OPFSrates Oct2012 by 76ppp7sb

VIEWS: 55 PAGES: 718

									                                                          Emergency (triggers bundling)



             Rates for Hospitals that do not qualify as trauma centers
                                                                                                                                University-
                                                            Critical Access                    Free-standing                      affiliated
                 Urban Peer     Large Rural     Small Rural        Hospital             Public    Children's Large Pediatric      Teaching
CPT                  Group      Peer Group      Peer Group      Peer Group         Peer Group    Peer Group Unit Hospital       Peer Group

Peer Group
                  1.00                 1.31             1.37             2.00             1.73          1.78            1.18           1.41
Multiplier
99281                $49.63          $65.02          $67.99            $99.26          $85.86         $88.34           $58.56        $69.98
99282                $85.41         $111.89         $117.01           $170.82         $147.76        $152.03          $100.78       $120.43
99283               $134.40         $176.06         $184.13           $268.80         $232.51        $239.23          $158.59       $189.50
99284               $216.15         $283.16         $296.13           $432.30         $373.94        $384.75          $255.06       $304.77
99285               $319.37         $418.37         $437.54           $638.74         $552.51        $568.48          $376.86       $450.31




             Rates for Hospitals that do qualify as trauma centers (additional 50% adjuster on 99283, 99284, 99285)
                                                                                                                                University-
                                                               Critical Access Public/Recentl Free-standing                       affiliated
                 Urban Peer     Large Rural     Small Rural           Hospital       y Public    Children's Large Pediatric       Teaching
CPT                  Group      Peer Group      Peer Group         Peer Group    Peer Group     Peer Group Unit Hospital        Peer Group
99281                $49.63          $65.02          $67.99              $99.26        $85.86        $88.34         $58.56           $69.98
99282                $85.41         $111.89        $117.01             $170.82        $147.76       $152.03        $100.78         $120.43
99283               $201.60         $243.26        $251.33             $336.00        $299.71       $306.43        $246.62         $256.70
99284               $324.23         $391.23        $404.20             $540.38        $482.01       $492.82        $396.64         $412.85
99285               $479.06         $578.06        $597.22             $798.43        $712.20       $728.16        $586.04         $610.00




                                                                   Page 1 of 718
             Emergency (triggers bundling)




Eff Date




10/01/2012
10/01/2012
10/01/2012
10/01/2012
10/01/2012




 Eff Date
10/01/2012
10/01/2012
10/01/2012
10/01/2012
10/01/2012




                    Page 2 of 718
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77620
77750
77761
77762
77763
77776
77777
77785
77786
77787
77789
77799
78000
78001
78003
78006
78007
78010
78011
78015
78016
78018
78070
78075
78099
78102
78103
78104
78110
78111
78120
78121
78122
78130
78135
78140
78185
78190
78191
78195
78199
78201
78202
78205
78206
78215
78216
78226
78227
78230
78231
78232
78258
78261
78262
78264
78270
78271
78272
78278
78282
78290
78291
78299
78300
78305
78306
78315
78320
78399
78414
78428
78445
78451
78452
78453
78454
78456
78457
78458
78459
78466
78468
78469
78472
78473
78481
78483
78491
78492
78494
78499
78579
78580
78582
78597
78598
78599
78600
78601
78605
78606
78607
78608
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
78806
78807
78811
78812
78813
78814
78815
78816
78999
79005
79101
79200
79300
79403
79440
79445
79999
90471
90472
90473
90474
90870
90911
90935
91110
91117
91120
91122
92018
92019
92020
92025
92060
92065
92081
92082
92083
92132
92133
92134
92136
92140
92225
92226
92230
92235
92240
92250
92260
92265
92270
92275
92283
92284
92285
92286
92287
92311
92312
92313
92315
92316
92317
92325
92326
92352
92353
92354
92355
92358
92371
92499
92502
92511
92584
92585
92586
92950
92960
92961
92973
92974
92977
92980
92981
92982
92984
92986
92987
92990
92995
92996
92997
92998
93005
93225
93226
93229
93270
93271
93279
93280
93281
93282
93283
93284
93285
93288
93289
93291
93292
93293
93296
93299
93303
93304
93306
93307
93308
93312
93313
93315
93316
93318
93350
93351
93451
93452
93453
93454
93455
93456
93457
93458
93459
93460
93461
93462
93503
93505
93530
93531
93532
93533
93580
93581
93600
93602
93603
93610
93612
93615
93616
93618
93624
93642
93660
93701
93724
93745
93750
93797
93798
93799
93880
93882
93886
93888
93890
93892
93893
93922
93923
93924
93925
93926
93930
93931
93965
93970
93971
93975
93976
93978
93979
93980
93981
93990
94060
94610
94640
94642
94664
94667
94668
94775
94776
95115
95117
95144
95145
95146
95147
95148
95149
95165
95170
95803
95805
95806
95807
95808
95810
95811
95812
95813
95816
95819
95822
95824
95827
95857
95860
95861
95863
95864
95865
95866
95867
95868
95869
95870
95872
95875
95885
95886
95887
95900
95903
95904
95905
95921
95922
95923
95925
95926
95927
95928
95929
95930
95933
95934
95936
95937
95938
95939
95950
95951
95953
95954
95956
95958
95961
95962
95965
95966
95967
95970
95971
95972
95973
95974
95975
95978
95979
95990
95991
95999
96000
96001
96002
96003
96360
96361
96365
96366
96367
96369
96370
96371
96372
96373
96374
96375
96379
96401
96402
96405
96406
96409
96411
96413
96415
96416
96417
96420
96422
96423
96425
96440
96446
96450
96521
96522
96542
96549
96567
96570
96571
96900
96910
96912
96913
96920
96921
96922
96999
97597
97598
97602
97605
97606
98925
98926
98927
98928
98929
98940
98941
98942
99170
99281
99282
99283
99284
99285
99465
C1300
C8921
C8922
C8923
C8924
C8925
C8926
C8927
C8928
C8929
C8930
C8957
C9724
C9725
C9726
G0008
G0009
G0010
G0104
G0105
G0106
G0117
G0118
G0120
G0121
G0127
G0166
G0173
G0186
G0247
G0251
G0257
G0260
G0290
G0291
G0302
G0303
G0304
G0305
G0339
G0340
G0365
G3001
Q0091
DESCRIPTION
COMPENSATOR-BASED BEAM MODULATION TREATMENT DELIVERY OF INVERSE PLANNED
SUPRACHOROIDAL DELIVERY OF PHARMACOLOGIC AGENT (DOES NOT INCLUDE SUPPLY OF MEDIC
PLACEMENT OF INTRAOCULAR RADIATION SRC APPLICATOR (LIST SEP IN ADD TO PRIM PROC)
INSERTION OF ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE, WITHOUT EXTRAOCULAR RESER
INSERTION OF ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE, WITHOUT EXTRAOCULAR RESER
INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEA
INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEA
INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEA
TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN OR PERCUTANEOUS, INCLUDING RADIOLOGICA
TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN OR PERCUTANEOUS, INCLUDING RADIOLOGICA
TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN OR PERCUTANEOUS, INCLUDING RADIOLOGICA
TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN OR PERCUTANEOUS, INCLUDING RADIOLOGICA
OPEN TREATMENT OF RIB FRACTURE REQUIRING INTERNAL FIXATION, UNILATERAL; 1-2 RIBS
OPEN TREATMENT OF RIB FRACTURE REQUIRING INTERNAL FIXATION, UNILATERAL; 3-4 RIBS
OPEN TREATMENT OF RIB FRACTURE REQUIRING INTERNAL FIXATION, UNILATERAL; 5-6 RIBS
OPEN TREATMENT OF RIB FRACTURE REQUIRING INTERNAL FIXATION, UNILATERAL; 7 OR MOR
LIGATION, HEMORRHOIDAL VASCULAR BUNDLE(S), INCLUDING ULTRASOUND GUIDANCE
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED
INSERTION OF ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE, WITHOUT EXTRAOCULAR RESER
FINE NEEDLE ASPIRATION; WITHOUT IMAGING GUIDANCE
FINE NEEDLE ASPIRATION; WITH IMAGING GUIDANCE
INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS,
INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS,
INCISION AND DRAINAGE OF PILONIDAL CYST; SIMPLE
INCISION AND DRAINAGE OF PILONIDAL CYST; COMPLICATED
INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES; SIMPLE
INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES; COMPLICATED
INCISION AND DRAINAGE OF HEMATOMA, SEROMA OR FLUID COLLECTION
PUNCTURE ASPIRATION OF ABSCESS, HEMATOMA, BULLA, OR CYST
INCISION AND DRAINAGE, COMPLEX, POSTOPERATIVE WOUND INFECTION
DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; UP TO 10% OF BODY SURFACE
DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; EACH ADDITIONAL 10% OF THE
DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTUR
DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTUR
DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTUR
DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED);
DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, DERMIS, AND SUBCUTANEOUS
DEBRIDEMENT, BONE (INCLUDES EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLE AND/O
DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED);
DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, DERMIS, AND SUBCUTANEOUS
DEBRIDEMENT, BONE (INCLUDES EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLE AND/O
PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); SINGLE L
PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); TWO TO
PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); MORE
BIOPSY OF SKIN, SUBCUTANEOUS TISSUE AND/OR MUCOUS MEMBRANE (INCLUDING SIMPLE CLO
BIOPSY OF SKIN, SUBCUTANEOUS TISSUE AND/OR MUCOUS MEMBRANE (INCLUDING SIMPLE
REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; UP TO AND INCLUDIN
REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; EACH ADDITIONAL 10
SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; LESIO
SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS;
SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS;
SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS;
SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, NECK, HANDS, FEET,
SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, NECK, HANDS, FEET,
SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, NECK, HANDS, FEET,
SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, NECK, HANDS, FEET,
SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS,
SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS,
SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS,
SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS,
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWH
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED
EXCISION, OTHER BENIGN LESION INCLUDING MARGINS (UNLESS LISTED ELSEWHERE),
EXCISION, OTHER BENIGN LESION INCLUDING MARGINS (UNLESS LISTED ELSEWHERE),
EXCISION, OTHER BENIGN LESION INCLUDING MARGINS (UNLESS LISTED ELSEWHERE),
EXCISION, OTHER BENIGN LESION INCLUDING MARGINS (UNLESS LISTED ELSEWHERE),
EXCISION, OTHER BENIGN LESION INCLUDING MARGINS (UNLESS LISTED ELSEWHERE),
EXCISION, OTHER BENIGN LESION INCLUDING MARGINS (UNLESS LISTED ELSEWHERE),
EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, AXILLARY; WITH
EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, AXILLARY; WITH
EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, INGUINAL; WITH
EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, INGUINAL; WITH
EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, PERIANAL, PERINEAL,
EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, PERIANAL, PERINEAL,
EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAM
EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED
EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED
EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED
EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED
EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED
EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET,
EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET,
EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET,
EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET,
EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET,
EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET,
EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS;
EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS;
EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS;
EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS;
EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS;
EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS;
TRIMMING OF NONDYSTROPHIC NAILS, ANY NUMBER
DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); ONE TO FIVE
DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); SIX OR MORE
AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE
AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; EACH ADDITIONAL NAIL PLATE
EVACUATION OF SUBUNGUAL HEMATOMA
EXCISION OF NAIL AND NAIL MATRIX, PARTIAL OR COMPLETE, (EG, INGROWN OR DEFORMED
EXCISION OF NAIL AND NAIL MATRIX, PARTIAL OR COMPLETE, (EG, INGROWN OR DEFORMED
BIOPSY OF NAIL UNIT (EG, PLATE, BED, MATRIX, HYPONYCHIUM, PROXIMAL AND LATERAL
REPAIR OF NAIL BED
RECONSTRUCTION OF NAIL BED WITH GRAFT
WEDGE EXCISION OF SKIN OF NAIL FOLD (EG, FOR INGROWN TOENAIL)
EXCISION OF PILONIDAL CYST OR SINUS; SIMPLE
EXCISION OF PILONIDAL CYST OR SINUS; EXTENSIVE
EXCISION OF PILONIDAL CYST OR SINUS; COMPLICATED
INJECTION, INTRALESIONAL; UP TO AND INCLUDING SEVEN LESIONS
INJECTION, INTRALESIONAL; MORE THAN SEVEN LESIONS
TATTOOING, INTRADERMAL INTRODUCTION OF INSOLUBLE OPAQUE PIGMENTS TO CORRECT
TATTOOING, INTRADERMAL INTRODUCTION OF INSOLUBLE OPAQUE PIGMENTS TO CORRECT
INSERTION OF TISSUE EXPANDER(S) FOR OTHER THAN BREAST, INCLUDING SUBSEQUENT
REMOVAL OF TISSUE EXPANDER(S) WITHOUT INSERTION OF PROSTHESIS
REMOVAL, IMPLANTABLE CONTRACEPTIVE CAPSULES
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA,
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR
TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; SIMPLE CLOSURE
TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; WITH PACKING
REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/ OR EXTREMITIES (EXCLU
REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/ OR EXTREMITIES (EXCLU
REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/ OR EXTREMITIES (EXCLU
REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/ OR EXTREMITIES (EXCLU
REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/ OR EXTREMITIES (EXCLU
REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/ OR EXTREMITIES (EXCLU
REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 2.5
REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 2.6
REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 7.6
REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 12.
REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 20.
REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; OVE
REPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS ME
REPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS ME
REPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS ME
REPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS ME
REPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS ME
REPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS ME
REPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS ME
REPAIR, COMPLEX, TRUNK; 1.1 CM TO 2.5 CM
REPAIR, COMPLEX, TRUNK; 2.6 CM TO 7.5 CM
REPAIR, COMPLEX, TRUNK; EACH ADDITIONAL 5 CM OR LESS (LIST SEPARATELY IN
REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 1.1 CM TO 2.5 CM
REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 2.6 CM TO 7.5 CM
REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; EACH ADDITIONAL 5 CM OR LESS (LIST
REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS
REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS
REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS
REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 1.0 CM OR LESS
REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 1.1 CM TO 2.5 CM
REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 2.6 CM TO 7.5 CM
REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; EACH ADDITIONAL 5 CM OR LESS
SECONDARY CLOSURE OF SURGICAL WOUND OR DEHISCENCE, EXTENSIVE OR COMPLICATED
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10 SQ CM OR LESS
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10.1 SQ CM TO 30.0 SQ
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS AND/OR LEGS; DEFECT 10
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS AND/OR LEGS; DEFECT 10.1
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK,
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK,
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS AND/OR LIPS;
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS AND/OR LIPS;
Adjacent tissue transfer or rearrangement, any area: defect 30.1 sq cm to 60.0 s
Adjacent tissue transfer or rearrangement, any area; each additional 30.0 sq cm
FILLETED FINGER OR TOE FLAP, INCLUDING PREPARATION OF RECIPIENT SITE
SURGICAL PREPARATION OR CREATION OF RECIPIENT SITE BY EXCISION OF OPEN WOUNDS, B
SURGICAL PREPARATION OR CREATION OF RECIPIENT SITE BY EXCISION OF OPEN WOUNDS, B
SURGICAL PREPARATION OR CREATION OF RECIPIENT SITE BY EXCISION OF OPEN WOUNDS, B
SURGICAL PREPARATION OR CREATION OF RECIPIENT SITE BY EXCISION OF OPEN WOUNDS, B
HARVEST OF SKIN FOR TISSUE CULTURED SKIN AUTOGRAFT, 100 SQ CM OR LESS
PINCH GRAFT, SINGLE OR MULTIPLE, TO COVER SMALL ULCER, TIP OF DIGIT, OR OTHER
SPLIT-THICKNESS AUTOGRAFT, TRUNK, ARMS, LEGS; FIRST 100 SQ CM OR LESS, OR ONE PE
SPLIT GRAFT, TRUNK, ARMS, LEGS; EACH ADDITIONAL 100 SQ CM, OR EACH ADDITIONAL
EPIDERMAL AUTOGRAFT, TRUNK, ARMS, LEGS; FIRST 100 SQ CM OR LESS, OR ONE PERCENT
EPIDERMAL AUTOGRAFT, TRUNK, ARMS, LEGS; EACH ADDITIONAL 100 SQ CM, OR EACH ADDIT
EPIDERMAL AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA,
EPIDERMAL AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA,
SPLIT-THICKNESS AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENI
SPLIT GRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS,
DERMAL AUTOGRAFT, TRUNK, ARMS, LEGS; FIRST 100 SQ CM OR LESS, OR ONE PERCENT OF
DERMAL AUTOGRAFT, TRUNK, ARMS, LEGS; EACH ADDITIONAL 100 SQ CM, OR EACH ADDITION
DERMAL AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HA
DERMAL AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HA
TISSUE CULTURED EPIDERMAL AUTOGRAFT, TRUNK, ARMS, LEGS; FIRST 25 SQ CM OR LESS
TISSUE CULTURED EPIDERMAL AUTOGRAFT, TRUNK, ARMS, LEGS; ADDITIONAL 1 SQ CM TO 75
TISSUE CULTURED EPIDERMAL AUTOGRAFT, TRUNK, ARMS, LEGS; EACH ADDITIONAL 100 SQ C
TISSUE CULTURED EPIDERMAL AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, OR
TISSUE CULTURED EPIDERMAL AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, OR
TISSUE CULTURED EPIDERMAL AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, OR
FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, TRUNK; 20
FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, TRUNK; EACH
FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, SCALP,
FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, SCALP, ARMS,
FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, FOREHEAD,
FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, FOREHEAD, CH
FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, NOSE, EARS,
FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, NOSE, EARS,
Application of skin substitute graft to trunk, arms, legs, total wound surface a
Application of skin substitute graft to trunk, arms, legs, total wound surface a
Application of skin substitute graft to trunk, arms, legs, total wound surface a
Application of skin substitute graft to trunk, arms, legs, total wound surface a
Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears,
Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears,
Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears,
Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears,
FORMATION OF DIRECT OR TUBED PEDICLE, WITH OR WITHOUT TRANSFER; TRUNK
FORMATION OF DIRECT OR TUBED PEDICLE, WITH OR WITHOUT TRANSFER; SCALP, ARMS, OR
FORMATION OF DIRECT OR TUBED PEDICLE, WITH OR WITHOUT TRANSFER; FOREHEAD,
FORMATION OF DIRECT OR TUBED PEDICLE, WITH OR WITHOUT TRANSFER; EYELIDS, NOSE,
DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT TRUNK
DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT SCALP, ARMS, OR
DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT FOREHEAD, CHEEKS,
DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT EYELIDS, NOSE,
TRANSFER, INTERMEDIATE, OF ANY PEDICLE FLAP (EG, ABDOMEN TO WRIST, WALKING
FOREHEAD FLAP WITH PRESERVATION OF VASCULAR PEDICLE (EG, AXIAL PATTERN FLAP, PAR
MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; HEAD AND NECK (EG, TEMPORALIS,
MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; TRUNK
MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; UPPER EXTREMITY
MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; LOWER EXTREMITY
FLAP; ISLAND PEDICLE
FLAP; NEUROVASCULAR PEDICLE
GRAFT; COMPOSITE (EG, FULL THICKNESS OF EXTERNAL EAR OR NASAL ALA), INCLUDING
GRAFT; DERMA-FAT-FASCIA
Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue r
CHEMICAL PEEL, FACIAL; EPIDERMAL
CHEMICAL PEEL, FACIAL; DERMAL
CHEMICAL PEEL, NONFACIAL; EPIDERMAL
CHEMICAL PEEL, NONFACIAL; DERMAL
BLEPHAROPLASTY, UPPER EYELID; WITH EXCESSIVE SKIN WEIGHTING DOWN LID
EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); ABDOMEN,
GRAFT FOR FACIAL NERVE PARALYSIS; FREE FASCIA GRAFT (INCLUDING OBTAINING FASCIA)
GRAFT FOR FACIAL NERVE PARALYSIS; FREE MUSCLE GRAFT (INCLUDING OBTAINING GRAFT)
GRAFT FOR FACIAL NERVE PARALYSIS; FREE MUSCLE FLAP BY MICROSURGICAL TECHNIQUE
GRAFT FOR FACIAL NERVE PARALYSIS; REGIONAL MUSCLE TRANSFER
EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY), ABDOMEN (
REMOVAL OF SUTURES UNDER ANESTHESIA (OTHER THAN LOCAL), SAME SURGEON
REMOVAL OF SUTURES UNDER ANESTHESIA (OTHER THAN LOCAL), OTHER SURGEON
EXCISION, COCCYGEAL PRESSURE ULCER, WITH COCCYGECTOMY; WITH PRIMARY SUTURE
EXCISION, COCCYGEAL PRESSURE ULCER, WITH COCCYGECTOMY; WITH FLAP CLOSURE
EXCISION, SACRAL PRESSURE ULCER, WITH PRIMARY SUTURE;
EXCISION, SACRAL PRESSURE ULCER, WITH PRIMARY SUTURE; WITH OSTECTOMY
EXCISION, SACRAL PRESSURE ULCER, WITH SKIN FLAP CLOSURE;
EXCISION, SACRAL PRESSURE ULCER, WITH SKIN FLAP CLOSURE; WITH OSTECTOMY
EXCISION, SACRAL PRESSURE ULCER, IN PREPARATION FOR MUSCLE OR MYOCUTANEOUS FLAP
EXCISION, SACRAL PRESSURE ULCER, IN PREPARATION FOR MUSCLE OR MYOCUTANEOUS FLAP
EXCISION, ISCHIAL PRESSURE ULCER, WITH PRIMARY SUTURE;
EXCISION, ISCHIAL PRESSURE ULCER, WITH PRIMARY SUTURE; WITH OSTECTOMY
EXCISION, ISCHIAL PRESSURE ULCER, WITH SKIN FLAP CLOSURE;
EXCISION, ISCHIAL PRESSURE ULCER, WITH SKIN FLAP CLOSURE; WITH OSTECTOMY
EXCISION, ISCHIAL PRESSURE ULCER, WITH OSTECTOMY, IN PREPARATION FOR MUSCLE OR
EXCISION, TROCHANTERIC PRESSURE ULCER, WITH PRIMARY SUTURE;
EXCISION, TROCHANTERIC PRESSURE ULCER, WITH PRIMARY SUTURE; WITH OSTECTOMY
EXCISION, TROCHANTERIC PRESSURE ULCER, WITH SKIN FLAP CLOSURE;
EXCISION, TROCHANTERIC PRESSURE ULCER, WITH SKIN FLAP CLOSURE; WITH OSTECTOMY
EXCISION, TROCHANTERIC PRESSURE ULCER, IN PREPARATION FOR MUSCLE OR
EXCISION, TROCHANTERIC PRESSURE ULCER, IN PREPARATION FOR MUSCLE OR
UNLISTED PROCEDURE, EXCISION PRESSURE ULCER
INITIAL TREATMENT, FIRST DEGREE BURN, WHEN NO MORE THAN LOCAL TREATMENT IS REQUI
DRESSINGS AND/OR DEBRIDEMENT OF PARTIAL-THICKNESS BURNS, INITIAL OR SUBSEQUENT;
DRESSINGS AND/OR DEBRIDEMENT OF PARTIAL-THICKNESS BURNS, INITIAL OR SUBSEQUENT;
DRESSINGS AND/OR DEBRIDEMENT OF PARTIAL-THICKNESS BURNS, INITIAL OR SUBSEQUENT;
ESCHAROTOMY; INITIAL INCISION
DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGI
DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY,
DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGI
DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, LASER TECHNIQUE);
DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, LASER TECHNIQUE);
DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, LASER TECHNIQUE);
DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGI
DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY,
CHEMICAL CAUTERIZATION OF GRANULATION TISSUE (PROUD FLESH, SINUS OR FISTULA)
DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, C
DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCI
MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCI
MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCI
MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCI
MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCI
CRYOTHERAPY (CO2 SLUSH, LIQUID N2) FOR ACNE
UNLISTED PROCEDURE, SKIN, MUCOUS MEMBRANE AND SUBCUTANEOUS TISSUE
PUNCTURE ASPIRATION OF CYST OF BREAST;
PUNCTURE ASPIRATION OF CYST OF BREAST; EACH ADDITIONAL CYST (LIST SEPARATELY IN
MASTOTOMY WITH EXPLORATION OR DRAINAGE OF ABSCESS, DEEP
BIOPSY OF BREAST; PERCUTANEOUS, NEEDLE CORE, NOT USING IMAGING GUIDANCE (SEPARAT
BIOPSY OF BREAST; OPEN, INCISIONAL
BIOPSY OF BREAST; PERCUTANEOUS, NEEDLE CORE, USING IMAGING GUIDANCE
BIOPSY OF BREAST; PERCUTANEOUS, AUTOMATED VACUUM ASSISTED OR ROTATING BIOPSY
ABLATION, CRYOSURGICAL, OF FIBROADENOMA, INCLUDING ULTRASOUND GUIDANCE, EACH FIB
NIPPLE EXPLORATION, WITH OR WITHOUT EXCISION OF A SOLITARY LACTIFEROUS DUCT OR
EXCISION OF LACTIFEROUS DUCT FISTULA
EXCISION OF CYST, FIBROADENOMA, OR OTHER BENIGN OR MALIGNANT TUMOR, ABERRANT BRE
EXCISION OF BREAST LESION IDENTIFIED BY PREOPERATIVE PLACEMENT OF RADIOLOGICAL
EXCISION OF BREAST LESION IDENTIFIED BY PREOPERATIVE PLACEMENT OF RADIOLOGICAL
EXCISION OF CHEST WALL TUMOR INCLUDING RIBS
PLACEMENT OF RADIOTHERAPY AFTERLOADING EXPANDABLE CATHETER (SINGLE OR MULTICHANN
PLACEMENT OF RADIOTHERAPY AFTERLOADING EXPANDABLE CATHETER (SINGLE OR MULTICHANN
PLACEMENT OF RADIOTHERAPY AFTERLOADING BRACHYTHERAPY CATHETERS (MULTIPLE TUBE
MASTECTOMY FOR GYNECOMASTIA
MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY);
MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY);
MASTECTOMY, SIMPLE, COMPLETE
MASTECTOMY, SUBCUTANEOUS
MASTECTOMY, MODIFIED RADICAL, INCLUDING AXILLARY LYMPH NODES, WITH OR WITHOUT PE
MASTOPEXY
REDUCTION MAMMAPLASTY
MAMMAPLASTY, AUGMENTATION; WITH PROSTHETIC IMPLANT
REMOVAL OF INTACT MAMMARY IMPLANT
REMOVAL OF MAMMARY IMPLANT MATERIAL
IMMEDIATE INSERTION OF BREAST PROSTHESIS FOLLOWING MASTOPEXY, MASTECTOMY OR IN
DELAYED INSERTION OF BREAST PROSTHESIS FOLLOWING MASTOPEXY, MASTECTOMY OR IN
NIPPLE/AREOLA RECONSTRUCTION
CORRECTION OF INVERTED NIPPLES
BREAST RECONSTRUCTION, IMMEDIATE OR DELAYED, WITH TISSUE EXPANDER, INCLUDING
BREAST RECONSTRUCTION WITH OTHER TECHNIQUE
OPEN PERIPROSTHETIC CAPSULOTOMY, BREAST
PERIPROSTHETIC CAPSULECTOMY, BREAST
REVISION OF RECONSTRUCTED BREAST
PREPARATION OF MOULAGE FOR CUSTOM BREAST IMPLANT
UNLISTED PROCEDURE, BREAST
INCISION AND DRAINAGE OF SOFT TISSUE ABSCESS, SUBFASCIAL (IE, INVOLVES THE SOFT
EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); NECK
EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); CHEST
EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); ABDOMEN/FLANK/BACK
EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); EXTREMITY
EXCISION OF EPIPHYSEAL BAR WITH/WITHOUT AUTOGENOUS SOFT TISSUE GRAFT OBTAINED TH
BIOPSY, MUSCLE; SUPERFICIAL
BIOPSY, MUSCLE; DEEP
BIOPSY, MUSCLE, PERCUTANEOUS NEEDLE
BIOPSY, BONE, TROCAR, OR NEEDLE; SUPERFICIAL (EG, ILIUM, STERNUM, SPINOUS
BIOPSY, BONE, TROCAR, OR NEEDLE; DEEP (EG, VERTEBRAL BODY, FEMUR)
BIOPSY, BONE, OPEN; SUPERFICIAL (EG, ILIUM, STERNUM, SPINOUS PROCESS, RIBS,
BIOPSY, BONE, OPEN; DEEP (EG, HUMERUS, ISCHIUM, FEMUR)
BIOPSY, VERTEBRAL BODY, OPEN; THORACIC
BIOPSY, VERTEBRAL BODY, OPEN; LUMBAR OR CERVICAL
INJECTION OF SINUS TRACT; THERAPEUTIC (SEPARATE PROCEDURE)
REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; SIMPLE
REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; DEEP OR COMPLICATED
INJECTION, THERAPEUTIC (EG, LOCAL ANESTHETIC, CORTICOSTEROID), CARPAL TUNNEL
Injection, enzyme (eg, collagenase), palmar fascial cord (ie, Dupuytren's contra
INJECTION(S); SINGLE TENDON SHEATH, OR LIGAMENT, APONEUROSIS (EG, PLANTAR
INJECTION(S); SINGLE TENDON ORIGIN/INSERTION
INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), ONE OR TWO MUSCLE(S)
INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), THREE OR MORE MUSCLE(S)
PLACEMENT OF NEEDLES OR CATHETERS INTO MUSCLE AND/OR SOFT TISSUE FOR SUBSEQUENT
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION; SMALL JOINT OR BURSA (EG, FINGERS,
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION; INTERMEDIATE JOINT OR BURSA (EG,
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION; MAJOR JOINT OR BURSA (EG,
ASPIRATION AND/OR INJECTION OF GANGLION CYST(S) ANY LOCATION
ASPIRATION AND INJECTION FOR TREATMENT OF BONE CYST
INSERTION OF WIRE OR PIN WITH APPLICATION OF SKELETAL TRACTION, INCLUDING
APPLICATION OF CRANIAL TONGS, CALIPER, OR STEREOTACTIC FRAME, INCLUDING REMOVAL
APPLICATION OF HALO, INCLUDING REMOVAL; PELVIC
APPLICATION OF HALO, INCLUDING REMOVAL; FEMORAL
REMOVAL OF IMPLANT; SUPERFICIAL, (EG, BURIED WIRE, PIN OR ROD) (SEPARATE
REMOVAL OF IMPLANT; DEEP (EG, BURIED WIRE, PIN, SCREW, METAL BAND, NAIL, ROD OR
APPLICATION OF A UNIPLANE (PINS OR WIRES IN ONE PLANE), UNILATERAL, EXTERNAL FIX
APPLICATION OF A MULTIPLANE (PINS OR WIRES IN MORE THAN ONE PLANE), UNILATERAL,
ADJUSTMENT OR REVISION OF EXTERNAL FIXATION SYSTEM REQUIRING ANESTHESIA (EG,
REMOVAL, UNDER ANESTHESIA, OF EXTERNAL FIXATION SYSTEM
Application of multiplane (pins or wires in more than one plane), unilateral, ex
Application of multiplane (pins or wires in more than one plane), unilateral, ex
REPLANTATION, DIGIT, EXCLUDING THUMB (INCLUDES DISTAL TIP TO SUBLIMIS TENDON
BONE GRAFT, ANY DONOR AREA; MINOR OR SMALL (EG, DOWEL OR BUTTON)
BONE GRAFT, ANY DONOR AREA; MAJOR OR LARGE
CARTILAGE GRAFT; COSTOCHONDRAL
CARTILAGE GRAFT; NASAL SEPTUM
FASCIA LATA GRAFT; BY STRIPPER
FASCIA LATA GRAFT; BY INCISION AND AREA EXPOSURE, COMPLEX OR SHEET
TENDON GRAFT, FROM A DISTANCE (EG, PALMARIS, TOE EXTENSOR, PLANTARIS)
TISSUE GRAFTS, OTHER (EG, PARATENON, FAT, DERMIS)
MONITORING OF INTERSTITIAL FLUID PRESSURE (INCLUDES INSERTION OF DEVICE, EG, WIC
FREE OSTEOCUTANEOUS FLAP WITH MICROVASCULAR ANASTOMOSIS; METATARSAL
FREE OSTEOCUTANEOUS FLAP WITH MICROVASCULAR ANASTOMOSIS; GREAT TOE WITH WEB
ABLATION, BONE TUMOR(S) (EG, OSTEOID OSTEOMA, METASTASIS) RADIOFREQUENCY,
UNLISTED PROCEDURE, MUSCULOSKELETAL SYSTEM, GENERAL
ARTHROTOMY, TEMPOROMANDIBULAR JOINT
Excision, tumor, soft tissue of face or scalp, subcutaneous; less than 2 cm
Excision, tumor, soft tissue of face or scalp, subcutaneous; 2 cm or greater
Excision, tumor, soft tissue of face and scalp, subfascial (eg, subgaleal, intra
Excision, tumor, soft tissue of face and scalp, subfascial (eg,subgaleal, intram
RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF FACE OR SCAL
Radical resection of tumor (eg, malignant neoplasm), soft tissue of face or scal
EXCISION OF BONE (EG, FOR OSTEOMYELITIS OR BONE ABSCESS); MANDIBLE
EXCISION OF BONE (EG, FOR OSTEOMYELITIS OR BONE ABSCESS); FACIAL BONE(S)
REMOVAL BY CONTOURING OF BENIGN TUMOR OF FACIAL BONE (EG, FIBROUS DYSPLASIA)
EXCISION OF BENIGN TUMOR OR CYST OF MAXILLA OR ZYGOMA BY ENUCLEATION AND
EXCISION OF TORUS MANDIBULARIS
EXCISION OF MAXILLARY TORUS PALATINUS
EXCISION OF MALIGNANT TUMOR OF MAXILLA OR ZYGOMA
EXCISION OF BENIGN TUMOR OR CYST OF MANDIBLE, BY ENUCLEATION AND/OR CURETTAGE
EXCISION OF MALIGNANT TUMOR OF MANDIBLE;
EXCISION OF BENIGN TUMOR OR CYST OF MANDIBLE; REQUIRING INTRA-ORAL OSTEOTOMY
EXCISION OF BENIGN TUMOR OR CYST OF MANDIBLE; REQUIRING EXTRA-ORAL OSTEOTOMY
EXCISION OF BENIGN TUMOR OR CYST OF MAXILLA; REQUIRING INTRA-ORAL OSTEOTOMY
EXCISION OF BENIGN TUMOR OR CYST OF MAXILLA; REQUIRING EXTRA-ORAL OSTEOTOMY AND
CONDYLECTOMY, TEMPOROMANDIBULAR JOINT (SEPARATE PROCEDURE)
MENISCECTOMY, PARTIAL OR COMPLETE, TEMPOROMANDIBULAR JOINT (SEPARATE PROCEDURE)
CORONOIDECTOMY (SEPARATE PROCEDURE)
MANIPULATION OF TEMPOROMANDIBULAR JOINT(S) (TMJ), THERAPEUTIC, REQUIRING AN ANES
IMPRESSION AND CUSTOM PREPARATION; SURGICAL OBTURATOR PROSTHESIS
IMPRESSION AND CUSTOM PREPARATION; ORBITAL PROSTHESIS
IMPRESSION AND CUSTOM PREPARATION; INTERIM OBTURATOR PROSTHESIS
IMPRESSION AND CUSTOM PREPARATION; DEFINITIVE OBTURATOR PROSTHESIS
IMPRESSION AND CUSTOM PREPARATION; MANDIBULAR RESECTION PROSTHESIS
IMPRESSION AND CUSTOM PREPARATION; PALATAL AUGMENTATION PROSTHESIS
IMPRESSION AND CUSTOM PREPARATION; PALATAL LIFT PROSTHESIS
IMPRESSION AND CUSTOM PREPARATION; SPEECH AID PROSTHESIS
IMPRESSION AND CUSTOM PREPARATION; ORAL SURGICAL SPLINT
IMPRESSION AND CUSTOM PREPARATION; AURICULAR PROSTHESIS
IMPRESSION AND CUSTOM PREPARATION; NASAL PROSTHESIS
IMPRESSION AND CUSTOM PREPARATION; FACIAL PROSTHESIS
UNLISTED MAXILLOFACIAL PROSTHETIC PROCEDURE
APPLICATION OF HALO TYPE APPLIANCE FOR MAXILLOFACIAL FIXATION, INCLUDES REMOVAL
APPLICATION OF INTERDENTAL FIXATION DEVICE FOR CONDITIONS OTHER THAN FRACTURE
GENIOPLASTY; AUGMENTATION (AUTOGRAFT, ALLOGRAFT, PROSTHETIC MATERIAL)
GENIOPLASTY; SLIDING OSTEOTOMY, SINGLE PIECE
GENIOPLASTY; SLIDING OSTEOTOMIES, TWO OR MORE OSTEOTOMIES (EG, WEDGE EXCISION
GENIOPLASTY; SLIDING, AUGMENTATION WITH INTERPOSITIONAL BONE GRAFTS (INCLUDES
AUGMENTATION, MANDIBULAR BODY OR ANGLE; PROSTHETIC MATERIAL
AUGMENTATION, MANDIBULAR BODY OR ANGLE; WITH BONE GRAFT, ONLAY OR
REDUCTION FOREHEAD; CONTOURING ONLY
REDUCTION FOREHEAD; CONTOURING AND APPLICATION OF PROSTHETIC MATERIAL OR BONE
REDUCTION FOREHEAD; CONTOURING AND SETBACK OF ANTERIOR FRONTAL SINUS WALL
RECONSTRUCTION MIDFACE, LEFORT II; ANTERIOR INTRUSION (EG, TREACHER-COLLINS
RECONSTRUCTION SUPERIOR-LATERAL ORBITAL RIM AND LOWER FOREHEAD, ADVANCEMENT OR
RECONSTRUCTION, BIFRONTAL, SUPERIOR-LATERAL ORBITAL RIMS AND LOWER FOREHEAD,
RECONSTRUCTION BY CONTOURING OF BENIGN TUMOR OF CRANIAL BONES (EG, FIBROUS
RECONSTRUCTION OF MANDIBULAR RAMI, HORIZONTAL, VERTICAL, C, OR L OSTEOTOMY;
RECONSTRUCTION OF MANDIBULAR RAMI AND/OR BODY, SAGITTAL SPLIT; WITHOUT INTERNAL
OSTEOTOMY, MANDIBLE, SEGMENTAL;
OSTEOTOMY, MANDIBLE, SEGMENTAL; WITH GENIOGLOSSUS ADVANCEMENT
OSTEOTOMY, MAXILLA, SEGMENTAL (EG, WASSMUND OR SCHUCHARD)
OSTEOPLASTY, FACIAL BONES; AUGMENTATION (AUTOGRAFT, ALLOGRAFT, OR PROSTHETIC
OSTEOPLASTY, FACIAL BONES; REDUCTION
GRAFT, BONE; NASAL, MAXILLARY OR MALAR AREAS (INCLUDES OBTAINING GRAFT)
GRAFT, BONE; MANDIBLE (INCLUDES OBTAINING GRAFT)
GRAFT; RIB CARTILAGE, AUTOGENOUS, TO FACE, CHIN, NOSE OR EAR (INCLUDES
GRAFT; EAR CARTILAGE, AUTOGENOUS, TO NOSE OR EAR (INCLUDES OBTAINING GRAFT)
ARTHROPLASTY, TEMPOROMANDIBULAR JOINT, WITH OR WITHOUT AUTOGRAFT (INCLUDES
ARTHROPLASTY, TEMPOROMANDIBULAR JOINT, WITH ALLOGRAFT
ARTHROPLASTY, TEMPOROMANDIBULAR JOINT, WITH PROSTHETIC JOINT REPLACEMENT
RECONSTRUCTION OF MANDIBLE, EXTRAORAL, WITH TRANSOSTEAL BONE PLATE (EG,
RECONSTRUCTION OF MANDIBLE OR MAXILLA, SUBPERIOSTEAL IMPLANT; PARTIAL
RECONSTRUCTION OF MANDIBLE OR MAXILLA, SUBPERIOSTEAL IMPLANT; COMPLETE
RECONSTRUCTION OF MANDIBLE OR MAXILLA, ENDOSTEAL IMPLANT (EG, BLADE, CYLINDER);
RECONSTRUCTION OF MANDIBLE OR MAXILLA, ENDOSTEAL IMPLANT (EG, BLADE, CYLINDER);
RECONSTRUCTION OF ORBIT WITH OSTEOTOMIES (EXTRACRANIAL) AND WITH BONE GRAFTS
PERIORBITAL OSTEOTOMIES FOR ORBITAL HYPERTELORISM, WITH BONE GRAFTS;
PERIORBITAL OSTEOTOMIES FOR ORBITAL HYPERTELORISM, WITH BONE GRAFTS; COMBINED
PERIORBITAL OSTEOTOMIES FOR ORBITAL HYPERTELORISM, WITH BONE GRAFTS; WITH
ORBITAL REPOSITIONING, PERIORBITAL OSTEOTOMIES, UNILATERAL, WITH BONE GRAFTS;
MALAR AUGMENTATION, PROSTHETIC MATERIAL
SECONDARY REVISION OF ORBITOCRANIOFACIAL RECONSTRUCTION
MEDIAL CANTHOPEXY (SEPARATE PROCEDURE)
LATERAL CANTHOPEXY
REDUCTION OF MASSETER MUSCLE AND BONE (EG, FOR TREATMENT OF BENIGN MASSETERIC
REDUCTION OF MASSETER MUSCLE AND BONE (EG, FOR TREATMENT OF BENIGN MASSETERIC
UNLISTED CRANIOFACIAL AND MAXILLOFACIAL PROCEDURE
CLOSED TREATMENT OF NASAL BONE FRACTURE WITHOUT MANIPULATION
CLOSED TREATMENT OF NASAL BONE FRACTURE; WITHOUT STABILIZATION
CLOSED TREATMENT OF NASAL BONE FRACTURE; WITH STABILIZATION
OPEN TREATMENT OF NASAL FRACTURE; UNCOMPLICATED
OPEN TREATMENT OF NASAL FRACTURE; COMPLICATED, WITH INTERNAL AND/OR EXTERNAL
OPEN TREATMENT OF NASAL FRACTURE; WITH CONCOMITANT OPEN TREATMENT OF FRACTURED
OPEN TREATMENT OF NASAL SEPTAL FRACTURE, WITH OR WITHOUT STABILIZATION
CLOSED TREATMENT OF NASAL SEPTAL FRACTURE, WITH OR WITHOUT STABILIZATION
OPEN TREATMENT OF NASOETHMOID FRACTURE; WITHOUT EXTERNAL FIXATION
OPEN TREATMENT OF NASOETHMOID FRACTURE; WITH EXTERNAL FIXATION
PERCUTANEOUS TREATMENT OF NASOETHMOID COMPLEX FRACTURE, WITH SPLINT, WIRE OR
CLOSED TREATMENT OF NASOMAXILLARY COMPLEX FRACTURE (LEFORT II TYPE), WITH
PERCUTANEOUS TREATMENT OF FRACTURE OF MALAR AREA, INCLUDING ZYGOMATIC ARCH AND
OPEN TREATMENT OF DEPRESSED ZYGOMATIC ARCH FRACTURE (EG, GILLIES APPROACH)
OPEN TREATMENT OF DEPRESSED MALAR FRACTURE, INCLUDING ZYGOMATIC ARCH AND MALAR
OPEN TREATMENT OF COMPLICATED (EG, COMMINUTED OR INVOLVING CRANIAL NERVE
OPEN TREATMENT OF ORBITAL FLOOR BLOWOUT FRACTURE; TRANSANTRAL APPROACH
OPEN TREATMENT OF ORBITAL FLOOR BLOWOUT FRACTURE; PERIORBITAL APPROACH
OPEN TREATMENT OF ORBITAL FLOOR BLOWOUT FRACTURE; COMBINED APPROACH
OPEN TREATMENT OF ORBITAL FLOOR BLOWOUT FRACTURE; PERIORBITAL APPROACH, WITH
OPEN TREATMENT OF ORBITAL FLOOR BLOWOUT FRACTURE; PERIORBITAL APPROACH WITH
CLOSED TREATMENT OF FRACTURE OF ORBIT, EXCEPT BLOWOUT; WITHOUT MANIPULATION
CLOSED TREATMENT OF FRACTURE OF ORBIT, EXCEPT BLOWOUT; WITH MANIPULATION
OPEN TREATMENT OF FRACTURE OF ORBIT, EXCEPT BLOWOUT; WITHOUT IMPLANT
OPEN TREATMENT OF FRACTURE OF ORBIT, EXCEPT BLOWOUT; WITH IMPLANT
OPEN TREATMENT OF FRACTURE OF ORBIT, EXCEPT BLOWOUT; WITH BONE GRAFTING
CLOSED TREATMENT OF PALATAL OR MAXILLARY FRACTURE (LEFORT I TYPE), WITH
CLOSED TREATMENT OF MANDIBULAR OR MAXILLARY ALVEOLAR RIDGE FRACTURE (SEPARATE
OPEN TREATMENT OF MANDIBULAR OR MAXILLARY ALVEOLAR RIDGE FRACTURE (SEPARATE
CLOSED TREATMENT OF MANDIBULAR FRACTURE; WITHOUT MANIPULATION
CLOSED TREATMENT OF MANDIBULAR FRACTURE; WITH MANIPULATION
PERCUTANEOUS TREATMENT OF MANDIBULAR FRACTURE, WITH EXTERNAL FIXATION
CLOSED TREATMENT OF MANDIBULAR FRACTURE WITH INTERDENTAL FIXATION
OPEN TREATMENT OF MANDIBULAR FRACTURE WITH EXTERNAL FIXATION
OPEN TREATMENT OF MANDIBULAR FRACTURE; WITHOUT INTERDENTAL FIXATION
OPEN TREATMENT OF MANDIBULAR FRACTURE; WITH INTERDENTAL FIXATION
OPEN TREATMENT OF MANDIBULAR CONDYLAR FRACTURE
OPEN TREATMENT OF COMPLICATED MANDIBULAR FRACTURE BY MULTIPLE SURGICAL
CLOSED TREATMENT OF TEMPOROMANDIBULAR DISLOCATION; INITIAL OR SUBSEQUENT
CLOSED TREATMENT OF TEMPOROMANDIBULAR DISLOCATION; COMPLICATED (EG, RECURRENT
OPEN TREATMENT OF TEMPOROMANDIBULAR DISLOCATION
OPEN TREATMENT OF HYOID FRACTURE
INTERDENTAL WIRING, FOR CONDITION OTHER THAN FRACTURE
UNLISTED MUSCULOSKELETAL PROCEDURE, HEAD
INCISION AND DRAINAGE, DEEP ABSCESS OR HEMATOMA, SOFT TISSUES OF NECK OR THORAX;
INCISION AND DRAINAGE, DEEP ABSCESS OR HEMATOMA, SOFT TISSUES OF NECK OR
BIOPSY, SOFT TISSUE OF NECK OR THORAX
Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; 3 cm or g
Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg,intramus
EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBCUTANEOUS; LESS THAN
EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBFASCIAL (EG, INTRAMU
RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF NECK OR ANTE
Radical resection of tumor (eg, malignant neoplasm), soft tissue of neck or ante
EXCISION OF RIB, PARTIAL
COSTOTRANSVERSECTOMY (SEPARATE PROCEDURE)
HYOID MYOTOMY AND SUSPENSION
DIVISION OF SCALENUS ANTICUS; WITHOUT RESECTION OF CERVICAL RIB
DIVISION OF STERNOCLEIDOMASTOID FOR TORTICOLLIS, OPEN OPERATION; WITHOUT CAST
DIVISION OF STERNOCLEIDOMASTOID FOR TORTICOLLIS, OPEN OPERATION; WITH CAST
RECONSTRUCTIVE REPAIR OF PECTUS EXCAVATUM OR CARINATUM; MINIMALLY INVASIVE
RECONSTRUCTIVE REPAIR OF PECTUS EXCAVATUM OR CARINATUM; MINIMALLY INVASIVE
CLOSED TREATMENT OF RIB FRACTURE, UNCOMPLICATED, EACH
OPEN TREATMENT OF RIB FRACTURE WITHOUT FIXATION, EACH
CLOSED TREATMENT OF STERNUM FRACTURE
UNLISTED PROCEDURE, NECK OR THORAX
BIOPSY, SOFT TISSUE OF BACK OR FLANK; SUPERFICIAL
BIOPSY, SOFT TISSUE OF BACK OR FLANK; DEEP
EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBCUTANEOUS; LESS THAN 3 CM
Excision, tumor, soft tissue of back or flank, subcutaneous; 3 cm or greater
Excision, tumor, soft tissue of back or flank, subfascial (eg, intramuscular); l
Excision, tumor, soft tissue of back or flank, subfascial (eg, intramuscular);
RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF BACK OR FLAN
Radical resection of tumor (eg, malignant neoplasm), soft tissue of backor flank
PARTIAL EXCISION OF POSTERIOR VERTEBRAL COMPONENT (EG, SPINOUS PROCESS, LAMINA O
PARTIAL EXCISION OF POSTERIOR VERTEBRAL COMPONENT (EG, SPINOUS PROCESS, LAMINA
PARTIAL EXCISION OF POSTERIOR VERTEBRAL COMPONENT (EG, SPINOUS PROCESS, LAMINA
PARTIAL EXCISION OF POSTERIOR VERTEBRAL COMPONENT (EG, SPINOUS PROCESS, LAMINA
OSTEOTOMY OF SPINE, INCLUDING DISKECTOMY, ANTERIOR APPROACH, SINGLE VERTEBRAL
CLOSED TREATMENT OF VERTEBRAL PROCESS FRACTURE(S)
CLOSED TREATMENT OF VERTEBRAL BODY FRACTURE(S), WITHOUT MANIPULATION, REQUIRING
CLOSED TREATMENT OF VERTEBRAL FRACTURE(S) AND/OR DISLOCATION(S) REQUIRING CASTIN
MANIPULATION OF SPINE REQUIRING ANESTHESIA, ANY REGION
PERCUTANEOUS VERTEBROPLASTY, 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION
PERCUTANEOUS VERTEBROPLASTY, 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION
PERCUTANEOUS VERTEBROPLASTY, ONE VERTEBRAL BODY, UNILATERAL OR BILATERAL
PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTI
PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTI
PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTI
ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE LEVEL; LUMBAR (WITH
ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE LEVEL; EACH
APPLICATION OF INTERVERTEBRAL BIOMECHANICAL DEVICE(S) (EG, SYNTHETIC CAGE(S), ME
UNLISTED PROCEDURE, SPINE
EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBFASCIAL (EG, INTRAMUSCULAR);
Excision, tumor, soft tissue of abdominal wall, subfascial (eg,intramuscular); 5
Excision, tumor, soft tissue of abdominal wall, subcutaneous; less than 3 cm
Excision, tumor, soft tissue of abdominal wall, subcutaneous; 3 cm or greater
Radical resection of tumor (eg, malignant neoplasm), soft tissue of abdominal wa
Radical resection of tumor (eg, malignant neoplasm), soft tissue of abdominal wa
UNLISTED PROCEDURE, ABDOMEN, MUSCULOSKELETAL SYSTEM
REMOVAL OF SUBDELTOID CALCAREOUS DEPOSITS, OPEN
CAPSULAR CONTRACTURE RELEASE (EG, SEVER TYPE PROCEDURE)
INCISION AND DRAINAGE, SHOULDER AREA; DEEP ABSCESS OR HEMATOMA
INCISION AND DRAINAGE, SHOULDER AREA; INFECTED BURSA
INCISION, BONE CORTEX (EG, OSTEOMYELITIS OR BONE ABSCESS), SHOULDER AREA
ARTHROTOMY, GLENOHUMERAL JOINT, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF
ARTHROTOMY, ACROMIOCLAVICULAR, STERNOCLAVICULAR JOINT, INCLUDING EXPLORATION,
BIOPSY, SOFT TISSUE OF SHOULDER AREA; SUPERFICIAL
BIOPSY, SOFT TISSUE OF SHOULDER AREA; DEEP
Excision, tumor, soft tissue of shoulder area, subcutaneous; 3 cm or greater
Excision, tumor, soft tissue of shoulder area, subfascial (eg, intramuscular); 5
EXCISION, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBCUTANEOUS; LESS THAN 3 CM
EXCISION, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBFASCIAL (EG, INTRAMUSCULAR); L
RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF SHOULDER ARE
Radical resection of tumor (eg, malignant neoplasm), soft tissue of shoulder are
ARTHROTOMY, GLENOHUMERAL JOINT, INCLUDING BIOPSY
ARTHROTOMY, ACROMIOCLAVICULAR JOINT OR STERNOCLAVICULAR JOINT, INCLUDING BIOPSY
ARTHROTOMY; GLENOHUMERAL JOINT, WITH SYNOVECTOMY, WITH OR WITHOUT BIOPSY
ARTHROTOMY; STERNOCLAVICULAR JOINT, WITH SYNOVECTOMY, WITH OR WITHOUT BIOPSY
ARTHROTOMY, GLENOHUMERAL JOINT, WITH JOINT EXPLORATION, WITH OR WITHOUT REMOVAL
CLAVICULECTOMY; PARTIAL
CLAVICULECTOMY; TOTAL
ACROMIOPLASTY OR ACROMIONECTOMY, PARTIAL, WITH OR WITHOUT CORACOACROMIAL
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CLAVICLE OR SCAPULA;
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CLAVICLE OR SCAPULA; WITH
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CLAVICLE OR SCAPULA; WITH
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL HUMERUS;
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL HUMERUS; WITH
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL HUMERUS; WITH
SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), CLAVICLE
SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), SCAPULA
SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), HUMERAL HEAD TO
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG,
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG,
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG,
OSTECTOMY OF SCAPULA, PARTIAL (EG, SUPERIOR MEDIAL ANGLE)
RESECTION, HUMERAL HEAD
REMOVAL OF FOREIGN BODY, SHOULDER; SUBCUTANEOUS
REMOVAL OF FOREIGN BODY, SHOULDER; DEEP (EG, NEER HEMIARTHROPLASTY REMOVAL)
MUSCLE TRANSFER, ANY TYPE, SHOULDER OR UPPER ARM; SINGLE
MUSCLE TRANSFER, ANY TYPE, SHOULDER OR UPPER ARM; MULTIPLE
SCAPULOPEXY (EG, SPRENGELS DEFORMITY OR FOR PARALYSIS)
TENOTOMY, SHOULDER AREA; SINGLE TENDON
TENOTOMY, SHOULDER AREA; MULTIPLE TENDONS THROUGH SAME INCISION
REPAIR OF RUPTURED MUSCULOTENDINOUS CUFF (EG, ROTATOR CUFF) OPEN; ACUTE
REPAIR OF RUPTURED MUSCULOTENDINOUS CUFF (EG, ROTATOR CUFF) OPEN; CHRONIC
CORACOACROMIAL LIGAMENT RELEASE, WITH OR WITHOUT ACROMIOPLASTY
RECONSTRUCTION OF COMPLETE SHOULDER (ROTATOR) CUFF AVULSION, CHRONIC (INCLUDES
TENODESIS OF LONG TENDON OF BICEPS
RESECTION OR TRANSPLANTATION OF LONG TENDON OF BICEPS
CAPSULORRHAPHY, ANTERIOR; PUTTI-PLATT PROCEDURE OR MAGNUSON TYPE OPERATION
CAPSULORRHAPHY, ANTERIOR; WITH LABRAL REPAIR (EG, BANKART PROCEDURE)
CAPSULORRHAPHY, ANTERIOR, ANY TYPE; WITH BONE BLOCK
CAPSULORRHAPHY, ANTERIOR, ANY TYPE; WITH CORACOID PROCESS TRANSFER
CAPSULORRHAPHY, GLENOHUMERAL JOINT, POSTERIOR, WITH OR WITHOUT BONE BLOCK
CAPSULORRHAPHY, GLENOHUMERAL JOINT, ANY TYPE MULTI-DIRECTIONAL INSTABILITY
ARTHROPLASTY, GLENOHUMERAL JOINT; HEMIARTHROPLASTY
OSTEOTOMY, CLAVICLE, WITH OR WITHOUT INTERNAL FIXATION;
OSTEOTOMY, CLAVICLE, WITH OR WITHOUT INTERNAL FIXATION; WITH BONE GRAFT FOR
PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT
PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT
CLOSED TREATMENT OF CLAVICULAR FRACTURE; WITHOUT MANIPULATION
CLOSED TREATMENT OF CLAVICULAR FRACTURE; WITH MANIPULATION
OPEN TREATMENT OF CLAVICULAR FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORME
CLOSED TREATMENT OF STERNOCLAVICULAR DISLOCATION; WITHOUT MANIPULATION
CLOSED TREATMENT OF STERNOCLAVICULAR DISLOCATION; WITH MANIPULATION
OPEN TREATMENT OF STERNOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC;
OPEN TREATMENT OF STERNOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC; WITH FASCIAL
CLOSED TREATMENT OF ACROMIOCLAVICULAR DISLOCATION; WITHOUT MANIPULATION
CLOSED TREATMENT OF ACROMIOCLAVICULAR DISLOCATION; WITH MANIPULATION
OPEN TREATMENT OF ACROMIOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC;
OPEN TREATMENT OF ACROMIOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC; WITH FASCIAL
CLOSED TREATMENT OF SCAPULAR FRACTURE; WITHOUT MANIPULATION
CLOSED TREATMENT OF SCAPULAR FRACTURE; WITH MANIPULATION, WITH OR WITHOUT
OPEN TREATMENT OF SCAPULAR FRACTURE (BODY, GLENOID OR ACROMION) INCLUDES INTERNA
CLOSED TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE;
CLOSED TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE;
OPEN TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE, INCLU
OPEN TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE, INCLU
CLOSED TREATMENT OF GREATER HUMERAL TUBEROSITY FRACTURE; WITHOUT MANIPULATION
CLOSED TREATMENT OF GREATER HUMERAL TUBEROSITY FRACTURE; WITH MANIPULATION
OPEN TREATMENT OF GREATER HUMERAL TUBEROSITY FRACTURE, INCLUDES INTERNAL FIXATIO
CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH MANIPULATION; WITHOUT ANESTHESIA
CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH MANIPULATION; REQUIRING
OPEN TREATMENT OF ACUTE SHOULDER DISLOCATION
CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH FRACTURE OF GREATER HUMERAL
OPEN TREATMENT OF SHOULDER DISLOCATION, WITH FRACTURE OF GREATER HUMERAL TUBEROS
CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH SURGICAL OR ANATOMICAL NECK
OPEN TREATMENT OF SHOULDER DISLOCATION, WITH SURGICAL OR ANATOMICAL NECK FRACTUR
MANIPULATION UNDER ANESTHESIA, SHOULDER JOINT, INCLUDING APPLICATION OF FIXATION
ARTHRODESIS, GLENOHUMERAL JOINT;
ARTHRODESIS, GLENOHUMERAL JOINT; WITH AUTOGENOUS GRAFT (INCLUDES OBTAINING
DISARTICULATION OF SHOULDER; SECONDARY CLOSURE OR SCAR REVISION
UNLISTED PROCEDURE, SHOULDER
INCISION AND DRAINAGE, UPPER ARM OR ELBOW AREA; DEEP ABSCESS OR HEMATOMA
INCISION AND DRAINAGE, UPPER ARM OR ELBOW AREA; BURSA
INCISION, DEEP, WITH OPENING OF BONE CORTEX (EG, FOR OSTEOMYELITIS OR BONE
ARTHROTOMY, ELBOW, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY
ARTHROTOMY OF THE ELBOW, WITH CAPSULAR EXCISION FOR CAPSULAR RELEASE (SEPARATE
BIOPSY, SOFT TISSUE OF UPPER ARM OR ELBOW AREA; SUPERFICIAL
BIOPSY, SOFT TISSUE OF UPPER ARM OR ELBOW AREA; DEEP (SUBFASCIAL OR
Excision, tumor, soft tissue of upper arm or elbow area, subcutaneous; 3 cm or g
Excision, tumor, soft tissue of upper arm or elbow area, subfascial (eg,intramus
EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOW AREA, SUBCUTANEOUS; LESS THAN
EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOW AREA, SUBFASCIAL (EG, INTRAMU
RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF UPPER ARM OR
Radical resection of tumor (eg, malignant neoplasm), soft tissue of upper ar
ARTHROTOMY, ELBOW; WITH SYNOVIAL BIOPSY ONLY
ARTHROTOMY, ELBOW; WITH JOINT EXPLORATION, WITH OR WITHOUT BIOPSY, WITH OR
ARTHROTOMY, ELBOW; WITH SYNOVECTOMY
EXCISION, OLECRANON BURSA
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, HUMERUS;
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, HUMERUS; WITH AUTOGRAFT
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, HUMERUS; WITH ALLOGRAFT
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF HEAD OR NECK OF RADIUS OR
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF HEAD OR NECK OF RADIUS OR
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF HEAD OR NECK OF RADIUS OR
EXCISION, RADIAL HEAD
SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), SHAFT OR DISTAL HUMERUS
SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), RADIAL HEAD OR NECK
SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), OLECRANON PROCESS
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG,
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG,
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG,
RADICAL RESECTION OF CAPSULE, SOFT TISSUE, AND HETEROTOPIC BONE, ELBOW, WITH
RADICAL RESECTION OF TUMOR, SHAFT OR DISTAL HUMERUS
RADICAL RESECTION OF TUMOR, RADIAL HEAD OR NECK
RESECTION OF ELBOW JOINT (ARTHRECTOMY)
IMPLANT REMOVAL; ELBOW JOINT
IMPLANT REMOVAL; RADIAL HEAD
REMOVAL OF FOREIGN BODY, UPPER ARM OR ELBOW AREA; SUBCUTANEOUS
REMOVAL OF FOREIGN BODY, UPPER ARM OR ELBOW AREA; DEEP (SUBFASCIAL OR
MANIPULATION, ELBOW, UNDER ANESTHESIA
MUSCLE OR TENDON TRANSFER, ANY TYPE, UPPER ARM OR ELBOW, SINGLE (EXCLUDING
TENDON LENGTHENING, UPPER ARM OR ELBOW, EACH TENDON
TENOTOMY, OPEN, ELBOW TO SHOULDER, EACH TENDON
TENOPLASTY, WITH MUSCLE TRANSFER, WITH OR WITHOUT FREE GRAFT, ELBOW TO
FLEXOR-PLASTY, ELBOW (EG, STEINDLER TYPE ADVANCEMENT);
FLEXOR-PLASTY, ELBOW (EG, STEINDLER TYPE ADVANCEMENT); WITH EXTENSOR ADVANCEMENT
TENOLYSIS, TRICEPS
TENODESIS OF BICEPS TENDON AT ELBOW (SEPARATE PROCEDURE)
REPAIR, TENDON OR MUSCLE, UPPER ARM OR ELBOW, EACH TENDON OR MUSCLE, PRIMARY OR
REINSERTION OF RUPTURED BICEPS OR TRICEPS TENDON, DISTAL, WITH OR WITHOUT
REPAIR LATERAL COLLATERAL LIGAMENT, ELBOW, WITH LOCAL TISSUE
RECONSTRUCTION LATERAL COLLATERAL LIGAMENT, ELBOW, WITH TENDON GRAFT (INCLUDES
REPAIR MEDIAL COLLATERAL LIGAMENT, ELBOW, WITH LOCAL TISSUE
RECONSTRUCTION MEDIAL COLLATERAL LIGAMENT, ELBOW, WITH TENDON GRAFT (INCLUDES
TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S EL
TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S EL
TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S EL
ARTHROPLASTY, ELBOW; WITH MEMBRANE (EG, FASCIAL)
ARTHROPLASTY, ELBOW; WITH DISTAL HUMERAL PROSTHETIC REPLACEMENT
ARTHROPLASTY, ELBOW; WITH IMPLANT AND FASCIA LATA LIGAMENT RECONSTRUCTION
ARTHROPLASTY, ELBOW; WITH DISTAL HUMERUS AND PROXIMAL ULNAR PROSTHETIC
ARTHROPLASTY, RADIAL HEAD;
ARTHROPLASTY, RADIAL HEAD; WITH IMPLANT
OSTEOTOMY, HUMERUS, WITH OR WITHOUT INTERNAL FIXATION
MULTIPLE OSTEOTOMIES WITH REALIGNMENT ON INTRAMEDULLARY ROD, HUMERAL SHAFT
OSTEOPLASTY, HUMERUS (EG, SHORTENING OR LENGTHENING) (EXCLUDING 64876)
REPAIR OF NONUNION OR MALUNION, HUMERUS; WITHOUT GRAFT (EG, COMPRESSION
REPAIR OF NONUNION OR MALUNION, HUMERUS; WITH ILIAC OR OTHER AUTOGRAFT
HEMIEPIPHYSEAL ARREST (EG, CUBITUS VARUS OR VALGUS, DISTAL HUMERUS)
DECOMPRESSION FASCIOTOMY, FOREARM, WITH BRACHIAL ARTERY EXPLORATION
PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING), WITH OR WITHOUT
CLOSED TREATMENT OF HUMERAL SHAFT FRACTURE; WITHOUT MANIPULATION
CLOSED TREATMENT OF HUMERAL SHAFT FRACTURE; WITH MANIPULATION, WITH OR WITHOUT
OPEN TREATMENT OF HUMERAL SHAFT FRACTURE WITH PLATE/SCREWS, WITH OR WITHOUT
TREATMENT OF HUMERAL SHAFT FRACTURE, WITH INSERTION OF INTRAMEDULLARY IMPLANT,
CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR HUMERAL FRACTURE, WITH OR
CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR HUMERAL FRACTURE, WITH OR
PERCUTANEOUS SKELETAL FIXATION OF SUPRACONDYLAR OR TRANSCONDYLAR HUMERAL
OPEN TREATMENT OF HUMERAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE, INCLUDES INTE
OPEN TREATMENT OF HUMERAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE, INCLUDES INTE
CLOSED TREATMENT OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR LATERAL; WITHOUT
CLOSED TREATMENT OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR LATERAL; WITH
PERCUTANEOUS SKELETAL FIXATION OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR
OPEN TREATMENT OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR LATERAL, INCLUDES INTE
CLOSED TREATMENT OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL; WITHOUT
CLOSED TREATMENT OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL; WITH
OPEN TREATMENT OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL, INCLUDES INTERNA
PERCUTANEOUS SKELETAL FIXATION OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL,
OPEN TREATMENT OF PERIARTICULAR FRACTURE AND/OR DISLOCATION OF THE ELBOW
OPEN TREATMENT OF PERIARTICULAR FRACTURE AND/OR DISLOCATION OF THE ELBOW
TREATMENT OF CLOSED ELBOW DISLOCATION; WITHOUT ANESTHESIA
TREATMENT OF CLOSED ELBOW DISLOCATION; REQUIRING ANESTHESIA
OPEN TREATMENT OF ACUTE OR CHRONIC ELBOW DISLOCATION
CLOSED TREATMENT OF MONTEGGIA TYPE OF FRACTURE DISLOCATION AT ELBOW (FRACTURE
OPEN TREATMENT OF MONTEGGIA TYPE OF FRACTURE DISLOCATION AT ELBOW (FRACTURE PROX
CLOSED TREATMENT OF RADIAL HEAD SUBLUXATION IN CHILD, NURSEMAID ELBOW, WITH
CLOSED TREATMENT OF RADIAL HEAD OR NECK FRACTURE; WITHOUT MANIPULATION
CLOSED TREATMENT OF RADIAL HEAD OR NECK FRACTURE; WITH MANIPULATION
OPEN TREATMENT OF RADIAL HEAD OR NECK FRACTURE, INCLUDES INTERNAL FIXATION OR RA
OPEN TREATMENT OF RADIAL HEAD OR NECK FRACTURE, INCLUDES INTERNAL FIXATION OR RA
CLOSED TREATMENT OF ULNAR FRACTURE, PROXIMAL END (EG, OLECRANON OR CORONOID PROC
CLOSED TREATMENT OF ULNAR FRACTURE, PROXIMAL END (EG, OLECRANON OR CORONOID PROC
OPEN TREATMENT OF ULNAR FRACTURE, PROXIMAL END (EG, OLECRANON OR CORONOID PROCES
ARTHRODESIS, ELBOW JOINT; LOCAL
ARTHRODESIS, ELBOW JOINT; WITH AUTOGENOUS GRAFT (INCLUDES OBTAINING GRAFT)
AMPUTATION, ARM THROUGH HUMERUS; SECONDARY CLOSURE OR SCAR REVISION
STUMP ELONGATION, UPPER EXTREMITY
UNLISTED PROCEDURE, HUMERUS OR ELBOW
INCISION, EXTENSOR TENDON SHEATH, WRIST (EG, DEQUERVAIN'S DISEASE)
INCISION, FLEXOR TENDON SHEATH, WRIST (EG, FLEXOR CARPI RADIALIS)
DECOMPRESSION FASCIOTOMY, FOREARM AND/OR WRIST, FLEXOR OR EXTENSOR COMPARTMENT;
DECOMPRESSION FASCIOTOMY, FOREARM AND/OR WRIST, FLEXOR OR EXTENSOR COMPARTMENT;
DECOMPRESSION FASCIOTOMY, FOREARM AND/OR WRIST, FLEXOR AND EXTENSOR
DECOMPRESSION FASCIOTOMY, FOREARM AND/OR WRIST, FLEXOR AND EXTENSOR
INCISION AND DRAINAGE, FOREARM AND/OR WRIST; DEEP ABSCESS OR HEMATOMA
INCISION AND DRAINAGE, FOREARM AND/OR WRIST; BURSA
INCISION, DEEP, BONE CORTEX, FOREARM AND/OR WRIST (EG, OSTEOMYELITIS OR BONE
ARTHROTOMY, RADIOCARPAL OR MIDCARPAL JOINT, WITH EXPLORATION, DRAINAGE, OR
BIOPSY, SOFT TISSUE OF FOREARM AND/OR WRIST; SUPERFICIAL
BIOPSY, SOFT TISSUE OF FOREARM AND/OR WRIST; DEEP (SUBFASCIAL OR INTRAMUSCULAR)
Excision, tumor, soft tissue of forearm and/or wrist area, subcutaneous; 3 cm or
Excision, tumor, soft tissue of forearm and/or wrist area, subfascial (eg, intra
EXCISION, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST AREA, SUBCUTANEOUS; LESS TH
EXCISION, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST AREA, SUBFASCIAL (EG, INTRA
RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF FOREARM AND/
Radical resection of tumor (eg, malignant neoplasm), soft tissue of forearm and/
CAPSULOTOMY, WRIST (EG, CONTRACTURE)
ARTHROTOMY, WRIST JOINT; WITH BIOPSY
ARTHROTOMY, WRIST JOINT; WITH JOINT EXPLORATION, WITH OR WITHOUT BIOPSY, WITH
ARTHROTOMY, WRIST JOINT; WITH SYNOVECTOMY
ARTHROTOMY, DISTAL RADIOULNAR JOINT INCLUDING REPAIR OF TRIANGULAR CARTILAGE,
EXCISION OF TENDON, FOREARM AND/OR WRIST, FLEXOR OR EXTENSOR, EACH
EXCISION, LESION OF TENDON SHEATH, FOREARM AND/OR WRIST
EXCISION OF GANGLION, WRIST (DORSAL OR VOLAR); PRIMARY
EXCISION OF GANGLION, WRIST (DORSAL OR VOLAR); RECURRENT
RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR FOREARM TENDON SHEATHS (EG,
RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR FOREARM TENDON SHEATHS (EG,
SYNOVECTOMY, EXTENSOR TENDON SHEATH, WRIST, SINGLE COMPARTMENT;
SYNOVECTOMY, EXTENSOR TENDON SHEATH, WRIST, SINGLE COMPARTMENT; WITH RESECTION
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF RADIUS OR ULNA (EXCLUDING
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF RADIUS OR ULNA (EXCLUDING
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF RADIUS OR ULNA (EXCLUDING
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CARPAL BONES;
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CARPAL BONES; WITH
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CARPAL BONES; WITH
SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), FOREARM AND/OR WRIST
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG,
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG,
RADICAL RESECTION OF TUMOR, RADIUS OR ULNA
CARPECTOMY; ONE BONE
CARPECTOMY; ALL BONES OF PROXIMAL ROW
RADIAL STYLOIDECTOMY (SEPARATE PROCEDURE)
EXCISION DISTAL ULNA PARTIAL OR COMPLETE (EG, DARRACH TYPE OR MATCHED RESECTION)
EXPLORATION WITH REMOVAL OF DEEP FOREIGN BODY, FOREARM OR WRIST
REMOVAL OF WRIST PROSTHESIS; (SEPARATE PROCEDURE)
REMOVAL OF WRIST PROSTHESIS; COMPLICATED, INCLUDING TOTAL WRIST
MANIPULATION, WRIST, UNDER ANESTHESIA
REPAIR, TENDON OR MUSCLE, FLEXOR, FOREARM AND/OR WRIST; PRIMARY, SINGLE, EACH TE
REPAIR, TENDON OR MUSCLE, FLEXOR, FOREARM AND/OR WRIST; SECONDARY, SINGLE, EACH
REPAIR, TENDON OR MUSCLE, FLEXOR, FOREARM AND/OR WRIST; SECONDARY, WITH FREE
REPAIR, TENDON OR MUSCLE, EXTENSOR, FOREARM AND/OR WRIST; PRIMARY, SINGLE, EACH
REPAIR, TENDON OR MUSCLE, EXTENSOR, FOREARM AND/OR WRIST; SECONDARY, SINGLE,
REPAIR, TENDON OR MUSCLE, EXTENSOR, FOREARM AND/OR WRIST; SECONDARY, WITH FREE
REPAIR, TENDON SHEATH, EXTENSOR, FOREARM AND/OR WRIST, WITH FREE GRAFT
LENGTHENING OR SHORTENING OF FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR WRIST,
TENOTOMY, OPEN, FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR WRIST, SINGLE, EACH
TENOLYSIS, FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR WRIST, SINGLE, EACH TENDON
TENODESIS AT WRIST; FLEXORS OF FINGERS
TENODESIS AT WRIST; EXTENSORS OF FINGERS
TENDON TRANSPLANTATION OR TRANSFER, FLEXOR OR EXTENSOR, FOREARM AND/OR WRIST,
TENDON TRANSPLANTATION OR TRANSFER, FLEXOR OR EXTENSOR, FOREARM AND/OR WRIST,
FLEXOR ORIGIN SLIDE (EG, FOR CEREBRAL PALSY, VOLKMANN CONTRACTURE), FOREARM
FLEXOR ORIGIN SLIDE (EG, FOR CEREBRAL PALSY, VOLKMANN CONTRACTURE), FOREARM
CAPSULORRHAPHY OR RECONSTRUCTION, WRIST, OPEN (EG, CAPSULODESIS, LIGAMENT
ARTHROPLASTY, WRIST, WITH OR WITHOUT INTERPOSITION, WITH OR WITHOUT EXTERNAL OR
CENTRALIZATION OF WRIST ON ULNA (EG, RADIAL CLUB HAND)
RECONSTRUCTION FOR STABILIZATION OF UNSTABLE DISTAL ULNA OR DISTAL RADIOULNAR
OSTEOTOMY, RADIUS; DISTAL THIRD
OSTEOTOMY, RADIUS; MIDDLE OR PROXIMAL THIRD
OSTEOTOMY; ULNA
OSTEOTOMY; RADIUS AND ULNA
MULTIPLE OSTEOTOMIES, WITH REALIGNMENT ON INTRAMEDULLARY ROD (SOFIELD TYPE
MULTIPLE OSTEOTOMIES, WITH REALIGNMENT ON INTRAMEDULLARY ROD (SOFIELD TYPE
OSTEOPLASTY, RADIUS OR ULNA; SHORTENING
OSTEOPLASTY, RADIUS OR ULNA; LENGTHENING WITH AUTOGRAFT
OSTEOPLASTY, RADIUS AND ULNA; SHORTENING (EXCLUDING 64876)
OSTEOPLASTY, RADIUS AND ULNA; LENGTHENING WITH AUTOGRAFT
OSTEOPLASTY, CARPAL BONE, SHORTENING
REPAIR OF NONUNION OR MALUNION, RADIUS OR ULNA; WITHOUT GRAFT (EG, COMPRESSION
REPAIR OF NONUNION OR MALUNION, RADIUS OR ULNA; WITH AUTOGRAFT (INCLUDES
REPAIR OF NONUNION OR MALUNION, RADIUS AND ULNA; WITHOUT GRAFT (EG, COMPRESSION
REPAIR OF NONUNION OR MALUNION, RADIUS AND ULNA; WITH AUTOGRAFT (INCLUDES
REPAIR OF DEFECT WITH AUTOGRAFT; RADIUS OR ULNA
REPAIR OF DEFECT WITH AUTOGRAFT; RADIUS AND ULNA
INSERTION OF VASCULAR PEDICLE INTO CARPAL BONE (EG, HORI PROCEDURE)
REPAIR OF NONUNION OF CARPAL BONE (EXCLUDING CARPAL SCAPHOID (NAVICULAR))
REPAIR OF NONUNION, SCAPHOID CARPAL (NAVICULAR) BONE, WITH OR WITHOUT RADIAL
ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; DISTAL RADIUS
ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; DISTAL ULNA
ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; SCAPHOID CARPAL (NAVICULAR)
ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; LUNATE
ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; TRAPEZIUM
ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; DISTAL RADIUS AND PARTIAL OR ENTIRE
ARTHROPLASTY, INTERPOSITION, INTERCARPAL OR CARPOMETACARPAL JOINTS
REVISION OF ARTHROPLASTY, INCLUDING REMOVAL OF IMPLANT, WRIST JOINT
EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING; DISTAL RADIUS OR ULNA
EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING; DISTAL RADIUS AND ULNA
PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT
PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT
PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT
CLOSED TREATMENT OF RADIAL SHAFT FRACTURE; WITHOUT MANIPULATION
CLOSED TREATMENT OF RADIAL SHAFT FRACTURE; WITH MANIPULATION
OPEN TREATMENT OF RADIAL SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFOR
CLOSED TREATMENT OF RADIAL SHAFT FRACTURE AND CLOSED TREATMENT OF DISLOCATION
OPEN TREATMENT OF RADIAL SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFOR
OPEN TREATMENT OF RADIAL SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFOR
CLOSED TREATMENT OF ULNAR SHAFT FRACTURE; WITHOUT MANIPULATION
CLOSED TREATMENT OF ULNAR SHAFT FRACTURE; WITH MANIPULATION
OPEN TREATMENT OF ULNAR SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORM
CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES; WITHOUT MANIPULATION
CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES; WITH MANIPULATION
OPEN TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES, WITH INTERNAL FIXATION, WHEN
OPEN TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES, WITH INTERNAL FIXATION, WHEN
CLOSED TREATMENT OF DISTAL RADIAL FRACTURE (EG, COLLES OR SMITH TYPE) OR EPIPHYS
CLOSED TREATMENT OF DISTAL RADIAL FRACTURE (EG, COLLES OR SMITH TYPE) OR
PERCUTANEOUS SKELETAL FIXATION OF DISTAL RADIAL FRACTURE OR EPIPHYSEAL SEPARATIO
OPEN TREATMENT OF DISTAL RADIAL EXTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATIO
OPEN TREATMENT OF DISTAL RADIAL INTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATIO
OPEN TREATMENT OF DISTAL RADIAL INTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATIO
CLOSED TREATMENT OF CARPAL SCAPHOID (NAVICULAR) FRACTURE; WITHOUT MANIPULATION
CLOSED TREATMENT OF CARPAL SCAPHOID (NAVICULAR) FRACTURE; WITH MANIPULATION
OPEN TREATMENT OF CARPAL SCAPHOID (NAVICULAR) FRACTURE, INCLUDES INTERNAL FIXATI
CLOSED TREATMENT OF CARPAL BONE FRACTURE (EXCLUDING CARPAL SCAPHOID
CLOSED TREATMENT OF CARPAL BONE FRACTURE (EXCLUDING CARPAL SCAPHOID
OPEN TREATMENT OF CARPAL BONE FRACTURE (OTHER THAN CARPAL SCAPHOID
CLOSED TREATMENT OF ULNAR STYLOID FRACTURE
PERCUTANEOUS SKELETAL FIXATION OF ULNAR STYLOID FRACTURE
OPEN TREATMENT OF ULNAR STYLOID FRACTURE
CLOSED TREATMENT OF RADIOCARPAL OR INTERCARPAL DISLOCATION, ONE OR MORE BONES,
OPEN TREATMENT OF RADIOCARPAL OR INTERCARPAL DISLOCATION, ONE OR MORE BONES
PERCUTANEOUS SKELETAL FIXATION OF DISTAL RADIOULNAR DISLOCATION
CLOSED TREATMENT OF DISTAL RADIOULNAR DISLOCATION WITH MANIPULATION
OPEN TREATMENT OF DISTAL RADIOULNAR DISLOCATION, ACUTE OR CHRONIC
CLOSED TREATMENT OF TRANS-SCAPHOPERILUNAR TYPE OF FRACTURE DISLOCATION, WITH
OPEN TREATMENT OF TRANS-SCAPHOPERILUNAR TYPE OF FRACTURE DISLOCATION
CLOSED TREATMENT OF LUNATE DISLOCATION, WITH MANIPULATION
OPEN TREATMENT OF LUNATE DISLOCATION
ARTHRODESIS, WRIST; COMPLETE, WITHOUT BONE GRAFT (INCLUDES RADIOCARPAL AND/ OR I
ARTHRODESIS, WRIST; WITH SLIDING GRAFT
ARTHRODESIS, WRIST; WITH ILIAC OR OTHER AUTOGRAFT (INCLUDES OBTAINING GRAFT)
ARTHRODESIS, WRIST; LIMITED, WITHOUT BONE GRAFT (EG, INTERCARPAL OR RADIOCARPAL)
ARTHRODESIS, WRIST; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT)
ARTHRODESIS, DISTAL RADIOULNAR JOINT WITH SEGMENTAL RESECTION OF ULNA, WITH OR
AMPUTATION, FOREARM, THROUGH RADIUS AND ULNA; SECONDARY CLOSURE OR SCAR REVISION
AMPUTATION, FOREARM, THROUGH RADIUS AND ULNA; RE-AMPUTATION
DISARTICULATION THROUGH WRIST; SECONDARY CLOSURE OR SCAR REVISION
TRANSMETACARPAL AMPUTATION; SECONDARY CLOSURE OR SCAR REVISION
TRANSMETACARPAL AMPUTATION; RE-AMPUTATION
UNLISTED PROCEDURE, FOREARM OR WRIST
DRAINAGE OF FINGER ABSCESS; SIMPLE
DRAINAGE OF FINGER ABSCESS; COMPLICATED (EG, FELON)
DRAINAGE OF TENDON SHEATH, DIGIT AND/OR PALM, EACH
DRAINAGE OF PALMAR BURSA; SINGLE, BURSA
DRAINAGE OF PALMAR BURSA; MULTIPLE BURSA
INCISION, BONE CORTEX, HAND OR FINGER (EG, OSTEOMYELITIS OR BONE ABSCESS)
DECOMPRESSION FINGERS AND/OR HAND, INJECTION INJURY (EG, GREASE GUN)
DECOMPRESSIVE FASCIOTOMY, HAND (EXCLUDES 26035)
FASCIOTOMY, PALMAR (EG, DUPUYTREN'S CONTRACTURE); PERCUTANEOUS
FASCIOTOMY, PALMAR (EG, DUPUYTREN'S CONTRACTURE); OPEN, PARTIAL
TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER)
TENOTOMY, PERCUTANEOUS, SINGLE, EACH DIGIT
ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY;
ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY;
ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY;
ARTHROTOMY WITH BIOPSY; CARPOMETACARPAL JOINT, EACH
ARTHROTOMY WITH BIOPSY; METACARPOPHALANGEAL JOINT, EACH
ARTHROTOMY WITH BIOPSY; INTERPHALANGEAL JOINT, EACH
Excision, tumor or vascular malformation, soft tissue of hand or finger,subcutan
Excision, tumor, soft tissue, or vascular malformation, of hand or finger, subfa
EXCISION, TUMOR OR VASCULAR MALFORMATION, SOFT TISSUE OF HAND OR FINGER, SUBCUTA
EXCISION, TUMOR, SOFT TISSUE, OR VASCULAR MALFORMATION, OF HAND OR FINGER, SUBFA
RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF HAND OR FING
Radical resection of tumor (eg, malignant neoplasm), soft tissue of hand or fing
FASCIECTOMY, PALM ONLY, WITH OR WITHOUT Z-PLASTY, OTHER LOCAL TISSUE
FASCIECTOMY, PARTIAL PALMAR WITH RELEASE OF SINGLE DIGIT INCLUDING PROXIMAL
FASCIECTOMY, PARTIAL PALMAR WITH RELEASE OF SINGLE DIGIT INCLUDING PROXIMAL
SYNOVECTOMY, CARPOMETACARPAL JOINT
SYNOVECTOMY, METACARPOPHALANGEAL JOINT INCLUDING INTRINSIC RELEASE AND EXTENSOR
SYNOVECTOMY, PROXIMAL INTERPHALANGEAL JOINT, INCLUDING EXTENSOR RECONSTRUCTION,
SYNOVECTOMY, TENDON SHEATH, RADICAL (TENOSYNOVECTOMY), FLEXOR TENDON, PALM
EXCISION OF LESION OF TENDON SHEATH OR JOINT CAPSULE (EG, CYST, MUCOUS CYST, OR
EXCISION OF TENDON, PALM, FLEXOR OR EXTENSOR, SINGLE, EACH TENDON
EXCISION OF TENDON, FINGER, FLEXOR OR EXTENSOR, EACH TENDON
SESAMOIDECTOMY, THUMB OR FINGER (SEPARATE PROCEDURE)
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF METACARPAL;
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF METACARPAL; WITH
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL, MIDDLE, OR
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL, MIDDLE, OR
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG,
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG,
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG,
RADICAL RESECTION OF TUMOR, METACARPAL
RADICAL RESECTION OF TUMOR, PROXIMAL OR MIDDLE PHALANX OF FINGER
RADICAL RESECTION OF TUMOR, DISTAL PHALANX OF FINGER
REMOVAL OF IMPLANT FROM FINGER OR HAND
MANIPULATION, FINGER JOINT, UNDER ANESTHESIA, EACH JOINT
Manipulation, palmar fascial cord (ie, Dupuytren’s cord), post enzyme injection
REPAIR OR ADVANCEMENT, FLEXOR TENDON, NOT IN ZONE 2 DIGITAL FLEXOR TENDON
REPAIR OR ADVANCEMENT, FLEXOR TENDON, IN ZONE 2 DIGITAL FLEXOR TENDON SHEATH
REPAIR OR ADVANCEMENT, FLEXOR TENDON, IN ZONE 2 DIGITAL FLEXOR TENDON SHEATH
REPAIR OR ADVANCEMENT, FLEXOR TENDON, IN ZONE 2 DIGITAL FLEXOR TENDON SHEATH
REPAIR OR ADVANCEMENT OF PROFUNDUS TENDON, WITH INTACT SUPERFICIALIS TENDON;
REPAIR OR ADVANCEMENT OF PROFUNDUS TENDON, WITH INTACT SUPERFICIALIS TENDON;
REPAIR OR ADVANCEMENT OF PROFUNDUS TENDON, WITH INTACT SUPERFICIALIS TENDON;
EXCISION FLEXOR TENDON, WITH IMPLANTATION OF SYNTHETIC ROD FOR DELAYED TENDON
REMOVAL OF SYNTHETIC ROD AND INSERTION OF FLEXOR TENDON GRAFT, HAND OR FINGER
REPAIR, EXTENSOR TENDON, HAND, PRIMARY OR SECONDARY; WITHOUT FREE GRAFT, EACH
REPAIR, EXTENSOR TENDON, HAND, PRIMARY OR SECONDARY; WITH FREE GRAFT (INCLUDES
EXCISION OF EXTENSOR TENDON, WITH IMPLANTATION OF SYNTHETIC ROD FOR DELAYED
REMOVAL OF SYNTHETIC ROD AND INSERTION OF EXTENSOR TENDON GRAFT (INCLUDES
REPAIR, EXTENSOR TENDON, FINGER, PRIMARY OR SECONDARY; WITHOUT FREE GRAFT, EACH
REPAIR, EXTENSOR TENDON, FINGER, PRIMARY OR SECONDARY; WITH FREE GRAFT
REPAIR OF EXTENSOR TENDON, CENTRAL SLIP, SECONDARY (EG, BOUTONNIERE DEFORMITY);
REPAIR OF EXTENSOR TENDON, CENTRAL SLIP, SECONDARY (EG, BOUTONNIERE DEFORMITY);
CLOSED TREATMENT OF DISTAL EXTENSOR TENDON INSERTION, WITH OR WITHOUT
REPAIR OF EXTENSOR TENDON, DISTAL INSERTION, PRIMARY OR SECONDARY; WITHOUT
REPAIR OF EXTENSOR TENDON, DISTAL INSERTION, PRIMARY OR SECONDARY; WITH FREE
REALIGNMENT OF EXTENSOR TENDON, HAND, EACH TENDON
TENOLYSIS, FLEXOR TENDON; PALM OR FINGER, EACH TENDON
TENOLYSIS, FLEXOR TENDON; PALM AND FINGER, EACH TENDON
TENOLYSIS, EXTENSOR TENDON, HAND OR FINGER, EACH TENDON
TENOLYSIS, COMPLEX, EXTENSOR TENDON, FINGER, INCLUDING FOREARM, EACH TENDON
TENOTOMY, FLEXOR, PALM, OPEN, EACH TENDON
TENOTOMY, FLEXOR, FINGER, OPEN, EACH TENDON
TENOTOMY, EXTENSOR, HAND OR FINGER, OPEN, EACH TENDON
TENODESIS; OF PROXIMAL INTERPHALANGEAL JOINT, EACH JOINT
TENODESIS; OF DISTAL JOINT, EACH JOINT
LENGTHENING OF TENDON, EXTENSOR, HAND OR FINGER, EACH TENDON
SHORTENING OF TENDON, EXTENSOR, HAND OR FINGER, EACH TENDON
LENGTHENING OF TENDON, FLEXOR, HAND OR FINGER, EACH TENDON
SHORTENING OF TENDON, FLEXOR, HAND OR FINGER, EACH TENDON
TRANSFER OR TRANSPLANT OF TENDON, CARPOMETACARPAL AREA OR DORSUM OF HAND;
TRANSFER OR TRANSPLANT OF TENDON, CARPOMETACARPAL AREA OR DORSUM OF HAND; WITH
TRANSFER OR TRANSPLANT OF TENDON, PALMAR; WITHOUT FREE TENDON GRAFT, EACH TENDON
TRANSFER OR TRANSPLANT OF TENDON, PALMAR; WITH FREE TENDON GRAFT (INCLUDES
OPPONENSPLASTY; SUPERFICIALIS TENDON TRANSFER TYPE, EACH TENDON
OPPONENSPLASTY; TENDON TRANSFER WITH GRAFT (INCLUDES OBTAINING GRAFT), EACH
OPPONENSPLASTY; HYPOTHENAR MUSCLE TRANSFER
OPPONENSPLASTY; OTHER METHODS
TRANSFER OF TENDON TO RESTORE INTRINSIC FUNCTION; RING AND SMALL FINGER
TRANSFER OF TENDON TO RESTORE INTRINSIC FUNCTION; ALL FOUR FINGERS
CORRECTION CLAW FINGER, OTHER METHODS
RECONSTRUCTION OF TENDON PULLEY, EACH TENDON; WITH LOCAL TISSUES (SEPARATE
RECONSTRUCTION OF TENDON PULLEY, EACH TENDON; WITH TENDON OR FASCIAL GRAFT
RELEASE OF THENAR MUSCLE(S) (EG, THUMB CONTRACTURE)
CROSS INTRINSIC TRANSFER, EACH TENDON
CAPSULODESIS, METACARPOPHALANGEAL JOINT; SINGLE DIGIT
CAPSULODESIS, METACARPOPHALANGEAL JOINT; TWO DIGITS
CAPSULODESIS, METACARPOPHALANGEAL JOINT; THREE OR FOUR DIGITS
CAPSULECTOMY OR CAPSULOTOMY; METACARPOPHALANGEAL JOINT, EACH JOINT
CAPSULECTOMY OR CAPSULOTOMY; INTERPHALANGEAL JOINT, EACH JOINT
ARTHROPLASTY, METACARPOPHALANGEAL JOINT; EACH JOINT
ARTHROPLASTY, METACARPOPHALANGEAL JOINT; WITH PROSTHETIC IMPLANT, EACH JOINT
ARTHROPLASTY, INTERPHALANGEAL JOINT; EACH JOINT
ARTHROPLASTY, INTERPHALANGEAL JOINT; WITH PROSTHETIC IMPLANT, EACH JOINT
REPAIR OF COLLATERAL LIGAMENT, METACARPOPHALANGEAL OR INTERPHALANGEAL JOINT
RECONSTRUCTION, COLLATERAL LIGAMENT, METACARPOPHALANGEAL JOINT, SINGLE; WITH
RECONSTRUCTION, COLLATERAL LIGAMENT, METACARPOPHALANGEAL JOINT, SINGLE; WITH
RECONSTRUCTION, COLLATERAL LIGAMENT, INTERPHALANGEAL JOINT, SINGLE, INCLUDING
REPAIR NON-UNION, METACARPAL OR PHALANX, (INCLUDES OBTAINING BONE GRAFT WITH OR
REPAIR AND RECONSTRUCTION, FINGER, VOLAR PLATE, INTERPHALANGEAL JOINT
POLLICIZATION OF A DIGIT
TRANSFER, FINGER TO ANOTHER POSITION WITHOUT MICROVASCULAR ANASTOMOSIS
REPAIR OF SYNDACTYLY (WEB FINGER) EACH WEB SPACE; WITH SKIN FLAPS
REPAIR OF SYNDACTYLY (WEB FINGER) EACH WEB SPACE; WITH SKIN FLAPS AND GRAFTS
REPAIR OF SYNDACTYLY (WEB FINGER) EACH WEB SPACE; COMPLEX (EG, INVOLVING BONE,
OSTEOTOMY; METACARPAL, EACH
OSTEOTOMY; PHALANX OF FINGER, EACH
OSTEOPLASTY, LENGTHENING, METACARPAL OR PHALANX
REPAIR CLEFT HAND
RECONSTRUCTION OF POLYDACTYLOUS DIGIT, SOFT TISSUE AND BONE
REPAIR MACRODACTYLIA, EACH DIGIT
REPAIR, INTRINSIC MUSCLES OF HAND, EACH MUSCLE
RELEASE, INTRINSIC MUSCLES OF HAND, EACH MUSCLE
EXCISION OF CONSTRICTING RING OF FINGER, WITH MULTIPLE Z-PLASTIES
CLOSED TREATMENT OF METACARPAL FRACTURE, SINGLE; WITHOUT MANIPULATION, EACH BONE
CLOSED TREATMENT OF METACARPAL FRACTURE, SINGLE; WITH MANIPULATION, EACH BONE
CLOSED TREATMENT OF METACARPAL FRACTURE, WITH MANIPULATION, WITH EXTERNAL
PERCUTANEOUS SKELETAL FIXATION OF METACARPAL FRACTURE, EACH BONE
OPEN TREATMENT OF METACARPAL FRACTURE, SINGLE, INCLUDES INTERNAL FIXATION, WHEN
CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION, THUMB, WITH MANIPULATION
CLOSED TREATMENT OF CARPOMETACARPAL FRACTURE DISLOCATION, THUMB (BENNETT
PERCUTANEOUS SKELETAL FIXATION OF CARPOMETACARPAL FRACTURE DISLOCATION, THUMB (B
OPEN TREATMENT OF CARPOMETACARPAL FRACTURE DISLOCATION, THUMB (BENNETT FRACTURE)
CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB, WITH
CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB, WITH
PERCUTANEOUS SKELETAL FIXATION OF CARPOMETACARPAL DISLOCATION, OTHER THAN
OPEN TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB; INCLUDES INTERN
OPEN TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB; COMPLEX,
CLOSED TREATMENT OF METACARPOPHALANGEAL DISLOCATION, SINGLE, WITH MANIPULATION;
CLOSED TREATMENT OF METACARPOPHALANGEAL DISLOCATION, SINGLE, WITH MANIPULATION;
PERCUTANEOUS SKELETAL FIXATION OF METACARPOPHALANGEAL DISLOCATION, SINGLE, WITH
OPEN TREATMENT OF METACARPOPHALANGEAL DISLOCATION, SINGLE, INCLUDES INTERNAL FIX
CLOSED TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX,
CLOSED TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX,
PERCUTANEOUS SKELETAL FIXATION OF UNSTABLE PHALANGEAL SHAFT FRACTURE, PROXIMAL
OPEN TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER
CLOSED TREATMENT OF ARTICULAR FRACTURE, INVOLVING METACARPOPHALANGEAL OR
CLOSED TREATMENT OF ARTICULAR FRACTURE, INVOLVING METACARPOPHALANGEAL OR
OPEN TREATMENT OF ARTICULAR FRACTURE, INVOLVING METACARPOPHALANGEAL OR INTERPHAL
CLOSED TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB; WITHOUT
CLOSED TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB; WITH
PERCUTANEOUS SKELETAL FIXATION OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB,
OPEN TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB, INCLUDES INTERNAL
CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE, WITH
CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE, WITH
PERCUTANEOUS SKELETAL FIXATION OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE,
OPEN TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, INCLUDES INTERNAL FIXATION,
FUSION IN OPPOSITION, THUMB, WITH AUTOGENOUS GRAFT (INCLUDES OBTAINING GRAFT)
ARTHRODESIS, CARPOMETACARPAL JOINT, THUMB, WITH OR WITHOUT INTERNAL FIXATION;
ARTHRODESIS, CARPOMETACARPAL JOINT, THUMB, WITH OR WITHOUT INTERNAL FIXATION;
ARTHRODESIS, CARPOMETACARPAL JOINT, DIGIT, OTHER THAN THUMB, EACH;
ARTHRODESIS, CARPOMETACARPAL JOINT, DIGIT, OTHER THAN THUMB, EACH; WITH
ARTHRODESIS, METACARPOPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION;
ARTHRODESIS, METACARPOPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION; WITH
ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION;
ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION; EACH
ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION; WITH
ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION; WITH
AMPUTATION, METACARPAL, WITH FINGER OR THUMB (RAY AMPUTATION), SINGLE, WITH OR W
AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX,
AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX,
UNLISTED PROCEDURE, HANDS OR FINGERS
INCISION AND DRAINAGE, PELVIS OR HIP JOINT AREA; DEEP ABSCESS OR HEMATOMA
INCISION AND DRAINAGE, PELVIS OR HIP JOINT AREA; INFECTED BURSA
TENOTOMY, ADDUCTOR OF HIP, PERCUTANEOUS (SEPARATE PROCEDURE)
TENOTOMY, ADDUCTOR OF HIP, OPEN
TENOTOMY, ADDUCTOR, SUBCUTANEOUS, OPEN, WITH OBTURATOR NEURECTOMY
TENOTOMY, ABDUCTORS AND/OR EXTENSOR(S) OF HIP, OPEN (SEPARATE PROCEDURE)
Decompression fasciotomy(ies), pelvic (buttock) compartment(s) (eg, gluteus medi
ARTHROTOMY, HIP, INCLUDING EXPLORATION OR REMOVAL OF LOOSE OR FOREIGN BODY
DENERVATION, HIP JOINT, INTRAPELVIC OR EXTRAPELVIC INTRA-ARTICULAR BRANCHES OF
BIOPSY, SOFT TISSUE OF PELVIS AND HIP AREA; SUPERFICIAL
BIOPSY, SOFT TISSUE OF PELVIS AND HIP AREA; DEEP, SUBFASCIAL OR INTRAMUSCULAR
Excision, tumor, soft tissue of pelvis and hip area, subcutaneous; 3 cm or great
Excision, tumor, soft tissue of pelvis and hip area, subfascial (eg, intramuscul
EXCISION, TUMOR, SOFT TISSUE OF PELVIS AND HIP AREA, SUBCUTANEOUS; LESS THAN 3 C
EXCISION, TUMOR, SOFT TISSUE OF PELVIS AND HIP AREA, SUBFASCIAL (EG, INTRAMUSCUL
RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF PELVIS AND H
ARTHROTOMY, WITH BIOPSY; SACROILIAC JOINT
ARTHROTOMY, WITH BIOPSY; HIP JOINT
Decompression fasciotomy(ies), pelvic (buttock) compartment(s) (eg, gluteus medi
Radical resection of tumor (eg, malignant neoplasm), soft tissue of pelvis and h
EXCISION; ISCHIAL BURSA
EXCISION; TROCHANTERIC BURSA OR CALCIFICATION
EXCISION OF BONE CYST OR BENIGN TUMOR, WING OF ILIUM, SYMPHYSIS PUBIS, OR GREATE
EXCISION OF BONE CYST OR BENIGN TUMOR, WING OF ILIUM, SYMPHYSIS PUBIS, OR GREATE
EXCISION OF BONE CYST OR BENIGN TUMOR, WING OF ILIUM, SYMPHYSIS PUBIS, OR GREATE
COCCYGECTOMY, PRIMARY
REMOVAL OF FOREIGN BODY, PELVIS OR HIP; SUBCUTANEOUS TISSUE
REMOVAL OF FOREIGN BODY, PELVIS OR HIP; DEEP (SUBFASCIAL OR INTRAMUSCULAR)
RELEASE OR RECESSION, HAMSTRING, PROXIMAL
TRANSFER, ADDUCTOR TO ISCHIUM
TRANSFER EXTERNAL OBLIQUE MUSCLE TO GREATER TROCHANTER INCLUDING FASCIAL OR
TRANSFER PARASPINAL MUSCLE TO HIP (INCLUDES FASCIAL OR TENDON EXTENSION GRAFT)
TRANSFER ILIOPSOAS; TO GREATER TROCHANTER OF FEMUR
TRANSFER ILIOPSOAS; TO FEMORAL NECK
OPEN TREATMENT OF SLIPPED FEMORAL EPIPHYSIS; OSTEOPLASTY OF FEMORAL NECK
CLOSED TREATMENT OF PELVIC RING FRACTURE, DISLOCATION, DIASTASIS OR SUBLUXATION;
CLOSED TREATMENT OF PELVIC RING FRACTURE, DISLOCATION, DIASTASIS OR
CLOSED TREATMENT OF COCCYGEAL FRACTURE
OPEN TREATMENT OF COCCYGEAL FRACTURE
CLOSED TREATMENT OF ACETABULUM (HIP SOCKET) FRACTURE(S); WITHOUT MANIPULATION
CLOSED TREATMENT OF FEMORAL FRACTURE, PROXIMAL END, NECK; WITHOUT MANIPULATION
PERCUTANEOUS SKELETAL FIXATION OF FEMORAL FRACTURE, PROXIMAL END, NECK
CLOSED TREATMENT OF INTERTROCHANTERIC, PERTROCHANTERIC, OR SUBTROCHANTERIC
CLOSED TREATMENT OF GREATER TROCHANTERIC FRACTURE, WITHOUT MANIPULATION
CLOSED TREATMENT OF HIP DISLOCATION, TRAUMATIC; WITHOUT ANESTHESIA
CLOSED TREATMENT OF HIP DISLOCATION, TRAUMATIC; REQUIRING ANESTHESIA
TREATMENT OF SPONTANEOUS HIP DISLOCATION (DEVELOPMENTAL, INCLUDING CONGENITAL
TREATMENT OF SPONTANEOUS HIP DISLOCATION (DEVELOPMENTAL, INCLUDING CONGENITAL
CLOSED TREATMENT OF POST HIP ARTHROPLASTY DISLOCATION; WITHOUT ANESTHESIA
CLOSED TREATMENT OF POST HIP ARTHROPLASTY DISLOCATION; REQUIRING REGIONAL OR
CLOSED TREATMENT OF FEMORAL FRACTURE, PROXIMAL END, HEAD; WITHOUT MANIPULATION
MANIPULATION, HIP JOINT, REQUIRING GENERAL ANESTHESIA
UNLISTED PROCEDURE, PELVIS OR HIP JOINT
INCISION AND DRAINAGE, DEEP ABSCESS, BURSA, OR HEMATOMA, THIGH OR KNEE REGION
FASCIOTOMY, ILIOTIBIAL (TENOTOMY), OPEN
TENOTOMY, PERCUTANEOUS, ADDUCTOR OR HAMSTRING; SINGLE TENDON (SEPARATE
TENOTOMY, PERCUTANEOUS, ADDUCTOR OR HAMSTRING; MULTIPLE TENDONS
ARTHROTOMY, KNEE, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY (EG,
BIOPSY, SOFT TISSUE OF THIGH OR KNEE AREA; SUPERFICIAL
BIOPSY, SOFT TISSUE OF THIGH OR KNEE AREA; DEEP (SUBFASCIAL OR INTRAMUSCULAR)
NEURECTOMY, HAMSTRING MUSCLE
NEURECTOMY, POPLITEAL (GASTROCNEMIUS)
EXCISION, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBCUTANEOUS; LESS THAN 3 CM
EXCISION, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBFASCIAL (EG, INTRAMUSCULA
EXCISION, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBFASCIAL (EG, INTRAMUSCULA
ARTHROTOMY, KNEE; WITH SYNOVIAL BIOPSY ONLY
ARTHROTOMY, KNEE; INCLUDING JOINT EXPLORATION, BIOPSY, OR REMOVAL OF LOOSE OR
ARTHROTOMY, WITH EXCISION OF SEMILUNAR CARTILAGE (MENISCECTOMY) KNEE; MEDIAL OR
ARTHROTOMY, WITH EXCISION OF SEMILUNAR CARTILAGE (MENISCECTOMY) KNEE; MEDIAL
ARTHROTOMY, WITH SYNOVECTOMY, KNEE; ANTERIOR OR POSTERIOR
ARTHROTOMY, WITH SYNOVECTOMY, KNEE; ANTERIOR AND POSTERIOR INCLUDING POPLITEAL
Excision, tumor, soft tissue of thigh or knee area, subcutaneous; 3 cm or greate
Excision, tumor, soft tissue of thigh or knee area, subfascial (eg, intramuscula
EXCISION, PREPATELLAR BURSA
EXCISION OF SYNOVIAL CYST OF POPLITEAL SPACE (EG, BAKER'S CYST)
EXCISION OF LESION OF MENISCUS OR CAPSULE (EG, CYST, GANGLION), KNEE
PATELLECTOMY OR HEMIPATELLECTOMY
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF FEMUR;
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF FEMUR; WITH ALLOGRAFT
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF FEMUR; WITH AUTOGRAFT
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF FEMUR; WITH INTERNAL
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE, FEMUR,
Radical resection of tumor (eg, malignant neoplasm), soft tissue of thigh or kne
REMOVAL OF FOREIGN BODY, DEEP, THIGH REGION OR KNEE AREA
SUTURE OF INFRAPATELLAR TENDON; PRIMARY
SUTURE OF INFRAPATELLAR TENDON; SECONDARY RECONSTRUCTION, INCLUDING FASCIAL OR
SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE; PRIMARY
SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE; SECONDARY RECONSTRUCTION,
TENOTOMY, OPEN, HAMSTRING, KNEE TO HIP; SINGLE TENDON
TENOTOMY, OPEN, HAMSTRING, KNEE TO HIP; MULTIPLE TENDONS, ONE LEG
TENOTOMY, OPEN, HAMSTRING, KNEE TO HIP; MULTIPLE TENDONS, BILATERAL
LENGTHENING OF HAMSTRING TENDON; SINGLE TENDON
LENGTHENING OF HAMSTRING TENDON; MULTIPLE TENDONS, ONE LEG
LENGTHENING OF HAMSTRING TENDON; MULTIPLE TENDONS, BILATERAL
TRANSPLANT OR TRANSFER (WITH MUSCLE REDIRECTION OR REROUTING), THIGH (EG, EXTENS
TRANSPLANT OR TRANSFER (WITH MUSCLE REDIRECTION OR REROUTING), THIGH (EG, EXTENS
TRANSFER, TENDON OR MUSCLE, HAMSTRINGS TO FEMUR (EG, EGGER'S TYPE PROCEDURE)
ARTHROTOMY WITH MENISCUS REPAIR, KNEE
REPAIR, PRIMARY, TORN LIGAMENT AND/OR CAPSULE, KNEE; COLLATERAL
REPAIR, PRIMARY, TORN LIGAMENT AND/OR CAPSULE, KNEE; CRUCIATE
REPAIR, PRIMARY, TORN LIGAMENT AND/OR CAPSULE, KNEE; COLLATERAL AND CRUCIATE
AUTOLOGOUS CHONDROCYTE IMPLANTATION, KNEE
OSTEOCHONDRAL ALLOGRAFT, KNEE, OPEN
OSTEOCHONDRAL AUTOGRAFT(S), KNEE, OPEN (EG, MOSAICPLASTY) (INCLUDES HARVESTING O
ANTERIOR TIBIAL TUBERCLEPLASTY (EG, MAQUET TYPE PROCEDURE)
RECONSTRUCTION OF DISLOCATING PATELLA; (EG, HAUSER TYPE PROCEDURE)
RECONSTRUCTION OF DISLOCATING PATELLA; WITH EXTENSOR REALIGNMENT AND/OR MUSCLE
RECONSTRUCTION OF DISLOCATING PATELLA; WITH PATELLECTOMY
LATERAL RETINACULAR RELEASE, OPEN
LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE; EXTRA-ARTICULAR
LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE; INTRA-ARTICULAR (OPEN)
LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE; INTRA-ARTICULAR (OPEN) AND
QUADRICEPSPLASTY (EG, BENNETT OR THOMPSON TYPE)
CAPSULOTOMY, POSTERIOR CAPSULAR RELEASE, KNEE
ARTHROPLASTY, PATELLA; WITHOUT PROSTHESIS
ARTHROPLASTY, PATELLA; WITH PROSTHESIS
ARTHROPLASTY, KNEE, TIBIAL PLATEAU;
ARTHROPLASTY, KNEE, TIBIAL PLATEAU; WITH DEBRIDEMENT AND PARTIAL SYNOVECTOMY
ARTHROPLASTY, FEMORAL CONDYLES OR TIBIAL PLATEAU(S), KNEE;
ARTHROPLASTY, FEMORAL CONDYLES OR TIBIAL PLATEAU(S), KNEE; WITH DEBRIDEMENT AND
ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL OR LATERAL COMPARTMENT
ARREST, EPIPHYSEAL, ANY METHOD (EG, EPIPHYSIODESIS); DISTAL FEMUR
ARREST, EPIPHYSEAL, ANY METHOD (EG, EPIPHYSIODESIS); COMBINED DISTAL FEMUR,
DECOMPRESSION FASCIOTOMY, THIGH AND/OR KNEE, ONE COMPARTMENT (FLEXOR OR
DECOMPRESSION FASCIOTOMY, THIGH AND/OR KNEE, ONE COMPARTMENT (FLEXOR OR
DECOMPRESSION FASCIOTOMY, THIGH AND/OR KNEE, MULTIPLE COMPARTMENTS;
DECOMPRESSION FASCIOTOMY, THIGH AND/OR KNEE, MULTIPLE COMPARTMENTS; WITH
CLOSED TREATMENT OF FEMORAL SHAFT FRACTURE, WITHOUT MANIPULATION
CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR FEMORAL FRACTURE WITH OR
CLOSED TREATMENT OF FEMORAL SHAFT FRACTURE, WITH MANIPULATION, WITH OR WITHOUT
CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR FEMORAL FRACTURE WITH OR
CLOSED TREATMENT OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR LATERAL CONDYLE,
PERCUTANEOUS SKELETAL FIXATION OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR
CLOSED TREATMENT OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR LATERAL CONDYLE,
CLOSED TREATMENT OF DISTAL FEMORAL EPIPHYSEAL SEPARATION; WITHOUT MANIPULATION
CLOSED TREATMENT OF DISTAL FEMORAL EPIPHYSEAL SEPARATION; WITH MANIPULATION,
CLOSED TREATMENT OF PATELLAR FRACTURE, WITHOUT MANIPULATION
OPEN TREATMENT OF PATELLAR FRACTURE, WITH INTERNAL FIXATION AND/OR PARTIAL OR
CLOSED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); WITHOUT MANIPULATION
CLOSED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); WITH OR WITHOUT
CLOSED TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY FRACTURE(S) OF
CLOSED TREATMENT OF KNEE DISLOCATION; WITHOUT ANESTHESIA
CLOSED TREATMENT OF KNEE DISLOCATION; REQUIRING ANESTHESIA
CLOSED TREATMENT OF PATELLAR DISLOCATION; WITHOUT ANESTHESIA
CLOSED TREATMENT OF PATELLAR DISLOCATION; REQUIRING ANESTHESIA
OPEN TREATMENT OF PATELLAR DISLOCATION, WITH OR WITHOUT PARTIAL OR TOTAL
MANIPULATION OF KNEE JOINT UNDER GENERAL ANESTHESIA (INCLUDES APPLICATION OF TRA
AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL; SECONDARY CLOSURE OR SCAR REVISION
UNLISTED PROCEDURE, FEMUR OR KNEE
DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL COMPARTMENTS ONLY
DECOMPRESSION FASCIOTOMY, LEG; POSTERIOR COMPARTMENT(S) ONLY
DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL, AND POSTERIOR
INCISION AND DRAINAGE, LEG OR ANKLE; DEEP ABSCESS OR HEMATOMA
INCISION AND DRAINAGE, LEG OR ANKLE; INFECTED BURSA
TENOTOMY, PERCUTANEOUS, ACHILLES TENDON (SEPARATE PROCEDURE); LOCAL ANESTHESIA
TENOTOMY, PERCUTANEOUS, ACHILLES TENDON (SEPARATE PROCEDURE); GENERAL ANESTHESIA
INCISION (EG, OSTEOMYELITIS OR BONE ABSCESS), LEG OR ANKLE
ARTHROTOMY, ANKLE, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY
ARTHROTOMY, POSTERIOR CAPSULAR RELEASE, ANKLE, WITH OR WITHOUT ACHILLES TENDON
BIOPSY, SOFT TISSUE OF LEG OR ANKLE AREA; SUPERFICIAL
BIOPSY, SOFT TISSUE OF LEG OR ANKLE AREA; DEEP (SUBFASCIAL OR INTRAMUSCULAR)
RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF LEG OR ANKLE
Radical resection of tumor (eg, malignant neoplasm), soft tissue of leg or ankle
EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA, SUBCUTANEOUS; LESS THAN 3 CM
EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA, SUBFASCIAL (EG, INTRAMUSCULAR
ARTHROTOMY, ANKLE, WITH JOINT EXPLORATION, WITH OR WITHOUT BIOPSY, WITH OR WITHO
ARTHROTOMY, WITH SYNOVECTOMY, ANKLE;
ARTHROTOMY, WITH SYNOVECTOMY, ANKLE; INCLUDING TENOSYNOVECTOMY
EXCISION OF LESION OF TENDON SHEATH OR CAPSULE (EG, CYST OR GANGLION), LEG
Excision, tumor, soft tissue of leg or ankle area, subcutaneous; 3 cm or greater
Excision, tumor, soft tissue of leg or ankle area, subfascial (eg, intramuscular
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TIBIA OR FIBULA;
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TIBIA OR FIBULA; WITH
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TIBIA OR FIBULA; WITH
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY), BONE (EG, OST
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY), BONE (EG, OST
RADICAL RESECTION OF TUMOR; TALUS OR CALCANEUS
REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLES TENDON;
REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLES TENDON; WITH GRAFT
REPAIR, SECONDARY, ACHILLES TENDON, WITH OR WITHOUT GRAFT
REPAIR, FASCIAL DEFECT OF LEG
REPAIR, FLEXOR TENDON, LEG; PRIMARY, WITHOUT GRAFT, EACH TENDON
REPAIR, FLEXOR TENDON, LEG; SECONDARY, WITH OR WITHOUT GRAFT, EACH TENDON
REPAIR, EXTENSOR TENDON, LEG; PRIMARY, WITHOUT GRAFT, EACH TENDON
REPAIR, EXTENSOR TENDON, LEG; SECONDARY, WITH OR WITHOUT GRAFT, EACH TENDON
REPAIR, DISLOCATING PERONEAL TENDONS; WITHOUT FIBULAR OSTEOTOMY
REPAIR, DISLOCATING PERONEAL TENDONS; WITH FIBULAR OSTEOTOMY
TENOLYSIS, FLEXOR OR EXTENSOR TENDON, LEG AND/OR ANKLE; SINGLE, EACH TENDON
TENOLYSIS, FLEXOR OR EXTENSOR TENDON, LEG AND/OR ANKLE; MULTIPLE TENDONS
LENGTHENING OR SHORTENING OF TENDON, LEG OR ANKLE; SINGLE TENDON (SEPARATE
LENGTHENING OR SHORTENING OF TENDON, LEG OR ANKLE; MULTIPLE TENDONS (THROUGH
GASTROCNEMIUS RECESSION (EG, STRAYER PROCEDURE)
TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE REDIRECTION OR REROUTING);
TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE REDIRECTION OR REROUTING);
TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE REDIRECTION OR REROUTING);
REPAIR, PRIMARY, DISRUPTED LIGAMENT, ANKLE; COLLATERAL
REPAIR, PRIMARY, DISRUPTED LIGAMENT, ANKLE; BOTH COLLATERAL LIGAMENTS
REPAIR, SECONDARY, DISRUPTED LIGAMENT, ANKLE, COLLATERAL (EG, WATSON-JONES
ARTHROPLASTY, ANKLE;
REMOVAL OF ANKLE IMPLANT
OSTEOTOMY; TIBIA
OSTEOTOMY; FIBULA
OSTEOTOMY; TIBIA AND FIBULA
REPAIR OF NONUNION OR MALUNION, TIBIA; WITHOUT GRAFT, (EG, COMPRESSION
REPAIR OF NONUNION OR MALUNION, TIBIA; WITH SLIDING GRAFT
REPAIR OF FIBULA NONUNION AND/OR MALUNION WITH INTERNAL FIXATION
ARREST, EPIPHYSEAL (EPIPHYSIODESIS), OPEN; DISTAL TIBIA
ARREST, EPIPHYSEAL (EPIPHYSIODESIS), OPEN; DISTAL FIBULA
ARREST, EPIPHYSEAL (EPIPHYSIODESIS), OPEN; DISTAL TIBIA AND FIBULA
ARREST, EPIPHYSEAL (EPIPHYSIODESIS), ANY METHOD, COMBINED, PROXIMAL AND DISTAL
ARREST, EPIPHYSEAL (EPIPHYSIODESIS), ANY METHOD, COMBINED, PROXIMAL AND DISTAL
PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT
CLOSED TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE); WI
CLOSED TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE);
PERCUTANEOUS SKELETAL FIXATION OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT
OPEN TREATMENT OF TIBIAL SHAFT FRACTURE, (WITH OR WITHOUT FIBULAR FRACTURE)
TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE) BY
CLOSED TREATMENT OF MEDIAL MALLEOLUS FRACTURE; WITHOUT MANIPULATION
CLOSED TREATMENT OF MEDIAL MALLEOLUS FRACTURE; WITH MANIPULATION, WITH OR
OPEN TREATMENT OF MEDIAL MALLEOLUS FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PE
CLOSED TREATMENT OF POSTERIOR MALLEOLUS FRACTURE; WITHOUT MANIPULATION
CLOSED TREATMENT OF POSTERIOR MALLEOLUS FRACTURE; WITH MANIPULATION
OPEN TREATMENT OF POSTERIOR MALLEOLUS FRACTURE, INCLUDES INTERNAL FIXATION, WHEN
CLOSED TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE; WITHOUT MANIPULATION
CLOSED TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE; WITH MANIPULATION
OPEN TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE, INCLUDES INTERNAL FIXATION,
CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS); WITHOUT
CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS); WITH
OPEN TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS), INCLUDES INTERNAL
CLOSED TREATMENT OF BIMALLEOLAR ANKLE FRACTURE (EG, LATERAL AND MEDIAL MALLEOLI,
CLOSED TREATMENT OF BIMALLEOLAR ANKLE FRACTURE (EG, LATERAL AND MEDIAL MALLEOLI,
OPEN TREATMENT OF BIMALLEOLAR ANKLE FRACTURE (EG, LATERAL AND MEDIAL MALLEOLI, O
CLOSED TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE; WITHOUT MANIPULATION
CLOSED TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE; WITH MANIPULATION
OPEN TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE, INCLUDES INTERNAL FIXATION, WHEN
OPEN TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE, INCLUDES INTERNAL FIXATION, WHEN
CLOSED TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR PORTION OF DISTAL
CLOSED TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR PORTION OF DISTAL
OPEN TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR SURFACE/PORTION OF DISTAL
OPEN TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR SURFACE/PORTION OF DISTAL
OPEN TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR SURFACE/PORTION OF DISTAL
OPEN TREATMENT OF DISTAL TIBIOFIBULAR JOINT (SYNDESMOSIS) DISRUPTION, INCLUDES I
CLOSED TREATMENT OF PROXIMAL TIBIOFIBULAR JOINT DISLOCATION; WITHOUT ANESTHESIA
CLOSED TREATMENT OF PROXIMAL TIBIOFIBULAR JOINT DISLOCATION; REQUIRING
OPEN TREATMENT OF PROXIMAL TIBIOFIBULAR JOINT DISLOCATION, INCLUDES INTERNAL FIX
CLOSED TREATMENT OF ANKLE DISLOCATION; WITHOUT ANESTHESIA
CLOSED TREATMENT OF ANKLE DISLOCATION; REQUIRING ANESTHESIA, WITH OR WITHOUT
OPEN TREATMENT OF ANKLE DISLOCATION, WITH OR WITHOUT PERCUTANEOUS SKELETAL
OPEN TREATMENT OF ANKLE DISLOCATION, WITH OR WITHOUT PERCUTANEOUS SKELETAL
MANIPULATION OF ANKLE UNDER GENERAL ANESTHESIA (INCLUDES APPLICATION OF TRACTION
ARTHRODESIS, ANKLE, OPEN
ARTHRODESIS, TIBIOFIBULAR JOINT, PROXIMAL OR DISTAL
AMPUTATION, LEG, THROUGH TIBIA AND FIBULA; SECONDARY CLOSURE OR SCAR REVISION
ANKLE DISARTICULATION
DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL COMPARTMENTS ONLY, WITH D
DECOMPRESSION FASCIOTOMY, LEG; POSTERIOR COMPARTMENT(S) ONLY, WITH DEBRIDEMENT
DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL, AND POSTERIOR
UNLISTED PROCEDURE, LEG OR ANKLE
INCISION AND DRAINAGE, BURSA, FOOT
INCISION AND DRAINAGE BELOW FASCIA, WITH OR WITHOUT TENDON SHEATH INVOLVEMENT,
INCISION AND DRAINAGE BELOW FASCIA, WITH OR WITHOUT TENDON SHEATH INVOLVEMENT,
INCISION, BONE CORTEX (EG, OSTEOMYELITIS OR BONE ABSCESS), FOOT
FASCIOTOMY, FOOT AND/OR TOE
TENOTOMY, PERCUTANEOUS, TOE; SINGLE TENDON
TENOTOMY, PERCUTANEOUS, TOE; MULTIPLE TENDONS
ARTHROTOMY, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN
ARTHROTOMY, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN
ARTHROTOMY, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN
RELEASE, TARSAL TUNNEL (POSTERIOR TIBIAL NERVE DECOMPRESSION)
Excision, tumor, soft tissue of foot or toe, subcutaneous; 1.5 cm or greater
Excision, tumor, soft tissue of foot or toe, subfascial (eg, intramuscular); 1.5
EXCISION, TUMOR, SOFT TISSUE OF FOOT OR TOE, SUBCUTANEOUS; LESS THAN 1.5 CM
EXCISION, TUMOR, SOFT TISSUE OF FOOT OR TOE, SUBFASCIAL (EG, INTRAMUSCULAR); LES
RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF FOOT OR TOE;
Radical resection of tumor (eg, malignant neoplasm), soft tissue of foot or toe;
ARTHROTOMY WITH BIOPSY; INTERTARSAL OR TARSOMETATARSAL JOINT
ARTHROTOMY WITH BIOPSY; METATARSOPHALANGEAL JOINT
ARTHROTOMY WITH BIOPSY; INTERPHALANGEAL JOINT
NEURECTOMY, INTRINSIC MUSCULATURE OF FOOT
FASCIECTOMY, PLANTAR FASCIA; PARTIAL (SEPARATE PROCEDURE)
FASCIECTOMY, PLANTAR FASCIA; RADICAL (SEPARATE PROCEDURE)
SYNOVECTOMY; INTERTARSAL OR TARSOMETATARSAL JOINT, EACH
SYNOVECTOMY; METATARSOPHALANGEAL JOINT, EACH
EXCISION, INTERDIGITAL (MORTON) NEUROMA, SINGLE, EACH
SYNOVECTOMY, TENDON SHEATH, FOOT; FLEXOR
SYNOVECTOMY, TENDON SHEATH, FOOT; EXTENSOR
EXCISION OF LESION, TENDON, TENDON SHEATH, OR CAPSULE (INCLUDING SYNOVECTOMY)
EXCISION OF LESION, TENDON, TENDON SHEATH, OR CAPSULE (INCLUDING SYNOVECTOMY)
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TALUS OR CALCANEUS;
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TALUS OR CALCANEUS; WITH
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TALUS OR CALCANEUS; WITH
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TARSAL OR METATARSAL,
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TARSAL OR METATARSAL,
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TARSAL OR METATARSAL,
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, PHALANGES OF FOOT
OSTECTOMY, PARTIAL EXCISION, FIFTH METATARSAL HEAD (BUNIONETTE) (SEPARATE
OSTECTOMY, COMPLETE EXCISION; FIRST METATARSAL HEAD
OSTECTOMY, COMPLETE EXCISION; OTHER METATARSAL HEAD (SECOND, THIRD OR FOURTH)
OSTECTOMY, COMPLETE EXCISION; FIFTH METATARSAL HEAD
OSTECTOMY, COMPLETE EXCISION; ALL METATARSAL HEADS, WITH PARTIAL PROXIMAL
OSTECTOMY, EXCISION OF TARSAL COALITION
OSTECTOMY, CALCANEUS;
OSTECTOMY, CALCANEUS; FOR SPUR, WITH OR WITHOUT PLANTAR FASCIAL RELEASE
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR
RESECTION, PARTIAL OR COMPLETE, PHALANGEAL BASE, EACH TOE
TALECTOMY (ASTRAGALECTOMY)
METATARSECTOMY
PHALANGECTOMY, TOE, EACH TOE
RESECTION, CONDYLE(S), DISTAL END OF PHALANX, EACH TOE
HEMIPHALANGECTOMY OR INTERPHALANGEAL JOINT EXCISION, TOE, PROXIMAL END OF
RADICAL RESECTION OF TUMOR; TARSAL (EXCEPT TALUS OR CALCANEUS)
RADICAL RESECTION OF TUMOR; METATARSAL
RADICAL RESECTION OF TUMOR; PHALANX OF TOE
REMOVAL OF FOREIGN BODY, FOOT; SUBCUTANEOUS
REMOVAL OF FOREIGN BODY, FOOT; DEEP
REMOVAL OF FOREIGN BODY, FOOT; COMPLICATED
REPAIR, TENDON, FLEXOR, FOOT; PRIMARY OR SECONDARY, WITHOUT FREE GRAFT, EACH TEN
REPAIR, TENDON, FLEXOR, FOOT; SECONDARY WITH FREE GRAFT, EACH TENDON (INCLUDES
REPAIR, TENDON, EXTENSOR, FOOT; PRIMARY OR SECONDARY, EACH TENDON
REPAIR, TENDON, EXTENSOR, FOOT; SECONDARY WITH FREE GRAFT, EACH TENDON
TENOLYSIS, FLEXOR, FOOT; SINGLE TENDON
TENOLYSIS, FLEXOR, FOOT; MULTIPLE TENDONS
TENOLYSIS, EXTENSOR, FOOT; SINGLE TENDON
TENOLYSIS, EXTENSOR, FOOT; MULTIPLE TENDONS
TENOTOMY, OPEN, TENDON FLEXOR; FOOT, SINGLE OR MULTIPLE TENDON(S) (SEPARATE
TENOTOMY, OPEN, TENDON FLEXOR; TOE, SINGLE TENDON (SEPARATE PROCEDURE)
TENOTOMY, OPEN, EXTENSOR, FOOT OR TOE, EACH TENDON
RECONSTRUCTION (ADVANCEMENT), POSTERIOR TIBIAL TENDON WITH EXCISION OF
TENOTOMY, LENGTHENING, OR RELEASE, ABDUCTOR HALLUCIS MUSCLE
DIVISION OF PLANTAR FASCIA AND MUSCLE (EG, STEINDLER STRIPPING) (SEPARATE
CAPSULOTOMY, MIDFOOT; MEDIAL RELEASE ONLY (SEPARATE PROCEDURE)
CAPSULOTOMY, MIDFOOT; WITH TENDON LENGTHENING
CAPSULOTOMY, MIDFOOT; EXTENSIVE, INCLUDING POSTERIOR TALOTIBIAL CAPSULOTOMY AND
CAPSULOTOMY, MIDTARSAL (EG, HEYMAN TYPE PROCEDURE)
CAPSULOTOMY; METATARSOPHALANGEAL JOINT, WITH OR WITHOUT TENORRHAPHY, EACH JOINT
CAPSULOTOMY; INTERPHALANGEAL JOINT, EACH JOINT (SEPARATE PROCEDURE)
SYNDACTYLIZATION, TOES (EG, WEBBING OR KELIKIAN TYPE PROCEDURE)
CORRECTION, HAMMERTOE (EG, INTERPHALANGEAL FUSION, PARTIAL OR TOTAL
CORRECTION, COCK-UP FIFTH TOE, WITH PLASTIC SKIN CLOSURE (EG, RUIZ-MORA TYPE
OSTECTOMY, PARTIAL, EXOSTECTOMY OR CONDYLECTOMY, METATARSAL HEAD, EACH
HALLUX RIGIDUS CORRECTION WITH CHEILECTOMY, DEBRIDEMENT AND CAPSULAR RELEASE OF
CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUT SESAMOIDECTOMY; SIMPLE
CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUT SESAMOIDECTOMY; KELLER,
CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUT SESAMOIDECTOMY; RESECTION
CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUT SESAMOIDECTOMY; WITH TENDON
CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUT SESAMOIDECTOMY; WITH
CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUT SESAMOIDECTOMY; LAPIDUS
CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUT SESAMOIDECTOMY; BY PHALANX
CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUT SESAMOIDECTOMY; BY DOUBLE
OSTEOTOMY; CALCANEUS (EG, DWYER OR CHAMBERS TYPE PROCEDURE), WITH OR WITHOUT
OSTEOTOMY; TALUS
OSTEOTOMY, TARSAL BONES, OTHER THAN CALCANEUS OR TALUS;
OSTEOTOMY, TARSAL BONES, OTHER THAN CALCANEUS OR TALUS; WITH AUTOGRAFT
OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION,
OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION,
OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION,
OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION,
OSTEOTOMY, SHORTENING, ANGULAR OR ROTATIONAL CORRECTION; PROXIMAL PHALANX,
OSTEOTOMY, SHORTENING, ANGULAR OR ROTATIONAL CORRECTION; OTHER PHALANGES, ANY
RECONSTRUCTION, ANGULAR DEFORMITY OF TOE, SOFT TISSUE PROCEDURES ONLY (EG,
SESAMOIDECTOMY, FIRST TOE (SEPARATE PROCEDURE)
REPAIR, NONUNION OR MALUNION; TARSAL BONES
REPAIR, NONUNION OR MALUNION; METATARSAL, WITH OR WITHOUT BONE GRAFT (INCLUDES
RECONSTRUCTION, TOE, MACRODACTYLY; SOFT TISSUE RESECTION
RECONSTRUCTION, TOE, MACRODACTYLY; REQUIRING BONE RESECTION
RECONSTRUCTION, TOE(S); POLYDACTYLY
RECONSTRUCTION, TOE(S); SYNDACTYLY, WITH OR WITHOUT SKIN GRAFT(S), EACH WEB
RECONSTRUCTION, CLEFT FOOT
CLOSED TREATMENT OF CALCANEAL FRACTURE; WITHOUT MANIPULATION
CLOSED TREATMENT OF CALCANEAL FRACTURE; WITH MANIPULATION
PERCUTANEOUS SKELETAL FIXATION OF CALCANEAL FRACTURE, WITH MANIPULATION
OPEN TREATMENT OF CALCANEAL FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
OPEN TREATMENT OF CALCANEAL FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
CLOSED TREATMENT OF TALUS FRACTURE; WITHOUT MANIPULATION
CLOSED TREATMENT OF TALUS FRACTURE; WITH MANIPULATION
PERCUTANEOUS SKELETAL FIXATION OF TALUS FRACTURE, WITH MANIPULATION
OPEN TREATMENT OF TALUS FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
OPEN OSTEOCHONDRAL AUTOGRAFT, TALUS (INCLUDES OBTAINING GRAFT¿S¿)
TREATMENT OF TARSAL BONE FRACTURE (EXCEPT TALUS AND CALCANEUS); WITHOUT
TREATMENT OF TARSAL BONE FRACTURE (EXCEPT TALUS AND CALCANEUS); WITH
PERCUTANEOUS SKELETAL FIXATION OF TARSAL BONE FRACTURE (EXCEPT TALUS AND
OPEN TREATMENT OF TARSAL BONE FRACTURE (EXCEPT TALUS AND CALCANEUS), INCLUDES IN
CLOSED TREATMENT OF METATARSAL FRACTURE; WITHOUT MANIPULATION, EACH
CLOSED TREATMENT OF METATARSAL FRACTURE; WITH MANIPULATION, EACH
PERCUTANEOUS SKELETAL FIXATION OF METATARSAL FRACTURE, WITH MANIPULATION, EACH
OPEN TREATMENT OF METATARSAL FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORME
CLOSED TREATMENT OF FRACTURE GREAT TOE, PHALANX OR PHALANGES; WITHOUT
CLOSED TREATMENT OF FRACTURE GREAT TOE, PHALANX OR PHALANGES; WITH MANIPULATION
PERCUTANEOUS SKELETAL FIXATION OF FRACTURE GREAT TOE, PHALANX OR PHALANGES,
OPEN TREATMENT OF FRACTURE, GREAT TOE, PHALANX OR PHALANGES, INCLUDES INTERNAL F
CLOSED TREATMENT OF FRACTURE, PHALANX OR PHALANGES, OTHER THAN GREAT TOE;
CLOSED TREATMENT OF FRACTURE, PHALANX OR PHALANGES, OTHER THAN GREAT TOE; WITH
OPEN TREATMENT OF FRACTURE, PHALANX OR PHALANGES, OTHER THAN GREAT TOE, INCLUDES
CLOSED TREATMENT OF SESAMOID FRACTURE
OPEN TREATMENT OF SESAMOID FRACTURE, WITH OR WITHOUT INTERNAL FIXATION
CLOSED TREATMENT OF TARSAL BONE DISLOCATION, OTHER THAN TALOTARSAL; WITHOUT
CLOSED TREATMENT OF TARSAL BONE DISLOCATION, OTHER THAN TALOTARSAL; REQUIRING
PERCUTANEOUS SKELETAL FIXATION OF TARSAL BONE DISLOCATION, OTHER THAN
OPEN TREATMENT OF TARSAL BONE DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN PERF
CLOSED TREATMENT OF TALOTARSAL JOINT DISLOCATION; WITHOUT ANESTHESIA
CLOSED TREATMENT OF TALOTARSAL JOINT DISLOCATION; REQUIRING ANESTHESIA
PERCUTANEOUS SKELETAL FIXATION OF TALOTARSAL JOINT DISLOCATION, WITH
OPEN TREATMENT OF TALOTARSAL JOINT DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN
CLOSED TREATMENT OF TARSOMETATARSAL JOINT DISLOCATION; WITHOUT ANESTHESIA
CLOSED TREATMENT OF TARSOMETATARSAL JOINT DISLOCATION; REQUIRING ANESTHESIA
PERCUTANEOUS SKELETAL FIXATION OF TARSOMETATARSAL JOINT DISLOCATION, WITH
OPEN TREATMENT OF TARSOMETATARSAL JOINT DISLOCATION, INCLUDES INTERNAL FIXATION,
CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION; WITHOUT ANESTHESIA
CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION; REQUIRING ANESTHESIA
PERCUTANEOUS SKELETAL FIXATION OF METATARSOPHALANGEAL JOINT DISLOCATION, WITH
OPEN TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION, INCLUDES INTERNAL FIXAT
CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION; WITHOUT ANESTHESIA
CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION; REQUIRING ANESTHESIA
PERCUTANEOUS SKELETAL FIXATION OF INTERPHALANGEAL JOINT DISLOCATION, WITH
OPEN TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, INCLUDES INTERNAL FIXATION,
ARTHRODESIS; PANTALAR
ARTHRODESIS; TRIPLE
ARTHRODESIS; SUBTALAR
ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, MULTIPLE OR TRANSVERSE;
ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, MULTIPLE OR TRANSVERSE; WITH
ARTHRODESIS, WITH TENDON LENGTHENING AND ADVANCEMENT, MIDTARSAL, TARSAL
ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, SINGLE JOINT
ARTHRODESIS, GREAT TOE; METATARSOPHALANGEAL JOINT
ARTHRODESIS, GREAT TOE; INTERPHALANGEAL JOINT
ARTHRODESIS, WITH EXTENSOR HALLUCIS LONGUS TRANSFER TO FIRST METATARSAL NECK,
AMPUTATION, FOOT; TRANSMETATARSAL
AMPUTATION, METATARSAL, WITH TOE, SINGLE
AMPUTATION, TOE; METATARSOPHALANGEAL JOINT
AMPUTATION, TOE; INTERPHALANGEAL JOINT
EXTRACORPOREAL SHOCK WAVE, HIGH ENERGY, PERFORMED BY A PHYSICIAN, REQUIRING ANES
UNLISTED PROCEDURE, FOOT OR TOES
APPLICATION OF HALO TYPE BODY CAST (SEE 20661-20663 FOR INSERTION)
APPLICATION OF RISSER JACKET, LOCALIZER, BODY; ONLY
APPLICATION OF RISSER JACKET, LOCALIZER, BODY; INCLUDING HEAD
APPLICATION OF TURNBUCKLE JACKET, BODY; ONLY
APPLICATION OF TURNBUCKLE JACKET, BODY; INCLUDING HEAD
APPLICATION OF BODY CAST, SHOULDER TO HIPS;
APPLICATION OF BODY CAST, SHOULDER TO HIPS; INCLUDING HEAD, MINERVA TYPE
APPLICATION OF BODY CAST, SHOULDER TO HIPS; INCLUDING ONE THIGH
APPLICATION OF BODY CAST, SHOULDER TO HIPS; INCLUDING BOTH THIGHS
APPLICATION, CAST; FIGURE-OF-EIGHT
APPLICATION, CAST; SHOULDER SPICA
APPLICATION, CAST; PLASTER VELPEAU
APPLICATION, CAST; SHOULDER TO HAND (LONG ARM)
APPLICATION, CAST; ELBOW TO FINGER (SHORT ARM)
APPLICATION, CAST; HAND AND LOWER FOREARM (GAUNTLET)
APPLICATION, CAST; FINGER (EG, CONTRACTURE)
APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND)
APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); STATIC
APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); DYNAMIC
APPLICATION OF FINGER SPLINT; STATIC
APPLICATION OF FINGER SPLINT; DYNAMIC
STRAPPING; THORAX
STRAPPING; SHOULDER (EG, VELPEAU)
STRAPPING; ELBOW OR WRIST
STRAPPING; HAND OR FINGER
APPLICATION OF HIP SPICA CAST; ONE LEG
APPLICATION OF HIP SPICA CAST; ONE AND ONE-HALF SPICA OR BOTH LEGS
APPLICATION OF LONG LEG CAST (THIGH TO TOES);
APPLICATION OF LONG LEG CAST (THIGH TO TOES); WALKER OR AMBULATORY TYPE
APPLICATION OF LONG LEG CAST BRACE
APPLICATION OF CYLINDER CAST (THIGH TO ANKLE)
APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES);
APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES); WALKING OR AMBULATORY TYPE
APPLICATION OF PATELLAR TENDON BEARING (PTB) CAST
ADDING WALKER TO PREVIOUSLY APPLIED CAST
APPLICATION OF RIGID TOTAL CONTACT LEG CAST
APPLICATION OF CLUBFOOT CAST WITH MOLDING OR MANIPULATION, LONG OR SHORT LEG
APPLICATION OF LONG LEG SPLINT (THIGH TO ANKLE OR TOES)
APPLICATION OF SHORT LEG SPLINT (CALF TO FOOT)
STRAPPING; HIP
STRAPPING; KNEE
STRAPPING; ANKLE AND/OR FOOT
STRAPPING; TOES
STRAPPING; UNNA BOOT
Application of multi-layer venous wound compression system, below knee
Application of multi-layer compression system; thigh and leg, including ankle a
Application of multi-layer compression system; upper arm and forearm
Application of multi-layer compression system; upper arm, forearm, hand, and fi
DENIS-BROWNE SPLINT STRAPPING
REMOVAL OR BIVALVING; GAUNTLET, BOOT OR BODY CAST
REMOVAL OR BIVALVING; FULL ARM OR FULL LEG CAST
REMOVAL OR BIVALVING; SHOULDER OR HIP SPICA, MINERVA, OR RISSER JACKET, ETC.
