), including lateral band(s), each finger

26428

1,175.77

813.78

Repair of extensor tendon, central slip, secondary (eg, boutonniere deformity); with free graft (includes obtaining graft), each finger

26432

735.73

550.77

Closed treatment of distal extensor tendon insertion, with or without percutaneous pinning (eg, mallet finger)

26433

735.73

589.09

Repair of extensor tendon, distal insertion, primary or secondary; without graft (eg, mallet finger)

26434

1,175.77

686.17

Repair of extensor tendon, distal insertion, primary or secondary; with free graft (includes obtaining graft)

26437

735.73

673.45

Realignment of extensor tendon, hand, each tendon

26440

735.73

700.52

Tenolysis, flexor tendon; palm OR finger, each tendon

26442

1,175.77

999.66

Tenolysis, flexor tendon; palm AND finger, each tendon

26445

735.73

660.39

Tenolysis, extensor tendon, hand OR finger, each tendon

26449

1,175.77

847.23

Tenolysis, complex, extensor tendon, finger, including forearm, each tendon

26450

735.73

432.49

Tenotomy, flexor, palm, open, each tendon

26455

735.73

429.33

Tenotomy, flexor, finger, open, each tendon

26460

735.73

418.14

Tenotomy, extensor, hand or finger, open, each tendon

26471

735.73

662.25

Tenodesis; of proximal interphalangeal joint, each joint

26474

735.73

643.74

Tenodesis; of distal joint, each joint

26476

735.73

623.75

Lengthening of tendon, extensor, hand or finger, each tendon

26477

735.73

631.15

Shortening of tendon, extensor, hand or finger, each tendon

26478

735.73

678.59

Lengthening of tendon, flexor, hand or finger, each tendon

26479

735.73

669.78

Shortening of tendon, flexor, hand or finger, each tendon

26480

1,175.77

830.29

Transfer or transplant of tendon, carpometacarpal area or dorsum of hand; without free graft, each tendon

26483

1,175.77

915.59

Transfer or transplant of tendon, carpometacarpal area or dorsum of hand; with free tendon graft (includes obtaining graft), each tendon

26485

1,175.77

885.70

Transfer or transplant of tendon, palmar; without free tendon graft, each tendon

26489

1,175.77

897.34

Transfer or transplant of tendon, palmar; with free tendon graft (includes obtaining graft), each tendon

26490

1,175.77

825.67

Opponensplasty; superficialis tendon transfer type, each tendon

26492

1,175.77

912.60

Opponensplasty; tendon transfer with graft (includes obtaining graft), each tendon

26494

1,175.77

841.32

Opponensplasty; hypothenar muscle transfer

26496

1,175.77

898.47

Opponensplasty; other methods

26497

1,175.77

903.49

Transfer of tendon to restore intrinsic function; ring and small finger

26498

1,175.77

1,184.35

Transfer of tendon to restore intrinsic function; all four fingers

26499

1,175.77

853.47

Correction claw finger, other methods

26500

735.73

674.39

Reconstruction of tendon pulley, each tendon; with local tissues (separate procedure)

26502

1,175.77

748.27

Reconstruction of tendon pulley, each tendon; with tendon or fascial graft (includes obtaining graft) (separate procedure)

26508

735.73

684.94

Release of thenar muscle(s) (eg, thumb contracture)

26510

1,175.77

647.93

Cross intrinsic transfer, each tendon

26516

1,175.77

752.31

Capsulodesis, metacarpophalangeal joint; single digit

26517

1,175.77

866.46

Capsulodesis, metacarpophalangeal joint; two digits

26518

1,175.77

867.47

Capsulodesis, metacarpophalangeal joint; three or four digits

26520

735.73

731.25

Capsulectomy or capsulotomy; metacarpophalangeal joint, each joint

26525

735.73

734.87

Capsulectomy or capsulotomy; interphalangeal joint, each joint

26530

1,604.48

528.02

Arthroplasty, metacarpophalangeal joint; each joint

26531

2,274.08

613.96

Arthroplasty, metacarpophalangeal joint; with prosthetic implant, each joint

26535

1,604.48

382.67

Arthroplasty, interphalangeal joint; each joint

26536

2,274.08

683.62

Arthroplasty, interphalangeal joint; with prosthetic implant, each joint

26540

735.73

710.16

Repair of collateral ligament, metacarpophalangeal or interphalangeal joint

26541

1,175.77

853.35

Reconstruction , collateralli ga ment, metacarpophalangeal joint, single; with tendon or fascial graft (includes obtaining graft)

26542

735.73

729.92

Reconstruction , collateral ligament, metacarpophalangeal joint, single; with local tissue (eg, adductor advancement)

26545

1,175.77

744.22

Reconstruction, collateral ligament, interphalangeal joint, single, including graft, each joint

26546

1,175.77

1,012.10

Repair non-union, metacarpal or phalanx (includes obtaining bone graft with or without external or internal fixation)

26548

1,175.77

811.01

Repair and reconstruction, finger, volar plate, interphalangeal joint

26550

1,175.77

1,548.85

Pollicization of a digit

26551

3,028.34

Transfer, toe-to-hand with microvascular anastomosis; great toe wrap-around with bone graft

26553

2,861.22

Transfer, toe-to-hand with microvascular anastomosis; other than great toe, single

26554

3,908.67

Transfer, toe-to-hand with microvascular anastomosis; other than great toe, double

26555

1,175.77

1,394.07

Transfer, finger to another position without microvascular anastomosis

26556

2,947.95

Transfer, free toe joint, with microvascular anastomosis

26560

735.73

589.69

Repair of syndactyly (web finger) each web space; with skin flaps

26561

1,175.77

921.44

Repair of syndactyly (web finger) each web space; with skin flaps and grafts

26562

1,175.77

1,223.61

Repair of syndactyly (web finger) each web space; complex (eg, involving bone, nails)

26565

1,175.77

726.11

Osteotomy; metacarpal, each

26567

1,175.77

728.20

Osteotomy; phalanx of finger, each

26568

1,175.77

958.66

Osteoplasty, lengthening, metacarpal or phalanx

26580

735.73

1,272.96

Repair cleft hand

26587

735.73

932.92

Reconstruction of polydactylous digit, soft tissue and bone

26590

735.73

1,322.43

Repair macrodactylia, each digit

26591

1,175.77

491.60

Repair, intrinsic muscles of hand, each muscle

26593

735.73

642.96

Release, intrinsic muscles of hand, each muscle

26596

735.73

726.42

Excision of constricting ring of finger, with multiple Z-plasties

26600

79.02

265.35

Closed treatment of metacarpal fracture, single; without manipulation, each bone

26605

79.02

313.23

Closed treatment of metacarpal fracture, single; with manipulation, each bone

26607

79.02

467.29

Closed treatment of metacarpal fracture, with manipulation, with external fixation, each bone

26608

1,169.01

475.98

Percutaneous skeletal fixation of metacarpal fracture, each bone

26615

1,837.10

522.23

Open treatment of metacarpal fracture, single, includes internal fixation, when performed, each bone

26641

79.02

346.52

Closed treatment of carpometacarpal dislocation, thumb, with manipulation

26645

79.02

397.78

Closed treatment of carpometacarpal fracture dislocation, thumb (Bennett fracture), with manipulation

26650

1,169.01

471.88

Percutaneous skeletal fixation of carpometacarpal fracture dislocation, thumb (Bennett fracture), with manipulation

26665

1,837.10

590.41

Open treatment of carpometacarpal fracture dislocation, thumb (Bennett fracture), includes internal fixation, when performed

26670

79.02

320.74

Closed treatment of carpometacarpal dislocation, other than thumb, with manipulation, each joint; without anesthesia

26675

79.02

431.07

Closed treatment of carpometacarpal dislocation, other than thumb, with manipulation, each joint; requiring anesthesia

26676

1,169.01

500.63

Percutaneous skeletal fixation of carpometacarpal dislocation, other than thumb, with manipulation, each joint

26685

1,169.01

547.53

Open treatment of carpometacarpal dislocation, other than thumb; includes internal fixation, when performed, each joint

26686

2,646.58

611.08

Open treatment of carpometacarpal dislocation, other than thumb; complex, multiple, or delayed reduction

26700

79.02

300.67

Closed treatment of metacarpophalangeal dislocation, single, with manipulation; without anesthesia

26705

79.02

397.21

Closed treatment of metacarpophalangeal dislocation, single, with manipulation; requiring anesthesia

26706

79.02

427.02

Percutaneous skeletal fixation of metacarpophalangeal dislocation, single, with manipulation

26715

1,169.01

526.96

Open treatment of metacarpophalangeal dislocation, single, includes internal fixation, when performed

26720

79.02

188.59

Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; without manipulation, each

26725

79.02

335.54

Closed treatment of phalangeal shaft fracture,

proximal or middle phalanx, finger or thumb; with manipulation, with or without skin or skeletal traction, each

26727

1,169.01

468.96

Percutaneous skeletal fixation of unstable phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, with manipulation, each

26735

1,169.01

545.16

Open treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, includes internal fixation, when performed, each

26740

79.02

218.54

Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint; without manipulation, each

26742

79.02

363.65

Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint; with manipulation, each

26746

1,169.01

648.37

Open treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint, includes internal fixation, when performed, each

26750

79.02

175.09

Closed treatment of distal phalangeal fracture, finger or thumb; without manipulation, each

26755

79.02

307.93

Closed treatment of distal phalangeal fracture, finger or thumb; with manipulation, each

26756

1,169.01

417.05

Percutaneous skeletal fixation of distal phalangeal fracture, finger or thumb, each

26765

1,169.01

441.32

Open treatment of distal phalangeal fracture, finger or thumb, includes internal fixation, when performed, each

26770

79.02

259.28

Closed treatment of interphalangeal joint dislocation, single, with manipulation; without anesthesia

26775

180.18

371.25

Closed treatment of interphalangeal joint dislocation, single, with manipulation; requiring anesthesia

26776

1,169.01

442.51

Percutaneous skeletal fixation of interphalangeal joint dislocation, single, with manipulation

26785

1,169.01

477.31

Open treatment of interphalangeal joint dislocation, includes internal fixation, when performed, single

26820

1,175.77

834.75

Fusion in opposition, thumb, with autogenous graft (includes obtaining graft)

26841

1,175.77

787.85

Arthrodesis, carpometacarpal joint, thumb, with or without internal fixation;

26842

1,175.77

840.86

Arthrodesis, carpometacarpal joint, thumb, with or without internal fixation; with autograft (includes obtaining graft)

26843

1,175.77

777.80

Arthrodesis, carpometacarpal joint, digit, other than thumb, each;

26844

1,175.77

861.11

Arthrodesis, carpometacarpal joint, digit, other than thumb, each; with autograft (includes obtaining graft)

26850

1,175.77

743.13

Arthrodesis, metacarpophalangeal joint, with or without internal fixation;

26852

1,175.77

837.09

Arthrodesis, metacarpophalangeal joint, with or without internal fixation; with autograft (includes obtaining graft)

26860

1,175.77

615.69

Arthrodesis, interphalangeal joint, with or without internal fixation;

26861

1,175.77

105.25

Arthrodesis, interphalangeal joint, with or without internal fixation; each additional interphalangeal joint (List separately in addition to code for primary procedure)

26862

1,175.77

770.75

Arthrodesis, interphalangeal joint, with or without internal fixation; with autograft (includes obtaining graft)

26863

1,175.77

234.75

Arthrodesis, interphalangeal joint, with or without internal fixation; with autograft (includes obtaining graft), each additional joint (List separately in addition to code for primary procedure)

26910

1,175.77

745.42

Amputation, metacarpal, with finger or thumb (ray amputation), single, with or without interosseous transfer

26951

735.73

648.16

Amputation, finger or thumb, primary or secondary, any joint or phalanx, single, including neurectomies; with direct closure

26952

735.73

696.58

Amputation, finger or thumb, primary or secondary, any joint or phalanx, single, including neurectomies; with local advancement flaps (V-Y, hood)

26989

I.C.

Unlisted procedure, hands or fingers

26990

950.47

613.10

Incision and drainage, pelvis or hip joint area; deep abscess or hematoma

26991

950.47

726.47

Incision and drainage, pelvis or hip joint area; infected bursa

26992

954.20

Incision, bone cortex, pelvis and/or hip joint (eg, osteomyelitis or bone abscess)

27000

950.47

448.16

Tenotomy, adductor of hip, percutaneous (separate procedure)

27001

1,304.45

538.40

Tenotomy, adductor of hip, open

27003

1,304.45

577.71

Tenotomy, adductor, subcutaneous, open, with obturator neurectomy

27005

721.02

Tenotomy, hip flexor(s), open (separate procedure)

27006

731.27

Tenotomy, abductors and/or extensor(s) of hip, open (separate procedure)

27025

873.42

Fasciotomy, hip or thigh, any type

27030

937.23

Arthrotomy, hip, with drainage (eg, infection)

27033

1,920.92

969.12

Arthrotomy, hip, including exploration or removal of loose or foreign body

27035

1,920.92

1,107.79

Denervation, hip joint, intrapelvic or extrapelvic intra-articular branches of sciatic, femoral, or obturator nerves

27036

988.08

Capsulectomy or capsulotomy, hip, with or without excision of heterotopic bone, with release of hip flexor muscles (ie, gluteus medius, gluteus minimus, tensor fascia latae, rectus femoris, sartorius, iliopsoas)

27040

388.12

347.03

Biopsy, soft tissue of pelvis and hip area; superficial

27041

388.12

669.20

Biopsy, soft tissue of pelvis and hip area; deep, subfascial or intramuscular

27047

943.36

612.71

Excision, tumor, pelvis and hip area; subcutaneous tissue

27048

943.36

463.79

Excision, tumor, pelvis and hip area; deep, subfascial, intramuscular

27049

943.36

962.60

Radical resection of tumor, soft tissue of pelvis and hip area (eg, malignant neoplasm)

27050

950.47

347.97

Arthrotomy, with biopsy; sacroiliac joint

27052

950.47

546.18

Arthrotomy, with biopsy; hip joint

27054

672.94

Arthrotomy with synovectomy, hip joint

27060

950.47

422.47

Excision; ischial bursa

27062

950.47

446.66

Excision; trochanteric bursa or calcification

27065

950.47

490.42

Excision of bone cyst or benign tumor; superficial (wing of ilium, symphysis pubis, or greater trochanter of femur) with or without autograft

27066

1,304.45

797.04

Excision of bone cyst or benign tumor; deep, with or without autograft

27067

1,304.45

1,002.15

Excision of bone cyst or benign tumor; with autograft requiring separate incision

27070

838.43

Partial excision (craterization, saucerization) (eg, osteomyelitis or bone abscess); superficial (eg, wing of ilium, symphysis pubis, or greater trochanter of femur)

27071

904.63

Partial excision (craterization, saucerization) (eg, osteomyelitis or bone abscess); deep (subfascial or intramuscular)

27075

2,238.88

Radical resection of tumor or infection; wing of ilium, one pubic or is chial ramus or symphysis pubis

27076

1,568.84

Radical resection of tumor or infection; ilium, including acetabulum, both pubic rami, or is chium and acetabulum

27077

2,617.35

Radical resection of tumor or infection; innominate bone, total

27078

995.03

Radical resection of tumor or infection; ischial tuberosity and greater trochanter of femur

27079

971.65

Radical resection of tumor or infection; is chial tuberosity and greater trochanter of femur, with skin flaps

27080

1,304.45

476.84

Coccygectomy, primary

27086

388.12

261.20

Removal of foreign body, pelvis or hip; subcutaneous tissue

27087

950.47

621.73

Removal of foreign body, pelvis or hip; deep (subfascial or intramuscular)

27090

826.31

Removal of hip prosthesis; (separate procedure)

27091

1,559.50

Removal of hip prosthesis; complicated, including total hip prosthesis, methylmethacrylate with or without insertion of spacer

27093

223.65

Injection procedure for hip arthrography; without anesthesia

27095

272.66

Injection procedure for hip arthrography; with anesthesia

27096

208.54

Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid

27097

1,304.45

653.47

Release or recession, hamstring, proximal

27098

1,304.45

617.38

Transfer, adductor to ischium

27100

1,920.92

808.56

Transfer external oblique muscle to greater trochanter including fascial or tendon extension (graft)

27105

1,920.92

838.35

Transfer paraspinal muscle to hip (includes fascial or tendon extension graft)

27110

1,920.92

931.46

Transfer iliopsoas; to greater trochanter of femur

27111

1,920.92

880.18

Transfer iliopsoas; to femoral neck

27120

1,266.25

Acetabuloplasty; (eg, Whitman, Colonna, Haygroves, or cup type)

27122

1,094.44

Acetabuloplasty; resection, femoral head (eg, Girdlestone procedure)

27125

1,103.78

Hemiarthroplasty, hip, partial (eg, femoral stem prosthesis, bipolar arthroplasty)

27130

1,420.24

Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft

27132

1,660.95

Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft

27134

1,925.06

Revision of total hip arthroplasty; both components, with or without autograft or allograft

27137

1,471.23

Revision of total hip arthroplasty; acetabular component only, with or without autograft or allograft

27138

1,529.81

Revision of total hip arthroplasty; femoral component only, with or without allograft

27140

893.94

Osteotomy and transfer of greater trochanter of femur (separate procedure)

27146

1,253.82

Osteotomy, iliac, acetabular or innominate bone;

27147

1,435.81

Osteotomy, iliac, acetabular or innominate bone; with open reduction of hip

27151

1,413.82

Osteotomy, iliac, acetabular or innominate bone; with femoral osteotomy

27156

1,701.06

Osteotomy, iliac, acetabular or innominate bone; with femoral osteotomy and with open reduction of hip

27158

1,326.09

Osteotomy, pelvis, bilateral (eg, congenital malformation)

27161

1,211.48

Osteotomy, femoral neck (separate procedure)

27165

1,341.98

Osteotomy, intertrochanteric or subtrochanteric including internal or external fixation and/or cast

27170

1,165.34

Bone graft, femoral head, neck, intertrochanteric or subtrochanteric area (includes obtaining bone graft)

27175

633.44

Treatment of slipped femoral epiphysis; by traction, without reduction

27176

899.03

Treatment of slipped femoral epiphysis; by single or multiple pinning, in situ

27177

1,095.48

Open treatment of slipped femoral epiphysis; single or multiple pinning or bone graft (includes obtaining graft)

27178

876.43

Open treatment of slipped femoral epiphysis; closed manipulation with single or multiple pinning

27179

967.54

Open treatment of slipped femoral epiphysis; osteoplasty of femoral neck (Heyman type procedure)

27181

1,052.03

Open treatment of slipped femoral epiphysis; osteotomy and internal fixation

27185

727.98

Epiphyseal arrest by epiphysiodesis or stapling, greater trochanter of femur

27187

990.14

Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate, femoral neck and proximal femur

27193

79.02

456.65

Closed treatment of pelvic ring fracture, dislocation, diastasis or subluxation; without manipulation

27194

659.86

721.80

Closed treatment of pelvic ring fracture, dislocation, diastasis or subluxation; with manipulation, requiring more than local anesthesia

27200

79.07

171.20

Closed treatment of coccygeal fracture

27202

1,837.10

780.56

Open treatment of coccygeal fracture

27215

730.06

Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s) (eg, pelvic fracture(s) which do not disrupt the pelvic ring), with internal fixation

27216

1,047.49

Percutaneous skeletal fixation of posterior pelvic ring fracture and/or dislocation (includes ilium, sacroiliac joint and/or sacrum)

27217

1,004.94

Open treatment of anterior ring fracture and/or dislocation with internal fixation (includes pubic symphysis and/or rami)

27218

1,342.57

Open treatment of posterior ring fracture and/or dislocation with internal fixation (includes ilium, sacroiliac joint and/or sacrum)

27220

79.02

514.21

Closed treatment of acetabulum (hip socket) fracture(s); without manipulation

27222

968.68

Closed treatment of acetabulum (hip socket) fracture(s); with manipulation, with or without skeletal traction

27226

987.40

Open treatment of posterior or anterior acetabular wall fracture, with internal fixation

27227

1,644.79

Open treatment of acetabular fracture(s) involving anterior or posterior (one) column, or a fracture running transversely across the acetabulum, with internal fixation

27228

1,882.07

Open treatment of acetabular fracture(s) involving anterior and posterior (two) columns, includes T-fracture and both column fracture with complete articular detachment, or single column or transverse fracture with associated acetabular wall fracture, with internal fixation

27230

79.02

463.48

Closed treatment of femoral fracture, proximal end, neck; without manipulation

27232

759.49

Closed treatment of femoral fracture, proximal end, neck; with manipulation, with or without skeletal traction

27235

904.67

Percutaneous skeletal fixation of femoral fracture, proximal end, neck

27236

1,164.54

Open treatment of femoral fracture, proximal end, neck, internal fixation or prosthetic replacement

27238

79.02

444.78

Closed treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; without manipulation

27240

938.33

Closed treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with manipulation, with or without skin or skeletal traction

27244

1,147.95

Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with plate/screw type implant, with or without cerclage

27245

1,403.54

Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with intramedullary implant, with or without interlocking screws and/or cerclage

27246

79.02

378.86

Closed treatment of greater trochanteric fracture, without manipulation

27248

753.84

Open treatment of greater trochanteric fracture, includes internal fixation, when performed

27250

79.02

470.04

Closed treatment of hip dislocation, traumatic; without anesthesia

27252

659.86

742.96

Closed treatment of hip dislocation, traumatic; requiring anesthesia

27253

940.34

Open treatment of hip dislocation, traumatic, without internal fixation

27254

1,256.41

Open treatment of hip dislocation, traumatic, with acetabular wall and femoral head fracture, with or without internal or external fixation

27256

79.02

297.90

Treatment of spontaneous hip dislocation (developmental, including congenital or pathological), by abduction, splint or traction; without anesthesia, without manipulation

27257

659.86

326.70

Treatment of spontaneous hip dislocation (developmental, including congenital or pathological), by abduction, splint or traction; with manipulation, requiring anesthesia

27258

1,095.65

Open treatment of spontaneous hip dislocation (developmental, including congenital or pathological), replacement of femoral head in acetabulum (including tenotomy, etc);

27259

1,517.80

Open treatment of spontaneous hip dislocation (developmental, including congenital or pathological), replacement of femoral head in acetabulum (including tenotomy, etc); with femoral shaft shortening

27265

79.02

394.84

Closed treatment of post hip arthroplasty dislocation; without anesthesia

27266

659.86

573.49

Closed treatment of post hip arthroplasty dislocation; requiring regional or general anesthesia

27267

79.02

412.89

Closed treatment of femoral fracture, proximal end, head; without manipulation

27268

504.83

Closed treatment of femoral fracture, proximal end, head; with manipulation

27269

1,183.23

Open treatment of femoral fracture, proximal end, head, includes internal fixation, when performed

27275

659.86

181.01

Manipulation, hip joint, requiring general anesthesia

27280

1,011.82

Arthrodesis, sacroiliac joint (including obtaining graft)

27282

819.03

Arthrodesis, symphysis pubis (including obtaining graft)

27284

1,584.62

Arthrodesis, hip joint (including obtaining graft);

27286

1,600.43

Arthrodesis, hip joint (including obtaining graft); with subtrochanteric osteotomy

27290

1,538.03

Interpelviabdominal amputation (hindquarter amputation)

27295

1,236.88

Disarticulation of hip

27299

I.C.

Unlisted procedure, pelvis or hip joint

27301

818.67

679.61

Incision and drainage, deep abscess, bursa, or hematoma, thigh or knee region

27303

632.49

Incision, deep, with opening of bone cortex, femur or knee (eg, osteomyelitis or bone abscess)

27305

950.47

465.12

Fasciotomy, iliotibial (tenotomy), open

27306

950.47

387.11

Tenotomy, percutaneous, adductor or hamstring; single tendon (separate procedure)

27307

950.47

467.91

Tenotomy, percutaneous, adductor or hamstring; multiple tendons

27310

1,304.45

716.07

Arthrotomy, knee, with exploration, drainage, or removal of foreign body (eg, infection)

27323

388.12

263.39

Biopsy, soft tissue of thigh or knee area; superficial

27324

943.36

375.60

Biopsy, soft tissue of thigh or knee area; deep (subfascial or intramuscular)

27325

806.70

503.51

Neurectomy, hamstring muscle

27326

806.70

487.35

Neurectomy, popliteal (gastrocnemius)

27327

943.36

450.60

Excision, tumor, thigh or knee area; subcutaneous

27328

943.36

411.30

Excision, tumor, thigh or knee area; deep, subfascial, or intramuscular

27329

943.36

1,002.56

Radical resection of tumor (eg, malignant neoplasm), soft tissue of thigh or knee area

27330

1,304.45

400.62

Arthrotomy, knee; with synovial biopsy only

27331

1,304.45

470.55

Arthrotomy, knee; including joint exploration, biopsy, or removal of loose or foreign bodies

27332

1,304.45

632.32

Arthrotomy, with excision of semilunar cartilage (meniscectomy) knee; medial OR lateral

27333

1,304.45

575.91

Arthrotomy, with excision of semilunar cartilage (meniscectomy) knee; medial AND lateral

27334

1,304.45

673.45

Arthrotomy, with synovectomy, knee; anterior OR posterior

27335

1,304.45

759.30

Arthrotomy, with synovectomy, knee; anterior AND posterior including popliteal area

27340

950.47

363.93

Excision, prepatellar bursa

27345

950.47

476.26

Excision of synovial cyst of popliteal space (eg, Baker's cyst)

27347

950.47

499.83

Excision of lesion of meniscus or capsule (eg, cyst, ganglion), knee

27350

1,304.45

644.54

Patellectomy or hemipatellectomy

27355

1,304.45

598.47

Excision or curettage of bone cyst or benign tumor of femur;

27356

1,304.45

727.71

Excision or curettage of bone cyst or benign tumor of femur; with allograft

27357

1,304.45

807.37

Excision or curettage of bone cyst or benign tumor of femur; with autograft (includes obtaining graft)

27358

1,304.45

285.96

Excision or curettage of bone cyst or benign tumor of femur; with internal fixation (List in addition to code for primary procedure)

27360

1,304.45

847.84

Partial excision (craterization, saucerization, or diaphysectomy) bone, femur, proximal tibia and/or fibula (eg, osteomyelitis or bone abscess)

27365

1,204.73

Radical resection of tumor, bone, femur or knee

27370

189.83

Injection procedure for knee arthrography

27372

943.36

622.53

Removal of foreign body, deep, thigh region or knee area

27380

950.47

594.79

Suture of infrapatellar tendon; primary

27381

950.47

800.65

Suture of infrapatellar tendon; secondary reconstruction, including fascial or tendon graft

27385

950.47

634.73

Suture of quadriceps or hamstring muscle rupture;

primary

27386

950.47

832.35

Suture of quadriceps or hamstring muscle rupture; secondary reconstruction, including fascial or tendon graft

27390

950.47

433.79

Tenotomy, open, hamstring, knee to hip; single tendon

27391

950.47

567.78

Tenotomy, open, hamstring, knee to hip; multiple tendons, one leg

27392

950.47

699.94

Tenotomy, open, hamstring, knee to hip; multiple tendons, bilateral

27393

1,304.45

503.45

Lengthening of hamstring tendon; single tendon

27394

1,304.45

648.35

Lengthening of hamstring tendon; multiple tendons, one leg

27395

1,920.92

871.80

Lengthening of hamstring tendon; multiple tendons, bilateral

27396

1,304.45

610.18

Transplant, hamstring tendon to patella; single tendon

27397

1,920.92

880.72

Transplant, hamstring tendon to patella; multiple tendons

27400

1,920.92

670.40

Transfer, tendon or muscle, hamstrings to femur (eg, Egger's type procedure)

27403

1,304.45

637.97

Arthrotomy with meniscus repair, knee

27405

1,920.92

670.62

Repair, primary, torn ligament and/or capsule, knee; collateral

27407

3,549.34

768.22

Repair, primary, torn ligament and/or capsule, knee; cruciate

27409

1,920.92

950.08

Repair, primary, torn ligament and/or capsule, knee; collateral and cruciate ligaments

27412

1,623.20

Autologous chondrocyte implantation, knee

27415

1,366.54

Osteochondral allograft, knee, open

27416

1,920.92

933.72

Osteochondral autograft(s), knee, open (eg,

mosaicplasty) (includes harvesting of autograft[s])

27418

1,920.92

827.20

Anterior tibial tubercleplasty (eg, Maquet type procedure)

27420

1,920.92

743.44

Reconstruction of dislocating patella; (eg, Hauser type procedure)

27422

1,920.92

740.97

Reconstruction of dislocating patella; with extensor realignment and/or muscle advancement or release (eg, Campbell, Goldwaite type procedure)

27424

1,920.92

742.00

Reconstruction of dislocating patella; with patellectomy

27425

1,304.45

442.92

Lateral retinacular release, open

27427

1,920.92

712.73

Ligamentous reconstruction (augmentation), knee; extra-articular

27428

3,549.34

1,086.45

Ligamentous reconstruction (augmentation), knee; intra-articular (open)

27429

3,549.34

1,214.83

Ligamentous reconstruction (augmentation), knee; intra-articular (open) and extra-articular

27430

1,920.92

735.28

Quadricepsplasty (eg, Bennett or Thompson type)

27435

1,920.92

785.67

Capsulotomy, posterior capsular release, knee

27437

1,604.48

655.11

Arthroplasty, patella; without prosthesis

27438

2,274.08

829.76

Arthroplasty, patella; with prosthesis

27440

1,604.48

728.29

Arthroplasty, knee, tibial plateau;

27441

1,604.48

770.60

Arthroplasty, knee, tibial plateau; with debridement and partial synovectomy

27442

1,604.48

862.31

Arthroplasty, femoral condyles or tibial plateau(s), knee;

27443

1,604.48

812.79

Arthroplasty, femoral condyles or tibial plateau(s), knee; with debridement and partial synovectomy

27445

1,249.21

Arthroplasty, knee, hinge prosthesis (eg, Walldius type)

27446

12,274.58

1,112.56

Arthroplasty, knee, condyle and plateau; medial OR lateral compartment

27447

1,526.08

Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty)

27448

816.80

Osteotomy, femur, shaft or supracondylar; without fixation

27450

1,013.82

Osteotomy, femur, shaft or supracondylar; with fixation

27454

1,276.36

Osteotomy, multiple, with realignment on intramedullary rod, femoral shaft (eg, Sofield type procedure)

27455

938.35

Osteotomy, proximal tibia, including fibular excision or osteotomy (includes correction of genu varus (bowleg) or genu valgus (knock-knee)); before epiphyseal closure

27457

963.65

Osteotomy, proximal tibia, including fibular excision or osteotomy (includes correction of genu varus (bowleg) or genu valgus (knock-knee)); after epiphyseal closure

27465

1,176.18

Osteoplasty, femur; shortening (excluding 64876)

27466

1,172.21

Osteoplasty, femur; lengthening

27468

1,317.68

Osteoplasty, femur; combined, lengthening and shortening with femoral segment transfer

27470

1,168.73

Repair, nonunion or malunion, femur, distal to head and neck; without graft (eg, compression technique)

27472

1,263.51

Repair, nonunion or malunion, femur, distal to head and neck; with iliac or other autogenous bone graft (includes obtaining graft)

27475

650.76

Arrest, epiphyseal, any method (eg, epiphysiodesis); distal femur

27477

724.63

Arrest, epiphyseal, any method (eg, epiphysiodesis); tibia and fibula, proximal

27479

954.62

Arrest, epiphyseal, any method (eg, epiphysiodesis); combined distal femur, proximal tibia and fibula

27485

667.28

Arrest, hemiepiphyseal, distal femur or proximal tibia or fibula (eg, genu varus or valgus)

27486

1,393.86

Revision of total knee arthroplasty, with or without allograft; one component

27487

1,753.53

Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component

27488

1,181.91

Removal of prosthesis, including total knee prosthesis, methylmethacrylate with or without insertion of spacer, knee

27495

1,125.23

Prophylactic treatment (nailing, pinning, plating, or wiring) with or without methylmethacrylate, femur

27496

950.47

500.56

Decompression fasciotomy, thigh and/or knee, one compartment (flexor or extensor or adductor);

27497

950.47

537.18

Decompression fasciotomy, thigh and/or knee, one compartment (flexor or extensor or adductor); with debridement of nonviable muscle and/or nerve

27498

950.47

585.13

Decompression fasciotomy, thigh and/or knee, multiple compartments;

27499

950.47

656.52

Decompression fasciotomy, thigh and/or knee, multiple compartments; with debridement of nonviable muscle and/or nerve

27500

79.02

507.26

Closed treatment of femoral shaft fracture, without manipulation

27501

79.02

495.89

Closed treatment of supracondylar or transcondylar femoral fracture with or without intercondylar extension, without manipulation

27502

79.02

782.17

Closed treatment of femoral shaft fracture, with manipulation, with or without skin or skeletal traction

27503

79.02

792.18

Closed treatment of supracondylar or transcondylar femoral fracture with or without intercondylar extension, with manipulation, with or without skin or skeletal traction

27506

1,310.20

Open treatment of femoral shaft fracture, with or without external fixation, with insertion of intramedullary implant, with or without cerclage and/or locking screws

27507

977.95

Open treatment of femoral shaft fracture with plate/screws, with or without cerclage

27508

79.02

516.52

Closed treatment of femoral fracture, distal end, medial or lateral condyle, without manipulation

27509

1,169.01

647.70

Percutaneous skeletal fixation of femoral fracture, distal end, medial or lateral condyle, or supracondylar or transcondylar, with or without intercondylar extension, or distal femoral epiphyseal separation

27510

79.02

689.36

Closed treatment of femoral fracture, distal end, medial or lateral condyle, with manipulation

27511

1,027.09

Open treatment of femoral supracondylar or transcondylar fracture without intercondylar extension, includes internal fixation, when performed

27513

1,290.35

Open treatment of femoral supracondylar or transcondylar fracture with intercondylar extension, includes internal fixation, when performed

27514

1,072.75

Open treatment of femoral fracture, distal end, medial or lateral condyle, includes internal fixation, when performed

27516

79.02

488.37

Closed treatment of distal femoral epiphyseal separation; without manipulation

27517

79.02

662.61

Closed treatment of distal femoral epiphyseal separation; with manipulation, with or without skin or skeletal traction

27519

961.16

Open treatment of distal femoral epiphyseal separation, includes internal fixation, when performed

27520

79.02

312.97

Closed treatment of patellar fracture, without manipulation

27524

751.78

Open treatment of patellar fracture, with internal fixation and/or partial or complete patellectomy and soft tissue repair

27530

79.02

388.39

Closed treatment of tibial fracture, proximal (plateau); without manipulation

27532

79.02

608.12

Closed treatment of tibial fracture, proximal (plateau); with or without manipulation, with skeletal traction

27535

917.45

Open treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation, when performed

27536

1,171.22

Open treatment of tibial fracture, proximal (plateau); bicondylar, with or without internal fixation

27538

79.02

462.53

Closed treatment of intercondylar spine(s) and/or tuberosity fracture(s) of knee, with or without manipulation

27540

838.32

Open treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, includes internal fixation, when performed

27550

79.02

480.85

Closed treatment of knee dislocation; without anesthesia

27552

659.86

615.38

Closed treatment of knee dislocation; requiring anesthesia

27556

949.74

Open treatment of knee dislocation, includes internal fixation, when performed; without primary ligamentous repair or augmentation/reconstruction

27557

1,124.06

Open treatment of knee dislocation, includes internal fixation, when performed; with primary ligamentous repair

27558

1,229.87

Open treatment of knee dislocation, includes internal fixation, when performed; with primary ligamentous repair, with augmentation/reconstruction

27560

79.02

353.43

Closed treatment of patellar dislocation; without anesthesia

27562

659.86

444.13

Closed treatment of patellar dislocation; requiring anesthesia

27566

1,837.10

890.01

Open treatment of patellar dislocation, with or without partial or total patellectomy

27570

659.86

147.33

Manipulation of knee joint under general anesthesia (includes application of traction or other fixation devices)

27580

1,436.28

Arthrodesis, knee, any technique

27590

800.54

Amputation, thigh, through femur, any level;

27591

900.93

Amputation, thigh, through femur, any level; immediate fitting technique including first cast

27592

681.68

Amputation, thigh, through femur, any level; open, circular (guillotine)

27594

950.47

503.22

Amputation, thigh, through femur, any level; secondary closure or scar revision

27596

722.34

Amputation, thigh, through femur, any level; re-amputation

27598

732.01

Disarticulation at knee

27599

I.C.

Unlisted procedure, femur or knee

27600

950.47

420.07

Decompression fasciotomy, leg; anterior and/or lateral compartments only

27601

950.47

434.38

Decompression fasciotomy, leg; posterior compartment(s) only

27602

950.47

513.01

Decompression fasciotomy, leg; anterior and/or lateral, and posterior compartment(s)

27603

818.67

531.62

Incision and drainage, leg or ankle; deep abscess or hematoma

27604

950.47

464.18

Incision and drainage, leg or ankle; infected bursa

27605

930.79

406.46

Tenotomy, percutaneous, Achilles tendon (separate procedure); local anesthesia

27606

950.47

300.00

Tenotomy, percutaneous, Achilles tendon (separate procedure); general anesthesia

27607

950.47

603.23

Incision (eg, osteomyelitis or bone abscess), leg or ankle

27610

1,304.45

651.54

Arthrotomy, ankle, including exploration, drainage, or removal of foreign body

27612

1,304.45

566.96

Arthrotomy, posterior capsular release, ankle, with or without Achilles tendon lengthening

27613

131.28

245.09

Biopsy, soft tissue of leg or ankle area; superficial

27614

943.36

561.25

Biopsy, soft tissue of leg or ankle area; deep (subfascial or intramuscular)

27615

1,304.45

880.50

Radical resection of tumor (eg, malignant neoplasm), soft tissue of leg or ankle area

27618

719.48

483.83

Excision, tumor, leg or ankle area; subcutaneous tissue

27619

943.36

775.89

Excision, tumor, leg or ankle area; deep (subfascial or intramuscular)

27620

1,304.45

466.36

Arthrotomy, ankle, with joint exploration, with or without biopsy, with or without removal of loose or foreign body

27625

1,304.45

599.39

Arthrotomy, with synovectomy, ankle;

27626

1,304.45

643.25

Arthrotomy, with synovectomy, ankle; including tenosynovectomy

27630

950.47

545.41

Excision of lesion of tendon sheath or capsule (eg, cyst or ganglion), leg and/or ankle

27635

1,304.45

594.25

Excision or curettage of bone cyst or benign tumor, tibia or fibula;

27637

1,304.45

746.81

Excision or curettage of bone cyst or benign tumor, tibia or fibula; with autograft (includes obtaining graft)

27638

1,304.45

779.62

Excision or curettage of bone cyst or benign tumor, tibia or fibula; with allograft

27640

1,920.92

878.97

Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis or exostosis); tibia

27641

1,304.45

708.30

Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis or exostosis); fibula

27645

1,055.87

Radical resection of tumor, bone; tibia

27646

942.68

Radical resection of tumor, bone; fibula

27647

1,920.92

817.37

Radical resection of tumor, bone; talus or calcaneus

27648

182.47

Injection procedure for ankle arthrography

27650

1,920.92

701.87

Repair, primary, open or percutaneous, ruptured Achilles tendon;

27652

3,549.34

748.08

Repair, primary, open or percutaneous, ruptured Achilles tendon; with graft (includes obtaining graft)

27654

1,920.92

702.12

Repair, secondary, Achilles tendon, with or without graft

27656

950.47

558.16

Repair, fascial defect of leg

27658

950.47

389.66

Repair, flexor tendon, leg; primary, without graft, each tendon

27659

950.47

508.84

Repair, flexor tendon, leg; secondary, with or without graft, each tendon

27664

950.47

375.44

Repair, extensor tendon, leg; primary, without graft, each tendon

27665

1,304.45

427.13

Repair, extensor tendon, leg; secondary, with or without graft, each tendon

27675

950.47

520.27

Repair, dislocating peroneal tendons; without fibular osteotomy

27676

1,304.45

622.25

Repair, dislocating peroneal tendons; with fibular osteotomy

27680

1,304.45

439.14

Tenolysis, flexor or extensor tendon, leg and/or ankle; single, each tendon

27681

1,304.45

525.04

Tenolysis, flexor or extensor tendon, leg and/or ankle; multiple tendons (through separate incision(s))

27685

1,304.45

623.46

Lengthening or shortening of tendon, leg or ankle; single tendon (separate procedure)

27686

1,304.45

569.13

Lengthening or shortening of tendon, leg or ankle; multiple tendons (through same incision), each

27687

1,304.45

470.61

Gastrocnemius recession (eg, Strayer procedure)

27690

1,920.92

615.51

Transfer or transplant of single tendon (with muscle redirection or rerouting); superficial (eg, anterior tibial extensors into midfoot)

27691

1,920.92

732.01

Transfer or transplant of single tendon (with muscle redirection or rerouting); deep (eg, anterior tibial or posterior tibial through interosseous space, flexor digitorum longus, flexor hallucis longus, or peroneal tendon to midfoot or hindfoot)

27692

1,920.92

111.18

Transfer or transplant of single tendon (with muscle redirection or rerouting); each additional tendon (List separately in addition to code for primary procedure)

27695

1,304.45

503.77

Repair, primary, disrupted ligament, ankle; collateral

27696

1,304.45

596.48

Repair, primary, disrupted ligament, ankle; both collateral ligaments

27698

1,304.45

663.12

Repair, secondary, disrupted ligament, ankle, collateral (eg, Watson-Jones procedure)

27700

1,604.48

615.55

Arthroplasty, ankle;

27702

998.93

Arthroplasty, ankle; with implant (total ankle)

27703

1,140.05

Arthroplasty, ankle; revision, total ankle

27704

950.47

558.85

Removal of ankle implant

27705

1,920.92

769.38

Osteotomy; tibia

27707

950.47

399.02

Osteotomy; fibula

27709

1,304.45

1,060.07

Osteotomy; tibia and fibula

27712

1,074.24

Osteotomy; multiple, with realignment on intramedullary rod (eg, Sofield type procedure)

27715

1,055.51

Osteoplasty, tibia and fibula, lengthening or shortening

27720

877.74

Repair of nonunion or malunion, tibia; without graft, (eg, compression technique)

27722

873.75

Repair of nonunion or malunion, tibia; with sliding graft

27724

1,271.38

Repair of nonunion or malunion, tibia; with iliac or other autograft (includes obtaining graft)

27725

1,184.90

Repair of nonunion or malunion, tibia; by synostosis, with fibula, any method

27726

1,169.01

881.19

Repair of fibula nonunion and/or malunion with internal fixation

27727

1,021.63

Repair of congenital pseudarthrosis, tibia

27730

1,304.45

581.19

Arrest, epiphyseal (epiphysiodesis), open; distal tibia

27732

1,304.45

415.86

Arrest, epiphyseal (epiphysiodesis), open; distal fibula

27734

1,304.45

624.95

Arrest, epiphyseal (epiphysiodesis), open; distal tibia and fibula

27740

1,304.45

708.58

Arrest, epiphyseal (epiphysiodesis), any method, combined, proximal and distal tibia and fibula;

27742

1,920.92

645.94

Arrest, epiphyseal (epiphysiodesis), any method, combined, proximal and distal tibia and fibula; and distal femur

27745

3,549.34

755.71

Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate, tibia

27750

79.02

336.76

Closed treatment of tibial shaft fracture (with or without fibular fracture); without manipulation

27752

79.02

530.23

Closed treatment of tibial shaft fracture (with or without fibular fracture); with manipulation, with or without skeletal traction

27756

1,169.01

566.57

Percutaneous skeletal fixation of tibial shaft fracture (with or without fibular fracture) (eg, pins or screws)

27758

1,837.10

880.82

Open treatment of tibial shaft fracture (with or without fibular fracture), with plate/screws, with or without cerclage

27759

2,646.58

997.49

Treatment of tibial shaft fracture (with or without fibular fracture) by intramedullary implant, with or without interlocking screws and/or cerclage

27760

79.02

326.10

Closed treatment of medial malleolus fracture; without manipulation

27762

79.02

479.49

Closed treatment of medial malleolus fracture; with manipulation, with or without skin or skeletal traction

27766

1,837.10

614.56

Open treatment of medial malleolus fracture, includes internal fixation, when performed

27767

79.02

260.97

Closed treatment of posterior malleolus fracture; without manipulation

27768

79.02

392.32

Closed treatment of posterior malleolus fracture; with manipulation

27769

1,837.10

664.75

Open treatment of posterior malleolus fracture, includes internal fixation, when performed

27780

79.02

290.19

Closed treatment of proximal fibula or shaft fracture; without manipulation

27781

79.02

413.39

Closed treatment of proximal fibula or shaft fracture; with manipulation

27784

1,837.10

668.12

Open treatment of proximal fibula or shaft fracture, includes internal fixation, when performed

27786

79.02

309.22

Closed treatment of distal fibular fracture (lateral malleolus); without manipulation

27788

79.02

420.92

Closed treatment of distal fibular fracture (lateral malleolus); with manipulation

27792

1,837.10

682.77

Open treatment of distal fibular fracture (lateral malleolus), includes internal fixation, when performed

27808

79.02

324.87

Closed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); without manipulation

27810

79.02

470.47

Closed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); with manipulation

27814

1,837.10

776.51

Open treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli, or medial and posterior malleoli), includes internal fixation, when performed

27816

79.02

306.81

Closed treatment of trimalleolar ankle fracture; without manipulation

27818

79.02

485.86

Closed treatment of trimalleolar ankle fracture; with manipulation

27822

1,837.10

868.19

Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; without fixation of posterior lip

27823

2,646.58

980.87

Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; with fixation of posterior lip

27824

79.02

300.42

Closed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), with or without anesthesia; without manipulation

27825

79.02

540.83

Closed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), with or without anesthesia; with skeletal traction and/or requiring manipulation

27826

1,837.10

809.07

Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of fibula only

27827

2,646.58

1,098.66

Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of tibia only

27828

2,646.58

1,293.25

Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of both tibia and fibula

27829

1,837.10

640.15

Open treatment of distal tibiofibular joint

(syndesmosis) disruption, includes internal fixation, when performed

27830

79.02

342.80

Closed treatment of proximal tibiofibular joint dislocation; without anesthesia

27831

79.02

375.70

Closed treatment of proximal tibiofibular joint dislocation; requiring anesthesia

27832

1,837.10

671.83

Open treatment of proximal tibiofibular joint dislocation, includes internal fixation, when performed, or with excision of proximal fibula

27840

79.02

343.32

Closed treatment of ankle dislocation; without anesthesia

27842

659.86

475.66

Closed treatment of ankle dislocation; requiring anesthesia, with or without percutaneous skeletal fixation

27846

1,837.10

736.46

Open treatment of ankle dislocation, with or without percutaneous skeletal fixation; without repair or internal fixation

27848

1,837.10

845.30

Open treatment of ankle dislocation, with or without percutaneous skeletal fixation; with repair or internal or external fixation

27860

659.86

176.96

Manipulation of ankle under general anesthesia (includes application of traction or other fixation apparatus)

27870

3,549.34

1,041.89

Arthrodesis, ankle, open

27871

3,549.34

694.25

Arthrodesis, tibiofibular joint, proximal or distal

27880

950.47

890.23

Amputation, leg, through tibia and fibula;

27881

888.18

Amputation, leg, through tibia and fibula; with immediate fitting technique including application of first cast

27882

631.19

Amputation, leg, through tibia and fibula; open, circular (guillotine)

27884

950.47

581.50

Amputation, leg, through tibia and fibula; secondary closure or scar revision

27886

659.15

Amputation, leg, through tibia and fibula; re-amputation

27888

705.70

Amputation, ankle, through malleoli of tibia and fibula (eg, Syme, Pirogoff type procedures), with plastic closure and resection of nerves

27889

1,304.45

684.10

Ankle disarticulation

27892

950.47

546.22

Decompression fasciotomy, leg; anterior and/or lateral compartments only, with debridement of nonviable muscle and/or nerve

27893

950.47

542.55

Decompression fasciotomy, leg; posterior compartment(s) only, with debridement of nonviable muscle and/or nerve

27894

950.47

821.49

Decompression fasciotomy, leg; anterior and/or lateral, and posterior compartment(s), with debridement of nonviable muscle and/or nerve

27899

I.C.

Unlisted procedure, leg or ankle

28001

128.34

264.42

Incision and drainage, bursa, foot

28002

950.47

483.98

Incision and drainage below fascia, with or without tendon sheath involvement, foot; single bursal space

28003

950.47

661.81

Incision and drainage below fascia, with or without tendon sheath involvement, foot; multiple areas

28005

930.79

618.80

Incision, bone cortex (eg, osteomyelitis or bone abscess), foot

28008

930.79

417.44

Fasciotomy, foot and/or toe

28010

96.35

230.06

Tenotomy, percutaneous, toe; single tendon

28011

930.79

324.14

Tenotomy, percutaneous, toe; multiple tendons

28020

930.79

502.27

Arthrotomy, including exploration, drainage, or removal of loose or foreign body; intertarsal or tarsometatarsal joint

28022

930.79

458.67

Arthrotomy, including exploration, drainage, or removal of loose or foreign body;

metatarsophalangeal joint

28024

930.79

439.74

Arthrotomy, including exploration, drainage, or removal of loose or foreign body; interphalangeal joint

28035

806.70

498.88

Release, tarsal tunnel (posterior tibial nerve decompression)

28043

943.36

333.94

Excision, tumor, foot; subcutaneous tissue

28045

930.79

467.12

Excision, tumor, foot; deep, subfascial, intramuscular

28046

930.79

841.46

Radical resection of tumor (eg, malignant neoplasm), soft tissue of foot

28050

930.79

437.29

Arthrotomy with biopsy; intertarsal or tarsometatarsal joint

28052

930.79

409.99

Arthrotomy with biopsy; metatarsophalangeal joint

28054

930.79

385.64

Arthrotomy with biopsy; interphalangeal joint

28055

806.70

397.27

Neurectomy, intrinsic musculature of foot

28060

930.79

490.66

Fasciectomy, plantar fascia; partial (separate procedure)

28062

930.79

579.56

Fasciectomy, plantar fascia; radical (separate procedure)

28070

930.79

487.24

Synovectomy; intertarsal or tarsometatarsal joint, each

28072

930.79

479.95

Synovectomy; metatarsophalangeal joint, each

28080

930.79

466.97

Excision, interdigital (Morton) neuroma, single, each

28086

930.79

552.70

Synovectomy, tendon sheath, foot; flexor

28088

930.79

445.10

Synovectomy, tendon sheath, foot; extensor

28090

930.79

444.29

Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion); foot

28092

930.79

409.48

Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion); toe(s), each

28100

930.79

589.48

Excision or curettage of bone cyst or benign tumor, talus or calcaneus;

28102

1,978.29

549.04

Excision or curettage of bone cyst or benign tumor, talus or calcaneus; with iliac or other autograft (includes obtaining graft)

28103

1,978.29

450.10

Excision or curettage of bone cyst or benign tumor, talus or calcaneus; with allograft

28104

930.79

490.24

Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneus;

28106

1,978.29

475.23

Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneus; with iliac or other autograft (includes obtaining graft)

28107

1,978.29

541.33

Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneus; with allograft

28108

930.79

411.40

Excision or curettage of bone cyst or benign tumor, phalanges of foot

28110

930.79

436.59

Ostectomy, partial excision, fifth metatarsal head (bunionette) (separate procedure)

28111

930.79

500.78

Ostectomy, complete excision; first metatarsal head

28112

930.79

472.48

Ostectomy, complete excision; other metatarsal head (second, third or fourth)

28113

930.79

551.51

Ostectomy, complete excision; fifth metatarsal head

28114

930.79

1,014.78

Ostectomy, complete excision; all metatarsal heads, with partial proximal phalangectomy, excluding first metatarsal (eg, Clayton type procedure)

28116

930.79

709.86

Ostectomy, excision of tarsal coalition

28118

930.79

557.06

Ostectomy, calcaneus;

28119

930.79

497.96

Ostectomy, calcaneus; for spur, with or without plantar fascial release

28120

930.79

569.60

Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); talus or calcaneus

28122

930.79

639.61

Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); tarsal or metatarsal bone, except talus or calcaneus

28124

216.23

455.25

Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); phalanx of toe

28126

930.79

369.32

Resection, partial or complete, phalangeal base, each toe

28130

930.79

651.72

Talectomy (astragalectomy)

28140

930.79

613.73

Metatarsectomy

28150

930.79

415.00

Phalangectomy, toe, each toe

28153

930.79

382.87

Resection, condyle(s), distal end of phalanx, each toe

28160

930.79

394.48

Hemiphalangectomy or interphalangeal joint excision, toe, proximal end of phalanx, each

28171

930.79

621.97

Radical resection of tumor, bone; tarsal (except talus or calcaneus)

28173

930.79

718.16

Radical resection of tumor, bone; metatarsal

28175

930.79

528.51

Radical resection of tumor, bone; phalanx of toe

28190

136.06

244.50

Removal of foreign body, foot; subcutaneous

28192

719.48

459.19

Removal of foreign body, foot; deep

28193

388.12

517.37

Removal of foreign body, foot; complicated

28200

930.79

452.76

Repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon

28202

930.79

609.66

Repair, tendon, flexor, foot; secondary with free graft, each tendon (includes obtaining graft)

28208

930.79

432.96

Repair, tendon, extensor, foot; primary or secondary, each tendon

28210

1,978.29

561.65

Repair, tendon, extensor, foot; secondary with free graft, each tendon (includes obtaining graft)

28220

203.73

428.46

Tenolysis, flexor, foot; single tendon

28222

930.79

494.59

Tenolysis, flexor, foot; multiple tendons

28225

930.79

377.16

Tenolysis, extensor, foot; single tendon

28226

930.79

442.57

Tenolysis, extensor, foot; multiple tendons

28230

200.78

414.39

Tenotomy, open, tendon flexor; foot, single or multiple tendon(s) (separate procedure)

28232

191.96

371.03

Tenotomy, open, tendon flexor; toe, single tendon (separate procedure)

28234

930.79

382.53

Tenotomy, open, extensor, foot or toe, each tendon

28238

1,978.29

659.74

Reconstruction (advancement), posterior tibial tendon with excision of accessory tarsal navicular bone (eg, Kidner type procedure)

28240

930.79

420.31

Tenotomy, lengthening, or release, abductor hallucis muscle

28250

930.79

531.74

Division of plantar fascia and muscle (eg, Steindler stripping) (separate procedure)

28260

930.79

650.20

Capsulotomy, midfoot; medial release only (separate procedure)

28261

930.79

931.56

Capsulotomy, midfoot; with tendon lengthening

28262

930.79

1,328.42

Capsulotomy, midfoot; extensive, including posterior talotibial capsulotomy and tendon(s) lengthening (eg, resistant clubfoot deformity)

28264

1,978.29

821.32

Capsulotomy, midtarsal (eg, Heyman type procedure)

28270

930.79

454.72

Capsulotomy; metatarsophalangeal joint, with or without tenorrhaphy, each joint (separate procedure)

28272

183.86

375.50

Capsulotomy; interphalangeal joint, each joint (separate procedure)

28280

930.79

512.40

Syndactylization, toes (eg, webbing or Kelikian type procedure)

28285

930.79

442.95

Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)

28286

930.79

435.00

Correction, cock-up fifth toe, with plastic skin closure (eg, Ruiz-Mora type procedure)

28288

930.79

552.48

Ostectomy, partial, exostectomy or condylectomy, metatarsal head, each metatarsal head

28289

930.79

708.38

Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint

28290

1,314.58

552.20

Correction, hallux valgus (bunion), with or without sesamoidectomy; simple exostectomy (eg, Silver type procedure)

28292

1,314.58

735.12

Correction, hallux valgus (bunion), with or without sesamoidectomy; Keller, McBride, or Mayo type procedure

28293

1,314.58

993.27

Correction, hallux valgus (bunion), with or without sesamoidectomy; resection of joint with implant

28294

1,314.58

716.27

Correction, hallux valgus (bunion), with or without sesamoidectomy; with tendon transplants (eg, Joplin type procedure)

28296

1,314.58

761.81

Correction, hallux valgus (bunion), with or without sesamoidectomy; with metatarsal osteotomy (eg, Mitchell, Chevron, or concentric type procedures)

28297

1,314.58

804.37

Correction, hallux valgus (bunion), with or without sesamoidectomy; Lapidus-type procedure

28298

1,314.58

685.15

Correction, hallux valgus (bunion), with or without sesamoidectomy; by phalanx osteotomy

28299

1,314.58

874.59

Correction, hallux valgus (bunion), with or without sesamoidectomy; by double osteotomy

28300

1,978.29

675.30

Osteotomy; calcaneus (eg, Dwyer or Chambers type procedure), with or without internal fixation

28302

930.79

672.50

Osteotomy; talus

28304

1,978.29

758.00

Osteotomy, tarsal bones, other than calcaneus or talus;

28305

1,978.29

689.15

Osteotomy, tarsal bones, other than calcaneus or talus; with autograft (includes obtaining graft) (eg, Fowler type)

28306

930.79

578.16

Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; first metatarsal

28307

930.79

712.34

Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; first metatarsal with autograft (other than first toe)

28308

930.79

518.36

Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; other than first metatarsal, each

28309

1,978.29

898.03

Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; multiple (eg, Swanson type cavus foot procedure)

28310

930.79

514.17

Osteotomy, shortening, angular or rotational correction; proximal phalanx, first toe (separate procedure)

28312

930.79

470.98

Osteotomy, shortening, angular or rotational correction; other phalanges, any toe

28313

930.79

483.70

Reconstruction, angular deformity of toe, soft tissue procedures only (eg, overlapping second toe, fifth toe, curly toes)

28315

930.79

453.03

Sesamoidectomy, first toe (separate procedure)

28320

1,978.29

644.06

Repair, nonunion or malunion; tarsal bones

28322

1,978.29

760.64

Repair, nonunion or malunion; metatarsal, with or without bone graft (includes obtaining graft)

28340

930.79

600.17

Reconstruction, toe, macrodactyly; soft tissue resection

28341

930.79

681.54

Reconstruction, toe, macrodactyly; requiring bone

resection

28344

930.79

442.29

Reconstruction, toe(s); polydactyly

28345

930.79

546.21

Reconstruction, toe(s); syndactyly, with or without skin graft(s), each web

28360

957.08

Reconstruction, cleft foot

28400

79.02

247.39

Closed treatment of calcaneal fracture; without manipulation

28405

79.02

393.07

Closed treatment of calcaneal fracture; with manipulation

28406

1,169.01

537.61

Percutaneous skeletal fixation of calcaneal fracture, with manipulation

28415

2,646.58

1,166.71

Open treatment of calcaneal fracture, includes internal fixation, when performed;

28420

1,837.10

1,208.49

Open treatment of calcaneal fracture, includes internal fixation, when performed; with primary iliac or other autogenous bone graft (includes obtaining graft)

28430

79.02

232.41

Closed treatment of talus fracture; without manipulation

28435

79.02

315.17

Closed treatment of talus fracture; with manipulation

28436

1,169.01

432.81

Percutaneous skeletal fixation of talus fracture, with manipulation

28445

1,837.10

1,080.13

Open treatment of talus fracture, includes internal fixation, when performed

28446

1,978.29

1,147.79

Open osteochondral autograft, talus (includes obtaining graft[s])

28450

79.02

213.98

Treatment of tarsal bone fracture (except talus and calcaneus); without manipulation, each

28455

79.02

285.52

Treatment of tarsal bone fracture (except talus and calcaneus); with manipulation, each

28456

1,169.01

288.43

Percutaneous skeletal fixation of tarsal bone fracture (except talus and calcaneus), with manipulation, each

28465

1,837.10

612.88

Open treatment of tarsal bone fracture (except talus and calcaneus), includes internal fixation, when performed, each

28470

79.02

213.18

Closed treatment of metatarsal fracture; without manipulation, each

28475

79.02

263.26

Closed treatment of metatarsal fracture; with manipulation, each

28476

1,169.01

348.35

Percutaneous skeletal fixation of metatarsal fracture, with manipulation, each

28485

1,837.10

527.06

Open treatment of metatarsal fracture, includes internal fixation, when performed, each

28490

75.39

136.79

Closed treatment of fracture great toe, phalanx or phalanges; without manipulation

28495

79.02

168.09

Closed treatment of fracture great toe, phalanx or phalanges; with manipulation

28496

1,169.01

452.79

Percutaneous skeletal fixation of fracture great toe, phalanx or phalanges, with manipulation

28505

1,169.01

646.46

Open treatment of fracture, great toe, phalanx or phalanges, includes internal fixation, when performed

28510

58.84

116.54

Closed treatment of fracture, phalanx or phalanges, other than great toe; without manipulation, each

28515

75.75

151.43

Closed treatment of fracture, phalanx or phalanges, other than great toe; with manipulation, each

28525

1,169.01

561.05

Open treatment of fracture, phalanx or phalanges, other than great toe, includes internal fixation, when performed, each

28530

56.26

111.49

Closed treatment of sesamoid fracture

28531

1,169.01

413.94

Open treatment of sesamoid fracture, with or without internal fixation

28540

79.02

198.25

Closed treatment of tarsal bone dislocation, other than talotarsal; without anesthesia

28545

1,169.01

229.81

Closed treatment of tarsal bone dislocation, other than talotarsal; requiring anesthesia

28546

1,169.01

472.33

Percutaneous skeletal fixation of tarsal bone dislocation, other than talotarsal, with manipulation

28555

1,837.10

832.04

Open treatment of tarsal bone dislocation, includes internal fixation, when performed

28570

79.02

178.17

Closed treatment of talotarsal joint dislocation; without anesthesia

28575

79.02

319.52

Closed treatment of talotarsal joint dislocation; requiring anesthesia

28576

1,169.01

363.28

Percutaneous skeletal fixation of talotarsal joint dislocation, with manipulation

28585

1,169.01

845.28

Open treatment of talotarsal joint dislocation, includes internal fixation, when performed

28600

79.02

208.73

Closed treatment of tarsometatarsal joint dislocation; without anesthesia

28605

79.02

268.47

Closed treatment of tarsometatarsal joint dislocation; requiring anesthesia

28606

1,169.01

396.79

Percutaneous skeletal fixation of tarsometatarsal joint dislocation, with manipulation

28615

1,837.10

768.47

Open treatment of tarsometatarsal joint dislocation, includes internal fixation, when performed

28630

62.52

143.43

Closed treatment of metatarsophalangeal joint dislocation; without anesthesia

28635

659.86

172.65

Closed treatment of metatarsophalangeal joint dislocation; requiring anesthesia

28636

1,169.01

297.56

Percutaneous skeletal fixation of metatarsophalangeal joint dislocation, with manipulation

28645

1,169.01

571.73

Open treatment of metatarsophalangeal joint dislocation, includes internal fixation, when performed

28660

28665

47.07

659.86

105.49

149.06

Closed treatment of interphalangeal joint dislocation; without anesthesia Closed treatment of interphalangeal joint dislocation;

28666

1,169.01

205.43

requiring anesthesia Percutaneous skeletal fixation of interphalangeal joint dislocation, with manipulation

28675

1,169.01

553.87

Open treatment of interphalangeal joint dislocation, includes internal fixation, when performed

28705

1,978.29

1,311.21

Arthrodesis; pantalar

28715

3,549.34

976.48

Arthrodesis; triple

28725

1,978.29

811.34

Arthrodesis; subtalar

28730

1,978.29

841.89

Arthrodesis, midtarsal or tarsometatarsal, multiple or transverse;

28735

1,978.29

802.01

Arthrodesis, midtarsal or tarsometatarsal, multiple or transverse; with osteotomy (eg, flatfoot correction)

28737

1,978.29

710.25

Arthrodesis, with tendon lengthening and advancement, midtarsal, tarsal navicular-cuneiform (eg, Miller type procedure)

28740

1,978.29

847.26

Arthrodesis, midtarsal or tarsometatarsal, single joint

28750

1,978.29

841.61

Arthrodesis, great toe; metatarsophalangeal joint

28755

930.79

490.50

Arthrodesis, great toe; interphalangeal joint

28760

1,978.29

747.28

Arthrodesis, with extensor hallucis longus transfer to first metatarsal neck, great toe, interphalangeal joint (eg, Jones type procedure)

28800

578.36

Amputation, foot; midtarsal (eg, Chopart type procedure)

28805

729.45

Amputation, foot; transmetatarsal

28810

930.79

444.93

Amputation, metatarsal, with toe, single

28820

930.79

535.06

Amputation, toe; metatarsophalangeal joint

28825

930.79

466.62

Amputation, toe; interphalangeal joint

28890

189.01

363.60

Extracorporeal shock wave, high energy, performed by a physician, requiring anesthesia other than local, including ultrasound guidance, involving the plantar fascia

28899

I.C.

