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Emergency _triggers bundling_

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					                                                           Emergency (triggers bundling)


                                                                     Critical
             Rates for Hospitals that do not qualify as trauma centers                                         University-
                                                                     Access Public/Recentl Free-standing        affiliated
                                                              Hospital        y Public       Children's    Teaching
                Urban Peer      Large Rural     Small Rural             Peer            Peer
CPT                   Group      Peer Group      Peer Group            Group           Group    Peer Group    Peer Group         Eff Date
Peer
Group                  1.00             1.45            1.50            2.15               1.48          2.13            1.14
Multiplier
99281                 $91.92         $133.28         $137.88          $197.63         $136.04         $195.79         $104.79    04/01/2011
99282                 $91.92         $133.28         $137.88          $197.63         $136.04         $195.79         $104.79    04/01/2011
99283                $148.68         $215.59         $223.03          $319.67         $220.05         $316.70         $169.50    04/01/2011
99284                $255.36         $370.27         $383.04          $549.02         $377.93         $543.92         $291.11    04/01/2011
99285                $255.36         $370.27         $383.04          $549.02         $377.93         $543.92         $291.11    04/01/2011




                                                                     Critical                                     University-
             Rates for Hospitals that do qualify as trauma centers (additional 50% adjuster on 99283, 99284, 99285)
                                                                     Access Public/Recentl Free-standing            affiliated
                                                              Hospital        y Public        Children's      Teaching
                Urban Peer      Large Rural      Small Rural            Peer            Peer
CPT                   Group      Peer Group       Peer Group           Group           Group     Peer Group      Peer Group      Eff Date
99281                 $91.92         $133.28         $137.88          $197.63         $136.04         $195.79         $104.79    04/01/2011
99282                 $91.92         $133.28         $137.88          $197.63         $136.04         $195.79         $104.79    04/01/2011
99283                $223.03         $289.93         $297.37          $394.01         $294.39         $391.04         $243.84    04/01/2011
99284                $383.04         $497.95         $510.72          $676.70         $505.61         $671.60         $418.79    04/01/2011
99285                $383.04         $497.95         $510.72          $676.70         $505.61         $671.60         $418.79    04/01/2011




                                                                  Page 1 of 709
        Surgery (triggers bundling)


PROC
10021
10022
10060
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10080
10081
10120
10121
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10160
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11000
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11400
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11402
11403
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11406
11420
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11422
11423
11424



                 Page 2
        Surgery (triggers bundling)


11426
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11441
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11443
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11450
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11463
11470
11471
11600
11601
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11762
11765
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11771
11772
11900
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11960
11971
11976
12001
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12004
12005



                 Page 3
        Surgery (triggers bundling)


12006
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13150
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13152
13153
13160
14000
14001
14020
14021
14040
14041
14060
14061
14301
14302
14350



                 Page 4
        Surgery (triggers bundling)


15002
15003
15004
15005
15040
15050
15100
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15110
15111
15115
15116
15120
15121
15130
15131
15135
15136
15150
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15200
15201
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15240
15241
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15321
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15331
15335
15336
15340
15341
15360
15361
15365
15366
15400
15401
15420
15421
15430



                 Page 5
        Surgery (triggers bundling)


15431
15570
15572
15574
15576
15600
15610
15620
15630
15650
15731
15732
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15736
15738
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15788
15789
15792
15793
15823
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15841
15842
15845
15847
15850
15851
15920
15922
15931
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15934
15935
15936
15937
15940
15941
15944
15945
15946
15950
15951
15952
15953
15956
15958
15999
16000
16020
16025



                 Page 6
        Surgery (triggers bundling)


16030
17000
17003
17004
17106
17107
17108
17110
17111
17250
17260
17261
17262
17263
17264
17266
17270
17271
17272
17273
17274
17276
17280
17281
17282
17283
17284
17286
17311
17312
17313
17314
17315
17340
17999
19000
19001
19020
19100
19101
19102
19103
19105
19110
19112
19120
19125
19126
19260
19296
19297
19298
19300
19301
19302



                 Page 7
        Surgery (triggers bundling)


19303
19304
19307
19316
19318
19328
19330
19340
19342
19350
19355
19357
19366
19370
19371
19380
19396
19499
20000
20005
20100
20101
20102
20103
20150
20200
20205
20206
20220
20225
20240
20245
20250
20251
20500
20520
20525
20526
20550
20551
20552
20553
20555
20600
20605
20610
20612
20615
20650
20660
20662
20663
20670
20680
20690



                 Page 8
        Surgery (triggers bundling)


20692
20693
20694
20696
20697
20822
20900
20902
20910
20912
20920
20922
20924
20926
20950
20972
20973
20982
20999
21010
21011
21012
21013
21014
21015
21016
21025
21026
21029
21030
21031
21032
21034
21040
21044
21046
21047
21048
21049
21050
21060
21070
21073
21076
21077
21079
21080
21081
21082
21083
21084
21085
21086
21087
21088



                 Page 9
        Surgery (triggers bundling)


21089
21100
21110
21120
21121
21122
21123
21125
21127
21137
21138
21139
21150
21172
21175
21181
21195
21198
21199
21206
21208
21209
21210
21215
21230
21235
21240
21242
21243
21244
21245
21246
21248
21249
21260
21261
21263
21267
21270
21275
21280
21282
21295
21296
21299
21310
21315
21320
21325
21330
21335
21336
21337
21338
21339



                 Page 10
        Surgery (triggers bundling)


21340
21345
21355
21356
21386
21387
21390
21400
21401
21406
21407
21408
21421
21440
21445
21450
21451
21452
21453
21454
21461
21462
21465
21470
21480
21485
21490
21495
21497
21499
21501
21502
21550
21552
21554
21555
21556
21557
21558
21600
21610
21685
21700
21720
21725
21742
21743
21800
21805
21820
21899
21920
21925
21930
21931



                 Page 11
        Surgery (triggers bundling)


21932
21933
21935
21936
22100
22101
22102
22103
22222
22305
22310
22315
22505
22520
22521
22522
22523
22524
22525
22612
22614
22899
22900
22901
22902
22903
22904
22905
22999
23000
23020
23030
23031
23035
23040
23044
23065
23066
23071
23073
23075
23076
23077
23078
23100
23101
23105
23106
23107
23120
23125
23130
23140
23145
23146



                 Page 12
        Surgery (triggers bundling)


23150
23155
23156
23170
23172
23174
23180
23182
23184
23190
23195
23330
23331
23395
23397
23400
23405
23406
23410
23412
23415
23420
23430
23440
23450
23455
23460
23462
23465
23466
23470
23480
23485
23490
23491
23500
23505
23515
23520
23525
23530
23532
23540
23545
23550
23552
23570
23575
23585
23600
23605
23615
23616
23620
23625



                 Page 13
        Surgery (triggers bundling)


23630
23650
23655
23660
23665
23670
23675
23680
23700
23800
23802
23921
23929
23930
23931
23935
24000
24006
24065
24066
24071
24073
24075
24076
24077
24079
24100
24101
24102
24105
24110
24115
24116
24120
24125
24126
24130
24134
24136
24138
24140
24145
24147
24149
24150
24152
24155
24160
24164
24200
24201
24300
24301
24305
24310



                 Page 14
        Surgery (triggers bundling)


24320
24330
24331
24332
24340
24341
24342
24343
24344
24345
24346
24357
24358
24359
24360
24361
24362
24363
24365
24366
24400
24410
24430
24435
24470
24495
24498
24500
24505
24515
24516
24530
24535
24538
24545
24546
24560
24565
24566
24575
24576
24577
24579
24582
24586
24587
24600
24605
24615
24620
24635
24640
24650
24655
24665



                 Page 15
        Surgery (triggers bundling)


24666
24670
24675
24685
24800
24802
24925
24935
24999
25000
25001
25020
25023
25024
25025
25028
25031
25035
25040
25065
25066
25071
25073
25075
25076
25077
25078
25085
25100
25101
25105
25107
25109
25110
25111
25112
25115
25116
25118
25119
25120
25125
25126
25130
25135
25136
25145
25150
25151
25170
25210
25215
25230
25240
25248



                 Page 16
        Surgery (triggers bundling)


25250
25251
25259
25260
25263
25265
25270
25272
25274
25275
25280
25290
25295
25300
25301
25310
25312
25315
25316
25320
25332
25335
25337
25350
25355
25360
25365
25370
25375
25390
25391
25392
25393
25394
25400
25405
25415
25420
25425
25426
25430
25431
25440
25441
25442
25443
25444
25445
25446
25447
25449
25450
25455
25490
25491



                 Page 17
        Surgery (triggers bundling)


25492
25500
25505
25515
25520
25525
25526
25530
25535
25545
25560
25565
25574
25575
25600
25605
25606
25607
25608
25609
25622
25624
25628
25630
25635
25645
25650
25651
25652
25660
25670
25671
25675
25676
25680
25685
25690
25695
25800
25805
25810
25820
25825
25830
25907
25922
25929
25999
26010
26011
26020
26025
26030
26034
26035



                 Page 18
        Surgery (triggers bundling)


26037
26040
26045
26055
26060
26070
26075
26080
26100
26105
26110
26111
26113
26115
26116
26117
26118
26121
26123
26125
26130
26135
26140
26145
26160
26170
26180
26185
26200
26205
26210
26215
26230
26235
26236
26250
26260
26262
26320
26340
26350
26352
26356
26357
26358
26370
26372
26373
26390
26392
26410
26412
26415
26416
26418



                 Page 19
        Surgery (triggers bundling)


26420
26426
26428
26432
26433
26434
26437
26440
26442
26445
26449
26450
26455
26460
26471
26474
26476
26477
26478
26479
26480
26483
26485
26489
26490
26492
26494
26496
26497
26498
26499
26500
26502
26508
26510
26516
26517
26518
26520
26525
26530
26531
26535
26536
26540
26541
26542
26545
26546
26548
26550
26555
26560
26561
26562



                 Page 20
        Surgery (triggers bundling)


26565
26567
26568
26580
26587
26590
26591
26593
26596
26600
26605
26607
26608
26615
26641
26645
26650
26665
26670
26675
26676
26685
26686
26700
26705
26706
26715
26720
26725
26727
26735
26740
26742
26746
26750
26755
26756
26765
26770
26775
26776
26785
26820
26841
26842
26843
26844
26850
26852
26860
26861
26862
26863
26910
26951



                 Page 21
        Surgery (triggers bundling)


26952
26989
26990
26991
27000
27001
27003
27027
27033
27035
27040
27041
27043
27045
27047
27048
27049
27050
27052
27057
27059
27060
27062
27065
27066
27067
27080
27086
27087
27097
27098
27100
27105
27110
27111
27193
27194
27200
27202
27220
27230
27235
27238
27246
27250
27252
27256
27257
27265
27266
27267
27275
27299
27301
27305



                 Page 22
        Surgery (triggers bundling)


27306
27307
27310
27323
27324
27325
27326
27327
27328
27329
27330
27331
27332
27333
27334
27335
27337
27339
27340
27345
27347
27350
27355
27356
27357
27358
27360
27364
27372
27380
27381
27385
27386
27390
27391
27392
27393
27394
27395
27396
27397
27400
27403
27405
27407
27409
27412
27415
27416
27418
27420
27422
27424
27425
27427



                 Page 23
        Surgery (triggers bundling)


27428
27429
27430
27435
27437
27438
27440
27441
27442
27443
27446
27475
27479
27496
27497
27498
27499
27500
27501
27502
27503
27508
27509
27510
27516
27517
27520
27524
27530
27532
27538
27550
27552
27560
27562
27566
27570
27594
27599
27600
27601
27602
27603
27604
27605
27606
27607
27610
27612
27613
27614
27615
27616
27618
27619



                 Page 24
        Surgery (triggers bundling)


27620
27625
27626
27630
27632
27634
27635
27637
27638
27640
27641
27647
27650
27652
27654
27656
27658
27659
27664
27665
27675
27676
27680
27681
27685
27686
27687
27690
27691
27692
27695
27696
27698
27700
27704
27705
27707
27709
27730
27732
27734
27740
27742
27745
27750
27752
27756
27758
27759
27760
27762
27766
27767
27768
27769



                 Page 25
        Surgery (triggers bundling)


27780
27781
27784
27786
27788
27792
27808
27810
27814
27816
27818
27822
27823
27824
27825
27826
27827
27828
27829
27830
27831
27832
27840
27842
27846
27848
27860
27870
27871
27884
27889
27892
27893
27894
27899
28001
28002
28003
28005
28008
28010
28011
28020
28022
28024
28035
28039
28041
28043
28045
28046
28047
28050
28052
28054



                 Page 26
        Surgery (triggers bundling)


28055
28060
28062
28070
28072
28080
28086
28088
28090
28092
28100
28102
28103
28104
28106
28107
28108
28110
28111
28112
28113
28114
28116
28118
28119
28120
28122
28124
28126
28130
28140
28150
28153
28160
28171
28173
28175
28190
28192
28193
28200
28202
28208
28210
28220
28222
28225
28226
28230
28232
28234
28238
28240
28250
28260



                 Page 27
        Surgery (triggers bundling)


28261
28262
28264
28270
28272
28280
28285
28286
28288
28289
28290
28292
28293
28294
28296
28297
28298
28299
28300
28302
28304
28305
28306
28307
28308
28309
28310
28312
28313
28315
28320
28322
28340
28341
28344
28345
28360
28400
28405
28406
28415
28420
28430
28435
28436
28445
28446
28450
28455
28456
28465
28470
28475
28476
28485



                 Page 28
        Surgery (triggers bundling)


28490
28495
28496
28505
28510
28515
28525
28530
28531
28540
28545
28546
28555
28570
28575
28576
28585
28600
28605
28606
28615
28630
28635
28636
28645
28660
28665
28666
28675
28705
28715
28725
28730
28735
28737
28740
28750
28755
28760
28810
28820
28825
28890
28899
29000
29010
29015
29020
29025
29035
29040
29044
29046
29049
29055



                 Page 29
        Surgery (triggers bundling)


29058
29065
29075
29085
29086
29105
29125
29126
29130
29131
29200
29240
29260
29280
29305
29325
29345
29355
29358
29365
29405
29425
29435
29440
29445
29450
29505
29515
29520
29530
29540
29550
29580
29581
29590
29700
29705
29710
29715
29720
29730
29740
29750
29799
29800
29804
29805
29806
29807
29819
29820
29821
29822
29823
29824



                 Page 30
        Surgery (triggers bundling)


29825
29826
29827
29828
29830
29834
29835
29836
29837
29838
29840
29843
29844
29845
29846
29847
29848
29850
29851
29855
29856
29860
29861
29862
29863
29866
29867
29868
29870
29871
29873
29874
29875
29876
29877
29879
29880
29881
29882
29883
29884
29885
29886
29887
29888
29889
29891
29892
29893
29894
29895
29897
29898
29899
29900



                 Page 31
        Surgery (triggers bundling)


29901
29902
29904
29905
29906
29907
29914
29915
29916
29999
30000
30020
30100
30110
30115
30117
30118
30120
30124
30125
30130
30140
30150
30160
30200
30210
30220
30310
30320
30400
30410
30420
30430
30435
30450
30460
30462
30465
30520
30540
30545
30560
30580
30600
30620
30630
30801
30802
30901
30903
30905
30906
30915
30920
30930



                 Page 32
        Surgery (triggers bundling)


30999
31000
31002
31020
31030
31032
31040
31050
31051
31070
31075
31080
31081
31084
31085
31086
31087
31090
31200
31201
31205
31231
31233
31235
31237
31238
31239
31240
31254
31255
31256
31267
31276
31287
31288
31292
31293
31294
31295
31296
31297
31299
31300
31320
31400
31420
31500
31502
31505
31510
31511
31512
31513
31515
31520



                 Page 33
        Surgery (triggers bundling)


31525
31526
31527
31528
31529
31530
31531
31535
31536
31540
31541
31545
31546
31560
31561
31570
31571
31575
31576
31577
31578
31579
31580
31582
31588
31590
31595
31599
31600
31601
31603
31605
31610
31611
31612
31613
31614
31615
31622
31623
31624
31625
31626
31628
31629
31630
31631
31632
31633
31634
31635
31636
31637
31638
31640



                 Page 34
        Surgery (triggers bundling)


31641
31643
31645
31646
31656
31717
31720
31730
31750
31755
31785
31820
31825
31830
31899
32201
32400
32405
32420
32421
32422
32550
32551
32552
32560
32561
32562
32601
32602
32603
32604
32605
32606
32960
32999
33010
33011
33206
33207
33208
33210
33211
33212
33213
33214
33215
33216
33217
33218
33220
33222
33223
33224
33225
33226



                 Page 35
        Surgery (triggers bundling)


33233
33234
33235
33241
33244
33282
33284
33999
34101
34111
34201
34203
34421
34471
34490
34501
34510
34520
34530
35011
35180
35184
35188
35190
35201
35206
35207
35226
35231
35236
35256
35261
35266
35286
35321
35458
35459
35460
35470
35471
35472
35473
35474
35475
35476
35484
35485
35490
35491
35492
35493
35494
35495
35500
35685



                 Page 36
        Surgery (triggers bundling)


35686
35761
35860
35875
35876
35879
35881
35883
35884
35903
36147
36260
36261
36262
36430
36440
36450
36455
36460
36468
36469
36470
36471
36475
36476
36478
36479
36511
36512
36513
36514
36515
36516
36522
36555
36556
36557
36558
36560
36561
36563
36565
36566
36568
36569
36570
36571
36575
36576
36578
36580
36581
36582
36583
36584



                 Page 37
        Surgery (triggers bundling)


36585
36589
36590
36593
36595
36596
36597
36640
36680
36800
36810
36815
36818
36819
36820
36821
36825
36830
36831
36832
36833
36835
36838
36860
36861
36870
37183
37184
37185
37186
37187
37188
37195
37200
37201
37202
37203
37204
37205
37206
37207
37208
37209
37210
37220
37221
37222
37223
37224
37225
37226
37227
37228
37229
37230



                 Page 38
        Surgery (triggers bundling)


37231
37232
37233
37234
37235
37500
37501
37565
37600
37605
37606
37607
37609
37615
37620
37650
37700
37718
37722
37735
37760
37761
37765
37766
37780
37785
37790
38120
38129
38206
38220
38221
38230
38240
38241
38242
38300
38305
38308
38500
38505
38510
38520
38525
38530
38542
38550
38555
38570
38571
38572
38589
38700
38720
38740



                 Page 39
        Surgery (triggers bundling)


38745
38760
38999
39400
40490
40500
40510
40520
40525
40527
40530
40650
40652
40654
40700
40701
40702
40720
40761
40799
40800
40801
40805
40806
40808
40810
40812
40814
40816
40818
40819
40820
40830
40831
40840
40842
40843
40844
40845
40899
41000
41005
41006
41007
41008
41009
41010
41015
41016
41017
41018
41019
41100
41105
41108



                 Page 40
        Surgery (triggers bundling)


41110
41112
41113
41114
41115
41116
41120
41250
41251
41252
41500
41510
41512
41520
41530
41599
41800
41805
41806
41820
41821
41822
41823
41825
41826
41827
41828
41830
41850
41870
41872
41874
41899
42000
42100
42104
42106
42107
42120
42140
42145
42160
42180
42182
42200
42205
42210
42215
42220
42225
42226
42227
42235
42260
42280



                 Page 41
        Surgery (triggers bundling)


42281
42299
42300
42305
42310
42320
42330
42335
42340
42400
42405
42408
42409
42410
42415
42420
42425
42440
42450
42500
42505
42507
42508
42509
42510
42600
42650
42660
42665
42699
42700
42720
42725
42800
42802
42804
42806
42808
42810
42815
42820
42821
42825
42826
42830
42831
42835
42836
42842
42844
42860
42870
42890
42892
42900



                 Page 42
        Surgery (triggers bundling)


42950
42955
42960
42962
42970
42972
42999
43020
43030
43130
43200
43201
43202
43204
43205
43215
43216
43217
43219
43220
43226
43227
43228
43231
43232
43234
43235
43236
43237
43238
43239
43240
43241
43242
43243
43244
43245
43246
43247
43248
43249
43250
43251
43255
43256
43257
43258
43259
43260
43261
43262
43263
43264
43265
43267



                 Page 43
        Surgery (triggers bundling)


43268
43269
43271
43272
43273
43280
43289
43420
43450
43453
43456
43458
43499
43510
43600
43648
43651
43652
43653
43659
43755
43760
43761
43830
43831
43870
43886
43887
43888
43999
44100
44180
44186
44206
44207
44208
44213
44238
44312
44340
44360
44361
44363
44364
44365
44366
44369
44370
44372
44373
44376
44377
44378
44379
44380



                 Page 44
        Surgery (triggers bundling)


44382
44383
44385
44386
44388
44389
44390
44391
44392
44393
44394
44397
44500
44799
44901
44970
44979
45000
45005
45020
45100
45108
45150
45160
45171
45172
45190
45300
45303
45305
45307
45308
45309
45315
45317
45320
45321
45327
45330
45331
45332
45333
45334
45335
45337
45338
45339
45340
45341
45342
45345
45355
45378
45379
45380



                 Page 45
        Surgery (triggers bundling)


45381
45382
45383
45384
45385
45386
45387
45391
45392
45499
45500
45505
45520
45541
45560
45900
45905
45910
45915
45990
45999
46020
46030
46040
46045
46050
46060
46070
46080
46083
46200
46220
46221
46230
46250
46255
46257
46258
46260
46261
46262
46270
46275
46280
46285
46288
46320
46500
46604
46606
46608
46610
46611
46612
46614



                 Page 46
        Surgery (triggers bundling)


46615
46700
46706
46707
46750
46753
46754
46760
46761
46762
46900
46910
46916
46917
46922
46924
46930
46940
46942
46945
46946
46947
46999
47000
47011
47370
47371
47379
47382
47399
47490
47510
47511
47525
47530
47552
47553
47554
47555
47556
47560
47561
47562
47563
47564
47579
47630
47999
48102
48511
48999
49021
49041
49061
49080



                 Page 47
        Surgery (triggers bundling)


49081
49180
49250
49320
49321
49322
49323
49324
49325
49326
49327
49329
49402
49418
49419
49420
49421
49422
49423
49426
49429
49435
49436
49440
49441
49442
49446
49450
49451
49452
49460
49491
49492
49495
49496
49500
49501
49505
49507
49520
49521
49525
49540
49550
49553
49555
49557
49560
49561
49565
49566
49568
49570
49572
49580



                 Page 48
        Surgery (triggers bundling)


49582
49585
49587
49590
49600
49650
49651
49652
49653
49654
49655
49656
49657
49659
49999
50020
50021
50080
50081
50200
50382
50384
50385
50386
50387
50389
50390
50391
50392
50393
50395
50396
50398
50541
50542
50543
50544
50549
50551
50553
50555
50557
50561
50562
50570
50572
50574
50575
50576
50590
50592
50593
50686
50688
50727



                 Page 49
        Surgery (triggers bundling)


50945
50947
50948
50949
50951
50953
50955
50957
50961
50970
50972
50974
50976
50980
51020
51030
51040
51045
51050
51065
51080
51100
51101
51102
51500
51520
51700
51703
51705
51710
51715
51720
51725
51726
51727
51728
51729
51736
51741
51784
51785
51792
51797
51845
51860
51880
51990
51992
51999
52000
52001
52005
52007
52010
52204



                 Page 50
        Surgery (triggers bundling)


52214
52224
52234
52235
52240
52250
52260
52265
52270
52275
52276
52277
52281
52282
52283
52285
52290
52300
52301
52305
52310
52315
52317
52318
52320
52325
52327
52330
52332
52334
52341
52342
52343
52344
52345
52346
52351
52352
52353
52354
52355
52400
52402
52450
52500
52601
52630
52640
52647
52648
52649
52700
53000
53010
53020



                 Page 51
        Surgery (triggers bundling)


53025
53040
53060
53080
53085
53200
53210
53215
53220
53230
53235
53240
53250
53260
53265
53270
53275
53400
53405
53410
53420
53425
53430
53431
53440
53442
53444
53445
53446
53447
53449
53450
53460
53500
53502
53505
53510
53515
53520
53600
53601
53605
53620
53621
53660
53661
53665
53850
53852
53855
53899
54000
54001
54015
54050



                 Page 52
        Surgery (triggers bundling)


54055
54056
54057
54060
54065
54100
54105
54110
54111
54112
54115
54120
54161
54162
54163
54164
54200
54205
54220
54231
54235
54240
54250
54300
54304
54308
54312
54316
54318
54322
54324
54326
54328
54332
54336
54340
54344
54348
54352
54360
54380
54385
54406
54408
54410
54415
54416
54420
54440
54450
54500
54505
54512
54520
54522



                 Page 53
        Surgery (triggers bundling)


54530
54535
54550
54560
54600
54620
54640
54660
54670
54680
54690
54692
54699
54700
54800
54830
54840
54860
54861
54865
54900
54901
55000
55040
55041
55060
55100
55110
55120
55150
55175
55180
55200
55250
55450
55500
55520
55530
55535
55540
55550
55559
55600
55680
55700
55705
55706
55720
55725
55860
55870
55873
55899
55920
56405



                 Page 54
        Surgery (triggers bundling)


56420
56440
56441
56442
56501
56515
56605
56606
56620
56625
56700
56740
56800
56805
56810
56820
56821
57000
57010
57020
57022
57023
57061
57065
57100
57105
57106
57107
57109
57120
57130
57135
57150
57155
57156
57160
57170
57180
57200
57210
57220
57230
57240
57250
57260
57265
57267
57268
57284
57285
57287
57288
57289
57291
57295



                 Page 55
        Surgery (triggers bundling)


57300
57310
57320
57330
57400
57410
57415
57420
57421
57423
57425
57426
57452
57454
57455
57456
57460
57461
57500
57505
57510
57511
57513
57520
57522
57530
57550
57555
57556
57558
57700
57720
57800
58100
58120
58145
58301
58346
58353
58356
58541
58542
58543
58544
58545
58546
58550
58552
58553
58554
58555
58558
58559
58560
58561



                 Page 56
        Surgery (triggers bundling)


58562
58563
58565
58570
58571
58572
58573
58578
58579
58600
58615
58660
58661
58662
58670
58671
58679
58800
58820
58823
58900
58920
58925
58999
59150
59151
59160
59300
59320
59409
59412
59414
59612
59812
59820
59821
59840
59841
59870
59871
59897
59898
59899
60000
60100
60200
60210
60212
60220
60225
60240
60252
60260
60280
60281



                 Page 57
        Surgery (triggers bundling)


60300
60500
60512
60659
60699
61000
61001
61020
61026
61050
61055
61070
61215
61330
61334
61623
61626
61790
61791
61880
61885
61886
61888
62194
62225
62230
62252
62263
62264
62267
62268
62269
62270
62272
62273
62280
62281
62282
62287
62292
62294
62310
62311
62318
62319
62350
62351
62355
62360
62361
62362
62365
62367
62368
63001



                 Page 58
        Surgery (triggers bundling)


63003
63005
63011
63012
63015
63016
63017
63020
63030
63035
63040
63042
63045
63046
63047
63048
63055
63056
63057
63064
63066
63075
63600
63610
63615
63650
63655
63661
63662
63663
63664
63685
63688
63741
63744
63746
64400
64402
64405
64408
64410
64412
64413
64415
64416
64417
64418
64420
64421
64425
64430
64435
64445
64446
64447



                 Page 59
        Surgery (triggers bundling)


64448
64449
64450
64455
64479
64480
64483
64484
64490
64491
64492
64493
64494
64495
64505
64508
64510
64517
64520
64530
64553
64555
64560
64561
64565
64566
64568
64569
64570
64573
64575
64577
64580
64581
64585
64590
64595
64600
64605
64610
64611
64612
64613
64614
64620
64622
64623
64626
64627
64630
64632
64640
64650
64653
64680



                 Page 60
        Surgery (triggers bundling)


64681
64702
64704
64708
64712
64713
64714
64716
64718
64719
64721
64722
64726
64727
64732
64734
64736
64738
64740
64742
64744
64746
64761
64763
64766
64771
64772
64774
64776
64778
64782
64783
64784
64786
64787
64788
64790
64792
64795
64802
64820
64821
64822
64823
64831
64832
64834
64835
64836
64837
64840
64856
64857
64858
64859



                 Page 61
        Surgery (triggers bundling)


64861
64862
64864
64865
64870
64872
64874
64876
64885
64886
64890
64891
64892
64893
64895
64896
64897
64898
64901
64902
64905
64907
64910
64911
64999
65091
65093
65101
65103
65105
65110
65112
65114
65125
65130
65135
65140
65150
65155
65175
65205
65210
65220
65222
65235
65260
65265
65270
65272
65275
65280
65285
65286
65290
65400



                 Page 62
        Surgery (triggers bundling)


65410
65420
65426
65430
65435
65436
65450
65600
65710
65730
65750
65755
65756
65770
65772
65775
65778
65779
65780
65781
65782
65800
65805
65810
65815
65820
65850
65855
65860
65865
65870
65875
65880
65900
65920
65930
66020
66030
66130
66150
66155
66160
66165
66170
66172
66174
66175
66180
66185
66220
66225
66250
66500
66505
66600



                 Page 63
        Surgery (triggers bundling)


66605
66625
66630
66635
66680
66682
66700
66710
66711
66720
66740
66761
66762
66770
66820
66821
66825
66830
66840
66850
66852
66920
66930
66940
66982
66983
66984
66985
66986
66999
67005
67010
67015
67025
67027
67028
67030
67031
67036
67039
67040
67041
67042
67043
67101
67105
67107
67108
67110
67112
67113
67115
67120
67121
67141



                 Page 64
        Surgery (triggers bundling)


67145
67208
67210
67218
67220
67221
67225
67227
67228
67229
67250
67255
67299
67311
67312
67314
67316
67318
67320
67331
67332
67334
67335
67340
67343
67345
67346
67399
67400
67405
67412
67413
67414
67415
67420
67430
67440
67445
67450
67500
67505
67515
67550
67560
67570
67599
67700
67710
67715
67800
67801
67805
67808
67810
67820



                 Page 65
        Surgery (triggers bundling)


67825
67830
67835
67840
67850
67875
67880
67882
67900
67901
67902
67903
67904
67906
67908
67909
67911
67912
67914
67915
67916
67917
67921
67922
67923
67924
67930
67935
67938
67950
67961
67966
67971
67973
67974
67975
67999
68020
68040
68100
68110
68115
68130
68135
68200
68320
68325
68326
68328
68330
68335
68340
68360
68362
68371



                 Page 66
        Surgery (triggers bundling)


68399
68400
68420
68440
68500
68505
68510
68520
68525
68530
68540
68550
68700
68705
68720
68745
68750
68760
68761
68770
68801
68810
68811
68815
68816
68840
68899
69000
69005
69020
69100
69105
69110
69120
69140
69145
69150
69220
69222
69300
69310
69320
69399
69400
69401
69405
69420
69421
69424
69433
69436
69440
69450
69501
69502



                 Page 67
        Surgery (triggers bundling)


69505
69511
69530
69540
69550
69552
69601
69602
69603
69604
69605
69610
69620
69631
69632
69633
69635
69636
69637
69641
69642
69643
69644
69645
69646
69650
69660
69661
69662
69666
69667
69670
69676
69700
69711
69714
69715
69717
69718
69720
69725
69740
69745
69799
69801
69802
69805
69806
69820
69840
69905
69910
69915
69930
69949



                 Page 68
        Surgery (triggers bundling)


69955
69960
69979
75572
75573
75574
76881
76882
76936
77785
77786
77787
78451
78452
78453
78454
91110
91117
91120
91122
92018
92019
92020
92060
92065
92081
92082
92083
92120
92130
92132
92133
92134
92135
92136
92140
92225
92226
92230
92235
92240
92250
92260
92265
92270
92275
92283
92284
92285
92286
92287
92499
92502
92511
92950



                 Page 69
        Surgery (triggers bundling)


92953
92973
92974
92977
92980
92981
92982
92984
92986
92987
92990
92995
92996
92997
92998
93229
93279
93280
93281
93282
93283
93284
93285
93288
93289
93290
93291
93292
93293
93296
93299
93306
93351
93451
93452
93453
93454
93455
93456
93457
93458
93459
93460
93461
93462
93501
93503
93505
93508
93510
93511
93514
93524
93526
93527



                 Page 70
        Surgery (triggers bundling)


93528
93529
93530
93531
93532
93533
93580
93581
93600
93602
93603
93610
93612
93615
93616
93618
93750
94060
95803
95905
95990
95991
96446
96567
96570
96571
96920
96921
96922
96999
99170
99291
0234T
0236T
0237T
0238T
0245T
0246T
0247T
0248T
0249T
0251T
0252T
0253T
C8929
C8930
G0105
G0117
G0118
G0121
G0127
G0166
G0186
G0247
G0260



                 Page 71
        Surgery (triggers bundling)


G0290
G0291
G0340
C9729




                 Page 72
                                   Surgery (triggers bundling)


DESCRIPTION
10021 - FINE NEEDLE ASPIRATION; WITHOUT IMAGING GUIDANCE
10022 - FINE NEEDLE ASPIRATION; WITH IMAGING GUIDANCE
10060 - INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS,
10061 - INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS,
10080 - INCISION AND DRAINAGE OF PILONIDAL CYST; SIMPLE
10081 - INCISION AND DRAINAGE OF PILONIDAL CYST; COMPLICATED
10120 - INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES; SIMPLE
10121 - INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES; COMPLICATED
10140 - INCISION AND DRAINAGE OF HEMATOMA, SEROMA OR FLUID COLLECTION
10160 - PUNCTURE ASPIRATION OF ABSCESS, HEMATOMA, BULLA, OR CYST
10180 - INCISION AND DRAINAGE, COMPLEX, POSTOPERATIVE WOUND INFECTION
11000 - DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; UP TO 10% OF BODY SURFACE
11001 - DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; EACH ADDITIONAL 10% OF THE
11010 - DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL ASSOCIATED WITH OPEN
11011 - DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL ASSOCIATED WITH OPEN
11012 - DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL ASSOCIATED WITH OPEN
11040 - DEBRIDEMENT; SKIN, PARTIAL THICKNESS
11041 - DEBRIDEMENT; SKIN, FULL THICKNESS
11042 - DEBRIDEMENT; SKIN, AND SUBCUTANEOUS TISSUE
11043 - DEBRIDEMENT; SKIN, SUBCUTANEOUS TISSUE, AND MUSCLE
11044 - DEBRIDEMENT; SKIN, SUBCUTANEOUS TISSUE, MUSCLE, AND BONE
11045 - Debridement, subcutaneous tissue (includes epidermis and dermis, if performed);
11046 - Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous
11047 - Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/o
11055 - PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); SINGLE L
11056 - PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); TWO TO
11057 - PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); MORE
11100 - BIOPSY OF SKIN, SUBCUTANEOUS TISSUE AND/OR MUCOUS MEMBRANE (INCLUDING SIMPLE CLO
11101 - BIOPSY OF SKIN, SUBCUTANEOUS TISSUE AND/OR MUCOUS MEMBRANE (INCLUDING SIMPLE
11200 - REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; UP TO AND INCLUDIN
11201 - REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; EACH ADDITIONAL 10
11300 - SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; LESIO
11301 - SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS;
11302 - SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS;
11303 - SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS;
11305 - SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, NECK, HANDS, FEET,
11306 - SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, NECK, HANDS, FEET,
11307 - SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, NECK, HANDS, FEET,
11308 - SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, NECK, HANDS, FEET,
11310 - SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS,
11311 - SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS,
11312 - SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS,
11313 - SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS,
11400 - EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWH
11401 - EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED
11402 - EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED
11403 - EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED
11404 - EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED
11406 - EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED
11420 - EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED
11421 - EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED
11422 - EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED
11423 - EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED
11424 - EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED



                                            Page 73
                                       Surgery (triggers bundling)


11426   - EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED
11440   - EXCISION, OTHER BENIGN LESION INCLUDING MARGINS (UNLESS LISTED ELSEWHERE),
11441   - EXCISION, OTHER BENIGN LESION INCLUDING MARGINS (UNLESS LISTED ELSEWHERE),
11442   - EXCISION, OTHER BENIGN LESION INCLUDING MARGINS (UNLESS LISTED ELSEWHERE),
11443   - EXCISION, OTHER BENIGN LESION INCLUDING MARGINS (UNLESS LISTED ELSEWHERE),
11444   - EXCISION, OTHER BENIGN LESION INCLUDING MARGINS (UNLESS LISTED ELSEWHERE),
11446   - EXCISION, OTHER BENIGN LESION INCLUDING MARGINS (UNLESS LISTED ELSEWHERE),
11450   - EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, AXILLARY; WITH
11451   - EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, AXILLARY; WITH
11462   - EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, INGUINAL; WITH
11463   - EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, INGUINAL; WITH
11470   - EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, PERIANAL, PERINEAL,
11471   - EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, PERIANAL, PERINEAL,
11600   - EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAM
11601   - EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED
11602   - EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED
11603   - EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED
11604   - EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED
11606   - EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED
11620   - EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET,
11621   - EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET,
11622   - EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET,
11623   - EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET,
11624   - EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET,
11626   - EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET,
11640   - EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS;
11641   - EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS;
11642   - EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS;
11643   - EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS;
11644   - EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS;
11646   - EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS;
11719   - TRIMMING OF NONDYSTROPHIC NAILS, ANY NUMBER
11720   - DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); ONE TO FIVE
11721   - DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); SIX OR MORE
11730   - AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE
11732   - AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; EACH ADDITIONAL NAIL PLATE
11740   - EVACUATION OF SUBUNGUAL HEMATOMA
11750   - EXCISION OF NAIL AND NAIL MATRIX, PARTIAL OR COMPLETE, (EG, INGROWN OR DEFORMED
11752   - EXCISION OF NAIL AND NAIL MATRIX, PARTIAL OR COMPLETE, (EG, INGROWN OR DEFORMED
11755   - BIOPSY OF NAIL UNIT (EG, PLATE, BED, MATRIX, HYPONYCHIUM, PROXIMAL AND LATERAL
11760   - REPAIR OF NAIL BED
11762   - RECONSTRUCTION OF NAIL BED WITH GRAFT
11765   - WEDGE EXCISION OF SKIN OF NAIL FOLD (EG, FOR INGROWN TOENAIL)
11770   - EXCISION OF PILONIDAL CYST OR SINUS; SIMPLE
11771   - EXCISION OF PILONIDAL CYST OR SINUS; EXTENSIVE
11772   - EXCISION OF PILONIDAL CYST OR SINUS; COMPLICATED
11900   - INJECTION, INTRALESIONAL; UP TO AND INCLUDING SEVEN LESIONS
11901   - INJECTION, INTRALESIONAL; MORE THAN SEVEN LESIONS
11960   - INSERTION OF TISSUE EXPANDER(S) FOR OTHER THAN BREAST, INCLUDING SUBSEQUENT
11971   - REMOVAL OF TISSUE EXPANDER(S) WITHOUT INSERTION OF PROSTHESIS
11976   - REMOVAL, IMPLANTABLE CONTRACEPTIVE CAPSULES
12001   - SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA,
12002   - SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL
12004   - SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL
12005   - SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL



                                                Page 74
                                      Surgery (triggers bundling)


12006   - SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL
12007   - SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL
12011   - SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR
12013   - SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR
12014   - SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR
12015   - SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR
12016   - SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR
12017   - SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR
12018   - SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR
12020   - TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; SIMPLE CLOSURE
12021   - TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; WITH PACKING
12031   - REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/ OR EXTREMITIES (EXCLU
12032   - REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/ OR EXTREMITIES (EXCLU
12034   - REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/ OR EXTREMITIES (EXCLU
12035   - REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/ OR EXTREMITIES (EXCLU
12036   - REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/ OR EXTREMITIES (EXCLU
12037   - REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/ OR EXTREMITIES (EXCLU
12041   - REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 2.5
12042   - REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 2.6
12044   - REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 7.6
12045   - REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 12.
12046   - REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 20.
12047   - REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; OVE
12051   - REPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS ME
12052   - REPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS ME
12053   - REPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS ME
12054   - REPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS ME
12055   - REPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS ME
12056   - REPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS ME
12057   - REPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS ME
13100   - REPAIR, COMPLEX, TRUNK; 1.1 CM TO 2.5 CM
13101   - REPAIR, COMPLEX, TRUNK; 2.6 CM TO 7.5 CM
13102   - REPAIR, COMPLEX, TRUNK; EACH ADDITIONAL 5 CM OR LESS (LIST SEPARATELY IN
13120   - REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 1.1 CM TO 2.5 CM
13121   - REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 2.6 CM TO 7.5 CM
13122   - REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; EACH ADDITIONAL 5 CM OR LESS (LIST
13131   - REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS
13132   - REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS
13133   - REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS
13150   - REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 1.0 CM OR LESS
13151   - REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 1.1 CM TO 2.5 CM
13152   - REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 2.6 CM TO 7.5 CM
13153   - REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; EACH ADDITIONAL 5 CM OR LESS
13160   - SECONDARY CLOSURE OF SURGICAL WOUND OR DEHISCENCE, EXTENSIVE OR COMPLICATED
14000   - ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10 SQ CM OR LESS
14001   - ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10.1 SQ CM TO 30.0 SQ
14020   - ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS AND/OR LEGS; DEFECT 10
14021   - ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS AND/OR LEGS; DEFECT 10.1
14040   - ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK,
14041   - ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK,
14060   - ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS AND/OR LIPS;
14061   - ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS AND/OR LIPS;
14301   - Adjacent tissue transfer or rearrangement, any area: defect 30.1 sq cm to 60.0 s
14302   - Adjacent tissue transfer or rearrangement, any area; each additional 30.0 sq cm
14350   - FILLETED FINGER OR TOE FLAP, INCLUDING PREPARATION OF RECIPIENT SITE



                                               Page 75
                                      Surgery (triggers bundling)


15002   - SURGICAL PREPARATION OR CREATION OF RECIPIENT SITE BY EXCISION OF OPEN WOUNDS, B
15003   - SURGICAL PREPARATION OR CREATION OF RECIPIENT SITE BY EXCISION OF OPEN WOUNDS, B
15004   - SURGICAL PREPARATION OR CREATION OF RECIPIENT SITE BY EXCISION OF OPEN WOUNDS, B
15005   - SURGICAL PREPARATION OR CREATION OF RECIPIENT SITE BY EXCISION OF OPEN WOUNDS, B
15040   - HARVEST OF SKIN FOR TISSUE CULTURED SKIN AUTOGRAFT, 100 SQ CM OR LESS
15050   - PINCH GRAFT, SINGLE OR MULTIPLE, TO COVER SMALL ULCER, TIP OF DIGIT, OR OTHER
15100   - SPLIT-THICKNESS AUTOGRAFT, TRUNK, ARMS, LEGS; FIRST 100 SQ CM OR LESS, OR ONE PE
15101   - SPLIT GRAFT, TRUNK, ARMS, LEGS; EACH ADDITIONAL 100 SQ CM, OR EACH ADDITIONAL
15110   - EPIDERMAL AUTOGRAFT, TRUNK, ARMS, LEGS; FIRST 100 SQ CM OR LESS, OR ONE PERCENT
15111   - EPIDERMAL AUTOGRAFT, TRUNK, ARMS, LEGS; EACH ADDITIONAL 100 SQ CM, OR EACH ADDIT
15115   - EPIDERMAL AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA,
15116   - EPIDERMAL AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA,
15120   - SPLIT-THICKNESS AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENI
15121   - SPLIT GRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS,
15130   - DERMAL AUTOGRAFT, TRUNK, ARMS, LEGS; FIRST 100 SQ CM OR LESS, OR ONE PERCENT OF
15131   - DERMAL AUTOGRAFT, TRUNK, ARMS, LEGS; EACH ADDITIONAL 100 SQ CM, OR EACH ADDITION
15135   - DERMAL AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HA
15136   - DERMAL AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HA
15150   - TISSUE CULTURED EPIDERMAL AUTOGRAFT, TRUNK, ARMS, LEGS; FIRST 25 SQ CM OR LESS
15151   - TISSUE CULTURED EPIDERMAL AUTOGRAFT, TRUNK, ARMS, LEGS; ADDITIONAL 1 SQ CM TO 75
15152   - TISSUE CULTURED EPIDERMAL AUTOGRAFT, TRUNK, ARMS, LEGS; EACH ADDITIONAL 100 SQ C
15155   - TISSUE CULTURED EPIDERMAL AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, OR
15156   - TISSUE CULTURED EPIDERMAL AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, OR
15157   - TISSUE CULTURED EPIDERMAL AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, OR
15170   - ACELLULAR DERMAL REPLACEMENT, TRUNK, ARMS, LEGS; FIRST 100 SQ CM OR LESS, OR ONE
15171   - ACELLULAR DERMAL REPLACEMENT, TRUNK, ARMS, LEGS; EACH ADDITIONAL 100 SQ CM, OR E
15175   - ACELLULAR DERMAL REPLACEMENT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, G
15176   - ACELLULAR DERMAL REPLACEMENT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, G
15200   - FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, TRUNK; 20
15201   - FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, TRUNK; EACH
15220   - FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, SCALP,
15221   - FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, SCALP, ARMS,
15240   - FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, FOREHEAD,
15241   - FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, FOREHEAD, CH
15260   - FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, NOSE, EARS,
15261   - FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, NOSE, EARS,
15300   - ALLOGRAFT SKIN FOR TEMPORARY WOUND CLOSURE, TRUNK, ARMS, LEGS; FIRST 100 SQ CM O
15301   - ALLOGRAFT SKIN FOR TEMPORARY WOUND CLOSURE, TRUNK, ARMS, LEGS; EACH ADDITIONAL 1
15320   - ALLOGRAFT SKIN FOR TEMPORARY WOUND CLOSURE, FACE, SCALP, EYELIDS, MOUTH, NECK, E
15321   - ALLOGRAFT SKIN FOR TEMPORARY WOUND CLOSURE, FACE, SCALP, EYELIDS, MOUTH, NECK, E
15330   - ACELLULAR DERMAL ALLOGRAFT, TRUNK, ARMS, LEGS; FIRST 100 SQ CM OR LESS, OR ONE P
15331   - ACELLULAR DERMAL ALLOGRAFT, TRUNK, ARMS, LEGS; EACH ADDITIONAL 100 SQ CM, OR EAC
15335   - ACELLULAR DERMAL ALLOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GEN
15336   - ACELLULAR DERMAL ALLOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GEN
15340   - TISSUE CULTURED ALLOGENEIC SKIN SUBSTITUTE; FIRST 25 SQ CM OR LESS
15341   - TISSUE CULTURED ALLOGENEIC SKIN SUBSTITUTE; EACH ADDITIONAL 25 SQ CM, OR PART TH
15360   - TISSUE CULTURED ALLOGENEIC DERMAL SUBSTITUTE; TRUNK, ARMS, LEGS; FIRST 100 SQ CM
15361   - TISSUE CULTURED ALLOGENEIC DERMAL SUBSTITUTE; EACH ADDITIONAL 100 SQ CM, OR EACH
15365   - TISSUE CULTURED ALLOGENEIC DERMAL SUBSTITUTE, FACE, SCALP, EYELIDS, MOUTH, NECK,
15366   - TISSUE CULTURED ALLOGENEIC DERMAL SUBSTITUTE, FACE, SCALP, EYELIDS, MOUTH, NECK,
15400   - XENOGRAFT, SKIN (DERMAL), FOR TEMPORARY WOUND CLOSURE; TRUNK, ARMS, LEGS; FIRST
15401   - XENOGRAFT, SKIN (DERMAL), FOR TEMPORARY WOUND CLOSURE; EACH ADDITIONAL 100 SQ CM
15420   - XENOGRAFT SKIN (DERMAL), FOR TEMPORARY WOUND CLOSURE, FACE, SCALP, EYELIDS, MOUT
15421   - XENOGRAFT SKIN (DERMAL), FOR TEMPORARY WOUND CLOSURE, FACE, SCALP, EYELIDS, MOUT
15430   - ACELLULAR XENOGRAFT IMPLANT; FIRST 100 SQ CM OR LESS, OR ONE PERCENT OF BODY ARE



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                                      Surgery (triggers bundling)


15431   - ACELLULAR XENOGRAFT IMPLANT; EACH ADDITIONAL 100 SQ CM, OR EACH ADDITIONAL ONE P
15570   - FORMATION OF DIRECT OR TUBED PEDICLE, WITH OR WITHOUT TRANSFER; TRUNK
15572   - FORMATION OF DIRECT OR TUBED PEDICLE, WITH OR WITHOUT TRANSFER; SCALP, ARMS, OR
15574   - FORMATION OF DIRECT OR TUBED PEDICLE, WITH OR WITHOUT TRANSFER; FOREHEAD,
15576   - FORMATION OF DIRECT OR TUBED PEDICLE, WITH OR WITHOUT TRANSFER; EYELIDS, NOSE,
15600   - DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT TRUNK
15610   - DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT SCALP, ARMS, OR
15620   - DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT FOREHEAD, CHEEKS,
15630   - DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT EYELIDS, NOSE,
15650   - TRANSFER, INTERMEDIATE, OF ANY PEDICLE FLAP (EG, ABDOMEN TO WRIST, WALKING
15731   - FOREHEAD FLAP WITH PRESERVATION OF VASCULAR PEDICLE (EG, AXIAL PATTERN FLAP, PAR
15732   - MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; HEAD AND NECK (EG, TEMPORALIS,
15734   - MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; TRUNK
15736   - MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; UPPER EXTREMITY
15738   - MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; LOWER EXTREMITY
15740   - FLAP; ISLAND PEDICLE
15750   - FLAP; NEUROVASCULAR PEDICLE
15760   - GRAFT; COMPOSITE (EG, FULL THICKNESS OF EXTERNAL EAR OR NASAL ALA), INCLUDING
15770   - GRAFT; DERMA-FAT-FASCIA
15788   - CHEMICAL PEEL, FACIAL; EPIDERMAL
15789   - CHEMICAL PEEL, FACIAL; DERMAL
15792   - CHEMICAL PEEL, NONFACIAL; EPIDERMAL
15793   - CHEMICAL PEEL, NONFACIAL; DERMAL
15823   - BLEPHAROPLASTY, UPPER EYELID; WITH EXCESSIVE SKIN WEIGHTING DOWN LID
15830   - EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); ABDOMEN,
15840   - GRAFT FOR FACIAL NERVE PARALYSIS; FREE FASCIA GRAFT (INCLUDING OBTAINING FASCIA)
15841   - GRAFT FOR FACIAL NERVE PARALYSIS; FREE MUSCLE GRAFT (INCLUDING OBTAINING GRAFT)
15842   - GRAFT FOR FACIAL NERVE PARALYSIS; FREE MUSCLE FLAP BY MICROSURGICAL TECHNIQUE
15845   - GRAFT FOR FACIAL NERVE PARALYSIS; REGIONAL MUSCLE TRANSFER
15847   - EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY), ABDOMEN (
15850   - REMOVAL OF SUTURES UNDER ANESTHESIA (OTHER THAN LOCAL), SAME SURGEON
15851   - REMOVAL OF SUTURES UNDER ANESTHESIA (OTHER THAN LOCAL), OTHER SURGEON
15920   - EXCISION, COCCYGEAL PRESSURE ULCER, WITH COCCYGECTOMY; WITH PRIMARY SUTURE
15922   - EXCISION, COCCYGEAL PRESSURE ULCER, WITH COCCYGECTOMY; WITH FLAP CLOSURE
15931   - EXCISION, SACRAL PRESSURE ULCER, WITH PRIMARY SUTURE;
15933   - EXCISION, SACRAL PRESSURE ULCER, WITH PRIMARY SUTURE; WITH OSTECTOMY
15934   - EXCISION, SACRAL PRESSURE ULCER, WITH SKIN FLAP CLOSURE;
15935   - EXCISION, SACRAL PRESSURE ULCER, WITH SKIN FLAP CLOSURE; WITH OSTECTOMY
15936   - EXCISION, SACRAL PRESSURE ULCER, IN PREPARATION FOR MUSCLE OR MYOCUTANEOUS FLAP
15937   - EXCISION, SACRAL PRESSURE ULCER, IN PREPARATION FOR MUSCLE OR MYOCUTANEOUS FLAP
15940   - EXCISION, ISCHIAL PRESSURE ULCER, WITH PRIMARY SUTURE;
15941   - EXCISION, ISCHIAL PRESSURE ULCER, WITH PRIMARY SUTURE; WITH OSTECTOMY
15944   - EXCISION, ISCHIAL PRESSURE ULCER, WITH SKIN FLAP CLOSURE;
15945   - EXCISION, ISCHIAL PRESSURE ULCER, WITH SKIN FLAP CLOSURE; WITH OSTECTOMY
15946   - EXCISION, ISCHIAL PRESSURE ULCER, WITH OSTECTOMY, IN PREPARATION FOR MUSCLE OR
15950   - EXCISION, TROCHANTERIC PRESSURE ULCER, WITH PRIMARY SUTURE;
15951   - EXCISION, TROCHANTERIC PRESSURE ULCER, WITH PRIMARY SUTURE; WITH OSTECTOMY
15952   - EXCISION, TROCHANTERIC PRESSURE ULCER, WITH SKIN FLAP CLOSURE;
15953   - EXCISION, TROCHANTERIC PRESSURE ULCER, WITH SKIN FLAP CLOSURE; WITH OSTECTOMY
15956   - EXCISION, TROCHANTERIC PRESSURE ULCER, IN PREPARATION FOR MUSCLE OR
15958   - EXCISION, TROCHANTERIC PRESSURE ULCER, IN PREPARATION FOR MUSCLE OR
15999   - UNLISTED PROCEDURE, EXCISION PRESSURE ULCER
16000   - INITIAL TREATMENT, FIRST DEGREE BURN, WHEN NO MORE THAN LOCAL TREATMENT IS REQUI
16020   - DRESSINGS AND/OR DEBRIDEMENT OF PARTIAL-THICKNESS BURNS, INITIAL OR SUBSEQUENT;
16025   - DRESSINGS AND/OR DEBRIDEMENT OF PARTIAL-THICKNESS BURNS, INITIAL OR SUBSEQUENT;



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                                     Surgery (triggers bundling)


16030   - DRESSINGS AND/OR DEBRIDEMENT OF PARTIAL-THICKNESS BURNS, INITIAL OR SUBSEQUENT;
17000   - DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGI
17003   - DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY,
17004   - DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGI
17106   - DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, LASER TECHNIQUE);
17107   - DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, LASER TECHNIQUE);
17108   - DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, LASER TECHNIQUE);
17110   - DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGI
17111   - DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY,
17250   - CHEMICAL CAUTERIZATION OF GRANULATION TISSUE (PROUD FLESH, SINUS OR FISTULA)
17260   - DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, C
17261   - DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
17262   - DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
17263   - DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
17264   - DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
17266   - DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
17270   - DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
17271   - DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
17272   - DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
17273   - DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
17274   - DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
17276   - DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
17280   - DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
17281   - DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
17282   - DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
17283   - DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
17284   - DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
17286   - DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
17311   - MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCI
17312   - MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCI
17313   - MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCI
17314   - MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCI
17315   - MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCI
17340   - CRYOTHERAPY (CO2 SLUSH, LIQUID N2) FOR ACNE
17999   - UNLISTED PROCEDURE, SKIN, MUCOUS MEMBRANE AND SUBCUTANEOUS TISSUE
19000   - PUNCTURE ASPIRATION OF CYST OF BREAST;
19001   - PUNCTURE ASPIRATION OF CYST OF BREAST; EACH ADDITIONAL CYST (LIST SEPARATELY IN
19020   - MASTOTOMY WITH EXPLORATION OR DRAINAGE OF ABSCESS, DEEP
19100   - BIOPSY OF BREAST; PERCUTANEOUS, NEEDLE CORE, NOT USING IMAGING GUIDANCE (SEPARAT
19101   - BIOPSY OF BREAST; OPEN, INCISIONAL
19102   - BIOPSY OF BREAST; PERCUTANEOUS, NEEDLE CORE, USING IMAGING GUIDANCE
19103   - BIOPSY OF BREAST; PERCUTANEOUS, AUTOMATED VACUUM ASSISTED OR ROTATING BIOPSY
19105   - ABLATION, CRYOSURGICAL, OF FIBROADENOMA, INCLUDING ULTRASOUND GUIDANCE, EACH FIB
19110   - NIPPLE EXPLORATION, WITH OR WITHOUT EXCISION OF A SOLITARY LACTIFEROUS DUCT OR
19112   - EXCISION OF LACTIFEROUS DUCT FISTULA
19120   - EXCISION OF CYST, FIBROADENOMA, OR OTHER BENIGN OR MALIGNANT TUMOR, ABERRANT BRE
19125   - EXCISION OF BREAST LESION IDENTIFIED BY PREOPERATIVE PLACEMENT OF RADIOLOGICAL
19126   - EXCISION OF BREAST LESION IDENTIFIED BY PREOPERATIVE PLACEMENT OF RADIOLOGICAL
19260   - EXCISION OF CHEST WALL TUMOR INCLUDING RIBS
19296   - PLACEMENT OF RADIOTHERAPY AFTERLOADING EXPANDABLE CATHETER (SINGLE OR MULTICHANN
19297   - PLACEMENT OF RADIOTHERAPY AFTERLOADING EXPANDABLE CATHETER (SINGLE OR MULTICHANN
19298   - PLACEMENT OF RADIOTHERAPY AFTERLOADING BRACHYTHERAPY CATHETERS (MULTIPLE TUBE
19300   - MASTECTOMY FOR GYNECOMASTIA
19301   - MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY);
19302   - MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY);



                                              Page 78
                                     Surgery (triggers bundling)


19303   - MASTECTOMY, SIMPLE, COMPLETE
19304   - MASTECTOMY, SUBCUTANEOUS
19307   - MASTECTOMY, MODIFIED RADICAL, INCLUDING AXILLARY LYMPH NODES, WITH OR WITHOUT PE
19316   - MASTOPEXY
19318   - REDUCTION MAMMAPLASTY
19328   - REMOVAL OF INTACT MAMMARY IMPLANT
19330   - REMOVAL OF MAMMARY IMPLANT MATERIAL
19340   - IMMEDIATE INSERTION OF BREAST PROSTHESIS FOLLOWING MASTOPEXY, MASTECTOMY OR IN
19342   - DELAYED INSERTION OF BREAST PROSTHESIS FOLLOWING MASTOPEXY, MASTECTOMY OR IN
19350   - NIPPLE/AREOLA RECONSTRUCTION
19355   - CORRECTION OF INVERTED NIPPLES
19357   - BREAST RECONSTRUCTION, IMMEDIATE OR DELAYED, WITH TISSUE EXPANDER, INCLUDING
19366   - BREAST RECONSTRUCTION WITH OTHER TECHNIQUE
19370   - OPEN PERIPROSTHETIC CAPSULOTOMY, BREAST
19371   - PERIPROSTHETIC CAPSULECTOMY, BREAST
19380   - REVISION OF RECONSTRUCTED BREAST
19396   - PREPARATION OF MOULAGE FOR CUSTOM BREAST IMPLANT
19499   - UNLISTED PROCEDURE, BREAST
20000   - INCISION OF SOFT TISSUE ABSCESS (EG, SECONDARY TO OSTEOMYELITIS); SUPERFICIAL
20005   - INCISION OF SOFT TISSUE ABSCESS (EG, SECONDARY TO OSTEOMYELITIS); DEEP OR
20100   - EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); NECK
20101   - EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); CHEST
20102   - EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); ABDOMEN/FLANK/BACK
20103   - EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); EXTREMITY
20150   - EXCISION OF EPIPHYSEAL BAR WITH/WITHOUT AUTOGENOUS SOFT TISSUE GRAFT OBTAINED TH
20200   - BIOPSY, MUSCLE; SUPERFICIAL
20205   - BIOPSY, MUSCLE; DEEP
20206   - BIOPSY, MUSCLE, PERCUTANEOUS NEEDLE
20220   - BIOPSY, BONE, TROCAR, OR NEEDLE; SUPERFICIAL (EG, ILIUM, STERNUM, SPINOUS
20225   - BIOPSY, BONE, TROCAR, OR NEEDLE; DEEP (EG, VERTEBRAL BODY, FEMUR)
20240   - BIOPSY, BONE, OPEN; SUPERFICIAL (EG, ILIUM, STERNUM, SPINOUS PROCESS, RIBS,
20245   - BIOPSY, BONE, OPEN; DEEP (EG, HUMERUS, ISCHIUM, FEMUR)
20250   - BIOPSY, VERTEBRAL BODY, OPEN; THORACIC
20251   - BIOPSY, VERTEBRAL BODY, OPEN; LUMBAR OR CERVICAL
20500   - INJECTION OF SINUS TRACT; THERAPEUTIC (SEPARATE PROCEDURE)
20520   - REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; SIMPLE
20525   - REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; DEEP OR COMPLICATED
20526   - INJECTION, THERAPEUTIC (EG, LOCAL ANESTHETIC, CORTICOSTEROID), CARPAL TUNNEL
20550   - INJECTION(S); SINGLE TENDON SHEATH, OR LIGAMENT, APONEUROSIS (EG, PLANTAR
20551   - INJECTION(S); SINGLE TENDON ORIGIN/INSERTION
20552   - INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), ONE OR TWO MUSCLE(S)
20553   - INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), THREE OR MORE MUSCLE(S)
20555   - PLACEMENT OF NEEDLES OR CATHETERS INTO MUSCLE AND/OR SOFT TISSUE FOR SUBSEQUENT
20600   - ARTHROCENTESIS, ASPIRATION AND/OR INJECTION; SMALL JOINT OR BURSA (EG, FINGERS,
20605   - ARTHROCENTESIS, ASPIRATION AND/OR INJECTION; INTERMEDIATE JOINT OR BURSA (EG,
20610   - ARTHROCENTESIS, ASPIRATION AND/OR INJECTION; MAJOR JOINT OR BURSA (EG,
20612   - ASPIRATION AND/OR INJECTION OF GANGLION CYST(S) ANY LOCATION
20615   - ASPIRATION AND INJECTION FOR TREATMENT OF BONE CYST
20650   - INSERTION OF WIRE OR PIN WITH APPLICATION OF SKELETAL TRACTION, INCLUDING
20660   - APPLICATION OF CRANIAL TONGS, CALIPER, OR STEREOTACTIC FRAME, INCLUDING REMOVAL
20662   - APPLICATION OF HALO, INCLUDING REMOVAL; PELVIC
20663   - APPLICATION OF HALO, INCLUDING REMOVAL; FEMORAL
20670   - REMOVAL OF IMPLANT; SUPERFICIAL, (EG, BURIED WIRE, PIN OR ROD) (SEPARATE
20680   - REMOVAL OF IMPLANT; DEEP (EG, BURIED WIRE, PIN, SCREW, METAL BAND, NAIL, ROD OR
20690   - APPLICATION OF A UNIPLANE (PINS OR WIRES IN ONE PLANE), UNILATERAL, EXTERNAL FIX



                                              Page 79
                                     Surgery (triggers bundling)


20692   - APPLICATION OF A MULTIPLANE (PINS OR WIRES IN MORE THAN ONE PLANE), UNILATERAL,
20693   - ADJUSTMENT OR REVISION OF EXTERNAL FIXATION SYSTEM REQUIRING ANESTHESIA (EG,
20694   - REMOVAL, UNDER ANESTHESIA, OF EXTERNAL FIXATION SYSTEM
20696   - Application of multiplane (pins or wires in more than one plane), unilateral, ex
20697   - Application of multiplane (pins or wires in more than one plane), unilateral, ex
20822   - REPLANTATION, DIGIT, EXCLUDING THUMB (INCLUDES DISTAL TIP TO SUBLIMIS TENDON
20900   - BONE GRAFT, ANY DONOR AREA; MINOR OR SMALL (EG, DOWEL OR BUTTON)
20902   - BONE GRAFT, ANY DONOR AREA; MAJOR OR LARGE
20910   - CARTILAGE GRAFT; COSTOCHONDRAL
20912   - CARTILAGE GRAFT; NASAL SEPTUM
20920   - FASCIA LATA GRAFT; BY STRIPPER
20922   - FASCIA LATA GRAFT; BY INCISION AND AREA EXPOSURE, COMPLEX OR SHEET
20924   - TENDON GRAFT, FROM A DISTANCE (EG, PALMARIS, TOE EXTENSOR, PLANTARIS)
20926   - TISSUE GRAFTS, OTHER (EG, PARATENON, FAT, DERMIS)
20950   - MONITORING OF INTERSTITIAL FLUID PRESSURE (INCLUDES INSERTION OF DEVICE, EG, WIC
20972   - FREE OSTEOCUTANEOUS FLAP WITH MICROVASCULAR ANASTOMOSIS; METATARSAL
20973   - FREE OSTEOCUTANEOUS FLAP WITH MICROVASCULAR ANASTOMOSIS; GREAT TOE WITH WEB
20982   - ABLATION, BONE TUMOR(S) (EG, OSTEOID OSTEOMA, METASTASIS) RADIOFREQUENCY,
20999   - UNLISTED PROCEDURE, MUSCULOSKELETAL SYSTEM, GENERAL
21010   - ARTHROTOMY, TEMPOROMANDIBULAR JOINT
21011   - Excision, tumor, soft tissue of face or scalp, subcutaneous; less than 2 cm
21012   - Excision, tumor, soft tissue of face or scalp, subcutaneous; 2 cm or greater
21013   - Excision, tumor, soft tissue of face and scalp, subfascial (eg, subgaleal, intra
21014   - Excision, tumor, soft tissue of face and scalp, subfascial (eg,subgaleal, intram
21015   - RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF FACE OR SCAL
21016   - Radical resection of tumor (eg, malignant neoplasm), soft tissue of face or scal
21025   - EXCISION OF BONE (EG, FOR OSTEOMYELITIS OR BONE ABSCESS); MANDIBLE
21026   - EXCISION OF BONE (EG, FOR OSTEOMYELITIS OR BONE ABSCESS); FACIAL BONE(S)
21029   - REMOVAL BY CONTOURING OF BENIGN TUMOR OF FACIAL BONE (EG, FIBROUS DYSPLASIA)
21030   - EXCISION OF BENIGN TUMOR OR CYST OF MAXILLA OR ZYGOMA BY ENUCLEATION AND
21031   - EXCISION OF TORUS MANDIBULARIS
21032   - EXCISION OF MAXILLARY TORUS PALATINUS
21034   - EXCISION OF MALIGNANT TUMOR OF MAXILLA OR ZYGOMA
21040   - EXCISION OF BENIGN TUMOR OR CYST OF MANDIBLE, BY ENUCLEATION AND/OR CURETTAGE
21044   - EXCISION OF MALIGNANT TUMOR OF MANDIBLE;
21046   - EXCISION OF BENIGN TUMOR OR CYST OF MANDIBLE; REQUIRING INTRA-ORAL OSTEOTOMY
21047   - EXCISION OF BENIGN TUMOR OR CYST OF MANDIBLE; REQUIRING EXTRA-ORAL OSTEOTOMY
21048   - EXCISION OF BENIGN TUMOR OR CYST OF MAXILLA; REQUIRING INTRA-ORAL OSTEOTOMY
21049   - EXCISION OF BENIGN TUMOR OR CYST OF MAXILLA; REQUIRING EXTRA-ORAL OSTEOTOMY AND
21050   - CONDYLECTOMY, TEMPOROMANDIBULAR JOINT (SEPARATE PROCEDURE)
21060   - MENISCECTOMY, PARTIAL OR COMPLETE, TEMPOROMANDIBULAR JOINT (SEPARATE PROCEDURE)
21070   - CORONOIDECTOMY (SEPARATE PROCEDURE)
21073   - MANIPULATION OF TEMPOROMANDIBULAR JOINT(S) (TMJ), THERAPEUTIC, REQUIRING AN ANES
21076   - IMPRESSION AND CUSTOM PREPARATION; SURGICAL OBTURATOR PROSTHESIS
21077   - IMPRESSION AND CUSTOM PREPARATION; ORBITAL PROSTHESIS
21079   - IMPRESSION AND CUSTOM PREPARATION; INTERIM OBTURATOR PROSTHESIS
21080   - IMPRESSION AND CUSTOM PREPARATION; DEFINITIVE OBTURATOR PROSTHESIS
21081   - IMPRESSION AND CUSTOM PREPARATION; MANDIBULAR RESECTION PROSTHESIS
21082   - IMPRESSION AND CUSTOM PREPARATION; PALATAL AUGMENTATION PROSTHESIS
21083   - IMPRESSION AND CUSTOM PREPARATION; PALATAL LIFT PROSTHESIS
21084   - IMPRESSION AND CUSTOM PREPARATION; SPEECH AID PROSTHESIS
21085   - IMPRESSION AND CUSTOM PREPARATION; ORAL SURGICAL SPLINT
21086   - IMPRESSION AND CUSTOM PREPARATION; AURICULAR PROSTHESIS
21087   - IMPRESSION AND CUSTOM PREPARATION; NASAL PROSTHESIS
21088   - IMPRESSION AND CUSTOM PREPARATION; FACIAL PROSTHESIS



                                              Page 80
                                     Surgery (triggers bundling)


21089   - UNLISTED MAXILLOFACIAL PROSTHETIC PROCEDURE
21100   - APPLICATION OF HALO TYPE APPLIANCE FOR MAXILLOFACIAL FIXATION, INCLUDES REMOVAL
21110   - APPLICATION OF INTERDENTAL FIXATION DEVICE FOR CONDITIONS OTHER THAN FRACTURE
21120   - GENIOPLASTY; AUGMENTATION (AUTOGRAFT, ALLOGRAFT, PROSTHETIC MATERIAL)
21121   - GENIOPLASTY; SLIDING OSTEOTOMY, SINGLE PIECE
21122   - GENIOPLASTY; SLIDING OSTEOTOMIES, TWO OR MORE OSTEOTOMIES (EG, WEDGE EXCISION
21123   - GENIOPLASTY; SLIDING, AUGMENTATION WITH INTERPOSITIONAL BONE GRAFTS (INCLUDES
21125   - AUGMENTATION, MANDIBULAR BODY OR ANGLE; PROSTHETIC MATERIAL
21127   - AUGMENTATION, MANDIBULAR BODY OR ANGLE; WITH BONE GRAFT, ONLAY OR
21137   - REDUCTION FOREHEAD; CONTOURING ONLY
21138   - REDUCTION FOREHEAD; CONTOURING AND APPLICATION OF PROSTHETIC MATERIAL OR BONE
21139   - REDUCTION FOREHEAD; CONTOURING AND SETBACK OF ANTERIOR FRONTAL SINUS WALL
21150   - RECONSTRUCTION MIDFACE, LEFORT II; ANTERIOR INTRUSION (EG, TREACHER-COLLINS
21172   - RECONSTRUCTION SUPERIOR-LATERAL ORBITAL RIM AND LOWER FOREHEAD, ADVANCEMENT OR
21175   - RECONSTRUCTION, BIFRONTAL, SUPERIOR-LATERAL ORBITAL RIMS AND LOWER FOREHEAD,
21181   - RECONSTRUCTION BY CONTOURING OF BENIGN TUMOR OF CRANIAL BONES (EG, FIBROUS
21195   - RECONSTRUCTION OF MANDIBULAR RAMI AND/OR BODY, SAGITTAL SPLIT; WITHOUT INTERNAL
21198   - OSTEOTOMY, MANDIBLE, SEGMENTAL;
21199   - OSTEOTOMY, MANDIBLE, SEGMENTAL; WITH GENIOGLOSSUS ADVANCEMENT
21206   - OSTEOTOMY, MAXILLA, SEGMENTAL (EG, WASSMUND OR SCHUCHARD)
21208   - OSTEOPLASTY, FACIAL BONES; AUGMENTATION (AUTOGRAFT, ALLOGRAFT, OR PROSTHETIC
21209   - OSTEOPLASTY, FACIAL BONES; REDUCTION
21210   - GRAFT, BONE; NASAL, MAXILLARY OR MALAR AREAS (INCLUDES OBTAINING GRAFT)
21215   - GRAFT, BONE; MANDIBLE (INCLUDES OBTAINING GRAFT)
21230   - GRAFT; RIB CARTILAGE, AUTOGENOUS, TO FACE, CHIN, NOSE OR EAR (INCLUDES
21235   - GRAFT; EAR CARTILAGE, AUTOGENOUS, TO NOSE OR EAR (INCLUDES OBTAINING GRAFT)
21240   - ARTHROPLASTY, TEMPOROMANDIBULAR JOINT, WITH OR WITHOUT AUTOGRAFT (INCLUDES
21242   - ARTHROPLASTY, TEMPOROMANDIBULAR JOINT, WITH ALLOGRAFT
21243   - ARTHROPLASTY, TEMPOROMANDIBULAR JOINT, WITH PROSTHETIC JOINT REPLACEMENT
21244   - RECONSTRUCTION OF MANDIBLE, EXTRAORAL, WITH TRANSOSTEAL BONE PLATE (EG,
21245   - RECONSTRUCTION OF MANDIBLE OR MAXILLA, SUBPERIOSTEAL IMPLANT; PARTIAL
21246   - RECONSTRUCTION OF MANDIBLE OR MAXILLA, SUBPERIOSTEAL IMPLANT; COMPLETE
21248   - RECONSTRUCTION OF MANDIBLE OR MAXILLA, ENDOSTEAL IMPLANT (EG, BLADE, CYLINDER);
21249   - RECONSTRUCTION OF MANDIBLE OR MAXILLA, ENDOSTEAL IMPLANT (EG, BLADE, CYLINDER);
21260   - PERIORBITAL OSTEOTOMIES FOR ORBITAL HYPERTELORISM, WITH BONE GRAFTS;
21261   - PERIORBITAL OSTEOTOMIES FOR ORBITAL HYPERTELORISM, WITH BONE GRAFTS; COMBINED
21263   - PERIORBITAL OSTEOTOMIES FOR ORBITAL HYPERTELORISM, WITH BONE GRAFTS; WITH
21267   - ORBITAL REPOSITIONING, PERIORBITAL OSTEOTOMIES, UNILATERAL, WITH BONE GRAFTS;
21270   - MALAR AUGMENTATION, PROSTHETIC MATERIAL
21275   - SECONDARY REVISION OF ORBITOCRANIOFACIAL RECONSTRUCTION
21280   - MEDIAL CANTHOPEXY (SEPARATE PROCEDURE)
21282   - LATERAL CANTHOPEXY
21295   - REDUCTION OF MASSETER MUSCLE AND BONE (EG, FOR TREATMENT OF BENIGN MASSETERIC
21296   - REDUCTION OF MASSETER MUSCLE AND BONE (EG, FOR TREATMENT OF BENIGN MASSETERIC
21299   - UNLISTED CRANIOFACIAL AND MAXILLOFACIAL PROCEDURE
21310   - CLOSED TREATMENT OF NASAL BONE FRACTURE WITHOUT MANIPULATION
21315   - CLOSED TREATMENT OF NASAL BONE FRACTURE; WITHOUT STABILIZATION
21320   - CLOSED TREATMENT OF NASAL BONE FRACTURE; WITH STABILIZATION
21325   - OPEN TREATMENT OF NASAL FRACTURE; UNCOMPLICATED
21330   - OPEN TREATMENT OF NASAL FRACTURE; COMPLICATED, WITH INTERNAL AND/OR EXTERNAL
21335   - OPEN TREATMENT OF NASAL FRACTURE; WITH CONCOMITANT OPEN TREATMENT OF FRACTURED
21336   - OPEN TREATMENT OF NASAL SEPTAL FRACTURE, WITH OR WITHOUT STABILIZATION
21337   - CLOSED TREATMENT OF NASAL SEPTAL FRACTURE, WITH OR WITHOUT STABILIZATION
21338   - OPEN TREATMENT OF NASOETHMOID FRACTURE; WITHOUT EXTERNAL FIXATION
21339   - OPEN TREATMENT OF NASOETHMOID FRACTURE; WITH EXTERNAL FIXATION



                                              Page 81
                                      Surgery (triggers bundling)


21340   - PERCUTANEOUS TREATMENT OF NASOETHMOID COMPLEX FRACTURE, WITH SPLINT, WIRE OR
21345   - CLOSED TREATMENT OF NASOMAXILLARY COMPLEX FRACTURE (LEFORT II TYPE), WITH
21355   - PERCUTANEOUS TREATMENT OF FRACTURE OF MALAR AREA, INCLUDING ZYGOMATIC ARCH AND
21356   - OPEN TREATMENT OF DEPRESSED ZYGOMATIC ARCH FRACTURE (EG, GILLIES APPROACH)
21386   - OPEN TREATMENT OF ORBITAL FLOOR BLOWOUT FRACTURE; PERIORBITAL APPROACH
21387   - OPEN TREATMENT OF ORBITAL FLOOR BLOWOUT FRACTURE; COMBINED APPROACH
21390   - OPEN TREATMENT OF ORBITAL FLOOR BLOWOUT FRACTURE; PERIORBITAL APPROACH, WITH
21400   - CLOSED TREATMENT OF FRACTURE OF ORBIT, EXCEPT BLOWOUT; WITHOUT MANIPULATION
21401   - CLOSED TREATMENT OF FRACTURE OF ORBIT, EXCEPT BLOWOUT; WITH MANIPULATION
21406   - OPEN TREATMENT OF FRACTURE OF ORBIT, EXCEPT BLOWOUT; WITHOUT IMPLANT
21407   - OPEN TREATMENT OF FRACTURE OF ORBIT, EXCEPT BLOWOUT; WITH IMPLANT
21408   - OPEN TREATMENT OF FRACTURE OF ORBIT, EXCEPT BLOWOUT; WITH BONE GRAFTING
21421   - CLOSED TREATMENT OF PALATAL OR MAXILLARY FRACTURE (LEFORT I TYPE), WITH
21440   - CLOSED TREATMENT OF MANDIBULAR OR MAXILLARY ALVEOLAR RIDGE FRACTURE (SEPARATE
21445   - OPEN TREATMENT OF MANDIBULAR OR MAXILLARY ALVEOLAR RIDGE FRACTURE (SEPARATE
21450   - CLOSED TREATMENT OF MANDIBULAR FRACTURE; WITHOUT MANIPULATION
21451   - CLOSED TREATMENT OF MANDIBULAR FRACTURE; WITH MANIPULATION
21452   - PERCUTANEOUS TREATMENT OF MANDIBULAR FRACTURE, WITH EXTERNAL FIXATION
21453   - CLOSED TREATMENT OF MANDIBULAR FRACTURE WITH INTERDENTAL FIXATION
21454   - OPEN TREATMENT OF MANDIBULAR FRACTURE WITH EXTERNAL FIXATION
21461   - OPEN TREATMENT OF MANDIBULAR FRACTURE; WITHOUT INTERDENTAL FIXATION
21462   - OPEN TREATMENT OF MANDIBULAR FRACTURE; WITH INTERDENTAL FIXATION
21465   - OPEN TREATMENT OF MANDIBULAR CONDYLAR FRACTURE
21470   - OPEN TREATMENT OF COMPLICATED MANDIBULAR FRACTURE BY MULTIPLE SURGICAL
21480   - CLOSED TREATMENT OF TEMPOROMANDIBULAR DISLOCATION; INITIAL OR SUBSEQUENT
21485   - CLOSED TREATMENT OF TEMPOROMANDIBULAR DISLOCATION; COMPLICATED (EG, RECURRENT
21490   - OPEN TREATMENT OF TEMPOROMANDIBULAR DISLOCATION
21495   - OPEN TREATMENT OF HYOID FRACTURE
21497   - INTERDENTAL WIRING, FOR CONDITION OTHER THAN FRACTURE
21499   - UNLISTED MUSCULOSKELETAL PROCEDURE, HEAD
21501   - INCISION AND DRAINAGE, DEEP ABSCESS OR HEMATOMA, SOFT TISSUES OF NECK OR THORAX;
21502   - INCISION AND DRAINAGE, DEEP ABSCESS OR HEMATOMA, SOFT TISSUES OF NECK OR
21550   - BIOPSY, SOFT TISSUE OF NECK OR THORAX
21552   - Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; 3 cm or g
21554   - Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg,intramus
21555   - EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBCUTANEOUS; LESS THAN
21556   - EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBFASCIAL (EG, INTRAMU
21557   - RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF NECK OR ANTE
21558   - Radical resection of tumor (eg, malignant neoplasm), soft tissue of neck or ante
21600   - EXCISION OF RIB, PARTIAL
21610   - COSTOTRANSVERSECTOMY (SEPARATE PROCEDURE)
21685   - HYOID MYOTOMY AND SUSPENSION
21700   - DIVISION OF SCALENUS ANTICUS; WITHOUT RESECTION OF CERVICAL RIB
21720   - DIVISION OF STERNOCLEIDOMASTOID FOR TORTICOLLIS, OPEN OPERATION; WITHOUT CAST
21725   - DIVISION OF STERNOCLEIDOMASTOID FOR TORTICOLLIS, OPEN OPERATION; WITH CAST
21742   - RECONSTRUCTIVE REPAIR OF PECTUS EXCAVATUM OR CARINATUM; MINIMALLY INVASIVE
21743   - RECONSTRUCTIVE REPAIR OF PECTUS EXCAVATUM OR CARINATUM; MINIMALLY INVASIVE
21800   - CLOSED TREATMENT OF RIB FRACTURE, UNCOMPLICATED, EACH
21805   - OPEN TREATMENT OF RIB FRACTURE WITHOUT FIXATION, EACH
21820   - CLOSED TREATMENT OF STERNUM FRACTURE
21899   - UNLISTED PROCEDURE, NECK OR THORAX
21920   - BIOPSY, SOFT TISSUE OF BACK OR FLANK; SUPERFICIAL
21925   - BIOPSY, SOFT TISSUE OF BACK OR FLANK; DEEP
21930   - EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBCUTANEOUS; LESS THAN 3 CM
21931   - Excision, tumor, soft tissue of back or flank, subcutaneous; 3 cm or greater



                                               Page 82
                                     Surgery (triggers bundling)


21932   - Excision, tumor, soft tissue of back or flank, subfascial (eg, intramuscular); l
21933   - Excision, tumor, soft tissue of back or flank, subfascial (eg, intramuscular);
21935   - RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF BACK OR FLAN
21936   - Radical resection of tumor (eg, malignant neoplasm), soft tissue of backor flank
22100   - PARTIAL EXCISION OF POSTERIOR VERTEBRAL COMPONENT (EG, SPINOUS PROCESS, LAMINA O
22101   - PARTIAL EXCISION OF POSTERIOR VERTEBRAL COMPONENT (EG, SPINOUS PROCESS, LAMINA
22102   - PARTIAL EXCISION OF POSTERIOR VERTEBRAL COMPONENT (EG, SPINOUS PROCESS, LAMINA
22103   - PARTIAL EXCISION OF POSTERIOR VERTEBRAL COMPONENT (EG, SPINOUS PROCESS, LAMINA
22222   - OSTEOTOMY OF SPINE, INCLUDING DISKECTOMY, ANTERIOR APPROACH, SINGLE VERTEBRAL
22305   - CLOSED TREATMENT OF VERTEBRAL PROCESS FRACTURE(S)
22310   - CLOSED TREATMENT OF VERTEBRAL BODY FRACTURE(S), WITHOUT MANIPULATION, REQUIRING
22315   - CLOSED TREATMENT OF VERTEBRAL FRACTURE(S) AND/OR DISLOCATION(S) REQUIRING
22505   - MANIPULATION OF SPINE REQUIRING ANESTHESIA, ANY REGION
22520   - PERCUTANEOUS VERTEBROPLASTY, 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION
22521   - PERCUTANEOUS VERTEBROPLASTY, 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION
22522   - PERCUTANEOUS VERTEBROPLASTY, ONE VERTEBRAL BODY, UNILATERAL OR BILATERAL
22523   - PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTI
22524   - PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTI
22525   - PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTI
22612   - ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE LEVEL; LUMBAR (WITH
22614   - ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE LEVEL; EACH
22899   - UNLISTED PROCEDURE, SPINE
22900   - EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBFASCIAL (EG, INTRAMUSCULAR);
22901   - Excision, tumor, soft tissue of abdominal wall, subfascial (eg,intramuscular); 5
22902   - Excision, tumor, soft tissue of abdominal wall, subcutaneous; less than 3 cm
22903   - Excision, tumor, soft tissue of abdominal wall, subcutaneous; 3 cm or greater
22904   - Radical resection of tumor (eg, malignant neoplasm), soft tissue of abdominal wa
22905   - Radical resection of tumor (eg, malignant neoplasm), soft tissue of abdominal wa
22999   - UNLISTED PROCEDURE, ABDOMEN, MUSCULOSKELETAL SYSTEM
23000   - REMOVAL OF SUBDELTOID CALCAREOUS DEPOSITS, OPEN
23020   - CAPSULAR CONTRACTURE RELEASE (EG, SEVER TYPE PROCEDURE)
23030   - INCISION AND DRAINAGE, SHOULDER AREA; DEEP ABSCESS OR HEMATOMA
23031   - INCISION AND DRAINAGE, SHOULDER AREA; INFECTED BURSA
23035   - INCISION, BONE CORTEX (EG, OSTEOMYELITIS OR BONE ABSCESS), SHOULDER AREA
23040   - ARTHROTOMY, GLENOHUMERAL JOINT, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF
23044   - ARTHROTOMY, ACROMIOCLAVICULAR, STERNOCLAVICULAR JOINT, INCLUDING EXPLORATION,
23065   - BIOPSY, SOFT TISSUE OF SHOULDER AREA; SUPERFICIAL
23066   - BIOPSY, SOFT TISSUE OF SHOULDER AREA; DEEP
23071   - Excision, tumor, soft tissue of shoulder area, subcutaneous; 3 cm or greater
23073   - Excision, tumor, soft tissue of shoulder area, subfascial (eg, intramuscular); 5
23075   - EXCISION, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBCUTANEOUS; LESS THAN 3 CM
23076   - EXCISION, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBFASCIAL (EG, INTRAMUSCULAR); L
23077   - RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF SHOULDER ARE
23078   - Radical resection of tumor (eg, malignant neoplasm), soft tissue of shoulder are
23100   - ARTHROTOMY, GLENOHUMERAL JOINT, INCLUDING BIOPSY
23101   - ARTHROTOMY, ACROMIOCLAVICULAR JOINT OR STERNOCLAVICULAR JOINT, INCLUDING BIOPSY
23105   - ARTHROTOMY; GLENOHUMERAL JOINT, WITH SYNOVECTOMY, WITH OR WITHOUT BIOPSY
23106   - ARTHROTOMY; STERNOCLAVICULAR JOINT, WITH SYNOVECTOMY, WITH OR WITHOUT BIOPSY
23107   - ARTHROTOMY, GLENOHUMERAL JOINT, WITH JOINT EXPLORATION, WITH OR WITHOUT REMOVAL
23120   - CLAVICULECTOMY; PARTIAL
23125   - CLAVICULECTOMY; TOTAL
23130   - ACROMIOPLASTY OR ACROMIONECTOMY, PARTIAL, WITH OR WITHOUT CORACOACROMIAL
23140   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CLAVICLE OR SCAPULA;
23145   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CLAVICLE OR SCAPULA; WITH
23146   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CLAVICLE OR SCAPULA; WITH



                                              Page 83
                                     Surgery (triggers bundling)


23150   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL HUMERUS;
23155   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL HUMERUS; WITH
23156   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL HUMERUS; WITH
23170   - SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), CLAVICLE
23172   - SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), SCAPULA
23174   - SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), HUMERAL HEAD TO
23180   - PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG,
23182   - PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG,
23184   - PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG,
23190   - OSTECTOMY OF SCAPULA, PARTIAL (EG, SUPERIOR MEDIAL ANGLE)
23195   - RESECTION, HUMERAL HEAD
23330   - REMOVAL OF FOREIGN BODY, SHOULDER; SUBCUTANEOUS
23331   - REMOVAL OF FOREIGN BODY, SHOULDER; DEEP (EG, NEER HEMIARTHROPLASTY REMOVAL)
23395   - MUSCLE TRANSFER, ANY TYPE, SHOULDER OR UPPER ARM; SINGLE
23397   - MUSCLE TRANSFER, ANY TYPE, SHOULDER OR UPPER ARM; MULTIPLE
23400   - SCAPULOPEXY (EG, SPRENGELS DEFORMITY OR FOR PARALYSIS)
23405   - TENOTOMY, SHOULDER AREA; SINGLE TENDON
23406   - TENOTOMY, SHOULDER AREA; MULTIPLE TENDONS THROUGH SAME INCISION
23410   - REPAIR OF RUPTURED MUSCULOTENDINOUS CUFF (EG, ROTATOR CUFF) OPEN; ACUTE
23412   - REPAIR OF RUPTURED MUSCULOTENDINOUS CUFF (EG, ROTATOR CUFF) OPEN; CHRONIC
23415   - CORACOACROMIAL LIGAMENT RELEASE, WITH OR WITHOUT ACROMIOPLASTY
23420   - RECONSTRUCTION OF COMPLETE SHOULDER (ROTATOR) CUFF AVULSION, CHRONIC (INCLUDES
23430   - TENODESIS OF LONG TENDON OF BICEPS
23440   - RESECTION OR TRANSPLANTATION OF LONG TENDON OF BICEPS
23450   - CAPSULORRHAPHY, ANTERIOR; PUTTI-PLATT PROCEDURE OR MAGNUSON TYPE OPERATION
23455   - CAPSULORRHAPHY, ANTERIOR; WITH LABRAL REPAIR (EG, BANKART PROCEDURE)
23460   - CAPSULORRHAPHY, ANTERIOR, ANY TYPE; WITH BONE BLOCK
23462   - CAPSULORRHAPHY, ANTERIOR, ANY TYPE; WITH CORACOID PROCESS TRANSFER
23465   - CAPSULORRHAPHY, GLENOHUMERAL JOINT, POSTERIOR, WITH OR WITHOUT BONE BLOCK
23466   - CAPSULORRHAPHY, GLENOHUMERAL JOINT, ANY TYPE MULTI-DIRECTIONAL INSTABILITY
23470   - ARTHROPLASTY, GLENOHUMERAL JOINT; HEMIARTHROPLASTY
23480   - OSTEOTOMY, CLAVICLE, WITH OR WITHOUT INTERNAL FIXATION;
23485   - OSTEOTOMY, CLAVICLE, WITH OR WITHOUT INTERNAL FIXATION; WITH BONE GRAFT FOR
23490   - PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT
23491   - PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT
23500   - CLOSED TREATMENT OF CLAVICULAR FRACTURE; WITHOUT MANIPULATION
23505   - CLOSED TREATMENT OF CLAVICULAR FRACTURE; WITH MANIPULATION
23515   - OPEN TREATMENT OF CLAVICULAR FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORME
23520   - CLOSED TREATMENT OF STERNOCLAVICULAR DISLOCATION; WITHOUT MANIPULATION
23525   - CLOSED TREATMENT OF STERNOCLAVICULAR DISLOCATION; WITH MANIPULATION
23530   - OPEN TREATMENT OF STERNOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC;
23532   - OPEN TREATMENT OF STERNOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC; WITH FASCIAL
23540   - CLOSED TREATMENT OF ACROMIOCLAVICULAR DISLOCATION; WITHOUT MANIPULATION
23545   - CLOSED TREATMENT OF ACROMIOCLAVICULAR DISLOCATION; WITH MANIPULATION
23550   - OPEN TREATMENT OF ACROMIOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC;
23552   - OPEN TREATMENT OF ACROMIOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC; WITH FASCIAL
23570   - CLOSED TREATMENT OF SCAPULAR FRACTURE; WITHOUT MANIPULATION
23575   - CLOSED TREATMENT OF SCAPULAR FRACTURE; WITH MANIPULATION, WITH OR WITHOUT
23585   - OPEN TREATMENT OF SCAPULAR FRACTURE (BODY, GLENOID OR ACROMION) INCLUDES INTERNA
23600   - CLOSED TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE;
23605   - CLOSED TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE;
23615   - OPEN TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE, INCLU
23616   - OPEN TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE, INCLU
23620   - CLOSED TREATMENT OF GREATER HUMERAL TUBEROSITY FRACTURE; WITHOUT MANIPULATION
23625   - CLOSED TREATMENT OF GREATER HUMERAL TUBEROSITY FRACTURE; WITH MANIPULATION



                                              Page 84
                                     Surgery (triggers bundling)


23630   - OPEN TREATMENT OF GREATER HUMERAL TUBEROSITY FRACTURE, INCLUDES INTERNAL FIXATIO
23650   - CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH MANIPULATION; WITHOUT ANESTHESIA
23655   - CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH MANIPULATION; REQUIRING
23660   - OPEN TREATMENT OF ACUTE SHOULDER DISLOCATION
23665   - CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH FRACTURE OF GREATER HUMERAL
23670   - OPEN TREATMENT OF SHOULDER DISLOCATION, WITH FRACTURE OF GREATER HUMERAL TUBEROS
23675   - CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH SURGICAL OR ANATOMICAL NECK
23680   - OPEN TREATMENT OF SHOULDER DISLOCATION, WITH SURGICAL OR ANATOMICAL NECK FRACTUR
23700   - MANIPULATION UNDER ANESTHESIA, SHOULDER JOINT, INCLUDING APPLICATION OF FIXATION
23800   - ARTHRODESIS, GLENOHUMERAL JOINT;
23802   - ARTHRODESIS, GLENOHUMERAL JOINT; WITH AUTOGENOUS GRAFT (INCLUDES OBTAINING
23921   - DISARTICULATION OF SHOULDER; SECONDARY CLOSURE OR SCAR REVISION
23929   - UNLISTED PROCEDURE, SHOULDER
23930   - INCISION AND DRAINAGE, UPPER ARM OR ELBOW AREA; DEEP ABSCESS OR HEMATOMA
23931   - INCISION AND DRAINAGE, UPPER ARM OR ELBOW AREA; BURSA
23935   - INCISION, DEEP, WITH OPENING OF BONE CORTEX (EG, FOR OSTEOMYELITIS OR BONE
24000   - ARTHROTOMY, ELBOW, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY
24006   - ARTHROTOMY OF THE ELBOW, WITH CAPSULAR EXCISION FOR CAPSULAR RELEASE (SEPARATE
24065   - BIOPSY, SOFT TISSUE OF UPPER ARM OR ELBOW AREA; SUPERFICIAL
24066   - BIOPSY, SOFT TISSUE OF UPPER ARM OR ELBOW AREA; DEEP (SUBFASCIAL OR
24071   - Excision, tumor, soft tissue of upper arm or elbow area, subcutaneous; 3 cm or g
24073   - Excision, tumor, soft tissue of upper arm or elbow area, subfascial (eg,intramus
24075   - EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOW AREA, SUBCUTANEOUS; LESS THAN
24076   - EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOW AREA, SUBFASCIAL (EG, INTRAMU
24077   - RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF UPPER ARM OR
24079   - Radical resection of tumor (eg, malignant neoplasm), soft tissue of upper ar
24100   - ARTHROTOMY, ELBOW; WITH SYNOVIAL BIOPSY ONLY
24101   - ARTHROTOMY, ELBOW; WITH JOINT EXPLORATION, WITH OR WITHOUT BIOPSY, WITH OR
24102   - ARTHROTOMY, ELBOW; WITH SYNOVECTOMY
24105   - EXCISION, OLECRANON BURSA
24110   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, HUMERUS;
24115   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, HUMERUS; WITH AUTOGRAFT
24116   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, HUMERUS; WITH ALLOGRAFT
24120   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF HEAD OR NECK OF RADIUS OR
24125   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF HEAD OR NECK OF RADIUS OR
24126   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF HEAD OR NECK OF RADIUS OR
24130   - EXCISION, RADIAL HEAD
24134   - SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), SHAFT OR DISTAL HUMERUS
24136   - SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), RADIAL HEAD OR NECK
24138   - SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), OLECRANON PROCESS
24140   - PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG,
24145   - PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG,
24147   - PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG,
24149   - RADICAL RESECTION OF CAPSULE, SOFT TISSUE, AND HETEROTOPIC BONE, ELBOW, WITH
24150   - RADICAL RESECTION OF TUMOR, SHAFT OR DISTAL HUMERUS
24152   - RADICAL RESECTION OF TUMOR, RADIAL HEAD OR NECK
24155   - RESECTION OF ELBOW JOINT (ARTHRECTOMY)
24160   - IMPLANT REMOVAL; ELBOW JOINT
24164   - IMPLANT REMOVAL; RADIAL HEAD
24200   - REMOVAL OF FOREIGN BODY, UPPER ARM OR ELBOW AREA; SUBCUTANEOUS
24201   - REMOVAL OF FOREIGN BODY, UPPER ARM OR ELBOW AREA; DEEP (SUBFASCIAL OR
24300   - MANIPULATION, ELBOW, UNDER ANESTHESIA
24301   - MUSCLE OR TENDON TRANSFER, ANY TYPE, UPPER ARM OR ELBOW, SINGLE (EXCLUDING
24305   - TENDON LENGTHENING, UPPER ARM OR ELBOW, EACH TENDON
24310   - TENOTOMY, OPEN, ELBOW TO SHOULDER, EACH TENDON



                                              Page 85
                                    Surgery (triggers bundling)


24320   - TENOPLASTY, WITH MUSCLE TRANSFER, WITH OR WITHOUT FREE GRAFT, ELBOW TO
24330   - FLEXOR-PLASTY, ELBOW (EG, STEINDLER TYPE ADVANCEMENT);
24331   - FLEXOR-PLASTY, ELBOW (EG, STEINDLER TYPE ADVANCEMENT); WITH EXTENSOR ADVANCEMENT
24332   - TENOLYSIS, TRICEPS
24340   - TENODESIS OF BICEPS TENDON AT ELBOW (SEPARATE PROCEDURE)
24341   - REPAIR, TENDON OR MUSCLE, UPPER ARM OR ELBOW, EACH TENDON OR MUSCLE, PRIMARY OR
24342   - REINSERTION OF RUPTURED BICEPS OR TRICEPS TENDON, DISTAL, WITH OR WITHOUT
24343   - REPAIR LATERAL COLLATERAL LIGAMENT, ELBOW, WITH LOCAL TISSUE
24344   - RECONSTRUCTION LATERAL COLLATERAL LIGAMENT, ELBOW, WITH TENDON GRAFT (INCLUDES
24345   - REPAIR MEDIAL COLLATERAL LIGAMENT, ELBOW, WITH LOCAL TISSUE
24346   - RECONSTRUCTION MEDIAL COLLATERAL LIGAMENT, ELBOW, WITH TENDON GRAFT (INCLUDES
24357   - TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S EL
24358   - TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S EL
24359   - TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S EL
24360   - ARTHROPLASTY, ELBOW; WITH MEMBRANE (EG, FASCIAL)
24361   - ARTHROPLASTY, ELBOW; WITH DISTAL HUMERAL PROSTHETIC REPLACEMENT
24362   - ARTHROPLASTY, ELBOW; WITH IMPLANT AND FASCIA LATA LIGAMENT RECONSTRUCTION
24363   - ARTHROPLASTY, ELBOW; WITH DISTAL HUMERUS AND PROXIMAL ULNAR PROSTHETIC
24365   - ARTHROPLASTY, RADIAL HEAD;
24366   - ARTHROPLASTY, RADIAL HEAD; WITH IMPLANT
24400   - OSTEOTOMY, HUMERUS, WITH OR WITHOUT INTERNAL FIXATION
24410   - MULTIPLE OSTEOTOMIES WITH REALIGNMENT ON INTRAMEDULLARY ROD, HUMERAL SHAFT
24430   - REPAIR OF NONUNION OR MALUNION, HUMERUS; WITHOUT GRAFT (EG, COMPRESSION
24435   - REPAIR OF NONUNION OR MALUNION, HUMERUS; WITH ILIAC OR OTHER AUTOGRAFT
24470   - HEMIEPIPHYSEAL ARREST (EG, CUBITUS VARUS OR VALGUS, DISTAL HUMERUS)
24495   - DECOMPRESSION FASCIOTOMY, FOREARM, WITH BRACHIAL ARTERY EXPLORATION
24498   - PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING), WITH OR WITHOUT
24500   - CLOSED TREATMENT OF HUMERAL SHAFT FRACTURE; WITHOUT MANIPULATION
24505   - CLOSED TREATMENT OF HUMERAL SHAFT FRACTURE; WITH MANIPULATION, WITH OR WITHOUT
24515   - OPEN TREATMENT OF HUMERAL SHAFT FRACTURE WITH PLATE/SCREWS, WITH OR WITHOUT
24516   - TREATMENT OF HUMERAL SHAFT FRACTURE, WITH INSERTION OF INTRAMEDULLARY IMPLANT,
24530   - CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR HUMERAL FRACTURE, WITH OR
24535   - CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR HUMERAL FRACTURE, WITH OR
24538   - PERCUTANEOUS SKELETAL FIXATION OF SUPRACONDYLAR OR TRANSCONDYLAR HUMERAL
24545   - OPEN TREATMENT OF HUMERAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE, INCLUDES INTE
24546   - OPEN TREATMENT OF HUMERAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE, INCLUDES INTE
24560   - CLOSED TREATMENT OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR LATERAL; WITHOUT
24565   - CLOSED TREATMENT OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR LATERAL; WITH
24566   - PERCUTANEOUS SKELETAL FIXATION OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR
24575   - OPEN TREATMENT OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR LATERAL, INCLUDES INTE
24576   - CLOSED TREATMENT OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL; WITHOUT
24577   - CLOSED TREATMENT OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL; WITH
24579   - OPEN TREATMENT OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL, INCLUDES INTERNA
24582   - PERCUTANEOUS SKELETAL FIXATION OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL,
24586   - OPEN TREATMENT OF PERIARTICULAR FRACTURE AND/OR DISLOCATION OF THE ELBOW
24587   - OPEN TREATMENT OF PERIARTICULAR FRACTURE AND/OR DISLOCATION OF THE ELBOW
24600   - TREATMENT OF CLOSED ELBOW DISLOCATION; WITHOUT ANESTHESIA
24605   - TREATMENT OF CLOSED ELBOW DISLOCATION; REQUIRING ANESTHESIA
24615   - OPEN TREATMENT OF ACUTE OR CHRONIC ELBOW DISLOCATION
24620   - CLOSED TREATMENT OF MONTEGGIA TYPE OF FRACTURE DISLOCATION AT ELBOW (FRACTURE
24635   - OPEN TREATMENT OF MONTEGGIA TYPE OF FRACTURE DISLOCATION AT ELBOW (FRACTURE PROX
24640   - CLOSED TREATMENT OF RADIAL HEAD SUBLUXATION IN CHILD, NURSEMAID ELBOW, WITH
24650   - CLOSED TREATMENT OF RADIAL HEAD OR NECK FRACTURE; WITHOUT MANIPULATION
24655   - CLOSED TREATMENT OF RADIAL HEAD OR NECK FRACTURE; WITH MANIPULATION
24665   - OPEN TREATMENT OF RADIAL HEAD OR NECK FRACTURE, INCLUDES INTERNAL FIXATION OR RA



                                             Page 86
                                     Surgery (triggers bundling)


24666   - OPEN TREATMENT OF RADIAL HEAD OR NECK FRACTURE, INCLUDES INTERNAL FIXATION OR RA
24670   - CLOSED TREATMENT OF ULNAR FRACTURE, PROXIMAL END (EG, OLECRANON OR CORONOID PROC
24675   - CLOSED TREATMENT OF ULNAR FRACTURE, PROXIMAL END (EG, OLECRANON OR CORONOID PROC
24685   - OPEN TREATMENT OF ULNAR FRACTURE, PROXIMAL END (EG, OLECRANON OR CORONOID PROCES
24800   - ARTHRODESIS, ELBOW JOINT; LOCAL
24802   - ARTHRODESIS, ELBOW JOINT; WITH AUTOGENOUS GRAFT (INCLUDES OBTAINING GRAFT)
24925   - AMPUTATION, ARM THROUGH HUMERUS; SECONDARY CLOSURE OR SCAR REVISION
24935   - STUMP ELONGATION, UPPER EXTREMITY
24999   - UNLISTED PROCEDURE, HUMERUS OR ELBOW
25000   - INCISION, EXTENSOR TENDON SHEATH, WRIST (EG, DEQUERVAIN'S DISEASE)
25001   - INCISION, FLEXOR TENDON SHEATH, WRIST (EG, FLEXOR CARPI RADIALIS)
25020   - DECOMPRESSION FASCIOTOMY, FOREARM AND/OR WRIST, FLEXOR OR EXTENSOR COMPARTMENT;
25023   - DECOMPRESSION FASCIOTOMY, FOREARM AND/OR WRIST, FLEXOR OR EXTENSOR COMPARTMENT;
25024   - DECOMPRESSION FASCIOTOMY, FOREARM AND/OR WRIST, FLEXOR AND EXTENSOR
25025   - DECOMPRESSION FASCIOTOMY, FOREARM AND/OR WRIST, FLEXOR AND EXTENSOR
25028   - INCISION AND DRAINAGE, FOREARM AND/OR WRIST; DEEP ABSCESS OR HEMATOMA
25031   - INCISION AND DRAINAGE, FOREARM AND/OR WRIST; BURSA
25035   - INCISION, DEEP, BONE CORTEX, FOREARM AND/OR WRIST (EG, OSTEOMYELITIS OR BONE
25040   - ARTHROTOMY, RADIOCARPAL OR MIDCARPAL JOINT, WITH EXPLORATION, DRAINAGE, OR
25065   - BIOPSY, SOFT TISSUE OF FOREARM AND/OR WRIST; SUPERFICIAL
25066   - BIOPSY, SOFT TISSUE OF FOREARM AND/OR WRIST; DEEP (SUBFASCIAL OR INTRAMUSCULAR)
25071   - Excision, tumor, soft tissue of forearm and/or wrist area, subcutaneous; 3 cm or
25073   - Excision, tumor, soft tissue of forearm and/or wrist area, subfascial (eg, intra
25075   - EXCISION, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST AREA, SUBCUTANEOUS; LESS TH
25076   - EXCISION, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST AREA, SUBFASCIAL (EG, INTRA
25077   - RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF FOREARM AND/
25078   - Radical resection of tumor (eg, malignant neoplasm), soft tissue of forearm and/
25085   - CAPSULOTOMY, WRIST (EG, CONTRACTURE)
25100   - ARTHROTOMY, WRIST JOINT; WITH BIOPSY
25101   - ARTHROTOMY, WRIST JOINT; WITH JOINT EXPLORATION, WITH OR WITHOUT BIOPSY, WITH
25105   - ARTHROTOMY, WRIST JOINT; WITH SYNOVECTOMY
25107   - ARTHROTOMY, DISTAL RADIOULNAR JOINT INCLUDING REPAIR OF TRIANGULAR CARTILAGE,
25109   - EXCISION OF TENDON, FOREARM AND/OR WRIST, FLEXOR OR EXTENSOR, EACH
25110   - EXCISION, LESION OF TENDON SHEATH, FOREARM AND/OR WRIST
25111   - EXCISION OF GANGLION, WRIST (DORSAL OR VOLAR); PRIMARY
25112   - EXCISION OF GANGLION, WRIST (DORSAL OR VOLAR); RECURRENT
25115   - RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR FOREARM TENDON SHEATHS (EG,
25116   - RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR FOREARM TENDON SHEATHS (EG,
25118   - SYNOVECTOMY, EXTENSOR TENDON SHEATH, WRIST, SINGLE COMPARTMENT;
25119   - SYNOVECTOMY, EXTENSOR TENDON SHEATH, WRIST, SINGLE COMPARTMENT; WITH RESECTION
25120   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF RADIUS OR ULNA (EXCLUDING
25125   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF RADIUS OR ULNA (EXCLUDING
25126   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF RADIUS OR ULNA (EXCLUDING
25130   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CARPAL BONES;
25135   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CARPAL BONES; WITH
25136   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CARPAL BONES; WITH
25145   - SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), FOREARM AND/OR WRIST
25150   - PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG,
25151   - PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG,
25170   - RADICAL RESECTION OF TUMOR, RADIUS OR ULNA
25210   - CARPECTOMY; ONE BONE
25215   - CARPECTOMY; ALL BONES OF PROXIMAL ROW
25230   - RADIAL STYLOIDECTOMY (SEPARATE PROCEDURE)
25240   - EXCISION DISTAL ULNA PARTIAL OR COMPLETE (EG, DARRACH TYPE OR MATCHED RESECTION)
25248   - EXPLORATION WITH REMOVAL OF DEEP FOREIGN BODY, FOREARM OR WRIST



                                              Page 87
                                      Surgery (triggers bundling)


25250   - REMOVAL OF WRIST PROSTHESIS; (SEPARATE PROCEDURE)
25251   - REMOVAL OF WRIST PROSTHESIS; COMPLICATED, INCLUDING TOTAL WRIST
25259   - MANIPULATION, WRIST, UNDER ANESTHESIA
25260   - REPAIR, TENDON OR MUSCLE, FLEXOR, FOREARM AND/OR WRIST; PRIMARY, SINGLE, EACH TE
25263   - REPAIR, TENDON OR MUSCLE, FLEXOR, FOREARM AND/OR WRIST; SECONDARY, SINGLE, EACH
25265   - REPAIR, TENDON OR MUSCLE, FLEXOR, FOREARM AND/OR WRIST; SECONDARY, WITH FREE
25270   - REPAIR, TENDON OR MUSCLE, EXTENSOR, FOREARM AND/OR WRIST; PRIMARY, SINGLE, EACH
25272   - REPAIR, TENDON OR MUSCLE, EXTENSOR, FOREARM AND/OR WRIST; SECONDARY, SINGLE,
25274   - REPAIR, TENDON OR MUSCLE, EXTENSOR, FOREARM AND/OR WRIST; SECONDARY, WITH FREE
25275   - REPAIR, TENDON SHEATH, EXTENSOR, FOREARM AND/OR WRIST, WITH FREE GRAFT
25280   - LENGTHENING OR SHORTENING OF FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR WRIST,
25290   - TENOTOMY, OPEN, FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR WRIST, SINGLE, EACH
25295   - TENOLYSIS, FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR WRIST, SINGLE, EACH TENDON
25300   - TENODESIS AT WRIST; FLEXORS OF FINGERS
25301   - TENODESIS AT WRIST; EXTENSORS OF FINGERS
25310   - TENDON TRANSPLANTATION OR TRANSFER, FLEXOR OR EXTENSOR, FOREARM AND/OR WRIST,
25312   - TENDON TRANSPLANTATION OR TRANSFER, FLEXOR OR EXTENSOR, FOREARM AND/OR WRIST,
25315   - FLEXOR ORIGIN SLIDE (EG, FOR CEREBRAL PALSY, VOLKMANN CONTRACTURE), FOREARM
25316   - FLEXOR ORIGIN SLIDE (EG, FOR CEREBRAL PALSY, VOLKMANN CONTRACTURE), FOREARM
25320   - CAPSULORRHAPHY OR RECONSTRUCTION, WRIST, OPEN (EG, CAPSULODESIS, LIGAMENT
25332   - ARTHROPLASTY, WRIST, WITH OR WITHOUT INTERPOSITION, WITH OR WITHOUT EXTERNAL OR
25335   - CENTRALIZATION OF WRIST ON ULNA (EG, RADIAL CLUB HAND)
25337   - RECONSTRUCTION FOR STABILIZATION OF UNSTABLE DISTAL ULNA OR DISTAL RADIOULNAR
25350   - OSTEOTOMY, RADIUS; DISTAL THIRD
25355   - OSTEOTOMY, RADIUS; MIDDLE OR PROXIMAL THIRD
25360   - OSTEOTOMY; ULNA
25365   - OSTEOTOMY; RADIUS AND ULNA
25370   - MULTIPLE OSTEOTOMIES, WITH REALIGNMENT ON INTRAMEDULLARY ROD (SOFIELD TYPE
25375   - MULTIPLE OSTEOTOMIES, WITH REALIGNMENT ON INTRAMEDULLARY ROD (SOFIELD TYPE
25390   - OSTEOPLASTY, RADIUS OR ULNA; SHORTENING
25391   - OSTEOPLASTY, RADIUS OR ULNA; LENGTHENING WITH AUTOGRAFT
25392   - OSTEOPLASTY, RADIUS AND ULNA; SHORTENING (EXCLUDING 64876)
25393   - OSTEOPLASTY, RADIUS AND ULNA; LENGTHENING WITH AUTOGRAFT
25394   - OSTEOPLASTY, CARPAL BONE, SHORTENING
25400   - REPAIR OF NONUNION OR MALUNION, RADIUS OR ULNA; WITHOUT GRAFT (EG, COMPRESSION
25405   - REPAIR OF NONUNION OR MALUNION, RADIUS OR ULNA; WITH AUTOGRAFT (INCLUDES
25415   - REPAIR OF NONUNION OR MALUNION, RADIUS AND ULNA; WITHOUT GRAFT (EG, COMPRESSION
25420   - REPAIR OF NONUNION OR MALUNION, RADIUS AND ULNA; WITH AUTOGRAFT (INCLUDES
25425   - REPAIR OF DEFECT WITH AUTOGRAFT; RADIUS OR ULNA
25426   - REPAIR OF DEFECT WITH AUTOGRAFT; RADIUS AND ULNA
25430   - INSERTION OF VASCULAR PEDICLE INTO CARPAL BONE (EG, HORI PROCEDURE)
25431   - REPAIR OF NONUNION OF CARPAL BONE (EXCLUDING CARPAL SCAPHOID (NAVICULAR))
25440   - REPAIR OF NONUNION, SCAPHOID CARPAL (NAVICULAR) BONE, WITH OR WITHOUT RADIAL
25441   - ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; DISTAL RADIUS
25442   - ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; DISTAL ULNA
25443   - ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; SCAPHOID CARPAL (NAVICULAR)
25444   - ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; LUNATE
25445   - ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; TRAPEZIUM
25446   - ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; DISTAL RADIUS AND PARTIAL OR ENTIRE
25447   - ARTHROPLASTY, INTERPOSITION, INTERCARPAL OR CARPOMETACARPAL JOINTS
25449   - REVISION OF ARTHROPLASTY, INCLUDING REMOVAL OF IMPLANT, WRIST JOINT
25450   - EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING; DISTAL RADIUS OR ULNA
25455   - EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING; DISTAL RADIUS AND ULNA
25490   - PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT
25491   - PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT



                                               Page 88
                                     Surgery (triggers bundling)


25492   - PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT
25500   - CLOSED TREATMENT OF RADIAL SHAFT FRACTURE; WITHOUT MANIPULATION
25505   - CLOSED TREATMENT OF RADIAL SHAFT FRACTURE; WITH MANIPULATION
25515   - OPEN TREATMENT OF RADIAL SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFOR
25520   - CLOSED TREATMENT OF RADIAL SHAFT FRACTURE AND CLOSED TREATMENT OF DISLOCATION
25525   - OPEN TREATMENT OF RADIAL SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFOR
25526   - OPEN TREATMENT OF RADIAL SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFOR
25530   - CLOSED TREATMENT OF ULNAR SHAFT FRACTURE; WITHOUT MANIPULATION
25535   - CLOSED TREATMENT OF ULNAR SHAFT FRACTURE; WITH MANIPULATION
25545   - OPEN TREATMENT OF ULNAR SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORM
25560   - CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES; WITHOUT MANIPULATION
25565   - CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES; WITH MANIPULATION
25574   - OPEN TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES, WITH INTERNAL FIXATION, WHEN
25575   - OPEN TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES, WITH INTERNAL FIXATION, WHEN
25600   - CLOSED TREATMENT OF DISTAL RADIAL FRACTURE (EG, COLLES OR SMITH TYPE) OR EPIPHYS
25605   - CLOSED TREATMENT OF DISTAL RADIAL FRACTURE (EG, COLLES OR SMITH TYPE) OR
25606   - PERCUTANEOUS SKELETAL FIXATION OF DISTAL RADIAL FRACTURE OR EPIPHYSEAL SEPARATIO
25607   - OPEN TREATMENT OF DISTAL RADIAL EXTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATIO
25608   - OPEN TREATMENT OF DISTAL RADIAL INTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATIO
25609   - OPEN TREATMENT OF DISTAL RADIAL INTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATIO
25622   - CLOSED TREATMENT OF CARPAL SCAPHOID (NAVICULAR) FRACTURE; WITHOUT MANIPULATION
25624   - CLOSED TREATMENT OF CARPAL SCAPHOID (NAVICULAR) FRACTURE; WITH MANIPULATION
25628   - OPEN TREATMENT OF CARPAL SCAPHOID (NAVICULAR) FRACTURE, INCLUDES INTERNAL FIXATI
25630   - CLOSED TREATMENT OF CARPAL BONE FRACTURE (EXCLUDING CARPAL SCAPHOID
25635   - CLOSED TREATMENT OF CARPAL BONE FRACTURE (EXCLUDING CARPAL SCAPHOID
25645   - OPEN TREATMENT OF CARPAL BONE FRACTURE (OTHER THAN CARPAL SCAPHOID
25650   - CLOSED TREATMENT OF ULNAR STYLOID FRACTURE
25651   - PERCUTANEOUS SKELETAL FIXATION OF ULNAR STYLOID FRACTURE
25652   - OPEN TREATMENT OF ULNAR STYLOID FRACTURE
25660   - CLOSED TREATMENT OF RADIOCARPAL OR INTERCARPAL DISLOCATION, ONE OR MORE BONES,
25670   - OPEN TREATMENT OF RADIOCARPAL OR INTERCARPAL DISLOCATION, ONE OR MORE BONES
25671   - PERCUTANEOUS SKELETAL FIXATION OF DISTAL RADIOULNAR DISLOCATION
25675   - CLOSED TREATMENT OF DISTAL RADIOULNAR DISLOCATION WITH MANIPULATION
25676   - OPEN TREATMENT OF DISTAL RADIOULNAR DISLOCATION, ACUTE OR CHRONIC
25680   - CLOSED TREATMENT OF TRANS-SCAPHOPERILUNAR TYPE OF FRACTURE DISLOCATION, WITH
25685   - OPEN TREATMENT OF TRANS-SCAPHOPERILUNAR TYPE OF FRACTURE DISLOCATION
25690   - CLOSED TREATMENT OF LUNATE DISLOCATION, WITH MANIPULATION
25695   - OPEN TREATMENT OF LUNATE DISLOCATION
25800   - ARTHRODESIS, WRIST; COMPLETE, WITHOUT BONE GRAFT (INCLUDES RADIOCARPAL AND/ OR I
25805   - ARTHRODESIS, WRIST; WITH SLIDING GRAFT
25810   - ARTHRODESIS, WRIST; WITH ILIAC OR OTHER AUTOGRAFT (INCLUDES OBTAINING GRAFT)
25820   - ARTHRODESIS, WRIST; LIMITED, WITHOUT BONE GRAFT (EG, INTERCARPAL OR RADIOCARPAL)
25825   - ARTHRODESIS, WRIST; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT)
25830   - ARTHRODESIS, DISTAL RADIOULNAR JOINT WITH SEGMENTAL RESECTION OF ULNA, WITH OR
25907   - AMPUTATION, FOREARM, THROUGH RADIUS AND ULNA; SECONDARY CLOSURE OR SCAR REVISION
25922   - DISARTICULATION THROUGH WRIST; SECONDARY CLOSURE OR SCAR REVISION
25929   - TRANSMETACARPAL AMPUTATION; SECONDARY CLOSURE OR SCAR REVISION
25999   - UNLISTED PROCEDURE, FOREARM OR WRIST
26010   - DRAINAGE OF FINGER ABSCESS; SIMPLE
26011   - DRAINAGE OF FINGER ABSCESS; COMPLICATED (EG, FELON)
26020   - DRAINAGE OF TENDON SHEATH, DIGIT AND/OR PALM, EACH
26025   - DRAINAGE OF PALMAR BURSA; SINGLE, BURSA
26030   - DRAINAGE OF PALMAR BURSA; MULTIPLE BURSA
26034   - INCISION, BONE CORTEX, HAND OR FINGER (EG, OSTEOMYELITIS OR BONE ABSCESS)
26035   - DECOMPRESSION FINGERS AND/OR HAND, INJECTION INJURY (EG, GREASE GUN)



                                              Page 89
                                     Surgery (triggers bundling)


26037   - DECOMPRESSIVE FASCIOTOMY, HAND (EXCLUDES 26035)
26040   - FASCIOTOMY, PALMAR (EG, DUPUYTREN'S CONTRACTURE); PERCUTANEOUS
26045   - FASCIOTOMY, PALMAR (EG, DUPUYTREN'S CONTRACTURE); OPEN, PARTIAL
26055   - TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER)
26060   - TENOTOMY, PERCUTANEOUS, SINGLE, EACH DIGIT
26070   - ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY;
26075   - ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY;
26080   - ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY;
26100   - ARTHROTOMY WITH BIOPSY; CARPOMETACARPAL JOINT, EACH
26105   - ARTHROTOMY WITH BIOPSY; METACARPOPHALANGEAL JOINT, EACH
26110   - ARTHROTOMY WITH BIOPSY; INTERPHALANGEAL JOINT, EACH
26111   - Excision, tumor or vascular malformation, soft tissue of hand or finger,subcutan
26113   - Excision, tumor, soft tissue, or vascular malformation, of hand or finger, subfa
26115   - EXCISION, TUMOR OR VASCULAR MALFORMATION, SOFT TISSUE OF HAND OR FINGER, SUBCUTA
26116   - EXCISION, TUMOR, SOFT TISSUE, OR VASCULAR MALFORMATION, OF HAND OR FINGER, SUBFA
26117   - RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF HAND OR FING
26118   - Radical resection of tumor (eg, malignant neoplasm), soft tissue of hand or fing
26121   - FASCIECTOMY, PALM ONLY, WITH OR WITHOUT Z-PLASTY, OTHER LOCAL TISSUE
26123   - FASCIECTOMY, PARTIAL PALMAR WITH RELEASE OF SINGLE DIGIT INCLUDING PROXIMAL
26125   - FASCIECTOMY, PARTIAL PALMAR WITH RELEASE OF SINGLE DIGIT INCLUDING PROXIMAL
26130   - SYNOVECTOMY, CARPOMETACARPAL JOINT
26135   - SYNOVECTOMY, METACARPOPHALANGEAL JOINT INCLUDING INTRINSIC RELEASE AND EXTENSOR
26140   - SYNOVECTOMY, PROXIMAL INTERPHALANGEAL JOINT, INCLUDING EXTENSOR RECONSTRUCTION,
26145   - SYNOVECTOMY, TENDON SHEATH, RADICAL (TENOSYNOVECTOMY), FLEXOR TENDON, PALM
26160   - EXCISION OF LESION OF TENDON SHEATH OR JOINT CAPSULE (EG, CYST, MUCOUS CYST, OR
26170   - EXCISION OF TENDON, PALM, FLEXOR OR EXTENSOR, SINGLE, EACH TENDON
26180   - EXCISION OF TENDON, FINGER, FLEXOR OR EXTENSOR, EACH TENDON
26185   - SESAMOIDECTOMY, THUMB OR FINGER (SEPARATE PROCEDURE)
26200   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF METACARPAL;
26205   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF METACARPAL; WITH
26210   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL, MIDDLE, OR
26215   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL, MIDDLE, OR
26230   - PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG,
26235   - PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG,
26236   - PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG,
26250   - RADICAL RESECTION OF TUMOR, METACARPAL
26260   - RADICAL RESECTION OF TUMOR, PROXIMAL OR MIDDLE PHALANX OF FINGER
26262   - RADICAL RESECTION OF TUMOR, DISTAL PHALANX OF FINGER
26320   - REMOVAL OF IMPLANT FROM FINGER OR HAND
26340   - MANIPULATION, FINGER JOINT, UNDER ANESTHESIA, EACH JOINT
26350   - REPAIR OR ADVANCEMENT, FLEXOR TENDON, NOT IN ZONE 2 DIGITAL FLEXOR TENDON
26352   - REPAIR OR ADVANCEMENT, FLEXOR TENDON, NOT IN ZONE 2 DIGITAL FLEXOR TENDON
26356   - REPAIR OR ADVANCEMENT, FLEXOR TENDON, IN ZONE 2 DIGITAL FLEXOR TENDON SHEATH
26357   - REPAIR OR ADVANCEMENT, FLEXOR TENDON, IN ZONE 2 DIGITAL FLEXOR TENDON SHEATH
26358   - REPAIR OR ADVANCEMENT, FLEXOR TENDON, IN ZONE 2 DIGITAL FLEXOR TENDON SHEATH
26370   - REPAIR OR ADVANCEMENT OF PROFUNDUS TENDON, WITH INTACT SUPERFICIALIS TENDON;
26372   - REPAIR OR ADVANCEMENT OF PROFUNDUS TENDON, WITH INTACT SUPERFICIALIS TENDON;
26373   - REPAIR OR ADVANCEMENT OF PROFUNDUS TENDON, WITH INTACT SUPERFICIALIS TENDON;
26390   - EXCISION FLEXOR TENDON, WITH IMPLANTATION OF SYNTHETIC ROD FOR DELAYED TENDON
26392   - REMOVAL OF SYNTHETIC ROD AND INSERTION OF FLEXOR TENDON GRAFT, HAND OR FINGER
26410   - REPAIR, EXTENSOR TENDON, HAND, PRIMARY OR SECONDARY; WITHOUT FREE GRAFT, EACH
26412   - REPAIR, EXTENSOR TENDON, HAND, PRIMARY OR SECONDARY; WITH FREE GRAFT (INCLUDES
26415   - EXCISION OF EXTENSOR TENDON, WITH IMPLANTATION OF SYNTHETIC ROD FOR DELAYED
26416   - REMOVAL OF SYNTHETIC ROD AND INSERTION OF EXTENSOR TENDON GRAFT (INCLUDES
26418   - REPAIR, EXTENSOR TENDON, FINGER, PRIMARY OR SECONDARY; WITHOUT FREE GRAFT, EACH



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                                     Surgery (triggers bundling)


26420   - REPAIR, EXTENSOR TENDON, FINGER, PRIMARY OR SECONDARY; WITH FREE GRAFT
26426   - REPAIR OF EXTENSOR TENDON, CENTRAL SLIP, SECONDARY (EG, BOUTONNIERE DEFORMITY);
26428   - REPAIR OF EXTENSOR TENDON, CENTRAL SLIP, SECONDARY (EG, BOUTONNIERE DEFORMITY);
26432   - CLOSED TREATMENT OF DISTAL EXTENSOR TENDON INSERTION, WITH OR WITHOUT
26433   - REPAIR OF EXTENSOR TENDON, DISTAL INSERTION, PRIMARY OR SECONDARY; WITHOUT
26434   - REPAIR OF EXTENSOR TENDON, DISTAL INSERTION, PRIMARY OR SECONDARY; WITH FREE
26437   - REALIGNMENT OF EXTENSOR TENDON, HAND, EACH TENDON
26440   - TENOLYSIS, FLEXOR TENDON; PALM OR FINGER, EACH TENDON
26442   - TENOLYSIS, FLEXOR TENDON; PALM AND FINGER, EACH TENDON
26445   - TENOLYSIS, EXTENSOR TENDON, HAND OR FINGER, EACH TENDON
26449   - TENOLYSIS, COMPLEX, EXTENSOR TENDON, FINGER, INCLUDING FOREARM, EACH TENDON
26450   - TENOTOMY, FLEXOR, PALM, OPEN, EACH TENDON
26455   - TENOTOMY, FLEXOR, FINGER, OPEN, EACH TENDON
26460   - TENOTOMY, EXTENSOR, HAND OR FINGER, OPEN, EACH TENDON
26471   - TENODESIS; OF PROXIMAL INTERPHALANGEAL JOINT, EACH JOINT
26474   - TENODESIS; OF DISTAL JOINT, EACH JOINT
26476   - LENGTHENING OF TENDON, EXTENSOR, HAND OR FINGER, EACH TENDON
26477   - SHORTENING OF TENDON, EXTENSOR, HAND OR FINGER, EACH TENDON
26478   - LENGTHENING OF TENDON, FLEXOR, HAND OR FINGER, EACH TENDON
26479   - SHORTENING OF TENDON, FLEXOR, HAND OR FINGER, EACH TENDON
26480   - TRANSFER OR TRANSPLANT OF TENDON, CARPOMETACARPAL AREA OR DORSUM OF HAND;
26483   - TRANSFER OR TRANSPLANT OF TENDON, CARPOMETACARPAL AREA OR DORSUM OF HAND; WITH
26485   - TRANSFER OR TRANSPLANT OF TENDON, PALMAR; WITHOUT FREE TENDON GRAFT, EACH TENDON
26489   - TRANSFER OR TRANSPLANT OF TENDON, PALMAR; WITH FREE TENDON GRAFT (INCLUDES
26490   - OPPONENSPLASTY; SUPERFICIALIS TENDON TRANSFER TYPE, EACH TENDON
26492   - OPPONENSPLASTY; TENDON TRANSFER WITH GRAFT (INCLUDES OBTAINING GRAFT), EACH
26494   - OPPONENSPLASTY; HYPOTHENAR MUSCLE TRANSFER
26496   - OPPONENSPLASTY; OTHER METHODS
26497   - TRANSFER OF TENDON TO RESTORE INTRINSIC FUNCTION; RING AND SMALL FINGER
26498   - TRANSFER OF TENDON TO RESTORE INTRINSIC FUNCTION; ALL FOUR FINGERS
26499   - CORRECTION CLAW FINGER, OTHER METHODS
26500   - RECONSTRUCTION OF TENDON PULLEY, EACH TENDON; WITH LOCAL TISSUES (SEPARATE
26502   - RECONSTRUCTION OF TENDON PULLEY, EACH TENDON; WITH TENDON OR FASCIAL GRAFT
26508   - RELEASE OF THENAR MUSCLE(S) (EG, THUMB CONTRACTURE)
26510   - CROSS INTRINSIC TRANSFER, EACH TENDON
26516   - CAPSULODESIS, METACARPOPHALANGEAL JOINT; SINGLE DIGIT
26517   - CAPSULODESIS, METACARPOPHALANGEAL JOINT; TWO DIGITS
26518   - CAPSULODESIS, METACARPOPHALANGEAL JOINT; THREE OR FOUR DIGITS
26520   - CAPSULECTOMY OR CAPSULOTOMY; METACARPOPHALANGEAL JOINT, EACH JOINT
26525   - CAPSULECTOMY OR CAPSULOTOMY; INTERPHALANGEAL JOINT, EACH JOINT
26530   - ARTHROPLASTY, METACARPOPHALANGEAL JOINT; EACH JOINT
26531   - ARTHROPLASTY, METACARPOPHALANGEAL JOINT; WITH PROSTHETIC IMPLANT, EACH JOINT
26535   - ARTHROPLASTY, INTERPHALANGEAL JOINT; EACH JOINT
26536   - ARTHROPLASTY, INTERPHALANGEAL JOINT; WITH PROSTHETIC IMPLANT, EACH JOINT
26540   - REPAIR OF COLLATERAL LIGAMENT, METACARPOPHALANGEAL OR INTERPHALANGEAL JOINT
26541   - RECONSTRUCTION, COLLATERAL LIGAMENT, METACARPOPHALANGEAL JOINT, SINGLE; WITH
26542   - RECONSTRUCTION, COLLATERAL LIGAMENT, METACARPOPHALANGEAL JOINT, SINGLE; WITH
26545   - RECONSTRUCTION, COLLATERAL LIGAMENT, INTERPHALANGEAL JOINT, SINGLE, INCLUDING
26546   - REPAIR NON-UNION, METACARPAL OR PHALANX, (INCLUDES OBTAINING BONE GRAFT WITH OR
26548   - REPAIR AND RECONSTRUCTION, FINGER, VOLAR PLATE, INTERPHALANGEAL JOINT
26550   - POLLICIZATION OF A DIGIT
26555   - TRANSFER, FINGER TO ANOTHER POSITION WITHOUT MICROVASCULAR ANASTOMOSIS
26560   - REPAIR OF SYNDACTYLY (WEB FINGER) EACH WEB SPACE; WITH SKIN FLAPS
26561   - REPAIR OF SYNDACTYLY (WEB FINGER) EACH WEB SPACE; WITH SKIN FLAPS AND GRAFTS
26562   - REPAIR OF SYNDACTYLY (WEB FINGER) EACH WEB SPACE; COMPLEX (EG, INVOLVING BONE,



                                              Page 91
                                     Surgery (triggers bundling)


26565   - OSTEOTOMY; METACARPAL, EACH
26567   - OSTEOTOMY; PHALANX OF FINGER, EACH
26568   - OSTEOPLASTY, LENGTHENING, METACARPAL OR PHALANX
26580   - REPAIR CLEFT HAND
26587   - RECONSTRUCTION OF POLYDACTYLOUS DIGIT, SOFT TISSUE AND BONE
26590   - REPAIR MACRODACTYLIA, EACH DIGIT
26591   - REPAIR, INTRINSIC MUSCLES OF HAND, EACH MUSCLE
26593   - RELEASE, INTRINSIC MUSCLES OF HAND, EACH MUSCLE
26596   - EXCISION OF CONSTRICTING RING OF FINGER, WITH MULTIPLE Z-PLASTIES
26600   - CLOSED TREATMENT OF METACARPAL FRACTURE, SINGLE; WITHOUT MANIPULATION, EACH BONE
26605   - CLOSED TREATMENT OF METACARPAL FRACTURE, SINGLE; WITH MANIPULATION, EACH BONE
26607   - CLOSED TREATMENT OF METACARPAL FRACTURE, WITH MANIPULATION, WITH EXTERNAL
26608   - PERCUTANEOUS SKELETAL FIXATION OF METACARPAL FRACTURE, EACH BONE
26615   - OPEN TREATMENT OF METACARPAL FRACTURE, SINGLE, INCLUDES INTERNAL FIXATION, WHEN
26641   - CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION, THUMB, WITH MANIPULATION
26645   - CLOSED TREATMENT OF CARPOMETACARPAL FRACTURE DISLOCATION, THUMB (BENNETT
26650   - PERCUTANEOUS SKELETAL FIXATION OF CARPOMETACARPAL FRACTURE DISLOCATION, THUMB (B
26665   - OPEN TREATMENT OF CARPOMETACARPAL FRACTURE DISLOCATION, THUMB (BENNETT FRACTURE)
26670   - CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB, WITH
26675   - CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB, WITH
26676   - PERCUTANEOUS SKELETAL FIXATION OF CARPOMETACARPAL DISLOCATION, OTHER THAN
26685   - OPEN TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB; INCLUDES INTERN
26686   - OPEN TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB; COMPLEX,
26700   - CLOSED TREATMENT OF METACARPOPHALANGEAL DISLOCATION, SINGLE, WITH MANIPULATION;
26705   - CLOSED TREATMENT OF METACARPOPHALANGEAL DISLOCATION, SINGLE, WITH MANIPULATION;
26706   - PERCUTANEOUS SKELETAL FIXATION OF METACARPOPHALANGEAL DISLOCATION, SINGLE, WITH
26715   - OPEN TREATMENT OF METACARPOPHALANGEAL DISLOCATION, SINGLE, INCLUDES INTERNAL FIX
26720   - CLOSED TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX,
26725   - CLOSED TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX,
26727   - PERCUTANEOUS SKELETAL FIXATION OF UNSTABLE PHALANGEAL SHAFT FRACTURE, PROXIMAL
26735   - OPEN TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER
26740   - CLOSED TREATMENT OF ARTICULAR FRACTURE, INVOLVING METACARPOPHALANGEAL OR
26742   - CLOSED TREATMENT OF ARTICULAR FRACTURE, INVOLVING METACARPOPHALANGEAL OR
26746   - OPEN TREATMENT OF ARTICULAR FRACTURE, INVOLVING METACARPOPHALANGEAL OR INTERPHAL
26750   - CLOSED TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB; WITHOUT
26755   - CLOSED TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB; WITH
26756   - PERCUTANEOUS SKELETAL FIXATION OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB,
26765   - OPEN TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB, INCLUDES INTERNAL
26770   - CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE, WITH
26775   - CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE, WITH
26776   - PERCUTANEOUS SKELETAL FIXATION OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE,
26785   - OPEN TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, INCLUDES INTERNAL FIXATION,
26820   - FUSION IN OPPOSITION, THUMB, WITH AUTOGENOUS GRAFT (INCLUDES OBTAINING GRAFT)
26841   - ARTHRODESIS, CARPOMETACARPAL JOINT, THUMB, WITH OR WITHOUT INTERNAL FIXATION;
26842   - ARTHRODESIS, CARPOMETACARPAL JOINT, THUMB, WITH OR WITHOUT INTERNAL FIXATION;
26843   - ARTHRODESIS, CARPOMETACARPAL JOINT, DIGIT, OTHER THAN THUMB, EACH;
26844   - ARTHRODESIS, CARPOMETACARPAL JOINT, DIGIT, OTHER THAN THUMB, EACH; WITH
26850   - ARTHRODESIS, METACARPOPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION;
26852   - ARTHRODESIS, METACARPOPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION; WITH
26860   - ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION;
26861   - ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION; EACH
26862   - ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION; WITH
26863   - ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION; WITH
26910   - AMPUTATION, METACARPAL, WITH FINGER OR THUMB (RAY AMPUTATION), SINGLE, WITH OR W
26951   - AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX,



                                              Page 92
                                      Surgery (triggers bundling)


26952   - AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX,
26989   - UNLISTED PROCEDURE, HANDS OR FINGERS
26990   - INCISION AND DRAINAGE, PELVIS OR HIP JOINT AREA; DEEP ABSCESS OR HEMATOMA
26991   - INCISION AND DRAINAGE, PELVIS OR HIP JOINT AREA; INFECTED BURSA
27000   - TENOTOMY, ADDUCTOR OF HIP, PERCUTANEOUS (SEPARATE PROCEDURE)
27001   - TENOTOMY, ADDUCTOR OF HIP, OPEN
27003   - TENOTOMY, ADDUCTOR, SUBCUTANEOUS, OPEN, WITH OBTURATOR NEURECTOMY
27027   - Decompression fasciotomy(ies), pelvic (buttock) compartment(s) (eg, gluteus medi
27033   - ARTHROTOMY, HIP, INCLUDING EXPLORATION OR REMOVAL OF LOOSE OR FOREIGN BODY
27035   - DENERVATION, HIP JOINT, INTRAPELVIC OR EXTRAPELVIC INTRA-ARTICULAR BRANCHES OF
27040   - BIOPSY, SOFT TISSUE OF PELVIS AND HIP AREA; SUPERFICIAL
27041   - BIOPSY, SOFT TISSUE OF PELVIS AND HIP AREA; DEEP, SUBFASCIAL OR INTRAMUSCULAR
27043   - Excision, tumor, soft tissue of pelvis and hip area, subcutaneous; 3 cm or great
27045   - Excision, tumor, soft tissue of pelvis and hip area, subfascial (eg, intramuscul
27047   - EXCISION, TUMOR, SOFT TISSUE OF PELVIS AND HIP AREA, SUBCUTANEOUS; LESS THAN 3 C
27048   - EXCISION, TUMOR, SOFT TISSUE OF PELVIS AND HIP AREA, SUBFASCIAL (EG, INTRAMUSCUL
27049   - RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF PELVIS AND H
27050   - ARTHROTOMY, WITH BIOPSY; SACROILIAC JOINT
27052   - ARTHROTOMY, WITH BIOPSY; HIP JOINT
27057   - Decompression fasciotomy(ies), pelvic (buttock) compartment(s) (eg, gluteus medi
27059   - Radical resection of tumor (eg, malignant neoplasm), soft tissue of pelvis and h
27060   - EXCISION; ISCHIAL BURSA
27062   - EXCISION; TROCHANTERIC BURSA OR CALCIFICATION
27065   - EXCISION OF BONE CYST OR BENIGN TUMOR; SUPERFICIAL (WING OF ILIUM, SYMPHYSIS
27066   - EXCISION OF BONE CYST OR BENIGN TUMOR; DEEP, WITH OR WITHOUT AUTOGRAFT
27067   - EXCISION OF BONE CYST OR BENIGN TUMOR; WITH AUTOGRAFT REQUIRING SEPARATE
27080   - COCCYGECTOMY, PRIMARY
27086   - REMOVAL OF FOREIGN BODY, PELVIS OR HIP; SUBCUTANEOUS TISSUE
27087   - REMOVAL OF FOREIGN BODY, PELVIS OR HIP; DEEP (SUBFASCIAL OR INTRAMUSCULAR)
27097   - RELEASE OR RECESSION, HAMSTRING, PROXIMAL
27098   - TRANSFER, ADDUCTOR TO ISCHIUM
27100   - TRANSFER EXTERNAL OBLIQUE MUSCLE TO GREATER TROCHANTER INCLUDING FASCIAL OR
27105   - TRANSFER PARASPINAL MUSCLE TO HIP (INCLUDES FASCIAL OR TENDON EXTENSION GRAFT)
27110   - TRANSFER ILIOPSOAS; TO GREATER TROCHANTER OF FEMUR
27111   - TRANSFER ILIOPSOAS; TO FEMORAL NECK
27193   - CLOSED TREATMENT OF PELVIC RING FRACTURE, DISLOCATION, DIASTASIS OR SUBLUXATION;
27194   - CLOSED TREATMENT OF PELVIC RING FRACTURE, DISLOCATION, DIASTASIS OR
27200   - CLOSED TREATMENT OF COCCYGEAL FRACTURE
27202   - OPEN TREATMENT OF COCCYGEAL FRACTURE
27220   - CLOSED TREATMENT OF ACETABULUM (HIP SOCKET) FRACTURE(S); WITHOUT MANIPULATION
27230   - CLOSED TREATMENT OF FEMORAL FRACTURE, PROXIMAL END, NECK; WITHOUT MANIPULATION
27235   - PERCUTANEOUS SKELETAL FIXATION OF FEMORAL FRACTURE, PROXIMAL END, NECK
27238   - CLOSED TREATMENT OF INTERTROCHANTERIC, PERTROCHANTERIC, OR SUBTROCHANTERIC
27246   - CLOSED TREATMENT OF GREATER TROCHANTERIC FRACTURE, WITHOUT MANIPULATION
27250   - CLOSED TREATMENT OF HIP DISLOCATION, TRAUMATIC; WITHOUT ANESTHESIA
27252   - CLOSED TREATMENT OF HIP DISLOCATION, TRAUMATIC; REQUIRING ANESTHESIA
27256   - TREATMENT OF SPONTANEOUS HIP DISLOCATION (DEVELOPMENTAL, INCLUDING CONGENITAL
27257   - TREATMENT OF SPONTANEOUS HIP DISLOCATION (DEVELOPMENTAL, INCLUDING CONGENITAL
27265   - CLOSED TREATMENT OF POST HIP ARTHROPLASTY DISLOCATION; WITHOUT ANESTHESIA
27266   - CLOSED TREATMENT OF POST HIP ARTHROPLASTY DISLOCATION; REQUIRING REGIONAL OR
27267   - CLOSED TREATMENT OF FEMORAL FRACTURE, PROXIMAL END, HEAD; WITHOUT MANIPULATION
27275   - MANIPULATION, HIP JOINT, REQUIRING GENERAL ANESTHESIA
27299   - UNLISTED PROCEDURE, PELVIS OR HIP JOINT
27301   - INCISION AND DRAINAGE, DEEP ABSCESS, BURSA, OR HEMATOMA, THIGH OR KNEE REGION
27305   - FASCIOTOMY, ILIOTIBIAL (TENOTOMY), OPEN



                                               Page 93
                                      Surgery (triggers bundling)


27306   - TENOTOMY, PERCUTANEOUS, ADDUCTOR OR HAMSTRING; SINGLE TENDON (SEPARATE
27307   - TENOTOMY, PERCUTANEOUS, ADDUCTOR OR HAMSTRING; MULTIPLE TENDONS
27310   - ARTHROTOMY, KNEE, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY (EG,
27323   - BIOPSY, SOFT TISSUE OF THIGH OR KNEE AREA; SUPERFICIAL
27324   - BIOPSY, SOFT TISSUE OF THIGH OR KNEE AREA; DEEP (SUBFASCIAL OR INTRAMUSCULAR)
27325   - NEURECTOMY, HAMSTRING MUSCLE
27326   - NEURECTOMY, POPLITEAL (GASTROCNEMIUS)
27327   - EXCISION, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBCUTANEOUS; LESS THAN 3 CM
27328   - EXCISION, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBFASCIAL (EG, INTRAMUSCULA
27329   - EXCISION, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBFASCIAL (EG, INTRAMUSCULA
27330   - ARTHROTOMY, KNEE; WITH SYNOVIAL BIOPSY ONLY
27331   - ARTHROTOMY, KNEE; INCLUDING JOINT EXPLORATION, BIOPSY, OR REMOVAL OF LOOSE OR
27332   - ARTHROTOMY, WITH EXCISION OF SEMILUNAR CARTILAGE (MENISCECTOMY) KNEE; MEDIAL OR
27333   - ARTHROTOMY, WITH EXCISION OF SEMILUNAR CARTILAGE (MENISCECTOMY) KNEE; MEDIAL
27334   - ARTHROTOMY, WITH SYNOVECTOMY, KNEE; ANTERIOR OR POSTERIOR
27335   - ARTHROTOMY, WITH SYNOVECTOMY, KNEE; ANTERIOR AND POSTERIOR INCLUDING POPLITEAL
27337   - Excision, tumor, soft tissue of thigh or knee area, subcutaneous; 3 cm or greate
27339   - Excision, tumor, soft tissue of thigh or knee area, subfascial (eg, intramuscula
27340   - EXCISION, PREPATELLAR BURSA
27345   - EXCISION OF SYNOVIAL CYST OF POPLITEAL SPACE (EG, BAKER'S CYST)
27347   - EXCISION OF LESION OF MENISCUS OR CAPSULE (EG, CYST, GANGLION), KNEE
27350   - PATELLECTOMY OR HEMIPATELLECTOMY
27355   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF FEMUR;
27356   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF FEMUR; WITH ALLOGRAFT
27357   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF FEMUR; WITH AUTOGRAFT
27358   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF FEMUR; WITH INTERNAL
27360   - PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE, FEMUR,
27364   - Radical resection of tumor (eg, malignant neoplasm), soft tissue of thigh or kne
27372   - REMOVAL OF FOREIGN BODY, DEEP, THIGH REGION OR KNEE AREA
27380   - SUTURE OF INFRAPATELLAR TENDON; PRIMARY
27381   - SUTURE OF INFRAPATELLAR TENDON; SECONDARY RECONSTRUCTION, INCLUDING FASCIAL OR
27385   - SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE; PRIMARY
27386   - SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE; SECONDARY RECONSTRUCTION,
27390   - TENOTOMY, OPEN, HAMSTRING, KNEE TO HIP; SINGLE TENDON
27391   - TENOTOMY, OPEN, HAMSTRING, KNEE TO HIP; MULTIPLE TENDONS, ONE LEG
27392   - TENOTOMY, OPEN, HAMSTRING, KNEE TO HIP; MULTIPLE TENDONS, BILATERAL
27393   - LENGTHENING OF HAMSTRING TENDON; SINGLE TENDON
27394   - LENGTHENING OF HAMSTRING TENDON; MULTIPLE TENDONS, ONE LEG
27395   - LENGTHENING OF HAMSTRING TENDON; MULTIPLE TENDONS, BILATERAL
27396   - TRANSPLANT OR TRANSFER (WITH MUSCLE REDIRECTION OR REROUTING), THIGH (EG, EXTENS
27397   - TRANSPLANT OR TRANSFER (WITH MUSCLE REDIRECTION OR REROUTING), THIGH (EG, EXTENS
27400   - TRANSFER, TENDON OR MUSCLE, HAMSTRINGS TO FEMUR (EG, EGGER'S TYPE PROCEDURE)
27403   - ARTHROTOMY WITH MENISCUS REPAIR, KNEE
27405   - REPAIR, PRIMARY, TORN LIGAMENT AND/OR CAPSULE, KNEE; COLLATERAL
27407   - REPAIR, PRIMARY, TORN LIGAMENT AND/OR CAPSULE, KNEE; CRUCIATE
27409   - REPAIR, PRIMARY, TORN LIGAMENT AND/OR CAPSULE, KNEE; COLLATERAL AND CRUCIATE
27412   - AUTOLOGOUS CHONDROCYTE IMPLANTATION, KNEE
27415   - OSTEOCHONDRAL ALLOGRAFT, KNEE, OPEN
27416   - OSTEOCHONDRAL AUTOGRAFT(S), KNEE, OPEN (EG, MOSAICPLASTY) (INCLUDES HARVESTING O
27418   - ANTERIOR TIBIAL TUBERCLEPLASTY (EG, MAQUET TYPE PROCEDURE)
27420   - RECONSTRUCTION OF DISLOCATING PATELLA; (EG, HAUSER TYPE PROCEDURE)
27422   - RECONSTRUCTION OF DISLOCATING PATELLA; WITH EXTENSOR REALIGNMENT AND/OR MUSCLE
27424   - RECONSTRUCTION OF DISLOCATING PATELLA; WITH PATELLECTOMY
27425   - LATERAL RETINACULAR RELEASE, OPEN
27427   - LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE; EXTRA-ARTICULAR



                                               Page 94
                                     Surgery (triggers bundling)


27428   - LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE; INTRA-ARTICULAR (OPEN)
27429   - LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE; INTRA-ARTICULAR (OPEN) AND
27430   - QUADRICEPSPLASTY (EG, BENNETT OR THOMPSON TYPE)
27435   - CAPSULOTOMY, POSTERIOR CAPSULAR RELEASE, KNEE
27437   - ARTHROPLASTY, PATELLA; WITHOUT PROSTHESIS
27438   - ARTHROPLASTY, PATELLA; WITH PROSTHESIS
27440   - ARTHROPLASTY, KNEE, TIBIAL PLATEAU;
27441   - ARTHROPLASTY, KNEE, TIBIAL PLATEAU; WITH DEBRIDEMENT AND PARTIAL SYNOVECTOMY
27442   - ARTHROPLASTY, FEMORAL CONDYLES OR TIBIAL PLATEAU(S), KNEE;
27443   - ARTHROPLASTY, FEMORAL CONDYLES OR TIBIAL PLATEAU(S), KNEE; WITH DEBRIDEMENT AND
27446   - ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL OR LATERAL COMPARTMENT
27475   - ARREST, EPIPHYSEAL, ANY METHOD (EG, EPIPHYSIODESIS); DISTAL FEMUR
27479   - ARREST, EPIPHYSEAL, ANY METHOD (EG, EPIPHYSIODESIS); COMBINED DISTAL FEMUR,
27496   - DECOMPRESSION FASCIOTOMY, THIGH AND/OR KNEE, ONE COMPARTMENT (FLEXOR OR
27497   - DECOMPRESSION FASCIOTOMY, THIGH AND/OR KNEE, ONE COMPARTMENT (FLEXOR OR
27498   - DECOMPRESSION FASCIOTOMY, THIGH AND/OR KNEE, MULTIPLE COMPARTMENTS;
27499   - DECOMPRESSION FASCIOTOMY, THIGH AND/OR KNEE, MULTIPLE COMPARTMENTS; WITH
27500   - CLOSED TREATMENT OF FEMORAL SHAFT FRACTURE, WITHOUT MANIPULATION
27501   - CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR FEMORAL FRACTURE WITH OR
27502   - CLOSED TREATMENT OF FEMORAL SHAFT FRACTURE, WITH MANIPULATION, WITH OR WITHOUT
27503   - CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR FEMORAL FRACTURE WITH OR
27508   - CLOSED TREATMENT OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR LATERAL CONDYLE,
27509   - PERCUTANEOUS SKELETAL FIXATION OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR
27510   - CLOSED TREATMENT OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR LATERAL CONDYLE,
27516   - CLOSED TREATMENT OF DISTAL FEMORAL EPIPHYSEAL SEPARATION; WITHOUT MANIPULATION
27517   - CLOSED TREATMENT OF DISTAL FEMORAL EPIPHYSEAL SEPARATION; WITH MANIPULATION,
27520   - CLOSED TREATMENT OF PATELLAR FRACTURE, WITHOUT MANIPULATION
27524   - OPEN TREATMENT OF PATELLAR FRACTURE, WITH INTERNAL FIXATION AND/OR PARTIAL OR
27530   - CLOSED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); WITHOUT MANIPULATION
27532   - CLOSED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); WITH OR WITHOUT
27538   - CLOSED TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY FRACTURE(S) OF
27550   - CLOSED TREATMENT OF KNEE DISLOCATION; WITHOUT ANESTHESIA
27552   - CLOSED TREATMENT OF KNEE DISLOCATION; REQUIRING ANESTHESIA
27560   - CLOSED TREATMENT OF PATELLAR DISLOCATION; WITHOUT ANESTHESIA
27562   - CLOSED TREATMENT OF PATELLAR DISLOCATION; REQUIRING ANESTHESIA
27566   - OPEN TREATMENT OF PATELLAR DISLOCATION, WITH OR WITHOUT PARTIAL OR TOTAL
27570   - MANIPULATION OF KNEE JOINT UNDER GENERAL ANESTHESIA (INCLUDES APPLICATION OF TRA
27594   - AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL; SECONDARY CLOSURE OR SCAR REVISION
27599   - UNLISTED PROCEDURE, FEMUR OR KNEE
27600   - DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL COMPARTMENTS ONLY
27601   - DECOMPRESSION FASCIOTOMY, LEG; POSTERIOR COMPARTMENT(S) ONLY
27602   - DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL, AND POSTERIOR
27603   - INCISION AND DRAINAGE, LEG OR ANKLE; DEEP ABSCESS OR HEMATOMA
27604   - INCISION AND DRAINAGE, LEG OR ANKLE; INFECTED BURSA
27605   - TENOTOMY, PERCUTANEOUS, ACHILLES TENDON (SEPARATE PROCEDURE); LOCAL ANESTHESIA
27606   - TENOTOMY, PERCUTANEOUS, ACHILLES TENDON (SEPARATE PROCEDURE); GENERAL ANESTHESIA
27607   - INCISION (EG, OSTEOMYELITIS OR BONE ABSCESS), LEG OR ANKLE
27610   - ARTHROTOMY, ANKLE, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY
27612   - ARTHROTOMY, POSTERIOR CAPSULAR RELEASE, ANKLE, WITH OR WITHOUT ACHILLES TENDON
27613   - BIOPSY, SOFT TISSUE OF LEG OR ANKLE AREA; SUPERFICIAL
27614   - BIOPSY, SOFT TISSUE OF LEG OR ANKLE AREA; DEEP (SUBFASCIAL OR INTRAMUSCULAR)
27615   - RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF LEG OR ANKLE
27616   - Radical resection of tumor (eg, malignant neoplasm), soft tissue of leg or ankle
27618   - EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA, SUBCUTANEOUS; LESS THAN 3 CM
27619   - EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA, SUBFASCIAL (EG, INTRAMUSCULAR



                                              Page 95
                                     Surgery (triggers bundling)


27620   - ARTHROTOMY, ANKLE, WITH JOINT EXPLORATION, WITH OR WITHOUT BIOPSY, WITH OR WITHO
27625   - ARTHROTOMY, WITH SYNOVECTOMY, ANKLE;
27626   - ARTHROTOMY, WITH SYNOVECTOMY, ANKLE; INCLUDING TENOSYNOVECTOMY
27630   - EXCISION OF LESION OF TENDON SHEATH OR CAPSULE (EG, CYST OR GANGLION), LEG
27632   - Excision, tumor, soft tissue of leg or ankle area, subcutaneous; 3 cm or greater
27634   - Excision, tumor, soft tissue of leg or ankle area, subfascial (eg, intramuscular
27635   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TIBIA OR FIBULA;
27637   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TIBIA OR FIBULA; WITH
27638   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TIBIA OR FIBULA; WITH
27640   - PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY), BONE (EG, OST
27641   - PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY), BONE (EG, OST
27647   - RADICAL RESECTION OF TUMOR; TALUS OR CALCANEUS
27650   - REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLES TENDON;
27652   - REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLES TENDON; WITH GRAFT
27654   - REPAIR, SECONDARY, ACHILLES TENDON, WITH OR WITHOUT GRAFT
27656   - REPAIR, FASCIAL DEFECT OF LEG
27658   - REPAIR, FLEXOR TENDON, LEG; PRIMARY, WITHOUT GRAFT, EACH TENDON
27659   - REPAIR, FLEXOR TENDON, LEG; SECONDARY, WITH OR WITHOUT GRAFT, EACH TENDON
27664   - REPAIR, EXTENSOR TENDON, LEG; PRIMARY, WITHOUT GRAFT, EACH TENDON
27665   - REPAIR, EXTENSOR TENDON, LEG; SECONDARY, WITH OR WITHOUT GRAFT, EACH TENDON
27675   - REPAIR, DISLOCATING PERONEAL TENDONS; WITHOUT FIBULAR OSTEOTOMY
27676   - REPAIR, DISLOCATING PERONEAL TENDONS; WITH FIBULAR OSTEOTOMY
27680   - TENOLYSIS, FLEXOR OR EXTENSOR TENDON, LEG AND/OR ANKLE; SINGLE, EACH TENDON
27681   - TENOLYSIS, FLEXOR OR EXTENSOR TENDON, LEG AND/OR ANKLE; MULTIPLE TENDONS
27685   - LENGTHENING OR SHORTENING OF TENDON, LEG OR ANKLE; SINGLE TENDON (SEPARATE
27686   - LENGTHENING OR SHORTENING OF TENDON, LEG OR ANKLE; MULTIPLE TENDONS (THROUGH
27687   - GASTROCNEMIUS RECESSION (EG, STRAYER PROCEDURE)
27690   - TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE REDIRECTION OR REROUTING);
27691   - TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE REDIRECTION OR REROUTING);
27692   - TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE REDIRECTION OR REROUTING);
27695   - REPAIR, PRIMARY, DISRUPTED LIGAMENT, ANKLE; COLLATERAL
27696   - REPAIR, PRIMARY, DISRUPTED LIGAMENT, ANKLE; BOTH COLLATERAL LIGAMENTS
27698   - REPAIR, SECONDARY, DISRUPTED LIGAMENT, ANKLE, COLLATERAL (EG, WATSON-JONES
27700   - ARTHROPLASTY, ANKLE;
27704   - REMOVAL OF ANKLE IMPLANT
27705   - OSTEOTOMY; TIBIA
27707   - OSTEOTOMY; FIBULA
27709   - OSTEOTOMY; TIBIA AND FIBULA
27730   - ARREST, EPIPHYSEAL (EPIPHYSIODESIS), OPEN; DISTAL TIBIA
27732   - ARREST, EPIPHYSEAL (EPIPHYSIODESIS), OPEN; DISTAL FIBULA
27734   - ARREST, EPIPHYSEAL (EPIPHYSIODESIS), OPEN; DISTAL TIBIA AND FIBULA
27740   - ARREST, EPIPHYSEAL (EPIPHYSIODESIS), ANY METHOD, COMBINED, PROXIMAL AND DISTAL
27742   - ARREST, EPIPHYSEAL (EPIPHYSIODESIS), ANY METHOD, COMBINED, PROXIMAL AND DISTAL
27745   - PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT
27750   - CLOSED TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE); WI
27752   - CLOSED TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE);
27756   - PERCUTANEOUS SKELETAL FIXATION OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT
27758   - OPEN TREATMENT OF TIBIAL SHAFT FRACTURE, (WITH OR WITHOUT FIBULAR FRACTURE)
27759   - TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE) BY
27760   - CLOSED TREATMENT OF MEDIAL MALLEOLUS FRACTURE; WITHOUT MANIPULATION
27762   - CLOSED TREATMENT OF MEDIAL MALLEOLUS FRACTURE; WITH MANIPULATION, WITH OR
27766   - OPEN TREATMENT OF MEDIAL MALLEOLUS FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PE
27767   - CLOSED TREATMENT OF POSTERIOR MALLEOLUS FRACTURE; WITHOUT MANIPULATION
27768   - CLOSED TREATMENT OF POSTERIOR MALLEOLUS FRACTURE; WITH MANIPULATION
27769   - OPEN TREATMENT OF POSTERIOR MALLEOLUS FRACTURE, INCLUDES INTERNAL FIXATION, WHEN