REMOVAL OR BIVALVING; TURNBUCKLE JACKET
REPAIR OF SPICA, BODY CAST OR JACKET
WINDOWING OF CAST
WEDGING OF CAST (EXCEPT CLUBFOOT CASTS)
WEDGING OF CLUBFOOT CAST
UNLISTED PROCEDURE, CASTING OR STRAPPING
ARTHROSCOPY, TEMPOROMANDIBULAR JOINT, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPS
ARTHROSCOPY, TEMPOROMANDIBULAR JOINT, SURGICAL
ARTHROSCOPY, SHOULDER, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE
ARTHROSCOPY, SHOULDER, SURGICAL; CAPSULORRHAPHY
ARTHROSCOPY, SHOULDER, SURGICAL; REPAIR OF SLAP LESION
ARTHROSCOPY, SHOULDER, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY
ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY, PARTIAL
ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY, COMPLETE
ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, LIMITED
ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, EXTENSIVE
ARTHROSCOPY, SHOULDER, SURGICAL; DISTAL CLAVICULECTOMY INCLUDING DISTAL
ARTHROSCOPY, SHOULDER, SURGICAL; WITH LYSIS AND RESECTION OF ADHESIONS, WITH OR
ARTHROSCOPY, SHOULDER, SURGICAL; DECOMPRESSION OF SUBACROMIAL SPACE WITH
ARTHROSCOPY, SHOULDER, SURGICAL; WITH ROTATOR CUFF REPAIR
ARTHROSCOPY, SHOULDER, SURGICAL; BICEPS TENODESIS
ARTHROSCOPY, ELBOW, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE
ARTHROSCOPY, ELBOW, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY
ARTHROSCOPY, ELBOW, SURGICAL; SYNOVECTOMY, PARTIAL
ARTHROSCOPY, ELBOW, SURGICAL; SYNOVECTOMY, COMPLETE
ARTHROSCOPY, ELBOW, SURGICAL; DEBRIDEMENT, LIMITED
ARTHROSCOPY, ELBOW, SURGICAL; DEBRIDEMENT, EXTENSIVE
ARTHROSCOPY, WRIST, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE
ARTHROSCOPY, WRIST, SURGICAL; FOR INFECTION, LAVAGE AND DRAINAGE
ARTHROSCOPY, WRIST, SURGICAL; SYNOVECTOMY, PARTIAL
ARTHROSCOPY, WRIST, SURGICAL; SYNOVECTOMY, COMPLETE
ARTHROSCOPY, WRIST, SURGICAL; EXCISION AND/OR REPAIR OF TRIANGULAR
ARTHROSCOPY, WRIST, SURGICAL; INTERNAL FIXATION FOR FRACTURE OR INSTABILITY
ENDOSCOPY, WRIST, SURGICAL, WITH RELEASE OF TRANSVERSE CARPAL LIGAMENT
ARTHROSCOPICALLY AIDED TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY
ARTHROSCOPICALLY AIDED TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY
ARTHROSCOPICALLY AIDED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); UNICOND
ARTHROSCOPICALLY AIDED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); BICONDY
ARTHROSCOPY, HIP, DIAGNOSTIC WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE
ARTHROSCOPY, HIP, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY
ARTHROSCOPY, HIP, SURGICAL; WITH DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE
ARTHROSCOPY, HIP, SURGICAL; WITH SYNOVECTOMY
ARTHROSCOPY, KNEE, SURGICAL; OSTEOCHONDRAL AUTOGRAFT(S) (EG, MOSAICPLASTY) (INCL
ARTHROSCOPY, KNEE, SURGICAL; OSTEOCHONDRAL ALLOGRAFT (EG, MOSAICPLASTY)
ARTHROSCOPY, KNEE, SURGICAL; MENISCAL TRANSPLANTATION (INCLUDES ARTHROTOMY FOR
ARTHROSCOPY, KNEE, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE
ARTHROSCOPY, KNEE, SURGICAL; FOR INFECTION, LAVAGE AND DRAINAGE
ARTHROSCOPY, KNEE, SURGICAL; WITH LATERAL RELEASE
ARTHROSCOPY, KNEE, SURGICAL; FOR REMOVAL OF LOOSE BODY OR FOREIGN BODY (EG,
ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, LIMITED (EG, PLICA OR SHELF
ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, MAJOR, TWO OR MORE COMPARTMENTS (EG,
ARTHROSCOPY, KNEE, SURGICAL; DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE
ARTHROSCOPY, KNEE, SURGICAL; ABRASION ARTHROPLASTY (INCLUDES CHONDROPLASTY
ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL AND LATERAL, INCLUDING
ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL OR LATERAL, INCLUDING
ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCUS REPAIR (MEDIAL OR LATERAL)
ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCUS REPAIR (MEDIAL AND LATERAL)
ARTHROSCOPY, KNEE, SURGICAL; WITH LYSIS OF ADHESIONS, WITH OR WITHOUT
ARTHROSCOPY, KNEE, SURGICAL; DRILLING FOR OSTEOCHONDRITIS DISSECANS WITH BONE
ARTHROSCOPY, KNEE, SURGICAL; DRILLING FOR INTACT OSTEOCHONDRITIS DISSECANS
ARTHROSCOPY, KNEE, SURGICAL; DRILLING FOR INTACT OSTEOCHONDRITIS DISSECANS
ARTHROSCOPICALLY AIDED ANTERIOR CRUCIATE LIGAMENT REPAIR/AUGMENTATION OR
ARTHROSCOPICALLY AIDED POSTERIOR CRUCIATE LIGAMENT REPAIR/ AUGMENTATION OR
ARTHROSCOPY, ANKLE, SURGICAL, EXCISION OF OSTEOCHONDRAL DEFECT OF TALUS AND/OR
ARTHROSCOPICALLY AIDED REPAIR OF LARGE OSTEOCHONDRITIS DISSECANS LESION, TALAR
ENDOSCOPIC PLANTAR FASCIOTOMY
ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; WITH REMOVAL
ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; SYNOVECTOMY,
ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; DEBRIDEMENT,
ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; DEBRIDEMENT,
ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; WITH ANKLE
ARTHROSCOPY, METACARPOPHALANGEAL JOINT, DIAGNOSTIC, INCLUDES SYNOVIAL BIOPSY
ARTHROSCOPY, METACARPOPHALANGEAL JOINT, SURGICAL; WITH DEBRIDEMENT
ARTHROSCOPY, METACARPOPHALANGEAL JOINT, SURGICAL; WITH REDUCTION OF DISPLACED
ARTHROSCOPY, SUBTALAR JOINT, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BOD
ARTHROSCOPY, SUBTALAR JOINT, SURGICAL; WITH SYNOVECTOMY
ARTHROSCOPY, SUBTALAR JOINT, SURGICAL; WITH DEBRIDEMENT
ARTHROSCOPY, SUBTALAR JOINT, SURGICAL; WITH SUBTALAR ARTHRODESIS
ARTHROSCOPY, HIP, SURGICAL; WITH FEMOROPLASTY (IE, TREATMENT OF CAM LESION)
ARTHROSCOPY, HIP, SURGICAL; WITH ACETABULOPLASTY (IE, TREATMENT OF PINCER LESION
ARTHROSCOPY, HIP, SURGICAL; WITH LABRAL REPAIR
UNLISTED PROCEDURE, ARTHROSCOPY
DRAINAGE ABSCESS OR HEMATOMA, NASAL, INTERNAL APPROACH
DRAINAGE ABSCESS OR HEMATOMA, NASAL SEPTUM
BIOPSY, INTRANASAL
EXCISION, NASAL POLYP(S), SIMPLE
EXCISION, NASAL POLYP(S), EXTENSIVE
EXCISION OR DESTRUCTION (EG, LASER), INTRANASAL LESION; INTERNAL APPROACH
EXCISION OR DESTRUCTION (EG, LASER), INTRANASAL LESION; EXTERNAL APPROACH
EXCISION OR SURGICAL PLANING OF SKIN OF NOSE FOR RHINOPHYMA
EXCISION DERMOID CYST, NOSE; SIMPLE, SKIN, SUBCUTANEOUS
EXCISION DERMOID CYST, NOSE; COMPLEX, UNDER BONE OR CARTILAGE
EXCISION INFERIOR TURBINATE, PARTIAL OR COMPLETE, ANY METHOD
SUBMUCOUS RESECTION INFERIOR TURBINATE, PARTIAL OR COMPLETE, ANY METHOD
RHINECTOMY; PARTIAL
RHINECTOMY; TOTAL
INJECTION INTO TURBINATE(S), THERAPEUTIC
DISPLACEMENT THERAPY (PROETZ TYPE)
INSERTION, NASAL SEPTAL PROSTHESIS (BUTTON)
REMOVAL FOREIGN BODY, INTRANASAL; REQUIRING GENERAL ANESTHESIA
REMOVAL FOREIGN BODY, INTRANASAL; BY LATERAL RHINOTOMY
RHINOPLASTY, PRIMARY; LATERAL AND ALAR CARTILAGES AND/OR ELEVATION OF NASAL TIP
RHINOPLASTY, PRIMARY; COMPLETE, EXTERNAL PARTS INCLUDING BONY PYRAMID, LATERAL
RHINOPLASTY, PRIMARY; INCLUDING MAJOR SEPTAL REPAIR
RHINOPLASTY, SECONDARY; MINOR REVISION (SMALL AMOUNT OF NASAL TIP WORK)
RHINOPLASTY, SECONDARY; INTERMEDIATE REVISION (BONY WORK WITH OSTEOTOMIES)
RHINOPLASTY, SECONDARY; MAJOR REVISION (NASAL TIP WORK AND OSTEOTOMIES)
RHINOPLASTY FOR NASAL DEFORMITY SECONDARY TO CONGENITAL CLEFT LIP AND/OR
RHINOPLASTY FOR NASAL DEFORMITY SECONDARY TO CONGENITAL CLEFT LIP AND/OR
REPAIR OF NASAL VESTIBULAR STENOSIS (EG, SPREADER GRAFTING, LATERAL NASAL WALL
SEPTOPLASTY OR SUBMUCOUS RESECTION, WITH OR WITHOUT CARTILAGE SCORING,
REPAIR CHOANAL ATRESIA; INTRANASAL
REPAIR CHOANAL ATRESIA; TRANSPALATINE
LYSIS INTRANASAL SYNECHIA
REPAIR FISTULA; OROMAXILLARY (COMBINE WITH 31030 IF ANTROTOMY IS INCLUDED)
REPAIR FISTULA; ORONASAL
SEPTAL OR OTHER INTRANASAL DERMATOPLASTY (DOES NOT INCLUDE OBTAINING GRAFT)
REPAIR NASAL SEPTAL PERFORATIONS
ABLATION, SOFT TISSUE OF INFERIOR TURBINATES, UNILATERAL OR BILATERAL, ANY METHO
ABLATION, SOFT TISSUE OF INFERIOR TURBINATES, UNILATERAL OR BILATERAL, ANY METHO
CONTROL NASAL HEMORRHAGE, ANTERIOR, SIMPLE (LIMITED CAUTERY AND/OR PACKING) ANY
CONTROL NASAL HEMORRHAGE, ANTERIOR, COMPLEX (EXTENSIVE CAUTERY AND/OR PACKING)
CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL PACKS AND/OR CAUTERY,
CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL PACKS AND/OR CAUTERY,
LIGATION ARTERIES; ETHMOIDAL
LIGATION ARTERIES; INTERNAL MAXILLARY ARTERY, TRANSANTRAL
FRACTURE NASAL INFERIOR TURBINATE(S), THERAPEUTIC
UNLISTED PROCEDURE, NOSE
LAVAGE BY CANNULATION; MAXILLARY SINUS (ANTRUM PUNCTURE OR NATURAL OSTIUM)
LAVAGE BY CANNULATION; SPHENOID SINUS
SINUSOTOMY, MAXILLARY (ANTROTOMY); INTRANASAL
SINUSOTOMY, MAXILLARY (ANTROTOMY); RADICAL (CALDWELL-LUC) WITHOUT REMOVAL OF
SINUSOTOMY, MAXILLARY (ANTROTOMY); RADICAL (CALDWELL-LUC) WITH REMOVAL OF
PTERYGOMAXILLARY FOSSA SURGERY, ANY APPROACH
SINUSOTOMY, SPHENOID, WITH OR WITHOUT BIOPSY;
SINUSOTOMY, SPHENOID, WITH OR WITHOUT BIOPSY; WITH MUCOSAL STRIPPING OR REMOVAL
SINUSOTOMY FRONTAL; EXTERNAL, SIMPLE (TREPHINE OPERATION)
SINUSOTOMY FRONTAL; TRANSORBITAL, UNILATERAL (FOR MUCOCELE OR OSTEOMA, LYNCH
SINUSOTOMY FRONTAL; OBLITERATIVE WITHOUT OSTEOPLASTIC FLAP, BROW INCISION
SINUSOTOMY FRONTAL; OBLITERATIVE, WITHOUT OSTEOPLASTIC FLAP, CORONAL INCISION
SINUSOTOMY FRONTAL; OBLITERATIVE, WITH OSTEOPLASTIC FLAP, BROW INCISION
SINUSOTOMY FRONTAL; OBLITERATIVE, WITH OSTEOPLASTIC FLAP, CORONAL INCISION
SINUSOTOMY FRONTAL; NONOBLITERATIVE, WITH OSTEOPLASTIC FLAP, BROW INCISION
SINUSOTOMY FRONTAL; NONOBLITERATIVE, WITH OSTEOPLASTIC FLAP, CORONAL INCISION
SINUSOTOMY, UNILATERAL, THREE OR MORE PARANASAL SINUSES (FRONTAL, MAXILLARY,
ETHMOIDECTOMY; INTRANASAL, ANTERIOR
ETHMOIDECTOMY; INTRANASAL, TOTAL
ETHMOIDECTOMY; EXTRANASAL, TOTAL
NASAL ENDOSCOPY, DIAGNOSTIC, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE)
NASAL/SINUS ENDOSCOPY, DIAGNOSTIC WITH MAXILLARY SINUSOSCOPY (VIA INFERIOR
NASAL/SINUS ENDOSCOPY, DIAGNOSTIC WITH SPHENOID SINUSOSCOPY (VIA PUNCTURE OF
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH BIOPSY, POLYPECTOMY OR DEBRIDEMENT
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONTROL OF NASAL HEMORRHAGE
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH DACRYOCYSTORHINOSTOMY
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONCHA BULLOSA RESECTION
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH ETHMOIDECTOMY, PARTIAL (ANTERIOR)
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH ETHMOIDECTOMY, TOTAL (ANTERIOR AND
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY;
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY; WITH REMOVAL OF
NASAL/SINUS ENDOSCOPY, SURGICAL WITH FRONTAL SINUS EXPLORATION, WITH OR WITHOUT
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY;
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY; WITH REMOVAL OF TISSUE
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH MEDIAL OR INFERIOR ORBITAL WALL
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH MEDIAL ORBITAL WALL AND INFERIOR ORBITAL
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH OPTIC NERVE DECOMPRESSION
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH DILATION OF MAXILLARY SINUS OSTIUM (EG, BA
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH DILATION OF FRONTAL SINUS OSTIUM (EG, BALL
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH DILATION OF SPHENOID SINUS OSTIUM (EG, BAL
UNLISTED PROCEDURE, ACCESSORY SINUSES
LARYNGOTOMY (THYROTOMY, LARYNGOFISSURE); WITH REMOVAL OF TUMOR OR LARYNGOCELE, C
LARYNGOTOMY (THYROTOMY, LARYNGOFISSURE); DIAGNOSTIC
ARYTENOIDECTOMY OR ARYTENOIDOPEXY, EXTERNAL APPROACH
EPIGLOTTIDECTOMY
INTUBATION, ENDOTRACHEAL, EMERGENCY PROCEDURE
TRACHEOTOMY TUBE CHANGE PRIOR TO ESTABLISHMENT OF FISTULA TRACT
LARYNGOSCOPY, INDIRECT (SEPARATE PROCEDURE); DIAGNOSTIC
LARYNGOSCOPY, INDIRECT; WITH BIOPSY
LARYNGOSCOPY, INDIRECT; WITH REMOVAL OF FOREIGN BODY
LARYNGOSCOPY, INDIRECT; WITH REMOVAL OF LESION
LARYNGOSCOPY, INDIRECT; WITH VOCAL CORD INJECTION
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; FOR ASPIRATION
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; DIAGNOSTIC, NEWBORN
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; DIAGNOSTIC, EXCEPT NEWBORN
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; DIAGNOSTIC, WITH OPERATING MI
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; WITH INSERTION OF OBTURATOR
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; WITH DILATION, INITIAL
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; WITH DILATION, SUBSEQUENT
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH FOREIGN BODY REMOVAL;
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH FOREIGN BODY REMOVAL; WITH OPERATING MICRO
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY;
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY; WITH OPERATING MICROSCOPE OR TELES
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH EXCISION OF TUMOR AND/ OR STRIPPING OF
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH EXCISION OF TUMOR AND/ OR STRIPPING OF VOC
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH OPERATING MICROSCOPE OR TELESCOPE, WITH
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH OPERATING MICROSCOPE OR TELESCOPE, WITH
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH ARYTENOIDECTOMY;
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH ARYTENOIDECTOMY; WITH OPERATING MICROSCOPE
LARYNGOSCOPY, DIRECT, WITH INJECTION INTO VOCAL CORD(S), THERAPEUTIC;
LARYNGOSCOPY, DIRECT, WITH INJECTION INTO VOCAL CORD(S), THERAPEUTIC; WITH OPERA
LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; DIAGNOSTIC
LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; WITH BIOPSY
LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; WITH REMOVAL OF FOREIGN BODY
LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; WITH REMOVAL OF LESION
LARYNGOSCOPY, FLEXIBLE OR RIGID FIBEROPTIC, WITH STROBOSCOPY
LARYNGOPLASTY; FOR LARYNGEAL WEB, TWO STAGE, WITH KEEL INSERTION AND REMOVAL
LARYNGOPLASTY; FOR LARYNGEAL STENOSIS, WITH GRAFT OR CORE MOLD, INCLUDING
LARYNGOPLASTY, NOT OTHERWISE SPECIFIED (EG, FOR BURNS, RECONSTRUCTION AFTER
LARYNGEAL REINNERVATION BY NEUROMUSCULAR PEDICLE
SECTION RECURRENT LARYNGEAL NERVE, THERAPEUTIC (SEPARATE PROCEDURE), UNILATERAL
UNLISTED PROCEDURE, LARYNX
TRACHEOSTOMY, PLANNED (SEPARATE PROCEDURE);
TRACHEOSTOMY, PLANNED (SEPARATE PROCEDURE); UNDER TWO YEARS
TRACHEOSTOMY, EMERGENCY PROCEDURE; TRANSTRACHEAL
TRACHEOSTOMY, EMERGENCY PROCEDURE; CRICOTHYROID MEMBRANE
TRACHEOSTOMY, FENESTRATION PROCEDURE WITH SKIN FLAPS
CONSTRUCTION OF TRACHEOESOPHAGEAL FISTULA AND SUBSEQUENT INSERTION OF AN
TRACHEAL PUNCTURE, PERCUTANEOUS WITH TRANSTRACHEAL ASPIRATION AND/OR INJECTION
TRACHEOSTOMA REVISION; SIMPLE, WITHOUT FLAP ROTATION
TRACHEOSTOMA REVISION; COMPLEX, WITH FLAP ROTATION
TRACHEOBRONCHOSCOPY THROUGH ESTABLISHED TRACHEOSTOMY INCISION
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED
BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH
BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH
BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH
Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed
BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH
BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH
BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH
BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH
BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH
BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED
BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH
BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH
BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; EACH
BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH
BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED
CATHETERIZATION WITH BRONCHIAL BRUSH BIOPSY
CATHETER ASPIRATION (SEPARATE PROCEDURE); NASOTRACHEAL
TRANSTRACHEAL (PERCUTANEOUS) INTRODUCTION OF NEEDLE WIRE DILATOR/ STENT OR
TRACHEOPLASTY; CERVICAL
TRACHEOPLASTY; TRACHEOPHARYNGEAL FISTULIZATION, EACH STAGE
EXCISION OF TRACHEAL TUMOR OR CARCINOMA; CERVICAL
SURGICAL CLOSURE TRACHEOSTOMY OR FISTULA; WITHOUT PLASTIC REPAIR
SURGICAL CLOSURE TRACHEOSTOMY OR FISTULA; WITH PLASTIC REPAIR
REVISION OF TRACHEOSTOMY SCAR
UNLISTED PROCEDURE, TRACHEA, BRONCHI
PNEUMONOSTOMY; WITH PERCUTANEOUS DRAINAGE OF ABSCESS OR CYST
BIOPSY, PLEURA; PERCUTANEOUS NEEDLE
BIOPSY, LUNG OR MEDIASTINUM, PERCUTANEOUS NEEDLE
PNEUMOCENTESIS, PUNCTURE OF LUNG FOR ASPIRATION
THORACENTESIS, PUNCTURE OF PLEURAL CAVITY FOR ASPIRATION, INITIAL OR SUBSEQUENT
THORACENTESIS WITH INSERTION OF TUBE, INCLUDES WATER SEAL (EG, FOR PNEUMOTHORAX)
INSERTION OF INDWELLING TUNNELED PLEURAL CATHETER WITH CUFF
TUBE THORACOSTOMY, INCLUDES WATER SEAL (EG, FOR ABSCESS, HEMOTHORAX, EMPYEMA), W
Removal of indwelling tunneled pleural catheter with cuff
INSTILLATION, VIA CHEST TUBE/CATHETER, AGENT FOR PLEURODESIS (EG, TALC FOR RECUR
Instillation(s), via chest tube/catheter, agent for fibrinolysis (eg, fibrinolyt
Instillation(s), via chest tube/catheter, agent for fibrinolysis (eg, fibrinolyt
THORACOSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE); LUNGS AND PLEURAL SPACE, WITHOUT
THORACOSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE); PERICARDIAL SAC, WITH BIOPSY
THORACOSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE); MEDIASTINAL SPACE, WITH BIOPSY
Thoracoscopy; with diagnostic biopsy(ies) of lung infiltrate(s) (eg, wedge, inci
Thoracoscopy; with diagnostic biopsy(ies) of lung nodule(s) or mass(es) (eg, wed
Thoracoscopy; with biopsy(ies) of pleura
PNEUMOTHORAX, THERAPEUTIC, INTRAPLEURAL INJECTION OF AIR
ABLATION THERAPY FOR REDUCTION OR ERADICATION OF ONE OR MORE PULMONARY TUMOR(S)
UNLISTED PROCEDURE, LUNGS AND PLEURA
PERICARDIOCENTESIS; INITIAL
PERICARDIOCENTESIS; SUBSEQUENT
INSERTION OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S);
INSERTION OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S);
INSERTION OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S);
INSERTION OR REPLACEMENT OF TEMPORARY TRANSVENOUS SINGLE CHAMBER CARDIAC
INSERTION OR REPLACEMENT OF TEMPORARY TRANSVENOUS DUAL CHAMBER PACING
INSERTION OR REPLACEMENT OF PACEMAKER PULSE GENERATOR ONLY; SINGLE CHAMBER,
INSERTION OR REPLACEMENT OF PACEMAKER PULSE GENERATOR ONLY; DUAL CHAMBER
UPGRADE OF IMPLANTED PACEMAKER SYSTEM, CONVERSION OF SINGLE CHAMBER SYSTEM TO
REPOSITIONING OF PREVIOUSLY IMPLANTED TRANSVENOUS PACEMAKER OR PACING
INSERTION OF A SINGLE TRANSVENOUS ELECTRODE, PERMANENT PACEMAKER OR CARDIOVERTER
INSERTION OF 2 TRANSVENOUS ELECTRODES, PERMANENT PACEMAKER OR CARDIOVERTER-DEFIB
REPAIR OF SINGLE TRANSVENOUS ELECTRODE FOR A SINGLE CHAMBER, PERMANENT
REPAIR OF TWO TRANSVENOUS ELECTRODES FOR A DUAL CHAMBER PERMANENT PACEMAKER OR
Insertion of pacemaker pulse generator only; with existing multiple leads
REVISION OR RELOCATION OF SKIN POCKET FOR PACEMAKER
REVISION OF SKIN POCKET FOR CARDIOVERTER-DEFIBRILLATOR
INSERTION OF PACING ELECTRODE, CARDIAC VENOUS SYSTEM, FOR LEFT VENTRICULAR
INSERTION OF PACING ELECTRODE, CARDIAC VENOUS SYSTEM, FOR LEFT VENTRICULAR
REPOSITIONING OF PREVIOUSLY IMPLANTED CARDIAC VENOUS SYSTEM (LEFT VENTRICULAR)
Removal of permanent pacemaker pulse generator with replacement of pacemaker pul
Removal of permanent pacemaker pulse generator with replacement of pacemaker pul
Removal of permanent pacemaker pulse generator with replacement of pacemaker pul
Insertion of pacing cardioverter-defibrillator pulse generator only; with exist
Insertion of pacing cardioverter-defibrillator pulse generator only; with exist
REMOVAL OF PERMANENT PACEMAKER PULSE GENERATOR
REMOVAL OF TRANSVENOUS PACEMAKER ELECTRODE(S); SINGLE LEAD SYSTEM, ATRIAL OR
REMOVAL OF TRANSVENOUS PACEMAKER ELECTRODE(S); DUAL LEAD SYSTEM
INSERTION OF SINGLE OR DUAL CHAMBER PACING CARDIOVERTER-DEFIBRILLATOR PULSE
SUBCUTANEOUS REMOVAL OF SINGLE OR DUAL CHAMBER PACING CARDIOVERTER-
REMOVAL OF SINGLE OR DUAL CHAMBER PACING CARDIOVERTER-DEFIBRILLATOR
INSERTION OR REPOSITIONING OF ELECTRODE LEAD(S) FOR SINGLE OR DUAL CHAMBER
Removal of pacing cardioverter-defibrillator pulse generator with replacement of
Removal of pacing cardioverter-defibrillator pulse generator with replacement of
Removal of pacing cardioverter-defibrillator pulse generator with replacement of
IMPLANTATION OF PATIENT-ACTIVATED CARDIAC EVENT RECORDER
REMOVAL OF AN IMPLANTABLE, PATIENT-ACTIVATED CARDIAC EVENT RECORDER
UNLISTED PROCEDURE, CARDIAC SURGERY
EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; AXILLARY, BRACHIAL,
EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; RADIAL OR ULNAR ARTERY,
EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; FEMOROPOPLITEAL,
EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; POPLITEAL-TIBIO-PERONEAL
THROMBECTOMY, DIRECT OR WITH CATHETER; VENA CAVA, ILIAC, FEMOROPOPLITEAL VEIN,
THROMBECTOMY, DIRECT OR WITH CATHETER; SUBCLAVIAN VEIN, BY NECK INCISION
THROMBECTOMY, DIRECT OR WITH CATHETER; AXILLARY AND SUBCLAVIAN VEIN, BY ARM
VALVULOPLASTY, FEMORAL VEIN
VENOUS VALVE TRANSPOSITION, ANY VEIN DONOR
CROSS-OVER VEIN GRAFT TO VENOUS SYSTEM
SAPHENOPOPLITEAL VEIN ANASTOMOSIS
DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
REPAIR, CONGENITAL ARTERIOVENOUS FISTULA; HEAD AND NECK
REPAIR, CONGENITAL ARTERIOVENOUS FISTULA; EXTREMITIES
REPAIR, ACQUIRED OR TRAUMATIC ARTERIOVENOUS FISTULA; HEAD AND NECK
REPAIR, ACQUIRED OR TRAUMATIC ARTERIOVENOUS FISTULA; EXTREMITIES
REPAIR BLOOD VESSEL, DIRECT; NECK
REPAIR BLOOD VESSEL, DIRECT; UPPER EXTREMITY
REPAIR BLOOD VESSEL, DIRECT; HAND, FINGER
REPAIR BLOOD VESSEL, DIRECT; LOWER EXTREMITY
REPAIR BLOOD VESSEL WITH VEIN GRAFT; NECK
REPAIR BLOOD VESSEL WITH VEIN GRAFT; UPPER EXTREMITY
REPAIR BLOOD VESSEL WITH VEIN GRAFT; LOWER EXTREMITY
REPAIR BLOOD VESSEL WITH GRAFT OTHER THAN VEIN; NECK
REPAIR BLOOD VESSEL WITH GRAFT OTHER THAN VEIN; UPPER EXTREMITY
REPAIR BLOOD VESSEL WITH GRAFT OTHER THAN VEIN; LOWER EXTREMITY
THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; AXILLARY-BRACHIAL
TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; BRACHIOCEPHALIC TRUNK OR BRANCHES, EACH
TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; VENOUS
TRANSLUMINAL BALLOON ANGIOPLASTY, PERCUTANEOUS; RENAL OR VISCERAL ARTERY
TRANSLUMINAL BALLOON ANGIOPLASTY, PERCUTANEOUS; AORTIC
TRANSLUMINAL BALLOON ANGIOPLASTY, PERCUTANEOUS; BRACHIOCEPHALIC TRUNK OR
TRANSLUMINAL BALLOON ANGIOPLASTY, PERCUTANEOUS; VENOUS
HARVEST OF UPPER EXTREMITY VEIN, ONE SEGMENT, FOR LOWER EXTREMITY OR CORONARY AR
PLACEMENT OF VEIN PATCH OR CUFF AT DISTAL ANASTOMOSIS OF BYPASS GRAFT, SYNTHETIC
CREATION OF DISTAL ARTERIOVENOUS FISTULA DURING LOWER EXTREMITY BYPASS SURGERY
EXPLORATION (NOT FOLLOWED BY SURGICAL REPAIR), WITH OR WITHOUT LYSIS OF ARTERY;
EXPLORATION FOR POSTOPERATIVE HEMORRHAGE, THROMBOSIS OR INFECTION; EXTREMITY
THROMBECTOMY OF ARTERIAL OR VENOUS GRAFT (OTHER THAN HEMODIALYSIS GRAFT OR
THROMBECTOMY OF ARTERIAL OR VENOUS GRAFT (OTHER THAN HEMODIALYSIS GRAFT OR
REVISION, LOWER EXTREMITY ARTERIAL BYPASS, WITHOUT THROMBECTOMY, OPEN; WITH
REVISION, LOWER EXTREMITY ARTERIAL BYPASS, WITHOUT THROMBECTOMY, OPEN; WITH
REVISION, FEMORAL ANASTOMOSIS OF SYNTHETIC ARTERIAL BYPASS GRAFT IN GROIN, OPEN;
REVISION, FEMORAL ANASTOMOSIS OF SYNTHETIC ARTERIAL BYPASS GRAFT IN GROIN, OPEN;
EXCISION OF INFECTED GRAFT; EXTREMITY
INJECTION PROCEDURES (EG, THROMBIN) FOR PERCUTANEOUS TREATMENT OF EXTREMITY
Introduction of needle and/or catheter, arteriovenous shunt created for dialysis
INSERTION OF IMPLANTABLE INTRA-ARTERIAL INFUSION PUMP (EG, FOR CHEMOTHERAPY OF
REVISION OF IMPLANTED INTRA-ARTERIAL INFUSION PUMP
REMOVAL OF IMPLANTED INTRA-ARTERIAL INFUSION PUMP
TRANSFUSION, BLOOD OR BLOOD COMPONENTS
PUSH TRANSFUSION, BLOOD, 2 YEARS OR UNDER
EXCHANGE TRANSFUSION, BLOOD; NEWBORN
EXCHANGE TRANSFUSION, BLOOD; OTHER THAN NEWBORN
TRANSFUSION, INTRAUTERINE, FETAL
SINGLE OR MULTIPLE INJECTIONS OF SCLEROSING SOLUTIONS, SPIDER VEINS
SINGLE OR MULTIPLE INJECTIONS OF SCLEROSING SOLUTIONS, SPIDER VEINS
INJECTION OF SCLEROSING SOLUTION; SINGLE VEIN
INJECTION OF SCLEROSING SOLUTION; MULTIPLE VEINS, SAME LEG
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL
THERAPEUTIC APHERESIS; FOR WHITE BLOOD CELLS
THERAPEUTIC APHERESIS; FOR RED BLOOD CELLS
THERAPEUTIC APHERESIS; FOR PLATELETS
THERAPEUTIC APHERESIS; FOR PLASMA PHERESIS
THERAPEUTIC APHERESIS; WITH EXTRACORPOREAL IMMUNOADSORPTION AND PLASMA
THERAPEUTIC APHERESIS; WITH EXTRACORPOREAL SELECTIVE ADSORPTION OR SELECTIVE
PHOTOPHERESIS, EXTRACORPOREAL
INSERTION OF NON-TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER; UNDER 5 YE
INSERTION OF NON-TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER; AGE 5
INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER, WITHOUT
INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER, WITHOUT
INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH
INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH
INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE WITH
INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE,
INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE,
INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER (PICC), WITHOUT
INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER (PICC), WITHOUT
INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH
INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH
REPAIR OF TUNNELED OR NON-TUNNELED CENTRAL VENOUS ACCESS CATHETER, WITHOUT SUBCU
REPAIR OF CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR PUMP, CENTRAL
REPLACEMENT, CATHETER ONLY, OF CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS P
REPLACEMENT, COMPLETE, OF A NON-TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHE
REPLACEMENT, COMPLETE, OF A TUNNELED CENTRALLY INSERTED CENTRAL VENOUS
REPLACEMENT, COMPLETE, OF A TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS
REPLACEMENT, COMPLETE, OF A TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS
REPLACEMENT, COMPLETE, OF A PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER
REPLACEMENT, COMPLETE, OF A PERIPHERALLY INSERTED CENTRAL VENOUS ACCESS DEVICE,
REMOVAL OF TUNNELED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP
REMOVAL OF TUNNELED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR
DECLOTTING BY THROMBOLYTIC AGENT OF IMPLANTED VASCULAR ACCESS DEVICE OR CATHETER
MECHANICAL REMOVAL OF PERICATHETER OBSTRUCTIVE MATERIAL (EG, FIBRIN SHEATH) FROM
MECHANICAL REMOVAL OF INTRALUMINAL (INTRACATHETER) OBSTRUCTIVE MATERIAL FROM
REPOSITIONING OF PREVIOUSLY PLACED CENTRAL VENOUS CATHETER UNDER FLUOROSCOPIC GU
CONTRAST INJECTION(S) FOR RADIOLOGIC EVALUATION OF EXISTING CENTRAL VENOUS ACCES
ARTERIAL CATHETERIZATION FOR PROLONGED INFUSION THERAPY (CHEMOTHERAPY), CUTDOWN
PLACEMENT OF NEEDLE FOR INTRAOSSEOUS INFUSION
INSERTION OF CANNULA FOR HEMODIALYSIS, OTHER PURPOSE (SEPARATE PROCEDURE); VEIN
INSERTION OF CANNULA FOR HEMODIALYSIS, OTHER PURPOSE (SEPARATE PROCEDURE);
INSERTION OF CANNULA FOR HEMODIALYSIS, OTHER PURPOSE (SEPARATE PROCEDURE);
ARTERIOVENOUS ANASTOMOSIS, OPEN; BY UPPER ARM CEPHALIC VEIN TRANSPOSITION
ARTERIOVENOUS ANASTOMOSIS, OPEN; BY UPPER ARM BASILIC VEIN TRANSPOSITION
ARTERIOVENOUS ANASTOMOSIS, OPEN; BY FOREARM VEIN TRANSPOSITION
ARTERIOVENOUS ANASTOMOSIS, OPEN; DIRECT, ANY SITE (EG, CIMINO TYPE) (SEPARATE
CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECT ARTERIOVENOUS
CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECT ARTERIOVENOUS
THROMBECTOMY, OPEN, ARTERIOVENOUS FISTULA WITHOUT REVISION, AUTOGENOUS OR
REVISION, OPEN, ARTERIOVENOUS FISTULA; WITHOUT THROMBECTOMY, AUTOGENOUS OR
REVISION, OPEN, ARTERIOVENOUS FISTULA; WITH THROMBECTOMY, AUTOGENOUS OR
INSERTION OF THOMAS SHUNT (SEPARATE PROCEDURE)
DISTAL REVASCULARIZATION AND INTERVAL LIGATION (DRIL), UPPER EXTREMITY
EXTERNAL CANNULA DECLOTTING (SEPARATE PROCEDURE); WITHOUT BALLOON CATHETER
EXTERNAL CANNULA DECLOTTING (SEPARATE PROCEDURE); WITH BALLOON CATHETER
THROMBECTOMY, PERCUTANEOUS, ARTERIOVENOUS FISTULA, AUTOGENOUS OR NONAUTOGENOUS
REVISION OF TRANSVENOUS INTRAHEPATIC PORTOSYSTEMIC SHUNT(S) (TIPS) (INCLUDES VEN
PRIMARY PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY, NONCORONARY, ARTERIAL
PRIMARY PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY, NONCORONARY, ARTERIAL
SECONDARY PERCUTANEOUS TRANSLUMINAL THROMBECTOMY (EG, NONPRIMARY MECHANICAL, SNA
PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY, VEIN(S), INCLUDING INTRAPROCE
PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY, VEIN(S), INCLUDING INTRAPROCE
Insertion of intravascular vena cava filter, endovascular approach including vas
Repositioning of intravascular vena cava filter, endovascular approach including
Retrieval (removal) of intravascular vena cava filter, endovascular approach inc
THROMBOLYSIS, CEREBRAL, BY INTRAVENOUS INFUSION
TRANSCATHETER BIOPSY
TRANSCATHETER THERAPY, INFUSION FOR THROMBOLYSIS OTHER THAN CORONARY
TRANSCATHETER THERAPY, INFUSION OTHER THAN FOR THROMBOLYSIS, ANY TYPE (EG,
TRANSCATHETER RETRIEVAL, PERCUTANEOUS, OF INTRAVASCULAR FOREIGN BODY (EG,
TRANSCATHETER OCCLUSION OR EMBOLIZATION (EG, FOR TUMOR DESTRUCTION, TO ACHIEVE
TRANSCATHETER PLACEMENT OF AN INTRAVASCULAR STENT(S) (EXCEPT CORONARY, CAROTID,
TRANSCATHETER PLACEMENT OF AN INTRAVASCULAR STENT(S) (EXCEPT CORONARY, CAROTID,
TRANSCATHETER PLACEMENT OF AN INTRAVASCULAR STENT(S) (EXCEPT CORONARY, CAROTID,
TRANSCATHETER PLACEMENT OF AN INTRAVASCULAR STENT(S) (EXCEPT CORONARY, CAROTID,
EXCHANGE OF A PREVIOUSLY PLACED INTRAVASCULAR CATHETER DURING THROMBOLYTIC THERA
UTERINE FIBROID EMBOLIZATION (UFE, EMBOLIZATION OF THE UTERINE ARTERIES TO TREAT
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, ILIAC ARTERY, UNILATERAL,
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, ILIAC ARTERY, UNILATERAL,
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, ILIAC ARTERY, EACH ADDITI
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, ILIAC ARTERY, EACH ADDITI
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, FEMORAL/POPLITEAL ARTERY(
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, FEMORAL/POPLITEAL ARTERY(
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, FEMORAL/POPLITEAL ARTERY(
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, FEMORAL/POPLITEAL ARTERY(
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL/PERONEAL ARTERY, U
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL/PERONEAL ARTERY, U
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL/PERONEAL ARTERY, U
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL/PERONEAL ARTERY, U
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL/PERONEAL ARTERY, U
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL/PERONEAL ARTERY, U
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL/PERONEAL ARTERY, U
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL/PERONEAL ARTERY, U
VASCULAR ENDOSCOPY, SURGICAL, WITH LIGATION OF PERFORA
UNLISTED VASCULAR ENDOSCOPY PROCEDURE
LIGATION, INTERNAL JUGULAR VEIN
LIGATION; EXTERNAL CAROTID ARTERY
LIGATION; INTERNAL OR COMMON CAROTID ARTERY
LIGATION; INTERNAL OR COMMON CAROTID ARTERY, WITH GRADUAL OCCLUSION, AS WITH
LIGATION OR BANDING OF ANGIOACCESS ARTERIOVENOUS FISTULA
LIGATION OR BIOPSY, TEMPORAL ARTERY
LIGATION, MAJOR ARTERY (EG, POST-TRAUMATIC, RUPTURE); NECK
Ligation of inferior vena cava
LIGATION OF FEMORAL VEIN
LIGATION AND DIVISION OF LONG SAPHENOUS VEIN AT SAPHENOFEMORAL JUNCTION, OR
LIGATION, DIVISION, AND STRIPPING, SHORT SAPHENOUS VEIN
LIGATION, DIVISION, AND STRIPPING, LONG (GREATER) SAPHENOUS VEINS FROM SAPHENOFE
LIGATION AND DIVISION AND COMPLETE STRIPPING OF LONG OR SHORT SAPHENOUS VEINS
LIGATION OF PERFORATOR VEINS, SUBFASCIAL, RADICAL (LINTON TYPE), INCLUDING SKIN
Ligation of perforator vein(s), subfascial, open, including ultrasound guidance,
STAB PHLEBECTOMY OF VARICOSE VEINS, ONE EXTREMITY; 10-20 STAB INCISIONS
STAB PHLEBECTOMY OF VARICOSE VEINS, ONE EXTREMITY; MORE THAN 20 INCISIONS
LIGATION AND DIVISION OF SHORT SAPHENOUS VEIN AT SAPHENOPOPLITEAL JUNCTION
LIGATION, DIVISION, AND/OR EXCISION OF VARICOSE VEIN CLUSTER(S), ONE LEG
PENILE VENOUS OCCLUSIVE PROCEDURE
LAPAROSCOPY, SURGICAL, SPLENECTOMY
UNLISTED LAPAROSCOPY PROCEDURE, SPLEEN
BLOOD-DERIVED HEMATOPOIETIC PROGENITOR CELL HARVESTING FOR TRANSPLANTATION, PER
TRANSPLANT PREPARATION OF HEMATOPOIETIC PROGENITOR CELLS; CRYOPRESERVATION AND
TRANSPLANT PREPARATION OF HEMATOPOIETIC PROGENITOR CELLS; THAWING OF PREVIOUSLY
TRANSPLANT PREPARATION OF HEMATOPOIETIC PROGENITOR CELLS; THAWING OF PREVIOUSLY
TRANSPLANT PREPARATION OF HEMATOPOIETIC PROGENITOR CELLS; SPECIFIC CELL
TRANSPLANT PREPARATION OF HEMATOPOIETIC PROGENITOR CELLS; TUMOR CELL DEPLETION
TRANSPLANT PREPARATION OF HEMATOPOIETIC PROGENITOR CELLS; RED BLOOD CELL REMOVAL
TRANSPLANT PREPARATION OF HEMATOPOIETIC PROGENITOR CELLS; PLATELET DEPLETION
TRANSPLANT PREPARATION OF HEMATOPOIETIC PROGENITOR CELLS; PLASMA (VOLUME)
TRANSPLANT PREPARATION OF HEMATOPOIETIC PROGENITOR CELLS; CELL CONCENTRATION IN
BONE MARROW; ASPIRATION ONLY
BONE MARROW; BIOPSY, NEEDLE OR TROCAR
BONE MARROW HARVESTING FOR TRANSPLANTATION
Bone marrow harvesting for transplantation; autologous
BONE MARROW OR BLOOD-DERIVED PERIPHERAL STEM CELL TRANSPLANTATION; ALLOGENIC
BONE MARROW OR BLOOD-DERIVED PERIPHERAL STEM CELL TRANSPLANTATION; AUTOLOGOUS
BONE MARROW OR BLOOD-DERIVED PERIPHERAL STEM CELL TRANSPLANTATION; ALLOGENEIC
DRAINAGE OF LYMPH NODE ABSCESS OR LYMPHADENITIS; SIMPLE
DRAINAGE OF LYMPH NODE ABSCESS OR LYMPHADENITIS; EXTENSIVE
LYMPHANGIOTOMY OR OTHER OPERATIONS ON LYMPHATIC CHANNELS
BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, SUPERFICIAL
BIOPSY OR EXCISION OF LYMPH NODE(S); BY NEEDLE, SUPERFICIAL (EG, CERVICAL,
BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP CERVICAL NODE(S)
BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP CERVICAL NODE(S) WITH EXCISION
BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP AXILLARY NODE(S)
BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, INTERNAL MAMMARY NODE(S)
DISSECTION, DEEP JUGULAR NODE(S)
EXCISION OF CYSTIC HYGROMA, AXILLARY OR CERVICAL; WITHOUT DEEP NEUROVASCULAR
EXCISION OF CYSTIC HYGROMA, AXILLARY OR CERVICAL; WITH DEEP NEUROVASCULAR
LAPAROSCOPY, SURGICAL; WITH RETROPERITONEAL LYMPH NODE SAMPLING (BIOPSY), SINGLE
LAPAROSCOPY, SURGICAL; WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY
LAPAROSCOPY, SURGICAL; WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY AND
UNLISTED LAPAROSCOPY PROCEDURE, LYMPHATIC SYSTEM
SUPRAHYOID LYMPHADENECTOMY
CERVICAL LYMPHADENECTOMY (COMPLETE)
AXILLARY LYMPHADENECTOMY; SUPERFICIAL
AXILLARY LYMPHADENECTOMY; COMPLETE
INGUINOFEMORAL LYMPHADENECTOMY, SUPERFICIAL, INCLUDING CLOQUETS NODE (SEPARATE
UNLISTED PROCEDURE, HEMIC OR LYMPHATIC SYSTEM
MEDIASTINOSCOPY, WITH OR WITHOUT BIOPSY
BIOPSY OF LIP
VERMILIONECTOMY (LIP SHAVE), WITH MUCOSAL ADVANCEMENT
EXCISION OF LIP; TRANSVERSE WEDGE EXCISION WITH PRIMARY CLOSURE
EXCISION OF LIP; V-EXCISION WITH PRIMARY DIRECT LINEAR CLOSURE
EXCISION OF LIP; FULL THICKNESS, RECONSTRUCTION WITH LOCAL FLAP (EG, ESTLANDER
EXCISION OF LIP; FULL THICKNESS, RECONSTRUCTION WITH CROSS LIP FLAP
RESECTION OF LIP, MORE THAN ONE-FOURTH, WITHOUT RECONSTRUCTION
REPAIR LIP, FULL THICKNESS; VERMILION ONLY
REPAIR LIP, FULL THICKNESS; UP TO HALF VERTICAL HEIGHT
REPAIR LIP, FULL THICKNESS; OVER ONE-HALF VERTICAL HEIGHT, OR COMPLEX
PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; PRIMARY, PARTIAL OR COMPLETE,
PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; PRIMARY BILATERAL, ONE STAGE
PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; PRIMARY BILATERAL, ONE OF TWO
PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; SECONDARY, BY RECREATION OF DEFECT
PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; WITH CROSS LIP PEDICLE FLAP
UNLISTED PROCEDURE, LIPS
DRAINAGE OF ABSCESS, CYST, HEMATOMA, VESTIBULE OF MOUTH; SIMPLE
DRAINAGE OF ABSCESS, CYST, HEMATOMA, VESTIBULE OF MOUTH; COMPLICATED
REMOVAL OF EMBEDDED FOREIGN BODY, VESTIBULE OF MOUTH; COMPLICATED
INCISION OF LABIAL FRENUM (FRENOTOMY)
BIOPSY, VESTIBULE OF MOUTH
EXCISION OF LESION OF MUCOSA AND SUBMUCOSA, VESTIBULE OF MOUTH; WITHOUT REPAIR
EXCISION OF LESION OF MUCOSA AND SUBMUCOSA, VESTIBULE OF MOUTH; WITH SIMPLE
EXCISION OF LESION OF MUCOSA AND SUBMUCOSA, VESTIBULE OF MOUTH; WITH COMPLEX
EXCISION OF LESION OF MUCOSA AND SUBMUCOSA, VESTIBULE OF MOUTH; COMPLEX, WITH
EXCISION OF MUCOSA OF VESTIBULE OF MOUTH AS DONOR GRAFT
EXCISION OF FRENUM, LABIAL OR BUCCAL (FRENUMECTOMY, FRENULECTOMY, FRENECTOMY)
DESTRUCTION OF LESION OR SCAR OF VESTIBULE OF MOUTH BY PHYSICAL METHODS (EG,
CLOSURE OF LACERATION, VESTIBULE OF MOUTH; 2.5 CM OR LESS
CLOSURE OF LACERATION, VESTIBULE OF MOUTH; OVER 2.5 CM OR COMPLEX
VESTIBULOPLASTY; ANTERIOR
VESTIBULOPLASTY; POSTERIOR, UNILATERAL
VESTIBULOPLASTY; POSTERIOR, BILATERAL
VESTIBULOPLASTY; ENTIRE ARCH
VESTIBULOPLASTY; COMPLEX (INCLUDING RIDGE EXTENSION, MUSCLE REPOSITIONING)
UNLISTED PROCEDURE, VESTIBULE OF MOUTH
INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF TONGUE OR FLOOR
INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF TONGUE OR
INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF TONGUE OR
INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF TONGUE OR
INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF TONGUE OR
INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF TONGUE OR
INCISION OF LINGUAL FRENUM (FRENOTOMY)
EXTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF FLOOR OF
EXTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF FLOOR OF
EXTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF FLOOR OF
EXTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF FLOOR OF
PLACEMENT OF NEEDLES, CATHETERS, OR OTHER DEVICE(S) INTO THE HEAD AND/OR NECK RE
BIOPSY OF TONGUE; ANTERIOR TWO-THIRDS
BIOPSY OF TONGUE; POSTERIOR ONE-THIRD
BIOPSY OF FLOOR OF MOUTH
EXCISION OF LESION OF TONGUE WITHOUT CLOSURE
EXCISION OF LESION OF TONGUE WITH CLOSURE; ANTERIOR TWO-THIRDS
EXCISION OF LESION OF TONGUE WITH CLOSURE; POSTERIOR ONE-THIRD
EXCISION OF LESION OF TONGUE WITH CLOSURE; WITH LOCAL TONGUE FLAP
EXCISION OF LINGUAL FRENUM (FRENECTOMY)
EXCISION, LESION OF FLOOR OF MOUTH
GLOSSECTOMY; LESS THAN ONE-HALF TONGUE
REPAIR OF LACERATION 2.5 CM OR LESS; FLOOR OF MOUTH AND/OR ANTERIOR TWO-THIRDS O
REPAIR OF LACERATION 2.5 CM OR LESS; POSTERIOR ONE-THIRD OF TONGUE
REPAIR OF LACERATION OF TONGUE, FLOOR OF MOUTH, OVER 2.6 CM OR COMPLEX
FIXATION OF TONGUE, MECHANICAL, OTHER THAN SUTURE (EG, K-WIRE)
SUTURE OF TONGUE TO LIP FOR MICROGNATHIA (DOUGLAS TYPE PROCEDURE)
Tongue base suspension, permanent suture technique
FRENOPLASTY (SURGICAL REVISION OF FRENUM, EG, WITH Z-PLASTY)
Submucosal ablation of the tongue base, radiofrequency, one or more sites, per s
UNLISTED PROCEDURE, TONGUE, FLOOR OF MOUTH
DRAINAGE OF ABSCESS, CYST, HEMATOMA FROM DENTOALVEOLAR STRUCTURES
REMOVAL OF EMBEDDED FOREIGN BODY FROM DENTOALVEOLAR STRUCTURES; SOFT TISSUES
REMOVAL OF EMBEDDED FOREIGN BODY FROM DENTOALVEOLAR STRUCTURES; BONE
GINGIVECTOMY, EXCISION GINGIVA, EACH QUADRANT
OPERCULECTOMY, EXCISION PERICORONAL TISSUES
EXCISION OF FIBROUS TUBEROSITIES, DENTOALVEOLAR STRUCTURES
EXCISION OF OSSEOUS TUBEROSITIES, DENTOALVEOLAR STRUCTURES
EXCISION OF LESION OR TUMOR (EXCEPT LISTED ABOVE), DENTOALVEOLAR STRUCTURES;
EXCISION OF LESION OR TUMOR (EXCEPT LISTED ABOVE), DENTOALVEOLAR STRUCTURES;
EXCISION OF LESION OR TUMOR (EXCEPT LISTED ABOVE), DENTOALVEOLAR STRUCTURES;
EXCISION OF HYPERPLASTIC ALVEOLAR MUCOSA, EACH QUADRANT (SPECIFY)
ALVEOLECTOMY, INCLUDING CURETTAGE OF OSTEITIS OR SEQUESTRECTOMY
DESTRUCTION OF LESION (EXCEPT EXCISION), DENTOALVEOLAR STRUCTURES
PERIODONTAL MUCOSAL GRAFTING
GINGIVOPLASTY, EACH QUADRANT (SPECIFY)
ALVEOLOPLASTY, EACH QUADRANT (SPECIFY)
UNLISTED PROCEDURE, DENTOALVEOLAR STRUCTURES
DRAINAGE OF ABSCESS OF PALATE, UVULA
BIOPSY OF PALATE, UVULA
EXCISION, LESION OF PALATE, UVULA; WITHOUT CLOSURE
EXCISION, LESION OF PALATE, UVULA; WITH SIMPLE PRIMARY CLOSURE
EXCISION, LESION OF PALATE, UVULA; WITH LOCAL FLAP CLOSURE
RESECTION OF PALATE OR EXTENSIVE RESECTION OF LESION
UVULECTOMY, EXCISION OF UVULA
PALATOPHARYNGOPLASTY (EG, UVULOPALATOPHARYNGOPLASTY, UVULOPHARYNGOPLASTY)
DESTRUCTION OF LESION, PALATE OR UVULA (THERMAL, CRYO OR CHEMICAL)
REPAIR, LACERATION OF PALATE; UP TO 2 CM
REPAIR, LACERATION OF PALATE; OVER 2 CM OR COMPLEX
PALATOPLASTY FOR CLEFT PALATE, SOFT AND/OR HARD PALATE ONLY
PALATOPLASTY FOR CLEFT PALATE, WITH CLOSURE OF ALVEOLAR RIDGE; SOFT TISSUE ONLY
PALATOPLASTY FOR CLEFT PALATE, WITH CLOSURE OF ALVEOLAR RIDGE; WITH BONE GRAFT
PALATOPLASTY FOR CLEFT PALATE; MAJOR REVISION
PALATOPLASTY FOR CLEFT PALATE; SECONDARY LENGTHENING PROCEDURE
PALATOPLASTY FOR CLEFT PALATE; ATTACHMENT PHARYNGEAL FLAP
LENGTHENING OF PALATE, AND PHARYNGEAL FLAP
LENGTHENING OF PALATE, WITH ISLAND FLAP
REPAIR OF ANTERIOR PALATE, INCLUDING VOMER FLAP
REPAIR OF NASOLABIAL FISTULA
MAXILLARY IMPRESSION FOR PALATAL PROSTHESIS
INSERTION OF PIN-RETAINED PALATAL PROSTHESIS
UNLISTED PROCEDURE, PALATE, UVULA
DRAINAGE OF ABSCESS; PAROTID, SIMPLE
DRAINAGE OF ABSCESS; PAROTID, COMPLICATED
DRAINAGE OF ABSCESS; SUBMAXILLARY OR SUBLINGUAL, INTRAORAL
DRAINAGE OF ABSCESS; SUBMAXILLARY, EXTERNAL
SIALOLITHOTOMY; SUBMANDIBULAR (SUBMAXILLARY), SUBLINGUAL OR PAROTID,
SIALOLITHOTOMY; SUBMANDIBULAR (SUBMAXILLARY), COMPLICATED, INTRAORAL
SIALOLITHOTOMY; PAROTID, EXTRAORAL OR COMPLICATED INTRAORAL
BIOPSY OF SALIVARY GLAND; NEEDLE
BIOPSY OF SALIVARY GLAND; INCISIONAL
EXCISION OF SUBLINGUAL SALIVARY CYST (RANULA)
MARSUPIALIZATION OF SUBLINGUAL SALIVARY CYST (RANULA)
EXCISION OF PAROTID TUMOR OR PAROTID GLAND; LATERAL LOBE, WITHOUT NERVE
EXCISION OF PAROTID TUMOR OR PAROTID GLAND; LATERAL LOBE, WITH DISSECTION AND
EXCISION OF PAROTID TUMOR OR PAROTID GLAND; TOTAL, WITH DISSECTION AND
EXCISION OF PAROTID TUMOR OR PAROTID GLAND; TOTAL, EN BLOC REMOVAL WITH
EXCISION OF SUBMANDIBULAR (SUBMAXILLARY) GLAND
EXCISION OF SUBLINGUAL GLAND
PLASTIC REPAIR OF SALIVARY DUCT, SIALODOCHOPLASTY; PRIMARY OR SIMPLE
PLASTIC REPAIR OF SALIVARY DUCT, SIALODOCHOPLASTY; SECONDARY OR COMPLICATED
PAROTID DUCT DIVERSION, BILATERAL (WILKE TYPE PROCEDURE);
PAROTID DUCT DIVERSION, BILATERAL (WILKE TYPE PROCEDURE); WITH EXCISION OF ONE
PAROTID DUCT DIVERSION, BILATERAL (WILKE TYPE PROCEDURE); WITH EXCISION OF BOTH
PAROTID DUCT DIVERSION, BILATERAL (WILKE TYPE PROCEDURE); WITH LIGATION OF BOTH
CLOSURE SALIVARY FISTULA
DILATION SALIVARY DUCT
DILATION AND CATHETERIZATION OF SALIVARY DUCT, WITH OR WITHOUT INJECTION
LIGATION SALIVARY DUCT, INTRAORAL
UNLISTED PROCEDURE, SALIVARY GLANDS OR DUCTS
INCISION AND DRAINAGE ABSCESS; PERITONSILLAR
INCISION AND DRAINAGE ABSCESS; RETROPHARYNGEAL OR PARAPHARYNGEAL, INTRAORAL
INCISION AND DRAINAGE ABSCESS; RETROPHARYNGEAL OR PARAPHARYNGEAL, EXTERNAL
BIOPSY; OROPHARYNX
BIOPSY; HYPOPHARYNX
BIOPSY; NASOPHARYNX, VISIBLE LESION, SIMPLE
BIOPSY; NASOPHARYNX, SURVEY FOR UNKNOWN PRIMARY LESION
EXCISION OR DESTRUCTION OF LESION OF PHARYNX, ANY METHOD
EXCISION BRANCHIAL CLEFT CYST OR VESTIGE, CONFINED TO SKIN AND SUBCUTANEOUS
EXCISION BRANCHIAL CLEFT CYST, VESTIGE, OR FISTULA, EXTENDING BENEATH
TONSILLECTOMY AND ADENOIDECTOMY; UNDER AGE 12
TONSILLECTOMY AND ADENOIDECTOMY; AGE 12 OR OVER
TONSILLECTOMY, PRIMARY OR SECONDARY; UNDER AGE 12
TONSILLECTOMY, PRIMARY OR SECONDARY; AGE 12 OR OVER
ADENOIDECTOMY, PRIMARY; UNDER AGE 12
ADENOIDECTOMY, PRIMARY; AGE 12 OR OVER
ADENOIDECTOMY, SECONDARY; UNDER AGE 12
ADENOIDECTOMY, SECONDARY; AGE 12 OR OVER
RADICAL RESECTION OF TONSIL, TONSILLAR PILLARS, AND/OR RETROMOLAR TRIGONE;
RADICAL RESECTION OF TONSIL, TONSILLAR PILLARS, AND/OR RETROMOLAR TRIGONE;
EXCISION OF TONSIL TAGS
EXCISION OR DESTRUCTION LINGUAL TONSIL, ANY METHOD (SEPARATE PROCEDURE)
LIMITED PHARYNGECTOMY
RESECTION OF LATERAL PHARYNGEAL WALL OR PYRIFORM SINUS, DIRECT CLOSURE BY
SUTURE PHARYNX FOR WOUND OR INJURY
PHARYNGOPLASTY (PLASTIC OR RECONSTRUCTIVE OPERATION ON PHARYNX)
PHARYNGOSTOMY (FISTULIZATION OF PHARYNX, EXTERNAL FOR FEEDING)
CONTROL OROPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG,
CONTROL OROPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG,
CONTROL OF NASOPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG,
CONTROL OF NASOPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG,
UNLISTED PROCEDURE, PHARYNX, ADENOIDS, OR TONSILS
ESOPHAGOTOMY, CERVICAL APPROACH; WITH REMOVAL OF FOREIGN BODY
CRICOPHARYNGEAL MYOTOMY
DIVERTICULECTOMY OF HYPOPHARYNX OR ESOPHAGUS, WITH OR WITHOUT MYOTOMY; CERVICAL
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPEC
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH INJECTION SCLEROSIS OF ESOPHAGEAL VARICES
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH BAND LIGATION OF ESOPHAGEAL VARICES
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH REMOVAL OF FOREIGN BODY
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH INSERTION OF PLASTIC TUBE OR STENT
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH BALLOON DILATION (LESS THAN 30 MM
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH INSERTION OF GUIDE WIRE FOLLOWED BY
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH CONTROL OF BLEEDING (EG, INJECTION,
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH ENDOSCOPIC ULTRASOUND EXAMINATION
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH TRANSENDOSCOPIC ULTRASOUND-GUIDED
UPPER GASTROINTESTINAL ENDOSCOPY, SIMPLE PRIMARY EXAMINATION (EG, WITH SMALL
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); DIAGNOSTIC, WITH OR
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH BIOPSY, SINGLE OR
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH PRESSURE
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ABLATION OF
Endoscopic cannulation of papilla with direct visualization of common bile duct(
LAPAROSCOPY, SURGICAL, ESOPHAGOGASTRIC FUNDOPLASTY (EG, NISSEN, TOUPET PROCEDURE
UNLISTED LAPAROSCOPY PROCEDURE, ESOPHAGUS
CLOSURE OF ESOPHAGOSTOMY OR FISTULA; CERVICAL APPROACH
DILATION OF ESOPHAGUS, BY UNGUIDED SOUND OR BOUGIE, SINGLE OR MULTIPLE PASSES
DILATION OF ESOPHAGUS, OVER GUIDE WIRE
DILATION OF ESOPHAGUS, BY BALLOON OR DILATOR, RETROGRADE
DILATION OF ESOPHAGUS WITH BALLOON (30 MM DIAMETER OR LARGER) FOR ACHALASIA
UNLISTED PROCEDURE, ESOPHAGUS
GASTROTOMY; WITH ESOPHAGEAL DILATION AND INSERTION OF PERMANENT INTRALUMINAL
LAPAROSCOPY, SURGICAL; REVISION OR REMOVAL OF GASTRIC NEUROSTIMULATOR ELECTRODES
LAPAROSCOPY, SURGICAL; TRANSECTION OF VAGUS NERVES, TRUNCAL
LAPAROSCOPY, SURGICAL; TRANSECTION OF VAGUS NERVES, SELECTIVE OR HIGHLY
LAPAROSCOPY, SURGICAL; GASTROSTOMY, WITHOUT CONSTRUCTION OF GASTRIC TUBE (EG,
UNLISTED LAPAROSCOPY PROCEDURE, STOMACH
GASTRIC INTUBATION AND ASPIRATION, DIAGNOSTIC; COLLECTION OF MULTIPLE FRACTIONAL
CHANGE OF GASTROSTOMY TUBE, PERCUTANEOUS, WITHOUT IMAGING OR ENDOSCOPIC GUIDANCE
REPOSITIONING OF A NASO- OR ORO-GASTRIC FEEDING TUBE, THROUGH THE DUODENUM FOR E
GASTROSTOMY, OPEN; WITHOUT CONSTRUCTION OF GASTRIC TUBE (EG, STAMM PROCEDURE)
GASTROSTOMY, OPEN; NEONATAL, FOR FEEDING
CLOSURE OF GASTROSTOMY, SURGICAL
GASTRIC RESTRICTIVE PROCEDURE, OPEN; REVISION OF SUBCUTANEOUS PORT COMPONENT ONL
GASTRIC RESTRICTIVE PROCEDURE, OPEN; REMOVAL OF SUBCUTANEOUS PORT COMPONENT ONLY
GASTRIC RESTRICTIVE PROCEDURE, OPEN; REMOVAL AND REPLACEMENT OF SUBCUTANEOUS POR
UNLISTED PROCEDURE, STOMACH
BIOPSY OF INTESTINE BY CAPSULE, TUBE, PERORAL (ONE OR MORE SPECIMENS)
LAPAROSCOPY, SURGICAL, ENTEROLYSIS (FREEING OF INTESTINAL ADHESION) (SEPARATE PR
LAPAROSCOPY, SURGICAL; JEJUNOSTOMY (EG, FOR DECOMPRESSION OR FEEDING)
LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH END COLOSTOMY AND CLOSURE OF
LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH ANASTOMOSIS, WITH
LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH ANASTOMOSIS, WITH
LAPAROSCOPY, SURGICAL, MOBILIZATION (TAKE-DOWN) OF SPLENIC FLEXURE PERFORMED IN
UNLISTED LAPAROSCOPY PROCEDURE, INTESTINE (EXCEPT RECTUM)
REVISION OF ILEOSTOMY; SIMPLE (RELEASE OF SUPERFICIAL SCAR) (SEPARATE PROCEDURE)
REVISION OF COLOSTOMY; SIMPLE (RELEASE OF SUPERFICIAL SCAR) (SEPARATE PROCEDURE)
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT I
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM,
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM,
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM,
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM,
ILEOSCOPY, THROUGH STOMA; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S)
ILEOSCOPY, THROUGH STOMA; WITH BIOPSY, SINGLE OR MULTIPLE
ILEOSCOPY, THROUGH STOMA; WITH TRANSENDOSCOPIC STENT PLACEMENT (INCLUDES
ENDOSCOPIC EVALUATION OF SMALL INTESTINAL (ABDOMINAL OR PELVIC) POUCH;
ENDOSCOPIC EVALUATION OF SMALL INTESTINAL (ABDOMINAL OR PELVIC) POUCH; WITH
COLONOSCOPY THROUGH STOMA; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF
COLONOSCOPY THROUGH STOMA; WITH BIOPSY, SINGLE OR MULTIPLE
COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF FOREIGN BODY
COLONOSCOPY THROUGH STOMA; WITH CONTROL OF BLEEDING (EG, INJECTION, BIPOLAR
COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER
COLONOSCOPY THROUGH STOMA; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER
COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER
COLONOSCOPY THROUGH STOMA; WITH TRANSENDOSCOPIC STENT PLACEMENT (INCLUDES
INTRODUCTION OF LONG GASTROINTESTINAL TUBE (EG, MILLER-ABBOTT) (SEPARATE PROCEDU
UNLISTED PROCEDURE, INTESTINE
INCISION AND DRAINAGE OF APPENDICEAL ABSCESS; PERCUTANEOUS
APPENDECTOMY;
APPENDECTOMY; WHEN DONE FOR INDICATED PURPOSE AT TIME OF OTHER MAJOR PROCEDURE
LAPAROSCOPY, SURGICAL, APPENDECTOMY
UNLISTED LAPAROSCOPY PROCEDURE, APPENDIX
TRANSRECTAL DRAINAGE OF PELVIC ABSCESS
INCISION AND DRAINAGE OF SUBMUCOSAL ABSCESS, RECTUM
INCISION AND DRAINAGE OF DEEP SUPRALEVATOR, PELVIRECTAL, OR RETRORECTAL ABSCESS
BIOPSY OF ANORECTAL WALL, ANAL APPROACH (EG, CONGENITAL MEGACOLON)
ANORECTAL MYOMECTOMY
DIVISION OF STRICTURE OF RECTUM
EXCISION OF RECTAL TUMOR BY PROCTOTOMY, TRANSSACRAL OR TRANSCOCCYGEAL APPROACH
Excision of rectal tumor, transanal approach; not including muscularis propria (
Excision of rectal tumor, transanal approach; including muscularis propria (ie,
DESTRUCTION OF RECTAL TUMOR (EG, ELECTRODESSICATION, ELECTROSURGERY, LASER ABLAT
PROCTOSIGMOIDOSCOPY, RIGID; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S
PROCTOSIGMOIDOSCOPY, RIGID; WITH DILATION (EG, BALLOON, GUIDE WIRE, BOUGIE)
PROCTOSIGMOIDOSCOPY, RIGID; WITH BIOPSY, SINGLE OR MULTIPLE
PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF FOREIGN BODY
PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR OTHER
PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR OTHER
PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF MULTIPLE TUMORS, POLYPS, OR OTHER
PROCTOSIGMOIDOSCOPY, RIGID; WITH CONTROL OF BLEEDING (EG, INJECTION, BIPOLAR
PROCTOSIGMOIDOSCOPY, RIGID; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER
PROCTOSIGMOIDOSCOPY, RIGID; WITH DECOMPRESSION OF VOLVULUS
PROCTOSIGMOIDOSCOPY, RIGID; WITH TRANSENDOSCOPIC STENT PLACEMENT (INCLUDES
SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S)
SIGMOIDOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE
SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF FOREIGN BODY
SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S)
SIGMOIDOSCOPY, FLEXIBLE; WITH CONTROL OF BLEEDING (EG, INJECTION, BIPOLAR
SIGMOIDOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE
SIGMOIDOSCOPY, FLEXIBLE; WITH DECOMPRESSION OF VOLVULUS, ANY METHOD
SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S)
SIGMOIDOSCOPY, FLEXIBLE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER
SIGMOIDOSCOPY, FLEXIBLE; WITH DILATION BY BALLOON, 1 OR MORE STRICTURES
SIGMOIDOSCOPY, FLEXIBLE; WITH ENDOSCOPIC ULTRASOUND EXAMINATION
SIGMOIDOSCOPY, FLEXIBLE; WITH TRANSENDOSCOPIC ULTRASOUND GUIDED INTRAMURAL OR
SIGMOIDOSCOPY, FLEXIBLE; WITH TRANSENDOSCOPIC STENT PLACEMENT (INCLUDES
COLONOSCOPY, RIGID OR FLEXIBLE, TRANSABDOMINAL VIA COLOTOMY, SINGLE OR MULTIPLE
COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; DIAGNOSTIC, WITH OR WITHOUT
COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH REMOVAL OF FOREIGN BODY
COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH BIOPSY, SINGLE OR
COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH DIRECTED SUBMUCOSAL
COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH CONTROL OF BLEEDING
COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH ABLATION OF TUMOR(S),
COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH REMOVAL OF TUMOR(S),
COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH REMOVAL OF TUMOR(S),
COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH DILATION BY BALLOON, 1
COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH TRANSENDOSCOPIC STENT
COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH ENDOSCOPIC ULTRASOUND
COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH TRANSENDOSCOPIC
UNLISTED LAPAROSCOPY PROCEDURE, RECTUM
PROCTOPLASTY; FOR STENOSIS
PROCTOPLASTY; FOR PROLAPSE OF MUCOUS MEMBRANE
PERIRECTAL INJECTION OF SCLEROSING SOLUTION FOR PROLAPSE
PROCTOPEXY FOR PROLAPSE; PERINEAL APPROACH
REPAIR OF RECTOCELE (SEPARATE PROCEDURE)
REDUCTION OF PROCIDENTIA (SEPARATE PROCEDURE) UNDER ANESTHESIA
DILATION OF ANAL SPHINCTER (SEPARATE PROCEDURE) UNDER ANESTHESIA OTHER THAN
DILATION OF RECTAL STRICTURE (SEPARATE PROCEDURE) UNDER ANESTHESIA OTHER THAN
REMOVAL OF FECAL IMPACTION OR FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA
ANORECTAL EXAM, SURGICAL, REQUIRING ANESTHESIA (GENERAL, SPINAL, OR EPIDURAL), D
UNLISTED PROCEDURE, RECTUM
PLACEMENT OF SETON
REMOVAL OF ANAL SETON, OTHER MARKER
INCISION AND DRAINAGE OF ISCHIORECTAL AND/OR PERIRECTAL ABSCESS (SEPARATE
INCISION AND DRAINAGE OF INTRAMURAL, INTRAMUSCULAR, OR SUBMUCOSAL ABSCESS,
INCISION AND DRAINAGE, PERIANAL ABSCESS, SUPERFICIAL
INCISION AND DRAINAGE OF ISCHIORECTAL OR INTRAMURAL ABSCESS, WITH FISTULECTOMY
INCISION, ANAL SEPTUM (INFANT)
SPHINCTEROTOMY, ANAL, DIVISION OF SPHINCTER (SEPARATE PROCEDURE)
INCISION OF THROMBOSED HEMORRHOID, EXTERNAL
FISSURECTOMY, INCLUDING SPHINCTEROTOMY, WHEN PERFORMED
EXCISION OF SINGLE EXTERNAL PAPILLA OR TAG, ANUS
HEMORRHOIDECTOMY, INTERNAL, BY RUBBER BAND LIGATION(S)
CODE IS OUT OF NUMERICAL SEQUENCE. SEE 46200-46288
HEMORRHOIDECTOMY, EXTERNAL, 2 OR MORE COLUMNS/GROUPS
HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SINGLE COLUMN/GROUP;
HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SIMPLE; WITH FISSURECTOMY
HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SINGLE COLUMN/GROUP; WITH FISTULECTOMY,
HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, 2 OR MORE COLUMNS/GROUPS;
HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, COMPLEX OR EXTENSIVE; WITH FISSURECTOMY
HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, 2 OR MORE COLUMNS/GROUPS; WITH FISTULEC
SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); SUBCUTANEOUS
SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); INTERSPHINCTERIC
SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); TRANSSPHINCTERIC,
SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); SECOND STAGE
CLOSURE OF ANAL FISTULA WITH RECTAL ADVANCEMENT FLAP
EXCISION OF THROMBOSED HEMORRHOID, EXTERNAL
INJECTION OF SCLEROSING SOLUTION, HEMORRHOIDS
CHEMODENERVATION OF INTERNAL ANAL SPHINCTER
ANOSCOPY; WITH DILATION (EG, BALLOON, GUIDE WIRE, BOUGIE)
ANOSCOPY; WITH BIOPSY, SINGLE OR MULTIPLE
ANOSCOPY; WITH REMOVAL OF FOREIGN BODY
ANOSCOPY; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR OTHER LESION BY HOT BIOPSY
ANOSCOPY; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR OTHER LESION BY SNARE
ANOSCOPY; WITH REMOVAL OF MULTIPLE TUMORS, POLYPS, OR OTHER LESIONS BY HOT
ANOSCOPY; WITH CONTROL OF BLEEDING (EG, INJECTION, BIPOLAR CAUTERY, UNIPOLAR
ANOSCOPY; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) NOT AMENABLE
ANOPLASTY, PLASTIC OPERATION FOR STRICTURE; ADULT
REPAIR OF ANAL FISTULA WITH FIBRIN GLUE
Repair of anorectal fistula with plug (eg, porcine small intestine submucosa ¿S
SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE OR PROLAPSE; ADULT
GRAFT (THIERSCH OPERATION) FOR RECTAL INCONTINENCE AND/OR PROLAPSE
REMOVAL OF THIERSCH WIRE OR SUTURE, ANAL CANAL
SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE, ADULT; MUSCLE TRANSPLANT
SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE, ADULT; LEVATOR MUSCLE IMBRICATION
SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE, ADULT; IMPLANTATION ARTIFICIAL
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM,
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM
Destruction of internal hemorrhoid(s) by thermal energy (eg, infrared coagulatio
CURETTAGE OR CAUTERY OF ANAL FISSURE, INCLUDING DILATION OF ANAL SPHINCTER
CURETTAGE OR CAUTERY OF ANAL FISSURE, INCLUDING DILATION OF ANAL SPHINCTER
HEMORRHOIDECTOMY, INTERNAL, BY LIGATION OTHER THAN RUBBER BAND; SINGLE HEMORRHOI
HEMORRHOIDECTOMY, INTERNAL, BY LIGATION OTHER THAN RUBBER BAND; SINGLE HEMORRHOI
HEMORRHOIDOPEXY (EG, FOR PROLAPSING INTERNAL HEMORRHOIDS) BY STAPLING
UNLISTED PROCEDURE, ANUS
BIOPSY OF LIVER, NEEDLE; PERCUTANEOUS
HEPATOTOMY; FOR PERCUTANEOUS DRAINAGE OF ABSCESS OR CYST, ONE OR TWO STAGES
LAPAROSCOPY, SURGICAL, ABLATION OF ONE OR MORE LIVER TUMOR(S); RADIOFREQUENCY
LAPAROSCOPY, SURGICAL, ABLATION OF ONE OR MORE LIVER TUMOR(S); CRYOSURGICAL
UNLISTED LAPAROSCOPIC PROCEDURE, LIVER
ABLATION, 1 OR MORE LIVER TUMOR(S), PERCUTANEOUS, RADIOFREQUENCY
UNLISTED PROCEDURE, LIVER
CHOLECYSTOSTOMY, PERCUTANEOUS, COMPLETE PROCEDURE, INCLUDING IMAGING GUIDANCE, C
INTRODUCTION OF PERCUTANEOUS TRANSHEPATIC CATHETER FOR BILIARY DRAINAGE
INTRODUCTION OF PERCUTANEOUS TRANSHEPATIC STENT FOR INTERNAL AND EXTERNAL
CHANGE OF PERCUTANEOUS BILIARY DRAINAGE CATHETER
REVISION AND/OR REINSERTION OF TRANSHEPATIC TUBE
BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT; DIAGNOSTIC, WITH OR
BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT; WITH BIOPSY, SINGLE
BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT; WITH REMOVAL OF
BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT; WITH DILATION OF
BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT; WITH DILATION OF
LAPAROSCOPY, SURGICAL; WITH GUIDED TRANSHEPATIC CHOLANGIOGRAPHY, WITHOUT BIOPSY
LAPAROSCOPY, SURGICAL; WITH GUIDED TRANSHEPATIC CHOLANGIOGRAPHY WITH BIOPSY
LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY
LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH CHOLANGIOGRAPHY
LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT
UNLISTED LAPAROSCOPY PROCEDURE, BILIARY TRACT
BILIARY DUCT STONE EXTRACTION, PERCUTANEOUS VIA T-TUBE TRACT, BASKET, OR SNARE
UNLISTED PROCEDURE, BILIARY TRACT
BIOPSY OF PANCREAS, PERCUTANEOUS NEEDLE
EXTERNAL DRAINAGE, PSEUDOCYST OF PANCREAS; PERCUTANEOUS
UNLISTED PROCEDURE, PANCREAS
DRAINAGE OF PERITONEAL ABSCESS OR LOCALIZED PERITONITIS, EXCLUSIVE OF
DRAINAGE OF SUBDIAPHRAGMATIC OR SUBPHRENIC ABSCESS; PERCUTANEOUS
DRAINAGE OF RETROPERITONEAL ABSCESS; PERCUTANEOUS
Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance
Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance
Peritoneal lavage, including imaging guidance, when performed
BIOPSY, ABDOMINAL OR RETROPERITONEAL MASS, PERCUTANEOUS NEEDLE
UMBILECTOMY, OMPHALECTOMY, EXCISION OF UMBILICUS (SEPARATE PROCEDURE)
LAPAROSCOPY, ABDOMEN, PERITONEUM, AND OMENTUM, DIAGNOSTIC, WITH OR WITHOUT COLLE
LAPAROSCOPY, SURGICAL; WITH BIOPSY (SINGLE OR MULTIPLE)
LAPAROSCOPY, SURGICAL; WITH ASPIRATION OF CAVITY OR CYST (EG, OVARIAN CYST)
LAPAROSCOPY, SURGICAL; WITH DRAINAGE OF LYMPHOCELE TO PERITONEAL CAVITY
LAPAROSCOPY, SURGICAL; WITH INSERTION OF TUNNELED INTRAPERITONEAL CATHETER
LAPAROSCOPY, SURGICAL; WITH REVISION OF PREVIOUSLY PLACED INTRAPERITONEAL CANNUL
LAPAROSCOPY, SURGICAL; WITH OMENTOPEXY (OMENTAL TACKING PROCEDURE) (LIST SEPARAT
LAPAROSCOPY, SURGICAL; WITH PLACEMENT OF INTERSTITIAL DEVICE(S) FOR RADIATION TH
UNLISTED LAPAROSCOPY PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM
REMOVAL OF PERITONEAL FOREIGN BODY FROM PERITONEAL CAVITY
INSERTION OF TUNNELED INTRAPERITONEAL CATHETER (EG, DIALYSIS, INTRAPERITONEAL CH
INSERTION OF TUNNELED INTRAPERITONEAL CATHETER, WITH SUBCUTANEOUS PORT (IE, TOTA
INSERTION OF TUNNELED INTRAPERITONEAL CATHETER FOR DIALYSIS, OPEN
REMOVAL OF TUNNELED INTRAPERITONEAL CATHETER
EXCHANGE OF PREVIOUSLY PLACED ABSCESS OR CYST DRAINAGE CATHETER UNDER
REVISION OF PERITONEAL-VENOUS SHUNT
REMOVAL OF PERITONEAL-VENOUS SHUNT
INSERTION OF SUBCUTANEOUS EXTENSION TO INTRAPERITONEAL CANNULA OR CATHETER WITH
DELAYED CREATION OF EXIT SITE FROM EMBEDDED SUBCUTANEOUS SEGMENT OF INTRAPERITON
INSERTION OF GASTROSTOMY TUBE, PERCUTANEOUS, UNDER FLUOROSCOPIC GUIDANCE INCLUDI
INSERTION OF DUODENOSTOMY OR JEJUNOSTOMY TUBE, PERCUTANEOUS, UNDER FLUOROSCOPIC
INSERTION OF CECOSTOMY OR OTHER COLONIC TUBE, PERCUTANEOUS, UNDER FLUOROSCOPIC G
CONVERSION OF GASTROSTOMY TUBE TO GASTRO-JEJUNOSTOMY TUBE, PERCUTANEOUS, UNDER F
REPLACEMENT OF GASTROSTOMY OR CECOSTOMY (OR OTHER COLONIC) TUBE, PERCUTANEOUS, U
REPLACEMENT OF DUODENOSTOMY OR JEJUNOSTOMY TUBE, PERCUTANEOUS, UNDER FLUOROSCOPI
REPLACEMENT OF GASTRO-JEJUNOSTOMY TUBE, PERCUTANEOUS, UNDER FLUOROSCOPIC GUIDANC
MECHANICAL REMOVAL OF OBSTRUCTIVE MATERIAL FROM GASTROSTOMY, DUODENOSTOMY, JEJUN
REPAIR, INITIAL INGUINAL HERNIA, PRETERM INFANT (LESS THAN 37 WEEKS GESTATION AT
REPAIR, INITIAL INGUINAL HERNIA, PRETERM INFANT (LESS THAN 37 WEEKS GESTATION
REPAIR, INITIAL INGUINAL HERNIA, FULL TERM INFANT UNDER AGE 6 MONTHS, OR
REPAIR, INITIAL INGUINAL HERNIA, FULL TERM INFANT UNDER AGE 6 MONTHS, OR
REPAIR INITIAL INGUINAL HERNIA, AGE 6 MONTHS TO UNDER 5 YEARS, WITH OR WITHOUT
REPAIR INITIAL INGUINAL HERNIA, AGE 6 MONTHS TO UNDER 5 YEARS, WITH OR WITHOUT
REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OVER; REDUCIBLE
REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OVER; INCARCERATED OR
REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; REDUCIBLE
REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; INCARCERATED OR STRANGULATED
REPAIR INGUINAL HERNIA, SLIDING, ANY AGE
REPAIR LUMBAR HERNIA
REPAIR INITIAL FEMORAL HERNIA, ANY AGE; REDUCIBLE
REPAIR INITIAL FEMORAL HERNIA, ANY AGE; INCARCERATED OR STRANGULATED
REPAIR RECURRENT FEMORAL HERNIA; REDUCIBLE
REPAIR RECURRENT FEMORAL HERNIA; INCARCERATED OR STRANGULATED
REPAIR INITIAL INCISIONAL OR VENTRAL HERNIA; REDUCIBLE
REPAIR INITIAL INCISIONAL OR VENTRAL HERNIA; INCARCERATED OR STRANGULATED
REPAIR RECURRENT INCISIONAL OR VENTRAL HERNIA; REDUCIBLE
REPAIR RECURRENT INCISIONAL OR VENTRAL HERNIA; INCARCERATED OR STRANGULATED
IMPLANTATION OF MESH OR OTHER PROSTHESIS FOR OPEN INCISIONAL OR VENTRAL HERNIA R
REPAIR EPIGASTRIC HERNIA (EG, PREPERITONEAL FAT); REDUCIBLE (SEPARATE PROCEDURE)
REPAIR EPIGASTRIC HERNIA (EG, PREPERITONEAL FAT); INCARCERATED OR STRANGULATED
REPAIR UMBILICAL HERNIA, UNDER AGE 5 YEARS; REDUCIBLE
REPAIR UMBILICAL HERNIA, UNDER AGE 5 YEARS; INCARCERATED OR STRANGULATED
REPAIR UMBILICAL HERNIA, AGE 5 YEARS OR OVER; REDUCIBLE
REPAIR UMBILICAL HERNIA, AGE 5 YEARS OR OVER; INCARCERATED OR STRANGULATED
REPAIR SPIGELIAN HERNIA
REPAIR OF SMALL OMPHALOCELE, WITH PRIMARY CLOSURE
LAPAROSCOPY, SURGICAL; REPAIR INITIAL INGUINAL HERNIA
LAPAROSCOPY, SURGICAL; REPAIR RECURRENT INGUINAL HERNIA
Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric herni
Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric herni
Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when
Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when
Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insert
Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insert
UNLISTED LAPAROSCOPY PROCEDURE, HERNIOPLASTY, HERNIORRHAPHY, HERNIOTOMY
UNLISTED PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM
DRAINAGE OF PERIRENAL OR RENAL ABSCESS; OPEN
DRAINAGE OF PERIRENAL OR RENAL ABSCESS; PERCUTANEOUS
PERCUTANEOUS NEPHROSTOLITHOTOMY OR PYELOSTOLITHOTOMY, WITH OR WITHOUT DILATION,
PERCUTANEOUS NEPHROSTOLITHOTOMY OR PYELOSTOLITHOTOMY, WITH OR WITHOUT DILATION,
RENAL BIOPSY; PERCUTANEOUS, BY TROCAR OR NEEDLE
REMOVAL (VIA SNARE/CAPTURE) AND REPLACEMENT OF INTERNALLY DWELLING URETERAL STEN
REMOVAL (VIA SNARE/CAPTURE) OF INTERNALLY DWELLING URETERAL STENT VIA PERCUTANEO
REMOVAL (VIA SNARE/CAPTURE) AND REPLACEMENT OF INTERNALLY DWELLING URETERAL STEN
REMOVAL (VIA SNARE/CAPTURE) OF INTERNALLY DWELLING URETERAL STENT VIA TRANSURETH
REMOVAL AND REPLACEMENT OF EXTERNALLY ACCESSIBLE TRANSNEPHRIC URETERAL STENT (EG
REMOVAL OF NEPHROSTOMY TUBE, REQUIRING FLUOROSCOPIC GUIDANCE (EG, WITH CONCURREN
ASPIRATION AND/OR INJECTION OF RENAL CYST OR PELVIS BY NEEDLE, PERCUTANEOUS
INSTILLATION(S) OF THERAPEUTIC AGENT INTO RENAL PELVIS AND/OR URETER THROUGH
INTRODUCTION OF INTRACATHETER OR CATHETER INTO RENAL PELVIS FOR DRAINAGE AND/OR
INTRODUCTION OF URETERAL CATHETER OR STENT INTO URETER THROUGH RENAL PELVIS FOR
INTRODUCTION OF GUIDE INTO RENAL PELVIS AND/OR URETER WITH DILATION TO
MANOMETRIC STUDIES THROUGH NEPHROSTOMY OR PYELOSTOMY TUBE, OR INDWELLING
CHANGE OF NEPHROSTOMY OR PYELOSTOMY TUBE
LAPAROSCOPY, SURGICAL; ABLATION OF RENAL CYSTS
LAPAROSCOPY, SURGICAL; ABLATION OF RENAL MASS LESION(S), INCLUDING INTRAOPERATIV
LAPAROSCOPY, SURGICAL; PARTIAL NEPHRECTOMY
LAPAROSCOPY, SURGICAL; PYELOPLASTY
UNLISTED LAPAROSCOPY PROCEDURE, RENAL
RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT I
RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT
RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT
RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT
RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT
RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT
RENAL ENDOSCOPY THROUGH NEPHROTOMY OR PYELOTOMY, WITH OR WITHOUT IRRIGATION,
RENAL ENDOSCOPY THROUGH NEPHROTOMY OR PYELOTOMY, WITH OR WITHOUT IRRIGATION,
RENAL ENDOSCOPY THROUGH NEPHROTOMY OR PYELOTOMY, WITH OR WITHOUT IRRIGATION,
RENAL ENDOSCOPY THROUGH NEPHROTOMY OR PYELOTOMY, WITH OR WITHOUT IRRIGATION,
RENAL ENDOSCOPY THROUGH NEPHROTOMY OR PYELOTOMY, WITH OR WITHOUT IRRIGATION,
RENAL ENDOSCOPY THROUGH NEPHROTOMY OR PYELOTOMY, WITH OR WITHOUT IRRIGATION,
LITHOTRIPSY, EXTRACORPOREAL SHOCK WAVE
ABLATION, ONE OR MORE RENAL TUMOR(S), PERCUTANEOUS, UNILATERAL, RADIOFREQUENCY
ABLATION, RENAL TUMOR(S), UNILATERAL, PERCUTANEOUS, CRYOTHERAPY
MANOMETRIC STUDIES THROUGH URETEROSTOMY OR INDWELLING URETERAL CATHETER
CHANGE OF URETEROSTOMY TUBE OR EXTERNALLY ACCESSIBLE URETERAL STENT VIA ILEAL CO
REVISION OF URINARY-CUTANEOUS ANASTOMOSIS (ANY TYPE UROSTOMY);
LAPAROSCOPY, SURGICAL, URETEROLITHOTOMY
LAPAROSCOPY, SURGICAL; URETERONEOCYSTOSTOMY WITH CYSTOSCOPY AND URETERAL STENT
LAPAROSCOPY, SURGICAL; URETERONEOCYSTOSTOMY WITHOUT CYSTOSCOPY AND URETERAL
UNLISTED LAPAROSCOPY PROCEDURE, URETER
URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT IRRIGATION,
URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT
URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT
URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT
URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT
URETERAL ENDOSCOPY THROUGH URETEROTOMY, WITH OR WITHOUT IRRIGATION,
URETERAL ENDOSCOPY THROUGH URETEROTOMY, WITH OR WITHOUT IRRIGATION,
URETERAL ENDOSCOPY THROUGH URETEROTOMY, WITH OR WITHOUT IRRIGATION,
URETERAL ENDOSCOPY THROUGH URETEROTOMY, WITH OR WITHOUT IRRIGATION,
URETERAL ENDOSCOPY THROUGH URETEROTOMY, WITH OR WITHOUT IRRIGATION,
CYSTOTOMY OR CYSTOSTOMY; WITH FULGURATION AND/OR INSERTION OF RADIOACTIVE
CYSTOTOMY OR CYSTOSTOMY; WITH CRYOSURGICAL DESTRUCTION OF INTRAVESICAL LESION
CYSTOSTOMY, CYSTOTOMY WITH DRAINAGE
CYSTOTOMY, WITH INSERTION OF URETERAL CATHETER OR STENT (SEPARATE PROCEDURE)
CYSTOLITHOTOMY, CYSTOTOMY WITH REMOVAL OF CALCULUS, WITHOUT VESICAL NECK
TRANSVESICAL URETEROLITHOTOMY
CYSTOTOMY, WITH CALCULUS BASKET EXTRACTION AND/OR ULTRASONIC OR
DRAINAGE OF PERIVESICAL OR PREVESICAL SPACE ABSCESS
ASPIRATION OF BLADDER; BY NEEDLE
ASPIRATION OF BLADDER; BY TROCAR OR INTRACATHETER
ASPIRATION OF BLADDER; WITH INSERTION OF SUPRAPUBIC CATHETER
EXCISION OF URACHAL CYST OR SINUS, WITH OR WITHOUT UMBILICAL HERNIA REPAIR
CYSTOTOMY; FOR SIMPLE EXCISION OF VESICAL NECK (SEPARATE PROCEDURE)
CYSTOTOMY FOR EXCISION, INCISION, OR REPAIR OF URETEROCELE
BLADDER IRRIGATION, SIMPLE, LAVAGE AND/OR INSTILLATION
INSERTION OF TEMPORARY INDWELLING BLADDER CATHETER; COMPLICATED (EG, ALTERED
CHANGE OF CYSTOSTOMY TUBE; SIMPLE
CHANGE OF CYSTOSTOMY TUBE; COMPLICATED
ENDOSCOPIC INJECTION OF IMPLANT MATERIAL INTO THE SUBMUCOSAL TISSUES OF THE
BLADDER INSTILLATION OF ANTICARCINOGENIC AGENT (INCLUDING RETENTION TIME)
SIMPLE CYSTOMETROGRAM (CMG) (EG, SPINAL MANOMETER)
COMPLEX CYSTOMETROGRAM (IE, CALIBRATED ELECTRONIC EQUIPMENT);
Complex cystometrogram (ie, calibrated electronic equipment); with urethral pres
Complex cystometrogram (ie, calibrated electronic equipment); with voiding press
Complex cystometrogram (ie, calibrated electronic equipment); with voiding press
COMPLEX UROFLOWMETRY (EG, CALIBRATED ELECTRONIC EQUIPMENT)
ELECTROMYOGRAPHY STUDIES (EMG) OF ANAL OR URETHRAL SPHINCTER, OTHER THAN
NEEDLE ELECTROMYOGRAPHY STUDIES (EMG) OF ANAL OR URETHRAL SPHINCTER, ANY
STIMULUS EVOKED RESPONSE (EG, MEASUREMENT OF BULBOCAVERNOSUS REFLEX LATENCY
51797 VOIDING PRESSURE STUDIES, INTRA-ABDOMINAL (IE, RECTAL, GASTRIC, INTRAPERIT
ABDOMINO-VAGINAL VESICAL NECK SUSPENSION, WITH OR WITHOUT ENDOSCOPIC CONTROL
CYSTORRHAPHY, SUTURE OF BLADDER WOUND, INJURY OR RUPTURE; SIMPLE
CLOSURE OF CYSTOSTOMY (SEPARATE PROCEDURE)
LAPAROSCOPY, SURGICAL; URETHRAL SUSPENSION FOR STRESS INCONTINENCE
LAPAROSCOPY, SURGICAL; SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA OR
UNLISTED LAPAROSCOPY PROCEDURE, BLADDER
CYSTOURETHROSCOPY (SEPARATE PROCEDURE)
CYSTOURETHROSCOPY WITH IRRIGATION AND EVACUATION OF MULTIPLE OBSTRUCTING CLOTS
CYSTOURETHROSCOPY, WITH URETERAL CATHETERIZATION, WITH OR WITHOUT IRRIGATION,
CYSTOURETHROSCOPY, WITH URETERAL CATHETERIZATION, WITH OR WITHOUT IRRIGATION,
CYSTOURETHROSCOPY, WITH EJACULATORY DUCT CATHETERIZATION, WITH OR WITHOUT
CYSTOURETHROSCOPY, WITH BIOPSY(S)
CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) OF
CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) OR
CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY)
CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY)
CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY)
CYSTOURETHROSCOPY WITH INSERTION OF RADIOACTIVE SUBSTANCE, WITH OR WITHOUT
CYSTOURETHROSCOPY, WITH DILATION OF BLADDER FOR INTERSTITIAL CYSTITIS; GENERAL
CYSTOURETHROSCOPY, WITH DILATION OF BLADDER FOR INTERSTITIAL CYSTITIS; LOCAL
CYSTOURETHROSCOPY, WITH INTERNAL URETHROTOMY; FEMALE
CYSTOURETHROSCOPY, WITH INTERNAL URETHROTOMY; MALE
CYSTOURETHROSCOPY WITH DIRECT VISION INTERNAL URETHROTOMY
CYSTOURETHROSCOPY, WITH RESECTION OF EXTERNAL SPHINCTER (SPHINCTEROTOMY)
CYSTOURETHROSCOPY, WITH CALIBRATION AND/OR DILATION OF URETHRAL STRICTURE OR
CYSTOURETHROSCOPY, WITH INSERTION OF PERMANENT URETHRAL STENT
CYSTOURETHROSCOPY, WITH STEROID INJECTION INTO STRICTURE
CYSTOURETHROSCOPY FOR TREATMENT OF THE FEMALE URETHRAL SYNDROME WITH ANY OR ALL
CYSTOURETHROSCOPY; WITH URETERAL MEATOTOMY, UNILATERAL OR BILATERAL
CYSTOURETHROSCOPY; WITH RESECTION OR FULGURATION OF ORTHOTOPIC URETEROCELE(S),
CYSTOURETHROSCOPY; WITH RESECTION OR FULGURATION OF ECTOPIC URETEROCELE(S),
CYSTOURETHROSCOPY; WITH INCISION OR RESECTION OF ORIFICE OF BLADDER
CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY, CALCULUS, OR URETERAL STENT
CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY, CALCULUS, OR URETERAL STENT
LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUS BY ANY MEANS IN BLADDER AND
LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUS BY ANY MEANS IN BLADDER AND
CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH REMOVAL OF URETERAL
CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH FRAGMENTATION OF
CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH SUBURETERIC
CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH MANIPULATION,
CYSTOURETHROSCOPY, WITH INSERTION OF INDWELLING URETERAL STENT (EG, GIBBONS OR
CYSTOURETHROSCOPY WITH INSERTION OF URETERAL GUIDE WIRE THROUGH KIDNEY TO
CYSTOURETHROSCOPY; WITH TREATMENT OF URETERAL STRICTURE (EG, BALLOON DILATION,
CYSTOURETHROSCOPY; WITH TREATMENT OF URETEROPELVIC JUNCTION STRICTURE (EG,
CYSTOURETHROSCOPY; WITH TREATMENT OF INTRA-RENAL STRICTURE (EG, BALLOON
CYSTOURETHROSCOPY WITH URETEROSCOPY; WITH TREATMENT OF URETERAL STRICTURE (EG,
CYSTOURETHROSCOPY WITH URETEROSCOPY; WITH TREATMENT OF URETEROPELVIC JUNCTION
CYSTOURETHROSCOPY WITH URETEROSCOPY; WITH TREATMENT OF INTRA-RENAL STRICTURE
CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; DIAGNOSTIC
CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH REMOVAL OR
CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH LITHOTRIPSY
CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH BIOPSY AND/OR
CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH RESECTION OF
CYSTOURETHROSCOPY WITH INCISION, FULGURATION, OR RESECTION OF CONGENITAL POSTERI
CYSTOURETHROSCOPY WITH TRANSURETHRAL RESECTION OR INCISION OF EJACULATORY DUCTS
TRANSURETHRAL INCISION OF PROSTATE
TRANSURETHRAL RESECTION OF BLADDER NECK (SEPARATE PROCEDURE)
TRANSURETHRAL ELECTROSURGICAL RESECTION OF PROSTATE, INCLUDING CONTROL OF
TRANSURETHRAL RESECTION; RESIDUAL OR REGROWTH OF OBSTRUCTIVE PROSTATE TISSUE INC
TRANSURETHRAL RESECTION; OF POSTOPERATIVE BLADDER NECK CONTRACTURE
LASER COAGULATION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMP
LASER VAPORIZATION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COM
LASER ENUCLEATION OF THE PROSTATE WITH MORCELLATION, INCLUDING CONTROL OF POSTOP
TRANSURETHRAL DRAINAGE OF PROSTATIC ABSCESS
URETHROTOMY OR URETHROSTOMY, EXTERNAL (SEPARATE PROCEDURE); PENDULOUS URETHRA
URETHROTOMY OR URETHROSTOMY, EXTERNAL (SEPARATE PROCEDURE); PERINEAL URETHRA,
MEATOTOMY, CUTTING OF MEATUS (SEPARATE PROCEDURE); EXCEPT INFANT
MEATOTOMY, CUTTING OF MEATUS (SEPARATE PROCEDURE); INFANT
DRAINAGE OF DEEP PERIURETHRAL ABSCESS
DRAINAGE OF SKENE'S GLAND ABSCESS OR CYST
DRAINAGE OF PERINEAL URINARY EXTRAVASATION; UNCOMPLICATED (SEPARATE PROCEDURE)
DRAINAGE OF PERINEAL URINARY EXTRAVASATION; COMPLICATED
BIOPSY OF URETHRA
URETHRECTOMY, TOTAL, INCLUDING CYSTOSTOMY; FEMALE
URETHRECTOMY, TOTAL, INCLUDING CYSTOSTOMY; MALE
EXCISION OR FULGURATION OF CARCINOMA OF URETHRA
EXCISION OF URETHRAL DIVERTICULUM (SEPARATE PROCEDURE); FEMALE
EXCISION OF URETHRAL DIVERTICULUM (SEPARATE PROCEDURE); MALE
MARSUPIALIZATION OF URETHRAL DIVERTICULUM, MALE OR FEMALE
EXCISION OF BULBOURETHRAL GLAND (COWPER'S GLAND)
EXCISION OR FULGURATION; URETHRAL POLYP(S), DISTAL URETHRA
EXCISION OR FULGURATION; URETHRAL CARUNCLE
EXCISION OR FULGURATION; SKENE'S GLANDS
EXCISION OR FULGURATION; URETHRAL PROLAPSE
URETHROPLASTY; FIRST STAGE, FOR FISTULA, DIVERTICULUM, OR STRICTURE (EG, JOHANNS
URETHROPLASTY; SECOND STAGE (FORMATION OF URETHRA), INCLUDING URINARY DIVERSION
URETHROPLASTY, ONE-STAGE RECONSTRUCTION OF MALE ANTERIOR URETHRA
URETHROPLASTY, TWO-STAGE RECONSTRUCTION OR REPAIR OF PROSTATIC OR MEMBRANOUS
URETHROPLASTY, TWO-STAGE RECONSTRUCTION OR REPAIR OF PROSTATIC OR MEMBRANOUS
URETHROPLASTY, RECONSTRUCTION OF FEMALE URETHRA
URETHROPLASTY WITH TUBULARIZATION OF POSTERIOR URETHRA AND/ OR LOWER BLADDER
SLING OPERATION FOR CORRECTION OF MALE URINARY INCONTINENCE (EG, FASCIA OR
REMOVAL OR REVISION OF SLING FOR MALE URINARY INCONTINENCE (EG, FASCIA OR
INSERTION OF TANDEM CUFF (DUAL CUFF)
INSERTION OF INFLATABLE URETHRAL/BLADDER NECK SPHINCTER, INCLUDING PLACEMENT OF
REMOVAL OF INFLATABLE URETHRAL/BLADDER NECK SPHINCTER, INCLUDING PUMP,
REMOVAL AND REPLACEMENT OF INFLATABLE URETHRAL/BLADDER NECK SPHINCTER INCLUDING
REPAIR OF INFLATABLE URETHRAL/BLADDER NECK SPHINCTER, INCLUDING PUMP,
URETHROMEATOPLASTY, WITH MUCOSAL ADVANCEMENT
URETHROMEATOPLASTY, WITH PARTIAL EXCISION OF DISTAL URETHRAL SEGMENT
URETHROLYSIS, TRANSVAGINAL, SECONDARY, OPEN, INCLUDING CYSTOURETHROSCOPY (EG,
URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY, FEMALE
URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY; PENILE
URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY; PERINEAL
URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY; PROSTATOMEMBRANOUS
CLOSURE OF URETHROSTOMY OR URETHROCUTANEOUS FISTULA, MALE (SEPARATE PROCEDURE)
DILATION OF URETHRAL STRICTURE BY PASSAGE OF SOUND OR URETHRAL DILATOR, MALE; IN
DILATION OF URETHRAL STRICTURE BY PASSAGE OF SOUND OR URETHRAL DILATOR, MALE;
DILATION OF URETHRAL STRICTURE OR VESICAL NECK BY PASSAGE OF SOUND OR URETHRAL
DILATION OF URETHRAL STRICTURE BY PASSAGE OF FILIFORM AND FOLLOWER, MALE;
DILATION OF URETHRAL STRICTURE BY PASSAGE OF FILIFORM AND FOLLOWER, MALE;
DILATION OF FEMALE URETHRA INCLUDING SUPPOSITORY AND/OR INSTILLATION; INITIAL
DILATION OF FEMALE URETHRA INCLUDING SUPPOSITORY AND/OR INSTILLATION; SUBSEQUENT
DILATION OF FEMALE URETHRA, GENERAL OR CONDUCTION (SPINAL) ANESTHESIA
TRANSURETHRAL DESTRUCTION OF PROSTATE TISSUE; BY MICROWAVE THERMOTHERAPY
TRANSURETHRAL DESTRUCTION OF PROSTATE TISSUE; BY RADIOFREQUENCY THERMOTHERAPY
Insertion of a temporary prostatic urethral stent, including urethral measuremen
UNLISTED PROCEDURE, URINARY SYSTEM
SLITTING OF PREPUCE, DORSAL OR LATERAL (SEPARATE PROCEDURE); NEWBORN
SLITTING OF PREPUCE, DORSAL OR LATERAL (SEPARATE PROCEDURE); EXCEPT NEWBORN
INCISION AND DRAINAGE OF PENIS, DEEP
DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM
DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM
DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM
DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM
DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM
DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM
BIOPSY OF PENIS; (SEPARATE PROCEDURE)
BIOPSY OF PENIS; DEEP STRUCTURES
EXCISION OF PENILE PLAQUE (PEYRONIE DISEASE);
EXCISION OF PENILE PLAQUE (PEYRONIE DISEASE); WITH GRAFT TO 5 CM IN LENGTH
EXCISION OF PENILE PLAQUE (PEYRONIE DISEASE); WITH GRAFT GREATER THAN 5 CM IN
REMOVAL FOREIGN BODY FROM DEEP PENILE TISSUE (EG, PLASTIC IMPLANT)
AMPUTATION OF PENIS; PARTIAL
OLDER THAN 28 DAYS OF AGE
LYSIS OR EXCISION OF PENILE POST-CIRCUMCISION ADHESIONS
REPAIR INCOMPLETE CIRCUMCISION
FRENULOTOMY OF PENIS
INJECTION PROCEDURE FOR PEYRONIE DISEASE;
INJECTION PROCEDURE FOR PEYRONIE DISEASE; WITH SURGICAL EXPOSURE OF PLAQUE
IRRIGATION OF CORPORA CAVERNOSA FOR PRIAPISM
DYNAMIC CAVERNOSOMETRY, INCLUDING INTRACAVERNOSAL INJECTION OF VASOACTIVE DRUGS
INJECTION OF CORPORA CAVERNOSA WITH PHARMACOLOGIC AGENT(S) (EG, PAPAVERINE,
PENILE PLETHYSMOGRAPHY
NOCTURNAL PENILE TUMESCENCE AND/OR RIGIDITY TEST
PLASTIC OPERATION OF PENIS FOR STRAIGHTENING OF CHORDEE (EG, HYPOSPADIAS), WITH
PLASTIC OPERATION ON PENIS FOR CORRECTION OF CHORDEE OR FOR FIRST STAGE
URETHROPLASTY FOR SECOND STAGE HYPOSPADIAS REPAIR (INCLUDING URINARY
URETHROPLASTY FOR SECOND STAGE HYPOSPADIAS REPAIR (INCLUDING URINARY
URETHROPLASTY FOR SECOND STAGE HYPOSPADIAS REPAIR (INCLUDING URINARY DIVERSION)
URETHROPLASTY FOR THIRD STAGE HYPOSPADIAS REPAIR TO RELEASE PENIS FROM SCROTUM
ONE STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION);
ONE STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION);
ONE STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION);
ONE STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION);
ONE STAGE PROXIMAL PENILE OR PENOSCROTAL HYPOSPADIAS REPAIR REQUIRING EXTENSIVE
ONE STAGE PERINEAL HYPOSPADIAS REPAIR REQUIRING EXTENSIVE DISSECTION TO CORRECT
REPAIR OF HYPOSPADIAS COMPLICATIONS (IE, FISTULA, STRICTURE, DIVERTICULA); BY
REPAIR OF HYPOSPADIAS COMPLICATIONS (IE, FISTULA, STRICTURE, DIVERTICULA);
REPAIR OF HYPOSPADIAS COMPLICATIONS (IE, FISTULA, STRICTURE, DIVERTICULA);
REPAIR OF HYPOSPADIAS CRIPPLE REQUIRING EXTENSIVE DISSECTION AND EXCISION OF
PLASTIC OPERATION ON PENIS TO CORRECT ANGULATION
PLASTIC OPERATION ON PENIS FOR EPISPADIAS DISTAL TO EXTERNAL SPHINCTER;
PLASTIC OPERATION ON PENIS FOR EPISPADIAS DISTAL TO EXTERNAL SPHINCTER; WITH
REMOVAL OF ALL COMPONENTS OF A MULTI-COMPONENT, INFLATABLE PENILE PROSTHESIS
REPAIR OF COMPONENT(S) OF A MULTI-COMPONENT, INFLATABLE PENILE PROSTHESIS
REMOVAL AND REPLACEMENT OF ALL COMPONENT(S) OF A MULTI-COMPONENT, INFLATABLE
REMOVAL OF NON-INFLATABLE (SEMI-RIGID) OR INFLATABLE (SELF-CONTAINED) PENILE
REMOVAL AND REPLACEMENT OF NON-INFLATABLE (SEMI-RIGID) OR INFLATABLE
CORPORA CAVERNOSA-SAPHENOUS VEIN SHUNT (PRIAPISM OPERATION), UNILATERAL OR
CORPORA CAVERNOSA-GLANS PENIS FISTULIZATION (EG, BIOPSY NEEDLE, WINTER
PLASTIC OPERATION OF PENIS FOR INJURY
FORESKIN MANIPULATION INCLUDING LYSIS OF PREPUTIAL ADHESIONS AND STRETCHING
BIOPSY OF TESTIS, NEEDLE (SEPARATE PROCEDURE)
BIOPSY OF TESTIS, INCISIONAL (SEPARATE PROCEDURE)
EXCISION OF EXTRAPARENCHYMAL LESION OF TESTIS
ORCHIECTOMY, SIMPLE (INCLUDING SUBCAPSULAR), WITH OR WITHOUT TESTICULAR
ORCHIECTOMY, PARTIAL
ORCHIECTOMY, RADICAL, FOR TUMOR; INGUINAL APPROACH
ORCHIECTOMY, RADICAL, FOR TUMOR; WITH ABDOMINAL EXPLORATION
EXPLORATION FOR UNDESCENDED TESTIS (INGUINAL OR SCROTAL AREA)
EXPLORATION FOR UNDESCENDED TESTIS WITH ABDOMINAL EXPLORATION
REDUCTION OF TORSION OF TESTIS, SURGICAL, WITH OR WITHOUT FIXATION OF CONTRALATE
FIXATION OF CONTRALATERAL TESTIS (SEPARATE PROCEDURE)
ORCHIOPEXY, INGUINAL APPROACH, WITH OR WITHOUT HERNIA REPAIR
INSERTION OF TESTICULAR PROSTHESIS (SEPARATE PROCEDURE)
SUTURE OR REPAIR OF TESTICULAR INJURY
TRANSPLANTATION OF TESTIS(ES) TO THIGH (BECAUSE OF SCROTAL DESTRUCTION)
LAPAROSCOPY, SURGICAL; ORCHIECTOMY
LAPAROSCOPY, SURGICAL; ORCHIOPEXY FOR INTRA-ABDOMINAL TESTIS
UNLISTED LAPAROSCOPY PROCEDURE, TESTIS
INCISION AND DRAINAGE OF EPIDIDYMIS, TESTIS AND/OR SCROTAL SPACE (EG, ABSCESS OR
BIOPSY OF EPIDIDYMIS, NEEDLE
EXCISION OF LOCAL LESION OF EPIDIDYMIS
EXCISION OF SPERMATOCELE, WITH OR WITHOUT EPIDIDYMECTOMY
EPIDIDYMECTOMY; UNILATERAL
EPIDIDYMECTOMY; BILATERAL
EXPLORATION OF EPIDIDYMIS, WITH OR WITHOUT BIOPSY
EPIDIDYMOVASOSTOMY, ANASTOMOSIS OF EPIDIDYMIS TO VAS DEFERENS; UNILATERAL
EPIDIDYMOVASOSTOMY, ANASTOMOSIS OF EPIDIDYMIS TO VAS DEFERENS; BILATERAL
PUNCTURE ASPIRATION OF HYDROCELE, TUNICA VAGINALIS, WITH OR WITHOUT INJECTION OF
EXCISION OF HYDROCELE; UNILATERAL
EXCISION OF HYDROCELE; BILATERAL
REPAIR OF TUNICA VAGINALIS HYDROCELE (BOTTLE TYPE)
DRAINAGE OF SCROTAL WALL ABSCESS
SCROTAL EXPLORATION
REMOVAL OF FOREIGN BODY IN SCROTUM
RESECTION OF SCROTUM
SCROTOPLASTY; SIMPLE
SCROTOPLASTY; COMPLICATED
VASOTOMY, CANNULIZATION WITH OR WITHOUT INCISION OF VAS, UNILATERAL OR BILATERAL
VASECTOMY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE), INCLUDING POSTOPERATIVE
LIGATION (PERCUTANEOUS) OF VAS DEFERENS, UNILATERAL OR BILATERAL (SEPARATE PROCE
EXCISION OF HYDROCELE OF SPERMATIC CORD, UNILATERAL (SEPARATE PROCEDURE)
EXCISION OF LESION OF SPERMATIC CORD (SEPARATE PROCEDURE)
EXCISION OF VARICOCELE OR LIGATION OF SPERMATIC VEINS FOR VARICOCELE; (SEPARATE
EXCISION OF VARICOCELE OR LIGATION OF SPERMATIC VEINS FOR VARICOCELE; ABDOMINAL
EXCISION OF VARICOCELE OR LIGATION OF SPERMATIC VEINS FOR VARICOCELE; WITH
LAPAROSCOPY, SURGICAL, WITH LIGATION OF SPERMATIC VEINS FOR VARICOCELE
UNLISTED LAPAROSCOPY PROCEDURE, SPERMATIC CORD
VESICULOTOMY;
EXCISION OF MULLERIAN DUCT CYST
BIOPSY, PROSTATE; NEEDLE OR PUNCH, SINGLE OR MULTIPLE, ANY APPROACH
BIOPSY, PROSTATE; INCISIONAL, ANY APPROACH
Biopsy, prostate; needle, transperineal, stereotactic template guided saturation
PROSTATOTOMY, EXTERNAL DRAINAGE OF PROSTATIC ABSCESS, ANY APPROACH; SIMPLE
PROSTATOTOMY, EXTERNAL DRAINAGE OF PROSTATIC ABSCESS, ANY APPROACH; COMPLICATED
EXPOSURE OF PROSTATE, ANY APPROACH, FOR INSERTION OF RADIOACTIVE SUBSTANCE;
ELECTROEJACULATION
CRYOSURGICAL ABLATION OF THE PROSTATE (INCLUDES ULTRASONIC GUIDANCE AND MONITORI
UNLISTED PROCEDURE, MALE GENITAL SYSTEM
PLACEMENT OF NEEDLES OR CATHETERS INTO PELVIC ORGANS AND/ OR GENITALIA (EXCEPT P
INCISION AND DRAINAGE OF VULVA OR PERINEAL ABSCESS
INCISION AND DRAINAGE OF BARTHOLIN'S GLAND ABSCESS
MARSUPIALIZATION OF BARTHOLIN'S GLAND CYST
LYSIS OF LABIAL ADHESIONS
HYMENOTOMY, SIMPLE INCISION
DESTRUCTION OF LESION(S), VULVA; SIMPLE (EG, LASER SURGERY, ELECTROSURGERY, CRYO
DESTRUCTION OF LESION(S), VULVA; EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY,
BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); ONE LESION
BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); EACH SEPARATE ADDITIONAL
VULVECTOMY SIMPLE; PARTIAL
VULVECTOMY SIMPLE; COMPLETE
PARTIAL HYMENECTOMY OR REVISION OF HYMENAL RING
EXCISION OF BARTHOLIN'S GLAND OR CYST
PLASTIC REPAIR OF INTROITUS
CLITOROPLASTY FOR INTERSEX STATE
PERINEOPLASTY, REPAIR OF PERINEUM, NONOBSTETRICAL (SEPARATE PROCEDURE)
COLPOSCOPY OF THE VULVA;
COLPOSCOPY OF THE VULVA; WITH BIOPSY(S)
COLPOTOMY; WITH EXPLORATION
COLPOTOMY; WITH DRAINAGE OF PELVIC ABSCESS
COLPOCENTESIS (SEPARATE PROCEDURE)
INCISION AND DRAINAGE OF VAGINAL HEMATOMA; OBSTETRICAL/POSTPARTUM
INCISION AND DRAINAGE OF VAGINAL HEMATOMA; NON-OBSTETRICAL (EG, POST-TRAUMA,
DESTRUCTION OF VAGINAL LESION(S); SIMPLE (EG, LASER SURGERY, ELECTROSURGERY, CRY
DESTRUCTION OF VAGINAL LESION(S); EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY,
BIOPSY OF VAGINAL MUCOSA; SIMPLE (SEPARATE PROCEDURE)
BIOPSY OF VAGINAL MUCOSA; EXTENSIVE, REQUIRING SUTURE (INCLUDING CYSTS)
VAGINECTOMY, PARTIAL REMOVAL OF VAGINAL WALL;
VAGINECTOMY, PARTIAL REMOVAL OF VAGINAL WALL; WITH REMOVAL OF PARAVAGINAL
VAGINECTOMY, PARTIAL REMOVAL OF VAGINAL WALL; WITH REMOVAL OF PARAVAGINAL
COLPOCLEISIS (LE FORT TYPE)
EXCISION OF VAGINAL SEPTUM
EXCISION OF VAGINAL CYST OR TUMOR
IRRIGATION OF VAGINA AND/OR APPLICATION OF MEDICAMENT FOR TREATMENT OF BACTERIAL
INSERTION OF UTERINE TANDEM AND/OR VAGINAL OVOIDS FOR CLINICAL BRACHYTHERAPY
INSERTION OF A VAGINAL RADIATION AFTERLOADING APPARATUS FOR CLINICAL BRACHYTHERA
FITTING AND INSERTION OF PESSARY OR OTHER INTRAVAGINAL SUPPORT DEVICE
DIAPHRAGM OR CERVICAL CAP FITTING WITH INSTRUCTIONS
INTRODUCTION OF ANY HEMOSTATIC AGENT OR PACK FOR SPONTANEOUS OR TRAUMATIC
COLPORRHAPHY, SUTURE OF INJURY OF VAGINA (NONOBSTETRICAL)
COLPOPERINEORRHAPHY, SUTURE OF INJURY OF VAGINA AND/OR PERINEUM (NONOBSTETRICAL)
PLASTIC OPERATION ON URETHRAL SPHINCTER, VAGINAL APPROACH (EG, KELLY URETHRAL
PLASTIC REPAIR OF URETHROCELE
ANTERIOR COLPORRHAPHY, REPAIR OF CYSTOCELE WITH OR WITHOUT REPAIR OF URETHROCELE
POSTERIOR COLPORRHAPHY, REPAIR OF RECTOCELE WITH OR WITHOUT PERINEORRHAPHY
COMBINED ANTEROPOSTERIOR COLPORRHAPHY;
COMBINED ANTEROPOSTERIOR COLPORRHAPHY; WITH ENTEROCELE REPAIR
INSERTION OF MESH OR OTHER PROSTHESIS FOR REPAIR OF PELVIC FLOOR DEFECT, EACH
REPAIR OF ENTEROCELE, VAGINAL APPROACH (SEPARATE PROCEDURE)
COLPOPEXY, VAGINAL; EXTRA-PERITONEAL APPROACH (SACROSPINOUS, ILIOCOCCYGEUS)
COLPOPEXY, VAGINAL; INTRA-PERITONEAL APPROACH (UTEROSACRAL, LEVATOR MYORRHAPHY)
PARAVAGINAL DEFECT REPAIR (INCLUDING REPAIR OF CYSTOCELE, IF PERFORMED); OPEN AB
PARAVAGINAL DEFECT REPAIR (INCLUDING REPAIR OF CYSTOCELE, IF PERFORMED); VAGINAL
REMOVAL OR REVISION OF SLING FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)
SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)
PEREYRA PROCEDURE, INCLUDING ANTERIOR COLPORRHAPHY
CONSTRUCTION OF ARTIFICIAL VAGINA; WITHOUT GRAFT
CONSTRUCTION OF ARTIFICIAL VAGINA; WITH GRAFT
REVISION (INCLUDING REMOVAL) OF PROSTHETIC VAGINAL GRAFT, VAGINAL APPROACH
CLOSURE OF RECTOVAGINAL FISTULA; VAGINAL OR TRANSANAL APPROACH
CLOSURE OF URETHROVAGINAL FISTULA;
CLOSURE OF VESICOVAGINAL FISTULA; VAGINAL APPROACH
CLOSURE OF VESICOVAGINAL FISTULA; TRANSVESICAL AND VAGINAL APPROACH
VAGINOPLASTY FOR INTERSEX STATE
DILATION OF VAGINA UNDER ANESTHESIA (OTHER THAN LOCAL)
PELVIC EXAMINATION UNDER ANESTHESIA (OTHER THAN LOCAL)
REMOVAL OF IMPACTED VAGINAL FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA (
COLPOSCOPY OF THE ENTIRE VAGINA, WITH CERVIX IF PRESENT;
COLPOSCOPY OF THE ENTIRE VAGINA, WITH CERVIX IF PRESENT; WITH BIOPSY(S) OF VAGIN
PARAVAGINAL DEFECT REPAIR (INCLUDING REPAIR OF CYSTOCELE, IF PERFORMED), LAPAROS
LAPAROSCOPY, SURGICAL, COLPOPEXY (SUSPENSION OF VAGINAL APEX)
Revision (including removal) of prosthetic vaginal graft, laparoscopic approach
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA;
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH BIOPSY(S) OF THE
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH BIOPSY(S) OF THE
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH ENDOCERVICAL
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE
BIOPSY OF CERVIX, SINGLE OR MULTIPLE, OR LOCAL EXCISION OF LESION, WITH OR WITHO
ENDOCERVICAL CURETTAGE (NOT DONE AS PART OF A DILATION AND CURETTAGE)
CAUTERY OF CERVIX; ELECTRO OR THERMAL
CAUTERY OF CERVIX; CRYOCAUTERY, INITIAL OR REPEAT
CAUTERY OF CERVIX; LASER ABLATION
CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND
CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND
TRACHELECTOMY (CERVICECTOMY), AMPUTATION OF CERVIX (SEPARATE PROCEDURE)
EXCISION OF CERVICAL STUMP, VAGINAL APPROACH;
EXCISION OF CERVICAL STUMP, VAGINAL APPROACH; WITH ANTERIOR AND/OR POSTERIOR
EXCISION OF CERVICAL STUMP, VAGINAL APPROACH; WITH REPAIR OF ENTEROCELE
DILATION AND CURETTAGE OF CERVICAL STUMP
CERCLAGE OF UTERINE CERVIX, NONOBSTETRICAL
TRACHELORRHAPHY, PLASTIC REPAIR OF UTERINE CERVIX, VAGINAL APPROACH
DILATION OF CERVICAL CANAL, INSTRUMENTAL (SEPARATE PROCEDURE)