Unlisted procedure, foot or toes

29000

48.85

249.75

Application of halo type body cast (see 20661-20663 for insertion)

29010

102.38

260.11

Application of Risser jacket, localizer, body; only

29015

102.38

242.11

Application of Risser jacket, localizer, body; including head

29020

48.85

241.53

Application of turnbuckle jacket, body; only

29025

48.85

260.37

Application of turnbuckle jacket, body; including head

29035

102.38

237.29

Application of body cast, shoulder to hips;

29040

48.85

218.69

Application of body cast, shoulder to hips; including head, Minerva type

29044

102.38

256.40

Application of body cast, shoulder to hips; including one thigh

29046

102.38

272.54

Application of body cast, shoulder to hips; including both thighs

29049

44.49

89.98

Application, cast; figure-of-eight

29055

102.38

203.25

Application, cast; shoulder spica

29058

48.85

114.72

Application, cast; plaster Velpeau

29065

47.81

94.04

Application, cast; shoulder to hand (long arm)

29075

45.59

87.72

Application, cast; elbow to finger (short arm)

29085

46.71

92.36

Application, cast; hand and lower forearm (gauntlet)

29086

37.51

70.22

Application, cast; finger (eg, contracture)

29105

42.66

86.69

Application of long arm splint (shoulder to hand)

29125

36.41

67.81

Application of short arm splint (forearm to hand); static

29126

40.82

79.48

Application of short arm splint (forearm to hand); dynamic

29130

16.55

39.58

Application of finger splint; static

29131

24.28

50.06

Application of finger splint; dynamic

29200

24.28

53.77

Strapping; thorax

29220

25.01

54.81

Strapping; low back

29240

27.95

61.02

Strapping; shoulder (eg, Velpeau)

29260

25.74

52.96

Strapping; elbow or wrist

29280

26.84

51.91

Strapping; hand or finger

29305

102.38

232.15

Application of hip spica cast; one leg

29325

102.38

249.08

Application of hip spica cast; one and one-half spica or both legs

29345

62.89

134.16

Application of long leg cast (thigh to toes);

29355

61.04

136.44

Application of long leg cast (thigh to toes); walker or ambulatory type

29358

74.65

150.22

Application of long leg cast brace

29365

59.57

120.85

Application of cylinder cast (thigh to ankle)

29405

44.13

89.25

Application of short leg cast (below knee to toes);

29425

44.86

95.60

Application of short leg cast (below knee to toes); walking or ambulatory type

29435

56.64

117.17

Application of patellar tendon bearing (PTB) cast

29440

24.64

52.70

Adding walker to previously applied cast

29445

61.77

146.20

Application of rigid total contact leg cast

29450

48.85

149.53

Application of clubfoot cast with molding or manipulation, long or short leg

29505

41.19

77.97

Application of long leg splint (thigh to ankle or toes)

29515

33.46

69.51

Application of short leg splint (calf to foot)

29520

27.58

53.86

Strapping; hip

29530

26.48

54.10

Strapping; knee

29540

17.65

41.30

Strapping; ankle and/or foot

29550

18.02

40.40

Strapping; toes

29580

25.01

52.18

Strapping; Unna boot

29590

20.23

53.96

Denis-Browne splint strapping

29700

33.83

64.21

Removal or bivalving; gauntlet, boot or body cast

29705

29.05

66.21

Removal or bivalving; full arm or full leg cast

29710

52.22

117.57

Removal or bivalving; shoulder or hip spica, Minerva, or Risser jacket, etc.

29715

43.39

89.57

Removal or bivalving; turnbuckle jacket

29720

42.66

80.21

Repair of spica, body cast or jacket

29730

28.31

64.65

Windowing of cast

29740

40.08

93.81

Wedging of cast (except clubfoot casts)

29750

29799

38.98

98.10 I.C.

Wedging of clubfoot cast Unlisted procedure, casting or strapping

29800

1,286.14

526.42

Arthroscopy, temporomandibular joint, diagnostic, with or without synovial biopsy (separate procedure)

29804

1,286.14

645.30

Arthroscopy, temporomandibular joint, surgical

29805

1,286.14

472.27

Arthroscopy, shoulder, diagnostic, with or without synovial biopsy (separate procedure)

29806

2,042.57

I

2,070.03

Arthroscopy, shoulder, surgical; capsulorrhaphy

29807

2,042.57

I

2,267.25

Arthroscopy, shoulder, surgical; repair of SLAP lesion

29819

2,042.57

587.62

Arthroscopy, shoulder, surgical; with removal of loose body or foreign body

29820

2,042.57

542.03

Arthroscopy, shoulder, surgical; synovectomy, partial

29821

2,042.57

592.25

Arthroscopy, shoulder, surgical; synovectomy, complete

29822

1,286.14

576.71

Arthroscopy, shoulder, surgical; debridement, limited

29823

2,042.57

I

1,997.99

Arthroscopy, shoulder, surgical; debridement, extensive

29824

1,286.14

667.28

Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure)

29825

2,042.57

587.16

Arthroscopy, shoulder, surgical; with lysis and resection of adhesions, with or without manipulation

29826

2,042.57

I

2,131.39

Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with or without coracoacromial release

29827

2,042.57

I

3,673.44

Arthroscopy, shoulder, surgical; with rotator cuff repair

29828

2,042.57

885.42

Arthroscopy, shoulder, surgical; biceps tenodesis

29830

1,286.14

454.16

Arthroscopy, elbow, diagnostic, with or without synovial biopsy (separate procedure)

29834

1,286.14

494.75

Arthroscopy, elbow, surgical; with removal of loose body or foreign body

29835

1,286.14

506.76

Arthroscopy, elbow, surgical; synovectomy, partial

29836

1,286.14

580.39

Arthroscopy, elbow, surgical; synovectomy, complete

29837

1,286.14

529.70

Arthroscopy, elbow, surgical; debridement, limited

29838

1,286.14

593.32

Arthroscopy, elbow, surgical; debridement, extensive

29840

1,286.14

445.26

Arthroscopy, wrist, diagnostic, with or without synovial biopsy (separate procedure)

29843

1,286.14

474.75

Arthroscopy, wrist, surgical; for infection, lavage and drainage

29844

1,286.14

496.62

Arthroscopy, wrist, surgical; synovectomy, partial

29845

1,286.14

566.49

Arthroscopy, wrist, surgical; synovectomy, complete

29846

1,286.14

521.54

Arthroscopy, wrist, surgical; excision and/or repair of triangular fibrocartilage and/or joint debridement

29847

2,042.57

540.01

Arthroscopy, wrist, surgical; internal fixation for fracture or instability

29848

1,286.14

489.22

Endoscopy, wrist, surgical, with release of transverse carpal ligament

29850

1,286.14

541.38

Arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, with or without manipulation; without internal or external fixation (includes arthroscopy)

29851

2,042.57

931.75

Arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, with or without manipulation; with internal or external fixation (includes arthroscopy)

29855

2,042.57

786.98

Arthroscopically aided treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation, when performed (includes arthroscopy)

29856

2,042.57

1,000.05

Arthroscopically aided treatment of tibial fracture, proximal (plateau); bicondylar, includes internal fixation, when performed (includes arthroscopy)

29860

2,042.57

646.72

Arthroscopy, hip, diagnostic with or without synovial biopsy (separate procedure)

29861

2,042.57

7 03.60

Arthroscopy, hip, surgical; with removal of loose body or foreign body

29862

2,042.57

794.56

Arthroscopy, hip, surgical; with debridement/shaving of articular cartilage (chondroplasty), abrasion arthroplasty, and/or resection of labrum

29863

2,042.57

785.34

Arthroscopy, hip, surgical; with synovectomy

29866

2,042.57

1,045.48

Arthroscopy, knee, surgical; osteochondral autograft(s) (eg, mosaicplasty) (includes harvesting of the autograft[s])

29867

1,262.67

Arthroscopy, knee, surgical; osteochondral allograft (eg, mosaicplasty)

29868

1,684.74

Arthroscopy, knee, surgical; meniscal transplantation (includes arthrotomy for meniscal insertion), medial or lateral

29870

1,286.14

408.46

Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure)

29871

1,286.14

511.29

Arthroscopy, knee, surgical; for infection, lavage and drainage

29873

1,286.14

519.42

Arthroscopy, knee, surgical; with lateral release

29874

1,286.14

532.52

Arthroscopy, knee, surgical; for removal of loose body or foreign body (eg, osteochondritis dissecans fragmentation, chondral fragmentation)

29875

1,286.14

496.99

Arthroscopy, knee, surgical; synovectomy, limited (eg, plica or shelf resection) (separate procedure)

29876

1,286.14

643.04

Arthroscopy, knee, surgical; synovectomy, major, two or more compartments (eg, medial or lateral)

29877

1,286.14

I

1,859.32

Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty)

29879

1,286.14

650.96

Arthroscopy, knee, surgical; abrasion arthroplasty (includes chondroplasty where necessary) or multiple drilling or microfracture

29880

1,286.14

I

1,736.57

Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving)

29881

1,286.14

I

1,826.52

Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving)

29882

1,286.14

682.91

Arthroscopy, knee, surgical; with meniscus repair (medial OR lateral)

29883

1,286.14

837.67

Arthroscopy, knee, surgical; with meniscus repair (medial AND lateral)

29884

1,286.14

607.01

Arthroscopy, knee, surgical; with lysis of adhesions, with or without manipulation (separate procedure)

29885

2,042.57

735.03

Arthroscopy, knee, surgical; drilling for osteochondritis dissecans with bone grafting, with or without internal fixation (including debridement of base of lesion)

29886

1,286.14

620.60

Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesion

29887

1,286.14

730.72

Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesion with internal fixation

29888

2,042.57

I

2,900.23

Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction

29889

2,042.57

1,199.89

Arthroscopically aided posterior cruciate ligament repair/augmentation or reconstruction

29891

2,042.57

690.88

Arthroscopy, ankle, surgical, excision of osteochondral defect of talus and/or tibia, including drilling of the defect

29892

2,042.57

711.50

Arthroscopically aided repair of large osteochondritis dissecans lesion, talar dome fracture, or tibial plafond fracture, with or without internal fixation (includes arthroscopy)

29893

930.79

574.45

Endoscopic plantar fasciotomy

29894

1,286.14

517.09

Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; with removal of loose body or foreign body

29895

1,286.14

503.78

Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; synovectomy, partial

29897

1,286.14

528.18

Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; debridement, limited

29898

1,286.14

587.77

Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; debridement, extensive

29899

2,042.57

1,046.31

Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; with ankle arthrodesis

29900

1,286.14

466.73

Arthroscopy, metacarpophalangeal joint, diagnostic, includes synovial biopsy

29901

1,286.14

513.44

Arthroscopy, metacarpophalangeal joint, surgical; with debridement

29902

1,286.14

532.39

Arthroscopy, metacarpophalangeal joint, surgical; with reduction of displaced ulnar collateral ligament (eg, Stenar lesion)

29904

1,286.14

598.79

Arthroscopy, subtalar joint, surgical; with removal of loose body or foreign body

29905

1,286.14

646.96

Arthroscopy, subtalar joint, surgical; with synovectomy

29906

1,286.14

681.67

Arthroscopy, subtalar joint, surgical; with debridement

29907

2,042.57

828.91

Arthroscopy, subtalar joint, surgical; with subtalar arthrodesis

29999

I.C.

Unlisted procedure, arthroscopy

30000

111.73

239.06

Drainage abscess or hematoma, nasal, internal approach

30020

111.73

224.33

Drainage abscess or hematoma, nasal septum

30100

83.85

139.14

Biopsy, intranasal

30110

131.28

224.85

Excision, nasal polyp(s), simple

30115

729.71

432.48

Excision, nasal polyp(s), extensive

30117

729.71

837.85

Excision or destruction (eg, laser), intranasal lesion; internal approach

30118

1,071.47

767.05

Excision or destruction (eg, laser), intranasal lesion; external approach (lateral rhinotomy)

30120

729.71

509.42

Excision or surgical planing of skin of nose for rhinophyma

30124

332.81

282.71

Excision dermoid cyst, nose; simple, skin, subcutaneous

30125

1,782.06

627.30

Excision dermoid cyst, nose; complex, under bone or cartilage

30130

729.71

384.40

Excision inferior turbinate, partial or complete, any method

30140

1,071.47

435.40

Submucous resection inferior turbinate, partial or complete, any method

30150

1,782.06

811.85

Rhinectomy; partial

30160

1,782.06

803.28

Rhinectomy; total

30200

66.92

112.20

Injection into turbinate(s), therapeutic

30210

84.58

146.58

Displacement therapy (Proetz type)

30220

332.81

288.38

Insertion, nasal septal prosthesis (button)

30300

28.19

243.88

Removal foreign body, intranasal; office type procedure

30310

729.71

210.94

Removal foreign body, intranasal; requiring general anesthesia

30320

729.71

475.77

Removal foreign body, intranasal; by lateral rhinotomy

30400

1,782.06

1,069.48

Rhinoplasty, primary; lateral and alar cartilages and/or elevation of nasal tip

30410

1,782.06

1,287.04

Rhinoplasty, primary; complete, external parts including bony pyramid, lateral and alar cartilages, and/or elevation of nasal tip

30420

1,782.06

1,388.18

Rhinoplasty, primary; including major septal repair

30430

1,071.47

968.71

Rhinoplasty, secondary; minor revision (small amount of nasal tip work)

30435

1,782.06

1,262.54

Rhinoplasty, secondary; intermediate revision (bony work with osteotomies)

30450

1,782.06

1,613.69

Rhinoplasty, secondary; major revision (nasal tip work and osteotomies)

30460

1,782.06

781.86

Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar lengthening; tip only

30462

1,782.06

1,566.75

Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar lengthening; tip, septum, osteotomies

30465

1,782.06

979.02

Repair of nasal vestibular stenosis (eg, spreader grafting, lateral nasal wall reconstruction)

30520

1,782.06

586.44

Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft

30540

1,071.47

697.31

Repair choanal atresia; intranasal

30545

1,782.06

973.23

Repair choanal atresia; transpalatine

30560

1,782.06

278.22

Lysis intranasal synechia

30580

111.73

623.87

Repair fistula; oromaxillary (combine with 31030 if antrotomy is included)

30600

1,782.06

578.04

Repair fistula; oronasal

30620

1,782.06

626.52

Septal or other intranasal dermatoplasty (does not include obtaining graft)

30630

1,782.06

624.29

Repair nasal septal perforations

30801

1,071.47

234.84

Cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral, any method; superficial

30802

332.81

295.26

Cauteryand/or ablation, mucosa of inferior turbinates, unilateral or bilateral, any method; intramural

30901

332.81

105.37

Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method

30903

48.17

194.56

Control nasal hemorrhage, anterior, complex (extensive cautery and/or packing) any method

30905

50.28

244.04

Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; initial

30906

50.28

277.90

Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; subsequent

30915

50.28

571.54

Ligation arteries; ethmoidal

30920

1,154.79

813.45

Ligation arteries; internal maxillary artery, transantral

30930

1,154.79

122.33

Fracture nasal inferior turbinate(s), therapeutic

30999

729.71

I.C.

Unlisted procedure, nose

31000

111.43

182.11

Lavage by cannulation; maxillary sinus (antrum puncture or natural ostium)

31002

332.81

207.10

Lavage by cannulation; sphenoid sinus

31020

1,071.47

505.24

Sinusotomy, maxillary (antrotomy); intranasal

31030

1,782.06

725.60

Sinusotomy, maxillary (antrotomy); radical (Caldwell-Luc) without removal of antrochoanal polyps

31032

1,782.06

571.09

Sinusotomy, maxillary (antrotomy); radical (Caldwell-Luc) with removal of antrochoanal polyps

31040

1,071.47

751.74

Pterygomaxillary fossa surgery, any approach

31050

1,782.06

491.95

Sinusotomy, sphenoid, with or without biopsy;

31051

1,782.06

645.54

Sinusotomy, sphenoid, with or without biopsy; with mucosal stripping or removal of polyp(s)

31070

1,071.47

437.82

Sinusotomy frontal; external, simple (trephine operation)

31075

1,782.06

782.07

Sinusotomy frontal; transorbital, unilateral (for mucocele or osteoma, Lynch type)

31080

1,782.06

1,021.04

Sinusotomy frontal; obliterative without osteoplastic flap, brow incision (includes ablation)

31081

1,782.06

1,227.85

Sinusotomy frontal; obliterative, without osteoplastic flap, coronal incision (includes ablation)

31084

1,782.06

1,146.85

Sinusotomy frontal; obliterative, with osteoplastic flap, brow incision

31085

1,782.06

1,232.63

Sinusotomy frontal; obliterative, with osteoplastic flap, coronal incision

31086

1,782.06

1,115.75

Sinusotomyfrontal; nonobliterative, with osteoplastic flap, brow incision

31087

1,782.06

1,091.42

Sinusotomyfrontal; nonobliterative, with osteoplastic flap, coronal incision

31090

1,782.06

997.56

Sinusotomy, unilateral, three or more paranasal sinuses (frontal, maxillary, ethmoid, sphenoid)

31200

1,782.06

563.85

Ethmoidectomy; intranasal, anterior

31201

1,782.06

732.85

Ethmoidectomy; intranasal, total

31205

1,782.06

870.06

Ethmoidectomy; extranasal, total

31225

1,772.93

Maxillectomy; without orbital exenteration

31230

1,991.56

Maxillectomy; with orbital exenteration (en bloc)

31231

72.02

200.89

Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)

31233

72.02

277.43

Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)

31235

760.42

317.95

Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoidal face or cannulation of ostium)

31237

760.42

342.58

Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure)

31238

760.42

350.92

Nasal/sinus endoscopy, surgical; with control of nasal hemorrhage

31239

1,015.27

665.59

Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy

31240

760.42

165.35

Nasal/sinus endoscopy, surgical; with concha bullosa resection

31254

1,015.27

281.92

Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial (anterior)

31255

1,015.27

415.67

Nasal/sinus endoscopy, surgical; with ethmoidectomy, total (anterior and posterior)

31256

1,015.27

205.07

Nasal/sinus endoscopy, surgical, with maxillary antrostomy;

31267

1,015.27

329.14

Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus

31276

1,015.27

523.18

Nasal/sinus endoscopy, surgical with frontal sinus exploration, with or without removal of tissue from frontal sinus

31287

1,015.27

240.47

Nasal/sinus endoscopy, surgical, with sphenoidotomy;

31288

1,015.27

278.45

Nasal/sinus endoscopy, surgical, with sphenoidotomy; with removal of tissue from the sphenoid sinus

31290

1,159.21

Nasal/sinus endoscopy, surgical, with repair of cerebrospinal fluid leak; ethmoid region

31291

1,221.51

Nasal/sinus endoscopy, surgical, with repair of cerebrospinal fluid leak; sphenoid region

31292

1,005.29

Nasal/sinus endoscopy, surgical; with medial or inferior orbital wall decompression

31293

1,093.21

Nasal/sinus endoscopy, surgical; with medial orbital wall and inferior orbital wall decompression

31294

1,254.75

Nasal/sinus endoscopy, surgical; with optic nerve decompression

31299

I.C.

Unlisted procedure, accessory sinuses

31300

1,071.47

1,252.21

Laryngotomy (thyrotomy, laryngofissure); with removal of tumor or laryngocele, cordectomy

31320

1,782.06

676.54

Laryngotomy (thyrotomy, laryngofissure); diagnostic

31360

1,898.35

Laryngectomy; total, without radical neck dissection

31365

2,371.19

Laryngectomy; total, with radical neck dissection

31367

2,108.09

Laryngectomy; subtotal supraglottic, without radical neck dissection

31368

2,375.45

Laryngectomy; subtotal supraglottic, with radical neck dissection

31370

2,004.92

Partial laryngectomy (hemilaryngectomy); horizontal

31375

1,883.83

Partial laryngectomy (hemilaryngectomy); laterovertical

31380

1,865.93

Partial laryngectomy (hemilaryngectomy); anterovertical

31382

2,034.66

Partial laryngectomy (h em ilaryngectomy); antero-latero-vertical

31390

2,666.41

Pharyngolaryngectomy, with radical neck dissection; without reconstruction

31395

2,866.62

Pharyngolaryngectomy, with radical neck dissection; with reconstruction

31400

1,782.06

1,021.65

Arytenoidectomy or arytenoidopexy, external approach

31420

1,782.06

828.85

Epiglottidectomy

31500

109.89

106.74

Intubation, endotracheal, emergency procedure

31502

59.71

35.20

Tracheotomy tube change prior to establishment of fistula tract

31505

36.75

88.61

Laryngoscopy, indirect; diagnostic (separate procedure)

31510

760.42

220.40

Laryngoscopy, indirect; with biopsy

31511

72.02

218.91

Laryngoscopy, indirect; with removal of foreign body

31512

760.42

218.30

Laryngoscopy, indirect; with removal of lesion

31513

72.02

135.25

Laryngoscopy, indirect; with vocal cord injection

31515

760.42

220.77

Laryngoscopy direct, with or without tracheoscopy; for aspiration

31525

760.42

259.49

Laryngoscopy direct, with or without tracheoscopy; diagnostic, except newborn

31526

1,015.27

162.16

Laryngoscopy direct, with or without tracheoscopy; diagnostic, with operating microscope or telescope

31527

1,015.27

194.93

Laryngoscopy direct, with or without tracheoscopy; with insertion of obturator

31528

760.42

145.07

Laryngoscopy direct, with or without tracheoscopy; with dilation, initial

31529

760.42

166.22

Laryngoscopy direct, with or without tracheoscopy; with dilation, subsequent

31530

1,015.27

202.34

Laryngoscopy, direct, operative, with foreign body removal;

31531

1,015.27

219.76

Laryngoscopy, direct, operative, with foreign body removal; with operating microscope or telescope

31535

1,015.27

194.85

Laryngoscopy, direct, operative, with biopsy;

31536

1,015.27

217.81

Laryngoscopy, direct, operative, with biopsy; with operating microscope or telescope

31540

1,015.27

249.52

Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis;

31541

1,015.27

273.12

Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis; with operating microscope or telescope

31545

1,015.27

363.82

Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal removal of non-neoplastic lesion(s) of vocal cord; reconstruction with local tissue flap(s)

31546

1,015.27

548.91

Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal removal of non-neoplastic lesion(s) of vocal cord; reconstruction with graft(s) (includes obtaining autograft)

31560

1,015.27

320.94

La ryngoscopy, dire ct, operative , with arytenoidectomy;

31561

1,015.27

350.38

La ryngoscopy, dire ct, operative , with arytenoidectomy; with operating microscope or telescope

31570

760.42

369.84

Laryngoscopy, direct, with injection into vocal cord(s), therapeutic;

31571

1,015.27

257.66

Laryngoscopy, direct, with injection into vocal cord(s), therapeutic; with operating microscope or telescope

31575

66.19

123.11

Laryngoscopy, flexible fiberoptic; diagnostic

31576

1,015.27

236.70

Laryngoscopy, flexible fiberoptic; with biopsy

31577

178.49

254.95

Laryngoscopy, flexible fiberoptic; with removal of foreign body

31578

1,015.27

294.42

Laryngoscopy, flexible fiberoptic; with removal of lesion

31579

122.09

235.37

Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy

31580

1,782.06

1,208.58

Laryngoplasty; for laryngeal web, two stage, with keel insertion and removal

31582

1,782.06

1,947.03

Laryngoplasty; for laryngeal stenosis, with graft or core mold, including tracheotomy

31584

1,515.96

Laryngoplasty; with open reduction of fracture

31587

957.73

Laryngoplasty, cricoid split

31588

1,782.06

1,132.53

Laryngoplasty, not otherwise specified (eg, for burns, reconstruction after partial laryngectomy)

31590

1,782.06

937.91

Laryngeal reinnervation by neuromuscular pedicle

31595

1,782.06

784.02

Section recurrent laryngeal nerve, therapeutic (separate procedure), unilateral

31599

I.C.

Unlisted procedure, larynx

31600

394.90

Tracheostomy, planned (separate procedure);

31603

332.81

221.28

Tracheostomy, emergency procedure; transtracheal

31605

332.81

179.91

Tracheostomy, emergency procedure; cricothyroid membrane

31610

709.09

Tracheostomy, fenestration procedure with skin flaps

31611

1,071.47

541.33

Construction of tracheoesophageal fistula and subsequent insertion of an alaryngeal speech prosthesis (eg, voice button, Blom-Singer prosthesis)

31612

1,071.47

83.64

Tracheal puncture, percutaneous with transtracheal aspiration and/or injection

31613

1,071.47

450.06

Tracheostoma revision; simple, without flap rotation

31614

1,782.06

727.73

Tracheostoma revision; complex, with flap rotation

31615

444.98

190.77

Tracheobronchoscopy through established tracheostomy incision

31620

319.44

Endobronchial ultrasound (EBUS) during bronchoscopic diagnostic or therapeutic intervention(s) (List separately in addition to code for primary procedure(s))

31622

444.98

351.17

Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; diagnostic, with or without cell washing (separate procedure)

31623

444.98

387.60

Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with brushing or protected brushings

31624

444.98

358.15

Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with bronchial alveolar lavage

31625

444.98

380.18

Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with bronchial or endobronchial biopsy(s), single or multiple sites

31628

444.98

456.88

Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with transbronchial lung biopsy(s), single lobe

31629

444.98

749.25

Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus(i)

31630

1,075.44

208.26

Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with tracheal/bronchial dilation or closed reduction of fracture

31631

1,075.44

232.24

Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with placement of tracheal stent(s) (includes tracheal/bronchial dilation as required)

31632

444.98

78.77

Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with transbronchial lung biopsy(s), each additional lobe (List separately in addition to code for primary procedure)

31633

444.98

93.59

Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with transbronchial needle aspiration biopsy(s), each additional lobe (List separately in addition to code for primary procedure)

31635

444.98

393.02

Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with removal of foreign body

31636

1,075.44

227.45

Bronchoscopy, rigid or flexible, with or without

fluoroscopic guidance; with placement of bronchial stent(s) (includes tracheal/bronchial dilation as required), initial bronchus

31637

444.98

79.94

Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; each additional major bronchus stented (List separately in addition to code for primary procedure)

31638

1,075.44

254.22

Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with revision of tracheal or bronchial stent inserted at previous session (includes tracheal/bronchial dilation as required)

31640

1,075.44

264.96

Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with excision of tumor

31641

1,075.44

259.68

Bronchoscopy (rigid or flexible); with destruction of tumor or relief of stenosis by any method other than excision (eg, laser therapy, cryotherapy)

31643

444.98

177.17

Bronchoscopy (rigid or flexible); with placement of catheter(s) for intracavitary radioelement application

31645

444.98

339.61

Bronchoscopy (rigid or flexible); with therapeutic aspiration of tracheobronchial tree, initial (eg, drainage of lung abscess)

31646

444.98

310.64

Bronchoscopy (rigid or flexible); with therapeutic aspiration of tracheobronchial tree, subsequent

31656

31715

444.98

377.31

53.81

Bronchoscopy (rigid or flexible); with injection of contrast material for segmental bronchography (fiberscope only)

Transtracheal injection for bronchography

31717

178.49

401.08

Catheterization with bronchial brush biopsy

31720

17.32

52.10

Catheter aspiration (separate procedure); nasotracheal

31725

93.67

Catheter aspiration (separate procedure); tracheobronchial with fiberscope, bedside

31730

178.49

746.62

Transtracheal (percutaneous) introduction of needle wire dilator/stent or indwelling tube for oxygen therapy

31750

1,782.06

1,356.06

Tracheoplasty; cervical

31755

1,782.06

1,742.69

Tracheoplasty; tracheopharyngeal fistulization, each stage

31760

1,357.80

Tracheoplasty; intrathoracic

31766

1,797.66

Carinal reconstruction

31770

1,319.01

Bronchoplasty; graft repair

31775

1,418.03

Bronchoplasty; excision stenosis and anastomosis

31780

1,179.14

Excision tracheal stenosis and anastomosis; cervical

31781

1,414.87

Excision tracheal stenosis and anastomosis; cervicothoracic

31785

1,083.17

Excision of tracheal tumor or carcinoma; cervical

31786

1,486.98

Excision of tracheal tumor or carcinoma; thoracic

31800

713.11

Suture of tracheal wound or injury; cervical

31805

819.63

Suture of tracheal wound or injury; intrathoracic

31820

729.71

432.89

Surgical closure tracheostomy or fistula; without plastic repair

31825

1,071.47

602.18

Surgical closure tracheostomy or fistula; with plastic repair

31830

1,071.47

437.46

Revision of tracheostomy scar

31899

I.C.

Unlisted procedure, trachea, bronchi

32035

694.96

Thoracostomy; with rib resection for empyema

32036

752.95

Thoracostomy; with open flap drainage for empyema

32095

621.24

Thoracotomy, limited, for biopsy of lung or pleura

32100

957.69

Thoracotomy, major; with exploration and biopsy

32110

1,429.77

Thoracotomy, major; with control of traumatic hemorrhage and/or repair of lung tear

32120

855.06

Thoracotomy, major; for postoperative complications

32124

906.71

Thoracotomy, major; with open intrapleural pneumonolysis

32140

970.83

Thoracotomy, major; with cyst(s) removal, with or without a pleural procedure

32141

1,393.80

Thoracotomy, major; with excision-plication of bullae, with or without any pleural procedure

32150

978.41

Thoracotomy, major; with removal of intrapleural foreign body or fibrin deposit

32151

1,001.82

Thoracotomy, major; with removal of intrapulmonary foreign body

32160

739.73

Thoracotomy, major; with cardiac massage

32200

1,095.09

Pneumonostomy; with open drainage of abscess or cyst

32201

1,077.34

Pneumonostomy; with percutaneous drainage of abscess or cyst

32215

794.53

Pleural scarification for repeat pneumothorax

32220

1,581.32

Decortication, pulmonary (separate procedure); total

32225

977.82

Decortication, pulmonary (separate procedure); partial

32310

907.12

Pleurectomy, parietal (separate procedure)

32320

1,572.33

Decortication and parietal pleurectomy

32400

417.18

161.59

Biopsy, pleura; percutaneous needle

32402

561.14

Biopsy, pleura; open

32405

417.18

100.49

Biopsy, lung or mediastinum, percutaneous needle

32420

232.48

110.25

Pneumocentesis, puncture of lung for aspiration

32421

232.48

180.64

Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent

32422

232.48

218.76

Thoracentesis with insertion of tube, includes water seal (eg, for pneumothorax), when performed (separate procedure)

32440

1,586.47

Removal of lung, total pneumonectomy;

32442

2,811.02

Removal of lung, total pneumonectomy; with resection of segment of trachea followed by broncho-tracheal anastomosis (sleeve pneumonectomy)

32445

3,131.31

Removal of lung, total pneumonectomy; extrapleural

32480

1,495.02

Removal of lung, other than total pneumonectomy; single lobe (lobectomy)

32482

1,594.23

Removal of lung, other than total pneumonectomy; two lobes (bilobectomy)

32484

1,437.32

Removal of lung, other than total pneumonectomy; single segment (segmentectomy)

32486

2,208.47

Removal of lung, other than total pneumonectomy; with circumferential resection of segment of bronchus followed by broncho-bronchial anastomosis (sleeve lobectomy)

32488

2,252.25

Removal of lung, other than total pneumonectomy; all remaining lung following previous removal of a portion of lung (completion pneumonectomy)

32491

1,476.98

Removal of lung, other than total pneumonectomy; excision-plication of emphysematous lung(s) (bullous or non-bullous) for lung volume reduction, sternal split or transthoracic approach, with or without any pleural procedure

32500

1,454.58

Removal of lung, other than total pneumonectomy; wedge resection, single or multiple

32501

245.55

Resection and repair of portion of bronchus (bronchoplasty) when performed at time of lobectomy or segmentectomy (List separately in addition to code for primary procedure)

32503

1,835.61

Resection of apical lung tumor (eg, Pancoast tumor), including chest wall resection, rib(s) resection(s), neurovascular dissection, when performed; without chest wall reconstruction(s)

32504

2,089.83

Resection of apical lung tumor (eg, Pancoast tumor), including chest wall resection, rib(s) resection(s), neurovascular dissection, when performed; with chest wall reconstruction

32540

1,580.21

Extrapleura l enucleation of em pye ma (empyemectomy)

32550

1,372.36

959.08

Insertion of indwelling tunneled pleural catheter with cuff

32551

178.61

Tube thoracostomy, includes water seal (eg, for abscess, hemothorax, empyema), when performed (separate procedure)

32560

346.79

Chemical pleurodesis (eg, for recurrent or persistent pneumothorax)

32601

311.78

Thoracoscopy, diagnostic (separate procedure); lungs and pleural space, without biopsy

32602

338.32

Thoracoscopy, diagnostic (separate procedure); lungs and pleural space, with biopsy

32603

433.51

Thoracoscopy, diagnostic (separate procedure); pericardial sac, without biopsy

32604

486.49

Thoracoscopy, diagnostic (separate procedure); pericardial sac, with biopsy

32605

392.36

Thoracoscopy, diagnostic (separate procedure); mediastinal space, without biopsy

32606

468.02

Thoracoscopy, diagnostic (separate procedure); mediastinal space, with biopsy

32650

691.25

Thoracoscopy, surgical; with pleurodesis (eg, mechanical or chemical)

32651

1,038.36

Thoracoscopy, surgical; with partial pulmonary decortication

32652

1,561.72

Thoracoscopy, surgical; with total pulmonary decortication, including intrapleural pneumonolysis

32653

1,006.62

Thoracoscopy, surgical; with removal of intrapleural foreign body or fibrin deposit

32654

1,103.46

Thoracoscopy, surgical; with control of traumatic hemorrhage

32655

931.27

Thoracoscopy, surgical; with excision-plication of bullae, including any pleural procedure

32656

826.85

Thoracoscopy, surgical; with parietal pleurectomy

32657

813.06

Thoracoscopy, surgical; with wedge resection of lung, single or multiple

32658

744.68

Thoracoscopy, surgical; with removal of clot or foreign body from pericardial sac

32659

758.66

Thoracoscopy, surgical; with creation of pericardial window or partial resection of pericardial sac for drainage

32660

1,059.72

Thoracoscopy, surgical; with total pericardiectomy

32661

829.44

Thoracoscopy, surgical; with excision of pericardial cyst, tumor, or mass

32662

930.68

Thoracoscopy, surgical; with excision of mediastinal cyst, tumor, or mass

32663

1,384.35

Thoracoscopy, surgical; with lobectomy, total or segmental

32664

860.06

Thoracoscopy, surgical; with thoracic sympathectomy

32665

1,181.45

Thoracoscopy, surgical; with esophagomyotomy (Heller type)

32800

921.96

Repair lung hernia through chest wall

32810

898.20

Closure of chest wall following open flap drainage for empyema (Clagett type procedure)

32815

2,479.06

Open closure of major bronchial fistula

32820

1,361.59

Major reconstruction, chest wall (posttraumatic)

32850

I.C.

Donor pneumonectomy(s) (including cold preservation), from cadaver donor

32851

2,666.99

Lung transplant, single; without cardiopulmonary bypass

32852

2,988.20

Lung transplant, single; with cardiopulmonary bypass

32853

3,178.94

Lung transplant, double (bilateral sequential or en bloc); without cardiopulmonary bypass

32854

3,449.32

Lung transplant, double (bilateral sequential or en bloc); with cardiopulmonary bypass

32855

I.C.

Backbench standard preparation of cadaver donor lung allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare pulmonary venous/atrial cuff, pulmonary artery, and bronchus; unilateral

32856

I.C.

Backbench standard preparation of cadaver donor lung allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare pulmonary venous/atrial cuff, pulmonary artery, and bronchus; bilateral

32900

1,344.83

Resection of ribs, extrapleural, all stages

32905

1,338.73

Thoracoplasty, Schede type or extrapleural (all stages);

32906

1,647.22

Thoracoplasty, Schede type or extrapleural (all stages); with closure of bronchopleural fistula

32940

1,224.94

Pneumonolysis, extraperiosteal, including filling or packing procedures

32960

232.48

144.95

Pneumothorax, therapeutic, intrapleural injection of air

32997

352.61

Total lung lavage (unilateral)

32998

1,921.50

3,438.66

Ablation therapy for reduction or eradication of one or more pulmonary tumor(s) including pleura or chest wall when involved by tumor extension, percutaneous, radiofrequency, unilateral

32999

I.C.

Unlisted procedure, lungs and pleura

33010

232.48

122.56

Pericardiocentesis; initial

33011

232.48

125.62

Pericardiocentesis; subsequent

33015

540.09

Tube pericardiostomy

33020

864.53

Pericardiotomy for removal of clot or foreign body (primary procedure)

33025

801.08

Creation of pericardial window or partial resection for drainage

33030

1,274.94

Pericardiectomy, subtotal or complete; without cardiopulmonary bypass

33031

1,409.48

Pericardiectomy, subtotal or complete; with cardiopulmonary bypass

33050

990.03

Excision of pericardial cyst or tumor

33120

1,554.03

Excision of intracardiac tumor, resection with cardiopulmonary bypass

33130

1,360.14

Resection of external cardiac tumor

33140

1,538.51

Transmyocardial laser revascularization, by thoracotomy; (separate procedure)

33141

161.72

Transmyocardial laser revascularization, by thoracotomy; performed at the time of other open cardiac procedure(s) (List separately in addition to code for primary procedure)

33202

780.09

Insertion of epicardial electrode(s); open incision (eg, thoracotomy, median sternotomy, subxiphoid approach)

33203

799.09

Insertion of epicardial electrode(s); endoscopic approach (eg, thoracoscopy, pericardioscopy)

33206

7,572.99

485.65

Insertion or replacement of permanent pacemaker with transvenous electrode(s); atrial

33207

7,572.99

518.21

Insertion or replacement of permanent pacemaker with transvenous electrode(s); ventricular

33208

8,772.15

554.32

Insertion or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular

33210

4,047.81

185.27

Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter (separate procedure)

33211

4,047.81

188.78

Insertion or replacement of temporary transvenous dual chamber pacing electrodes (separate procedure)

33212

6,350.39

363.50

Insertion or replacement of pacemaker pulse generator only; single chamber, atrial or ventricular

33213

6,912.08

413.37

Insertion or replacement of pacemaker pulse generator only; dual chamber

33214

8,772.15

519.14

Upgrade of implanted pacemaker system, conversion of single chamber system to dual chamber system (includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator)

33215

1,071.63

331.32

Repositioning of previously implanted transvenous pacemaker or pacing cardioverter-defibrillator (right atrial or right ventricular) electrode

33216

4,047.81

410.31

Insertion of a transvenous electrode; single chamber (one electrode) permanent pacemaker or single chamber pacing cardioverter-defibrillator

33217

4,047.81

408.34

Insertion of a transvenous electrode; dual chamber (two electrodes) permanent pacemaker or dual chamber pacing cardioverter-defibrillator

33218

1,071.63

424.81

Repair of single transvenous electrode for a single chamber, permanent pacemaker or single chamber pacing cardioverter-defibrillator

33220

1,071.63

426.16

Repair of two transvenous electrodes for a dual chamber permanent pacemaker or dual chamber pacing cardioverter-defibrillator

33222

672.37

381.57

Revision or relocation of skin pocket for pacemaker

33223

672.37

453.25

Revision of skin pocket for single or dual chamber pacing cardioverter-defibrillator

33224

16,765.50

529.67

Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or pacing cardioverter-defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of generator)

33225

16,765.50

472.81

Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter-defibrillator or pacemaker pulse generator (including upgrade to dual chamber system) (List separately in addition to code for primary procedure)

33226

1,071.63

511.05

Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion and/or replacement of generator)

33233

1,071.63

270.80

Removal of permanent pacemaker pulse generator

33234

1,071.63

524.16

Removal of transvenous pacemaker electrode(s); single lead system, atrial or ventricular

33235

1,071.63

684.50

Removal of transvenous pacemaker electrode(s); dual lead system

33236

800.28

Removal of permanent epicardial pacemaker and electrodes by thoracotomy; single lead system, atrial or ventricular

33237

880.75

Removal of permanent epicardial pacemaker and electrodes by thoracotomy; dual lead system

33238

956.76

Removal of permanent transvenous electrode(s) by thoracotomy

33240

22,075.11

498.58

Insertion of single or dual chamber pacing cardioverter-defibrillator pulse generator

33241

1,071.63

253.87

Subcutaneous removal of single or dual chamber pacing cardioverter-defibrillator pulse generator

33243

1,378.09

Removal of single or dual chamber pacing cardioverter-defibrillator electrode(s); by thoracotomy

33244

924.29

Removal of single or dual chamber pacing cardioverter-defibrillator electrode(s); by transvenous extraction

33249

26,786.01

962.13

Insertion or repositioning of electrode lead(s) for single or dual chamber pacing cardioverter-defibrillator and insertion of pulse generator

33250

1,480.30

Operative ablation of supraventricular arrhythmogenic focus or pathway (eg, Wolff-Parkinson-White, atrioventricular node re-entry), tract(s) and/or focus (foci); without cardiopulmonary bypass

33251

1,612.27

Operative ablation of supraventricular arrhythmogenic focus or pathway (eg, Wolff-Parkinson-White, atrioventricular node re-entry), tract(s) and/or focus (foci); with cardiopulmonary bypass

33254

1,355.20

Operative tissue ablation and reconstruction of atria, limited (eg, modified maze procedure)

33255

1,628.52

Operative tissue ablation and reconstruction of atria, extensive (eg, maze procedure); without cardiopulmonary bypass

33256

1,939.42

Operative tissue ablation and reconstruction of atria, extensive (eg, maze procedure); with cardiopulmonary bypass

33257

607.25

Operative tissue ablation and reconstruction of atria, performed at the time of other cardiac procedure(s), limited (eg, modified maze procedure) (List separately in addition to code for primary procedure)

33258

683.96

Operative tissue ablation and reconstruction of atria, performed at the time of other cardiac procedure(s), extensive (eg, maze procedure), without cardiopulmonary bypass (List separately in addition to code for primary procedure)

33259

895.16

Operative tissue ablation and reconstruction of atria, performed at the time of other cardiac procedure(s), extensive (eg, maze procedure), with cardiopulmonary bypass (List separately in addition to code for primary procedure)

33261

1,626.94

Operative ablation of ventricular arrhythmogenic focus with cardiopulmonary bypass

33265

1,355.20

Endoscopy, surgical; operative tissue ablation and reconstruction of atria, limited (eg, modified maze procedure), without cardiopulmonary bypass

33266

1,846.10

Endoscopy, surgical; operative tissue ablation and reconstruction of atria, extensive (eg, maze procedure), without cardiopulmonary bypass

33282

4,398.16

357.46

Implantation of patient-activated cardiac event recorder

33284

388.12

266.79

Removal of an implantable, patient-activated cardiac event recorder

33300

2,171.66

Repair of cardiac wound; without bypass

33305

3,540.70

Repair of cardiac wound; with cardiopulmonary bypass

33310

1,180.88

Cardiotomy, exploratory (includes removal of foreign body, atrial or ventricular thrombus); without bypass

33315

1,476.56

Cardiotomy, exploratory (includes removal of foreign body, atrial or ventricular thrombus); with cardiopulmonary bypass

33320

1,065.92

Suture repair of aorta or great vessels; without shunt or cardiopulmonary bypass

33321

1,212.27

Suture repair of aorta or great vessels; with shunt bypass

33322

1,373.85

Suture repair of aorta or great vessels; with cardiopulmonary bypass

33330

1,399.13

Insertion of graft, aorta or great vessels; without shunt, or cardiopulmonary bypass

33332

1,385.78

Insertion of graft, aorta or great vessels; with shunt bypass

33335

1,876.67

Insertion of graft, aorta or great vessels; with cardiopulmonary bypass

33400

2,232.10

Valvuloplasty, aortic valve; open, with cardiopulmonary bypass

33401

1,487.72

Valvuloplasty, aortic valve; open, with inflow occlusion

33403

1,591.00

Valvuloplasty, aortic valve; using transventricular dilation, with cardiopulmonary bypass

33404

1,808.02

Construction of apical-aortic conduit

33405

2,335.25

Replacement, aortic valve, with cardiopulmonary bypass; with prosthetic valve other than homograft or stentless valve

33406

2,821.07

Replacement, aortic valve, with cardiopulmonary bypass; with allograft valve (freehand)

33410

2,482.95

Replacement, aortic valve, with cardiopulmonary bypass; with stentless tissue valve

33411

3,196.43

Replacement, aortic valve; with aortic annulus enlargement, noncoronary cusp

33412

2,529.22

Replacement, aortic valve; with transventricular aortic annulus enlargement (Konno procedure)

33413

3,256.81

Replacement, aortic valve; by translocation of autologous pulmonary valve with allograft replacement of pulmonary valve (Ross procedure)

33414

2,132.53

Repair of left ventricular outflow tract obstruction by patch enlargement of the outflow tract

33415

1,973.37

Resection or incision of subvalvular tissue for discrete subvalvular aortic stenosis

33416

1,996.67

Ventriculomyotomy (-myectomy) for idiopathic hypertrophic subaortic stenosis (eg, asymmetric septal hypertrophy)

33417

1,701.57

Aortoplasty (gusset) for supravalvular stenosis

33420

1,369.66

Valvotomy, mitral valve; closed heart

33422

1,704.89

Valvotomy, mitral valve; open heart, with cardiopulmonary bypass

33425

2,529.42

Valvuloplasty, mitral valve, with cardiopulmonary bypass;

33426

2,381.21

Valvuloplasty, mitral valve, with cardiopulmonary bypass; with prosthetic ring

33427

2,516.08

Valvuloplasty, mitral valve, with cardiopulmonary bypass; radical reconstruction, with or without ring

33430

2,710.92

Replacement, mitral valve, with cardiopulmonary bypass

33460

2,225.70

Valvectomy, tricuspid valve, with cardiopulmonary bypass

33463

2,812.09

Valvuloplasty, tricuspid valve; without ring insertion

33464

2,319.57

Valvuloplasty, tricuspid valve; with ring insertion

33465

2,563.58

Replacement, tricuspid valve, with cardiopulmonary bypass

33468

1,907.68

Tricuspid valve repositioning and plication for Ebstein anomaly

33470

1,187.33

Valvotomy, pulmonary valve, closed heart; transventricular

33471

1,372.68

Valvotomy, pulmonary valve, closed heart; via pulmonary artery

33472

1,363.76

Valvotomy, pulmonary valve, open heart; with inflow occlusion

33474

1,985.97

Valvotomy, pulmonary valve, open heart; with cardiopulmonary bypass

33475

2,291.55

Replacement, pulmonary valve

33476

1,488.39

Right ventricular resection for infundibular stenosis, with or without commissurotomy

33478

1,605.62

Outflow tract augmentation (gusset), with or without commissurotomy or infundibular resection

33496

1,687.30

Repair of non-structural prosthetic valve dysfunction with cardiopulmonary bypass (separate procedure)

33500

1,583.68

Repair of coronary arteriovenous or arteriocardiac chamber fistula; with cardiopulmonary bypass

33501

1,095.32

Repair of coronary arteriovenous or arteriocardiac chamber fistula; without cardiopulmonary bypass

33502

1,300.44

Repair of anomalous coronary artery from pulmonary artery origin; by ligation

33503

1,322.10

Repair of anomalous coronary artery from pulmonary artery origin; by graft, without cardiopulmonary bypass

33504

1,480.05

Repair of anomalous coronary artery from pulmonary artery origin; by graft, with cardiopulmonary bypass

33505

2,020.81

Repair of anomalous coronary artery from pulmonary artery origin; with construction of intrapulmonary artery tunnel (Takeuchi procedure)

33506

2,058.11

Repair of anomalous coronary artery from pulmonary artery origin; by translocation from pulmonary artery to aorta

33507

1,761.45

Repair of anomalous (eg, intramural) aortic origin of coronary artery by unroofing or translocation

33508

16.39

Endoscopy, surgical, including video-assisted harvest of vein(s) for coronary artery bypass procedure (List separately in addition to code for primary procedure)

33510

1,996.15

Coronary artery bypass, vein only; single coronary venous graft

33511

2,164.69

Coronary artery bypass, vein only; two coronary venous grafts

33512

2,410.19

Coronary artery bypass, vein only; three coronary venous grafts

33513

2,478.21

Coronary artery bypass, vein only; four coronary venous grafts

33514

2,595.98

Coronary artery bypass, vein only; five coronary venous grafts

33516

2,695.43

Coronary artery bypass, vein only; six or more coronary venous grafts

33517

179.13

Coronary artery bypass, using venous graft(s) and arterial graft(s); single vein graft (List separately in addition to code for primary procedure)

33518

383.31

Coronary artery bypass, using venous graft(s) and arterial graft(s); two venous grafts (List separately in addition to code for primary procedure)

33519

514.99

Coronary artery bypass, using venous graft(s) and arterial graft(s); three venous grafts (List separately in addition to code for primary procedure)

33521

628.34

Coronary artery bypass, using venous graft(s) and arterial graft(s); four venous grafts (List separately in addition to code for primary procedure)

33522

721.17

Coronary artery bypass, using venous graft(s) and arterial graft(s); five venous grafts (List separately in addition to code for primary procedure)

33523

827.36

Coronary artery bypass, using venous graft(s) and arterial graft(s); six or more venous grafts (List separately in addition to code for primary procedure)

33530

484.10

Reoperation, coronary artery bypass procedure or valve procedure, more than one month after original operation (List separately in addition to code for primary procedure)

33533

1,953.59

Coronary artery bypass, using arterial graft(s); single arterial graft

33534

2,246.25

Coronary artery bypass, using arterial graft(s); two coronary arterial grafts

33535

2,467.53

Coronary artery bypass, using arterial graft(s); three coronary arterial grafts

33536

2,633.08

Coronary artery bypass, using arterial graft(s); four or more coronary arterial grafts

33542

2,461.01

Myocardial resection (eg, ventricular aneurysmectomy)

33545

2,923.84

Repair of postinfarction ventricular septal defect, with or without myocardial resection

33548

2,897.85

Surgical ventricular restoration procedure, includes prosthetic patch, when performed (eg, ventricular remodeling, SVR, SAVER, Dor procedures)

33572

234.60

Coronary endarterectomy, open, any method, of left anterior descending, circumflex, or right coronary artery performed in conjunction with coronary artery bypass graft procedure, each vessel (List separately in addition to primary procedure)

33600

1,729.89

Closure of atrioventricular valve (mitral or tricuspid) by suture or patch

33602

1,654.39

Closure of semilunar valve (aortic or pulmonary) by suture or patch

33606

1,792.42

Anastomosis of pulmonary artery to aorta (Damus-Kaye-Stansel procedure)

33608

1,846.02

Repair of complex cardiac anomaly other than pulmonary atresia with ventricular septal defect by construction or replacement of conduit from right or left ventricle to pulmonary artery

33610

1,828.38

Repair of complex cardiac anomalies (eg, single ventricle with subaortic obstruction) by surgical enlargement of ventricular septal defect

33611

1,953.06

Repair of double outlet right ventricle with intraventricular tunnel repair;

33612

2,083.20

Repair of double outlet right ventricle with intraventricular tunnel repair; with repair of right ventricular outflow tract obstruction

33615

1,970.91

Repair of complex cardiac anomalies (eg, tricuspid atresia) by closure of atrial septal defect and anastomosis of atria or vena cava to pulmonary artery (simple Fontan procedure)

33617

2,189.37

Repair of complex cardiac anomalies (eg, single ventricle) by modified Fontan procedure

33619

2,745.94

Repair of single ventricle with aortic outflow obstruction and aortic arch hypoplasia (hypoplastic left heart syndrome) (eg, Norwood procedure)

33641

1,575.37

Repair atrial septal defect, secundum, with cardiopulmonary bypass, with or without patch

33645

1,585.82

Direct or patch closure, sinus venosus, with or without anomalous pulmonary venous drainage

33647

1,712.17

Repair of atrial septal defect and ventricular septal defect, with direct or patch closure

33660

1,801.35

Repair of incomplete or partial atrioventricular canal (ostium primum atrial septal defect), with or without atrioventricular valve repair

33665

1,905.88

Repair of intermediate or transitional atrioventricular canal, with or without atrioventricular valve repair

33670

2,051.60

Repair of complete atrioventricular canal, with or without prosthetic valve

33675

2,098.49

Closure of multiple ventricular septal defects;

33676

2,161.13

Closure of multiple ventricular septal defects; with pulmonary valvotomy or infundibular resection (acyanotic)

33677

2,245.77

Closure of multiple ventricular septal defects; with removal of pulmonary artery band, with or without gusset

33681

1,866.16

Closure of single ventricular septal defect, with or without patch;

33684

1,891.92

Closure of single ventricular septal defect, with or without patch; with pulmonary valvotomy or infundibular resection (acyanotic)

33688

1,834.13

Closure of single ventricular septal defect, with or without patch; with removal of pulmonary artery band, with or without gusset

33690

1,181.41

Banding of pulmonary artery

33692

1,980.13

Complete repair tetralogy of Fallot without pulmonary atresia;

33694

1,928.79

Complete repair tetralogy of Fallot without pulmonary atresia; with transannular patch

33697

2,134.93

Complete repair tetralogy of Fallot with pulmonary atresia including construction of conduit from right ventricle to pulmonary artery and closure of ventricular septal defect

33702

1,567.55

Repair sinus of Valsalva fistula, with cardiopulmonary bypass;

33710

1,747.52

Repair sinus of Valsalva fistula, with cardiopulmonary bypass; with repair of ventricular septal defect

33720

1,570.27

Repair sinus of Valsalva aneurysm, with cardiopulmonary bypass

33722

1,594.21

Closure of aortico-left ventricular tunnel

33724

1,538.31

Repair of isolated partial anomalous pulmonary venous return (eg, Scimitar Syndrome)

33726

2,024.39

Repair of pulmonary venous stenosis

33730

2,001.65

Complete repair of anomalous pulmonary venous return (supracardiac, intracardiac, or infracardiac types)

33732

1,693.37

Repair of cortriatriatum or supravalvular mitral ring by resection of left atrial membrane

33735

1,270.35

Atrial septectomy or septostomy; closed heart (Blalock-Hanlon type operation)

33736

1,468.02

Atrial septectomy or septostomy; open heart with cardiopulmonary bypass

33737

1,321.84

Atrial septectomy or septostomy; open heart, with inflow occlusion

33750

1,239.96

Shunt; subclavian to pulmonary artery (Blalock-Taussig type operation)

33755

1,245.92

Shunt; ascending aorta to pulmonary artery (Waterston type operation)

33762

1,294.34

Shunt; descending aorta to pulmonary artery (Potts-Smith type operation)

33764

1,297.80

Shunt; central, with prosthetic graft

33766

1,374.16

Shunt; superior vena cava to pulmonary artery for flow to one lung (classical Glenn procedure)

33767

1,438.67

Shunt; superior vena cava to pulmonary artery for flow to both lungs (bidirectional Glenn procedure)

33768

412.38

Anastomosis, cavopulmonary, second superior vena cava (List separately in addition to primary procedure)

33770

2,116.49

Repair of transposition of the great arteries with ventricular septal defect and subpulmonary stenosis; without surgical enlargement of ventricular septal defect

33771

2,142.18

Repair of transposition of the great arteries with ventricular septal defect and subpulmonary stenosis; with surgical enlargement of ventricular septal defect

33774

1,839.67

Repair of transposition of the great arteries, atrial baffle procedure (eg, Mustard or Senning type) with cardiopulmonary bypass;

33775

1,848.14

Repair of transposition of the great arteries, atrial baffle procedure (eg, Mustard or Senning type) with cardiopulmonary bypass; with removal of pulmonary band

33776

1,931.28

Repair of transposition of the great arteries, atrial baffle procedure (eg, Mustard or Senning type) with cardiopulmonary bypass; with closure of ventricular septal defect

33777

1,911.96

Repair of transposition of the great arteries, atrial baffle procedure (eg, Mustard or Senning type) with cardiopulmonary bypass; with repair of subpulmonic obstruction

33778

2,373.79

Repair of transposition of the great arteries, aortic pulmonary artery reconstruction (eg, Jatene type);

33779

2,201.51

Repair of transposition of the great arteries, aortic pulmonary artery reconstruction (eg, Jatene type); with removal of pulmonary band

33780

2,349.46

Repair of transposition of the great arteries, aortic pulmonary artery reconstruction (eg, Jatene type); with closure of ventricular septal defect

33781

2,215.49

Repair of transposition of the great arteries, aortic pulmonary artery reconstruction (eg, Jatene type); with repair of subpulmonic obstruction

33786

2,305.58

Total repair, truncus arteriosus (Rastelli type operation)

33788

1,516.42

Reimplantation of an anomalous pulmonary artery

33800

1,005.85

Aortic suspension (aortopexy) for tracheal decompression (eg, for tracheomalacia) (separate procedure)

33802

1,086.19

Division of aberrant vessel (vascular ring);

33803

1,156.83

Division of aberrant vessel (vascular ring); with reanastomosis

33813

1,272.98

Obliteration of aortopulmonary septal defect; without cardiopulmonary bypass

33814

1,547.83

Obliteration of aortopulmonary septal defect; with cardiopulmonary bypass

33820

990.13

Repair of patent ductus arteriosus; by ligation

33822

1,025.18

Repair of patent ductus arteriosus; by division, younger than 18 years

33824

1,197.28

Repair of patent ductus arteriosus; by division, 18 years and older

33840

1,240.92

Excision of coarctation of aorta, with or without associated patent ductus arteriosus; with direct anastomosis

33845

1,351.27

Excision of coarctation of aorta, with or without associated patent ductus arteriosus; with graft

33851

1,291.50

Excision of coarctation of aorta, with or without associated patent ductus arteriosus; repair using either left subclavian artery or prosthetic material as gusset for enlargement

33852

1,495.33

Repair of hypoplastic or interrupted aortic arch using autogenous or prosthetic material; without cardiopulmonary bypass

33853

1,862.04

Repair of hypoplastic or interrupted aortic arch using autogenous or prosthetic material; with cardiopulmonary bypass

33860

3,042.52

Ascending aorta graft, with cardiopulmonary bypass, with or without valve suspension;

33861

2,460.32

Ascending aorta graft, with cardiopulmonary bypass, with or without valve suspension; with coronary reconstruction

33863

3,083.51

Ascending aorta graft, with cardiopulmonary bypass, with or without valve suspension; with aortic root replacement using composite prosthesis and coronary reconstruction

33864

3,175.94

Ascending aorta graft, with cardiopulmonary bypass with valve suspension, with coronary reconstruction and valve-sparing aortic annulus remodeling (eg, David Procedure, Yacoub Procedure)

33870

2,564.75

Transverse arch graft, with cardiopulmonary bypass

33875

1,986.64

Descending thoracic aorta graft, with or without bypass

33877

3,388.61

Repair of thoracoabdominal aortic aneurysm with graft, with or without cardiopulmonary bypass

33880

1,821.23

Endovascular repair of descending thoracic aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption); involving coverage of left subclavian artery origin, initial endoprosthesis plus descending thoracic aortic extension(s), if required, to level of celiac artery origin

33881

1,574.40

Endovascular repair of descending thoracic aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption); not involving coverage of left subclavian artery origin, initial endoprosthesis plus descending thoracic aortic extension(s), if required, to level of celiac artery origin

33883

1,157.80

Placement of proximal extension prosthesis for endovascular repair of descending thoracic aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption); initial extension

33884

413.00

Placement of proximal extension prosthesis for endovascular repair of descending thoracic aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption); each additional proximal extension (List separately in addition to code for primary procedure)

33886

1,003.73

Placement of distal extension prosthesis(s) delayed after endovascular repair of descending thoracic aorta

33889

819.71

Open subclavian to carotid artery transposition performed in conjunction with endovascular repair of descending thoracic aorta, by neck incision, unilateral

33891

1,058.81

Bypass graft, with other than vein, transcervical retropharyngeal carotid-carotid, performed in conjunction with endovascular repair of descending thoracic aorta, by neck incision

33910

1,645.46

Pulmonary artery embolectomy; with cardiopulmonary bypass

33915

1,322.68

Pulmonary artery embolectomy; without cardiopulmonary bypass

33916

1,586.71

Pulmonary endarterectomy, with or without embolectomy, with cardiopulmonary bypass

33917

1,481.10

Repair of pulmonary artery stenosis by reconstruction with patch or graft

33920

1,779.90

Repair of pulmonary atresia with ventricular septal defect, by construction or replacement of conduit from right or left ventricle to pulmonary artery

33922

1,402.41

Transection of pulmonary artery with cardiopulmonary bypass

33924

291.19

Ligation and takedown of a systemic-to-pulmonary artery shunt, performed in conjunction with a congenital heart procedure (List separately in addition to code for primary procedure)

33925

1,921.35

Repair of pulmonary artery arborization anomalies by unifocalization; without cardiopulmonary bypass

33926

2,459.91

Repair of pulmonary artery arborization anomalies by unifocalization; with cardiopulmonary bypass

33930

I.C.