                                              Page 96
                                     Surgery (triggers bundling)


27780   - CLOSED TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE; WITHOUT MANIPULATION
27781   - CLOSED TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE; WITH MANIPULATION
27784   - OPEN TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE, INCLUDES INTERNAL FIXATION,
27786   - CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS); WITHOUT
27788   - CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS); WITH
27792   - OPEN TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS), INCLUDES INTERNAL
27808   - CLOSED TREATMENT OF BIMALLEOLAR ANKLE FRACTURE (EG, LATERAL AND MEDIAL MALLEOLI,
27810   - CLOSED TREATMENT OF BIMALLEOLAR ANKLE FRACTURE (EG, LATERAL AND MEDIAL MALLEOLI,
27814   - OPEN TREATMENT OF BIMALLEOLAR ANKLE FRACTURE (EG, LATERAL AND MEDIAL MALLEOLI, O
27816   - CLOSED TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE; WITHOUT MANIPULATION
27818   - CLOSED TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE; WITH MANIPULATION
27822   - OPEN TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE, INCLUDES INTERNAL FIXATION, WHEN
27823   - OPEN TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE, INCLUDES INTERNAL FIXATION, WHEN
27824   - CLOSED TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR PORTION OF DISTAL
27825   - CLOSED TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR PORTION OF DISTAL
27826   - OPEN TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR SURFACE/PORTION OF DISTAL
27827   - OPEN TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR SURFACE/PORTION OF DISTAL
27828   - OPEN TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR SURFACE/PORTION OF DISTAL
27829   - OPEN TREATMENT OF DISTAL TIBIOFIBULAR JOINT (SYNDESMOSIS) DISRUPTION, INCLUDES I
27830   - CLOSED TREATMENT OF PROXIMAL TIBIOFIBULAR JOINT DISLOCATION; WITHOUT ANESTHESIA
27831   - CLOSED TREATMENT OF PROXIMAL TIBIOFIBULAR JOINT DISLOCATION; REQUIRING
27832   - OPEN TREATMENT OF PROXIMAL TIBIOFIBULAR JOINT DISLOCATION, INCLUDES INTERNAL FIX
27840   - CLOSED TREATMENT OF ANKLE DISLOCATION; WITHOUT ANESTHESIA
27842   - CLOSED TREATMENT OF ANKLE DISLOCATION; REQUIRING ANESTHESIA, WITH OR WITHOUT
27846   - OPEN TREATMENT OF ANKLE DISLOCATION, WITH OR WITHOUT PERCUTANEOUS SKELETAL
27848   - OPEN TREATMENT OF ANKLE DISLOCATION, WITH OR WITHOUT PERCUTANEOUS SKELETAL
27860   - MANIPULATION OF ANKLE UNDER GENERAL ANESTHESIA (INCLUDES APPLICATION OF TRACTION
27870   - ARTHRODESIS, ANKLE, OPEN
27871   - ARTHRODESIS, TIBIOFIBULAR JOINT, PROXIMAL OR DISTAL
27884   - AMPUTATION, LEG, THROUGH TIBIA AND FIBULA; SECONDARY CLOSURE OR SCAR REVISION
27889   - ANKLE DISARTICULATION
27892   - DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL COMPARTMENTS ONLY, WITH D
27893   - DECOMPRESSION FASCIOTOMY, LEG; POSTERIOR COMPARTMENT(S) ONLY, WITH DEBRIDEMENT
27894   - DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL, AND POSTERIOR
27899   - UNLISTED PROCEDURE, LEG OR ANKLE
28001   - INCISION AND DRAINAGE, BURSA, FOOT
28002   - INCISION AND DRAINAGE BELOW FASCIA, WITH OR WITHOUT TENDON SHEATH INVOLVEMENT,
28003   - INCISION AND DRAINAGE BELOW FASCIA, WITH OR WITHOUT TENDON SHEATH INVOLVEMENT,
28005   - INCISION, BONE CORTEX (EG, OSTEOMYELITIS OR BONE ABSCESS), FOOT
28008   - FASCIOTOMY, FOOT AND/OR TOE
28010   - TENOTOMY, PERCUTANEOUS, TOE; SINGLE TENDON
28011   - TENOTOMY, PERCUTANEOUS, TOE; MULTIPLE TENDONS
28020   - ARTHROTOMY, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN
28022   - ARTHROTOMY, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN
28024   - ARTHROTOMY, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN
28035   - RELEASE, TARSAL TUNNEL (POSTERIOR TIBIAL NERVE DECOMPRESSION)
28039   - Excision, tumor, soft tissue of foot or toe, subcutaneous; 1.5 cm or greater
28041   - Excision, tumor, soft tissue of foot or toe, subfascial (eg, intramuscular); 1.5
28043   - EXCISION, TUMOR, SOFT TISSUE OF FOOT OR TOE, SUBCUTANEOUS; LESS THAN 1.5 CM
28045   - EXCISION, TUMOR, SOFT TISSUE OF FOOT OR TOE, SUBFASCIAL (EG, INTRAMUSCULAR); LES
28046   - RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF FOOT OR TOE;
28047   - Radical resection of tumor (eg, malignant neoplasm), soft tissue of foot or toe;
28050   - ARTHROTOMY WITH BIOPSY; INTERTARSAL OR TARSOMETATARSAL JOINT
28052   - ARTHROTOMY WITH BIOPSY; METATARSOPHALANGEAL JOINT
28054   - ARTHROTOMY WITH BIOPSY; INTERPHALANGEAL JOINT



                                              Page 97
                                      Surgery (triggers bundling)


28055   - NEURECTOMY, INTRINSIC MUSCULATURE OF FOOT
28060   - FASCIECTOMY, PLANTAR FASCIA; PARTIAL (SEPARATE PROCEDURE)
28062   - FASCIECTOMY, PLANTAR FASCIA; RADICAL (SEPARATE PROCEDURE)
28070   - SYNOVECTOMY; INTERTARSAL OR TARSOMETATARSAL JOINT, EACH
28072   - SYNOVECTOMY; METATARSOPHALANGEAL JOINT, EACH
28080   - EXCISION, INTERDIGITAL (MORTON) NEUROMA, SINGLE, EACH
28086   - SYNOVECTOMY, TENDON SHEATH, FOOT; FLEXOR
28088   - SYNOVECTOMY, TENDON SHEATH, FOOT; EXTENSOR
28090   - EXCISION OF LESION, TENDON, TENDON SHEATH, OR CAPSULE (INCLUDING SYNOVECTOMY)
28092   - EXCISION OF LESION, TENDON, TENDON SHEATH, OR CAPSULE (INCLUDING SYNOVECTOMY)
28100   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TALUS OR CALCANEUS;
28102   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TALUS OR CALCANEUS; WITH
28103   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TALUS OR CALCANEUS; WITH
28104   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TARSAL OR METATARSAL,
28106   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TARSAL OR METATARSAL,
28107   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TARSAL OR METATARSAL,
28108   - EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, PHALANGES OF FOOT
28110   - OSTECTOMY, PARTIAL EXCISION, FIFTH METATARSAL HEAD (BUNIONETTE) (SEPARATE
28111   - OSTECTOMY, COMPLETE EXCISION; FIRST METATARSAL HEAD
28112   - OSTECTOMY, COMPLETE EXCISION; OTHER METATARSAL HEAD (SECOND, THIRD OR FOURTH)
28113   - OSTECTOMY, COMPLETE EXCISION; FIFTH METATARSAL HEAD
28114   - OSTECTOMY, COMPLETE EXCISION; ALL METATARSAL HEADS, WITH PARTIAL PROXIMAL
28116   - OSTECTOMY, EXCISION OF TARSAL COALITION
28118   - OSTECTOMY, CALCANEUS;
28119   - OSTECTOMY, CALCANEUS; FOR SPUR, WITH OR WITHOUT PLANTAR FASCIAL RELEASE
28120   - PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR
28122   - PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR
28124   - PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR
28126   - RESECTION, PARTIAL OR COMPLETE, PHALANGEAL BASE, EACH TOE
28130   - TALECTOMY (ASTRAGALECTOMY)
28140   - METATARSECTOMY
28150   - PHALANGECTOMY, TOE, EACH TOE
28153   - RESECTION, CONDYLE(S), DISTAL END OF PHALANX, EACH TOE
28160   - HEMIPHALANGECTOMY OR INTERPHALANGEAL JOINT EXCISION, TOE, PROXIMAL END OF
28171   - RADICAL RESECTION OF TUMOR; TARSAL (EXCEPT TALUS OR CALCANEUS)
28173   - RADICAL RESECTION OF TUMOR; METATARSAL
28175   - RADICAL RESECTION OF TUMOR; PHALANX OF TOE
28190   - REMOVAL OF FOREIGN BODY, FOOT; SUBCUTANEOUS
28192   - REMOVAL OF FOREIGN BODY, FOOT; DEEP
28193   - REMOVAL OF FOREIGN BODY, FOOT; COMPLICATED
28200   - REPAIR, TENDON, FLEXOR, FOOT; PRIMARY OR SECONDARY, WITHOUT FREE GRAFT, EACH TEN
28202   - REPAIR, TENDON, FLEXOR, FOOT; SECONDARY WITH FREE GRAFT, EACH TENDON (INCLUDES
28208   - REPAIR, TENDON, EXTENSOR, FOOT; PRIMARY OR SECONDARY, EACH TENDON
28210   - REPAIR, TENDON, EXTENSOR, FOOT; SECONDARY WITH FREE GRAFT, EACH TENDON
28220   - TENOLYSIS, FLEXOR, FOOT; SINGLE TENDON
28222   - TENOLYSIS, FLEXOR, FOOT; MULTIPLE TENDONS
28225   - TENOLYSIS, EXTENSOR, FOOT; SINGLE TENDON
28226   - TENOLYSIS, EXTENSOR, FOOT; MULTIPLE TENDONS
28230   - TENOTOMY, OPEN, TENDON FLEXOR; FOOT, SINGLE OR MULTIPLE TENDON(S) (SEPARATE
28232   - TENOTOMY, OPEN, TENDON FLEXOR; TOE, SINGLE TENDON (SEPARATE PROCEDURE)
28234   - TENOTOMY, OPEN, EXTENSOR, FOOT OR TOE, EACH TENDON
28238   - RECONSTRUCTION (ADVANCEMENT), POSTERIOR TIBIAL TENDON WITH EXCISION OF
28240   - TENOTOMY, LENGTHENING, OR RELEASE, ABDUCTOR HALLUCIS MUSCLE
28250   - DIVISION OF PLANTAR FASCIA AND MUSCLE (EG, STEINDLER STRIPPING) (SEPARATE
28260   - CAPSULOTOMY, MIDFOOT; MEDIAL RELEASE ONLY (SEPARATE PROCEDURE)



                                               Page 98
                                     Surgery (triggers bundling)


28261   - CAPSULOTOMY, MIDFOOT; WITH TENDON LENGTHENING
28262   - CAPSULOTOMY, MIDFOOT; EXTENSIVE, INCLUDING POSTERIOR TALOTIBIAL CAPSULOTOMY AND
28264   - CAPSULOTOMY, MIDTARSAL (EG, HEYMAN TYPE PROCEDURE)
28270   - CAPSULOTOMY; METATARSOPHALANGEAL JOINT, WITH OR WITHOUT TENORRHAPHY, EACH JOINT
28272   - CAPSULOTOMY; INTERPHALANGEAL JOINT, EACH JOINT (SEPARATE PROCEDURE)
28280   - SYNDACTYLIZATION, TOES (EG, WEBBING OR KELIKIAN TYPE PROCEDURE)
28285   - CORRECTION, HAMMERTOE (EG, INTERPHALANGEAL FUSION, PARTIAL OR TOTAL
28286   - CORRECTION, COCK-UP FIFTH TOE, WITH PLASTIC SKIN CLOSURE (EG, RUIZ-MORA TYPE
28288   - OSTECTOMY, PARTIAL, EXOSTECTOMY OR CONDYLECTOMY, METATARSAL HEAD, EACH
28289   - HALLUX RIGIDUS CORRECTION WITH CHEILECTOMY, DEBRIDEMENT AND CAPSULAR RELEASE OF
28290   - CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUT SESAMOIDECTOMY; SIMPLE
28292   - CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUT SESAMOIDECTOMY; KELLER,
28293   - CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUT SESAMOIDECTOMY; RESECTION
28294   - CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUT SESAMOIDECTOMY; WITH TENDON
28296   - CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUT SESAMOIDECTOMY; WITH
28297   - CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUT SESAMOIDECTOMY; LAPIDUS
28298   - CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUT SESAMOIDECTOMY; BY PHALANX
28299   - CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUT SESAMOIDECTOMY; BY DOUBLE
28300   - OSTEOTOMY; CALCANEUS (EG, DWYER OR CHAMBERS TYPE PROCEDURE), WITH OR WITHOUT
28302   - OSTEOTOMY; TALUS
28304   - OSTEOTOMY, TARSAL BONES, OTHER THAN CALCANEUS OR TALUS;
28305   - OSTEOTOMY, TARSAL BONES, OTHER THAN CALCANEUS OR TALUS; WITH AUTOGRAFT
28306   - OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION,
28307   - OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION,
28308   - OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION,
28309   - OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION,
28310   - OSTEOTOMY, SHORTENING, ANGULAR OR ROTATIONAL CORRECTION; PROXIMAL PHALANX,
28312   - OSTEOTOMY, SHORTENING, ANGULAR OR ROTATIONAL CORRECTION; OTHER PHALANGES, ANY
28313   - RECONSTRUCTION, ANGULAR DEFORMITY OF TOE, SOFT TISSUE PROCEDURES ONLY (EG,
28315   - SESAMOIDECTOMY, FIRST TOE (SEPARATE PROCEDURE)
28320   - REPAIR, NONUNION OR MALUNION; TARSAL BONES
28322   - REPAIR, NONUNION OR MALUNION; METATARSAL, WITH OR WITHOUT BONE GRAFT (INCLUDES
28340   - RECONSTRUCTION, TOE, MACRODACTYLY; SOFT TISSUE RESECTION
28341   - RECONSTRUCTION, TOE, MACRODACTYLY; REQUIRING BONE RESECTION
28344   - RECONSTRUCTION, TOE(S); POLYDACTYLY
28345   - RECONSTRUCTION, TOE(S); SYNDACTYLY, WITH OR WITHOUT SKIN GRAFT(S), EACH WEB
28360   - RECONSTRUCTION, CLEFT FOOT
28400   - CLOSED TREATMENT OF CALCANEAL FRACTURE; WITHOUT MANIPULATION
28405   - CLOSED TREATMENT OF CALCANEAL FRACTURE; WITH MANIPULATION
28406   - PERCUTANEOUS SKELETAL FIXATION OF CALCANEAL FRACTURE, WITH MANIPULATION
28415   - OPEN TREATMENT OF CALCANEAL FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
28420   - OPEN TREATMENT OF CALCANEAL FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
28430   - CLOSED TREATMENT OF TALUS FRACTURE; WITHOUT MANIPULATION
28435   - CLOSED TREATMENT OF TALUS FRACTURE; WITH MANIPULATION
28436   - PERCUTANEOUS SKELETAL FIXATION OF TALUS FRACTURE, WITH MANIPULATION
28445   - OPEN TREATMENT OF TALUS FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
28446   - OPEN OSTEOCHONDRAL AUTOGRAFT, TALUS (INCLUDES OBTAINING GRAFT¿S¿)
28450   - TREATMENT OF TARSAL BONE FRACTURE (EXCEPT TALUS AND CALCANEUS); WITHOUT
28455   - TREATMENT OF TARSAL BONE FRACTURE (EXCEPT TALUS AND CALCANEUS); WITH
28456   - PERCUTANEOUS SKELETAL FIXATION OF TARSAL BONE FRACTURE (EXCEPT TALUS AND
28465   - OPEN TREATMENT OF TARSAL BONE FRACTURE (EXCEPT TALUS AND CALCANEUS), INCLUDES IN
28470   - CLOSED TREATMENT OF METATARSAL FRACTURE; WITHOUT MANIPULATION, EACH
28475   - CLOSED TREATMENT OF METATARSAL FRACTURE; WITH MANIPULATION, EACH
28476   - PERCUTANEOUS SKELETAL FIXATION OF METATARSAL FRACTURE, WITH MANIPULATION, EACH
28485   - OPEN TREATMENT OF METATARSAL FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORME



                                              Page 99
                                     Surgery (triggers bundling)


28490   - CLOSED TREATMENT OF FRACTURE GREAT TOE, PHALANX OR PHALANGES; WITHOUT
28495   - CLOSED TREATMENT OF FRACTURE GREAT TOE, PHALANX OR PHALANGES; WITH MANIPULATION
28496   - PERCUTANEOUS SKELETAL FIXATION OF FRACTURE GREAT TOE, PHALANX OR PHALANGES,
28505   - OPEN TREATMENT OF FRACTURE, GREAT TOE, PHALANX OR PHALANGES, INCLUDES INTERNAL F
28510   - CLOSED TREATMENT OF FRACTURE, PHALANX OR PHALANGES, OTHER THAN GREAT TOE;
28515   - CLOSED TREATMENT OF FRACTURE, PHALANX OR PHALANGES, OTHER THAN GREAT TOE; WITH
28525   - OPEN TREATMENT OF FRACTURE, PHALANX OR PHALANGES, OTHER THAN GREAT TOE, INCLUDES
28530   - CLOSED TREATMENT OF SESAMOID FRACTURE
28531   - OPEN TREATMENT OF SESAMOID FRACTURE, WITH OR WITHOUT INTERNAL FIXATION
28540   - CLOSED TREATMENT OF TARSAL BONE DISLOCATION, OTHER THAN TALOTARSAL; WITHOUT
28545   - CLOSED TREATMENT OF TARSAL BONE DISLOCATION, OTHER THAN TALOTARSAL; REQUIRING
28546   - PERCUTANEOUS SKELETAL FIXATION OF TARSAL BONE DISLOCATION, OTHER THAN
28555   - OPEN TREATMENT OF TARSAL BONE DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN PERF
28570   - CLOSED TREATMENT OF TALOTARSAL JOINT DISLOCATION; WITHOUT ANESTHESIA
28575   - CLOSED TREATMENT OF TALOTARSAL JOINT DISLOCATION; REQUIRING ANESTHESIA
28576   - PERCUTANEOUS SKELETAL FIXATION OF TALOTARSAL JOINT DISLOCATION, WITH
28585   - OPEN TREATMENT OF TALOTARSAL JOINT DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN
28600   - CLOSED TREATMENT OF TARSOMETATARSAL JOINT DISLOCATION; WITHOUT ANESTHESIA
28605   - CLOSED TREATMENT OF TARSOMETATARSAL JOINT DISLOCATION; REQUIRING ANESTHESIA
28606   - PERCUTANEOUS SKELETAL FIXATION OF TARSOMETATARSAL JOINT DISLOCATION, WITH
28615   - OPEN TREATMENT OF TARSOMETATARSAL JOINT DISLOCATION, INCLUDES INTERNAL FIXATION,
28630   - CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION; WITHOUT ANESTHESIA
28635   - CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION; REQUIRING ANESTHESIA
28636   - PERCUTANEOUS SKELETAL FIXATION OF METATARSOPHALANGEAL JOINT DISLOCATION, WITH
28645   - OPEN TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION, INCLUDES INTERNAL FIXAT
28660   - CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION; WITHOUT ANESTHESIA
28665   - CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION; REQUIRING ANESTHESIA
28666   - PERCUTANEOUS SKELETAL FIXATION OF INTERPHALANGEAL JOINT DISLOCATION, WITH
28675   - OPEN TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, INCLUDES INTERNAL FIXATION,
28705   - ARTHRODESIS; PANTALAR
28715   - ARTHRODESIS; TRIPLE
28725   - ARTHRODESIS; SUBTALAR
28730   - ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, MULTIPLE OR TRANSVERSE;
28735   - ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, MULTIPLE OR TRANSVERSE; WITH
28737   - ARTHRODESIS, WITH TENDON LENGTHENING AND ADVANCEMENT, MIDTARSAL, TARSAL
28740   - ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, SINGLE JOINT
28750   - ARTHRODESIS, GREAT TOE; METATARSOPHALANGEAL JOINT
28755   - ARTHRODESIS, GREAT TOE; INTERPHALANGEAL JOINT
28760   - ARTHRODESIS, WITH EXTENSOR HALLUCIS LONGUS TRANSFER TO FIRST METATARSAL NECK,
28810   - AMPUTATION, METATARSAL, WITH TOE, SINGLE
28820   - AMPUTATION, TOE; METATARSOPHALANGEAL JOINT
28825   - AMPUTATION, TOE; INTERPHALANGEAL JOINT
28890   - EXTRACORPOREAL SHOCK WAVE, HIGH ENERGY, PERFORMED BY A PHYSICIAN, REQUIRING ANES
28899   - UNLISTED PROCEDURE, FOOT OR TOES
29000   - APPLICATION OF HALO TYPE BODY CAST (SEE 20661-20663 FOR INSERTION)
29010   - APPLICATION OF RISSER JACKET, LOCALIZER, BODY; ONLY
29015   - APPLICATION OF RISSER JACKET, LOCALIZER, BODY; INCLUDING HEAD
29020   - APPLICATION OF TURNBUCKLE JACKET, BODY; ONLY
29025   - APPLICATION OF TURNBUCKLE JACKET, BODY; INCLUDING HEAD
29035   - APPLICATION OF BODY CAST, SHOULDER TO HIPS;
29040   - APPLICATION OF BODY CAST, SHOULDER TO HIPS; INCLUDING HEAD, MINERVA TYPE
29044   - APPLICATION OF BODY CAST, SHOULDER TO HIPS; INCLUDING ONE THIGH
29046   - APPLICATION OF BODY CAST, SHOULDER TO HIPS; INCLUDING BOTH THIGHS
29049   - APPLICATION, CAST; FIGURE-OF-EIGHT
29055   - APPLICATION, CAST; SHOULDER SPICA



                                             Page 100
                                     Surgery (triggers bundling)


29058   - APPLICATION, CAST; PLASTER VELPEAU
29065   - APPLICATION, CAST; SHOULDER TO HAND (LONG ARM)
29075   - APPLICATION, CAST; ELBOW TO FINGER (SHORT ARM)
29085   - APPLICATION, CAST; HAND AND LOWER FOREARM (GAUNTLET)
29086   - APPLICATION, CAST; FINGER (EG, CONTRACTURE)
29105   - APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND)
29125   - APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); STATIC
29126   - APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); DYNAMIC
29130   - APPLICATION OF FINGER SPLINT; STATIC
29131   - APPLICATION OF FINGER SPLINT; DYNAMIC
29200   - STRAPPING; THORAX
29240   - STRAPPING; SHOULDER (EG, VELPEAU)
29260   - STRAPPING; ELBOW OR WRIST
29280   - STRAPPING; HAND OR FINGER
29305   - APPLICATION OF HIP SPICA CAST; ONE LEG
29325   - APPLICATION OF HIP SPICA CAST; ONE AND ONE-HALF SPICA OR BOTH LEGS
29345   - APPLICATION OF LONG LEG CAST (THIGH TO TOES);
29355   - APPLICATION OF LONG LEG CAST (THIGH TO TOES); WALKER OR AMBULATORY TYPE
29358   - APPLICATION OF LONG LEG CAST BRACE
29365   - APPLICATION OF CYLINDER CAST (THIGH TO ANKLE)
29405   - APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES);
29425   - APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES); WALKING OR AMBULATORY TYPE
29435   - APPLICATION OF PATELLAR TENDON BEARING (PTB) CAST
29440   - ADDING WALKER TO PREVIOUSLY APPLIED CAST
29445   - APPLICATION OF RIGID TOTAL CONTACT LEG CAST
29450   - APPLICATION OF CLUBFOOT CAST WITH MOLDING OR MANIPULATION, LONG OR SHORT LEG
29505   - APPLICATION OF LONG LEG SPLINT (THIGH TO ANKLE OR TOES)
29515   - APPLICATION OF SHORT LEG SPLINT (CALF TO FOOT)
29520   - STRAPPING; HIP
29530   - STRAPPING; KNEE
29540   - STRAPPING; ANKLE AND/OR FOOT
29550   - STRAPPING; TOES
29580   - STRAPPING; UNNA BOOT
29581   - Application of multi-layer venous wound compression system, below knee
29590   - DENIS-BROWNE SPLINT STRAPPING
29700   - REMOVAL OR BIVALVING; GAUNTLET, BOOT OR BODY CAST
29705   - REMOVAL OR BIVALVING; FULL ARM OR FULL LEG CAST
29710   - REMOVAL OR BIVALVING; SHOULDER OR HIP SPICA, MINERVA, OR RISSER JACKET, ETC.
29715   - REMOVAL OR BIVALVING; TURNBUCKLE JACKET
29720   - REPAIR OF SPICA, BODY CAST OR JACKET
29730   - WINDOWING OF CAST
29740   - WEDGING OF CAST (EXCEPT CLUBFOOT CASTS)
29750   - WEDGING OF CLUBFOOT CAST
29799   - UNLISTED PROCEDURE, CASTING OR STRAPPING
29800   - ARTHROSCOPY, TEMPOROMANDIBULAR JOINT, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPS
29804   - ARTHROSCOPY, TEMPOROMANDIBULAR JOINT, SURGICAL
29805   - ARTHROSCOPY, SHOULDER, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE
29806   - ARTHROSCOPY, SHOULDER, SURGICAL; CAPSULORRHAPHY
29807   - ARTHROSCOPY, SHOULDER, SURGICAL; REPAIR OF SLAP LESION
29819   - ARTHROSCOPY, SHOULDER, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY
29820   - ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY, PARTIAL
29821   - ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY, COMPLETE
29822   - ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, LIMITED
29823   - ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, EXTENSIVE
29824   - ARTHROSCOPY, SHOULDER, SURGICAL; DISTAL CLAVICULECTOMY INCLUDING DISTAL



                                             Page 101
                                      Surgery (triggers bundling)


29825   - ARTHROSCOPY, SHOULDER, SURGICAL; WITH LYSIS AND RESECTION OF ADHESIONS, WITH OR
29826   - ARTHROSCOPY, SHOULDER, SURGICAL; DECOMPRESSION OF SUBACROMIAL SPACE WITH
29827   - ARTHROSCOPY, SHOULDER, SURGICAL; WITH ROTATOR CUFF REPAIR
29828   - ARTHROSCOPY, SHOULDER, SURGICAL; BICEPS TENODESIS
29830   - ARTHROSCOPY, ELBOW, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE
29834   - ARTHROSCOPY, ELBOW, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY
29835   - ARTHROSCOPY, ELBOW, SURGICAL; SYNOVECTOMY, PARTIAL
29836   - ARTHROSCOPY, ELBOW, SURGICAL; SYNOVECTOMY, COMPLETE
29837   - ARTHROSCOPY, ELBOW, SURGICAL; DEBRIDEMENT, LIMITED
29838   - ARTHROSCOPY, ELBOW, SURGICAL; DEBRIDEMENT, EXTENSIVE
29840   - ARTHROSCOPY, WRIST, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE
29843   - ARTHROSCOPY, WRIST, SURGICAL; FOR INFECTION, LAVAGE AND DRAINAGE
29844   - ARTHROSCOPY, WRIST, SURGICAL; SYNOVECTOMY, PARTIAL
29845   - ARTHROSCOPY, WRIST, SURGICAL; SYNOVECTOMY, COMPLETE
29846   - ARTHROSCOPY, WRIST, SURGICAL; EXCISION AND/OR REPAIR OF TRIANGULAR
29847   - ARTHROSCOPY, WRIST, SURGICAL; INTERNAL FIXATION FOR FRACTURE OR INSTABILITY
29848   - ENDOSCOPY, WRIST, SURGICAL, WITH RELEASE OF TRANSVERSE CARPAL LIGAMENT
29850   - ARTHROSCOPICALLY AIDED TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY
29851   - ARTHROSCOPICALLY AIDED TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY
29855   - ARTHROSCOPICALLY AIDED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); UNICOND
29856   - ARTHROSCOPICALLY AIDED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); BICONDY
29860   - ARTHROSCOPY, HIP, DIAGNOSTIC WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE
29861   - ARTHROSCOPY, HIP, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY
29862   - ARTHROSCOPY, HIP, SURGICAL; WITH DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE
29863   - ARTHROSCOPY, HIP, SURGICAL; WITH SYNOVECTOMY
29866   - ARTHROSCOPY, KNEE, SURGICAL; OSTEOCHONDRAL AUTOGRAFT(S) (EG, MOSAICPLASTY) (INCL
29867   - ARTHROSCOPY, KNEE, SURGICAL; OSTEOCHONDRAL ALLOGRAFT (EG, MOSAICPLASTY)
29868   - ARTHROSCOPY, KNEE, SURGICAL; MENISCAL TRANSPLANTATION (INCLUDES ARTHROTOMY FOR
29870   - ARTHROSCOPY, KNEE, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE
29871   - ARTHROSCOPY, KNEE, SURGICAL; FOR INFECTION, LAVAGE AND DRAINAGE
29873   - ARTHROSCOPY, KNEE, SURGICAL; WITH LATERAL RELEASE
29874   - ARTHROSCOPY, KNEE, SURGICAL; FOR REMOVAL OF LOOSE BODY OR FOREIGN BODY (EG,
29875   - ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, LIMITED (EG, PLICA OR SHELF
29876   - ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, MAJOR, TWO OR MORE COMPARTMENTS (EG,
29877   - ARTHROSCOPY, KNEE, SURGICAL; DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE
29879   - ARTHROSCOPY, KNEE, SURGICAL; ABRASION ARTHROPLASTY (INCLUDES CHONDROPLASTY
29880   - ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL AND LATERAL, INCLUDING
29881   - ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL OR LATERAL, INCLUDING
29882   - ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCUS REPAIR (MEDIAL OR LATERAL)
29883   - ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCUS REPAIR (MEDIAL AND LATERAL)
29884   - ARTHROSCOPY, KNEE, SURGICAL; WITH LYSIS OF ADHESIONS, WITH OR WITHOUT
29885   - ARTHROSCOPY, KNEE, SURGICAL; DRILLING FOR OSTEOCHONDRITIS DISSECANS WITH BONE
29886   - ARTHROSCOPY, KNEE, SURGICAL; DRILLING FOR INTACT OSTEOCHONDRITIS DISSECANS
29887   - ARTHROSCOPY, KNEE, SURGICAL; DRILLING FOR INTACT OSTEOCHONDRITIS DISSECANS
29888   - ARTHROSCOPICALLY AIDED ANTERIOR CRUCIATE LIGAMENT REPAIR/AUGMENTATION OR
29889   - ARTHROSCOPICALLY AIDED POSTERIOR CRUCIATE LIGAMENT REPAIR/ AUGMENTATION OR
29891   - ARTHROSCOPY, ANKLE, SURGICAL, EXCISION OF OSTEOCHONDRAL DEFECT OF TALUS AND/OR
29892   - ARTHROSCOPICALLY AIDED REPAIR OF LARGE OSTEOCHONDRITIS DISSECANS LESION, TALAR
29893   - ENDOSCOPIC PLANTAR FASCIOTOMY
29894   - ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; WITH REMOVAL
29895   - ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; SYNOVECTOMY,
29897   - ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; DEBRIDEMENT,
29898   - ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; DEBRIDEMENT,
29899   - ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; WITH ANKLE
29900   - ARTHROSCOPY, METACARPOPHALANGEAL JOINT, DIAGNOSTIC, INCLUDES SYNOVIAL BIOPSY



                                              Page 102
                                   Surgery (triggers bundling)


29901 - ARTHROSCOPY, METACARPOPHALANGEAL JOINT, SURGICAL; WITH DEBRIDEMENT
29902 - ARTHROSCOPY, METACARPOPHALANGEAL JOINT, SURGICAL; WITH REDUCTION OF DISPLACED
29904 - ARTHROSCOPY, SUBTALAR JOINT, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BOD
29905 - ARTHROSCOPY, SUBTALAR JOINT, SURGICAL; WITH SYNOVECTOMY
29906 - ARTHROSCOPY, SUBTALAR JOINT, SURGICAL; WITH DEBRIDEMENT
29907 - ARTHROSCOPY, SUBTALAR JOINT, SURGICAL; WITH SUBTALAR ARTHRODESIS
29914 - Arthroscopy, hip, surgical; with femoroplasty (ie, treatment of cam lesion)
29915 - Arthroscopy, subtalar joint, surgical; with acetabuloplasty (ie, treatment of pi
29916 - Arthroscopy, subtalar joint, surgical; with labral repair
29999 - UNLISTED PROCEDURE, ARTHROSCOPY
30000 - DRAINAGE ABSCESS OR HEMATOMA, NASAL, INTERNAL APPROACH
30020 - DRAINAGE ABSCESS OR HEMATOMA, NASAL SEPTUM
30100 - BIOPSY, INTRANASAL
30110 - EXCISION, NASAL POLYP(S), SIMPLE
30115 - EXCISION, NASAL POLYP(S), EXTENSIVE
30117 - EXCISION OR DESTRUCTION (EG, LASER), INTRANASAL LESION; INTERNAL APPROACH
30118 - EXCISION OR DESTRUCTION (EG, LASER), INTRANASAL LESION; EXTERNAL APPROACH
30120 - EXCISION OR SURGICAL PLANING OF SKIN OF NOSE FOR RHINOPHYMA
30124 - EXCISION DERMOID CYST, NOSE; SIMPLE, SKIN, SUBCUTANEOUS
30125 - EXCISION DERMOID CYST, NOSE; COMPLEX, UNDER BONE OR CARTILAGE
30130 - EXCISION INFERIOR TURBINATE, PARTIAL OR COMPLETE, ANY METHOD
30140 - SUBMUCOUS RESECTION INFERIOR TURBINATE, PARTIAL OR COMPLETE, ANY METHOD
30150 - RHINECTOMY; PARTIAL
30160 - RHINECTOMY; TOTAL
30200 - INJECTION INTO TURBINATE(S), THERAPEUTIC
30210 - DISPLACEMENT THERAPY (PROETZ TYPE)
30220 - INSERTION, NASAL SEPTAL PROSTHESIS (BUTTON)
30310 - REMOVAL FOREIGN BODY, INTRANASAL; REQUIRING GENERAL ANESTHESIA
30320 - REMOVAL FOREIGN BODY, INTRANASAL; BY LATERAL RHINOTOMY
30400 - RHINOPLASTY, PRIMARY; LATERAL AND ALAR CARTILAGES AND/OR ELEVATION OF NASAL TIP
30410 - RHINOPLASTY, PRIMARY; COMPLETE, EXTERNAL PARTS INCLUDING BONY PYRAMID, LATERAL
30420 - RHINOPLASTY, PRIMARY; INCLUDING MAJOR SEPTAL REPAIR
30430 - RHINOPLASTY, SECONDARY; MINOR REVISION (SMALL AMOUNT OF NASAL TIP WORK)
30435 - RHINOPLASTY, SECONDARY; INTERMEDIATE REVISION (BONY WORK WITH OSTEOTOMIES)
30450 - RHINOPLASTY, SECONDARY; MAJOR REVISION (NASAL TIP WORK AND OSTEOTOMIES)
30460 - RHINOPLASTY FOR NASAL DEFORMITY SECONDARY TO CONGENITAL CLEFT LIP AND/OR
30462 - RHINOPLASTY FOR NASAL DEFORMITY SECONDARY TO CONGENITAL CLEFT LIP AND/OR
30465 - REPAIR OF NASAL VESTIBULAR STENOSIS (EG, SPREADER GRAFTING, LATERAL NASAL WALL
30520 - SEPTOPLASTY OR SUBMUCOUS RESECTION, WITH OR WITHOUT CARTILAGE SCORING,
30540 - REPAIR CHOANAL ATRESIA; INTRANASAL
30545 - REPAIR CHOANAL ATRESIA; TRANSPALATINE
30560 - LYSIS INTRANASAL SYNECHIA
30580 - REPAIR FISTULA; OROMAXILLARY (COMBINE WITH 31030 IF ANTROTOMY IS INCLUDED)
30600 - REPAIR FISTULA; ORONASAL
30620 - SEPTAL OR OTHER INTRANASAL DERMATOPLASTY (DOES NOT INCLUDE OBTAINING GRAFT)
30630 - REPAIR NASAL SEPTAL PERFORATIONS
30801 - ABLATION, SOFT TISSUE OF INFERIOR TURBINATES, UNILATERAL OR BILATERAL, ANY METHO
30802 - ABLATION, SOFT TISSUE OF INFERIOR TURBINATES, UNILATERAL OR BILATERAL, ANY METHO
30901 - CONTROL NASAL HEMORRHAGE, ANTERIOR, SIMPLE (LIMITED CAUTERY AND/OR PACKING) ANY
30903 - CONTROL NASAL HEMORRHAGE, ANTERIOR, COMPLEX (EXTENSIVE CAUTERY AND/OR PACKING)
30905 - CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL PACKS AND/OR CAUTERY,
30906 - CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL PACKS AND/OR CAUTERY,
30915 - LIGATION ARTERIES; ETHMOIDAL
30920 - LIGATION ARTERIES; INTERNAL MAXILLARY ARTERY, TRANSANTRAL
30930 - FRACTURE NASAL INFERIOR TURBINATE(S), THERAPEUTIC



                                           Page 103
                                  Surgery (triggers bundling)


30999 - UNLISTED PROCEDURE, NOSE
31000 - LAVAGE BY CANNULATION; MAXILLARY SINUS (ANTRUM PUNCTURE OR NATURAL OSTIUM)
31002 - LAVAGE BY CANNULATION; SPHENOID SINUS
31020 - SINUSOTOMY, MAXILLARY (ANTROTOMY); INTRANASAL
31030 - SINUSOTOMY, MAXILLARY (ANTROTOMY); RADICAL (CALDWELL-LUC) WITHOUT REMOVAL OF
31032 - SINUSOTOMY, MAXILLARY (ANTROTOMY); RADICAL (CALDWELL-LUC) WITH REMOVAL OF
31040 - PTERYGOMAXILLARY FOSSA SURGERY, ANY APPROACH
31050 - SINUSOTOMY, SPHENOID, WITH OR WITHOUT BIOPSY;
31051 - SINUSOTOMY, SPHENOID, WITH OR WITHOUT BIOPSY; WITH MUCOSAL STRIPPING OR REMOVAL
31070 - SINUSOTOMY FRONTAL; EXTERNAL, SIMPLE (TREPHINE OPERATION)
31075 - SINUSOTOMY FRONTAL; TRANSORBITAL, UNILATERAL (FOR MUCOCELE OR OSTEOMA, LYNCH
31080 - SINUSOTOMY FRONTAL; OBLITERATIVE WITHOUT OSTEOPLASTIC FLAP, BROW INCISION
31081 - SINUSOTOMY FRONTAL; OBLITERATIVE, WITHOUT OSTEOPLASTIC FLAP, CORONAL INCISION
31084 - SINUSOTOMY FRONTAL; OBLITERATIVE, WITH OSTEOPLASTIC FLAP, BROW INCISION
31085 - SINUSOTOMY FRONTAL; OBLITERATIVE, WITH OSTEOPLASTIC FLAP, CORONAL INCISION
31086 - SINUSOTOMY FRONTAL; NONOBLITERATIVE, WITH OSTEOPLASTIC FLAP, BROW INCISION
31087 - SINUSOTOMY FRONTAL; NONOBLITERATIVE, WITH OSTEOPLASTIC FLAP, CORONAL INCISION
31090 - SINUSOTOMY, UNILATERAL, THREE OR MORE PARANASAL SINUSES (FRONTAL, MAXILLARY,
31200 - ETHMOIDECTOMY; INTRANASAL, ANTERIOR
31201 - ETHMOIDECTOMY; INTRANASAL, TOTAL
31205 - ETHMOIDECTOMY; EXTRANASAL, TOTAL
31231 - NASAL ENDOSCOPY, DIAGNOSTIC, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE)
31233 - NASAL/SINUS ENDOSCOPY, DIAGNOSTIC WITH MAXILLARY SINUSOSCOPY (VIA INFERIOR
31235 - NASAL/SINUS ENDOSCOPY, DIAGNOSTIC WITH SPHENOID SINUSOSCOPY (VIA PUNCTURE OF
31237 - NASAL/SINUS ENDOSCOPY, SURGICAL; WITH BIOPSY, POLYPECTOMY OR DEBRIDEMENT
31238 - NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONTROL OF NASAL HEMORRHAGE
31239 - NASAL/SINUS ENDOSCOPY, SURGICAL; WITH DACRYOCYSTORHINOSTOMY
31240 - NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONCHA BULLOSA RESECTION
31254 - NASAL/SINUS ENDOSCOPY, SURGICAL; WITH ETHMOIDECTOMY, PARTIAL (ANTERIOR)
31255 - NASAL/SINUS ENDOSCOPY, SURGICAL; WITH ETHMOIDECTOMY, TOTAL (ANTERIOR AND
31256 - NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY;
31267 - NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY; WITH REMOVAL OF
31276 - NASAL/SINUS ENDOSCOPY, SURGICAL WITH FRONTAL SINUS EXPLORATION, WITH OR WITHOUT
31287 - NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY;
31288 - NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY; WITH REMOVAL OF TISSUE
31292 - NASAL/SINUS ENDOSCOPY, SURGICAL; WITH MEDIAL OR INFERIOR ORBITAL WALL
31293 - NASAL/SINUS ENDOSCOPY, SURGICAL; WITH MEDIAL ORBITAL WALL AND INFERIOR ORBITAL
31294 - NASAL/SINUS ENDOSCOPY, SURGICAL; WITH OPTIC NERVE DECOMPRESSION
31295 - Nasal/sinus endoscopy, surgical; with dilation of maxillary sinus ostium (eg, ba
31296 - Nasal/sinus endoscopy, surgical; with dilation of frontal sinus ostium (eg, bal
31297 - Nasal/sinus endoscopy, surgical; with dilation of sphenoid sinus ostium (eg, b
31299 - UNLISTED PROCEDURE, ACCESSORY SINUSES
31300 - LARYNGOTOMY (THYROTOMY, LARYNGOFISSURE); WITH REMOVAL OF TUMOR OR LARYNGOCELE, C
31320 - LARYNGOTOMY (THYROTOMY, LARYNGOFISSURE); DIAGNOSTIC
31400 - ARYTENOIDECTOMY OR ARYTENOIDOPEXY, EXTERNAL APPROACH
31420 - EPIGLOTTIDECTOMY
31500 - INTUBATION, ENDOTRACHEAL, EMERGENCY PROCEDURE
31502 - TRACHEOTOMY TUBE CHANGE PRIOR TO ESTABLISHMENT OF FISTULA TRACT
31505 - LARYNGOSCOPY, INDIRECT (SEPARATE PROCEDURE); DIAGNOSTIC
31510 - LARYNGOSCOPY, INDIRECT; WITH BIOPSY
31511 - LARYNGOSCOPY, INDIRECT; WITH REMOVAL OF FOREIGN BODY
31512 - LARYNGOSCOPY, INDIRECT; WITH REMOVAL OF LESION
31513 - LARYNGOSCOPY, INDIRECT; WITH VOCAL CORD INJECTION
31515 - LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; FOR ASPIRATION
31520 - LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; DIAGNOSTIC, NEWBORN



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31525 - LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; DIAGNOSTIC, EXCEPT NEWBORN
31526 - LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; DIAGNOSTIC, WITH OPERATING MI
31527 - LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; WITH INSERTION OF OBTURATOR
31528 - LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; WITH DILATION, INITIAL
31529 - LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; WITH DILATION, SUBSEQUENT
31530 - LARYNGOSCOPY, DIRECT, OPERATIVE, WITH FOREIGN BODY REMOVAL;
31531 - LARYNGOSCOPY, DIRECT, OPERATIVE, WITH FOREIGN BODY REMOVAL; WITH OPERATING MICRO
31535 - LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY;
31536 - LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY; WITH OPERATING MICROSCOPE OR TELES
31540 - LARYNGOSCOPY, DIRECT, OPERATIVE, WITH EXCISION OF TUMOR AND/ OR STRIPPING OF
31541 - LARYNGOSCOPY, DIRECT, OPERATIVE, WITH EXCISION OF TUMOR AND/ OR STRIPPING OF VOC
31545 - LARYNGOSCOPY, DIRECT, OPERATIVE, WITH OPERATING MICROSCOPE OR TELESCOPE, WITH
31546 - LARYNGOSCOPY, DIRECT, OPERATIVE, WITH OPERATING MICROSCOPE OR TELESCOPE, WITH
31560 - LARYNGOSCOPY, DIRECT, OPERATIVE, WITH ARYTENOIDECTOMY;
31561 - LARYNGOSCOPY, DIRECT, OPERATIVE, WITH ARYTENOIDECTOMY; WITH OPERATING MICROSCOPE
31570 - LARYNGOSCOPY, DIRECT, WITH INJECTION INTO VOCAL CORD(S), THERAPEUTIC;
31571 - LARYNGOSCOPY, DIRECT, WITH INJECTION INTO VOCAL CORD(S), THERAPEUTIC; WITH OPERA
31575 - LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; DIAGNOSTIC
31576 - LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; WITH BIOPSY
31577 - LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; WITH REMOVAL OF FOREIGN BODY
31578 - LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; WITH REMOVAL OF LESION
31579 - LARYNGOSCOPY, FLEXIBLE OR RIGID FIBEROPTIC, WITH STROBOSCOPY
31580 - LARYNGOPLASTY; FOR LARYNGEAL WEB, TWO STAGE, WITH KEEL INSERTION AND REMOVAL
31582 - LARYNGOPLASTY; FOR LARYNGEAL STENOSIS, WITH GRAFT OR CORE MOLD, INCLUDING
31588 - LARYNGOPLASTY, NOT OTHERWISE SPECIFIED (EG, FOR BURNS, RECONSTRUCTION AFTER
31590 - LARYNGEAL REINNERVATION BY NEUROMUSCULAR PEDICLE
31595 - SECTION RECURRENT LARYNGEAL NERVE, THERAPEUTIC (SEPARATE PROCEDURE), UNILATERAL
31599 - UNLISTED PROCEDURE, LARYNX
31600 - TRACHEOSTOMY, PLANNED (SEPARATE PROCEDURE);
31601 - TRACHEOSTOMY, PLANNED (SEPARATE PROCEDURE); UNDER TWO YEARS
31603 - TRACHEOSTOMY, EMERGENCY PROCEDURE; TRANSTRACHEAL
31605 - TRACHEOSTOMY, EMERGENCY PROCEDURE; CRICOTHYROID MEMBRANE
31610 - TRACHEOSTOMY, FENESTRATION PROCEDURE WITH SKIN FLAPS
31611 - CONSTRUCTION OF TRACHEOESOPHAGEAL FISTULA AND SUBSEQUENT INSERTION OF AN
31612 - TRACHEAL PUNCTURE, PERCUTANEOUS WITH TRANSTRACHEAL ASPIRATION AND/OR INJECTION
31613 - TRACHEOSTOMA REVISION; SIMPLE, WITHOUT FLAP ROTATION
31614 - TRACHEOSTOMA REVISION; COMPLEX, WITH FLAP ROTATION
31615 - TRACHEOBRONCHOSCOPY THROUGH ESTABLISHED TRACHEOSTOMY INCISION
31622 - BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED
31623 - BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH
31624 - BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH
31625 - BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH
31626 - Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed
31628 - BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH
31629 - BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH
31630 - BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH
31631 - BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH
31632 - BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH
31633 - BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH
31634 - Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed
31635 - BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH
31636 - BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH
31637 - BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; EACH
31638 - BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH
31640 - BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH



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                                     Surgery (triggers bundling)


31641   - BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED
31643   - BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED
31645   - BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED
31646   - BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED
31656   - BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED
31717   - CATHETERIZATION WITH BRONCHIAL BRUSH BIOPSY
31720   - CATHETER ASPIRATION (SEPARATE PROCEDURE); NASOTRACHEAL
31730   - TRANSTRACHEAL (PERCUTANEOUS) INTRODUCTION OF NEEDLE WIRE DILATOR/ STENT OR
31750   - TRACHEOPLASTY; CERVICAL
31755   - TRACHEOPLASTY; TRACHEOPHARYNGEAL FISTULIZATION, EACH STAGE
31785   - EXCISION OF TRACHEAL TUMOR OR CARCINOMA; CERVICAL
31820   - SURGICAL CLOSURE TRACHEOSTOMY OR FISTULA; WITHOUT PLASTIC REPAIR
31825   - SURGICAL CLOSURE TRACHEOSTOMY OR FISTULA; WITH PLASTIC REPAIR
31830   - REVISION OF TRACHEOSTOMY SCAR
31899   - UNLISTED PROCEDURE, TRACHEA, BRONCHI
32201   - PNEUMONOSTOMY; WITH PERCUTANEOUS DRAINAGE OF ABSCESS OR CYST
32400   - BIOPSY, PLEURA; PERCUTANEOUS NEEDLE
32405   - BIOPSY, LUNG OR MEDIASTINUM, PERCUTANEOUS NEEDLE
32420   - PNEUMOCENTESIS, PUNCTURE OF LUNG FOR ASPIRATION
32421   - THORACENTESIS, PUNCTURE OF PLEURAL CAVITY FOR ASPIRATION, INITIAL OR SUBSEQUENT
32422   - THORACENTESIS WITH INSERTION OF TUBE, INCLUDES WATER SEAL (EG, FOR PNEUMOTHORAX)
32550   - INSERTION OF INDWELLING TUNNELED PLEURAL CATHETER WITH CUFF
32551   - TUBE THORACOSTOMY, INCLUDES WATER SEAL (EG, FOR ABSCESS, HEMOTHORAX, EMPYEMA), W
32552   - Removal of indwelling tunneled pleural catheter with cuff
32560   - INSTILLATION, VIA CHEST TUBE/CATHETER, AGENT FOR PLEURODESIS (EG, TALC FOR RECUR
32561   - Instillation(s), via chest tube/catheter, agent for fibrinolysis (eg, fibrinolyt
32562   - Instillation(s), via chest tube/catheter, agent for fibrinolysis (eg, fibrinolyt
32601   - THORACOSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE); LUNGS AND PLEURAL SPACE, WITHOUT
32602   - THORACOSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE); LUNGS AND PLEURAL SPACE, WITH
32603   - THORACOSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE); PERICARDIAL SAC, WITHOUT BIOPSY
32604   - THORACOSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE); PERICARDIAL SAC, WITH BIOPSY
32605   - THORACOSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE); MEDIASTINAL SPACE, WITHOUT BIOPSY
32606   - THORACOSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE); MEDIASTINAL SPACE, WITH BIOPSY
32960   - PNEUMOTHORAX, THERAPEUTIC, INTRAPLEURAL INJECTION OF AIR
32999   - UNLISTED PROCEDURE, LUNGS AND PLEURA
33010   - PERICARDIOCENTESIS; INITIAL
33011   - PERICARDIOCENTESIS; SUBSEQUENT
33206   - INSERTION OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S);
33207   - INSERTION OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S);
33208   - INSERTION OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S);
33210   - INSERTION OR REPLACEMENT OF TEMPORARY TRANSVENOUS SINGLE CHAMBER CARDIAC
33211   - INSERTION OR REPLACEMENT OF TEMPORARY TRANSVENOUS DUAL CHAMBER PACING
33212   - INSERTION OR REPLACEMENT OF PACEMAKER PULSE GENERATOR ONLY; SINGLE CHAMBER,
33213   - INSERTION OR REPLACEMENT OF PACEMAKER PULSE GENERATOR ONLY; DUAL CHAMBER
33214   - UPGRADE OF IMPLANTED PACEMAKER SYSTEM, CONVERSION OF SINGLE CHAMBER SYSTEM TO
33215   - REPOSITIONING OF PREVIOUSLY IMPLANTED TRANSVENOUS PACEMAKER OR PACING
33216   - INSERTION OF A SINGLE TRANSVENOUS ELECTRODE, PERMANENT PACEMAKER OR CARDIOVERTER
33217   - INSERTION OF 2 TRANSVENOUS ELECTRODES, PERMANENT PACEMAKER OR CARDIOVERTER-DEFIB
33218   - REPAIR OF SINGLE TRANSVENOUS ELECTRODE FOR A SINGLE CHAMBER, PERMANENT
33220   - REPAIR OF TWO TRANSVENOUS ELECTRODES FOR A DUAL CHAMBER PERMANENT PACEMAKER OR
33222   - REVISION OR RELOCATION OF SKIN POCKET FOR PACEMAKER
33223   - REVISION OF SKIN POCKET FOR CARDIOVERTER-DEFIBRILLATOR
33224   - INSERTION OF PACING ELECTRODE, CARDIAC VENOUS SYSTEM, FOR LEFT VENTRICULAR
33225   - INSERTION OF PACING ELECTRODE, CARDIAC VENOUS SYSTEM, FOR LEFT VENTRICULAR
33226   - REPOSITIONING OF PREVIOUSLY IMPLANTED CARDIAC VENOUS SYSTEM (LEFT VENTRICULAR)



                                             Page 106
                                     Surgery (triggers bundling)


33233   - REMOVAL OF PERMANENT PACEMAKER PULSE GENERATOR
33234   - REMOVAL OF TRANSVENOUS PACEMAKER ELECTRODE(S); SINGLE LEAD SYSTEM, ATRIAL OR
33235   - REMOVAL OF TRANSVENOUS PACEMAKER ELECTRODE(S); DUAL LEAD SYSTEM
33241   - SUBCUTANEOUS REMOVAL OF SINGLE OR DUAL CHAMBER PACING CARDIOVERTER-
33244   - REMOVAL OF SINGLE OR DUAL CHAMBER PACING CARDIOVERTER-DEFIBRILLATOR
33282   - IMPLANTATION OF PATIENT-ACTIVATED CARDIAC EVENT RECORDER
33284   - REMOVAL OF AN IMPLANTABLE, PATIENT-ACTIVATED CARDIAC EVENT RECORDER
33999   - UNLISTED PROCEDURE, CARDIAC SURGERY
34101   - EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; AXILLARY, BRACHIAL,
34111   - EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; RADIAL OR ULNAR ARTERY,
34201   - EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; FEMOROPOPLITEAL,
34203   - EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; POPLITEAL-TIBIO-PERONEAL
34421   - THROMBECTOMY, DIRECT OR WITH CATHETER; VENA CAVA, ILIAC, FEMOROPOPLITEAL VEIN,
34471   - THROMBECTOMY, DIRECT OR WITH CATHETER; SUBCLAVIAN VEIN, BY NECK INCISION
34490   - THROMBECTOMY, DIRECT OR WITH CATHETER; AXILLARY AND SUBCLAVIAN VEIN, BY ARM
34501   - VALVULOPLASTY, FEMORAL VEIN
34510   - VENOUS VALVE TRANSPOSITION, ANY VEIN DONOR
34520   - CROSS-OVER VEIN GRAFT TO VENOUS SYSTEM
34530   - SAPHENOPOPLITEAL VEIN ANASTOMOSIS
35011   - DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
35180   - REPAIR, CONGENITAL ARTERIOVENOUS FISTULA; HEAD AND NECK
35184   - REPAIR, CONGENITAL ARTERIOVENOUS FISTULA; EXTREMITIES
35188   - REPAIR, ACQUIRED OR TRAUMATIC ARTERIOVENOUS FISTULA; HEAD AND NECK
35190   - REPAIR, ACQUIRED OR TRAUMATIC ARTERIOVENOUS FISTULA; EXTREMITIES
35201   - REPAIR BLOOD VESSEL, DIRECT; NECK
35206   - REPAIR BLOOD VESSEL, DIRECT; UPPER EXTREMITY
35207   - REPAIR BLOOD VESSEL, DIRECT; HAND, FINGER
35226   - REPAIR BLOOD VESSEL, DIRECT; LOWER EXTREMITY
35231   - REPAIR BLOOD VESSEL WITH VEIN GRAFT; NECK
35236   - REPAIR BLOOD VESSEL WITH VEIN GRAFT; UPPER EXTREMITY
35256   - REPAIR BLOOD VESSEL WITH VEIN GRAFT; LOWER EXTREMITY
35261   - REPAIR BLOOD VESSEL WITH GRAFT OTHER THAN VEIN; NECK
35266   - REPAIR BLOOD VESSEL WITH GRAFT OTHER THAN VEIN; UPPER EXTREMITY
35286   - REPAIR BLOOD VESSEL WITH GRAFT OTHER THAN VEIN; LOWER EXTREMITY
35321   - THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; AXILLARY-BRACHIAL
35458   - TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; BRACHIOCEPHALIC TRUNK OR BRANCHES, EACH
35459   - TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; TIBIOPERONEAL TRUNK AND BRANCHES
35460   - TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; VENOUS
35470   - TRANSLUMINAL BALLOON ANGIOPLASTY, PERCUTANEOUS; TIBIOPERONEAL TRUNK OR BRANCHES,
35471   - TRANSLUMINAL BALLOON ANGIOPLASTY, PERCUTANEOUS; RENAL OR VISCERAL ARTERY
35472   - TRANSLUMINAL BALLOON ANGIOPLASTY, PERCUTANEOUS; AORTIC
35473   - TRANSLUMINAL BALLOON ANGIOPLASTY, PERCUTANEOUS; ILIAC
35474   - TRANSLUMINAL BALLOON ANGIOPLASTY, PERCUTANEOUS; FEMORAL-POPLITEAL
35475   - TRANSLUMINAL BALLOON ANGIOPLASTY, PERCUTANEOUS; BRACHIOCEPHALIC TRUNK OR
35476   - TRANSLUMINAL BALLOON ANGIOPLASTY, PERCUTANEOUS; VENOUS
35484   - TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN; BRACHIOCEPHALIC TRUNK OR BRANCHES,
35485   - TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN; TIBIOPERONEAL TRUNK AND BRANCHES
35490   - TRANSLUMINAL PERIPHERAL ATHERECTOMY, PERCUTANEOUS; RENAL OR OTHER VISCERAL ARTER
35491   - TRANSLUMINAL PERIPHERAL ATHERECTOMY, PERCUTANEOUS; AORTIC
35492   - TRANSLUMINAL PERIPHERAL ATHERECTOMY, PERCUTANEOUS; ILIAC
35493   - TRANSLUMINAL PERIPHERAL ATHERECTOMY, PERCUTANEOUS; FEMORAL-POPLITEAL
35494   - TRANSLUMINAL PERIPHERAL ATHERECTOMY, PERCUTANEOUS; BRACHIOCEPHALIC TRUNK OR
35495   - TRANSLUMINAL PERIPHERAL ATHERECTOMY, PERCUTANEOUS; TIBIOPERONEAL TRUNK AND
35500   - HARVEST OF UPPER EXTREMITY VEIN, ONE SEGMENT, FOR LOWER EXTREMITY OR CORONARY AR
35685   - PLACEMENT OF VEIN PATCH OR CUFF AT DISTAL ANASTOMOSIS OF BYPASS GRAFT, SYNTHETIC



                                             Page 107
                                     Surgery (triggers bundling)


35686   - CREATION OF DISTAL ARTERIOVENOUS FISTULA DURING LOWER EXTREMITY BYPASS SURGERY
35761   - EXPLORATION (NOT FOLLOWED BY SURGICAL REPAIR), WITH OR WITHOUT LYSIS OF ARTERY;
35860   - EXPLORATION FOR POSTOPERATIVE HEMORRHAGE, THROMBOSIS OR INFECTION; EXTREMITY
35875   - THROMBECTOMY OF ARTERIAL OR VENOUS GRAFT (OTHER THAN HEMODIALYSIS GRAFT OR
35876   - THROMBECTOMY OF ARTERIAL OR VENOUS GRAFT (OTHER THAN HEMODIALYSIS GRAFT OR
35879   - REVISION, LOWER EXTREMITY ARTERIAL BYPASS, WITHOUT THROMBECTOMY, OPEN; WITH
35881   - REVISION, LOWER EXTREMITY ARTERIAL BYPASS, WITHOUT THROMBECTOMY, OPEN; WITH
35883   - REVISION, FEMORAL ANASTOMOSIS OF SYNTHETIC ARTERIAL BYPASS GRAFT IN GROIN, OPEN;
35884   - REVISION, FEMORAL ANASTOMOSIS OF SYNTHETIC ARTERIAL BYPASS GRAFT IN GROIN, OPEN;
35903   - EXCISION OF INFECTED GRAFT; EXTREMITY
36147   - Introduction of needle and/or catheter, arteriovenous shunt created for dialysis
36260   - INSERTION OF IMPLANTABLE INTRA-ARTERIAL INFUSION PUMP (EG, FOR CHEMOTHERAPY OF
36261   - REVISION OF IMPLANTED INTRA-ARTERIAL INFUSION PUMP
36262   - REMOVAL OF IMPLANTED INTRA-ARTERIAL INFUSION PUMP
36430   - TRANSFUSION, BLOOD OR BLOOD COMPONENTS
36440   - PUSH TRANSFUSION, BLOOD, 2 YEARS OR UNDER
36450   - EXCHANGE TRANSFUSION, BLOOD; NEWBORN
36455   - EXCHANGE TRANSFUSION, BLOOD; OTHER THAN NEWBORN
36460   - TRANSFUSION, INTRAUTERINE, FETAL
36468   - SINGLE OR MULTIPLE INJECTIONS OF SCLEROSING SOLUTIONS, SPIDER VEINS
36469   - SINGLE OR MULTIPLE INJECTIONS OF SCLEROSING SOLUTIONS, SPIDER VEINS
36470   - INJECTION OF SCLEROSING SOLUTION; SINGLE VEIN
36471   - INJECTION OF SCLEROSING SOLUTION; MULTIPLE VEINS, SAME LEG
36475   - ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL
36476   - ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL
36478   - ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL
36479   - ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL
36511   - THERAPEUTIC APHERESIS; FOR WHITE BLOOD CELLS
36512   - THERAPEUTIC APHERESIS; FOR RED BLOOD CELLS
36513   - THERAPEUTIC APHERESIS; FOR PLATELETS
36514   - THERAPEUTIC APHERESIS; FOR PLASMA PHERESIS
36515   - THERAPEUTIC APHERESIS; WITH EXTRACORPOREAL IMMUNOADSORPTION AND PLASMA
36516   - THERAPEUTIC APHERESIS; WITH EXTRACORPOREAL SELECTIVE ADSORPTION OR SELECTIVE
36522   - PHOTOPHERESIS, EXTRACORPOREAL
36555   - INSERTION OF NON-TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER; UNDER 5 YE
36556   - INSERTION OF NON-TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER; AGE 5
36557   - INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER, WITHOUT
36558   - INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER, WITHOUT
36560   - INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH
36561   - INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH
36563   - INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE WITH
36565   - INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE,
36566   - INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE,
36568   - INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER (PICC), WITHOUT
36569   - INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER (PICC), WITHOUT
36570   - INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH
36571   - INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH
36575   - REPAIR OF TUNNELED OR NON-TUNNELED CENTRAL VENOUS ACCESS CATHETER, WITHOUT SUBCU
36576   - REPAIR OF CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR PUMP, CENTRAL
36578   - REPLACEMENT, CATHETER ONLY, OF CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS P
36580   - REPLACEMENT, COMPLETE, OF A NON-TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHE
36581   - REPLACEMENT, COMPLETE, OF A TUNNELED CENTRALLY INSERTED CENTRAL VENOUS
36582   - REPLACEMENT, COMPLETE, OF A TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS
36583   - REPLACEMENT, COMPLETE, OF A TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS
36584   - REPLACEMENT, COMPLETE, OF A PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER



                                             Page 108
                                  Surgery (triggers bundling)


36585 - REPLACEMENT, COMPLETE, OF A PERIPHERALLY INSERTED CENTRAL VENOUS ACCESS DEVICE,
36589 - REMOVAL OF TUNNELED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP
36590 - REMOVAL OF TUNNELED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR
36593 - DECLOTTING BY THROMBOLYTIC AGENT OF IMPLANTED VASCULAR ACCESS DEVICE OR CATHETER
36595 - MECHANICAL REMOVAL OF PERICATHETER OBSTRUCTIVE MATERIAL (EG, FIBRIN SHEATH) FROM
36596 - MECHANICAL REMOVAL OF INTRALUMINAL (INTRACATHETER) OBSTRUCTIVE MATERIAL FROM
36597 - REPOSITIONING OF PREVIOUSLY PLACED CENTRAL VENOUS CATHETER UNDER FLUOROSCOPIC GU
36640 - ARTERIAL CATHETERIZATION FOR PROLONGED INFUSION THERAPY (CHEMOTHERAPY), CUTDOWN
36680 - PLACEMENT OF NEEDLE FOR INTRAOSSEOUS INFUSION
36800 - INSERTION OF CANNULA FOR HEMODIALYSIS, OTHER PURPOSE (SEPARATE PROCEDURE); VEIN
36810 - INSERTION OF CANNULA FOR HEMODIALYSIS, OTHER PURPOSE (SEPARATE PROCEDURE);
36815 - INSERTION OF CANNULA FOR HEMODIALYSIS, OTHER PURPOSE (SEPARATE PROCEDURE);
36818 - ARTERIOVENOUS ANASTOMOSIS, OPEN; BY UPPER ARM CEPHALIC VEIN TRANSPOSITION
36819 - ARTERIOVENOUS ANASTOMOSIS, OPEN; BY UPPER ARM BASILIC VEIN TRANSPOSITION
36820 - ARTERIOVENOUS ANASTOMOSIS, OPEN; BY FOREARM VEIN TRANSPOSITION
36821 - ARTERIOVENOUS ANASTOMOSIS, OPEN; DIRECT, ANY SITE (EG, CIMINO TYPE) (SEPARATE
36825 - CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECT ARTERIOVENOUS
36830 - CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECT ARTERIOVENOUS
36831 - THROMBECTOMY, OPEN, ARTERIOVENOUS FISTULA WITHOUT REVISION, AUTOGENOUS OR
36832 - REVISION, OPEN, ARTERIOVENOUS FISTULA; WITHOUT THROMBECTOMY, AUTOGENOUS OR
36833 - REVISION, OPEN, ARTERIOVENOUS FISTULA; WITH THROMBECTOMY, AUTOGENOUS OR
36835 - INSERTION OF THOMAS SHUNT (SEPARATE PROCEDURE)
36838 - DISTAL REVASCULARIZATION AND INTERVAL LIGATION (DRIL), UPPER EXTREMITY
36860 - EXTERNAL CANNULA DECLOTTING (SEPARATE PROCEDURE); WITHOUT BALLOON CATHETER
36861 - EXTERNAL CANNULA DECLOTTING (SEPARATE PROCEDURE); WITH BALLOON CATHETER
36870 - THROMBECTOMY, PERCUTANEOUS, ARTERIOVENOUS FISTULA, AUTOGENOUS OR NONAUTOGENOUS
37183 - REVISION OF TRANSVENOUS INTRAHEPATIC PORTOSYSTEMIC SHUNT(S) (TIPS) (INCLUDES VEN
37184 - PRIMARY PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY, NONCORONARY, ARTERIAL
37185 - PRIMARY PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY, NONCORONARY, ARTERIAL
37186 - SECONDARY PERCUTANEOUS TRANSLUMINAL THROMBECTOMY (EG, NONPRIMARY MECHANICAL, SNA
37187 - PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY, VEIN(S), INCLUDING INTRAPROCE
37188 - PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY, VEIN(S), INCLUDING INTRAPROCE
37195 - THROMBOLYSIS, CEREBRAL, BY INTRAVENOUS INFUSION
37200 - TRANSCATHETER BIOPSY
37201 - TRANSCATHETER THERAPY, INFUSION FOR THROMBOLYSIS OTHER THAN CORONARY
37202 - TRANSCATHETER THERAPY, INFUSION OTHER THAN FOR THROMBOLYSIS, ANY TYPE (EG,
37203 - TRANSCATHETER RETRIEVAL, PERCUTANEOUS, OF INTRAVASCULAR FOREIGN BODY (EG,
37204 - TRANSCATHETER OCCLUSION OR EMBOLIZATION (EG, FOR TUMOR DESTRUCTION, TO ACHIEVE
37205 - TRANSCATHETER PLACEMENT OF AN INTRAVASCULAR STENT(S), (EXCEPT CORONARY,
37206 - TRANSCATHETER PLACEMENT OF AN INTRAVASCULAR STENT(S), (EXCEPT CORONARY,
37207 - TRANSCATHETER PLACEMENT OF AN INTRAVASCULAR STENT(S), (NON-CORONARY VESSEL),
37208 - TRANSCATHETER PLACEMENT OF AN INTRAVASCULAR STENT(S), (NON-CORONARY VESSEL),
37209 - EXCHANGE OF A PREVIOUSLY PLACED INTRAVASCULAR CATHETER DURING THROMBOLYTIC THERA
37210 - UTERINE FIBROID EMBOLIZATION (UFE, EMBOLIZATION OF THE UTERINE ARTERIES TO TREAT
37220 - Revascularization, endovascular, open or percutaneous, iliac artery, unilateral,
37221 - Revascularization, endovascular, open or percutaneous, iliac artery, unilateral,
37222 - Revascularization, endovascular, open or percutaneous, iliac artery, each additi
37223 - Revascularization, endovascular, open or percutaneous, iliac artery, each additi
37224 - Revascularization, endovascular, open or percutaneous, femoral, popliteal artery
37225 - Revascularization, endovascular, open or percutaneous, femoral, popliteal artery
37226 - Revascularization, endovascular, open or percutaneous, femoral, popliteal artery
37227 - Revascularization, endovascular, open or percutaneous, femoral, popliteal artery
37228 - Revascularization, endovascular, open or percutaneous, tibial, peroneal artery,
37229 - Revascularization, endovascular, open or percutaneous, tibial, peroneal artery,
37230 - Revascularization, endovascular, open or percutaneous, tibial, peroneal artery,



                                          Page 109
                                   Surgery (triggers bundling)


37231 - Revascularization, endovascular, open or percutaneous, tibial, peroneal artery,
37232 - Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, u
37233 - Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, u
37234 - Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, u
37235 - Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, u
37500 - VASCULAR ENDOSCOPY, SURGICAL, WITH LIGATION OF PERFORA
37501 - UNLISTED VASCULAR ENDOSCOPY PROCEDURE
37565 - LIGATION, INTERNAL JUGULAR VEIN
37600 - LIGATION; EXTERNAL CAROTID ARTERY
37605 - LIGATION; INTERNAL OR COMMON CAROTID ARTERY
37606 - LIGATION; INTERNAL OR COMMON CAROTID ARTERY, WITH GRADUAL OCCLUSION, AS WITH
37607 - LIGATION OR BANDING OF ANGIOACCESS ARTERIOVENOUS FISTULA
37609 - LIGATION OR BIOPSY, TEMPORAL ARTERY
37615 - LIGATION, MAJOR ARTERY (EG, POST-TRAUMATIC, RUPTURE); NECK
37620 - INTERRUPTION, PARTIAL OR COMPLETE, OF INFERIOR VENA CAVA BY SUTURE, LIGATION,
37650 - LIGATION OF FEMORAL VEIN
37700 - LIGATION AND DIVISION OF LONG SAPHENOUS VEIN AT SAPHENOFEMORAL JUNCTION, OR
37718 - LIGATION, DIVISION, AND STRIPPING, SHORT SAPHENOUS VEIN
37722 - LIGATION, DIVISION, AND STRIPPING, LONG (GREATER) SAPHENOUS VEINS FROM SAPHENOFE
37735 - LIGATION AND DIVISION AND COMPLETE STRIPPING OF LONG OR SHORT SAPHENOUS VEINS
37760 - LIGATION OF PERFORATOR VEINS, SUBFASCIAL, RADICAL (LINTON TYPE), INCLUDING SKIN
37761 - Ligation of perforator vein(s), subfascial, open, including ultrasound guidance,
37765 - STAB PHLEBECTOMY OF VARICOSE VEINS, ONE EXTREMITY; 10-20 STAB INCISIONS
37766 - STAB PHLEBECTOMY OF VARICOSE VEINS, ONE EXTREMITY; MORE THAN 20 INCISIONS
37780 - LIGATION AND DIVISION OF SHORT SAPHENOUS VEIN AT SAPHENOPOPLITEAL JUNCTION
37785 - LIGATION, DIVISION, AND/OR EXCISION OF VARICOSE VEIN CLUSTER(S), ONE LEG
37790 - PENILE VENOUS OCCLUSIVE PROCEDURE
38120 - LAPAROSCOPY, SURGICAL, SPLENECTOMY
38129 - UNLISTED LAPAROSCOPY PROCEDURE, SPLEEN
38206 - BLOOD-DERIVED HEMATOPOIETIC PROGENITOR CELL HARVESTING FOR TRANSPLANTATION, PER
38220 - BONE MARROW; ASPIRATION ONLY
38221 - BONE MARROW; BIOPSY, NEEDLE OR TROCAR
38230 - BONE MARROW HARVESTING FOR TRANSPLANTATION
38240 - BONE MARROW OR BLOOD-DERIVED PERIPHERAL STEM CELL TRANSPLANTATION; ALLOGENIC
38241 - BONE MARROW OR BLOOD-DERIVED PERIPHERAL STEM CELL TRANSPLANTATION; AUTOLOGOUS
38242 - BONE MARROW OR BLOOD-DERIVED PERIPHERAL STEM CELL TRANSPLANTATION; ALLOGENEIC
38300 - DRAINAGE OF LYMPH NODE ABSCESS OR LYMPHADENITIS; SIMPLE
38305 - DRAINAGE OF LYMPH NODE ABSCESS OR LYMPHADENITIS; EXTENSIVE
38308 - LYMPHANGIOTOMY OR OTHER OPERATIONS ON LYMPHATIC CHANNELS
38500 - BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, SUPERFICIAL
38505 - BIOPSY OR EXCISION OF LYMPH NODE(S); BY NEEDLE, SUPERFICIAL (EG, CERVICAL,
38510 - BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP CERVICAL NODE(S)
38520 - BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP CERVICAL NODE(S) WITH EXCISION
38525 - BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP AXILLARY NODE(S)
38530 - BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, INTERNAL MAMMARY NODE(S)
38542 - DISSECTION, DEEP JUGULAR NODE(S)
38550 - EXCISION OF CYSTIC HYGROMA, AXILLARY OR CERVICAL; WITHOUT DEEP NEUROVASCULAR
38555 - EXCISION OF CYSTIC HYGROMA, AXILLARY OR CERVICAL; WITH DEEP NEUROVASCULAR
38570 - LAPAROSCOPY, SURGICAL; WITH RETROPERITONEAL LYMPH NODE SAMPLING (BIOPSY), SINGLE
38571 - LAPAROSCOPY, SURGICAL; WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY
38572 - LAPAROSCOPY, SURGICAL; WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY AND
38589 - UNLISTED LAPAROSCOPY PROCEDURE, LYMPHATIC SYSTEM
38700 - SUPRAHYOID LYMPHADENECTOMY
38720 - CERVICAL LYMPHADENECTOMY (COMPLETE)
38740 - AXILLARY LYMPHADENECTOMY; SUPERFICIAL



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                                      Surgery (triggers bundling)


38745   - AXILLARY LYMPHADENECTOMY; COMPLETE
38760   - INGUINOFEMORAL LYMPHADENECTOMY, SUPERFICIAL, INCLUDING CLOQUETS NODE (SEPARATE
38999   - UNLISTED PROCEDURE, HEMIC OR LYMPHATIC SYSTEM
39400   - MEDIASTINOSCOPY, WITH OR WITHOUT BIOPSY
40490   - BIOPSY OF LIP
40500   - VERMILIONECTOMY (LIP SHAVE), WITH MUCOSAL ADVANCEMENT
40510   - EXCISION OF LIP; TRANSVERSE WEDGE EXCISION WITH PRIMARY CLOSURE
40520   - EXCISION OF LIP; V-EXCISION WITH PRIMARY DIRECT LINEAR CLOSURE
40525   - EXCISION OF LIP; FULL THICKNESS, RECONSTRUCTION WITH LOCAL FLAP (EG, ESTLANDER
40527   - EXCISION OF LIP; FULL THICKNESS, RECONSTRUCTION WITH CROSS LIP FLAP
40530   - RESECTION OF LIP, MORE THAN ONE-FOURTH, WITHOUT RECONSTRUCTION
40650   - REPAIR LIP, FULL THICKNESS; VERMILION ONLY
40652   - REPAIR LIP, FULL THICKNESS; UP TO HALF VERTICAL HEIGHT
40654   - REPAIR LIP, FULL THICKNESS; OVER ONE-HALF VERTICAL HEIGHT, OR COMPLEX
40700   - PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; PRIMARY, PARTIAL OR COMPLETE,
40701   - PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; PRIMARY BILATERAL, ONE STAGE
40702   - PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; PRIMARY BILATERAL, ONE OF TWO
40720   - PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; SECONDARY, BY RECREATION OF DEFECT
40761   - PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; WITH CROSS LIP PEDICLE FLAP
40799   - UNLISTED PROCEDURE, LIPS
40800   - DRAINAGE OF ABSCESS, CYST, HEMATOMA, VESTIBULE OF MOUTH; SIMPLE
40801   - DRAINAGE OF ABSCESS, CYST, HEMATOMA, VESTIBULE OF MOUTH; COMPLICATED
40805   - REMOVAL OF EMBEDDED FOREIGN BODY, VESTIBULE OF MOUTH; COMPLICATED
40806   - INCISION OF LABIAL FRENUM (FRENOTOMY)
40808   - BIOPSY, VESTIBULE OF MOUTH
40810   - EXCISION OF LESION OF MUCOSA AND SUBMUCOSA, VESTIBULE OF MOUTH; WITHOUT REPAIR
40812   - EXCISION OF LESION OF MUCOSA AND SUBMUCOSA, VESTIBULE OF MOUTH; WITH SIMPLE
40814   - EXCISION OF LESION OF MUCOSA AND SUBMUCOSA, VESTIBULE OF MOUTH; WITH COMPLEX
40816   - EXCISION OF LESION OF MUCOSA AND SUBMUCOSA, VESTIBULE OF MOUTH; COMPLEX, WITH
40818   - EXCISION OF MUCOSA OF VESTIBULE OF MOUTH AS DONOR GRAFT
40819   - EXCISION OF FRENUM, LABIAL OR BUCCAL (FRENUMECTOMY, FRENULECTOMY, FRENECTOMY)
40820   - DESTRUCTION OF LESION OR SCAR OF VESTIBULE OF MOUTH BY PHYSICAL METHODS (EG,
40830   - CLOSURE OF LACERATION, VESTIBULE OF MOUTH; 2.5 CM OR LESS
40831   - CLOSURE OF LACERATION, VESTIBULE OF MOUTH; OVER 2.5 CM OR COMPLEX
40840   - VESTIBULOPLASTY; ANTERIOR
40842   - VESTIBULOPLASTY; POSTERIOR, UNILATERAL
40843   - VESTIBULOPLASTY; POSTERIOR, BILATERAL
40844   - VESTIBULOPLASTY; ENTIRE ARCH
40845   - VESTIBULOPLASTY; COMPLEX (INCLUDING RIDGE EXTENSION, MUSCLE REPOSITIONING)
40899   - UNLISTED PROCEDURE, VESTIBULE OF MOUTH
41000   - INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF TONGUE OR FLOOR
41005   - INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF TONGUE OR
41006   - INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF TONGUE OR
41007   - INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF TONGUE OR
41008   - INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF TONGUE OR
41009   - INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF TONGUE OR
41010   - INCISION OF LINGUAL FRENUM (FRENOTOMY)
41015   - EXTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF FLOOR OF
41016   - EXTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF FLOOR OF
41017   - EXTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF FLOOR OF
41018   - EXTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF FLOOR OF
41019   - PLACEMENT OF NEEDLES, CATHETERS, OR OTHER DEVICE(S) INTO THE HEAD AND/OR NECK RE
41100   - BIOPSY OF TONGUE; ANTERIOR TWO-THIRDS
41105   - BIOPSY OF TONGUE; POSTERIOR ONE-THIRD
41108   - BIOPSY OF FLOOR OF MOUTH



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                                      Surgery (triggers bundling)


41110   - EXCISION OF LESION OF TONGUE WITHOUT CLOSURE
41112   - EXCISION OF LESION OF TONGUE WITH CLOSURE; ANTERIOR TWO-THIRDS
41113   - EXCISION OF LESION OF TONGUE WITH CLOSURE; POSTERIOR ONE-THIRD
41114   - EXCISION OF LESION OF TONGUE WITH CLOSURE; WITH LOCAL TONGUE FLAP
41115   - EXCISION OF LINGUAL FRENUM (FRENECTOMY)
41116   - EXCISION, LESION OF FLOOR OF MOUTH
41120   - GLOSSECTOMY; LESS THAN ONE-HALF TONGUE
41250   - REPAIR OF LACERATION 2.5 CM OR LESS; FLOOR OF MOUTH AND/OR ANTERIOR TWO-THIRDS O
41251   - REPAIR OF LACERATION 2.5 CM OR LESS; POSTERIOR ONE-THIRD OF TONGUE
41252   - REPAIR OF LACERATION OF TONGUE, FLOOR OF MOUTH, OVER 2.6 CM OR COMPLEX
41500   - FIXATION OF TONGUE, MECHANICAL, OTHER THAN SUTURE (EG, K-WIRE)
41510   - SUTURE OF TONGUE TO LIP FOR MICROGNATHIA (DOUGLAS TYPE PROCEDURE)
41512   - Tongue base suspension, permanent suture technique
41520   - FRENOPLASTY (SURGICAL REVISION OF FRENUM, EG, WITH Z-PLASTY)
41530   - Submucosal ablation of the tongue base, radiofrequency, one or more sites, per s
41599   - UNLISTED PROCEDURE, TONGUE, FLOOR OF MOUTH
41800   - DRAINAGE OF ABSCESS, CYST, HEMATOMA FROM DENTOALVEOLAR STRUCTURES
41805   - REMOVAL OF EMBEDDED FOREIGN BODY FROM DENTOALVEOLAR STRUCTURES; SOFT TISSUES
41806   - REMOVAL OF EMBEDDED FOREIGN BODY FROM DENTOALVEOLAR STRUCTURES; BONE
41820   - GINGIVECTOMY, EXCISION GINGIVA, EACH QUADRANT
41821   - OPERCULECTOMY, EXCISION PERICORONAL TISSUES
41822   - EXCISION OF FIBROUS TUBEROSITIES, DENTOALVEOLAR STRUCTURES
41823   - EXCISION OF OSSEOUS TUBEROSITIES, DENTOALVEOLAR STRUCTURES
41825   - EXCISION OF LESION OR TUMOR (EXCEPT LISTED ABOVE), DENTOALVEOLAR STRUCTURES;
41826   - EXCISION OF LESION OR TUMOR (EXCEPT LISTED ABOVE), DENTOALVEOLAR STRUCTURES;
41827   - EXCISION OF LESION OR TUMOR (EXCEPT LISTED ABOVE), DENTOALVEOLAR STRUCTURES;
41828   - EXCISION OF HYPERPLASTIC ALVEOLAR MUCOSA, EACH QUADRANT (SPECIFY)
41830   - ALVEOLECTOMY, INCLUDING CURETTAGE OF OSTEITIS OR SEQUESTRECTOMY
41850   - DESTRUCTION OF LESION (EXCEPT EXCISION), DENTOALVEOLAR STRUCTURES
41870   - PERIODONTAL MUCOSAL GRAFTING
41872   - GINGIVOPLASTY, EACH QUADRANT (SPECIFY)
41874   - ALVEOLOPLASTY, EACH QUADRANT (SPECIFY)
41899   - UNLISTED PROCEDURE, DENTOALVEOLAR STRUCTURES
42000   - DRAINAGE OF ABSCESS OF PALATE, UVULA
42100   - BIOPSY OF PALATE, UVULA
42104   - EXCISION, LESION OF PALATE, UVULA; WITHOUT CLOSURE
42106   - EXCISION, LESION OF PALATE, UVULA; WITH SIMPLE PRIMARY CLOSURE
42107   - EXCISION, LESION OF PALATE, UVULA; WITH LOCAL FLAP CLOSURE
42120   - RESECTION OF PALATE OR EXTENSIVE RESECTION OF LESION
42140   - UVULECTOMY, EXCISION OF UVULA
42145   - PALATOPHARYNGOPLASTY (EG, UVULOPALATOPHARYNGOPLASTY, UVULOPHARYNGOPLASTY)
42160   - DESTRUCTION OF LESION, PALATE OR UVULA (THERMAL, CRYO OR CHEMICAL)
42180   - REPAIR, LACERATION OF PALATE; UP TO 2 CM
42182   - REPAIR, LACERATION OF PALATE; OVER 2 CM OR COMPLEX
42200   - PALATOPLASTY FOR CLEFT PALATE, SOFT AND/OR HARD PALATE ONLY
42205   - PALATOPLASTY FOR CLEFT PALATE, WITH CLOSURE OF ALVEOLAR RIDGE; SOFT TISSUE ONLY
42210   - PALATOPLASTY FOR CLEFT PALATE, WITH CLOSURE OF ALVEOLAR RIDGE; WITH BONE GRAFT
42215   - PALATOPLASTY FOR CLEFT PALATE; MAJOR REVISION
42220   - PALATOPLASTY FOR CLEFT PALATE; SECONDARY LENGTHENING PROCEDURE
42225   - PALATOPLASTY FOR CLEFT PALATE; ATTACHMENT PHARYNGEAL FLAP
42226   - LENGTHENING OF PALATE, AND PHARYNGEAL FLAP
42227   - LENGTHENING OF PALATE, WITH ISLAND FLAP
42235   - REPAIR OF ANTERIOR PALATE, INCLUDING VOMER FLAP
42260   - REPAIR OF NASOLABIAL FISTULA
42280   - MAXILLARY IMPRESSION FOR PALATAL PROSTHESIS



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                                      Surgery (triggers bundling)


42281   - INSERTION OF PIN-RETAINED PALATAL PROSTHESIS
42299   - UNLISTED PROCEDURE, PALATE, UVULA
42300   - DRAINAGE OF ABSCESS; PAROTID, SIMPLE
42305   - DRAINAGE OF ABSCESS; PAROTID, COMPLICATED
42310   - DRAINAGE OF ABSCESS; SUBMAXILLARY OR SUBLINGUAL, INTRAORAL
42320   - DRAINAGE OF ABSCESS; SUBMAXILLARY, EXTERNAL
42330   - SIALOLITHOTOMY; SUBMANDIBULAR (SUBMAXILLARY), SUBLINGUAL OR PAROTID,
42335   - SIALOLITHOTOMY; SUBMANDIBULAR (SUBMAXILLARY), COMPLICATED, INTRAORAL
42340   - SIALOLITHOTOMY; PAROTID, EXTRAORAL OR COMPLICATED INTRAORAL
42400   - BIOPSY OF SALIVARY GLAND; NEEDLE
42405   - BIOPSY OF SALIVARY GLAND; INCISIONAL
42408   - EXCISION OF SUBLINGUAL SALIVARY CYST (RANULA)
42409   - MARSUPIALIZATION OF SUBLINGUAL SALIVARY CYST (RANULA)
42410   - EXCISION OF PAROTID TUMOR OR PAROTID GLAND; LATERAL LOBE, WITHOUT NERVE
42415   - EXCISION OF PAROTID TUMOR OR PAROTID GLAND; LATERAL LOBE, WITH DISSECTION AND
42420   - EXCISION OF PAROTID TUMOR OR PAROTID GLAND; TOTAL, WITH DISSECTION AND
42425   - EXCISION OF PAROTID TUMOR OR PAROTID GLAND; TOTAL, EN BLOC REMOVAL WITH
42440   - EXCISION OF SUBMANDIBULAR (SUBMAXILLARY) GLAND
42450   - EXCISION OF SUBLINGUAL GLAND
42500   - PLASTIC REPAIR OF SALIVARY DUCT, SIALODOCHOPLASTY; PRIMARY OR SIMPLE
42505   - PLASTIC REPAIR OF SALIVARY DUCT, SIALODOCHOPLASTY; SECONDARY OR COMPLICATED
42507   - PAROTID DUCT DIVERSION, BILATERAL (WILKE TYPE PROCEDURE);
42508   - PAROTID DUCT DIVERSION, BILATERAL (WILKE TYPE PROCEDURE); WITH EXCISION OF ONE
42509   - PAROTID DUCT DIVERSION, BILATERAL (WILKE TYPE PROCEDURE); WITH EXCISION OF BOTH
42510   - PAROTID DUCT DIVERSION, BILATERAL (WILKE TYPE PROCEDURE); WITH LIGATION OF BOTH
42600   - CLOSURE SALIVARY FISTULA
42650   - DILATION SALIVARY DUCT
42660   - DILATION AND CATHETERIZATION OF SALIVARY DUCT, WITH OR WITHOUT INJECTION
42665   - LIGATION SALIVARY DUCT, INTRAORAL
42699   - UNLISTED PROCEDURE, SALIVARY GLANDS OR DUCTS
42700   - INCISION AND DRAINAGE ABSCESS; PERITONSILLAR
42720   - INCISION AND DRAINAGE ABSCESS; RETROPHARYNGEAL OR PARAPHARYNGEAL, INTRAORAL
42725   - INCISION AND DRAINAGE ABSCESS; RETROPHARYNGEAL OR PARAPHARYNGEAL, EXTERNAL
42800   - BIOPSY; OROPHARYNX
42802   - BIOPSY; HYPOPHARYNX
42804   - BIOPSY; NASOPHARYNX, VISIBLE LESION, SIMPLE
42806   - BIOPSY; NASOPHARYNX, SURVEY FOR UNKNOWN PRIMARY LESION
42808   - EXCISION OR DESTRUCTION OF LESION OF PHARYNX, ANY METHOD
42810   - EXCISION BRANCHIAL CLEFT CYST OR VESTIGE, CONFINED TO SKIN AND SUBCUTANEOUS
42815   - EXCISION BRANCHIAL CLEFT CYST, VESTIGE, OR FISTULA, EXTENDING BENEATH
42820   - TONSILLECTOMY AND ADENOIDECTOMY; UNDER AGE 12
42821   - TONSILLECTOMY AND ADENOIDECTOMY; AGE 12 OR OVER
42825   - TONSILLECTOMY, PRIMARY OR SECONDARY; UNDER AGE 12
42826   - TONSILLECTOMY, PRIMARY OR SECONDARY; AGE 12 OR OVER
42830   - ADENOIDECTOMY, PRIMARY; UNDER AGE 12
42831   - ADENOIDECTOMY, PRIMARY; AGE 12 OR OVER
42835   - ADENOIDECTOMY, SECONDARY; UNDER AGE 12
42836   - ADENOIDECTOMY, SECONDARY; AGE 12 OR OVER
42842   - RADICAL RESECTION OF TONSIL, TONSILLAR PILLARS, AND/OR RETROMOLAR TRIGONE;
42844   - RADICAL RESECTION OF TONSIL, TONSILLAR PILLARS, AND/OR RETROMOLAR TRIGONE;
42860   - EXCISION OF TONSIL TAGS
42870   - EXCISION OR DESTRUCTION LINGUAL TONSIL, ANY METHOD (SEPARATE PROCEDURE)
42890   - LIMITED PHARYNGECTOMY
42892   - RESECTION OF LATERAL PHARYNGEAL WALL OR PYRIFORM SINUS, DIRECT CLOSURE BY
42900   - SUTURE PHARYNX FOR WOUND OR INJURY



                                              Page 113
                                     Surgery (triggers bundling)


42950   - PHARYNGOPLASTY (PLASTIC OR RECONSTRUCTIVE OPERATION ON PHARYNX)
42955   - PHARYNGOSTOMY (FISTULIZATION OF PHARYNX, EXTERNAL FOR FEEDING)
42960   - CONTROL OROPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG,
42962   - CONTROL OROPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG,
42970   - CONTROL OF NASOPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG,
42972   - CONTROL OF NASOPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG,
42999   - UNLISTED PROCEDURE, PHARYNX, ADENOIDS, OR TONSILS
43020   - ESOPHAGOTOMY, CERVICAL APPROACH; WITH REMOVAL OF FOREIGN BODY
43030   - CRICOPHARYNGEAL MYOTOMY
43130   - DIVERTICULECTOMY OF HYPOPHARYNX OR ESOPHAGUS, WITH OR WITHOUT MYOTOMY; CERVICAL
43200   - ESOPHAGOSCOPY, RIGID OR FLEXIBLE; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPEC
43201   - ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY
43202   - ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE
43204   - ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH INJECTION SCLEROSIS OF ESOPHAGEAL VARICES
43205   - ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH BAND LIGATION OF ESOPHAGEAL VARICES
43215   - ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH REMOVAL OF FOREIGN BODY
43216   - ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER
43217   - ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER
43219   - ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH INSERTION OF PLASTIC TUBE OR STENT
43220   - ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH BALLOON DILATION (LESS THAN 30 MM
43226   - ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH INSERTION OF GUIDE WIRE FOLLOWED BY
43227   - ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH CONTROL OF BLEEDING (EG, INJECTION,
43228   - ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER
43231   - ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH ENDOSCOPIC ULTRASOUND EXAMINATION
43232   - ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH TRANSENDOSCOPIC ULTRASOUND-GUIDED
43234   - UPPER GASTROINTESTINAL ENDOSCOPY, SIMPLE PRIMARY EXAMINATION (EG, WITH SMALL
43235   - UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
43236   - UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
43237   - UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
43238   - UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
43239   - UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
43240   - UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
43241   - UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
43242   - UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
43243   - UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
43244   - UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
43245   - UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
43246   - UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
43247   - UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
43248   - UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
43249   - UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
43250   - UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
43251   - UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
43255   - UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
43256   - UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
43257   - UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
43258   - UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
43259   - UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
43260   - ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); DIAGNOSTIC, WITH OR
43261   - ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH BIOPSY, SINGLE OR
43262   - ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH
43263   - ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH PRESSURE
43264   - ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC
43265   - ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC
43267   - ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC



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                                  Surgery (triggers bundling)


43268 - ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC
43269 - ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC
43271 - ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC
43272 - ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ABLATION OF
43273 - Endoscopic cannulation of papilla with direct visualization of common bile duct(
43280 - LAPAROSCOPY, SURGICAL, ESOPHAGOGASTRIC FUNDOPLASTY (EG, NISSEN, TOUPET PROCEDURE
43289 - UNLISTED LAPAROSCOPY PROCEDURE, ESOPHAGUS
43420 - CLOSURE OF ESOPHAGOSTOMY OR FISTULA; CERVICAL APPROACH
43450 - DILATION OF ESOPHAGUS, BY UNGUIDED SOUND OR BOUGIE, SINGLE OR MULTIPLE PASSES
43453 - DILATION OF ESOPHAGUS, OVER GUIDE WIRE
43456 - DILATION OF ESOPHAGUS, BY BALLOON OR DILATOR, RETROGRADE
43458 - DILATION OF ESOPHAGUS WITH BALLOON (30 MM DIAMETER OR LARGER) FOR ACHALASIA
43499 - UNLISTED PROCEDURE, ESOPHAGUS
43510 - GASTROTOMY; WITH ESOPHAGEAL DILATION AND INSERTION OF PERMANENT INTRALUMINAL
43600 - BIOPSY OF STOMACH; BY CAPSULE, TUBE, PERORAL (ONE OR MORE SPECIMENS)
43648 - LAPAROSCOPY, SURGICAL; REVISION OR REMOVAL OF GASTRIC NEUROSTIMULATOR ELECTRODES
43651 - LAPAROSCOPY, SURGICAL; TRANSECTION OF VAGUS NERVES, TRUNCAL
43652 - LAPAROSCOPY, SURGICAL; TRANSECTION OF VAGUS NERVES, SELECTIVE OR HIGHLY
43653 - LAPAROSCOPY, SURGICAL; GASTROSTOMY, WITHOUT CONSTRUCTION OF GASTRIC TUBE (EG,
43659 - UNLISTED LAPAROSCOPY PROCEDURE, STOMACH
43755 - Gastric intubation and aspiration, diagnostic; collection of multiple fractional
43760 - CHANGE OF GASTROSTOMY TUBE, PERCUTANEOUS, WITHOUT IMAGING OR ENDOSCOPIC GUIDANCE
43761 - REPOSITIONING OF A NASO- OR ORO-GASTRIC FEEDING TUBE, THROUGH THE DUODENUM FOR E
43830 - GASTROSTOMY, OPEN; WITHOUT CONSTRUCTION OF GASTRIC TUBE (EG, STAMM PROCEDURE)
43831 - GASTROSTOMY, OPEN; NEONATAL, FOR FEEDING
43870 - CLOSURE OF GASTROSTOMY, SURGICAL
43886 - GASTRIC RESTRICTIVE PROCEDURE, OPEN; REVISION OF SUBCUTANEOUS PORT COMPONENT ONL
43887 - GASTRIC RESTRICTIVE PROCEDURE, OPEN; REMOVAL OF SUBCUTANEOUS PORT COMPONENT ONLY
43888 - GASTRIC RESTRICTIVE PROCEDURE, OPEN; REMOVAL AND REPLACEMENT OF SUBCUTANEOUS POR
43999 - UNLISTED PROCEDURE, STOMACH
44100 - BIOPSY OF INTESTINE BY CAPSULE, TUBE, PERORAL (ONE OR MORE SPECIMENS)
44180 - LAPAROSCOPY, SURGICAL, ENTEROLYSIS (FREEING OF INTESTINAL ADHESION) (SEPARATE PR
44186 - LAPAROSCOPY, SURGICAL; JEJUNOSTOMY (EG, FOR DECOMPRESSION OR FEEDING)
44206 - LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH END COLOSTOMY AND CLOSURE OF
44207 - LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH ANASTOMOSIS, WITH
44208 - LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH ANASTOMOSIS, WITH
44213 - LAPAROSCOPY, SURGICAL, MOBILIZATION (TAKE-DOWN) OF SPLENIC FLEXURE PERFORMED IN
44238 - UNLISTED LAPAROSCOPY PROCEDURE, INTESTINE (EXCEPT RECTUM)
44312 - REVISION OF ILEOSTOMY; SIMPLE (RELEASE OF SUPERFICIAL SCAR) (SEPARATE PROCEDURE)
44340 - REVISION OF COLOSTOMY; SIMPLE (RELEASE OF SUPERFICIAL SCAR) (SEPARATE PROCEDURE)
44360 - SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT I
44361 - SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT
44363 - SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT
44364 - SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT
44365 - SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT
44366 - SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT
44369 - SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT
44370 - SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT
44372 - SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT
44373 - SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT
44376 - SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM,
44377 - SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM,
44378 - SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM,
44379 - SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM,
44380 - ILEOSCOPY, THROUGH STOMA; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S)



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                                     Surgery (triggers bundling)


44382   - ILEOSCOPY, THROUGH STOMA; WITH BIOPSY, SINGLE OR MULTIPLE
44383   - ILEOSCOPY, THROUGH STOMA; WITH TRANSENDOSCOPIC STENT PLACEMENT (INCLUDES
44385   - ENDOSCOPIC EVALUATION OF SMALL INTESTINAL (ABDOMINAL OR PELVIC) POUCH;
44386   - ENDOSCOPIC EVALUATION OF SMALL INTESTINAL (ABDOMINAL OR PELVIC) POUCH; WITH
44388   - COLONOSCOPY THROUGH STOMA; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF
44389   - COLONOSCOPY THROUGH STOMA; WITH BIOPSY, SINGLE OR MULTIPLE
44390   - COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF FOREIGN BODY
44391   - COLONOSCOPY THROUGH STOMA; WITH CONTROL OF BLEEDING (EG, INJECTION, BIPOLAR
44392   - COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER
44393   - COLONOSCOPY THROUGH STOMA; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER
44394   - COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER
44397   - COLONOSCOPY THROUGH STOMA; WITH TRANSENDOSCOPIC STENT PLACEMENT (INCLUDES
44500   - INTRODUCTION OF LONG GASTROINTESTINAL TUBE (EG, MILLER-ABBOTT) (SEPARATE PROCEDU
44799   - UNLISTED PROCEDURE, INTESTINE
44901   - INCISION AND DRAINAGE OF APPENDICEAL ABSCESS; PERCUTANEOUS
44970   - LAPAROSCOPY, SURGICAL, APPENDECTOMY
44979   - UNLISTED LAPAROSCOPY PROCEDURE, APPENDIX
45000   - TRANSRECTAL DRAINAGE OF PELVIC ABSCESS
45005   - INCISION AND DRAINAGE OF SUBMUCOSAL ABSCESS, RECTUM
45020   - INCISION AND DRAINAGE OF DEEP SUPRALEVATOR, PELVIRECTAL, OR RETRORECTAL ABSCESS
45100   - BIOPSY OF ANORECTAL WALL, ANAL APPROACH (EG, CONGENITAL MEGACOLON)
45108   - ANORECTAL MYOMECTOMY
45150   - DIVISION OF STRICTURE OF RECTUM
45160   - EXCISION OF RECTAL TUMOR BY PROCTOTOMY, TRANSSACRAL OR TRANSCOCCYGEAL APPROACH
45171   - Excision of rectal tumor, transanal approach; not including muscularis propria (
45172   - Excision of rectal tumor, transanal approach; including muscularis propria (ie,
45190   - DESTRUCTION OF RECTAL TUMOR (EG, ELECTRODESSICATION, ELECTROSURGERY, LASER ABLAT
45300   - PROCTOSIGMOIDOSCOPY, RIGID; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S
45303   - PROCTOSIGMOIDOSCOPY, RIGID; WITH DILATION (EG, BALLOON, GUIDE WIRE, BOUGIE)
45305   - PROCTOSIGMOIDOSCOPY, RIGID; WITH BIOPSY, SINGLE OR MULTIPLE
45307   - PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF FOREIGN BODY
45308   - PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR OTHER
45309   - PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR OTHER
45315   - PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF MULTIPLE TUMORS, POLYPS, OR OTHER
45317   - PROCTOSIGMOIDOSCOPY, RIGID; WITH CONTROL OF BLEEDING (EG, INJECTION, BIPOLAR
45320   - PROCTOSIGMOIDOSCOPY, RIGID; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER
45321   - PROCTOSIGMOIDOSCOPY, RIGID; WITH DECOMPRESSION OF VOLVULUS
45327   - PROCTOSIGMOIDOSCOPY, RIGID; WITH TRANSENDOSCOPIC STENT PLACEMENT (INCLUDES
45330   - SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S)
45331   - SIGMOIDOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE
45332   - SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF FOREIGN BODY
45333   - SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S)
45334   - SIGMOIDOSCOPY, FLEXIBLE; WITH CONTROL OF BLEEDING (EG, INJECTION, BIPOLAR
45335   - SIGMOIDOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE
45337   - SIGMOIDOSCOPY, FLEXIBLE; WITH DECOMPRESSION OF VOLVULUS, ANY METHOD
45338   - SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S)
45339   - SIGMOIDOSCOPY, FLEXIBLE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER
45340   - SIGMOIDOSCOPY, FLEXIBLE; WITH DILATION BY BALLOON, 1 OR MORE STRICTURES
45341   - SIGMOIDOSCOPY, FLEXIBLE; WITH ENDOSCOPIC ULTRASOUND EXAMINATION
45342   - SIGMOIDOSCOPY, FLEXIBLE; WITH TRANSENDOSCOPIC ULTRASOUND GUIDED INTRAMURAL OR
45345   - SIGMOIDOSCOPY, FLEXIBLE; WITH TRANSENDOSCOPIC STENT PLACEMENT (INCLUDES
45355   - COLONOSCOPY, RIGID OR FLEXIBLE, TRANSABDOMINAL VIA COLOTOMY, SINGLE OR MULTIPLE
45378   - COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; DIAGNOSTIC, WITH OR WITHOUT
45379   - COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH REMOVAL OF FOREIGN BODY
45380   - COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH BIOPSY, SINGLE OR



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                                     Surgery (triggers bundling)


45381   - COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH DIRECTED SUBMUCOSAL
45382   - COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH CONTROL OF BLEEDING
45383   - COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH ABLATION OF TUMOR(S),
45384   - COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH REMOVAL OF TUMOR(S),
45385   - COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH REMOVAL OF TUMOR(S),
45386   - COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH DILATION BY BALLOON, 1
45387   - COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH TRANSENDOSCOPIC STENT
45391   - COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH ENDOSCOPIC ULTRASOUND
45392   - COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH TRANSENDOSCOPIC
45499   - UNLISTED LAPAROSCOPY PROCEDURE, RECTUM
45500   - PROCTOPLASTY; FOR STENOSIS
45505   - PROCTOPLASTY; FOR PROLAPSE OF MUCOUS MEMBRANE
45520   - PERIRECTAL INJECTION OF SCLEROSING SOLUTION FOR PROLAPSE
45541   - PROCTOPEXY FOR PROLAPSE; PERINEAL APPROACH
45560   - REPAIR OF RECTOCELE (SEPARATE PROCEDURE)
45900   - REDUCTION OF PROCIDENTIA (SEPARATE PROCEDURE) UNDER ANESTHESIA
45905   - DILATION OF ANAL SPHINCTER (SEPARATE PROCEDURE) UNDER ANESTHESIA OTHER THAN
45910   - DILATION OF RECTAL STRICTURE (SEPARATE PROCEDURE) UNDER ANESTHESIA OTHER THAN
45915   - REMOVAL OF FECAL IMPACTION OR FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA
45990   - ANORECTAL EXAM, SURGICAL, REQUIRING ANESTHESIA (GENERAL, SPINAL, OR EPIDURAL), D
45999   - UNLISTED PROCEDURE, RECTUM
46020   - PLACEMENT OF SETON
46030   - REMOVAL OF ANAL SETON, OTHER MARKER
46040   - INCISION AND DRAINAGE OF ISCHIORECTAL AND/OR PERIRECTAL ABSCESS (SEPARATE
46045   - INCISION AND DRAINAGE OF INTRAMURAL, INTRAMUSCULAR, OR SUBMUCOSAL ABSCESS,
46050   - INCISION AND DRAINAGE, PERIANAL ABSCESS, SUPERFICIAL
46060   - INCISION AND DRAINAGE OF ISCHIORECTAL OR INTRAMURAL ABSCESS, WITH FISTULECTOMY
46070   - INCISION, ANAL SEPTUM (INFANT)
46080   - SPHINCTEROTOMY, ANAL, DIVISION OF SPHINCTER (SEPARATE PROCEDURE)
46083   - INCISION OF THROMBOSED HEMORRHOID, EXTERNAL
46200   - FISSURECTOMY, INCLUDING SPHINCTEROTOMY, WHEN PERFORMED
46220   - EXCISION OF SINGLE EXTERNAL PAPILLA OR TAG, ANUS
46221   - HEMORRHOIDECTOMY, INTERNAL, BY RUBBER BAND LIGATION(S)
46230   - CODE IS OUT OF NUMERICAL SEQUENCE. SEE 46200-46288
46250   - HEMORRHOIDECTOMY, EXTERNAL, 2 OR MORE COLUMNS/GROUPS
46255   - HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SINGLE COLUMN/GROUP;
46257   - HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SIMPLE; WITH FISSURECTOMY
46258   - HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SINGLE COLUMN/GROUP; WITH FISTULECTOMY,
46260   - HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, 2 OR MORE COLUMNS/GROUPS;
46261   - HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, COMPLEX OR EXTENSIVE; WITH FISSURECTOMY
46262   - HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, 2 OR MORE COLUMNS/GROUPS; WITH FISTULEC
46270   - SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); SUBCUTANEOUS
46275   - SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); INTERSPHINCTERIC
46280   - SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); TRANSSPHINCTERIC,
46285   - SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); SECOND STAGE
46288   - CLOSURE OF ANAL FISTULA WITH RECTAL ADVANCEMENT FLAP
46320   - EXCISION OF THROMBOSED HEMORRHOID, EXTERNAL
46500   - INJECTION OF SCLEROSING SOLUTION, HEMORRHOIDS
46604   - ANOSCOPY; WITH DILATION (EG, BALLOON, GUIDE WIRE, BOUGIE)
46606   - ANOSCOPY; WITH BIOPSY, SINGLE OR MULTIPLE
46608   - ANOSCOPY; WITH REMOVAL OF FOREIGN BODY
46610   - ANOSCOPY; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR OTHER LESION BY HOT BIOPSY
46611   - ANOSCOPY; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR OTHER LESION BY SNARE
46612   - ANOSCOPY; WITH REMOVAL OF MULTIPLE TUMORS, POLYPS, OR OTHER LESIONS BY HOT
46614   - ANOSCOPY; WITH CONTROL OF BLEEDING (EG, INJECTION, BIPOLAR CAUTERY, UNIPOLAR



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                                     Surgery (triggers bundling)


46615   - ANOSCOPY; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) NOT AMENABLE
46700   - ANOPLASTY, PLASTIC OPERATION FOR STRICTURE; ADULT
46706   - REPAIR OF ANAL FISTULA WITH FIBRIN GLUE
46707   - Repair of anorectal fistula with plug (eg, porcine small intestine submucosa ¿S
46750   - SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE OR PROLAPSE; ADULT
46753   - GRAFT (THIERSCH OPERATION) FOR RECTAL INCONTINENCE AND/OR PROLAPSE
46754   - REMOVAL OF THIERSCH WIRE OR SUTURE, ANAL CANAL
46760   - SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE, ADULT; MUSCLE TRANSPLANT
46761   - SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE, ADULT; LEVATOR MUSCLE IMBRICATION
46762   - SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE, ADULT; IMPLANTATION ARTIFICIAL
46900   - DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM,
46910   - DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM
46916   - DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM
46917   - DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM
46922   - DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM
46924   - DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM
46930   - Destruction of internal hemorrhoid(s) by thermal energy (eg, infrared coagulatio
46940   - CURETTAGE OR CAUTERY OF ANAL FISSURE, INCLUDING DILATION OF ANAL SPHINCTER
46942   - CURETTAGE OR CAUTERY OF ANAL FISSURE, INCLUDING DILATION OF ANAL SPHINCTER
46945   - HEMORRHOIDECTOMY, INTERNAL, BY LIGATION OTHER THAN RUBBER BAND; SINGLE HEMORRHOI
46946   - HEMORRHOIDECTOMY, INTERNAL, BY LIGATION OTHER THAN RUBBER BAND; SINGLE HEMORRHOI
46947   - HEMORRHOIDOPEXY (EG, FOR PROLAPSING INTERNAL HEMORRHOIDS) BY STAPLING
46999   - UNLISTED PROCEDURE, ANUS
47000   - BIOPSY OF LIVER, NEEDLE; PERCUTANEOUS
47011   - HEPATOTOMY; FOR PERCUTANEOUS DRAINAGE OF ABSCESS OR CYST, ONE OR TWO STAGES
47370   - LAPAROSCOPY, SURGICAL, ABLATION OF ONE OR MORE LIVER TUMOR(S); RADIOFREQUENCY
47371   - LAPAROSCOPY, SURGICAL, ABLATION OF ONE OR MORE LIVER TUMOR(S); CRYOSURGICAL
47379   - UNLISTED LAPAROSCOPIC PROCEDURE, LIVER
47382   - ABLATION, 1 OR MORE LIVER TUMOR(S), PERCUTANEOUS, RADIOFREQUENCY
47399   - UNLISTED PROCEDURE, LIVER
47490   - PERCUTANEOUS CHOLECYSTOSTOMY
47510   - INTRODUCTION OF PERCUTANEOUS TRANSHEPATIC CATHETER FOR BILIARY DRAINAGE
47511   - INTRODUCTION OF PERCUTANEOUS TRANSHEPATIC STENT FOR INTERNAL AND EXTERNAL
47525   - CHANGE OF PERCUTANEOUS BILIARY DRAINAGE CATHETER
47530   - REVISION AND/OR REINSERTION OF TRANSHEPATIC TUBE
47552   - BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT; DIAGNOSTIC, WITH OR
47553   - BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT; WITH BIOPSY, SINGLE
47554   - BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT; WITH REMOVAL OF
47555   - BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT; WITH DILATION OF
47556   - BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT; WITH DILATION OF
47560   - LAPAROSCOPY, SURGICAL; WITH GUIDED TRANSHEPATIC CHOLANGIOGRAPHY, WITHOUT BIOPSY
47561   - LAPAROSCOPY, SURGICAL; WITH GUIDED TRANSHEPATIC CHOLANGIOGRAPHY WITH BIOPSY
47562   - LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY
47563   - LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH CHOLANGIOGRAPHY
47564   - LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT
47579   - UNLISTED LAPAROSCOPY PROCEDURE, BILIARY TRACT
47630   - BILIARY DUCT STONE EXTRACTION, PERCUTANEOUS VIA T-TUBE TRACT, BASKET, OR SNARE
47999   - UNLISTED PROCEDURE, BILIARY TRACT
48102   - BIOPSY OF PANCREAS, PERCUTANEOUS NEEDLE
48511   - EXTERNAL DRAINAGE, PSEUDOCYST OF PANCREAS; PERCUTANEOUS
48999   - UNLISTED PROCEDURE, PANCREAS
49021   - DRAINAGE OF PERITONEAL ABSCESS OR LOCALIZED PERITONITIS, EXCLUSIVE OF
49041   - DRAINAGE OF SUBDIAPHRAGMATIC OR SUBPHRENIC ABSCESS; PERCUTANEOUS
49061   - DRAINAGE OF RETROPERITONEAL ABSCESS; PERCUTANEOUS
49080   - PERITONEOCENTESIS, ABDOMINAL PARACENTESIS, OR PERITONEAL LAVAGE (DIAGNOSTIC OR



                                             Page 118
                                 Surgery (triggers bundling)


49081 - PERITONEOCENTESIS, ABDOMINAL PARACENTESIS, OR PERITONEAL LAVAGE (DIAGNOSTIC OR
49180 - BIOPSY, ABDOMINAL OR RETROPERITONEAL MASS, PERCUTANEOUS NEEDLE
49250 - UMBILECTOMY, OMPHALECTOMY, EXCISION OF UMBILICUS (SEPARATE PROCEDURE)
49320 - LAPAROSCOPY, ABDOMEN, PERITONEUM, AND OMENTUM, DIAGNOSTIC, WITH OR WITHOUT COLLE
49321 - LAPAROSCOPY, SURGICAL; WITH BIOPSY (SINGLE OR MULTIPLE)
49322 - LAPAROSCOPY, SURGICAL; WITH ASPIRATION OF CAVITY OR CYST (EG, OVARIAN CYST)
49323 - LAPAROSCOPY, SURGICAL; WITH DRAINAGE OF LYMPHOCELE TO PERITONEAL CAVITY
49324 - LAPAROSCOPY, SURGICAL; WITH INSERTION OF INTRAPERITONEAL CANNULA OR CATHETER, PE
49325 - LAPAROSCOPY, SURGICAL; WITH REVISION OF PREVIOUSLY PLACED INTRAPERITONEAL CANNUL
49326 - LAPAROSCOPY, SURGICAL; WITH OMENTOPEXY (OMENTAL TACKING PROCEDURE) (LIST SEPARAT
49327 - Laparoscopy, surgical; with placement of interstitial device(s) for radiation th
49329 - UNLISTED LAPAROSCOPY PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM
49402 - REMOVAL OF PERITONEAL FOREIGN BODY FROM PERITONEAL CAVITY
49418 - Insertion of tunneled intraperitoneal catheter (eg, dialysis, intraperitoneal ch
49419 - INSERTION OF INTRAPERITONEAL CANNULA OR CATHETER, WITH SUBCUTANEOUS RESERVOIR,
49420 - INSERTION OF INTRAPERITONEAL CANNULA OR CATHETER FOR DRAINAGE OR DIALYSIS;
49421 - INSERTION OF INTRAPERITONEAL CANNULA OR CATHETER FOR DRAINAGE OR DIALYSIS;
49422 - REMOVAL OF PERMANENT INTRAPERITONEAL CANNULA OR CATHETER
49423 - EXCHANGE OF PREVIOUSLY PLACED ABSCESS OR CYST DRAINAGE CATHETER UNDER
49426 - REVISION OF PERITONEAL-VENOUS SHUNT
49429 - REMOVAL OF PERITONEAL-VENOUS SHUNT
49435 - INSERTION OF SUBCUTANEOUS EXTENSION TO INTRAPERITONEAL CANNULA OR CATHETER WITH
49436 - DELAYED CREATION OF EXIT SITE FROM EMBEDDED SUBCUTANEOUS SEGMENT OF INTRAPERITON
49440 - INSERTION OF GASTROSTOMY TUBE, PERCUTANEOUS, UNDER FLUOROSCOPIC GUIDANCE INCLUDI
49441 - INSERTION OF DUODENOSTOMY OR JEJUNOSTOMY TUBE, PERCUTANEOUS, UNDER FLUOROSCOPIC
49442 - INSERTION OF CECOSTOMY OR OTHER COLONIC TUBE, PERCUTANEOUS, UNDER FLUOROSCOPIC G
49446 - CONVERSION OF GASTROSTOMY TUBE TO GASTRO-JEJUNOSTOMY TUBE, PERCUTANEOUS, UNDER F
49450 - REPLACEMENT OF GASTROSTOMY OR CECOSTOMY (OR OTHER COLONIC) TUBE, PERCUTANEOUS, U
49451 - REPLACEMENT OF DUODENOSTOMY OR JEJUNOSTOMY TUBE, PERCUTANEOUS, UNDER FLUOROSCOPI
49452 - REPLACEMENT OF GASTRO-JEJUNOSTOMY TUBE, PERCUTANEOUS, UNDER FLUOROSCOPIC GUIDANC
49460 - MECHANICAL REMOVAL OF OBSTRUCTIVE MATERIAL FROM GASTROSTOMY, DUODENOSTOMY, JEJUN
49491 - REPAIR, INITIAL INGUINAL HERNIA, PRETERM INFANT (LESS THAN 37 WEEKS GESTATION AT
49492 - REPAIR, INITIAL INGUINAL HERNIA, PRETERM INFANT (LESS THAN 37 WEEKS GESTATION
49495 - REPAIR, INITIAL INGUINAL HERNIA, FULL TERM INFANT UNDER AGE 6 MONTHS, OR
49496 - REPAIR, INITIAL INGUINAL HERNIA, FULL TERM INFANT UNDER AGE 6 MONTHS, OR
49500 - REPAIR INITIAL INGUINAL HERNIA, AGE 6 MONTHS TO UNDER 5 YEARS, WITH OR WITHOUT
49501 - REPAIR INITIAL INGUINAL HERNIA, AGE 6 MONTHS TO UNDER 5 YEARS, WITH OR WITHOUT
49505 - REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OVER; REDUCIBLE
49507 - REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OVER; INCARCERATED OR
49520 - REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; REDUCIBLE
49521 - REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; INCARCERATED OR STRANGULATED
49525 - REPAIR INGUINAL HERNIA, SLIDING, ANY AGE
49540 - REPAIR LUMBAR HERNIA
49550 - REPAIR INITIAL FEMORAL HERNIA, ANY AGE; REDUCIBLE
49553 - REPAIR INITIAL FEMORAL HERNIA, ANY AGE; INCARCERATED OR STRANGULATED
49555 - REPAIR RECURRENT FEMORAL HERNIA; REDUCIBLE
49557 - REPAIR RECURRENT FEMORAL HERNIA; INCARCERATED OR STRANGULATED
49560 - REPAIR INITIAL INCISIONAL OR VENTRAL HERNIA; REDUCIBLE
49561 - REPAIR INITIAL INCISIONAL OR VENTRAL HERNIA; INCARCERATED OR STRANGULATED
49565 - REPAIR RECURRENT INCISIONAL OR VENTRAL HERNIA; REDUCIBLE
49566 - REPAIR RECURRENT INCISIONAL OR VENTRAL HERNIA; INCARCERATED OR STRANGULATED
49568 - IMPLANTATION OF MESH OR OTHER PROSTHESIS FOR OPEN INCISIONAL OR VENTRAL HERNIA R
49570 - REPAIR EPIGASTRIC HERNIA (EG, PREPERITONEAL FAT); REDUCIBLE (SEPARATE PROCEDURE)
49572 - REPAIR EPIGASTRIC HERNIA (EG, PREPERITONEAL FAT); INCARCERATED OR STRANGULATED
49580 - REPAIR UMBILICAL HERNIA, UNDER AGE 5 YEARS; REDUCIBLE



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49582   - REPAIR UMBILICAL HERNIA, UNDER AGE 5 YEARS; INCARCERATED OR STRANGULATED
49585   - REPAIR UMBILICAL HERNIA, AGE 5 YEARS OR OVER; REDUCIBLE
49587   - REPAIR UMBILICAL HERNIA, AGE 5 YEARS OR OVER; INCARCERATED OR STRANGULATED
49590   - REPAIR SPIGELIAN HERNIA
49600   - REPAIR OF SMALL OMPHALOCELE, WITH PRIMARY CLOSURE
49650   - LAPAROSCOPY, SURGICAL; REPAIR INITIAL INGUINAL HERNIA
49651   - LAPAROSCOPY, SURGICAL; REPAIR RECURRENT INGUINAL HERNIA
49652   - Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric herni
49653   - Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric herni
49654   - Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when
49655   - Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when
49656   - Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insert
49657   - Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insert
49659   - UNLISTED LAPAROSCOPY PROCEDURE, HERNIOPLASTY, HERNIORRHAPHY, HERNIOTOMY
49999   - UNLISTED PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM
50020   - DRAINAGE OF PERIRENAL OR RENAL ABSCESS; OPEN
50021   - DRAINAGE OF PERIRENAL OR RENAL ABSCESS; PERCUTANEOUS
50080   - PERCUTANEOUS NEPHROSTOLITHOTOMY OR PYELOSTOLITHOTOMY, WITH OR WITHOUT DILATION,
50081   - PERCUTANEOUS NEPHROSTOLITHOTOMY OR PYELOSTOLITHOTOMY, WITH OR WITHOUT DILATION,
50200   - RENAL BIOPSY; PERCUTANEOUS, BY TROCAR OR NEEDLE
50382   - REMOVAL (VIA SNARE/CAPTURE) AND REPLACEMENT OF INTERNALLY DWELLING URETERAL STEN
50384   - REMOVAL (VIA SNARE/CAPTURE) OF INTERNALLY DWELLING URETERAL STENT VIA PERCUTANEO
50385   - REMOVAL (VIA SNARE/CAPTURE) AND REPLACEMENT OF INTERNALLY DWELLING URETERAL STEN
50386   - REMOVAL (VIA SNARE/CAPTURE) OF INTERNALLY DWELLING URETERAL STENT VIA TRANSURETH
50387   - REMOVAL AND REPLACEMENT OF EXTERNALLY ACCESSIBLE TRANSNEPHRIC URETERAL STENT (EG
50389   - REMOVAL OF NEPHROSTOMY TUBE, REQUIRING FLUOROSCOPIC GUIDANCE (EG, WITH CONCURREN
50390   - ASPIRATION AND/OR INJECTION OF RENAL CYST OR PELVIS BY NEEDLE, PERCUTANEOUS
50391   - INSTILLATION(S) OF THERAPEUTIC AGENT INTO RENAL PELVIS AND/OR URETER THROUGH
50392   - INTRODUCTION OF INTRACATHETER OR CATHETER INTO RENAL PELVIS FOR DRAINAGE AND/OR
50393   - INTRODUCTION OF URETERAL CATHETER OR STENT INTO URETER THROUGH RENAL PELVIS FOR
50395   - INTRODUCTION OF GUIDE INTO RENAL PELVIS AND/OR URETER WITH DILATION TO
50396   - MANOMETRIC STUDIES THROUGH NEPHROSTOMY OR PYELOSTOMY TUBE, OR INDWELLING
50398   - CHANGE OF NEPHROSTOMY OR PYELOSTOMY TUBE
50541   - LAPAROSCOPY, SURGICAL; ABLATION OF RENAL CYSTS
50542   - LAPAROSCOPY, SURGICAL; ABLATION OF RENAL MASS LESION(S)
50543   - LAPAROSCOPY, SURGICAL; PARTIAL NEPHRECTOMY
50544   - LAPAROSCOPY, SURGICAL; PYELOPLASTY
50549   - UNLISTED LAPAROSCOPY PROCEDURE, RENAL
50551   - RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT I
50553   - RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT
50555   - RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT
50557   - RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT
50561   - RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT
50562   - RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT
50570   - RENAL ENDOSCOPY THROUGH NEPHROTOMY OR PYELOTOMY, WITH OR WITHOUT IRRIGATION,
50572   - RENAL ENDOSCOPY THROUGH NEPHROTOMY OR PYELOTOMY, WITH OR WITHOUT IRRIGATION,
50574   - RENAL ENDOSCOPY THROUGH NEPHROTOMY OR PYELOTOMY, WITH OR WITHOUT IRRIGATION,
50575   - RENAL ENDOSCOPY THROUGH NEPHROTOMY OR PYELOTOMY, WITH OR WITHOUT IRRIGATION,
50576   - RENAL ENDOSCOPY THROUGH NEPHROTOMY OR PYELOTOMY, WITH OR WITHOUT IRRIGATION,
50590   - LITHOTRIPSY, EXTRACORPOREAL SHOCK WAVE
50592   - ABLATION, ONE OR MORE RENAL TUMOR(S), PERCUTANEOUS, UNILATERAL, RADIOFREQUENCY
50593   - ABLATION, RENAL TUMOR(S), UNILATERAL, PERCUTANEOUS, CRYOTHERAPY
50686   - MANOMETRIC STUDIES THROUGH URETEROSTOMY OR INDWELLING URETERAL CATHETER
50688   - CHANGE OF URETEROSTOMY TUBE OR EXTERNALLY ACCESSIBLE URETERAL STENT VIA ILEAL CO
50727   - REVISION OF URINARY-CUTANEOUS ANASTOMOSIS (ANY TYPE UROSTOMY);



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50945   - LAPAROSCOPY, SURGICAL, URETEROLITHOTOMY
50947   - LAPAROSCOPY, SURGICAL; URETERONEOCYSTOSTOMY WITH CYSTOSCOPY AND URETERAL STENT
50948   - LAPAROSCOPY, SURGICAL; URETERONEOCYSTOSTOMY WITHOUT CYSTOSCOPY AND URETERAL
50949   - UNLISTED LAPAROSCOPY PROCEDURE, URETER
50951   - URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT IRRIGATION,
50953   - URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT
50955   - URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT
50957   - URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT
50961   - URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT
50970   - URETERAL ENDOSCOPY THROUGH URETEROTOMY, WITH OR WITHOUT IRRIGATION,
50972   - URETERAL ENDOSCOPY THROUGH URETEROTOMY, WITH OR WITHOUT IRRIGATION,
50974   - URETERAL ENDOSCOPY THROUGH URETEROTOMY, WITH OR WITHOUT IRRIGATION,
50976   - URETERAL ENDOSCOPY THROUGH URETEROTOMY, WITH OR WITHOUT IRRIGATION,
50980   - URETERAL ENDOSCOPY THROUGH URETEROTOMY, WITH OR WITHOUT IRRIGATION,
51020   - CYSTOTOMY OR CYSTOSTOMY; WITH FULGURATION AND/OR INSERTION OF RADIOACTIVE
51030   - CYSTOTOMY OR CYSTOSTOMY; WITH CRYOSURGICAL DESTRUCTION OF INTRAVESICAL LESION
51040   - CYSTOSTOMY, CYSTOTOMY WITH DRAINAGE
51045   - CYSTOTOMY, WITH INSERTION OF URETERAL CATHETER OR STENT (SEPARATE PROCEDURE)
51050   - CYSTOLITHOTOMY, CYSTOTOMY WITH REMOVAL OF CALCULUS, WITHOUT VESICAL NECK
51065   - CYSTOTOMY, WITH CALCULUS BASKET EXTRACTION AND/OR ULTRASONIC OR
51080   - DRAINAGE OF PERIVESICAL OR PREVESICAL SPACE ABSCESS
51100   - ASPIRATION OF BLADDER; BY NEEDLE
51101   - ASPIRATION OF BLADDER; BY TROCAR OR INTRACATHETER
51102   - ASPIRATION OF BLADDER; WITH INSERTION OF SUPRAPUBIC CATHETER
51500   - EXCISION OF URACHAL CYST OR SINUS, WITH OR WITHOUT UMBILICAL HERNIA REPAIR
51520   - CYSTOTOMY; FOR SIMPLE EXCISION OF VESICAL NECK (SEPARATE PROCEDURE)
51700   - BLADDER IRRIGATION, SIMPLE, LAVAGE AND/OR INSTILLATION
51703   - INSERTION OF TEMPORARY INDWELLING BLADDER CATHETER; COMPLICATED (EG, ALTERED
51705   - CHANGE OF CYSTOSTOMY TUBE; SIMPLE
51710   - CHANGE OF CYSTOSTOMY TUBE; COMPLICATED
51715   - ENDOSCOPIC INJECTION OF IMPLANT MATERIAL INTO THE SUBMUCOSAL TISSUES OF THE
51720   - BLADDER INSTILLATION OF ANTICARCINOGENIC AGENT (INCLUDING RETENTION TIME)
51725   - SIMPLE CYSTOMETROGRAM (CMG) (EG, SPINAL MANOMETER)
51726   - COMPLEX CYSTOMETROGRAM (IE, CALIBRATED ELECTRONIC EQUIPMENT);
51727   - Complex cystometrogram (ie, calibrated electronic equipment); with urethral pres
51728   - Complex cystometrogram (ie, calibrated electronic equipment); with voiding press
51729   - Complex cystometrogram (ie, calibrated electronic equipment); with voiding press
51736   - SIMPLE UROFLOWMETRY (UFR) (EG, STOP-WATCH FLOW RATE, MECHANICAL UROFLOWMETER)
51741   - COMPLEX UROFLOWMETRY (EG, CALIBRATED ELECTRONIC EQUIPMENT)
51784   - ELECTROMYOGRAPHY STUDIES (EMG) OF ANAL OR URETHRAL SPHINCTER, OTHER THAN
51785   - NEEDLE ELECTROMYOGRAPHY STUDIES (EMG) OF ANAL OR URETHRAL SPHINCTER, ANY
51792   - STIMULUS EVOKED RESPONSE (EG, MEASUREMENT OF BULBOCAVERNOSUS REFLEX LATENCY
51797   - 51797 VOIDING PRESSURE STUDIES, INTRA-ABDOMINAL (IE, RECTAL, GASTRIC, INTRAPERIT
51845   - ABDOMINO-VAGINAL VESICAL NECK SUSPENSION, WITH OR WITHOUT ENDOSCOPIC CONTROL
51860   - CYSTORRHAPHY, SUTURE OF BLADDER WOUND, INJURY OR RUPTURE; SIMPLE
51880   - CLOSURE OF CYSTOSTOMY (SEPARATE PROCEDURE)
51990   - LAPAROSCOPY, SURGICAL; URETHRAL SUSPENSION FOR STRESS INCONTINENCE
51992   - LAPAROSCOPY, SURGICAL; SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA OR
51999   - UNLISTED LAPAROSCOPY PROCEDURE, BLADDER
52000   - CYSTOURETHROSCOPY (SEPARATE PROCEDURE)
52001   - CYSTOURETHROSCOPY WITH IRRIGATION AND EVACUATION OF MULTIPLE OBSTRUCTING CLOTS
52005   - CYSTOURETHROSCOPY, WITH URETERAL CATHETERIZATION, WITH OR WITHOUT IRRIGATION,
52007   - CYSTOURETHROSCOPY, WITH URETERAL CATHETERIZATION, WITH OR WITHOUT IRRIGATION,
52010   - CYSTOURETHROSCOPY, WITH EJACULATORY DUCT CATHETERIZATION, WITH OR WITHOUT
52204   - CYSTOURETHROSCOPY, WITH BIOPSY(S)



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52214   - CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) OF
52224   - CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) OR
52234   - CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY)
52235   - CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY)
52240   - CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY)
52250   - CYSTOURETHROSCOPY WITH INSERTION OF RADIOACTIVE SUBSTANCE, WITH OR WITHOUT
52260   - CYSTOURETHROSCOPY, WITH DILATION OF BLADDER FOR INTERSTITIAL CYSTITIS; GENERAL
52265   - CYSTOURETHROSCOPY, WITH DILATION OF BLADDER FOR INTERSTITIAL CYSTITIS; LOCAL
52270   - CYSTOURETHROSCOPY, WITH INTERNAL URETHROTOMY; FEMALE
52275   - CYSTOURETHROSCOPY, WITH INTERNAL URETHROTOMY; MALE
52276   - CYSTOURETHROSCOPY WITH DIRECT VISION INTERNAL URETHROTOMY
52277   - CYSTOURETHROSCOPY, WITH RESECTION OF EXTERNAL SPHINCTER (SPHINCTEROTOMY)
52281   - CYSTOURETHROSCOPY, WITH CALIBRATION AND/OR DILATION OF URETHRAL STRICTURE OR
52282   - CYSTOURETHROSCOPY, WITH INSERTION OF PERMANENT URETHRAL STENT
52283   - CYSTOURETHROSCOPY, WITH STEROID INJECTION INTO STRICTURE
52285   - CYSTOURETHROSCOPY FOR TREATMENT OF THE FEMALE URETHRAL SYNDROME WITH ANY OR ALL
52290   - CYSTOURETHROSCOPY; WITH URETERAL MEATOTOMY, UNILATERAL OR BILATERAL
52300   - CYSTOURETHROSCOPY; WITH RESECTION OR FULGURATION OF ORTHOTOPIC URETEROCELE(S),
52301   - CYSTOURETHROSCOPY; WITH RESECTION OR FULGURATION OF ECTOPIC URETEROCELE(S),
52305   - CYSTOURETHROSCOPY; WITH INCISION OR RESECTION OF ORIFICE OF BLADDER
52310   - CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY, CALCULUS, OR URETERAL STENT
52315   - CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY, CALCULUS, OR URETERAL STENT
52317   - LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUS BY ANY MEANS IN BLADDER AND
52318   - LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUS BY ANY MEANS IN BLADDER AND
52320   - CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH REMOVAL OF URETERAL
52325   - CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH FRAGMENTATION OF
52327   - CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH SUBURETERIC
52330   - CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH MANIPULATION,
52332   - CYSTOURETHROSCOPY, WITH INSERTION OF INDWELLING URETERAL STENT (EG, GIBBONS OR
52334   - CYSTOURETHROSCOPY WITH INSERTION OF URETERAL GUIDE WIRE THROUGH KIDNEY TO
52341   - CYSTOURETHROSCOPY; WITH TREATMENT OF URETERAL STRICTURE (EG, BALLOON DILATION,
52342   - CYSTOURETHROSCOPY; WITH TREATMENT OF URETEROPELVIC JUNCTION STRICTURE (EG,
52343   - CYSTOURETHROSCOPY; WITH TREATMENT OF INTRA-RENAL STRICTURE (EG, BALLOON
52344   - CYSTOURETHROSCOPY WITH URETEROSCOPY; WITH TREATMENT OF URETERAL STRICTURE (EG,
52345   - CYSTOURETHROSCOPY WITH URETEROSCOPY; WITH TREATMENT OF URETEROPELVIC JUNCTION
52346   - CYSTOURETHROSCOPY WITH URETEROSCOPY; WITH TREATMENT OF INTRA-RENAL STRICTURE
52351   - CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; DIAGNOSTIC
52352   - CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH REMOVAL OR
52353   - CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH LITHOTRIPSY
52354   - CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH BIOPSY AND/OR
52355   - CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH RESECTION OF
52400   - CYSTOURETHROSCOPY WITH INCISION, FULGURATION, OR RESECTION OF CONGENITAL POSTERI
52402   - CYSTOURETHROSCOPY WITH TRANSURETHRAL RESECTION OR INCISION OF EJACULATORY DUCTS
52450   - TRANSURETHRAL INCISION OF PROSTATE
52500   - TRANSURETHRAL RESECTION OF BLADDER NECK (SEPARATE PROCEDURE)
52601   - TRANSURETHRAL ELECTROSURGICAL RESECTION OF PROSTATE, INCLUDING CONTROL OF
52630   - TRANSURETHRAL RESECTION; RESIDUAL OR REGROWTH OF OBSTRUCTIVE PROSTATE TISSUE INC
52640   - TRANSURETHRAL RESECTION; OF POSTOPERATIVE BLADDER NECK CONTRACTURE
52647   - LASER COAGULATION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMP
52648   - LASER VAPORIZATION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COM
52649   - LASER ENUCLEATION OF THE PROSTATE WITH MORCELLATION, INCLUDING CONTROL OF POSTOP
52700   - TRANSURETHRAL DRAINAGE OF PROSTATIC ABSCESS
53000   - URETHROTOMY OR URETHROSTOMY, EXTERNAL (SEPARATE PROCEDURE); PENDULOUS URETHRA
53010   - URETHROTOMY OR URETHROSTOMY, EXTERNAL (SEPARATE PROCEDURE); PERINEAL URETHRA,
53020   - MEATOTOMY, CUTTING OF MEATUS (SEPARATE PROCEDURE); EXCEPT INFANT



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53025   - MEATOTOMY, CUTTING OF MEATUS (SEPARATE PROCEDURE); INFANT
53040   - DRAINAGE OF DEEP PERIURETHRAL ABSCESS
53060   - DRAINAGE OF SKENE'S GLAND ABSCESS OR CYST
53080   - DRAINAGE OF PERINEAL URINARY EXTRAVASATION; UNCOMPLICATED (SEPARATE PROCEDURE)
53085   - DRAINAGE OF PERINEAL URINARY EXTRAVASATION; COMPLICATED
53200   - BIOPSY OF URETHRA
53210   - URETHRECTOMY, TOTAL, INCLUDING CYSTOSTOMY; FEMALE
53215   - URETHRECTOMY, TOTAL, INCLUDING CYSTOSTOMY; MALE
53220   - EXCISION OR FULGURATION OF CARCINOMA OF URETHRA
53230   - EXCISION OF URETHRAL DIVERTICULUM (SEPARATE PROCEDURE); FEMALE
53235   - EXCISION OF URETHRAL DIVERTICULUM (SEPARATE PROCEDURE); MALE
53240   - MARSUPIALIZATION OF URETHRAL DIVERTICULUM, MALE OR FEMALE
53250   - EXCISION OF BULBOURETHRAL GLAND (COWPER'S GLAND)
53260   - EXCISION OR FULGURATION; URETHRAL POLYP(S), DISTAL URETHRA
53265   - EXCISION OR FULGURATION; URETHRAL CARUNCLE
53270   - EXCISION OR FULGURATION; SKENE'S GLANDS
53275   - EXCISION OR FULGURATION; URETHRAL PROLAPSE
53400   - URETHROPLASTY; FIRST STAGE, FOR FISTULA, DIVERTICULUM, OR STRICTURE (EG, JOHANNS
53405   - URETHROPLASTY; SECOND STAGE (FORMATION OF URETHRA), INCLUDING URINARY DIVERSION
53410   - URETHROPLASTY, ONE-STAGE RECONSTRUCTION OF MALE ANTERIOR URETHRA
53420   - URETHROPLASTY, TWO-STAGE RECONSTRUCTION OR REPAIR OF PROSTATIC OR MEMBRANOUS
53425   - URETHROPLASTY, TWO-STAGE RECONSTRUCTION OR REPAIR OF PROSTATIC OR MEMBRANOUS
53430   - URETHROPLASTY, RECONSTRUCTION OF FEMALE URETHRA
53431   - URETHROPLASTY WITH TUBULARIZATION OF POSTERIOR URETHRA AND/ OR LOWER BLADDER
53440   - SLING OPERATION FOR CORRECTION OF MALE URINARY INCONTINENCE (EG, FASCIA OR
53442   - REMOVAL OR REVISION OF SLING FOR MALE URINARY INCONTINENCE (EG, FASCIA OR
53444   - INSERTION OF TANDEM CUFF (DUAL CUFF)
53445   - INSERTION OF INFLATABLE URETHRAL/BLADDER NECK SPHINCTER, INCLUDING PLACEMENT OF
53446   - REMOVAL OF INFLATABLE URETHRAL/BLADDER NECK SPHINCTER, INCLUDING PUMP,
53447   - REMOVAL AND REPLACEMENT OF INFLATABLE URETHRAL/BLADDER NECK SPHINCTER INCLUDING
53449   - REPAIR OF INFLATABLE URETHRAL/BLADDER NECK SPHINCTER, INCLUDING PUMP,
53450   - URETHROMEATOPLASTY, WITH MUCOSAL ADVANCEMENT
53460   - URETHROMEATOPLASTY, WITH PARTIAL EXCISION OF DISTAL URETHRAL SEGMENT
53500   - URETHROLYSIS, TRANSVAGINAL, SECONDARY, OPEN, INCLUDING CYSTOURETHROSCOPY (EG,
53502   - URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY, FEMALE
53505   - URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY; PENILE
53510   - URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY; PERINEAL
53515   - URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY; PROSTATOMEMBRANOUS
53520   - CLOSURE OF URETHROSTOMY OR URETHROCUTANEOUS FISTULA, MALE (SEPARATE PROCEDURE)
53600   - DILATION OF URETHRAL STRICTURE BY PASSAGE OF SOUND OR URETHRAL DILATOR, MALE; IN
53601   - DILATION OF URETHRAL STRICTURE BY PASSAGE OF SOUND OR URETHRAL DILATOR, MALE;
53605   - DILATION OF URETHRAL STRICTURE OR VESICAL NECK BY PASSAGE OF SOUND OR URETHRAL
53620   - DILATION OF URETHRAL STRICTURE BY PASSAGE OF FILIFORM AND FOLLOWER, MALE;
53621   - DILATION OF URETHRAL STRICTURE BY PASSAGE OF FILIFORM AND FOLLOWER, MALE;
53660   - DILATION OF FEMALE URETHRA INCLUDING SUPPOSITORY AND/OR INSTILLATION; INITIAL
53661   - DILATION OF FEMALE URETHRA INCLUDING SUPPOSITORY AND/OR INSTILLATION; SUBSEQUENT
53665   - DILATION OF FEMALE URETHRA, GENERAL OR CONDUCTION (SPINAL) ANESTHESIA
53850   - TRANSURETHRAL DESTRUCTION OF PROSTATE TISSUE; BY MICROWAVE THERMOTHERAPY
53852   - TRANSURETHRAL DESTRUCTION OF PROSTATE TISSUE; BY RADIOFREQUENCY THERMOTHERAPY
53855   - Insertion of a temporary prostatic urethral stent, including urethral measuremen
53899   - UNLISTED PROCEDURE, URINARY SYSTEM
54000   - SLITTING OF PREPUCE, DORSAL OR LATERAL (SEPARATE PROCEDURE); NEWBORN
54001   - SLITTING OF PREPUCE, DORSAL OR LATERAL (SEPARATE PROCEDURE); EXCEPT NEWBORN
54015   - INCISION AND DRAINAGE OF PENIS, DEEP
54050   - DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM



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                                     Surgery (triggers bundling)


54055   - DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM
54056   - DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM
54057   - DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM
54060   - DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM
54065   - DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM
54100   - BIOPSY OF PENIS; (SEPARATE PROCEDURE)
54105   - BIOPSY OF PENIS; DEEP STRUCTURES
54110   - EXCISION OF PENILE PLAQUE (PEYRONIE DISEASE);
54111   - EXCISION OF PENILE PLAQUE (PEYRONIE DISEASE); WITH GRAFT TO 5 CM IN LENGTH
54112   - EXCISION OF PENILE PLAQUE (PEYRONIE DISEASE); WITH GRAFT GREATER THAN 5 CM IN
54115   - REMOVAL FOREIGN BODY FROM DEEP PENILE TISSUE (EG, PLASTIC IMPLANT)
54120   - AMPUTATION OF PENIS; PARTIAL
54161   - OLDER THAN 28 DAYS OF AGE
54162   - LYSIS OR EXCISION OF PENILE POST-CIRCUMCISION ADHESIONS
54163   - REPAIR INCOMPLETE CIRCUMCISION
54164   - FRENULOTOMY OF PENIS
54200   - INJECTION PROCEDURE FOR PEYRONIE DISEASE;
54205   - INJECTION PROCEDURE FOR PEYRONIE DISEASE; WITH SURGICAL EXPOSURE OF PLAQUE
54220   - IRRIGATION OF CORPORA CAVERNOSA FOR PRIAPISM
54231   - DYNAMIC CAVERNOSOMETRY, INCLUDING INTRACAVERNOSAL INJECTION OF VASOACTIVE DRUGS
54235   - INJECTION OF CORPORA CAVERNOSA WITH PHARMACOLOGIC AGENT(S) (EG, PAPAVERINE,
54240   - PENILE PLETHYSMOGRAPHY
54250   - NOCTURNAL PENILE TUMESCENCE AND/OR RIGIDITY TEST
54300   - PLASTIC OPERATION OF PENIS FOR STRAIGHTENING OF CHORDEE (EG, HYPOSPADIAS), WITH
54304   - PLASTIC OPERATION ON PENIS FOR CORRECTION OF CHORDEE OR FOR FIRST STAGE
54308   - URETHROPLASTY FOR SECOND STAGE HYPOSPADIAS REPAIR (INCLUDING URINARY
54312   - URETHROPLASTY FOR SECOND STAGE HYPOSPADIAS REPAIR (INCLUDING URINARY
54316   - URETHROPLASTY FOR SECOND STAGE HYPOSPADIAS REPAIR (INCLUDING URINARY DIVERSION)
54318   - URETHROPLASTY FOR THIRD STAGE HYPOSPADIAS REPAIR TO RELEASE PENIS FROM SCROTUM
54322   - ONE STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION);
54324   - ONE STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION);
54326   - ONE STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION);
54328   - ONE STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION);
54332   - ONE STAGE PROXIMAL PENILE OR PENOSCROTAL HYPOSPADIAS REPAIR REQUIRING EXTENSIVE
54336   - ONE STAGE PERINEAL HYPOSPADIAS REPAIR REQUIRING EXTENSIVE DISSECTION TO CORRECT
54340   - REPAIR OF HYPOSPADIAS COMPLICATIONS (IE, FISTULA, STRICTURE, DIVERTICULA); BY
54344   - REPAIR OF HYPOSPADIAS COMPLICATIONS (IE, FISTULA, STRICTURE, DIVERTICULA);
54348   - REPAIR OF HYPOSPADIAS COMPLICATIONS (IE, FISTULA, STRICTURE, DIVERTICULA);
54352   - REPAIR OF HYPOSPADIAS CRIPPLE REQUIRING EXTENSIVE DISSECTION AND EXCISION OF
54360   - PLASTIC OPERATION ON PENIS TO CORRECT ANGULATION
54380   - PLASTIC OPERATION ON PENIS FOR EPISPADIAS DISTAL TO EXTERNAL SPHINCTER;
54385   - PLASTIC OPERATION ON PENIS FOR EPISPADIAS DISTAL TO EXTERNAL SPHINCTER; WITH
54406   - REMOVAL OF ALL COMPONENTS OF A MULTI-COMPONENT, INFLATABLE PENILE PROSTHESIS
54408   - REPAIR OF COMPONENT(S) OF A MULTI-COMPONENT, INFLATABLE PENILE PROSTHESIS
54410   - REMOVAL AND REPLACEMENT OF ALL COMPONENT(S) OF A MULTI-COMPONENT, INFLATABLE
54415   - REMOVAL OF NON-INFLATABLE (SEMI-RIGID) OR INFLATABLE (SELF-CONTAINED) PENILE
54416   - REMOVAL AND REPLACEMENT OF NON-INFLATABLE (SEMI-RIGID) OR INFLATABLE
54420   - CORPORA CAVERNOSA-SAPHENOUS VEIN SHUNT (PRIAPISM OPERATION), UNILATERAL OR
54440   - PLASTIC OPERATION OF PENIS FOR INJURY
54450   - FORESKIN MANIPULATION INCLUDING LYSIS OF PREPUTIAL ADHESIONS AND STRETCHING
54500   - BIOPSY OF TESTIS, NEEDLE (SEPARATE PROCEDURE)
54505   - BIOPSY OF TESTIS, INCISIONAL (SEPARATE PROCEDURE)
54512   - EXCISION OF EXTRAPARENCHYMAL LESION OF TESTIS
54520   - ORCHIECTOMY, SIMPLE (INCLUDING SUBCAPSULAR), WITH OR WITHOUT TESTICULAR
54522   - ORCHIECTOMY, PARTIAL



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54530   - ORCHIECTOMY, RADICAL, FOR TUMOR; INGUINAL APPROACH
54535   - ORCHIECTOMY, RADICAL, FOR TUMOR; WITH ABDOMINAL EXPLORATION
54550   - EXPLORATION FOR UNDESCENDED TESTIS (INGUINAL OR SCROTAL AREA)
54560   - EXPLORATION FOR UNDESCENDED TESTIS WITH ABDOMINAL EXPLORATION
54600   - REDUCTION OF TORSION OF TESTIS, SURGICAL, WITH OR WITHOUT FIXATION OF CONTRALATE
54620   - FIXATION OF CONTRALATERAL TESTIS (SEPARATE PROCEDURE)
54640   - ORCHIOPEXY, INGUINAL APPROACH, WITH OR WITHOUT HERNIA REPAIR
54660   - INSERTION OF TESTICULAR PROSTHESIS (SEPARATE PROCEDURE)
54670   - SUTURE OR REPAIR OF TESTICULAR INJURY
54680   - TRANSPLANTATION OF TESTIS(ES) TO THIGH (BECAUSE OF SCROTAL DESTRUCTION)
54690   - LAPAROSCOPY, SURGICAL; ORCHIECTOMY
54692   - LAPAROSCOPY, SURGICAL; ORCHIOPEXY FOR INTRA-ABDOMINAL TESTIS
54699   - UNLISTED LAPAROSCOPY PROCEDURE, TESTIS
54700   - INCISION AND DRAINAGE OF EPIDIDYMIS, TESTIS AND/OR SCROTAL SPACE (EG, ABSCESS OR
54800   - BIOPSY OF EPIDIDYMIS, NEEDLE
54830   - EXCISION OF LOCAL LESION OF EPIDIDYMIS
54840   - EXCISION OF SPERMATOCELE, WITH OR WITHOUT EPIDIDYMECTOMY
54860   - EPIDIDYMECTOMY; UNILATERAL
54861   - EPIDIDYMECTOMY; BILATERAL
54865   - EXPLORATION OF EPIDIDYMIS, WITH OR WITHOUT BIOPSY
54900   - EPIDIDYMOVASOSTOMY, ANASTOMOSIS OF EPIDIDYMIS TO VAS DEFERENS; UNILATERAL
54901   - EPIDIDYMOVASOSTOMY, ANASTOMOSIS OF EPIDIDYMIS TO VAS DEFERENS; BILATERAL
55000   - PUNCTURE ASPIRATION OF HYDROCELE, TUNICA VAGINALIS, WITH OR WITHOUT INJECTION OF
55040   - EXCISION OF HYDROCELE; UNILATERAL
55041   - EXCISION OF HYDROCELE; BILATERAL
55060   - REPAIR OF TUNICA VAGINALIS HYDROCELE (BOTTLE TYPE)
55100   - DRAINAGE OF SCROTAL WALL ABSCESS
55110   - SCROTAL EXPLORATION
55120   - REMOVAL OF FOREIGN BODY IN SCROTUM
55150   - RESECTION OF SCROTUM
55175   - SCROTOPLASTY; SIMPLE
55180   - SCROTOPLASTY; COMPLICATED
55200   - VASOTOMY, CANNULIZATION WITH OR WITHOUT INCISION OF VAS, UNILATERAL OR BILATERAL
55250   - VASECTOMY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE), INCLUDING POSTOPERATIVE
55450   - LIGATION (PERCUTANEOUS) OF VAS DEFERENS, UNILATERAL OR BILATERAL (SEPARATE PROCE
55500   - EXCISION OF HYDROCELE OF SPERMATIC CORD, UNILATERAL (SEPARATE PROCEDURE)
55520   - EXCISION OF LESION OF SPERMATIC CORD (SEPARATE PROCEDURE)
55530   - EXCISION OF VARICOCELE OR LIGATION OF SPERMATIC VEINS FOR VARICOCELE; (SEPARATE
55535   - EXCISION OF VARICOCELE OR LIGATION OF SPERMATIC VEINS FOR VARICOCELE; ABDOMINAL
55540   - EXCISION OF VARICOCELE OR LIGATION OF SPERMATIC VEINS FOR VARICOCELE; WITH
55550   - LAPAROSCOPY, SURGICAL, WITH LIGATION OF SPERMATIC VEINS FOR VARICOCELE
55559   - UNLISTED LAPAROSCOPY PROCEDURE, SPERMATIC CORD
55600   - VESICULOTOMY;
55680   - EXCISION OF MULLERIAN DUCT CYST
55700   - BIOPSY, PROSTATE; NEEDLE OR PUNCH, SINGLE OR MULTIPLE, ANY APPROACH
55705   - BIOPSY, PROSTATE; INCISIONAL, ANY APPROACH
55706   - Biopsy, prostate; needle, transperineal, stereotactic template guided saturation
55720   - PROSTATOTOMY, EXTERNAL DRAINAGE OF PROSTATIC ABSCESS, ANY APPROACH; SIMPLE
55725   - PROSTATOTOMY, EXTERNAL DRAINAGE OF PROSTATIC ABSCESS, ANY APPROACH; COMPLICATED
55860   - EXPOSURE OF PROSTATE, ANY APPROACH, FOR INSERTION OF RADIOACTIVE SUBSTANCE;
55870   - ELECTROEJACULATION
55873   - CRYOSURGICAL ABLATION OF THE PROSTATE (INCLUDES ULTRASONIC GUIDANCE AND MONITORI
55899   - UNLISTED PROCEDURE, MALE GENITAL SYSTEM
55920   - PLACEMENT OF NEEDLES OR CATHETERS INTO PELVIC ORGANS AND/ OR GENITALIA (EXCEPT P
56405   - INCISION AND DRAINAGE OF VULVA OR PERINEAL ABSCESS



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                                   Surgery (triggers bundling)


56420 - INCISION AND DRAINAGE OF BARTHOLIN'S GLAND ABSCESS
56440 - MARSUPIALIZATION OF BARTHOLIN'S GLAND CYST
56441 - LYSIS OF LABIAL ADHESIONS
56442 - HYMENOTOMY, SIMPLE INCISION
56501 - DESTRUCTION OF LESION(S), VULVA; SIMPLE (EG, LASER SURGERY, ELECTROSURGERY, CRYO
56515 - DESTRUCTION OF LESION(S), VULVA; EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY,
56605 - BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); ONE LESION
56606 - BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); EACH SEPARATE ADDITIONAL
56620 - VULVECTOMY SIMPLE; PARTIAL
56625 - VULVECTOMY SIMPLE; COMPLETE
56700 - PARTIAL HYMENECTOMY OR REVISION OF HYMENAL RING
56740 - EXCISION OF BARTHOLIN'S GLAND OR CYST
56800 - PLASTIC REPAIR OF INTROITUS
56805 - CLITOROPLASTY FOR INTERSEX STATE
56810 - PERINEOPLASTY, REPAIR OF PERINEUM, NONOBSTETRICAL (SEPARATE PROCEDURE)
56820 - COLPOSCOPY OF THE VULVA;
56821 - COLPOSCOPY OF THE VULVA; WITH BIOPSY(S)
57000 - COLPOTOMY; WITH EXPLORATION
57010 - COLPOTOMY; WITH DRAINAGE OF PELVIC ABSCESS
57020 - COLPOCENTESIS (SEPARATE PROCEDURE)
57022 - INCISION AND DRAINAGE OF VAGINAL HEMATOMA; OBSTETRICAL/POSTPARTUM
57023 - INCISION AND DRAINAGE OF VAGINAL HEMATOMA; NON-OBSTETRICAL (EG, POST-TRAUMA,
57061 - DESTRUCTION OF VAGINAL LESION(S); SIMPLE (EG, LASER SURGERY, ELECTROSURGERY, CRY
57065 - DESTRUCTION OF VAGINAL LESION(S); EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY,
57100 - BIOPSY OF VAGINAL MUCOSA; SIMPLE (SEPARATE PROCEDURE)
57105 - BIOPSY OF VAGINAL MUCOSA; EXTENSIVE, REQUIRING SUTURE (INCLUDING CYSTS)
57106 - VAGINECTOMY, PARTIAL REMOVAL OF VAGINAL WALL;
57107 - VAGINECTOMY, PARTIAL REMOVAL OF VAGINAL WALL; WITH REMOVAL OF PARAVAGINAL
57109 - VAGINECTOMY, PARTIAL REMOVAL OF VAGINAL WALL; WITH REMOVAL OF PARAVAGINAL
57120 - COLPOCLEISIS (LE FORT TYPE)
57130 - EXCISION OF VAGINAL SEPTUM
57135 - EXCISION OF VAGINAL CYST OR TUMOR
57150 - IRRIGATION OF VAGINA AND/OR APPLICATION OF MEDICAMENT FOR TREATMENT OF BACTERIAL
57155 - INSERTION OF UTERINE TANDEMS AND/OR VAGINAL OVOIDS FOR CLINICAL BRACHYTHERAPY
57156 - Insertion of a vaginal radiation afterloading apparatus for clinical brachythera
57160 - FITTING AND INSERTION OF PESSARY OR OTHER INTRAVAGINAL SUPPORT DEVICE
57170 - DIAPHRAGM OR CERVICAL CAP FITTING WITH INSTRUCTIONS
57180 - INTRODUCTION OF ANY HEMOSTATIC AGENT OR PACK FOR SPONTANEOUS OR TRAUMATIC
57200 - COLPORRHAPHY, SUTURE OF INJURY OF VAGINA (NONOBSTETRICAL)
57210 - COLPOPERINEORRHAPHY, SUTURE OF INJURY OF VAGINA AND/OR PERINEUM (NONOBSTETRICAL)
57220 - PLASTIC OPERATION ON URETHRAL SPHINCTER, VAGINAL APPROACH (EG, KELLY URETHRAL
57230 - PLASTIC REPAIR OF URETHROCELE
57240 - ANTERIOR COLPORRHAPHY, REPAIR OF CYSTOCELE WITH OR WITHOUT REPAIR OF URETHROCELE
57250 - POSTERIOR COLPORRHAPHY, REPAIR OF RECTOCELE WITH OR WITHOUT PERINEORRHAPHY
57260 - COMBINED ANTEROPOSTERIOR COLPORRHAPHY;
57265 - COMBINED ANTEROPOSTERIOR COLPORRHAPHY; WITH ENTEROCELE REPAIR
57267 - INSERTION OF MESH OR OTHER PROSTHESIS FOR REPAIR OF PELVIC FLOOR DEFECT, EACH
57268 - REPAIR OF ENTEROCELE, VAGINAL APPROACH (SEPARATE PROCEDURE)
57284 - PARAVAGINAL DEFECT REPAIR (INCLUDING REPAIR OF CYSTOCELE, IF PERFORMED); OPEN AB
57285 - PARAVAGINAL DEFECT REPAIR (INCLUDING REPAIR OF CYSTOCELE, IF PERFORMED); VAGINAL
57287 - REMOVAL OR REVISION OF SLING FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)
57288 - SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)
57289 - PEREYRA PROCEDURE, INCLUDING ANTERIOR COLPORRHAPHY
57291 - CONSTRUCTION OF ARTIFICIAL VAGINA; WITHOUT GRAFT
57295 - REVISION (INCLUDING REMOVAL) OF PROSTHETIC VAGINAL GRAFT, VAGINAL APPROACH