ENDOMETRIAL SAMPLING (BIOPSY) WITH OR WITHOUT ENDOCERVICAL SAMPLING (BIOPSY), WI
DILATION AND CURETTAGE, DIAGNOSTIC AND/OR THERAPEUTIC (NONOBSTETRICAL)
MYOMECTOMY, EXCISION OF FIBROID TUMOR(S) OF UTERUS, 1 TO 4 INTRAMURAL MYOMA(S)
VAGINAL HYSTERECTOMY, FOR UTERUS 250 GRAMS OR LESS;
VAGINAL HYSTERECTOMY, FOR UTERUS 250 GRAMS OR LESS; WITH REMOVAL OF TUBE(S),
VAGINAL HYSTERECTOMY, FOR UTERUS 250 GRAMS OR LESS; WITH REMOVAL OF TUBE(S),
VAGINAL HYSTERECTOMY, FOR UTERUS 250 GRAMS OR LESS; WITH REPAIR OF ENTEROCELE
VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 GRAMS;
VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 GRAMS; WITH REMOVAL OF
VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 GRAMS; WITH REMOVAL OF
VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 GRAMS; WITH REPAIR OF
REMOVAL OF INTRAUTERINE DEVICE (IUD)
INSERTION OF HEYMAN CAPSULES FOR CLINICAL BRACHYTHERAPY
ENDOMETRIAL ABLATION, THERMAL, WITHOUT HYSTEROSCOPIC GUIDANCE
ENDOMETRIAL CRYOABLATION WITH ULTRASONIC GUIDANCE, INCLUDING ENDOMETRIAL
LAPAROSCOPY, SURGICAL, SUPRACERVICAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS;
LAPAROSCOPY, SURGICAL, SUPRACERVICAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WIT
LAPAROSCOPY, SURGICAL, SUPRACERVICAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G
LAPAROSCOPY, SURGICAL, SUPRACERVICAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G
LAPAROSCOPY, SURGICAL, MYOMECTOMY, EXCISION; 1 TO 4 INTRAMURAL MYOMAS WITH TOTAL
LAPAROSCOPY, SURGICAL, MYOMECTOMY, EXCISION; 5 OR MORE INTRAMURAL MYOMAS AND/OR
LAPAROSCOPY SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS 250 GRAMS OR LESS;
LAPAROSCOPY SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS 250 GRAMS OR LESS;
LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250
LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250
HYSTEROSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE)
HYSTEROSCOPY, SURGICAL; WITH SAMPLING (BIOPSY) OF ENDOMETRIUM AND/OR
HYSTEROSCOPY, SURGICAL; WITH LYSIS OF INTRAUTERINE ADHESIONS (ANY METHOD)
HYSTEROSCOPY, SURGICAL; WITH DIVISION OR RESECTION OF INTRAUTERINE SEPTUM (ANY
HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF LEIOMYOMATA
HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF IMPACTED FOREIGN BODY
HYSTEROSCOPY, SURGICAL; WITH ENDOMETRIAL ABLATION (EG, ENDOMETRIAL RESECTION,
HYSTEROSCOPY, SURGICAL; WITH BILATERAL FALLOPIAN TUBE CANNULATION TO INDUCE
LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS;
LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH R
LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G;
LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; W
UNLISTED LAPAROSCOPY PROCEDURE, UTERUS
UNLISTED HYSTEROSCOPY PROCEDURE, UTERUS
LIGATION OR TRANSECTION OF FALLOPIAN TUBE(S), ABDOMINAL OR VAGINAL APPROACH, UNI
OCCLUSION OF FALLOPIAN TUBE(S) BY DEVICE (EG, BAND, CLIP, FALOPE RING) VAGINAL
LAPAROSCOPY, SURGICAL; WITH LYSIS OF ADHESIONS (SALPINGOLYSIS, OVARIOLYSIS) (SEP
LAPAROSCOPY, SURGICAL; WITH REMOVAL OF ADNEXAL STRUCTURES (PARTIAL OR TOTAL
LAPAROSCOPY, SURGICAL; WITH FULGURATION OR EXCISION OF LESIONS OF THE OVARY,
LAPAROSCOPY, SURGICAL; WITH FULGURATION OF OVIDUCTS (WITH OR WITHOUT
LAPAROSCOPY, SURGICAL; WITH OCCLUSION OF OVIDUCTS BY DEVICE (EG, BAND, CLIP, OR
UNLISTED LAPAROSCOPY PROCEDURE, OVIDUCT, OVARY
DRAINAGE OF OVARIAN CYST(S), UNILATERAL OR BILATERAL, (SEPARATE PROCEDURE); VAGI
DRAINAGE OF OVARIAN CYST(S), UNILATERAL OR BILATERAL, (SEPARATE PROCEDURE);
DRAINAGE OF OVARIAN ABSCESS; VAGINAL APPROACH, OPEN
DRAINAGE OF PELVIC ABSCESS, TRANSVAGINAL OR TRANSRECTAL APPROACH, PERCUTANEOUS
BIOPSY OF OVARY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE)
WEDGE RESECTION OR BISECTION OF OVARY, UNILATERAL OR BILATERAL
OVARIAN CYSTECTOMY, UNILATERAL OR BILATERAL
UNLISTED PROCEDURE, FEMALE GENITAL SYSTEM (NONOBSTETRICAL)
AMNIOCENTESIS; DIAGNOSTIC
AMNIOCENTESIS; THERAPEUTIC AMNIOTIC FLUID REDUCTION (INCLUDES ULTRASOUND
CORDOCENTESIS (INTRAUTERINE), ANY METHOD
CHORIONIC VILLUS SAMPLING, ANY METHOD
FETAL CONTRACTION STRESS TEST
FETAL NON-STRESS TEST
FETAL SCALP BLOOD SAMPLING
TRANSABDOMINAL AMNIOINFUSION, INCLUDING ULTRASOUND GUIDANCE
FETAL FLUID DRAINAGE (EG, VESICOCENTESIS, THORACOCENTESIS, PARACENTESIS),
FETAL SHUNT PLACEMENT, INCLUDING ULTRASOUND GUIDANCE
HYSTEROTOMY, ABDOMINAL (EG, FOR HYDATIDIFORM MOLE, ABORTION)
LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITHOUT SALPINGECTOMY AND/OR
LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITH SALPINGECTOMY AND/OR
CURETTAGE, POSTPARTUM
INSERTION OF CERVICAL DILATOR (EG, LAMINARIA, PROSTAGLANDIN) (SEPARATE PROCEDURE
EPISIOTOMY OR VAGINAL REPAIR, BY OTHER THAN ATTENDING PHYSICIAN
CERCLAGE OF CERVIX, DURING PREGNANCY; VAGINAL
VAGINAL DELIVERY ONLY (WITH OR WITHOUT EPISIOTOMY AND/OR FORCEPS);
EXTERNAL CEPHALIC VERSION, WITH OR WITHOUT TOCOLYSIS
DELIVERY OF PLACENTA (SEPARATE PROCEDURE)
VAGINAL DELIVERY ONLY, AFTER PREVIOUS CESAREAN DELIVERY (WITH OR WITHOUT
TREATMENT OF INCOMPLETE ABORTION, ANY TRIMESTER, COMPLETED SURGICALLY
TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; FIRST TRIMESTER
TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; SECOND TRIMESTER
INDUCED ABORTION, BY DILATION AND CURETTAGE
INDUCED ABORTION, BY DILATION AND EVACUATION
UTERINE EVACUATION AND CURETTAGE FOR HYDATIDIFORM MOLE
REMOVAL OF CERCLAGE SUTURE UNDER ANESTHESIA (OTHER THAN LOCAL)
UNLISTED FETAL INVASIVE PROCEDURE, INCLUDING ULTRASOUND GUIDANCE, WHEN PERFORMED
UNLISTED LAPAROSCOPY PROCEDURE, MATERNITY CARE AND DELIVERY
UNLISTED PROCEDURE, MATERNITY CARE AND DELIVERY
INCISION AND DRAINAGE OF THYROGLOSSAL DUCT CYST, INFECTED
BIOPSY THYROID, PERCUTANEOUS CORE NEEDLE
EXCISION OF CYST OR ADENOMA OF THYROID, OR TRANSECTION OF ISTHMUS
PARTIAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY
PARTIAL THYROID LOBECTOMY, UNILATERAL; WITH CONTRALATERAL SUBTOTAL LOBECTOMY,
TOTAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY
TOTAL THYROID LOBECTOMY, UNILATERAL; WITH CONTRALATERAL SUBTOTAL LOBECTOMY,
THYROIDECTOMY, TOTAL OR COMPLETE
THYROIDECTOMY, TOTAL OR SUBTOTAL FOR MALIGNANCY; WITH LIMITED NECK DISSECTION
THYROIDECTOMY, REMOVAL OF ALL REMAINING THYROID TISSUE FOLLOWING PREVIOUS
THYROIDECTOMY, INCLUDING SUBSTERNAL THYROID; CERVICAL APPROACH
EXCISION OF THYROGLOSSAL DUCT CYST OR SINUS;
EXCISION OF THYROGLOSSAL DUCT CYST OR SINUS; RECURRENT
ASPIRATION AND/OR INJECTION, THYROID CYST
PARATHYROIDECTOMY OR EXPLORATION OF PARATHYROID(S);
PARATHYROIDECTOMY OR EXPLORATION OF PARATHYROID(S); RE-EXPLORATION
PARATHYROID AUTOTRANSPLANTATION (LIST SEPARATELY IN ADDITION TO CODE FOR
THYMECTOMY, PARTIAL OR TOTAL; TRANSCERVICAL APPROACH (SEPARATE PROCEDURE)
UNLISTED LAPAROSCOPY PROCEDURE, ENDOCRINE SYSTEM
UNLISTED PROCEDURE, ENDOCRINE SYSTEM
SUBDURAL TAP THROUGH FONTANELLE, OR SUTURE, INFANT, UNILATERAL OR BILATERAL; INI
SUBDURAL TAP THROUGH FONTANELLE, OR SUTURE, INFANT, UNILATERAL OR BILATERAL;
VENTRICULAR PUNCTURE THROUGH PREVIOUS BURR HOLE, FONTANELLE, SUTURE, OR
VENTRICULAR PUNCTURE THROUGH PREVIOUS BURR HOLE, FONTANELLE, SUTURE, OR
CISTERNAL OR LATERAL CERVICAL (C1-C2) PUNCTURE; WITHOUT INJECTION (SEPARATE
CISTERNAL OR LATERAL CERVICAL (C1-C2) PUNCTURE; WITH INJECTION OF MEDICATION OR
PUNCTURE OF SHUNT TUBING OR RESERVOIR FOR ASPIRATION OR INJECTION PROCEDURE
INSERTION OF SUBCUTANEOUS RESERVOIR, PUMP OR CONTINUOUS INFUSION SYSTEM FOR
DECOMPRESSION OF ORBIT ONLY, TRANSCRANIAL APPROACH
EXPLORATION OF ORBIT (TRANSCRANIAL APPROACH); WITH REMOVAL OF FOREIGN BODY
ENDOVASCULAR TEMPORARY BALLOON ARTERIAL OCCLUSION, HEAD OR NECK (EXTRACRANIAL/IN
TRANSCATHETER PERMANENT OCCLUSION OR EMBOLIZATION (EG, FOR TUMOR DESTRUCTION,
CREATION OF LESION BY STEREOTACTIC METHOD, INCLUDING BURR HOLE(S) AND LOCALIZING
STEREOTACTIC LOCALIZATION, INCLUDING BURR HOLE(S), WITH INSERTION OF
CREATION OF LESION BY STEREOTACTIC METHOD, PERCUTANEOUS, BY NEUROLYTIC AGENT
CREATION OF LESION BY STEREOTACTIC METHOD, PERCUTANEOUS, BY NEUROLYTIC AGENT
REVISION OR REMOVAL OF INTRACRANIAL NEUROSTIMULATOR ELECTRODES
INSERTION OR REPLACEMENT OF CRANIAL NEUROSTIMULATOR PULSE GENERATOR OR
INSERTION OR REPLACEMENT OF CRANIAL NEUROSTIMULATOR PULSE GENERATOR OR
REVISION OR REMOVAL OF CRANIAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER
ELEVATION OF DEPRESSED SKULL FRACTURE; SIMPLE, EXTRADURAL
REPLACEMENT OR IRRIGATION, SUBARACHNOID/SUBDURAL CATHETER
REPLACEMENT OR IRRIGATION, VENTRICULAR CATHETER
REPLACEMENT OR REVISION OF CEREBROSPINAL FLUID SHUNT, OBSTRUCTED VALVE, OR
REPROGRAMMING OF PROGRAMMABLE CEREBROSPINAL SHUNT
PERCUTANEOUS LYSIS OF EPIDURAL ADHESIONS USING SOLUTION INJECTION (EG, HYPERTONI
PERCUTANEOUS LYSIS OF EPIDURAL ADHESIONS USING SOLUTION INJECTION (EG,
Percutaneous aspiration within the nucleus pulposus, intervertebral disc, or par
PERCUTANEOUS ASPIRATION, SPINAL CORD CYST OR SYRINX
BIOPSY OF SPINAL CORD, PERCUTANEOUS NEEDLE
SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC
SPINAL PUNCTURE, THERAPEUTIC, FOR DRAINAGE OF CEREBROSPINAL FLUID (BY NEEDLE OR
INJECTION, EPIDURAL, OF BLOOD OR CLOT PATCH
INJECTION/INFUSION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, ICED SALINE
INJECTION/INFUSION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, ICED SALINE
INJECTION/INFUSION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, ICED SALINE
DECOMPRESSION PROCEDURE, PERCUTANEOUS, OF NUCLEUS PULPOSUS OF INTERVERTEBRAL DIS
INJECTION PROCEDURE FOR CHEMONUCLEOLYSIS, INCLUDING DISKOGRAPHY, INTERVERTEBRAL
INJECTION PROCEDURE, ARTERIAL, FOR OCCLUSION OF ARTERIOVENOUS MALFORMATION,
INJECTION, SINGLE (NOT VIA INDWELLING CATHETER), NOT INCLUDING NEUROLYTIC
INJECTION, SINGLE (NOT VIA INDWELLING CATHETER), NOT INCLUDING NEUROLYTIC
INJECTION, INCLUDING CATHETER PLACEMENT, CONTINUOUS INFUSION OR INTERMITTENT
INJECTION, INCLUDING CATHETER PLACEMENT, CONTINUOUS INFUSION OR INTERMITTENT
IMPLANTATION, REVISION OR REPOSITIONING OF TUNNELED INTRATHECAL OR EPIDURAL CATH
IMPLANTATION, REVISION OR REPOSITIONING OF TUNNELED INTRATHECAL OR EPIDURAL
REMOVAL OF PREVIOUSLY IMPLANTED INTRATHECAL OR EPIDURAL CATHETER
IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INFUSION;
IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG
IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG
REMOVAL OF SUBCUTANEOUS RESERVOIR OR PUMP, PREVIOUSLY IMPLANTED FOR INTRATHECAL
ELECTRONIC ANALYSIS OF PROGRAMMABLE, IMPLANTED PUMP FOR INTRATHECAL OR EPIDURAL
ELECTRONIC ANALYSIS OF PROGRAMMABLE, IMPLANTED PUMP FOR INTRATHECAL OR EPIDURAL
Electronic analysis of programmable, implanted pump for intrathecal or epidural
Electronic analysis of programmable, implanted pump for intrathecal or epidural
LAMINECTOMY WITH EXPLORATION AND/OR DECOMPRESSION OF SPINAL CORD AND/OR CAUDA EQ
LAMINECTOMY WITH EXPLORATION AND/OR DECOMPRESSION OF SPINAL CORD AND/OR CAUDA
LAMINECTOMY WITH EXPLORATION AND/OR DECOMPRESSION OF SPINAL CORD AND/OR CAUDA
LAMINECTOMY WITH EXPLORATION AND/OR DECOMPRESSION OF SPINAL CORD AND/OR CAUDA
LAMINECTOMY WITH REMOVAL OF ABNORMAL FACETS AND/OR PARS INTER-ARTICULARIS WITH
LAMINECTOMY WITH EXPLORATION AND/OR DECOMPRESSION OF SPINAL CORD AND/OR CAUDA
LAMINECTOMY WITH EXPLORATION AND/OR DECOMPRESSION OF SPINAL CORD AND/OR CAUDA
LAMINECTOMY WITH EXPLORATION AND/OR DECOMPRESSION OF SPINAL CORD AND/OR CAUDA
LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PAR
LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PAR
LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PAR
LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING
LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING
LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH
LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH
LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH
LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH
TRANSPEDICULAR APPROACH WITH DECOMPRESSION OF SPINAL CORD, EQUINA AND/OR NERVE R
TRANSPEDICULAR APPROACH WITH DECOMPRESSION OF SPINAL CORD, EQUINA AND/OR NERVE
TRANSPEDICULAR APPROACH WITH DECOMPRESSION OF SPINAL CORD, EQUINA AND/OR NERVE
COSTOVERTEBRAL APPROACH WITH DECOMPRESSION OF SPINAL CORD OR NERVE ROOT(S),
COSTOVERTEBRAL APPROACH WITH DECOMPRESSION OF SPINAL CORD OR NERVE ROOT(S),
DISKECTOMY, ANTERIOR, WITH DECOMPRESSION OF SPINAL CORD AND/ OR NERVE ROOT(S), I
DISKECTOMY, ANTERIOR, WITH DECOMPRESSION OF SPINAL CORD AND/ OR NERVE ROOT(S),
CREATION OF LESION OF SPINAL CORD BY STEREOTACTIC METHOD, PERCUTANEOUS, ANY MODA
STEREOTACTIC STIMULATION OF SPINAL CORD, PERCUTANEOUS, SEPARATE PROCEDURE NOT
STEREOTACTIC BIOPSY, ASPIRATION, OR EXCISION OF LESION, SPINAL CORD
PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY, EPIDURAL
LAMINECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES, PLATE/PADDLE,
Removal of spinal neurostimulator electrode percutaneous array(s), including flu
Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotom
Revision including replacement, when performed, of spinal neurostimulator electr
Revision including replacement, when performed, of spinal neurostimulator electr
INSERTION OR REPLACEMENT OF SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER,
REVISION OR REMOVAL OF IMPLANTED SPINAL NEUROSTIMULATOR PULSE GENERATOR OR
CREATION OF SHUNT, LUMBAR, SUBARACHNOID-PERITONEAL, -PLEURAL, OR OTHER;
REPLACEMENT, IRRIGATION OR REVISION OF LUMBOSUBARACHNOID SHUNT
REMOVAL OF ENTIRE LUMBOSUBARACHNOID SHUNT SYSTEM WITHOUT REPLACEMENT
INJECTION, ANESTHETIC AGENT; TRIGEMINAL NERVE, ANY DIVISION OR BRANCH
INJECTION, ANESTHETIC AGENT; FACIAL NERVE
INJECTION, ANESTHETIC AGENT; GREATER OCCIPITAL NERVE
INJECTION, ANESTHETIC AGENT; VAGUS NERVE
INJECTION, ANESTHETIC AGENT; PHRENIC NERVE
INJECTION, ANESTHETIC AGENT; SPINAL ACCESSORY NERVE
INJECTION, ANESTHETIC AGENT; CERVICAL PLEXUS
INJECTION, ANESTHETIC AGENT; BRACHIAL PLEXUS, SINGLE
INJECTION, ANESTHETIC AGENT; BRACHIAL PLEXUS, CONTINUOUS INFUSION BY CATHETER (I
INJECTION, ANESTHETIC AGENT; AXILLARY NERVE
INJECTION, ANESTHETIC AGENT; SUPRASCAPULAR NERVE
INJECTION, ANESTHETIC AGENT; INTERCOSTAL NERVE, SINGLE
INJECTION, ANESTHETIC AGENT; INTERCOSTAL NERVES, MULTIPLE, REGIONAL BLOCK
INJECTION, ANESTHETIC AGENT; ILIOINGUINAL, ILIOHYPOGASTRIC NERVES
INJECTION, ANESTHETIC AGENT; PUDENDAL NERVE
INJECTION, ANESTHETIC AGENT; PARACERVICAL (UTERINE) NERVE
INJECTION, ANESTHETIC AGENT; SCIATIC NERVE, SINGLE
INJECTION, ANESTHETIC AGENT; SCIATIC NERVE, CONTINUOUS INFUSION BY CATHETER (INC
INJECTION, ANESTHETIC AGENT; FEMORAL NERVE, SINGLE
INJECTION, ANESTHETIC AGENT; FEMORAL NERVE, CONTINUOUS INFUSION BY CATHETER (INC
INJECTION, ANESTHETIC AGENT; LUMBAR PLEXUS, POSTERIOR APPROACH, CONTINUOUS INFUS
INJECTION, ANESTHETIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH
Injection(s), anesthetic agent and/or steroid; plantar common digital nerve(s) (
INJECTION(S), ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL, WITH IMA
INJECTION(S), ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL, WITH IMA
INJECTION(S), ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL, WITH IMA
INJECTION(S), ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL, WITH IMA
Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophysea
Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophysea
Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophysea
Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophysea
Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophysea
Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophysea
INJECTION, ANESTHETIC AGENT; SPHENOPALATINE GANGLION
INJECTION, ANESTHETIC AGENT; CAROTID SINUS (SEPARATE PROCEDURE)
INJECTION, ANESTHETIC AGENT; STELLATE GANGLION (CERVICAL SYMPATHETIC)
INJECTION, ANESTHETIC AGENT; SUPERIOR HYPOGASTRIC PLEXUS
INJECTION, ANESTHETIC AGENT; LUMBAR OR THORACIC (PARAVERTEBRAL SYMPATHETIC)
INJECTION, ANESTHETIC AGENT; CELIAC PLEXUS, WITH OR WITHOUT RADIOLOGIC
PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; CRANIAL NERVE
PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; PERIPHERAL NERVE
PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; SACRAL NERVE
PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; NEUROMUSCULAR
POSTERIOR TIBIAL NEUROSTIMULATION, PERCUTANEOUS NEEDLE ELECTRODE, SINGLE TREATME
INCISION FOR IMPLANTATION OF CRANIAL NERVE (EG, VAGUS NERVE) NEUROSTIMULATOR ELE
REVISION OR REPLACEMENT OF CRANIAL NERVE (EG, VAGUS NERVE) NEUROSTIMULATOR ELECT
REMOVAL OF CRANIAL NERVE (EG, VAGUS NERVE) NEUROSTIMULATOR ELECTRODE ARRAY AND P
INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; PERIPHERAL NERVE (EXCLU
INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; NEUROMUSCULAR
INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; SACRAL NERVE
REVISION OR REMOVAL OF PERIPHERAL NEUROSTIMULATOR ELECTRODES
INSERTION OR REPLACEMENT OF PERIPHERAL OR GASTRIC NEUROSTIMULATOR PULSE GENERATO
REVISION OR REMOVAL OF PERIPHERAL OR GASTRIC NEUROSTIMULATOR PULSE GENERATOR OR
DESTRUCTION BY NEUROLYTIC AGENT, TRIGEMINAL NERVE; SUPRAORBITAL, INFRAORBITAL, M
DESTRUCTION BY NEUROLYTIC AGENT, TRIGEMINAL NERVE; SECOND AND THIRD DIVISION
DESTRUCTION BY NEUROLYTIC AGENT, TRIGEMINAL NERVE; SECOND AND THIRD DIVISION
CHEMODENERVATION OF PAROTID AND SUBMANDIBULAR SALIVARY GLANDS, BILATERAL
CHEMODENERVATION OF MUSCLE(S); MUSCLE(S) INNERVATED BY FACIAL NERVE (EG, FOR
CHEMODENERVATION OF MUSCLE(S); NECK MUSCLE(S) (EG, FOR SPASMODIC TORTICOLLIS, SP
CHEMODENERVATION OF MUSCLE(S); EXTREMITY(S) AND/OR TRUNK MUSCLE(S) (EG, FOR
DESTRUCTION BY NEUROLYTIC AGENT, INTERCOSTAL NERVE
DESTRUCTION BY NEUROLYTIC AGENT; PUDENDAL NERVE
Destruction by neurolytic agent; plantar common digital nerve
Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imagin
Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imagin
Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imagin
Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imagin
DESTRUCTION BY NEUROLYTIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH
CHEMODENERVATION OF ECCRINE GLANDS; BOTH AXILLAE
CHEMODENERVATION OF ECCRINE GLANDS; OTHER AREA(S) (EG, SCALP, FACE, NECK), PER D
DESTRUCTION BY NEUROLYTIC AGENT, WITH OR WITHOUT RADIOLOGIC MONITORING; CELIAC P
DESTRUCTION BY NEUROLYTIC AGENT, WITH OR WITHOUT RADIOLOGIC MONITORING;
NEUROPLASTY; DIGITAL, ONE OR BOTH, SAME DIGIT
NEUROPLASTY; NERVE OF HAND OR FOOT
NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG, OPEN; OTHER THAN SPECIFIED
NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG, OPEN; SCIATIC NERVE
NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG, OPEN; BRACHIAL PLEXUS
NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG, OPEN; LUMBAR PLEXUS
NEUROPLASTY AND/OR TRANSPOSITION; CRANIAL NERVE (SPECIFY)
NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT ELBOW
NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT WRIST
NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL
DECOMPRESSION; UNSPECIFIED NERVE(S) (SPECIFY)
DECOMPRESSION; PLANTAR DIGITAL NERVE
INTERNAL NEUROLYSIS, REQUIRING USE OF OPERATING MICROSCOPE (LIST SEPARATELY IN
TRANSECTION OR AVULSION OF; SUPRAORBITAL NERVE
TRANSECTION OR AVULSION OF; INFRAORBITAL NERVE
TRANSECTION OR AVULSION OF; MENTAL NERVE
TRANSECTION OR AVULSION OF; INFERIOR ALVEOLAR NERVE BY OSTEOTOMY
TRANSECTION OR AVULSION OF; LINGUAL NERVE
TRANSECTION OR AVULSION OF; FACIAL NERVE, DIFFERENTIAL OR COMPLETE
TRANSECTION OR AVULSION OF; GREATER OCCIPITAL NERVE
TRANSECTION OR AVULSION OF; PHRENIC NERVE
TRANSECTION OR AVULSION OF; PUDENDAL NERVE
TRANSECTION OR AVULSION OF OBTURATOR NERVE, EXTRAPELVIC, WITH OR WITHOUT
TRANSECTION OR AVULSION OF OBTURATOR NERVE, INTRAPELVIC, WITH OR WITHOUT
TRANSECTION OR AVULSION OF OTHER CRANIAL NERVE, EXTRADURAL
TRANSECTION OR AVULSION OF OTHER SPINAL NERVE, EXTRADURAL
EXCISION OF NEUROMA; CUTANEOUS NERVE, SURGICALLY IDENTIFIABLE
EXCISION OF NEUROMA; DIGITAL NERVE, ONE OR BOTH, SAME DIGIT
EXCISION OF NEUROMA; DIGITAL NERVE, EACH ADDITIONAL DIGIT (LIST SEPARATELY IN
EXCISION OF NEUROMA; HAND OR FOOT, EXCEPT DIGITAL NERVE
EXCISION OF NEUROMA; HAND OR FOOT, EACH ADDITIONAL NERVE, EXCEPT SAME DIGIT
EXCISION OF NEUROMA; MAJOR PERIPHERAL NERVE, EXCEPT SCIATIC
EXCISION OF NEUROMA; SCIATIC NERVE
IMPLANTATION OF NERVE END INTO BONE OR MUSCLE (LIST SEPARATELY IN ADDITION TO
EXCISION OF NEUROFIBROMA OR NEUROLEMMOMA; CUTANEOUS NERVE
EXCISION OF NEUROFIBROMA OR NEUROLEMMOMA; MAJOR PERIPHERAL NERVE
EXCISION OF NEUROFIBROMA OR NEUROLEMMOMA; EXTENSIVE (INCLUDING MALIGNANT TYPE)
BIOPSY OF NERVE
SYMPATHECTOMY, CERVICAL
SYMPATHECTOMY, CERVICOTHORACIC
SYMPATHECTOMY; DIGITAL ARTERIES, EACH DIGIT
SYMPATHECTOMY; RADIAL ARTERY
SYMPATHECTOMY; ULNAR ARTERY
SYMPATHECTOMY; SUPERFICIAL PALMAR ARCH
SUTURE OF DIGITAL NERVE, HAND OR FOOT; ONE NERVE
SUTURE OF DIGITAL NERVE, HAND OR FOOT; EACH ADDITIONAL DIGITAL NERVE (LIST
SUTURE OF ONE NERVE; HAND OR FOOT, COMMON SENSORY NERVE
SUTURE OF ONE NERVE; MEDIAN MOTOR THENAR
SUTURE OF ONE NERVE; ULNAR MOTOR
SUTURE OF EACH ADDITIONAL NERVE, HAND OR FOOT (LIST SEPARATELY IN ADDITION TO
SUTURE OF POSTERIOR TIBIAL NERVE
SUTURE OF MAJOR PERIPHERAL NERVE, ARM OR LEG, EXCEPT SCIATIC; INCLUDING
SUTURE OF MAJOR PERIPHERAL NERVE, ARM OR LEG, EXCEPT SCIATIC; WITHOUT
SUTURE OF SCIATIC NERVE
SUTURE OF EACH ADDITIONAL MAJOR PERIPHERAL NERVE (LIST SEPARATELY IN ADDITION
SUTURE OF; BRACHIAL PLEXUS
SUTURE OF; LUMBAR PLEXUS
SUTURE OF FACIAL NERVE; EXTRACRANIAL
SUTURE OF FACIAL NERVE; INFRATEMPORAL, WITH OR WITHOUT GRAFTING
ANASTOMOSIS; FACIAL-PHRENIC
SUTURE OF NERVE; REQUIRING SECONDARY OR DELAYED SUTURE (LIST SEPARATELY IN
SUTURE OF NERVE; REQUIRING EXTENSIVE MOBILIZATION, OR TRANSPOSITION OF NERVE
SUTURE OF NERVE; REQUIRING SHORTENING OF BONE OF EXTREMITY (LIST SEPARATELY IN
NERVE GRAFT (INCLUDES OBTAINING GRAFT), HEAD OR NECK; UP TO 4 CM IN LENGTH
NERVE GRAFT (INCLUDES OBTAINING GRAFT), HEAD OR NECK; MORE THAN 4 CM LENGTH
NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, HAND OR FOOT; UP TO 4 CM
NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, HAND OR FOOT; MORE THAN
NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, ARM OR LEG; UP TO 4 CM
NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, ARM OR LEG; MORE THAN 4
NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS (CABLE), HAND OR FOOT;
NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS (CABLE), HAND OR FOOT;
NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS (CABLE), ARM OR LEG;
NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS (CABLE), ARM OR LEG;
NERVE GRAFT, EACH ADDITIONAL NERVE; SINGLE STRAND (LIST SEPARATELY IN ADDITION
NERVE GRAFT, EACH ADDITIONAL NERVE; MULTIPLE STRANDS (CABLE) (LIST SEPARATELY
NERVE PEDICLE TRANSFER; FIRST STAGE
NERVE PEDICLE TRANSFER; SECOND STAGE
NERVE REPAIR; WITH SYNTHETIC CONDUIT OR VEIN ALLOGRAFT (EG, NERVE TUBE), EACH NE
NERVE REPAIR; WITH AUTOGENOUS VEIN GRAFT (INCLUDES HARVEST OF VEIN GRAFT), EACH
UNLISTED PROCEDURE, NERVOUS SYSTEM
EVISCERATION OF OCULAR CONTENTS; WITHOUT IMPLANT
EVISCERATION OF OCULAR CONTENTS; WITH IMPLANT
ENUCLEATION OF EYE; WITHOUT IMPLANT
ENUCLEATION OF EYE; WITH IMPLANT, MUSCLES NOT ATTACHED TO IMPLANT
ENUCLEATION OF EYE; WITH IMPLANT, MUSCLES ATTACHED TO IMPLANT
EXENTERATION OF ORBIT (DOES NOT INCLUDE SKIN GRAFT), REMOVAL OF ORBITAL
EXENTERATION OF ORBIT (DOES NOT INCLUDE SKIN GRAFT), REMOVAL OF ORBITAL
EXENTERATION OF ORBIT (DOES NOT INCLUDE SKIN GRAFT), REMOVAL OF ORBITAL
MODIFICATION OF OCULAR IMPLANT WITH PLACEMENT OR REPLACEMENT OF PEGS (EG, DRILLI
INSERTION OF OCULAR IMPLANT SECONDARY; AFTER EVISCERATION, IN SCLERAL SHELL
INSERTION OF OCULAR IMPLANT SECONDARY; AFTER ENUCLEATION, MUSCLES NOT ATTACHED
INSERTION OF OCULAR IMPLANT SECONDARY; AFTER ENUCLEATION, MUSCLES ATTACHED TO
REINSERTION OF OCULAR IMPLANT; WITH OR WITHOUT CONJUNCTIVAL GRAFT
REINSERTION OF OCULAR IMPLANT; WITH USE OF FOREIGN MATERIAL FOR REINFORCEMENT
REMOVAL OF OCULAR IMPLANT
REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CONJUNCTIVAL SUPERFICIAL
REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CONJUNCTIVAL EMBEDDED (INCLUDES
REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CORNEAL, WITHOUT SLIT LAMP
REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CORNEAL, WITH SLIT LAMP
REMOVAL OF FOREIGN BODY, INTRAOCULAR; FROM ANTERIOR CHAMBER OF EYE OR LENS
REMOVAL OF FOREIGN BODY, INTRAOCULAR; FROM POSTERIOR SEGMENT, MAGNETIC
REMOVAL OF FOREIGN BODY, INTRAOCULAR; FROM POSTERIOR SEGMENT, NONMAGNETIC
REPAIR OF LACERATION; CONJUNCTIVA, WITH OR WITHOUT NONPERFORATING LACERATION SCL
REPAIR OF LACERATION; CONJUNCTIVA, BY MOBILIZATION AND REARRANGEMENT, WITHOUT
REPAIR OF LACERATION; CORNEA, NONPERFORATING, WITH OR WITHOUT REMOVAL FOREIGN
REPAIR OF LACERATION; CORNEA AND/OR SCLERA, PERFORATING, NOT INVOLVING UVEAL
REPAIR OF LACERATION; CORNEA AND/OR SCLERA, PERFORATING, WITH REPOSITION OR
REPAIR OF LACERATION; APPLICATION OF TISSUE GLUE, WOUNDS OF CORNEA AND/OR SCLERA
REPAIR OF WOUND, EXTRAOCULAR MUSCLE, TENDON AND/OR TENON'S CAPSULE
EXCISION OF LESION, CORNEA (KERATECTOMY, LAMELLAR, PARTIAL), EXCEPT PTERYGIUM
BIOPSY OF CORNEA
EXCISION OR TRANSPOSITION OF PTERYGIUM; WITHOUT GRAFT
EXCISION OR TRANSPOSITION OF PTERYGIUM; WITH GRAFT
SCRAPING OF CORNEA, DIAGNOSTIC, FOR SMEAR AND/OR CULTURE
REMOVAL OF CORNEAL EPITHELIUM; WITH OR WITHOUT CHEMOCAUTERIZATION (ABRASION,
REMOVAL OF CORNEAL EPITHELIUM; WITH APPLICATION OF CHELATING AGENT (EG, EDTA)
DESTRUCTION OF LESION OF CORNEA BY CRYOTHERAPY, PHOTOCOAGULATION OR
MULTIPLE PUNCTURES OF ANTERIOR CORNEA (EG, FOR CORNEAL EROSION, TATTOO)
KERATOPLASTY (CORNEAL TRANSPLANT); ANTERIOR LAMELLAR
KERATOPLASTY (CORNEAL TRANSPLANT); PENETRATING (EXCEPT IN APHAKIA OR PSEUDOPHAKI
KERATOPLASTY (CORNEAL TRANSPLANT); PENETRATING (IN APHAKIA)
KERATOPLASTY (CORNEAL TRANSPLANT); PENETRATING (IN PSEUDOPHAKIA)
Keratoplasty (corneal transplant); endothelial
KERATOPROSTHESIS
CORNEAL RELAXING INCISION FOR CORRECTION OF SURGICALLY INDUCED ASTIGMATISM
CORNEAL WEDGE RESECTION FOR CORRECTION OF SURGICALLY INDUCED ASTIGMATISM
PLACEMENT OF AMNIOTIC MEMBRANE ON THE OCULAR SURFACE FOR WOUND HEALING; SELF-RET
PLACEMENT OF AMNIOTIC MEMBRANE ON THE OCULAR SURFACE FOR WOUND HEALING; SINGLE L
OCULAR SURFACE RECONSTRUCTION; AMNIOTIC MEMBRANE TRANSPLANTATION, MULTIPLE LAYER
OCULAR SURFACE RECONSTRUCTION; LIMBAL STEM CELL ALLOGRAFT (EG, CADAVERIC OR
OCULAR SURFACE RECONSTRUCTION; LIMBAL CONJUNCTIVAL AUTOGRAFT (INCLUDES
PARACENTESIS OF ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); WITH DIAGNOSTIC AS
PARACENTESIS OF ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); WITH THERAPEUTIC
PARACENTESIS OF ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); WITH REMOVAL OF
PARACENTESIS OF ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); WITH REMOVAL OF
GONIOTOMY
TRABECULOTOMY AB EXTERNO
TRABECULOPLASTY BY LASER SURGERY, ONE OR MORE SESSIONS (DEFINED TREATMENT
SEVERING ADHESIONS OF ANTERIOR SEGMENT, LASER TECHNIQUE (SEPARATE PROCEDURE)
SEVERING ADHESIONS OF ANTERIOR SEGMENT OF EYE, INCISIONAL TECHNIQUE (WITH OR WIT
SEVERING ADHESIONS OF ANTERIOR SEGMENT OF EYE, INCISIONAL TECHNIQUE (WITH OR
SEVERING ADHESIONS OF ANTERIOR SEGMENT OF EYE, INCISIONAL TECHNIQUE (WITH OR
SEVERING ADHESIONS OF ANTERIOR SEGMENT OF EYE, INCISIONAL TECHNIQUE (WITH OR
REMOVAL OF EPITHELIAL DOWNGROWTH, ANTERIOR CHAMBER OF EYE
REMOVAL OF IMPLANTED MATERIAL, ANTERIOR SEGMENT OF EYE
REMOVAL OF BLOOD CLOT, ANTERIOR SEGMENT OF EYE
INJECTION, ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); AIR OR LIQUID
INJECTION, ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); MEDICATION
EXCISION OF LESION, SCLERA
FISTULIZATION OF SCLERA FOR GLAUCOMA; TREPHINATION WITH IRIDECTOMY
FISTULIZATION OF SCLERA FOR GLAUCOMA; THERMOCAUTERIZATION WITH IRIDECTOMY
FISTULIZATION OF SCLERA FOR GLAUCOMA; SCLERECTOMY WITH PUNCH OR SCISSORS, WITH
FISTULIZATION OF SCLERA FOR GLAUCOMA; IRIDENCLEISIS OR IRIDOTASIS
FISTULIZATION OF SCLERA FOR GLAUCOMA; TRABECULECTOMY AB EXTERNO IN ABSENCE OF
FISTULIZATION OF SCLERA FOR GLAUCOMA; TRABECULECTOMY AB EXTERNO WITH SCARRING
TRANSLUMINAL DILATION OF AQUEOUS OUTFLOW CANAL; WITHOUT RETENTION OF DEVICE OR S
TRANSLUMINAL DILATION OF AQUEOUS OUTFLOW CANAL; WITH RETENTION OF DEVICE OR STEN
AQUEOUS SHUNT TO EXTRAOCULAR RESERVOIR (EG, MOLTENO, SCHOCKET, DENVER-KRUPIN)
REVISION OF AQUEOUS SHUNT TO EXTRAOCULAR RESERVOIR
REPAIR OF SCLERAL STAPHYLOMA; WITHOUT GRAFT
REPAIR OF SCLERAL STAPHYLOMA; WITH GRAFT
REVISION OR REPAIR OF OPERATIVE WOUND OF ANTERIOR SEGMENT, ANY TYPE, EARLY OR
IRIDOTOMY BY STAB INCISION (SEPARATE PROCEDURE); EXCEPT TRANSFIXION
IRIDOTOMY BY STAB INCISION (SEPARATE PROCEDURE); WITH TRANSFIXION AS FOR IRIS
IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; FOR REMOVAL OF LESION
IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; WITH CYCLECTOMY
IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; PERIPHERAL FOR GLAUCOMA
IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; SECTOR FOR GLAUCOMA
IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; OPTICAL (SEPARATE PROCEDURE)
REPAIR OF IRIS, CILIARY BODY (AS FOR IRIDODIALYSIS)
SUTURE OF IRIS, CILIARY BODY (SEPARATE PROCEDURE) WITH RETRIEVAL OF SUTURE
CILIARY BODY DESTRUCTION; DIATHERMY
CILIARY BODY DESTRUCTION; CYCLOPHOTOCOAGULATION, TRANSSCLERAL
CILIARY BODY DESTRUCTION; CYCLOPHOTOCOAGULATION, ENDOSCOPIC
CILIARY BODY DESTRUCTION; CRYOTHERAPY
CILIARY BODY DESTRUCTION; CYCLODIALYSIS
IRIDOTOMY/IRIDECTOMY BY LASER SURGERY (EG, FOR GLAUCOMA) (PER SESSION)
IRIDOPLASTY BY PHOTOCOAGULATION (ONE OR MORE SESSIONS) (EG, FOR IMPROVEMENT OF
DESTRUCTION OF CYST OR LESION IRIS OR CILIARY BODY (NONEXCISIONAL PROCEDURE)
DISCISSION OF SECONDARY MEMBRANOUS CATARACT (OPACIFIED POSTERIOR LENS CAPSULE AN
DISCISSION OF SECONDARY MEMBRANOUS CATARACT (OPACIFIED POSTERIOR LENS CAPSULE
REPOSITIONING OF INTRAOCULAR LENS PROSTHESIS, REQUIRING AN INCISION (SEPARATE
REMOVAL OF SECONDARY MEMBRANOUS CATARACT (OPACIFIED POSTERIOR LENS CAPSULE AND/O
REMOVAL OF LENS MATERIAL; ASPIRATION TECHNIQUE, ONE OR MORE STAGES
REMOVAL OF LENS MATERIAL; PHACOFRAGMENTATION TECHNIQUE (MECHANICAL OR
REMOVAL OF LENS MATERIAL; PARS PLANA APPROACH, WITH OR WITHOUT VITRECTOMY
REMOVAL OF LENS MATERIAL; INTRACAPSULAR
REMOVAL OF LENS MATERIAL; INTRACAPSULAR, FOR DISLOCATED LENS
REMOVAL OF LENS MATERIAL; EXTRACAPSULAR (OTHER THAN 66840, 66850, 66852)
EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS
INTRACAPSULAR CATARACT EXTRACTION WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS
EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS
INSERTION OF INTRAOCULAR LENS PROSTHESIS (SECONDARY IMPLANT), NOT ASSOCIATED
EXCHANGE OF INTRAOCULAR LENS
UNLISTED PROCEDURE, ANTERIOR SEGMENT OF EYE
REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUE OR LIMBAL INCISION);
REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUE OR LIMBAL INCISION);
ASPIRATION OR RELEASE OF VITREOUS, SUBRETINAL OR CHOROIDAL FLUID, PARS PLANA
INJECTION OF VITREOUS SUBSTITUTE, PARS PLANA OR LIMBAL APPROACH, (FLUID-GAS
IMPLANTATION OF INTRAVITREAL DRUG DELIVERY SYSTEM (EG, GANCICLOVIR IMPLANT),
INTRAVITREAL INJECTION OF A PHARMACOLOGIC AGENT (SEPARATE PROCEDURE)
DISCISSION OF VITREOUS STRANDS (WITHOUT REMOVAL), PARS PLANA APPROACH
SEVERING OF VITREOUS STRANDS, VITREOUS FACE ADHESIONS, SHEETS, MEMBRANES OR
VITRECTOMY, MECHANICAL, PARS PLANA APPROACH;
VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH FOCAL ENDOLASER
VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH ENDOLASER PANRETINAL
VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH REMOVAL OF PRERETINAL CELLULAR
VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH REMOVAL OF INTERNAL LIMITING M
VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH REMOVAL OF SUBRETINAL MEMBRANE
REPAIR OF RETINAL DETACHMENT, ONE OR MORE SESSIONS; CRYOTHERAPY OR DIATHERMY, WI
REPAIR OF RETINAL DETACHMENT, ONE OR MORE SESSIONS; PHOTOCOAGULATION, WITH OR
REPAIR OF RETINAL DETACHMENT; SCLERAL BUCKLING (SUCH AS LAMELLAR SCLERAL
REPAIR OF RETINAL DETACHMENT; WITH VITRECTOMY, ANY METHOD, WITH OR WITHOUT AIR
REPAIR OF RETINAL DETACHMENT; BY INJECTION OF AIR OR OTHER GAS (EG, PNEUMATIC
REPAIR OF RETINAL DETACHMENT; BY SCLERAL BUCKLING OR VITRECTOMY, ON PATIENT
REPAIR OF COMPLEX RETINAL DETACHMENT (EG, PROLIFERATIVE VITREORETINOPATHY, STAGE
RELEASE OF ENCIRCLING MATERIAL (POSTERIOR SEGMENT)
REMOVAL OF IMPLANTED MATERIAL, POSTERIOR SEGMENT; EXTRAOCULAR
REMOVAL OF IMPLANTED MATERIAL, POSTERIOR SEGMENT; INTRAOCULAR
PROPHYLAXIS OF RETINAL DETACHMENT (EG, RETINAL BREAK, LATTICE DEGENERATION) WITH
PROPHYLAXIS OF RETINAL DETACHMENT (EG, RETINAL BREAK, LATTICE DEGENERATION)
DESTRUCTION OF LOCALIZED LESION OF RETINA (EG, MACULAR EDEMA, TUMORS), ONE OR MO
DESTRUCTION OF LOCALIZED LESION OF RETINA (EG, MACULAR EDEMA, TUMORS), ONE OR
DESTRUCTION OF LOCALIZED LESION OF RETINA (EG, MACULAR EDEMA, TUMORS), ONE OR
DESTRUCTION OF LOCALIZED LESION OF CHOROID (EG, CHOROIDAL NEOVASCULARIZATION);
DESTRUCTION OF LOCALIZED LESION OF CHOROID (EG, CHOROIDAL NEOVASCULARIZATION);
DESTRUCTION OF LOCALIZED LESION OF CHOROID (EG, CHOROIDAL NEOVASCULARIZATION);
DESTRUCTION OF EXTENSIVE OR PROGRESSIVE RETINOPATHY (EG, DIABETIC RETINOPATHY),
TREATMENT OF EXTENSIVE OR PROGRESSIVE RETINOPATHY, ONE OR MORE SESSIONS; (EG, DI
TREATMENT OF EXTENSIVE OR PROGRESSIVE RETINOPATHY, ONE OR MORE SESSIONS; PRETERM
SCLERAL REINFORCEMENT (SEPARATE PROCEDURE); WITHOUT GRAFT
SCLERAL REINFORCEMENT (SEPARATE PROCEDURE); WITH GRAFT
UNLISTED PROCEDURE, POSTERIOR SEGMENT
STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE; ONE HORIZONTAL MUSCLE
STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE; TWO HORIZONTAL MUSCLES
STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE; ONE VERTICAL MUSCLE
STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE; TWO OR MORE VERTICAL
STRABISMUS SURGERY, ANY PROCEDURE, SUPERIOR OBLIQUE MUSCLE
TRANSPOSITION PROCEDURE (EG, FOR PARETIC EXTRAOCULAR MUSCLE), ANY EXTRAOCULAR
STRABISMUS SURGERY ON PATIENT WITH PREVIOUS EYE SURGERY OR INJURY THAT DID NOT
STRABISMUS SURGERY ON PATIENT WITH SCARRING OF EXTRAOCULAR MUSCLES (EG, PRIOR
STRABISMUS SURGERY BY POSTERIOR FIXATION SUTURE TECHNIQUE, WITH OR WITHOUT
PLACEMENT OF ADJUSTABLE SUTURE(S) DURING STRABISMUS SURGERY, INCLUDING
STRABISMUS SURGERY INVOLVING EXPLORATION AND/OR REPAIR OF DETACHED EXTRAOCULAR
RELEASE OF EXTENSIVE SCAR TISSUE WITHOUT DETACHING EXTRAOCULAR MUSCLE (SEPARATE
CHEMODENERVATION OF EXTRAOCULAR MUSCLE
BIOPSY OF EXTRAOCULAR MUSCLE
UNLISTED PROCEDURE, OCULAR MUSCLE
ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); FOR EXPLOR
ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); WITH
ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); WITH
ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); WITH
ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); WITH
FINE NEEDLE ASPIRATION OF ORBITAL CONTENTS
ORBITOTOMY WITH BONE FLAP OR WINDOW, LATERAL APPROACH (EG, KROENLEIN); WITH
ORBITOTOMY WITH BONE FLAP OR WINDOW, LATERAL APPROACH (EG, KROENLEIN); WITH
ORBITOTOMY WITH BONE FLAP OR WINDOW, LATERAL APPROACH (EG, KROENLEIN); WITH
ORBITOTOMY WITH BONE FLAP OR WINDOW, LATERAL APPROACH (EG, KROENLEIN); WITH
ORBITOTOMY WITH BONE FLAP OR WINDOW, LATERAL APPROACH (EG, KROENLEIN); FOR
RETROBULBAR INJECTION; MEDICATION (SEPARATE PROCEDURE, DOES NOT INCLUDE SUPPLY O
RETROBULBAR INJECTION; ALCOHOL
INJECTION OF MEDICATION OR OTHER SUBSTANCE INTO TENON'S CAPSULE
ORBITAL IMPLANT (IMPLANT OUTSIDE MUSCLE CONE); INSERTION
ORBITAL IMPLANT (IMPLANT OUTSIDE MUSCLE CONE); REMOVAL OR REVISION
OPTIC NERVE DECOMPRESSION (EG, INCISION OR FENESTRATION OF OPTIC NERVE SHEATH)
UNLISTED PROCEDURE, ORBIT
BLEPHAROTOMY, DRAINAGE OF ABSCESS, EYELID
SEVERING OF TARSORRHAPHY
CANTHOTOMY (SEPARATE PROCEDURE)
EXCISION OF CHALAZION; SINGLE
EXCISION OF CHALAZION; MULTIPLE, SAME LID
EXCISION OF CHALAZION; MULTIPLE, DIFFERENT LIDS
EXCISION OF CHALAZION; UNDER GENERAL ANESTHESIA AND/OR REQUIRING
BIOPSY OF EYELID
CORRECTION OF TRICHIASIS; EPILATION, BY FORCEPS ONLY
CORRECTION OF TRICHIASIS; EPILATION BY OTHER THAN FORCEPS (EG, BY
CORRECTION OF TRICHIASIS; INCISION OF LID MARGIN
CORRECTION OF TRICHIASIS; INCISION OF LID MARGIN, WITH FREE MUCOUS MEMBRANE
EXCISION OF LESION OF EYELID (EXCEPT CHALAZION) WITHOUT CLOSURE OR WITH SIMPLE
DESTRUCTION OF LESION OF LID MARGIN (UP TO 1 CM)
TEMPORARY CLOSURE OF EYELIDS BY SUTURE (EG, FROST SUTURE)
CONSTRUCTION OF INTERMARGINAL ADHESIONS, MEDIAN TARSORRHAPHY, OR CANTHORRHAPHY;
CONSTRUCTION OF INTERMARGINAL ADHESIONS, MEDIAN TARSORRHAPHY, OR CANTHORRHAPHY;
REPAIR OF BROW PTOSIS (SUPRACILIARY, MID-FOREHEAD OR CORONAL APPROACH)
REPAIR OF BLEPHAROPTOSIS; FRONTALIS MUSCLE TECHNIQUE WITH SUTURE OR OTHER MATERI
REPAIR OF BLEPHAROPTOSIS; FRONTALIS MUSCLE TECHNIQUE WITH AUTOLOGOUS FASCIAL SLI
REPAIR OF BLEPHAROPTOSIS; (TARSO) LEVATOR RESECTION OR ADVANCEMENT, INTERNAL
REPAIR OF BLEPHAROPTOSIS; (TARSO) LEVATOR RESECTION OR ADVANCEMENT, EXTERNAL
REPAIR OF BLEPHAROPTOSIS; SUPERIOR RECTUS TECHNIQUE WITH FASCIAL SLING
REPAIR OF BLEPHAROPTOSIS; CONJUNCTIVO-TARSO-MULLER'S MUSCLE-LEVATOR RESECTION
REDUCTION OF OVERCORRECTION OF PTOSIS
CORRECTION OF LID RETRACTION
CORRECTION OF LAGOPHTHALMOS, WITH IMPLANTATION OF UPPER EYELID LID LOAD (EG,
REPAIR OF ECTROPION; SUTURE
REPAIR OF ECTROPION; THERMOCAUTERIZATION
REPAIR OF ECTROPION; EXCISION TARSAL WEDGE
REPAIR OF ECTROPION; EXTENSIVE (EG, TARSAL STRIP OPERATIONS)
REPAIR OF ENTROPION; SUTURE
REPAIR OF ENTROPION; THERMOCAUTERIZATION
REPAIR OF ENTROPION; EXCISION TARSAL WEDGE
REPAIR OF ENTROPION; EXTENSIVE (EG, TARSAL STRIP OR CAPSULOPALPEBRAL FASCIA
SUTURE OF RECENT WOUND, EYELID, INVOLVING LID MARGIN, TARSUS, AND/OR PALPEBRAL C
SUTURE OF RECENT WOUND, EYELID, INVOLVING LID MARGIN, TARSUS, AND/OR PALPEBRAL
REMOVAL OF EMBEDDED FOREIGN BODY, EYELID
CANTHOPLASTY (RECONSTRUCTION OF CANTHUS)
EXCISION AND REPAIR OF EYELID, INVOLVING LID MARGIN, TARSUS, CONJUNCTIVA,
EXCISION AND REPAIR OF EYELID, INVOLVING LID MARGIN, TARSUS, CONJUNCTIVA,
RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OF TARSOCONJUNCTIVAL FLAP
RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OF TARSOCONJUNCTIVAL FLAP
RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OF TARSOCONJUNCTIVAL FLAP
RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OF TARSOCONJUNCTIVAL FLAP
UNLISTED PROCEDURE, EYELIDS
INCISION OF CONJUNCTIVA, DRAINAGE OF CYST
EXPRESSION OF CONJUNCTIVAL FOLLICLES (EG, FOR TRACHOMA)
BIOPSY OF CONJUNCTIVA
EXCISION OF LESION, CONJUNCTIVA; UP TO 1 CM
EXCISION OF LESION, CONJUNCTIVA; OVER 1 CM
EXCISION OF LESION, CONJUNCTIVA; WITH ADJACENT SCLERA
DESTRUCTION OF LESION, CONJUNCTIVA
SUBCONJUNCTIVAL INJECTION
CONJUNCTIVOPLASTY; WITH CONJUNCTIVAL GRAFT OR EXTENSIVE REARRANGEMENT
CONJUNCTIVOPLASTY; WITH BUCCAL MUCOUS MEMBRANE GRAFT (INCLUDES OBTAINING GRAFT)
CONJUNCTIVOPLASTY, RECONSTRUCTION CUL-DE-SAC; WITH CONJUNCTIVAL GRAFT OR
CONJUNCTIVOPLASTY, RECONSTRUCTION CUL-DE-SAC; WITH BUCCAL MUCOUS MEMBRANE GRAFT
REPAIR OF SYMBLEPHARON; CONJUNCTIVOPLASTY, WITHOUT GRAFT
REPAIR OF SYMBLEPHARON; WITH FREE GRAFT CONJUNCTIVA OR BUCCAL MUCOUS MEMBRANE
REPAIR OF SYMBLEPHARON; DIVISION OF SYMBLEPHARON, WITH OR WITHOUT INSERTION OF
CONJUNCTIVAL FLAP; BRIDGE OR PARTIAL (SEPARATE PROCEDURE)
CONJUNCTIVAL FLAP; TOTAL (SUCH AS GUNDERSON THIN FLAP OR PURSE STRING FLAP)
HARVESTING CONJUNCTIVAL ALLOGRAFT, LIVING DONOR
UNLISTED PROCEDURE, CONJUNCTIVA
INCISION, DRAINAGE OF LACRIMAL GLAND
INCISION, DRAINAGE OF LACRIMAL SAC (DACRYOCYSTOTOMY OR DACRYOCYSTOSTOMY)
SNIP INCISION OF LACRIMAL PUNCTUM
EXCISION OF LACRIMAL GLAND (DACRYOADENECTOMY), EXCEPT FOR TUMOR; TOTAL
EXCISION OF LACRIMAL GLAND (DACRYOADENECTOMY), EXCEPT FOR TUMOR; PARTIAL
BIOPSY OF LACRIMAL GLAND
EXCISION OF LACRIMAL SAC (DACRYOCYSTECTOMY)
BIOPSY OF LACRIMAL SAC
REMOVAL OF FOREIGN BODY OR DACRYOLITH, LACRIMAL PASSAGES
EXCISION OF LACRIMAL GLAND TUMOR; FRONTAL APPROACH
EXCISION OF LACRIMAL GLAND TUMOR; INVOLVING OSTEOTOMY
PLASTIC REPAIR OF CANALICULI
CORRECTION OF EVERTED PUNCTUM, CAUTERY
DACRYOCYSTORHINOSTOMY (FISTULIZATION OF LACRIMAL SAC TO NASAL CAVITY)
CONJUNCTIVORHINOSTOMY (FISTULIZATION OF CONJUNCTIVA TO NASAL CAVITY); WITHOUT
CONJUNCTIVORHINOSTOMY (FISTULIZATION OF CONJUNCTIVA TO NASAL CAVITY); WITH
CLOSURE OF THE LACRIMAL PUNCTUM; BY THERMOCAUTERIZATION, LIGATION, OR LASER
CLOSURE OF THE LACRIMAL PUNCTUM; BY PLUG, EACH
CLOSURE OF LACRIMAL FISTULA (SEPARATE PROCEDURE)
DILATION OF LACRIMAL PUNCTUM, WITH OR WITHOUT IRRIGATION
PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION;
PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION; REQUIRING GENERAL
PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION; WITH INSERTION OF
PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION; WITH TRANSLUMINAL BALL
PROBING OF LACRIMAL CANALICULI, WITH OR WITHOUT IRRIGATION
UNLISTED PROCEDURE, LACRIMAL SYSTEM
DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA; SIMPLE
DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA; COMPLICATED
DRAINAGE EXTERNAL AUDITORY CANAL, ABSCESS
BIOPSY EXTERNAL EAR
BIOPSY EXTERNAL AUDITORY CANAL
EXCISION EXTERNAL EAR; PARTIAL, SIMPLE REPAIR
EXCISION EXTERNAL EAR; COMPLETE AMPUTATION
EXCISION EXOSTOSIS(ES), EXTERNAL AUDITORY CANAL
EXCISION SOFT TISSUE LESION, EXTERNAL AUDITORY CANAL
RADICAL EXCISION EXTERNAL AUDITORY CANAL LESION; WITHOUT NECK DISSECTION
REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITH GENERAL ANESTHESIA
DEBRIDEMENT, MASTOIDECTOMY CAVITY, SIMPLE (EG, ROUTINE CLEANING)
DEBRIDEMENT, MASTOIDECTOMY CAVITY, COMPLEX (EG, WITH ANESTHESIA OR MORE THAN
OTOPLASTY, PROTRUDING EAR, WITH OR WITHOUT SIZE REDUCTION
RECONSTRUCTION OF EXTERNAL AUDITORY CANAL (MEATOPLASTY) (EG, FOR STENOSIS DUE
RECONSTRUCTION EXTERNAL AUDITORY CANAL FOR CONGENITAL ATRESIA, SINGLE STAGE
UNLISTED PROCEDURE, EXTERNAL EAR
EUSTACHIAN TUBE INFLATION, TRANSNASAL; WITH CATHETERIZATION
EUSTACHIAN TUBE INFLATION, TRANSNASAL; WITHOUT CATHETERIZATION
EUSTACHIAN TUBE CATHETERIZATION, TRANSTYMPANIC
MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN TUBE INFLATION
MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN TUBE INFLATION REQUIRING
VENTILATING TUBE REMOVAL REQUIRING GENERAL ANESTHESIA
TYMPANOSTOMY (REQUIRING INSERTION OF VENTILATING TUBE), LOCAL OR TOPICAL
TYMPANOSTOMY (REQUIRING INSERTION OF VENTILATING TUBE), GENERAL ANESTHESIA
MIDDLE EAR EXPLORATION THROUGH POSTAURICULAR OR EAR CANAL INCISION
TYMPANOLYSIS, TRANSCANAL
TRANSMASTOID ANTROTOMY (''SIMPLE'' MASTOIDECTOMY)
MASTOIDECTOMY; COMPLETE
MASTOIDECTOMY; MODIFIED RADICAL
MASTOIDECTOMY; RADICAL
PETROUS APICECTOMY INCLUDING RADICAL MASTOIDECTOMY
EXCISION AURAL POLYP
EXCISION AURAL GLOMUS TUMOR; TRANSCANAL
EXCISION AURAL GLOMUS TUMOR; TRANSMASTOID
REVISION MASTOIDECTOMY; RESULTING IN COMPLETE MASTOIDECTOMY
REVISION MASTOIDECTOMY; RESULTING IN MODIFIED RADICAL MASTOIDECTOMY
REVISION MASTOIDECTOMY; RESULTING IN RADICAL MASTOIDECTOMY
REVISION MASTOIDECTOMY; RESULTING IN TYMPANOPLASTY
REVISION MASTOIDECTOMY; WITH APICECTOMY
TYMPANIC MEMBRANE REPAIR, WITH OR WITHOUT SITE PREPARATION OF PERFORATION FOR
MYRINGOPLASTY (SURGERY CONFINED TO DRUMHEAD AND DONOR AREA)
TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, ATTICOTOMY AND/OR
TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, ATTICOTOMY AND/OR
TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, ATTICOTOMY AND/OR
TYMPANOPLASTY WITH ANTROTOMY OR MASTOIDOTOMY (INCLUDING CANALPLASTY,
TYMPANOPLASTY WITH ANTROTOMY OR MASTOIDOTOMY (INCLUDING CANALPLASTY,
TYMPANOPLASTY WITH ANTROTOMY OR MASTOIDOTOMY (INCLUDING CANALPLASTY,
TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY,
TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY,
TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY,
TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY,
TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY,
TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY,
STAPES MOBILIZATION
STAPEDECTOMY OR STAPEDOTOMY WITH REESTABLISHMENT OF OSSICULAR CONTINUITY, WITH
STAPEDECTOMY OR STAPEDOTOMY WITH REESTABLISHMENT OF OSSICULAR CONTINUITY, WITH
REVISION OF STAPEDECTOMY OR STAPEDOTOMY
REPAIR OVAL WINDOW FISTULA
REPAIR ROUND WINDOW FISTULA
MASTOID OBLITERATION (SEPARATE PROCEDURE)
TYMPANIC NEURECTOMY
CLOSURE POSTAURICULAR FISTULA, MASTOID (SEPARATE PROCEDURE)
REMOVAL OR REPAIR OF ELECTROMAGNETIC BONE CONDUCTION HEARING DEVICE IN TEMPORAL
IMPLANTATION, OSSEOINTEGRATED IMPLANT, TEMPORAL BONE, WITH PERCUTANEOUS
IMPLANTATION, OSSEOINTEGRATED IMPLANT, TEMPORAL BONE, WITH PERCUTANEOUS
REPLACEMENT (INCLUDING REMOVAL OF EXISTING DEVICE), OSSEOINTEGRATED IMPLANT,
REPLACEMENT (INCLUDING REMOVAL OF EXISTING DEVICE), OSSEOINTEGRATED IMPLANT,
DECOMPRESSION FACIAL NERVE, INTRATEMPORAL; LATERAL TO GENICULATE GANGLION
DECOMPRESSION FACIAL NERVE, INTRATEMPORAL; INCLUDING MEDIAL TO GENICULATE
SUTURE FACIAL NERVE, INTRATEMPORAL, WITH OR WITHOUT GRAFT OR DECOMPRESSION;
SUTURE FACIAL NERVE, INTRATEMPORAL, WITH OR WITHOUT GRAFT OR DECOMPRESSION;
UNLISTED PROCEDURE, MIDDLE EAR
LABYRINTHOTOMY, WITH PERFUSION OF VESTIBULOACTIVE DRUG(S); TRANSCANAL
ENDOLYMPHATIC SAC OPERATION; WITHOUT SHUNT
ENDOLYMPHATIC SAC OPERATION; WITH SHUNT
FENESTRATION SEMICIRCULAR CANAL
REVISION FENESTRATION OPERATION
LABYRINTHECTOMY; TRANSCANAL
LABYRINTHECTOMY; WITH MASTOIDECTOMY
VESTIBULAR NERVE SECTION, TRANSLABYRINTHINE APPROACH
COCHLEAR DEVICE IMPLANTATION, WITH OR WITHOUT MASTOIDECTOMY
UNLISTED PROCEDURE, INNER EAR
TOTAL FACIAL NERVE DECOMPRESSION AND/OR REPAIR (MAY INCLUDE GRAFT)
DECOMPRESSION INTERNAL AUDITORY CANAL
REMOVAL OF TUMOR, TEMPORAL BONE
UNLISTED PROCEDURE, TEMPORAL BONE, MIDDLE FOSSA APPROACH
MAGNETIC RESONANCE IMAGING, BRAIN, FUNCTIONAL MRI; REQUIRING PHYSICIAN OR PSYCHO
MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM AND SKULL
MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM AND SKULL
MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM AND SKULL
Computed tomographic angiography, abdomen and pelvis, with contrast material(s),
RADIOLOGIC EXAMINATION; PHARYNX AND/OR CERVICAL ESOPHAGUS
RADIOLOGIC EXAMINATION; ESOPHAGUS
SWALLOWING FUNCTION, WITH CINERADIOGRAPHY/VIDEORADIOGRAPHY
RADIOLOGIC EXAMINATION, GASTROINTESTINAL TRACT, UPPER; WITH OR WITHOUT DELAYED
RADIOLOGIC EXAMINATION, GASTROINTESTINAL TRACT, UPPER; WITH OR WITHOUT DELAYED
RADIOLOGIC EXAMINATION, GASTROINTESTINAL TRACT, UPPER; WITH SMALL INTESTINE,
RADIOLOGICAL EXAMINATION, GASTROINTESTINAL TRACT, UPPER, AIR CONTRAST, WITH
RADIOLOGICAL EXAMINATION, GASTROINTESTINAL TRACT, UPPER, AIR CONTRAST, WITH
RADIOLOGICAL EXAMINATION, GASTROINTESTINAL TRACT, UPPER, AIR CONTRAST, WITH
RADIOLOGIC EXAMINATION, SMALL INTESTINE, INCLUDES MULTIPLE SERIAL FILMS;
RADIOLOGIC EXAMINATION, SMALL INTESTINE, INCLUDES MULTIPLE SERIAL FILMS; VIA
DUODENOGRAPHY, HYPOTONIC
RADIOLOGIC EXAMINATION, COLON; CONTRAST (EG, BARIUM) ENEMA, WITH OR WITHOUT KUB
RADIOLOGIC EXAMINATION, COLON; AIR CONTRAST WITH SPECIFIC HIGH DENSITY BARIUM,
THERAPEUTIC ENEMA, CONTRAST OR AIR, FOR REDUCTION OF INTUSSUSCEPTION OR OTHER
CHOLECYSTOGRAPHY, ORAL CONTRAST;
CHOLECYSTOGRAPHY, ORAL CONTRAST; ADDITIONAL OR REPEAT EXAMINATION OR MULTIPLE
UROGRAPHY (PYELOGRAPHY), INTRAVENOUS, WITH OR WITHOUT KUB, WITH OR WITHOUT TOMOG
UROGRAPHY, INFUSION, DRIP TECHNIQUE AND/OR BOLUS TECHNIQUE;
UROGRAPHY, INFUSION, DRIP TECHNIQUE AND/OR BOLUS TECHNIQUE; WITH
UROGRAPHY, RETROGRADE, WITH OR WITHOUT KUB
PERINEOGRAM (EG, VAGINOGRAM, FOR SEX DETERMINATION OR EXTENT OF ANOMALIES)
Computed tomography, heart, with contrast material, for evaluation of cardiac st
Computed tomography, heart, with contrast material, for evaluation of cardiac st
Computed tomographic angiography, heart, coronary arteries and bypass grafts (wh
COMPUTED TOMOGRAPHY, LIMITED OR LOCALIZED FOLLOW-UP STUDY
UNLISTED COMPUTED TOMOGRAPHY PROCEDURE (EG, DIAGNOSTIC, INTERVENTIONAL)
UNLISTED MAGNETIC RESONANCE PROCEDURE (EG, DIAGNOSTIC, INTERVENTIONAL)
ECHOENCEPHALOGRAPHY, REAL TIME WITH IMAGE DOCUMENTATION (GRAY SCALE) (FOR DETERM
OPHTHALMIC ULTRASOUND, DIAGNOSTIC; B-SCAN AND QUANTITATIVE A-SCAN PERFORMED
OPHTHALMIC ULTRASOUND, DIAGNOSTIC; QUANTITATIVE A-SCAN ONLY
OPHTHALMIC ULTRASOUND, DIAGNOSTIC; B-SCAN (WITH OR WITHOUT SUPERIMPOSED
OPHTHALMIC ULTRASOUND, DIAGNOSTIC; ANTERIOR SEGMENT ULTRASOUND, IMMERSION
OPHTHALMIC BIOMETRY BY ULTRASOUND ECHOGRAPHY, A-SCAN;
OPHTHALMIC BIOMETRY BY ULTRASOUND ECHOGRAPHY, A-SCAN; WITH INTRAOCULAR LENS
OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION
ULTRASOUND, SOFT TISSUES OF HEAD AND NECK (EG, THYROID, PARATHYROID, PAROTID), R
ULTRASOUND, BREAST(S) (UNILATERAL OR BILATERAL), REAL TIME WITH IMAGE DOCUMENTAT
ULTRASOUND, SPINAL CANAL AND CONTENTS
ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL AND MATER
ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL AND
ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL AND
ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL AND
ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL AND
ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL AND
ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FIRST TRIMESTER
ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FIRST TRIMESTER
ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, LIMITED (EG,
ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FOLLOW-UP (EG,
ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, TRANSVAGINAL
FETAL BIOPHYSICAL PROFILE; WITH NON-STRESS TESTING
FETAL BIOPHYSICAL PROFILE; WITHOUT NON-STRESS TESTING
DOPPLER VELOCIMETRY, FETAL; UMBILICAL ARTERY
DOPPLER VELOCIMETRY, FETAL; MIDDLE CEREBRAL ARTERY
ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM, REAL TIME WITH IMAGE
ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM, REAL TIME WITH IMAGE
DOPPLER ECHOCARDIOGRAPHY, FETAL, PULSED WAVE AND/OR CONTINUOUS WAVE WITH
DOPPLER ECHOCARDIOGRAPHY, FETAL, PULSED WAVE AND/OR CONTINUOUS WAVE WITH
ULTRASOUND, TRANSVAGINAL
ULTRASOUND, TRANSRECTAL;
ULTRASOUND, TRANSRECTAL; PROSTATE VOLUME STUDY FOR BRACHYTHERAPY TREATMENT
ULTRASOUND, EXTREMITY, NONVASCULAR, REAL-TIME WITH IMAGE DOCUMENTATION; COMPLETE
ULTRASOUND, EXTREMITY, NONVASCULAR, REAL-TIME WITH IMAGE DOCUMENTATION; LIMITED,
ULTRASOUND, INFANT HIPS, REAL TIME WITH IMAGING DOCUMENTATION; DYNAMIC
ULTRASOUND, INFANT HIPS, REAL TIME WITH IMAGING DOCUMENTATION; LIMITED, STATIC
ULTRASOUND GUIDED COMPRESSION REPAIR OF ARTERIAL PSEUDOANEURYSM OR
ULTRASOUND STUDY FOLLOW-UP (SPECIFY)
UNLISTED ULTRASOUND PROCEDURE (EG, DIAGNOSTIC, INTERVENTIONAL)
COMPUTED TOMOGRAPHY, BONE MINERAL DENSITY STUDY, 1 OR MORE SITES; AXIAL SKELETON
DUAL-ENERGY X-RAY ABSORPTIOMETRY (DXA), BONE DENSITY STUDY, 1 OR MORE SITES; AXI
DUAL-ENERGY X-RAY ABSORPTIOMETRY (DXA), BONE DENSITY STUDY, 1 OR MORE SITES; APP
MAGNETIC RESONANCE (EG, PROTON) IMAGING, BONE MARROW BLOOD SUPPLY
RADIATION TREATMENT DELIVERY, STEREOTACTIC RADIOSURGERY (SRS), COMPLETE COURSE O
RADIATION TREATMENT DELIVERY, SUPERFICIAL AND/OR ORTHO VOLTAGE
RADIATION TREATMENT DELIVERY, SINGLE TREATMENT AREA, SINGLE PORT OR PARALLEL
RADIATION TREATMENT DELIVERY, SINGLE TREATMENT AREA, SINGLE PORT OR PARALLEL
RADIATION TREATMENT DELIVERY, SINGLE TREATMENT AREA, SINGLE PORT OR PARALLEL
RADIATION TREATMENT DELIVERY, SINGLE TREATMENT AREA, SINGLE PORT OR PARALLEL
RADIATION TREATMENT DELIVERY, TWO SEPARATE TREATMENT AREAS, THREE OR MORE PORTS
RADIATION TREATMENT DELIVERY, TWO SEPARATE TREATMENT AREAS, THREE OR MORE PORTS
RADIATION TREATMENT DELIVERY, TWO SEPARATE TREATMENT AREAS, THREE OR MORE PORTS
RADIATION TREATMENT DELIVERY, TWO SEPARATE TREATMENT AREAS, THREE OR MORE PORTS
RADIATION TREATMENT DELIVERY, THREE OR MORE SEPARATE TREATMENT AREAS, CUSTOM BLO
RADIATION TREATMENT DELIVERY, THREE OR MORE SEPARATE TREATMENT AREAS, CUSTOM
RADIATION TREATMENT DELIVERY, THREE OR MORE SEPARATE TREATMENT AREAS, CUSTOM
RADIATION TREATMENT DELIVERY, THREE OR MORE SEPARATE TREATMENT AREAS, CUSTOM
INTENSITY MODULATED TREATMENT DELIVERY, SINGLE OR MULTIPLE FIELDS/ARCS, VIA
HIGH ENERGY NEUTRON RADIATION TREATMENT DELIVERY; SINGLE TREATMENT AREA USING A
HIGH ENERGY NEUTRON RADIATION TREATMENT DELIVERY; 1 OR MORE ISOCENTER(S) WITH CO
SPECIAL TREATMENT PROCEDURE (EG, TOTAL BODY IRRADIATION, HEMIBODY RADIATION,
PROTON TREATMENT DELIVERY; SIMPLE, WITHOUT COMPENSATION
PROTON TREATMENT DELIVERY; SIMPLE, WITH COMPENSATION
PROTON TREATMENT DELIVERY; INTERMEDIATE
PROTON TREATMENT DELIVERY; COMPLEX
HYPERTHERMIA, EXTERNALLY GENERATED; SUPERFICIAL (IE, HEATING TO A DEPTH OF 4 CM
HYPERTHERMIA, EXTERNALLY GENERATED; DEEP (IE, HEATING TO DEPTHS GREATER THAN 4
HYPERTHERMIA GENERATED BY INTERSTITIAL PROBE(S); 5 OR FEWER INTERSTITIAL
HYPERTHERMIA GENERATED BY INTERSTITIAL PROBE(S); MORE THAN 5 INTERSTITIAL
HYPERTHERMIA GENERATED BY INTRACAVITARY PROBE(S)
INFUSION OR INSTILLATION OF RADIOELEMENT SOLUTION (INCLUDES THREE MONTHS FOLLOW-
INTRACAVITARY RADIATION SOURCE APPLICATION; SIMPLE
INTRACAVITARY RADIATION SOURCE APPLICATION; INTERMEDIATE
INTRACAVITARY RADIATION SOURCE APPLICATION; COMPLEX
INTERSTITIAL RADIATION SOURCE APPLICATION; SIMPLE
INTERSTITIAL RADIATION SOURCE APPLICATION; INTERMEDIATE
Remote afterloading high dose rate radionuclide brachytherapy; 1 channel
Remote afterloading high dose rate radionuclide brachytherapy; 2 - 12 channels
Remote afterloading high dose rate radionuclide brachytherapy; over 12 channels
SURFACE APPLICATION OF RADIATION SOURCE
UNLISTED PROCEDURE, CLINICAL BRACHYTHERAPY
THYROID UPTAKE; SINGLE DETERMINATION
THYROID UPTAKE; MULTIPLE DETERMINATIONS
THYROID UPTAKE; STIMULATION, SUPPRESSION OR DISCHARGE (NOT INCLUDING INITIAL
THYROID IMAGING, WITH UPTAKE; SINGLE DETERMINATION
THYROID IMAGING, WITH UPTAKE; MULTIPLE DETERMINATIONS
THYROID IMAGING; ONLY
THYROID IMAGING; WITH VASCULAR FLOW
THYROID CARCINOMA METASTASES IMAGING; LIMITED AREA (EG, NECK AND CHEST ONLY)
THYROID CARCINOMA METASTASES IMAGING; WITH ADDITIONAL STUDIES (EG, URINARY
THYROID CARCINOMA METASTASES IMAGING; WHOLE BODY
PARATHYROID IMAGING
ADRENAL IMAGING, CORTEX AND/OR MEDULLA
UNLISTED ENDOCRINE PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
BONE MARROW IMAGING; LIMITED AREA
BONE MARROW IMAGING; MULTIPLE AREAS
BONE MARROW IMAGING; WHOLE BODY
PLASMA VOLUME, RADIOPHARMACEUTICAL VOLUME-DILUTION TECHNIQUE (SEPARATE
PLASMA VOLUME, RADIOPHARMACEUTICAL VOLUME-DILUTION TECHNIQUE (SEPARATE
RED CELL VOLUME DETERMINATION (SEPARATE PROCEDURE); SINGLE SAMPLING
RED CELL VOLUME DETERMINATION (SEPARATE PROCEDURE); MULTIPLE SAMPLINGS
WHOLE BLOOD VOLUME DETERMINATION, INCLUDING SEPARATE MEASUREMENT OF PLASMA
RED CELL SURVIVAL STUDY;
RED CELL SURVIVAL STUDY; DIFFERENTIAL ORGAN/TISSUE KINETICS, (EG, SPLENIC
LABELED RED CELL SEQUESTRATION, DIFFERENTIAL ORGAN/TISSUE, (EG, SPLENIC AND/OR
SPLEEN IMAGING ONLY, WITH OR WITHOUT VASCULAR FLOW
KINETICS, STUDY OF PLATELET SURVIVAL, WITH OR WITHOUT DIFFERENTIAL ORGAN/TISSUE
PLATELET SURVIVAL STUDY
LYMPHATICS AND LYMPH NODES IMAGING
UNLISTED HEMATOPOIETIC, RETICULOENDOTHELIAL AND LYMPHATIC PROCEDURE, DIAGNOSTIC
LIVER IMAGING; STATIC ONLY
LIVER IMAGING; WITH VASCULAR FLOW
LIVER IMAGING (SPECT);
LIVER IMAGING (SPECT); WITH VASCULAR FLOW
LIVER AND SPLEEN IMAGING; STATIC ONLY
LIVER AND SPLEEN IMAGING; WITH VASCULAR FLOW
Hepatobiliary system imaging, including gallbladder when present;
with pharmacologic intervention, including quantitative measurement(s) when perf
SALIVARY GLAND IMAGING;
SALIVARY GLAND IMAGING; WITH SERIAL IMAGES
SALIVARY GLAND FUNCTION STUDY
ESOPHAGEAL MOTILITY
GASTRIC MUCOSA IMAGING
GASTROESOPHAGEAL REFLUX STUDY
GASTRIC EMPTYING STUDY
VITAMIN B-12 ABSORPTION STUDY (EG, SCHILLING TEST); WITHOUT INTRINSIC FACTOR
VITAMIN B-12 ABSORPTION STUDY (EG, SCHILLING TEST); WITH INTRINSIC FACTOR
VITAMIN B-12 ABSORPTION STUDIES COMBINED, WITH AND WITHOUT INTRINSIC FACTOR
ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING
GASTROINTESTINAL PROTEIN LOSS
INTESTINE IMAGING (EG, ECTOPIC GASTRIC MUCOSA, MECKEL'S LOCALIZATION, VOLVULUS)
PERITONEAL-VENOUS SHUNT PATENCY TEST (EG, FOR LEVEEN, DENVER SHUNT)
UNLISTED GASTROINTESTINAL PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
BONE AND/OR JOINT IMAGING; LIMITED AREA
BONE AND/OR JOINT IMAGING; MULTIPLE AREAS
BONE AND/OR JOINT IMAGING; WHOLE BODY
BONE AND/OR JOINT IMAGING; THREE PHASE STUDY
BONE AND/OR JOINT IMAGING; TOMOGRAPHIC (SPECT)
UNLISTED MUSCULOSKELETAL PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
DETERMINATION OF CENTRAL C-V HEMODYNAMICS (NON-IMAGING) (EG, EJECTION FRACTION W
CARDIAC SHUNT DETECTION
NON-CARDIAC VASCULAR FLOW IMAGING (IE, ANGIOGRAPHY, VENOGRAPHY)
Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correct
Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correct
Myocardial perfusion imaging, planar (including qualitative or quantitative wall
Myocardial perfusion imaging, planar (including qualitative or quantitative wall
ACUTE VENOUS THROMBOSIS IMAGING, PEPTIDE
VENOUS THROMBOSIS IMAGING, VENOGRAM; UNILATERAL
VENOUS THROMBOSIS IMAGING, VENOGRAM; BILATERAL
MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY (PET), METABOLIC EVALUATION
MYOCARDIAL IMAGING, INFARCT AVID, PLANAR; QUALITATIVE OR QUANTITATIVE
MYOCARDIAL IMAGING, INFARCT AVID, PLANAR; WITH EJECTION FRACTION BY FIRST PASS
MYOCARDIAL IMAGING, INFARCT AVID, PLANAR; TOMOGRAPHIC SPECT WITH OR WITHOUT
CARDIAC BLOOD POOL IMAGING, GATED EQUILIBRIUM; PLANAR, SINGLE STUDY AT REST OR
CARDIAC BLOOD POOL IMAGING, GATED EQUILIBRIUM; MULTIPLE STUDIES, WALL MOTION
CARDIAC BLOOD POOL IMAGING, (PLANAR), FIRST PASS TECHNIQUE; SINGLE STUDY, AT
CARDIAC BLOOD POOL IMAGING, (PLANAR), FIRST PASS TECHNIQUE; MULTIPLE STUDIES,
MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY (PET), PERFUSION; SINGLE STUDY
MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY (PET), PERFUSION; MULTIPLE
CARDIAC BLOOD POOL IMAGING, GATED EQUILIBRIUM, SPECT, AT REST, WALL MOTION
UNLISTED CARDIOVASCULAR PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
Pulmonary ventilation imaging (eg, aerosol or gas)
PULMONARY PERFUSION IMAGING; PARTICULATE
Pulmonary ventilation (eg, aerosol or gas) and perfusion imaging
Quantitative differential pulmonary perfusion, including imaging when performed
Quantitative differential pulmonary perfusion and ventilation (eg, aerosol or ga
UNLISTED RESPIRATORY PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
BRAIN IMAGING, LESS THAN 4 STATIC VIEWS;
BRAIN IMAGING, LESS THAN 4 STATIC VIEWS; WITH VASCULAR FLOW
BRAIN IMAGING, MINIMUM 4 STATIC VIEWS;
BRAIN IMAGING, MINIMUM 4 STATIC VIEWS; WITH VASCULAR FLOW
BRAIN IMAGING, TOMOGRAPHIC (SPECT)
BRAIN IMAGING, POSITRON EMISSION TOMOGRAPHY (PET); METABOLIC EVALUATION
BRAIN IMAGING, VASCULAR FLOW ONLY
CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDING INTRODUCTION OF MATERIAL);
CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDING INTRODUCTION OF MATERIAL);
CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDING INTRODUCTION OF MATERIAL);
CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDING INTRODUCTION OF MATERIAL);
CEREBROSPINAL FLUID LEAKAGE DETECTION AND LOCALIZATION
RADIOPHARMACEUTICAL DACRYOCYSTOGRAPHY
UNLISTED NERVOUS SYSTEM PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
KIDNEY IMAGING MORPHOLOGY;
KIDNEY IMAGING; WITH VASCULAR FLOW
KIDNEY IMAGING MORPHOLOGY; WITH VASCULAR FLOW AND FUNCTION, SINGLE STUDY WITHOUT
KIDNEY IMAGING MORPHOLOGY; WITH VASCULAR FLOW AND FUNCTION, SINGLE STUDY, WITH P
KIDNEY IMAGING MORPHOLOGY; WITH VASCULAR FLOW AND FUNCTION, MULTIPLE STUDIES, WI
KIDNEY IMAGING MORPHOLOGY; TOMOGRAPHIC (SPECT)
KIDNEY FUNCTION STUDY, NON-IMAGING RADIOISOTOPIC STUDY
URINARY BLADDER RESIDUAL STUDY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY
URETERAL REFLUX STUDY (RADIOPHARMACEUTICAL VOIDING CYSTOGRAM)
TESTICULAR IMAGING WITH VASCULAR FLOW
UNLISTED GENITOURINARY PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR OR DISTRIBUTION OF RADIOPHARMACEUTICAL
RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR OR DISTRIBUTION OF
RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR OR DISTRIBUTION OF
RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR OR DISTRIBUTION OF
RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR OR DISTRIBUTION OF
RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; LIMITED AREA
RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY
RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; TOMOGRAPHIC (SPECT)
POSITRON EMISSION TOMOGRAPHY (PET) IMAGING; LIMITED AREA (EG, CHEST, HEAD/NECK)
POSITRON EMISSION TOMOGRAPHY (PET) IMAGING; SKULL BASE TO MID-THIGH
POSITRON EMISSION TOMOGRAPHY (PET) IMAGING; WHOLE BODY
POSITRON EMISSION TOMOGRAPHY (PET) WITH CONCURRENTLY ACQUIRED COMPUTED TOMOGRAPH
POSITRON EMISSION TOMOGRAPHY (PET) WITH CONCURRENTLY ACQUIRED COMPUTED TOMOGRAPH
POSITRON EMISSION TOMOGRAPHY (PET) WITH CONCURRENTLY ACQUIRED COMPUTED TOMOGRAPH
UNLISTED MISCELLANEOUS PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
RADIOPHARMACEUTICAL THERAPY, BY ORAL ADMINISTRATION
RADIOPHARMACEUTICAL THERAPY, BY INTRAVENOUS ADMINISTRATION
RADIOPHARMACEUTICAL THERAPY, BY INTRACAVITARY ADMINISTRATION
RADIOPHARMACEUTICAL THERAPY, BY INTERSTITIAL RADIOACTIVE COLLOID ADMINISTRATION
RADIOPHARMACEUTICAL THERAPY, RADIOLABELED MONOCLONAL ANTIBODY BY INTRAVENOUS
RADIOPHARMACEUTICAL THERAPY, BY INTRA-ARTICULAR ADMINISTRATION
RADIOPHARMACEUTICAL THERAPY, BY INTRA-ARTERIAL PARTICULATE ADMINISTRATION
RADIOPHARMACEUTICAL THERAPY, UNLISTED PROCEDURE
IMMUNIZATION ADMINISTRATION (INCLUDES PERCUTANEOUS, INTRADERMAL, SUBCUTANEOUS,
IMMUNIZATION ADMINISTRATION (INCLUDES PERCUTANEOUS, INTRADERMAL, SUBCUTANEOUS,
IMMUNIZATION ADMINISTRATION BY INTRANASAL OR ORAL ROUTE; ONE VACCINE (SINGLE OR
IMMUNIZATION ADMINISTRATION BY INTRANASAL OR ORAL ROUTE; EACH ADDITIONAL
ELECTROCONVULSIVE THERAPY (INCLUDES NECESSARY MONITORING)
BIOFEEDBACK TRAINING, PERINEAL MUSCLES, ANORECTAL OR URETHRAL SPHINCTER,
HEMODIALYSIS PROCEDURE WITH SINGLE PHYSICIAN EVALUATION
GASTROINTESTINAL TRACT IMAGING, INTRALUMINAL (EG, CAPSULE ENDOSCOPY), ESOPHAGUS
COLON MOTILITY (MANOMETRIC) STUDY, MINIMUM 6 HOURS CONTINUOUS RECORDING (INCLUDI
RECTAL SENSATION, TONE, AND COMPLIANCE TEST (IE, RESPONSE TO GRADED BALLOON
ANORECTAL MANOMETRY
OPHTHALMOLOGICAL EXAMINATION AND EVALUATION, UNDER GENERAL ANESTHESIA, WITH OR
OPHTHALMOLOGICAL EXAMINATION AND EVALUATION, UNDER GENERAL ANESTHESIA, WITH OR
GONIOSCOPY (SEPARATE PROCEDURE)
COMPUTERIZED CORNEAL TOPOGRAPHY, UNILATERAL OR BILATERAL, WITH INTERPRETATION AN
SENSORIMOTOR EXAMINATION WITH MULTIPLE MEASUREMENTS OF OCULAR DEVIATION (EG,
ORTHOPTIC AND/OR PLEOPTIC TRAINING, WITH CONTINUING MEDICAL DIRECTION AND
VISUAL FIELD EXAMINATION, UNILATERAL OR BILATERAL, WITH INTERPRETATION AND
VISUAL FIELD EXAMINATION, UNILATERAL OR BILATERAL, WITH INTERPRETATION AND
VISUAL FIELD EXAMINATION, UNILATERAL OR BILATERAL, WITH INTERPRETATION AND
SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGING, ANTERIOR SEGMENT, WITH INTE
SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGING, POSTERIOR SEGMENT, WITH INT
SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGING, POSTERIOR SEGMENT, WITH INT
OPHTHALMIC BIOMETRY BY PARTIAL COHERENCE INTERFEROMETRY WITH INTRAOCULAR LENS
PROVOCATIVE TESTS FOR GLAUCOMA, WITH INTERPRETATION AND REPORT, WITHOUT
OPHTHALMOSCOPY, EXTENDED, WITH RETINAL DRAWING (EG, FOR RETINAL DETACHMENT, MELA
OPHTHALMOSCOPY, EXTENDED, WITH RETINAL DRAWING (EG, FOR RETINAL DETACHMENT,
FLUORESCEIN ANGIOSCOPY WITH INTERPRETATION AND REPORT
FLUORESCEIN ANGIOGRAPHY (INCLUDES MULTIFRAME IMAGING) WITH INTERPRETATION AND
INDOCYANINE-GREEN ANGIOGRAPHY (INCLUDES MULTIFRAME IMAGING) WITH INTERPRETATION
FUNDUS PHOTOGRAPHY WITH INTERPRETATION AND REPORT
OPHTHALMODYNAMOMETRY
NEEDLE OCULOELECTROMYOGRAPHY, ONE OR MORE EXTRAOCULAR MUSCLES, ONE OR BOTH EYES,
ELECTRO-OCULOGRAPHY WITH INTERPRETATION AND REPORT
ELECTRORETINOGRAPHY WITH INTERPRETATION AND REPORT
COLOR VISION EXAMINATION, EXTENDED, EG, ANOMALOSCOPE OR EQUIVALENT
DARK ADAPTATION EXAMINATION WITH INTERPRETATION AND REPORT
EXTERNAL OCULAR PHOTOGRAPHY WITH INTERPRETATION AND REPORT FOR DOCUMENTATION OF
SPECIAL ANTERIOR SEGMENT PHOTOGRAPHY WITH INTERPRETATION AND REPORT; WITH
SPECIAL ANTERIOR SEGMENT PHOTOGRAPHY WITH INTERPRETATION AND REPORT; WITH
PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF AND FITTING OF CONTACT
PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF AND FITTING OF CONTACT
PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF AND FITTING OF CONTACT
PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF CONTACT LENS, WITH
PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF CONTACT LENS, WITH
PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF CONTACT LENS, WITH
MODIFICATION OF CONTACT LENS (SEPARATE PROCEDURE), WITH MEDICAL SUPERVISION OF
REPLACEMENT OF CONTACT LENS
FITTING OF SPECTACLE PROSTHESIS FOR APHAKIA; MONOFOCAL
FITTING OF SPECTACLE PROSTHESIS FOR APHAKIA; MULTIFOCAL
FITTING OF SPECTACLE MOUNTED LOW VISION AID; SINGLE ELEMENT SYSTEM
FITTING OF SPECTACLE MOUNTED LOW VISION AID; TELESCOPIC OR OTHER COMPOUND LENS
PROSTHESIS SERVICE FOR APHAKIA, TEMPORARY (DISPOSABLE OR LOAN, INCLUDING
REPAIR AND REFITTING SPECTACLES; SPECTACLE PROSTHESIS FOR APHAKIA
UNLISTED OPHTHALMOLOGICAL SERVICE OR PROCEDURE
OTOLARYNGOLOGIC EXAMINATION UNDER GENERAL ANESTHESIA
NASOPHARYNGOSCOPY WITH ENDOSCOPE (SEPARATE PROCEDURE)
ELECTROCOCHLEOGRAPHY
AUDITORY EVOKED POTENTIALS FOR EVOKED RESPONSE AUDIOMETRY AND/OR TESTING OF THE
AUDITORY EVOKED POTENTIALS FOR EVOKED RESPONSE AUDIOMETRY AND/OR TESTING OF THE
CARDIOPULMONARY RESUSCITATION (EG, IN CARDIAC ARREST)
CARDIOVERSION, ELECTIVE, ELECTRICAL CONVERSION OF ARRHYTHMIA; EXTERNAL
CARDIOVERSION, ELECTIVE, ELECTRICAL CONVERSION OF ARRHYTHMIA; INTERNAL
PERCUTANEOUS TRANSLUMINAL CORONARY THROMBECTOMY (LIST SEPARATELY IN ADDITION TO
TRANSCATHETER PLACEMENT OF RADIATION DELIVERY DEVICE FOR SUBSEQUENT CORONARY
THROMBOLYSIS, CORONARY; BY INTRAVENOUS INFUSION
TRANSCATHETER PLACEMENT OF AN INTRACORONARY STENT(S), PERCUTANEOUS, WITH OR
TRANSCATHETER PLACEMENT OF AN INTRACORONARY STENT(S), PERCUTANEOUS, WITH OR
PERCUTANEOUS TRANSLUMINAL CORONARY BALLOON ANGIOPLASTY; SINGLE VESSEL
PERCUTANEOUS TRANSLUMINAL CORONARY BALLOON ANGIOPLASTY; EACH ADDITIONAL VESSEL
PERCUTANEOUS BALLOON VALVULOPLASTY; AORTIC VALVE
PERCUTANEOUS BALLOON VALVULOPLASTY; MITRAL VALVE
PERCUTANEOUS BALLOON VALVULOPLASTY; PULMONARY VALVE
PERCUTANEOUS TRANSLUMINAL CORONARY ATHERECTOMY, BY MECHANICAL OR OTHER METHOD,
PERCUTANEOUS TRANSLUMINAL CORONARY ATHERECTOMY, BY MECHANICAL OR OTHER METHOD,
PERCUTANEOUS TRANSLUMINAL PULMONARY ARTERY BALLOON ANGIOPLASTY; SINGLE VESSEL
PERCUTANEOUS TRANSLUMINAL PULMONARY ARTERY BALLOON ANGIOPLASTY; EACH ADDITIONAL
ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; TRACING ONLY, WITHOUT
EXTERNAL ELECTROCARDIOGRAPHIC RECORDING UP TO 48 HOURS BY CONTINUOUS RHYTHM RECO
EXTERNAL ELECTROCARDIOGRAPHIC RECORDING UP TO 48 HOURS BY CONTINUOUS RHYTHM RECO
EXTERNAL MOBILE CARDIOVASCULAR TELEMETRY WITH ELECTROCARDIOGRAPHIC RECORDING, CO
EXTERNAL PATIENT AND, WHEN PERFORMED, AUTO ACTIVATED ELECTROCARDIOGRAPHIC RHYTHM
EXTERNAL PATIENT AND, WHEN PERFORMED, AUTO ACTIVATED ELECTROCARDIOGRAPHIC RHYTHM
PROGRAMMING DEVICE EVALUATION (IN PERSON) WITH ITERATIVE ADJUSTMENT OF THE IMPLA
PROGRAMMING DEVICE EVALUATION (IN PERSON) WITH ITERATIVE ADJUSTMENT OF THE IMPLA
PROGRAMMING DEVICE EVALUATION (IN PERSON) WITH ITERATIVE ADJUSTMENT OF THE IMPLA
PROGRAMMING DEVICE EVALUATION (IN PERSON) WITH ITERATIVE ADJUSTMENT OF THE IMPLA
PROGRAMMING DEVICE EVALUATION (IN PERSON) WITH ITERATIVE ADJUSTMENT OF THE IMPLA
PROGRAMMING DEVICE EVALUATION (IN PERSON) WITH ITERATIVE ADJUSTMENT OF THE IMPLA
PROGRAMMING DEVICE EVALUATION (IN PERSON) WITH ITERATIVE ADJUSTMENT OF THE IMPLA
Interrogation device evaluation (in person) with physician analysis, review and
Interrogation device evaluation (in person) with physician analysis, review and
Interrogation device evaluation (in person) with physician analysis, review and
Interrogation device evaluation (in person) with physician analysis, review and
Transtelephonic rhythm strip pacemaker evaluation(s) single, dual, or multiple l
Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or mul
Interrogation device evaluation(s), (remote) up to 30 days: implantable cardiova
TRANSTHORACIC ECHOCARDIOGRAPHY FOR CONGENIAL CARDIAC ANOMALIES; COMPLETE
TRANSTHORACIC ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; FOLLOW-UP OR
Echocardiography, transthoracic real-time with image documentation (2D), includi
ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUD
ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUD
ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, REAL TIME WITH IMAGE DOCUMENTATION (2D)
ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, REAL TIME WITH IMAGE DOCUMENTATION (2D)
TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; INCLUDING
TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; PLACEMENT OF
ECHOCARDIOGRAPHY, TRANSESOPHAGEAL (TEE) FOR MONITORING PURPOSES, INCLUDING
ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUD
Echocardiography, transthoracic, real-time with image documentation (2D), with o
RIGHT HEART CATHETERIZATION INCLUDING MEASUREMENT(S) OF OXYGEN SATURATION AND CA
LEFT HEART CATHETERIZATION INCLUDING INTRAPROCEDURAL INJECTION(S) FOR LEFT VENTR
COMBINED RIGHT AND LEFT HEART CATHETERIZATION INCLUDING INTRAPROCEDURAL INJECTIO
CATHETER PLACEMENT IN CORONARY ARTERY(S) FOR CORONARY ANGIOGRAPHY, INCLUDING INT
CATHETER PLACEMENT IN CORONARY ARTERY(S) FOR CORONARY ANGIOGRAPHY, INCLUDING INT
CATHETER PLACEMENT IN CORONARY ARTERY(S) FOR CORONARY ANGIOGRAPHY, INCLUDING INT
CATHETER PLACEMENT IN CORONARY ARTERY(S) FOR CORONARY ANGIOGRAPHY, INCLUDING INT
CATHETER PLACEMENT IN CORONARY ARTERY(S) FOR CORONARY ANGIOGRAPHY, INCLUDING INT
CATHETER PLACEMENT IN CORONARY ARTERY(S) FOR CORONARY ANGIOGRAPHY, INCLUDING INT
CATHETER PLACEMENT IN CORONARY ARTERY(S) FOR CORONARY ANGIOGRAPHY, INCLUDING INT
CATHETER PLACEMENT IN CORONARY ARTERY(S) FOR CORONARY ANGIOGRAPHY, INCLUDING INT
LEFT HEART CATHETERIZATION BY TRANSSEPTAL PUNCTURE THROUGH INTACT SEPTUM OR BY T
INSERTION AND PLACEMENT OF FLOW DIRECTED CATHETER (EG, SWAN-GANZ) FOR
ENDOMYOCARDIAL BIOPSY
RIGHT HEART CATHETERIZATION, FOR CONGENITAL CARDIAC ANOMALIES
COMBINED RIGHT HEART CATHETERIZATION AND RETROGRADE LEFT HEART CATHETERIZATION,
COMBINED RIGHT HEART CATHETERIZATION AND TRANSSEPTAL LEFT HEART CATHETERIZATION
COMBINED RIGHT HEART CATHETERIZATION AND TRANSSEPTAL LEFT HEART CATHETERIZATION
PERCUTANEOUS TRANSCATHETER CLOSURE OF CONGENITAL INTERATRIAL COMMUNICATION (IE,
PERCUTANEOUS TRANSCATHETER CLOSURE OF A CONGENITAL VENTRICULAR SEPTAL DEFECT
BUNDLE OF HIS RECORDING
INTRA-ATRIAL RECORDING
RIGHT VENTRICULAR RECORDING
INTRA-ATRIAL PACING
INTRAVENTRICULAR PACING
ESOPHAGEAL RECORDING OF ATRIAL ELECTROGRAM WITH OR WITHOUT VENTRICULAR
ESOPHAGEAL RECORDING OF ATRIAL ELECTROGRAM WITH OR WITHOUT VENTRICULAR
INDUCTION OF ARRHYTHMIA BY ELECTRICAL PACING
ELECTROPHYSIOLOGIC FOLLOW-UP STUDY WITH PACING AND RECORDING TO TEST EFFECTIVENE
ELECTROPHYSIOLOGIC EVALUATION OF SINGLE OR DUAL CHAMBER PACING CARDIOVERTER-DEFI
EVALUATION OF CARDIOVASCULAR FUNCTION WITH TILT TABLE EVALUATION, WITH CONTINUOU
BIOIMPEDANCE-DERIVED PHYSIOLOGIC CARDIOVASCULAR ANALYSIS
ELECTRONIC ANALYSIS OF ANTITACHYCARDIA PACEMAKER SYSTEM (INCLUDES
INITIAL SET-UP AND PROGRAMMING BY A PHYSICIAN OF WEARABLE
Interrogation of ventricular assist device (VAD), in person, with physician anal
PHYSICIAN SERVICES FOR OUTPATIENT CARDIAC REHABILITATION; WITHOUT CONTINUOUS ECG
PHYSICIAN SERVICES FOR OUTPATIENT CARDIAC REHABILITATION; WITH CONTINUOUS ECG
UNLISTED CARDIOVASCULAR SERVICE OR PROCEDURE
DUPLEX SCAN OF EXTRACRANIAL ARTERIES; COMPLETE BILATERAL STUDY
DUPLEX SCAN OF EXTRACRANIAL ARTERIES; UNILATERAL OR LIMITED STUDY
TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; COMPLETE STUDY
TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; LIMITED STUDY
TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; VASOREACTIVITY STUDY
TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; EMBOLI DETECTION
TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; EMBOLI DETECTION WITH
LIMITED BILATERAL NONINVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY AR
COMPLETE BILATERAL NONINVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY A
NONINVASIVE PHYSIOLOGIC STUDIES OF LOWER EXTREMITY ARTERIES, AT REST AND FOLLOWI
DUPLEX SCAN OF LOWER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; COMPLETE
DUPLEX SCAN OF LOWER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; UNILATERAL
DUPLEX SCAN OF UPPER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; COMPLETE
DUPLEX SCAN OF UPPER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; UNILATERAL
NON-INVASIVE PHYSIOLOGIC STUDIES OF EXTREMITY VEINS, COMPLETE BILATERAL STUDY (E
DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER
DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER
DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABDOMINAL, PELVIC, AND/OR R
DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABDOMINAL, PELVIC, SCROTAL
DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE, OR BYPASS GRAFTS;
DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE, OR BYPASS GRAFTS;
DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF PENILE VESSELS; COMPLETE
DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF PENILE VESSELS; FOLLOW-UP
DUPLEX SCAN OF HEMODIALYSIS ACCESS (INCLUDING ARTERIAL INFLOW, BODY OF ACCESS AN
BRONCHODILATION RESPONSIVENESS, SPIROMETRY AS IN 94010, PRE- AND
INTRAPULMONARY SURFACTANT ADMINISTRATION BY A PHYSICIAN THROUGH ENDOTRACHEAL TUB
PRESSURIZED OR NONPRESSURIZED INHALATION TREATMENT FOR ACUTE AIRWAY OBSTRUCTION
AEROSOL INHALATION OF PENTAMIDINE FOR PNEUMOCYSTIS CARINII PNEUMONIA TREATMENT
DEMONSTRATION AND/OR EVALUATION OF PATIENT UTILIZATION OF AN AEROSOL GENERATOR,
MANIPULATION CHEST WALL, SUCH AS CUPPING, PERCUSSING, AND VIBRATION TO
MANIPULATION CHEST WALL, SUCH AS CUPPING, PERCUSSING, AND VIBRATION TO
PEDIATRIC HOME APNEA MONITORING EVENT RECORDING INCLUDING RESPIRATORY RATE, PATT
PEDIATRIC HOME APNEA MONITORING EVENT RECORDING INCLUDING RESPIRATORY RATE, PATT
PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF ALLE
PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF
PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF
PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF
PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF
PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF
PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF
PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF
PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF
PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF
Actigraphy testing, recording analysis, interpretation, and report (minimum of 7
MULTIPLE SLEEP LATENCY OR MAINTENANCE OF WAKEFULNESS TESTING, RECORDING, ANALYSI
SLEEP STUDY, UNATTENDED, SIMULTANEOUS RECORDING OF, HEART RATE, OXYGEN SATURATIO
SLEEP STUDY, SIMULTANEOUS RECORDING OF VENTILATION, RESPIRATORY EFFORT, ECG OR
POLYSOMNOGRAPHY; SLEEP STAGING WITH 1-3 ADDITIONAL PARAMETERS OF SLEEP,
POLYSOMNOGRAPHY; SLEEP STAGING WITH 4 OR MORE ADDITIONAL PARAMETERS OF SLEEP,
POLYSOMNOGRAPHY; SLEEP STAGING WITH 4 OR MORE ADDITIONAL PARAMETERS OF SLEEP,
ELECTROENCEPHALOGRAM (EEG) EXTENDED MONITORING; 41-60 MINUTES
ELECTROENCEPHALOGRAM (EEG) EXTENDED MONITORING; GREATER THAN ONE HOUR
ELECTROENCEPHALOGRAM (EEG); INCLUDING RECORDING AWAKE AND DROWSY
ELECTROENCEPHALOGRAM (EEG); INCLUDING RECORDING AWAKE AND ASLEEP
ELECTROENCEPHALOGRAM (EEG); RECORDING IN COMA OR SLEEP ONLY
ELECTROENCEPHALOGRAM (EEG); CEREBRAL DEATH EVALUATION ONLY
ELECTROENCEPHALOGRAM (EEG); ALL NIGHT RECORDING
CHOLINESTERASE INHIBITOR CHALLENGE TEST FOR MYASTHENIA GRAVIS
NEEDLE ELECTROMYOGRAPHY, ONE EXTREMITY WITH OR WITHOUT RELATED PARASPINAL AREAS
NEEDLE ELECTROMYOGRAPHY; TWO EXTREMITIES WITH OR WITHOUT RELATED PARASPINAL
NEEDLE ELECTROMYOGRAPHY; THREE EXTREMITIES WITH OR WITHOUT RELATED PARASPINAL
NEEDLE ELECTROMYOGRAPHY; FOUR EXTREMITIES WITH OR WITHOUT RELATED PARASPINAL
NEEDLE ELECTROMYOGRAPHY; LARYNX
NEEDLE ELECTROMYOGRAPHY; HEMIDIAPHRAGM
NEEDLE ELECTROMYOGRAPHY; CRANIAL NERVE SUPPLIED MUSCLE(S), UNILATERAL
NEEDLE ELECTROMYOGRAPHY; CRANIAL NERVE SUPPLIED MUSCLES, BILATERAL
NEEDLE ELECTROMYOGRAPHY; THORACIC PARASPINAL MUSCLES (EXCLUDING T1 OR T12)
NEEDLE ELECTROMYOGRAPHY; LIMITED STUDY OF MUSCLES IN ONE EXTREMITY OR NON-LIMB
NEEDLE ELECTROMYOGRAPHY USING SINGLE FIBER ELECTRODE, WITH QUANTITATIVE
ISCHEMIC LIMB EXERCISE TEST WITH SERIAL SPECIMEN(S) ACQUISITION FOR MUSCLE(S)
Needle electromyography, each extremity, with related paraspinal areas, when per
Needle electromyography, each extremity, with related paraspinal areas, when per
Needle electromyography, non-extremity (cranial nerve supplied or axial) muscle(
NERVE CONDUCTION, AMPLITUDE AND LATENCY/VELOCITY STUDY, EACH NERVE; MOTOR,
NERVE CONDUCTION, AMPLITUDE AND LATENCY/VELOCITY STUDY, EACH NERVE; MOTOR, WITH
NERVE CONDUCTION, AMPLITUDE AND LATENCY/VELOCITY STUDY, EACH NERVE; SENSORY
Motor and/or sensory nerve conduction, using preconfigured electrode array(s), a
TESTING OF AUTONOMIC NERVOUS SYSTEM FUNCTION: CARDIOVAGAL INNERVATION (PARASYMPA
TESTING OF AUTONOMIC NERVOUS SYSTEM FUNCTION; VASOMOTOR ADRENERGIC INNERVATION
TESTING OF AUTONOMIC NERVOUS SYSTEM FUNCTION; SUDOMOTOR, INCLUDING ONE OR MORE
SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL STUDY, STIMULATION OF ANY/ALL PERIP
SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL STUDY, STIMULATION OF ANY/ALL
SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL STUDY, STIMULATION OF ANY/ALL
CENTRAL MOTOR EVOKED POTENTIAL STUDY (TRANSCRANIAL MOTOR STIMULATION); UPPER
CENTRAL MOTOR EVOKED POTENTIAL STUDY (TRANSCRANIAL MOTOR STIMULATION); LOWER
VISUAL EVOKED POTENTIAL (VEP) TESTING CENTRAL NERVOUS SYSTEM, CHECKERBOARD OR
ORBICULARIS OCULI (BLINK) REFLEX, BY ELECTRODIAGNOSTIC TESTING
H-REFLEX, AMPLITUDE AND LATENCY STUDY; RECORD GASTROCNEMIUS/SOLEUS MUSCLE
H-REFLEX, AMPLITUDE AND LATENCY STUDY; RECORD MUSCLE OTHER THAN
NEUROMUSCULAR JUNCTION TESTING (REPETITIVE STIMULATION, PAIRED STIMULI), EACH
Short-latency somatosensory evoked potential study, stimulation of any/all perip
Central motor evoked potential study (transcranial motor stimulation); in upper
MONITORING FOR IDENTIFICATION AND LATERALIZATION OF CEREBRALSEIZURE FOCUS ELECTR
MONITORING FOR LOCALIZATION OF CEREBRAL SEIZURE FOCUS BY CABLE OR RADIO, 16 OR
MONITORING FOR LOCALIZATION OF CEREBRAL SEIZURE FOCUS BY COMPUTERIZED PORTABLE 1
PHARMACOLOGICAL OR PHYSICAL ACTIVATION REQUIRING PHYSICIAN ATTENDANCE DURING
MONITORING FOR LOCALIZATION OF CEREBRAL SEIZURE FOCUS BY CABLE OR RADIO, 16 OR M
WADA ACTIVATION TEST FOR HEMISPHERIC FUNCTION, INCLUDING
FUNCTIONAL CORTICAL AND SUBCORTICAL MAPPING BY STIMULATION AND/OR RECORDING OF
FUNCTIONAL CORTICAL AND SUBCORTICAL MAPPING BY STIMULATION AND/OR RECORDING OF
MAGNETOENCEPHALOGRAPHY (MEG), RECORDING AND ANALYSIS; FOR SPONTANEOUS BRAIN
MAGNETOENCEPHALOGRAPHY (MEG), RECORDING AND ANALYSIS; FOR EVOKED MAGNETIC
MAGNETOENCEPHALOGRAPHY (MEG), RECORDING AND ANALYSIS; FOR EVOKED MAGNETIC
ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG, RAT
ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG,
ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG,
ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG,
ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG,
ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG,
ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG,
ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG,
REFILLING AND MAINTENANCE OF IMPLANTABLE PUMP OR RESERVOIR FOR DRUG DELIVERY, SP
REFILLING AND MAINTENANCE OF IMPLANTABLE PUMP OR RESERVOIR FOR DRUG DELIVERY,
UNLISTED NEUROLOGICAL OR NEUROMUSCULAR DIAGNOSTIC PROCEDURE
COMPREHENSIVE COMPUTER-BASED MOTION ANALYSIS BY VIDEO-TAPING AND 3-D KINEMATICS;
COMPREHENSIVE COMPUTER-BASED MOTION ANALYSIS BY VIDEO-TAPING AND 3-D
DYNAMIC SURFACE ELECTROMYOGRAPHY, DURING WALKING OR OTHER FUNCTIONAL
DYNAMIC FINE WIRE ELECTROMYOGRAPHY, DURING WALKING OR OTHER FUNCTIONAL
Intravenous infusion, hydration; initial 31 minutes to 1 hour
Intravenous infusion, hydration; each additional hour (List separately in additi
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance
Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); in
Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); ea
Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); ad
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug);
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug);
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug);
Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); ea
Unlisted therapeutic, prophylactic, or diagnostic intravenous or intra-arterial
CHEMOTHERAPY ADMINISTRATION, SUBCUTANEOUS OR INTRAMUSCULAR; NON-HORMONAL ANTI-NE
CHEMOTHERAPY ADMINISTRATION, SUBCUTANEOUS OR INTRAMUSCULAR; HORMONAL ANTI-NEOPLA
CHEMOTHERAPY ADMINISTRATION; INTRALESIONAL, UP TO AND INCLUDING 7 LESIONS
CHEMOTHERAPY ADMINISTRATION; INTRALESIONAL, MORE THAN 7 LESIONS
CHEMOTHERAPY ADMINISTRATION; INTRAVENOUS, PUSH TECHNIQUE, SINGLE OR INITIAL SUBS
CHEMOTHERAPY ADMINISTRATION; INTRAVENOUS, PUSH TECHNIQUE, EACH ADDITIONAL SUBSTA
CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS INFUSION TECHNIQUE; UP TO 1 HOUR, SINGL
CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS INFUSION TECHNIQUE; EACH ADDITIONAL HOU
CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS INFUSION TECHNIQUE; INITIATION OF PROLO
CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS INFUSION TECHNIQUE; EACH ADDITIONAL SEQ
CHEMOTHERAPY ADMINISTRATION, INTRA-ARTERIAL; PUSH TECHNIQUE
CHEMOTHERAPY ADMINISTRATION, INTRA-ARTERIAL; INFUSION TECHNIQUE, UP TO ONE HOUR
CHEMOTHERAPY ADMINISTRATION, INTRA-ARTERIAL; INFUSION TECHNIQUE, EACH ADDITIONAL
CHEMOTHERAPY ADMINISTRATION, INTRA-ARTERIAL; INFUSION TECHNIQUE, INITIATION OF
CHEMOTHERAPY ADMINISTRATION INTO PLEURAL CAVITY, REQUIRING AND INCLUDING
CHEMOTHERAPY ADMINISTRATION INTO THE PERITONEAL CAVITY VIA INDWELLING PORT OR CA
CHEMOTHERAPY ADMINISTRATION, INTO CNS (EG, INTRATHECAL), REQUIRING AND
REFILLING AND MAINTENANCE OF PORTABLE PUMP
REFILLING AND MAINTENANCE OF IMPLANTABLE PUMP OR RESERVOIR FOR DRUG DELIVERY, SY
CHEMOTHERAPY INJECTION, SUBARACHNOID OR INTRAVENTRICULAR VIA SUBCUTANEOUS
UNLISTED CHEMOTHERAPY PROCEDURE
PHOTODYNAMIC THERAPY BY EXTERNAL APPLICATION OF LIGHT TO DESTROY PREMALIGNANT AN
PHOTODYNAMIC THERAPY BY ENDOSCOPIC APPLICATION OF LIGHT TO ABLATE ABNORMAL TISSU
PHOTODYNAMIC THERAPY BY ENDOSCOPIC APPLICATION OF LIGHT TO ABLATE ABNORMAL TISSU
ACTINOTHERAPY (ULTRAVIOLET LIGHT)
PHOTOCHEMOTHERAPY; TAR AND ULTRAVIOLET B (GOECKERMAN TREATMENT) OR PETROLATUM
PHOTOCHEMOTHERAPY; PSORALENS AND ULTRAVIOLET A (PUVA)
PHOTOCHEMOTHERAPY (GOECKERMAN AND/OR PUVA) FOR SEVERE PHOTORESPONSIVE
LASER TREATMENT FOR INFLAMMATORY SKIN DISEASE (PSORIASIS); TOTAL AREA LESS THAN
LASER TREATMENT FOR INFLAMMATORY SKIN DISEASE (PSORIASIS); 250 SQ CM TO 500 SQ
LASER TREATMENT FOR INFLAMMATORY SKIN DISEASE (PSORIASIS); OVER 500 SQ CM
UNLISTED SPECIAL DERMATOLOGICAL SERVICE OR PROCEDURE
DEBRIDEMENT (EG, HIGH PRESSURE WATERJET WITH/WITHOUT SUCTION, SHARP SELECTIVE DE
DEBRIDEMENT (EG, HIGH PRESSURE WATERJET WITH/WITHOUT SUCTION, SHARP SELECTIVE DE
REMOVAL OF DEVITALIZED TISSUE FROM WOUND(S), NON-SELECTIVE DEBRIDEMENT, WITHOUT
NEGATIVE PRESSURE WOUND THERAPY (EG, VACUUM ASSISTED DRAINAGE COLLECTION),
NEGATIVE PRESSURE WOUND THERAPY (EG, VACUUM ASSISTED DRAINAGE COLLECTION),
OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); ONE TO TWO BODY REGIONS INVOLVED
OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); THREE TO FOUR BODY REGIONS INVOLVED
OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); FIVE TO SIX BODY REGIONS INVOLVED
OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); SEVEN TO EIGHT BODY REGIONS INVOLVED
OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); NINE TO TEN BODY REGIONS INVOLVED
CHIROPRATIC MANIPULATIVE TREATMENT (CMT) SPINAL, ONE TO TWO REGIONS
CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, THREE TO FOUR REGIONS
CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, FIVE REGIONS
ANOGENITAL EXAMINATION WITH COLPOSCOPIC MAGNIFICATION IN CHILDHOOD FOR SUSP TRAU
EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH
EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT,
EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT,
EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT,
EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT,
Delivery/birthing room resuscitation, provision of positive pressure ventilation
HYPERBARIC OXYGEN UNDER PRESSURE, FULL BODY CHAMBER, PER 30 MINUTE INTERVAL
TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WI
TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WI
TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WI
TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WI
TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE) WITH CONTRAST, OR WITHOUT CONTRAST FOLLOW
TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE) WITH CONTRAST, OR WITHOUT CONTRAST FOLLOW
TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE) WITH CONTRAST, OR WITHOUT CONTRAST FOLLOW
TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WI
TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WI
TRANSTHORACIC ECHOCARDIOGRAPHY, WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY W
IV INFUSION FOR THERAPY/DIAG;INITIATION OF PROLONGED INFUSION >8 HRS./PUMP
ENDOSCOPIC FULL-THICKNESS PLICATION IN THE GASTRIC CARDIA USING ENDOSCOPIC PLICA
PLACEMENT OF ENDORECTAL INTRACAVITARY APPLICATOR FOR HIGH INTENSITY BRACHYTHERAP
RXT BREAST APP. PLACE/REMOVE
ADMINISTRATION OF INFLUENZA VIRUS VACCINE
ADMINISTRATION OF PNEUMOCOCCAL VACCINE
ADMINISTRATION OF HEPATITIS B VACCINE
COLORECTAL CANCER SCREENING; FLEXIBLE SIGMOIDOSCOPY
COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK
COLORECTAL CANCER SCREENING; ALTERNATIVE TO G0104, SCREENING SIGMOIDOSCOPY,
GLAUCOMA SCREENING FOR HIGH RISK PATIENTS FURNISHED BY AN OPTOMETRIST OR
GLAUCOMA SCREENING FOR HIGH RISK PATIENT FURNISHED UNDER THE DIRECT SUPERVISION
COLORECTAL CANCER SCREENING; ALTERNATIVE TO G0105, SCREENING COLONOSCOPY,
COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR
TRIMMING OF DYSTROPHIC NAILS, ANY NUMBER
EXTERNAL COUNTERPULSATION, PER TREATMENT SESSION
LINEAR ACCELERATOR BASED STEREOTACTIC RADIOSURGERY, COMPLETE COURSE OF THERAPY
DESTRUCTION OF LOCALIZED LESION OF CHOROID (FOR EXAMPLE, CHOROIDAL
ROUTINE FOOT CARE BY A PHYSICIAN OF A DIABETIC PATIENT WITH DIABETIC SENSORY
LINEAR ACCELERATOR BASED STEREOTACTIC RADIOSURGERY, DELIVERY INCLUDING
UNSCHEDULED OR EMERGENCY DIALYSIS TREATMENT FOR AN ESRD PATIENT IN A HOSPITAL
INJECTION PROCEDURE FOR SACROILIAC JOINT; PROVISION OF ANESTHETIC, STEROID
TRANSCATHETER PLACEMENT OF A DRUG ELUTING INTRACORONARY STENT(S), PERCUTANEOUS,
TRANSCATHETER PLACEMENT OF A DRUG ELUTING INTRACORONARY STENT(S), PERCUTANEOUS,
PRE-OPERATIVE PULMONARY SURGERY SERVICES FOR PREPARATION FOR LVRS, COMPLETE
PRE-OPERATIVE PULMONARY SURGERY SERVICES FOR PREPARATION FOR LVRS, 10 TO 15
PRE-OPERATIVE PULMONARY SURGERY SERVICES FOR PREPARATION FOR LVRS, 1 TO 9 DAYS
POST-DISCHARGE PULMONARY SURGERY SERVICES AFTER LVRS, MINIMUM OF 6 DAYS OF
IMAGE-GUIDED ROBOTIC LINEAR ACCELERATOR-BASED STEREOTACTIC RADIOSURGERY,
IMAGE-GUIDED ROBOTIC LINEAR ACCELERATOR-BASED STEROTACTIC RADIOSURGERY,
VESSEL MAPPING OF VESSELS FOR HEMODIALYSIS ACCESS (SERVICES FOR PREOPERATIVE
ADMINISTRATION AND SUPPLY OF TOSITUMOMAB, 450 MG
SCREENING PAPANICOLAOU SMEAR; OBTAINING, PREPARING AND CONVEYANCE OF CERVICAL
    RATE      Eff Date
  $452.68   10/01/2012
$1,491.32   10/01/2012
$1,491.32   10/01/2012
$2,876.42   10/01/2012
$2,876.42   10/01/2012
  $516.53   10/01/2012
  $516.53   10/01/2012
  $180.51   10/01/2012
$7,269.10   10/01/2012
$7,269.10   10/01/2012
$7,269.10   10/01/2012
$7,269.10   10/01/2012
$1,808.49   10/01/2012
$1,808.49   10/01/2012
$1,808.49   10/01/2012
$1,808.49   10/01/2012
$1,068.80   10/01/2012
  $723.68   10/01/2012
  $723.68   10/01/2012
$2,876.42   10/01/2012
  $111.36   10/01/2012
  $316.14   10/01/2012
   $98.17   10/01/2012
   $98.17   10/01/2012
   $98.17   10/01/2012
  $907.01   10/01/2012
  $190.68   10/01/2012
$1,175.31   10/01/2012
  $907.01   10/01/2012
   $98.17   10/01/2012
$1,421.15   10/01/2012
  $190.68   10/01/2012
   $60.71   10/01/2012
  $305.71   10/01/2012
  $305.71   10/01/2012
  $305.71   10/01/2012
  $190.68   10/01/2012
  $190.68   10/01/2012
  $571.82   10/01/2012
  $190.68   10/01/2012
  $190.68   10/01/2012
  $571.82   10/01/2012
   $60.71   10/01/2012
   $60.71   10/01/2012
  $103.59   10/01/2012
  $103.59   10/01/2012
   $60.71   10/01/2012
   $60.71   10/01/2012
   $60.71   10/01/2012
   $60.71   10/01/2012
   $60.71   10/01/2012
   $60.71   10/01/2012
  $103.59   10/01/2012
   $60.71   10/01/2012
   $60.71   10/01/2012
   $60.71   10/01/2012