Donor cardiectomy-pneumonectomy (including cold preservation)

33933

I.C.

Backbench standard preparation of cadaver donor heart/lung allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare aorta, superior vena cava, inferior vena cava, and trachea for implantation

33935

3,568.26

Heart-lung transplant with recipient cardiectomy-pneumonectomy

33940

I.C.

Donor cardiectomy (including cold preservation)

33944

I.C.

Backbench standard preparation of cadaver donor heart allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare aorta, superior vena cava, inferior vena cava, pulmonary artery, and left atrium for implantation

33945

4,421.24

Heart transplant, with or without recipient cardiectomy

33960

973.84

Prolonged extracorporeal circulation for cardiopulmonary insufficiency; initial 24 hours

33961

550.77

Prolonged extracorporeal circu lation for cardiopulmonary insufficiency; each additional 24 hours (List separately in addition to code for primary procedure)

33967

273.78

Insertion of intra-aortic balloon assist device, percutaneous

33968

35.00

Removal of intra-aortic balloon assist device, percutaneous

33970

365.63

Insertion of intra-aortic balloon assist device through the femoral artery, open approach

33971

720.74

Removal of intra-aortic balloon assist device including repair of femoral artery, with or without graft

33973

537.75

Insertion of intra-aortic balloon assist device through the ascending aorta

33974

921.39

Removal of intra-aortic balloon assist device from the ascending aorta, including repair of the ascending aorta, with or without graft

33975

1,097.52

Insertion of ventricular assist device; extracorporeal, single ventricle

33976

1,232.26

Insertion of ventricular assist device; extracorporeal, biventricular

33977

1,241.27

Removal of ventricular assist device; extracorporeal, single ventricle

33978

1,378.23

Removal of ventricular assist device; extracorporeal, biventricular

33979

2,426.57

Insertion of ventricular assist device, implantable intracorporeal, single ventricle

33980

3,584.50

Removal of ventricular assist device, implantable intracorporeal, single ventricle

33999

I.C.

Unlisted procedure, cardiac surgery

34001

963.54

Embolectomy or thrombectomy, with or without catheter; carotid, subclavian or innominate artery, by neck incision

34051

993.88

Embolectomy or thrombectomy, with or without catheter; innominate, subclavian artery, by thoracic incision

34101

635.03

Embolectomy or thrombectomy, with or without catheter; axillary, brachial, innominate, subclavian artery, by arm incision

34111

634.27

Embolectomy or thrombectomy, with or without catheter; radial or ulnar artery, by arm incision

34151

1,447.08

Embolectomy or thrombectomy, with or without catheter; renal, celiac, mesentery, aortoiliac artery, by abdominal incision

34201

980.40

Embolectomy or thrombectomy, with or without catheter; femoropopliteal, aortoiliac artery, by leg incision

34203

1,008.42

Embolectomy or thrombectomy, with or without catheter; popliteal-tibio-peroneal artery, by leg incision

34401

1,453.54

Thrombectomy, direct or with catheter; vena cava, iliac vein, by abdominal incision

34421

764.88

Thrombectomy, direct or with catheter; vena cava, iliac, femoropopliteal vein, by leg incision

34451

1,564.72

Thrombectomy, direct or with catheter; vena cava, iliac, femoropopliteal vein, by abdominal and leg incision

34471

1,055.70

Thrombectomy, direct or with catheter; subclavian vein, by neck incision

34490

637.11

Thrombectomy, direct or with catheter; axillary and subclavian vein, by arm incision

34501

985.37

Valvuloplasty, femoral vein

34502

1,584.30

Reconstruction of vena cava, any method

34510

1,135.73

Venous valve transposition, any vein donor

34520

1,075.33

Cross-over vein graft to venous system

34530

1,012.84

Saphenopopliteal vein anastomosis

34800

1,184.34

Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using aorto-aortic tube prosthesis

34802

1,293.17

Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using modular bifurcated prosthesis (one docking limb)

34803

1,324.73

Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using modular bifurcated prosthesis (two docking limbs)

34804

1,289.97

Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using unibody bifurcated prosthesis

34805

1,220.94

Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using aorto-uniiliac or aorto-unifemoral prosthesis

34806

102.80

Transcatheter placement of wireless physiologic sensor in aneurysmal sac during endovascular repair, including radiological supervision and interpretation, instrument calibration, and collection of pressure data

34808

214.05

Endovascular placement of iliac artery occlusion device (List separately in addition to code for primary procedure)

34812

355.25

Open femoral artery exposure for delivery of endovascular prosthesis, by groin incision, unilateral

34813

246.23

Placement of femoral-femoral prosthetic graft during endovascular aortic aneurysm repair (List separately in addition to code for primary procedure)

34820

508.24

Open iliac artery exposure for delivery of endovascular prosthesis or iliac occlusion during endovascular therapy, by abdominal or retroperitoneal incision, unilateral

34825

732.73

Placement of proximal or distal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, or dissection; initial vessel

34826

211.39

Placement of proximal or distal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, or dissection; each additional vessel (List separately in addition to code for primary procedure)

34830

1,888.07

Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following unsuccessful endovascular repair; tube prosthesis

34831

1,968.68

Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following unsuccessful endovascular repair; aorto-bi-iliac prosthesis

34832

2,046.19

Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following unsuccessful endovascular repair; aorto-bifemoral prosthesis

34833

637.66

Open iliac artery exposure with creation of conduit for delivery of aortic or iliac endovascular prosthesis, by abdominal or retroperitoneal incision, unilateral

34834

291.64

Open brachial artery exposure to assist in the deployment of aortic or iliac endovascular prosthesis by arm incision, unilateral

34900

946.44

Endovascular graft placement for repair of iliac artery (eg, aneurysm, pseudoaneurysm, arteriovenous malformation, trauma)

35001

1,188.21

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm and associated occlusive disease, carotid, subclavian artery, by neck incision

35002

1,241.47

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, carotid, subclavian artery, by neck incision

35005

1,107.90

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, vertebral artery

35011

1,036.72

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm and associated occlusive disease, axillary-brachial artery, by arm incision

35013

1,282.99

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, axillary-brachial artery, by arm incision

35021

1,251.74

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, innominate, subclavian artery, by thoracic incision

35022

1,440.17

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, innominate, subclavian artery, by thoracic incision

35045

1,003.10

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, radial or ulnar artery

35081

1,770.01

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal aorta

35082

2,240.92

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, abdominal aorta

35091

1,903.70

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal aorta involving visceral vessels (mesenteric, celiac, renal)

35092

2,666.78

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, abdominal aorta involving visceral vessels (mesenteric, celiac, renal)

35102

1,920.58

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal aorta involving iliac vessels (common, hypogastric, external)

35103

2,313.44

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, abdominal aorta involving iliac vessels (common, hypogastric, external)

35111

1,434.34

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, splenic artery

35112

1,737.13

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, splenic artery

35121

1,715.46

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, hepatic, celiac, renal, or mesenteric artery

35122

2,014.34

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, hepatic, celiac, renal, or mesenteric artery

35131

1,457.54

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, iliac artery (common, hypogastric, external)

35132

1,758.45

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, iliac artery (common, hypogastric, external)

35141

1,163.13

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, common femoral artery (profunda femoris, superficial femoral)

35142

1,383.84

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, common femoral artery (profunda femoris, superficial femoral)

35151

1,309.20

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, popliteal artery

35152

1,519.96

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, popliteal artery

35180

846.25

Repair, congenital arteriovenous fistula; head and neck

35182

1,752.98

Repair, congenital arteriovenous fistula; thorax and abdomen

35184

1,055.60

Repair, congenital arteriovenous fistula; extremities

35188

1,732.44

898.95

Repair, acquired or traumatic arteriovenous fistula; head and neck

35189

1,660.41

Repair, acquired or traumatic arteriovenous fistula; thorax and abdomen

35190

778.81

Repair, acquired or traumatic arteriovenous fistula; extremities

35201

974.67

Repair blood vessel, direct; neck

35206

798.81

Repair blood vessel, direct; upper extremity

35207

1,732.44

737.01

Repair blood vessel, direct; hand, finger

35211

1,400.53

Repair blood vessel, direct; intrathoracic, with bypass

35216

1,843.83

Repair blood vessel, direct; intrathoracic, without bypass

35221

1,427.87

Repair blood vessel, direct; intra-abdominal

35226

884.91

Repair blood vessel, direct; lower extremity

35231

1,209.11

Repair blood vessel with vein graft; neck

35236

1,011.71

Repair blood vessel with vein graft; upper extremity

35241

1,463.44

Repair blood vessel with vein graft; intrathoracic, with bypass

35246

1,572.55

Repair blood vessel with vein graft; intrathoracic, without bypass

35251

1,699.85

Repair blood vessel with vein graft; intra-abdominal

35256

1,065.64

Repair blood vessel with vein graft; lower extremity

35261

1,068.07

Repair blood vessel with graft other than vein; neck

35266

887.92

Repair blood vessel with graft other than vein; upper extremity

35271

1,396.11

Repair blood vessel with graft other than vein; intrathoracic, with bypass

35276

1,466.07

Repair blood vessel with graft other than vein; intrathoracic, without bypass

35281

1,624.20

Repair blood vessel with graft other than vein; intra-abdominal

35286

983.40

Repair blood vessel with graft other than vein; lower extremity

35301

1,095.12

Thromboendarterectomy, including patch graft, if performed; carotid, vertebral, subclavian, by neck incision

35302

1,133.60

Thromboendarterectomy, including patch graft, if performed; superficial femoral artery

35303

1,244.13

Thromboendarterectomy, including patch graft, if performed; popliteal artery

35304

1,294.28

Thromboendarterectomy, including patch graft, if performed; tibioperoneal trunk artery

35305

1,244.13

Thromboendarterectomy, including patch graft, if performed; tibial or peroneal artery, initial vessel

35306

460.93

Thromboendarterectomy, including patch graft, if performed; each additional tibial or peroneal artery (List separately in addition to code for primary procedure)

35311

1,568.32

Thromboendarterectomy, including patch graft, if performed; subclavian, innominate, by thoracic incision

35321

934.01

Thromboendarterectomy, including patch graft, if performed; axillary-brachial

35331

1,519.16

Thromboendarterectomy, including patch graft, if performed; abdominal aorta

35341

1,444.47

Thromboendarterectomy, including patch graft, if performed; mesenteric, celiac, or renal

35351

1,334.71

Thromboendarterectomy, including patch graft, if performed; iliac

35355

1,087.71

Thromboendarterectomy, including patch graft, if performed; iliofemoral

35361

1,642.64

Thromboendarterectomy, including patch graft, if performed; combined aortoiliac

35363

1,760.12

Thromboendarterectomy, including patch graft, if performed; combined aortoiliofemoral

35371

866.76

Thromboendarterectomy, including patch graft, if performed; common femoral

35372

1,036.82

Thromboendarterectomy, including patch graft, if performed; deep (profunda) femoral

35390

165.97

Reoperation, carotid, thromboendarterectomy, more than one month after original operation (List separately in addition to code for primary procedure)

35400

157.20

Angioscopy (non-coronary vessels or grafts) during therapeutic intervention (List separately in addition to code for primary procedure)

35450

531.12

Transluminal balloon angioplasty, open; renal or other visceral artery

35452

371.01

Transluminal balloon angioplasty, open; aortic

35454

325.86

Transluminal balloon angioplasty, open; iliac

35456

394.09

Transluminal balloon angioplasty, open; femoral-popliteal

35458

505.97

Transluminal balloon an gioplasty, open; brachiocephalic trunk or branches, each vessel

35459

464.52

Transluminal balloon angioplasty, open; tibioperoneal trunk and branches

35460

323.28

Transluminal balloon angioplasty, open; venous

35470

3,769.87

Transluminal balloon angioplasty, percutaneous; tibioperoneal trunk or branches, each vessel

35471

4,192.30

Transluminal balloon angioplasty, percutaneous; renal or visceral artery

35472

2,829.17

Transluminal balloon angioplasty, percutaneous; aortic

35473

2,028.15

2,670.79

Transluminal balloon angioplasty, percutaneous; iliac

35474

3,679.18

Transluminal balloon angioplasty, percutaneous; femoral-popliteal

35475

2,754.60

Transluminal balloon angioplasty, percutaneous; brachiocephalic trunk or branches, each vessel

35476

2,028.15

2,101.39

Transluminal balloon angioplasty, percutaneous; venous

35480

601.94

Transluminal peripheral atherectomy, open; renal or other visceral artery

35481

418.56

Transluminal peripheral atherectomy, open; aortic

35482

358.79

Transluminal peripheral atherectomy, open; iliac

35483

439.11

Transluminal peripheral atherectomy, open; femoral-popliteal

35484

547.57

Transluminal peripheral atherectomy, open; brachiocephalic trunk or branches, each vessel

35485

511.43

Transluminal peripheral atherectomy, open; tibioperoneal trunk and branches

35490

626.28

Transluminal peripheral atherectomy, percutaneous; renal or other visceral artery

35491

445.99

Transluminal peripheral atherectomy, percutaneous; aortic

35492

3,910.83

393.33

Transluminal peripheral atherectomy, percutaneous; iliac

35493

471.59

Transluminal peripheral atherectomy, percutaneous; femoral-popliteal

35494

594.85

Transluminal peripheral atherectomy, percutaneous; brachiocephalic trunk or branches, each vessel

35495

547.80

Transluminal peripheral atherectomy, percutaneous; tibioperoneal trunk and branches

35500

331.07

Harvest of upper extremity vein, one segment, for lower extremity or coronary artery bypass procedure (List separately in addition to code for primary procedure)

35501

1,562.40

Bypass graft, with vein; common carotid-ipsilateral internal carotid

35506

1,356.65

Bypass graft, with vein; carotid-subclavian or subclavian-carotid

35508

1,390.03

Bypass graft, with vein; carotid-vertebral

35509

1,523.32

Bypass graft, with vein; carotid-contralateral carotid

35510

1,304.37

Bypass graft, with vein; carotid-brachial

35511

1,234.17

Bypass graft, with vein; subclavian-subclavian

35512

1,278.10

Bypass graft, with vein; subclavian-brachial

35515

1,393.71

Bypass graft, with vein; subclavian-vertebral

35516

1,221.51

Bypass graft, with vein; subclavian-axillary

35518

1,236.56

Bypass graft, with vein; axillary-axillary

35521

1,322.45

Bypass graft, with vein; axillary-femoral

35522

1,245.47

Bypass graft, with vein; axillary-brachial

35523

1,307.96

Bypass graft, with vein; brachial-ulnar or -radial

35525

1,178.59

Bypass graft, with vein; brachial-brachial

35526

1,794.55

Bypass graft, with vein; aortosubclavian or carotid

35531

2,083.61

Bypass graft, with vein; aortoceliac or aortomesenteric

35533

1,620.88

Bypass graft, with vein; axillary-femoral-femoral

35536

1,802.59

Bypass graft, with vein; splenorenal

35537

2,199.90

Bypass graft, with vein; aortoiliac

35538

2,455.22

Bypass graft, with vein; aortobi-iliac

35539

2,302.06

Bypass graft, with vein; aortofemoral

35540

2,564.61

Bypass graft, with vein; aortobifemoral

35548

1,254.86

Bypass graft, with vein; aortoiliofemoral, unilateral

35549

1,369.99

Bypass graft, with vein; aortoiliofemoral, bilateral

35551

1,539.39

Bypass graft, with vein; aortofemoral-popliteal

35556

1,424.35

Bypass graft, with vein; femoral-popliteal

35558

1,276.12

Bypass graft, with vein; femoral-femoral

35560

1,850.79

Bypass graft, with vein; aortorenal

35563

1,439.36

Bypass graft, with vein; ilioiliac

35565

1,373.65

Bypass graft, with vein; iliofemoral

35566

1,703.71

Bypass graft, with vein; femoral-anterior tibial, posterior tibial, peroneal artery or other distal vessels

35571

1,405.59

Bypass graft, with vein; popliteal-tibial, -peroneal artery or other distal vessels

35572

357.93

Harvest of femoropopliteal vein, one segment, for vascular reconstruction procedure (eg, aortic, vena caval, coronary, peripheral artery) (List separately in addition to code for primary procedure)

35583

1,470.72

In-situ vein bypass; femoral-popliteal

35585

1,734.72

In-situ vein bypass; femoral-anterior tibial, posterior tibial, or peroneal artery

35587

1,455.32

In-situ vein bypass; popliteal-tibial, peroneal

35600

262.81

Harvest of upper extremity artery, one segment, for coronary artery bypass procedure (List separately in addition to code for primary procedure)

35601

1,471.68

Bypass graft, with other than vein; common carotid-ipsilateral internal carotid

35606

1,219.96

Bypass graft, with other than vein; carotid-subclavian

35612

959.98

Bypass graft, with other than vein; subclavian-subclavian

35616

1,158.95

Bypass graft, with other than vein; subclavian-axillary

35621

1,158.62

Bypass graft, with other than vein; axillary-femoral

35623

1,420.15

Bypass graft, with other than vein; axillary-popliteal or -tibial

35626

1,626.79

Bypass graft, with other than vein; aortosubclavian or carotid

35631

1,935.95

Bypass graft, with other than vein; aortoceliac, aortomesenteric, aortorenal

35636

1,709.27

Bypass graft, with other than vein; splenorenal (splenic to renal arterial anastomosis)

35637

1,747.28

Bypass graft, with other than vein; aortoiliac

35638

1,774.90

Bypass graft, with other than vein; aortobi-iliac

35642

1,054.85

Bypass graft, with other than vein; carotid-vertebral

35645

1,075.33

Bypass graft, with other than vein; subclavian-vertebral

35646

1,796.56

Bypass graft, with other than vein; aortobifemoral

35647

1,624.34

Bypass graft, with other than vein; aortofemoral

35650

1,119.24

Bypass graft, with other than vein; axillary-axillary

35651

1,434.80

Bypass graft, with other than vein; aortofemoral-popliteal

35654

1,437.06

Bypass graft, with other than vein; axillary-femoral-femoral

35656

1,135.44

Bypass graft, with other than vein; femoral-popliteal

35661

1,139.67

Bypass graft, with other than vein; femoral-femoral

35663

1,317.32

Bypass graft, with other than vein; ilioiliac

35665

1,235.98

Bypass graft, with other than vein; iliofemoral

35666

1,339.06

Bypass graft, with other than vein; femoral-anterior tibial, posterior tibial, or peroneal artery

35671

1,179.28

Bypass graft, with other than vein; popliteal-tibial or

-peroneal artery

35681

83.16

Bypass graft; composite, prosthetic and vein (List separately in addition to code for primary procedure)

35682

370.26

Bypass graft; autogenous composite, two segments of veins from two locations (List separately in addition to code for primary procedure)

35683

435.85

Bypass graft; autogenous composite, three or more segments of vein from two or more locations (List separately in addition to code for primary procedure)

35685

208.26

Placement of vein patch or cuff at distal anastomosis of bypass graft, synthetic conduit (List separately in addition to code for primary procedure)

35686

173.69

Creation of distal arteriovenous fistula during lower extremity bypass surgery (non-hemodialysis) (List separately in addition to code for primary procedure)

35691

1,033.62

Transposition and/or reimplantation; vertebral to carotid artery

35693

919.06

Transposition and/or reimplantation; vertebral to subclavian artery

35694

1,079.51

Transposition and/or reimplantation; subclavian to carotid artery

35695

1,115.16

Transposition and/or reimplantation; carotid to subclavian artery

35697

155.22

Reimplantation, visceral artery to infrarenal aortic prosthesis, each artery (List separately in addition to code for primary procedure)

35700

159.31

Reoperation, femoral-popliteal or femoral (popliteal)-anterior tibial, posterior tibial, peroneal artery, or other distal vessels, more than one month after original operation (List separately in addition to code for primary procedure)

35701

562.33

Exploration (not followed by surgical repair), with or without lysis of artery; carotid artery

35721

482.51

Exploration (not followed by surgical repair), with or without lysis of artery; femoral artery

35741

523.62

Exploration (not followed by surgical repair), with or without lysis of artery; popliteal artery

35761

1,327.08

393.10

Exploration (not followed by surgical repair), with or without lysis of artery; other vessels

35800

499.20

Exploration for postoperative hemorrhage, thrombosis or infection; neck

35820

1,778.30

Exploration for postoperative hemorrhage, thrombosis or infection; chest

35840

643.74

Exploration for postoperative hemorrhage, thrombosis or infection; abdomen

35860

423.59

Exploration for postoperative hemorrhage, thrombosis or infection; extremity

35870

1,330.32

Repair of graft-enteric fistula

35875

1,732.44

623.72

Thrombectomy of arterial or venous graft (other than hemodialysis graft or fistula);

35876

1,732.44

987.41

Thrombectomy of arterial or venous graft (other than hemodialysis graft or fistula); with revision of arterial or venous graft

35879

972.71

Revision, lower extremity arterial bypass, without thrombectomy, open; with vein patch angioplasty

35881

1,081.40

Revision, lower extremity arterial bypass, without thrombectomy, open; with segmental vein interposition

35883

1,274.54

Revision, femoral anastomosis of synthetic arterial bypass graft in groin, open; with nonautogenous patch graft (eg, Dacron, ePTFE, bovine pericardium)

35884

1,352.60

Revision, femoral anastomosis of synthetic arterial bypass graft in groin, open; with autogenous vein patch graft

35901

536.05

Excision of infected graft; neck

35903

608.91

Excision of infected graft; extremity

35905

1,821.78

Excision of infected graft; thorax

35907

1,992.28

Excision of infected graft; abdomen

36000

29.92

Introduction of needle or intracatheter, vein

36002

106.32

189.39

Injection procedures (eg, thrombin) for percutaneous

treatment of extremity pseudoaneurysm

36005

404.92

Injection procedure for extremity venography

(including introduction of needle or intracatheter)

36010

789.05

Introduction of catheter, superior or inferior vena cava

36011

1,207.55

Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein)

36012

1,029.35

Selective catheter placement, venous system; second order, or more selective, branch (eg, left adrenal vein, petrosal sinus)

36013

1,017.78

Introduction of catheter, right heart or main pulmonary artery

36014

1,008.66

Selective catheter placement, left or right pulmonary artery

36015

1,098.25

Selective catheter placement, segmental or subsegmental pulmonary artery

36100

647.59

Introduction of needle or intracatheter, carotid or vertebral artery

36120

531.26

Introduction of needle or intracatheter; retrograde brachial artery

36140

608.73

Introduction of needle or intracatheter; extremity artery

36145

598.03

Introduction of needle or intracatheter; arteriovenous shunt created for dialysis (cannula, fistula, or graft)

36160

670.11

Introduction of needle or intracatheter, aortic, translumbar

36200

805.33

Introduction of catheter, aorta

36215

1,387.75

Selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a vascular family

36216

1,504.71

Selective catheter placement, arterial system; initial second order thoracic or brachiocephalic branch, within a vascular family

36217

2,561.12

Selective catheter placement, arterial system; initial third order or more selective thoracic or brachiocephalic branch, within a vascular family

36218

240.49

Selective catheter placement, arterial system; additional second order, third order, and beyond, thoracic or brachiocephalic branch, within a vascular family (List in addition to code for initial second or third order vessel as appropriate)

36245

1,570.76

Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family

36246

1,513.25

Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family

36247

2,409.20

Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family

36248

202.74

Selective catheter placement, arterial system; additional second order, third order, and beyond, abdominal, pelvic, or lower extremity artery branch, within a vascular family (List in addition to code for initial second or third order vessel as appropriate)

36260

1,290.34

593.05

Insertion of implantable intra-arterial infusion pump (eg, for chemotherapy of liver)

36261

1,071.63

365.13

Revision of implanted intra-arterial infusion pump

36262

1,071.63

280.12

Removal of implanted intra-arterial infusion pump

36299

I.C.

Unlisted procedure, vascular injection

36410

20.25

Venipuncture, age 3 years or older, necessitating physician's skill (separate procedure), for diagnostic or therapeutic purposes (not to be used for routine venipuncture)

36415

I.C.

Collection of venous blood by venipuncture

36416

I.C.

Collection of capillary blood specimen (eg, finger, heel, ear stick)

36425

9.57

37.41

Venipuncture, cutdown; age one or over

36455

35.44

126.13

Exchange transfusion, blood; other than newborn

36460

341.78

Transfusion, intrauterine, fetal

36468

35.44

I.C.

Single or multiple injections of sclerosing solutions, spider veins (telangiectasia); limb or trunk

36469

35.44

I.C.

Single or multiple injections of sclerosing solutions, spider veins (telangiectasia); face

36470

35.44

158.18

Injection of sclerosing solution; single vein

36471

35.44

190.12

Injection of sclerosing solution; multiple veins, same leg

36475

1,904.22

2,247.36

Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated

36476

1,154.79

443.46

Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; second and subsequent veins treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure)

36478

1,154.79

1,938.97

Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; first vein treated

36479

1,154.79

451.28

Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; second and subsequent veins treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure)

36481

368.95

Percutaneous portal vein catheterization by any method

36500

186.13

Venous catheterization for selective organ blood sampling

36511

514.17

91.73

Therapeutic apheresis; for white blood cells

36512

514.17

92.65

Therapeutic apheresis; for red blood cells

36513

514.17

93.96

Therapeutic apheresis; for platelets

36514

514.17

694.23

Therapeutic apheresis; for plasma pheresis

36515

1,367.62

2,636.16

Therapeutic apheresis; with extracorporeal immunoadsorption and plasma reinfusion

36516

1,367.62

3,121.03

Therapeutic apheresis; with extracorporeal selective adsorption or selective filtration and plasma reinfusion

36522

1,367.62

1,668.22

Photopheresis, extracorporeal

36556

487.51

286.21

Insertion of non-tunneled centrally inserted central venous catheter; age five years or older

36558

1,077.30

1,007.52

Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; age five years or older

36561

1,290.34

1,416.26

Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; age five years or older

36563

1,290.34

1,385.15

Insertion of tunneled centrally inserted central venous access device with subcutaneous pump

36565

1,290.34

1,194.40

Insertion of tunneled centrally inserted central venous access device, requiring two catheters via two separate venous access sites; without subcutaneous port or pump (eg, Tesio type catheter)

36566

4,811.43

3,402.87

Insertion of tunneled centrally inserted central venous access device, requiring two catheters via two separate venous access sites; with subcutaneous port(s)

36569

487.51

339.86

Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump; age five years or older

36571

1,077.30

1,528.60

Insertion of peripherally inserted central venous access device, with subcutaneous port; age five years or older

36575

253.00

198.25

Repair of tunneled or non-tunneled central venous access catheter, without subcutaneous port or pump, central or peripheral insertion site

36576

487.51

411.26

Repair of central venous access device, with subcutaneous port or pump, central or peripheral insertion site

36578

1,077.30

593.18

Replacement, catheter only, of central venous access device, with subcutaneous port or pump, central or peripheral insertion site

36580

487.51

301.28

Replacement, complete, of a non-tunneled centrally inserted central venous catheter, without subcutaneous port or pump, through same venous access

36581

1,077.30

929.44

Replacement, complete, of a tunneled centrally inserted central venous catheter, without subcutaneous port or pump, through same venous access

36582

1,290.34

1,278.59

Replacement, complete, of a tunneled centrally inserted central venous access device, with subcutaneous port, through same venous access

36583

1,290.34

1,281.68

Replacement, complete, of a tunneled centrally inserted central venous access device, with subcutaneous pump, through same venous access

36584

487.51

298.44

Replacement, complete, of a peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, through same venous access

36585

1,077.30

1,329.83

Replacement, complete, of a peripherally inserted central venous access device, with subcutaneous port, through same venous access

36589

253.00

179.06

Removal of tunneled central venous catheter, without subcutaneous port or pump

36590

487.51

287.64

Removal of tunneled central venous access device, with subcutaneous port or pump, central or peripheral insertion

36591

25.15

Collection of blood specimen from a completely implantable venous access device

36592

31.14

Collection of blood specimen using established central or peripheral catheter, venous, not otherwise specified

36593

22.06

38.71

Declotting by thrombolytic agent of implanted vascular access device or catheter

36595

1,077.30

775.56

Mechanical removal of pericatheter obstructive material (eg, fibrin sheath) from central venous device via separate venous access

36596

487.51

171.17

Mechanical removal of intraluminal (intracatheter) obstructive material from central venous device through device lumen

36597

487.51

145.59

Repositioning of previously placed central venous catheter under fluoroscopic guidance

36598

89.36

138.61

Contrast injection(s) for radiologic evaluation of existing central venous access device, including fluoroscopy, image documentation and report

36600

34.08

Arterial puncture, withdrawal of blood for diagnosis

36620

50.11

Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure); percutaneous

36625

103.77

Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure); cutdown

36640

1,290.34

122.64

Arterial catheterization for prolonged infusion therapy (chemotherapy), cutdown

36660

71.33

Catheterization, umbilical artery, newborn, for diagnosis or therapy

36680

49.59

62.22

Placement of needle for intraosseous infusion

36800

1,327.08

167.33

Insertion of cannula for hemodialysis, other purpose (separate procedure); vein to vein

36810

1,327.08

217.74

Insertion of cannula for hemodialysis, other purpose (separate procedure); arteriovenous, external (Scribner type)

36815

1,327.08

150.58

Insertion of cannula for hemodialysis, other purpose (separate procedure); arteriovenous, external revision, or closure

36818

1,732.44

702.29

Arteriovenous anastomosis, open; by upper arm cephalic vein transposition

36819

1,732.44

814.73

Arteriovenous anastomosis, open; by upper arm basilic vein transposition

36820

1,732.44

817.65

Arteriovenous anastomosis, open; by forearm vein transposition

36821

1,732.44

547.20

Arteriovenous anastomosis, open; direct, any site (eg, Cimino type) (separate procedure)

36822

398.68

Insertion of cannula(s) for prolonged extracorporeal circulation for cardiopulmonary insufficiency

(ECMO) (separate procedure)

36823

1,280.49

Insertion of arterial and venous cannula(s) for isolated extracorporeal circulation including regional chemotherapy perfusion to an extremity, with or without hyperthermia, with removal of cannula(s) and repair of arteriotomy and venotomy sites

36825

1,732.44

595.47

Creation of arteriovenous fistula by other than direct arteriovenous anastomosis (separate procedure); autogenous graft

36830

1,732.44

674.89

Creation of arteriovenous fistula by other than direct arteriovenous anastomosis (separate procedure); nonautogenous graft (eg, biological collagen, thermoplastic graft)

36831

1,732.44

470.48

Thrombectomy, open, arteriovenous fistula without revision, autogenous or nonautogenous dialysis graft (separate procedure)

36832

1,732.44

596.37

Revision, open, arteriovenous fistula; without thrombectomy, autogenous or nonautogenous dialysis graft (separate procedure)

36833

1,732.44

671.96

Revision, open, arteriovenous fistula; with thrombectomy, autogenous or nonautogenous dialysis graft (separate procedure)

36834

1,732.44

627.52

Plastic repair of arteriovenous aneurysm (separate procedure)

36835

36838

1,327.08

1,206.02

468.55

Insertion of Thomas shunt (separate procedure) Distal revascularization and interval ligation (DRIL), upper extremity hemodialysis access (steal syndrome)

36860

110.93

190.22

External cannula declotting (separate procedure); without balloon catheter

36861

1,327.08

156.27

External cannuladeclotting (separate procedure); with balloon catheter

36870

1,808.38

2,345.77

Thrombectomy, percutaneous, arteriovenous fistula, autogenous or nonautogenous graft (includes mechanical thrombus extraction and intra-graft thrombolysis)

37140

1,365.16

Venous anastomosis, open; portocaval

37145

1,480.54

Venous anastomosis, open; renoportal

37160

1,270.10

Venous anastomosis, open; caval-mesenteric

37180

1,443.19

Venous anastomosis, open; splenorenal, proximal

37181

1,523.70

Venous anastomosis, open; splenorenal, distal (selective decompression of esophagogastric varices, any technique)

37182

894.76

Insertion of transvenous intrahepatic portosystemic shunt(s) (TIPS) (includes venous access, hepatic and portal vein catheterization, portography with hemodynamic evaluation, intrahepatic tract formation/dilatation, stent placement and all associated imaging guidance and documentation)

37183

427.28

Revision of transvenous intrahepatic portosystemic shunt(s) (TIPS) (includes venous access, hepatic and portal vein catheterization, portography with hemodynamic evaluation, intrahepatic tract recanulization/dilatation, stent placement and all associated imaging guidance and documentation)

37184

1,732.44

3,113.44

Primary percutaneous transluminal mechanical thrombectomy, noncoronary, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); initial vessel

37185

1,732.44

1,022.74

Primary percutaneous transluminal mechanical thrombectomy, noncoronary, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); second and all subsequent vessel(s) within the same vascular family (List separately in addition to code for primary mechanical thrombectomy procedure)

37186

1,732.44

2,119.04

Secondary percutaneous transluminal thrombectomy (eg, nonprimary mechanical, snare basket, suction technique), noncoronary, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injections, provided in conjunction with another percutaneous intervention other than primary mechanical thrombectomy (List separately in addition to code for primary procedure)

37187

1,732.44

3,016.62

Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance

37188

1,732.44

2,605.95

Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance, repeat treatment on subsequent day during course of thrombolytic therapy

37195

I.C.

Thrombolysis, cerebral, by intravenous infusion

37200

1,290.34

236.17

Transcatheter biopsy

37201

292.57

Transcatheter therapy, infusion for thrombolysis other than coronary

37202

353.31

Transcatheter therapy, infusion other than for thrombolysis, any type (eg, spasmolytic, vasoconstrictive)

37203

1,290.34

1,630.90

Transcatheter retrieval, percutaneous, of intravascular foreign body (eg, fractured venous or arterial catheter)

37204

942.08

Transcatheter occlusion or embolization (eg, for tumor destruction, to achieve hemostasis, to occlude a vascular malformation), percutaneous, any method, non-central nervous system, non-head or neck

37205

2,889.89

Transcatheter placement of an intravascular stent(s) (except coronary, carotid, and vertebral vessel), percutaneous; initial vessel

37206

1,714.00

Transcatheter placement of an intravascular stent(s) (except coronary, carotid, and vertebral vessel), percutaneous; each additional vessel (List separately in addition to code for primary procedure)

37207

444.93

Transcatheter placement of an intravascular stent(s) (non-coronary vessel), open; initial vessel

37208

213.13

Transcatheter placement of an intravascular stent(s) (non-coronary vessel), open; each additional vessel (List separately in addition to code for primary procedure)

37209

116.52

Exchange of a previously placed intravascular catheter during thrombolytic therapy

37210

4,214.51

Uterine fibroid embolization (UFE, embolization of the uterine arteries to treat uterine fibroids, leiomyomata), percutaneous approach inclusive of vascular access, vessel selection, embolization, and all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the procedure

37215

1,139.38

Transcatheter placement of intravascular stent(s), cervical carotid artery, percutaneous; with distal embolic protection

37216

1,010.32

Transcatheter placement of intravascular stent(s),

cervical carotid artery, percutaneous; without distal embolic protection

37250

112.98

Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure)

37251

84.26

Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; each additional vessel (List separately in addition to code for primary procedure)

37500

1,904.22

720.94

Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS)

37501

I.C.

Unlisted vascular endoscopy procedure

37565

696.19

Ligation, internal jugular vein

37600

729.63

Ligation; external carotid artery

37605

828.94

Ligation; internal or common carotid artery

37606

551.39

Ligation; internal or common carotid artery, with gradual occlusion, as with Selverstone or Crutchfield clamp

37607

1,154.79

388.26

Ligation or banding of angioaccess arteriovenous fistula

37609

719.48

314.13

Ligation or biopsy, temporal artery

37615

472.68

Ligation, major artery (eg, post-traumatic, rupture); neck

37616

1,083.49

Ligation, major artery (eg, post-traumatic, rupture); chest

37617

1,291.48

Ligation, major artery (eg, post-traumatic, rupture); abdomen

37618

383.87

Ligation, major artery (eg, post-traumatic, rupture); extremity

37620

676.42

Interruption, partial or complete, of inferior vena cava by suture, ligation, plication, clip, extravascular, intravascular (umbrella device)

37650

1,154.79

522.70

Ligation of femoral vein

37660

1,216.03

Ligation of common iliac vein

37700

1,154.79

263.48

Ligation and division of long saphenous vein at saphenofemoral junction, or distal interruptions

37718

1,154.79

418.43

Ligation, division, and stripping, short saphenous vein

37722

1,904.22

488.07

Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below

37735

1,904.22

648.19

Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia

37760

1,154.79

634.15

Ligation of perforator veins, subfascial, radical (Linton type), with or without skin graft, open

37765

1,154.79

463.15

Stab phlebectomy of varicose veins, one extremity; ten - 20 stab incisions

37766

1,154.79

559.19

Stab phlebectomy of varicose veins, one extremity; more than 20 incisions

37780

1,154.79

268.61

Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure)

37785

1,154.79

381.22

Ligation, division, and/or excision of varicose vein cluster(s), one leg

37788

1,346.72

Penile revascularization, artery, with or without vein graft

37790

1,516.30

522.56

Penile venous occlusive procedure

37799

I.C.

Unlisted procedure, vascular surgery

38100

1,021.96

Splenectomy; total (separate procedure)

38101

1,035.52

Splenectomy; partial (separate procedure)

38102

248.25

plenectomy; total, en bloc for extensive disease, in conjunction with other procedure (List in addition to code for primary procedure)

38115

1,131.00

Repair of ruptured spleen (splenorrhaphy) with or

without partial splenectomy

38120

976.41

Laparoscopy, surgical, splenectomy

38129

I.C.

Unlisted laparoscopy procedure, spleen

38200

139.90

Injection procedure for splenoportography

38204

91.26

Management of recipient hematopoietic progenitor cell donor search and cell acquisition

38205

514.17

80.93

Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; allogenic

38206

514.17

81.39

Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; autologous

38207

49.10

Transplant preparation of hematopoietic progenitor cells; cryopreservation and storage

38208

31.23

Transplant preparation of hematopoietic progenitor cells; thawing of previously frozen harvest, without washing

38209

13.56

Transplant preparation of hematopoietic progenitor cells; thawing of previously frozen harvest, with washing

38210

87.18

Transplant preparation of hematopoietic progenitor cells; specific cell depletion within harvest, T-cell depletion

38211

78.54

Transplant preparation of hematopoietic progenitor

cells; tumor cell depletion

38212

52.03

Transplant preparation of hematopoietic progenitor cells; red blood cell removal

38213

13.56

Transplant preparation of hematopoietic progenitor cells; platelet depletion

38214

44.53

Transplant preparation of hematopoietic progenitor cells; plasma (volume) depletion

38215

52.03

Transplant preparation of hematopoietic progenitor cells; cell concentration in plasma, mononuclear, or buffy coat layer

38220

117.68

185.66

Bone marrow; aspiration only

38221

123.56

203.53

Bone marrow; biopsy, needle or trocar

38230

1,367.62

324.64

Bone marrow harvesting for transplantation

38240

1,367.62

124.89

Bone marrow or blood-derived peripheral stem cell transplantation; allogenic

38241

514.17

125.35

Bone marrow or blood-derived peripheral stem cell transplantation; autologous

38242

516.57

94.38

Bone marrow or blood-derived peripheral stem cell transplantation; allogeneic donor lymphocyte infusions

38300

818.67

281.42

Drainage of lymph node abscess or lymphadenitis; simple

38305

1,025.97

448.86

Drainage of lymph node abscess or lymphadenitis; extensive

38308

1,025.97

422.80

Lymphangiotomy or other operations on lymphatic channels

38380

554.11

Suture and/or ligation of thoracic duct; cervical approach

38381

808.50

Suture and/or ligation of thoracic duct; thoracic approach

38382

657.67

Suture and/or ligation of thoracic duct; abdominal approach

38500

1,025.97

314.29

Biopsy or excision of lymph node(s); open, superficial

38505

317.95

137.36

Biopsy or excision of lymph node(s); by needle, superficial (eg, cervical, inguinal, axillary)

38510

1,025.97

501.77

Biopsy or excision of lymph node(s); open, deep cervical node(s)

38520

1,025.97

441.98

Biopsy or excision of lymph node(s); open, deep cervical node(s) with excision scalene fat pad

38525

1,025.97

396.36

Biopsy or excision of lymph node(s); open, deep axillary node(s)

38530

1,025.97

511.67

Biopsy or excision of lymph node(s); open, internal mammary node(s)

38542

1,980.76

419.81

Dissection, deep jugular node(s)

38550

1,025.97

453.75

Excision of cystic hygroma, axillary or cervical; without deep neurovascular dissection

38555

1,025.97

947.01

Excision of cystic hygroma, axillary or cervical; with deep neurovascular dissection

38562

674.39

Limited lymphadenectomy for staging (separate procedure); pelvic and para-aortic

38564

665.77

Limited lymphadenectomy for staging (separate procedure); retroperitoneal (aortic and/or splenic)

38570

2,034.73

534.83

Laparoscopy, surgical; with retroperitoneal lymph node sampling (biopsy), single or multiple

38571

3,113.22

822.67

Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy

38572

2,034.73

932.55

Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling (biopsy), single or multiple

38589

I.C.

Unlisted laparoscopy procedure, lymphatic system

38700

1,025.97

748.18

Suprahyoid lymphadenectomy

38720

1,227.25

Cervical lymphadenectomy (complete)

38724

1,326.01

Cervical lymphadenectomy (modified radical neck dissection)

38740

1,980.76

629.22

Axillary lymphadenectomy; superficial

38745

1,980.76

799.19

Axillary lymphadenectomy; complete

38746

257.70

Thoracic lymphadenectomy, regional, including mediastinal and peritracheal nodes (List separately in addition to code for primary procedure)

38747

253.46

Abdominal lymphadenectomy, regional, including celiac, gastric, portal, peripancreatic, with or without para-aortic and vena caval nodes (List separately in addition to code for primary procedure)

38760

1,025.97

789.24

Inguinofemoral lymphadenectomy, superficial, including Cloquets node (separate procedure)

38765

1,212.90

Inguinofemoral lymphadenectomy, superficial, in

continuity with pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes (separate procedure)

38770

806.04

Pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes (separate procedure)

38780

1,028.57

Retroperitoneal transabdominal lymphadenectomy, extensive, including pelvic, aortic, and renal nodes (separate procedure)

38790

82.46

Injection procedure; lymphangiography

38792

40.73

Injection procedure; for identification of sentinel node

38794

315.93

Cannulation, thoracic duct

38999

I.C.

Unlisted procedure, hemic or lymphatic system

39000

487.69

Mediastinotomy with exploration, drainage, removal of foreign body, or biopsy; cervical approach

39010

819.81

Mediastinotomy with exploration, drainage, removal of foreign body, or biopsy; transthoracic approach, including either transthoracic or median sternotomy

39200

890.57

Excision of mediastinal cyst

39220

1,138.03

Excision of mediastinal tumor

39400

504.85

Mediastinoscopy, with or without biopsy

39499

I.C.

Unlisted procedure, mediastinum

39501

810.22

Repair, laceration of diaphragm, any approach

39502

964.76

Repair, paraesophageal hiatus hernia, transabdominal, with or without fundoplasty, vagotomy, and/or pyloroplasty, except neonatal

39503

5,438.71

Repair, neonatal diaphragmatic hernia, with or without chest tube insertion and with or without creation of ventral hernia

39520

976.47

Repair, diaphragmatic hernia (esophageal hiatal); transthoracic

39530

924.52

Repair, diaphragmatic hernia (esophageal hiatal); combined, thoracoabdominal

39531

976.11

Repair, diaphragmatic hernia (esophageal hiatal); combined, thoracoabdominal, with dilation of stricture (with or without gastroplasty)

39540

823.70

Repair, diaphragmatic hernia (other than neonatal), traumatic; acute

39541

884.23

Repair, diaphragmatic hernia (other than neonatal), traumatic; chronic

39545

886.20

Imbrication of diaphragm for eventration, transthoracic or transabdominal, paralytic or nonparalytic

39560

762.06

Resection, diaphragm; with simple repair (eg, primary suture)

39561

1,177.21

Resection, diaphragm; with complex repair (eg, prosthetic material, local muscle flap)

39599

I.C.

Unlisted procedure, diaphragm

40490

68.03

128.31

Biopsy of lip

40500

729.71

500.52

Vermilionectomy (lip shave), with mucosal advancement

40510

1,071.

7

483.99

Excision of lip; transverse wedge excision with primary closure

40520

729.71

511.03

Excision of lip; V-excision with primary direct linear closure

40525

1,071.47

553.19

Excision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan)

40527

1,071.47

653.88

Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander)

40530

1,071.47

556.98

Resection of lip, more than one-fourth, without reconstruction

40650

332.81

431.50

Repair lip, full thickness; vermilion only

40652

332.81

508.30

Repair lip, full thickness; up to half vertical height

40654

332.81

585.67

Repair lip, full thickness; over one-half vertical height, or complex

40700

1,782.06

913.72

Plastic repair of cleft lip/nasal deformity; primary, partial or complete, unilateral

40701

1,782.06

1,071.86

Plastic repair of cleft lip/nasal deformity; primary bilateral, one stage procedure

40702

1,782.06

841.52

Plastic repair of cleft lip/nasal deformity; primary bilateral, one of two stages

40720

1,782.06

997.33

Plastic repair of cleft lip/nasal deformity; secondary, by recreation of defect and reclosure

40761

1,782.06

1,044.47

Plastic repair of cleft lip/nasal deformity; with cross lip pedicle flap (Abbe-Estlander type), including sectioning and inserting of pedicle

40799

I.C.

Unlisted procedure, lips

40800

62.85

201.02

Drainage of abscess, cyst, hematoma, vestibule of mouth; simple

40801

332.81

301.87

Drainage of abscess, cyst, hematoma, vestibule of mouth; complicated

40804

28.19

211.56

Removal of embedded foreign body, vestibule of mouth; simple

40805

176.51

324.20

Removal of embedded foreign body, vestibule of mouth; complicated

40806

78.33

109.82

Incision of labial frenum (frenotomy)

40808

111.73

180.53

Biopsy, vestibule of mouth

40810

120.61

200.74

Excision of lesion of mucosa and submucosa, vestibule of mouth; without repair

40812

151.87

278.04

Excision of lesion of mucosa and submucosa, vestibule of mouth; with simple repair

40814

729.71

374.95

Excision of lesion of mucosa and submucosa, vestibule of mouth; with complex repair

40816

1,071.47

393.32

Excision of lesion of mucosa and submucosa, vestibule of mouth; complex, with excision of underlying muscle

40818

111.73

352.32

Excision of mucosa of vestibule of mouth as donor graft

40819

332.81

299.93

Excision of frenum, labial or buccal (frenumectomy, frenulectomy, frenectomy)

40820

169.52

260.33

Destruction of lesion or scar of vestibule of mouth by physical methods (eg, laser, thermal, cryo, chemical)

40830

111.73

245.06

Closure of laceration, vestibule of mouth; 2.5 cm or less

40831

332.81

322.19

Closure of laceration, vestibule of mouth; over 2.5 cm or complex

40840

1,071.47

796.82

Vestibuloplasty; anterior

40842

1,071.47

807.41

Vestibuloplasty; posterior, unilateral

40843

1,071.47

1,008.78

Vestibuloplasty; posterior, bilateral

40844

1,782.06

1,339.14

Vestibuloplasty; entire arch

40845

1,782.06

1,475.17

Vestibuloplasty; complex (including ridge extension, muscle repositioning)

40899

I.C.

Unlisted procedure, vestibule of mouth

41000

89.36

160.97

Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; lingual

41005

111.73

223.59

Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; sublingual, superficial

41006

1,071.47

357.68

Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; sublingual, deep, supramylohyoid

41007

729.71

357.69

Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; submental space

41008

729.71

363.42

Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; submandibular space

41009

111.73

386.58

Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; masticator space

41010

332.81

207.44

Incision of lingual frenum (frenotomy)

41015

111.73

419.63

Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; sublingual

41016

332.81

428.70

Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; submental

41017

332.81

432.84

Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; submandibular

41018

332.81

492.76

Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; masticator space

41019

1,071.47

470.48

Placement of needles, catheters, or other device(s) into the head and/or neck region (percutaneous, transoral, or transnasal) for subsequent interstitial radioelement application

41100

93.77

169.33

Biopsy of tongue; anterior two-thirds

41105

91.57

167.67

Biopsy of tongue; posterior one-third

41108

84.58

145.40

Biopsy of floor of mouth

41110

122.09

208.95

Excision of lesion of tongue without closure

41112

729.71

327.13

Excision of lesion of tongue with closure; anterior two-thirds

41113

729.71

356.60

Excision of lesion of tongue with closure; posterior one-third

41114

1,071.47

632.96

Excision of lesion of tongue with closure; with local tongue flap

41115

137.54

237.63

Excision of lingual frenum (frenectomy)

41116

729.71

319.53

Excision, lesion of floor of mouth

41120

1,071.47

1,078.78

Glossectomy; less than one-half tongue

41130

1,296.19

Glossectomy; hemiglossectomy

41135

2,113.08

Glossectomy; partial, with unilateral radical neck dissection

41140

2,208.85

Glossectomy; complete or total, with or without tracheostomy, without radical neck dissection

41145

2,726.91

Glossectomy; complete or total, with or without tracheostomy, with unilateral radical neck dissection

41150

2,165.97

Glossectomy; composite procedure with resection floor of mouth and mandibular resection, without radical neck dissection

41153

2,323.76

Glossectomy; composite procedure with resection floor of mouth, with suprahyoid neck dissection

41155

2,823.96

Glossectomy; composite procedure with resection floor of mouth, mandibular resection, and radical neck dissection (Commando type)

41250

111.73

223.18

Repair of laceration 2.5 cm or less; floor of mouth and/or anterior two-thirds of tongue

41251

111.73

240.36

Repair of laceration 2.5 cm or less; posterior one-third of tongue

41252

332.81

305.94

Repair of laceration of tongue, floor of mouth, over 2.6 cm or complex

41500

1,071.47

481.44

Fixation of tongue, mechanical, other than suture (eg, K-wire)

41510

729.71

455.65

Suture of tongue to lip for micrognathia (Douglas type procedure)

41520

332.81

342.94

Frenoplasty (surgical revision of frenum, eg, with Z-plasty)

41599

I.C.

Unlisted procedure, tongue, floor of mouth

41800

62.85

215.21

Drainage of abscess, cyst, hematoma from dentoalveolar structures

41805

134.22

216.06

Removal of embedded foreign body from dentoalveolar structures; soft tissues

41806

172.83

321.09

Removal of embedded foreign body from dentoalveolar structures; bone

41820

332.81

I.C.

Gingivectomy, excision gingiva, each quadrant

41821

332.81

I.C.

Operculectomy, excision pericoronal tissues

41822

159.60

289.75

Excision of fibrous tuberosities, dentoalveolar structures

41823

221.01

414.66

Excision of osseous tuberosities, dentoalveolar structures

41825

123.93

206.16

Excision of lesion or tumor (except listed above), dentoalveolar structures; without repair

41826

138.27

262.29

Excision of lesion or tumor (except listed above), dentoalveolar structures; with simple repair

41827

1,071.47

417.35

Excision of lesion or tumor (except listed above), dentoalveolar structures; with complex repair

41828

144.89

301.19

Excision of hyperplastic alveolar mucosa, each quadrant (specify)

41830

201.15

380.37

Alveolectomy, including curettage of osteitis or sequestrectomy

41850

729.71

I.C.

Destruction of lesion (except excision), dentoalveolar structures

41870

1,071.47

I.C.

Periodontal mucosal grafting

41872

203.36

362.54

Gingivoplasty, each quadrant (specify)

41874

193.06

362.00

Alveoloplasty, each quadrant (specify)

41899

I.C.

Unlisted procedure, dentoalveolar structures

42000

111.73

162.27

Drainage of abscess of palate, uvula

42100

80.17

149.65

Biopsy of palate, uvula

42104

112.53

202.32

Excision, lesion of palate, uvula; without closure

42106

140.84

256.63

Excision, lesion of palate, uvula; with simple primary closure

42107

1,071.47

448.30

Excision, lesion of palate, uvula; with local flap closure

42120

1,782.06

968.78

Resection of palate or extensive resection of lesion

42140

332.81

251.25

Uvulectomy, excision of uvula

42145

1,071.47

693.03

Palatopharyngoplasty (eg, uvulopalatopharyngoplasty, uvulopharyngoplasty)

42160

147.46

251.81

Destruction of lesion, palate or uvula (thermal, cryo or chemical)

42180

111.73

240.55

Repair, laceration of palate; up to 2 cm

42182

1,782.06

323.99

Repair, laceration of palate; over 2 cm or complex

42200

1,782.06

895.37

Palatoplasty for cleft palate, soft and/or hard palate only

42205

1,782.06

912.05

Palatoplasty for cleft palate, with closure of alveolar ridge; soft tissue only

42210

1,782.06

1,073.98

Palatoplasty for cleft palate, with closure of alveolar ridge; with bone graft to alveolar ridge (includes obtaining graft)

42215

1,782.06

722.19

Palatoplasty for cleft palate; major revision

42220

1,782.06

585.47

Palatoplasty for cleft palate; secondary lengthening procedure

42225

1,030.37

Palatoplasty for cleft palate; attachment pharyngeal flap

42226

42227

1,782.06

980.64

992.53

Lengthening of palate, and pharyngeal flap Lengthening of palate, with island flap

42235

729.71

803.37

Repair of anterior palate, including vomer flap

42260

1,071.47

841.51

Repair of nasolabial fistula

42280

77.22

155.62

Maxillary impression for palatal prosthesis

42281

42299

729.71

201.93 I.C.

Insertion of pin-retained palatal prosthesis Unlisted procedure, palate, uvula

42300

729.71

208.54

Drainage of abscess; parotid, simple

42305

729.71

428.68

Drainage of abscess; parotid, complicated

42310

111.73

162.79

Drainage of abscess; submaxillary or sublingual, intraoral

42320

111.73

248.77

Drainage of abscess; submaxillary, external

42330

120.25

232.81

Sialolithotomy; submandibular (submaxillary), sublingual or parotid, uncomplicated, intraoral

42335

196.00

368.86

Sialolithotomy; submandibular (submaxillary), complicated, intraoral

42340

729.71

464.67

Sialolithotomy; parotid, extraoral or complicated intraoral

42400

66.92

112.20

Biopsy of salivary gland; needle

42405

729.71

304.60

Biopsy of salivary gland; incisional

42408

729.71

453.86

Excision of sublingual salivary cyst (ranula)

42409

729.71

331.86

Marsupialization of sublingual salivary cyst (ranula)

42410

1,782.06

617.23

Excision of parotid tumor or parotid gland; lateral lobe, without nerve dissection

42415

1,782.06

1,105.87

Excision of parotid tumor or parotid gland; lateral lobe, with dissection and preservation of facial nerve

42420

1,782.06

1,267.41

Excision of parotid tumor or parotid gland; total, with dissection and preservation of facial nerve

42425

1,782.06

841.26

Excision of parotid tumor or parotid gland; total, en bloc removal with sacrifice of facial nerve

42426

1,354.08

Excision of parotid tumor or parotid gland; total, with unilateral radical neck dissection

42440

1,782.06

457.70

Excision of submandibular (submaxillary) gland

42450

1,071.47

454.31

Excision of sublingual gland

42500

1,071.47

432.04

Plastic repair of salivary duct, sialodochoplasty; primary or simple

42505

1,782.06

560.60

Plastic repair of salivary duct, sialodochoplasty; secondary or complicated

42507

1,782.06

521.43

Parotid duct diversion, bilateral (Wilke type procedure);

42508

1,782.06

723.86

Parotid duct diversion, bilateral (Wilke type procedure); with excision of one submandibular gland

42509

1,782.06

865.67

Parotid duct diversion, bilateral (Wilke type procedure); with excision of both submandibular glands

42510

1,782.06

640.11

Parotid duct diversion, bilateral (Wilke type procedure); with ligation of both submandibular (Wharton's) ducts

42550

171.35

Injection procedure for sialography

42600

729.71

481.69

Closure salivary fistula

42650

43.76

83.16

Dilation salivary duct

42660

51.49

105.72

Dilation and catheterization of salivary duct, with or without injection

42665

1,071.47

305.91

Ligation salivary duct, intraoral

42699

I.C.

Unlisted procedure, salivary glands or ducts

42700

111.73

189.23

Incision and drainage abscess; peritonsillar

42720

729.71

447.73

Incision and drainage abscess; retropharyngeal or parapharyngeal, intraoral approach

42725

1,782.06

798.67

Incision and drainage abscess; retropharyngeal or parapharyngeal, external approach

42800

85.32

158.68

Biopsy; oropharynx

42802

729.71

261.69

Biopsy; hypopharynx

42804

729.71

214.48

Biopsy; nasopharynx, visible lesion, simple

42806

1,071.47

240.34

Biopsy; nasopharynx, survey for unknown primary lesion

42808

729.71

230.36

Excision or destruction of lesion of pharynx, any method

42809

28.19

172.22

Removal of foreign body from pharynx

42810

1,071.47

396.15

Excision branchial cleft cyst or vestige, confined to skin and subcutaneous tissues

42815

1,782.06

556.96

Excision branchial cleft cyst, vestige, or fistula, extending beneath subcutaneous tissues and/or into pharynx

42821

994.57

307.24

Tonsillectomy and adenoidectomy; age 12 or over

42826

994.57

255.82

Tonsillectomy, primary or secondary; age 12 or over

42831

994.57

227.07

Adenoidectomy, primary; age 12 or over

42836

994.57

246.73

Adenoidectomy, secondary; age 12 or over

42842

961.93

Radical resection of tonsil, tonsillar pillars, and/or retromolar trigone; without closure

42844

1,364.67

Radical resection of tonsil, tonsillar pillars, and/or retromolar trigone; closure with local flap (eg, tongue, buccal)

42845

2,185.08

Radical resection of tonsil, tonsillar pillars, and/or retromolar trigone; closure with other flap

42860

994.57

190.38

Excision of tonsil tags

42870

994.57

596.61

Excision or destruction lingual tonsil, any method (separate procedure)

42890

994.57

1,354.53

Limited pharyngectomy

42892

994.57

1,755.95

Resection of lateral pharyngeal wall or pyriform sinus direct closure by advancement of lateral and posterior pharyngeal walls

42894

2,252.58

Resection of pharyngeal wall requiring closure with myocutaneous flap

42900

332.81

346.93

Suture pharynx for wound or injury

42950

1,071.47

828.13

Pharyngoplasty (plastic or reconstructive operation on pharynx)

42953

1,061.13

Pharyngoesophageal repair

42955

1,071.47

772.63

Pharyngostomy (fistulization of pharynx, external for feeding)

42960

50.28

170.62

Control oropharyngeal hemorrhage, primary or secondary (eg, post-tonsillectomy); simple

42961

425.02

Control oropharyngeal hemorrhage, primary or secondary (eg, post-tonsillectomy); complicated, requiring hospitalization

42962

1,782.06

522.43

Control oropharyngeal hemorrhage, primary or secondary (eg, post-tonsillectomy); with secondary surgical intervention

42970

50.28

386.94

Control of nasopharyngeal hemorrhage, primary or secondary (eg, postadenoidectomy); simple, with posterior nasal packs, with or without anterior packs and/or cautery

42971

459.98

Control of nasopharyngeal hemorrhage, primary or secondary (eg, postadenoidectomy); complicated, requiring hospitalization

42972

729.71

521.93

Control of nasopharyngeal hemorrhage, primary or secondary (eg, postadenoidectomy); with secondary surgical intervention

42999

I.C.