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57300   - CLOSURE OF RECTOVAGINAL FISTULA; VAGINAL OR TRANSANAL APPROACH
57310   - CLOSURE OF URETHROVAGINAL FISTULA;
57320   - CLOSURE OF VESICOVAGINAL FISTULA; VAGINAL APPROACH
57330   - CLOSURE OF VESICOVAGINAL FISTULA; TRANSVESICAL AND VAGINAL APPROACH
57400   - DILATION OF VAGINA UNDER ANESTHESIA (OTHER THAN LOCAL)
57410   - PELVIC EXAMINATION UNDER ANESTHESIA (OTHER THAN LOCAL)
57415   - REMOVAL OF IMPACTED VAGINAL FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA (
57420   - COLPOSCOPY OF THE ENTIRE VAGINA, WITH CERVIX IF PRESENT;
57421   - COLPOSCOPY OF THE ENTIRE VAGINA, WITH CERVIX IF PRESENT; WITH BIOPSY(S) OF VAGIN
57423   - PARAVAGINAL DEFECT REPAIR (INCLUDING REPAIR OF CYSTOCELE, IF PERFORMED), LAPAROS
57425   - LAPAROSCOPY, SURGICAL, COLPOPEXY (SUSPENSION OF VAGINAL APEX)
57426   - Revision (including removal) of prosthetic vaginal graft, laparoscopic approach
57452   - COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA;
57454   - COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH BIOPSY(S) OF THE
57455   - COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH BIOPSY(S) OF THE
57456   - COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH ENDOCERVICAL
57460   - COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE
57461   - COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE
57500   - BIOPSY OF CERVIX, SINGLE OR MULTIPLE, OR LOCAL EXCISION OF LESION, WITH OR WITHO
57505   - ENDOCERVICAL CURETTAGE (NOT DONE AS PART OF A DILATION AND CURETTAGE)
57510   - CAUTERY OF CERVIX; ELECTRO OR THERMAL
57511   - CAUTERY OF CERVIX; CRYOCAUTERY, INITIAL OR REPEAT
57513   - CAUTERY OF CERVIX; LASER ABLATION
57520   - CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND
57522   - CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND
57530   - TRACHELECTOMY (CERVICECTOMY), AMPUTATION OF CERVIX (SEPARATE PROCEDURE)
57550   - EXCISION OF CERVICAL STUMP, VAGINAL APPROACH;
57555   - EXCISION OF CERVICAL STUMP, VAGINAL APPROACH; WITH ANTERIOR AND/OR POSTERIOR
57556   - EXCISION OF CERVICAL STUMP, VAGINAL APPROACH; WITH REPAIR OF ENTEROCELE
57558   - DILATION AND CURETTAGE OF CERVICAL STUMP
57700   - CERCLAGE OF UTERINE CERVIX, NONOBSTETRICAL
57720   - TRACHELORRHAPHY, PLASTIC REPAIR OF UTERINE CERVIX, VAGINAL APPROACH
57800   - DILATION OF CERVICAL CANAL, INSTRUMENTAL (SEPARATE PROCEDURE)
58100   - ENDOMETRIAL SAMPLING (BIOPSY) WITH OR WITHOUT ENDOCERVICAL SAMPLING (BIOPSY), WI
58120   - DILATION AND CURETTAGE, DIAGNOSTIC AND/OR THERAPEUTIC (NONOBSTETRICAL)
58145   - MYOMECTOMY, EXCISION OF FIBROID TUMOR(S) OF UTERUS, 1 TO 4 INTRAMURAL MYOMA(S)
58301   - REMOVAL OF INTRAUTERINE DEVICE (IUD)
58346   - INSERTION OF HEYMAN CAPSULES FOR CLINICAL BRACHYTHERAPY
58353   - ENDOMETRIAL ABLATION, THERMAL, WITHOUT HYSTEROSCOPIC GUIDANCE
58356   - ENDOMETRIAL CRYOABLATION WITH ULTRASONIC GUIDANCE, INCLUDING ENDOMETRIAL
58541   - LAPAROSCOPY, SURGICAL, SUPRACERVICAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS;
58542   - LAPAROSCOPY, SURGICAL, SUPRACERVICAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WIT
58543   - LAPAROSCOPY, SURGICAL, SUPRACERVICAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G
58544   - LAPAROSCOPY, SURGICAL, SUPRACERVICAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G
58545   - LAPAROSCOPY, SURGICAL, MYOMECTOMY, EXCISION; 1 TO 4 INTRAMURAL MYOMAS WITH TOTAL
58546   - LAPAROSCOPY, SURGICAL, MYOMECTOMY, EXCISION; 5 OR MORE INTRAMURAL MYOMAS AND/OR
58550   - LAPAROSCOPY SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS 250 GRAMS OR LESS;
58552   - LAPAROSCOPY SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS 250 GRAMS OR LESS;
58553   - LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250
58554   - LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250
58555   - HYSTEROSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE)
58558   - HYSTEROSCOPY, SURGICAL; WITH SAMPLING (BIOPSY) OF ENDOMETRIUM AND/OR
58559   - HYSTEROSCOPY, SURGICAL; WITH LYSIS OF INTRAUTERINE ADHESIONS (ANY METHOD)
58560   - HYSTEROSCOPY, SURGICAL; WITH DIVISION OR RESECTION OF INTRAUTERINE SEPTUM (ANY
58561   - HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF LEIOMYOMATA



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                                     Surgery (triggers bundling)


58562   - HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF IMPACTED FOREIGN BODY
58563   - HYSTEROSCOPY, SURGICAL; WITH ENDOMETRIAL ABLATION (EG, ENDOMETRIAL RESECTION,
58565   - HYSTEROSCOPY, SURGICAL; WITH BILATERAL FALLOPIAN TUBE CANNULATION TO INDUCE
58570   - LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS;
58571   - LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH R
58572   - LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G;
58573   - LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; W
58578   - UNLISTED LAPAROSCOPY PROCEDURE, UTERUS
58579   - UNLISTED HYSTEROSCOPY PROCEDURE, UTERUS
58600   - LIGATION OR TRANSECTION OF FALLOPIAN TUBE(S), ABDOMINAL OR VAGINAL APPROACH, UNI
58615   - OCCLUSION OF FALLOPIAN TUBE(S) BY DEVICE (EG, BAND, CLIP, FALOPE RING) VAGINAL
58660   - LAPAROSCOPY, SURGICAL; WITH LYSIS OF ADHESIONS (SALPINGOLYSIS, OVARIOLYSIS) (SEP
58661   - LAPAROSCOPY, SURGICAL; WITH REMOVAL OF ADNEXAL STRUCTURES (PARTIAL OR TOTAL
58662   - LAPAROSCOPY, SURGICAL; WITH FULGURATION OR EXCISION OF LESIONS OF THE OVARY,
58670   - LAPAROSCOPY, SURGICAL; WITH FULGURATION OF OVIDUCTS (WITH OR WITHOUT
58671   - LAPAROSCOPY, SURGICAL; WITH OCCLUSION OF OVIDUCTS BY DEVICE (EG, BAND, CLIP, OR
58679   - UNLISTED LAPAROSCOPY PROCEDURE, OVIDUCT, OVARY
58800   - DRAINAGE OF OVARIAN CYST(S), UNILATERAL OR BILATERAL, (SEPARATE PROCEDURE); VAGI
58820   - DRAINAGE OF OVARIAN ABSCESS; VAGINAL APPROACH, OPEN
58823   - DRAINAGE OF PELVIC ABSCESS, TRANSVAGINAL OR TRANSRECTAL APPROACH, PERCUTANEOUS
58900   - BIOPSY OF OVARY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE)
58920   - WEDGE RESECTION OR BISECTION OF OVARY, UNILATERAL OR BILATERAL
58925   - OVARIAN CYSTECTOMY, UNILATERAL OR BILATERAL
58999   - UNLISTED PROCEDURE, FEMALE GENITAL SYSTEM (NONOBSTETRICAL)
59150   - LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITHOUT SALPINGECTOMY AND/OR
59151   - LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITH SALPINGECTOMY AND/OR
59160   - CURETTAGE, POSTPARTUM
59300   - EPISIOTOMY OR VAGINAL REPAIR, BY OTHER THAN ATTENDING PHYSICIAN
59320   - CERCLAGE OF CERVIX, DURING PREGNANCY; VAGINAL
59409   - VAGINAL DELIVERY ONLY (WITH OR WITHOUT EPISIOTOMY AND/OR FORCEPS);
59412   - EXTERNAL CEPHALIC VERSION, WITH OR WITHOUT TOCOLYSIS
59414   - DELIVERY OF PLACENTA (SEPARATE PROCEDURE)
59612   - VAGINAL DELIVERY ONLY, AFTER PREVIOUS CESAREAN DELIVERY (WITH OR WITHOUT
59812   - TREATMENT OF INCOMPLETE ABORTION, ANY TRIMESTER, COMPLETED SURGICALLY
59820   - TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; FIRST TRIMESTER
59821   - TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; SECOND TRIMESTER
59840   - INDUCED ABORTION, BY DILATION AND CURETTAGE
59841   - INDUCED ABORTION, BY DILATION AND EVACUATION
59870   - UTERINE EVACUATION AND CURETTAGE FOR HYDATIDIFORM MOLE
59871   - REMOVAL OF CERCLAGE SUTURE UNDER ANESTHESIA (OTHER THAN LOCAL)
59897   - UNLISTED FETAL INVASIVE PROCEDURE, INCLUDING ULTRASOUND GUIDANCE, WHEN PERFORMED
59898   - UNLISTED LAPAROSCOPY PROCEDURE, MATERNITY CARE AND DELIVERY
59899   - UNLISTED PROCEDURE, MATERNITY CARE AND DELIVERY
60000   - INCISION AND DRAINAGE OF THYROGLOSSAL DUCT CYST, INFECTED
60100   - BIOPSY THYROID, PERCUTANEOUS CORE NEEDLE
60200   - EXCISION OF CYST OR ADENOMA OF THYROID, OR TRANSECTION OF ISTHMUS
60210   - PARTIAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY
60212   - PARTIAL THYROID LOBECTOMY, UNILATERAL; WITH CONTRALATERAL SUBTOTAL LOBECTOMY,
60220   - TOTAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY
60225   - TOTAL THYROID LOBECTOMY, UNILATERAL; WITH CONTRALATERAL SUBTOTAL LOBECTOMY,
60240   - THYROIDECTOMY, TOTAL OR COMPLETE
60252   - THYROIDECTOMY, TOTAL OR SUBTOTAL FOR MALIGNANCY; WITH LIMITED NECK DISSECTION
60260   - THYROIDECTOMY, REMOVAL OF ALL REMAINING THYROID TISSUE FOLLOWING PREVIOUS
60280   - EXCISION OF THYROGLOSSAL DUCT CYST OR SINUS;
60281   - EXCISION OF THYROGLOSSAL DUCT CYST OR SINUS; RECURRENT



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60300   - ASPIRATION AND/OR INJECTION, THYROID CYST
60500   - PARATHYROIDECTOMY OR EXPLORATION OF PARATHYROID(S);
60512   - PARATHYROID AUTOTRANSPLANTATION (LIST SEPARATELY IN ADDITION TO CODE FOR
60659   - UNLISTED LAPAROSCOPY PROCEDURE, ENDOCRINE SYSTEM
60699   - UNLISTED PROCEDURE, ENDOCRINE SYSTEM
61000   - SUBDURAL TAP THROUGH FONTANELLE, OR SUTURE, INFANT, UNILATERAL OR BILATERAL; INI
61001   - SUBDURAL TAP THROUGH FONTANELLE, OR SUTURE, INFANT, UNILATERAL OR BILATERAL;
61020   - VENTRICULAR PUNCTURE THROUGH PREVIOUS BURR HOLE, FONTANELLE, SUTURE, OR
61026   - VENTRICULAR PUNCTURE THROUGH PREVIOUS BURR HOLE, FONTANELLE, SUTURE, OR
61050   - CISTERNAL OR LATERAL CERVICAL (C1-C2) PUNCTURE; WITHOUT INJECTION (SEPARATE
61055   - CISTERNAL OR LATERAL CERVICAL (C1-C2) PUNCTURE; WITH INJECTION OF MEDICATION OR
61070   - PUNCTURE OF SHUNT TUBING OR RESERVOIR FOR ASPIRATION OR INJECTION PROCEDURE
61215   - INSERTION OF SUBCUTANEOUS RESERVOIR, PUMP OR CONTINUOUS INFUSION SYSTEM FOR
61330   - DECOMPRESSION OF ORBIT ONLY, TRANSCRANIAL APPROACH
61334   - EXPLORATION OF ORBIT (TRANSCRANIAL APPROACH); WITH REMOVAL OF FOREIGN BODY
61623   - ENDOVASCULAR TEMPORARY BALLOON ARTERIAL OCCLUSION, HEAD OR NECK (EXTRACRANIAL/IN
61626   - TRANSCATHETER PERMANENT OCCLUSION OR EMBOLIZATION (EG, FOR TUMOR DESTRUCTION,
61790   - CREATION OF LESION BY STEREOTACTIC METHOD, PERCUTANEOUS, BY NEUROLYTIC AGENT
61791   - CREATION OF LESION BY STEREOTACTIC METHOD, PERCUTANEOUS, BY NEUROLYTIC AGENT
61880   - REVISION OR REMOVAL OF INTRACRANIAL NEUROSTIMULATOR ELECTRODES
61885   - INSERTION OR REPLACEMENT OF CRANIAL NEUROSTIMULATOR PULSE GENERATOR OR
61886   - INSERTION OR REPLACEMENT OF CRANIAL NEUROSTIMULATOR PULSE GENERATOR OR
61888   - REVISION OR REMOVAL OF CRANIAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER
62194   - REPLACEMENT OR IRRIGATION, SUBARACHNOID/SUBDURAL CATHETER
62225   - REPLACEMENT OR IRRIGATION, VENTRICULAR CATHETER
62230   - REPLACEMENT OR REVISION OF CEREBROSPINAL FLUID SHUNT, OBSTRUCTED VALVE, OR
62252   - REPROGRAMMING OF PROGRAMMABLE CEREBROSPINAL SHUNT
62263   - PERCUTANEOUS LYSIS OF EPIDURAL ADHESIONS USING SOLUTION INJECTION (EG, HYPERTONI
62264   - PERCUTANEOUS LYSIS OF EPIDURAL ADHESIONS USING SOLUTION INJECTION (EG,
62267   - Percutaneous aspiration within the nucleus pulposus, intervertebral disc, or par
62268   - PERCUTANEOUS ASPIRATION, SPINAL CORD CYST OR SYRINX
62269   - BIOPSY OF SPINAL CORD, PERCUTANEOUS NEEDLE
62270   - SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC
62272   - SPINAL PUNCTURE, THERAPEUTIC, FOR DRAINAGE OF CEREBROSPINAL FLUID (BY NEEDLE OR
62273   - INJECTION, EPIDURAL, OF BLOOD OR CLOT PATCH
62280   - INJECTION/INFUSION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, ICED SALINE
62281   - INJECTION/INFUSION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, ICED SALINE
62282   - INJECTION/INFUSION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, ICED SALINE
62287   - DECOMPRESSION PROCEDURE, PERCUTANEOUS, OF NUCLEUS PULPOSUS OF INTERVERTEBRAL DIS
62292   - INJECTION PROCEDURE FOR CHEMONUCLEOLYSIS, INCLUDING DISKOGRAPHY, INTERVERTEBRAL
62294   - INJECTION PROCEDURE, ARTERIAL, FOR OCCLUSION OF ARTERIOVENOUS MALFORMATION,
62310   - INJECTION, SINGLE (NOT VIA INDWELLING CATHETER), NOT INCLUDING NEUROLYTIC
62311   - INJECTION, SINGLE (NOT VIA INDWELLING CATHETER), NOT INCLUDING NEUROLYTIC
62318   - INJECTION, INCLUDING CATHETER PLACEMENT, CONTINUOUS INFUSION OR INTERMITTENT
62319   - INJECTION, INCLUDING CATHETER PLACEMENT, CONTINUOUS INFUSION OR INTERMITTENT
62350   - IMPLANTATION, REVISION OR REPOSITIONING OF TUNNELED INTRATHECAL OR EPIDURAL CATH
62351   - IMPLANTATION, REVISION OR REPOSITIONING OF TUNNELED INTRATHECAL OR EPIDURAL
62355   - REMOVAL OF PREVIOUSLY IMPLANTED INTRATHECAL OR EPIDURAL CATHETER
62360   - IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INFUSION;
62361   - IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG
62362   - IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG
62365   - REMOVAL OF SUBCUTANEOUS RESERVOIR OR PUMP, PREVIOUSLY IMPLANTED FOR INTRATHECAL
62367   - ELECTRONIC ANALYSIS OF PROGRAMMABLE, IMPLANTED PUMP FOR INTRATHECAL OR EPIDURAL
62368   - ELECTRONIC ANALYSIS OF PROGRAMMABLE, IMPLANTED PUMP FOR INTRATHECAL OR EPIDURAL
63001   - LAMINECTOMY WITH EXPLORATION AND/OR DECOMPRESSION OF SPINAL CORD AND/OR CAUDA EQ



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63003   - LAMINECTOMY WITH EXPLORATION AND/OR DECOMPRESSION OF SPINAL CORD AND/OR CAUDA
63005   - LAMINECTOMY WITH EXPLORATION AND/OR DECOMPRESSION OF SPINAL CORD AND/OR CAUDA
63011   - LAMINECTOMY WITH EXPLORATION AND/OR DECOMPRESSION OF SPINAL CORD AND/OR CAUDA
63012   - LAMINECTOMY WITH REMOVAL OF ABNORMAL FACETS AND/OR PARS INTER-ARTICULARIS WITH
63015   - LAMINECTOMY WITH EXPLORATION AND/OR DECOMPRESSION OF SPINAL CORD AND/OR CAUDA
63016   - LAMINECTOMY WITH EXPLORATION AND/OR DECOMPRESSION OF SPINAL CORD AND/OR CAUDA
63017   - LAMINECTOMY WITH EXPLORATION AND/OR DECOMPRESSION OF SPINAL CORD AND/OR CAUDA
63020   - LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PAR
63030   - LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PAR
63035   - LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PAR
63040   - LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING
63042   - LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING
63045   - LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH
63046   - LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH
63047   - LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH
63048   - LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH
63055   - TRANSPEDICULAR APPROACH WITH DECOMPRESSION OF SPINAL CORD, EQUINA AND/OR NERVE R
63056   - TRANSPEDICULAR APPROACH WITH DECOMPRESSION OF SPINAL CORD, EQUINA AND/OR NERVE
63057   - TRANSPEDICULAR APPROACH WITH DECOMPRESSION OF SPINAL CORD, EQUINA AND/OR NERVE
63064   - COSTOVERTEBRAL APPROACH WITH DECOMPRESSION OF SPINAL CORD OR NERVE ROOT(S),
63066   - COSTOVERTEBRAL APPROACH WITH DECOMPRESSION OF SPINAL CORD OR NERVE ROOT(S),
63075   - DISKECTOMY, ANTERIOR, WITH DECOMPRESSION OF SPINAL CORD AND/ OR NERVE ROOT(S), I
63600   - CREATION OF LESION OF SPINAL CORD BY STEREOTACTIC METHOD, PERCUTANEOUS, ANY MODA
63610   - STEREOTACTIC STIMULATION OF SPINAL CORD, PERCUTANEOUS, SEPARATE PROCEDURE NOT
63615   - STEREOTACTIC BIOPSY, ASPIRATION, OR EXCISION OF LESION, SPINAL CORD
63650   - PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY, EPIDURAL
63655   - LAMINECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES, PLATE/PADDLE,
63661   - Removal of spinal neurostimulator electrode percutaneous array(s), including flu
63662   - Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotom
63663   - Revision including replacement, when performed, of spinal neurostimulator electr
63664   - Revision including replacement, when performed, of spinal neurostimulator electr
63685   - INSERTION OR REPLACEMENT OF SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER,
63688   - REVISION OR REMOVAL OF IMPLANTED SPINAL NEUROSTIMULATOR PULSE GENERATOR OR
63741   - CREATION OF SHUNT, LUMBAR, SUBARACHNOID-PERITONEAL, -PLEURAL, OR OTHER;
63744   - REPLACEMENT, IRRIGATION OR REVISION OF LUMBOSUBARACHNOID SHUNT
63746   - REMOVAL OF ENTIRE LUMBOSUBARACHNOID SHUNT SYSTEM WITHOUT REPLACEMENT
64400   - INJECTION, ANESTHETIC AGENT; TRIGEMINAL NERVE, ANY DIVISION OR BRANCH
64402   - INJECTION, ANESTHETIC AGENT; FACIAL NERVE
64405   - INJECTION, ANESTHETIC AGENT; GREATER OCCIPITAL NERVE
64408   - INJECTION, ANESTHETIC AGENT; VAGUS NERVE
64410   - INJECTION, ANESTHETIC AGENT; PHRENIC NERVE
64412   - INJECTION, ANESTHETIC AGENT; SPINAL ACCESSORY NERVE
64413   - INJECTION, ANESTHETIC AGENT; CERVICAL PLEXUS
64415   - INJECTION, ANESTHETIC AGENT; BRACHIAL PLEXUS, SINGLE
64416   - INJECTION, ANESTHETIC AGENT; BRACHIAL PLEXUS, CONTINUOUS INFUSION BY CATHETER (I
64417   - INJECTION, ANESTHETIC AGENT; AXILLARY NERVE
64418   - INJECTION, ANESTHETIC AGENT; SUPRASCAPULAR NERVE
64420   - INJECTION, ANESTHETIC AGENT; INTERCOSTAL NERVE, SINGLE
64421   - INJECTION, ANESTHETIC AGENT; INTERCOSTAL NERVES, MULTIPLE, REGIONAL BLOCK
64425   - INJECTION, ANESTHETIC AGENT; ILIOINGUINAL, ILIOHYPOGASTRIC NERVES
64430   - INJECTION, ANESTHETIC AGENT; PUDENDAL NERVE
64435   - INJECTION, ANESTHETIC AGENT; PARACERVICAL (UTERINE) NERVE
64445   - INJECTION, ANESTHETIC AGENT; SCIATIC NERVE, SINGLE
64446   - INJECTION, ANESTHETIC AGENT; SCIATIC NERVE, CONTINUOUS INFUSION BY CATHETER (INC
64447   - INJECTION, ANESTHETIC AGENT; FEMORAL NERVE, SINGLE



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64448 - INJECTION, ANESTHETIC AGENT; FEMORAL NERVE, CONTINUOUS INFUSION BY CATHETER (INC
64449 - INJECTION, ANESTHETIC AGENT; LUMBAR PLEXUS, POSTERIOR APPROACH, CONTINUOUS INFUS
64450 - INJECTION, ANESTHETIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH
64455 - Injection(s), anesthetic agent and/or steroid; plantar common digital nerve(s) (
64479 - INJECTION, ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL; CERVICAL
64480 - INJECTION, ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL; CERVICAL
64483 - INJECTION, ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL; LUMBAR OR
64484 - INJECTION, ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL; LUMBAR OR
64490 - Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophysea
64491 - Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophysea
64492 - Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophysea
64493 - Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophysea
64494 - Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophysea
64495 - Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophysea
64505 - INJECTION, ANESTHETIC AGENT; SPHENOPALATINE GANGLION
64508 - INJECTION, ANESTHETIC AGENT; CAROTID SINUS (SEPARATE PROCEDURE)
64510 - INJECTION, ANESTHETIC AGENT; STELLATE GANGLION (CERVICAL SYMPATHETIC)
64517 - INJECTION, ANESTHETIC AGENT; SUPERIOR HYPOGASTRIC PLEXUS
64520 - INJECTION, ANESTHETIC AGENT; LUMBAR OR THORACIC (PARAVERTEBRAL SYMPATHETIC)
64530 - INJECTION, ANESTHETIC AGENT; CELIAC PLEXUS, WITH OR WITHOUT RADIOLOGIC
64553 - PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; CRANIAL NERVE
64555 - PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; PERIPHERAL NERVE
64560 - PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; AUTONOMIC NERVE
64561 - PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; SACRAL NERVE
64565 - PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; NEUROMUSCULAR
64566 - Posterior tibial neurostimulation, percutaneous needle electrode, single treatme
64568 - Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator ele
64569 - Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator elect
64570 - Removal of cranial nerve (eg, vagus nerve) neurostimulator electrode array and p
64573 - INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; CRANIAL NERVE
64575 - INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; PERIPHERAL NERVE
64577 - INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; AUTONOMIC NERVE
64580 - INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; NEUROMUSCULAR
64581 - INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; SACRAL NERVE
64585 - REVISION OR REMOVAL OF PERIPHERAL NEUROSTIMULATOR ELECTRODES
64590 - INSERTION OR REPLACEMENT OF PERIPHERAL OR GASTRIC NEUROSTIMULATOR PULSE GENERATO
64595 - REVISION OR REMOVAL OF PERIPHERAL OR GASTRIC NEUROSTIMULATOR PULSE GENERATOR OR
64600 - DESTRUCTION BY NEUROLYTIC AGENT, TRIGEMINAL NERVE; SUPRAORBITAL, INFRAORBITAL, M
64605 - DESTRUCTION BY NEUROLYTIC AGENT, TRIGEMINAL NERVE; SECOND AND THIRD DIVISION
64610 - DESTRUCTION BY NEUROLYTIC AGENT, TRIGEMINAL NERVE; SECOND AND THIRD DIVISION
64611 - Chemodenervation of parotid and submandibular salivary glands, bilateral
64612 - CHEMODENERVATION OF MUSCLE(S); MUSCLE(S) INNERVATED BY FACIAL NERVE (EG, FOR
64613 - CHEMODENERVATION OF MUSCLE(S); NECK MUSCLE(S) (EG, FOR SPASMODIC TORTICOLLIS, SP
64614 - CHEMODENERVATION OF MUSCLE(S); EXTREMITY(S) AND/OR TRUNK MUSCLE(S) (EG, FOR
64620 - DESTRUCTION BY NEUROLYTIC AGENT, INTERCOSTAL NERVE
64622 - DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE; LUMBAR OR
64623 - DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE; LUMBAR OR
64626 - DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE; CERVICAL OR
64627 - DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE; CERVICAL OR
64630 - DESTRUCTION BY NEUROLYTIC AGENT; PUDENDAL NERVE
64632 - Destruction by neurolytic agent; plantar common digital nerve
64640 - DESTRUCTION BY NEUROLYTIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH
64650 - CHEMODENERVATION OF ECCRINE GLANDS; BOTH AXILLAE
64653 - CHEMODENERVATION OF ECCRINE GLANDS; OTHER AREA(S) (EG, SCALP, FACE, NECK), PER D
64680 - DESTRUCTION BY NEUROLYTIC AGENT, WITH OR WITHOUT RADIOLOGIC MONITORING; CELIAC P



                                          Page 131
                                     Surgery (triggers bundling)


64681   - DESTRUCTION BY NEUROLYTIC AGENT, WITH OR WITHOUT RADIOLOGIC MONITORING;
64702   - NEUROPLASTY; DIGITAL, ONE OR BOTH, SAME DIGIT
64704   - NEUROPLASTY; NERVE OF HAND OR FOOT
64708   - NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG; OTHER THAN SPECIFIED
64712   - NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG; SCIATIC NERVE
64713   - NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG; BRACHIAL PLEXUS
64714   - NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG; LUMBAR PLEXUS
64716   - NEUROPLASTY AND/OR TRANSPOSITION; CRANIAL NERVE (SPECIFY)
64718   - NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT ELBOW
64719   - NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT WRIST
64721   - NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL
64722   - DECOMPRESSION; UNSPECIFIED NERVE(S) (SPECIFY)
64726   - DECOMPRESSION; PLANTAR DIGITAL NERVE
64727   - INTERNAL NEUROLYSIS, REQUIRING USE OF OPERATING MICROSCOPE (LIST SEPARATELY IN
64732   - TRANSECTION OR AVULSION OF; SUPRAORBITAL NERVE
64734   - TRANSECTION OR AVULSION OF; INFRAORBITAL NERVE
64736   - TRANSECTION OR AVULSION OF; MENTAL NERVE
64738   - TRANSECTION OR AVULSION OF; INFERIOR ALVEOLAR NERVE BY OSTEOTOMY
64740   - TRANSECTION OR AVULSION OF; LINGUAL NERVE
64742   - TRANSECTION OR AVULSION OF; FACIAL NERVE, DIFFERENTIAL OR COMPLETE
64744   - TRANSECTION OR AVULSION OF; GREATER OCCIPITAL NERVE
64746   - TRANSECTION OR AVULSION OF; PHRENIC NERVE
64761   - TRANSECTION OR AVULSION OF; PUDENDAL NERVE
64763   - TRANSECTION OR AVULSION OF OBTURATOR NERVE, EXTRAPELVIC, WITH OR WITHOUT
64766   - TRANSECTION OR AVULSION OF OBTURATOR NERVE, INTRAPELVIC, WITH OR WITHOUT
64771   - TRANSECTION OR AVULSION OF OTHER CRANIAL NERVE, EXTRADURAL
64772   - TRANSECTION OR AVULSION OF OTHER SPINAL NERVE, EXTRADURAL
64774   - EXCISION OF NEUROMA; CUTANEOUS NERVE, SURGICALLY IDENTIFIABLE
64776   - EXCISION OF NEUROMA; DIGITAL NERVE, ONE OR BOTH, SAME DIGIT
64778   - EXCISION OF NEUROMA; DIGITAL NERVE, EACH ADDITIONAL DIGIT (LIST SEPARATELY IN
64782   - EXCISION OF NEUROMA; HAND OR FOOT, EXCEPT DIGITAL NERVE
64783   - EXCISION OF NEUROMA; HAND OR FOOT, EACH ADDITIONAL NERVE, EXCEPT SAME DIGIT
64784   - EXCISION OF NEUROMA; MAJOR PERIPHERAL NERVE, EXCEPT SCIATIC
64786   - EXCISION OF NEUROMA; SCIATIC NERVE
64787   - IMPLANTATION OF NERVE END INTO BONE OR MUSCLE (LIST SEPARATELY IN ADDITION TO
64788   - EXCISION OF NEUROFIBROMA OR NEUROLEMMOMA; CUTANEOUS NERVE
64790   - EXCISION OF NEUROFIBROMA OR NEUROLEMMOMA; MAJOR PERIPHERAL NERVE
64792   - EXCISION OF NEUROFIBROMA OR NEUROLEMMOMA; EXTENSIVE (INCLUDING MALIGNANT TYPE)
64795   - BIOPSY OF NERVE
64802   - SYMPATHECTOMY, CERVICAL
64820   - SYMPATHECTOMY; DIGITAL ARTERIES, EACH DIGIT
64821   - SYMPATHECTOMY; RADIAL ARTERY
64822   - SYMPATHECTOMY; ULNAR ARTERY
64823   - SYMPATHECTOMY; SUPERFICIAL PALMAR ARCH
64831   - SUTURE OF DIGITAL NERVE, HAND OR FOOT; ONE NERVE
64832   - SUTURE OF DIGITAL NERVE, HAND OR FOOT; EACH ADDITIONAL DIGITAL NERVE (LIST
64834   - SUTURE OF ONE NERVE; HAND OR FOOT, COMMON SENSORY NERVE
64835   - SUTURE OF ONE NERVE; MEDIAN MOTOR THENAR
64836   - SUTURE OF ONE NERVE; ULNAR MOTOR
64837   - SUTURE OF EACH ADDITIONAL NERVE, HAND OR FOOT (LIST SEPARATELY IN ADDITION TO
64840   - SUTURE OF POSTERIOR TIBIAL NERVE
64856   - SUTURE OF MAJOR PERIPHERAL NERVE, ARM OR LEG, EXCEPT SCIATIC; INCLUDING
64857   - SUTURE OF MAJOR PERIPHERAL NERVE, ARM OR LEG, EXCEPT SCIATIC; WITHOUT
64858   - SUTURE OF SCIATIC NERVE
64859   - SUTURE OF EACH ADDITIONAL MAJOR PERIPHERAL NERVE (LIST SEPARATELY IN ADDITION



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64861   - SUTURE OF; BRACHIAL PLEXUS
64862   - SUTURE OF; LUMBAR PLEXUS
64864   - SUTURE OF FACIAL NERVE; EXTRACRANIAL
64865   - SUTURE OF FACIAL NERVE; INFRATEMPORAL, WITH OR WITHOUT GRAFTING
64870   - ANASTOMOSIS; FACIAL-PHRENIC
64872   - SUTURE OF NERVE; REQUIRING SECONDARY OR DELAYED SUTURE (LIST SEPARATELY IN
64874   - SUTURE OF NERVE; REQUIRING EXTENSIVE MOBILIZATION, OR TRANSPOSITION OF NERVE
64876   - SUTURE OF NERVE; REQUIRING SHORTENING OF BONE OF EXTREMITY (LIST SEPARATELY IN
64885   - NERVE GRAFT (INCLUDES OBTAINING GRAFT), HEAD OR NECK; UP TO 4 CM IN LENGTH
64886   - NERVE GRAFT (INCLUDES OBTAINING GRAFT), HEAD OR NECK; MORE THAN 4 CM LENGTH
64890   - NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, HAND OR FOOT; UP TO 4 CM
64891   - NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, HAND OR FOOT; MORE THAN
64892   - NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, ARM OR LEG; UP TO 4 CM
64893   - NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, ARM OR LEG; MORE THAN 4
64895   - NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS (CABLE), HAND OR FOOT;
64896   - NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS (CABLE), HAND OR FOOT;
64897   - NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS (CABLE), ARM OR LEG;
64898   - NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS (CABLE), ARM OR LEG;
64901   - NERVE GRAFT, EACH ADDITIONAL NERVE; SINGLE STRAND (LIST SEPARATELY IN ADDITION
64902   - NERVE GRAFT, EACH ADDITIONAL NERVE; MULTIPLE STRANDS (CABLE) (LIST SEPARATELY
64905   - NERVE PEDICLE TRANSFER; FIRST STAGE
64907   - NERVE PEDICLE TRANSFER; SECOND STAGE
64910   - NERVE REPAIR; WITH SYNTHETIC CONDUIT OR VEIN ALLOGRAFT (EG, NERVE TUBE), EACH NE
64911   - NERVE REPAIR; WITH AUTOGENOUS VEIN GRAFT (INCLUDES HARVEST OF VEIN GRAFT), EACH
64999   - UNLISTED PROCEDURE, NERVOUS SYSTEM
65091   - EVISCERATION OF OCULAR CONTENTS; WITHOUT IMPLANT
65093   - EVISCERATION OF OCULAR CONTENTS; WITH IMPLANT
65101   - ENUCLEATION OF EYE; WITHOUT IMPLANT
65103   - ENUCLEATION OF EYE; WITH IMPLANT, MUSCLES NOT ATTACHED TO IMPLANT
65105   - ENUCLEATION OF EYE; WITH IMPLANT, MUSCLES ATTACHED TO IMPLANT
65110   - EXENTERATION OF ORBIT (DOES NOT INCLUDE SKIN GRAFT), REMOVAL OF ORBITAL
65112   - EXENTERATION OF ORBIT (DOES NOT INCLUDE SKIN GRAFT), REMOVAL OF ORBITAL
65114   - EXENTERATION OF ORBIT (DOES NOT INCLUDE SKIN GRAFT), REMOVAL OF ORBITAL
65125   - MODIFICATION OF OCULAR IMPLANT WITH PLACEMENT OR REPLACEMENT OF PEGS (EG, DRILLI
65130   - INSERTION OF OCULAR IMPLANT SECONDARY; AFTER EVISCERATION, IN SCLERAL SHELL
65135   - INSERTION OF OCULAR IMPLANT SECONDARY; AFTER ENUCLEATION, MUSCLES NOT ATTACHED
65140   - INSERTION OF OCULAR IMPLANT SECONDARY; AFTER ENUCLEATION, MUSCLES ATTACHED TO
65150   - REINSERTION OF OCULAR IMPLANT; WITH OR WITHOUT CONJUNCTIVAL GRAFT
65155   - REINSERTION OF OCULAR IMPLANT; WITH USE OF FOREIGN MATERIAL FOR REINFORCEMENT
65175   - REMOVAL OF OCULAR IMPLANT
65205   - REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CONJUNCTIVAL SUPERFICIAL
65210   - REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CONJUNCTIVAL EMBEDDED (INCLUDES
65220   - REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CORNEAL, WITHOUT SLIT LAMP
65222   - REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CORNEAL, WITH SLIT LAMP
65235   - REMOVAL OF FOREIGN BODY, INTRAOCULAR; FROM ANTERIOR CHAMBER OF EYE OR LENS
65260   - REMOVAL OF FOREIGN BODY, INTRAOCULAR; FROM POSTERIOR SEGMENT, MAGNETIC
65265   - REMOVAL OF FOREIGN BODY, INTRAOCULAR; FROM POSTERIOR SEGMENT, NONMAGNETIC
65270   - REPAIR OF LACERATION; CONJUNCTIVA, WITH OR WITHOUT NONPERFORATING LACERATION SCL
65272   - REPAIR OF LACERATION; CONJUNCTIVA, BY MOBILIZATION AND REARRANGEMENT, WITHOUT
65275   - REPAIR OF LACERATION; CORNEA, NONPERFORATING, WITH OR WITHOUT REMOVAL FOREIGN
65280   - REPAIR OF LACERATION; CORNEA AND/OR SCLERA, PERFORATING, NOT INVOLVING UVEAL
65285   - REPAIR OF LACERATION; CORNEA AND/OR SCLERA, PERFORATING, WITH REPOSITION OR
65286   - REPAIR OF LACERATION; APPLICATION OF TISSUE GLUE, WOUNDS OF CORNEA AND/OR SCLERA
65290   - REPAIR OF WOUND, EXTRAOCULAR MUSCLE, TENDON AND/OR TENON'S CAPSULE
65400   - EXCISION OF LESION, CORNEA (KERATECTOMY, LAMELLAR, PARTIAL), EXCEPT PTERYGIUM



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                                   Surgery (triggers bundling)


65410 - BIOPSY OF CORNEA
65420 - EXCISION OR TRANSPOSITION OF PTERYGIUM; WITHOUT GRAFT
65426 - EXCISION OR TRANSPOSITION OF PTERYGIUM; WITH GRAFT
65430 - SCRAPING OF CORNEA, DIAGNOSTIC, FOR SMEAR AND/OR CULTURE
65435 - REMOVAL OF CORNEAL EPITHELIUM; WITH OR WITHOUT CHEMOCAUTERIZATION (ABRASION,
65436 - REMOVAL OF CORNEAL EPITHELIUM; WITH APPLICATION OF CHELATING AGENT (EG, EDTA)
65450 - DESTRUCTION OF LESION OF CORNEA BY CRYOTHERAPY, PHOTOCOAGULATION OR
65600 - MULTIPLE PUNCTURES OF ANTERIOR CORNEA (EG, FOR CORNEAL EROSION, TATTOO)
65710 - KERATOPLASTY (CORNEAL TRANSPLANT); ANTERIOR LAMELLAR
65730 - KERATOPLASTY (CORNEAL TRANSPLANT); PENETRATING (EXCEPT IN APHAKIA OR PSEUDOPHAKI
65750 - KERATOPLASTY (CORNEAL TRANSPLANT); PENETRATING (IN APHAKIA)
65755 - KERATOPLASTY (CORNEAL TRANSPLANT); PENETRATING (IN PSEUDOPHAKIA)
65756 - Keratoplasty (corneal transplant); endothelial
65770 - KERATOPROSTHESIS
65772 - CORNEAL RELAXING INCISION FOR CORRECTION OF SURGICALLY INDUCED ASTIGMATISM
65775 - CORNEAL WEDGE RESECTION FOR CORRECTION OF SURGICALLY INDUCED ASTIGMATISM
65778 - Placement of amniotic membrane on the ocular surface for wound healing; self-ret
65779 - Placement of amniotic membrane on the ocular surface for wound healing; single l
65780 - OCULAR SURFACE RECONSTRUCTION; AMNIOTIC MEMBRANE TRANSPLANTATION
65781 - OCULAR SURFACE RECONSTRUCTION; LIMBAL STEM CELL ALLOGRAFT (EG, CADAVERIC OR
65782 - OCULAR SURFACE RECONSTRUCTION; LIMBAL CONJUNCTIVAL AUTOGRAFT (INCLUDES
65800 - PARACENTESIS OF ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); WITH DIAGNOSTIC AS
65805 - PARACENTESIS OF ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); WITH THERAPEUTIC
65810 - PARACENTESIS OF ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); WITH REMOVAL OF
65815 - PARACENTESIS OF ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); WITH REMOVAL OF
65820 - GONIOTOMY
65850 - TRABECULOTOMY AB EXTERNO
65855 - TRABECULOPLASTY BY LASER SURGERY, ONE OR MORE SESSIONS (DEFINED TREATMENT
65860 - SEVERING ADHESIONS OF ANTERIOR SEGMENT, LASER TECHNIQUE (SEPARATE PROCEDURE)
65865 - SEVERING ADHESIONS OF ANTERIOR SEGMENT OF EYE, INCISIONAL TECHNIQUE (WITH OR WIT
65870 - SEVERING ADHESIONS OF ANTERIOR SEGMENT OF EYE, INCISIONAL TECHNIQUE (WITH OR
65875 - SEVERING ADHESIONS OF ANTERIOR SEGMENT OF EYE, INCISIONAL TECHNIQUE (WITH OR
65880 - SEVERING ADHESIONS OF ANTERIOR SEGMENT OF EYE, INCISIONAL TECHNIQUE (WITH OR
65900 - REMOVAL OF EPITHELIAL DOWNGROWTH, ANTERIOR CHAMBER OF EYE
65920 - REMOVAL OF IMPLANTED MATERIAL, ANTERIOR SEGMENT OF EYE
65930 - REMOVAL OF BLOOD CLOT, ANTERIOR SEGMENT OF EYE
66020 - INJECTION, ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); AIR OR LIQUID
66030 - INJECTION, ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); MEDICATION
66130 - EXCISION OF LESION, SCLERA
66150 - FISTULIZATION OF SCLERA FOR GLAUCOMA; TREPHINATION WITH IRIDECTOMY
66155 - FISTULIZATION OF SCLERA FOR GLAUCOMA; THERMOCAUTERIZATION WITH IRIDECTOMY
66160 - FISTULIZATION OF SCLERA FOR GLAUCOMA; SCLERECTOMY WITH PUNCH OR SCISSORS, WITH
66165 - FISTULIZATION OF SCLERA FOR GLAUCOMA; IRIDENCLEISIS OR IRIDOTASIS
66170 - FISTULIZATION OF SCLERA FOR GLAUCOMA; TRABECULECTOMY AB EXTERNO IN ABSENCE OF
66172 - FISTULIZATION OF SCLERA FOR GLAUCOMA; TRABECULECTOMY AB EXTERNO WITH SCARRING
66174 - Transluminal dilation of aqueous outflow canal; without retention of device or s
66175 - Transluminal dilation of aqueous outflow canal; with retention of device or sten
66180 - AQUEOUS SHUNT TO EXTRAOCULAR RESERVOIR (EG, MOLTENO, SCHOCKET, DENVER-KRUPIN)
66185 - REVISION OF AQUEOUS SHUNT TO EXTRAOCULAR RESERVOIR
66220 - REPAIR OF SCLERAL STAPHYLOMA; WITHOUT GRAFT
66225 - REPAIR OF SCLERAL STAPHYLOMA; WITH GRAFT
66250 - REVISION OR REPAIR OF OPERATIVE WOUND OF ANTERIOR SEGMENT, ANY TYPE, EARLY OR
66500 - IRIDOTOMY BY STAB INCISION (SEPARATE PROCEDURE); EXCEPT TRANSFIXION
66505 - IRIDOTOMY BY STAB INCISION (SEPARATE PROCEDURE); WITH TRANSFIXION AS FOR IRIS
66600 - IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; FOR REMOVAL OF LESION



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66605   - IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; WITH CYCLECTOMY
66625   - IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; PERIPHERAL FOR GLAUCOMA
66630   - IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; SECTOR FOR GLAUCOMA
66635   - IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; OPTICAL (SEPARATE PROCEDURE)
66680   - REPAIR OF IRIS, CILIARY BODY (AS FOR IRIDODIALYSIS)
66682   - SUTURE OF IRIS, CILIARY BODY (SEPARATE PROCEDURE) WITH RETRIEVAL OF SUTURE
66700   - CILIARY BODY DESTRUCTION; DIATHERMY
66710   - CILIARY BODY DESTRUCTION; CYCLOPHOTOCOAGULATION, TRANSSCLERAL
66711   - CILIARY BODY DESTRUCTION; CYCLOPHOTOCOAGULATION, ENDOSCOPIC
66720   - CILIARY BODY DESTRUCTION; CRYOTHERAPY
66740   - CILIARY BODY DESTRUCTION; CYCLODIALYSIS
66761   - IRIDOTOMY/IRIDECTOMY BY LASER SURGERY (EG, FOR GLAUCOMA) (ONE OR MORE SESSIONS)
66762   - IRIDOPLASTY BY PHOTOCOAGULATION (ONE OR MORE SESSIONS) (EG, FOR IMPROVEMENT OF
66770   - DESTRUCTION OF CYST OR LESION IRIS OR CILIARY BODY (NONEXCISIONAL PROCEDURE)
66820   - DISCISSION OF SECONDARY MEMBRANOUS CATARACT (OPACIFIED POSTERIOR LENS CAPSULE AN
66821   - DISCISSION OF SECONDARY MEMBRANOUS CATARACT (OPACIFIED POSTERIOR LENS CAPSULE
66825   - REPOSITIONING OF INTRAOCULAR LENS PROSTHESIS, REQUIRING AN INCISION (SEPARATE
66830   - REMOVAL OF SECONDARY MEMBRANOUS CATARACT (OPACIFIED POSTERIOR LENS CAPSULE AND/O
66840   - REMOVAL OF LENS MATERIAL; ASPIRATION TECHNIQUE, ONE OR MORE STAGES
66850   - REMOVAL OF LENS MATERIAL; PHACOFRAGMENTATION TECHNIQUE (MECHANICAL OR
66852   - REMOVAL OF LENS MATERIAL; PARS PLANA APPROACH, WITH OR WITHOUT VITRECTOMY
66920   - REMOVAL OF LENS MATERIAL; INTRACAPSULAR
66930   - REMOVAL OF LENS MATERIAL; INTRACAPSULAR, FOR DISLOCATED LENS
66940   - REMOVAL OF LENS MATERIAL; EXTRACAPSULAR (OTHER THAN 66840, 66850, 66852)
66982   - EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS
66983   - INTRACAPSULAR CATARACT EXTRACTION WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS
66984   - EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS
66985   - INSERTION OF INTRAOCULAR LENS PROSTHESIS (SECONDARY IMPLANT), NOT ASSOCIATED
66986   - EXCHANGE OF INTRAOCULAR LENS
66999   - UNLISTED PROCEDURE, ANTERIOR SEGMENT OF EYE
67005   - REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUE OR LIMBAL INCISION);
67010   - REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUE OR LIMBAL INCISION);
67015   - ASPIRATION OR RELEASE OF VITREOUS, SUBRETINAL OR CHOROIDAL FLUID, PARS PLANA
67025   - INJECTION OF VITREOUS SUBSTITUTE, PARS PLANA OR LIMBAL APPROACH, (FLUID-GAS
67027   - IMPLANTATION OF INTRAVITREAL DRUG DELIVERY SYSTEM (EG, GANCICLOVIR IMPLANT),
67028   - INTRAVITREAL INJECTION OF A PHARMACOLOGIC AGENT (SEPARATE PROCEDURE)
67030   - DISCISSION OF VITREOUS STRANDS (WITHOUT REMOVAL), PARS PLANA APPROACH
67031   - SEVERING OF VITREOUS STRANDS, VITREOUS FACE ADHESIONS, SHEETS, MEMBRANES OR
67036   - VITRECTOMY, MECHANICAL, PARS PLANA APPROACH;
67039   - VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH FOCAL ENDOLASER
67040   - VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH ENDOLASER PANRETINAL
67041   - VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH REMOVAL OF PRERETINAL CELLULAR
67042   - VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH REMOVAL OF INTERNAL LIMITING M
67043   - VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH REMOVAL OF SUBRETINAL MEMBRANE
67101   - REPAIR OF RETINAL DETACHMENT, ONE OR MORE SESSIONS; CRYOTHERAPY OR DIATHERMY, WI
67105   - REPAIR OF RETINAL DETACHMENT, ONE OR MORE SESSIONS; PHOTOCOAGULATION, WITH OR
67107   - REPAIR OF RETINAL DETACHMENT; SCLERAL BUCKLING (SUCH AS LAMELLAR SCLERAL
67108   - REPAIR OF RETINAL DETACHMENT; WITH VITRECTOMY, ANY METHOD, WITH OR WITHOUT AIR
67110   - REPAIR OF RETINAL DETACHMENT; BY INJECTION OF AIR OR OTHER GAS (EG, PNEUMATIC
67112   - REPAIR OF RETINAL DETACHMENT; BY SCLERAL BUCKLING OR VITRECTOMY, ON PATIENT
67113   - REPAIR OF COMPLEX RETINAL DETACHMENT (EG, PROLIFERATIVE VITREORETINOPATHY, STAGE
67115   - RELEASE OF ENCIRCLING MATERIAL (POSTERIOR SEGMENT)
67120   - REMOVAL OF IMPLANTED MATERIAL, POSTERIOR SEGMENT; EXTRAOCULAR
67121   - REMOVAL OF IMPLANTED MATERIAL, POSTERIOR SEGMENT; INTRAOCULAR
67141   - PROPHYLAXIS OF RETINAL DETACHMENT (EG, RETINAL BREAK, LATTICE DEGENERATION) WITH



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67145   - PROPHYLAXIS OF RETINAL DETACHMENT (EG, RETINAL BREAK, LATTICE DEGENERATION)
67208   - DESTRUCTION OF LOCALIZED LESION OF RETINA (EG, MACULAR EDEMA, TUMORS), ONE OR MO
67210   - DESTRUCTION OF LOCALIZED LESION OF RETINA (EG, MACULAR EDEMA, TUMORS), ONE OR
67218   - DESTRUCTION OF LOCALIZED LESION OF RETINA (EG, MACULAR EDEMA, TUMORS), ONE OR
67220   - DESTRUCTION OF LOCALIZED LESION OF CHOROID (EG, CHOROIDAL NEOVASCULARIZATION);
67221   - DESTRUCTION OF LOCALIZED LESION OF CHOROID (EG, CHOROIDAL NEOVASCULARIZATION);
67225   - DESTRUCTION OF LOCALIZED LESION OF CHOROID (EG, CHOROIDAL NEOVASCULARIZATION);
67227   - DESTRUCTION OF EXTENSIVE OR PROGRESSIVE RETINOPATHY (EG, DIABETIC RETINOPATHY),
67228   - TREATMENT OF EXTENSIVE OR PROGRESSIVE RETINOPATHY, ONE OR MORE SESSIONS; (EG, DI
67229   - TREATMENT OF EXTENSIVE OR PROGRESSIVE RETINOPATHY, ONE OR MORE SESSIONS; PRETERM
67250   - SCLERAL REINFORCEMENT (SEPARATE PROCEDURE); WITHOUT GRAFT
67255   - SCLERAL REINFORCEMENT (SEPARATE PROCEDURE); WITH GRAFT
67299   - UNLISTED PROCEDURE, POSTERIOR SEGMENT
67311   - STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE; ONE HORIZONTAL MUSCLE
67312   - STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE; TWO HORIZONTAL MUSCLES
67314   - STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE; ONE VERTICAL MUSCLE
67316   - STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE; TWO OR MORE VERTICAL
67318   - STRABISMUS SURGERY, ANY PROCEDURE, SUPERIOR OBLIQUE MUSCLE
67320   - TRANSPOSITION PROCEDURE (EG, FOR PARETIC EXTRAOCULAR MUSCLE), ANY EXTRAOCULAR
67331   - STRABISMUS SURGERY ON PATIENT WITH PREVIOUS EYE SURGERY OR INJURY THAT DID NOT
67332   - STRABISMUS SURGERY ON PATIENT WITH SCARRING OF EXTRAOCULAR MUSCLES (EG, PRIOR
67334   - STRABISMUS SURGERY BY POSTERIOR FIXATION SUTURE TECHNIQUE, WITH OR WITHOUT
67335   - PLACEMENT OF ADJUSTABLE SUTURE(S) DURING STRABISMUS SURGERY, INCLUDING
67340   - STRABISMUS SURGERY INVOLVING EXPLORATION AND/OR REPAIR OF DETACHED EXTRAOCULAR
67343   - RELEASE OF EXTENSIVE SCAR TISSUE WITHOUT DETACHING EXTRAOCULAR MUSCLE (SEPARATE
67345   - CHEMODENERVATION OF EXTRAOCULAR MUSCLE
67346   - BIOPSY OF EXTRAOCULAR MUSCLE
67399   - UNLISTED PROCEDURE, OCULAR MUSCLE
67400   - ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); FOR EXPLOR
67405   - ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); WITH
67412   - ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); WITH
67413   - ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); WITH
67414   - ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); WITH
67415   - FINE NEEDLE ASPIRATION OF ORBITAL CONTENTS
67420   - ORBITOTOMY WITH BONE FLAP OR WINDOW, LATERAL APPROACH (EG, KROENLEIN); WITH
67430   - ORBITOTOMY WITH BONE FLAP OR WINDOW, LATERAL APPROACH (EG, KROENLEIN); WITH
67440   - ORBITOTOMY WITH BONE FLAP OR WINDOW, LATERAL APPROACH (EG, KROENLEIN); WITH
67445   - ORBITOTOMY WITH BONE FLAP OR WINDOW, LATERAL APPROACH (EG, KROENLEIN); WITH
67450   - ORBITOTOMY WITH BONE FLAP OR WINDOW, LATERAL APPROACH (EG, KROENLEIN); FOR
67500   - RETROBULBAR INJECTION; MEDICATION (SEPARATE PROCEDURE, DOES NOT INCLUDE SUPPLY O
67505   - RETROBULBAR INJECTION; ALCOHOL
67515   - INJECTION OF MEDICATION OR OTHER SUBSTANCE INTO TENON'S CAPSULE
67550   - ORBITAL IMPLANT (IMPLANT OUTSIDE MUSCLE CONE); INSERTION
67560   - ORBITAL IMPLANT (IMPLANT OUTSIDE MUSCLE CONE); REMOVAL OR REVISION
67570   - OPTIC NERVE DECOMPRESSION (EG, INCISION OR FENESTRATION OF OPTIC NERVE SHEATH)
67599   - UNLISTED PROCEDURE, ORBIT
67700   - BLEPHAROTOMY, DRAINAGE OF ABSCESS, EYELID
67710   - SEVERING OF TARSORRHAPHY
67715   - CANTHOTOMY (SEPARATE PROCEDURE)
67800   - EXCISION OF CHALAZION; SINGLE
67801   - EXCISION OF CHALAZION; MULTIPLE, SAME LID
67805   - EXCISION OF CHALAZION; MULTIPLE, DIFFERENT LIDS
67808   - EXCISION OF CHALAZION; UNDER GENERAL ANESTHESIA AND/OR REQUIRING
67810   - BIOPSY OF EYELID
67820   - CORRECTION OF TRICHIASIS; EPILATION, BY FORCEPS ONLY



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                                     Surgery (triggers bundling)


67825   - CORRECTION OF TRICHIASIS; EPILATION BY OTHER THAN FORCEPS (EG, BY
67830   - CORRECTION OF TRICHIASIS; INCISION OF LID MARGIN
67835   - CORRECTION OF TRICHIASIS; INCISION OF LID MARGIN, WITH FREE MUCOUS MEMBRANE
67840   - EXCISION OF LESION OF EYELID (EXCEPT CHALAZION) WITHOUT CLOSURE OR WITH SIMPLE
67850   - DESTRUCTION OF LESION OF LID MARGIN (UP TO 1 CM)
67875   - TEMPORARY CLOSURE OF EYELIDS BY SUTURE (EG, FROST SUTURE)
67880   - CONSTRUCTION OF INTERMARGINAL ADHESIONS, MEDIAN TARSORRHAPHY, OR CANTHORRHAPHY;
67882   - CONSTRUCTION OF INTERMARGINAL ADHESIONS, MEDIAN TARSORRHAPHY, OR CANTHORRHAPHY;
67900   - REPAIR OF BROW PTOSIS (SUPRACILIARY, MID-FOREHEAD OR CORONAL APPROACH)
67901   - REPAIR OF BLEPHAROPTOSIS; FRONTALIS MUSCLE TECHNIQUE WITH SUTURE OR OTHER MATERI
67902   - REPAIR OF BLEPHAROPTOSIS; FRONTALIS MUSCLE TECHNIQUE WITH AUTOLOGOUS FASCIAL SLI
67903   - REPAIR OF BLEPHAROPTOSIS; (TARSO) LEVATOR RESECTION OR ADVANCEMENT, INTERNAL
67904   - REPAIR OF BLEPHAROPTOSIS; (TARSO) LEVATOR RESECTION OR ADVANCEMENT, EXTERNAL
67906   - REPAIR OF BLEPHAROPTOSIS; SUPERIOR RECTUS TECHNIQUE WITH FASCIAL SLING
67908   - REPAIR OF BLEPHAROPTOSIS; CONJUNCTIVO-TARSO-MULLER'S MUSCLE-LEVATOR RESECTION
67909   - REDUCTION OF OVERCORRECTION OF PTOSIS
67911   - CORRECTION OF LID RETRACTION
67912   - CORRECTION OF LAGOPHTHALMOS, WITH IMPLANTATION OF UPPER EYELID LID LOAD (EG,
67914   - REPAIR OF ECTROPION; SUTURE
67915   - REPAIR OF ECTROPION; THERMOCAUTERIZATION
67916   - REPAIR OF ECTROPION; EXCISION TARSAL WEDGE
67917   - REPAIR OF ECTROPION; EXTENSIVE (EG, TARSAL STRIP OPERATIONS)
67921   - REPAIR OF ENTROPION; SUTURE
67922   - REPAIR OF ENTROPION; THERMOCAUTERIZATION
67923   - REPAIR OF ENTROPION; EXCISION TARSAL WEDGE
67924   - REPAIR OF ENTROPION; EXTENSIVE (EG, TARSAL STRIP OR CAPSULOPALPEBRAL FASCIA
67930   - SUTURE OF RECENT WOUND, EYELID, INVOLVING LID MARGIN, TARSUS, AND/OR PALPEBRAL C
67935   - SUTURE OF RECENT WOUND, EYELID, INVOLVING LID MARGIN, TARSUS, AND/OR PALPEBRAL
67938   - REMOVAL OF EMBEDDED FOREIGN BODY, EYELID
67950   - CANTHOPLASTY (RECONSTRUCTION OF CANTHUS)
67961   - EXCISION AND REPAIR OF EYELID, INVOLVING LID MARGIN, TARSUS, CONJUNCTIVA,
67966   - EXCISION AND REPAIR OF EYELID, INVOLVING LID MARGIN, TARSUS, CONJUNCTIVA,
67971   - RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OF TARSOCONJUNCTIVAL FLAP
67973   - RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OF TARSOCONJUNCTIVAL FLAP
67974   - RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OF TARSOCONJUNCTIVAL FLAP
67975   - RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OF TARSOCONJUNCTIVAL FLAP
67999   - UNLISTED PROCEDURE, EYELIDS
68020   - INCISION OF CONJUNCTIVA, DRAINAGE OF CYST
68040   - EXPRESSION OF CONJUNCTIVAL FOLLICLES (EG, FOR TRACHOMA)
68100   - BIOPSY OF CONJUNCTIVA
68110   - EXCISION OF LESION, CONJUNCTIVA; UP TO 1 CM
68115   - EXCISION OF LESION, CONJUNCTIVA; OVER 1 CM
68130   - EXCISION OF LESION, CONJUNCTIVA; WITH ADJACENT SCLERA
68135   - DESTRUCTION OF LESION, CONJUNCTIVA
68200   - SUBCONJUNCTIVAL INJECTION
68320   - CONJUNCTIVOPLASTY; WITH CONJUNCTIVAL GRAFT OR EXTENSIVE REARRANGEMENT
68325   - CONJUNCTIVOPLASTY; WITH BUCCAL MUCOUS MEMBRANE GRAFT (INCLUDES OBTAINING GRAFT)
68326   - CONJUNCTIVOPLASTY, RECONSTRUCTION CUL-DE-SAC; WITH CONJUNCTIVAL GRAFT OR
68328   - CONJUNCTIVOPLASTY, RECONSTRUCTION CUL-DE-SAC; WITH BUCCAL MUCOUS MEMBRANE GRAFT
68330   - REPAIR OF SYMBLEPHARON; CONJUNCTIVOPLASTY, WITHOUT GRAFT
68335   - REPAIR OF SYMBLEPHARON; WITH FREE GRAFT CONJUNCTIVA OR BUCCAL MUCOUS MEMBRANE
68340   - REPAIR OF SYMBLEPHARON; DIVISION OF SYMBLEPHARON, WITH OR WITHOUT INSERTION OF
68360   - CONJUNCTIVAL FLAP; BRIDGE OR PARTIAL (SEPARATE PROCEDURE)
68362   - CONJUNCTIVAL FLAP; TOTAL (SUCH AS GUNDERSON THIN FLAP OR PURSE STRING FLAP)
68371   - HARVESTING CONJUNCTIVAL ALLOGRAFT, LIVING DONOR



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68399   - UNLISTED PROCEDURE, CONJUNCTIVA
68400   - INCISION, DRAINAGE OF LACRIMAL GLAND
68420   - INCISION, DRAINAGE OF LACRIMAL SAC (DACRYOCYSTOTOMY OR DACRYOCYSTOSTOMY)
68440   - SNIP INCISION OF LACRIMAL PUNCTUM
68500   - EXCISION OF LACRIMAL GLAND (DACRYOADENECTOMY), EXCEPT FOR TUMOR; TOTAL
68505   - EXCISION OF LACRIMAL GLAND (DACRYOADENECTOMY), EXCEPT FOR TUMOR; PARTIAL
68510   - BIOPSY OF LACRIMAL GLAND
68520   - EXCISION OF LACRIMAL SAC (DACRYOCYSTECTOMY)
68525   - BIOPSY OF LACRIMAL SAC
68530   - REMOVAL OF FOREIGN BODY OR DACRYOLITH, LACRIMAL PASSAGES
68540   - EXCISION OF LACRIMAL GLAND TUMOR; FRONTAL APPROACH
68550   - EXCISION OF LACRIMAL GLAND TUMOR; INVOLVING OSTEOTOMY
68700   - PLASTIC REPAIR OF CANALICULI
68705   - CORRECTION OF EVERTED PUNCTUM, CAUTERY
68720   - DACRYOCYSTORHINOSTOMY (FISTULIZATION OF LACRIMAL SAC TO NASAL CAVITY)
68745   - CONJUNCTIVORHINOSTOMY (FISTULIZATION OF CONJUNCTIVA TO NASAL CAVITY); WITHOUT
68750   - CONJUNCTIVORHINOSTOMY (FISTULIZATION OF CONJUNCTIVA TO NASAL CAVITY); WITH
68760   - CLOSURE OF THE LACRIMAL PUNCTUM; BY THERMOCAUTERIZATION, LIGATION, OR LASER
68761   - CLOSURE OF THE LACRIMAL PUNCTUM; BY PLUG, EACH
68770   - CLOSURE OF LACRIMAL FISTULA (SEPARATE PROCEDURE)
68801   - DILATION OF LACRIMAL PUNCTUM, WITH OR WITHOUT IRRIGATION
68810   - PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION;
68811   - PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION; REQUIRING GENERAL
68815   - PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION; WITH INSERTION OF
68816   - PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION; WITH TRANSLUMINAL BALL
68840   - PROBING OF LACRIMAL CANALICULI, WITH OR WITHOUT IRRIGATION
68899   - UNLISTED PROCEDURE, LACRIMAL SYSTEM
69000   - DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA; SIMPLE
69005   - DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA; COMPLICATED
69020   - DRAINAGE EXTERNAL AUDITORY CANAL, ABSCESS
69100   - BIOPSY EXTERNAL EAR
69105   - BIOPSY EXTERNAL AUDITORY CANAL
69110   - EXCISION EXTERNAL EAR; PARTIAL, SIMPLE REPAIR
69120   - EXCISION EXTERNAL EAR; COMPLETE AMPUTATION
69140   - EXCISION EXOSTOSIS(ES), EXTERNAL AUDITORY CANAL
69145   - EXCISION SOFT TISSUE LESION, EXTERNAL AUDITORY CANAL
69150   - RADICAL EXCISION EXTERNAL AUDITORY CANAL LESION; WITHOUT NECK DISSECTION
69220   - DEBRIDEMENT, MASTOIDECTOMY CAVITY, SIMPLE (EG, ROUTINE CLEANING)
69222   - DEBRIDEMENT, MASTOIDECTOMY CAVITY, COMPLEX (EG, WITH ANESTHESIA OR MORE THAN
69300   - OTOPLASTY, PROTRUDING EAR, WITH OR WITHOUT SIZE REDUCTION
69310   - RECONSTRUCTION OF EXTERNAL AUDITORY CANAL (MEATOPLASTY) (EG, FOR STENOSIS DUE
69320   - RECONSTRUCTION EXTERNAL AUDITORY CANAL FOR CONGENITAL ATRESIA, SINGLE STAGE
69399   - UNLISTED PROCEDURE, EXTERNAL EAR
69400   - EUSTACHIAN TUBE INFLATION, TRANSNASAL; WITH CATHETERIZATION
69401   - EUSTACHIAN TUBE INFLATION, TRANSNASAL; WITHOUT CATHETERIZATION
69405   - EUSTACHIAN TUBE CATHETERIZATION, TRANSTYMPANIC
69420   - MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN TUBE INFLATION
69421   - MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN TUBE INFLATION REQUIRING
69424   - VENTILATING TUBE REMOVAL REQUIRING GENERAL ANESTHESIA
69433   - TYMPANOSTOMY (REQUIRING INSERTION OF VENTILATING TUBE), LOCAL OR TOPICAL
69436   - TYMPANOSTOMY (REQUIRING INSERTION OF VENTILATING TUBE), GENERAL ANESTHESIA
69440   - MIDDLE EAR EXPLORATION THROUGH POSTAURICULAR OR EAR CANAL INCISION
69450   - TYMPANOLYSIS, TRANSCANAL
69501   - TRANSMASTOID ANTROTOMY (''SIMPLE'' MASTOIDECTOMY)
69502   - MASTOIDECTOMY; COMPLETE



                                              Page 138
                                     Surgery (triggers bundling)


69505   - MASTOIDECTOMY; MODIFIED RADICAL
69511   - MASTOIDECTOMY; RADICAL
69530   - PETROUS APICECTOMY INCLUDING RADICAL MASTOIDECTOMY
69540   - EXCISION AURAL POLYP
69550   - EXCISION AURAL GLOMUS TUMOR; TRANSCANAL
69552   - EXCISION AURAL GLOMUS TUMOR; TRANSMASTOID
69601   - REVISION MASTOIDECTOMY; RESULTING IN COMPLETE MASTOIDECTOMY
69602   - REVISION MASTOIDECTOMY; RESULTING IN MODIFIED RADICAL MASTOIDECTOMY
69603   - REVISION MASTOIDECTOMY; RESULTING IN RADICAL MASTOIDECTOMY
69604   - REVISION MASTOIDECTOMY; RESULTING IN TYMPANOPLASTY
69605   - REVISION MASTOIDECTOMY; WITH APICECTOMY
69610   - TYMPANIC MEMBRANE REPAIR, WITH OR WITHOUT SITE PREPARATION OF PERFORATION FOR
69620   - MYRINGOPLASTY (SURGERY CONFINED TO DRUMHEAD AND DONOR AREA)
69631   - TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, ATTICOTOMY AND/OR
69632   - TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, ATTICOTOMY AND/OR
69633   - TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, ATTICOTOMY AND/OR
69635   - TYMPANOPLASTY WITH ANTROTOMY OR MASTOIDOTOMY (INCLUDING CANALPLASTY,
69636   - TYMPANOPLASTY WITH ANTROTOMY OR MASTOIDOTOMY (INCLUDING CANALPLASTY,
69637   - TYMPANOPLASTY WITH ANTROTOMY OR MASTOIDOTOMY (INCLUDING CANALPLASTY,
69641   - TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY,
69642   - TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY,
69643   - TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY,
69644   - TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY,
69645   - TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY,
69646   - TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY,
69650   - STAPES MOBILIZATION
69660   - STAPEDECTOMY OR STAPEDOTOMY WITH REESTABLISHMENT OF OSSICULAR CONTINUITY, WITH
69661   - STAPEDECTOMY OR STAPEDOTOMY WITH REESTABLISHMENT OF OSSICULAR CONTINUITY, WITH
69662   - REVISION OF STAPEDECTOMY OR STAPEDOTOMY
69666   - REPAIR OVAL WINDOW FISTULA
69667   - REPAIR ROUND WINDOW FISTULA
69670   - MASTOID OBLITERATION (SEPARATE PROCEDURE)
69676   - TYMPANIC NEURECTOMY
69700   - CLOSURE POSTAURICULAR FISTULA, MASTOID (SEPARATE PROCEDURE)
69711   - REMOVAL OR REPAIR OF ELECTROMAGNETIC BONE CONDUCTION HEARING DEVICE IN TEMPORAL
69714   - IMPLANTATION, OSSEOINTEGRATED IMPLANT, TEMPORAL BONE, WITH PERCUTANEOUS
69715   - IMPLANTATION, OSSEOINTEGRATED IMPLANT, TEMPORAL BONE, WITH PERCUTANEOUS
69717   - REPLACEMENT (INCLUDING REMOVAL OF EXISTING DEVICE), OSSEOINTEGRATED IMPLANT,
69718   - REPLACEMENT (INCLUDING REMOVAL OF EXISTING DEVICE), OSSEOINTEGRATED IMPLANT,
69720   - DECOMPRESSION FACIAL NERVE, INTRATEMPORAL; LATERAL TO GENICULATE GANGLION
69725   - DECOMPRESSION FACIAL NERVE, INTRATEMPORAL; INCLUDING MEDIAL TO GENICULATE
69740   - SUTURE FACIAL NERVE, INTRATEMPORAL, WITH OR WITHOUT GRAFT OR DECOMPRESSION;
69745   - SUTURE FACIAL NERVE, INTRATEMPORAL, WITH OR WITHOUT GRAFT OR DECOMPRESSION;
69799   - UNLISTED PROCEDURE, MIDDLE EAR
69801   - LABYRINTHOTOMY, WITH OR WITHOUT CRYOSURGERY INCLUDING OTHER NONEXCISIONAL DESTRU
69802   - LABYRINTHOTOMY, WITH OR WITHOUT CRYOSURGERY INCLUDING OTHER NONEXCISIONAL
69805   - ENDOLYMPHATIC SAC OPERATION; WITHOUT SHUNT
69806   - ENDOLYMPHATIC SAC OPERATION; WITH SHUNT
69820   - FENESTRATION SEMICIRCULAR CANAL
69840   - REVISION FENESTRATION OPERATION
69905   - LABYRINTHECTOMY; TRANSCANAL
69910   - LABYRINTHECTOMY; WITH MASTOIDECTOMY
69915   - VESTIBULAR NERVE SECTION, TRANSLABYRINTHINE APPROACH
69930   - COCHLEAR DEVICE IMPLANTATION, WITH OR WITHOUT MASTOIDECTOMY
69949   - UNLISTED PROCEDURE, INNER EAR



                                             Page 139
                                  Surgery (triggers bundling)


69955 - TOTAL FACIAL NERVE DECOMPRESSION AND/OR REPAIR (MAY INCLUDE GRAFT)
69960 - DECOMPRESSION INTERNAL AUDITORY CANAL
69979 - UNLISTED PROCEDURE, TEMPORAL BONE, MIDDLE FOSSA APPROACH
75572 - Computed tomography, heart, with contrast material, for evaluation of cardiac st
75573 - Computed tomography, heart, with contrast material, for evaluation of cardiac st
75574 - Computed tomographic angiography, heart, coronary arteries and bypass grafts (wh
76881 - Ultrasound, extremity, nonvascular, real-time with image documentation; complete
76882 - Ultrasound, extremity, nonvascular, real-time with image documentation; limited,
76936 - ULTRASOUND GUIDED COMPRESSION REPAIR OF ARTERIAL PSEUDOANEURYSM OR
77785 - Remote afterloading high dose rate radionuclide brachytherapy; 1 channel
77786 - Remote afterloading high dose rate radionuclide brachytherapy; 2 - 12 channels
77787 - Remote afterloading high dose rate radionuclide brachytherapy; over 12 channels
78451 - Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correct
78452 - Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correct
78453 - Myocardial perfusion imaging, planar (including qualitative or quantitative wall
78454 - Myocardial perfusion imaging, planar (including qualitative or quantitative wall
91110 - GASTROINTESTINAL TRACT IMAGING, INTRALUMINAL (EG, CAPSULE ENDOSCOPY), ESOPHAGUS
91117 - Colon motility (manometric) study, minimum 6 hours continuous recording (includi
91120 - RECTAL SENSATION, TONE, AND COMPLIANCE TEST (IE, RESPONSE TO GRADED BALLOON
91122 - ANORECTAL MANOMETRY
92018 - OPHTHALMOLOGICAL EXAMINATION AND EVALUATION, UNDER GENERAL ANESTHESIA, WITH OR
92019 - OPHTHALMOLOGICAL EXAMINATION AND EVALUATION, UNDER GENERAL ANESTHESIA, WITH OR
92020 - GONIOSCOPY (SEPARATE PROCEDURE)
92060 - SENSORIMOTOR EXAMINATION WITH MULTIPLE MEASUREMENTS OF OCULAR DEVIATION (EG,
92065 - ORTHOPTIC AND/OR PLEOPTIC TRAINING, WITH CONTINUING MEDICAL DIRECTION AND
92081 - VISUAL FIELD EXAMINATION, UNILATERAL OR BILATERAL, WITH INTERPRETATION AND
92082 - VISUAL FIELD EXAMINATION, UNILATERAL OR BILATERAL, WITH INTERPRETATION AND
92083 - VISUAL FIELD EXAMINATION, UNILATERAL OR BILATERAL, WITH INTERPRETATION AND
92120 - TONOGRAPHY WITH INTERPRETATION AND REPORT, RECORDING INDENTATION TONOMETER
92130 - TONOGRAPHY WITH WATER PROVOCATION
92132 - Scanning computerized ophthalmic diagnostic imaging, anterior segment, with inte
92133 - Scanning, computerized ophthalmic diagnostic imaging, posterior segment, with in
92134 - Scanning, computerized ophthalmic diagnostic imaging, posterior segment, with in
92135 - SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGING, POSTERIOR SEGMENT, (EG, SCA
92136 - OPHTHALMIC BIOMETRY BY PARTIAL COHERENCE INTERFEROMETRY WITH INTRAOCULAR LENS
92140 - PROVOCATIVE TESTS FOR GLAUCOMA, WITH INTERPRETATION AND REPORT, WITHOUT
92225 - OPHTHALMOSCOPY, EXTENDED, WITH RETINAL DRAWING (EG, FOR RETINAL DETACHMENT, MELA
92226 - OPHTHALMOSCOPY, EXTENDED, WITH RETINAL DRAWING (EG, FOR RETINAL DETACHMENT,
92230 - FLUORESCEIN ANGIOSCOPY WITH INTERPRETATION AND REPORT
92235 - FLUORESCEIN ANGIOGRAPHY (INCLUDES MULTIFRAME IMAGING) WITH INTERPRETATION AND
92240 - INDOCYANINE-GREEN ANGIOGRAPHY (INCLUDES MULTIFRAME IMAGING) WITH INTERPRETATION
92250 - FUNDUS PHOTOGRAPHY WITH INTERPRETATION AND REPORT
92260 - OPHTHALMODYNAMOMETRY
92265 - NEEDLE OCULOELECTROMYOGRAPHY, ONE OR MORE EXTRAOCULAR MUSCLES, ONE OR BOTH EYES,
92270 - ELECTRO-OCULOGRAPHY WITH INTERPRETATION AND REPORT
92275 - ELECTRORETINOGRAPHY WITH INTERPRETATION AND REPORT
92283 - COLOR VISION EXAMINATION, EXTENDED, EG, ANOMALOSCOPE OR EQUIVALENT
92284 - DARK ADAPTATION EXAMINATION WITH INTERPRETATION AND REPORT
92285 - EXTERNAL OCULAR PHOTOGRAPHY WITH INTERPRETATION AND REPORT FOR DOCUMENTATION OF
92286 - SPECIAL ANTERIOR SEGMENT PHOTOGRAPHY WITH INTERPRETATION AND REPORT; WITH
92287 - SPECIAL ANTERIOR SEGMENT PHOTOGRAPHY WITH INTERPRETATION AND REPORT; WITH
92499 - UNLISTED OPHTHALMOLOGICAL SERVICE OR PROCEDURE
92502 - OTOLARYNGOLOGIC EXAMINATION UNDER GENERAL ANESTHESIA
92511 - NASOPHARYNGOSCOPY WITH ENDOSCOPE (SEPARATE PROCEDURE)
92950 - CARDIOPULMONARY RESUSCITATION (EG, IN CARDIAC ARREST)



                                          Page 140
                                   Surgery (triggers bundling)


92953 - TEMPORARY TRANSCUTANEOUS PACING
92973 - PERCUTANEOUS TRANSLUMINAL CORONARY THROMBECTOMY (LIST SEPARATELY IN ADDITION TO
92974 - TRANSCATHETER PLACEMENT OF RADIATION DELIVERY DEVICE FOR SUBSEQUENT CORONARY
92977 - THROMBOLYSIS, CORONARY; BY INTRAVENOUS INFUSION
92980 - TRANSCATHETER PLACEMENT OF AN INTRACORONARY STENT(S), PERCUTANEOUS, WITH OR
92981 - TRANSCATHETER PLACEMENT OF AN INTRACORONARY STENT(S), PERCUTANEOUS, WITH OR
92982 - PERCUTANEOUS TRANSLUMINAL CORONARY BALLOON ANGIOPLASTY; SINGLE VESSEL
92984 - PERCUTANEOUS TRANSLUMINAL CORONARY BALLOON ANGIOPLASTY; EACH ADDITIONAL VESSEL
92986 - PERCUTANEOUS BALLOON VALVULOPLASTY; AORTIC VALVE
92987 - PERCUTANEOUS BALLOON VALVULOPLASTY; MITRAL VALVE
92990 - PERCUTANEOUS BALLOON VALVULOPLASTY; PULMONARY VALVE
92995 - PERCUTANEOUS TRANSLUMINAL CORONARY ATHERECTOMY, BY MECHANICAL OR OTHER METHOD,
92996 - PERCUTANEOUS TRANSLUMINAL CORONARY ATHERECTOMY, BY MECHANICAL OR OTHER METHOD,
92997 - PERCUTANEOUS TRANSLUMINAL PULMONARY ARTERY BALLOON ANGIOPLASTY; SINGLE VESSEL
92998 - PERCUTANEOUS TRANSLUMINAL PULMONARY ARTERY BALLOON ANGIOPLASTY; EACH ADDITIONAL
93229 - Wearable mobile cardiovascular telemetry with electrocardiographic recording, co
93279 - PROGRAMMING DEVICE EVALUATION (IN PERSON) WITH ITERATIVE ADJUSTMENT OF THE IMPLA
93280 - PROGRAMMING DEVICE EVALUATION (IN PERSON) WITH ITERATIVE ADJUSTMENT OF THE IMPLA
93281 - PROGRAMMING DEVICE EVALUATION (IN PERSON) WITH ITERATIVE ADJUSTMENT OF THE IMPLA
93282 - PROGRAMMING DEVICE EVALUATION (IN PERSON) WITH ITERATIVE ADJUSTMENT OF THE IMPLA
93283 - PROGRAMMING DEVICE EVALUATION (IN PERSON) WITH ITERATIVE ADJUSTMENT OF THE IMPLA
93284 - PROGRAMMING DEVICE EVALUATION (IN PERSON) WITH ITERATIVE ADJUSTMENT OF THE IMPLA
93285 - PROGRAMMING DEVICE EVALUATION (IN PERSON) WITH ITERATIVE ADJUSTMENT OF THE IMPLA
93288 - Interrogation device evaluation (in person) with physician analysis, review and
93289 - Interrogation device evaluation (in person) with physician analysis, review and
93290 - Interrogation device evaluation (in person) with physician analysis, review and
93291 - Interrogation device evaluation (in person) with physician analysis, review and
93292 - Interrogation device evaluation (in person) with physician analysis, review and
93293 - Transtelephonic rhythm strip pacemaker evaluation(s) single, dual, or multiple l
93296 - Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or mul
93299 - Interrogation device evaluation(s), (remote) up to 30 days: implantable cardiova
93306 - Echocardiography, transthoracic real-time with image documentation (2D), includi
93351 - Echocardiography, transthoracic, real-time with image documentation (2D), with o
93451 - Right heart catheterization including measurement(s) of oxygen saturation and ca
93452 - Left heart catheterization including intraprocedural injection(s) for left ventr
93453 - Combined right and left heart catheterization including intraprocedural injectio
93454 - Catheter placement in coronary artery(s) for coronary angiography, including int
93455 - Catheter placement in coronary artery(s) for coronary angiography, including int
93456 - Catheter placement in coronary artery(s) for coronary angiography, including int
93457 - Catheter placement in coronary artery(s) for coronary angiography, including int
93458 - Catheter placement in coronary artery(s) for coronary angiography, including int
93459 - Catheter placement in coronary artery(s) for coronary angiography, including int
93460 - Catheter placement in coronary artery(s) for coronary angiography, including int
93461 - Catheter placement in coronary artery(s) for coronary angiography, including int
93462 - Left heart catheterization by transseptal puncture through intact septum or by t
93501 - RIGHT HEART CATHETERIZATION
93503 - INSERTION AND PLACEMENT OF FLOW DIRECTED CATHETER (EG, SWAN-GANZ) FOR
93505 - ENDOMYOCARDIAL BIOPSY
93508 - CATHETER PLACEMENT IN CORONARY ARTERY(S), ARTERIAL CORONARY CONDUIT(S), AND/OR V
93510 - LEFT HEART CATHETERIZATION, RETROGRADE, FROM THE BRACHIAL ARTERY, AXILLARY ARTER
93511 - LEFT HEART CATHETERIZATION, RETROGRADE, FROM THE BRACHIAL ARTERY, AXILLARY ARTER
93514 - LEFT HEART CATHETERIZATION BY LEFT VENTRICULAR PUNCTURE
93524 - COMBINED TRANSSEPTAL AND RETROGRADE LEFT HEART CATHETERIZATION
93526 - COMBINED RIGHT HEART CATHETERIZATION AND RETROGRADE LEFT HEART CATHETERIZATION
93527 - COMBINED RIGHT HEART CATHETERIZATION AND TRANSSEPTAL LEFT HEART CATHETERIZATION



                                           Page 141
                                  Surgery (triggers bundling)


93528 - COMBINED RIGHT HEART CATHETERIZATION WITH LEFT VENTRICULAR PUNCTURE (WITH OR WIT
93529 - COMBINED RIGHT HEART CATHETERIZATION AND LEFT HEART CATHETERIZATION THROUGH EXIS
93530 - RIGHT HEART CATHETERIZATION, FOR CONGENITAL CARDIAC ANOMALIES
93531 - COMBINED RIGHT HEART CATHETERIZATION AND RETROGRADE LEFT HEART CATHETERIZATION,
93532 - COMBINED RIGHT HEART CATHETERIZATION AND TRANSSEPTAL LEFT HEART CATHETERIZATION
93533 - COMBINED RIGHT HEART CATHETERIZATION AND TRANSSEPTAL LEFT HEART CATHETERIZATION
93580 - PERCUTANEOUS TRANSCATHETER CLOSURE OF CONGENITAL INTERATRIAL COMMUNICATION (IE,
93581 - PERCUTANEOUS TRANSCATHETER CLOSURE OF A CONGENITAL VENTRICULAR SEPTAL DEFECT
93600 - BUNDLE OF HIS RECORDING
93602 - INTRA-ATRIAL RECORDING
93603 - RIGHT VENTRICULAR RECORDING
93610 - INTRA-ATRIAL PACING
93612 - INTRAVENTRICULAR PACING
93615 - ESOPHAGEAL RECORDING OF ATRIAL ELECTROGRAM WITH OR WITHOUT VENTRICULAR
93616 - ESOPHAGEAL RECORDING OF ATRIAL ELECTROGRAM WITH OR WITHOUT VENTRICULAR
93618 - INDUCTION OF ARRHYTHMIA BY ELECTRICAL PACING
93750 - Interrogation of ventricular assist device (VAD), in person, with physician anal
94060 - BRONCHODILATION RESPONSIVENESS, SPIROMETRY AS IN 94010, PRE- AND
95803 - Actigraphy testing, recording analysis, interpretation, and report (minimum of 7
95905 - Motor and/or sensory nerve conduction, using preconfigured electrode array(s), a
95990 - REFILLING AND MAINTENANCE OF IMPLANTABLE PUMP OR RESERVOIR FOR DRUG DELIVERY, SP
95991 - REFILLING AND MAINTENANCE OF IMPLANTABLE PUMP OR RESERVOIR FOR DRUG DELIVERY,
96446 - Chemotherapy administration into the peritoneal cavity via indwelling port or ca
96567 - PHOTODYNAMIC THERAPY BY EXTERNAL APPLICATION OF LIGHT TO DESTROY PREMALIGNANT AN
96570 - PHOTODYNAMIC THERAPY BY ENDOSCOPIC APPLICATION OF LIGHT TO ABLATE ABNORMAL TISSU
96571 - PHOTODYNAMIC THERAPY BY ENDOSCOPIC APPLICATION OF LIGHT TO ABLATE ABNORMAL TISSU
96920 - LASER TREATMENT FOR INFLAMMATORY SKIN DISEASE (PSORIASIS); TOTAL AREA LESS THAN
96921 - LASER TREATMENT FOR INFLAMMATORY SKIN DISEASE (PSORIASIS); 250 SQ CM TO 500 SQ
96922 - LASER TREATMENT FOR INFLAMMATORY SKIN DISEASE (PSORIASIS); OVER 500 SQ CM
96999 - UNLISTED SPECIAL DERMATOLOGICAL SERVICE OR PROCEDURE
99170 - ANOGENITAL EXAMINATION WITH COLPOSCOPIC MAGNIFICATION IN CHILDHOOD FOR SUSP TRAU
99291 - CRITICAL CARE, EVALUATION AND MANAGEMENT OF THE CRITICALLY ILL OR CRITICALLY INJ
0234T - Transluminal peripheral atherectomy, open or percutaneous, including radiologica
0236T - Transluminal peripheral atherectomy, open or percutaneous, including radiologica
0237T - Transluminal peripheral atherectomy, open or percutaneous, including radiologica
0238T - Transluminal peripheral atherectomy, open or percutaneous, including radiologica
0245T - Open treatment of rib fracture requiring internal fixation, unilateral; 1-2 ribs
0246T - Open treatment of rib fracture requiring internal fixation, unilateral; 3-4 ribs
0247T - Open treatment of rib fracture requiring internal fixation, unilateral; 5-6 ribs
0248T - Open treatment of rib fracture requiring internal fixation, unilateral; 7 or mor
0249T - Ligation, hemorrhoidal vascular bundle(s), including ultrasound guidance
0251T - Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed
0252T - Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed
0253T - Insertion of anterior segment aqueous drainage device, without extraocular reser
C8929 - TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WI
C8930 - TRANSTHORACIC ECHOCARDIOGRAPHY, WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY W
G0105 - COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK
G0117 - GLAUCOMA SCREENING FOR HIGH RISK PATIENTS FURNISHED BY AN OPTOMETRIST OR
G0118 - GLAUCOMA SCREENING FOR HIGH RISK PATIENT FURNISHED UNDER THE DIRECT SUPERVISION
G0121 - COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR
G0127 - TRIMMING OF DYSTROPHIC NAILS, ANY NUMBER
G0166 - EXTERNAL COUNTERPULSATION, PER TREATMENT SESSION
G0186 - DESTRUCTION OF LOCALIZED LESION OF CHOROID (FOR EXAMPLE, CHOROIDAL
G0247 - ROUTINE FOOT CARE BY A PHYSICIAN OF A DIABETIC PATIENT WITH DIABETIC SENSORY
G0260 - INJECTION PROCEDURE FOR SACROILIAC JOINT; PROVISION OF ANESTHETIC, STEROID



                                          Page 142
                                     Surgery (triggers bundling)


G0290   - TRANSCATHETER PLACEMENT OF A DRUG ELUTING INTRACORONARY STENT(S), PERCUTANEOUS,
G0291   - TRANSCATHETER PLACEMENT OF A DRUG ELUTING INTRACORONARY STENT(S), PERCUTANEOUS,
G0340   - IMAGE-GUIDED ROBOTIC LINEAR ACCELERATOR-BASED STEROTACTIC RADIOSURGERY,
C9729   - PERCUT LAMINOT/LAMINECT (INTRALAM APPR) FOR DECOMP




                                             Page 143
                         Surgery (triggers bundling)


    RATE    Eff Date
   $56.44   04/01/2011
  $151.59   04/01/2011
  $116.57   04/01/2011
  $116.57   04/01/2011
  $116.57   04/01/2011
  $146.74   04/01/2011
  $196.86   04/01/2011
  $879.68   04/01/2011
  $146.74   04/01/2011
  $116.57   04/01/2011
$1,143.80   04/01/2011
  $153.69   04/01/2011
  $173.31   04/01/2011
  $656.77   04/01/2011
  $656.77   04/01/2011
  $656.77   04/01/2011
  $153.69   04/01/2011
  $153.69   04/01/2011
  $196.86   04/01/2011
  $196.86   04/01/2011
  $787.35   04/01/2011
  $196.86   04/01/2011
  $196.86   04/01/2011
  $787.35   04/01/2011
  $173.31   04/01/2011
  $173.31   04/01/2011
  $173.31   04/01/2011
  $153.69   04/01/2011
  $173.31   04/01/2011
  $173.31   04/01/2011
  $173.31   04/01/2011
  $173.31   04/01/2011
  $173.31   04/01/2011
  $173.31   04/01/2011
  $153.69   04/01/2011
  $173.31   04/01/2011
  $173.31   04/01/2011
  $173.31   04/01/2011
  $173.31   04/01/2011
  $173.31   04/01/2011
  $173.31   04/01/2011
  $173.31   04/01/2011
  $173.31   04/01/2011
  $656.77   04/01/2011
  $656.77   04/01/2011
  $656.77   04/01/2011
  $787.35   04/01/2011
  $879.68   04/01/2011
  $879.68   04/01/2011
  $787.35   04/01/2011
  $787.35   04/01/2011
  $787.35   04/01/2011
  $879.68   04/01/2011
  $879.68   04/01/2011



                                 Page 144
                         Surgery (triggers bundling)


$1,144.56   04/01/2011
  $656.77   04/01/2011
  $656.77   04/01/2011
  $787.35   04/01/2011
  $787.35   04/01/2011
  $787.35   04/01/2011
$1,144.56   04/01/2011
$1,144.56   04/01/2011
$1,144.56   04/01/2011
$1,144.56   04/01/2011
$1,144.56   04/01/2011
$1,144.56   04/01/2011
$1,144.56   04/01/2011
  $787.35   04/01/2011
  $656.77   04/01/2011
  $656.77   04/01/2011
  $787.35   04/01/2011
  $787.35   04/01/2011
  $879.68   04/01/2011
  $787.35   04/01/2011
  $656.77   04/01/2011
  $787.35   04/01/2011
  $879.68   04/01/2011
  $879.68   04/01/2011
$1,144.56   04/01/2011
  $787.35   04/01/2011
  $787.35   04/01/2011
  $787.35   04/01/2011
  $787.35   04/01/2011
  $879.68   04/01/2011
$1,144.56   04/01/2011
   $90.41   04/01/2011
  $173.31   04/01/2011
  $173.31   04/01/2011
  $173.31   04/01/2011
  $173.31   04/01/2011
   $90.41   04/01/2011
  $656.77   04/01/2011
$1,144.56   04/01/2011
  $656.77   04/01/2011
   $78.27   04/01/2011
  $920.58   04/01/2011
  $173.31   04/01/2011
$1,144.56   04/01/2011
$1,144.56   04/01/2011
$1,144.56   04/01/2011
  $173.31   04/01/2011
  $173.31   04/01/2011
$1,236.37   04/01/2011
$1,144.56   04/01/2011
  $656.77   04/01/2011
   $78.27   04/01/2011
   $78.27   04/01/2011
   $78.27   04/01/2011
   $78.27   04/01/2011



                                 Page 145
                         Surgery (triggers bundling)


   $78.27   04/01/2011
   $78.27   04/01/2011
   $78.27   04/01/2011
   $78.27   04/01/2011
   $78.27   04/01/2011
   $78.27   04/01/2011
   $78.27   04/01/2011
   $78.27   04/01/2011
   $78.27   04/01/2011
  $276.94   04/01/2011
  $128.80   04/01/2011
   $78.27   04/01/2011
  $128.80   04/01/2011
   $78.27   04/01/2011
   $78.27   04/01/2011
  $128.80   04/01/2011
  $128.80   04/01/2011
   $78.27   04/01/2011
   $78.27   04/01/2011
   $78.27   04/01/2011
  $128.80   04/01/2011
  $128.80   04/01/2011
  $128.80   04/01/2011
   $78.27   04/01/2011
   $78.27   04/01/2011
   $78.27   04/01/2011
   $78.27   04/01/2011
  $128.80   04/01/2011
  $128.80   04/01/2011
  $128.80   04/01/2011
  $276.94   04/01/2011
  $276.94   04/01/2011
  $276.94   04/01/2011
  $128.80   04/01/2011
  $128.80   04/01/2011
   $78.27   04/01/2011
  $128.80   04/01/2011
  $276.94   04/01/2011
  $128.80   04/01/2011
  $276.94   04/01/2011
  $276.94   04/01/2011
  $276.94   04/01/2011
  $128.80   04/01/2011
$1,236.37   04/01/2011
  $920.58   04/01/2011
  $920.58   04/01/2011
  $920.58   04/01/2011
  $920.58   04/01/2011
  $920.58   04/01/2011
  $920.58   04/01/2011
  $920.58   04/01/2011
  $920.58   04/01/2011
$1,236.37   04/01/2011
$1,236.37   04/01/2011
$1,236.37   04/01/2011



                                 Page 146
                         Surgery (triggers bundling)


  $276.94   04/01/2011
  $276.94   04/01/2011
  $276.94   04/01/2011
  $276.94   04/01/2011
  $128.80   04/01/2011
  $276.94   04/01/2011
$1,236.37   04/01/2011
$1,236.37   04/01/2011
  $276.94   04/01/2011
  $276.94   04/01/2011
  $276.94   04/01/2011
  $276.94   04/01/2011
$1,236.37   04/01/2011
$1,236.37   04/01/2011
  $920.58   04/01/2011
  $920.58   04/01/2011
  $920.58   04/01/2011
  $920.58   04/01/2011
  $276.94   04/01/2011
  $276.94   04/01/2011
  $276.94   04/01/2011
  $276.94   04/01/2011
  $276.94   04/01/2011
  $276.94   04/01/2011
  $276.94   04/01/2011
  $128.80   04/01/2011
  $276.94   04/01/2011
  $276.94   04/01/2011
  $920.58   04/01/2011
  $920.58   04/01/2011
  $920.58   04/01/2011
  $276.94   04/01/2011
  $920.58   04/01/2011
  $276.94   04/01/2011
  $920.58   04/01/2011
  $920.58   04/01/2011
  $276.94   04/01/2011
  $276.94   04/01/2011
  $276.94   04/01/2011
  $276.94   04/01/2011
  $276.94   04/01/2011
  $276.94   04/01/2011
  $276.94   04/01/2011
  $276.94   04/01/2011
  $128.80   04/01/2011
  $128.80   04/01/2011
  $128.80   04/01/2011
  $128.80   04/01/2011
  $128.80   04/01/2011
  $128.80   04/01/2011
  $276.94   04/01/2011
  $276.94   04/01/2011
  $276.94   04/01/2011
  $276.94   04/01/2011
  $276.94   04/01/2011



                                 Page 147
                         Surgery (triggers bundling)


  $276.94   04/01/2011
$1,236.37   04/01/2011
$1,236.37   04/01/2011
$1,236.37   04/01/2011
$1,236.37   04/01/2011
$1,236.37   04/01/2011
$1,236.37   04/01/2011
$1,236.37   04/01/2011
$1,236.37   04/01/2011
$1,236.37   04/01/2011
$1,236.37   04/01/2011
$1,236.37   04/01/2011
$1,236.37   04/01/2011
$1,236.37   04/01/2011
$1,236.37   04/01/2011
  $920.58   04/01/2011
$1,236.37   04/01/2011
$1,236.37   04/01/2011
$1,236.37   04/01/2011
  $173.31   04/01/2011
  $153.69   04/01/2011
  $153.69   04/01/2011
  $173.31   04/01/2011
$1,236.37   04/01/2011
$1,144.56   04/01/2011
$1,236.37   04/01/2011
$1,236.37   04/01/2011
$1,236.37   04/01/2011
$1,236.37   04/01/2011
$1,144.56   04/01/2011
  $196.86   04/01/2011
  $196.86   04/01/2011
  $656.77   04/01/2011
$1,236.37   04/01/2011
$1,144.56   04/01/2011
$1,144.56   04/01/2011
$1,236.37   04/01/2011
$1,236.37   04/01/2011
  $920.58   04/01/2011
$1,236.37   04/01/2011
$1,144.56   04/01/2011
$1,144.56   04/01/2011
$1,236.37   04/01/2011
$1,236.37   04/01/2011
$1,236.37   04/01/2011
$1,144.56   04/01/2011
$1,144.56   04/01/2011
  $920.58   04/01/2011
  $920.58   04/01/2011
  $920.58   04/01/2011
  $920.58   04/01/2011
  $656.77   04/01/2011
  $173.31   04/01/2011
  $153.69   04/01/2011
  $153.69   04/01/2011



                                 Page 148
                         Surgery (triggers bundling)


  $153.69   04/01/2011
  $173.31   04/01/2011
   $90.41   04/01/2011
  $196.86   04/01/2011
  $196.86   04/01/2011
  $196.86   04/01/2011
  $196.86   04/01/2011
  $173.31   04/01/2011
  $153.69   04/01/2011
  $153.69   04/01/2011
  $153.69   04/01/2011
  $153.69   04/01/2011
  $153.69   04/01/2011
  $153.69   04/01/2011
  $153.69   04/01/2011
  $196.86   04/01/2011
  $153.69   04/01/2011
  $153.69   04/01/2011
  $153.69   04/01/2011
  $196.86   04/01/2011
  $196.86   04/01/2011
  $196.86   04/01/2011
  $153.69   04/01/2011
  $196.86   04/01/2011
  $196.86   04/01/2011
  $196.86   04/01/2011
  $196.86   04/01/2011
  $196.86   04/01/2011
  $248.37   04/01/2011
  $248.37   04/01/2011
  $248.37   04/01/2011
  $248.37   04/01/2011
  $248.37   04/01/2011
  $173.31   04/01/2011
   $90.41   04/01/2011
  $151.59   04/01/2011
   $56.44   04/01/2011
$1,143.80   04/01/2011
  $151.59   04/01/2011
$1,110.10   04/01/2011
  $220.95   04/01/2011
  $552.02   04/01/2011
$1,853.37   04/01/2011
$1,110.10   04/01/2011
$1,110.10   04/01/2011
$1,110.10   04/01/2011
$1,110.10   04/01/2011
$1,110.10   04/01/2011
  $879.68   04/01/2011
$3,067.09   04/01/2011
$3,067.09   04/01/2011
$3,067.09   04/01/2011
$1,110.10   04/01/2011
$1,110.10   04/01/2011
$2,321.09   04/01/2011



                                 Page 149
                         Surgery (triggers bundling)


$1,853.37   04/01/2011
$1,853.37   04/01/2011
$2,321.09   04/01/2011
$1,853.37   04/01/2011
$2,321.09   04/01/2011
$1,853.37   04/01/2011
$1,853.37   04/01/2011
$2,321.09   04/01/2011
$3,067.09   04/01/2011
$1,110.10   04/01/2011
$1,853.37   04/01/2011
$3,067.09   04/01/2011
$1,853.37   04/01/2011
$1,853.37   04/01/2011
$1,853.37   04/01/2011
$2,321.09   04/01/2011
$1,853.37   04/01/2011
$1,110.10   04/01/2011
  $116.57   04/01/2011
  $956.23   04/01/2011
  $542.55   04/01/2011
$1,236.37   04/01/2011
$1,236.37   04/01/2011
  $146.74   04/01/2011
$1,231.40   04/01/2011
  $879.68   04/01/2011
  $879.68   04/01/2011
  $220.95   04/01/2011
  $787.35   04/01/2011
  $879.68   04/01/2011
$1,144.56   04/01/2011
$1,144.56   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
  $542.55   04/01/2011
  $656.77   04/01/2011
$1,144.56   04/01/2011
  $201.09   04/01/2011
  $201.09   04/01/2011
  $201.09   04/01/2011
  $201.09   04/01/2011
  $201.09   04/01/2011
$1,453.61   04/01/2011
  $201.09   04/01/2011
  $201.09   04/01/2011
  $201.09   04/01/2011
  $201.09   04/01/2011
  $151.59   04/01/2011
  $956.23   04/01/2011
  $384.93   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
  $879.68   04/01/2011
$1,144.56   04/01/2011
$1,453.61   04/01/2011



                                 Page 150
                         Surgery (triggers bundling)


$1,453.61   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
$1,453.61   04/01/2011
$1,244.24   04/01/2011
$1,665.86   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,236.37   04/01/2011
$1,236.37   04/01/2011
  $920.58   04/01/2011
  $920.58   04/01/2011
$1,453.61   04/01/2011
  $276.94   04/01/2011
  $116.57   04/01/2011
$1,570.66   04/01/2011
$1,570.66   04/01/2011
$1,231.40   04/01/2011
  $956.23   04/01/2011
$1,313.37   04/01/2011
  $787.35   04/01/2011
  $787.35   04/01/2011
  $787.35   04/01/2011
  $787.35   04/01/2011
  $879.68   04/01/2011
$1,144.56   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
$1,952.62   04/01/2011
$1,313.37   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
  $542.55   04/01/2011
$1,313.37   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
  $928.01   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011



                                 Page 151
                         Surgery (triggers bundling)


  $195.16   04/01/2011
$1,952.62   04/01/2011
  $542.55   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
$1,952.62   04/01/2011
$1,313.37   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,313.37   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,313.37   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
  $928.01   04/01/2011
  $542.55   04/01/2011
$1,313.37   04/01/2011
  $195.16   04/01/2011
  $195.16   04/01/2011
  $928.01   04/01/2011
  $928.01   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
$1,500.48   04/01/2011
  $928.01   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011



                                 Page 152
                         Surgery (triggers bundling)


$1,952.62   04/01/2011
$1,313.37   04/01/2011
$1,952.62   04/01/2011
$1,313.37   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
  $542.55   04/01/2011
  $928.01   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
  $685.47   04/01/2011
  $542.55   04/01/2011
  $928.01   04/01/2011
$1,952.62   04/01/2011
$1,313.37   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
  $195.16   04/01/2011
  $928.01   04/01/2011
$1,952.62   04/01/2011
  $928.01   04/01/2011
  $928.01   04/01/2011
  $195.16   04/01/2011
$1,143.80   04/01/2011
  $956.23   04/01/2011
  $879.68   04/01/2011
$1,144.56   04/01/2011
$1,144.56   04/01/2011
  $879.68   04/01/2011
$1,144.56   04/01/2011
  $879.68   04/01/2011
$1,144.56   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
  $542.55   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
  $116.57   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
  $100.03   04/01/2011
$1,500.48   04/01/2011
  $100.03   04/01/2011
  $195.16   04/01/2011
  $787.35   04/01/2011
$1,144.56   04/01/2011
  $879.68   04/01/2011
$1,144.56   04/01/2011



                                 Page 153
                         Surgery (triggers bundling)


  $879.68   04/01/2011
$1,144.56   04/01/2011
  $879.68   04/01/2011
$1,144.56   04/01/2011
$2,515.43   04/01/2011
$2,515.43   04/01/2011
$2,515.43   04/01/2011
$2,515.43   04/01/2011
$2,515.43   04/01/2011
  $100.03   04/01/2011
  $384.93   04/01/2011
$1,244.24   04/01/2011
  $839.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,568.75   04/01/2011
$1,568.75   04/01/2011
$1,568.75   04/01/2011
$2,515.43   04/01/2011
$2,515.43   04/01/2011
  $956.23   04/01/2011
$1,144.56   04/01/2011
$1,144.56   04/01/2011
  $879.68   04/01/2011
$1,144.56   04/01/2011
  $879.68   04/01/2011
$1,144.56   04/01/2011
  $956.23   04/01/2011
  $879.68   04/01/2011
$1,231.40   04/01/2011
$1,143.80   04/01/2011
$1,143.80   04/01/2011
  $956.23   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
  $787.35   04/01/2011
$1,144.56   04/01/2011
$1,144.56   04/01/2011
$1,144.56   04/01/2011
  $879.68   04/01/2011
  $879.68   04/01/2011
  $879.68   04/01/2011
$1,144.56   04/01/2011
  $956.23   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,231.40   04/01/2011
  $956.23   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011



                                 Page 154
                         Surgery (triggers bundling)


$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
  $787.35   04/01/2011
$1,144.56   04/01/2011
$1,231.40   04/01/2011
$1,568.75   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,568.75   04/01/2011
$1,568.75   04/01/2011
$1,568.75   04/01/2011
$1,231.40   04/01/2011
$1,568.75   04/01/2011
$1,231.40   04/01/2011
$5,927.26   04/01/2011
$1,231.40   04/01/2011
$1,568.75   04/01/2011
$1,231.40   04/01/2011
$1,568.75   04/01/2011
  $100.03   04/01/2011
$1,244.24   04/01/2011
$3,363.29   04/01/2011
  $384.93   04/01/2011
  $384.93   04/01/2011
$2,206.54   04/01/2011
$1,500.48   04/01/2011
  $100.03   04/01/2011
  $384.93   04/01/2011
$2,206.54   04/01/2011
$2,206.54   04/01/2011
  $100.03   04/01/2011
  $384.93   04/01/2011
$3,363.29   04/01/2011
  $100.03   04/01/2011
$1,244.24   04/01/2011
$3,363.29   04/01/2011
$3,363.29   04/01/2011
  $100.03   04/01/2011
$1,244.24   04/01/2011



                                 Page 155
                         Surgery (triggers bundling)


$3,363.29   04/01/2011
  $100.03   04/01/2011
  $839.61   04/01/2011
$2,206.54   04/01/2011
  $384.93   04/01/2011
$3,363.29   04/01/2011
  $100.03   04/01/2011
$2,206.54   04/01/2011
  $839.61   04/01/2011
$1,568.75   04/01/2011
$1,231.40   04/01/2011
  $920.58   04/01/2011
  $100.03   04/01/2011
$1,143.80   04/01/2011
$1,143.80   04/01/2011
  $956.23   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
  $879.68   04/01/2011
  $879.68   04/01/2011
$1,144.56   04/01/2011
$1,144.56   04/01/2011
  $879.68   04/01/2011
  $879.68   04/01/2011
  $879.68   04/01/2011
$1,144.56   04/01/2011
  $956.23   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
  $956.23   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
  $656.77   04/01/2011
  $879.68   04/01/2011
  $839.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
  $956.23   04/01/2011



                                 Page 156
                         Surgery (triggers bundling)


$1,231.40   04/01/2011
$1,568.75   04/01/2011
$1,231.40   04/01/2011
  $956.23   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,453.61   04/01/2011
$1,568.75   04/01/2011
$1,453.61   04/01/2011
$1,231.40   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,834.68   04/01/2011
$5,927.26   04/01/2011
$2,387.09   04/01/2011
$5,927.26   04/01/2011
$1,834.68   04/01/2011
$5,927.26   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,568.75   04/01/2011
$1,568.75   04/01/2011
$1,231.40   04/01/2011
$1,453.61   04/01/2011
$1,568.75   04/01/2011
  $100.03   04/01/2011
  $100.03   04/01/2011
$3,363.29   04/01/2011
$3,363.29   04/01/2011
  $100.03   04/01/2011
  $384.93   04/01/2011
$1,500.48   04/01/2011
$3,363.29   04/01/2011
$3,363.29   04/01/2011
  $100.03   04/01/2011
  $100.03   04/01/2011
$1,500.48   04/01/2011
$3,363.29   04/01/2011
  $100.03   04/01/2011
  $384.93   04/01/2011
$3,363.29   04/01/2011
$1,500.48   04/01/2011
$3,363.29   04/01/2011
$3,363.29   04/01/2011
  $100.03   04/01/2011
  $839.61   04/01/2011
$3,363.29   04/01/2011
$1,244.24   04/01/2011
$3,363.29   04/01/2011
  $100.03   04/01/2011
  $100.03   04/01/2011
  $384.93   04/01/2011
$2,206.54   04/01/2011



                                 Page 157
                         Surgery (triggers bundling)


$3,363.29   04/01/2011
  $100.03   04/01/2011
  $100.03   04/01/2011
$2,206.54   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
  $956.23   04/01/2011
$1,568.75   04/01/2011
  $100.03   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
$1,453.61   04/01/2011
  $787.35   04/01/2011
$1,144.56   04/01/2011
$1,144.56   04/01/2011
$1,144.56   04/01/2011
  $879.68   04/01/2011
  $879.68   04/01/2011
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$1,144.56   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
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  $956.23   04/01/2011
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$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,231.40   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
  $956.23   04/01/2011



                                 Page 158
                         Surgery (triggers bundling)


$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,244.24   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
  $956.23   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,568.75   04/01/2011
$1,231.40   04/01/2011
$1,834.68   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,453.61   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,568.75   04/01/2011
$1,568.75   04/01/2011
$1,568.75   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,568.75   04/01/2011
$5,927.26   04/01/2011
$5,927.26   04/01/2011
$2,387.09   04/01/2011
$2,387.09   04/01/2011
$2,387.09   04/01/2011
$5,927.26   04/01/2011
$1,834.68   04/01/2011
$1,834.68   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011



                                 Page 159
                         Surgery (triggers bundling)


$1,231.40   04/01/2011
  $100.03   04/01/2011
  $384.93   04/01/2011
$2,206.54   04/01/2011
  $384.93   04/01/2011
$2,206.54   04/01/2011
$2,206.54   04/01/2011
  $100.03   04/01/2011
  $100.03   04/01/2011
$2,206.54   04/01/2011
  $100.03   04/01/2011
  $384.93   04/01/2011
$3,363.29   04/01/2011
$3,363.29   04/01/2011
  $100.03   04/01/2011
  $384.93   04/01/2011
$1,500.48   04/01/2011
$3,363.29   04/01/2011
$3,363.29   04/01/2011
$3,363.29   04/01/2011
  $100.03   04/01/2011
  $384.93   04/01/2011
$2,206.54   04/01/2011
  $100.03   04/01/2011
  $384.93   04/01/2011
$2,206.54   04/01/2011
  $100.03   04/01/2011
$1,500.48   04/01/2011
$2,206.54   04/01/2011
  $100.03   04/01/2011
$1,500.48   04/01/2011
$1,500.48   04/01/2011
  $100.03   04/01/2011
$1,500.48   04/01/2011
  $100.03   04/01/2011
$1,500.48   04/01/2011
$1,244.24   04/01/2011
$1,500.48   04/01/2011
$1,568.75   04/01/2011
$1,231.40   04/01/2011
$1,568.75   04/01/2011
$1,231.40   04/01/2011
$1,568.75   04/01/2011
$1,568.75   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
  $920.58   04/01/2011
  $100.03   04/01/2011
  $116.57   04/01/2011
  $146.74   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011



                                 Page 160
                         Surgery (triggers bundling)


$1,225.00   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,144.56   04/01/2011
$1,144.56   04/01/2011
  $879.68   04/01/2011
  $879.68   04/01/2011
  $879.68   04/01/2011
$1,144.56   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,665.86   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
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$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,665.86   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
  $879.68   04/01/2011
  $384.93   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,225.00   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,225.00   04/01/2011



                                 Page 161
                         Surgery (triggers bundling)


$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,665.86   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,665.86   04/01/2011
$1,225.00   04/01/2011
$1,665.86   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,225.00   04/01/2011
$1,665.86   04/01/2011
$1,225.00   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,834.68   04/01/2011
$2,387.09   04/01/2011
$1,834.68   04/01/2011
$2,387.09   04/01/2011
$1,225.00   04/01/2011
$1,665.86   04/01/2011
$1,225.00   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,225.00   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011



                                 Page 162
                         Surgery (triggers bundling)


$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
$1,665.86   04/01/2011
$1,225.00   04/01/2011
$1,225.00   04/01/2011
  $100.03   04/01/2011
  $100.03   04/01/2011
$1,244.24   04/01/2011
$1,500.48   04/01/2011
$2,206.54   04/01/2011
  $100.03   04/01/2011
  $384.93   04/01/2011
$1,500.48   04/01/2011
$2,206.54   04/01/2011
  $100.03   04/01/2011
  $384.93   04/01/2011
$1,500.48   04/01/2011
$1,500.48   04/01/2011
$3,363.29   04/01/2011
  $100.03   04/01/2011
  $100.03   04/01/2011
$1,244.24   04/01/2011
$1,500.48   04/01/2011
  $100.03   04/01/2011
  $100.03   04/01/2011
$1,500.48   04/01/2011
$1,500.48   04/01/2011
  $100.03   04/01/2011
  $100.03   04/01/2011
$1,500.48   04/01/2011
  $100.03   04/01/2011
  $100.03   04/01/2011
$1,500.48   04/01/2011
$1,500.48   04/01/2011
  $100.03   04/01/2011
  $839.61   04/01/2011
$1,500.48   04/01/2011
$1,500.48   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,225.00   04/01/2011



                                 Page 163
                         Surgery (triggers bundling)


$1,225.00   04/01/2011
  $100.03   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
  $956.23   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
  $787.35   04/01/2011
  $787.35   04/01/2011
$1,144.56   04/01/2011
$1,144.56   04/01/2011
  $879.68   04/01/2011
  $879.68   04/01/2011
  $879.68   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
$1,144.56   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
  $787.35   04/01/2011
  $956.23   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
  $100.03   04/01/2011
  $839.61   04/01/2011
  $100.03   04/01/2011
$2,206.54   04/01/2011
  $100.03   04/01/2011
  $100.03   04/01/2011
$1,453.61   04/01/2011
  $384.93   04/01/2011
  $384.93   04/01/2011
  $100.03   04/01/2011
  $839.61   04/01/2011
  $100.03   04/01/2011
  $839.61   04/01/2011
  $100.03   04/01/2011
  $839.61   04/01/2011
  $100.03   04/01/2011
  $839.61   04/01/2011
  $100.03   04/01/2011
$1,143.80   04/01/2011
  $956.23   04/01/2011



                                 Page 164
                         Surgery (triggers bundling)


  $956.23   04/01/2011
  $956.23   04/01/2011
$1,453.61   04/01/2011
  $787.35   04/01/2011
$1,144.56   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,144.56   04/01/2011
  $879.68   04/01/2011
  $879.68   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,144.56   04/01/2011
$1,144.56   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,144.56   04/01/2011
$1,144.56   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,231.40   04/01/2011
$1,453.61   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,453.61   04/01/2011
$1,231.40   04/01/2011
$1,568.75   04/01/2011
$1,231.40   04/01/2011
$1,568.75   04/01/2011
$1,568.75   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,453.61   04/01/2011
$1,231.40   04/01/2011



                                 Page 165
                         Surgery (triggers bundling)


$1,568.75   04/01/2011
$1,568.75   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,834.68   04/01/2011
$2,387.09   04/01/2011
$1,834.68   04/01/2011
$1,834.68   04/01/2011
$1,834.68   04/01/2011
$1,834.68   04/01/2011
$5,927.26   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
  $956.23   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
  $384.93   04/01/2011
  $100.03   04/01/2011
$1,244.24   04/01/2011
  $100.03   04/01/2011
  $100.03   04/01/2011
$1,500.48   04/01/2011
  $384.93   04/01/2011
  $100.03   04/01/2011
  $100.03   04/01/2011
  $100.03   04/01/2011
$2,206.54   04/01/2011
  $100.03   04/01/2011
$1,244.24   04/01/2011
  $100.03   04/01/2011
  $100.03   04/01/2011
  $839.61   04/01/2011
  $100.03   04/01/2011
  $839.61   04/01/2011
$2,206.54   04/01/2011
  $839.61   04/01/2011
  $956.23   04/01/2011
  $100.03   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
$1,143.80   04/01/2011
  $956.23   04/01/2011
$1,143.04   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
  $787.35   04/01/2011
$1,144.56   04/01/2011
  $879.68   04/01/2011
$1,144.56   04/01/2011
  $879.68   04/01/2011
  $879.68   04/01/2011



                                 Page 166
                         Surgery (triggers bundling)


$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
  $956.23   04/01/2011
$1,144.56   04/01/2011
$1,144.56   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,231.40   04/01/2011
$1,453.61   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,568.75   04/01/2011
$1,231.40   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
  $956.23   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,231.40   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,834.68   04/01/2011
  $956.23   04/01/2011
$1,231.40   04/01/2011
  $956.23   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,231.40   04/01/2011
$1,568.75   04/01/2011
  $100.03   04/01/2011
$1,244.24   04/01/2011
$1,500.48   04/01/2011
$2,206.54   04/01/2011
$3,363.29   04/01/2011
  $100.03   04/01/2011
$1,244.24   04/01/2011
$2,206.54   04/01/2011
  $100.03   04/01/2011
  $100.03   04/01/2011
$2,206.54   04/01/2011



                                 Page 167
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  $100.03   04/01/2011
$1,244.24   04/01/2011
$2,206.54   04/01/2011
  $100.03   04/01/2011
  $100.03   04/01/2011
$2,206.54   04/01/2011
  $100.03   04/01/2011
  $384.93   04/01/2011
$2,206.54   04/01/2011
  $100.03   04/01/2011
  $384.93   04/01/2011
$2,206.54   04/01/2011
$3,363.29   04/01/2011
  $100.03   04/01/2011
$1,244.24   04/01/2011
$2,206.54   04/01/2011
$3,363.29   04/01/2011
$3,363.29   04/01/2011
$2,206.54   04/01/2011
  $100.03   04/01/2011
$1,244.24   04/01/2011
$2,206.54   04/01/2011
  $384.93   04/01/2011
  $839.61   04/01/2011
$2,206.54   04/01/2011
$2,206.54   04/01/2011
  $839.61   04/01/2011
$1,568.75   04/01/2011
$1,568.75   04/01/2011
  $956.23   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
$1,453.61   04/01/2011
  $100.03   04/01/2011
  $146.74   04/01/2011
  $956.23   04/01/2011
  $956.23   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,022.03   04/01/2011
$1,144.56   04/01/2011
$1,144.56   04/01/2011
  $879.68   04/01/2011
  $879.68   04/01/2011
  $879.68   04/01/2011
$1,144.56   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011



                                 Page 168
                         Surgery (triggers bundling)


$1,022.03   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,570.66   04/01/2011
$1,570.66   04/01/2011
$1,143.04   04/01/2011
$1,570.66   04/01/2011
$1,570.66   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
  $787.35   04/01/2011
  $879.68   04/01/2011
  $787.35   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,570.66   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,570.66   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011



                                 Page 169
                         Surgery (triggers bundling)


$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,570.66   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,931.35   04/01/2011
$1,931.35   04/01/2011
$1,931.35   04/01/2011
$1,931.35   04/01/2011
$1,931.35   04/01/2011
$1,931.35   04/01/2011
$1,931.35   04/01/2011
$1,931.35   04/01/2011
$1,570.66   04/01/2011
$1,143.04   04/01/2011
$1,570.66   04/01/2011
$1,570.66   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,570.66   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,570.66   04/01/2011
$1,570.66   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,570.66   04/01/2011
  $100.03   04/01/2011
$1,244.24   04/01/2011
$1,500.48   04/01/2011
$3,363.29   04/01/2011
$2,206.54   04/01/2011
  $100.03   04/01/2011
  $100.03   04/01/2011
$1,500.48   04/01/2011
$2,206.54   04/01/2011
$1,570.66   04/01/2011
  $100.03   04/01/2011
  $100.03   04/01/2011
$1,500.48   04/01/2011
$2,206.54   04/01/2011
  $100.03   04/01/2011
  $100.03   04/01/2011
$1,500.48   04/01/2011
$2,206.54   04/01/2011



                                 Page 170
                         Surgery (triggers bundling)


  $100.03   04/01/2011
  $100.03   04/01/2011
$1,500.48   04/01/2011
$1,500.48   04/01/2011
  $100.03   04/01/2011
  $100.03   04/01/2011
$1,500.48   04/01/2011
  $100.03   04/01/2011
$1,500.48   04/01/2011
  $100.03   04/01/2011
$1,500.48   04/01/2011
$1,500.48   04/01/2011
$2,206.54   04/01/2011
  $384.93   04/01/2011
$1,244.24   04/01/2011
$1,500.48   04/01/2011
$1,500.48   04/01/2011
  $100.03   04/01/2011
  $100.03   04/01/2011
$1,500.48   04/01/2011
$2,206.54   04/01/2011
  $100.03   04/01/2011
  $839.61   04/01/2011
$1,500.48   04/01/2011
$1,500.48   04/01/2011
  $100.03   04/01/2011
  $839.61   04/01/2011
$1,500.48   04/01/2011
$1,500.48   04/01/2011
$1,570.66   04/01/2011
$1,568.75   04/01/2011
$1,570.66   04/01/2011
$1,570.66   04/01/2011
$1,570.66   04/01/2011
$1,570.66   04/01/2011
$1,570.66   04/01/2011
$1,570.66   04/01/2011
$1,143.04   04/01/2011
$1,570.66   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,143.04   04/01/2011
$1,453.61   04/01/2011
  $100.03   04/01/2011
   $75.81   04/01/2011
  $126.02   04/01/2011
  $126.02   04/01/2011
   $75.81   04/01/2011
   $75.81   04/01/2011
  $126.02   04/01/2011
   $75.81   04/01/2011
  $126.02   04/01/2011
  $126.02   04/01/2011
   $75.81   04/01/2011
  $126.02   04/01/2011



                                 Page 171
                         Surgery (triggers bundling)


   $75.81   04/01/2011
  $126.02   04/01/2011
  $126.02   04/01/2011
   $75.81   04/01/2011
   $75.81   04/01/2011
   $75.81   04/01/2011
   $75.81   04/01/2011
   $75.81   04/01/2011
   $75.81   04/01/2011
   $75.81   04/01/2011
   $75.81   04/01/2011
   $75.81   04/01/2011
   $75.81   04/01/2011
   $75.81   04/01/2011
  $126.02   04/01/2011
  $126.02   04/01/2011
  $126.02   04/01/2011
  $126.02   04/01/2011
  $126.02   04/01/2011
  $126.02   04/01/2011
  $126.02   04/01/2011
  $126.02   04/01/2011
  $126.02   04/01/2011
   $75.81   04/01/2011
  $126.02   04/01/2011
   $75.81   04/01/2011
   $75.81   04/01/2011
   $75.81   04/01/2011
   $75.81   04/01/2011
   $75.81   04/01/2011
   $75.81   04/01/2011
   $75.81   04/01/2011
   $75.81   04/01/2011
   $75.81   04/01/2011
   $75.81   04/01/2011
   $75.81   04/01/2011
   $75.81   04/01/2011
  $126.02   04/01/2011
   $75.81   04/01/2011
   $75.81   04/01/2011
   $75.81   04/01/2011
   $75.81   04/01/2011
   $75.81   04/01/2011
   $75.81   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,925.01   04/01/2011
$1,925.01   04/01/2011
$1,925.01   04/01/2011
$1,925.01   04/01/2011
$1,925.01   04/01/2011
$1,656.00   04/01/2011
$1,925.01   04/01/2011
$1,656.00   04/01/2011



                                 Page 172
                         Surgery (triggers bundling)


$1,925.01   04/01/2011
$1,925.01   04/01/2011
$1,925.01   04/01/2011
$1,925.01   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,925.01   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,925.01   04/01/2011
$1,925.01   04/01/2011
$1,925.01   04/01/2011
$1,925.01   04/01/2011
$1,925.01   04/01/2011
$1,925.01   04/01/2011
$1,925.01   04/01/2011
$1,925.01   04/01/2011
$1,925.01   04/01/2011
$1,925.01   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,925.01   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,568.75   04/01/2011
$1,568.75   04/01/2011
$1,925.01   04/01/2011
$1,568.75   04/01/2011
$1,143.04   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,925.01   04/01/2011
$1,656.00   04/01/2011



                                 Page 173
                         Surgery (triggers bundling)


$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,656.00   04/01/2011
$1,925.01   04/01/2011
$1,925.01   04/01/2011
$1,925.01   04/01/2011
$1,925.01   04/01/2011
$1,656.00   04/01/2011
  $685.47   04/01/2011
  $685.47   04/01/2011
  $542.55   04/01/2011
  $928.01   04/01/2011
  $928.01   04/01/2011
  $928.01   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
  $542.55   04/01/2011
$1,952.62   04/01/2011
  $928.01   04/01/2011
$1,313.37   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
  $542.55   04/01/2011
  $542.55   04/01/2011
  $542.55   04/01/2011
  $928.01   04/01/2011
  $928.01   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,313.37   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,313.37   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
  $685.47   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,313.37   04/01/2011
  $542.55   04/01/2011
  $928.01   04/01/2011
  $195.16   04/01/2011
  $195.16   04/01/2011
  $195.16   04/01/2011
  $195.16   04/01/2011
$1,595.13   04/01/2011
$1,595.13   04/01/2011
  $928.01   04/01/2011



                                 Page 174
                         Surgery (triggers bundling)


  $195.16   04/01/2011
  $685.47   04/01/2011
  $542.55   04/01/2011
$1,313.37   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,313.37   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,313.37   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
   $82.14   04/01/2011
   $82.14   04/01/2011
  $952.55   04/01/2011
  $952.55   04/01/2011
  $952.55   04/01/2011
$1,237.12   04/01/2011
  $952.55   04/01/2011
$1,237.12   04/01/2011
$1,237.12   04/01/2011
$1,237.12   04/01/2011
$1,237.12   04/01/2011
$1,237.12   04/01/2011
$1,237.12   04/01/2011
$1,237.12   04/01/2011
$1,237.12   04/01/2011
$1,237.12   04/01/2011
$1,237.12   04/01/2011
$1,237.12   04/01/2011
$1,237.12   04/01/2011
$1,237.12   04/01/2011
  $195.16   04/01/2011
$1,313.37   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
  $312.67   04/01/2011
   $52.82   04/01/2011
   $43.69   04/01/2011
  $952.55   04/01/2011
   $82.14   04/01/2011
  $952.55   04/01/2011
   $82.14   04/01/2011
  $952.55   04/01/2011
   $82.14   04/01/2011



                                 Page 175
                         Surgery (triggers bundling)


  $952.55   04/01/2011
  $952.55   04/01/2011
$1,237.12   04/01/2011
  $952.55   04/01/2011
  $952.55   04/01/2011
  $952.55   04/01/2011
  $952.55   04/01/2011
  $952.55   04/01/2011
  $952.55   04/01/2011
  $952.55   04/01/2011
  $952.55   04/01/2011
$1,237.12   04/01/2011
$1,237.12   04/01/2011
$1,237.12   04/01/2011
$1,237.12   04/01/2011
  $952.55   04/01/2011
$1,237.12   04/01/2011
   $82.14   04/01/2011
  $952.55   04/01/2011
  $244.48   04/01/2011
$1,237.12   04/01/2011
  $244.48   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
  $195.16   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
  $542.55   04/01/2011
  $542.55   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
$1,952.62   04/01/2011
  $542.55   04/01/2011
  $557.65   04/01/2011
  $557.65   04/01/2011
  $557.65   04/01/2011
  $557.65   04/01/2011
  $557.65   04/01/2011
  $557.65   04/01/2011
  $557.65   04/01/2011
$1,299.44   04/01/2011
$1,299.44   04/01/2011
  $557.65   04/01/2011
  $557.65   04/01/2011
  $557.65   04/01/2011
  $557.65   04/01/2011
$1,299.44   04/01/2011
  $557.65   04/01/2011
$1,299.44   04/01/2011
$1,299.44   04/01/2011



                                 Page 176
                         Surgery (triggers bundling)


$1,299.44   04/01/2011
  $557.65   04/01/2011
  $557.65   04/01/2011
  $557.65   04/01/2011
  $557.65   04/01/2011
  $244.48   04/01/2011
   $19.07   04/01/2011
  $244.48   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
  $557.65   04/01/2011
  $261.73   04/01/2011
  $347.47   04/01/2011
  $347.47   04/01/2011
  $261.73   04/01/2011
  $261.73   04/01/2011
  $261.73   04/01/2011
$1,686.40   04/01/2011
  $261.73   04/01/2011
   $52.82   04/01/2011
  $261.73   04/01/2011
  $261.73   04/01/2011
  $261.73   04/01/2011
$1,767.69   04/01/2011
$1,767.69   04/01/2011
$1,767.69   04/01/2011
$1,767.69   04/01/2011
$1,767.69   04/01/2011
$1,767.69   04/01/2011
  $261.73   04/01/2011
  $261.73   04/01/2011
  $261.73   04/01/2011
  $261.73   04/01/2011
$6,654.10   04/01/2011
$6,654.10   04/01/2011
$8,206.38   04/01/2011
$3,348.46   04/01/2011
$3,348.46   04/01/2011
$5,497.98   04/01/2011
$6,398.94   04/01/2011
$8,206.38   04/01/2011
$1,273.07   04/01/2011
$3,348.46   04/01/2011
$3,348.46   04/01/2011
$1,273.07   04/01/2011
$1,273.07   04/01/2011
  $920.58   04/01/2011
  $920.58   04/01/2011
$4,524.66   04/01/2011
$4,524.66   04/01/2011
$1,273.07   04/01/2011



                                 Page 177
                         Surgery (triggers bundling)


$1,273.07   04/01/2011
$1,273.07   04/01/2011
$1,273.07   04/01/2011
$1,273.07   04/01/2011
$1,273.07   04/01/2011
$3,883.11   04/01/2011
  $787.35   04/01/2011
  $261.73   04/01/2011
$2,605.46   04/01/2011
$2,605.46   04/01/2011
$2,605.46   04/01/2011
$2,605.46   04/01/2011
$2,605.46   04/01/2011
$2,605.46   04/01/2011
$2,605.46   04/01/2011
$2,605.46   04/01/2011
$2,605.46   04/01/2011
$2,605.46   04/01/2011
$2,605.46   04/01/2011
$1,705.33   04/01/2011
$1,420.22   04/01/2011
$1,420.22   04/01/2011
$2,605.46   04/01/2011
$1,420.22   04/01/2011
$1,420.22   04/01/2011
$1,420.22   04/01/2011
$2,605.46   04/01/2011
  $787.35   04/01/2011
$1,420.22   04/01/2011
$1,420.22   04/01/2011
$1,420.22   04/01/2011
$1,705.33   04/01/2011
$1,705.33   04/01/2011
$1,705.33   04/01/2011
$1,420.22   04/01/2011
$3,361.68   04/01/2011
$3,361.68   04/01/2011
$3,361.68   04/01/2011
$3,361.68   04/01/2011
$3,361.68   04/01/2011
$3,361.68   04/01/2011
$3,361.68   04/01/2011
$3,361.68   04/01/2011
$3,361.68   04/01/2011
$3,361.68   04/01/2011
$6,258.34   04/01/2011
$6,258.34   04/01/2011
$6,258.34   04/01/2011
$6,258.34   04/01/2011
$6,258.34   04/01/2011
$6,258.34   04/01/2011
$6,258.34   04/01/2011
$6,258.34   04/01/2011
  $776.07   04/01/2011
$1,420.22   04/01/2011



                                 Page 178
                         Surgery (triggers bundling)


$1,420.22   04/01/2011
$1,420.22   04/01/2011
$1,420.22   04/01/2011
$2,605.46   04/01/2011
$2,605.46   04/01/2011
$2,605.46   04/01/2011
$2,605.46   04/01/2011
$2,605.46   04/01/2011
$2,605.46   04/01/2011
$1,420.22   04/01/2011
  $252.48   04/01/2011
$1,611.99   04/01/2011
$1,273.07   04/01/2011
$1,273.07   04/01/2011
  $439.86   04/01/2011
  $439.86   04/01/2011
  $439.86   04/01/2011
  $439.86   04/01/2011
  $439.86   04/01/2011
  $173.31   04/01/2011
  $173.31   04/01/2011
  $173.31   04/01/2011
  $173.31   04/01/2011
$1,752.70   04/01/2011
$1,595.13   04/01/2011
$1,595.13   04/01/2011
$1,595.13   04/01/2011
  $751.97   04/01/2011
  $751.97   04/01/2011
  $751.97   04/01/2011
  $751.97   04/01/2011
$2,205.89   04/01/2011
$2,205.89   04/01/2011
$2,205.89   04/01/2011
  $488.77   04/01/2011
  $488.77   04/01/2011
$1,261.59   04/01/2011
$1,261.59   04/01/2011
$1,611.99   04/01/2011
$1,611.99   04/01/2011
$1,611.99   04/01/2011
$1,611.99   04/01/2011
$1,611.99   04/01/2011
  $488.77   04/01/2011
  $488.77   04/01/2011
$1,261.59   04/01/2011
$1,261.59   04/01/2011
  $135.36   04/01/2011
  $488.77   04/01/2011
$1,261.59   04/01/2011
  $488.77   04/01/2011
$1,261.59   04/01/2011
$1,611.99   04/01/2011
$1,611.99   04/01/2011
  $488.77   04/01/2011



                                 Page 179
                          Surgery (triggers bundling)


 $1,261.59   04/01/2011
   $135.36   04/01/2011
   $488.77   04/01/2011
   $252.48   04/01/2011
 $1,261.59   04/01/2011
   $488.77   04/01/2011
   $488.77   04/01/2011
 $1,611.99   04/01/2011
    $56.44   04/01/2011
 $2,000.71   04/01/2011
 $2,000.71   04/01/2011
 $2,000.71   04/01/2011
 $2,605.46   04/01/2011
 $2,605.46   04/01/2011
 $2,605.46   04/01/2011
 $2,605.46   04/01/2011
 $2,605.46   04/01/2011
 $2,605.46   04/01/2011
 $2,605.46   04/01/2011
 $2,605.46   04/01/2011
 $2,605.46   04/01/2011
 $2,000.71   04/01/2011
 $2,605.46   04/01/2011
   $252.48   04/01/2011
 $2,000.71   04/01/2011
 $1,705.33   04/01/2011
 $3,773.01   04/01/2011
 $2,605.46   04/01/2011
 $2,605.46   04/01/2011
 $2,605.46   04/01/2011
 $2,605.46   04/01/2011
 $2,605.46   04/01/2011
   $252.48   04/01/2011
 $1,611.99   04/01/2011
   $776.07   04/01/2011
   $776.07   04/01/2011
 $1,611.99   04/01/2011
 $6,258.34   04/01/2011
 $3,773.01   04/01/2011
 $3,773.01   04/01/2011
 $3,773.01   04/01/2011
 $3,773.01   04/01/2011
 $1,611.99   04/01/2011
 $3,773.01   04/01/2011
 $3,361.68   04/01/2011
 $3,361.68   04/01/2011
 $3,361.68   04/01/2011
 $3,361.68   04/01/2011
 $3,361.68   04/01/2011
 $3,773.01   04/01/2011
 $3,773.01   04/01/2011
$13,203.77   04/01/2011
 $3,361.68   04/01/2011
 $3,773.01   04/01/2011
 $3,773.01   04/01/2011



                                  Page 180
                          Surgery (triggers bundling)


$13,203.77   04/01/2011
 $3,361.68   04/01/2011
 $3,773.01   04/01/2011
 $3,361.68   04/01/2011
 $3,361.68   04/01/2011
 $1,752.70   04/01/2011
 $1,595.13   04/01/2011
 $1,420.22   04/01/2011
 $1,420.22   04/01/2011
 $1,752.70   04/01/2011
 $1,595.13   04/01/2011
 $1,595.13   04/01/2011
   $879.68   04/01/2011
 $1,595.13   04/01/2011
 $1,752.70   04/01/2011
 $1,595.13   04/01/2011
 $1,595.13   04/01/2011
 $1,595.13   04/01/2011
 $1,752.70   04/01/2011
 $1,752.70   04/01/2011
 $1,595.13   04/01/2011
 $1,595.13   04/01/2011
 $1,595.13   04/01/2011
 $1,595.13   04/01/2011
 $1,595.13   04/01/2011
 $1,595.13   04/01/2011
 $1,872.11   04/01/2011
 $2,438.90   04/01/2011
 $1,872.13   04/01/2011
   $751.97   04/01/2011
   $270.87   04/01/2011
   $270.87   04/01/2011
 $2,205.89   04/01/2011
 $2,205.89   04/01/2011
 $2,205.89   04/01/2011
   $751.97   04/01/2011
   $146.74   04/01/2011
 $1,143.80   04/01/2011
 $1,241.13   04/01/2011
 $1,241.13   04/01/2011
   $220.95   04/01/2011
 $1,241.13   04/01/2011
 $1,241.13   04/01/2011
 $1,241.13   04/01/2011
 $1,241.13   04/01/2011
 $1,388.94   04/01/2011
 $1,241.13   04/01/2011
 $1,241.13   04/01/2011
 $2,438.90   04/01/2011
 $3,623.40   04/01/2011
 $2,438.90   04/01/2011
 $1,872.13   04/01/2011
 $1,241.13   04/01/2011
 $1,241.13   04/01/2011
 $1,388.94   04/01/2011



                                  Page 181
                         Surgery (triggers bundling)


$1,388.94   04/01/2011
$1,241.13   04/01/2011
  $439.86   04/01/2011
$1,767.69   04/01/2011
  $685.47   04/01/2011
  $928.01   04/01/2011
$1,313.37   04/01/2011
  $928.01   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
  $542.55   04/01/2011
  $542.55   04/01/2011
  $542.55   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
  $195.16   04/01/2011
  $116.57   04/01/2011
  $542.55   04/01/2011
  $542.55   04/01/2011
  $685.47   04/01/2011
  $685.47   04/01/2011
  $928.01   04/01/2011
  $928.01   04/01/2011
  $928.01   04/01/2011
$1,313.37   04/01/2011
  $685.47   04/01/2011
  $542.55   04/01/2011
  $928.01   04/01/2011
  $685.47   04/01/2011
  $542.55   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
  $195.16   04/01/2011
  $928.01   04/01/2011
  $685.47   04/01/2011
$1,313.37   04/01/2011
  $928.01   04/01/2011
  $928.01   04/01/2011
  $685.47   04/01/2011
  $542.55   04/01/2011
  $685.47   04/01/2011
  $542.55   04/01/2011
  $542.55   04/01/2011
  $542.55   04/01/2011
$1,313.37   04/01/2011
  $542.55   04/01/2011
  $928.01   04/01/2011
  $656.77   04/01/2011



                                 Page 182
                         Surgery (triggers bundling)


  $928.01   04/01/2011
  $928.01   04/01/2011
  $928.01   04/01/2011
$1,313.37   04/01/2011
  $542.55   04/01/2011
  $928.01   04/01/2011
$1,313.37   04/01/2011
  $195.16   04/01/2011
  $685.47   04/01/2011
  $542.55   04/01/2011
$1,313.37   04/01/2011
  $928.01   04/01/2011
  $542.55   04/01/2011
  $542.55   04/01/2011
$1,313.37   04/01/2011
  $195.16   04/01/2011
  $116.57   04/01/2011
$1,313.37   04/01/2011
  $928.01   04/01/2011
  $542.55   04/01/2011
  $542.55   04/01/2011
  $928.01   04/01/2011
$1,313.37   04/01/2011
  $928.01   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
  $928.01   04/01/2011
  $928.01   04/01/2011
  $928.01   04/01/2011
$1,313.37   04/01/2011
  $928.01   04/01/2011
$1,313.37   04/01/2011
  $195.16   04/01/2011
  $685.47   04/01/2011
  $542.55   04/01/2011
  $928.01   04/01/2011
  $928.01   04/01/2011
$1,313.37   04/01/2011
$1,952.62   04/01/2011
  $542.55   04/01/2011
$1,313.37   04/01/2011
  $928.01   04/01/2011
  $685.47   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
  $928.01   04/01/2011
$1,313.37   04/01/2011
  $685.47   04/01/2011



                                 Page 183
                         Surgery (triggers bundling)


  $928.01   04/01/2011
  $195.16   04/01/2011
  $928.01   04/01/2011
  $928.01   04/01/2011
  $685.47   04/01/2011
  $685.47   04/01/2011
  $928.01   04/01/2011
  $928.01   04/01/2011
  $928.01   04/01/2011
  $220.95   04/01/2011
$1,313.37   04/01/2011
  $928.01   04/01/2011
  $928.01   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
  $928.01   04/01/2011
  $542.55   04/01/2011
  $685.47   04/01/2011
$1,313.37   04/01/2011
  $195.16   04/01/2011
  $685.47   04/01/2011
  $928.01   04/01/2011
$1,952.62   04/01/2011
  $928.01   04/01/2011
  $928.01   04/01/2011
  $928.01   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
$1,952.62   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
$1,952.62   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
  $542.55   04/01/2011



                                 Page 184
                         Surgery (triggers bundling)


$1,313.37   04/01/2011
$1,313.37   04/01/2011
  $195.16   04/01/2011
$1,952.62   04/01/2011
  $195.16   04/01/2011
  $928.01   04/01/2011
  $195.16   04/01/2011
  $542.55   04/01/2011
  $928.01   04/01/2011
$1,952.62   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
$1,626.89   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
$1,311.54   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
$1,626.89   04/01/2011
$1,311.54   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
$1,106.71   04/01/2011
$1,106.71   04/01/2011
$1,106.71   04/01/2011
$1,106.71   04/01/2011
$1,106.71   04/01/2011
$1,106.71   04/01/2011
$1,106.71   04/01/2011



                                 Page 185
                         Surgery (triggers bundling)


$1,626.89   04/01/2011
$1,626.89   04/01/2011
$1,106.71   04/01/2011
$1,106.71   04/01/2011
$1,106.71   04/01/2011
$3,623.40   04/01/2011
$1,872.13   04/01/2011
$1,313.37   04/01/2011
  $383.53   04/01/2011
  $383.53   04/01/2011
  $383.53   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
$1,872.13   04/01/2011
$3,623.40   04/01/2011
$3,623.40   04/01/2011
$2,438.90   04/01/2011
$1,872.13   04/01/2011
   $61.25   04/01/2011
  $252.48   04/01/2011
  $477.01   04/01/2011
$1,311.54   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
$1,236.37   04/01/2011
  $276.94   04/01/2011
$1,236.37   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
$2,438.90   04/01/2011
$2,438.90   04/01/2011
$3,623.40   04/01/2011
$3,623.40   04/01/2011
$3,623.40   04/01/2011
$1,872.13   04/01/2011
$1,872.13   04/01/2011
$1,236.37   04/01/2011
$1,236.37   04/01/2011
  $514.49   04/01/2011
  $514.49   04/01/2011
  $514.49   04/01/2011
  $514.49   04/01/2011
  $514.49   04/01/2011
  $514.49   04/01/2011
  $514.49   04/01/2011
$1,626.89   04/01/2011
  $514.49   04/01/2011
  $514.49   04/01/2011
  $514.49   04/01/2011
  $514.49   04/01/2011
  $514.49   04/01/2011
$1,626.89   04/01/2011
  $514.49   04/01/2011



                                 Page 186
                         Surgery (triggers bundling)


  $514.49   04/01/2011
$1,626.89   04/01/2011
  $508.12   04/01/2011
  $508.12   04/01/2011
  $508.12   04/01/2011
  $508.12   04/01/2011
  $508.12   04/01/2011
  $508.12   04/01/2011
  $508.12   04/01/2011
  $508.12   04/01/2011
  $508.12   04/01/2011
$1,626.89   04/01/2011
  $135.36   04/01/2011
$1,433.18   04/01/2011
  $552.02   04/01/2011
$2,438.90   04/01/2011
$1,872.13   04/01/2011
  $774.61   04/01/2011
  $774.61   04/01/2011
  $774.61   04/01/2011
$1,302.62   04/01/2011
$1,302.62   04/01/2011
$1,302.62   04/01/2011
$1,302.62   04/01/2011
  $774.61   04/01/2011
$1,302.62   04/01/2011
$1,302.62   04/01/2011
  $256.93   04/01/2011
  $474.19   04/01/2011
  $474.19   04/01/2011
$1,192.76   04/01/2011
  $474.19   04/01/2011
  $474.19   04/01/2011
  $474.19   04/01/2011
  $474.19   04/01/2011
$1,192.76   04/01/2011
$1,192.76   04/01/2011
$1,626.89   04/01/2011
  $256.93   04/01/2011
  $256.93   04/01/2011
  $256.93   04/01/2011
  $474.19   04/01/2011
  $474.19   04/01/2011
  $256.93   04/01/2011
  $256.93   04/01/2011
  $474.19   04/01/2011
  $474.19   04/01/2011
  $474.19   04/01/2011
  $474.19   04/01/2011
  $474.19   04/01/2011
$1,626.89   04/01/2011
  $508.12   04/01/2011
  $508.12   04/01/2011
  $508.12   04/01/2011
  $508.12   04/01/2011



                                 Page 187
                         Surgery (triggers bundling)


  $508.12   04/01/2011
  $508.12   04/01/2011
  $508.12   04/01/2011
  $508.12   04/01/2011
  $508.12   04/01/2011
  $508.12   04/01/2011
$1,626.89   04/01/2011
  $508.12   04/01/2011
  $508.12   04/01/2011
$1,872.13   04/01/2011
$1,302.62   04/01/2011
$1,370.02   04/01/2011
  $173.31   04/01/2011
$1,370.02   04/01/2011
$1,370.02   04/01/2011
  $254.84   04/01/2011
$1,302.62   04/01/2011
$1,302.62   04/01/2011
  $774.61   04/01/2011
$1,302.62   04/01/2011
  $254.84   04/01/2011
$1,302.62   04/01/2011
  $254.84   04/01/2011
$1,302.62   04/01/2011
$1,302.62   04/01/2011
  $774.61   04/01/2011
$1,302.62   04/01/2011
  $774.61   04/01/2011
$1,302.62   04/01/2011
   $74.23   04/01/2011
$1,302.62   04/01/2011
  $774.61   04/01/2011
  $254.84   04/01/2011
$1,302.62   04/01/2011
$1,302.62   04/01/2011
$1,302.62   04/01/2011
$1,302.62   04/01/2011
$1,302.62   04/01/2011
$1,302.62   04/01/2011
$1,302.62   04/01/2011
$1,302.62   04/01/2011
$1,302.62   04/01/2011
$1,302.62   04/01/2011
$1,302.62   04/01/2011
$1,302.62   04/01/2011
$1,302.62   04/01/2011
$1,302.62   04/01/2011
  $774.61   04/01/2011
  $474.19   04/01/2011
  $256.93   04/01/2011
  $474.19   04/01/2011
$1,192.76   04/01/2011
  $474.19   04/01/2011
$1,192.76   04/01/2011
  $256.93   04/01/2011



                                 Page 188
                         Surgery (triggers bundling)


$1,192.76   04/01/2011
$1,302.62   04/01/2011
$1,370.02   04/01/2011
$1,370.02   04/01/2011
$1,370.02   04/01/2011
$1,302.62   04/01/2011
$1,302.62   04/01/2011
$1,370.02   04/01/2011
$1,370.02   04/01/2011
$1,370.02   04/01/2011
  $196.86   04/01/2011
$1,027.53   04/01/2011
  $153.69   04/01/2011
$1,027.53   04/01/2011
$1,027.53   04/01/2011
$1,027.53   04/01/2011
  $254.84   04/01/2011
$1,302.62   04/01/2011
  $254.84   04/01/2011
  $774.61   04/01/2011
  $774.61   04/01/2011
$1,370.02   04/01/2011
  $254.84   04/01/2011
  $347.47   04/01/2011
  $552.02   04/01/2011
$7,496.11   04/01/2011
$7,496.11   04/01/2011
$1,872.13   04/01/2011
$1,818.19   04/01/2011
  $151.59   04/01/2011
  $736.17   04/01/2011
  $736.17   04/01/2011
  $736.17   04/01/2011
  $594.44   04/01/2011
  $594.44   04/01/2011
  $736.17   04/01/2011
  $736.17   04/01/2011
  $736.17   04/01/2011
  $736.17   04/01/2011
  $736.17   04/01/2011
$1,872.13   04/01/2011
$1,872.13   04/01/2011
$2,438.90   04/01/2011
$2,438.90   04/01/2011
$2,438.90   04/01/2011
$1,872.13   04/01/2011
  $736.17   04/01/2011
  $736.17   04/01/2011
  $347.47   04/01/2011
  $552.02   04/01/2011
  $151.59   04/01/2011
  $552.02   04/01/2011
  $552.02   04/01/2011
  $552.02   04/01/2011
  $261.73   04/01/2011



                                 Page 189
                         Surgery (triggers bundling)


  $261.73   04/01/2011
  $347.47   04/01/2011
$1,433.18   04/01/2011
$1,872.13   04/01/2011
$1,872.13   04/01/2011
$1,872.13   04/01/2011
$1,872.13   04/01/2011
$1,872.13   04/01/2011
$1,872.13   04/01/2011
$1,872.13   04/01/2011
$1,872.13   04/01/2011
$1,872.13   04/01/2011
$1,433.18   04/01/2011
$1,686.40   04/01/2011
$2,000.71   04/01/2011
$1,686.40   04/01/2011
$1,686.40   04/01/2011
$1,273.07   04/01/2011
  $594.44   04/01/2011
$1,433.18   04/01/2011
$1,273.07   04/01/2011
  $594.44   04/01/2011
  $594.44   04/01/2011
  $477.01   04/01/2011
  $477.01   04/01/2011
  $774.61   04/01/2011
  $477.01   04/01/2011
  $135.36   04/01/2011
  $135.36   04/01/2011
  $135.36   04/01/2011
  $135.36   04/01/2011
$1,626.37   04/01/2011
$1,626.37   04/01/2011
$1,626.37   04/01/2011
$1,626.37   04/01/2011
$1,626.37   04/01/2011
$1,626.37   04/01/2011
$1,626.37   04/01/2011
$1,626.37   04/01/2011
$1,626.37   04/01/2011
$1,626.37   04/01/2011
$1,626.37   04/01/2011
$1,626.37   04/01/2011
$1,626.37   04/01/2011
$1,626.37   04/01/2011
$1,626.37   04/01/2011
$1,626.37   04/01/2011
$1,626.37   04/01/2011
$1,626.37   04/01/2011
$1,626.37   04/01/2011
$1,626.37   04/01/2011
$1,626.37   04/01/2011
$1,626.37   04/01/2011
$1,626.37   04/01/2011
$1,626.37   04/01/2011



                                 Page 190
                         Surgery (triggers bundling)


$1,626.37   04/01/2011
$1,626.37   04/01/2011
$1,626.37   04/01/2011
$1,626.37   04/01/2011
$1,626.37   04/01/2011
$2,438.90   04/01/2011
$2,438.90   04/01/2011
$3,623.40   04/01/2011
$3,623.40   04/01/2011
$3,623.40   04/01/2011
$3,623.40   04/01/2011
$3,623.40   04/01/2011
$3,623.40   04/01/2011
$1,872.13   04/01/2011
$1,433.18   04/01/2011
$1,447.41   04/01/2011
  $552.02   04/01/2011
$2,498.70   04/01/2011
$2,498.70   04/01/2011
  $347.47   04/01/2011
$1,447.41   04/01/2011
$1,140.90   04/01/2011
$1,447.41   04/01/2011
  $769.69   04/01/2011
  $594.44   04/01/2011
  $769.69   04/01/2011
  $347.47   04/01/2011
   $64.00   04/01/2011
$1,140.90   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
   $74.23   04/01/2011
  $594.44   04/01/2011
$1,872.13   04/01/2011
$7,496.11   04/01/2011
$2,438.90   04/01/2011
$1,872.13   04/01/2011
$1,872.13   04/01/2011
  $769.69   04/01/2011
$1,447.41   04/01/2011
  $769.69   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
  $769.69   04/01/2011
  $769.69   04/01/2011
  $769.69   04/01/2011
  $769.69   04/01/2011
$2,643.26   04/01/2011
$1,140.90   04/01/2011
$3,870.76   04/01/2011
$1,818.19   04/01/2011
$1,818.19   04/01/2011
   $64.00   04/01/2011
  $594.44   04/01/2011
  $947.88   04/01/2011



                                 Page 191
                         Surgery (triggers bundling)


$2,438.90   04/01/2011
$2,438.90   04/01/2011
$2,438.90   04/01/2011
$1,872.13   04/01/2011
  $769.69   04/01/2011
  $769.69   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
  $769.69   04/01/2011
  $769.69   04/01/2011
$1,140.90   04/01/2011
$1,140.90   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
  $769.69   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$1,143.80   04/01/2011
   $74.23   04/01/2011
   $64.00   04/01/2011
  $947.88   04/01/2011
$1,626.37   04/01/2011
$1,447.41   04/01/2011
   $74.23   04/01/2011
   $64.00   04/01/2011
   $74.23   04/01/2011
  $135.36   04/01/2011
$1,818.32   04/01/2011
  $337.55   04/01/2011
  $337.55   04/01/2011
  $337.55   04/01/2011
  $337.55   04/01/2011
  $337.55   04/01/2011
  $337.55   04/01/2011
   $64.00   04/01/2011
   $64.00   04/01/2011
   $64.00   04/01/2011
   $74.23   04/01/2011
   $64.00   04/01/2011
   $74.23   04/01/2011
$2,408.69   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$2,438.90   04/01/2011
$2,438.90   04/01/2011
$1,872.13   04/01/2011
  $769.69   04/01/2011
$1,140.90   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
  $769.69   04/01/2011
$1,447.41   04/01/2011



                                 Page 192
                         Surgery (triggers bundling)


$1,447.41   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$1,140.90   04/01/2011
  $769.69   04/01/2011
$1,140.90   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$1,140.90   04/01/2011
$2,643.26   04/01/2011
$1,447.41   04/01/2011
$1,140.90   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$1,140.90   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$2,643.26   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$2,643.26   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
$2,643.26   04/01/2011
$2,643.26   04/01/2011
$1,447.41   04/01/2011
$2,498.70   04/01/2011
$2,498.70   04/01/2011
$2,498.70   04/01/2011
$1,447.41   04/01/2011
$1,049.98   04/01/2011
$1,049.98   04/01/2011
$1,049.98   04/01/2011



                                 Page 193
                         Surgery (triggers bundling)


$1,049.98   04/01/2011
$1,049.98   04/01/2011
$1,049.98   04/01/2011
$1,049.98   04/01/2011
$1,049.98   04/01/2011
$1,049.98   04/01/2011
$1,818.32   04/01/2011
$1,049.98   04/01/2011
$1,818.32   04/01/2011
$1,818.32   04/01/2011
$1,049.98   04/01/2011
$1,818.32   04/01/2011
$1,049.98   04/01/2011
$1,049.98   04/01/2011
$1,049.98   04/01/2011
$1,049.98   04/01/2011
$1,049.98   04/01/2011
$1,818.32   04/01/2011
$1,818.32   04/01/2011
$1,818.32   04/01/2011
$1,818.32   04/01/2011
$1,818.32   04/01/2011
$1,818.32   04/01/2011
$1,818.32   04/01/2011
$4,231.40   04/01/2011
$1,818.32   04/01/2011
$4,231.40   04/01/2011
$6,921.25   04/01/2011
$1,818.32   04/01/2011
$6,921.25   04/01/2011
$1,818.32   04/01/2011
$1,818.32   04/01/2011
$1,049.98   04/01/2011
$1,818.32   04/01/2011
$1,049.98   04/01/2011
$1,818.32   04/01/2011
$1,049.98   04/01/2011
$1,818.32   04/01/2011
$1,818.32   04/01/2011
  $337.55   04/01/2011
   $64.00   04/01/2011
$1,140.90   04/01/2011
  $947.88   04/01/2011
   $74.23   04/01/2011
   $64.00   04/01/2011
   $64.00   04/01/2011
$1,049.98   04/01/2011
$2,498.70   04/01/2011
$2,498.70   04/01/2011
   $74.23   04/01/2011
   $64.00   04/01/2011
$1,049.98   04/01/2011
$1,049.98   04/01/2011
$1,143.80   04/01/2011
  $173.31   04/01/2011



                                 Page 194
                         Surgery (triggers bundling)