  $103.59   10/01/2012
   $60.71   10/01/2012
   $60.71   10/01/2012
  $103.59   10/01/2012
  $103.59   10/01/2012
  $305.71   10/01/2012
  $305.71   10/01/2012
  $305.71   10/01/2012
  $571.82   10/01/2012
$1,175.31   10/01/2012
$1,175.31   10/01/2012
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   $83.10   10/01/2012
   $83.10   10/01/2012
   $83.10   10/01/2012
   $83.10   10/01/2012
   $83.10   10/01/2012
   $43.63   10/01/2012
   $43.63   10/01/2012
   $83.10   10/01/2012
   $83.10   10/01/2012
   $83.10   10/01/2012
   $83.10   10/01/2012
   $43.63   10/01/2012
   $43.63   10/01/2012
   $43.63   10/01/2012
   $43.63   10/01/2012
   $43.63   10/01/2012
   $83.10   10/01/2012
   $83.10   10/01/2012
   $83.10   10/01/2012
  $182.86   10/01/2012
  $182.86   10/01/2012
  $182.86   10/01/2012
   $83.10   10/01/2012
   $83.10   10/01/2012
  $182.86   10/01/2012
   $43.63   10/01/2012
   $43.63   10/01/2012
   $43.63   10/01/2012
   $83.10   10/01/2012
  $182.86   10/01/2012
   $83.10   10/01/2012
  $784.93   10/01/2012
  $784.93   10/01/2012
  $784.93   10/01/2012
   $83.10   10/01/2012
  $784.93   10/01/2012
  $168.01   10/01/2012
  $182.86   10/01/2012
  $182.86   10/01/2012
$2,487.10   10/01/2012
$890.63   10/01/2012
$890.63   10/01/2012
 $83.10   10/01/2012
$110.71   10/01/2012
$110.71   10/01/2012
 $83.10   10/01/2012
$110.71   10/01/2012
 $83.10   10/01/2012
$110.71   10/01/2012
$110.71   10/01/2012
$125.11   10/01/2012
$125.11   10/01/2012
 $43.63   10/01/2012
$182.86   10/01/2012
$182.86   10/01/2012
 $83.10   10/01/2012
 $83.10   10/01/2012
 $71.81   10/01/2012
 $24.51   10/01/2012
$125.11   10/01/2012
 $34.40   10/01/2012
 $34.40   10/01/2012
$125.11   10/01/2012
 $34.40   10/01/2012
 $34.40   10/01/2012
 $34.40   10/01/2012
 $34.40   10/01/2012
 $34.40   10/01/2012
 $34.40   10/01/2012
 $24.51   10/01/2012
 $34.40   10/01/2012
 $34.40   10/01/2012
 $34.40   10/01/2012
$125.11   10/01/2012
$125.11   10/01/2012
 $71.81   10/01/2012
$205.25   10/01/2012
 $34.40   10/01/2012
$205.25   10/01/2012
 $71.81   10/01/2012
 $71.81   10/01/2012
$205.25   10/01/2012
 $71.81   10/01/2012
$205.25   10/01/2012
$125.11   10/01/2012
$125.11   10/01/2012
$205.25   10/01/2012
$125.11   10/01/2012
$125.11   10/01/2012
 $71.81   10/01/2012
 $24.51   10/01/2012
$103.59   10/01/2012
  $103.59   10/01/2012
  $103.59   10/01/2012
   $34.84   10/01/2012
   $34.84   10/01/2012
   $34.84   10/01/2012
  $209.82   10/01/2012
  $103.59   10/01/2012
  $103.59   10/01/2012
  $103.59   10/01/2012
   $26.80   10/01/2012
  $103.59   10/01/2012
  $103.59   10/01/2012
   $60.71   10/01/2012
   $60.71   10/01/2012
  $103.59   10/01/2012
   $24.78   10/01/2012
   $24.78   10/01/2012
   $24.78   10/01/2012
   $24.78   10/01/2012
   $24.78   10/01/2012
   $24.78   10/01/2012
   $24.78   10/01/2012
   $24.78   10/01/2012
    $9.05   10/01/2012
   $49.63   10/01/2012
   $85.41   10/01/2012
  $134.40   10/01/2012
  $216.15   10/01/2012
  $319.37   10/01/2012
  $154.20   10/01/2012
  $103.47   10/01/2012
  $549.94   10/01/2012
  $549.94   10/01/2012
  $549.94   10/01/2012
  $549.94   10/01/2012
  $549.94   10/01/2012
  $549.94   10/01/2012
  $549.94   10/01/2012
  $549.94   10/01/2012
  $549.94   10/01/2012
  $549.94   10/01/2012
  $205.25   10/01/2012
$1,793.89   10/01/2012
  $384.30   10/01/2012
$1,762.57   10/01/2012
   $24.51   10/01/2012
   $24.51   10/01/2012
   $34.40   10/01/2012
  $373.71   10/01/2012
  $574.27   10/01/2012
  $190.08   10/01/2012
   $73.17   10/01/2012
   $44.39   10/01/2012
  $190.08   10/01/2012
  $574.27   10/01/2012
   $26.80   10/01/2012
   $92.42   10/01/2012
$3,329.15   10/01/2012
  $332.59   10/01/2012
   $60.71   10/01/2012
  $890.63   10/01/2012
  $462.11   10/01/2012
  $516.53   10/01/2012
$7,312.83   10/01/2012
$7,312.83   10/01/2012
  $784.93   10/01/2012
  $784.93   10/01/2012
  $168.01   10/01/2012
  $168.01   10/01/2012
$3,329.15   10/01/2012
$2,487.10   10/01/2012
  $150.28   10/01/2012
$1,680.26   10/01/2012
    $9.05   10/01/2012
PROC
00176
00192
00211
00214
00215
00452
00474
0048T
0050T
00524
00540
00542
00546
00560
00561
00562
00567
00580
0058T
0059T
00604
00622
00632
00670
00792
00794
00796
00802
00844
00846
00848
00864
00865
00866
00868
00882
00904
00908
0092T
00932
00934
00936
00944
0095T
0098T
01140
01150
01212
01214
01232
01234
01272
01274
01402
01404
01442
01444
01486
01502
01634
01636
01638
0163T
0164T
01652
01654
01656
0165T
0169T
01756
0184T
0214T
0215T
0217T
0235T
0254T
0255T
0258T
0259T
0262T
11004
11005
11006
11008
11980
11981
11982
11983
15756
15757
15758
15852
15860
16036
19271
19272
19295
19305
19306
19361
19364
19367
19368
19369
20661
20664
20665
20802
20805
20808
20816
20824
20827
20838
20936
20937
20938
20955
20956
20957
20962
20969
20970
20974
20979
21045
21141
21142
21143
21145
21146
21147
21151
21154
21155
21159
21160
21179
21180
21182
21183
21184
21188
21194
21196
21247
21255
21268
21343
21344
21346
21347
21348
21366
21422
21423
21431
21432
21433
21435
21436
21510
21615
21616
21620
21627
21630
21632
21705
21740
21750
21810
21825
22010
22015
22110
22112
22114
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
22633
22634
22800
22802
22804
22808
22810
22812
22818
22819
22830
22840
22841
22842
22843
22844
22845
22846
22847
22848
22849
22850
22852
22855
22856
22857
22861
22862
22864
22865
23200
23210
23220
23332
23472
23900
23920
24900
24920
24930
24931
24940
25900
25905
25915
25920
25924
25927
26350
26551
26553
26554
26556
26992
27005
27025
27030
27036
27054
27070
27071
27075
27076
27077
27078
27090
27091
27096
27120
27122
27125
27130
27132
27134
27137
27138
27140
27146
27147
27151
27156
27158
27161
27165
27170
27175
27176
27177
27178
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
27286
27290
27295
27303
27365
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
27702
27703
27712
27715
27724
27725
27727
27880
27881
27882
27886
27888
28800
30300
31225
31230
31290
31291
31360
31365
31367
31368
31370
31375
31380
31382
31390
31395
31584
31587
31725
31760
31766
31770
31775
31780
31781
31786
31800
31805
32035
32036
32096
32097
32098
32100
32110
32120
32124
32140
32141
32150
32151
32160
32200
32215
32220
32225
32310
32320
32440
32442
32445
32480
32482
32484
32486
32488
32491
32501
32503
32504
32505
32506
32507
32540
32553
32650
32651
32652
32653
32654
32655
32656
32658
32659
32661
32662
32663
32664
32665
32666
32667
32668
32669
32670
32671
32672
32673
32674
32800
32810
32815
32820
32850
32851
32852
32853
32854
32855
32856
32900
32905
32906
32940
32997
33015
33020
33025
33030
33031
33050
33120
33130
33140
33141
33202
33203
33236
33237
33238
33243
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
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
33510
33511
33512
33513
33514
33516
33517
33518
33519
33521
33522
33523
33530
33533
33534
33535
33536
33542
33545
33548
33572
33600
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
33778
33779
33780
33781
33782
33783
33786
33788
33800
33802
33803
33813
33814
33820
33822
33824
33840
33845
33851
33852
33853
33860
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
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
35091
35092
35102
35103
35111
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
35501
35506
35508
35509
35510
35511
35512
35515
35516
35518
35521
35522
35523
35525
35526
35531
35533
35535
35536
35537
35538
35539
35540
35556
35558
35560
35563
35565
35566
35570
35571
35583
35585
35587
35600
35601
35606
35612
35616
35621
35623
35626
35631
35632
35633
35634
35636
35637
35638
35642
35645
35646
35647
35650
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
36251
36252
36253
36254
36415
36420
36425
36591
36592
36600
36660
36822
36823
37140
37145
37160
37180
37181
37182
37215
37216
37616
37617
37618
37660
37788
37799
38100
38101
38102
38115
38205
38380
38381
38382
38562
38564
38724
38746
38747
38765
38770
38780
38792
39000
39010
39200
39220
39499
39501
39503
39540
39541
39545
39560
39561
39599
40804
41130
41135
41140
41145
41150
41153
41155
42426
42809
42845
42894
42953
42961
42971
43045
43100
43101
43107
43108
43112
43113
43116
43117
43118
43121
43122
43123
43124
43135
43279
43281
43282
43283
43300
43305
43310
43312
43313
43314
43320
43325
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
43605
43610
43611
43620
43621
43622
43631
43632
43633
43634
43635
43640
43641
43644
43645
43752
43753
43754
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43757
43770
43771
43772
43773
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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
44050
44055
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
44605
44615
44620
44625
44626
44640
44650
44660
44661
44680
44700
44715
44720
44721
44800
44820
44850
44899
44900
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
46600
46705
46710
46712
46715
46716
46730
46735
46740
46742
46744
46746
46748
46751
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
47550
47570
47600
47605
47610
47612
47620
47700
47701
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
49204
49205
49215
49220
49255
49411
49412
49425
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
50365
50370
50380
50400
50405
50500
50520
50525
50526
50540
50545
50546
50547
50548
50600
50605
50610
50620
50630
50650
50660
50700
50715
50722
50725
50728
50740
50750
50760
50770
50780
50782
50783
50785
50800
50810
50815
50820
50825
50830
50840
50845
50860
50900
50920
50930
50940
51525
51530
51550
51555
51565
51570
51575
51580
51585
51590
51595
51596
51597
51701
51702
51736
51798
51800
51820
51840
51841
51865
51900
51920
51925
51940
51960
51980
53415
53448
54125
54130
54135
54390
54411
54417
54430
54650
55605
55650
55801
55810
55812
55815
55821
55831
55840
55842
55845
55862
55865
55866
55875
55876
56630
56631
56632
56633
56634
56637
56640
57110
57111
57112
57270
57280
57296
57305
57307
57308
57311
57531
57540
57545
58140
58146
58150
58152
58180
58200
58210
58240
58267
58275
58280
58285
58293
58300
58400
58410
58520
58540
58548
58605
58611
58700
58720
58740
58822
58825
58940
58943
58950
58951
58952
58953
58954
58956
58957
58958
58960
59050
59051
59120
59121
59130
59135
59136
59140
59325
59350
59400
59410
59425
59426
59430
59510
59514
59515
59525
59610
59614
59618
59620
59622
59830
59850
59851
59852
59855
59856
59857
60254
60270
60505
60521
60522
60540
60545
60600
60605
60650
61105
61107
61108
61120
61140
61150
61151
61154
61156
61210
61250
61253
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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
L8507
L8509
L8510
L8511
L8512
L8513
L8514
L8515
L8615
L8616
L8617
L8618
L8619
L8621
L8622
L8623
L8624
L8627
L8628
L8629
L8681
L8683
L8684
L8689
L8691
L8692
L8693
L8695
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
Q0035
Q0036
Q0081
Q0083
Q0084
Q0085
Q0111
Q0112
Q0113
Q0114
Q0115
Q0116
Q0138
Q0139
Q0144
Q0174
Q0181
Q0184
Q0478
Q0479
Q0480
Q0481
Q0482
Q0483
Q0484
Q0485
Q0486
Q0487
Q0488
Q0489
Q0490
Q0491
Q0492
Q0493
Q0494
Q0495
Q0496
Q0497
Q0498
Q0499
Q0500
Q0501
Q0502
Q0503
Q0504
Q0505
Q0506
Q0515
Q1004
Q1005
Q2017
Q2034
Q2043
Q2046
Q2047
Q2049
Q3001
Q3025
Q3026
Q4001
Q4002
Q4003
Q4004
Q4005
Q4006
Q4007
Q4008
Q4009
Q4010
Q4011
Q4012
Q4013
Q4014
Q4015
Q4016
Q4017
Q4018
Q4019
Q4020
Q4021
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
Q4101
Q4102
Q4103
Q4104
Q4105
Q4106
Q4107
Q4108
Q4110
Q4111
Q4112
Q4113
Q4114
Q9968
R0070
R0075
R0076
S0020
S0023
S0028
S0077
S0119
S0190
S0191
S0199
S0209
S0215
S0270
S0271
S0272
S0315
S0316
S1040
S3620
S3800
S4989
S5035
S5036
S5100
S5101
S5102
S5110
S5125
S5130
S5131
S5135
S5136
S5140
S5150
S5151
S5160
S5161
S5165
S5170
S5180
S5181
S5497
S5498
S5501
S5502
S5517
S5518
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
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
T1002
T1003
T1016
T1019
T1020
T1021
T1503
T2003
T2005
T2007
T2016
T2017
T2018
T2019
T2020
T2021
T2026
T2031
T2033
T2040
T2049
T4521
T4522
T4523
T4524
T4529
T4530
T4533
T4539
T4543
V2020
V2100
V2101
V2102
V2103
V2104
V2105
V2106
V2107
V2108
V2109
V2110
V2111
V2112
V2113
V2114
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
V2511
V2512
V2513
V2520
V2521
V2522
V2523
V2530
V2531
V2599
V2600
V2610
V2615
V2623
V2624
V2625
V2626
V2627
V2628
V2629
V2700
V2710
V2715
V2718
V2730
V2744
V2750
V2755
V2760
V2770
V2780
V2781
V2782
V2783
V2784
V2785
V2787
V2799
V5008
V5010
V5011
V5014
V5020
V5030
V5040
V5050
V5060
V5070
V5080
V5090
V5095
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
DESCRIPTION
ANESTHESIA FOR INTRAORAL PROCEDURES, INCLUDING BIOPSY; RADICAL SURGERY
ANESTHESIA FOR PROCEDURES ON FACIAL BONES OR SKULL; RADICAL SURGERY (INCLUDING
Anesthesia for intracranial procedures; craniotomy or craniectomy for evacuation
ANESTHESIA FOR INTRACRANIAL PROCEDURES; BURR HOLES, INCLUDING VENTRICULOGRAPHY
ANESTHESIA FOR INTRACRANIAL PROCEDURES; CRANIOPLASTY OR ELEVATION OF DEPRESSED
ANESTHESIA FOR PROCEDURES ON CLAVICLE AND SCAPULA; RADICAL SURGERY
ANESTHESIA FOR PARTIAL RIB RESECTION; RADICAL PROCEDURES (EG, PECTUS EXCAVATUM)
IMPLANTATION OF A VENTRICULAR ASSIST DEVICE, EXTRACORPOREAL, PERCUTANEOUS
REMOVAL OF A VENTRICULAR ASSIST DEVICE, EXTRACORPOREAL, PERCUTANEOUS
ANESTHESIA FOR CLOSED CHEST PROCEDURES; PNEUMOCENTESIS
ANESTHESIA FOR THORACOTOMY PROCEDURES INVOLVING LUNGS, PLEURA, DIAPHRAGM, AND
ANESTHESIA FOR THORACOTOMY PROCEDURES INVOLVING LUNGS, PLEURA, DIAPHRAGM, AND
ANESTHESIA FOR THORACOTOMY PROCEDURES INVOLVING LUNGS, PLEURA, DIAPHRAGM, AND
ANESTHESIA FOR PROCEDURES ON HEART, PERICARDIAL SAC, AND GREAT VESSELS OF
ANESTHESIA FOR PROCEDURES ON HEART, PERICARDIAL SAC, AND GREAT VESSELS OF
ANESTHESIA FOR PROCEDURES ON HEART, PERICARDIAL SAC, AND GREAT VESSELS OF CHEST;
Anesthesia for direct coronary artery bypass grafting; with pump oxygenator
ANESTHESIA FOR HEART TRANSPLANT OR HEART/LUNG TRANSPLANT
CRYOPRESERVATION; REPRODUCTIVE TISSUE, OVARIAN
CRYOPRESERVATION; OOCYTE(S)
ANESTHESIA FOR PROCEDURES ON CERVICAL SPINE AND CORD; PROCEDURES WITH PATIENT
ANESTHESIA FOR PROCEDURES ON THORACIC SPINE AND CORD; THORACOLUMBAR
ANESTHESIA FOR PROCEDURES IN LUMBAR REGION; LUMBAR SYMPATHECTOMY
ANESTHESIA FOR EXTENSIVE SPINE AND SPINAL CORD PROCEDURES (EG, SPINAL
ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN UPPER ABDOMEN INCLUDING
ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN UPPER ABDOMEN INCLUDING
ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN UPPER ABDOMEN INCLUDING
ANESTHESIA FOR PROCEDURES ON LOWER ANTERIOR ABDOMINAL WALL; PANNICULECTOMY
ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN INCLUDING
ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN INCLUDING
ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN INCLUDING
ANESTHESIA FOR EXTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN, INCLUDING URINARY
ANESTHESIA FOR EXTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN, INCLUDING URINARY
ANESTHESIA FOR EXTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN, INCLUDING URINARY
ANESTHESIA FOR EXTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN, INCLUDING URINARY
ANESTHESIA FOR PROCEDURES ON MAJOR LOWER ABDOMINAL VESSELS; INFERIOR VENA CAVA
ANESTHESIA FOR; RADICAL PERINEAL PROCEDURE
ANESTHESIA FOR; PERINEAL PROSTATECTOMY
TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH, INCLUDING DISCECTO
ANESTHESIA FOR PROCEDURES ON MALE GENITALIA (INCLUDING OPEN URETHRAL
ANESTHESIA FOR PROCEDURES ON MALE GENITALIA (INCLUDING OPEN URETHRAL
ANESTHESIA FOR PROCEDURES ON MALE GENITALIA (INCLUDING OPEN URETHRAL
ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY OF LABIA, VAGINA, CERVIX OR
REMOVAL OF TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH, EACH AD
REVISION INCLUDING REPLACEMENT OF TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANT
ANESTHESIA FOR INTERPELVIABDOMINAL (HINDQUARTER) AMPUTATION
ANESTHESIA FOR RADICAL PROCEDURES FOR TUMOR OF PELVIS, EXCEPT HINDQUARTER
ANESTHESIA FOR OPEN PROCEDURES INVOLVING HIP JOINT; HIP DISARTICULATION
ANESTHESIA FOR OPEN PROCEDURES INVOLVING HIP JOINT; TOTAL HIP ARTHROPLASTY
ANESTHESIA FOR OPEN PROCEDURES INVOLVING UPPER 2/3 OF FEMUR; AMPUTATION
ANESTHESIA FOR OPEN PROCEDURES INVOLVING UPPER 2/3 OF FEMUR; RADICAL RESECTION
ANESTHESIA FOR PROCEDURES INVOLVING ARTERIES OF UPPER LEG, INCLUDING BYPASS
ANESTHESIA FOR PROCEDURES INVOLVING ARTERIES OF UPPER LEG, INCLUDING BYPASS
ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC PROCEDURES ON KNEE JOINT; TOTAL
ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC PROCEDURES ON KNEE JOINT;
ANESTHESIA FOR PROCEDURES ON ARTERIES OF KNEE AND POPLITEAL AREA; POPLITEAL
ANESTHESIA FOR PROCEDURES ON ARTERIES OF KNEE AND POPLITEAL AREA; POPLITEAL
ANESTHESIA FOR OPEN PROCEDURES ON BONES OF LOWER LEG, ANKLE, AND FOOT; TOTAL
ANESTHESIA FOR PROCEDURES ON ARTERIES OF LOWER LEG, INCLUDING BYPASS GRAFT;
ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC PROCEDURES ON HUMERAL HEAD AND
ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC PROCEDURES ON HUMERAL HEAD AND
ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC PROCEDURES ON HUMERAL HEAD AND
TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH, INCLUDING DISCECTO
REMOVAL OF TOTAL DISC ARTHROPLASTY, (ARTIFICIAL DISC), ANTERIOR APPROACH, EACH A
ANESTHESIA FOR PROCEDURES ON ARTERIES OF SHOULDER AND AXILLA; AXILLARY-BRACHIAL
ANESTHESIA FOR PROCEDURES ON ARTERIES OF SHOULDER AND AXILLA; BYPASS GRAFT
ANESTHESIA FOR PROCEDURES ON ARTERIES OF SHOULDER AND AXILLA; AXILLARY-FEMORAL
REVISION INCLUDING REPLACEMENT OF TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANT
STEREOTACTIC PLACEMENT OF INFUSION CATHETER(S) IN THE BRAIN FOR DELIVERY OF THER
ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC PROCEDURES OF THE ELBOW; RADICAL
EXCISION OF RECTAL TUMOR, TRANSANAL ENDOSCOPIC MICROSURGICAL APPROACH (IE, TEMS)
INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEA
INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEA
INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEA
TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN OR PERCUTANEOUS, INCLUDING RADIOLOGICA
ENDOVASCULAR REPAIR OF ILIAC ARTERY BIFURCATION (EG, ANEURYSM, PSEUDOANEURYSM, A
ENDOVASCULAR REPAIR OF ILIAC ARTERY BIFURCATION (EG, ANEURYSM, PSEUDOANEURYSM, A
TRANSTHORACIC CARDIAC EXPOSURE (EG, STERNOTOMY, THORACOTOMY, SUBXIPHOID) FOR CAT
TRANSTHORACIC CARDIAC EXPOSURE (EG, STERNOTOMY, THORACOTOMY, SUBXIPHOID) FOR CAT
Implantation of catheter-delivered prosthetic pulmonary valve, endovascular appr
DEBRIDEMENT OF SKIN, SUBCUTANEOUS TISSUE, MUSCLE AND FASCIA FOR NECROTIZING
DEBRIDEMENT OF SKIN, SUBCUTANEOUS TISSUE, MUSCLE AND FASCIA FOR NECROTIZING
DEBRIDEMENT OF SKIN, SUBCUTANEOUS TISSUE, MUSCLE AND FASCIA FOR NECROTIZING
REMOVAL OF PROSTHETIC MATERIAL OR MESH, ABDOMINAL WALL FOR INFECTION (EG, FOR CH
SUBCUTANEOUS HORMONE PELLET IMPLANTATION (IMPLANTATION OF ESTRADIOL AND/OR
INSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
REMOVAL, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
REMOVAL WITH REINSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
FREE MUSCLE OR MYOCUTANEOUS FLAP WITH MICROVASCULAR ANASTOMOSIS
FREE SKIN FLAP WITH MICROVASCULAR ANASTOMOSIS
FREE FASCIAL FLAP WITH MICROVASCULAR ANASTOMOSIS
DRESSING CHANGE (FOR OTHER THAN BURNS) UNDER ANESTHESIA (OTHER THAN LOCAL)
INTRAVENOUS INJECTION OF AGENT (EG, FLUORESCEIN) TO TEST VASCULAR FLOW IN FLAP
ESCHAROTOMY; EACH ADDITIONAL INCISION (LIST SEPARATELY IN ADDITION TO CODE FOR
EXCISION OF CHEST WALL TUMOR INVOLVING RIBS, WITH PLASTIC RECONSTRUCTION;
EXCISION OF CHEST WALL TUMOR INVOLVING RIBS, WITH PLASTIC RECONSTRUCTION; WITH
IMAGE GUIDED PLACEMENT, METALLIC LOCALIZATION CLIP, PERCUTANEOUS, DURING BREAST
MASTECTOMY, RADICAL, INCLUDING PECTORAL MUSCLES, AXILLARY LYMPH NODES
MASTECTOMY, RADICAL, INCLUDING PECTORAL MUSCLES, AXILLARY AND INTERNAL MAMMARY L
BREAST RECONSTRUCTION WITH LATISSIMUS DORSI FLAP, WITHOUT PROSTHETIC IMPLANT
BREAST RECONSTRUCTION WITH FREE FLAP
BREAST RECONSTRUCTION WITH TRANSVERSE RECTUS ABDOMINIS MYOCUTANEOUS FLAP
BREAST RECONSTRUCTION WITH TRANSVERSE RECTUS ABDOMINIS MYOCUTANEOUS FLAP
BREAST RECONSTRUCTION WITH TRANSVERSE RECTUS ABDOMINIS MYOCUTANEOUS FLAP
APPLICATION OF HALO, INCLUDING REMOVAL; CRANIAL
APPLICATION OF HALO, INCLUDING REMOVAL, CRANIAL, 6 OR MORE PINS PLACED, FOR THIN
REMOVAL OF TONGS OR HALO APPLIED BY ANOTHER PHYSICIAN
REPLANTATION, ARM (INCLUDES SURGICAL NECK OF HUMERUS THROUGH ELBOW JOINT); COMPL
REPLANTATION, FOREARM (INCLUDES RADIUS AND ULNA TO RADIAL CARPAL JOINT),
REPLANTATION, HAND (INCLUDES HAND THROUGH METACARPOPHALANGEAL JOINTS), COMPLETE
REPLANTATION, DIGIT, EXCLUDING THUMB (INCLUDES METACARPOPHALANGEAL JOINT TO
REPLANTATION, THUMB (INCLUDES CARPOMETACARPAL JOINT TO MP JOINT), COMPLETE
REPLANTATION, THUMB (INCLUDES DISTAL TIP TO MP JOINT), COMPLETE AMPUTATION
REPLANTATION, FOOT, COMPLETE AMPUTATION
AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE GRAFT); LOCAL (EG, RIB
AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE GRAFT); MORSELIZED (TH
AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE GRAFT); STRUCTURAL, BI
BONE GRAFT WITH MICROVASCULAR ANASTOMOSIS; FIBULA
BONE GRAFT WITH MICROVASCULAR ANASTOMOSIS; ILIAC CREST
BONE GRAFT WITH MICROVASCULAR ANASTOMOSIS; METATARSAL
BONE GRAFT WITH MICROVASCULAR ANASTOMOSIS; OTHER THAN FIBULA, ILIAC CREST, OR
FREE OSTEOCUTANEOUS FLAP WITH MICROVASCULAR ANASTOMOSIS; OTHER THAN ILIAC
FREE OSTEOCUTANEOUS FLAP WITH MICROVASCULAR ANASTOMOSIS; ILIAC CREST
ELECTRICAL STIMULATION TO AID BONE HEALING; NONINVASIVE (NONOPERATIVE)
LOW INTENSITY ULTRASOUND STIMULATION TO AID BONE HEALING, NONINVASIVE
EXCISION OF MALIGNANT TUMOR OF MANDIBLE; RADICAL RESECTION
RECONSTRUCTION MIDFACE, LEFORT I; SINGLE PIECE, SEGMENT MOVEMENT IN ANY
RECONSTRUCTION MIDFACE, LEFORT I; TWO PIECES, SEGMENT MOVEMENT IN ANY
RECONSTRUCTION MIDFACE, LEFORT I; THREE OR MORE PIECES, SEGMENT MOVEMENT IN ANY
RECONSTRUCTION MIDFACE, LEFORT I; SINGLE PIECE, SEGMENT MOVEMENT IN ANY
RECONSTRUCTION MIDFACE, LEFORT I; TWO PIECES, SEGMENT MOVEMENT IN ANY
RECONSTRUCTION MIDFACE, LEFORT I; THREE OR MORE PIECES, SEGMENT MOVEMENT IN ANY
RECONSTRUCTION MIDFACE, LEFORT II; ANY DIRECTION, REQUIRING BONE GRAFTS
RECONSTRUCTION MIDFACE, LEFORT III (EXTRACRANIAL), ANY TYPE, REQUIRING BONE
RECONSTRUCTION MIDFACE, LEFORT III (EXTRACRANIAL), ANY TYPE, REQUIRING BONE
RECONSTRUCTION MIDFACE, LEFORT III (EXTRA AND INTRACRANIAL) WITH FOREHEAD
RECONSTRUCTION MIDFACE, LEFORT III (EXTRA AND INTRACRANIAL) WITH FOREHEAD
RECONSTRUCTION, ENTIRE OR MAJORITY OF FOREHEAD AND/OR SUPRAORBITAL RIMS; WITH
RECONSTRUCTION, ENTIRE OR MAJORITY OF FOREHEAD AND/OR SUPRAORBITAL RIMS; WITH
RECONSTRUCTION OF ORBITAL WALLS, RIMS, FOREHEAD, NASOETHMOID COMPLEX FOLLOWING
RECONSTRUCTION OF ORBITAL WALLS, RIMS, FOREHEAD, NASOETHMOID COMPLEX FOLLOWING
RECONSTRUCTION OF ORBITAL WALLS, RIMS, FOREHEAD, NASOETHMOID COMPLEX FOLLOWING
RECONSTRUCTION MIDFACE, OSTEOTOMIES (OTHER THAN LEFORT TYPE) AND BONE GRAFTS
RECONSTRUCTION OF MANDIBULAR RAMI, HORIZONTAL, VERTICAL, C, OR L OSTEOTOMY;
RECONSTRUCTION OF MANDIBULAR RAMI AND/OR BODY, SAGITTAL SPLIT; WITH INTERNAL
RECONSTRUCTION OF MANDIBULAR CONDYLE WITH BONE AND CARTILAGE AUTOGRAFTS
RECONSTRUCTION OF ZYGOMATIC ARCH AND GLENOID FOSSA WITH BONE AND CARTILAGE
ORBITAL REPOSITIONING, PERIORBITAL OSTEOTOMIES, UNILATERAL, WITH BONE GRAFTS;
OPEN TREATMENT OF DEPRESSED FRONTAL SINUS FRACTURE
OPEN TREATMENT OF COMPLICATED (EG, COMMINUTED OR INVOLVING POSTERIOR WALL)
OPEN TREATMENT OF NASOMAXILLARY COMPLEX FRACTURE (LEFORT II TYPE); WITH WIRING
OPEN TREATMENT OF NASOMAXILLARY COMPLEX FRACTURE (LEFORT II TYPE); REQUIRING
OPEN TREATMENT OF NASOMAXILLARY COMPLEX FRACTURE (LEFORT II TYPE); WITH BONE
OPEN TREATMENT OF COMPLICATED (EG, COMMINUTED OR INVOLVING CRANIAL NERVE
OPEN TREATMENT OF PALATAL OR MAXILLARY FRACTURE (LEFORT I TYPE);
OPEN TREATMENT OF PALATAL OR MAXILLARY FRACTURE (LEFORT I TYPE); COMPLICATED
CLOSED TREATMENT OF CRANIOFACIAL SEPARATION (LEFORT III TYPE) USING INTERDENTAL
OPEN TREATMENT OF CRANIOFACIAL SEPARATION (LEFORT III TYPE); WITH WIRING AND/OR
OPEN TREATMENT OF CRANIOFACIAL SEPARATION (LEFORT III TYPE); COMPLICATED (EG,
OPEN TREATMENT OF CRANIOFACIAL SEPARATION (LEFORT III TYPE); COMPLICATED,
OPEN TREATMENT OF CRANIOFACIAL SEPARATION (LEFORT III TYPE); COMPLICATED,
INCISION, DEEP, WITH OPENING OF BONE CORTEX (EG, FOR OSTEOMYELITIS OR BONE
EXCISION FIRST AND/OR CERVICAL RIB;
EXCISION FIRST AND/OR CERVICAL RIB; WITH SYMPATHECTOMY
OSTECTOMY OF STERNUM, PARTIAL
STERNAL DEBRIDEMENT
RADICAL RESECTION OF STERNUM;
RADICAL RESECTION OF STERNUM; WITH MEDIASTINAL LYMPHADENECTOMY
DIVISION OF SCALENUS ANTICUS; WITH RESECTION OF CERVICAL RIB
RECONSTRUCTIVE REPAIR OF PECTUS EXCAVATUM OR CARINATUM; OPEN
CLOSURE OF MEDIAN STERNOTOMY SEPARATION WITH OR WITHOUT DEBRIDEMENT (SEPARATE
TREATMENT OF RIB FRACTURE REQUIRING EXTERNAL FIXATION (FLAIL CHEST)
OPEN TREATMENT OF STERNUM FRACTURE WITH OR WITHOUT SKELETAL FIXATION
INCISION AND DRAINAGE, OPEN, OF DEEP ABSCESS (SUBFASCIAL), POSTERIOR SPINE; CERV
INCISION AND DRAINAGE, OPEN, OF DEEP ABSCESS (SUBFASCIAL), POSTERIOR SPINE; LUMB
PARTIAL EXCISION OF VERTEBRAL BODY, FOR INTRINSIC BONY LESION, WITHOUT
PARTIAL EXCISION OF VERTEBRAL BODY, FOR INTRINSIC BONY LESION, WITHOUT
PARTIAL EXCISION OF VERTEBRAL BODY, FOR INTRINSIC BONY LESION, WITHOUT
PARTIAL EXCISION OF VERTEBRAL BODY, FOR INTRINSIC BONY LESION, WITHOUT
OSTEOTOMY OF SPINE, POSTERIOR OR POSTEROLATERAL APPROACH, THREE COLUMNS, ONE VER
OSTEOTOMY OF SPINE, POSTERIOR OR POSTEROLATERAL APPROACH, THREE COLUMNS, ONE VER
OSTEOTOMY OF SPINE, POSTERIOR OR POSTEROLATERAL APPROACH, THREE COLUMNS, ONE VER
OSTEOTOMY OF SPINE, POSTERIOR OR POSTEROLATERAL APPROACH, ONE VERTEBRAL SEGMENT;
OSTEOTOMY OF SPINE, POSTERIOR OR POSTEROLATERAL APPROACH, ONE VERTEBRAL
OSTEOTOMY OF SPINE, POSTERIOR OR POSTEROLATERAL APPROACH, ONE VERTEBRAL
OSTEOTOMY OF SPINE, POSTERIOR OR POSTEROLATERAL APPROACH, ONE VERTEBRAL
OSTEOTOMY OF SPINE, INCLUDING DISKECTOMY, ANTERIOR APPROACH, SINGLE VERTEBRAL
OSTEOTOMY OF SPINE, INCLUDING DISKECTOMY, ANTERIOR APPROACH, SINGLE VERTEBRAL
OSTEOTOMY OF SPINE, INCLUDING DISKECTOMY, ANTERIOR APPROACH, SINGLE VERTEBRAL
OPEN TREATMENT AND/OR REDUCTION OF ODONTOID FRACTURE(S) AND OR DISLOCATION(S)
OPEN TREATMENT AND/OR REDUCTION OF ODONTOID FRACTURE(S) AND OR DISLOCATION(S)
OPEN TREATMENT AND/OR REDUCTION OF VERTEBRAL FRACTURE(S) AND/ OR
OPEN TREATMENT AND/OR REDUCTION OF VERTEBRAL FRACTURE(S) AND/ OR
OPEN TREATMENT AND/OR REDUCTION OF VERTEBRAL FRACTURE(S) AND/ OR
OPEN TREATMENT AND/OR REDUCTION OF VERTEBRAL FRACTURE(S) AND/ OR
ARTHRODESIS, LATERAL EXTRACAVITARY TECHNIQUE, INCLUDING MINIMAL DISKECTOMY TO PR
ARTHRODESIS, LATERAL EXTRACAVITARY TECHNIQUE, INCLUDING MINIMAL DISKECTOMY TO
ARTHRODESIS, LATERAL EXTRACAVITARY TECHNIQUE, INCLUDING MINIMAL DISKECTOMY TO
ARTHRODESIS, ANTERIOR TRANSORAL OR EXTRAORAL TECHNIQUE, CLIVUS-C1-C2 (ATLAS-AXIS
ARTHRODESIS, ANTERIOR INTERBODY, INCLUDING DISC SPACE PREPARATION, DISCECTOMY, O
ARTHRODESIS, ANTERIOR INTERBODY, INCLUDING DISC SPACE PREPARATION, DISCECTOMY, O
ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMAL DISKECTOMY TO
ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMAL DISKECTOMY TO
ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMAL DISKECTOMY TO
ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMAL DISKECTOMY TO
ARTHRODESIS, POSTERIOR TECHNIQUE, CRANIOCERVICAL (OCCIPUT-C2)
ARTHRODESIS, POSTERIOR TECHNIQUE, ATLAS-AXIS (C1-C2)
ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE LEVEL; CERVICAL
ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE LEVEL; THORACIC
ARTHRODESIS, POSTERIOR INTERBODY TECHNIQUE, INCLUDING LAMINECTOMY AND/OR
ARTHRODESIS, POSTERIOR INTERBODY TECHNIQUE, INCLUDING LAMINECTOMY AND/OR
Arthrodesis, combined posterior or posterolateral technique with posterior inter
Arthrodesis, combined posterior or posterolateral technique with posterior inter
ARTHRODESIS, POSTERIOR, FOR SPINAL DEFORMITY, WITH OR WITHOUT CAST; UP TO 6 VERT
ARTHRODESIS, POSTERIOR, FOR SPINAL DEFORMITY, WITH OR WITHOUT CAST; 7 TO 12
ARTHRODESIS, POSTERIOR, FOR SPINAL DEFORMITY, WITH OR WITHOUT CAST; 13 OR MORE
ARTHRODESIS, ANTERIOR, FOR SPINAL DEFORMITY, WITH OR WITHOUT CAST; 2 TO 3
ARTHRODESIS, ANTERIOR, FOR SPINAL DEFORMITY, WITH OR WITHOUT CAST; 4 TO 7
ARTHRODESIS, ANTERIOR, FOR SPINAL DEFORMITY, WITH OR WITHOUT CAST; 8 OR MORE
KYPHECTOMY, CIRCUMFERENTIAL EXPOSURE OF SPINE AND RESECTION OF VERTEBRAL
KYPHECTOMY, CIRCUMFERENTIAL EXPOSURE OF SPINE AND RESECTION OF VERTEBRAL
EXPLORATION OF SPINAL FUSION
POSTERIOR NON-SEGMENTAL INSTRUMENTATION (EG, HARRINGTON ROD TECHNIQUE, PEDICLE F
INTERNAL SPINAL FIXATION BY WIRING OF SPINOUS PROCESSES (LIST SEPARATELY IN ADDI
POSTERIOR SEGMENTAL INSTRUMENTATION (EG, PEDICLE FIXATION, DUAL RODS WITH MULTIP
POSTERIOR SEGMENTAL INSTRUMENTATION (EG, PEDICLE FIXATION, DUAL RODS WITH MULTIP
POSTERIOR SEGMENTAL INSTRUMENTATION (EG, PEDICLE FIXATION, DUAL RODS WITH MULTIP
ANTERIOR INSTRUMENTATION; 2 TO 3 VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDITION
ANTERIOR INSTRUMENTATION; 4 TO 7 VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDITION
ANTERIOR INSTRUMENTATION; 8 OR MORE VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDIT
PELVIC FIXATION (ATTACHMENT OF CAUDAL END OF INSTRUMENTATION TO PELVIC BONY STRU
REINSERTION OF SPINAL FIXATION DEVICE
REMOVAL OF POSTERIOR NONSEGMENTAL INSTRUMENTATION (EG, HARRINGTON ROD)
REMOVAL OF POSTERIOR SEGMENTAL INSTRUMENTATION
REMOVAL OF ANTERIOR INSTRUMENTATION
Total disc arthroplasty (artificial disc), anterior approach, including discecto
TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH, INCLUDING DISCECTO
Revision including replacement of total disc arthroplasty (artificial disc), ant
REVISION INCLUDING REPLACEMENT OF TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANT
Removal of total disc arthroplasty (artificial disc), anterior approach, single
REMOVAL OF TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH, SINGLE
RADICAL RESECTION OF TUMOR; CLAVICLE
RADICAL RESECTION OF TUMOR; SCAPULA
RADICAL RESECTION OF TUMOR, PROXIMAL HUMERUS
REMOVAL OF FOREIGN BODY, SHOULDER; COMPLICATED (EG, TOTAL SHOULDER)
ARTHROPLASTY, GLENOHUMERAL JOINT; TOTAL SHOULDER (GLENOID AND PROXIMAL HUMERAL
INTERTHORACOSCAPULAR AMPUTATION (FOREQUARTER)
DISARTICULATION OF SHOULDER;
AMPUTATION, ARM THROUGH HUMERUS; WITH PRIMARY CLOSURE
AMPUTATION, ARM THROUGH HUMERUS; OPEN, CIRCULAR (GUILLOTINE)
AMPUTATION, ARM THROUGH HUMERUS; RE-AMPUTATION
AMPUTATION, ARM THROUGH HUMERUS; WITH IMPLANT
CINEPLASTY, UPPER EXTREMITY, COMPLETE PROCEDURE
AMPUTATION, FOREARM, THROUGH RADIUS AND ULNA;
AMPUTATION, FOREARM, THROUGH RADIUS AND ULNA; OPEN, CIRCULAR (GUILLOTINE)
KRUKENBERG PROCEDURE
DISARTICULATION THROUGH WRIST;
DISARTICULATION THROUGH WRIST; RE-AMPUTATION
TRANSMETACARPAL AMPUTATION;
REPAIR OR ADVANCEMENT, FLEXOR TENDON, NOT IN ZONE 2 DIGITAL FLEXOR TENDON
TRANSFER, TOE-TO-HAND WITH MICROVASCULAR ANASTOMOSIS; GREAT TOE WRAP-AROUND
TRANSFER, TOE-TO-HAND WITH MICROVASCULAR ANASTOMOSIS; OTHER THAN GREAT TOE,
TRANSFER, TOE-TO-HAND WITH MICROVASCULAR ANASTOMOSIS; OTHER THAN GREAT TOE,
TRANSFER, FREE TOE JOINT, WITH MICROVASCULAR ANASTOMOSIS
INCISION, BONE CORTEX, PELVIS AND/OR HIP JOINT (EG, OSTEOMYELITIS OR BONE
TENOTOMY, HIP FLEXOR(S), OPEN (SEPARATE PROCEDURE)
FASCIOTOMY, HIP OR THIGH, ANY TYPE
ARTHROTOMY, HIP, WITH DRAINAGE (EG, INFECTION)
CAPSULECTOMY OR CAPSULOTOMY, HIP, WITH OR WITHOUT EXCISION OF HETEROTOPIC BONE,
ARTHROTOMY WITH SYNOVECTOMY, HIP JOINT
PARTIAL EXCISION, WING OF ILIUM, SYMPHYSIS PUBIS, OR GREATER TROCHANTER OF FEMUR
PARTIAL EXCISION, WING OF ILIUM, SYMPHYSIS PUBIS, OR GREATER TROCHANTER OF FEMUR
RADICAL RESECTION OF TUMOR; WING OF ILIUM, 1 PUBIC OR ISCHIAL RAMUS OR SYMPHYSIS
RADICAL RESECTION OF TUMOR; ILIUM, INCLUDING ACETABULUM, BOTH PUBIC RAMI, OR ISC
RADICAL RESECTION OF TUMOR; INNOMINATE BONE, TOTAL
RADICAL RESECTION OF TUMOR; ISCHIAL TUBEROSITY AND GREATER TROCHANTER OF FEMUR
REMOVAL OF HIP PROSTHESIS; (SEPARATE PROCEDURE)
REMOVAL OF HIP PROSTHESIS; COMPLICATED, INCLUDING TOTAL HIP PROSTHESIS,
INJECTION PROCEDURE FOR SACROILIAC JOINT, ARTHROGRAPHY AND/ OR
ACETABULOPLASTY; (EG, WHITMAN, COLONNA, HAYGROVES, OR CUP TYPE)
ACETABULOPLASTY; RESECTION, FEMORAL HEAD (EG, GIRDLESTONE PROCEDURE)
HEMIARTHROPLASTY, HIP, PARTIAL (EG, FEMORAL STEM PROSTHESIS, BIPOLAR
ARTHROPLASTY, ACETABULAR AND PROXIMAL FEMORAL PROSTHETIC REPLACEMENT (TOTAL HIP
CONVERSION OF PREVIOUS HIP SURGERY TO TOTAL HIP ARTHROPLASTY, WITH OR WITHOUT
REVISION OF TOTAL HIP ARTHROPLASTY; BOTH COMPONENTS, WITH OR WITHOUT AUTOGRAFT
REVISION OF TOTAL HIP ARTHROPLASTY; ACETABULAR COMPONENT ONLY, WITH OR WITHOUT
REVISION OF TOTAL HIP ARTHROPLASTY; FEMORAL COMPONENT ONLY, WITH OR WITHOUT
OSTEOTOMY AND TRANSFER OF GREATER TROCHANTER OF FEMUR (SEPARATE PROCEDURE)
OSTEOTOMY, ILIAC, ACETABULAR OR INNOMINATE BONE;
OSTEOTOMY, ILIAC, ACETABULAR OR INNOMINATE BONE; WITH OPEN REDUCTION OF HIP
OSTEOTOMY, ILIAC, ACETABULAR OR INNOMINATE BONE; WITH FEMORAL OSTEOTOMY
OSTEOTOMY, ILIAC, ACETABULAR OR INNOMINATE BONE; WITH FEMORAL OSTEOTOMY AND
OSTEOTOMY, PELVIS, BILATERAL (EG, CONGENITAL MALFORMATION)
OSTEOTOMY, FEMORAL NECK (SEPARATE PROCEDURE)
OSTEOTOMY, INTERTROCHANTERIC OR SUBTROCHANTERIC INCLUDING INTERNAL OR EXTERNAL
BONE GRAFT, FEMORAL HEAD, NECK, INTERTROCHANTERIC OR SUBTROCHANTERIC AREA
TREATMENT OF SLIPPED FEMORAL EPIPHYSIS; BY TRACTION, WITHOUT REDUCTION
TREATMENT OF SLIPPED FEMORAL EPIPHYSIS; BY SINGLE OR MULTIPLE PINNING, IN SITU
OPEN TREATMENT OF SLIPPED FEMORAL EPIPHYSIS; SINGLE OR MULTIPLE PINNING OR BONE
OPEN TREATMENT OF SLIPPED FEMORAL EPIPHYSIS; CLOSED MANIPULATION WITH SINGLE OR
OPEN TREATMENT OF SLIPPED FEMORAL EPIPHYSIS; OSTEOTOMY AND INTERNAL FIXATION
EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING, GREATER TROCHANTER OF FEMUR
PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT
OPEN TREATMENT OF ILIAC SPINE(S), TUBEROSITY AVULSION, OR ILIAC WING FRACTURE(S)
PERCUTANEOUS SKELETAL FIXATION OF POSTERIOR PELVIC BONE FRACTURE AND/OR DISLOCAT
OPEN TREATMENT OF ANTERIOR PELVIC BONE FRACTURE AND/OR DISLOCATION FOR FRACTURE
OPEN TREATMENT OF POSTERIOR PELVIC BONE FRACTURE AND/OR DISLOCATION, FOR FRACTUR
CLOSED TREATMENT OF ACETABULUM (HIP SOCKET) FRACTURE(S); WITH MANIPULATION,
OPEN TREATMENT OF POSTERIOR OR ANTERIOR ACETABULAR WALL FRACTURE, WITH INTERNAL
OPEN TREATMENT OF ACETABULAR FRACTURE(S) INVOLVING ANTERIOR OR POSTERIOR (ONE)
OPEN TREATMENT OF ACETABULAR FRACTURE(S) INVOLVING ANTERIOR AND POSTERIOR (TWO)
CLOSED TREATMENT OF FEMORAL FRACTURE, PROXIMAL END, NECK; WITH MANIPULATION,
OPEN TREATMENT OF FEMORAL FRACTURE, PROXIMAL END, NECK, INTERNAL FIXATION OR
CLOSED TREATMENT OF INTERTROCHANTERIC, PERTROCHANTERIC, OR SUBTROCHANTERIC
TREATMENT OF INTERTROCHANTERIC, PERTROCHANTERIC, OR SUBTROCHANTERIC FEMORAL
TREATMENT OF INTERTROCHANTERIC, PERTROCHANTERIC, OR SUBTROCHANTERIC FEMORAL
OPEN TREATMENT OF GREATER TROCHANTERIC FRACTURE, INCLUDES INTERNAL FIXATION, WHE
OPEN TREATMENT OF HIP DISLOCATION, TRAUMATIC, WITHOUT INTERNAL FIXATION
OPEN TREATMENT OF HIP DISLOCATION, TRAUMATIC, WITH ACETABULAR WALL AND FEMORAL
OPEN TREATMENT OF SPONTANEOUS HIP DISLOCATION (DEVELOPMENTAL, INCLUDING
OPEN TREATMENT OF SPONTANEOUS HIP DISLOCATION (DEVELOPMENTAL, INCLUDING
CLOSED TREATMENT OF FEMORAL FRACTURE, PROXIMAL END, HEAD; WITH MANIPULATION
OPEN TREATMENT OF FEMORAL FRACTURE, PROXIMAL END, HEAD, INCLUDES INTERNAL FIXATI
ARTHRODESIS, SACROILIAC JOINT (INCLUDING OBTAINING GRAFT)
ARTHRODESIS, SYMPHYSIS PUBIS (INCLUDING OBTAINING GRAFT)
ARTHRODESIS, HIP JOINT (INCLUDING OBTAINING GRAFT);
ARTHRODESIS, HIP JOINT (INCLUDING OBTAINING GRAFT); WITH SUBTROCHANTERIC
INTERPELVIABDOMINAL AMPUTATION (HINDQUARTER AMPUTATION)
DISARTICULATION OF HIP
INCISION, DEEP, WITH OPENING OF BONE CORTEX, FEMUR OR KNEE (EG, OSTEOMYELITIS
RADICAL RESECTION OF TUMOR, FEMUR OR KNEE
ARTHROPLASTY, KNEE, HINGE PROSTHESIS (EG, WALLDIUS TYPE)
ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL AND LATERAL COMPARTMENTS WITH
OSTEOTOMY, FEMUR, SHAFT OR SUPRACONDYLAR; WITHOUT FIXATION
OSTEOTOMY, FEMUR, SHAFT OR SUPRACONDYLAR; WITH FIXATION
OSTEOTOMY, MULTIPLE, WITH REALIGNMENT ON INTRAMEDULLARY ROD, FEMORAL SHAFT (EG,
OSTEOTOMY, PROXIMAL TIBIA, INCLUDING FIBULAR EXCISION OR OSTEOTOMY (INCLUDES
OSTEOTOMY, PROXIMAL TIBIA, INCLUDING FIBULAR EXCISION OR OSTEOTOMY (INCLUDES
OSTEOPLASTY, FEMUR; SHORTENING (EXCLUDING 64876)
OSTEOPLASTY, FEMUR; LENGTHENING
OSTEOPLASTY, FEMUR; COMBINED, LENGTHENING AND SHORTENING WITH FEMORAL SEGMENT
REPAIR, NONUNION OR MALUNION, FEMUR, DISTAL TO HEAD AND NECK; WITHOUT GRAFT
REPAIR, NONUNION OR MALUNION, FEMUR, DISTAL TO HEAD AND NECK; WITH ILIAC OR
ARREST, EPIPHYSEAL, ANY METHOD (EG, EPIPHYSIODESIS); TIBIA AND FIBULA, PROXIMAL
ARREST, HEMIEPIPHYSEAL, DISTAL FEMUR OR PROXIMAL TIBIA OR FIBULA (EG, GENU
REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; ONE COMPONENT
REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; FEMORAL AND
REMOVAL OF PROSTHESIS, INCLUDING TOTAL KNEE PROSTHESIS, METHYLMETHACRYLATE WITH
PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT
OPEN TREATMENT OF FEMORAL SHAFT FRACTURE, WITH OR WITHOUT EXTERNAL FIXATION,
OPEN TREATMENT OF FEMORAL SHAFT FRACTURE WITH PLATE/SCREWS, WITH OR WITHOUT
OPEN TREATMENT OF FEMORAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE WITHOUT INTERC
OPEN TREATMENT OF FEMORAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE WITH INTERCOND
OPEN TREATMENT OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR LATERAL CONDYLE, INCLU
OPEN TREATMENT OF DISTAL FEMORAL EPIPHYSEAL SEPARATION, INCLUDES INTERNAL FIXATI
OPEN TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); UNICONDYLAR, INCLUDES INT
OPEN TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); BICONDYLAR, WITH OR
OPEN TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY FRACTURE(S) OF THE KN
OPEN TREATMENT OF KNEE DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN PERFORMED;
OPEN TREATMENT OF KNEE DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN PERFORMED;
OPEN TREATMENT OF KNEE DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN PERFORMED;
ARTHRODESIS, KNEE, ANY TECHNIQUE
AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL;
AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL; IMMEDIATE FITTING TECHNIQUE
AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL; OPEN, CIRCULAR (GUILLOTINE)
AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL; RE-AMPUTATION
DISARTICULATION AT KNEE
RADICAL RESECTION OF TUMOR; TIBIA
RADICAL RESECTION OF TUMOR; FIBULA
ARTHROPLASTY, ANKLE; WITH IMPLANT (TOTAL ANKLE)
ARTHROPLASTY, ANKLE; REVISION, TOTAL ANKLE
OSTEOTOMY; MULTIPLE, WITH REALIGNMENT ON INTRAMEDULLARY ROD (EG, SOFIELD TYPE
OSTEOPLASTY, TIBIA AND FIBULA, LENGTHENING OR SHORTENING
REPAIR OF NONUNION OR MALUNION, TIBIA; WITH ILIAC OR OTHER AUTOGRAFT (INCLUDES
REPAIR OF NONUNION OR MALUNION, TIBIA; BY SYNOSTOSIS, WITH FIBULA, ANY METHOD
REPAIR OF CONGENITAL PSEUDARTHROSIS, TIBIA
AMPUTATION LEG, THROUGH TIBIA AND FIBULA;
AMPUTATION, LEG, THROUGH TIBIA AND FIBULA; WITH IMMEDIATE FITTING TECHNIQUE
AMPUTATION, LEG, THROUGH TIBIA AND FIBULA; OPEN, CIRCULAR (GUILLOTINE)
AMPUTATION, LEG, THROUGH TIBIA AND FIBULA; RE-AMPUTATION
AMPUTATION, ANKLE, THROUGH MALLEOLI OF TIBIA AND FIBULA (EG, SYME, PIROGOFF
AMPUTATION, FOOT; MIDTARSAL (EG, CHOPART TYPE PROCEDURE)
REMOVAL FOREIGN BODY, INTRANASAL; OFFICE TYPE PROCEDURE
MAXILLECTOMY; WITHOUT ORBITAL EXENTERATION
MAXILLECTOMY; WITH ORBITAL EXENTERATION (EN BLOC)
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH REPAIR OF CEREBROSPINAL FLUID LEAK;
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH REPAIR OF CEREBROSPINAL FLUID LEAK;
LARYNGECTOMY; TOTAL, WITHOUT RADICAL NECK DISSECTION
LARYNGECTOMY; TOTAL, WITH RADICAL NECK DISSECTION
LARYNGECTOMY; SUBTOTAL SUPRAGLOTTIC, WITHOUT RADICAL NECK DISSECTION
LARYNGECTOMY; SUBTOTAL SUPRAGLOTTIC, WITH RADICAL NECK DISSECTION
PARTIAL LARYNGECTOMY (HEMILARYNGECTOMY); HORIZONTAL
PARTIAL LARYNGECTOMY (HEMILARYNGECTOMY); LATEROVERTICAL
PARTIAL LARYNGECTOMY (HEMILARYNGECTOMY); ANTEROVERTICAL
PARTIAL LARYNGECTOMY (HEMILARYNGECTOMY); ANTERO-LATERO-VERTICAL
PHARYNGOLARYNGECTOMY, WITH RADICAL NECK DISSECTION; WITHOUT RECONSTRUCTION
PHARYNGOLARYNGECTOMY, WITH RADICAL NECK DISSECTION; WITH RECONSTRUCTION
LARYNGOPLASTY; WITH OPEN REDUCTION OF FRACTURE
LARYNGOPLASTY, CRICOID SPLIT
CATHETER ASPIRATION (SEPARATE PROCEDURE); TRACHEOBRONCHIAL WITH FIBERSCOPE,
TRACHEOPLASTY; INTRATHORACIC
CARINAL RECONSTRUCTION
BRONCHOPLASTY; GRAFT REPAIR
BRONCHOPLASTY; EXCISION STENOSIS AND ANASTOMOSIS
EXCISION TRACHEAL STENOSIS AND ANASTOMOSIS; CERVICAL
EXCISION TRACHEAL STENOSIS AND ANASTOMOSIS; CERVICOTHORACIC
EXCISION OF TRACHEAL TUMOR OR CARCINOMA; THORACIC
SUTURE OF TRACHEAL WOUND OR INJURY; CERVICAL
SUTURE OF TRACHEAL WOUND OR INJURY; INTRATHORACIC
THORACOSTOMY; WITH RIB RESECTION FOR EMPYEMA
THORACOSTOMY; WITH OPEN FLAP DRAINAGE FOR EMPYEMA
Thoracotomy, with diagnostic biopsy(ies) of lung infiltrate(s) (eg, wedge, incis
Thoracotomy, with diagnostic biopsy(ies) of lung nodule(s) or mass(es) (eg, wedg
Thoracotomy, with biopsy(ies) of pleura
THORACOTOMY, MAJOR; WITH EXPLORATION AND BIOPSY
THORACOTOMY, MAJOR; WITH CONTROL OF TRAUMATIC HEMORRHAGE AND/OR REPAIR OF LUNG
THORACOTOMY, MAJOR; FOR POSTOPERATIVE COMPLICATIONS
THORACOTOMY, MAJOR; WITH OPEN INTRAPLEURAL PNEUMONOLYSIS
THORACOTOMY, MAJOR; WITH CYST(S) REMOVAL, WITH OR WITHOUT A PLEURAL PROCEDURE
THORACOTOMY, MAJOR; WITH EXCISION-PLICATION OF BULLAE, WITH OR WITHOUT ANY
THORACOTOMY, MAJOR; WITH REMOVAL OF INTRAPLEURAL FOREIGN BODY OR FIBRIN DEPOSIT
THORACOTOMY, MAJOR; WITH REMOVAL OF INTRAPULMONARY FOREIGN BODY
THORACOTOMY, MAJOR; WITH CARDIAC MASSAGE
PNEUMONOSTOMY; WITH OPEN DRAINAGE OF ABSCESS OR CYST
PLEURAL SCARIFICATION FOR REPEAT PNEUMOTHORAX
DECORTICATION, PULMONARY (SEPARATE PROCEDURE); TOTAL
DECORTICATION, PULMONARY (SEPARATE PROCEDURE); PARTIAL
PLEURECTOMY, PARIETAL (SEPARATE PROCEDURE)
DECORTICATION AND PARIETAL PLEURECTOMY
REMOVAL OF LUNG, TOTAL PNEUMONECTOMY;
REMOVAL OF LUNG, TOTAL PNEUMONECTOMY; WITH RESECTION OF SEGMENT OF TRACHEA
REMOVAL OF LUNG, TOTAL PNEUMONECTOMY; EXTRAPLEURAL
REMOVAL OF LUNG, OTHER THAN TOTAL PNEUMONECTOMY; SINGLE LOBE (LOBECTOMY)
REMOVAL OF LUNG, OTHER THAN TOTAL PNEUMONECTOMY; TWO LOBES (BILOBECTOMY)
REMOVAL OF LUNG, OTHER THAN TOTAL PNEUMONECTOMY; SINGLE SEGMENT (SEGMENTECTOMY)
REMOVAL OF LUNG, OTHER THAN TOTAL PNEUMONECTOMY; WITH CIRCUMFERENTIAL RESECTION
REMOVAL OF LUNG, OTHER THAN TOTAL PNEUMONECTOMY; ALL REMAINING LUNG FOLLOWING
REMOVAL OF LUNG, OTHER THAN TOTAL PNEUMONECTOMY; EXCISION-PLICATION OF
RESECTION AND REPAIR OF PORTION OF BRONCHUS (BRONCHOPLASTY) WHEN PERFORMED AT
RESECTION OF APICAL LUNG TUMOR (EG, PANCOAST TUMOR), INCLUDING CHEST WALL RESECT
RESECTION OF APICAL LUNG TUMOR (EG, PANCOAST TUMOR), INCLUDING CHEST WALL RESECT
Thoracotomy; with therapeutic wedge resection (eg, mass, nodule), initial
Thoracotomy; with therapeutic wedge resection (eg, mass or nodule), each additio
Thoracotomy; with diagnostic wedge resection followed by anatomic lung resection
EXTRAPLEURAL ENUCLEATION OF EMPYEMA (EMPYEMECTOMY)
Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial
THORACOSCOPY, SURGICAL; WITH PLEURODESIS (EG, MECHANICAL OR CHEMICAL)
THORACOSCOPY, SURGICAL; WITH PARTIAL PULMONARY DECORTICATION
THORACOSCOPY, SURGICAL; WITH TOTAL PULMONARY DECORTICATION, INCLUDING
THORACOSCOPY, SURGICAL; WITH REMOVAL OF INTRAPLEURAL FOREIGN BODY OR FIBRIN
THORACOSCOPY, SURGICAL; WITH CONTROL OF TRAUMATIC HEMORRHAGE
THORACOSCOPY, SURGICAL; WITH EXCISION-PLICATION OF BULLAE, INCLUDING ANY
THORACOSCOPY, SURGICAL; WITH PARIETAL PLEURECTOMY
THORACOSCOPY, SURGICAL; WITH REMOVAL OF CLOT OR FOREIGN BODY FROM PERICARDIAL
THORACOSCOPY, SURGICAL; WITH CREATION OF PERICARDIAL WINDOW OR PARTIAL
THORACOSCOPY, SURGICAL; WITH EXCISION OF PERICARDIAL CYST, TUMOR, OR MASS
THORACOSCOPY, SURGICAL; WITH EXCISION OF MEDIASTINAL CYST, TUMOR, OR MASS
THORACOSCOPY, SURGICAL; WITH LOBECTOMY, TOTAL OR SEGMENTAL
THORACOSCOPY, SURGICAL; WITH THORACIC SYMPATHECTOMY
THORACOSCOPY, SURGICAL; WITH ESOPHAGOMYOTOMY (HELLER TYPE)
Thoracoscopy, surgical; with therapeutic wedge resection (eg, mass, nodule), ini
Thoracoscopy, surgical; with therapeutic wedge resection (eg, mass or nodule), e
Thoracoscopy, surgical; with diagnostic wedge resection followed by anatomic lun
Thoracoscopy, surgical; with removal of a single lung segment (segmentectomy)
Thoracoscopy, surgical; with removal of two lobes (bilobectomy)
Thoracoscopy, surgical; with removal of lung (pneumonectomy)
Thoracoscopy, surgical; with resection-plication for emphysematous lung (bullous
Thoracoscopy, surgical; with resection of thymus, unilateral or bilateral
Thoracoscopy, surgical; with mediastinal and regional lymphadenectomy (List sepa
REPAIR LUNG HERNIA THROUGH CHEST WALL
CLOSURE OF CHEST WALL FOLLOWING OPEN FLAP DRAINAGE FOR EMPYEMA (CLAGETT TYPE
OPEN CLOSURE OF MAJOR BRONCHIAL FISTULA
MAJOR RECONSTRUCTION, CHEST WALL (POSTTRAUMATIC)
DONOR PNEUMONECTOMY(IES)(INCL. COLD PRESERVATION), FROM CADAVER DONOR
LUNG TRANSPLANT, SINGLE; WITHOUT CARDIOPULMONARY BYPASS
LUNG TRANSPLANT, SINGLE; WITH CARDIOPULMONARY BYPASS
LUNG TRANSPLANT, DOUBLE (BILATERAL SEQUENTIAL OR EN BLOC); WITHOUT
LUNG TRANSPLANT, DOUBLE (BILATERAL SEQUENTIAL OR EN BLOC); WITH CARDIOPULMONARY
BACKBENCH STANDARD PREPARATION OF CADAVER DONOR LUNG ALLOGRAFT PRIOR TO
BACKBENCH STANDARD PREPARATION OF CADAVER DONOR LUNG ALLOGRAFT PRIOR TO
RESECTION OF RIBS, EXTRAPLEURAL, ALL STAGES
THORACOPLASTY, SCHEDE TYPE OR EXTRAPLEURAL (ALL STAGES);
THORACOPLASTY, SCHEDE TYPE OR EXTRAPLEURAL (ALL STAGES); WITH CLOSURE OF
PNEUMONOLYSIS, EXTRAPERIOSTEAL, INCLUDING FILLING OR PACKING PROCEDURES
TOTAL LUNG LAVAGE (UNILATERAL)
TUBE PERICARDIOSTOMY
PERICARDIOTOMY FOR REMOVAL OF CLOT OR FOREIGN BODY (PRIMARY PROCEDURE)
CREATION OF PERICARDIAL WINDOW OR PARTIAL RESECTION FOR DRAINAGE
PERICARDIECTOMY, SUBTOTAL OR COMPLETE; WITHOUT CARDIOPULMONARY BYPASS
PERICARDIECTOMY, SUBTOTAL OR COMPLETE; WITH CARDIOPULMONARY BYPASS
EXCISION OF PERICARDIAL CYST OR TUMOR
EXCISION OF INTRACARDIAC TUMOR, RESECTION WITH CARDIOPULMONARY BYPASS
RESECTION OF EXTERNAL CARDIAC TUMOR
TRANSMYOCARDIAL LASER REVASCULARIZATION, BY THORACOTOMY (SEPARATE PROCEDURE)
TRANSMYOCARDIAL LASER REVASCULARIZATION, BY THORACOTOMY; PERFORMED AT THE TIME
INSERTION OF EPICARDIAL ELECTRODE(S); OPEN INCISION (EG, THORACOTOMY, MEDIAN STE
INSERTION OF EPICARDIAL ELECTRODE(S); ENDOSCOPIC APPROACH (EG, THORACOSCOPY, PER
REMOVAL OF PERMANENT EPICARDIAL PACEMAKER AND ELECTRODES BY THORACOTOMY; SINGLE
REMOVAL OF PERMANENT EPICARDIAL PACEMAKER AND ELECTRODES BY THORACOTOMY; DUAL
REMOVAL OF PERMANENT TRANSVENOUS ELECTRODE(S) BY THORACOTOMY
REMOVAL OF SINGLE OR DUAL CHAMBER PACING CARDIOVERTER-DEFIBRILLATOR
OPERATIVE ABLATION OF SUPRAVENTRICULAR ARRHYTHMOGENIC FOCUS OR PATHWAY (EG, WOLF
OPERATIVE ABLATION OF SUPRAVENTRICULAR ARRHYTHMOGENIC FOCUS OR PATHWAY (EG,
OPERATIVE TISSUE ABLATION AND RECONSTRUCTION OF ATRIA, LIMITED (EG, MODIFIED MAZ
OPERATIVE TISSUE ABLATION AND RECONSTRUCTION OF ATRIA, EXTENSIVE (EG, MAZE PROCE
OPERATIVE TISSUE ABLATION AND RECONSTRUCTION OF ATRIA, EXTENSIVE (EG, MAZE PROCE
OPERATIVE TISSUE ABLATION AND RECONSTRUCTION OF ATRIA, PERFORMED AT THE TIME OF
OPERATIVE TISSUE ABLATION AND RECONSTRUCTION OF ATRIA, PERFORMED AT THE TIME OF
OPERATIVE TISSUE ABLATION AND RECONSTRUCTION OF ATRIA, PERFORMED AT THE TIME OF
OPERATIVE ABLATION OF VENTRICULAR ARRHYTHMOGENIC FOCUS WITH CARDIOPULMONARY
ENDOSCOPY, SURGICAL; OPERATIVE TISSUE ABLATION AND RECONSTRUCTION OF ATRIA, LIMI
ENDOSCOPY, SURGICAL; OPERATIVE TISSUE ABLATION AND RECONSTRUCTION OF ATRIA, EXTE
REPAIR OF CARDIAC WOUND; WITHOUT BYPASS
REPAIR OF CARDIAC WOUND; WITH CARDIOPULMONARY BYPASS
CARDIOTOMY, EXPLORATORY (INCLUDES REMOVAL OF FOREIGN BODY, ATRIAL OR
CARDIOTOMY, EXPLORATORY (INCLUDES REMOVAL OF FOREIGN BODY, ATRIAL OR
SUTURE REPAIR OF AORTA OR GREAT VESSELS; WITHOUT SHUNT OR CARDIOPULMONARY BYPASS
SUTURE REPAIR OF AORTA OR GREAT VESSELS; WITH SHUNT BYPASS
SUTURE REPAIR OF AORTA OR GREAT VESSELS; WITH CARDIOPULMONARY BYPASS
INSERTION OF GRAFT, AORTA OR GREAT VESSELS; WITHOUT SHUNT, OR CARDIOPULMONARY
INSERTION OF GRAFT, AORTA OR GREAT VESSELS; WITH SHUNT BYPASS
INSERTION OF GRAFT, AORTA OR GREAT VESSELS; WITH CARDIOPULMONARY BYPASS
VALVULOPLASTY, AORTIC VALVE, OPEN, WITH CARDIOPULMONARY BYPASS
VALVULOPLASTY, AORTIC VALVE; OPEN, WITH INFLOW OCCLUSION
VALVULOPLASTY, AORTIC VALVE; USING TRANSVENTRICULAR DILATION, WITH
CONSTRUCTION OF APICAL-AORTIC CONDUIT
REPLACEMENT, AORTIC VALVE, WITH CARDIOPULMONARY BYPASS; WITH PROSTHETIC VALVE
REPLACEMENT, AORTIC VALVE, WITH CARDIOPULMONARY BYPASS; WITH ALLOGRAFT VALVE
REPLACEMENT, AORTIC VALVE, WITH CARDIOPULMONARY BYPASS; WITH STENTLESS TISSUE
REPLACEMENT, AORTIC VALVE; WITH AORTIC ANNULUS ENLARGEMENT, NONCORONARY SINUS
REPLACEMENT, AORTIC VALVE; WITH TRANSVENTRICULAR AORTIC ANNULUS ENLARGEMENT
REPLACEMENT, AORTIC VALVE; BY TRANSLOCATION OF AUTOLOGOUS PULMONARY VALVE WITH
REPAIR OF LEFT VENTRICULAR OUTFLOW TRACT OBSTRUCTION BY PATCH ENLARGEMENT OF
RESECTION OR INCISION OF SUBVALVULAR TISSUE FOR DISCRETE SUBVALVULAR AORTIC
VENTRICULOMYOTOMY (-MYECTOMY) FOR IDIOPATHIC HYPERTROPHIC SUBAORTIC STENOSIS
AORTOPLASTY (GUSSET) FOR SUPRAVALVULAR STENOSIS
VALVOTOMY, MITRAL VALVE; CLOSED HEART
VALVOTOMY, MITRAL VALVE; OPEN HEART, WITH CARDIOPULMONARY BYPASS
VALVULOPLASTY, MITRAL VALVE, WITH CARDIOPULMONARY BYPASS;
VALVULOPLASTY, MITRAL VALVE, WITH CARDIOPULMONARY BYPASS; WITH PROSTHETIC RING
VALVULOPLASTY, MITRAL VALVE, WITH CARDIOPULMONARY BYPASS; RADICAL
REPLACEMENT, MITRAL VALVE, WITH CARDIOPULMONARY BYPASS
VALVECTOMY, TRICUSPID VALVE, WITH CARDIOPULMONARY BYPASS
VALVULOPLASTY, TRICUSPID VALVE; WITHOUT RING INSERTION
VALVULOPLASTY, TRICUSPID VALVE; WITH RING INSERTION
REPLACEMENT, TRICUSPID VALVE, WITH CARDIOPULMONARY BYPASS
TRICUSPID VALVE REPOSITIONING AND PLICATION FOR EBSTEIN ANOMALY
VALVOTOMY, PULMONARY VALVE, CLOSED HEART; TRANSVENTRICULAR
VALVOTOMY, PULMONARY VALVE, OPEN HEART; WITH INFLOW OCCLUSION
VALVOTOMY, PULMONARY VALVE, OPEN HEART; WITH CARDIOPULMONARY BYPASS
REPLACEMENT, PULMONARY VALVE
RIGHT VENTRICULAR RESECTION FOR INFUNDIBULAR STENOSIS, WITH OR WITHOUT
OUTFLOW TRACT AUGMENTATION (GUSSET), WITH OR WITHOUT COMMISSUROTOMY OR
REPAIR OF NON-STRUCTURAL PROSTHETIC VALVE DYSFUNCTION WITH CARDIOPULMONARY BYPAS
REPAIR OF CORONARY ARTERIOVENOUS OR ARTERIOCARDIAC CHAMBER FISTULA; WITH CARDIOP
REPAIR OF CORONARY ARTERIOVENOUS OR ARTERIOCARDIAC CHAMBER FISTULA; WITHOUT
REPAIR OF ANOMALOUS CORONARY ARTERY FROM PULMONARY ARTERY ORIGIN; BY LIGATION
REPAIR OF ANOMALOUS CORONARY ARTERY; BY GRAFT, WITHOUT CARDIOPULMONARY BYPASS
REPAIR OF ANOMALOUS CORONARY ARTERY; BY GRAFT, WITH CARDIOPULMONARY BYPASS
REPAIR OF ANOMALOUS CORONARY ARTERY; WITH CONSTRUCTION OF INTRAPULMONARY ARTERY
REPAIR OF ANOMALOUS CORONARY ARTERY; BY TRANSLOCATION FROM PULMONARY ARTERY TO
REPAIR OF ANOMALOUS (EG, INTRAMURAL) AORTIC ORIGIN OF CORONARY ARTERY BY UNROOFI
CORONARY ARTERY BYPASS, VEIN ONLY; SINGLE CORONARY VENOUS GRAFT
CORONARY ARTERY BYPASS, VEIN ONLY; TWO CORONARY VENOUS GRAFTS
CORONARY ARTERY BYPASS, VEIN ONLY; THREE CORONARY VENOUS GRAFTS
CORONARY ARTERY BYPASS, VEIN ONLY; FOUR CORONARY VENOUS GRAFTS
CORONARY ARTERY BYPASS, VEIN ONLY; FIVE CORONARY VENOUS GRAFTS
CORONARY ARTERY BYPASS, VEIN ONLY; SIX OR MORE CORONARY VENOUS GRAFTS
CORONARY ARTERY BYPASS, USING VENOUS GRAFT(S) AND ARTERIAL GRAFT(S); SINGLE VEIN
CORONARY ARTERY BYPASS, USING VENOUS GRAFT(S) AND ARTERIAL GRAFT(S); TWO VENOUS
CORONARY ARTERY BYPASS, USING VENOUS GRAFT(S) AND ARTERIAL GRAFT(S); THREE VENOU
CORONARY ARTERY BYPASS, USING VENOUS GRAFT(S) AND ARTERIAL GRAFT(S); FOUR VENOUS
CORONARY ARTERY BYPASS, USING VENOUS GRAFT(S) AND ARTERIAL GRAFT(S); FIVE VENOUS
CORONARY ARTERY BYPASS, USING VENOUS GRAFT(S) AND ARTERIAL GRAFT(S); SIX OR MORE
REOPERATION, CORONARY ARTERY BYPASS PROCEDURE OR VALVE PROCEDURE, MORE THAN ONE
CORONARY ARTERY BYPASS, USING ARTERIAL GRAFT(S); SINGLE ARTERIAL GRAFT
CORONARY ARTERY BYPASS, USING ARTERIAL GRAFT(S); TWO CORONARY ARTERIAL GRAFTS
CORONARY ARTERY BYPASS, USING ARTERIAL GRAFT(S); THREE CORONARY ARTERIAL GRAFTS
CORONARY ARTERY BYPASS, USING ARTERIAL GRAFT(S); FOUR OR MORE CORONARY ARTERIAL
MYOCARDIAL RESECTION (EG, VENTRICULAR ANEURYSMECTOMY)
REPAIR OF POSTINFARCTION VENTRICULAR SEPTAL DEFECT, WITH OR WITHOUT MYOCARDIAL
SURGICAL VENTRICULAR RESTORATION PROCEDURE, INCLUDES PROSTHETIC PATCH, WHEN PERF
CORONARY ENDARTERECTOMY, OPEN, ANY METHOD, OF LEFT ANTERIOR DESCENDING, CIRCUMFL
CLOSURE OF ATRIOVENTRICULAR VALVE (MITRAL OR TRICUSPID) BY SUTURE OR PATCH
CLOSURE OF SEMILUNAR VALVE (AORTIC OR PULMONARY) BY SUTURE OR PATCH
ANASTOMOSIS OF PULMONARY ARTERY TO AORTA (DAMUS-KAYE-STANSEL PROCEDURE)
REPAIR OF COMPLEX CARDIAC ANOMALY OTHER THAN PULMONARY ATRESIA WITH VENTRICULAR
REPAIR OF COMPLEX CARDIAC ANOMALIES (EG, SINGLE VENTRICLE WITH SUBAORTIC
REPAIR OF DOUBLE OUTLET RIGHT VENTRICLE WITH INTRAVENTRICULAR TUNNEL REPAIR;
REPAIR OF DOUBLE OUTLET RIGHT VENTRICLE WITH INTRAVENTRICULAR TUNNEL REPAIR;
REPAIR OF COMPLEX CARDIAC ANOMALIES (EG, TRICUSPID ATRESIA) BY CLOSURE OF
REPAIR OF COMPLEX CARDIAC ANOMALIES (EG, SINGLE VENTRICLE) BY MODIFIED FONTAN
REPAIR OF SINGLE VENTRICLE WITH AORTIC OUTFLOW OBSTRUCTION AND AORTIC ARCH
APPLICATION OF RIGHT AND LEFT PULMONARY ARTERY BANDS (EG, HYBRID APPROACH STAGE
TRANSTHORACIC INSERTION OF CATHETER FOR STENT PLACEMENT WITH CATHETER REMOVAL AN
RECONSTRUCTION OF COMPLEX CARDIAC ANOMALY (EG, SINGLE VENTRICLE OR HYPOPLASTIC L
REPAIR ATRIAL SEPTAL DEFECT, SECUNDUM, WITH CARDIOPULMONARY BYPASS, WITH OR WITH
DIRECT OR PATCH CLOSURE, SINUS VENOSUS, WITH OR WITHOUT ANOMALOUS PULMONARY
REPAIR OF ATRIAL SEPTAL DEFECT AND VENTRICULAR SEPTAL DEFECT, WITH DIRECT OR
REPAIR OF INCOMPLETE OR PARTIAL ATRIOVENTRICULAR CANAL (OSTIUM PRIMUM ATRIAL
REPAIR OF INTERMEDIATE OR TRANSITIONAL ATRIOVENTRICULAR CANAL, WITH OR WITHOUT
REPAIR OF COMPLETE ATRIOVENTRICULAR CANAL, WITH OR WITHOUT PROSTHETIC VALVE
CLOSURE OF MULTIPLE VENTRICULAR SEPTAL DEFECTS;
CLOSURE OF MULTIPLE VENTRICULAR SEPTAL DEFECTS; WITH PULMONARY VALVOTOMY OR INFU
CLOSURE OF MULTIPLE VENTRICULAR SEPTAL DEFECTS; WITH REMOVAL OF PULMONARY ARTERY
CLOSURE OF SINGLE VENTRICULAR SEPTAL DEFECT, WITH OR WITHOUT PATCH;
CLOSURE OF VENTRICULAR SEPTAL DEFECT, WITH OR WITHOUT PATCH; WITH PULMONARY
CLOSURE OF VENTRICULAR SEPTAL DEFECT, WITH OR WITHOUT PATCH; WITH REMOVAL OF
BANDING OF PULMONARY ARTERY
COMPLETE REPAIR TETRALOGY OF FALLOT WITHOUT PULMONARY ATRESIA;
COMPLETE REPAIR TETRALOGY OF FALLOT WITHOUT PULMONARY ATRESIA; WITH
COMPLETE REPAIR TETRALOGY OF FALLOT WITH PULMONARY ATRESIA INCLUDING
REPAIR SINUS OF VALSALVA FISTULA, WITH CARDIOPULMONARY BYPASS;
REPAIR SINUS OF VALSALVA FISTULA, WITH CARDIOPULMONARY BYPASS; WITH REPAIR OF
REPAIR SINUS OF VALSALVA ANEURYSM, WITH CARDIOPULMONARY BYPASS
CLOSURE OF AORTICO-LEFT VENTRICULAR TUNNEL
REPAIR OF ISOLATED PARTIAL ANOMALOUS PULMONARY VENOUS RETURN (EG, SCIMITAR SYNDR
REPAIR OF PULMONARY VENOUS STENOSIS
COMPLETE REPAIR OF ANOMALOUS VENOUS RETURN (SUPRACARDIAC, INTRACARDIAC, OR INFRA
REPAIR OF COR TRIATRIATUM OR SUPRAVALVULAR MITRAL RING BY RESECTION OF LEFT
ATRIAL SEPTECTOMY OR SEPTOSTOMY; CLOSED HEART (BLALOCK-HANLON TYPE OPERATION)
ATRIAL SEPTECTOMY OR SEPTOSTOMY; OPEN HEART WITH CARDIOPULMONARY BYPASS
ATRIAL SEPTECTOMY OR SEPTOSTOMY; OPEN HEART, WITH INFLOW OCCLUSION
SHUNT; SUBCLAVIAN TO PULMONARY ARTERY (BLALOCK-TAUSSIG TYPE OPERATION)
SHUNT; ASCENDING AORTA TO PULMONARY ARTERY (WATERSTON TYPE OPERATION)
SHUNT; DESCENDING AORTA TO PULMONARY ARTERY (POTTS-SMITH TYPE OPERATION)
SHUNT; CENTRAL, WITH PROSTHETIC GRAFT
SHUNT; SUPERIOR VENA CAVA TO PULMONARY ARTERY FOR FLOW TO ONE LUNG (CLASSICAL
SHUNT; SUPERIOR VENA CAVA TO PULMONARY ARTERY FOR FLOW TO BOTH LUNGS
ANASTOMOSIS, CAVOPULMONARY, SECOND SUPERIOR VENA CAVA (LIST SEPARATELY IN ADDITI
REPAIR OF TRANSPOSITION OF THE GREAT ARTERIES WITH VENTRICULAR SEPTAL DEFECT AND
REPAIR OF TRANSPOSITION OF THE GREAT ARTERIES WITH VENTRICULAR SEPTAL DEFECT
REPAIR OF TRANSPOSITION OF THE GREAT ARTERIES, ATRIAL BAFFLE PROCEDURE (EG,
REPAIR OF TRANSPOSITION OF THE GREAT ARTERIES, ATRIAL BAFFLE PROCEDURE (EG,
REPAIR OF TRANSPOSITION OF THE GREAT ARTERIES, ATRIAL BAFFLE PROCEDURE (EG,
REPAIR OF TRANSPOSITION OF THE GREAT ARTERIES, ATRIAL BAFFLE PROCEDURE (EG,
REPAIR OF TRANSPOSITION OF THE GREAT ARTERIES, AORTIC PULMONARY ARTERY
REPAIR OF TRANSPOSITION OF THE GREAT ARTERIES, AORTIC PULMONARY ARTERY
REPAIR OF TRANSPOSITION OF THE GREAT ARTERIES, AORTIC PULMONARY ARTERY
REPAIR OF TRANSPOSITION OF THE GREAT ARTERIES, AORTIC PULMONARY ARTERY
Aortic root translocation with ventricular septal defect and pulmonary stenosis
Aortic root translocation with ventricular septal defect and pulmonary stenosis
TOTAL REPAIR, TRUNCUS ARTERIOSUS (RASTELLI TYPE OPERATION)
REIMPLANTATION OF AN ANOMALOUS PULMONARY ARTERY
AORTIC SUSPENSION (AORTOPEXY) FOR TRACHEAL DECOMPRESSION (EG, FOR TRACHEOMALACIA
DIVISION OF ABERRANT VESSEL (VASCULAR RING);
DIVISION OF ABERRANT VESSEL (VASCULAR RING); WITH REANASTOMOSIS
OBLITERATION OF AORTOPULMONARY SEPTAL DEFECT; WITHOUT CARDIOPULMONARY BYPASS
OBLITERATION OF AORTOPULMONARY SEPTAL DEFECT; WITH CARDIOPULMONARY BYPASS
REPAIR OF PATENT DUCTUS ARTERIOSUS; BY LIGATION
REPAIR OF PATENT DUCTUS ARTERIOSUS; BY DIVISION, UNDER 18 YEARS
REPAIR OF PATENT DUCTUS ARTERIOSUS; BY DIVISION, 18 YEARS AND OLDER
EXCISION OF COARCTATION OF AORTA, WITH OR WITHOUT ASSOCIATED PATENT DUCTUS
EXCISION OF COARCTATION OF AORTA, WITH OR WITHOUT ASSOCIATED PATENT DUCTUS
EXCISION OF COARCTATION OF AORTA, WITH OR WITHOUT ASSOCIATED PATENT DUCTUS
REPAIR OF HYPOPLASTIC OR INTERRUPTED AORTIC ARCH USING AUTOGENOUS OR PROSTHETIC
REPAIR OF HYPOPLASTIC OR INTERRUPTED AORTIC ARCH USING AUTOGENOUS OR PROSTHETIC
ASCENDING AORTA GRAFT, WITH CARDIOPULMONARY BYPASS, INCLUDES VALVE SUSPENSION, W
ASCENDING AORTA GRAFT, WITH CARDIOPULMONARY BYPASS, WITH AORTIC ROOT REPLACEMENT
ASCENDING AORTA GRAFT, WITH CARDIOPULMONARY BYPASS WITH VALVE SUSPENSION, WITH C
TRANSVERSE ARCH GRAFT, WITH CARDIOPULMONARY BYPASS
DESCENDING THORACIC AORTA GRAFT, WITH OR WITHOUT BYPASS
REPAIR OF THORACOABDOMINAL AORTIC ANEURYSM WITH GRAFT, WITH OR WITHOUT
ENDOVASCULAR REPAIR OF DESCENDING THORACIC AORTA (EG, ANEURYSM, PSEUDOANEURYSM,
ENDOVASCULAR REPAIR OF DESCENDING THORACIC AORTA (EG, ANEURYSM, PSEUDOANEURYSM,
PLACEMENT OF PROXIMAL EXTENSION PROSTHESIS FOR ENDOVASCULAR REPAIR OF DESCENDING
PLACEMENT OF PROXIMAL EXTENSION PROSTHESIS FOR ENDOVASCULAR REPAIR OF DESCENDING
PLACEMENT OF DISTAL EXTENSION PROSTHESIS(S) DELAYED AFTER ENDOVASCULAR REPAIR OF
OPEN SUBCLAVIAN TO CAROTID ARTERY TRANSPOSITION PERFORMED IN CONJUNCTION WITH EN
BYPASS GRAFT, WITH OTHER THAN VEIN, TRANSCERVICAL RETROPHARYNGEAL CAROTID-CAROTI
PULMONARY ARTERY EMBOLECTOMY; WITH CARDIOPULMONARY BYPASS
PULMONARY ARTERY EMBOLECTOMY; WITHOUT CARDIOPULMONARY BYPASS
PULMONARY ENDARTERECTOMY, WITH OR WITHOUT EMBOLECTOMY, WITH CARDIOPULMONARY
REPAIR OF PULMONARY ARTERY STENOSIS BY RECONSTRUCTION WITH PATCH OR GRAFT
REPAIR OF PULMONARY ATRESIA WITH VENTRICULAR SEPTAL DEFECT, BY CONSTRUCTION OR
TRANSECTION OF PULMONARY ARTERY WITH CARDIOPULMONARY BYPASS
LIGATION AND TAKEDOWN OF A SYSTEMIC-TO-PULMONARY ARTERY SHUNT, PERFORMED IN
REPAIR OF PULMONARY ARTERY ARBORIZATION ANOMALIES BY UNIFOCALIZATION; WITHOUT CA
REPAIR OF PULMONARY ARTERY ARBORIZATION ANOMALIES BY UNIFOCALIZATION; WITH CARDI
DONOR CARDIECTOMY-PNEUMONECTOMY (INCLUDING COLD PRESERVATION)
BACKBENCH STANDARD PREPARATION OF CADAVER DONOR HEART/LUNG ALLOGRAFT PRIOR TO
HEART-LUNG TRANSPLANT WITH RECIPIENT CARDIECTOMY-PNEUMONECTOMY
DONOR CARDIECTOMY (INCLUDING COLD PRESERVATION)
BACKBENCH STANDARD PREPARATION OF CADAVER DONOR HEART ALLOGRAFT PRIOR TO
HEART TRANSPLANT, WITH OR WITHOUT RECIPIENT CARDIECTOMY
PROLONGED EXTRACORPOREAL CIRCULATION FOR CARDIOPULMONARY INSUFFICIENCY; INITIAL
PROLONGED EXTRACORPOREAL CIRCULATION FOR CARDIOPULMONARY INSUFFICIENCY; EACH
INSERTION OF INTRA-AORTIC BALLOON ASSIST DEVICE, PERCUTANEOUS
REMOVAL OF INTRA-AORTIC BALLOON ASSIST DEVICE, PERCUTANEOUS
INSERTION OF INTRA-AORTIC BALLOON ASSIST DEVICE THROUGH THE FEMORAL ARTERY,
REMOVAL OF INTRA-AORTIC BALLOON ASSIST DEVICE INCLUDING REPAIR OF FEMORAL
INSERTION OF INTRA-AORTIC BALLOON ASSIST DEVICE THROUGH THE ASCENDING AORTA
REMOVAL OF INTRA-AORTIC BALLOON ASSIST DEVICE FROM THE ASCENDING AORTA,
INSERTION OF VENTRICULAR ASSIST DEVICE; EXTRACORPOREAL, SINGLE VENTRICLE
INSERTION OF VENTRICULAR ASSIST DEVICE; EXTRACORPOREAL, BIVENTRICULAR
REMOVAL OF VENTRICULAR ASSIST DEVICE; EXTRACORPOREAL, SINGLE VENTRICLE
REMOVAL OF VENTRICULAR ASSIST DEVICE; EXTRACORPOREAL, BIVENTRICULAR
INSERTION OF VENTRICULAR ASSIST DEVICE, IMPLANTABLE INTRACORPOREAL, SINGLE
REMOVAL OF VENTRICULAR ASSIST DEVICE, IMPLANTABLE INTRACORPOREAL, SINGLE
Replacement of extracorporeal ventricular assist device, single or biventricular
Replacement of ventricular assist device pump(s); implantable intracorporeal, si
Replacement of ventricular assist device pump(s); implantable intracorporeal, si
EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; CAROTID, SUBCLAVIAN OR IN
EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; INNOMINATE, SUBCLAVIAN
EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; RENAL, CELIAC,
THROMBECTOMY, DIRECT OR WITH CATHETER; VENA CAVA, ILIAC VEIN, BY ABDOMINAL INCIS
THROMBECTOMY, DIRECT OR WITH CATHETER; VENA CAVA, ILIAC, FEMOROPOPLITEAL VEIN,
RECONSTRUCTION OF VENA CAVA, ANY METHOD
ENDOVASCULAR REPAIR OF INFRARENAL ABDOMINAL AORTIC ANEURYSM OR DISSECTION; USING
ENDOVASCULAR REPAIR OF INFRARENAL ABDOMINAL AORTIC ANEURYSM OR DISSECTION;
ENDOVASCULAR REPAIR OF INFRARENAL ABDOMINAL AORTIC ANEURYSM OR DISSECTION;
ENDOVASCULAR REPAIR OF INFRARENAL ABDOMINAL AORTIC ANEURYSM OR DISSECTION;
ENDOVASCULAR REPAIR OF INFRARENAL ABDOMINAL AORTIC ANEURYSM OR DISSECTION;
ENDOVASCULAR PLACEMENT OF ILIAC ARTERY OCCLUSION DEVICE (LIST SEPARATELY IN
OPEN FEMORAL ARTERY EXPOSURE FOR DELIVERY OF ENDOVASCULAR PROSTHESIS, BY GROIN
PLACEMENT OF FEMORAL-FEMORAL PROSTHETIC GRAFT DURING ENDOVASCULAR AORTIC
OPEN ILIAC ARTERY EXPOSURE FOR DELIVERY OF ENDOVASCULAR PROSTHESIS OR ILIAC
PLACEMENT OF PROXIMAL OR DISTAL EXTENSION PROSTHESIS FOR ENDOVASCULAR REPAIR OF
PLACEMENT OF PROXIMAL OR DISTAL EXTENSION PROSTHESIS FOR ENDOVASCULAR REPAIR OF
OPEN REPAIR OF INFRARENAL AORTIC ANEURYSM OR DISSECTION, PLUS REPAIR OF
OPEN REPAIR OF INFRARENAL AORTIC ANEURYSM OR DISSECTION, PLUS REPAIR OF
OPEN REPAIR OF INFRARENAL AORTIC ANEURYSM OR DISSECTION, PLUS REPAIR OF
OPEN ILIAC ARTERY EXPOSURE WITH CREATION OF CONDUIT FOR DELIVERY OF AORTIC OR IL
OPEN BRACHIAL ARTERY EXPOSURE TO ASSIST IN THE DEPLOYMENT OF AORTIC OR ILIAC END
ENDOVASCULAR REPAIR OF ILIAC ARTERY (EG, ANEURYSM, PSEUDOANEURYSM, ARTERIOVENOUS
DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND GR
DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND
REPAIR, CONGENITAL ARTERIOVENOUS FISTULA; THORAX AND ABDOMEN
REPAIR, ACQUIRED OR TRAUMATIC ARTERIOVENOUS FISTULA; THORAX AND ABDOMEN
REPAIR BLOOD VESSEL, DIRECT; INTRATHORACIC, WITH BYPASS
REPAIR BLOOD VESSEL, DIRECT; INTRATHORACIC, WITHOUT BYPASS
REPAIR BLOOD VESSEL, DIRECT; INTRA-ABDOMINAL
REPAIR BLOOD VESSEL WITH VEIN GRAFT; INTRATHORACIC, WITH BYPASS
REPAIR BLOOD VESSEL WITH VEIN GRAFT; INTRATHORACIC, WITHOUT BYPASS
REPAIR BLOOD VESSEL WITH VEIN GRAFT; INTRA-ABDOMINAL
REPAIR BLOOD VESSEL WITH GRAFT OTHER THAN VEIN; INTRATHORACIC, WITH BYPASS
REPAIR BLOOD VESSEL WITH GRAFT OTHER THAN VEIN; INTRATHORACIC, WITHOUT BYPASS
REPAIR BLOOD VESSEL WITH GRAFT OTHER THAN VEIN; INTRA-ABDOMINAL
THROMBOENDARTERECTOMY, INCLUDING PATCH GRAFT, IF PERFORMED; CAROTID, VERTEBRAL,
THROMBOENDARTERECTOMY, INCLUDING PATCH GRAFT, IF PERFORMED; SUPERFICIAL FEMORAL
THROMBOENDARTERECTOMY, INCLUDING PATCH GRAFT, IF PERFORMED; POPLITEAL ARTERY
THROMBOENDARTERECTOMY, INCLUDING PATCH GRAFT, IF PERFORMED; TIBIOPERONEAL TRUNK
THROMBOENDARTERECTOMY, INCLUDING PATCH GRAFT, IF PERFORMED; TIBIAL OR PERONEAL A
THROMBOENDARTERECTOMY, INCLUDING PATCH GRAFT, IF PERFORMED; EACH ADDITIONAL TIBI
THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; SUBCLAVIAN, INNOMINATE, BY
THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; ABDOMINAL AORTA
THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; MESENTERIC, CELIAC, OR RENAL
THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; ILIAC
THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; ILIOFEMORAL
THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; COMBINED AORTOILIAC
THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; COMBINED AORTOILIOFEMORAL
THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; COMMON FEMORAL
THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; DEEP (PROFUNDA) FEMORAL
REOPERATION, CAROTID, THROMBOENDARTERECTOMY, MORE THAN ONE MONTH AFTER ORIGINAL
ANGIOSCOPY (NON-CORONARY VESSELS OR GRAFTS) DURING THERAPEUTIC INTERVENTION (LIS
TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; RENAL OR OTHER VISCERAL ARTERY
TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; AORTIC
BYPASS GRAFT, WITH VEIN; COMMON CAROTID-IPSILATERAL INTERNAL CAROTID
BYPASS GRAFT, WITH VEIN; CAROTID-SUBCLAVIAN OR SUBCLAVIAN-CAROTID
BYPASS GRAFT, WITH VEIN; CAROTID-VERTEBRAL
BYPASS GRAFT, WITH VEIN; CAROTID-CONTRALATERAL CAROTID
BYPASS GRAFT, WITH VEIN; CAROTID-BRACHIAL
BYPASS GRAFT, WITH VEIN; SUBCLAVIAN-SUBCLAVIAN
BYPASS GRAFT, WITH VEIN; SUBCLAVIAN-BRACHIAL
BYPASS GRAFT, WITH VEIN; SUBCLAVIAN-VERTEBRAL
BYPASS GRAFT, WITH VEIN; SUBCLAVIAN-AXILLARY
BYPASS GRAFT, WITH VEIN; AXILLARY-AXILLARY
BYPASS GRAFT, WITH VEIN; AXILLARY-FEMORAL
BYPASS GRAFT, WITH VEIN; AXILLARY-BRACHIAL
BYPASS GRAFT, WITH VEIN; BRACHIAL-ULNAR OR -RADIAL
BYPASS GRAFT, WITH VEIN; BRACHIAL-BRACHIAL
BYPASS GRAFT, WITH VEIN; AORTOSUBCLAVIAN, AORTOINNOMINATE, OR AORTOCAROTID
BYPASS GRAFT, WITH VEIN; AORTOCELIAC OR AORTOMESENTERIC
BYPASS GRAFT, WITH VEIN; AXILLARY-FEMORAL-FEMORAL
Bypass graft, with vein; hepatorenal
BYPASS GRAFT, WITH VEIN; SPLENORENAL
BYPASS GRAFT, WITH VEIN; AORTOILIAC
BYPASS GRAFT, WITH VEIN; AORTOBI-ILIAC
BYPASS GRAFT, WITH VEIN; AORTOFEMORAL
BYPASS GRAFT, WITH VEIN; AORTOBIFEMORAL
BYPASS GRAFT, WITH VEIN; FEMORAL-POPLITEAL
BYPASS GRAFT, WITH VEIN; FEMORAL-FEMORAL
BYPASS GRAFT, WITH VEIN; AORTORENAL
BYPASS GRAFT, WITH VEIN; ILIOILIAC
BYPASS GRAFT, WITH VEIN; ILIOFEMORAL
BYPASS GRAFT, WITH VEIN; FEMORAL-ANTERIOR TIBIAL, POSTERIOR TIBIAL, PERONEAL
Bypass graft, with vein; tibial-tibial, peroneal-tibial, or tibial/peroneal trun
BYPASS GRAFT, WITH VEIN; POPLITEAL-TIBIAL, -PERONEAL ARTERY OR OTHER DISTAL
IN-SITU VEIN BYPASS; FEMORAL-POPLITEAL
IN-SITU VEIN BYPASS; FEMORAL-ANTERIOR TIBIAL, POSTERIOR TIBIAL, OR PERONEAL
IN-SITU VEIN BYPASS; POPLITEAL-TIBIAL, PERONEAL
HARVEST OF UPPER EXTREMITY ARTERY, ONE SEGMENT, FOR CORONARY ARTERY BYPASS PROCE
BYPASS GRAFT, WITH OTHER THAN VEIN; COMMON CAROTID-IPSILATERAL INTERNAL CAROTID
BYPASS GRAFT, WITH OTHER THAN VEIN; CAROTID-SUBCLAVIAN
BYPASS GRAFT, WITH OTHER THAN VEIN; SUBCLAVIAN-SUBCLAVIAN
BYPASS GRAFT, WITH OTHER THAN VEIN; SUBCLAVIAN-AXILLARY
BYPASS GRAFT, WITH OTHER THAN VEIN; AXILLARY-FEMORAL
BYPASS GRAFT, WITH OTHER THAN VEIN; AXILLARY-POPLITEAL OR -TIBIAL
BYPASS GRAFT, WITH OTHER THAN VEIN; AORTOSUBCLAVIAN, AORTOINNOMINATE, OR AORTOCA
BYPASS GRAFT, WITH OTHER THAN VEIN; AORTOCELIAC, AORTOMESENTERIC, AORTORENAL
Bypass graft, with other than vein; ilio-celiac
Bypass graft, with other than vein; ilio-mesenteric
Bypass graft, with other than vein; iliorenal
BYPASS GRAFT, WITH OTHER THAN VEIN; SPLENORENAL (SPLENIC TO RENAL ARTERIAL
BYPASS GRAFT, WITH OTHER THAN VEIN; AORTOILIAC
BYPASS GRAFT, WITH OTHER THAN VEIN; AORTOBI-ILIAC
BYPASS GRAFT, WITH OTHER THAN VEIN; CAROTID-VERTEBRAL
BYPASS GRAFT, WITH OTHER THAN VEIN; SUBCLAVIAN-VERTEBRAL
BYPASS GRAFT, WITH OTHER THAN VEIN; AORTOBIFEMORAL
BYPASS GRAFT, WITH OTHER THAN VEIN; AORTOFEMORAL
BYPASS GRAFT, WITH OTHER THAN VEIN; AXILLARY-AXILLARY
BYPASS GRAFT, WITH OTHER THAN VEIN; AXILLARY-FEMORAL-FEMORAL
BYPASS GRAFT, WITH OTHER THAN VEIN; FEMORAL-POPLITEAL
BYPASS GRAFT, WITH OTHER THAN VEIN; FEMORAL-FEMORAL
BYPASS GRAFT, WITH OTHER THAN VEIN; ILIOILIAC
BYPASS GRAFT, WITH OTHER THAN VEIN; ILIOFEMORAL
BYPASS GRAFT, WITH OTHER THAN VEIN; FEMORAL-ANTERIOR TIBIAL, POSTERIOR TIBIAL,
BYPASS GRAFT, WITH OTHER THAN VEIN; POPLITEAL-TIBIAL OR -PERONEAL ARTERY
BYPASS GRAFT; COMPOSITE, PROSTHETIC AND VEIN (LIST SEPARATELY IN ADDITION TO COD
BYPASS GRAFT; AUTOGENOUS COMPOSITE, TWO SEGMENTS OF VEINS FROM TWO LOCATIONS
TRANSPOSITION AND/OR REIMPLANTATION; VERTEBRAL TO CAROTID ARTERY
TRANSPOSITION AND/OR REIMPLANTATION; VERTEBRAL TO SUBCLAVIAN ARTERY
TRANSPOSITION AND/OR REIMPLANTATION; SUBCLAVIAN TO CAROTID ARTERY
TRANSPOSITION AND/OR REIMPLANTATION; CAROTID TO SUBCLAVIAN ARTERY
REIMPLANTATION, VISCERAL ARTERY TO INFRARENAL AORTIC PROSTHESIS, EACH ARTERY
REOPERATION, FEMORAL-POPLITEAL OR FEMORAL (POPLITEAL) -ANTERIOR TIBIAL, POSTERIO
EXPLORATION (NOT FOLLOWED BY SURGICAL REPAIR), WITH OR WITHOUT LYSIS OF ARTERY;
EXPLORATION (NOT FOLLOWED BY SURGICAL REPAIR), WITH OR WITHOUT LYSIS OF ARTERY;
EXPLORATION (NOT FOLLOWED BY SURGICAL REPAIR), WITH OR WITHOUT LYSIS OF ARTERY;
EXPLORATION FOR POSTOPERATIVE HEMORRHAGE, THROMBOSIS OR INFECTION; NECK
EXPLORATION FOR POSTOPERATIVE HEMORRHAGE, THROMBOSIS OR INFECTION; CHEST
EXPLORATION FOR POSTOPERATIVE HEMORRHAGE, THROMBOSIS OR INFECTION; ABDOMEN
REPAIR OF GRAFT-ENTERIC FISTULA
EXCISION OF INFECTED GRAFT; NECK
EXCISION OF INFECTED GRAFT; THORAX
EXCISION OF INFECTED GRAFT; ABDOMEN
Selective catheter placement (first-order), main renal artery and any accessory
Selective catheter placement (first-order), main renal artery and any accessory
Superselective catheter placement (one or more second order or higher renal arte
Superselective catheter placement (one or more second order or higher renal arte
COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE
VENIPUNCTURE, CUTDOWN; UNDER AGE 1 YEAR
VENIPUNCTURE, CUTDOWN; AGE 1 OR OVER
COLLECTION OF BLOOD SPECIMEN FROM A COMPLETELY IMPLANTABLE VENOUS ACCESS DEVICE
COLLECTION OF BLOOD SPECIMEN USING ESTABLISHED CENTRAL OR PERIPHERAL CATHETER, V
ARTERIAL PUNCTURE, WITHDRAWAL OF BLOOD FOR DIAGNOSIS
CATHETERIZATION, UMBILICAL ARTERY, NEWBORN, FOR DIAGNOSIS OR THERAPY
INSERTION OF CANNULA(S) FOR PROLONGED EXTRACORPOREAL CIRCULATION FOR
INSERTION OF ARTERIAL AND VENOUS CANNULA(S) FOR ISOLATED EXTRACORPOREAL
VENOUS ANASTOMOSIS, OPEN; PORTOCAVAL
VENOUS ANASTOMOSIS, OPEN; RENOPORTAL
VENOUS ANASTOMOSIS, OPEN; CAVAL-MESENTERIC
VENOUS ANASTOMOSIS, OPEN; SPLENORENAL, PROXIMAL
VENOUS ANASTOMOSIS, OPEN; SPLENORENAL, DISTAL (SELECTIVE DECOMPRESSION OF
INSERTION OF TRANSVENOUS INTRAHEPATIC PORTOSYSTEMIC SHUNT(S) (TIPS) (INCLUDE3
TRANSCATHETER PLACEMENT OF INTRAVASCULAR STENT(S), CERVICAL CAROTID ARTERY,
TRANSCATHETER PLACEMENT OF INTRAVASCULAR STENT(S), CERVICAL CAROTID ARTERY,
LIGATION, MAJOR ARTERY (EG, POST-TRAUMATIC, RUPTURE); CHEST
LIGATION, MAJOR ARTERY (EG, POST-TRAUMATIC, RUPTURE); ABDOMEN
LIGATION, MAJOR ARTERY (EG, POST-TRAUMATIC, RUPTURE); EXTREMITY
LIGATION OF COMMON ILIAC VEIN
PENILE REVASCULARIZATION, ARTERY, WITH OR WITHOUT VEIN GRAFT
UNLISTED PROCEDURE, VASCULAR SURGERY
SPLENECTOMY (SEPARATE PROCEDURE); TOTAL
SPLENECTOMY; PARTIAL (SEPARATE PROCEDURE)
SPLENECTOMY; TOTAL, EN BLOC FOR EXTENSIVE DISEASE, IN CONJUNCTION WITH OTHER
REPAIR OF RUPTURED SPLEEN (SPLENORRHAPHY) WITH OR WITHOUT PARTIAL SPLENECTOMY
BLOOD-DERIVED HEMATOPOIETIC PROGENITOR CELL HARVESTING FOR TRANSPLANTATION, PER
SUTURE AND/OR LIGATION OF THORACIC DUCT; CERVICAL APPROACH
SUTURE AND/OR LIGATION OF THORACIC DUCT; THORACIC APPROACH
SUTURE AND/OR LIGATION OF THORACIC DUCT; ABDOMINAL APPROACH
LIMITED LYMPHADENECTOMY FOR STAGING (SEPARATE PROCEDURE); PELVIC AND PARA-AORTIC
LIMITED LYMPHADENECTOMY FOR STAGING (SEPARATE PROCEDURE); RETROPERITONEAL
CERVICAL LYMPHADENECTOMY (MODIFIED RADICAL NECK DISSECTION)
THORACIC LYMPHADENECTOMY, REGIONAL, INCLUDING MEDIASTINAL AND PERITRACHEAL
ABDOMINAL LYMPHADENECTOMY, REGIONAL, INCLUDING CELIAC, GASTRIC, PORTAL,
INGUINOFEMORAL LYMPHADENECTOMY, SUPERFICIAL, IN CONTINUITY WITH PELVIC
PELVIC LYMPHADENECTOMY, INCLUDING EXTERNAL ILIAC, HYPOGASTRIC, AND OBTURATOR
RETROPERITONEAL TRANSABDOMINAL LYMPHADENECTOMY, EXTENSIVE, INCLUDING PELVIC,
INJECTION PROCEDURE; FOR IDENTIFICATION OF SENTINEL NODE
MEDIASTINOTOMY WITH EXPLORATION, DRAINAGE, REMOVAL OF FOREIGN BODY, OR BIOPSY; C
MEDIASTINOTOMY WITH EXPLORATION, DRAINAGE, REMOVAL OF FOREIGN BODY, OR BIOPSY;
EXCISION OF MEDIASTINAL CYST
EXCISION OF MEDIASTINAL TUMOR
UNLISTED PROCEDURE, MEDIASTINUM
REPAIR, LACERATION OF DIAPHRAGM, ANY APPROACH
REPAIR, NEONATAL DIAPHRAGMATIC HERNIA, WITH OR WITHOUT CHEST TUBE INSERTION AND
REPAIR, DIAPHRAGMATIC HERNIA (OTHER THAN NEONATAL), TRAUMATIC; ACUTE
REPAIR, DIAPHRAGMATIC HERNIA (OTHER THAN NEONATAL), TRAUMATIC; CHRONIC
IMBRICATION OF DIAPHRAGM FOR EVENTRATION, TRANSTHORACIC OR TRANSABDOMINAL,
RESECTION, DIAPHRAGM; WITH SIMPLE REPAIR (EG, PRIMARY SUTURE)
RESECTION, DIAPHRAGM; WITH COMPLEX REPAIR (EG, PROSTHETIC MATERIAL, LOCAL
UNLISTED PROCEDURE, DIAPHRAGM
REMOVAL OF EMBEDDED FOREIGN BODY, VESTIBULE OF MOUTH; SIMPLE
GLOSSECTOMY; HEMIGLOSSECTOMY
GLOSSECTOMY; PARTIAL, WITH UNILATERAL RADICAL NECK DISSECTION
GLOSSECTOMY; COMPLETE OR TOTAL, WITH OR WITHOUT TRACHEOSTOMY, WITHOUT RADICAL
GLOSSECTOMY; COMPLETE OR TOTAL, WITH OR WITHOUT TRACHEOSTOMY, WITH UNILATERAL
GLOSSECTOMY; COMPOSITE PROCEDURE WITH RESECTION FLOOR OF MOUTH AND MANDIBULAR
GLOSSECTOMY; COMPOSITE PROCEDURE WITH RESECTION FLOOR OF MOUTH, WITH SUPRAHYOID
GLOSSECTOMY; COMPOSITE PROCEDURE WITH RESECTION FLOOR OF MOUTH, MANDIBULAR
EXCISION OF PAROTID TUMOR OR PAROTID GLAND; TOTAL, WITH UNILATERAL RADICAL NECK
REMOVAL OF FOREIGN BODY FROM PHARYNX
RADICAL RESECTION OF TONSIL, TONSILLAR PILLARS, AND/OR RETROMOLAR TRIGONE;
RESECTION OF PHARYNGEAL WALL REQUIRING CLOSURE WITH MYOCUTANEOUS OR FASCIOCUTANE
PHARYNGOESOPHAGEAL REPAIR
CONTROL OROPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG,
CONTROL OF NASOPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG,
ESOPHAGOTOMY, THORACIC APPROACH, WITH REMOVAL OF FOREIGN BODY
EXCISION OF LESION, ESOPHAGUS, WITH PRIMARY REPAIR; CERVICAL APPROACH
EXCISION OF LESION, ESOPHAGUS, WITH PRIMARY REPAIR; THORACIC OR ABDOMINAL
TOTAL OR NEAR TOTAL ESOPHAGECTOMY, WITHOUT THORACOTOMY; WITH
TOTAL OR NEAR TOTAL ESOPHAGECTOMY, WITHOUT THORACOTOMY; WITH COLON
TOTAL OR NEAR TOTAL ESOPHAGECTOMY, WITH THORACOTOMY; WITH PHARYNGOGASTROSTOMY
TOTAL OR NEAR TOTAL ESOPHAGECTOMY, WITH THORACOTOMY; WITH COLON INTERPOSITION
PARTIAL ESOPHAGECTOMY, CERVICAL, WITH FREE INTESTINAL GRAFT, INCLUDING
PARTIAL ESOPHAGECTOMY, DISTAL TWO-THIRDS, WITH THORACOTOMY AND SEPARATE
PARTIAL ESOPHAGECTOMY, DISTAL TWO-THIRDS, WITH THORACOTOMY AND SEPARATE
PARTIAL ESOPHAGECTOMY, DISTAL TWO-THIRDS, WITH THORACOTOMY ONLY, WITH OR
PARTIAL ESOPHAGECTOMY, THORACOABDOMINAL OR ABDOMINAL APPROACH, WITH OR WITHOUT
PARTIAL ESOPHAGECTOMY, THORACOABDOMINAL OR ABDOMINAL APPROACH, WITH OR WITHOUT
TOTAL OR PARTIAL ESOPHAGECTOMY, WITHOUT RECONSTRUCTION (ANY APPROACH), WITH
DIVERTICULECTOMY OF HYPOPHARYNX OR ESOPHAGUS, WITH OR WITHOUT MYOTOMY; THORACIC
Laparoscopy, surgical, esophagomyotomy (Heller type), with fundoplasty, when per
Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, wh
Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, wh
LAPAROSCOPY, SURGICAL, ESOPHAGEAL LENGTHENING PROCEDURE (EG, COLLIS GASTROPLASTY
ESOPHAGOPLASTY (PLASTIC REPAIR OR RECONSTRUCTION), CERVICAL APPROACH; WITHOUT RE
ESOPHAGOPLASTY (PLASTIC REPAIR OR RECONSTRUCTION), CERVICAL APPROACH; WITH
ESOPHAGOPLASTY (PLASTIC REPAIR OR RECONSTRUCTION), THORACIC APPROACH; WITHOUT
ESOPHAGOPLASTY (PLASTIC REPAIR OR RECONSTRUCTION), THORACIC APPROACH; WITH
ESOPHAGOPLASTY FOR CONGENITAL DEFECT (PLASTIC REPAIR OR RECONSTRUCTION),
ESOPHAGOPLASTY FOR CONGENITAL DEFECT (PLASTIC REPAIR OR RECONSTRUCTION),
ESOPHAGOGASTROSTOMY (CARDIOPLASTY), WITH OR WITHOUT VAGOTOMY AND PYLOROPLASTY,
ESOPHAGOGASTRIC FUNDOPLASTY; WITH FUNDIC PATCH (THAL-NISSEN PROCEDURE)
ESOPHAGOGASTRIC FUNDOPLASTY PARTIAL OR COMPLETE; LAPAROTOMY
ESOPHAGOGASTRIC FUNDOPLASTY PARTIAL OR COMPLETE; THORACOTOMY
ESOPHAGOMYOTOMY (HELLER TYPE); ABDOMINAL APPROACH
ESOPHAGOMYOTOMY (HELLER TYPE); THORACIC APPROACH
REPAIR, PARAESOPHAGEAL HIATAL HERNIA (INCLUDING FUNDOPLICATION), VIA LAPAROTOMY,
REPAIR, PARAESOPHAGEAL HIATAL HERNIA (INCLUDING FUNDOPLICATION), VIA LAPAROTOMY,
REPAIR, PARAESOPHAGEAL HIATAL HERNIA (INCLUDING FUNDOPLICATION), VIA THORACOTOMY
REPAIR, PARAESOPHAGEAL HIATAL HERNIA (INCLUDING FUNDOPLICATION), VIA THORACOTOMY
REPAIR, PARAESOPHAGEAL HIATAL HERNIA, (INCLUDING FUNDOPLICATION), VIA THORACOABD
REPAIR, PARAESOPHAGEAL HIATAL HERNIA, (INCLUDING FUNDOPLICATION), VIA THORACOABD
ESOPHAGEAL LENGTHENING PROCEDURE (EG, COLLIS GASTROPLASTY OR WEDGE GASTROPLASTY)
ESOPHAGOJEJUNOSTOMY (WITHOUT TOTAL GASTRECTOMY); ABDOMINAL APPROACH
ESOPHAGOJEJUNOSTOMY (WITHOUT TOTAL GASTRECTOMY); THORACIC APPROACH
ESOPHAGOSTOMY, FISTULIZATION OF ESOPHAGUS, EXTERNAL; ABDOMINAL APPROACH
ESOPHAGOSTOMY, FISTULIZATION OF ESOPHAGUS, EXTERNAL; THORACIC APPROACH
ESOPHAGOSTOMY, FISTULIZATION OF ESOPHAGUS, EXTERNAL; CERVICAL APPROACH
GASTROINTESTINAL RECONSTRUCTION FOR PREVIOUS ESOPHAGECTOMY, FOR OBSTRUCTING
GASTROINTESTINAL RECONSTRUCTION FOR PREVIOUS ESOPHAGECTOMY, FOR OBSTRUCTING
LIGATION, DIRECT, ESOPHAGEAL VARICES
TRANSECTION OF ESOPHAGUS WITH REPAIR, FOR ESOPHAGEAL VARICES
LIGATION OR STAPLING AT GASTROESOPHAGEAL JUNCTION FOR PRE-EXISTING ESOPHAGEAL
SUTURE OF ESOPHAGEAL WOUND OR INJURY; CERVICAL APPROACH
SUTURE OF ESOPHAGEAL WOUND OR INJURY; TRANSTHORACIC OR TRANSABDOMINAL APPROACH
CLOSURE OF ESOPHAGOSTOMY OR FISTULA; TRANSTHORACIC OR TRANSABDOMINAL APPROACH
ESOPHAGOGASTRIC TAMPONADE, WITH BALLOON (SENGSTAKEN TYPE)
FREE JEJUNUM TRANSFER WITH MICROVASCULAR ANASTOMOSIS
GASTROTOMY; WITH EXPLORATION OR FOREIGN BODY REMOVAL
GASTROTOMY; WITH SUTURE REPAIR OF BLEEDING ULCER
GASTROTOMY; WITH SUTURE REPAIR OF PRE-EXISTING ESOPHAGOGASTRIC LACERATION (EG,
PYLOROMYOTOMY, CUTTING OF PYLORIC MUSCLE (FREDET-RAMSTEDT TYPE OPERATION)
BIOPSY OF STOMACH, BY LAPAROTOMY
EXCISION, LOCAL; ULCER OR BENIGN TUMOR OF STOMACH
EXCISION, LOCAL; MALIGNANT TUMOR OF STOMACH
GASTRECTOMY, TOTAL; WITH ESOPHAGOENTEROSTOMY
GASTRECTOMY, TOTAL; WITH ROUX-EN-Y RECONSTRUCTION
GASTRECTOMY, TOTAL; WITH FORMATION OF INTESTINAL POUCH, ANY TYPE
GASTRECTOMY, PARTIAL, DISTAL; WITH GASTRODUODENOSTOMY
GASTRECTOMY, PARTIAL, DISTAL; WITH GASTROJEJUNOSTOMY
GASTRECTOMY, PARTIAL, DISTAL; WITH ROUX-EN-Y RECONSTRUCTION
GASTRECTOMY, PARTIAL, DISTAL; WITH FORMATION OF INTESTINAL POUCH
VAGOTOMY WHEN PERFORMED WITH PARTIAL DISTAL GASTRECTOMY (LIST SEPARATELY IN
VAGOTOMY INCLUDING PYLOROPLASTY, WITH OR WITHOUT GASTROSTOMY; TRUNCAL OR
VAGOTOMY INCLUDING PYLOROPLASTY, WITH OR WITHOUT GASTROSTOMY; PARIETAL CELL
LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; WITH GASTRIC BYPASS AND RO
LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; WITH GASTRIC BYPASS AND
NASO- OR ORO-GASTRIC TUBE PLACEMENT, REQUIRING PHYSICIAN'S SKILL AND
GASTRIC INTUBATION AND ASPIRATION(S) THERAPEUTIC, NECESSITATING PHYSICIAN'S SKIL
GASTRIC INTUBATION AND ASPIRATION, DIAGNOSTIC; SINGLE SPECIMEN (EG, ACID ANALYSI
DUODENAL INTUBATION AND ASPIRATION, DIAGNOSTIC, INCLUDES IMAGE GUIDANCE; SINGLE
DUODENAL INTUBATION AND ASPIRATION, DIAGNOSTIC, INCLUDES IMAGE GUIDANCE; COLLECT
LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; PLACEMENT OF ADJUSTABLE GA
LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; REVISION OF ADJUSTABLE GAS
LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; REMOVAL OF ADJUSTABLE GAST
LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; REMOVAL AND REPLACEMENT OF
LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; REMOVAL OF ADJUSTABLE GAST
Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (
PYLOROPLASTY
GASTRODUODENOSTOMY
GASTROJEJUNOSTOMY; WITHOUT VAGOTOMY
GASTROJEJUNOSTOMY; WITH VAGOTOMY, ANY TYPE
GASTROSTOMY, OPEN; WITH CONSTRUCTION OF GASTRIC TUBE (EG, JANEWAY PROCEDURE)
GASTRORRHAPHY, SUTURE OF PERFORATED DUODENAL OR GASTRIC ULCER, WOUND, OR INJURY
GASTRIC RESTRICTIVE PROCEDURE, WITHOUT GASTRIC BYPASS, FOR MORBID OBESITY;
GASTRIC RESTRICTIVE PROCEDURE, WITHOUT GASTRIC BYPASS, FOR MORBID OBESITY;
GASTRIC RESTRICTIVE PROCEDURE WITH PARTIAL GASTRECTOMY, PYLORUS-PRESERVING
GASTRIC RESTRICTIVE PROCEDURE, WITH GASTRIC BYPASS FOR MORBID OBESITY; WITH
GASTRIC RESTRICTIVE PROCEDURE, WITH GASTRIC BYPASS FOR MORBID OBESITY; WITH
REVISION, OPEN, OF GASTRIC RESTRICTIVE PROCEDURE FOR MORBID OBESITY, OTHER THAN
REVISION OF GASTRODUODENAL ANASTOMOSIS (GASTRODUODENOSTOMY) WITH
REVISION OF GASTRODUODENAL ANASTOMOSIS (GASTRODUODENOSTOMY) WITH
REVISION OF GASTROJEJUNAL ANASTOMOSIS (GASTROJEJUNOSTOMY) WITH RECONSTRUCTION,
REVISION OF GASTROJEJUNAL ANASTOMOSIS (GASTROJEJUNOSTOMY) WITH RECONSTRUCTION,
CLOSURE OF GASTROCOLIC FISTULA
REVISION OR REMOVAL OF GASTRIC NEUROSTIMULATOR ELECTRODES, ANTRUM, OPEN
ENTEROLYSIS (FREEING OF INTESTINAL ADHESION) (SEPARATE PROCEDURE)
DUODENOTOMY, FOR EXPLORATION, BIOPSY(S), OR FOREIGN BODY REMOVAL
TUBE OR NEEDLE CATHETER JEJUNOSTOMY FOR ENTERAL ALIMENTATION, INTRAOPERATIVE,
ENTEROTOMY, SMALL INTESTINE, OTHER THAN DUODENUM; FOR EXPLORATION, BIOPSY(S),
ENTEROTOMY, SMALL INTESTINE, OTHER THAN DUODENUM; FOR DECOMPRESSION (EG, BAKER
COLOTOMY, FOR EXPLORATION, BIOPSY(S), OR FOREIGN BODY REMOVAL
REDUCTION OF VOLVULUS, INTUSSUSCEPTION, INTERNAL HERNIA, BY LAPAROTOMY
CORRECTION OF MALROTATION BY LYSIS OF DUODENAL BANDS AND/OR REDUCTION OF MIDGUT
EXCISION OF ONE OR MORE LESIONS OF SMALL OR LARGE INTESTINE NOT REQUIRING
EXCISION OF ONE OR MORE LESIONS OF SMALL OR LARGE INTESTINE NOT REQUIRING
ENTERECTOMY, RESECTION OF SMALL INTESTINE; SINGLE RESECTION AND ANASTOMOSIS
ENTERECTOMY, RESECTION OF SMALL INTESTINE; EACH ADDITIONAL RESECTION AND
ENTERECTOMY, RESECTION OF SMALL INTESTINE; WITH ENTEROSTOMY
ENTERECTOMY, RESECTION OF SMALL INTESTINE FOR CONGENITAL ATRESIA, SINGLE
ENTERECTOMY, RESECTION OF SMALL INTESTINE FOR CONGENITAL ATRESIA, SINGLE
ENTERECTOMY, RESECTION OF SMALL INTESTINE FOR CONGENITAL ATRESIA, SINGLE
ENTEROENTEROSTOMY, ANASTOMOSIS OF INTESTINE, WITH OR WITHOUT CUTANEOUS
DONOR ENTERECTOMY (INCLUDING COLD PRESERVATION), OPEN; FROM CADAVER DONOR
DONOR ENTERECTOMY (INCLUDING COLD PRESERVATION), OPEN; PARTIAL, FROM LIVING
INTESTINAL ALLOTRANSPLANTATION; FROM CADAVER DONOR
INTESTINAL ALLOTRANSPLANTATION; FROM LIVING DONOR
REMOVAL OF TRANSPLANTED INTESTINAL ALLOGRAFT, COMPLETE
MOBILIZATION (TAKE-DOWN) OF SPLENIC FLEXURE PERFORMED IN CONJUNCTION WITH
COLECTOMY, PARTIAL; WITH ANASTOMOSIS
COLECTOMY, PARTIAL; WITH SKIN LEVEL CECOSTOMY OR COLOSTOMY
COLECTOMY, PARTIAL; WITH END COLOSTOMY AND CLOSURE OF DISTAL SEGMENT (HARTMANN
COLECTOMY, PARTIAL; WITH RESECTION, WITH COLOSTOMY OR ILEOSTOMY AND CREATION OF
COLECTOMY, PARTIAL; WITH COLOPROCTOSTOMY (LOW PELVIC ANASTOMOSIS)
COLECTOMY, PARTIAL; WITH COLOPROCTOSTOMY (LOW PELVIC ANASTOMOSIS), WITH
COLECTOMY, PARTIAL; ABDOMINAL AND TRANSANAL APPROACH
COLECTOMY, TOTAL, ABDOMINAL, WITHOUT PROCTECTOMY; WITH ILEOSTOMY OR
COLECTOMY, TOTAL, ABDOMINAL, WITHOUT PROCTECTOMY; WITH CONTINENT ILEOSTOMY
COLECTOMY, TOTAL, ABDOMINAL, WITH PROCTECTOMY; WITH ILEOSTOMY
COLECTOMY, TOTAL, ABDOMINAL, WITH PROCTECTOMY; WITH CONTINENT ILEOSTOMY
COLECTOMY, TOTAL, ABDOMINAL, WITH PROCTECTOMY; WITH ILEOANAL ANASTOMOSIS, INCLUD
COLECTOMY, TOTAL, ABDOMINAL, WITH PROCTECTOMY; WITH ILEOANAL ANASTOMOSIS, CREATI
COLECTOMY, PARTIAL, WITH REMOVAL OF TERMINAL ILEUM WITH ILEOCOLOSTOMY
LAPAROSCOPY, SURGICAL; ILEOSTOMY OR JEJUNOSTOMY, NON-TUBE
LAPAROSCOPY, SURGICAL, COLOSTOMY OR SKIN LEVEL CECOSTOMY
LAPAROSCOPY, SURGICAL; ENTERECTOMY, RESECTION OF SMALL INTESTINE, SINGLE RESECTI
LAPAROSCOPY, SURGICAL; EACH ADDITIONAL SMALL INTESTINE RESECTION AND
LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH ANASTOMOSIS
LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH REMOVAL OF TERMINAL ILEUM WITH
LAPAROSCOPY, SURGICAL; COLECTOMY, TOTAL, ABDOMINAL, WITHOUT PROCTECTOMY, WITH
LAPAROSCOPY, SURGICAL; COLECTOMY, TOTAL, ABDOMINAL, WITH PROCTECTOMY, WITH ILEOA
LAPAROSCOPY, SURGICAL; COLECTOMY, TOTAL, ABDOMINAL, WITH PROCTECTOMY, WITH
LAPAROSCOPY, SURGICAL, CLOSURE OF ENTEROSTOMY, LARGE OR SMALL INTESTINE, WITH RE
PLACEMENT, ENTEROSTOMY OR CECOSTOMY, TUBE OPEN (EG, FOR FEEDING OR DECOMPRESSION
ILEOSTOMY OR JEJUNOSTOMY, NON-TUBE
REVISION OF ILEOSTOMY; COMPLICATED (RECONSTRUCTION IN-DEPTH) (SEPARATE
CONTINENT ILEOSTOMY (KOCK PROCEDURE) (SEPARATE PROCEDURE)
COLOSTOMY OR SKIN LEVEL CECOSTOMY;
COLOSTOMY OR SKIN LEVEL CECOSTOMY; WITH MULTIPLE BIOPSIES (EG, FOR CONGENITAL
REVISION OF COLOSTOMY; COMPLICATED (RECONSTRUCTION IN-DEPTH) (SEPARATE
REVISION OF COLOSTOMY; WITH REPAIR OF PARACOLOSTOMY HERNIA (SEPARATE PROCEDURE)
SUTURE OF SMALL INTESTINE (ENTERORRHAPHY) FOR PERFORATED ULCER, DIVERTICULUM, WO
SUTURE OF SMALL INTESTINE (ENTERORRHAPHY) FOR PERFORATED ULCER, DIVERTICULUM,
SUTURE OF LARGE INTESTINE (COLORRHAPHY) FOR PERFORATED ULCER, DIVERTICULUM,
SUTURE OF LARGE INTESTINE (COLORRHAPHY) FOR PERFORATED ULCER, DIVERTICULUM,
INTESTINAL STRICTUROPLASTY (ENTEROTOMY AND ENTERORRHAPHY) WITH OR WITHOUT
CLOSURE OF ENTEROSTOMY, LARGE OR SMALL INTESTINE;
CLOSURE OF ENTEROSTOMY, LARGE OR SMALL INTESTINE; WITH RESECTION AND
CLOSURE OF ENTEROSTOMY, LARGE OR SMALL INTESTINE; WITH RESECTION AND COLORECTAL
CLOSURE OF INTESTINAL CUTANEOUS FISTULA
CLOSURE OF ENTEROENTERIC OR ENTEROCOLIC FISTULA
CLOSURE OF ENTEROVESICAL FISTULA; WITHOUT INTESTINAL OR BLADDER RESECTION
CLOSURE OF ENTEROVESICAL FISTULA; WITH INTESTINE AND/OR BLADDER RESECTION
INTESTINAL PLICATION (SEPARATE PROCEDURE)
EXCLUSION OF SMALL INTESTINE FROM PELVIS BY MESH OR OTHER PROSTHESIS, OR NATIVE
BACKBENCH STANDARD PREPARATION OF CADAVER OR LIVING DONOR INTESTINE ALLOGRAFT
BACKBENCH RECONSTRUCTION OF CADAVER OR LIVING DONOR INTESTINE ALLOGRAFT PRIOR
BACKBENCH RECONSTRUCTION OF CADAVER OR LIVING DONOR INTESTINE ALLOGRAFT PRIOR
EXCISION OF MECKEL'S DIVERTICULUM (DIVERTICULECTOMY) OR OMPHALOMESENTERIC DUCT
EXCISION OF LESION OF MESENTERY (SEPARATE PROCEDURE)
SUTURE OF MESENTERY (SEPARATE PROCEDURE)
UNLISTED PROCEDURE, MECKEL'S DIVERTICULUM AND THE MESENTERY
INCISION AND DRAINAGE OF APPENDICEAL ABSCESS; OPEN
APPENDECTOMY; FOR RUPTURED APPENDIX WITH ABSCESS OR GENERALIZED PERITONITIS
PROCTECTOMY; COMPLETE, COMBINED ABDOMINOPERINEAL, WITH COLOSTOMY
PROCTECTOMY; PARTIAL RESECTION OF RECTUM, TRANSABDOMINAL APPROACH
PROCTECTOMY, COMBINED ABDOMINOPERINEAL, PULL-THROUGH PROCEDURE (EG, COLO-ANAL
PROCTECTOMY, PARTIAL, WITH RECTAL MUCOSECTOMY, ILEOANAL ANASTOMOSIS, CREATION
PROCTECTOMY, PARTIAL, WITH ANASTOMOSIS; ABDOMINAL AND TRANSSACRAL APPROACH
PROCTECTOMY, PARTIAL, WITH ANASTOMOSIS; TRANSSACRAL APPROACH ONLY (KRASKE TYPE)
PROCTECTOMY, COMBINED ABDOMINOPERINEAL PULL-THROUGH PROCEDURE (EG, COLO-ANAL ANA
PROCTECTOMY, COMPLETE (FOR CONGENITAL MEGACOLON), ABDOMINAL AND PERINEAL
PROCTECTOMY, COMPLETE (FOR CONGENITAL MEGACOLON), ABDOMINAL AND PERINEAL
PROCTECTOMY, PARTIAL, WITHOUT ANASTOMOSIS, PERINEAL APPROACH
PELVIC EXENTERATION FOR COLORECTAL MALIGNANCY, WITH PROCTECTOMY (WITH OR
EXCISION OF RECTAL PROCIDENTIA, WITH ANASTOMOSIS; PERINEAL APPROACH
EXCISION OF RECTAL PROCIDENTIA, WITH ANASTOMOSIS; ABDOMINAL AND PERINEAL
EXCISION OF ILEOANAL RESERVOIR WITH ILEOSTOMY
LAPAROSCOPY, SURGICAL; PROCTECTOMY, COMPLETE, COMBINED ABDOMINOPERINEAL, WITH CO
LAPAROSCOPY, SURGICAL; PROCTECTOMY, COMBINED ABDOMINOPERINEAL PULL-THROUGH PROCE
LAPAROSCOPY, SURGICAL; PROCTOPEXY (FOR PROLAPSE)
LAPAROSCOPY, SURGICAL; PROCTOPEXY (FOR PROLAPSE), WITH SIGMOID RESECTION
PROCTOPEXY (EG, FOR PROLAPSE); ABDOMINAL APPROACH
PROCTOPEXY (EG, FOR PROLAPSE); WITH SIGMOID RESECTION, ABDOMINAL APPROACH
EXPLORATION, REPAIR, AND PRESACRAL DRAINAGE FOR RECTAL INJURY;
EXPLORATION, REPAIR, AND PRESACRAL DRAINAGE FOR RECTAL INJURY; WITH COLOSTOMY
CLOSURE OF RECTOVESICAL FISTULA;
CLOSURE OF RECTOVESICAL FISTULA; WITH COLOSTOMY
CLOSURE OF RECTOURETHRAL FISTULA;
CLOSURE OF RECTOURETHRAL FISTULA; WITH COLOSTOMY
ANOSCOPY; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR W
ANOPLASTY, PLASTIC OPERATION FOR STRICTURE; INFANT
REPAIR OF ILEOANAL POUCH FISTULA/SINUS (EG, PERINEAL OR VAGINAL), POUCH ADVANCEM
REPAIR OF ILEOANAL POUCH FISTULA/SINUS (EG, PERINEAL OR VAGINAL), POUCH ADVANCEM
REPAIR OF LOW IMPERFORATE ANUS; WITH ANOPERINEAL FISTULA (CUT-BACK PROCEDURE)
REPAIR OF LOW IMPERFORATE ANUS; WITH TRANSPOSITION OF ANOPERINEAL OR
REPAIR OF HIGH IMPERFORATE ANUS WITHOUT FISTULA; PERINEAL OR SACROPERINEAL
REPAIR OF HIGH IMPERFORATE ANUS WITHOUT FISTULA; COMBINED TRANSABDOMINAL AND
REPAIR OF HIGH IMPERFORATE ANUS WITH RECTOURETHRAL OR RECTOVAGINAL FISTULA;
REPAIR OF HIGH IMPERFORATE ANUS WITH RECTOURETHRAL OR RECTOVAGINAL FISTULA;
REPAIR OF CLOACAL ANOMALY BY ANORECTOVAGINOPLASTY AND URETHROPLASTY,