Unlisted procedure, pharynx, adenoids, or tonsils

43020

534.14

Esophagotomy, cervical approach, with removal of foreign body

43030

729.71

521.66

Cricopharyngeal myotomy

43045

1,279.28

Esophagotomy, thoracic approach, with removal of foreign body

43100

617.22

Excision of lesion, esophagus, with primary repair; cervical approach

43101

996.22

Excision of lesion, esophagus, with primary repair; thoracic or abdominal approach

43107

2,453.25

Total or near total esophagectomy, without thoracotomy; with pharyngogastrostomy or cervical esophagogastrostomy, with or without pyloroplasty (transhiatal)

43108

3,835.21

Total or near total esophagectomy, without thoracotomy; with colon interposition or small intestine reconstruction, including intestine mobilization, preparation and anastomosis(es)

43112

2,625.81

Total or near total esophagectomy, with thoracotomy; with pharyngogastrostomy or cervical esophagogastrostomy, with or without pyloroplasty

43113

3,790.72

Total or near total esophagectomy, with thoracotomy; with colon interposition or small intestine reconstruction, including intestine mobilization, preparation, and anastomosis(es)

43116

4,342.10

Partial esophagectomy, cervical, with free intestinal graft, including microvascular anastomosis, obtaining the graft and intestinal reconstruction

43117

2,388.05

Partial esophagectomy, distal two-thirds, with thoracotomy and separate abdominal incision, with or without proximal gastrectomy; with thoracic esophagogastrostomy, with or without pyloroplasty (Ivor Lewis)

43118

3,218.86

Partial esophagectomy, distal two-thirds, with thoracotomy and separate abdominal incision, with or without proximal gastrectomy; with colon interposition or small intestine reconstruction, including intestine mobilization, preparation, and anastomosis(es)

43121

2,601.54

Partial esophagectomy, distal two-thirds, with thoracotomy only, with or without proximal gastrectomy, with thoracic esophagogastrostomy, with or without pyloroplasty

43122

2,423.66

Partial esophagectomy, thoracoabdominal or abdominal approach, with or without proximal gastrectomy; with esophagogastrostomy, with or without pyloroplasty

43123

3,873.76

Partial esophagectomy, thoracoabdominal or abdominal approach, with or without proximal gastrectomy; with colon interposition or small intestine reconstruction, including intestine mobilization, preparation, and anastomosis(es)

43124

3,324.28

Total or partial esophagectomy, without reconstruction (any approach), with cervical esophagostomy

43130

779.30

Diverticulectomy of hypopharynx or esophagus, with or without myotomy; cervical approach

43135

1,375.65

Diverticulectomy of hypopharynx or esophagus, with or without myotomy; thoracic approach

43200

379.98

239.07

Esophagoscopy, rigid or flexible; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)

43201

379.98

311.98

Esophagoscopy, rigid or flexible; with directed submucosal injection(s), any substance

43202

379.98

315.74

Esophagoscopy, rigid or flexible; with biopsy, single or multiple

43204

379.98

218.38

Esophagoscopy, rigid or flexible; with injection sclerosis of esophageal varices

43205

379.98

219.84

Esophagoscopy, rigid or flexible; with band ligation of esophageal varices

43215

379.98

152.44

Esophagoscopy, rigid or flexible; with removal of foreign body

43216

379.98

183.22

Esophagoscopy, rigid or flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery

43217

379.98

418.42

Esophagoscopy, rigid or flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

43219

1,116.3

7

169.54

Esophagoscopy, rigid or flexible; with insertion of plastic tube or stent

43220

379.98

125.13

Esophagoscopy, rigid or flexible; with balloon dilation (less than 30 mm diameter)

43226

43227

379.98

379.98

138.98

205.07

Esophagoscopy, rigid or flexible; with insertion of guide wire followed by dilation over guide wire Esophagoscopy, rigid or flexible; with control of

bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)

43228

1,131.65

217.74

Esophagoscopy, rigid or flexible; with ablation of tumor(s), polyp(s), or other lesion(s), not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique

43231

379.98

186.23

Esophagoscopy, rigid or flexible; with endoscopic ultrasound examination

43232

379.98

259.47

Esophagoscopy, rigid or flexible; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s)

43234

379.98

311.23

Upper gastrointestinal endoscopy, simple primary examination (eg, with small diameter flexible endoscope) (separate procedure)

43235

379.98

328.02

Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)

43236

379.98

407.94

Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed submucosal injection(s), any substance

43237

379.98

235.31

Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with endoscopic ultrasound examination limited to the esophagus

43238

379.98

288.77

Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s), esophagus (includes endoscopic ultrasound examination limited to the esophagus)

43239

379.98

375.69

Upper gastrointestinal endoscopy including

esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple

43240

379.98

386.45

Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with transmural drainage of pseudocyst

43241

379.98

152.26

Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with transendoscopic intraluminal tube or catheter placement

43242

379.98

412.88

Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s) (includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum and/or jejunum as appropriate)

43243

379.98

261.32

Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with injection sclerosis of esophageal and/or gastric varices

43244

379.98

289.50

Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with band ligation of esophageal and/or gastric varices

43245

379.98

183.57

Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with dilation of gastric outlet for obstruction (eg, balloon, guide wire, bougie)

43246

379.98

245.14

Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube

43247

379.98

196.22

Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with removal of foreign body

43248

379.98

185.33

Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with insertion of guide wire followed by dilation of esophagus over guide wire

43249

379.98

170.51

Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with balloon dilation of esophagus (less than 30 mm diameter)

43250

379.98

184.25

Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery

43251

379.98

212.93

Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

43255

379.98

276.44

Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with control of bleeding, any method

43256

1,116.37

248.91

Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with transendoscopic stent placement (includes predilation)

43257

1,131.65

298.46

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

43258

379.98

260.64

Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique

43259

379.98

295.40

Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with endoscopic ultrasound examination, including the esophagus, stomach, and either the duodenum and/or jejunum as appropriate

43260

936.26

338.94

Endoscopic retrograde cholangiopancreatography (ERCP); diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)

43261

936.26

356.40

Endoscopic retrograde cholangiopancreatography (ERCP); with biopsy, single or multiple

43262

936.26

418.21

Endoscopic retrograde cholangiopancreatography (ERCP); with sphincterotomy/papillotomy

43263

936.26

412.04

Endoscopic retrograde cholangiopancreatography (ERCP); with pressure measurement of sphincter of Oddi (pancreatic duct or common bile duct)

43264

936.26

501.60

Endoscopic retrograde cholangiopancreatography (ERCP); with endoscopic retrograde removal of calculus/calculi from biliary and/or pancreatic ducts

43265

936.26

563.07

Endoscopic retrograde cholangiopancreatography (ERCP); with endoscopic retrograde destruction, lithotripsy of calculus/calculi, any method

43267

936.26

410.39

Endoscopic retrograde cholangiopancreatography (ERCP); with endoscopic retrograde insertion of nasobiliary or nasopancreatic drainage tube

43268

1,116.37

424.20

Endoscopic retrograde cholangiopancreatography (ERCP); with endoscopic retrograde insertion of tube or stent into bile or pancreatic duct

43269

1,116.37

463.20

Endoscopic retrograde cholangiopancreatography (ERCP); with endoscopic retrograde removal of foreign body and/or change of tube or stent

43271

936.26

417.75

Endoscopic retrograde cholangiopancreatography (ERCP); with endoscopic retrograde balloon dilation of ampulla, biliary and/or pancreatic duct(s)

43272

936.26

419.13

Endoscopic retrograde cholangiopancreatography (ERCP); with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique

43280

1,003.27

Laparoscopy, surgical, esophagogastric fundoplasty (eg, Nissen, Toupet procedures)

43289

I.C.

Unlisted laparoscopy procedure, esophagus

43300

619.60

Esophagoplasty (plastic repair or reconstruction), cervical approach; without repair of tracheoesophageal fistula

43305

1,098.24

Esophagoplasty (plastic repair or reconstruction), cervical approach; with repair of tracheoesophageal fistula

43310

1,482.61

Esophagoplasty (plastic repair or reconstruction), thoracic approach; without repair of tracheoesophageal fistula

43312

1,628.65

Esophagoplasty (plastic repair or reconstruction), thoracic approach; with repair of tracheoesophageal fistula

43313

2,644.05

Esophagoplasty for congenital defect (plastic repair or reconstruction), thoracic approach; without repair of congenital tracheoesophageal fistula

43314

2,803.42

Esophagoplasty for congenital defect (plastic repair or reconstruction), thoracic approach; with repair of congenital tracheoesophageal fistula

43320

1,283.68

Esophagogastrostomy (cardioplasty), with or without vagotomy and pyloroplasty, transabdominal or transthoracic approach

43324

1,257.24

Esophagogastric fundoplasty (eg, Nissen, Belsey IV, Hill procedures)

43325

1,240.51

Esophagogastric fundoplasty; with fundic patch (Thal-Nissen procedure)

43326

1,267.46

Esophagogastric fundoplasty; with gastroplasty (eg, Collis)

43330

1,214.98

Esophagomyotomy (Heller type); abdominal approach

43331

1,322.56

Esophagomyotomy (Heller type); thoracic approach

43340

1,274.49

Esophagojejunostomy (without total gastrectomy); abdominal approach

43341

1,363.29

Esophagojejunostomy (without total gastrectomy); thoracic approach

43350

1,097.71

Esophagostomy, fistulization of esophagus, external; abdominal approach

43351

1,296.22

Esophagostomy, fistulization of esophagus, external; thoracic approach

43352

1,041.45

Esophagostomy, fistulization of esophagus, external; cervical approach

43360

2,201.25

Gastrointestinal reconstruction for previous esophagectomy, for obstructing esophageal lesion or fistula, or for previous esophageal exclusion; with stomach, with or without pyloroplasty

43361

2,494.81

Gastrointestinal reconstruction for previous esophagectomy, for obstructing esophageal lesion or fistula, or for previous esophageal exclusion; with colon interposition or small intestine reconstruction, including intestine mobilization, preparation, and anastomosis(es)

43400

1,458.62

Ligation, direct, esophageal varices

43401

1,429.62

Transection of esophagus with repair, for esophageal varices

43405

1,389.61

Ligation or stapling at gastroesophageal junction for pre-existing esophageal perforation

43410

959.52

Suture of esophageal wound or injury; cervical approach

43415

1,628.39

Suture of esophageal wound or injury; transthoracic or transabdominal approach

43420

953.80

Closure of esophagostomy or fistula; cervical approach

43425

1,411.74

Closure of esophagostomy or fistula; transthoracic or transabdominal approach

43450

261.12

172.85

Dilation of esophagus, by unguided sound or bougie, single or multiple passes

43453

261.12

339.77

Dilation of esophagus, over guide wire

43456

261.12

710.06

Dilation of esophagus, by balloon or dilator, retrograde

43458

379.98

424.20

Dilation of esophagus with balloon (30 mm diameter or larger) for achalasia

43460

213.26

Esophagogastric tamponade, with balloon (Sengstaaken type)

43496

I.C.

Free jejunum transfer with microvascular anastomosis

43499

I.C.

Unlisted procedure, esophagus

43500

713.55

Gastrotomy; with exploration or foreign body removal

43501

1,224.06

Gastrotomy; with suture repair of bleeding ulcer

43502

1,390.00

Gastrotomy; with suture repair of pre-existing esophagogastric laceration (eg, Mallory-Weiss)

43510

918.63

Gastrotomy; with esophageal dilation and insertion of permanent intraluminal tube (eg, Celestin or Mousseaux-Barbin)

43520

655.49

Pyloromyotomy, cutting of pyloric muscle (Fredet-Ramstedt type operation)

43600

379.98

102.09

Biopsy of stomach; by capsule, tube, peroral (one or more specimens)

43605

757.94

Biopsy of stomach; by laparotomy

43610

893.63

Excision, local; ulcer or benign tumor of stomach

43611

1,108.73

Excision, local; malignant tumor of stomach

43620

1,803.51

Gastrectomy, total; with esophagoenterostomy

43621

2,027.42

Gastrectomy, total; with Roux-en-Y reconstruction

43622

2,068.85

Gastrectomy, total; with formation of intestinal pouch, any type

43631

1,330.76

Gastrectomy, partial, distal; with gastroduodenostomy

43632

1,755.38

Gastrectomy, partial, distal; with gastrojejunostomy

43633

1,680.91

Gastrectomy, partial, distal; with Roux-en-Y reconstruction

43634

1,849.93

Gastrectomy, partial, distal; with formation of intestinal pouch

43635

106.51

Vagotomy when performed with partial distal gastrectomy (List separately in addition to code(s) for primary procedure)

43640

1,067.15

Vagotomy including pyloroplasty, with or without gastrostomy; truncal or selective

43641

1,084.59

Vagotomy including pyloroplasty, with or without gastrostomy; parietal cell (highly selective)

43644

1,583.72

Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less)

43645

1,695.00

Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption

43647

I.C.

Laparoscopy, surgical; implantation or replacement of gastric neurostimulator electrodes, antrum

43648

I.C.

Laparoscopy, surgical; revision or removal of gastric neurostimulator electrodes, antrum

43651

601.61

Laparoscopy, surgical; transection of vagus nerves, truncal

43652

713.31

Laparoscopy, surgical; transection of vagus nerves, selective or highly selective

43653

2,034.73

515.24

Laparoscopy, surgical; gastrostomy, without construction of gastric tube (eg, Stamm procedure) (separate procedure)

43659

I.C.

Unlisted laparoscopy procedure, stomach

43752

40.22

Naso- or oro-gastric tube placement, requiring physician's skill and fluoroscopic guidance (includes fluoroscopy, image documentation and report)

43760

144.72

219.38

Change of gastrostomy tube, percutaneous, without imaging or endoscopic guidance

43761

379.98

123.16

Repositioning of the gastric feeding tube, through the duodenum for enteric nutrition

43770

1,023.07

Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric restrictive device (eg, gastric band and subcutaneous port components)

43771

1,165.94

Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric restrictive device component only

43772

877.00

Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device component only

43773

1,165.78

Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric restrictive device component only

43774

883.33

Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device and subcutaneous port components

43800

848.38

Pyloroplasty

43810

915.29

Gastroduodenostomy

43820

1,159.20

Gastrojejunostomy; without vagotomy

43825

1,181.03

Gastrojejunostomy; with vagotomy, any type

43830

635.11

Gastrostomy, open; without construction of gastric tube (eg, Stamm procedure) (separate procedure)

43831

534.25

Gastrostomy, open; neonatal, for feeding

43832

969.02

Gastrostomy, open; with construction of gastric tube (eg, Janeway procedure)

43840

1,180.17

Gastrorrhaphy, suture of perforated duodenal or gastric ulcer, wound, or injury

43842

1,121.65

Gastric restrictive procedure, without gastric bypass, for morbid obesity; vertical-banded gastroplasty

43843

1,152.49

Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical-banded gastroplasty

43845

1,797.03

Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch)

43846

1,486.08

Gastric restrictive procedure, with gastric bypass for

morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomy

43847

1,627.38

Gastric restrictive procedure, with gastric bypass for morbid obesity; with small intestine reconstruction to limit absorption

43848

1,760.43

Revision, open, of gastric restrictive procedure for morbid obesity, other than adjustable gastric restrictive device (separate procedure)

43850

1,480.18

Revision of gastroduodenal anastomosis (gastroduodenostomy) with reconstruction; without vagotomy

43855

1,540.34

Revision of gastroduodenal anastomosis (gastroduodenostomy) with reconstruction; with vagotomy

43860

1,494.88

Revision of gastrojejunal anastomosis (gastrojejunostomy) with reconstruction, with or without partial gastrectomy or intestine resection; without vagotomy

43865

1,558.43

Revision of gas trojejunal anastomosis (gastrojejunostomy) with reconstruction, with or without partial gastrectomy or intestine resection; with vagotomy

43870

379.98

643.65

Closure of gastrostomy, surgical

43880

1,463.00

Closure of gastrocolic fistula

43881

I.C.

Implantation or replacement of gastric neurostimulator electrodes, antrum, open

43882

I.C.

Revision or removal of gastric neurostimulat or electrodes, antrum, open

43886

903.02

313.94

Gastric restrictive procedure, open; revision of subcutaneous port component only

43887

202.27

294.00

Gastric restrictive procedure, open; removal of subcutaneous port component only

43888

903.02

416.50

Gastric restrictive procedure, open; removal and replacement of subcutaneous port component only

43999

I.C.

Unlisted procedure, stomach

44005

998.08

Enterolysis (freeing of intestinal adhesion) (separate procedure)

44010

786.00

Duodenotomy, for exploration, biopsy(s), or foreign body removal

44015

135.85

Tube or needle catheter jejunostomy for enteral alimentation, intraoperative, any method (List separately in addition to primary procedure)

44020

881.61

Enterotomy, small intestine, other than duodenum; for exploration, biopsy(s), or foreign body removal

44021

889.13

Enterotomy, small intestine, other than duodenum; for decompression (eg, Baker tube)

44025

895.93

Colotomy, for exploration, biopsy(s), or foreign body removal

44050

854.03

Reduction of volvulus, intussusception, internal hernia, by laparotomy

44055

1,355.20

Correction of malrotation by lysis of duodenal bands and/or reduction of midgut volvulus (eg, Ladd procedure)

44100

379.98

111.01

Biopsy of intestine by capsule, tube, peroral (one or more specimens)

44110

770.27

Excision of one or more lesions of small or large intestine not requiring anastomosis, exteriorization, or fistulization; single enterotomy

44111

898.14

Excision of one or more lesions of small or large intestine not requiring anastomosis, exteriorization, or fistulization; multiple enterotomies

44120

1,102.83

Enterectomy, resection of small intestine; single resection and anastomosis

44121

229.74

Enterectomy, resection of small intestine; each additional resection and anastomosis (List separately in addition to code for primary procedure)

44125

1,077.16

Enterectomy, resection of small intestine; with enterostomy

44126

2,213.22

Enterectomy, resection of small intestine for congenital atresia, single resection and anastomosis of proximal segment of intestine; without tapering

44127

2,571.22

Enterectomy, resection of small intestine for congenital atresia, single resection and anastomosis of proximal segment of intestine; with tapering

44128

232.94

Enterectomy, resection of small intestine for congenital atresia, single resection and anastomosis of proximal segment of intestine; each additional resection and anastomosis (List separately in addition to code for primary procedure)

44130

1,133.62

Enteroenterostomy, anastomosis of intestine, with or without cutaneous enterostomy (separate procedure)

44132

I.C.

Donor enterectomy (including cold preservation), open; from cadaver donor

44133

I.C.

Donor enterectomy (including cold preservation), open; partial, from living donor

44135

I.C.

Intestinal allotransplantation; from cadaver donor

44136

I.C.

Intestinal allotransplantation; from living donor

44137

I.C.

Removal of transplanted intestinal allograft, complete

44139

114.91

Mobilization (take-down) of splenic flexure performed in conjunction with partial colectomy (List separately in addition to primary procedure)

44140

1,232.88

Colectomy, partial; with anastomosis

44141

1,595.60

Colectomy, partial; with skin level cecostomy or colostomy

44143

1,517.63

Colectomy, partial; with end colostomy and closure of distal segment (Hartmann type procedure)

44144

1,567.29

Colectomy, partial; with resection, with colostomy or ileostomy and creation of mucofistula

44145

1,537.17

Colectomy, partial; with coloproctostomy (low pelvic anastomosis)

44146

1,905.89

Colectomy, partial; with coloproctostomy (low pelvic anastomosis), with colostomy

44147

1,670.89

Colectomy, partial; abdominal and transanal approach

44150

1,682.14

Colectomy, total, abdominal, without proctectomy; with ileostomy or ileoproctostomy

44151

1,919.61

Colectomy, total, abdominal, without proctectomy; with continent ileostomy

44155

1,882.89

Colectomy, total, abdominal, with proctectomy; with ileostomy

44156

2,068.92

Colectomy, total, abdominal, with proctectomy; with continent ileostomy

44157

2,116.62

Colectomy, total, abdominal, with proctectomy; with ileoanal anastomosis, includes loop ileostomy, and rectal mucosectomy, when performed

44158

2,170.31

Colectomy, total, abdominal, with proctectomy; with ileoanal anastomosis, creation of ileal reservoir (S or J), includes loop ileostomy, and rectal mucosectomy, when performed

44160

1,131.73

Colectomy, partial, with removal of terminal ileum with ileocolostomy

44180

851.48

Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure)

44186

605.61

Laparoscopy, surgical; jejunostomy (eg, for decompression or feeding)

44187

1,025.83

Laparoscopy, surgical; ileostomy or jejunostomy, non-tube

44188

1,125.90

Laparoscopy, surgical, colostomy or skin level cecostomy

44202

1,276.36

Laparoscopy, surgical; enterectomy, resection of small intestine, single resection and anastomosis

44203

228.98

Laparoscopy, surgical; each additional small intestine resection and anastomosis (List separately in addition to code for primary procedure)

44204

1,424.43

Laparoscopy, surgical; colectomy, partial, with anastomosis

44205

1,246.36

Laparoscopy, surgical; colectomy, partial, with removal of terminal ileum with ileocolostomy

44206

1,615.70

Laparoscopy, surgical; colectomy, partial, with end colostomy and closure of distal segment (Hartmann type procedure)

44207

1,692.52

Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis)

44208

1,851.42

Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis) with colostomy

44210

1,653.41

Laparoscopy, surgical; colectomy, total, abdominal, without proctectomy, with ileostomy or ileoproctostomy

44211

2,034.69

Laparoscopy, surgical; colectomy, total, abdominal, with proctectomy, with ileoanal anastomosis, creation of ileal reservoir (S or J), with loop ileostomy, includes rectal mucosectomy, when performed

44212

1,902.20

Laparoscopy, surgical; colectomy, total, abdominal, with proctectomy, with ileostomy

44213

180.56

Laparoscopy, surgical, mobilization (take-down) of splenic flexure performed in conjunction with partial colectomy (List separately in addition to primary procedure)

44227

1,537.09

Laparoscopy, surgical, closure of enterostomy, large or small intestine, with resection and anastomosis

44238

I.C.

Unlisted laparoscopy procedure, intestine (except rectum)

44300

768.09

Placement, enterostomy or cecostomy, tube open (eg, for feeding or decompression) (separate procedure)

44310

958.30

Ileostomy or jejunostomy, non-tube

44312

903.02

544.97

Revision of ileostomy; simple (release of superficial scar) (separate procedure)

44314

926.58

Revision of ileostomy; complicated (reconstruction in-depth) (separate procedure)

44316

1,273.24

Continent ileostomy (Kock procedure) (separate procedure)

44320

1,093.26

Colostomy or skin level cecostomy;

44322

902.03

Colostomy or skin level cecostomy; with multiple biopsies (eg, for congenital megacolon) (separate procedure)

44340

903.02

552.79

Revision of colostomy; simple (release of superficial scar) (separate procedure)

44345

959.13

Revision of colostomy; complicated (reconstruction in-depth) (separate procedure)

44346

1,071.98

Revision of colostomy; with repair of paracolostomy hernia (separate procedure)

44360

425.84

153.96

Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)

44361

425.84

169.19

Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with biopsy, single or multiple

44363

425.84

201.36

Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with removal of foreign body

44364

425.84

215.08

Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

44365

425.84

191.55

Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery

44366

425.84

254.18

Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)

44369

425.84

258.23

Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique

44370

1,116.37

279.12

Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with transendoscopic stent placement (includes predilation)

44372

425.84

249.56

Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with placement of percutaneous jejunostomy tube

44373

425.84

200.44

Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with conversion of percutaneous gastrostomy tube to percutaneous jejunostomy tube

44376

425.84

295.40

Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)

44377

425.84

313.23

Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; with biopsy, single or multiple

44378

425.84

403.21

Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)

44379

1,116.37

430.71

Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; with transendoscopic stent placement (includes predilation)

44380

425.84

68.17

Ileoscopy, through stoma; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)

44382

425.84

80.56

Ileoscopy, through stoma; with biopsy, single or multiple

44383

1,116.37

172.96

Ileoscopy, through stoma; with transendoscopic stent placement (includes predilation)

44385

395.43

256.73

Endoscopic evaluation of small intestinal (abdominal or pelvic) pouch; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)

44386

395.43

384.47

Endoscopic evaluation of small intestinal (abdominal or pelvic) pouch; with biopsy, single or multiple

44388

395.43

361.83

Colonoscopy through stoma; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)

44389

395.43

431.17

Colonoscopy through stoma; with biopsy, single or multiple

44390

395.43

495.82

Colonoscopy through stoma; with removal of foreign body

44391

395.43

564.24

Colonoscopy through stoma; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)

44392

395.43

461.55

Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery

44393

395.43

521.33

Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique

44394

395.43

537.89

Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

44397

1,116.37

263.30

Colonoscopy through stoma; with transendoscopic stent placement (includes predilation)

44500

144.72

25.45

Introduction of long gastrointestinal tube (eg, Miller-Abbott) (separate procedure)

44602

1,227.49

Suture of small intestine (enterorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture; single perforation

44603

1,403.32

Suture of small intestine (enterorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture; multiple perforations

44604

968.31

Suture of large intestine (colorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture (single or multiple perforations); without colostomy

44605

1,199.97

Suture of large intestine (colorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture (single or multiple perforations); with colostomy

44615

983.60

Intestinal stricturoplasty (enterotomy and enterorrhaphy) with or without dilation, for intestinal obstruction

44620

784.69

Closure of enterostomy, large or small intestine;

44625

929.77

Closure of enterostomy, large or small intestine; with resection and anastomosis other than colorectal

44626

1,478.24

Closure of enterostomy, large or small intestine; with resection and colorectal anastomosis (eg, closure of Hartmann type procedure)

44640

1,288.89

Closure of intestinal cutaneous fistula

44650

1,338.61

Closure of enteroenteric or enterocolic fistula

44660

1,294.33

Closure of enterovesical fistula; without intestinal or bladder resection

44661

1,451.66

Closure of enterovesical fistula; with intestine and/or bladder resection

44680

972.83

Intestinal plication (separate procedure)

44700

944.28

Exclusion of small intestine from pelvis by mesh or other prosthesis, or native tissue (eg, bladder or omentum)

44701

158.82

Intraoperative colonic lavage (List separately in addition to code for primary procedure)

44715

I.C.

Backbench standard preparation of cadaver or living donor intestine allograft prior to transplantation, including mobilization and fashioning of the superior mesenteric artery and vein

44720

250.39

Backbench reconstruction of cadaver or living donor intestine allograft prior to transplantation; venous anastomosis, each

44721

364.28

Backbench reconstruction of cadaver or living donor intestine allograft prior to transplantation; arterial anastomosis, each

44799

I.C.

Unlisted procedure, intestine

44800

702.12

Excision of Meckel's diverticulum (diverticulectomy) or omphalomesenteric duct

44820

767.57

Excision of lesion of mesentery (separate procedure)

44850

683.01

Suture of mesentery (separate procedure)

44899

I.C.

Unlisted procedure, Meckel's diverticulum and the mesentery

44900

688.30

Incision and drainage of appendiceal abscess; open

44901

1,219.89

Incision and drainage of appendiceal abscess; percutaneous

44950

590.85

Appendectomy;

44955

79.87

Appendectomy; when done for indicated purpose at time of other major procedure (not as separate procedure) (List separately in addition to code for primary procedure)

44960

787.35

Appendectomy; for ruptured appendix with abscess or generalized peritonitis

44970

543.97

Laparoscopy, surgical, appendectomy

44979

I.C.

Unlisted laparoscopy procedure, appendix

45000

487.69

377.79

Transrectal drainage of pelvic abscess

45005

487.69

260.81

Incision and drainage of submucosal abscess, rectum

45020

487.69

484.28

Incision and drainage of deep supralevator, pelvirectal, or retrorectal abscess

45100

1,016.44

267.61

Biopsy of anorectal wall, anal approach (eg, congenital megacolon)

45108

1,016.44

325.09

Anorectal myomectomy

45110

1,702.79

Proctectomy; complete, combined abdominoperineal, with colostomy

45111

998.75

Proctectomy; partial resection of rectum, transabdominal approach

45112

1,739.39

Proctectomy, combined abdominoperineal, pull-through procedure (eg, colo-anal anastomosis)

45113

1,790.89

Proctectomy, partial, with rectal mucosectomy, ileoanal anastomosis, creation of ileal reservoir (S or J), with or without loop ileostomy

45114

1,633.96

Proctectomy, partial, with anastomosis; abdominal and transsacral approach

45116

1,480.23

Proctectomy, partial, with anastomosis; transsacral approach only (Kraske type)

45119

1,791.72

Proctectomy, combined abdominoperineal pull-through procedure (eg, colo-anal anastomosis), with creation of colonic reservoir (eg, J-pouch), with diverting enterostomy when performed

45120

1,429.66

Proctectomy, complete (for congenital megacolon), abdominal and perineal approach; with pull-through procedure and anastomosis (eg, Swenson, Duhamel, or Soave type operation)

45121

1,571.69

Proctectomy, complete (for congenital megacolon), abdominal and perineal approach; with subtotal or total colectomy, with multiple biopsies

45123

1,011.82

Proctectomy, partial, without anastomosis, perineal approach

45126

2,652.87

Pelvic exenteration for colorectal malignancy, with proctectomy (with or without colostomy), with removal of bladder and ureteral transplantations, and/or hysterectomy, or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), or any combination thereof

45130

990.47

Excision of rectal procidentia, with anastomosis; perineal approach

45135

1,218.71

Excision of rectal procidentia, with anastomosis; abdominal and perineal approach

45136

1,693.72

Excision of ileoanal reservoir with ileostomy

45150

1,016.44

360.28

Division of stricture of rectum

45160

1,016.44

903.48

Excision of rectal tumor by proctotomy, transsacral or transcoccygeal approach

45170

1,016.44

710.52

Excision of rectal tumor, transanal approach

45190

1,016.44

618.57

Destruction of rectal tumor (eg, electrodesiccation, electrosurgery, laser ablation, laser resection, cryosurgery) transanal approach

45300

63.99

108.60

Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)

45303

388.93

941.52

Proctosigmoidoscopy, rigid; with dilation (eg, balloon, guide wire, bougie)

45305

388.93

179.92

Proctosigmoidoscopy, rigid; with biopsy, single or multiple

45307

959.15

205.87

Proctosigmoidoscopy, rigid; with removal of foreign body

45308

388.93

174.77

Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by hot biopsy forceps or bipolar cautery

45309

388.93

203.72

Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by snare technique

45315

388.93

219.69

Proctosigmoidoscopy, rigid; with removal of multiple tumors, polyps, or other lesions by hot biopsy forceps, bipolar cautery or snare technique

45317

388.93

206.26

Proctosigmoidoscopy, rigid; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)

45320

959.15

211.02

Proctosigmoidoscopy, rigid; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique (eg, laser)

45321

959.15

96.33

Proctosigmoidoscopy, rigid; with decompression of volvulus

45327

1,116.37

109.90

Proctosigmoidoscopy, rigid; with transendoscopic stent placement (includes predilation)

45330

88.25

145.64

Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)

45331

227.79

188.33

Sigmoidoscopy, flexible; with biopsy, single or multiple

45332

227.79

308.48

Sigmoidoscopy, flexible; with removal of foreign body

45333

388.93

308.18

Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery

45334

388.93

160.88

Sigmoidoscopy, flexible; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)

45335

227.79

250.15

Sigmoidoscopy, flexible; with directed submucosal injection(s), any substance

45337

227.79

138.42

Sigmoidoscopy, flexible; with decompression of volvulus, any method

45338

388.93

341.97

Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

45339

388.93

326.73

Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique

45340

388.93

447.38

Sigmoidoscopy, flexible; with dilation by balloon, one or more strictures

45341

388.93

152.92

Sigmoidoscopy, flexible; with endoscopic ultrasound examination

45342

388.93

232.42

Sigmoidoscopy, flexible; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s)

45345

1,116.37

167.81

Sigmoidoscopy, flexible; with transendoscopic stent placement (includes predilation)

45355

395.43

198.75

Colonoscopy, rigid or flexible, transabdominal via colotomy, single or multiple

45378

395.43

423.58

Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure)

45379

395.43

533.72

Colonoscopy, flexible, proximal to splenic flexure; with removal of foreign body

45380

395.43

506.04

Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple

45381

395.43

493.58

Colonoscopy, flexible, proximal to splenic flexure; with directed submucosal injection(s), any substance

45382

395.43

673.41

Colonoscopy, flexible, proximal to splenic flexure; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)

45383

395.43

593.74

Colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique

45384

395.43

493.72

Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery

45385

395.43

565.92

Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

45386

395.43

738.01

Colonoscopy, flexible, proximal to splenic flexure; with dilation by balloon, one or more strictures

45387

1,116.37

334.12

Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic stent placement (includes predilation)

45391

395.43

291.78

Colonoscopy, flexible, proximal to splenic flexure; with endoscopic ultrasound examination

45392

395.43

367.07

Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s)

45395

1,841.46

Laparoscopy, surgical; proctectomy, complete, combined abdominoperineal, with colostomy

45397

1,985.63

Laparoscopy, surgical; proctectomy, combined abdominoperineal pull-through procedure (eg, colo-anal anastomosis), with creation of colonic reservoir (eg, J-pouch), with diverting enterostomy, when performed

45400

1,063.52

Laparoscopy, surgical; proctopexy (for prolapse)

45402

1,416.51

Laparoscopy, surgical; proctopexy (for prolapse), with sigmoid resection

45499

I.C.

Unlisted laparoscopy procedure, rectum

45500

1,016.44

467.45

Proctoplasty; for stenosis

45505

1,347.83

510.58

Proctoplasty; for prolapse of mucous membrane

45520

35.44

123.84

Perirectal injection of sclerosing solution for prolapse

45540

961.61

Proctopexy (eg, for prolapse); abdominal approach

45541

837.64

Proctopexy (eg, for prolapse); perineal approach

45550

1,339.24

Proctopexy (eg, for prolapse); with sigmoid resection, abdominal approach

45560

1,347.83

667.27

Repair of rectocele (separate procedure)

45562

1,011.10

Exploration, repair, and presacral drainage for rectal injury;

45563

1,478.19

Exploration, repair, and presacral drainage for rectal injury; with colostomy

45800

1,126.33

Closure of rectovesical fistula;

45805

1,300.02

Closure of rectovesical fistula; with colostomy

45820

1,123.21

Closure of rectourethral fistula;

45825

1,333.03

Closure of rectourethral fistula; with colostomy

45900

214.22

182.78

Reduction of procidentia (separate procedure) under anesthesia

45905

1,016.44

156.81

Dilation of anal sphincter (separate procedure) under anesthesia other than local

45910

1,016.44

185.83

Dilation of rectal stricture (separate procedure) under anesthesia other than local

45915

487.69

312.96

Removal of fecal impaction or foreign body (separate procedure) under anesthesia

45990

45999

1,016.44

I.C.

101.53

Anorectal exam, surgical, requiring anesthesia (general, spinal, or epidural), diagnostic Unlisted procedure, rectum

46020

1,016.44

238.55

Placement of seton

46030

214.22

121.10

Removal of anal seton, other marker

46040

1,016.44

475.27

Incision and drainage of ischiorectal and/or perirectal abscess (separate procedure)

46045

1,016.44

371.29

Incision and drainage of intramural, intramuscular, or submucosal abscess, transanal, under anesthesia

46050

487.69

177.61

Incision and drainage, perianal abscess, superficial

46060

1,016.44

409.42

Incision and drainage of ischiorectal or intramural abscess, with fistulectomy or fistulotomy, submuscular, with or without placement of seton

46070

487.69

200.54

Incision, anal septum (infant)

46080

1,016.44

219.55

Sphincterotomy, anal, division of sphincter (separate procedure)

46083

89.73

165.29

Incision of thrombosed hemorrhoid, external

46200

1,016.44

363.87

Fissurectomy, with or without sphincterotomy

46210

1,016.44

354.28

Cryptectomy; single

46211

1,016.44

466.71

Cryptectomy; multiple (separate procedure)

46220

1,016.44

181.48

Papillectomy or excision of single tag, anus (separate procedure)

46221

117.31

232.59

Hemorrhoidectomy, by simple ligature (eg, rubber band)

46230

1,016.44

248.86

Excision of external hemorrhoid tags and/or multiple papillae

46250

1,016.44

415.90

Hemorrhoidectomy, external, complete

46255

1,016.44

464.31

Hemorrhoidectomy, internal and external, simple;

46257

1,016.44

367.77

Hemorrhoidectomy, internal and external, simple; with fissurectomy

46258

1,016.44

400.96

Hemorrhoidectomy, internal and external, simple; with fistulectomy, with or without fissurectomy

46260

1,016.44

416.91

Hemorrhoidectomy, internal and external, complex or extensive;

46261

1,016.44

466.00

Hemorrhoidectomy, internal and external, complex or extensive; with fissurectomy

46262

1,016.44

484.51

Hemorrhoidectomy, internal and external, complex or extensive; with fistulectomy, with or without fissurectomy

46270

1,016.44

439.92

Surgical treatment of anal fistula

(fistulectomy/fistulotomy); subcutaneous

46275

1,016.44

456.03

Surgical treatment of anal fistula

(fistulectomy/fistulotomy); submuscular

46280

1,016.44

407.27

Surgical treatment of anal fistula

(fistulectomy/fistulotomy); complex or multiple, with or without placement of seton

46285

1,016.44

431.53

Surgical treatment of anal fistula

(fistulectomy/fistulotomy); second stage

46288

1,016.44

477.84

Closure of anal fistula with rectal advancement flap

46320

83.10

165.19

Enucleation or excision of external thrombotic hemorrhoid

46500

105.18

192.43

Injection of sclerosing solution, hemorrhoids

46505

214.22

256.51

Chemodenervation of internal anal sphincter

46600

28.19

87.94

Anoscopy; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)

46604

388.93

537.25

Anoscopy; with dilation (eg, balloon, guide wire, bougie)

46606

140.47

219.96

Anoscopy; with biopsy, single or multiple

46608

388.93

236.98

Anoscopy; with removal of foreign body

46610

959.15

228.17

Anoscopy; with removal of single tumor, polyp, or other lesion by hot biopsy forceps or bipolar cautery

46611

388.93

184.94

Anoscopy; with removal of single tumor, polyp, or other lesion by snare technique

46612

959.15

286.99

Anoscopy; with removal of multiple tumors, polyps, or other lesions by hot biopsy forceps, bipolar cautery or snare technique

46614

78.33

138.18

Anoscopy; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)

46615

959.15

158.23

Anoscopy; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique

46700

1,016.44

574.09

Anoplasty, plastic operation for stricture; adult

46705

455.33

Anoplasty, plastic operation for stricture; infant

46706

1,347.83

153.74

Repair of anal fistula with fibrin glue

46710

974.25

Repair of ileoanal pouch fistula/sinus (eg, perineal or vaginal), pouch advancement; transperineal approach

46712

2,018.87

Repair of ileoanal pouch fistula/sinus (eg, perineal or vaginal), pouch advancement; combined transperineal and transabdominal approach

46715

453.48

Repair of low imperforate anus; with anoperineal fistula (cut-back procedure)

46716

1,037.16

Repair of low imperforate anus; with transposition of anoperineal or anovestibular fistula

46730

1,668.44

Repair of high imperforate anus without fistula; perineal or sacroperineal approach

46735

1,971.04

Repair of high imperforate anus without fistula; combined transabdominal and sacroperineal approaches

46740

1,869.96

Repair of high imperforate anus with rectourethral or rectovaginal fistula; perineal or sacroperineal approach

46742

2,167.15

Repair of high imperforate anus with rectourethral or rectovaginal fistula; combined transabdominal and sacroperineal approaches

46744

3,091.84

Repair of cloacal anomaly by anorectovaginoplasty and urethroplasty, sacroperineal approach

46746

3,479.67

Repair of cloacal anomaly by anorectovaginoplasty and urethroplasty, combined abdominal and sacroperineal approach;

46748

3,550.83

Repair of cloacal anomaly by anorectovaginoplasty and urethroplasty, combined abdominal and sacroperineal approach; with vaginal lengthening by intestinal graft or pedicle flaps

46750

1,347.83

692.38

Sphincteroplasty, anal, for incontinence or prolapse; adult

46751

582.22

Sphincteroplasty, anal, for incontinence or prolapse; child

46753

1,016.44

523.22

Graft (Thiersch operation) for rectal incontinence and/or prolapse

46754

1,016.44

270.19

Removal of Thiersch wire or suture, anal canal

46760

1,347.83

983.70

Sphincteroplasty, anal, for incontinence, adult; muscle transplant

46761

1,347.83

847.69

Sphincteroplasty, anal, for incontinence, adult; levator muscle imbrication (Park posterior anal repair)

46762

1,347.83

827.68

Sphincteroplasty, anal, for incontinence, adult; implantation artificial sphincter

46900

114.73

213.92

Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; chemical

46910

124.66

225.92

Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; electrodesiccation

46916

65.22

226.74

Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; cryosurgery

46917

889.48

482.90

Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; laser surgery

46922

889.48

241.55

Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; surgical excision

46924

889.48

523.41

Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)

46934

195.26

383.86

Destruction of hemorrhoids, any method; internal

46935

134.59

258.67

Destruction of hemorrhoids, any method; external

46936

204.09

392.44

Destruction of hemorrhoids, any method; internal and external

46937

1,016.44

238.61

Cryosurgery of rectal tumor; benign

46938

1,347.83

399.25

Cryosurgery of rectal tumor; malignant

46940

89.00

197.84

Curettage or cautery of anal fissure, including dilation of anal sphincter (separate procedure); initial

46942

85.32

182.47

Curettage or cautery of anal fissure, including dilation of anal sphincter (separate procedure); subsequent

46945

148.19

263.91

Ligation of internal hemorrhoids; single procedure

46946

487.69

289.26

Ligation of internal hemorrhoids; multiple procedures

46947

1,347.83

343.87

Hemorrhoidopexy (eg, for prolapsing internal hemorrhoids) by stapling

46999

I.C.

Unlisted procedure, anus

47000

417.18

315.64

Biopsy of liver, needle; percutaneous

47001

98.60

Biopsy of liver, needle; when done for indicated purpose at time of other major procedure (List separately in addition to code for primary procedure)

47010

1,096.99

Hepatotomy; for open drainage of abscess or cyst, one or two stages

47011

190.58

Hepatotomy; for percutaneous drainage of abscess or cyst, one or two stages

47015

1,042.76

Laparotomy, with aspiration and/or injection of hepatic parasitic (eg, amoebic or echinococcal) cyst(s) or abscess(es)

47100

766.66

Biopsy of liver, wedge

47120

2,137.59

Hepatectomy, resection of liver; partial lobectomy

47122

3,168.14

Hepatectomy, resection of liver; trisegmentectomy

47125

2,845.06

Hepatectomy, resection of liver; total left lobectomy

47130

3,056.68

Hepatectomy, resection of liver; total right lobectomy

47133

I.C.

Donor hepatectomy (including cold preservation), from cadaver donor

47135

4,506.60

Liver allotransplantation; orthotopic, partial or whole, from cadaver or living donor, any age

47136

3,843.84

Liver allotransplantation; heterotopic, partial or whole, from cadaver or living donor, any age

47140

3,187.84

Donor hepatectomy (including cold preservation), from living donor; left lateral segment only (segments II and III)

47141

3,792.12

Donor hepatectomy (including cold preservation), from living donor; total left lobectomy (segments II, III and IV)

47142

4,168.62

Donor hepatectomy (including cold preservation), from living donor; total right lobectomy (segments V, VI, VII and VIII)

47143

I.C.

Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation, including cholecystectomy, if necessary, and dissection and removal of surrounding soft tissues to prepare the vena cava, portal vein, hepatic artery, and common bile duct for implantation; without trisegment or lobe split

47144

I.C.

Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation, including cholecystectomy, if necessary, and dissection and removal of surrounding soft tissues to prepare the vena cava, portal vein, hepatic artery, and common bile duct for implantation; with trisegment split of whole liver graft into two partial liver grafts (ie, left lateral segment (segments II and III) and right trisegment (segments I and IV through VIII))

47145

I.C.

Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation, including cholecystectomy, if necessary, and dissection and removal of surrounding soft tissues to prepare the vena cava, portal vein, hepatic artery, and common bile duct for implantation; with lobe split of whole liver graft into two partial liver grafts (ie, left lobe (segments II, III, and IV) and right lobe (segments I and V through VIII))

47146

312.13

Backbench reconstruction of cadaver or living donor liver graft prior to allotransplantation; venous anastomosis, each

47147

363.82

Backbench reconstruction of cadaver or living donor liver graft prior to allotransplantation; arterial anastomosis, each

47300

1,019.32

Marsupialization of cyst or abscess of liver

47350

1,247.04

Management of liver hemorrhage; simple suture of liver wound or injury

47360

1,691.08

Management of liver hemorrhage; complex suture of liver wound or injury, with or without hepatic artery ligation

47361

2,794.11

Management of liver hemorrhage; exploration of hepatic wound, extensive debridement, coagulation and/or suture, with or without packing of liver

47362

1,289.24

Management of liver hemorrhage; re-exploration of hepatic wound for removal of packing

47370

1,146.56

Laparoscopy, surgical, ablation of one or more liver tumor(s); radiofrequency

47371

1,153.12

Laparoscopy, surgical, ablation of one or more liver tumor(s); cryosurgical

47379

I.C.

Unlisted laparoscopic procedure, liver

47380

1,333.48

Ablation, open, of one or more liver tumor(s); radiofrequency

47381

1,364.87

Ablation, open, of one or more liver tumor(s); cryosurgical

47382

1,921.50

830.02

Ablation, one or more liver tumor(s), percutaneous, radiofrequency

47399

I.C.

Unlisted procedure, liver

47400

1,938.28

Hepaticotomy or hepaticostomy with exploration, drainage, or removal of calculus

47420

1,225.85

Choledochotomy or choledochostomy with exploration, drainage, or removal of calculus, with or without cholecystotomy; without transduodenal sphincterotomy or sphincteroplasty

47425

1,238.34

Choledochotomy or choledochostomy with exploration, drainage, or removal of calculus, with or without cholecystotomy; with transduodenal sphincterotomy or sphincteroplasty

47460

1,165.85

Transduodenal sphincterotomy or sphincteroplasty, with or without transduodenal extraction of calculus (separate procedure)

47480

779.58

Cholecystotomy or cholecystostomy with exploration, drainage, or removal of calculus (separate procedure)

47490

537.67

Percutaneous cholecystostomy

47500

101.36

Injection procedure for percutaneous transhepatic cholangiography

47505

39.12

Injection procedure for cholangiography through an existing catheter (eg, percutaneous transhepatic or T-tube)

47510

1,282.04

506.74

Introduction of percutaneous transhepatic catheter for biliary drainage

47511

1,282.04

618.18

Introduction of percutaneous transhepatic stent for internal and external biliary drainage

47525

686.16

888.89

Change of percutaneous biliary drainage catheter

47530

686.16

1,696.69

Revision and/or reinsertion of transhepatic tube

47550

156.53

Biliary endoscopy, intraoperative (choledochoscopy) (List separately in addition to code for primary procedure)

47552

1,282.04

330.32

Biliary endoscopy, percutaneous via T-tube or other tract; diagnostic, with or without collection of specimen(s) by brushing and/or washing (separate procedure)

47553

1,282.04

326.98

Biliary endoscopy, percutaneous via T-tube or other tract; with biopsy, single or multiple

47554

1,282.04

490.58

Biliary endoscopy, percutaneous via T-tube or other tract; with removal of calculus/calculi

47555

1,282.04

391.40

Biliary endoscopy, percutaneous via T-tube or other tract; with dilation of biliary duct stricture(s) without stent

47556

1,282.04

442.23

Biliary endoscopy, percutaneous via T-tube or other tract; with dilation of biliary duct stricture(s) with stent

47560

1,537.09

252.84

Laparoscopy, surgical; with guided transhepatic cholangiography, without biopsy

47561

1,537.09

276.85

Laparoscopy, surgical; with guided transhepatic cholangiography with biopsy

47562

2,034.73

676.97

Laparoscopy, surgical; cholecystectomy

47563

2,034.73

696.53

Laparoscopy, surgical; cholecystectomy with cholangiography

47564

2,034.73

803.27

Laparoscopy, surgical; cholecystectomy with exploration of common duct

47570

716.26

Laparoscopy, surgical; cholecystoenterostomy

47579

I.C.

Unlisted laparoscopy procedure, biliary tract

47600

953.81

Cholecystectomy;

47605

897.75

Cholecystectomy; with cholangiography

47610

1,144.74

Cholecystectomy with exploration of common duct;

47612

1,153.88

Cholecystectomy with exploration of common duct; with choledochoenterostomy

47620

1,250.96

Cholecystectomy with exploration of common duct; with transduodenal sphincterotomy or sphincteroplasty, with or without cholangiography

47630

1,282.04

567.63

Biliary duct stone extraction, percutaneous via T-tube tract, basket, or snare (eg, Burhenne technique)

47700

960.42

Exploration for congenital atresia of bile ducts, without repair, with or without liver biopsy, with or

without cholangiography

47701

1,596.55

Portoenterostomy (eg, Kasai procedure)

47711

1,421.45

Excision of bile duct tumor, with or without primary repair of bile duct; extrahepatic

47712

1,818.85

Excision of bile duct tumor, with or without primary

repair of bile duct; intrahepatic

47715

1,198.14

Excision of choledochal cyst

47720

1,034.35

Cholecystoenterostomy; direct

47721

1,215.74

Cholecystoenterostomy; with gastroenterostomy

47740

1,177.29

Cholecystoenterostomy; Roux-en-Y

47741

1,333.67

Cholecys to en terostomy; Roux-en-Y with

gastroenterostomy

47760

1,954.31

Anastomosis, of extrahepatic biliary ducts and

gastrointestinal tract

47765

2,513.11

Anastomosis, of intrahepatic ducts and

gastrointestinal tract

47780

2,126.42

Anastomosis, Roux-en-Y, of extrahepatic biliary ducts

and gastrointestinal tract

47785

2,743.16

Anastomosis, Roux-en-Y, of intrahepatic biliary ducts

and gastrointestinal tract

47800

1,437.55

Reconstruction, plastic, of extrahepatic biliary ducts

with end-to-end anastomosis

47801

1,012.82

Placement of choledochal stent

47802

1,378.03

U-tube hepaticoenterostomy

47900

1,248.97

Suture of extrahepatic biliary duct for pre-existing

injury (separate procedure)

47999

I.C.

Unlisted procedure, biliary tract

48000

1,705.34

Placement of drains, peripancreatic, for acute

pancreatitis;

48001

2,104.38

Placement of drains, peripancreatic, for acute

pancreatitis; with cholecystostomy, gastrostomy, and

jejunostomy

48020

1,054.11

Removal of pancreatic calculus

48100

805.12

Biopsy of pancreas, open (eg, fine needle aspiration,

needle core biopsy, wedge biopsy)

48102

417.18

572.31

Biopsy of pancreas, percutaneous needle

48105

2,585.65

Resection or debridement of pancreas and

peripancreatic tissue for acute necrotizing pancreatitis

48120

1,004.08

Excision of lesion of pancreas (eg, cyst, adenoma)

48140

1,420.46

Pancreatectomy, distal subtotal, with or without

splenectomy; without pancreaticojejunostomy

48145

1,472.07

Pancreatectomy, distal subtotal, with or without

splenectomy; with pancreaticojejunostomy

48146

1,694.04

Pancreatectomy, distal, near-total with preservation of duodenum (Child-type procedure)

48148

1,124.30

Excision of ampulla of Vater

48150

2,850.34

Pancreatectomy, proximal subtotal with total duode nectomy , partialgas trectomy,

choledochoenterostomy and gastrojejunostomy (Whipple-type procedure); with pancreatojejunostomy

48152

2,635.18

Pancreatectomy, proximal subtotal with total duodenectomy, partial gastrectomy,

choledochoenterostomy and gastrojejunostomy (Whipple-type procedure) ; without pancreatojejunostomy

48153

2,847.52

Pancreatectomy, proximal subtotal with near-total duodenectomy, choledochoenterostomy and duodenojejunostomy (pylorus-sparing, Whipple-type procedure); with pancreatojejunostomy

48154

2,649.76

Pancreatectomy, proximal subtotal with near-total duodenectomy, choledochoenterostomy and duodenojejunostomy (pylorus-sparing, Whipple-type procedure); without pancreatojejunostomy

48155

1,640.98

Pancreatectomy, total

48160

I.C.

Pancreatectomy, total or subtotal, with autologous transplantation of pancreas or pancreatic islet cells

48400

100.99

Injection procedure for intraoperative pancreatography (List separately in addition to code for primary procedure)

48500

1,021.66

Marsupialization of pancreatic cyst

48510

983.47

External drainage, pseudocyst of pancreas; open

48511

1,089.30

External drainage, pseudocyst of pancreas; percutaneous

48520

989.86

Internal anastomosis of pancreatic cyst to gastrointestinal tract; direct

48540

1,190.53

Internal anastomosis of pancreatic cyst to gastrointestinal tract; Roux-en-Y

48545

1,203.33

Pancreatorrhaphy for injury

48547

1,613.11

Duodenal exclusion with gastrojejunostomy for pancreatic injury

48548

1,514.16

Pancreaticojejunostomy, side-to-side anastomosis (Puestow-type operation)

48550

I.C.

Donor pancreatectomy (including cold preservation), with or without duodenal segment for transplantation

48551

I.C.

Backbench standard preparation of cadaver donor pancreas allograft prior to transplantation, including dissection of allograft from surrounding soft tissues, splenectomy, duodenotomy, ligation of bile duct, ligation of mesenteric vessels, and Y-graft arterial anastomoses from iliac artery to superior mesenteric artery and to splenic artery

48552

215.94

Backbench reconstruction of cadaver donor pancreas allograft prior to transplantation, venous anastomosis, each

48554

2,282.86

Transplantation of pancreatic allograft

48556

1,117.40

Removal of transplanted pancreatic allograft

48999

I.C.

Unlisted procedure, pancreas

49000

713.79

Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate procedure)

49002

49010

902.64

869.34

Reopening of recent laparotomy Exploration, retroperitoneal area with or without biopsy(s) (separate procedure)

49020

1,450.98

Drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess; open

49021

1,058.19

Drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess; percutaneous

49040

909.05

Drainage of subdiaphragmatic or subphrenic abscess; open

49041

1,051.56

Drainage of subdiaphragmatic or subphrenic abscess; percutaneous

49060

1,019.22

Drainage of retroperitoneal abscess; open

49061

1,039.34

Drainage of retroperitoneal abscess; percutaneous

49062

698.05

Drainage of extraperitoneal lymphocele to peritoneal cavity, open

49080

232.48

203.15

Peritoneocentesis, abdominal paracentesis, or peritoneal lavage (diagnostic or therapeutic); initial

49081

232.48

172.76

Peritoneocentesis, abdominal paracentesis, or peritoneal lavage (diagnostic or therapeutic); subsequent

49180

417.18

190.48

Biopsy, abdominal or retroperitoneal mass, percutaneous needle

49203

1,103.48

Excision or destruction, open, intra-abdominal tumors, cysts or endometriomas, one or more peritoneal, mesenteric, or retroperitoneal primary or secondary tumors; largest tumor five cm diameter or less

49204

1,402.53

Excision or destruction, open, intra-abdominal tumors, cysts or endometriomas, one or more peritoneal, mesenteric, or retroperitoneal primary or secondary tumors; largest tumor 5.1-10.0 cm diameter

49205

1,602.60

Excision or destruction, open, intra-abdominal tumors, cysts or endometriomas, one or more peritoneal, mesenteric, or retroperitoneal primary or secondary tumors; largest tumor greater than 10.0 cm diameter

49215

2,032.51

Excision of presacral or sacrococcygeal tumor

49220

893.72

Staging laparotomy for Hodgkins disease or lymphoma (includes splenectomy, needle or open biopsies of both liver lobes, possibly also removal of abdominal nodes, abdominal node and/or bone marrow biopsies, ovarian repositioning)

49250

1,148.25

535.19

Umbilectomy, omphalectomy, excision of umbilicus (separate procedure)

49255

725.26

Omentectomy, epiploectomy, resection of omentum (separate procedure)

49320

1,537.09

310.18

Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)

49321

1,537.09

324.69

Laparoscopy, surgical; with biopsy (single or multiple)

49322

1,537.09

354.11

Laparoscopy, surgical; with aspiration of cavity or cyst (eg, ovarian cyst) (single or multiple)

49323

593.11

Laparoscopy, surgical; with drainage of lymphocele to peritoneal cavity

49324

364.38

Laparo scopy, surgical; with insertion of intraperitoneal cannula or catheter, permanent

49325

390.87

Laparoscopy, surgical; with revision of previously placed intraperitoneal cannula or catheter, with removal of intraluminal obstructive material if performed

49326

175.04

Laparoscopy, surgical; with omentopexy (omental tacking procedure) (List separately in addition to code for primary procedure)

49329

I.C.

Unlisted laparoscopy procedure, abdomen, peritoneum and omentum

49400

196.18

Injection of air or contrast into peritoneal cavity (separate procedure)

49402

1,148.25

780.52

Removal of peritoneal foreign body from peritoneal cavity

49419

1,327.08

425.40

Insertion of intraperitoneal cannula or catheter, with subcutaneous reservoir, permanent (ie, totally implantable)

49420

1,372.36

134.10

Insertion of intraperitoneal cannula or catheter for drainage or dialysis; temporary

49421

1,372.36

367.13

Insertion of intraperitoneal cannula or catheter for drainage or dialysis; permanent

49422

1,071.63

365.19

Removal of permanent intraperitoneal cannula or catheter

49423

686.16

678.07

Exchange of previously placed abscess or cyst drainage catheter under radiological guidance (separate procedure)

49424

183.64

Contrast injection for assessment of abscess or cyst via previously placed drainage catheter or tube (separate procedure)

49425

710.71

Insertion of peritoneal-venous shunt

49426

1,148.25

605.56

Revision of peritoneal-venous shunt

49427

46.75

Injection procedure (eg, contrast media) for evaluation of previously placed peritoneal-venous shunt

49428

415.07

Ligation of peritoneal-venous shunt

49429

1,071.63

431.32

Removal of peritoneal-venous shunt

49435

113.75

Insertion of subcutaneous extension to intraperitoneal cannula or catheter with remote chest exit site (List separately in addition to code for primary procedure)

49436

176.64

Delayed creation of exit site from embedded subcutaneous segment of intraperitoneal cannula or catheter

49440

379.98

1,310.87

Insertion of gastrostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report

49441

379.98

1,558.38

Insertion of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report

49442

1,269.61

Insertion of cecostomy or other colonic tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report

49446

379.98

1,305.01

Conversion of gastrostomy tube to gastro-jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report

49450

144.72

921.99

Replacement of gastrostomy or cecostomy (or other colonic) tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report

49451

144.72

973.34

Replacement of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report

49452

144.72

1,185.17

Replacement of gastro-jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report

49460

144.72

982.00

Mechanical removal of obstructive material from gastrostomy, duodenostomy, jejunostomy,

gastro-jejunostomy, or cecostomy (or other colonic) tube, any method, under fluoroscopic guidance including contrast injection(s), if performed, image documentation and report

49465

1,370.98

201.12

Contrast injection(s) for radiological evaluation of existing gastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or cecostomy (or other colonic) tube, from a percutaneous approach including image documentation and report

49505

1,370.98

I

758.85

Repair initial inguinal hernia, age five years or older; reducible

49507

1,370.98

583.30

Repair initial inguinal hernia, age five years or older; incarcerated or strangulated

49520

1,370.98

579.25

Repair recurrent inguinal hernia, any age; reducible

49521

1,370.98

704.87

Repair recurrent inguinal hernia, any age; incarcerated or strangulated

49525

1,370.98

524.75

Repair inguinal hernia, sliding, any age

49540

1,370.98

619.52

Repair lumbar hernia

49550

1,370.98

528.02

Repair initial femoral hernia, any age; reducible

49553

1,370.98

576.12

Repair initial femoral hernia, any age; incarcerated or strangulated

49555

1,370.98

548.54

Repair recurrent femoral hernia; reducible

49557

1,370.98

664.07

Repair recurrent femoral hernia; incarcerated or strangulated

49560

1,370.98

680.42

Repair initial incisional or ventral hernia; reducible

49561

1,370.98

851.99

Repair initial incisional or ventral hernia; incarcerated or strangulated

49565

1,370.98

702.23

Repair recurrent incisional or ventral hernia; reducible

49566

1,370.98

860.47

Repair recurrent incisional or ventral hernia; incarcerated or strangulated

49568

1,370.98

252.54

Implantation of mesh or other prosthesis for incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair)

49570

1,370.98

376.83

Repair epigastric hernia (eg, preperitoneal fat); reducible (separate procedure)

49572

1,370.98

459.89

Repair epigastric hernia (eg, preperitoneal fat); incarcerated or strangulated

49585

1,370.98

403.35

Repair umbilical hernia, age five years or older; reducible

49587

1,370.98

476.36

Repair umbilical hernia, age five years or older; incarcerated or strangulated

49590

1,370.98

522.81

Repair spigelian hernia

49600

1,370.98

677.44

Repair of small omphalocele, with primary closure

49605

4,537.88

Repair of large omphalocele or gastroschisis; with or without prosthesis

49606

1,052.51

Repair of large omphalocele or gastroschisis; with removal of prosthesis, final reduction and closure, in operating room

49610

643.03

Repair of omphalocele (Gross type operation); first stage

49611

596.84

Repair of omphalocele (Gross type operation); second stage

49650

2,034.73

I

789.44

Laparoscopy, surgical; repair initial inguinal hernia

49651

2,034.73

507.31

Laparoscopy, surgical; repair recurrent inguinal hernia

49659

I.C.

Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy

49900

755.29

Suture, secondary, of abdominal wall for evisceration or dehiscence

49904

1,461.22

Omental flap, extra-abdominal (eg, for reconstruction of sternal and chest wall defects)

49905

337.37

Omental flap, intra-abdominal (List separately in addition to code for primary procedure)

49906

I.C.

Free omental flap with microvascular anastomosis

49999

I.C.

Unlisted procedure, abdomen, peritoneum and omentum

50010

717.28

Renal exploration, not necessitating other specific procedures

50020

1,024.39

Drainage of perirenal or renal abscess; open

50021

1,105.60

Drainage of perirenal or renal abscess; percutaneous

50040

953.49

Nephrostomy, nephrotomy with drainage

50045

945.56

Nephrotomy, with exploration

50060

1,180.38

Nephrolithotomy; removal of calculus

50065

1,209.66

Nephrolithotomy; secondary surgical operation for calculus

50070

1,233.76

Nephrolithotomy; complicated by congenital kidney abnormality

50075

1,511.57

Nephrolithotomy; removal of large staghorn calculus filling renal pelvis and calyces (including anatrophic pyelolithotomy)

50080

905.68

Percuta neousnep hrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; up to 2 cm

50081

1,324.29

Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; over 2 cm

50100

981.82

Transection or repositioning of aberrant renal vessels (separate procedure)

50120

984.21

Pyelotomy; with exploration

50125

1,030.05

Pyelotomy; with drainage, pyelostomy

50130

1,070.32

Pyelotomy; with removal of calculus (pyelolithotomy, pelviolithotomy, including coagulum pyelolithotomy)

50135

1,163.05

Pyelotomy; complicated (eg, secondary operation, congenital kidney abnormality)

50200

417.18

151.67

Renal biopsy; percutaneous, by trocar or needle

50205

697.28

Renal biopsy; by surgical exposure of kidney

50220

1,058.85

Nephrectomy, including partial ureterectomy, any open approach including rib resection;

50225

1,227.84

Nephrectomy, including partial ureterectomy, any open approach including rib resection; complicated because of previous surgery on same kidney

50230

1,320.31

Nephrectomy, including partial ureterectomy, any open approach including rib resection; radical, with regional lymphadenectomy and/or vena caval thrombectomy

50234

1,344.21

Nephrectomy with total ureterectomy and bladder cuff; through same incision

50236

1,522.06

Nephrectomy with total ureterectomy and bladder cuff; through separate incision

50240

1,363.80

Nephrectomy, partial

50250

1,270.33

Ablation, open, one or more renal mass lesion(s), cryosurgical, including intraoperative ultrasound, if performed

50280

976.76

Excision or unroofing of cyst(s) of kidney

50290

915.35

Excision of perinephric cyst

50300

I.C.

Donor nephrectomy (including cold preservation); from cadaver donor, unilateral or bilateral

50320

1,359.85

Donor nephrectomy (including cold preservation); open, from living donor

50323

I.C.

Backbench standard preparation of cadaver donor renal allograft prior to transplantation, including dissection and removal of perinephric fat, diaphragmatic and retroperitoneal attachments, excision of adrenal gland, and preparation of ureter(s), renal vein(s), and renal artery(s), ligating branches, as necessary

50325

I.C.