$1,027.53   04/01/2011
  $173.31   04/01/2011
$1,027.53   04/01/2011
$1,027.53   04/01/2011
$1,027.53   04/01/2011
  $879.68   04/01/2011
$1,144.56   04/01/2011
$1,872.11   04/01/2011
$1,872.11   04/01/2011
$1,872.11   04/01/2011
$1,143.80   04/01/2011
$1,872.11   04/01/2011
$1,384.48   04/01/2011
$1,384.48   04/01/2011
$1,384.48   04/01/2011
$1,384.48   04/01/2011
   $74.23   04/01/2011
$1,872.11   04/01/2011
   $74.23   04/01/2011
  $947.88   04/01/2011
   $74.23   04/01/2011
   $64.00   04/01/2011
   $74.23   04/01/2011
$1,872.11   04/01/2011
$1,872.11   04/01/2011
$1,872.11   04/01/2011
$1,872.11   04/01/2011
$1,872.11   04/01/2011
$1,872.11   04/01/2011
$1,872.11   04/01/2011
$1,872.11   04/01/2011
$1,872.11   04/01/2011
$1,872.11   04/01/2011
$1,872.11   04/01/2011
$1,872.11   04/01/2011
$1,872.11   04/01/2011
$1,872.11   04/01/2011
$1,872.11   04/01/2011
$1,872.11   04/01/2011
$1,872.11   04/01/2011
$1,872.11   04/01/2011
$1,872.11   04/01/2011
$1,872.11   04/01/2011
$1,872.11   04/01/2011
$6,921.25   04/01/2011
$1,872.11   04/01/2011
$6,921.25   04/01/2011
$1,872.11   04/01/2011
$1,872.11   04/01/2011
  $337.55   04/01/2011
  $552.02   04/01/2011
$1,384.48   04/01/2011
$1,384.48   04/01/2011
$1,384.48   04/01/2011
$1,384.48   04/01/2011



                                 Page 195
                         Surgery (triggers bundling)


$1,626.37   04/01/2011
$1,872.11   04/01/2011
$1,626.37   04/01/2011
$1,384.48   04/01/2011
$1,384.48   04/01/2011
$1,384.48   04/01/2011
$1,626.37   04/01/2011
$1,384.48   04/01/2011
$1,384.48   04/01/2011
$1,384.48   04/01/2011
$2,438.90   04/01/2011
$3,623.40   04/01/2011
$1,872.13   04/01/2011
$1,384.48   04/01/2011
  $151.59   04/01/2011
$1,384.48   04/01/2011
$1,384.48   04/01/2011
$1,384.48   04/01/2011
$1,384.48   04/01/2011
$1,384.48   04/01/2011
$1,384.48   04/01/2011
$1,384.48   04/01/2011
  $151.59   04/01/2011
$1,626.37   04/01/2011
$1,626.37   04/01/2011
$1,384.48   04/01/2011
  $146.74   04/01/2011
$1,384.48   04/01/2011
$1,384.48   04/01/2011
$1,384.48   04/01/2011
$1,384.48   04/01/2011
$1,384.48   04/01/2011
$1,384.48   04/01/2011
$1,384.48   04/01/2011
$1,384.48   04/01/2011
$1,384.48   04/01/2011
$1,384.48   04/01/2011
$1,384.48   04/01/2011
$1,626.37   04/01/2011
$1,626.37   04/01/2011
$2,438.90   04/01/2011
$1,872.13   04/01/2011
$1,384.48   04/01/2011
$1,384.48   04/01/2011
  $245.47   04/01/2011
  $245.47   04/01/2011
  $245.47   04/01/2011
$1,447.41   04/01/2011
$1,447.41   04/01/2011
  $947.88   04/01/2011
  $184.73   04/01/2011
$6,812.16   04/01/2011
   $64.00   04/01/2011
$1,433.18   04/01/2011
  $124.18   04/01/2011



                                 Page 196
                         Surgery (triggers bundling)


  $124.18   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
$1,027.53   04/01/2011
$1,027.53   04/01/2011
  $184.73   04/01/2011
  $124.18   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
  $124.18   04/01/2011
  $124.18   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
  $226.20   04/01/2011
  $146.74   04/01/2011
$1,143.80   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
  $226.20   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
$1,563.35   04/01/2011
$1,563.35   04/01/2011
$1,563.35   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
  $124.18   04/01/2011
  $226.20   04/01/2011
  $184.73   04/01/2011
  $124.18   04/01/2011
   $10.81   04/01/2011
  $124.18   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
$2,408.69   04/01/2011
$1,563.35   04/01/2011
$1,563.35   04/01/2011
$1,563.35   04/01/2011
$1,563.35   04/01/2011
$2,408.69   04/01/2011
$1,563.35   04/01/2011
$1,563.35   04/01/2011
$2,408.69   04/01/2011
$2,408.69   04/01/2011
$1,563.35   04/01/2011
$2,408.69   04/01/2011
$1,563.35   04/01/2011
$1,563.35   04/01/2011
  $440.28   04/01/2011



                                 Page 197
                         Surgery (triggers bundling)


$1,563.35   04/01/2011
$2,408.69   04/01/2011
$1,563.35   04/01/2011
$1,563.35   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
  $184.73   04/01/2011
  $184.73   04/01/2011
$2,408.69   04/01/2011
$1,872.13   04/01/2011
  $440.28   04/01/2011
  $124.18   04/01/2011
  $184.73   04/01/2011
  $184.73   04/01/2011
  $184.73   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
  $226.20   04/01/2011
  $226.20   04/01/2011
  $440.28   04/01/2011
  $124.18   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
$1,563.35   04/01/2011
$1,563.35   04/01/2011
$1,563.35   04/01/2011
$2,408.69   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
  $124.18   04/01/2011
  $440.28   04/01/2011
$1,563.35   04/01/2011
  $124.18   04/01/2011
  $440.28   04/01/2011
$1,563.35   04/01/2011
$2,408.69   04/01/2011
$3,623.40   04/01/2011
$3,623.40   04/01/2011
$3,623.40   04/01/2011
$3,623.40   04/01/2011
$1,872.13   04/01/2011
$2,438.90   04/01/2011
$3,623.40   04/01/2011
$2,438.90   04/01/2011
$2,438.90   04/01/2011
$2,438.90   04/01/2011
$1,145.59   04/01/2011
$1,145.59   04/01/2011
$1,145.59   04/01/2011
$1,792.51   04/01/2011
$1,792.51   04/01/2011



                                 Page 198
                         Surgery (triggers bundling)


$1,145.59   04/01/2011
$1,792.51   04/01/2011
$2,408.69   04/01/2011
$2,438.90   04/01/2011
$2,438.90   04/01/2011
$2,438.90   04/01/2011
$2,438.90   04/01/2011
$1,872.13   04/01/2011
$1,145.59   04/01/2011
$1,563.35   04/01/2011
  $440.28   04/01/2011
$2,438.90   04/01/2011
$2,438.90   04/01/2011
$2,438.90   04/01/2011
$2,438.90   04/01/2011
$2,438.90   04/01/2011
$1,872.13   04/01/2011
  $440.28   04/01/2011
$1,563.35   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
$1,563.35   04/01/2011
$1,563.35   04/01/2011
   $10.81   04/01/2011
$2,438.90   04/01/2011
$2,438.90   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
  $440.28   04/01/2011
   $10.81   04/01/2011
$1,872.13   04/01/2011
   $10.81   04/01/2011
  $542.55   04/01/2011
  $151.59   04/01/2011
$1,388.94   04/01/2011
$1,388.94   04/01/2011
$1,388.94   04/01/2011
$1,388.94   04/01/2011
$1,388.94   04/01/2011
$1,388.94   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,388.94   04/01/2011
$1,388.94   04/01/2011



                                 Page 199
                          Surgery (triggers bundling)


   $151.59   04/01/2011
 $1,952.62   04/01/2011
 $1,144.56   04/01/2011
 $1,872.13   04/01/2011
 $1,388.94   04/01/2011
   $316.16   04/01/2011
   $316.16   04/01/2011
   $316.16   04/01/2011
   $316.16   04/01/2011
   $316.16   04/01/2011
   $316.16   04/01/2011
   $135.36   04/01/2011
 $2,298.29   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $6,258.34   04/01/2011
 $6,258.34   04/01/2011
 $1,022.03   04/01/2011
   $645.43   04/01/2011
 $1,186.29   04/01/2011
$13,354.03   04/01/2011
$20,821.06   04/01/2011
 $2,465.68   04/01/2011
   $316.16   04/01/2011
   $594.44   04/01/2011
 $2,298.29   04/01/2011
   $149.43   04/01/2011
   $316.16   04/01/2011
   $645.43   04/01/2011
   $151.59   04/01/2011
   $316.16   04/01/2011
   $347.47   04/01/2011
   $288.34   04/01/2011
   $288.34   04/01/2011
   $288.34   04/01/2011
   $316.16   04/01/2011
   $316.16   04/01/2011
   $316.16   04/01/2011
 $1,696.34   04/01/2011
   $316.16   04/01/2011
   $316.16   04/01/2011
   $316.16   04/01/2011
   $316.16   04/01/2011
   $316.16   04/01/2011
   $316.16   04/01/2011
 $2,298.29   04/01/2011
 $2,515.43   04/01/2011
   $645.43   04/01/2011
 $2,298.29   04/01/2011
 $9,132.38   04/01/2011
 $9,132.38   04/01/2011
 $1,696.34   04/01/2011
   $149.43   04/01/2011
   $149.43   04/01/2011
 $2,515.43   04/01/2011



                                  Page 200
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 $2,515.43   04/01/2011
 $2,515.43   04/01/2011
 $2,515.43   04/01/2011
 $2,515.43   04/01/2011
 $2,515.43   04/01/2011
 $2,515.43   04/01/2011
 $2,515.43   04/01/2011
 $2,515.43   04/01/2011
 $2,515.43   04/01/2011
 $2,515.43   04/01/2011
 $2,515.43   04/01/2011
 $2,515.43   04/01/2011
 $2,515.43   04/01/2011
 $2,515.43   04/01/2011
 $2,515.43   04/01/2011
 $2,515.43   04/01/2011
 $2,515.43   04/01/2011
 $2,515.43   04/01/2011
 $2,515.43   04/01/2011
 $2,515.43   04/01/2011
 $2,515.43   04/01/2011
 $2,515.43   04/01/2011
 $1,022.03   04/01/2011
 $1,022.03   04/01/2011
 $1,022.03   04/01/2011
 $2,992.02   04/01/2011
 $5,546.42   04/01/2011
 $1,186.29   04/01/2011
 $1,186.29   04/01/2011
 $1,186.29   04/01/2011
 $1,186.29   04/01/2011
$13,354.03   04/01/2011
 $2,465.68   04/01/2011
 $2,298.29   04/01/2011
 $2,298.29   04/01/2011
   $645.43   04/01/2011
   $201.09   04/01/2011
   $201.09   04/01/2011
   $288.34   04/01/2011
   $316.16   04/01/2011
   $316.16   04/01/2011
   $316.16   04/01/2011
   $288.34   04/01/2011
   $288.34   04/01/2011
   $316.16   04/01/2011
   $288.34   04/01/2011
   $288.34   04/01/2011
   $288.34   04/01/2011
   $316.16   04/01/2011
   $288.34   04/01/2011
   $316.16   04/01/2011
   $288.34   04/01/2011
   $316.16   04/01/2011
   $316.16   04/01/2011
   $288.34   04/01/2011



                                  Page 201
                          Surgery (triggers bundling)


   $316.16   04/01/2011
   $316.16   04/01/2011
   $288.34   04/01/2011
   $201.09   04/01/2011
   $316.16   04/01/2011
   $288.34   04/01/2011
   $316.16   04/01/2011
   $288.34   04/01/2011
   $316.16   04/01/2011
   $201.09   04/01/2011
   $201.09   04/01/2011
   $316.16   04/01/2011
   $201.09   04/01/2011
   $201.09   04/01/2011
   $201.09   04/01/2011
   $201.09   04/01/2011
   $316.16   04/01/2011
   $316.16   04/01/2011
   $316.16   04/01/2011
   $316.16   04/01/2011
 $2,992.02   04/01/2011
 $2,992.02   04/01/2011
 $2,992.02   04/01/2011
 $2,992.02   04/01/2011
 $2,992.02   04/01/2011
   $201.09   04/01/2011
$21,664.20   04/01/2011
 $1,186.29   04/01/2011
 $1,696.34   04/01/2011
$12,783.20   04/01/2011
 $5,546.42   04/01/2011
 $5,546.42   04/01/2011
 $5,546.42   04/01/2011
 $5,546.42   04/01/2011
 $1,186.29   04/01/2011
$13,354.03   04/01/2011
 $2,465.68   04/01/2011
   $645.43   04/01/2011
 $1,022.03   04/01/2011
 $1,022.03   04/01/2011
   $201.09   04/01/2011
   $201.09   04/01/2011
   $288.34   04/01/2011
   $288.34   04/01/2011
   $316.16   04/01/2011
   $645.43   04/01/2011
   $316.16   04/01/2011
   $316.16   04/01/2011
   $201.09   04/01/2011
   $316.16   04/01/2011
   $201.09   04/01/2011
   $316.16   04/01/2011
   $201.09   04/01/2011
   $201.09   04/01/2011
   $316.16   04/01/2011



                                  Page 202
                         Surgery (triggers bundling)


  $645.43   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,696.34   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,696.34   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,696.34   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,022.03   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,665.86   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011



                                 Page 203
                         Surgery (triggers bundling)


$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
$1,696.34   04/01/2011
  $201.09   04/01/2011
$1,787.12   04/01/2011
$1,787.12   04/01/2011
$1,787.12   04/01/2011
$1,787.12   04/01/2011
$1,787.12   04/01/2011
$1,787.12   04/01/2011
$1,787.12   04/01/2011
$1,787.12   04/01/2011
$1,390.66   04/01/2011
$1,390.66   04/01/2011
$1,390.66   04/01/2011
$1,787.12   04/01/2011
$1,390.66   04/01/2011
$1,787.12   04/01/2011
  $941.58   04/01/2011
  $140.00   04/01/2011
  $140.00   04/01/2011
  $140.00   04/01/2011
  $140.00   04/01/2011
  $867.71   04/01/2011
  $306.47   04/01/2011
  $592.24   04/01/2011
  $941.58   04/01/2011
$1,308.00   04/01/2011
$1,308.00   04/01/2011
  $592.24   04/01/2011
$1,364.80   04/01/2011
  $408.43   04/01/2011
$1,220.73   04/01/2011
  $867.71   04/01/2011



                                 Page 204
                         Surgery (triggers bundling)


  $867.71   04/01/2011
  $867.71   04/01/2011
$1,308.00   04/01/2011
  $140.00   04/01/2011
  $396.00   04/01/2011
  $867.71   04/01/2011
  $118.61   04/01/2011
  $941.58   04/01/2011
$2,345.79   04/01/2011
$2,345.79   04/01/2011
$2,345.79   04/01/2011
$2,345.79   04/01/2011
$2,345.79   04/01/2011
$3,055.99   04/01/2011
  $867.71   04/01/2011
  $867.71   04/01/2011
  $396.00   04/01/2011
  $492.97   04/01/2011
$2,345.79   04/01/2011
$2,345.79   04/01/2011
$2,345.79   04/01/2011
  $867.71   04/01/2011
  $867.71   04/01/2011
$1,308.00   04/01/2011
$1,308.00   04/01/2011
  $408.43   04/01/2011
$1,308.00   04/01/2011
  $334.45   04/01/2011
  $334.45   04/01/2011
  $867.71   04/01/2011
$1,308.00   04/01/2011
$1,308.00   04/01/2011
  $867.71   04/01/2011
  $867.71   04/01/2011
$1,308.00   04/01/2011
$1,308.00   04/01/2011
  $867.71   04/01/2011
  $408.43   04/01/2011
$1,308.00   04/01/2011
$1,308.00   04/01/2011
$1,308.00   04/01/2011
$1,308.00   04/01/2011
$1,308.00   04/01/2011
$1,308.00   04/01/2011
$1,308.00   04/01/2011
$1,718.41   04/01/2011
$1,718.41   04/01/2011
$1,718.41   04/01/2011
$1,308.00   04/01/2011
$1,364.80   04/01/2011
$1,718.41   04/01/2011
  $867.71   04/01/2011
  $408.43   04/01/2011
  $408.43   04/01/2011
$1,308.00   04/01/2011



                                 Page 205
                         Surgery (triggers bundling)


$1,308.00   04/01/2011
  $867.71   04/01/2011
$1,308.00   04/01/2011
$1,308.00   04/01/2011
$1,308.00   04/01/2011
$1,308.00   04/01/2011
  $867.71   04/01/2011
  $867.71   04/01/2011
  $867.71   04/01/2011
  $867.71   04/01/2011
$1,308.00   04/01/2011
  $334.45   04/01/2011
  $334.45   04/01/2011
  $334.45   04/01/2011
  $408.43   04/01/2011
  $334.45   04/01/2011
$1,308.00   04/01/2011
  $408.43   04/01/2011
  $823.50   04/01/2011
$1,681.77   04/01/2011
$1,681.77   04/01/2011
$1,681.77   04/01/2011
$1,681.77   04/01/2011
  $823.50   04/01/2011
$1,378.62   04/01/2011
$1,378.62   04/01/2011
$1,378.62   04/01/2011
$1,378.62   04/01/2011
$1,378.62   04/01/2011
  $408.43   04/01/2011
  $592.24   04/01/2011
$1,364.80   04/01/2011
$1,364.80   04/01/2011
  $592.24   04/01/2011
$1,364.80   04/01/2011
  $536.34   04/01/2011
  $592.24   04/01/2011
  $334.45   04/01/2011
$1,364.80   04/01/2011
$1,364.80   04/01/2011
$1,364.80   04/01/2011
$1,364.80   04/01/2011
$1,364.80   04/01/2011
$1,364.80   04/01/2011
  $592.24   04/01/2011
  $334.45   04/01/2011
$1,364.80   04/01/2011
$1,364.80   04/01/2011
  $592.24   04/01/2011
$1,364.80   04/01/2011
$1,364.80   04/01/2011
  $592.24   04/01/2011
  $592.24   04/01/2011
  $592.24   04/01/2011
  $306.47   04/01/2011



                                 Page 206
                         Surgery (triggers bundling)


  $334.45   04/01/2011
  $306.47   04/01/2011
  $334.45   04/01/2011
  $592.24   04/01/2011
  $306.47   04/01/2011
  $306.47   04/01/2011
  $306.47   04/01/2011
  $592.24   04/01/2011
  $334.45   04/01/2011
  $334.45   04/01/2011
  $941.58   04/01/2011
  $592.24   04/01/2011
  $306.47   04/01/2011
$1,220.73   04/01/2011
$1,220.73   04/01/2011
$1,220.73   04/01/2011
$1,220.73   04/01/2011
$1,220.73   04/01/2011
$1,220.73   04/01/2011
$1,220.73   04/01/2011
$1,220.73   04/01/2011
$1,220.73   04/01/2011
$1,220.73   04/01/2011
$1,220.73   04/01/2011
$1,220.73   04/01/2011
  $536.34   04/01/2011
  $722.03   04/01/2011
$1,220.73   04/01/2011
  $941.58   04/01/2011
$1,390.66   04/01/2011
  $941.58   04/01/2011
$1,390.66   04/01/2011
$1,787.12   04/01/2011
  $941.58   04/01/2011
$1,787.12   04/01/2011
$1,787.12   04/01/2011
$1,787.12   04/01/2011
$1,787.12   04/01/2011
$1,787.12   04/01/2011
  $118.61   04/01/2011
  $536.34   04/01/2011
  $536.34   04/01/2011
$1,787.12   04/01/2011
$1,390.66   04/01/2011
$1,787.12   04/01/2011
  $536.34   04/01/2011
  $536.34   04/01/2011
  $396.00   04/01/2011
  $941.58   04/01/2011
  $536.34   04/01/2011
  $396.00   04/01/2011
  $536.34   04/01/2011
  $941.58   04/01/2011
  $536.34   04/01/2011
  $140.00   04/01/2011



                                 Page 207
                         Surgery (triggers bundling)


  $536.34   04/01/2011
  $396.00   04/01/2011
  $941.58   04/01/2011
  $396.00   04/01/2011
  $396.00   04/01/2011
  $396.00   04/01/2011
  $867.71   04/01/2011
  $941.58   04/01/2011
$1,390.66   04/01/2011
  $941.58   04/01/2011
$1,390.66   04/01/2011
  $941.58   04/01/2011
  $941.58   04/01/2011
  $941.58   04/01/2011
  $941.58   04/01/2011
  $941.58   04/01/2011
  $941.58   04/01/2011
  $941.58   04/01/2011
  $941.58   04/01/2011
  $941.58   04/01/2011
  $941.58   04/01/2011
  $941.58   04/01/2011
  $941.58   04/01/2011
  $941.58   04/01/2011
  $941.58   04/01/2011
  $941.58   04/01/2011
  $941.58   04/01/2011
  $941.58   04/01/2011
  $118.61   04/01/2011
  $941.58   04/01/2011
  $941.58   04/01/2011
  $941.58   04/01/2011
  $941.58   04/01/2011
$1,390.66   04/01/2011
  $941.58   04/01/2011
  $941.58   04/01/2011
  $536.34   04/01/2011
  $536.34   04/01/2011
  $140.00   04/01/2011
  $408.43   04/01/2011
  $722.03   04/01/2011
  $941.58   04/01/2011
  $867.71   04/01/2011
  $396.00   04/01/2011
  $140.00   04/01/2011
$1,390.66   04/01/2011
$1,390.66   04/01/2011
  $941.58   04/01/2011
$1,390.66   04/01/2011
$1,308.00   04/01/2011
$1,390.66   04/01/2011
  $941.58   04/01/2011
$1,308.00   04/01/2011
$1,308.00   04/01/2011
  $867.71   04/01/2011



                                 Page 208
                         Surgery (triggers bundling)


  $536.34   04/01/2011
  $536.34   04/01/2011
  $941.58   04/01/2011
  $536.34   04/01/2011
$1,390.66   04/01/2011
$1,390.66   04/01/2011
  $941.58   04/01/2011
$1,390.66   04/01/2011
  $941.58   04/01/2011
  $536.34   04/01/2011
  $941.58   04/01/2011
$1,390.66   04/01/2011
  $941.58   04/01/2011
  $536.34   04/01/2011
$1,390.66   04/01/2011
$1,390.66   04/01/2011
$1,390.66   04/01/2011
  $536.34   04/01/2011
  $536.34   04/01/2011
$1,390.66   04/01/2011
  $140.00   04/01/2011
  $536.34   04/01/2011
  $941.58   04/01/2011
  $941.58   04/01/2011
  $941.58   04/01/2011
  $118.61   04/01/2011
  $536.34   04/01/2011
  $116.57   04/01/2011
$1,143.80   04/01/2011
  $116.57   04/01/2011
  $685.47   04/01/2011
  $928.01   04/01/2011
  $879.68   04/01/2011
$1,313.37   04/01/2011
$1,313.37   04/01/2011
  $879.68   04/01/2011
  $542.55   04/01/2011
  $173.31   04/01/2011
  $928.01   04/01/2011
$1,313.37   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
  $195.16   04/01/2011
  $685.47   04/01/2011
  $685.47   04/01/2011
  $542.55   04/01/2011
  $685.47   04/01/2011
  $928.01   04/01/2011
  $928.01   04/01/2011
  $542.55   04/01/2011
  $928.01   04/01/2011
$1,313.37   04/01/2011
$1,952.62   04/01/2011
$1,952.62   04/01/2011
$1,313.37   04/01/2011



                                 Page 209
                          Surgery (triggers bundling)


 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
   $928.01   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,313.37   04/01/2011
 $1,313.37   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,313.37   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $5,927.26   04/01/2011
 $5,927.26   04/01/2011
 $5,927.26   04/01/2011
 $5,927.26   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
   $195.16   04/01/2011
 $1,313.37   04/01/2011
 $1,313.37   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
 $1,952.62   04/01/2011
$26,968.07   04/01/2011
   $195.16   04/01/2011



                                  Page 210
                            Surgery (triggers bundling)


$1,952.62   04/01/2011
$1,952.62   04/01/2011
  $195.16   04/01/2011
  $287.60   04/01/2011
  $287.60   04/01/2011
  $287.60   04/01/2011
  $101.07   04/01/2011
   $61.88   04/01/2011
  $100.66   04/01/2011
$1,715.61   04/01/2011
$1,715.61   04/01/2011
$1,715.61   04/01/2011
  $550.76   04/01/2011
  $550.76   04/01/2011
  $550.76   04/01/2011
  $550.76   04/01/2011
  $514.49   04/01/2011
  $337.55   04/01/2011
   $64.00   04/01/2011
  $337.55   04/01/2011
  $722.03   04/01/2011
  $722.03   04/01/2011
   $47.38   04/01/2011
  $140.00   04/01/2011
  $140.00   04/01/2011
   $47.38   04/01/2011
  $140.00   04/01/2011
  $140.00   04/01/2011
  $140.00      04/01/2011
   $47.38      04/01/2011
   $47.38      04/01/2011
   $47.38      04/01/2011
   $47.38      04/01/2011
   $47.38      04/01/2011
  $140.00      04/01/2011
   $47.38      04/01/2011
   $47.38      04/01/2011
  $140.00      04/01/2011
  $118.61      04/01/2011
  $118.61      04/01/2011
  $118.61      04/01/2011
  $140.00      04/01/2011
   $47.38      04/01/2011
  $140.00      04/01/2011
   $47.38      04/01/2011
  $118.61      04/01/2011
   $47.38      04/01/2011
  $140.00      04/01/2011
  $140.00      04/01/2011
  $118.61      04/01/2011
  $118.61      04/01/2011
   $47.38      04/01/2011
  $685.47      04/01/2011
   $43.69      04/01/2011
  $312.67      04/01/2011



                                    Page 211
                            Surgery (triggers bundling)


  $312.67      04/01/2011
$2,605.46      04/01/2011
  $776.07      04/01/2011
  $252.48      04/01/2011
$4,925.63      04/01/2011
$4,925.63      04/01/2011
$3,361.68      04/01/2011
$3,361.68      04/01/2011
$3,361.68      04/01/2011
$3,361.68      04/01/2011
$3,361.68      04/01/2011
$6,258.34      04/01/2011
$6,258.34      04/01/2011
$3,361.68      04/01/2011
$3,361.68      04/01/2011
  $810.73      04/01/2011
   $28.28      04/01/2011
   $28.28      04/01/2011
   $28.28      04/01/2011
   $34.59      04/01/2011
   $34.59      04/01/2011
   $34.59      04/01/2011
   $28.28      04/01/2011
   $28.28      04/01/2011
   $34.59      04/01/2011
   $28.28      04/01/2011
   $28.28      04/01/2011
   $34.59      04/01/2011
   $34.59      04/01/2011
   $34.59      04/01/2011
   $34.59      04/01/2011
  $192.35   04/01/2011
  $359.36   04/01/2011
$2,202.15   04/01/2011
$2,202.15   04/01/2011
$2,202.15   04/01/2011
$2,202.15   04/01/2011
$2,202.15   04/01/2011
$2,202.15   04/01/2011
$2,202.15   04/01/2011
$2,202.15   04/01/2011
$2,202.15   04/01/2011
$2,202.15   04/01/2011
$2,202.15   04/01/2011
$2,202.15   04/01/2011
$2,202.15   04/01/2011
  $776.07   04/01/2011
  $776.07   04/01/2011
$2,202.15   04/01/2011
$2,202.15   04/01/2011
$2,202.15   04/01/2011
$2,202.15   04/01/2011
$2,202.15   04/01/2011
$2,202.15   04/01/2011
$2,202.15   04/01/2011



                                    Page 212
                         Surgery (triggers bundling)


$2,202.15   04/01/2011
$2,202.15   04/01/2011
$2,202.15   04/01/2011
$2,202.15   04/01/2011
$2,202.15   04/01/2011
$2,202.15   04/01/2011
$5,135.34   04/01/2011
$5,135.34   04/01/2011
  $628.53   04/01/2011
  $628.53   04/01/2011
  $628.53   04/01/2011
  $628.53   04/01/2011
  $628.53   04/01/2011
  $628.53   04/01/2011
  $628.53   04/01/2011
  $628.53   04/01/2011
  $121.63   04/01/2011
   $52.82   04/01/2011
   $67.61   04/01/2011
   $39.00   04/01/2011
   $93.15   04/01/2011
   $93.15   04/01/2011
   $93.15   04/01/2011
  $196.86   04/01/2011
  $153.69   04/01/2011
  $153.69   04/01/2011
  $153.69   04/01/2011
  $153.69   04/01/2011
  $153.69   04/01/2011
   $90.41   04/01/2011
   $10.81   04/01/2011
  $387.33   04/01/2011
$6,258.34   04/01/2011
$6,258.34   04/01/2011
$6,258.34   04/01/2011
$6,258.34   04/01/2011
$1,500.48   04/01/2011
$1,500.48   04/01/2011
$1,500.48   04/01/2011
$1,500.48   04/01/2011
  $774.61   04/01/2011
  $557.65   04/01/2011
  $557.65   04/01/2011
$1,308.00   04/01/2011
  $519.44   04/01/2011
  $519.44   04/01/2011
  $457.41   04/01/2011
  $140.00   04/01/2011
   $47.38   04/01/2011
  $457.41   04/01/2011
   $90.41   04/01/2011
  $105.96   04/01/2011
  $306.47   04/01/2011
  $173.31   04/01/2011
  $316.16   04/01/2011



                                 Page 213
                         Surgery (triggers bundling)


$6,383.70   04/01/2011
$6,383.70   04/01/2011
$2,529.34   04/01/2011
$2,515.43   04/01/2011




                                 Page 214
        All Other (no trigger bundling)


PROC
00100
00102
00103
00104
00120
00124
00126
00140
00142
00144
00145
00147
00148
00160
00162
00164
0016T
00170
00172
00174
00176
0017T
00190
00192
00210
00211
00212
00214
00215
00216
00218
00220
00222
00300
00320
00322
00326
00350
00352
00400
00402
00404
00406
00410
00450
00452
00454
00470
00472
00474
0048T



                  Page 215
        All Other (no trigger bundling)


00500
0050T
00520
00522
00524
00528
00529
00530
00532
00534
00537
00539
00540
00541
00542
00546
00548
0054T
00550
0055T
00560
00561
00562
00563
00566
00567
00580
00600
00604
00620
00622
00625
00626
00630
00632
00634
00635
00640
00670
00700
00702
00730
0073T
00740
00750
00752
00754
00756
00770
00790
00792
00794



                  Page 216
        All Other (no trigger bundling)


00796
00797
00800
00802
00810
00820
00830
00832
00834
00836
00840
00842
00844
00846
00848
00851
00860
00862
00864
00865
00866
00868
00870
00872
00873
00880
00882
00902
00904
00906
00908
00910
00912
00914
00916
00918
00920
00921
00922
00924
00926
00928
0092T
00930
00932
00934
00936
00940
00942
00944
00948
00950



                  Page 217
        All Other (no trigger bundling)


00952
0095T
0098T
01112
01120
01130
01140
01150
01160
01170
01173
01180
01190
01200
01202
01210
01212
01214
01215
01220
01230
01232
01234
01250
01260
01270
01272
01274
01320
01340
01360
01380
01382
01390
01392
01400
01402
01404
01420
01430
01432
01440
01442
01444
01462
01464
01470
01472
01474
01480
01482
01484



                  Page 218
        All Other (no trigger bundling)


01486
01490
01500
01502
01520
01522
01610
01620
01622
01630
01634
01636
01638
0163T
0164T
01650
01652
01654
01656
0165T
0166T
01670
0167T
01680
01682
0169T
01710
01712
01714
01716
01730
01732
01740
01742
01744
01756
01758
01760
01770
01772
01780
01782
01810
01820
01829
01830
01832
01840
01842
01844
0184T
01850



                  Page 219
        All Other (no trigger bundling)


01852
01860
0186T
0187T
0190T
01916
0191T
01920
01922
01924
01925
01926
0192T
01930
01931
01932
01933
01935
01936
01951
01952
01953
01958
01960
01961
01962
01963
01965
01966
01967
01968
01969
01991
01992
01996
01999
0235T
0254T
0255T
0258T
0259T
11004
11005
11006
11008
11975
11977
11980
11981
11982
11983
15756



                  Page 220
        All Other (no trigger bundling)


15757
15758
15852
15860
16035
16036
19030
19271
19272
19290
19291
19295
19305
19306
19361
19364
19367
19368
19369
20501
20661
20664
20665
20802
20805
20808
20816
20824
20827
20838
20930
20931
20936
20937
20938
20955
20956
20957
20962
20969
20970
20974
20975
20979
21045
21116
21141
21142
21143
21145
21146
21147



                  Page 221
        All Other (no trigger bundling)


21151
21154
21155
21159
21160
21179
21180
21182
21183
21184
21188
21193
21194
21196
21247
21255
21256
21268
21343
21344
21346
21347
21348
21360
21365
21366
21385
21395
21422
21423
21431
21432
21433
21435
21436
21510
21615
21616
21620
21627
21630
21632
21705
21740
21750
21810
21825
22010
22015
22110
22112
22114



                  Page 222
        All Other (no trigger bundling)


22116
22206
22207
22208
22210
22212
22214
22216
22220
22224
22226
22318
22319
22325
22326
22327
22328
22532
22533
22534
22548
22551
22552
22554
22556
22558
22585
22590
22595
22600
22610
22630
22632
22800
22802
22804
22808
22810
22812
22818
22819
22830
22840
22841
22842
22843
22844
22845
22846
22847
22848
22849



                  Page 223
        All Other (no trigger bundling)


22850
22851
22852
22855
22856
22857
22861
22862
22864
22865
23200
23210
23220
23332
23350
23472
23900
23920
24220
24420
24900
24920
24930
24931
24940
25246
25900
25905
25909
25915
25920
25924
25927
25931
26551
26553
26554
26556
26992
27005
27006
27025
27030
27036
27054
27070
27071
27075
27076
27077
27078
27090



                  Page 224
        All Other (no trigger bundling)


27091
27093
27095
27096
27120
27122
27125
27130
27132
27134
27137
27138
27140
27146
27147
27151
27156
27158
27161
27165
27170
27175
27176
27177
27178
27179
27181
27185
27187
27215
27216
27217
27218
27222
27226
27227
27228
27232
27236
27240
27244
27245
27248
27253
27254
27258
27259
27268
27269
27280
27282
27284



                  Page 225
        All Other (no trigger bundling)


27286
27290
27295
27303
27365
27370
27445
27447
27448
27450
27454
27455
27457
27465
27466
27468
27470
27472
27477
27485
27486
27487
27488
27495
27506
27507
27511
27513
27514
27519
27535
27536
27540
27556
27557
27558
27580
27590
27591
27592
27596
27598
27645
27646
27648
27702
27703
27712
27715
27720
27722
27724



                  Page 226
        All Other (no trigger bundling)


27725
27726
27727
27880
27881
27882
27886
27888
28800
28805
30300
31225
31230
31290
31291
31360
31365
31367
31368
31370
31375
31380
31382
31390
31395
31584
31587
31620
31627
31715
31725
31760
31766
31770
31775
31780
31781
31786
31800
31805
32035
32036
32095
32100
32110
32120
32124
32140
32141
32150
32151
32160



                  Page 227
        All Other (no trigger bundling)


32200
32215
32220
32225
32310
32320
32402
32440
32442
32445
32480
32482
32484
32486
32488
32491
32500
32501
32503
32504
32540
32553
32650
32651
32652
32653
32654
32655
32656
32657
32658
32659
32660
32661
32662
32663
32664
32665
32800
32810
32815
32820
32850
32851
32852
32853
32854
32855
32856
32900
32905
32906



                  Page 228
        All Other (no trigger bundling)


32940
32997
33015
33020
33025
33030
33031
33050
33120
33130
33140
33141
33202
33203
33236
33237
33238
33240
33243
33249
33250
33251
33254
33255
33256
33257
33258
33259
33261
33265
33266
33300
33305
33310
33315
33320
33321
33322
33330
33332
33335
33400
33401
33403
33404
33405
33406
33410
33411
33412
33413
33414



                  Page 229
        All Other (no trigger bundling)


33415
33416
33417
33420
33422
33425
33426
33427
33430
33460
33463
33464
33465
33468
33470
33472
33474
33475
33476
33478
33496
33500
33501
33502
33503
33504
33505
33506
33507
33508
33510
33511
33512
33513
33514
33516
33517
33518
33519
33521
33522
33523
33530
33533
33534
33535
33536
33542
33545
33548
33572
33600



                  Page 230
        All Other (no trigger bundling)


33602
33606
33608
33610
33611
33612
33615
33617
33619
33620
33621
33622
33641
33645
33647
33660
33665
33670
33675
33676
33677
33681
33684
33688
33690
33692
33694
33697
33702
33710
33720
33722
33724
33726
33730
33732
33735
33736
33737
33750
33755
33762
33764
33766
33767
33768
33770
33771
33774
33775
33776
33777



                  Page 231
        All Other (no trigger bundling)


33778
33779
33780
33781
33782
33783
33786
33788
33800
33802
33803
33813
33814
33820
33822
33824
33840
33845
33851
33852
33853
33860
33861
33863
33864
33870
33875
33877
33880
33881
33883
33884
33886
33889
33891
33910
33915
33916
33917
33920
33922
33924
33925
33926
33930
33933
33935
33940
33944
33945
33960
33961



                  Page 232
        All Other (no trigger bundling)


33967
33968
33970
33971
33973
33974
33975
33976
33977
33978
33979
33980
33981
33982
33983
34001
34051
34151
34401
34451
34502
34800
34802
34803
34804
34805
34808
34812
34813
34820
34825
34826
34830
34831
34832
34833
34834
34900
35001
35002
35005
35013
35021
35022
35045
35081
35082
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35112
35121
35122
35131
35132
35141
35142
35151
35152
35182
35189
35211
35216
35221
35241
35246
35251
35271
35276
35281
35301
35302
35303
35304
35305
35306
35311
35331
35341
35351
35355
35361
35363
35371
35372
35390
35400
35450
35452
35454
35456
35480
35481
35482
35483
35501
35506
35508
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                  Page 234
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35516
35518
35521
35522
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35525
35526
35531
35533
35535
35536
35537
35538
35539
35540
35548
35549
35551
35556
35558
35560
35563
35565
35566
35570
35571
35572
35583
35585
35587
35600
35601
35606
35612
35616
35621
35623
35626
35631
35632
35633
35634
35636
35637
35638
35642
35645
35646
35647
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35651



                  Page 235
        All Other (no trigger bundling)


35654
35656
35661
35663
35665
35666
35671
35681
35682
35691
35693
35694
35695
35697
35700
35701
35721
35741
35800
35820
35840
35870
35901
35905
35907
36000
36002
36005
36010
36011
36012
36013
36014
36015
36100
36120
36140
36148
36160
36200
36215
36216
36217
36218
36245
36246
36247
36248
36299
36400
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36406



                  Page 236
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36410
36415
36416
36420
36425
36481
36500
36510
36591
36592
36598
36600
36620
36625
36660
36822
36823
37140
37145
37160
37180
37181
37182
37215
37216
37250
37251
37616
37617
37618
37660
37788
37799
38100
38101
38102
38115
38200
38204
38205
38207
38208
38209
38210
38211
38212
38213
38214
38215
38380
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38382



                  Page 237
        All Other (no trigger bundling)


38562
38564
38724
38746
38747
38765
38770
38780
38790
38792
38794
38900
39000
39010
39200
39220
39499
39501
39502
39503
39520
39530
39531
39540
39541
39545
39560
39561
39599
40804
41130
41135
41140
41145
41150
41153
41155
42426
42550
42809
42845
42894
42953
42961
42971
43045
43100
43101
43107
43108
43112
43113



                  Page 238
        All Other (no trigger bundling)


43116
43117
43118
43121
43122
43123
43124
43135
43279
43281
43282
43283
43300
43305
43310
43312
43313
43314
43320
43324
43325
43326
43327
43328
43330
43331
43332
43333
43334
43335
43336
43337
43338
43340
43341
43350
43351
43352
43360
43361
43400
43401
43405
43410
43415
43425
43460
43496
43500
43501
43502
43520



                  Page 239
        All Other (no trigger bundling)


43605
43610
43611
43620
43621
43622
43631
43632
43633
43634
43635
43640
43641
43644
43645
43752
43753
43754
43756
43757
43770
43771
43772
43773
43774
43775
43800
43810
43820
43825
43832
43840
43842
43843
43845
43846
43847
43848
43850
43855
43860
43865
43880
43882
44005
44010
44015
44020
44021
44025
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44055



                  Page 240
        All Other (no trigger bundling)


44110
44111
44120
44121
44125
44126
44127
44128
44130
44132
44133
44135
44136
44137
44139
44140
44141
44143
44144
44145
44146
44147
44150
44151
44155
44156
44157
44158
44160
44187
44188
44202
44203
44204
44205
44210
44211
44212
44227
44300
44310
44314
44316
44320
44322
44345
44346
44602
44603
44604
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44615



                  Page 241
        All Other (no trigger bundling)


44620
44625
44626
44640
44650
44660
44661
44680
44700
44701
44715
44720
44721
44800
44820
44850
44899
44900
44950
44955
44960
45110
45111
45112
45113
45114
45116
45119
45120
45121
45123
45126
45130
45135
45136
45395
45397
45400
45402
45540
45550
45562
45563
45800
45805
45820
45825
46505
46600
46705
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46712



                  Page 242
        All Other (no trigger bundling)


46715
46716
46730
46735
46740
46742
46744
46746
46748
46751
47001
47010
47015
47100
47120
47122
47125
47130
47133
47135
47136
47140
47141
47142
47143
47144
47145
47146
47147
47300
47350
47360
47361
47362
47380
47381
47400
47420
47425
47460
47480
47500
47505
47550
47570
47600
47605
47610
47612
47620
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47701



                  Page 243
        All Other (no trigger bundling)


47711
47712
47715
47720
47721
47740
47741
47760
47765
47780
47785
47800
47801
47802
47900
48000
48001
48020
48100
48105
48120
48140
48145
48146
48148
48150
48152
48153
48154
48155
48160
48400
48500
48510
48520
48540
48545
48547
48548
48550
48551
48552
48554
48556
49000
49002
49010
49020
49040
49060
49062
49203



                  Page 244
        All Other (no trigger bundling)


49204
49205
49215
49220
49255
49400
49411
49412
49424
49425
49427
49428
49465
49605
49606
49610
49611
49900
49904
49905
49906
50010
50040
50045
50060
50065
50070
50075
50100
50120
50125
50130
50135
50205
50220
50225
50230
50234
50236
50240
50250
50280
50290
50300
50320
50323
50325
50327
50328
50329
50340
50360



                  Page 245
        All Other (no trigger bundling)


50365
50370
50380
50394
50400
50405
50500
50520
50525
50526
50540
50545
50546
50547
50548
50580
50600
50605
50610
50620
50630
50650
50660
50684
50690
50700
50715
50722
50725
50728
50740
50750
50760
50770
50780
50782
50783
50785
50800
50810
50815
50820
50825
50830
50840
50845
50860
50900
50920
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51060



                  Page 246
        All Other (no trigger bundling)


51525
51530
51535
51550
51555
51565
51570
51575
51580
51585
51590
51595
51596
51597
51600
51605
51610
51701
51702
51798
51800
51820
51840
51841
51865
51900
51920
51925
51940
51960
51980
53415
53448
54125
54130
54135
54230
54390
54411
54417
54430
54435
54650
55300
55605
55650
55801
55810
55812
55815
55821
55831



                  Page 247
        All Other (no trigger bundling)


55840
55842
55845
55862
55865
55866
55875
55876
56630
56631
56632
56633
56634
56637
56640
57110
57111
57112
57270
57280
57282
57283
57292
57296
57305
57307
57308
57311
57335
57531
57540
57545
58110
58140
58146
58150
58152
58180
58200
58210
58240
58260
58262
58263
58267
58270
58275
58280
58285
58290
58291
58292



                  Page 248
        All Other (no trigger bundling)


58293
58294
58300
58340
58400
58410
58520
58540
58548
58605
58611
58700
58720
58740
58805
58822
58825
58940
58943
58950
58951
58952
58953
58954
58956
58957
58958
58960
59000
59001
59012
59015
59020
59025
59030
59050
59051
59070
59074
59076
59100
59120
59121
59130
59135
59136
59140
59200
59325
59350
59400
59410



                  Page 249
        All Other (no trigger bundling)


59425
59426
59430
59510
59514
59515
59525
59610
59614
59618
59620
59622
59830
59850
59851
59852
59855
59856
59857
60254
60270
60271
60502
60505
60520
60521
60522
60540
60545
60600
60605
60650
61105
61107
61108
61120
61140
61150
61151
61154
61156
61210
61250
61253
61304
61305
61312
61313
61314
61315
61316
61320



                  Page 250
        All Other (no trigger bundling)


61321
61322
61323
61332
61333
61340
61343
61345
61440
61450
61458
61460
61470
61480
61490
61500
61501
61510
61512
61514
61516
61517
61518
61519
61520
61521
61522
61524
61526
61530
61531
61533
61534
61535
61536
61537
61538
61539
61540
61541
61542
61543
61544
61545
61546
61548
61550
61552
61556
61557
61558
61559



                  Page 251
        All Other (no trigger bundling)


61563
61564
61566
61567
61570
61571
61575
61576
61580
61581
61582
61583
61584
61585
61586
61590
61591
61592
61595
61596
61597
61598
61600
61601
61605
61606
61607
61608
61609
61610
61611
61612
61613
61615
61616
61618
61619
61624
61680
61682
61684
61686
61690
61692
61697
61698
61700
61702
61703
61705
61708
61710



                  Page 252
        All Other (no trigger bundling)


61711
61720
61735
61750
61751
61760
61770
61795
61796
61797
61798
61799
61800
61850
61860
61863
61864
61867
61868
61870
61875
62000
62005
62010
62100
62115
62116
62117
62120
62121
62140
62141
62142
62143
62145
62146
62147
62148
62160
62161
62162
62163
62164
62165
62180
62190
62192
62200
62201
62220
62223
62256



                  Page 253
        All Other (no trigger bundling)


62258
62284
62290
62291
63043
63044
63050
63051
63076
63077
63078
63081
63082
63085
63086
63087
63088
63090
63091
63101
63102
63103
63170
63172
63173
63180
63182
63185
63190
63191
63194
63195
63196
63197
63198
63199
63200
63250
63251
63252
63265
63266
63267
63268
63270
63271
63272
63273
63275
63276
63277
63278



                  Page 254
        All Other (no trigger bundling)


63280
63281
63282
63283
63285
63286
63287
63290
63295
63300
63301
63302
63303
63304
63305
63306
63307
63308
63620
63621
63700
63702
63704
63706
63707
63709
63710
63740
64550
64752
64755
64760
64804
64809
64818
64866
64868
65273
65757
66990
68850
69155
69200
69205
69210
69535
69554
69710
69950
69970
69990
70010



                  Page 255
        All Other (no trigger bundling)


70015
70030
70100
70110
70120
70130
70134
70140
70150
70160
70170
70190
70200
70210
70220
70240
70250
70260
70300
70310
70320
70328
70330
70332
70336
70350
70355
70360
70370
70371
70373
70380
70390
70450
70460
70470
70480
70481
70482
70486
70487
70488
70490
70491
70492
70496
70498
70540
70542
70543
70544
70545



                  Page 256
        All Other (no trigger bundling)


70546
70547
70548
70549
70551
70552
70553
70554
70555
70557
70558
70559
71010
71015
71020
71021
71022
71023
71030
71034
71035
71040
71060
71090
71100
71101
71110
71111
71120
71130
71250
71260
71270
71275
71550
71551
71552
71555
72010
72020
72040
72050
72052
72069
72070
72072
72074
72080
72090
72100
72110
72114



                  Page 257
        All Other (no trigger bundling)


72120
72125
72126
72127
72128
72129
72130
72131
72132
72133
72141
72142
72146
72147
72148
72149
72156
72157
72158
72159
72170
72190
72191
72192
72193
72194
72195
72196
72197
72198
72200
72202
72220
72240
72255
72265
72270
72275
72285
72291
72292
72295
73000
73010
73020
73030
73040
73050
73060
73070
73080
73085



                  Page 258
        All Other (no trigger bundling)


73090
73092
73100
73110
73115
73120
73130
73140
73200
73201
73202
73206
73218
73219
73220
73221
73222
73223
73225
73500
73510
73520
73525
73530
73540
73542
73550
73560
73562
73564
73565
73580
73590
73592
73600
73610
73615
73620
73630
73650
73660
73700
73701
73702
73706
73718
73719
73720
73721
73722
73723
73725



                  Page 259
        All Other (no trigger bundling)


74000
74010
74020
74022
74150
74160
74170
74175
74176
74177
74178
74181
74182
74183
74185
74190
74210
74220
74230
74235
74240
74241
74245
74246
74247
74249
74250
74251
74260
74261
74262
74263
74270
74280
74283
74290
74291
74300
74301
74305
74320
74327
74328
74329
74330
74340
74355
74360
74363
74400
74410
74415



                  Page 260
        All Other (no trigger bundling)


74420
74425
74430
74440
74445
74450
74455
74470
74475
74480
74485
74710
74740
74775
75557
75559
75561
75563
75565
75571
75600
75605
75625
75630
75635
75650
75658
75660
75662
75665
75671
75676
75680
75685
75705
75710
75716
75722
75724
75726
75731
75733
75736
75741
75743
75746
75756
75774
75791
75801
75803
75805



                  Page 261
        All Other (no trigger bundling)


75807
75809
75810
75820
75822
75825
75827
75831
75833
75840
75842
75860
75870
75872
75880
75885
75887
75889
75891
75893
75894
75896
75898
75900
75901
75902
75940
75945
75946
75952
75953
75954
75956
75957
75958
75959
75960
75961
75962
75964
75966
75968
75970
75978
75980
75982
75984
75989
75992
75993
75994
75995



                  Page 262
        All Other (no trigger bundling)


75996
76000
76001
76010
76080
76098
76100
76101
76102
76120
76125
76140
76150
76350
76376
76377
76380
76390
76496
76497
76498
76499
76506
76510
76511
76512
76513
76514
76516
76519
76529
76536
76604
76645
76700
76705
76770
76775
76776
76800
76801
76802
76805
76810
76811
76812
76813
76814
76815
76816
76817
76818



                  Page 263
        All Other (no trigger bundling)


76819
76820
76821
76825
76826
76827
76828
76830
76831
76856
76857
76870
76872
76873
76880
76885
76886
76930
76932
76937
76940
76941
76942
76945
76946
76950
76965
76970
76975
76977
76998
76999
77001
77002
77003
77011
77012
77013
77014
77021
77022
77031
77032
77051
77052
77053
77054
77055
77056
77057
77058
77059



                  Page 264
        All Other (no trigger bundling)


77071
77072
77073
77074
77075
77076
77077
77078
77079
77080
77081
77082
77083
77084
77261
77262
77263
77280
77285
77290
77295
77299
77300
77301
77305
77310
77315
77321
77326
77327
77328
77331
77332
77333
77334
77336
77338
77370
77371
77372
77373
77399
77401
77402
77403
77404
77407
77408
77409
77411
77412
77413



                  Page 265
        All Other (no trigger bundling)


77414
77416
77417
77418
77421
77422
77423
77427
77431
77432
77435
77470
77499
77520
77522
77523
77525
77600
77605
77610
77615
77620
77750
77761
77762
77763
77776
77777
77778
77789
77790
77799
78000
78001
78003
78006
78007
78010
78011
78015
78016
78018
78020
78070
78075
78099
78102
78103
78104
78110
78111
78120



                  Page 266
        All Other (no trigger bundling)


78121
78122
78130
78135
78140
78185
78190
78191
78195
78199
78201
78202
78205
78206
78215
78216
78220
78223
78230
78231
78232
78258
78261
78262
78264
78267
78268
78270
78271
78272
78278
78282
78290
78291
78299
78300
78305
78306
78315
78320
78350
78399
78414
78428
78445
78456
78457
78458
78459
78466
78468
78469



                  Page 267
        All Other (no trigger bundling)


78472
78473
78481
78483
78491
78492
78494
78496
78499
78580
78584
78585
78586
78587
78588
78591
78593
78594
78596
78599
78600
78601
78605
78606
78607
78608
78609
78610
78630
78635
78645
78647
78650
78660
78699
78700
78701
78707
78708
78709
78710
78725
78730
78740
78761
78799
78800
78801
78802
78803
78804
78805



                  Page 268
        All Other (no trigger bundling)


78806
78807
78808
78811
78812
78813
78814
78815
78816
78999
79005
79101
79200
79300
79403
79440
79445
79999
80047
80048
80050
80051
80053
80055
80061
80069
80074
80076
80100
80101
80102
80103
80104
80150
80152
80154
80156
80157
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80160
80162
80164
80166
80168
80170
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80185
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80200
80201
80202
80299
80400
80402
80406
80408
80410
80412
80414
80415
80416
80417
80418
80420
80422
80424
80426
80428
80430
80432
80434
80435
80436
80438
80439
80440
80500
80502
81000
81001
81002
81003
81005
81007
81015
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82003
82009
82010
82013
82016
82017
82024
82030
82040
82042
82043
82044
82045
82055
82075
82085
82088
82101
82103
82104
82105
82106
82107
82108
82120
82127
82128
82131
82135
82136
82139
82140
82143
82145
82150
82154
82157
82160
82163
82164
82172
82175
82180
82190
82205
82232
82239
82240
82247
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                  Page 271
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82270
82271
82272
82274
82286
82300
82306
82308
82310
82330
82331
82340
82355
82360
82365
82370
82373
82374
82375
82376
82378
82379
82380
82382
82383
82384
82387
82390
82397
82415
82435
82436
82438
82441
82465
82480
82482
82485
82486
82487
82488
82489
82491
82492
82495
82507
82520
82523
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                  Page 272
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82540
82541
82542
82543
82544
82550
82552
82553
82554
82565
82570
82575
82585
82595
82600
82607
82608
82610
82615
82626
82627
82633
82634
82638
82646
82649
82651
82652
82654
82656
82657
82658
82664
82666
82668
82670
82671
82672
82677
82679
82690
82693
82696
82705
82710
82715
82725
82726
82728
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                  Page 273
        All Other (no trigger bundling)


82746
82747
82757
82759
82760
82775
82776
82784
82785
82787
82800
82803
82805
82810
82820
82926
82928
82930
82938
82941
82943
82945
82946
82947
82948
82950
82951
82952
82953
82955
82960
82962
82963
82965
82975
82977
82978
82979
82980
82985
83001
83002
83003
83008
83009
83010
83012
83013
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83020



                  Page 274
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83021
83026
83030
83033
83036
83037
83045
83050
83051
83055
83060
83065
83068
83069
83070
83071
83080
83088
83090
83150
83491
83497
83498
83499
83500
83505
83516
83518
83519
83520
83525
83527
83528
83540
83550
83570
83582
83586
83593
83605
83615
83625
83630
83631
83632
83633
83634
83655
83661
83662
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83664



                  Page 275
        All Other (no trigger bundling)


83670
83690
83695
83698
83700
83701
83704
83718
83719
83721
83727
83735
83775
83785
83788
83789
83805
83825
83835
83840
83857
83858
83864
83866
83872
83873
83874
83876
83880
83883
83885
83887
83890
83891
83892
83893
83894
83896
83897
83898
83900
83901
83902
83903
83904
83905
83906
83907
83908
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                  Page 276
        All Other (no trigger bundling)


83914
83915
83916
83918
83919
83921
83925
83930
83935
83937
83945
83950
83951
83970
83986
83987
83992
83993
84022
84030
84035
84060
84061
84066
84075
84078
84080
84081
84085
84087
84100
84105
84106
84110
84112
84119
84120
84126
84127
84132
84133
84134
84135
84138
84140
84143
84144
84145
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                  Page 277
        All Other (no trigger bundling)


84154
84155
84156
84157
84160
84163
84165
84166
84181
84182
84202
84203
84206
84207
84210
84220
84228
84233
84234
84235
84238
84244
84252
84255
84260
84270
84275
84285
84295
84300
84302
84305
84307
84311
84315
84375
84376
84377
84378
84379
84392
84402
84403
84425
84430
84431
84432
84436
84437
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                  Page 278
        All Other (no trigger bundling)


84445
84446
84449
84450
84460
84466
84478
84479
84480
84481
84482
84484
84485
84488
84490
84510
84512
84520
84525
84540
84545
84550
84560
84577
84578
84580
84583
84585
84586
84588
84590
84591
84597
84600
84620
84630
84681
84702
84703
84704
84999
85002
85004
85007
85008
85009
85013
85014
85018
85025
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                  Page 279
        All Other (no trigger bundling)


85041
85044
85045
85046
85048
85049
85055
85060
85097
85130
85170
85175
85210
85220
85230
85240
85244
85245
85246
85247
85250
85260
85270
85280
85290
85291
85292
85293
85300
85301
85302
85303
85305
85306
85307
85335
85337
85345
85347
85348
85360
85362
85366
85370
85378
85379
85380
85384
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                  Page 280
        All Other (no trigger bundling)


85400
85410
85415
85420
85421
85441
85445
85460
85461
85475
85520
85525
85530
85536
85540
85547
85549
85555
85557
85576
85597
85598
85610
85611
85612
85613
85635
85651
85652
85660
85670
85675
85705
85730
85732
85810
85999
86000
86001
86003
86005
86021
86022
86023
86038
86039
86060
86063
86077
86078
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                  Page 281
        All Other (no trigger bundling)


86141
86146
86147
86148
86155
86156
86157
86160
86161
86162
86171
86185
86200
86215
86225
86226
86235
86243
86255
86256
86277
86280
86294
86300
86301
86304
86308
86309
86310
86316
86317
86318
86320
86325
86327
86329
86331
86332
86334
86335
86336
86337
86340
86341
86343
86344
86353
86355
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                  Page 282
        All Other (no trigger bundling)


86361
86367
86376
86378
86382
86384
86403
86406
86430
86431
86480
86481
86485
86486
86490
86510
86580
86590
86592
86593
86602
86603
86606
86609
86611
86612
86615
86617
86618
86619
86622
86625
86628
86631
86632
86635
86638
86641
86644
86645
86648
86651
86652
86653
86654
86658
86663
86664
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86666
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                  Page 283
        All Other (no trigger bundling)


86674
86677
86682
86684
86687
86688
86689
86692
86694
86695
86696
86698
86701
86702
86703
86704
86705
86706
86707
86708
86709
86710
86713
86717
86720
86723
86727
86729
86732
86735
86738
86741
86744
86747
86750
86753
86756
86757
86759
86762
86765
86768
86771
86774
86777
86778
86780
86784
86787
86788
86789
86790



                  Page 284
        All Other (no trigger bundling)


86793
86800
86803
86804
86805
86806
86807
86808
86812
86813
86816
86817
86821
86822
86825
86826
86849
86850
86860
86870
86880
86885
86886
86890
86891
86900
86901
86902
86903
86904
86905
86906
86920
86921
86922
86923
86927
86930
86931
86932
86940
86941
86945
86950
86960
86965
86970
86971
86972
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                  Page 285
        All Other (no trigger bundling)


86978
86985
86999
87001
87003
87015
87040
87045
87046
87070
87071
87073
87075
87076
87077
87081
87084
87086
87088
87101
87102
87103
87106
87107
87109
87110
87116
87118
87140
87143
87147
87149
87152
87158
87164
87166
87168
87169
87172
87176
87177
87181
87184
87185
87186
87187
87188
87190
87197
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                  Page 286
        All Other (no trigger bundling)


87209
87210
87220
87230
87250
87252
87253
87254
87255
87260
87265
87267
87269
87270
87271
87272
87273
87274
87275
87276
87277
87278
87279
87280
87281
87283
87285
87290
87299
87300
87301
87305
87320
87324
87327
87328
87329
87332
87335
87336
87337
87338
87339
87340
87341
87350
87380
87385
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                  Page 287
        All Other (no trigger bundling)


87425
87427
87430
87449
87450
87451
87470
87471
87472
87475
87476
87477
87480
87481
87482
87485
87486
87487
87490
87491
87492
87493
87495
87496
87497
87498
87500
87501
87502
87503
87510
87511
87512
87515
87516
87517
87520
87521
87522
87525
87526
87527
87528
87529
87530
87531
87532
87533
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                  Page 288
        All Other (no trigger bundling)


87538
87539
87540
87541
87542
87550
87551
87552
87555
87556
87557
87560
87561
87562
87580
87581
87582
87590
87591
87592
87620
87621
87622
87640
87641
87650
87651
87652
87653
87660
87797
87798
87799
87800
87801
87802
87803
87804
87807
87808
87809
87810
87850
87880
87899
87900
87901
87902
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                  Page 289
        All Other (no trigger bundling)


87999
88104
88106
88107
88108
88112
88120
88121
88125
88130
88140
88141
88142
88143
88147
88148
88150
88152
88153
88154
88155
88160
88161
88162
88164
88165
88166
88167
88172
88173
88174
88175
88177
88182
88184
88185
88187
88188
88189
88199
88230
88233
88235
88237
88239
88240
88241
88245
88248
88249
88261
88262



                  Page 290
        All Other (no trigger bundling)


88263
88264
88267
88269
88271
88272
88273
88274
88275
88280
88283
88285
88289
88291
88299
88300
88302
88304
88305
88307
88309
88311
88312
88313
88314
88318
88319
88321
88323
88325
88329
88331
88332
88333
88334
88342
88346
88347
88348
88349
88355
88356
88358
88360
88361
88362
88365
88367
88368
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                  Page 291
        All Other (no trigger bundling)


88381
88384
88385
88386
88387
88388
88399
88720
88738
88740
88741
88749
89049
89050
89051
89055
89060
89100
89105
89125
89130
89132
89135
89136
89140
89141
89160
89190
89220
89225
89230
89235
89240
89264
89321
89322
90296
90371
90375
90376
90378
90384
90385
90393
90396
90460
90461
90470
90471
90472
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90474



                  Page 292
        All Other (no trigger bundling)


90476
90477
90581
90585
90586
90632
90633
90634
90636
90644
90645
90646
90647
90648
90649
90650
90655
90656
90657
90658
90660
90662
90663
90665
90669
90670
90675
90676
90680
90681
90690
90691
90692
90693
90696
90698
90700
90701
90702
90703
90704
90705
90706
90707
90708
90710
90712
90713
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                  Page 293
        All Other (no trigger bundling)


90718
90719
90720
90721
90723
90725
90727
90732
90733
90734
90736
90740
90743
90744
90746
90747
90748
90749
90801
90802
90804
90805
90806
90807
90808
90809
90810
90811
90812
90813
90814
90815
90816
90817
90818
90819
90821
90822
90823
90824
90826
90827
90828
90829
90845
90846
90847
90849
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                  Page 294
        All Other (no trigger bundling)


90870
90875
90876
90887
90889
90901
90911
90935
90937
90940
90945
90947
90951
90952
90953
90954
90955
90956
90957
90958
90959
90960
90961
90962
90963
90964
90965
90966
90967
90968
90969
90970
90989
90993
90997
90999
91000
91010
91011
91012
91013
91020
91022
91030
91034
91035
91037
91038
91040
91052
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                  Page 295
        All Other (no trigger bundling)


91105
91123
91132
91133
91299
92002
92004
92012
92014
92015
92025
92070
92100
92227
92228
92310
92311
92312
92313
92314
92315
92316
92317
92325
92326
92340
92341
92342
92352
92353
92354
92355
92358
92370
92371
92504
92506
92507
92508
92512
92516
92520
92526
92531
92532
92533
92534
92540
92541
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                  Page 296
        All Other (no trigger bundling)


92545
92546
92547
92548
92550
92551
92552
92553
92555
92556
92557
92560
92561
92562
92563
92564
92565
92567
92568
92570
92571
92572
92575
92576
92577
92579
92582
92583
92584
92585
92586
92587
92588
92590
92591
92592
92593
92594
92595
92596
92597
92601
92602
92603
92604
92605
92606
92607
92608
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                  Page 297
        All Other (no trigger bundling)


92612
92613
92614
92615
92616
92617
92620
92621
92625
92626
92627
92630
92633
92640
92700
92960
92961
92970
92971
92975
92978
92979
92992
92993
93000
93005
93010
93012
93014
93015
93016
93017
93018
93024
93025
93040
93041
93042
93224
93225
93226
93227
93228
93230
93231
93232
93233
93235
93236
93237
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                  Page 298
        All Other (no trigger bundling)


93271
93272
93278
93286
93287
93294
93295
93297
93298
93303
93304
93307
93308
93312
93313
93314
93315
93316
93317
93318
93320
93321
93325
93350
93352
93463
93464
93539
93540
93541
93542
93543
93544
93545
93555
93556
93561
93562
93563
93564
93565
93566
93567
93568
93571
93572
93609
93613
93619
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                  Page 299
        All Other (no trigger bundling)


93623
93624
93631
93640
93641
93642
93650
93651
93652
93660
93662
93701
93720
93721
93722
93724
93740
93745
93770
93797
93798
93799
93875
93880
93882
93886
93888
93890
93892
93893
93922
93923
93924
93925
93926
93930
93931
93965
93970
93971
93975
93976
93978
93979
93980
93981
93990
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                  Page 300
        All Other (no trigger bundling)


94011
94012
94013
94014
94015
94016
94070
94150
94200
94240
94250
94260
94350
94360
94370
94375
94400
94450
94452
94453
94610
94620
94621
94640
94642
94644
94645
94660
94662
94664
94667
94668
94680
94681
94690
94720
94725
94750
94760
94761
94762
94770
94772
94774
94775
94776
94777
94799
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                  Page 301
        All Other (no trigger bundling)


95024
95027
95028
95044
95052
95056
95060
95065
95070
95071
95075
95115
95117
95120
95125
95130
95131
95132
95133
95134
95144
95145
95146
95147
95148
95149
95165
95170
95180
95199
95250
95251
95805
95806
95807
95808
95810
95811
95812
95813
95816
95819
95822
95824
95827
95829
95830
95831
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                  Page 302
        All Other (no trigger bundling)


95852
95857
95860
95861
95863
95864
95865
95866
95867
95868
95869
95870
95872
95873
95874
95875
95900
95903
95904
95920
95921
95922
95923
95925
95926
95927
95928
95929
95930
95933
95934
95936
95937
95950
95951
95953
95954
95955
95956
95957
95958
95961
95962
95965
95966
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                  Page 303
        All Other (no trigger bundling)


95978
95979
95992
95999
96000
96001
96002
96003
96004
96020
96101
96102
96103
96105
96110
96111
96116
96118
96119
96120
96150
96151
96152
96153
96154
96155
96360
96361
96365
96366
96367
96368
96369
96370
96371
96372
96373
96374
96375
96376
96379
96401
96402
96405
96406
96409
96411
96413
96415
96416
96417
96420



                  Page 304
        All Other (no trigger bundling)


96422
96423
96425
96440
96445
96450
96521
96522
96523
96542
96549
96900
96904
96910
96912
96913
97001
97002
97003
97004
97012
97014
97016
97018
97022
97024
97026
97028
97032
97033
97034
97035
97036
97039
97110
97112
97113
97116
97124
97139
97140
97150
97530
97532
97533
97535
97537
97542
97545
97546
97597
97598



                  Page 305
        All Other (no trigger bundling)


97602
97605
97606
97750
97755
97760
97761
97762
97799
97802
97803
97804
98925
98926
98927
98928
98929
98940
98941
98942
98943
99000
99001
99002
99050
99051
99053
99058
99060
99143
99144
99145
99148
99149
99150
99173
99174
99175
99183
99190
99191
99192
99195
99199
99201
99202
99203
99204
99205
99211
99212
99213



                  Page 306
        All Other (no trigger bundling)


99214
99215
99217
99218
99219
99220
99221
99222
99223
99224
99225
99226
99231
99232
99233
99234
99235
99236
99238
99239
99241
99242
99243
99244
99245
99251
99252
99253
99254
99255
99288
99292
99304
99305
99306
99307
99308
99309
99310
99315
99316
99318
99324
99325
99326
99327
99328
99334
99335
99336
99337
99339



                  Page 307
        All Other (no trigger bundling)


99340
99341
99342
99343
99344
99345
99347
99348
99349
99350
99354
99355
99356
99357
99358
99359
99360
99363
99364
99367
99368
99374
99375
99377
99378
99379
99380
99381
99382
99383
99384
99385
99386
99387
99391
99392
99393
99394
99395
99396
99397
99401
99402
99403
99404
99411
99412
99420
99429
99441
99442
99443



                  Page 308
        All Other (no trigger bundling)


99460
99461
99462
99463
99464
99465
99466
99467
99468
99469
99471
99472
99475
99476
99477
99478
99479
99480
99499
99601
99602
A4206
A4207
A4208
A4209
A4210
A4211
A4212
A4213
A4215
A4216
A4217
A4218
A4220
A4221
A4222
A4223
A4230
A4231
A4232
A4233
A4234
A4235
A4236
A4244
A4245
A4246
A4247
A4248
A4250
A4252
A4253



                  Page 309
        All Other (no trigger bundling)


A4255
A4256
A4257
A4258
A4259
A4261
A4262
A4263
A4265
A4266
A4267
A4268
A4269
A4270
A4280
A4281
A4282
A4283
A4284
A4285
A4286
A4290
A4300
A4301
A4305
A4306
A4310
A4311
A4312
A4313
A4314
A4315
A4316
A4320
A4321
A4322
A4326
A4327
A4328
A4330
A4331
A4332
A4333
A4334
A4335
A4336
A4338
A4340
A4344
A4346
A4349
A4351



                  Page 310
        All Other (no trigger bundling)


A4352
A4353
A4354
A4355
A4356
A4357
A4358
A4360
A4361
A4362
A4363
A4364
A4366
A4367
A4368
A4369
A4371
A4372
A4373
A4375
A4376
A4377
A4378
A4379
A4380
A4381
A4382
A4383
A4384
A4385
A4387
A4388
A4389
A4390
A4391
A4392
A4393
A4394
A4395
A4396
A4397
A4398
A4399
A4400
A4402
A4404
A4405
A4406
A4407
A4408
A4409
A4410



                  Page 311
        All Other (no trigger bundling)


A4411
A4412
A4413
A4414
A4415
A4416
A4417
A4418
A4419
A4420
A4421
A4422
A4423
A4424
A4425
A4426
A4427
A4428
A4429
A4430
A4431
A4432
A4433
A4434
A4450
A4452
A4455
A4458
A4461
A4463
A4465
A4470
A4480
A4481
A4483
A4490
A4495
A4500
A4510
A4520
A4554
A4556
A4557
A4558
A4559
A4561
A4562
A4565
A4575
A4595
A4600
A4601



                  Page 312
        All Other (no trigger bundling)


A4604
A4605
A4606
A4608
A4611
A4612
A4613
A4614
A4615
A4616
A4617
A4618
A4619
A4620
A4623
A4624
A4625
A4626
A4627
A4628
A4629
A4630
A4633
A4634
A4635
A4636
A4637
A4638
A4639
A4640
A4641
A4642
A4648
A4649
A4650
A4651
A4652
A4653
A4657
A4660
A4663
A4670
A4671
A4672
A4673
A4674
A4680
A4690
A4706
A4707
A4708
A4709



                  Page 313
        All Other (no trigger bundling)


A4714
A4719
A4720
A4721
A4722
A4723
A4724
A4725
A4726
A4728
A4730
A4736
A4737
A4740
A4750
A4755
A4760
A4765
A4766
A4770
A4771
A4772
A4773
A4774
A4802
A4860
A4870
A4890
A4911
A4913
A4918
A4927
A4928
A4929
A4930
A4931
A4932
A5051
A5052
A5053
A5054
A5055
A5061
A5062
A5063
A5071
A5072
A5073
A5081
A5082
A5083
A5093



                  Page 314
        All Other (no trigger bundling)


A5102
A5105
A5112
A5113
A5114
A5120
A5121
A5122
A5126
A5131
A5200
A5500
A5501
A5503
A5504
A5505
A5506
A5507
A5508
A5510
A5512
A5513
A6010
A6011
A6021
A6022
A6023
A6024
A6025
A6154
A6196
A6197
A6198
A6199
A6203
A6204
A6205
A6206
A6207
A6208
A6209
A6210
A6211
A6212
A6213
A6214
A6215
A6216
A6217
A6218
A6219
A6220



                  Page 315
        All Other (no trigger bundling)


A6221
A6222
A6223
A6224
A6228
A6229
A6230
A6231
A6232
A6233
A6234
A6235
A6236
A6237
A6238
A6239
A6240
A6241
A6242
A6243
A6244
A6245
A6246
A6247
A6248
A6250
A6251
A6252
A6253
A6254
A6255
A6256
A6257
A6258
A6259
A6260
A6261
A6262
A6266
A6402
A6403
A6404
A6407
A6410
A6411
A6412
A6413
A6441
A6442
A6443
A6444
A6445



                  Page 316
        All Other (no trigger bundling)


A6446
A6447
A6448
A6449
A6450
A6451
A6452
A6453
A6454
A6455
A6456
A6457
A6501
A6502
A6503
A6504
A6505
A6506
A6507
A6508
A6509
A6510
A6511
A6512
A6513
A6530
A6531
A6532
A6533
A6534
A6535
A6536
A6537
A6538
A6539
A6540
A6541
A6544
A6545
A6549
A6550
A7000
A7001
A7002
A7003
A7004
A7005
A7006
A7007
A7008
A7009
A7010



                  Page 317
        All Other (no trigger bundling)


A7011
A7012
A7013
A7014
A7015
A7016
A7017
A7018
A7020
A7025
A7026
A7027
A7028
A7029
A7030
A7031
A7032
A7033
A7034
A7035
A7036
A7037
A7038
A7039
A7040
A7041
A7042
A7043
A7044
A7045
A7046
A7501
A7502
A7503
A7504
A7505
A7506
A7507
A7508
A7509
A7520
A7521
A7522
A7523
A7524
A7525
A7526
A7527
A8000
A8001
A8002
A8003



                  Page 318
        All Other (no trigger bundling)


A8004
A9155
A9281
A9283
A9284
A9300
A9500
A9501
A9502
A9503
A9504
A9505
A9507
A9508
A9509
A9510
A9512
A9516
A9517
A9521
A9524
A9526
A9527
A9528
A9529
A9530
A9531
A9532
A9536
A9537
A9538
A9539
A9540
A9541
A9542
A9543
A9544
A9545
A9546
A9547
A9548
A9550
A9551
A9552
A9553
A9554
A9555
A9556
A9557
A9558
A9559
A9560



                  Page 319
        All Other (no trigger bundling)


A9561
A9562
A9563
A9564
A9566
A9567
A9568
A9569
A9570
A9571
A9572
A9576
A9577
A9578
A9579
A9580
A9581
A9582
A9583
A9600
A9604
A9698
A9699
A9700
A9900
A9901
A9999
B4034
B4035
B4036
B4081
B4082
B4083
B4087
B4088
B4100
B4102
B4103
B4104
B4149
B4150
B4152
B4153
B4154
B4155
B4157
B4158
B4159
B4160
B4161
B4162
B4164



                  Page 320
        All Other (no trigger bundling)


B4168
B4172
B4176
B4178
B4180
B4185
B4189
B4193
B4197
B4199
B4216
B4220
B4222
B4224
B5000
B5100
B5200
B9000
B9002
B9004
B9006
B9998
B9999
C1300
C1304
C1713
C1714
C1715
C1716
C1717
C1719
C1721
C1722
C1724
C1725
C1726
C1727
C1728
C1729
C1730
C1731
C1732
C1733
C1750
C1751
C1752
C1753
C1754
C1755
C1756
C1757
C1758



                  Page 321
        All Other (no trigger bundling)


C1759
C1760
C1762
C1763
C1764
C1765
C1766
C1767
C1768
C1769
C1770
C1771
C1772
C1773
C1776
C1777
C1778
C1779
C1780
C1781
C1782
C1783
C1784
C1785
C1786
C1787
C1788
C1789
C1813
C1814
C1815
C1816
C1817
C1818
C1819
C1820
C1821
C1864
C1874
C1875
C1876
C1877
C1878
C1880
C1881
C1882
C1883
C1884
C1885
C1887
C1888
C1891



                  Page 322
        All Other (no trigger bundling)


C1892
C1893
C1894
C1895
C1897
C1898
C1899
C1900
C2614
C2615
C2616
C2617
C2618
C2619
C2620
C2621
C2622
C2625
C2626
C2627
C2628
C2629
C2630
C2631
C2634
C2635
C2636
C2637
C2638
C2639
C2640
C2641
C2642
C2643
C2698
C2699
C8900
C8901
C8902
C8903
C8904
C8905
C8906
C8907
C8908
C8909
C8910
C8911
C8912
C8913
C8914
C8918



                  Page 323
        All Other (no trigger bundling)


C8919
C8920
C8921
C8922
C8923
C8924
C8925
C8926
C8927
C8928
C8957
C9113
C9121
C9219
C9248
C9254
C9255
C9256
C9257
C9258
C9259
C9260
C9261
C9263
C9264
C9265
C9266
C9267
C9268
C9274
C9275
C9276
C9277
C9278
C9279
C9352
C9353
C9359
C9399
C9716
C9724
C9725
C9726
C9728
C9898
C9899
D1352
D3354
D5992
D7251
E0100
E0105



                  Page 324
        All Other (no trigger bundling)


E0110
E0111
E0112
E0113
E0114
E0116
E0117
E0130
E0135
E0140
E0141
E0143
E0144
E0147
E0148
E0149
E0153
E0154
E0155
E0156
E0157
E0158
E0159
E0160
E0161
E0162
E0163
E0165
E0167
E0168
E0170
E0171
E0172
E0175
E0181
E0182
E0184
E0185
E0186
E0187
E0188
E0189
E0190
E0191
E0193
E0194
E0196
E0197
E0198
E0199
E0200
E0202



                  Page 325
        All Other (no trigger bundling)


E0205
E0210
E0215
E0217
E0218
E0220
E0221
E0225
E0230
E0235
E0236
E0238
E0239
E0240
E0241
E0242
E0243
E0244
E0245
E0246
E0247
E0248
E0249
E0250
E0251
E0255
E0256
E0260
E0261
E0265
E0266
E0270
E0271
E0272
E0273
E0274
E0275
E0276
E0277
E0280
E0290
E0291
E0292
E0293
E0294
E0295
E0296
E0297
E0300
E0301
E0302
E0303



                  Page 326
        All Other (no trigger bundling)


E0304
E0305
E0310
E0315
E0316
E0325
E0326
E0328
E0329
E0350
E0352
E0370
E0371
E0372
E0373
E0424
E0425
E0430
E0431
E0433
E0434
E0435
E0439
E0440
E0441
E0442
E0443
E0444
E0445
E0446
E0450
E0455
E0457
E0459
E0460
E0461
E0462
E0463
E0464
E0470
E0471
E0472
E0480
E0482
E0483
E0484
E0485
E0486
E0487
E0500
E0550
E0555



                  Page 327
        All Other (no trigger bundling)


E0560
E0561
E0562
E0565
E0570
E0571
E0572
E0574
E0575
E0580
E0585
E0600
E0601
E0602
E0603
E0604
E0605
E0606
E0607
E0610
E0615
E0616
E0617
E0618
E0619
E0620
E0621
E0625
E0627
E0628
E0629
E0630
E0635
E0636
E0637
E0638
E0639
E0640
E0641
E0642
E0650
E0651
E0652
E0655
E0656
E0657
E0660
E0665
E0666
E0667
E0668
E0669



                  Page 328
        All Other (no trigger bundling)


E0671
E0672
E0673
E0675
E0676
E0691
E0692
E0693
E0694
E0700
E0705
E0710
E0720
E0730
E0731
E0740
E0744
E0745
E0746
E0747
E0748
E0749
E0755
E0760
E0765
E0769
E0770
E0776
E0779
E0780
E0781
E0782
E0783
E0784
E0785
E0791
E0830
E0840
E0849
E0850
E0855
E0856
E0860
E0870
E0880
E0890
E0900
E0910
E0911
E0912
E0920
E0930



                  Page 329
        All Other (no trigger bundling)


E0935
E0936
E0940
E0941
E0942
E0944
E0945
E0946
E0947
E0948
E0950
E0951
E0952
E0955
E0956
E0957
E0958
E0959
E0960
E0961
E0966
E0967
E0968
E0969
E0970
E0971
E0973
E0974
E0978
E0980
E0981
E0982
E0983
E0984
E0985
E0986
E0990
E0992
E0994
E0995
E1002
E1003
E1004
E1005
E1006
E1007
E1008
E1009
E1010
E1011
E1014
E1015



                  Page 330
        All Other (no trigger bundling)


E1016
E1017
E1018
E1020
E1028
E1029
E1030
E1031
E1035
E1036
E1037
E1038
E1039
E1050
E1060
E1070
E1083
E1084
E1085
E1086
E1087
E1088
E1089
E1090
E1092
E1093
E1100
E1110
E1130
E1140
E1150
E1160
E1161
E1170
E1171
E1172
E1180
E1190
E1195
E1200
E1220
E1221
E1222
E1223
E1224
E1225
E1226
E1227
E1228
E1229
E1230
E1231



                  Page 331
        All Other (no trigger bundling)


E1232
E1233
E1234
E1235
E1236
E1237
E1238
E1239
E1240
E1250
E1260
E1270
E1280
E1285
E1290
E1295
E1296
E1297
E1298
E1300
E1310
E1353
E1354
E1355
E1356
E1357
E1358
E1372
E1390
E1391
E1392
E1399
E1405
E1406
E1500
E1510
E1520
E1530
E1540
E1550
E1560
E1570
E1575
E1580
E1590
E1592
E1594
E1600
E1610
E1615
E1620
E1625



                  Page 332
        All Other (no trigger bundling)


E1630
E1632
E1634
E1635
E1636
E1637
E1639
E1699
E1700
E1701
E1702
E1800
E1801
E1802
E1805
E1806
E1810
E1811
E1812
E1815
E1816
E1818
E1820
E1821
E1825
E1830
E1831
E1840
E1841
E1902
E2000
E2100
E2101
E2120
E2201
E2202
E2203
E2204
E2205
E2206
E2207
E2208
E2209
E2210
E2211
E2212
E2213
E2214
E2215
E2216
E2217
E2218



                  Page 333
        All Other (no trigger bundling)


E2219
E2220
E2221
E2222
E2224
E2225
E2226
E2227
E2228
E2230
E2231
E2291
E2292
E2293
E2294
E2295
E2300
E2301
E2310
E2311
E2312
E2313
E2321
E2322
E2323
E2324
E2325
E2326
E2327
E2328
E2329
E2330
E2331
E2340
E2341
E2342
E2343
E2351
E2360
E2361
E2362
E2363
E2364
E2365
E2366
E2367
E2368
E2369
E2370
E2371
E2372
E2373



                  Page 334
        All Other (no trigger bundling)


E2374
E2375
E2376
E2377
E2381
E2382
E2383
E2384
E2385
E2386
E2387
E2388
E2389
E2390
E2391
E2392
E2394
E2395
E2396
E2397
E2402
E2500
E2502
E2504
E2506
E2508
E2510
E2511
E2512
E2599
E2601
E2602
E2603
E2604
E2605
E2606
E2607
E2608
E2609
E2610
E2611
E2612
E2613
E2614
E2615
E2616
E2617
E2619
E2620
E2621
E2622
E2623



                  Page 335
        All Other (no trigger bundling)


E2624
E2625
E8000
E8001
E8002
G0008
G0009
G0010
G0027
G0054
G0055
G0056
G0057
G0101
G0102
G0103
G0104
G0106
G0120
G0122
G0123
G0124
G0130
G0141
G0143
G0144
G0145
G0147
G0148
G0154
G0168
G0173
G0175
G0179
G0180
G0202
G0204
G0206
G0219
G0245
G0246
G0248
G0249
G0250
G0251
G0257
G0259
G0268
G0269
G0270
G0271
G0275



                  Page 336
        All Other (no trigger bundling)


G0278
G0281
G0283
G0289
G0293
G0294
G0302
G0303
G0304
G0305
G0306
G0307
G0328
G0329
G0337
G0339
G0364
G0365
G0378
G0379
G0432
G0433
G0435
G3001
J0120
J0128
J0129
J0130
J0132
J0133
J0135
J0150
J0152
J0170
J0171
J0180
J0190
J0200
J0205
J0207
J0210
J0215
J0220
J0256
J0278
J0280
J0282
J0285
J0287
J0288
J0289
J0290



                  Page 337
        All Other (no trigger bundling)


J0295
J0300
J0330
J0348
J0350
J0360
J0364
J0365
J0380
J0390
J0395
J0400
J0456
J0461
J0470
J0475
J0476
J0480
J0500
J0515
J0520
J0558
J0559
J0560
J0561
J0570
J0580
J0583
J0585
J0586
J0587
J0592
J0594
J0595
J0597
J0598
J0600
J0610
J0620
J0630
J0636
J0637
J0638
J0640
J0641
J0670
J0690
J0692
J0694
J0696
J0697
J0698



                  Page 338
        All Other (no trigger bundling)


J0702
J0704
J0710
J0713
J0715
J0718
J0720
J0725
J0735
J0740
J0743
J0744
J0745
J0760
J0770
J0775
J0780
J0795
J0800
J0833
J0834
J0850
J0878
J0881
J0882
J0885
J0886
J0894
J0895
J0900
J0945
J0970
J1000
J1020
J1030
J1040
J1051
J1055
J1056
J1060
J1070
J1080
J1094
J1100
J1110
J1120
J1160
J1162
J1165
J1170
J1180
J1190



                  Page 339
        All Other (no trigger bundling)


J1200
J1205
J1212
J1230
J1240
J1245
J1250
J1260
J1265
J1267
J1270
J1290
J1300
J1320
J1324
J1325
J1327
J1330
J1335
J1364
J1380
J1390
J1410
J1430
J1435
J1436
J1438
J1440
J1441
J1450
J1451
J1452
J1453
J1455
J1457
J1458
J1459
J1460
J1470
J1480
J1490
J1500
J1510
J1520
J1530
J1540
J1550
J1559
J1560
J1561
J1562
J1566



                  Page 340
        All Other (no trigger bundling)


J1568
J1569
J1570
J1571
J1572
J1573
J1580
J1590
J1599
J1600
J1610
J1620
J1626
J1630
J1631
J1640
J1642
J1644
J1645
J1650
J1652
J1655
J1670
J1675
J1680
J1700
J1710
J1720
J1730
J1740
J1742
J1743
J1745
J1750
J1756
J1785
J1786
J1790
J1800
J1810
J1815
J1817
J1825
J1826
J1830
J1835
J1840
J1850
J1885
J1890
J1930
J1931



                  Page 341
        All Other (no trigger bundling)


J1940
J1945
J1950
J1953
J1955
J1956
J1960
J1980
J1990
J2001
J2010
J2020
J2060
J2150
J2170
J2175
J2180
J2185
J2210
J2248
J2250
J2260
J2270
J2271
J2275
J2278
J2280
J2300
J2310
J2315
J2320
J2321
J2322
J2323
J2325
J2353
J2354
J2355
J2357
J2358
J2360
J2370
J2400
J2405
J2410
J2425
J2426
J2430
J2440
J2460
J2469
J2501



                  Page 342
        All Other (no trigger bundling)


J2503
J2504
J2505
J2510
J2513
J2515
J2540
J2543
J2545
J2550
J2560
J2562
J2590
J2597
J2650
J2670
J2675
J2680
J2690
J2700
J2710
J2720
J2724
J2725
J2730
J2760
J2765
J2770
J2778
J2780
J2783
J2785
J2788
J2790
J2791
J2792
J2793
J2794
J2795
J2796
J2800
J2805
J2810
J2820
J2850
J2910
J2916
J2920
J2930
J2940
J2941
J2950



                  Page 343
        All Other (no trigger bundling)


J2993
J2995
J2997
J3000
J3010
J3030
J3070
J3095
J3101
J3105
J3110
J3120
J3130
J3140
J3150
J3230
J3240
J3243
J3246
J3250
J3260
J3262
J3265
J3280
J3285
J3300
J3301
J3302
J3303
J3305
J3310
J3315
J3320
J3350
J3357
J3360
J3364
J3365
J3370
J3385
J3396
J3400
J3410
J3411
J3415
J3420
J3430
J3465
J3470
J3471
J3472
J3473



                  Page 344
        All Other (no trigger bundling)


J3475
J3480
J3485
J3486
J3487
J3488
J3490
J3520
J3530
J3535
J3590
J7030
J7040
J7042
J7050
J7060
J7070
J7100
J7110
J7120
J7130
J7184
J7185
J7186
J7187
J7189
J7190
J7191
J7192
J7193
J7194
J7195
J7196
J7197
J7198
J7199
J7300
J7302
J7303
J7304
J7307
J7308
J7309
J7310
J7311
J7312
J7321
J7323
J7324
J7325
J7335
J7500



                  Page 345
        All Other (no trigger bundling)


J7501
J7502
J7504
J7505
J7506
J7507
J7509
J7510
J7511
J7513
J7515
J7516
J7517
J7518
J7520
J7525
J7599
J7604
J7605
J7606
J7607
J7608
J7609
J7610
J7611
J7612
J7613
J7614
J7615
J7620
J7622
J7624
J7626
J7627
J7628
J7629
J7631
J7632
J7633
J7634
J7635
J7636
J7637
J7638
J7639
J7641
J7642
J7643
J7644
J7645
J7647
J7648



                  Page 346
        All Other (no trigger bundling)


J7649
J7650
J7657
J7658
J7659
J7660
J7667
J7668
J7669
J7670
J7674
J7676
J7680
J7681
J7682
J7683
J7684
J7685
J7686
J7699
J7799
J8499
J8501
J8510
J8520
J8521
J8530
J8540
J8560
J8562
J8565
J8600
J8610
J8650
J8700
J8705
J8999
J9000
J9001
J9010
J9015
J9017
J9020
J9025
J9027
J9031
J9033
J9035
J9040
J9041
J9045
J9050



                  Page 347
        All Other (no trigger bundling)


J9055
J9060
J9062
J9065
J9070
J9080
J9090
J9091
J9092
J9093
J9094
J9095
J9096
J9097
J9098
J9100
J9110
J9120
J9130
J9140
J9150
J9151
J9155
J9160
J9165
J9171
J9175
J9178
J9181
J9185
J9190
J9200
J9201
J9202
J9206
J9207
J9208
J9209
J9211
J9212
J9213
J9214
J9215
J9216
J9217
J9218
J9219
J9225
J9226
J9230
J9245
J9250



                  Page 348
        All Other (no trigger bundling)


J9260
J9261
J9263
J9264
J9265
J9266
J9268
J9270
J9280
J9290
J9291
J9293
J9300
J9302
J9303
J9305
J9307
J9310
J9315
J9320
J9328
J9330
J9340
J9350
J9351
J9355
J9357
J9360
J9370
J9375
J9380
J9390
J9395
J9600
J9999
K0001
K0002
K0003
K0004
K0005
K0006
K0007
K0009
K0010
K0011
K0012
K0014
K0015
K0017
K0018
K0019
K0020



                  Page 349
        All Other (no trigger bundling)


K0037
K0038
K0039
K0040
K0041
K0042
K0043
K0044
K0045
K0046
K0047
K0050
K0051
K0052
K0053
K0056
K0065
K0069
K0070
K0071
K0072
K0073
K0077
K0105
K0108
K0195
K0455
K0462
K0535
K0536
K0537
K0552
K0601
K0602
K0604
K0605
K0606
K0607
K0608
K0609
K0669
K0672
K0730
K0733
K0734
K0735
K0736
K0737
K0738
K0739
K0740
K0800



                  Page 350
        All Other (no trigger bundling)


K0801
K0802
K0806
K0807
K0808
K0812
K0813
K0814
K0815
K0816
K0820
K0821
K0822
K0823
K0824
K0825
K0826
K0827
K0828
K0829
K0830
K0831
K0835
K0836
K0837
K0838
K0839
K0840
K0841
K0842
K0843
K0848
K0849
K0850
K0851
K0852
K0853
K0854
K0855
K0856
K0857
K0858
K0859
K0860
K0861
K0862
K0863
K0864
K0868
K0869
K0870
K0871



                  Page 351
        All Other (no trigger bundling)


K0877
K0878
K0879
K0880
K0884
K0885
K0886
K0890
K0891
K0898
K0899
L0112
L0113
L0120
L0130
L0140
L0150
L0160
L0170
L0172
L0174
L0180
L0190
L0200
L0220
L0430
L0450
L0452
L0454
L0456
L0458
L0460
L0462
L0464
L0466
L0468
L0470
L0472
L0480
L0482
L0484
L0486
L0488
L0490
L0491
L0492
L0621
L0622
L0623
L0624
L0625
L0626



                  Page 352
        All Other (no trigger bundling)


L0627
L0628
L0629
L0630
L0631
L0632
L0633
L0634
L0635
L0636
L0637
L0638
L0639
L0640
L0700
L0710
L0810
L0820
L0830
L0859
L0861
L0970
L0972
L0974
L0976
L0978
L0980
L0982
L0984
L0999
L1000
L1001
L1005
L1010
L1020
L1025
L1030
L1040
L1050
L1060
L1070
L1080
L1085
L1090
L1100
L1110
L1120
L1200
L1210
L1220
L1230
L1240



                  Page 353
        All Other (no trigger bundling)


L1250
L1260
L1270
L1280
L1290
L1300
L1310
L1499
L1500
L1510
L1520
L1600
L1610
L1620
L1630
L1640
L1650
L1652
L1660
L1680
L1685
L1686
L1690
L1700
L1710
L1720
L1730
L1755
L1810
L1820
L1830
L1831
L1832
L1834
L1836
L1840
L1843
L1844
L1845
L1846
L1847
L1850
L1860
L1900
L1902
L1904
L1906
L1907
L1910
L1920
L1930
L1932



                  Page 354
        All Other (no trigger bundling)


L1940
L1945
L1950
L1951
L1960
L1970
L1971
L1980
L1990
L2000
L2005
L2010
L2020
L2030
L2034
L2035
L2036
L2037
L2038
L2040
L2050
L2060
L2070
L2080
L2090
L2106
L2108
L2112
L2114
L2116
L2126
L2128
L2132
L2134
L2136
L2180
L2182
L2184
L2186
L2188
L2190
L2192
L2200
L2210
L2220
L2230
L2232
L2240
L2250
L2260
L2265
L2270



                  Page 355
        All Other (no trigger bundling)


L2275
L2280
L2300
L2310
L2320
L2330
L2335
L2340
L2350
L2360
L2370
L2375
L2380
L2385
L2387
L2390
L2395
L2397
L2405
L2415
L2425
L2430
L2492
L2500
L2510
L2520
L2525
L2526
L2530
L2540
L2550
L2570
L2580
L2600
L2610
L2620
L2622
L2624
L2627
L2628
L2630
L2640
L2650
L2660
L2670
L2680
L2750
L2755
L2760
L2768
L2780
L2785



                  Page 356
        All Other (no trigger bundling)


L2795
L2800
L2810
L2820
L2830
L2840
L2850
L2861
L2999
L3000
L3001
L3002
L3003
L3010
L3020
L3030
L3031
L3040
L3050
L3060
L3070
L3080
L3090
L3100
L3140
L3150
L3160
L3170
L3201
L3202
L3203
L3204
L3206
L3207
L3208
L3209
L3211
L3212
L3213
L3214
L3215
L3216
L3217
L3219
L3221
L3222
L3224
L3225
L3230
L3250
L3251
L3252



                  Page 357
        All Other (no trigger bundling)


L3253
L3254
L3255
L3257
L3260
L3265
L3300
L3310
L3320
L3330
L3332
L3334
L3340
L3350
L3360
L3370
L3380
L3390
L3400
L3410
L3420
L3430
L3440
L3450
L3455
L3460
L3465
L3470
L3480
L3485
L3500
L3510
L3520
L3530
L3540
L3550
L3560
L3570
L3580
L3590
L3595
L3600
L3610
L3620
L3630
L3640
L3649
L3650
L3660
L3670
L3671
L3672



                  Page 358
        All Other (no trigger bundling)


L3673
L3674
L3675
L3677
L3702
L3710
L3720
L3730
L3740
L3760
L3762
L3763
L3764
L3765
L3766
L3806
L3807
L3808
L3891
L3900
L3901
L3904
L3905
L3906
L3908
L3912
L3913
L3915
L3917
L3919
L3921
L3923
L3925
L3927
L3929
L3931
L3933
L3935
L3956
L3960
L3961
L3962
L3964
L3965
L3966
L3967
L3968
L3969
L3970
L3971
L3972
L3973



                  Page 359
        All Other (no trigger bundling)


L3974
L3975
L3976
L3977
L3978
L3980
L3982
L3984
L3995
L3999
L4000
L4002
L4010
L4020
L4030
L4040
L4045
L4050
L4055
L4060
L4070
L4080
L4090
L4100
L4110
L4130
L4205
L4210
L4350
L4360
L4370
L4380
L4386
L4392
L4394
L4396
L4398
L4631
L5000
L5010
L5020
L5050
L5060
L5100
L5105
L5150
L5160
L5200
L5210
L5220
L5230
L5250



                  Page 360
        All Other (no trigger bundling)


L5270
L5280
L5301
L5311
L5321
L5331
L5341
L5400
L5410
L5420
L5430
L5450
L5460
L5500
L5505
L5510
L5520
L5530
L5535
L5540
L5560
L5570
L5580
L5585
L5590
L5595
L5600
L5610
L5611
L5613
L5614
L5616
L5617
L5618
L5620
L5622
L5624
L5626
L5628
L5629
L5630
L5631
L5632
L5634
L5636
L5637
L5638
L5639
L5640
L5642
L5643
L5644



                  Page 361
        All Other (no trigger bundling)


L5645
L5646
L5647
L5648
L5649
L5650
L5651
L5652
L5653
L5654
L5655
L5656
L5658
L5661
L5665
L5666
L5668
L5670
L5671
L5672
L5673
L5676
L5677
L5678
L5679
L5680
L5681
L5682
L5683
L5684
L5685
L5686
L5688
L5690
L5692
L5694
L5695
L5696
L5697
L5698
L5699
L5700
L5701
L5702
L5703
L5704
L5705
L5706
L5707
L5710
L5711
L5712



                  Page 362
        All Other (no trigger bundling)


L5714
L5716
L5718
L5722
L5724
L5726
L5728
L5780
L5781
L5782
L5785
L5790
L5795
L5810
L5811
L5812
L5814
L5816
L5818
L5822
L5824
L5826
L5828
L5830
L5840
L5845
L5848
L5850
L5855
L5856
L5857
L5858
L5910
L5920
L5925
L5930
L5940
L5950
L5960
L5961
L5962
L5964
L5966
L5968
L5970
L5971
L5972
L5974
L5975
L5976
L5978
L5979



                  Page 363
        All Other (no trigger bundling)


L5980
L5981
L5982
L5984
L5985
L5986
L5987
L5988
L5990
L5999
L6000
L6010
L6020
L6025
L6050
L6055
L6100
L6110
L6120
L6130
L6200
L6205
L6250
L6300
L6310
L6320
L6350
L6360
L6370
L6380
L6382
L6384
L6386
L6388
L6400
L6450
L6500
L6550
L6570
L6580
L6582
L6584
L6586
L6588
L6590
L6600
L6605
L6610
L6611
L6615
L6616
L6620



                  Page 364
        All Other (no trigger bundling)


L6621
L6623
L6624
L6625
L6628
L6629
L6630
L6632
L6635
L6637
L6638
L6640
L6641
L6642
L6645
L6646
L6647
L6648
L6650
L6655
L6660
L6665
L6670
L6672
L6675
L6676
L6677
L6680
L6682
L6684
L6686
L6687
L6688
L6689
L6690
L6691
L6692
L6693
L6694
L6695
L6696
L6697
L6698
L6703
L6704
L6706
L6707
L6708
L6709
L6711
L6712
L6713



                  Page 365
        All Other (no trigger bundling)


L6714
L6721
L6722
L6805
L6810
L6881
L6882
L6883
L6884
L6885
L6890
L6895
L6900
L6905
L6910
L6915
L6920
L6925
L6930
L6935
L6940
L6945
L6950
L6955
L6960
L6965
L6970
L6975
L7007
L7008
L7009
L7040
L7045
L7170
L7180
L7181
L7185
L7186
L7190
L7191
L7260
L7261
L7266
L7272
L7274
L7360
L7362
L7364
L7366
L7367
L7368
L7400



                  Page 366
        All Other (no trigger bundling)


L7401
L7402
L7403
L7404
L7405
L7499
L7500
L7510
L7520
L7600
L8000
L8001
L8002
L8010
L8015
L8020
L8030
L8031
L8032
L8035
L8039
L8040
L8041
L8042
L8043
L8044
L8045
L8046
L8047
L8048
L8049
L8300
L8310
L8320
L8330
L8400
L8410
L8415
L8417
L8420
L8430
L8435
L8440
L8460
L8465
L8470
L8480
L8485
L8499
L8500
L8501
L8505



                  Page 367
        All Other (no trigger bundling)


L8507
L8509
L8510
L8511
L8512
L8513
L8514
L8515
L8600
L8603
L8604
L8606
L8609
L8610
L8612
L8613
L8614
L8615
L8616
L8617
L8618
L8619
L8621
L8622
L8623
L8624
L8627
L8628
L8629
L8630
L8631
L8641
L8642
L8658
L8659
L8670
L8680
L8681
L8682
L8683
L8684
L8685
L8686
L8687
L8688
L8689
L8690
L8691
L8692
L8693
L8695
L8699



                  Page 368
        All Other (no trigger bundling)


L9900
M0064
M0076
M0100
P2028
P2029
P2033
P2038
P3000
P3001
P7001
P9010
P9011
P9012
P9016
P9017
P9019
P9020
P9021
P9022
P9023
P9031
P9032
P9033
P9034
P9035
P9036
P9037
P9038
P9039
P9040
P9041
P9043
P9044
P9045
P9046
P9047
P9048
P9050
P9051
P9052
P9053
P9054
P9055
P9056
P9057
P9058
P9059
P9060
P9603
P9604
P9612



                  Page 369
        All Other (no trigger bundling)


Q0035
Q0036
Q0081
Q0083
Q0084
Q0085
Q0091
Q0092
Q0111
Q0112
Q0113
Q0114
Q0115
Q0116
Q0138
Q0139
Q0144
Q0163
Q0164
Q0165
Q0166
Q0167
Q0168
Q0169
Q0170
Q0171
Q0172
Q0173
Q0174
Q0175
Q0176
Q0177
Q0178
Q0179
Q0180
Q0181
Q0184
Q0478
Q0479
Q0480
Q0481
Q0482
Q0483
Q0484
Q0485
Q0486
Q0487
Q0488
Q0489
Q0490
Q0491
Q0492



                  Page 370
        All Other (no trigger bundling)


Q0493
Q0494
Q0495
Q0496
Q0497
Q0498
Q0499
Q0500
Q0501
Q0502
Q0503
Q0504
Q0505
Q0506
Q0515
Q1003
Q1004
Q1005
Q2004
Q2009
Q2017
Q2025
Q2035
Q2036
Q2037
Q2038
Q2039
Q3001
Q3025
Q3026
Q3031
Q4001
Q4002
Q4003
Q4004
Q4005
Q4006
Q4007
Q4008
Q4009
Q4010
Q4011
Q4012
Q4013
Q4014
Q4015
Q4016
Q4017
Q4018
Q4019
Q4020
Q4021



                  Page 371
        All Other (no trigger bundling)


Q4022
Q4023
Q4024
Q4025
Q4026
Q4027
Q4028
Q4029
Q4030
Q4031
Q4032
Q4033
Q4034
Q4035
Q4036
Q4037
Q4038
Q4039
Q4040
Q4041
Q4042
Q4043
Q4044
Q4045
Q4046
Q4047
Q4048
Q4049
Q4050
Q4051
Q4074
Q4078
Q4081
Q4082
Q4100
Q4101
Q4102
Q4103
Q4104
Q4105
Q4106
Q4107
Q4108
Q4109
Q4110
Q4111
Q4112
Q4113
Q4114
Q9951
Q9953
Q9954



                  Page 372
        All Other (no trigger bundling)


Q9955
Q9956
Q9957
Q9958
Q9959
Q9960
Q9961
Q9962
Q9963
Q9964
Q9965
Q9966
Q9967
Q9968
R0070
R0075
R0076
S0023
S0028
S0077
S0181
S0190
S0191
S0196
S0199
S0209
S0215
S0270
S0271
S0272
S0315
S0316
S0625
S1040
S3620
S3628
S3711
S3800
S3818
S3819
S3820
S3822
S3823
S4989
S5035
S5036
S5100
S5101
S5102
S5108
S5109
S5110



                  Page 373
        All Other (no trigger bundling)


S5115
S5125
S5130
S5131
S5135
S5136
S5140
S5150
S5151
S5160
S5161
S5165
S5170
S5180
S5181
S5497
S5498
S5501
S5502
S5517
S5518
S5522
S8265
S8270
S9001
S9123
S9124
S9208
S9209
S9211
S9212
S9213
S9214
S9325
S9326
S9327
S9328
S9329
S9330
S9331
S9335
S9336
S9338
S9340
S9341
S9342
S9343
S9345
S9346
S9347
S9348
S9349



                  Page 374
        All Other (no trigger bundling)


S9351
S9353
S9357
S9359
S9361
S9363
S9365
S9366
S9367
S9368
S9370
S9372
S9373
S9374
S9375
S9376
S9377
S9379
S9433
S9435
S9451
S9470
S9484
S9485
S9490
S9494
S9497
S9500
S9501
S9502
S9503
S9504
S9542
S9975
S9976
S9977
V2020
V2100
V2101
V2102
V2103
V2104
V2105
V2106
V2107
V2108
V2109
V2110
V2111
V2112
V2113
V2114



                  Page 375
        All Other (no trigger bundling)


V2115
V2118
V2121
V2199
V2200
V2201
V2202
V2203
V2204
V2205
V2206
V2207
V2208
V2209
V2210
V2211
V2212
V2213
V2214
V2215
V2218
V2219
V2220
V2221
V2299
V2300
V2301
V2302
V2303
V2304
V2305
V2306
V2307
V2308
V2309
V2310
V2311
V2312
V2313
V2314
V2315
V2318
V2319
V2320
V2321
V2399
V2410
V2430
V2499
V2500
V2501
V2502
V2503
V2510



                  Page 376
        All Other (no trigger bundling)


V2511
V2512
V2513
V2520
V2521
V2522
V2523
V2530
V2531
V2599
V2600
V2610
V2615
V2623
V2624
V2625
V2626
V2627
V2628
V2629
V2630
V2631
V2632
V2700
V2710
V2715
V2718
V2730
V2744
V2750
V2755
V2760
V2770
V2780
V2781
V2782
V2783
V2784
V2785
V2787
V2790
V2799
V5008
V5010
V5011
V5014
V5020
V5030
V5040
V5050
V5060
V5070
V5080
V5090
V5095



                  Page 377
        All Other (no trigger bundling)


V5100
V5110
V5120
V5130
V5140
V5150
V5160
V5170
V5180
V5190
V5200
V5210
V5220
V5230
V5240
V5241
V5242
V5243
V5244
V5245
V5246
V5247
V5248
V5249
V5250
V5251
V5252
V5253
V5254
V5255
V5256
V5257
V5258
V5259
V5260
V5261
V5262
V5263
V5264
V5265
V5266
V5267
V5275
V5298
V5299
V5336
V5362
V5363
V5364
Q2040
C9280
C9281
C9282
C9283
C9285



                  Page 378
        All Other (no trigger bundling)


C9406
K0743
K0744
K0745

K0746
Q2041
Q2042
Q2043

Q2044




                  Page 379
                                 All Other (no trigger bundling)


DESCRIPTION
00100 - ANESTHESIA FOR PROCEDURES ON SALIVARY GLANDS, INCLUDING BIOPSY
00102 - ANESTHESIA FOR PROCEDURES INVOLVING PLASTIC REPAIR OF CLEFT LIP
00103 - ANESTHESIA FOR RECONSTRUCTIVE PROCEDURES OF EYELID (EG, BLEPHAROPLASTY, PTOSIS
00104 - ANESTHESIA FOR ELECTROCONVULSIVE THERAPY
00120 - ANESTHESIA FOR PROCEDURES ON EXTERNAL, MIDDLE, AND INNER EAR INCLUDING BIOPSY;
00124 - ANESTHESIA FOR PROCEDURES ON EXTERNAL, MIDDLE, AND INNER EAR INCLUDING BIOPSY;
00126 - ANESTHESIA FOR PROCEDURES ON EXTERNAL, MIDDLE, AND INNER EAR INCLUDING BIOPSY;
00140 - ANESTHESIA FOR PROCEDURES ON EYE; NOT OTHERWISE SPECIFIED
00142 - ANESTHESIA FOR PROCEDURES ON EYE; LENS SURGERY
00144 - ANESTHESIA FOR PROCEDURES ON EYE; CORNEAL TRANSPLANT
00145 - ANESTHESIA FOR PROCEDURES ON EYE; VITREORETINAL SURGERY
00147 - ANESTHESIA FOR PROCEDURES ON EYE; IRIDECTOMY
00148 - ANESTHESIA FOR PROCEDURES ON EYE; OPHTHALMOSCOPY
00160 - ANESTHESIA FOR PROCEDURES ON NOSE AND ACCESSORY SINUSES; NOT OTHERWISE SPECIFIED
00162 - ANESTHESIA FOR PROCEDURES ON NOSE AND ACCESSORY SINUSES; RADICAL SURGERY
00164 - ANESTHESIA FOR PROCEDURES ON NOSE AND ACCESSORY SINUSES; BIOPSY, SOFT TISSUE
0016T - DESTRUCTION OF LOCALIZED LESION OF CHOROID (EG, CHOROIDAL NEOVASCULARIZATION),
00170 - ANESTHESIA FOR INTRAORAL PROCEDURES, INCLUDING BIOPSY; NOT OTHERWISE SPECIFIED
00172 - ANESTHESIA FOR INTRAORAL PROCEDURES, INCLUDING BIOPSY; REPAIR OF CLEFT PALATE
00174 - ANESTHESIA FOR INTRAORAL PROCEDURES, INCLUDING BIOPSY; EXCISION OF
00176 - ANESTHESIA FOR INTRAORAL PROCEDURES, INCLUDING BIOPSY; RADICAL SURGERY
0017T - DESTRUCTION OF MACULAR DRUSEN, PHOTOCOAGULATION
00190 - ANESTHESIA FOR PROCEDURES ON FACIAL BONES OR SKULL; NOT OTHERWISE SPECIFIED
00192 - ANESTHESIA FOR PROCEDURES ON FACIAL BONES OR SKULL; RADICAL SURGERY (INCLUDING
00210 - ANESTHESIA FOR INTRACRANIAL PROCEDURES; NOT OTHERWISE SPECIFIED
00211 - Anesthesia for intracranial procedures; craniotomy or craniectomy for evacuation
00212 - ANESTHESIA FOR INTRACRANIAL PROCEDURES; SUBDURAL TAPS
00214 - ANESTHESIA FOR INTRACRANIAL PROCEDURES; BURR HOLES, INCLUDING VENTRICULOGRAPHY
00215 - ANESTHESIA FOR INTRACRANIAL PROCEDURES; CRANIOPLASTY OR ELEVATION OF DEPRESSED
00216 - ANESTHESIA FOR INTRACRANIAL PROCEDURES; VASCULAR PROCEDURES
00218 - ANESTHESIA FOR INTRACRANIAL PROCEDURES; PROCEDURES IN SITTING POSITION
00220 - ANESTHESIA FOR INTRACRANIAL PROCEDURES; CEREBROSPINAL FLUID SHUNTING PROCEDURES
00222 - ANESTHESIA FOR INTRACRANIAL PROCEDURES; ELECTROCOAGULATION OF INTRACRANIAL NERVE
00300 - ANESTHESIA FOR ALL PROCEDURES ON THE INTEGUMENTARY SYSTEM, MUSCLES AND NERVES OF
00320 - ANESTHESIA FOR ALL PROCEDURES ON ESOPHAGUS, THYROID, LARYNX, TRACHEA AND
00322 - ANESTHESIA FOR ALL PROCEDURES ON ESOPHAGUS, THYROID, LARYNX, TRACHEA AND
00326 - ANESTHESIA FOR ALL PROCEDURES ON THE LARYNX AND TRACHEA IN CHILDREN LESS THAN 1
00350 - ANESTHESIA FOR PROCEDURES ON MAJOR VESSELS OF NECK; NOT OTHERWISE SPECIFIED
00352 - ANESTHESIA FOR PROCEDURES ON MAJOR VESSELS OF NECK; SIMPLE LIGATION
00400 - ANESTHESIA FOR PROCEDURES ON THE INTEGUMENTARY SYSTEM ON THE EXTREMITIES, ANTERI
00402 - ANESTHESIA FOR PROCEDURES ON THE INTEGUMENTARY SYSTEM ON THE EXTREMITIES,
00404 - ANESTHESIA FOR PROCEDURES ON THE INTEGUMENTARY SYSTEM ON THE EXTREMITIES,
00406 - ANESTHESIA FOR PROCEDURES ON THE INTEGUMENTARY SYSTEM ON THE EXTREMITIES,
00410 - ANESTHESIA FOR PROCEDURES ON THE INTEGUMENTARY SYSTEM ON THE EXTREMITIES,
00450 - ANESTHESIA FOR PROCEDURES ON CLAVICLE AND SCAPULA; NOT OTHERWISE SPECIFIED
00452 - ANESTHESIA FOR PROCEDURES ON CLAVICLE AND SCAPULA; RADICAL SURGERY
00454 - ANESTHESIA FOR PROCEDURES ON CLAVICLE AND SCAPULA; BIOPSY OF CLAVICLE
00470 - ANESTHESIA FOR PARTIAL RIB RESECTION; NOT OTHERWISE SPECIFIED
00472 - ANESTHESIA FOR PARTIAL RIB RESECTION; THORACOPLASTY (ANY TYPE)
00474 - ANESTHESIA FOR PARTIAL RIB RESECTION; RADICAL PROCEDURES (EG, PECTUS EXCAVATUM)
0048T - IMPLANTATION OF A VENTRICULAR ASSIST DEVICE, EXTRACORPOREAL, PERCUTANEOUS



                                           Page 380
                                   All Other (no trigger bundling)


00500   - ANESTHESIA FOR ALL PROCEDURES ON ESOPHAGUS
0050T   - REMOVAL OF A VENTRICULAR ASSIST DEVICE, EXTRACORPOREAL, PERCUTANEOUS
00520   - ANESTHESIA FOR CLOSED CHEST PROCEDURES; (INCLUDING BRONCHOSCOPY) NOT OTHERWISE
00522   - ANESTHESIA FOR CLOSED CHEST PROCEDURES; NEEDLE BIOPSY OF PLEURA
00524   - ANESTHESIA FOR CLOSED CHEST PROCEDURES; PNEUMOCENTESIS
00528   - ANESTHESIA FOR CLOSED CHEST PROCEDURES; MEDIASTINOSCOPY AND DIAGNOSTIC
00529   - ANESTHESIA FOR CLOSED CHEST PROCEDURES; MEDIASTINOSCOPY AND DIAGNOSTIC
00530   - ANESTHESIA FOR PERMANENT TRANSVENOUS PACEMAKER INSERTION
00532   - ANESTHESIA FOR ACCESS TO CENTRAL VENOUS CIRCULATION
00534   - ANESTHESIA FOR TRANSVENOUS INSERTION OR REPLACEMENT OF PACING
00537   - ANESTHESIA FOR CARDIAC ELECTROPHYSIOLOGIC PROCEDURES INCLUDING RADIOFREQUENCY
00539   - ANESTHESIA FOR TRACHEOBRONCHIAL RECONSTRUCTION
00540   - ANESTHESIA FOR THORACOTOMY PROCEDURES INVOLVING LUNGS, PLEURA, DIAPHRAGM, AND
00541   - ANESTHESIA FOR THORACOTOMY PROCEDURES INVOLVING LUNGS, PLEURA, DIAPHRAGM, AND
00542   - ANESTHESIA FOR THORACOTOMY PROCEDURES INVOLVING LUNGS, PLEURA, DIAPHRAGM, AND
00546   - ANESTHESIA FOR THORACOTOMY PROCEDURES INVOLVING LUNGS, PLEURA, DIAPHRAGM, AND
00548   - ANESTHESIA FOR THORACOTOMY PROCEDURES INVOLVING LUNGS, PLEURA, DIAPHRAGM, AND
0054T   - COMPUTER-ASSISTED MUSCULOSKELETAL SURGICAL NAVIGATIONAL ORTHOPEDIC PROCEDURE, WI
00550   - ANESTHESIA FOR STERNAL DEBRIDEMENT
0055T   - COMPUTER-ASSISTED MUSCULOSKELETAL SURGICAL NAVIGATIONAL ORTHOPEDIC PROCEDURE, WI
00560   - ANESTHESIA FOR PROCEDURES ON HEART, PERICARDIAL SAC, AND GREAT VESSELS OF
00561   - ANESTHESIA FOR PROCEDURES ON HEART, PERICARDIAL SAC, AND GREAT VESSELS OF
00562   - ANESTHESIA FOR PROCEDURES ON HEART, PERICARDIAL SAC, AND GREAT VESSELS OF CHEST;
00563   - ANESTHESIA FOR PROCEDURES ON HEART, PERICARDIAL SAC, AND GREAT VESSELS OF
00566   - ANESTHESIA FOR DIRECT CORONARY ARTERY BYPASS GRAFTING; WITHOUT PUMP OXYGENATOR
00567   - Anesthesia for direct coronary artery bypass grafting; with pump oxygenator
00580   - ANESTHESIA FOR HEART TRANSPLANT OR HEART/LUNG TRANSPLANT
00600   - ANESTHESIA FOR PROCEDURES ON CERVICAL SPINE AND CORD; NOT OTHERWISE SPECIFIED
00604   - ANESTHESIA FOR PROCEDURES ON CERVICAL SPINE AND CORD; PROCEDURES WITH PATIENT
00620   - ANESTHESIA FOR PROCEDURES ON THORACIC SPINE AND CORD; NOT OTHERWISE SPECIFIED
00622   - ANESTHESIA FOR PROCEDURES ON THORACIC SPINE AND CORD; THORACOLUMBAR
00625   - ANESTHESIA FOR PROCEDURES ON THE THORACIC SPINE AND CORD, VIA AN ANTERIOR TRANST
00626   - ANESTHESIA FOR PROCEDURES ON THE THORACIC SPINE AND CORD, VIA AN ANTERIOR TRANST
00630   - ANESTHESIA FOR PROCEDURES IN LUMBAR REGION; NOT OTHERWISE SPECIFIED
00632   - ANESTHESIA FOR PROCEDURES IN LUMBAR REGION; LUMBAR SYMPATHECTOMY
00634   - ANESTHESIA FOR PROCEDURES IN LUMBAR REGION; CHEMONUCLEOLYSIS
00635   - ANESTHESIA FOR PROCEDURES IN LUMBAR REGION; DIAGNOSTIC OR THERAPEUTIC LUMBAR
00640   - ANESTHESIA FOR MANIPULATION OF THE SPINE OR FOR CLOSED PROCEDURES ON THE
00670   - ANESTHESIA FOR EXTENSIVE SPINE AND SPINAL CORD PROCEDURES (EG, SPINAL
00700   - ANESTHESIA FOR PROCEDURES ON UPPER ANTERIOR ABDOMINAL WALL; NOT OTHERWISE SPECIF
00702   - ANESTHESIA FOR PROCEDURES ON UPPER ANTERIOR ABDOMINAL WALL; PERCUTANEOUS LIVER
00730   - ANESTHESIA FOR PROCEDURES ON UPPER POSTERIOR ABDOMINAL WALL
0073T   - COMPENSATOR-BASED BEAM MODULATION TREATMENT DELIVERY OF INVERSE PLANNED
00740   - ANESTHESIA FOR UPPER GASTROINTESTINAL ENDOSCOPIC PROCEDURES, ENDOSCOPE
00750   - ANESTHESIA FOR HERNIA REPAIRS IN UPPER ABDOMEN; NOT OTHERWISE SPECIFIED
00752   - ANESTHESIA FOR HERNIA REPAIRS IN UPPER ABDOMEN; LUMBAR AND VENTRAL (INCISIONAL)
00754   - ANESTHESIA FOR HERNIA REPAIRS IN UPPER ABDOMEN; OMPHALOCELE
00756   - ANESTHESIA FOR HERNIA REPAIRS IN UPPER ABDOMEN; TRANSABDOMINAL REPAIR OF
00770   - ANESTHESIA FOR ALL PROCEDURES ON MAJOR ABDOMINAL BLOOD VESSELS
00790   - ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN UPPER ABDOMEN INCLUDING
00792   - ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN UPPER ABDOMEN INCLUDING
00794   - ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN UPPER ABDOMEN INCLUDING



                                             Page 381
                                    All Other (no trigger bundling)


00796   - ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN UPPER ABDOMEN INCLUDING
00797   - ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN UPPER ABDOMEN INCLUDING
00800   - ANESTHESIA FOR PROCEDURES ON LOWER ANTERIOR ABDOMINAL WALL; NOT OTHERWISE SPECIF
00802   - ANESTHESIA FOR PROCEDURES ON LOWER ANTERIOR ABDOMINAL WALL; PANNICULECTOMY
00810   - ANESTHESIA FOR LOWER INTESTINAL ENDOSCOPIC PROCEDURES, ENDOSCOPE INTRODUCED
00820   - ANESTHESIA FOR PROCEDURES ON LOWER POSTERIOR ABDOMINAL WALL
00830   - ANESTHESIA FOR HERNIA REPAIRS IN LOWER ABDOMEN; NOT OTHERWISE SPECIFIED
00832   - ANESTHESIA FOR HERNIA REPAIRS IN LOWER ABDOMEN; VENTRAL AND INCISIONAL HERNIAS
00834   - ANESTHESIA FOR HERNIA REPAIRS IN THE LOWER ABDOMEN NOT OTHERWISE SPECIFIED,
00836   - ANESTHESIA FOR HERNIA REPAIRS IN THE LOWER ABDOMEN NOT OTHERWISE SPECIFIED,
00840   - ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN INCLUDING
00842   - ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN INCLUDING
00844   - ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN INCLUDING
00846   - ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN INCLUDING
00848   - ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN INCLUDING
00851   - ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN INCLUDING
00860   - ANESTHESIA FOR EXTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN, INCLUDING URINARY
00862   - ANESTHESIA FOR EXTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN, INCLUDING URINARY
00864   - ANESTHESIA FOR EXTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN, INCLUDING URINARY
00865   - ANESTHESIA FOR EXTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN, INCLUDING URINARY
00866   - ANESTHESIA FOR EXTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN, INCLUDING URINARY
00868   - ANESTHESIA FOR EXTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN, INCLUDING URINARY
00870   - ANESTHESIA FOR EXTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN, INCLUDING URINARY
00872   - ANESTHESIA FOR LITHOTRIPSY, EXTRACORPOREAL SHOCK WAVE; WITH WATER BATH
00873   - ANESTHESIA FOR LITHOTRIPSY, EXTRACORPOREAL SHOCK WAVE; WITHOUT WATER BATH
00880   - ANESTHESIA FOR PROCEDURES ON MAJOR LOWER ABDOMINAL VESSELS; NOT OTHERWISE
00882   - ANESTHESIA FOR PROCEDURES ON MAJOR LOWER ABDOMINAL VESSELS; INFERIOR VENA CAVA
00902   - ANESTHESIA FOR; ANORECTAL PROCEDURE
00904   - ANESTHESIA FOR; RADICAL PERINEAL PROCEDURE
00906   - ANESTHESIA FOR; VULVECTOMY
00908   - ANESTHESIA FOR; PERINEAL PROSTATECTOMY
00910   - ANESTHESIA FOR TRANSURETHRAL PROCEDURES (INCLUDING URETHROCYSTOSCOPY); NOT
00912   - ANESTHESIA FOR TRANSURETHRAL PROCEDURES (INCLUDING URETHROCYSTOSCOPY);
00914   - ANESTHESIA FOR TRANSURETHRAL PROCEDURES (INCLUDING URETHROCYSTOSCOPY);
00916   - ANESTHESIA FOR TRANSURETHRAL PROCEDURES (INCLUDING URETHROCYSTOSCOPY);
00918   - ANESTHESIA FOR TRANSURETHRAL PROCEDURES (INCLUDING URETHROCYSTOSCOPY); WITH
00920   - ANESTHESIA FOR PROCEDURES ON MALE GENITALIA (INCLUDING OPEN URETHRAL
00921   - ANESTHESIA FOR PROCEDURES ON MALE GENITALIA (INCLUDING OPEN URETHRAL
00922   - ANESTHESIA FOR PROCEDURES ON MALE GENITALIA (INCLUDING OPEN URETHRAL
00924   - ANESTHESIA FOR PROCEDURES ON MALE GENITALIA (INCLUDING OPEN URETHRAL
00926   - ANESTHESIA FOR PROCEDURES ON MALE GENITALIA (INCLUDING OPEN URETHRAL
00928   - ANESTHESIA FOR PROCEDURES ON MALE GENITALIA (INCLUDING OPEN URETHRAL
0092T   - TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH, INCLUDING DISCECTO
00930   - ANESTHESIA FOR PROCEDURES ON MALE GENITALIA (INCLUDING OPEN URETHRAL
00932   - ANESTHESIA FOR PROCEDURES ON MALE GENITALIA (INCLUDING OPEN URETHRAL
00934   - ANESTHESIA FOR PROCEDURES ON MALE GENITALIA (INCLUDING OPEN URETHRAL
00936   - ANESTHESIA FOR PROCEDURES ON MALE GENITALIA (INCLUDING OPEN URETHRAL
00940   - ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY OF LABIA, VAGINA, CERVIX OR
00942   - ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY OF LABIA, VAGINA, CERVIX OR
00944   - ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY OF LABIA, VAGINA, CERVIX OR
00948   - ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY OF LABIA, VAGINA, CERVIX OR
00950   - ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY OF LABIA, VAGINA, CERVIX OR



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00952   - ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY OF LABIA, VAGINA, CERVIX OR
0095T   - REMOVAL OF TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH, EACH AD
0098T   - REVISION INCLUDING REPLACEMENT OF TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANT
01112   - ANESTHESIA FOR BONE MARROW ASPIRATION AND/OR BIOPSY, ANTERIOR OR POSTERIOR ILIAC
01120   - ANESTHESIA FOR PROCEDURES ON BONY PELVIS
01130   - ANESTHESIA FOR BODY CAST APPLICATION OR REVISION
01140   - ANESTHESIA FOR INTERPELVIABDOMINAL (HINDQUARTER) AMPUTATION
01150   - ANESTHESIA FOR RADICAL PROCEDURES FOR TUMOR OF PELVIS, EXCEPT HINDQUARTER
01160   - ANESTHESIA FOR CLOSED PROCEDURES INVOLVING SYMPHYSIS PUBIS OR SACROILIAC JOINT
01170   - ANESTHESIA FOR OPEN PROCEDURES INVOLVING SYMPHYSIS PUBIS OR SACROILIAC JOINT
01173   - ANESTHESIA FOR OPEN REPAIR OF FRACTURE DISRUPTION OF PELVIS OR COLUMN FRACTURE
01180   - ANESTHESIA FOR OBTURATOR NEURECTOMY; EXTRAPELVIC
01190   - ANESTHESIA FOR OBTURATOR NEURECTOMY; INTRAPELVIC
01200   - ANESTHESIA FOR ALL CLOSED PROCEDURES INVOLVING HIP JOINT
01202   - ANESTHESIA FOR ARTHROSCOPIC PROCEDURES OF HIP JOINT
01210   - ANESTHESIA FOR OPEN PROCEDURES INVOLVING HIP JOINT; NOT OTHERWISE SPECIFIED
01212   - ANESTHESIA FOR OPEN PROCEDURES INVOLVING HIP JOINT; HIP DISARTICULATION
01214   - ANESTHESIA FOR OPEN PROCEDURES INVOLVING HIP JOINT; TOTAL HIP ARTHROPLASTY
01215   - ANESTHESIA FOR OPEN PROCEDURES INVOLVING HIP JOINT; REVISION OF TOTAL HIP
01220   - ANESTHESIA FOR ALL CLOSED PROCEDURES INVOLVING UPPER 2/3 OF FEMUR
01230   - ANESTHESIA FOR OPEN PROCEDURES INVOLVING UPPER 2/3 OF FEMUR; NOT OTHERWISE
01232   - ANESTHESIA FOR OPEN PROCEDURES INVOLVING UPPER 2/3 OF FEMUR; AMPUTATION
01234   - ANESTHESIA FOR OPEN PROCEDURES INVOLVING UPPER 2/3 OF FEMUR; RADICAL RESECTION
01250   - ANESTHESIA FOR ALL PROCEDURES ON NERVES, MUSCLES, TENDONS, FASCIA, AND BURSAE
01260   - ANESTHESIA FOR ALL PROCEDURES INVOLVING VEINS OF UPPER LEG, INCLUDING
01270   - ANESTHESIA FOR PROCEDURES INVOLVING ARTERIES OF UPPER LEG, INCLUDING BYPASS
01272   - ANESTHESIA FOR PROCEDURES INVOLVING ARTERIES OF UPPER LEG, INCLUDING BYPASS
01274   - ANESTHESIA FOR PROCEDURES INVOLVING ARTERIES OF UPPER LEG, INCLUDING BYPASS
01320   - ANESTHESIA FOR ALL PROCEDURES ON NERVES, MUSCLES, TENDONS, FASCIA, AND BURSAE OF
01340   - ANESTHESIA FOR ALL CLOSED PROCEDURES ON LOWER 1/3 OF FEMUR
01360   - ANESTHESIA FOR ALL OPEN PROCEDURES ON LOWER 1/3 OF FEMUR
01380   - ANESTHESIA FOR ALL CLOSED PROCEDURES ON KNEE JOINT
01382   - ANESTHESIA FOR DIAGNOSTIC ARTHROSCOPIC PROCEDURES OF KNEE JOINT
01390   - ANESTHESIA FOR ALL CLOSED PROCEDURES ON UPPER ENDS OF TIBIA, FIBULA, AND/OR
01392   - ANESTHESIA FOR ALL OPEN PROCEDURES ON UPPER ENDS OF TIBIA, FIBULA, AND/OR
01400   - ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC PROCEDURES ON KNEE JOINT; NOT
01402   - ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC PROCEDURES ON KNEE JOINT; TOTAL
01404   - ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC PROCEDURES ON KNEE JOINT;
01420   - ANESTHESIA FOR ALL CAST APPLICATIONS, REMOVAL, OR REPAIR INVOLVING KNEE JOINT
01430   - ANESTHESIA FOR PROCEDURES ON VEINS OF KNEE AND POPLITEAL AREA; NOT OTHERWISE
01432   - ANESTHESIA FOR PROCEDURES ON VEINS OF KNEE AND POPLITEAL AREA; ARTERIOVENOUS
01440   - ANESTHESIA FOR PROCEDURES ON ARTERIES OF KNEE AND POPLITEAL AREA; NOT OTHERWISE
01442   - ANESTHESIA FOR PROCEDURES ON ARTERIES OF KNEE AND POPLITEAL AREA; POPLITEAL
01444   - ANESTHESIA FOR PROCEDURES ON ARTERIES OF KNEE AND POPLITEAL AREA; POPLITEAL
01462   - ANESTHESIA FOR ALL CLOSED PROCEDURES ON LOWER LEG, ANKLE, AND FOOT
01464   - ANESTHESIA FOR ARTHROSCOPIC PROCEDURES OF ANKLE AND/OR FOOT
01470   - ANESTHESIA FOR PROCEDURES ON NERVES, MUSCLES, TENDONS, AND FASCIA OF LOWER LEG,
01472   - ANESTHESIA FOR PROCEDURES ON NERVES, MUSCLES, TENDONS, AND FASCIA OF LOWER LEG,
01474   - ANESTHESIA FOR PROCEDURES ON NERVES, MUSCLES, TENDONS, AND FASCIA OF LOWER LEG,
01480   - ANESTHESIA FOR OPEN PROCEDURES ON BONES OF LOWER LEG, ANKLE, AND FOOT; NOT
01482   - ANESTHESIA FOR OPEN PROCEDURES ON BONES OF LOWER LEG, ANKLE, AND FOOT; RADICAL
01484   - ANESTHESIA FOR OPEN PROCEDURES ON BONES OF LOWER LEG, ANKLE, AND FOOT;



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                                    All Other (no trigger bundling)


01486   - ANESTHESIA FOR OPEN PROCEDURES ON BONES OF LOWER LEG, ANKLE, AND FOOT; TOTAL
01490   - ANESTHESIA FOR LOWER LEG CAST APPLICATION, REMOVAL, OR REPAIR
01500   - ANESTHESIA FOR PROCEDURES ON ARTERIES OF LOWER LEG, INCLUDING BYPASS GRAFT; NOT
01502   - ANESTHESIA FOR PROCEDURES ON ARTERIES OF LOWER LEG, INCLUDING BYPASS GRAFT;
01520   - ANESTHESIA FOR PROCEDURES ON VEINS OF LOWER LEG; NOT OTHERWISE SPECIFIED
01522   - ANESTHESIA FOR PROCEDURES ON VEINS OF LOWER LEG; VENOUS THROMBECTOMY, DIRECT OR
01610   - ANESTHESIA FOR ALL PROCEDURES ON NERVES, MUSCLES, TENDONS, FASCIA, AND BURSAE OF
01620   - ANESTHESIA FOR ALL CLOSED PROCEDURES ON HUMERAL HEAD AND NECK, STERNOCLAVICULAR
01622   - ANESTHESIA FOR DIAGNOSTIC ARTHROSCOPIC PROCEDURES OF SHOULDER JOINT
01630   - ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC PROCEDURES ON HUMERAL HEAD AND
01634   - ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC PROCEDURES ON HUMERAL HEAD AND
01636   - ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC PROCEDURES ON HUMERAL HEAD AND
01638   - ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC PROCEDURES ON HUMERAL HEAD AND
0163T   - TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH, INCLUDING DISCECTO
0164T   - REMOVAL OF TOTAL DISC ARTHROPLASTY, (ARTIFICIAL DISC), ANTERIOR APPROACH, EACH A
01650   - ANESTHESIA FOR PROCEDURES ON ARTERIES OF SHOULDER AND AXILLA; NOT OTHERWISE
01652   - ANESTHESIA FOR PROCEDURES ON ARTERIES OF SHOULDER AND AXILLA; AXILLARY-BRACHIAL
01654   - ANESTHESIA FOR PROCEDURES ON ARTERIES OF SHOULDER AND AXILLA; BYPASS GRAFT
01656   - ANESTHESIA FOR PROCEDURES ON ARTERIES OF SHOULDER AND AXILLA; AXILLARY-FEMORAL
0165T   - REVISION INCLUDING REPLACEMENT OF TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANT
0166T   - TRANSMYOCARDIAL TRANSCATHETER CLOSURE OF VENTRICULAR SEPTAL DEFECT, WITH IMPLANT
01670   - ANESTHESIA FOR ALL PROCEDURES ON VEINS OF SHOULDER AND AXILLA
0167T   - TRANSMYOCARDIAL TRANSCATHETER CLOSURE OF VENTRICULAR SEPTAL DEFECT, WITH IMPLANT
01680   - ANESTHESIA FOR SHOULDER CAST APPLICATION, REMOVAL OR REPAIR; NOT OTHERWISE
01682   - ANESTHESIA FOR SHOULDER CAST APPLICATION, REMOVAL OR REPAIR; SHOULDER SPICA
0169T   - STEREOTACTIC PLACEMENT OF INFUSION CATHETER(S) IN THE BRAIN FOR DELIVERY OF THER
01710   - ANESTHESIA FOR PROCEDURES ON NERVES, MUSCLES, TENDONS, FASCIA, AND BURSAE OF UPP
01712   - ANESTHESIA FOR PROCEDURES ON NERVES, MUSCLES, TENDONS, FASCIA, AND BURSAE OF
01714   - ANESTHESIA FOR PROCEDURES ON NERVES, MUSCLES, TENDONS, FASCIA, AND BURSAE OF
01716   - ANESTHESIA FOR PROCEDURES ON NERVES, MUSCLES, TENDONS, FASCIA, AND BURSAE OF
01730   - ANESTHESIA FOR ALL CLOSED PROCEDURES ON HUMERUS AND ELBOW
01732   - ANESTHESIA FOR DIAGNOSTIC ARTHROSCOPIC PROCEDURES OF ELBOW JOINT
01740   - ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC PROCEDURES OF THE ELBOW; NOT
01742   - ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC PROCEDURES OF THE ELBOW; OSTEOTOMY
01744   - ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC PROCEDURES OF THE ELBOW; REPAIR OF
01756   - ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC PROCEDURES OF THE ELBOW; RADICAL
01758   - ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC PROCEDURES OF THE ELBOW; EXCISION
01760   - ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC PROCEDURES OF THE ELBOW; TOTAL
01770   - ANESTHESIA FOR PROCEDURES ON ARTERIES OF UPPER ARM AND ELBOW; NOT OTHERWISE
01772   - ANESTHESIA FOR PROCEDURES ON ARTERIES OF UPPER ARM AND ELBOW; EMBOLECTOMY
01780   - ANESTHESIA FOR PROCEDURES ON VEINS OF UPPER ARM AND ELBOW; NOT OTHERWISE
01782   - ANESTHESIA FOR PROCEDURES ON VEINS OF UPPER ARM AND ELBOW; PHLEBORRHAPHY
01810   - ANESTHESIA FOR ALL PROCEDURES ON NERVES, MUSCLES, TENDONS, FASCIA, AND BURSAE OF
01820   - ANESTHESIA FOR ALL CLOSED PROCEDURES ON RADIUS, ULNA, WRIST, OR HAND BONES
01829   - ANESTHESIA FOR DIAGNOSTIC ARTHROSCOPIC PROCEDURES ON THE WRIST
01830   - ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC/ENDOSCOPIC PROCEDURES ON DISTAL
01832   - ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC/ENDOSCOPIC PROCEDURES ON DISTAL
01840   - ANESTHESIA FOR PROCEDURES ON ARTERIES OF FOREARM, WRIST, AND HAND; NOT
01842   - ANESTHESIA FOR PROCEDURES ON ARTERIES OF FOREARM, WRIST, AND HAND; EMBOLECTOMY
01844   - ANESTHESIA FOR VASCULAR SHUNT, OR SHUNT REVISION, ANY TYPE (EG, DIALYSIS)
0184T   - EXCISION OF RECTAL TUMOR, TRANSANAL ENDOSCOPIC MICROSURGICAL APPROACH (IE, TEMS)
01850   - ANESTHESIA FOR PROCEDURES ON VEINS OF FOREARM, WRIST, AND HAND; NOT OTHERWISE



                                              Page 384
                                 All Other (no trigger bundling)


01852 - ANESTHESIA FOR PROCEDURES ON VEINS OF FOREARM, WRIST, AND HAND; PHLEBORRHAPHY
01860 - ANESTHESIA FOR FOREARM, WRIST, OR HAND CAST APPLICATION, REMOVAL, OR REPAIR
0186T - SUPRACHOROIDAL DELIVERY OF PHARMACOLOGIC AGENT (DOES NOT INCLUDE SUPPLY OF MEDIC
0187T - SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGING, ANTERIOR SEGMENT, WITH INTE
0190T - PLACEMENT OF INTRAOCULAR RADIATION SRC APPLICATOR (LIST SEP IN ADD TO PRIM PROC)
01916 - ANESTHESIA FOR DIAGNOSTIC ARTERIOGRAPHY/VENOGRAPHY
0191T - INSERTION OF ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE, WITHOUT EXTRAOCULAR RESER
01920 - ANESTHESIA FOR CARDIAC CATHETERIZATION INCLUDING CORONARY ANGIOGRAPHY AND
01922 - ANESTHESIA FOR NON-INVASIVE IMAGING OR RADIATION THERAPY
01924 - ANESTHESIA FOR THERAPEUTIC INTERVENTIONAL RADIOLOGIC PROCEDURES INVOLVING THE
01925 - ANESTHESIA FOR THERAPEUTIC INTERVENTIONAL RADIOLOGIC PROCEDURES INVOLVING THE
01926 - ANESTHESIA FOR THERAPEUTIC INTERVENTIONAL RADIOLOGIC PROCEDURES INVOLVING THE
0192T - INSERTION OF ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE, WITHOUT EXTRAOCULAR RESER
01930 - ANESTHESIA FOR THERAPEUTIC INTERVENTIONAL RADIOLOGIC PROCEDURES INVOLVING THE
01931 - ANESTHESIA FOR THERAPEUTIC INTERVENTIONAL RADIOLOGICAL PROCEDURES INVOLVING THE
01932 - ANESTHESIA FOR THERAPEUTIC INTERVENTIONAL RADIOLOGIC PROCEDURES INVOLVING THE
01933 - ANESTHESIA FOR THERAPEUTIC INTERVENTIONAL RADIOLOGIC PROCEDURES INVOLVING THE
01935 - ANESTHESIA FOR PERCUTANEOUS IMAGE GUIDED PROCEDURES ON THE SPINE AND SPINAL CORD
01936 - ANESTHESIA FOR PERCUTANEOUS IMAGE GUIDED PROCEDURES ON THE SPINE AND SPINAL CORD
01951 - ANESTHESIA FOR SECOND AND THIRD DEGREE BURN EXCISION OR DEBRIDEMENT WITH OR WITH
01952 - ANESTHESIA FOR SECOND AND THIRD DEGREE BURN EXCISION OR DEBRIDEMENT WITH OR
01953 - ANESTHESIA FOR SECOND AND THIRD DEGREE BURN EXCISION OR DEBRIDEMENT WITH OR
01958 - ANESTHESIA FOR EXTERNAL CEPHALIC VERSION PROCEDURE
01960 - ANESTHESIA FOR VAGINAL DELIVERY ONLY
01961 - ANESTHESIA FOR CESAREAN DELIVERY ONLY
01962 - ANESTHESIA FOR URGENT HYSTERECTOMY FOLLOWING DELIVERY
01963 - ANESTHESIA FOR CESAREAN HYSTERECTOMY WITHOUT ANY LABOR ANALGESIA/ ANESTHESIA
01965 - ANESTHESIA FOR INCOMPLETE OR MISSED ABORTION PROCEDURES
01966 - ANESTHESIA FOR INDUCED ABORTION PROCEDURES
01967 - NEURAXIAL LABOR ANALGESIA/ANESTHESIA FOR PLANNED VAGINAL DELIVERY (THIS
01968 - ANESTHESIA FOR CESAREAN DELIVERY FOLLOWING NEURAXIAL LABOR ANALGESIA/ANESTHESIA
01969 - ANESTHESIA FOR CESAREAN HYSTERECTOMY FOLLOWING NEURAXIAL LABOR
01991 - ANESTHESIA FOR DIAGNOSTIC OR THERAPEUTIC NERVE BLOCKS AND INJECTIONS (WHEN
01992 - ANESTHESIA FOR DIAGNOSTIC OR THERAPEUTIC NERVE BLOCKS AND INJECTIONS (WHEN
01996 - DAILY HOSPITAL MANAGEMENT OF EPIDURAL OR SUBARACHNOID CONTINUOUS DRUG
01999 - UNLISTED ANESTHESIA PROCEDURE(S)
0235T - Transluminal peripheral atherectomy, open or percutaneous, including radiologica
0254T - Endovascular repair of iliac artery bifurcation (eg, aneurysm, pseudoaneurysm, a
0255T - Endovascular repair of ilicac artery bifurcation (eg, aneurysm, pseudoaneurysm,
0258T - Transthoracic cardiac exposure (eg, sternotomy, thoracotomy, subxiphoid) for cat
0259T - Transthoracic cardiac exposure (eg, sternotomy, thoracotomy, subxiphoid) for cat
11004 - DEBRIDEMENT OF SKIN, SUBCUTANEOUS TISSUE, MUSCLE AND FASCIA FOR NECROTIZING
11005 - DEBRIDEMENT OF SKIN, SUBCUTANEOUS TISSUE, MUSCLE AND FASCIA FOR NECROTIZING
11006 - DEBRIDEMENT OF SKIN, SUBCUTANEOUS TISSUE, MUSCLE AND FASCIA FOR NECROTIZING
11008 - REMOVAL OF PROSTHETIC MATERIAL OR MESH, ABDOMINAL WALL FOR INFECTION (EG, FOR CH
11975 - INSERTION, IMPLANTABLE CONTRACEPTIVE CAPSULES
11977 - REMOVAL WITH REINSERTION, IMPLANTABLE CONTRACEPTIVE CAPSULES
11980 - SUBCUTANEOUS HORMONE PELLET IMPLANTATION (IMPLANTATION OF ESTRADIOL AND/OR
11981 - INSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
11982 - REMOVAL, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
11983 - REMOVAL WITH REINSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
15756 - FREE MUSCLE OR MYOCUTANEOUS FLAP WITH MICROVASCULAR ANASTOMOSIS



                                           Page 385
                                    All Other (no trigger bundling)


15757   - FREE SKIN FLAP WITH MICROVASCULAR ANASTOMOSIS
15758   - FREE FASCIAL FLAP WITH MICROVASCULAR ANASTOMOSIS
15852   - DRESSING CHANGE (FOR OTHER THAN BURNS) UNDER ANESTHESIA (OTHER THAN LOCAL)
15860   - INTRAVENOUS INJECTION OF AGENT (EG, FLUORESCEIN) TO TEST VASCULAR FLOW IN FLAP
16035   - ESCHAROTOMY; INITIAL INCISION
16036   - ESCHAROTOMY; EACH ADDITIONAL INCISION (LIST SEPARATELY IN ADDITION TO CODE FOR
19030   - INJECTION PROCEDURE ONLY FOR MAMMARY DUCTOGRAM OR GALACTOGRAM
19271   - EXCISION OF CHEST WALL TUMOR INVOLVING RIBS, WITH PLASTIC RECONSTRUCTION;
19272   - EXCISION OF CHEST WALL TUMOR INVOLVING RIBS, WITH PLASTIC RECONSTRUCTION; WITH
19290   - PREOPERATIVE PLACEMENT OF NEEDLE LOCALIZATION WIRE, BREAST;
19291   - PREOPERATIVE PLACEMENT OF NEEDLE LOCALIZATION WIRE, BREAST; EACH ADDITIONAL
19295   - IMAGE GUIDED PLACEMENT, METALLIC LOCALIZATION CLIP, PERCUTANEOUS, DURING BREAST
19305   - MASTECTOMY, RADICAL, INCLUDING PECTORAL MUSCLES, AXILLARY LYMPH NODES
19306   - MASTECTOMY, RADICAL, INCLUDING PECTORAL MUSCLES, AXILLARY AND INTERNAL MAMMARY L
19361   - BREAST RECONSTRUCTION WITH LATISSIMUS DORSI FLAP, WITHOUT PROSTHETIC IMPLANT
19364   - BREAST RECONSTRUCTION WITH FREE FLAP
19367   - BREAST RECONSTRUCTION WITH TRANSVERSE RECTUS ABDOMINIS MYOCUTANEOUS FLAP
19368   - BREAST RECONSTRUCTION WITH TRANSVERSE RECTUS ABDOMINIS MYOCUTANEOUS FLAP
19369   - BREAST RECONSTRUCTION WITH TRANSVERSE RECTUS ABDOMINIS MYOCUTANEOUS FLAP
20501   - INJECTION OF SINUS TRACT; DIAGNOSTIC (SINOGRAM)
20661   - APPLICATION OF HALO, INCLUDING REMOVAL; CRANIAL
20664   - APPLICATION OF HALO, INCLUDING REMOVAL, CRANIAL, 6 OR MORE PINS PLACED, FOR
20665   - REMOVAL OF TONGS OR HALO APPLIED BY ANOTHER PHYSICIAN
20802   - REPLANTATION, ARM (INCLUDES SURGICAL NECK OF HUMERUS THROUGH ELBOW JOINT); COMPL
20805   - REPLANTATION, FOREARM (INCLUDES RADIUS AND ULNA TO RADIAL CARPAL JOINT),
20808   - REPLANTATION, HAND (INCLUDES HAND THROUGH METACARPOPHALANGEAL JOINTS), COMPLETE
20816   - REPLANTATION, DIGIT, EXCLUDING THUMB (INCLUDES METACARPOPHALANGEAL JOINT TO
20824   - REPLANTATION, THUMB (INCLUDES CARPOMETACARPAL JOINT TO MP JOINT), COMPLETE
20827   - REPLANTATION, THUMB (INCLUDES DISTAL TIP TO MP JOINT), COMPLETE AMPUTATION
20838   - REPLANTATION, FOOT, COMPLETE AMPUTATION
20930   - ALLOGRAFT FOR SPINE SURGERY ONLY; MORSELIZED (LIST SEPARATELY IN ADDITION TO COD
20931   - ALLOGRAFT FOR SPINE SURGERY ONLY; STRUCTURAL (LIST SEPARATELY IN ADDITION TO COD
20936   - AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE GRAFT); LOCAL (EG, RIB
20937   - AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE GRAFT); MORSELIZED (TH
20938   - AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE GRAFT); STRUCTURAL, BI
20955   - BONE GRAFT WITH MICROVASCULAR ANASTOMOSIS; FIBULA
20956   - BONE GRAFT WITH MICROVASCULAR ANASTOMOSIS; ILIAC CREST
20957   - BONE GRAFT WITH MICROVASCULAR ANASTOMOSIS; METATARSAL
20962   - BONE GRAFT WITH MICROVASCULAR ANASTOMOSIS; OTHER THAN FIBULA, ILIAC CREST, OR
20969   - FREE OSTEOCUTANEOUS FLAP WITH MICROVASCULAR ANASTOMOSIS; OTHER THAN ILIAC
20970   - FREE OSTEOCUTANEOUS FLAP WITH MICROVASCULAR ANASTOMOSIS; ILIAC CREST
20974   - ELECTRICAL STIMULATION TO AID BONE HEALING; NONINVASIVE (NONOPERATIVE)
20975   - ELECTRICAL STIMULATION TO AID BONE HEALING; INVASIVE (OPERATIVE)
20979   - LOW INTENSITY ULTRASOUND STIMULATION TO AID BONE HEALING, NONINVASIVE
21045   - EXCISION OF MALIGNANT TUMOR OF MANDIBLE; RADICAL RESECTION
21116   - INJECTION PROCEDURE FOR TEMPOROMANDIBULAR JOINT ARTHROGRAPHY
21141   - RECONSTRUCTION MIDFACE, LEFORT I; SINGLE PIECE, SEGMENT MOVEMENT IN ANY
21142   - RECONSTRUCTION MIDFACE, LEFORT I; TWO PIECES, SEGMENT MOVEMENT IN ANY
21143   - RECONSTRUCTION MIDFACE, LEFORT I; THREE OR MORE PIECES, SEGMENT MOVEMENT IN ANY
21145   - RECONSTRUCTION MIDFACE, LEFORT I; SINGLE PIECE, SEGMENT MOVEMENT IN ANY
21146   - RECONSTRUCTION MIDFACE, LEFORT I; TWO PIECES, SEGMENT MOVEMENT IN ANY
21147   - RECONSTRUCTION MIDFACE, LEFORT I; THREE OR MORE PIECES, SEGMENT MOVEMENT IN ANY



                                              Page 386
                                    All Other (no trigger bundling)


21151   - RECONSTRUCTION MIDFACE, LEFORT II; ANY DIRECTION, REQUIRING BONE GRAFTS
21154   - RECONSTRUCTION MIDFACE, LEFORT III (EXTRACRANIAL), ANY TYPE, REQUIRING BONE
21155   - RECONSTRUCTION MIDFACE, LEFORT III (EXTRACRANIAL), ANY TYPE, REQUIRING BONE
21159   - RECONSTRUCTION MIDFACE, LEFORT III (EXTRA AND INTRACRANIAL) WITH FOREHEAD
21160   - RECONSTRUCTION MIDFACE, LEFORT III (EXTRA AND INTRACRANIAL) WITH FOREHEAD
21179   - RECONSTRUCTION, ENTIRE OR MAJORITY OF FOREHEAD AND/OR SUPRAORBITAL RIMS; WITH
21180   - RECONSTRUCTION, ENTIRE OR MAJORITY OF FOREHEAD AND/OR SUPRAORBITAL RIMS; WITH
21182   - RECONSTRUCTION OF ORBITAL WALLS, RIMS, FOREHEAD, NASOETHMOID COMPLEX FOLLOWING
21183   - RECONSTRUCTION OF ORBITAL WALLS, RIMS, FOREHEAD, NASOETHMOID COMPLEX FOLLOWING
21184   - RECONSTRUCTION OF ORBITAL WALLS, RIMS, FOREHEAD, NASOETHMOID COMPLEX FOLLOWING
21188   - RECONSTRUCTION MIDFACE, OSTEOTOMIES (OTHER THAN LEFORT TYPE) AND BONE GRAFTS
21193   - RECONSTRUCTION OF MANDIBULAR RAMI, HORIZONTAL, VERTICAL, C, OR L OSTEOTOMY;
21194   - RECONSTRUCTION OF MANDIBULAR RAMI, HORIZONTAL, VERTICAL, C, OR L OSTEOTOMY;
21196   - RECONSTRUCTION OF MANDIBULAR RAMI AND/OR BODY, SAGITTAL SPLIT; WITH INTERNAL
21247   - RECONSTRUCTION OF MANDIBULAR CONDYLE WITH BONE AND CARTILAGE AUTOGRAFTS
21255   - RECONSTRUCTION OF ZYGOMATIC ARCH AND GLENOID FOSSA WITH BONE AND CARTILAGE
21256   - RECONSTRUCTION OF ORBIT WITH OSTEOTOMIES (EXTRACRANIAL) AND WITH BONE GRAFTS
21268   - ORBITAL REPOSITIONING, PERIORBITAL OSTEOTOMIES, UNILATERAL, WITH BONE GRAFTS;
21343   - OPEN TREATMENT OF DEPRESSED FRONTAL SINUS FRACTURE
21344   - OPEN TREATMENT OF COMPLICATED (EG, COMMINUTED OR INVOLVING POSTERIOR WALL)
21346   - OPEN TREATMENT OF NASOMAXILLARY COMPLEX FRACTURE (LEFORT II TYPE); WITH WIRING
21347   - OPEN TREATMENT OF NASOMAXILLARY COMPLEX FRACTURE (LEFORT II TYPE); REQUIRING
21348   - OPEN TREATMENT OF NASOMAXILLARY COMPLEX FRACTURE (LEFORT II TYPE); WITH BONE
21360   - OPEN TREATMENT OF DEPRESSED MALAR FRACTURE, INCLUDING ZYGOMATIC ARCH AND MALAR
21365   - OPEN TREATMENT OF COMPLICATED (EG, COMMINUTED OR INVOLVING CRANIAL NERVE
21366   - OPEN TREATMENT OF COMPLICATED (EG, COMMINUTED OR INVOLVING CRANIAL NERVE
21385   - OPEN TREATMENT OF ORBITAL FLOOR BLOWOUT FRACTURE; TRANSANTRAL APPROACH
21395   - OPEN TREATMENT OF ORBITAL FLOOR BLOWOUT FRACTURE; PERIORBITAL APPROACH WITH
21422   - OPEN TREATMENT OF PALATAL OR MAXILLARY FRACTURE (LEFORT I TYPE);
21423   - OPEN TREATMENT OF PALATAL OR MAXILLARY FRACTURE (LEFORT I TYPE); COMPLICATED
21431   - CLOSED TREATMENT OF CRANIOFACIAL SEPARATION (LEFORT III TYPE) USING INTERDENTAL
21432   - OPEN TREATMENT OF CRANIOFACIAL SEPARATION (LEFORT III TYPE); WITH WIRING AND/OR
21433   - OPEN TREATMENT OF CRANIOFACIAL SEPARATION (LEFORT III TYPE); COMPLICATED (EG,
21435   - OPEN TREATMENT OF CRANIOFACIAL SEPARATION (LEFORT III TYPE); COMPLICATED,
21436   - OPEN TREATMENT OF CRANIOFACIAL SEPARATION (LEFORT III TYPE); COMPLICATED,
21510   - INCISION, DEEP, WITH OPENING OF BONE CORTEX (EG, FOR OSTEOMYELITIS OR BONE
21615   - EXCISION FIRST AND/OR CERVICAL RIB;
21616   - EXCISION FIRST AND/OR CERVICAL RIB; WITH SYMPATHECTOMY
21620   - OSTECTOMY OF STERNUM, PARTIAL
21627   - STERNAL DEBRIDEMENT
21630   - RADICAL RESECTION OF STERNUM;
21632   - RADICAL RESECTION OF STERNUM; WITH MEDIASTINAL LYMPHADENECTOMY
21705   - DIVISION OF SCALENUS ANTICUS; WITH RESECTION OF CERVICAL RIB
21740   - RECONSTRUCTIVE REPAIR OF PECTUS EXCAVATUM OR CARINATUM; OPEN
21750   - CLOSURE OF MEDIAN STERNOTOMY SEPARATION WITH OR WITHOUT DEBRIDEMENT (SEPARATE
21810   - TREATMENT OF RIB FRACTURE REQUIRING EXTERNAL FIXATION (FLAIL CHEST)
21825   - OPEN TREATMENT OF STERNUM FRACTURE WITH OR WITHOUT SKELETAL FIXATION
22010   - INCISION AND DRAINAGE, OPEN, OF DEEP ABSCESS (SUBFASCIAL), POSTERIOR SPINE; CERV
22015   - INCISION AND DRAINAGE, OPEN, OF DEEP ABSCESS (SUBFASCIAL), POSTERIOR SPINE; LUMB
22110   - PARTIAL EXCISION OF VERTEBRAL BODY, FOR INTRINSIC BONY LESION, WITHOUT
22112   - PARTIAL EXCISION OF VERTEBRAL BODY, FOR INTRINSIC BONY LESION, WITHOUT
22114   - PARTIAL EXCISION OF VERTEBRAL BODY, FOR INTRINSIC BONY LESION, WITHOUT



                                              Page 387
                                 All Other (no trigger bundling)