REPAIR OF CLOACAL ANOMALY BY ANORECTOVAGINOPLASTY AND URETHROPLASTY, COMBINED
REPAIR OF CLOACAL ANOMALY BY ANORECTOVAGINOPLASTY AND URETHROPLASTY, COMBINED
SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE OR PROLAPSE; CHILD
HEPATOTOMY; FOR OPEN DRAINAGE OF ABSCESS OR CYST, ONE OR TWO STAGES
LAPAROTOMY, WITH ASPIRATION AND/OR INJECTION OF HEPATIC PARASITIC (EG, AMOEBIC
BIOPSY OF LIVER, WEDGE
HEPATECTOMY, RESECTION OF LIVER; PARTIAL LOBECTOMY
HEPATECTOMY, RESECTION OF LIVER; TRISEGMENTECTOMY
HEPATECTOMY, RESECTION OF LIVER; TOTAL LEFT LOBECTOMY
HEPATECTOMY, RESECTION OF LIVER; TOTAL RIGHT LOBECTOMY
DONOR HEPATECTOMY (INCLUDING COLD PRESERVATION), FROM CADAVER DONOR
LIVER ALLOTRANSPLANTATION; ORTHOTOPIC, PARTIAL OR WHOLE, FROM CADAVER OR LIVING
LIVER ALLOTRANSPLANTATION; HETEROTOPIC, PARTIAL OR WHOLE, FROM CADAVER OR
DONOR HEPATECTOMY (INCLUDING COLD PRESERVATION), FROM LIVING DONOR; LEFT
DONOR HEPATECTOMY (INCLUDING COLD PRESERVATION), FROM LIVING DONOR; TOTAL LEFT
DONOR HEPATECTOMY (INCLUDING COLD PRESERVATION), FROM LIVING DONOR; TOTAL RIGHT
BACKBENCH STANDARD PREPARATION OF CADAVER DONOR WHOLE LIVER GRAFT PRIOR TO
BACKBENCH STANDARD PREPARATION OF CADAVER DONOR WHOLE LIVER GRAFT PRIOR TO
BACKBENCH STANDARD PREPARATION OF CADAVER DONOR WHOLE LIVER GRAFT PRIOR TO
BACKBENCH RECONSTRUCTION OF CADAVER OR LIVING DONOR LIVER GRAFT PRIOR TO
BACKBENCH RECONSTRUCTION OF CADAVER OR LIVING DONOR LIVER GRAFT PRIOR TO
MARSUPIALIZATION OF CYST OR ABSCESS OF LIVER
MANAGEMENT OF LIVER HEMORRHAGE; SIMPLE SUTURE OF LIVER WOUND OR INJURY
MANAGEMENT OF LIVER HEMORRHAGE; COMPLEX SUTURE OF LIVER WOUND OR INJURY, WITH
MANAGEMENT OF LIVER HEMORRHAGE; EXPLORATION OF HEPATIC WOUND, EXTENSIVE
MANAGEMENT OF LIVER HEMORRHAGE; RE-EXPLORATION OF HEPATIC WOUND FOR REMOVAL OF
ABLATION, OPEN, OF ONE OR MORE LIVER TUMOR(S); RADIOFREQUENCY
ABLATION, OPEN, OF ONE OR MORE LIVER TUMOR(S); CRYOSURGICAL
HEPATICOTOMY OR HEPATICOSTOMY WITH EXPLORATION, DRAINAGE, OR REMOVAL OF CALCULUS
CHOLEDOCHOTOMY OR CHOLEDOCHOSTOMY WITH EXPLORATION, DRAINAGE, OR REMOVAL OF
CHOLEDOCHOTOMY OR CHOLEDOCHOSTOMY WITH EXPLORATION, DRAINAGE, OR REMOVAL OF
TRANSDUODENAL SPHINCTEROTOMY OR SPHINCTEROPLASTY, WITH OR WITHOUT TRANSDUODENAL
CHOLECYSTOTOMY OR CHOLECYSTOSTOMY, OPEN, WITH EXPLORATION, DRAINAGE, OR REMOVAL
BILIARY ENDOSCOPY, INTRAOPERATIVE (CHOLEDOCHOSCOPY) (LIST SEPARATELY IN ADDITION
LAPAROSCOPY, SURGICAL; CHOLECYSTOENTEROSTOMY
CHOLECYSTECTOMY;
CHOLECYSTECTOMY; WITH CHOLANGIOGRAPHY
CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT;
CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT; WITH CHOLEDOCHOENTEROSTOMY
CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT; WITH TRANSDUODENAL
EXPLORATION FOR CONGENITAL ATRESIA OF BILE DUCTS, WITHOUT REPAIR, WITH OR
PORTOENTEROSTOMY (EG, KASAI PROCEDURE)
EXCISION OF BILE DUCT TUMOR, WITH OR WITHOUT PRIMARY REPAIR OF BILE DUCT;
EXCISION OF BILE DUCT TUMOR, WITH OR WITHOUT PRIMARY REPAIR OF BILE DUCT;
EXCISION OF CHOLEDOCHAL CYST
CHOLECYSTOENTEROSTOMY; DIRECT
CHOLECYSTOENTEROSTOMY; WITH GASTROENTEROSTOMY
CHOLECYSTOENTEROSTOMY; ROUX-EN-Y
CHOLECYSTOENTEROSTOMY; ROUX-EN-Y WITH GASTROENTEROSTOMY
ANASTOMOSIS, OF EXTRAHEPATIC BILIARY DUCTS AND GASTROINTESTINAL TRACT
ANASTOMOSIS, OF INTRAHEPATIC DUCTS AND GASTROINTESTINAL TRACT
ANASTOMOSIS, ROUX-EN-Y, OF EXTRAHEPATIC BILIARY DUCTS AND GASTROINTESTINAL TRACT
ANASTOMOSIS, ROUX-EN-Y, OF INTRAHEPATIC BILIARY DUCTS AND GASTROINTESTINAL TRACT
RECONSTRUCTION, PLASTIC, OF EXTRAHEPATIC BILIARY DUCTS WITH END-TO-END
PLACEMENT OF CHOLEDOCHAL STENT
U-TUBE HEPATICOENTEROSTOMY
SUTURE OF EXTRAHEPATIC BILIARY DUCT FOR PRE-EXISTING INJURY (SEPARATE PROCEDURE)
PLACEMENT OF DRAINS, PERIPANCREATIC, FOR ACUTE PANCREATITIS;
PLACEMENT OF DRAINS, PERIPANCREATIC, FOR ACUTE PANCREATITIS; WITH
REMOVAL OF PANCREATIC CALCULUS
BIOPSY OF PANCREAS, OPEN (EG, FINE NEEDLE ASPIRATION, NEEDLE CORE BIOPSY, WEDGE
RESECTION OR DEBRIDEMENT OF PANCREAS AND PERIPANCREATIC TISSUE FOR ACUTE NECROTI
EXCISION OF LESION OF PANCREAS (EG, CYST, ADENOMA)
PANCREATECTOMY, DISTAL SUBTOTAL, WITH OR WITHOUT SPLENECTOMY; WITHOUT
PANCREATECTOMY, DISTAL SUBTOTAL, WITH OR WITHOUT SPLENECTOMY; WITH
PANCREATECTOMY, DISTAL, NEAR-TOTAL WITH PRESERVATION OF DUODENUM (CHILD-TYPE
EXCISION OF AMPULLA OF VATER
PANCREATECTOMY, PROXIMAL SUBTOTAL WITH TOTAL DUODENECTOMY, PARTIAL GASTRECTOMY,
PANCREATECTOMY, PROXIMAL SUBTOTAL WITH TOTAL DUODENECTOMY, PARTIAL GASTRECTOMY,
PANCREATECTOMY, PROXIMAL SUBTOTAL WITH NEAR-TOTAL DUODENECTOMY,
PANCREATECTOMY, PROXIMAL SUBTOTAL WITH NEAR-TOTAL DUODENECTOMY,
PANCREATECTOMY, TOTAL
PANCREATECTOMY, TOTAL OR SUBTOTAL, WITH AUTOLOGOUS TRANSPLANTATION OF PANCREAS
INJECTION PROCEDURE FOR INTRAOPERATIVE PANCREATOGRAPHY (LIST SEPARATELY IN ADDIT
MARSUPIALIZATION OF PANCREATIC CYST
EXTERNAL DRAINAGE, PSEUDOCYST OF PANCREAS; OPEN
INTERNAL ANASTOMOSIS OF PANCREATIC CYST TO GASTROINTESTINAL TRACT; DIRECT
INTERNAL ANASTOMOSIS OF PANCREATIC CYST TO GASTROINTESTINAL TRACT; ROUX-EN-Y
PANCREATORRHAPHY FOR INJURY
DUODENAL EXCLUSION WITH GASTROJEJUNOSTOMY FOR PANCREATIC INJURY
PANCREATICOJEJUNOSTOMY, SIDE-TO-SIDE ANASTOMOSIS (PUESTOW-TYPE OPERATION)
DONOR PANCREATECTOMY (INCLUDING COLD PRESERVATION), WITH OR WITHOUT DUODENAL SEG
BACKBENCH STANDARD PREPARATION OF CADAVER DONOR PANCREAS ALLOGRAFT PRIOR TO
BACKBENCH RECONSTRUCTION OF CADAVER DONOR PANCREAS ALLOGRAFT PRIOR TO
TRANSPLANTATION OF PANCREATIC ALLOGRAFT
REMOVAL OF TRANSPLANTED PANCREATIC ALLOGRAFT
EXPLORATORY LAPAROTOMY, EXPLORATORY CELIOTOMY WITH OR WITHOUT BIOPSY(S) (SEPARAT
REOPENING OF RECENT LAPAROTOMY
EXPLORATION, RETROPERITONEAL AREA WITH OR WITHOUT BIOPSY(S) (SEPARATE PROCEDURE)
DRAINAGE OF PERITONEAL ABSCESS OR LOCALIZED PERITONITIS, EXCLUSIVE OF
DRAINAGE OF SUBDIAPHRAGMATIC OR SUBPHRENIC ABSCESS; OPEN
DRAINAGE OF RETROPERITONEAL ABSCESS; OPEN
DRAINAGE OF EXTRAPERITONEAL LYMPHOCELE TO PERITONEAL CAVITY, OPEN
EXCISION OR DESTRUCTION, OPEN, INTRA-ABDOMINAL TUMORS, CYSTS OR ENDOMETRIOMAS, 1
EXCISION OR DESTRUCTION, OPEN, INTRA-ABDOMINAL TUMORS, CYSTS OR ENDOMETRIOMAS, 1
EXCISION OR DESTRUCTION, OPEN, INTRA-ABDOMINAL TUMORS, CYSTS OR ENDOMETRIOMAS, 1
EXCISION OF PRESACRAL OR SACROCOCCYGEAL TUMOR
STAGING LAPAROTOMY FOR HODGKINS DISEASE OR LYMPHOMA (INCLUDES SPLENECTOMY,
OMENTECTOMY, EPIPLOECTOMY, RESECTION OF OMENTUM (SEPARATE PROCEDURE)
Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial
PLACEMENT OF INTERSTITIAL DEVICE(S) FOR RADIATION THERAPY GUIDANCE (EG, FIDUCIAL
INSERTION OF PERITONEAL-VENOUS SHUNT
LIGATION OF PERITONEAL-VENOUS SHUNT
CONTRAST INJECTION(S) FOR RADIOLOGICAL EVALUATION OF EXISTING GASTROSTOMY, DUODE
REPAIR OF LARGE OMPHALOCELE OR GASTROSCHISIS; WITH OR WITHOUT PROSTHESIS
REPAIR OF LARGE OMPHALOCELE OR GASTROSCHISIS; WITH REMOVAL OF PROSTHESIS, FINAL
REPAIR OF OMPHALOCELE (GROSS TYPE OPERATION); FIRST STAGE
REPAIR OF OMPHALOCELE (GROSS TYPE OPERATION); SECOND STAGE
SUTURE, SECONDARY, OF ABDOMINAL WALL FOR EVISCERATION OR DEHISCENCE
OMENTAL FLAP, EXTRA-ABDOMINAL (EG, FOR RECONSTRUCTION OF STERNAL AND CHEST WALL
OMENTAL FLAP, INTRA-ABDOMINAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY
FREE OMENTAL FLAP WITH MICROVASCULAR ANASTOMOSIS
RENAL EXPLORATION, NOT NECESSITATING OTHER SPECIFIC PROCEDURES
NEPHROSTOMY, NEPHROTOMY WITH DRAINAGE
NEPHROTOMY, WITH EXPLORATION
NEPHROLITHOTOMY; REMOVAL OF CALCULUS
NEPHROLITHOTOMY; SECONDARY SURGICAL OPERATION FOR CALCULUS
NEPHROLITHOTOMY; COMPLICATED BY CONGENITAL KIDNEY ABNORMALITY
NEPHROLITHOTOMY; REMOVAL OF LARGE STAGHORN CALCULUS FILLING RENAL PELVIS AND
TRANSECTION OR REPOSITIONING OF ABERRANT RENAL VESSELS (SEPARATE PROCEDURE)
PYELOTOMY; WITH EXPLORATION
PYELOTOMY; WITH DRAINAGE, PYELOSTOMY
PYELOTOMY; WITH REMOVAL OF CALCULUS (PYELOLITHOTOMY, PELVIOLITHOTOMY, INCLUDING
PYELOTOMY; COMPLICATED (EG, SECONDARY OPERATION, CONGENITAL KIDNEY ABNORMALITY)
RENAL BIOPSY; BY SURGICAL EXPOSURE OF KIDNEY
NEPHRECTOMY, INCLUDING PARTIAL URETERECTOMY, ANY OPEN APPROACH INCLUDING RIB
NEPHRECTOMY, INCLUDING PARTIAL URETERECTOMY, ANY OPEN APPROACH INCLUDING RIB
NEPHRECTOMY, INCLUDING PARTIAL URETERECTOMY, ANY OPEN APPROACH INCLUDING RIB
NEPHRECTOMY WITH TOTAL URETERECTOMY AND BLADDER CUFF; THROUGH SAME INCISION
NEPHRECTOMY WITH TOTAL URETERECTOMY AND BLADDER CUFF; THROUGH SEPARATE INCISION
NEPHRECTOMY, PARTIAL
ABLATION, OPEN, 1 OR MORE RENAL MASS LESION(S), CRYOSURGICAL, INCLUDING INTRAOPE
EXCISION OR UNROOFING OF CYST(S) OF KIDNEY
EXCISION OF PERINEPHRIC CYST
DONOR NEPHRECTOMY (INCLUDING COLD PRESERVATION); FROM CADAVER DONOR, UNILATERAL
DONOR NEPHRECTOMY (INCLUDING COLD PRESERVATION); OPEN, FROM LIVING DONOR
BACKBENCH STANDARD PREPARATION OF CADAVER DONOR RENAL ALLOGRAFT PRIOR TO
BACKBENCH STANDARD PREPARATION OF LIVING DONOR RENAL ALLOGRAFT (OPEN OR
BACKBENCH RECONSTRUCTION OF CADAVER OR LIVING DONOR RENAL ALLOGRAFT PRIOR TO
BACKBENCH RECONSTRUCTION OF CADAVER OR LIVING DONOR RENAL ALLOGRAFT PRIOR TO
BACKBENCH RECONSTRUCTION OF CADAVER OR LIVING DONOR RENAL ALLOGRAFT PRIOR TO
RECIPIENT NEPHRECTOMY (SEPARATE PROCEDURE)
RENAL ALLOTRANSPLANTATION, IMPLANTATION OF GRAFT; WITHOUT RECIPIENT NEPHRECTOMY
RENAL ALLOTRANSPLANTATION, IMPLANTATION OF GRAFT; WITH RECIPIENT NEPHRECTOMY
REMOVAL OF TRANSPLANTED RENAL ALLOGRAFT
RENAL AUTOTRANSPLANTATION, REIMPLANTATION OF KIDNEY
PYELOPLASTY (FOLEY Y-PYELOPLASTY), PLASTIC OPERATION ON RENAL PELVIS, WITH OR WI
PYELOPLASTY (FOLEY Y-PYELOPLASTY), PLASTIC OPERATION ON RENAL PELVIS, WITH OR
NEPHRORRHAPHY, SUTURE OF KIDNEY WOUND OR INJURY
CLOSURE OF NEPHROCUTANEOUS OR PYELOCUTANEOUS FISTULA
CLOSURE OF NEPHROVISCERAL FISTULA (EG, RENOCOLIC), INCLUDING VISCERAL REPAIR;
CLOSURE OF NEPHROVISCERAL FISTULA (EG, RENOCOLIC), INCLUDING VISCERAL REPAIR;
SYMPHYSIOTOMY FOR HORSESHOE KIDNEY WITH OR WITHOUT PYELOPLASTY AND/OR OTHER
LAPAROSCOPY, SURGICAL; RADICAL NEPHRECTOMY (INCLUDES REMOVAL OF GEROTA'S FASCIA
LAPAROSCOPY, SURGICAL; NEPHRECTOMY, INCLUDING PARTIAL URETERECTOMY
LAPAROSCOPY, SURGICAL; DONOR NEPHRECTOMY (INCLUDING COLD PRESERVATION), FROM
LAPAROSCOPY, SURGICAL; NEPHRECTOMY WITH TOTAL URETERECTOMY
URETEROTOMY WITH EXPLORATION OR DRAINAGE (SEPARATE PROCEDURE)
URETEROTOMY FOR INSERTION OF INDWELLING STENT, ALL TYPES
URETEROLITHOTOMY; UPPER ONE-THIRD OF URETER
URETEROLITHOTOMY; MIDDLE ONE-THIRD OF URETER
URETEROLITHOTOMY; LOWER ONE-THIRD OF URETER
URETERECTOMY, WITH BLADDER CUFF (SEPARATE PROCEDURE)
URETERECTOMY, TOTAL, ECTOPIC URETER, COMBINATION ABDOMINAL, VAGINAL AND/OR
URETEROPLASTY, PLASTIC OPERATION ON URETER (EG, STRICTURE)
URETEROLYSIS, WITH OR WITHOUT REPOSITIONING OF URETER FOR RETROPERITONEAL
URETEROLYSIS FOR OVARIAN VEIN SYNDROME
URETEROLYSIS FOR RETROCAVAL URETER, WITH REANASTOMOSIS OF UPPER URINARY TRACT
REVISION OF URINARY-CUTANEOUS ANASTOMOSIS (ANY TYPE UROSTOMY); WITH REPAIR OF
URETEROPYELOSTOMY, ANASTOMOSIS OF URETER AND RENAL PELVIS
URETEROCALYCOSTOMY, ANASTOMOSIS OF URETER TO RENAL CALYX
URETEROURETEROSTOMY
TRANSURETEROURETEROSTOMY, ANASTOMOSIS OF URETER TO CONTRALATERAL URETER
URETERONEOCYSTOSTOMY; ANASTOMOSIS OF SINGLE URETER TO BLADDER
URETERONEOCYSTOSTOMY; ANASTOMOSIS OF DUPLICATED URETER TO BLADDER
URETERONEOCYSTOSTOMY; WITH EXTENSIVE URETERAL TAILORING
URETERONEOCYSTOSTOMY; WITH VESICO-PSOAS HITCH OR BLADDER FLAP
URETEROENTEROSTOMY, DIRECT ANASTOMOSIS OF URETER TO INTESTINE
URETEROSIGMOIDOSTOMY, WITH CREATION OF SIGMOID BLADDER AND ESTABLISHMENT OF
URETEROCOLON CONDUIT, INCLUDING INTESTINE ANASTOMOSIS
URETEROILEAL CONDUIT (ILEAL BLADDER), INCLUDING INTESTINE ANASTOMOSIS (BRICKER
CONTINENT DIVERSION, INCLUDING INTESTINE ANASTOMOSIS USING ANY SEGMENT OF SMALL
URINARY UNDIVERSION (EG, TAKING DOWN OF URETEROILEAL CONDUIT,
REPLACEMENT OF ALL OR PART OF URETER BY INTESTINE SEGMENT, INCLUDING INTESTINE
CUTANEOUS APPENDICO-VESICOSTOMY
URETEROSTOMY, TRANSPLANTATION OF URETER TO SKIN
URETERORRHAPHY, SUTURE OF URETER (SEPARATE PROCEDURE)
CLOSURE OF URETEROCUTANEOUS FISTULA
CLOSURE OF URETEROVISCERAL FISTULA (INCLUDING VISCERAL REPAIR)
DELIGATION OF URETER
CYSTOTOMY; FOR EXCISION OF BLADDER DIVERTICULUM, SINGLE OR MULTIPLE (SEPARATE
CYSTOTOMY; FOR EXCISION OF BLADDER TUMOR
CYSTECTOMY, PARTIAL; SIMPLE
CYSTECTOMY, PARTIAL; COMPLICATED (EG, POSTRADIATION, PREVIOUS SURGERY,
CYSTECTOMY, PARTIAL, WITH REIMPLANTATION OF URETER(S) INTO BLADDER
CYSTECTOMY, COMPLETE; (SEPARATE PROCEDURE)
CYSTECTOMY, COMPLETE; WITH BILATERAL PELVIC LYMPHADENECTOMY, INCLUDING EXTERNAL
CYSTECTOMY, COMPLETE, WITH URETEROSIGMOIDOSTOMY OR URETEROCUTANEOUS
CYSTECTOMY, COMPLETE, WITH URETEROSIGMOIDOSTOMY OR URETEROCUTANEOUS
CYSTECTOMY, COMPLETE, WITH URETEROILEAL CONDUIT OR SIGMOID BLADDER, INCLUDING
CYSTECTOMY, COMPLETE, WITH URETEROILEAL CONDUIT OR SIGMOID BLADDER, INCLUDING
CYSTECTOMY, COMPLETE, WITH CONTINENT DIVERSION, ANY OPEN TECHNIQUE, USING ANY
PELVIC EXENTERATION, COMPLETE, FOR VESICAL, PROSTATIC OR URETHRAL MALIGNANCY,
INSERTION OF NON-INDWELLING BLADDER CATHETER (EG, STRAIGHT CATHETERIZATION FOR
INSERTION OF TEMPORARY INDWELLING BLADDER CATHETER; SIMPLE (EG, FOLEY)
SIMPLE UROFLOWMETRY (UFR) (EG, STOP-WATCH FLOW RATE, MECHANICAL UROFLOWMETER)
MEASUREMENT OF POST-VOIDING RESIDUAL URINE AND/OR BLADDER CAPACITY BY
CYSTOPLASTY OR CYSTOURETHROPLASTY, PLASTIC OPERATION ON BLADDER AND/OR VESICAL N
CYSTOURETHROPLASTY WITH UNILATERAL OR BILATERAL URETERONEOCYSTOSTOMY
ANTERIOR VESICOURETHROPEXY, OR URETHROPEXY (EG, MARSHALL-MARCHETTI-KRANTZ,
ANTERIOR VESICOURETHROPEXY, OR URETHROPEXY (EG, MARSHALL-MARCHETTI-KRANTZ,
CYSTORRHAPHY, SUTURE OF BLADDER WOUND, INJURY OR RUPTURE; COMPLICATED
CLOSURE OF VESICOVAGINAL FISTULA, ABDOMINAL APPROACH
CLOSURE OF VESICOUTERINE FISTULA;
CLOSURE OF VESICOUTERINE FISTULA; WITH HYSTERECTOMY
CLOSURE, EXSTROPHY OF BLADDER
ENTEROCYSTOPLASTY, INCLUDING INTESTINAL ANASTOMOSIS
CUTANEOUS VESICOSTOMY
URETHROPLASTY, TRANSPUBIC OR PERINEAL, ONE STAGE, FOR RECONSTRUCTION OR REPAIR
REMOVAL AND REPLACEMENT OF INFLATABLE URETHRAL/BLADDER NECK SPHINCTER INCLUDING
AMPUTATION OF PENIS; COMPLETE
AMPUTATION OF PENIS, RADICAL; WITH BILATERAL INGUINOFEMORAL LYMPHADENECTOMY
AMPUTATION OF PENIS, RADICAL; IN CONTINUITY WITH BILATERAL PELVIC
PLASTIC OPERATION ON PENIS FOR EPISPADIAS DISTAL TO EXTERNAL SPHINCTER; WITH
REMOVAL AND REPLACEMENT OF ALL COMPONENTS OF A MULTI-COMPONENT INFLATABLE
REMOVAL AND REPLACEMENT OF NON-INFLATABLE (SEMI-RIGID) OR INFLATABLE
CORPORA CAVERNOSA-CORPUS SPONGIOSUM SHUNT (PRIAPISM OPERATION), UNILATERAL OR
ORCHIOPEXY, ABDOMINAL APPROACH, FOR INTRA-ABDOMINAL TESTIS (EG, FOWLER-STEPHENS)
VESICULOTOMY; COMPLICATED
VESICULECTOMY, ANY APPROACH
PROSTATECTOMY, PERINEAL, SUBTOTAL (INCLUDING CONTROL OF POSTOPERATIVE BLEEDING,
PROSTATECTOMY, PERINEAL RADICAL;
PROSTATECTOMY, PERINEAL RADICAL; WITH LYMPH NODE BIOPSY(S) (LIMITED PELVIC
PROSTATECTOMY, PERINEAL RADICAL; WITH BILATERAL PELVIC LYMPHADENECTOMY,
PROSTATECTOMY (INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, VASECTOMY,
PROSTATECTOMY (INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, VASECTOMY,
PROSTATECTOMY, RETROPUBIC RADICAL, WITH OR WITHOUT NERVE SPARING;
PROSTATECTOMY, RETROPUBIC RADICAL, WITH OR WITHOUT NERVE SPARING; WITH LYMPH
PROSTATECTOMY, RETROPUBIC RADICAL, WITH OR WITHOUT NERVE SPARING; WITH
EXPOSURE OF PROSTATE, ANY APPROACH, FOR INSERTION OF RADIOACTIVE SUBSTANCE;
EXPOSURE OF PROSTATE, ANY APPROACH, FOR INSERTION OF RADIOACTIVE SUBSTANCE;
LAPAROSCOPY, SURGICAL PROSTATECTOMY, RETROPUBIC RADICAL, INCLUDING NERVE SPARING
TRANSPERINEAL PLACEMENT OF NEEDLES OR CATHETERS INTO PROSTATE FOR INTERSTITIAL R
PLACEMENT OF INTERSTITIAL DEVICE(S) FOR RADIATION THERAPY GUIDANCE (EG, FIDUCIAL
VULVECTOMY, RADICAL, PARTIAL;
VULVECTOMY, RADICAL, PARTIAL; WITH UNILATERAL INGUINOFEMORAL LYMPHADENECTOMY
VULVECTOMY, RADICAL, PARTIAL; WITH BILATERAL INGUINOFEMORAL LYMPHADENECTOMY
VULVECTOMY, RADICAL, COMPLETE;
VULVECTOMY, RADICAL, COMPLETE; WITH UNILATERAL INGUINOFEMORAL LYMPHADENECTOMY
VULVECTOMY, RADICAL, COMPLETE; WITH BILATERAL INGUINOFEMORAL LYMPHADENECTOMY
VULVECTOMY, RADICAL, COMPLETE, WITH INGUINOFEMORAL, ILIAC, AND PELVIC
VAGINECTOMY, COMPLETE REMOVAL OF VAGINAL WALL;
VAGINECTOMY, COMPLETE REMOVAL OF VAGINAL WALL; WITH REMOVAL OF PARAVAGINAL
VAGINECTOMY, COMPLETE REMOVAL OF VAGINAL WALL; WITH REMOVAL OF PARAVAGINAL
REPAIR OF ENTEROCELE, ABDOMINAL APPROACH (SEPARATE PROCEDURE)
COLPOPEXY, ABDOMINAL APPROACH
REVISION (INCLUDING REMOVAL) OF PROSTHETIC VAGINAL GRAFT; OPEN ABDOMINAL APPROAC
CLOSURE OF RECTOVAGINAL FISTULA; ABDOMINAL APPROACH
CLOSURE OF RECTOVAGINAL FISTULA; ABDOMINAL APPROACH, WITH CONCOMITANT COLOSTOMY
CLOSURE OF RECTOVAGINAL FISTULA; TRANSPERINEAL APPROACH, WITH PERINEAL BODY
CLOSURE OF URETHROVAGINAL FISTULA; WITH BULBOCAVERNOSUS TRANSPLANT
RADICAL TRACHELECTOMY, WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY AND
EXCISION OF CERVICAL STUMP, ABDOMINAL APPROACH;
EXCISION OF CERVICAL STUMP, ABDOMINAL APPROACH; WITH PELVIC FLOOR REPAIR
MYOMECTOMY, EXCISION OF FIBROID TUMOR(S) OF UTERUS, 1 TO 4 INTRAMURAL MYOMA(S)
MYOMECTOMY, EXCISION OF FIBROID TUMOR(S) OF UTERUS, 5 OR MORE INTRAMURAL MYOMAS
TOTAL ABDOMINAL HYSTERECTOMY (CORPUS AND CERVIX), WITH OR WITHOUT REMOVAL OF
TOTAL ABDOMINAL HYSTERECTOMY (CORPUS AND CERVIX), WITH OR WITHOUT REMOVAL OF
SUPRACERVICAL ABDOMINAL HYSTERECTOMY (SUBTOTAL HYSTERECTOMY), WITH OR WITHOUT
TOTAL ABDOMINAL HYSTERECTOMY, INCLUDING PARTIAL VAGINECTOMY, WITH PARA-AORTIC
RADICAL ABDOMINAL HYSTERECTOMY, WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY AND
PELVIC EXENTERATION FOR GYNECOLOGIC MALIGNANCY, WITH TOTAL ABDOMINAL
VAGINAL HYSTERECTOMY, FOR UTERUS 250 GRAMS OR LESS; WITH COLPO-URETHROCYSTOPEXY
VAGINAL HYSTERECTOMY, WITH TOTAL OR PARTIAL VAGINECTOMY;
VAGINAL HYSTERECTOMY, WITH TOTAL OR PARTIAL VAGINECTOMY; WITH REPAIR OF
VAGINAL HYSTERECTOMY, RADICAL (SCHAUTA TYPE OPERATION)
VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 GRAMS; WITH
INSERTION OF INTRAUTERINE DEVICE (IUD)
UTERINE SUSPENSION, WITH OR WITHOUT SHORTENING OF ROUND LIGAMENTS, WITH OR WITHO
UTERINE SUSPENSION, WITH OR WITHOUT SHORTENING OF ROUND LIGAMENTS, WITH OR
HYSTERORRHAPHY, REPAIR OF RUPTURED UTERUS (NONOBSTETRICAL)
HYSTEROPLASTY, REPAIR OF UTERINE ANOMALY (STRASSMAN TYPE)
LAPAROSCOPY, SURGICAL, WITH RADICAL HYSTERECTOMY, WITH BILATERAL TOTAL PELVIC LY
LIGATION OR TRANSECTION OF FALLOPIAN TUBE(S), ABDOMINAL OR VAGINAL APPROACH,
LIGATION OR TRANSECTION OF FALLOPIAN TUBE(S) WHEN DONE AT THE TIME OF CESAREAN
SALPINGECTOMY, COMPLETE OR PARTIAL, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE)
SALPINGO-OOPHORECTOMY, COMPLETE OR PARTIAL, UNILATERAL OR BILATERAL (SEPARATE
LYSIS OF ADHESIONS (SALPINGOLYSIS, OVARIOLYSIS)
DRAINAGE OF OVARIAN ABSCESS; ABDOMINAL APPROACH
TRANSPOSITION, OVARY(S)
OOPHORECTOMY, PARTIAL OR TOTAL, UNILATERAL OR BILATERAL;
OOPHORECTOMY, PARTIAL OR TOTAL, UNILATERAL OR BILATERAL; FOR OVARIAN, TUBAL OR
RESECTION (INITIAL) OF OVARIAN, TUBAL OR PRIMARY PERITONEAL MALIGNANCY WITH BILA
RESECTION OF OVARIAN, TUBAL OR PRIMARY PERITONEAL MALIGNANCY WITH BILATERAL
RESECTION OF OVARIAN, TUBAL OR PRIMARY PERITONEAL MALIGNANCY WITH BILATERAL
BILATERAL SALPINGO-OOPHORECTOMY WITH OMENTECTOMY, TOTAL ABDOMINAL HYSTERECTOMY
BILATERAL SALPINGO-OOPHORECTOMY WITH OMENTECTOMY, TOTAL ABDOMINAL HYSTERECTOMY
BILATERAL SALPINGO-OOPHORECTOMY WITH TOTAL OMENTECTOMY, TOTAL ABDOMINAL
RESECTION (TUMOR DEBULKING) OF RECURRENT OVARIAN, TUBAL, PRIMARY PERITONEAL, UTE
RESECTION (TUMOR DEBULKING) OF RECURRENT OVARIAN, TUBAL, PRIMARY PERITONEAL, UTE
LAPAROTOMY, FOR STAGING OR RESTAGING OF OVARIAN, TUBAL OR PRIMARY PERITONEAL
FETAL MONITORING DURING LABOR BY CONSULTING PHYSICIAN (IE, NON-ATTENDING
FETAL MONITORING DURING LABOR BY CONSULTING PHYSICIAN (IE, NON-ATTENDING
SURGICAL TREATMENT OF ECTOPIC PREGNANCY; TUBAL OR OVARIAN, REQUIRING
SURGICAL TREATMENT OF ECTOPIC PREGNANCY; TUBAL OR OVARIAN, WITHOUT
SURGICAL TREATMENT OF ECTOPIC PREGNANCY; ABDOMINAL PREGNANCY
SURGICAL TREATMENT OF ECTOPIC PREGNANCY; INTERSTITIAL, UTERINE PREGNANCY
SURGICAL TREATMENT OF ECTOPIC PREGNANCY; INTERSTITIAL, UTERINE PREGNANCY WITH
SURGICAL TREATMENT OF ECTOPIC PREGNANCY; CERVICAL, WITH EVACUATION
CERCLAGE OF CERVIX, DURING PREGNANCY; ABDOMINAL
HYSTERORRHAPHY OF RUPTURED UTERUS
ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE, VAGINAL DELIVERY (WITH OR WITH
VAGINAL DELIVERY ONLY (WITH OR WITHOUT EPISIOTOMY AND/OR FORCEPS); INCLUDING
ANTEPARTUM CARE ONLY; 4-6 VISITS
ANTEPARTUM CARE ONLY; 7 OR MORE VISITS
POSTPARTUM CARE ONLY (SEPARATE PROCEDURE)
ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE, CESAREAN DELIVERY, AND POSTPAR
CESAREAN DELIVERY ONLY;
CESAREAN DELIVERY ONLY; INCLUDING POSTPARTUM CARE
SUBTOTAL OR TOTAL HYSTERECTOMY AFTER CESAREAN DELIVERY (LIST SEPARATELY IN
ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE, VAGINAL DELIVERY (WITH OR WITH
VAGINAL DELIVERY ONLY, AFTER PREVIOUS CESAREAN DELIVERY (WITH OR WITHOUT
ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE, CESAREAN DELIVERY, AND
CESAREAN DELIVERY ONLY, FOLLOWING ATTEMPTED VAGINAL DELIVERY AFTER PREVIOUS
CESAREAN DELIVERY ONLY, FOLLOWING ATTEMPTED VAGINAL DELIVERY AFTER PREVIOUS
TREATMENT OF SEPTIC ABORTION, COMPLETED SURGICALLY
INDUCED ABORTION, BY ONE OR MORE INTRA-AMNIOTIC INJECTIONS
INDUCED ABORTION, BY ONE OR MORE INTRA-AMNIOTIC INJECTIONS
INDUCED ABORTION, BY ONE OR MORE INTRA-AMNIOTIC INJECTIONS
INDUCED ABORTION, BY ONE OR MORE VAGINAL SUPPOSITORIES (EG, PROSTAGLANDIN) WITH
INDUCED ABORTION, BY ONE OR MORE VAGINAL SUPPOSITORIES (EG, PROSTAGLANDIN) WITH
INDUCED ABORTION, BY ONE OR MORE VAGINAL SUPPOSITORIES (EG, PROSTAGLANDIN) WITH
THYROIDECTOMY, TOTAL OR SUBTOTAL FOR MALIGNANCY; WITH RADICAL NECK DISSECTION
THYROIDECTOMY, INCLUDING SUBSTERNAL THYROID; STERNAL SPLIT OR TRANSTHORACIC
PARATHYROIDECTOMY OR EXPLORATION OF PARATHYROID(S); WITH MEDIASTINAL
THYMECTOMY, PARTIAL OR TOTAL; STERNAL SPLIT OR TRANSTHORACIC APPROACH, WITHOUT
THYMECTOMY, PARTIAL OR TOTAL; STERNAL SPLIT OR TRANSTHORACIC APPROACH, WITH
ADRENALECTOMY, PARTIAL OR COMPLETE, OR EXPLORATION OF ADRENAL GLAND WITH OR
ADRENALECTOMY, PARTIAL OR COMPLETE, OR EXPLORATION OF ADRENAL GLAND WITH OR
EXCISION OF CAROTID BODY TUMOR; WITHOUT EXCISION OF CAROTID ARTERY
EXCISION OF CAROTID BODY TUMOR; WITH EXCISION OF CAROTID ARTERY
LAPAROSCOPY, SURGICAL, WITH ADRENALECTOMY, PARTIAL OR COMPLETE, OR EXPLORATION O
TWIST DRILL HOLE FOR SUBDURAL OR VENTRICULAR PUNCTURE;
TWIST DRILL HOLE(S) FOR SUBDURAL, INTRACEREBRAL, OR VENTRICULAR PUNCTURE; FOR IM
TWIST DRILL HOLE FOR SUBDURAL OR VENTRICULAR PUNCTURE; FOR EVACUATION AND/OR
BURR HOLE(S) FOR VENTRICULAR PUNCTURE (INCLUDING INJECTION OF GAS, CONTRAST
BURR HOLE(S) OR TREPHINE; WITH BIOPSY OF BRAIN OR INTRACRANIAL LESION
BURR HOLE(S) OR TREPHINE; WITH DRAINAGE OF BRAIN ABSCESS OR CYST
BURR HOLE(S) OR TREPHINE; WITH SUBSEQUENT TAPPING (ASPIRATION) OF INTRACRANIAL
BURR HOLE(S) WITH EVACUATION AND/OR DRAINAGE OF HEMATOMA, EXTRADURAL OR SUBDURAL
BURR HOLE(S); WITH ASPIRATION OF HEMATOMA OR CYST, INTRACEREBRAL
BURR HOLE(S); FOR IMPLANTING VENTRICULAR CATHETER, RESERVOIR, EEG ELECTRODE(S),
BURR HOLE(S) OR TREPHINE, SUPRATENTORIAL, EXPLORATORY, NOT FOLLOWED BY OTHER
BURR HOLE(S) OR TREPHINE, INFRATENTORIAL, UNILATERAL OR BILATERAL
CRANIECTOMY OR CRANIOTOMY, EXPLORATORY; SUPRATENTORIAL
CRANIECTOMY OR CRANIOTOMY, EXPLORATORY; INFRATENTORIAL (POSTERIOR FOSSA)
CRANIECTOMY OR CRANIOTOMY FOR EVACUATION OF HEMATOMA, SUPRATENTORIAL;
CRANIECTOMY OR CRANIOTOMY FOR EVACUATION OF HEMATOMA, SUPRATENTORIAL;
CRANIECTOMY OR CRANIOTOMY FOR EVACUATION OF HEMATOMA, INFRATENTORIAL;
CRANIECTOMY OR CRANIOTOMY FOR EVACUATION OF HEMATOMA, INFRATENTORIAL;
INCISION AND SUBCUTANEOUS PLACEMENT OF CRANIAL BONE GRAFT (LIST SEPARATELY IN
CRANIECTOMY OR CRANIOTOMY, DRAINAGE OF INTRACRANIAL ABSCESS; SUPRATENTORIAL
CRANIECTOMY OR CRANIOTOMY, DRAINAGE OF INTRACRANIAL ABSCESS; INFRATENTORIAL
CRANIECTOMY OR CRANIOTOMY, DECOMPRESSIVE, WITH OR WITHOUT DURAPLASTY, FOR
CRANIECTOMY OR CRANIOTOMY, DECOMPRESSIVE, WITH OR WITHOUT DURAPLASTY, FOR
EXPLORATION OF ORBIT (TRANSCRANIAL APPROACH); WITH BIOPSY
EXPLORATION OF ORBIT (TRANSCRANIAL APPROACH); WITH REMOVAL OF LESION
SUBTEMPORAL CRANIAL DECOMPRESSION (PSEUDOTUMOR CEREBRI, SLIT VENTRICLE SYNDROME)
CRANIECTOMY, SUBOCCIPITAL WITH CERVICAL LAMINECTOMY FOR DECOMPRESSION OF
OTHER CRANIAL DECOMPRESSION, POSTERIOR FOSSA
CRANIOTOMY FOR SECTION OF TENTORIUM CEREBELLI (SEPARATE PROCEDURE)
CRANIECTOMY, SUBTEMPORAL, FOR SECTION, COMPRESSION, OR DECOMPRESSION OF SENSORY
CRANIECTOMY, SUBOCCIPITAL; FOR EXPLORATION OR DECOMPRESSION OF CRANIAL NERVES
CRANIECTOMY, SUBOCCIPITAL; FOR SECTION OF ONE OR MORE CRANIAL NERVES
CRANIECTOMY, SUBOCCIPITAL; FOR MEDULLARY TRACTOTOMY
CRANIECTOMY, SUBOCCIPITAL; FOR MESENCEPHALIC TRACTOTOMY OR PEDUNCULOTOMY
CRANIOTOMY FOR LOBOTOMY, INCLUDING CINGULOTOMY
CRANIECTOMY; WITH EXCISION OF TUMOR OR OTHER BONE LESION OF SKULL
CRANIECTOMY; FOR OSTEOMYELITIS
CRANIECTOMY, TREPHINATION, BONE FLAP CRANIOTOMY; FOR EXCISION OF BRAIN TUMOR,
CRANIECTOMY, TREPHINATION, BONE FLAP CRANIOTOMY; FOR EXCISION OF MENINGIOMA,
CRANIECTOMY, TREPHINATION, BONE FLAP CRANIOTOMY; FOR EXCISION OF BRAIN ABSCESS,
CRANIECTOMY, TREPHINATION, BONE FLAP CRANIOTOMY; FOR EXCISION OR FENESTRATION
IMPLANTATION OF BRAIN INTRACAVITARY CHEMOTHERAPY AGENT (LIST SEPARATELY IN
CRANIECTOMY FOR EXCISION OF BRAIN TUMOR, INFRATENTORIAL OR POSTERIOR FOSSA;
CRANIECTOMY FOR EXCISION OF BRAIN TUMOR, INFRATENTORIAL OR POSTERIOR FOSSA;
CRANIECTOMY FOR EXCISION OF BRAIN TUMOR, INFRATENTORIAL OR POSTERIOR FOSSA;
CRANIECTOMY FOR EXCISION OF BRAIN TUMOR, INFRATENTORIAL OR POSTERIOR FOSSA;
CRANIECTOMY, INFRATENTORIAL OR POSTERIOR FOSSA; FOR EXCISION OF BRAIN ABSCESS
CRANIECTOMY, INFRATENTORIAL OR POSTERIOR FOSSA; FOR EXCISION OR FENESTRATION OF
CRANIECTOMY, BONE FLAP CRANIOTOMY, TRANSTEMPORAL (MASTOID) FOR EXCISION OF
CRANIECTOMY, BONE FLAP CRANIOTOMY, TRANSTEMPORAL (MASTOID) FOR EXCISION OF
SUBDURAL IMPLANTATION OF STRIP ELECTRODES THROUGH ONE OR MORE BURR OR TREPHINE
CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR SUBDURAL IMPLANTATION OF AN
CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR EXCISION OF EPILEPTOGENIC FOCUS
CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR REMOVAL OF EPIDURAL OR SUBDURAL
CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR EXCISION OF CEREBRAL EPILEPTOGENIC
CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR LOBECTOMY, TEMPORAL LOBE, WITHOUT
CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR LOBECTOMY, TEMPORAL LOBE, WITH
CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR LOBECTOMY, OTHER THAN TEMPORAL
CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR LOBECTOMY, OTHER THAN TEMPORAL
CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR TRANSECTION OF CORPUS CALLOSUM
CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR TOTAL HEMISPHERECTOMY
CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR PARTIAL OR SUBTOTAL (FUNCTIONAL)
CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR EXCISION OR COAGULATION OF CHOROID
CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR EXCISION OF CRANIOPHARYNGIOMA
CRANIOTOMY FOR HYPOPHYSECTOMY OR EXCISION OF PITUITARY TUMOR, INTRACRANIAL
HYPOPHYSECTOMY OR EXCISION OF PITUITARY TUMOR, TRANSNASAL OR TRANSSEPTAL
CRANIECTOMY FOR CRANIOSYNOSTOSIS; SINGLE CRANIAL SUTURE
CRANIECTOMY FOR CRANIOSYNOSTOSIS; MULTIPLE CRANIAL SUTURES
CRANIOTOMY FOR CRANIOSYNOSTOSIS; FRONTAL OR PARIETAL BONE FLAP
CRANIOTOMY FOR CRANIOSYNOSTOSIS; BIFRONTAL BONE FLAP
EXTENSIVE CRANIECTOMY FOR MULTIPLE CRANIAL SUTURE CRANIOSYNOSTOSIS (EG,
EXTENSIVE CRANIECTOMY FOR MULTIPLE CRANIAL SUTURE CRANIOSYNOSTOSIS (EG,
EXCISION, INTRA AND EXTRACRANIAL, BENIGN TUMOR OF CRANIAL BONE (EG, FIBROUS
EXCISION, INTRA AND EXTRACRANIAL, BENIGN TUMOR OF CRANIAL BONE (EG, FIBROUS
CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR SELECTIVE AMYGDALOHIPPOCAMPECTOMY
CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR MULTIPLE SUBPIAL TRANSECTIONS, WITH
CRANIECTOMY OR CRANIOTOMY; WITH EXCISION OF FOREIGN BODY FROM BRAIN
CRANIECTOMY OR CRANIOTOMY; WITH TREATMENT OF PENETRATING WOUND OF BRAIN
TRANSORAL APPROACH TO SKULL BASE, BRAIN STEM OR UPPER SPINAL CORD FOR BIOPSY,
TRANSORAL APPROACH TO SKULL BASE, BRAIN STEM OR UPPER SPINAL CORD FOR BIOPSY,
CRANIOFACIAL APPROACH TO ANTERIOR CRANIAL FOSSA; EXTRADURAL, INCLUDING LATERAL R
CRANIOFACIAL APPROACH TO ANTERIOR CRANIAL FOSSA; EXTRADURAL, INCLUDING LATERAL
CRANIOFACIAL APPROACH TO ANTERIOR CRANIAL FOSSA; EXTRADURAL, INCLUDING
CRANIOFACIAL APPROACH TO ANTERIOR CRANIAL FOSSA; INTRADURAL, INCLUDING
ORBITOCRANIAL APPROACH TO ANTERIOR CRANIAL FOSSA, EXTRADURAL, INCLUDING
ORBITOCRANIAL APPROACH TO ANTERIOR CRANIAL FOSSA, EXTRADURAL, INCLUDING
BICORONAL, TRANSZYGOMATIC AND/OR LEFORT I OSTEOTOMY APPROACH TO ANTERIOR
INFRATEMPORAL PRE-AURICULAR APPROACH TO MIDDLE CRANIAL FOSSA (PARAPHARYNGEAL SPA
INFRATEMPORAL POST-AURICULAR APPROACH TO MIDDLE CRANIAL FOSSA (INTERNAL
ORBITOCRANIAL ZYGOMATIC APPROACH TO MIDDLE CRANIAL FOSSA (CAVERNOUS SINUS AND
TRANSTEMPORAL APPROACH TO POSTERIOR CRANIAL FOSSA, JUGULAR FORAMEN OR MIDLINE SK
TRANSCOCHLEAR APPROACH TO POSTERIOR CRANIAL FOSSA, JUGULAR FORAMEN OR MIDLINE
TRANSCONDYLAR (FAR LATERAL) APPROACH TO POSTERIOR CRANIAL FOSSA, JUGULAR
TRANSPETROSAL APPROACH TO POSTERIOR CRANIAL FOSSA, CLIVUS OR FORAMEN MAGNUM,
RESECTION OR EXCISION OF NEOPLASTIC, VASCULAR OR INFECTIOUS LESION OF BASE OF AN
RESECTION OR EXCISION OF NEOPLASTIC, VASCULAR OR INFECTIOUS LESION OF BASE OF
RESECTION OR EXCISION OF NEOPLASTIC, VASCULAR OR INFECTIOUS LESION OF INFRATEMPO
RESECTION OR EXCISION OF NEOPLASTIC, VASCULAR OR INFECTIOUS LESION OF
RESECTION OR EXCISION OF NEOPLASTIC, VASCULAR OR INFECTIOUS LESION OF
RESECTION OR EXCISION OF NEOPLASTIC, VASCULAR OR INFECTIOUS LESION OF
TRANSECTION OR LIGATION, CAROTID ARTERY IN CAVERNOUS SINUS; WITHOUT REPAIR
TRANSECTION OR LIGATION, CAROTID ARTERY IN CAVERNOUS SINUS; WITH REPAIR BY
TRANSECTION OR LIGATION, CAROTID ARTERY IN PETROUS CANAL; WITHOUT REPAIR (LIST
TRANSECTION OR LIGATION, CAROTID ARTERY IN PETROUS CANAL; WITH REPAIR BY
OBLITERATION OF CAROTID ANEURYSM, ARTERIOVENOUS MALFORMATION, OR
RESECTION OR EXCISION OF NEOPLASTIC, VASCULAR OR INFECTIOUS LESION OF BASE OF PO
RESECTION OR EXCISION OF NEOPLASTIC, VASCULAR OR INFECTIOUS LESION OF BASE OF
SECONDARY REPAIR OF DURA FOR CEREBROSPINAL FLUID LEAK, ANTERIOR, MIDDLE OR POSTE
SECONDARY REPAIR OF DURA FOR CEREBROSPINAL FLUID LEAK, ANTERIOR, MIDDLE OR
TRANSCATHETER PERMANENT OCCLUSION OR EMBOLIZATION (EG, FOR TUMOR DESTRUCTION,
SURGERY OF INTRACRANIAL ARTERIOVENOUS MALFORMATION; SUPRATENTORIAL, SIMPLE
SURGERY OF INTRACRANIAL ARTERIOVENOUS MALFORMATION; SUPRATENTORIAL, COMPLEX
SURGERY OF INTRACRANIAL ARTERIOVENOUS MALFORMATION; INFRATENTORIAL, SIMPLE
SURGERY OF INTRACRANIAL ARTERIOVENOUS MALFORMATION; INFRATENTORIAL, COMPLEX
SURGERY OF INTRACRANIAL ARTERIOVENOUS MALFORMATION; DURAL, SIMPLE
SURGERY OF INTRACRANIAL ARTERIOVENOUS MALFORMATION; DURAL, COMPLEX
SURGERY OF COMPLEX INTRACRANIAL ANEURYSM, INTRACRANIAL APPROACH; CAROTID
SURGERY OF COMPLEX INTRACRANIAL ANEURYSM, INTRACRANIAL APPROACH;
SURGERY OF SIMPLE INTRACRANIAL ANEURYSM, INTRACRANIAL APPROACH; CAROTID
SURGERY OF SIMPLE INTRACRANIAL ANEURYSM, INTRACRANIAL APPROACH; VERTEBROBASILAR
SURGERY OF INTRACRANIAL ANEURYSM, CERVICAL APPROACH BY APPLICATION OF OCCLUDING
SURGERY OF ANEURYSM, VASCULAR MALFORMATION OR CAROTID-CAVERNOUS FISTULA; BY
SURGERY OF ANEURYSM, VASCULAR MALFORMATION OR CAROTID-CAVERNOUS FISTULA; BY
SURGERY OF ANEURYSM, VASCULAR MALFORMATION OR CAROTID-CAVERNOUS FISTULA; BY
ANASTOMOSIS, ARTERIAL, EXTRACRANIAL-INTRACRANIAL (EG, MIDDLE CEREBRAL/CORTICAL)
CREATION OF LESION BY STEREOTACTIC METHOD, INCLUDING BURR HOLE(S) AND
STEREOTACTIC BIOPSY, ASPIRATION, OR EXCISION, INCLUDING BURR HOLE(S), FOR
STEREOTACTIC BIOPSY, ASPIRATION, OR EXCISION, INCLUDING BURR HOLE(S), FOR
STEREOTACTIC IMPLANTATION OF DEPTH ELECTRODES INTO THE CEREBRUM FOR LONG TERM
Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator); 1 si
Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator); each
Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator); 1 co
Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator); each
Application of stereotactic headframe for stereotactic radiosurgery (List separa
TWIST DRILL OR BURR HOLE(S) FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; CORT
CRANIECTOMY OR CRANIOTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES,
TWIST DRILL, BURR HOLE, CRANIOTOMY, OR CRANIECTOMY WITH STEREOTACTIC
TWIST DRILL, BURR HOLE, CRANIOTOMY, OR CRANIECTOMY WITH STEREOTACTIC
TWIST DRILL, BURR HOLE, CRANIOTOMY, OR CRANIECTOMY WITH STEREOTACTIC
TWIST DRILL, BURR HOLE, CRANIOTOMY, OR CRANIECTOMY WITH STEREOTACTIC
CRANIECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES, CEREBELLAR; CORTICAL
CRANIECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES, CEREBELLAR;
ELEVATION OF DEPRESSED SKULL FRACTURE; COMPOUND OR COMMINUTED, EXTRADURAL
ELEVATION OF DEPRESSED SKULL FRACTURE; WITH REPAIR OF DURA AND/OR DEBRIDEMENT
CRANIOTOMY FOR REPAIR OF DURAL/CEREBROSPINAL FLUID LEAK, INCLUDING SURGERY FOR
REDUCTION OF CRANIOMEGALIC SKULL (EG, TREATED HYDROCEPHALUS); NOT REQUIRING
REDUCTION OF CRANIOMEGALIC SKULL (EG, TREATED HYDROCEPHALUS); WITH SIMPLE
REDUCTION OF CRANIOMEGALIC SKULL (EG, TREATED HYDROCEPHALUS); REQUIRING
REPAIR OF ENCEPHALOCELE, SKULL VAULT, INCLUDING CRANIOPLASTY
CRANIOTOMY FOR REPAIR OF ENCEPHALOCELE, SKULL BASE
CRANIOPLASTY FOR SKULL DEFECT; UP TO 5 CM DIAMETER
CRANIOPLASTY FOR SKULL DEFECT; LARGER THAN 5 CM DIAMETER
REMOVAL OF BONE FLAP OR PROSTHETIC PLATE OF SKULL
REPLACEMENT OF BONE FLAP OR PROSTHETIC PLATE OF SKULL
CRANIOPLASTY FOR SKULL DEFECT WITH REPARATIVE BRAIN SURGERY
CRANIOPLASTY WITH AUTOGRAFT (INCLUDES OBTAINING BONE GRAFTS); UP TO 5 CM
CRANIOPLASTY WITH AUTOGRAFT (INCLUDES OBTAINING BONE GRAFTS); LARGER THAN 5 CM
INCISION AND RETRIEVAL OF SUBCUTANEOUS CRANIAL BONE GRAFT FOR CRANIOPLASTY
NEUROENDOSCOPY, INTRACRANIAL; WITH DISSECTION OF ADHESIONS, FENESTRATION OF
NEUROENDOSCOPY, INTRACRANIAL; WITH FENESTRATION OR EXCISION OF COLLOID CYST,
NEUROENDOSCOPY, INTRACRANIAL; WITH RETRIEVAL OF FOREIGN BODY
NEUROENDOSCOPY, INTRACRANIAL; WITH EXCISION OF BRAIN TUMOR, INCLUDING PLACEMENT
NEUROENDOSCOPY, INTRACRANIAL; WITH EXCISION OF PITUITARY TUMOR, TRANSNASAL OR
VENTRICULOCISTERNOSTOMY (TORKILDSEN TYPE OPERATION)
CREATION OF SHUNT; SUBARACHNOID/SUBDURAL-ATRIAL, -JUGULAR, -AURICULAR
CREATION OF SHUNT; SUBARACHNOID/SUBDURAL-PERITONEAL, -PLEURAL, OTHER TERMINUS
VENTRICULOCISTERNOSTOMY, THIRD VENTRICLE;
VENTRICULOCISTERNOSTOMY, THIRD VENTRICLE; STEREOTACTIC, NEUROENDOSCOPIC METHOD
CREATION OF SHUNT; VENTRICULO-ATRIAL, -JUGULAR, -AURICULAR
CREATION OF SHUNT; VENTRICULO-PERITONEAL, -PLEURAL, OTHER TERMINUS
REMOVAL OF COMPLETE CEREBROSPINAL FLUID SHUNT SYSTEM; WITHOUT REPLACEMENT
REMOVAL OF COMPLETE CEREBROSPINAL FLUID SHUNT SYSTEM; WITH REPLACEMENT BY
LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING
LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING
LAMINOPLASTY, CERVICAL, WITH DECOMPRESSION OF THE SPINAL CORD, TWO OR MORE
LAMINOPLASTY, CERVICAL, WITH DECOMPRESSION OF THE SPINAL CORD, TWO OR MORE
DISKECTOMY, ANTERIOR, WITH DECOMPRESSION OF SPINAL CORD AND/ OR NERVE ROOT(S),
DISKECTOMY, ANTERIOR, WITH DECOMPRESSION OF SPINAL CORD AND/ OR NERVE ROOT(S),
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, ANTERIOR
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, ANTERIOR
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE,
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE,
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, COMBINED
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, COMBINED
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE,
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE,
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, LATERAL EX
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, LATERAL
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, LATERAL
LAMINECTOMY WITH MYELOTOMY (EG, BISCHOF OR DREZ TYPE), CERVICAL, THORACIC OR THO
LAMINECTOMY WITH DRAINAGE OF INTRAMEDULLARY CYST/SYRINX; TO SUBARACHNOID SPACE
LAMINECTOMY WITH DRAINAGE OF INTRAMEDULLARY CYST/SYRINX; TO PERITONEAL OR
LAMINECTOMY AND SECTION OF DENTATE LIGAMENTS, WITH OR WITHOUT DURAL GRAFT,
LAMINECTOMY AND SECTION OF DENTATE LIGAMENTS, WITH OR WITHOUT DURAL GRAFT,
LAMINECTOMY WITH RHIZOTOMY; ONE OR TWO SEGMENTS
LAMINECTOMY WITH RHIZOTOMY; MORE THAN TWO SEGMENTS
LAMINECTOMY WITH SECTION OF SPINAL ACCESSORY NERVE
LAMINECTOMY WITH CORDOTOMY, WITH SECTION OF ONE SPINOTHALAMIC TRACT, ONE STAGE;
LAMINECTOMY WITH CORDOTOMY, WITH SECTION OF ONE SPINOTHALAMIC TRACT, ONE STAGE;
LAMINECTOMY WITH CORDOTOMY, WITH SECTION OF BOTH SPINOTHALAMIC TRACTS, ONE
LAMINECTOMY WITH CORDOTOMY, WITH SECTION OF BOTH SPINOTHALAMIC TRACTS, ONE
LAMINECTOMY WITH CORDOTOMY WITH SECTION OF BOTH SPINOTHALAMIC TRACTS, TWO
LAMINECTOMY WITH CORDOTOMY WITH SECTION OF BOTH SPINOTHALAMIC TRACTS, TWO
LAMINECTOMY, WITH RELEASE OF TETHERED SPINAL CORD, LUMBAR
LAMINECTOMY FOR EXCISION OR OCCLUSION OF ARTERIOVENOUS MALFORMATION OF SPINAL CO
LAMINECTOMY FOR EXCISION OR OCCLUSION OF ARTERIOVENOUS MALFORMATION OF SPINAL
LAMINECTOMY FOR EXCISION OR OCCLUSION OF ARTERIOVENOUS MALFORMATION OF SPINAL
LAMINECTOMY FOR EXCISION OR EVACUATION OF INTRASPINAL LESION OTHER THAN
LAMINECTOMY FOR EXCISION OR EVACUATION OF INTRASPINAL LESION OTHER THAN
LAMINECTOMY FOR EXCISION OR EVACUATION OF INTRASPINAL LESION OTHER THAN
LAMINECTOMY FOR EXCISION OR EVACUATION OF INTRASPINAL LESION OTHER THAN
LAMINECTOMY FOR EXCISION OF INTRASPINAL LESION OTHER THAN NEOPLASM, INTRADURAL;
LAMINECTOMY FOR EXCISION OF INTRASPINAL LESION OTHER THAN NEOPLASM, INTRADURAL;
LAMINECTOMY FOR EXCISION OF INTRASPINAL LESION OTHER THAN NEOPLASM, INTRADURAL;
LAMINECTOMY FOR EXCISION OF INTRASPINAL LESION OTHER THAN NEOPLASM, INTRADURAL;
LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; EXTRADURAL, CERVICAL
LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; EXTRADURAL, THORACIC
LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; EXTRADURAL, LUMBAR
LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; EXTRADURAL, SACRAL
LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; INTRADURAL,
LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; INTRADURAL,
LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; INTRADURAL,
LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; INTRADURAL, SACRAL
LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; INTRADURAL,
LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; INTRADURAL,
LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; INTRADURAL,
LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; COMBINED
OSTEOPLASTIC RECONSTRUCTION OF DORSAL SPINAL ELEMENTS, FOLLOWING PRIMARY
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, FOR EXCISI
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, FOR
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, FOR
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, FOR
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, FOR
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, FOR
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, FOR
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, FOR
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, FOR
Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator); 1 sp
Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator); each
REPAIR OF MENINGOCELE; LESS THAN 5 CM DIAMETER
REPAIR OF MENINGOCELE; LARGER THAN 5 CM DIAMETER
REPAIR OF MYELOMENINGOCELE; LESS THAN 5 CM DIAMETER
REPAIR OF MYELOMENINGOCELE; LARGER THAN 5 CM DIAMETER
REPAIR OF DURAL/CEREBROSPINAL FLUID LEAK, NOT REQUIRING LAMINECTOMY
REPAIR OF DURAL/CEREBROSPINAL FLUID LEAK OR PSEUDOMENINGOCELE, WITH LAMINECTOMY
DURAL GRAFT, SPINAL
CREATION OF SHUNT, LUMBAR, SUBARACHNOID-PERITONEAL, -PLEURAL, OR OTHER; INCLUDIN
APPLICATION OF SURFACE (TRANSCUTANEOUS) NEUROSTIMULATOR
TRANSECTION OR AVULSION OF; VAGUS NERVE (VAGOTOMY), TRANSTHORACIC
TRANSECTION OR AVULSION OF; VAGUS NERVES LIMITED TO PROXIMAL STOMACH (SELECTIVE
TRANSECTION OR AVULSION OF; VAGUS NERVE (VAGOTOMY), ABDOMINAL
SYMPATHECTOMY, THORACOLUMBAR
SYMPATHECTOMY, LUMBAR
ANASTOMOSIS; FACIAL-SPINAL ACCESSORY
ANASTOMOSIS; FACIAL-HYPOGLOSSAL
REPAIR OF LACERATION; CONJUNCTIVA, BY MOBILIZATION AND REARRANGEMENT, WITH
RADICAL EXCISION EXTERNAL AUDITORY CANAL LESION; WITH NECK DISSECTION
REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITHOUT GENERAL ANESTHESIA
REMOVAL IMPACTED CERUMEN (SEPARATE PROCEDURE), ONE OR BOTH EARS
RESECTION TEMPORAL BONE, EXTERNAL APPROACH
EXCISION AURAL GLOMUS TUMOR; EXTENDED (EXTRATEMPORAL)
IMPLANTATION OR REPLACEMENT OF ELECTROMAGNETIC BONE CONDUCTION HEARING DEVICE
VESTIBULAR NERVE SECTION, TRANSCRANIAL APPROACH
MYELOGRAPHY, POSTERIOR FOSSA, RADIOLOGICAL SUPERVISION AND INTERPRETATION
CISTERNOGRAPHY, POSITIVE CONTRAST, RADIOLOGICAL SUPERVISION AND INTERPRETATION
RADIOLOGIC EXAMINATION, EYE, FOR DETECTION OF FOREIGN BODY
RADIOLOGIC EXAMINATION, MANDIBLE; PARTIAL, LESS THAN FOUR VIEWS
RADIOLOGIC EXAMINATION, MANDIBLE; COMPLETE, MINIMUM OF FOUR VIEWS
RADIOLOGIC EXAMINATION, MASTOIDS; LESS THAN THREE VIEWS PER SIDE
RADIOLOGIC EXAMINATION, MASTOIDS; COMPLETE, MINIMUM OF THREE VIEWS PER SIDE
RADIOLOGIC EXAMINATION, INTERNAL AUDITORY MEATI, COMPLETE
RADIOLOGIC EXAMINATION, FACIAL BONES; LESS THAN THREE VIEWS
RADIOLOGIC EXAMINATION, FACIAL BONES; COMPLETE, MINIMUM OF THREE VIEWS
RADIOLOGIC EXAMINATION, NASAL BONES, COMPLETE, MINIMUM OF THREE VIEWS
DACRYOCYSTOGRAPHY, NASOLACRIMAL DUCT, RADIOLOGICAL SUPERVISION AND
RADIOLOGIC EXAMINATION; OPTIC FORAMINA
RADIOLOGIC EXAMINATION; ORBITS, COMPLETE, MINIMUM OF FOUR VIEWS
RADIOLOGIC EXAMINATION, SINUSES, PARANASAL, LESS THAN THREE VIEWS
RADIOLOGIC EXAMINATION, SINUSES, PARANASAL, COMPLETE, MINIMUM OF THREE VIEWS
RADIOLOGIC EXAMINATION, SELLA TURCICA
RADIOLOGIC EXAMINATION, SKULL; LESS THAN FOUR VIEWS
RADIOLOGIC EXAMINATION, SKULL; COMPLETE, MINIMUM OF FOUR VIEWS
RADIOLOGIC EXAMINATION, TEETH; SINGLE VIEW
RADIOLOGIC EXAMINATION, TEETH; PARTIAL EXAMINATION, LESS THAN FULL MOUTH
RADIOLOGIC EXAMINATION, TEETH; COMPLETE, FULL MOUTH
RADIOLOGIC EXAMINATION, TEMPOROMANDIBULAR JOINT, OPEN AND CLOSED MOUTH;
RADIOLOGIC EXAMINATION, TEMPOROMANDIBULAR JOINT, OPEN AND CLOSED MOUTH;
TEMPOROMANDIBULAR JOINT ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND
MAGNETIC RESONANCE (EG, PROTON) IMAGING, TEMPOROMANDIBULAR JOINT(S)
CEPHALOGRAM, ORTHODONTIC
ORTHOPANTOGRAM
RADIOLOGIC EXAMINATION; NECK, SOFT TISSUE
RADIOLOGIC EXAMINATION; PHARYNX OR LARYNX, INCLUDING FLUOROSCOPY AND/OR
COMPLEX DYNAMIC PHARYNGEAL AND SPEECH EVALUATION BY CINE OR VIDEO RECORDING
LARYNGOGRAPHY, CONTRAST, RADIOLOGICAL SUPERVISION AND INTERPRETATION
RADIOLOGIC EXAMINATION, SALIVARY GLAND FOR CALCULUS
SIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITHOUT CONTRAST MATERIAL
COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITH CONTRAST MATERIAL(S)
COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITHOUT CONTRAST MATERIAL, FOLLOWED BY
COMPUTED TOMOGRAPHY, ORBIT, SELLA, OR POSTERIOR FOSSA OR OUTER, MIDDLE, OR
COMPUTED TOMOGRAPHY, ORBIT, SELLA, OR POSTERIOR FOSSA OR OUTER, MIDDLE, OR
COMPUTED TOMOGRAPHY, ORBIT, SELLA, OR POSTERIOR FOSSA OR OUTER, MIDDLE, OR
COMPUTED TOMOGRAPHY, MAXILLOFACIAL AREA; WITHOUT CONTRAST MATERIAL
COMPUTED TOMOGRAPHY, MAXILLOFACIAL AREA; WITH CONTRAST MATERIAL(S)
COMPUTED TOMOGRAPHY, MAXILLOFACIAL AREA; WITHOUT CONTRAST MATERIAL, FOLLOWED BY
COMPUTED TOMOGRAPHY, SOFT TISSUE NECK; WITHOUT CONTRAST MATERIAL
COMPUTED TOMOGRAPHY, SOFT TISSUE NECK; WITH CONTRAST MATERIAL(S)
COMPUTED TOMOGRAPHY, SOFT TISSUE NECK; WITHOUT CONTRAST MATERIAL FOLLOWED BY
COMPUTED TOMOGRAPHIC ANGIOGRAPHY, HEAD, WITH CONTRAST MATERIAL(S), INCLUDING NON
COMPUTED TOMOGRAPHIC ANGIOGRAPHY, NECK, WITH CONTRAST MATERIAL(S), INCLUDING NON
MAGNETIC RESONANCE (EG, PROTON) IMAGING, ORBIT, FACE, AND/OR NECK; WITHOUT CONTR
MAGNETIC RESONANCE (EG, PROTON) IMAGING, ORBIT, FACE, AND NECK; WITH CONTRAST
MAGNETIC RESONANCE (EG, PROTON) IMAGING, ORBIT, FACE, AND NECK; WITHOUT
MAGNETIC RESONANCE ANGIOGRAPHY, HEAD; WITHOUT CONTRAST MATERIAL(S)
MAGNETIC RESONANCE ANGIOGRAPHY, HEAD; WITH CONTRAST MATERIAL(S)
MAGNETIC RESONANCE ANGIOGRAPHY, HEAD; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY
MAGNETIC RESONANCE ANGIOGRAPHY, NECK; WITHOUT CONTRAST MATERIAL(S)
MAGNETIC RESONANCE ANGIOGRAPHY, NECK; WITH CONTRAST MATERIAL(S)
MAGNETIC RESONANCE ANGIOGRAPHY, NECK; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY
MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM); WITHOUT
MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM); WITH
MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM); WITHOUT
MAGNETIC RESONANCE IMAGING, BRAIN, FUNCTIONAL MRI; INCLUDING TEST SELECTION AND
RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW, FRONTAL
RADIOLOGIC EXAMINATION, CHEST; STEREO, FRONTAL
RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL;
RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL; WITH APICAL
RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL; WITH OBLIQUE
RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL; WITH FLUOROSCOPY
RADIOLOGIC EXAMINATION, CHEST, COMPLETE, MINIMUM OF FOUR VIEWS;
RADIOLOGIC EXAMINATION, CHEST, COMPLETE, MINIMUM OF FOUR VIEWS; WITH FLUOROSCOPY
RADIOLOGIC EXAMINATION, CHEST, SPECIAL VIEWS (EG, LATERAL DECUBITUS, BUCKY
BRONCHOGRAPHY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
BRONCHOGRAPHY, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
RADIOLOGIC EXAMINATION, RIBS, UNILATERAL; TWO VIEWS
RADIOLOGIC EXAMINATION, RIBS, UNILATERAL; INCLUDING POSTEROANTERIOR CHEST,
RADIOLOGIC EXAMINATION, RIBS, BILATERAL; THREE VIEWS
RADIOLOGIC EXAMINATION, RIBS, BILATERAL; INCLUDING POSTEROANTERIOR CHEST,
RADIOLOGIC EXAMINATION; STERNUM, MINIMUM OF TWO VIEWS
RADIOLOGIC EXAMINATION; STERNOCLAVICULAR JOINT OR JOINTS, MINIMUM OF THREE VIEWS
COMPUTED TOMOGRAPHY, THORAX; WITHOUT CONTRAST MATERIAL
COMPUTED TOMOGRAPHY, THORAX; WITH CONTRAST MATERIAL(S)
COMPUTED TOMOGRAPHY, THORAX; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST
COMPUTED TOMOGRAPHIC ANGIOGRAPHY, CHEST (NONCORONARY), WITH CONTRAST MATERIAL(S)
MAGNETIC RESONANCE (EG, PROTON) IMAGING, CHEST (EG, FOR EVALUATION OF HILAR AND
MAGNETIC RESONANCE (EG, PROTON) IMAGING, CHEST (EG, FOR EVALUATION OF HILAR AND
MAGNETIC RESONANCE (EG, PROTON) IMAGING, CHEST (EG, FOR EVALUATION OF HILAR AND
MAGNETIC RESONANCE ANGIOGRAPHY, CHEST (EXCLUDING MYOCARDIUM), WITH OR WITHOUT
RADIOLOGIC EXAMINATION, SPINE, ENTIRE, SURVEY STUDY, ANTEROPOSTERIOR AND LATERAL
RADIOLOGIC EXAMINATION, SPINE, SINGLE VIEW, SPECIFY LEVEL
RADIOLOGIC EXAMINATION, SPINE, CERVICAL; TWO OR THREE VIEWS
RADIOLOGIC EXAMINATION, SPINE, CERVICAL; MINIMUM OF FOUR VIEWS
RADIOLOGIC EXAMINATION, SPINE, CERVICAL; COMPLETE, INCLUDING OBLIQUE AND
RADIOLOGIC EXAMINATION, SPINE, THORACOLUMBAR, STANDING (SCOLIOSIS)
RADIOLOGIC EXAMINATION, SPINE; THORACIC, TWO VIEWS
RADIOLOGIC EXAMINATION, SPINE; THORACIC, THREE VIEWS
RADIOLOGIC EXAMINATION, SPINE; THORACIC, MINIMUM OF FOUR VIEWS
RADIOLOGIC EXAMINATION, SPINE; THORACOLUMBAR, TWO VIEWS
RADIOLOGIC EXAMINATION, SPINE; SCOLIOSIS STUDY, INCLUDING SUPINE AND ERECT
RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; TWO OR THREE VIEWS
RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; MINIMUM OF FOUR VIEWS
RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; COMPLETE, INCLUDING BENDING VIEWS
RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL, BENDING VIEWS ONLY, MINIMUM OF FOUR
COMPUTED TOMOGRAPHY, CERVICAL SPINE; WITHOUT CONTRAST MATERIAL
COMPUTED TOMOGRAPHY, CERVICAL SPINE; WITH CONTRAST MATERIAL
COMPUTED TOMOGRAPHY, CERVICAL SPINE; WITHOUT CONTRAST MATERIAL, FOLLOWED BY
COMPUTED TOMOGRAPHY, THORACIC SPINE; WITHOUT CONTRAST MATERIAL
COMPUTED TOMOGRAPHY, THORACIC SPINE; WITH CONTRAST MATERIAL
COMPUTED TOMOGRAPHY, THORACIC SPINE; WITHOUT CONTRAST MATERIAL, FOLLOWED BY
COMPUTED TOMOGRAPHY, LUMBAR SPINE; WITHOUT CONTRAST MATERIAL
COMPUTED TOMOGRAPHY, LUMBAR SPINE; WITH CONTRAST MATERIAL
COMPUTED TOMOGRAPHY, LUMBAR SPINE; WITHOUT CONTRAST MATERIAL, FOLLOWED BY
MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, CERVICAL;
MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, CERVICAL;
MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, THORACIC;
MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, THORACIC;
MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, LUMBAR;
MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, LUMBAR;
MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, WITHOUT
MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, WITHOUT
MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, WITHOUT
MAGNETIC RESONANCE ANGIOGRAPHY, SPINAL CANAL AND CONTENTS, WITH OR WITHOUT
RADIOLOGIC EXAMINATION, PELVIS; ONE OR TWO VIEWS
RADIOLOGIC EXAMINATION, PELVIS; COMPLETE, MINIMUM OF THREE VIEWS
COMPUTED TOMOGRAPHIC ANGIOGRAPHY, PELVIS, WITH CONTRAST MATERIAL(S), INCLUDING N
COMPUTED TOMOGRAPHY, PELVIS; WITHOUT CONTRAST MATERIAL
COMPUTED TOMOGRAPHY, PELVIS; WITH CONTRAST MATERIAL(S)
COMPUTED TOMOGRAPHY, PELVIS; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST
MAGNETIC RESONANCE (EG, PROTON) IMAGING, PELVIS; WITHOUT CONTRAST MATERIAL(S)
MAGNETIC RESONANCE (EG, PROTON) IMAGING, PELVIS; WITH CONTRAST MATERIAL(S)
MAGNETIC RESONANCE (EG, PROTON) IMAGING, PELVIS; WITHOUT CONTRAST MATERIAL(S),
MAGNETIC RESONANCE ANGIOGRAPHY, PELVIS, WITH OR WITHOUT CONTRAST MATERIAL(S)
RADIOLOGIC EXAMINATION, SACROILIAC JOINTS; LESS THAN THREE VIEWS
RADIOLOGIC EXAMINATION, SACROILIAC JOINTS; THREE OR MORE VIEWS
RADIOLOGIC EXAMINATION, SACRUM AND COCCYX, MINIMUM OF TWO VIEWS
MYELOGRAPHY, CERVICAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
MYELOGRAPHY, THORACIC, RADIOLOGICAL SUPERVISION AND INTERPRETATION
MYELOGRAPHY, LUMBOSACRAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
MYELOGRAPHY, TWO OR MORE REGIONS (EG, LUMBAR/THORACIC, CERVICAL/ THORACIC,
DISKOGRAPHY, CERVICAL OR THORACIC, RADIOLOGICAL SUPERVISION AND INTERPRETATION
DISKOGRAPHY, LUMBAR, RADIOLOGICAL SUPERVISION AND INTERPRETATION
RADIOLOGIC EXAMINATION; CLAVICLE, COMPLETE
RADIOLOGIC EXAMINATION; SCAPULA, COMPLETE
RADIOLOGIC EXAMINATION, SHOULDER; ONE VIEW
RADIOLOGIC EXAMINATION, SHOULDER; COMPLETE, MINIMUM OF TWO VIEWS
RADIOLOGIC EXAMINATION, SHOULDER, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND
RADIOLOGIC EXAMINATION; ACROMIOCLAVICULAR JOINTS, BILATERAL, WITH OR WITHOUT
RADIOLOGIC EXAMINATION; HUMERUS, MINIMUM OF TWO VIEWS
RADIOLOGIC EXAMINATION, ELBOW; TWO VIEWS
RADIOLOGIC EXAMINATION, ELBOW; COMPLETE, MINIMUM OF THREE VIEWS
RADIOLOGIC EXAMINATION, ELBOW, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND
RADIOLOGIC EXAMINATION; FOREARM, TWO VIEWS
RADIOLOGIC EXAMINATION; UPPER EXTREMITY, INFANT, MINIMUM OF TWO VIEWS
RADIOLOGIC EXAMINATION, WRIST; TWO VIEWS
RADIOLOGIC EXAMINATION, WRIST; COMPLETE, MINIMUM OF THREE VIEWS
RADIOLOGIC EXAMINATION, WRIST, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND
RADIOLOGIC EXAMINATION, HAND; TWO VIEWS
RADIOLOGIC EXAMINATION, HAND; MINIMUM OF THREE VIEWS
RADIOLOGIC EXAMINATION, FINGER(S), MINIMUM OF TWO VIEWS
COMPUTED TOMOGRAPHY, UPPER EXTREMITY; WITHOUT CONTRAST MATERIAL
COMPUTED TOMOGRAPHY, UPPER EXTREMITY; WITH CONTRAST MATERIAL(S)
COMPUTED TOMOGRAPHY, UPPER EXTREMITY; WITHOUT CONTRAST MATERIAL, FOLLOWED BY
COMPUTED TOMOGRAPHIC ANGIOGRAPHY, UPPER EXTREMITY, WITH CONTRAST MATERIAL(S), IN
MAGNETIC RESONANCE (EG, PROTON) IMAGING, UPPER EXTREMITY, OTHER THAN JOINT;
MAGNETIC RESONANCE (EG, PROTON) IMAGING, UPPER EXTREMITY, OTHER THAN JOINT;
MAGNETIC RESONANCE (EG, PROTON) IMAGING, UPPER EXTREMITY, OTHER THAN JOINT;
MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF UPPER EXTREMITY; WITHOUT
MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF UPPER EXTREMITY; WITH
MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF UPPER EXTREMITY; WITHOUT
MAGNETIC RESONANCE ANGIOGRAPHY, UPPER EXTREMITY, WITH OR WITHOUT CONTRAST
RADIOLOGIC EXAMINATION, HIP; UNILATERAL, ONE VIEW
RADIOLOGIC EXAMINATION, HIP, UNILATERAL; COMPLETE, MINIMUM OF TWO VIEWS
RADIOLOGIC EXAMINATION, HIPS, BILATERAL, MINIMUM OF TWO VIEWS OF EACH HIP,
RADIOLOGIC EXAMINATION, HIP, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND
RADIOLOGIC EXAMINATION, PELVIS AND HIPS, INFANT OR CHILD, MINIMUM OF TWO VIEWS
RADIOLOGIC EXAMINATION, FEMUR, TWO VIEWS
RADIOLOGIC EXAMINATION, KNEE; ONE OR TWO VIEWS
RADIOLOGIC EXAMINATION, KNEE; THREE VIEWS
RADIOLOGIC EXAMINATION, KNEE; COMPLETE, FOUR OR MORE VIEWS
RADIOLOGIC EXAMINATION, KNEE; BOTH KNEES, STANDING, ANTEROPOSTERIOR
RADIOLOGIC EXAMINATION, KNEE, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND
RADIOLOGIC EXAMINATION; TIBIA AND FIBULA, TWO VIEWS
RADIOLOGIC EXAMINATION; LOWER EXTREMITY, INFANT, MINIMUM OF TWO VIEWS
RADIOLOGIC EXAMINATION, ANKLE; TWO VIEWS
RADIOLOGIC EXAMINATION, ANKLE; COMPLETE, MINIMUM OF THREE VIEWS
RADIOLOGIC EXAMINATION, ANKLE, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND
RADIOLOGIC EXAMINATION, FOOT; TWO VIEWS
RADIOLOGIC EXAMINATION, FOOT; COMPLETE, MINIMUM OF THREE VIEWS
RADIOLOGIC EXAMINATION; CALCANEUS, MINIMUM OF TWO VIEWS
RADIOLOGIC EXAMINATION; TOE(S), MINIMUM OF TWO VIEWS
COMPUTED TOMOGRAPHY, LOWER EXTREMITY; WITHOUT CONTRAST MATERIAL
COMPUTED TOMOGRAPHY, LOWER EXTREMITY; WITH CONTRAST MATERIAL(S)
COMPUTED TOMOGRAPHY, LOWER EXTREMITY; WITHOUT CONTRAST MATERIAL, FOLLOWED BY
COMPUTED TOMOGRAPHIC ANGIOGRAPHY, LOWER EXTREMITY, WITH CONTRAST MATERIAL(S), IN
MAGNETIC RESONANCE (EG, PROTON) IMAGING, LOWER EXTREMITY OTHER THAN JOINT;
MAGNETIC RESONANCE (EG, PROTON) IMAGING, LOWER EXTREMITY OTHER THAN JOINT; WITH
MAGNETIC RESONANCE (EG, PROTON) IMAGING, LOWER EXTREMITY OTHER THAN JOINT;
MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF LOWER EXTREMITY; WITHOUT
MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF LOWER EXTREMITY; WITH
MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF LOWER EXTREMITY; WITHOUT
MAGNETIC RESONANCE ANGIOGRAPHY, LOWER EXTREMITY, WITH OR WITHOUT CONTRAST
RADIOLOGIC EXAMINATION, ABDOMEN; SINGLE ANTEROPOSTERIOR VIEW
RADIOLOGIC EXAMINATION, ABDOMEN; ANTEROPOSTERIOR AND ADDITIONAL OBLIQUE AND
RADIOLOGIC EXAMINATION, ABDOMEN; COMPLETE, INCLUDING DECUBITUS AND/OR ERECT
RADIOLOGIC EXAMINATION, ABDOMEN; COMPLETE ACUTE ABDOMEN SERIES, INCLUDING
COMPUTED TOMOGRAPHY, ABDOMEN; WITHOUT CONTRAST MATERIAL
COMPUTED TOMOGRAPHY, ABDOMEN; WITH CONTRAST MATERIAL(S)
COMPUTED TOMOGRAPHY, ABDOMEN; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST
COMPUTED TOMOGRAPHIC ANGIOGRAPHY, ABDOMEN, WITH CONTRAST MATERIAL(S), INCLUDING
COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITHOUT CONTRAST MATERIAL
COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITH CONTRAST MATERIAL
COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITHOUT CONTRAST MATERIAL IN ONE OR BOT
MAGNETIC RESONANCE (EG, PROTON) IMAGING, ABDOMEN; WITHOUT CONTRAST MATERIAL(S)
MAGNETIC RESONANCE (EG, PROTON) IMAGING, ABDOMEN; WITH CONTRAST MATERIAL(S)
MAGNETIC RESONANCE (EG, PROTON) IMAGING, ABDOMEN; WITHOUT CONTRAST MATERIAL(S),
MAGNETIC RESONANCE ANGIOGRAPHY, ABDOMEN, WITH OR WITHOUT CONTRAST MATERIAL(S)
PERITONEOGRAM (EG, AFTER INJECTION OF AIR OR CONTRAST), RADIOLOGICAL
Computed tomographic (CT) colonography, diagnostic, including image postprocessi
Computed tomographic (CT) colonography, diagnostic, including image postprocessi
Computed tomographic (CT) colonography, screening, including image postprocessin
CHOLANGIOGRAPHY AND/OR PANCREATOGRAPHY; THROUGH EXISTING CATHETER, RADIOLOGICAL
CHOLANGIOGRAPHY, PERCUTANEOUS, TRANSHEPATIC, RADIOLOGICAL SUPERVISION AND
UROGRAPHY, ANTEGRADE, (PYELOSTOGRAM, NEPHROSTOGRAM, LOOPOGRAM), RADIOLOGICAL
CYSTOGRAPHY, MINIMUM OF THREE VIEWS, RADIOLOGICAL SUPERVISION AND INTERPRETATION
VASOGRAPHY, VESICULOGRAPHY, OR EPIDIDYMOGRAPHY, RADIOLOGICAL SUPERVISION AND
CORPORA CAVERNOSOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
URETHROCYSTOGRAPHY, RETROGRADE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
URETHROCYSTOGRAPHY, VOIDING, RADIOLOGICAL SUPERVISION AND INTERPRETATION
RADIOLOGIC EXAMINATION, RENAL CYST STUDY, TRANSLUMBAR, CONTRAST VISUALIZATION,
INTRODUCTION OF INTRACATHETER OR CATHETER INTO RENAL PELVIS FOR DRAINAGE AND/OR
INTRODUCTION OF URETERAL CATHETER OR STENT INTO URETER THROUGH RENAL PELVIS FOR
DILATION OF NEPHROSTOMY, URETERS, OR URETHRA, RADIOLOGICAL SUPERVISION AND
PELVIMETRY, WITH OR WITHOUT PLACENTAL LOCALIZATION
HYSTEROSALPINGOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY AND FUNCTION WITHOUT CONTRAST
CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY AND FUNCTION WITHOUT CONTRAST
CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY AND FUNCTION WITHOUT CONTRAST
CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY AND FUNCTION WITHOUT CONTRAST
Computed tomography, heart, without contrast material, with quantitative evaluat
AORTOGRAPHY, THORACIC, WITHOUT SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTER
AORTOGRAPHY, THORACIC, BY SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND
AORTOGRAPHY, ABDOMINAL, BY SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND
AORTOGRAPHY, ABDOMINAL PLUS BILATERAL ILIOFEMORAL LOWER EXTREMITY, CATHETER, BY
COMPUTED TOMOGRAPHIC ANGIOGRAPHY, ABDOMINAL AORTA AND BILATERAL ILIOFEMORAL LOWE
ANGIOGRAPHY, CERVICOCEREBRAL, CATHETER, INCLUDING VESSEL ORIGIN, RADIOLOGICAL
ANGIOGRAPHY, BRACHIAL, RETROGRADE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
ANGIOGRAPHY, EXTERNAL CAROTID, UNILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION
ANGIOGRAPHY, EXTERNAL CAROTID, BILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION
ANGIOGRAPHY, CAROTID, CEREBRAL, UNILATERAL, RADIOLOGICAL SUPERVISION AND
ANGIOGRAPHY, CAROTID, CEREBRAL, BILATERAL, RADIOLOGICAL SUPERVISION AND
ANGIOGRAPHY, CAROTID, CERVICAL, UNILATERAL, RADIOLOGICAL SUPERVISION AND
ANGIOGRAPHY, CAROTID, CERVICAL, BILATERAL, RADIOLOGICAL SUPERVISION AND
ANGIOGRAPHY, VERTEBRAL, CERVICAL, AND/OR INTRACRANIAL, RADIOLOGICAL SUPERVISION
ANGIOGRAPHY, SPINAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
ANGIOGRAPHY, EXTREMITY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
ANGIOGRAPHY, EXTREMITY, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
ANGIOGRAPHY, VISCERAL, SELECTIVE OR SUPRASELECTIVE, (WITH OR WITHOUT FLUSH
ANGIOGRAPHY, ADRENAL, UNILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND
ANGIOGRAPHY, ADRENAL, BILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND
ANGIOGRAPHY, PELVIC, SELECTIVE OR SUPRASELECTIVE, RADIOLOGICAL SUPERVISION AND
ANGIOGRAPHY, PULMONARY, UNILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND
ANGIOGRAPHY, PULMONARY, BILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND
ANGIOGRAPHY, PULMONARY, BY NONSELECTIVE CATHETER OR VENOUS INJECTION,
ANGIOGRAPHY, INTERNAL MAMMARY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
Angiography, arteriovenous shunt (eg, dialysis patient fistula/graft), complete
LYMPHANGIOGRAPHY, EXTREMITY ONLY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTER
LYMPHANGIOGRAPHY, EXTREMITY ONLY, BILATERAL, RADIOLOGICAL SUPERVISION AND
LYMPHANGIOGRAPHY, PELVIC/ABDOMINAL, UNILATERAL, RADIOLOGICAL SUPERVISION AND
LYMPHANGIOGRAPHY, PELVIC/ABDOMINAL, BILATERAL, RADIOLOGICAL SUPERVISION AND
SHUNTOGRAM FOR INVESTIGATION OF PREVIOUSLY PLACED INDWELLING NONVASCULAR SHUNT
SPLENOPORTOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
VENOGRAPHY, EXTREMITY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
VENOGRAPHY, EXTREMITY, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
VENOGRAPHY, CAVAL, INFERIOR, WITH SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND
VENOGRAPHY, CAVAL, SUPERIOR, WITH SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND
VENOGRAPHY, RENAL, UNILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND
VENOGRAPHY, RENAL, BILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND
VENOGRAPHY, ADRENAL, UNILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND
VENOGRAPHY, ADRENAL, BILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND
VENOGRAPHY, VENOUS SINUS (EG, PETROSAL AND INFERIOR SAGITTAL) OR JUGULAR,
VENOGRAPHY, SUPERIOR SAGITTAL SINUS, RADIOLOGICAL SUPERVISION AND INTERPRETATION
VENOGRAPHY, EPIDURAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
VENOGRAPHY, ORBITAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
PERCUTANEOUS TRANSHEPATIC PORTOGRAPHY WITH HEMODYNAMIC EVALUATION, RADIOLOGICAL
PERCUTANEOUS TRANSHEPATIC PORTOGRAPHY WITHOUT HEMODYNAMIC EVALUATION,
HEPATIC VENOGRAPHY, WEDGED OR FREE, WITH HEMODYNAMIC EVALUATION, RADIOLOGICAL
HEPATIC VENOGRAPHY, WEDGED OR FREE, WITHOUT HEMODYNAMIC EVALUATION,
VENOUS SAMPLING THROUGH CATHETER, WITH OR WITHOUT ANGIOGRAPHY (EG, FOR
ANGIOGRAPHY THROUGH EXISTING CATHETER FOR FOLLOW-UP STUDY FOR TRANSCATHETER
EXCHANGE OF A PREVIOUSLY PLACED INTRAVASCULAR CATHETER DURING THROMBOLYTIC THERA
INTRAVASCULAR ULTRASOUND (NON-CORONARY VESSEL), RADIOLOGICAL SUPERVISION AND
ENDOVASCULAR REPAIR OF INFRARENAL ABDOMINAL AORTIC ANEURYSM OR DISSECTION,
PLACEMENT OF PROXIMAL OR DISTAL EXTENSION PROSTHESIS FOR ENDOVASCULAR REPAIR OF
ENDOVASCULAR REPAIR OF ILIAC ARTERY ANEURYSM, PSEUDOANEURYSM, ARTERIOVENOUS MALF
ENDOVASCULAR REPAIR OF DESCENDING THORACIC AORTA (EG, ANEURYSM, PSEUDOANEURYSM,
ENDOVASCULAR REPAIR OF DESCENDING THORACIC AORTA (EG, ANEURYSM, PSEUDOANEURYSM,
PLACEMENT OF PROXIMAL EXTENSION PROSTHESIS FOR ENDOVASCULAR REPAIR OF DESCENDING
PLACEMENT OF DISTAL EXTENSION PROSTHESIS(S) (DELAYED) AFTER ENDOVASCULAR REPAIR
TRANSLUMINAL BALLOON ANGIOPLASTY, PERIPHERAL ARTERY OTHER THAN CERVICAL CAROTID,
TRANSLUMINAL BALLOON ANGIOPLASTY, RENAL OR OTHER VISCERAL ARTERY, RADIOLOGICAL
TRANSLUMINAL BALLOON ANGIOPLASTY, VENOUS (EG, SUBCLAVIAN STENOSIS),
FLUOROSCOPY (SEPARATE PROCEDURE), UP TO ONE HOUR PHYSICIAN TIME, OTHER THAN
RADIOLOGIC EXAMINATION FROM NOSE TO RECTUM FOR FOREIGN BODY, SINGLE VIEW, CHILD
RADIOLOGIC EXAMINATION, ABSCESS, FISTULA OR SINUS TRACT STUDY, RADIOLOGICAL
RADIOLOGICAL EXAMINATION, SURGICAL SPECIMEN
RADIOLOGIC EXAMINATION, SINGLE PLANE BODY SECTION (EG, TOMOGRAPHY), OTHER THAN
RADIOLOGIC EXAMINATION, COMPLEX MOTION (IE, HYPERCYCLOIDAL) BODY SECTION (EG,
RADIOLOGIC EXAMINATION, COMPLEX MOTION (IE, HYPERCYCLOIDAL) BODY SECTION (EG,
CINERADIOGRAPHY/VIDEORADIOGRAPHY, EXCEPT WHERE SPECIFICALLY INCLUDED
CONSULTATION ON X-RAY EXAMINATION MADE ELSEWHERE, WRITTEN REPORT
MAGNETIC RESONANCE SPECTROSCOPY
UNLISTED FLUOROSCOPIC PROCEDURE (EG, DIAGNOSTIC, INTERVENTIONAL)
UNLISTED DIAGNOSTIC RADIOGRAPHIC PROCEDURE
OPHTHALMIC ULTRASOUND, DIAGNOSTIC; CORNEAL PACHYMETRY, UNILATERAL OR BILATERAL
ULTRASOUND, CHEST (INCLUDES MEDIASTINUM), REAL TIME WITH IMAGE DOCUMENTATION
ULTRASOUND, ABDOMINAL, REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE
ULTRASOUND, ABDOMINAL, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION;
ULTRASOUND, RETROPERITONEAL (EG, RENAL, AORTA, NODES), REAL TIME WITH IMAGE DOCU
ULTRASOUND, RETROPERITONEAL (EG, RENAL, AORTA, NODES), B-SCAN AND/OR REAL TIME
ULTRASOUND, TRANSPLANTED KIDNEY, REAL TIME AND DUPLEX DOPPLER WITH IMAGE DOCUMEN
SALINE INFUSION SONOHYSTEROGRAPHY (SIS), INCLUDING COLOR FLOW DOPPLER, WHEN
ULTRASOUND, PELVIC (NONOBSTETRIC), REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE
ULTRASOUND, PELVIC (NONOBSTETRIC), B-SCAN AND/OR REAL TIME WITH IMAGE
ULTRASOUND, SCROTUM AND CONTENTS
GASTROINTESTINAL ENDOSCOPIC ULTRASOUND, SUPERVISION AND INTERPRETATION
ULTRASOUND BONE DENSITY MEASUREMENT AND INTERPRETATION, PERIPHERAL SITE(S), ANY
COMPUTER-AIDED DETECTION (COMPUTER ALGORITHM ANALYSIS OF DIGITAL IMAGE DATA FOR
COMPUTER-AIDED DETECTION (COMPUTER ALGORITHM ANALYSIS OF DIGITAL IMAGE DATA FOR
MAMMARY DUCTOGRAM OR GALACTOGRAM, SINGLE DUCT, RADIOLOGICAL SUPERVISION AND INTE
MAMMARY DUCTOGRAM OR GALACTOGRAM, MULTIPLE DUCTS, RADIOLOGICAL SUPERVISION AND I
MAMMOGRAPHY; UNILATERAL
MAMMOGRAPHY; BILATERAL
SCREENING MAMMOGRAPHY, BILATERAL (2-VIEW FILM STUDY OF EACH BREAST)
MAGNETIC RESONANCE IMAGING, BREAST, WITHOUT AND/OR WITH CONTRAST MATERIAL(S); UN
MAGNETIC RESONANCE IMAGING, BREAST, WITHOUT AND/OR WITH CONTRAST MATERIAL(S); BI
MANUAL APPLICATION OF STRESS PERFORMED BY PHYSICIAN FOR JOINT RADIOGRAPHY, INCLU
BONE AGE STUDIES
BONE LENGTH STUDIES (ORTHOROENTGENOGRAM, SCANOGRAM)
RADIOLOGIC EXAMINATION, OSSEOUS SURVEY; LIMITED (EG, FOR METASTASES)
RADIOLOGIC EXAMINATION, OSSEOUS SURVEY; COMPLETE (AXIAL AND APPENDICULAR SKELETO
RADIOLOGIC EXAMINATION, OSSEOUS SURVEY, INFANT
JOINT SURVEY, SINGLE VIEW, 2 OR MORE JOINTS (SPECIFY)
DUAL-ENERGY X-RAY ABSORPTIOMETRY (DXA), BONE DENSITY STUDY, 1 OR MORE SITES; VER
THERAPEUTIC RADIOLOGY TREATMENT PLANNING; SIMPLE
THERAPEUTIC RADIOLOGY TREATMENT PLANNING; INTERMEDIATE
THERAPEUTIC RADIOLOGY TREATMENT PLANNING; COMPLEX
THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING; SIMPLE
THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING; INTERMEDIATE
THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING; COMPLEX
THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING; THREE-DIMENSIONAL
UNLISTED PROCEDURE, THERAPEUTIC RADIOLOGY CLINICAL TREATMENT PLANNING
BASIC RADIATION DOSIMETRY CALCULATION, CENTRAL AXIS DEPTH DOSE CALCULATION, TDF,
INTENSITY MODULATED RADIOTHERAPY PLAN, INCLUDING DOSE-VOLUME HISTOGRAMS FOR
TELETHERAPY, ISODOSE PLAN (WHETHER HAND OR COMPUTER CALCULATED); SIMPLE (ONE OR
TELETHERAPY, ISODOSE PLAN (WHETHER HAND OR COMPUTER CALCULATED); INTERMEDIATE
TELETHERAPY, ISODOSE PLAN (WHETHER HAND OR COMPUTER CALCULATED); COMPLEX
SPECIAL TELETHERAPY PORT PLAN, PARTICLES, HEMIBODY, TOTAL BODY
BRACHYTHERAPY ISODOSE PLAN; SIMPLE (CALCULATION MADE FROM SINGLE PLANE, ONE TO
BRACHYTHERAPY ISODOSE PLAN; INTERMEDIATE (MULTIPLANE DOSAGE CALCULATIONS,
BRACHYTHERAPY ISODOSE PLAN; COMPLEX (MULTIPLANE ISODOSE PLAN, VOLUME IMPLANT
SPECIAL DOSIMETRY (EG, TLD, MICRODOSIMETRY) (SPECIFY), ONLY WHEN PRESCRIBED BY
TREATMENT DEVICES, DESIGN AND CONSTRUCTION; SIMPLE (SIMPLE BLOCK, SIMPLE BOLUS)
TREATMENT DEVICES, DESIGN AND CONSTRUCTION; INTERMEDIATE (MULTIPLE BLOCKS,
TREATMENT DEVICES, DESIGN AND CONSTRUCTION; COMPLEX (IRREGULAR BLOCKS, SPECIAL
CONTINUING MEDICAL PHYSICS CONSULTATION, INCLUDING ASSESSMENT OF TREATMENT
Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy
SPECIAL MEDICAL RADIATION PHYSICS CONSULTATION
RADIATION TREATMENT DELIVERY, STEREOTACTIC RADIOSURGERY (SRS), COMPLETE COURSE O
STEREOTACTIC BODY RADIATION THERAPY, TREATMENT DELIVERY, PER FRACTION TO 1 OR MO
UNLISTED PROCEDURE, MEDICAL RADIATION PHYSICS, DOSIMETRY AND TREATMENT DEVICES,
RADIATION TREATMENT MANAGEMENT, FIVE TREATMENTS
RADIATION THERAPY MANAGEMENT WITH COMPLETE COURSE OF THERAPY CONSISTING OF ONE
STEREOTACTIC RADIATION TREATMENT MANAGEMENT OF CRANIAL LESION(S) (COMPLETE COURS
UNLISTED PROCEDURE, THERAPEUTIC RADIOLOGY TREATMENT MANAGEMENT
INTERSTITIAL RADIATION SOURCE APPLICATION; COMPLEX
UREA BREATH TEST, C-14 (ISOTOPIC); ACQUISITION FOR ANALYSIS
UREA BREATH TEST, C-14 (ISOTOPIC); ANALYSIS
BONE DENSITY (BONE MINERAL CONTENT) STUDY, ONE OR MORE SITES; SINGLE PHOTON
BRAIN IMAGING, POSITRON EMISSION TOMOGRAPHY (PET); PERFUSION EVALUATION
INJECTION PROCEDURE FOR RADIOPHARMACEUTICAL LOCALIZATION BY NON-IMAGING PROBE ST
BASIC METABOLIC PANEL (CALCIUM, IONIZED)
BASIC METABOLIC PANEL (CALCIUM, TOTAL)
GENERAL HEALTH PANEL
ELECTROLYTE PANEL
COMPREHENSIVE METABOLIC PANEL
OBSTETRIC PANEL
LIPID PANEL
RENAL FUNCTION PANEL
ACUTE HEPATITIS PANEL
HEPATIC FUNCTION PANEL
DRUG SCREEN, QUALITATIVE; MULTIPLE DRUG CLASSES CHROMATOGRAPHIC METHOD, EACH PRO
DRUG SCREEN, QUALITATIVE; SINGLE DRUG CLASS METHOD (EG, IMMUNOASSAY, ENZYME ASSA
DRUG CONFIRMATION, EACH PROCEDURE
DRUG SCREEN, QUALITATIVE; MULTIPLE DRUG CLASSES OTHER THAN CHROMATOGRAPHIC METHO
AMIKACIN
AMITRIPTYLINE
BENZODIAZEPINES
CARBAMAZEPINE; TOTAL
CARBAMAZEPINE; FREE
CYCLOSPORINE
DESIPRAMINE
DIGOXIN
DIPROPYLACETIC ACID (VALPROIC ACID)
DOXEPIN
ETHOSUXIMIDE
GENTAMICIN
GOLD
HALOPERIDOL
IMIPRAMINE
LIDOCAINE
LITHIUM
NORTRIPTYLINE
PHENOBARBITAL
PHENYTOIN; TOTAL
PHENYTOIN; FREE
PRIMIDONE
PROCAINAMIDE;
PROCAINAMIDE; WITH METABOLITES (EG, N-ACETYL PROCAINAMIDE)
QUINIDINE
SIROLIMUS
SALICYLATE
TACROLIMUS
THEOPHYLLINE
TOBRAMYCIN
TOPIRAMATE
VANCOMYCIN
QUANTITATION OF DRUG, NOT ELSEWHERE SPECIFIED
ACTH STIMULATION PANEL; FOR ADRENAL INSUFFICIENCY
ACTH STIMULATION PANEL; FOR 21 HYDROXYLASE DEFICIENCY
ACTH STIMULATION PANEL; FOR 3 BETA-HYDROXYDEHYDROGENASE DEFICIENCY
ALDOSTERONE SUPPRESSION EVALUATION PANEL (EG, SALINE INFUSION)
CALCITONIN STIMULATION PANEL (EG, CALCIUM, PENTAGASTRIN)
CORTICOTROPIC RELEASING HORMONE (CRH) STIMULATION PANEL
CHORIONIC GONADOTROPIN STIMULATION PANEL; TESTOSTERONE RESPONSE
CHORIONIC GONADOTROPIN STIMULATION PANEL; ESTRADIOL RESPONSE
RENAL VEIN RENIN STIMULATION PANEL (EG, CAPTOPRIL)
PERIPHERAL VEIN RENIN STIMULATION PANEL (EG, CAPTOPRIL)
COMBINED RAPID ANTERIOR PITUITARY EVALUATION PANEL
DEXAMETHASONE SUPPRESSION PANEL, 48 HOUR
GLUCAGON TOLERANCE PANEL; FOR INSULINOMA
GLUCAGON TOLERANCE PANEL; FOR PHEOCHROMOCYTOMA
GONADOTROPIN RELEASING HORMONE STIMULATION PANEL
GROWTH HORMONE STIMULATION PANEL (EG, ARGININE INFUSION, L-DOPA ADMINISTRATION)
GROWTH HORMONE SUPPRESSION PANEL (GLUCOSE ADMINISTRATION)
INSULIN-INDUCED C-PEPTIDE SUPPRESSION PANEL
INSULIN TOLERANCE PANEL; FOR ACTH INSUFFICIENCY
INSULIN TOLERANCE PANEL; FOR GROWTH HORMONE DEFICIENCY
METYRAPONE PANEL
THYROTROPIN RELEASING HORMONE (TRH) STIMULATION PANEL; ONE HOUR
THYROTROPIN RELEASING HORMONE (TRH) STIMULATION PANEL; TWO HOUR
THYROTROPIN RELEASING HORMONE (TRH) STIMULATION PANEL; FOR HYPERPROLACTINEMIA
CLINICAL PATHOLOGY CONSULTATION; LIMITED, WITHOUT REVIEW OF PATIENT'S HISTORY AN
CLINICAL PATHOLOGY CONSULTATION; COMPREHENSIVE, FOR A COMPLEX DIAGNOSTIC
URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, K
URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN,
URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN,
URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN,
URINALYSIS; QUALITATIVE OR SEMIQUANTITATIVE, EXCEPT IMMUNOASSAYS
URINALYSIS; BACTERIURIA SCREEN, EXCEPT BY CULTURE OR DIPSTICK
URINALYSIS; MICROSCOPIC ONLY
URINALYSIS; TWO OR THREE GLASS TEST
URINE PREGNANCY TEST, BY VISUAL COLOR COMPARISON METHODS
VOLUME MEASUREMENT FOR TIMED COLLECTION, EACH
UNLISTED URINALYSIS PROCEDURE
ASPA (aspartoacylase) (eg, Canavan disease) gene analysis, common variants (eg,
BCKDHB (branched-chain keto acid dehydrogenase E1, beta polypeptide) (eg, Maple
BCR/ABL1 (t(9;22) (eg, chronic myelogenous leukemia) translocation analysis; maj
BCR/ABL1 (t(9;22) (eg, chronic myelogenous leukemia) translocation analysis; min
BCR/ABL1 (t(9;22) (eg, chronic myelogenous leukemia) translocation analysis; oth
BLM (Bloom syndrome, RecQ helicase-like) (eg, Bloom syndrome) gene analysis, 228
BRAF-(v-raf murine sarcoma viral oncogene homolog B1) (eg, colon cancer), gene a
BRCA1, BRCA2 (breast cancer 1 and 2) (eg, hereditary breast and ovarian cancer)
BRCA1, BRCA2 (breast cancer 1 and 2) (eg, hereditary breast and ovarian cancer)
BRCA1, BRCA2 (breast cancer 1 and 2) (eg, hereditary breast and ovarian cancer)
BRCA1 (breast cancer 1) (eg, hereditary breast and ovarian cancer) gene analysis
BRCA1 (breast cancer 1) (eg, hereditary breast and ovarian cancer) gene analysis
BRCA2 (breast cancer 2) (eg, hereditary breast and ovarian cancer) gene analysis
BRCA2 (breast cancer 2) (eg, hereditary breast and ovarian cancer) gene analysis
CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis)
CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis)
CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis)
CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis)
CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis)
CYP2C19 (cytochrome P450, family 2, subfamily C, polypeptide 19) (eg, drug metab
CYPD6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metaboli
CYP2C9 (cytochrome P450, family 2, subfamily C, polypeptide 9) (eg, drug metabol
Cytogenomic constitutional (genome-wide) microarray analysis; interrogation of g
Cytogenomic constitutional (genome-wide) microarray analysis; interrogation of g
F2 (prothrombin, coagulation factor II) (eg, hereditary hypercoagulability) gene
F5 (coagulation Factor V) (eg, hereditary hypercoagulability) gene analysis, Lei
FANCC (Fanconi anemia, complementation group C) (eg, Fanconi anemia, type C) gen
FMR1 (Fragile X mental retardation 1) (eg, fragile X mental retardation) gene an
FMR1 (Fragile X mental retardation 1) (eg, fragile X mental retardation) gene an
FLT3 (fms-related tyrosine kinase 3) (eg, acute myeloid leukemia), gene analysis
G6PC (glucose-6-phosphatase, catalytic subunit) (eg, Glycogen storage disease, T
GBA (glucosidase, beta, acid) (eg, Gaucher disease) gene analysis, common varian
HEXA (hexosaminidase A [Alpha polypeptide]) (eg, Tay-Sachs disease) gene analysi
HFE (hemochromatosis) (eg, hereditary homechromatosis) gene analysis, common var
HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart hy
IKBKAP (inhibitor of kappa light polypeptide gene enhancer in B-cells, kinase co
IGH (Immunoglobulin heavy chain locus) (eg, leukemias and lymphomas, B-cell), ge
IGH (Immunoglobulin heavy chain locus) (eg, leukemias and lymphomas, B-cell), ge
IGH (Immunoglobulin heavy chain locus) (eg, leukemia and lymphoma, B-cell), vari
IGK (Immunoglobulin kappa light chain locus) (eg, leukemia and lymphoma, B-cell)
Comp analysis using Short Tandem Repeat(STR markers; patient and comparative spe
Comp analysis using Short Tandem Repeat (STR) markers; ea add'l specimen (eg, ad
Chimerism (engraftment) analysis, post transplantation specimen )eg, hematopoiet
Chimerism (engraftment) analysis, post transplantation specimen )eg, hematopoiet
JAK2 (Janus kinase 2) (eg, myeloproliferative disorder) gene analysis, p.VaI617P
KRAS (v-Ki-ras2 Kirsten rat sarcoma viral oncogene) (eg, carcinoma) gene analysi
Long QT syndrome gene analyses (eg, KCNQ1, KCNH2, SCN5A, KCNE1, KCNE2, KCNJ2, CA
Long QT syndrome gene analyses (eg, KCNQ1, KCNH2, SCN5A, KCNE1, KCNE2, KCNJ2, CA
Long QT syndrome gene analyses (eg, KCNQ1, KCNH2, SCN5A, KCNE1, KCNE2, KCNJ2, CA
MCOLN1 (mucolipin 1) (eg, Mucolipidosis, type IV) gene analysis, common variants
MTHFR (5, 10-methylenetetrahydrofolate reductase) (eg, hereditary hypersoagulabi
MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary non-pol
MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary non-pol
MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary non-pol
MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (eg, hereditary nonpoly
MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (eg, hereditary nonpoly
MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (eg, hereditary nonpoly
MSH6 (mutS homolog 6 [E. coli]) (eg, hereditary non-polyposis colorectal cancer,
MSH6 (mutS homolog 6 [E. coli]) (eg, hereditary non-polyposis colorectal cancer,
MSH6 (mutS homolog 6 [E. coli]) (eg, hereditary non-polyposis colorectal cancer,
Microsatellite instability analysis (eg, hereditary non-polyposis colorectal can
MECP2 (methyl CpG binding protein 2) (eg, Rett syndrome) gene analysis; full seq
MECP2 (methyl CpG binding protein 2) (eg, Rett syndrome) gene analysis; known fa
MECP2 (methyl CpG binding protein 2) (eg, Rett syndrome) gene analysis; duplicat
NPM1 (nucleophosmin) (eg, acute myeloid leukemia) gene analysis, exon 12 variant
PML/RARalpha, (t(15;17)), (promyelocytic leukemia/retinoic acid receptor alpha)
PML/RARalpha, (t(15;17)), (promyelocytic leukemia/retinoic acid receptor alpha)
PMS2 (postmeiotic segregation increased 2 [S.cerevisiae]) (eg, hereditary non-po
PMS2 (postmeiotic segregation increased 2 [S.cerevisiae]) (eg, hereditary non-po
PMS2 (postmeiotic segregation increased 2 [S.cerevisiae]) (eg, hereditary non-po
SMPD1 (sphingomyelin phosphodiesterase 1, acid lysosomal) (eg, Niemann-Pick dise
SNRPN/UBE3A (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein
SERPINA1 9serpin peptidase inhibitor, clade A, alpha-1 antiproteinase, antitryps
TRB (T cell antigen receptor, beta) (eg, leukemia and lymphoma), gene rearrangem
TRB (T cell antigen receptor, beta) (eg, leukemia and lymphoma), gene rearrangem
TRG (T cell antigen receptor, gamma) (eg, leukemia and lymphoma), gene rearrange
UGT1A1 (UDP glucuronosy/transferase 1 family, polypeptide A1) (eg, irinotecan me
VKORC1 (vitamin K epoxide reductase complex, subunit 1) (eg, warfarin metabolism
HLA Class I and II typing, low resolution (eg, antigen equivalents); HLA-A, -B,
HLA Class I and II typing, low resolution (eg, antigen equivalents); HLA-A, -B,
HLA Class I typing, low resolution (eg, antigen equivalents); complete (ie, HLA-
HLA Class I typing, low resolution (eg, antigen equivalents); one locus (eg, HLA
HLA Class I typing, low resolution (eg, antigen equivalents); one antigen equiva
HLS Class II typing, low resolution (eg, antigen equivalents); HLA-DRB1/3/4/5 an
HLS Class II typing, low resolution (eg, antigen equivalents); one locus (eg, HL
HLS Class II typing, low resolution (eg, antigen equivalents); one antigen equiv
HLA Class I and II typing, high resolution (ie, alleles or allele groups), HLA-A
HLA Class I typing, high resolution (ie, alleles or allele groups); complete (ie
HLA Class I typing, high resolution (ie, alleles or allele groups); one locus (e
HLA Class I typing, high resolution (ie, alleles or allele groups); one allele o
HLA Class II typing, high resolution (ie, alleles or allele groups); one locus (
HLA Class II typing, high resolution (ie, alleles or allele groups); one allele
Molecular pathology procedure, Level 1(eg, identification of single germline var
Molecular pathology procedure, Level 2 (eg, 2-10 SNPs, 1 methylated variant, or
Molecular path px, Level 3 (eg, >10 SNPs, 2-10 methylated variants, or 2-10 soma
Molecular pathology procedure, Level 4 (eg, analysis of single exon by DNA seque
Molecular pathology procedure, Level 5 (eg, analysis of 2-5 exons by DNA sequenc
Molecular pathology procedure, Level 6 (eg, analysisi of 6-10 exons by DNA seque
Molecular pathology procedure, Level 7 (eg, analysis of 11-25 exons by DNA seque
Molecular pathology procedure, Level 8 (eg, analysis of 26-50 exons by DNA seque
Molecular pathology procedure, Level 9 (eg, analysis of >50 exons in a single ge
ACETALDEHYDE, BLOOD
ACETAMINOPHEN
ACETONE OR OTHER KETONE BODIES, SERUM; QUALITATIVE
ACETONE OR OTHER KETONE BODIES, SERUM; QUANTITATIVE
ACETYLCHOLINESTERASE
ACYLCARNITINES; QUALITATIVE, EACH SPECIMEN
ACYLCARNITINES; QUANTITATIVE, EACH SPECIMEN
ADRENOCORTICOTROPIC HORMONE (ACTH)
ADENOSINE, 5-MONOPHOSPHATE, CYCLIC (CYCLIC AMP)
ALBUMIN; SERUM, PLASMA OR WHOLE BLOOD
ALBUMIN; URINE OR OTHER SOURCE, QUANTITATIVE, EACH SPECIMEN
ALBUMIN; URINE, MICROALBUMIN, QUANTITATIVE
ALBUMIN; URINE, MICROALBUMIN, SEMIQUANTITATIVE (EG, REAGENT STRIP ASSAY)
ALBUMIN; ISCHEMIA MODIFIED
ALCOHOL (ETHANOL); ANY SPECIMEN EXCEPT BREATH
ALCOHOL (ETHANOL); BREATH
ALDOLASE
ALDOSTERONE
ALKALOIDS, URINE, QUANTITATIVE
ALPHA-1-ANTITRYPSIN; TOTAL
ALPHA-1-ANTITRYPSIN; PHENOTYPE
ALPHA-FETOPROTEIN; SERUM
ALPHA-FETOPROTEIN; AMNIOTIC FLUID
ALPHA-FETOPROTEIN (AFP); AFP-L3 FRACTION ISOFORM AND TOTAL AFP (INCLUDING RATIO)
ALUMINUM
AMINES, VAGINAL FLUID, QUALITATIVE
AMINO ACIDS; SINGLE, QUALITATIVE, EACH SPECIMEN
AMINO ACIDS; MULTIPLE, QUALITATIVE, EACH SPECIMEN
AMINO ACIDS; SINGLE, QUANTITATIVE, EACH SPECIMEN
AMINOLEVULINIC ACID, DELTA (ALA)
AMINO ACIDS, 2 TO 5 AMINO ACIDS, QUANTITATIVE, EACH SPECIMEN
AMINO ACIDS, 6 OR MORE AMINO ACIDS, QUANTITATIVE, EACH SPECIMEN
AMMONIA
AMNIOTIC FLUID SCAN (SPECTROPHOTOMETRIC)
AMPHETAMINE OR METHAMPHETAMINE
AMYLASE
ANDROSTANEDIOL GLUCURONIDE
ANDROSTENEDIONE
ANDROSTERONE
ANGIOTENSIN II
ANGIOTENSIN I - CONVERTING ENZYME (ACE)
APOLIPOPROTEIN, EACH
ARSENIC
ASCORBIC ACID (VITAMIN C), BLOOD
ATOMIC ABSORPTION SPECTROSCOPY, EACH ANALYTE
BARBITURATES, NOT ELSEWHERE SPECIFIED
BETA-2 MICROGLOBULIN
BILE ACIDS; TOTAL
BILE ACIDS; CHOLYLGLYCINE
BILIRUBIN; TOTAL
BILIRUBIN; DIRECT
BILIRUBIN; FECES, QUALITATIVE
BIOTINIDASE, EACH SPECIMEN
BLOOD, OCCULT, BY PEROXIDASE ACTIVITY (EG, GUAIAC), QUALITATIVE; FECES, CONSECUT
BLOOD, OCCULT, BY PEROXIDASE ACTIVITY (EG, GUAIAC), QUALITATIVE; OTHER SOURCES
BLOOD, OCCULT, BY PEROXIDASE ACTIVITY (EG, GUAIAC), QUALITATIVE, FECES, 1-3 SIMU
BLOOD, OCCULT, BY FECAL HEMOGLOBIN DETERMINATION BY IMMUNOASSAY, QUALITATIVE,
BRADYKININ
CADMIUM
VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED
CALCITONIN
CALCIUM; TOTAL
CALCIUM; IONIZED
CALCIUM; AFTER CALCIUM INFUSION TEST
CALCIUM; URINE QUANTITATIVE, TIMED SPECIMEN
CALCULUS; QUALITATIVE ANALYSIS
CALCULUS; QUANTITATIVE ANALYSIS, CHEMICAL
CALCULUS; INFRARED SPECTROSCOPY
CALCULUS; X-RAY DIFFRACTION
CARBOHYDRATE DEFICIENT TRANSFERRIN
CARBON DIOXIDE (BICARBONATE)
CARBOXYHEMOGLOBIN; QUANTITATIVE
CARBOXYHEMOGLOBIN; QUALITATIVE
CARCINOEMBRYONIC ANTIGEN (CEA)
CARNITINE (TOTAL AND FREE), QUANTITATIVE, EACH SPECIMEN
CAROTENE
CATECHOLAMINES; TOTAL URINE
CATECHOLAMINES; BLOOD
CATECHOLAMINES; FRACTIONATED
CATHEPSIN-D
CERULOPLASMIN
CHEMILUMINESCENT ASSAY
CHLORAMPHENICOL
CHLORIDE; BLOOD
CHLORIDE; URINE
CHLORIDE; OTHER SOURCE
CHLORINATED HYDROCARBONS, SCREEN
CHOLESTEROL, SERUM OR WHOLE BLOOD, TOTAL
CHOLINESTERASE; SERUM
CHOLINESTERASE; RBC
CHONDROITIN B SULFATE, QUANTITATIVE
CHROMATOGRAPHY, QUALITATIVE; COLUMN (EG, GAS LIQUID OR HPLC), ANALYTE NOT
CHROMATOGRAPHY, QUALITATIVE; PAPER, 1-DIMENSIONAL, ANALYTE NOT ELSEWHERE
CHROMATOGRAPHY, QUALITATIVE; PAPER, 2-DIMENSIONAL, ANALYTE NOT ELSEWHERE
CHROMATOGRAPHY, QUALITATIVE; THIN LAYER, ANALYTE NOT ELSEWHERE SPECIFIED
CHROMATOGRAPHY, QUANTITATIVE, COLUMN (EG, GAS LIQUID OR HPLC); SINGLE ANALYTE
CHROMATOGRAPHY, QUANTITATIVE, COLUMN (EG, GAS LIQUID OR HPLC); MULTIPLE
CHROMIUM
CITRATE
COCAINE OR METABOLITE
COLLAGEN CROSS LINKS, ANY METHOD
COPPER
CORTICOSTERONE
CORTISOL; FREE
CORTISOL; TOTAL
CREATINE
COLUMN CHROMATOGRAPHY/MASS SPECTROMETRY (EG, GC/MS, OR HPLC/ MS), ANALYTE NOT
COLUMN CHROMATOGRAPHY/MASS SPECTROMETRY (EG, GC/MS, OR HPLC/ MS), ANALYTE NOT
COLUMN CHROMATOGRAPHY/MASS SPECTROMETRY (EG, GC/MS, OR HPLC/ MS), ANALYTE NOT
COLUMN CHROMATOGRAPHY/MASS SPECTROMETRY (EG, GC/MS, OR HPLC/ MS), ANALYTE NOT
CREATINE KINASE (CK), (CPK); TOTAL
CREATINE KINASE (CK), (CPK); ISOENZYMES
CREATINE KINASE (CK), (CPK); MB FRACTION ONLY
CREATINE KINASE (CK), (CPK); ISOFORMS
CREATININE; BLOOD
CREATININE; OTHER SOURCE
CREATININE; CLEARANCE
CRYOFIBRINOGEN
CRYOGLOBULIN, QUALITATIVE OR SEMI-QUANTITATIVE (EG, CRYOCRIT)
CYANIDE
CYANOCOBALAMIN (VITAMIN B-12);
CYANOCOBALAMIN (VITAMIN B-12); UNSATURATED BINDING CAPACITY
CYSTATIN C
CYSTINE AND HOMOCYSTINE, URINE, QUALITATIVE
DEHYDROEPIANDROSTERONE (DHEA)
DEHYDROEPIANDROSTERONE-SULFATE (DHEA-S)
DESOXYCORTICOSTERONE, 11-
DEOXYCORTISOL, 11-
DIBUCAINE NUMBER
DIHYDROCODEINONE
DIHYDROMORPHINONE
DIHYDROTESTOSTERONE (DHT)
DIHYDROTESTOSTERONE (DHT) 1, 25 DIHYDROXY, INCLUDES FRACTION(S), IF PERFORMED
DIMETHADIONE
ELASTASE, PANCREATIC (EL-1), FECAL, QUALITATIVE OR SEMI-QUANTITATIVE
ENZYME ACTIVITY IN BLOOD CELLS, CULTURED CELLS, OR TISSUE, NOT ELSEWHERE
ENZYME ACTIVITY IN BLOOD CELLS, CULTURED CELLS, OR TISSUE, NOT ELSEWHERE
ELECTROPHORETIC TECHNIQUE, NOT ELSEWHERE SPECIFIED
EPIANDROSTERONE
ERYTHROPOIETIN
ESTRADIOL
ESTROGENS; FRACTIONATED
ESTROGENS; TOTAL
ESTRIOL
ESTRONE
ETHCHLORVYNOL
ETHYLENE GLYCOL
ETIOCHOLANOLONE
FAT OR LIPIDS, FECES; QUALITATIVE
FAT OR LIPIDS, FECES; QUANTITATIVE
FAT DIFFERENTIAL, FECES, QUANTITATIVE
FATTY ACIDS, NONESTERIFIED
VERY LONG CHAIN FATTY ACIDS
FERRITIN
FETAL FIBRONECTIN, CERVICOVAGINAL SECRETIONS, SEMI-QUANTITATIVE
FLUORIDE
FLURAZEPAM
FOLIC ACID; SERUM
FOLIC ACID; RBC
FRUCTOSE, SEMEN
GALACTOKINASE, RBC
GALACTOSE
GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE; QUANTITATIVE
GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE; SCREEN
GAMMAGLOBULIN (IMMUNOGLOBULIN); IGA, IGD, IGG, IGM, EACH
GAMMAGLOBULIN (IMMUNOGLOBULIN); IGE
GAMMAGLOBULIN (IMMUNOGLOBULIN); IMMUNOGLOBULIN SUBCLASSES (EG, IGG1, 2, 3, OR 4)
GASES, BLOOD, PH ONLY
GASES, BLOOD, ANY COMBINATION OF PH, PCO2, PO2, CO2, HCO3 (INCLUDING CALCULATED
GASES, BLOOD, ANY COMBINATION OF PH, PCO2, PO2, CO2, HCO3 (INCLUDING CALCULATED
GASES, BLOOD, O2 SATURATION ONLY, BY DIRECT MEASUREMENT, EXCEPT PULSE OXIMETRY
HEMOGLOBIN-OXYGEN AFFINITY (PO2 FOR 50% HEMOGLOBIN SATURATION WITH OXYGEN)
GASTRIC ACID ANALYSIS, INCLUDES PH IF PERFORMED, EACH SPECIMEN
GASTRIN AFTER SECRETIN STIMULATION
GASTRIN
GLUCAGON
GLUCOSE, BODY FLUID, OTHER THAN BLOOD
GLUCAGON TOLERANCE TEST
GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP)
GLUCOSE; BLOOD, REAGENT STRIP
GLUCOSE; POST GLUCOSE DOSE (INCLUDES GLUCOSE)
GLUCOSE; TOLERANCE TEST (GTT), THREE SPECIMENS (INCLUDES GLUCOSE)
GLUCOSE; TOLERANCE TEST, EACH ADDITIONAL BEYOND 3 SPECIMENS (LIST SEPARATELY IN
GLUCOSE; TOLBUTAMIDE TOLERANCE TEST
GLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD); QUANTITATIVE
GLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD); SCREEN
GLUCOSE, BLOOD BY GLUCOSE MONITORING DEVICE(S) CLEARED BY THE FDA SPECIFICALLY
GLUCOSIDASE, BETA
GLUTAMATE DEHYDROGENASE
GLUTAMINE (GLUTAMIC ACID AMIDE)
GLUTAMYLTRANSFERASE, GAMMA (GGT)
GLUTATHIONE
GLUTATHIONE REDUCTASE, RBC
GLUTETHIMIDE
GLYCATED PROTEIN
GONADOTROPIN; FOLLICLE STIMULATING HORMONE (FSH)
GONADOTROPIN; LUTEINIZING HORMONE (LH)
GROWTH HORMONE, HUMAN (HGH) (SOMATOTROPIN)
GUANOSINE MONOPHOSPHATE (GMP), CYCLIC
HELICOBACTER PYLORI, BLOOD TEST ANALYSIS FOR UREASE ACTIVITY, NON-RADIOACTIVE
HAPTOGLOBIN; QUANTITATIVE
HAPTOGLOBIN; PHENOTYPES
HELICOBACTER PYLORI; BREATH TEST ANALYSIS FOR UREASE ACTIVITY, NON-RADIOACTIVE
HELICOBACTER PYLORI; DRUG ADMINISTRATION
HEAVY METAL (EG, ARSENIC, BARIUM, BERYLLIUM, BISMUTH, ANTIMONY, MERCURY); SCREEN
HEAVY METAL (EG, ARSENIC, BARIUM, BERYLLIUM, BISMUTH, ANTIMONY, MERCURY);
HEMOGLOBIN FRACTIONATION AND QUANTITATION; ELECTROPHORESIS (EG, A2, S, C,
HEMOGLOBIN FRACTIONATION AND QUANTITATION; CHROMATOGRAPHY (EG, A2, S, C, AND/OR
HEMOGLOBIN; BY COPPER SULFATE METHOD, NON-AUTOMATED
HEMOGLOBIN; F (FETAL), CHEMICAL
HEMOGLOBIN; F (FETAL), QUALITATIVE
HEMOGLOBIN; GLYCOSYLATED (A1C)
HEMOGLOBIN; GLYCOSYLATED (A1C) BY DEVICE CLEARED BY FDA FOR HOME USE
HEMOGLOBIN; METHEMOGLOBIN, QUALITATIVE
HEMOGLOBIN; METHEMOGLOBIN, QUANTITATIVE
HEMOGLOBIN; PLASMA
HEMOGLOBIN; SULFHEMOGLOBIN, QUALITATIVE
HEMOGLOBIN; SULFHEMOGLOBIN, QUANTITATIVE
HEMOGLOBIN; THERMOLABILE
HEMOGLOBIN; UNSTABLE, SCREEN
HEMOGLOBIN; URINE
HEMOSIDERIN; QUALITATIVE
HEMOSIDERIN; QUANTITATIVE
B-HEXOSAMINIDASE, EACH ASSAY
HISTAMINE
HOMOCYSTINE
HOMOVANILLIC ACID (HVA)
HYDROXYCORTICOSTEROIDS, 17- (17-OHCS)
HYDROXYINDOLACETIC ACID, 5-(HIAA)
HYDROXYPROGESTERONE, 17-D
HYDROXYPROGESTERONE, 20-
HYDROXYPROLINE; FREE
HYDROXYPROLINE; TOTAL
IMMUNOASSAY FOR ANALYTE OTHER THAN INFECTIOUS AGENT ANTIBODY OR INFECTIOUS AGENT
IMMUNOASSAY FOR ANALYTE OTHER THAN INFECTIOUS AGENT ANTIBODY OR INFECTIOUS AGENT
IMMUNOASSAY FOR ANALYTE OTHER THAN INFECTIOUS AGENT ANTIBODY OR INFECTIOUS AGENT
IMMUNOASSAY FOR ANALYTE OTHER THAN INFECTIOUS AGENT ANTIBODY OR INFECTIOUS AGENT
INSULIN; TOTAL
INSULIN; FREE
INTRINSIC FACTOR
IRON
IRON BINDING CAPACITY
ISOCITRIC DEHYDROGENASE (IDH)
KETOGENIC STEROIDS, FRACTIONATION
KETOSTEROIDS, 17- (17-KS); TOTAL
KETOSTEROIDS, 17- (17-KS); FRACTIONATION
LACTATE (LACTIC ACID)
LACTATE DEHYDROGENASE (LD), (LDH);
LACTATE DEHYDROGENASE (LD), (LDH); ISOENZYMES, SEPARATION AND QUANTITATION
LACTOFERRIN, FECAL; QUALITATIVE
LACTOFERRIN, FECAL; QUANTITATIVE
LACTOGEN, HUMAN PLACENTAL (HPL) HUMAN CHORIONIC SOMATOMAMMOTROPIN
LACTOSE, URINE; QUALITATIVE
LACTOSE, URINE; QUANTITATIVE
LEAD
FETAL LUNG MATURITY ASSESSMENT; LECITHIN SPHINGOMYELIN (L/S) RATIO
FETAL LUNG MATURITY ASSESSMENT; FOAM STABILITY TEST
FETAL LUNG MATURITY ASSESSMENT; FLUORESCENCE POLARIZATION
FETAL LUNG MATURITY ASSESSMENT; LAMELLAR BODY DENSITY
LEUCINE AMINOPEPTIDASE (LAP)
LIPASE
LIPOPROTEIN (A)
LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2, (LP-PLA2)
LIPOPROTEIN, BLOOD; ELECTROPHORETIC SEPARATION AND QUANTITATION
LIPOPROTEIN, BLOOD; HIGH RESOLUTION FRACTIONATION AND QUANTITATION OF LIPOPROTEI
LIPOPROTEIN, BLOOD; QUANTITATION OF LIPOPROTEIN PARTICLE NUMBERS AND LIPOPROTEIN
LIPOPROTEIN, DIRECT MEASUREMENT; HIGH DENSITY CHOLESTEROL (HDL CHOLESTEROL)
LIPOPROTEIN, DIRECT MEASUREMENT; DIRECT MEASUREMENT, VLDL CHOLESTEROL
LIPOPROTEIN, DIRECT MEASUREMENT; DIRECT MEASUREMENT, LDL CHOLESTEROL
LUTEINIZING RELEASING FACTOR (LRH)
MAGNESIUM
MALATE DEHYDROGENASE
MANGANESE
MASS SPECTROMETRY AND TANDEM MASS SPECTROMETRY (MS, MS/MS), ANALYTE NOT
MASS SPECTROMETRY AND TANDEM MASS SPECTROMETRY (MS, MS/MS), ANALYTE NOT
MEPROBAMATE
MERCURY, QUANTITATIVE
METANEPHRINES
METHADONE
METHEMALBUMIN
METHSUXIMIDE
MUCOPOLYSACCHARIDES, ACID; QUANTITATIVE
MUCOPOLYSACCHARIDES, ACID; SCREEN
MUCIN, SYNOVIAL FLUID (ROPES TEST)
MYELIN BASIC PROTEIN, CEREBROSPINAL FLUID
MYOGLOBIN
Myeloperoxidase (MPO)
NATRIURETIC PEPTIDE
NEPHELOMETRY, EACH ANALYTE NOT ELSEWHERE SPECIFIED
NICKEL
NICOTINE