Backbench standard preparation of living donor renal allograft (open or laparoscopic) prior to transplantation, including dissection and removal of perinephric fat and preparation of ureter(s), renal vein(s), and renal artery(s), ligating branches, as necessary

50327

201.42

Backbench reconstruction of cadaver or living donor renal allograft prior to transplantation; venous anastomosis, each

50328

177.00

Backbench reconstruction of cadaver or living donor renal allograft prior to transplantation; arterial anastomosis, each

50329

171.70

Backbench reconstruction of cadaver or living donor renal allograft prior to transplantation; ureteral anastomosis, each

50340

851.78

Recipient nephrectomy (separate procedure)

50360

2,281.75

Renal allotransplantation, implantation of graft; without recipient nephrectomy

50365

2,558.23

Renal allotransplantation, implantation of graft; with recipient nephrectomy

50370

1,064.20

Removal of transplanted renal allograft

50380

1,737.84

Renal autotransplantation, reimplantation of kidney

50382

1,107.15

1,636.82

Removal (via snare/capture) and replacement of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation

50384

801.80

1,466.95

Removal (via snare/capture) of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation

50385

801.80

1,569.99

Removal (via snare/capture) and replacement of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation

50386

266.95

1,010.69

Removal (via snare/capture) of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation

50387

686.16

781.64

Removal and replacement of externally accessible transnephric ureteral stent (eg, external/internal stent) requiring fluoroscopic guidance, including radiological supervision and interpretation

50389

266.95

487.05

Removal of nephrostomy tube, requiring fluoroscopic guidance (eg, with concurrent indwelling ureteral stent)

50390

417.18

101.36

Aspiration and/or injection of renal cyst or pelvis by needle, percutaneous

50391

46.27

139.24

Instillation(s) of therapeutic agent into renal pelvis and/or ureter through established nephrostomy, pyelostomy or ureterostomy tube (eg, anticarcinogenic or antifungal agent)

50392

801.80

191.02

Introduction of intracatheter or catheter into renal pelvis for drainage and/or injection, percutaneous

50393

1,107.15

232.04

Introduction of ureteral catheter or stent into ureter through renal pelvis for drainage and/or injection, percutaneous

50394

132.39

Injection procedure for pyelography (as nephrostogram, pyelostogram, antegrade pyeloureterograms) through nephrostomy or pyelostomy tube, or indwelling ureteral catheter

50395

801.80

191.78

Introduction of guide into renal pelvis and/or ureter with dilation to establish nephrostomy tract, percutaneous

50396

89.72

124.97

Manometric studies through nephrostomy or pyelostomy tube, or indwelling ureteral catheter

50398

686.16

700.62

Change of nephrostomy or pyelostomy tube

50400

1,195.59

Pyeloplasty (Foley Y-pyeloplasty), plastic operation on renal pelvis, with or without plastic operation on ureter, nephropexy, nephrostomy, pyelostomy, or ureteral splinting; simple

50405

1,435.38

Pyeloplasty (Foley Y-pyeloplasty), plastic operation on renal pelvis, with or without plastic operation on ureter, nephropexy, nephrostomy, pyelostomy, or ureteral splinting; complicated (congenital kidney abnormality, secondary pyeloplasty, solitary kidney, calycoplasty)

50500

1,173.02

Nephrorrhaphy, suture of kidney wound or injury

50520

1,068.04

Closure of nephrocutaneous or pyelocutaneous fistula

50525

1,360.45

Closure of nephrovisceral fistula (eg, renocolic), including visceral repair; abdominal approach

50526

1,365.92

Closure of nephrovisceral fistula (eg, renocolic), including visceral repair; thoracic approach

50540

1,191.95

Symphysiotomy for horseshoe kidney with or without pyeloplasty and/or other plastic procedure, unilateral or bilateral (one operation)

50541

955.46

Laparoscopy, surgical; ablation of renal cysts

50542

1,209.45

Laparoscopy, surgical; ablation of renal mass lesion(s)

50543

1,541.51

Laparoscopy, surgical; partial nephrectomy

50544

1,301.23

Laparoscopy, surgical; pyeloplasty

50545

1,393.56

Laparoscopy, surgical; radical nephrectomy (includes removal of Gerota's fascia and surrounding fatty tissue, removal of regional lymph nodes, and adrenalectomy)

50546

1,240.08

Laparoscopy, surgical; nephrectomy, including partial ureterectomy

50547

1,521.62

Laparoscopy, surgical; donor nephrectomy (including cold preservation), from living donor

50548

1,404.51

Laparoscopy, surgical; nephrectomy with total ureterectomy

50549

I.C.

Unlisted laparoscopy procedure, renal

50551

266.95

403.99

Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service;

50553

1,107.15

419.77

Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with ureteral catheterization, with or without dilation of ureter

50555

266.95

463.94

Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with biopsy

50557

1,107.15

466.23

Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy

50561

1,107.15

525.84

Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus

50562

266.95

616.82

Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with resection of tumor

50570

266.95

515.15

Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service;

50572

266.95

558.15

Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with ureteral catheterization, with or without dilation of ureter

50574

266.95

595.19

Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with biopsy

50575

1,612.24

749.80

Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with endopyelotomy (includes cystoscopy, ureteroscopy, dilation of ureter and ureteral pelvic junction, incision of ureteral pelvic junction and insertion of endopyelotomy stent)

50576

801.80

592.17

Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy

50580

801.80

637.64

Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus

50590

1,855.90

1,027.54

Lithotripsy, extracorporeal shock wave

50592

1,921.50

5,413.46

Ablation, one or more renal tumor(s), percutaneous, unilateral, radiofrequency

50593

5,603.15

Ablation, renal tumor(s), unilateral, percutaneous, cryotherapy

50600

965.02

Ureterotomy with exploration or drainage (separate procedure)

50605

948.75

Ureterotomy for insertion of indwelling stent, all types

50610

994.24

Ureterolithotomy; upper one-third of ureter

50620

938.88

Ureterolithotomy; middle one-third of ureter

50630

914.94

Ureterolithotomy; lower one-third of ureter

50650

1,069.70

Ureterectomy, with bladder cuff (separate procedure)

50660

1,183.83

Ureterectomy, total, ectopic ureter, combination abdominal, vaginal and/or perineal approach

50684

233.19

Injection procedure fo r ureterography or ureteropyelography through ureterostomy or indwelling ureteral catheter

50686

46.27

186.95

Manometric studies through ureterostomy or indwelling ureteral catheter

50688

686.16

88.88

Change of ureterostomy tube or externally accessible ureteral stent via ileal conduit

50690

117.19

Injection procedure for visualization of ileal conduit and/or ureteropyelography, exclusive of radiologic service

50700

968.26

Ureteroplasty, plastic operation on ureter (eg, stricture)

50715

1,161.42

Ureterolysis, with or without repositioning of ureter for retroperitoneal fibrosis

50722

1,012.05

Ureterolysis for ovarian vein syndrome

50725

1,118.15

Ureterolysis for retrocaval ureter, with reanastomosis of upper urinary tract or vena cava

50727

527.37

Revision of urinary-cutaneous anastomosis (any type urostomy);

50728

722.76

Revision of urinary-cutaneous anastomosis (any type urostomy); with repair of fascial defect and hernia

50740

1,123.52

Ureteropyelostomy, anastomosis of ureter and renal pelvis

50750

1,199.41

Ureterocalycostomy, anastomosis of ureter to renal calyx

50760

1,130.72

Ureteroureterostomy

50770

1,196.90

Transureteroureterostomy, anastomosis of ureter to contralateral ureter

50780

1,128.64

Ureteroneocystostomy; anastomosis of single ureter to bladder

50782

1,143.83

Ureteroneocystostomy; anastomosis of duplicated ureter to bladder

50783

1,182.34

Ureteroneocystostomy; with extensive ureteral tailoring

50785

1,245.66

Ureteroneocystostomy; with vesico-psoas hitch or bladder flap

50800

949.75

Ureteroenterostomy, direct anastomosis of ureter to intestine

50810

1,286.12

Ureterosigmoidostomy, with creation of sigmoid bladder and establishment of abdominal or perineal colostomy, including intestine anastomosis

50815

1,257.34

Ureterocolon conduit, including intestine anastomosis

50820

1,344.42

Ureteroileal conduit (ileal bladder), including intestine anastomosis (Bricker operation)

50825

1,702.32

Continent diversion, including intestine anastomosis using any segment of small and/or large intestine (Kock pouch or Camey enterocystoplasty)

50830

1,857.31

Urinary undiversion (eg, taking down of ureteroileal conduit, ureterosigmoidostomy or ureteroenterostomy with ureteroureterostomy or ureteroneocystostomy)

50840

1,270.26

Replacement of all or part of ureter by intestine segment, including intestine anastomosis

50845

1,287.75

Cutaneous appendico-vesicostomy

50860

981.25

Ureterostomy, transplantation of ureter to skin

50900

867.52

Ureterorrhaphy, suture of ureter (separate procedure)

50920

912.01

Closure of ureterocutaneous fistula

50930

1,124.42

Closure of ureterovisceral fistula (including visceral repair)

50940

902.89

Deligation of ureter

50945

1,026.49

Laparoscopy, surgical; ureterolithotomy

50947

2,034.73

1,445.98

Laparoscopy, surgical; ureteroneocystostomy with cystoscopy and ureteral stent placement

50948

2,034.73

1,317.63

Laparoscopy, surgical; ureteroneocystostomy without cystoscopy and ureteral stent placement

50949

I.C.

Unlisted laparoscopy procedure, ureter

50951

266.95

421.23

Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service;

50953

266.95

440.55

Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with ureteral catheterization, with or without dilation of ureter

50955

1,107.15

510.56

Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with biopsy

50957

1,107.15

474.64

Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy

50961

1,107.15

427.94

Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus

50970

266.95

390.21

Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service;

50972

266.95

376.63

Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with ureteral catheterization, with or without dilation of ureter

50974

801.80

490.27

Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with biopsy

50976

801.80

487.35

Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy

50980

1,107.15

374.50

Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus

51020

1,107.15

484.86

Cystotomy or cystostomy; with fulguration and/or insertion of radioactive material

51030

1,107.15

483.51

Cystotomy or cystostomy; with cryosurgical destruction of intravesical lesion

51040

1,107.15

309.22

Cystostomy, cystotomy with drainage

51045

266.95

486.77

Cystotomy, with insertion of ureteral catheter or stent (separate procedure)

51050

1,107.15

489.60

Cystolithotomy, cystotomy with removal of calculus, without vesical neck resection

51060

605.18

Transvesical ureterolithotomy

51065

1,107.15

598.12

Cystotomy, with calculus basket extraction and/or ultrasonic or electrohydraulic fragmentation of ureteral calculus

51080

818.67

425.91

Drainage of perivesical or prevesical space abscess

51100

33.83

70.48

Aspiration of bladder; by needle

51101

46.27

148.75

Aspiration of bladder; by trocar or intracatheter

51102

864.33

372.82

Aspiration of bladder; with insertion of suprapubic catheter

51500

1,370.98

651.35

Excision of urachal cyst or sinus, with or without umbilical hernia repair

51520

1,107.15

617.54

Cystotomy; for simple excision of vesical neck (separate procedure)

51525

887.73

Cystotomy; for excision of bladder diverticulum, single or multiple (separate procedure)

51530

797.54

Cystotomy; for excision of bladder tumor

51535

817.25

Cystotomy for excision, incision, or repair of ureterocele

51550

978.45

Cystectomy, partial; simple

51555

1,298.01

Cystectomy, partial; complicated (eg, postradiation, previous surgery, difficult location)

51565

1,336.36

Cystectomy, partial, with reimplantation of ureter(s) into bladder (ureteroneocystostomy)

51570

1,518.85

Cystectomy, complete; (separate procedure)

51575

1,881.35

Cystectomy, complete; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes

51580

1,959.50

Cystectomy, complete, with ureterosigmoidostomy or ureterocutaneous transplantations;

51585

2,178.76

Cystectomy, complete, with ureterosigmoidostomy or ureterocutaneous transplantations; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes

51590

1,989.82

Cystectomy, complete, with ureteroileal conduit or sigmoid bladder, including intestine anastomosis;

51595

2,257.47

Cystectomy, complete, with ureteroileal conduit or sigmoid bladder, including intestine anastomosis; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes

51596

2,424.14

Cystectomy, complete, with continent diversion, any open technique, using any segment of small and/or large intestine to construct neobladder

51597

2,345.32

Pelvic exenteration, complete, for vesical, prostatic or urethral malignancy, with removal of bladder and ureteral transplantations, with or without hysterectomy and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof

51600

245.41

Injection procedure for cystography or voiding urethrocystography

51605

41.00

Injection procedure and placement of chain for contrast and/or chain urethrocystography

51610

134.61

Injection procedure for retrograde urethrocystography

51700

57.00

103.19

Bladder irrigation, simple, lavage and/or instillation

51701

28.19

78.57

Insertion of non-indwelling bladder catheter (eg, straight catheterization for residual urine)

51702

28.19

101.58

Insertion of temporary indwelling bladder catheter; simple (eg, Foley)

51703

46.27

168.26

Insertion of temporary indwelling bladder catheter; complicated (eg, altered anatomy, fractured catheter/balloon)

51705

79.07

136.23

Change of cystostomy tube; simple

51710

686.16

193.98

Change of cystostomy tube; complicated

51715

1,331.1

1

327.52

Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck

51720

61.77

132.74

Bladder instillation of anticarcinogenic agent (including retention time)

51725

136.16

282.35

79.09

203.26

Simple cystometrogram (CMG) (eg, spinal manometer)

51726

136.16

400.25

89.90

310.35

Complex cystometrogram (eg, calibrated electronic equipment)

51736

19.86

57.61

32.45

25.15

Simple uroflowmetry (UFR) (eg, stop-watch flow rate, mechanical uroflowmeter)

51741

22.80

89.63

60.49

29.14

Complex uroflowmetry (eg, calibrated electronic equipment)

51772

89.72

305.84

84.78

221.05

Urethral pressure profile studies (UPP) (urethral closure pressure profile), any technique

51784

46.27

243.45

80.23

163.22

Electromyography studies (EMG) of anal or urethral sphincter, other than needle, any technique

51785

89.72

263.86

79.93

183.93

Needle electromyography studies (EMG) of anal or urethral sphincter, any technique

51792

46.27

297.63

58.07

239.56

Stimulus evoked response (eg, measurement of bulbocavernosus reflex latency time)

51795

89.72

381.03

80.23

300.80

Voiding pressure studies (VP); bladder voiding pressure, any technique

51797

89.72

221.59

49.78

171.80

Voiding pressure studies (VP); intra-abdominal voiding pressure (AP) (rectal, gastric, intraperitoneal) (List separately in addition to code for primary procedure)

51798

17.28

24.03

Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging

51800

1,077.09

Cystoplasty or cystourethroplasty, plastic operation on bladder and/or vesical neck (anterior Y-plasty, vesical fundus resection), any procedure, with or without wedge resection of posterior vesical neck

51820

1,130.35

Cystourethroplasty with unilateral or bilateral ureteroneocystostomy

51840

677.43

Anterior vesicourethropexy, or urethropexy (eg, Marshall-Marchetti-Krantz, Burch); simple

51841

806.22

Anterior vesicourethropexy, or urethropexy (eg, Marshall-Marchetti-Krantz, Burch); complicated (eg, secondary repair)

51845

611.91

Abdomino-vaginal vesical neck suspension, with or without endoscopic control (eg, Stamey, Raz, modified Pereyra)

51860

748.89

Cystorrhaphy, suture of bladder wound, injury or rupture; simple

51865

917.79

Cystorrhaphy, suture of bladder wound, injury or rupture; complicated

51880

1,107.15

488.00

Closure of cystostomy (separate procedure)

51900

853.78

Closure of vesicovaginal fistula, abdominal approach

51920

802.94

Closure of vesicouterine fistula;

51925

1,137.29

Closure of vesicouterine fistula; with hysterectomy

51940

1,653.32

Closure, exstrophy of bladder

51960

1,428.00

Enterocystoplasty, including intestinal anastomosis

51980

736.81

Cutaneous vesicostomy

51990

772.41

Laparoscopy, surgical; urethral suspension for stress incontinence

51992

2,034.73

839.30

Laparoscopy, surgical; sling operation for stress incontinence (eg, fascia or synthetic)

51999

I.C.

Unlisted laparoscopy procedure, bladder

52000

266.95

240.51

Cystourethroscopy (separate procedure)

52001

801.80

430.33

Cystourethroscopy with irrigation and evacuation of multiple obstructing clots

52005

801.80

346.07

Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service;

52007

1,107.15

734.77

Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with brush biopsy of ureter and/or renal pelvis

52010

266.95

542.99

Cystourethroscopy, with ejaculatory duct catheterization, with or without irrigation, instillation, or duct radiography, exclusive of radiologic service

52204

801.80

618.71

Cystourethroscopy, with biopsy(s)

52214

1,107.15

1,469.40

Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands

52224

1,107.15

1,392.01

Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) or treatment of MINOR (less than 0.5 cm) lesion(s) with or without biopsy

52234

1,107.15

257.85

Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of SMALL bladder tumor(s) (0.5 up to 2.0 cm)

52235

1,107.15

302.83

Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of MEDIUM bladder tumor(s) (2.0 to 5.0 cm)

52240

1,107.15

528.04

Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of LARGE bladder tumor(s)

52250

1,107.15

253.57

Cystourethroscopy with insertion of radioactive substance, with or without biopsy or fulguration

52260

801.80

218.76

Cystourethroscopy, with dilation of bladder for interstitial cystitis; general or conduction (spinal) anesthesia

52265

266.95

586.59

Cystourethroscopy, with dilation of bladder for interstitial cystitis; local anesthesia

52270

801.80

537.55

Cystourethroscopy, with internal urethrotomy; female

52275

1,107.15

742.15

Cystourethroscopy, with internal urethrotomy; male

52276

1,107.15

277.98

Cystourethroscopy with direct vision internal urethrotomy

52277

1,107.15

341.34

Cystourethroscopy, with resection of external sphincter (sphincterotomy)

52281

801.80

386.51

Cystourethroscopy, with calibration and/or dilation of urethral stricture or stenosis, with or without meatotomy, with or without injection procedure for cystography, male or female

52282

1,612.24

351.34

Cystourethroscopy, with insertion of urethral stent

52283

1,107.15

319.26

Cystourethroscopy, with steroid injection into stricture

52285

801.80

322.65

Cystourethroscopyfor treatment of the female urethral syndrome with any or all of the following: urethral meatotomy, urethral dilation, internal urethrotomy, lysis of urethrovaginal septal fibrosis, lateral incisions of the bladder neck, and fulguration

52290

801.80

255.72

Cystourethroscopy; with ureteral meatotomy, unilateral or bilateral

52300

1,107.15

294.99

Cystourethroscopy; with resection or fulguration of orthotopic ureterocele(s), unilateral or bilateral

52301

1,107.15

308.82

Cystourethroscopy; with resection or fulguration of ectopic ureterocele(s), unilateral or bilateral

52305

1,107.15

292.23

Cystourethroscopy; with incision or resection of orifice of bladder diverticulum, single or multiple

52310

801.80

302.16

Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); simple

52315

1,107.15

540.75

Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); complicated

52317

1,107.15

1,302.60

Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; simple or small (less than 2.5 cm)

52318

1,107.15

497.24

Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; complicated or large (over 2.5 cm)

52320

1,107.15

258.40

Cystourethroscopy (including ureteral catheterization); with removal of ureteral calculus

52325

1,107.15

335.94

Cystourethroscopy (including ureteral catheterization); with fragmentation of ureteral calculus (eg, ultrasonic or electro-hydraulic technique)

52327

1,107.15

967.67

Cystourethroscopy (including ureteral catheterization); with subureteric injection of implant material

52330

1,107.15

1,546.34

Cystourethroscopy (including ureteral catheterization); with manipulation, without removal of ureteral calculus

52332

1,107.15

520.86

Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type)

52334

1,107.15

268.50

Cystourethroscopy with insertion of ureteral guide wire through kidney to establish a percutaneous nephrostomy, retrograde

52341

1,107.15

342.56

Cystourethroscopy; with treatment of ureteral stricture (eg, balloon dilation, laser, electrocautery, and incision)

52342

1,107.15

368.35

Cystourethroscopy; with treatment of ureteropelvic junction stricture (eg, balloon dilation, laser, electrocautery, and incision)

52343

1,107.15

404.80

Cystourethroscopy; with treatment of intra-renal stricture (eg, balloon dilation, laser, electrocautery, and incision)

52344

1,107.15

437.34

Cystourethroscopy with ureteroscopy; with treatment of ureteral stricture (eg, balloon dilation, laser, electrocautery, and incision)

52345

1,107.15

463.59

Cystourethroscopy with ureteroscopy; with treatment of ureteropelvic junction stricture (eg, balloon dilation, laser, electrocautery, and incision)

52346

1,107.15

517.89

Cystourethroscopy with ureteroscopy; with treatment of intra-renal stricture (eg, balloon dilation, laser, electrocautery, and incision)

52351

1,107.15

329.40

Cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic

52352

1,107.15

386.41

Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus (ureteral catheterization is included)

52353

1,612.24

444.44

Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included)

52354

1,107.15

411.30

Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with biopsy and/or fulguration of ureteral or renal pelvic lesion

52355

1,107.15

489.53

Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with resection of ureteral or renal pelvic tumor

52400

1,107.15

573.75

Cystourethroscopy with incision, fulguration, or resection of congenital posterior urethral valves, or congenital obstructive hypertrophic mucosal folds

52402

1,107.15

280.30

Cystourethroscopy with transurethral resection or incision of ejaculatory ducts

52450

1,107.15

487.51

Transurethral incision of prostate

52500

1,107.15

571.03

Transurethral resection of bladder neck (separate procedure)

52601

1,612.24

853.81

Transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included)

52606

1,107.15

526.96

Transurethral fulguration for postoperative bleeding occurring after the usual follow-up time

52612

1,612.24

547.86

Transurethral resection of prostate; first stage of two-stage resection (partial resection)

52614

1,612.24

481.73

Transurethral resection of prostate; second stage of two-stage resection (resection completed)

52620

1,612.24

434.48

Transurethral resection; of residual obstructive tissue after 90 days postoperative

52630

1,612.24

460.13

Transurethral resection; of regrowth of obstructive tissue longer than one year postoperative

52640

1,107.15

419.18

Transurethral resection; of postoperative bladder neck contracture

52647

2,020.10

3,070.83

Laser coagulation of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included if performed)

52648

2,020.10

3,114.08

Laser vaporization of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, internal urethrotomy and transurethral resection of prostate are included if performed)

52649

1,048.15

Laser enucleation of the prostate with morcellation, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, internal urethrotomy and transurethral resection of prostate are included if performed)

52700

1,107.15

452.66

Transurethral drainage of prostatic abscess

53000

855.80

159.73

Urethrotomy or urethrostomy, external (separate procedure); pendulous urethra

53010

855.80

310.83

Urethrotomy or urethrostomy, external (separate procedure); perineal urethra, external

53020

855.80

101.61

Meatotomy, cutting of meatus (separate procedure); except infant

53040

855.80

415.51

Drainage of deep periurethral abscess

53060

76.85

195.07

Drainage of Skene's gland abscess or cyst

53080

855.80

499.76

Drainage of perineal urinary extravasation; uncomplicated (separate procedure)

53085

855.80

676.88

Drainage of perineal urinary extravasation; complicated

53200

855.80

163.93

Biopsy of urethra

53210

1,331.11

803.67

Urethrectomy, total, including cystostomy; female

53215

855.80

966.55

Urethrectomy, total, including cystostomy; male

53220

1,331.11

472.01

Excision or fulguration of carcinoma of urethra

53230

1,331.11

628.89

Excision of urethral diverticulum (separate procedure); female

53235

855.80

664.40

Excision of urethral diverticulum (separate procedure); male

53240

1,331.11

447.22

Marsupialization of urethral diverticulum, male or female

53250

855.80

410.63

Excision of bulbourethral gland (Cowper's gland)

53260

855.80

218.09

Excision or fulguration; urethral polyp(s), distal urethra

53265

855.80

244.20

Excision or fulguration; urethral caruncle

53270

855.80

222.42

Excision or fulguration; Skene's glands

53275

855.80

280.13

Excision or fulguration; urethral prolapse

53400

1,331.11

833.50

Urethroplasty; first stage, for fistula, diverticulum, or stricture (eg, Johannsen type)

53405

1,331.11

907.74

Urethroplasty; second stage (formation of urethra), including urinary diversion

53410

1,331.11

1,018.09

Urethroplasty, one-stage reconstruction of male anterior urethra

53415

1,157.42

Urethroplasty, transpubic or perineal, one stage, for reconstruction or repair of prostatic or membranous urethra

53420

1,331.11

850.68

Urethroplasty, two-stage reconstruction or repair of prostatic or membranous urethra; first stage

53425

1,331.11

977.72

Urethroplasty, two-stage reconstruction or repair of prostatic or membranous urethra; second stage

53430

1,331.11

988.77

Urethroplasty, reconstruction of female urethra

53431

1,331.11

1,198.48

Urethroplasty with tubularization of posterior urethra and/or lower bladder for incontinence (eg, Tenago, Leadbetter procedure)

53440

4,775.24

901.42

Sling operation for correction of male urinary incontinence (eg, fascia or synthetic)

53442

1,331.11

795.94

Removal or revision of sling for male urinary incontinence (eg, fascia or synthetic)

53444

4,775.24

828.12

Insertion of tandem cuff (dual cuff)

53445

8,643.94

913.53

Insertion of inflatable urethral/bladder neck sphincter, including placement of pump, reservoir, and cuff

53446

1,331.11

674.63

Removal of inflatable urethral/bladder neck sphincter, including pump, reservoir, and cuff

53447

8,643.94

852.21

Re mova l a nd rep la cem en t of in f l a tab le urethral/bladder neck sphincter including pump, reservoir, and cuff at the same operative session

53448

1,331.17

Removal and replacement of inflatable urethral/bladder neck sphincter including pump, reservoir, and cuff through an infected field at the same operative session including irrigation and debridement of infected tissue

53449

1,331.11

637.01

Repair of inflatable urethral/bladder neck sphincter, including pump, reservoir, and cuff

53450

1,331.11

425.66

Urethromeatoplasty, with mucosal advancement

53460

855.80

477.33

Urethromeatoplasty, with partial excision of distal urethral segment (Richardson type procedure)

53500

779.85

Urethrolysis, transvaginal, secondary, open, including cystourethroscopy (eg, postsurgical obstruction, scarring)

53502

855.80

506.16

Urethrorrhaphy, suture of urethral wound or injury, female

53505

1,331.11

507.44

Urethrorrhaphy, suture of urethral wound or injury; penile

53510

855.80

668.12

Urethrorrhaphy, suture of urethral wound or injury; perineal

53515

1,331.11

832.45

Urethrorrhaphy, suture of urethral wound or injury; prostatomembranous

53520

1,331.11

583.31

Closure of urethrostomy or urethrocutaneous fistula, male (separate procedure)

53600

41.92

96.48

Dilation of urethral stricture by passage of sound or urethral dilator, male; initial

53601

46.27

96.32

Dilation of urethral stricture by passage of sound or urethral dilator, male; subsequent

53605

801.80

67.57

Dilation of urethral stricture or vesical neck by passage of sound or urethral dilator, male, general or conduction (spinal) anesthesia

53620

67.67

143.76

Dilation of urethral stricture by passage of filiform and follower, male; initial

53621

71.34

138.39

Dilation of urethral stricture by passage of filiform and follower, male; subsequent

53660

46.27

86.04

Dilation of female urethra including suppository and/or instillation; initial

53661

46.27

85.92

Dilation of female urethra including suppository and/or instillation; subsequent

53665

855.80

39.71

Dilation of female urethra, general or conduction (spinal) anesthesia

53850

2,020.10

3,660.13

Transurethral destruction of prostate tissue; by microwave thermotherapy

53852

2,020.10

3,497.13

Transurethral destruction of prostate tissue; by radiofrequency thermotherapy

53853

1,107.15

2,144.47

Transurethral destruction of prostate tissue; by water-induced thermotherapy

53899

I.C.

Unlisted procedure, urinary system

54000

855.80

185.44

Slitting of prepuce, dorsal or lateral (separate procedure); newborn

54001

855.80

223.56

Slitting of prepuce, dorsal or lateral (separate procedure); except newborn

54015

818.67

325.93

Incision and drainage of penis, deep

54050

65.22

131.95

Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; chemical

54055

65.09

125.86

Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; electrodesiccation

54056

35.44

138.26

Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; cryosurgery

54057

889.48

157.11

Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; laser surgery

54060

889.48

213.16

Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; surgical excision

54065

889.48

223.91

Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)

54100

719.48

209.64

Biopsy of penis; (separate procedure)

54105

943.36

317.43

Biopsy of penis; deep structures

54110

1,516.30

654.19

Excision of penile plaque (Peyronie disease);

54111

1,516.30

834.27

Excision of penile plaque (Peyronie disease); with graft to 5 cm in length

54112

1,516.30

978.43

Excision of penile plaque (Peyronie disease); with graft greater than 5 cm in length

54115

818.67

479.11

Removal foreign body from deep penile tissue (eg, plastic implant)

54120

1,516.30

654.22

Amputation of penis; partial

54125

841.06

Amputation of penis; complete

54130

1,239.40

Amputation of penis, radical; with bilateral inguinofemoral lymphadenectomy

54135

1,570.80

Amputation of penis, radical; in continuity with bilateral pelvic lymphadenectomy, including external iliac, hypogastric and obturator nodes

54150

997.67

213.74

Circumcision, using clamp or other device with regional dorsal penile or ring block

54161

997.67

205.76

Circumcision, surgical excision other than clamp, device, or dorsal slit; older than 28 days of age

54162

997.67

317.24

Lysis or excision of penile post-circumcision adhesions

54163

997.67

229.79

Repair incomplete circumcision

54164

997.67

203.54

Frenulotomy of penis

54200

69.87

127.19

Injection procedure for Peyronie disease;

54205

1,516.30

565.78

Injection procedure for Peyronie disease; with surgical exposure of plaque

54220

89.72

252.50

Irrigation of corpora cavernosa for priapism

54230

105.52

Injection procedure for corpora cavernosography

54231

61.41

151.31

Dynamic cavernosometry, including intracavernosal injection of vasoactive drugs (eg, papaverine, phentolamine)

54235

43.02

96.88

Injection of corpora cavernosa with pharmacologic agent(s) (eg, papaverine, phentolamine)

54240

29.79

107.82

68.74 39.08

Penile plethysmography

54250

10.30

129.98

116.50 13.49

Nocturnal penile tumescence and/or rigidity test

54300

1,516.30

683.36

Plastic operation of penis for straightening of chordee (eg, hypospadias), with or without mobilization of urethra

54304

1,516.30

800.32

Plastic operation on penis for correction of chordee or for first stage hypospadias repair with or without transplantation of prepuce and/or skin flaps

54308

1,516.30

698.34

Urethroplasty for second stage hypospadias repair (including urinary diversion); less than 3 cm

54312

1,516.30

892.47

Urethroplasty for second stage hypospadias repair (including urinary diversion); greater than 3 cm

54316

1,516.30

1,058.92

Urethroplasty for second stage hypospadias repair (including urinary diversion) with free skin graft obtained from site other than genitalia

54318

1,516.30

705.35

Urethroplasty for third stage hypospadias repair to release penis from scrotum (eg, third stage Cecil repair)

54322

1,516.30

831.86

One stage distal hypospadias repair (with or without chordee or circumcision); with simple meatal advancement (eg, Magpi, V-flap)

54324

1,516.30

1,035.61

One stage distal hypospadias repair (with or without chordee or circumcision); with urethroplasty by local skin flaps (eg, flip-flap, prepucial flap)

54326

1,516.30

999.12

One stage distal hypospadias repair (with or without chordee or circumcision); with urethroplasty by local skin flaps and mobilization of urethra

54328

1,516.30

985.73

One stage distal hypospadias repair (with or without chordee or circumcision); with extensive dissection to correct chordee and urethroplasty with local skin flaps, skin graft patch, and/or island flap

54332

1,068.01

One stage proximal penile or penoscrotal hypospadias repair requiring extensive dissection to correct chordee and urethroplasty by use of skin graft tube and/or is land flap

54336

1,203.32

One stage perineal hypospadias repair requiring extensive dissection to correct chordee and urethroplasty by use of skin graft tube and/or island flap

54340

1,516.30

608.34

Repair of hypospadias complications (ie, fistula, stricture, diverticula); by closure, incision, or excision, simple

54344

1,516.30

1,021.20

Repair of hypospadias complications (ie, fistula, stricture, diverticula); requiring mobilization of skin flaps and urethroplasty with flap or patch graft

54348

1,516.30

1,082.09

Repair of hypospadias complications (ie, fistula, stricture, diverticula); requiring extensive dissection and urethroplasty with flap, patch or tubed graft (includes urinary diversion)

54352

1,516.30

1,532.95

Repair of hypospadias cripple requiring extensive dissection and excision of previously constructed structures including re-release of chordee and reconstruction of urethra and penis by use of local skin as grafts and island flaps and skin brought in as flaps or grafts

54360

1,516.30

767.32

Plastic operation on penis to correct angulation

54380

1,516.30

843.83

Plastic operation on penis for epispadias distal to external sphincter;

54385

1,516.30

1,035.20

Plastic operation on penis for epispadias distal to external sphincter; with incontinence

54390

1,205.01

Plastic operation on penis for epispadias distal to external sphincter; with exstrophy of bladder

54400

4,775.24

561.99

Insertion of penile prosthesis; non-inflatable

(semi-rigid)

54401

8,643.94

691.63

Insertion of penile prosthesis; inflatable

(self-contained)

54405

8,643.94

842.91

Insertion of multi-component, inflatable penile prosthesis, including placement of pump, cylinders, and reservoir

54406

1,516.30

761.09

Removal of all components of a multi-component, inflatable penile prosthesis without replacement of prosthesis

54408

1,516.30

817.50

Repair of component(s) of a multi-component, inflatable penile prosthesis

54410

8,643.94

962.96

Removal and replacement of all component(s) of a multi-component, inflatable penile prosthesis at the same operative session

54411

1,054.59

Removal and replacement of all components of a multi-component inflatable penile prosthesis through an infected field at the same operative session, including irrigation and debridement of infected tissue

54415

1,516.30

550.88

Removal of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis, without replacement of prosthesis

54416

8,643.94

733.99

Removal and replacement of non-inflatable

(semi-rigid) or inflatable (self-contained) penile prosthesis at the same operative session

54417

925.41

Removal and replacement of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis through an infected field at the same operative session, including irrigation and debridement of infected tissue

54420

1,516.30

741.14

Corpora cavernosa-saphenous vein shunt (priapism operation), unilateral or bilateral

54430

672.32

Corpora cavernosa-corpus spongiosum shunt (priapism operation), unilateral or bilateral

54435

1,516.30

439.91

Corpora cavernosa-glans penis fistulization (eg, biopsy needle, Winter procedure, rongeur, or punch) for priapism

54440

1,516.30

I.C.

Plastic operation of penis for injury

54450

136.16

82.06

Foreskin manipulation including lysis of preputial adhesions and stretching

54500

606.71

78.10

Biopsy of testis, needle (separate procedure)

54505

997.67

226.91

Biopsy of testis, incisional (separate procedure)

54512

997.67

560.76

Excision of extraparenchymal lesion of testis

54520

997.67

343.83

Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach

54522

997.67

613.50

Orchiectomy, partial

54530

1,370.98

574.70

Orchiectomy, radical, for tumor; inguinal approach

54535

760.68

Orchiectomy, radical, for tumor; with abdominal exploration

54550

1,370.98

509.00

Exploration for undescended testis (inguinal or scrotal area)

54560

997.67

712.30

Exploration for undescended testis with abdominal exploration

54600

997.67

472.03

Reduction of torsion of testis, surgical, with or without fixation of contralateral testis

54620

997.67

317.53

Fixation of contralateral testis (separate procedure)

54640

1,370.98

486.02

Orchiopexy, inguinal approach, with or without hernia repair

54650

707.22

Orchiopexy, abdominal approach, for intra-abdominal testis (eg, Fowler-Stephens)

54660

997.67

374.68

Insertion of testicular prosthesis (separate procedure)

54670

997.67

429.89

Suture or repair of testicular injury

54680

997.67

828.22

Transplantation of testis(es) to thigh (because of scrotal destruction)

54690

2,034.73

668.74

Laparoscopy, surgical; orchiectomy

54692

3,113.22

803.40

Laparoscopy, surgical; orchiopexy for intra-abdominal testis

54699

I.C.

Unlisted laparoscopy procedure, testis

54700

997.67

225.27

Incision and drainage of epididymis, testis and/or scrotal space (eg, abscess or hematoma)

54800

193.36

135.24

Biopsy of epididymis, needle

54830

997.67

385.30

Excision of local lesion of epididymis

54840

997.67

340.75

Excision of spermatocele, with or without epididymectomy

54860

997.67

435.62

Epididymectomy; unilateral

54861

997.67

588.66

Epididymectomy; bilateral

54865

997.67

371.28

Exploration of epididymis, with or without biopsy

54900

997.67

761.66

Epididymovasostomy, anastomosis of epididymis to vas deferens; unilateral

54901

997.67

1,115.55

Epididymovasostomy, anastomosis of epididymis to vas deferens; bilateral

55000

72.07

142.34

Puncture aspiration of hydrocele, tunica vaginalis, with or without injection of medication

55040

1,370.98

354.34

Excision of hydrocele; unilateral

55041

1,370.98

526.98

Excision of hydrocele; bilateral

55060

997.67

393.42

Repair of tunica vaginalis hydrocele (Bottle type)

55100

516.57

251.82

Drainage of scrotal wall abscess

55110

997.67

400.51

Scrotal exploration

55120

997.67

368.36

Removal of foreign body in scrotum

55150

997.67

503.84

Resection of scrotum

55175

997.67

377.02

Scrotoplasty; simple

55180

997.67

714.96

Scrotoplasty; complicated

55200

997.67

631.64

Vasotomy, cannulization with or without incision of vas, unilateral or bilateral (separate procedure)

55250

997.67

565.02

Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s)

55300

197.42

Vasotomy for vasograms, seminal vesiculograms, or epididymograms, unilateral or bilateral

55400

997.67

528.14

Vasovasostomy, vasovasorrhaphy

55450

228.72

444.99

Ligation (percutaneous) of vas deferens, unilateral or bilateral (separate procedure)

55500

997.67

392.98

Excision of hydrocele of spermatic cord, unilateral (separate procedure)

55520

997.67

408.94

Excision of lesion of spermatic cord (separate procedure)

55530

997.67

371.16

Excision of varicocele or ligation of spermatic veins for varicocele; (separate procedure)

55535

1,370.98

445.34

Excision of varicocele or ligation of spermatic veins for varicocele; abdominal approach

55540

1,370.98

493.18

Excision of varicocele or ligation of spermatic veins for varicocele; with hernia repair

55550

2,034.73

439.93

Laparoscopy, surgical, with ligation of spermatic veins for varicocele

55559

I.C.

Unlisted laparoscopy procedure, spermatic cord

55600

997.67

443.69

Vesiculotomy;

55605

518.66

Vesiculotomy; complicated

55650

746.41

Vesiculectomy, any approach

55680

997.67

363.75

Excision of Mullerian duct cyst

55700

493.08

273.20

Biopsy, prostate; needle or punch, single or multiple, any approach

55705

493.08

284.26

Biopsy, prostate; incisional, any approach

55720

1,107.15

490.58

Prostatotomy, external drainage of prostatic abscess, any approach; simple

55725

1,107.15

606.63

Prostatotomy, external drainage of prostatic abscess, any approach; complicated

55801

1,122.93

Prostatectomy, perineal, subtotal (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and internal urethrotomy)

55810

1,361.91

Prostatectomy, perineal radical;

55812

1,654.65

Prostatectomy, perineal radical; with lymph node biopsy(s) (limited pelvic lymphadenectomy)

55815

1,829.01

Prostatectomy, perineal radical; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric and obturator nodes

55821

905.92

Prostatectomy (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and internal urethrotomy); suprapubic, subtotal, one or two stages

55831

980.92

Prostatectomy (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and internal urethrotomy); retropubic, subtotal

55840

1,388.45

Prostatectomy, retropubic radical, with or without nerve sparing;

55842

1,486.39

Prostatectomy, retropubic radical, with or without nerve sparing; with lymph node biopsy(s) (limited pelvic lymphadenectomy)

55845

1,696.20

Prostatectomy, retropubic radical, with or without nerve sparing; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes

55860

864.33

910.79

Exposure of prostate, any approach, for insertion of radioactive substance;

55862

1,150.45

Exposure of prostate, any approach, for insertion of radioactive substance; with lymph node biopsy(s) (limited pelvic lymphadenectomy)

55865

1,380.09

Exposure of prostate, any approach, for insertion of radioactive substance; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric and obturator nodes

55866

1,802.73

Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing

55870

73.92

185.40

Electroejaculation

55873

7,263.53

1,198.11

Cryosurgical ablation of the prostate (includes ultrasonic guidance for interstitial cryosurgical probe placement)

55875

1,612.24

795.95

Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy

55876

76.12

162.74

Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), prostate (via needle, any approach), single or multiple

55899

I.C.

Unlisted procedure, male genital system

55920

1,148.25

445.64

Placement of needles or catheters into pelvic organs and/or genitalia (except prostate) for subsequent interstitial radioelement application

56405

45.97

112.48

Incision and drainage of vulva or perineal abscess

56420

60.41

140.39

Incision and drainage of Bartholin's gland abscess

56440

849.98

182.87

Marsupialization of Bartholin's gland cyst

56441

849.98

154.95

Lysis of labial adhesions

56442

849.98

49.09

Hymenotomy, simple incision

56501

62.89

137.03

Destruction of lesion(s), vulva; simple (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)

56515

889.48

227.03

Destruction of lesion(s), vulva; extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)

56605

36.78

87.48

Biopsyof vulva or perineum (separate procedure); one lesion

56606

15.45

40.67

Biopsy of vulva or perineum (separate procedure); each separate additional lesion (List separately in addition to code for primary procedure)

56620

849.98

526.41

Vulvectomy simple; partial

56625

849.98

589.54

Vulvectomy simple; complete

56630

847.49

Vulvectomy, radical, partial;

56631

1,083.02

Vulvectomy, radical, partial; with unilateral inguinofemoral lymphadenectomy

56632

1,242.60

Vulvectomy, radical, partial; with bilateral inguinofemoral lymphadenectomy

56633

1,101.55

Vulvectomy, radical, complete;

56634

1,169.80

Vulvectomy, radical, complete; with unilateral inguinofemoral lymphadenectomy

56637

1,386.16

Vulvectomy, radical, complete; with bilateral inguinofemoral lymphadenectomy

56640

1,376.11

Vulvectomy, radical, complete, with inguinofemoral, iliac, and pelvic lymphadenectomy

56700

849.98

187.10

Partial hymenectomy or revision of hymenal ring

56740

849.98

294.47

Excision of Bartholin's gland or cyst

56800

849.98

242.09

Plastic repair of introitus

56805

849.98

1,132.31

Clitoroplasty for intersex state

56810

849.98

260.02

Perineoplasty, repair of perineum, nonobstetrical (separate procedure)

56820

45.97

114.15

Colposcopy of the vulva;

56821

60.31

153.43

Colposcopy of the vulva; with biopsy(s)

57000

849.98

191.01

Colpotomy; with exploration

57010

849.98

426.31

Colpotomy; with drainage of pelvic abscess

57020

271.63

96.19

Colpocentesis (separate procedure)

57022

516.57

167.18

Incision and drainage of vaginal hematoma; obstetrical/postpartum

57023

818.67

306.23

Incision and drainage of vaginal hematoma; non-obstetrical (eg, post-trauma, spontaneous bleeding)

57061

58.10

121.04

Destruction of vaginal lesion(s); simple (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)

57065

849.98

198.51

Destruction of vaginal lesion(s); extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)

57100

37.14

92.12

Biopsyof vaginal mucosa; simple (separate procedure)

57105

849.98

142.17

Biopsy of vaginal mucosa; extensive, requiring suture (including cysts)

57106

467.53

Vaginectomy, partial removal of vaginal wall;

57107

1,364.88

Vaginectomy, partial removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy)

57109

1,555.86

Vaginectomy, partial removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy) with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy)

57110

887.05

Vaginectomy, complete removal of vaginal wall;

57111

1,590.57

Vaginectomy, complete removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy)

57112

1,652.13

Vaginectomy, complete removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy) with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy)

57120

508.49

Colpocleisis (Le Fort type)

57130

849.98

186.82

Excision of vaginal septum

57135

849.98

199.76

Excision of vaginal cyst or tumor

57150

30.89

59.54

Irrigation of vagina and/or application of medicament for treatment of bacterial, parasitic, or fungoid disease

57155

271.63

430.21

Insertion of uterine tandems and/or vaginal ovoids for clinical brachytherapy

57160

37.88

80.79

Fitting and insertion of pessary or other intravaginal support device

57170

5.85

81.32

Diaphragm or cervical cap fitting with instructions

57180

60.41

152.84

Introduction of any hemostatic agent or pack for spontaneous or traumatic nonobstetrical vaginal hemorrhage (separate procedure)

57200

849.98

297.29

Colporrhaphy, suture of injury of vagina (nonobstetrical)

57210

849.98

365.00

Colpoperineorrhaphy, suture of injury of vagina and/or perineum (nonobstetrical)

57220

1,908.63

319.00

Plastic operation on urethral sphincter, vaginal approach (eg, Kelly urethral plication)

57230

1,448.95

390.58

Plastic repair of urethrocele

57240

1,448.95

622.53

Anterior colporrhaphy, repair of cystocele with or without repair of urethrocele

57250

1,448.95

607.78

Posterior colporrhaphy, repair of rectocele with or without perineorrhaphy

57260

1,448.95

765.16

Combined anteroposterior colporrhaphy;

57265

1,908.63

865.53

Combined anteroposterior colporrhaphy; with enterocele repair

57267

1,448.95

265.89

Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site (anterior, posterior compartment), vaginal approach (List separately in addition to code for primary procedure)

57268

1,448.95

474.81

Repair of enterocele, vaginal approach (separate procedure)

57270

783.90

Repair of enterocele, abdominal approach (separate procedure)

57280

947.84

Colpopexy, abdominal approach

57282

505.38

Colpopexy, vaginal; extra-peritoneal approach (sacrospinous, iliococcygeus)

57283

680.03

Colpopexy, vaginal; intra-peritoneal approach (uterosacral, levator myorrhaphy)

57284

831.21

Paravaginal defect repair (including repair of cystocele, if performed); open abdominal approach

57285

649.72

Paravaginal defect repair (including repair of cystocele, if performed); vaginal approach

57287

1,448.95

691.77

Removal or revision of sling for stress incontinence (eg, fascia or synthetic)

57288

1,908.63

809.26

Sling operation for stress incontinence (eg, fascia or synthetic)

57289

1,448.95

762.74

Pereyra procedure, including anterior colporrhaphy

57291

1,448.95

545.46

Construction of artificial vagina; without graft

57292

817.79

Construction of artificial vagina; with graft

57295

487.62

Revision (including removal) of prosthetic vaginal graft; vaginal approach

57296

919.36

Revision (including removal) of prosthetic vaginal graft; open abdominal approach

57300

1,448.95

519.71

Closure of rectovaginal fistula; vaginal or transanal approach

57305

858.95

Closure of rectovaginal fistula; abdominal approach

57307

961.56

Closure of rectovaginal fistula; abdominal approach, with concomitant colostomy

57308

623.51

Closure of rectovaginal fistula; transperineal approach, with perineal body reconstruction, with or without levator plication

57310

477.87

Closure of urethrovaginal fistula;

57311

541.68

Clos u re of ure t hro va g inal f ist ula; wi th bulbocavernosus transplant

57320

1,448.95

542.31

Closure of vesicovaginal fistula; vaginal approach

57330

776.73

Closure of vesicovaginal fistula; transvesical and vaginal approach

57335

1,123.99

Vaginoplasty for intersex state

57400

849.98

133.63

Dilation of vagina under anesthesia

57410

849.98

106.57

Pelvic examination under anesthesia

57415

849.98

157.70

Removal of impacted vaginal foreign body (separate procedure) under anesthesia

57420

47.44

119.70

Colposcopy of the entire vagina, with cervix if present;

57421

63.25

162.38

Colposcopy of the entire vagina, with cervix if present; with biopsy(s) of vagina/cervix

57423

895.85

Paravaginal defect repair (including repair of cystocele, if performed), laparoscopic approach

57425

942.41

Laparoscopy, surgical, colpopexy (suspension of vaginal apex)

57452

45.23

113.22

Colposcopy of the cervix including upper/adjacent vagina;

57454

55.52

157.91

Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix and endocervical curettage

57455

59.21

149.24

Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix

57456

57.00

141.10

Colposcopy of the cervix including upper/adjacent vagina; with endocervical curettage

57460

186.08

339.72

Colposcopy of the cervix including upper/adjacent vagina; with loop electrode biopsy(s) of the cervix

57461

196.00

375.19

Colposcopy of the cervix including upper/adjacent vagina; with loop electrode conization of the cervix

57500

83.85

149.51

Biopsy of cervix, single or multiple, or local excision of lesion, with or without fulguration (separate procedure)

57505

51.11

107.78

Endocervical curettage (not done as part of a dilation and curettage)

57510

52.59

137.59

Cautery of cervix; electro or thermal

57511

60.41

151.16

Cautery of cervix; cryocautery, initial or repeat

57513

849.98

147.94

Cautery of cervix; laser ablation

57520

849.98

321.77

Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; cold knife or laser

57522

849.98

272.13

Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; loop electrode excision

57530

1,448.95

343.72

Trachelectomy (cervicectomy), amputation of cervix (separate procedure)

57531

1,670.11

Radical trachelectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling biopsy, with or without removal of tube(s), with or without removal of ovary(s)

57540

763.81

Excision of cervical stump, abdominal approach;

57545

808.94

Excision of cervical stump, abdominal approach; with pelvic floor repair

57550

1,448.95

404.36

Excision of cervical stump, vaginal approach;

57555

595.10

Excision of cervical stump, vaginal approach; with anterior and/or posterior repair

57556

1,908.63

561.45

Excision of cervical stump, vaginal approach; with repair of enterocele

57558

849.98

128.60

Dilation and curettage of cervical stump

57700

849.98

303.20

Cerclage of uterine cervix, nonobstetrical

57720

849.98

308.36

Trachelorrhaphy, plastic repair of uterine cervix, vaginal approach

57800

27.21

63.05

Dilation of cervical canal, instrumental (separate procedure)

58100

45.23

114.25

Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation, any method (separate procedure)

58110

50.62

Endometrial sampling (biopsy) performed in conjunction with colposcopy (List separately in addition to code for primary procedure)

58120

849.98

247.63

Dilation and curettage, diagnostic and/or therapeutic (nonobstetrical)

58140

895.89

Myomectomy, excision of fibroid tumor(s) of uterus, one to four intramural myoma(s) with total weight of 250 g or less and/or removal of surface myomas; abdominal approach

58145

1,448.95

537.46

Myomectomy, excision of fibroid tumor(s) of uterus, one to four intramural myoma(s) with total weight of 250 g or less and/or removal of surface myomas; vaginal approach

58146

1,137.41

Myomectomy, excision of fibroid tumor(s) of uterus, five or more intramural myomas and/or intramural myomas with total weight greater than 250 g, abdominal approach

58150

966.17

Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s);

58152

1,228.22

Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); with colpo-urethrocystopexy (eg, Marshall-Marchetti-Krantz, Burch)

58180

929.65

Supracervical abdominal hysterectomy (subtotal hysterectomy), with or without removal of tube(s), with or without removal of ovary(s)

58200

1,279.20

Total abdominal hysterectomy, including partial vaginectomy, with para-aortic and pelvic lymph node sampling, with or without removal of tube(s), with or without removal of ovary(s)

58210

1,702.05

Radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with or without removal of tube(s), with or without removal of ovary(s)

58240

2,611.96

Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof

58260

812.96

Vaginal hysterectomy, for uterus 250 g or less;

58262

907.21

Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s)

58263

976.46

Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s), with repair of enterocele

58267

1,037.51

Vaginal hysterectomy, for uterus 250 g or less; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control

58270

870.31

Vaginal hysterectomy, for uterus 250 g or less; with repair of enterocele

58275

965.51

Vaginal hysterectomy, with total or partial vaginectomy;

58280

1,033.27

Vaginal hysterectomy, with total or partial vaginectomy; with repair of enterocele

58285

1,288.26

Vaginal hysterectomy, radical (Schauta type operation)

58290

1,136.88

Vaginal hysterectomy, for uterus greater than 250 g;

58291

1,232.97

Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)

58292

1,301.76

Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s), with repair of enterocele

58293

1,352.33

Vaginal hysterectomy, for uterus greater than 250 g; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control

58294

1,196.93

Vaginal hysterectomy, for uterus greater than 250 g; with repair of enterocele

58300

85.49

Insertion of intrauterine device (IUD)

58301

43.39

102.17

Removal of intrauterine device (IUD)

58340

155.18

Catheterization and introduction of saline or contrast material for saline infusion sonohysterography (SIS) or hysterosalpingography

58345

849.98

276.22

Transcervical introduction of fallopian tube catheter for diagnosis and/or re-establishing patency (any method), with or without hysterosalpingography

58346

849.98

448.46

Insertion of Heyman capsules for clinical brachytherap

58350

1,448.95

104.12

Chromotubation of oviduct, including materials

58353

1,448.95

1,481.5

Endometrial ablation, thermal, without hysteroscopic guidance

58356

1,925.44

2,654.98

Endometrial cryoablation with ultrasonic guidance, including endometrial curettage, when performed

58400

443.04

Uterine suspension, with or without shortening of round ligaments, with or without shortening of sacrouterine ligaments; (separate procedure)

58410

786.93

Uterine suspension, with or without shortening of round ligaments, with or without shortening of sacrouterine ligaments; with presacral sympathectomy

58520

766.02

Hysterorrhaphy, repair of ruptured uterus (nonobstetrical)

58540

888.11

Hysteroplasty, repair of uterine anomaly (Strassman type)

58541

829.97

Laparoscopy, surgical, supracervical hysterectomy, fo uterus 250 g or less;

58542

917.26

Laparoscopy, surgical, supracervical hysterectomy, fo uterus 250 g or less; with removal of tube(s) and/or ovary(s)

58543

932.26

Laparoscopy, surgical, supracervical hysterectomy, fo uterus greater than 250 g;

58544

1,006.68

Laparoscopy, surgical, supracervical hysterectomy, fo uterus greater than 250 g; with removal of tube(s) and/or ovary(s)

58545

1,537.09

880.97

Laparoscopy, surgical, myomectomy, excision; 1 to 4 intramural myomas with total weight of 250 g or less and/or removal of surface myomas

58546

2,034.73

1,114.41

Laparoscopy, surgical, myomectomy, excision; 5 or more intramural myomas and/or intramural myomas with total weight greater than 250 g

58548

1,753.28

Laparoscopy, surgical, with radical hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with removal of tube(s) and ovary(s), if performed

58550

3,113.22

871.83

Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less;

58552

2,034.73

960.32

Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)

58553

1,118.96

Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g;

58554

1,281.93

Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)

58555

967.84

239.84

Hysteroscopy, diagnostic (separate procedure)

58558

967.84

312.41

Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C

58559

967.84

342.51

Hysteroscopy, surgical; with lysis of intrauterine adhesions (any method)

58560

1,528.55

388.11

Hysteroscopy, surgical; with division or resection of intrauterine septum (any method)

58561

1,528.55

547.66

Hysteroscopy, surgical; with removal of leiomyomata

58562

967.84

331.75

Hysteroscopy, surgical; with removal of impacted foreign body

58563

1,528.55

2,383.86

Hysteroscopy, surgical; with endometrial ablation (eg, endometrial resection, electrosurgical ablation, thermoablation)

58565

1,908.63

2,384.35

Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants

58570

889.65

Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less;

58571

973.70

Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)

58572

1,100.55

Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g;

58573

1,240.51

Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)

58578

I.C.

Unlisted laparoscopy procedure, uterus

58579

I.C.

Unlisted hysteroscopy procedure, uterus

58600

1,448.95

363.93

Ligation or transection of fallopian tube(s), abdominal or vaginal approach, unilateral or bilateral

58660

2,034.73

660.59

Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure)

58661

2,034.73

635.41

Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy)

58662

2,034.73

697.88

Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method

58670

2,034.73

363.31

Laparoscopy, surgical; with fulguration of oviducts (with or without transection)

58671

2,034.73

363.61

Laparoscopy, surgical; with occlusion of oviducts by device (eg, band, clip, or Falope ring)

58672

2,034.73

739.96

Laparoscopy, surgical; with fimbrioplasty

58673

2,034.73

797.88

Laparoscopy, surgical; with salpingostomy (salpingoneostomy)

58679

I.C.

Unlisted laparoscopy procedure, oviduct, ovary

58700

747.86

Salpingectomy, complete or partial, unilateral or bilateral (separate procedure)

58720

704.05

Salpingo-oophorectomy, complete or partial, unilateral or bilateral (separate procedure)

58740

859.86

Lysis of adhesions (salpingolysis, ovariolysis)

58750

895.57

Tubotubal anastomosis

58752

883.32

Tubouterine implantation

58760

809.91

Fimbrioplasty

58770

845.08

Salpingostomy (salpingoneostomy)

58800

849.98

325.78

Drainage of ovarian cyst(s), unilateral or bilateral (separate procedure); vaginal approach

58805

1,448.95

398.25

Drainage of ovarian cyst(s), unilateral or bilateral (separate procedure); abdominal approach

58820

1,448.95

316.02

Drainage of ovarian abscess; vaginal approach, open

58822

673.47

Drainage of ovarian abscess; abdominal approach

58823

1,073.66

Drainage of pelvic abscess, transvaginal or transrectal approach, percutaneous (eg, ovarian, pericolic)

58825

683.91

Transposition, ovary(s)

58900

849.98

406.81

Biopsy of ovary, unilateral or bilateral (separate procedure)

58920

692.55

Wedge resection or bisection of ovary, unilateral or bilateral

58925

715.02

Ovarian cystectomy, unilateral or bilateral

58940

491.85

Oophorectomy, partial or total, unilateral or bilateral;

58943

1,093.99

Oophorectomy, partial or total, unilateral or bilateral; for ovarian, tubal or primary peritoneal malignancy, with para-aortic and pelvic lymph node biopsies, peritoneal washings, peritoneal biopsies, diaphragmatic assessments, with or without salpingectomy(s), with or without omentectomy

58950

1,044.16

Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy;

58951

1,341.88

Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy; with total abdominal hysterectomy, pelvic and limited para-aortic lymphadenectomy

58952

1,514.45

Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy; with radical dissection for debulking (ie, radical excision or destruction, intra-abdominal or retroperitoneal tumors)

58953

1,877.45

Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking;

58954

2,037.48

Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking; with pelvic lymphadenectomy and limited para-aortic lymphadenectomy

58956

1,328.51

Bilateral salpingo-oophorectomy with total omentectomy, total abdominal hysterectomy for malignancy

58957

1,418.68

Resection (tumor debulking) of recurrent ovarian, tubal, primary peritoneal, uterine malignancy (intra-abdominal, retroperitoneal tumors), with omentectomy, if performed;

58958

1,567.67

Resection (tumor debulking) of recurrent ovarian, tubal, primary peritoneal, uterine malignancy (intra-abdominal, retroperitoneal tumors), with omentectomy, if performed; with pelvic lymphadenectomy and limited para-aortic lymphadenectomy

58960

902.31

Laparotomy, for staging or restaging of ovarian, tubal, or primary peritoneal malignancy (second look), with or without omentectomy, peritoneal washing, biopsy of abdominal and pelvic peritoneum, diaphragmatic assessment with pelvic and limited para-aortic lymphadenectomy

58970

123.27

228.81

Follicle puncture for oocyte retrieval, any method

58974

123.27

I.C.

Embryo transfer, intrauterine

58976

123.27

250.84

Gamete, zygote, or embryo intrafallopian transfer, any method

58999

I.C.

Unlisted procedure, female genital system (nonobstetrical)

59000

70.24

141.59

Amniocentesis; diagnostic

59001

271.63

180.79

Amniocentesis; therapeutic amniotic fluid reduction (includes ultrasound guidance)

59012

123.27

203.71

Cordocentesis (intrauterine), any method

59015

54.42

158.82

Chorionic villus sampling, any method

59020

25.74

72.67

37.46

35.22

Fetal contraction stress test

59025

13.23

47.45

30.28

17.17

Fetal non-stress test

59030

110.11

Fetal scalp blood sampling

59050

50.95

Fetal monitoring during labor by consulting physician (ie, non-attending physician) with written report; supervision and interpretation

59051

41.87

Fetal monitoring during labor by consulting physician (ie, non-attending physician) with written report; interpretation only

59070

123.27

406.86

Transabdominal amnioinfusion, including ultrasound guidance

59072

123.27

438.78

Fetal umbilical cord occlusion, including ultrasound guidance

59074

375.56

Fetal fluid drainage (eg, vesicocentesis, thoracocentesis, paracentesis), including ultrasound guidance

59076

123.27

438.78

Fetal shunt placement, including ultrasound guidance

59100

1,448.95

817.33

Hysterotomy, abdominal (eg, for hydatidiform mole, abortion)

59121

784.00

Surgical treatment of ectopic pregnancy; tubal or ovarian, without salpingectomy and/or oophorectomy

59160

849.98

233.91

Curettage, postpartum

59200

38.98

81.46

Insertion of cervical dilator (eg, laminaria, prostaglandin) (separate procedure)

59300

80.17

199.71

Episiotomy or vaginal repair, by other than attending physician

59320

849.98

153.91

Cerclage of cervix, during pregnancy; vaginal

59325

241.87

Cerclage of cervix, during pregnancy; abdominal

59350

274.62

Hysterorrhaphy of ruptured uterus

59400

1,756.97

Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care

59409

764.35

Vaginal delivery only (with or without episiotomy and/or forceps);

59410

885.78

Vaginal delivery only (with or without episiotomy and/or forceps); including postpartum care

59412

849.98

103.51

External cephalic version, with or without tocolysis

59414

849.98

91.22

Delivery of placenta (separate procedure)

59510

1,988.69

Routine obstetric care including antepartum care, cesarean delivery, and postpartum care

59514

903.36

Cesarean delivery only;

59515

1,068.52

Cesarean delivery only; including postpartum care

59525

477.65

Subtotal or total hysterectomy after cesarean delivery (List separately in addition to code for primary procedure)

59610

1,848.42

Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, after previous cesarean delivery

59612

857.25

Vaginal delivery only, after previous cesarean deliver (with or without episiotomy and/or forceps);

59614

960.12

Vaginal delivery only, after previous cesarean deliver (with or without episiotomy and/or forceps); including postpartum care

59618

2,079.49

Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous cesarean delivery

59620

985.32

Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery;

59622

1,160.54

Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery; including postpartum care

59812

849.98

308.16

Treatment of incomplete abortion, any trimester, completed surgically

59820

849.98

383.89

Treatment of missed abortion, completed surgically; first trimester

59821

849.98

389.72

Treatment of missed abortion, completed surgically; second trimester

59830

436.20

Treatment of septic abortion, completed surgically

59840

849.98

218.87

Induced abortion, by dilation and curettage

59841

849.98

379.24

Induced abortion, by dilation and evacuation

59850

371.45

Induced abortion, by one or more intra-amniotic injections (amniocentesis-injections), including hospital admission and visits, delivery of fetus and secundines;

59851

402.05

Induced abortion, by one or more intra-amniotic injections (amniocentesis-injections), including hospital admission and visits, delivery of fetus and secundines; with dilation and curettage and/or evacuation

59852

539.16

Induced abortion, by one or more intra-amniotic injections (amniocentesis-injections), including hospital admission and visits, delivery of fetus and secundines; with hysterotomy (failed intra-amniotic injection)

59855

413.65

Induced abortion, by one or more vaginal suppositories (eg, prostaglandin) with or without cervical dilation (eg, laminaria), including hospital admission and visits, delivery of fetus and secundines;

59856

487.77

Induced abortion, by one or more vaginal suppositories (eg, prostaglandin) with or without cervical dilation (eg, laminaria), including hospital admission and visits, delivery of fetus and secundines; with dilation and curettage and/or evacuation

59857

570.48

Induced abortion, by one or more vaginal suppositories (eg, prostaglandin) with or without cervical dilation (eg, laminaria), including hospital admission and visits, delivery of fetus and secundines; with hysterotomy (failed medical evacuation)

59866

123.27

237.33

Multifetal pregnancy reduction(s) (MPR)

59870

849.98

464.98

Uterine evacuation and curettage for hydatidiform mole

59871

849.98

134.66

Removal of cerclage suture under anesthesia (other than local)

59897

I.C.