22116 - PARTIAL EXCISION OF VERTEBRAL BODY, FOR INTRINSIC BONY LESION, WITHOUT
22206 - OSTEOTOMY OF SPINE, POSTERIOR OR POSTEROLATERAL APPROACH, THREE COLUMNS, ONE VER
22207 - OSTEOTOMY OF SPINE, POSTERIOR OR POSTEROLATERAL APPROACH, THREE COLUMNS, ONE VER
22208 - OSTEOTOMY OF SPINE, POSTERIOR OR POSTEROLATERAL APPROACH, THREE COLUMNS, ONE VER
22210 - OSTEOTOMY OF SPINE, POSTERIOR OR POSTEROLATERAL APPROACH, ONE VERTEBRAL SEGMENT;
22212 - OSTEOTOMY OF SPINE, POSTERIOR OR POSTEROLATERAL APPROACH, ONE VERTEBRAL
22214 - OSTEOTOMY OF SPINE, POSTERIOR OR POSTEROLATERAL APPROACH, ONE VERTEBRAL
22216 - OSTEOTOMY OF SPINE, POSTERIOR OR POSTEROLATERAL APPROACH, ONE VERTEBRAL
22220 - OSTEOTOMY OF SPINE, INCLUDING DISKECTOMY, ANTERIOR APPROACH, SINGLE VERTEBRAL
22224 - OSTEOTOMY OF SPINE, INCLUDING DISKECTOMY, ANTERIOR APPROACH, SINGLE VERTEBRAL
22226 - OSTEOTOMY OF SPINE, INCLUDING DISKECTOMY, ANTERIOR APPROACH, SINGLE VERTEBRAL
22318 - OPEN TREATMENT AND/OR REDUCTION OF ODONTOID FRACTURE(S) AND OR DISLOCATION(S)
22319 - OPEN TREATMENT AND/OR REDUCTION OF ODONTOID FRACTURE(S) AND OR DISLOCATION(S)
22325 - OPEN TREATMENT AND/OR REDUCTION OF VERTEBRAL FRACTURE(S) AND/ OR
22326 - OPEN TREATMENT AND/OR REDUCTION OF VERTEBRAL FRACTURE(S) AND/ OR
22327 - OPEN TREATMENT AND/OR REDUCTION OF VERTEBRAL FRACTURE(S) AND/ OR
22328 - OPEN TREATMENT AND/OR REDUCTION OF VERTEBRAL FRACTURE(S) AND/ OR
22532 - ARTHRODESIS, LATERAL EXTRACAVITARY TECHNIQUE, INCLUDING MINIMAL DISKECTOMY TO PR
22533 - ARTHRODESIS, LATERAL EXTRACAVITARY TECHNIQUE, INCLUDING MINIMAL DISKECTOMY TO
22534 - ARTHRODESIS, LATERAL EXTRACAVITARY TECHNIQUE, INCLUDING MINIMAL DISKECTOMY TO
22548 - ARTHRODESIS, ANTERIOR TRANSORAL OR EXTRAORAL TECHNIQUE, CLIVUS-C1-C2 (ATLAS-AXIS
22551 - Arthrodesis, anterior interbody, including disc space preparation, discectomy, o
22552 - Arthrodesis, anterior interbody, including disc space preparation, discectomy, o
22554 - ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMAL DISKECTOMY TO
22556 - ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMAL DISKECTOMY TO
22558 - ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMAL DISKECTOMY TO
22585 - ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMAL DISKECTOMY TO
22590 - ARTHRODESIS, POSTERIOR TECHNIQUE, CRANIOCERVICAL (OCCIPUT-C2)
22595 - ARTHRODESIS, POSTERIOR TECHNIQUE, ATLAS-AXIS (C1-C2)
22600 - ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE LEVEL; CERVICAL
22610 - ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE LEVEL; THORACIC
22630 - ARTHRODESIS, POSTERIOR INTERBODY TECHNIQUE, INCLUDING LAMINECTOMY AND/OR
22632 - ARTHRODESIS, POSTERIOR INTERBODY TECHNIQUE, INCLUDING LAMINECTOMY AND/OR
22800 - ARTHRODESIS, POSTERIOR, FOR SPINAL DEFORMITY, WITH OR WITHOUT CAST; UP TO 6 VERT
22802 - ARTHRODESIS, POSTERIOR, FOR SPINAL DEFORMITY, WITH OR WITHOUT CAST; 7 TO 12
22804 - ARTHRODESIS, POSTERIOR, FOR SPINAL DEFORMITY, WITH OR WITHOUT CAST; 13 OR MORE
22808 - ARTHRODESIS, ANTERIOR, FOR SPINAL DEFORMITY, WITH OR WITHOUT CAST; 2 TO 3
22810 - ARTHRODESIS, ANTERIOR, FOR SPINAL DEFORMITY, WITH OR WITHOUT CAST; 4 TO 7
22812 - ARTHRODESIS, ANTERIOR, FOR SPINAL DEFORMITY, WITH OR WITHOUT CAST; 8 OR MORE
22818 - KYPHECTOMY, CIRCUMFERENTIAL EXPOSURE OF SPINE AND RESECTION OF VERTEBRAL
22819 - KYPHECTOMY, CIRCUMFERENTIAL EXPOSURE OF SPINE AND RESECTION OF VERTEBRAL
22830 - EXPLORATION OF SPINAL FUSION
22840 - POSTERIOR NON-SEGMENTAL INSTRUMENTATION (EG, HARRINGTON ROD TECHNIQUE, PEDICLE F
22841 - INTERNAL SPINAL FIXATION BY WIRING OF SPINOUS PROCESSES (LIST SEPARATELY IN ADDI
22842 - POSTERIOR SEGMENTAL INSTRUMENTATION (EG, PEDICLE FIXATION, DUAL RODS WITH MULTIP
22843 - POSTERIOR SEGMENTAL INSTRUMENTATION (EG, PEDICLE FIXATION, DUAL RODS WITH MULTIP
22844 - POSTERIOR SEGMENTAL INSTRUMENTATION (EG, PEDICLE FIXATION, DUAL RODS WITH MULTIP
22845 - ANTERIOR INSTRUMENTATION; 2 TO 3 VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDITION
22846 - ANTERIOR INSTRUMENTATION; 4 TO 7 VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDITION
22847 - ANTERIOR INSTRUMENTATION; 8 OR MORE VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDIT
22848 - PELVIC FIXATION (ATTACHMENT OF CAUDAL END OF INSTRUMENTATION TO PELVIC BONY STRU
22849 - REINSERTION OF SPINAL FIXATION DEVICE



                                           Page 388
                                     All Other (no trigger bundling)


22850   - REMOVAL OF POSTERIOR NONSEGMENTAL INSTRUMENTATION (EG, HARRINGTON ROD)
22851   - APPLICATION OF INTERVERTEBRAL BIOMECHANICAL DEVICE(S) (EG, SYNTHETIC CAGE(S), TH
22852   - REMOVAL OF POSTERIOR SEGMENTAL INSTRUMENTATION
22855   - REMOVAL OF ANTERIOR INSTRUMENTATION
22856   - Total disc arthroplasty (artificial disc), anterior approach, including discecto
22857   - TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH, INCLUDING DISCECTO
22861   - Revision including replacement of total disc arthroplasty (artificial disc), ant
22862   - REVISION INCLUDING REPLACEMENT OF TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANT
22864   - Removal of total disc arthroplasty (artificial disc), anterior approach, single
22865   - REMOVAL OF TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH, SINGLE
23200   - RADICAL RESECTION OF TUMOR; CLAVICLE
23210   - RADICAL RESECTION OF TUMOR; SCAPULA
23220   - RADICAL RESECTION OF TUMOR, PROXIMAL HUMERUS
23332   - REMOVAL OF FOREIGN BODY, SHOULDER; COMPLICATED (EG, TOTAL SHOULDER)
23350   - INJECTION PROCEDURE FOR SHOULDER ARTHROGRAPHY OR ENHANCED CT/MRI SHOULDER
23472   - ARTHROPLASTY, GLENOHUMERAL JOINT; TOTAL SHOULDER (GLENOID AND PROXIMAL HUMERAL
23900   - INTERTHORACOSCAPULAR AMPUTATION (FOREQUARTER)
23920   - DISARTICULATION OF SHOULDER;
24220   - INJECTION PROCEDURE FOR ELBOW ARTHROGRAPHY
24420   - OSTEOPLASTY, HUMERUS (EG, SHORTENING OR LENGTHENING) (EXCLUDING 64876)
24900   - AMPUTATION, ARM THROUGH HUMERUS; WITH PRIMARY CLOSURE
24920   - AMPUTATION, ARM THROUGH HUMERUS; OPEN, CIRCULAR (GUILLOTINE)
24930   - AMPUTATION, ARM THROUGH HUMERUS; RE-AMPUTATION
24931   - AMPUTATION, ARM THROUGH HUMERUS; WITH IMPLANT
24940   - CINEPLASTY, UPPER EXTREMITY, COMPLETE PROCEDURE
25246   - INJECTION PROCEDURE FOR WRIST ARTHROGRAPHY
25900   - AMPUTATION, FOREARM, THROUGH RADIUS AND ULNA;
25905   - AMPUTATION, FOREARM, THROUGH RADIUS AND ULNA; OPEN, CIRCULAR (GUILLOTINE)
25909   - AMPUTATION, FOREARM, THROUGH RADIUS AND ULNA; RE-AMPUTATION
25915   - KRUKENBERG PROCEDURE
25920   - DISARTICULATION THROUGH WRIST;
25924   - DISARTICULATION THROUGH WRIST; RE-AMPUTATION
25927   - TRANSMETACARPAL AMPUTATION;
25931   - TRANSMETACARPAL AMPUTATION; RE-AMPUTATION
26551   - TRANSFER, TOE-TO-HAND WITH MICROVASCULAR ANASTOMOSIS; GREAT TOE WRAP-AROUND
26553   - TRANSFER, TOE-TO-HAND WITH MICROVASCULAR ANASTOMOSIS; OTHER THAN GREAT TOE,
26554   - TRANSFER, TOE-TO-HAND WITH MICROVASCULAR ANASTOMOSIS; OTHER THAN GREAT TOE,
26556   - TRANSFER, FREE TOE JOINT, WITH MICROVASCULAR ANASTOMOSIS
26992   - INCISION, BONE CORTEX, PELVIS AND/OR HIP JOINT (EG, OSTEOMYELITIS OR BONE
27005   - TENOTOMY, HIP FLEXOR(S), OPEN (SEPARATE PROCEDURE)
27006   - TENOTOMY, ABDUCTORS AND/OR EXTENSOR(S) OF HIP, OPEN (SEPARATE PROCEDURE)
27025   - FASCIOTOMY, HIP OR THIGH, ANY TYPE
27030   - ARTHROTOMY, HIP, WITH DRAINAGE (EG, INFECTION)
27036   - CAPSULECTOMY OR CAPSULOTOMY, HIP, WITH OR WITHOUT EXCISION OF HETEROTOPIC BONE,
27054   - ARTHROTOMY WITH SYNOVECTOMY, HIP JOINT
27070   - PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION) (EG, OSTEOMYELITIS OR BONE
27071   - PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION) (EG, OSTEOMYELITIS OR BONE
27075   - RADICAL RESECTION OF TUMOR; WING OF ILIUM, 1 PUBIC OR ISCHIAL RAMUS OR SYMPHYSIS
27076   - RADICAL RESECTION OF TUMOR; ILIUM, INCLUDING ACETABULUM, BOTH PUBIC RAMI, OR ISC
27077   - RADICAL RESECTION OF TUMOR; INNOMINATE BONE, TOTAL
27078   - RADICAL RESECTION OF TUMOR; ISCHIAL TUBEROSITY AND GREATER TROCHANTER OF FEMUR
27090   - REMOVAL OF HIP PROSTHESIS; (SEPARATE PROCEDURE)



                                               Page 389
                                    All Other (no trigger bundling)


27091   - REMOVAL OF HIP PROSTHESIS; COMPLICATED, INCLUDING TOTAL HIP PROSTHESIS,
27093   - INJECTION PROCEDURE FOR HIP ARTHROGRAPHY; WITHOUT ANESTHESIA
27095   - INJECTION PROCEDURE FOR HIP ARTHROGRAPHY; WITH ANESTHESIA
27096   - INJECTION PROCEDURE FOR SACROILIAC JOINT, ARTHROGRAPHY AND/ OR
27120   - ACETABULOPLASTY; (EG, WHITMAN, COLONNA, HAYGROVES, OR CUP TYPE)
27122   - ACETABULOPLASTY; RESECTION, FEMORAL HEAD (EG, GIRDLESTONE PROCEDURE)
27125   - HEMIARTHROPLASTY, HIP, PARTIAL (EG, FEMORAL STEM PROSTHESIS, BIPOLAR
27130   - ARTHROPLASTY, ACETABULAR AND PROXIMAL FEMORAL PROSTHETIC REPLACEMENT (TOTAL HIP
27132   - CONVERSION OF PREVIOUS HIP SURGERY TO TOTAL HIP ARTHROPLASTY, WITH OR WITHOUT
27134   - REVISION OF TOTAL HIP ARTHROPLASTY; BOTH COMPONENTS, WITH OR WITHOUT AUTOGRAFT
27137   - REVISION OF TOTAL HIP ARTHROPLASTY; ACETABULAR COMPONENT ONLY, WITH OR WITHOUT
27138   - REVISION OF TOTAL HIP ARTHROPLASTY; FEMORAL COMPONENT ONLY, WITH OR WITHOUT
27140   - OSTEOTOMY AND TRANSFER OF GREATER TROCHANTER OF FEMUR (SEPARATE PROCEDURE)
27146   - OSTEOTOMY, ILIAC, ACETABULAR OR INNOMINATE BONE;
27147   - OSTEOTOMY, ILIAC, ACETABULAR OR INNOMINATE BONE; WITH OPEN REDUCTION OF HIP
27151   - OSTEOTOMY, ILIAC, ACETABULAR OR INNOMINATE BONE; WITH FEMORAL OSTEOTOMY
27156   - OSTEOTOMY, ILIAC, ACETABULAR OR INNOMINATE BONE; WITH FEMORAL OSTEOTOMY AND
27158   - OSTEOTOMY, PELVIS, BILATERAL (EG, CONGENITAL MALFORMATION)
27161   - OSTEOTOMY, FEMORAL NECK (SEPARATE PROCEDURE)
27165   - OSTEOTOMY, INTERTROCHANTERIC OR SUBTROCHANTERIC INCLUDING INTERNAL OR EXTERNAL
27170   - BONE GRAFT, FEMORAL HEAD, NECK, INTERTROCHANTERIC OR SUBTROCHANTERIC AREA
27175   - TREATMENT OF SLIPPED FEMORAL EPIPHYSIS; BY TRACTION, WITHOUT REDUCTION
27176   - TREATMENT OF SLIPPED FEMORAL EPIPHYSIS; BY SINGLE OR MULTIPLE PINNING, IN SITU
27177   - OPEN TREATMENT OF SLIPPED FEMORAL EPIPHYSIS; SINGLE OR MULTIPLE PINNING OR BONE
27178   - OPEN TREATMENT OF SLIPPED FEMORAL EPIPHYSIS; CLOSED MANIPULATION WITH SINGLE OR
27179   - OPEN TREATMENT OF SLIPPED FEMORAL EPIPHYSIS; OSTEOPLASTY OF FEMORAL NECK
27181   - OPEN TREATMENT OF SLIPPED FEMORAL EPIPHYSIS; OSTEOTOMY AND INTERNAL FIXATION
27185   - EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING, GREATER TROCHANTER OF FEMUR
27187   - PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT
27215   - OPEN TREATMENT OF ILIAC SPINE(S), TUBEROSITY AVULSION, OR ILIAC WING FRACTURE(S)
27216   - PERCUTANEOUS SKELETAL FIXATION OF POSTERIOR PELVIC BONE FRACTURE AND/OR DISLOCAT
27217   - OPEN TREATMENT OF ANTERIOR PELVIC BONE FRACTURE AND/OR DISLOCATION FOR FRACTURE
27218   - OPEN TREATMENT OF POSTERIOR PELVIC BONE FRACTURE AND/OR DISLOCATION, FOR FRACTUR
27222   - CLOSED TREATMENT OF ACETABULUM (HIP SOCKET) FRACTURE(S); WITH MANIPULATION,
27226   - OPEN TREATMENT OF POSTERIOR OR ANTERIOR ACETABULAR WALL FRACTURE, WITH INTERNAL
27227   - OPEN TREATMENT OF ACETABULAR FRACTURE(S) INVOLVING ANTERIOR OR POSTERIOR (ONE)
27228   - OPEN TREATMENT OF ACETABULAR FRACTURE(S) INVOLVING ANTERIOR AND POSTERIOR (TWO)
27232   - CLOSED TREATMENT OF FEMORAL FRACTURE, PROXIMAL END, NECK; WITH MANIPULATION,
27236   - OPEN TREATMENT OF FEMORAL FRACTURE, PROXIMAL END, NECK, INTERNAL FIXATION OR
27240   - CLOSED TREATMENT OF INTERTROCHANTERIC, PERTROCHANTERIC, OR SUBTROCHANTERIC
27244   - TREATMENT OF INTERTROCHANTERIC, PERTROCHANTERIC, OR SUBTROCHANTERIC FEMORAL
27245   - TREATMENT OF INTERTROCHANTERIC, PERTROCHANTERIC, OR SUBTROCHANTERIC FEMORAL
27248   - OPEN TREATMENT OF GREATER TROCHANTERIC FRACTURE, INCLUDES INTERNAL FIXATION, WHE
27253   - OPEN TREATMENT OF HIP DISLOCATION, TRAUMATIC, WITHOUT INTERNAL FIXATION
27254   - OPEN TREATMENT OF HIP DISLOCATION, TRAUMATIC, WITH ACETABULAR WALL AND FEMORAL
27258   - OPEN TREATMENT OF SPONTANEOUS HIP DISLOCATION (DEVELOPMENTAL, INCLUDING
27259   - OPEN TREATMENT OF SPONTANEOUS HIP DISLOCATION (DEVELOPMENTAL, INCLUDING
27268   - CLOSED TREATMENT OF FEMORAL FRACTURE, PROXIMAL END, HEAD; WITH MANIPULATION
27269   - OPEN TREATMENT OF FEMORAL FRACTURE, PROXIMAL END, HEAD, INCLUDES INTERNAL FIXATI
27280   - ARTHRODESIS, SACROILIAC JOINT (INCLUDING OBTAINING GRAFT)
27282   - ARTHRODESIS, SYMPHYSIS PUBIS (INCLUDING OBTAINING GRAFT)
27284   - ARTHRODESIS, HIP JOINT (INCLUDING OBTAINING GRAFT);



                                              Page 390
                                   All Other (no trigger bundling)


27286   - ARTHRODESIS, HIP JOINT (INCLUDING OBTAINING GRAFT); WITH SUBTROCHANTERIC
27290   - INTERPELVIABDOMINAL AMPUTATION (HINDQUARTER AMPUTATION)
27295   - DISARTICULATION OF HIP
27303   - INCISION, DEEP, WITH OPENING OF BONE CORTEX, FEMUR OR KNEE (EG, OSTEOMYELITIS
27365   - RADICAL RESECTION OF TUMOR, FEMUR OR KNEE
27370   - INJECTION PROCEDURE FOR KNEE ARTHROGRAPHY
27445   - ARTHROPLASTY, KNEE, HINGE PROSTHESIS (EG, WALLDIUS TYPE)
27447   - ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL AND LATERAL COMPARTMENTS WITH
27448   - OSTEOTOMY, FEMUR, SHAFT OR SUPRACONDYLAR; WITHOUT FIXATION
27450   - OSTEOTOMY, FEMUR, SHAFT OR SUPRACONDYLAR; WITH FIXATION
27454   - OSTEOTOMY, MULTIPLE, WITH REALIGNMENT ON INTRAMEDULLARY ROD, FEMORAL SHAFT (EG,
27455   - OSTEOTOMY, PROXIMAL TIBIA, INCLUDING FIBULAR EXCISION OR OSTEOTOMY (INCLUDES
27457   - OSTEOTOMY, PROXIMAL TIBIA, INCLUDING FIBULAR EXCISION OR OSTEOTOMY (INCLUDES
27465   - OSTEOPLASTY, FEMUR; SHORTENING (EXCLUDING 64876)
27466   - OSTEOPLASTY, FEMUR; LENGTHENING
27468   - OSTEOPLASTY, FEMUR; COMBINED, LENGTHENING AND SHORTENING WITH FEMORAL SEGMENT
27470   - REPAIR, NONUNION OR MALUNION, FEMUR, DISTAL TO HEAD AND NECK; WITHOUT GRAFT
27472   - REPAIR, NONUNION OR MALUNION, FEMUR, DISTAL TO HEAD AND NECK; WITH ILIAC OR
27477   - ARREST, EPIPHYSEAL, ANY METHOD (EG, EPIPHYSIODESIS); TIBIA AND FIBULA, PROXIMAL
27485   - ARREST, HEMIEPIPHYSEAL, DISTAL FEMUR OR PROXIMAL TIBIA OR FIBULA (EG, GENU
27486   - REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; ONE COMPONENT
27487   - REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; FEMORAL AND
27488   - REMOVAL OF PROSTHESIS, INCLUDING TOTAL KNEE PROSTHESIS, METHYLMETHACRYLATE WITH
27495   - PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT
27506   - OPEN TREATMENT OF FEMORAL SHAFT FRACTURE, WITH OR WITHOUT EXTERNAL FIXATION,
27507   - OPEN TREATMENT OF FEMORAL SHAFT FRACTURE WITH PLATE/SCREWS, WITH OR WITHOUT
27511   - OPEN TREATMENT OF FEMORAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE WITHOUT INTERC
27513   - OPEN TREATMENT OF FEMORAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE WITH INTERCOND
27514   - OPEN TREATMENT OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR LATERAL CONDYLE, INCLU
27519   - OPEN TREATMENT OF DISTAL FEMORAL EPIPHYSEAL SEPARATION, INCLUDES INTERNAL FIXATI
27535   - OPEN TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); UNICONDYLAR, INCLUDES INT
27536   - OPEN TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); BICONDYLAR, WITH OR
27540   - OPEN TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY FRACTURE(S) OF THE KN
27556   - OPEN TREATMENT OF KNEE DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN PERFORMED;
27557   - OPEN TREATMENT OF KNEE DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN PERFORMED;
27558   - OPEN TREATMENT OF KNEE DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN PERFORMED;
27580   - ARTHRODESIS, KNEE, ANY TECHNIQUE
27590   - AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL;
27591   - AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL; IMMEDIATE FITTING TECHNIQUE
27592   - AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL; OPEN, CIRCULAR (GUILLOTINE)
27596   - AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL; RE-AMPUTATION
27598   - DISARTICULATION AT KNEE
27645   - RADICAL RESECTION OF TUMOR; TIBIA
27646   - RADICAL RESECTION OF TUMOR; FIBULA
27648   - INJECTION PROCEDURE FOR ANKLE ARTHROGRAPHY
27702   - ARTHROPLASTY, ANKLE; WITH IMPLANT (TOTAL ANKLE)
27703   - ARTHROPLASTY, ANKLE; REVISION, TOTAL ANKLE
27712   - OSTEOTOMY; MULTIPLE, WITH REALIGNMENT ON INTRAMEDULLARY ROD (EG, SOFIELD TYPE
27715   - OSTEOPLASTY, TIBIA AND FIBULA, LENGTHENING OR SHORTENING
27720   - REPAIR OF NONUNION OR MALUNION, TIBIA; WITHOUT GRAFT, (EG, COMPRESSION
27722   - REPAIR OF NONUNION OR MALUNION, TIBIA; WITH SLIDING GRAFT
27724   - REPAIR OF NONUNION OR MALUNION, TIBIA; WITH ILIAC OR OTHER AUTOGRAFT (INCLUDES



                                             Page 391
                                    All Other (no trigger bundling)


27725   - REPAIR OF NONUNION OR MALUNION, TIBIA; BY SYNOSTOSIS, WITH FIBULA, ANY METHOD
27726   - REPAIR OF FIBULA NONUNION AND/OR MALUNION WITH INTERNAL FIXATION
27727   - REPAIR OF CONGENITAL PSEUDARTHROSIS, TIBIA
27880   - AMPUTATION LEG, THROUGH TIBIA AND FIBULA;
27881   - AMPUTATION, LEG, THROUGH TIBIA AND FIBULA; WITH IMMEDIATE FITTING TECHNIQUE
27882   - AMPUTATION, LEG, THROUGH TIBIA AND FIBULA; OPEN, CIRCULAR (GUILLOTINE)
27886   - AMPUTATION, LEG, THROUGH TIBIA AND FIBULA; RE-AMPUTATION
27888   - AMPUTATION, ANKLE, THROUGH MALLEOLI OF TIBIA AND FIBULA (EG, SYME, PIROGOFF
28800   - AMPUTATION, FOOT; MIDTARSAL (EG, CHOPART TYPE PROCEDURE)
28805   - AMPUTATION, FOOT; TRANSMETATARSAL
30300   - REMOVAL FOREIGN BODY, INTRANASAL; OFFICE TYPE PROCEDURE
31225   - MAXILLECTOMY; WITHOUT ORBITAL EXENTERATION
31230   - MAXILLECTOMY; WITH ORBITAL EXENTERATION (EN BLOC)
31290   - NASAL/SINUS ENDOSCOPY, SURGICAL, WITH REPAIR OF CEREBROSPINAL FLUID LEAK;
31291   - NASAL/SINUS ENDOSCOPY, SURGICAL, WITH REPAIR OF CEREBROSPINAL FLUID LEAK;
31360   - LARYNGECTOMY; TOTAL, WITHOUT RADICAL NECK DISSECTION
31365   - LARYNGECTOMY; TOTAL, WITH RADICAL NECK DISSECTION
31367   - LARYNGECTOMY; SUBTOTAL SUPRAGLOTTIC, WITHOUT RADICAL NECK DISSECTION
31368   - LARYNGECTOMY; SUBTOTAL SUPRAGLOTTIC, WITH RADICAL NECK DISSECTION
31370   - PARTIAL LARYNGECTOMY (HEMILARYNGECTOMY); HORIZONTAL
31375   - PARTIAL LARYNGECTOMY (HEMILARYNGECTOMY); LATEROVERTICAL
31380   - PARTIAL LARYNGECTOMY (HEMILARYNGECTOMY); ANTEROVERTICAL
31382   - PARTIAL LARYNGECTOMY (HEMILARYNGECTOMY); ANTERO-LATERO-VERTICAL
31390   - PHARYNGOLARYNGECTOMY, WITH RADICAL NECK DISSECTION; WITHOUT RECONSTRUCTION
31395   - PHARYNGOLARYNGECTOMY, WITH RADICAL NECK DISSECTION; WITH RECONSTRUCTION
31584   - LARYNGOPLASTY; WITH OPEN REDUCTION OF FRACTURE
31587   - LARYNGOPLASTY, CRICOID SPLIT
31620   - ENDOBRONCHIAL ULTRASOUND (EBUS) DURING BRONCHOSCOPIC DIAGNOSTIC OR THERAPEUTIC
31627   - Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed
31715   - TRANSTRACHEAL INJECTION FOR BRONCHOGRAPHY
31725   - CATHETER ASPIRATION (SEPARATE PROCEDURE); TRACHEOBRONCHIAL WITH FIBERSCOPE,
31760   - TRACHEOPLASTY; INTRATHORACIC
31766   - CARINAL RECONSTRUCTION
31770   - BRONCHOPLASTY; GRAFT REPAIR
31775   - BRONCHOPLASTY; EXCISION STENOSIS AND ANASTOMOSIS
31780   - EXCISION TRACHEAL STENOSIS AND ANASTOMOSIS; CERVICAL
31781   - EXCISION TRACHEAL STENOSIS AND ANASTOMOSIS; CERVICOTHORACIC
31786   - EXCISION OF TRACHEAL TUMOR OR CARCINOMA; THORACIC
31800   - SUTURE OF TRACHEAL WOUND OR INJURY; CERVICAL
31805   - SUTURE OF TRACHEAL WOUND OR INJURY; INTRATHORACIC
32035   - THORACOSTOMY; WITH RIB RESECTION FOR EMPYEMA
32036   - THORACOSTOMY; WITH OPEN FLAP DRAINAGE FOR EMPYEMA
32095   - THORACOTOMY, LIMITED, FOR BIOPSY OF LUNG OR PLEURA
32100   - THORACOTOMY, MAJOR; WITH EXPLORATION AND BIOPSY
32110   - THORACOTOMY, MAJOR; WITH CONTROL OF TRAUMATIC HEMORRHAGE AND/OR REPAIR OF LUNG
32120   - THORACOTOMY, MAJOR; FOR POSTOPERATIVE COMPLICATIONS
32124   - THORACOTOMY, MAJOR; WITH OPEN INTRAPLEURAL PNEUMONOLYSIS
32140   - THORACOTOMY, MAJOR; WITH CYST(S) REMOVAL, WITH OR WITHOUT A PLEURAL PROCEDURE
32141   - THORACOTOMY, MAJOR; WITH EXCISION-PLICATION OF BULLAE, WITH OR WITHOUT ANY
32150   - THORACOTOMY, MAJOR; WITH REMOVAL OF INTRAPLEURAL FOREIGN BODY OR FIBRIN DEPOSIT
32151   - THORACOTOMY, MAJOR; WITH REMOVAL OF INTRAPULMONARY FOREIGN BODY
32160   - THORACOTOMY, MAJOR; WITH CARDIAC MASSAGE



                                              Page 392
                                    All Other (no trigger bundling)


32200   - PNEUMONOSTOMY; WITH OPEN DRAINAGE OF ABSCESS OR CYST
32215   - PLEURAL SCARIFICATION FOR REPEAT PNEUMOTHORAX
32220   - DECORTICATION, PULMONARY (SEPARATE PROCEDURE); TOTAL
32225   - DECORTICATION, PULMONARY (SEPARATE PROCEDURE); PARTIAL
32310   - PLEURECTOMY, PARIETAL (SEPARATE PROCEDURE)
32320   - DECORTICATION AND PARIETAL PLEURECTOMY
32402   - BIOPSY, PLEURA; OPEN
32440   - REMOVAL OF LUNG, TOTAL PNEUMONECTOMY;
32442   - REMOVAL OF LUNG, TOTAL PNEUMONECTOMY; WITH RESECTION OF SEGMENT OF TRACHEA
32445   - REMOVAL OF LUNG, TOTAL PNEUMONECTOMY; EXTRAPLEURAL
32480   - REMOVAL OF LUNG, OTHER THAN TOTAL PNEUMONECTOMY; SINGLE LOBE (LOBECTOMY)
32482   - REMOVAL OF LUNG, OTHER THAN TOTAL PNEUMONECTOMY; TWO LOBES (BILOBECTOMY)
32484   - REMOVAL OF LUNG, OTHER THAN TOTAL PNEUMONECTOMY; SINGLE SEGMENT (SEGMENTECTOMY)
32486   - REMOVAL OF LUNG, OTHER THAN TOTAL PNEUMONECTOMY; WITH CIRCUMFERENTIAL RESECTION
32488   - REMOVAL OF LUNG, OTHER THAN TOTAL PNEUMONECTOMY; ALL REMAINING LUNG FOLLOWING
32491   - REMOVAL OF LUNG, OTHER THAN TOTAL PNEUMONECTOMY; EXCISION-PLICATION OF
32500   - REMOVAL OF LUNG, OTHER THAN TOTAL PNEUMONECTOMY; WEDGE RESECTION, SINGLE OR
32501   - RESECTION AND REPAIR OF PORTION OF BRONCHUS (BRONCHOPLASTY) WHEN PERFORMED AT
32503   - RESECTION OF APICAL LUNG TUMOR (EG, PANCOAST TUMOR), INCLUDING CHEST WALL RESECT
32504   - RESECTION OF APICAL LUNG TUMOR (EG, PANCOAST TUMOR), INCLUDING CHEST WALL RESECT
32540   - EXTRAPLEURAL ENUCLEATION OF EMPYEMA (EMPYEMECTOMY)
32553   - Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial
32650   - THORACOSCOPY, SURGICAL; WITH PLEURODESIS (EG, MECHANICAL OR CHEMICAL)
32651   - THORACOSCOPY, SURGICAL; WITH PARTIAL PULMONARY DECORTICATION
32652   - THORACOSCOPY, SURGICAL; WITH TOTAL PULMONARY DECORTICATION, INCLUDING
32653   - THORACOSCOPY, SURGICAL; WITH REMOVAL OF INTRAPLEURAL FOREIGN BODY OR FIBRIN
32654   - THORACOSCOPY, SURGICAL; WITH CONTROL OF TRAUMATIC HEMORRHAGE
32655   - THORACOSCOPY, SURGICAL; WITH EXCISION-PLICATION OF BULLAE, INCLUDING ANY
32656   - THORACOSCOPY, SURGICAL; WITH PARIETAL PLEURECTOMY
32657   - THORACOSCOPY, SURGICAL; WITH WEDGE RESECTION OF LUNG, SINGLE OR MULTIPLE
32658   - THORACOSCOPY, SURGICAL; WITH REMOVAL OF CLOT OR FOREIGN BODY FROM PERICARDIAL
32659   - THORACOSCOPY, SURGICAL; WITH CREATION OF PERICARDIAL WINDOW OR PARTIAL
32660   - THORACOSCOPY, SURGICAL; WITH TOTAL PERICARDIECTOMY
32661   - THORACOSCOPY, SURGICAL; WITH EXCISION OF PERICARDIAL CYST, TUMOR, OR MASS
32662   - THORACOSCOPY, SURGICAL; WITH EXCISION OF MEDIASTINAL CYST, TUMOR, OR MASS
32663   - THORACOSCOPY, SURGICAL; WITH LOBECTOMY, TOTAL OR SEGMENTAL
32664   - THORACOSCOPY, SURGICAL; WITH THORACIC SYMPATHECTOMY
32665   - THORACOSCOPY, SURGICAL; WITH ESOPHAGOMYOTOMY (HELLER TYPE)
32800   - REPAIR LUNG HERNIA THROUGH CHEST WALL
32810   - CLOSURE OF CHEST WALL FOLLOWING OPEN FLAP DRAINAGE FOR EMPYEMA (CLAGETT TYPE
32815   - OPEN CLOSURE OF MAJOR BRONCHIAL FISTULA
32820   - MAJOR RECONSTRUCTION, CHEST WALL (POSTTRAUMATIC)
32850   - DONOR PNEUMONECTOMY(IES)(INCL. COLD PRESERVATION), FROM CADAVER DONOR
32851   - LUNG TRANSPLANT, SINGLE; WITHOUT CARDIOPULMONARY BYPASS
32852   - LUNG TRANSPLANT, SINGLE; WITH CARDIOPULMONARY BYPASS
32853   - LUNG TRANSPLANT, DOUBLE (BILATERAL SEQUENTIAL OR EN BLOC); WITHOUT
32854   - LUNG TRANSPLANT, DOUBLE (BILATERAL SEQUENTIAL OR EN BLOC); WITH CARDIOPULMONARY
32855   - BACKBENCH STANDARD PREPARATION OF CADAVER DONOR LUNG ALLOGRAFT PRIOR TO
32856   - BACKBENCH STANDARD PREPARATION OF CADAVER DONOR LUNG ALLOGRAFT PRIOR TO
32900   - RESECTION OF RIBS, EXTRAPLEURAL, ALL STAGES
32905   - THORACOPLASTY, SCHEDE TYPE OR EXTRAPLEURAL (ALL STAGES);
32906   - THORACOPLASTY, SCHEDE TYPE OR EXTRAPLEURAL (ALL STAGES); WITH CLOSURE OF



                                              Page 393
                                   All Other (no trigger bundling)


32940   - PNEUMONOLYSIS, EXTRAPERIOSTEAL, INCLUDING FILLING OR PACKING PROCEDURES
32997   - TOTAL LUNG LAVAGE (UNILATERAL)
33015   - TUBE PERICARDIOSTOMY
33020   - PERICARDIOTOMY FOR REMOVAL OF CLOT OR FOREIGN BODY (PRIMARY PROCEDURE)
33025   - CREATION OF PERICARDIAL WINDOW OR PARTIAL RESECTION FOR DRAINAGE
33030   - PERICARDIECTOMY, SUBTOTAL OR COMPLETE; WITHOUT CARDIOPULMONARY BYPASS
33031   - PERICARDIECTOMY, SUBTOTAL OR COMPLETE; WITH CARDIOPULMONARY BYPASS
33050   - EXCISION OF PERICARDIAL CYST OR TUMOR
33120   - EXCISION OF INTRACARDIAC TUMOR, RESECTION WITH CARDIOPULMONARY BYPASS
33130   - RESECTION OF EXTERNAL CARDIAC TUMOR
33140   - TRANSMYOCARDIAL LASER REVASCULARIZATION, BY THORACOTOMY (SEPARATE PROCEDURE)
33141   - TRANSMYOCARDIAL LASER REVASCULARIZATION, BY THORACOTOMY; PERFORMED AT THE TIME
33202   - INSERTION OF EPICARDIAL ELECTRODE(S); OPEN INCISION (EG, THORACOTOMY, MEDIAN STE
33203   - INSERTION OF EPICARDIAL ELECTRODE(S); ENDOSCOPIC APPROACH (EG, THORACOSCOPY, PER
33236   - REMOVAL OF PERMANENT EPICARDIAL PACEMAKER AND ELECTRODES BY THORACOTOMY; SINGLE
33237   - REMOVAL OF PERMANENT EPICARDIAL PACEMAKER AND ELECTRODES BY THORACOTOMY; DUAL
33238   - REMOVAL OF PERMANENT TRANSVENOUS ELECTRODE(S) BY THORACOTOMY
33240   - INSERTION OF SINGLE OR DUAL CHAMBER PACING CARDIOVERTER-DEFIBRILLATOR PULSE
33243   - REMOVAL OF SINGLE OR DUAL CHAMBER PACING CARDIOVERTER-DEFIBRILLATOR
33249   - INSERTION OR REPOSITIONING OF ELECTRODE LEAD(S) FOR SINGLE OR DUAL CHAMBER
33250   - OPERATIVE ABLATION OF SUPRAVENTRICULAR ARRHYTHMOGENIC FOCUS OR PATHWAY (EG, WOLF
33251   - OPERATIVE ABLATION OF SUPRAVENTRICULAR ARRHYTHMOGENIC FOCUS OR PATHWAY (EG,
33254   - OPERATIVE TISSUE ABLATION AND RECONSTRUCTION OF ATRIA, LIMITED (EG, MODIFIED MAZ
33255   - OPERATIVE TISSUE ABLATION AND RECONSTRUCTION OF ATRIA, EXTENSIVE (EG, MAZE PROCE
33256   - OPERATIVE TISSUE ABLATION AND RECONSTRUCTION OF ATRIA, EXTENSIVE (EG, MAZE PROCE
33257   - OPERATIVE TISSUE ABLATION AND RECONSTRUCTION OF ATRIA, PERFORMED AT THE TIME OF
33258   - OPERATIVE TISSUE ABLATION AND RECONSTRUCTION OF ATRIA, PERFORMED AT THE TIME OF
33259   - OPERATIVE TISSUE ABLATION AND RECONSTRUCTION OF ATRIA, PERFORMED AT THE TIME OF
33261   - OPERATIVE ABLATION OF VENTRICULAR ARRHYTHMOGENIC FOCUS WITH CARDIOPULMONARY
33265   - ENDOSCOPY, SURGICAL; OPERATIVE TISSUE ABLATION AND RECONSTRUCTION OF ATRIA, LIMI
33266   - ENDOSCOPY, SURGICAL; OPERATIVE TISSUE ABLATION AND RECONSTRUCTION OF ATRIA, EXTE
33300   - REPAIR OF CARDIAC WOUND; WITHOUT BYPASS
33305   - REPAIR OF CARDIAC WOUND; WITH CARDIOPULMONARY BYPASS
33310   - CARDIOTOMY, EXPLORATORY (INCLUDES REMOVAL OF FOREIGN BODY, ATRIAL OR
33315   - CARDIOTOMY, EXPLORATORY (INCLUDES REMOVAL OF FOREIGN BODY, ATRIAL OR
33320   - SUTURE REPAIR OF AORTA OR GREAT VESSELS; WITHOUT SHUNT OR CARDIOPULMONARY BYPASS
33321   - SUTURE REPAIR OF AORTA OR GREAT VESSELS; WITH SHUNT BYPASS
33322   - SUTURE REPAIR OF AORTA OR GREAT VESSELS; WITH CARDIOPULMONARY BYPASS
33330   - INSERTION OF GRAFT, AORTA OR GREAT VESSELS; WITHOUT SHUNT, OR CARDIOPULMONARY
33332   - INSERTION OF GRAFT, AORTA OR GREAT VESSELS; WITH SHUNT BYPASS
33335   - INSERTION OF GRAFT, AORTA OR GREAT VESSELS; WITH CARDIOPULMONARY BYPASS
33400   - VALVULOPLASTY, AORTIC VALVE, OPEN, WITH CARDIOPULMONARY BYPASS
33401   - VALVULOPLASTY, AORTIC VALVE; OPEN, WITH INFLOW OCCLUSION
33403   - VALVULOPLASTY, AORTIC VALVE; USING TRANSVENTRICULAR DILATION, WITH
33404   - CONSTRUCTION OF APICAL-AORTIC CONDUIT
33405   - REPLACEMENT, AORTIC VALVE, WITH CARDIOPULMONARY BYPASS; WITH PROSTHETIC VALVE
33406   - REPLACEMENT, AORTIC VALVE, WITH CARDIOPULMONARY BYPASS; WITH ALLOGRAFT VALVE
33410   - REPLACEMENT, AORTIC VALVE, WITH CARDIOPULMONARY BYPASS; WITH STENTLESS TISSUE
33411   - REPLACEMENT, AORTIC VALVE; WITH AORTIC ANNULUS ENLARGEMENT, NONCORONARY CUSP
33412   - REPLACEMENT, AORTIC VALVE; WITH TRANSVENTRICULAR AORTIC ANNULUS ENLARGEMENT
33413   - REPLACEMENT, AORTIC VALVE; BY TRANSLOCATION OF AUTOLOGOUS PULMONARY VALVE WITH
33414   - REPAIR OF LEFT VENTRICULAR OUTFLOW TRACT OBSTRUCTION BY PATCH ENLARGEMENT OF



                                             Page 394
                                   All Other (no trigger bundling)


33415   - RESECTION OR INCISION OF SUBVALVULAR TISSUE FOR DISCRETE SUBVALVULAR AORTIC
33416   - VENTRICULOMYOTOMY (-MYECTOMY) FOR IDIOPATHIC HYPERTROPHIC SUBAORTIC STENOSIS
33417   - AORTOPLASTY (GUSSET) FOR SUPRAVALVULAR STENOSIS
33420   - VALVOTOMY, MITRAL VALVE; CLOSED HEART
33422   - VALVOTOMY, MITRAL VALVE; OPEN HEART, WITH CARDIOPULMONARY BYPASS
33425   - VALVULOPLASTY, MITRAL VALVE, WITH CARDIOPULMONARY BYPASS;
33426   - VALVULOPLASTY, MITRAL VALVE, WITH CARDIOPULMONARY BYPASS; WITH PROSTHETIC RING
33427   - VALVULOPLASTY, MITRAL VALVE, WITH CARDIOPULMONARY BYPASS; RADICAL
33430   - REPLACEMENT, MITRAL VALVE, WITH CARDIOPULMONARY BYPASS
33460   - VALVECTOMY, TRICUSPID VALVE, WITH CARDIOPULMONARY BYPASS
33463   - VALVULOPLASTY, TRICUSPID VALVE; WITHOUT RING INSERTION
33464   - VALVULOPLASTY, TRICUSPID VALVE; WITH RING INSERTION
33465   - REPLACEMENT, TRICUSPID VALVE, WITH CARDIOPULMONARY BYPASS
33468   - TRICUSPID VALVE REPOSITIONING AND PLICATION FOR EBSTEIN ANOMALY
33470   - VALVOTOMY, PULMONARY VALVE, CLOSED HEART; TRANSVENTRICULAR
33472   - VALVOTOMY, PULMONARY VALVE, OPEN HEART; WITH INFLOW OCCLUSION
33474   - VALVOTOMY, PULMONARY VALVE, OPEN HEART; WITH CARDIOPULMONARY BYPASS
33475   - REPLACEMENT, PULMONARY VALVE
33476   - RIGHT VENTRICULAR RESECTION FOR INFUNDIBULAR STENOSIS, WITH OR WITHOUT
33478   - OUTFLOW TRACT AUGMENTATION (GUSSET), WITH OR WITHOUT COMMISSUROTOMY OR
33496   - REPAIR OF NON-STRUCTURAL PROSTHETIC VALVE DYSFUNCTION WITH CARDIOPULMONARY BYPAS
33500   - REPAIR OF CORONARY ARTERIOVENOUS OR ARTERIOCARDIAC CHAMBER FISTULA; WITH CARDIOP
33501   - REPAIR OF CORONARY ARTERIOVENOUS OR ARTERIOCARDIAC CHAMBER FISTULA; WITHOUT
33502   - REPAIR OF ANOMALOUS CORONARY ARTERY FROM PULMONARY ARTERY ORIGIN; BY LIGATION
33503   - REPAIR OF ANOMALOUS CORONARY ARTERY; BY GRAFT, WITHOUT CARDIOPULMONARY BYPASS
33504   - REPAIR OF ANOMALOUS CORONARY ARTERY; BY GRAFT, WITH CARDIOPULMONARY BYPASS
33505   - REPAIR OF ANOMALOUS CORONARY ARTERY; WITH CONSTRUCTION OF INTRAPULMONARY ARTERY
33506   - REPAIR OF ANOMALOUS CORONARY ARTERY; BY TRANSLOCATION FROM PULMONARY ARTERY TO
33507   - REPAIR OF ANOMALOUS (EG, INTRAMURAL) AORTIC ORIGIN OF CORONARY ARTERY BY UNROOFI
33508   - ENDOSCOPY, SURGICAL, INCLUDING VIDEO-ASSISTED HARVEST OF VEIN(S) FOR CORONARY AR
33510   - CORONARY ARTERY BYPASS, VEIN ONLY; SINGLE CORONARY VENOUS GRAFT
33511   - CORONARY ARTERY BYPASS, VEIN ONLY; TWO CORONARY VENOUS GRAFTS
33512   - CORONARY ARTERY BYPASS, VEIN ONLY; THREE CORONARY VENOUS GRAFTS
33513   - CORONARY ARTERY BYPASS, VEIN ONLY; FOUR CORONARY VENOUS GRAFTS
33514   - CORONARY ARTERY BYPASS, VEIN ONLY; FIVE CORONARY VENOUS GRAFTS
33516   - CORONARY ARTERY BYPASS, VEIN ONLY; SIX OR MORE CORONARY VENOUS GRAFTS
33517   - CORONARY ARTERY BYPASS, USING VENOUS GRAFT(S) AND ARTERIAL GRAFT(S); SINGLE VEIN
33518   - CORONARY ARTERY BYPASS, USING VENOUS GRAFT(S) AND ARTERIAL GRAFT(S); TWO VENOUS
33519   - CORONARY ARTERY BYPASS, USING VENOUS GRAFT(S) AND ARTERIAL GRAFT(S); THREE VENOU
33521   - CORONARY ARTERY BYPASS, USING VENOUS GRAFT(S) AND ARTERIAL GRAFT(S); FOUR VENOUS
33522   - CORONARY ARTERY BYPASS, USING VENOUS GRAFT(S) AND ARTERIAL GRAFT(S); FIVE VENOUS
33523   - CORONARY ARTERY BYPASS, USING VENOUS GRAFT(S) AND ARTERIAL GRAFT(S); SIX OR MORE
33530   - REOPERATION, CORONARY ARTERY BYPASS PROCEDURE OR VALVE PROCEDURE, MORE THAN ONE
33533   - CORONARY ARTERY BYPASS, USING ARTERIAL GRAFT(S); SINGLE ARTERIAL GRAFT
33534   - CORONARY ARTERY BYPASS, USING ARTERIAL GRAFT(S); TWO CORONARY ARTERIAL GRAFTS
33535   - CORONARY ARTERY BYPASS, USING ARTERIAL GRAFT(S); THREE CORONARY ARTERIAL GRAFTS
33536   - CORONARY ARTERY BYPASS, USING ARTERIAL GRAFT(S); FOUR OR MORE CORONARY ARTERIAL
33542   - MYOCARDIAL RESECTION (EG, VENTRICULAR ANEURYSMECTOMY)
33545   - REPAIR OF POSTINFARCTION VENTRICULAR SEPTAL DEFECT, WITH OR WITHOUT MYOCARDIAL
33548   - SURGICAL VENTRICULAR RESTORATION PROCEDURE, INCLUDES PROSTHETIC PATCH, WHEN PERF
33572   - CORONARY ENDARTERECTOMY, OPEN, ANY METHOD, OF LEFT ANTERIOR DESCENDING, CIRCUMFL
33600   - CLOSURE OF ATRIOVENTRICULAR VALVE (MITRAL OR TRICUSPID) BY SUTURE OR PATCH



                                             Page 395
                                  All Other (no trigger bundling)


33602 - CLOSURE OF SEMILUNAR VALVE (AORTIC OR PULMONARY) BY SUTURE OR PATCH
33606 - ANASTOMOSIS OF PULMONARY ARTERY TO AORTA (DAMUS-KAYE-STANSEL PROCEDURE)
33608 - REPAIR OF COMPLEX CARDIAC ANOMALY OTHER THAN PULMONARY ATRESIA WITH VENTRICULAR
33610 - REPAIR OF COMPLEX CARDIAC ANOMALIES (EG, SINGLE VENTRICLE WITH SUBAORTIC
33611 - REPAIR OF DOUBLE OUTLET RIGHT VENTRICLE WITH INTRAVENTRICULAR TUNNEL REPAIR;
33612 - REPAIR OF DOUBLE OUTLET RIGHT VENTRICLE WITH INTRAVENTRICULAR TUNNEL REPAIR;
33615 - REPAIR OF COMPLEX CARDIAC ANOMALIES (EG, TRICUSPID ATRESIA) BY CLOSURE OF
33617 - REPAIR OF COMPLEX CARDIAC ANOMALIES (EG, SINGLE VENTRICLE) BY MODIFIED FONTAN
33619 - REPAIR OF SINGLE VENTRICLE WITH AORTIC OUTFLOW OBSTRUCTION AND AORTIC ARCH
33620 - Application of right and left pulmonary artery bands (eg, hybrid approach stage
33621 - Transthoracic insertion of catheter for stent placement with catheter removal an
33622 - Reconstruction of complex cardiac anomaly (eg, single ventricle or hypoplastic l
33641 - REPAIR ATRIAL SEPTAL DEFECT, SECUNDUM, WITH CARDIOPULMONARY BYPASS, WITH OR WITH
33645 - DIRECT OR PATCH CLOSURE, SINUS VENOSUS, WITH OR WITHOUT ANOMALOUS PULMONARY
33647 - REPAIR OF ATRIAL SEPTAL DEFECT AND VENTRICULAR SEPTAL DEFECT, WITH DIRECT OR
33660 - REPAIR OF INCOMPLETE OR PARTIAL ATRIOVENTRICULAR CANAL (OSTIUM PRIMUM ATRIAL
33665 - REPAIR OF INTERMEDIATE OR TRANSITIONAL ATRIOVENTRICULAR CANAL, WITH OR WITHOUT
33670 - REPAIR OF COMPLETE ATRIOVENTRICULAR CANAL, WITH OR WITHOUT PROSTHETIC VALVE
33675 - CLOSURE OF MULTIPLE VENTRICULAR SEPTAL DEFECTS;
33676 - CLOSURE OF MULTIPLE VENTRICULAR SEPTAL DEFECTS; WITH PULMONARY VALVOTOMY OR INFU
33677 - CLOSURE OF MULTIPLE VENTRICULAR SEPTAL DEFECTS; WITH REMOVAL OF PULMONARY ARTERY
33681 - CLOSURE OF SINGLE VENTRICULAR SEPTAL DEFECT, WITH OR WITHOUT PATCH;
33684 - CLOSURE OF VENTRICULAR SEPTAL DEFECT, WITH OR WITHOUT PATCH; WITH PULMONARY
33688 - CLOSURE OF VENTRICULAR SEPTAL DEFECT, WITH OR WITHOUT PATCH; WITH REMOVAL OF
33690 - BANDING OF PULMONARY ARTERY
33692 - COMPLETE REPAIR TETRALOGY OF FALLOT WITHOUT PULMONARY ATRESIA;
33694 - COMPLETE REPAIR TETRALOGY OF FALLOT WITHOUT PULMONARY ATRESIA; WITH
33697 - COMPLETE REPAIR TETRALOGY OF FALLOT WITH PULMONARY ATRESIA INCLUDING
33702 - REPAIR SINUS OF VALSALVA FISTULA, WITH CARDIOPULMONARY BYPASS;
33710 - REPAIR SINUS OF VALSALVA FISTULA, WITH CARDIOPULMONARY BYPASS; WITH REPAIR OF
33720 - REPAIR SINUS OF VALSALVA ANEURYSM, WITH CARDIOPULMONARY BYPASS
33722 - CLOSURE OF AORTICO-LEFT VENTRICULAR TUNNEL
33724 - REPAIR OF ISOLATED PARTIAL ANOMALOUS PULMONARY VENOUS RETURN (EG, SCIMITAR SYNDR
33726 - REPAIR OF PULMONARY VENOUS STENOSIS
33730 - COMPLETE REPAIR OF ANOMALOUS VENOUS RETURN (SUPRACARDIAC, INTRACARDIAC, OR INFRA
33732 - REPAIR OF COR TRIATRIATUM OR SUPRAVALVULAR MITRAL RING BY RESECTION OF LEFT
33735 - ATRIAL SEPTECTOMY OR SEPTOSTOMY; CLOSED HEART (BLALOCK-HANLON TYPE OPERATION)
33736 - ATRIAL SEPTECTOMY OR SEPTOSTOMY; OPEN HEART WITH CARDIOPULMONARY BYPASS
33737 - ATRIAL SEPTECTOMY OR SEPTOSTOMY; OPEN HEART, WITH INFLOW OCCLUSION
33750 - SHUNT; SUBCLAVIAN TO PULMONARY ARTERY (BLALOCK-TAUSSIG TYPE OPERATION)
33755 - SHUNT; ASCENDING AORTA TO PULMONARY ARTERY (WATERSTON TYPE OPERATION)
33762 - SHUNT; DESCENDING AORTA TO PULMONARY ARTERY (POTTS-SMITH TYPE OPERATION)
33764 - SHUNT; CENTRAL, WITH PROSTHETIC GRAFT
33766 - SHUNT; SUPERIOR VENA CAVA TO PULMONARY ARTERY FOR FLOW TO ONE LUNG (CLASSICAL
33767 - SHUNT; SUPERIOR VENA CAVA TO PULMONARY ARTERY FOR FLOW TO BOTH LUNGS
33768 - ANASTOMOSIS, CAVOPULMONARY, SECOND SUPERIOR VENA CAVA (LIST SEPARATELY IN ADDITI
33770 - REPAIR OF TRANSPOSITION OF THE GREAT ARTERIES WITH VENTRICULAR SEPTAL DEFECT AND
33771 - REPAIR OF TRANSPOSITION OF THE GREAT ARTERIES WITH VENTRICULAR SEPTAL DEFECT
33774 - REPAIR OF TRANSPOSITION OF THE GREAT ARTERIES, ATRIAL BAFFLE PROCEDURE (EG,
33775 - REPAIR OF TRANSPOSITION OF THE GREAT ARTERIES, ATRIAL BAFFLE PROCEDURE (EG,
33776 - REPAIR OF TRANSPOSITION OF THE GREAT ARTERIES, ATRIAL BAFFLE PROCEDURE (EG,
33777 - REPAIR OF TRANSPOSITION OF THE GREAT ARTERIES, ATRIAL BAFFLE PROCEDURE (EG,



                                            Page 396
                                    All Other (no trigger bundling)


33778   - REPAIR OF TRANSPOSITION OF THE GREAT ARTERIES, AORTIC PULMONARY ARTERY
33779   - REPAIR OF TRANSPOSITION OF THE GREAT ARTERIES, AORTIC PULMONARY ARTERY
33780   - REPAIR OF TRANSPOSITION OF THE GREAT ARTERIES, AORTIC PULMONARY ARTERY
33781   - REPAIR OF TRANSPOSITION OF THE GREAT ARTERIES, AORTIC PULMONARY ARTERY
33782   - Aortic root translocation with ventricular septal defect and pulmonary stenosis
33783   - Aortic root translocation with ventricular septal defect and pulmonary stenosis
33786   - TOTAL REPAIR, TRUNCUS ARTERIOSUS (RASTELLI TYPE OPERATION)
33788   - REIMPLANTATION OF AN ANOMALOUS PULMONARY ARTERY
33800   - AORTIC SUSPENSION (AORTOPEXY) FOR TRACHEAL DECOMPRESSION (EG, FOR TRACHEOMALACIA
33802   - DIVISION OF ABERRANT VESSEL (VASCULAR RING);
33803   - DIVISION OF ABERRANT VESSEL (VASCULAR RING); WITH REANASTOMOSIS
33813   - OBLITERATION OF AORTOPULMONARY SEPTAL DEFECT; WITHOUT CARDIOPULMONARY BYPASS
33814   - OBLITERATION OF AORTOPULMONARY SEPTAL DEFECT; WITH CARDIOPULMONARY BYPASS
33820   - REPAIR OF PATENT DUCTUS ARTERIOSUS; BY LIGATION
33822   - REPAIR OF PATENT DUCTUS ARTERIOSUS; BY DIVISION, UNDER 18 YEARS
33824   - REPAIR OF PATENT DUCTUS ARTERIOSUS; BY DIVISION, 18 YEARS AND OLDER
33840   - EXCISION OF COARCTATION OF AORTA, WITH OR WITHOUT ASSOCIATED PATENT DUCTUS
33845   - EXCISION OF COARCTATION OF AORTA, WITH OR WITHOUT ASSOCIATED PATENT DUCTUS
33851   - EXCISION OF COARCTATION OF AORTA, WITH OR WITHOUT ASSOCIATED PATENT DUCTUS
33852   - REPAIR OF HYPOPLASTIC OR INTERRUPTED AORTIC ARCH USING AUTOGENOUS OR PROSTHETIC
33853   - REPAIR OF HYPOPLASTIC OR INTERRUPTED AORTIC ARCH USING AUTOGENOUS OR PROSTHETIC
33860   - ASCENDING AORTA GRAFT, WITH CARDIOPULMONARY BYPASS, WITH OR WITHOUT VALVE SUSPEN
33861   - ASCENDING AORTA GRAFT, WITH CARDIOPULMONARY BYPASS, WITH OR WITHOUT VALVE
33863   - ASCENDING AORTA GRAFT, WITH CARDIOPULMONARY BYPASS, WITH OR WITHOUT VALVE
33864   - ASCENDING AORTA GRAFT, WITH CARDIOPULMONARY BYPASS WITH VALVE SUSPENSION, WITH C
33870   - TRANSVERSE ARCH GRAFT, WITH CARDIOPULMONARY BYPASS
33875   - DESCENDING THORACIC AORTA GRAFT, WITH OR WITHOUT BYPASS
33877   - REPAIR OF THORACOABDOMINAL AORTIC ANEURYSM WITH GRAFT, WITH OR WITHOUT
33880   - ENDOVASCULAR REPAIR OF DESCENDING THORACIC AORTA (EG, ANEURYSM, PSEUDOANEURYSM,
33881   - ENDOVASCULAR REPAIR OF DESCENDING THORACIC AORTA (EG, ANEURYSM, PSEUDOANEURYSM,
33883   - PLACEMENT OF PROXIMAL EXTENSION PROSTHESIS FOR ENDOVASCULAR REPAIR OF DESCENDING
33884   - PLACEMENT OF PROXIMAL EXTENSION PROSTHESIS FOR ENDOVASCULAR REPAIR OF DESCENDING
33886   - PLACEMENT OF DISTAL EXTENSION PROSTHESIS(S) DELAYED AFTER ENDOVASCULAR REPAIR OF
33889   - OPEN SUBCLAVIAN TO CAROTID ARTERY TRANSPOSITION PERFORMED IN CONJUNCTION WITH EN
33891   - BYPASS GRAFT, WITH OTHER THAN VEIN, TRANSCERVICAL RETROPHARYNGEAL CAROTID-CAROTI
33910   - PULMONARY ARTERY EMBOLECTOMY; WITH CARDIOPULMONARY BYPASS
33915   - PULMONARY ARTERY EMBOLECTOMY; WITHOUT CARDIOPULMONARY BYPASS
33916   - PULMONARY ENDARTERECTOMY, WITH OR WITHOUT EMBOLECTOMY, WITH CARDIOPULMONARY
33917   - REPAIR OF PULMONARY ARTERY STENOSIS BY RECONSTRUCTION WITH PATCH OR GRAFT
33920   - REPAIR OF PULMONARY ATRESIA WITH VENTRICULAR SEPTAL DEFECT, BY CONSTRUCTION OR
33922   - TRANSECTION OF PULMONARY ARTERY WITH CARDIOPULMONARY BYPASS
33924   - LIGATION AND TAKEDOWN OF A SYSTEMIC-TO-PULMONARY ARTERY SHUNT, PERFORMED IN
33925   - REPAIR OF PULMONARY ARTERY ARBORIZATION ANOMALIES BY UNIFOCALIZATION; WITHOUT CA
33926   - REPAIR OF PULMONARY ARTERY ARBORIZATION ANOMALIES BY UNIFOCALIZATION; WITH CARDI
33930   - DONOR CARDIECTOMY-PNEUMONECTOMY (INCLUDING COLD PRESERVATION)
33933   - BACKBENCH STANDARD PREPARATION OF CADAVER DONOR HEART/LUNG ALLOGRAFT PRIOR TO
33935   - HEART-LUNG TRANSPLANT WITH RECIPIENT CARDIECTOMY-PNEUMONECTOMY
33940   - DONOR CARDIECTOMY (INCLUDING COLD PRESERVATION)
33944   - BACKBENCH STANDARD PREPARATION OF CADAVER DONOR HEART ALLOGRAFT PRIOR TO
33945   - HEART TRANSPLANT, WITH OR WITHOUT RECIPIENT CARDIECTOMY
33960   - PROLONGED EXTRACORPOREAL CIRCULATION FOR CARDIOPULMONARY INSUFFICIENCY; INITIAL
33961   - PROLONGED EXTRACORPOREAL CIRCULATION FOR CARDIOPULMONARY INSUFFICIENCY; EACH



                                              Page 397
                                    All Other (no trigger bundling)


33967   - INSERTION OF INTRA-AORTIC BALLOON ASSIST DEVICE, PERCUTANEOUS
33968   - REMOVAL OF INTRA-AORTIC BALLOON ASSIST DEVICE, PERCUTANEOUS
33970   - INSERTION OF INTRA-AORTIC BALLOON ASSIST DEVICE THROUGH THE FEMORAL ARTERY,
33971   - REMOVAL OF INTRA-AORTIC BALLOON ASSIST DEVICE INCLUDING REPAIR OF FEMORAL
33973   - INSERTION OF INTRA-AORTIC BALLOON ASSIST DEVICE THROUGH THE ASCENDING AORTA
33974   - REMOVAL OF INTRA-AORTIC BALLOON ASSIST DEVICE FROM THE ASCENDING AORTA,
33975   - INSERTION OF VENTRICULAR ASSIST DEVICE; EXTRACORPOREAL, SINGLE VENTRICLE
33976   - INSERTION OF VENTRICULAR ASSIST DEVICE; EXTRACORPOREAL, BIVENTRICULAR
33977   - REMOVAL OF VENTRICULAR ASSIST DEVICE; EXTRACORPOREAL, SINGLE VENTRICLE
33978   - REMOVAL OF VENTRICULAR ASSIST DEVICE; EXTRACORPOREAL, BIVENTRICULAR
33979   - INSERTION OF VENTRICULAR ASSIST DEVICE, IMPLANTABLE INTRACORPOREAL, SINGLE
33980   - REMOVAL OF VENTRICULAR ASSIST DEVICE, IMPLANTABLE INTRACORPOREAL, SINGLE
33981   - Replacement of extracorporeal ventricular assist device, single or biventricular
33982   - Replacement of ventricular assist device pump(s); implantable intracorporeal, si
33983   - Replacement of ventricular assist device pump(s); implantable intracorporeal, si
34001   - EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; CAROTID, SUBCLAVIAN OR IN
34051   - EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; INNOMINATE, SUBCLAVIAN
34151   - EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; RENAL, CELIAC,
34401   - THROMBECTOMY, DIRECT OR WITH CATHETER; VENA CAVA, ILIAC VEIN, BY ABDOMINAL INCIS
34451   - THROMBECTOMY, DIRECT OR WITH CATHETER; VENA CAVA, ILIAC, FEMOROPOPLITEAL VEIN,
34502   - RECONSTRUCTION OF VENA CAVA, ANY METHOD
34800   - ENDOVASCULAR REPAIR OF INFRARENAL ABDOMINAL AORTIC ANEURYSM OR DISSECTION; USING
34802   - ENDOVASCULAR REPAIR OF INFRARENAL ABDOMINAL AORTIC ANEURYSM OR DISSECTION;
34803   - ENDOVASCULAR REPAIR OF INFRARENAL ABDOMINAL AORTIC ANEURYSM OR DISSECTION;
34804   - ENDOVASCULAR REPAIR OF INFRARENAL ABDOMINAL AORTIC ANEURYSM OR DISSECTION;
34805   - ENDOVASCULAR REPAIR OF INFRARENAL ABDOMINAL AORTIC ANEURYSM OR DISSECTION;
34808   - ENDOVASCULAR PLACEMENT OF ILIAC ARTERY OCCLUSION DEVICE (LIST SEPARATELY IN
34812   - OPEN FEMORAL ARTERY EXPOSURE FOR DELIVERY OF ENDOVASCULAR PROSTHESIS, BY GROIN
34813   - PLACEMENT OF FEMORAL-FEMORAL PROSTHETIC GRAFT DURING ENDOVASCULAR AORTIC
34820   - OPEN ILIAC ARTERY EXPOSURE FOR DELIVERY OF ENDOVASCULAR PROSTHESIS OR ILIAC
34825   - PLACEMENT OF PROXIMAL OR DISTAL EXTENSION PROSTHESIS FOR ENDOVASCULAR REPAIR OF
34826   - PLACEMENT OF PROXIMAL OR DISTAL EXTENSION PROSTHESIS FOR ENDOVASCULAR REPAIR OF
34830   - OPEN REPAIR OF INFRARENAL AORTIC ANEURYSM OR DISSECTION, PLUS REPAIR OF
34831   - OPEN REPAIR OF INFRARENAL AORTIC ANEURYSM OR DISSECTION, PLUS REPAIR OF
34832   - OPEN REPAIR OF INFRARENAL AORTIC ANEURYSM OR DISSECTION, PLUS REPAIR OF
34833   - OPEN ILIAC ARTERY EXPOSURE WITH CREATION OF CONDUIT FOR DELIVERY OF AORTIC OR IL
34834   - OPEN BRACHIAL ARTERY EXPOSURE TO ASSIST IN THE DEPLOYMENT OF AORTIC OR ILIAC END
34900   - ENDOVASCULAR GRAFT REPLACEMENT FOR REPAIR OF ILIAC ARTERY (EG, ANEURYSM, PSEUDOA
35001   - DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND GR
35002   - DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
35005   - DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
35013   - DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
35021   - DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
35022   - DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
35045   - DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
35081   - DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
35082   - DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
35091   - DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
35092   - DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
35102   - DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
35103   - DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
35111   - DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND



                                              Page 398
                                    All Other (no trigger bundling)


35112   - DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
35121   - DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
35122   - DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
35131   - DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
35132   - DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
35141   - DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
35142   - DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
35151   - DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
35152   - DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
35182   - REPAIR, CONGENITAL ARTERIOVENOUS FISTULA; THORAX AND ABDOMEN
35189   - REPAIR, ACQUIRED OR TRAUMATIC ARTERIOVENOUS FISTULA; THORAX AND ABDOMEN
35211   - REPAIR BLOOD VESSEL, DIRECT; INTRATHORACIC, WITH BYPASS
35216   - REPAIR BLOOD VESSEL, DIRECT; INTRATHORACIC, WITHOUT BYPASS
35221   - REPAIR BLOOD VESSEL, DIRECT; INTRA-ABDOMINAL
35241   - REPAIR BLOOD VESSEL WITH VEIN GRAFT; INTRATHORACIC, WITH BYPASS
35246   - REPAIR BLOOD VESSEL WITH VEIN GRAFT; INTRATHORACIC, WITHOUT BYPASS
35251   - REPAIR BLOOD VESSEL WITH VEIN GRAFT; INTRA-ABDOMINAL
35271   - REPAIR BLOOD VESSEL WITH GRAFT OTHER THAN VEIN; INTRATHORACIC, WITH BYPASS
35276   - REPAIR BLOOD VESSEL WITH GRAFT OTHER THAN VEIN; INTRATHORACIC, WITHOUT BYPASS
35281   - REPAIR BLOOD VESSEL WITH GRAFT OTHER THAN VEIN; INTRA-ABDOMINAL
35301   - THROMBOENDARTERECTOMY, INCLUDING PATCH GRAFT, IF PERFORMED; CAROTID, VERTEBRAL,
35302   - THROMBOENDARTERECTOMY, INCLUDING PATCH GRAFT, IF PERFORMED; SUPERFICIAL FEMORAL
35303   - THROMBOENDARTERECTOMY, INCLUDING PATCH GRAFT, IF PERFORMED; POPLITEAL ARTERY
35304   - THROMBOENDARTERECTOMY, INCLUDING PATCH GRAFT, IF PERFORMED; TIBIOPERONEAL TRUNK
35305   - THROMBOENDARTERECTOMY, INCLUDING PATCH GRAFT, IF PERFORMED; TIBIAL OR PERONEAL A
35306   - THROMBOENDARTERECTOMY, INCLUDING PATCH GRAFT, IF PERFORMED; EACH ADDITIONAL TIBI
35311   - THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; SUBCLAVIAN, INNOMINATE, BY
35331   - THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; ABDOMINAL AORTA
35341   - THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; MESENTERIC, CELIAC, OR RENAL
35351   - THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; ILIAC
35355   - THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; ILIOFEMORAL
35361   - THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; COMBINED AORTOILIAC
35363   - THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; COMBINED AORTOILIOFEMORAL
35371   - THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; COMMON FEMORAL
35372   - THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; DEEP (PROFUNDA) FEMORAL
35390   - REOPERATION, CAROTID, THROMBOENDARTERECTOMY, MORE THAN ONE MONTH AFTER ORIGINAL
35400   - ANGIOSCOPY (NON-CORONARY VESSELS OR GRAFTS) DURING THERAPEUTIC INTERVENTION (LIS
35450   - TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; RENAL OR OTHER VISCERAL ARTERY
35452   - TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; AORTIC
35454   - TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; ILIAC
35456   - TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; FEMORAL-POPLITEAL
35480   - TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN; RENAL OR OTHER VISCERAL ARTERY
35481   - TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN; AORTIC
35482   - TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN; ILIAC
35483   - TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN; FEMORAL-POPLITEAL
35501   - BYPASS GRAFT, WITH VEIN; COMMON CAROTID-IPSILATERAL INTERNAL CAROTID
35506   - BYPASS GRAFT, WITH VEIN; CAROTID-SUBCLAVIAN OR SUBCLAVIAN-CAROTID
35508   - BYPASS GRAFT, WITH VEIN; CAROTID-VERTEBRAL
35509   - BYPASS GRAFT, WITH VEIN; CAROTID-CONTRALATERAL CAROTID
35510   - BYPASS GRAFT, WITH VEIN; CAROTID-BRACHIAL
35511   - BYPASS GRAFT, WITH VEIN; SUBCLAVIAN-SUBCLAVIAN
35512   - BYPASS GRAFT, WITH VEIN; SUBCLAVIAN-BRACHIAL



                                              Page 399
                                    All Other (no trigger bundling)


35515   - BYPASS GRAFT, WITH VEIN; SUBCLAVIAN-VERTEBRAL
35516   - BYPASS GRAFT, WITH VEIN; SUBCLAVIAN-AXILLARY
35518   - BYPASS GRAFT, WITH VEIN; AXILLARY-AXILLARY
35521   - BYPASS GRAFT, WITH VEIN; AXILLARY-FEMORAL
35522   - BYPASS GRAFT, WITH VEIN; AXILLARY-BRACHIAL
35523   - BYPASS GRAFT, WITH VEIN; BRACHIAL-ULNAR OR -RADIAL
35525   - BYPASS GRAFT, WITH VEIN; BRACHIAL-BRACHIAL
35526   - BYPASS GRAFT, WITH VEIN; AORTOSUBCLAVIAN OR CAROTID
35531   - BYPASS GRAFT, WITH VEIN; AORTOCELIAC OR AORTOMESENTERIC
35533   - BYPASS GRAFT, WITH VEIN; AXILLARY-FEMORAL-FEMORAL
35535   - Bypass graft, with vein; hepatorenal
35536   - BYPASS GRAFT, WITH VEIN; SPLENORENAL
35537   - BYPASS GRAFT, WITH VEIN; AORTOILIAC
35538   - BYPASS GRAFT, WITH VEIN; AORTOBI-ILIAC
35539   - BYPASS GRAFT, WITH VEIN; AORTOFEMORAL
35540   - BYPASS GRAFT, WITH VEIN; AORTOBIFEMORAL
35548   - BYPASS GRAFT, WITH VEIN; AORTOILIOFEMORAL, UNILATERAL
35549   - BYPASS GRAFT, WITH VEIN; AORTOILIOFEMORAL, BILATERAL
35551   - BYPASS GRAFT, WITH VEIN; AORTOFEMORAL-POPLITEAL
35556   - BYPASS GRAFT, WITH VEIN; FEMORAL-POPLITEAL
35558   - BYPASS GRAFT, WITH VEIN; FEMORAL-FEMORAL
35560   - BYPASS GRAFT, WITH VEIN; AORTORENAL
35563   - BYPASS GRAFT, WITH VEIN; ILIOILIAC
35565   - BYPASS GRAFT, WITH VEIN; ILIOFEMORAL
35566   - BYPASS GRAFT, WITH VEIN; FEMORAL-ANTERIOR TIBIAL, POSTERIOR TIBIAL, PERONEAL
35570   - Bypass graft, with vein; tibial-tibial, peroneal-tibial, or tibial/peroneal trun
35571   - BYPASS GRAFT, WITH VEIN; POPLITEAL-TIBIAL, -PERONEAL ARTERY OR OTHER DISTAL
35572   - HARVEST OF FEMOROPOPLITEAL VEIN, ONE SEGMENT, FOR VASCULAR RECONSTRUCTION
35583   - IN-SITU VEIN BYPASS; FEMORAL-POPLITEAL
35585   - IN-SITU VEIN BYPASS; FEMORAL-ANTERIOR TIBIAL, POSTERIOR TIBIAL, OR PERONEAL
35587   - IN-SITU VEIN BYPASS; POPLITEAL-TIBIAL, PERONEAL
35600   - HARVEST OF UPPER EXTREMITY ARTERY, ONE SEGMENT, FOR CORONARY ARTERY BYPASS PROCE
35601   - BYPASS GRAFT, WITH OTHER THAN VEIN; COMMON CAROTID-IPSILATERAL INTERNAL CAROTID
35606   - BYPASS GRAFT, WITH OTHER THAN VEIN; CAROTID-SUBCLAVIAN
35612   - BYPASS GRAFT, WITH OTHER THAN VEIN; SUBCLAVIAN-SUBCLAVIAN
35616   - BYPASS GRAFT, WITH OTHER THAN VEIN; SUBCLAVIAN-AXILLARY
35621   - BYPASS GRAFT, WITH OTHER THAN VEIN; AXILLARY-FEMORAL
35623   - BYPASS GRAFT, WITH OTHER THAN VEIN; AXILLARY-POPLITEAL OR -TIBIAL
35626   - BYPASS GRAFT, WITH OTHER THAN VEIN; AORTOSUBCLAVIAN OR CAROTID
35631   - BYPASS GRAFT, WITH OTHER THAN VEIN; AORTOCELIAC, AORTOMESENTERIC, AORTORENAL
35632   - Bypass graft, with other than vein; ilio-celiac
35633   - Bypass graft, with other than vein; ilio-mesenteric
35634   - Bypass graft, with other than vein; iliorenal
35636   - BYPASS GRAFT, WITH OTHER THAN VEIN; SPLENORENAL (SPLENIC TO RENAL ARTERIAL
35637   - BYPASS GRAFT, WITH OTHER THAN VEIN; AORTOILIAC
35638   - BYPASS GRAFT, WITH OTHER THAN VEIN; AORTOBI-ILIAC
35642   - BYPASS GRAFT, WITH OTHER THAN VEIN; CAROTID-VERTEBRAL
35645   - BYPASS GRAFT, WITH OTHER THAN VEIN; SUBCLAVIAN-VERTEBRAL
35646   - BYPASS GRAFT, WITH OTHER THAN VEIN; AORTOBIFEMORAL
35647   - BYPASS GRAFT, WITH OTHER THAN VEIN; AORTOFEMORAL
35650   - BYPASS GRAFT, WITH OTHER THAN VEIN; AXILLARY-AXILLARY
35651   - BYPASS GRAFT, WITH OTHER THAN VEIN; AORTOFEMORAL-POPLITEAL



                                              Page 400
                                     All Other (no trigger bundling)


35654   - BYPASS GRAFT, WITH OTHER THAN VEIN; AXILLARY-FEMORAL-FEMORAL
35656   - BYPASS GRAFT, WITH OTHER THAN VEIN; FEMORAL-POPLITEAL
35661   - BYPASS GRAFT, WITH OTHER THAN VEIN; FEMORAL-FEMORAL
35663   - BYPASS GRAFT, WITH OTHER THAN VEIN; ILIOILIAC
35665   - BYPASS GRAFT, WITH OTHER THAN VEIN; ILIOFEMORAL
35666   - BYPASS GRAFT, WITH OTHER THAN VEIN; FEMORAL-ANTERIOR TIBIAL, POSTERIOR TIBIAL,
35671   - BYPASS GRAFT, WITH OTHER THAN VEIN; POPLITEAL-TIBIAL OR -PERONEAL ARTERY
35681   - BYPASS GRAFT; COMPOSITE, PROSTHETIC AND VEIN (LIST SEPARATELY IN ADDITION TO COD
35682   - BYPASS GRAFT; AUTOGENOUS COMPOSITE, TWO SEGMENTS OF VEINS FROM TWO LOCATIONS
35691   - TRANSPOSITION AND/OR REIMPLANTATION; VERTEBRAL TO CAROTID ARTERY
35693   - TRANSPOSITION AND/OR REIMPLANTATION; VERTEBRAL TO SUBCLAVIAN ARTERY
35694   - TRANSPOSITION AND/OR REIMPLANTATION; SUBCLAVIAN TO CAROTID ARTERY
35695   - TRANSPOSITION AND/OR REIMPLANTATION; CAROTID TO SUBCLAVIAN ARTERY
35697   - REIMPLANTATION, VISCERAL ARTERY TO INFRARENAL AORTIC PROSTHESIS, EACH ARTERY
35700   - REOPERATION, FEMORAL-POPLITEAL OR FEMORAL (POPLITEAL) -ANTERIOR TIBIAL, POSTERIO
35701   - EXPLORATION (NOT FOLLOWED BY SURGICAL REPAIR), WITH OR WITHOUT LYSIS OF ARTERY;
35721   - EXPLORATION (NOT FOLLOWED BY SURGICAL REPAIR), WITH OR WITHOUT LYSIS OF ARTERY;
35741   - EXPLORATION (NOT FOLLOWED BY SURGICAL REPAIR), WITH OR WITHOUT LYSIS OF ARTERY;
35800   - EXPLORATION FOR POSTOPERATIVE HEMORRHAGE, THROMBOSIS OR INFECTION; NECK
35820   - EXPLORATION FOR POSTOPERATIVE HEMORRHAGE, THROMBOSIS OR INFECTION; CHEST
35840   - EXPLORATION FOR POSTOPERATIVE HEMORRHAGE, THROMBOSIS OR INFECTION; ABDOMEN
35870   - REPAIR OF GRAFT-ENTERIC FISTULA
35901   - EXCISION OF INFECTED GRAFT; NECK
35905   - EXCISION OF INFECTED GRAFT; THORAX
35907   - EXCISION OF INFECTED GRAFT; ABDOMEN
36000   - INTRODUCTION OF NEEDLE OR INTRACATHETER, VEIN
36002   - INJECTION PROCEDURES (EG, THROMBIN) FOR PERCUTANEOUS TREATMENT OF EXTREMITY
36005   - INJECTION PROCEDURE FOR EXTREMITY VENOGRAPHY (INCLUDING INTRODUCTION OF NEEDLE
36010   - INTRODUCTION OF CATHETER, SUPERIOR OR INFERIOR VENA CAVA
36011   - SELECTIVE CATHETER PLACEMENT, VENOUS SYSTEM; FIRST ORDER BRANCH (EG, RENAL
36012   - SELECTIVE CATHETER PLACEMENT, VENOUS SYSTEM; SECOND ORDER, OR MORE SELECTIVE,
36013   - INTRODUCTION OF CATHETER, RIGHT HEART OR MAIN PULMONARY ARTERY
36014   - SELECTIVE CATHETER PLACEMENT, LEFT OR RIGHT PULMONARY ARTERY
36015   - SELECTIVE CATHETER PLACEMENT, SEGMENTAL OR SUBSEGMENTAL PULMONARY ARTERY
36100   - INTRODUCTION OF NEEDLE OR INTRACATHETER, CAROTID OR VERTEBRAL ARTERY
36120   - INTRODUCTION OF NEEDLE OR INTRACATHETER; RETROGRADE BRACHIAL ARTERY
36140   - INTRODUCTION OF NEEDLE OR INTRACATHETER; EXTREMITY ARTERY
36148   - Introduction of needle and/or catheter, arteriovenous shunt created for dialysis
36160   - INTRODUCTION OF NEEDLE OR INTRACATHETER, AORTIC, TRANSLUMBAR
36200   - INTRODUCTION OF CATHETER, AORTA
36215   - SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; EACH FIRST ORDER THORACIC OR
36216   - SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; INITIAL SECOND ORDER THORACIC OR
36217   - SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; INITIAL THIRD ORDER OR MORE
36218   - SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; ADDITIONAL SECOND ORDER, THIRD
36245   - SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; EACH FIRST ORDER ABDOMINAL,
36246   - SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; INITIAL SECOND ORDER ABDOMINAL,
36247   - SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; INITIAL THIRD ORDER OR MORE
36248   - SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; ADDITIONAL SECOND ORDER, THIRD
36299   - UNLISTED PROCEDURE, VASCULAR INJECTION
36400   - VENIPUNCTURE, UNDER AGE 3 YEARS, NECESSITATING PHYSICIAN'S SKILL, NOT TO BE USED
36405   - VENIPUNCTURE, UNDER AGE 3 YEARS, NECESSITATING PHYSICIAN'S SKILL, NOT TO BE
36406   - VENIPUNCTURE, UNDER AGE 3 YEARS, NECESSITATING PHYSICIAN'S SKILL, NOT TO BE



                                               Page 401
                                    All Other (no trigger bundling)


36410   - VENIPUNCTURE, AGE 3 YEARS OR OLDER, NECESSITATING PHYSICIAN'S SKILL (SEPARATE
36415   - COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE
36416   - COLLECTION OF CAPILLARY BLOOD SPECIMEN (EG, FINGER, HEEL, EAR STICK)
36420   - VENIPUNCTURE, CUTDOWN; UNDER AGE 1 YEAR
36425   - VENIPUNCTURE, CUTDOWN; AGE 1 OR OVER
36481   - PERCUTANEOUS PORTAL VEIN CATHETERIZATION BY ANY METHOD
36500   - VENOUS CATHETERIZATION FOR SELECTIVE ORGAN BLOOD SAMPLING
36510   - CATHETERIZATION OF UMBILICAL VEIN FOR DIAGNOSIS OR THERAPY, NEWBORN
36591   - COLLECTION OF BLOOD SPECIMEN FROM A COMPLETELY IMPLANTABLE VENOUS ACCESS DEVICE
36592   - COLLECTION OF BLOOD SPECIMEN USING ESTABLISHED CENTRAL OR PERIPHERAL CATHETER, V
36598   - CONTRAST INJECTION(S) FOR RADIOLOGIC EVALUATION OF EXISTING CENTRAL VENOUS ACCES
36600   - ARTERIAL PUNCTURE, WITHDRAWAL OF BLOOD FOR DIAGNOSIS
36620   - ARTERIAL CATHETERIZATION OR CANNULATION FOR SAMPLING, MONITORING OR TRANSFUSION
36625   - ARTERIAL CATHETERIZATION OR CANNULATION FOR SAMPLING, MONITORING OR TRANSFUSION
36660   - CATHETERIZATION, UMBILICAL ARTERY, NEWBORN, FOR DIAGNOSIS OR THERAPY
36822   - INSERTION OF CANNULA(S) FOR PROLONGED EXTRACORPOREAL CIRCULATION FOR
36823   - INSERTION OF ARTERIAL AND VENOUS CANNULA(S) FOR ISOLATED EXTRACORPOREAL
37140   - VENOUS ANASTOMOSIS, OPEN; PORTOCAVAL
37145   - VENOUS ANASTOMOSIS, OPEN; RENOPORTAL
37160   - VENOUS ANASTOMOSIS, OPEN; CAVAL-MESENTERIC
37180   - VENOUS ANASTOMOSIS, OPEN; SPLENORENAL, PROXIMAL
37181   - VENOUS ANASTOMOSIS, OPEN; SPLENORENAL, DISTAL (SELECTIVE DECOMPRESSION OF
37182   - INSERTION OF TRANSVENOUS INTRAHEPATIC PORTOSYSTEMIC SHUNT(S) (TIPS) (INCLUDE3
37215   - TRANSCATHETER PLACEMENT OF INTRAVASCULAR STENT(S), CERVICAL CAROTID ARTERY,
37216   - TRANSCATHETER PLACEMENT OF INTRAVASCULAR STENT(S), CERVICAL CAROTID ARTERY,
37250   - INTRAVASCULAR ULTRASOUND (NON-CORONARY VESSEL) DURING DIAGNOSTIC EVALUATION AND/
37251   - INTRAVASCULAR ULTRASOUND (NON-CORONARY VESSEL) DURING DIAGNOSTIC EVALUATION
37616   - LIGATION, MAJOR ARTERY (EG, POST-TRAUMATIC, RUPTURE); CHEST
37617   - LIGATION, MAJOR ARTERY (EG, POST-TRAUMATIC, RUPTURE); ABDOMEN
37618   - LIGATION, MAJOR ARTERY (EG, POST-TRAUMATIC, RUPTURE); EXTREMITY
37660   - LIGATION OF COMMON ILIAC VEIN
37788   - PENILE REVASCULARIZATION, ARTERY, WITH OR WITHOUT VEIN GRAFT
37799   - UNLISTED PROCEDURE, VASCULAR SURGERY
38100   - SPLENECTOMY (SEPARATE PROCEDURE); TOTAL
38101   - SPLENECTOMY; PARTIAL (SEPARATE PROCEDURE)
38102   - SPLENECTOMY; TOTAL, EN BLOC FOR EXTENSIVE DISEASE, IN CONJUNCTION WITH OTHER
38115   - REPAIR OF RUPTURED SPLEEN (SPLENORRHAPHY) WITH OR WITHOUT PARTIAL SPLENECTOMY
38200   - INJECTION PROCEDURE FOR SPLENOPORTOGRAPHY
38204   - MANAGEMENT OF RECIPIENT HEMATOPOIETIC PROGENITOR CELL DONOR SEARCH AND CELL ACQU
38205   - BLOOD-DERIVED HEMATOPOIETIC PROGENITOR CELL HARVESTING FOR TRANSPLANTATION, PER
38207   - TRANSPLANT PREPARATION OF HEMATOPOIETIC PROGENITOR CELLS; CRYOPRESERVATION AND
38208   - TRANSPLANT PREPARATION OF HEMATOPOIETIC PROGENITOR CELLS; THAWING OF PREVIOUSLY
38209   - TRANSPLANT PREPARATION OF HEMATOPOIETIC PROGENITOR CELLS; THAWING OF PREVIOUSLY
38210   - TRANSPLANT PREPARATION OF HEMATOPOIETIC PROGENITOR CELLS; SPECIFIC CELL
38211   - TRANSPLANT PREPARATION OF HEMATOPOIETIC PROGENITOR CELLS; TUMOR CELL DEPLETION
38212   - TRANSPLANT PREPARATION OF HEMATOPOIETIC PROGENITOR CELLS; RED BLOOD CELL REMOVAL
38213   - TRANSPLANT PREPARATION OF HEMATOPOIETIC PROGENITOR CELLS; PLATELET DEPLETION
38214   - TRANSPLANT PREPARATION OF HEMATOPOIETIC PROGENITOR CELLS; PLASMA (VOLUME)
38215   - TRANSPLANT PREPARATION OF HEMATOPOIETIC PROGENITOR CELLS; CELL CONCENTRATION IN
38380   - SUTURE AND/OR LIGATION OF THORACIC DUCT; CERVICAL APPROACH
38381   - SUTURE AND/OR LIGATION OF THORACIC DUCT; THORACIC APPROACH
38382   - SUTURE AND/OR LIGATION OF THORACIC DUCT; ABDOMINAL APPROACH



                                              Page 402
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38562 - LIMITED LYMPHADENECTOMY FOR STAGING (SEPARATE PROCEDURE); PELVIC AND PARA-AORTIC
38564 - LIMITED LYMPHADENECTOMY FOR STAGING (SEPARATE PROCEDURE); RETROPERITONEAL
38724 - CERVICAL LYMPHADENECTOMY (MODIFIED RADICAL NECK DISSECTION)
38746 - THORACIC LYMPHADENECTOMY, REGIONAL, INCLUDING MEDIASTINAL AND PERITRACHEAL
38747 - ABDOMINAL LYMPHADENECTOMY, REGIONAL, INCLUDING CELIAC, GASTRIC, PORTAL,
38765 - INGUINOFEMORAL LYMPHADENECTOMY, SUPERFICIAL, IN CONTINUITY WITH PELVIC
38770 - PELVIC LYMPHADENECTOMY, INCLUDING EXTERNAL ILIAC, HYPOGASTRIC, AND OBTURATOR
38780 - RETROPERITONEAL TRANSABDOMINAL LYMPHADENECTOMY, EXTENSIVE, INCLUDING PELVIC,
38790 - INJECTION PROCEDURE; LYMPHANGIOGRAPHY
38792 - INJECTION PROCEDURE; FOR IDENTIFICATION OF SENTINEL NODE
38794 - CANNULATION, THORACIC DUCT
38900 - Intraoperative identification (eg, mapping) of sentinel lymph node(s) includes i
39000 - MEDIASTINOTOMY WITH EXPLORATION, DRAINAGE, REMOVAL OF FOREIGN BODY, OR BIOPSY; C
39010 - MEDIASTINOTOMY WITH EXPLORATION, DRAINAGE, REMOVAL OF FOREIGN BODY, OR BIOPSY;
39200 - EXCISION OF MEDIASTINAL CYST
39220 - EXCISION OF MEDIASTINAL TUMOR
39499 - UNLISTED PROCEDURE, MEDIASTINUM
39501 - REPAIR, LACERATION OF DIAPHRAGM, ANY APPROACH
39502 - REPAIR, PARAESOPHAGEAL HIATUS HERNIA, TRANSABDOMINAL, WITH OR WITHOUT
39503 - REPAIR, NEONATAL DIAPHRAGMATIC HERNIA, WITH OR WITHOUT CHEST TUBE INSERTION AND
39520 - REPAIR, DIAPHRAGMATIC HERNIA (ESOPHAGEAL HIATAL); TRANSTHORACIC
39530 - REPAIR, DIAPHRAGMATIC HERNIA (ESOPHAGEAL HIATAL); COMBINED, THORACOABDOMINAL
39531 - REPAIR, DIAPHRAGMATIC HERNIA (ESOPHAGEAL HIATAL); COMBINED, THORACOABDOMINAL,
39540 - REPAIR, DIAPHRAGMATIC HERNIA (OTHER THAN NEONATAL), TRAUMATIC; ACUTE
39541 - REPAIR, DIAPHRAGMATIC HERNIA (OTHER THAN NEONATAL), TRAUMATIC; CHRONIC
39545 - IMBRICATION OF DIAPHRAGM FOR EVENTRATION, TRANSTHORACIC OR TRANSABDOMINAL,
39560 - RESECTION, DIAPHRAGM; WITH SIMPLE REPAIR (EG, PRIMARY SUTURE)
39561 - RESECTION, DIAPHRAGM; WITH COMPLEX REPAIR (EG, PROSTHETIC MATERIAL, LOCAL
39599 - UNLISTED PROCEDURE, DIAPHRAGM
40804 - REMOVAL OF EMBEDDED FOREIGN BODY, VESTIBULE OF MOUTH; SIMPLE
41130 - GLOSSECTOMY; HEMIGLOSSECTOMY
41135 - GLOSSECTOMY; PARTIAL, WITH UNILATERAL RADICAL NECK DISSECTION
41140 - GLOSSECTOMY; COMPLETE OR TOTAL, WITH OR WITHOUT TRACHEOSTOMY, WITHOUT RADICAL
41145 - GLOSSECTOMY; COMPLETE OR TOTAL, WITH OR WITHOUT TRACHEOSTOMY, WITH UNILATERAL
41150 - GLOSSECTOMY; COMPOSITE PROCEDURE WITH RESECTION FLOOR OF MOUTH AND MANDIBULAR
41153 - GLOSSECTOMY; COMPOSITE PROCEDURE WITH RESECTION FLOOR OF MOUTH, WITH SUPRAHYOID
41155 - GLOSSECTOMY; COMPOSITE PROCEDURE WITH RESECTION FLOOR OF MOUTH, MANDIBULAR
42426 - EXCISION OF PAROTID TUMOR OR PAROTID GLAND; TOTAL, WITH UNILATERAL RADICAL NECK
42550 - INJECTION PROCEDURE FOR SIALOGRAPHY
42809 - REMOVAL OF FOREIGN BODY FROM PHARYNX
42845 - RADICAL RESECTION OF TONSIL, TONSILLAR PILLARS, AND/OR RETROMOLAR TRIGONE;
42894 - RESECTION OF PHARYNGEAL WALL REQUIRING CLOSURE WITH MYOCUTANEOUS OR FASCIOCUTANE
42953 - PHARYNGOESOPHAGEAL REPAIR
42961 - CONTROL OROPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG,
42971 - CONTROL OF NASOPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG,
43045 - ESOPHAGOTOMY, THORACIC APPROACH, WITH REMOVAL OF FOREIGN BODY
43100 - EXCISION OF LESION, ESOPHAGUS, WITH PRIMARY REPAIR; CERVICAL APPROACH
43101 - EXCISION OF LESION, ESOPHAGUS, WITH PRIMARY REPAIR; THORACIC OR ABDOMINAL
43107 - TOTAL OR NEAR TOTAL ESOPHAGECTOMY, WITHOUT THORACOTOMY; WITH
43108 - TOTAL OR NEAR TOTAL ESOPHAGECTOMY, WITHOUT THORACOTOMY; WITH COLON
43112 - TOTAL OR NEAR TOTAL ESOPHAGECTOMY, WITH THORACOTOMY; WITH PHARYNGOGASTROSTOMY
43113 - TOTAL OR NEAR TOTAL ESOPHAGECTOMY, WITH THORACOTOMY; WITH COLON INTERPOSITION



                                           Page 403
                                 All Other (no trigger bundling)


43116 - PARTIAL ESOPHAGECTOMY, CERVICAL, WITH FREE INTESTINAL GRAFT, INCLUDING
43117 - PARTIAL ESOPHAGECTOMY, DISTAL TWO-THIRDS, WITH THORACOTOMY AND SEPARATE
43118 - PARTIAL ESOPHAGECTOMY, DISTAL TWO-THIRDS, WITH THORACOTOMY AND SEPARATE
43121 - PARTIAL ESOPHAGECTOMY, DISTAL TWO-THIRDS, WITH THORACOTOMY ONLY, WITH OR
43122 - PARTIAL ESOPHAGECTOMY, THORACOABDOMINAL OR ABDOMINAL APPROACH, WITH OR WITHOUT
43123 - PARTIAL ESOPHAGECTOMY, THORACOABDOMINAL OR ABDOMINAL APPROACH, WITH OR WITHOUT
43124 - TOTAL OR PARTIAL ESOPHAGECTOMY, WITHOUT RECONSTRUCTION (ANY APPROACH), WITH
43135 - DIVERTICULECTOMY OF HYPOPHARYNX OR ESOPHAGUS, WITH OR WITHOUT MYOTOMY; THORACIC
43279 - Laparoscopy, surgical, esophagomyotomy (Heller type), with fundoplasty, when per
43281 - Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, wh
43282 - Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, wh
43283 - Laparoscopy, surgical, esophageal lengthening procedure (eg, Collis gastroplasty
43300 - ESOPHAGOPLASTY (PLASTIC REPAIR OR RECONSTRUCTION), CERVICAL APPROACH; WITHOUT RE
43305 - ESOPHAGOPLASTY (PLASTIC REPAIR OR RECONSTRUCTION), CERVICAL APPROACH; WITH
43310 - ESOPHAGOPLASTY (PLASTIC REPAIR OR RECONSTRUCTION), THORACIC APPROACH; WITHOUT
43312 - ESOPHAGOPLASTY (PLASTIC REPAIR OR RECONSTRUCTION), THORACIC APPROACH; WITH
43313 - ESOPHAGOPLASTY FOR CONGENITAL DEFECT (PLASTIC REPAIR OR RECONSTRUCTION),
43314 - ESOPHAGOPLASTY FOR CONGENITAL DEFECT (PLASTIC REPAIR OR RECONSTRUCTION),
43320 - ESOPHAGOGASTROSTOMY (CARDIOPLASTY), WITH OR WITHOUT VAGOTOMY AND PYLOROPLASTY,
43324 - ESOPHAGOGASTRIC FUNDOPLASTY (EG, NISSEN, BELSEY IV, HILL PROCEDURES)
43325 - ESOPHAGOGASTRIC FUNDOPLASTY; WITH FUNDIC PATCH (THAL-NISSEN PROCEDURE)
43326 - ESOPHAGOGASTRIC FUNDOPLASTY; WITH GASTROPLASTY (EG, COLLIS)
43327 - Esophagogastric fundoplasty partial or complete; laparotomy
43328 - Esophagogastric fundoplasty partial or complete; thoracotomy
43330 - ESOPHAGOMYOTOMY (HELLER TYPE); ABDOMINAL APPROACH
43331 - ESOPHAGOMYOTOMY (HELLER TYPE); THORACIC APPROACH
43332 - Repair, paraesophageal hiatal hernia (including fundoplication), via laparotomy,
43333 - Repair, paraesophageal hiatal hernia (including fundoplication), via laparotomy,
43334 - Repair, paraesophageal hiatal hernia (including fundoplicaton), via thoracotomy,
43335 - Repair, paraesophageal hiatal hernia (including fundoplicaton), via thoracotomy,
43336 - Repair, paraesophageal hiatal hernia, (including fundoplication), via thoracoabd
43337 - Repair, paraesophageal hiatal hernia, (including fundoplication), via thoracoabd
43338 - Esophageal lengthening procedure (eg, Collis gastroplasty or wedge gastroplasty)
43340 - ESOPHAGOJEJUNOSTOMY (WITHOUT TOTAL GASTRECTOMY); ABDOMINAL APPROACH
43341 - ESOPHAGOJEJUNOSTOMY (WITHOUT TOTAL GASTRECTOMY); THORACIC APPROACH
43350 - ESOPHAGOSTOMY, FISTULIZATION OF ESOPHAGUS, EXTERNAL; ABDOMINAL APPROACH
43351 - ESOPHAGOSTOMY, FISTULIZATION OF ESOPHAGUS, EXTERNAL; THORACIC APPROACH
43352 - ESOPHAGOSTOMY, FISTULIZATION OF ESOPHAGUS, EXTERNAL; CERVICAL APPROACH
43360 - GASTROINTESTINAL RECONSTRUCTION FOR PREVIOUS ESOPHAGECTOMY, FOR OBSTRUCTING
43361 - GASTROINTESTINAL RECONSTRUCTION FOR PREVIOUS ESOPHAGECTOMY, FOR OBSTRUCTING
43400 - LIGATION, DIRECT, ESOPHAGEAL VARICES
43401 - TRANSECTION OF ESOPHAGUS WITH REPAIR, FOR ESOPHAGEAL VARICES
43405 - LIGATION OR STAPLING AT GASTROESOPHAGEAL JUNCTION FOR PRE-EXISTING ESOPHAGEAL
43410 - SUTURE OF ESOPHAGEAL WOUND OR INJURY; CERVICAL APPROACH
43415 - SUTURE OF ESOPHAGEAL WOUND OR INJURY; TRANSTHORACIC OR TRANSABDOMINAL APPROACH
43425 - CLOSURE OF ESOPHAGOSTOMY OR FISTULA; TRANSTHORACIC OR TRANSABDOMINAL APPROACH
43460 - ESOPHAGOGASTRIC TAMPONADE, WITH BALLOON (SENGSTAKEN TYPE)
43496 - FREE JEJUNUM TRANSFER WITH MICROVASCULAR ANASTOMOSIS
43500 - GASTROTOMY; WITH EXPLORATION OR FOREIGN BODY REMOVAL
43501 - GASTROTOMY; WITH SUTURE REPAIR OF BLEEDING ULCER
43502 - GASTROTOMY; WITH SUTURE REPAIR OF PRE-EXISTING ESOPHAGOGASTRIC LACERATION (EG,
43520 - PYLOROMYOTOMY, CUTTING OF PYLORIC MUSCLE (FREDET-RAMSTEDT TYPE OPERATION)



                                           Page 404
                                  All Other (no trigger bundling)


43605 - BIOPSY OF STOMACH; BY LAPAROTOMY
43610 - EXCISION, LOCAL; ULCER OR BENIGN TUMOR OF STOMACH
43611 - EXCISION, LOCAL; MALIGNANT TUMOR OF STOMACH
43620 - GASTRECTOMY, TOTAL; WITH ESOPHAGOENTEROSTOMY
43621 - GASTRECTOMY, TOTAL; WITH ROUX-EN-Y RECONSTRUCTION
43622 - GASTRECTOMY, TOTAL; WITH FORMATION OF INTESTINAL POUCH, ANY TYPE
43631 - GASTRECTOMY, PARTIAL, DISTAL; WITH GASTRODUODENOSTOMY
43632 - GASTRECTOMY, PARTIAL, DISTAL; WITH GASTROJEJUNOSTOMY
43633 - GASTRECTOMY, PARTIAL, DISTAL; WITH ROUX-EN-Y RECONSTRUCTION
43634 - GASTRECTOMY, PARTIAL, DISTAL; WITH FORMATION OF INTESTINAL POUCH
43635 - VAGOTOMY WHEN PERFORMED WITH PARTIAL DISTAL GASTRECTOMY (LIST SEPARATELY IN
43640 - VAGOTOMY INCLUDING PYLOROPLASTY, WITH OR WITHOUT GASTROSTOMY; TRUNCAL OR
43641 - VAGOTOMY INCLUDING PYLOROPLASTY, WITH OR WITHOUT GASTROSTOMY; PARIETAL CELL
43644 - LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; WITH GASTRIC BYPASS AND RO
43645 - LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; WITH GASTRIC BYPASS AND
43752 - NASO- OR ORO-GASTRIC TUBE PLACEMENT, REQUIRING PHYSICIAN'S SKILL AND
43753 - Gastric intubation and aspiration(s) therapeutic, necessitating physician's skil
43754 - Gastric intubation and aspiration, diagnostic; single specimen (eg, acid analysi
43756 - Duodenal intubation and aspiration, diagnostic, includes image guidance; single
43757 - Duodenal intubation and aspiration, diagnostic, includes image guidance; collect
43770 - LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; PLACEMENT OF ADJUSTABLE GA
43771 - LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; REVISION OF ADJUSTABLE GAS
43772 - LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; REMOVAL OF ADJUSTABLE GAST
43773 - LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; REMOVAL AND REPLACEMENT OF
43774 - LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; REMOVAL OF ADJUSTABLE GAST
43775 - Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (
43800 - PYLOROPLASTY
43810 - GASTRODUODENOSTOMY
43820 - GASTROJEJUNOSTOMY; WITHOUT VAGOTOMY
43825 - GASTROJEJUNOSTOMY; WITH VAGOTOMY, ANY TYPE
43832 - GASTROSTOMY, OPEN; WITH CONSTRUCTION OF GASTRIC TUBE (EG, JANEWAY PROCEDURE)
43840 - GASTRORRHAPHY, SUTURE OF PERFORATED DUODENAL OR GASTRIC ULCER, WOUND, OR INJURY
43842 - GASTRIC RESTRICTIVE PROCEDURE, WITHOUT GASTRIC BYPASS, FOR MORBID OBESITY;
43843 - GASTRIC RESTRICTIVE PROCEDURE, WITHOUT GASTRIC BYPASS, FOR MORBID OBESITY;
43845 - GASTRIC RESTRICTIVE PROCEDURE WITH PARTIAL GASTRECTOMY, PYLORUS-PRESERVING
43846 - GASTRIC RESTRICTIVE PROCEDURE, WITH GASTRIC BYPASS FOR MORBID OBESITY; WITH
43847 - GASTRIC RESTRICTIVE PROCEDURE, WITH GASTRIC BYPASS FOR MORBID OBESITY; WITH
43848 - REVISION, OPEN, OF GASTRIC RESTRICTIVE PROCEDURE FOR MORBID OBESITY, OTHER THAN
43850 - REVISION OF GASTRODUODENAL ANASTOMOSIS (GASTRODUODENOSTOMY) WITH
43855 - REVISION OF GASTRODUODENAL ANASTOMOSIS (GASTRODUODENOSTOMY) WITH
43860 - REVISION OF GASTROJEJUNAL ANASTOMOSIS (GASTROJEJUNOSTOMY) WITH RECONSTRUCTION,
43865 - REVISION OF GASTROJEJUNAL ANASTOMOSIS (GASTROJEJUNOSTOMY) WITH RECONSTRUCTION,
43880 - CLOSURE OF GASTROCOLIC FISTULA
43882 - REVISION OR REMOVAL OF GASTRIC NEUROSTIMULATOR ELECTRODES, ANTRUM, OPEN
44005 - ENTEROLYSIS (FREEING OF INTESTINAL ADHESION) (SEPARATE PROCEDURE)
44010 - DUODENOTOMY, FOR EXPLORATION, BIOPSY(S), OR FOREIGN BODY REMOVAL
44015 - TUBE OR NEEDLE CATHETER JEJUNOSTOMY FOR ENTERAL ALIMENTATION, INTRAOPERATIVE,
44020 - ENTEROTOMY, SMALL INTESTINE, OTHER THAN DUODENUM; FOR EXPLORATION, BIOPSY(S),
44021 - ENTEROTOMY, SMALL INTESTINE, OTHER THAN DUODENUM; FOR DECOMPRESSION (EG, BAKER
44025 - COLOTOMY, FOR EXPLORATION, BIOPSY(S), OR FOREIGN BODY REMOVAL
44050 - REDUCTION OF VOLVULUS, INTUSSUSCEPTION, INTERNAL HERNIA, BY LAPAROTOMY
44055 - CORRECTION OF MALROTATION BY LYSIS OF DUODENAL BANDS AND/OR REDUCTION OF MIDGUT



                                            Page 405
                                    All Other (no trigger bundling)


44110   - EXCISION OF ONE OR MORE LESIONS OF SMALL OR LARGE INTESTINE NOT REQUIRING
44111   - EXCISION OF ONE OR MORE LESIONS OF SMALL OR LARGE INTESTINE NOT REQUIRING
44120   - ENTERECTOMY, RESECTION OF SMALL INTESTINE; SINGLE RESECTION AND ANASTOMOSIS
44121   - ENTERECTOMY, RESECTION OF SMALL INTESTINE; EACH ADDITIONAL RESECTION AND
44125   - ENTERECTOMY, RESECTION OF SMALL INTESTINE; WITH ENTEROSTOMY
44126   - ENTERECTOMY, RESECTION OF SMALL INTESTINE FOR CONGENITAL ATRESIA, SINGLE
44127   - ENTERECTOMY, RESECTION OF SMALL INTESTINE FOR CONGENITAL ATRESIA, SINGLE
44128   - ENTERECTOMY, RESECTION OF SMALL INTESTINE FOR CONGENITAL ATRESIA, SINGLE
44130   - ENTEROENTEROSTOMY, ANASTOMOSIS OF INTESTINE, WITH OR WITHOUT CUTANEOUS
44132   - DONOR ENTERECTOMY (INCLUDING COLD PRESERVATION), OPEN; FROM CADAVER DONOR
44133   - DONOR ENTERECTOMY (INCLUDING COLD PRESERVATION), OPEN; PARTIAL, FROM LIVING
44135   - INTESTINAL ALLOTRANSPLANTATION; FROM CADAVER DONOR
44136   - INTESTINAL ALLOTRANSPLANTATION; FROM LIVING DONOR
44137   - REMOVAL OF TRANSPLANTED INTESTINAL ALLOGRAFT, COMPLETE
44139   - MOBILIZATION (TAKE-DOWN) OF SPLENIC FLEXURE PERFORMED IN CONJUNCTION WITH
44140   - COLECTOMY, PARTIAL; WITH ANASTOMOSIS
44141   - COLECTOMY, PARTIAL; WITH SKIN LEVEL CECOSTOMY OR COLOSTOMY
44143   - COLECTOMY, PARTIAL; WITH END COLOSTOMY AND CLOSURE OF DISTAL SEGMENT (HARTMANN
44144   - COLECTOMY, PARTIAL; WITH RESECTION, WITH COLOSTOMY OR ILEOSTOMY AND CREATION OF
44145   - COLECTOMY, PARTIAL; WITH COLOPROCTOSTOMY (LOW PELVIC ANASTOMOSIS)
44146   - COLECTOMY, PARTIAL; WITH COLOPROCTOSTOMY (LOW PELVIC ANASTOMOSIS), WITH
44147   - COLECTOMY, PARTIAL; ABDOMINAL AND TRANSANAL APPROACH
44150   - COLECTOMY, TOTAL, ABDOMINAL, WITHOUT PROCTECTOMY; WITH ILEOSTOMY OR
44151   - COLECTOMY, TOTAL, ABDOMINAL, WITHOUT PROCTECTOMY; WITH CONTINENT ILEOSTOMY
44155   - COLECTOMY, TOTAL, ABDOMINAL, WITH PROCTECTOMY; WITH ILEOSTOMY
44156   - COLECTOMY, TOTAL, ABDOMINAL, WITH PROCTECTOMY; WITH CONTINENT ILEOSTOMY
44157   - COLECTOMY, TOTAL, ABDOMINAL, WITH PROCTECTOMY; WITH ILEOANAL ANASTOMOSIS, INCLUD
44158   - COLECTOMY, TOTAL, ABDOMINAL, WITH PROCTECTOMY; WITH ILEOANAL ANASTOMOSIS, CREATI
44160   - COLECTOMY, PARTIAL, WITH REMOVAL OF TERMINAL ILEUM WITH ILEOCOLOSTOMY
44187   - LAPAROSCOPY, SURGICAL; ILEOSTOMY OR JEJUNOSTOMY, NON-TUBE
44188   - LAPAROSCOPY, SURGICAL, COLOSTOMY OR SKIN LEVEL CECOSTOMY
44202   - LAPAROSCOPY, SURGICAL; ENTERECTOMY, RESECTION OF SMALL INTESTINE, SINGLE RESECTI
44203   - LAPAROSCOPY, SURGICAL; EACH ADDITIONAL SMALL INTESTINE RESECTION AND
44204   - LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH ANASTOMOSIS
44205   - LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH REMOVAL OF TERMINAL ILEUM WITH
44210   - LAPAROSCOPY, SURGICAL; COLECTOMY, TOTAL, ABDOMINAL, WITHOUT PROCTECTOMY, WITH
44211   - LAPAROSCOPY, SURGICAL; COLECTOMY, TOTAL, ABDOMINAL, WITH PROCTECTOMY, WITH ILEOA
44212   - LAPAROSCOPY, SURGICAL; COLECTOMY, TOTAL, ABDOMINAL, WITH PROCTECTOMY, WITH
44227   - LAPAROSCOPY, SURGICAL, CLOSURE OF ENTEROSTOMY, LARGE OR SMALL INTESTINE, WITH RE
44300   - PLACEMENT, ENTEROSTOMY OR CECOSTOMY, TUBE OPEN (EG, FOR FEEDING OR DECOMPRESSION
44310   - ILEOSTOMY OR JEJUNOSTOMY, NON-TUBE
44314   - REVISION OF ILEOSTOMY; COMPLICATED (RECONSTRUCTION IN-DEPTH) (SEPARATE
44316   - CONTINENT ILEOSTOMY (KOCK PROCEDURE) (SEPARATE PROCEDURE)
44320   - COLOSTOMY OR SKIN LEVEL CECOSTOMY;
44322   - COLOSTOMY OR SKIN LEVEL CECOSTOMY; WITH MULTIPLE BIOPSIES (EG, FOR CONGENITAL
44345   - REVISION OF COLOSTOMY; COMPLICATED (RECONSTRUCTION IN-DEPTH) (SEPARATE
44346   - REVISION OF COLOSTOMY; WITH REPAIR OF PARACOLOSTOMY HERNIA (SEPARATE PROCEDURE)
44602   - SUTURE OF SMALL INTESTINE (ENTERORRHAPHY) FOR PERFORATED ULCER, DIVERTICULUM, WO
44603   - SUTURE OF SMALL INTESTINE (ENTERORRHAPHY) FOR PERFORATED ULCER, DIVERTICULUM,
44604   - SUTURE OF LARGE INTESTINE (COLORRHAPHY) FOR PERFORATED ULCER, DIVERTICULUM,
44605   - SUTURE OF LARGE INTESTINE (COLORRHAPHY) FOR PERFORATED ULCER, DIVERTICULUM,
44615   - INTESTINAL STRICTUROPLASTY (ENTEROTOMY AND ENTERORRHAPHY) WITH OR WITHOUT



                                              Page 406
                                   All Other (no trigger bundling)


44620   - CLOSURE OF ENTEROSTOMY, LARGE OR SMALL INTESTINE;
44625   - CLOSURE OF ENTEROSTOMY, LARGE OR SMALL INTESTINE; WITH RESECTION AND
44626   - CLOSURE OF ENTEROSTOMY, LARGE OR SMALL INTESTINE; WITH RESECTION AND COLORECTAL
44640   - CLOSURE OF INTESTINAL CUTANEOUS FISTULA
44650   - CLOSURE OF ENTEROENTERIC OR ENTEROCOLIC FISTULA
44660   - CLOSURE OF ENTEROVESICAL FISTULA; WITHOUT INTESTINAL OR BLADDER RESECTION
44661   - CLOSURE OF ENTEROVESICAL FISTULA; WITH INTESTINE AND/OR BLADDER RESECTION
44680   - INTESTINAL PLICATION (SEPARATE PROCEDURE)
44700   - EXCLUSION OF SMALL INTESTINE FROM PELVIS BY MESH OR OTHER PROSTHESIS, OR NATIVE
44701   - INTRAOPERATIVE COLONIC LAVAGE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY
44715   - BACKBENCH STANDARD PREPARATION OF CADAVER OR LIVING DONOR INTESTINE ALLOGRAFT
44720   - BACKBENCH RECONSTRUCTION OF CADAVER OR LIVING DONOR INTESTINE ALLOGRAFT PRIOR
44721   - BACKBENCH RECONSTRUCTION OF CADAVER OR LIVING DONOR INTESTINE ALLOGRAFT PRIOR
44800   - EXCISION OF MECKEL'S DIVERTICULUM (DIVERTICULECTOMY) OR OMPHALOMESENTERIC DUCT
44820   - EXCISION OF LESION OF MESENTERY (SEPARATE PROCEDURE)
44850   - SUTURE OF MESENTERY (SEPARATE PROCEDURE)
44899   - UNLISTED PROCEDURE, MECKEL'S DIVERTICULUM AND THE MESENTERY
44900   - INCISION AND DRAINAGE OF APPENDICEAL ABSCESS; OPEN
44950   - APPENDECTOMY;
44955   - APPENDECTOMY; WHEN DONE FOR INDICATED PURPOSE AT TIME OF OTHER MAJOR PROCEDURE
44960   - APPENDECTOMY; FOR RUPTURED APPENDIX WITH ABSCESS OR GENERALIZED PERITONITIS
45110   - PROCTECTOMY; COMPLETE, COMBINED ABDOMINOPERINEAL, WITH COLOSTOMY
45111   - PROCTECTOMY; PARTIAL RESECTION OF RECTUM, TRANSABDOMINAL APPROACH
45112   - PROCTECTOMY, COMBINED ABDOMINOPERINEAL, PULL-THROUGH PROCEDURE (EG, COLO-ANAL
45113   - PROCTECTOMY, PARTIAL, WITH RECTAL MUCOSECTOMY, ILEOANAL ANASTOMOSIS, CREATION
45114   - PROCTECTOMY, PARTIAL, WITH ANASTOMOSIS; ABDOMINAL AND TRANSSACRAL APPROACH
45116   - PROCTECTOMY, PARTIAL, WITH ANASTOMOSIS; TRANSSACRAL APPROACH ONLY (KRASKE TYPE)
45119   - PROCTECTOMY, COMBINED ABDOMINOPERINEAL PULL-THROUGH PROCEDURE (EG, COLO-ANAL ANA
45120   - PROCTECTOMY, COMPLETE (FOR CONGENITAL MEGACOLON), ABDOMINAL AND PERINEAL
45121   - PROCTECTOMY, COMPLETE (FOR CONGENITAL MEGACOLON), ABDOMINAL AND PERINEAL
45123   - PROCTECTOMY, PARTIAL, WITHOUT ANASTOMOSIS, PERINEAL APPROACH
45126   - PELVIC EXENTERATION FOR COLORECTAL MALIGNANCY, WITH PROCTECTOMY (WITH OR
45130   - EXCISION OF RECTAL PROCIDENTIA, WITH ANASTOMOSIS; PERINEAL APPROACH
45135   - EXCISION OF RECTAL PROCIDENTIA, WITH ANASTOMOSIS; ABDOMINAL AND PERINEAL
45136   - EXCISION OF ILEOANAL RESERVOIR WITH ILEOSTOMY
45395   - LAPAROSCOPY, SURGICAL; PROCTECTOMY, COMPLETE, COMBINED ABDOMINOPERINEAL, WITH CO
45397   - LAPAROSCOPY, SURGICAL; PROCTECTOMY, COMBINED ABDOMINOPERINEAL PULL-THROUGH PROCE
45400   - LAPAROSCOPY, SURGICAL; PROCTOPEXY (FOR PROLAPSE)
45402   - LAPAROSCOPY, SURGICAL; PROCTOPEXY (FOR PROLAPSE), WITH SIGMOID RESECTION
45540   - PROCTOPEXY (EG, FOR PROLAPSE); ABDOMINAL APPROACH
45550   - PROCTOPEXY (EG, FOR PROLAPSE); WITH SIGMOID RESECTION, ABDOMINAL APPROACH
45562   - EXPLORATION, REPAIR, AND PRESACRAL DRAINAGE FOR RECTAL INJURY;
45563   - EXPLORATION, REPAIR, AND PRESACRAL DRAINAGE FOR RECTAL INJURY; WITH COLOSTOMY
45800   - CLOSURE OF RECTOVESICAL FISTULA;
45805   - CLOSURE OF RECTOVESICAL FISTULA; WITH COLOSTOMY
45820   - CLOSURE OF RECTOURETHRAL FISTULA;
45825   - CLOSURE OF RECTOURETHRAL FISTULA; WITH COLOSTOMY
46505   - CHEMODENERVATION OF INTERNAL ANAL SPHINCTER
46600   - ANOSCOPY; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR W
46705   - ANOPLASTY, PLASTIC OPERATION FOR STRICTURE; INFANT
46710   - REPAIR OF ILEOANAL POUCH FISTULA/SINUS (EG, PERINEAL OR VAGINAL), POUCH ADVANCEM
46712   - REPAIR OF ILEOANAL POUCH FISTULA/SINUS (EG, PERINEAL OR VAGINAL), POUCH ADVANCEM



                                             Page 407
                                   All Other (no trigger bundling)


46715   - REPAIR OF LOW IMPERFORATE ANUS; WITH ANOPERINEAL FISTULA (CUT-BACK PROCEDURE)
46716   - REPAIR OF LOW IMPERFORATE ANUS; WITH TRANSPOSITION OF ANOPERINEAL OR
46730   - REPAIR OF HIGH IMPERFORATE ANUS WITHOUT FISTULA; PERINEAL OR SACROPERINEAL
46735   - REPAIR OF HIGH IMPERFORATE ANUS WITHOUT FISTULA; COMBINED TRANSABDOMINAL AND
46740   - REPAIR OF HIGH IMPERFORATE ANUS WITH RECTOURETHRAL OR RECTOVAGINAL FISTULA;
46742   - REPAIR OF HIGH IMPERFORATE ANUS WITH RECTOURETHRAL OR RECTOVAGINAL FISTULA;
46744   - REPAIR OF CLOACAL ANOMALY BY ANORECTOVAGINOPLASTY AND URETHROPLASTY,
46746   - REPAIR OF CLOACAL ANOMALY BY ANORECTOVAGINOPLASTY AND URETHROPLASTY, COMBINED
46748   - REPAIR OF CLOACAL ANOMALY BY ANORECTOVAGINOPLASTY AND URETHROPLASTY, COMBINED
46751   - SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE OR PROLAPSE; CHILD
47001   - BIOPSY OF LIVER, NEEDLE; WHEN DONE FOR INDICATED PURPOSE AT TIME OF OTHER MAJOR
47010   - HEPATOTOMY; FOR OPEN DRAINAGE OF ABSCESS OR CYST, ONE OR TWO STAGES
47015   - LAPAROTOMY, WITH ASPIRATION AND/OR INJECTION OF HEPATIC PARASITIC (EG, AMOEBIC
47100   - BIOPSY OF LIVER, WEDGE
47120   - HEPATECTOMY, RESECTION OF LIVER; PARTIAL LOBECTOMY
47122   - HEPATECTOMY, RESECTION OF LIVER; TRISEGMENTECTOMY
47125   - HEPATECTOMY, RESECTION OF LIVER; TOTAL LEFT LOBECTOMY
47130   - HEPATECTOMY, RESECTION OF LIVER; TOTAL RIGHT LOBECTOMY
47133   - DONOR HEPATECTOMY (INCLUDING COLD PRESERVATION), FROM CADAVER DONOR
47135   - LIVER ALLOTRANSPLANTATION; ORTHOTOPIC, PARTIAL OR WHOLE, FROM CADAVER OR LIVING
47136   - LIVER ALLOTRANSPLANTATION; HETEROTOPIC, PARTIAL OR WHOLE, FROM CADAVER OR
47140   - DONOR HEPATECTOMY (INCLUDING COLD PRESERVATION), FROM LIVING DONOR; LEFT
47141   - DONOR HEPATECTOMY (INCLUDING COLD PRESERVATION), FROM LIVING DONOR; TOTAL LEFT
47142   - DONOR HEPATECTOMY (INCLUDING COLD PRESERVATION), FROM LIVING DONOR; TOTAL RIGHT
47143   - BACKBENCH STANDARD PREPARATION OF CADAVER DONOR WHOLE LIVER GRAFT PRIOR TO
47144   - BACKBENCH STANDARD PREPARATION OF CADAVER DONOR WHOLE LIVER GRAFT PRIOR TO
47145   - BACKBENCH STANDARD PREPARATION OF CADAVER DONOR WHOLE LIVER GRAFT PRIOR TO
47146   - BACKBENCH RECONSTRUCTION OF CADAVER OR LIVING DONOR LIVER GRAFT PRIOR TO
47147   - BACKBENCH RECONSTRUCTION OF CADAVER OR LIVING DONOR LIVER GRAFT PRIOR TO
47300   - MARSUPIALIZATION OF CYST OR ABSCESS OF LIVER
47350   - MANAGEMENT OF LIVER HEMORRHAGE; SIMPLE SUTURE OF LIVER WOUND OR INJURY
47360   - MANAGEMENT OF LIVER HEMORRHAGE; COMPLEX SUTURE OF LIVER WOUND OR INJURY, WITH
47361   - MANAGEMENT OF LIVER HEMORRHAGE; EXPLORATION OF HEPATIC WOUND, EXTENSIVE
47362   - MANAGEMENT OF LIVER HEMORRHAGE; RE-EXPLORATION OF HEPATIC WOUND FOR REMOVAL OF
47380   - ABLATION, OPEN, OF ONE OR MORE LIVER TUMOR(S); RADIOFREQUENCY
47381   - ABLATION, OPEN, OF ONE OR MORE LIVER TUMOR(S); CRYOSURGICAL
47400   - HEPATICOTOMY OR HEPATICOSTOMY WITH EXPLORATION, DRAINAGE, OR REMOVAL OF CALCULUS
47420   - CHOLEDOCHOTOMY OR CHOLEDOCHOSTOMY WITH EXPLORATION, DRAINAGE, OR REMOVAL OF
47425   - CHOLEDOCHOTOMY OR CHOLEDOCHOSTOMY WITH EXPLORATION, DRAINAGE, OR REMOVAL OF
47460   - TRANSDUODENAL SPHINCTEROTOMY OR SPHINCTEROPLASTY, WITH OR WITHOUT TRANSDUODENAL
47480   - CHOLECYSTOTOMY OR CHOLECYSTOSTOMY WITH EXPLORATION, DRAINAGE, OR REMOVAL OF
47500   - INJECTION PROCEDURE FOR PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY
47505   - INJECTION PROCEDURE FOR CHOLANGIOGRAPHY THROUGH AN EXISTING CATHETER (EG,
47550   - BILIARY ENDOSCOPY, INTRAOPERATIVE (CHOLEDOCHOSCOPY) (LIST SEPARATELY IN ADDITION
47570   - LAPAROSCOPY, SURGICAL; CHOLECYSTOENTEROSTOMY
47600   - CHOLECYSTECTOMY;
47605   - CHOLECYSTECTOMY; WITH CHOLANGIOGRAPHY
47610   - CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT;
47612   - CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT; WITH CHOLEDOCHOENTEROSTOMY
47620   - CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT; WITH TRANSDUODENAL
47700   - EXPLORATION FOR CONGENITAL ATRESIA OF BILE DUCTS, WITHOUT REPAIR, WITH OR
47701   - PORTOENTEROSTOMY (EG, KASAI PROCEDURE)



                                             Page 408
                                    All Other (no trigger bundling)


47711   - EXCISION OF BILE DUCT TUMOR, WITH OR WITHOUT PRIMARY REPAIR OF BILE DUCT;
47712   - EXCISION OF BILE DUCT TUMOR, WITH OR WITHOUT PRIMARY REPAIR OF BILE DUCT;
47715   - EXCISION OF CHOLEDOCHAL CYST
47720   - CHOLECYSTOENTEROSTOMY; DIRECT
47721   - CHOLECYSTOENTEROSTOMY; WITH GASTROENTEROSTOMY
47740   - CHOLECYSTOENTEROSTOMY; ROUX-EN-Y
47741   - CHOLECYSTOENTEROSTOMY; ROUX-EN-Y WITH GASTROENTEROSTOMY
47760   - ANASTOMOSIS, OF EXTRAHEPATIC BILIARY DUCTS AND GASTROINTESTINAL TRACT
47765   - ANASTOMOSIS, OF INTRAHEPATIC DUCTS AND GASTROINTESTINAL TRACT
47780   - ANASTOMOSIS, ROUX-EN-Y, OF EXTRAHEPATIC BILIARY DUCTS AND GASTROINTESTINAL TRACT
47785   - ANASTOMOSIS, ROUX-EN-Y, OF INTRAHEPATIC BILIARY DUCTS AND GASTROINTESTINAL TRACT
47800   - RECONSTRUCTION, PLASTIC, OF EXTRAHEPATIC BILIARY DUCTS WITH END-TO-END
47801   - PLACEMENT OF CHOLEDOCHAL STENT
47802   - U-TUBE HEPATICOENTEROSTOMY
47900   - SUTURE OF EXTRAHEPATIC BILIARY DUCT FOR PRE-EXISTING INJURY (SEPARATE PROCEDURE)
48000   - PLACEMENT OF DRAINS, PERIPANCREATIC, FOR ACUTE PANCREATITIS;
48001   - PLACEMENT OF DRAINS, PERIPANCREATIC, FOR ACUTE PANCREATITIS; WITH
48020   - REMOVAL OF PANCREATIC CALCULUS
48100   - BIOPSY OF PANCREAS, OPEN (EG, FINE NEEDLE ASPIRATION, NEEDLE CORE BIOPSY, WEDGE
48105   - RESECTION OR DEBRIDEMENT OF PANCREAS AND PERIPANCREATIC TISSUE FOR ACUTE NECROTI
48120   - EXCISION OF LESION OF PANCREAS (EG, CYST, ADENOMA)
48140   - PANCREATECTOMY, DISTAL SUBTOTAL, WITH OR WITHOUT SPLENECTOMY; WITHOUT
48145   - PANCREATECTOMY, DISTAL SUBTOTAL, WITH OR WITHOUT SPLENECTOMY; WITH
48146   - PANCREATECTOMY, DISTAL, NEAR-TOTAL WITH PRESERVATION OF DUODENUM (CHILD-TYPE
48148   - EXCISION OF AMPULLA OF VATER
48150   - PANCREATECTOMY, PROXIMAL SUBTOTAL WITH TOTAL DUODENECTOMY, PARTIAL GASTRECTOMY,
48152   - PANCREATECTOMY, PROXIMAL SUBTOTAL WITH TOTAL DUODENECTOMY, PARTIAL GASTRECTOMY,
48153   - PANCREATECTOMY, PROXIMAL SUBTOTAL WITH NEAR-TOTAL DUODENECTOMY,
48154   - PANCREATECTOMY, PROXIMAL SUBTOTAL WITH NEAR-TOTAL DUODENECTOMY,
48155   - PANCREATECTOMY, TOTAL
48160   - PANCREATECTOMY, TOTAL OR SUBTOTAL, WITH AUTOLOGOUS TRANSPLANTATION OF PANCREAS
48400   - INJECTION PROCEDURE FOR INTRAOPERATIVE PANCREATOGRAPHY (LIST SEPARATELY IN ADDIT
48500   - MARSUPIALIZATION OF PANCREATIC CYST
48510   - EXTERNAL DRAINAGE, PSEUDOCYST OF PANCREAS; OPEN
48520   - INTERNAL ANASTOMOSIS OF PANCREATIC CYST TO GASTROINTESTINAL TRACT; DIRECT
48540   - INTERNAL ANASTOMOSIS OF PANCREATIC CYST TO GASTROINTESTINAL TRACT; ROUX-EN-Y
48545   - PANCREATORRHAPHY FOR INJURY
48547   - DUODENAL EXCLUSION WITH GASTROJEJUNOSTOMY FOR PANCREATIC INJURY
48548   - PANCREATICOJEJUNOSTOMY, SIDE-TO-SIDE ANASTOMOSIS (PUESTOW-TYPE OPERATION)
48550   - DONOR PANCREATECTOMY (INCLUDING COLD PRESERVATION), WITH OR WITHOUT DUODENAL SEG
48551   - BACKBENCH STANDARD PREPARATION OF CADAVER DONOR PANCREAS ALLOGRAFT PRIOR TO
48552   - BACKBENCH RECONSTRUCTION OF CADAVER DONOR PANCREAS ALLOGRAFT PRIOR TO
48554   - TRANSPLANTATION OF PANCREATIC ALLOGRAFT
48556   - REMOVAL OF TRANSPLANTED PANCREATIC ALLOGRAFT
49000   - EXPLORATORY LAPAROTOMY, EXPLORATORY CELIOTOMY WITH OR WITHOUT BIOPSY(S) (SEPARAT
49002   - REOPENING OF RECENT LAPAROTOMY
49010   - EXPLORATION, RETROPERITONEAL AREA WITH OR WITHOUT BIOPSY(S) (SEPARATE PROCEDURE)
49020   - DRAINAGE OF PERITONEAL ABSCESS OR LOCALIZED PERITONITIS, EXCLUSIVE OF
49040   - DRAINAGE OF SUBDIAPHRAGMATIC OR SUBPHRENIC ABSCESS; OPEN
49060   - DRAINAGE OF RETROPERITONEAL ABSCESS; OPEN
49062   - DRAINAGE OF EXTRAPERITONEAL LYMPHOCELE TO PERITONEAL CAVITY, OPEN
49203   - EXCISION OR DESTRUCTION, OPEN, INTRA-ABDOMINAL TUMORS, CYSTS OR ENDOMETRIOMAS, 1



                                              Page 409
                                  All Other (no trigger bundling)


49204 - EXCISION OR DESTRUCTION, OPEN, INTRA-ABDOMINAL TUMORS, CYSTS OR ENDOMETRIOMAS, 1
49205 - EXCISION OR DESTRUCTION, OPEN, INTRA-ABDOMINAL TUMORS, CYSTS OR ENDOMETRIOMAS, 1
49215 - EXCISION OF PRESACRAL OR SACROCOCCYGEAL TUMOR
49220 - STAGING LAPAROTOMY FOR HODGKINS DISEASE OR LYMPHOMA (INCLUDES SPLENECTOMY,
49255 - OMENTECTOMY, EPIPLOECTOMY, RESECTION OF OMENTUM (SEPARATE PROCEDURE)
49400 - INJECTION OF AIR OR CONTRAST INTO PERITONEAL CAVITY (SEPARATE PROCEDURE)
49411 - Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial
49412 - Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial
49424 - CONTRAST INJECTION FOR ASSESSMENT OF ABSCESS OR CYST VIA PREVIOUSLY PLACED
49425 - INSERTION OF PERITONEAL-VENOUS SHUNT
49427 - INJECTION PROCEDURE (EG, CONTRAST MEDIA) FOR EVALUATION OF PREVIOUSLY PLACED
49428 - LIGATION OF PERITONEAL-VENOUS SHUNT
49465 - CONTRAST INJECTION(S) FOR RADIOLOGICAL EVALUATION OF EXISTING GASTROSTOMY, DUODE
49605 - REPAIR OF LARGE OMPHALOCELE OR GASTROSCHISIS; WITH OR WITHOUT PROSTHESIS
49606 - REPAIR OF LARGE OMPHALOCELE OR GASTROSCHISIS; WITH REMOVAL OF PROSTHESIS, FINAL
49610 - REPAIR OF OMPHALOCELE (GROSS TYPE OPERATION); FIRST STAGE
49611 - REPAIR OF OMPHALOCELE (GROSS TYPE OPERATION); SECOND STAGE
49900 - SUTURE, SECONDARY, OF ABDOMINAL WALL FOR EVISCERATION OR DEHISCENCE
49904 - OMENTAL FLAP, EXTRA-ABDOMINAL (EG, FOR RECONSTRUCTION OF STERNAL AND CHEST WALL
49905 - OMENTAL FLAP, INTRA-ABDOMINAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY
49906 - FREE OMENTAL FLAP WITH MICROVASCULAR ANASTOMOSIS
50010 - RENAL EXPLORATION, NOT NECESSITATING OTHER SPECIFIC PROCEDURES
50040 - NEPHROSTOMY, NEPHROTOMY WITH DRAINAGE
50045 - NEPHROTOMY, WITH EXPLORATION
50060 - NEPHROLITHOTOMY; REMOVAL OF CALCULUS
50065 - NEPHROLITHOTOMY; SECONDARY SURGICAL OPERATION FOR CALCULUS
50070 - NEPHROLITHOTOMY; COMPLICATED BY CONGENITAL KIDNEY ABNORMALITY
50075 - NEPHROLITHOTOMY; REMOVAL OF LARGE STAGHORN CALCULUS FILLING RENAL PELVIS AND
50100 - TRANSECTION OR REPOSITIONING OF ABERRANT RENAL VESSELS (SEPARATE PROCEDURE)
50120 - PYELOTOMY; WITH EXPLORATION
50125 - PYELOTOMY; WITH DRAINAGE, PYELOSTOMY
50130 - PYELOTOMY; WITH REMOVAL OF CALCULUS (PYELOLITHOTOMY, PELVIOLITHOTOMY, INCLUDING
50135 - PYELOTOMY; COMPLICATED (EG, SECONDARY OPERATION, CONGENITAL KIDNEY ABNORMALITY)
50205 - RENAL BIOPSY; BY SURGICAL EXPOSURE OF KIDNEY
50220 - NEPHRECTOMY, INCLUDING PARTIAL URETERECTOMY, ANY OPEN APPROACH INCLUDING RIB
50225 - NEPHRECTOMY, INCLUDING PARTIAL URETERECTOMY, ANY OPEN APPROACH INCLUDING RIB
50230 - NEPHRECTOMY, INCLUDING PARTIAL URETERECTOMY, ANY OPEN APPROACH INCLUDING RIB
50234 - NEPHRECTOMY WITH TOTAL URETERECTOMY AND BLADDER CUFF; THROUGH SAME INCISION
50236 - NEPHRECTOMY WITH TOTAL URETERECTOMY AND BLADDER CUFF; THROUGH SEPARATE INCISION
50240 - NEPHRECTOMY, PARTIAL
50250 - ABLATION, OPEN, ONE OR MORE RENAL MASS LESION(S), CRYOSURGICAL, INCLUDING INTRAO
50280 - EXCISION OR UNROOFING OF CYST(S) OF KIDNEY
50290 - EXCISION OF PERINEPHRIC CYST
50300 - DONOR NEPHRECTOMY (INCLUDING COLD PRESERVATION); FROM CADAVER DONOR, UNILATERAL
50320 - DONOR NEPHRECTOMY (INCLUDING COLD PRESERVATION); OPEN, FROM LIVING DONOR
50323 - BACKBENCH STANDARD PREPARATION OF CADAVER DONOR RENAL ALLOGRAFT PRIOR TO
50325 - BACKBENCH STANDARD PREPARATION OF LIVING DONOR RENAL ALLOGRAFT (OPEN OR
50327 - BACKBENCH RECONSTRUCTION OF CADAVER OR LIVING DONOR RENAL ALLOGRAFT PRIOR TO
50328 - BACKBENCH RECONSTRUCTION OF CADAVER OR LIVING DONOR RENAL ALLOGRAFT PRIOR TO
50329 - BACKBENCH RECONSTRUCTION OF CADAVER OR LIVING DONOR RENAL ALLOGRAFT PRIOR TO
50340 - RECIPIENT NEPHRECTOMY (SEPARATE PROCEDURE)
50360 - RENAL ALLOTRANSPLANTATION, IMPLANTATION OF GRAFT; WITHOUT RECIPIENT NEPHRECTOMY



                                            Page 410
                                 All Other (no trigger bundling)


50365 - RENAL ALLOTRANSPLANTATION, IMPLANTATION OF GRAFT; WITH RECIPIENT NEPHRECTOMY
50370 - REMOVAL OF TRANSPLANTED RENAL ALLOGRAFT
50380 - RENAL AUTOTRANSPLANTATION, REIMPLANTATION OF KIDNEY
50394 - INJECTION PROCEDURE FOR PYELOGRAPHY (AS NEPHROSTOGRAM, PYELOSTOGRAM, ANTEGRADE
50400 - PYELOPLASTY (FOLEY Y-PYELOPLASTY), PLASTIC OPERATION ON RENAL PELVIS, WITH OR WI
50405 - PYELOPLASTY (FOLEY Y-PYELOPLASTY), PLASTIC OPERATION ON RENAL PELVIS, WITH OR
50500 - NEPHRORRHAPHY, SUTURE OF KIDNEY WOUND OR INJURY
50520 - CLOSURE OF NEPHROCUTANEOUS OR PYELOCUTANEOUS FISTULA
50525 - CLOSURE OF NEPHROVISCERAL FISTULA (EG, RENOCOLIC), INCLUDING VISCERAL REPAIR;
50526 - CLOSURE OF NEPHROVISCERAL FISTULA (EG, RENOCOLIC), INCLUDING VISCERAL REPAIR;
50540 - SYMPHYSIOTOMY FOR HORSESHOE KIDNEY WITH OR WITHOUT PYELOPLASTY AND/OR OTHER
50545 - LAPAROSCOPY, SURGICAL; RADICAL NEPHRECTOMY (INCLUDES REMOVAL OF GEROTA'S FASCIA
50546 - LAPAROSCOPY, SURGICAL; NEPHRECTOMY, INCLUDING PARTIAL URETERECTOMY
50547 - LAPAROSCOPY, SURGICAL; DONOR NEPHRECTOMY (INCLUDING COLD PRESERVATION), FROM
50548 - LAPAROSCOPY, SURGICAL; NEPHRECTOMY WITH TOTAL URETERECTOMY
50580 - RENAL ENDOSCOPY THROUGH NEPHROTOMY OR PYELOTOMY, WITH OR WITHOUT IRRIGATION,
50600 - URETEROTOMY WITH EXPLORATION OR DRAINAGE (SEPARATE PROCEDURE)
50605 - URETEROTOMY FOR INSERTION OF INDWELLING STENT, ALL TYPES
50610 - URETEROLITHOTOMY; UPPER ONE-THIRD OF URETER
50620 - URETEROLITHOTOMY; MIDDLE ONE-THIRD OF URETER
50630 - URETEROLITHOTOMY; LOWER ONE-THIRD OF URETER
50650 - URETERECTOMY, WITH BLADDER CUFF (SEPARATE PROCEDURE)
50660 INJECTION PROCEDURE ECTOPIC URETER, COMBINATION ABDOMINAL, VAGINAL AND/OR
50684 - URETERECTOMY, TOTAL,FOR URETEROGRAPHY OR URETEROPYELOGRAPHY THROUGH
URETEROSTOMY
50690 - INJECTION PROCEDURE FOR VISUALIZATION OF ILEAL CONDUIT AND/ OR
50700 - URETEROPLASTY, PLASTIC OPERATION ON URETER (EG, STRICTURE)
50715 - URETEROLYSIS, WITH OR WITHOUT REPOSITIONING OF URETER FOR RETROPERITONEAL
50722 - URETEROLYSIS FOR OVARIAN VEIN SYNDROME
50725 - URETEROLYSIS FOR RETROCAVAL URETER, WITH REANASTOMOSIS OF UPPER URINARY TRACT
50728 - REVISION OF URINARY-CUTANEOUS ANASTOMOSIS (ANY TYPE UROSTOMY); WITH REPAIR OF
50740 - URETEROPYELOSTOMY, ANASTOMOSIS OF URETER AND RENAL PELVIS
50750 - URETEROCALYCOSTOMY, ANASTOMOSIS OF URETER TO RENAL CALYX
50760 - URETEROURETEROSTOMY
50770 - TRANSURETEROURETEROSTOMY, ANASTOMOSIS OF URETER TO CONTRALATERAL URETER
50780 - URETERONEOCYSTOSTOMY; ANASTOMOSIS OF SINGLE URETER TO BLADDER
50782 - URETERONEOCYSTOSTOMY; ANASTOMOSIS OF DUPLICATED URETER TO BLADDER
50783 - URETERONEOCYSTOSTOMY; WITH EXTENSIVE URETERAL TAILORING
50785 - URETERONEOCYSTOSTOMY; WITH VESICO-PSOAS HITCH OR BLADDER FLAP
50800 - URETEROENTEROSTOMY, DIRECT ANASTOMOSIS OF URETER TO INTESTINE
50810 - URETEROSIGMOIDOSTOMY, WITH CREATION OF SIGMOID BLADDER AND ESTABLISHMENT OF
50815 - URETEROCOLON CONDUIT, INCLUDING INTESTINE ANASTOMOSIS
50820 - URETEROILEAL CONDUIT (ILEAL BLADDER), INCLUDING INTESTINE ANASTOMOSIS (BRICKER
50825 - CONTINENT DIVERSION, INCLUDING INTESTINE ANASTOMOSIS USING ANY SEGMENT OF SMALL
50830 - URINARY UNDIVERSION (EG, TAKING DOWN OF URETEROILEAL CONDUIT,
50840 - REPLACEMENT OF ALL OR PART OF URETER BY INTESTINE SEGMENT, INCLUDING INTESTINE
50845 - CUTANEOUS APPENDICO-VESICOSTOMY
50860 - URETEROSTOMY, TRANSPLANTATION OF URETER TO SKIN
50900 - URETERORRHAPHY, SUTURE OF URETER (SEPARATE PROCEDURE)
50920 - CLOSURE OF URETEROCUTANEOUS FISTULA
50930 - CLOSURE OF URETEROVISCERAL FISTULA (INCLUDING VISCERAL REPAIR)
50940 - DELIGATION OF URETER
51060 - TRANSVESICAL URETEROLITHOTOMY



                                           Page 411
                                    All Other (no trigger bundling)


51525   - CYSTOTOMY; FOR EXCISION OF BLADDER DIVERTICULUM, SINGLE OR MULTIPLE (SEPARATE
51530   - CYSTOTOMY; FOR EXCISION OF BLADDER TUMOR
51535   - CYSTOTOMY FOR EXCISION, INCISION, OR REPAIR OF URETEROCELE
51550   - CYSTECTOMY, PARTIAL; SIMPLE
51555   - CYSTECTOMY, PARTIAL; COMPLICATED (EG, POSTRADIATION, PREVIOUS SURGERY,
51565   - CYSTECTOMY, PARTIAL, WITH REIMPLANTATION OF URETER(S) INTO BLADDER
51570   - CYSTECTOMY, COMPLETE; (SEPARATE PROCEDURE)
51575   - CYSTECTOMY, COMPLETE; WITH BILATERAL PELVIC LYMPHADENECTOMY, INCLUDING EXTERNAL
51580   - CYSTECTOMY, COMPLETE, WITH URETEROSIGMOIDOSTOMY OR URETEROCUTANEOUS
51585   - CYSTECTOMY, COMPLETE, WITH URETEROSIGMOIDOSTOMY OR URETEROCUTANEOUS
51590   - CYSTECTOMY, COMPLETE, WITH URETEROILEAL CONDUIT OR SIGMOID BLADDER, INCLUDING
51595   - CYSTECTOMY, COMPLETE, WITH URETEROILEAL CONDUIT OR SIGMOID BLADDER, INCLUDING
51596   - CYSTECTOMY, COMPLETE, WITH CONTINENT DIVERSION, ANY OPEN TECHNIQUE, USING ANY
51597   - PELVIC EXENTERATION, COMPLETE, FOR VESICAL, PROSTATIC OR URETHRAL MALIGNANCY,
51600   - INJECTION PROCEDURE FOR CYSTOGRAPHY OR VOIDING URETHROCYSTOGRAPHY
51605   - INJECTION PROCEDURE AND PLACEMENT OF CHAIN FOR CONTRAST AND/ OR CHAIN
51610   - INJECTION PROCEDURE FOR RETROGRADE URETHROCYSTOGRAPHY
51701   - INSERTION OF NON-INDWELLING BLADDER CATHETER (EG, STRAIGHT CATHETERIZATION FOR
51702   - INSERTION OF TEMPORARY INDWELLING BLADDER CATHETER; SIMPLE (EG, FOLEY)
51798   - MEASUREMENT OF POST-VOIDING RESIDUAL URINE AND/OR BLADDER CAPACITY BY
51800   - CYSTOPLASTY OR CYSTOURETHROPLASTY, PLASTIC OPERATION ON BLADDER AND/OR VESICAL N
51820   - CYSTOURETHROPLASTY WITH UNILATERAL OR BILATERAL URETERONEOCYSTOSTOMY
51840   - ANTERIOR VESICOURETHROPEXY, OR URETHROPEXY (EG, MARSHALL-MARCHETTI-KRANTZ,
51841   - ANTERIOR VESICOURETHROPEXY, OR URETHROPEXY (EG, MARSHALL-MARCHETTI-KRANTZ,
51865   - CYSTORRHAPHY, SUTURE OF BLADDER WOUND, INJURY OR RUPTURE; COMPLICATED
51900   - CLOSURE OF VESICOVAGINAL FISTULA, ABDOMINAL APPROACH
51920   - CLOSURE OF VESICOUTERINE FISTULA;
51925   - CLOSURE OF VESICOUTERINE FISTULA; WITH HYSTERECTOMY
51940   - CLOSURE, EXSTROPHY OF BLADDER
51960   - ENTEROCYSTOPLASTY, INCLUDING INTESTINAL ANASTOMOSIS
51980   - CUTANEOUS VESICOSTOMY
53415   - URETHROPLASTY, TRANSPUBIC OR PERINEAL, ONE STAGE, FOR RECONSTRUCTION OR REPAIR
53448   - REMOVAL AND REPLACEMENT OF INFLATABLE URETHRAL/BLADDER NECK SPHINCTER INCLUDING
54125   - AMPUTATION OF PENIS; COMPLETE
54130   - AMPUTATION OF PENIS, RADICAL; WITH BILATERAL INGUINOFEMORAL LYMPHADENECTOMY
54135   - AMPUTATION OF PENIS, RADICAL; IN CONTINUITY WITH BILATERAL PELVIC
54230   - INJECTION PROCEDURE FOR CORPORA CAVERNOSOGRAPHY
54390   - PLASTIC OPERATION ON PENIS FOR EPISPADIAS DISTAL TO EXTERNAL SPHINCTER; WITH
54411   - REMOVAL AND REPLACEMENT OF ALL COMPONENTS OF A MULTI-COMPONENT INFLATABLE
54417   - REMOVAL AND REPLACEMENT OF NON-INFLATABLE (SEMI-RIGID) OR INFLATABLE
54430   - CORPORA CAVERNOSA-CORPUS SPONGIOSUM SHUNT (PRIAPISM OPERATION), UNILATERAL OR
54435   - CORPORA CAVERNOSA-GLANS PENIS FISTULIZATION (EG, BIOPSY NEEDLE, WINTER
54650   - ORCHIOPEXY, ABDOMINAL APPROACH, FOR INTRA-ABDOMINAL TESTIS (EG, FOWLER-STEPHENS)
55300   - VASOTOMY FOR VASOGRAMS, SEMINAL VESICULOGRAMS, OR EPIDIDYMOGRAMS, UNILATERAL OR
55605   - VESICULOTOMY; COMPLICATED
55650   - VESICULECTOMY, ANY APPROACH
55801   - PROSTATECTOMY, PERINEAL, SUBTOTAL (INCLUDING CONTROL OF POSTOPERATIVE BLEEDING,
55810   - PROSTATECTOMY, PERINEAL RADICAL;
55812   - PROSTATECTOMY, PERINEAL RADICAL; WITH LYMPH NODE BIOPSY(S) (LIMITED PELVIC
55815   - PROSTATECTOMY, PERINEAL RADICAL; WITH BILATERAL PELVIC LYMPHADENECTOMY,
55821   - PROSTATECTOMY (INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, VASECTOMY,
55831   - PROSTATECTOMY (INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, VASECTOMY,



                                              Page 412
                                    All Other (no trigger bundling)


55840   - PROSTATECTOMY, RETROPUBIC RADICAL, WITH OR WITHOUT NERVE SPARING;
55842   - PROSTATECTOMY, RETROPUBIC RADICAL, WITH OR WITHOUT NERVE SPARING; WITH LYMPH
55845   - PROSTATECTOMY, RETROPUBIC RADICAL, WITH OR WITHOUT NERVE SPARING; WITH
55862   - EXPOSURE OF PROSTATE, ANY APPROACH, FOR INSERTION OF RADIOACTIVE SUBSTANCE;
55865   - EXPOSURE OF PROSTATE, ANY APPROACH, FOR INSERTION OF RADIOACTIVE SUBSTANCE;
55866   - LAPAROSCOPY, SURGICAL PROSTATECTOMY, RETROPUBIC RADICAL, INCLUDING NERVE SPARING
55875   - TRANSPERINEAL PLACEMENT OF NEEDLES OR CATHETERS INTO PROSTATE FOR INTERSTITIAL R
55876   - PLACEMENT OF INTERSTITIAL DEVICE(S) FOR RADIATION THERAPY GUIDANCE (EG, FIDUCIAL
56630   - VULVECTOMY, RADICAL, PARTIAL;
56631   - VULVECTOMY, RADICAL, PARTIAL; WITH UNILATERAL INGUINOFEMORAL LYMPHADENECTOMY
56632   - VULVECTOMY, RADICAL, PARTIAL; WITH BILATERAL INGUINOFEMORAL LYMPHADENECTOMY
56633   - VULVECTOMY, RADICAL, COMPLETE;
56634   - VULVECTOMY, RADICAL, COMPLETE; WITH UNILATERAL INGUINOFEMORAL LYMPHADENECTOMY
56637   - VULVECTOMY, RADICAL, COMPLETE; WITH BILATERAL INGUINOFEMORAL LYMPHADENECTOMY
56640   - VULVECTOMY, RADICAL, COMPLETE, WITH INGUINOFEMORAL, ILIAC, AND PELVIC
57110   - VAGINECTOMY, COMPLETE REMOVAL OF VAGINAL WALL;
57111   - VAGINECTOMY, COMPLETE REMOVAL OF VAGINAL WALL; WITH REMOVAL OF PARAVAGINAL
57112   - VAGINECTOMY, COMPLETE REMOVAL OF VAGINAL WALL; WITH REMOVAL OF PARAVAGINAL
57270   - REPAIR OF ENTEROCELE, ABDOMINAL APPROACH (SEPARATE PROCEDURE)
57280   - COLPOPEXY, ABDOMINAL APPROACH
57282   - COLPOPEXY, VAGINAL; EXTRA-PERITONEAL APPROACH (SACROSPINOUS, ILIOCOCCYGEUS)
57283   - COLPOPEXY, VAGINAL; INTRA-PERITONEAL APPROACH (UTEROSACRAL, LEVATOR MYORRHAPHY)
57292   - CONSTRUCTION OF ARTIFICIAL VAGINA; WITH GRAFT
57296   - REVISION (INCLUDING REMOVAL) OF PROSTHETIC VAGINAL GRAFT; OPEN ABDOMINAL APPROAC
57305   - CLOSURE OF RECTOVAGINAL FISTULA; ABDOMINAL APPROACH
57307   - CLOSURE OF RECTOVAGINAL FISTULA; ABDOMINAL APPROACH, WITH CONCOMITANT COLOSTOMY
57308   - CLOSURE OF RECTOVAGINAL FISTULA; TRANSPERINEAL APPROACH, WITH PERINEAL BODY
57311   - CLOSURE OF URETHROVAGINAL FISTULA; WITH BULBOCAVERNOSUS TRANSPLANT
57335   - VAGINOPLASTY FOR INTERSEX STATE
57531   - RADICAL TRACHELECTOMY, WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY AND
57540   - EXCISION OF CERVICAL STUMP, ABDOMINAL APPROACH;
57545   - EXCISION OF CERVICAL STUMP, ABDOMINAL APPROACH; WITH PELVIC FLOOR REPAIR
58110   - ENDOMETRIAL SAMPLING (BIOPSY) PERFORMED IN CONJUNCTION WITH COLPOSCOPY (LIST SEP
58140   - MYOMECTOMY, EXCISION OF FIBROID TUMOR(S) OF UTERUS, 1 TO 4 INTRAMURAL MYOMA(S)
58146   - MYOMECTOMY, EXCISION OF FIBROID TUMOR(S) OF UTERUS, 5 OR MORE INTRAMURAL MYOMAS
58150   - TOTAL ABDOMINAL HYSTERECTOMY (CORPUS AND CERVIX), WITH OR WITHOUT REMOVAL OF
58152   - TOTAL ABDOMINAL HYSTERECTOMY (CORPUS AND CERVIX), WITH OR WITHOUT REMOVAL OF
58180   - SUPRACERVICAL ABDOMINAL HYSTERECTOMY (SUBTOTAL HYSTERECTOMY), WITH OR WITHOUT
58200   - TOTAL ABDOMINAL HYSTERECTOMY, INCLUDING PARTIAL VAGINECTOMY, WITH PARA-AORTIC
58210   - RADICAL ABDOMINAL HYSTERECTOMY, WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY AND
58240   - PELVIC EXENTERATION FOR GYNECOLOGIC MALIGNANCY, WITH TOTAL ABDOMINAL
58260   - VAGINAL HYSTERECTOMY, FOR UTERUS 250 GRAMS OR LESS;
58262   - VAGINAL HYSTERECTOMY, FOR UTERUS 250 GRAMS OR LESS; WITH REMOVAL OF TUBE(S),
58263   - VAGINAL HYSTERECTOMY, FOR UTERUS 250 GRAMS OR LESS; WITH REMOVAL OF TUBE(S),
58267   - VAGINAL HYSTERECTOMY, FOR UTERUS 250 GRAMS OR LESS; WITH COLPO-URETHROCYSTOPEXY
58270   - VAGINAL HYSTERECTOMY, FOR UTERUS 250 GRAMS OR LESS; WITH REPAIR OF ENTEROCELE
58275   - VAGINAL HYSTERECTOMY, WITH TOTAL OR PARTIAL VAGINECTOMY;
58280   - VAGINAL HYSTERECTOMY, WITH TOTAL OR PARTIAL VAGINECTOMY; WITH REPAIR OF
58285   - VAGINAL HYSTERECTOMY, RADICAL (SCHAUTA TYPE OPERATION)
58290   - VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 GRAMS;
58291   - VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 GRAMS; WITH REMOVAL OF
58292   - VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 GRAMS; WITH REMOVAL OF



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                                    All Other (no trigger bundling)