MOLECULAR DIAGNOSTICS; MOLECULAR ISOLATION OR EXTRACTION, EACH NUCLEIC ACID TYPE
MOLECULAR DIAGNOSTICS; ISOLATION OR EXTRACTION OF HIGHLY PURIFIED NUCLEIC ACID,
MOLECULAR DIAGNOSTICS; ENZYMATIC DIGESTION, EACH ENZYME TREATMENT
MOLECULAR DIAGNOSTICS; DOT/SLOT BLOT PRODUCTION, EACH NUCLEIC ACID PREPARATION
MOLECULAR DIAGNOSTICS; SEPARATION BY GEL ELECTROPHORESIS (EG, AGAROSE, POLYACRYL
MOLECULAR DIAGNOSTICS; NUCLEIC ACID PROBE, EACH
MOLECULAR DIAGNOSTICS; NUCLEIC ACID TRANSFER (EG, SOUTHERN, NORTHERN), EACH NUCL
MOLECULAR DIAGNOSTICS; AMPLIFICATION, TARGET, EACH NUCLEIC ACID SEQUENCE
MOLECULAR DIAGNOSTICS; AMPLIFICATION, TARGET, MULTIPLEX, FIRST TWO NUCLEIC ACID
MOLECULAR DIAGNOSTICS; AMPLIFICATION, TARGET, MULTIPLEX, EACH ADDITIONAL NUCLEIC
MOLECULAR DIAGNOSTICS; REVERSE TRANSCRIPTION
MOLECULAR DIAGNOSTICS; MUTATION SCANNING, BY PHYSICAL PROPERTIES (EG, SINGLE
MOLECULAR DIAGNOSTICS; MUTATION IDENTIFICATION BY SEQUENCING, SINGLE SEGMENT,
MOLECULAR DIAGNOSTICS; MUTATION IDENTIFICATION BY ALLELE SPECIFIC
MOLECULAR DIAGNOSTICS; MUTATION IDENTIFICATION BY ALLELE SPECIFIC TRANSLATION,
MOLECULAR DIAGNOSTICS; LYSIS OF CELLS PRIOR TO NUCLEIC ACID EXTRACTION (EG, STOO
MOLECULAR DIAGNOSTICS; AMPLIFICATION, SIGNAL, EACH NUCLEIC ACID SEQUENCE
MOLECULAR DIAGNOSTICS; SEPARATION AND IDENTIFICATION BY HIGH RESOLUTION TECHNIQU
MOLECULAR DIAGNOSTICS; INTERPRETATION AND REPORT
MOLECULAR DIAGNOSTICS; RNA STABILIZATION
MUTATION IDENTIFICATION BY ENZYMATIC LIGATION OR PRIMER EXTENSION, SINGLE SEGMEN
NUCLEOTIDASE 5-
OLIGOCLONAL IMMUNE (OLIGOCLONAL BANDS)
ORGANIC ACIDS; TOTAL, QUANTITATIVE, EACH SPECIMEN
ORGANIC ACIDS; QUALITATIVE, EACH SPECIMEN
ORGANIC ACID, SINGLE, QUANTITATIVE
OPIATE(S), DRUG AND METABOLITES, EACH PROCEDURE
OSMOLALITY; BLOOD
OSMOLALITY; URINE
OSTEOCALCIN (BONE G1A PROTEIN)
OXALATE
ONCOPROTEIN; HER-2/NEU
Oncoprotein; des-gamma-carboxy-prothrombin (DCP)
PARATHORMONE (PARATHYROID HORMONE)
PH; BODY FLUID, NOT OTHERWISE SPECIFIED
pH; exhaled breath condensate
PHENCYCLIDINE (PCP)
CALPROTECTIN, FECAL
PHENOTHIAZINE
PHENYLALANINE (PKU), BLOOD
PHENYLKETONES, QUALITATIVE
PHOSPHATASE, ACID; TOTAL
PHOSPHATASE, ACID; FORENSIC EXAMINATION
PHOSPHATASE, ACID; PROSTATIC
PHOSPHATASE, ALKALINE;
PHOSPHATASE, ALKALINE; HEAT STABLE (TOTAL NOT INCLUDED)
PHOSPHATASE, ALKALINE; ISOENZYMES
PHOSPHATIDYLGLYCEROL
PHOSPHOGLUCONATE, 6-, DEHYDROGENASE, RBC
PHOSPHOHEXOSE ISOMERASE
PHOSPHORUS INORGANIC (PHOSPHATE);
PHOSPHORUS INORGANIC (PHOSPHATE); URINE
PORPHOBILINOGEN, URINE; QUALITATIVE
PORPHOBILINOGEN, URINE; QUANTITATIVE
PLACENTAL ALPHA MICROGLOBULIN-1 (PAMG-1), CERVICOVAGINAL SECRETION, QUALITATIVE
PORPHYRINS, URINE; QUALITATIVE
PORPHYRINS, URINE; QUANTITATION AND FRACTIONATION
PORPHYRINS, FECES; QUANTITATIVE
PORPHYRINS, FECES; QUALITATIVE
POTASSIUM; SERUM, PLASMA OR WHOLE BLOOD
POTASSIUM; URINE
PREALBUMIN
PREGNANEDIOL
PREGNANETRIOL
PREGNENOLONE
17-HYDROXYPREGNENOLONE
PROGESTERONE
Procalcitonin (PCT)
PROLACTIN
PROSTAGLANDIN, EACH
PROSTATE SPECIFIC ANTIGEN (PSA); COMPLEXED (DIRECT MEASUREMENT)
PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL
PROSTATE SPECIFIC ANTIGEN (PSA); FREE
PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; SERUM, PLASMA OR WHOLE BLOOD
PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; URINE
PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; OTHER SOURCE (EG, SYNOVIAL FLUID,
PROTEIN, TOTAL, BY REFRACTOMETRY, ANY SOURCE
PREGNANCY-ASSOCIATED PLASMA PROTEIN-A (PAPP-A)
PROTEIN; ELECTROPHORETIC FRACTIONATION AND QUANTITATION, SERUM
PROTEIN; ELECTROPHORETIC FRACTIONATION AND QUANTITATION, OTHER FLUIDS WITH
PROTEIN; WESTERN BLOT, WITH INTERPRETATION AND REPORT, BLOOD OR OTHER BODY FLUID
PROTEIN; WESTERN BLOT, WITH INTERPRETATION AND REPORT, BLOOD OR OTHER BODY
PROTOPORPHYRIN, RBC; QUANTITATIVE
PROTOPORPHYRIN, RBC; SCREEN
PROINSULIN
PYRIDOXAL PHOSPHATE (VITAMIN B-6)
PYRUVATE
PYRUVATE KINASE
QUININE
RECEPTOR ASSAY; ESTROGEN
RECEPTOR ASSAY; PROGESTERONE
RECEPTOR ASSAY; ENDOCRINE, OTHER THAN ESTROGEN OR PROGESTERONE (SPECIFY HORMONE)
RECEPTOR ASSAY; NON-ENDOCRINE (SPECIFY RECEPTOR)
RENIN
RIBOFLAVIN (VITAMIN B-2)
SELENIUM
SEROTONIN
SEX HORMONE BINDING GLOBULIN (SHBG)
SIALIC ACID
SILICA
SODIUM; SERUM, PLASMA OR WHOLE BLOOD
SODIUM; URINE
SODIUM; OTHER SOURCE
SOMATOMEDIN
SOMATOSTATIN
SPECTROPHOTOMETRY, ANALYTE NOT ELSEWHERE SPECIFIED
SPECIFIC GRAVITY (EXCEPT URINE)
SUGARS, CHROMATOGRAPHIC, TLC OR PAPER CHROMATOGRAPHY
SUGARS (MONO-, DI-, AND OLIGOSACCHARIDES); SINGLE QUALITATIVE, EACH SPECIMEN
SUGARS (MONO-, DI-, AND OLIGOSACCHARIDES); MULTIPLE QUALITATIVE, EACH SPECIMEN
SUGARS (MONO-, DI-, AND OLIGOSACCHARIDES); SINGLE QUANTITATIVE, EACH SPECIMEN
SUGARS (MONO-, DI-, AND OLIGOSACCHARIDES); MULTIPLE QUANTITATIVE, EACH SPECIMEN
SULFATE, URINE
TESTOSTERONE; FREE
TESTOSTERONE; TOTAL
THIAMINE (VITAMIN B-1)
THIOCYANATE
Thromboxane metabolite(s), including thromboxane if performed, urine
THYROGLOBULIN
THYROXINE; TOTAL
THYROXINE; REQUIRING ELUTION (EG, NEONATAL)
THYROXINE; FREE
THYROXINE BINDING GLOBULIN (TBG)
THYROID STIMULATING HORMONE (TSH)
THYROID STIMULATING IMMUNE GLOBULINS (TSI)
TOCOPHEROL ALPHA (VITAMIN E)
TRANSCORTIN (CORTISOL BINDING GLOBULIN)
TRANSFERASE; ASPARTATE AMINO (AST) (SGOT)
TRANSFERASE; ALANINE AMINO (ALT) (SGPT)
TRANSFERRIN
TRIGLYCERIDES
THYROID HORMONE (T3 OR T4) UPTAKE OR THYROID HORMONE BINDING RATIO (THBR)
TRIIODOTHYRONINE T3; TOTAL (TT-3)
TRIIODOTHYRONINE T3; FREE
TRIIODOTHYRONINE T3; REVERSE
TROPONIN, QUANTITATIVE
TRYPSIN; DUODENAL FLUID
TRYPSIN; FECES, QUALITATIVE
TRYPSIN; FECES, QUANTITATIVE, 24-HOUR COLLECTION
TYROSINE
TROPONIN, QUALITATIVE
UREA NITROGEN; QUANTITATIVE
UREA NITROGEN; SEMIQUANTITATIVE (EG, REAGENT STRIP TEST)
UREA NITROGEN, URINE
UREA NITROGEN, CLEARANCE
URIC ACID; BLOOD
URIC ACID; OTHER SOURCE
UROBILINOGEN, FECES, QUANTITATIVE
UROBILINOGEN, URINE; QUALITATIVE
UROBILINOGEN, URINE; QUANTITATIVE, TIMED SPECIMEN
UROBILINOGEN, URINE; SEMIQUANTITATIVE
VANILLYLMANDELIC ACID (VMA), URINE
VASOACTIVE INTESTINAL PEPTIDE (VIP)
VASOPRESSIN (ANTIDIURETIC HORMONE, ADH)
VITAMIN A
VITAMIN, NOT OTHERWISE SPECIFIED
VITAMIN K
VOLATILES (EG, ACETIC ANHYDRIDE, CARBON TETRACHLORIDE, DICHLOROETHANE,
XYLOSE ABSORPTION TEST, BLOOD AND/OR URINE
ZINC
C-PEPTIDE
GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE
GONADOTROPIN, CHORIONIC (HCG); QUALITATIVE
GONADOTROPIN, CHORIONIC (HCG); FREE BETA CHAIN
UNLISTED CHEMISTRY PROCEDURE
BLEEDING TIME
BLOOD COUNT; AUTOMATED DIFFERENTIAL WBC COUNT
BLOOD COUNT; BLOOD SMEAR, MICROSCOPIC EXAMINATION WITH MANUAL DIFFERENTIAL WBC
BLOOD COUNT; BLOOD SMEAR, MICROSCOPIC EXAMINATION WITHOUT MANUAL DIFFERENTIAL
BLOOD COUNT; MANUAL DIFFERENTIAL WBC COUNT, BUFFY COAT
BLOOD COUNT; SPUN MICROHEMATOCRIT
BLOOD COUNT; HEMATOCRIT (HCT)
BLOOD COUNT; HEMOGLOBIN (HGB)
BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT)
BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT)
BLOOD COUNT; MANUAL CELL COUNT (ERYTHROCYTE, LEUKOCYTE, OR PLATELET) EACH
BLOOD COUNT; RED BLOOD CELL (RBC), AUTOMATED
BLOOD COUNT; RETICULOCYTE, MANUAL
BLOOD COUNT; RETICULOCYTE, AUTOMATED
BLOOD COUNT; RETICULOCYTES, AUTOMATED, INCLUDING ONE OR MORE CELLULAR
BLOOD COUNT; LEUKOCYTE (WBC), AUTOMATED
BLOOD COUNT; PLATELET, AUTOMATED
RETICULATED PLATELET ASSAY
BLOOD SMEAR, PERIPHERAL, INTERPRETATION BY PHYSICIAN WITH WRITTEN REPORT
BONE MARROW, SMEAR INTERPRETATION
CHROMOGENIC SUBSTRATE ASSAY
CLOT RETRACTION
CLOT LYSIS TIME, WHOLE BLOOD DILUTION
CLOTTING; FACTOR II, PROTHROMBIN, SPECIFIC
CLOTTING; FACTOR V (ACG OR PROACCELERIN), LABILE FACTOR
CLOTTING; FACTOR VII (PROCONVERTIN, STABLE FACTOR)
CLOTTING; FACTOR VIII (AHG), ONE STAGE
CLOTTING; FACTOR VIII RELATED ANTIGEN
CLOTTING; FACTOR VIII, VW FACTOR, RISTOCETIN COFACTOR
CLOTTING; FACTOR VIII, VW FACTOR ANTIGEN
CLOTTING; FACTOR VIII, VON WILLEBRAND FACTOR, MULTIMETRIC ANALYSIS
CLOTTING; FACTOR IX (PTC OR CHRISTMAS)
CLOTTING; FACTOR X (STUART-PROWER)
CLOTTING; FACTOR XI (PTA)
CLOTTING; FACTOR XII (HAGEMAN)
CLOTTING; FACTOR XIII (FIBRIN STABILIZING)
CLOTTING; FACTOR XIII (FIBRIN STABILIZING), SCREEN SOLUBILITY
CLOTTING; PREKALLIKREIN ASSAY (FLETCHER FACTOR ASSAY)
CLOTTING; HIGH MOLECULAR WEIGHT KININOGEN ASSAY (FITZGERALD FACTOR ASSAY)
CLOTTING INHIBITORS OR ANTICOAGULANTS; ANTITHROMBIN III, ACTIVITY
CLOTTING INHIBITORS OR ANTICOAGULANTS; ANTITHROMBIN III, ANTIGEN ASSAY
CLOTTING INHIBITORS OR ANTICOAGULANTS; PROTEIN C, ANTIGEN
CLOTTING INHIBITORS OR ANTICOAGULANTS; PROTEIN C, ACTIVITY
CLOTTING INHIBITORS OR ANTICOAGULANTS; PROTEIN S, TOTAL
CLOTTING INHIBITORS OR ANTICOAGULANTS; PROTEIN S, FREE
ACTIVATED PROTEIN C (APC) RESISTANCE ASSAY
FACTOR INHIBITOR TEST
THROMBOMODULIN
COAGULATION TIME; LEE AND WHITE
COAGULATION TIME; ACTIVATED
COAGULATION TIME; OTHER METHODS
EUGLOBULIN LYSIS
FIBRIN(OGEN) DEGRADATION (SPLIT) PRODUCTS (FDP)(FSP); AGGLUTINATION SLIDE,
FIBRIN(OGEN) DEGRADATION (SPLIT) PRODUCTS (FDP)(FSP); PARACOAGULATION
FIBRIN(OGEN) DEGRADATION (SPLIT) PRODUCTS (FDP)(FSP); QUANTITATIVE
FIBRIN DEGRADATION PRODUCTS, D-DIMER; QUALITATIVE OR SEMIQUANTITATIVE
FIBRIN DEGRADATION PRODUCTS, D-DIMER; QUANTITATIVE
FIBRIN DEGRADATION PRODUCTS, D-DIMER; ULTRASENSITIVE (EG, FOR EVALUATION FOR
FIBRINOGEN; ACTIVITY
FIBRINOGEN; ANTIGEN
FIBRINOLYSINS OR COAGULOPATHY SCREEN, INTERPRETATION AND REPORT
Coagulation and fibrinolysis, functional activity, not otherwise specified (eg,
FIBRINOLYTIC FACTORS AND INHIBITORS; PLASMIN
FIBRINOLYTIC FACTORS AND INHIBITORS; ALPHA-2 ANTIPLASMIN
FIBRINOLYTIC FACTORS AND INHIBITORS; PLASMINOGEN ACTIVATOR
FIBRINOLYTIC FACTORS AND INHIBITORS; PLASMINOGEN, EXCEPT ANTIGENIC ASSAY
FIBRINOLYTIC FACTORS AND INHIBITORS; PLASMINOGEN, ANTIGENIC ASSAY
HEINZ BODIES; DIRECT
HEINZ BODIES; INDUCED, ACETYL PHENYLHYDRAZINE
HEMOGLOBIN OR RBCS, FETAL, FOR FETOMATERNAL HEMORRHAGE; DIFFERENTIAL LYSIS
HEMOGLOBIN OR RBCS, FETAL, FOR FETOMATERNAL HEMORRHAGE; ROSETTE
HEMOLYSIN, ACID
HEPARIN ASSAY
HEPARIN NEUTRALIZATION
HEPARIN-PROTAMINE TOLERANCE TEST
IRON STAIN, PERIPHERAL BLOOD
LEUKOCYTE ALKALINE PHOSPHATASE WITH COUNT
MECHANICAL FRAGILITY, RBC
MURAMIDASE
OSMOTIC FRAGILITY, RBC; UNINCUBATED
OSMOTIC FRAGILITY, RBC; INCUBATED
PLATELET, AGGREGATION (IN VITRO), EACH AGENT
PHOSPHOLIPID NEUTRALIZATION; PLATELET
PHOSPHOLIPID NEUTRALIZATION; HEXAGONAL PHOSPHOLIPID
PROTHROMBIN TIME;
PROTHROMBIN TIME; SUBSTITUTION, PLASMA FRACTIONS, EACH
RUSSELL VIPER VENOM TIME (INCLUDES VENOM); UNDILUTED
RUSSELL VIPER VENOM TIME (INCLUDES VENOM); DILUTED
REPTILASE TEST
SEDIMENTATION RATE, ERYTHROCYTE; NON-AUTOMATED
SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED
SICKLING OF RBC, REDUCTION
THROMBIN TIME; PLASMA
THROMBIN TIME; TITER
THROMBOPLASTIN INHIBITION, TISSUE
THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD
THROMBOPLASTIN TIME, PARTIAL (PTT); SUBSTITUTION, PLASMA FRACTIONS, EACH
VISCOSITY
UNLISTED HEMATOLOGY AND COAGULATION PROCEDURE
AGGLUTININS, FEBRILE (EG, BRUCELLA, FRANCISELLA, MURINE TYPHUS, Q FEVER, ROCKY M
ALLERGEN SPECIFIC IGG QUANTITATIVE OR SEMIQUANTITATIVE, EACH ALLERGEN
ALLERGEN SPECIFIC IGE; QUANTITATIVE OR SEMIQUANTITATIVE, EACH ALLERGEN
ALLERGEN SPECIFIC IGE; QUALITATIVE, MULTIALLERGEN SCREEN (DIPSTICK, PADDLE OR
ANTIBODY IDENTIFICATION; LEUKOCYTE ANTIBODIES
ANTIBODY IDENTIFICATION; PLATELET ANTIBODIES
ANTIBODY IDENTIFICATION; PLATELET ASSOCIATED IMMUNOGLOBULIN ASSAY
ANTINUCLEAR ANTIBODIES (ANA);
ANTINUCLEAR ANTIBODIES (ANA); TITER
ANTISTREPTOLYSIN 0; TITER
ANTISTREPTOLYSIN 0; SCREEN
BLOOD BANK PHYSICIAN SERVICES; DIFFICULT CROSS MATCH AND/OR EVALUATION OF
BLOOD BANK PHYSICIAN SERVICES; INVESTIGATION OF TRANSFUSION REACTION INCLUDING
BLOOD BANK PHYSICIAN SERVICES; AUTHORIZATION FOR DEVIATION FROM STANDARD BLOOD
C-REACTIVE PROTEIN;
C-REACTIVE PROTEIN; HIGH SENSITIVITY (HSCRP)
BETA 2 GLYCOPROTEIN I ANTIBODY, EACH
CARDIOLIPIN (PHOSPHOLIPID) ANTIBODY, EACH IG CLASS
ANTI-PHOSPHATIDYLSERINE (PHOSPHOLIPID) ANTIBODY
CHEMOTAXIS ASSAY, SPECIFY METHOD
COLD AGGLUTININ; SCREEN
COLD AGGLUTININ; TITER
COMPLEMENT; ANTIGEN, EACH COMPONENT
COMPLEMENT; FUNCTIONAL ACTIVITY, EACH COMPONENT
COMPLEMENT; TOTAL HEMOLYTIC (CH50)
COMPLEMENT FIXATION TESTS, EACH ANTIGEN
COUNTERIMMUNOELECTROPHORESIS, EACH ANTIGEN
CYCLIC CITRULLINATED PEPTIDE (CCP), ANTIBODY
DEOXYRIBONUCLEASE, ANTIBODY
DEOXYRIBONUCLEIC ACID (DNA) ANTIBODY; NATIVE OR DOUBLE STRANDED
DEOXYRIBONUCLEIC ACID (DNA) ANTIBODY; SINGLE STRANDED
EXTRACTABLE NUCLEAR ANTIGEN, ANTIBODY TO, ANY METHOD (EG, NRNP, SS-A, SS-B, SM,
FC RECEPTOR
FLUORESCENT NONINFECTIOUS AGENT ANTIBODY; SCREEN, EACH ANTIBODY
FLUORESCENT NONINFECTIOUS AGENT ANTIBODY; TITER, EACH ANTIBODY
GROWTH HORMONE, HUMAN (HGH), ANTIBODY
HEMAGGLUTINATION INHIBITION TEST (HAI)
IMMUNOASSAY FOR TUMOR ANTIGEN, QUALITATIVE OR SEMIQUANTITATIVE (EG, BLADDER
IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 15-3 (27.29)
IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 19-9
IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 125
HETEROPHILE ANTIBODIES; SCREENING
HETEROPHILE ANTIBODIES; TITER
HETEROPHILE ANTIBODIES; TITERS AFTER ABSORPTION WITH BEEF CELLS AND GUINEA PIG
IMMUNOASSAY FOR TUMOR ANTIGEN, OTHER ANTIGEN, QUANTITATIVE (EG, CA 50, 72-4,
IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY, QUANTITATIVE, NOT OTHERWISE SPECIFIED
IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY, QUALITATIVE OR SEMIQUANTITATIVE,
IMMUNOELECTROPHORESIS; SERUM
IMMUNOELECTROPHORESIS; OTHER FLUIDS (EG, URINE, CEREBROSPINAL FLUID) WITH
IMMUNOELECTROPHORESIS; CROSSED (2-DIMENSIONAL ASSAY)
IMMUNODIFFUSION; NOT ELSEWHERE SPECIFIED
IMMUNODIFFUSION; GEL DIFFUSION, QUALITATIVE (OUCHTERLONY), EACH ANTIGEN OR
IMMUNE COMPLEX ASSAY
IMMUNOFIXATION ELECTROPHORESIS; SERUM
IMMUNOFIXATION ELECTROPHORESIS; OTHER FLUIDS WITH CONCENTRATION (EG, URINE, CSF)
INHIBIN A
INSULIN ANTIBODIES
INTRINSIC FACTOR ANTIBODIES
ISLET CELL ANTIBODY
LEUKOCYTE HISTAMINE RELEASE TEST (LHR)
LEUKOCYTE PHAGOCYTOSIS
LYMPHOCYTE TRANSFORMATION, MITOGEN (PHYTOMITOGEN) OR ANTIGEN INDUCED
B CELLS, TOTAL COUNT
MONONUCLEAR CELL ANTIGEN, QUANTITATIVE (EG, FLOW CYTOMETRY), NOT OTHERWISE SPECI
NATURAL KILLER (NK) CELLS, TOTAL COUNT
T CELLS; TOTAL COUNT
T CELLS; ABSOLUTE CD4 AND CD8 COUNT, INCLUDING RATIO
T CELLS; ABSOLUTE CD4 COUNT
STEM CELLS (IE, CD34), TOTAL COUNT
MICROSOMAL ANTIBODIES (EG, THYROID OR LIVER-KIDNEY), EACH
MIGRATION INHIBITORY FACTOR TEST (MIF)
NEUTRALIZATION TEST, VIRAL
NITROBLUE TETRAZOLIUM DYE TEST (NTD)
Nuclear Matrix Protein 22 (NMP22), qualitatiuve
PARTICLE AGGLUTINATION; SCREEN, EACH ANTIBODY
PARTICLE AGGLUTINATION; TITER, EACH ANTIBODY
RHEUMATOID FACTOR; QUALITATIVE
RHEUMATOID FACTOR; QUANTITATIVE
TUBERCULOSIS TEST, CELL MEDIATED IMMUNITY ANTIGEN RESPONSE MEASUREMENT; GAMMA IN
TUBERCULOSIS TEST, CELL MEDIATED IMMUNITY ANTIGEN RESPONSE MEASUREMENT; ENUMERAT
SKIN TEST; CANDIDA
SKIN TEST; UNLISTED ANTIGEN, EACH
SKIN TEST; COCCIDIOIDOMYCOSIS
SKIN TEST; HISTOPLASMOSIS
SKIN TEST; TUBERCULOSIS, INTRADERMAL
STREPTOKINASE, ANTIBODY
SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUALITATIVE (EG, VDRL, RPR, ART)
SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUANTITATIVE
ANTIBODY; ACTINOMYCES
ANTIBODY; ADENOVIRUS
ANTIBODY; ASPERGILLUS
ANTIBODY; BACTERIUM, NOT ELSEWHERE SPECIFIED
ANTIBODY; BARTONELLA
ANTIBODY; BLASTOMYCES
ANTIBODY; BORDETELLA
ANTIBODY; BORRELIA BURGDORFERI (LYME DISEASE) CONFIRMATORY TEST (EG, WESTERN
ANTIBODY; BORRELIA BURGDORFERI (LYME DISEASE)
ANTIBODY; BORRELIA (RELAPSING FEVER)
ANTIBODY; BRUCELLA
ANTIBODY; CAMPYLOBACTER
ANTIBODY; CANDIDA
ANTIBODY; CHLAMYDIA
ANTIBODY; CHLAMYDIA, IGM
ANTIBODY; COCCIDIOIDES
ANTIBODY; COXIELLA BURNETII (Q FEVER)
ANTIBODY; CRYPTOCOCCUS
ANTIBODY; CYTOMEGALOVIRUS (CMV)
ANTIBODY; CYTOMEGALOVIRUS (CMV), IGM
ANTIBODY; DIPHTHERIA
ANTIBODY; ENCEPHALITIS, CALIFORNIA (LA CROSSE)
ANTIBODY; ENCEPHALITIS, EASTERN EQUINE
ANTIBODY; ENCEPHALITIS, ST. LOUIS
ANTIBODY; ENCEPHALITIS, WESTERN EQUINE
ANTIBODY; ENTEROVIRUS (EG, COXSACKIE, ECHO, POLIO)
ANTIBODY; EPSTEIN-BARR (EB) VIRUS, EARLY ANTIGEN (EA)
ANTIBODY; EPSTEIN-BARR (EB) VIRUS, NUCLEAR ANTIGEN (EBNA)
ANTIBODY; EPSTEIN-BARR (EB) VIRUS, VIRAL CAPSID (VCA)
ANTIBODY; EHRLICHIA
ANTIBODY; FRANCISELLA TULARENSIS
ANTIBODY; FUNGUS, NOT ELSEWHERE SPECIFIED
ANTIBODY; GIARDIA LAMBLIA
ANTIBODY; HELICOBACTER PYLORI
ANTIBODY; HELMINTH, NOT ELSEWHERE SPECIFIED
ANTIBODY; HAEMOPHILUS INFLUENZA
ANTIBODY; HTLV-I
ANTIBODY; HTLV-II
ANTIBODY; HTLV OR HIV ANTIBODY, CONFIRMATORY TEST (EG, WESTERN BLOT)
ANTIBODY; HEPATITIS, DELTA AGENT
ANTIBODY; HERPES SIMPLEX, NON-SPECIFIC TYPE TEST
ANTIBODY; HERPES SIMPLEX, TYPE 1
ANTIBODY; HERPES SIMPLEX, TYPE 2
ANTIBODY; HISTOPLASMA
ANTIBODY; HIV-1
ANTIBODY; HIV-2
ANTIBODY; HIV-1 AND HIV-2, SINGLE ASSAY
HEPATITIS B CORE ANTIBODY (HBCAB); TOTAL
HEPATITIS B CORE ANTIBODY (HBCAB); IGM ANTIBODY
HEPATITIS B SURFACE ANTIBODY (HBSAB)
HEPATITIS BE ANTIBODY (HBEAB)
HEPATITIS A ANTIBODY (HAAB); TOTAL
HEPATITIS A ANTIBODY (HAAB); IGM ANTIBODY
ANTIBODY; INFLUENZA VIRUS
ANTIBODY; LEGIONELLA
ANTIBODY; LEISHMANIA
ANTIBODY; LEPTOSPIRA
ANTIBODY; LISTERIA MONOCYTOGENES
ANTIBODY; LYMPHOCYTIC CHORIOMENINGITIS
ANTIBODY; LYMPHOGRANULOMA VENEREUM
ANTIBODY; MUCORMYCOSIS
ANTIBODY; MUMPS
ANTIBODY; MYCOPLASMA
ANTIBODY; NEISSERIA MENINGITIDIS
ANTIBODY; NOCARDIA
ANTIBODY; PARVOVIRUS
ANTIBODY; PLASMODIUM (MALARIA)
ANTIBODY; PROTOZOA, NOT ELSEWHERE SPECIFIED
ANTIBODY; RESPIRATORY SYNCYTIAL VIRUS
ANTIBODY; RICKETTSIA
ANTIBODY; ROTAVIRUS
ANTIBODY; RUBELLA
ANTIBODY; RUBEOLA
ANTIBODY; SALMONELLA
ANTIBODY; SHIGELLA
ANTIBODY; TETANUS
ANTIBODY; TOXOPLASMA
ANTIBODY; TOXOPLASMA, IGM
Antibody; treponema pallidum
ANTIBODY; TRICHINELLA
ANTIBODY; VARICELLA-ZOSTER
ANTIBODY; WEST NILE VIRUS, IGM
ANTIBODY; WEST NILE VIRUS
ANTIBODY; VIRUS, NOT ELSEWHERE SPECIFIED
ANTIBODY; YERSINIA
THYROGLOBULIN ANTIBODY
HEPATITIS C ANTIBODY;
HEPATITIS C ANTIBODY; CONFIRMATORY TEST (EG, IMMUNOBLOT)
LYMPHOCYTOTOXICITY ASSAY, VISUAL CROSSMATCH; WITH TITRATION
LYMPHOCYTOTOXICITY ASSAY, VISUAL CROSSMATCH; WITHOUT TITRATION
SERUM SCREENING FOR CYTOTOXIC PERCENT REACTIVE ANTIBODY (PRA); STANDARD METHOD
SERUM SCREENING FOR CYTOTOXIC PERCENT REACTIVE ANTIBODY (PRA); QUICK METHOD
HLA TYPING; A, B, OR C (EG, A10, B7, B27), SINGLE ANTIGEN
HLA TYPING; A, B, OR C, MULTIPLE ANTIGENS
HLA TYPING; DR/DQ, SINGLE ANTIGEN
HLA TYPING; DR/DQ, MULTIPLE ANTIGENS
HLA TYPING; LYMPHOCYTE CULTURE, MIXED (MLC)
HLA TYPING; LYMPHOCYTE CULTURE, PRIMED (PLC)
Human leukocyte antigen (HLA) crossmatch, non-cytotoxic (eg, using flow cytometr
Human leukocyte antigen (HLA) crossmatch, non-cytotoxic (eg, using flow cytometr
UNLISTED IMMUNOLOGY PROCEDURE
ANTIBODY SCREEN, RBC, EACH SERUM TECHNIQUE
ANTIBODY ELUTION (RBC), EACH ELUTION
ANTIBODY IDENTIFICATION, RBC ANTIBODIES, EACH PANEL FOR EACH SERUM TECHNIQUE
ANTIHUMAN GLOBULIN TEST (COOMBS TEST); DIRECT, EACH ANTISERUM
ANTIHUMAN GLOBULIN TEST (COOMBS TEST); INDIRECT, QUALITATIVE, EACH REAGENT RED C
ANTIHUMAN GLOBULIN TEST (COOMBS TEST); INDIRECT, EACH ANTIBODY TITER
AUTOLOGOUS BLOOD OR COMPONENT, COLLECTION PROCESSING AND STORAGE; PREDEPOSITED
AUTOLOGOUS BLOOD OR COMPONENT, COLLECTION PROCESSING AND STORAGE; INTRA- OR
BLOOD TYPING; ABO
BLOOD TYPING; RH (D)
BLOOD TYPING; ANTIGEN TESTING OF DONOR BLOOD USING REAGENT SERUM, EACH ANTIGEN T
BLOOD TYPING; ANTIGEN SCREENING FOR COMPATIBLE UNIT USING PATIENT SERUM, PER
BLOOD TYPING; RBC ANTIGENS, OTHER THAN ABO OR RH (D), EACH
BLOOD TYPING; RH PHENOTYPING, COMPLETE
COMPATIBILITY TEST EACH UNIT; IMMEDIATE SPIN TECHNIQUE
COMPATIBILITY TEST EACH UNIT; INCUBATION TECHNIQUE
COMPATIBILITY TEST EACH UNIT; ANTIGLOBULIN TECHNIQUE
COMPATIBILITY TEST EACH UNIT; ELECTRONIC
FRESH FROZEN PLASMA, THAWING, EACH UNIT
FROZEN BLOOD, EACH UNIT; FREEZING (INCLUDES PREPARATION)
FROZEN BLOOD, EACH UNIT; THAWING
FROZEN BLOOD, EACH UNIT; FREEZING (INCLUDES PREPARATION) AND THAWING
HEMOLYSINS AND AGGLUTININS; AUTO, SCREEN, EACH
HEMOLYSINS AND AGGLUTININS; INCUBATED
IRRADIATION OF BLOOD PRODUCT, EACH UNIT
LEUKOCYTE TRANSFUSION
VOLUME REDUCTION OF BLOOD OR BLOOD PRODUCT (EG, RED BLOOD CELLS OR PLATELETS), E
POOLING OF PLATELETS OR OTHER BLOOD PRODUCTS
PRETREATMENT OF RBCS FOR USE IN RBC ANTIBODY DETECTION, IDENTIFICATION, AND/OR
PRETREATMENT OF RBCS FOR USE IN RBC ANTIBODY DETECTION, IDENTIFICATION, AND/OR
PRETREATMENT OF RBCS FOR USE IN RBC ANTIBODY DETECTION, IDENTIFICATION, AND/OR
PRETREATMENT OF SERUM FOR USE IN RBC ANTIBODY IDENTIFICATION; INCUBATION WITH
PRETREATMENT OF SERUM FOR USE IN RBC ANTIBODY IDENTIFICATION; BY DILUTION
PRETREATMENT OF SERUM FOR USE IN RBC ANTIBODY IDENTIFICATION; INCUBATION WITH
PRETREATMENT OF SERUM FOR USE IN RBC ANTIBODY IDENTIFICATION; BY DIFFERENTIAL
SPLITTING OF BLOOD OR BLOOD PRODUCTS, EACH UNIT
UNLISTED TRANSFUSION MEDICINE PROCEDURE
ANIMAL INOCULATION, SMALL ANIMAL; WITH OBSERVATION
ANIMAL INOCULATION, SMALL ANIMAL; WITH OBSERVATION AND DISSECTION
CONCENTRATION (ANY TYPE), FOR INFECTIOUS AGENTS
CULTURE, BACTERIAL; BLOOD, AEROBIC, WITH ISOLATION AND PRESUMPTIVE
CULTURE, BACTERIAL; STOOL, AEROBIC, WITH ISOLATION AND PRELIMINARY EXAMINATION
CULTURE, BACTERIAL; STOOL, AEROBIC, ADDITIONAL PATHOGENS, ISOLATION AND
CULTURE, BACTERIAL; ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC,
CULTURE, BACTERIAL; QUANTITATIVE, AEROBIC WITH ISOLATION AND PRESUMPTIVE
CULTURE, BACTERIAL; QUANTITATIVE, ANAEROBIC WITH ISOLATION AND PRESUMPTIVE
CULTURE, BACTERIAL; ANY SOURCE, EXCEPT BLOOD, ANAEROBIC WITH ISOLATION AND
CULTURE, BACTERIAL; ANAEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR
CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFINITIVE
CULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS, SCREENING ONLY;
CULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS, SCREENING ONLY; WITH COLONY
CULTURE, BACTERIAL; QUANTITATIVE COLONY COUNT, URINE
CULTURE, BACTERIAL; WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF EACH ISOLAT
CULTURE, FUNGI (MOLD OR YEAST) ISOLATION, WITH PRESUMPTIVE IDENTIFICATION OF
CULTURE, FUNGI (MOLD OR YEAST) ISOLATION, WITH PRESUMPTIVE IDENTIFICATION OF
CULTURE, FUNGI (MOLD OR YEAST) ISOLATION, WITH PRESUMPTIVE IDENTIFICATION OF
CULTURE, FUNGI, DEFINITIVE IDENTIFICATION, EACH ORGANISM; YEAST
CULTURE, FUNGI, DEFINITIVE IDENTIFICATION, EACH ORGANISM; MOLD
CULTURE, MYCOPLASMA, ANY SOURCE
CULTURE, CHLAMYDIA, ANY SOURCE
CULTURE, TUBERCLE OR OTHER ACID-FAST BACILLI (EG, TB, AFB, MYCOBACTERIA) ANY
CULTURE, MYCOBACTERIAL, DEFINITIVE IDENTIFICATION, EACH ISOLATE
CULTURE, TYPING; IMMUNOFLUORESCENT METHOD, EACH ANTISERUM
CULTURE, TYPING; GAS LIQUID CHROMATOGRAPHY (GLC) OR HIGH PRESSURE LIQUID
CULTURE, TYPING; IMMUNOLOGIC METHOD, OTHER THAN IMMUNOFLUORESENCE (EG,
CULTURE, TYPING; IDENTIFICATION BY NUCLEIC ACID (DNA OR RNA) PROBE, DIRECT PROBE
CULTURE, TYPING; IDENTIFICATION BY PULSE FIELD GEL TYPING
CULTURE, TYPING; OTHER METHODS
DARK FIELD EXAMINATION, ANY SOURCE (EG, PENILE, VAGINAL, ORAL, SKIN); INCLUDES
DARK FIELD EXAMINATION, ANY SOURCE (EG, PENILE, VAGINAL, ORAL, SKIN); WITHOUT
MACROSCOPIC EXAMINATION; ARTHROPOD
MACROSCOPIC EXAMINATION; PARASITE
PINWORM EXAM (EG, CELLOPHANE TAPE PREP)
HOMOGENIZATION, TISSUE, FOR CULTURE
OVA AND PARASITES, DIRECT SMEARS, CONCENTRATION AND IDENTIFICATION
SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; AGAR DILUTION METHOD, PER AGENT
SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; DISK METHOD, PER PLATE (12 OR
SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; ENZYME DETECTION (EG, BETA
SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MICRODILUTION OR AGAR DILUTION
SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MICRODILUTION OR AGAR DILUTION,
SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MACROBROTH DILUTION METHOD, EACH
SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MYCOBACTERIA, PROPORTION METHOD,
SERUM BACTERICIDAL TITER (SCHLICTER TEST)
SMEAR, PRIMARY SOURCE WITH INTERPRETATION; GRAM OR GIEMSA STAIN FOR BACTERIA,
SMEAR, PRIMARY SOURCE WITH INTERPRETATION; FLUORESCENT AND/OR ACID FAST STAIN
SMEAR, PRIMARY SOURCE WITH INTERPRETATION; SPECIAL STAIN FOR INCLUSION BODIES
SMEAR, PRIMARY SOURCE WITH INTERPRETATION; COMPLEX SPECIAL STAIN (EG, TRICHROME,
SMEAR, PRIMARY SOURCE WITH INTERPRETATION; WET MOUNT FOR INFECTIOUS AGENTS (EG,
TISSUE EXAMINATION BY KOH SLIDE OF SAMPLES FROM SKIN, HAIR, OR NAILS FOR FUNGI
TOXIN OR ANTITOXIN ASSAY, TISSUE CULTURE (EG, CLOSTRIDIUM DIFFICILE TOXIN)
VIRUS ISOLATION; INOCULATION OF EMBRYONATED EGGS, OR SMALL ANIMAL, INCLUDES
VIRUS ISOLATION; TISSUE CULTURE INOCULATION, OBSERVATION, AND PRESUMPTIVE
VIRUS ISOLATION; TISSUE CULTURE, ADDITIONAL STUDIES OR DEFINITIVE
VIRUS ISOLATION; CENTRIFUGE ENHANCED (SHELL VIAL) TECHNIQUE, INCLUDES
VIRUS ISOLATION; INCLUDING IDENTIFICATION BY NON-IMMUNOLOGIC METHOD, OTHER THAN
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; ADENOVIRUS
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; BORDETELLA
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; ENTEROVIRUS,
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; GIARDIA
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; CHLAMYDIA
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE;
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE;
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; HERPES
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; HERPES
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; INFLUENZA B
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; INFLUENZA A
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; LEGIONELLA
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; LEGIONELLA
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE;
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; RESPIRATORY
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; PNEUMOCYSTIS
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; RUBEOLA
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; TREPONEMA
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; VARICELLA
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; NOT
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE, POLYVALENT
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE QUALITATIVE
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE QUALITATIVE
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE QUALITATIVE
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); BARTONELLA HENSELAE
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); BARTONELLA HENSELAE
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); BARTONELLA HENSELAE
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); BORRELIA BURGDORFERI,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); BORRELIA BURGDORFERI,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); BORRELIA BURGDORFERI,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA PNEUMONIAE,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA PNEUMONIAE,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA PNEUMONIAE,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS,
Clostridium difficile, toxin gene(s), amplified probe technique
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CYTOMEGALOVIRUS,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CYTOMEGALOVIRUS,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CYTOMEGALOVIRUS,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); ENTEROVIRUS, AMPLIFIED
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); VANCOMYCIN RESISTANCE (
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); INFLUENZA VIRUS, REVERS
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); INFLUENZA VIRUS, FOR MU
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); INFLUENZA VIRUS, FOR MU
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); GARDNERELLA VAGINALIS,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); GARDNERELLA VAGINALIS,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); GARDNERELLA VAGINALIS,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS B VIRUS,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS B VIRUS,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS B VIRUS,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS C, DIRECT
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS C, AMPLIFIED
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS C,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS G, DIRECT
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS G, AMPLIFIED
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS G,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HERPES SIMPLEX VIRUS,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HERPES SIMPLEX VIRUS,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HERPES SIMPLEX VIRUS,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HERPES VIRUS-6, DIRECT
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HERPES VIRUS-6,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HERPES VIRUS-6,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HIV-1, DIRECT PROBE
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HIV-1, AMPLIFIED PROBE
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HIV-1, QUANTIFICATION
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HIV-2, DIRECT PROBE
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HIV-2, AMPLIFIED PROBE
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HIV-2, QUANTIFICATION
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); LEGIONELLA
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); LEGIONELLA
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); LEGIONELLA
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA SPECIES,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA SPECIES,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA SPECIES,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOPLASMA PNEUMONIAE,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOPLASMA PNEUMONIAE,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOPLASMA PNEUMONIAE,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHOEAE,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHOEAE,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHOEAE,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); PAPILLOMAVIRUS, HUMAN,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); PAPILLOMAVIRUS, HUMAN,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); PAPILLOMAVIRUS, HUMAN,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STAPHYLOCOCCUS AUREUS,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STAPHYLOCOCCUS AUREUS,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STREPTOCOCCUS, GROUP
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STREPTOCOCCUS, GROUP
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STREPTOCOCCUS, GROUP
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STREPTOCOCCUS, GROUP B,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); TRICHOMONAS VAGINALIS,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), MULTIPLE ORGANISMS;
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), MULTIPLE ORGANISMS;
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATIO
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATIO
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATIO
INFECTIOUS AGENT DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION;
INFECTIOUS AGENT DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION;
INFECTIOUS AGENT DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; NOT
INFECTIOUS AGENT DRUG SUSCEPTIBILITY PHENOTYPE PREDICTION USING REGULARLY UPDATE
INFECTIOUS AGENT GENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA); HIV-1, REVERSE
INFECTIOUS AGENT GENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA); HEPATITIS C
INFECTIOUS AGENT PHENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA) WITH DRUG
INFECTIOUS AGENT PHENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA) WITH DRUG RESIS
Infectious agent enzymatic activity other than virus (eg, sialidase activity in
INFECTIOUS AGENT GENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA); HIV-1, OTHER RE
UNLISTED MICROBIOLOGY PROCEDURE
CYTOPATHOLOGY, FLUIDS, WASHINGS OR BRUSHINGS, EXCEPT CERVICAL OR VAGINAL; SMEARS
CYTOPATHOLOGY, FLUIDS, WASHINGS OR BRUSHINGS, EXCEPT CERVICAL OR VAGINAL; SIMPLE
CYTOPATHOLOGY, CONCENTRATION TECHNIQUE, SMEARS AND INTERPRETATION (EG,
CYTOPATHOLOGY, SELECTIVE CELLULAR ENHANCEMENT TECHNIQUE WITH INTERPRETATION
CYTOPATHOLOGY, IN SITU HYBRIDIZATION (EG, FISH), URINARY TRACT SPECIMEN WITH MOR
CYTOPATHOLOGY, IN SITU HYBRIDIZATION (EG, FISH), URINARY TRACT SPECIMEN WITH MOR
CYTOPATHOLOGY, FORENSIC (EG, SPERM)
SEX CHROMATIN IDENTIFICATION; BARR BODIES
SEX CHROMATIN IDENTIFICATION; PERIPHERAL BLOOD SMEAR, POLYMORPHONUCLEAR
CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN
CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN
CYTOPATHOLOGY SMEARS, CERVICAL OR VAGINAL; SCREENING BY AUTOMATED SYSTEM UNDER
CYTOPATHOLOGY SMEARS, CERVICAL OR VAGINAL; SCREENING BY AUTOMATED SYSTEM WITH
CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL; MANUAL SCREENING UNDER PHYSICIAN
CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL; WITH MANUAL SCREENING AND
CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL; WITH MANUAL SCREENING AND
CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL; WITH MANUAL SCREENING AND
CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL, DEFINITIVE HORMONAL EVALUATION (EG,
CYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; SCREENING AND INTERPRETATION
CYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; PREPARATION, SCREENING AND
CYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; EXTENDED STUDY INVOLVING OVER 5 SLIDES
CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL (THE BETHESDA SYSTEM); MANUAL
CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL (THE BETHESDA SYSTEM); WITH MANUAL
CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL (THE BETHESDA SYSTEM); WITH MANUAL
CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL (THE BETHESDA SYSTEM); WITH MANUAL
CYTOPATHOLOGY, EVALUATION OF FINE NEEDLE ASPIRATE; IMMEDIATE CYTOHISTOLOGIC STUD
CYTOPATHOLOGY, EVALUATION OF FINE NEEDLE ASPIRATE; INTERPRETATION AND REPORT
CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN
CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN PRESERVA
CYTOPATHOLOGY, EVALUATION OF FINE NEEDLE ASPIRATE; IMMEDIATE CYTOHISTOLOGIC STUD
FLOW CYTOMETRY; CELL CYCLE OR DNA ANALYSIS
FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR MARKER, TECHNICAL
FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR MARKER, TECHNICAL
FLOW CYTOMETRY, INTERPRETATION; 2 TO 8 MARKERS
FLOW CYTOMETRY, INTERPRETATION; 9 TO 15 MARKERS
FLOW CYTOMETRY, INTERPRETATION; 16 OR MORE MARKERS
UNLISTED CYTOPATHOLOGY PROCEDURE
TISSUE CULTURE FOR NON-NEOPLASTIC DISORDERS; LYMPHOCYTE
TISSUE CULTURE FOR NON-NEOPLASTIC DISORDERS; SKIN OR OTHER SOLID TISSUE BIOPSY
TISSUE CULTURE FOR NON-NEOPLASTIC DISORDERS; AMNIOTIC FLUID OR CHORIONIC VILLUS
TISSUE CULTURE FOR NEOPLASTIC DISORDERS; BONE MARROW, BLOOD CELLS
TISSUE CULTURE FOR NEOPLASTIC DISORDERS; SOLID TUMOR
CRYOPRESERVATION, FREEZING AND STORAGE OF CELLS, EACH CELL LINE
THAWING AND EXPANSION OF FROZEN CELLS, EACH ALIQUOT
CHROMOSOME ANALYSIS FOR BREAKAGE SYNDROMES; BASELINE SISTER CHROMATID EXCHANGE
CHROMOSOME ANALYSIS FOR BREAKAGE SYNDROMES; BASELINE BREAKAGE, SCORE 50-100
CHROMOSOME ANALYSIS FOR BREAKAGE SYNDROMES; SCORE 100 CELLS, CLASTOGEN STRESS
CHROMOSOME ANALYSIS; COUNT 5 CELLS, 1 KARYOTYPE, WITH BANDING
CHROMOSOME ANALYSIS; COUNT 15-20 CELLS, 2 KARYOTYPES, WITH BANDING
CHROMOSOME ANALYSIS; COUNT 45 CELLS FOR MOSAICISM, 2 KARYOTYPES, WITH BANDING
CHROMOSOME ANALYSIS; ANALYZE 20-25 CELLS
CHROMOSOME ANALYSIS, AMNIOTIC FLUID OR CHORIONIC VILLUS, COUNT 15 CELLS, 1
CHROMOSOME ANALYSIS, IN SITU FOR AMNIOTIC FLUID CELLS, COUNT CELLS FROM 6-12
MOLECULAR CYTOGENETICS; DNA PROBE, EACH (EG, FISH)
MOLECULAR CYTOGENETICS; CHROMOSOMAL IN SITU HYBRIDIZATION, ANALYZE 3-5 CELLS
MOLECULAR CYTOGENETICS; CHROMOSOMAL IN SITU HYBRIDIZATION, ANALYZE 10-30 CELLS
MOLECULAR CYTOGENETICS; INTERPHASE IN SITU HYBRIDIZATION, ANALYZE 25-99 CELLS
MOLECULAR CYTOGENETICS; INTERPHASE IN SITU HYBRIDIZATION, ANALYZE 100-300 CELLS
CHROMOSOME ANALYSIS; ADDITIONAL KARYOTYPES, EACH STUDY
CHROMOSOME ANALYSIS; ADDITIONAL SPECIALIZED BANDING TECHNIQUE (EG, NOR,
CHROMOSOME ANALYSIS; ADDITIONAL CELLS COUNTED, EACH STUDY
CHROMOSOME ANALYSIS; ADDITIONAL HIGH RESOLUTION STUDY
CYTOGENETICS AND MOLECULAR CYTOGENETICS, INTERPRETATION AND REPORT
UNLISTED CYTOGENETIC STUDY
LEVEL I - SURGICAL PATHOLOGY, GROSS EXAMINATION ONLY
LEVEL II - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION
LEVEL III - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION
LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION
LEVEL V - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION
LEVEL VI - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION
DECALCIFICATION PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FOR SURGICAL
SPECIAL STAINS; GROUP I FOR MICROORGANISMS (EG, GRIDLEY, ACID FAST, METHENAMINE
SPECIAL STAINS; GROUP II, ALL OTHER (EG, IRON, TRICHROME), EXCEPT IMMUNOCYTOCHEM
SPECIAL STAINS; HISTOCHEMICAL STAINING WITH FROZEN SECTION(S), INCLUDING INTERPR
DETERMINATIVE HISTOCHEMISTRY OR CYTOCHEMISTRY TO IDENTIFY ENZYME CONSTITUENTS,
CONSULTATION AND REPORT ON REFERRED SLIDES PREPARED ELSEWHERE
CONSULTATION AND REPORT ON REFERRED MATERIAL REQUIRING PREPARATION OF SLIDES
CONSULTATION, COMPREHENSIVE, WITH REVIEW OF RECORDS AND SPECIMENS, WITH REPORT
PATHOLOGY CONSULTATION DURING SURGERY;
PATHOLOGY CONSULTATION DURING SURGERY; FIRST TISSUE BLOCK, WITH FROZEN
PATHOLOGY CONSULTATION DURING SURGERY; EACH ADDITIONAL TISSUE BLOCK WITH FROZEN
PATHOLOGY CONSULTATION DURING SURGERY; CYTOLOGIC EXAMINATION (EG, TOUCH PREP, SQ
PATHOLOGY CONSULTATION DURING SURGERY; CYTOLOGIC EXAMINATION (EG, TOUCH PREP, SQ
IMMUNOHISTOCHEMISTRY (INCLUDING TISSUE IMMUNOPEROXIDASE), EACH ANTIBODY
IMMUNOFLUORESCENT STUDY, EACH ANTIBODY; DIRECT METHOD
IMMUNOFLUORESCENT STUDY, EACH ANTIBODY; INDIRECT METHOD
ELECTRON MICROSCOPY; DIAGNOSTIC
ELECTRON MICROSCOPY; SCANNING
MORPHOMETRIC ANALYSIS; SKELETAL MUSCLE
MORPHOMETRIC ANALYSIS; NERVE
MORPHOMETRIC ANALYSIS; TUMOR (EG, DNA PLOIDY)
MORPHOMETRIC ANALYSIS, TUMOR IMMUNOHISTOCHEMISTRY (EG, HER-2/NEU, ESTROGEN
MORPHOMETRIC ANALYSIS, TUMOR IMMUNOHISTOCHEMISTRY (EG, HER-2/NEU, ESTROGEN
NERVE TEASING PREPARATIONS
EXAMINATION AND SELECTION OF RETRIEVED ARCHIVAL (IE, PREVIOUSLY DIAGNOSED) TISSU
IN SITU HYBRIDIZATION (EG, FISH), EACH PROBE
MORPHOMETRIC ANALYSIS, IN SITU HYBRIDIZATION, (QUANTITATIVE OR
MORPHOMETRIC ANALYSIS, IN SITU HYBRIDIZATION, (QUANTITATIVE OR
PROTEIN ANALYSIS OF TISSUE BY WESTERN BLOT, WITH INTERPRETATION AND REPORT;
PROTEIN ANALYSIS OF TISSUE BY WESTERN BLOT, WITH INTERPRETATION AND REPORT;
ARRAY-BASED EVALUATION OF MULTIPLE MOLECULAR PROBES; 11 THROUGH 50 PROBES
ARRAY-BASED EVALUATION OF MULTIPLE MOLECULAR PROBES; 51 THROUGH 250 PROBES
ARRAY-BASED EVALUATION OF MULTIPLE MOLECULAR PROBES; 251 THROUGH 500 PROBES
UNLISTED MISCELLANEOUS PATHOLOGY PROCEDURE
Bilirubin, total, transcutaneous
Hemoglobin (Hgb), quantitative, transcutaneous
Hemoglobin, quantitative, transcutaneous, per day; carboxyhemoglobin
Hemoglobin, quantitative, transcutaneous, per day; methemoglobin
UNLISTED IN VIVO (EG, TRANSCUTANEOUS) LABORATORY SERVICE
CAFFEINE HALOTHANE CONTRACTURE TEST (CHCT) FOR MALIGNANT HYPERTHERMIA SUSCEPTIBI
CELL COUNT, MISCELLANEOUS BODY FLUIDS (EG, CEREBROSPINAL FLUID, JOINT FLUID), EX
CELL COUNT, MISCELLANEOUS BODY FLUIDS (EG, CEREBROSPINAL FLUID, JOINT FLUID),
LEUKOCYTE ASSESSMENT, FECAL, QUALITATIVE OR SEMIQUANTITATIVE
CRYSTAL IDENTIFICATION BY LIGHT MICROSCOPY WITH OR WITHOUT POLARIZING LENS ANALY
FAT STAIN, FECES, URINE, OR RESPIRATORY SECRETIONS
MEAT FIBERS, FECES
NASAL SMEAR FOR EOSINOPHILS
SPUTUM, OBTAINING SPECIMEN, AEROSOL INDUCED TECHNIQUE (SEPARATE PROCEDURE)
SWEAT COLLECTION BY IONTOPHORESIS
UNLISTED MISCELLANEOUS PATHOLOGY TEST
SPERM IDENTIFICATION FROM TESTIS TISSUE, FRESH OR CRYOPRESERVED
SEMEN ANALYSIS; SPERM PRESENCE AND MOTILITY OF SPERM, IF PERFORMED
SEMEN ANALYSIS; VOLUME, COUNT, MOTILITY, AND DIFFERENTIAL USING STRICT MORPHOLOG
DIPHTHERIA ANTITOXIN, EQUINE, ANY ROUTE
HEPATITIS B IMMUNE GLOBULIN (HBIG), HUMAN, FOR INTRAMUSCULAR USE
RABIES IMMUNE GLOBULIN (RIG), HUMAN, FOR INTRAMUSCULAR AND/OR SUBCUTANEOUS USE
RABIES IMMUNE GLOBULIN, HEAT-TREATED (RIG-HT), HUMAN, FOR INTRAMUSCULAR AND/OR S
RESPIRATORY SYNCYTIAL VIRUS, MONOCLONAL ANTIBODY, RECOMBINANT, FOR INTRAMUSCULAR
RHO(D) IMMUNE GLOBULIN (RHIG), HUMAN, FULL-DOSE, FOR INTRAMUSCULAR USE
VACCINIA IMMUNE GLOBULIN, HUMAN, FOR INTRAMUSCULAR USE
VARICELLA-ZOSTER IMMUNE GLOBULIN, HUMAN, FOR INTRAMUSCULAR USE
ADENOVIRUS VACCINE, TYPE 4, LIVE, FOR ORAL USE
ADENOVIRUS VACCINE, TYPE 7, LIVE, FOR ORAL USE
ANTHRAX VACCINE, FOR SUBCUTANEOUS USE
BACILLUS CALMETTE-GUERIN VACCINE (BCG) FOR TUBERCULOSIS, LIVE, FOR PERCUTANEOUS
BACILLUS CALMETTE-GUERIN VACCINE (BCG) FOR BLADDER CANCER, LIVE, FOR INTRAVESICA
MENINGOCOCCAL CONJUGATE VACCINE, SEROGROUPS C & Y AND HEMOPHILUS INFLUENZA B VAC
HUMAN PAPILLOMA VIRUS (HPV) VACCINE, TYPES 6, 11, 16, 18 (QUADRIVALENT), 3 DOSE
HUMAN PAPILLOMA VIRUS (HPV) VACCINE, TYPES 16, 18, BIVALENT, 3 DOSE SCHEDULE, FO
INFLUENZA VIRUS VACCINE, SPLIT VIRUS, PRESERVATIVE FREE, WHEN ADMINISTERED TO CH
INFLUENZA VIRUS VACCINE, SPLIT VIRUS, PRESERVATIVE FREE, WHEN ADMINISTERED TO IN
INFLUENZA VIRUS VACCINE, SPLIT VIRUS, WHEN ADMINISTERED TO CHILDREN 6-35 MONTHS
INFLUENZA VIRUS VACCINE, SPLIT VIRUS, WHEN ADMINISTERED TO INDIVIDUALS 3 YEARS O
INFLUENZA VIRUS VACCINE, LIVE, FOR INTRANASAL USE
INFLUENZA VIRUS VACCINE, SPLIT VIRUS, PRESERVATIVE FREE, ENHANCED IMMUNOGENICITY
PNEUMOCOCCAL CONJUGATE VACCINE, 7 VALENT, FOR INTRAMUSCULAR USE
PNEUMOCOCCAL CONJUGATE VACCINE, 13 VALENT, FOR INTRAMUSCULAR USE
RABIES VACCINE, FOR INTRAMUSCULAR USE
RABIES VACCINE, FOR INTRADERMAL USE
ROTAVIRUS VACCINE, PENTAVALENT, 3 DOSE SCHEDULE, LIVE, FOR ORAL USE
Rotavirus vaccine, human, attenuated, 2 dose schedule, live, for oral use
TYPHOID VACCINE, ACETONE-KILLED, DRIED (AKD), FOR SUBCUTANEOUS USE (U.S. MILITAR
VARICELLA VIRUS VACCINE, LIVE, FOR SUBCUTANEOUS USE
DIPHTHERIA, TETANUS TOXOIDS, ACELLULAR PERTUSSIS VACCINE, HEPATITIS B, AND POLIO
CHOLERA VACCINE FOR INJECTABLE USE
PLAGUE VACCINE, FOR INTRAMUSCULAR USE
PNEUMOCOCCAL POLYSACCHARIDE VACCINE, 23-VALENT, ADULT OR IMMUNOSUPPRESSED PATIEN
MENINGOCOCCAL POLYSACCHARIDE VACCINE (ANY GROUP¿S¿), FOR SUBCUTANEOUS USE
MENINGOCOCCAL CONJUGATE VACCINE, SEROGROUPS A, C, Y AND W-135 (TETRAVALENT), FOR
ZOSTER (SHINGLES) VACCINE, LIVE, FOR SUBCUTANEOUS INJECTION
HEPATITIS B VACCINE, DIALYSIS OR IMMUNOSUPPRESSED PATIENT DOSAGE (3 DOSE SCHEDUL
HEPATITIS B VACCINE, ADOLESCENT (2 DOSE SCHEDULE), FOR INTRAMUSCULAR USE
HEPATITIS B VACCINE, PEDIATRIC/ADOLESCENT DOSAGE (3 DOSE SCHEDULE), FOR INTRAMUS
HEPATITIS B VACCINE, ADULT DOSAGE, FOR INTRAMUSCULAR USE
HEPATITIS B VACCINE, DIALYSIS OR IMMUNOSUPPRESSED PATIENT DOSAGE (4 DOSE SCHEDUL
HEPATITIS B AND HEMOPHILUS INFLUENZA B VACCINE (HEPB-HIB), FOR INTRAMUSCULAR USE
PSYCHIATRIC DIAGNOSTIC INTERVIEW EXAMINATION
INTERACTIVE PSYCHIATRIC DIAGNOSTIC INTERVIEW EXAMINATION USING PLAY EQUIPMENT,
INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR SUPPORTIVE
INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR
INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR
INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR
INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR
INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR
INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES, L
INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES,
INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES,
INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES,
INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES,
INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES,
INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR SUPPORTIVE
INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR
INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR
INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR
INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR
INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR
INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES, L
INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES,
INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES,
INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES,
INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES,
INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES,
PSYCHOANALYSIS
FAMILY PSYCHOTHERAPY (WITHOUT THE PATIENT PRESENT)
FAMILY PSYCHOTHERAPY (CONJOINT PSYCHOTHERAPY) (WITH PATIENT PRESENT)
MULTIPLE-FAMILY GROUP PSYCHOTHERAPY
GROUP PSYCHOTHERAPY (OTHER THAN OF A MULTIPLE-FAMILY GROUP)
INTERACTIVE GROUP PSYCHOTHERAPY
PHARMACOLOGIC MANAGEMENT, INCLUDING PRESCRIPTION, USE, AND REVIEW OF MEDICATION
NARCOSYNTHESIS FOR PSYCHIATRIC DIAGNOSTIC AND THERAPEUTIC PURPOSES (EG, SODIUM
INDIVIDUAL PSYCHOPHYSIOLOGICAL THERAPY INCORPORATING BIOFEEDBACK TRAINING BY
INDIVIDUAL PSYCHOPHYSIOLOGICAL THERAPY INCORPORATING BIOFEEDBACK TRAINING BY
BIOFEEDBACK TRAINING BY ANY MODALITY
HEMODIALYSIS PROCEDURE REQUIRING REPEATED EVALUATION(S) WITH OR WITHOUT
DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS (EG, PERITONEAL DIALYSIS, HEMOFILTRAT
DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS (EG, PERITONEAL DIALYSIS,
End-stage renal disease (ESRD) related services monthly, for patients younger th
End-stage renal disease (ESRD) related services monthly, for patients younger th
End-stage renal disease (ESRD) related services monthly, for patients younger th
End-stage renal disease (ESRD) related services monthly, for patients 2-11 years
End-stage renal disease (ESRD) related services monthly, for patients 2-11 years
End-stage renal disease (ESRD) related services monthly, for patients 2-11 years
End-stage renal disease (ESRD) related services monthly, for patients 12-19 year
End-stage renal disease (ESRD) related services monthly, for patients 12-19 year
End-stage renal disease (ESRD) related services monthly, for patients 12-19 year
End-stage renal disease (ESRD) related services monthly, for patients 20 years o
End-stage renal disease (ESRD) related services monthly, for patients 20 years o
End-stage renal disease (ESRD) related services monthly, for patients 20 years o
End-stage renal disease (ESRD) related services for home dialysis per full month
End-stage renal disease (ESRD) related services for home dialysis per full month
End-stage renal disease (ESRD) related services for home dialysis per full month
End-stage renal disease (ESRD) related services for home dialysis per full month
End-stage renal disease (ESRD) related services for dialysis less than a full mo
End-stage renal disease (ESRD) related services for dialysis less than a full mo
End-stage renal disease (ESRD) related services for dialysis less than a full mo
End-stage renal disease (ESRD) related services for dialysis less than a full mo
DIALYSIS TRAINING, PATIENT, INCLUDING HELPER WHERE APPLICABLE, ANY MODE,
DIALYSIS TRAINING, PATIENT, INCLUDING HELPER WHERE APPLICABLE, ANY MODE, COURSE
HEMOPERFUSION (EG, WITH ACTIVATED CHARCOAL OR RESIN)
UNLISTED DIALYSIS PROCEDURE, INPATIENT OR OUTPATIENT
ESOPHAGEAL MOTILITY (MANOMETRIC STUDY OF THE ESOPHAGUS AND/OR GASTROESOPHAGEAL J
ESOPHAGEAL MOTILITY (MANOMETRIC STUDY OF THE ESOPHAGUS AND/OR GASTROESOPHAGEAL J
GASTRIC MOTILITY (MANOMETRIC) STUDIES
DUODENAL MOTILITY (MANOMETRIC) STUDY
ESOPHAGUS, ACID PERFUSION (BERNSTEIN) TEST FOR ESOPHAGITIS
ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH NASAL CATHETER PH ELECTRODE(S)
ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH MUCOSAL ATTACHED TELEMETRY PH
ESOPHAGEAL FUNCTION TEST, GASTROESOPHAGEAL REFLUX TEST WITH NASAL CATHETER
ESOPHAGEAL FUNCTION TEST, GASTROESOPHAGEAL REFLUX TEST WITH NASAL CATHETER
ESOPHAGEAL BALLOON DISTENSION PROVOCATION STUDY
BREATH HYDROGEN TEST (EG, FOR DETECTION OF LACTASE DEFICIENCY), FRUCTOSE
ELECTROGASTROGRAPHY, DIAGNOSTIC, TRANSCUTANEOUS;
ELECTROGASTROGRAPHY, DIAGNOSTIC, TRANSCUTANEOUS; WITH PROVOCATIVE TESTING
UNLISTED DIAGNOSTIC GASTROENTEROLOGY PROCEDURE
OPHTHALMOLOGICAL SERVICES: MEDICAL EXAMINATION AND EVALUATION WITH INITIATION OF
OPHTHALMOLOGICAL SERVICES: MEDICAL EXAMINATION AND EVALUATION WITH INITIATION
OPHTHALMOLOGICAL SERVICES: MEDICAL EXAMINATION AND EVALUATION, WITH INITIATION O
OPHTHALMOLOGICAL SERVICES: MEDICAL EXAMINATION AND EVALUATION, WITH INITIATION
DETERMINATION OF REFRACTIVE STATE
REMOTE IMAGING FOR DETECTION OF RETINAL DISEASE (EG, RETINOPATHY IN A PATIENT WI
REMOTE IMAGING FOR MONITORING AND MANAGEMENT OF ACTIVE RETINAL DISEASE (EG, DIAB
PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF AND FITTING OF CONTACT L
PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF CONTACT LENS, WITH
FITTING OF SPECTACLES, EXCEPT FOR APHAKIA; MONOFOCAL
FITTING OF SPECTACLES, EXCEPT FOR APHAKIA; BIFOCAL
FITTING OF SPECTACLES, EXCEPT FOR APHAKIA; MULTIFOCAL, OTHER THAN BIFOCAL
REPAIR AND REFITTING SPECTACLES; EXCEPT FOR APHAKIA
EVALUATION OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/ OR AUDITORY PROCESSIN
TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/ OR AUDITORY PROCESSING
TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR AUDITORY PROCESSING
NASAL FUNCTION STUDIES (EG, RHINOMANOMETRY)
FACIAL NERVE FUNCTION STUDIES (EG, ELECTRONEURONOGRAPHY)
LARYNGEAL FUNCTION STUDIES (IE, AERODYNAMIC TESTING AND ACOUSTIC TESTING)
TREATMENT OF SWALLOWING DYSFUNCTION AND/OR ORAL FUNCTION FOR FEEDING
Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric
SPONTANEOUS NYSTAGMUS TEST, INCLUDING GAZE AND FIXATION NYSTAGMUS, WITH RECORDIN
POSITIONAL NYSTAGMUS TEST, MINIMUM OF 4 POSITIONS, WITH RECORDING
CALORIC VESTIBULAR TEST, EACH IRRIGATION (BINAURAL, BITHERMAL STIMULATION
OPTOKINETIC NYSTAGMUS TEST, BIDIRECTIONAL, FOVEAL OR PERIPHERAL STIMULATION,
OSCILLATING TRACKING TEST, WITH RECORDING
SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING
COMPUTERIZED DYNAMIC POSTUROGRAPHY
Tympanometry and reflex threshold measurements
SCREENING TEST, PURE TONE, AIR ONLY
PURE TONE AUDIOMETRY (THRESHOLD); AIR ONLY
PURE TONE AUDIOMETRY (THRESHOLD); AIR AND BONE
SPEECH AUDIOMETRY THRESHOLD;
SPEECH AUDIOMETRY THRESHOLD; WITH SPEECH RECOGNITION
COMPREHENSIVE AUDIOMETRY THRESHOLD EVALUATION AND SPEECH RECOGNITION (92553 AND
Evoked otoacoustic emissions, screening (qualitative measurement of distortion p
BEKESY AUDIOMETRY; SCREENING
BEKESY AUDIOMETRY; DIAGNOSTIC
LOUDNESS BALANCE TEST, ALTERNATE BINAURAL OR MONAURAL
TONE DECAY TEST
SHORT INCREMENT SENSITIVITY INDEX (SISI)
STENGER TEST, PURE TONE
TYMPANOMETRY (IMPEDANCE TESTING)
Acoustic immittance testing, includes tympanometry (impedance testing), acoustic
FILTERED SPEECH TEST
STAGGERED SPONDAIC WORD TEST
SENSORINEURAL ACUITY LEVEL TEST
SYNTHETIC SENTENCE IDENTIFICATION TEST
STENGER TEST, SPEECH
VISUAL REINFORCEMENT AUDIOMETRY (VRA)
CONDITIONING PLAY AUDIOMETRY
SELECT PICTURE AUDIOMETRY
EVOKED OTOACOUSTIC EMISSIONS; LIMITED (SINGLE STIMULUS LEVEL, EITHER TRANSIENT
EVOKED OTOACOUSTIC EMISSIONS; COMPREHENSIVE OR DIAGNOSTIC EVALUATION
HEARING AID EXAMINATION AND SELECTION; MONAURAL
HEARING AID EXAMINATION AND SELECTION; BINAURAL
HEARING AID CHECK; MONAURAL
HEARING AID CHECK; BINAURAL
ELECTROACOUSTIC EVALUATION FOR HEARING AID; MONAURAL
ELECTROACOUSTIC EVALUATION FOR HEARING AID; BINAURAL
EAR PROTECTOR ATTENUATION MEASUREMENTS
EVALUATION FOR USE AND/OR FITTING OF VOICE PROSTHETIC DEVICE TO SUPPLEMENT ORAL
DIAGNOSTIC ANALYSIS OF COCHLEAR IMPLANT, PATIENT UNDER 7 YEARS OF AGE; WITH PROG
DIAGNOSTIC ANALYSIS OF COCHLEAR IMPLANT, PATIENT UNDER 7 YEARS OF AGE;
DIAGNOSTIC ANALYSIS OF COCHLEAR IMPLANT, AGE 7 YEARS OR OLDER; WITH PROGRAMMING
DIAGNOSTIC ANALYSIS OF COCHLEAR IMPLANT, AGE 7 YEARS OR OLDER; SUBSEQUENT
EVALUATION FOR PRESCRIPTION OF NON-SPEECH-GENERATING AUGMENTATIVE AND
THERAPEUTIC SERVICE(S) FOR THE USE OF NON-SPEECH-GENERATING DEVICE, INCLUDING
EVALUATION FOR PRESCRIPTION FOR SPEECH-GENERATING AUGMENTATIVE AND ALTERNATIVE
EVALUATION FOR PRESCRIPTION FOR SPEECH-GENERATING AUGMENTATIVE AND ALTERNATIVE
THERAPEUTIC SERVICES FOR THE USE OF SPEECH-GENERATING DEVICE, INCLUDING
EVALUATION OF ORAL AND PHARYNGEAL SWALLOWING FUNCTION
MOTION FLUOROSCOPIC EVALUATION OF SWALLOWING FUNCTION BY CINE OR VIDEO RECORDING
FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING BY CINE OR VIDEO
FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING BY CINE OR VIDEO
FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION, LARYNGEAL SENSORY TESTING BY CINE OR
FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION, LARYNGEAL SENSORY TESTING BY CINE OR
FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING AND LARYNGEAL SENSORY
FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING AND LARYNGEAL SENSORY
Evaluation for prescription of non-speech-generating augmentative and alternativ
EVALUATION OF CENTRAL AUDITORY FUNCTION, WITH REPORT; INITIAL 60 MINUTES
ASSESSMENT OF TINNITUS (INCLUDES PITCH, LOUDNESS MATCHING, AND MASKING)
EVALUATION OF AUDITORY REHABILITATION STATUS; FIRST HOUR
AUDITORY REHABILITATION; PRE-LINGUAL HEARING LOSS
AUDITORY REHABILITATION; POST-LINGUAL HEARING LOSS
DIAGNOSTIC ANALYSIS WITH PROGRAMMING OF AUDITORY BRAINSTEM IMPLANT, PER HOUR
UNLISTED OTORHINOLARYNGOLOGICAL SERVICE OR PROCEDURE
TEMPORARY TRANSCUTANEOUS PACING
CARDIOASSIST-METHOD OF CIRCULATORY ASSIST; INTERNAL
CARDIOASSIST-METHOD OF CIRCULATORY ASSIST; EXTERNAL
THROMBOLYSIS, CORONARY; BY INTRACORONARY INFUSION, INCLUDING SELECTIVE CORONARY
ATRIAL SEPTECTOMY OR SEPTOSTOMY; TRANSVENOUS METHOD, BALLOON (EG, RASHKIND
ATRIAL SEPTECTOMY OR SEPTOSTOMY; BLADE METHOD (PARK SEPTOSTOMY) (INCLUDES
ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; WITH INTERPRETATION AND R
ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; INTERPRETATION AND
CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMAL TREADMILL OR BICYCLE
CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMAL TREADMILL OR BICYCLE
CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMAL TREADMILL OR BICYCLE
CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMAL TREADMILL OR BICYCLE
ERGONOVINE PROVOCATION TEST
MICROVOLT T-WAVE ALTERNANS FOR ASSESSMENT OF VENTRICULAR ARRHYTHMIAS
RHYTHM ECG, ONE TO THREE LEADS; WITH INTERPRETATION AND REPORT
RHYTHM ECG, ONE TO THREE LEADS; TRACING ONLY WITHOUT INTERPRETATION AND REPORT
RHYTHM ECG, ONE TO THREE LEADS; INTERPRETATION AND REPORT ONLY
EXTERNAL ELECTROCARDIOGRAPHIC RECORDING UP TO 48 HOURS BY CONTINUOUS RHYTHM RECO
EXTERNAL ELECTROCARDIOGRAPHIC RECORDING UP TO 48 HOURS BY CONTINUOUS RHYTHM RECO
EXTERNAL MOBILE CARDIOVASCULAR TELEMETRY WITH ELECTROCARDIOGRAPHIC RECORDING, CO
EXTERNAL PATIENT AND, WHEN PERFORMED, AUTO ACTIVATED ELECTROCARDIOGRAPHIC RHYTHM
EXTERNAL PATIENT AND, WHEN PERFORMED, AUTO ACTIVATED ELECTROCARDIOGRAPHIC RHYTHM
SIGNAL-AVERAGED ELECTROCARDIOGRAPHY (SAECG), WITH OR WITHOUT ECG
Interrogation device evaluation (in person) with physician analysis, review and
Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or mul
Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or mul
Interrogation device evaluation(s), (remote) up to 30 days: implantable cardiova
Interrogation device evaluation(s), (remote) up to 30 days: implantable loop rec
Use of echocardiographic contrast agent during stress echocardiography (List sep
COMPREHENSIVE ELECTROPHYSIOLOGIC EVALUATION WITH RIGHT ATRIAL PACING AND RECORDI
COMPREHENSIVE ELECTROPHYSIOLOGIC EVALUATION INCLUDING INSERTION AND REPOSITIONIN
INTRACARDIAC CATHETER ABLATION OF ATRIOVENTRICULAR NODE FUNCTION, ATRIOVENTRICUL
INTRACARDIAC CATHETER ABLATION OF ARRHYTHMOGENIC FOCUS; FOR TREATMENT OF SUPRAVE
INTRACARDIAC CATHETER ABLATION OF ARRHYTHMOGENIC FOCUS; FOR TREATMENT OF VENTRIC
TEMPERATURE GRADIENT STUDIES
AMBULATORY BLOOD PRESSURE MONITORING, UTILIZING A SYSTEM SUCH AS MAGNETIC TAPE
AMBULATORY BLOOD PRESSURE MONITORING, UTILIZING A SYSTEM SUCH AS MAGNETIC TAPE
AMBULATORY BLOOD PRESSURE MONITORING, UTILIZING A SYSTEM SUCH AS MAGNETIC TAPE
AMBULATORY BLOOD PRESSURE MONITORING, UTILIZING A SYSTEM SUCH AS MAGNETIC TAPE
Unlisted noninvasive vascular diagnostic study
VENTILATION ASSIST AND MANAGEMENT, INITIATION OF PRESSURE OR VOLUME PRESET VENTI
VENTILATION ASSIST AND MANAGEMENT, INITIATION OF PRESSURE OR VOLUME PRESET VENTI
VENTILATION ASSIST AND MANAGEMENT, INITIATION OF PRESSURE OR VOLUME PRESET VENTI
HOME VENTILATOR MANAGEMENT CARE PLAN OVERSIGHT OF A PATIENT (PATIENT NOT PRESENT
SPIROMETRY, INCLUDING GRAPHIC RECORD, TOTAL AND TIMED VITAL CAPACITY, EXPIRATORY
Measurement of spirometric forced expiratory flows in an infant or child through
Measurement of spirometric forced expiratory flows, before and after bronchodila
Measurement of lung volumes (ie, functional residual capacity ¿FRC¿, forced vi
PATIENT-INITIATED SPIROMETRIC RECORDING PER 30-DAY PERIOD OF TIME; INCLUDES
PATIENT-INITIATED SPIROMETRIC RECORDING PER 30-DAY PERIOD OF TIME; RECORDING
PATIENT-INITIATED SPIROMETRIC RECORDING PER 30-DAY PERIOD OF TIME; PHYSICIAN
BRONCHOSPASM PROVOCATION EVALUATION, MULTIPLE SPIROMETRIC DETERMINATIONS AS IN
VITAL CAPACITY, TOTAL (SEPARATE PROCEDURE)
MAXIMUM BREATHING CAPACITY, MAXIMAL VOLUNTARY VENTILATION
EXPIRED GAS COLLECTION, QUANTITATIVE, SINGLE PROCEDURE (SEPARATE PROCEDURE)
RESPIRATORY FLOW VOLUME LOOP
BREATHING RESPONSE TO CO2 (CO2 RESPONSE CURVE)
BREATHING RESPONSE TO HYPOXIA (HYPOXIA RESPONSE CURVE)
HIGH ALTITUDE SIMULATION TEST (HAST), WITH PHYSICIAN INTERPRETATION AND REPORT;
HIGH ALTITUDE SIMULATION TEST (HAST), WITH PHYSICIAN INTERPRETATION AND REPORT;
PULMONARY STRESS TESTING; SIMPLE (EG, 6-MINUTE WALK TEST, PROLONGED EXERCISE TES
PULMONARY STRESS TESTING; COMPLEX (INCLUDING MEASUREMENTS OF CO2 PRODUCTION, O2
CONTINUOUS INHALATION TREATMENT WITH AEROSOL MEDICATION FOR ACUTE AIRWAY OBSTRUC
CONTINUOUS INHALATION TREATMENT WITH AEROSOL MEDICATION FOR ACUTE AIRWAY OBSTRUC
CONTINUOUS POSITIVE AIRWAY PRESSURE VENTILATION (CPAP), INITIATION AND
CONTINUOUS NEGATIVE PRESSURE VENTILATION (CNP), INITIATION AND MANAGEMENT
OXYGEN UPTAKE, EXPIRED GAS ANALYSIS; REST AND EXERCISE, DIRECT, SIMPLE
OXYGEN UPTAKE, EXPIRED GAS ANALYSIS; INCLUDING CO2 OUTPUT, PERCENTAGE OXYGEN
OXYGEN UPTAKE, EXPIRED GAS ANALYSIS; REST, INDIRECT (SEPARATE PROCEDURE)
Plethysmography for determination of lung volumes and, when performed, airway re
Gas dilution or washout for determination of lung volumes and, when performed, d
Airway resistance by impulse oscillometry
Diffusing capacity (eg, carbon monoxide, membrane) (List separately in addition
PULMONARY COMPLIANCE STUDY (EG, PLETHYSMOGRAPHY, VOLUME AND PRESSURE
NONINVASIVE EAR OR PULSE OXIMETRY FOR OXYGEN SATURATION; BY CONTINUOUS
CARBON DIOXIDE, EXPIRED GAS DETERMINATION BY INFRARED ANALYZER
CIRCADIAN RESPIRATORY PATTERN RECORDING (PEDIATRIC PNEUMOGRAM), 12 TO 24 HOUR
PEDIATRIC HOME APNEA MONITORING EVENT RECORDING INCLUDING RESPIRATORY RATE, PATT
PEDIATRIC HOME APNEA MONITORING EVENT RECORDING INCLUDING RESPIRATORY RATE, PATT
Car seat/bed testing for airway integrity, neonate, with continual nursing obser
Car seat/bed testing for airway integrity, neonate, with continual nursing obser
UNLISTED PULMONARY SERVICE OR PROCEDURE
PERCUTANEOUS TESTS (SCRATCH, PUNCTURE, PRICK) WITH ALLERGENIC EXTRACTS, IMMEDIAT
PERCUTANEOUS TESTS (SCRATCH, PUNCTURE, PRICK) SEQUENTIAL AND INCREMENTAL, WITH D
NITRIC OXIDE EXPIRED GAS DETERMINATION
INTRACUTANEOUS (INTRADERMAL) TESTS, SEQUENTIAL AND INCREMENTAL, WITH DRUGS, BIOL
INTRACUTANEOUS (INTRADERMAL) TESTS WITH ALLERGENIC EXTRACTS, IMMEDIATE TYPE REAC
INTRACUTANEOUS (INTRADERMAL) TESTS, SEQUENTIAL AND INCREMENTAL, WITH ALLERGENIC
INTRACUTANEOUS (INTRADERMAL) TESTS WITH ALLERGENIC EXTRACTS, DELAYED TYPE
PATCH OR APPLICATION TEST(S) (SPECIFY NUMBER OF TESTS)
PHOTO PATCH TEST(S) (SPECIFY NUMBER OF TESTS)
PHOTO TESTS
OPHTHALMIC MUCOUS MEMBRANE TESTS
DIRECT NASAL MUCOUS MEMBRANE TEST
INHALATION BRONCHIAL CHALLENGE TESTING (NOT INCLUDING NECESSARY PULMONARY
INHALATION BRONCHIAL CHALLENGE TESTING (NOT INCLUDING NECESSARY PULMONARY
INGESTION CHALLENGE TEST (SEQUENTIAL AND INCREMENTAL INGESTION OF TEST ITEMS,
PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY IN PRESCRIBING PHYSICIANS
PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY IN PRESCRIBING PHYSICIANS
PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY IN PRESCRIBING PHYSICIANS
PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY IN PRESCRIBING PHYSICIANS
PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY IN PRESCRIBING PHYSICIANS
PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY IN PRESCRIBING PHYSICIANS
PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY IN PRESCRIBING PHYSICIANS
RAPID DESENSITIZATION PROCEDURE, EACH HOUR (EG, INSULIN, PENICILLIN, EQUINE
UNLISTED ALLERGY/CLINICAL IMMUNOLOGIC SERVICE OR PROCEDURE
AMBULATORY CONTINUOUS GLUCOSE MONITORING OF INTERSTITIAL TISSUE FLUID VIA A SUBC
AMBULATORY CONTINUOUS GLUCOSE MONITORING OF INTERSTITIAL TISSUE FLUID VIA A SUBC
INSERTION BY PHYSICIAN OF SPHENOIDAL ELECTRODES FOR ELECTROENCEPHALOGRAPHIC
MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE) WITH REPORT; EXTREMITY (EXCLUDING HA
MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE) WITH REPORT; HAND, WITH OR WITHOUT
MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE) WITH REPORT; TOTAL EVALUATION OF
MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE) WITH REPORT; TOTAL EVALUATION OF
RANGE OF MOTION MEASUREMENTS AND REPORT (SEPARATE PROCEDURE); EACH EXTREMITY
RANGE OF MOTION MEASUREMENTS AND REPORT (SEPARATE PROCEDURE); HAND, WITH OR
Canalith repositioning procedure(s) (eg, Epley maneuver, Semont maneuver), per d
PHYSICIAN REVIEW AND INTERPRETATION OF COMPREHENSIVE COMPUTER BASED MOTION
PSYCHOLOGICAL TESTING (INCLUDES PSYCHODIAGNOSTIC ASSESSMENT OF EMOTIONALITY, INT
PSYCHOLOGICAL TESTING (INCLUDES PSYCHODIAGNOSTIC ASSESSMENT OF EMOTIONALITY, INT
PSYCHOLOGICAL TESTING (INCLUDES PSYCHODIAGNOSTIC ASSESSMENT OF EMOTIONALITY, INT
ASSESSMENT OF APHASIA (INCLUDES ASSESSMENT OF EXPRESSIVE AND RECEPTIVE SPEECH
DEVELOPMENTAL TESTING; LIMITED (EG, DEVELOPMENTAL SCREENING TEST II, EARLY
DEVELOPMENTAL TESTING; EXTENDED (INCLUDES ASSESSMENT OF MOTOR, LANGUAGE,
NEUROBEHAVIORAL STATUS EXAM (CLINICAL ASSESSMENT OF THINKING, REASONING AND JUDG
NEUROPSYCHOLOGICAL TESTING (EG, HALSTEAD-REITAN NEUROPSYCHOLOGICAL BATTERY, WECH
NEUROPSYCHOLOGICAL TESTING (EG, HALSTEAD-REITAN NEUROPSYCHOLOGICAL BATTERY, WECH
NEUROPSYCHOLOGICAL TESTING (EG, WISCONSIN CARD SORTING TEST), ADMINISTERED BY A
HEALTH AND BEHAVIOR ASSESSMENT (EG, HEALTH-FOCUSED CLINICAL INTERVIEW, BEHAVIORA
HEALTH AND BEHAVIOR ASSESSMENT (EG, HEALTH-FOCUSED CLINICAL INTERVIEW,
HEALTH AND BEHAVIOR INTERVENTION, EACH 15 MINUTES, FACE-TO-FACE; INDIVIDUAL
HEALTH AND BEHAVIOR INTERVENTION, EACH 15 MINUTES, FACE-TO-FACE; FAMILY (WITH
HEALTH AND BEHAVIOR INTERVENTION, EACH 15 MINUTES, FACE-TO-FACE; FAMILY
IRRIGATION OF IMPLANTED VENOUS ACCESS DEVICE FOR DRUG DELIVERY SYSTEMS
PHYSICAL THERAPY EVALUATION
PHYSICAL THERAPY RE-EVALUATION
OCCUPATIONAL THERAPY EVALUATION
OCCUPATIONAL THERAPY RE-EVALUATION
APPLICATION OF A MODALITY TO ONE OR MORE AREAS; TRACTION, MECHANICAL
APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ELECTRICAL STIMULATION
APPLICATION OF A MODALITY TO ONE OR MORE AREAS; VASOPNEUMATIC DEVICES
APPLICATION OF A MODALITY TO ONE OR MORE AREAS; PARAFFIN BATH
APPLICATION OF A MODALITY TO ONE OR MORE AREAS; WHIRLPOOL
APPLICATION OF A MODALITY TO ONE OR MORE AREAS; DIATHERMY (EG, MICROWAVE)
APPLICATION OF A MODALITY TO ONE OR MORE AREAS; INFRARED
APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ULTRAVIOLET
APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ELECTRICAL STIMULATION (MANUAL),
APPLICATION OF A MODALITY TO ONE OR MORE AREAS; IONTOPHORESIS, EACH 15 MINUTES
APPLICATION OF A MODALITY TO ONE OR MORE AREAS; CONTRAST BATHS, EACH 15 MINUTES
APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ULTRASOUND, EACH 15 MINUTES
APPLICATION OF A MODALITY TO ONE OR MORE AREAS; HUBBARD TANK, EACH 15 MINUTES
UNLISTED MODALITY (SPECIFY TYPE AND TIME IF CONSTANT ATTENDANCE)
THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; THERAPEUTIC EXERCISES
THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; NEUROMUSCULAR
THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; AQUATIC THERAPY WITH
THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; GAIT TRAINING
THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; MASSAGE, INCLUDING
UNLISTED THERAPEUTIC PROCEDURE (SPECIFY)
MANUAL THERAPY TECHNIQUES (EG, MOBILIZATION/ MANIPULATION, MANUAL LYMPHATIC
THERAPEUTIC PROCEDURE(S), GROUP (2 OR MORE INDIVIDUALS)
THERAPEUTIC ACTIVITIES, DIRECT (ONE-ON-ONE) PATIENT CONTACT BY THE PROVIDER
DEVELOPMENT OF COGNITIVE SKILLS TO IMPROVE ATTENTION, MEMORY, PROBLEM SOLVING,
SENSORY INTEGRATIVE TECHNIQUES TO ENHANCE SENSORY PROCESSING AND PROMOTE
SELF-CARE/HOME MANAGEMENT TRAINING (EG, ACTIVITIES OF DAILY LIVING (ADL) AND
COMMUNITY/WORK REINTEGRATION TRAINING (EG, SHOPPING, TRANSPORTATION, MONEY
WHEELCHAIR MANAGEMENT (EG, ASSESSMENT, FITTING, TRAINING), EACH 15 MINUTES
WORK HARDENING/CONDITIONING; INITIAL 2 HOURS
WORK HARDENING/CONDITIONING; EACH ADDITIONAL HOUR (LIST SEPARATELY IN ADDITION
PHYSICAL PERFORMANCE TEST OR MEASUREMENT (EG, MUSCULOSKELETAL, FUNCTIONAL
ASSISTIVE TECHNOLOGY ASSESSMENT (EG, TO RESTORE, AUGMENT OR COMPENSATE FOR
ORTHOTIC(S) MANAGEMENT AND TRAINING (INCLUDING ASSESSMENT AND FITTING WHEN NOT O
PROSTHETIC TRAINING, UPPER AND/OR LOWER EXTREMITY(S), EACH 15 MINUTES
CHECKOUT FOR ORTHOTIC/PROSTHETIC USE, ESTABLISHED PATIENT, EACH 15 MINUTES
UNLISTED PHYSICAL MEDICINE/REHABILITATION SERVICE OR PROCEDURE
MEDICAL NUTRITION THERAPY; INITIAL ASSESSMENT AND INTERVENTION, INDIVIDUAL, FACE
MEDICAL NUTRITION THERAPY; RE-ASSESSMENT AND INTERVENTION, INDIVIDUAL,
MEDICAL NUTRITION THERAPY; GROUP (2 OR MORE INDIVIDUAL(S)), EACH 30 MINUTES
CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); EXTRASPINAL, ONE OR MORE REGIONS
TELEPHONE ASSESSMENT AND MANAGEMENT SERVICE PROVIDED BY A QUALIFIED NONPHYSICIAN
TELEPHONE ASSESSMENT AND MANAGEMENT SERVICE PROVIDED BY A QUALIFIED NONPHYSICIAN
TELEPHONE ASSESSMENT AND MANAGEMENT SERVICE PROVIDED BY A QUALIFIED NONPHYSICIAN
HANDLING AND/OR CONVEYANCE OF SPECIMEN FOR TRANSFER FROM THE PHYSICIAN'S OFFICE
HANDLING AND/OR CONVEYANCE OF SPECIMEN FOR TRANSFER FROM THE PATIENT IN OTHER
HANDLING, CONVEYANCE, AND/OR ANY OTHER SERVICE IN CONNECTION WITH THE
SERVICES PROVIDED IN THE OFFICE AT TIMES OTHER THAN REGULARLY SCHEDULED OFFICE H
SERVICE(S) PROVIDED IN THE OFFICE DURING REGULARLY SCHEDULED EVENING, WEEKEND, O
SERVICE(S) PROVIDED BETWEEN 10:00 PM AND 8:00 AM AT 24-HOUR FACILITY, IN ADDITIO
SERVICE(S) PROVIDED ON AN EMERGENCY BASIS IN THE OFFICE, WHICH DISRUPTS OTHER SC
SERVICE(S) PROVIDED ON AN EMERGENCY BASIS, OUT OF THE OFFICE, WHICH DISRUPTS OTH
SCREENING TEST OF VISUAL ACUITY, QUANTITATIVE, BILATERAL
OCULAR PHOTOSCREENING WITH INTERPRETATION AND REPORT, BILATERAL
PHYSICIAN ATTENDANCE AND SUPERVISION OF HYPERBARIC OXYGEN THERAPY, PER SESSION
ASSEMBLY AND OPERATION OF PUMP WITH OXYGENATOR OR HEAT EXCHANGER (WITH OR
ASSEMBLY AND OPERATION OF PUMP WITH OXYGENATOR OR HEAT EXCHANGER (WITH OR
ASSEMBLY AND OPERATION OF PUMP WITH OXYGENATOR OR HEAT EXCHANGER (WITH OR
PHLEBOTOMY, THERAPEUTIC (SEPARATE PROCEDURE)
UNLISTED SPECIAL SERVICE, PROCEDURE OR REPORT
OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATI
OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW
OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW
OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW
OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW
OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLI
OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN
OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN
OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN
OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN
OBSERVATION CARE DISCHARGE DAY MANAGEMENT (THIS CODE IS TO BE UTILIZED BY THE PH
INITIAL OBSERVATION CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIEN
INITIAL OBSERVATION CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A
INITIAL OBSERVATION CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A
INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT W
INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT,
INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT,
SUBSEQUENT OBSERVATION CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PAT
SUBSEQUENT OBSERVATION CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PAT
SUBSEQUENT OBSERVATION CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PAT
SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIEN
SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A
SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A
OBSERVATION OR INPATIENT HOSPITAL CARE, FOR THE EVALUATION AND MANAGEMENT OF A P
OBSERVATION OR INPATIENT HOSPITAL CARE, FOR THE EVALUATION AND MANAGEMENT OF A
OBSERVATION OR INPATIENT HOSPITAL CARE, FOR THE EVALUATION AND MANAGEMENT OF A
HOSPITAL DISCHARGE DAY MANAGEMENT; 30 MINUTES OR LESS
HOSPITAL DISCHARGE DAY MANAGEMENT; MORE THAN 30 MINUTES
OFFICE CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE THREE
OFFICE CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE
OFFICE CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE
OFFICE CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE
OFFICE CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE
INPATIENT CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE TH
INPATIENT CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE TH
INPATIENT CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE TH
INPATIENT CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE TH
INPATIENT CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE TH
PHYSICIAN DIRECTION OF EMERGENCY MEDICAL SYSTEMS (EMS) EMERGENCY CARE, ADVANCED
CRITICAL CARE, EVALUATION AND MANAGEMENT OF THE CRITICALLY ILL OR CRITICALLY INJ
INITIAL NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A P
INITIAL NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A P
INITIAL NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A P
SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF
SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF
SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF
SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF
NURSING FACILITY DISCHARGE DAY MANAGEMENT; 30 MINUTES OR LESS
NURSING FACILITY DISCHARGE DAY MANAGEMENT; MORE THAN 30 MINUTES
EVALUATION AND MANAGEMENT OF A PATIENT INVOLVING AN ANNUAL NURSING FACILITY ASSE
DOMICILIARY OR REST HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIEN
DOMICILIARY OR REST HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIEN
DOMICILIARY OR REST HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIEN
DOMICILIARY OR REST HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIEN
DOMICILIARY OR REST HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIEN
DOMICILIARY OR REST HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISH
DOMICILIARY OR REST HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISH
DOMICILIARY OR REST HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISH
DOMICILIARY OR REST HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISH
INDIVIDUAL PHYSICIAN SUPERVISION OF A PATIENT (PATIENT NOT PRESENT) IN HOME, DOM
INDIVIDUAL PHYSICIAN SUPERVISION OF A PATIENT (PATIENT NOT PRESENT) IN HOME, DOM
HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH
HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES
HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES
HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES
HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES
HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE
HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH
HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH
HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH
PROLONGED PHYSICIAN SERVICE IN THE INPATIENT SETTING, REQUIRING UNIT/FLOOR TIME
PROLONGED PHYSICIAN SERVICE IN THE INPATIENT SETTING, REQUIRING UNIT/FLOOR TIME
PHYSICIAN STANDBY SERVICE, REQUIRING PROLONGED PHYSICIAN ATTENDANCE, EACH 30 MIN
ANTICOAGULANT MANAGEMENT FOR AN OUTPATIENT TAKING WARFARIN, PHYSICIAN REVIEW AND
ANTICOAGULANT MANAGEMENT FOR AN OUTPATIENT TAKING WARFARIN, PHYSICIAN REVIEW AND
PHYSICIAN SUPERVISION OF A PATIENT UNDER CARE OF HOME HEALTH AGENCY (PATIENT NOT
PHYSICIAN SUPERVISION OF A PATIENT UNDER CARE OF HOME HEALTH AGENCY (PATIENT
PHYSICIAN SUPERVISION OF A HOSPICE PATIENT (PATIENT NOT PRESENT) REQUIRING
PHYSICIAN SUPERVISION OF A HOSPICE PATIENT (PATIENT NOT PRESENT) REQUIRING
PHYSICIAN SUPERVISION OF A NURSING FACILITY PATIENT (PATIENT NOT PRESENT)
PHYSICIAN SUPERVISION OF A NURSING FACILITY PATIENT (PATIENT NOT PRESENT)
INITIAL COMPREHENSIVE PREVENTIVE MEDICINE EVALUATION AND MANAGEMENT OF AN INDIVI
INITIAL COMPREHENSIVE PREVENTIVE MEDICINE EVALUATION AND MANAGEMENT OF AN INDIVI
INITIAL COMPREHENSIVE PREVENTIVE MEDICINE EVALUATION AND MANAGEMENT OF AN INDIVI
INITIAL COMPREHENSIVE PREVENTIVE MEDICINE EVALUATION AND MANAGEMENT OF AN INDIVI
INITIAL COMPREHENSIVE PREVENTIVE MEDICINE EVALUATION AND MANAGEMENT OF AN INDIVI
PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF AN IND
PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF AN IND
PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF AN IND
PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF AN IND
PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF AN IND
PREVENTIVE MEDICINE COUNSELING AND/OR RISK FACTOR REDUCTION INTERVENTION(S) PROV
PREVENTIVE MEDICINE COUNSELING AND/OR RISK FACTOR REDUCTION INTERVENTION(S)
PREVENTIVE MEDICINE COUNSELING AND/OR RISK FACTOR REDUCTION INTERVENTION(S)
PREVENTIVE MEDICINE COUNSELING AND/OR RISK FACTOR REDUCTION INTERVENTION(S)
PREVENTIVE MEDICINE COUNSELING AND/OR RISK FACTOR REDUCTION INTERVENTION(S) PROV
PREVENTIVE MEDICINE COUNSELING AND/OR RISK FACTOR REDUCTION INTERVENTION(S)
ADMINISTRATION AND INTERPRETATION OF HEALTH RISK ASSESSMENT INSTRUMENT (EG, HEAL
UNLISTED PREVENTIVE MEDICINE SERVICE
TELEPHONE EVALUATION AND MANAGEMENT SERVICE PROVIDED BY A PHYSICIAN TO AN ESTABL
TELEPHONE EVALUATION AND MANAGEMENT SERVICE PROVIDED BY A PHYSICIAN TO AN ESTABL
TELEPHONE EVALUATION AND MANAGEMENT SERVICE PROVIDED BY A PHYSICIAN TO AN ESTABL
Initial hospital or birthing center care, per day, for evaluation and management
Initial care, per day, for evaluation and management of normal newborn infant se
Subsequent hospital care, per day, for evaluation and management of normal newbo
Initial hospital or birthing center care, per day, for evaluation and management
Initial inpatient neonatal critical care, per day, for the evaluation and manage
Subsequent inpatient neonatal critical care, per day, for the evaluation and man
Initial inpatient pediatric critical care, per day, for the evaluation and manag
Subsequent inpatient pediatric critical care, per day, for the evaluation and ma
Initial inpatient pediatric critical care, per day, for the evaluation and manag
Subsequent inpatient pediatric critical care, per day, for the evaluation and ma
INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF THE NEONATE
Subsequent intensive care, per day, for the evaluation and management of the rec
Subsequent intensive care, per day, for the evaluation and management of the rec
Subsequent intensive care, per day, for the evaluation and management of the rec
UNLISTED EVALUATION AND MANAGEMENT SERVICE
HOME INFUSION/SPECIALTY DRUG ADMINISTRATION, PER VISIT (UP TO 2 HOURS)
HOME INFUSION/SPECIALTY DRUG ADMINISTRATION, PER VISIT (UP TO 2 HOURS) EACH
NON-EMERGENCY TRANSPORTATION, PER MILE - VEHICLE PROVIDED BY VOLUNTEER
NON-EMERGENCY TRANSPORTATION, PER MILE - VEHICLE PROVIDED BY INDIVIDUAL (FAMILY
NON-EMERGENCY TRANSPORTATION; TAXI
NON-EMERGENCY TRANSPORTATION AND BUS, INTRA OR INTER STATE CARRIER
NON-EMERGENCY TRANSPORTATION: MINI-BUS, MOUNTAIN AREA TRANSPORTS, OR OTHER
NON-EMERGENCY TRANSPORTATION: WHEEL-CHAIR VAN
NON-EMERGENCY TRANSPORTATION AND AIR TRAVEL (PRIVATE OR COMMERCIAL) INTRA OR
NON-EMERGENCY TRANSPORTATION: PER MILE - CASE WORKER OR SOCIAL WORKER
TRANSPORTATION ANCILLARY: PARKING FEES, TOLLS, OTHER
NON-EMERGENCY TRANSPORTATION: ANCILLARY: LODGING-RECIPIENT
NON-EMERGENCY TRANSPORTATION: ANCILLARY: MEALS-RECIPIENT
NON-EMERGENCY TRANSPORTATION: ANCILLARY: LODGING ESCORT
NON-EMERGENCY TRANSPORTATION: ANCILLARY: MEALS-ESCORT
AMBULANCE SERVICE, NEONATAL TRANSPORT, BASE RATE, EMERGENCY TRANSPORT, ONE WAY
BLS ROUTINE DISPOSABLE SUPPLIES
ALS ROUTINE DISPOSABLE SUPPLIES
AMBULANCE WAITING TIME (ALS OR BLS), ONE HALF (1/2) HOUR INCREMENTS
AMBULANCE (ALS OR BLS) OXYGEN AND OXYGEN SUPPLIES, LIFE SUSTAINING SITUATION
GROUND MILEAGE, PER STATUTE MILE
AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, NON-EMERGENCY TRANSPORT, LEVEL 1 (ALS
AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, EMERGENCY TRANSPORT, LEVEL 1
AMBULANCE SERVICE, BASIC LIFE SUPPORT, NON-EMERGENCY TRANSPORT, (BLS)
AMBULANCE SERVICE, BASIC LIFE SUPPORT, EMERGENCY TRANSPORT (BLS-EMERGENCY)
AMBULANCE SERVICE, CONVENTIONAL AIR SERVICES, TRANSPORT, ONE WAY (FIXED WING)
AMBULANCE SERVICE, CONVENTIONAL AIR SERVICES, TRANSPORT, ONE WAY (ROTARY WING)
ADVANCED LIFE SUPPORT, LEVEL 2 (ALS 2)
SPECIALTY CARE TRANSPORT (SCT)
FIXED WING AIR MILEAGE, PER STATUTE MILE
ROTARY WING AIR MILEAGE, PER STATUTE MILE
NONCOVERED AMBULANCE MILEAGE, PER MILE (E.G., FOR MILES TRAVELED BEYOND CLOSEST
UNLISTED AMBULANCE SERVICE
SYRINGE WITH NEEDLE, STERILE, 1 CC OR LESS, EACH
SYRINGE WITH NEEDLE, STERILE 2CC, EACH
SYRINGE WITH NEEDLE, STERILE 3CC, EACH
SYRINGE WITH NEEDLE, STERILE 5CC OR GREATER, EACH
NEEDLE-FREE INJECTION DEVICE, EACH
SUPPLIES FOR SELF-ADMINISTERED INJECTIONS
NON-CORING NEEDLE OR STYLET WITH OR WITHOUT CATHETER
SYRINGE, STERILE, 20 CC OR GREATER, EACH
NEEDLE, STERILE, ANY SIZE, EACH
STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML
STERILE WATER/SALINE, 500 ML
SUPPLIES FOR MAINTENANCE OF DRUG INFUSION CATHETER, PER WEEK (LIST DRUG
INFUSION SUPPLIES FOR EXTERNAL DRUG INFUSION PUMP, PER CASSETTE OR BAG (LIST
INFUSION SUPPLIES NOT USED WITH EXTERNAL INFUSION PUMP, PER CASSETTE OR BAG
SYRINGE WITH NEEDLE FOR EXTERNAL INSULIN PUMP, STERILE, 3CC
REPLACEMENT BATTERY, ALKALINE (OTHER THAN J CELL), FOR USE WITH MEDICALLY NECESS
REPLACEMENT BATTERY, ALKALINE, J CELL, FOR USE WITH MEDICALLY NECESSARY HOME BLO
REPLACEMENT BATTERY, LITHIUM, FOR USE WITH MEDICALLY NECESSARY HOME BLOOD GLUCOS
REPLACEMENT BATTERY, SILVER OXIDE, FOR USE WITH MEDICALLY NECESSARY HOME BLOOD G
ALCOHOL OR PEROXIDE, PER PINT
ALCOHOL WIPES, PER BOX
BETADINE OR PHISOHEX SOLUTION, PER PINT
BETADINE OR IODINE SWABS/WIPES, PER BOX
URINE TEST OR REAGENT STRIPS OR TABLETS (100 TABLETS OR STRIPS)
BLOOD KETONE TEST OR REAGENT STRIP, EACH
BLOOD GLUCOSE TEST OR REAGENT STRIPS FOR HOME BLOOD GLUCOSE MONITOR, PER 50
PLATFORMS FOR HOME BLOOD GLUCOSE MONITOR, 50 PER BOX
NORMAL, LOW AND HIGH CALIBRATOR SOLUTION / CHIPS
REPLACEMENT LENS SHIELD CARTRIDGE FOR USE WITH LASER SKIN PIERCING DEVICE, EACH
SPRING-POWERED DEVICE FOR LANCET, EACH
LANCETS, PER BOX OF 100
CERVICAL CAP FOR CONTRACEPTIVE USE
PARAFFIN, PER POUND
DIAPHRAGM FOR CONTRACEPTIVE USE
CONTRACEPTIVE SUPPLY, CONDOM, MALE, EACH
CONTRACEPTIVE SUPPLY, CONDOM, FEMALE, EACH
CONTRACEPTIVE SUPPLY, SPERMICIDE (E.G., FOAM, GEL), EACH
ADHESIVE SKIN SUPPORT ATTACHMENT FOR USE WITH EXTERNAL BREAST PROSTHESIS, EACH
TUBING FOR BREAST PUMP, REPLACEMENT
ADAPTER FOR BREAST PUMP, REPLACEMENT
CAP FOR BREAST PUMP BOTTLE, REPLACEMENT
BREAST SHIELD AND SPLASH PROTECTOR FOR USE WITH BREAST PUMP, REPLACEMENT
POLYCARBONATE BOTTLE FOR USE WITH BREAST PUMP, REPLACEMENT
LOCKING RING FOR BREAST PUMP, REPLACEMENT
SACRAL NERVE STIMULATION TEST LEAD, EACH
INSERTION TRAY WITHOUT DRAINAGE BAG AND WITHOUT CATHETER (ACCESSORIES ONLY)
INSERTION TRAY WITHOUT DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE,
INSERTION TRAY WITHOUT DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE,
INSERTION TRAY WITHOUT DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE,
INSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE, TWO-WAY
INSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE, TWO-WAY,
INSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE,
IRRIGATION TRAY WITH BULB OR PISTON SYRINGE, ANY PURPOSE
THERAPEUTIC AGENT FOR URINARY CATHETER IRRIGATION
IRRIGATION SYRINGE, BULB OR PISTON, EACH
MALE EXTERNAL CATHETER WITH INTEGRAL COLLECTION CHAMBER, ANY TYPE, EACH
FEMALE EXTERNAL URINARY COLLECTION DEVICE; MEATAL CUP, EACH
FEMALE EXTERNAL URINARY COLLECTION DEVICE; POUCH, EACH
PERIANAL FECAL COLLECTION POUCH WITH ADHESIVE, EACH
EXTENSION DRAINAGE TUBING, ANY TYPE, ANY LENGTH, WITH CONNECTOR/ADAPTOR, FOR
LUBRICANT, INDIVIDUAL STERILE PACKET, EACH
URINARY CATHETER ANCHORING DEVICE, ADHESIVE SKIN ATTACHMENT, EACH
URINARY CATHETER ANCHORING DEVICE, LEG STRAP, EACH
INCONTINENCE SUPPLY; MISCELLANEOUS
INCONTINENCE SUPPLY, URETHRAL INSERT, ANY TYPE, EACH
INDWELLING CATHETER; FOLEY TYPE, TWO-WAY LATEX WITH COATING (TEFLON, SILICONE,
INDWELLING CATHETER; SPECIALTY TYPE, EG; COUDE, MUSHROOM, WING, ETC.), EACH
INDWELLING CATHETER, FOLEY TYPE, TWO-WAY, ALL SILICONE, EACH
INDWELLING CATHETER; FOLEY TYPE, THREE WAY FOR CONTINUOUS IRRIGATION, EACH
MALE EXTERNAL CATHETER, WITH OR WITHOUT ADHESIVE, DISPOSABLE, EACH
INTERMITTENT URINARY CATHETER; STRAIGHT TIP, WITH OR WITHOUT COATING (TEFLON,
INTERMITTENT URINARY CATHETER; COUDE (CURVED) TIP, WITH OR WITHOUT COATING
INTERMITTENT URINARY CATHETER, WITH INSERTION SUPPLIES
INSERTION TRAY WITH DRAINAGE BAG BUT WITHOUT CATHETER
IRRIGATION TUBING SET FOR CONTINUOUS BLADDER IRRIGATION THROUGH A THREE-WAY
EXTERNAL URETHRAL CLAMP OR COMPRESSION DEVICE (NOT TO BE USED FOR CATHETER CLAMP
BEDSIDE DRAINAGE BAG, DAY OR NIGHT, WITH OR WITHOUT ANTI-REFLUX DEVICE, WITH OR
URINARY DRAINAGE BAG, LEG OR ABDOMEN, VINYL, WITH OR WITHOUT TUBE, WITH STRAPS,
DISPOSABLE EXTERNAL URETHRAL CLAMP OR COMPRESSION DEVICE, WITH PAD AND/OR
OSTOMY FACEPLATE, EACH
SKIN BARRIER; SOLID, 4 X 4 OR EQUIVALENT; EACH
OSTOMY CLAMP, ANY TYPE, REPLACEMENT ONLY, EACH
ADHESIVE, LIQUID OR EQUAL, ANY TYPE, PER OZ
OSTOMY VENT, ANY TYPE, EACH
OSTOMY BELT, EACH
OSTOMY FILTER, ANY TYPE, EACH
OSTOMY SKIN BARRIER, LIQUID (SPRAY, BRUSH, ETC), PER OZ
OSTOMY SKIN BARRIER, POWDER, PER OZ
OSTOMY SKIN BARRIER, SOLID 4X4 OR EQUIVALENT, STANDARD WEAR, WITH BUILT-IN CONV
OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDIAN), WITH BUILT-IN
OSTOMY POUCH, DRAINABLE, WITH FACEPLATE ATTACHED, PLASTIC, EACH
OSTOMY POUCH, DRAINABLE, WITH FACEPLATE ATTACHED, RUBBER, EACH
OSTOMY POUCH, DRAINABLE, FOR USE ON FACEPLATE, PLASTIC, EACH
OSTOMY POUCH, DRAINABLE, FOR USE ON FACEPLATE, RUBBER, EACH
OSTOMY POUCH, URINARY, WITH FACEPLATE ATTACHED, PLASTIC, EACH
OSTOMY POUCH, URINARY, WITH FACEPLATE ATTACHED, RUBBER, EACH
OSTOMY POUCH, URINARY, FOR USE ON FACEPLATE, PLASTIC, EACH
OSTOMY POUCH, URINARY, FOR USE ON FACEPLATE, HEAVY PLASTIC, EACH
OSTOMY POUCH, URINARY, FOR USE ON FACEPLATE, RUBBER, EACH
OSTOMY FACEPLATE EQUIVALENT, SILICONE RING, EACH
OSTOMY SKIN BARRIER, SOLID 4X4 OR EQUIVALENT, EXTENDED WEAR, WITHOUT BUILT-IN
OSTOMY POUCH, CLOSED, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY (1 PIECE),
OSTOMY POUCH, DRAINABLE, WITH EXTENDED WEAR BARRIER ATTACHED, (1 PIECE), EACH
OSTOMY POUCH, DRAINABLE, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY (1
OSTOMY POUCH, DRAINABLE, WITH EXTENDED WEAR BARRIER ATTACHED, WITH BUILT-IN
OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED (1 PIECE), EACH
OSTOMY POUCH, URINARY, WITH STANDARD WEAR BARRIER ATTACHED, WITH BUILT-IN
OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED, WITH BUILT-IN
OSTOMY DEODORANT, WITH OR WITHOUT LUBRICANT, FOR USE IN OSTOMY POUCH, PER FLUID
OSTOMY DEODORANT FOR USE IN OSTOMY POUCH, SOLID, PER TABLET
OSTOMY BELT WITH PERISTOMAL HERNIA SUPPORT
IRRIGATION SUPPLY; SLEEVE, EACH
OSTOMY IRRIGATION SUPPLY; BAG, EACH
OSTOMY IRRIGATION SUPPLY; CONE/CATHETER, WITH OR WITHOUT BRUSH
OSTOMY IRRIGATION SET
LUBRICANT, PER OUNCE
OSTOMY RING, EACH
OSTOMY SKIN BARRIER, NON-PECTIN BASED, PASTE, PER OUNCE
OSTOMY SKIN BARRIER, PECTIN-BASED, PASTE, PER OUNCE
OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE, OR ACCORDION), EXTENDED
OSTOMY SKIN BARRIER, WTIH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR,
OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR,
OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR,
OSTOMY SKIN BARRIER, SOLID 4X4 OR EQUIVALENT, EXTENDED WEAR, WITH BUILT-IN CONVE
OSTOMY POUCH, DRAINABLE, HIGH OUTPUT, FOR USE ON A BARRIER WITH FLANGE (2 PIECE
OSTOMY POUCH, DRAINABLE, HIGH OUTPUT, FOR USE ON A BARRIER WITH FLANGE (2 PIECE
OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), WITHOUT
OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), WITHOUT
OSTOMY POUCH, CLOSED, WITH BARRIER ATTACHED, WITH FILTER (1 PIECE), EACH
OSTOMY POUCH, CLOSED, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY, WITH
OSTOMY POUCH, CLOSED; WITHOUT BARRIER ATTACHED, WITH FILTER (1 PIECE), EACH
OSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH NON-LOCKING FLANGE, WITH FILTER
OSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH LOCKING FLANGE (2 PIECE), EACH
OSTOMY SUPPLY; MISCELLANEOUS
OSTOMY ABSORBENT MATERIAL (SHEET/PAD/CRYSTAL PACKET) FOR USE IN OSTOMY POUCH TO
OSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH LOCKING FLANGE, WITH FILTER (2
OSTOMY POUCH, DRAINABLE, WITH BARRIER ATTACHED, WITH FILTER (1 PIECE), EACH
OSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH NON-LOCKING FLANGE, WITH
OSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH LOCKING FLANGE (2 PIECE
OSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH LOCKING FLANGE, WITH FILTER (2
OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED, WITH FAUCET-TYPE
OSTOMY POUCH, URINARY, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY, WITH
OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED, WITH BUILT-IN
OSTOMY POUCH, URINARY; WITH BARRIER ATTACHED, WITH FAUCET-TYPE TAP WITH VALVE
OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH NON-LOCKING FLANGE, WITH
OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH LOCKING FLANGE (2 PIECE), EACH
OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH LOCKING FLANGE, WITH FAUCET-TYPE
TAPE, NON-WATERPROOF, PER 18 SQUARE INCHES
TAPE, WATERPROOF, PER 18 SQUARE INCHES
ADHESIVE REMOVER OR SOLVENT (FOR TAPE, CEMENT OR OTHER ADHESIVE), PER OUNCE
ENEMA BAG WITH TUBING, REUSABLE
SURGICAL DRESSING HOLDER, NON-REUSABLE, EACH
SURGICAL DRESSING HOLDER, REUSABLE, EACH
TRACHEOSTOMA FILTER, ANY TYPE, ANY SIZE, EACH
MOISTURE EXCHANGER, DISPOSABLE, FOR USE WITH INVASIVE MECHANICAL VENTILATION
SURGICAL STOCKINGS ABOVE KNEE LENGTH, EACH
SURGICAL STOCKINGS THIGH LENGTH, EACH
SURGICAL STOCKINGS BELOW KNEE LENGTH, EACH
SURGICAL STOCKINGS FULL LENGTH, EACH
INCONTINENCE GARMENT, ANY TYPE, (E.G. BRIEF, DIAPER), EACH
DISPOSABLE UNDERPADS, ALL SIZES, (E.G., CHUX'S)
ELECTRODES, (E.G., APNEA MONITOR), PER PAIR
LEAD WIRES, (E.G., APNEA MONITOR), PER PAIR
CONDUCTIVE GEL OR PASTE, FOR USE WITH ELECTRICAL DEVICE (E.G., TENS, NMES), PER
COUPLING GEL OR PASTE, FOR USE WITH ULTRASOUND DEVICE, PER OZ
TOPICAL HYPERBARIC OXYGEN CHAMBER, DISPOSABLE
ELECTRICAL STIMULATOR SUPPLIES, 2 LEAD, PER MONTH, (E.G. TENS, NMES)
SLEEVE FOR INTERMITTENT LIMB COMPRESSION DEVICE, REPLACEMENT ONLY, EACH
LITHIUM ION BATTERY FOR NON-PROSTHETIC USE, REPLACEMENT
TUBING WITH INTEGRATED HEATING ELEMENT FOR USE WITH POSITIVE AIRWAY PRESSURE DEV
TRACHEAL SUCTION CATHETER, CLOSED SYSTEM, EACH
OXYGEN PROBE FOR USE WITH OXIMETER DEVICE, REPLACEMENT
TRANSTRACHEAL OXYGEN CATHETER, EACH
BATTERY, HEAVY DUTY; REPLACEMENT FOR PATIENT OWNED VENTILATOR
BATTERY CABLES; REPLACEMENT FOR PATIENT-OWNED VENTILATOR
BATTERY CHARGER; REPLACEMENT FOR PATIENT-OWNED VENTILATOR
PEAK EXPIRATORY FLOW RATE METER, HAND HELD
CANNULA, NASAL
TUBING (OXYGEN), PER FOOT
MOUTH PIECE
BREATHING CIRCUITS
FACE TENT
VARIABLE CONCENTRATION MASK
TRACHEOSTOMY, INNER CANNULA
TRACHEAL SUCTION CATHETER, ANY TYPE OTHER THAN CLOSED SYSTEM, EACH
TRACHEOSTOMY CARE KIT FOR NEW TRACHEOSTOMY
TRACHEOSTOMY CLEANING BRUSH, EACH
SPACER, BAG OR RESERVOIR, WITH OR WITHOUT MASK, FOR USE WITH METERED DOSE
OROPHARYNGEAL SUCTION CATHETER, EACH
TRACHEOSTOMY CARE KIT FOR ESTABLISHED TRACHEOSTOMY
REPLACEMENT BATTERIES, MEDICALLY NECESSARY, TRANSCUTANEOUS ELECTRICAL STIMULATO
REPLACEMENT BULB/LAMP FOR ULTRAVIOLET LIGHT THERAPY SYSTEM, EACH
REPLACEMENT BULB FOR THERAPEUTIC LIGHT BOX, TABLETOP MODEL
UNDERARM PAD, CRUTCH, REPLACEMENT, EACH
REPLACEMENT, HANDGRIP, CANE, CRUTCH, OR WALKER, EACH
REPLACEMENT, TIP, CANE, CRUTCH, WALKER, EACH.