Unlisted fetal invasive procedure, including ultrasound guidance

59898

I.C.

Unlisted laparoscopy procedure, maternity care and delivery

59899

I.C.

Unlisted procedure, maternity care and delivery

60000

332.81

157.79

Incision and drainage of thyroglossal duct cyst, infected

60100

49.64

118.86

Biopsy thyroid, percutaneous core needle

60200

1,980.76

632.83

Excision of cyst or adenoma of thyroid, or transection of isthmus

60210

667.50

Partial thyroid lobectomy, unilateral; with or without isthmusectomy

60212

952.13

Partial thyroid lobectomy, unilateral; with contralateral subtotal lobectomy, including isthmusectomy

60220

731.21

Total thyroid lobectomy, unilateral; with or without isthmusectomy

60225

879.60

Total thyroid lobectomy, unilateral; with contralateral subtotal lobectomy, including isthmusectomy

60240

929.92

Thyroidectomy, total or complete

60252

1,251.42

Thyroidectomy, total or subtotal for malignancy; with limited neck dissection

60254

1,628.24

Thyroidectomy, total or subtotal for malignancy; with radical neck dissection

60260

1,048.48

Thyroidectomy, removal of all remaining thyroid tissue following previous removal of a portion of thyroid

60270

1,312.74

Thyroidectomy, including substernal thyroid; sternal split or transthoracic approach

60271

1,013.57

Thyroidectomy, including substernal thyroid; cervical approach

60280

1,980.76

433.10

Excision of thyroglossal duct cyst or sinus;

60281

1,980.76

576.10

Excision of thyroglossal duct cyst or sinus; recurrent

60300

61.41

112.08

Aspiration and/or injection, thyroid cyst

60500

958.28

Parathyroidectomy or exploration of parathyroid(s);

60502

1,207.28

Parathyroidectomy or exploration of parathyroid(s); re-exploration

60505

1,329.30

Parathyroidectomy or exploration of parathyroid(s); with mediastinal exploration, sternal split or transthoracic approach

60512

232.38

Parathyroid autotransplantation (List separately in addition to code for primary procedure)

60520

1,000.88

Thymectomy, partial or total; transcervical approach (separate procedure)

60521

1,143.89

Thymectomy, partial or total; sternal split or transthoracic approach, without radical mediastinal dissection (separate procedure)

60522

1,376.48

Thymectomy, partial or total; sternal split or transthoracic approach, with radical mediastinal dissection (separate procedure)

60540

1,028.50

Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal (separate procedure);

60545

1,175.49

Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal (separate procedure); with excision of adjacent retroperitoneal tumor

60600

1,374.86

Excision of carotid body tumor; without excision of carotid artery

60605

1,724.28

Excision of carotid body tumor; with excision of carotid artery

60650

1,143.08

Laparoscopy, surgical, with adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal

60659

I.C.

Unlisted laparoscopy procedure, endocrine system

60699

I.C.

Unlisted procedure, endocrine system

61020

381.03

129.87

Ventricular puncture through previous burr hole, fontanelle, suture, or implanted ventricular catheter/reservoir; without injection

61026

381.03

129.27

Ventricular puncture through previous burr hole, fontanelle, suture, or implanted ventricular catheter/reservoir; with injection of medication or other substance for diagnosis or treatment

61050

381.03

110.55

Cisternal or lateral cervical (C1-C2) puncture; without injection (separate procedure)

61055

381.03

139.85

Cisternal or lateral cervical (C1-C2) puncture; with injection of medication or other substance for diagnosis or treatment (eg, C1-C2)

61070

144.72

85.19

Puncture of shunt tubing or reservoir for aspiration or injection procedure

61105

427.38

Twist drill hole for subdural or ventricular puncture

61107

309.38

Twist drill hole(s) for subdural, intracerebral, or ventricular puncture; for implanting ventricular catheter, pressure recording device, or other intracerebral monitoring device

61108

828.84

Twist drill hole(s) for subdural, intracerebral, or ventricular puncture; for evacuation and/or drainage of subdural hematoma

61120

682.11

Burr hole(s) for ventricular puncture (including injection of gas, contrast media, dye, or radioactive material)

61140

1,174.53

Burr hole(s) or trephine; with biopsy of brain or intracranial lesion

61150

1,256.06

Burr hole(s) or trephine; with drainage of brain abscess or cyst

61151

922.29

Burr hole(s) or trephine; with subsequent tapping (aspiration) of intracranial abscess or cyst

61154

1,171.54

Burr hole(s) with evacuation and/or drainage of hematoma, extradural or subdural

61156

1,170.01

Burr hole(s); with aspiration of hematoma or cyst, intracerebral

61210

360.47

Burr hole(s); for implanting ventricular catheter, reservoir, EEG electrode(s), pressure recording device, or other cerebral monitoring device (separate procedure)

61215

1,621.15

452.03

Insertion of subcutaneous reservoir, pump or continuous infusion system for connection to ventricular catheter

61250

800.32

Burr hole(s) or trephine, supratentorial, exploratory, not followed by other surgery

61253

886.67

Burr hole(s) or trephine, infratentorial, unilateral or bilateral

61304

1,548.73

Craniectomy or craniotomy, exploratory; supratentoria

61305

1,852.83

Craniectomy or craniotomy, exploratory; infratentoria (posterior fossa)

61312

1,914.19

Craniectomy or craniotomy for evacuation of hematoma, supratentorial; extradural or subdural

61313

1,841.86

Craniectomy or craniotomy for evacuation of hematoma, supratentorial; intracerebral

61314

1,694.09

Craniectomy or craniotomy for evacuation of hematoma, infratentorial; extradural or subdural

61315

1,948.39

Craniectomy or craniotomy for evacuation of hematoma, infratentorial; intracerebellar

61316

83.73

Incision and subcutaneous placement of cranial bone graft (List separately in addition to code for primary procedure)

61320

1,798.63

Craniectomy or craniotomy, drainage of intracranial abscess; supratentorial

61321

1,993.02

Craniectomy or craniotomy, drainage of intracranial abscess; infratentorial

61322

2,155.45

Craniectomy or craniotomy, decompressive, with or without duraplasty, for treatment of intracranial hypertension, without evacuation of associated intraparenchymal hematoma; without lobectomy

61323

2,201.98

Craniectomy or craniotomy, decompressive, with or without duraplasty, for treatment of intracranial hypertension, without evacuation of associated intraparenchymal hematoma; with lobectomy

61330

61332

1,782.06

1,775.14

1,510.26

Decompression of orbit only, transcranial approach Exploration of orbit (transcranial approach); with biopsy

61333

1,768.90

Exploration of orbit (transcranial approach); with removal of lesion

61334

1,782.06

1,170.70

Exploration of orbit (transcranial approach); with removal of foreign body

61340

1,353.00

Subtemporal cranial decompression (pseudotumor cerebri, slit ventricle syndrome)

61343

2,065.85

Craniectomy, suboccipital with cervical laminectomy for decompression of medulla and spinal cord, with or without dural graft (eg, Arnold-Chiari malformation)

61345

1,900.99

Other cranial decompression, posterior fossa

61440

1,858.46

Craniotomy for section of tentorium cerebelli (separate procedure)

61450

1,768.24

Craniectomy, subtemporal, for section, compression, or decompression of sensory root of gasserian ganglion

61458

1,890.60

Craniectomy, suboccipital; for exploration or decompression of cranial nerves

61460

1,922.53

Craniectomy, suboccipital; for section of one or more cranial nerves

61470

1,759.02

Craniectomy, suboccipital; for medullary tractotomy

61480

1,695.02

Craniectomy, suboccipital; for mesencephalic tractotomy or pedunculotomy

61490

1,790.67

Craniotomy for lobotomy, including cingulotomy

61500

1,268.42

Craniectomy; with excision of tumor or other bone lesion of skull

61501

1,079.76

Craniectomy; for osteomyelitis

61510

2,040.77

Craniectomy, trephination, bone flap craniotomy; for excision of brain tumor, supratentorial, except meningioma

61512

2,413.34

Craniectomy, trephination, bone flap craniotomy; for excision of meningioma, supratentorial

61514

1,785.50

Craniectomy, trephination, bone flap craniotomy; for excision of brain abscess, supratentorial

61516

1,745.18

Craniectomy, trephination, bone flap craniotomy; for excision or fenestration of cyst, supratentorial

61517

84.30

Implantation of brain intracavitary chemotherapy agent (List separately in addition to code for primary procedure)

61518

2,597.64

Craniectomy for excision of brain tumor, infratentorial or posterior fossa; except meningioma, cerebellopontine angle tumor, or midline tumor at base of skull

61519

2,793.31

Craniectomy for excision of brain tumor, infratentorial or posterior fossa; meningioma

61520

3,574.11

Craniectomy for excision of brain tumor, infratentorial or posterior fossa; cerebellopontine angle tumor

61521

3,008.07

Craniectomy for ex cision of brain tumor, infratentorial or posterior fossa; midline tumor at base of skull

61522

2,041.89

Craniectomy, infratentorial or posterior fossa; for excision of brain abscess

61524

1,952.90

Craniectomy, infratentorial or posterior fossa; for excision or fenestration of cyst

61526

3,249.89

Craniectomy, bone flap craniotomy, transtemporal (mastoid) for excision of cerebellopontine angle tumor;

61530

2,760.97

Craniectomy, bone flap craniotomy, transtemporal (mastoid) for excision of cerebellopontine angle tumor; combined with middle/posterior fossa craniotomy/craniectomy

61531

1,120.53

Subdural implantation of strip electrodes through one or more burr or trephine hole(s) for long-term seizure monitoring

61533

1,419.45

Craniotomy with elevation of bone flap; for subdural implantation of an electrode array, for long-term seizure monitoring

61534

1,524.67

Craniotomy with elevation of bone flap; for excision of epileptogenic focus without electrocorticography during surgery

61535

910.30

Craniotomy with elevation of bone flap; for removal of epidural or subdural electrode array, without excision of cerebral tissue (separate procedure)

61536

2,441.86

Craniotomy with elevation of bone flap; for excision of cerebral epileptogenic focus, with electrocorticography during surgery (includes removal of electrode array)

61537

2,180.51

Craniotomy with elevation of bone flap; for lobectomy, temporal lobe, without electrocorticography during surgery

61538

2,326.67

Craniotomy with elevation of bone flap; for lobectomy, temporal lobe, with electrocorticography during surgery

61539

2,211.66

Craniotomy with elevation of bone flap; for lobectomy, other than temporal lobe, partial or total, with electrocorticography during surgery

61540

2,090.42

Craniotomy with elevation of bone flap; for lobectomy, other than temporal lobe, partial or total, without electrocorticography during surgery

61541

1,993.14

Craniotomy with elevation of bone flap; for transection of corpus callosum

61542

2,165.19

Craniotomy with elevation of bone flap; for total hemispherectomy

61543

1,987.60

Craniotomy with elevation of bone flap; for partial or subtotal (functional) hemispherectomy

61544

1,756.84

Craniotomy with elevation of bone flap; for excision or coagulation of choroid plexus

61545

2,980.11

Craniotomy with elevation of bone flap; for excision of craniopharyngioma

61546

2,155.21

Craniotomy for hypophysectomy or excision of pituitary tumor, intracranial approach

61548

1,458.87

Hypophysectomy or excision of pituitary tumor, transnasal or transseptal approach, nonstereotactic

61550

846.06

Craniectomy for craniosynostosis; single cranial suture

61552

1,213.59

Craniectomy for craniosynostosis; multiple cranial sutures

61556

1,526.34

Craniotomy for craniosynostosis; frontal or parietal bone flap

61557

1,591.97

Craniotomy for craniosynostosis; bifrontal bone flap

61558

1,605.54

Extensive craniectomy for multiple cranial suture craniosynostosis (eg, cloverleaf skull); not requiring bone grafts

61559

2,277.43

Extensive craniectomy for multiple cranial suture craniosynostosis (eg, cloverleaf skull); recontouring with multiple osteotomies and bone autografts (eg, barrel-stave procedure) (includes obtaining grafts)

61563

1,775.14

Excision, intra and extracranial, benign tumor of cranial bone (eg, fibrous dysplasia); without optic nerve decompression

61564

2,277.30

Excision, intra and extracranial, benign tumor of cranial bone (eg, fibrous dysplasia); with optic nerve decompression

61566

2,103.67

Craniotomy with elevation of bone flap; for selective amygdalohippocampectomy

61567

2,368.91

Craniotomy with elevation of bone flap; for multiple subpial transections, with electrocorticography during surgery

61570

1,719.96

Craniectomy or craniotomy; with excision of foreign body from brain

61571

1,854.79

Craniectomy or craniotomy; with treatment of penetrating wound of brain

61575

2,226.42

Transoral approach to skull base, brain stem or upper spinal cord for biopsy, decompression or excision of lesion;

61576

3,495.09

Transoral approach to skull base, brain stem or upper spinal cord for biopsy, decompression or excision of lesion; requiring splitting of tongue and/or mandible (including tracheostomy)

61580

2,388.29

Craniofacial approach to anterior cranial fossa; extradural, including lateral rhinotomy, ethmoidectomy, sphenoidectomy, without maxillectomy or orbital exenteration

61581

2,625.61

Craniofacial approach to anterior cranial fossa; extradural, including lateral rhinotomy, orbital exenteration, ethmoidectomy, sphenoidectomy and/or maxillectomy

61582

2,738.95

Craniofacial approach to anterior cranial fossa; extradural, including unilateral or bifrontal craniotomy, elevation of frontal lobe(s), osteotomy of base of anterior cranial fossa

61583

2,761.68

Craniofacial approach to anterior cranial fossa; intradural, including unilateral or bifrontal craniotomy, elevation or resection of frontal lobe, osteotomy of base of anterior cranial fossa

61584

2,693.37

Orbitocranial approach to anterior cranial fossa, extradural, including supraorbital ridge osteotomy and elevation of frontal and/or temporal lobe(s); without orbital exenteration

61585

2,848.88

Orbitocranial approach to anterior cranial fossa, extradural, including supraorbital ridge osteotomy and elevation of frontal and/or temporal lobe(s); with orbital exenteration

61586

2,103.57

Bicoronal, transzygomatic and/or LeFort I osteotomy approach to anterior cranial fossa with or without internal fixation, without bone graft

61590

2,989.78

Infratemporal pre-auricular approach to middle cranial fossa (parapharyngeal space, infratemporal and midline skull base, nasopharynx), with or without disarticulation of the mandible, including parotidectomy, craniotomy, decompression and/or mobilization of the facial nerve and/or petrous carotid artery

61591

3,015.93

Infratemporal post-auricular approach to middle cranial fossa (internal auditory meatus, petrous apex, tentorium, cavernous sinus, parasellar area, infratemporal fossa) including mastoidectomy, resection of sigmoid sinus, with or without decompression and/or mobilization of contents of auditory canal or petrous carotid artery

61592

2,996.42

Orbitocranial zygomatic approach to middle cranial fossa (cavernous sinus and carotid artery, clivus, basilar artery or petrous apex) including osteotomy of zygoma, craniotomy, extra- or intradural elevation of temporal lobe

61595

2,266.60

Transtemporal approach to posterior cranial fossa, jugular foramen or midline skull base, including mastoidectomy, decompression of sigmoid sinus and/or facial nerve, with or without mobilization

61596

2,488.92

Transcochlear approach to posterior cranial fossa, jugular foramen or midline skull base, including labyrinthectomy, decompression, with or without mobilization of facial nerve and/or petrous carotid artery

61597

2,720.71

Transcondylar (far lateral) approach to posterior cranial fossa, jugular foramen or midline skull base, including occipital condylectomy, mastoidectomy, resection of C1-C3 vertebral body(s), decompression of vertebral artery, with or without mobilization

61598

2,458.84

Transpetrosal approach to posterior cranial fossa, clivus or foramen magnum, including ligation of superior petrosal sinus and/or sigmoid sinus

61600

2,042.41

Resection or excision of neoplastic, vascular or infectious lesion of base of anterior cranial fossa; extradural

61601

2,245.38

Resection or excision of neoplastic, vascular or infectious lesion of base of anterior cranial fossa; intradural, including dural repair, with or without graft

61605

2,145.67

Resection or excision of neoplastic, vascular or infectious lesion of infratemporal fossa, parapharyngeal space, petrous apex; extradural

61606

2,827.14

Resection or excision of neoplastic, vascular or infectious lesion of infratemporal fossa, parapharyngeal space, petrous apex; intradural, including dural repair, with or without graft

61607

2,631.58

Resection or excision of neoplastic, vascular or infectious lesion of parasellar area, cavernous sinus, clivus or midline skull base; extradural

61608

3,091.93

Resection or excision of neoplastic, vascular or infectious lesion of parasellar area, cavernous sinus, clivus or midline skull base; intradural, including dural repair, with or without graft

61609

600.48

Transection or ligation, carotid artery in cavernous sinus; without repair (List separately in addition to code for primary procedure)

61610

1,799.27

Transection or ligation, carotid artery in cavernous sinus; with repair by anastomosis or graft (List separately in addition to code for primary procedure)

61611

436.69

Transection or ligation, carotid artery in petrous canal; without repair (List separately in addition to code for primary procedure)

61612

1,533.57

Transection or ligation, carotid artery in petrous canal; with repair by anastomosis or graft (List separately in addition to code for primary procedure)

61613

3,022.15

Obliteration of carotid aneurysm, arteriovenous malformation, or carotid-cavernous fistula by dissection within cavernous sinus

61615

2,371.84

Resection or excision of neoplastic, vascular or infectious lesion of base of posterior cranial fossa, jugular foramen, foramen magnum, or C1-C3 vertebral bodies; extradural

61616

3,125.61

Resection or excision of neoplastic, vascular or infectious lesion of base of posterior cranial fossa, jugular foramen, foramen magnum, or C1-C3 vertebral bodies; intradural, including dural repair, with or without graft

61618

1,226.42

Secondary repair of dura for cerebrospinal fluid leak, anterior, middle or posterior cranial fossa following surgery of the skull base; by free tissue graft (eg, pericranium, fascia, tensor fascia lata, adipose tissue, homologous or synthetic grafts)

61619

1,420.39

Secondary repair of dura for cerebrospinal fluid leak, anterior, middle or posterior cranial fossa following surgery of the skull base; by local or regionalized vascularized pedicle flap or myocutaneous flap (including galea, temporalis, frontalis or occipitalis muscle)

61623

550.71

Endovascular temporary balloon arterial occlusion, head or neck (extracranial/intracranial) including selective catheterization of vessel to be occluded, positioning and inflation of occlusion balloon, concomitant neurological monitoring, and radiologic supervision and interpretation of all angiography required for balloon occlusion and to exclude vascular injury post occlusion

61624

1,072.05

Transcatheter permanent occlusion or embolization (eg, for tumor destruction, to achieve hemostasis, to occlude a vascular malformation), percutaneous, any method; central nervous system (intracranial, spinal cord)

61626

868.61

Transcatheter permanent occlusion or embolization (eg, for tumor destruction, to achieve hemostasis, to occlude a vascular malformation), percutaneous, any method; non-central nervous system, head or neck (extracranial, brachiocephalic branch)

61630

1,249.97

Balloon angioplasty, intracranial (eg, atherosclerotic stenosis), percutaneous

61635

1,367.03

Transcatheter placement of intravascular stent(s), intracranial (eg, atherosclerotic stenosis), including balloon angioplasty, if performed

61640

572.18

Balloon dilatation of intracranial vasospasm, percutaneous; initial vessel

61641

201.36

Balloon dilatation of intracranial vasospasm, percutaneous; each additional vessel in same vascular family (List separately in addition to code for primary procedure)

61642

402.26

Balloon dilatation of intracranial vasospasm, percutaneous; each additional vessel in different vascular family (List separately in addition to code for primary procedure)

61680

2,131.16

Surgery of intracranial arteriovenous malformation; supratentorial, simple

61682

4,013.98

Surgery of intracranial arteriovenous malformation; supratentorial, complex

61684

2,700.97

Surgery of intracranial arteriovenous malformation; infratentorial, simple

61686

4,300.37

Surgery of intracranial arteriovenous malformation; infratentorial, complex

61690

2,038.05

Surgery of intracranial arteriovenous malformation; dural, simple

61692

3,454.02

Surgery of intracranial arteriovenous malformation; dural, complex

61697

3,847.68

Surgery of complex intracranial aneurysm, intracranial approach; carotid circulation

61698

4,065.83

Surgery of complex intracranial aneurysm, intracranial approach; vertebrobasilar circulation

61700

3,305.50

Surgery of simple intracranial aneurysm, intracranial approach; carotid circulation

61702

3,599.87

Surgery of simple intracranial aneurysm, intracranial approach; vertebrobasilar circulation

61703

1,232.88

Surgery of intracranial aneurysm, cervical approach by application of occluding clamp to cervical carotid artery (Selverstone-Crutchfield type)

61705

2,427.16

Surgery of aneurysm, vascular malformation or carotid-cavernous fistula; by intracranial and cervical occlusion of carotid artery

61708

2,032.26

Surgery of aneurysm, vascular malformation or carotid-cavernous fistula; by intracranial electrothrombosis

61710

1,831.91

Surgery of aneurysm, vascular malformation or carotid-cavernous fistula; by intra-arterial embolization, injection procedure, or balloon catheter

61711

2,467.41

Anastomosis, arterial, extracranial-intracranial (eg, middle cerebral/cortical) arteries

61720

1,092.85

Creation of lesion by stereotactic method, including burr hole(s) and localizing and recording techniques, single or multiple stages; globus pallidus or thalamus

61735

1,331.61

Creation of lesion by stereotactic method, including burr hole(s) and localizing and recording techniques, single or multiple stages; subcortical structure(s) other than globus pallidus or thalamus

61750

1,311.77

Stereotactic biopsy, aspiration, or excision, including burr hole(s), for intracranial lesion;

61751

1,284.02

Stereotactic biopsy, aspiration, or excision, including burr hole(s), for intracranial lesion; with computed tomography and/or magnetic resonance guidance

61760

1,400.04

Stereotactic implantation of depth electrodes into the cerebrum for long-term seizure monitoring

61770

1,404.77

Stereotactic localization, including burr hole(s), with insertion of catheter(s) or probe(s) for placement of radiation source

61790

806.70

790.63

Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (eg, alcohol, thermal, electrical, radiofrequency); gasserian ganglion

61791

647.43

1,019.11

Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (eg, alcohol, thermal, electrical, radiofrequency); trigeminal medullary tract

61793

1,192.64

Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator), one or more sessions

61795

240.91

Stereotactic computer-assisted volumetric (navigational) procedure, intracranial, extracranial, or spinal (List separately in addition to code for primary procedure)

61850

907.35

Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical

61860

1,449.50

Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical

61863

1,421.68

Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array

61864

407.20

Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; each additional array (List separately in addition to primary procedure)

61867

2,077.07

Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array

61868

593.01

Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; each additional array (List separately in addition to primary procedure)

61870

1,116.96

Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical

61875

966.90

Craniectomy for implantation of neurostimulator electrodes, cerebellar; subcortical

61880

1,004.30

508.48

Revision or removal of intracranial neurostimulator electrodes

61885

1,004.30

584.21

Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array

61886

1,004.30

733.71

Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to two or more electrode arrays

61888

1,004.30

381.73

Revision or removal of cranial neurostimulator pulse generator or receiver

62000

806.38

Elevation of depressed skull fracture; simple, extradural

62005

1,137.99

Elevation of depressed skull fracture; compound or comminuted, extradural

62010

1,422.61

Elevation of depressed skull fracture; with repair of dura and/or debridement of brain

62100

1,516.62

Craniotomy for repair of dural/cerebrospinal fluid leak, including surgery for rhinorrhea/otorrhea

62115

1,528.33

Reduction of craniomegalic skull (eg, treated hydrocephalus); not requiring bone grafts or cranioplasty

62116

1,648.24

Reduction of craniomegalic skull (eg, treated hydrocephalus); with simple cranioplasty

62117

1,747.82

Reduction of craniomegalic skull (eg, treated hydrocephalus); requiring craniotomy and reconstruction with or without bone graft (includes obtaining grafts)

62120

1,747.04

Repair of encephalocele, skull vault, including cranioplasty

62121

1,591.41

Craniotomy for repair of encephalocele, skull base

62140

987.70

Cranioplasty for skull defect; up to 5 cm diameter

62141

1,080.97

Cranioplasty for skull defect; larger than 5 cm diameter

62142

822.48

Removal of bone flap or prosthetic plate of skull

62143

966.90

Replacement of bone flap or prosthetic plate of skull

62145

1,304.38

Cranioplasty for skull defect with reparative brain surgery

62146

1,136.04

Cranioplasty with autograft (includes obtaining bone grafts); up to 5 cm diameter

62147

1,345.03

Cranioplasty with autograft (includes obtaining bone grafts); larger than 5 cm diameter

62148

119.50

Incision and retrieval of subcutaneous cranial bone graft for cranioplasty (List separately in addition to code for primary procedure)

62160

186.27

Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)

62161

1,434.31

Neuroendoscopy, intracranial; with dissection of adhesions, fenestration of septum pellucidum or intraventricular cysts (including placement, replacement, or removal of ventricular catheter)

62162

1,766.66

Neuroendoscopy, intracranial; with fenestration or excision of colloid cyst, including placement of external ventricular catheter for drainage

62163

1,121.55

Neuroendoscopy, intracranial; with retrieval of foreign body

62164

1,871.31

Neuroendoscopy, intracranial; with excision of brain tumor, including placement of external ventricular catheter for drainage

62165

1,457.96

Neuroendoscopy, intracranial; with excision of pituitary tumor, transnasal or trans-sphenoidal approach

62180

1,483.31

Ventriculocisternostomy (Torkildsen type operation)

62190

828.82

Creation of shunt; subarachnoid/subdural-atrial,

-jugular, -auricular

62192

902.86

Creation of shunt; subarachnoid/subdural-peritoneal,

-pleural, other terminus

62194

381.03

349.93

Replacement or irrigation, subarachnoid/subdural catheter

62200

1,290.31

Ventriculocisternostomy, third ventricle;

62201

1,108.52

Ventriculocisternostomy, third ventricle; stereotactic, neuroendoscopic method

62220

960.45

Creation of shunt; ventriculo-atrial, -jugular, -auricular

62223

973.76

Creation of shunt; ventriculo-peritoneal, -pleural, other terminus

62225

470.75

Replacement or irrigation, ventricular catheter

62230

1,621.15

784.05

Replacement or revision of cerebrospinal fluid shunt, obstructed valve, or distal catheter in shunt system

62252

47.81

106.13

45.69

60.44

Reprogramming of programmable cerebrospinal shunt

62256

544.75

Removal of complete cerebrospinal fluid shunt system; without replacement

62258

1,057.40

Removal of complete cerebrospinal fluid shunt system; with replacement by similar or other shunt at same operation

62263

647.43

741.14

Percutaneous lysis of epidural adhesions using solution injection (eg, hypertonic saline, enzyme) or mechanical means (eg, catheter) including radiologic localization (includes contrast when administered), multiple adhesiolysis sessions; 2 or more days

62264

647.43

466.47

Percutaneous lysis of epidural adhesions using solution injection (eg, hypertonic saline, enzyme) or mechanical means (eg, catheter) including radiologic localization (includes contrast when administered), multiple adhesiolysis sessions; 1 day

62268

381.03

594.16

Percutaneous aspiration, spinal cord cyst or syrinx

62269

417.18

664.06

Biopsy of spinal cord, percutaneous needle

62270

183.07

172.99

Spinal puncture, lumbar, diagnostic

62272

183.07

206.60

Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter)

62273

183.07

178.11

Injection, epidural, of blood or clot patch

62280

315.26

364.83

Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other therapeutic substance; subarachnoid

62281

315.26

320.67

Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other therapeutic substance; epidural, cervical or thoracic

62282

315.26

370.94

Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other therapeutic substance; epidural, lumbar, sacral (caudal)

62284

258.08

Injection procedure for myelography and/or computed tomography, spinal (other than C1-C2 and posterior fossa)

62287

1,486.81

547.49

Aspiration or decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method, single or multiple levels, lumbar (eg, manual or automated percutaneous discectomy, percutaneous laser discectomy)

62290

377.21

Injection procedure for discography, each level; lumbar

62291

341.43

Injection procedure for discography, each level; cervical or thoracic

62292

381.03

505.57

Injection procedure for chemonucleolysis, including discography, intervertebral disc, single or multiple levels, lumbar

62294

381.03

751.19

Injection procedure, arterial, for occlusion of arteriovenous malformation, spinal

62310

315.26

248.32

Injection, single (not via indwelling catheter), not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic

62311

315.26

229.72

Injection, single (not via indwelling catheter), not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; lumbar, sacral (caudal)

62318

315.26

276.23

Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic

62319

315.26

246.19

Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; lumbar, sacral (caudal)

62350

1,621.15

487.36

Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; without laminectomy

62351

801.60

Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; with laminectomy

62355

647.43

400.36

Removal of previously implanted intrathecal or epidural catheter

62360

1,621.15

270.70

Implantation or replacement of device for intrathecal or epidural drug infusion; subcutaneous reservoir

62361

11,790.17

432.64

Implantation or replacement of device for intrathecal or epidural drug infusion; nonprogrammable pump

62362

11,790.17

535.90

Implantation or replacement of device for intrathecal or epidural drug infusion; programmable pump, including preparation of pump, with or without programming

62365

1,486.81

418.10

Removal of subcutaneous reservoir or pump, previously implanted for intrathecal or epidural infusion

62367

19.13

41.22

Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); without reprogramming

62368

23.16

56.40

Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming

63001

1,154.56

Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; cervical

63003

1,165.17

Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; thoracic

63005

1,110.10

Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; lumbar, except for spondylolisthesis

63011

1,037.78

Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; sacral

63012

1,133.46

Laminectomy with removal of abnormal facets and/or pars inter-articularis with decompression of cauda equina and nerve roots for spondylolisthesis, lumbar (Gill type procedure)

63015

1,395.33

Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), more than 2 vertebral segments; cervical

63016

1,424.77

Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), more than 2 vertebral segments; thoracic

63017

1,173.00

Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), more than 2 vertebral segments; lumbar

63020

1,109.66

Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; one interspace, cervical

63030

I

2,974.28

Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; one interspace, lumbar (including open or endoscopically-assisted approach)

63035

195.21

Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; each additional interspace, cervical or lumbar (List separately in addition to code for primary procedure)

63040

1,348.03

Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; cervical

63042

1,268.02

Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar

63043

I.C.

Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; each additional cervical interspace (List separately in addition to code for primary procedure)

63044

I.C.

Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; each additional lumbar interspace (List separately in addition to code for primary procedure)

63045

1,204.42

Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; cervical

63046

1,151.06

Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; thoracic

63047

I

3,399.04

Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar

63048

208.64

Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; each additional segment, cervical, thoracic, or lumbar (List separately in addition to code for primary procedure)

63050

1,431.55

Laminoplasty, cervical, with decompression of the spinal cord, two or more vertebral segments;

63051

1,617.79

Laminoplasty, cervical, with decompression of the spinal cord, two or more vertebral segments; with reconstruction of the posterior bony elements (including the application of bridging bone graft and non-segmental fixation devices (eg, wire, suture, mini-plates), when performed)

63055

1,547.36

Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single segment; thoracic

63056

1,436.03

Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single segment; lumbar (including transfacet, or lateral extraforaminal approach) (eg, far lateral herniated intervertebral disc)

63057

322.15

Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single segment; each additional segment, thoracic or lumbar (List separately in addition to code for primary procedure)

63064

1,698.06

Costovertebral approach with decompression of spinal cord or nerve root(s) (eg, herniated intervertebral disc), thoracic; single segment

63066

197.81

Costovertebral approach with decompression of spinal cord or nerve root(s) (eg, herniated intervertebral disc), thoracic; each additional segment (List separately in addition to code for primary procedure)

63075

I

3,880.72

Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; cervical, single interspace

63076

249.10

Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; cervical, each additional interspace (List separately in addition to code for primary procedure)

63077

1,445.93

Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; thoracic, single interspace

63078

197.59

Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; thoracic, each additional interspace (List separately in addition to code for primary procedure)

63081

1,693.61

Vertebral corpectomy (vertebral body resection), partial or complete, anterior approach with decompression of spinal cord and/or nerve root(s); cervical, single segment

63082

268.73

Vertebral corpectomy (vertebral body resection), partial or complete, anterior approach with decompression of spinal cord and/or nerve root(s); cervical, each additional segment (List separately in addition to code for primary procedure)

63085

1,804.21

Vertebral corpectomy (vertebral body resection), partial or complete, transthoracic approach with decompression of spinal cord and/or nerve root(s); thoracic, single segment

63086

190.12

Vertebral corpectomy (vertebral body resection), partial or complete, transthoracic approach with decompression of spinal cord and/or nerve root(s); thoracic, each additional segment (List separately in addition to code for primary procedure)

63087

2,293.98

Vertebral corpectomy (vertebral body resection), partial or complete, combined thoracolumbar approach with decompression of spinal cord, cauda equina or nerve root(s), lower thoracic or lumbar; single segment

63088

258.61

Vertebral corpectomy (vertebral body resection), partial or complete, combined thoracolumbar approach with decompression of spinal cord, cauda equina or nerve root(s), lower thoracic or lumbar; each additional segment (List separately in addition to code for primary procedure)

3090

1,877.97

Vertebral corpectomy (vertebral body resection), partial or complete, transperitoneal or retroperitoneal approach with decompression of spinal cord, cauda equina or nerve root(s), lower thoracic, lumbar, or sacral; single segment

3091

177.68

Vertebral corpectomy (vertebral body resection), partial or complete, transperitoneal or retroperitoneal approach with decompression of spinal cord, cauda equina or nerve root(s), lower thoracic, lumbar, or sacral; each additional segment (List separately in addition to code for primary procedure)

3101

2,165.16

Vertebral corpectomy (vertebral body resection), partial or complete, lateral extracavitary approach with decompression of spinal cord and/or nerve root(s) (eg, for tumor or retropulsed bone fragments); thoracic, single segment

3102

2,160.56

Vertebral corpectomy (vertebral body resection), partial or complete, lateral extracavitary approach with decompression of spinal cord and/or nerve root(s) (eg, for tumor or retropulsed bone fragments); lumbar, single segment

3103

282.83

Vertebral corpectomy (vertebral body resection), partial or complete, lateral extracavitary approach with decompression of spinal cord and/or nerve root(s) (eg, for tumor or retropulsed bone fragments); thoracic or lumbar, each additional segment (List separately in addition to code for primary procedure)

3170

1,413.07

Laminectomy with myelotomy (eg, Bischof or DREZ type), cervical, thoracic, or thoracolumbar

3172

1,305.70

Laminectomy with drainage of intramedullary cyst/syrinx; to subarachnoid space

3173

1,603.55

Laminectomy with drainage of intramedullary cyst/syrinx; to peritoneal or pleural space

3180

1,320.15

Laminectomy and section of dentate ligaments, with or without dural graft, cervical; one or two segments

3182

1,351.65

Laminectomy and section of dentate ligaments, with or without dural graft, cervical; more than two segments

3185

1,054.46

Laminectomy with rhizotomy; one or two segments

3190

1,192.24

Laminectomywith rhizotomy; more than two segments

3191

1,167.73

Laminectomy with section of spinal accessory nerve

3194

1,375.62

Laminectomy with cordotomy, with section of one spinothalamic tract, one stage; cervical

3195

1,414.26

Laminectomy with cordotomy, with section of one spinothalamic tract, one stage; thoracic

3196

1,657.13

Laminectomy with cordotomy, with section of both spinothalamic tracts, one stage; cervical

3197

1,431.91

Laminectomy with cordotomy, with section of both spinothalamic tracts, one stage; thoracic

3198

1,608.62

Laminectomy with cordotomy with section of both spinothalamic tracts, two stages within 14 days; cervical

3199

1,671.03

Laminectomy with cordotomy with section of both spinothalamic tracts, two stages within 14 days; thoracic

63200

1,415.09

Laminectomy, with release of tethered spinal cord, lumbar

63250

2,703.94

Laminectomy for excision or occlusion of arteriovenous malformation of spinal cord; cervical

63251

2,847.80

Laminectomy for excision or occlusion of arteriovenous malformation of spinal cord; thoracic

63252

2,830.88

Laminectomy for excision or occlusion of arteriovenous malformation of spinal cord; thoracolumbar

63265

1,565.05

Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; cervical

63266

1,611.52

Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; thoracic

63267

1,301.85

Laminectomyfor excision or evacuation of intraspinal lesion other than neoplasm, extradural; lumbar

63268

1,287.58

Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; sacral

63270

1,927.35

Laminectomy for excision of intraspinal lesion other than neoplasm, intradural; cervical

63271

1,935.68

Laminectomy for excision of intraspinal lesion other than neoplasm, intradural; thoracic

63272

1,787.29

Laminectomy for excision of intraspinal lesion other than neoplasm, intradural; lumbar

63273

1,726.04

Laminectomy for excision of intraspinal lesion other than neoplasm, intradural; sacral

63275

1,686.30

Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, cervical

63276

1,674.03

Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, thoracic

63277

1,477.86

Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, lumbar

63278

1,447.19

Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, sacral

63280

1,988.64

Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, cervical

63281

1,971.72

Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, thoracic

63282

1,857.48

Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, lumbar

63283

1,772.02

Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, sacral

63285

2,445.54

Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, cervical

63286

2,445.11

Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, thoracic

63287

2,567.18

Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, thoracolumbar

63290

2,577.67

Laminectomy for biopsy/excision of intraspinal neoplasm; combined extradural-intradural lesion, any level

63295

304.48

Osteoplastic reconstruction of dorsal spinal elements, following primary intraspinal procedure (List separately in addition to code for primary procedure)

63300

1,736.84

Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; extradural, cervical

63301

1,919.84

Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; extradural, thoracic by transthoracic approach

63302

1,906.93

Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; extradural, thoracic by thoracolumbar approach

63303

2,016.25

Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; extradural, lumbar or sacral by transperitoneal or retroperitoneal approach

63304

2,145.63

Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; intradural, cervical

63305

2,210.39

Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; intradural, thoracic by transthoracic approach

63306

2,251.56

Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; intradural, thoracic by thoracolumbar approach

63307

2,050.67

Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; intradural, lumbar or sacral by transperitoneal or retroperitoneal approach

63308

322.52

Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; each additional segment (List separately in addition to codes for single segment)

63600

806.70

775.64

Creation of lesion of spinal cord by stereotactic method, percutaneous, any modality (including stimulation and/or recording)

63610

806.70

2,018.72

Stereotactic stimulation of spinal cord, percutaneous, separate procedure not followed by other surgery

63615

806.70

1,083.02

Stereotactic biopsy, aspiration, or excision of lesion, spinal cord

63650

3,714.19

414.74

Percutaneous implantation of neurostimulator electrode array, epidural

63655

4,911.13

797.56

Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural

63660

1,004.30

419.96

Revision or removal of spinal neurostimulator electrode percutaneous array(s) or plate/paddle(s)

63685

15,677.98

479.69

Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling

63688

1,538.02

397.89

Revision or removal of implanted spinal neurostimulator pulse generator or receiver

63700

1,163.43

Repair of meningocele; less than 5 cm diameter

63702

1,265.15

Repair of meningocele; larger than 5 cm diameter

63704

1,461.97

Repair of myelomeningocele; less than 5 cm diameter

63706

1,687.67

Repair of myelomeningocele; larger than 5 cm diameter

63707

860.65

Repair of dural/cerebrospinal fluid leak, not requiring laminectomy

63709

1,045.82

Repair of dural/cerebrospinal fluid leak or pseudomeningocele, with laminectomy

63710

1,043.36

Dural graft, spinal

63740

874.39

Creation of shunt, lumbar, subarachnoid-peritoneal,

-pleural, or other; including laminectomy

63741

580.50

Creation of shunt, lumbar, subarachnoid-peritoneal, -pleural, or other; percutaneous, not requiring laminectomy

63744

1,621.15

613.07

Rep lac e m en t, irr i gat io n or rev ision of lumbosubarachnoid shunt

63746

253.00

511.11

Removal of entire lumbosubarachnoid shunt system without replacement

64400

60.67

116.40

Injection, anesthetic agent; trigeminal nerve, any division or branch

64402

55.52

114.88

Injection, anesthetic agent; facial nerve

64405

48.17

107.76

Injection, anesthetic agent; greater occipital nerve

64408

55.52

120.64

Injection, anesthetic agent; vagus nerve

64410

315.26

153.24

Injection, anesthetic agent; phrenic nerve

64412

87.88

152.69

Injection, anesthetic agent; spinal accessory nerve

64413

57.74

122.92

Injection, anesthetic agent; cervical plexus

64415

183.07

150.35

Injection, anesthetic agent; brachial plexus, single

64416

315.26

169.74

Injection, anesthetic agent; brachial plexus, continuous infusion by catheter (including catheter placement) including daily management for anesthetic agent administration

64417

183.07

155.11

Injection, anesthetic agent; axillary nerve

64418

83.10

151.19

Injection, anesthetic agent; suprascapular nerve

64420

183.07

187.22

Injection, anesthetic agent; intercostal nerve, single

64421

183.07

282.51

Injection, anesthetic agent; intercostal nerves, multiple, regional block

64425

54.06

131.31

Injection, anesthetic agent; ilioinguinal, iliohypogastric nerves

64430

315.26

165.62

Injection, anesthetic agent; pudendal nerve

64435

83.10

158.33

Injection, anesthetic agent; paracervical (uterine) nerve

64445

79.07

152.49

Injection, anesthetic agent; sciatic nerve, single

64446

647.43

163.31

Injection, anesthetic agent; sciatic nerve, continuous infusion by catheter (including catheter placement), including daily management for anesthetic agent administration

64447

183.07

67.72

Injection, anesthetic agent; femoral nerve, single

64448

147.73

Injection, anesthetic agent; femoral nerve, continuous infusion by catheter (including catheter placement) including daily management for anesthetic agent administration

64449

146.88

Injection, anesthetic agent; lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement) including daily management for anesthetic agent administration

64450

45.97

105.25

Injection, anesthetic agent; other peripheral nerve or branch

64470

315.26

321.00

Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level

64472

183.07

128.37

Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, each additional level (List separately in addition to code for primary procedure)

64475

315.26

293.25

Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; lumbar or sacral, single level

64476

103.73

109.66

Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; lumbar or sacral, each additional level (List separately in addition to code for primary procedure)

64479

315.26

337.39

Injection, anesthetic agent and/or steroid, transforaminal epidural; cervical or thoracic, single level

64480

183.07

156.84

Injection, anesthetic agent and/or steroid, transforaminal epidural; cervical or thoracic, each additional level (List separately in addition to code for primary procedure)

64483

315.26

337.89

Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, single level

64484

183.07

160.58

Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, each additional level (List separately in addition to code for primary procedure)

64505

43.39

103.75

Injection, anesthetic agent; sphenopalatine ganglion

64508

98.55

163.69

Injection, anesthetic agent; carotid sinus (separate procedure)

64510

315.26

167.11

Injection, anesthetic agent; stellate ganglion (cervical sympathetic)

64517

315.26

180.59

Injection, anesthetic agent; superior hypogastric plexus

64520

315.26

226.16

Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic)

64530

64550

315.26

223.57

17.49

Injection, anesthetic agent; celiac plexus, with or without radiologic monitoring Application of surface (transcutaneous) neurostimulator

64553

14,145.64

211.07

Percutaneous implantation of neurostimulator electrodes; cranial nerve

64555

3,714.19

219.21

Percutaneous implantation of neurostimulator electrodes; peripheral nerve (excludes sacral nerve)

64560

3,714.19

203.85

Percutaneous implantation of neurostimulator electrodes; autonomic nerve

64561

3,714.19

1,400.02

Percutaneous implantation of neurostimulator electrodes; sacral nerve (transforaminal placement)

64565

3,714.19

197.23

Percutaneous implantation of neurostimulator electrodes; neuromuscular

64573

14,145.64

566.03

Incision for implantation of neurostimulator electrodes; cranial nerve

64575

4,911.13

276.58

Incision for implantation of neurostimulator electrodes; peripheral nerve (excludes sacral nerve)

64577

4,911.13

375.09

Incision for implantation of neurostimulator electrodes; autonomic nerve

64580

4,911.13

296.21

Incision for implantation of neurostimulator electrodes; neuromuscular

64581

4,911.13

790.31

Incision for implantation of neurostimulator electrodes; sacral nerve (transforaminal placement)

64585

1,004.30

472.85

Revision or removal of peripheral neurostimulator electrodes

64590

12,045.40

399.93

Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver, direct or inductive coupling

64595

1,538.02

453.00

Revision or removal of peripheral or gastric neurostimulator pulse generator or receiver

64600

647.43

468.47

Destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital, mental, or inferior alveolar branch

64605

647.43

601.74

Destruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale

64610

647.43

707.34

Destruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale under radiologic monitoring

64612

74.65

164.34

Chemodenervation of muscle(s); muscle(s) innervated by facial nerve (eg, for blepharospasm, hemifacial spasm)

64613

79.07

169.86

Chemodenervation of muscle(s); neck muscle(s) (eg, for spasmodic torticollis, spasmodic dysphonia)

64614

89.00

189.50

Chemodenervation of muscle(s); extremity(s) and/or trunk muscle(s) (eg, for dystonia, cerebral palsy, multiple sclerosis)

64620

315.26

296.04

Destruction by neurolytic agent, intercostal nerve

64622

647.43

380.53

Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level

64623

315.26

142.39

Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, each additional level (List separately in addition to code for primary procedure)

64626

647.43

424.56

Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, single level

64627

103.73

200.50

Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, each additional level (List separately in addition to code for primary procedure)

64630

315.26

236.28

Destruction by neurolytic agent; pudendal nerve

64640

121.36

255.50

Destruction by neurolytic agent; other peripheral nerve or branch

64650

29.05

62.06

Chemodenervation of eccrine glands; both axillae

64653

30.53

70.65

Chemodenervation of eccrine glands; other area(s) (eg, scalp, face, neck), per day

64680

647.43

347.77

Destruction by neurolytic agent, with or without radiologic monitoring; celiac plexus

64681

647.43

462.41

Destruction by neurolytic agent, with or without radiologic monitoring; superior hypogastric plexus

64702

806.70

435.06

Neuroplasty; digital, one or both, same digit

64704

806.70

327.58

Neuroplasty; nerve of hand or foot

64708

806.70

449.65

Neuroplasty, major peripheral nerve, arm or leg; other than specified

64712

806.70

515.89

Neuroplasty, major peripheral nerve, arm or leg; sciatic nerve

64713

806.70

714.66

Neuroplasty, major peripheral nerve, arm or leg; brachial plexus

64714

806.70

589.58

Neuroplasty, major peripheral nerve, arm or leg; lumbar plexus

64716

806.70

516.39

Neuroplasty and/or transposition; cranial nerve (specify)

64718

806.70

I

1,425.12

Neuroplasty and/or transposition; ulnar nerve at elbow

64719

806.70

389.34

Neuroplasty and/or transposition; ulnar nerve at wrist

64721

806.70

I

1,033.44

Neuroplasty and/or transposition; median nerve at carpal tunnel

64722

806.70

315.23

Decompression; unspecified nerve(s) (specify)

64726

806.70

288.81

Decompression; plantar digital nerve

64727

806.70

181.91

Internal neurolysis, requiring use of operating microscope (List separately in addition to code for neuroplasty) (Neuroplasty includes external neurolysis)

64732

806.70

358.38

Transection or avulsion of; supraorbital nerve

64734

806.70

407.92

Transection or avulsion of; infraorbital nerve

64736

806.70

368.87

Transection or avulsion of; mental nerve

64738

806.70

459.22

Transection or avulsion of; inferior alveolar nerve by osteotomy

64740

806.70

462.08

Transection or avulsion of; lingual nerve

64742

806.70

459.01

Transection or avulsion of; facial nerve, differential or complete

64744

806.70

407.31

Transection or avulsion of; greater occipital nerve

64746

806.70

437.54

Transection or avulsion of; phrenic nerve

64752

472.98

Transection or avulsion of; vagus nerve (vagotomy), transthoracic

64755

822.65

Transection or avulsion of; vagus nerves limited to proximal stomach (selective proximal vagotomy, proximal gastric vagotomy, parietal cell vagotomy, supra- or highly selective vagotomy)

64760

446.63

Transection or avulsion of; vagus nerve (vagotomy), abdominal

64761

806.70

433.27

Transection or avulsion of; pudendal nerve

64763

806.70

492.31

Transection or avulsion of obturator nerve, extrapelvic, with or without adductor tenotomy

64766

1,486.8

1

580.35

Transection or avulsion of obturator nerve, intrapelvic, with or without adductor tenotomy

64771

806.70

568.45

Transection or avulsion of other cranial nerve, extradural

64772

806.70

537.29

Transection or avulsion of other spinal nerve, extradural

64774

806.70

397.69

Excision of neuroma; cutaneous nerve, surgically identifiable

64776

806.70

381.55

Excision of neuroma; digital nerve, one or both, same digit

64778

806.70

182.11

Excision of neuroma; digital nerve, each additional digit (List separately in addition to code for primary procedure)

64782

806.70

440.70

Excision of neuroma; hand or foot, except digital nerve

64783

806.70

215.60

Excision of neuroma; hand or foot, each additional nerve, except same digit (List separately in addition to code for primary procedure)

64784

806.70

698.71

Excision of neuroma; major peripheral nerve, except sciatic

64786

1,486.81

1,049.32

Excision of neuroma; sciatic nerve

64787

806.70

250.39

Implantation of nerve end into bone or muscle (List separately in addition to neuroma excision)

64788

806.70

370.44

Excision of neurofibroma or neurolemmoma; cutaneous nerve

64790

806.70

798.28

Excision of neurofibroma or neurolemmoma; major peripheral nerve

64792

1,486.81

1,005.49

Excision of neurofibroma or neurolemmoma; extensive (including malignant type)

64795

806.70

186.94

Biopsy of nerve

64802

806.70

587.13

Sympathectomy, cervical

64804

905.63

Sympathectomy, cervicothoracic

64809

838.37

Sympathectomy, thoracolumbar

64818

644.57

Sympathectomy, lumbar

64820

806.70

731.52

Sympathectomy; digital arteries, each digit

64821

1,175.77

670.38

Sympathectomy; radial artery

64822

1,175.77

667.11

Sympathectomy; ulnar artery

64823

1,175.77

751.81

Sympathectomy; superficial palmar arch

64831

1,486.81

706.84

Suture of digital nerve, hand or foot; one nerve

64832

1,486.81

338.98

Suture of digital nerve, hand or foot; each additional digital nerve (List separately in addition to code for primary procedure)

64834

1,486.81

723.44

Suture of one nerve; hand or foot, common sensory nerve

64835

1,486.81

784.22

Suture of one nerve; median motor thenar

64836

1,486.81

785.64

Suture of one nerve; ulnar motor

64837

1,486.81

375.95

Suture of each additional nerve, hand or foot (List separately in addition to code for primary procedure)

64840

1,486.81

877.79

Suture of posterior tibial nerve

64856

1,486.81

980.83

Suture of major peripheral nerve, arm or leg, except sciatic; including transposition

64857

1,486.81

1,025.71

Suture of major peripheral nerve, arm or leg, except sciatic; without transposition

64858

1,486.81

1,172.21

Suture of sciatic nerve

64859

1,486.81

255.87

Suture of each additional major peripheral nerve (List separately in addition to code for primary procedure)

64861

1,486.81

1,331.97

Suture of brachial plexus

64862

1,486.81

1,352.14

Suture of lumbar plexus

64864

1,486.81

865.96

Suture of facial nerve; extracranial

64865

1,486.81

1,166.62

Suture of facial nerve; infratemporal, with or without grafting

64866

1,190.42

Anastomosis; facial-spinal accessory

64868

1,036.54

Anastomosis; facial-hypoglossal

64870

1,486.81

1,004.33

Anastomosis; facial-phrenic

64872

1,486.81

119.44

Suture of nerve; requiring secondary or delayed suture (List separately in addition to code for primary neurorrhaphy)

64874

1,486.81

178.31

Suture of nerve; requiring extensive mobilization, or transposition of nerve (List separately in addition to code for nerve suture)

64876

1,486.81

202.34

Suture of nerve; requiring shortening of bone of extremity (List separatelyin addition to code for nerve suture)

64885

1,486.81

1,119.53

Nerve graft (includes obtaining graft), head or neck; up to 4 cm in length

64886

1,486.81

1,320.59

Nerve graft (includes obtaining graft), head or neck; more than 4 cm length

64890

1,486.81

1,055.79

Nerve graft (includes obtaining graft), single strand, hand or foot; up to 4 cm length

64891

1,486.81

1,033.57

Nerve graft (includes obtaining graft), single strand, hand or foot; more than 4 cm length

64892

1,486.81

1,021.56

Nerve graft (includes obtaining graft), single strand, arm or leg; up to 4 cm length

64893

1,486.81

1,098.86

Nerve graft (includes obtaining graft), single strand, arm or leg; more than 4 cm length

64895

1,486.81

1,245.47

Nerve graft (includes obtaining graft), multiple strands (cable), hand or foot; up to 4 cm length

64896

1,486.81

1,361.18

Nerve graft (includes obtaining graft), multiple strands (cable), hand or foot; more than 4 cm length

64897

1,486.81

1,221.59

Nerve graft (includes obtaining graft), multiple strands (cable), arm or leg; up to 4 cm length

64898

1,486.81

1,329.50

Nerve graft (includes obtaining graft), multiple strands (cable), arm or leg; more than 4 cm length

64901

1,486.81

594.15

Nerve graft, each additional nerve; single strand (List separately in addition to code for primary procedure)

64902

1,486.81

694.10

Nerve graft, each additional nerve; multiple strands (cable) (List separately in addition to code for primary procedure)

64905

1,486.81

928.43

Nerve pedicle transfer; first stage

64907

1,486.81

1,208.97

Nerve pedicle transfer; second stage

64910

806.70

649.39

Nerve repair; with synthetic conduit or vein allograft (eg, nerve tube), each nerve

64911

787.29

Nerve repair; with autogenous vein graft (includes harvest of vein graft), each nerve

64999

I.C.

Unlisted procedure, nervous system

65091

1,685.83

600.08

Evisceration of ocular contents; without implant

65093

1,685.83

603.98

Evisceration of ocular contents; with implant

65101

1,685.83

689.80

Enucleation of eye; without implant

65103

1,685.83

717.12

Enucleation of eye; with implant, muscles not attached to implant

65105

1,685.83

786.57

Enucleation of eye; with implant, muscles attached to implant

65110

1,685.83

1,128.42

Exenteration of orbit (does not include skin graft), removal of orbital contents; only

65112

1,685.83

1,337.22

Exenteration of orbit (does not include skin graft), removal of orbital contents; with therapeutic removal of bone

65114

1,685.83

1,378.80

Exenteration of orbit (does not include skin graft), removal of orbital contents; with muscle or myocutaneous flap

65125

837.04

471.45

Modification of ocular implant with placement or replacement of pegs (eg, drilling receptacle for prosthesis appendage) (separate procedure)

65130

1,086.26

678.70

Insertion of ocular implant secondary; after evisceration, in scleral shell

65135

1,086.26

690.21

Insertion of ocular implant secondary; after enucleation, muscles not attached to implant

65140

1,685.83

747.37

Insertion of ocular implant secondary; after enucleation, muscles attached to implant

65150

1,086.26

553.26

Reinsertion of ocular implant; with or without conjunctival graft

65155

1,685.83

795.23

Reinsertion of ocular implant; with use of foreign material for reinforcement and/or attachment of muscles to implant

65175

837.04

612.98

Removal of ocular implant

65205

22.06

52.76

Removal of foreign body, external eye; conjunctival superficial

65210

27.95

64.86

Removal of foreign body, external eye; conjunctival embedded (includes concretions), subconjunctival, or scleral nonperforating

65220

38.86

54.28

Removal of foreign body, external eye; corneal, without slit lamp

65222

30.53

71.16

Removal of foreign body, external eye; corneal, with slit lamp

65235

722.66

622.02

Removal of foreign body, intraocular; from anterior chamber of eye or lens

65260

814.89

860.16

Removal of foreign body, intraocular; from posterior segment, magnetic extraction, anterior or posterior route

65265

1,244.34

963.98

Removal of foreign body, intraocular; from posterior segment, nonmagnetic extraction

65270

837.04

276.30

Repair of laceration; conjunctiva, with or without nonperforating laceration sclera, direct closure

65272

1,035.68

481.19

Repair of laceration; conjunctiva, by mobilization and rearrangement, without hospitalization

65273

338.05

Repair of laceration; conjunctiva, by mobilization and rearrangement, with hospitalization

65275

1,035.68

507.87

Repair of laceration; cornea, nonperforating, with or without removal foreign body

65280

814.89

591.79

Repair of laceration; cornea and/or sclera, perforating, not involving uveal tissue

65285

1,662.75

916.92

Repair of laceration; cornea and/or sclera, perforating, with reposition or resection of uveal tissue

65286

228.66

684.92

Repair of laceration; application of tissue glue, wounds of cornea and/or sclera

65290

1,078.29

437.37

Repair of wound, extraocular muscle, tendon and/or Tenon's capsule

65400

722.66

619.91

Excision of lesion, cornea (keratectomy, lamellar, partial), except pterygium

65410

722.66

139.28

Biopsy of cornea

65420

722.66

512.84

Excision or transposition of pterygium; without graft

65426

1,035.68

630.20

Excision or transposition of pterygium; with graft

65430

38.86

107.06

Scraping of cornea, diagnostic, for smear and/or culture

65435

34.20

75.42

Removal of corneal epithelium; with or without chemocauterization (abrasion, curettage)

65436

722.66

347.88

Removal of corneal epithelium; with application of chelating agent (eg, EDTA)

65450

97.37

297.30

Destruction of lesion of cornea by cryotherapy, photocoagulation or thermocauterization

65600

173.20

361.31

Multiple punctures of anterior cornea (eg, for corneal erosion, tattoo)

65710

1,675.35

990.48

Keratoplasty (corneal transplant); lamellar

65730

1,675.35

1,095.79

Keratoplasty (corneal transplant); penetrating (except in aphakia)

65750

1,675.35

1,108.61

Keratoplasty (corneal transplant); penetrating (in aphakia)

65755

1,675.35

1,102.26

Keratoplasty (corneal transplant); penetrating (in pseudophakia)

65760

I.C.

Keratomileusis

65765

I.C.

Keratophakia

65767

I.C.

Epikeratoplasty

65770

65771

3,789.74

I.C.