58293   - VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 GRAMS; WITH
58294   - VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 GRAMS; WITH REPAIR OF
58300   - INSERTION OF INTRAUTERINE DEVICE (IUD)
58340   - CATHETERIZATION AND INTRODUCTION OF SALINE OR CONTRAST MATERIAL FOR SALINE
58400   - UTERINE SUSPENSION, WITH OR WITHOUT SHORTENING OF ROUND LIGAMENTS, WITH OR WITHO
58410   - UTERINE SUSPENSION, WITH OR WITHOUT SHORTENING OF ROUND LIGAMENTS, WITH OR
58520   - HYSTERORRHAPHY, REPAIR OF RUPTURED UTERUS (NONOBSTETRICAL)
58540   - HYSTEROPLASTY, REPAIR OF UTERINE ANOMALY (STRASSMAN TYPE)
58548   - LAPAROSCOPY, SURGICAL, WITH RADICAL HYSTERECTOMY, WITH BILATERAL TOTAL PELVIC LY
58605   - LIGATION OR TRANSECTION OF FALLOPIAN TUBE(S), ABDOMINAL OR VAGINAL APPROACH,
58611   - LIGATION OR TRANSECTION OF FALLOPIAN TUBE(S) WHEN DONE AT THE TIME OF CESAREAN
58700   - SALPINGECTOMY, COMPLETE OR PARTIAL, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE)
58720   - SALPINGO-OOPHORECTOMY, COMPLETE OR PARTIAL, UNILATERAL OR BILATERAL (SEPARATE
58740   - LYSIS OF ADHESIONS (SALPINGOLYSIS, OVARIOLYSIS)
58805   - DRAINAGE OF OVARIAN CYST(S), UNILATERAL OR BILATERAL, (SEPARATE PROCEDURE);
58822   - DRAINAGE OF OVARIAN ABSCESS; ABDOMINAL APPROACH
58825   - TRANSPOSITION, OVARY(S)
58940   - OOPHORECTOMY, PARTIAL OR TOTAL, UNILATERAL OR BILATERAL;
58943   - OOPHORECTOMY, PARTIAL OR TOTAL, UNILATERAL OR BILATERAL; FOR OVARIAN, TUBAL OR
58950   - RESECTION (INITIAL) OF OVARIAN, TUBAL OR PRIMARY PERITONEAL MALIGNANCY WITH BILA
58951   - RESECTION OF OVARIAN, TUBAL OR PRIMARY PERITONEAL MALIGNANCY WITH BILATERAL
58952   - RESECTION OF OVARIAN, TUBAL OR PRIMARY PERITONEAL MALIGNANCY WITH BILATERAL
58953   - BILATERAL SALPINGO-OOPHORECTOMY WITH OMENTECTOMY, TOTAL ABDOMINAL HYSTERECTOMY
58954   - BILATERAL SALPINGO-OOPHORECTOMY WITH OMENTECTOMY, TOTAL ABDOMINAL HYSTERECTOMY
58956   - BILATERAL SALPINGO-OOPHORECTOMY WITH TOTAL OMENTECTOMY, TOTAL ABDOMINAL
58957   - RESECTION (TUMOR DEBULKING) OF RECURRENT OVARIAN, TUBAL, PRIMARY PERITONEAL, UTE
58958   - RESECTION (TUMOR DEBULKING) OF RECURRENT OVARIAN, TUBAL, PRIMARY PERITONEAL, UTE
58960   - LAPAROTOMY, FOR STAGING OR RESTAGING OF OVARIAN, TUBAL OR PRIMARY PERITONEAL
59000   - AMNIOCENTESIS; DIAGNOSTIC
59001   - AMNIOCENTESIS; THERAPEUTIC AMNIOTIC FLUID REDUCTION (INCLUDES ULTRASOUND
59012   - CORDOCENTESIS (INTRAUTERINE), ANY METHOD
59015   - CHORIONIC VILLUS SAMPLING, ANY METHOD
59020   - FETAL CONTRACTION STRESS TEST
59025   - FETAL NON-STRESS TEST
59030   - FETAL SCALP BLOOD SAMPLING
59050   - FETAL MONITORING DURING LABOR BY CONSULTING PHYSICIAN (IE, NON-ATTENDING
59051   - FETAL MONITORING DURING LABOR BY CONSULTING PHYSICIAN (IE, NON-ATTENDING
59070   - TRANSABDOMINAL AMNIOINFUSION, INCLUDING ULTRASOUND GUIDANCE
59074   - FETAL FLUID DRAINAGE (EG, VESICOCENTESIS, THORACOCENTESIS, PARACENTESIS),
59076   - FETAL SHUNT PLACEMENT, INCLUDING ULTRASOUND GUIDANCE
59100   - HYSTEROTOMY, ABDOMINAL (EG, FOR HYDATIDIFORM MOLE, ABORTION)
59120   - SURGICAL TREATMENT OF ECTOPIC PREGNANCY; TUBAL OR OVARIAN, REQUIRING
59121   - SURGICAL TREATMENT OF ECTOPIC PREGNANCY; TUBAL OR OVARIAN, WITHOUT
59130   - SURGICAL TREATMENT OF ECTOPIC PREGNANCY; ABDOMINAL PREGNANCY
59135   - SURGICAL TREATMENT OF ECTOPIC PREGNANCY; INTERSTITIAL, UTERINE PREGNANCY
59136   - SURGICAL TREATMENT OF ECTOPIC PREGNANCY; INTERSTITIAL, UTERINE PREGNANCY WITH
59140   - SURGICAL TREATMENT OF ECTOPIC PREGNANCY; CERVICAL, WITH EVACUATION
59200   - INSERTION OF CERVICAL DILATOR (EG, LAMINARIA, PROSTAGLANDIN) (SEPARATE PROCEDURE
59325   - CERCLAGE OF CERVIX, DURING PREGNANCY; ABDOMINAL
59350   - HYSTERORRHAPHY OF RUPTURED UTERUS
59400   - ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE, VAGINAL DELIVERY (WITH OR WITH
59410   - VAGINAL DELIVERY ONLY (WITH OR WITHOUT EPISIOTOMY AND/OR FORCEPS); INCLUDING



                                              Page 414
                                    All Other (no trigger bundling)


59425   - ANTEPARTUM CARE ONLY; 4-6 VISITS
59426   - ANTEPARTUM CARE ONLY; 7 OR MORE VISITS
59430   - POSTPARTUM CARE ONLY (SEPARATE PROCEDURE)
59510   - ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE, CESAREAN DELIVERY, AND POSTPAR
59514   - CESAREAN DELIVERY ONLY;
59515   - CESAREAN DELIVERY ONLY; INCLUDING POSTPARTUM CARE
59525   - SUBTOTAL OR TOTAL HYSTERECTOMY AFTER CESAREAN DELIVERY (LIST SEPARATELY IN
59610   - ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE, VAGINAL DELIVERY (WITH OR WITH
59614   - VAGINAL DELIVERY ONLY, AFTER PREVIOUS CESAREAN DELIVERY (WITH OR WITHOUT
59618   - ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE, CESAREAN DELIVERY, AND
59620   - CESAREAN DELIVERY ONLY, FOLLOWING ATTEMPTED VAGINAL DELIVERY AFTER PREVIOUS
59622   - CESAREAN DELIVERY ONLY, FOLLOWING ATTEMPTED VAGINAL DELIVERY AFTER PREVIOUS
59830   - TREATMENT OF SEPTIC ABORTION, COMPLETED SURGICALLY
59850   - INDUCED ABORTION, BY ONE OR MORE INTRA-AMNIOTIC INJECTIONS
59851   - INDUCED ABORTION, BY ONE OR MORE INTRA-AMNIOTIC INJECTIONS
59852   - INDUCED ABORTION, BY ONE OR MORE INTRA-AMNIOTIC INJECTIONS
59855   - INDUCED ABORTION, BY ONE OR MORE VAGINAL SUPPOSITORIES (EG, PROSTAGLANDIN) WITH
59856   - INDUCED ABORTION, BY ONE OR MORE VAGINAL SUPPOSITORIES (EG, PROSTAGLANDIN) WITH
59857   - INDUCED ABORTION, BY ONE OR MORE VAGINAL SUPPOSITORIES (EG, PROSTAGLANDIN) WITH
60254   - THYROIDECTOMY, TOTAL OR SUBTOTAL FOR MALIGNANCY; WITH RADICAL NECK DISSECTION
60270   - THYROIDECTOMY, INCLUDING SUBSTERNAL THYROID; STERNAL SPLIT OR TRANSTHORACIC
60271   - THYROIDECTOMY, INCLUDING SUBSTERNAL THYROID; CERVICAL APPROACH
60502   - PARATHYROIDECTOMY OR EXPLORATION OF PARATHYROID(S); RE-EXPLORATION
60505   - PARATHYROIDECTOMY OR EXPLORATION OF PARATHYROID(S); WITH MEDIASTINAL
60520   - THYMECTOMY, PARTIAL OR TOTAL; TRANSCERVICAL APPROACH (SEPARATE PROCEDURE)
60521   - THYMECTOMY, PARTIAL OR TOTAL; STERNAL SPLIT OR TRANSTHORACIC APPROACH, WITHOUT
60522   - THYMECTOMY, PARTIAL OR TOTAL; STERNAL SPLIT OR TRANSTHORACIC APPROACH, WITH
60540   - ADRENALECTOMY, PARTIAL OR COMPLETE, OR EXPLORATION OF ADRENAL GLAND WITH OR
60545   - ADRENALECTOMY, PARTIAL OR COMPLETE, OR EXPLORATION OF ADRENAL GLAND WITH OR
60600   - EXCISION OF CAROTID BODY TUMOR; WITHOUT EXCISION OF CAROTID ARTERY
60605   - EXCISION OF CAROTID BODY TUMOR; WITH EXCISION OF CAROTID ARTERY
60650   - LAPAROSCOPY, SURGICAL, WITH ADRENALECTOMY, PARTIAL OR COMPLETE, OR EXPLORATION O
61105   - TWIST DRILL HOLE FOR SUBDURAL OR VENTRICULAR PUNCTURE;
61107   - TWIST DRILL HOLE(S) FOR SUBDURAL, INTRACEREBRAL, OR VENTRICULAR PUNCTURE; FOR IM
61108   - TWIST DRILL HOLE FOR SUBDURAL OR VENTRICULAR PUNCTURE; FOR EVACUATION AND/OR
61120   - BURR HOLE(S) FOR VENTRICULAR PUNCTURE (INCLUDING INJECTION OF GAS, CONTRAST
61140   - BURR HOLE(S) OR TREPHINE; WITH BIOPSY OF BRAIN OR INTRACRANIAL LESION
61150   - BURR HOLE(S) OR TREPHINE; WITH DRAINAGE OF BRAIN ABSCESS OR CYST
61151   - BURR HOLE(S) OR TREPHINE; WITH SUBSEQUENT TAPPING (ASPIRATION) OF INTRACRANIAL
61154   - BURR HOLE(S) WITH EVACUATION AND/OR DRAINAGE OF HEMATOMA, EXTRADURAL OR SUBDURAL
61156   - BURR HOLE(S); WITH ASPIRATION OF HEMATOMA OR CYST, INTRACEREBRAL
61210   - BURR HOLE(S); FOR IMPLANTING VENTRICULAR CATHETER, RESERVOIR, EEG ELECTRODE(S),
61250   - BURR HOLE(S) OR TREPHINE, SUPRATENTORIAL, EXPLORATORY, NOT FOLLOWED BY OTHER
61253   - BURR HOLE(S) OR TREPHINE, INFRATENTORIAL, UNILATERAL OR BILATERAL
61304   - CRANIECTOMY OR CRANIOTOMY, EXPLORATORY; SUPRATENTORIAL
61305   - CRANIECTOMY OR CRANIOTOMY, EXPLORATORY; INFRATENTORIAL (POSTERIOR FOSSA)
61312   - CRANIECTOMY OR CRANIOTOMY FOR EVACUATION OF HEMATOMA, SUPRATENTORIAL;
61313   - CRANIECTOMY OR CRANIOTOMY FOR EVACUATION OF HEMATOMA, SUPRATENTORIAL;
61314   - CRANIECTOMY OR CRANIOTOMY FOR EVACUATION OF HEMATOMA, INFRATENTORIAL;
61315   - CRANIECTOMY OR CRANIOTOMY FOR EVACUATION OF HEMATOMA, INFRATENTORIAL;
61316   - INCISION AND SUBCUTANEOUS PLACEMENT OF CRANIAL BONE GRAFT (LIST SEPARATELY IN
61320   - CRANIECTOMY OR CRANIOTOMY, DRAINAGE OF INTRACRANIAL ABSCESS; SUPRATENTORIAL



                                              Page 415
                                    All Other (no trigger bundling)


61321   - CRANIECTOMY OR CRANIOTOMY, DRAINAGE OF INTRACRANIAL ABSCESS; INFRATENTORIAL
61322   - CRANIECTOMY OR CRANIOTOMY, DECOMPRESSIVE, WITH OR WITHOUT DURAPLASTY, FOR
61323   - CRANIECTOMY OR CRANIOTOMY, DECOMPRESSIVE, WITH OR WITHOUT DURAPLASTY, FOR
61332   - EXPLORATION OF ORBIT (TRANSCRANIAL APPROACH); WITH BIOPSY
61333   - EXPLORATION OF ORBIT (TRANSCRANIAL APPROACH); WITH REMOVAL OF LESION
61340   - SUBTEMPORAL CRANIAL DECOMPRESSION (PSEUDOTUMOR CEREBRI, SLIT VENTRICLE SYNDROME)
61343   - CRANIECTOMY, SUBOCCIPITAL WITH CERVICAL LAMINECTOMY FOR DECOMPRESSION OF
61345   - OTHER CRANIAL DECOMPRESSION, POSTERIOR FOSSA
61440   - CRANIOTOMY FOR SECTION OF TENTORIUM CEREBELLI (SEPARATE PROCEDURE)
61450   - CRANIECTOMY, SUBTEMPORAL, FOR SECTION, COMPRESSION, OR DECOMPRESSION OF SENSORY
61458   - CRANIECTOMY, SUBOCCIPITAL; FOR EXPLORATION OR DECOMPRESSION OF CRANIAL NERVES
61460   - CRANIECTOMY, SUBOCCIPITAL; FOR SECTION OF ONE OR MORE CRANIAL NERVES
61470   - CRANIECTOMY, SUBOCCIPITAL; FOR MEDULLARY TRACTOTOMY
61480   - CRANIECTOMY, SUBOCCIPITAL; FOR MESENCEPHALIC TRACTOTOMY OR PEDUNCULOTOMY
61490   - CRANIOTOMY FOR LOBOTOMY, INCLUDING CINGULOTOMY
61500   - CRANIECTOMY; WITH EXCISION OF TUMOR OR OTHER BONE LESION OF SKULL
61501   - CRANIECTOMY; FOR OSTEOMYELITIS
61510   - CRANIECTOMY, TREPHINATION, BONE FLAP CRANIOTOMY; FOR EXCISION OF BRAIN TUMOR,
61512   - CRANIECTOMY, TREPHINATION, BONE FLAP CRANIOTOMY; FOR EXCISION OF MENINGIOMA,
61514   - CRANIECTOMY, TREPHINATION, BONE FLAP CRANIOTOMY; FOR EXCISION OF BRAIN ABSCESS,
61516   - CRANIECTOMY, TREPHINATION, BONE FLAP CRANIOTOMY; FOR EXCISION OR FENESTRATION
61517   - IMPLANTATION OF BRAIN INTRACAVITARY CHEMOTHERAPY AGENT (LIST SEPARATELY IN
61518   - CRANIECTOMY FOR EXCISION OF BRAIN TUMOR, INFRATENTORIAL OR POSTERIOR FOSSA;
61519   - CRANIECTOMY FOR EXCISION OF BRAIN TUMOR, INFRATENTORIAL OR POSTERIOR FOSSA;
61520   - CRANIECTOMY FOR EXCISION OF BRAIN TUMOR, INFRATENTORIAL OR POSTERIOR FOSSA;
61521   - CRANIECTOMY FOR EXCISION OF BRAIN TUMOR, INFRATENTORIAL OR POSTERIOR FOSSA;
61522   - CRANIECTOMY, INFRATENTORIAL OR POSTERIOR FOSSA; FOR EXCISION OF BRAIN ABSCESS
61524   - CRANIECTOMY, INFRATENTORIAL OR POSTERIOR FOSSA; FOR EXCISION OR FENESTRATION OF
61526   - CRANIECTOMY, BONE FLAP CRANIOTOMY, TRANSTEMPORAL (MASTOID) FOR EXCISION OF
61530   - CRANIECTOMY, BONE FLAP CRANIOTOMY, TRANSTEMPORAL (MASTOID) FOR EXCISION OF
61531   - SUBDURAL IMPLANTATION OF STRIP ELECTRODES THROUGH ONE OR MORE BURR OR TREPHINE
61533   - CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR SUBDURAL IMPLANTATION OF AN
61534   - CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR EXCISION OF EPILEPTOGENIC FOCUS
61535   - CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR REMOVAL OF EPIDURAL OR SUBDURAL
61536   - CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR EXCISION OF CEREBRAL EPILEPTOGENIC
61537   - CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR LOBECTOMY, TEMPORAL LOBE, WITHOUT
61538   - CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR LOBECTOMY, TEMPORAL LOBE, WITH
61539   - CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR LOBECTOMY, OTHER THAN TEMPORAL
61540   - CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR LOBECTOMY, OTHER THAN TEMPORAL
61541   - CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR TRANSECTION OF CORPUS CALLOSUM
61542   - CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR TOTAL HEMISPHERECTOMY
61543   - CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR PARTIAL OR SUBTOTAL (FUNCTIONAL)
61544   - CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR EXCISION OR COAGULATION OF CHOROID
61545   - CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR EXCISION OF CRANIOPHARYNGIOMA
61546   - CRANIOTOMY FOR HYPOPHYSECTOMY OR EXCISION OF PITUITARY TUMOR, INTRACRANIAL
61548   - HYPOPHYSECTOMY OR EXCISION OF PITUITARY TUMOR, TRANSNASAL OR TRANSSEPTAL
61550   - CRANIECTOMY FOR CRANIOSYNOSTOSIS; SINGLE CRANIAL SUTURE
61552   - CRANIECTOMY FOR CRANIOSYNOSTOSIS; MULTIPLE CRANIAL SUTURES
61556   - CRANIOTOMY FOR CRANIOSYNOSTOSIS; FRONTAL OR PARIETAL BONE FLAP
61557   - CRANIOTOMY FOR CRANIOSYNOSTOSIS; BIFRONTAL BONE FLAP
61558   - EXTENSIVE CRANIECTOMY FOR MULTIPLE CRANIAL SUTURE CRANIOSYNOSTOSIS (EG,
61559   - EXTENSIVE CRANIECTOMY FOR MULTIPLE CRANIAL SUTURE CRANIOSYNOSTOSIS (EG,



                                              Page 416
                                    All Other (no trigger bundling)


61563   - EXCISION, INTRA AND EXTRACRANIAL, BENIGN TUMOR OF CRANIAL BONE (EG, FIBROUS
61564   - EXCISION, INTRA AND EXTRACRANIAL, BENIGN TUMOR OF CRANIAL BONE (EG, FIBROUS
61566   - CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR SELECTIVE AMYGDALOHIPPOCAMPECTOMY
61567   - CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR MULTIPLE SUBPIAL TRANSECTIONS, WITH
61570   - CRANIECTOMY OR CRANIOTOMY; WITH EXCISION OF FOREIGN BODY FROM BRAIN
61571   - CRANIECTOMY OR CRANIOTOMY; WITH TREATMENT OF PENETRATING WOUND OF BRAIN
61575   - TRANSORAL APPROACH TO SKULL BASE, BRAIN STEM OR UPPER SPINAL CORD FOR BIOPSY,
61576   - TRANSORAL APPROACH TO SKULL BASE, BRAIN STEM OR UPPER SPINAL CORD FOR BIOPSY,
61580   - CRANIOFACIAL APPROACH TO ANTERIOR CRANIAL FOSSA; EXTRADURAL, INCLUDING LATERAL R
61581   - CRANIOFACIAL APPROACH TO ANTERIOR CRANIAL FOSSA; EXTRADURAL, INCLUDING LATERAL
61582   - CRANIOFACIAL APPROACH TO ANTERIOR CRANIAL FOSSA; EXTRADURAL, INCLUDING
61583   - CRANIOFACIAL APPROACH TO ANTERIOR CRANIAL FOSSA; INTRADURAL, INCLUDING
61584   - ORBITOCRANIAL APPROACH TO ANTERIOR CRANIAL FOSSA, EXTRADURAL, INCLUDING
61585   - ORBITOCRANIAL APPROACH TO ANTERIOR CRANIAL FOSSA, EXTRADURAL, INCLUDING
61586   - BICORONAL, TRANSZYGOMATIC AND/OR LEFORT I OSTEOTOMY APPROACH TO ANTERIOR
61590   - INFRATEMPORAL PRE-AURICULAR APPROACH TO MIDDLE CRANIAL FOSSA (PARAPHARYNGEAL SPA
61591   - INFRATEMPORAL POST-AURICULAR APPROACH TO MIDDLE CRANIAL FOSSA (INTERNAL
61592   - ORBITOCRANIAL ZYGOMATIC APPROACH TO MIDDLE CRANIAL FOSSA (CAVERNOUS SINUS AND
61595   - TRANSTEMPORAL APPROACH TO POSTERIOR CRANIAL FOSSA, JUGULAR FORAMEN OR MIDLINE SK
61596   - TRANSCOCHLEAR APPROACH TO POSTERIOR CRANIAL FOSSA, JUGULAR FORAMEN OR MIDLINE
61597   - TRANSCONDYLAR (FAR LATERAL) APPROACH TO POSTERIOR CRANIAL FOSSA, JUGULAR
61598   - TRANSPETROSAL APPROACH TO POSTERIOR CRANIAL FOSSA, CLIVUS OR FORAMEN MAGNUM,
61600   - RESECTION OR EXCISION OF NEOPLASTIC, VASCULAR OR INFECTIOUS LESION OF BASE OF AN
61601   - RESECTION OR EXCISION OF NEOPLASTIC, VASCULAR OR INFECTIOUS LESION OF BASE OF
61605   - RESECTION OR EXCISION OF NEOPLASTIC, VASCULAR OR INFECTIOUS LESION OF INFRATEMPO
61606   - RESECTION OR EXCISION OF NEOPLASTIC, VASCULAR OR INFECTIOUS LESION OF
61607   - RESECTION OR EXCISION OF NEOPLASTIC, VASCULAR OR INFECTIOUS LESION OF
61608   - RESECTION OR EXCISION OF NEOPLASTIC, VASCULAR OR INFECTIOUS LESION OF
61609   - TRANSECTION OR LIGATION, CAROTID ARTERY IN CAVERNOUS SINUS; WITHOUT REPAIR
61610   - TRANSECTION OR LIGATION, CAROTID ARTERY IN CAVERNOUS SINUS; WITH REPAIR BY
61611   - TRANSECTION OR LIGATION, CAROTID ARTERY IN PETROUS CANAL; WITHOUT REPAIR (LIST
61612   - TRANSECTION OR LIGATION, CAROTID ARTERY IN PETROUS CANAL; WITH REPAIR BY
61613   - OBLITERATION OF CAROTID ANEURYSM, ARTERIOVENOUS MALFORMATION, OR
61615   - RESECTION OR EXCISION OF NEOPLASTIC, VASCULAR OR INFECTIOUS LESION OF BASE OF PO
61616   - RESECTION OR EXCISION OF NEOPLASTIC, VASCULAR OR INFECTIOUS LESION OF BASE OF
61618   - SECONDARY REPAIR OF DURA FOR CEREBROSPINAL FLUID LEAK, ANTERIOR, MIDDLE OR POSTE
61619   - SECONDARY REPAIR OF DURA FOR CEREBROSPINAL FLUID LEAK, ANTERIOR, MIDDLE OR
61624   - TRANSCATHETER PERMANENT OCCLUSION OR EMBOLIZATION (EG, FOR TUMOR DESTRUCTION,
61680   - SURGERY OF INTRACRANIAL ARTERIOVENOUS MALFORMATION; SUPRATENTORIAL, SIMPLE
61682   - SURGERY OF INTRACRANIAL ARTERIOVENOUS MALFORMATION; SUPRATENTORIAL, COMPLEX
61684   - SURGERY OF INTRACRANIAL ARTERIOVENOUS MALFORMATION; INFRATENTORIAL, SIMPLE
61686   - SURGERY OF INTRACRANIAL ARTERIOVENOUS MALFORMATION; INFRATENTORIAL, COMPLEX
61690   - SURGERY OF INTRACRANIAL ARTERIOVENOUS MALFORMATION; DURAL, SIMPLE
61692   - SURGERY OF INTRACRANIAL ARTERIOVENOUS MALFORMATION; DURAL, COMPLEX
61697   - SURGERY OF COMPLEX INTRACRANIAL ANEURYSM, INTRACRANIAL APPROACH; CAROTID
61698   - SURGERY OF COMPLEX INTRACRANIAL ANEURYSM, INTRACRANIAL APPROACH;
61700   - SURGERY OF SIMPLE INTRACRANIAL ANEURYSM, INTRACRANIAL APPROACH; CAROTID
61702   - SURGERY OF SIMPLE INTRACRANIAL ANEURYSM, INTRACRANIAL APPROACH; VERTEBROBASILAR
61703   - SURGERY OF INTRACRANIAL ANEURYSM, CERVICAL APPROACH BY APPLICATION OF OCCLUDING
61705   - SURGERY OF ANEURYSM, VASCULAR MALFORMATION OR CAROTID-CAVERNOUS FISTULA; BY
61708   - SURGERY OF ANEURYSM, VASCULAR MALFORMATION OR CAROTID-CAVERNOUS FISTULA; BY
61710   - SURGERY OF ANEURYSM, VASCULAR MALFORMATION OR CAROTID-CAVERNOUS FISTULA; BY



                                              Page 417
                                   All Other (no trigger bundling)


61711   - ANASTOMOSIS, ARTERIAL, EXTRACRANIAL-INTRACRANIAL (EG, MIDDLE CEREBRAL/CORTICAL)
61720   - CREATION OF LESION BY STEREOTACTIC METHOD, INCLUDING BURR HOLE(S) AND LOCALIZING
61735   - CREATION OF LESION BY STEREOTACTIC METHOD, INCLUDING BURR HOLE(S) AND
61750   - STEREOTACTIC BIOPSY, ASPIRATION, OR EXCISION, INCLUDING BURR HOLE(S), FOR
61751   - STEREOTACTIC BIOPSY, ASPIRATION, OR EXCISION, INCLUDING BURR HOLE(S), FOR
61760   - STEREOTACTIC IMPLANTATION OF DEPTH ELECTRODES INTO THE CEREBRUM FOR LONG TERM
61770   - STEREOTACTIC LOCALIZATION, INCLUDING BURR HOLE(S), WITH INSERTION OF
61795   - STEREOTACTIC COMPUTER ASSISTED VOLUMETRIC (NAVIGATIONAL) PROCEDURE,
61796   - Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator); 1 si
61797   - Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator); each
61798   - Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator); 1 co
61799   - Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator); each
61800   - Application of stereotactic headframe for stereotactic radiosurgery (List separa
61850   - TWIST DRILL OR BURR HOLE(S) FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; CORT
61860   - CRANIECTOMY OR CRANIOTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES,
61863   - TWIST DRILL, BURR HOLE, CRANIOTOMY, OR CRANIECTOMY WITH STEREOTACTIC
61864   - TWIST DRILL, BURR HOLE, CRANIOTOMY, OR CRANIECTOMY WITH STEREOTACTIC
61867   - TWIST DRILL, BURR HOLE, CRANIOTOMY, OR CRANIECTOMY WITH STEREOTACTIC
61868   - TWIST DRILL, BURR HOLE, CRANIOTOMY, OR CRANIECTOMY WITH STEREOTACTIC
61870   - CRANIECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES, CEREBELLAR; CORTICAL
61875   - CRANIECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES, CEREBELLAR;
62000   - ELEVATION OF DEPRESSED SKULL FRACTURE; SIMPLE, EXTRADURAL
62005   - ELEVATION OF DEPRESSED SKULL FRACTURE; COMPOUND OR COMMINUTED, EXTRADURAL
62010   - ELEVATION OF DEPRESSED SKULL FRACTURE; WITH REPAIR OF DURA AND/OR DEBRIDEMENT
62100   - CRANIOTOMY FOR REPAIR OF DURAL/CEREBROSPINAL FLUID LEAK, INCLUDING SURGERY FOR
62115   - REDUCTION OF CRANIOMEGALIC SKULL (EG, TREATED HYDROCEPHALUS); NOT REQUIRING
62116   - REDUCTION OF CRANIOMEGALIC SKULL (EG, TREATED HYDROCEPHALUS); WITH SIMPLE
62117   - REDUCTION OF CRANIOMEGALIC SKULL (EG, TREATED HYDROCEPHALUS); REQUIRING
62120   - REPAIR OF ENCEPHALOCELE, SKULL VAULT, INCLUDING CRANIOPLASTY
62121   - CRANIOTOMY FOR REPAIR OF ENCEPHALOCELE, SKULL BASE
62140   - CRANIOPLASTY FOR SKULL DEFECT; UP TO 5 CM DIAMETER
62141   - CRANIOPLASTY FOR SKULL DEFECT; LARGER THAN 5 CM DIAMETER
62142   - REMOVAL OF BONE FLAP OR PROSTHETIC PLATE OF SKULL
62143   - REPLACEMENT OF BONE FLAP OR PROSTHETIC PLATE OF SKULL
62145   - CRANIOPLASTY FOR SKULL DEFECT WITH REPARATIVE BRAIN SURGERY
62146   - CRANIOPLASTY WITH AUTOGRAFT (INCLUDES OBTAINING BONE GRAFTS); UP TO 5 CM
62147   - CRANIOPLASTY WITH AUTOGRAFT (INCLUDES OBTAINING BONE GRAFTS); LARGER THAN 5 CM
62148   - INCISION AND RETRIEVAL OF SUBCUTANEOUS CRANIAL BONE GRAFT FOR CRANIOPLASTY
62160   - NEUROENDOSCOPY, INTRACRANIAL, FOR PLACEMENT OR REPLACEMENT OF VENTRICULAR CATHET
62161   - NEUROENDOSCOPY, INTRACRANIAL; WITH DISSECTION OF ADHESIONS, FENESTRATION OF
62162   - NEUROENDOSCOPY, INTRACRANIAL; WITH FENESTRATION OR EXCISION OF COLLOID CYST,
62163   - NEUROENDOSCOPY, INTRACRANIAL; WITH RETRIEVAL OF FOREIGN BODY
62164   - NEUROENDOSCOPY, INTRACRANIAL; WITH EXCISION OF BRAIN TUMOR, INCLUDING PLACEMENT
62165   - NEUROENDOSCOPY, INTRACRANIAL; WITH EXCISION OF PITUITARY TUMOR, TRANSNASAL OR
62180   - VENTRICULOCISTERNOSTOMY (TORKILDSEN TYPE OPERATION)
62190   - CREATION OF SHUNT; SUBARACHNOID/SUBDURAL-ATRIAL, -JUGULAR, -AURICULAR
62192   - CREATION OF SHUNT; SUBARACHNOID/SUBDURAL-PERITONEAL, -PLEURAL, OTHER TERMINUS
62200   - VENTRICULOCISTERNOSTOMY, THIRD VENTRICLE;
62201   - VENTRICULOCISTERNOSTOMY, THIRD VENTRICLE; STEREOTACTIC, NEUROENDOSCOPIC METHOD
62220   - CREATION OF SHUNT; VENTRICULO-ATRIAL, -JUGULAR, -AURICULAR
62223   - CREATION OF SHUNT; VENTRICULO-PERITONEAL, -PLEURAL, OTHER TERMINUS
62256   - REMOVAL OF COMPLETE CEREBROSPINAL FLUID SHUNT SYSTEM; WITHOUT REPLACEMENT



                                             Page 418
                                   All Other (no trigger bundling)


62258   - REMOVAL OF COMPLETE CEREBROSPINAL FLUID SHUNT SYSTEM; WITH REPLACEMENT BY
62284   - INJECTION PROCEDURE FOR MYELOGRAPHY AND/OR COMPUTED TOMOGRAPHY, SPINAL (OTHER TH
62290   - INJECTION PROCEDURE FOR DISKOGRAPHY, EACH LEVEL; LUMBAR
62291   - INJECTION PROCEDURE FOR DISKOGRAPHY, EACH LEVEL; CERVICAL OR THORACIC
63043   - LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING
63044   - LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING
63050   - LAMINOPLASTY, CERVICAL, WITH DECOMPRESSION OF THE SPINAL CORD, TWO OR MORE
63051   - LAMINOPLASTY, CERVICAL, WITH DECOMPRESSION OF THE SPINAL CORD, TWO OR MORE
63076   - DISKECTOMY, ANTERIOR, WITH DECOMPRESSION OF SPINAL CORD AND/ OR NERVE ROOT(S),
63077   - DISKECTOMY, ANTERIOR, WITH DECOMPRESSION OF SPINAL CORD AND/ OR NERVE ROOT(S),
63078   - DISKECTOMY, ANTERIOR, WITH DECOMPRESSION OF SPINAL CORD AND/ OR NERVE ROOT(S),
63081   - VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, ANTERIOR
63082   - VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, ANTERIOR
63085   - VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE,
63086   - VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE,
63087   - VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, COMBINED
63088   - VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, COMBINED
63090   - VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE,
63091   - VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE,
63101   - VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, LATERAL EX
63102   - VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, LATERAL
63103   - VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, LATERAL
63170   - LAMINECTOMY WITH MYELOTOMY (EG, BISCHOF OR DREZ TYPE), CERVICAL, THORACIC OR THO
63172   - LAMINECTOMY WITH DRAINAGE OF INTRAMEDULLARY CYST/SYRINX; TO SUBARACHNOID SPACE
63173   - LAMINECTOMY WITH DRAINAGE OF INTRAMEDULLARY CYST/SYRINX; TO PERITONEAL OR
63180   - LAMINECTOMY AND SECTION OF DENTATE LIGAMENTS, WITH OR WITHOUT DURAL GRAFT,
63182   - LAMINECTOMY AND SECTION OF DENTATE LIGAMENTS, WITH OR WITHOUT DURAL GRAFT,
63185   - LAMINECTOMY WITH RHIZOTOMY; ONE OR TWO SEGMENTS
63190   - LAMINECTOMY WITH RHIZOTOMY; MORE THAN TWO SEGMENTS
63191   - LAMINECTOMY WITH SECTION OF SPINAL ACCESSORY NERVE
63194   - LAMINECTOMY WITH CORDOTOMY, WITH SECTION OF ONE SPINOTHALAMIC TRACT, ONE STAGE;
63195   - LAMINECTOMY WITH CORDOTOMY, WITH SECTION OF ONE SPINOTHALAMIC TRACT, ONE STAGE;
63196   - LAMINECTOMY WITH CORDOTOMY, WITH SECTION OF BOTH SPINOTHALAMIC TRACTS, ONE
63197   - LAMINECTOMY WITH CORDOTOMY, WITH SECTION OF BOTH SPINOTHALAMIC TRACTS, ONE
63198   - LAMINECTOMY WITH CORDOTOMY WITH SECTION OF BOTH SPINOTHALAMIC TRACTS, TWO
63199   - LAMINECTOMY WITH CORDOTOMY WITH SECTION OF BOTH SPINOTHALAMIC TRACTS, TWO
63200   - LAMINECTOMY, WITH RELEASE OF TETHERED SPINAL CORD, LUMBAR
63250   - LAMINECTOMY FOR EXCISION OR OCCLUSION OF ARTERIOVENOUS MALFORMATION OF SPINAL CO
63251   - LAMINECTOMY FOR EXCISION OR OCCLUSION OF ARTERIOVENOUS MALFORMATION OF SPINAL
63252   - LAMINECTOMY FOR EXCISION OR OCCLUSION OF ARTERIOVENOUS MALFORMATION OF SPINAL
63265   - LAMINECTOMY FOR EXCISION OR EVACUATION OF INTRASPINAL LESION OTHER THAN
63266   - LAMINECTOMY FOR EXCISION OR EVACUATION OF INTRASPINAL LESION OTHER THAN
63267   - LAMINECTOMY FOR EXCISION OR EVACUATION OF INTRASPINAL LESION OTHER THAN
63268   - LAMINECTOMY FOR EXCISION OR EVACUATION OF INTRASPINAL LESION OTHER THAN
63270   - LAMINECTOMY FOR EXCISION OF INTRASPINAL LESION OTHER THAN NEOPLASM, INTRADURAL;
63271   - LAMINECTOMY FOR EXCISION OF INTRASPINAL LESION OTHER THAN NEOPLASM, INTRADURAL;
63272   - LAMINECTOMY FOR EXCISION OF INTRASPINAL LESION OTHER THAN NEOPLASM, INTRADURAL;
63273   - LAMINECTOMY FOR EXCISION OF INTRASPINAL LESION OTHER THAN NEOPLASM, INTRADURAL;
63275   - LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; EXTRADURAL, CERVICAL
63276   - LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; EXTRADURAL, THORACIC
63277   - LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; EXTRADURAL, LUMBAR
63278   - LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; EXTRADURAL, SACRAL



                                             Page 419
                                    All Other (no trigger bundling)


63280   - LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; INTRADURAL,
63281   - LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; INTRADURAL,
63282   - LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; INTRADURAL,
63283   - LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; INTRADURAL, SACRAL
63285   - LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; INTRADURAL,
63286   - LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; INTRADURAL,
63287   - LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; INTRADURAL,
63290   - LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; COMBINED
63295   - OSTEOPLASTIC RECONSTRUCTION OF DORSAL SPINAL ELEMENTS, FOLLOWING PRIMARY
63300   - VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, FOR EXCISI
63301   - VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, FOR
63302   - VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, FOR
63303   - VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, FOR
63304   - VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, FOR
63305   - VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, FOR
63306   - VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, FOR
63307   - VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, FOR
63308   - VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, FOR
63620   - Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator); 1 sp
63621   - Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator); each
63700   - REPAIR OF MENINGOCELE; LESS THAN 5 CM DIAMETER
63702   - REPAIR OF MENINGOCELE; LARGER THAN 5 CM DIAMETER
63704   - REPAIR OF MYELOMENINGOCELE; LESS THAN 5 CM DIAMETER
63706   - REPAIR OF MYELOMENINGOCELE; LARGER THAN 5 CM DIAMETER
63707   - REPAIR OF DURAL/CEREBROSPINAL FLUID LEAK, NOT REQUIRING LAMINECTOMY
63709   - REPAIR OF DURAL/CEREBROSPINAL FLUID LEAK OR PSEUDOMENINGOCELE, WITH LAMINECTOMY
63710   - DURAL GRAFT, SPINAL
63740   - CREATION OF SHUNT, LUMBAR, SUBARACHNOID-PERITONEAL, -PLEURAL, OR OTHER; INCLUDIN
64550   - APPLICATION OF SURFACE (TRANSCUTANEOUS) NEUROSTIMULATOR
64752   - TRANSECTION OR AVULSION OF; VAGUS NERVE (VAGOTOMY), TRANSTHORACIC
64755   - TRANSECTION OR AVULSION OF; VAGUS NERVES LIMITED TO PROXIMAL STOMACH (SELECTIVE
64760   - TRANSECTION OR AVULSION OF; VAGUS NERVE (VAGOTOMY), ABDOMINAL
64804   - SYMPATHECTOMY, CERVICOTHORACIC
64809   - SYMPATHECTOMY, THORACOLUMBAR
64818   - SYMPATHECTOMY, LUMBAR
64866   - ANASTOMOSIS; FACIAL-SPINAL ACCESSORY
64868   - ANASTOMOSIS; FACIAL-HYPOGLOSSAL
65273   - REPAIR OF LACERATION; CONJUNCTIVA, BY MOBILIZATION AND REARRANGEMENT, WITH
65757   - Backbench preparation of corneal endothelial allograft prior to transplantation
66990   - USE OF OPHTHALMIC ENDOSCOPE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY
68850   - INJECTION OF CONTRAST MEDIUM FOR DACRYOCYSTOGRAPHY
69155   - RADICAL EXCISION EXTERNAL AUDITORY CANAL LESION; WITH NECK DISSECTION
69200   - REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITHOUT GENERAL ANESTHESIA
69205   - REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITH GENERAL ANESTHESIA
69210   - REMOVAL IMPACTED CERUMEN (SEPARATE PROCEDURE), ONE OR BOTH EARS
69535   - RESECTION TEMPORAL BONE, EXTERNAL APPROACH
69554   - EXCISION AURAL GLOMUS TUMOR; EXTENDED (EXTRATEMPORAL)
69710   - IMPLANTATION OR REPLACEMENT OF ELECTROMAGNETIC BONE CONDUCTION HEARING DEVICE
69950   - VESTIBULAR NERVE SECTION, TRANSCRANIAL APPROACH
69970   - REMOVAL OF TUMOR, TEMPORAL BONE
69990   - MICROSURGICAL TECHNIQUES, REQUIRING USE OF OPERATING MICROSCOPE (LIST SEPARATELY
70010   - MYELOGRAPHY, POSTERIOR FOSSA, RADIOLOGICAL SUPERVISION AND INTERPRETATION



                                              Page 420
                                    All Other (no trigger bundling)


70015   - CISTERNOGRAPHY, POSITIVE CONTRAST, RADIOLOGICAL SUPERVISION AND INTERPRETATION
70030   - RADIOLOGIC EXAMINATION, EYE, FOR DETECTION OF FOREIGN BODY
70100   - RADIOLOGIC EXAMINATION, MANDIBLE; PARTIAL, LESS THAN FOUR VIEWS
70110   - RADIOLOGIC EXAMINATION, MANDIBLE; COMPLETE, MINIMUM OF FOUR VIEWS
70120   - RADIOLOGIC EXAMINATION, MASTOIDS; LESS THAN THREE VIEWS PER SIDE
70130   - RADIOLOGIC EXAMINATION, MASTOIDS; COMPLETE, MINIMUM OF THREE VIEWS PER SIDE
70134   - RADIOLOGIC EXAMINATION, INTERNAL AUDITORY MEATI, COMPLETE
70140   - RADIOLOGIC EXAMINATION, FACIAL BONES; LESS THAN THREE VIEWS
70150   - RADIOLOGIC EXAMINATION, FACIAL BONES; COMPLETE, MINIMUM OF THREE VIEWS
70160   - RADIOLOGIC EXAMINATION, NASAL BONES, COMPLETE, MINIMUM OF THREE VIEWS
70170   - DACRYOCYSTOGRAPHY, NASOLACRIMAL DUCT, RADIOLOGICAL SUPERVISION AND
70190   - RADIOLOGIC EXAMINATION; OPTIC FORAMINA
70200   - RADIOLOGIC EXAMINATION; ORBITS, COMPLETE, MINIMUM OF FOUR VIEWS
70210   - RADIOLOGIC EXAMINATION, SINUSES, PARANASAL, LESS THAN THREE VIEWS
70220   - RADIOLOGIC EXAMINATION, SINUSES, PARANASAL, COMPLETE, MINIMUM OF THREE VIEWS
70240   - RADIOLOGIC EXAMINATION, SELLA TURCICA
70250   - RADIOLOGIC EXAMINATION, SKULL; LESS THAN FOUR VIEWS
70260   - RADIOLOGIC EXAMINATION, SKULL; COMPLETE, MINIMUM OF FOUR VIEWS
70300   - RADIOLOGIC EXAMINATION, TEETH; SINGLE VIEW
70310   - RADIOLOGIC EXAMINATION, TEETH; PARTIAL EXAMINATION, LESS THAN FULL MOUTH
70320   - RADIOLOGIC EXAMINATION, TEETH; COMPLETE, FULL MOUTH
70328   - RADIOLOGIC EXAMINATION, TEMPOROMANDIBULAR JOINT, OPEN AND CLOSED MOUTH;
70330   - RADIOLOGIC EXAMINATION, TEMPOROMANDIBULAR JOINT, OPEN AND CLOSED MOUTH;
70332   - TEMPOROMANDIBULAR JOINT ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND
70336   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, TEMPOROMANDIBULAR JOINT(S)
70350   - CEPHALOGRAM, ORTHODONTIC
70355   - ORTHOPANTOGRAM
70360   - RADIOLOGIC EXAMINATION; NECK, SOFT TISSUE
70370   - RADIOLOGIC EXAMINATION; PHARYNX OR LARYNX, INCLUDING FLUOROSCOPY AND/OR
70371   - COMPLEX DYNAMIC PHARYNGEAL AND SPEECH EVALUATION BY CINE OR VIDEO RECORDING
70373   - LARYNGOGRAPHY, CONTRAST, RADIOLOGICAL SUPERVISION AND INTERPRETATION
70380   - RADIOLOGIC EXAMINATION, SALIVARY GLAND FOR CALCULUS
70390   - SIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
70450   - COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITHOUT CONTRAST MATERIAL
70460   - COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITH CONTRAST MATERIAL(S)
70470   - COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITHOUT CONTRAST MATERIAL, FOLLOWED BY
70480   - COMPUTED TOMOGRAPHY, ORBIT, SELLA, OR POSTERIOR FOSSA OR OUTER, MIDDLE, OR
70481   - COMPUTED TOMOGRAPHY, ORBIT, SELLA, OR POSTERIOR FOSSA OR OUTER, MIDDLE, OR
70482   - COMPUTED TOMOGRAPHY, ORBIT, SELLA, OR POSTERIOR FOSSA OR OUTER, MIDDLE, OR
70486   - COMPUTED TOMOGRAPHY, MAXILLOFACIAL AREA; WITHOUT CONTRAST MATERIAL
70487   - COMPUTED TOMOGRAPHY, MAXILLOFACIAL AREA; WITH CONTRAST MATERIAL(S)
70488   - COMPUTED TOMOGRAPHY, MAXILLOFACIAL AREA; WITHOUT CONTRAST MATERIAL, FOLLOWED BY
70490   - COMPUTED TOMOGRAPHY, SOFT TISSUE NECK; WITHOUT CONTRAST MATERIAL
70491   - COMPUTED TOMOGRAPHY, SOFT TISSUE NECK; WITH CONTRAST MATERIAL(S)
70492   - COMPUTED TOMOGRAPHY, SOFT TISSUE NECK; WITHOUT CONTRAST MATERIAL FOLLOWED BY
70496   - COMPUTED TOMOGRAPHIC ANGIOGRAPHY, HEAD, WITH CONTRAST MATERIAL(S), INCLUDING NON
70498   - COMPUTED TOMOGRAPHIC ANGIOGRAPHY, NECK, WITH CONTRAST MATERIAL(S), INCLUDING NON
70540   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, ORBIT, FACE, AND/OR NECK; WITHOUT CONTR
70542   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, ORBIT, FACE, AND NECK; WITH CONTRAST
70543   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, ORBIT, FACE, AND NECK; WITHOUT
70544   - MAGNETIC RESONANCE ANGIOGRAPHY, HEAD; WITHOUT CONTRAST MATERIAL(S)
70545   - MAGNETIC RESONANCE ANGIOGRAPHY, HEAD; WITH CONTRAST MATERIAL(S)



                                              Page 421
                                   All Other (no trigger bundling)


70546   - MAGNETIC RESONANCE ANGIOGRAPHY, HEAD; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY
70547   - MAGNETIC RESONANCE ANGIOGRAPHY, NECK; WITHOUT CONTRAST MATERIAL(S)
70548   - MAGNETIC RESONANCE ANGIOGRAPHY, NECK; WITH CONTRAST MATERIAL(S)
70549   - MAGNETIC RESONANCE ANGIOGRAPHY, NECK; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY
70551   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM); WITHOUT
70552   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM); WITH
70553   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM); WITHOUT
70554   - MAGNETIC RESONANCE IMAGING, BRAIN, FUNCTIONAL MRI; INCLUDING TEST SELECTION AND
70555   - MAGNETIC RESONANCE IMAGING, BRAIN, FUNCTIONAL MRI; REQUIRING PHYSICIAN OR PSYCHO
70557   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM AND SKULL
70558   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM AND SKULL
70559   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM AND SKULL
71010   - RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW, FRONTAL
71015   - RADIOLOGIC EXAMINATION, CHEST; STEREO, FRONTAL
71020   - RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL;
71021   - RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL; WITH APICAL
71022   - RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL; WITH OBLIQUE
71023   - RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL; WITH FLUOROSCOPY
71030   - RADIOLOGIC EXAMINATION, CHEST, COMPLETE, MINIMUM OF FOUR VIEWS;
71034   - RADIOLOGIC EXAMINATION, CHEST, COMPLETE, MINIMUM OF FOUR VIEWS; WITH FLUOROSCOPY
71035   - RADIOLOGIC EXAMINATION, CHEST, SPECIAL VIEWS (EG, LATERAL DECUBITUS, BUCKY
71040   - BRONCHOGRAPHY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
71060   - BRONCHOGRAPHY, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
71090   - INSERTION PACEMAKER, FLUOROSCOPY AND RADIOGRAPHY, RADIOLOGICAL SUPERVISION AND
71100   - RADIOLOGIC EXAMINATION, RIBS, UNILATERAL; TWO VIEWS
71101   - RADIOLOGIC EXAMINATION, RIBS, UNILATERAL; INCLUDING POSTEROANTERIOR CHEST,
71110   - RADIOLOGIC EXAMINATION, RIBS, BILATERAL; THREE VIEWS
71111   - RADIOLOGIC EXAMINATION, RIBS, BILATERAL; INCLUDING POSTEROANTERIOR CHEST,
71120   - RADIOLOGIC EXAMINATION; STERNUM, MINIMUM OF TWO VIEWS
71130   - RADIOLOGIC EXAMINATION; STERNOCLAVICULAR JOINT OR JOINTS, MINIMUM OF THREE VIEWS
71250   - COMPUTED TOMOGRAPHY, THORAX; WITHOUT CONTRAST MATERIAL
71260   - COMPUTED TOMOGRAPHY, THORAX; WITH CONTRAST MATERIAL(S)
71270   - COMPUTED TOMOGRAPHY, THORAX; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST
71275   - COMPUTED TOMOGRAPHIC ANGIOGRAPHY, CHEST (NONCORONARY), WITH CONTRAST MATERIAL(S)
71550   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, CHEST (EG, FOR EVALUATION OF HILAR AND
71551   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, CHEST (EG, FOR EVALUATION OF HILAR AND
71552   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, CHEST (EG, FOR EVALUATION OF HILAR AND
71555   - MAGNETIC RESONANCE ANGIOGRAPHY, CHEST (EXCLUDING MYOCARDIUM), WITH OR WITHOUT
72010   - RADIOLOGIC EXAMINATION, SPINE, ENTIRE, SURVEY STUDY, ANTEROPOSTERIOR AND LATERAL
72020   - RADIOLOGIC EXAMINATION, SPINE, SINGLE VIEW, SPECIFY LEVEL
72040   - RADIOLOGIC EXAMINATION, SPINE, CERVICAL; TWO OR THREE VIEWS
72050   - RADIOLOGIC EXAMINATION, SPINE, CERVICAL; MINIMUM OF FOUR VIEWS
72052   - RADIOLOGIC EXAMINATION, SPINE, CERVICAL; COMPLETE, INCLUDING OBLIQUE AND
72069   - RADIOLOGIC EXAMINATION, SPINE, THORACOLUMBAR, STANDING (SCOLIOSIS)
72070   - RADIOLOGIC EXAMINATION, SPINE; THORACIC, TWO VIEWS
72072   - RADIOLOGIC EXAMINATION, SPINE; THORACIC, THREE VIEWS
72074   - RADIOLOGIC EXAMINATION, SPINE; THORACIC, MINIMUM OF FOUR VIEWS
72080   - RADIOLOGIC EXAMINATION, SPINE; THORACOLUMBAR, TWO VIEWS
72090   - RADIOLOGIC EXAMINATION, SPINE; SCOLIOSIS STUDY, INCLUDING SUPINE AND ERECT
72100   - RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; TWO OR THREE VIEWS
72110   - RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; MINIMUM OF FOUR VIEWS
72114   - RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; COMPLETE, INCLUDING BENDING VIEWS



                                             Page 422
                                    All Other (no trigger bundling)


72120   - RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL, BENDING VIEWS ONLY, MINIMUM OF FOUR
72125   - COMPUTED TOMOGRAPHY, CERVICAL SPINE; WITHOUT CONTRAST MATERIAL
72126   - COMPUTED TOMOGRAPHY, CERVICAL SPINE; WITH CONTRAST MATERIAL
72127   - COMPUTED TOMOGRAPHY, CERVICAL SPINE; WITHOUT CONTRAST MATERIAL, FOLLOWED BY
72128   - COMPUTED TOMOGRAPHY, THORACIC SPINE; WITHOUT CONTRAST MATERIAL
72129   - COMPUTED TOMOGRAPHY, THORACIC SPINE; WITH CONTRAST MATERIAL
72130   - COMPUTED TOMOGRAPHY, THORACIC SPINE; WITHOUT CONTRAST MATERIAL, FOLLOWED BY
72131   - COMPUTED TOMOGRAPHY, LUMBAR SPINE; WITHOUT CONTRAST MATERIAL
72132   - COMPUTED TOMOGRAPHY, LUMBAR SPINE; WITH CONTRAST MATERIAL
72133   - COMPUTED TOMOGRAPHY, LUMBAR SPINE; WITHOUT CONTRAST MATERIAL, FOLLOWED BY
72141   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, CERVICAL;
72142   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, CERVICAL;
72146   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, THORACIC;
72147   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, THORACIC;
72148   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, LUMBAR;
72149   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, LUMBAR;
72156   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, WITHOUT
72157   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, WITHOUT
72158   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, WITHOUT
72159   - MAGNETIC RESONANCE ANGIOGRAPHY, SPINAL CANAL AND CONTENTS, WITH OR WITHOUT
72170   - RADIOLOGIC EXAMINATION, PELVIS; ONE OR TWO VIEWS
72190   - RADIOLOGIC EXAMINATION, PELVIS; COMPLETE, MINIMUM OF THREE VIEWS
72191   - COMPUTED TOMOGRAPHIC ANGIOGRAPHY, PELVIS, WITH CONTRAST MATERIAL(S), INCLUDING N
72192   - COMPUTED TOMOGRAPHY, PELVIS; WITHOUT CONTRAST MATERIAL
72193   - COMPUTED TOMOGRAPHY, PELVIS; WITH CONTRAST MATERIAL(S)
72194   - COMPUTED TOMOGRAPHY, PELVIS; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST
72195   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, PELVIS; WITHOUT CONTRAST MATERIAL(S)
72196   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, PELVIS; WITH CONTRAST MATERIAL(S)
72197   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, PELVIS; WITHOUT CONTRAST MATERIAL(S),
72198   - MAGNETIC RESONANCE ANGIOGRAPHY, PELVIS, WITH OR WITHOUT CONTRAST MATERIAL(S)
72200   - RADIOLOGIC EXAMINATION, SACROILIAC JOINTS; LESS THAN THREE VIEWS
72202   - RADIOLOGIC EXAMINATION, SACROILIAC JOINTS; THREE OR MORE VIEWS
72220   - RADIOLOGIC EXAMINATION, SACRUM AND COCCYX, MINIMUM OF TWO VIEWS
72240   - MYELOGRAPHY, CERVICAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
72255   - MYELOGRAPHY, THORACIC, RADIOLOGICAL SUPERVISION AND INTERPRETATION
72265   - MYELOGRAPHY, LUMBOSACRAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
72270   - MYELOGRAPHY, TWO OR MORE REGIONS (EG, LUMBAR/THORACIC, CERVICAL/ THORACIC,
72275   - EPIDUROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
72285   - DISKOGRAPHY, CERVICAL OR THORACIC, RADIOLOGICAL SUPERVISION AND INTERPRETATION
72291   - RADIOLOGICAL SUPERVISION AND INTERPRETATION, PERCUTANEOUS VERTEBROPLASTY, VERTEB
72292   - RADIOLOGICAL SUPERVISION AND INTERPRETATION, PERCUTANEOUS VERTEBROPLASTY, VERTEB
72295   - DISKOGRAPHY, LUMBAR, RADIOLOGICAL SUPERVISION AND INTERPRETATION
73000   - RADIOLOGIC EXAMINATION; CLAVICLE, COMPLETE
73010   - RADIOLOGIC EXAMINATION; SCAPULA, COMPLETE
73020   - RADIOLOGIC EXAMINATION, SHOULDER; ONE VIEW
73030   - RADIOLOGIC EXAMINATION, SHOULDER; COMPLETE, MINIMUM OF TWO VIEWS
73040   - RADIOLOGIC EXAMINATION, SHOULDER, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND
73050   - RADIOLOGIC EXAMINATION; ACROMIOCLAVICULAR JOINTS, BILATERAL, WITH OR WITHOUT
73060   - RADIOLOGIC EXAMINATION; HUMERUS, MINIMUM OF TWO VIEWS
73070   - RADIOLOGIC EXAMINATION, ELBOW; TWO VIEWS
73080   - RADIOLOGIC EXAMINATION, ELBOW; COMPLETE, MINIMUM OF THREE VIEWS
73085   - RADIOLOGIC EXAMINATION, ELBOW, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND



                                              Page 423
                                    All Other (no trigger bundling)


73090   - RADIOLOGIC EXAMINATION; FOREARM, TWO VIEWS
73092   - RADIOLOGIC EXAMINATION; UPPER EXTREMITY, INFANT, MINIMUM OF TWO VIEWS
73100   - RADIOLOGIC EXAMINATION, WRIST; TWO VIEWS
73110   - RADIOLOGIC EXAMINATION, WRIST; COMPLETE, MINIMUM OF THREE VIEWS
73115   - RADIOLOGIC EXAMINATION, WRIST, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND
73120   - RADIOLOGIC EXAMINATION, HAND; TWO VIEWS
73130   - RADIOLOGIC EXAMINATION, HAND; MINIMUM OF THREE VIEWS
73140   - RADIOLOGIC EXAMINATION, FINGER(S), MINIMUM OF TWO VIEWS
73200   - COMPUTED TOMOGRAPHY, UPPER EXTREMITY; WITHOUT CONTRAST MATERIAL
73201   - COMPUTED TOMOGRAPHY, UPPER EXTREMITY; WITH CONTRAST MATERIAL(S)
73202   - COMPUTED TOMOGRAPHY, UPPER EXTREMITY; WITHOUT CONTRAST MATERIAL, FOLLOWED BY
73206   - COMPUTED TOMOGRAPHIC ANGIOGRAPHY, UPPER EXTREMITY, WITH CONTRAST MATERIAL(S), IN
73218   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, UPPER EXTREMITY, OTHER THAN JOINT;
73219   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, UPPER EXTREMITY, OTHER THAN JOINT;
73220   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, UPPER EXTREMITY, OTHER THAN JOINT;
73221   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF UPPER EXTREMITY; WITHOUT
73222   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF UPPER EXTREMITY; WITH
73223   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF UPPER EXTREMITY; WITHOUT
73225   - MAGNETIC RESONANCE ANGIOGRAPHY, UPPER EXTREMITY, WITH OR WITHOUT CONTRAST
73500   - RADIOLOGIC EXAMINATION, HIP; UNILATERAL, ONE VIEW
73510   - RADIOLOGIC EXAMINATION, HIP, UNILATERAL; COMPLETE, MINIMUM OF TWO VIEWS
73520   - RADIOLOGIC EXAMINATION, HIPS, BILATERAL, MINIMUM OF TWO VIEWS OF EACH HIP,
73525   - RADIOLOGIC EXAMINATION, HIP, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND
73530   - RADIOLOGIC EXAMINATION, HIP, DURING OPERATIVE PROCEDURE
73540   - RADIOLOGIC EXAMINATION, PELVIS AND HIPS, INFANT OR CHILD, MINIMUM OF TWO VIEWS
73542   - RADIOLOGICAL EXAMINATION, SACROILIAC JOINT ARTHROGRAPHY, RADIOLOGICAL
73550   - RADIOLOGIC EXAMINATION, FEMUR, TWO VIEWS
73560   - RADIOLOGIC EXAMINATION, KNEE; ONE OR TWO VIEWS
73562   - RADIOLOGIC EXAMINATION, KNEE; THREE VIEWS
73564   - RADIOLOGIC EXAMINATION, KNEE; COMPLETE, FOUR OR MORE VIEWS
73565   - RADIOLOGIC EXAMINATION, KNEE; BOTH KNEES, STANDING, ANTEROPOSTERIOR
73580   - RADIOLOGIC EXAMINATION, KNEE, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND
73590   - RADIOLOGIC EXAMINATION; TIBIA AND FIBULA, TWO VIEWS
73592   - RADIOLOGIC EXAMINATION; LOWER EXTREMITY, INFANT, MINIMUM OF TWO VIEWS
73600   - RADIOLOGIC EXAMINATION, ANKLE; TWO VIEWS
73610   - RADIOLOGIC EXAMINATION, ANKLE; COMPLETE, MINIMUM OF THREE VIEWS
73615   - RADIOLOGIC EXAMINATION, ANKLE, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND
73620   - RADIOLOGIC EXAMINATION, FOOT; TWO VIEWS
73630   - RADIOLOGIC EXAMINATION, FOOT; COMPLETE, MINIMUM OF THREE VIEWS
73650   - RADIOLOGIC EXAMINATION; CALCANEUS, MINIMUM OF TWO VIEWS
73660   - RADIOLOGIC EXAMINATION; TOE(S), MINIMUM OF TWO VIEWS
73700   - COMPUTED TOMOGRAPHY, LOWER EXTREMITY; WITHOUT CONTRAST MATERIAL
73701   - COMPUTED TOMOGRAPHY, LOWER EXTREMITY; WITH CONTRAST MATERIAL(S)
73702   - COMPUTED TOMOGRAPHY, LOWER EXTREMITY; WITHOUT CONTRAST MATERIAL, FOLLOWED BY
73706   - COMPUTED TOMOGRAPHIC ANGIOGRAPHY, LOWER EXTREMITY, WITH CONTRAST MATERIAL(S), IN
73718   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, LOWER EXTREMITY OTHER THAN JOINT;
73719   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, LOWER EXTREMITY OTHER THAN JOINT; WITH
73720   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, LOWER EXTREMITY OTHER THAN JOINT;
73721   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF LOWER EXTREMITY; WITHOUT
73722   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF LOWER EXTREMITY; WITH
73723   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF LOWER EXTREMITY; WITHOUT
73725   - MAGNETIC RESONANCE ANGIOGRAPHY, LOWER EXTREMITY, WITH OR WITHOUT CONTRAST



                                              Page 424
                                 All Other (no trigger bundling)


74000 - RADIOLOGIC EXAMINATION, ABDOMEN; SINGLE ANTEROPOSTERIOR VIEW
74010 - RADIOLOGIC EXAMINATION, ABDOMEN; ANTEROPOSTERIOR AND ADDITIONAL OBLIQUE AND
74020 - RADIOLOGIC EXAMINATION, ABDOMEN; COMPLETE, INCLUDING DECUBITUS AND/OR ERECT
74022 - RADIOLOGIC EXAMINATION, ABDOMEN; COMPLETE ACUTE ABDOMEN SERIES, INCLUDING
74150 - COMPUTED TOMOGRAPHY, ABDOMEN; WITHOUT CONTRAST MATERIAL
74160 - COMPUTED TOMOGRAPHY, ABDOMEN; WITH CONTRAST MATERIAL(S)
74170 - COMPUTED TOMOGRAPHY, ABDOMEN; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST
74175 - COMPUTED TOMOGRAPHIC ANGIOGRAPHY, ABDOMEN, WITH CONTRAST MATERIAL(S), INCLUDING
74176 - Computed tomography, abdomen and pelvis; without contrast material
74177 - Computed tomography, abdomen and pelvis; with contrast material(s)
74178 - Computed tomography, abdomen and pelvis; without contrast material in one or bot
74181 - MAGNETIC RESONANCE (EG, PROTON) IMAGING, ABDOMEN; WITHOUT CONTRAST MATERIAL(S)
74182 - MAGNETIC RESONANCE (EG, PROTON) IMAGING, ABDOMEN; WITH CONTRAST MATERIAL(S)
74183 - MAGNETIC RESONANCE (EG, PROTON) IMAGING, ABDOMEN; WITHOUT CONTRAST MATERIAL(S),
74185 - MAGNETIC RESONANCE ANGIOGRAPHY, ABDOMEN, WITH OR WITHOUT CONTRAST MATERIAL(S)
74190 - PERITONEOGRAM (EG, AFTER INJECTION OF AIR OR CONTRAST), RADIOLOGICAL
74210 - RADIOLOGIC EXAMINATION; PHARYNX AND/OR CERVICAL ESOPHAGUS
74220 - RADIOLOGIC EXAMINATION; ESOPHAGUS
74230 - SWALLOWING FUNCTION, WITH CINERADIOGRAPHY/VIDEORADIOGRAPHY
74235 - REMOVAL OF FOREIGN BODY(S), ESOPHAGEAL, WITH USE OF BALLOON CATHETER,
74240 - RADIOLOGIC EXAMINATION, GASTROINTESTINAL TRACT, UPPER; WITH OR WITHOUT DELAYED
74241 - RADIOLOGIC EXAMINATION, GASTROINTESTINAL TRACT, UPPER; WITH OR WITHOUT DELAYED
74245 - RADIOLOGIC EXAMINATION, GASTROINTESTINAL TRACT, UPPER; WITH SMALL INTESTINE,
74246 - RADIOLOGICAL EXAMINATION, GASTROINTESTINAL TRACT, UPPER, AIR CONTRAST, WITH
74247 - RADIOLOGICAL EXAMINATION, GASTROINTESTINAL TRACT, UPPER, AIR CONTRAST, WITH
74249 - RADIOLOGICAL EXAMINATION, GASTROINTESTINAL TRACT, UPPER, AIR CONTRAST, WITH
74250 - RADIOLOGIC EXAMINATION, SMALL INTESTINE, INCLUDES MULTIPLE SERIAL FILMS;
74251 - RADIOLOGIC EXAMINATION, SMALL INTESTINE, INCLUDES MULTIPLE SERIAL FILMS; VIA
74260 - DUODENOGRAPHY, HYPOTONIC
74261 - Computed tomographic (CT) colonography, diagnostic, including image postprocessi
74262 - Computed tomographic (CT) colonography, diagnostic, including image postprocessi
74263 - Computed tomographic (CT) colonography, screening, including image postprocessin
74270 - RADIOLOGIC EXAMINATION, COLON; CONTRAST (EG, BARIUM) ENEMA, WITH OR WITHOUT KUB
74280 - RADIOLOGIC EXAMINATION, COLON; AIR CONTRAST WITH SPECIFIC HIGH DENSITY BARIUM,
74283 - THERAPEUTIC ENEMA, CONTRAST OR AIR, FOR REDUCTION OF INTUSSUSCEPTION OR OTHER
74290 - CHOLECYSTOGRAPHY, ORAL CONTRAST;
74291 - CHOLECYSTOGRAPHY, ORAL CONTRAST; ADDITIONAL OR REPEAT EXAMINATION OR MULTIPLE
74300 - CHOLANGIOGRAPHY AND/OR PANCREATOGRAPHY; INTRAOPERATIVE, RADIOLOGICAL
74301 - CHOLANGIOGRAPHY AND/OR PANCREATOGRAPHY; ADDITIONAL SET INTRAOPERATIVE,
74305 - CHOLANGIOGRAPHY AND/OR PANCREATOGRAPHY; THROUGH EXISTING CATHETER, RADIOLOGICAL
74320 - CHOLANGIOGRAPHY, PERCUTANEOUS, TRANSHEPATIC, RADIOLOGICAL SUPERVISION AND
74327 - POSTOPERATIVE BILIARY DUCT CALCULUS REMOVAL, PERCUTANEOUS VIA T-TUBE TRACT,
74328 - ENDOSCOPIC CATHETERIZATION OF THE BILIARY DUCTAL SYSTEM, RADIOLOGICAL
74329 - ENDOSCOPIC CATHETERIZATION OF THE PANCREATIC DUCTAL SYSTEM, RADIOLOGICAL
74330 - COMBINED ENDOSCOPIC CATHETERIZATION OF THE BILIARY AND PANCREATIC DUCTAL
74340 - INTRODUCTION OF LONG GASTROINTESTINAL TUBE (EG, MILLER-ABBOTT), INCLUDING
74355 - PERCUTANEOUS PLACEMENT OF ENTEROCLYSIS TUBE, RADIOLOGICAL SUPERVISION AND
74360 - INTRALUMINAL DILATION OF STRICTURES AND/OR OBSTRUCTIONS (EG, ESOPHAGUS),
74363 - PERCUTANEOUS TRANSHEPATIC DILATION OF BILIARY DUCT STRICTURE WITH OR WITHOUT
74400 - UROGRAPHY (PYELOGRAPHY), INTRAVENOUS, WITH OR WITHOUT KUB, WITH OR WITHOUT TOMOG
74410 - UROGRAPHY, INFUSION, DRIP TECHNIQUE AND/OR BOLUS TECHNIQUE;
74415 - UROGRAPHY, INFUSION, DRIP TECHNIQUE AND/OR BOLUS TECHNIQUE; WITH



                                           Page 425
                                   All Other (no trigger bundling)


74420   - UROGRAPHY, RETROGRADE, WITH OR WITHOUT KUB
74425   - UROGRAPHY, ANTEGRADE, (PYELOSTOGRAM, NEPHROSTOGRAM, LOOPOGRAM), RADIOLOGICAL
74430   - CYSTOGRAPHY, MINIMUM OF THREE VIEWS, RADIOLOGICAL SUPERVISION AND INTERPRETATION
74440   - VASOGRAPHY, VESICULOGRAPHY, OR EPIDIDYMOGRAPHY, RADIOLOGICAL SUPERVISION AND
74445   - CORPORA CAVERNOSOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
74450   - URETHROCYSTOGRAPHY, RETROGRADE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
74455   - URETHROCYSTOGRAPHY, VOIDING, RADIOLOGICAL SUPERVISION AND INTERPRETATION
74470   - RADIOLOGIC EXAMINATION, RENAL CYST STUDY, TRANSLUMBAR, CONTRAST VISUALIZATION,
74475   - INTRODUCTION OF INTRACATHETER OR CATHETER INTO RENAL PELVIS FOR DRAINAGE AND/OR
74480   - INTRODUCTION OF URETERAL CATHETER OR STENT INTO URETER THROUGH RENAL PELVIS FOR
74485   - DILATION OF NEPHROSTOMY, URETERS, OR URETHRA, RADIOLOGICAL SUPERVISION AND
74710   - PELVIMETRY, WITH OR WITHOUT PLACENTAL LOCALIZATION
74740   - HYSTEROSALPINGOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
74775   - PERINEOGRAM (EG, VAGINOGRAM, FOR SEX DETERMINATION OR EXTENT OF ANOMALIES)
75557   - CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY AND FUNCTION WITHOUT CONTRAST
75559   - CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY AND FUNCTION WITHOUT CONTRAST
75561   - CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY AND FUNCTION WITHOUT CONTRAST
75563   - CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY AND FUNCTION WITHOUT CONTRAST
75565   - Cardiac magnetic resonance imaging for velocity flow mapping (List separately in
75571   - Computed tomography, heart, without contrast material, with quantitative evaluat
75600   - AORTOGRAPHY, THORACIC, WITHOUT SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTER
75605   - AORTOGRAPHY, THORACIC, BY SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND
75625   - AORTOGRAPHY, ABDOMINAL, BY SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND
75630   - AORTOGRAPHY, ABDOMINAL PLUS BILATERAL ILIOFEMORAL LOWER EXTREMITY, CATHETER, BY
75635   - COMPUTED TOMOGRAPHIC ANGIOGRAPHY, ABDOMINAL AORTA AND BILATERAL ILIOFEMORAL LOWE
75650   - ANGIOGRAPHY, CERVICOCEREBRAL, CATHETER, INCLUDING VESSEL ORIGIN, RADIOLOGICAL
75658   - ANGIOGRAPHY, BRACHIAL, RETROGRADE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
75660   - ANGIOGRAPHY, EXTERNAL CAROTID, UNILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION
75662   - ANGIOGRAPHY, EXTERNAL CAROTID, BILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION
75665   - ANGIOGRAPHY, CAROTID, CEREBRAL, UNILATERAL, RADIOLOGICAL SUPERVISION AND
75671   - ANGIOGRAPHY, CAROTID, CEREBRAL, BILATERAL, RADIOLOGICAL SUPERVISION AND
75676   - ANGIOGRAPHY, CAROTID, CERVICAL, UNILATERAL, RADIOLOGICAL SUPERVISION AND
75680   - ANGIOGRAPHY, CAROTID, CERVICAL, BILATERAL, RADIOLOGICAL SUPERVISION AND
75685   - ANGIOGRAPHY, VERTEBRAL, CERVICAL, AND/OR INTRACRANIAL, RADIOLOGICAL SUPERVISION
75705   - ANGIOGRAPHY, SPINAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
75710   - ANGIOGRAPHY, EXTREMITY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
75716   - ANGIOGRAPHY, EXTREMITY, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
75722   - ANGIOGRAPHY, RENAL, UNILATERAL, SELECTIVE (INCLUDING FLUSH AORTOGRAM),
75724   - ANGIOGRAPHY, RENAL, BILATERAL, SELECTIVE (INCLUDING FLUSH AORTOGRAM),
75726   - ANGIOGRAPHY, VISCERAL, SELECTIVE OR SUPRASELECTIVE, (WITH OR WITHOUT FLUSH
75731   - ANGIOGRAPHY, ADRENAL, UNILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND
75733   - ANGIOGRAPHY, ADRENAL, BILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND
75736   - ANGIOGRAPHY, PELVIC, SELECTIVE OR SUPRASELECTIVE, RADIOLOGICAL SUPERVISION AND
75741   - ANGIOGRAPHY, PULMONARY, UNILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND
75743   - ANGIOGRAPHY, PULMONARY, BILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND
75746   - ANGIOGRAPHY, PULMONARY, BY NONSELECTIVE CATHETER OR VENOUS INJECTION,
75756   - ANGIOGRAPHY, INTERNAL MAMMARY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
75774   - ANGIOGRAPHY, SELECTIVE, EACH ADDITIONAL VESSEL STUDIED AFTER BASIC EXAMINATION,
75791   - Angiography, arteriovenous shunt (eg, dialysis patient fistula/graft), complete
75801   - LYMPHANGIOGRAPHY, EXTREMITY ONLY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTER
75803   - LYMPHANGIOGRAPHY, EXTREMITY ONLY, BILATERAL, RADIOLOGICAL SUPERVISION AND
75805   - LYMPHANGIOGRAPHY, PELVIC/ABDOMINAL, UNILATERAL, RADIOLOGICAL SUPERVISION AND



                                             Page 426
                                   All Other (no trigger bundling)


75807   - LYMPHANGIOGRAPHY, PELVIC/ABDOMINAL, BILATERAL, RADIOLOGICAL SUPERVISION AND
75809   - SHUNTOGRAM FOR INVESTIGATION OF PREVIOUSLY PLACED INDWELLING NONVASCULAR SHUNT
75810   - SPLENOPORTOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
75820   - VENOGRAPHY, EXTREMITY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
75822   - VENOGRAPHY, EXTREMITY, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
75825   - VENOGRAPHY, CAVAL, INFERIOR, WITH SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND
75827   - VENOGRAPHY, CAVAL, SUPERIOR, WITH SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND
75831   - VENOGRAPHY, RENAL, UNILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND
75833   - VENOGRAPHY, RENAL, BILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND
75840   - VENOGRAPHY, ADRENAL, UNILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND
75842   - VENOGRAPHY, ADRENAL, BILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND
75860   - VENOGRAPHY, VENOUS SINUS (EG, PETROSAL AND INFERIOR SAGITTAL) OR JUGULAR,
75870   - VENOGRAPHY, SUPERIOR SAGITTAL SINUS, RADIOLOGICAL SUPERVISION AND INTERPRETATION
75872   - VENOGRAPHY, EPIDURAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
75880   - VENOGRAPHY, ORBITAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
75885   - PERCUTANEOUS TRANSHEPATIC PORTOGRAPHY WITH HEMODYNAMIC EVALUATION, RADIOLOGICAL
75887   - PERCUTANEOUS TRANSHEPATIC PORTOGRAPHY WITHOUT HEMODYNAMIC EVALUATION,
75889   - HEPATIC VENOGRAPHY, WEDGED OR FREE, WITH HEMODYNAMIC EVALUATION, RADIOLOGICAL
75891   - HEPATIC VENOGRAPHY, WEDGED OR FREE, WITHOUT HEMODYNAMIC EVALUATION,
75893   - VENOUS SAMPLING THROUGH CATHETER, WITH OR WITHOUT ANGIOGRAPHY (EG, FOR
75894   - TRANSCATHETER THERAPY, EMBOLIZATION, ANY METHOD, RADIOLOGICAL SUPERVISION AND IN
75896   - TRANSCATHETER THERAPY, INFUSION, ANY METHOD (EG, THROMBOLYSIS OTHER THAN
75898   - ANGIOGRAPHY THROUGH EXISTING CATHETER FOR FOLLOW-UP STUDY FOR TRANSCATHETER
75900   - EXCHANGE OF A PREVIOUSLY PLACED INTRAVASCULAR CATHETER DURING THROMBOLYTIC THERA
75901   - MECHANICAL REMOVAL OF PERICATHETER OBSTRUCTIVE MATERIAL (EG, FIBRIN SHEATH)
75902   - MECHANICAL REMOVAL OF INTRALUMINAL (INTRACATHETER) OBSTRUCTIVE MATERIAL FROM
75940   - PERCUTANEOUS PLACEMENT OF IVC FILTER, RADIOLOGICAL SUPERVISION AND
75945   - INTRAVASCULAR ULTRASOUND (NON-CORONARY VESSEL), RADIOLOGICAL SUPERVISION AND
75946   - INTRAVASCULAR ULTRASOUND (NON-CORONARY VESSEL), RADIOLOGICAL SUPERVISION AND
75952   - ENDOVASCULAR REPAIR OF INFRARENAL ABDOMINAL AORTIC ANEURYSM OR DISSECTION,
75953   - PLACEMENT OF PROXIMAL OR DISTAL EXTENSION PROSTHESIS FOR ENDOVASCULAR REPAIR OF
75954   - ENDOVASCULAR REPAIR OF ILIAC ARTERY ANEURYSM, PSEUDOANEURYSM, ARTERIOVENOUS
75956   - ENDOVASCULAR REPAIR OF DESCENDING THORACIC AORTA (EG, ANEURYSM, PSEUDOANEURYSM,
75957   - ENDOVASCULAR REPAIR OF DESCENDING THORACIC AORTA (EG, ANEURYSM, PSEUDOANEURYSM,
75958   - PLACEMENT OF PROXIMAL EXTENSION PROSTHESIS FOR ENDOVASCULAR REPAIR OF DESCENDING
75959   - PLACEMENT OF DISTAL EXTENSION PROSTHESIS(S) (DELAYED) AFTER ENDOVASCULAR REPAIR
75960   - TRANSCATHETER INTRODUCTION OF INTRAVASCULAR STENT(S), (EXCEPT CORONARY,
75961   - TRANSCATHETER RETRIEVAL, PERCUTANEOUS, OF INTRAVASCULAR FOREIGN BODY (EG,
75962   - TRANSLUMINAL BALLOON ANGIOPLASTY, PERIPHERAL ARTERY, RADIOLOGICAL SUPERVISION
75964   - TRANSLUMINAL BALLOON ANGIOPLASTY, EACH ADDITIONAL PERIPHERAL ARTERY,
75966   - TRANSLUMINAL BALLOON ANGIOPLASTY, RENAL OR OTHER VISCERAL ARTERY, RADIOLOGICAL
75968   - TRANSLUMINAL BALLOON ANGIOPLASTY, EACH ADDITIONAL VISCERAL ARTERY, RADIOLOGICAL
75970   - TRANSCATHETER BIOPSY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
75978   - TRANSLUMINAL BALLOON ANGIOPLASTY, VENOUS (EG, SUBCLAVIAN STENOSIS),
75980   - PERCUTANEOUS TRANSHEPATIC BILIARY DRAINAGE WITH CONTRAST MONITORING,
75982   - PERCUTANEOUS PLACEMENT OF DRAINAGE CATHETER FOR COMBINED INTERNAL AND EXTERNAL
75984   - CHANGE OF PERCUTANEOUS TUBE OR DRAINAGE CATHETER WITH CONTRAST MONITORING (EG, G
75989   - RADIOLOGICAL GUIDANCE (IE, FLUOROSCOPY, ULTRASOUND, OR COMPUTED TOMOGRAPHY),
75992   - TRANSLUMINAL ATHERECTOMY, PERIPHERAL ARTERY, RADIOLOGICAL SUPERVISION AND INTERP
75993   - TRANSLUMINAL ATHERECTOMY, EACH ADDITIONAL PERIPHERAL ARTERY, RADIOLOGICAL
75994   - TRANSLUMINAL ATHERECTOMY, RENAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
75995   - TRANSLUMINAL ATHERECTOMY, VISCERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION



                                             Page 427
                                    All Other (no trigger bundling)


75996   - TRANSLUMINAL ATHERECTOMY, EACH ADDITIONAL VISCERAL ARTERY, RADIOLOGICAL
76000   - FLUOROSCOPY (SEPARATE PROCEDURE), UP TO ONE HOUR PHYSICIAN TIME, OTHER THAN
76001   - FLUOROSCOPY, PHYSICIAN TIME MORE THAN ONE HOUR, ASSISTING A NON-RADIOLOGIC
76010   - RADIOLOGIC EXAMINATION FROM NOSE TO RECTUM FOR FOREIGN BODY, SINGLE VIEW, CHILD
76080   - RADIOLOGIC EXAMINATION, ABSCESS, FISTULA OR SINUS TRACT STUDY, RADIOLOGICAL
76098   - RADIOLOGICAL EXAMINATION, SURGICAL SPECIMEN
76100   - RADIOLOGIC EXAMINATION, SINGLE PLANE BODY SECTION (EG, TOMOGRAPHY), OTHER THAN
76101   - RADIOLOGIC EXAMINATION, COMPLEX MOTION (IE, HYPERCYCLOIDAL) BODY SECTION (EG,
76102   - RADIOLOGIC EXAMINATION, COMPLEX MOTION (IE, HYPERCYCLOIDAL) BODY SECTION (EG,
76120   - CINERADIOGRAPHY/VIDEORADIOGRAPHY, EXCEPT WHERE SPECIFICALLY INCLUDED
76125   - CINERADIOGRAPHY/VIDEORADIOGRAPHY TO COMPLEMENT ROUTINE EXAMINATION (LIST
76140   - CONSULTATION ON X-RAY EXAMINATION MADE ELSEWHERE, WRITTEN REPORT
76150   - XERORADIOGRAPHY
76350   - SUBTRACTION IN CONJUNCTION WITH CONTRAST STUDIES
76376   - 3D RENDERING WITH INTERPRETATION AND REPORTING OF COMPUTED TOMOGRAPHY, MAGNETIC
76377   - 3D RENDERING WITH INTERPRETATION AND REPORTING OF COMPUTED TOMOGRAPHY, MAGNETIC
76380   - COMPUTED TOMOGRAPHY, LIMITED OR LOCALIZED FOLLOW-UP STUDY
76390   - MAGNETIC RESONANCE SPECTROSCOPY
76496   - UNLISTED FLUOROSCOPIC PROCEDURE (EG, DIAGNOSTIC, INTERVENTIONAL)
76497   - UNLISTED COMPUTED TOMOGRAPHY PROCEDURE (EG, DIAGNOSTIC, INTERVENTIONAL)
76498   - UNLISTED MAGNETIC RESONANCE PROCEDURE (EG, DIAGNOSTIC, INTERVENTIONAL)
76499   - UNLISTED DIAGNOSTIC RADIOGRAPHIC PROCEDURE
76506   - ECHOENCEPHALOGRAPHY, REAL TIME WITH IMAGE DOCUMENTATION (GRAY SCALE) (FOR DETERM
76510   - OPHTHALMIC ULTRASOUND, DIAGNOSTIC; B-SCAN AND QUANTITATIVE A-SCAN PERFORMED
76511   - OPHTHALMIC ULTRASOUND, DIAGNOSTIC; QUANTITATIVE A-SCAN ONLY
76512   - OPHTHALMIC ULTRASOUND, DIAGNOSTIC; B-SCAN (WITH OR WITHOUT SUPERIMPOSED
76513   - OPHTHALMIC ULTRASOUND, DIAGNOSTIC; ANTERIOR SEGMENT ULTRASOUND, IMMERSION
76514   - OPHTHALMIC ULTRASOUND, DIAGNOSTIC; CORNEAL PACHYMETRY, UNILATERAL OR BILATERAL
76516   - OPHTHALMIC BIOMETRY BY ULTRASOUND ECHOGRAPHY, A-SCAN;
76519   - OPHTHALMIC BIOMETRY BY ULTRASOUND ECHOGRAPHY, A-SCAN; WITH INTRAOCULAR LENS
76529   - OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION
76536   - ULTRASOUND, SOFT TISSUES OF HEAD AND NECK (EG, THYROID, PARATHYROID, PAROTID), R
76604   - ULTRASOUND, CHEST (INCLUDES MEDIASTINUM), REAL TIME WITH IMAGE DOCUMENTATION
76645   - ULTRASOUND, BREAST(S) (UNILATERAL OR BILATERAL), REAL TIME WITH IMAGE DOCUMENTAT
76700   - ULTRASOUND, ABDOMINAL, REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE
76705   - ULTRASOUND, ABDOMINAL, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION;
76770   - ULTRASOUND, RETROPERITONEAL (EG, RENAL, AORTA, NODES), REAL TIME WITH IMAGE DOCU
76775   - ULTRASOUND, RETROPERITONEAL (EG, RENAL, AORTA, NODES), B-SCAN AND/OR REAL TIME
76776   - ULTRASOUND, TRANSPLANTED KIDNEY, REAL TIME AND DUPLEX DOPPLER WITH IMAGE DOCUMEN
76800   - ULTRASOUND, SPINAL CANAL AND CONTENTS
76801   - ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL AND MATER
76802   - ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL AND
76805   - ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL AND
76810   - ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL AND
76811   - ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL AND
76812   - ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL AND
76813   - ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FIRST TRIMESTER
76814   - ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FIRST TRIMESTER
76815   - ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, LIMITED (EG,
76816   - ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FOLLOW-UP (EG,
76817   - ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, TRANSVAGINAL
76818   - FETAL BIOPHYSICAL PROFILE; WITH NON-STRESS TESTING



                                              Page 428
                                    All Other (no trigger bundling)


76819   - FETAL BIOPHYSICAL PROFILE; WITHOUT NON-STRESS TESTING
76820   - DOPPLER VELOCIMETRY, FETAL; UMBILICAL ARTERY
76821   - DOPPLER VELOCIMETRY, FETAL; MIDDLE CEREBRAL ARTERY
76825   - ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM, REAL TIME WITH IMAGE
76826   - ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM, REAL TIME WITH IMAGE
76827   - DOPPLER ECHOCARDIOGRAPHY, FETAL, PULSED WAVE AND/OR CONTINUOUS WAVE WITH
76828   - DOPPLER ECHOCARDIOGRAPHY, FETAL, PULSED WAVE AND/OR CONTINUOUS WAVE WITH
76830   - ULTRASOUND, TRANSVAGINAL
76831   - SALINE INFUSION SONOHYSTEROGRAPHY (SIS), INCLUDING COLOR FLOW DOPPLER, WHEN
76856   - ULTRASOUND, PELVIC (NONOBSTETRIC), REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE
76857   - ULTRASOUND, PELVIC (NONOBSTETRIC), B-SCAN AND/OR REAL TIME WITH IMAGE
76870   - ULTRASOUND, SCROTUM AND CONTENTS
76872   - ULTRASOUND, TRANSRECTAL;
76873   - ULTRASOUND, TRANSRECTAL; PROSTATE VOLUME STUDY FOR BRACHYTHERAPY TREATMENT
76880   - ULTRASOUND, EXTREMITY, NONVASCULAR, REAL TIME WITH IMAGE DOCUMENTATION
76885   - ULTRASOUND, INFANT HIPS, REAL TIME WITH IMAGING DOCUMENTATION; DYNAMIC
76886   - ULTRASOUND, INFANT HIPS, REAL TIME WITH IMAGING DOCUMENTATION; LIMITED, STATIC
76930   - ULTRASONIC GUIDANCE FOR PERICARDIOCENTESIS, IMAGING SUPERVISION AND INTERPRETATI
76932   - ULTRASONIC GUIDANCE FOR ENDOMYOCARDIAL BIOPSY, IMAGING SUPERVISION AND
76937   - ULTRASOUND GUIDANCE FOR VASCULAR ACCESS REQUIRING ULTRASOUND EVALUATION OF
76940   - ULTRASOUND GUIDANCE FOR, AND MONITORING OF, PARENCHYMAL TISSUE ABLATION
76941   - ULTRASONIC GUIDANCE FOR INTRAUTERINE FETAL TRANSFUSION OR CORDOCENTESIS,
76942   - ULTRASONIC GUIDANCE FOR NEEDLE PLACEMENT (EG, BIOPSY, ASPIRATION, INJECTION,
76945   - ULTRASONIC GUIDANCE FOR CHORIONIC VILLUS SAMPLING, IMAGING SUPERVISION AND
76946   - ULTRASONIC GUIDANCE FOR AMNIOCENTESIS, IMAGING SUPERVISION AND INTERPRETATION
76950   - ULTRASONIC GUIDANCE FOR PLACEMENT OF RADIATION THERAPY FIELDS
76965   - ULTRASONIC GUIDANCE FOR INTERSTITIAL RADIOELEMENT APPLICATION
76970   - ULTRASOUND STUDY FOLLOW-UP (SPECIFY)
76975   - GASTROINTESTINAL ENDOSCOPIC ULTRASOUND, SUPERVISION AND INTERPRETATION
76977   - ULTRASOUND BONE DENSITY MEASUREMENT AND INTERPRETATION, PERIPHERAL SITE(S), ANY
76998   - ULTRASONIC GUIDANCE, INTRAOPERATIVE
76999   - UNLISTED ULTRASOUND PROCEDURE (EG, DIAGNOSTIC, INTERVENTIONAL)
77001   - FLUOROSCOPIC GUIDANCE FOR CENTRAL VENOUS ACCESS DEVICE PLACEMENT, REPLACEMENT (C
77002   - FLUOROSCOPIC GUIDANCE FOR NEEDLE PLACEMENT (EG, BIOPSY, ASPIRATION, INJECTION, L
77003   - FLUOROSCOPIC GUIDANCE AND LOCALIZATION OF NEEDLE OR CATHETER TIP FOR SPINE OR PA
77011   - COMPUTED TOMOGRAPHY GUIDANCE FOR STEREOTACTIC LOCALIZATION
77012   - COMPUTED TOMOGRAPHY GUIDANCE FOR NEEDLE PLACEMENT (EG, BIOPSY, ASPIRATION, INJEC
77013   - COMPUTERIZED TOMOGRAPHY GUIDANCE FOR, AND MONITORING OF, PARENCHYMAL TISSUE ABLA
77014   - COMPUTED TOMOGRAPHY GUIDANCE FOR PLACEMENT OF RADIATION THERAPY FIELDS
77021   - MAGNETIC RESONANCE GUIDANCE FOR NEEDLE PLACEMENT (EG, FOR BIOPSY, NEEDLE ASPIRAT
77022   - MAGNETIC RESONANCE GUIDANCE FOR, AND MONITORING OF, PARENCHYMAL TISSUE ABLATION
77031   - STEREOTACTIC LOCALIZATION GUIDANCE FOR BREAST BIOPSY OR NEEDLE PLACEMENT (EG, FO
77032   - MAMMOGRAPHIC GUIDANCE FOR NEEDLE PLACEMENT, BREAST (EG, FOR WIRE LOCALIZATION OR
77051   - COMPUTER-AIDED DETECTION (COMPUTER ALGORITHM ANALYSIS OF DIGITAL IMAGE DATA FOR
77052   - COMPUTER-AIDED DETECTION (COMPUTER ALGORITHM ANALYSIS OF DIGITAL IMAGE DATA FOR
77053   - MAMMARY DUCTOGRAM OR GALACTOGRAM, SINGLE DUCT, RADIOLOGICAL SUPERVISION AND INTE
77054   - MAMMARY DUCTOGRAM OR GALACTOGRAM, MULTIPLE DUCTS, RADIOLOGICAL SUPERVISION AND I
77055   - MAMMOGRAPHY; UNILATERAL
77056   - MAMMOGRAPHY; BILATERAL
77057   - SCREENING MAMMOGRAPHY, BILATERAL (2-VIEW FILM STUDY OF EACH BREAST)
77058   - MAGNETIC RESONANCE IMAGING, BREAST, WITHOUT AND/OR WITH CONTRAST MATERIAL(S); UN
77059   - MAGNETIC RESONANCE IMAGING, BREAST, WITHOUT AND/OR WITH CONTRAST MATERIAL(S); BI



                                              Page 429
                                    All Other (no trigger bundling)


77071   - MANUAL APPLICATION OF STRESS PERFORMED BY PHYSICIAN FOR JOINT RADIOGRAPHY, INCLU
77072   - BONE AGE STUDIES
77073   - BONE LENGTH STUDIES (ORTHOROENTGENOGRAM, SCANOGRAM)
77074   - RADIOLOGIC EXAMINATION, OSSEOUS SURVEY; LIMITED (EG, FOR METASTASES)
77075   - RADIOLOGIC EXAMINATION, OSSEOUS SURVEY; COMPLETE (AXIAL AND APPENDICULAR SKELETO
77076   - RADIOLOGIC EXAMINATION, OSSEOUS SURVEY, INFANT
77077   - JOINT SURVEY, SINGLE VIEW, 2 OR MORE JOINTS (SPECIFY)
77078   - COMPUTED TOMOGRAPHY, BONE MINERAL DENSITY STUDY, 1 OR MORE SITES; AXIAL SKELETON
77079   - COMPUTED TOMOGRAPHY, BONE MINERAL DENSITY STUDY, 1 OR MORE SITES; APPENDICULAR S
77080   - DUAL-ENERGY X-RAY ABSORPTIOMETRY (DXA), BONE DENSITY STUDY, 1 OR MORE SITES; AXI
77081   - DUAL-ENERGY X-RAY ABSORPTIOMETRY (DXA), BONE DENSITY STUDY, 1 OR MORE SITES; APP
77082   - DUAL-ENERGY X-RAY ABSORPTIOMETRY (DXA), BONE DENSITY STUDY, 1 OR MORE SITES; VER
77083   - RADIOGRAPHIC ABSORPTIOMETRY (EG, PHOTODENSITOMETRY, RADIOGRAMMETRY), 1 OR MORE S
77084   - MAGNETIC RESONANCE (EG, PROTON) IMAGING, BONE MARROW BLOOD SUPPLY
77261   - THERAPEUTIC RADIOLOGY TREATMENT PLANNING; SIMPLE
77262   - THERAPEUTIC RADIOLOGY TREATMENT PLANNING; INTERMEDIATE
77263   - THERAPEUTIC RADIOLOGY TREATMENT PLANNING; COMPLEX
77280   - THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING; SIMPLE
77285   - THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING; INTERMEDIATE
77290   - THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING; COMPLEX
77295   - THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING; THREE-DIMENSIONAL
77299   - UNLISTED PROCEDURE, THERAPEUTIC RADIOLOGY CLINICAL TREATMENT PLANNING
77300   - BASIC RADIATION DOSIMETRY CALCULATION, CENTRAL AXIS DEPTH DOSE CALCULATION, TDF,
77301   - INTENSITY MODULATED RADIOTHERAPY PLAN, INCLUDING DOSE-VOLUME HISTOGRAMS FOR
77305   - TELETHERAPY, ISODOSE PLAN (WHETHER HAND OR COMPUTER CALCULATED); SIMPLE (ONE OR
77310   - TELETHERAPY, ISODOSE PLAN (WHETHER HAND OR COMPUTER CALCULATED); INTERMEDIATE
77315   - TELETHERAPY, ISODOSE PLAN (WHETHER HAND OR COMPUTER CALCULATED); COMPLEX
77321   - SPECIAL TELETHERAPY PORT PLAN, PARTICLES, HEMIBODY, TOTAL BODY
77326   - BRACHYTHERAPY ISODOSE PLAN; SIMPLE (CALCULATION MADE FROM SINGLE PLANE, ONE TO
77327   - BRACHYTHERAPY ISODOSE PLAN; INTERMEDIATE (MULTIPLANE DOSAGE CALCULATIONS,
77328   - BRACHYTHERAPY ISODOSE PLAN; COMPLEX (MULTIPLANE ISODOSE PLAN, VOLUME IMPLANT
77331   - SPECIAL DOSIMETRY (EG, TLD, MICRODOSIMETRY) (SPECIFY), ONLY WHEN PRESCRIBED BY
77332   - TREATMENT DEVICES, DESIGN AND CONSTRUCTION; SIMPLE (SIMPLE BLOCK, SIMPLE BOLUS)
77333   - TREATMENT DEVICES, DESIGN AND CONSTRUCTION; INTERMEDIATE (MULTIPLE BLOCKS,
77334   - TREATMENT DEVICES, DESIGN AND CONSTRUCTION; COMPLEX (IRREGULAR BLOCKS, SPECIAL
77336   - CONTINUING MEDICAL PHYSICS CONSULTATION, INCLUDING ASSESSMENT OF TREATMENT
77338   - Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy
77370   - SPECIAL MEDICAL RADIATION PHYSICS CONSULTATION
77371   - RADIATION TREATMENT DELIVERY, STEREOTACTIC RADIOSURGERY (SRS), COMPLETE COURSE O
77372   - RADIATION TREATMENT DELIVERY, STEREOTACTIC RADIOSURGERY (SRS), COMPLETE COURSE O
77373   - STEREOTACTIC BODY RADIATION THERAPY, TREATMENT DELIVERY, PER FRACTION TO 1 OR MO
77399   - UNLISTED PROCEDURE, MEDICAL RADIATION PHYSICS, DOSIMETRY AND TREATMENT DEVICES,
77401   - RADIATION TREATMENT DELIVERY, SUPERFICIAL AND/OR ORTHO VOLTAGE
77402   - RADIATION TREATMENT DELIVERY, SINGLE TREATMENT AREA, SINGLE PORT OR PARALLEL
77403   - RADIATION TREATMENT DELIVERY, SINGLE TREATMENT AREA, SINGLE PORT OR PARALLEL
77404   - RADIATION TREATMENT DELIVERY, SINGLE TREATMENT AREA, SINGLE PORT OR PARALLEL
77407   - RADIATION TREATMENT DELIVERY, TWO SEPARATE TREATMENT AREAS, THREE OR MORE PORTS
77408   - RADIATION TREATMENT DELIVERY, TWO SEPARATE TREATMENT AREAS, THREE OR MORE PORTS
77409   - RADIATION TREATMENT DELIVERY, TWO SEPARATE TREATMENT AREAS, THREE OR MORE PORTS
77411   - RADIATION TREATMENT DELIVERY, TWO SEPARATE TREATMENT AREAS, THREE OR MORE PORTS
77412   - RADIATION TREATMENT DELIVERY, THREE OR MORE SEPARATE TREATMENT AREAS, CUSTOM BLO
77413   - RADIATION TREATMENT DELIVERY, THREE OR MORE SEPARATE TREATMENT AREAS, CUSTOM



                                              Page 430
                                    All Other (no trigger bundling)


77414   - RADIATION TREATMENT DELIVERY, THREE OR MORE SEPARATE TREATMENT AREAS, CUSTOM
77416   - RADIATION TREATMENT DELIVERY, THREE OR MORE SEPARATE TREATMENT AREAS, CUSTOM
77417   - THERAPEUTIC RADIOLOGY PORT FILM(S)
77418   - INTENSITY MODULATED TREATMENT DELIVERY, SINGLE OR MULTIPLE FIELDS/ARCS, VIA
77421   - STEREOSCOPIC X-RAY GUIDANCE FOR LOCALIZATION OF TARGET VOLUME FOR THE DELIVERY O
77422   - HIGH ENERGY NEUTRON RADIATION TREATMENT DELIVERY; SINGLE TREATMENT AREA USING A
77423   - HIGH ENERGY NEUTRON RADIATION TREATMENT DELIVERY; 1 OR MORE ISOCENTER(S) WITH CO
77427   - RADIATION TREATMENT MANAGEMENT, FIVE TREATMENTS
77431   - RADIATION THERAPY MANAGEMENT WITH COMPLETE COURSE OF THERAPY CONSISTING OF ONE
77432   - STEREOTACTIC RADIATION TREATMENT MANAGEMENT OF CRANIAL LESION(S) (COMPLETE COURS
77435   - STEREOTACTIC BODY RADIATION THERAPY, TREATMENT MANAGEMENT, PER TREATMENT COURSE,
77470   - SPECIAL TREATMENT PROCEDURE (EG, TOTAL BODY IRRADIATION, HEMIBODY RADIATION,
77499   - UNLISTED PROCEDURE, THERAPEUTIC RADIOLOGY TREATMENT MANAGEMENT
77520   - PROTON TREATMENT DELIVERY; SIMPLE, WITHOUT COMPENSATION
77522   - PROTON TREATMENT DELIVERY; SIMPLE, WITH COMPENSATION
77523   - PROTON TREATMENT DELIVERY; INTERMEDIATE
77525   - PROTON TREATMENT DELIVERY; COMPLEX
77600   - HYPERTHERMIA, EXTERNALLY GENERATED; SUPERFICIAL (IE, HEATING TO A DEPTH OF 4 CM
77605   - HYPERTHERMIA, EXTERNALLY GENERATED; DEEP (IE, HEATING TO DEPTHS GREATER THAN 4
77610   - HYPERTHERMIA GENERATED BY INTERSTITIAL PROBE(S); 5 OR FEWER INTERSTITIAL
77615   - HYPERTHERMIA GENERATED BY INTERSTITIAL PROBE(S); MORE THAN 5 INTERSTITIAL
77620   - HYPERTHERMIA GENERATED BY INTRACAVITARY PROBE(S)
77750   - INFUSION OR INSTILLATION OF RADIOELEMENT SOLUTION (INCLUDES THREE MONTHS FOLLOW-
77761   - INTRACAVITARY RADIATION SOURCE APPLICATION; SIMPLE
77762   - INTRACAVITARY RADIATION SOURCE APPLICATION; INTERMEDIATE
77763   - INTRACAVITARY RADIATION SOURCE APPLICATION; COMPLEX
77776   - INTERSTITIAL RADIATION SOURCE APPLICATION; SIMPLE
77777   - INTERSTITIAL RADIATION SOURCE APPLICATION; INTERMEDIATE
77778   - INTERSTITIAL RADIATION SOURCE APPLICATION; COMPLEX
77789   - SURFACE APPLICATION OF RADIATION SOURCE
77790   - SUPERVISION, HANDLING, LOADING OF RADIATION SOURCE
77799   - UNLISTED PROCEDURE, CLINICAL BRACHYTHERAPY
78000   - THYROID UPTAKE; SINGLE DETERMINATION
78001   - THYROID UPTAKE; MULTIPLE DETERMINATIONS
78003   - THYROID UPTAKE; STIMULATION, SUPPRESSION OR DISCHARGE (NOT INCLUDING INITIAL
78006   - THYROID IMAGING, WITH UPTAKE; SINGLE DETERMINATION
78007   - THYROID IMAGING, WITH UPTAKE; MULTIPLE DETERMINATIONS
78010   - THYROID IMAGING; ONLY
78011   - THYROID IMAGING; WITH VASCULAR FLOW
78015   - THYROID CARCINOMA METASTASES IMAGING; LIMITED AREA (EG, NECK AND CHEST ONLY)
78016   - THYROID CARCINOMA METASTASES IMAGING; WITH ADDITIONAL STUDIES (EG, URINARY
78018   - THYROID CARCINOMA METASTASES IMAGING; WHOLE BODY
78020   - THYROID CARCINOMA METASTASES UPTAKE (LIST SEPARATELY IN ADDITION TO CODE FOR
78070   - PARATHYROID IMAGING
78075   - ADRENAL IMAGING, CORTEX AND/OR MEDULLA
78099   - UNLISTED ENDOCRINE PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
78102   - BONE MARROW IMAGING; LIMITED AREA
78103   - BONE MARROW IMAGING; MULTIPLE AREAS
78104   - BONE MARROW IMAGING; WHOLE BODY
78110   - PLASMA VOLUME, RADIOPHARMACEUTICAL VOLUME-DILUTION TECHNIQUE (SEPARATE
78111   - PLASMA VOLUME, RADIOPHARMACEUTICAL VOLUME-DILUTION TECHNIQUE (SEPARATE
78120   - RED CELL VOLUME DETERMINATION (SEPARATE PROCEDURE); SINGLE SAMPLING



                                              Page 431
                                     All Other (no trigger bundling)


78121   - RED CELL VOLUME DETERMINATION (SEPARATE PROCEDURE); MULTIPLE SAMPLINGS
78122   - WHOLE BLOOD VOLUME DETERMINATION, INCLUDING SEPARATE MEASUREMENT OF PLASMA
78130   - RED CELL SURVIVAL STUDY;
78135   - RED CELL SURVIVAL STUDY; DIFFERENTIAL ORGAN/TISSUE KINETICS, (EG, SPLENIC
78140   - LABELED RED CELL SEQUESTRATION, DIFFERENTIAL ORGAN/TISSUE, (EG, SPLENIC AND/OR
78185   - SPLEEN IMAGING ONLY, WITH OR WITHOUT VASCULAR FLOW
78190   - KINETICS, STUDY OF PLATELET SURVIVAL, WITH OR WITHOUT DIFFERENTIAL ORGAN/TISSUE
78191   - PLATELET SURVIVAL STUDY
78195   - LYMPHATICS AND LYMPH NODES IMAGING
78199   - UNLISTED HEMATOPOIETIC, RETICULOENDOTHELIAL AND LYMPHATIC PROCEDURE, DIAGNOSTIC
78201   - LIVER IMAGING; STATIC ONLY
78202   - LIVER IMAGING; WITH VASCULAR FLOW
78205   - LIVER IMAGING (SPECT);
78206   - LIVER IMAGING (SPECT); WITH VASCULAR FLOW
78215   - LIVER AND SPLEEN IMAGING; STATIC ONLY
78216   - LIVER AND SPLEEN IMAGING; WITH VASCULAR FLOW
78220   - LIVER FUNCTION STUDY WITH HEPATOBILIARY AGENTS, WITH SERIAL IMAGES
78223   - HEPATOBILIARY DUCTAL SYSTEM IMAGING, INCLUDING GALLBLADDER, WITH OR WITHOUT
78230   - SALIVARY GLAND IMAGING;
78231   - SALIVARY GLAND IMAGING; WITH SERIAL IMAGES
78232   - SALIVARY GLAND FUNCTION STUDY
78258   - ESOPHAGEAL MOTILITY
78261   - GASTRIC MUCOSA IMAGING
78262   - GASTROESOPHAGEAL REFLUX STUDY
78264   - GASTRIC EMPTYING STUDY
78267   - UREA BREATH TEST, C-14 (ISOTOPIC); ACQUISITION FOR ANALYSIS
78268   - UREA BREATH TEST, C-14 (ISOTOPIC); ANALYSIS
78270   - VITAMIN B-12 ABSORPTION STUDY (EG, SCHILLING TEST); WITHOUT INTRINSIC FACTOR
78271   - VITAMIN B-12 ABSORPTION STUDY (EG, SCHILLING TEST); WITH INTRINSIC FACTOR
78272   - VITAMIN B-12 ABSORPTION STUDIES COMBINED, WITH AND WITHOUT INTRINSIC FACTOR
78278   - ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING
78282   - GASTROINTESTINAL PROTEIN LOSS
78290   - INTESTINE IMAGING (EG, ECTOPIC GASTRIC MUCOSA, MECKEL'S LOCALIZATION, VOLVULUS)
78291   - PERITONEAL-VENOUS SHUNT PATENCY TEST (EG, FOR LEVEEN, DENVER SHUNT)
78299   - UNLISTED GASTROINTESTINAL PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
78300   - BONE AND/OR JOINT IMAGING; LIMITED AREA
78305   - BONE AND/OR JOINT IMAGING; MULTIPLE AREAS
78306   - BONE AND/OR JOINT IMAGING; WHOLE BODY
78315   - BONE AND/OR JOINT IMAGING; THREE PHASE STUDY
78320   - BONE AND/OR JOINT IMAGING; TOMOGRAPHIC (SPECT)
78350   - BONE DENSITY (BONE MINERAL CONTENT) STUDY, ONE OR MORE SITES; SINGLE PHOTON
78399   - UNLISTED MUSCULOSKELETAL PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
78414   - DETERMINATION OF CENTRAL C-V HEMODYNAMICS (NON-IMAGING) (EG, EJECTION FRACTION W
78428   - CARDIAC SHUNT DETECTION
78445   - NON-CARDIAC VASCULAR FLOW IMAGING (IE, ANGIOGRAPHY, VENOGRAPHY)
78456   - ACUTE VENOUS THROMBOSIS IMAGING, PEPTIDE
78457   - VENOUS THROMBOSIS IMAGING, VENOGRAM; UNILATERAL
78458   - VENOUS THROMBOSIS IMAGING, VENOGRAM; BILATERAL
78459   - MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY (PET), METABOLIC EVALUATION
78466   - MYOCARDIAL IMAGING, INFARCT AVID, PLANAR; QUALITATIVE OR QUANTITATIVE
78468   - MYOCARDIAL IMAGING, INFARCT AVID, PLANAR; WITH EJECTION FRACTION BY FIRST PASS
78469   - MYOCARDIAL IMAGING, INFARCT AVID, PLANAR; TOMOGRAPHIC SPECT WITH OR WITHOUT



                                               Page 432
                                    All Other (no trigger bundling)


78472   - CARDIAC BLOOD POOL IMAGING, GATED EQUILIBRIUM; PLANAR, SINGLE STUDY AT REST OR
78473   - CARDIAC BLOOD POOL IMAGING, GATED EQUILIBRIUM; MULTIPLE STUDIES, WALL MOTION
78481   - CARDIAC BLOOD POOL IMAGING, (PLANAR), FIRST PASS TECHNIQUE; SINGLE STUDY, AT
78483   - CARDIAC BLOOD POOL IMAGING, (PLANAR), FIRST PASS TECHNIQUE; MULTIPLE STUDIES,
78491   - MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY (PET), PERFUSION; SINGLE STUDY
78492   - MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY (PET), PERFUSION; MULTIPLE
78494   - CARDIAC BLOOD POOL IMAGING, GATED EQUILIBRIUM, SPECT, AT REST, WALL MOTION
78496   - CARDIAC BLOOD POOL IMAGING, GATED EQUILIBRIUM, SINGLE STUDY, AT REST, WITH
78499   - UNLISTED CARDIOVASCULAR PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
78580   - PULMONARY PERFUSION IMAGING; PARTICULATE
78584   - PULMONARY PERFUSION IMAGING, PARTICULATE, WITH VENTILATION; SINGLE BREATH
78585   - PULMONARY PERFUSION IMAGING, PARTICULATE, WITH VENTILATION; REBREATHING AND
78586   - PULMONARY VENTILATION IMAGING, AEROSOL; SINGLE PROJECTION
78587   - PULMONARY VENTILATION IMAGING, AEROSOL; MULTIPLE PROJECTIONS (EG, ANTERIOR,
78588   - PULMONARY PERFUSION IMAGING, PARTICULATE, WITH VENTILATION IMAGING, AEROSOL,
78591   - PULMONARY VENTILATION IMAGING, GASEOUS, SINGLE BREATH, SINGLE PROJECTION
78593   - PULMONARY VENTILATION IMAGING, GASEOUS, WITH REBREATHING AND WASHOUT WITH OR
78594   - PULMONARY VENTILATION IMAGING, GASEOUS, WITH REBREATHING AND WASHOUT WITH OR
78596   - PULMONARY QUANTITATIVE DIFFERENTIAL FUNCTION (VENTILATION/ PERFUSION) STUDY
78599   - UNLISTED RESPIRATORY PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
78600   - BRAIN IMAGING, LESS THAN 4 STATIC VIEWS;
78601   - BRAIN IMAGING, LESS THAN 4 STATIC VIEWS; WITH VASCULAR FLOW
78605   - BRAIN IMAGING, MINIMUM 4 STATIC VIEWS;
78606   - BRAIN IMAGING, MINIMUM 4 STATIC VIEWS; WITH VASCULAR FLOW
78607   - BRAIN IMAGING, TOMOGRAPHIC (SPECT)
78608   - BRAIN IMAGING, POSITRON EMISSION TOMOGRAPHY (PET); METABOLIC EVALUATION
78609   - BRAIN IMAGING, POSITRON EMISSION TOMOGRAPHY (PET); PERFUSION EVALUATION
78610   - BRAIN IMAGING, VASCULAR FLOW ONLY
78630   - CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDING INTRODUCTION OF MATERIAL);
78635   - CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDING INTRODUCTION OF MATERIAL);
78645   - CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDING INTRODUCTION OF MATERIAL);
78647   - CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDING INTRODUCTION OF MATERIAL);
78650   - CEREBROSPINAL FLUID LEAKAGE DETECTION AND LOCALIZATION
78660   - RADIOPHARMACEUTICAL DACRYOCYSTOGRAPHY
78699   - UNLISTED NERVOUS SYSTEM PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
78700   - KIDNEY IMAGING MORPHOLOGY;
78701   - KIDNEY IMAGING; WITH VASCULAR FLOW
78707   - KIDNEY IMAGING MORPHOLOGY; WITH VASCULAR FLOW AND FUNCTION, SINGLE STUDY WITHOUT
78708   - KIDNEY IMAGING MORPHOLOGY; WITH VASCULAR FLOW AND FUNCTION, SINGLE STUDY, WITH P
78709   - KIDNEY IMAGING MORPHOLOGY; WITH VASCULAR FLOW AND FUNCTION, MULTIPLE STUDIES, WI
78710   - KIDNEY IMAGING MORPHOLOGY; TOMOGRAPHIC (SPECT)
78725   - KIDNEY FUNCTION STUDY, NON-IMAGING RADIOISOTOPIC STUDY
78730   - URINARY BLADDER RESIDUAL STUDY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY
78740   - URETERAL REFLUX STUDY (RADIOPHARMACEUTICAL VOIDING CYSTOGRAM)
78761   - TESTICULAR IMAGING WITH VASCULAR FLOW
78799   - UNLISTED GENITOURINARY PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
78800   - RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR OR DISTRIBUTION OF RADIOPHARMACEUTICAL
78801   - RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR OR DISTRIBUTION OF
78802   - RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR OR DISTRIBUTION OF
78803   - RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR OR DISTRIBUTION OF
78804   - RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR OR DISTRIBUTION OF
78805   - RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; LIMITED AREA



                                              Page 433
                                 All Other (no trigger bundling)


78806 - RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY
78807 - RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; TOMOGRAPHIC (SPECT)
78808 - INJECTION PROCEDURE FOR RADIOPHARMACEUTICAL LOCALIZATION BY NON-IMAGING PROBE ST
78811 - POSITRON EMISSION TOMOGRAPHY (PET) IMAGING; LIMITED AREA (EG, CHEST, HEAD/NECK)
78812 - POSITRON EMISSION TOMOGRAPHY (PET) IMAGING; SKULL BASE TO MID-THIGH
78813 - POSITRON EMISSION TOMOGRAPHY (PET) IMAGING; WHOLE BODY
78814 - POSITRON EMISSION TOMOGRAPHY (PET) WITH CONCURRENTLY ACQUIRED COMPUTED TOMOGRAPH
78815 - POSITRON EMISSION TOMOGRAPHY (PET) WITH CONCURRENTLY ACQUIRED COMPUTED TOMOGRAPH
78816 - POSITRON EMISSION TOMOGRAPHY (PET) WITH CONCURRENTLY ACQUIRED COMPUTED TOMOGRAPH
78999 - UNLISTED MISCELLANEOUS PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
79005 - RADIOPHARMACEUTICAL THERAPY, BY ORAL ADMINISTRATION
79101 - RADIOPHARMACEUTICAL THERAPY, BY INTRAVENOUS ADMINISTRATION
79200 - RADIOPHARMACEUTICAL THERAPY, BY INTRACAVITARY ADMINISTRATION
79300 - RADIOPHARMACEUTICAL THERAPY, BY INTERSTITIAL RADIOACTIVE COLLOID ADMINISTRATION
79403 - RADIOPHARMACEUTICAL THERAPY, RADIOLABELED MONOCLONAL ANTIBODY BY INTRAVENOUS
79440 - RADIOPHARMACEUTICAL THERAPY, BY INTRA-ARTICULAR ADMINISTRATION
79445 - RADIOPHARMACEUTICAL THERAPY, BY INTRA-ARTERIAL PARTICULATE ADMINISTRATION
79999 - RADIOPHARMACEUTICAL THERAPY, UNLISTED PROCEDURE
80047 - BASIC METABOLIC PANEL (CALCIUM, IONIZED)
80048 - BASIC METABOLIC PANEL (CALCIUM, TOTAL)
80050 - GENERAL HEALTH PANEL
80051 - ELECTROLYTE PANEL
80053 - COMPREHENSIVE METABOLIC PANEL
80055 - OBSTETRIC PANEL
80061 - LIPID PANEL
80069 - RENAL FUNCTION PANEL
80074 - ACUTE HEPATITIS PANEL
80076 - HEPATIC FUNCTION PANEL
80100 - DRUG SCREEN, QUALITATIVE; MULTIPLE DRUG CLASSES CHROMATOGRAPHIC METHOD, EACH PRO
80101 - DRUG SCREEN, QUALITATIVE; SINGLE DRUG CLASS METHOD (EG, IMMUNOASSAY, ENZYME
80102 - DRUG CONFIRMATION, EACH PROCEDURE
80103 - TISSUE PREPARATION FOR DRUG ANALYSIS
80104 - Drug screen, qualitative; multiple drug classes other than chromatographic metho
80150 - AMIKACIN
80152 - AMITRIPTYLINE
80154 - BENZODIAZEPINES
80156 - CARBAMAZEPINE; TOTAL
80157 - CARBAMAZEPINE; FREE
80158 - CYCLOSPORINE
80160 - DESIPRAMINE
80162 - DIGOXIN
80164 - DIPROPYLACETIC ACID (VALPROIC ACID)
80166 - DOXEPIN
80168 - ETHOSUXIMIDE
80170 - GENTAMICIN
80172 - GOLD
80173 - HALOPERIDOL
80174 - IMIPRAMINE
80176 - LIDOCAINE
80178 - LITHIUM
80182 - NORTRIPTYLINE
80184 - PHENOBARBITAL



                                           Page 434
                                     All Other (no trigger bundling)


80185   - PHENYTOIN; TOTAL
80186   - PHENYTOIN; FREE
80188   - PRIMIDONE
80190   - PROCAINAMIDE;
80192   - PROCAINAMIDE; WITH METABOLITES (EG, N-ACETYL PROCAINAMIDE)
80194   - QUINIDINE
80195   - SIROLIMUS
80196   - SALICYLATE
80197   - TACROLIMUS
80198   - THEOPHYLLINE
80200   - TOBRAMYCIN
80201   - TOPIRAMATE
80202   - VANCOMYCIN
80299   - QUANTITATION OF DRUG, NOT ELSEWHERE SPECIFIED
80400   - ACTH STIMULATION PANEL; FOR ADRENAL INSUFFICIENCY
80402   - ACTH STIMULATION PANEL; FOR 21 HYDROXYLASE DEFICIENCY
80406   - ACTH STIMULATION PANEL; FOR 3 BETA-HYDROXYDEHYDROGENASE DEFICIENCY
80408   - ALDOSTERONE SUPPRESSION EVALUATION PANEL (EG, SALINE INFUSION)
80410   - CALCITONIN STIMULATION PANEL (EG, CALCIUM, PENTAGASTRIN)
80412   - CORTICOTROPIC RELEASING HORMONE (CRH) STIMULATION PANEL
80414   - CHORIONIC GONADOTROPIN STIMULATION PANEL; TESTOSTERONE RESPONSE
80415   - CHORIONIC GONADOTROPIN STIMULATION PANEL; ESTRADIOL RESPONSE
80416   - RENAL VEIN RENIN STIMULATION PANEL (EG, CAPTOPRIL)
80417   - PERIPHERAL VEIN RENIN STIMULATION PANEL (EG, CAPTOPRIL)
80418   - COMBINED RAPID ANTERIOR PITUITARY EVALUATION PANEL
80420   - DEXAMETHASONE SUPPRESSION PANEL, 48 HOUR
80422   - GLUCAGON TOLERANCE PANEL; FOR INSULINOMA
80424   - GLUCAGON TOLERANCE PANEL; FOR PHEOCHROMOCYTOMA
80426   - GONADOTROPIN RELEASING HORMONE STIMULATION PANEL
80428   - GROWTH HORMONE STIMULATION PANEL (EG, ARGININE INFUSION, L-DOPA ADMINISTRATION)
80430   - GROWTH HORMONE SUPPRESSION PANEL (GLUCOSE ADMINISTRATION)
80432   - INSULIN-INDUCED C-PEPTIDE SUPPRESSION PANEL
80434   - INSULIN TOLERANCE PANEL; FOR ACTH INSUFFICIENCY
80435   - INSULIN TOLERANCE PANEL; FOR GROWTH HORMONE DEFICIENCY
80436   - METYRAPONE PANEL
80438   - THYROTROPIN RELEASING HORMONE (TRH) STIMULATION PANEL; ONE HOUR
80439   - THYROTROPIN RELEASING HORMONE (TRH) STIMULATION PANEL; TWO HOUR
80440   - THYROTROPIN RELEASING HORMONE (TRH) STIMULATION PANEL; FOR HYPERPROLACTINEMIA
80500   - CLINICAL PATHOLOGY CONSULTATION; LIMITED, WITHOUT REVIEW OF PATIENT'S HISTORY AN
80502   - CLINICAL PATHOLOGY CONSULTATION; COMPREHENSIVE, FOR A COMPLEX DIAGNOSTIC
81000   - URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, K
81001   - URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN,
81002   - URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN,
81003   - URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN,
81005   - URINALYSIS; QUALITATIVE OR SEMIQUANTITATIVE, EXCEPT IMMUNOASSAYS
81007   - URINALYSIS; BACTERIURIA SCREEN, EXCEPT BY CULTURE OR DIPSTICK
81015   - URINALYSIS; MICROSCOPIC ONLY
81020   - URINALYSIS; TWO OR THREE GLASS TEST
81025   - URINE PREGNANCY TEST, BY VISUAL COLOR COMPARISON METHODS
81050   - VOLUME MEASUREMENT FOR TIMED COLLECTION, EACH
81099   - UNLISTED URINALYSIS PROCEDURE
82000   - ACETALDEHYDE, BLOOD



                                               Page 435
                                      All Other (no trigger bundling)


82003   - ACETAMINOPHEN
82009   - ACETONE OR OTHER KETONE BODIES, SERUM; QUALITATIVE
82010   - ACETONE OR OTHER KETONE BODIES, SERUM; QUANTITATIVE
82013   - ACETYLCHOLINESTERASE
82016   - ACYLCARNITINES; QUALITATIVE, EACH SPECIMEN
82017   - ACYLCARNITINES; QUANTITATIVE, EACH SPECIMEN
82024   - ADRENOCORTICOTROPIC HORMONE (ACTH)
82030   - ADENOSINE, 5-MONOPHOSPHATE, CYCLIC (CYCLIC AMP)
82040   - ALBUMIN; SERUM, PLASMA OR WHOLE BLOOD
82042   - ALBUMIN; URINE OR OTHER SOURCE, QUANTITATIVE, EACH SPECIMEN
82043   - ALBUMIN; URINE, MICROALBUMIN, QUANTITATIVE
82044   - ALBUMIN; URINE, MICROALBUMIN, SEMIQUANTITATIVE (EG, REAGENT STRIP ASSAY)
82045   - ALBUMIN; ISCHEMIA MODIFIED
82055   - ALCOHOL (ETHANOL); ANY SPECIMEN EXCEPT BREATH
82075   - ALCOHOL (ETHANOL); BREATH
82085   - ALDOLASE
82088   - ALDOSTERONE
82101   - ALKALOIDS, URINE, QUANTITATIVE
82103   - ALPHA-1-ANTITRYPSIN; TOTAL
82104   - ALPHA-1-ANTITRYPSIN; PHENOTYPE
82105   - ALPHA-FETOPROTEIN; SERUM
82106   - ALPHA-FETOPROTEIN; AMNIOTIC FLUID
82107   - ALPHA-FETOPROTEIN (AFP); AFP-L3 FRACTION ISOFORM AND TOTAL AFP (INCLUDING RATIO)
82108   - ALUMINUM
82120   - AMINES, VAGINAL FLUID, QUALITATIVE
82127   - AMINO ACIDS; SINGLE, QUALITATIVE, EACH SPECIMEN
82128   - AMINO ACIDS; MULTIPLE, QUALITATIVE, EACH SPECIMEN
82131   - AMINO ACIDS; SINGLE, QUANTITATIVE, EACH SPECIMEN
82135   - AMINOLEVULINIC ACID, DELTA (ALA)
82136   - AMINO ACIDS, 2 TO 5 AMINO ACIDS, QUANTITATIVE, EACH SPECIMEN
82139   - AMINO ACIDS, 6 OR MORE AMINO ACIDS, QUANTITATIVE, EACH SPECIMEN
82140   - AMMONIA
82143   - AMNIOTIC FLUID SCAN (SPECTROPHOTOMETRIC)
82145   - AMPHETAMINE OR METHAMPHETAMINE
82150   - AMYLASE
82154   - ANDROSTANEDIOL GLUCURONIDE
82157   - ANDROSTENEDIONE
82160   - ANDROSTERONE
82163   - ANGIOTENSIN II
82164   - ANGIOTENSIN I - CONVERTING ENZYME (ACE)
82172   - APOLIPOPROTEIN, EACH
82175   - ARSENIC
82180   - ASCORBIC ACID (VITAMIN C), BLOOD
82190   - ATOMIC ABSORPTION SPECTROSCOPY, EACH ANALYTE
82205   - BARBITURATES, NOT ELSEWHERE SPECIFIED
82232   - BETA-2 MICROGLOBULIN
82239   - BILE ACIDS; TOTAL
82240   - BILE ACIDS; CHOLYLGLYCINE
82247   - BILIRUBIN; TOTAL
82248   - BILIRUBIN; DIRECT
82252   - BILIRUBIN; FECES, QUALITATIVE
82261   - BIOTINIDASE, EACH SPECIMEN



                                                Page 436
                                      All Other (no trigger bundling)


82270   - BLOOD, OCCULT, BY PEROXIDASE ACTIVITY (EG, GUAIAC), QUALITATIVE; FECES, CONSECUT
82271   - BLOOD, OCCULT, BY PEROXIDASE ACTIVITY (EG, GUAIAC), QUALITATIVE; OTHER SOURCES
82272   - BLOOD, OCCULT, BY PEROXIDASE ACTIVITY (EG, GUAIAC), QUALITATIVE, FECES, 1-3 SIMU
82274   - BLOOD, OCCULT, BY FECAL HEMOGLOBIN DETERMINATION BY IMMUNOASSAY, QUALITATIVE,
82286   - BRADYKININ
82300   - CADMIUM
82306   - VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED
82308   - CALCITONIN
82310   - CALCIUM; TOTAL
82330   - CALCIUM; IONIZED
82331   - CALCIUM; AFTER CALCIUM INFUSION TEST
82340   - CALCIUM; URINE QUANTITATIVE, TIMED SPECIMEN
82355   - CALCULUS; QUALITATIVE ANALYSIS
82360   - CALCULUS; QUANTITATIVE ANALYSIS, CHEMICAL
82365   - CALCULUS; INFRARED SPECTROSCOPY
82370   - CALCULUS; X-RAY DIFFRACTION
82373   - CARBOHYDRATE DEFICIENT TRANSFERRIN
82374   - CARBON DIOXIDE (BICARBONATE)
82375   - CARBOXYHEMOGLOBIN; QUANTITATIVE
82376   - CARBOXYHEMOGLOBIN; QUALITATIVE
82378   - CARCINOEMBRYONIC ANTIGEN (CEA)
82379   - CARNITINE (TOTAL AND FREE), QUANTITATIVE, EACH SPECIMEN
82380   - CAROTENE
82382   - CATECHOLAMINES; TOTAL URINE
82383   - CATECHOLAMINES; BLOOD
82384   - CATECHOLAMINES; FRACTIONATED
82387   - CATHEPSIN-D
82390   - CERULOPLASMIN
82397   - CHEMILUMINESCENT ASSAY
82415   - CHLORAMPHENICOL
82435   - CHLORIDE; BLOOD
82436   - CHLORIDE; URINE
82438   - CHLORIDE; OTHER SOURCE
82441   - CHLORINATED HYDROCARBONS, SCREEN
82465   - CHOLESTEROL, SERUM OR WHOLE BLOOD, TOTAL
82480   - CHOLINESTERASE; SERUM
82482   - CHOLINESTERASE; RBC
82485   - CHONDROITIN B SULFATE, QUANTITATIVE
82486   - CHROMATOGRAPHY, QUALITATIVE; COLUMN (EG, GAS LIQUID OR HPLC), ANALYTE NOT
82487   - CHROMATOGRAPHY, QUALITATIVE; PAPER, 1-DIMENSIONAL, ANALYTE NOT ELSEWHERE
82488   - CHROMATOGRAPHY, QUALITATIVE; PAPER, 2-DIMENSIONAL, ANALYTE NOT ELSEWHERE
82489   - CHROMATOGRAPHY, QUALITATIVE; THIN LAYER, ANALYTE NOT ELSEWHERE SPECIFIED
82491   - CHROMATOGRAPHY, QUANTITATIVE, COLUMN (EG, GAS LIQUID OR HPLC); SINGLE ANALYTE
82492   - CHROMATOGRAPHY, QUANTITATIVE, COLUMN (EG, GAS LIQUID OR HPLC); MULTIPLE
82495   - CHROMIUM
82507   - CITRATE
82520   - COCAINE OR METABOLITE
82523   - COLLAGEN CROSS LINKS, ANY METHOD
82525   - COPPER
82528   - CORTICOSTERONE
82530   - CORTISOL; FREE
82533   - CORTISOL; TOTAL



                                                Page 437
                                    All Other (no trigger bundling)


82540   - CREATINE
82541   - COLUMN CHROMATOGRAPHY/MASS SPECTROMETRY (EG, GC/MS, OR HPLC/ MS), ANALYTE NOT
82542   - COLUMN CHROMATOGRAPHY/MASS SPECTROMETRY (EG, GC/MS, OR HPLC/ MS), ANALYTE NOT
82543   - COLUMN CHROMATOGRAPHY/MASS SPECTROMETRY (EG, GC/MS, OR HPLC/ MS), ANALYTE NOT
82544   - COLUMN CHROMATOGRAPHY/MASS SPECTROMETRY (EG, GC/MS, OR HPLC/ MS), ANALYTE NOT
82550   - CREATINE KINASE (CK), (CPK); TOTAL
82552   - CREATINE KINASE (CK), (CPK); ISOENZYMES
82553   - CREATINE KINASE (CK), (CPK); MB FRACTION ONLY
82554   - CREATINE KINASE (CK), (CPK); ISOFORMS
82565   - CREATININE; BLOOD
82570   - CREATININE; OTHER SOURCE
82575   - CREATININE; CLEARANCE
82585   - CRYOFIBRINOGEN
82595   - CRYOGLOBULIN, QUALITATIVE OR SEMI-QUANTITATIVE (EG, CRYOCRIT)
82600   - CYANIDE
82607   - CYANOCOBALAMIN (VITAMIN B-12);
82608   - CYANOCOBALAMIN (VITAMIN B-12); UNSATURATED BINDING CAPACITY
82610   - CYSTATIN C
82615   - CYSTINE AND HOMOCYSTINE, URINE, QUALITATIVE
82626   - DEHYDROEPIANDROSTERONE (DHEA)
82627   - DEHYDROEPIANDROSTERONE-SULFATE (DHEA-S)
82633   - DESOXYCORTICOSTERONE, 11-
82634   - DEOXYCORTISOL, 11-
82638   - DIBUCAINE NUMBER
82646   - DIHYDROCODEINONE
82649   - DIHYDROMORPHINONE
82651   - DIHYDROTESTOSTERONE (DHT)
82652   - DIHYDROTESTOSTERONE (DHT) 1, 25 DIHYDROXY, INCLUDES FRACTION(S), IF PERFORMED
82654   - DIMETHADIONE
82656   - ELASTASE, PANCREATIC (EL-1), FECAL, QUALITATIVE OR SEMI-QUANTITATIVE
82657   - ENZYME ACTIVITY IN BLOOD CELLS, CULTURED CELLS, OR TISSUE, NOT ELSEWHERE
82658   - ENZYME ACTIVITY IN BLOOD CELLS, CULTURED CELLS, OR TISSUE, NOT ELSEWHERE
82664   - ELECTROPHORETIC TECHNIQUE, NOT ELSEWHERE SPECIFIED
82666   - EPIANDROSTERONE
82668   - ERYTHROPOIETIN
82670   - ESTRADIOL
82671   - ESTROGENS; FRACTIONATED
82672   - ESTROGENS; TOTAL
82677   - ESTRIOL
82679   - ESTRONE
82690   - ETHCHLORVYNOL
82693   - ETHYLENE GLYCOL
82696   - ETIOCHOLANOLONE
82705   - FAT OR LIPIDS, FECES; QUALITATIVE
82710   - FAT OR LIPIDS, FECES; QUANTITATIVE
82715   - FAT DIFFERENTIAL, FECES, QUANTITATIVE
82725   - FATTY ACIDS, NONESTERIFIED
82726   - VERY LONG CHAIN FATTY ACIDS
82728   - FERRITIN
82731   - FETAL FIBRONECTIN, CERVICOVAGINAL SECRETIONS, SEMI-QUANTITATIVE
82735   - FLUORIDE
82742   - FLURAZEPAM



                                              Page 438
                                   All Other (no trigger bundling)


82746 - FOLIC ACID; SERUM
82747 - FOLIC ACID; RBC
82757 - FRUCTOSE, SEMEN
82759 - GALACTOKINASE, RBC
82760 - GALACTOSE
82775 - GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE; QUANTITATIVE
82776 - GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE; SCREEN
82784 - GAMMAGLOBULIN (IMMUNOGLOBULIN); IGA, IGD, IGG, IGM, EACH
82785 - GAMMAGLOBULIN (IMMUNOGLOBULIN); IGE
82787 - GAMMAGLOBULIN (IMMUNOGLOBULIN); IMMUNOGLOBULIN SUBCLASSES (EG, IGG1, 2, 3, OR 4)
82800 - GASES, BLOOD, PH ONLY
82803 - GASES, BLOOD, ANY COMBINATION OF PH, PCO2, PO2, CO2, HCO3 (INCLUDING CALCULATED
82805 - GASES, BLOOD, ANY COMBINATION OF PH, PCO2, PO2, CO2, HCO3 (INCLUDING CALCULATED
82810 - GASES, BLOOD, O2 SATURATION ONLY, BY DIRECT MEASUREMENT, EXCEPT PULSE OXIMETRY
82820 - HEMOGLOBIN-OXYGEN AFFINITY (PO2 FOR 50% HEMOGLOBIN SATURATION WITH OXYGEN)
82926 - GASTRIC ACID, FREE AND TOTAL, EACH SPECIMEN
82928 - GASTRIC ACID, FREE OR TOTAL, EACH SPECIMEN
82930 - Gastric acid analysis, includes pH if performed, each specimen
82938 - GASTRIN AFTER SECRETIN STIMULATION
82941 - GASTRIN
82943 - GLUCAGON
82945 - GLUCOSE, BODY FLUID, OTHER THAN BLOOD
82946 - GLUCAGON TOLERANCE TEST
82947 - GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP)
82948 - GLUCOSE; BLOOD, REAGENT STRIP
82950 - GLUCOSE; POST GLUCOSE DOSE (INCLUDES GLUCOSE)
82951 - GLUCOSE; TOLERANCE TEST (GTT), THREE SPECIMENS (INCLUDES GLUCOSE)
82952 - GLUCOSE; TOLERANCE TEST, EACH ADDITIONAL BEYOND THREE SPECIMENS
82953 - GLUCOSE; TOLBUTAMIDE TOLERANCE TEST
82955 - GLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD); QUANTITATIVE
82960 - GLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD); SCREEN
82962 - GLUCOSE, BLOOD BY GLUCOSE MONITORING DEVICE(S) CLEARED BY THE FDA SPECIFICALLY
82963 - GLUCOSIDASE, BETA
82965 - GLUTAMATE DEHYDROGENASE
82975 - GLUTAMINE (GLUTAMIC ACID AMIDE)
82977 - GLUTAMYLTRANSFERASE, GAMMA (GGT)
82978 - GLUTATHIONE
82979 - GLUTATHIONE REDUCTASE, RBC
82980 - GLUTETHIMIDE
82985 - GLYCATED PROTEIN
83001 - GONADOTROPIN; FOLLICLE STIMULATING HORMONE (FSH)
83002 - GONADOTROPIN; LUTEINIZING HORMONE (LH)
83003 - GROWTH HORMONE, HUMAN (HGH) (SOMATOTROPIN)
83008 - GUANOSINE MONOPHOSPHATE (GMP), CYCLIC
83009 - HELICOBACTER PYLORI, BLOOD TEST ANALYSIS FOR UREASE ACTIVITY, NON-RADIOACTIVE
83010 - HAPTOGLOBIN; QUANTITATIVE
83012 - HAPTOGLOBIN; PHENOTYPES
83013 - HELICOBACTER PYLORI; BREATH TEST ANALYSIS FOR UREASE ACTIVITY, NON-RADIOACTIVE
83014 - HELICOBACTER PYLORI; DRUG ADMINISTRATION
83015 - HEAVY METAL (EG, ARSENIC, BARIUM, BERYLLIUM, BISMUTH, ANTIMONY, MERCURY); SCREEN
83018 - HEAVY METAL (EG, ARSENIC, BARIUM, BERYLLIUM, BISMUTH, ANTIMONY, MERCURY);
83020 - HEMOGLOBIN FRACTIONATION AND QUANTITATION; ELECTROPHORESIS (EG, A2, S, C,



                                             Page 439
                                    All Other (no trigger bundling)


83021   - HEMOGLOBIN FRACTIONATION AND QUANTITATION; CHROMATOGRAPHY (EG, A2, S, C, AND/OR
83026   - HEMOGLOBIN; BY COPPER SULFATE METHOD, NON-AUTOMATED
83030   - HEMOGLOBIN; F (FETAL), CHEMICAL
83033   - HEMOGLOBIN; F (FETAL), QUALITATIVE
83036   - HEMOGLOBIN; GLYCOSYLATED (A1C)
83037   - HEMOGLOBIN; GLYCOSYLATED (A1C) BY DEVICE CLEARED BY FDA FOR HOME USE
83045   - HEMOGLOBIN; METHEMOGLOBIN, QUALITATIVE
83050   - HEMOGLOBIN; METHEMOGLOBIN, QUANTITATIVE
83051   - HEMOGLOBIN; PLASMA
83055   - HEMOGLOBIN; SULFHEMOGLOBIN, QUALITATIVE
83060   - HEMOGLOBIN; SULFHEMOGLOBIN, QUANTITATIVE
83065   - HEMOGLOBIN; THERMOLABILE
83068   - HEMOGLOBIN; UNSTABLE, SCREEN
83069   - HEMOGLOBIN; URINE
83070   - HEMOSIDERIN; QUALITATIVE
83071   - HEMOSIDERIN; QUANTITATIVE
83080   - B-HEXOSAMINIDASE, EACH ASSAY
83088   - HISTAMINE
83090   - HOMOCYSTINE
83150   - HOMOVANILLIC ACID (HVA)
83491   - HYDROXYCORTICOSTEROIDS, 17- (17-OHCS)
83497   - HYDROXYINDOLACETIC ACID, 5-(HIAA)
83498   - HYDROXYPROGESTERONE, 17-D
83499   - HYDROXYPROGESTERONE, 20-
83500   - HYDROXYPROLINE; FREE
83505   - HYDROXYPROLINE; TOTAL
83516   - IMMUNOASSAY FOR ANALYTE OTHER THAN INFECTIOUS AGENT ANTIBODY OR INFECTIOUS AGENT
83518   - IMMUNOASSAY FOR ANALYTE OTHER THAN INFECTIOUS AGENT ANTIBODY OR INFECTIOUS AGENT
83519   - IMMUNOASSAY FOR ANALYTE OTHER THAN INFECTIOUS AGENT ANTIBODY OR INFECTIOUS AGENT
83520   - IMMUNOASSAY FOR ANALYTE OTHER THAN INFECTIOUS AGENT ANTIBODY OR INFECTIOUS AGENT
83525   - INSULIN; TOTAL
83527   - INSULIN; FREE
83528   - INTRINSIC FACTOR
83540   - IRON
83550   - IRON BINDING CAPACITY
83570   - ISOCITRIC DEHYDROGENASE (IDH)
83582   - KETOGENIC STEROIDS, FRACTIONATION
83586   - KETOSTEROIDS, 17- (17-KS); TOTAL
83593   - KETOSTEROIDS, 17- (17-KS); FRACTIONATION
83605   - LACTATE (LACTIC ACID)
83615   - LACTATE DEHYDROGENASE (LD), (LDH);
83625   - LACTATE DEHYDROGENASE (LD), (LDH); ISOENZYMES, SEPARATION AND QUANTITATION
83630   - LACTOFERRIN, FECAL; QUALITATIVE
83631   - LACTOFERRIN, FECAL; QUANTITATIVE
83632   - LACTOGEN, HUMAN PLACENTAL (HPL) HUMAN CHORIONIC SOMATOMAMMOTROPIN
83633   - LACTOSE, URINE; QUALITATIVE
83634   - LACTOSE, URINE; QUANTITATIVE
83655   - LEAD
83661   - FETAL LUNG MATURITY ASSESSMENT; LECITHIN SPHINGOMYELIN (L/S) RATIO
83662   - FETAL LUNG MATURITY ASSESSMENT; FOAM STABILITY TEST
83663   - FETAL LUNG MATURITY ASSESSMENT; FLUORESCENCE POLARIZATION
83664   - FETAL LUNG MATURITY ASSESSMENT; LAMELLAR BODY DENSITY



                                              Page 440
                                    All Other (no trigger bundling)


83670   - LEUCINE AMINOPEPTIDASE (LAP)
83690   - LIPASE
83695   - LIPOPROTEIN (A)
83698   - LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2, (LP-PLA2)
83700   - LIPOPROTEIN, BLOOD; ELECTROPHORETIC SEPARATION AND QUANTITATION
83701   - LIPOPROTEIN, BLOOD; HIGH RESOLUTION FRACTIONATION AND QUANTITATION OF LIPOPROTEI
83704   - LIPOPROTEIN, BLOOD; QUANTITATION OF LIPOPROTEIN PARTICLE NUMBERS AND LIPOPROTEIN
83718   - LIPOPROTEIN, DIRECT MEASUREMENT; HIGH DENSITY CHOLESTEROL (HDL CHOLESTEROL)
83719   - LIPOPROTEIN, DIRECT MEASUREMENT; DIRECT MEASUREMENT, VLDL CHOLESTEROL
83721   - LIPOPROTEIN, DIRECT MEASUREMENT; DIRECT MEASUREMENT, LDL CHOLESTEROL
83727   - LUTEINIZING RELEASING FACTOR (LRH)
83735   - MAGNESIUM
83775   - MALATE DEHYDROGENASE
83785   - MANGANESE
83788   - MASS SPECTROMETRY AND TANDEM MASS SPECTROMETRY (MS, MS/MS), ANALYTE NOT
83789   - MASS SPECTROMETRY AND TANDEM MASS SPECTROMETRY (MS, MS/MS), ANALYTE NOT
83805   - MEPROBAMATE
83825   - MERCURY, QUANTITATIVE
83835   - METANEPHRINES
83840   - METHADONE
83857   - METHEMALBUMIN
83858   - METHSUXIMIDE
83864   - MUCOPOLYSACCHARIDES, ACID; QUANTITATIVE
83866   - MUCOPOLYSACCHARIDES, ACID; SCREEN
83872   - MUCIN, SYNOVIAL FLUID (ROPES TEST)
83873   - MYELIN BASIC PROTEIN, CEREBROSPINAL FLUID
83874   - MYOGLOBIN
83876   - Myeloperoxidase (MPO)
83880   - NATRIURETIC PEPTIDE
83883   - NEPHELOMETRY, EACH ANALYTE NOT ELSEWHERE SPECIFIED
83885   - NICKEL
83887   - NICOTINE
83890   - MOLECULAR DIAGNOSTICS; MOLECULAR ISOLATION OR EXTRACTION, EACH NUCLEIC ACID TYPE
83891   - MOLECULAR DIAGNOSTICS; ISOLATION OR EXTRACTION OF HIGHLY PURIFIED NUCLEIC ACID,
83892   - MOLECULAR DIAGNOSTICS; ENZYMATIC DIGESTION, EACH ENZYME TREATMENT
83893   - MOLECULAR DIAGNOSTICS; DOT/SLOT BLOT PRODUCTION, EACH NUCLEIC ACID PREPARATION
83894   - MOLECULAR DIAGNOSTICS; SEPARATION BY GEL ELECTROPHORESIS (EG, AGAROSE, POLYACRYL
83896   - MOLECULAR DIAGNOSTICS; NUCLEIC ACID PROBE, EACH
83897   - MOLECULAR DIAGNOSTICS; NUCLEIC ACID TRANSFER (EG, SOUTHERN, NORTHERN), EACH NUCL
83898   - MOLECULAR DIAGNOSTICS; AMPLIFICATION, TARGET, EACH NUCLEIC ACID SEQUENCE
83900   - MOLECULAR DIAGNOSTICS; AMPLIFICATION, TARGET, MULTIPLEX, FIRST TWO NUCLEIC ACID
83901   - MOLECULAR DIAGNOSTICS; AMPLIFICATION, TARGET, MULTIPLEX, EACH ADDITIONAL NUCLEIC
83902   - MOLECULAR DIAGNOSTICS; REVERSE TRANSCRIPTION
83903   - MOLECULAR DIAGNOSTICS; MUTATION SCANNING, BY PHYSICAL PROPERTIES (EG, SINGLE
83904   - MOLECULAR DIAGNOSTICS; MUTATION IDENTIFICATION BY SEQUENCING, SINGLE SEGMENT,
83905   - MOLECULAR DIAGNOSTICS; MUTATION IDENTIFICATION BY ALLELE SPECIFIC
83906   - MOLECULAR DIAGNOSTICS; MUTATION IDENTIFICATION BY ALLELE SPECIFIC TRANSLATION,
83907   - MOLECULAR DIAGNOSTICS; LYSIS OF CELLS PRIOR TO NUCLEIC ACID EXTRACTION (EG, STOO
83908   - MOLECULAR DIAGNOSTICS; AMPLIFICATION, SIGNAL, EACH NUCLEIC ACID SEQUENCE
83909   - MOLECULAR DIAGNOSTICS; SEPARATION AND IDENTIFICATION BY HIGH RESOLUTION TECHNIQU
83912   - MOLECULAR DIAGNOSTICS; INTERPRETATION AND REPORT
83913   - MOLECULAR DIAGNOSTICS; RNA STABILIZATION



                                              Page 441
                                   All Other (no trigger bundling)


83914 - MUTATION IDENTIFICATION BY ENZYMATIC LIGATION OR PRIMER EXTENSION, SINGLE SEGMEN
83915 - NUCLEOTIDASE 5-
83916 - OLIGOCLONAL IMMUNE (OLIGOCLONAL BANDS)
83918 - ORGANIC ACIDS; TOTAL, QUANTITATIVE, EACH SPECIMEN
83919 - ORGANIC ACIDS; QUALITATIVE, EACH SPECIMEN
83921 - ORGANIC ACID, SINGLE, QUANTITATIVE
83925 - OPIATE(S), DRUG AND METABOLITES, EACH PROCEDURE
83930 - OSMOLALITY; BLOOD
83935 - OSMOLALITY; URINE
83937 - OSTEOCALCIN (BONE G1A PROTEIN)
83945 - OXALATE
83950 - ONCOPROTEIN; HER-2/NEU
83951 - Oncoprotein; des-gamma-carboxy-prothrombin (DCP)
83970 - PARATHORMONE (PARATHYROID HORMONE)
83986 - PH; BODY FLUID, NOT OTHERWISE SPECIFIED
83987 - pH; exhaled breath condensate
83992 - PHENCYCLIDINE (PCP)
83993 - CALPROTECTIN, FECAL
84022 - PHENOTHIAZINE
84030 - PHENYLALANINE (PKU), BLOOD
84035 - PHENYLKETONES, QUALITATIVE
84060 - PHOSPHATASE, ACID; TOTAL
84061 - PHOSPHATASE, ACID; FORENSIC EXAMINATION
84066 - PHOSPHATASE, ACID; PROSTATIC
84075 - PHOSPHATASE, ALKALINE;
84078 - PHOSPHATASE, ALKALINE; HEAT STABLE (TOTAL NOT INCLUDED)
84080 - PHOSPHATASE, ALKALINE; ISOENZYMES
84081 - PHOSPHATIDYLGLYCEROL
84085 - PHOSPHOGLUCONATE, 6-, DEHYDROGENASE, RBC
84087 - PHOSPHOHEXOSE ISOMERASE
84100 - PHOSPHORUS INORGANIC (PHOSPHATE);
84105 - PHOSPHORUS INORGANIC (PHOSPHATE); URINE
84106 - PORPHOBILINOGEN, URINE; QUALITATIVE
84110 - PORPHOBILINOGEN, URINE; QUANTITATIVE
84112 - Placental alpha microglobulin-1 (PAMG-1), cervicovaginal secretion, qualitative
84119 - PORPHYRINS, URINE; QUALITATIVE
84120 - PORPHYRINS, URINE; QUANTITATION AND FRACTIONATION
84126 - PORPHYRINS, FECES; QUANTITATIVE
84127 - PORPHYRINS, FECES; QUALITATIVE
84132 - POTASSIUM; SERUM, PLASMA OR WHOLE BLOOD
84133 - POTASSIUM; URINE
84134 - PREALBUMIN
84135 - PREGNANEDIOL
84138 - PREGNANETRIOL
84140 - PREGNENOLONE
84143 - 17-HYDROXYPREGNENOLONE
84144 - PROGESTERONE
84145 - Procalcitonin (PCT)
84146 - PROLACTIN
84150 - PROSTAGLANDIN, EACH
84152 - PROSTATE SPECIFIC ANTIGEN (PSA); COMPLEXED (DIRECT MEASUREMENT)
84153 - PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL



                                             Page 442
                                   All Other (no trigger bundling)


84154   - PROSTATE SPECIFIC ANTIGEN (PSA); FREE
84155   - PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; SERUM, PLASMA OR WHOLE BLOOD
84156   - PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; URINE
84157   - PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; OTHER SOURCE (EG, SYNOVIAL FLUID,
84160   - PROTEIN, TOTAL, BY REFRACTOMETRY, ANY SOURCE
84163   - PREGNANCY-ASSOCIATED PLASMA PROTEIN-A (PAPP-A)
84165   - PROTEIN; ELECTROPHORETIC FRACTIONATION AND QUANTITATION, SERUM
84166   - PROTEIN; ELECTROPHORETIC FRACTIONATION AND QUANTITATION, OTHER FLUIDS WITH
84181   - PROTEIN; WESTERN BLOT, WITH INTERPRETATION AND REPORT, BLOOD OR OTHER BODY FLUID
84182   - PROTEIN; WESTERN BLOT, WITH INTERPRETATION AND REPORT, BLOOD OR OTHER BODY
84202   - PROTOPORPHYRIN, RBC; QUANTITATIVE
84203   - PROTOPORPHYRIN, RBC; SCREEN
84206   - PROINSULIN
84207   - PYRIDOXAL PHOSPHATE (VITAMIN B-6)
84210   - PYRUVATE
84220   - PYRUVATE KINASE
84228   - QUININE
84233   - RECEPTOR ASSAY; ESTROGEN
84234   - RECEPTOR ASSAY; PROGESTERONE
84235   - RECEPTOR ASSAY; ENDOCRINE, OTHER THAN ESTROGEN OR PROGESTERONE (SPECIFY HORMONE)
84238   - RECEPTOR ASSAY; NON-ENDOCRINE (SPECIFY RECEPTOR)
84244   - RENIN
84252   - RIBOFLAVIN (VITAMIN B-2)
84255   - SELENIUM
84260   - SEROTONIN
84270   - SEX HORMONE BINDING GLOBULIN (SHBG)
84275   - SIALIC ACID
84285   - SILICA
84295   - SODIUM; SERUM, PLASMA OR WHOLE BLOOD
84300   - SODIUM; URINE
84302   - SODIUM; OTHER SOURCE
84305   - SOMATOMEDIN
84307   - SOMATOSTATIN
84311   - SPECTROPHOTOMETRY, ANALYTE NOT ELSEWHERE SPECIFIED
84315   - SPECIFIC GRAVITY (EXCEPT URINE)
84375   - SUGARS, CHROMATOGRAPHIC, TLC OR PAPER CHROMATOGRAPHY
84376   - SUGARS (MONO-, DI-, AND OLIGOSACCHARIDES); SINGLE QUALITATIVE, EACH SPECIMEN
84377   - SUGARS (MONO-, DI-, AND OLIGOSACCHARIDES); MULTIPLE QUALITATIVE, EACH SPECIMEN
84378   - SUGARS (MONO-, DI-, AND OLIGOSACCHARIDES); SINGLE QUANTITATIVE, EACH SPECIMEN
84379   - SUGARS (MONO-, DI-, AND OLIGOSACCHARIDES); MULTIPLE QUANTITATIVE, EACH SPECIMEN
84392   - SULFATE, URINE
84402   - TESTOSTERONE; FREE
84403   - TESTOSTERONE; TOTAL
84425   - THIAMINE (VITAMIN B-1)
84430   - THIOCYANATE
84431   - Thromboxane metabolite(s), including thromboxane if performed, urine
84432   - THYROGLOBULIN
84436   - THYROXINE; TOTAL
84437   - THYROXINE; REQUIRING ELUTION (EG, NEONATAL)
84439   - THYROXINE; FREE
84442   - THYROXINE BINDING GLOBULIN (TBG)
84443   - THYROID STIMULATING HORMONE (TSH)



                                             Page 443
                                    All Other (no trigger bundling)


84445   - THYROID STIMULATING IMMUNE GLOBULINS (TSI)
84446   - TOCOPHEROL ALPHA (VITAMIN E)
84449   - TRANSCORTIN (CORTISOL BINDING GLOBULIN)
84450   - TRANSFERASE; ASPARTATE AMINO (AST) (SGOT)
84460   - TRANSFERASE; ALANINE AMINO (ALT) (SGPT)
84466   - TRANSFERRIN
84478   - TRIGLYCERIDES
84479   - THYROID HORMONE (T3 OR T4) UPTAKE OR THYROID HORMONE BINDING RATIO (THBR)
84480   - TRIIODOTHYRONINE T3; TOTAL (TT-3)
84481   - TRIIODOTHYRONINE T3; FREE
84482   - TRIIODOTHYRONINE T3; REVERSE
84484   - TROPONIN, QUANTITATIVE
84485   - TRYPSIN; DUODENAL FLUID
84488   - TRYPSIN; FECES, QUALITATIVE
84490   - TRYPSIN; FECES, QUANTITATIVE, 24-HOUR COLLECTION
84510   - TYROSINE
84512   - TROPONIN, QUALITATIVE
84520   - UREA NITROGEN; QUANTITATIVE
84525   - UREA NITROGEN; SEMIQUANTITATIVE (EG, REAGENT STRIP TEST)
84540   - UREA NITROGEN, URINE
84545   - UREA NITROGEN, CLEARANCE
84550   - URIC ACID; BLOOD
84560   - URIC ACID; OTHER SOURCE
84577   - UROBILINOGEN, FECES, QUANTITATIVE
84578   - UROBILINOGEN, URINE; QUALITATIVE
84580   - UROBILINOGEN, URINE; QUANTITATIVE, TIMED SPECIMEN
84583   - UROBILINOGEN, URINE; SEMIQUANTITATIVE
84585   - VANILLYLMANDELIC ACID (VMA), URINE
84586   - VASOACTIVE INTESTINAL PEPTIDE (VIP)
84588   - VASOPRESSIN (ANTIDIURETIC HORMONE, ADH)
84590   - VITAMIN A
84591   - VITAMIN, NOT OTHERWISE SPECIFIED
84597   - VITAMIN K
84600   - VOLATILES (EG, ACETIC ANHYDRIDE, CARBON TETRACHLORIDE, DICHLOROETHANE,
84620   - XYLOSE ABSORPTION TEST, BLOOD AND/OR URINE
84630   - ZINC
84681   - C-PEPTIDE
84702   - GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE
84703   - GONADOTROPIN, CHORIONIC (HCG); QUALITATIVE
84704   - GONADOTROPIN, CHORIONIC (HCG); FREE BETA CHAIN
84999   - UNLISTED CHEMISTRY PROCEDURE
85002   - BLEEDING TIME
85004   - BLOOD COUNT; AUTOMATED DIFFERENTIAL WBC COUNT
85007   - BLOOD COUNT; BLOOD SMEAR, MICROSCOPIC EXAMINATION WITH MANUAL DIFFERENTIAL WBC
85008   - BLOOD COUNT; BLOOD SMEAR, MICROSCOPIC EXAMINATION WITHOUT MANUAL DIFFERENTIAL
85009   - BLOOD COUNT; MANUAL DIFFERENTIAL WBC COUNT, BUFFY COAT
85013   - BLOOD COUNT; SPUN MICROHEMATOCRIT
85014   - BLOOD COUNT; HEMATOCRIT (HCT)
85018   - BLOOD COUNT; HEMOGLOBIN (HGB)
85025   - BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT)
85027   - BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT)
85032   - BLOOD COUNT; MANUAL CELL COUNT (ERYTHROCYTE, LEUKOCYTE, OR PLATELET) EACH



                                              Page 444
                                     All Other (no trigger bundling)


85041   - BLOOD COUNT; RED BLOOD CELL (RBC), AUTOMATED
85044   - BLOOD COUNT; RETICULOCYTE, MANUAL
85045   - BLOOD COUNT; RETICULOCYTE, AUTOMATED
85046   - BLOOD COUNT; RETICULOCYTES, AUTOMATED, INCLUDING ONE OR MORE CELLULAR
85048   - BLOOD COUNT; LEUKOCYTE (WBC), AUTOMATED
85049   - BLOOD COUNT; PLATELET, AUTOMATED
85055   - RETICULATED PLATELET ASSAY
85060   - BLOOD SMEAR, PERIPHERAL, INTERPRETATION BY PHYSICIAN WITH WRITTEN REPORT
85097   - BONE MARROW, SMEAR INTERPRETATION
85130   - CHROMOGENIC SUBSTRATE ASSAY
85170   - CLOT RETRACTION
85175   - CLOT LYSIS TIME, WHOLE BLOOD DILUTION
85210   - CLOTTING; FACTOR II, PROTHROMBIN, SPECIFIC
85220   - CLOTTING; FACTOR V (ACG OR PROACCELERIN), LABILE FACTOR
85230   - CLOTTING; FACTOR VII (PROCONVERTIN, STABLE FACTOR)
85240   - CLOTTING; FACTOR VIII (AHG), ONE STAGE
85244   - CLOTTING; FACTOR VIII RELATED ANTIGEN
85245   - CLOTTING; FACTOR VIII, VW FACTOR, RISTOCETIN COFACTOR
85246   - CLOTTING; FACTOR VIII, VW FACTOR ANTIGEN
85247   - CLOTTING; FACTOR VIII, VON WILLEBRAND FACTOR, MULTIMETRIC ANALYSIS
85250   - CLOTTING; FACTOR IX (PTC OR CHRISTMAS)
85260   - CLOTTING; FACTOR X (STUART-PROWER)
85270   - CLOTTING; FACTOR XI (PTA)
85280   - CLOTTING; FACTOR XII (HAGEMAN)
85290   - CLOTTING; FACTOR XIII (FIBRIN STABILIZING)
85291   - CLOTTING; FACTOR XIII (FIBRIN STABILIZING), SCREEN SOLUBILITY
85292   - CLOTTING; PREKALLIKREIN ASSAY (FLETCHER FACTOR ASSAY)
85293   - CLOTTING; HIGH MOLECULAR WEIGHT KININOGEN ASSAY (FITZGERALD FACTOR ASSAY)
85300   - CLOTTING INHIBITORS OR ANTICOAGULANTS; ANTITHROMBIN III, ACTIVITY
85301   - CLOTTING INHIBITORS OR ANTICOAGULANTS; ANTITHROMBIN III, ANTIGEN ASSAY
85302   - CLOTTING INHIBITORS OR ANTICOAGULANTS; PROTEIN C, ANTIGEN
85303   - CLOTTING INHIBITORS OR ANTICOAGULANTS; PROTEIN C, ACTIVITY
85305   - CLOTTING INHIBITORS OR ANTICOAGULANTS; PROTEIN S, TOTAL
85306   - CLOTTING INHIBITORS OR ANTICOAGULANTS; PROTEIN S, FREE
85307   - ACTIVATED PROTEIN C (APC) RESISTANCE ASSAY
85335   - FACTOR INHIBITOR TEST
85337   - THROMBOMODULIN
85345   - COAGULATION TIME; LEE AND WHITE
85347   - COAGULATION TIME; ACTIVATED
85348   - COAGULATION TIME; OTHER METHODS
85360   - EUGLOBULIN LYSIS
85362   - FIBRIN(OGEN) DEGRADATION (SPLIT) PRODUCTS (FDP)(FSP); AGGLUTINATION SLIDE,
85366   - FIBRIN(OGEN) DEGRADATION (SPLIT) PRODUCTS (FDP)(FSP); PARACOAGULATION
85370   - FIBRIN(OGEN) DEGRADATION (SPLIT) PRODUCTS (FDP)(FSP); QUANTITATIVE
85378   - FIBRIN DEGRADATION PRODUCTS, D-DIMER; QUALITATIVE OR SEMIQUANTITATIVE
85379   - FIBRIN DEGRADATION PRODUCTS, D-DIMER; QUANTITATIVE
85380   - FIBRIN DEGRADATION PRODUCTS, D-DIMER; ULTRASENSITIVE (EG, FOR EVALUATION FOR
85384   - FIBRINOGEN; ACTIVITY
85385   - FIBRINOGEN; ANTIGEN
85390   - FIBRINOLYSINS OR COAGULOPATHY SCREEN, INTERPRETATION AND REPORT
85396   - COAGULATION/FIBRINOLYSIS ASSAY, WHOLE BLOOD (EG, VISCOELASTIC CLOT ASSESSMENT),
85397   - Coagulation and fibrinolysis, functional activity, not otherwise specified (eg,