REPLACEMENT BATTERY FOR PATIENT-OWNED EAR PULSE GENERATOR, EACH
REPLACEMENT PAD FOR INFRARED HEATING PAD SYSTEM, EACH
REPLACEMENT PAD FOR USE WITH MEDICALLY NECESSARY ALTERNATING PRESSURE PAD
CALIBRATED MICROCAPILLARY TUBE, EACH
MICROCAPILLARY TUBE SEALANT
PERITONEAL DIALYSIS CATHETER ANCHORING DEVICE, BELT, EACH
AUTOMATIC BLOOD PRESSURE MONITOR
DISPOSABLE CYCLER SET USED WITH CYCLER DIALYSIS MACHINE, EACH
DRAINAGE EXTENSION LINE, STERILE, FOR DIALYSIS, EACH
EXTENSION LINE WITH EASY LOCK CONNECTORS, USED WITH DIALYSIS
CHEMICALS/ANTISEPTICS SOLUTION USED TO CLEAN/STERILIZE DIALYSIS EQUIPMENT, PER
DIALYSATE SOLUTION, NON-DEXTROSE CONTAINING, 500 ML
RECTAL THERMOMETER, REUSABLE, ANY TYPE, EACH
OSTOMY POUCH, CLOSED; WITH BARRIER ATTACHED (1 PIECE), EACH
OSTOMY POUCH, CLOSED; WITHOUT BARRIER ATTACHED (1 PIECE), EACH
OSTOMY POUCH, CLOSED; FOR USE ON FACEPLATE, EACH
OSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH FLANGE (2 PIECE), EACH
STOMA CAP
Ostomy pouch, drainable with extended wear barrier attached, with filter (1 piec
Ostomy pouch, drainable with extended wear barrier attached, with built in conve
OSTOMY POUCH, DRAINABLE; WITH BARRIER ATTACHED, (1 PIECE), EACH
OSTOMY POUCH, DRAINABLE; WITHOUT BARRIER ATTACHED (1 PIECE), EACH
OSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH FLANGE (2 PIECE SYSTEM), EACH
OSTOMY POUCH, URINARY; WITH BARRIER ATTACHED (1 PIECE), EACH
OSTOMY POUCH, URINARY; WITHOUT BARRIER ATTACHED (1 PIECE), EACH
OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH FLANGE (2 PIECE), EACH
CONTINENT DEVICE; PLUG FOR CONTINENT STOMA
CONTINENT DEVICE; CATHETER FOR CONTINENT STOMA
CONTINENT DEVICE, STOMA ABSORPTIVE COVER FOR CONTINENT STOMA
OSTOMY ACCESSORY; CONVEX INSERT
BEDSIDE DRAINAGE BOTTLE WITH OR WITHOUT TUBING, RIGID OR EXPANDABLE, EACH
URINARY SUSPENSORY WITH LEG BAG, WITH OR WITHOUT TUBE, EACH
URINARY DRAINAGE BAG, LEG OR ABDOMEN, LATEX, WITH OR WITHOUT TUBE, WITH STRAPS,
LEG STRAP; LATEX, REPLACEMENT ONLY, PER SET
LEG STRAP; FOAM OR FABRIC, REPLACEMENT ONLY, PER SET
SKIN BARRIER, WIPES OR SWABS, EACH
SKIN BARRIER; SOLID, 6 X 6 OR EQUIVALENT, EACH
SKIN BARRIER; SOLID, 8 X 8 OR EQUIVALENT, EACH
ADHESIVE OR NON-ADHESIVE; DISK OR FOAM PAD
APPLIANCE CLEANER, INCONTINENCE AND OSTOMY APPLIANCES, PER 16 OZ.
PERCUTANEOUS CATHETER/TUBE ANCHORING DEVICE, ADHESIVE SKIN ATTACHMENT
FOR DIABETICS ONLY, FITTING (INCLUDING FOLLOW-UP), CUSTOM PREPARATION AND SUPPLY
FOR DIABETICS ONLY, FITTING (INCLUDING FOLLOW-UP), CUSTOM PREPARATION AND
FOR DIABETICS ONLY, MODIFICATION (INCLUDING FITTING) OF OFF-THE-SHELF
FOR DIABETICS ONLY, MODIFICATION (INCLUDING FITTING) OF OFF-THE-SHELF
FOR DIABETICS ONLY, MODIFICATION (INCLUDING FITTING) OF OFF-THE-SHELF
FOR DIABETICS ONLY, MODIFICATION (INCLUDING FITTING) OF OFF-THE-SHELF
FOR DIABETICS ONLY, NOT OTHERWISE SPECIFIED MODIFICATION (INCLUDING FITTING) OF
FOR DIABETICS ONLY, DELUXE FEATURE OF OFF-THE-SHELF DEPTH-INLAY SHOE OR
FOR DIABETICS ONLY, DIRECT FORMED, COMPRESSION MOLDED TO PATIENT'S FOOT WITHOUT
FOR DIABETICS ONLY, MULTIPLE DENSITY INSERT, DIRECT FORMED, MOLDED TO FOOT AFTER
FOR DIABETICS ONLY, MULTIPLE DENSITY INSERT, CUSTOM MOLDED FROM MODEL OF PATIENT
COLLAGEN BASED WOUND FILLER, DRY FORM, STERILE, PER GRAM OF COLLAGEN
COLLAGEN BASED WOUND FILLER, GEL/PASTE, PER GRAM OF COLLAGEN
COLLAGEN DRESSING, STERILE, PAD SIZE 16 SQ. IN. OR LESS, EACH
COLLAGEN DRESSING, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL
COLLAGEN DRESSING, STERILE, PAD SIZE MORE THAN 48 SQ. IN., EACH
COLLAGEN DRESSING WOUND FILLER, STERILE, PER 6 INCHES
GEL SHEET FOR DERMAL OR EPIDERMAL APPLICATION, (E.G., SILICONE, HYDROGEL,
WOUND POUCH, EACH
ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ.
ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, STERILE, PAD SIZE MORE TH
ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, STERILE, PAD SIZE MORE TH
ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND FILLER, STERILE, PER 6 INCHES
COMPOSITE DRESSING, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE ADHESIVE
COMPOSITE DRESSING, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUA
COMPOSITE DRESSING, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITH ANY SIZE ADHESI
CONTACT LAYER, STERILE, 16 SQ. IN. OR LESS, EACH DRESSING
CONTACT LAYER, STERILE, MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN
CONTACT LAYER, STERILE, MORE THAN 48 SQ. IN., EACH DRESSING
FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESI
FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN
FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHE
FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE
FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN
FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITH ANY SIZ
FOAM DRESSING, WOUND FILLER, STERILE, PER GRAM
GAUZE, NON-IMPREGNATED, NON-STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT
GAUZE, NON-IMPREGNATED, NON-STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS
GAUZE, NON-IMPREGNATED, NON-STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT
GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE ADHE
GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR
GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITH ANY SIZE AD
GAUZE, IMPREGNATED WITH OTHER THAN WATER, NORMAL SALINE, OR HYDROGEL, STERILE, P
GAUZE, IMPREGNATED WITH OTHER THAN WATER, NORMAL SALINE, OR HYDROGEL, STERILE, P
GAUZE, IMPREGNATED WITH OTHER THAN WATER, NORMAL SALINE, OR HYDROGEL, STERILE, P
GAUZE, IMPREGNATED, WATER OR NORMAL SALINE, STERILE, PAD SIZE 16 SQ. IN. OR LESS
GAUZE, IMPREGNATED, WATER OR NORMAL SALINE, STERILE, PAD SIZE MORE THAN 16 SQ. I
GAUZE, IMPREGNATED, WATER OR NORMAL SALINE, STERILE, PAD SIZE MORE THAN 48 SQ. I
GAUZE, IMPREGNATED, HYDROGEL, FOR DIRECT WOUND CONTACT, STERILE, PAD SIZE 16 SQ.
GAUZE, IMPREGNATED, HYDROGEL, FOR DIRECT WOUND CONTACT, STERILE, PAD SIZE GREATE
GAUZE, IMPREGNATED, HYDROGEL, FOR DIRECT WOUND CONTACT, STERILE, PAD SIZE MORE T
HYDROCOLLOID DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOU
HYDROCOLLOID DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT L
HYDROCOLLOID DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITH
HYDROCOLLOID DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITH A
HYDROCOLLOID DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT L
HYDROCOLLOID DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITH
HYDROCOLLOID DRESSING, WOUND FILLER, PASTE, STERILE, PER OUNCE
HYDROCOLLOID DRESSING, WOUND FILLER, DRY FORM, STERILE, PER GRAM
HYDROGEL DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT AD
HYDROGEL DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS
HYDROGEL DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT
HYDROGEL DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY S
HYDROGEL DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS
HYDROGEL DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITH ANY
HYDROGEL DRESSING, WOUND FILLER, GEL, PER FLUID OUNCE
SKIN SEALANTS, PROTECTANTS, MOISTURIZERS, OINTMENTS, ANY TYPE, ANY SIZE
SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS
SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. I
SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. I
SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS
SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. I
SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. I
TRANSPARENT FILM, STERILE, 16 SQ. IN. OR LESS, EACH DRESSING
TRANSPARENT FILM, STERILE, MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ.
TRANSPARENT FILM, STERILE, MORE THAN 48 SQ. IN., EACH DRESSING
WOUND CLEANSERS, ANY TYPE, ANY SIZE
WOUND FILLER, GEL/PASTE, PER FLUID OUNCE, NOT OTHERWISE SPECIFIED
WOUND FILLER, DRY FORM, PER GRAM, NOT OTHERWISE SPECIFIED
GAUZE, IMPREGNATED, OTHER THAN WATER, NORMAL SALINE, OR ZINC PASTE, STERILE, ANY
GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE
GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE MORE THAN 16 SQ. IN. LESS THAN OR
GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT
PACKING STRIPS, NON-IMPREGNATED, STERILE, UP TO 2 INCHES IN WIDTH, PER LINEAR YA
EYE PAD, STERILE, EACH
EYE PAD, NON-STERILE, EACH
EYE PATCH, OCCLUSIVE, EACH
ADHESIVE BANDAGE, FIRST-AID TYPE, ANY SIZE, EACH
PADDING BANDAGE, NON-ELASTIC, NON-WOVEN/NON-KNITTED, WIDTH GREATER THAN OR
CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, NON-STERILE, WIDTH LESS THAN
CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, NON-STERILE, WIDTH GREATER THAN
CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, NON-STERILE, WIDTH GREATER THAN
CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, STERILE, WIDTH LESS THAN THREE
CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, STERILE, WIDTH GREATER THAN OR
CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, STERILE, WIDTH GREATER THAN OR
LIGHT COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, WIDTH LESS THAN THREE
LIGHT COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, WIDTH GREATER THAN OR EQUAL
LIGHT COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, WIDTH GREATER THAN OR EQUAL
MODERATE COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, LOAD RESISTANCE OF 1.25
HIGH COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, LOAD RESISTANCE GREATER THAN
SELF-ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NON-WOVEN, WIDTH LESS THAN THREE
SELF-ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NON-WOVEN, WIDTH GREATER THAN OR
SELF-ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NON-WOVEN, WIDTH GREATER THAN OR
ZINC PASTE IMPREGNATED BANDAGE, NON-ELASTIC, KNITTED/WOVEN, WIDTH GREATER THAN
TUBULAR DRESSING WITH OR WITHOUT ELASTIC, ANY WIDTH, PER LINEAR YARD
COMPRESSION BURN GARMENT, BODYSUIT (HEAD TO FOOT), CUSTOM FABRICATED
COMPRESSION BURN GARMENT, CHIN STRAP, CUSTOM FABRICATED
COMPRESSION BURN GARMENT, FACIAL HOOD, CUSTOM FABRICATED
COMPRESSION BURN GARMENT, GLOVE TO WRIST, CUSTOM FABRICATED
COMPRESSION BURN GARMENT, GLOVE TO ELBOW, CUSTOM FABRICATED
COMPRESSION BURN GARMENT, GLOVE TO AXILLA, CUSTOM FABRICATED
COMPRESSION BURN GARMENT, FOOT TO KNEE LENGTH, CUSTOM FABRICATED
COMPRESSION BURN GARMENT, FOOT TO THIGH LENGTH, CUSTOM FABRICATED
COMPRESSION BURN GARMENT, UPPER TRUNK TO WAIST INCLUDING ARM OPENINGS (VEST),
COMPRESSION BURN GARMENT, TRUNK, INCLUDING ARMS DOWN TO LEG OPENINGS (LEOTARD),
COMPRESSION BURN GARMENT, LOWER TRUNK INCLUDING LEG OPENINGS (PANTY), CUSTOM
COMPRESSION BURN GARMENT, NOT OTHERWISE CLASSIFIED
COMPRESSION BURN MASK, FACE AND/OR NECK, PLASTIC OR EQUAL, CUSTOM FABRICATED
GRADIENT COMPRESSION STOCKING, BELOW KNEE, 18-30 MMHG, EACH
GRADIENT COMPRESSION STOCKING, BELOW KNEE, 30-40 MMHG, EACH
GRADIENT COMPRESSION STOCKING, BELOW KNEE, 40-50 MMHG, EACH
GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 18-30 MMHG, EACH
GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 30-40 MMHG, EACH
GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 40-50 MMHG, EACH
GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 18-30 MMHG, EACH
GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 30-40 MMHG, EACH
GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 40-50 MMHG, EACH
GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 18-30 MMHG, EACH
GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 30-40 MMHG, EACH
GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 40-50 MMHG, EACH
GRADIENT COMPRESSION STOCKING, GARTER BELT
GRADIENT COMPRESSION WRAP, NON-ELASTIC, BELOW KNEE, 30-50 MM HG, EACH
GRADIENT COMPRESSION STOCKING/SLEEVE, NOT OTHERWISE SPECIFIED
WOUND CARE SET, FOR NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, INCLUDES AL
CANISTER, DISPOSABLE, USED WITH SUCTION PUMP, EACH
CANISTER, NON-DISPOSABLE, USED WITH SUCTION PUMP, EACH
TUBING, USED WITH SUCTION PUMP, EACH
ADMINISTRATION SET, WITH SMALL VOLUME NONFILTERED PNEUMATIC NEBULIZER,
SMALL VOLUME NONFILTERED PNEUMATIC NEBULIZER, DISPOSABLE
ADMINISTRATION SET, WITH SMALL VOLUME NONFILTERED PNEUMATIC NEBULIZER,
ADMINISTRATION SET, WITH SMALL VOLUME FILTERED PNEUMATIC NEBULIZER
LARGE VOLUME NEBULIZER, DISPOSABLE, UNFILLED, USED WITH AEROSOL COMPRESSOR
LARGE VOLUME NEBULIZER, DISPOSABLE, PREFILLED, USED WITH AEROSOL COMPRESSOR
RESERVOIR BOTTLE, NON-DISPOSABLE, USED WITH LARGE VOLUME ULTRASONIC NEBULIZER
CORRUGATED TUBING, DISPOSABLE, USED WITH LARGE VOLUME NEBULIZER, 100 FEET
CORRUGATED TUBING, NON-DISPOSABLE, USED WITH LARGE VOLUME NEBULIZER, 10 FEET
WATER COLLECTION DEVICE, USED WITH LARGE VOLUME NEBULIZER
FILTER, DISPOSABLE, USED WITH AEROSOL COMPRESSOR OR ULTRASONIC GENERATOR
FILTER, NONDISPOSABLE, USED WITH AEROSOL COMPRESSOR OR ULTRASONIC GENERATOR
AEROSOL MASK, USED WITH DME NEBULIZER
DOME AND MOUTHPIECE, USED WITH SMALL VOLUME ULTRASONIC NEBULIZER
NEBULIZER, DURABLE, GLASS OR AUTOCLAVABLE PLASTIC, BOTTLE TYPE, NOT USED WITH
WATER, DISTILLED, USED WITH LARGE VOLUME NEBULIZER, 1000 ML
INTERFACE FOR COUGH STIMULATING DEVICE, INCLUDES ALL COMPONENTS, REPLACEMENT ONL
HIGH FREQUENCY CHEST WALL OSCILLATION SYSTEM VEST, REPLACEMENT FOR USE WITH
HIGH FREQUENCY CHEST WALL OSCILLATION SYSTEM HOSE, REPLACEMENT FOR USE WITH
COMBINATION ORAL/NASAL MASK, USED WITH CONTINUOUS POSITIVE AIRWAY PRESSURE DEVIC
ORAL CUSHION FOR COMBINATION ORAL/NASAL MASK, REPLACEMENT ONLY, EACH
NASAL PILLOWS FOR COMBINATION ORAL/NASAL MASK, REPLACEMENT ONLY, PAIR
FULL FACE MASK USED WITH POSITIVE AIRWAY PRESSURE DEVICE, EACH
FACE MASK INTERFACE, REPLACEMENT FOR FULL FACE MASK, EACH
CUSHION FOR USE ON NASAL MASK INTERFACE, REPLACEMENT ONLY, EACH
PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE, REPLACEMENT ONLY, PAIR
NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH POSITIVE AIRWAY PRESSURE
HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE DEVICE
CHINSTRAP USED WITH POSITIVE AIRWAY PRESSURE DEVICE
TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE
FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE
FILTER, NON DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE
ONE WAY CHEST DRAIN VALVE
WATER SEAL DRAINAGE CONTAINER AND TUBING FOR USE WITH IMPLANTED CHEST TUBE
VACUUM DRAINAGE BOTTLE AND TUBING FOR USE WITH IMPLANTED CATHETER
ORAL INTERFACE USED WITH POSITIVE AIRWAY PRESSURE DEVICE, EACH
EXHALATION PORT WITH OR WITHOUT SWIVEL USED WITH ACCESSORIES FOR POSITIVE
WATER CHAMBER FOR HUMIDIFIER, USED WITH POSITIVE AIRWAY PRESSURE DEVICE,
TRACHEOSTOMA VALVE, INCLUDING DIAPHRAGM, EACH
REPLACEMENT DIAPHRAGM/FACEPLATE FOR TRACHEOSTOMA VALVE, EACH
FILTER HOLDER OR FILTER CAP, REUSABLE, FOR USE IN A TRACHEOSTOMA HEAT AND
FILTER FOR USE IN A TRACHEOSTOMA HEAT AND MOISTURE EXCHANGE SYSTEM, EACH
HOUSING, REUSABLE WITHOUT ADHESIVE, FOR USE IN A HEAT AND MOISTURE EXCHANGE
ADHESIVE DISC FOR USE IN A HEAT AND MOISTURE EXCHANGE SYSTEM AND/OR WITH
FILTER HOLDER AND INTEGRATED FILTER WITHOUT ADHESIVE, FOR USE IN A TRACHEOSTOMA
HOUSING AND INTEGRATED ADHESIVE, FOR USE IN A TRACHEOSTOMA HEAT AND MOISTURE
FILTER HOLDER AND INTEGRATED FILTER HOUSING, AND ADHESIVE, FOR USE AS A
TRACHEOSTOMY/LARYNGECTOMY TUBE, NON-CUFFED, POLYVINYLCHLORIDE (PVC), SILICONE
TRACHEOSTOMY/LARYNGECTOMY TUBE, CUFFED, POLYVINYLCHLORIDE (PVC), SILICONE OR
TRACHEOSTOMY/LARYNGECTOMY TUBE, STAINLESS STEEL OR EQUAL (STERILIZABLE AND
TRACHEOSTOMY SHOWER PROTECTOR, EACH
TRACHEOSTOMA STENT/STUD/BUTTON, EACH
TRACHEOSTOMY MASK, EACH
TRACHEOSTOMY TUBE COLLAR/HOLDER, EACH
TRACHEOSTOMY/LARYNGECTOMY TUBE PLUG/STOP, EACH
HELMET, PROTECTIVE, SOFT, PREFABRICATED, INCLUDES ALL COMPONENTS AND ACCESSORIES
HELMET, PROTECTIVE, HARD, PREFABRICATED, INCLUDES ALL COMPONENTS AND ACCESSORIES
HELMET, PROTECTIVE, SOFT, CUSTOM FABRICATED, INCLUDES ALL COMPONENTS AND ACCESSO
HELMET, PROTECTIVE, HARD, CUSTOM FABRICATED, INCLUDES ALL COMPONENTS AND ACCESSO
SOFT INTERFACE FOR HELMET, REPLACEMENT ONLY
ARTIFICIAL SALIVA, 30 ML
MECHANICAL WOUND SUCTION, DISPOSABLE, INCLUDES DRESSING, ALL ACCESSORIES AND COM
REACHING/GRABBING DEVICE, ANY TYPE, ANY LENGTH, EACH
FOOT PRESSURE OFF LOADING/SUPPORTIVE DEVICE, ANY TYPE, EACH
EXERCISE EQUIPMENT
IODINE I-131 SODIUM IODIDE CAPSULE(S), THERAPEUTIC, PER MILLICURIE
IODINE I-125, SODIUM IODIDE SOLUTION, THERAPEUTIC, PER MILLICURIE
IODINE I-131 SODIUM IODIDE SOLUTION, THERAPEUTIC, PER MILLICURIE
YTTRIUM Y-90 IBRITUMOMAB TIUXETAN, THERAPEUTIC, PER TREATMENT DOSE, UP TO 40 MIL
IODINE I-131 TOSITUMOMAB, THERAPEUTIC, PER TREATMENT DOSE
SODIUM PHOSPHATE P-32, THERAPEUTIC, PER MILLICURIE
CHROMIC PHOSPHATE P-32 SUSPENSION, THERAPEUTIC, PER MILLICURIE
IODINE I-123 IOBENGUANE, DIAGNOSTIC, PER STUDY DOSE, UP TO 15 MILLICURIES
INJECTION, GADOFOSVESET TRISODIUM, 1 ML
IODINE 1-123 IOFLUPANE, DIAGNOSTIC, PER STUDY DOSE, UP TO 5 MILLICURIES
STRONTIUM SR-89 CHLORIDE, THERAPEUTIC, PER MILLICURIE
SAMARIUM SM-153 LEXIDRONAM, THERAPEUTIC, PER TREATMENT DOSE, UP TO 150
SUPPLY OF INJECTABLE CONTRAST MATERIAL FOR USE IN ECHOCARDIOGRAPHY, PER STUDY
MISCELLANEOUS DME SUPPLY, ACCESSORY, AND/OR SERVICE COMPONENT OF ANOTHER HCPCS C
DME DELIVERY, SET UP, AND/OR DISPENSING SERVICE COMPONENT OF ANOTHER HCPCS CODE
MISCELLANEOUS DME SUPPLY OR ACCESSORY, NOT OTHERWISE SPECIFIED
ENTERAL FEEDING SUPPLY KIT; SYRINGE FED, PER DAY, INCLUDES BUT NOT LIMITED TO FE
ENTERAL FEEDING SUPPLY KIT; PUMP FED, PER DAY, INCLUDES BUT NOT LIMITED TO FEED
ENTERAL FEEDING SUPPLY KIT; GRAVITY FED, PER DAY, INCLUDES BUT NOT LIMITED TO FE
NASOGASTRIC TUBING WITH STYLET
NASOGASTRIC TUBING WITHOUT STYLET
STOMACH TUBE - LEVINE TYPE
GASTROSTOMY/JEJUNOSTOMY TUBE, STANDARD, ANY MATERIAL, ANY TYPE, EACH
GASTROSTOMY/JEJUNOSTOMY TUBE, LOW-PROFILE, ANY MATERIAL, ANY TYPE, EACH
FOOD THICKENER, ADMINISTERED ORALLY, PER OUNCE
ENTERAL FORMULA, FOR ADULTS, USED TO REPLACE FLUIDS AND ELECTROLYTES (E.G.
ENTERAL FORMULA, FOR PEDIATRICS, USED TO REPLACE FLUIDS AND ELECTROLYTES (E.G.
ADDITIVE FOR ENTERAL FORMULA (E.G. FIBER)
ENTERAL FORMULA, MANUFACTURED BLENDERIZED NATURAL FOODS WITH INTACT NUTRIENTS, I
ENTERAL FORMULA, NUTRITIONALLY COMPLETE WITH INTACT NUTRIENTS, INCLUDES
ENTERAL FORMULA, NUTRITIONALLY COMPLETE, CALORICALLY DENSE (EQUAL TO OR GREATER
ENTERAL FORMULA, NUTRITIONALLY COMPLETE, HYDROLYZED PROTEINS (AMINO ACIDS AND
ENTERAL FORMULA, NUTRITIONALLY COMPLETE, FOR SPECIAL METABOLIC NEEDS, EXCLUDES
ENTERAL FORMULA, NUTRITIONALLY INCOMPLETE/MODULAR NUTRIENTS, INCLUDES SPECIFIC
ENTERAL FORMULA, NUTRITIONALLY COMPLETE, FOR SPECIAL METABOLIC NEEDS FOR
ENTERAL FORMULA, FOR PEDIATRICS, NUTRITIONALLY COMPLETE WITH INTACT NUTRIENTS,
ENTERAL FORMULA, FOR PEDIATRICS, NUTRITIONALLY COMPLETE SOY BASED WITH INTACT
ENTERAL FORMULA, FOR PEDIATRICS, NUTRITIONALLY COMPLETE CALORICALLY DENSE
ENTERAL FORMULA, FOR PEDIATRICS, HYDROLYZED/AMINO ACIDS AND PEPTIDE CHAIN
ENTERAL FORMULA, FOR PEDIATRICS, SPECIAL METABOLIC NEEDS FOR INHERITED DISEASE
PARENTERAL NUTRITION SOLUTION: CARBOHYDRATES (DEXTROSE), 50% OR LESS (500 ML =
PARENTERAL NUTRITION SOLUTION; AMINO ACID, 3.5%, (500 ML = 1 UNIT) - HOMEMIX
PARENTERAL NUTRITION SOLUTION; AMINO ACID, 5.5% THROUGH 7%, (500 ML = 1 UNIT) -
PARENTERAL NUTRITION SOLUTION; AMINO ACID, 7% THROUGH 8.5%, (500 ML = 1 UNIT) -
PARENTERAL NUTRITION SOLUTION: AMINO ACID, GREATER THAN 8.5% (500 ML = 1 UNIT)
PARENTERAL NUTRITION SOLUTION; CARBOHYDRATES (DEXTROSE), GREATER THAN 50% (500
PARENTERAL NUTRITION SOLUTION, PER 10 GRAMS LIPIDS
PARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH
PARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH
PARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH
PARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH
PARENTERAL NUTRITION; ADDITIVES (VITAMINS, TRACE ELEMENTS, HEPARIN,
PARENTERAL NUTRITION SUPPLY KIT; PREMIX, PER DAY
PARENTERAL NUTRITION SUPPLY KIT; HOME MIX, PER DAY
PARENTERAL NUTRITION ADMINISTRATION KIT, PER DAY
PARENTERAL NUTRITION SOLUTION: COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH
PARENTERAL NUTRITION SOLUTION: COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH
PARENTERAL NUTRITION SOLUTION: COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH
ENTERAL NUTRTION INFUSION PUMP - WITHOUT ALARM
ENTERAL NUTRITION INFUSION PUMP - WITH ALARM
PARENTERAL NUTRITION INFUSION PUMP, PORTABLE
PARENTERAL NUTRITION INFUSION PUMP, STATIONARY
NOC FOR ENTERAL SUPPLIES
NOC FOR PARENTERAL SUPPLIES
CATHETER, IMAGING, SONICATH ULTRA MODEL 37-416 ULTRASOUND IMAGING CATHETER,
BRACHYTHERAPY SOURCE, NON-STRANDED, GOLD-198, PER SOURCE
BRACHYTHERAPY SOURCE, NON-STRANDED, HIGH DOSE RATE IRIDIUM-192, PER SOURCE
BRACHYTHERAPY SOURCE, NON-STRANDED, NON-HIGH DOSE RATE IRIDIUM-192, PER SOURCE
Endoscope, retrograde imaging/illumination colonoscope device (implantable)
BARD SPERMA TEX MESH, PER 13.44 SQUARE CENTIMETERS
CATHETER, EXTRAVASCULAR TISSUE ABLATION, ANY MODALITY (INSERTABLE)
BRACHYTHERAPY SOURCE, NON-STRANDED, YTTRIUM-90, PER SOURCE
BRACHYTHERAPY SOURCE, NON-STRANDED, HIGH ACTIVITY, IODINE-125, GREATER THAN 1.01
BRACHYTHERAPY SOURCE, NON-STRANDED, HIGH ACTIVITY, PALADIUM-103, GREATER THAN 2.
BRACHYTHERAPY LINEAR SOURCE, NON-STRANDED, PALADIUM-103, PER 1 MM
BRACHYTHERAPY SOURCE, NON-STRANDED, YTTERBIUM-169, PER SOURCE
BRACHYTHERAPY SOURCE, STRANDED, IODINE-125, PER SOURCE
BRACHYTHERAPY SOURCE, NON-STRANDED, IODINE-125, PER SOURCE
BRACHYTHERAPY SOURCE, STRANDED, PALLADIUM-103. PER SOURCE
BRACHYTHERAPY SOURCE, STRANDED, PALLADIUM-103 PER SOURCE
BRACHYTHERAPY SOURCE, STRANDED, CESIUM0131, PER SOURCE
BRACHYTHERAPY SOURCE, NON-STRANDED CESIUM-131, PER SOURCE
BRACHYTHERAPY SOURCE, STRANDED, NOT OTHERWISE SPECIFIED, PERSOURCE
BRACHYTHERAPY SOURCE, NON-STRANDED, NOT OTHERWISE SPECIFIED,PER SOURCE
MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST, ABDOMEN
MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST, ABDOMEN
MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,
MAGNETIC RESONANCE IMAGING WITH CONTRAST, BREAST; UNILATERAL
MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST, BREAST; UNILATERAL
MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, BREAST;
MAGNETIC RESONANCE IMAGING WITH CONTRAST, BREAST; BILATERAL
MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST, BREAST; BILATERAL
MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, BREAST;
MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST, CHEST (EXCLUDING MYOCARDIUM)
MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST, CHEST (EXCLUDING MYOCARDIUM)
MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,
MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST, LOWER EXTREMITY
MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST, LOWER EXTREMITY
MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,
MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST, PELVIS
MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST, PELVIS
MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,
Magnetic resonance angiography with contrast, spinal canal and contents
Magnetic resonance angiography without contrast, spinal canal and contents
Magnetic resonance angiography without contrast followed by with contrast, spina
Magnetic resonance angiography with contrast, upper extremity
Magnetic resonance angiography without contrast, upper extremity
Magnetic resonance angiography without contrast followed by with contrast, upper
INJECTION, ARGATROBAN, PER 5 MG
MYCOPHENOLIC ACID, ORAL
INJECTION, CLEVIDIPINE BUTYRATE, 1 MG
INJECTION, LACOSAMIDE, 1 MG
INJECTION, BEVACIZUMAB, 0.25 MG
INJECTION, HEXAMINOLEVULINATE HYDROCHLORIDE, 100 MG, PER STUDY DOSE
INJECTION, IBUPROFEN, 100 MG
LIDOCAINE 70 MG/TETRACAINE 70 MG, PER PATCH
INJECTION, BELATACEPT, 1 MG
INJECTION, BRENTUXIMAB VEDOTIN, 1 MG
INJECTION, CENTRUROIDES (SCORPION) IMMUNE F(AB)2 (EQUINE), 1VIAL
INJECTION, ASPARAGINASE ERWINIA CHRYSANTHEMI, 1,000 INTERNATIONAL UNITS (I.U.)
INJECTION, BUPIVACAINE LIPOSOME, 1 MG
UNCLASSIFIED DRUGS OR BIOLOGICALS
PLACEMENT OF INTERSTITIAL DEVICE(S) FOR RADIATION THERAPY/SURGERY GUIDANCE (EG,
NON-OPHTHALMIC FLUORESCENT VASCULAR ANGIOGRAPHY
IMPLANTED PROSTHETIC DEVICE, PAYABLE ONLY FOR INPATIENTS WHO DO NOT HAVE INPATIE
PERIODIC ORAL EVALUATION - ESTABLISHED PATIENT
LIMITED ORAL EVALUATION - PROBLEM FOCUSED
ORAL EVALUATION FOR A PATIENT UNDER THREE YEARS OF AGE AND COUNSELING WITH PRIMA
COMPREHENSIVE ORAL EVALUATION - NEW OR ESTABLISHED PATIENT
DETAILED AND EXTENSIVE ORAL EVALUATION - PROBLEM FOCUSED, BY REPORT
COMPREHENSIVE PERIODONTAL EVALUATION - NEW OR ESTABLISHED PATIENT
INTRAORAL-COMPLETE SERIES (INCLUDING BITEWINGS)
INTRAORAL-PERIAPICAL-FIRST FILM
INTRAORAL-PERIAPICAL-EACH ADDITIONAL FILM
INTRAORAL-0CCLUSAL FILM
EXTRAORAL-FIRST FILM
EXTRAORAL-EACH ADDITIONAL FILM
BITEWING-SINGLE FILM
BITEWINGS-TWO FILMS
BITEWINGS - THREE FILMS
BITEWINGS-FOUR FILMS
VERTICAL BITEWINGS - 7 TO 8 FILMS
POSTERIOR-ANTERIOR OR LATERAL SKULL AND FACIAL BONE SURVEY FILM
SIALOGRAPHY
TEMPOROMANDIBULAR JOINT ARTHROGRAM, INCLUDING INJECTION
OTHER TEMPOROMANDIBULAR JOINT FILMS, BY REPORT
PANORAMIC FILM
CEPHALOMETRIC FILM
ORAL/FACIAL PHOTOGRAPHIC IMAGES
DIAGNOSTIC CASTS
OTHER ORAL PATHOLOGY PROCEDURES, BY REPORT
UNSPECIFIED DIAGNOSTIC PROCEDURE, BY REPORT
PROPHYLAXIS-ADULT
PROPHYLAXIS-CHILD
TOPICAL APPLICATION OF FLUORIDE - CHILD
TOPICAL APPLICATION OF FLUORIDE - ADULT
TOPICAL FLUORIDE VARNISH; THERAPEUTIC APPLICATION FOR MODERATE TO HIGH CARIES RI
SEALANT-PER TOOTH
PREVENTIVE RESIN RESTORATION IN A MODERATE TO HIGH CARIES RISK PATIENT - PERMANE
SPACE MAINTAINER-FIXED UNILATERAL
SPACE MAINTAINER-FIXED BILATERAL
SPACE MAINTAINER-REMOVABLE UNILATERAL
SPACE MAINTAINER-REMOVABLE BILATERAL
RECEMENTATION OF SPACE MAINTAINER
REMOVAL OF FIXED SPACE MAINTAINER
AMALGAM-ONE SURFACE, PRIMARY OR PERMANENT
AMALGAM-TWO SURFACES, PRIMARY OR PERMANENT
AMALGAM-THREE SURFACES, PRIMARY OR PERMANENT
AMALGAM-FOUR OR MORE SURFACES, PRIMARY OR PERMANENT
RESIN-ONE SURFACE, ANTERIOR
RESIN-TWO SURFACES, ANTERIOR
RESIN-THREE SURFACES, ANTERIOR
RESIN-FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR)
RESIN-BASED COMPOSITE CROWN, ANTERIOR
RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR
RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR
RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR
RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR
CROWN-PORCELAIN/CERAMIC SUBSTRATE
CROWN-PORCELAIN FUSED TO HIGH NOBLE METAL
CROWN-PROCELAIN FUSED TO PREDOMINANTLY BASE METAL
CROWN-PORCELAIN FUSED TO NOBLE METAL
CROWN-FULL CAST HIGH NOBLE METAL
CROWN-FULL CAST PREDOMINANTLY BASE METAL
CROWN-FULL CAST NOBLE METAL
CROWN-TITANIUM
RECEMENT INLAY, ONLAY OR PARTIAL COVERAGE RESTORATION
RECEMENT CAST OR PREFABRICATED POST AND CORE
RECEMENT CROWN
PREFABRICATED STAINLESS STEEL CROWN-PRIMARY TOOTH
PREFABRICATED STAINLESS STEEL CROWN-PERMANENT TOOTH
PREFABRICATED RESIN CROWN
PREFABRICATED STAINLESS STEEL CROWN WITH RESIN WINDOW
PREFABRICATED ESTHETIC COATED STAINLESS STEEL CROWN - PRIMARY TOOTH
PROTECTIVE RESTORATION
CORE BUILD-UP, INCLUDING ANY PINS
PIN RETENTION-PER TOOTH, IN ADDITION TO RESTORATION
POST AND CORE IN ADDITION TO CROWN, INDIRECTLY FABRICATED
PREFABRICATED POST AND CORE IN ADDITION TO CROWN
TEMPORARY CROWN (FRACTURED TOOTH)
UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT
PULP CAP-DIRECT (EXCLUDING FINAL RESTORATION)
PULP CAP-INDIRECT (EXCLUDING FINAL RESTORATION)
THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) REMOVAL OF PULP CORONAL TO
PULPAL DEBRIDEMENT, PRIMARY AND PERMANENT TEETH
Partial pulpotomy for apexogenesis - permanent tooth with incomplete root develo
PULPAL THERAPY (RESORBABLE FILLING)-ANTERIOR, PRIMARY TOOTH (EXCLUDING FINAL RES
PULPAL THERAPY (RESORBABLE FILLING)-POSTERIOR, PRIMARY TOOTH (EXCLUDING FINAL
ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)
ENDODONTIC THERAPY, BICUSPID TOOTH (EXCLUDING FINAL RESTORATION)
ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION)
TREATMENT OF ROOT CANAL OBSTRUCTION; NON-SURGICAL ACCESS
INCOMPLETE ENDODONTIC THERAPY; INOPERABLE, UNRESTORABLE OR FRACTURED TOOTH
INTERNAL ROOT REPAIR OF PERFORATION DEFECTS
RETREATMENT OF PREVIOUS ROOT CANAL THERAPY-ANTERIOR
RETREATMENT OF PREVIOUS ROOT CANAL THERAPY-BICUSPID
RETREATMENT OF PREVIOUS ROOT CANAL THERAPY-MOLAR
APEXIFICATION/RECALCIFICATION/PULPAL REGENERATION-INITIAL VISIT (APICAL CLOSURE/
APEXIFICATION/RECALCIFICATION/PULPAL REGENERATION-INTERIM MEDICATION REPLACEMENT
APEXIFICATION/RECALCIFICATION-FINAL VISIT (INCLUDES COMPLETED ROOT CANAL
PULPAL REGENERATION (COMPLETION OF REGENERATIVE TREATMENT IN AN IMMATURE PERMANE
APICOECTOMY/PERIRADICULAR SURGERY-ANTERIOR
APICOECTOMY/PERIRADICULAR SURGERY-BICUSPID (FIRST ROOT)
APICOECTOMY/PERIRADICULAR SURGERY-MOLAR (FIRST ROOT).
APICOECTOMY/PERIRADICULAR SURGERY (EACH ADDITIONAL ROOT)
RETROGRADE FILLING-PER ROOT
ROOT AMPUTATION-PER ROOT
HEMISECTION (INCLUDING ANY ROOT REMOVAL), NOT INCLUDING ROOT CANAL THERAPY
UNSPECIFIED ENDODONTIC PROCEDURE, BY REPORT
GINGIVECTOMY OR GINGIVOPLASTY - FOUR OR MORE CONTIGUOUS TEETH OR TOOTH BOUNDED S
GINGIVECTOMY OR GINGIVOPLASTY - ONE TO THREE CONTIGUOUS TEETH OR TOOTH BOUNDED S
GINGIVAL FLAP PROCEDURE, INCLUDING ROOT PLANING - FOUR OR MORE CONTIGUOUS TEETH
GINGIVAL FLAP PROCEDURE, INCLUDING ROOT PLANING - ONE TO THREE CONTIGUOUS TEETH
CLINICAL CROWN LENGTHENING-HARD TISSUE
OSSEOUS SURGERY (INCLUDING FLAP ENTRY AND CLOSURE) - FOUR OR MORE CONTIGUOUS TEE
OSSEOUS SURGERY (INCLUDING FLAP ENTRY AND CLOSURE) - ONE TO THREE CONTIGUOUS TEE
BONE REPLACEMENT GRAFT - FIRST SITE IN QUADRANT
BONE REPLACEMENT GRAFT - EACH ADDITIONAL SITE IN QUADRANT
BIOLOGIC MATERIALS TO AID IN SOFT AND OSSEOUS TISSUE REGENERATION
GUIDED TISSUE REGENERATION - RESORBABLE BARRIER, PER SITE
GUIDED TISSUE REGENERATION - NONRESORBABLE BARRIER, PER SITE, (INCLUDES
PEDICLE SOFT TISSUE GRAFT PROCEDURE
FREE SOFT TISSUE GRAFT PROCEDURE (INCLUDING DONOR SITE SURGERY)
SUBEPITHELIAL CONNECTIVE TISSUE GRAFT PROCEDURES, PER TOOTH
DISTAL OR PROXIMAL WEDGE PROCEDURE (WHEN NOT PERFORMED IN CONJUCTION WITH
SOFT TISSUE ALLOGRAFT
COMBINED CONNECTIVE TISSUE AND DOUBLE PEDICLE GRAFT, PER TOOTH
PROVISIONAL SPLINTING-INTRACORONAL
PROVISIONAL SPLINTING-EXTRACORONAL
PERIODONTAL SCALING AND ROOT PLANING - FOUR OR MORE TEETH PER QUADRANT
PERIODONTAL SCALING AND ROOT PLANING - ONE TO THREE TEETH, PER QUADRANT
FULL MOUTH DEBRIDEMENT TO ENABLE COMPREHENSIVE EVALUATION AND DIAGNOSIS
PERIODONTAL MAINTENANCE
UNSCHEDULED DRESSING CHANGE (BY SOMEONE OTHER THAN TREATING DENTIST)
UNSPECIFIED PERIODONTAL PROCEDURE, BY REPORT
COMPLETE DENTURE - MAXILLARY
COMPLETE DENTURE - MANDIBULAR
IMMEDIATE DENTURE - MAXILLARY
IMMEDIATE DENTURE - MANDIBULAR
UPPER PARTIAL-RESIN BASE (INCLUDING ANY CONVENTIONAL CLASPS, RESTS AND TEETH)
LOWER PARTIAL-RESIN BASE (INCLUDING ANY CONVENTIONAL CLASPS, RESTS AND TEETH)
MAXILLARY PARTIAL DENTURE - CAST METAL FRAMEWORK WITH RESIN DENTURE BASES
MANDIBULAR PARTIAL DENTURE - CAST METAL FRAMEWORK WITH RESIN DENTURE BASES
REMOVABLE UNILATERAL PARTIAL DENTURE-ONE PIECE CAST METAL (INCLUDING CLASPS AND
ADJUST COMPLETE DENTURE - MAXILLARY
ADJUST COMPLETE DENTURE - MANDIBULAR
ADJUST PARTIAL DENTURE - MAXILLARY
ADJUST PARTIAL DENTURE - MANDIBULAR
REPAIR BROKEN COMPLETE DENTURE BASE
REPLACE MISSING OR BROKEN TEETH-COMPLETE DENTURE (EACH TOOTH)
REPAIR RESIN DENTURE BASE
REPAIR CAST FRAMEWORK
REPAIR OR REPLACE BROKEN CLASP
REPLACE BROKEN TEETH-PER TOOTH
ADD TOOTH TO EXISTING PARTIAL DENTURE
ADD CLASP TO EXISTING PARTIAL DENTURE
REBASE COMPLETE MAXILLARY DENTURE
REBASE COMPLETE MANDIBULAR DENTURE
REBASE MAXILLARY PARTIAL DENTURE
REBASE MANDIBULAR PARTIAL DENTURE
RELINE COMPLETE MAXILLARY DENTURE (CHAIRSIDE)
RELINE LOWER COMPLETE MANDIBULAR DENTURE (CHAIRSIDE)
RELINE MAXILLARY PARTIAL DENTURE (CHAIRSIDE)
RELINE MANDIBULAR PARTIAL DENTURE (CHAIRSIDE)
RELINE COMPLETE MAXILLARY DENTURE (LABORATORY)
RELINE COMPLETE MANDIBULAR DENTURE (LABORATORY)
RELINE MAXILLARY PARTIAL DENTURE (LABORATORY)
RELINE MANDIBULAR PARTIAL DENTURE (LABORATORY)
INTERIM PARTIAL DENTURE (MAXILLARY)
INTERIM PARTIAL DENTURE (MANDIBULAR)
TISSUE CONDITIONING, MAXILLARY
TISSUE CONDITIONING, MANDIBULAR
UNSPECIFIED REMOVABLE PROSTHODONTIC PROCEDURE, BY REPORT
FACIAL MOULAGE (SECTIONAL)
FACIAL MOULAGE (COMPLETE)
NASAL PROSTHESIS
AURICULAR PROSTHESIS
ORBITAL PROSTHESIS
OCULAR PROSTHESIS
FACIAL PROSTHESIS
NASAL SEPTAL PROSTHESIS
OCULAR PROSTHESIS, INTERIM
CRANIAL PROSTHESIS
FACIAL AUGMENTATION IMPLANT PROSTHESIS
NASAL PROSTHESIS, REPLACEMENT
AURICULAR PROSTHESIS, REPLACEMENT
ORBITAL PROSTHESIS, REPLACEMENT
FACIAL PROSTHESIS, REPLACEMENT
OBTURATOR PROSTHESIS, SURGICAL
OBTURATOR PROSTHESIS, DEFINITIVE
OBTURATOR PROSTHESIS, MODIFICATION
MANDIBULAR RESECTION PROSTHESIS WITH GUIDE FLANGE
MANDIBULAR RESECTION PROSTHESIS WITHOUT GUIDE FLANGE
OBTURATOR/PROSTHESIS, INTERIM
TRISMUS APPLIANCE (NOT FOR TM TREATMENT)
FEEDING AID
SPEECH AID PROSTHESIS, PEDIATRIC
SPEECH AID PROSTHESIS, ADULT
PALATAL AUGMENTATION PROSTHESIS
PALATAL LIFT PROSTHESIS, DEFINITIVE
PALATAL LIFT PROSTHESIS, INTERIM
PALATAL LIFT PROSTHESIS, MODIFICATION
SPEECH AID PROSTHESIS, MODIFICATION
SURGICAL STENT
RADIATION CARRIER
RADIATION SHIELD
RADIATION CONE LOCATOR
FLUORIDE GEL CARRIER
COMMISSURE SPLINT
SURGICAL SPLINT
Topical medicament carrier
ADJUST MAXILLOFACIAL PROSTHETIC APPLIANCE
UNSPECIFIED MAXILLOFACIAL PROSTHESIS, BY REPORT
UNSPECIFIED FIXED PROSTHODONTIC PROCEDURE, BY REPORT
EXTRACTION, CORONAL REMNANTS - DECIDUOUS TOOTH
EXTRACTION, ERUPTED TOOTH OR EXPOSED ROOT (ELEVATION AND/OR FORCEPS REMOVAL)
SURGICAL REMOVAL OF ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF
REMOVAL OF IMPACTED TOOTH-SOFT TISSUE
REMOVAL OF IMPACTED TOOTH-PARTIALLY BONY
REMOVAL OF IMPACTED TOOTH-COMPLETELY BONY
REMOVAL OF IMPACTED TOOTH-COMPLETELY BONY, WITH UNUSUAL SURGICAL COMPLICATIONS
SURGICAL REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)
CORONECTOMY - INTENTIONAL PARTIAL TOOTH REMOVAL
ORAL ANTRAL FISTULA CLOSURE
PRIMARY CLOSURE OF A SINUS PERFORATION
TOOTH REIMPLANTATION AND/OR STABILIZATION OF ACCIDENTALLY EVULSED OR DISPLACED
SURGICAL ACCESS OF AN UNERUPTED TOOTH
MOBILIZATION OF ERUPTED OR MALPOSITIONED TOOTH TO AID ERUPTION
PLACEMENT OF DEVICE TO FACILITATE ERUPTION OF IMPACTED TOOTH
BIOPSY OF ORAL TISSUE - HARD (BONE, TOOTH)
BIOPSY OF ORAL TISSUE - SOFT
SURGICAL PLACEMENT: TEMPORARY ANCHORAGE DEVICE ¿SCREW RETAINED PLATE¿ REQUIRIN
SURGICAL PLACEMENT: TEMPORARY ANCHORAGE DEVICE REQUIRING SURGICAL FLAP
SURGICAL PLACEMENT: TEMPORARY ANCHORAGE DEVICE WITHOUT SURGICAL FLAP
ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPAC
ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - ONE TO THREE TEETH OR TOOTH
ALVEOLOPLASTY NOT IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH
ALVEOLOPLASTY NOT IN CONJUNCTION WITH EXTRACTIONS - ONE TO THREE TEETH OR TOOTH
EXCISION OF BENIGN LESION UP TO 1.25 CM
EXCISION OF BENIGN LESION GREATER THAN 1.25 CM
EXCISION OF BENIGN LESION, COMPLICATED
EXCISION OF MALIGNANT LESION UP TO 1.25 CM
EXCISION OF MALIGNANT LESION GREATER THAN 1.25 CM
EXCISION OF MALIGNANT LESION, COMPLICATED
EXCISION OF MALIGNANT TUMOR-LESION DIAMETER UP TO 1.25 CM
EXCISION OF MALIGNANT TUMOR-LESION DIAMETER GREATER THAN 1.25 CM
REMOVAL OF BENIGN ODONTOGENIC CYST OR TUMOR-LESION DIAMETER UP T0 1.25 CM
REMOVAL OF BENIGN ODONTOGENIC CYST OR TUMOR-LESION DIAMETER GREATER THAN 1.25 CM
REMOVAL OF BENIGN NONODONTOGENIC CYST OR TUMOR-LESION DIAMETER UP TO 1.25 CM
REMOVAL OF BENIGN NONODONTOGENIC CYST OR TUMOR-LESION DIAMETER GREATER THAN
DESTRUCTION OF LESION(S) BY PHYSICAL OR CHEMICAL METHODS, BY REPORT
REMOVAL OF LATERAL EXOSTOSIS (MAXILLA OR MANDIBLE)
REMOVAL OF TORUS PALATINUS
REMOVAL OF TORUS MANDIBULARIS
SURGICAL REDUCTION OF OSSEOUS TUBEROSITY
RADICAL RESECTION OF MAXILLA OR MANDIBLE
INCISION AND DRAINAGE OF ABSCESS-INTRAORAL SOFT TISSUE
INCISION AND DRAINAGE OF ABSCESS - INTRAORAL SOFT TISSUE - COMPLICATED
INCISION AND DRAINAGE OF ABSCESS-EXTRAORAL SOFT TISSUE
INCISION AND DRAINAGE OF ABSCESS - EXTRAORAL SOFT TISSUE - COMPLICATED
REMOVAL OF FOREIGN BODY FROM MUCOSA, SKIN, OR SUBCUTANEOUS ALVEOLAR TISSUE
REMOVAL OF REACTION-PRODUCING FOREIGN BODIES-MUSCULOSKELETAL SYSTEM
PARTIAL OSTECTOMY/SEQUESTRECTOMY FOR REMOVAL OF NON-VITAL BONE
MAXILLARY SINUSOTOMY FOR REMOVAL OF TOOTH FRAGMENT OR FOREIGN BODY
MAXILLA-OPEN REDUCTION (TEETH IMMOBILIZED IF PRESENT)
MAXILLA-CLOSED REDUCTION (TEETH IMMOBILIZED IF PRESENT)
MANDIBLE-OPEN REDUCTION (TEETH IMMOBILIZED IF PRESENT)
MANDIBLE-CLOSED REDUCTION (TEETH IMMOBILIZED IF PRESENT)
MALAR AND/OR ZYGOMATIC ARCH-OPEN REDUCTION
MALAR AND/OR ZYGOMATIC ARCH-CLOSED REDUCTION
ALVEOLUS - CLOSED REDUCTION, MAY INCLUDE STABILIZATION OF TEETH
ALVEOLUS - OPEN REDUCTION, MAY INCLUDE STABILIZATION OF TEETH
FACIAL BONES-COMPLICATED REDUCTION WITH FIXATION AND MULTIPLE SURGICAL
MAXILLA-OPEN REDUCTION
MAXILLA-CLOSED REDUCTION
MANDIBLE-OPEN REDUCTION
MANDIBLE-CLOSED REDUCTION
MALAR AND/OR ZYGOMATIC ARCH-OPEN REDUCTION
MALAR AND/OR ZYGOMATIC ARCH-CLOSED REDUCTION
ALVEOLUS - OPEN REDUCTION STABILIZATION OF TEETH
ALVEOLUS, CLOSED REDUCTION STABILIZATION OF TEETH
FACIAL BONES-COMPLICATED REDUCTION WITH FIXATION AND MULTIPLE SURGICAL
OPEN REDUCTION OF DISLOCATION
CLOSED REDUCTION OF DISLOCATION
MANIPULATION UNDER ANESTHESIA
CONDYLECTOMY
SURGICAL DISCECTOMY; WITH/WITHOUT IMPLANT
DISC REPAIR
SYNOVECTOMY
MYOTOMY
JOINT RECONSTRUCTION
ARTHROTOMY
ARTHROPLASTY
ARTHROCENTESIS
NON-ARTHROSCOPIC LYSIS AND LAVAGE
ARTHROSCOPY-DIAGNOSIS, WITH OR WITHOUT BIOPSY
ARTHROSCOPY-SURGICAL: LAVAGE AND LYSIS OF ADHESIONS
ARTHROSCOPY-SURGICAL: DISC REPOSITIONING AND STABILIZATION
ARTHROSCOPY-SURGICAL: SYNOVECTOMY
ARTHROSCOPY-SURGICAL: DISCECTOMY
ARTHROSCOPY-SURGICAL: DEBRIDEMENT
OCCLUSAL ORTHOTIC APPLIANCE
UNSPECIFIED TMD THERAPY, BY REPORT
SUTURE OF RECENT SMALL WOUNDS UP TO 5 CM
COMPLICATED SUTURE-UP TO 5 CM
COMPLICATED SUTURE-GREATER THAN 5 CM
SKIN GRAFT (IDENTIFY DEFECT COVERED, LOCATION, AND TYPE OF GRAFT)
OSTEOPLASTY-FOR ORTHOGNATHIC DEFORMITIES
OSTEOTOMY - MANDIBULAR RAMI
OSTEOTOMY - MANDIBULAR RAMI WITH BONE GRAFT; INCLUDES OBTAINING THE GRAFT
OSTEOTOMY-SEGMENTED OR SUBAPICAL
OSTEOTOMY-BODY OF MANDIBLE
LEFORT I (MAXILLA-TOTAL)
LEFORT I (MAXILLA-SEGMENTED)
LEFORT II OR LEFORT III (OSTEOPLASTY OF FACIAL BONES FOR MIDFACE HYPOPLASIA OR
LEFORT II OR LEFORT III-WITH BONE GRAFT
OSSEOUS, OSTEOPERIOSTEAL, OR CARTILAGE GRAFT OF THE MANDIBLE OR MAXILLA - AUTOGE
SINUS AUGMENTATION WITH BONE OR BONE SUBSTITUTES
BONE REPLACEMENT GRAFT FOR RIDGE PRESERVATION - PER SITE
REPAIR OF MAXILLOFACIAL SOFT AND/OR HARD TISSUE DEFECT
FRENULECTOMY - ALSO KNOWN AS FRENECTOMY OR FRENOTOMY - SEPARATE PROCEDURE NOT IN
FRENULOPLASTY
EXCISION OF HYPERPLASTIC TISSUE-PER ARCH
EXCISION OF PERICORONAL GINGIVA
SURGICAL REDUCTION OF FIBROUS TUBEROSITY
SIALOLITHOTOMY
EXCISION OF SALIVARY GLAND, BY REPORT
SIALODOCHOPLASTY
CLOSURE OF SALIVARY FISTULA
EMERGENCY TRACHEOTOMY
CORONOIDECTOMY
SYNTHETIC GRAFT-MANDIBLE OR FACIAL BONES, BY REPORT
IMPLANT-MANDIBLE FOR AUGMENTATION PURPOSES (EXCLUDING ALVEOLAR RIDGE), BY REPORT
APPLIANCE REMOVAL (NOT BY DENTIST WHO PLACED APPLIANCE), INCLUDES REMOVAL OF
INTRAORAL PLACEMENT OF A FIXATION DEVICE NOT IN CONJUNCTION WITH A FRACTURE
UNSPECIFIED ORAL SURGERY PROCEDURE, BY REPORT
LIMITED ORTHODONTIC TREATMENT OF THE PRIMARY DENTITION
LIMITED ORTHODONTIC TREATMENT OF THE TRANSITIONAL DENTITION
LIMITED ORTHODONTIC TREATMENT OF THE ADOLESCENT DENTITION
LIMITED ORTHODONTIC TREATMENT OF THE ADULT DENTITION
INTERCEPTIVE ORTHODONTIC TREATMENT OF THE PRIMARY DENTITION
INTERCEPTIVE ORTHODONTIC TREATMENT OF THE TRANSITIONAL DENTITION
COMPREHENSIVE ORTHODONTIC TREATMENT OF THE TRANSITIONAL DENTITION
COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADOLESCENT DENTITION
COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADULT DENTITION
REMOVABLE APPLIANCE THERAPY
FIXED APPLIANCE THERAPY
PRE-ORTHODONTIC VISIT
PERIODIC ORTHODONTIC TREATMENT VISIT (AS PART OF CONTRACT)
ORTHODONTIC RETENTION (REMOVAL OF APPLIANCES, CONSTRUCTION AND PLACEMENT OF
ORTHODONTIC TREATMENT (ALTERNATIVE BILLING TO A CONTRACT FEE)
REPAIR OF ORTHODONTIC APPLIANCE
REPLACEMENT OF LOST OR BROKEN RETAINER
REBONDING OR RECEMENTING; AND/OR REPAIR, AS REQUIRED, OF FIXED RETAINERS
UNSPECIFIED ORTHODONTIC PROCEDURE, BY REPORT
FIXED PARTIAL DENTURE SECTIONING
LOCAL ANESTHESIA N0T IN CONJUNCTION WITH OPERATIVE OR SURGICAL PROCEDURES
DEEP SEDATION/GENERAL ANESTHESIA-FIRST 30 MINUTES
DEEP SEDATION/GENERAL ANESTHESIA-EACH ADDITIONAL 15 MINUTES
INTRAVENOUS CONSCIOUS SEDATION/ANALGESIA - FIRST 30 MINUTES
INTRAVENOUS CONSCIOUS SEDATION/ANALGESIA - EACH ADDITIONAL 15 MINUTES
CONSULTATION - DIAGNOSTIC SERVICE PROVIDED BY DENTIST OR PHYSICIAN OTHER THAN RE
HOUSE/EXTENDED CARE FACILITY CALL
HOSPITAL OR AMBULATORY SURGICAL CENTER CALL
OFFICE VISIT FOR OBSERVATION (DURING REGULARLY SCHEDULED HOURS) NO OTHER
OFFICE VISIT-AFTER REGULARLY SCHEDULED HOURS
THERAPEUTIC PARENTERAL DRUG, SINGLE ADMINISTRATION
THERAPEUTIC PARENTERAL DRUGS, TWO OR MORE ADMINISTRATIONS, DIFFERENT MEDICATIONS
TREATMENT OF COMPLICATIONS (POSTSURGICAL) - UNUSUAL CIRCUMSTANCES, BY REPORT
OCCLUSAL GUARDS, BY REPORT
OCCLUSAL ADJUSTMENT-LIMITED
UNSPECIFIED ADJUNCTIVE PROCEDURE, BY REPORT
CANE, INCLUDES CANES OF ALL MATERIALS, ADJUSTABLE OR FIXED, WITH TIP
CANE, QUAD OR THREE PRONG, INCLUDES CANES OF ALL MATERIALS, ADJUSTABLE OR
CRUTCHES, FOREARM, INCLUDES CRUTCHES OF VARIOUS MATERIALS, ADJUSTABLE OR FIXED,
CRUTCH FOREARM, INCLUDES CRUTCHES OF VARIOUS MATERIALS, ADJUSTABLE OR FIXED,
CRUTCHES UNDERARM, WOOD, ADJUSTABLE OR FIXED, PAIR, WITH PADS, TIPS AND
CRUTCH UNDERARM, WOOD, ADJUSTABLE OR FIXED, EACH, WITH PAD, TIP AND HANDGRIP
CRUTCHES UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR FIXED, PAIR, WITH PADS, TIPS
CRUTCH, UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR FIXED, WITH PAD, TIP, HANDGRIP,
CRUTCH, UNDERARM, ARTICULATING, SPRING ASSISTED, EACH
WALKER, RIGID (PICKUP), ADJUSTABLE OR FIXED HEIGHT
WALKER, FOLDING (PICKUP), ADJUSTABLE OR FIXED HEIGHT
WALKER, WITH TRUNK SUPPORT, ADJUSTABLE OR FIXED HEIGHT, ANY TYPE
WALKER, RIGID, WHEELED, ADJUSTABLE OR FIXED HEIGHT
WALKER, FOLDING, WHEELED, ADJUSTABLE OR FIXED HEIGHT
WALKER, ENCLOSED, FOUR SIDED FRAMED, RIGID OR FOLDING, WHEELED WITH POSTERIOR
WALKER, HEAVY DUTY, MULTIPLE BRAKING SYSTEM, VARIABLE WHEEL RESISTANCE
WALKER, HEAVY DUTY, WITHOUT WHEELS, RIGID OR FOLDING, ANY TYPE, EACH
WALKER, HEAVY DUTY, WHEELED, RIGID OR FOLDING, ANY TYPE
PLATFORM ATTACHMENT, FOREARM CRUTCH, EACH
PLATFORM ATTACHMENT, WALKER, EACH
WHEEL ATTACHMENT, RIGID PICK-UP WALKER, PER PAIR
SEAT ATTACHMENT, WALKER
CRUTCH ATTACHMENT, WALKER, EACH
LEG EXTENSIONS FOR WALKER, PER SET OF FOUR (4)
BRAKE ATTACHMENT FOR WHEELED WALKER, REPLACEMENT, EACH
SITZ TYPE BATH OR EQUIPMENT, PORTABLE, USED WITH OR WITHOUT COMMODE
SITZ TYPE BATH OR EQUIPMENT, PORTABLE, USED WITH OR WITHOUT COMMODE, WITH
SITZ BATH CHAIR
COMMODE CHAIR, MOBILE OR STATIONARY, WITH FIXED ARMS
COMMODE CHAIR, MOBILE OR STATIONARY, WITH DETACHABLE ARMS
PAIL OR PAN FOR USE WITH COMMODE CHAIR, REPLACEMENT ONLY
COMMODE CHAIR, EXTRA WIDE AND/OR HEAVY DUTY, STATIONARY OR MOBILE, WITH OR
COMMODE CHAIR WITH INTEGRATED SEAT LIFT MECHANISM, ELECTRIC, ANY TYPE
COMMODE CHAIR WITH INTEGRATED SEAT LIFT MECHANISM, NON-ELECTRIC, ANY TYPE
SEAT LIFT MECHANISM PLACED OVER OR ON TOP OF TOILET, ANY TYPE
FOOT REST, FOR USE WITH COMMODE CHAIR, EACH
POWERED PRESSURE REDUCING MATTRESS OVERLAY/PAD, ALTERNATING, WITH PUMP, INCLUDES
PUMP FOR ALTERNATING PRESSURE PAD, FOR REPLACEMENT ONLY
DRY PRESSURE MATTRESS
GEL OR GEL-LIKE PRESSURE PAD FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH
AIR PRESSURE MATTRESS
WATER PRESSURE MATTRESS
SYNTHETIC SHEEPSKIN PAD
LAMBSWOOL SHEEPSKIN PAD, ANY SIZE
POSITIONING CUSHION/PILLOW/WEDGE, ANY SHAPE OR SIZE, INCLUDES ALL COMPONENTS AND
HEEL OR ELBOW PROTECTOR, EACH
POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY)
AIR FLUIDIZED BED
GEL PRESSURE MATTRESS
AIR PRESSURE PAD FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH
WATER PRESSURE PAD FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH
DRY PRESSURE PAD FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH
HEAT LAMP, WITHOUT STAND (TABLE MODEL), INCLUDES BULB, OR INFRARED ELEMENT
PHOTOTHERAPY (BILIRUBIN) LIGHT WITH PHOTOMETER
HEAT LAMP, WITH STAND, INCLUDES BULB, OR INFRARED ELEMENT
ELECTRIC HEAT PAD, STANDARD
ELECTRIC HEAT PAD, MOIST
WATER CIRCULATING HEAT PAD WITH PUMP
WATER CIRCULATING COLD PAD WITH PUMP
INFRARED HEATING PAD SYSTEM
HYDROCOLLATOR UNIT, INCLUDES PADS
PARAFFIN BATH UNIT, PORTABLE (SEE MEDICAL SUPPLY CODE A4265 FOR PARAFFIN)
PUMP FOR WATER CIRCULATING PAD
HYDROCOLLATOR UNIT, PORTABLE
BATH/SHOWER CHAIR, WITH OR WITHOUT WHEELS, ANY SIZE
BATH TUB WALL RAIL, EACH
BATH TUB RAIL, FLOOR BASE
TOILET RAIL, EACH
RAISED TOILET SEAT
TUB STOOL OR BENCH
TRANSFER TUB RAIL ATTACHMENT
TRANSFER BENCH FOR TUB OR TOILET WITH OR WITHOUT COMMODE OPENING
TRANSFER BENCH, HEAVY DUTY, FOR TUB OR TOILET WITH OR WITHOUT COMMODE OPENING
PAD FOR WATER CIRCULATING HEAT UNIT, FOR REPLACEMENT ONLY
HOSPITAL BED, FIXED HEIGHT, WITH ANY TYPE SIDE RAILS, WITH MATTRESS
HOSPITAL BED, FIXED HEIGHT, WITH ANY TYPE SIDE RAILS, WITHOUT MATTRESS
HOSPITAL BED, VARIABLE HEIGHT, HI-LO, WITH ANY TYPE SIDE RAILS, WITH MATTRESS
HOSPITAL BED, VARIABLE HEIGHT, HI-LO, WITH ANY TYPE SIDE RAILS, WITHOUT MATTRESS
HOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTMENT), WITH ANY TYPE SIDE
HOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTMENT), WITH ANY TYPE SIDE
HOSPITAL BED, TOTAL ELECTRIC (HEAD, FOOT AND HEIGHT ADJUSTMENTS), WITH ANY TYPE
HOSPITAL BED, TOTAL ELECTRIC (HEAD, FOOT AND HEIGHT ADJUSTMENTS), WITH ANY TYPE
HOSPITAL BED, INSTITUTIONAL TYPE INCLUDES: OSCILLATING, CIRCULATING AND STRYKER
MATTRESS, INNERSPRING
MATTRESS, FOAM RUBBER
BED BOARD
OVER-BED TABLE
BED PAN, STANDARD, METAL OR PLASTIC
BED PAN, FRACTURE, METAL OR PLASTIC
POWERED PRESSURE-REDUCING AIR MATTRESS
BED CRADLE, ANY TYPE
HOSPITAL BED, FIXED HEIGHT, WITHOUT SIDE RAILS, WITH MATTRESS
HOSPITAL BED, FIXED HEIGHT, WITHOUT SIDE RAILS, WITHOUT MATTRESS
HOSPITAL BED, VARIABLE HEIGHT, HI-LO, WITHOUT SIDE RAILS, WITH MATTRESS
HOSPITAL BED, VARIABLE HEIGHT, HI-LO, WITHOUT SIDE RAILS, WITHOUT MATTRESS
HOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTMENT), WITHOUT SIDE RAILS,
HOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTMENT), WITHOUT SIDE RAILS,
HOSPITAL BED, TOTAL ELECTRIC (HEAD, FOOT AND HEIGHT ADJUSTMENTS). WITHOUT SIDE
HOSPITAL BED, TOTAL ELECTRIC (HEAD, FOOT AND HEIGHT ADJUSTMENTS), WITHOUT SIDE
PEDIATRIC CRIB, HOSPITAL GRADE, FULLY ENCLOSED
HOSPITAL BED, HEAVY DUTY, EXTRA WIDE, WITH WEIGHT CAPACITY GREATER THAN 350
HOSPITAL BED, EXTRA HEAVY DUTY, EXTRA WIDE, WITH WEIGHT CAPACITY GREATER THAN
HOSPITAL BED, HEAVY DUTY, EXTRA WIDE, WITH WEIGHT CAPACITY GREATER THAN 350
HOSPITAL BED, EXTRA HEAVY DUTY, EXTRA WIDE, WITH WEIGHT CAPACITY GREATER THAN
BED SIDE RAILS, HALF LENGTH
BED SIDE RAILS, FULL LENGTH
BED ACCESSORY: BOARD, TABLE, OR SUPPORT DEVICE, ANY TYPE
SAFETY ENCLOSURE FRAME/CANOPY FOR USE WITH HOSPITAL BED, ANY TYPE
URINAL; MALE, JUG-TYPE, ANY MATERIAL
URINAL; FEMALE, JUG-TYPE, ANY MATERIAL
HOSPITAL BED, PEDIATRIC, MANUAL, 360 DEGREE SIDE ENCLOSURES, TOP OF HEADBOARD, F
HOSPITAL BED, PEDIATRIC, ELECTRIC OR SEMI-ELECTRIC, 360 DEGREE SIDE ENCLOSURES,
CONTROL UNIT FOR ELECTRONIC BOWEL IRRIGATION/EVACUATION SYSTEM
DISPOSABLE PACK (WATER RESERVOIR BAG, SPECULUM, VALVING MECHANISM AND
AIR PRESSURE ELEVATOR FOR HEEL
NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS
POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH
NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS
STATIONARY COMPRESSED GASEOUS OXYGEN SYSTEM, RENTAL; INCLUDES CONTAINER,
STATIONARY COMPRESSED GAS SYSTEM, PURCHASE; INCLUDES REGULATOR, FLOWMETER,
PORTABLE GASEOUS OXYGEN SYSTEM, PURCHASE; INCLUDES REGULATOR, FLOWMETER,
PORTABLE GASEOUS OXYGEN SYSTEM, RENTAL; INCLUDES PORTABLE CONTAINER, REGULATOR,
PORTABLE LIQUID OXYGEN SYSTEM, RENTAL; HOME LIQUEFIER USED TO FILL PORTABLE
PORTABLE LIQUID OXYGEN SYSTEM, RENTAL; INCLUDES PORTABLE CONTAINER, SUPPLY
PORTABLE LIQUID OXYGEN SYSTEM, PURCHASE; INCLUDES PORTABLE CONTAINER, SUPPLY
STATIONARY LIQUID OXYGEN SYSTEM, RENTAL; INCLUDES CONTAINER, CONTENTS,
STATIONARY LIQUID OXYGEN SYSTEM, PURCHASE; INCLUDES USE OF RESERVOIR, CONTENTS
STATIONARY OXYGEN CONTENTS, GASEOUS, 1 MONTH'S SUPPLY = 1 UNIT
STATIONARY OXYGEN CONTENTS, LIQUID, 1 MONTH'S SUPPLY = 1 UNIT
PORTABLE OXYGEN CONTENTS, GASEOUS, 1 MONTH'S SUPPLY = 1 UNIT
PORTABLE OXYGEN CONTENTS, LIQUID, 1 MONTH'S SUPPLY = 1 UNIT
VOLUME CONTROL VENTILATOR, WITHOUT PRESSURE SUPPORT MODE, MAY INCLUDE PRESSURE
OXYGEN TENT, EXCLUDING CROUP OR PEDIATRIC TENTS
CHEST SHELL (CUIRASS)
CHEST WRAP
NEGATIVE PRESSURE VENTILATOR; PORTABLE OR STATIONARY
VOLUME CONTROL VENTILATOR, WITHOUT PRESSURE SUPPORT MODE, MAY INCLUDE PRESSURE
ROCKING BED WITH OR WITHOUT SIDE RAILS
PRESSURE SUPPORT VENTILATOR WITH VOLUME CONTROL MODE, MAY INCLUDE PRESSURE
PRESSURE SUPPORT VENTILATOR WITH VOLUME CONTROL MODE, MAY INCLUDE PRESSURE
RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITHOUT BACKUP RATE
RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITH BACK-UP RATE
RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITH BACKUP RATE
PERCUSSOR, ELECTRIC OR PNEUMATIC, HOME MODEL
COUGH STIMULATING DEVICE, ALTERNATING POSITIVE AND NEGATIVE AIRWAY PRESSURE
HIGH FREQUENCY CHEST WALL OSCILLATION AIR-PULSE GENERATOR SYSTEM, (INCLUDES
OSCILLATORY POSITIVE EXPIRATORY PRESSURE DEVICE, NON-ELECTRIC, ANY TYPE, EACH
ORAL DEVICE/APPLIANCE USED TO REDUCE UPPER AIRWAY COLLAPSIBILITY, ADJUSTABLE OR
ORAL DEVICE/APPLIANCE USED TO REDUCE UPPER AIRWAY COLLAPSIBILITY, ADJUSTABLE OR
IPPB MACHINE, ALL TYPES, WITH BUILT-IN NEBULIZATION; MANUAL OR AUTOMATIC VALVES
HUMIDIFIER, DURABLE FOR EXTENSIVE SUPPLEMENTAL HUMIDIFICATION DURING IPPB TREATM
HUMIDIFIER, DURABLE, GLASS OR AUTOCLAVABLE PLASTIC BOTTLE TYPE, FOR USE WITH
HUMIDIFIER, DURABLE FOR SUPPLEMENTAL HUMIDIFICATION DURING IPPB TREATMENT OR
HUMIDIFIER, NON-HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE
HUMIDIFIER, HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE
COMPRESSOR, AIR POWER SOURCE FOR EQUIPMENT WHICH IS NOT SELF- CONTAINED OR
NEBULIZER, WITH COMPRESSOR
AEROSOL COMPRESSOR, ADJUSTABLE PRESSURE, LIGHT DUTY FOR INTERMITTENT USE
ULTRASONIC/ELECTRONIC AEROSOL GENERATOR WITH SMALL VOLUME NEBULIZER
NEBULIZER, ULTRASONIC, LARGE VOLUME
NEBULIZER, DURABLE, GLASS OR AUTOCLAVABLE PLASTIC, BOTTLE TYPE, FOR USE WITH
NEBULIZER, WITH COMPRESSOR AND HEATER
RESPIRATORY SUCTION PUMP, HOME MODEL, PORTABLE OR STATIONARY, ELECTRIC
CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE
BREAST PUMP, MANUAL, ANY TYPE
BREAST PUMP, HOSPITAL GRADE, ELECTRIC (AC AND / OR DC), ANY TYPE
VAPORIZER, ROOM TYPE
POSTURAL DRAINAGE BOARD
HOME BLOOD GLUCOSE MONITOR
PACEMAKER MONITOR, SELF-CONTAINED, (CHECKS BATTERY DEPLETION, INCLUDES AUDIBLE
PACEMAKER MONITOR, SELF CONTAINED, CHECKS BATTERY DEPLETION AND OTHER PACEMAKER
EXTERNAL DEFIBRILLATOR WITH INTEGRATED ELECTROCARDIOGRAM ANALYSIS
APNEA MONITOR, WITHOUT RECORDING FEATURE
APNEA MONITOR, WITH RECORDING FEATURE
SKIN PIERCING DEVICE FOR COLLECTION OF CAPILLARY BLOOD, LASER, EACH
SLING OR SEAT, PATIENT LIFT, CANVAS OR NYLON
PATIENT LIFT, BATHROOM OR TOILET, NOT OTHERWISE CLASSIFIED
SEAT LIFT MECHANISM INCORPORATED INTO A COMBINATION LIFT-CHAIR MECHANISM
SEPARATE SEAT LIFT MECHANISM FOR USE WITH PATIENT OWNED FURNITURE-ELECTRIC
SEPARATE SEAT LIFT MECHANISM FOR USE WITH PATIENT OWNED FURNITURE-NON-ELECTRIC
PATIENT LIFT, HYDRAULIC OR MECHANICAL, INCLUDES ANY SEAT, SLING, STRAP(S) OR PAD
PATIENT LIFT, ELECTRIC WITH SEAT OR SLING
MULTIPOSITIONAL PATIENT SUPPORT SYSTEM, WITH INTEGRATED LIFT, PATIENT
COMBINATION SIT TO STAND SYSTEM, ANY SIZE INCLUDING PEDIATRIC, WITH SEATLIFT FEA
STANDING FRAME SYSTEM, ONE POSITION (E.G. UPRIGHT, SUPINE OR PRONE STANDER), ANY
PATIENT LIFT, MOVEABLE FROM ROOM TO ROOM WITH DISASSEMBLY AND REASSEMBLY,
PATIENT LIFT, FIXED SYSTEM, INCLUDES ALL COMPONENTS/ACCESSORIES
STANDING FRAME SYSTEM, MULTI-POSITION (E.G. THREE-WAY STANDER), ANY SIZE INCLUDI
STANDING FRAME SYSTEM, MOBILE (DYNAMIC STANDER), ANY SIZE INCLUDING PEDIATRIC
PNEUMATIC COMPRESSOR, NON-SEGMENTAL HOME MODEL
PNEUMATIC COMPRESSOR, SEGMENTAL HOME MODEL WITHOUT CALIBRATED GRADIENT PRESSURE
PNEUMATIC COMPRESSOR, SEGMENTAL HOME MODEL WITH CALIBRATED GRADIENT PRESSURE
NON-SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, HALF ARM
SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, TRUNK
SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, CHEST
NON-SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, FULL LEG
NON-SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, FULL ARM
NON-SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, HALF LEG
SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, FULL LEG
SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, FULL ARM
SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, HALF LEG
SEGMENTAL GRADIENT PRESSURE PNEUMATIC APPLIANCE, FULL LEG
SEGMENTAL GRADIENT PRESSURE PNEUMATIC APPLIANCE, FULL ARM
SEGMENTAL GRADIENT PRESSURE PNEUMATIC APPLIANCE, HALF LEG
PNEUMATIC COMPRESSION DEVICE, HIGH PRESSURE, RAPID INFLATION/DEFLATION CYCLE,
INTERMITTENT LIMB COMPRESSION DEVICE (INCLUDES ALL ACCESSORIES), NOT OTHERWISE S
ULTRAVIOLET LIGHT THERAPY SYSTEM PANEL, INCLUDES BULBS/LAMPS, TIMER AND EYE
ULTRAVIOLET LIGHT THERAPY SYSTEM PANEL, INCLUDES BULBS/LAMPS, TIMER AND EYE
ULTRAVIOLET LIGHT THERAPY SYSTEM PANEL, INCLUDES BULBS/LAMPS, TIMER AND EYE
ULTRAVIOLET MULTIDIRECTIONAL LIGHT THERAPY SYSTEM IN 6 FOOT CABINET, INCLUDES
SAFETY EQUIPMENT, DEVICE OR ACCESSORY, ANY TYPE
TRANSFER DEVICE, ANY TYPE, EACH
RESTRAINTS, ANY TYPE (BODY, CHEST, WRIST OR ANKLE)
TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) DEVICE, TWO LEAD, LOCALIZED S
TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) DEVICE, FOUR OR MORE LEADS, F
FORM FITTING CONDUCTIVE GARMENT FOR DELIVERY OF TENS OR NMES (WITH CONDUCTIVE
INCONTINENCE TREATMENT SYSTEM, PELVIC FLOOR STIMULATOR, MONITOR, SENSOR AND/OR
NEUROMUSCULAR STIMULATOR FOR SCOLIOSIS
NEUROMUSCULAR STIMULATOR, ELECTRONIC SHOCK UNIT
OSTEOGENESIS STIMULATOR, ELECTRICAL, NON-INVASIVE, OTHER THAN SPINAL
OSTEOGENESIS STIMULATOR, ELECTRICAL, NON-INVASIVE, SPINAL APPLICATIONS
ELECTRONIC SALIVARY REFLEX STIMULATOR (INTRA-ORAL/NON-INVASIVE)
OSTOGENESIS STIMULATOR, LOW INTENSITY ULTRASOUND, NON-INVASIVE
FDA APPROVED NERVE STIMULATOR, WITH REPLACEABLE BATTERIES, FOR TREATMENT OF
ELECTRICAL STIMULATION OR ELECTROMAGNETIC WOUND TREATMENT DEVICE, NOT OTHERWISE
FUNCTIONAL ELECTRICAL STIMULATOR, TRANSCUTANEOUS STIMULATION OF NERVE AND/OR MUS
IV POLE
AMBULATORY INFUSION PUMP, MECHANICAL, REUSABLE, FOR INFUSION 8 HOURS OR GREATER
AMBULATORY INFUSION PUMP, MECHANICAL, REUSABLE, FOR INFUSION LESS THAN 8 HOURS
AMBULATORY INFUSION PUMP, SINGLE OR MULTIPLE CHANNELS, ELECTRIC OR BATTERY
EXTERNAL AMBULATORY INFUSION PUMP, INSULIN
PARENTERAL INFUSION PUMP, STATIONARY, SINGLE OR MULTI-CHANNEL
TRACTION FRAME, ATTACHED TO HEADBOARD, CERVICAL TRACTION
TRACTION EQUIPMENT, CERVICAL, FREE-STANDING STAND/FRAME, PNEUMATIC, APPLYING
TRACTION STAND, FREE STANDING, CERVICAL TRACTION
CERVICAL TRACTION EQUIPMENT NOT REQUIRING ADDITIONAL STAND OR FRAME
CERVICAL TRACTION DEVICE, CERVICAL COLLAR WITH INFLATABLE AIR BLADDER
TRACTION EQUIPMENT, OVERDOOR, CERVICAL
TRACTION FRAME, ATTACHED TO FOOTBOARD, EXTREMITY TRACTION, (E.G. BUCK'S)
TRACTION STAND, FREE STANDING, EXTREMITY TRACTION, (E.G., BUCK'S)
TRACTION FRAME, ATTACHED TO FOOTBOARD, PELVIC TRACTION
TRACTION STAND, FREE STANDING, PELVIC TRACTION, (E.G., BUCK'S)
TRAPEZE BARS, A/K/A PATIENT HELPER, ATTACHED TO BED, WITH GRAB BAR
TRAPEZE BAR, HEAVY DUTY, FOR PATIENT WEIGHT CAPACITY GREATER THAN 250 POUNDS, AT
TRAPEZE BAR, HEAVY DUTY, FOR PATIENT WEIGHT CAPACITY GREATER THAN 250 POUNDS, FR
FRACTURE FRAME, ATTACHED TO BED, INCLUDES WEIGHTS
FRACTURE FRAME, FREE STANDING, INCLUDES WEIGHTS
CONTINUOUS PASSIVE MOTION EXERCISE DEVICE FOR USE ON KNEE ONLY
CONTINUOUS PASSIVE MOTION EXERCISE DEVICE FOR USE OTHER THAN KNEE
TRAPEZE BAR, FREE STANDING, COMPLETE WITH GRAB BAR
GRAVITY ASSISTED TRACTION DEVICE, ANY TYPE
CERVICAL HEAD HARNESS/HALTER
PELVIC BELT/HARNESS/BOOT
EXTREMITY BELT/HARNESS
FRACTURE, FRAME, DUAL WITH CROSS BARS, ATTACHED TO BED, (E.G. BALKEN, 4 POSTER)
FRACTURE FRAME, ATTACHMENTS FOR COMPLEX PELVIC TRACTION
FRACTURE FRAME, ATTACHMENTS FOR COMPLEX CERVICAL TRACTION
WHEELCHAIR ACCESSORY, TRAY, EACH
HEEL LOOP/HOLDER, ANY TYPE, WITH OR WITHOUT ANKLE STRAP, EACH
TOE LOOP/HOLDER, ANY TYPE, EACH
WHEELCHAIR ACCESSORY, HEADREST, CUSHIONED, ANY TYPE, INCLUDING FIXED MOUNTING
WHEELCHAIR ACCESSORY, LATERAL TRUNK OR HIP SUPPORT, ANY TYPE, INCLUDING FIXED
WHEELCHAIR ACCESSORY, MEDIAL THIGH SUPPORT, ANY TYPE, INCLUDING FIXED MOUNTING
MANUAL WHEELCHAIR ACCESSORY, ONE-ARM DRIVE ATTACHMENT, EACH
MANUAL WHEELCHAIR ACCESSORY, ADAPTER FOR AMPUTEE, EACH
WHEELCHAIR ACCESSORY, SHOULDER HARNESS/STRAPS OR CHEST STRAP, INCLUDING ANY
MANUAL WHEELCHAIR ACCESSORY, WHEEL LOCK BRAKE EXTENSION (HANDLE), EACH
MANUAL WHEELCHAIR ACCESSORY, HEADREST EXTENSION, EACH
MANUAL WHEELCHAIR ACCESSORY, HAND RIM WITH PROJECTIONS, ANY TYPE, EACH
COMMODE SEAT, WHEELCHAIR
NARROWING DEVICE, WHEELCHAIR
NO.2 FOOTPLATES, EXCEPT FOR ELEVATING LEG REST
MANUAL WHEELCHAIR ACCESSORY, ANTI-TIPPING DEVICE, EACH
WHEELCHAIR ACCESSORY, ADJUSTABLE HEIGHT, DETACHABLE ARMREST, COMPLETE ASSEMBLY,
MANUAL WHEELCHAIR ACCESSORY, ANTI-ROLLBACK DEVICE, EACH
WHEELCHAIR ACCESSORY, POSITIONING BELT/SAFETY BELT/PELVIC STRAP, EACH
SAFETY VEST, WHEELCHAIR
WHEELCHAIR ACCESSORY, SEAT UPHOLSTERY, REPLACEMENT ONLY, EACH
WHEELCHAIR ACCESSORY, BACK UPHOLSTERY, REPLACEMENT ONLY, EACH
MANUAL WHEELCHAIR ACCESSORY, POWER ADD-ON TO CONVERT MANUAL WHEELCHAIR TO
MANUAL WHEELCHAIR ACCESSORY, POWER ADD-ON TO CONVERT MANUAL WHEELCHAIR TO
WHEELCHAIR ACCESSORY, SEAT LIFT MECHANISM
MANUAL WHEELCHAIR ACCESSORY, PUSH ACTIVATED POWER ASSIST, EACH
MANUAL WHEELCHAIR ACCESSORY, LEVER-ACTIVATED, WHEEL DRIVE, PAIR
WHEELCHAIR ACCESSORY, ELEVATING LEG REST, COMPLETE ASSEMBLY, EACH
MANUAL WHEELCHAIR ACCESSORY, SOLID SEAT INSERT
ARM REST, EACH
WHEELCHAIR ACCESSORY, CALF REST/PAD, EACH
WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, TILT ONLY
WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, RECLINE ONLY, WITHOUT SHEAR
WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, RECLINE ONLY, WITH MECHANICAL SHEAR
WHEELCHAIR ACCESSORY, POWER SEATNG SYSTEM, RECLINE ONLY, WITH POWER SHEAR
WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, COMBINATION TILT AND RECLINE,
WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, COMBINATION TILT AND RECLINE, WITH
WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, COMBINATION TILT AND RECLINE, WITH
WHEELCHAIR ACCESSORY, ADDITION TO POWER SEATING SYSTEM, MECHANICALLY LINKED LEG
WHEELCHAIR ACCESSORY, ADDITION TO POWER SEATING SYSTEM, POWER LEG ELEVATION
MODIFICATION TO PEDIATRIC SIZE WHEELCHAIR, WIDTH ADJUSTMENT PACKAGE (NOT TO BE
RECLINING BACK, ADDITION TO PEDIATRIC SIZE WHEELCHAIR
SHOCK ABSORBER FOR MANUAL WHEELCHAIR, EACH
SHOCK ABSORBER FOR POWER WHEELCHAIR, EACH
HEAVY DUTY SHOCK ABSORBER FOR HEAVY DUTY OR EXTRA HEAVY DUTY MANUAL WHEELCHAIR,
HEAVY DUTY SHOCK ABSORBER FOR HEAVY DUTY OR EXTRA HEAVY DUTY POWER WHEELCHAIR,
RESIDUAL LIMB SUPPORT SYSTEM FOR WHEELCHAIR
WHEELCHAIR ACCESSORY, MANUAL SWINGAWAY, RETRACTABLE OR REMOVABLE MOUNTING
WHEELCHAIR ACCESSORY, VENTILATOR TRAY, FIXED
WHEELCHAIR ACCESSORY, VENTILATOR TRAY, GIMBALED
ROLLABOUT CHAIR, ANY AND ALL TYPES WITH CASTORS 5" OR GREATER
MULTI-POSITIONAL PATIENT TRANSFER SYSTEM, WITH INTEGRATED SEAT, OPERATED BY CARE
MULTI-POSITIONAL PATIENT TRANSFER SYSTEM, EXTRA-WIDE, WITH INTEGRATED SEAT,
TRANSPORT CHAIR, PEDIATRIC SIZE
TRANSPORT CHAIR, ADULT SIZE, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POU
TRANSPORT CHAIR, ADULT SIZE, HEAVY DUTY, PATIENT WEIGHT CAPACITY GREATER THAN 30
FULLY-RECLINING WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVAT
FULLY-RECLINING WHEELCHAIR, DETACHABLE ARMS, DESK OR FULL LENGTH, SWING AWAY
FULLY-RECLINING WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) SWING AWAY
HEMI-WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVATING LEG
HEMI-WHEELCHAIR, DETACHABLE ARMS DESK OR FULL LENGTH ARMS, SWING AWAY
HEMI-WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE FOOT RESTS
HEMI-WHEELCHAIR DETACHABLE ARMS DESK OR FULL LENGTH, SWING AWAY DETACHABLE
HIGH STRENGTH LIGHTWEIGHT WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY
HIGH STRENGTH LIGHTWEIGHT WHEELCHAIR, DETACHABLE ARMS DESK OR FULL LENGTH,
HIGH STRENGTH LIGHTWEIGHT WHEELCHAIR, FIXED LENGTH ARMS, SWING AWAY DETACHABLE
HIGH STRENGTH LIGHTWEIGHT WHEELCHAIR, DETACHABLE ARMS DESK OR FULL LENGTH,
WIDE HEAVY DUTY WHEEL CHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH), SWING AWAY
WIDE HEAVY DUTY WHEELCHAIR, DETACHABLE ARMS DESK OR FULL LENGTH ARMS, SWING
SEMI-RECLINING WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVATI
SEMI-RECLINING WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) ELEVATING LEG
STANDARD WHEELCHAIR, FIXED FULL LENGTH ARMS, FIXED OR SWING AWAY DETACHABLE FOOT
WHEELCHAIR, DETACHABLE ARMS, DESK OR FULL LENGTH, SWING AWAY DETACHABLE
WHEELCHAIR, DETACHABLE ARMS, DESK OR FULL LENGTH SWING AWAY DETACHABLE
WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVATING LEGRESTS
MANUAL ADULT SIZE WHEELCHAIR, INCLUDES TILT IN SPACE
AMPUTEE WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVATING LEGR
AMPUTEE WHEELCHAIR, FIXED FULL LENGTH ARMS, WITHOUT FOOTRESTS OR LEGREST
AMPUTEE WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) WITHOUT FOOTRESTS OR
AMPUTEE WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) SWING AWAY DETACHABLE
AMPUTEE WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) SWING AWAY DETACHABLE
HEAVY DUTY WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVATING
AMPUTEE WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE FOOTREST
WHEELCHAIR; SPECIALLY SIZED OR CONSTRUCTED, (INDICATE BRAND NAME, MODEL NUMBER,
WHEELCHAIR WITH FIXED ARM, FOOTRESTS
WHEELCHAIR WITH FIXED ARM, ELEVATING LEGRESTS
WHEELCHAIR WITH DETACHABLE ARMS, FOOTRESTS
WHEELCHAIR WITH DETACHABLE ARMS, ELEVATING LEGRESTS
WHEELCHAIR ACCESSORY, MANUAL SEMI-RECLINING BACK, (RECLINE GREATER THAN 15
WHEELCHAIR ACCESSORY, MANUAL FULLY RECLINING BACK, (RECLINE GREATER THAN 80
SPECIAL HEIGHT ARMS FOR WHEELCHAIR
SPECIAL BACK HEIGHT FOR WHEELCHAIR
WHEELCHAIR, PEDIATRIC SIZE, NOT OTHERWISE SPECIFIED
POWER OPERATED VEHICLE (THREE OR FOUR WHEEL NONHIGHWAY) SPECIFY BRAND NAME AND
WHEELCHAIR, PEDIATRIC SIZE, TILT-IN-SPACE, RIGID, ADJUSTABLE, WITH SEATING
WHEELCHAIR, PEDIATRIC SIZE, TILT-IN-SPACE, FOLDING, ADJUSTABLE, WITH SEATING
WHEELCHAIR, PEDIATRIC SIZE, TILT-IN-SPACE, RIGID, ADJUSTABLE, WITHOUT SEATING
WHEELCHAIR, PEDIATRIC SIZE, TILT-IN-SPACE, FOLDING, ADJUSTABLE, WITHOUT SEATING
WHEELCHAIR, PEDIATRIC SIZE, RIGID, ADJUSTABLE, WITH SEATING SYSTEM
WHEELCHAIR, PEDIATRIC SIZE, FOLDING, ADJUSTABLE, WITH SEATING SYSTEM
WHEELCHAIR, PEDIATRIC SIZE, RIGID, ADJUSTABLE, WITHOUT SEATING SYSTEM
WHEELCHAIR, PEDIATRIC SIZE, FOLDING, ADJUSTABLE, WITHOUT SEATING SYSTEM
POWER WHEELCHAIR, PEDIATRIC SIZE, NOT OTHERWISE SPECIFIED
LIGHTWEIGHT WHEELCHAIR, DETACHABLE ARMS, (DESK OR FULL LENGTH) SWING AWAY DETACH
LIGHTWEIGHT WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE FOOTREST
LIGHTWEIGHT WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) SWING AWAY
LIGHTWEIGHT WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVATING
HEAVY DUTY WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) ELEVATING LEGRESTS
HEAVY DUTY WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE FOOTREST
HEAVY DUTY WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) SWING AWAY
HEAVY DUTY WHEELCHAIR, FIXED FULL LENGTH ARMS, ELEVATING LEGREST
SPECIAL WHEELCHAIR SEAT HEIGHT FROM FLOOR
SPECIAL WHEELCHAIR SEAT DEPTH, BY UPHOLSTERY
SPECIAL WHEELCHAIR SEAT DEPTH AND/OR WIDTH, BY CONSTRUCTION
WHIRLPOOL, PORTABLE (OVERTUB TYPE)
WHIRLPOOL, NON-PORTABLE (BUILT-IN TYPE)
REGULATOR
OXYGEN ACCESSORY, WHEELED CART FOR PORTABLE CYLINDER OR PORTABLE CONCENTRATOR, A
STAND/RACK
OXYGEN ACCESSORY, BATTERY PACK/CARTRIDGE FOR PORTABLE CONCENTRATOR, ANY TYPE, RE
OXYGEN ACCESSORY, BATTERY CHARGER FOR PORTABLE CONCENTRATOR, ANY TYPE, REPLACEME
OXYGEN ACCESSORY, DC POWER ADAPTER FOR PORTABLE CONCENTRATOR, ANY TYPE, REPLACEM
IMMERSION EXTERNAL HEATER FOR NEBULIZER
OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT, CAPABLE OF DELIVERING 85 PERCENT OR
OXYGEN CONCENTRATOR, DUAL DELIVERY PORT, CAPABLE OF DELIVERING 85 PERCENT OR
PORTABLE OXYGEN CONCENTRATOR, RENTAL
DURABLE MEDICAL EQUIPMENT, MISCELLANEOUS
OXYGEN AND WATER VAPOR ENRICHING SYSTEM WITH HEATED DELIVERY
OXYGEN AND WATER VAPOR ENRICHING SYSTEM WITHOUT HEATED DELIVERY
CENTRIFUGE, FOR DIALYSIS
KIDNEY, DIALYSATE DELIVERY SYST. KIDNEY MACHINE, PUMP RECIRCULAT- ING, AIR REMOV
HEPARIN INFUSION PUMP FOR HEMODIALYSIS
AIR BUBBLE DETECTOR FOR HEMODIALYSIS, EACH, REPLACEMENT
PRESSURE ALARM FOR HEMODIALYSIS, EACH, REPLACEMENT
BATH CONDUCTIVITY METER FOR HEMODIALYSIS, EACH
BLOOD LEAK DETECTOR FOR HEMODIALYSIS, EACH, REPLACEMENT
ADJUSTABLE CHAIR, FOR ESRD PATIENTS
TRANSDUCER PROTECTORS/FLUID BARRIERS, FOR HEMODIALYSIS, ANY SIZE, PER 10
UNIPUNCTURE CONTROL SYSTEM FOR HEMODIALYSIS
HEMODIALYSIS MACHINE
AUTOMATIC INTERMITTENT PERITIONEAL DIALYSIS SYSTEM
CYCLER DIALYSIS MACHINE FOR PERITONEAL DIALYSIS
DELIVERY AND/OR INSTALLATION CHARGES FOR HEMODIALYSIS EQUIPMENT
REVERSE OSMOSIS WATER PURIFICATION SYSTEM, FOR HEMODIALYSIS
DEIONIZER WATER PURIFICATION SYSTEM, FOR HEMODIALYSIS
BLOOD PUMP FOR HEMODIALYSIS, REPLACEMENT
WATER SOFTENING SYSTEM, FOR HEMODIALYSIS
RECIPROCATING PERITONEAL DIALYSIS SYSTEM
WEARABLE ARTIFICIAL KIDNEY, EACH
PERITONEAL DIALYSIS CLAMPS, EACH
COMPACT (PORTABLE) TRAVEL HEMODIALYZER SYSTEM
SORBENT CARTRIDGES, FOR HEMODIALYSIS, PER 10
HEMOSTATS, EACH
SCALE, EACH
DIALYSIS EQUIPMENT, NOT OTHERWISE SPECIFIED
JAW MOTION REHABILITATION SYSTEM
REPLACEMENT CUSHIONS FOR JAW MOTION REHABILITATION SYSTEM, PKG. OF 6
REPLACEMENT MEASURING SCALES FOR JAW MOTION REHABILITATION SYSTEM, PKG. OF 200
DYNAMIC ADJUSTABLE ELBOW EXTENSION/FLEXION DEVICE, INCLUDES SOFT INTERFACE MATER
STATIC PROGRESSIVE STRETCH ELBOW DEVICE, EXTENSION AND/OR FLEXION, WITH OR WITH
DYNAMIC ADJUSTABLE FOREARM PRONATION/SUPINATION DEVICE, INCLUDES SOFT INTERFACE
DYNAMIC ADJUSTABLE WRIST EXTENSION / FLEXION DEVICE, INCLUDES SOFT INTERFACE
STATIC PROGRESSIVE STRETCH WRIST DEVICE, FLEXION AND/OR EXTENSION, WITH OR WITHO
DYNAMIC ADJUSTABLE KNEE EXTENSION / FLEXION DEVICE, INCLUDES SOFT INTERFACE
STATIC PROGRESSIVE STRETCH KNEE DEVICE, EXTENSION AND/OR FLEXION, WITH OR WITHO
DYNAMIC KNEE, EXTENSION/FLEXION DEVICE WITH ACTIVE RESISTANCE CONTROL
DYNAMIC ADJUSTABLE ANKLE EXTENSION/FLEXION DEVICE, INCLUDES SOFT INTERFACE
STATIC PROGRESSIVE STRETCH ANKLE DEVICE, FLEXION AND/OR EXTENSION, WITH OR WITHO
STATIC PROGRESSIVE STRETCH FOREARM PRONATION / SUPINATION DEVICE, WITH OR WITHOU
REPLACEMENT SOFT INTERFACE MATERIAL, DYNAMIC ADJUSTABLE EXTENSION/FLEXION DEVICE
REPLACEMENT SOFT INTERFACE MATERIAL/CUFFS FOR BI-DIRECTIONAL STATIC PROGRESSIVE
DYNAMIC ADJUSTABLE FINGER EXTENSION/FLEXION DEVICE, INCLUDES SOFT INTERFACE
DYNAMIC ADJUSTABLE TOE EXTENSION/FLEXION DEVICE, INCLUDES SOFT INTERFACE
STATIC PROGRESSIVE STRETCH TOE DEVICE, EXTENSION AND/OR FLEXION, WITH OR WITHOUT
DYNAMIC ADJUSTABLE SHOULDER FLEXION / ABDUCTION / ROTATION DEVICE, INCLUDES
STATIC PROGRESSIVE STRETCH SHOULDER DEVICE, WITH OR WITHOUT RANGE OF MOTION ADJU
COMMUNICATION BOARD, NON-ELECTRONIC AUGMENTATIVE OR ALTERNATIVE COMMUNICATION
GASTRIC SUCTION PUMP, HOME MODEL, PORTABLE OR STATIONARY, ELECTRIC
BLOOD GLUCOSE MONITOR WITH INTEGRATED VOICE SYNTHESIZER
BLOOD GLUCOSE MONITOR WITH INTEGRATED LANCING/BLOOD SAMPLE
PULSE GENERATOR SYSTEM FOR TYMPANIC TREATMENT OF INNER EAR ENDOLYMPHATIC FLUID
MANUAL WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME, WIDTH GREATER THAN OR EQUAL
MANUAL WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME WIDTH, 24-27 INCHES
MANUAL WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME DEPTH, 20 TO LESS THAN 22
MANUAL WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME DEPTH, 22 TO 25 INCHES
MANUAL WHEELCHAIR ACCESSORY, HANDRIM WITHOUT PROJECTIONS (INCLUDES ERGONOMIC OR
MANUAL WHEELCHAIR ACCESSORY, WHEEL LOCK ASSEMBLY, COMPLETE, EACH
WHEELCHAIR ACCESSORY, CRUTCH AND CANE HOLDER, EACH
WHEELCHAIR ACCESSORY, CYLINDER TANK CARRIER, EACH
ACCESSORY, ARM TROUGH, WITH OR WITHOUT HAND SUPPORT, EACH
WHEELCHAIR ACCESSORY, BEARINGS, ANY TYPE, REPLACEMENT ONLY, EACH
MANUAL WHEELCHAIR ACCESSORY, PNEUMATIC PROPULSION TIRE, ANY SIZE, EACH
MANUAL WHEELCHAIR ACCESSORY, TUBE FOR PNEUMATIC PROPULSION TIRE, ANY SIZE, EACH
MANUAL WHEELCHAIR ACCESSORY, INSERT FOR PNEUMATIC PROPULSION TIRE (REMOVABLE), A
MANUAL WHEELCHAIR ACCESSORY, PNEUMATIC CASTER TIRE, ANY SIZE, EACH
MANUAL WHEELCHAIR ACCESSORY, TUBE FOR PNEUMATIC CASTER TIRE, ANY SIZE, EACH
MANUAL WHEELCHAIR ACCESSORY, FOAM FILLED PROPULSION TIRE, ANY SIZE, EACH
MANUAL WHEELCHAIR ACCESSORY, FOAM FILLED CASTER TIRE, ANY SIZE, EACH
MANUAL WHEELCHAIR ACCESSORY, FOAM PROPULSION TIRE, ANY SIZE, EACH
MANUAL WHEELCHAIR ACCESSORY, FOAM CASTER TIRE, ANY SIZE, EACH
MANUAL WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) PROPULSION TIRE, ANY SIZE, E
MANUAL WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) CASTER TIRE (REMOVABLE), ANY
MANUAL WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) CASTER TIRE WITH INTEGRATED
MANUAL WHEELCHAIR ACCESSORY, PROPULSION WHEEL EXCLUDES TIRE, ANY SIZE, EACH
MANUAL WHEELCHAIR ACCESSORY, CASTER WHEEL EXCLUDES TIRE, ANY SIZE, REPLACEMENT O
MANUAL WHEELCHAIR ACCESSORY, CASTER FORK, ANY SIZE, REPLACEMENT ONLY, EACH
MANUAL WHEELCHAIR ACCESSORY, GEAR REDUCTION DRIVE WHEEL, EACH
MANUAL WHEELCHAIR ACCESSORY, WHEEL BRAKING SYSTEM AND LOCK, COMPLETE, EACH
MANUAL WHEELCHAIR ACCESSORY, MANUAL STANDING SYSTEM
MANUAL WHEELCHAIR ACCESSORY, SOLID SEAT SUPPORT BASE (REPLACES SLING SEAT), INCL
BACK, PLANAR, FOR PEDIATRIC SIZE WHEELCHAIR INCLUDING FIXED ATTACHING HARDWARE
SEAT, PLANAR, FOR PEDIATRIC SIZE WHEELCHAIR INCLUDING FIXED ATTACHING HARDWARE
BACK, CONTOURED, FOR PEDIATRIC SIZE WHEELCHAIR INCLUDING FIXED ATTACHING
SEAT, CONTOURED, FOR PEDIATRIC SIZE WHEELCHAIR INCLUDING FIXED ATTACHING
MANUAL WHEELCHAIR ACCESSORY, FOR PEDIATRIC SIZE WHEELCHAIR, DYNAMIC SEATING FRAM
POWER WHEELCHAIR ACCESSORY, POWER SEAT ELEVATION SYSTEM
POWER WHEELCHAIR ACCESSORY, POWER STANDING SYSTEM
POWER WHEELCHAIR ACCESSORY, ELECTRONIC CONNECTION BETWEEN WHEELCHAIR CONTROLLER
POWER WHEELCHAIR ACCESSORY, ELECTRONIC CONNECTION BETWEEN WHEELCHAIR CONTROLLER
POWER WHEELCHAIR ACCESSORY, HAND OR CHIN CONTROL INTERFACE, MINI-PROPORTIONAL RE
POWER WHEELCHAIR ACCESSORY, HARNESS FOR UPGRADE TO EXPANDABLE CONTROLLER, INCLUD
POWER WHEELCHAIR ACCESSORY, HAND CONTROL INTERFACE, REMOTE JOYSTICK,
POWER WHEELCHAIR ACCESSORY, HAND CONTROL INTERFACE, MULTIPLE MECHANICAL
POWER WHEELCHAIR ACCESSORY, SPECIALTY JOYSTICK HANDLE FOR HAND CONTROL
POWER WHEELCHAIR ACCESSORY, CHIN CUP FOR CHIN CONTROL INTERFACE
POWER WHEELCHAIR ACCESSORY, SIP AND PUFF INTERFACE, NONPROPORTIONAL, INCLUDING
POWER WHEELCHAIR ACCESSORY, BREATH TUBE KIT FOR SIP AND PUFF INTERFACE
POWER WHEELCHAIR ACCESSORY, HEAD CONTROL INTERFACE, MECHANICAL, PROPORTIONAL,
POWER WHEELCHAIR ACCESSORY, HEAD CONTROL OR EXTREMITY CONTROL INTERFACE,
POWER WHEELCHAIR ACCESSORY, HEAD CONTROL INTERFACE, CONTACT SWITCH MECHANISM,
POWER WHEELCHAIR ACCESSORY, HEAD CONTROL INTERFACE, PROXIMITY SWITCH MECHANISM,
POWER WHEELCHAIR ACCESSORY, ATTENDANT CONTROL, PROPORTIONAL, INCLUDING ALL
POWER WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME WIDTH, 20-23 INCHES
POWER WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME WIDTH, 24-27 INCHES
POWER WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME DEPTH, 20 OR 21 INCHES
POWER WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME DEPTH, 22-25 INCHES
POWER WHEELCHAIR ACCESSORY, ELECTRONIC INTERFACE TO OPERATE SPEECH GENERATING
POWER WHEELCHAIR ACCESSORY, GROUP 34 NON-SEALED LEAD ACID BATTERY, EACH
POWER WHEELCHAIR ACCESSORY, GROUP 34 SEALED LEAD ACID BATTERY, EACH (E.G. GEL, C
POWER WHEELCHAIR ACCESSORY, 22 NF NON-SEALED LEAD ACID BATTERY, EACH
POWER WHEELCHAIR ACCESSORY, 22NF SEALED LEAD ACID BATTERY, EACH, (E.G. GEL
POWER WHEELCHAIR ACCESSORY, GROUP 24 NON-SEALED LEAD ACID BATTERY, EACH
POWER WHEELCHAIR ACCESSORY, GROUP 24 SEALED LEAD ACID BATTERY, EACH (E.G. GEL
POWER WHEELCHAIR ACCESSORY, U-1 NON-SEALED LEAD ACID BATTERY, EACH
POWER WHEELCHAIR ACCESSORY, U-1 SEALED LEAD ACID BATTERY, EACH (E.G. GEL CELL,
POWER WHEELCHAIR ACCESSORY, BATTERY CHARGER, SINGLE MODE, FOR USE WITH ONLY ONE
POWER WHEELCHAIR ACCESSORY, BATTERY CHARGER, DUAL MODE, FOR USE WITH EITHER
POWER WHEELCHAIR COMPONENT, MOTOR, REPLACEMENT ONLY
POWER WHEELCHAIR COMPONENT, GEAR BOX, REPLACEMENT ONLY
POWER WHEELCHAIR COMPONENT, MOTOR AND GEAR BOX COMBINATION, REPLACEMENT ONLY
POWER WHEELCHAIR ACCESSORY, GROUP 27 SEALED LEAD ACID BATTERY, (E.G. GEL CELL, A
POWER WHEELCHAIR ACCESSORY, GROUP 27 NON-SEALED LEAD ACID BATTERY, EACH
POWER WHEELCHAIR ACCESSORY, HAND OR CHIN CONTROL INTERFACE, COMPACT REMOTE JOYST
POWER WHEELCHAIR ACCESSORY, HAND OR CHIN CONTROL INTERFACE, STANDARD REMOTE JOYS
POWER WHEELCHAIR ACCESSORY, NON-EXPANDABLE CONTROLLER, INCLUDING ALL RELATED ELE
POWER WHEELCHAIR ACCESSORY, EXPANDABLE CONTROLLER, INCLUDING ALL RELATED ELECTRO
POWER WHEELCHAIR ACCESSORY, EXPANDABLE CONTROLLER, INCLUDING ALL RELATED ELECTRO
POWER WHEELCHAIR ACCESSORY, PNEUMATIC DRIVE WHEEL TIRE, ANY SIZE, REPLACEMENT ON
POWER WHEELCHAIR ACCESSORY, TUBE FOR PNEUMATIC DRIVE WHEEL TIRE, ANY SIZE, REPLA
POWER WHEELCHAIR ACCESSORY, INSERT FOR PNEUMATIC DRIVE WHEEL TIRE (REMOVABLE), A
POWER WHEELCHAIR ACCESSORY, PNEUMATIC CASTER TIRE, ANY SIZE, REPLACEMENT ONLY, E
POWER WHEELCHAIR ACCESSORY, TUBE FOR PNEUMATIC CASTER TIRE, ANY SIZE, REPLACEMEN
POWER WHEELCHAIR ACCESSORY, FOAM FILLED DRIVE WHEEL TIRE, ANY SIZE, REPLACEMENT
POWER WHEELCHAIR ACCESSORY, FOAM FILLED CASTER TIRE, ANY SIZE, REPLACEMENT ONLY,
POWER WHEELCHAIR ACCESSORY, FOAM DRIVE WHEEL TIRE, ANY SIZE, REPLACEMENT ONLY, E
POWER WHEELCHAIR ACCESSORY, FOAM CASTER TIRE, ANY SIZE, REPLACEMENT ONLY, EACH
POWER WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) DRIVE WHEEL TIRE, ANY SIZE, R
POWER WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) CASTER TIRE (REMOVABLE), ANY
POWER WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) CASTER TIRE WITH INTEGRATED W
POWER WHEELCHAIR ACCESSORY, DRIVE WHEEL EXCLUDES TIRE, ANY SIZE, REPLACEMENT ONL
POWER WHEELCHAIR ACCESSORY, CASTER WHEEL EXCLUDES TIRE, ANY SIZE, REPLACEMENT ON
POWER WHEELCHAIR ACCESSORY, CASTER FORK, ANY SIZE, REPLACEMENT ONLY, EACH
POWER WHEELCHAIR ACCESSORY, LITHIUM-BASED BATTERY, EACH
NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR PORTABLE
SPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING PRE-RECORDED MESSAGES, LESS TH
SPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING PRE-RECORDED MESSAGES,
SPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING PRE-RECORDED MESSAGES,
SPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING PRE-RECORDED MESSAGES,
SPEECH GENERATING DEVICE, SYNTHESIZED SPEECH, REQUIRING MESSAGE FORMULATION BY
SPEECH GENERATING DEVICE, SYNTHESIZED SPEECH, PERMITTING MULTIPLE METHODS OF
SPEECH GENERATING SOFTWARE PROGRAM, FOR PERSONAL COMPUTER OR PERSONAL DIGITAL
ACCESSORY FOR SPEECH GENERATING DEVICE, MOUNTING SYSTEM
ACCESSORY FOR SPEECH GENERATING DEVICE, NOT OTHERWISE CLASSIFIED
GENERAL USE WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH
GENERAL USE WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR GREATER, ANY DEPTH
SKIN PROTECTION WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH
SKIN PROTECTION WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR GREATER, ANY DEPTH
POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH
POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR GREATER, ANY DEPTH
SKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22
SKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR
CUSTOM FABRICATED WHEELCHAIR SEAT CUSHION, ANY SIZE
WHEELCHAIR SEAT CUSHION, POWERED
GENERAL USE WHEELCHAIR BACK CUSHION, WIDTH LESS THAN 22 INCHES, ANY HEIGHT,
GENERAL USE WHEELCHAIR BACK CUSHION, WIDTH 22 INCHES OR GREATER, ANY HEIGHT,
POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR, WIDTH LESS THAN 22 INCHES, ANY
POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR, WIDTH 22 INCHES OR GREATER, ANY
POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR-LATERAL, WIDTH LESS THAN 22
POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR-LATERAL, WIDTH 22 INCHES OR
CUSTOM FABRICATED WHEELCHAIR BACK CUSHION, ANY SIZE, INCLUDING ANY TYPE
REPLACEMENT COVER FOR WHEELCHAIR SEAT CUSHION OR BACK CUSHION, EACH
POSITIONING WHEELCHAIR BACK CUSHION, PLANAR BACK WITH LATERAL SUPPORTS, WIDTH
POSITIONING WHEELCHAIR BACK CUSHION, PLANAR BACK WITH LATERAL SUPPORTS, WIDTH
SKIN PROTECTION WHEELCHAIR SEAT CUSHION, ADJUSTABLE, WIDTH LESS THAN 22 INCHES,
SKIN PROTECTION WHEELCHAIR SEAT CUSHION, ADJUSTABLE, WIDTH 22 INCHES OR GREATER,
SKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CUSHION, ADJUSTABLE, WIDTH LESS
SKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CUSHION, ADJUSTABLE, WIDTH 22 IN
WHEELCHAIR ACCESSORY, SHOULDER ELBOW, MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR,
WHEELCHAIR ACCESSORY, SHOULDER ELBOW, MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR,
WHEELCHAIR ACCESSORY, SHOULDER ELBOW, MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR,
WHEELCHAIR ACCESSORY, SHOULDER ELBOW, MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR,
WHEELCHAIR ACCESSORY, SHOULDER ELBOW, MOBILE ARM SUPPORT, MONOSUSPENSION ARM AND
WHEELCHAIR ACCESSORY, ADDITION TO MOBILE ARM SUPPORT, ELEVATING PROXIMAL ARM
WHEELCHAIR ACCESSORY, ADDITION TO MOBILE ARM SUPPORT, OFFSET OR LATERAL ROCKER
WHEELCHAIR ACCESSORY, ADDITION TO MOBILE ARM SUPPORT, SUPINATOR
GAIT TRAINER, PEDIATRIC SIZE, POSTERIOR SUPPORT, INCLUDES ALL ACCESSORIES AND
GAIT TRAINER, PEDIATRIC SIZE, UPRIGHT SUPPORT, INCLUDES ALL ACCESSORIES AND
GAIT TRAINER, PEDIATRIC SIZE, ANTERIOR SUPPORT, INCLUDES ALL ACCESSORIES AND
SEMEN ANALYSIS; PRESENCE AND/OR MOTILITY OF SPERM EXCLUDING HUHNER
BLOOD CHOLESTEROL TEST, BY CHOLESTEROL MONITORING DEVICE APPROVED BY FDA FOR HOM
GLUCOSE POST DOSE (INCLUDES GLUCOSE) DIRECT MEASUREMENT BY A GLUCOSE TESTING DEV
GLUCOSE TOLERANCE TEST (GTT), BY DIRECT MEASUREMENT BY GLUCOSE TESTING DEVICE AP
GLUCOSE TOLERANCE TEST (GTT), BY DIRECT MEASUREMENT BY A GLUCOSE TESTING DEVICE
CERVICAL OR VAGINAL CANCER SCREENING; PELVIC AND CLINICAL BREAST EXAMINATION
PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA)
COLORECTAL CANCER SCREENING; BARIUM ENEMA
SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED
SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED
SINGLE ENERGY X-RAY ABSORPTIOMETRY (SEXA) BONE DENSITY STUDY, ONE OR MORE
SCREENING CYTOPATHOLOGY SMEARS, CERVICAL OR VAGINAL, PERFORMED BY AUTOMATED
SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED
SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED
SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED
SCREENING CYTOPATHOLOGY SMEARS, CERVICAL OR VAGINAL, PERFORMED BY AUTOMATED
SCREENING CYTOPATHOLOGY SMEARS, CERVICAL OR VAGINAL, PERFORMED BY AUTOMATED
DIRECT SKILLED NURSING SERVICES OF A LICENSED NURSE (LPN OR RN) IN THE HOME HEAL
WOUND CLOSURE UTILIZING TISSUE ADHESIVE(S) ONLY
SCHEDULED INTERDISCIPLINARY TEAM CONFERENCE (MINIMUM OF THREE EXCLUSIVE OF
PHYSICIAN RE-CERTIFICATION FOR MEDICARE-COVERED HOME HEALTH SERVICES UNDER A
PHYSICIAN CERTIFICATION FOR MEDICARE-COVERED HOME HEALTH SERVICES UNDER A HOME
SCREENING MAMMOGRAPHY, PRODUCING DIRECT DIGITAL IMAGE, BILATERAL, ALL VIEWS
DIAGNOSTIC MAMMOGRAPHY, PRODUCING DIRECT DIGITAL IMAGE, BILATERAL, ALL VIEWS
DIAGNOSTIC MAMMOGRAPHY, PRODUCING DIRECT DIGITAL IMAGE, UNILATERAL, ALL VIEWS
PET IMAGING WHOLE BODY; MELANOMA FOR NON-COVERED INDICATIONS
INITIAL PHYSICIAN EVALUATION AND MANAGEMENT OF A DIABETIC PATIENT WITH DIABETIC
FOLLOW-UP PHYSICIAN EVALUATION AND MANAGEMENT OF A DIABETIC PATIENT WITH
DEMONSTRATION, PRIOR TO INITIAL USE, OF HOME INR MONITORING FOR PATIENT WITH EIT
PROVISION OF TEST MATERIALS AND EQUIPMENT FOR HOME INR MONITORING OF PATIENT WIT
PHYSICIAN REVIEW, INTERPRETATION, AND PATIENT MANAGEMENT OF HOME INR TESTING FOR
MEDICAL NUTRITION THERAPY; REASSESSMENT AND SUBSEQUENT INTERVENTION(S)
MEDICAL NUTRITION THERAPY, REASSESSMENT AND SUBSEQUENT INTERVENTION(S)
ELECTRICAL STIMULATION, (UNATTENDED), TO ONE OR MORE AREAS, FOR CHRONIC STAGE
ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR INDICATION(S)
NONCOVERED SURGICAL PROCEDURE(S) USING CONSCIOUS SEDATION, REGIONAL, GENERAL OR
NONCOVERED PROCEDURE(S) USING EITHER NO ANESTHESIA OR LOCAL ANESTHESIA ONLY, IN
COMPLETE CBC, AUTOMATED (HGB, HCT, RBC, WBC, WITHOUT PLATELET COUNT) AND
COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC; WITHOUT PLATELET COUNT)
COLORECTAL CANCER SCREENING; FECAL OCCULT BLOOD TEST, IMMUNOASSAY, 1-3
ELECTROMAGNETIC THERAPY, TO ONE OR MORE AREAS FOR CHRONIC STAGE III AND STAGE
HOSPICE EVALUATION AND COUNSELING SERVICES, PRE-ELECTION
BONE MARROW ASPIRATION PERFORMED WITH BONE MARROW BIOPSY THROUGH THE SAME
DIRECT ADMISSION OF PATIENT FOR HOSPITAL OBSERVATION CARE
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY (EIA) TECHNIQUE, QUALIT
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME-LINKED IMMONOSORBENT ASSAY (ELISA)
INFECTIOUS AGENT ANTIGEN DETECTION BY RAPID ANTIBODY TEST ORORAL MUCOSA TRANSUD
EVALUATION FOR WHEELCHAIR REQUIRING FACE TO FACE VISIT WITH PHYSICIAN
ALCOHOL AND/OR DRUG ASSESSMENT
BEHAVIORAL HEALTH SCREENING TO DETERMINE ELIGIBILITY FOR ADMISSION TO TREATMENT
BEHAVIORAL HEALTH COUNSELING AND THERAPY, PER 15 MINUTES (GROUP)
BEHAVIORAL HEALTH; SHORT-TERM RESIDENTIAL (NON-HOSPITAL RESIDENTIAL TREATMENT
BEHAVIORAL HEALTH; LONG-TERM RESIDENTIAL (NON-MEDIAL, NON-ACUTE CARE IN A
ALCOHOL AND/OR DRUG SERVICES; METHADONE ADMINISTRATION AND/OR SERVICE
BEHAVIORAL HEALTH PREVENTION EDUCATION SERVICE (DELIVERY OF SERVICES WITH
MENTAL HEALTH ASSESSMENT, BY NON-PHYSICIAN
MEDICATION TRAINING AND SUPPORT, PER 15 MINUTES
COMMUNITY PSYCHIATRIC SUPPORTIVE TREATMENT, FACE-TO-FACE, PER 15 MINUTES
COMMUNITY PSYCHIATRIC SUPPORTIVE TREATMENT PROGRAM, PER DIEM
SELF-HELP/PEER SERVICES, PER 15 MINUTES
COMPREHENSIVE MEDICATION SERVICES, PER 15 MINUTES
CRISIS INTERVENTION SERVICE, PER 15 MINUTES
BEHAVIORAL HEALTH DAY TREATMENT, PER HOUR
SKILLS TRAINING AND DEVELOPMENT, PER 15 MINUTES
COMPREHENSIVE COMMUNITY SUPPORT SERVICES, PER 15 MINUTES
COMPREHENSIVE COMMUNITY SUPPORT SERVICES, PER DIEM
PSYCHOSOCIAL REHABILITATION SERVICES, PER 15 MINUTES
THERAPEUTIC BEHAVIORAL SERVICES, PER 15 MINUTES
THERAPEUTIC BEHAVIORAL SERVICES, PER DIEM
ONGOING SUPPORT TO MAINTAIN EMPLOYMENT, PER 15 MINUTES
ONGOING SUPPORT TO MAINTAIN EMPLOYMENT, PER DIEM
PSYCHOEDUCATIONAL SERVICE, PER 15 MINUTES
INJECTION, ABATACEPT, 10 MG
INJECTION ABCIXIMAB, 10 MG
INJECTION, ACETAMINOPHEN, 10 MG
INJECTION, ACETYLCYSTEINE, 100 MG
INJECTION, ADALIMUMAB, 20 MG
INJECTION, ADENOSINE FOR DIAGNOSTIC USE, 30 MG (NOT TO BE USED TO REPORT ANY
INJECTION, AGALSIDASE BETA, 1 MG
INJECTION, BIPERIDEN LACTATE, PER 5 MG
INJECTION, ALGLUCERASE, PER 10 UNITS
INJECTION, AMIFOSTINE, 500 MG
INJECTION, METHYLDOPATE HCL, UP TO 250 MG
INJECTION, ALEFACEPT, 0.5 MG
INJECTION, ALGLUCOSIDASE ALFA, 10 MG.