1,260.93

Keratoprosthesis Radial keratotomy

65772

722.66

414.53

Corneal relaxing incision for correction of surgically induced astigmatism

65775

722.66

497.31

Corneal wedge resection for correction of surgically induced astigmatism

65780

1,675.35

811.63

Ocular surface reconstruction; amniotic membrane transplantation

65781

1,675.35

1,203.64

Ocular surface reconstruction; limbal stem cell allograft (eg, cadaveric or living donor)

65782

1,675.35

1,041.25

Ocular surface reconstruction; limbal conjunctival autograft (includes obtaining graft)

65800

722.66

141.56

Paracentesis of anterior chamber of eye (separate procedure); with diagnostic aspiration of aqueous

65805

722.66

157.21

Paracentesis of anterior chamber of eye (separate procedure); with therapeutic release of aqueous

65810

1,035.68

416.20

Paracentesis of anterior chamber of eye (separate procedure); with removal of vitreous and/or discission of anterior hyaloid membrane, with or without air injection

65815

1,035.68

619.64

Paracentesis of anterior chamber of eye (separate procedure); with removal of blood, with or without irrigation and/or air injection

65820

228.66

690.83

Goniotomy

65850

1,035.68

762.06

Trabeculotomy ab externo

65855

143.05

318.36

Trabeculoplastybylaser surgery, one or more sessions (defined treatment series)

65860

133.86

294.95

Severing adhesions of anterior segment, laser technique (separate procedure)

65865

722.66

439.15

Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); goniosynechiae

65870

1,035.68

534.39

Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); anterior synechiae, except goniosynechiae

65875

1,035.68

566.76

Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); posterior synechiae

65880

722.66

596.11

Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); corneovitreal adhesions

65900

722.66

875.73

Removal of epithelial downgrowth, anterior chamber of eye

65920

1,035.68

704.78

Removal of implanted material, anterior segment of eye

65930

1,035.68

582.41

Removal of blood clot, anterior segment of eye

66020

722.66

184.87

Injection, anterior chamber of eye (separate procedure); air or liquid

66030

228.66

166.21

Injection, anterior chamber of eye (separate procedure); medication

66130

1,035.68

670.12

Excision of lesion, sclera

66150

1,035.68

780.68

Fistulization of sclera for glaucoma; trephination with iridectomy

66155

1,035.68

777.46

Fistulization of sclera for glaucoma;

thermocauterization with iridectomy

66160

1,035.68

878.53

Fistulization of sclera for glaucoma; sclerectomy with punch or scissors, with iridectomy

66165

1,035.68

764.38

Fistulization of sclera for glaucoma; iridencleisis or iridotasis

66170

1,035.68

1,062.72

Fistulization of sclera for glaucoma; trabeculectomy ab externo in absence of previous surgery

66172

1,035.68

1,332.37

Fistulization of sclera for glaucoma; trabeculectomy ab externo with scarring from previous ocular surgery or trauma (includes injection of antifibrotic agents)

66180

1,774.58

1,039.12

Aqueous shunt to extraocular reservoir (eg, Molteno, Schocket, Denver-Krupin)

66185

1,774.58

663.09

Revision of aqueous shunt to extraocular reservoir

66220

1,662.75

646.78

Repair of scleral staphyloma; without graft

66225

1,774.58

827.20

Repair of scleral staphyloma; with graft

66250

722.66

727.18

Revision or repair of operative wound of anterior segment, any type, early or late, major or minor procedure

66500

228.66

330.89

Iridotomy by stab incision (separate procedure); except transfixion

66505

228.66

361.04

Iridotomy by stab incision (separate procedure); with transfixion as for iris bombe

66600

1,035.68

729.84

Iridectomy, with corneoscleral or corneal section; for removal of lesion

66605

1,035.68

949.06

Iridectomy, with corneoscleral or corneal section; with cyclectomy

66625

228.66

390.74

Iridectomy, with corneoscleral or corneal section; peripheral for glaucoma (separate procedure)

66630

1,035.68

506.24

Iridectomy, with corneoscleral or corneal section; sector for glaucoma (separate procedure)

66635

1,035.68

510.70

Iridectomy, with corneoscleral or corneal section; optical (separate procedure)

66680

1,035.68

459.11

Repair of iris, ciliary body (as for iridodialysis)

66682

1,035.68

559.96

Suture of iris, ciliary body (separate procedure) with retrieval of suture through small incision (eg, McCannel suture)

66700

722.66

410.56

Ciliary body destruction; diathermy

66710

722.66

404.28

Ciliary body destruction; cyclophotocoagulation, transscleral

66711

722.66

565.55

Ciliary body destruction; cyclophotocoagulation, endoscopic

66720

722.66

430.57

Ciliary body destruction; cryotherapy

66740

1,035.68

401.05

Ciliary body destruction; cyclodialysis

66761

194.90

416.68

Iridotomy/iridectomy by laser surgery (eg, for glaucoma) (one or more sessions)

66762

197.48

433.78

Iridoplasty by photocoagulation (one or more sessions) (eg, for improvement of vision, for widening of anterior chamber angle)

66770

213.29

479.39

Destruction of cyst or lesion iris or ciliary body (nonexcisional procedure)

66820

228.66

380.14

Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); stab incision technique (Ziegler or Wheeler knife)

66821

232.38

298.92

Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); laser surgery (eg, YAG laser) (one or more stages)

66825

1,035.68

700.69

Repositioning of intraocular lens prosthesis, requiring an incision (separate procedure)

66830

228.66

633.84

Removal of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid) with corneo-scleral section, with or without iridectomy (iridocapsulotomy, iridocapsulectomy)

66840

666.62

621.16

Removal of lens material; aspiration technique, one or more stages

66850

1,282.70

704.15

Removal of lens material; phacofragmentation technique (mechanical or ultrasonic) (eg, phacoemulsification), with aspiration

66852

1,282.70

752.67

Removal of lens material; pars plana approach, with or without vitrectomy

66920

1,282.70

673.05

Removal of lens material; intracapsular

66930

1,282.70

762.26

Removal of lens material; intracapsular, for dislocated lens

66940

666.62

695.11

Removal of lens material; extracapsular (other than 66840, 66850, 66852)

66982

1,066.48

958.35

Extracapsular cataract removal with insertion of intraocular lens prosthesis (one stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage

66983

1,066.48

642.89

Intracapsular cataract extraction with insertion of intraocular lens prosthesis (one stage procedure)

66984

1,066.48

684.39

Extracapsular cataract removal with insertion of intraocular lens prosthesis (one stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification)

66985

1,066.48

678.55

Insertion of intraocular lens prosthesis (secondary implant), not associated with concurrent cataract removal

66986

1,066.48

833.34

Exchange of intraocular lens

66990

81.73

Use of ophthalmic endoscope (List separately in addition to code for primary procedure)

66999

I.C.

Unlisted procedure, anterior segment of eye

67005

1,244.34

422.65

Removal of vitreous, anterior approach (open sky technique or limbal incision); partial removal

67010

1,244.34

486.95

Removal of vitreous, anterior approach (open sky technique or limbal incision); subtotal removal with mechanical vitrectomy

67015

1,244.34

529.04

Aspiration or release of vitreous, subretinal or choroidal fluid, pars plana approach (posterior sclerotomy)

67025

1,244.34

673.34

Injection of vitreous substitute, pars plana or limbal approach (fluid-gas exchange), with or without aspiration (separate procedure)

67027

1,662.75

759.94

Implantation of intravitreal drug delivery system (eg, ganciclovir implant), includes concomitant removal of vitreous

67028

89.00

201.49

Intravitreal injection of a pharmacologic agent (separate procedure)

67030

814.89

472.72

Discission of vitreous strands (without removal), pars plana approach

67031

232.38

353.80

Severing of vitreous strands, vitreous face adhesions, sheets, membranes or opacities, laser surgery (one or more stages)

67036

1,662.75

859.70

Vitrectomy, mechanical, pars plana approach;

67039

1,662.75

1,107.45

Vitrectomy, mechanical, pars plana approach; with focal endolaser photocoagulation

67040

1,662.75

1,273.05

Vitrectomy, mechanical, pars plana approach; with endolaser panretinal photocoagulation

67041

1,662.75

1,151.81

Vitrectomy, mechanical, pars plana approach; with removal of preretinal cellular membrane (eg, macular pucker)

67042

1,662.75

1,314.43

Vitrectomy, mechanical, pars plana approach; with removal of internal limiting membrane of retina (eg, for repair of macular hole, diabetic macular edema), includes, if performed, intraocular tamponade (ie, air, gas or silicone oil)

67043

1,662.75

1,382.86

Vitrectomy, mechanical, pars plana approach; with removal of subretinal membrane (eg, choroidal neovascularization), includes, if performed, intraocular tamponade (ie, air, gas or silicone oil) and laser photocoagulation

67101

323.60

710.23

Repair of retinal detachment, one or more sessions; cryotherapy or diathermy, with or without drainage of subretinal fluid

67105

232.38

652.90

Repair of retinal detachment, one or more sessions; photocoagulation, with or without drainage of subretinal fluid

67107

1,662.75

1,078.61

Repair of retinal detachment; scleral buckling (such as lamellar scleral dissection, imbrication or encircling procedure), with or without implant, with or without cryotherapy, photocoagulation, and drainage of subretinal fluid

67108

1,662.75

1,428.12

Repair of retinal detachment; with vitrectomy, any method, with or without air or gas tamponade, focal endolaser photocoagulation, cryotherapy, drainage of subretinal fluid, scleral buckling, and/or removal of lens by same technique

67110

351.92

796.25

Repair of retinal detachment; by injection of air or other gas (eg, pneumatic retinopexy)

67112

1,662.75

1,176.32

Repair of retinal detachment; by scleral buckling or vitrectomy, on patient having previous ipsilateral retinal detachment repair(s) using scleral buckling or vitrectomy techniques

67113

1,662.75

1,520.34

Repair of complex retinal detachment (eg,

proliferative vitreoretinopathy, stage C-1 or greater, diabetic traction retinal detachment, retinopathy of prematurity, retinal tear of greater than 90 degrees), with vitrectomy and membrane peeling, may include air, gas, or silicone oil tamponade, cryotherapy, endolaser photocoagulation, drainage of subretinal fluid, scleral buckling, and/or removal of lens

67115

814.89

440.10

Release of encircling material (posterior segment)

67120

814.89

611.81

Removal of implanted material, posterior segment; extraocular

67121

1,244.34

804.88

Removal of implanted material, posterior segment; intraocular

67141

184.70

471.79

Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage, one or more sessions; cryotherapy, diathermy

67145

203.36

473.29

Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage, one or more sessions; photocoagulation (laser or xenon arc)

67208

216.23

537.07

Destruction of localized lesion of retina (eg, macular edema, tumors), one or more sessions; cryotherapy, diathermy

67210

229.47

619.64

Destruction of localized lesion of retina (eg, macular edema, tumors), one or more sessions; photocoagulation

67218

814.89

1,242.21

Destruction of localized lesion of retina (eg, macular edema, tumors), one or more sessions; radiation by implantation of source (includes removal of source)

67220

184.70

955.97

Destruction of localized lesion of choroid (eg, choroidal neovascularization); photocoagulation (eg, laser), one or more sessions

67221

133.12

290.41

Destruction of localized lesion of choroid (eg, choroidal neovascularization); photodynamic therapy (includes intravenous infusion)

67225

8.83

27.69

Destruction of localized lesion of choroid (eg, choroidal neovascularization); photodynamic therapy, second eye, at single session (List separately in addition to code for primary eye treatment)

67227

1,244.34

551.38

Destruction of extensive or progressive retinopathy (eg, diabetic retinopathy), one or more sessions, cryotherapy, diathermy

67228

232.38

1,062.81

Treatment of extensive or progressive retinopathy, one or more sessions; (eg, diabetic retinopathy), photocoagulation

67250

837.04

724.64

Scleral reinforcement (separate procedure); without graft

67255

1,244.34

775.21

Scleral reinforcement (separate procedure); with graft

67299

I.C.

Unlisted procedure, posterior segment

67311

1,078.29

535.36

Strabismus surgery, recession or resection procedure; one horizontal muscle

67312

1,078.29

634.37

Strabismus surgery, recession or resection procedure; two horizontal muscles

67314

1,078.29

597.26

Strabismus surgery, recession or resection procedure; one vertical muscle (excluding superior oblique)

67316

1,078.29

712.91

Strabismus surgery, recession or resection procedure; two or more vertical muscles (excluding superior oblique)

67318

1,078.29

626.16

Strabismus surgery, any procedure, superior oblique muscle

67320

1,078.29

280.26

Transposition procedure (eg, for paretic extraocular muscle), any extraocular muscle (specify) (List separately in addition to code for primary procedure)

67331

1,078.29

265.22

Strabismus surgery on patient with previous eye surgery or injury that did not involve the extraocular muscles (List separately in addition to code for primary procedure)

67332

1,078.29

288.79

Strabismus surgery on patient with scarring of extraocular muscles (eg, prior ocular injury, strabismus or retinal detachment surgery) or restrictive myopathy (eg, dysthyroid ophthalmopathy) (List separately in addition to code for primary procedure)

67334

1,078.29

261.27

Strabismus surgery by posterior fixation suture technique, with or without muscle recession (List separately in addition to code for primary procedure)

67335

1,078.29

134.94

Placement of adjustable suture(s) during strabismus surgery, including postoperative adjustment(s) of suture(s) (List separately in addition to code for specific strabismus surgery)

67340

1,078.29

312.23

Strabismus surgery involving exploration and/or repair of detached extraocular muscle(s) (List separately in addition to code for primary procedure)

67343

1,078.29

583.65

Release of extensive scar tissue without detaching extraocular muscle (separate procedure)

67345

87.52

216.39

Chemodenervation of extraocular muscle

67346

67399

614.25

183.04 I.C.

Biopsy of extraocular muscle Unlisted procedure, ocular muscle

67400

1,086.26

867.27

Orbitotomy without bone flap (frontal or transconjunctival approach); for exploration, with or without biopsy

67405

1,086.26

737.49

Orbitotomy without bone flap (frontal or transconjunctival approach); with drainage only

67412

1,086.26

809.48

Orbitotomy without bone flap (frontal or transconjunctival approach); with removal of lesion

67413

1,086.26

807.81

Orbitotomy without bone flap (frontal or transconjunctival approach); with removal of foreign body

67414

1,685.83

1,171.52

Orbitotomy without bone flap (frontal or transconjunctival approach); with removal of bone for decompression

67415

837.04

94.55

Fine needle aspiration of orbital contents

67420

1,685.83

1,500.81

Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); with removal of lesion

67430

1,685.83

1,153.44

Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); with removal of foreign body

67440

1,685.83

1,119.69

Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); with drainage

67445

1,685.83

1,274.08

Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); with removal of bone for decompression

67450

1,685.83

1,157.67

Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); for exploration, with or without biopsy

67500

97.37

79.20

Retrobulbar injection; medication (separate procedure, does not include supply of medication)

67505

129.69

75.70

Retrobulbar injection; alcohol

67515

25.01

80.00

Injection of medication or other substance into Tenon's capsule

67550

1,685.83

901.43

Orbital implant (implant outside muscle cone); insertion

67560

1,086.26

912.29

Orbital implant (implant outside muscle cone); removal or revision

67570

1,685.83

1,071.70

Optic nerve decompression (eg, incision or fenestration of optic nerve sheath)

67599

I.C.

Unlisted procedure, orbit

67700

129.69

286.84

Blepharotomy, drainage of abscess, eyelid

67710

166.58

245.98

Severing of tarsorrhaphy

67715

837.04

256.33

Canthotomy (separate procedure)

67800

55.16

118.60

Excision of chalazion; single

67801

66.92

151.00

Excision of chalazion; multiple, same lid

67805

86.42

187.94

Excision of chalazion; multiple, different lids

67808

837.04

328.16

Excision of chalazion; under general anesthesia and/or requiring hospitalization, single or multiple

67810

129.69

219.87

Biopsy of eyelid

67820

19.13

49.38

Correction of trichiasis; epilation, by forceps only

67825

57.74

122.16

Correction of trichiasis; epilation by other than forceps (eg, by electrosurgery, cryotherapy, laser surgery)

67830

325.54

280.22

Correction of trichiasis; incision of lid margin

67835

837.04

401.08

Correction of trichiasis; incision of lid margin, with free mucous membrane graft

67840

172.47

289.20

Excision of lesion of eyelid (except chalazion) without closure or with simple direct closure

67850

122.46

213.76

Destruction of lesion of lid margin (up to 1 cm)

67875

325.54

178.91

Temporary closure of eyelids by suture (eg, Frost suture)

67880

722.66

435.86

Construction of intermarginal adhesions, median tarsorrhaphy, or canthorrhaphy;

67882

837.04

529.65

Construction of intermarginal adhesions, median tarsorrhaphy, or canthorrhaphy; with transposition of tarsal plate

67900

837.04

618.16

Repair of brow ptosis (supraciliary, mid-forehead or coronal approach)

67901

837.04

602.64

Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia)

67902

837.04

620.06

Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia)

67903

837.04

606.11

Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach

67904

837.04

689.28

Repair of blepharoptosis; (tarso) levator resection or advancement, external approach

67906

837.04

465.96

Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia)

67908

837.04

465.91

Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type)

67909

837.04

522.97

Reduction of overcorrection of ptosis

67911

837.04

487.27

Correction of lid retraction

67912

837.04

959.40

Correction of lagophthalmos, with implantation of upper eyelid lid load (eg, gold weight)

67914

837.04

387.48

Repair of ectropion; suture

67915

189.38

351.44

Repair of ectropion; thermocauterization

67916

837.04

523.60

Repair of ectropion; excision tarsal wedge

67917

837.04

567.73

Repair of ectropion; extensive (eg, tarsal strip operations)

67921

837.04

370.88

Repair of entropion; suture

67922

184.97

341.98

Repair of entropion; thermocauterization

67923

837.04

546.89

Repair of entropion; excision tarsal wedge

67924

837.04

572.93

Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation)

67930

185.33

361.28

Suture of recent wound, eyelid, involving lid margin, tarsus, and/or palpebral conjunctiva direct closure; partial thickness

67935

837.04

577.42

Suture of recent wound, eyelid, involving lid margin, tarsus, and/or palpebral conjunctiva direct closure; full thickness

67938

97.37

260.08

Removal of embedded foreign body, eyelid

67950

837.04

563.67

Canthoplasty (reconstruction of canthus)

67961

837.04

562.93

Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin

67966

837.04

707.96

Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin

67971

1,086.2

6

662.65

Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, one stage or first stage

67973

1,086.2

6

857.14

Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, one stage or first stage

67974

1,086.2

6

853.35

Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, one stage or first stage

67975

837.04

626.33

Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage

67999

I.C.

Unlisted procedure, eyelids

68020

48.54

110.01

Incision of conjunctiva, drainage of cyst

68040

23.90

60.60

Expression of conjunctival follicles (eg, for trachoma)

68100

102.96

177.53

Biopsy of conjunctiva

68110

131.64

229.05

Excision of lesion, conjunctiva; up to 1 cm

68115

837.04

321.90

Excision of lesion, conjunctiva; over 1 cm

68130

722.66

531.06

Excision of lesion, conjunctiva; with adjacent sclera

68135

62.52

144.45

Destruction of lesion, conjunctiva

68200

18.02

39.88

Subconjunctival injection

68320

837.04

698.38

Conjunctivoplasty; with conjunctival graft or extensive rearrangement

68325

1,086.26

591.91

Conjunctivoplasty; with buccal mucous membrane graft (includes obtaining graft)

68326

1,086.26

575.14

Conjunctivoplasty, reconstruction cul-de-sac; with conjunctival graft or extensive rearrangement

68328

1,086.26

646.84

Conjunctivoplasty, reconstruction cul-de-sac; with buccal mucous membrane graft (includes obtaining graft)

68330

1,035.68

586.98

Repair of symblepharon; conjunctivoplasty, without graft

68335

1,086.26

575.89

Repair of symblepharon; with free graft conjunctiva or buccal mucous membrane (includes obtaining graft)

68340

837.04

534.25

Repair of symblepharon; division of symblepharon, with or without insertion of conformer or contact lens

68360

1,035.68

511.92

Conjunctival flap; bridge or partial (separate procedure)

68362

1,035.68

582.85

Conjunctival flap; total (such as Gunderson thin flap or purse string flap)

68371

722.66

384.94

Harvesting conjunctival allograft, living donor

68399

I.C.

Unlisted procedure, conjunctiva

68400

129.69

298.29

Incision, drainage of lacrimal gland

68420

198.21

330.60

Incision, drainage of lacrimal sac (dacryocystotomy or dacryocystostomy)

68440

61.41

111.14

Snip incision of lacrimal punctum

68500

1,086.26

886.18

Excision of lacrimal gland (dacryoadenectomy), except for tumor; total

68505

1,086.26

890.82

Excision of lacrimal gland (dacryoadenectomy), except for tumor; partial

68510

837.04

452.55

Biopsy of lacrimal gland

68520

1,086.26

624.39

Excision of lacrimal sac (dacryocystectomy)

68525

837.04

240.36

Biopsy of lacrimal sac

68530

253.00

447.83

Removal of foreign body or dacryolith, lacrimal passages

68540

1,086.26

834.41

Excision of lacrimal gland tumor; frontal approach

68550

1,086.26

1,015.56

Excision of lacrimal gland tumor; involving osteotomy

68700

1,086.26

537.05

Plastic repair of canaliculi

68705

129.69

239.72

Correction of everted punctum, cautery

68720

1,086.26

686.34

Dacryocystorhinostomy (fistulization of lacrimal sac to nasal cavity)

68745

1,086.26

688.30

Conjunctivorhinostomy (fistulization of conjunctiva to nasal cavity); without tube

68750

1,086.26

711.20

Conjunctivorhinostomy (fistulization of conjunctiva to nasal cavity); with insertion of tube or stent

68760

97.37

203.29

Closure of the lacrimal punctum; by thermocauterization, ligation, or laser surgery

68761

75.39

143.27

Closure of the lacrimal punctum; by plug, each

68770

837.04

492.45

Closure of lacrimal fistula (separate procedure)

68801

38.86

119.89

Dilation of lacrimal punctum, with or without irrigation

68810

97.37

255.27

Probing of nasolacrimal duct, with or without irrigation;

68811

837.04

189.98

Probing of nasolacrimal duct, with or without irrigation; requiring general anesthesia

68815

837.04

453.11

Probing of nasolacrimal duct, with or without irrigation; with insertion of tube or stent

68816

468.12

694.08

Probing of nasolacrimal duct, with or without irrigation; with transluminal balloon catheter dilation

68840

57.00

116.50

Probing of lacrimal canaliculi, with or without irrigation

68850

65.34

Injection of contrast medium for dacryocystography

68899

I.C.

Unlisted procedure, lacrimal system

69000

62.85

186.35

Drainage external ear, abscess or hematoma; simple

69005

108.85

214.06

Drainage external ear, abscess or hematoma; complicated

69020

62.85

240.77

Drainage external auditory canal, abscess

69100

65.45

110.49

Biopsy external ear

69105

91.57

145.73

Biopsy external auditory canal

69110

719.48

463.01

Excision external ear; partial, simple repair

69120

1,071.47

416.28

Excision external ear; complete amputation

69140

1,071.47

903.99

Excision exostosis(es), external auditory canal

69145

719.48

391.81

Excision soft tissue lesion, external auditory canal

69150

332.81

1,069.75

Radical excision external auditory canal lesion; without neck dissection

69155

1,686.59

Radical excision external auditory canal lesion; with neck dissection

69200

28.19

132.57

Removal foreign body from external auditory canal; without general anesthesia

69205

943.36

103.81

Removal foreign body from external auditory canal; with general anesthesia

69210

22.06

49.94

Removal impacted cerumen (separate procedure), one or both ears

69220

35.44

143.67

Debridement, mastoidectomy cavity, simple (eg, routine cleaning)

69222

143.79

232.05

Debridement, mastoidectomy cavity, complex (eg, with anesthesia or more than routine cleaning)

69310

1,782.06

1,127.78

Reconstruction of external auditory canal

(meatoplasty) (eg, for stenosis due to injury, infection) (separate procedure)

69399

I.C.

Unlisted procedure, external ear

69400

91.57

145.05

Eustachian tube inflation, transnasal; with catheterization

69401

50.74

86.53

Eustachian tube inflation, transnasal; without catheterization

69405

131.64

261.55

Eustachian tube catheterization, transtympanic

69420

111.73

198.52

Myringotomy including aspiration and/or eustachian tube inflation

69421

729.71

156.76

Myringotomy including aspiration and/or eustachian tube inflation requiring general anesthesia

69424

83.10

135.14

Ventilating tube removal requiring general anesthesia

69433

117.68

204.23

Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia

69436

729.71

169.96

Tympanostomy (requiring insertion of ventilating tube), general anesthesia

69440

1,071.47

690.41

Middle ear exploration through postauricular or ear canal incision

69450

1,782.06

542.42

Tympanolysis, transcanal

69501

1,782.06

740.16

Transmastoid antrotomy (simple mastoidectomy)

69502

1,071.47

975.75

Mastoidectomy; complete

69505

1,782.06

1,244.79

Mastoidectomy; modified radical

69511

1,782.06

1,274.67

Mastoidectomy; radical

69530

1,782.06

1,688.16

Petrous apicectomy including radical mastoidectomy

69535

140.47

2,712.65

Resection temporal bone, external approach

69540

1,782.06

220.48

Excision aural polyp

69550

1,782.06

1,074.71

Excision aural glomus tumor; transcanal

69552

69554

1,782.06

2,557.82

1,614.72

Excision aural glomus tumor; transmastoid Excision aural glomus tumor; extended (extratemporal)

69601

1,782.06

1,053.12

Revision mastoidectomy; resulting in complete mastoidectomy

69602

1,782.06

1,098.43

Revision mastoidectomy; resulting in modified radical mastoidectomy

69603

1,782.06

1,316.26

Revision mastoidectomy; resulting in radical mastoidectomy

69604

1,782.06

1,124.32

Revision mastoidectomy; resulting in tympanoplasty

69605

1,782.06

1,604.86

Revision mastoidectomy; with apicectomy

69610

192.33

403.57

Tympanic membrane repair, with or without site preparation of perforation for closure, with or without patch

69620

1,071.47

724.43

Myringoplasty (surgery confined to drumhead and donor area)

69631

1,782.06

886.36

Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; without ossicular chain reconstruction

69632

1,782.06

1,085.37

Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction (eg, postfenestration)

69633

1,782.06

1,046.94

Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicular replacement prosthesis (PORP), total ossicular replacement prosthesis (TORP))

69635

1,782.06

1,250.39

Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); without ossicular chain reconstruction

69636

1,782.06

1,422.40

Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); with ossicular chain reconstruction

69637

1,782.06

1,414.67

Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); with ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicular replacement prosthesis (PORP), total

69641

1,782.06

1,048.68

Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); without ossicular chain reconstruction

69642

1,782.06

1,350.89

Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with ossicular chain reconstruction

69643

1,782.06

1,232.09

Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with intact or reconstructed wall, without ossicular chain reconstruction

69644

1,782.06

1,525.80

Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with intact or reconstructed canal wall, with ossicular chain reconstruction

69645

1,782.06

1,494.88

Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); radical or complete, without ossicular chain reconstruction

69646

1,782.06

1,584.45

Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); radical or complete, with ossicular chain reconstruction

69650

1,071.47

802.76

Stapes mobilization

69660

1,782.06

935.85

Stapedectomy or stapedotomy with reestablishment of ossicular continuity, with or without use of foreign material;

69661

1,782.06

1,226.07

Stapedectomy or stapedotomy with reestablishment of ossicular continuity, with or without use of foreign material; with footplate drill out

69662

1,782.06

1,170.69

Revision of stapedectomy or stapedotomy

69666

1,782.06

813.50

Repair oval window fistula

69667

1,782.06

815.22

Repair round window fistula

69670

1,782.06

953.02

Mastoid obliteration (separate procedure)

69676

1,782.06

843.41

Tympanic neurectomy

69700

1,782.06

715.66

Closure postauricular fistula, mastoid (separate procedure)

69710

I.C.

Implantation or replacement of electromagnetic bone conduction hearing device in temporal bone

69711

1,782.06

871.74

Removal or repair of electromagnetic bone conduction hearing device in temporal bone

69714

1,782.06

1,085.38

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

69715

1,782.06

1,339.39

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

69717

1,782.06

1,157.52

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

69718

1,782.06

1,407.91

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

69720

1,782.06

1,189.52

Decompression facial nerve, intratemporal; lateral to geniculate ganglion

69725

1,889.00

Decompression facial nerve, intratemporal; including medial to geniculate ganglion

69740

1,782.06

1,166.32

Suture facial nerve, intratemporal, with or without graft or decompression; lateral to geniculate ganglion

69745

69799

1,782.06

I.C.

1,185.04

Suture facial nerve, intratemporal, with or without graft or decompression; including medial to geniculate ganglion Unlisted procedure, middle ear

69801

1,782.06

754.22

Labyrinthotomy, with or without cryosurgery including other nonexcisional destructive procedures or perfusion of vestibuloactive drugs (single or multiple perfusions); transcanal

69802

1,782.06

1,045.89

Labyrinthotomy, with or without cryosurgery including other nonexcisional destructive procedures or perfusion of vestibuloactive drugs (single or multiple perfusions); with mastoidectomy

69805

1,782.06

1,054.61

Endolymphatic sac operation; without shunt

69806

1,782.06

950.87

Endolymphatic sac operation; with shunt

69820

1,782.06

876.41

Fenestration semicircular canal

69840

1,782.06

941.26

Revision fenestration operation

69905

1,782.06

923.19

Labyrinthectomy; transcanal

69910

1,782.06

1,028.43

Labyrinthectomy; with mastoidectomy

69915

1,782.06

1,544.64

Vestibular nerve section, translabyrinthine approach

69930

25,420.43

1,283.32

Cochlear device implantation, with or without mastoidectomy

69949

I.C.

Unlisted procedure, inner ear

69950

1,828.97

Vestibular nerve section, transcranial approach

69955

2,011.27

Total facial nerve decompression and/or repair (may include graft)

69960

1,937.08

Decompression internal auditory canal

69970

2,157.75

Removal of tumor, temporal bone

69979

I.C.

Unlisted procedure, temporal bone, middle fossa approach

69990

215.24

Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure)

88000

I.C.

Necropsy (autopsy), gross examination only; without CNS

88005

I.C.

Necropsy (autopsy), gross examination only; with brain

88007

I.C.

Necropsy (autopsy), gross examination only; with brain and spinal cord

88020

I.C.

Necropsy (autopsy), gross and microscopic; without CNS

88025

I.C.

Necropsy (autopsy), gross and microscopic; with brain

88027

I.C.

Necropsy (autopsy), gross and microscopic; with brain and spinal cord

88036

I.C.

Necropsy (autopsy), limited, gross and/or microscopic; regional

88037

I.C.

Necropsy (autopsy), limited, gross and/or microscopic; single organ

88040

I.C.

Necropsy (autopsy); forensic examination

88045

I.C.

Necropsy (autopsy); coroner's call

88099

I.C.

Unlisted necropsy (autopsy) procedure

88300

26.81

4.41 2

2.39

Level I - Surgical pathology, gross examination only

88302

58.73

7.04

51.69

Level II - Surgical pathology, gross and microscopic examination Appendix, incidental Fallopian tube, sterilization Fingers/toes, amputation, traumatic Foreskin, newborn Hernia sac, any location Hydrocele sac Nerve Skin, plastic repair Sympathetic ganglion Testis, castration Vaginal mucosa, incidental Vas deferens, sterilization

88304

72.39

11.03

61.36

Level III - Surgical pathology, gross and microscopic examination Abortion, induced Abscess Aneurysm -arterial/ventricular Anus, tag Appendix, other than incidental Artery, atheromatous plaque Bartholin's gland cyst Bone fragment(s), other than pathologic fracture Bursa/synovial cyst Carpal tunnel tissue Cartilage, shavings Cholesteatoma Colon, colostomy stoma Conjunctiva - biopsy/pterygium Cornea Diverticulum - esophagus/small intestine Dupuytren's contracture tissue Femoral head, other than fracture Fissure/fistula Foreskin, other than newborn Gallbladder Ganglion cyst Hematoma Hemorrhoids Hydatid of Morgagni Intervertebral disc Joint, loose body Meniscus Mucocele, salivary Neuroma -Morton's/traumatic Pilonidal cyst/sinus Polyps, inflammatory - nasal/sinusoidal Skin - cyst/tag/debridement Soft tissue, debridement Soft tissue, lipoma Spermatocele Tendon/tendon sheath Testicular appendage Thrombus or embolus Tonsil and/or adenoids Varicocele Vas deferens, other than sterilization Vein, varicosity

88305

118.38

38.47

79.91

Level IV - Surgical pathology, gross and microscopic examination Abortion - spontaneous/missed Artery, biopsy Bone marrow, biopsy Bone exostosis Brain/meninges, other than for tumor resection Breast, biopsy, not requiring microscopic evaluation of surgical margins Breast, reduction mammoplasty Bronchus, biopsy Cell block, any source Cervix, biopsy Colon, biopsy Duodenum, biopsy Endocervix, curettings/biopsy Endometrium, curettings/biopsy Esophagus, biopsy Extremity, amputation, traumatic Fallopian tube, biopsy Fallopian tube, ectopic pregnancy Femoral head, fracture Fingers/toes, amputation, non-traumatic Gingiva/oral mucosa, biopsy Heart valve Joint, resection Kidney, biopsy Larynx, biopsy Leiomyoma(s), uterine myomectomy - without uterus Lip, biopsy/wedge resection Lung, transbronchial biopsy Lymph node, biopsy Muscle, biop sy Nasal mu cosa, biopsy Nasopharynx/oropharynx, biopsy Nerve, biopsy Odontogenic/dental cyst Omentum, biopsy Ovary with or without tube, non-neoplastic Ovary, biopsy/wedge resection Parathyroid gland Peritoneum, biopsy Pituitary tumor Placenta, other than third trimester Pleura/pericardium - biopsy/tissue Polyp, cervical/endometrial Polyp, colorectal Polyp, stomach/smallintestineProstate,needlebiopsy

Prostate, TUR Salivary gland, biopsy Sinus, paranasal biopsy Skin, other than cyst/tag/debridement/plastic repair Small intestine, biopsy Soft tissue, other than tumor/mass/lipoma/debridement Spleen Stomach,

biopsy Synovium Testis, other than tumor/biopsy/castration Thyroglossal duct/brachial cleft cyst Tongue, biopsy Tonsil, biopsy Trachea, biopsy Ureter, biopsy Urethra, biopsy Urinary bladder,

88307

232.33

82.78

149.55

biopsy Uterus, with or without tubes and ovaries, for prolapse Vagina, biopsy Vulva/labia, biopsy

Level V - Surgical pathology, gross and microscopic

examination Adrenal, resection Bone -

biopsy/curettings Bone fragment(s), pathologic fracture Brain, biopsy Brain/meninges, tumor resection Breast, excision of lesion, requiring microscopic evaluation of surgical margins Breast, mastectomy - partial/simple Cervix, conization Colon, segmental resection, other than for tumor Extremity,

amputation, non-traumatic Eye, enucleation Kidney, partial/total nephrectomy Larynx, partial/total resection Liver, biopsy - needle/wedge Liver, partial resection Lung, wedge biopsy Lymph nodes, regional resection Mediastinum, mass Myocardium, biopsy Odontogenic tumor Ovary with or without tube, neoplastic Pancreas, biopsy Placenta, third trimester

Prostate, except radical resection Salivary gland Sentinel lymph node Small intestine, resection, other than for tumor Soft tissue mass (except lipoma) -biopsy/simple excision Stomach - subtotal/total resection, other than for tumor Testis, biopsy Thymus,

88309

342.83

139.4

203.40

tumor Thyroid, total/lobe Ureter, resection Urinary bladder, TUR Uterus, with or without tubes and ovaries, other than neoplastic/prolapse

Level VI - Surgical pathology, gross and microscopic

examination Bone resection Breast, mastectomy -with regional lymph nodes Colon, segmental resection for tumor Colon, total resection Esophagus, partial/total resection Extremity, disarticulation Fetus, with dissection Larynx, partial/total resection - with

regional lymph nodes Lung - total/lobe/segment resection Pancreas, total/subtotal resection Prostate, radical resection Small intestine, resection for tumor Soft tissue tumor, extensive resection Stomach -subtotal/total resection for tumor Testis, tumor

Tongue/tonsil -resection for tumor Urinary bladder, partial/total resection Uterus, with or without tubes and ovaries, neoplastic Vulva, total/subtotal resection

88311

88312

19.38

106.79

12.18

27.32

7.20

79.47

Decalcification procedure (List separately in addition to code for surgical pathology examination)

Special stains (List separately in addition to code for

primary service); Group I for microorganisms (eg, Gridley, acid fast, methenamine silver), each

88313

82.44

12.18

70.26

Special stains (List separately in addition to code for primary service); Group II, all other (eg, iron, trichrome), except immunocytochemistry and immunoperoxidase stains, each

88314

109.08

23.33

85.75

Special stains (List separately in addition to code for primary service); histochemical staining with frozen section(s)

88318

121.10

21.84

99.26

Determinative histochemistry to identify chemical components (eg, copper, zinc)

88319

172.11

27.44

144.67

Determinative histochemistry or cytochemistry to identify enzyme constituents, each

88321

91.67

Consultation and report on referred slides prepared elsewhere

88323

156.64

87.92

68.72

Consultation and report on referred material requiring preparation of slides

88325

210.35

Consultation, comprehensive, with review of records and specimens, with report on referred material

88329

53.85

Pathology consultation during surgery;

88331

96.42

62.08

34.34

Pathology consultation during surgery; first tissue block, with frozen section(s), single specimen

88332

42.98

30.87

12.11

Pathology consultation during surgery; each additional tissue block with frozen section(s)

88333

98.60

62.88

35.72

Pathology consultation during surgery; cytologic examination (eg, touch prep, squash prep), initial site

88334

57.88

36.57

21.31

Pathology consultation during surgery; cytologic examination (eg, touch prep, squash prep), each additional site

88342

109.69

43.27

66.42

Immunohist ochemistry (includ i n g t i ssue immunoperoxidase), each antibody

88346

110.95

43.61

67.34

Immunofluorescent study, each antibody; direct method

88347

90.24

42.69

47.55

Immunofluorescent study, each antibody; indirect method

88348

691.10

77.75

613.35

Electron microscopy; diagnostic

88349

326.91

39.74

287.17

Electron microscopy; scanning

88355

343.23

91.96

251.27

Morphometric analysis; skeletal muscle

88356

328.36

149.06

179.31

Morphometric analysis; nerve

88358

82.18

48.32

33.86

Morphometric analysis; tumor (eg, DNA ploidy)

88360

131.09

56.39

74.70

Morphometric analysis, tumor immunohistochemistry (eg, Her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, each antibody; manual

88361

179.33

60.78

118.55

Morphometric analysis, tumor immunohistochemistry (eg, Her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, each antibody; using computer-assisted technology

88362

301.82

111.31

190.51

Nerve teasing preparations

88365

168.13

60.28

107.85

In situ hybridization (eg, FISH), each probe

88367

259.71

63.68

196.04

Morphometric analysis, in situ hybridization (quantitative or semi-quantitative) each probe; using computer-assisted technology

88368

221.24

69.39

151.85

Morphometric analysis, in situ hybridization (quantitative or semi-quantitative) each probe; manual

88371

18.46

Protein analysis of tissue by Western Blot, with interpretation and report;

88372

19.38

Protein analysis of tissue by Western Blot, with interpretation and report; immunological probe for band identification, each

88380

179.89

75.15

104.74

Microdissection (ie, sample preparation of microscopically identified target); laser capture

88381

248.43

56.82

191.62

Microdissection (ie, sample preparation of microscopically identified target); manual

88384

I.C.

I.C.

I.C.

Array-based evaluation of multiple molecular probes; 11 through 50 probes

88385

575.85

74.19

501.66

Array-based evaluation of multiple molecular probes; 51 through 250 probes

88386

586.80

93.28

493.52

Array-based evaluation of multiple molecular probes; 251 through 500 probes

88399

I.C.

I.C.

I.C.

Unlisted surgical pathology procedure
(9) Homemakers.

Code

Fee

40.06(9) Homemaker - Description

S5130

4.38

Homemaker service, NOS; per 15 minutes
(10) Medicine / Podiatric Care.

Code

GL Fee

PC Fee

TC Fee

40.06(10) - Medical Service Description

90281

I.C.

Immune globulin (Ig), human, for intramuscular use

90283

I.C.

Immune globulin (IgIV), human, for intravenous use

90284

I.C.

Immune globulin (SCIg), human, for use in subcutaneous infusions, 100 mg, each

90287

I.C.

Botulinum antitoxin, equine, any route

90288

I.C.

Botulism immune globulin, human, for intravenous use

90291

I.C.

Cytomegalovirus immune globulin (CMV-IgIV), human, for intravenous use

90296

I.C.

Diphtheria antitoxin, equine, any route

90371

I.C.

Hepatitis B immune globulin (HBIg), human, for intramuscular use

90375

I.C.

Rabies immune globulin (RIg), human, for intramuscular and/or subcutaneous use

90376

I.C.

Rabies immune globulin, heat-treated (RIg-HT), human, for intramuscular and/or subcutaneous use

90378

I.C.

Respiratory syncytial virus immune globulin (RSV-IgIM), for intramuscular use, 50 mg, each

90379

I.C.

Respiratory syncytial virus immune globulin (RSV-IgIV), human, for intravenous use

90384

I.C.

Rho(D) immune globulin (RhIg), human, full-dose, for intramuscular use

90385

I.C.

Rho(D) immune globulin (RhIg), human, mini-dose, for intramuscular use

90386

I.C.

Rho(D) immune globulin (RhIgIV), human, for intravenous use

90389

I.C.

Tetanus immune globulin (TIg), human, for intramuscular use

90393

I.C.

Vaccinia immune globulin, human, for intramuscular use

90396

I.C.

Varicella-zoster immune globulin, human, for intramuscular use

90399

I.C.

Unlisted immune globulin

90471

23.59

Immunization administration (includes percutaneous,

intradermal, subcutaneous, or intramuscular injections); one vaccine (single or combination vaccine/toxoid)

90472

11.40

Immunization administration (includes percutaneous,

intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)

90473

14.39

Immunization administration by intranasal or oral route; one vaccine (single or combination vaccine/toxoid)

90474

9.56

Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)

90476

I.C.

Adenovirus vaccine, type 4, live, for oral use

90477

I.C.

Adenovirus vaccine, type 7, live, for oral use

90581

I.C.

Anthrax vaccine, for subcutaneous use

90585

I.C.

Bacillus Calmette-Guerin vaccine (BCG) for tuberculosis, live, for percutaneous use

90586

I.C.

Bacillus Calmette-Guerin vaccine (BCG) for bladder cancer, live, for intravesical use

90632

I.C.

Hepatitis A vaccine, adult dosage, for intramuscular use

90633

I.C.

Hepatitis A vaccine, pediatric/adolescent dosage-2 dose schedule, for intramuscular use

90634

I.C.

Hepatitis A vaccine, pediatric/adolescent dosage-3 dose schedule, for intramuscular use

90636

I.C.

Hepatitis A and hepatitis B vaccine (HepA-HepB), adult dosage, for intramuscular use

90645

I.C.

Hemophilus influenza b vaccine (Hib), HbOC conjugate (4 dose schedule), for intramuscular use

90646

I.C.

Hemophilus influenza b vaccine (Hib), PRP-D conjugate, for booster use only, intramuscular use

90647

I.C.

Hemophilus influenza b vaccine (Hib), PRP-OMP conjugate (3 dose schedule), for intramuscular use

90648

I.C.

Hemophilus influenza b vaccine (Hib), PRP-T conjugate (4 dose schedule), for intramuscular use

90649

I.C.

Human Papilloma virus (HPV) vaccine, types 6, 11, 16, 18 (quadrivalent), three dose schedule, for intramuscular use

90675

I.C.

Rabies vaccine, for intramuscular use

90676

I.C.

Rabies vaccine, for intradermal use

90680

I.C.

Rotavirus vaccine, pentavalent, thee dose schedule, live, for oral use

90703

I.C.

Tetanus toxoid adsorbed, for intramuscular use

90716

I.C.

Varicella virus vaccine, live, for subcutaneous use

90740

I.C.

Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (three dose schedule), for intramuscular use

90743

I.C.

Hepatitis B vaccine, adolescent (two dose schedule), for intramuscular use

90744

I.C.

Hepatitis B vaccine, pediatric/adolescent dosage (three dose schedule), for intramuscular use

90746

I.C.

Hepatitis B vaccine, adult dosage, for intramuscular use

90747

I.C.

Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (four dose schedule), for intramuscular use

90748

I.C.

Hepatitis B and Hemophilus influenza b vaccine (HepB-Hib), for intramuscular use

90749

I.C.

Unlisted vaccine/toxoid

90760

70.96

Intravenous infusion, hydration; initial, 31 minutes to one hour

90761

20.84

Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure)

90765

87.06

Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to one hour

90766

26.68

Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)

90767

44.05

Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); additional sequential infusion, up to 1 hour (List separately in addition to code for primary procedure)

90768

24.95

Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); concurrent infusion (List separately in addition to code for primary procedure)

90769

189.86

Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); initial, up to one hour, including pump set-up and establishment of subcutaneous infusion site(s)

90770

17.47

Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)

90771

85.91

Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); additional pump set-up with establishment of new subcutaneous infusion site(s) (List separately in addition to code for primary procedure)

90772

23.59

Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

90773

20.67

Therapeutic, prophylactic or diagnostic injection (specify substance or drug); intra-arterial

90774

68.10

Therapeutic, prophylactic or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug

90775

29.47

Therapeutic, prophylactic or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug (List separately in addition to code for primary procedure)

90776

I.C.

Therapeutic, prophylactic or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility (List separately in addition to code for primary procedure)

90779

I.C.

Unlisted therapeutic, prophylactic or diagnostic intravenous or intra-arterial injection or infusion

90862

56.51

Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy

90901

40.37

Biofeedback training by any modality

90911

99.85

Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry

90935

70.47

Hemodialysis procedure with single physician evaluation

90937

114.18

Hemodialysis procedure requiring repeated evaluation(s) with or without substantial revision of dialysis prescription

90940

I.C.

Hemodialysis access flow study to determine blood flow in grafts and arteriovenous fistulae by an indicator method

90945

73.44

Dialysis procedure other than hemodialysis (eg, peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies), with single physician evaluation

90947

116.81

Dialysis procedure other than hemodialysis (eg, peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies) requiring repeated physician evaluations, with or without substantial revision of dialysis prescription

90989

I.C.

Dialysis training, patient, including helper where applicable, any mode, completed course

90993

I.C.

Dialysis training, patient, including helper where applicable, any mode, course not completed, per training session

90997

91.32

Hemoperfusion (eg, with activated charcoal or resin)

90999

I.C.

Unlisted dialysis procedure, inpatient or outpatient

91000

82.74

36.87

45.87

Esophageal intubation and collection of washings for cytology, including preparation of specimens (separate procedure)

91010

232.23

67.03

65.20

Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study;

91011

299.06

81.85

217.21

Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study; with mecholyl or similar stimulant

91012

311.50

79.26

232.24

Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study; with acid perfusion studies

91020

268.01

76.58

191.43

Gastric motility (manometric) studies

91022

226.13

77.04

149.09

Duodenal motility (manometric) study

91030

155.76

49.30

106.46

Esophagus, acid perfusion (Bernstein) test for esophagitis

91034

252.59

52.41

200.18

Esophagus, gastroesophageal reflux test; with nasal catheter pH electrode(s) placement, recording, analysis and interpretation

91035

568.80

85.08

483.71

Esophagus, gastroesophageal reflux test; with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation

91037

184.01

52.87

131.14

Esophageal function test, gastroesophageal reflux test with nasal catheter intraluminal impedance electrode(s) placement, recording, analysis and interpretation;

91038

157.15

60.07

97.08

Esophageal function test, gastroesophageal reflux test with nasal catheter intraluminal impedance electrode(s) placement, recording, analysis and interpretation; prolonged (greater than one hour, up to 24 hours)

91040

470.76

49.19

421.58

Esophageal balloon distension provocation study

91052

151.83

42.60

109.23

Gastric analysis test with injection of stimulant of gastric secretion (eg, histamine, insulin, pentagastrin, calcium and secretin)

91055

161.23

46.48

114.75

Gastric intubation, washings, and preparing slides for cytology (separate procedure)

91065

72.17

10.35

61.82

Breath hydrogen test (eg, for detection of lactase deficiency, fructose intolerance, bacterial overgrowth, or oro-cecal gastrointestinal transit)

91100

152.66

I.C.

I.C.

Intestinal bleeding tube, passage, positioning and monitoring

91105

100.53

I.C.

I.C.

Gastric intubation, and aspiration or lavage for treatment (eg, for ingested poisons)

91110

1,115.00

194.64

920.36

Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus through ileum, with physician interpretation and report

91111

902.81

55.76

847.06

Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus with physician interpretation and report

91120

493.94

49.49

444.45

Rectal sensation, tone, and compliance test (ie, response to graded balloon distention)

91122

283.06

92.41

190.65

Anorectal manometry

91123

I.C.

I.C.

I.C.

Pulsed irrigation of fecal impaction

91132

I.C.

28.48

I.C.

Electrogastrography, diagnostic, transcutaneous;

91133

I.C.

36.32

I.C.

Electrogastrography, diagnostic, transcutaneous; with provocative testing

91299

I.C.

I.C.

I.C.

Unlisted diagnostic gastroenterology procedure

92002

74.37

Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient

92004

138.37

Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, one or more visits

92012

78.50

Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient

92014

113.36

Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, one or more visits

92015

49.64

Determination of refractive state

92018

131.64

Ophthalmological examination and evaluation, under general anesthesia, with or without manipulation of globe for passive range of motion or other manipulation to facilitate diagnostic examination; complete

92019

66.80

Ophthalmological examination and evaluation, under general anesthesia, with or without manipulation of globe for passive range of motion or other manipulation to facilitate diagnostic examination; limited

92020

26.28

Gonioscopy (separate procedure)

92025

35.10

17.77

17.33

Computerized corneal topography, unilateral or bilateral, with interpretation and report

92060

58.98

36.13

22.85

Sensorimotor examination with multiple measurements of ocular deviation (eg, restrictive or paretic muscle with diplopia) with interpretation and report (separate procedure)

92065

44.99

18.46

26.54

Orthoptic and/or pleoptic training, with continuing medical direction and evaluation

92070

70.07

Fitting of contact lens for treatment of disease, including supply of lens

92081

56.62

18.57

38.04

Visual field examination, unilateral or bilateral, with interpretation and report; limited examination (eg, tangent screen, Autoplot, arc perimeter, or single stimulus level automated test, such as Octopus three or seven equivalent)

92082

74.08

22.69

51.39

Visual field examination, unilateral or bilateral, with interpretation and report; intermediate examination (eg, at least two isopters on Goldmann perimeter, or semiquantitative, automated suprathreshold screening program, Humphrey suprathreshold automatic diagnostic test, Octopus program 33)

92083

85.33

26.12

59.22

Visual field examination, unilateral or bilateral, with interpretation and report; extended examination (eg, Goldmann visual fields with at least three isopters plotted and static determination within the central 30/, or quantitative, automated threshold periimetry, Octopus program G-1, 32 or 42,

Humphrey Visual field analyzer full threshold programs; 30-2, 24-2, or 30/60-2)

92100

91.39

Serial tonometry (separate procedure) with multiple measurements of intraocular pressure over an extended time period with interpretation and report, same day (eg, diurnal curve or medical treatment of acute elevation of intraocular pressure)

92120

75.20

Tonography with interpretation and report, recording indentation tonometer method or perilimbal suction method

92130

84.87

Tonography with water provocation

92135

48.91

18.23

30.68

Scanning computerized ophthalmic diagnostic imaging, posterior segment, (eg, scanning laser) with interpretation and report, unilateral

92136

91.72

28.86

62.86

Ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation

92140

60.64

Provocative tests for glaucoma, with interpretation and report, without tonography

92225

23.86

Ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report; initial

92226

21.69

Ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report; subsequent

92230

71.72

Fluorescein angioscopy with interpretation and report

92235

142.36

43.44

98.92

Fluorescein angiography (includes multiframe imaging) with interpretation and report

92240

281.90

59.17

222.73

Indocyanine-green angiography (includes multiframe imaging) with interpretation and report

92250

80.52

22.69

57.83

Fundus photography with interpretation and report

92260

18.18

Ophthalmodynamometry

92265

86.53

40.82

45.71

Needle oculoelectromyography, one or more extraocular muscles, one or both eyes, with interpretation and report

92270

94.51

41.44

53.07

Electro-oculography with interpretation and report

92275

136.32

53.33

82.99

Electroretinography with interpretation and report

92283

48.29

8.87

39.42

Color vision examination, extended, eg, anomaloscope or equivalent

92284

77.84

11.72

66.12

Dark adaptation examination with interpretation and report

92285

48.39

10.81

37.58

External ocular photography with interpretation and report for documentation of medical progress (eg, close-up photography, slit lamp photography, goniophotography, stereo-photography)

92286

141.57

34.64

106.92

Special anterior segment photography with interpretation and report; with specular endothelial microscopy and cell count

92287

126.76

Special anterior segment photography with interpretation and report; with fluorescein angiography

92311

92.09

Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens for aphakia, one eye

92312

102.38

Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens for aphakia, both eyes

92313

89.09

Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneoscleral lens

92315

65.37

Prescription of optical and physical characteristics of contact lens, with medical supervision of adaptation and direction of fitting by independent technician; corneal lens for aphakia, one eye

92316

82.27

Prescription of optical and physical characteristics of contact lens, with medical supervision of adaptation and direction of fitting by independent technician; corneal lens for aphakia, both

eyes

92352

41.47

Fitting of spectacle prosthesis for aphakia; monofocal

92353

48.05

Fitting of spectacle prosthesis for aphakia; multifocal

92354

213.81

Fitting of spectacle mounted low vision aid; single element system

92355

110.31

Fitting of spectacle mounted low vision aid; telescopic or other compound lens system

92358

29.12

Prosthesis service for aphakia, temporary (disposable or loan, including materials)

92371

20.39

Repair and refitting spectacles; spectacle prosthesis for aphakia

92499

I.C.

Unlisted ophthalmological service or procedure

92502

99.54

Otolaryngologic examination under general anesthesia

92504

31.76

Binocular microscopy (separate diagnostic procedure)

92531

I.C.

Spontaneous nystagmus, including gaze

92532

I.C.

Positional nystagmus test

92533

I.C.

Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes four tests)

92534

I.C.

Optokinetic nystagmus test

92541

65.03

21.16

43.87

Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording

92542

68.32

17.55

50.77

Positional nystagmus test, minimum of 4 positions, with recording

92543

32.09

5.56

26.54

Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes four tests), with recording

92544

54.42

13.78

40.64

Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording

92545

50.18

12.30

37.88

Oscillating tracking test, with recording

92546

98.25

14.80

83.45

Sinusoidal vertical axis rotational testing

92547

5.94

Use of vertical electrodes (List separately in addition to code for primary procedure)

92548

112.70

26.88

85.83

Computerized dynamic posturography

92603

155.79

Diagnostic analysis of cochlear implant, age 7 years or older; with programming

92604

93.57

Diagnostic analysis of cochlear implant, age 7 years or older; subsequent reprogramming

92605

I.C.

Evaluation for prescription of non-speech-generating augmentative and alternative communication device

92606

I.C.

Therapeutic service(s) for the use of non-speech-generating device, including programming and modification

92607

179.17

Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour

92608

34.64

Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; each additional 30 minutes (List separately in addition to code for primary procedure)

92609

94.18

Therapeutic services for the use of speech-generating device, including programming and modification

92610

120.69

Evaluation of oral and pharyngeal swallowing function

92611

126.21

Motion fluoroscopic evaluation of swallowing function by cine or video recording

92612

176.20

Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording;

92613

40.47

Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording; physician interpretation and report only

92614

157.79

Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video recording;

92615

35.90

Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video recording; physician interpretation and report only

92616

216.96

Flexible fiberoptic endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recording;

92617

44.58

Flexible fiberoptic endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recording; physician interpretation and report only

92620

72.68

Evaluation of central auditory function, with report; initial 60 minutes

92621

17.45

Evaluation of central auditory function, with report; each additional 15 minutes

92625

72.22

Assessment of tinnitus (includes pitch, loudness matching, and masking)

92626

98.46

Evaluation of auditory rehabilitation status; first hour

92627

23.61

Evaluation of auditory rehabilitation status; each additional 15 minutes (List separately in addition to code for primary procedure)

92630

I.C.

Auditory rehabilitation; prelingual hearing loss

92633

I.C.

Auditory rehabilitation; postlingual hearing loss

92640

61.98

Diagnostic analysis with programming of auditory brainstem implant, per hour

92700

I.C.

Unlisted otorhinolaryngological service or procedure

92950

309.02

Cardiopulmonary resuscitation (eg, in cardiac arrest)

92953

11.67

Temporary transcutaneous pacing

92960

324.71

Cardioversion, elective, electrical conversion of arrhythmia; external

92961

269.43

Cardioversion, elective, electrical conversion of arrhythmia; internal (separate procedure)

92970

182.63

Cardioassist-method of circulatory assist; internal

92971

106.88

Cardioassist-method of circulatory assist; external

92973

188.85

Percutaneous transluminal coronary thrombectomy (List separately in addition to code for primary procedure)

92974

173.16

Transcatheter placement of radiation delivery device for subsequent coronary intravascular brachytherapy (List separately in addition to code for primary procedure)

92975

415.46

Thrombolysis, coronary; by intracoronary infusion, including selective coronary angiography

92977

238.87

Thrombolysis, coronary; by intravenous infusion

92978

I.C.

101.92

I.C.

Intravascular ultrasound (coronary vessel or graft) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; initial vessel (List separately in addition to code for primary procedure)

92979

I.C.

81.80

I.C.

Intravascular ultrasound (coronary vessel or graft) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; each additional vessel (List separately in addition to code for primary procedure)

92980

863.21

Transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; single vessel

92981

239.56

Transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; each additional vessel (List separately in addition to code for primary procedure)

92982

640.48

Percutaneous transluminal coronary balloon angioplasty; single vessel

92984

170.76

Percutaneous transluminal coronary balloon angioplasty; each additional vessel (List separately in addition to code for primary procedure)

92986

1,445.83

Percutaneous balloon valvuloplasty; aortic valve

92987

1,497.88

Percutaneous balloon valvuloplasty; mitral valve

92990

1,141.16

Percutaneous balloon valvuloplasty; pulmonary valve

92992

I.C.

Atrial septectomy or septostomy; transvenous method, balloon (eg, Rashkind type) (includes cardiac catheterization)

92993

I.C.

Atrial septectomy or septostomy; blade method (Park septostomy) (includes cardiac catheterization)

92995

704.25

Percutaneous transluminal coronary atherectomy, by mechanical or other method, with or without balloon angioplasty; single vessel

92996

183.81

Percutaneous transluminal coronary atherectomy, by mechanical or other method, with or without balloon angioplasty; each additional vessel (List separately in addition to code for primary procedure)

92997

661.29

Percutaneous transluminal pulmonary artery balloon angioplasty; single vessel

92998

332.58

Percutaneous transluminal pulmonary artery balloon angioplasty; each additional vessel (List separately in addition to code for primary procedure)

93000

26.04

Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report

93005

17.17

Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report

93010

8.87

Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only

93012

239.68

Telephonic transmission of post-symptom electrocardiogram rhythm strip(s), 24-hour attended monitoring, per 30 day period of time; tracing only

93014

28.02

Telephonic transmission of post-symptom electrocardiogram rhythm strip(s), 24-hour attended monitoring, per 30 day period of time; physician review with interpretation and report only

93015

119.10

Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report

93016

25.17

Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; physician supervision only, without interpretation and report

93017

77.40

Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; tracing only, without interpretation and report

93018

16.53

Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; interpretation and report only

93024

134.68

4.62

70.06

Ergonovine provocation test

93025

295.39

2.16

253.23

Microvolt T-wave alternans for assessment of ventricular arrhythmias

93040

15.27

Rhythm ECG, one to three leads; with interpretation and report

93041

7.20

Rhythm ECG, one to three leads; tracing only without interpretation and report

93042

8.06

Rhythm ECG, one to three leads; interpretation and report only

93224

161.65

Electrocardiographic monitoring for 24 hours by continuous original ECG waveform recording and storage, with visual superimposition scanning; includes recording, scanning analysis with report, physician review and interpretation

93225

50.73

Electrocardiographic monitoring for 24 hours by continuous original ECG waveform recording and storage, with visual superimposition scanning; recording (includes hook-up, recording, and disconnection)

93226

81.98

Electrocardiographic monitoring for 24 hours by continuous original ECG waveform recording and storage, with visual superimposition scanning; scanning analysis with report

93227

28.94

Electrocardiographic monitoring for 24 hours by continuous original ECG waveform recording and storage, with visual superimposition scanning; physician review and interpretation

93230

168.24

Electrocardiographic monitoring for 24 hours by continuous original ECG waveform recording and storage without superimposition scanning utilizing a device capable of producing a full miniaturized printout; includes recording, microprocessor-based analysis

93231

54.85

Electrocardiographic monitoring for 24 hours by continuous original ECG waveform recording and storage without superimposition scanning utilizing a device capable of producing a full miniaturized printout; recording (includes hook-up, recording, and disconnection)

93232

85.37

Electrocardiographic monitoring for 24 hours by continuous original ECG waveform recording and storage without superimposition scanning utilizing a device capable of producing a full miniaturized printout; microprocessor-based analysis with report

93233

28.02

Electrocardiographic monitoring for 24 hours by continuous original ECG waveform recording and storage without superimposition scanning utilizing a device capable of producing a full miniaturized printout; physician review and interpretation

93235

I.C.

Electrocardiographic monitoring for 24 hours by continuous computerized monitoring and non-continuous recording, and real-time data analysis utilizing a device capable of producing intermittent full-sized waveform tracings, possibly patient activated; includes monitoring and real-time data analysis with report, physician review and interpretation

93236

I.C.

Electrocardiographic monitoring for 24 hours by continuous computerized monitoring and non-continuous recording, and real-time data analysis utilizing a device capable of producing intermittent full-sized waveform tracings, possibly patient activated; includes monitoring and real-time data analysis with report,

93237

24.71

Electrocardiographic monitoring for 24 hours by continuous computerized monitoring and non-continuous recording, and real-time data analysis utilizing a device capable of producing intermittent full-sized waveform tracings, possibly patient activated; physician review and interpretation

93268

330.39

Patient demand single or multiple event recording with presymptom memory loop, 24-hour attended monitoring, per 30 day period of time; includes transmission, physician review and interpretation

93270

37.38

Patient demand single or multiple event recording with presymptom memory loop, 24-hour attended monitoring, per 30 day period of time; recording (includes hook-up, recording, and disconnection)

93271

265.45

Patient demand single or multiple event recording with presymptom memory loop, 24-hour attended monitoring, per 30 day period of time; monitoring, receipt of transmissions, and analysis

93272

27.56

Patient demand single or multiple event recording with presymptom memory loop, 24-hour attended monitoring, per 30 day period of time; physician review and interpretation only

93278

54.94

13.44

41.50

Signal-averaged electrocardiography (SAECG), with or without ECG

93303

255.46

68.60

186.86

Transthoracic echocardiography for congenital cardiac anomalies; complete

93304

153.00

39.55

113.44

Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study

93307

221.94

50.72

171.21

Echocardiography, transthoracic, real-time with image documentation (2D) with or without M-mode recording; complete

93308

132.14

29.28

102.86

Echocardiography, transthoracic, real-time with image documentation (2D) with or without M-mode recording; follow-up or limited study

93312

361.45

118.02

243.44

Echocardiography, transesophageal, real time with image documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report

93313

42.06

Echocardiography, transesophageal, real time with image documentation (2D) (with or without M-mode recording); placement of transesophageal probe only

93314

316.31

67.35

248.96

Echocardiography, transesophageal, real time with image documentation (2D) (with or without M-mode recording); image acquisition, interpretation and report only

93315

I.C.

151.01

I.C.

Transesophageal echocardiography for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report

93316

45.44

Transesophageal echocardiography for congenital cardiac anomalies; placement of transesophageal probe only

93317

I.C.

92.96

I.C.

Transesophageal echocardiography for congenital cardiac anomalies; image acquisition, interpretation and report only

93318

I.C.

110.15

I.C.

Echocardiography, transesophageal (TEE) for monitoring purposes, including probe placement, real time 2-dimensional image acquisition and interpretation leading to ongoing (continuous) assessment of (dynamically changing) cardiac pumping function and to therapeutic measures on an immediate time basis

93320

98.34

21.10

77.24

Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to codes for echocardiographic imaging); complete

93321

48.78

8.64

40.14

Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to codes for echocardiographic imaging); follow-up or limited study (List separately in addition to codes for echocardiographic imaging)

93325

91.84

4.07

87.76

Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiography)

93350

226.69

82.41

144.28

Echocardiography, transthoracic, real-time with image documentation (2D), with or without M-mode recording, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report

93501

987.64

172.01

815.63

Right heart catheterization

93503

105.35

Insertion and placement of flow directed catheter (eg, Swan-Ganz) for monitoring purposes

93505

728.68

249.33

479.35

Endomyocardial biopsy

93508

1,170.01

246.08

923.94

Catheter placement in coronary artery(s), arterial coronary conduit(s), and/or venous coronary bypass graft(s) for coronary angiography without concomitant left heart catheterization

93510

1,774.58

259.13

1,515.45

Left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; percutaneous

93511

I.C.

299.26

I.C.

Left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; by cutdown

93514

I.C.

394.98

I.C.

Left heart catheterization by left ventricular puncture

93524

I.C.