                                               Page 445
                                   All Other (no trigger bundling)


85400 - FIBRINOLYTIC FACTORS AND INHIBITORS; PLASMIN
85410 - FIBRINOLYTIC FACTORS AND INHIBITORS; ALPHA-2 ANTIPLASMIN
85415 - FIBRINOLYTIC FACTORS AND INHIBITORS; PLASMINOGEN ACTIVATOR
85420 - FIBRINOLYTIC FACTORS AND INHIBITORS; PLASMINOGEN, EXCEPT ANTIGENIC ASSAY
85421 - FIBRINOLYTIC FACTORS AND INHIBITORS; PLASMINOGEN, ANTIGENIC ASSAY
85441 - HEINZ BODIES; DIRECT
85445 - HEINZ BODIES; INDUCED, ACETYL PHENYLHYDRAZINE
85460 - HEMOGLOBIN OR RBCS, FETAL, FOR FETOMATERNAL HEMORRHAGE; DIFFERENTIAL LYSIS
85461 - HEMOGLOBIN OR RBCS, FETAL, FOR FETOMATERNAL HEMORRHAGE; ROSETTE
85475 - HEMOLYSIN, ACID
85520 - HEPARIN ASSAY
85525 - HEPARIN NEUTRALIZATION
85530 - HEPARIN-PROTAMINE TOLERANCE TEST
85536 - IRON STAIN, PERIPHERAL BLOOD
85540 - LEUKOCYTE ALKALINE PHOSPHATASE WITH COUNT
85547 - MECHANICAL FRAGILITY, RBC
85549 - MURAMIDASE
85555 - OSMOTIC FRAGILITY, RBC; UNINCUBATED
85557 - OSMOTIC FRAGILITY, RBC; INCUBATED
85576 - PLATELET, AGGREGATION (IN VITRO), EACH AGENT
85597 - PLATELET NEUTRALIZATION
85598 - Phospholipid neutralization; hexagonal phospholipid
85610 - PROTHROMBIN TIME;
85611 - PROTHROMBIN TIME; SUBSTITUTION, PLASMA FRACTIONS, EACH
85612 - RUSSELL VIPER VENOM TIME (INCLUDES VENOM); UNDILUTED
85613 - RUSSELL VIPER VENOM TIME (INCLUDES VENOM); DILUTED
85635 - REPTILASE TEST
85651 - SEDIMENTATION RATE, ERYTHROCYTE; NON-AUTOMATED
85652 - SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED
85660 - SICKLING OF RBC, REDUCTION
85670 - THROMBIN TIME; PLASMA
85675 - THROMBIN TIME; TITER
85705 - THROMBOPLASTIN INHIBITION, TISSUE
85730 - THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD
85732 - THROMBOPLASTIN TIME, PARTIAL (PTT); SUBSTITUTION, PLASMA FRACTIONS, EACH
85810 - VISCOSITY
85999 - UNLISTED HEMATOLOGY AND COAGULATION PROCEDURE
86000 - AGGLUTININS, FEBRILE (EG, BRUCELLA, FRANCISELLA, MURINE TYPHUS, Q FEVER, ROCKY M
86001 - ALLERGEN SPECIFIC IGG QUANTITATIVE OR SEMIQUANTITATIVE, EACH ALLERGEN
86003 - ALLERGEN SPECIFIC IGE; QUANTITATIVE OR SEMIQUANTITATIVE, EACH ALLERGEN
86005 - ALLERGEN SPECIFIC IGE; QUALITATIVE, MULTIALLERGEN SCREEN (DIPSTICK, PADDLE OR
86021 - ANTIBODY IDENTIFICATION; LEUKOCYTE ANTIBODIES
86022 - ANTIBODY IDENTIFICATION; PLATELET ANTIBODIES
86023 - ANTIBODY IDENTIFICATION; PLATELET ASSOCIATED IMMUNOGLOBULIN ASSAY
86038 - ANTINUCLEAR ANTIBODIES (ANA);
86039 - ANTINUCLEAR ANTIBODIES (ANA); TITER
86060 - ANTISTREPTOLYSIN 0; TITER
86063 - ANTISTREPTOLYSIN 0; SCREEN
86077 - BLOOD BANK PHYSICIAN SERVICES; DIFFICULT CROSS MATCH AND/OR EVALUATION OF
86078 - BLOOD BANK PHYSICIAN SERVICES; INVESTIGATION OF TRANSFUSION REACTION INCLUDING
86079 - BLOOD BANK PHYSICIAN SERVICES; AUTHORIZATION FOR DEVIATION FROM STANDARD BLOOD
86140 - C-REACTIVE PROTEIN;



                                             Page 446
                                    All Other (no trigger bundling)


86141   - C-REACTIVE PROTEIN; HIGH SENSITIVITY (HSCRP)
86146   - BETA 2 GLYCOPROTEIN I ANTIBODY, EACH
86147   - CARDIOLIPIN (PHOSPHOLIPID) ANTIBODY, EACH IG CLASS
86148   - ANTI-PHOSPHATIDYLSERINE (PHOSPHOLIPID) ANTIBODY
86155   - CHEMOTAXIS ASSAY, SPECIFY METHOD
86156   - COLD AGGLUTININ; SCREEN
86157   - COLD AGGLUTININ; TITER
86160   - COMPLEMENT; ANTIGEN, EACH COMPONENT
86161   - COMPLEMENT; FUNCTIONAL ACTIVITY, EACH COMPONENT
86162   - COMPLEMENT; TOTAL HEMOLYTIC (CH50)
86171   - COMPLEMENT FIXATION TESTS, EACH ANTIGEN
86185   - COUNTERIMMUNOELECTROPHORESIS, EACH ANTIGEN
86200   - CYCLIC CITRULLINATED PEPTIDE (CCP), ANTIBODY
86215   - DEOXYRIBONUCLEASE, ANTIBODY
86225   - DEOXYRIBONUCLEIC ACID (DNA) ANTIBODY; NATIVE OR DOUBLE STRANDED
86226   - DEOXYRIBONUCLEIC ACID (DNA) ANTIBODY; SINGLE STRANDED
86235   - EXTRACTABLE NUCLEAR ANTIGEN, ANTIBODY TO, ANY METHOD (EG, NRNP, SS-A, SS-B, SM,
86243   - FC RECEPTOR
86255   - FLUORESCENT NONINFECTIOUS AGENT ANTIBODY; SCREEN, EACH ANTIBODY
86256   - FLUORESCENT NONINFECTIOUS AGENT ANTIBODY; TITER, EACH ANTIBODY
86277   - GROWTH HORMONE, HUMAN (HGH), ANTIBODY
86280   - HEMAGGLUTINATION INHIBITION TEST (HAI)
86294   - IMMUNOASSAY FOR TUMOR ANTIGEN, QUALITATIVE OR SEMIQUANTITATIVE (EG, BLADDER
86300   - IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 15-3 (27.29)
86301   - IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 19-9
86304   - IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 125
86308   - HETEROPHILE ANTIBODIES; SCREENING
86309   - HETEROPHILE ANTIBODIES; TITER
86310   - HETEROPHILE ANTIBODIES; TITERS AFTER ABSORPTION WITH BEEF CELLS AND GUINEA PIG
86316   - IMMUNOASSAY FOR TUMOR ANTIGEN, OTHER ANTIGEN, QUANTITATIVE (EG, CA 50, 72-4,
86317   - IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY, QUANTITATIVE, NOT OTHERWISE SPECIFIED
86318   - IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY, QUALITATIVE OR SEMIQUANTITATIVE,
86320   - IMMUNOELECTROPHORESIS; SERUM
86325   - IMMUNOELECTROPHORESIS; OTHER FLUIDS (EG, URINE, CEREBROSPINAL FLUID) WITH
86327   - IMMUNOELECTROPHORESIS; CROSSED (2-DIMENSIONAL ASSAY)
86329   - IMMUNODIFFUSION; NOT ELSEWHERE SPECIFIED
86331   - IMMUNODIFFUSION; GEL DIFFUSION, QUALITATIVE (OUCHTERLONY), EACH ANTIGEN OR
86332   - IMMUNE COMPLEX ASSAY
86334   - IMMUNOFIXATION ELECTROPHORESIS; SERUM
86335   - IMMUNOFIXATION ELECTROPHORESIS; OTHER FLUIDS WITH CONCENTRATION (EG, URINE, CSF)
86336   - INHIBIN A
86337   - INSULIN ANTIBODIES
86340   - INTRINSIC FACTOR ANTIBODIES
86341   - ISLET CELL ANTIBODY
86343   - LEUKOCYTE HISTAMINE RELEASE TEST (LHR)
86344   - LEUKOCYTE PHAGOCYTOSIS
86353   - LYMPHOCYTE TRANSFORMATION, MITOGEN (PHYTOMITOGEN) OR ANTIGEN INDUCED
86355   - B CELLS, TOTAL COUNT
86356   - MONONUCLEAR CELL ANTIGEN, QUANTITATIVE (EG, FLOW CYTOMETRY), NOT OTHERWISE SPECI
86357   - NATURAL KILLER (NK) CELLS, TOTAL COUNT
86359   - T CELLS; TOTAL COUNT
86360   - T CELLS; ABSOLUTE CD4 AND CD8 COUNT, INCLUDING RATIO



                                              Page 447
                                  All Other (no trigger bundling)


86361 - T CELLS; ABSOLUTE CD4 COUNT
86367 - STEM CELLS (IE, CD34), TOTAL COUNT
86376 - MICROSOMAL ANTIBODIES (EG, THYROID OR LIVER-KIDNEY), EACH
86378 - MIGRATION INHIBITORY FACTOR TEST (MIF)
86382 - NEUTRALIZATION TEST, VIRAL
86384 - NITROBLUE TETRAZOLIUM DYE TEST (NTD)
86403 - PARTICLE AGGLUTINATION; SCREEN, EACH ANTIBODY
86406 - PARTICLE AGGLUTINATION; TITER, EACH ANTIBODY
86430 - RHEUMATOID FACTOR; QUALITATIVE
86431 - RHEUMATOID FACTOR; QUANTITATIVE
86480 - TUBERCULOSIS TEST, CELL MEDIATED IMMUNITY MEASUREMENT OF GAMMA INTERFERON ANTIGE
86481 - Tuberculosis test, cell mediated immunity antigen response measurement; enumerat
86485 - SKIN TEST; CANDIDA
86486 - SKIN TEST; UNLISTED ANTIGEN, EACH
86490 - SKIN TEST; COCCIDIOIDOMYCOSIS
86510 - SKIN TEST; HISTOPLASMOSIS
86580 - SKIN TEST; TUBERCULOSIS, INTRADERMAL
86590 - STREPTOKINASE, ANTIBODY
86592 - SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUALITATIVE (EG, VDRL, RPR, ART)
86593 - SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUANTITATIVE
86602 - ANTIBODY; ACTINOMYCES
86603 - ANTIBODY; ADENOVIRUS
86606 - ANTIBODY; ASPERGILLUS
86609 - ANTIBODY; BACTERIUM, NOT ELSEWHERE SPECIFIED
86611 - ANTIBODY; BARTONELLA
86612 - ANTIBODY; BLASTOMYCES
86615 - ANTIBODY; BORDETELLA
86617 - ANTIBODY; BORRELIA BURGDORFERI (LYME DISEASE) CONFIRMATORY TEST (EG, WESTERN
86618 - ANTIBODY; BORRELIA BURGDORFERI (LYME DISEASE)
86619 - ANTIBODY; BORRELIA (RELAPSING FEVER)
86622 - ANTIBODY; BRUCELLA
86625 - ANTIBODY; CAMPYLOBACTER
86628 - ANTIBODY; CANDIDA
86631 - ANTIBODY; CHLAMYDIA
86632 - ANTIBODY; CHLAMYDIA, IGM
86635 - ANTIBODY; COCCIDIOIDES
86638 - ANTIBODY; COXIELLA BURNETII (Q FEVER)
86641 - ANTIBODY; CRYPTOCOCCUS
86644 - ANTIBODY; CYTOMEGALOVIRUS (CMV)
86645 - ANTIBODY; CYTOMEGALOVIRUS (CMV), IGM
86648 - ANTIBODY; DIPHTHERIA
86651 - ANTIBODY; ENCEPHALITIS, CALIFORNIA (LA CROSSE)
86652 - ANTIBODY; ENCEPHALITIS, EASTERN EQUINE
86653 - ANTIBODY; ENCEPHALITIS, ST. LOUIS
86654 - ANTIBODY; ENCEPHALITIS, WESTERN EQUINE
86658 - ANTIBODY; ENTEROVIRUS (EG, COXSACKIE, ECHO, POLIO)
86663 - ANTIBODY; EPSTEIN-BARR (EB) VIRUS, EARLY ANTIGEN (EA)
86664 - ANTIBODY; EPSTEIN-BARR (EB) VIRUS, NUCLEAR ANTIGEN (EBNA)
86665 - ANTIBODY; EPSTEIN-BARR (EB) VIRUS, VIRAL CAPSID (VCA)
86666 - ANTIBODY; EHRLICHIA
86668 - ANTIBODY; FRANCISELLA TULARENSIS
86671 - ANTIBODY; FUNGUS, NOT ELSEWHERE SPECIFIED



                                            Page 448
                                     All Other (no trigger bundling)


86674   - ANTIBODY; GIARDIA LAMBLIA
86677   - ANTIBODY; HELICOBACTER PYLORI
86682   - ANTIBODY; HELMINTH, NOT ELSEWHERE SPECIFIED
86684   - ANTIBODY; HAEMOPHILUS INFLUENZA
86687   - ANTIBODY; HTLV-I
86688   - ANTIBODY; HTLV-II
86689   - ANTIBODY; HTLV OR HIV ANTIBODY, CONFIRMATORY TEST (EG, WESTERN BLOT)
86692   - ANTIBODY; HEPATITIS, DELTA AGENT
86694   - ANTIBODY; HERPES SIMPLEX, NON-SPECIFIC TYPE TEST
86695   - ANTIBODY; HERPES SIMPLEX, TYPE 1
86696   - ANTIBODY; HERPES SIMPLEX, TYPE 2
86698   - ANTIBODY; HISTOPLASMA
86701   - ANTIBODY; HIV-1
86702   - ANTIBODY; HIV-2
86703   - ANTIBODY; HIV-1 AND HIV-2, SINGLE ASSAY
86704   - HEPATITIS B CORE ANTIBODY (HBCAB); TOTAL
86705   - HEPATITIS B CORE ANTIBODY (HBCAB); IGM ANTIBODY
86706   - HEPATITIS B SURFACE ANTIBODY (HBSAB)
86707   - HEPATITIS BE ANTIBODY (HBEAB)
86708   - HEPATITIS A ANTIBODY (HAAB); TOTAL
86709   - HEPATITIS A ANTIBODY (HAAB); IGM ANTIBODY
86710   - ANTIBODY; INFLUENZA VIRUS
86713   - ANTIBODY; LEGIONELLA
86717   - ANTIBODY; LEISHMANIA
86720   - ANTIBODY; LEPTOSPIRA
86723   - ANTIBODY; LISTERIA MONOCYTOGENES
86727   - ANTIBODY; LYMPHOCYTIC CHORIOMENINGITIS
86729   - ANTIBODY; LYMPHOGRANULOMA VENEREUM
86732   - ANTIBODY; MUCORMYCOSIS
86735   - ANTIBODY; MUMPS
86738   - ANTIBODY; MYCOPLASMA
86741   - ANTIBODY; NEISSERIA MENINGITIDIS
86744   - ANTIBODY; NOCARDIA
86747   - ANTIBODY; PARVOVIRUS
86750   - ANTIBODY; PLASMODIUM (MALARIA)
86753   - ANTIBODY; PROTOZOA, NOT ELSEWHERE SPECIFIED
86756   - ANTIBODY; RESPIRATORY SYNCYTIAL VIRUS
86757   - ANTIBODY; RICKETTSIA
86759   - ANTIBODY; ROTAVIRUS
86762   - ANTIBODY; RUBELLA
86765   - ANTIBODY; RUBEOLA
86768   - ANTIBODY; SALMONELLA
86771   - ANTIBODY; SHIGELLA
86774   - ANTIBODY; TETANUS
86777   - ANTIBODY; TOXOPLASMA
86778   - ANTIBODY; TOXOPLASMA, IGM
86780   - Antibody; treponema pallidum
86784   - ANTIBODY; TRICHINELLA
86787   - ANTIBODY; VARICELLA-ZOSTER
86788   - ANTIBODY; WEST NILE VIRUS, IGM
86789   - ANTIBODY; WEST NILE VIRUS
86790   - ANTIBODY; VIRUS, NOT ELSEWHERE SPECIFIED



                                               Page 449
                                 All Other (no trigger bundling)


86793 - ANTIBODY; YERSINIA
86800 - THYROGLOBULIN ANTIBODY
86803 - HEPATITIS C ANTIBODY;
86804 - HEPATITIS C ANTIBODY; CONFIRMATORY TEST (EG, IMMUNOBLOT)
86805 - LYMPHOCYTOTOXICITY ASSAY, VISUAL CROSSMATCH; WITH TITRATION
86806 - LYMPHOCYTOTOXICITY ASSAY, VISUAL CROSSMATCH; WITHOUT TITRATION
86807 - SERUM SCREENING FOR CYTOTOXIC PERCENT REACTIVE ANTIBODY (PRA); STANDARD METHOD
86808 - SERUM SCREENING FOR CYTOTOXIC PERCENT REACTIVE ANTIBODY (PRA); QUICK METHOD
86812 - HLA TYPING; A, B, OR C (EG, A10, B7, B27), SINGLE ANTIGEN
86813 - HLA TYPING; A, B, OR C, MULTIPLE ANTIGENS
86816 - HLA TYPING; DR/DQ, SINGLE ANTIGEN
86817 - HLA TYPING; DR/DQ, MULTIPLE ANTIGENS
86821 - HLA TYPING; LYMPHOCYTE CULTURE, MIXED (MLC)
86822 - HLA TYPING; LYMPHOCYTE CULTURE, PRIMED (PLC)
86825 - Human leukocyte antigen (HLA) crossmatch, non-cytotoxic (eg, using flow cytometr
86826 - Human leukocyte antigen (HLA) crossmatch, non-cytotoxic (eg, using flow cytometr
86849 - UNLISTED IMMUNOLOGY PROCEDURE
86850 - ANTIBODY SCREEN, RBC, EACH SERUM TECHNIQUE
86860 - ANTIBODY ELUTION (RBC), EACH ELUTION
86870 - ANTIBODY IDENTIFICATION, RBC ANTIBODIES, EACH PANEL FOR EACH SERUM TECHNIQUE
86880 - ANTIHUMAN GLOBULIN TEST (COOMBS TEST); DIRECT, EACH ANTISERUM
86885 - ANTIHUMAN GLOBULIN TEST (COOMBS TEST); INDIRECT, QUALITATIVE, EACH REAGENT RED C
86886 - ANTIHUMAN GLOBULIN TEST (COOMBS TEST); INDIRECT, EACH ANTIBODY TITER
86890 - AUTOLOGOUS BLOOD OR COMPONENT, COLLECTION PROCESSING AND STORAGE; PREDEPOSITED
86891 - AUTOLOGOUS BLOOD OR COMPONENT, COLLECTION PROCESSING AND STORAGE; INTRA- OR
86900 - BLOOD TYPING; ABO
86901 - BLOOD TYPING; RH (D)
86902 - Blood typing; antigen testing of donor blood using reagent serum, each antigen t
86903 - BLOOD TYPING; ANTIGEN SCREENING FOR COMPATIBLE BLOOD UNIT USING REAGENT SERUM,
86904 - BLOOD TYPING; ANTIGEN SCREENING FOR COMPATIBLE UNIT USING PATIENT SERUM, PER
86905 - BLOOD TYPING; RBC ANTIGENS, OTHER THAN ABO OR RH (D), EACH
86906 - BLOOD TYPING; RH PHENOTYPING, COMPLETE
86920 - COMPATIBILITY TEST EACH UNIT; IMMEDIATE SPIN TECHNIQUE
86921 - COMPATIBILITY TEST EACH UNIT; INCUBATION TECHNIQUE
86922 - COMPATIBILITY TEST EACH UNIT; ANTIGLOBULIN TECHNIQUE
86923 - COMPATIBILITY TEST EACH UNIT; ELECTRONIC
86927 - FRESH FROZEN PLASMA, THAWING, EACH UNIT
86930 - FROZEN BLOOD, EACH UNIT; FREEZING (INCLUDES PREPARATION)
86931 - FROZEN BLOOD, EACH UNIT; THAWING
86932 - FROZEN BLOOD, EACH UNIT; FREEZING (INCLUDES PREPARATION) AND THAWING
86940 - HEMOLYSINS AND AGGLUTININS; AUTO, SCREEN, EACH
86941 - HEMOLYSINS AND AGGLUTININS; INCUBATED
86945 - IRRADIATION OF BLOOD PRODUCT, EACH UNIT
86950 - LEUKOCYTE TRANSFUSION
86960 - VOLUME REDUCTION OF BLOOD OR BLOOD PRODUCT (EG, RED BLOOD CELLS OR PLATELETS), E
86965 - POOLING OF PLATELETS OR OTHER BLOOD PRODUCTS
86970 - PRETREATMENT OF RBCS FOR USE IN RBC ANTIBODY DETECTION, IDENTIFICATION, AND/OR
86971 - PRETREATMENT OF RBCS FOR USE IN RBC ANTIBODY DETECTION, IDENTIFICATION, AND/OR
86972 - PRETREATMENT OF RBCS FOR USE IN RBC ANTIBODY DETECTION, IDENTIFICATION, AND/OR
86975 - PRETREATMENT OF SERUM FOR USE IN RBC ANTIBODY IDENTIFICATION; INCUBATION WITH
86976 - PRETREATMENT OF SERUM FOR USE IN RBC ANTIBODY IDENTIFICATION; BY DILUTION
86977 - PRETREATMENT OF SERUM FOR USE IN RBC ANTIBODY IDENTIFICATION; INCUBATION WITH



                                           Page 450
                                      All Other (no trigger bundling)


86978   - PRETREATMENT OF SERUM FOR USE IN RBC ANTIBODY IDENTIFICATION; BY DIFFERENTIAL
86985   - SPLITTING OF BLOOD OR BLOOD PRODUCTS, EACH UNIT
86999   - UNLISTED TRANSFUSION MEDICINE PROCEDURE
87001   - ANIMAL INOCULATION, SMALL ANIMAL; WITH OBSERVATION
87003   - ANIMAL INOCULATION, SMALL ANIMAL; WITH OBSERVATION AND DISSECTION
87015   - CONCENTRATION (ANY TYPE), FOR INFECTIOUS AGENTS
87040   - CULTURE, BACTERIAL; BLOOD, AEROBIC, WITH ISOLATION AND PRESUMPTIVE
87045   - CULTURE, BACTERIAL; STOOL, AEROBIC, WITH ISOLATION AND PRELIMINARY EXAMINATION
87046   - CULTURE, BACTERIAL; STOOL, AEROBIC, ADDITIONAL PATHOGENS, ISOLATION AND
87070   - CULTURE, BACTERIAL; ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC,
87071   - CULTURE, BACTERIAL; QUANTITATIVE, AEROBIC WITH ISOLATION AND PRESUMPTIVE
87073   - CULTURE, BACTERIAL; QUANTITATIVE, ANAEROBIC WITH ISOLATION AND PRESUMPTIVE
87075   - CULTURE, BACTERIAL; ANY SOURCE, EXCEPT BLOOD, ANAEROBIC WITH ISOLATION AND
87076   - CULTURE, BACTERIAL; ANAEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR
87077   - CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFINITIVE
87081   - CULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS, SCREENING ONLY;
87084   - CULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS, SCREENING ONLY; WITH COLONY
87086   - CULTURE, BACTERIAL; QUANTITATIVE COLONY COUNT, URINE
87088   - CULTURE, BACTERIAL; WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF EACH ISOLAT
87101   - CULTURE, FUNGI (MOLD OR YEAST) ISOLATION, WITH PRESUMPTIVE IDENTIFICATION OF
87102   - CULTURE, FUNGI (MOLD OR YEAST) ISOLATION, WITH PRESUMPTIVE IDENTIFICATION OF
87103   - CULTURE, FUNGI (MOLD OR YEAST) ISOLATION, WITH PRESUMPTIVE IDENTIFICATION OF
87106   - CULTURE, FUNGI, DEFINITIVE IDENTIFICATION, EACH ORGANISM; YEAST
87107   - CULTURE, FUNGI, DEFINITIVE IDENTIFICATION, EACH ORGANISM; MOLD
87109   - CULTURE, MYCOPLASMA, ANY SOURCE
87110   - CULTURE, CHLAMYDIA, ANY SOURCE
87116   - CULTURE, TUBERCLE OR OTHER ACID-FAST BACILLI (EG, TB, AFB, MYCOBACTERIA) ANY
87118   - CULTURE, MYCOBACTERIAL, DEFINITIVE IDENTIFICATION, EACH ISOLATE
87140   - CULTURE, TYPING; IMMUNOFLUORESCENT METHOD, EACH ANTISERUM
87143   - CULTURE, TYPING; GAS LIQUID CHROMATOGRAPHY (GLC) OR HIGH PRESSURE LIQUID
87147   - CULTURE, TYPING; IMMUNOLOGIC METHOD, OTHER THAN IMMUNOFLUORESENCE (EG,
87149   - CULTURE, TYPING; IDENTIFICATION BY NUCLEIC ACID (DNA OR RNA) PROBE, DIRECT PROBE
87152   - CULTURE, TYPING; IDENTIFICATION BY PULSE FIELD GEL TYPING
87158   - CULTURE, TYPING; OTHER METHODS
87164   - DARK FIELD EXAMINATION, ANY SOURCE (EG, PENILE, VAGINAL, ORAL, SKIN); INCLUDES
87166   - DARK FIELD EXAMINATION, ANY SOURCE (EG, PENILE, VAGINAL, ORAL, SKIN); WITHOUT
87168   - MACROSCOPIC EXAMINATION; ARTHROPOD
87169   - MACROSCOPIC EXAMINATION; PARASITE
87172   - PINWORM EXAM (EG, CELLOPHANE TAPE PREP)
87176   - HOMOGENIZATION, TISSUE, FOR CULTURE
87177   - OVA AND PARASITES, DIRECT SMEARS, CONCENTRATION AND IDENTIFICATION
87181   - SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; AGAR DILUTION METHOD, PER AGENT
87184   - SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; DISK METHOD, PER PLATE (12 OR
87185   - SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; ENZYME DETECTION (EG, BETA
87186   - SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MICRODILUTION OR AGAR DILUTION
87187   - SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MICRODILUTION OR AGAR DILUTION,
87188   - SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MACROBROTH DILUTION METHOD, EACH
87190   - SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MYCOBACTERIA, PROPORTION METHOD,
87197   - SERUM BACTERICIDAL TITER (SCHLICTER TEST)
87205   - SMEAR, PRIMARY SOURCE WITH INTERPRETATION; GRAM OR GIEMSA STAIN FOR BACTERIA,
87206   - SMEAR, PRIMARY SOURCE WITH INTERPRETATION; FLUORESCENT AND/OR ACID FAST STAIN
87207   - SMEAR, PRIMARY SOURCE WITH INTERPRETATION; SPECIAL STAIN FOR INCLUSION BODIES



                                                Page 451
                                    All Other (no trigger bundling)


87209   - SMEAR, PRIMARY SOURCE WITH INTERPRETATION; COMPLEX SPECIAL STAIN (EG, TRICHROME,
87210   - SMEAR, PRIMARY SOURCE WITH INTERPRETATION; WET MOUNT FOR INFECTIOUS AGENTS (EG,
87220   - TISSUE EXAMINATION BY KOH SLIDE OF SAMPLES FROM SKIN, HAIR, OR NAILS FOR FUNGI
87230   - TOXIN OR ANTITOXIN ASSAY, TISSUE CULTURE (EG, CLOSTRIDIUM DIFFICILE TOXIN)
87250   - VIRUS ISOLATION; INOCULATION OF EMBRYONATED EGGS, OR SMALL ANIMAL, INCLUDES
87252   - VIRUS ISOLATION; TISSUE CULTURE INOCULATION, OBSERVATION, AND PRESUMPTIVE
87253   - VIRUS ISOLATION; TISSUE CULTURE, ADDITIONAL STUDIES OR DEFINITIVE
87254   - VIRUS ISOLATION; CENTRIFUGE ENHANCED (SHELL VIAL) TECHNIQUE, INCLUDES
87255   - VIRUS ISOLATION; INCLUDING IDENTIFICATION BY NON-IMMUNOLOGIC METHOD, OTHER THAN
87260   - INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; ADENOVIRUS
87265   - INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; BORDETELLA
87267   - INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; ENTEROVIRUS,
87269   - INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; GIARDIA
87270   - INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; CHLAMYDIA
87271   - INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE;
87272   - INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE;
87273   - INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; HERPES
87274   - INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; HERPES
87275   - INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; INFLUENZA B
87276   - INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; INFLUENZA A
87277   - INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; LEGIONELLA
87278   - INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; LEGIONELLA
87279   - INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE;
87280   - INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; RESPIRATORY
87281   - INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; PNEUMOCYSTIS
87283   - INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; RUBEOLA
87285   - INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; TREPONEMA
87290   - INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; VARICELLA
87299   - INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; NOT
87300   - INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE, POLYVALENT
87301   - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
87305   - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
87320   - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
87324   - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
87327   - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
87328   - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
87329   - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
87332   - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
87335   - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
87336   - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
87337   - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
87338   - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
87339   - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
87340   - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
87341   - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
87350   - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
87380   - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
87385   - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
87390   - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
87391   - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
87400   - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
87420   - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE



                                              Page 452
                                   All Other (no trigger bundling)


87425 - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
87427 - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
87430 - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
87449 - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE QUALITATIVE
87450 - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE QUALITATIVE
87451 - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE QUALITATIVE
87470 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); BARTONELLA HENSELAE
87471 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); BARTONELLA HENSELAE
87472 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); BARTONELLA HENSELAE
87475 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); BORRELIA BURGDORFERI,
87476 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); BORRELIA BURGDORFERI,
87477 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); BORRELIA BURGDORFERI,
87480 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES,
87481 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES,
87482 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES,
87485 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA PNEUMONIAE,
87486 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA PNEUMONIAE,
87487 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA PNEUMONIAE,
87490 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS,
87491 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS,
87492 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS,
87493 - Clostridium difficile, toxin gene(s), amplified probe technique
87495 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CYTOMEGALOVIRUS,
87496 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CYTOMEGALOVIRUS,
87497 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CYTOMEGALOVIRUS,
87498 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); ENTEROVIRUS, AMPLIFIED
87500 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); VANCOMYCIN RESISTANCE (
87501 - Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, revers
87502 - Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, for mu
87503 - Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, for mu
87510 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); GARDNERELLA VAGINALIS,
87511 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); GARDNERELLA VAGINALIS,
87512 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); GARDNERELLA VAGINALIS,
87515 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS B VIRUS,
87516 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS B VIRUS,
87517 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS B VIRUS,
87520 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS C, DIRECT
87521 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS C, AMPLIFIED
87522 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS C,
87525 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS G, DIRECT
87526 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS G, AMPLIFIED
87527 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS G,
87528 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HERPES SIMPLEX VIRUS,
87529 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HERPES SIMPLEX VIRUS,
87530 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HERPES SIMPLEX VIRUS,
87531 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HERPES VIRUS-6, DIRECT
87532 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HERPES VIRUS-6,
87533 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HERPES VIRUS-6,
87534 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HIV-1, DIRECT PROBE
87535 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HIV-1, AMPLIFIED PROBE
87536 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HIV-1, QUANTIFICATION
87537 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HIV-2, DIRECT PROBE



                                             Page 453
                                  All Other (no trigger bundling)


87538 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HIV-2, AMPLIFIED PROBE
87539 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HIV-2, QUANTIFICATION
87540 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); LEGIONELLA
87541 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); LEGIONELLA
87542 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); LEGIONELLA
87550 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA SPECIES,
87551 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA SPECIES,
87552 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA SPECIES,
87555 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA
87556 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA
87557 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA
87560 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA
87561 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA
87562 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA
87580 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOPLASMA PNEUMONIAE,
87581 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOPLASMA PNEUMONIAE,
87582 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOPLASMA PNEUMONIAE,
87590 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHOEAE,
87591 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHOEAE,
87592 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHOEAE,
87620 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); PAPILLOMAVIRUS, HUMAN,
87621 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); PAPILLOMAVIRUS, HUMAN,
87622 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); PAPILLOMAVIRUS, HUMAN,
87640 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STAPHYLOCOCCUS AUREUS,
87641 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STAPHYLOCOCCUS AUREUS,
87650 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STREPTOCOCCUS, GROUP
87651 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STREPTOCOCCUS, GROUP
87652 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STREPTOCOCCUS, GROUP
87653 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STREPTOCOCCUS, GROUP B,
87660 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); TRICHOMONAS VAGINALIS,
87797 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE
87798 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE
87799 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE
87800 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), MULTIPLE ORGANISMS;
87801 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), MULTIPLE ORGANISMS;
87802 - INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL
87803 - INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL
87804 - INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL
87807 - INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL
87808 - INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATIO
87809 - INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATIO
87810 - INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATIO
87850 - INFECTIOUS AGENT DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION;
87880 - INFECTIOUS AGENT DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION;
87899 - INFECTIOUS AGENT DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; NOT
87900 - INFECTIOUS AGENT DRUG SUSCEPTIBILITY PHENOTYPE PREDICTION USING REGULARLY UPDATE
87901 - INFECTIOUS AGENT GENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA); HIV 1, REVERSE
87902 - INFECTIOUS AGENT GENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA); HEPATITIS C
87903 - INFECTIOUS AGENT PHENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA) WITH DRUG
87904 - INFECTIOUS AGENT PHENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA) WITH DRUG RESIS
87905 - Infectious agent enzymatic activity other than virus (eg, sialidase activity in
87906 - Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV-1, other re



                                            Page 454
                                  All Other (no trigger bundling)


87999 - UNLISTED MICROBIOLOGY PROCEDURE
88104 - CYTOPATHOLOGY, FLUIDS, WASHINGS OR BRUSHINGS, EXCEPT CERVICAL OR VAGINAL; SMEARS
88106 - CYTOPATHOLOGY, FLUIDS, WASHINGS OR BRUSHINGS, EXCEPT CERVICAL OR VAGINAL; SIMPLE
88107 - CYTOPATHOLOGY, FLUIDS, WASHINGS OR BRUSHINGS, EXCEPT CERVICAL OR VAGINAL; SMEARS
88108 - CYTOPATHOLOGY, CONCENTRATION TECHNIQUE, SMEARS AND INTERPRETATION (EG,
88112 - CYTOPATHOLOGY, SELECTIVE CELLULAR ENHANCEMENT TECHNIQUE WITH INTERPRETATION
88120 - Cytopathology, in situ hybridization (eg, FISH), urinary tract specimen with mor
88121 - Cytopathology, in situ hybridization (eg, FISH), urinary tract specimen with mor
88125 - CYTOPATHOLOGY, FORENSIC (EG, SPERM)
88130 - SEX CHROMATIN IDENTIFICATION; BARR BODIES
88140 - SEX CHROMATIN IDENTIFICATION; PERIPHERAL BLOOD SMEAR, POLYMORPHONUCLEAR
88141 - CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), REQUIRING
88142 - CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN
88143 - CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN
88147 - CYTOPATHOLOGY SMEARS, CERVICAL OR VAGINAL; SCREENING BY AUTOMATED SYSTEM UNDER
88148 - CYTOPATHOLOGY SMEARS, CERVICAL OR VAGINAL; SCREENING BY AUTOMATED SYSTEM WITH
88150 - CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL; MANUAL SCREENING UNDER PHYSICIAN
88152 - CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL; WITH MANUAL SCREENING AND
88153 - CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL; WITH MANUAL SCREENING AND
88154 - CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL; WITH MANUAL SCREENING AND
88155 - CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL, DEFINITIVE HORMONAL EVALUATION (EG,
88160 - CYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; SCREENING AND INTERPRETATION
88161 - CYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; PREPARATION, SCREENING AND
88162 - CYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; EXTENDED STUDY INVOLVING OVER 5 SLIDES
88164 - CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL (THE BETHESDA SYSTEM); MANUAL
88165 - CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL (THE BETHESDA SYSTEM); WITH MANUAL
88166 - CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL (THE BETHESDA SYSTEM); WITH MANUAL
88167 - CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL (THE BETHESDA SYSTEM); WITH MANUAL
88172 - CYTOPATHOLOGY, EVALUATION OF FINE NEEDLE ASPIRATE; IMMEDIATE CYTOHISTOLOGIC
88173 - CYTOPATHOLOGY, EVALUATION OF FINE NEEDLE ASPIRATE; INTERPRETATION AND REPORT
88174 - CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN
88175 - CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN PRESERVA
88177 - Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic stud
88182 - FLOW CYTOMETRY; CELL CYCLE OR DNA ANALYSIS
88184 - FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR MARKER, TECHNICAL
88185 - FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR MARKER, TECHNICAL
88187 - FLOW CYTOMETRY, INTERPRETATION; 2 TO 8 MARKERS
88188 - FLOW CYTOMETRY, INTERPRETATION; 9 TO 15 MARKERS
88189 - FLOW CYTOMETRY, INTERPRETATION; 16 OR MORE MARKERS
88199 - UNLISTED CYTOPATHOLOGY PROCEDURE
88230 - TISSUE CULTURE FOR NON-NEOPLASTIC DISORDERS; LYMPHOCYTE
88233 - TISSUE CULTURE FOR NON-NEOPLASTIC DISORDERS; SKIN OR OTHER SOLID TISSUE BIOPSY
88235 - TISSUE CULTURE FOR NON-NEOPLASTIC DISORDERS; AMNIOTIC FLUID OR CHORIONIC VILLUS
88237 - TISSUE CULTURE FOR NEOPLASTIC DISORDERS; BONE MARROW, BLOOD CELLS
88239 - TISSUE CULTURE FOR NEOPLASTIC DISORDERS; SOLID TUMOR
88240 - CRYOPRESERVATION, FREEZING AND STORAGE OF CELLS, EACH CELL LINE
88241 - THAWING AND EXPANSION OF FROZEN CELLS, EACH ALIQUOT
88245 - CHROMOSOME ANALYSIS FOR BREAKAGE SYNDROMES; BASELINE SISTER CHROMATID EXCHANGE
88248 - CHROMOSOME ANALYSIS FOR BREAKAGE SYNDROMES; BASELINE BREAKAGE, SCORE 50-100
88249 - CHROMOSOME ANALYSIS FOR BREAKAGE SYNDROMES; SCORE 100 CELLS, CLASTOGEN STRESS
88261 - CHROMOSOME ANALYSIS; COUNT 5 CELLS, 1 KARYOTYPE, WITH BANDING
88262 - CHROMOSOME ANALYSIS; COUNT 15-20 CELLS, 2 KARYOTYPES, WITH BANDING



                                            Page 455
                                    All Other (no trigger bundling)


88263   - CHROMOSOME ANALYSIS; COUNT 45 CELLS FOR MOSAICISM, 2 KARYOTYPES, WITH BANDING
88264   - CHROMOSOME ANALYSIS; ANALYZE 20-25 CELLS
88267   - CHROMOSOME ANALYSIS, AMNIOTIC FLUID OR CHORIONIC VILLUS, COUNT 15 CELLS, 1
88269   - CHROMOSOME ANALYSIS, IN SITU FOR AMNIOTIC FLUID CELLS, COUNT CELLS FROM 6-12
88271   - MOLECULAR CYTOGENETICS; DNA PROBE, EACH (EG, FISH)
88272   - MOLECULAR CYTOGENETICS; CHROMOSOMAL IN SITU HYBRIDIZATION, ANALYZE 3-5 CELLS
88273   - MOLECULAR CYTOGENETICS; CHROMOSOMAL IN SITU HYBRIDIZATION, ANALYZE 10-30 CELLS
88274   - MOLECULAR CYTOGENETICS; INTERPHASE IN SITU HYBRIDIZATION, ANALYZE 25-99 CELLS
88275   - MOLECULAR CYTOGENETICS; INTERPHASE IN SITU HYBRIDIZATION, ANALYZE 100-300 CELLS
88280   - CHROMOSOME ANALYSIS; ADDITIONAL KARYOTYPES, EACH STUDY
88283   - CHROMOSOME ANALYSIS; ADDITIONAL SPECIALIZED BANDING TECHNIQUE (EG, NOR,
88285   - CHROMOSOME ANALYSIS; ADDITIONAL CELLS COUNTED, EACH STUDY
88289   - CHROMOSOME ANALYSIS; ADDITIONAL HIGH RESOLUTION STUDY
88291   - CYTOGENETICS AND MOLECULAR CYTOGENETICS, INTERPRETATION AND REPORT
88299   - UNLISTED CYTOGENETIC STUDY
88300   - LEVEL I - SURGICAL PATHOLOGY, GROSS EXAMINATION ONLY
88302   - LEVEL II - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION
88304   - LEVEL III - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION
88305   - LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION
88307   - LEVEL V - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION
88309   - LEVEL VI - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION
88311   - DECALCIFICATION PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FOR SURGICAL
88312   - SPECIAL STAINS; GROUP I FOR MICROORGANISMS (EG, GRIDLEY, ACID FAST, METHENAMINE
88313   - SPECIAL STAINS; GROUP II, ALL OTHER (EG, IRON, TRICHROME), EXCEPT IMMUNOCYTOCHEM
88314   - SPECIAL STAINS; HISTOCHEMICAL STAINING WITH FROZEN SECTION(S), INCLUDING INTERPR
88318   - DETERMINATIVE HISTOCHEMISTRY TO IDENTIFY CHEMICAL COMPONENTS (EG, COPPER, ZINC)
88319   - DETERMINATIVE HISTOCHEMISTRY OR CYTOCHEMISTRY TO IDENTIFY ENZYME CONSTITUENTS,
88321   - CONSULTATION AND REPORT ON REFERRED SLIDES PREPARED ELSEWHERE
88323   - CONSULTATION AND REPORT ON REFERRED MATERIAL REQUIRING PREPARATION OF SLIDES
88325   - CONSULTATION, COMPREHENSIVE, WITH REVIEW OF RECORDS AND SPECIMENS, WITH REPORT
88329   - PATHOLOGY CONSULTATION DURING SURGERY;
88331   - PATHOLOGY CONSULTATION DURING SURGERY; FIRST TISSUE BLOCK, WITH FROZEN
88332   - PATHOLOGY CONSULTATION DURING SURGERY; EACH ADDITIONAL TISSUE BLOCK WITH FROZEN
88333   - PATHOLOGY CONSULTATION DURING SURGERY; CYTOLOGIC EXAMINATION (EG, TOUCH PREP, SQ
88334   - PATHOLOGY CONSULTATION DURING SURGERY; CYTOLOGIC EXAMINATION (EG, TOUCH PREP, SQ
88342   - IMMUNOHISTOCHEMISTRY (INCLUDING TISSUE IMMUNOPEROXIDASE), EACH ANTIBODY
88346   - IMMUNOFLUORESCENT STUDY, EACH ANTIBODY; DIRECT METHOD
88347   - IMMUNOFLUORESCENT STUDY, EACH ANTIBODY; INDIRECT METHOD
88348   - ELECTRON MICROSCOPY; DIAGNOSTIC
88349   - ELECTRON MICROSCOPY; SCANNING
88355   - MORPHOMETRIC ANALYSIS; SKELETAL MUSCLE
88356   - MORPHOMETRIC ANALYSIS; NERVE
88358   - MORPHOMETRIC ANALYSIS; TUMOR (EG, DNA PLOIDY)
88360   - MORPHOMETRIC ANALYSIS, TUMOR IMMUNOHISTOCHEMISTRY (EG, HER-2/NEU, ESTROGEN
88361   - MORPHOMETRIC ANALYSIS, TUMOR IMMUNOHISTOCHEMISTRY (EG, HER-2/NEU, ESTROGEN
88362   - NERVE TEASING PREPARATIONS
88365   - IN SITU HYBRIDIZATION (EG, FISH), EACH PROBE
88367   - MORPHOMETRIC ANALYSIS, IN SITU HYBRIDIZATION, (QUANTITATIVE OR
88368   - MORPHOMETRIC ANALYSIS, IN SITU HYBRIDIZATION, (QUANTITATIVE OR
88371   - PROTEIN ANALYSIS OF TISSUE BY WESTERN BLOT, WITH INTERPRETATION AND REPORT;
88372   - PROTEIN ANALYSIS OF TISSUE BY WESTERN BLOT, WITH INTERPRETATION AND REPORT;
88380   - MICRODISSECTION (IE, SAMPLE PREPARATION OF MICROSCOPICALLY IDENTIFIED TARGET); L



                                              Page 456
                                  All Other (no trigger bundling)


88381 - MICRODISSECTION (IE, SAMPLE PREPARATION OF MICROSCOPICALLY IDENTIFIED TARGET); M
88384 - ARRAY-BASED EVALUATION OF MULTIPLE MOLECULAR PROBES; 11 THROUGH 50 PROBES
88385 - ARRAY-BASED EVALUATION OF MULTIPLE MOLECULAR PROBES; 51 THROUGH 250 PROBES
88386 - ARRAY-BASED EVALUATION OF MULTIPLE MOLECULAR PROBES; 251 THROUGH 500 PROBES
88387 - Macroscopic exam, dissection, and prep of tissue for non-micro analytical studie
88388 - Macroscopic exam, dissection, and prep of tissue for non-micro analytical studie
88399 - UNLISTED MISCELLANEOUS PATHOLOGY PROCEDURE
88720 - Bilirubin, total, transcutaneous
88738 - Hemoglobin (Hgb), quantitative, transcutaneous
88740 - Hemoglobin, quantitative, transcutaneous, per day; carboxyhemoglobin
88741 - Hemoglobin, quantitative, transcutaneous, per day; methemoglobin
88749 - Unlisted in vivo (eg, transcutaneous) laboratory service
89049 - CAFFEINE HALOTHANE CONTRACTURE TEST (CHCT) FOR MALIGNANT HYPERTHERMIA SUSCEPTIBI
89050 - CELL COUNT, MISCELLANEOUS BODY FLUIDS (EG, CEREBROSPINAL FLUID, JOINT FLUID), EX
89051 - CELL COUNT, MISCELLANEOUS BODY FLUIDS (EG, CEREBROSPINAL FLUID, JOINT FLUID),
89055 - LEUKOCYTE ASSESSMENT, FECAL, QUALITATIVE OR SEMIQUANTITATIVE
89060 - CRYSTAL IDENTIFICATION BY LIGHT MICROSCOPY WITH OR WITHOUT POLARIZING LENS ANALY
89100 - DUODENAL INTUBATION AND ASPIRATION; SINGLE SPECIMEN (EG, SIMPLE BILE STUDY OR
89105 - DUODENAL INTUBATION AND ASPIRATION; COLLECTION OF MULTIPLE FRACTIONAL SPECIMENS
89125 - FAT STAIN, FECES, URINE, OR RESPIRATORY SECRETIONS
89130 - GASTRIC INTUBATION AND ASPIRATION, DIAGNOSTIC, EACH SPECIMEN, FOR CHEMICAL
89132 - GASTRIC INTUBATION AND ASPIRATION, DIAGNOSTIC, EACH SPECIMEN, FOR CHEMICAL
89135 - GASTRIC INTUBATION, ASPIRATION, AND FRACTIONAL COLLECTIONS (EG, GASTRIC
89136 - GASTRIC INTUBATION, ASPIRATION, AND FRACTIONAL COLLECTIONS (EG, GASTRIC
89140 - GASTRIC INTUBATION, ASPIRATION, AND FRACTIONAL COLLECTIONS (EG, GASTRIC
89141 - GASTRIC INTUBATION, ASPIRATION, AND FRACTIONAL COLLECTIONS (EG, GASTRIC
89160 - MEAT FIBERS, FECES
89190 - NASAL SMEAR FOR EOSINOPHILS
89220 - SPUTUM, OBTAINING SPECIMEN, AEROSOL INDUCED TECHNIQUE (SEPARATE PROCEDURE)
89225 - STARCH GRANULES, FECES
89230 - SWEAT COLLECTION BY IONTOPHORESIS
89235 - WATER LOAD TEST
89240 - UNLISTED MISCELLANEOUS PATHOLOGY TEST
89264 - SPERM IDENTIFICATION FROM TESTIS TISSUE, FRESH OR CRYOPRESERVED
89321 - SEMEN ANALYSIS; SPERM PRESENCE AND MOTILITY OF SPERM, IF PERFORMED
89322 - SEMEN ANALYSIS; VOLUME, COUNT, MOTILITY, AND DIFFERENTIAL USING STRICT MORPHOLOG
90296 - DIPHTHERIA ANTITOXIN, EQUINE, ANY ROUTE
90371 - HEPATITIS B IMMUNE GLOBULIN (HBIG), HUMAN, FOR INTRAMUSCULAR USE
90375 - RABIES IMMUNE GLOBULIN (RIG), HUMAN, FOR INTRAMUSCULAR AND/OR SUBCUTANEOUS USE
90376 - RABIES IMMUNE GLOBULIN, HEAT-TREATED (RIG-HT), HUMAN, FOR INTRAMUSCULAR AND/OR S
90378 - RESPIRATORY SYNCYTIAL VIRUS, MONOCLONAL ANTIBODY, RECOMBINANT, FOR INTRAMUSCULAR
90384 - RHO(D) IMMUNE GLOBULIN (RHIG), HUMAN, FULL-DOSE, FOR INTRAMUSCULAR USE
90385 - RHO(D) IMMUNE GLOBULIN (RHIG), HUMAN, MINI-DOSE, FOR INTRAMUSCULAR USE
90393 - VACCINIA IMMUNE GLOBULIN, HUMAN, FOR INTRAMUSCULAR USE
90396 - VARICELLA-ZOSTER IMMUNE GLOBULIN, HUMAN, FOR INTRAMUSCULAR USE
90460 - Immunization administration through 18 years of age via any route of administrat
90461 - Immunization administration through 18 years of age via any route of administrat
90470 - H1N1 IMMUNIZATION ADMINISTRATION (INTRAMUSCULAR, INTRANASAL), INCLUDING COUNSELI
90471 - IMMUNIZATION ADMINISTRATION (INCLUDES PERCUTANEOUS, INTRADERMAL, SUBCUTANEOUS,
90472 - IMMUNIZATION ADMINISTRATION (INCLUDES PERCUTANEOUS, INTRADERMAL, SUBCUTANEOUS,
90473 - IMMUNIZATION ADMINISTRATION BY INTRANASAL OR ORAL ROUTE; ONE VACCINE (SINGLE OR
90474 - IMMUNIZATION ADMINISTRATION BY INTRANASAL OR ORAL ROUTE; EACH ADDITIONAL



                                            Page 457
                                     All Other (no trigger bundling)


90476   - ADENOVIRUS VACCINE, TYPE 4, LIVE, FOR ORAL USE
90477   - ADENOVIRUS VACCINE, TYPE 7, LIVE, FOR ORAL USE
90581   - ANTHRAX VACCINE, FOR SUBCUTANEOUS USE
90585   - BACILLUS CALMETTE-GUERIN VACCINE (BCG) FOR TUBERCULOSIS, LIVE, FOR PERCUTANEOUS
90586   - BACILLUS CALMETTE-GUERIN VACCINE (BCG) FOR BLADDER CANCER, LIVE, FOR INTRAVESICA
90632   - HEPATITIS A VACCINE, ADULT DOSAGE, FOR INTRAMUSCULAR USE
90633   - HEPATITIS A VACCINE, PEDIATRIC/ADOLESCENT DOSAGE-2 DOSE SCHEDULE, FOR INTRAMUSCU
90634   - HEPATITIS A VACCINE, PEDIATRIC/ADOLESCENT DOSAGE-3 DOSE SCHEDULE, FOR INTRAMUSCU
90636   - HEPATITIS A AND HEPATITIS B VACCINE (HEPA-HEPB), ADULT DOSAGE, FOR INTRAMUSCULAR
90644   - Meningococcal conjugate vaccine, serogroups C & Y and Hemophilus influenza b vac
90645   - HEMOPHILUS INFLUENZA B VACCINE (HIB), HBOC CONJUGATE (4 DOSE SCHEDULE), FOR INTR
90646   - HEMOPHILUS INFLUENZA B VACCINE (HIB), PRP-D CONJUGATE, FOR BOOSTER USE ONLY, INT
90647   - HEMOPHILUS INFLUENZA B VACCINE (HIB), PRP-OMP CONJUGATE (3 DOSE SCHEDULE), FOR I
90648   - HEMOPHILUS INFLUENZA B VACCINE (HIB), PRP-T CONJUGATE (4 DOSE SCHEDULE), FOR INT
90649   - HUMAN PAPILLOMA VIRUS (HPV) VACCINE, TYPES 6, 11, 16, 18 (QUADRIVALENT), 3 DOSE
90650   - Human Papilloma virus (HPV) vaccine, types 16, 18, bivalent, 3 dose schedule, fo
90655   - INFLUENZA VIRUS VACCINE, SPLIT VIRUS, PRESERVATIVE FREE, WHEN ADMINISTERED TO CH
90656   - INFLUENZA VIRUS VACCINE, SPLIT VIRUS, PRESERVATIVE FREE, WHEN ADMINISTERED TO IN
90657   - INFLUENZA VIRUS VACCINE, SPLIT VIRUS, WHEN ADMINISTERED TO CHILDREN 6-35 MONTHS
90658   - INFLUENZA VIRUS VACCINE, SPLIT VIRUS, WHEN ADMINISTERED TO INDIVIDUALS 3 YEARS O
90660   - INFLUENZA VIRUS VACCINE, LIVE, FOR INTRANASAL USE
90662   - INFLUENZA VIRUS VACCINE, SPLIT VIRUS, PRESERVATIVE FREE, ENHANCED IMMUNOGENICITY
90663   - INFLUENZA VIRUS VACCINE, PANDEMIC FORMULATION, H1N1
90665   - LYME DISEASE VACCINE, ADULT DOSAGE, FOR INTRAMUSCULAR USE
90669   - PNEUMOCOCCAL CONJUGATE VACCINE, 7 VALENT, FOR INTRAMUSCULAR USE
90670   - PNEUMOCOCCAL CONJUGATE VACCINE, 13 VALENT, FOR INTRAMUSCULAR USE
90675   - RABIES VACCINE, FOR INTRAMUSCULAR USE
90676   - RABIES VACCINE, FOR INTRADERMAL USE
90680   - ROTAVIRUS VACCINE, PENTAVALENT, 3 DOSE SCHEDULE, LIVE, FOR ORAL USE
90681   - Rotavirus vaccine, human, attenuated, 2 dose schedule, live, for oral use
90690   - TYPHOID VACCINE, LIVE, ORAL
90691   - TYPHOID VACCINE, VI CAPSULAR POLYSACCHARIDE (VICPS), FOR INTRAMUSCULAR USE
90692   - TYPHOID VACCINE, HEAT- AND PHENOL-INACTIVATED (H-P), FOR SUBCUTANEOUS OR INTRADE
90693   - TYPHOID VACCINE, ACETONE-KILLED, DRIED (AKD), FOR SUBCUTANEOUS USE (U.S. MILITAR
90696   - DIPTHERIA, TETNUS TOXOIDS, ACELLULAR PERTUSSIS VACCINE & POLIOVIRUS VACCINE INAC
90698   - DIPHTHERIA, TETANUS TOXOIDS, ACELLULAR PERTUSSIS VACCINE, HAEMOPHILUS INFLUENZA
90700   - DIPHTHERIA, TETANUS TOXOIDS, AND ACELLULAR PERTUSSIS VACCINE (DTAP), WHEN ADMINI
90701   - DIPHTHERIA, TETANUS TOXOIDS, AND WHOLE CELL PERTUSSIS VACCINE (DTP), FOR INTRAMU
90702   - DIPHTHERIA AND TETANUS TOXOIDS (DT) ADSORBED WHEN ADMINISTERED TO INDIVIDUALS YO
90703   - TETANUS TOXOID ADSORBED, FOR INTRAMUSCULAR USE
90704   - MUMPS VIRUS VACCINE, LIVE, FOR SUBCUTANEOUS USE
90705   - MEASLES VIRUS VACCINE, LIVE, FOR SUBCUTANEOUS USE
90706   - RUBELLA VIRUS VACCINE, LIVE, FOR SUBCUTANEOUS USE
90707   - MEASLES, MUMPS AND RUBELLA VIRUS VACCINE (MMR), LIVE, FOR SUBCUTANEOUS USE
90708   - MEASLES AND RUBELLA VIRUS VACCINE, LIVE, FOR SUBCUTANEOUS USE
90710   - MEASLES, MUMPS, RUBELLA, AND VARICELLA VACCINE (MMRV), LIVE, FOR SUBCUTANEOUS US
90712   - POLIOVIRUS VACCINE, (ANY TYPE¿S¿) (OPV), LIVE, FOR ORAL USE
90713   - POLIOVIRUS VACCINE, INACTIVATED (IPV), FOR SUBCUTANEOUS OR INTRAMUSCULAR USE
90714   - TETANUS AND DIPHTHERIA TOXOIDS (TD) ADSORBED, PRESERVATIVE FREE, WHEN ADMINISTER
90715   - TETANUS, DIPHTHERIA TOXOIDS AND ACELLULAR PERTUSSIS VACCINE (TDAP), WHEN ADMINIS
90716   - VARICELLA VIRUS VACCINE, LIVE, FOR SUBCUTANEOUS USE
90717   - YELLOW FEVER VACCINE, LIVE, FOR SUBCUTANEOUS USE



                                               Page 458
                                    All Other (no trigger bundling)


90718   - TETANUS AND DIPHTHERIA TOXOIDS (TD) ADSORBED WHEN ADMINISTERED TO INDIVIDUALS 7
90719   - DIPHTHERIA TOXOID, FOR INTRAMUSCULAR USE
90720   - DIPHTHERIA, TETANUS TOXOIDS, AND WHOLE CELL PERTUSSIS VACCINE AND HEMOPHILUS INF
90721   - DIPHTHERIA, TETANUS TOXOIDS, AND ACELLULAR PERTUSSIS VACCINE AND HEMOPHILUS INFL
90723   - DIPHTHERIA, TETANUS TOXOIDS, ACELLULAR PERTUSSIS VACCINE, HEPATITIS B, AND POLIO
90725   - CHOLERA VACCINE FOR INJECTABLE USE
90727   - PLAGUE VACCINE, FOR INTRAMUSCULAR USE
90732   - PNEUMOCOCCAL POLYSACCHARIDE VACCINE, 23-VALENT, ADULT OR IMMUNOSUPPRESSED PATIEN
90733   - MENINGOCOCCAL POLYSACCHARIDE VACCINE (ANY GROUP¿S¿), FOR SUBCUTANEOUS USE
90734   - MENINGOCOCCAL CONJUGATE VACCINE, SEROGROUPS A, C, Y AND W-135 (TETRAVALENT), FOR
90736   - ZOSTER (SHINGLES) VACCINE, LIVE, FOR SUBCUTANEOUS INJECTION
90740   - HEPATITIS B VACCINE, DIALYSIS OR IMMUNOSUPPRESSED PATIENT DOSAGE (3 DOSE SCHEDUL
90743   - HEPATITIS B VACCINE, ADOLESCENT (2 DOSE SCHEDULE), FOR INTRAMUSCULAR USE
90744   - HEPATITIS B VACCINE, PEDIATRIC/ADOLESCENT DOSAGE (3 DOSE SCHEDULE), FOR INTRAMUS
90746   - HEPATITIS B VACCINE, ADULT DOSAGE, FOR INTRAMUSCULAR USE
90747   - HEPATITIS B VACCINE, DIALYSIS OR IMMUNOSUPPRESSED PATIENT DOSAGE (4 DOSE SCHEDUL
90748   - HEPATITIS B AND HEMOPHILUS INFLUENZA B VACCINE (HEPB-HIB), FOR INTRAMUSCULAR USE
90749   - UNLISTED VACCINE/TOXOID
90801   - PSYCHIATRIC DIAGNOSTIC INTERVIEW EXAMINATION
90802   - INTERACTIVE PSYCHIATRIC DIAGNOSTIC INTERVIEW EXAMINATION USING PLAY EQUIPMENT,
90804   - INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR SUPPORTIVE
90805   - INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR
90806   - INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR
90807   - INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR
90808   - INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR
90809   - INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR
90810   - INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES, L
90811   - INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES,
90812   - INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES,
90813   - INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES,
90814   - INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES,
90815   - INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES,
90816   - INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR SUPPORTIVE
90817   - INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR
90818   - INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR
90819   - INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR
90821   - INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR
90822   - INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR
90823   - INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES, L
90824   - INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES,
90826   - INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES,
90827   - INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES,
90828   - INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES,
90829   - INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES,
90845   - PSYCHOANALYSIS
90846   - FAMILY PSYCHOTHERAPY (WITHOUT THE PATIENT PRESENT)
90847   - FAMILY PSYCHOTHERAPY (CONJOINT PSYCHOTHERAPY) (WITH PATIENT PRESENT)
90849   - MULTIPLE-FAMILY GROUP PSYCHOTHERAPY
90853   - GROUP PSYCHOTHERAPY (OTHER THAN OF A MULTIPLE-FAMILY GROUP)
90857   - INTERACTIVE GROUP PSYCHOTHERAPY
90862   - PHARMACOLOGIC MANAGEMENT, INCLUDING PRESCRIPTION, USE, AND REVIEW OF MEDICATION
90865   - NARCOSYNTHESIS FOR PSYCHIATRIC DIAGNOSTIC AND THERAPEUTIC PURPOSES (EG, SODIUM



                                              Page 459
                                 All Other (no trigger bundling)


90870 - ELECTROCONVULSIVE THERAPY (INCLUDES NECESSARY MONITORING)
90875 - INDIVIDUAL PSYCHOPHYSIOLOGICAL THERAPY INCORPORATING BIOFEEDBACK TRAINING BY
90876 - INDIVIDUAL PSYCHOPHYSIOLOGICAL THERAPY INCORPORATING BIOFEEDBACK TRAINING BY
90887 - INTERPRETATION OR EXPLANATION OF RESULTS OF PSYCHIATRIC, OTHER MEDICAL
90889 - PREPARATION OF REPORT OF PATIENT'S PSYCHIATRIC STATUS, HISTORY, TREATMENT, OR
90901 - BIOFEEDBACK TRAINING BY ANY MODALITY
90911 - BIOFEEDBACK TRAINING, PERINEAL MUSCLES, ANORECTAL OR URETHRAL SPHINCTER,
90935 - HEMODIALYSIS PROCEDURE WITH SINGLE PHYSICIAN EVALUATION
90937 - HEMODIALYSIS PROCEDURE REQUIRING REPEATED EVALUATION(S) WITH OR WITHOUT
90940 - HEMODIALYSIS ACCESS FLOW STUDY TO DETERMINE BLOOD FLOW IN GRAFTS AND ARTERIOVENO
90945 - DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS (EG, PERITONEAL DIALYSIS, HEMOFILTRAT
90947 - DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS (EG, PERITONEAL DIALYSIS,
90951 - End-stage renal disease (ESRD) related services monthly, for patients younger th
90952 - End-stage renal disease (ESRD) related services monthly, for patients younger th
90953 - End-stage renal disease (ESRD) related services monthly, for patients younger th
90954 - End-stage renal disease (ESRD) related services monthly, for patients 2-11 years
90955 - End-stage renal disease (ESRD) related services monthly, for patients 2-11 years
90956 - End-stage renal disease (ESRD) related services monthly, for patients 2-11 years
90957 - End-stage renal disease (ESRD) related services monthly, for patients 12-19 year
90958 - End-stage renal disease (ESRD) related services monthly, for patients 12-19 year
90959 - End-stage renal disease (ESRD) related services monthly, for patients 12-19 year
90960 - End-stage renal disease (ESRD) related services monthly, for patients 20 years o
90961 - End-stage renal disease (ESRD) related services monthly, for patients 20 years o
90962 - End-stage renal disease (ESRD) related services monthly, for patients 20 years o
90963 - End-stage renal disease (ESRD) related services for home dialysis per full month
90964 - End-stage renal disease (ESRD) related services for home dialysis per full month
90965 - End-stage renal disease (ESRD) related services for home dialysis per full month
90966 - End-stage renal disease (ESRD) related services for home dialysis per full month
90967 - End-stage renal disease (ESRD) related services for dialysis less than a full mo
90968 - End-stage renal disease (ESRD) related services for dialysis less than a full mo
90969 - End-stage renal disease (ESRD) related services for dialysis less than a full mo
90970 - End-stage renal disease (ESRD) related services for dialysis less than a full mo
90989 - DIALYSIS TRAINING, PATIENT, INCLUDING HELPER WHERE APPLICABLE, ANY MODE,
90993 - DIALYSIS TRAINING, PATIENT, INCLUDING HELPER WHERE APPLICABLE, ANY MODE, COURSE
90997 - HEMOPERFUSION (EG, WITH ACTIVATED CHARCOAL OR RESIN)
90999 - UNLISTED DIALYSIS PROCEDURE, INPATIENT OR OUTPATIENT
91000 - ESOPHAGEAL INTUBATION AND COLLECTION OF WASHINGS FOR CYTOLOGY, INCLUDING PREPARA
91010 - ESOPHAGEAL MOTILITY (MANOMETRIC STUDY OF THE ESOPHAGUS AND/ OR GASTROESOPHAGEAL
91011 - ESOPHAGEAL MOTILITY (MANOMETRIC STUDY OF THE ESOPHAGUS AND/ OR GASTROESOPHAGEAL
91012 - ESOPHAGEAL MOTILITY (MANOMETRIC STUDY OF THE ESOPHAGUS AND/ OR GASTROESOPHAGEAL
91013 - Esophageal motility (manometric study of the esophagus and/or gastroesophageal j
91020 - GASTRIC MOTILITY (MANOMETRIC) STUDIES
91022 - DUODENAL MOTILITY (MANOMETRIC) STUDY
91030 - ESOPHAGUS, ACID PERFUSION (BERNSTEIN) TEST FOR ESOPHAGITIS
91034 - ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH NASAL CATHETER PH ELECTRODE(S)
91035 - ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH MUCOSAL ATTACHED TELEMETRY PH
91037 - ESOPHAGEAL FUNCTION TEST, GASTROESOPHAGEAL REFLUX TEST WITH NASAL CATHETER
91038 - ESOPHAGEAL FUNCTION TEST, GASTROESOPHAGEAL REFLUX TEST WITH NASAL CATHETER
91040 - ESOPHAGEAL BALLOON DISTENSION PROVOCATION STUDY
91052 - GASTRIC ANALYSIS TEST WITH INJECTION OF STIMULANT OF GASTRIC SECRETION (EG,
91055 - GASTRIC INTUBATION, WASHINGS, AND PREPARING SLIDES FOR CYTOLOGY (SEPARATE
91065 - BREATH HYDROGEN TEST (EG, FOR DETECTION OF LACTASE DEFICIENCY), FRUCTOSE



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91105 - GASTRIC INTUBATION, AND ASPIRATION OR LAVAGE FOR TREATMENT (EG, FOR INGESTED
91123 - PULSED IRRIGATION OF FECAL IMPACTION
91132 - ELECTROGASTROGRAPHY, DIAGNOSTIC, TRANSCUTANEOUS;
91133 - ELECTROGASTROGRAPHY, DIAGNOSTIC, TRANSCUTANEOUS; WITH PROVOCATIVE TESTING
91299 - UNLISTED DIAGNOSTIC GASTROENTEROLOGY PROCEDURE
92002 - OPHTHALMOLOGICAL SERVICES: MEDICAL EXAMINATION AND EVALUATION WITH INITIATION OF
92004 - OPHTHALMOLOGICAL SERVICES: MEDICAL EXAMINATION AND EVALUATION WITH INITIATION
92012 - OPHTHALMOLOGICAL SERVICES: MEDICAL EXAMINATION AND EVALUATION, WITH INITIATION O
92014 - OPHTHALMOLOGICAL SERVICES: MEDICAL EXAMINATION AND EVALUATION, WITH INITIATION
92015 - DETERMINATION OF REFRACTIVE STATE
92025 - COMPUTERIZED CORNEAL TOPOGRAPHY, UNILATERAL OR BILATERAL, WITH INTERPRETATION AN
92070 - FITTING OF CONTACT LENS FOR TREATMENT OF DISEASE, INCLUDING SUPPLY OF LENS
92100 - SERIAL TONOMETRY (SEPARATE PROCEDURE) WITH MULTIPLE MEASUREMENTS OF INTRAOCULAR
92227 - Remote imaging for detection of retinal disease (eg, retinopathy in a patient wi
92228 - Remote imaging for monitoring and management of active retinal disease (eg, diab
92310 - PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF AND FITTING OF CONTACT L
92311 - PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF AND FITTING OF CONTACT
92312 - PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF AND FITTING OF CONTACT
92313 - PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF AND FITTING OF CONTACT
92314 - PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF CONTACT LENS, WITH
92315 - PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF CONTACT LENS, WITH
92316 - PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF CONTACT LENS, WITH
92317 - PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF CONTACT LENS, WITH
92325 - MODIFICATION OF CONTACT LENS (SEPARATE PROCEDURE), WITH MEDICAL SUPERVISION OF
92326 - REPLACEMENT OF CONTACT LENS
92340 - FITTING OF SPECTACLES, EXCEPT FOR APHAKIA; MONOFOCAL
92341 - FITTING OF SPECTACLES, EXCEPT FOR APHAKIA; BIFOCAL
92342 - FITTING OF SPECTACLES, EXCEPT FOR APHAKIA; MULTIFOCAL, OTHER THAN BIFOCAL
92352 - FITTING OF SPECTACLE PROSTHESIS FOR APHAKIA; MONOFOCAL
92353 - FITTING OF SPECTACLE PROSTHESIS FOR APHAKIA; MULTIFOCAL
92354 - FITTING OF SPECTACLE MOUNTED LOW VISION AID; SINGLE ELEMENT SYSTEM
92355 - FITTING OF SPECTACLE MOUNTED LOW VISION AID; TELESCOPIC OR OTHER COMPOUND LENS
92358 - PROSTHESIS SERVICE FOR APHAKIA, TEMPORARY (DISPOSABLE OR LOAN, INCLUDING
92370 - REPAIR AND REFITTING SPECTACLES; EXCEPT FOR APHAKIA
92371 - REPAIR AND REFITTING SPECTACLES; SPECTACLE PROSTHESIS FOR APHAKIA
92504 - BINOCULAR MICROSCOPY (SEPARATE DIAGNOSTIC PROCEDURE)
92506 - EVALUATION OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/ OR AUDITORY PROCESSIN
92507 - TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/ OR AUDITORY PROCESSING
92508 - TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR AUDITORY PROCESSING
92512 - NASAL FUNCTION STUDIES (EG, RHINOMANOMETRY)
92516 - FACIAL NERVE FUNCTION STUDIES (EG, ELECTRONEURONOGRAPHY)
92520 - LARYNGEAL FUNCTION STUDIES (IE, AERODYNAMIC TESTING AND ACOUSTIC TESTING)
92526 - TREATMENT OF SWALLOWING DYSFUNCTION AND/OR ORAL FUNCTION FOR FEEDING
92531 - SPONTANEOUS NYSTAGMUS, INCLUDING GAZE
92532 - POSITIONAL NYSTAGMUS TEST
92533 - CALORIC VESTIBULAR TEST, EACH IRRIGATION (BINAURAL, BITHERMAL STIMULATION
92534 - OPTOKINETIC NYSTAGMUS TEST
92540 - Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric
92541 - SPONTANEOUS NYSTAGMUS TEST, INCLUDING GAZE AND FIXATION NYSTAGMUS, WITH RECORDIN
92542 - POSITIONAL NYSTAGMUS TEST, MINIMUM OF 4 POSITIONS, WITH RECORDING
92543 - CALORIC VESTIBULAR TEST, EACH IRRIGATION (BINAURAL, BITHERMAL STIMULATION
92544 - OPTOKINETIC NYSTAGMUS TEST, BIDIRECTIONAL, FOVEAL OR PERIPHERAL STIMULATION,



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92545   - OSCILLATING TRACKING TEST, WITH RECORDING
92546   - SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING
92547   - USE OF VERTICAL ELECTRODES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY
92548   - COMPUTERIZED DYNAMIC POSTUROGRAPHY
92550   - Tympanometry and reflex threshold measurements
92551   - SCREENING TEST, PURE TONE, AIR ONLY
92552   - PURE TONE AUDIOMETRY (THRESHOLD); AIR ONLY
92553   - PURE TONE AUDIOMETRY (THRESHOLD); AIR AND BONE
92555   - SPEECH AUDIOMETRY THRESHOLD;
92556   - SPEECH AUDIOMETRY THRESHOLD; WITH SPEECH RECOGNITION
92557   - COMPREHENSIVE AUDIOMETRY THRESHOLD EVALUATION AND SPEECH RECOGNITION (92553 AND
92560   - BEKESY AUDIOMETRY; SCREENING
92561   - BEKESY AUDIOMETRY; DIAGNOSTIC
92562   - LOUDNESS BALANCE TEST, ALTERNATE BINAURAL OR MONAURAL
92563   - TONE DECAY TEST
92564   - SHORT INCREMENT SENSITIVITY INDEX (SISI)
92565   - STENGER TEST, PURE TONE
92567   - TYMPANOMETRY (IMPEDANCE TESTING)
92568   - ACOUSTIC REFLEX TESTING; THRESHOLD
92570   - Acoustic immittance testing, includes tympanometry (impedance testing), acoustic
92571   - FILTERED SPEECH TEST
92572   - STAGGERED SPONDAIC WORD TEST
92575   - SENSORINEURAL ACUITY LEVEL TEST
92576   - SYNTHETIC SENTENCE IDENTIFICATION TEST
92577   - STENGER TEST, SPEECH
92579   - VISUAL REINFORCEMENT AUDIOMETRY (VRA)
92582   - CONDITIONING PLAY AUDIOMETRY
92583   - SELECT PICTURE AUDIOMETRY
92584   - ELECTROCOCHLEOGRAPHY
92585   - AUDITORY EVOKED POTENTIALS FOR EVOKED RESPONSE AUDIOMETRY AND/OR TESTING OF THE
92586   - AUDITORY EVOKED POTENTIALS FOR EVOKED RESPONSE AUDIOMETRY AND/OR TESTING OF THE
92587   - EVOKED OTOACOUSTIC EMISSIONS; LIMITED (SINGLE STIMULUS LEVEL, EITHER TRANSIENT
92588   - EVOKED OTOACOUSTIC EMISSIONS; COMPREHENSIVE OR DIAGNOSTIC EVALUATION
92590   - HEARING AID EXAMINATION AND SELECTION; MONAURAL
92591   - HEARING AID EXAMINATION AND SELECTION; BINAURAL
92592   - HEARING AID CHECK; MONAURAL
92593   - HEARING AID CHECK; BINAURAL
92594   - ELECTROACOUSTIC EVALUATION FOR HEARING AID; MONAURAL
92595   - ELECTROACOUSTIC EVALUATION FOR HEARING AID; BINAURAL
92596   - EAR PROTECTOR ATTENUATION MEASUREMENTS
92597   - EVALUATION FOR USE AND/OR FITTING OF VOICE PROSTHETIC DEVICE TO SUPPLEMENT ORAL
92601   - DIAGNOSTIC ANALYSIS OF COCHLEAR IMPLANT, PATIENT UNDER 7 YEARS OF AGE; WITH PROG
92602   - DIAGNOSTIC ANALYSIS OF COCHLEAR IMPLANT, PATIENT UNDER 7 YEARS OF AGE;
92603   - DIAGNOSTIC ANALYSIS OF COCHLEAR IMPLANT, AGE 7 YEARS OR OLDER; WITH PROGRAMMING
92604   - DIAGNOSTIC ANALYSIS OF COCHLEAR IMPLANT, AGE 7 YEARS OR OLDER; SUBSEQUENT
92605   - EVALUATION FOR PRESCRIPTION OF NON-SPEECH-GENERATING AUGMENTATIVE AND
92606   - THERAPEUTIC SERVICE(S) FOR THE USE OF NON-SPEECH-GENERATING DEVICE, INCLUDING
92607   - EVALUATION FOR PRESCRIPTION FOR SPEECH-GENERATING AUGMENTATIVE AND ALTERNATIVE
92608   - EVALUATION FOR PRESCRIPTION FOR SPEECH-GENERATING AUGMENTATIVE AND ALTERNATIVE
92609   - THERAPEUTIC SERVICES FOR THE USE OF SPEECH-GENERATING DEVICE, INCLUDING
92610   - EVALUATION OF ORAL AND PHARYNGEAL SWALLOWING FUNCTION
92611   - MOTION FLUOROSCOPIC EVALUATION OF SWALLOWING FUNCTION BY CINE OR VIDEO RECORDING



                                              Page 462
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92612   - FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING BY CINE OR VIDEO
92613   - FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING BY CINE OR VIDEO
92614   - FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION, LARYNGEAL SENSORY TESTING BY CINE OR
92615   - FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION, LARYNGEAL SENSORY TESTING BY CINE OR
92616   - FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING AND LARYNGEAL SENSORY
92617   - FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING AND LARYNGEAL SENSORY
92620   - EVALUATION OF CENTRAL AUDITORY FUNCTION, WITH REPORT; INITIAL 60 MINUTES
92621   - EVALUATION OF CENTRAL AUDITORY FUNCTION, WITH REPORT; EACH ADDITIONAL 15 MINUTES
92625   - ASSESSMENT OF TINNITUS (INCLUDES PITCH, LOUDNESS MATCHING, AND MASKING)
92626   - EVALUATION OF AUDITORY REHABILITATION STATUS; FIRST HOUR
92627   - EVALUATION OF AUDITORY REHABILITATION STATUS; EACH ADDITIONAL 15 MINUTES (LIST S
92630   - AUDITORY REHABILITATION; PRE-LINGUAL HEARING LOSS
92633   - AUDITORY REHABILITATION; POST-LINGUAL HEARING LOSS
92640   - DIAGNOSTIC ANALYSIS WITH PROGRAMMING OF AUDITORY BRAINSTEM IMPLANT, PER HOUR
92700   - UNLISTED OTORHINOLARYNGOLOGICAL SERVICE OR PROCEDURE
92960   - CARDIOVERSION, ELECTIVE, ELECTRICAL CONVERSION OF ARRHYTHMIA; EXTERNAL
92961   - CARDIOVERSION, ELECTIVE, ELECTRICAL CONVERSION OF ARRHYTHMIA; INTERNAL
92970   - CARDIOASSIST-METHOD OF CIRCULATORY ASSIST; INTERNAL
92971   - CARDIOASSIST-METHOD OF CIRCULATORY ASSIST; EXTERNAL
92975   - THROMBOLYSIS, CORONARY; BY INTRACORONARY INFUSION, INCLUDING SELECTIVE CORONARY
92978   - INTRAVASCULAR ULTRASOUND (CORONARY VESSEL OR GRAFT) DURING DIAGNOSTIC
92979   - INTRAVASCULAR ULTRASOUND (CORONARY VESSEL OR GRAFT) DURING DIAGNOSTIC
92992   - ATRIAL SEPTECTOMY OR SEPTOSTOMY; TRANSVENOUS METHOD, BALLOON (EG, RASHKIND
92993   - ATRIAL SEPTECTOMY OR SEPTOSTOMY; BLADE METHOD (PARK SEPTOSTOMY) (INCLUDES
93000   - ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; WITH INTERPRETATION AND R
93005   - ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; TRACING ONLY, WITHOUT
93010   - ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; INTERPRETATION AND
93012   - TELEPHONIC TRANSMISSION OF POST-SYMPTOM ELECTROCARDIOGRAM RHYTHM STRIP(S),
93014   - TELEPHONIC TRANSMISSION OF POST-SYMPTOM ELECTROCARDIOGRAM RHYTHM STRIP(S),
93015   - CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMAL TREADMILL OR BICYCLE
93016   - CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMAL TREADMILL OR BICYCLE
93017   - CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMAL TREADMILL OR BICYCLE
93018   - CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMAL TREADMILL OR BICYCLE
93024   - ERGONOVINE PROVOCATION TEST
93025   - MICROVOLT T-WAVE ALTERNANS FOR ASSESSMENT OF VENTRICULAR ARRHYTHMIAS
93040   - RHYTHM ECG, ONE TO THREE LEADS; WITH INTERPRETATION AND REPORT
93041   - RHYTHM ECG, ONE TO THREE LEADS; TRACING ONLY WITHOUT INTERPRETATION AND REPORT
93042   - RHYTHM ECG, ONE TO THREE LEADS; INTERPRETATION AND REPORT ONLY
93224   - WEARABLE ELECTROCARDIOGRAPHIC RHYTHM DERIVED MONITORING FOR 24 HOURS BY CONTINUO
93225   - WEARABLE ELECTROCARDIOGRAPHIC RHYTHM DERIVED MONITORING FOR 24 HOURS BY CONTINUO
93226   - WEARABLE ELECTROCARDIOGRAPHIC RHYTHM DERIVED MONITORING FOR 24 HOURS BY CONTINUO
93227   - WEARABLE ELECTROCARDIOGRAPHIC RHYTHM DERIVED MONITORING FOR 24 HOURS BY CONTINUO
93228   - Wearable mobile cardiovascular telemetry with electrocardiographic recording, co
93230   - WEARABLE ELECTROCARDIOGRAPHIC RHYTHM DERIVED MONITORING FOR 24 HOURS BY CONTINUO
93231   - WEARABLE ELECTROCARDIOGRAPHIC RHYTHM DERIVED MONITORING FOR 24 HOURS BY CONTINUO
93232   - WEARABLE ELECTROCARDIOGRAPHIC RHYTHM DERIVED MONITORING FOR 24 HOURS BY CONTINUO
93233   - WEARABLE ELECTROCARDIOGRAPHIC RHYTHM DERIVED MONITORING FOR 24 HOURS BY CONTINUO
93235   - WEARABLE ELECTROCARDIOGRAPHIC RHYTHM DERIVED MONITORING FOR 24 HOURS BY CONTINUO
93236   - WEARABLE ELECTROCARDIOGRAPHIC RHYTHM DERIVED MONITORING FOR 24 HOURS BY CONTINUO
93237   - WEARABLE ELECTROCARDIOGRAPHIC RHYTHM DERIVED MONITORING FOR 24 HOURS BY CONTINUO
93268   - WEARABLE PATIENT ACTIVATED ELECTROCARDIOGRAPHIC RHYTHM DERIVED EVENT RECORDING W
93270   - WEARABLE PATIENT ACTIVATED ELECTROCARDIOGRAPHIC RHYTHM DERIVED EVENT RECORDING W



                                             Page 463
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93271 - WEARABLE PATIENT ACTIVATED ELECTROCARDIOGRAPHIC RHYTHM DERIVED EVENT RECORDING W
93272 - WEARABLE PATIENT ACTIVATED ELECTROCARDIOGRAPHIC RHYTHM DERIVED EVENT RECORDING W
93278 - SIGNAL-AVERAGED ELECTROCARDIOGRAPHY (SAECG), WITH OR WITHOUT ECG
93286 - PERI-PROCEDURAL DEVICE EVALUATION (IN PERSON) AND PROGRAMMING OF DEVICE SYSTEM P
93287 - PERI-PROCEDURAL DEVICE EVALUATION (IN PERSON) AND PROGRAMMING OF DEVICE SYSTEM P
93294 - Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or mul
93295 - Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or mul
93297 - Interrogation device evaluation(s), (remote) up to 30 days: implantable cardiova
93298 - Interrogation device evaluation(s), (remote) up to 30 days: implantable loop rec
93303 - TRANSTHORACIC ECHOCARDIOGRAPHY FOR CONGENIAL CARDIAC ANOMALIES; COMPLETE
93304 - TRANSTHORACIC ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; FOLLOW-UP OR
93307 - ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUD
93308 - ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUD
93312 - ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, REAL TIME WITH IMAGE DOCUMENTATION (2D)
93313 - ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, REAL TIME WITH IMAGE DOCUMENTATION (2D)
93314 - ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, REAL TIME WITH IMAGE DOCUMENTATION (2D)
93315 - TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; INCLUDING
93316 - TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; PLACEMENT OF
93317 - TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; IMAGE
93318 - ECHOCARDIOGRAPHY, TRANSESOPHAGEAL (TEE) FOR MONITORING PURPOSES, INCLUDING
93320 - DOPPLER ECHOCARDIOGRAPHY, PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL
93321 - DOPPLER ECHOCARDIOGRAPHY, PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL
93325 - DOPPLER ECHOCARDIOGRAPHY COLOR FLOW VELOCITY MAPPING (LIST SEPARATELY IN
93350 - ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUD
93352 - Use of echocardiographic contrast agent during stress echocardiography (List sep
93463 - Pharmacologic agent administration (eg, inhaled nitric oxide, intravenous infusi
93464 - Physiologic exercise study (eg, bicycle or arm ergometry) including assessing he
93539 - INJECTION PROCEDURE DURING CARDIAC CATHETERIZATION; FOR SELECTIVE OPACIFICATION
93540 - INJECTION PROCEDURE DURING CARDIAC CATHETERIZATION; FOR SELECTIVE OPACIFICATION
93541 - INJECTION PROCEDURE DURING CARDIAC CATHETERIZATION; FOR PULMONARY ANGIOGRAPHY
93542 - INJECTION PROCEDURE DURING CARDIAC CATHETERIZATION; FOR SELECTIVE RIGHT VENTRICU
93543 - INJECTION PROCEDURE DURING CARDIAC CATHETERIZATION; FOR SELECTIVE LEFT VENTRICUL
93544 - INJECTION PROCEDURE DURING CARDIAC CATHETERIZATION; FOR AORTOGRAPHY
93545 - INJECTION PROCEDURE DURING CARDIAC CATHETERIZATION; FOR SELECTIVE CORONARY
93555 - IMAGING SUPERVISION, INTERPRETATION AND REPORT FOR INJECTION PROCEDURE(S)
93556 - IMAGING SUPERVISION, INTERPRETATION AND REPORT FOR INJECTION PROCEDURE(S)
93561 - INDICATOR DILUTION STUDIES SUCH AS DYE OR THERMAL DILUTION, INCLUDING ARTERIAL
93562 - INDICATOR DILUTION STUDIES SUCH AS DYE OR THERMAL DILUTION, INCLUDING ARTERIAL
93563 - Injection procedure during cardiac catheterization including imaging supervision
93564 - Injection procedure during cardiac catheterization including imaging supervision
93565 - Injection procedure during cardiac catheterization including imaging supervision
93566 - Injection procedure during cardiac catheterization including imaging supervision
93567 - Injection procedure during cardiac catheterization including imaging supervision
93568 - Injection procedure during cardiac catheterization including imaging supervision
93571 - INTRAVASCULAR DOPPLER VELOCITY AND/OR PRESSURE DERIVED CORONARY FLOW RESERVE
93572 - INTRAVASCULAR DOPPLER VELOCITY AND/OR PRESSURE DERIVED CORONARY FLOW RESERVE
93609 - INTRAVENTRICULAR AND/OR INTRA-ATRIAL MAPPING OF TACHYCARDIA SITE(S) WITH
93613 - INTRACARDIAC ELECTROPHYSIOLOGIC 3-DIMENSIONAL MAPPING (LIST SEPARATELY IN
93619 - COMPREHENSIVE ELECTROPHYSIOLOGIC EVALUATION WITH RIGHT ATRIAL PACING AND RECORDI
93620 - COMPREHENSIVE ELECTROPHYSIOLOGIC EVALUATION INCLUDING INSERTION AND REPOSITIONIN
93621 - COMPREHENSIVE ELECTROPHYSIOLOGIC EVALUATION INCLUDING INSERTION AND
93622 - COMPREHENSIVE ELECTROPHYSIOLOGIC EVALUATION INCLUDING INSERTION AND



                                           Page 464
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93623   - PROGRAMMED STIMULATION AND PACING AFTER INTRAVENOUS DRUG INFUSION (LIST
93624   - ELECTROPHYSIOLOGIC FOLLOW-UP STUDY WITH PACING AND RECORDING TO TEST EFFECTIVENE
93631   - INTRA-OPERATIVE EPICARDIAL AND ENDOCARDIAL PACING AND MAPPING TO LOCALIZE THE
93640   - ELECTROPHYSIOLOGIC EVALUATION OF SINGLE OR DUAL CHAMBER PACING CARDIOVERTER-DEFI
93641   - ELECTROPHYSIOLOGIC EVALUATION OF SINGLE OR DUAL CHAMBER PACING CARDIOVERTER-DEFI
93642   - ELECTROPHYSIOLOGIC EVALUATION OF SINGLE OR DUAL CHAMBER PACING CARDIOVERTER-DEFI
93650   - INTRACARDIAC CATHETER ABLATION OF ATRIOVENTRICULAR NODE FUNCTION, ATRIOVENTRICUL
93651   - INTRACARDIAC CATHETER ABLATION OF ARRHYTHMOGENIC FOCUS; FOR TREATMENT OF SUPRAVE
93652   - INTRACARDIAC CATHETER ABLATION OF ARRHYTHMOGENIC FOCUS; FOR TREATMENT OF VENTRIC
93660   - EVALUATION OF CARDIOVASCULAR FUNCTION WITH TILT TABLE EVALUATION, WITH CONTINUOU
93662   - INTRACARDIAC ECHOCARDIOGRAPHY DURING THERAPEUTIC/DIAGNOSTIC INTERVENTION,
93701   - BIOIMPEDANCE-DERIVED PHYSIOLOGIC CARDIOVASCULAR ANALYSIS
93720   - PLETHYSMOGRAPHY, TOTAL BODY; WITH INTERPRETATION AND REPORT
93721   - PLETHYSMOGRAPHY, TOTAL BODY; TRACING ONLY, WITHOUT INTERPRETATION AND REPORT
93722   - PLETHYSMOGRAPHY, TOTAL BODY; INTERPRETATION AND REPORT ONLY
93724   - ELECTRONIC ANALYSIS OF ANTITACHYCARDIA PACEMAKER SYSTEM (INCLUDES
93740   - TEMPERATURE GRADIENT STUDIES
93745   - INITIAL SET-UP AND PROGRAMMING BY A PHYSICIAN OF WEARABLE
93770   - DETERMINATION OF VENOUS PRESSURE
93797   - PHYSICIAN SERVICES FOR OUTPATIENT CARDIAC REHABILITATION; WITHOUT CONTINUOUS ECG
93798   - PHYSICIAN SERVICES FOR OUTPATIENT CARDIAC REHABILITATION; WITH CONTINUOUS ECG
93799   - UNLISTED CARDIOVASCULAR SERVICE OR PROCEDURE
93875   - NON-INVASIVE PHYSIOLOGIC STUDIES OF EXTRACRANIAL ARTERIES, BILATERAL, (EG, PERIO
93880   - DUPLEX SCAN OF EXTRACRANIAL ARTERIES; COMPLETE BILATERAL STUDY
93882   - DUPLEX SCAN OF EXTRACRANIAL ARTERIES; UNILATERAL OR LIMITED STUDY
93886   - TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; COMPLETE STUDY
93888   - TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; LIMITED STUDY
93890   - TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; VASOREACTIVITY STUDY
93892   - TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; EMBOLI DETECTION
93893   - TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; EMBOLI DETECTION WITH
93922   - NONINVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY ARTERIES, SINGLE LEV
93923   - NON-INVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY ARTERIES, MULTIPLE
93924   - NON-INVASIVE PHYSIOLOGIC STUDIES OF LOWER EXTREMITY ARTERIES, AT REST AND
93925   - DUPLEX SCAN OF LOWER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; COMPLETE
93926   - DUPLEX SCAN OF LOWER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; UNILATERAL
93930   - DUPLEX SCAN OF UPPER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; COMPLETE
93931   - DUPLEX SCAN OF UPPER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; UNILATERAL
93965   - NON-INVASIVE PHYSIOLOGIC STUDIES OF EXTREMITY VEINS, COMPLETE BILATERAL STUDY (E
93970   - DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER
93971   - DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER
93975   - DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABDOMINAL, PELVIC, AND/OR R
93976   - DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABDOMINAL, PELVIC, SCROTAL
93978   - DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE, OR BYPASS GRAFTS;
93979   - DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE, OR BYPASS GRAFTS;
93980   - DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF PENILE VESSELS; COMPLETE
93981   - DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF PENILE VESSELS; FOLLOW-UP
93990   - DUPLEX SCAN OF HEMODIALYSIS ACCESS (INCLUDING ARTERIAL INFLOW, BODY OF ACCESS AN
94002   - VENTILATION ASSIST AND MANAGEMENT, INITIATION OF PRESSURE OR VOLUME PRESET VENTI
94003   - VENTILATION ASSIST AND MANAGEMENT, INITIATION OF PRESSURE OR VOLUME PRESET VENTI
94004   - VENTILATION ASSIST AND MANAGEMENT, INITIATION OF PRESSURE OR VOLUME PRESET VENTI
94005   - HOME VENTILATOR MANAGEMENT CARE PLAN OVERSIGHT OF A PATIENT (PATIENT NOT PRESENT
94010   - SPIROMETRY, INCLUDING GRAPHIC RECORD, TOTAL AND TIMED VITAL CAPACITY, EXPIRATORY



                                              Page 465
                                    All Other (no trigger bundling)


94011   - Measurement of spirometric forced expiratory flows in an infant or child through
94012   - Measurement of spirometric forced expiratory flows, before and after bronchodila
94013   - Measurement of lung volumes (ie, functional residual capacity ¿FRC¿, forced vi
94014   - PATIENT-INITIATED SPIROMETRIC RECORDING PER 30-DAY PERIOD OF TIME; INCLUDES
94015   - PATIENT-INITIATED SPIROMETRIC RECORDING PER 30-DAY PERIOD OF TIME; RECORDING
94016   - PATIENT-INITIATED SPIROMETRIC RECORDING PER 30-DAY PERIOD OF TIME; PHYSICIAN
94070   - BRONCHOSPASM PROVOCATION EVALUATION, MULTIPLE SPIROMETRIC DETERMINATIONS AS IN
94150   - VITAL CAPACITY, TOTAL (SEPARATE PROCEDURE)
94200   - MAXIMUM BREATHING CAPACITY, MAXIMAL VOLUNTARY VENTILATION
94240   - FUNCTIONAL RESIDUAL CAPACITY OR RESIDUAL VOLUME: HELIUM METHOD, NITROGEN OPEN
94250   - EXPIRED GAS COLLECTION, QUANTITATIVE, SINGLE PROCEDURE (SEPARATE PROCEDURE)
94260   - THORACIC GAS VOLUME
94350   - DETERMINATION OF MALDISTRIBUTION OF INSPIRED GAS: MULTIPLE BREATH NITROGEN
94360   - DETERMINATION OF RESISTANCE TO AIRFLOW, OSCILLATORY OR PLETHYSMOGRAPHIC METHODS
94370   - DETERMINATION OF AIRWAY CLOSING VOLUME, SINGLE BREATH TESTS
94375   - RESPIRATORY FLOW VOLUME LOOP
94400   - BREATHING RESPONSE TO CO2 (CO2 RESPONSE CURVE)
94450   - BREATHING RESPONSE TO HYPOXIA (HYPOXIA RESPONSE CURVE)
94452   - HIGH ALTITUDE SIMULATION TEST (HAST), WITH PHYSICIAN INTERPRETATION AND REPORT;
94453   - HIGH ALTITUDE SIMULATION TEST (HAST), WITH PHYSICIAN INTERPRETATION AND REPORT;
94610   - INTRAPULMONARY SURFACTANT ADMINISTRATION BY A PHYSICIAN THROUGH ENDOTRACHEAL TUB
94620   - PULMONARY STRESS TESTING; SIMPLE (EG, 6-MINUTE WALK TEST, PROLONGED EXERCISE TES
94621   - PULMONARY STRESS TESTING; COMPLEX (INCLUDING MEASUREMENTS OF CO2 PRODUCTION, O2
94640   - PRESSURIZED OR NONPRESSURIZED INHALATION TREATMENT FOR ACUTE AIRWAY OBSTRUCTION
94642   - AEROSOL INHALATION OF PENTAMIDINE FOR PNEUMOCYSTIS CARINII PNEUMONIA TREATMENT
94644   - CONTINUOUS INHALATION TREATMENT WITH AEROSOL MEDICATION FOR ACUTE AIRWAY OBSTRUC
94645   - CONTINUOUS INHALATION TREATMENT WITH AEROSOL MEDICATION FOR ACUTE AIRWAY OBSTRUC
94660   - CONTINUOUS POSITIVE AIRWAY PRESSURE VENTILATION (CPAP), INITIATION AND
94662   - CONTINUOUS NEGATIVE PRESSURE VENTILATION (CNP), INITIATION AND MANAGEMENT
94664   - DEMONSTRATION AND/OR EVALUATION OF PATIENT UTILIZATION OF AN AEROSOL GENERATOR,
94667   - MANIPULATION CHEST WALL, SUCH AS CUPPING, PERCUSSING, AND VIBRATION TO
94668   - MANIPULATION CHEST WALL, SUCH AS CUPPING, PERCUSSING, AND VIBRATION TO
94680   - OXYGEN UPTAKE, EXPIRED GAS ANALYSIS; REST AND EXERCISE, DIRECT, SIMPLE
94681   - OXYGEN UPTAKE, EXPIRED GAS ANALYSIS; INCLUDING CO2 OUTPUT, PERCENTAGE OXYGEN
94690   - OXYGEN UPTAKE, EXPIRED GAS ANALYSIS; REST, INDIRECT (SEPARATE PROCEDURE)
94720   - CARBON MONOXIDE DIFFUSING CAPACITY (EG, SINGLE BREATH, STEADY STATE)
94725   - MEMBRANE DIFFUSION CAPACITY
94750   - PULMONARY COMPLIANCE STUDY (EG, PLETHYSMOGRAPHY, VOLUME AND PRESSURE
94760   - NONINVASIVE EAR OR PULSE OXIMETRY FOR OXYGEN SATURATION; SINGLE DETERMINATION
94761   - NONINVASIVE EAR OR PULSE OXIMETRY FOR OXYGEN SATURATION; MULTIPLE
94762   - NONINVASIVE EAR OR PULSE OXIMETRY FOR OXYGEN SATURATION; BY CONTINUOUS
94770   - CARBON DIOXIDE, EXPIRED GAS DETERMINATION BY INFRARED ANALYZER
94772   - CIRCADIAN RESPIRATORY PATTERN RECORDING (PEDIATRIC PNEUMOGRAM), 12 TO 24 HOUR
94774   - PEDIATRIC HOME APNEA MONITORING EVENT RECORDING INCLUDING RESPIRATORY RATE, PATT
94775   - PEDIATRIC HOME APNEA MONITORING EVENT RECORDING INCLUDING RESPIRATORY RATE, PATT
94776   - PEDIATRIC HOME APNEA MONITORING EVENT RECORDING INCLUDING RESPIRATORY RATE, PATT
94777   - PEDIATRIC HOME APNEA MONITORING EVENT RECORDING INCLUDING RESPIRATORY RATE, PATT
94799   - UNLISTED PULMONARY SERVICE OR PROCEDURE
95004   - PERCUTANEOUS TESTS (SCRATCH, PUNCTURE, PRICK) WITH ALLERGENIC EXTRACTS, IMMEDIAT
95010   - PERCUTANEOUS TESTS (SCRATCH, PUNCTURE, PRICK) SEQUENTIAL AND INCREMENTAL, WITH D
95012   - NITRIC OXIDE EXPIRED GAS DETERMINATION
95015   - INTRACUTANEOUS (INTRADERMAL) TESTS, SEQUENTIAL AND INCREMENTAL, WITH DRUGS, BIOL



                                              Page 466
                                    All Other (no trigger bundling)


95024   - INTRACUTANEOUS (INTRADERMAL) TESTS WITH ALLERGENIC EXTRACTS, IMMEDIATE TYPE REAC
95027   - INTRACUTANEOUS (INTRADERMAL) TESTS, SEQUENTIAL AND INCREMENTAL, WITH ALLERGENIC
95028   - INTRACUTANEOUS (INTRADERMAL) TESTS WITH ALLERGENIC EXTRACTS, DELAYED TYPE
95044   - PATCH OR APPLICATION TEST(S) (SPECIFY NUMBER OF TESTS)
95052   - PHOTO PATCH TEST(S) (SPECIFY NUMBER OF TESTS)
95056   - PHOTO TESTS
95060   - OPHTHALMIC MUCOUS MEMBRANE TESTS
95065   - DIRECT NASAL MUCOUS MEMBRANE TEST
95070   - INHALATION BRONCHIAL CHALLENGE TESTING (NOT INCLUDING NECESSARY PULMONARY
95071   - INHALATION BRONCHIAL CHALLENGE TESTING (NOT INCLUDING NECESSARY PULMONARY
95075   - INGESTION CHALLENGE TEST (SEQUENTIAL AND INCREMENTAL INGESTION OF TEST ITEMS,
95115   - PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF ALLE
95117   - PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF
95120   - PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY IN PRESCRIBING PHYSICIANS
95125   - PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY IN PRESCRIBING PHYSICIANS
95130   - PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY IN PRESCRIBING PHYSICIANS
95131   - PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY IN PRESCRIBING PHYSICIANS
95132   - PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY IN PRESCRIBING PHYSICIANS
95133   - PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY IN PRESCRIBING PHYSICIANS
95134   - PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY IN PRESCRIBING PHYSICIANS
95144   - PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF
95145   - PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF
95146   - PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF
95147   - PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF
95148   - PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF
95149   - PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF
95165   - PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF
95170   - PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF
95180   - RAPID DESENSITIZATION PROCEDURE, EACH HOUR (EG, INSULIN, PENICILLIN, EQUINE
95199   - UNLISTED ALLERGY/CLINICAL IMMUNOLOGIC SERVICE OR PROCEDURE
95250   - AMBULATORY CONTINUOUS GLUCOSE MONITORING OF INTERSTITIAL TISSUE FLUID VIA A SUBC
95251   - AMBULATORY CONTINUOUS GLUCOSE MONITORING OF INTERSTITIAL TISSUE FLUID VIA A SUBC
95805   - MULTIPLE SLEEP LATENCY OR MAINTENANCE OF WAKEFULNESS TESTING, RECORDING, ANALYSI
95806   - SLEEP STUDY, UNATTENDED, SIMULTANEOUS RECORDING OF, HEART RATE, OXYGEN SATURATIO
95807   - SLEEP STUDY, SIMULTANEOUS RECORDING OF VENTILATION, RESPIRATORY EFFORT, ECG OR
95808   - POLYSOMNOGRAPHY; SLEEP STAGING WITH 1-3 ADDITIONAL PARAMETERS OF SLEEP,
95810   - POLYSOMNOGRAPHY; SLEEP STAGING WITH 4 OR MORE ADDITIONAL PARAMETERS OF SLEEP,
95811   - POLYSOMNOGRAPHY; SLEEP STAGING WITH 4 OR MORE ADDITIONAL PARAMETERS OF SLEEP,
95812   - ELECTROENCEPHALOGRAM (EEG) EXTENDED MONITORING; 41-60 MINUTES
95813   - ELECTROENCEPHALOGRAM (EEG) EXTENDED MONITORING; GREATER THAN ONE HOUR
95816   - ELECTROENCEPHALOGRAM (EEG); INCLUDING RECORDING AWAKE AND DROWSY
95819   - ELECTROENCEPHALOGRAM (EEG); INCLUDING RECORDING AWAKE AND ASLEEP
95822   - ELECTROENCEPHALOGRAM (EEG); RECORDING IN COMA OR SLEEP ONLY
95824   - ELECTROENCEPHALOGRAM (EEG); CEREBRAL DEATH EVALUATION ONLY
95827   - ELECTROENCEPHALOGRAM (EEG); ALL NIGHT RECORDING
95829   - ELECTROCORTICOGRAM AT SURGERY (SEPARATE PROCEDURE)
95830   - INSERTION BY PHYSICIAN OF SPHENOIDAL ELECTRODES FOR ELECTROENCEPHALOGRAPHIC
95831   - MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE) WITH REPORT; EXTREMITY (EXCLUDING HA
95832   - MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE) WITH REPORT; HAND, WITH OR WITHOUT
95833   - MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE) WITH REPORT; TOTAL EVALUATION OF
95834   - MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE) WITH REPORT; TOTAL EVALUATION OF
95851   - RANGE OF MOTION MEASUREMENTS AND REPORT (SEPARATE PROCEDURE); EACH EXTREMITY



                                              Page 467
                                    All Other (no trigger bundling)


95852   - RANGE OF MOTION MEASUREMENTS AND REPORT (SEPARATE PROCEDURE); HAND, WITH OR
95857   - TENSILON TEST FOR MYASTHENIA GRAVIS;
95860   - NEEDLE ELECTROMYOGRAPHY, ONE EXTREMITY WITH OR WITHOUT RELATED PARASPINAL AREAS
95861   - NEEDLE ELECTROMYOGRAPHY; TWO EXTREMITIES WITH OR WITHOUT RELATED PARASPINAL
95863   - NEEDLE ELECTROMYOGRAPHY; THREE EXTREMITIES WITH OR WITHOUT RELATED PARASPINAL
95864   - NEEDLE ELECTROMYOGRAPHY; FOUR EXTREMITIES WITH OR WITHOUT RELATED PARASPINAL
95865   - NEEDLE ELECTROMYOGRAPHY; LARYNX
95866   - NEEDLE ELECTROMYOGRAPHY; HEMIDIAPHRAGM
95867   - NEEDLE ELECTROMYOGRAPHY; CRANIAL NERVE SUPPLIED MUSCLE(S), UNILATERAL
95868   - NEEDLE ELECTROMYOGRAPHY; CRANIAL NERVE SUPPLIED MUSCLES, BILATERAL
95869   - NEEDLE ELECTROMYOGRAPHY; THORACIC PARASPINAL MUSCLES (EXCLUDING T1 OR T12)
95870   - NEEDLE ELECTROMYOGRAPHY; LIMITED STUDY OF MUSCLES IN ONE EXTREMITY OR NON-LIMB
95872   - NEEDLE ELECTROMYOGRAPHY USING SINGLE FIBER ELECTRODE, WITH QUANTITATIVE
95873   - ELECTRICAL STIMULATION FOR GUIDANCE IN CONJUNCTION WITH CHEMODENERVATION (LIST S
95874   - NEEDLE ELECTROMYOGRAPHY FOR GUIDANCE IN CONJUNCTION WITH CHEMODENERVATION (LIST
95875   - ISCHEMIC LIMB EXERCISE TEST WITH SERIAL SPECIMEN(S) ACQUISITION FOR MUSCLE(S)
95900   - NERVE CONDUCTION, AMPLITUDE AND LATENCY/VELOCITY STUDY, EACH NERVE; MOTOR,
95903   - NERVE CONDUCTION, AMPLITUDE AND LATENCY/VELOCITY STUDY, EACH NERVE; MOTOR, WITH
95904   - NERVE CONDUCTION, AMPLITUDE AND LATENCY/VELOCITY STUDY, EACH NERVE; SENSORY
95920   - INTRAOPERATIVE NEUROPHYSIOLOGY TESTING, PER HOUR (LIST SEPARATELY IN ADDITION TO
95921   - TESTING OF AUTONOMIC NERVOUS SYSTEM FUNCTION: CARDIOVAGAL INNERVATION (PARASYMPA
95922   - TESTING OF AUTONOMIC NERVOUS SYSTEM FUNCTION; VASOMOTOR ADRENERGIC INNERVATION
95923   - TESTING OF AUTONOMIC NERVOUS SYSTEM FUNCTION; SUDOMOTOR, INCLUDING ONE OR MORE
95925   - SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL STUDY, STIMULATION OF ANY/ALL PERIP
95926   - SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL STUDY, STIMULATION OF ANY/ALL
95927   - SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL STUDY, STIMULATION OF ANY/ALL
95928   - CENTRAL MOTOR EVOKED POTENTIAL STUDY (TRANSCRANIAL MOTOR STIMULATION); UPPER
95929   - CENTRAL MOTOR EVOKED POTENTIAL STUDY (TRANSCRANIAL MOTOR STIMULATION); LOWER
95930   - VISUAL EVOKED POTENTIAL (VEP) TESTING CENTRAL NERVOUS SYSTEM, CHECKERBOARD OR
95933   - ORBICULARIS OCULI (BLINK) REFLEX, BY ELECTRODIAGNOSTIC TESTING
95934   - H-REFLEX, AMPLITUDE AND LATENCY STUDY; RECORD GASTROCNEMIUS/SOLEUS MUSCLE
95936   - H-REFLEX, AMPLITUDE AND LATENCY STUDY; RECORD MUSCLE OTHER THAN
95937   - NEUROMUSCULAR JUNCTION TESTING (REPETITIVE STIMULATION, PAIRED STIMULI), EACH
95950   - MONITORING FOR IDENTIFICATION AND LATERALIZATION OF CEREBRALSEIZURE FOCUS ELECTR
95951   - MONITORING FOR LOCALIZATION OF CEREBRAL SEIZURE FOCUS BY CABLE OR RADIO, 16 OR
95953   - MONITORING FOR LOCALIZATION OF CEREBRAL SEIZURE FOCUS BY COMPUTERIZED PORTABLE
95954   - PHARMACOLOGICAL OR PHYSICAL ACTIVATION REQUIRING PHYSICIAN ATTENDANCE DURING
95955   - ELECTROENCEPHALOGRAM (EEG) DURING NONINTRACRANIAL SURGERY (EG, CAROTID SURGERY)
95956   - MONITORING FOR LOCALIZATION OF CEREBRAL SEIZURE FOCUS BY CABLE OR RADIO, 16 OR
95957   - DIGITAL ANALYSIS OF ELECTROENCEPHALOGRAM (EEG) (EG, FOR EPILEPTIC SPIKE
95958   - WADA ACTIVATION TEST FOR HEMISPHERIC FUNCTION, INCLUDING
95961   - FUNCTIONAL CORTICAL AND SUBCORTICAL MAPPING BY STIMULATION AND/OR RECORDING OF
95962   - FUNCTIONAL CORTICAL AND SUBCORTICAL MAPPING BY STIMULATION AND/OR RECORDING OF
95965   - MAGNETOENCEPHALOGRAPHY (MEG), RECORDING AND ANALYSIS; FOR SPONTANEOUS BRAIN
95966   - MAGNETOENCEPHALOGRAPHY (MEG), RECORDING AND ANALYSIS; FOR EVOKED MAGNETIC
95967   - MAGNETOENCEPHALOGRAPHY (MEG), RECORDING AND ANALYSIS; FOR EVOKED MAGNETIC
95970   - ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG, RAT
95971   - ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG,
95972   - ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG,
95973   - ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG,
95974   - ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG,
95975   - ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG,



                                              Page 468
                                   All Other (no trigger bundling)


95978   - ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG,
95979   - ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG,
95992   - Canalith repositioning procedure(s) (eg, Epley maneuver, Semont maneuver), per d
95999   - UNLISTED NEUROLOGICAL OR NEUROMUSCULAR DIAGNOSTIC PROCEDURE
96000   - COMPREHENSIVE COMPUTER-BASED MOTION ANALYSIS BY VIDEO-TAPING AND 3-D KINEMATICS;
96001   - COMPREHENSIVE COMPUTER-BASED MOTION ANALYSIS BY VIDEO-TAPING AND 3-D
96002   - DYNAMIC SURFACE ELECTROMYOGRAPHY, DURING WALKING OR OTHER FUNCTIONAL
96003   - DYNAMIC FINE WIRE ELECTROMYOGRAPHY, DURING WALKING OR OTHER FUNCTIONAL
96004   - PHYSICIAN REVIEW AND INTERPRETATION OF COMPREHENSIVE COMPUTER BASED MOTION
96020   - NEUROFUNCTIONAL TESTING SELECTION AND ADMINISTRATION DURING NONINVASIVE IMAGING
96101   - PSYCHOLOGICAL TESTING (INCLUDES PSYCHODIAGNOSTIC ASSESSMENT OF EMOTIONALITY, INT
96102   - PSYCHOLOGICAL TESTING (INCLUDES PSYCHODIAGNOSTIC ASSESSMENT OF EMOTIONALITY, INT
96103   - PSYCHOLOGICAL TESTING (INCLUDES PSYCHODIAGNOSTIC ASSESSMENT OF EMOTIONALITY, INT
96105   - ASSESSMENT OF APHASIA (INCLUDES ASSESSMENT OF EXPRESSIVE AND RECEPTIVE SPEECH
96110   - DEVELOPMENTAL TESTING; LIMITED (EG, DEVELOPMENTAL SCREENING TEST II, EARLY
96111   - DEVELOPMENTAL TESTING; EXTENDED (INCLUDES ASSESSMENT OF MOTOR, LANGUAGE,
96116   - NEUROBEHAVIORAL STATUS EXAM (CLINICAL ASSESSMENT OF THINKING, REASONING AND JUDG
96118   - NEUROPSYCHOLOGICAL TESTING (EG, HALSTEAD-REITAN NEUROPSYCHOLOGICAL BATTERY, WECH
96119   - NEUROPSYCHOLOGICAL TESTING (EG, HALSTEAD-REITAN NEUROPSYCHOLOGICAL BATTERY, WECH
96120   - NEUROPSYCHOLOGICAL TESTING (EG, WISCONSIN CARD SORTING TEST), ADMINISTERED BY A
96150   - HEALTH AND BEHAVIOR ASSESSMENT (EG, HEALTH-FOCUSED CLINICAL INTERVIEW, BEHAVIORA
96151   - HEALTH AND BEHAVIOR ASSESSMENT (EG, HEALTH-FOCUSED CLINICAL INTERVIEW,
96152   - HEALTH AND BEHAVIOR INTERVENTION, EACH 15 MINUTES, FACE-TO-FACE; INDIVIDUAL
96153   - HEALTH AND BEHAVIOR INTERVENTION, EACH 15 MINUTES, FACE-TO-FACE; GROUP (2 OR
96154   - HEALTH AND BEHAVIOR INTERVENTION, EACH 15 MINUTES, FACE-TO-FACE; FAMILY (WITH
96155   - HEALTH AND BEHAVIOR INTERVENTION, EACH 15 MINUTES, FACE-TO-FACE; FAMILY
96360   - Intravenous infusion, hydration; initial 31 minutes to 1 hour
96361   - Intravenous infusion, hydration; each additional hour (List separately in additi
96365   - Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance
96366   - Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance
96367   - Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance
96368   - Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance
96369   - Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); in
96370   - Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); ea
96371   - Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); ad
96372   - Therapeutic, prophylactic, or diagnostic injection (specify substance or drug);
96373   - Therapeutic, prophylactic, or diagnostic injection (specify substance or drug);
96374   - Therapeutic, prophylactic, or diagnostic injection (specify substance or drug);
96375   - Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); ea
96376   - Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); ea
96379   - Unlisted therapeutic, prophylactic, or diagnostic intravenous or intra-arterial
96401   - CHEMOTHERAPY ADMINISTRATION, SUBCUTANEOUS OR INTRAMUSCULAR; NON-HORMONAL ANTI-NE
96402   - CHEMOTHERAPY ADMINISTRATION, SUBCUTANEOUS OR INTRAMUSCULAR; HORMONAL ANTI-NEOPLA
96405   - CHEMOTHERAPY ADMINISTRATION; INTRALESIONAL, UP TO AND INCLUDING 7 LESIONS
96406   - CHEMOTHERAPY ADMINISTRATION; INTRALESIONAL, MORE THAN 7 LESIONS
96409   - CHEMOTHERAPY ADMINISTRATION; INTRAVENOUS, PUSH TECHNIQUE, SINGLE OR INITIAL SUBS
96411   - CHEMOTHERAPY ADMINISTRATION; INTRAVENOUS, PUSH TECHNIQUE, EACH ADDITIONAL SUBSTA
96413   - CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS INFUSION TECHNIQUE; UP TO 1 HOUR, SINGL
96415   - CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS INFUSION TECHNIQUE; EACH ADDITIONAL HOU
96416   - CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS INFUSION TECHNIQUE; INITIATION OF PROLO
96417   - CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS INFUSION TECHNIQUE; EACH ADDITIONAL SEQ
96420   - CHEMOTHERAPY ADMINISTRATION, INTRA-ARTERIAL; PUSH TECHNIQUE



                                             Page 469
                                    All Other (no trigger bundling)


96422   - CHEMOTHERAPY ADMINISTRATION, INTRA-ARTERIAL; INFUSION TECHNIQUE, UP TO ONE HOUR
96423   - CHEMOTHERAPY ADMINISTRATION, INTRA-ARTERIAL; INFUSION TECHNIQUE, EACH ADDITIONAL
96425   - CHEMOTHERAPY ADMINISTRATION, INTRA-ARTERIAL; INFUSION TECHNIQUE, INITIATION OF
96440   - CHEMOTHERAPY ADMINISTRATION INTO PLEURAL CAVITY, REQUIRING AND INCLUDING
96445   - CHEMOTHERAPY ADMINISTRATION INTO PERITONEAL CAVITY, REQUIRING AND INCLUDING
96450   - CHEMOTHERAPY ADMINISTRATION, INTO CNS (EG, INTRATHECAL), REQUIRING AND
96521   - REFILLING AND MAINTENANCE OF PORTABLE PUMP
96522   - REFILLING AND MAINTENANCE OF IMPLANTABLE PUMP OR RESERVOIR FOR DRUG DELIVERY, SY
96523   - IRRIGATION OF IMPLANTED VENOUS ACCESS DEVICE FOR DRUG DELIVERY SYSTEMS
96542   - CHEMOTHERAPY INJECTION, SUBARACHNOID OR INTRAVENTRICULAR VIA SUBCUTANEOUS
96549   - UNLISTED CHEMOTHERAPY PROCEDURE
96900   - ACTINOTHERAPY (ULTRAVIOLET LIGHT)
96904   - WHOLE BODY INTEGUMENTARY PHOTOGRAPHY, FOR MONITORING OF HIGH RISK PATIENTS WITH
96910   - PHOTOCHEMOTHERAPY; TAR AND ULTRAVIOLET B (GOECKERMAN TREATMENT) OR PETROLATUM
96912   - PHOTOCHEMOTHERAPY; PSORALENS AND ULTRAVIOLET A (PUVA)
96913   - PHOTOCHEMOTHERAPY (GOECKERMAN AND/OR PUVA) FOR SEVERE PHOTORESPONSIVE
97001   - PHYSICAL THERAPY EVALUATION
97002   - PHYSICAL THERAPY RE-EVALUATION
97003   - OCCUPATIONAL THERAPY EVALUATION
97004   - OCCUPATIONAL THERAPY RE-EVALUATION
97012   - APPLICATION OF A MODALITY TO ONE OR MORE AREAS; TRACTION, MECHANICAL
97014   - APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ELECTRICAL STIMULATION
97016   - APPLICATION OF A MODALITY TO ONE OR MORE AREAS; VASOPNEUMATIC DEVICES
97018   - APPLICATION OF A MODALITY TO ONE OR MORE AREAS; PARAFFIN BATH
97022   - APPLICATION OF A MODALITY TO ONE OR MORE AREAS; WHIRLPOOL
97024   - APPLICATION OF A MODALITY TO ONE OR MORE AREAS; DIATHERMY (EG, MICROWAVE)
97026   - APPLICATION OF A MODALITY TO ONE OR MORE AREAS; INFRARED
97028   - APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ULTRAVIOLET
97032   - APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ELECTRICAL STIMULATION (MANUAL),
97033   - APPLICATION OF A MODALITY TO ONE OR MORE AREAS; IONTOPHORESIS, EACH 15 MINUTES
97034   - APPLICATION OF A MODALITY TO ONE OR MORE AREAS; CONTRAST BATHS, EACH 15 MINUTES
97035   - APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ULTRASOUND, EACH 15 MINUTES
97036   - APPLICATION OF A MODALITY TO ONE OR MORE AREAS; HUBBARD TANK, EACH 15 MINUTES
97039   - UNLISTED MODALITY (SPECIFY TYPE AND TIME IF CONSTANT ATTENDANCE)
97110   - THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; THERAPEUTIC EXERCISES
97112   - THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; NEUROMUSCULAR
97113   - THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; AQUATIC THERAPY WITH
97116   - THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; GAIT TRAINING
97124   - THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; MASSAGE, INCLUDING
97139   - UNLISTED THERAPEUTIC PROCEDURE (SPECIFY)
97140   - MANUAL THERAPY TECHNIQUES (EG, MOBILIZATION/ MANIPULATION, MANUAL LYMPHATIC
97150   - THERAPEUTIC PROCEDURE(S), GROUP (2 OR MORE INDIVIDUALS)
97530   - THERAPEUTIC ACTIVITIES, DIRECT (ONE-ON-ONE) PATIENT CONTACT BY THE PROVIDER
97532   - DEVELOPMENT OF COGNITIVE SKILLS TO IMPROVE ATTENTION, MEMORY, PROBLEM SOLVING,
97533   - SENSORY INTEGRATIVE TECHNIQUES TO ENHANCE SENSORY PROCESSING AND PROMOTE
97535   - SELF-CARE/HOME MANAGEMENT TRAINING (EG, ACTIVITIES OF DAILY LIVING (ADL) AND
97537   - COMMUNITY/WORK REINTEGRATION TRAINING (EG, SHOPPING, TRANSPORTATION, MONEY
97542   - WHEELCHAIR MANAGEMENT (EG, ASSESSMENT, FITTING, TRAINING), EACH 15 MINUTES
97545   - WORK HARDENING/CONDITIONING; INITIAL 2 HOURS
97546   - WORK HARDENING/CONDITIONING; EACH ADDITIONAL HOUR (LIST SEPARATELY IN ADDITION
97597   - REMOVAL OF DEVITALIZED TISSUE FROM WOUND(S), SELECTIVE DEBRIDEMENT, WITHOUT ANES
97598   - REMOVAL OF DEVITALIZED TISSUE FROM WOUND(S), SELECTIVE DEBRIDEMENT, WITHOUT



                                              Page 470
                                    All Other (no trigger bundling)


97602   - REMOVAL OF DEVITALIZED TISSUE FROM WOUND(S), NON-SELECTIVE DEBRIDEMENT, WITHOUT
97605   - NEGATIVE PRESSURE WOUND THERAPY (EG, VACUUM ASSISTED DRAINAGE COLLECTION),
97606   - NEGATIVE PRESSURE WOUND THERAPY (EG, VACUUM ASSISTED DRAINAGE COLLECTION),
97750   - PHYSICAL PERFORMANCE TEST OR MEASUREMENT (EG, MUSCULOSKELETAL, FUNCTIONAL
97755   - ASSISTIVE TECHNOLOGY ASSESSMENT (EG, TO RESTORE, AUGMENT OR COMPENSATE FOR
97760   - ORTHOTIC(S) MANAGEMENT AND TRAINING (INCLUDING ASSESSMENT AND FITTING WHEN NOT O
97761   - PROSTHETIC TRAINING, UPPER AND/OR LOWER EXTREMITY(S), EACH 15 MINUTES
97762   - CHECKOUT FOR ORTHOTIC/PROSTHETIC USE, ESTABLISHED PATIENT, EACH 15 MINUTES
97799   - UNLISTED PHYSICAL MEDICINE/REHABILITATION SERVICE OR PROCEDURE
97802   - MEDICAL NUTRITION THERAPY; INITIAL ASSESSMENT AND INTERVENTION, INDIVIDUAL, FACE
97803   - MEDICAL NUTRITION THERAPY; RE-ASSESSMENT AND INTERVENTION, INDIVIDUAL,
97804   - MEDICAL NUTRITION THERAPY; GROUP (2 OR MORE INDIVIDUAL(S)), EACH 30 MINUTES
98925   - OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); ONE TO TWO BODY REGIONS INVOLVED
98926   - OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); THREE TO FOUR BODY REGIONS INVOLVED
98927   - OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); FIVE TO SIX BODY REGIONS INVOLVED
98928   - OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); SEVEN TO EIGHT BODY REGIONS INVOLVED
98929   - OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); NINE TO TEN BODY REGIONS INVOLVED
98940   - CHIROPRATIC MANIPULATIVE TREATMENT (CMT) SPINAL, ONE TO TWO REGIONS
98941   - CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, THREE TO FOUR REGIONS
98942   - CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, FIVE REGIONS
98943   - CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); EXTRASPINAL, ONE OR MORE REGIONS
99000   - HANDLING AND/OR CONVEYANCE OF SPECIMEN FOR TRANSFER FROM THE PHYSICIAN'S OFFICE
99001   - HANDLING AND/OR CONVEYANCE OF SPECIMEN FOR TRANSFER FROM THE PATIENT IN OTHER
99002   - HANDLING, CONVEYANCE, AND/OR ANY OTHER SERVICE IN CONNECTION WITH THE
99050   - SERVICES PROVIDED IN THE OFFICE AT TIMES OTHER THAN REGULARLY SCHEDULED OFFICE H
99051   - SERVICE(S) PROVIDED IN THE OFFICE DURING REGULARLY SCHEDULED EVENING, WEEKEND, O
99053   - SERVICE(S) PROVIDED BETWEEN 10:00 PM AND 8:00 AM AT 24-HOUR FACILITY, IN ADDITIO
99058   - SERVICE(S) PROVIDED ON AN EMERGENCY BASIS IN THE OFFICE, WHICH DISRUPTS OTHER SC
99060   - SERVICE(S) PROVIDED ON AN EMERGENCY BASIS, OUT OF THE OFFICE, WHICH DISRUPTS OTH
99143   - MODERATE SEDATION SVC-1ST 30 MIN-OTHER THAN THOSE SVC DESRI BED BY CODES 00100-0
99144   - MODERATE SEDATION SERVICES (OTHER THAN THOSE SERVICES DESCRIBED BY CODES 00100-0
99145   - MODERATE SEDATION SERVICES (OTHER THAN THOSE SERVICES DESCRIBED BY CODES 00100-0
99148   - MODERATE SEDATION SERVICES (OTHER THAN THOSE SERVICES DESCRIBED BY CODES 00100-0
99149   - MODERATE SEDATION SERVICES (OTHER THAN THOSE SERVICES DESCRIBED BY CODES 00100-0
99150   - MODERATE SEDATION SERVICES (OTHER THAN THOSE SERVICES DESCRIBED BY CODES 00100-0
99173   - SCREENING TEST OF VISUAL ACUITY, QUANTITATIVE, BILATERAL
99174   - OCULAR PHOTOSCREENING WITH INTERPRETATION AND REPORT, BILATERAL
99175   - IPECAC OR SIMILAR ADMINISTRATION FOR INDIVIDUAL EMESIS AND CONTINUED
99183   - PHYSICIAN ATTENDANCE AND SUPERVISION OF HYPERBARIC OXYGEN THERAPY, PER SESSION
99190   - ASSEMBLY AND OPERATION OF PUMP WITH OXYGENATOR OR HEAT EXCHANGER (WITH OR
99191   - ASSEMBLY AND OPERATION OF PUMP WITH OXYGENATOR OR HEAT EXCHANGER (WITH OR
99192   - ASSEMBLY AND OPERATION OF PUMP WITH OXYGENATOR OR HEAT EXCHANGER (WITH OR
99195   - PHLEBOTOMY, THERAPEUTIC (SEPARATE PROCEDURE)
99199   - UNLISTED SPECIAL SERVICE, PROCEDURE OR REPORT
99201   - OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATI
99202   - OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW
99203   - OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW
99204   - OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW
99205   - OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW
99211   - OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLI
99212   - OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN
99213   - OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN



                                              Page 471
                                  All Other (no trigger bundling)


99214 - OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN
99215 - OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN
99217 - OBSERVATION CARE DISCHARGE DAY MANAGEMENT (THIS CODE IS TO BE UTILIZED BY THE PH
99218 - INITIAL OBSERVATION CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIEN
99219 - INITIAL OBSERVATION CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A
99220 - INITIAL OBSERVATION CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A
99221 - INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT W
99222 - INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT,
99223 - INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT,
99224 - Subsequent observation care, per day, for the evaluation and management of a pat
99225 - Subsequent observation care, per day, for the evaluation and management of a pat
99226 - Subsequent observation care, per day, for the evaluation and management of a pat
99231 - SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIEN
99232 - SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A
99233 - SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A
99234 - OBSERVATION OR INPATIENT HOSPITAL CARE, FOR THE EVALUATION AND MANAGEMENT OF A P
99235 - OBSERVATION OR INPATIENT HOSPITAL CARE, FOR THE EVALUATION AND MANAGEMENT OF A
99236 - OBSERVATION OR INPATIENT HOSPITAL CARE, FOR THE EVALUATION AND MANAGEMENT OF A
99238 - HOSPITAL DISCHARGE DAY MANAGEMENT; 30 MINUTES OR LESS
99239 - HOSPITAL DISCHARGE DAY MANAGEMENT; MORE THAN 30 MINUTES
99241 - OFFICE CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE THREE
99242 - OFFICE CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE
99243 - OFFICE CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE
99244 - OFFICE CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE
99245 - OFFICE CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE
99251 - INPATIENT CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE TH
99252 - INPATIENT CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE TH
99253 - INPATIENT CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE TH
99254 - INPATIENT CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE TH
99255 - INPATIENT CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE TH
99288 - PHYSICIAN DIRECTION OF EMERGENCY MEDICAL SYSTEMS (EMS) EMERGENCY CARE, ADVANCED
99292 - CRITICAL CARE, EVALUATION AND MANAGEMENT OF THE CRITICALLY ILL OR CRITICALLY
99304 - INITIAL NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A P
99305 - INITIAL NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A P
99306 - INITIAL NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A P
99307 - SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF
99308 - SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF
99309 - SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF
99310 - SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF
99315 - NURSING FACILITY DISCHARGE DAY MANAGEMENT; 30 MINUTES OR LESS
99316 - NURSING FACILITY DISCHARGE DAY MANAGEMENT; MORE THAN 30 MINUTES
99318 - EVALUATION AND MANAGEMENT OF A PATIENT INVOLVING AN ANNUAL NURSING FACILITY ASSE
99324 - DOMICILIARY OR REST HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIEN
99325 - DOMICILIARY OR REST HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIEN
99326 - DOMICILIARY OR REST HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIEN
99327 - DOMICILIARY OR REST HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIEN
99328 - DOMICILIARY OR REST HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIEN
99334 - DOMICILIARY OR REST HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISH
99335 - DOMICILIARY OR REST HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISH
99336 - DOMICILIARY OR REST HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISH
99337 - DOMICILIARY OR REST HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISH
99339 - INDIVIDUAL PHYSICIAN SUPERVISION OF A PATIENT (PATIENT NOT PRESENT) IN HOME, DOM



                                            Page 472
                                    All Other (no trigger bundling)


99340   - INDIVIDUAL PHYSICIAN SUPERVISION OF A PATIENT (PATIENT NOT PRESENT) IN HOME, DOM
99341   - HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH
99342   - HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES
99343   - HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES
99344   - HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES
99345   - HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES
99347   - HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE
99348   - HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH
99349   - HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH
99350   - HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH
99354   - PROLONGED PHYSICIAN SERVICE IN THE OFFICE OR OTHER OUTPATIENT SETTING REQUIRING
99355   - EACH ADDITIONAL 30 MINUTES (LIST SEPARATELY IN ADDITION TO CODE FOR PROLONGED PH
99356   - PROLONGED PHYSICIAN SERVICE IN THE INPATIENT SETTING, REQUIRING UNIT/FLOOR TIME
99357   - PROLONGED PHYSICIAN SERVICE IN THE INPATIENT SETTING, REQUIRING UNIT/FLOOR TIME
99358   - PROLONGED EVALUATION AND MANAGEMENT SERVICE BEFORE AND/ OR AFTER DIRECT (FACE-TO
99359   - PROLONGED EVALUATION AND MANAGEMENT SERVICE BEFORE AND/ OR AFTER DIRECT (FACE-TO
99360   - PHYSICIAN STANDBY SERVICE, REQUIRING PROLONGED PHYSICIAN ATTENDANCE, EACH 30 MIN
99363   - ANTICOAGULANT MANAGEMENT FOR AN OUTPATIENT TAKING WARFARIN, PHYSICIAN REVIEW AND
99364   - ANTICOAGULANT MANAGEMENT FOR AN OUTPATIENT TAKING WARFARIN, PHYSICIAN REVIEW AND
99367   - MEDICAL TEAM CONFERENCE WITH INTERDISCIPLINARY TEAM OF HEALTH CARE PROFESSIONALS
99368   - MEDICAL TEAM CONFERENCE WITH INTERDISCIPLINARY TEAM OF HEALTH CARE PROFESSIONALS
99374   - PHYSICIAN SUPERVISION OF A PATIENT UNDER CARE OF HOME HEALTH AGENCY (PATIENT NOT
99375   - PHYSICIAN SUPERVISION OF A PATIENT UNDER CARE OF HOME HEALTH AGENCY (PATIENT
99377   - PHYSICIAN SUPERVISION OF A HOSPICE PATIENT (PATIENT NOT PRESENT) REQUIRING
99378   - PHYSICIAN SUPERVISION OF A HOSPICE PATIENT (PATIENT NOT PRESENT) REQUIRING
99379   - PHYSICIAN SUPERVISION OF A NURSING FACILITY PATIENT (PATIENT NOT PRESENT)
99380   - PHYSICIAN SUPERVISION OF A NURSING FACILITY PATIENT (PATIENT NOT PRESENT)
99381   - INITIAL COMPREHENSIVE PREVENTIVE MEDICINE EVALUATION AND MANAGEMENT OF AN INDIVI
99382   - INITIAL COMPREHENSIVE PREVENTIVE MEDICINE EVALUATION AND MANAGEMENT OF AN INDIVI
99383   - INITIAL COMPREHENSIVE PREVENTIVE MEDICINE EVALUATION AND MANAGEMENT OF AN INDIVI
99384   - INITIAL COMPREHENSIVE PREVENTIVE MEDICINE EVALUATION AND MANAGEMENT OF AN INDIVI
99385   - INITIAL COMPREHENSIVE PREVENTIVE MEDICINE EVALUATION AND MANAGEMENT OF AN INDIVI
99386   - INITIAL COMPREHENSIVE PREVENTIVE MEDICINE EVALUATION AND MANAGEMENT OF AN INDIVI
99387   - INITIAL COMPREHENSIVE PREVENTIVE MEDICINE EVALUATION AND MANAGEMENT OF AN INDIVI
99391   - PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF AN IND
99392   - PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF AN IND
99393   - PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF AN IND
99394   - PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF AN IND
99395   - PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF AN IND
99396   - PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF AN IND
99397   - PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF AN IND
99401   - PREVENTIVE MEDICINE COUNSELING AND/OR RISK FACTOR REDUCTION INTERVENTION(S) PROV
99402   - PREVENTIVE MEDICINE COUNSELING AND/OR RISK FACTOR REDUCTION INTERVENTION(S)
99403   - PREVENTIVE MEDICINE COUNSELING AND/OR RISK FACTOR REDUCTION INTERVENTION(S)
99404   - PREVENTIVE MEDICINE COUNSELING AND/OR RISK FACTOR REDUCTION INTERVENTION(S)
99411   - PREVENTIVE MEDICINE COUNSELING AND/OR RISK FACTOR REDUCTION INTERVENTION(S) PROV
99412   - PREVENTIVE MEDICINE COUNSELING AND/OR RISK FACTOR REDUCTION INTERVENTION(S)
99420   - ADMINISTRATION AND INTERPRETATION OF HEALTH RISK ASSESSMENT INSTRUMENT (EG, HEAL
99429   - UNLISTED PREVENTIVE MEDICINE SERVICE
99441   - TELEPHONE EVALUATION AND MANAGEMENT SERVICE PROVIDED BY A PHYSICIAN TO AN ESTABL
99442   - TELEPHONE EVALUATION AND MANAGEMENT SERVICE PROVIDED BY A PHYSICIAN TO AN ESTABL
99443   - TELEPHONE EVALUATION AND MANAGEMENT SERVICE PROVIDED BY A PHYSICIAN TO AN ESTABL



                                              Page 473
                                    All Other (no trigger bundling)


99460   - Initial hospital or birthing center care, per day, for evaluation and management
99461   - Initial care, per day, for evaluation and management of normal newborn infant se
99462   - Subsequent hospital care, per day, for evaluation and management of normal newbo
99463   - Initial hospital or birthing center care, per day, for evaluation and management
99464   - Attendance at delivery (when requested by the delivering physician) and initial
99465   - Delivery/birthing room resuscitation, provision of positive pressure ventilation
99466   - Critical care services delivery by a physican, face-to-face, during an interfaci
99467   - Critical care services delivery by a physican, face-to-face, during an interfaci
99468   - Initial inpatient neonatal critical care, per day, for the evaluation and manage
99469   - Subsequent inpatient neonatal critical care, per day, for the evaluation and man
99471   - Initial inpatient pediatric critical care, per day, for the evaluation and manag
99472   - Subsequent inpatient pediatric critical care, per day, for the evaluation and ma
99475   - Initial inpatient pediatric critical care, per day, for the evaluation and manag
99476   - Subsequent inpatient pediatric critical care, per day, for the evaluation and ma
99477   - INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF THE NEONATE
99478   - Subsequent intensive care, per day, for the evaluation and management of the rec
99479   - Subsequent intensive care, per day, for the evaluation and management of the rec
99480   - Subsequent intensive care, per day, for the evaluation and management of the rec
99499   - UNLISTED EVALUATION AND MANAGEMENT SERVICE
99601   - HOME INFUSION/SPECIALTY DRUG ADMINISTRATION, PER VISIT (UP TO 2 HOURS)
99602   - HOME INFUSION/SPECIALTY DRUG ADMINISTRATION, PER VISIT (UP TO 2 HOURS) EACH
A4206   - SYRINGE WITH NEEDLE, STERILE, 1 CC OR LESS, EACH
A4207   - SYRINGE WITH NEEDLE, STERILE 2CC, EACH
A4208   - SYRINGE WITH NEEDLE, STERILE 3CC, EACH
A4209   - SYRINGE WITH NEEDLE, STERILE 5CC OR GREATER, EACH
A4210   - NEEDLE-FREE INJECTION DEVICE, EACH
A4211   - SUPPLIES FOR SELF-ADMINISTERED INJECTIONS
A4212   - NON-CORING NEEDLE OR STYLET WITH OR WITHOUT CATHETER
A4213   - SYRINGE, STERILE, 20 CC OR GREATER, EACH
A4215   - NEEDLE, STERILE, ANY SIZE, EACH
A4216   - STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML
A4217   - STERILE WATER/SALINE, 500 ML
A4218   - STERILE SALINE OR WATER, METERED DOSE DISPENSER, 10 ML
A4220   - REFILL KIT FOR IMPLANTABLE INFUSION PUMP
A4221   - SUPPLIES FOR MAINTENANCE OF DRUG INFUSION CATHETER, PER WEEK (LIST DRUG
A4222   - INFUSION SUPPLIES FOR EXTERNAL DRUG INFUSION PUMP, PER CASSETTE OR BAG (LIST
A4223   - INFUSION SUPPLIES NOT USED WITH EXTERNAL INFUSION PUMP, PER CASSETTE OR BAG
A4230   - INFUSION SET FOR EXTERNAL INSULIN PUMP, NON NEEDLE CANNULA TYPE
A4231   - INFUSION SET FOR EXTERNAL INSULIN PUMP, NEEDLE TYPE
A4232   - SYRINGE WITH NEEDLE FOR EXTERNAL INSULIN PUMP, STERILE, 3CC
A4233   - REPLACEMENT BATTERY, ALKALINE (OTHER THAN J CELL), FOR USE WITH MEDICALLY NECESS
A4234   - REPLACEMENT BATTERY, ALKALINE, J CELL, FOR USE WITH MEDICALLY NECESSARY HOME BLO
A4235   - REPLACEMENT BATTERY, LITHIUM, FOR USE WITH MEDICALLY NECESSARY HOME BLOOD GLUCOS
A4236   - REPLACEMENT BATTERY, SILVER OXIDE, FOR USE WITH MEDICALLY NECESSARY HOME BLOOD G
A4244   - ALCOHOL OR PEROXIDE, PER PINT
A4245   - ALCOHOL WIPES, PER BOX
A4246   - BETADINE OR PHISOHEX SOLUTION, PER PINT
A4247   - BETADINE OR IODINE SWABS/WIPES, PER BOX
A4248   - CHLORHEXIDINE CONTAINING ANTISEPTIC, 1 ML
A4250   - URINE TEST OR REAGENT STRIPS OR TABLETS (100 TABLETS OR STRIPS)
A4252   - BLOOD KETONE TEST OR REAGENT STRIP, EACH
A4253   - BLOOD GLUCOSE TEST OR REAGENT STRIPS FOR HOME BLOOD GLUCOSE MONITOR, PER 50



                                              Page 474
                                    All Other (no trigger bundling)


A4255   - PLATFORMS FOR HOME BLOOD GLUCOSE MONITOR, 50 PER BOX
A4256   - NORMAL, LOW AND HIGH CALIBRATOR SOLUTION / CHIPS
A4257   - REPLACEMENT LENS SHIELD CARTRIDGE FOR USE WITH LASER SKIN PIERCING DEVICE, EACH
A4258   - SPRING-POWERED DEVICE FOR LANCET, EACH
A4259   - LANCETS, PER BOX OF 100
A4261   - CERVICAL CAP FOR CONTRACEPTIVE USE
A4262   - TEMPORARY, ABSORBABLE LACRIMAL DUCT IMPLANT, EACH
A4263   - PERMANENT, LONG TERM, NON-DISSOLVABLE LACRIMAL DUCT IMPLANT, EACH
A4265   - PARAFFIN, PER POUND
A4266   - DIAPHRAGM FOR CONTRACEPTIVE USE
A4267   - CONTRACEPTIVE SUPPLY, CONDOM, MALE, EACH
A4268   - CONTRACEPTIVE SUPPLY, CONDOM, FEMALE, EACH
A4269   - CONTRACEPTIVE SUPPLY, SPERMICIDE (E.G., FOAM, GEL), EACH
A4270   - DISPOSABLE ENDOSCOPE SHEATH, EACH
A4280   - ADHESIVE SKIN SUPPORT ATTACHMENT FOR USE WITH EXTERNAL BREAST PROSTHESIS, EACH
A4281   - TUBING FOR BREAST PUMP, REPLACEMENT
A4282   - ADAPTER FOR BREAST PUMP, REPLACEMENT
A4283   - CAP FOR BREAST PUMP BOTTLE, REPLACEMENT
A4284   - BREAST SHIELD AND SPLASH PROTECTOR FOR USE WITH BREAST PUMP, REPLACEMENT
A4285   - POLYCARBONATE BOTTLE FOR USE WITH BREAST PUMP, REPLACEMENT
A4286   - LOCKING RING FOR BREAST PUMP, REPLACEMENT
A4290   - SACRAL NERVE STIMULATION TEST LEAD, EACH
A4300   - IMPLANTABLE ACCESS CATHETER, (E,G., VENOUS, ARTERIAL, EPIDURAL SUBARACHNOID, OR
A4301   - IMPLANTABLE ACCESS TOTAL CATHETER, PORT/RESERVOIR (E.G., VENOUS, ARTERIAL,
A4305   - DISPOSABLE DRUG DELIVERY SYSTEM, FLOW RATE OF 50 ML OR GREATER PER HOUR
A4306   - DISPOSABLE DRUG DELIVERY SYSTEM, FLOW RATE OF LESS THAN 50 ML PER HOUR
A4310   - INSERTION TRAY WITHOUT DRAINAGE BAG AND WITHOUT CATHETER (ACCESSORIES ONLY)
A4311   - INSERTION TRAY WITHOUT DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE,
A4312   - INSERTION TRAY WITHOUT DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE,
A4313   - INSERTION TRAY WITHOUT DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE,
A4314   - INSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE, TWO-WAY
A4315   - INSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE, TWO-WAY,
A4316   - INSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE,
A4320   - IRRIGATION TRAY WITH BULB OR PISTON SYRINGE, ANY PURPOSE
A4321   - THERAPEUTIC AGENT FOR URINARY CATHETER IRRIGATION
A4322   - IRRIGATION SYRINGE, BULB OR PISTON, EACH
A4326   - MALE EXTERNAL CATHETER WITH INTEGRAL COLLECTION CHAMBER, ANY TYPE, EACH
A4327   - FEMALE EXTERNAL URINARY COLLECTION DEVICE; MEATAL CUP, EACH
A4328   - FEMALE EXTERNAL URINARY COLLECTION DEVICE; POUCH, EACH
A4330   - PERIANAL FECAL COLLECTION POUCH WITH ADHESIVE, EACH
A4331   - EXTENSION DRAINAGE TUBING, ANY TYPE, ANY LENGTH, WITH CONNECTOR/ADAPTOR, FOR
A4332   - LUBRICANT, INDIVIDUAL STERILE PACKET, EACH
A4333   - URINARY CATHETER ANCHORING DEVICE, ADHESIVE SKIN ATTACHMENT, EACH
A4334   - URINARY CATHETER ANCHORING DEVICE, LEG STRAP, EACH
A4335   - INCONTINENCE SUPPLY; MISCELLANEOUS
A4336   - INCONTINENCE SUPPLY, URETHRAL INSERT, ANY TYPE, EACH
A4338   - INDWELLING CATHETER; FOLEY TYPE, TWO-WAY LATEX WITH COATING (TEFLON, SILICONE,
A4340   - INDWELLING CATHETER; SPECIALTY TYPE, EG; COUDE, MUSHROOM, WING, ETC.), EACH
A4344   - INDWELLING CATHETER, FOLEY TYPE, TWO-WAY, ALL SILICONE, EACH
A4346   - INDWELLING CATHETER; FOLEY TYPE, THREE WAY FOR CONTINUOUS IRRIGATION, EACH
A4349   - MALE EXTERNAL CATHETER, WITH OR WITHOUT ADHESIVE, DISPOSABLE, EACH
A4351   - INTERMITTENT URINARY CATHETER; STRAIGHT TIP, WITH OR WITHOUT COATING (TEFLON,



                                              Page 475
                                    All Other (no trigger bundling)


A4352   - INTERMITTENT URINARY CATHETER; COUDE (CURVED) TIP, WITH OR WITHOUT COATING
A4353   - INTERMITTENT URINARY CATHETER, WITH INSERTION SUPPLIES
A4354   - INSERTION TRAY WITH DRAINAGE BAG BUT WITHOUT CATHETER
A4355   - IRRIGATION TUBING SET FOR CONTINUOUS BLADDER IRRIGATION THROUGH A THREE-WAY
A4356   - EXTERNAL URETHRAL CLAMP OR COMPRESSION DEVICE (NOT TO BE USED FOR CATHETER CLAMP
A4357   - BEDSIDE DRAINAGE BAG, DAY OR NIGHT, WITH OR WITHOUT ANTI-REFLUX DEVICE, WITH OR
A4358   - URINARY DRAINAGE BAG, LEG OR ABDOMEN, VINYL, WITH OR WITHOUT TUBE, WITH STRAPS,
A4360   - DISPOSABLE EXTERNAL URETHRAL CLAMP OR COMPRESSION DEVICE, WITH PAD AND/OR
A4361   - OSTOMY FACEPLATE, EACH
A4362   - SKIN BARRIER; SOLID, 4 X 4 OR EQUIVALENT; EACH
A4363   - OSTOMY CLAMP, ANY TYPE, REPLACEMENT ONLY, EACH
A4364   - ADHESIVE, LIQUID OR EQUAL, ANY TYPE, PER OZ
A4366   - OSTOMY VENT, ANY TYPE, EACH
A4367   - OSTOMY BELT, EACH
A4368   - OSTOMY FILTER, ANY TYPE, EACH
A4369   - OSTOMY SKIN BARRIER, LIQUID (SPRAY, BRUSH, ETC), PER OZ
A4371   - OSTOMY SKIN BARRIER, POWDER, PER OZ
A4372   - OSTOMY SKIN BARRIER, SOLID 4X4 OR EQUIVALENT, STANDARD WEAR, WITH BUILT-IN CONV
A4373   - OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDIAN), WITH BUILT-IN
A4375   - OSTOMY POUCH, DRAINABLE, WITH FACEPLATE ATTACHED, PLASTIC, EACH
A4376   - OSTOMY POUCH, DRAINABLE, WITH FACEPLATE ATTACHED, RUBBER, EACH
A4377   - OSTOMY POUCH, DRAINABLE, FOR USE ON FACEPLATE, PLASTIC, EACH
A4378   - OSTOMY POUCH, DRAINABLE, FOR USE ON FACEPLATE, RUBBER, EACH
A4379   - OSTOMY POUCH, URINARY, WITH FACEPLATE ATTACHED, PLASTIC, EACH
A4380   - OSTOMY POUCH, URINARY, WITH FACEPLATE ATTACHED, RUBBER, EACH
A4381   - OSTOMY POUCH, URINARY, FOR USE ON FACEPLATE, PLASTIC, EACH
A4382   - OSTOMY POUCH, URINARY, FOR USE ON FACEPLATE, HEAVY PLASTIC, EACH
A4383   - OSTOMY POUCH, URINARY, FOR USE ON FACEPLATE, RUBBER, EACH
A4384   - OSTOMY FACEPLATE EQUIVALENT, SILICONE RING, EACH
A4385   - OSTOMY SKIN BARRIER, SOLID 4X4 OR EQUIVALENT, EXTENDED WEAR, WITHOUT BUILT-IN
A4387   - OSTOMY POUCH, CLOSED, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY (1 PIECE),
A4388   - OSTOMY POUCH, DRAINABLE, WITH EXTENDED WEAR BARRIER ATTACHED, (1 PIECE), EACH
A4389   - OSTOMY POUCH, DRAINABLE, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY (1
A4390   - OSTOMY POUCH, DRAINABLE, WITH EXTENDED WEAR BARRIER ATTACHED, WITH BUILT-IN
A4391   - OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED (1 PIECE), EACH
A4392   - OSTOMY POUCH, URINARY, WITH STANDARD WEAR BARRIER ATTACHED, WITH BUILT-IN
A4393   - OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED, WITH BUILT-IN
A4394   - OSTOMY DEODORANT, WITH OR WITHOUT LUBRICANT, FOR USE IN OSTOMY POUCH, PER FLUID
A4395   - OSTOMY DEODORANT FOR USE IN OSTOMY POUCH, SOLID, PER TABLET
A4396   - OSTOMY BELT WITH PERISTOMAL HERNIA SUPPORT
A4397   - IRRIGATION SUPPLY; SLEEVE, EACH
A4398   - OSTOMY IRRIGATION SUPPLY; BAG, EACH
A4399   - OSTOMY IRRIGATION SUPPLY; CONE/CATHETER, INCLUDING BRUSH
A4400   - OSTOMY IRRIGATION SET
A4402   - LUBRICANT, PER OUNCE
A4404   - OSTOMY RING, EACH
A4405   - OSTOMY SKIN BARRIER, NON-PECTIN BASED, PASTE, PER OUNCE
A4406   - OSTOMY SKIN BARRIER, PECTIN-BASED, PASTE, PER OUNCE
A4407   - OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE, OR ACCORDION), EXTENDED
A4408   - OSTOMY SKIN BARRIER, WTIH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR,
A4409   - OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR,
A4410   - OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR,



                                              Page 476
                                    All Other (no trigger bundling)


A4411   - OSTOMY SKIN BARRIER, SOLID 4X4 OR EQUIVALENT, EXTENDED WEAR, WITH BUILT-IN CONVE
A4412   - OSTOMY POUCH, DRAINABLE, HIGH OUTPUT, FOR USE ON A BARRIER WITH FLANGE (2 PIECE
A4413   - OSTOMY POUCH, DRAINABLE, HIGH OUTPUT, FOR USE ON A BARRIER WITH FLANGE (2 PIECE
A4414   - OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), WITHOUT
A4415   - OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), WITHOUT
A4416   - OSTOMY POUCH, CLOSED, WITH BARRIER ATTACHED, WITH FILTER (1 PIECE), EACH
A4417   - OSTOMY POUCH, CLOSED, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY, WITH
A4418   - OSTOMY POUCH, CLOSED; WITHOUT BARRIER ATTACHED, WITH FILTER (1 PIECE), EACH
A4419   - OSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH NON-LOCKING FLANGE, WITH FILTER
A4420   - OSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH LOCKING FLANGE (2 PIECE), EACH
A4421   - OSTOMY SUPPLY; MISCELLANEOUS
A4422   - OSTOMY ABSORBENT MATERIAL (SHEET/PAD/CRYSTAL PACKET) FOR USE IN OSTOMY POUCH TO
A4423   - OSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH LOCKING FLANGE, WITH FILTER (2
A4424   - OSTOMY POUCH, DRAINABLE, WITH BARRIER ATTACHED, WITH FILTER (1 PIECE), EACH
A4425   - OSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH NON-LOCKING FLANGE, WITH
A4426   - OSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH LOCKING FLANGE (2 PIECE
A4427   - OSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH LOCKING FLANGE, WITH FILTER (2
A4428   - OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED, WITH FAUCET-TYPE
A4429   - OSTOMY POUCH, URINARY, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY, WITH
A4430   - OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED, WITH BUILT-IN
A4431   - OSTOMY POUCH, URINARY; WITH BARRIER ATTACHED, WITH FAUCET-TYPE TAP WITH VALVE
A4432   - OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH NON-LOCKING FLANGE, WITH
A4433   - OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH LOCKING FLANGE (2 PIECE), EACH
A4434   - OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH LOCKING FLANGE, WITH FAUCET-TYPE
A4450   - TAPE, NON-WATERPROOF, PER 18 SQUARE INCHES
A4452   - TAPE, WATERPROOF, PER 18 SQUARE INCHES
A4455   - ADHESIVE REMOVER OR SOLVENT (FOR TAPE, CEMENT OR OTHER ADHESIVE), PER OUNCE
A4458   - ENEMA BAG WITH TUBING, REUSABLE
A4461   - SURGICAL DRESSING HOLDER, NON-REUSABLE, EACH
A4463   - SURGICAL DRESSING HOLDER, REUSABLE, EACH
A4465   - NON-ELASTIC BINDER FOR EXTREMITY
A4470   - GRAVLEE JET WASHER
A4480   - VABRA ASPIRATOR
A4481   - TRACHEOSTOMA FILTER, ANY TYPE, ANY SIZE, EACH
A4483   - MOISTURE EXCHANGER, DISPOSABLE, FOR USE WITH INVASIVE MECHANICAL VENTILATION
A4490   - SURGICAL STOCKINGS ABOVE KNEE LENGTH, EACH
A4495   - SURGICAL STOCKINGS THIGH LENGTH, EACH
A4500   - SURGICAL STOCKINGS BELOW KNEE LENGTH, EACH
A4510   - SURGICAL STOCKINGS FULL LENGTH, EACH
A4520   - INCONTINENCE GARMENT, ANY TYPE, (E.G. BRIEF, DIAPER), EACH
A4554   - DISPOSABLE UNDERPADS, ALL SIZES, (E.G., CHUX'S)
A4556   - ELECTRODES, (E.G., APNEA MONITOR), PER PAIR
A4557   - LEAD WIRES, (E.G., APNEA MONITOR), PER PAIR
A4558   - CONDUCTIVE GEL OR PASTE, FOR USE WITH ELECTRICAL DEVICE (E.G., TENS, NMES), PER
A4559   - COUPLING GEL OR PASTE, FOR USE WITH ULTRASOUND DEVICE, PER OZ
A4561   - PESSARY, RUBBER, ANY TYPE
A4562   - PESSARY, NON RUBBER, ANY TYPE
A4565   - SLINGS
A4575   - TOPICAL HYPERBARIC OXYGEN CHAMBER, DISPOSABLE
A4595   - ELECTRICAL STIMULATOR SUPPLIES, 2 LEAD, PER MONTH, (E.G. TENS, NMES)
A4600   - SLEEVE FOR INTERMITTENT LIMB COMPRESSION DEVICE, REPLACEMENT ONLY, EACH
A4601   - LITHIUM ION BATTERY FOR NON-PROSTHETIC USE, REPLACEMENT



                                              Page 477
                                    All Other (no trigger bundling)