411.06

I.C.

Combined transseptal and retrograde left heart catheterization

93526

2,288.94

354.39

1,934.55

Combined right heart catheterization and retrograde left heart catheterization

93527

I.C.

428.75

I.C.

Combined right heart catheterization and transseptal left heart catheterization through intact septum (with or without retrograde left heart catheterization)

93528

I.C.

520.23

I.C.

Combined right heart catheterization with left ventricular puncture (with or without retrograde left heart catheterization)

93529

I.C.

285.29

I.C.

Combined right heart catheterization and left heart catheterization through existing septal opening (with or without retrograde left heart catheterization)

93530

I.C.

239.77

I.C.

Right heart catheterization, for congenital cardiac anomalies

93531

I.C.

466.92

I.C.

Combined right heart catheterization and retrograde left heart catheterization, for congenital cardiac anomalies

93532

I.C.

543.58

I.C.

Combined right heart catheterization and transseptal left heart catheterization through intact septum with or without retrograde left heart catheterization, for congenital cardiac anomalies

93533

I.C.

379.67

I.C.

Combined right heart catheterization and transseptal left heart catheterization through existing septal opening, with or without retrograde left heart catheterization, for congenital cardiac anomalies

93539

74.25

Injection procedure during cardiac catheterization; for selective opacification of arterial conduits (eg, internal mammary), whether native or used for bypass

93540

217.04

Injection procedure during cardiac catheterization; for selective opacification of aortocoronary venous bypass grafts, one or more coronary arteries

93541

16.18

Injection procedure during cardiac catheterization; for pulmonary angiography

93542

132.18

Injection procedure during cardiac catheterization; for selective right ventricular or right atrial angiography

93543

73.26

Injection procedure during cardiac catheterization; for selective left ventricular or left atrial angiography

93544

53.48

Injection procedure during cardiac catheterization; for aortography

93545

152.50

Injection procedure during cardiac catheterization; for selective coronary angiography (injection of radiopaque material may be by hand)

93555

203.99

45.59

158.40

Imaging supervision, interpretation and report for injection procedure(s) during cardiac catheterization; ventricular and/or atrial angiography

93556

299.98

46.73

253.25

Imaging supervision, interpretation and report for injection procedure(s) during cardiac catheterization; pulmonary angiography, aortography, and/or selective coronary angiography including venous bypass grafts and arterial conduits (whether native or used in bypass)

93561

I.C.

24.58

I.C.

Indicator dilution studies such as dye or thermal dilution, including arterial and/or venous catheterization; with cardiac output measurement (separate procedure)

93562

I.C.

7.60

I.C.

Indicator dilution studies such as dye or thermal dilution, including arterial and/or venous catheterization; subsequent measurement of cardiac output

93571

I.C.

101.00

I.C.

Intravascular Doppler velocity and/or pressure derived coronar flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress; initial vessel (List separately in addition to code for primary procedure)

93572

I.C.

78.90

I.C.

Intravascular Doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress; each additional vessel (List separatelyin addition to code for primary procedure)

93580

1,037.66

Percutaneous transcatheter closure of congenital interatrial communication (ie, Fontan fenestration, atrial septal defect) with implant

93581

1,366.68

Percutaneous transcatheter closure of a congenital ventricular septal defect with implant

93600

I.C.

121.37

I.C.

Bundle of His recording

93602

I.C.

120.29

I.C.

Intra-atrial recording

93603

I.C.

120.12

I.C.

Right ventricular recording

93609

I.C.

286.27

I.C.

Intraventricular and/or intra-atrial mapping of tachycardia site(s) with catheter manipulation to record from multiple sites to identify origin of tachycardia (List separately in addition to code for primary procedure)

93610

I.C.

170.60

I.C.

Intra-atrial pacing

93612

I.C.

169.98

I.C.

Intraventricular pacing

93613

402.02

Intracardiac electrophysiologic 3-dimensional mapping (List separately in addition to code for primary procedure)

93615

I.C.

53.11

I.C.

Esophageal recording of atrial electrogram with or without ventricular electrogram(s);

93616

I.C.

69.68

I.C.

Esophageal recording of atrial electrogram with or without ventricular electrogram(s); with pacing

93618

I.C.

244.78

I.C.

Induction of arrhythmia by electrical pacing

93619

I.C.

427.35

I.C.

Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording, including insertion and repositioning of multiple electrode catheters, without induction or attempted induction of arrhythmia

93620

I.C.

670.33

I.C.

Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording

93621

I.C.

120.38

I.C.

Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with left atrial pacing and recording from coronary sinus or left atrium (List separately in addition to code for primary procedure)

93622

I.C.

176.42

I.C.

Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with left ventricular pacing and recording (List separately in addition to code for primary procedure)

93623

I.C.

163.14

I.C.

Programmed stimulation and pacing after intravenous drug infusion (List separately in addition to code for primary procedure)

93624

I.C.

284.25

I.C.

Electrophysiologic follow-up study with pacing and recording to test effectiveness of therapy, including induction or attempted induction of arrhythmia

93631

I.C.

415.26

I.C.

Intra-operative epicardial and endocardial pacing and mapping to localize the site of tachycardia or zone of slow conduction for surgical correction

93640

I.C.

200.22

I.C.

Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and

93641

I.C.

339.15

I.C.

pacing for arrhythmia termination) at time of initial implant Electrophysiologic evaluation of single or dual chamber pacing

cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implant

93642

I.C.

282.04

287.38

Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination, and programming or reprogramming

93650

615.71

Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement

93651

930.00

Intracardiac catheter ablation of arrhythmogenic focus; for treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathways, accessory atrioventricular connections or other atrial foci, singly or in combination

93652

1,013.24

Intracardiac catheter ablation of arrhythmogenic focus; for treatment of ventricular tachycardia

93660

191.66

105.45

86.21

Evaluation of cardiovascular function with tilt table evaluation, with continuous ECG monitoring and intermittent blood pressure monitoring, with or without pharmacological intervention

93662

I.C.

157.67

I.C.

Intracardiac echocardiography during therapeutic/diagnostic intervention, including imaging supervision and interpretation (List separately in addition to code for primary procedure)

93668

19.17

Peripheral arterial disease (PAD) rehabilitation, per session

93701

45.07

9.33

35.74

Bioimpedance, thoracic, electrical

93720

52.55

Plethysmography, total body; with interpretation and report

93721

44.14

Plethysmography, total body; tracing only, without interpretation and report

93722

8.41

Plethysmography, total body; interpretation and report only

93724

387.74

269.15

118.58

Electronic analysis of antitachycardia pacemaker system (includes electrocardiographic recording, programming of device, induction and termination of tachycardia via implanted pacemaker, and interpretation of recordings)

93727

37.69

Electronic analysis of implantable loop recorder (ILR) system (includes retrieval of recorded and stored ECG data, physician review and interpretation of retrieved ECG data and reprogramming)

93731

50.00

24.87

25.13

Electronic analysis of dual-chamber pacemaker system (includes evaluation of programmable parameters at rest and during activity where applicable, using electrocardiographic recording and interpretation of recordings at rest and during exercise, analysis of event markers and device response); without reprogramming

93732

80.00

51.64

28.36

Electronic analysis of dual-chamber pacemaker system (includes evaluation of programmable parameters at rest and during activity where applicable, using electrocardiographic recording and interpretation of recordings at rest and during exercise, analysis of event markers and device response); with reprogramming

93733

47.49

9.33

38.16

Electronic analysis of dual chamber internal pacemaker system (may include rate, pulse amplitude and duration, configuration of wave form, and/or testing of sensory function of pacemaker), telephonic analysis

93734

41.49

21.10

20.39

Electronic analysis of single chamber pacemaker system (includes evaluation of programmable parameters at rest and during activity where applicable, using electrocardiographic recording and interpretation of recordings at rest and during exercise, analysis of event markers and device response); without reprogramming

93735

65.73

41.05

24.67

Electronic analysis of single chamber pacemaker system (includes evaluation of programmable parameters at rest and during activity where applicable, using electrocardiographic recording and interpretation of recordings at rest and during exercise, analysis of event markers and device response); with reprogramming

93736

43.58

8.18

35.40

Electronic analysis of single chamber internal pacemaker system (may include rate, pulse amplitude and duration, configuration of wave form, and/or testing of sensory function of pacemaker), telephonic analysis

93740

11.13

7.60

3.52

Temperature gradient studies

93741

74.98

44.78

30.20

Electronic analysis of pacing cardioverter-defibrillator (includes interrogation, evaluation of pulse generator status, evaluation of programmable parameters at rest and during activity where applicable, using electrocardiographic recording and interpretation of recordings at rest and during exercise, analysis of event markers and device response); single chamber or wearable cardioverter-defibrillator system, without reprogramming

93742

83.34

51.30

32.04

Electronic analysis of pacing cardioverter-defibrillator (includes interrogation, evaluation of pulse generator status, evaluation of programmable parameters at rest and during activity where applicable, using electrocardiographic recording and interpretation of recordings at rest and during exercise, analysis of event markers and device response); single chamber or wearable cardioverter-defibrillator system, with reprogramming

93743

90.66

57.70

32.96

Electronic analysis of pacing cardioverter-defibrillator (includes interrogation, evaluation of pulse generator status, evaluation of programmable parameters at rest and during activity where applicable, using electrocardiographic recording and interpretation of recordings at rest and during exercise, analysis of event markers and device response); dual chamber or wearable cardioverter-defibrillator system, without reprogramming

93744

99.30

66.34

32.96

Electronic analysis of pacing cardioverter-defibrillator (includes interrogation, evaluation of pulse generator status, evaluation of programmable parameters at rest and during activity where applicable, using electrocardiographic recording and interpretation of recordings at rest and during exercise, analysis of event markers and device response); dual chamber or wearable cardioverter-defibrillator system, with reprogramming

93745

I.C.

I.C.

I.C.

Initial set-up and programming by a physician of wearable cardioverter-defibrillator includes initial programming of system, establishing baseline electronic ECG, transmission of data to data repository, patient instruction in wearing system and patient reporting of problems or events

93760

I.C.

Thermogram; cephalic

93762

I.C.

Thermogram; peripheral

93770

8.36

7.60

0.76

Determination of venous pressure

93784

81.53

Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; including recording, scanning analysis, interpretation and report

93786

39.88

Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; recording only

93788

22.39

Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; scanning analysis with report

93790

19.26

Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; physician review with interpretation and report

93797

20.71

Physician services for outpatient cardiac rehabilitation; without continuous ECG monitoring (per session)

93798

30.57

Physician services for outpatient cardiac rehabilitation; with continuous ECG monitoring (per session)

93799

I.C.

I.C.

I.C.

Unlisted cardiovascular service or procedure

93875

123.42

11.03

112.38

Noninvasive physiologic studies of extracranial arteries, complete bilateral study (eg, periorbital flow direction with arterial compression, ocular pneumoplethysmography, Doppler ultrasound spectral analysis)

93880

301.44

30.89

270.55

Duplex scan of extracranial arteries; complete bilateral study

93882

197.28

20.84

176.44

Duplex scan of extracranial arteries; unilateral or limited study

93886

362.26

48.62

313.63

Transcranial Doppler study of the intracranial arteries; complete study

93888

241.11

32.33

208.78

Transcranial Doppler study of the intracranial arteries; limited study

93890

309.07

52.51

256.56

Transcranial Doppler study of the intracranial arteries; vasoreactivity study

93892

328.92

59.01

269.91

Transcranial Doppler study of the intracranial arteries; emboli detection without intravenous microbubble injection

93893

329.38

59.01

270.37

Transcranial Doppler study of the intracranial arteries; emboli

detection with intravenous microbubble injection

93922

146.51

12.82

133.70

Noninvasive physiologic studies of upper or lower extremity arteries, single level, bilateral (eg, ankle/brachial indices, Doppler waveform analysis, volume plethysmography, transcutaneous oxygen tension measurement)

93923

223.38

23.01

200.37

Noninvasive physiologic studies of upper or lower extremity arteries, multiple levels or with provocative functional maneuvers, complete bilateral study (eg, segmental blood pressure measurements, segmental Doppler waveform analysis, segmental volume plethsmography, segmental transcutaneous oxygen tension measurements with postural provicative tests, measurements with reactive hyperemia)

93924

272.77

26.40

246.38

Noninvasive physiologic studies of lower extremity arteries, at rest and following treadmill stress testing, complete bilateral study

93925

372.10

29.75

342.35

Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study

93926

233.14

20.04

213.10

Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study

93930

294.96

23.81

271.15

Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study

93931

194.97

16.09

178.88

Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study

93965

149.63

17.61

132.02

Noninvasive physiologic studies of extremity veins, complete bilateral study (eg, Doppler waveform analysis with responses to compression and other maneuvers, phleborheography, impedance plethysmography)

93970

300.75

35.14

265.60

Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study

93971

200.64

23.17

177.48

Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study

93975

448.31

93.43

354.88

Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study

93976

256.63

61.68

194.95

Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; limited study

93978

278.11

34.12

243.99

Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study

93979

192.96

22.83

170.13

Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; unilateral or limited study

93980

200.72

64.87

135.85

Duplex scan of arterial inflow and venous outflow of penile vessels; complete study

93981

156.56

22.53

134.03

Duplex scan of arterial inflow and venous outflow of penile vessels; follow-up or limited study

93982

47.37

Noninvasive physiologic study of implanted wireless pressure sensor in aneurysmal sac following endovascular repair, complete study including recording, analysis of pressure and waveform tracings, interpretation and report

93990

228.52

13.12

215.40

Duplex scan of hemodialysis access (including arterial inflow, body of access and venous outflow)

94002

86.29

Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day

94003

63.30

Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, each subsequent day

94004

45.93

Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; nursing facility, per day

94005

85.23

Home ventilator management care plan oversight of a patient (patient not present) in home, domiciliary or rest home (eg, assisted living) requiring review of status, review of laboratories and other studies and revision of orders and respiratory care plan

94010

39.38

8.41

30.98

Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation

94014

54.56

Patient-initiated spirometric recording per 30-day period of time; includes reinforced education, transmission of spirometric tracing, data capture, analysis of transmitted data, periodic recalibration and physician review and interpretation

94015

29.30

Patient-initiated spirometric recording per 30-day period of time; recording (includes hook-up, reinforced education, data transmission, data capture, trend analysis, and periodic recalibration)

94016

25.26

Patient-initiated spirometric recording per 30-day period of time; physician review and interpretation only

94060

67.46

14.57

52.89

Bronchodilation responsiveness, spirometry as in 94010, pre-and post-bronchodilator administration

94070

65.81

28.75

37.06

Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents (eg, antigen[s], cold air, methacholine)

94150

24.62

3.61

21.01

Vital capacity, total (separate procedure)

94200

26.29

5.44

20.85

Maximum breathing capacity, maximal voluntary ventilation

94240

44.74

12.40

32.34

Functional residual capacity or residual volume: helium method, nitrogen open circuit method, or other method

94250

31.05

5.44

25.62

Expired gas collection, quantitative, single procedure (separate procedure)

94260

36.32

6.12

30.20

Thoracic gas volume

94350

42.14

12.40

29.74

Determination of maldistribution of inspired gas: multiple breath nitrogen washout curve including alveolar nitrogen or helium equilibration time

94360

48.72

12.40

36.32

Determination of resistance to airflow, oscillatory or plethysmographic methods

94370

40.16

12.40

27.76

Determination of airway closing volume, single breath tests

94375

41.86

14.57

27.30

Respiratory flow volume loop

94400

59.62

19.62

40.00

Breathing response to CO2 (CO2 response curve)

94450

57.20

18.86

38.34

Breathing response to hypoxia (hypoxia response curve)

94452

64.26

14.87

49.39

High altitude simulation test (HAST), with physician interpretation and report;

94453

88.50

19.32

69.18

High altitude simulation test (HAST), with physician interpretation and report; with supplemental oxygen titration

94610

63.05

Intrapulmonary surfactant administration by a physician through endotracheal tube

94620

101.23

31.04

70.20

Pulmonary stress testing; simple (eg, 6-minute walk test, prolonged exercise test for bronchospasm with pre- and post-spirometry and oximetry)

94621

177.09

70.53

106.56

Pulmonary stress testing; complex (including measurements of CO2 production, O2 uptake, and electrocardiographic recordings)

94640

16.25

Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device)

94642

I.C.

Aerosol inhalation of pentamidine for pneumocystis carinii pneumonia treatment or prophylaxis

94644

44.79

Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour

94645

16.71

Continuous inhalation treatment with aerosol medication for acute airway obstruction; each additional hour (List separately in addition to code for primary procedure)

94660

60.75

Continuous positive airway pressure ventilation (CPAP), initiation and management

94662

36.51

Continuous negative pressure ventilation (CNP), initiation and management

94664

17.77

Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device

94667

25.89

Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; initial demonstration and/or evaluation

94668

22.69

Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent

94680

78.18

12.40

65.78

Oxygen uptake, expired gas analysis; rest and exercise, direct, simple

94681

93.12

9.43

83.69

Oxygen uptake, expired gas analysis; including CO2 output, percentage oxygen extracted

94690

73.85

3.61

70.24

Oxygen uptake, expired gas analysis; rest, indirect (separate procedure)

94720

60.69

12.40

48.29

Carbon monoxide diffusing capacity (eg, single breath, steady state)

94725

102.07

12.40

89.67

Membrane diffusion capacity

94750

80.70

10.91

69.78

Pulmonary compliance study (eg, plethysmography, volume and pressure measurements)

94760

2.90

Noninvasive ear or pulse oximetry for oxygen saturation; single determination

94761

5.94

Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations (eg, during exercise)

94762

33.38

Noninvasive ear or pulse oximetry for oxygen saturation; by continuous overnight monitoring (separate procedure)

94770

43.42

7.26

36.16

Carbon dioxide, expired gas determination by infrared analyzer

94799

I.C.

I.C.

I.C.

Unlisted pulmonary service or procedure

95004

6.62

Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, including test interpretation and report by a physician, specify number of tests

95010

20.15

Percutaneous tests (scratch, puncture, prick) sequential and incremental, with drugs, biologicals or venoms, immediate type reaction, specify number of tests

95012

22.85

Nitric oxide expired gas determination

95015

13.71

Intracutaneous (intradermal) tests, sequential and incremental, with drugs, biologicals, or venoms, immediate type reaction, specify number of tests

95024

8.01

Intracutaneous (intradermal) tests with allergenic extracts, immediate type reaction, including test interpretation and report by a physician, specify number of tests

95027

6.16

Intracutaneous (intradermal) tests, sequential and incremental, with allergenic extracts for airborne allergens, immediate type reaction, including test interpretation and report by a physician, specify number of tests

95028

12.73

Intracutaneous (intradermal) tests with allergenic extracts, delayed type reaction, including reading, specify number of tests

95044

8.58

Patch or application test(s) (specify number of tests)

95052

9.51

Photo patch test(s) (specify number of tests)

95056

32.98

Photo tests

95060

25.45

Ophthalmic mucous membrane tests

95065

21.01

Direct nasal mucous membrane test

95070

71.94

Inhalation bronchial challenge testing (not including necessary pulmonary function tests); with histamine, methacholine, or similar compounds

95071

90.35

Inhalation bronchial challenge testing (not including necessary pulmonary function tests); with antigens or gases, specify

95075

67.86

Ingestion challenge test (sequential and incremental ingestion of test items, eg, food, drug or other substance such as metabisulfite)

95115

14.87

Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection

95117

18.55

Professional services for allergen immunotherapy not including provision of allergenic extracts; two or more injections

95120

I.C.

Professional services for allergen immunotherapy in prescribing physicians office or institution, including provision of allergenic extract; single injection

95125

I.C.

Professional services for allergen immunotherapy in prescribing physicians office or institution, including provision of allergenic extract; two or more injections

95130

I.C.

Professional services for allergen immunotherapy in prescribing physicians office or institution, including provision of allergenic extract; single stinging insect venom

95131

I.C.

Professional services for allergen immunotherapy in prescribing physicians office or institution, including provision of allergenic extract; two stinging insect venoms

95132

I.C.

Professional services for allergen immunotherapy in prescribing physicians office or institution, including provision of allergenic extract; three stinging insect venoms

95133

I.C.

Professional services for allergen immunotherapy in prescribing physicians office or institution, including provision of allergenic extract; four stinging insect venoms

95134

I.C.

Professional services for allergen immunotherapy in prescribing

physicians office or institution, including provision of allergenic extract; five stinging insect venoms

95144

12.93

Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy, single dose vial(s) (specify number of vials)

95145

18.00

Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); single stinging insect venom

95146

28.12

Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); two single stinging insect venoms

95147

27.20

Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); three single stinging insect venoms

95148

38.25

Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); four single stinging insect venoms

95149

50.68

Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); five single stinging insect venoms

95165

12.93

Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens (specify number of doses)

95170

10.17

Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; whole body extract of biting insect or other arthropod (specify number of doses)

95180

154.98

Rapid desensitization procedure, each hour (eg, insulin, penicillin, equine serum)

95199

I.C.

Unlisted allergy/clinical immunologic service or procedure

95250

175.21

Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for up to 72 hours; sensor placement, hook-up, calibration of monitor, patient training, removal of sensor, and printout of recording

95251

39.75

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

95805

635.86

93.58

542.28

Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness

95806

235.91

82.55

153.36

Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, unattended by a technologist

95807

627.68

80.71

546.98

Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist

95808

773.45

131.66

641.79

Polysomnography; sleep staging with one - three additional parameters of sleep, attended by a technologist

95810

947.96

173.15

774.82

Polysomnography; sleep staging with four or more additional parameters of sleep, attended by a technologist

95811

1,042.93

185.89

857.05

Polysomnography; sleep staging with four or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist

95812

270.73

56.16

214.57

Electroencephalogram (EEG) extended monitoring; 41-60 minutes

95813

330.64

88.92

241.72

Electroencephalogram (EEG) extended monitoring; greater than one hour

95816

248.34

56.16

192.17

Electroencephalogram (EEG); including recording awake and drowsy

95819

251.56

56.16

195.40

Electroencephalogram (EEG); including recording awake and asleep

95822

275.47

56.16

219.31

Electroencephalogram (EEG); recording in coma or sleep only

95824

I.C.

38.43

I.C.

Electroencephalogram (EEG); cerebral death evaluation only

95827

370.29

54.48

315.81

Electroencephalogram (EEG); all night recording

95829

1,510.86

319.97

1,190.89

Electrocorticogram at surgery (separate procedure)

95830

205.41

I.C.

I.C.

Insertion by physician of sphenoidal electrodes for electroencephalographic (EEG) recording

95831

29.65

Muscle testing, manual (separate procedure) with report; extremity (excluding hand) or trunk

95832

26.61

Muscle testing, manual (separate procedure) with report; hand, with or without comparison with normal side

95833

41.50

Muscle testing, manual (separate procedure) with report; total evaluation of body, excluding hands

95834

48.08

Muscle testing, manual (separate procedure) with report; total evaluation of body, including hands

95851

20.03

Range of motion measurements and report (separate procedure); each extremity (excluding hand) or each trunk section (spine)

95852

15.56

Range of motion measurements and report (separate procedure); hand, with or without comparison with normal side

95857

45.85

Tensilon test for myasthenia gravis

95860

94.25

51.31

42.95

Needle electromyography; one extremity with or without related paraspinal areas

95861

126.90

81.84

45.06

Needle electromyography; two extremities with or without related paraspinal areas

95863

152.12

97.84

54.27

Needle electromyography; three extremities with or without related paraspinal areas

95864

184.71

104.70

80.00

Needle electromyography; four extremities with or without related paraspinal areas

95865

122.26

85.00

37.26

Needle electromyography; larynx

95866

93.09

66.41

26.67

Needle electromyography; hemidiaphragm

95867

76.94

41.22

35.72

Needle electromyography; cranial nerve supplied muscle(s), unilateral

95868

105.42

62.04

43.38

Needle electromyography; cranial nerve supplied muscles, bilateral

95869

46.05

19.68

26.38

Needle electromyography; thoracic paraspinal muscles (excluding T1 or T12)

95870

45.13

19.68

25.45

Needle electromyography; limited study of muscles in one extremity or non-limb (axial) muscles (unilateral or bilateral), other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters

95872

168.05

135.25

32.80

Needle electromyography using single fiber electrode, with quantitative measurement of jitter, blocking and/or fiber density, any/all sites of each muscle studied

95873

45.59

20.14

25.45

Electrical stimulation for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure)

95874

44.67

20.14

24.53

Needle electromyography for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure)

95875

108.06

58.85

49.21

Ischemic limb exercise test with serial specimen(s) acquisition for muscle(s) metabolite(s)

95900

65.71

22.30

43.41

Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study

95903

72.62

31.51

41.10

Nerve conduction, amplitude and latency/velocity study, each nerve; motor, with F-wave study

95904

57.45

18.19

39.26

Nerve conduction, amplitude and latency/velocity study, each nerve; sensory

95920

170.53

112.74

57.79

Intraoperativeneurophysiologytesting, per hour (List separately in addition to code for primary procedure)

95921

75.79

45.28

30.52

Testing of autonomic nervous system function; cardiovagal innervation (parasympathetic function), including two or more of the following: heart rate response to deep breathing with recorded R-R interval, Valsalva ratio, and 30:15 ratio

95922

89.65

49.47

40.18

Testing of autonomic nervous system function; vasomotor adrenergic innervation (sympathetic adrenergic function), including beat-to-beat blood pressure and R-R interval changes during Valsalva maneuver and at least five minutes of passive tilt

95923

131.33

46.96

84.37

Testing of autonomic nervous system function; sudomotor, including one or more of the following: quantitative sudomotor axon reflex test (QSART), silastic sweat imprint, thermoregulatory sweat test, and changes in sympathetic skin potential

95925

118.09

28.38

89.71

Short-latency somatosensory evoked potential study,

stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper limbs

95926

116.41

28.08

88.33

Short-latency somatosensory evoked potential study,

stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in lower limbs

95927

120.40

29.30

91.09

Short-latency somatosensory evoked potential study,

stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in the trunk or head

95928

214.09

77.87

136.22

Central motor evoked potential study (transcranial motor stimulation); upper limbs

95929

226.06

78.33

147.73

Central motor evoked potential study (transcranial motor stimulation); lower limbs

95930

125.62

18.53

107.09

Visual evoked potential (VEP) testing central nervous system, checkerboard or flash

95933

72.39

31.01

41.38

Orbicularis oculi (blink) reflex, by electrodiagnostic testing

95934

48.07

26.76

21.31

H-reflex, amplitude and latency study; record gastrocnemius/soleus muscle

95936

44.21

28.88

15.33

H-reflex, amplitude and latency study; record muscle other than gastrocnemius/soleus muscle

95937

60.17

35.18

24.99

Neuromuscular junction testing (repetitive stimulation, paired stimuli), each nerve, any one method

95950

270.75

78.35

192.40

Monitoring for identification and lateralization of cerebral seizure focus, electroencephalographic (eg, eight channel EEG) recording and interpretation, each 24 hours

95951

I.C.

311.69

I.C.

Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, combined electroencephalographic (EEG) and video recording and interpretation (eg, for presurgical localization), each 24 hours

95953

472.65

168.86

303.79

Monitoring for localization of cerebral seizure focus by computerized portable 16 or more channel EEG, electroencephalographic (EEG) recording and interpretation, each 24 hours

95954

287.27

121.15

166.12

Pharmacological or physical activation requiring physician attendance during EEG recording of activation phase (eg, thiopental activation test)

95955

157.99

50.71

107.28

Electroencephalogram (EEG) during nonintracranial surgery (eg, carotid surgery)

95956

852.85

159.67

693.18

Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, electroencephalographic (EEG) recording and interpretation, each 24 hours

95957

267.82

103.12

164.70

Digital analysis of electroencephalogram (EEG) (eg, for epileptic spike analysis)

95958

389.70

219.64

170.06

Wada activation test for hemispheric function, including electroencephalographic (EEG) monitoring

95961

248.61

166.42

82.19

Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; initial hour of physician attendance

95962

234.06

172.12

61.93

Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; each additional hour of physician attendance (List separately in addition to code for primary procedure)

95965

I.C.

420.53

I.C.

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

95966

I.C.

208.67

I.C.

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

95967

I.C.

174.13

I.C.

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)

95970

56.31

Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements

95971

57.73

Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements

95972

109.72

Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements

95973

58.83

Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements

95974

179.49

Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements

95975

98.92

Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements

95978

212.35

Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse

95979

95.22

Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse

95980

40.92

Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient measurements) gastric neurostimulator pulse generator/transmitter; intraoperative, with programming

95981

31.09

Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient measurements) gastric neurostimulator pulse generator/transmitter; subsequent, without programming

95982

45.32

Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient measurements) gastric neurostimulator pulse generator/transmitter; subsequent, with programming

95990

73.60

Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular);

95991

99.43

Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular); administered by physician

95999

I.C.

Unlisted neurological or neuromuscular diagnostic procedure

96000

86.85

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

96001

104.48

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

96002

20.58

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

96003

17.84

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

96004

112.73

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

96020

I.C.

171.46

I.C.

Neurofunctional testing selection and administration during noninvasive imaging functional brain mapping, with test administered entirely by a physician or psychologist, with review of test results and report

96040

45.41

Medical genetics and genetic counseling services, each 30 minutes face-to-face with patient/family

96401

76.97

Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic

96402

47.75

Chemotherapy administration, subcutaneous or intramuscular; hormonal anti-neoplastic

96405

159.50

Chemotherapy administration; intralesional, up to and including seven lesions

96406

180.57

Chemotherapy administration; intralesional, more than seven lesions

96409

141.63

Chemotherapy administration; intravenous, push technique, single or initial substance/drug

96411

79.97

Chemotherapy administration; intravenous, push technique, each additional substance/drug (List separately in addition to code for primary procedure)

96413

191.93

Chemotherapy administration, intravenous infusion technique; up to one hour, single or initial substance/drug

96415

41.27

Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)

96416

209.33

Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than eight hours), requiring use of a portable or implantable pump

96417

93.96

Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to one hour (List separately in addition to code for primary procedure)

96420

133.40

Chemotherapy administration, intra-arterial; push technique

96422

222.69

Chemotherapyadministration, intra-arterial; infusion technique, up to one hour

96423

95.70

Chemotherapyadministration, intra-arterial; infusion technique, each additional hour (List separately in addition to code for primary procedure)

96425

218.55

Chemotherapyadministration, intra-arterial; infusion technique, initiation of prolonged infusion (more than eight hours), requiring the use of a portable or implantable pump

96440

400.85

Chemotherapy administration into pleural cavity, requiring and including thoracentesis

96445

389.08

Chemotherapy administration into peritoneal cavity, requiring and including peritoneocentesis

96450

329.72

Chemotherapy administration, into CNS (eg, intrathecal), requiring and including spinal puncture

96521

168.23

Refilling and maintenance of portable pump

96522

133.70

Refilling and maintenance of implantable pump or reservoir for drug delivery, systemic (eg, intravenous, intra-arterial)

96523

32.50

Irrigation of implanted venous access device for drug delivery systems

96542

207.22

Chemotherapy injection, subarachnoid or intraventricular via subcutaneous reservoir, single or multiple agents

96549

I.C.

Unlisted chemotherapy procedure

96567

132.38

Photodynamic therapy by external application of light to destroy premalignant and/or malignant lesions of the skin and adjacent mucosa (eg, lip) by activation of photosensitive drug(s), each phototherapy exposure session

96570

58.35

Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug(s); first 30 minutes (List separately in addition to code for endoscopy or bronchoscopy procedures of lung and esophagus)

96571

28.42

Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug(s); each additional 15 minutes (List separately in addition to code for endoscopy or bronchoscopy procedures of lung and esophagus)

96900

23.61

Actinotherapy (ultraviolet light)

96902

21.20

Microscopic examination of hairs plucked or clipped by the examiner (excluding hair collected by the patient) to determine telogen and anagen counts, or structural hair shaft abnormality

96904

87.75

Whole body integumentary photography, for monitoring of high risk patients with dysplastic nevus syndrome or a history of dysplastic nevi, or patients with a personal or familial history of melanoma

96910

70.24

Photochemotherapy; tar and ultraviolet B (Goeckerman treatment) or petrolatum and ultraviolet B

96912

89.87

Photochemotherapy; psoralens and ultraviolet A (PUVA)

96913

121.29

Photochemotherapy (Goeckerman and/or PUVA) for severe photoresponsive dermatoses requiring at least four to eight hours of care under direct supervision of the physician (includes application of medication and dressings)

96920

180.71

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

96921

177.55

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

96922

259.77

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

96999

I.C.

Unlisted special dermatological service or procedure

97802

29.47

Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes

97803

26.28

Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes

97804

14.82

Medical nutrition therapy; group (two or more individual(s)), each 30 minutes

98925

29.77

Osteopathic manipulative treatment (OMT); one to two body regions involved

98926

41.04

Osteopathic manipulative treatment (OMT); three to four body regions involved

98927

52.70

Osteopathic manipulative treatment (OMT); five to six body regions involved

98928

61.68

Osteopathic manipulative treatment (OMT); seven to eight body regions involved

98929

70.67

Osteopathic manipulative treatment (OMT); nine to ten body regions involved

98960

27.00

Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient

98961

13.19

Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; two - four patients

98962

9.51

Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; five - eight patients

98966

12.98

Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; five - ten minutes of medical discussion

98967

24.11

Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion

98968

35.71

Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion

98969

I.C.

Online assessment and management service provided by a qualified nonphysician health care professional to an established patient, guardian, or health care provider not originating from a related assessment and management service provided within the previous seven days, using the internet or similar electronic communications network

99024

0.00

0.00

0.00

Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure

99026

I.C.

Hospital mandated on call service; in-hospital, each hour

99027

I.C.

Hospital mandated on call service; out-of-hospital, each hour

99050

0.00

0.00

0.00

Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed (eg, holidays, Saturday or Sunday), in addition to basic service

99051

0.00

0.00

0.00

Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service

99053

0.00

0.00

0.00

Service(s) provided between 10:00 PM and 8:00 AM at 24-hour facility, in addition to basic service

99056

0.00

0.00

0.00

Service(s) typically provided in the office, provided out of the office at request of patient, in addition to basic service

99058

0.00

0.00

0.00

Service(s) provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service

99060

0.00

0.00

0.00

Service(s) provided on an emergency basis, out of the office, which disrupts other scheduled office services, in addition to basic service

99070

I.C.

Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided)

99071

I.C.

Educational supplies, such as books, tapes, and pamphlets, provided by the physician for the patient's education at cost to physician

99075

I.C.

Medical testimony

99080

I.C.

Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form

99082

I.C.

Unusual travel (eg, transportation and escort of patient)

99090

I.C.

Analysis of clinical data stored in computers (eg, ECGs, blood pressures, hematologic data)

99091

50.26

Collection and interpretation of physiologic data (eg, ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, requiring a minimum of 30 min

99144

I.C.

Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological sattus; five years or older, first 30 minutes intra-service time

99145

I.C.

Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; each additinal 15 minutes intra-service time (list separately in addition to code for primary service)

99149

I.C.

Moderate sedation services (other than those services described by codes 00100-01999), provided by a physician other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; age five years or older, first 30 minutes intra-service time

99150

I.C.

Moderate sedation services (other than those services described by codes 00100-01999), provided by a physician other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; each additional 15 minutes (list separately in addition to code for primary service)

99172

I.C.

Visual function screening, automated or semi-automated bilateral quantitative determination of visual acuity, ocular alignment, color vision by pseudoisochromatic plates, and field of vision (may include all or some screening of the determination[s] for contrast sensitivity, vision under glare)

99173

3.06

Screening test of visual acuity, quantitative, bilateral

99174

I.C.

Ocular photoscreening with interpretation and report, bilateral

99175

43.04

Ipecac or similar administration for individual emesis and continued observation until stomach adequately emptied of poison

99183

219.09

Physician attendance and supervision of hyperbaric oxygen therapy, per session

99185

54.13

Hypothermia; regional

99186

92.20

Hypothermia; total body

99190

I.C.

Assembly and operation of pump with oxygenator or heat exchanger (with or without ECG and/or pressure monitoring); each hour

99191

I.C.

Assembly and operation of pump with oxygenator or heat exchanger (with or without ECG and/or pressure monitoring); 45 minutes

99192

I.C.

Assembly and operation of pump with oxygenator or heat exchanger (with or without ECG and/or pressure monitoring); 30 minutes

99195

69.64

Phlebotomy, therapeutic (separate procedure)

99199

I.C.

Unlisted special service, procedure or report

99201

40.20

Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend ten minutes face-to-face with the patient and/or family.

99202

68.83

Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 20 minutes face-to-face with the patient and/or family.

99203

100.00

Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family.

99204

150.71

Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 45 minutes face-to-face with the patient and/or family.

99205

188.86

Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s)

99211

22.67

Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically, five minutes are spent performing or supervising these services.

99212

41.58

Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend ten minutes face-to-face with the patient and/or family.

99213

65.91

Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 15 minutes face-to-face with the patient and/or family.

99214

98.77

Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 25 minutes face-to-face with the patient and/or family.

99215

132.82

Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 40 minutes face-to-face with the patient and/or family.

99217

68.98

Observation care discharge day management (This code is to be utilized by the physician to report all services provided to a patient on discharge from "observation status" if the discharge is on other than the initial date of "observation status." To report services to a patient designated as "observation status" or "inpatient status" and discharged on the same date, use the codes for Observation or Inpatient Care Services [including Admission and Discharge Services, 99234-99236 as appropriate.])

99218

64.37

A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity. Initial observation care, per day, for the evaluation and management of a patient which requires these three key components: Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission to "observation status" are of low severity.

99219

105.98

Initial observation care, per day, for the evaluation and management of a patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission to "observation status" are of moderate severity.

99220

149.09

Initial observation care, per day, for the evaluation and management of a patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission to "observation status" are of high severity.

99221

89.30

Initial hospital care, per day, for the evaluation and management of a patient, which requires these three key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of low severity. Physicians typically spend 30 minutes at the bedside and on the patient's hospital floor or unit.

99222

123.54

Initial hospital care, per day, for the evaluation and management

of a patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of moderate severity. Physicians typically spend 50 minutes at the bedside and on the patient's hospital floor or unit.

99223

181.29

Initial hospital care, per day, for the evaluation and management of a patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of high severity. Physicians typically spend 70 minutes at the bedside and on the patient's hospital floor or unit.

99231

37.43

Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: A problem focused interval history; A problem focused examination; Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is stable, recovering or improving. Physicians typically spend 15 minutes at the bedside and on the patient's hospital floor or unit.

99232

67.07

Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Physicians typically spend 25 minutes at the bedside and on the patient's hospital floor or unit.

99233

95.86

Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: A detailed interval history; A detailed examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant complication or a significant new problem. Physicians typically spend 35 minutes at the bedside and on the patient's hospital floor or unit.

99234

129.51

Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date which requires these three key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the presenting problem(s) requiring admission are of low severity.

99235

170.47

Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the presenting problem(s) requiring admission are of moderate severity.

99236

211.90

Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the presenting problem(s) requiring admission are of high severity.

99238

69.14

Hospital discharge day management; 30 minutes or less

99239

99.19

Hospital discharge day management; more than 30 minutes

99241

53.27

Office consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other providers

99242

97.54

Office consultation for a new or established patient, which requires these three key components: An expanded problem focused history; An expanded problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care

99243

133.45

Office consultation for a new or established patient, which requires these three key components: A detailed history; A detailed examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies

99244

194.44

Office consultation for a new or established patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 60 minutes face-to-face with the patient and/or family.

99245

239.50

Office consultation for a new or established patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 80 minutes face-to-face with the patient and/or family.

99251

48.07

Inpatient consultation for a new or established patient, which requires these three key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 20 minutes at the bedside and on the patient's hospital floor or unit.

99252

76.93

Inpatient consultation for a new or established patient, which requires these three key components: An expanded problem focused history; An expanded problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Physicians typically spend 40 minutes at the bedside and on the patient's hospital floor or unit.

99253

114.86

Inpatient consultation for a new or established patient, which requires these three key components: A detailed history; A detailed examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 55 minutes at the bedside and on the patient's hospital floor or unit.

99254

165.94

Inpatient consultation for a new or established patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 80 minutes at the bedside and on the patient's hospital floor or unit.

99255

205.03

Inpatient consultation for a new or established patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 110 minutes at the bedside and on the patient's hospital floor or unit.

99281

20.11

Emergency department visit for the evaluation and management of a patient, which requires these three key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor.

99282

38.15

Emergency department visit for the evaluation and management of a patient, which requires these three key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity.

99283

61.34

Emergency department visit for the evaluation and management of a patient, which requires these three key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity.

99284

113.24

Emergency department visit for the evaluation and management of a patient, which requires these three key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity, and require urgent evaluation by the physician but do not pose an immediate significant threat to life or physiologic function.

99285

168.40

Emergency department visit for the evaluation and management of a patient, which requires these three key components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity and pose an immediate significant threat to life or physiologic function.

99288

I.C.

Physician direction of emergency medical systems (EMS) emergency care, advanced life support

99291

271.33

Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes

99292

119.24

Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes (List separately in addition to code for primary service)

99304

80.86

Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these three key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity.Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the problem(s) requiring admission are of low severity. Physicians typically spend 25 minutes with the patient and/or family or caregiver

99305

111.93

Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the problem(s) requiring admission are of moderate severity. Physicians typically spend 35 minutes with the patient and/or family or caregiver

99306

143.33

Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the problem(s) requiring admission are of high severity. Physicians typically spend 45 minutes with the patient and/or family or caregiver

99307

40.20

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the patient is stable, recovering or improving. Physicians typically spend ten minutes with the patient and/or family or caregiver.

99308

61.98

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the patient is responding inadequately to therapy or has developed a minor complication. Physicians typically spend 15 minutes with the patient and/or family or caregiver.

99309

82.80

Subsequent nursing facility care, per day, for the evaluation and

management of a patient, which requires at least two of these three key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the patient has developed a significant complication or a significant new problem. Physicians typically spend 25 minutes with the patient and/or family or caregiver.

99310

120.38

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: A comprehensive interval history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. The patient may be unstable or may have developed a significant new problem. Physicians typically spend 35 minutes with the patient and/or family or caregiver.

99315

59.87

Nursing facility discharge day management; 30 minutes or less

99316

78.33

Nursing facility discharge day management; more than 30 minutes

99318

84.28

Evaluation and management of a patient involving an annual nursing facility assessment, which requires these three key components: A detailed interval history; A comprehensive examination; and Medical decision making that is of low to moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the patient is stable, recovering or improving. Physicians typically spend 30 minutes with the patient and/or family or caregiver.

99324

57.16

Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these three key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the presenting problem(s) are of low severity. Physicians typically spend 20 minutes with the patient and/or family or caregiver

99325

82.53

Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these three key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the problem(s) requiring admission are of low severity. Physicians typically spend 25 minutes with the patient and/or family or caregiver. Usually the presenting problem(s) are of moderate severity. Physicians typically spend 30 minutes with the patient and/or family or caregiver.

99326

132.84

Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these three key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the presenting problem(s) are of moderate to high severity. Physicians typically spend 45 minutes with the patient and/or family or caregiver.

99327

172.20

Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the presenting problem(s) are of high severity. Physicians typically spend 60 minutes with the patient and/or family or caregiver.

99328

203.82

Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the patient is unstable or has developed a significant new problem requiring immediate physician attention. Physicians typically spend 75 minutes with the patient and/or family or caregiver.

99334

57.06

Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least two of these three key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the presenting problem(s) are self-limited or minor. Physicians typically spend 15 minutes with the patient and/or family or caregiver.

99335

87.22

Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least two of these three key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the presenting problem(s) are of low to moderate severity. Physicians typically spend 25 minutes with the patient and/or family or caregiver.

99336

123.05

Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least two of these three key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the presenting problem(s) are of moderate to high severity. Physicians typically spend 40 minutes with the patient and/or family or caregiver.

99337

176.30

Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least two of these three key components: A comprehensive interval history; A comprehensive examination; Medical decision making of moderate to high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the presenting problem(s) are of moderate to high severity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Physicians typically spend 60 minutes with the patient and/or family or caregiver.

99339

71.17

Individual physician supervision of a patient (patient not present) in home, domiciliary or rest home (eg, assisted living facility) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of related laboratory and other studies, communication (including telephone calls) for purposes of assessment or care decisions with health care professional(s), family member(s), surrogate decision maker(s) (e.g., legal guardian) and/or key caregiver(s) involved inpatient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month, 15-29 minutes

99340

99.00

Individual physician supervision of a patient (patient not present) in home, domiciliary or rest home (eg, assisted living facility) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of related laboratory and other studies, communication (including telephone calls) for purposes of assessment or care decisions with health care professional(s), family member(s), surrogate decision maker(s) (e.g., legal guardian) and/or key caregiver(s) involved inpatient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month, 30 minutes or more

99341

56.70

Home visit for the evaluation and management of a new patient, which requires these three key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the presenting problem(s) are of low severity. Physicians typically spend 20 minutes face-to-face with the patient and/or family.

99342

82.53

Home visit for the evaluation and management of a new patient, which requires these three key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the presenting problem(s) are of moderate severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family.

99343

129.88

Home visit for the evaluation and management of a new patient, which requires these three key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the presenting problem(s) are of moderate to high severity. Physicians typically spend 45 minutes face-to-face with the patient and/or family.

99344

169.47

Home visit for the evaluation and management of a new patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the presenting problem(s) are of high severity. Physicians typically spend 60 minutes face -to-face with the patient and/or family.

99345

203.82

Home visit for the evaluation and management of a new patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the patient is unstable or has developed a significant new problem requiring immediate physician attention.Physicians typically spend 75 minutes face-to-face with the patient and/or family.

99347

54.21

Home visit for the evaluation and management of an established patient, which requires at least two of these three key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs.

99348

81.30

Home visit for the evaluation and management of an established patient, which requires at least two of these three key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity.

99349

118.15

Home visit for the evaluation and management of an established patient, which requires at least two of these three key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the presenting problem(s) are self-limited or minor. Physicians typically spend 15 minutes with the patient and/or family.

99350

165.14

Home visit for the evaluation and management of an established patient, which requires at least two of these three key components: A comprehensive interval history; A comprehensive examination; Medical decision making of moderate to high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs.

99354

95.51

Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service (eg, prolonged care and treatment of an acute asthmatic patient in an outpatient setting); first hour (List separately in addition to code for office or other Evaluation and Management procedure)

99355

93.83

Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service (eg, prolonged care and treatment of an acute asthmatic patient in an outpatient setting); each additional 30 minutes (List separately in addition to code for office or other Evaluation and Management procedure)

99356

86.26

Prolonged physician service in the inpatient setting, requiring direct (face-to-face) patient contact beyond the usual service (eg, maternal fetal monitoring for high risk delivery or other physiological monitoring, prolonged care of an acutely ill inpatient); first hour (List separately in addition to code for office or other Evaluation and Management procedure).

99357

86.56

Prolonged physician service in the inpatient setting, requiring direct (face-to-face) patient contact beyond the usual service (eg, maternal fetal monitoring for high risk delivery or other physiological monitoring, prolonged care of an acutely ill inpatient); each additional 30 minutes (List separately in addition to code for office or other Evaluation and Management procedure).

99358

97.87

Prolonged evaluation and management service before and/or after direct (face-to-face) patient care (eg, review of extensive records and tests, communication with other professionals and/or the patient/family); first hour (List separately in addition to code for other physician service(s) and/or inpatient or outpatient Evaluation and Management service)

99359

47.31

Prolonged evaluation and management service before and/or after direct (face-to-face) patient care (eg, review of extensive records and tests, communication with other professionals and/or the patient/family); each additional 30 minutes (List separately in addition to code for prolonged physician service)

99360

55.36

Physician standby service, requiring prolonged physician attendance, each 30 minutes (eg, operative standby, standby for frozen section, for cesarean/high risk delivery, for monitoring EEG)

99363

118.27

Anticoagulant management for an outpatient taking warfarin, physician review and interpretation of International Normalized Ratio (INR) testing, patient instructions, dosage adjustment (as needed), and ordering of additional tests; initial 90 days of therapy (must include a minimum of 8 INR measurements)

99364

40.20

Anticoagulant management for an outpatient taking warfarin, physician review and interpretation of International Normalized Ratio (INR) testing, patient instructions, dosage adjustment (as needed), and ordering of additional tests; each subsequent 90 days of therapy (must include a minimum of three INR measurements)

99366

39.00

Medical team conference with interdisciplinary team of health care professionals, face-to-face with patient and/or family, 30 minutes or more, participation by nonphysician qualified health care professional

99367

50.56

Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more; participation by physician

99368

32.85

Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more; participation by nonphysician qualified health care professional

99374

67.59

Physician supervision of a patient under care of home health agency (patient not present) in home, domiciliary or equivalent environment (eg, Alzheimer's facility) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of related laboratory and other studies, communication (including telephone calls) for purposes of assessment of care decisions with health care professional(s), family member(s), surrogate decision maker(s) (e.g., legal guardian) and/or key caregiver(s) involved in patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 15-29 minutes

99375

114.10

Physician supervision of a patient under care of home health agency (patient not present) in home, domiciliary or equivalent environment (eg, Alzheimer's facility) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of related laboratory and other studies, communication (including telephone calls) for purposes of assessment of care decisions with health care professional(s), family member(s), surrogate decision maker(s) (e.g., legal guardian) and/or key caregiver(s) involved in patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 30 minutes or more

99377

67.59

Physician supervision of a hospice patient (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of related laboratory and other studies, communication (including telephone calls) for purposes of assessment of care decisions with health care professional(s), family member(s), surrogate decision maker(s) (e.g., legal guardian) and/or key caregiver(s) involved in patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 15-29 minutes

99378

123.30

Physician supervision of a hospice patient (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of related laboratory and other studies, communication (including telephone calls) for purposes of assessment of care decisions with health care professional(s), family member(s), surrogate decision maker(s) (e.g., legal guardian) and/or key caregiver(s) involved in patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 30 minutes or more

99379

67.29

Physician supervision of a nursing facility patient (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of related laboratory and other studies, communication (including telephone calls) for purposes of assessment of care decisions with health care professional(s), family member(s), surrogate decision maker(s) (e.g., legal guardian) and/or key caregiver(s) involved in patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 15-29 minutes

99380

100.91

Physician supervision of a nursing facility patient (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of related laboratory and other studies, communication (including telephone calls) for purposes of assessment of care decisions with health care professional(s), family member(s), surrogate decision maker(s) (e.g., legal guardian) and/or key caregiver(s) involved in patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 30 minutes or more

99441

13.28

Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; five - ten minutes of medical discussion

99442

24.11

Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion

99443

35.71

Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion

99444

I.C.

Online evaluation and management service provided by a physician to an established patient, guardian, or health care provider not originating from a related E/M service provided within the previous seven days, using the Internet or similar electronic communications network

99450

I.C.

Basic life and/or disability examination that includes: Measurement of height, weight, and blood pressure; Completion of a medical history following a life insurance pro forma; Collection of blood sample and/or urinalysis complying with "chain of custody" protocols; and completion of necessary documentatioin/certificates

99455

I.C.

Work related or medical disability examination by the treating physician that includes: Completion of a medical history commensurate with the patient's condition; Performance of an examination commensurate with the patient's condition; Formulation of a diagnosis, assessment of capabilities and stability, and calculation of impairment; development of future medical treatment plan; and completion of necessary documentation/certification and report.

99456

I.C.

Work related or medical disability examination by other than the treating physician that includes: Completion of a medical history commensurate with the patient's condition; Performance of an examination commensurate with the patient's condition; Formulation of a diagnosis, assessment of capabilities and stability, and calculation of impairment; development of future medical treatment plan; and completion of necessary documentation/certification and report.

99499

I.C.

Unlisted evaluation and management service

99503

I.C.

Home visit for respiratory therapy care (eg, bronchodilator, oxygen therapy, respiratory assessment, apnea evaluation)

99504

I.C.

Home visit for mechanical ventilation care

99505

I.C.

Home visit for stoma care and maintenance including colostomy and cystostomy

99506

I.C.

Home visit for intramuscular injections

99507

I.C.

Home visit for care and maintenance of catheter(s) (eg, urinary, drainage, and enteral)

99509

I.C.

Home visit for assistance with activities of daily living and personal care

99511

I.C.

Home visit for fecal impaction management and enema administration

99512

I.C.

Home visit for hemodialysis

99600

I.C.

Unlisted home visit service or procedure
(11) Psychological Services.

Code

Unit

40.06(11) - Psychological Services Description

90801

124.41

Psychiatric diagnostic interview examination

90802

131.71

Interactive psychiatric diagnostic interview examination using play equipment, physical devices, language interpreter, or other mechanisms of communication

90804

51.88

Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient;

90805

57.25

Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient; with medical evaluation and management services

90806

72.77

Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient;

90807

80.54

Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient; with medical evaluation and management services

90808

107.17

Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient;

90809

114.22

Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient; with medical evaluation and management services

90810

55.06

Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient;

90811

63.68

Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient; with medical evaluation

90812

79.69

Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient;

90813

87.10

Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient; with medical evaluation

90814

113.37

Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient;

90815

120.41

Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient; with medical evaluation

90816

48.26

Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 20 to 30 minutes face-to-face with the patient;

90817

52.91

Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 20 to 30 minutes face-to-face with the patient; with medical evaluation and management

90818

71.77

Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 45 to 50 minutes face-to-face with the patient;

90819

76.29

Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 45 to 50 minutes face-to-face with the patient; with medical evaluation and management

90821

106.08

Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face-to-face with the patient;

90822

110.47

Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face-to-face with the patient; with medical evaluation and management

90823

51.93

Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 20 to 30 minutes face-to-face with the patient;

90824

57.17

Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 20 to 30 minutes face-to-face with the patient;

90826

76.30

Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 45 to 50 minutes face-to-face with the patient;

90827

79.96

Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 45 to 50 minutes face-to-face with the patient;

90828

110.47

Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face-to-face with the patient;

90829

113.90

Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face-to-face with the patient;

90845

66.20

Psychoanalysis

90846

70.89

Family psychotherapy (without the patient present)

90847

88.52

Family psychotherapy (conjoint psychotherapy) (with patient present)

90849

27.10

Multiple-family group psychotherapy

90853

25.42

Group psychotherapy (other than of a multiple-family group)

90857

29.02

Interactive group psychotherapy

90862

44.32

Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy

90865

124.36

Narcosynthesis for psychiatric diagnostic and therapeutic purposes (eg, sodium amobarbital (Amytal) interview)

90870

120.96

Electroconvulsive therapy (includes necessary monitoring)

90875

58.71

Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); approximately 20-30 minutes

90876

85.27

Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); approximately 45-50 minutes

90880

89.07

Hypnotherapy

90885

37.28

Psychiatric evaluation of hospital records, other psychiatric reports, psychometric and/or projective tests, and other accumulated data for medical diagnostic purposes

90887

66.21

Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient

90889

26.79

Preparation of report of patient's psychiatric status, history, treatment, or progress (other than for legal or consultative purposes) for other physicians, agencies, or insurance carriers

96101

69.04

Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, eg, MMPI, Rorschach, WAIS), per hour of the psychologist's or physician's time, both face-to-face time administering test

96102

45.39

Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, eg, MMPI and WAIS), with qualified health care professional interpretation and report, administered by technician, per hour

96103

34.34

Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, eg, MMPI), administered by a computer, with qualified health care professional interpretation and report

96105

65.97

Assessment of aphasia (includes assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, writing, eg, by Boston Diagnostic Aphasia Examination) with interpretation and report

96110

10.73

Developmental testing; limited (eg, Developmental Screening Test II, Early Language Milestone Screen), with interpretation and report

96111

105.27

Developmental testing; extended (includes assessment of motor, language, social, adaptive and/or cognitive functioning by standardized developmental instruments) with interpretation and report

96116

78.59

Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), per hour of the psychologist's or physician's time, both face-to-face

96118

94.11

Neuropsychological testing (eg, Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test), per hour of the psychologist's or physician's time, both face-to-face time administering tests to the patient and time interpreting

96119

64.81

Neuropsychological testing (eg, Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test), with qualified health care professional interpretation and report, administered by technician, per hour of technician time

96120

57.81

Neuropsychological testing (eg, Wisconsin Card Sorting Test), administered by a computer, with qualified health care professional interpretation and report

96125

76.72

Standardized cognitive performance testing (eg, Ross Information Processing Assessment) per hour of a qualified health care professional's time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report

96150

18.68

Health and behavior assessment (eg, health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face-to-face with the patient; initial assessment

96151

18.14

Health and behavior assessment (eg, health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face-to-face with the patient; re-assessment

96152

17.25

Health and behavior intervention, each 15 minutes, face-to-face; individual

96153

4.00

Health and behavior intervention, each 15 minutes, face-to-face; group (two or more patients)

96154

16.98

Health and behavior intervention, each 15 minutes, face-to-face; family (with the patient present)

96155

17.31

Health and behavior intervention, each 15 minutes, face-to-face; family (without the patient present)

99358

76.76

Prolonged evaluation and management service before and/or after direct (face-to-face) patient care (eg, review of extensive records and tests, communication with other professionals and/or the patient/family); first hour (List separately in addition to code(s) for other physician service(s) and. or inpatient or outpatient evaluation and management service)

99359

37.11

Prolonged evaluation and management service before and/or after direct (face-to-face) patient care (eg, review of extensive records and tests, communication with other professionals and/or the patient/family); each additional 30 minutes (List separately in addition to code for prolonged physician service)

99368

25.76

Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more; participation by nonphysician qualified health care professional
(12) Restorative Services.

Code

Unit

40.06(12) - Restorative Services Description

16000

54.51

Initial treatment, first degree burn, when no more than local treatment is required

16020

66.97

Dressings and/or debridement of partial-thickness burns, initial or subsequent; small (less than 5% total body surface area)

16025

114.88

Dressings and/or debridement of partial-thickness burns, initial or subsequent; medium (eg, whole face or whole extremity, or 5% to 10% total body surface area)

16030

138.94

Dressings and/or debridement of partial-thickness burns, initial or subsequent; large (eg, more than one extremity, or greater than 10% total body surface area)

92506

196.25

Evaluation of speech, language, voice, communication, and/or auditory processing

92507

56.92

Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual

92508

26.46

Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, two or more individuals

92511

140.15

Nasopharyngoscopy with endoscope (separate procedure)

92512

54.10

Nasal function studies (eg, rhinomanometry)

92516

55.72

Facial nerve function studies (eg, electroneuronography)

92520

47.02

Laryngeal function studies (ie, aerodynamic testing and acoustic testing)

92526

75.87

Treatment of swallowing dysfunction and/or oral function for feeding

92531

I.C.

Spontaneous nystagmus, including gaze

92532

I.C.

Positional nystagmus test

92533

I.C.

Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes four tests)

92534

I.C.

Optokinetic nystagmus test

97001

85.89

Physical therapy evaluation

97002

31.86

Physical therapy re-evaluation

97003

92.59

Occupational therapy evaluation

97004

38.75

Occupational therapy re-evaluation

97005

I.C.

Athletic training evaluation

97006

I.C.

Athletic training re-evaluation

97012

12.05

Application of a modality to one or more areas; traction, mechanical

97014

11.61

Application of a modality to one or more areas; electrical stimulation (unattended)

97016

12.70

Application of a modality to one or more areas; vasopneumatic devices

97018

6.57

Application of a modality to one or more areas; paraffin bath

97022

14.61

Application of a modality to one or more areas; whirlpool

97024

4.39

Application of a modality to one or more areas; diathermy (eg, microwave)

97026

4.03

Application of a modality to one or more areas; infrared

97028

5.29

Application of a modality to one or more areas; ultraviolet

97032

13.50

Application of a modality to one or more areas; electrical stimulation (manual), each 15 minutes

97033

20.30

Application of a modality to one or more areas; iontophoresis, each 15 minutes

97034

12.05

Application of a modality to one or more areas; contrast baths, each 15 minutes

97035

9.51

Application of a modality to one or more areas; ultrasound, each 15 minutes

97036

21.56

Application of a modality to one or more areas; Hubbard tank, each 15 minutes

97039

I.C.

Unlisted modality (specify type and time if constant attendance)

97110

23.10

Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility

97112

24.32

Therapeutic procedure, one or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities

97113

28.77

Therapeutic procedure, one or more areas, each 15 minutes; aquatic therapy with therapeutic exercises

97116

20.43

Therapeutic procedure, one or more areas, each 15 minutes; gait training (includes stair climbing)

97124

18.73

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

97139

I.C.

Unlisted therapeutic procedure (specify)

97140

21.61

Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes

97150

14.76

Therapeutic procedure(s), group (two or more individuals)

97530

24.78

Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes

97532

19.70

Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact by the provider, each 15 minutes

97533

21.15

Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact by the provider, each 15 minutes

97535

25.04

Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact by provider, each 15 minutes

97537

22.14

Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or work environment/modification analysis, work task analysis, use of assistive technology device/adaptive equipment), direct one-on-one contact by provider each 15 minutes

97542

22.51

Wheelchair management (eg, assessment, fitting, training), each 15 minutes

97545

114.82

Work hardening/conditioning; initial two hours

97546

57.41

Work hardening/conditioning; each additional hour (List separately in addition to code for primary procedure)

97597

48.72

Removal of devitalized tissue from wound(s), selective debridement, without anesthesia (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), with or without topical application(s), wound assessment and instruction(s) for ongoing care, may include use of a whirlpool, per session; total wound(s) surface area less than or equal to 20 square centimeters

97598

60.08

Removal of devitalized tissue from wound(s), selective debridement, without anesthesia (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), with or without topical application(s), wound assessment and instruction(s) for ongoing care, may include use of a whirlpool, per session; total wound(s) surface area greater than 20 square centimeters

97602

I.C.

Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (eg, wet-to-moist dressings, enzymatic, abrasion), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session

97605

28.70

Negative pressure wound therapy (eg, vacuum assisted drainage collection), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters

97606

30.65

Negative pressure wound therapy (eg, vacuum assisted drainage collection), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters

97750

24.19

Physical performance test or measurement (eg, musculoskeletal, functional capacity), with written report, each 15 minutes

97755

27.32

Assistive technology assessment (eg, to restore, augment or compensate for existing function, optimize functional tasks and/or maximize environmental accessibility), direct one-on-one contact by provider, with written report, each 15 minutes

97760

26.60

Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(s), lower extremity(s) and/or trunk, each 15 minutes

97761

23.47

Prosthetic training, upper and/or lower extremity(s), each 15 minutes

97762

28.24

Checkout for orthotic/prosthetic use, established patient, each 15 minutes

97799

I.C.

Unlisted physical medicine/rehabilitation service or procedure

G0237

12.81

Therapeutic procedures to increase strength or endurance of respiratory muscles, face-to-face, one-on-one, each 15 minutes (includes monitoring)

CPT Codes 29000 through 29750 are incorporated by reference and shall be paid at the listed fee.

Notes

114 CMR 40.06

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