A4604   - TUBING WITH INTEGRATED HEATING ELEMENT FOR USE WITH POSITIVE AIRWAY PRESSURE DEV
A4605   - TRACHEAL SUCTION CATHETER, CLOSED SYSTEM, EACH
A4606   - OXYGEN PROBE FOR USE WITH OXIMETER DEVICE, REPLACEMENT
A4608   - TRANSTRACHEAL OXYGEN CATHETER, EACH
A4611   - BATTERY, HEAVY DUTY; REPLACEMENT FOR PATIENT OWNED VENTILATOR
A4612   - BATTERY CABLES; REPLACEMENT FOR PATIENT-OWNED VENTILATOR
A4613   - BATTERY CHARGER; REPLACEMENT FOR PATIENT-OWNED VENTILATOR
A4614   - PEAK EXPIRATORY FLOW RATE METER, HAND HELD
A4615   - CANNULA, NASAL
A4616   - TUBING (OXYGEN), PER FOOT
A4617   - MOUTH PIECE
A4618   - BREATHING CIRCUITS
A4619   - FACE TENT
A4620   - VARIABLE CONCENTRATION MASK
A4623   - TRACHEOSTOMY, INNER CANNULA
A4624   - TRACHEAL SUCTION CATHETER, ANY TYPE OTHER THAN CLOSED SYSTEM, EACH
A4625   - TRACHEOSTOMY CARE KIT FOR NEW TRACHEOSTOMY
A4626   - TRACHEOSTOMY CLEANING BRUSH, EACH
A4627   - SPACER, BAG OR RESERVOIR, WITH OR WITHOUT MASK, FOR USE WITH METERED DOSE
A4628   - OROPHARYNGEAL SUCTION CATHETER, EACH
A4629   - TRACHEOSTOMY CARE KIT FOR ESTABLISHED TRACHEOSTOMY
A4630   - REPLACEMENT BATTERIES, MEDICALLY NECESSARY, TRANSCUTANEOUS ELECTRICAL STIMULATO
A4633   - REPLACEMENT BULB/LAMP FOR ULTRAVIOLET LIGHT THERAPY SYSTEM, EACH
A4634   - REPLACEMENT BULB FOR THERAPEUTIC LIGHT BOX, TABLETOP MODEL
A4635   - UNDERARM PAD, CRUTCH, REPLACEMENT, EACH
A4636   - REPLACEMENT, HANDGRIP, CANE, CRUTCH, OR WALKER, EACH
A4637   - REPLACEMENT, TIP, CANE, CRUTCH, WALKER, EACH.
A4638   - REPLACEMENT BATTERY FOR PATIENT-OWNED EAR PULSE GENERATOR, EACH
A4639   - REPLACEMENT PAD FOR INFRARED HEATING PAD SYSTEM, EACH
A4640   - REPLACEMENT PAD FOR USE WITH MEDICALLY NECESSARY ALTERNATING PRESSURE PAD
A4641   - RADIOPHARMACEUTICAL, DIAGNOSTIC, NOT OTHERWISE CLASSIFIED
A4642   - INDIUM IN-111 SATUMOMAB PENDETIDE, DIAGNOSTIC, PER STUDY DOSE, UP TO 6 MILLICURI
A4648   - TISSUE MARKER, IMPLANTABLE, ANY TYPE, EACH
A4649   - SURGICAL SUPPLY; MISCELLANEOUS
A4650   - IMPLANTABLE RADIATION DOSIMETER, EACH
A4651   - CALIBRATED MICROCAPILLARY TUBE, EACH
A4652   - MICROCAPILLARY TUBE SEALANT
A4653   - PERITONEAL DIALYSIS CATHETER ANCHORING DEVICE, BELT, EACH
A4657   - SYRINGE, WITH OR WITHOUT NEEDLE, EACH
A4660   - SPHYGMOMANOMETER/BLOOD PRESSURE APPARATUS WITH CUFF AND STETHOSCOPE
A4663   - BLOOD PRESSURE CUFF ONLY
A4670   - AUTOMATIC BLOOD PRESSURE MONITOR
A4671   - DISPOSABLE CYCLER SET USED WITH CYCLER DIALYSIS MACHINE, EACH
A4672   - DRAINAGE EXTENSION LINE, STERILE, FOR DIALYSIS, EACH
A4673   - EXTENSION LINE WITH EASY LOCK CONNECTORS, USED WITH DIALYSIS
A4674   - CHEMICALS/ANTISEPTICS SOLUTION USED TO CLEAN/STERILIZE DIALYSIS EQUIPMENT, PER
A4680   - ACTIVATED CARBON FILTER FOR HEMODIALYSIS, EACH
A4690   - DIALYZER (ARTIFICIAL KIDNEYS), ALL TYPES, ALL SIZES, FOR HEMODIALYSIS, EACH
A4706   - BICARBONATE CONCENTRATE, SOLUTION, FOR HEMODIALYSIS, PER GALLON
A4707   - BICARBONATE CONCENTRATE, POWDER, FOR HEMODIALYSIS, PER PACKET
A4708   - ACETATE CONCENTRATE SOLUTION, FOR HEMODIALYSIS, PER GALLON
A4709   - ACID CONCENTRATE, SOLUTION, FOR HEMODIALYSIS, PER GALLON



                                              Page 478
                                   All Other (no trigger bundling)


A4714 - TREATED WATER (DEIONIZED, DISTILLED, OR REVERSE OSMOSIS) FOR PERITONEAL
"A4719 - ""Y SET"" TUBING FOR PERITONEAL DIALYSIS
A4720 - DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN
A4721 - DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN
A4722 - DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN
A4723 - DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN
A4724 - DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN
A4725 - DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN
A4726 - DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN
A4728 - DIALYSATE SOLUTION, NON-DEXTROSE CONTAINING, 500 ML
A4730 - FISTULA CANNULATION SET FOR HEMODIALYSIS, EACH
A4736 - TOPICAL ANESTHETIC, FOR DIALYSIS, PER GRAM
A4737 - INJECTABLE ANESTHETIC, FOR DIALYSIS, PER 10 ML
A4740 - SHUNT ACCESSORY, FOR HEMODIALYSIS, ANY TYPE, EACH
A4750 - BLOOD TUBING, ARTERIAL OR VENOUS, FOR HEMODIALYSIS, EACH
A4755 - BLOOD TUBING, ARTERIAL AND VENOUS COMBINED, FOR HEMODIALYSIS, EACH
A4760 - DIALYSATE SOLUTION TEST KIT, FOR PERITONEAL DIALYSIS, ANY TYPE, EACH
A4765 - DIALYSATE CONCENTRATE, POWDER, ADDITIVE FOR PERITONEAL DIALYSIS, PER PACKET
A4766 - DIALYSATE CONCENTRATE, SOLUTION, ADDITIVE FOR PERITONEAL DIALYSIS, PER 10 ML
A4770 - BLOOD COLLECTION TUBE, VACUUM, FOR DIALYSIS, PER 50
A4771 - SERUM CLOTTING TIME TUBE, FOR DIALYSIS, PER 50
A4772 - BLOOD GLUCOSE TEST STRIPS, FOR DIALYSIS, PER 50
A4773 - OCCULT BLOOD TEST STRIPS, FOR DIALYSIS, PER 50
A4774 - AMMONIA TEST STRIPS, FOR DIALYSIS, PER 50
A4802 - PROTAMINE SULFATE, FOR HEMODIALYSIS, PER 50 MG
A4860 - DISPOSABLE CATHETER TIPS FOR PERITONEAL DIALYSIS, PER 10
A4870 - PLUMBING AND/OR ELECTRICAL WORK FOR HOME HEMODIALYSIS EQUIPMENT
A4890 - CONTRACTS, REPAIR AND MAINTENANCE, FOR HEMODIALYSIS EQUIPMENT
A4911 - DRAIN BAG/BOTTLE, FOR DIALYSIS, EACH
A4913 - MISCELLANEOUS DIALYSIS SUPPLIES, NOT OTHERWISE SPECIFIED
A4918 - VENOUS PRESSURE CLAMP, FOR HEMODIALYSIS, EACH
A4927 - GLOVES, NON-STERILE, PER 100
A4928 - SURGICAL MASK, PER 20
A4929 - TOURNIQUET FOR DIALYSIS, EACH
A4930 - GLOVES, STERILE, PER PAIR
A4931 - ORAL THERMOMETER, REUSABLE, ANY TYPE, EACH
A4932 - RECTAL THERMOMETER, REUSABLE, ANY TYPE, EACH
A5051 - OSTOMY POUCH, CLOSED; WITH BARRIER ATTACHED (1 PIECE), EACH
A5052 - OSTOMY POUCH, CLOSED; WITHOUT BARRIER ATTACHED (1 PIECE), EACH
A5053 - OSTOMY POUCH, CLOSED; FOR USE ON FACEPLATE, EACH
A5054 - OSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH FLANGE (2 PIECE), EACH
A5055 - STOMA CAP
A5061 - OSTOMY POUCH, DRAINABLE; WITH BARRIER ATTACHED, (1 PIECE), EACH
A5062 - OSTOMY POUCH, DRAINABLE; WITHOUT BARRIER ATTACHED (1 PIECE), EACH
A5063 - OSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH FLANGE (2 PIECE SYSTEM), EACH
A5071 - OSTOMY POUCH, URINARY; WITH BARRIER ATTACHED (1 PIECE), EACH
A5072 - OSTOMY POUCH, URINARY; WITHOUT BARRIER ATTACHED (1 PIECE), EACH
A5073 - OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH FLANGE (2 PIECE), EACH
A5081 - CONTINENT DEVICE; PLUG FOR CONTINENT STOMA
A5082 - CONTINENT DEVICE; CATHETER FOR CONTINENT STOMA
A5083 - CONTINENT DEVICE, STOMA ABSORPTIVE COVER FOR CONTINENT STOMA
A5093 - OSTOMY ACCESSORY; CONVEX INSERT



                                             Page 479
                                     All Other (no trigger bundling)


A5102   - BEDSIDE DRAINAGE BOTTLE WITH OR WITHOUT TUBING, RIGID OR EXPANDABLE, EACH
A5105   - URINARY SUSPENSORY WITH LEG BAG, WITH OR WITHOUT TUBE, EACH
A5112   - URINARY LEG BAG; LATEX
A5113   - LEG STRAP; LATEX, REPLACEMENT ONLY, PER SET
A5114   - LEG STRAP; FOAM OR FABRIC, REPLACEMENT ONLY, PER SET
A5120   - SKIN BARRIER, WIPES OR SWABS, EACH
A5121   - SKIN BARRIER; SOLID, 6 X 6 OR EQUIVALENT, EACH
A5122   - SKIN BARRIER; SOLID, 8 X 8 OR EQUIVALENT, EACH
A5126   - ADHESIVE OR NON-ADHESIVE; DISK OR FOAM PAD
A5131   - APPLIANCE CLEANER, INCONTINENCE AND OSTOMY APPLIANCES, PER 16 OZ.
A5200   - PERCUTANEOUS CATHETER/TUBE ANCHORING DEVICE, ADHESIVE SKIN ATTACHMENT
A5500   - FOR DIABETICS ONLY, FITTING (INCLUDING FOLLOW-UP), CUSTOM PREPARATION AND SUPPLY
A5501   - FOR DIABETICS ONLY, FITTING (INCLUDING FOLLOW-UP), CUSTOM PREPARATION AND
A5503   - FOR DIABETICS ONLY, MODIFICATION (INCLUDING FITTING) OF OFF-THE-SHELF
A5504   - FOR DIABETICS ONLY, MODIFICATION (INCLUDING FITTING) OF OFF-THE-SHELF
A5505   - FOR DIABETICS ONLY, MODIFICATION (INCLUDING FITTING) OF OFF-THE-SHELF
A5506   - FOR DIABETICS ONLY, MODIFICATION (INCLUDING FITTING) OF OFF-THE-SHELF
A5507   - FOR DIABETICS ONLY, NOT OTHERWISE SPECIFIED MODIFICATION (INCLUDING FITTING) OF
A5508   - FOR DIABETICS ONLY, DELUXE FEATURE OF OFF-THE-SHELF DEPTH-INLAY SHOE OR
A5510   - FOR DIABETICS ONLY, DIRECT FORMED, COMPRESSION MOLDED TO PATIENT'S FOOT WITHOUT
A5512   - FOR DIABETICS ONLY, MULTIPLE DENSITY INSERT, DIRECT FORMED, MOLDED TO FOOT AFTER
A5513   - FOR DIABETICS ONLY, MULTIPLE DENSITY INSERT, CUSTOM MOLDED FROM MODEL OF PATIENT
A6010   - COLLAGEN BASED WOUND FILLER, DRY FORM, STERILE, PER GRAM OF COLLAGEN
A6011   - COLLAGEN BASED WOUND FILLER, GEL/PASTE, STERILE, PER GRAM OF COLLAGEN
A6021   - COLLAGEN DRESSING, STERILE, PAD SIZE 16 SQ. IN. OR LESS, EACH
A6022   - COLLAGEN DRESSING, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL
A6023   - COLLAGEN DRESSING, STERILE, PAD SIZE MORE THAN 48 SQ. IN., EACH
A6024   - COLLAGEN DRESSING WOUND FILLER, STERILE, PER 6 INCHES
A6025   - GEL SHEET FOR DERMAL OR EPIDERMAL APPLICATION, (E.G., SILICONE, HYDROGEL,
A6154   - WOUND POUCH, EACH
A6196   - ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ.
A6197   - ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, STERILE, PAD SIZE MORE TH
A6198   - ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, STERILE, PAD SIZE MORE TH
A6199   - ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND FILLER, STERILE, PER 6 INCHES
A6203   - COMPOSITE DRESSING, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE ADHESIVE
A6204   - COMPOSITE DRESSING, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUA
A6205   - COMPOSITE DRESSING, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITH ANY SIZE ADHESI
A6206   - CONTACT LAYER, STERILE, 16 SQ. IN. OR LESS, EACH DRESSING
A6207   - CONTACT LAYER, STERILE, MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN
A6208   - CONTACT LAYER, STERILE, MORE THAN 48 SQ. IN., EACH DRESSING
A6209   - FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESI
A6210   - FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN
A6211   - FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHE
A6212   - FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE
A6213   - FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN
A6214   - FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITH ANY SIZ
A6215   - FOAM DRESSING, WOUND FILLER, STERILE, PER GRAM
A6216   - GAUZE, NON-IMPREGNATED, NON-STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT
A6217   - GAUZE, NON-IMPREGNATED, NON-STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS
A6218   - GAUZE, NON-IMPREGNATED, NON-STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT
A6219   - GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE ADHE
A6220   - GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR



                                               Page 480
                                    All Other (no trigger bundling)


A6221   - GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITH ANY SIZE AD
A6222   - GAUZE, IMPREGNATED WITH OTHER THAN WATER, NORMAL SALINE, OR HYDROGEL, STERILE, P
A6223   - GAUZE, IMPREGNATED WITH OTHER THAN WATER, NORMAL SALINE, OR HYDROGEL, STERILE, P
A6224   - GAUZE, IMPREGNATED WITH OTHER THAN WATER, NORMAL SALINE, OR HYDROGEL, STERILE, P
A6228   - GAUZE, IMPREGNATED, WATER OR NORMAL SALINE, STERILE, PAD SIZE 16 SQ. IN. OR LESS
A6229   - GAUZE, IMPREGNATED, WATER OR NORMAL SALINE, STERILE, PAD SIZE MORE THAN 16 SQ. I
A6230   - GAUZE, IMPREGNATED, WATER OR NORMAL SALINE, STERILE, PAD SIZE MORE THAN 48 SQ. I
A6231   - GAUZE, IMPREGNATED, HYDROGEL, FOR DIRECT WOUND CONTACT, STERILE, PAD SIZE 16 SQ.
A6232   - GAUZE, IMPREGNATED, HYDROGEL, FOR DIRECT WOUND CONTACT, STERILE, PAD SIZE GREATE
A6233   - GAUZE, IMPREGNATED, HYDROGEL, FOR DIRECT WOUND CONTACT, STERILE, PAD SIZE MORE T
A6234   - HYDROCOLLOID DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOU
A6235   - HYDROCOLLOID DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT L
A6236   - HYDROCOLLOID DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITH
A6237   - HYDROCOLLOID DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITH A
A6238   - HYDROCOLLOID DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT L
A6239   - HYDROCOLLOID DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITH
A6240   - HYDROCOLLOID DRESSING, WOUND FILLER, PASTE, STERILE, PER OUNCE
A6241   - HYDROCOLLOID DRESSING, WOUND FILLER, DRY FORM, STERILE, PER GRAM
A6242   - HYDROGEL DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT AD
A6243   - HYDROGEL DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS
A6244   - HYDROGEL DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT
A6245   - HYDROGEL DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY S
A6246   - HYDROGEL DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS
A6247   - HYDROGEL DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITH ANY
A6248   - HYDROGEL DRESSING, WOUND FILLER, GEL, STERILE, PER FLUID OUNCE
A6250   - SKIN SEALANTS, PROTECTANTS, MOISTURIZERS, OINTMENTS, ANY TYPE, ANY SIZE
A6251   - SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS
A6252   - SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. I
A6253   - SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. I
A6254   - SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS
A6255   - SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. I
A6256   - SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. I
A6257   - TRANSPARENT FILM, STERILE, 16 SQ. IN. OR LESS, EACH DRESSING
A6258   - TRANSPARENT FILM, STERILE, MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ.
A6259   - TRANSPARENT FILM, STERILE, MORE THAN 48 SQ. IN., EACH DRESSING
A6260   - WOUND CLEANSERS, STERILE, ANY TYPE, ANY SIZE
A6261   - WOUND FILLER, GEL/PASTE, STERILE, PER FLUID OUNCE, NOT OTHERWISE SPECIFIED
A6262   - WOUND FILLER, DRY FORM, STERILE, PER GRAM, NOT OTHERWISE SPECIFIED
A6266   - GAUZE, IMPREGNATED, OTHER THAN WATER, NORMAL SALINE, OR ZINC PASTE, STERILE, ANY
A6402   - GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE
A6403   - GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE MORE THAN 16 SQ. IN. LESS THAN OR
A6404   - GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT
A6407   - PACKING STRIPS, NON-IMPREGNATED, STERILE, UP TO 2 INCHES IN WIDTH, PER LINEAR YA
A6410   - EYE PAD, STERILE, EACH
A6411   - EYE PAD, NON-STERILE, EACH
A6412   - EYE PATCH, OCCLUSIVE, EACH
A6413   - ADHESIVE BANDAGE, FIRST-AID TYPE, ANY SIZE, EACH
A6441   - PADDING BANDAGE, NON-ELASTIC, NON-WOVEN/NON-KNITTED, WIDTH GREATER THAN OR
A6442   - CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, NON-STERILE, WIDTH LESS THAN
A6443   - CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, NON-STERILE, WIDTH GREATER THAN
A6444   - CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, NON-STERILE, WIDTH GREATER THAN
A6445   - CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, STERILE, WIDTH LESS THAN THREE



                                              Page 481
                                    All Other (no trigger bundling)


A6446   - CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, STERILE, WIDTH GREATER THAN OR
A6447   - CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, STERILE, WIDTH GREATER THAN OR
A6448   - LIGHT COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, WIDTH LESS THAN THREE
A6449   - LIGHT COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, WIDTH GREATER THAN OR EQUAL
A6450   - LIGHT COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, WIDTH GREATER THAN OR EQUAL
A6451   - MODERATE COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, LOAD RESISTANCE OF 1.25
A6452   - HIGH COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, LOAD RESISTANCE GREATER THAN
A6453   - SELF-ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NON-WOVEN, WIDTH LESS THAN THREE
A6454   - SELF-ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NON-WOVEN, WIDTH GREATER THAN OR
A6455   - SELF-ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NON-WOVEN, WIDTH GREATER THAN OR
A6456   - ZINC PASTE IMPREGNATED BANDAGE, NON-ELASTIC, KNITTED/WOVEN, WIDTH GREATER THAN
A6457   - TUBULAR DRESSING WITH OR WITHOUT ELASTIC, ANY WIDTH, PER LINEAR YARD
A6501   - COMPRESSION BURN GARMENT, BODYSUIT (HEAD TO FOOT), CUSTOM FABRICATED
A6502   - COMPRESSION BURN GARMENT, CHIN STRAP, CUSTOM FABRICATED
A6503   - COMPRESSION BURN GARMENT, FACIAL HOOD, CUSTOM FABRICATED
A6504   - COMPRESSION BURN GARMENT, GLOVE TO WRIST, CUSTOM FABRICATED
A6505   - COMPRESSION BURN GARMENT, GLOVE TO ELBOW, CUSTOM FABRICATED
A6506   - COMPRESSION BURN GARMENT, GLOVE TO AXILLA, CUSTOM FABRICATED
A6507   - COMPRESSION BURN GARMENT, FOOT TO KNEE LENGTH, CUSTOM FABRICATED
A6508   - COMPRESSION BURN GARMENT, FOOT TO THIGH LENGTH, CUSTOM FABRICATED
A6509   - COMPRESSION BURN GARMENT, UPPER TRUNK TO WAIST INCLUDING ARM OPENINGS (VEST),
A6510   - COMPRESSION BURN GARMENT, TRUNK, INCLUDING ARMS DOWN TO LEG OPENINGS (LEOTARD),
A6511   - COMPRESSION BURN GARMENT, LOWER TRUNK INCLUDING LEG OPENINGS (PANTY), CUSTOM
A6512   - COMPRESSION BURN GARMENT, NOT OTHERWISE CLASSIFIED
A6513   - COMPRESSION BURN MASK, FACE AND/OR NECK, PLASTIC OR EQUAL, CUSTOM FABRICATED
A6530   - GRADIENT COMPRESSION STOCKING, BELOW KNEE, 18-30 MMHG, EACH
A6531   - GRADIENT COMPRESSION STOCKING, BELOW KNEE, 30-40 MMHG, EACH
A6532   - GRADIENT COMPRESSION STOCKING, BELOW KNEE, 40-50 MMHG, EACH
A6533   - GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 18-30 MMHG, EACH
A6534   - GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 30-40 MMHG, EACH
A6535   - GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 40-50 MMHG, EACH
A6536   - GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 18-30 MMHG, EACH
A6537   - GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 30-40 MMHG, EACH
A6538   - GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 40-50 MMHG, EACH
A6539   - GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 18-30 MMHG, EACH
A6540   - GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 30-40 MMHG, EACH
A6541   - GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 40-50 MMHG, EACH
A6544   - GRADIENT COMPRESSION STOCKING, GARTER BELT
A6545   - GRADIENT COMPRESSION WRAP, NON-ELASTIC, BELOW KNEE, 30-50 MM HG, EACH
A6549   - GRADIENT COMPRESSION STOCKING/SLEEVE, NOT OTHERWISE SPECIFIED
A6550   - WOUND CARE SET, FOR NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, INCLUDES AL
A7000   - CANISTER, DISPOSABLE, USED WITH SUCTION PUMP, EACH
A7001   - CANISTER, NON-DISPOSABLE, USED WITH SUCTION PUMP, EACH
A7002   - TUBING, USED WITH SUCTION PUMP, EACH
A7003   - ADMINISTRATION SET, WITH SMALL VOLUME NONFILTERED PNEUMATIC NEBULIZER,
A7004   - SMALL VOLUME NONFILTERED PNEUMATIC NEBULIZER, DISPOSABLE
A7005   - ADMINISTRATION SET, WITH SMALL VOLUME NONFILTERED PNEUMATIC NEBULIZER,
A7006   - ADMINISTRATION SET, WITH SMALL VOLUME FILTERED PNEUMATIC NEBULIZER
A7007   - LARGE VOLUME NEBULIZER, DISPOSABLE, UNFILLED, USED WITH AEROSOL COMPRESSOR
A7008   - LARGE VOLUME NEBULIZER, DISPOSABLE, PREFILLED, USED WITH AEROSOL COMPRESSOR
A7009   - RESERVOIR BOTTLE, NON-DISPOSABLE, USED WITH LARGE VOLUME ULTRASONIC NEBULIZER
A7010   - CORRUGATED TUBING, DISPOSABLE, USED WITH LARGE VOLUME NEBULIZER, 100 FEET



                                              Page 482
                                  All Other (no trigger bundling)


A7011 - CORRUGATED TUBING, NON-DISPOSABLE, USED WITH LARGE VOLUME NEBULIZER, 10 FEET
A7012 - WATER COLLECTION DEVICE, USED WITH LARGE VOLUME NEBULIZER
A7013 - FILTER, DISPOSABLE, USED WITH AEROSOL COMPRESSOR
A7014 - FILTER, NONDISPOSABLE, USED WITH AEROSOL COMPRESSOR OR ULTRASONIC GENERATOR
A7015 - AEROSOL MASK, USED WITH DME NEBULIZER
A7016 - DOME AND MOUTHPIECE, USED WITH SMALL VOLUME ULTRASONIC NEBULIZER
A7017 - NEBULIZER, DURABLE, GLASS OR AUTOCLAVABLE PLASTIC, BOTTLE TYPE, NOT USED WITH
A7018 - WATER, DISTILLED, USED WITH LARGE VOLUME NEBULIZER, 1000 ML
A7020 - INTERFACE FOR COUGH STIMULATING DEVICE, INCLUDES ALL COMPONENTS, REPLACEMENT ONL
A7025 - HIGH FREQUENCY CHEST WALL OSCILLATION SYSTEM VEST, REPLACEMENT FOR USE WITH
A7026 - HIGH FREQUENCY CHEST WALL OSCILLATION SYSTEM HOSE, REPLACEMENT FOR USE WITH
A7027 - COMBINATION ORAL/NASAL MASK, USED WITH CONTINUOUS POSITIVE AIRWAY PRESSURE DEVIC
A7028 - ORAL CUSHION FOR COMBINATION ORAL/NASAL MASK, REPLACEMENT ONLY, EACH
A7029 - NASAL PILLOWS FOR COMBINATION ORAL/NASAL MASK, REPLACEMENT ONLY, PAIR
A7030 - FULL FACE MASK USED WITH POSITIVE AIRWAY PRESSURE DEVICE, EACH
A7031 - FACE MASK INTERFACE, REPLACEMENT FOR FULL FACE MASK, EACH
A7032 - CUSHION FOR USE ON NASAL MASK INTERFACE, REPLACEMENT ONLY, EACH
A7033 - PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE, REPLACEMENT ONLY, PAIR
A7034 - NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH POSITIVE AIRWAY PRESSURE
A7035 - HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE DEVICE
A7036 - CHINSTRAP USED WITH POSITIVE AIRWAY PRESSURE DEVICE
A7037 - TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE
A7038 - FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE
A7039 - FILTER, NON DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE
A7040 - ONE WAY CHEST DRAIN VALVE
A7041 - WATER SEAL DRAINAGE CONTAINER AND TUBING FOR USE WITH IMPLANTED CHEST TUBE
A7042 - IMPLANTED PLEURAL CATHETER, EACH
A7043 - VACUUM DRAINAGE BOTTLE AND TUBING FOR USE WITH IMPLANTED CATHETER
A7044 - ORAL INTERFACE USED WITH POSITIVE AIRWAY PRESSURE DEVICE, EACH
A7045 - EXHALATION PORT WITH OR WITHOUT SWIVEL USED WITH ACCESSORIES FOR POSITIVE
A7046 - WATER CHAMBER FOR HUMIDIFIER, USED WITH POSITIVE AIRWAY PRESSURE DEVICE,
A7501 - TRACHEOSTOMA VALVE, INCLUDING DIAPHRAGM, EACH
A7502 - REPLACEMENT DIAPHRAGM/FACEPLATE FOR TRACHEOSTOMA VALVE, EACH
A7503 - FILTER HOLDER OR FILTER CAP, REUSABLE, FOR USE IN A TRACHEOSTOMA HEAT AND
A7504 - FILTER FOR USE IN A TRACHEOSTOMA HEAT AND MOISTURE EXCHANGE SYSTEM, EACH
A7505 - HOUSING, REUSABLE WITHOUT ADHESIVE, FOR USE IN A HEAT AND MOISTURE EXCHANGE
A7506 - ADHESIVE DISC FOR USE IN A HEAT AND MOISTURE EXCHANGE SYSTEM AND/OR WITH
A7507 - FILTER HOLDER AND INTEGRATED FILTER WITHOUT ADHESIVE, FOR USE IN A TRACHEOSTOMA
A7508 - HOUSING AND INTEGRATED ADHESIVE, FOR USE IN A TRACHEOSTOMA HEAT AND MOISTURE
A7509 - FILTER HOLDER AND INTEGRATED FILTER HOUSING, AND ADHESIVE, FOR USE AS A
A7520 - TRACHEOSTOMY/LARYNGECTOMY TUBE, NON-CUFFED, POLYVINYLCHLORIDE (PVC), SILICONE
A7521 - TRACHEOSTOMY/LARYNGECTOMY TUBE, CUFFED, POLYVINYLCHLORIDE (PVC), SILICONE OR
A7522 - TRACHEOSTOMY/LARYNGECTOMY TUBE, STAINLESS STEEL OR EQUAL (STERILIZABLE AND
A7523 - TRACHEOSTOMY SHOWER PROTECTOR, EACH
A7524 - TRACHEOSTOMA STENT/STUD/BUTTON, EACH
A7525 - TRACHEOSTOMY MASK, EACH
A7526 - TRACHEOSTOMY TUBE COLLAR/HOLDER, EACH
A7527 - TRACHEOSTOMY/LARYNGECTOMY TUBE PLUG/STOP, EACH
A8000 - HELMET, PROTECTIVE, SOFT, PREFABRICATED, INCLUDES ALL COMPONENTS AND ACCESSORIES
A8001 - HELMET, PROTECTIVE, HARD, PREFABRICATED, INCLUDES ALL COMPONENTS AND ACCESSORIES
A8002 - HELMET, PROTECTIVE, SOFT, CUSTOM FABRICATED, INCLUDES ALL COMPONENTS AND ACCESSO
A8003 - HELMET, PROTECTIVE, HARD, CUSTOM FABRICATED, INCLUDES ALL COMPONENTS AND ACCESSO



                                            Page 483
                                     All Other (no trigger bundling)


A8004   - SOFT INTERFACE FOR HELMET, REPLACEMENT ONLY
A9155   - ARTIFICIAL SALIVA, 30 ML
A9281   - REACHING/GRABBING DEVICE, ANY TYPE, ANY LENGTH, EACH
A9283   - FOOT PRESSURE OFF LOADING/SUPPORTIVE DEVICE, ANY TYPE, EACH
A9284   - SPIROMETER, NON-ELECTRONIC, INCLUDES ALL ACCESSORIES
A9300   - EXERCISE EQUIPMENT
A9500   - TECHNETIUM TC-99M SESTAMIBI, DIAGNOSTIC, PER STUDY DOSE
A9501   - TECHNETIUM TC-99M TEBOROXIME, DIAGNOSTIC, PER STUDY DOSE
A9502   - TECHNETIUM TC-99M TETROFOSMIN, DIAGNOSTIC, PER STUDY DOSE
A9503   - TECHNETIUM TC-99M MEDRONATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 30 MILLICURIES
A9504   - TECHNETIUM TC-99M APCITIDE, DIAGNOSTIC, PER STUDY DOSE, UP TO 20 MILLICURIES
A9505   - THALLIUM TL-201 THALLOUS CHLORIDE, DIAGNOSTIC, PER MILLICURIE
A9507   - INDIUM IN-111 CAPROMAB PENDETIDE, DIAGNOSTIC, PER STUDY DOSE, UP TO 10 MILLICURI
A9508   - IODINE I-131 IOBENGUANE SULFATE, DIAGNOSTIC, PER 0.5 MILLICURIE
A9509   - IODINE I-123 SODIUM IODIDE, DIAGNOSTIC, PER MILLICURIE
A9510   - TECHNETIUM TC-99M DISOFENIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 15 MILLICURIES
A9512   - TECHNETIUM TC-99M PERTECHNETATE, DIAGNOSTIC, PER MILLICURIE
A9516   - IODINE I-123 SODIUM IODIDE, DIAGNOSTIC, PER 100 MICROCURIES, UP TO 999 MICROCURI
A9517   - IODINE I-131 SODIUM IODIDE CAPSULE(S), THERAPEUTIC, PER MILLICURIE
A9521   - TECHNETIUM TC-99M EXAMETAZIME, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES
A9524   - IODINE I-131 IODINATED SERUM ALBUMIN, DIAGNOSTIC, PER 5 MICROCURIES
A9526   - NITROGEN N-13 AMMONIA, DIAGNOSTIC, PER STUDY DOSE, UP TO 40 MILLICURIES
A9527   - IODINE I-125, SODIUM IODIDE SOLUTION, THERAPEUTIC, PER MILLICURIE
A9528   - IODINE I-131 SODIUM IODIDE CAPSULE(S), DIAGNOSTIC, PER MILLICURIE
A9529   - IODINE I-131 SODIUM IODIDE SOLUTION, DIAGNOSTIC, PER MILLICURIE
A9530   - IODINE I-131 SODIUM IODIDE SOLUTION, THERAPEUTIC, PER MILLICURIE
A9531   - IODINE I-131 SODIUM IODIDE, DIAGNOSTIC, PER MICROCURIE (UP TO 100 MICROCURIES)
A9532   - IODINE I-125 SERUM ALBUMIN, DIAGNOSTIC, PER 5 MICROCURIES
A9536   - TECHNETIUM TC-99M DEPREOTIDE, DIAGNOSTIC, PER STUDY DOSE, UP TO 35 MILLICURIES
A9537   - TECHNETIUM TC-99M MEBROFENIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 15 MILLICURIES
A9538   - TECHNETIUM TC-99M PYROPHOSPHATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIE
A9539   - TECHNETIUM TC-99M PENTETATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES
A9540   - TECHNETIUM TC-99M MACROAGGREGATED ALBUMIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 10
A9541   - TECHNETIUM TC-99M SULFUR COLLOID, DIAGNOSTIC, PER STUDY DOSE, UP TO 20 MILLICURI
A9542   - INDIUM IN-111 IBRITUMOMAB TIUXETAN, DIAGNOSTIC, PER STUDY DOSE, UP TO 5 MILLICUR
A9543   - YTTRIUM Y-90 IBRITUMOMAB TIUXETAN, THERAPEUTIC, PER TREATMENT DOSE, UP TO 40 MIL
A9544   - IODINE I-131 TOSITUMOMAB, DIAGNOSTIC, PER STUDY DOSE
A9545   - IODINE I-131 TOSITUMOMAB, THERAPEUTIC, PER TREATMENT DOSE
A9546   - COBALT CO-57/58, CYANOCOBALAMIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 1 MICROCURIE
A9547   - INDIUM IN-111 OXYQUINOLINE, DIAGNOSTIC, PER 0.5 MILLICURIE
A9548   - INDIUM IN-111 PENTETATE, DIAGNOSTIC, PER 0.5 MILLICURIE
A9550   - TECHNETIUM TC-99M SODIUM GLUCEPTATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLIC
A9551   - TECHNETIUM TC-99M SUCCIMER, DIAGNOSTIC, PER STUDY DOSE, UP TO 10 MILLICURIES
A9552   - FLUORODEOXYGLUCOSE F-18 FDG, DIAGNOSTIC, PER STUDY DOSE, UP TO 45 MILLICURIES
A9553   - CHROMIUM CR-51 SODIUM CHROMATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 250 MICROCURIE
A9554   - IODINE I-125 SODIUM IOTHALAMATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 10 MICROCURIE
A9555   - RUBIDIUM RB-82, DIAGNOSTIC, PER STUDY DOSE, UP TO 60 MILLICURIES
A9556   - GALLIUM GA-67 CITRATE, DIAGNOSTIC, PER MILLICURIE
A9557   - TECHNETIUM TC-99M BICISATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES
A9558   - XENON XE-133 GAS, DIAGNOSTIC, PER 10 MILLICURIES
A9559   - COBALT CO-57 CYANOCOBALAMIN, ORAL, DIAGNOSTIC, PER STUDY DOSE, UP TO 1 MICROCURI
A9560   - TECHNETIUM TC-99M LABELED RED BLOOD CELLS, DIAGNOSTIC, PER STUDY DOSE, UP TO 30



                                               Page 484
                                   All Other (no trigger bundling)


A9561   - TECHNETIUM TC-99M OXIDRONATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 30 MILLICURIES
A9562   - TECHNETIUM TC-99M MERTIATIDE, DIAGNOSTIC, PER STUDY DOSE, UP TO 15 MILLICURIES
A9563   - SODIUM PHOSPHATE P-32, THERAPEUTIC, PER MILLICURIE
A9564   - CHROMIC PHOSPHATE P-32 SUSPENSION, THERAPEUTIC, PER MILLICURIE
A9566   - TECHNETIUM TC-99M FANOLESOMAB, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES
A9567   - TECHNETIUM TC-99M PENTETATE, DIAGNOSTIC, AEROSOL, PER STUDY DOSE, UP TO 75 MILLI
A9568   - TECHNETIUM TC-99M ARCITUMOMAB, DIAGNOSTIC, PER STUDY DOSE, UP TO 45 MILLICURIES
A9569   - TECHNETIUM TC-99M EXAMETAZIME LABELED AUTOLOGOUS WHITE BLOOD CELLS, DIAGNOSTIC,
A9570   - INDIUM IN-111 LABELED AUTOLOGOUS WHITE BLOOD CELLS, DIAGNOSTIC, PER STUDY DOSE
A9571   - INDIUM IN-111 LABELED AUTOLOGOUS PLATELETS, DIAGNOSTIC, PER STUDY DOSE
A9572   - INDIUM IN-111 PENTETREOTIDE, DIAGNOSTIC, PER STUDY DOSE, UP TO 6 MILLICURIES
A9576   - INJECTION, GADOTERIDOL, (PROHANCE MULTIPACK), PER ML
A9577   - INJECTION, GADOBENATE DIMEGLUMINE (MULTIHANCE), PER ML
A9578   - INJECTION, GADOBENATE DIMEGLUMINE (MULTIHANCE MULTIPACK), PER ML
A9579   - INJECTION, GADOLINIUM-BASED MAGNETIC RESONANCE CONTRAST AGENT, NOT OTHERWISE SPE
A9580   - SODIUM FLUORIDE F-18, DIAGNOSTIC, PER STUDY DOSE, UP TO 30 MILLICURIES
A9581   - INJECTION, GADOXETATE DISODIUM, 1 ML
A9582   - IODINE I-123 IOBENGUANE, DIAGNOSTIC, PER STUDY DOSE, UP TO 15 MILLICURIES
A9583   - INJECTION, GADOFOSVESET TRISODIUM, 1 ML
A9600   - STRONTIUM SR-89 CHLORIDE, THERAPEUTIC, PER MILLICURIE
A9604   - SAMARIUM SM-153 LEXIDRONAM, THERAPEUTIC, PER TREATMENT DOSE, UP TO 150
A9698   - NON-RADIOACTIVE CONTRAST IMAGING MATERIAL, NOT OTHERWISE CLASSIFIED, PER STUDY
A9699   - RADIOPHARMACEUTICAL, THERAPEUTIC, NOT OTHERWISE CLASSIFIED
A9700   - SUPPLY OF INJECTABLE CONTRAST MATERIAL FOR USE IN ECHOCARDIOGRAPHY, PER STUDY
A9900   - MISCELLANEOUS DME SUPPLY, ACCESSORY, AND/OR SERVICE COMPONENT OF ANOTHER HCPCS C
A9901   - DME DELIVERY, SET UP, AND/OR DISPENSING SERVICE COMPONENT OF ANOTHER HCPCS CODE
A9999   - MISCELLANEOUS DME SUPPLY OR ACCESSORY, NOT OTHERWISE SPECIFIED
B4034   - ENTERAL FEEDING SUPPLY KIT; SYRINGE FED, PER DAY
B4035   - ENTERAL FEEDING SUPPLY KIT; PUMP FED, PER DAY
B4036   - ENTERAL FEEDING SUPPLY KIT; GRAVITY FED, PER DAY
B4081   - NASOGASTRIC TUBING WITH STYLET
B4082   - NASOGASTRIC TUBING WITHOUT STYLET
B4083   - STOMACH TUBE - LEVINE TYPE
B4087   - GASTROSTOMY/JEJUNOSTOMY TUBE, STANDARD, ANY MATERIAL, ANY TYPE, EACH
B4088   - GASTROSTOMY/JEJUNOSTOMY TUBE, LOW-PROFILE, ANY MATERIAL, ANY TYPE, EACH
B4100   - FOOD THICKENER, ADMINISTERED ORALLY, PER OUNCE
B4102   - ENTERAL FORMULA, FOR ADULTS, USED TO REPLACE FLUIDS AND ELECTROLYTES (E.G.
B4103   - ENTERAL FORMULA, FOR PEDIATRICS, USED TO REPLACE FLUIDS AND ELECTROLYTES (E.G.
B4104   - ADDITIVE FOR ENTERAL FORMULA (E.G. FIBER)
B4149   - ENTERAL FORMULA, MANUFACTURED BLENDERIZED NATURAL FOODS WITH INTACT NUTRIENTS, I
B4150   - ENTERAL FORMULA, NUTRITIONALLY COMPLETE WITH INTACT NUTRIENTS, INCLUDES
B4152   - ENTERAL FORMULA, NUTRITIONALLY COMPLETE, CALORICALLY DENSE (EQUAL TO OR GREATER
B4153   - ENTERAL FORMULA, NUTRITIONALLY COMPLETE, HYDROLYZED PROTEINS (AMINO ACIDS AND
B4154   - ENTERAL FORMULA, NUTRITIONALLY COMPLETE, FOR SPECIAL METABOLIC NEEDS, EXCLUDES
B4155   - ENTERAL FORMULA, NUTRITIONALLY INCOMPLETE/MODULAR NUTRIENTS, INCLUDES SPECIFIC
B4157   - ENTERAL FORMULA, NUTRITIONALLY COMPLETE, FOR SPECIAL METABOLIC NEEDS FOR
B4158   - ENTERAL FORMULA, FOR PEDIATRICS, NUTRITIONALLY COMPLETE WITH INTACT NUTRIENTS,
B4159   - ENTERAL FORMULA, FOR PEDIATRICS, NUTRITIONALLY COMPLETE SOY BASED WITH INTACT
B4160   - ENTERAL FORMULA, FOR PEDIATRICS, NUTRITIONALLY COMPLETE CALORICALLY DENSE
B4161   - ENTERAL FORMULA, FOR PEDIATRICS, HYDROLYZED/AMINO ACIDS AND PEPTIDE CHAIN
B4162   - ENTERAL FORMULA, FOR PEDIATRICS, SPECIAL METABOLIC NEEDS FOR INHERITED DISEASE
B4164   - PARENTERAL NUTRITION SOLUTION: CARBOHYDRATES (DEXTROSE), 50% OR LESS (500 ML =



                                             Page 485
                                    All Other (no trigger bundling)


B4168   - PARENTERAL NUTRITION SOLUTION; AMINO ACID, 3.5%, (500 ML = 1 UNIT) - HOMEMIX
B4172   - PARENTERAL NUTRITION SOLUTION; AMINO ACID, 5.5% THROUGH 7%, (500 ML = 1 UNIT) -
B4176   - PARENTERAL NUTRITION SOLUTION; AMINO ACID, 7% THROUGH 8.5%, (500 ML = 1 UNIT) -
B4178   - PARENTERAL NUTRITION SOLUTION: AMINO ACID, GREATER THAN 8.5% (500 ML = 1 UNIT)
B4180   - PARENTERAL NUTRITION SOLUTION; CARBOHYDRATES (DEXTROSE), GREATER THAN 50% (500
B4185   - PARENTERAL NUTRITION SOLUTION, PER 10 GRAMS LIPIDS
B4189   - PARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH
B4193   - PARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH
B4197   - PARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH
B4199   - PARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH
B4216   - PARENTERAL NUTRITION; ADDITIVES (VITAMINS, TRACE ELEMENTS, HEPARIN,
B4220   - PARENTERAL NUTRITION SUPPLY KIT; PREMIX, PER DAY
B4222   - PARENTERAL NUTRITION SUPPLY KIT; HOME MIX, PER DAY
B4224   - PARENTERAL NUTRITION ADMINISTRATION KIT, PER DAY
B5000   - PARENTERAL NUTRITION SOLUTION: COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH
B5100   - PARENTERAL NUTRITION SOLUTION: COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH
B5200   - PARENTERAL NUTRITION SOLUTION: COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH
B9000   - ENTERAL NUTRTION INFUSION PUMP - WITHOUT ALARM
B9002   - ENTERAL NUTRITION INFUSION PUMP - WITH ALARM
B9004   - PARENTERAL NUTRITION INFUSION PUMP, PORTABLE
B9006   - PARENTERAL NUTRITION INFUSION PUMP, STATIONARY
B9998   - NOC FOR ENTERAL SUPPLIES
B9999   - NOC FOR PARENTERAL SUPPLIES
C1300   - HYPERBARIC OXYGEN UNDER PRESSURE, FULL BODY CHAMBER, PER 30 MINUTE INTERVAL
C1304   - CATHETER, IMAGING, SONICATH ULTRA MODEL 37-416 ULTRASOUND IMAGING CATHETER,
C1713   - ANCHOR/SCREW FOR OPPOSING BONE-TO-BONE OR SOFT TISSUE-TO-BONE (IMPLANTABLE)
C1714   - CATHETER, TRANSLUMINAL ATHERECTOMY, DIRECTIONAL
C1715   - BRACHYTHERAPY NEEDLE
C1716   - BRACHYTHERAPY SOURCE, NON-STRANDED, GOLD-198, PER SOURCE
C1717   - BRACHYTHERAPY SOURCE, NON-STRANDED, HIGH DOSE RATE IRIDIUM-192, PER SOURCE
C1719   - BRACHYTHERAPY SOURCE, NON-STRANDED, NON-HIGH DOSE RATE IRIDIUM-192, PER SOURCE
C1721   - CARDIOVERTER-DEFIBRILLATOR, DUAL CHAMBER (IMPLANTABLE)
C1722   - CARDIOVERTER-DEFIBRILLATOR, SINGLE CHAMBER (IMPLANTABLE)
C1724   - CATHETER, TRANSLUMINAL ATHERECTOMY, ROTATIONAL
C1725   - CATHETER, TRANSLUMINAL ANGIOPLASTY, NON-LASER (MAY INCLUDE GUIDANCE,
C1726   - CATHETER, BALLOON DILATATION, NON-VASCULAR
C1727   - CATHETER, BALLOON TISSUE DISSECTOR, NON-VASCULAR (INSERTABLE)
C1728   - CATHETER, BRACHYTHERAPY SEED ADMINISTRATION
C1729   - CATHETER, DRAINAGE
C1730   - CATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC, OTHER THAN 3D MAPPING (19 OR FEWER
C1731   - CATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC, OTHER THAN 3D MAPPING (20 OR MORE
C1732   - CATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC/ABLATION, 3D OR VECTOR MAPPING
C1733   - CATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC/ABLATION, OTHER THAN 3D OR VECTOR
C1750   - CATHETER, HEMODIALYSIS/PERITONEAL, LONG-TERM
C1751   - CATHETER, INFUSION, INSERTED PERIPHERALLY, CENTRALLY OR MIDLINE (OTHER THAN
C1752   - CATHETER, HEMODIALYSIS/PERITONEAL, SHORT-TERM
C1753   - CATHETER, INTRAVASCULAR ULTRASOUND
C1754   - CATHETER, INTRADISCAL
C1755   - CATHETER, INTRASPINAL
C1756   - CATHETER, PACING, TRANSESOPHAGEAL
C1757   - CATHETER, THROMBECTOMY/EMBOLECTOMY
C1758   - CATHETER, URETERAL



                                              Page 486
                                    All Other (no trigger bundling)


C1759   - CATHETER, INTRACARDIAC ECHOCARDIOGRAPHY
C1760   - CLOSURE DEVICE, VASCULAR (IMPLANTABLE/INSERTABLE)
C1762   - CONNECTIVE TISSUE, HUMAN (INCLUDES FASCIA LATA)
C1763   - CONNECTIVE TISSUE, NON-HUMAN (INCLUDES SYNTHETIC)
C1764   - EVENT RECORDER, CARDIAC (IMPLANTABLE)
C1765   - ADHESION BARRIER
C1766   - INTRODUCER/SHEATH, GUIDING, INTRACARDIAC ELECTROPHYSIOLOGICAL, STEERABLE, OTHER
C1767   - GENERATOR, NEUROSTIMULATOR (IMPLANTABLE), NON-RECHARGEABLE
C1768   - GRAFT, VASCULAR
C1769   - GUIDE WIRE
C1770   - IMAGING COIL, MAGNETIC RESONANCE (INSERTABLE)
C1771   - REPAIR DEVICE, URINARY, INCONTINENCE, WITH SLING GRAFT
C1772   - INFUSION PUMP, PROGRAMMABLE (IMPLANTABLE)
C1773   - RETRIEVAL DEVICE, INSERTABLE (USED TO RETRIEVE FRACTURED MEDICAL DEVICES)
C1776   - JOINT DEVICE (IMPLANTABLE)
C1777   - LEAD, CARDIOVERTER-DEFIBRILLATOR, ENDOCARDIAL SINGLE COIL (IMPLANTABLE)
C1778   - LEAD, NEUROSTIMULATOR (IMPLANTABLE)
C1779   - LEAD, PACEMAKER, TRANSVENOUS VDD SINGLE PASS
C1780   - LENS, INTRAOCULAR (NEW TECHNOLOGY)
C1781   - MESH (IMPLANTABLE)
C1782   - MORCELLATOR
C1783   - OCULAR IMPLANT, AQUEOUS DRAINAGE ASSIST DEVICE
C1784   - OCULAR DEVICE, INTRAOPERATIVE, DETACHED RETINA
C1785   - PACEMAKER, DUAL CHAMBER, RATE-RESPONSIVE (IMPLANTABLE)
C1786   - PACEMAKER, SINGLE CHAMBER, RATE-RESPONSIVE (IMPLANTABLE)
C1787   - PATIENT PROGRAMMER, NEUROSTIMULATOR
C1788   - PORT, INDWELLING (IMPLANTABLE)
C1789   - PROSTHESIS, BREAST (IMPLANTABLE)
C1813   - PROSTHESIS, PENILE, INFLATABLE
C1814   - RETINAL TAMPONADE DEVICE, SILICONE OIL
C1815   - PROSTHESIS, URINARY SPHINCTER (IMPLANTABLE)
C1816   - RECEIVER AND/OR TRANSMITTER, NEUROSTIMULATOR (IMPLANTABLE)
C1817   - SEPTAL DEFECT IMPLANT SYSTEM, INTRACARDIAC
C1818   - INTEGRATED KERATOPROSTHESIS
C1819   - SURGICAL TISSUE LOCALIZATION AND EXCISION DEVICE (IMPLANTABLE)
C1820   - GENERATOR NEURO RECHG BAT SYS
C1821   - INTERSPINOUS PROCESS DISTRACTION DEVICE (IMPLANTABLE)
C1864   - BARD SPERMA TEX MESH, PER 13.44 SQUARE CENTIMETERS
C1874   - STENT, COATED/COVERED, WITH DELIVERY SYSTEM
C1875   - STENT, COATED/COVERED, WITHOUT DELIVERY SYSTEM
C1876   - STENT, NON-COATED/NON-COVERED, WITH DELIVERY SYSTEM
C1877   - STENT, NON-COATED/NON-COVERED, WITHOUT DELIVERY SYSTEM
C1878   - MATERIAL FOR VOCAL CORD MEDIALIZATION, SYNTHETIC (IMPLANTABLE)
C1880   - VENA CAVA FILTER
C1881   - DIALYSIS ACCESS SYSTEM (IMPLANTABLE)
C1882   - CARDIOVERTER-DEFIBRILLATOR, OTHER THAN SINGLE OR DUAL CHAMBER (IMPLANTABLE)
C1883   - ADAPTOR/EXTENSION, PACING LEAD OR NEUROSTIMULATOR LEAD (IMPLANTABLE)
C1884   - EMBOLIZATION PROTECTIVE SYSTEM
C1885   - CATHETER, TRANSLUMINAL ANGIOPLASTY, LASER
C1887   - CATHETER, GUIDING (MAY INCLUDE INFUSION/PERFUSION CAPABILITY)
C1888   - CATHETER, ABLATION, NON-CARDIAC, ENDOVASCULAR (IMPLANTABLE)
C1891   - INFUSION PUMP, NON-PROGRAMMABLE, PERMANENT (IMPLANTABLE)



                                              Page 487
                                    All Other (no trigger bundling)


C1892   - INTRODUCER/SHEATH, GUIDING, INTRACARDIAC ELECTROPHYSIOLOGICAL, FIXED-CURVE,
C1893   - INTRODUCER/SHEATH, GUIDING, INTRACARDIAC ELECTROPHYSIOLOGICAL, FIXED-CURVE,
C1894   - INTRODUCER/SHEATH, OTHER THAN GUIDING, OTHER THAN INTRACARDIAC ELECTROPHYSIOLOGI
C1895   - LEAD, CARDIOVERTER-DEFIBRILLATOR, ENDOCARDIAL DUAL COIL (IMPLANTABLE)
C1897   - LEAD, NEUROSTIMULATOR TEST KIT (IMPLANTABLE)
C1898   - LEAD, PACEMAKER, OTHER THAN TRANSVENOUS VDD SINGLE PASS
C1899   - LEAD, PACEMAKER/CARDIOVERTER-DEFIBRILLATOR COMBINATION (IMPLANTABLE)
C1900   - LEAD, LEFT VENTRICULAR CORONARY VENOUS SYSTEM
C2614   - PROBE, PERCUTANEOUS LUMBAR DISCECTOMY
C2615   - SEALANT, PULMONARY, LIQUID
C2616   - BRACHYTHERAPY SOURCE, NON-STRANDED, YTTRIUM-90, PER SOURCE
C2617   - STENT, NON-CORONARY, TEMPORARY, WITHOUT DELIVERY SYSTEM
C2618   - PROBE, CRYOABLATION
C2619   - PACEMAKER, DUAL CHAMBER, NON RATE-RESPONSIVE (IMPLANTABLE)
C2620   - PACEMAKER, SINGLE CHAMBER, NON RATE-RESPONSIVE (IMPLANTABLE)
C2621   - PACEMAKER, OTHER THAN SINGLE OR DUAL CHAMBER (IMPLANTABLE)
C2622   - PROSTHESIS, PENILE, NON-INFLATABLE
C2625   - STENT, NON-CORONARY, TEMPORARY, WITH DELIVERY SYSTEM
C2626   - INFUSION PUMP, NON-PROGRAMMABLE, TEMPORARY (IMPLANTABLE)
C2627   - CATHETER, SUPRAPUBIC/CYSTOSCOPIC
C2628   - CATHETER, OCCLUSION
C2629   - INTRODUCER/SHEATH, OTHER THAN GUIDING, INTRACARDIAC ELECTROPHYSIOLOGICAL, LASER
C2630   - CATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC/ABLATION, OTHER THAN 3D OR VECTOR
C2631   - REPAIR DEVICE, URINARY, INCONTINENCE, WITHOUT SLING GRAFT
C2634   - BRACHYTHERAPY SOURCE, NON-STRANDED, HIGH ACTIVITY, IODINE-125, GREATER THAN 1.01
C2635   - BRACHYTHERAPY SOURCE, NON-STRANDED, HIGH ACTIVITY, PALADIUM-103, GREATER THAN 2.
C2636   - BRACHYTHERAPY LINEAR SOURCE, NON-STRANDED, PALADIUM-103, PER 1 MM
C2637   - BRACHYTHERAPY SOURCE, NON-STRANDED, YTTERBIUM-169, PER SOURCE
C2638   - BRACHYTHERAPY SOURCE, STRANDED, IODINE-125, PER SOURCE
C2639   - BRACHYTHERAPY SOURCE, NON-STRANDED, IODINE-125, PER SOURCE
C2640   - BRACHYTHERAPY SOURCE, STRANDED, PALLADIUM-103. PER SOURCE
C2641   - BRACHYTHERAPY SOURCE, STRANDED, PALLADIUM-103 PER SOURCE
C2642   - BRACHYTHERAPY SOURCE, STRANDED, CESIUM0131, PER SOURCE
C2643   - BRACHYTHERAPY SOURCE, NON-STRANDED CESIUM-131, PER SOURCE
C2698   - BRACHYTHERAPY SOURCE, STRANDED, NOT OTHERWISE SPECIFIED, PERSOURCE
C2699   - BRACHYTHERAPY SOURCE, NON-STRANDED, NOT OTHERWISE SPECIFIED,PER SOURCE
C8900   - MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST, ABDOMEN
C8901   - MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST, ABDOMEN
C8902   - MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,
C8903   - MAGNETIC RESONANCE IMAGING WITH CONTRAST, BREAST; UNILATERAL
C8904   - MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST, BREAST; UNILATERAL
C8905   - MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, BREAST;
C8906   - MAGNETIC RESONANCE IMAGING WITH CONTRAST, BREAST; BILATERAL
C8907   - MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST, BREAST; BILATERAL
C8908   - MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, BREAST;
C8909   - MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST, CHEST (EXCLUDING MYOCARDIUM)
C8910   - MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST, CHEST (EXCLUDING MYOCARDIUM)
C8911   - MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,
C8912   - MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST, LOWER EXTREMITY
C8913   - MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST, LOWER EXTREMITY
C8914   - MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,
C8918   - MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST, PELVIS



                                              Page 488
                                 All Other (no trigger bundling)


C8919 - MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST, PELVIS
C8920 - MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,
C8921 - TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WI
C8922 - TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WI
C8923 - TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WI
C8924 - TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WI
C8925 - TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE) WITH CONTRAST, OR WITHOUT CONTRAST FOLLOW
C8926 - TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE) WITH CONTRAST, OR WITHOUT CONTRAST FOLLOW
C8927 - TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE) WITH CONTRAST, OR WITHOUT CONTRAST FOLLOW
C8928 - TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WI
C8957 - IV INFUSION FOR THERAPY/DIAG;INITIATION OF PROLONGED INFUSION >8 HRS./PUMP
C9113 - INJECTION, PANTOPRAZOLE SODIUM, PER VIAL
C9121 - INJECTION, ARGATROBAN, PER 5 MG
C9219 - MYCOPHENOLIC ACID, ORAL
C9248 - INJECTION, CLEVIDIPINE BUTYRATE, 1 MG
C9254 - INJECTION, LACOSAMIDE, 1 MG
C9255 - INJECTION, PALIPERIDONE PALMITATE, 1 MG
C9256 - INJECTION, DEXAMETHASONE INTRAVITREAL IMPLANT, 0.1 MG
C9257 - INJECTION, BEVACIZUMAB, 0.25 MG
C9258 - INJECTION, TELAVANCIN, 10 MG
C9259 - INJECTION, PRALATREXATE, 1 MG
C9260 - INJECTION, OFATUMUMAB, 10 MG
C9261 - INJECTION, USTEKINUMAB, 1 MG
C9263 - INJECTION, ECALLANTIDE, 1 MG
C9264 - Injection, Tolicizumab, 1mg
C9265 - Injection, Romidepsin, 1 mg
C9266 - Injection, Collagenase, clostridium histolyticum, 0.1 mg
C9267 - Injection, von Willebrand factor complex, Wilate, per 100 IU
C9268 - Capsaicin patch, per 10 squaqre centimeters
C9274 - CROTALIDAE POLYVALENT IMMUNE FAB (OVINE), 1 VIAL
C9275 - INJECTION, HEXAMINOLEVULINATE HYDROCHLORIDE, 100 MG, PER STUDY DOSE
C9276 - INJECTION, CABAZITAXEL, 1 MG
C9277 - INJECTION, ALGLUCOSIDASE ALFA (LUMIZYME), 1 MG
C9278 - INJECTION, INCOBOTULINUMTOXIN A, 1 UNIT
C9279 - INJECTION, IBUPROFEN, 100 MG
C9352 - MICROPOROUS COLLAGEN IMPLANTABLE TUBE (NEURAGEN NERVE GUIDE), PER CENTIMETER LEN
C9353 - MICROPOROUS COLLAGEN IMPLANTABLE SLIT TUBE (NEURAWRAP NERVE PROTECTOR), PER CENT
C9359 - Porous purified collagen matrix bone void filler (Integra Mozaik Osteoconductive
C9399 - UNCLASSIFIED DRUGS OR BIOLOGICALS
C9716 - CREATIONS OF THERMAL ANAL LESIONS BY RADIOFREQUENCY ENERGY
C9724 - ENDOSCOPIC FULL-THICKNESS PLICATION IN THE GASTRIC CARDIA USING ENDOSCOPIC PLICA
C9725 - PLACEMENT OF ENDORECTAL INTRACAVITARY APPLICATOR FOR HIGH INTENSITY BRACHYTHERAP
C9726 - RXT BREAST APP. PLACE/REMOVE
C9728 - PLACEMENT OF INTERSTITIAL DEVICE(S) FOR RADIATION THERAPY/SURGERY GUIDANCE (EG,
C9898 - Radiolabeled product provided during a hospital inpatient stay
C9899 - IMPLANTED PROSTHETIC DEVICE, PAYABLE ONLY FOR INPATIENTS WHO DO NOT HAVE INPATIE
D1352 - Preventive resin restoration in a moderate to high caries risk patient - permane
D3354 - Pulpal regeneration - (completion of regenerative treatment in an immature perma
D5992 - Adjust maxillofacial prosthetic appliance
D7251 - Coronectomy - intentional partial tooth removal
E0100 - CANE, INCLUDES CANES OF ALL MATERIALS, ADJUSTABLE OR FIXED, WITH TIP
E0105 - CANE, QUAD OR THREE PRONG, INCLUDES CANES OF ALL MATERIALS, ADJUSTABLE OR



                                           Page 489
                                    All Other (no trigger bundling)


E0110   - CRUTCHES, FOREARM, INCLUDES CRUTCHES OF VARIOUS MATERIALS, ADJUSTABLE OR FIXED,
E0111   - CRUTCH FOREARM, INCLUDES CRUTCHES OF VARIOUS MATERIALS, ADJUSTABLE OR FIXED,
E0112   - CRUTCHES UNDERARM, WOOD, ADJUSTABLE OR FIXED, PAIR, WITH PADS, TIPS AND
E0113   - CRUTCH UNDERARM, WOOD, ADJUSTABLE OR FIXED, EACH, WITH PAD, TIP AND HANDGRIP
E0114   - CRUTCHES UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR FIXED, PAIR, WITH PADS, TIPS
E0116   - CRUTCH, UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR FIXED, WITH PAD, TIP, HANDGRIP,
E0117   - CRUTCH, UNDERARM, ARTICULATING, SPRING ASSISTED, EACH
E0130   - WALKER, RIGID (PICKUP), ADJUSTABLE OR FIXED HEIGHT
E0135   - WALKER, FOLDING (PICKUP), ADJUSTABLE OR FIXED HEIGHT
E0140   - WALKER, WITH TRUNK SUPPORT, ADJUSTABLE OR FIXED HEIGHT, ANY TYPE
E0141   - WALKER, RIGID, WHEELED, ADJUSTABLE OR FIXED HEIGHT
E0143   - WALKER, FOLDING, WHEELED, ADJUSTABLE OR FIXED HEIGHT
E0144   - WALKER, ENCLOSED, FOUR SIDED FRAMED, RIGID OR FOLDING, WHEELED WITH POSTERIOR
E0147   - WALKER, HEAVY DUTY, MULTIPLE BRAKING SYSTEM, VARIABLE WHEEL RESISTANCE
E0148   - WALKER, HEAVY DUTY, WITHOUT WHEELS, RIGID OR FOLDING, ANY TYPE, EACH
E0149   - WALKER, HEAVY DUTY, WHEELED, RIGID OR FOLDING, ANY TYPE
E0153   - PLATFORM ATTACHMENT, FOREARM CRUTCH, EACH
E0154   - PLATFORM ATTACHMENT, WALKER, EACH
E0155   - WHEEL ATTACHMENT, RIGID PICK-UP WALKER, PER PAIR
E0156   - SEAT ATTACHMENT, WALKER
E0157   - CRUTCH ATTACHMENT, WALKER, EACH
E0158   - LEG EXTENSIONS FOR WALKER, PER SET OF FOUR (4)
E0159   - BRAKE ATTACHMENT FOR WHEELED WALKER, REPLACEMENT, EACH
E0160   - SITZ TYPE BATH OR EQUIPMENT, PORTABLE, USED WITH OR WITHOUT COMMODE
E0161   - SITZ TYPE BATH OR EQUIPMENT, PORTABLE, USED WITH OR WITHOUT COMMODE, WITH
E0162   - SITZ BATH CHAIR
E0163   - COMMODE CHAIR, MOBILE OR STATIONARY, WITH FIXED ARMS
E0165   - COMMODE CHAIR, MOBILE OR STATIONARY, WITH DETACHABLE ARMS
E0167   - PAIL OR PAN FOR USE WITH COMMODE CHAIR, REPLACEMENT ONLY
E0168   - COMMODE CHAIR, EXTRA WIDE AND/OR HEAVY DUTY, STATIONARY OR MOBILE, WITH OR
E0170   - COMMODE CHAIR WITH INTEGRATED SEAT LIFT MECHANISM, ELECTRIC, ANY TYPE
E0171   - COMMODE CHAIR WITH INTEGRATED SEAT LIFT MECHANISM, NON-ELECTRIC, ANY TYPE
E0172   - SEAT LIFT MECHANISM PLACED OVER OR ON TOP OF TOILET, ANY TYPE
E0175   - FOOT REST, FOR USE WITH COMMODE CHAIR, EACH
E0181   - POWERED PRESSURE REDUCING MATTRESS OVERLAY/PAD, ALTERNATING, WITH PUMP, INCLUDES
E0182   - PUMP FOR ALTERNATING PRESSURE PAD, FOR REPLACEMENT ONLY
E0184   - DRY PRESSURE MATTRESS
E0185   - GEL OR GEL-LIKE PRESSURE PAD FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH
E0186   - AIR PRESSURE MATTRESS
E0187   - WATER PRESSURE MATTRESS
E0188   - SYNTHETIC SHEEPSKIN PAD
E0189   - LAMBSWOOL SHEEPSKIN PAD, ANY SIZE
E0190   - POSITIONING CUSHION/PILLOW/WEDGE, ANY SHAPE OR SIZE, INCLUDES ALL COMPONENTS AND
E0191   - HEEL OR ELBOW PROTECTOR, EACH
E0193   - POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY)
E0194   - AIR FLUIDIZED BED
E0196   - GEL PRESSURE MATTRESS
E0197   - AIR PRESSURE PAD FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH
E0198   - WATER PRESSURE PAD FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH
E0199   - DRY PRESSURE PAD FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH
E0200   - HEAT LAMP, WITHOUT STAND (TABLE MODEL), INCLUDES BULB, OR INFRARED ELEMENT
E0202   - PHOTOTHERAPY (BILIRUBIN) LIGHT WITH PHOTOMETER



                                              Page 490
                                     All Other (no trigger bundling)


E0205   - HEAT LAMP, WITH STAND, INCLUDES BULB, OR INFRARED ELEMENT
E0210   - ELECTRIC HEAT PAD, STANDARD
E0215   - ELECTRIC HEAT PAD, MOIST
E0217   - WATER CIRCULATING HEAT PAD WITH PUMP
E0218   - WATER CIRCULATING COLD PAD WITH PUMP
E0220   - HOT WATER BOTTLE
E0221   - INFRARED HEATING PAD SYSTEM
E0225   - HYDROCOLLATOR UNIT, INCLUDES PADS
E0230   - ICE CAP OR COLLAR
E0235   - PARAFFIN BATH UNIT, PORTABLE (SEE MEDICAL SUPPLY CODE A4265 FOR PARAFFIN)
E0236   - PUMP FOR WATER CIRCULATING PAD
E0238   - NON-ELECTRIC HEAT PAD, MOIST
E0239   - HYDROCOLLATOR UNIT, PORTABLE
E0240   - BATH/SHOWER CHAIR, WITH OR WITHOUT WHEELS, ANY SIZE
E0241   - BATH TUB WALL RAIL, EACH
E0242   - BATH TUB RAIL, FLOOR BASE
E0243   - TOILET RAIL, EACH
E0244   - RAISED TOILET SEAT
E0245   - TUB STOOL OR BENCH
E0246   - TRANSFER TUB RAIL ATTACHMENT
E0247   - TRANSFER BENCH FOR TUB OR TOILET WITH OR WITHOUT COMMODE OPENING
E0248   - TRANSFER BENCH, HEAVY DUTY, FOR TUB OR TOILET WITH OR WITHOUT COMMODE OPENING
E0249   - PAD FOR WATER CIRCULATING HEAT UNIT, FOR REPLACEMENT ONLY
E0250   - HOSPITAL BED, FIXED HEIGHT, WITH ANY TYPE SIDE RAILS, WITH MATTRESS
E0251   - HOSPITAL BED, FIXED HEIGHT, WITH ANY TYPE SIDE RAILS, WITHOUT MATTRESS
E0255   - HOSPITAL BED, VARIABLE HEIGHT, HI-LO, WITH ANY TYPE SIDE RAILS, WITH MATTRESS
E0256   - HOSPITAL BED, VARIABLE HEIGHT, HI-LO, WITH ANY TYPE SIDE RAILS, WITHOUT MATTRESS
E0260   - HOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTMENT), WITH ANY TYPE SIDE
E0261   - HOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTMENT), WITH ANY TYPE SIDE
E0265   - HOSPITAL BED, TOTAL ELECTRIC (HEAD, FOOT AND HEIGHT ADJUSTMENTS), WITH ANY TYPE
E0266   - HOSPITAL BED, TOTAL ELECTRIC (HEAD, FOOT AND HEIGHT ADJUSTMENTS), WITH ANY TYPE
E0270   - HOSPITAL BED, INSTITUTIONAL TYPE INCLUDES: OSCILLATING, CIRCULATING AND STRYKER
E0271   - MATTRESS, INNERSPRING
E0272   - MATTRESS, FOAM RUBBER
E0273   - BED BOARD
E0274   - OVER-BED TABLE
E0275   - BED PAN, STANDARD, METAL OR PLASTIC
E0276   - BED PAN, FRACTURE, METAL OR PLASTIC
E0277   - POWERED PRESSURE-REDUCING AIR MATTRESS
E0280   - BED CRADLE, ANY TYPE
E0290   - HOSPITAL BED, FIXED HEIGHT, WITHOUT SIDE RAILS, WITH MATTRESS
E0291   - HOSPITAL BED, FIXED HEIGHT, WITHOUT SIDE RAILS, WITHOUT MATTRESS
E0292   - HOSPITAL BED, VARIABLE HEIGHT, HI-LO, WITHOUT SIDE RAILS, WITH MATTRESS
E0293   - HOSPITAL BED, VARIABLE HEIGHT, HI-LO, WITHOUT SIDE RAILS, WITHOUT MATTRESS
E0294   - HOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTMENT), WITHOUT SIDE RAILS,
E0295   - HOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTMENT), WITHOUT SIDE RAILS,
E0296   - HOSPITAL BED, TOTAL ELECTRIC (HEAD, FOOT AND HEIGHT ADJUSTMENTS). WITHOUT SIDE
E0297   - HOSPITAL BED, TOTAL ELECTRIC (HEAD, FOOT AND HEIGHT ADJUSTMENTS), WITHOUT SIDE
E0300   - PEDIATRIC CRIB, HOSPITAL GRADE, FULLY ENCLOSED
E0301   - HOSPITAL BED, HEAVY DUTY, EXTRA WIDE, WITH WEIGHT CAPACITY GREATER THAN 350
E0302   - HOSPITAL BED, EXTRA HEAVY DUTY, EXTRA WIDE, WITH WEIGHT CAPACITY GREATER THAN
E0303   - HOSPITAL BED, HEAVY DUTY, EXTRA WIDE, WITH WEIGHT CAPACITY GREATER THAN 350



                                               Page 491
                                 All Other (no trigger bundling)


E0304 - HOSPITAL BED, EXTRA HEAVY DUTY, EXTRA WIDE, WITH WEIGHT CAPACITY GREATER THAN
E0305 - BED SIDE RAILS, HALF LENGTH
E0310 - BED SIDE RAILS, FULL LENGTH
E0315 - BED ACCESSORY: BOARD, TABLE, OR SUPPORT DEVICE, ANY TYPE
E0316 - SAFETY ENCLOSURE FRAME/CANOPY FOR USE WITH HOSPITAL BED, ANY TYPE
E0325 - URINAL; MALE, JUG-TYPE, ANY MATERIAL
E0326 - URINAL; FEMALE, JUG-TYPE, ANY MATERIAL
E0328 - HOSPITAL BED, PEDIATRIC, MANUAL, 360 DEGREE SIDE ENCLOSURES, TOP OF HEADBOARD, F
E0329 - HOSPITAL BED, PEDIATRIC, ELECTRIC OR SEMI-ELECTRIC, 360 DEGREE SIDE ENCLOSURES,
E0350 - CONTROL UNIT FOR ELECTRONIC BOWEL IRRIGATION/EVACUATION SYSTEM
E0352 - DISPOSABLE PACK (WATER RESERVOIR BAG, SPECULUM, VALVING MECHANISM AND
E0370 - AIR PRESSURE ELEVATOR FOR HEEL
E0371 - NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS
E0372 - POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH
E0373 - NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS
E0424 - STATIONARY COMPRESSED GASEOUS OXYGEN SYSTEM, RENTAL; INCLUDES CONTAINER,
E0425 - STATIONARY COMPRESSED GAS SYSTEM, PURCHASE; INCLUDES REGULATOR, FLOWMETER,
E0430 - PORTABLE GASEOUS OXYGEN SYSTEM, PURCHASE; INCLUDES REGULATOR, FLOWMETER,
E0431 - PORTABLE GASEOUS OXYGEN SYSTEM, RENTAL; INCLUDES PORTABLE CONTAINER, REGULATOR,
E0433 - PORTABLE LIQUID OXYGEN SYSTEM, RENTAL; HOME LIQUEFIER USED TO FILL PORTABLE
E0434 - PORTABLE LIQUID OXYGEN SYSTEM, RENTAL; INCLUDES PORTABLE CONTAINER, SUPPLY
E0435 - PORTABLE LIQUID OXYGEN SYSTEM, PURCHASE; INCLUDES PORTABLE CONTAINER, SUPPLY
E0439 - STATIONARY LIQUID OXYGEN SYSTEM, RENTAL; INCLUDES CONTAINER, CONTENTS,
E0440 - STATIONARY LIQUID OXYGEN SYSTEM, PURCHASE; INCLUDES USE OF RESERVOIR, CONTENTS
E0441 - STATIONARY OXYGEN CONTENTS, GASEOUS, 1 MONTH'S SUPPLY = 1 UNIT
E0442 - STATIONARY OXYGEN CONTENTS, LIQUID, 1 MONTH'S SUPPLY = 1 UNIT
E0443 - PORTABLE OXYGEN CONTENTS, GASEOUS, 1 MONTH'S SUPPLY = 1 UNIT
E0444 - PORTABLE OXYGEN CONTENTS, LIQUID, 1 MONTH'S SUPPLY = 1 UNIT
E0445 - OXIMETER DEVICE FOR MEASURING BLOOD OXYGEN LEVELS NON-INVASIVELY
E0446 - TOPICAL OXYGEN DELIVERY SYSTEM, NOT OTHERWISE SPECIFIED, INCLUDES ALL SUPPLIES
E0450 - VOLUME CONTROL VENTILATOR, WITHOUT PRESSURE SUPPORT MODE, MAY INCLUDE PRESSURE
E0455 - OXYGEN TENT, EXCLUDING CROUP OR PEDIATRIC TENTS
E0457 - CHEST SHELL (CUIRASS)
E0459 - CHEST WRAP
E0460 - NEGATIVE PRESSURE VENTILATOR; PORTABLE OR STATIONARY
E0461 - VOLUME CONTROL VENTILATOR, WITHOUT PRESSURE SUPPORT MODE, MAY INCLUDE PRESSURE
E0462 - ROCKING BED WITH OR WITHOUT SIDE RAILS
E0463 - PRESSURE SUPPORT VENTILATOR WITH VOLUME CONTROL MODE, MAY INCLUDE PRESSURE
E0464 - PRESSURE SUPPORT VENTILATOR WITH VOLUME CONTROL MODE, MAY INCLUDE PRESSURE
E0470 - RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITHOUT BACKUP RATE
E0471 - RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITH BACK-UP RATE
E0472 - RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITH BACKUP RATE
E0480 - PERCUSSOR, ELECTRIC OR PNEUMATIC, HOME MODEL
E0482 - COUGH STIMULATING DEVICE, ALTERNATING POSITIVE AND NEGATIVE AIRWAY PRESSURE
E0483 - HIGH FREQUENCY CHEST WALL OSCILLATION AIR-PULSE GENERATOR SYSTEM, (INCLUDES
E0484 - OSCILLATORY POSITIVE EXPIRATORY PRESSURE DEVICE, NON-ELECTRIC, ANY TYPE, EACH
E0485 - ORAL DEVICE/APPLIANCE USED TO REDUCE UPPER AIRWAY COLLAPSIBILITY, ADJUSTABLE OR
E0486 - ORAL DEVICE/APPLIANCE USED TO REDUCE UPPER AIRWAY COLLAPSIBILITY, ADJUSTABLE OR
E0487 - SPIROMETER, ELECTRONIC, INCLUDES ALL ACCESSORIES
E0500 - IPPB MACHINE, ALL TYPES, WITH BUILT-IN NEBULIZATION; MANUAL OR AUTOMATIC VALVES
E0550 - HUMIDIFIER, DURABLE FOR EXTENSIVE SUPPLEMENTAL HUMIDIFICATION DURING IPPB TREATM
E0555 - HUMIDIFIER, DURABLE, GLASS OR AUTOCLAVABLE PLASTIC BOTTLE TYPE, FOR USE WITH



                                           Page 492
                                   All Other (no trigger bundling)


E0560   - HUMIDIFIER, DURABLE FOR SUPPLEMENTAL HUMIDIFICATION DURING IPPB TREATMENT OR
E0561   - HUMIDIFIER, NON-HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE
E0562   - HUMIDIFIER, HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE
E0565   - COMPRESSOR, AIR POWER SOURCE FOR EQUIPMENT WHICH IS NOT SELF- CONTAINED OR
E0570   - NEBULIZER, WITH COMPRESSOR
E0571   - AEROSOL COMPRESSOR, BATTERY POWERED, FOR USE WITH SMALL VOLUME NEBULIZER
E0572   - AEROSOL COMPRESSOR, ADJUSTABLE PRESSURE, LIGHT DUTY FOR INTERMITTENT USE
E0574   - ULTRASONIC/ELECTRONIC AEROSOL GENERATOR WITH SMALL VOLUME NEBULIZER
E0575   - NEBULIZER, ULTRASONIC, LARGE VOLUME
E0580   - NEBULIZER, DURABLE, GLASS OR AUTOCLAVABLE PLASTIC, BOTTLE TYPE, FOR USE WITH
E0585   - NEBULIZER, WITH COMPRESSOR AND HEATER
E0600   - RESPIRATORY SUCTION PUMP, HOME MODEL, PORTABLE OR STATIONARY, ELECTRIC
E0601   - CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE
E0602   - BREAST PUMP, MANUAL, ANY TYPE
E0603   - BREAST PUMP, ELECTRIC (AC AND/OR DC), ANY TYPE
E0604   - BREAST PUMP, HOSPITAL GRADE, ELECTRIC (AC AND / OR DC), ANY TYPE
E0605   - VAPORIZER, ROOM TYPE
E0606   - POSTURAL DRAINAGE BOARD
E0607   - HOME BLOOD GLUCOSE MONITOR
E0610   - PACEMAKER MONITOR, SELF-CONTAINED, (CHECKS BATTERY DEPLETION, INCLUDES AUDIBLE
E0615   - PACEMAKER MONITOR, SELF CONTAINED, CHECKS BATTERY DEPLETION AND OTHER PACEMAKER
E0616   - IMPLANTABLE CARDIAC EVENT RECORDER WITH MEMORY, ACTIVATOR AND PROGRAMMER
E0617   - EXTERNAL DEFIBRILLATOR WITH INTEGRATED ELECTROCARDIOGRAM ANALYSIS
E0618   - APNEA MONITOR, WITHOUT RECORDING FEATURE
E0619   - APNEA MONITOR, WITH RECORDING FEATURE
E0620   - SKIN PIERCING DEVICE FOR COLLECTION OF CAPILLARY BLOOD, LASER, EACH
E0621   - SLING OR SEAT, PATIENT LIFT, CANVAS OR NYLON
E0625   - PATIENT LIFT, BATHROOM OR TOILET, NOT OTHERWISE CLASSIFIED
E0627   - SEAT LIFT MECHANISM INCORPORATED INTO A COMBINATION LIFT-CHAIR MECHANISM
E0628   - SEPARATE SEAT LIFT MECHANISM FOR USE WITH PATIENT OWNED FURNITURE-ELECTRIC
E0629   - SEPARATE SEAT LIFT MECHANISM FOR USE WITH PATIENT OWNED FURNITURE-NON-ELECTRIC
E0630   - PATIENT LIFT, HYDRAULIC OR MECHANICAL, INCLUDES ANY SEAT, SLING, STRAP(S) OR PAD
E0635   - PATIENT LIFT, ELECTRIC WITH SEAT OR SLING
E0636   - MULTIPOSITIONAL PATIENT SUPPORT SYSTEM, WITH INTEGRATED LIFT, PATIENT
E0637   - COMBINATION SIT TO STAND SYSTEM, ANY SIZE INCLUDING PEDIATRIC, WITH SEATLIFT FEA
E0638   - STANDING FRAME SYSTEM, ONE POSITION (E.G. UPRIGHT, SUPINE OR PRONE STANDER), ANY
E0639   - PATIENT LIFT, MOVEABLE FROM ROOM TO ROOM WITH DISASSEMBLY AND REASSEMBLY,
E0640   - PATIENT LIFT, FIXED SYSTEM, INCLUDES ALL COMPONENTS/ACCESSORIES
E0641   - STANDING FRAME SYSTEM, MULTI-POSITION (E.G. THREE-WAY STANDER), ANY SIZE INCLUDI
E0642   - STANDING FRAME SYSTEM, MOBILE (DYNAMIC STANDER), ANY SIZE INCLUDING PEDIATRIC
E0650   - PNEUMATIC COMPRESSOR, NON-SEGMENTAL HOME MODEL
E0651   - PNEUMATIC COMPRESSOR, SEGMENTAL HOME MODEL WITHOUT CALIBRATED GRADIENT PRESSURE
E0652   - PNEUMATIC COMPRESSOR, SEGMENTAL HOME MODEL WITH CALIBRATED GRADIENT PRESSURE
E0655   - NON-SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, HALF ARM
E0656   - SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, TRUNK
E0657   - SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, CHEST
E0660   - NON-SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, FULL LEG
E0665   - NON-SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, FULL ARM
E0666   - NON-SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, HALF LEG
E0667   - SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, FULL LEG
E0668   - SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, FULL ARM
E0669   - SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, HALF LEG



                                             Page 493
                                    All Other (no trigger bundling)


E0671   - SEGMENTAL GRADIENT PRESSURE PNEUMATIC APPLIANCE, FULL LEG
E0672   - SEGMENTAL GRADIENT PRESSURE PNEUMATIC APPLIANCE, FULL ARM
E0673   - SEGMENTAL GRADIENT PRESSURE PNEUMATIC APPLIANCE, HALF LEG
E0675   - PNEUMATIC COMPRESSION DEVICE, HIGH PRESSURE, RAPID INFLATION/DEFLATION CYCLE,
E0676   - INTERMITTENT LIMB COMPRESSION DEVICE (INCLUDES ALL ACCESSORIES), NOT OTHERWISE S
E0691   - ULTRAVIOLET LIGHT THERAPY SYSTEM PANEL, INCLUDES BULBS/LAMPS, TIMER AND EYE
E0692   - ULTRAVIOLET LIGHT THERAPY SYSTEM PANEL, INCLUDES BULBS/LAMPS, TIMER AND EYE
E0693   - ULTRAVIOLET LIGHT THERAPY SYSTEM PANEL, INCLUDES BULBS/LAMPS, TIMER AND EYE
E0694   - ULTRAVIOLET MULTIDIRECTIONAL LIGHT THERAPY SYSTEM IN 6 FOOT CABINET, INCLUDES
E0700   - SAFETY EQUIPMENT, DEVICE OR ACCESSORY, ANY TYPE
E0705   - TRANSFER DEVICE, ANY TYPE, EACH
E0710   - RESTRAINTS, ANY TYPE (BODY, CHEST, WRIST OR ANKLE)
E0720   - TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) DEVICE, TWO LEAD, LOCALIZED S
E0730   - TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) DEVICE, FOUR OR MORE LEADS, F
E0731   - FORM FITTING CONDUCTIVE GARMENT FOR DELIVERY OF TENS OR NMES (WITH CONDUCTIVE
E0740   - INCONTINENCE TREATMENT SYSTEM, PELVIC FLOOR STIMULATOR, MONITOR, SENSOR AND/OR
E0744   - NEUROMUSCULAR STIMULATOR FOR SCOLIOSIS
E0745   - NEUROMUSCULAR STIMULATOR, ELECTRONIC SHOCK UNIT
E0746   - ELECTROMYOGRAPHY (EMG), BIOFEEDBACK DEVICE
E0747   - OSTEOGENESIS STIMULATOR, ELECTRICAL, NON-INVASIVE, OTHER THAN SPINAL
E0748   - OSTEOGENESIS STIMULATOR, ELECTRICAL, NON-INVASIVE, SPINAL APPLICATIONS
E0749   - OSTEOGENESIS STIMULATOR, ELECTRICAL, SURGICALLY IMPLANTED
E0755   - ELECTRONIC SALIVARY REFLEX STIMULATOR (INTRA-ORAL/NON-INVASIVE)
E0760   - OSTOGENESIS STIMULATOR, LOW INTENSITY ULTRASOUND, NON-INVASIVE
E0765   - FDA APPROVED NERVE STIMULATOR, WITH REPLACEABLE BATTERIES, FOR TREATMENT OF
E0769   - ELECTRICAL STIMULATION OR ELECTROMAGNETIC WOUND TREATMENT DEVICE, NOT OTHERWISE
E0770   - FUNCTIONAL ELECTRICAL STIMULATOR, TRANSCUTANEOUS STIMULATION OF NERVE AND/OR MUS
E0776   - IV POLE
E0779   - AMBULATORY INFUSION PUMP, MECHANICAL, REUSABLE, FOR INFUSION 8 HOURS OR GREATER
E0780   - AMBULATORY INFUSION PUMP, MECHANICAL, REUSABLE, FOR INFUSION LESS THAN 8 HOURS
E0781   - AMBULATORY INFUSION PUMP, SINGLE OR MULTIPLE CHANNELS, ELECTRIC OR BATTERY
E0782   - INFUSION PUMP, IMPLANTABLE, NON-PROGRAMMABLE (INCLUDES ALL COMPONENTS, E.G.,
E0783   - INFUSION PUMP SYSTEM, IMPLANTABLE, PROGRAMMABLE (INCLUDES ALL COMPONENTS, E.G.,
E0784   - EXTERNAL AMBULATORY INFUSION PUMP, INSULIN
E0785   - IMPLANTABLE INTRASPINAL (EPIDURAL/INTRATHECAL) CATHETER USED WITH IMPLANTABLE
E0791   - PARENTERAL INFUSION PUMP, STATIONARY, SINGLE OR MULTI-CHANNEL
E0830   - AMBULATORY TRACTION DEVICE, ALL TYPES, EACH
E0840   - TRACTION FRAME, ATTACHED TO HEADBOARD, CERVICAL TRACTION
E0849   - TRACTION EQUIPMENT, CERVICAL, FREE-STANDING STAND/FRAME, PNEUMATIC, APPLYING
E0850   - TRACTION STAND, FREE STANDING, CERVICAL TRACTION
E0855   - CERVICAL TRACTION EQUIPMENT NOT REQUIRING ADDITIONAL STAND OR FRAME
E0856   - CERVICAL TRACTION DEVICE, CERVICAL COLLAR WITH INFLATABLE AIR BLADDER
E0860   - TRACTION EQUIPMENT, OVERDOOR, CERVICAL
E0870   - TRACTION FRAME, ATTACHED TO FOOTBOARD, EXTREMITY TRACTION, (E.G. BUCK'S)
E0880   - TRACTION STAND, FREE STANDING, EXTREMITY TRACTION, (E.G., BUCK'S)
E0890   - TRACTION FRAME, ATTACHED TO FOOTBOARD, PELVIC TRACTION
E0900   - TRACTION STAND, FREE STANDING, PELVIC TRACTION, (E.G., BUCK'S)
E0910   - TRAPEZE BARS, A/K/A PATIENT HELPER, ATTACHED TO BED, WITH GRAB BAR
E0911   - TRAPEZE BAR, HEAVY DUTY, FOR PATIENT WEIGHT CAPACITY GREATER THAN 250 POUNDS, AT
E0912   - TRAPEZE BAR, HEAVY DUTY, FOR PATIENT WEIGHT CAPACITY GREATER THAN 250 POUNDS, FR
E0920   - FRACTURE FRAME, ATTACHED TO BED, INCLUDES WEIGHTS
E0930   - FRACTURE FRAME, FREE STANDING, INCLUDES WEIGHTS



                                              Page 494
                                   All Other (no trigger bundling)


E0935   - CONTINUOUS PASSIVE MOTION EXERCISE DEVICE FOR USE ON KNEE ONLY
E0936   - CONTINUOUS PASSIVE MOTION EXERCISE DEVICE FOR USE OTHER THAN KNEE
E0940   - TRAPEZE BAR, FREE STANDING, COMPLETE WITH GRAB BAR
E0941   - GRAVITY ASSISTED TRACTION DEVICE, ANY TYPE
E0942   - CERVICAL HEAD HARNESS/HALTER
E0944   - PELVIC BELT/HARNESS/BOOT
E0945   - EXTREMITY BELT/HARNESS
E0946   - FRACTURE, FRAME, DUAL WITH CROSS BARS, ATTACHED TO BED, (E.G. BALKEN, 4 POSTER)
E0947   - FRACTURE FRAME, ATTACHMENTS FOR COMPLEX PELVIC TRACTION
E0948   - FRACTURE FRAME, ATTACHMENTS FOR COMPLEX CERVICAL TRACTION
E0950   - WHEELCHAIR ACCESSORY, TRAY, EACH
E0951   - HEEL LOOP/HOLDER, ANY TYPE, WITH OR WITHOUT ANKLE STRAP, EACH
E0952   - TOE LOOP/HOLDER, ANY TYPE, EACH
E0955   - WHEELCHAIR ACCESSORY, HEADREST, CUSHIONED, ANY TYPE, INCLUDING FIXED MOUNTING
E0956   - WHEELCHAIR ACCESSORY, LATERAL TRUNK OR HIP SUPPORT, ANY TYPE, INCLUDING FIXED
E0957   - WHEELCHAIR ACCESSORY, MEDIAL THIGH SUPPORT, ANY TYPE, INCLUDING FIXED MOUNTING
E0958   - MANUAL WHEELCHAIR ACCESSORY, ONE-ARM DRIVE ATTACHMENT, EACH
E0959   - MANUAL WHEELCHAIR ACCESSORY, ADAPTER FOR AMPUTEE, EACH
E0960   - WHEELCHAIR ACCESSORY, SHOULDER HARNESS/STRAPS OR CHEST STRAP, INCLUDING ANY
E0961   - MANUAL WHEELCHAIR ACCESSORY, WHEEL LOCK BRAKE EXTENSION (HANDLE), EACH
E0966   - MANUAL WHEELCHAIR ACCESSORY, HEADREST EXTENSION, EACH
E0967   - MANUAL WHEELCHAIR ACCESSORY, HAND RIM WITH PROJECTIONS, ANY TYPE, EACH
E0968   - COMMODE SEAT, WHEELCHAIR
E0969   - NARROWING DEVICE, WHEELCHAIR
E0970   - NO.2 FOOTPLATES, EXCEPT FOR ELEVATING LEG REST
E0971   - MANUAL WHEELCHAIR ACCESSORY, ANTI-TIPPING DEVICE, EACH
E0973   - WHEELCHAIR ACCESSORY, ADJUSTABLE HEIGHT, DETACHABLE ARMREST, COMPLETE ASSEMBLY,
E0974   - MANUAL WHEELCHAIR ACCESSORY, ANTI-ROLLBACK DEVICE, EACH
E0978   - WHEELCHAIR ACCESSORY, POSITIONING BELT/SAFETY BELT/PELVIC STRAP, EACH
E0980   - SAFETY VEST, WHEELCHAIR
E0981   - WHEELCHAIR ACCESSORY, SEAT UPHOLSTERY, REPLACEMENT ONLY, EACH
E0982   - WHEELCHAIR ACCESSORY, BACK UPHOLSTERY, REPLACEMENT ONLY, EACH
E0983   - MANUAL WHEELCHAIR ACCESSORY, POWER ADD-ON TO CONVERT MANUAL WHEELCHAIR TO
E0984   - MANUAL WHEELCHAIR ACCESSORY, POWER ADD-ON TO CONVERT MANUAL WHEELCHAIR TO
E0985   - WHEELCHAIR ACCESSORY, SEAT LIFT MECHANISM
E0986   - MANUAL WHEELCHAIR ACCESSORY, PUSH ACTIVATED POWER ASSIST, EACH
E0990   - WHEELCHAIR ACCESSORY, ELEVATING LEG REST, COMPLETE ASSEMBLY, EACH
E0992   - MANUAL WHEELCHAIR ACCESSORY, SOLID SEAT INSERT
E0994   - ARM REST, EACH
E0995   - WHEELCHAIR ACCESSORY, CALF REST/PAD, EACH
E1002   - WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, TILT ONLY
E1003   - WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, RECLINE ONLY, WITHOUT SHEAR
E1004   - WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, RECLINE ONLY, WITH MECHANICAL SHEAR
E1005   - WHEELCHAIR ACCESSORY, POWER SEATNG SYSTEM, RECLINE ONLY, WITH POWER SHEAR
E1006   - WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, COMBINATION TILT AND RECLINE,
E1007   - WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, COMBINATION TILT AND RECLINE, WITH
E1008   - WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, COMBINATION TILT AND RECLINE, WITH
E1009   - WHEELCHAIR ACCESSORY, ADDITION TO POWER SEATING SYSTEM, MECHANICALLY LINKED LEG
E1010   - WHEELCHAIR ACCESSORY, ADDITION TO POWER SEATING SYSTEM, POWER LEG ELEVATION
E1011   - MODIFICATION TO PEDIATRIC SIZE WHEELCHAIR, WIDTH ADJUSTMENT PACKAGE (NOT TO BE
E1014   - RECLINING BACK, ADDITION TO PEDIATRIC SIZE WHEELCHAIR
E1015   - SHOCK ABSORBER FOR MANUAL WHEELCHAIR, EACH



                                             Page 495
                                  All Other (no trigger bundling)


E1016 - SHOCK ABSORBER FOR POWER WHEELCHAIR, EACH
E1017 - HEAVY DUTY SHOCK ABSORBER FOR HEAVY DUTY OR EXTRA HEAVY DUTY MANUAL WHEELCHAIR,
E1018 - HEAVY DUTY SHOCK ABSORBER FOR HEAVY DUTY OR EXTRA HEAVY DUTY POWER WHEELCHAIR,
E1020 - RESIDUAL LIMB SUPPORT SYSTEM FOR WHEELCHAIR
E1028 - WHEELCHAIR ACCESSORY, MANUAL SWINGAWAY, RETRACTABLE OR REMOVABLE MOUNTING
E1029 - WHEELCHAIR ACCESSORY, VENTILATOR TRAY, FIXED
E1030 - WHEELCHAIR ACCESSORY, VENTILATOR TRAY, GIMBALED
"E1031 - ROLLABOUT CHAIR, ANY AND ALL TYPES WITH CASTORS 5"" OR GREATER
E1035 - MULTI-POSITIONAL PATIENT TRANSFER SYSTEM, WITH INTEGRATED SEAT, OPERATED BY CARE
E1036 - MULTI-POSITIONAL PATIENT TRANSFER SYSTEM, EXTRA-WIDE, WITH INTEGRATED SEAT,
E1037 - TRANSPORT CHAIR, PEDIATRIC SIZE
E1038 - TRANSPORT CHAIR, ADULT SIZE, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POU
E1039 - TRANSPORT CHAIR, ADULT SIZE, HEAVY DUTY, PATIENT WEIGHT CAPACITY GREATER THAN 30
E1050 - FULLY-RECLINING WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVAT
E1060 - FULLY-RECLINING WHEELCHAIR, DETACHABLE ARMS, DESK OR FULL LENGTH, SWING AWAY
E1070 - FULLY-RECLINING WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) SWING AWAY
E1083 - HEMI-WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVATING LEG
E1084 - HEMI-WHEELCHAIR, DETACHABLE ARMS DESK OR FULL LENGTH ARMS, SWING AWAY
E1085 - HEMI-WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE FOOT RESTS
E1086 - HEMI-WHEELCHAIR DETACHABLE ARMS DESK OR FULL LENGTH, SWING AWAY DETACHABLE
E1087 - HIGH STRENGTH LIGHTWEIGHT WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY
E1088 - HIGH STRENGTH LIGHTWEIGHT WHEELCHAIR, DETACHABLE ARMS DESK OR FULL LENGTH,
E1089 - HIGH STRENGTH LIGHTWEIGHT WHEELCHAIR, FIXED LENGTH ARMS, SWING AWAY DETACHABLE
E1090 - HIGH STRENGTH LIGHTWEIGHT WHEELCHAIR, DETACHABLE ARMS DESK OR FULL LENGTH,
E1092 - WIDE HEAVY DUTY WHEEL CHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH), SWING AWAY
E1093 - WIDE HEAVY DUTY WHEELCHAIR, DETACHABLE ARMS DESK OR FULL LENGTH ARMS, SWING
E1100 - SEMI-RECLINING WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVATI
E1110 - SEMI-RECLINING WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) ELEVATING LEG
E1130 - STANDARD WHEELCHAIR, FIXED FULL LENGTH ARMS, FIXED OR SWING AWAY DETACHABLE FOOT
E1140 - WHEELCHAIR, DETACHABLE ARMS, DESK OR FULL LENGTH, SWING AWAY DETACHABLE
E1150 - WHEELCHAIR, DETACHABLE ARMS, DESK OR FULL LENGTH SWING AWAY DETACHABLE
E1160 - WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVATING LEGRESTS
E1161 - MANUAL ADULT SIZE WHEELCHAIR, INCLUDES TILT IN SPACE
E1170 - AMPUTEE WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVATING LEGR
E1171 - AMPUTEE WHEELCHAIR, FIXED FULL LENGTH ARMS, WITHOUT FOOTRESTS OR LEGREST
E1172 - AMPUTEE WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) WITHOUT FOOTRESTS OR
E1180 - AMPUTEE WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) SWING AWAY DETACHABLE
E1190 - AMPUTEE WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) SWING AWAY DETACHABLE
E1195 - HEAVY DUTY WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVATING
E1200 - AMPUTEE WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE FOOTREST
E1220 - WHEELCHAIR; SPECIALLY SIZED OR CONSTRUCTED, (INDICATE BRAND NAME, MODEL NUMBER,
E1221 - WHEELCHAIR WITH FIXED ARM, FOOTRESTS
E1222 - WHEELCHAIR WITH FIXED ARM, ELEVATING LEGRESTS
E1223 - WHEELCHAIR WITH DETACHABLE ARMS, FOOTRESTS
E1224 - WHEELCHAIR WITH DETACHABLE ARMS, ELEVATING LEGRESTS
E1225 - WHEELCHAIR ACCESSORY, MANUAL SEMI-RECLINING BACK, (RECLINE GREATER THAN 15
E1226 - WHEELCHAIR ACCESSORY, MANUAL FULLY RECLINING BACK, (RECLINE GREATER THAN 80
E1227 - SPECIAL HEIGHT ARMS FOR WHEELCHAIR
E1228 - SPECIAL BACK HEIGHT FOR WHEELCHAIR
E1229 - WHEELCHAIR, PEDIATRIC SIZE, NOT OTHERWISE SPECIFIED
E1230 - POWER OPERATED VEHICLE (THREE OR FOUR WHEEL NONHIGHWAY) SPECIFY BRAND NAME AND
E1231 - WHEELCHAIR, PEDIATRIC SIZE, TILT-IN-SPACE, RIGID, ADJUSTABLE, WITH SEATING



                                            Page 496
                                   All Other (no trigger bundling)


E1232   - WHEELCHAIR, PEDIATRIC SIZE, TILT-IN-SPACE, FOLDING, ADJUSTABLE, WITH SEATING
E1233   - WHEELCHAIR, PEDIATRIC SIZE, TILT-IN-SPACE, RIGID, ADJUSTABLE, WITHOUT SEATING
E1234   - WHEELCHAIR, PEDIATRIC SIZE, TILT-IN-SPACE, FOLDING, ADJUSTABLE, WITHOUT SEATING
E1235   - WHEELCHAIR, PEDIATRIC SIZE, RIGID, ADJUSTABLE, WITH SEATING SYSTEM
E1236   - WHEELCHAIR, PEDIATRIC SIZE, FOLDING, ADJUSTABLE, WITH SEATING SYSTEM
E1237   - WHEELCHAIR, PEDIATRIC SIZE, RIGID, ADJUSTABLE, WITHOUT SEATING SYSTEM
E1238   - WHEELCHAIR, PEDIATRIC SIZE, FOLDING, ADJUSTABLE, WITHOUT SEATING SYSTEM
E1239   - POWER WHEELCHAIR, PEDIATRIC SIZE, NOT OTHERWISE SPECIFIED
E1240   - LIGHTWEIGHT WHEELCHAIR, DETACHABLE ARMS, (DESK OR FULL LENGTH) SWING AWAY DETACH
E1250   - LIGHTWEIGHT WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE FOOTREST
E1260   - LIGHTWEIGHT WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) SWING AWAY
E1270   - LIGHTWEIGHT WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVATING
E1280   - HEAVY DUTY WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) ELEVATING LEGRESTS
E1285   - HEAVY DUTY WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE FOOTREST
E1290   - HEAVY DUTY WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) SWING AWAY
E1295   - HEAVY DUTY WHEELCHAIR, FIXED FULL LENGTH ARMS, ELEVATING LEGREST
E1296   - SPECIAL WHEELCHAIR SEAT HEIGHT FROM FLOOR
E1297   - SPECIAL WHEELCHAIR SEAT DEPTH, BY UPHOLSTERY
E1298   - SPECIAL WHEELCHAIR SEAT DEPTH AND/OR WIDTH, BY CONSTRUCTION
E1300   - WHIRLPOOL, PORTABLE (OVERTUB TYPE)
E1310   - WHIRLPOOL, NON-PORTABLE (BUILT-IN TYPE)
E1353   - REGULATOR
E1354   - OXYGEN ACCESSORY, WHEELED CART FOR PORTABLE CYLINDER OR PORTABLE CONCENTRATOR, A
E1355   - STAND/RACK
E1356   - OXYGEN ACCESSORY, BATTERY PACK/CARTRIDGE FOR PORTABLE CONCENTRATOR, ANY TYPE, RE
E1357   - OXYGEN ACCESSORY, BATTERY CHARGER FOR PORTABLE CONCENTRATOR, ANY TYPE, REPLACEME
E1358   - OXYGEN ACCESSORY, DC POWER ADAPTER FOR PORTABLE CONCENTRATOR, ANY TYPE, REPLACEM
E1372   - IMMERSION EXTERNAL HEATER FOR NEBULIZER
E1390   - OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT, CAPABLE OF DELIVERING 85 PERCENT OR
E1391   - OXYGEN CONCENTRATOR, DUAL DELIVERY PORT, CAPABLE OF DELIVERING 85 PERCENT OR
E1392   - PORTABLE OXYGEN CONCENTRATOR, RENTAL
E1399   - DURABLE MEDICAL EQUIPMENT, MISCELLANEOUS
E1405   - OXYGEN AND WATER VAPOR ENRICHING SYSTEM WITH HEATED DELIVERY
E1406   - OXYGEN AND WATER VAPOR ENRICHING SYSTEM WITHOUT HEATED DELIVERY
E1500   - CENTRIFUGE, FOR DIALYSIS
E1510   - KIDNEY, DIALYSATE DELIVERY SYST. KIDNEY MACHINE, PUMP RECIRCULAT- ING, AIR REMOV
E1520   - HEPARIN INFUSION PUMP FOR HEMODIALYSIS
E1530   - AIR BUBBLE DETECTOR FOR HEMODIALYSIS, EACH, REPLACEMENT
E1540   - PRESSURE ALARM FOR HEMODIALYSIS, EACH, REPLACEMENT
E1550   - BATH CONDUCTIVITY METER FOR HEMODIALYSIS, EACH
E1560   - BLOOD LEAK DETECTOR FOR HEMODIALYSIS, EACH, REPLACEMENT
E1570   - ADJUSTABLE CHAIR, FOR ESRD PATIENTS
E1575   - TRANSDUCER PROTECTORS/FLUID BARRIERS, FOR HEMODIALYSIS, ANY SIZE, PER 10
E1580   - UNIPUNCTURE CONTROL SYSTEM FOR HEMODIALYSIS
E1590   - HEMODIALYSIS MACHINE
E1592   - AUTOMATIC INTERMITTENT PERITIONEAL DIALYSIS SYSTEM
E1594   - CYCLER DIALYSIS MACHINE FOR PERITONEAL DIALYSIS
E1600   - DELIVERY AND/OR INSTALLATION CHARGES FOR HEMODIALYSIS EQUIPMENT
E1610   - REVERSE OSMOSIS WATER PURIFICATION SYSTEM, FOR HEMODIALYSIS
E1615   - DEIONIZER WATER PURIFICATION SYSTEM, FOR HEMODIALYSIS
E1620   - BLOOD PUMP FOR HEMODIALYSIS, REPLACEMENT
E1625   - WATER SOFTENING SYSTEM, FOR HEMODIALYSIS



                                             Page 497
                                 All Other (no trigger bundling)


E1630 - RECIPROCATING PERITONEAL DIALYSIS SYSTEM
E1632 - WEARABLE ARTIFICIAL KIDNEY, EACH
E1634 - PERITONEAL DIALYSIS CLAMPS, EACH
E1635 - COMPACT (PORTABLE) TRAVEL HEMODIALYZER SYSTEM
E1636 - SORBENT CARTRIDGES, FOR HEMODIALYSIS, PER 10
E1637 - HEMOSTATS, EACH
E1639 - SCALE, EACH
E1699 - DIALYSIS EQUIPMENT, NOT OTHERWISE SPECIFIED
E1700 - JAW MOTION REHABILITATION SYSTEM
E1701 - REPLACEMENT CUSHIONS FOR JAW MOTION REHABILITATION SYSTEM, PKG. OF 6
E1702 - REPLACEMENT MEASURING SCALES FOR JAW MOTION REHABILITATION SYSTEM, PKG. OF 200
E1800 - DYNAMIC ADJUSTABLE ELBOW EXTENSION/FLEXION DEVICE, INCLUDES SOFT INTERFACE MATER
E1801 - STATIC PROGRESSIVE STRETCH ELBOW DEVICE, EXTENSION AND/OR FLEXION, WITH OR WITH
E1802 - DYNAMIC ADJUSTABLE FOREARM PRONATION/SUPINATION DEVICE, INCLUDES SOFT INTERFACE
E1805 - DYNAMIC ADJUSTABLE WRIST EXTENSION / FLEXION DEVICE, INCLUDES SOFT INTERFACE
E1806 - STATIC PROGRESSIVE STRETCH WRIST DEVICE, FLEXION AND/OR EXTENSION, WITH OR WITHO
E1810 - DYNAMIC ADJUSTABLE KNEE EXTENSION / FLEXION DEVICE, INCLUDES SOFT INTERFACE
E1811 - STATIC PROGRESSIVE STRETCH KNEE DEVICE, EXTENSION AND/OR FLEXION, WITH OR WITHO
E1812 - DYNAMIC KNEE, EXTENSION/FLEXION DEVICE WITH ACTIVE RESISTANCE CONTROL
E1815 - DYNAMIC ADJUSTABLE ANKLE EXTENSION/FLEXION DEVICE, INCLUDES SOFT INTERFACE
E1816 - STATIC PROGRESSIVE STRETCH ANKLE DEVICE, FLEXION AND/OR EXTENSION, WITH OR WITHO
E1818 - STATIC PROGRESSIVE STRETCH FOREARM PRONATION / SUPINATION DEVICE, WITH OR WITHOU
E1820 - REPLACEMENT SOFT INTERFACE MATERIAL, DYNAMIC ADJUSTABLE EXTENSION/FLEXION DEVICE
E1821 - REPLACEMENT SOFT INTERFACE MATERIAL/CUFFS FOR BI-DIRECTIONAL STATIC PROGRESSIVE
E1825 - DYNAMIC ADJUSTABLE FINGER EXTENSION/FLEXION DEVICE, INCLUDES SOFT INTERFACE
E1830 - DYNAMIC ADJUSTABLE TOE EXTENSION/FLEXION DEVICE, INCLUDES SOFT INTERFACE
E1831 - STATIC PROGRESSIVE STRETCH TOE DEVICE, EXTENSION AND/OR FLEXION, WITH OR WITHOUT
E1840 - DYNAMIC ADJUSTABLE SHOULDER FLEXION / ABDUCTION / ROTATION DEVICE, INCLUDES
E1841 - STATIC PROGRESSIVE STRETCH SHOULDER DEVICE, WITH OR WITHOUT RANGE OF MOTION ADJU
E1902 - COMMUNICATION BOARD, NON-ELECTRONIC AUGMENTATIVE OR ALTERNATIVE COMMUNICATION
E2000 - GASTRIC SUCTION PUMP, HOME MODEL, PORTABLE OR STATIONARY, ELECTRIC
E2100 - BLOOD GLUCOSE MONITOR WITH INTEGRATED VOICE SYNTHESIZER
E2101 - BLOOD GLUCOSE MONITOR WITH INTEGRATED LANCING/BLOOD SAMPLE
E2120 - PULSE GENERATOR SYSTEM FOR TYMPANIC TREATMENT OF INNER EAR ENDOLYMPHATIC FLUID
E2201 - MANUAL WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME, WIDTH GREATER THAN OR EQUAL
E2202 - MANUAL WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME WIDTH, 24-27 INCHES
E2203 - MANUAL WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME DEPTH, 20 TO LESS THAN 22
E2204 - MANUAL WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME DEPTH, 22 TO 25 INCHES
E2205 - MANUAL WHEELCHAIR ACCESSORY, HANDRIM WITHOUT PROJECTIONS (INCLUDES ERGONOMIC OR
E2206 - MANUAL WHEELCHAIR ACCESSORY, WHEEL LOCK ASSEMBLY, COMPLETE, EACH
E2207 - WHEELCHAIR ACCESSORY, CRUTCH AND CANE HOLDER, EACH
E2208 - WHEELCHAIR ACCESSORY, CYLINDER TANK CARRIER, EACH
E2209 - ACCESSORY, ARM TROUGH, WITH OR WITHOUT HAND SUPPORT, EACH
E2210 - WHEELCHAIR ACCESSORY, BEARINGS, ANY TYPE, REPLACEMENT ONLY, EACH
E2211 - MANUAL WHEELCHAIR ACCESSORY, PNEUMATIC PROPULSION TIRE, ANY SIZE, EACH
E2212 - MANUAL WHEELCHAIR ACCESSORY, TUBE FOR PNEUMATIC PROPULSION TIRE, ANY SIZE, EACH
E2213 - MANUAL WHEELCHAIR ACCESSORY, INSERT FOR PNEUMATIC PROPULSION TIRE (REMOVABLE), A
E2214 - MANUAL WHEELCHAIR ACCESSORY, PNEUMATIC CASTER TIRE, ANY SIZE, EACH
E2215 - MANUAL WHEELCHAIR ACCESSORY, TUBE FOR PNEUMATIC CASTER TIRE, ANY SIZE, EACH
E2216 - MANUAL WHEELCHAIR ACCESSORY, FOAM FILLED PROPULSION TIRE, ANY SIZE, EACH
E2217 - MANUAL WHEELCHAIR ACCESSORY, FOAM FILLED CASTER TIRE, ANY SIZE, EACH
E2218 - MANUAL WHEELCHAIR ACCESSORY, FOAM PROPULSION TIRE, ANY SIZE, EACH



                                           Page 498
                                   All Other (no trigger bundling)


E2219   - MANUAL WHEELCHAIR ACCESSORY, FOAM CASTER TIRE, ANY SIZE, EACH
E2220   - MANUAL WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) PROPULSION TIRE, ANY SIZE, E
E2221   - MANUAL WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) CASTER TIRE (REMOVABLE), ANY
E2222   - MANUAL WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) CASTER TIRE WITH INTEGRATED
E2224   - MANUAL WHEELCHAIR ACCESSORY, PROPULSION WHEEL EXCLUDES TIRE, ANY SIZE, EACH
E2225   - MANUAL WHEELCHAIR ACCESSORY, CASTER WHEEL EXCLUDES TIRE, ANY SIZE, REPLACEMENT O
E2226   - MANUAL WHEELCHAIR ACCESSORY, CASTER FORK, ANY SIZE, REPLACEMENT ONLY, EACH
E2227   - MANUAL WHEELCHAIR ACCESSORY, GEAR REDUCTION DRIVE WHEEL, EACH
E2228   - MANUAL WHEELCHAIR ACCESSORY, WHEEL BRAKING SYSTEM AND LOCK, COMPLETE, EACH
E2230   - MANUAL WHEELCHAIR ACCESSORY, MANUAL STANDING SYSTEM
E2231   - MANUAL WHEELCHAIR ACCESSORY, SOLID SEAT SUPPORT BASE (REPLACES SLING SEAT), INCL
E2291   - BACK, PLANAR, FOR PEDIATRIC SIZE WHEELCHAIR INCLUDING FIXED ATTACHING HARDWARE
E2292   - SEAT, PLANAR, FOR PEDIATRIC SIZE WHEELCHAIR INCLUDING FIXED ATTACHING HARDWARE
E2293   - BACK, CONTOURED, FOR PEDIATRIC SIZE WHEELCHAIR INCLUDING FIXED ATTACHING
E2294   - SEAT, CONTOURED, FOR PEDIATRIC SIZE WHEELCHAIR INCLUDING FIXED ATTACHING
E2295   - MANUAL WHEELCHAIR ACCESSORY, FOR PEDIATRIC SIZE WHEELCHAIR, DYNAMIC SEATING FRAM
E2300   - POWER WHEELCHAIR ACCESSORY, POWER SEAT ELEVATION SYSTEM
E2301   - POWER WHEELCHAIR ACCESSORY, POWER STANDING SYSTEM
E2310   - POWER WHEELCHAIR ACCESSORY, ELECTRONIC CONNECTION BETWEEN WHEELCHAIR CONTROLLER
E2311   - POWER WHEELCHAIR ACCESSORY, ELECTRONIC CONNECTION BETWEEN WHEELCHAIR CONTROLLER
E2312   - POWER WHEELCHAIR ACCESSORY, HAND OR CHIN CONTROL INTERFACE, MINI-PROPORTIONAL RE
E2313   - POWER WHEELCHAIR ACCESSORY, HARNESS FOR UPGRADE TO EXPANDABLE CONTROLLER, INCLUD
E2321   - POWER WHEELCHAIR ACCESSORY, HAND CONTROL INTERFACE, REMOTE JOYSTICK,
E2322   - POWER WHEELCHAIR ACCESSORY, HAND CONTROL INTERFACE, MULTIPLE MECHANICAL
E2323   - POWER WHEELCHAIR ACCESSORY, SPECIALTY JOYSTICK HANDLE FOR HAND CONTROL
E2324   - POWER WHEELCHAIR ACCESSORY, CHIN CUP FOR CHIN CONTROL INTERFACE
E2325   - POWER WHEELCHAIR ACCESSORY, SIP AND PUFF INTERFACE, NONPROPORTIONAL, INCLUDING
E2326   - POWER WHEELCHAIR ACCESSORY, BREATH TUBE KIT FOR SIP AND PUFF INTERFACE
E2327   - POWER WHEELCHAIR ACCESSORY, HEAD CONTROL INTERFACE, MECHANICAL, PROPORTIONAL,
E2328   - POWER WHEELCHAIR ACCESSORY, HEAD CONTROL OR EXTREMITY CONTROL INTERFACE,
E2329   - POWER WHEELCHAIR ACCESSORY, HEAD CONTROL INTERFACE, CONTACT SWITCH MECHANISM,
E2330   - POWER WHEELCHAIR ACCESSORY, HEAD CONTROL INTERFACE, PROXIMITY SWITCH MECHANISM,
E2331   - POWER WHEELCHAIR ACCESSORY, ATTENDANT CONTROL, PROPORTIONAL, INCLUDING ALL
E2340   - POWER WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME WIDTH, 20-23 INCHES
E2341   - POWER WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME WIDTH, 24-27 INCHES
E2342   - POWER WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME DEPTH, 20 OR 21 INCHES
E2343   - POWER WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME DEPTH, 22-25 INCHES
E2351   - POWER WHEELCHAIR ACCESSORY, ELECTRONIC INTERFACE TO OPERATE SPEECH GENERATING
E2360   - POWER WHEELCHAIR ACCESSORY, 22 NF NON-SEALED LEAD ACID BATTERY, EACH
E2361   - POWER WHEELCHAIR ACCESSORY, 22NF SEALED LEAD ACID BATTERY, EACH, (E.G. GEL
E2362   - POWER WHEELCHAIR ACCESSORY, GROUP 24 NON-SEALED LEAD ACID BATTERY, EACH
E2363   - POWER WHEELCHAIR ACCESSORY, GROUP 24 SEALED LEAD ACID BATTERY, EACH (E.G. GEL
E2364   - POWER WHEELCHAIR ACCESSORY, U-1 NON-SEALED LEAD ACID BATTERY, EACH
E2365   - POWER WHEELCHAIR ACCESSORY, U-1 SEALED LEAD ACID BATTERY, EACH (E.G. GEL CELL,
E2366   - POWER WHEELCHAIR ACCESSORY, BATTERY CHARGER, SINGLE MODE, FOR USE WITH ONLY ONE
E2367   - POWER WHEELCHAIR ACCESSORY, BATTERY CHARGER, DUAL MODE, FOR USE WITH EITHER
E2368   - POWER WHEELCHAIR COMPONENT, MOTOR, REPLACEMENT ONLY
E2369   - POWER WHEELCHAIR COMPONENT, GEAR BOX, REPLACEMENT ONLY
E2370   - POWER WHEELCHAIR COMPONENT, MOTOR AND GEAR BOX COMBINATION, REPLACEMENT ONLY
E2371   - POWER WHEELCHAIR ACCESSORY, GROUP 27 SEALED LEAD ACID BATTERY, (E.G. GEL CELL, A
E2372   - POWER WHEELCHAIR ACCESSORY, GROUP 27 NON-SEALED LEAD ACID BATTERY, EACH
E2373   - POWER WHEELCHAIR ACCESSORY, HAND OR CHIN CONTROL INTERFACE, COMPACT REMOTE JOYST



                                             Page 499
                                 All Other (no trigger bundling)


E2374 - POWER WHEELCHAIR ACCESSORY, HAND OR CHIN CONTROL INTERFACE, STANDARD REMOTE JOYS
E2375 - POWER WHEELCHAIR ACCESSORY, NON-EXPANDABLE CONTROLLER, INCLUDING ALL RELATED ELE
E2376 - POWER WHEELCHAIR ACCESSORY, EXPANDABLE CONTROLLER, INCLUDING ALL RELATED ELECTRO
E2377 - POWER WHEELCHAIR ACCESSORY, EXPANDABLE CONTROLLER, INCLUDING ALL RELATED ELECTRO
E2381 - POWER WHEELCHAIR ACCESSORY, PNEUMATIC DRIVE WHEEL TIRE, ANY SIZE, REPLACEMENT ON
E2382 - POWER WHEELCHAIR ACCESSORY, TUBE FOR PNEUMATIC DRIVE WHEEL TIRE, ANY SIZE, REPLA
E2383 - POWER WHEELCHAIR ACCESSORY, INSERT FOR PNEUMATIC DRIVE WHEEL TIRE (REMOVABLE), A
E2384 - POWER WHEELCHAIR ACCESSORY, PNEUMATIC CASTER TIRE, ANY SIZE, REPLACEMENT ONLY, E
E2385 - POWER WHEELCHAIR ACCESSORY, TUBE FOR PNEUMATIC CASTER TIRE, ANY SIZE, REPLACEMEN
E2386 - POWER WHEELCHAIR ACCESSORY, FOAM FILLED DRIVE WHEEL TIRE, ANY SIZE, REPLACEMENT
E2387 - POWER WHEELCHAIR ACCESSORY, FOAM FILLED CASTER TIRE, ANY SIZE, REPLACEMENT ONLY,
E2388 - POWER WHEELCHAIR ACCESSORY, FOAM DRIVE WHEEL TIRE, ANY SIZE, REPLACEMENT ONLY, E
E2389 - POWER WHEELCHAIR ACCESSORY, FOAM CASTER TIRE, ANY SIZE, REPLACEMENT ONLY, EACH
E2390 - POWER WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) DRIVE WHEEL TIRE, ANY SIZE, R
E2391 - POWER WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) CASTER TIRE (REMOVABLE), ANY
E2392 - POWER WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) CASTER TIRE WITH INTEGRATED W
E2394 - POWER WHEELCHAIR ACCESSORY, DRIVE WHEEL EXCLUDES TIRE, ANY SIZE, REPLACEMENT ONL
E2395 - POWER WHEELCHAIR ACCESSORY, CASTER WHEEL EXCLUDES TIRE, ANY SIZE, REPLACEMENT ON
E2396 - POWER WHEELCHAIR ACCESSORY, CASTER FORK, ANY SIZE, REPLACEMENT ONLY, EACH
E2397 - POWER WHEELCHAIR ACCESSORY, LITHIUM-BASED BATTERY, EACH
E2402 - NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR PORTABLE
E2500 - SPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING PRE-RECORDED MESSAGES, LESS TH
E2502 - SPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING PRE-RECORDED MESSAGES,
E2504 - SPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING PRE-RECORDED MESSAGES,
E2506 - SPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING PRE-RECORDED MESSAGES,
E2508 - SPEECH GENERATING DEVICE, SYNTHESIZED SPEECH, REQUIRING MESSAGE FORMULATION BY
E2510 - SPEECH GENERATING DEVICE, SYNTHESIZED SPEECH, PERMITTING MULTIPLE METHODS OF
E2511 - SPEECH GENERATING SOFTWARE PROGRAM, FOR PERSONAL COMPUTER OR PERSONAL DIGITAL
E2512 - ACCESSORY FOR SPEECH GENERATING DEVICE, MOUNTING SYSTEM
E2599 - ACCESSORY FOR SPEECH GENERATING DEVICE, NOT OTHERWISE CLASSIFIED
E2601 - GENERAL USE WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH
E2602 - GENERAL USE WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR GREATER, ANY DEPTH
E2603 - SKIN PROTECTION WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH
E2604 - SKIN PROTECTION WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR GREATER, ANY DEPTH
E2605 - POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH
E2606 - POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR GREATER, ANY DEPTH
E2607 - SKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22
E2608 - SKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR
E2609 - CUSTOM FABRICATED WHEELCHAIR SEAT CUSHION, ANY SIZE
E2610 - WHEELCHAIR SEAT CUSHION, POWERED
E2611 - GENERAL USE WHEELCHAIR BACK CUSHION, WIDTH LESS THAN 22 INCHES, ANY HEIGHT,
E2612 - GENERAL USE WHEELCHAIR BACK CUSHION, WIDTH 22 INCHES OR GREATER, ANY HEIGHT,
E2613 - POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR, WIDTH LESS THAN 22 INCHES, ANY
E2614 - POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR, WIDTH 22 INCHES OR GREATER, ANY
E2615 - POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR-LATERAL, WIDTH LESS THAN 22
E2616 - POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR-LATERAL, WIDTH 22 INCHES OR
E2617 - CUSTOM FABRICATED WHEELCHAIR BACK CUSHION, ANY SIZE, INCLUDING ANY TYPE
E2619 - REPLACEMENT COVER FOR WHEELCHAIR SEAT CUSHION OR BACK CUSHION, EACH
E2620 - POSITIONING WHEELCHAIR BACK CUSHION, PLANAR BACK WITH LATERAL SUPPORTS, WIDTH
E2621 - POSITIONING WHEELCHAIR BACK CUSHION, PLANAR BACK WITH LATERAL SUPPORTS, WIDTH
E2622 - SKIN PROTECTION WHEELCHAIR SEAT CUSHION, ADJUSTABLE, WIDTH LESS THAN 22 INCHES,
E2623 - SKIN PROTECTION WHEELCHAIR SEAT CUSHION, ADJUSTABLE, WIDTH 22 INCHES OR GREATER,



                                           Page 500
                                 All Other (no trigger bundling)


E2624 - SKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CUSHION, ADJUSTABLE, WIDTH LESS
E2625 - SKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CUSHION, ADJUSTABLE, WIDTH 22 IN
E8000 - GAIT TRAINER, PEDIATRIC SIZE, POSTERIOR SUPPORT, INCLUDES ALL ACCESSORIES AND
E8001 - GAIT TRAINER, PEDIATRIC SIZE, UPRIGHT SUPPORT, INCLUDES ALL ACCESSORIES AND
E8002 - GAIT TRAINER, PEDIATRIC SIZE, ANTERIOR SUPPORT, INCLUDES ALL ACCESSORIES AND
G0008 - ADMINISTRATION OF INFLUENZA VIRUS VACCINE
G0009 - ADMINISTRATION OF PNEUMOCOCCAL VACCINE
G0010 - ADMINISTRATION OF HEPATITIS B VACCINE
G0027 - SEMEN ANALYSIS; PRESENCE AND/OR MOTILITY OF SPERM EXCLUDING HUHNER
G0054 - BLOOD CHOLESTEROL TEST, BY CHOLESTEROL MONITORING DEVICE APPROVED BY FDA FOR HOM
G0055 - GLUCOSE POST DOSE (INCLUDES GLUCOSE) DIRECT MEASUREMENT BY A GLUCOSE TESTING DEV
G0056 - GLUCOSE TOLERANCE TEST (GTT), BY DIRECT MEASUREMENT BY GLUCOSE TESTING DEVICE AP
G0057 - GLUCOSE TOLERANCE TEST (GTT), BY DIRECT MEASUREMENT BY A GLUCOSE TESTING DEVICE
G0101 - CERVICAL OR VAGINAL CANCER SCREENING; PELVIC AND CLINICAL BREAST EXAMINATION
G0102 - PROSTATE CANCER SCREENING; DIGITAL RECTAL EXAMINATION
G0103 - PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA)
G0104 - COLORECTAL CANCER SCREENING; FLEXIBLE SIGMOIDOSCOPY
G0106 - COLORECTAL CANCER SCREENING; ALTERNATIVE TO G0104, SCREENING SIGMOIDOSCOPY,
G0120 - COLORECTAL CANCER SCREENING; ALTERNATIVE TO G0105, SCREENING COLONOSCOPY,
G0122 - COLORECTAL CANCER SCREENING; BARIUM ENEMA
G0123 - SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED
G0124 - SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED
G0130 - SINGLE ENERGY X-RAY ABSORPTIOMETRY (SEXA) BONE DENSITY STUDY, ONE OR MORE
G0141 - SCREENING CYTOPATHOLOGY SMEARS, CERVICAL OR VAGINAL, PERFORMED BY AUTOMATED
G0143 - SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED
G0144 - SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED
G0145 - SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED
G0147 - SCREENING CYTOPATHOLOGY SMEARS, CERVICAL OR VAGINAL, PERFORMED BY AUTOMATED
G0148 - SCREENING CYTOPATHOLOGY SMEARS, CERVICAL OR VAGINAL, PERFORMED BY AUTOMATED
G0154 - SERVICES OF SKILLED NURSE IN HOME HEALTH, OR NURSE IN HOSPICE SETTINGS, EACH 15
G0168 - WOUND CLOSURE UTILIZING TISSUE ADHESIVE(S) ONLY
G0173 - LINEAR ACCELERATOR BASED STEREOTACTIC RADIOSURGERY, COMPLETE COURSE OF THERAPY
G0175 - SCHEDULED INTERDISCIPLINARY TEAM CONFERENCE (MINIMUM OF THREE EXCLUSIVE OF
G0179 - PHYSICIAN RE-CERTIFICATION FOR MEDICARE-COVERED HOME HEALTH SERVICES UNDER A
G0180 - PHYSICIAN CERTIFICATION FOR MEDICARE-COVERED HOME HEALTH SERVICES UNDER A HOME
G0202 - SCREENING MAMMOGRAPHY, PRODUCING DIRECT DIGITAL IMAGE, BILATERAL, ALL VIEWS
G0204 - DIAGNOSTIC MAMMOGRAPHY, PRODUCING DIRECT DIGITAL IMAGE, BILATERAL, ALL VIEWS
G0206 - DIAGNOSTIC MAMMOGRAPHY, PRODUCING DIRECT DIGITAL IMAGE, UNILATERAL, ALL VIEWS
G0219 - PET IMAGING WHOLE BODY; MELANOMA FOR NON-COVERED INDICATIONS
G0245 - INITIAL PHYSICIAN EVALUATION AND MANAGEMENT OF A DIABETIC PATIENT WITH DIABETIC
G0246 - FOLLOW-UP PHYSICIAN EVALUATION AND MANAGEMENT OF A DIABETIC PATIENT WITH
G0248 - DEMONSTRATION, PRIOR TO INITIAL USE, OF HOME INR MONITORING FOR PATIENT WITH EIT
G0249 - PROVISION OF TEST MATERIALS AND EQUIPMENT FOR HOME INR MONITORING OF PATIENT WIT
G0250 - PHYSICIAN REVIEW, INTERPRETATION, AND PATIENT MANAGEMENT OF HOME INR TESTING FOR
G0251 - LINEAR ACCELERATOR BASED STEREOTACTIC RADIOSURGERY, DELIVERY INCLUDING
G0257 - UNSCHEDULED OR EMERGENCY DIALYSIS TREATMENT FOR AN ESRD PATIENT IN A HOSPITAL
G0259 - INJECTION PROCEDURE FOR SACROILIAC JOINT; ARTHROGRAPY
G0268 - REMOVAL OF IMPACTED CERUMEN (ONE OR BOTH EARS) BY PHYSICIAN ON SAME DATE OF
G0269 - PLACEMENT OF OCCLUSIVE DEVICE INTO EITHER A VENOUS OR ARTERIAL ACCESS SITE,
G0270 - MEDICAL NUTRITION THERAPY; REASSESSMENT AND SUBSEQUENT INTERVENTION(S)
G0271 - MEDICAL NUTRITION THERAPY, REASSESSMENT AND SUBSEQUENT INTERVENTION(S)
G0275 - RENAL ARTERY ANGIOGRAPHY (UNILATERAL OR BILATERAL) PERFORMED AT THE TIME OF



                                           Page 501
                                  All Other (no trigger bundling)


G0278 - ILIAC ARTERY ANGIOGRAPHY PERFORMED AT THE SAME TIME OF CARDIAC CATHETERIZATION,
G0281 - ELECTRICAL STIMULATION, (UNATTENDED), TO ONE OR MORE AREAS, FOR CHRONIC STAGE
G0283 - ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR INDICATION(S)
G0289 - ARTHROSCOPY, KNEE, SURGICAL, FOR REMOVAL OF LOOSE BODY, FOREIGN BODY,
G0293 - NONCOVERED SURGICAL PROCEDURE(S) USING CONSCIOUS SEDATION, REGIONAL, GENERAL OR
G0294 - NONCOVERED PROCEDURE(S) USING EITHER NO ANESTHESIA OR LOCAL ANESTHESIA ONLY, IN
G0302 - PRE-OPERATIVE PULMONARY SURGERY SERVICES FOR PREPARATION FOR LVRS, COMPLETE
G0303 - PRE-OPERATIVE PULMONARY SURGERY SERVICES FOR PREPARATION FOR LVRS, 10 TO 15
G0304 - PRE-OPERATIVE PULMONARY SURGERY SERVICES FOR PREPARATION FOR LVRS, 1 TO 9 DAYS
G0305 - POST-DISCHARGE PULMONARY SURGERY SERVICES AFTER LVRS, MINIMUM OF 6 DAYS OF
G0306 - COMPLETE CBC, AUTOMATED (HGB, HCT, RBC, WBC, WITHOUT PLATELET COUNT) AND
G0307 - COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC; WITHOUT PLATELET COUNT)
G0328 - COLORECTAL CANCER SCREENING; FECAL OCCULT BLOOD TEST, IMMUNOASSAY, 1-3
G0329 - ELECTROMAGNETIC THERAPY, TO ONE OR MORE AREAS FOR CHRONIC STAGE III AND STAGE
G0337 - HOSPICE EVALUATION AND COUNSELING SERVICES, PRE-ELECTION
G0339 - IMAGE-GUIDED ROBOTIC LINEAR ACCELERATOR-BASED STEREOTACTIC RADIOSURGERY,
G0364 - BONE MARROW ASPIRATION PERFORMED WITH BONE MARROW BIOPSY THROUGH THE SAME
G0365 - VESSEL MAPPING OF VESSELS FOR HEMODIALYSIS ACCESS (SERVICES FOR PREOPERATIVE
G0378 - HOSPITAL OBSERVATION SERVICE, PER HOUR
G0379 - DIRECT ADMISSION OF PATIENT FOR HOSPITAL OBSERVATION CARE
G0432 - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY (EIA) TECHNIQUE, QUALIT
G0433 - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME-LINKED IMMONOSORBENT ASSAY (ELISA)
G0435 - INFECTIOUS AGENT ANTIGEN DETECTION BY RAPID ANTIBODY TEST ORORAL MUCOSA TRANSUD
G3001 - ADMINISTRATION AND SUPPLY OF TOSITUMOMAB, 450 MG
J0120 - INJECTION, TETRACYCLINE, UP TO 250 MG
J0128 - INJECTION, ABARELIX, 10 MG
J0129 - INJECTION, ABATACEPT, 10 MG
J0130 - INJECTION ABCIXIMAB, 10 MG
J0132 - INJECTION, ACETYLCYSTEINE, 100 MG
J0133 - INJECTION, ACYCLOVIR, 5 MG
J0135 - INJECTION, ADALIMUMAB, 20 MG
J0150 - INJECTION, ADENOSINE FOR THERAPEUTIC USE, 6 MG (NOT TO BE USED TO REPORT ANY
J0152 - INJECTION, ADENOSINE FOR DIAGNOSTIC USE, 30 MG (NOT TO BE USED TO REPORT ANY
J0170 - INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
J0171 - INJECTION, ADRENALIN, EPINEPHRINE, 0.1 MG
J0180 - INJECTION, AGALSIDASE BETA, 1 MG
J0190 - INJECTION, BIPERIDEN LACTATE, PER 5 MG
J0200 - INJECTION, ALATROFLOXACIN MESYLATE, 100 MG
J0205 - INJECTION, ALGLUCERASE, PER 10 UNITS
J0207 - INJECTION, AMIFOSTINE, 500 MG
J0210 - INJECTION, METHYLDOPATE HCL, UP TO 250 MG
J0215 - INJECTION, ALEFACEPT, 0.5 MG
J0220 - INJECTION, ALGLUCOSIDASE ALFA, 10 MG.
J0256 - INJECTION, ALPHA 1 - PROTEINASE INHIBITOR - HUMAN, 10 MG
J0278 - INJECTION, AMIKACIN SULFATE, 100 MG
J0280 - INJECTION, AMINOPHYLLIN, UP TO 250 MG
J0282 - INJECTION, AMIODARONE HYDROCHLORIDE, 30 MG
J0285 - INJECTION, AMPHOTERICIN B, 50 MG
J0287 - INJECTION, AMPHOTERICIN B LIPID COMPLEX, 10 MG
J0288 - INJECTION, AMPHOTERICIN B CHOLESTERYL SULFATE COMPLEX, 10 MG
J0289 - INJECTION, AMPHOTERICIN B LIPOSOME, 10 MG
J0290 - INJECTION, AMPICILLIN SODIUM, 500 MG



                                            Page 502
                                    All Other (no trigger bundling)


J0295 - INJECTION, AMPICILLIN SODIUM/SULBACTAM SODIUM, PER 1.5 GM
J0300 - INJECTION, AMOBARBITAL, UP TO 125 MG
J0330 - INJECTION, SUCCINYLCHOLINE CHLORIDE, UP TO 20 MG
J0348 - INJECTION, ANIDULAFUNGIN, 1 MG
J0350 - INJECTION, ANISTREPLASE, PER 30 UNITS
J0360 - INJECTION, HYDRALAZINE HCL, UP TO 20 MG
J0364 - INJECTION, APOMORPHINE HYDROCHLORIDE, 1 MG
J0365 - INJECTION, APROTONIN, 10,000 KIU
J0380 - INJECTION, METARAMINOL BITARTRATE, PER 10 MG
J0390 - INJECTION, CHLOROQUINE HYDROCHLORIDE, UP TO 250 MG
J0395 - INJECTION, ARBUTAMINE HCL, 1 MG
J0400 - INJECTION, ARIPIPRAZOLE, INTRAMUSCULAR, 0.25 MG
J0456 - INJECTION, AZITHROMYCIN, 500 MG
J0461 - INJECTION, ATROPINE SULFATE, 0.01 MG
J0470 - INJECTION, DIMERCAPROL, PER 100 MG
J0475 - INJECTION, BACLOFEN, 10 MG
J0476 - INJECTION, BACLOFEN, 50 MCG FOR INTRATHECAL TRIAL
J0480 - INJECTION, BASILIXIMAB, 20 MG
J0500 - INJECTION, DICYCLOMINE HCL, UP TO 20 MG
J0515 - INJECTION, BENZTROPINE MESYLATE, PER 1 MG
J0520 - INJECTION, BETHANECHOL CHLORIDE, MYOTONACHOL OR URECHOLINE, UP TO 5 MG
J0558 - INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, 100,000 UNITS
J0559 - INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, 2500 UNITS
J0560 - INJECTION, PENICILLIN G BENZATHINE, UP TO 600,000 UNITS
J0561 - INJECTION, PENICILLIN G BENZATHINE, 100,000 UNITS
J0570 - INJECTION, PENICILLIN G BENZATHINE, UP TO 1,200,000 UNITS
J0580 - INJECTION, PENICILLIN G BENZATHINE, UP TO 2,400,000 UNITS
J0583 - INJECTION, BIVALIRUDIN, 1 MG
J0585 - INJECTION, ONABOTULINUMTOXINA, 1 UNIT
J0586 - INJECTION, ABOBOTULINUMTOXINA, 5 UNITS
J0587 - INJECTION, RIMABOTULINUMTOXINB, 100 UNITS
J0592 - INJECTION, BUPRENORPHINE HYDROCHLORIDE, 0.1 MG
J0594 - INJECTION, BUSULFAN, 1 MG
J0595 - INJECTION, BUTORPHANOL TARTRATE, 1 MG
J0597 - INJECTION, C-1 ESTERASE INHIBITOR (HUMAN), BERINERT, 10 UNITS
J0598 - INJECTION, C1 ESTERASE INHIBITOR (HUMAN), 10 UNITS
J0600 - INJECTION, EDETATE CALCIUM DISODIUM, UP TO 1000 MG
J0610 - INJECTION, CALCIUM GLUCONATE, PER 10 ML
J0620 - INJECTION, CALCIUM GLYCEROPHOSPHATE AND CALCIUM LACTATE, PER 10 ML
J0630 - INJECTION, CALCITONIN SALMON, UP TO 400 UNITS
J0636 - INJECTION, CALCITRIOL, 0.1 MCG
J0637 - INJECTION, CASPOFUNGIN ACETATE, 5 MG
J0638 - INJECTION, CANAKINUMAB, 1 MG
J0640 - INJECTION, LEUCOVORIN CALCIUM, PER 50 MG
J0641 - INJECTION, LEVOLEUCOVORIN CALCIUM, 0.5 MG
J0670 - INJECTION, MEPIVACAINE HYDROCHLORIDE, PER 10 ML
J0690 - INJECTION, CEFAZOLIN SODIUM, 500 MG
J0692 - INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
J0694 - INJECTION, CEFOXITIN SODIUM, 1 GM
J0696 - INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
J0697 - INJECTION, STERILE CEFUROXIME SODIUM, PER 750 MG
J0698 - INJECTION, CEFOTAXIME SODIUM, PER GM



                                              Page 503
                                 All Other (no trigger bundling)


J0702 - INJECTION, BETAMETHASONE ACETATE 3MG AND BETAMETHASONE SODIUM PHOSPHATE 3MG
J0704 - INJECTION, BETAMETHASONE SODIUM PHOSPHATE, PER 4 MG
J0710 - INJECTION, CEPHAPIRIN SODIUM, UP TO 1 GM
J0713 - INJECTION, CEFTAZIDIME, PER 500 MG
J0715 - INJECTION, CEFTIZOXIME SODIUM, PER 500 MG
J0718 - INJECTION, CERTOLIZUMAB PEGOL, 1 MG
J0720 - INJECTION, CHLORAMPHENICOL SODIUM SUCCINATE, UP TO 1 GM
J0725 - INJECTION, CHORIONIC GONADOTROPIN, PER 1,000 USP UNITS
J0735 - INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG
J0740 - INJECTION, CIDOFOVIR, 375 MG
J0743 - INJECTION, CILASTATIN SODIUM; IMIPENEM, PER 250 MG
J0744 - INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION, 200 MG
J0745 - INJECTION, CODEINE PHOSPHATE, PER 30 MG
J0760 - INJECTION, COLCHICINE, PER 1MG
J0770 - INJECTION, COLISTIMETHATE SODIUM, UP TO 150 MG
J0775 - INJECTION, COLLAGENASE, CLOSTRIDIUM HISTOLYTICUM, 0.01 MG
J0780 - INJECTION, PROCHLORPERAZINE, UP TO 10 MG
J0795 - INJECTION, CORTICORELIN OVINE TRIFLUTATE, 1 MICROGRAM
J0800 - INJECTION, CORTICOTROPIN, UP TO 40 UNITS
J0833 - INJECTION, COSYNTROPIN, NOT OTHERWISE SPECIFIED, 0.25 MG
J0834 - INJECTION, COSYNTROPIN (CORTROSYN), 0.25 MG
J0850 - INJECTION, CYTOMEGALOVIRUS IMMUNE GLOBULIN INTRAVENOUS (HUMAN), PER VIAL
J0878 - INJECTION, DAPTOMYCIN, 1 MG
J0881 - INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (NON-ESRD USE)
J0882 - INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (FOR ESRD ON DIALYSIS)
J0885 - INJECTION, EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
J0886 - INJECTION, EPOETIN ALFA, 1000 UNITS (FOR ESRD ON DIALYSIS)
J0894 - INJECTION, DECITABINE, 1 MG
J0895 - INJECTION, DEFEROXAMINE MESYLATE, 500 MG
J0900 - INJECTION, TESTOSTERONE ENANTHATE AND ESTRADIOL VALERATE, UP TO 1 CC
J0945 - INJECTION, BROMPHENIRAMINE MALEATE, PER 10 MG
J0970 - INJECTION, ESTRADIOL VALERATE, UP TO 40 MG
J1000 - INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
J1020 - INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG
J1030 - INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
J1040 - INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
J1051 - INJECTION, MEDROXYPROGESTERONE ACETATE, 50 MG
J1055 - INJECTION, MEDROXYPROGESTERONE ACETATE FOR CONTRACEPTIVE USE, 150 MG
J1056 - INJECTION, MEDROXYPROGESTERONE ACETATE / ESTRADIOL CYPIONATE, 5MG / 25MG
J1060 - INJECTION, TESTOSTERONE CYPIONATE AND ESTRADIOL CYPIONATE, UP TO 1 ML
J1070 - INJECTION, TESTOSTERONE CYPIONATE, UP TO 100 MG
J1080 - INJECTION, TESTOSTERONE CYPIONATE, 1 CC, 200 MG
J1094 - INJECTION, DEXAMETHASONE ACETATE, 1 MG
J1100 - INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG
J1110 - INJECTION, DIHYDROERGOTAMINE MESYLATE, PER 1 MG
J1120 - INJECTION, ACETAZOLAMIDE SODIUM, UP TO 500 MG
J1160 - INJECTION, DIGOXIN, UP TO 0.5 MG
J1162 - INJECTION, DIGOXIN IMMUNE FAB (OVINE), PER VIAL
J1165 - INJECTION, PHENYTOIN SODIUM, PER 50 MG
J1170 - INJECTION, HYDROMORPHONE, UP TO 4 MG
J1180 - INJECTION, DYPHYLLINE, UP TO 500 MG
J1190 - INJECTION, DEXRAZOXANE HYDROCHLORIDE, PER 250 MG



                                           Page 504
                                   All Other (no trigger bundling)


J1200 - INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG
J1205 - INJECTION, CHLOROTHIAZIDE SODIUM, PER 500 MG
J1212 - INJECTION, DMSO, DIMETHYL SULFOXIDE, 50%, 50 ML
J1230 - INJECTION, METHADONE HCL, UP TO 10 MG
J1240 - INJECTION, DIMENHYDRINATE, UP TO 50 MG
J1245 - INJECTION, DIPYRIDAMOLE, PER 10 MG
J1250 - INJECTION, DOBUTAMINE HYDROCHLORIDE, PER 250 MG
J1260 - INJECTION, DOLASETRON MESYLATE, 10 MG
J1265 - INJECTION, DOPAMINE HCL, 40 MG
J1267 - INJECTION, DORIPENEM, 10 MG
J1270 - INJECTION, DOXERCALCIFEROL, 1 MCG
J1290 - INJECTION, ECALLANTIDE, 1 MG
J1300 - INJECTION, ECULIZUMAB, 10 MG
J1320 - INJECTION, AMITRIPTYLINE HCL, UP TO 20 MG
J1324 - INJECTION, ENFUVIRTIDE, 1 MG
J1325 - INJECTION, EPOPROSTENOL, 0.5 MG
J1327 - INJECTION, EPTIFIBATIDE, 5 MG
J1330 - INJECTION, ERGONOVINE MALEATE, UP TO 0.2 MG
J1335 - INJECTION, ERTAPENEM SODIUM, 500 MG
J1364 - INJECTION, ERYTHROMYCIN LACTOBIONATE, PER 500 MG
J1380 - INJECTION, ESTRADIOL VALERATE, UP TO 10 MG
J1390 - INJECTION, ESTRADIOL VALERATE, UP TO 20 MG
J1410 - INJECTION, ESTROGEN CONJUGATED, PER 25 MG
J1430 - INJECTION, ETHANOLAMINE OLEATE, 100 MG
J1435 - INJECTION, ESTRONE, PER 1 MG
J1436 - INJECTION, ETIDRONATE DISODIUM, PER 300 MG
J1438 - INJECTION, ETANERCEPT, 25 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG
J1440 - INJECTION, FILGRASTIM (G-CSF), 300 MCG
J1441 - INJECTION, FILGRASTIM (G-CSF), 480 MCG
J1450 - INJECTION FLUCONAZOLE, 200 MG
J1451 - INJECTION, FOMEPIZOLE, 15 MG
J1452 - INJECTION, FOMIVIRSEN SODIUM, INTRAOCULAR, 1.65 MG
J1453 - INJECTION, FOSAPREPITANT, 1 MG
J1455 - INJECTION, FOSCARNET SODIUM, PER 1000 MG
J1457 - INJECTION, GALLIUM NITRATE, 1 MG
J1458 - INJECTION, GALSULFASE, 1 MG
J1459 - INJECTION, IMMUNE GLOBULIN (PRIVIGEN), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID
J1460 - INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 1 CC
J1470 - INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 2 CC
J1480 - INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 3 CC
J1490 - INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 4 CC
J1500 - INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 5 CC
J1510 - INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 6 CC
J1520 - INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 7 CC
J1530 - INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 8 CC
J1540 - INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 9 CC
J1550 - INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 10 CC
J1559 - INJECTION, IMMUNE GLOBULIN (HIZENTRA), 100 MG
J1560 - INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, OVER 10 CC
J1561 - INJECTION, IMMUNE GLOBULIN, (GAMUNEX), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID
J1562 - INJECTION, IMMUNE GLOBULIN (VIVAGLOBIN), 100 MG
J1566 - INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G. POWDER), NOT OTHERWIS



                                             Page 505
                                   All Other (no trigger bundling)


J1568 - INJECTION, IMMUNE GLOBULIN, (OCTAGAM), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID
J1569 - INJECTION, IMMUNE GLOBULIN, (GAMMAGARD LIQUID), INTRAVENOUS, NON-LYOPHILIZED, (E
J1570 - INJECTION, GANCICLOVIR SODIUM, 500 MG
J1571 - INJECTION, HEPATITIS B IMMUNE GLOBULIN (HEPAGAM B), INTRAMUSCULAR, 0.5 ML
J1572 - INJECTION, IMMUNE GLOBULIN, (FLEBOGAMMA/FLEBOGAMMA DIF), INTRAVENOUS, NON-LYOPHI
J1573 - INJECTION, HEPATITIS B IMMUNE GLOBULIN (HEPAGAM B), INTRAVENOUS, 0.5 ML
J1580 - INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG
J1590 - INJECTION, GATIFLOXACIN, 10MG
J1599 - INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), NOT OTHE
J1600 - INJECTION, GOLD SODIUM THIOMALATE, UP TO 50 MG
J1610 - INJECTION, GLUCAGON HYDROCHLORIDE, PER 1 MG
J1620 - INJECTION, GONADORELIN HYDROCHLORIDE, PER 100 MCG
J1626 - INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG
J1630 - INJECTION, HALOPERIDOL, UP TO 5 MG
J1631 - INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
J1640 - INJECTION, HEMIN, 1 MG
J1642 - INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH), PER 10 UNITS
J1644 - INJECTION, HEPARIN SODIUM, PER 1000 UNITS
J1645 - INJECTION, DALTEPARIN SODIUM, PER 2500 IU
J1650 - INJECTION, ENOXAPARIN SODIUM, 10 MG
J1652 - INJECTION, FONDAPARINUX SODIUM, 0.5 MG
J1655 - INJECTION, TINZAPARIN SODIUM, 1000 IU
J1670 - INJECTION, TETANUS IMMUNE GLOBULIN, HUMAN, UP TO 250 UNITS
J1675 - INJECTION, HISTRELIN ACETATE, 10 MICROGRAMS
J1680 - INJECTION, HUMAN FIBRINOGEN CONCENTRATE, 100 MG
J1700 - INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
J1710 - INJECTION, HYDROCORTISONE SODIUM PHOSPHATE, UP TO 50 MG
J1720 - INJECTION, HYDROCORTISONE SODIUM SUCCINATE, UP TO 100 MG
J1730 - INJECTION, DIAZOXIDE, UP TO 300 MG
J1740 - INJECTION, IBANDRONATE SODIUM, 1 MG
J1742 - INJECTION, IBUTILIDE FUMARATE, 1 MG
J1743 - INJECTION, IDURSULFASE, 1 MG
J1745 - INJECTION INFLIXIMAB, 10 MG
J1750 - INJECTION, IRON DEXTRAN, 50 MG
J1756 - INJECTION, IRON SUCROSE, 1 MG
J1785 - INJECTION, IMIGLUCERASE, PER UNIT
J1786 - INJECTION, IMIGLUCERASE, 10 UNITS
J1790 - INJECTION, DROPERIDOL, UP TO 5 MG
J1800 - INJECTION, PROPRANOLOL HCL, UP TO 1 MG
J1810 - INJECTION, DROPERIDOL AND FENTANYL CITRATE, UP TO 2 ML AMPULE
J1815 - INJECTION, INSULIN, PER 5 UNITS
J1817 - INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITS
J1825 - INJECTION, INTERFERON BETA-1A, 33 MCG
J1826 - INJECTION, INTERFERON BETA-1A, 30 MCG
J1830 - INJECTION INTERFERON BETA-1B, 0.25 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG
J1835 - INJECTION, ITRACONAZOLE, 50 MG
J1840 - INJECTION, KANAMYCIN SULFATE, UP TO 500 MG
J1850 - INJECTION, KANAMYCIN SULFATE, UP TO 75 MG
J1885 - INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG
J1890 - INJECTION, CEPHALOTHIN SODIUM, UP TO 1 GRAM
J1930 - INJECTION, LANREOTIDE, 1 MG
J1931 - INJECTION, LARONIDASE, 0.1 MG



                                             Page 506
                                    All Other (no trigger bundling)


J1940 - INJECTION, FUROSEMIDE, UP TO 20 MG
J1945 - INJECTION, LEPIRUDIN, 50 MG
J1950 - INJECTION, LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), PER 3.75 MG
J1953 - INJECTION, LEVETIRACETAM, 10 MG
J1955 - INJECTION, LEVOCARNITINE, PER 1 GM
J1956 - INJECTION, LEVOFLOXACIN, 250 MG
J1960 - INJECTION, LEVORPHANOL TARTRATE, UP TO 2 MG
J1980 - INJECTION, HYOSCYAMINE SULFATE, UP TO 0.25 MG
J1990 - INJECTION, CHLORDIAZEPOXIDE HCL, UP TO 100 MG
J2001 - INJECTION, LIDOCAINE HCL FOR INTRAVENOUS INFUSION, 10 MG
J2010 - INJECTION, LINCOMYCIN HCL, UP TO 300 MG
J2020 - INJECTION, LINEZOLID, 200MG
J2060 - INJECTION, LORAZEPAM, 2 MG
J2150 - INJECTION, MANNITOL, 25% IN 50 ML
J2170 - INJECTION, MECASERMIN, 1 MG
J2175 - INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
J2180 - INJECTION, MEPERIDINE AND PROMETHAZINE HCL, UP TO 50 MG
J2185 - INJECTION, MEROPENEM, 100 MG
J2210 - INJECTION, METHYLERGONOVINE MALEATE, UP TO 0.2 MG
J2248 - INJECTION, MICAFUNGIN SODIUM, 1 MG
J2250 - INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG
J2260 - INJECTION, MILRINONE LACTATE, 5 MG
J2270 - INJECTION, MORPHINE SULFATE, UP TO 10 MG
J2271 - INJECTION, MORPHINE SULFATE, 100MG
J2275 - INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE SOLUTION), PER 10 MG
J2278 - INJECTION, ZICONOTIDE, 1 MICROGRAM
J2280 - INJECTION, MOXIFLOXACIN, 100 MG
J2300 - INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
J2310 - INJECTION, NALOXONE HYDROCHLORIDE, PER 1 MG
J2315 - INJECTION, NALTREXONE, DEPOT FORM, 1 MG
J2320 - INJECTION, NANDROLONE DECANOATE, UP TO 50 MG
J2321 - INJECTION, NANDROLONE DECANOATE, UP TO 100 MG
J2322 - INJECTION, NANDROLONE DECANOATE, UP TO 200 MG
J2323 - INJECTION, NATALIZUMAB, 1 MG
J2325 - INJECTION, NESIRITIDE, 0.1 MG
J2353 - INJECTION, OCTREOTIDE, DEPOT FORM FOR INTRAMUSCULAR INJECTION, 1 MG
J2354 - INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR INTRAVENOUS
J2355 - INJECTION, OPRELVEKIN, 5 MG
J2357 - INJECTION, OMALIZUMAB, 5 MG
J2358 - INJECTION, OLANZAPINE, LONG-ACTING, 1 MG
J2360 - INJECTION, ORPHENADRINE CITRATE, UP TO 60 MG
J2370 - INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML
J2400 - INJECTION, CHLOROPROCAINE HYDROCHLORIDE, PER 30 ML
J2405 - INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
J2410 - INJECTION, OXYMORPHONE HCL, UP TO 1 MG
J2425 - INJECTION, PALIFERMIN, 50 MICROGRAMS
J2426 - INJECTION, PALIPERIDONE PALMITATE EXTENDED RELEASE, 1 MG
J2430 - INJECTION, PAMIDRONATE DISODIUM, PER 30 MG
J2440 - INJECTION, PAPAVERINE HCL, UP TO 60 MG
J2460 - INJECTION, OXYTETRACYCLINE HCL, UP TO 50 MG
J2469 - INJECTION, PALONOSETRON HCL, 25 MCG
J2501 - INJECTION, PARICALCITOL, 1 MCG



                                              Page 507
                                     All Other (no trigger bundling)


J2503   - INJECTION, PEGAPTANIB SODIUM, 0.3 MG
J2504   - INJECTION, PEGADEMASE BOVINE, 25 IU
J2505   - INJECTION, PEGFILGRASTIM, 6 MG
J2510   - INJECTION, PENICILLIN G PROCAINE, AQUEOUS, UP TO 600,000 UNITS
J2513   - INJECTION, PENTASTARCH, 10% SOLUTION, 100 ML
J2515   - INJECTION, PENTOBARBITAL SODIUM, PER 50 MG
J2540   - INJECTION, PENICILLIN G POTASSIUM, UP TO 600,000 UNITS
J2543   - INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.125 GRAMS (1.125
J2545   - PENTAMIDINE ISETHIONATE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-CO
J2550   - INJECTION, PROMETHAZINE HCL, UP TO 50 MG
J2560   - INJECTION, PHENOBARBITAL SODIUM, UP TO 120 MG
J2562   - INJECTION, PLERIXAFOR, 1 MG
J2590   - INJECTION, OXYTOCIN, UP TO 10 UNITS
J2597   - INJECTION, DESMOPRESSIN ACETATE, PER 1 MCG
J2650   - INJECTION, PREDNISOLONE ACETATE, UP TO 1 ML
J2670   - INJECTION, TOLAZOLINE HCL, UP TO 25 MG
J2675   - INJECTION, PROGESTERONE, PER 50 MG
J2680   - INJECTION, FLUPHENAZINE DECANOATE, UP TO 25 MG
J2690   - INJECTION, PROCAINAMIDE HCL, UP TO 1 GM
J2700   - INJECTION, OXACILLIN SODIUM, UP TO 250 MG
J2710   - INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG
J2720   - INJECTION, PROTAMINE SULFATE, PER 10 MG
J2724   - INJECTION, PROTEIN C CONCENTRATE, INTRAVENOUS, HUMAN, 10 IU
J2725   - INJECTION, PROTIRELIN, PER 250 MCG
J2730   - INJECTION, PRALIDOXIME CHLORIDE, UP TO 1 GM
J2760   - INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG
J2765   - INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
J2770   - INJECTION, QUINUPRISTIN/DALFOPRISTIN, 500 MG (150/350)
J2778   - INJECTION, RANIBIZUMAB, 0.1 MG
J2780   - INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
J2783   - INJECTION, RASBURICASE, 0.5 MG
J2785   - INJECTION, REGADENOSON, 0.1 MG
J2788   - INJECTION, RHO D IMMUNE GLOBULIN, HUMAN, MINIDOSE, 50 MICROGRAMS (250 I.U.)
J2790   - INJECTION, RHO D IMMUNE GLOBULIN, HUMAN, FULL DOSE, 300 MICROGRAMS (1500 I.U.)
J2791   - INJECTION, RHO(D) IMMUNE GLOBULIN (HUMAN), (RHOPHYLAC), INTRAMUSCULAR OR INTRAVE
J2792   - INJECTION, RHO D IMMUNE GLOBULIN, INTRAVENOUS, HUMAN, SOLVENT DETERGENT, 100 IU
J2793   - INJECTION, RILONACEPT, 1 MG
J2794   - INJECTION, RISPERIDONE, LONG ACTING, 0.5 MG
J2795   - INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG
J2796   - INJECTION, ROMIPLOSTIM, 10 MICROGRAMS
J2800   - INJECTION, METHOCARBAMOL, UP TO 10 ML
J2805   - INJECTION, SINCALIDE, 5 MICROGRAMS
J2810   - INJECTION, THEOPHYLLINE, PER 40 MG
J2820   - INJECTION, SARGRAMOSTIM (GM-CSF), 50 MCG
J2850   - INJECTION, SECRETIN, SYNTHETIC, HUMAN, 1 MICROGRAM
J2910   - INJECTION, AUROTHIOGLUCOSE, UP TO 50 MG
J2916   - INJECTION, SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE INJECTION, 12.5 MG
J2920   - INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 40 MG
J2930   - INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
J2940   - INJECTION,