INJECTION, ALGLUCOSIDASE ALFA, (LUMIZYME), 10 MG
INJECTION, ALPHA 1 - PROTEINASE INHIBITOR - HUMAN, 10 MG
INJECTION, ALPHA 1 PROTEINASE INHIBITOR (HUMAN), (GLASSIA), 10 MG
INJECTION, AMPHOTERICIN B LIPID COMPLEX, 10 MG
INJECTION, AMPHOTERICIN B CHOLESTERYL SULFATE COMPLEX, 10 MG
INJECTION, AMPHOTERICIN B LIPOSOME, 10 MG
INJECTION, AMOBARBITAL, UP TO 125 MG
INJECTION, ANIDULAFUNGIN, 1 MG
INJECTION, ANISTREPLASE, PER 30 UNITS
INJECTION, APOMORPHINE HYDROCHLORIDE, 1 MG
INJECTION, ARBUTAMINE HCL, 1 MG
INJECTION, BACLOFEN, 10 MG
INJECTION, BACLOFEN, 50 MCG FOR INTRATHECAL TRIAL
INJECTION, BASILIXIMAB, 20 MG
INJECTION, BELIMUMAB, 10 MG
INJECTION, BENZTROPINE MESYLATE, PER 1 MG
INJECTION, BIVALIRUDIN, 1 MG
INJECTION, ONABOTULINUMTOXINA, 1 UNIT
INJECTION, ABOBOTULINUMTOXINA, 5 UNITS
INJECTION, RIMABOTULINUMTOXINB, 100 UNITS
INJECTION, INCOBOTULINUMTOXIN A, 1 UNIT
INJECTION, BUSULFAN, 1 MG
INJECTION, C-1 ESTERASE INHIBITOR (HUMAN), BERINERT, 10 UNITS
INJECTION, C-1 ESTERASE INHIBITOR (HUMAN), CINRYZE, 10 UNITS
INJECTION, EDETATE CALCIUM DISODIUM, UP TO 1000 MG
INJECTION, CALCITONIN SALMON, UP TO 400 UNITS
INJECTION, CASPOFUNGIN ACETATE, 5 MG
INJECTION, CANAKINUMAB, 1 MG
INJECTION, LEVOLEUCOVORIN CALCIUM, 0.5 MG
INJECTION, CEFTAROLINE FOSAMIL, 10 MG
INJECTION, CERTOLIZUMAB PEGOL, 1 MG
INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG
INJECTION, CIDOFOVIR, 375 MG
INJECTION, COLLAGENASE, CLOSTRIDIUM HISTOLYTICUM, 0.01 MG
INJECTION, CORTICORELIN OVINE TRIFLUTATE, 1 MICROGRAM
INJECTION, CORTICOTROPIN, UP TO 40 UNITS
INJECTION, COSYNTROPIN, NOT OTHERWISE SPECIFIED, 0.25 MG
INJECTION, COSYNTROPIN (CORTROSYN), 0.25 MG
INJECTION, CROTALIDAE POLYVALENT IMMUNE FAB (OVINE), UP TO 1 GRAM
INJECTION, CYTOMEGALOVIRUS IMMUNE GLOBULIN INTRAVENOUS (HUMAN), PER VIAL
INJECTION, DAPTOMYCIN, 1 MG
INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (NON-ESRD USE)
INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (FOR ESRD ON DIALYSIS)
INJECTION, EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
INJECTION, EPOETIN ALFA, 1000 UNITS (FOR ESRD ON DIALYSIS)
INJECTION, DECITABINE, 1 MG
INJECTION, DENOSUMAB, 1 MG
INJECTION, BROMPHENIRAMINE MALEATE, PER 10 MG
INJECTION, MEDROXYPROGESTERONE ACETATE FOR CONTRACEPTIVE USE, 150 MG
INJECTION, MEDROXYPROGESTERONE ACETATE / ESTRADIOL CYPIONATE, 5MG / 25MG
INJECTION, DIGOXIN IMMUNE FAB (OVINE), PER VIAL
INJECTION, DEXRAZOXANE HYDROCHLORIDE, PER 250 MG
INJECTION, CHLOROTHIAZIDE SODIUM, PER 500 MG
INJECTION, DMSO, DIMETHYL SULFOXIDE, 50%, 50 ML
INJECTION, ECALLANTIDE, 1 MG
INJECTION, ECULIZUMAB, 10 MG
INJECTION, ENFUVIRTIDE, 1 MG
INJECTION, EPTIFIBATIDE, 5 MG
INJECTION, ESTROGEN CONJUGATED, PER 25 MG
INJECTION, ETHANOLAMINE OLEATE, 100 MG
INJECTION, ESTRONE, PER 1 MG
INJECTION, ETANERCEPT, 25 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG
INJECTION, FILGRASTIM (G-CSF), 300 MCG
INJECTION, FILGRASTIM (G-CSF), 480 MCG
INJECTION, FOMEPIZOLE, 15 MG
INJECTION, FOMIVIRSEN SODIUM, INTRAOCULAR, 1.65 MG
INJECTION, FOSAPREPITANT, 1 MG
INJECTION, FOSCARNET SODIUM, PER 1000 MG
INJECTION, GALLIUM NITRATE, 1 MG
INJECTION, GALSULFASE, 1 MG
INJECTION, IMMUNE GLOBULIN (PRIVIGEN), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 1 CC
INJECTION, IMMUNE GLOBULIN, (GAMMAPLEX), INTRAVENOUS, NON-LYOPHILIZED (E.G.LIQUI
INJECTION, IMMUNE GLOBULIN (HIZENTRA), 100 MG
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, OVER 10 CC
INJECTION, IMMUNE GLOBULIN, (GAMUNEX), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID
INJECTION, IMMUNE GLOBULIN (VIVAGLOBIN), 100 MG
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G. POWDER), NOT OTHERWIS
INJECTION, IMMUNE GLOBULIN, (OCTAGAM), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID
INJECTION, IMMUNE GLOBULIN, (GAMMAGARD LIQUID), INTRAVENOUS, NON-LYOPHILIZED, (E
INJECTION, GANCICLOVIR SODIUM, 500 MG
INJECTION, HEPATITIS B IMMUNE GLOBULIN (HEPAGAM B), INTRAMUSCULAR, 0.5 ML
INJECTION, IMMUNE GLOBULIN, (FLEBOGAMMA/FLEBOGAMMA DIF), INTRAVENOUS, NON-LYOPHI
INJECTION, HEPATITIS B IMMUNE GLOBULIN (HEPAGAM B), INTRAVENOUS, 0.5 ML
INJECTION, GLUCAGON HYDROCHLORIDE, PER 1 MG
INJECTION, GONADORELIN HYDROCHLORIDE, PER 100 MCG
INJECTION, HEMIN, 1 MG
INJECTION, TETANUS IMMUNE GLOBULIN, HUMAN, UP TO 250 UNITS
INJECTION, HISTRELIN ACETATE, 10 MICROGRAMS
INJECTION, HUMAN FIBRINOGEN CONCENTRATE, 100 MG
INJECTION, HYDROXYPROGESTERONE CAPROATE, 1 MG
INJECTION, DIAZOXIDE, UP TO 300 MG
INJECTION, IBANDRONATE SODIUM, 1 MG
INJECTION, IBUTILIDE FUMARATE, 1 MG
INJECTION, IDURSULFASE, 1 MG
INJECTION INFLIXIMAB, 10 MG
INJECTION, IRON DEXTRAN, 50 MG
INJECTION, IRON SUCROSE, 1 MG
INJECTION, IMIGLUCERASE, 10 UNITS
INJECTION, DROPERIDOL AND FENTANYL CITRATE, UP TO 2 ML AMPULE
INJECTION, INTERFERON BETA-1A, 30 MCG
INJECTION INTERFERON BETA-1B, 0.25 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG
INJECTION, ITRACONAZOLE, 50 MG
INJECTION, LANREOTIDE, 1 MG
INJECTION, LARONIDASE, 0.1 MG
INJECTION, LEPIRUDIN, 50 MG
INJECTION, LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), PER 3.75 MG
INJECTION, LEVOCARNITINE, PER 1 GM
INJECTION, LINEZOLID, 200MG
INJECTION, MECASERMIN, 1 MG
INJECTION, MICAFUNGIN SODIUM, 1 MG
INJECTION, MINOCYCLINE HYDROCHLORIDE, 1 MG
INJECTION, ZICONOTIDE, 1 MICROGRAM
INJECTION, NALTREXONE, DEPOT FORM, 1 MG
INJECTION, NANDROLONE DECANOATE, UP TO 50 MG
INJECTION, NATALIZUMAB, 1 MG
INJECTION, NESIRITIDE, 0.1 MG
INJECTION, OCTREOTIDE, DEPOT FORM FOR INTRAMUSCULAR INJECTION, 1 MG
INJECTION, OPRELVEKIN, 5 MG
INJECTION, OMALIZUMAB, 5 MG
INJECTION, OLANZAPINE, LONG-ACTING, 1 MG
INJECTION, PALIFERMIN, 50 MICROGRAMS
INJECTION, PALIPERIDONE PALMITATE EXTENDED RELEASE, 1 MG
INJECTION, OXYTETRACYCLINE HCL, UP TO 50 MG
INJECTION, PALONOSETRON HCL, 25 MCG
INJECTION, PEGAPTANIB SODIUM, 0.3 MG
INJECTION, PEGADEMASE BOVINE, 25 IU
INJECTION, PEGFILGRASTIM, 6 MG
INJECTION, PEGLOTICASE, 1 MG
INJECTION, PENICILLIN G PROCAINE, AQUEOUS, UP TO 600,000 UNITS
INJECTION, PENTASTARCH, 10% SOLUTION, 100 ML
PENTAMIDINE ISETHIONATE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-CO
INJECTION, PLERIXAFOR, 1 MG
INJECTION, OXACILLIN SODIUM, UP TO 250 MG
INJECTION, PROTEIN C CONCENTRATE, INTRAVENOUS, HUMAN, 10 IU
INJECTION, PROTIRELIN, PER 250 MCG
INJECTION, PRALIDOXIME CHLORIDE, UP TO 1 GM
INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG
INJECTION, QUINUPRISTIN/DALFOPRISTIN, 500 MG (150/350)
INJECTION, RANIBIZUMAB, 0.1 MG
INJECTION, RASBURICASE, 0.5 MG
INJECTION, REGADENOSON, 0.1 MG
INJECTION, RHO D IMMUNE GLOBULIN, HUMAN, MINIDOSE, 50 MICROGRAMS (250 I.U.)
INJECTION, RHO D IMMUNE GLOBULIN, HUMAN, FULL DOSE, 300 MICROGRAMS (1500 I.U.)
INJECTION, RHO(D) IMMUNE GLOBULIN (HUMAN), (RHOPHYLAC), INTRAMUSCULAR OR INTRAVE
INJECTION, RHO D IMMUNE GLOBULIN, INTRAVENOUS, HUMAN, SOLVENT DETERGENT, 100 IU
INJECTION, RILONACEPT, 1 MG
INJECTION, RISPERIDONE, LONG ACTING, 0.5 MG
INJECTION, ROMIPLOSTIM, 10 MICROGRAMS
INJECTION, SINCALIDE, 5 MICROGRAMS
INJECTION, SARGRAMOSTIM (GM-CSF), 50 MCG
INJECTION, SECRETIN, SYNTHETIC, HUMAN, 1 MICROGRAM
INJECTION, SOMATREM, 1 MG
INJECTION, SOMATROPIN, 1 MG
INJECTION, RETEPLASE, 18.1 MG
INJECTION, STREPTOKINASE, PER 250,000 IU
INJECTION, ALTEPLASE RECOMBINANT, 1 MG
INJECTION, SUMATRIPTAN SUCCINATE, 6 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG
INJECTION, TELEVANCIN, 10 MG
INJECTION, TENECTEPLASE, 1 MG
INJECTION, TERIPARATIDE, 10 MCG
INJECTION, THYROTROPIN ALPHA, 0.9 MG, PROVIDED IN 1.1 MG VIAL
INJECTION, TIGECYCLINE, 1 MG
INJECTION, TIROFIBAN HCL, 0.25MG
INJECTION, TOCILIZUMAB, 1 MG
INJECTION, TREPROSTINIL, 1 MG
INJECTION, TRIAMCINOLONE ACETONIDE, PRESERVATIVE FREE, 1 MG
INJECTION, TRIMETREXATE GLUCURONATE, PER 25 MG
INJECTION, PERPHENAZINE, UP TO 5 MG
INJECTION, TRIPTORELIN PAMOATE, 3.75 MG
INJECTION, SPECTINOMYCIN DIHYDROCHLORIDE, UP TO 2 GM
INJECTION, UREA, UP TO 40 GM
INJECTION, USTEKINUMAB, 1 MG
INJECTION, IV, UROKINASE, 250,000 I.U. VIAL
INJECTION, VELAGLUCERASE ALFA, 100 UNITS
INJECTION, VERTEPORFIN, 0.1 MG
INJECTION, TRIFLUPROMAZINE HCL, UP TO 20 MG
INJECTION, VORICONAZOLE, 10 MG
INJECTION, ZOLEDRONIC ACID (ZOMETA), 1 MG
INJECTION, ZOLEDRONIC ACID (RECLAST), 1 MG
EDETATE DISODIUM, PER 150 MG
DRUG ADMINISTERED THROUGH A METERED DOSE INHALER
INJECTION, FACTOR XIII (ANTIHEMOPHILIC FACTOR, HUMAN), 1 I.U.
INJECTION, VON WILLEBRAND FACTOR COMPLEX (HUMAN), WILATE, 1 I.U. VWF:RCO
INJECTION, FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) (XYNTHA), PER I.U.
INJECTION, ANTIHEMOPHILIC FACTOR VIII/VON WILLEBRAND FACTOR COMPLEX (HUMAN), PER
INJECTION, VON WILLEBRAND FACTOR COMPLEX (HUMATE-P), PER IU VWF:RCO
FACTOR VIIA (ANTIHEMOPHILIC FACTOR, RECOMBINANT), PER 1 MICROGRAM
FACTOR VIII (ANTIHEMOPHILIC FACTOR, HUMAN) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR (PORCINE)), PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U., NOT OTHERWISE SPECIFI
FACTOR IX (ANTIHEMOPHILIC FACTOR, PURIFIED, NON-RECOMBINANT) PER I.U.
FACTOR IX, COMPLEX, PER I.U.
FACTOR IX (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.
INJECTION, ANTITHROMBIN RECOMBINANT, 50 I.U.
ANTITHROMBIN III (HUMAN), PER I.U.
ANTI-INHIBITOR, PER I.U.
HEMOPHILIA CLOTTING FACTOR, NOT OTHERWISE CLASSIFIED
INTRAUTERINE COPPER CONTRACEPTIVE
LEVONORGESTREL-RELEASING INTRAUTERINE CONTRACEPTIVE SYSTEM, 52 MG
CONTRACEPTIVE SUPPLY, HORMONE CONTAINING VAGINAL RING, EACH
CONTRACEPTIVE SUPPLY, HORMONE CONTAINING PATCH, EACH
ETONOGESTREL (CONTRACEPTIVE) IMPLANT SYSTEM, INCLUDING IMPLANT AND SUPPLIES
AMINOLEVULINIC ACID HCL FOR TOPICAL ADMINISTRATION, 20%, SINGLE UNIT DOSAGE
METHYL AMINOLEVULINATE (MAL) FOR TOPICAL ADMINISTRATION, 16.8%, 1 GRAM
GANCICLOVIR, 4.5 MG, LONG-ACTING IMPLANT
FLUOCINOLONE ACETONIDE, INTRAVITREAL IMPLANT
INJECTION, DEXAMETHASONE, INTRAVITREAL IMPLANT, 0.1 MG
HYALURONAN OR DERIVATIVE, HYALGAN OR SUPARTZ, FOR INTRA-ARTICULAR INJECTION, PER
HYALURONAN OR DERIVATIVE, EUFLEXXA, FOR INTRA-ARTICULAR INJECTION, PER DOSE
HYALURONAN OR DERIVATIVE, ORTHOVISC, FOR INTRA-ARTICULAR INJECTION, PER DOSE
HYALURONAN OR DERIVATIVE, SYNVISC OR SYNVISC-ONE, FOR INTRA-ARTICULAR INJECTION,
HYALURONAN OR DERIVATIVE, GEL-ONE, FOR INTRA-ARTICULAR INJECTION, PER DOSE
CAPSAICIN 8% PATCH, PER 10 SQUARE CENTIMETERS
AZATHIOPRINE, PARENTERAL, 100 MG
LYMPHOCYTE IMMUNE GLOBULIN, ANTITHYMOCYTE GLOBULIN, EQUINE, PARENTERAL, 250 MG
MUROMONAB-CD3, PARENTERAL, 5 MG
LYMPHOCYTE IMMUNE GLOBULIN, ANTITHYMOCYTE GLOBULIN, RABBIT, PARENTERAL, 25MG
DACLIZUMAB, PARENTERAL, 25 MG
TACROLIMUS, PARENTERAL, 5 MG
ACETYLCYSTEINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DM
ARFORMOTEROL, INHALATION SOLUTION, FDA APPROVED FINAL PRODUCT, NON-COMPOUNDED, A
FORMOTEROL FUMARATE, INHALATION SOLUTION, FDA APPROVED FINAL PRODUCT, NON-COMPOU
LEVALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME,
ACETYLCYSTEINE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED,
ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UN
ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, CO
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMI
LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, A
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMI
LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, A
LEVALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME,
ALBUTEROL, UP TO 2.5 MG AND IPRATROPIUM BROMIDE, UP TO 0.5 MG, FDA-APPROVED FINA
BECLOMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH D
BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME
BUDESONIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADM
BUDESONIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, U
BITOLTEROL MESYLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THRO
BITOLTEROL MESYLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THRO
CROMOLYN SODIUM, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED
CROMOLYN SODIUM, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH D
BUDESONIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADM
BUDESONIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, C
ATROPINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, CON
ATROPINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNI
DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME
DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME
DORNASE ALFA, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, A
FLUNISOLIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME,
GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DM
GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DM
IPRATROPIUM BROMIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOU
IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROU
ISOETHARINE HCL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH D
ISOETHARINE HCL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED
ISOETHARINE HCL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED
ISOETHARINE HCL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH D
ISOPROTERENOL HCL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH
ISOPROTERENOL HCL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUND
ISOPROTERENOL HCL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUND
ISOPROTERENOL HCL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH
MANNITOL, ADMINISTERED THROUGH AN INHALER, 5 MG
METAPROTERENOL SULFATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, CONCENTRATED FO
METAPROTERENOL SULFATE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COM
METAPROTERENOL SULFATE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COM
METAPROTERENOL SULFATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED TH
PENTAMIDINE ISETHIONATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED T
TERBUTALINE SULFATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROU
TERBUTALINE SULFATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROU
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, UNI
TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME
TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME
TOBRAMYCIN, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, U
TREPROSTINIL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, A
NOC DRUGS, INHALATION SOLUTION ADMINISTERED THROUGH DME
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
APREPITANT, ORAL, 5 MG
BUSULFAN; ORAL, 2 MG
CAPECITABINE, ORAL, 150 MG
CAPECITABINE, ORAL, 500 MG
ETOPOSIDE; ORAL, 50 MG
EVEROLIMUS, ORAL, 0.25 MG
FLUDARABINE PHOSPHATE, ORAL, 10 MG
GEFITINIB, ORAL, 250 MG
NABILONE, ORAL, 1 MG
TEMOZOLOMIDE, ORAL, 5 MG
TOPOTECAN, ORAL, 0.25 MG
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
INJECTION, DOXORUBICIN HYDROCHLORIDE, ALL LIPID FORMULATIONS, 10 MG
INJECTION, ALEMTUZUMAB, 10 MG
INJECTION, ALDESLEUKIN, PER SINGLE USE VIAL
INJECTION, ARSENIC TRIOXIDE, 1 MG
INJECTION, ASPARAGINASE, 10,000 UNITS
INJECTION, AZACITIDINE, 1 MG
INJECTION, CLOFARABINE, 1 MG
BCG (INTRAVESICAL) PER INSTILLATION
INJECTION, BENDAMUSTINE HCL, 1 MG
INJECTION, BEVACIZUMAB, 10 MG
INJECTION, BORTEZOMIB, 0.1 MG
INJECTION, CABAZITAXEL, 1 MG
INJECTION, CARMUSTINE, 100 MG
INJECTION, CETUXIMAB, 10 MG
INJECTION, CLADRIBINE, PER 1 MG
CYCLOPHOSPHAMIDE, 100 MG
INJECTION, CYTARABINE LIPOSOME, 10 MG
INJECTION, DACTINOMYCIN, 0.5 MG
INJECTION, DAUNORUBICIN, 10 MG
INJECTION, DAUNORUBICIN CITRATE, LIPOSOMAL FORMULATION, 10 MG
INJECTION, DEGARELIX, 1 MG
INJECTION, DENILEUKIN DIFTITOX, 300 MICROGRAMS
INJECTION, DIETHYLSTILBESTROL DIPHOSPHATE, 250 MG
INJECTION, DOCETAXEL, 1 MG
INJECTION, EPIRUBICIN HCL, 2 MG
INJECTION, ERIBULIN MESYLATE, 0.1 MG
INJECTION, FLUDARABINE PHOSPHATE, 50 MG
INJECTION, FLOXURIDINE, 500 MG
INJECTION, GEMCITABINE HYDROCHLORIDE, 200 MG
GOSERELIN ACETATE IMPLANT, PER 3.6 MG
INJECTION, IRINOTECAN, 20 MG
INJECTION, IXABEPILONE, 1 MG
INJECTION, IFOSFAMIDE, 1 GRAM
INJECTION, IDARUBICIN HYDROCHLORIDE, 5 MG
INJECTION, INTERFERON ALFACON-1, RECOMBINANT, 1 MICROGRAM
INJECTION, INTERFERON, ALFA-2B, RECOMBINANT, 1 MILLION UNITS
INJECTION, INTERFERON, ALFA-N3, (HUMAN LEUKOCYTE DERIVED), 250,000 IU
INJECTION, INTERFERON, GAMMA 1-B, 3 MILLION UNITS
LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG
LEUPROLIDE ACETATE, PER 1 MG
LEUPROLIDE ACETATE IMPLANT, 65 MG
HISTRELIN IMPLANT (VANTAS), 50 MG
HISTRELIN IMPLANT (SUPPRELIN LA), 50 MG
INJECTION, IPILIMUMAB, 1 MG
INJECTION, MECHLORETHAMINE HYDROCHLORIDE, (NITROGEN MUSTARD), 10 MG
INJECTION, MELPHALAN HYDROCHLORIDE, 50 MG
INJECTION, NELARABINE, 50 MG
INJECTION, OXALIPLATIN, 0.5 MG
INJECTION, PACLITAXEL PROTEIN-BOUND PARTICLES, 1 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PEGASPARGASE, PER SINGLE DOSE VIAL
INJECTION, PENTOSTATIN, 10 MG
MITOMYCIN, 5 MG
INJECTION, MITOXANTRONE HYDROCHLORIDE, PER 5 MG
INJECTION, GEMTUZUMAB OZOGAMICIN, 5 MG
INJECTION, OFATUMUMAB, 10 MG
INJECTION, PANITUMUMAB, 10 MG
INJECTION, PEMETREXED, 10 MG
INJECTION, PRALATREXATE, 1 MG
INJECTION, RITUXIMAB, 100 MG
INJECTION, ROMIDEPSIN, 1 MG
INJECTION, STREPTOZOCIN, 1 GRAM
INJECTION, TEMOZOLOMIDE, 1 MG
INJECTION, TEMSIROLIMUS, 1 MG
INJECTION, THIOTEPA, 15 MG
INJECTION, TOPOTECAN, 0.1 MG
INJECTION, TRASTUZUMAB, 10 MG
INJECTION, VALRUBICIN, INTRAVESICAL, 200 MG
INJECTION, VINORELBINE TARTRATE, 10 MG
INJECTION, FULVESTRANT, 25 MG
INJECTION, PORFIMER SODIUM, 75 MG
STANDARD WHEELCHAIR
STANDARD HEMI (LOW SEAT) WHEELCHAIR
LIGHTWEIGHT WHEELCHAIR
HIGH STRENGTH, LIGHTWEIGHT WHEELCHAIR
ULTRALIGHTWEIGHT WHEELCHAIR
HEAVY DUTY WHEELCHAIR
EXTRA HEAVY DUTY WHEELCHAIR
OTHER MANUAL WHEELCHAIR/BASE
STANDARD - WEIGHT FRAME MOTORIZED/POWER WHEELCHAIR
STANDARD - WEIGHT FRAME MOTORIZED/POWER WHEELCHAIR WITH PROGRAMMABLE CONTROL
LIGHTWEIGHT PORTABLE MOTORIZED/POWER WHEELCHAIR
OTHER MOTORIZED/POWER WHEELCHAIR BASE
DETACHABLE, NON-ADJUSTABLE HEIGHT ARMREST, EACH
DETACHABLE, ADJUSTABLE HEIGHT ARMREST, BASE, EACH
DETACHABLE, ADJUSTABLE HEIGHT ARMREST, UPPER PORTION, EACH
ARM PAD, EACH
FIXED, ADJUSTABLE HEIGHT ARMREST, PAIR
HIGH MOUNT FLIP-UP FOOTREST, EACH
LEG STRAP, EACH
LEG STRAP, H STYLE, EACH
ADJUSTABLE ANGLE FOOTPLATE, EACH
LARGE SIZE FOOTPLATE, EACH
STANDARD SIZE FOOTPLATE, EACH
FOOTREST, LOWER EXTENSION TUBE, EACH
FOOTREST, UPPER HANGER BRACKET, EACH
FOOTREST, COMPLETE ASSEMBLY
ELEVATING LEGREST, LOWER EXTENSION TUBE, EACH
ELEVATING LEGREST, UPPER HANGER BRACKET, EACH
RATCHET ASSEMBLY
CAM RELEASE ASSEMBLY, FOOTREST OR LEGREST, EACH
SWINGAWAY, DETACHABLE FOOTRESTS, EACH
ELEVATING FOOTRESTS, ARTICULATING (TELESCOPING), EACH
SEAT HEIGHT LESS THAN17" OR EQUAL TOOR GREATER THAN 21" FOR A HIGH
SPOKE PROTECTORS, EACH
REAR WHEEL ASSEMBLY, COMPLETE, WITH SOLID TIRE, SPOKES OR MOLDED, EACH
REAR WHEEL ASSEMBLY, COMPLETE, WITH PNEUMATIC TIRE, SPOKES OR MOLDED, EACH
FRONT CASTER ASSEMBLY, COMPLETE, WITH PNEUMATIC TIRE, EACH
FRONT CASTER ASSEMBLY, COMPLETE, WITH SEMI-PNEUMATIC TIRE, EACH
CASTER PIN LOCK,EACH
FRONT CASTER ASSEMBLY, COMPLETE, WITH SOLID TIRE, EACH
IV HANGER, EACH
WHEELCHAIR COMPONENT OR ACCESSORY, NOT OTHERWISE SPECIFIED
ELEVATING LEG RESTS, PAIR (FOR USE WITH CAPPED RENTAL WHEELCHAIR BASE)
INFUSION PUMP USED FOR UNINTERRUPTED PARENTERAL ADMINISTRATION OF MEDICATION,
TEMPORARY REPLACEMENT FOR PATIENT OWNED EQUIPMENT BEING REPAIRED, ANY TYPE
GAUZ,IMPREGNATED,HYDROGEL,FOR DIRECT WOUND CONTACT,PAD SIZE 16SQ IN OR LESS W/O
GAUZE,IMPREGNATED,HYDROGEL,FOR DIRECT WOULD CONTACT,PAD SIZEMORE>16SQ<48SQ IN
GAUZE,IMPREGNATED,HYDROGEL,FOR DIRECT WOUND CONTACT,PAD>48SQINCHES W/O ADHESIVE
SUPPLIES FOR EXTERNAL DRUG INFUSION PUMP, SYRINGE TYPE CARTRIDGE, STERILE, EACH
REPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP OWNED BY PATIENT, SILVER OXIDE,
REPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP OWNED BY PATIENT, SILVER OXIDE,
REPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP OWNED BY PATIENT, LITHIUM, 3.6
REPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP OWNED BY PATIENT, LITHIUM, 4.5
AUTOMATIC EXTERNAL DEFIBRILLATOR, WITH INTEGRATED ELECTROCARDIOGRAM ANALYSIS,
REPLACEMENT BATTERY FOR AUTOMATED EXTERNAL DEFIBRILLATOR, GARMENT TYPE ONLY,
REPLACEMENT GARMENT FOR USE WITH AUTOMATED EXTERNAL DEFIBRILLATOR, EACH
REPLACEMENT ELECTRODES FOR USE WITH AUTOMATED EXTERNAL DEFIBRILLATOR, GARMENT
WHEELCHAIR ACCESSORY, WHEELCHAIR SEAT OR BACK CUSHION, DOES NOT MEET SPECIFIC CO
ADDITION TO LOWER EXTREMITY ORTHOSIS, REMOVABLE SOFT INTERFACE, ALL COMPONENTS
CONTROLLED DOSE INHALATION DRUG DELIVERY SYSTEM
POWER WHEELCHAIR ACCESSORY, 12-14 AMP HOUR SEALED LEAD ACID BATTERY (E.G.GEL CEL
PORTABLE GASEOUS OXYTEN SYSTEM, RENTAL, HOME COMPRESSOR USEDTO FILL CYLINDERS
Repair or nonroutine service for durable medical equipment other than oxygen req
Repair or nonroutine service for oxygen equipment requiring the skill of a techn
Suction pump, home model, portable, for use on wounds
Absorptive wound dressing for use with suction pump, home model, portable, pad s
Absorptive wound dressing for use with suction pump, home model, portable, pad s
Absorptive wound dressing for use with suction pump, home model, portable, pad s
POWERED OPERATED VEHICLE GRP. 1 STD PT WT UP TO AND INCL. 300 LBS
POWER OPER. VEH. GRP 1 HEAVY DUTY WEIGHT CAPACITY 301 TO 450 LBS
POWER OPERATED VEHICLE, GRP 1 HVY DUTY, PT. WT. CAPACITY 461TO 600 LBD
POWER OPERATED VEHICLE, GRP. 2 STD, PATIENT WT CAPACITY UP TO/INCL 300 LBS
POWER OPERATED VEHICLE GRP 2 PT WT CAP. 301 TO 450 LBS
POWER VEHICLE GRP. 2 VERY HEAVY DUTY, PT. WEIGHT CAPACITY 451-600 LBS
POWER OPERATED VEHICLE, NOT OTHERWISE CLASSIFIED
POWER WHEELCHAIR GRP 1 STD. PORTABLE SLING/SOLID SEAT & BACKUP TO/INCL 300 LBS
POWER WHEELCHAIR, GRP 1 STANDARD PORTABLE CAPTAINS CHAIR - CAP. UP TO 300 LBS.
POWER WHEELCHAIR GRP 1, STD. SLING/SOLID SEAT & BACK CAP TO & INCL. 300 LBS
POWER WHEELCHAIR, GRP 1 STD. CAPTAINS CHAIR PT. WT CAP. UP TO & INCL. 300 LBS.
POWER WHEELCHAIR, GRP 2 STD, PORTABLE PT. WEIGHT CAP. UP TO & INCL. 300 LBS
POWER WHEELCHAIR, GRP 2 STD. PORTABLE, CAPTAINS CHAIR PT WT.UP TO/INCL. 300 LBS.
POWER WHEELCHAIR, GRP 2 STD, SLING/SOLID SEAT/BACK-PT. WT. UP TO/INCL. 300 LBS.
POWER WHEELCHAIR, GRP 2 STD/ CAPTAINS CHAIR, PT WEIGHT CAP UP TO/INCL 300 LBS
POWER WHEELCHAIR, GRP 2, HEAVY DUTY, SLING/SOLID SEAT/BACK, PT. WT. 301-450 LBS
POWER WHEELCHAIR, GRP. 2 HEAVY DUTY, CAPTAINS CHAIR, PT. WGTCAP. 451-600 LBS.
POWER WHEELCHAIR, GRP 2 VERY HEAVY DUTY, SLING/SOLID SEAT/BACK PT WT CAP 451-600
POWER WHEELCHAIR, GRP 2, VERY HEAVY DUTY, CAPTAINS CHAIR, PTWT. 451-600 LBS.
POWER WHEELCHAIR, GRP 2 EXTRA HEAVY DUTY, SLING/SOLID SEAT/BACK PT. WT. 600#
POWER WHEELCHAIR, GRP. 2 EXTRA HEAVY DUTY, CAPTAINS CHAIR,PTWT CAP. 601# OR MORE
POWER WHEELCHAIR, GRP 2,STD SEAT ELEVATOR SLING/SOLID SEAT/BACK PT. WT UP TO 300
POWER WHEELCHAIR, GRP 2 STD SEAT ELEVATOR, CAPTAINS CHAIR WTCAP UP TO/INCL 300#
POWER WHEELCHAIR, GRP 2 STD, SINGLE POWER OPTION SLING/SOLIDSEAT/BACK-300# CAP
POWER WHEELCHAIR, GRP 2 STD. SINGLE POWER OPTION, CAPTAINS CHAIR WT CAP 300#
POWER WHEELCHAIR GRP 2 HEAVY DUTY SINGLE POWER OPTION, SLING/SOLD SEAT/BACK 450#
POWER WHEELCHAIR, GRP 2 HVY DUTY SINGLE POWER OPTION, CAPT. CHAIR CAP 301-450#
POWER WHEELCHAIR GRP 2 VERY HEAVY DUTY SINGLE POWER OPTION CAP 451 TO 600 LBS
POWER WHEELCHAIR GRP 2 EXTRA HEAVY DUTY, SINGLE POWER OPTIONPT. WT. 601# OR MORE
POWER WHEELCHAIR GRP 2 STD MULTIPLE POWER OPTION SLING/SOLD SEAT/BACK CAP. 300#
POWER WHEELCHAIR GRP 2 STD MULTIPLE POWER OPTION CAPT. CHAIRWHT CAP 300 LBS.
POWER WHEELCHAIR GRP 2 HVY DUTY MULTIPLE POWER OPTION SLING/SOLID SEAT/BACK 450#
POWER WHEELCHAIR GRP 3 STD SLING/SOLID SEAT/BACK PT WT. CAP UP TO/INCL. 300 LBS.
POWER WHEELCHAIR, GRP 3 STD, CAPTAINS CHAIR PT WT UP TO AND INCL 300 LBS.
POWER WHEELCHAIR GRP 3 HVY DUTY SLING/DOLID SEAT/BACK PT WT CAP 301 TO 450 LBS.
POWER WHEELCHAIR, GRP 3 HVY DUTY, CAPTAINS CHAIR, PT. WT CAP301 TO 450 LBS.
POWER WHEELCHAIR, GRP 3 VERY HVY DUTY SLING/SOLID SEAT/BACK WT CAP. 451-600 LBS
POWER WHEELCHAIR GRP 3 VERY HVY DUTY CAPTAINS CHAIR PT WT CAP 451-600 LBS
POWER WHEELCHAIR, GRP 3 EX. HVY DUTY SLING/SOLID SEAR/BACK PT WT. 601# OR MORE
POWER WHEELCHAIR, GRP 3, EX. HVY DUTY CAPTAINS CHAIR PT WT CAP 601# OR MORE
POWER WHEELCHAIR, GRP 3 STD. SINGLE POWER OPTION SLING/SOLIDSEAT/BACK-CAP 300#
POWER WHEELCHAIR, GRP 3 STD SINGLE POWER OPTION CAPTAINS CHAIR WT CAP 300 LBS.
POWER WHEELCHAIR GRP 3 HVY DTY SINGLE POWER OPT. SLING/SOLIDSEAT/BACK-301-450#
POWER WHEELCHAIR, GRP 3 HVY DUTY SINGLE POWER OPTION CAPTAINS CHAIR WT 301-450#
POWER WHEELCHAIR, GRP 3 VRY HVY DUTY SINGLE POWER OPTION-SLING/SOLID-CAP 451-600
POWER WHEELCHAIR, GRP 3 STD. MULTI POWER OPT. SLING'SOLID SEAT;BACK - CAP 300#
POWER WHEELCHAIR, GRP 3 HVY DUTY MULTIPLE POWER OPTION SLING/SOLID-301-450 LBS.
POWR ER WHEELCHAIR, GRP 3 VRY HVY DUTY MULTI POWER OPTION - PT. WEIGHT 451-600#
POWER WHEELCHAIR GRP 3 EX. HVY DUTY MULTI POWER OPTION - PT WHT 601# OR MORE
POWER WHEELCHAIR, GRP 4 STD. SLING/SOLID SEAT/BACK - PT WT. UP TO & INCL. 300#
POWER WHEELCHAIR, GRP 4, STD. CAPTAINS CHAIR-PT WHT CAP UP TO & INCL. 300 LBS
POWER WHEELCHAIR GRP 4 HVY DUTY SLING/SOLID SEAT/BACK PT WT CAPACITY 301-450 LBS
POWER WHEELCHAIR, GRP 4 VERY HVY DUTY, SLING/SOLID SEAT/BACKPT WT. CAP 451-600#
POWER WHEELCHAIR, GRP 4 STD. SINGLE POWER OPTION, SLING/SOLID SEAT/BACK-300# CAP
POWER WHEELCHAIR, GRP 4 STD. SINGLE POWER OPTION, CAPT. CHAIR WT. UP TO 300#
POWER WHEELCHAIR, HVY DUTY, SINGLE POWER OPTION SLING/SOLID SEAT BACK 301-450#
POWER WHEELCHAIR GRP 4 VERY HVY DUTY, SINGLE POWER OPTION PT WT. 451-600 LBS.
POWER WHEELCHAIR, GRP 4 STD. MULTIPLE POWER OPTION PT WT CAP UP TO 300 LBS.
POWER WHEELCHAIR, GRP 4 STD MULT. POWER OPTION, CAPT. CHAI R - CAP. TO 300#
POWER WHEELCHAIR GRP 4 HVY DUTY MULTIPLE POWER OPTION - PT WT. CAP 301-450 LBS.
POWER WHEELCHAIR GRP 5 PED. SINGLE POWER OPTION SLING/SOLID SEAT/BACK-WT TO 125#
POWER WHEELCHAIR GRP 5 PED. MULTIPLE POWER OPTION SLING/SOLID SEAT/BACK 125# CAP
POWER WHEELCHAIR NOT OTHERWISE CLASSIFIED
POWER MOBILITY DEVICE, NOT CODED BY DME PDAC OR DOES NOT MEET CRITERIA
CRANIAL CERVICAL ORTHOSIS, CONGENITAL TORTICOLLIS TYPE, WITH OR WITHOUT SOFT
CRANIAL CERVICAL ORTHOSIS, TORTICOLLIS TYPE, WITH OR WITHOUT JOINT, WITH OR WITH
CERVICAL, FLEXIBLE, NON-ADJUSTABLE (FOAM COLLAR)
CERVICAL, FLEXIBLE, THERMOPLASTIC COLLAR, MOLDED TO PATIENT
CERVICAL, SEMI-RIGID, ADJUSTABLE (PLASTIC COLLAR)
CERVICAL, SEMI-RIGID, ADJUSTABLE MOLDED CHIN CUP (PLASTIC COLLAR WITH
CERVICAL, SEMI-RIGID, WIRE FRAME OCCIPITAL/MANDIBULAR SUPPORT
CERVICAL, COLLAR, MOLDED TO PATIENT MODEL
CERVICAL, COLLAR, SEMI-RIGID THERMOPLASTIC FOAM, TWO PIECE
CERVICAL, COLLAR, SEMI-RIGID, THERMOPLASTIC FOAM, TWO PIECE WITH THORACIC
CERVICAL, MULTIPLE POST COLLAR, OCCIPITAL/MANDIBULAR SUPPORTS, ADJUSTABLE
CERVICAL, MULTIPLE POST COLLAR, OCCIPITAL/MANDIBULAR SUPPORTS, ADJUSTABLE
CERVICAL, MULTIPLE POST COLLAR, OCCIPITAL/MANDIBULAR SUPPORTS, ADJUSTABLE
THORACIC, RIB BELT, CUSTOM FABRICATED
SPINAL ORTHOSIS, ANTERIOR-POSTERIOR-LATERAL CONTROL, WITH INTERFACE MATERIAL,
TLSO, FLEXIBLE, PROVIDES TRUNK SUPPORT, UPPER THORACIC REGION, PRODUCES
TLSO, FLEXIBLE, PROVIDES TRUNK SUPPORT, UPPER THORACIC REGION, PRODUCES
TLSO FLEXIBLE, PROVIDES TRUNK SUPPORT, EXTENDS FROM SACROCOCCYGEAL JUNCTION TO
TLSO, FLEXIBLE, PROVIDES TRUNK SUPPORT, THORACIC REGION, RIGID POSTERIOR PANEL
TLSO, TRIPLANAR CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, TWO RIGID PLASTIC
TLSO, TRIPLANAR CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, TWO RIGID PLASTIC
TLSO, TRIPLANAR CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, THREE RIGID PLASTIC
TLSO, TRIPLANAR CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, FOUR RIGID PLASTIC
TLSO, SAGITTAL CONTROL, RIGID POSTERIOR FRAME AND FLEXIBLE SOFT ANTERIOR APRON
TLSO, SAGITTAL-CORONAL CONTROL, RIGID POSTERIOR FRAME AND FLEXIBLE SOFT
TLSO, TRIPLANAR CONTROL, RIGID POSTERIOR FRAME AND FLEXIBLE SOFT ANTERIOR APRON
TLSO, TRIPLANAR CONTROL, HYPEREXTENSION, RIGID ANTERIOR AND LATERAL FRAME
TLSO, TRIPLANAR CONTROL, ONE PIECE RIGID PLASTIC SHELL WITHOUT INTERFACE LINER,
TLSO, TRIPLANAR CONTROL, ONE PIECE RIGID PLASTIC SHELL WITH INTERFACE LINER,
TLSO, TRIPLANAR CONTROL, TWO PIECE RIGID PLASTIC SHELL WITHOUT INTERFACE LINER,
TLSO, TRIPLANAR CONTROL, TWO PIECE RIGID PLASTIC SHELL WITH INTERFACE LINER,
TLSO, TRIPLANAR CONTROL, ONE PIECE RIGID PLASTIC SHELL WITH INTERFACE LINER,
TLSO, SAGITTAL-CORONAL CONTROL, ONE PIECE RIGID PLASTIC SHELL, WITH OVERLAPPING
TLSO, SAGITTAL-CORONAL CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, TWO RIGID PLAST
TLSO, SAGITTAL-CORONAL CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, THREE RIGID PLA
SACROILIAC ORTHOSIS, FLEXIBLE, PROVIDES PELVIC-SACRAL SUPPORT, REDUCES MOTION AB
SACROILIAC ORTHOSIS, FLEXIBLE, PROVIDES PELVIC-SACRAL SUPPORT, REDUCES MOTION AB
SACROILIAC ORTHOSIS, PROVIDES PELVIC-SACRAL SUPPORT, WITH RIGID OR SEMI-RIGID PA
SACROILIAC ORTHOSIS, PROVIDES PELVIC-SACRAL SUPPORT, WITH RIGID OR SEMI-RIGID PA
LUMBAR ORTHOSIS, FLEXIBLE, PROVIDES LUMBAR SUPPORT, POSTERIOR EXTENDS FROM L-1 T
LUMBAR ORTHOSIS, SAGITTAL CONTROL, WITH RIGID POSTERIOR PANEL(S), POSTERIOR EXTE
LUMBAR ORTHOSIS, SAGITTAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR PANELS, POS
LUMBAR-SACRAL ORTHOSIS, FLEXIBLE, PROVIDES LUMBO-SACRAL SUPPORT, POSTERIOR EXTEN
LUMBAR-SACRAL ORTHOSIS, FLEXIBLE, PROVIDES LUMBO-SACRAL SUPPORT, POSTERIOR EXTEN
LUMBAR-SACRAL ORTHOSIS, SAGITTAL CONTROL, WITH RIGID POSTERIOR PANEL(S), POSTERI
LUMBAR-SACRAL ORTHOSIS, SAGITTAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR PANE
LUMBAR-SACRAL ORTHOSIS, SAGITTAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR PANE
LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID POSTERIOR FRAME/PAN
LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID POSTERIOR FRAME/PAN
LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, LUMBAR FLEXION, RIGID POSTERIO
LUMBAR SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, LUMBAR FLEXION, RIGID POSTERIO
LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID ANTERIOR AND POSTER
LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID ANTERIOR AND POSTER
LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, RIGID SHELL(S)/PANEL(S), POSTE
LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, RIGID SHELL(S)/PANEL(S), POSTE
CERVICAL-THORACIC-LUMBAR-SACRAL-ORTHOSES (CTLSO), ANTERIOR-POSTERIOR-LATERAL CON
CTLSO, ANTERIOR-POSTERIOR-LATERAL-CONTROL, MOLDED TO PATIENT MODEL, WITH
HALO PROCEDURE, CERVICAL HALO INCORPORATED INTO JACKET VEST
HALO PROCEDURE, CERVICAL HALO INCORPORATED INTO PLASTER BODY JACKET
HALO PROCEDURE, CERVICAL HALO INCORPORATED INTO MILWAUKEE TYPE ORTHOSIS
ADDITION TO HALO PROCEDURE, MAGNETIC RESONANCE IMAGE COMPATIBLE SYSTEMS, RINGS A
ADDITION TO HALO PROCEDURE, REPLACEMENT LINER/INTERFACE MATERIAL
TLSO, CORSET FRONT
LSO, CORSET FRONT
TLSO, FULL CORSET
LSO, FULL CORSET
AXILLARY CRUTCH EXTENSION
PERONEAL STRAPS, PAIR
STOCKING SUPPORTER GRIPS, SET OF FOUR (4)
PROTECTIVE BODY SOCK, EACH
ADDITION TO SPINAL ORTHOSIS, NOT OTHERWISE SPECIFIED
CERVICAL-THORACIC-LUMBAR-SACRAL ORTHOSIS (CTLSO) (MILWAUKEE), INCLUSIVE OF FURNI
CERVICAL THORACIC LUMBAR SACRAL ORTHOSIS, IMMOBILIZER, INFANT SIZE, PREFABRICATE
TENSION BASED SCOLIOSIS ORTHOSIS AND ACCESSORY PADS, INCLUDES FITTING AND
ADDITION TO CERVICAL-THORACIC-LUMBAR-SACRAL ORTHOSIS (CTLSO) OR SCOLIOSIS ORTHOS
ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, KYPHOSIS PAD
ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, KYPHOSIS PAD, FLOATING
ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, LUMBAR BOLSTER PAD
ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, LUMBAR OR LUMBAR RIB PAD
ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, STERNAL PAD
ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, THORACIC PAD
ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, TRAPEZIUS SLING
ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, OUTRIGGER
ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, OUTRIGGER, BILATERAL WITH VERTICAL
ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, LUMBAR SLING
ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, RING FLANGE, PLASTIC OR LEATHER
ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, RING FLANGE, PLASTIC OR LEATHER,
ADDITION TO CTLSO, SCOLIOSIS ORTHOSIS, COVER FOR UPRIGHT, EACH
THORACIC-LUMBAR-SACRAL-ORTHOSIS (TLSO), INCLUSIVE OF FURNISHING INITIAL ORTHOSIS
ADDITION TO TLSO, (LOW PROFILE), LATERAL THORACIC EXTENSION
ADDITION TO TLSO, (LOW PROFILE), ANTERIOR THORACIC EXTENSION
ADDITION TO TLSO, (LOW PROFILE), MILWAUKEE TYPE SUPERSTRUCTURE
ADDITION TO TLSO, (LOW PROFILE), LUMBAR DEROTATION PAD
ADDITION TO TLSO, (LOW PROFILE), ANTERIOR ASIS PAD
ADDITION TO TLSO, (LOW PROFILE), ANTERIOR THORACIC DEROTATION PAD
ADDITION TO TLSO, (LOW PROFILE), ABDOMINAL PAD
ADDITION TO TLSO, (LOW PROFILE), RIB GUSSET (ELASTIC), EACH
ADDITION TO TLSO, (LOW PROFILE), LATERAL TROCHANTERIC PAD
OTHER SCOLIOSIS PROCEDURE, BODY JACKET MOLDED TO PATIENT MODEL
OTHER SCOLIOSIS PROCEDURE, POST-OPERATIVE BODY JACKET
SPINAL ORTHOSIS, NOT OTHERWISE SPECIFIED
HIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, FLEXIBLE, FREJKA TYPE WITH COVER,
HIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, FLEXIBLE, (FREJKA COVER ONLY),
HIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, FLEXIBLE, (PAVLIK HARNESS),
HIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, SEMI-FLEXIBLE (VON ROSEN TYPE),
HIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, STATIC, PELVIC BAND OR SPREADER
HIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, STATIC, ADJUSTABLE, (ILFLED
HIP ORTHOSIS, BILATERAL THIGH CUFFS WITH ADJUSTABLE ABDUCTOR SPREADER BAR,
HIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, STATIC, PLASTIC, PREFABRICATED,
HIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, DYNAMIC, PELVIC CONTROL,
HIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINT, POSTOPERATIVE HIP ABDUCTION TYPE,
HIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINT, POSTOPERATIVE HIP ABDUCTION TYPE,
COMBINATION, BILATERAL, LUMBO-SACRAL, HIP, FEMUR ORTHOSIS PROVIDING ADDUCTION
LEGG PERTHES ORTHOSIS, (TORONTO TYPE), CUSTOM-FABRICATED
LEGG PERTHES ORTHOSIS, (NEWINGTON TYPE), CUSTOM FABRICATED
LEGG PERTHES ORTHOSIS, TRILATERAL, (TACHDIJAN TYPE), CUSTOM-FABRICATED
LEGG PERTHES ORTHOSIS, (SCOTTISH RITE TYPE), CUSTOM-FABRICATED
LEGG PERTHES ORTHOSIS, (PATTEN BOTTOM TYPE), CUSTOM-FABRICATED
KNEE ORTHOSIS, ELASTIC WITH JOINTS, PREFABRICATED, INCLUDES FITTING AND
KNEE ORTHOSIS, ELASTIC WITH CONDYLAR PADS AND JOINTS, WITH OR WITHOUT PATELLAR
KNEE ORTHOSIS, IMMOBILIZER, CANVAS LONGITUDINAL, PREFABRICATED, INCLUDES
KNEE ORTHOSIS, LOCKING KNEE JOINT(S), POSITIONAL ORTHOSIS, PREFABRICATED,
KNEE ORTHOSIS, ADJUSTABLE KNEE JOINTS (UNICENTRIC OR POLYCENTRIC), POSITIONAL OR
KNEE ORTHOSIS, WITHOUT KNEE JOINT, RIGID, CUSTOM-FABRICATED
KNEE ORTHOSIS, RIGID, WITHOUT JOINT(S), INCLUDES SOFT INTERFACE MATERIAL,
KNEE ORTHOSIS, DEROTATION, MEDIAL-LATERAL, ANTERIOR CRUCIATE LIGAMENT, CUSTOM
KNEE ORTHOSIS, SINGLE UPRIGHT, THIGH AND CALF, WITH ADJUSTABLE FLEXION AND EXTEN
KNEE ORTHOSIS, SINGLE UPRIGHT, THIGH AND CALF, WITH ADJUSTABLE FLEXION AND EXTEN
KNEE ORTHOSIS, DOUBLE UPRIGHT, THIGH AND CALF, WITH ADJUSTABLE FLEXION AND EXTEN
KNEE ORTHOSIS, DOUBLE UPRIGHT, THIGH AND CALF, WITH ADJUSTABLE FLEXION AND EXTEN
KNEE ORTHOSIS, DOUBLE UPRIGHT WITH ADJUSTABLE JOINT, WITH INFLATABLE AIR
KNEE ORTHOSIS, SWEDISH TYPE, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
KNEE ORTHOSIS, MODIFICATION OF SUPRACONDYLAR PROSTHETIC SOCKET,
ANKLE FOOT ORTHOSIS, SPRING WIRE, DORSIFLEXION ASSIST CALF BAND, CUSTOM-FABRICAT
ANKLE FOOT ORTHOSIS, ANKLE GAUNTLET, PREFABRICATED, INCLUDES FITTING AND
ANKLE FOOT ORTHOSIS, MOLDED ANKLE GAUNTLET, CUSTOM-FABRICATED
ANKLE FOOT ORTHOSIS, MULTILIGAMENTUS ANKLE SUPPORT, PREFABRICATED, INCLUDES
AFO, SUPRAMALLEOLAR WITH STRAPS, WITH OR WITHOUT INTERFACE/PADS, CUSTOM
ANKLE FOOT ORTHOSIS, POSTERIOR, SINGLE BAR, CLASP ATTACHMENT TO SHOE COUNTER,
ANKLE FOOT ORTHOSIS, SINGLE UPRIGHT WITH STATIC OR ADJUSTABLE STOP (PHELPS OR
ANKLE FOOT ORTHOSIS, PLASTIC OR OTHER MATERIAL, PREFABRICATED, INCLUDES FITTING
AFO, RIGID ANTERIOR TIBIAL SECTION, TOTAL CARBON FIBER OR EQUAL MATERIAL,
ANKLE FOOT ORTHOSIS, PLASTIC OR OTHER MATERIAL, CUSTOM-FABRICATED
ANKLE FOOT ORTHOSIS, PLASTIC, RIGID ANTERIOR TIBIAL SECTION (FLOOR REACTION),
ANKLE FOOT ORTHOSIS, SPIRAL, (INSTITUTE OF REHABILITATIVE MEDICINE TYPE),
ANKLE FOOT ORTHOSIS, SPIRAL, (INSTITUTE OF REHABILITATIVE MEDICINE TYPE),
ANKLE FOOT ORTHOSIS, POSTERIOR SOLID ANKLE, PLASTIC, CUSTOM-FABRICATED
ANKLE FOOT ORTHOSIS, PLASTIC WITH ANKLE JOINT, CUSTOM-FABRICATED
ANKLE FOOT ORTHOSIS, PLASTIC OR OTHER MATERIAL WITH ANKLE JOINT, PREFABRICATED,
ANKLE FOOT ORTHOSIS, SINGLE UPRIGHT FREE PLANTAR DORSIFLEXION, SOLID STIRRUP,
ANKLE FOOT ORTHOSIS, DOUBLE UPRIGHT FREE PLANTAR DORSIFLEXION, SOLID STIRRUP,
KNEE ANKLE FOOT ORTHOSIS, SINGLE UPRIGHT, FREE KNEE, FREE ANKLE, SOLID STIRRUP,
KNEE ANKLE FOOT ORTHOSIS, ANY MATERIAL, SINGLE OR DOUBLE UPRIGHT, STANCE
KNEE ANKLE FOOT ORTHOSIS, SINGLE UPRIGHT, FREE ANKLE, SOLID STIRRUP, THIGH AND
KNEE ANKLE FOOT ORTHOSIS, DOUBLE UPRIGHT, FREE ANKLE, SOLID STIRRUP, THIGH AND
KNEE ANKLE FOOT ORTHOSIS, DOUBLE UPRIGHT, FREE ANKLE, SOLID STIRRUP, THIGH AND
KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, SINGLE UPRIGHT, WITH OR WITHOUT FREE MOT
KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, STATIC (PEDIATRIC SIZE), WITHOUT FREE
KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, DOUBLE UPRIGHT, WITH OR WITHOUT FREE MOT
KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, SINGLE UPRIGHT, WITH OR WITHOUT FREE MOT
KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, WITH OR WITHOUT FREE MOTION KNEE, MULTI-
HIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, BILATERAL ROTATION STRAPS, PELVIC
HIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, BILATERAL TORSION CABLES, HIP
HIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, BILATERAL TORSION CABLES, BALL
HIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, UNILATERAL ROTATION STRAPS,
HIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, UNILATERAL TORSION CABLE, HIP
HIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, UNILATERAL TORSION CABLE, BALL
ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE CAST ORTHOSIS,
ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE CAST ORTHOSIS,
ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE ORTHOSIS, SOFT,
ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE ORTHOSIS, SEMI-RIGID,
ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE ORTHOSIS, RIGID,
KNEE ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS,
KNEE ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS,
KAFO, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS, SOFT, PREFABRICATED,
KAFO, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS, SEMI-RIGID,
KAFO, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS, RIGID, PREFABRICATED,
ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, PLASTIC SHOE INSERT WITH ANKLE JO
ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, DROP LOCK KNEE JOINT
ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, LIMITED MOTION KNEE JOINT
ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, ADJUSTABLE MOTION KNEE JOINT,
ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, QUADRILATERAL BRIM
ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, WAIST BELT
ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, HIP JOINT, PELVIC BAND, THIGH
ADDITION TO LOWER EXTREMITY, LIMITED ANKLE MOTION, EACH JOINT
ADDITION TO LOWER EXTREMITY, DORSIFLEXION ASSIST (PLANTAR FLEXION RESIST), EACH
ADDITION TO LOWER EXTREMITY, DORSIFLEXION AND PLANTAR FLEXION ASSIST/RESIST,
ADDITION TO LOWER EXTREMITY, SPLIT FLAT CALIPER STIRRUPS AND PLATE ATTACHMENT
ADDITION TO LOWER EXTREMITY ORTHOSIS, ROCKER BOTTOM FOR TOTAL CONTACT ANKLE
ADDITION TO LOWER EXTREMITY, ROUND CALIPER AND PLATE ATTACHMENT
ADDITION TO LOWER EXTREMITY, FOOT PLATE, MOLDED TO PATIENT MODEL, STIRRUP
ADDITION TO LOWER EXTREMITY, REINFORCED SOLID STIRRUP (SCOTT-CRAIG TYPE)
ADDITION TO LOWER EXTREMITY, LONG TONGUE STIRRUP
ADDITION TO LOWER EXTREMITY, VARUS/VALGUS CORRECTION ('T') STRAP, PADDED/LINED
ADDITION TO LOWER EXTREMITY, VARUS/VALGUS CORRECTION, PLASTIC MODIFICATION,
ADDITION TO LOWER EXTREMITY, MOLDED INNER BOOT
ADDITION TO LOWER EXTREMITY, ABDUCTION BAR (BILATERAL HIP INVOLVEMENT),
ADDITION TO LOWER EXTREMITY, ABDUCTION BAR-STRAIGHT
ADDITION TO LOWER EXTREMITY, NON-MOLDED LACER, FOR CUSTOM FABRICATED ORTHOSIS
ADDITION TO LOWER EXTREMITY, LACER MOLDED TO PATIENT MODEL, FOR CUSTOM
ADDITION TO LOWER EXTREMITY, ANTERIOR SWING BAND
ADDITION TO LOWER EXTREMITY, PRE-TIBIAL SHELL, MOLDED TO PATIENT MODEL
ADDITION TO LOWER EXTREMITY, PROSTHETIC TYPE, (BK) SOCKET, MOLDED TO PATIENT
ADDITION TO LOWER EXTREMITY, EXTENDED STEEL SHANK
ADDITION TO LOWER EXTREMITY, PATTEN BOTTOM
ADDITION TO LOWER EXTREMITY, TORSION CONTROL, ANKLE JOINT AND HALF SOLID
ADDITION TO LOWER EXTREMITY, TORSION CONTROL, STRAIGHT KNEE JOINT, EACH JOINT
ADDITION TO LOWER EXTREMITY, STRAIGHT KNEE JOINT, HEAVY DUTY, EACH JOINT
ADDITION TO LOWER EXTREMITY, POLYCENTRIC KNEE JOINT, FOR CUSTOM FABRICATED KNEE
ADDITION TO LOWER EXTREMITY, OFFSET KNEE JOINT, EACH JOINT
ADDITION TO LOWER EXTREMITY, OFFSET KNEE JOINT, HEAVY DUTY, EACH JOINT
ADDITION TO LOWER EXTREMITY ORTHOSIS, SUSPENSION SLEEVE
ADDITION TO KNEE JOINT, DROP LOCK, EACH
ADDITION TO KNEE LOCK WITH INTEGRATED RELEASE MECHANISM ( BAIL, CABLE, OR
ADDITION TO KNEE JOINT, DISC OR DIAL LOCK FOR ADJUSTABLE KNEE FLEXION, EACH
ADDITION TO KNEE JOINT, RATCHET LOCK FOR ACTIVE AND PROGRESSIVE KNEE EXTENSION,
ADDITION TO KNEE JOINT, LIFT LOOP FOR DROP LOCK RING
ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, GLUTEAL/ ISCHIAL WEIGHT BEARI
ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, QUADRI- LATERAL BRIM, MOLDED
ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, QUADRI- LATERAL BRIM,
ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, ISCHIAL CONTAINMENT/NARROW
ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, ISCHIAL CONTAINMENT/NARROW
ADDITION TO LOWER EXTREMITY, THIGH-WEIGHT BEARING, LACER, NON-MOLDED
ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, LACER, MOLDED TO PATIENT
ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, HIGH ROLL CUFF
ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, HIP JOINT, CLEVIS TYPE TWO POSITION
ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, PELVIC SLING
ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, HIP JOINT, CLEVIS TYPE, OR THRUST
ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, HIP JOINT, CLEVIS OR THRUST
ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, HIP JOINT, HEAVY DUTY, EACH
ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, HIP JOINT, ADJUSTABLE FLEXION, EACH
ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, HIP JOINT, ADJUSTABLE FLEXION,
ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, PLASTIC, MOLDED TO PATIENT MODEL,
ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, METAL FRAME, RECIPROCATING HIP
ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, BAND AND BELT, UNILATERAL
ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, BAND AND BELT, BILATERAL
ADDITION TO LOWER EXTREMITY, PELVIC AND THORACIC CONTROL, GLUTEAL PAD, EACH
ADDITION TO LOWER EXTREMITY, THORACIC CONTROL, THORACIC BAND
ADDITION TO LOWER EXTREMITY, THORACIC CONTROL, PARASPINAL UPRIGHTS
ADDITION TO LOWER EXTREMITY, THORACIC CONTROL, LATERAL SUPPORT UPRIGHTS
ADDITION TO LOWER EXTREMITY ORTHOSIS, PLATING CHROME OR NICKEL, PER BAR
ADDITION TO LOWER EXTREMITY ORTHOSIS, HIGH STRENGTH, LIGHTWEIGHT MATERIAL, ALL
ADDITION TO LOWER EXTREMITY ORTHOSIS, EXTENSION, PER EXTENSION, PER BAR (FOR
ORTHOTIC SIDE BAR DISCONNECT DEVICE, PER BAR
ADDITION TO LOWER EXTREMITY ORTHOSIS, NON-CORROSIVE FINISH, PER BAR
ADDITION TO LOWER EXTREMITY ORTHOSIS, DROP LOCK RETAINER, EACH
ADDITION TO LOWER EXTREMITY ORTHOSIS, KNEE CONTROL, FULL KNEECAP
ADDITION TO LOWER EXTREMITY ORTHOSIS, KNEE CONTROL, KNEE CAP, MEDIAL OR LATERAL
ADDITION TO LOWER EXTREMITY ORTHOSIS, KNEE CONTROL, CONDYLAR PAD
ADDITION TO LOWER EXTREMITY ORTHOSIS, SOFT INTERFACE FOR MOLDED PLASTIC, BELOW
ADDITION TO LOWER EXTREMITY ORTHOSIS, SOFT INTERFACE FOR MOLDED PLASTIC, ABOVE
ADDITION TO LOWER EXTREMITY ORTHOSIS, TIBIAL LENGTH SOCK, FRACTURE OR EQUAL,
ADDITION TO LOWER EXTREMITY ORTHOSIS, FEMORAL LENGTH SOCK, FRACTURE OR EQUAL,
ADDITION TO LOWER EXTREMITY JOINT, KNEE OR ANKLE, CONCENTRIC ADJUSTABLE TORSION
LOWER EXTREMITY ORTHOSES, NOT OTHERWISE SPECIFIED
FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, "UCB" TYPE, BERKELEY SHELL,
FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, SPENCO, EACH
FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, PLASTAZOTE OR EQUAL, EACH
FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, SILICONE GEL, EACH
FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, LONGITUDINAL ARCH SUPPORT,
FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, LONGITUDINAL/ METATARSAL
FOOT, INSERT, REMOVABLE, FORMED TO PATIENT FOOT, EACH
FOOT, INSERT/PLATE, REMOVABLE, ADDITION TO LOWER EXTREMITY ORTHOSIS, HIGH
FOOT, ARCH SUPPORT, REMOVABLE, PREMOLDED, LONGITUDINAL, EACH
FOOT, ARCH SUPPORT, REMOVABLE, PREMOLDED, METATARSAL, EACH
FOOT, ARCH SUPPORT, REMOVABLE, PREMOLDED, LONGITUDINAL/ METATARSAL, EACH
FOOT, ARCH SUPPORT, NON-REMOVABLE ATTACHED TO SHOE, LONGITUDINAL, EACH
FOOT, ARCH SUPPORT, NON-REMOVABLE ATTACHED TO SHOE, METATARSAL, EACH
FOOT, ARCH SUPPORT, NON-REMOVABLE ATTACHED TO SHOE, LONGITUDINAL/METATARSAL,
HALLUS-VALGUS NIGHT DYNAMIC SPLINT
FOOT, ABDUCTION ROTATION BAR, INCLUDING SHOES
FOOT, ABDUCTION ROTATATION BAR, WITHOUT SHOES
FOOT, ADJUSTABLE SHOE-STYLED POSITIONING DEVICE
FOOT, PLASTIC, SILICONE OR EQUAL, HEEL STABILIZER, EACH
ORTHOPEDIC SHOE, OXFORD WITH SUPINATOR OR PRONATOR, INFANT
ORTHOPEDIC SHOE, OXFORD WITH SUPINATOR OR PRONATOR, CHILD
ORTHOPEDIC SHOE, OXFORD WITH SUPINATOR OR PRONATOR, JUNIOR
ORTHOPEDIC SHOE, HIGHTOP WITH SUPINATOR OR PRONATOR, INFANT
ORTHOPEDIC SHOE, HIGHTOP WITH SUPINATOR OR PRONATOR, CHILD
ORTHOPEDIC SHOE, HIGHTOP WITH SUPINATOR OR PRONATOR, JUNIOR
SURGICAL BOOT, EACH, INFANT
SURGICAL BOOT, EACH, CHILD
SURGICAL BOOT, EACH, JUNIOR
BENESCH BOOT, PAIR, INFANT
BENESCH BOOT, PAIR, CHILD
BENESCH BOOT, PAIR, JUNIOR
ORTHOPEDIC FOOTWEAR, LADIES SHOE, OXFORD, EACH
ORTHOPEDIC FOOTWEAR, LADIES SHOE, DEPTH INLAY, EACH
ORTHOPEDIC FOOTWEAR, LADIES SHOE, HIGHTOP, DEPTH INLAY, EACH
ORTHOPEDIC FOOTWEAR, MENS SHOE, OXFORD, EACH
ORTHOPEDIC FOOTWEAR, MENS SHOE, DEPTH INLAY, EACH
ORTHOPEDIC FOOTWEAR, MENS SHOE, HIGHTOP, DEPTH INLAY, EACH
ORTHOPEDIC FOOTWEAR, WOMAN'S SHOE, OXFORD, USED AS AN INTEGRAL PART OF A BRACE
ORTHOPEDIC FOOTWEAR, MAN'S SHOE, OXFORD, USED AS AN INTEGRAL PART OF A BRACE
ORTHOPEDIC FOOTWEAR, CUSTOM SHOE, DEPTH INLAY, EACH
ORTHOPEDIC FOOTWEAR, CUSTOM MOLDED SHOE, REMOVABLE INNER MOLD, PROSTHETIC SHOE,
FOOT, SHOE MOLDED TO PATIENT MODEL, SILICONE SHOE, EACH
FOOT, SHOE MOLDED TO PATIENT MODEL, PLASTAZOTE (OR SIMILAR), CUSTOM FABRICATED,
FOOT, MOLDED SHOE PLASTAZOTE (OR SIMILAR) CUSTOM FITTED, EACH
NON-STANDARD SIZE OR WIDTH
NON-STANDARD SIZE OR LENGTH
ORTHOPEDIC FOOTWEAR, ADDITIONAL CHARGE FOR SPLIT SIZE
SURGICAL BOOT/SHOE, EACH
PLASTAZOTE SANDAL, EACH
LIFT, ELEVATION, HEEL, TAPERED TO METATARSALS, PER INCH
LIFT, ELEVATION, HEEL AND SOLE, NEOPRENE, PER INCH
LIFT, ELEVATION, HEEL AND SOLE, CORK, PER INCH
LIFT, ELEVATION, METAL EXTENSION (SKATE)
LIFT, ELEVATION, INSIDE SHOE, TAPERED, UP TO ONE-HALF INCH
LIFT, ELEVATION, HEEL, PER INCH
HEEL WEDGE, SACH
HEEL WEDGE
SOLE WEDGE, OUTSIDE SOLE
SOLE WEDGE, BETWEEN SOLE
CLUBFOOT WEDGE
OUTFLARE WEDGE
METATARSAL BAR WEDGE, ROCKER
METATARSAL BAR WEDGE, BETWEEN SOLE
FULL SOLE AND HEEL WEDGE, BETWEEN SOLE
HEEL, COUNTER, PLASTIC REINFORCED
HEEL, COUNTER, LEATHER REINFORCED
HEEL, SACH CUSHION TYPE
HEEL, NEW LEATHER, STANDARD
HEEL, NEW RUBBER, STANDARD
HEEL, THOMAS WITH WEDGE
HEEL, THOMAS EXTENDED TO BALL
HEEL, PAD AND DEPRESSION FOR SPUR
HEEL, PAD, REMOVABLE FOR SPUR
ORTHOPEDIC SHOE ADDITION, INSOLE, LEATHER
ORTHOPEDIC SHOE ADDITION, INSOLE, RUBBER
ORTHOPEDIC SHOE ADDITION, INSOLE, FELT COVERED WITH LEATHER
ORTHOPEDIC SHOE ADDITION, SOLE, HALF
ORTHOPEDIC SHOE ADDITION, SOLE, FULL
ORTHOPEDIC SHOE ADDITION, TOE TAP STANDARD
ORTHOPEDIC SHOE ADDITION, TOE TAP, HORSESHOE
ORTHOPEDIC SHOE ADDITION, SPECIAL EXTENSION TO INSTEP (LEATHER WITH EYELETS)
ORTHOPEDIC SHOE ADDITION, CONVERT INSTEP TO VELCRO CLOSURE
ORTHOPEDIC SHOE ADDITION, CONVERT FIRM SHOE COUNTER TO SOFT COUNTER
ORTHOPEDIC SHOE ADDITION, MARCH BAR
TRANSFER OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, CALIPER PLATE, EXISTING
TRANSFER OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, CALIPER PLATE, NEW
TRANSFER OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, SOLID STIRRUP, EXISTING
TRANSFER OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, SOLID STIRRUP, NEW
TRANSFER OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, DENNIS BROWNE SPLINT
ORTHOPEDIC SHOE, MODIFICATION, ADDITION OR TRANSFER, NOT OTHERWISE SPECIFIED
SHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, PREFABRICATED, I
SHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, CANVAS AND
SHOULDER ORTHOSIS, ACROMIO/CLAVICULAR (CANVAS AND WEBBING TYPE), PREFABRICATED,
SHOULDER ORTHOSIS, SHOULDER JOINT DESIGN, WITHOUT JOINTS, MAY INCLUDE SOFT INTER
SHOULDER ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE DESIGN), THORACIC COMPONENT A
SHOULDER ORTHOSIS, VEST TYPE ABDUCTION RESTRAINER, CANVAS WEBBING TYPE OR
SHOULDER ORTHOSIS, SHOULDER JOINT DESIGN, WITHOUT JOINTS, MAY INCLUDE SOFT INTER
ELBOW ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRI
ELBOW ORTHOSIS, ELASTIC WITH METAL JOINTS, PREFABRICATED, INCLUDES FITTING AND
ELBOW ORTHOSIS, DOUBLE UPRIGHT WITH FOREARM/ARM CUFFS, FREE MOTION,
ELBOW ORTHOSIS, DOUBLE UPRIGHT WITH FOREARM/ARM CUFFS, EXTENSION/ FLEXION
ELBOW ORTHOSIS, DOUBLE UPRIGHT WITH FOREARM/ARM CUFFS, ADJUSTABLE POSITION LOCK
ELBOW ORTHOSIS, WITH ADJUSTABLE POSITION LOCKING JOINT(S), PREFABRICATED,
ELBOW ORTHOSIS, RIGID, WITHOUT JOINTS, INCLUDES SOFT INTERFACE MATERIAL,
ELBOW WRIST HAND ORTHOSIS, RIGID, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, ST
ELBOW WRIST HAND ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINTS, ELASTIC BANDS
ELBOW WRIST HAND FINGER ORTHOSIS, RIGID, WITHOUT JOINTS, MAY INCLUDE SOFT INTERF
ELBOW WRIST HAND FINGER ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINTS, ELASTI
WRIST HAND FINGER ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINT(S), TURNBUCKLE
WRIST HAND FINGER ORTHOSIS, WITHOUT JOINT(S), PREFABRICATED, INCLUDES FITTING
WRIST HAND FINGER ORTHOSIS, RIGID WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE MAT
ADDITION TO UPPER EXTREMITY JOINT, WRIST OR ELBOW, CONCENTRIC ADJUSTABLE TORSION
WRIST HAND FINGER ORTHOSIS, DYNAMIC FLEXOR HINGE, RECIPROCAL WRIST EXTENSION/
WRIST HAND FINGER ORTHOSIS, DYNAMIC FLEXOR HINGE, RECIPROCAL WRIST EXTENSION/
WRIST HAND FINGER ORTHOSIS, EXTERNAL POWERED, ELECTRIC, CUSTOM-FABRICATED
WRIST HAND ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINTS, ELASTIC BANDS, TURN
WRIST HAND ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM
WRST HAND ORTHOSIS, WRIST EXTENSION CONTROL COCK-UP, NON MOLDED, PREFABRICATED,
HAND FINGER ORTHOSIS, FLEXION GLOVE WITH ELASTIC FINGER CONTROL, PREFABRICATED,
HAND FINGER ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM
WRIST HAND ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINT(S), ELASTIC BANDS, TU
HAND ORTHOSIS, METACARPAL FRACTURE ORTHOSIS, PREFABRICATED, INCLUDES FITTING
HAND ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRIC
HAND FINGER ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINTS, ELASTIC BANDS, TUR
HAND FINGER ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, PREFAB
FINGER ORTHOSIS, PROXIMAL INTERPHALANGEAL (PIP)/DISTAL INTERPHALANGEAL (DIP), NO
FINGER ORTHOSIS, PROXIMAL INTERPHALANGEAL (PIP)/DISTAL INTERPHALANGEAL (DIP), WI
HAND FINGER ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINT(S), TURNBUCKLES, ELA
WRIST HAND FINGER ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINT(S), TURNBUCKLE
FINGER ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, CUSTOM FABRICATED,
FINGER ORTHOSIS, NONTORSION JOINT, MAY INCLUDE SOFT INTERFACE, CUSTOM FABRICATED
ADDITION OF JOINT TO UPPER EXTREMITY ORTHOSIS, ANY MATERIAL; PER JOINT
SHOULDER ELBOW WRIST HAND ORTHOSIS, ABDUCTION POSITIONING, AIRPLANE DESIGN, PREF
SHOULDER ELBOW WRIST HAND ORTHOSIS, SHOULDER CAP DESIGN, WITHOUT JOINTS, MAY INC
SHOULDER ELBOW WRIST HAND ORTHOSIS, ABDUCTION POSITIONING, ERBS PALSEY DESIGN,
SHOULDER ELBOW WRIST HAND ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE DESIGN), THO
SHOULDER ELBOW WRIST HAND ORTHOSIS, SHOULDER CAP DESIGN, INCLUDES ONE OR MORE NO
SHOULDER ELBOW WRIST HAND ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE DESIGN), THO
SHOULDER ELBOW WRIST HAND FINGER ORTHOSIS, SHOULDER CAP DESIGN, WITHOUT JOINTS,
SHOULDER ELBOW WRIST HAND FINGER ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE DESIG
SHOULDER ELBOW WRIST HAND FINGER ORTHOSIS, SHOULDER CAP DESIGN, INCLUDES ONE OR
SHOULDER ELBOW WRIST HAND FINGER ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE DESIG
UPPER EXTREMITY FRACTURE ORTHOSIS, HUMERAL, PREFABRICATED, INCLUDES FITTING AND
UPPER EXTREMITY FRACTURE ORTHOSIS, RADIUS/ULNAR, PREFABRICATED, INCLUDES
UPPER EXTREMITY FRACTURE ORTHOSIS, WRIST, PREFABRICATED, INCLUDES FITTING AND
ADDITION TO UPPER EXTREMITY ORTHOSIS, SOCK, FRACTURE OR EQUAL, EACH
UPPER LIMB ORTHOSIS, NOT OTHERWISE SPECIFIED
REPLACE GIRDLE FOR SPINAL ORTHOSIS (CTLSO OR SO)
REPLACEMENT STRAP, ANY ORTHOSIS, INCLUDES ALL COMPONENTS, ANY LENGTH, ANY TYPE
REPLACE TRILATERAL SOCKET BRIM
REPLACE QUADRILATERAL SOCKET BRIM, MOLDED TO PATIENT MODEL
REPLACE QUADRILATERAL SOCKET BRIM, CUSTOM FITTED
REPLACE MOLDED THIGH LACER, FOR CUSTOM FABRICATED ORTHOSIS ONLY
REPLACE NON-MOLDED THIGH LACER, FOR CUSTOM FABRICATED ORTHOSIS ONLY
REPLACE MOLDED CALF LACER, FOR CUSTOM FABRICATED ORTHOSIS ONLY
REPLACE NON-MOLDED CALF LACER, FOR CUSTOM FABRICATED ORTHOSIS ONLY
REPLACE HIGH ROLL CUFF
REPLACE PROXIMAL AND DISTAL UPRIGHT FOR KAFO
REPLACE METAL BANDS KAFO, PROXIMAL THIGH
REPLACE METAL BANDS KAFO-AFO, CALF OR DISTAL THIGH
REPLACE LEATHER CUFF KAFO, PROXIMAL THIGH
REPLACE LEATHER CUFF KAFO-AFO, CALF OR DISTAL THIGH
REPLACE PRETIBIAL SHELL
REPAIR OF ORTHOTIC DEVICE, LABOR COMPONENT, PER 15 MINUTES
REPAIR OF ORTHOTIC DEVICE, REPAIR OR REPLACE MINOR PARTS
ANKLE CONTROL ORTHOSIS, STIRRUP STYLE, RIGID, INCLUDES ANY TYPE INTERFACE
WALKING BOOT, PNEUMATIC AND/OR VACUUM, WITH OR WITHOUT JOINTS, WITH OR WITHOUT I
PNEUMATIC FULL LEG SPLINT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
WALKING BOOT, NON-PNEUMATIC, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE
REPLACEMENT, SOFT INTERFACE MATERIAL, STATIC AFO
REPLACE SOFT INTERFACE MATERIAL, FOOT DROP SPLINT
STATIC OR DYNAMIC ANKLE FOOT ORTHOSIS, INCLUDING SOFT INTERFACE MATERIAL, ADJUST
FOOT DROP SPLINT, RECUMBENT POSITIONING DEVICE, PREFABRICATED, INCLUDES FITTING
ANKLE FOOT ORTHOSIS, WALKING BOOT TYPE, VARUS/VALGUS CORRECTION, ROCKER BOTTOM,
PARTIAL FOOT, SHOE INSERT WITH LONGITUDINAL ARCH, TOE FILLER
PARTIAL FOOT, MOLDED SOCKET, ANKLE HEIGHT, WITH TOE FILLER
PARTIAL FOOT, MOLDED SOCKET, TIBIAL TUBERCLE HEIGHT, WITH TOE FILLER
ANKLE, SYMES, MOLDED SOCKET, SACH FOOT
ANKLE, SYMES, METAL FRAME, MOLDED LEATHER SOCKET, ARTICULATED ANKLE/FOOT
BELOW KNEE, MOLDED SOCKET, SHIN, SACH FOOT
BELOW KNEE, PLASTIC SOCKET, JOINTS AND THIGH LACER, SACH FOOT
KNEE DISARTICULATION (OR THROUGH KNEE), MOLDED SOCKET, EXTERNAL KNEE JOINTS, SHI
KNEE DISARTICULATION (OR THROUGH KNEE), MOLDED SOCKET, BENT KNEE CONFIGURATION,
ABOVE KNEE, MOLDED SOCKET, SINGLE AXIS CONSTANT FRICTION KNEE, SHIN, SACH FOOT
ABOVE KNEE, SHORT PROSTHESIS, NO KNEE JOINT ('STUBBIES'), WITH FOOT BLOCKS, NO
ABOVE KNEE, SHORT PROSTHESIS, NO KNEE JOINT ('STUBBIES'), WITH ARTICULATED
ABOVE KNEE, FOR PROXIMAL FEMORAL FOCAL DEFICIENCY, CONSTANT FRICTION KNEE,
HIP DISARTICULATION, CANADIAN TYPE; MOLDED SOCKET, HIP JOINT, SINGLE AXIS CONSTA
HIP DISARTICULATION, TILT TABLE TYPE; MOLDED SOCKET, LOCKING HIP JOINT, SINGLE
HEMIPELVECTOMY, CANADIAN TYPE; MOLDED SOCKET, HIP JOINT, SINGLE AXIS CONSTANT FR
BELOW KNEE, MOLDED SOCKET, SHIN, SACH FOOT, ENDOSKELETAL SYSTEM
KNEE DISARTICULATION (OR THROUGH KNEE), MOLDED SOCKET, SINGLE AXIS KNEE, PYLON,
ABOVE KNEE, MOLDED SOCKET, OPEN END, SACH FOOT, ENDOSKELETAL SYSTEM, SINGLE
HIP DISARTICULATION, CANADIAN TYPE, MOLDED SOCKET, ENDOSKELETAL SYSTEM, HIP
HEMIPELVECTOMY, CANADIAN TYPE, MOLDED SOCKET, ENDOSKELETAL SYSTEM, HIP JOINT,
IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID DRESSING,
IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID
IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID
IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID
IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF NON-WEIGHT BEARING
IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF NON-WEIGHT BEARING
INITIAL, BELOW KNEE 'PTB' TYPE SOCKET, NON-ALIGNABLE SYSTEM, PYLON, NO COVER, SA
INITIAL, ABOVE KNEE - KNEE DISARTICULATION, ISCHIAL LEVEL SOCKET, NON-ALIGNABLE
PREPARATORY, BELOW KNEE 'PTB' TYPE SOCKET, NON-ALIGNABLE SYSTEM, PYLON, NO COV
PREPARATORY, BELOW KNEE 'PTB' TYPE SOCKET, NON-ALIGNABLE SYSTEM, PYLON, NO
PREPARATORY, BELOW KNEE 'PTB' TYPE SOCKET, NON-ALIGNABLE SYSTEM, PYLON, NO
PREPARATORY, BELOW KNEE 'PTB' TYPE SOCKET, NON-ALIGNABLE SYSTEM, NO COVER, SACH
PREPARATORY, BELOW KNEE 'PTB' TYPE SOCKET, NON-ALIGNABLE SYSTEM, PYLON, NO
PREPARATORY, ABOVE KNEE- KNEE DISARTICULATION, ISCHIAL LEVEL SOCKET,
PREPARATORY, ABOVE KNEE - KNEE DISARTICULATION, ISCHIAL LEVEL SOCKET,
PREPARATORY, ABOVE KNEE - KNEE DISARTICULATION ISCHIAL LEVEL SOCKET,
PREPARATORY, ABOVE KNEE - KNEE DISARTICULATION, ISCHIAL LEVEL SOCKET,
PREPARATORY, ABOVE KNEE - KNEE DISARTICULATION ISCHIAL LEVEL SOCKET,
PREPARATORY, HIP DISARTICULATION-HEMIPELVECTOMY, PYLON, NO COVER, SACH FOOT,
PREPARATORY, HIP DISARTICULATION-HEMIPELVECTOMY, PYLON, NO COVER, SACH FOOT, LAM
ADDITION TO LOWER EXTREMITY, ENDOSKELETAL SYSTEM, ABOVE KNEE, HYDRACADENCE
ADDITION TO LOWER EXTREMITY, ENDOSKELETAL SYSTEM, ABOVE KNEE - KNEE
ADDITION TO LOWER EXTREMITY, ENDOSKELETAL SYSTEM, ABOVE KNEE-KNEE
ADDITION TO LOWER EXTREMITY, EXOSKELETAL SYSTEM, ABOVE KNEE-KNEE
ADDITION TO LOWER EXTREMITY, ENDOSKELETAL SYSTEM, ABOVE KNEE, UNIVERSAL
ADDITION TO LOWER EXTREMITY, QUICK CHANGE SELF-ALIGNING UNIT, ABOVE KNEE OR
ADDITION TO LOWER EXTREMITY, TEST SOCKET, SYMES
ADDITION TO LOWER EXTREMITY, TEST SOCKET, BELOW KNEE
ADDITION TO LOWER EXTREMITY, TEST SOCKET, KNEE DISARTICULATION
ADDITION TO LOWER EXTREMITY, TEST SOCKET, ABOVE KNEE
ADDITION TO LOWER EXTREMITY, TEST SOCKET, HIP DISARTICULATION
ADDITION TO LOWER EXTREMITY, TEST SOCKET, HEMIPELVECTOMY
ADDITION TO LOWER EXTREMITY, BELOW KNEE, ACRYLIC SOCKET
ADDITION TO LOWER EXTREMITY, SYMES TYPE, EXPANDABLE WALL SOCKET
ADDITION TO LOWER EXTREMITY, ABOVE KNEE OR KNEE DISARTICULATION, ACRYLIC SOCKET
ADDITION TO LOWER EXTREMITY, SYMES TYPE, 'PTB' BRIM DESIGN SOCKET
ADDITION TO LOWER EXTREMITY, SYMES TYPE, POSTERIOR OPENING (CANADIAN) SOCKET
ADDITION TO LOWER EXTREMITY, SYMES TYPE, MEDIAL OPENING SOCKET
ADDITION TO LOWER EXTREMITY, BELOW KNEE, TOTAL CONTACT
ADDITION TO LOWER EXTREMITY, BELOW KNEE, LEATHER SOCKET
ADDITION TO LOWER EXTREMITY, BELOW KNEE, WOOD SOCKET
ADDITION TO LOWER EXTREMITY, KNEE DISARTICULATION, LEATHER SOCKET
ADDITION TO LOWER EXTREMITY, ABOVE KNEE, LEATHER SOCKET
ADDITION TO LOWER EXTREMITY, HIP DISARTICULATION, FLEXIBLE INNER SOCKET,
ADDITION TO LOWER EXTREMITY, ABOVE KNEE, WOOD SOCKET
ADDITION TO LOWER EXTREMITY, BELOW KNEE, FLEXIBLE INNER SOCKET, EXTERNAL FRAME
ADDITION TO LOWER EXTREMITY, BELOW KNEE, AIR, FLUID, GEL OR EQUAL, CUSHION
ADDITION TO LOWER EXTREMITY, BELOW KNEE SUCTION SOCKET
ADDITION TO LOWER EXTREMITY, ABOVE KNEE, AIR, FLUID, GEL OR EQUAL, CUSHION
ADDITION TO LOWER EXTREMITY, ISCHIAL CONTAINMENT/NARROW M-L SOCKET
ADDITIONS TO LOWER EXTREMITY, TOTAL CONTACT, ABOVE KNEE OR KNEE DISARTICULATION
ADDITION TO LOWER EXTREMITY, ABOVE KNEE, FLEXIBLE INNER SOCKET, EXTERNAL FRAME
ADDITION TO LOWER EXTREMITY, SUCTION SUSPENSION, ABOVE KNEE OR KNEE
ADDITION TO LOWER EXTREMITY, KNEE DISARTICULATION, EXPANDABLE WALL SOCKET
ADDITION TO LOWER EXTREMITY, SOCKET INSERT, SYMES, (KEMBLO, PELITE, ALIPLAST, P
ADDITION TO LOWER EXTREMITY, SOCKET INSERT, BELOW KNEE (KEMBLO, PELITE,
ADDITION TO LOWER EXTREMITY, SOCKET INSERT, KNEE DISARTICULATION (KEMBLO,
ADDITION TO LOWER EXTREMITY, SOCKET INSERT, ABOVE KNEE (KEMBLO, PELITE,
ADDITION TO LOWER EXTREMITY, SOCKET INSERT, MULTI-DUROMETER SYMES
ADDITION TO LOWER EXTREMITY, SOCKET INSERT, MULTI-DUROMETER, BELOW KNEE
ADDITION TO LOWER EXTREMITY, BELOW KNEE, CUFF SUSPENSION
ADDITION TO LOWER EXTREMITY, BELOW KNEE, MOLDED DISTAL CUSHION
ADDITION TO LOWER EXTREMITY, BELOW KNEE, MOLDED SUPRACONDYLAR SUSPENSION
ADDITION TO LOWER EXTREMITY, BELOW KNEE / ABOVE KNEE SUSPENSION LOCKING
ADDITION TO LOWER EXTREMITY, BELOW KNEE, REMOVABLE MEDIAL BRIM SUSPENSION
ADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED FROM
ADDITIONS TO LOWER EXTREMITY, BELOW KNEE, KNEE JOINTS, SINGLE AXIS, PAIR
ADDITIONS TO LOWER EXTREMITY, BELOW KNEE, KNEE JOINTS, POLYCENTRIC, PAIR
ADDITIONS TO LOWER EXTREMITY, BELOW KNEE, JOINT COVERS, PAIR
ADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED FROM
ADDITION TO LOWER EXTREMITY, BELOW KNEE, THIGH LACER, NONMOLDED
ADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED SOCKET
ADDITION TO LOWER EXTREMITY, BELOW KNEE, THIGH LACER, GLUTEAL/ISCHIAL, MOLDED
ADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED SOCKET
ADDITION TO LOWER EXTREMITY, BELOW KNEE, FORK STRAP
ADDITION TO LOWER EXTREMITY PROSTHESIS, BELOW KNEE, SUSPENSION/SEALING SLEEVE,
ADDITION TO LOWER EXTREMITY, BELOW KNEE, BACK CHECK (EXTENSION CONTROL)
ADDITION TO LOWER EXTREMITY, BELOW KNEE, WAIST BELT, WEBBING
ADDITION TO LOWER EXTREMITY, BELOW KNEE, WAIST BELT, PADDED AND LINED
ADDITION TO LOWER EXTREMITY, ABOVE KNEE, PELVIC CONTROL BELT, LIGHT
ADDITION TO LOWER EXTREMITY, ABOVE KNEE, PELVIC CONTROL BELT, PADDED AND LINED
ADDITION TO LOWER EXTREMITY, ABOVE KNEE, PELVIC CONTROL, SLEEVE SUSPENSION,
ADDITION TO LOWER EXTREMITY, ABOVE KNEE OR KNEE DISARTICULATION, PELVIC JOINT
ADDITION TO LOWER EXTREMITY, ABOVE KNEE OR KNEE DISARTICULATION, PELVIC BAND
ADDITION TO LOWER EXTREMITY, ABOVE KNEE OR KNEE DISARTICULATION, SILESIAN
ALL LOWER EXTREMITY PROSTHESES, SHOULDER HARNESS
ALL LOWER EXTREMITY PROSTHESES,FOOT,EXTERNAL KEEL,SACH FOOT
REPLACEMENT, SOCKET, ABOVE KNEE/KNEE DISARTICULATION, INCLUDING ATTACHMENT
REPLACEMENT, SOCKET, HIP DISARTICULATION, INCLUDING HIP JOINT, MOLDED TO
ANKLE, SYMES, MOLDED TO PATIENT MODEL, SOCKET WITHOUT SOLID ANKLE CUSHION HEEL (
CUSTOM SHAPED PROTECTIVE COVER, BELOW KNEE
CUSTOM SHAPED PROTECTIVE COVER, ABOVE KNEE
CUSTOM SHAPED PROTECTIVE COVER, KNEE DISARTICULATION
CUSTOM SHAPED PROTECTIVE COVER, HIP DISARTICULATION
ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, MANUAL LOCK
ADDITIONS EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, MANUAL LOCK, ULTRA-LIGHT
ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FRICTION SWING AND STANCE
ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, VARIABLE FRICTION SWING
ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC, MECHANICAL STANCE PHASE
ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC, FRICTION SWING AND
ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, PNEUMATIC SWING, FRICTION
ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FLUID SWING PHASE CONTROL
ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, EXTERNAL JOINTS FLUID
ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FLUID SWING AND STANCE
ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, PNEUMATIC/HYDRA PNEUMATIC
ADDITION TO LOWER LIMB PROSTHESIS, VACUUM PUMP, RESIDUAL LIMB VOLUME MANAGEMENT
ADDITION TO LOWER LIMB PROSTHESIS, VACUUM PUMP, RESIDUAL LIMB VOLUME MANAGEMENT
ADDITION, EXOSKELETAL SYSTEM, BELOW KNEE, ULTRA-LIGHT MATERIAL (TITANIUM, CARBON
ADDITION, EXOSKELETAL SYSTEM, ABOVE KNEE, ULTRA-LIGHT MATERIAL (TITANIUM,
ADDITION, EXOSKELETAL SYSTEM, HIP DISARTICULATION, ULTRA-LIGHT MATERIAL
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, MANUAL LOCK
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, MANUAL LOCK, ULTRA-LIGHT
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FRICTION SWING AND STANCE
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC, HYDRAULIC SWING PHASE
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC, MECHANICAL STANCE PHASE
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC, FRICTION SWING, AND
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, PNEUMATIC SWING, FRICTION
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FLUID SWING PHASE CONTROL
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, HYDRAULIC SWING PHASE
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FLUID SWING AND STANCE
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, PNEUMATIC/ SWING PHASE
ADDITION, ENDOSKELETAL KNEE/SHIN SYSTEM, 4-BAR LINKAGE OR MULTIAXIAL, PNEUMATIC
ADDITION, ENDOSKELETAL, KNEE-SHIN SYSTEM, STANCE FLEXION FEATURE, ADJUSTABLE
ADDITION TO ENDOSKELETAL KNEE-SHIN SYSTEM, FLUID STANCE EXTENSION, DAMPENING FEA
ADDITION, ENDOSKELETAL SYSTEM, ABOVE KNEE OR HIP DISARTICULATION, KNEE
ADDITION, ENDOSKELETAL SYSTEM, HIP DISARTICULATION, MECHANICAL HIP EXTENSION
ADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL KNEE-SHIN SYSTEM,
ADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL KNEE-SHIN SYSTEM,
ADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL KNEE SHIN SYSTEM, MICROPROC
ADDITION, ENDOSKELETAL SYSTEM, BELOW KNEE, ALIGNABLE SYSTEM
ADDITION, ENDOSKELETAL SYSTEM, ABOVE KNEE OR HIP DISARTICULATION, ALIGNABLE
ADDITION, ENDOSKELETAL SYSTEM, ABOVE KNEE, KNEE DISARTICULATION OR HIP
ADDITION, ENDOSKELETAL SYSTEM, HIGH ACTIVITY KNEE CONTROL FRAME
ADDITION, ENDOSKELETAL SYSTEM, BELOW KNEE, ULTRA-LIGHT MATERIAL (TITANIUM,
ADDITION, ENDOSKELETAL SYSTEM, ABOVE KNEE, ULTRA-LIGHT MATERIAL (TITANIUM,
ADDITION, ENDOSKELETAL SYSTEM, HIP DISARTICULATION, ULTRA-LIGHT MATERIAL
ADDITION, ENDOSKELETAL SYSTEM, POLYCENTRIC HIP JOINT, PNEUMATIC OR HYDRAULIC CON
ADDITION, ENDOSKELETAL SYSTEM, BELOW KNEE, FLEXIBLE PROTECTIVE OUTER SURFACE
ADDITION, ENDOSKELETAL SYSTEM, ABOVE KNEE, FLEXIBLE PROTECTIVE OUTER SURFACE
ADDITION, ENDOSKELETAL SYSTEM, HIP DISARTICULATION, FLEXIBLE PROTECTIVE OUTER
ADDITION TO LOWER LIMB PROSTHESIS, MULTIAXIAL ANKLE WITH SWING PHASE ACTIVE
ALL LOWER EXTREMITY PROSTHESES, FOOT, EXTERNAL KEEL, SACH FOOT
ALL LOWER EXTREMITY PROSTHESIS, SOLID ANKLE CUSHION HEEL (SACH) FOOT, REPLACEMEN
ALL LOWER EXTREMITY PROSTHESES, FLEXIBLE KEEL FOOT (SAFE, STEN, BOCK DYNAMIC OR
ALL LOWER EXTREMITY PROSTHESES, FOOT, SINGLE AXIS ANKLE/FOOT
ALL LOWER EXTREMITY PROSTHESIS, COMBINATION SINGLE AXIS ANKLE AND FLEXIBLE KEEL
ALL LOWER EXTREMITY PROSTHESES, ENERGY STORING FOOT (SEATTLE CARBON COPY II OR
ALL LOWER EXTREMITY PROSTHESES, FOOT, MULTIAXIAL ANKLE/FOOT
ALL LOWER EXTREMITY PROSTHESIS, MULTI-AXIAL ANKLE, DYNAMIC RESPONSE FOOT, ONE
ALL LOWER EXTREMITY PROSTHESES, FLEX FOOT SYSTEM
ALL LOWER EXTREMITY PROSTHESES, FLEX-WALK SYSTEM OR EQUAL
ALL EXOSKELETAL LOWER EXTREMITY PROSTHESES, AXIAL ROTATION UNIT
ALL ENDOSKELETAL LOWER EXTREMITY PROSTHESIS, AXIAL ROTATION UNIT, WITH OR
ALL ENDOSKELETAL LOWER EXTREMITY PROTHESES, DYNAMIC PROSTHETIC PYLON
ALL LOWER EXTREMITY PROSTHESES, MULTI-AXIAL ROTATION UNIT ('MCP' OR EQUAL)
ALL LOWER EXTREMITY PROSTHESIS, SHANK FOOT SYSTEM WITH VERTICAL LOADING PYLON
ADDITION TO LOWER LIMB PROSTHESIS, VERTICAL SHOCK REDUCING PYLON FEATURE
ADDITION TO LOWER EXTREMITY PROSTHESIS, USER ADJUSTABLE HEEL HEIGHT
LOWER EXTREMITY PROSTHESIS, NOT OTHERWISE SPECIFIED
PARTIAL HAND, ROBIN-AIDS, THUMB REMAINING (OR EQUAL)
PARTIAL HAND, ROBIN-AIDS, LITTLE AND/OR RING FINGER REMAINING (OR EQUAL)
PARTIAL HAND, ROBIN-AIDS, NO FINGER REMAINING (OR EQUAL)
TRANSCARPAL/METACARPAL OR PARTIAL HAND DISARTICULATION PROSTHESIS, EXTERNAL
WRIST DISARTICULATION, MOLDED SOCKET, FLEXIBLE ELBOW HINGES, TRICEPS PAD
WRIST DISARTICULATION, MOLDED SOCKET WITH EXPANDABLE INTERFACE, FLEXIBLE ELBOW
BELOW ELBOW, MOLDED SOCKET, FLEXIBLE ELBOW HINGE, TRICEPS PAD
BELOW ELBOW, MOLDED SOCKET, (MUENSTER OR NORTHWESTERN SUSPENSION TYPES)
BELOW ELBOW, MOLDED DOUBLE WALL SPLIT SOCKET, STEP-UP HINGES, HALF CUFF
BELOW ELBOW, MOLDED DOUBLE WALL SPLIT SOCKET, STUMP ACTIVATED LOCKING HINGE,
ELBOW DISARTICULATION, MOLDED SOCKET, OUTSIDE LOCKING HINGE, FOREARM
ELBOW DISARTICULATION, MOLDED SOCKET WITH EXPANDABLE INTERFACE, OUTSIDE LOCKING
ABOVE ELBOW, MOLDED DOUBLE WALL SOCKET, INTERNAL LOCKING ELBOW, FOREARM
SHOULDER DISARTICULATION, MOLDED SOCKET, SHOULDER BULKHEAD, HUMERAL SECTION, INT
SHOULDER DISARTICULATION, PASSIVE RESTORATION (COMPLETE PROSTHESIS)
SHOULDER DISARTICULATION, PASSIVE RESTORATION (SHOULDER CAP ONLY)
INTERSCAPULAR THORACIC, MOLDED SOCKET, SHOULDER BULKHEAD, HUMERAL SECTION, INTER
INTERSCAPULAR THORACIC, PASSIVE RESTORATION (COMPLETE PROSTHESIS)
INTERSCAPULAR THORACIC, PASSIVE RESTORATION (SHOULDER CAP ONLY)
IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID DRESSING,
IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID DRESSING
IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID DRESSING
IMMEDIATE POST SURGICAL OR EARLY FITTING, EACH ADDITIONAL CAST CHANGE AND
IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF RIGID DRESSING ONLY
BELOW ELBOW, MOLDED SOCKET, ENDOSKELETAL SYSTEM, INCLUDING SOFT PROSTHETIC TISSU
ELBOW DISARTICULATION, MOLDED SOCKET, ENDOSKELETAL SYSTEM, INCLUDING SOFT PROSTH
ABOVE ELBOW, MOLDED SOCKET, ENDOSKELETAL SYSTEM, INCLUDING SOFT PROSTHETIC TISSU
SHOULDER DISARTICULATION, MOLDED SOCKET, ENDOSKELETAL SYSTEM, INCLUDING SOFT PRO
INTERSCAPULAR THORACIC, MOLDED SOCKET, ENDOSKELETAL SYSTEM, INCLUDING SOFT PROST
PREPARATORY, WRIST DISARTICULATION OR BELOW ELBOW, SINGLE WALL PLASTIC SOCKET,
PREPARATORY, WRIST DISARTICULATION OR BELOW ELBOW, SINGLE WALL SOCKET, FRICTION
PREPARATORY, ELBOW DISARTICULATION OR ABOVE ELBOW, SINGLE WALL PLASTIC SOCKET,
PREPARATORY, ELBOW DISARTICULATION OR ABOVE ELBOW, SINGLE WALL SOCKET, FRICTION
PREPARATORY, SHOULDER DISARTICULATION OR INTERSCAPULAR THORACIC, SINGLE WALL
PREPARATORY, SHOULDER DISARTICULATION OR INTERSCAPULAR THORACIC, SINGLE WALL
UPPER EXTREMITY ADDITIONS, POLYCENTRIC HINGE, PAIR
UPPER EXTREMITY ADDITIONS, SINGLE PIVOT HINGE, PAIR
UPPER EXTREMITY ADDITIONS, FLEXIBLE METAL HINGE, PAIR
ADDITION TO UPPER EXTREMITY PROSTHESIS, EXTERNAL POWERED, ADDITIONAL SWITCH, ANY
UPPER EXTREMITY ADDITION, DISCONNECT LOCKING WRIST UNIT
UPPER EXTREMITY ADDITION, ADDITIONAL DISCONNECT INSERT FOR LOCKING WRIST UNIT,
UPPER EXTREMITY ADDITION, FLEXION/EXTENSION WRIST UNIT, WITH OR WITHOUT
UPPER EXTREMITY PROSTHESIS ADDITION, FLEXION/EXTENSION WRIST WITH OR WITHOUT FRI
UPPER EXTREMITY ADDITION, SPRING ASSISTED ROTATIONAL WRIST UNIT WITH LATCH
UPPER EXTREMITY ADDITION, FLEXION/EXTENSION AND ROTATION WRIST UNIT
UPPER EXTREMITY ADDITION, ROTATION WRIST UNIT WITH CABLE LOCK
UPPER EXTREMITY ADDITION, QUICK DISCONNECT HOOK ADAPTER, OTTO BOCK OR EQUAL
UPPER EXTREMITY ADDITION, QUICK DISCONNECT LAMINATION COLLAR WITH COUPLING
UPPER EXTREMITY ADDITION, STAINLESS STEEL, ANY WRIST
UPPER EXTREMITY ADDITION, LATEX SUSPENSION SLEEVE, EACH
UPPER EXTREMITY ADDITION, LIFT ASSIST FOR ELBOW
UPPER EXTREMITY ADDITION, NUDGE CONTROL ELBOW LOCK
UPPER EXTREMITY ADDITION TO PROSTHESIS, ELECTRIC LOCKING FEATURE, ONLY FOR USE
UPPER EXTREMITY ADDITIONS, SHOULDER ABDUCTION JOINT, PAIR
UPPER EXTREMITY ADDITION, EXCURSION AMPLIFIER, PULLEY TYPE
UPPER EXTREMITY ADDITION, EXCURSION AMPLIFIER, LEVER TYPE
UPPER EXTREMITY ADDITION, SHOULDER FLEXION-ABDUCTION JOINT, EACH
UPPER EXTREMITY ADDITION, SHOULDER JOINT, MULTIPOSITIONAL LOCKING, FLEXION,
UPPER EXTREMITY ADDITION, SHOULDER LOCK MECHANISM, BODY POWERED ACTUATOR
UPPER EXTREMITY ADDITION, SHOULDER LOCK MECHANISM, EXTERNAL POWERED ACTUATOR
UPPER EXTREMITY ADDITION, SHOULDER UNIVERSAL JOINT, EACH
UPPER EXTREMITY ADDITION, STANDARD CONTROL CABLE, EXTRA
UPPER EXTREMITY ADDITION, HEAVY DUTY CONTROL CABLE
UPPER EXTREMITY ADDITION, TEFLON, OR EQUAL, CABLE LINING
UPPER EXTREMITY ADDITION, HOOK TO HAND, CABLE ADAPTER
UPPER EXTREMITY ADDITION, HARNESS, CHEST OR SHOULDER, SADDLE TYPE
UPPER EXTREMITY ADDITION, HARNESS, (E.G. FIGURE OF EIGHT TYPE), SINGLE CABLE
UPPER EXTREMITY ADDITION, HARNESS, (E.G. FIGURE OF EIGHT TYPE), DUAL CABLE
UPPER EXTREMITY ADDITION, HARNESS, TRIPLE CONTROL, SIMULTANEOUS OPERATION OF TER
UPPER EXTREMITY ADDITION, TEST SOCKET, WRIST DISARTICULATION OR BELOW ELBOW
UPPER EXTREMITY ADDITION, TEST SOCKET, ELBOW DISARTICULATION OR ABOVE ELBOW
UPPER EXTREMITY ADDITION, TEST SOCKET, SHOULDER DISARTICULATION OR
UPPER EXTREMITY ADDITION, SUCTION SOCKET
UPPER EXTREMITY ADDITION, FRAME TYPE SOCKET, BELOW ELBOW OR WRIST
UPPER EXTREMITY ADDITION, FRAME TYPE SOCKET, ABOVE ELBOW OR ELBOW
UPPER EXTREMITY ADDITION, FRAME TYPE SOCKET, SHOULDER DISARTICULATION
UPPER EXTREMITY ADDITION, FRAME TYPE SOCKET, INTERSCAPULAR-THORACIC
UPPER EXTREMITY ADDITION, REMOVABLE INSERT, EACH
UPPER EXTREMITY ADDITION, SILICONE GEL INSERT OR EQUAL, EACH
UPPER EXTREMITY ADDITION, LOCKING ELBOW, FOREARM COUNTERBALANCE
ADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/ABOVE ELBOW, CUSTOM
ADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/ABOVE ELBOW, CUSTOM
ADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/ABOVE ELBOW, CUSTOM
ADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/ABOVE ELBOW, CUSTOM
ADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/ABOVE ELBOW, LOCK
TERMINAL DEVICE, PASSIVE HAND/MITT, ANY MATERIAL, ANY SIZE
TERMINAL DEVICE, SPORT/RECREATIONAL/WORK ATTACHMENT, ANY MATERIAL, ANY SIZE
TERMINAL DEVICE, HOOK, MECHANICAL, VOLUNTARY OPENING, ANY MATERIAL, ANY SIZE, LI
TERMINAL DEVICE, HOOK, MECHANICAL, VOLUNTARY CLOSING, ANY MATERIAL, ANY SIZE, LI
TERMINAL DEVICE, HAND, MECHANICAL, VOLUNTARY OPENING, ANY MATERIAL, ANY SIZE
TERMINAL DEVICE, HAND, MECHANICAL, VOLUNTARY CLOSING, ANY MATERIAL, ANY SIZE
TERMINAL DEVICE, HOOK, MECHANICAL, VOLUNTARY OPENING, ANY MATERIAL, ANY SIZE, LI
TERMINAL DEVICE, HOOK, MECHANICAL, VOLUNTARY CLOSING, ANY MATERIAL, ANY SIZE, LI
TERMINAL DEVICE, HAND, MECHANICAL, VOLUNTARY OPENING, ANY MATERIAL, ANY SIZE, PE
TERMINAL DEVICE, HAND, MECHANICAL, VOLUNTARY CLOSING, ANY MATERIAL, ANY SIZE, PE
TERMINAL DEVICE, HOOK OR HAND, HEAVY DUTY, MECHANICAL, VOLUNTARY OPENING, ANY MA
TERMINAL DEVICE, HOOK OR HAND, HEAVY DUTY, MECHANICAL, VOLUNTARY CLOSING, ANY MA
ADDITION TO TERMINAL DEVICE, MODIFIER WRIST UNIT
ADDITION TO TERMINAL DEVICE, PRECISION PINCH DEVICE
AUTOMATIC GRASP FEATURE, ADDITION TO UPPER LIMB ELECTRIC PROSTHETIC TERMINAL DEV
MICROPROCESSOR CONTROL FEATURE, ADDITION TO UPPER LIMB PROSTHETIC TERMINAL
REPLACEMENT SOCKET, BELOW ELBOW/WRIST DISARTICULATION, MOLDED TO PATIENT MODEL,
REPLACEMENT SOCKET, ABOVE ELBOW/ELBOW DISARTICULATION, MOLDED TO PATIENT MODEL,
REPLACEMENT SOCKET, SHOULDER DISARTICULATION/INTERSCAPULAR THORACIC, MOLDED TO P
ADDITION TO UPPER EXTREMITY PROSTHESIS, GLOVE FOR TERMINAL DEVICE, ANY MATERIAL,
ADDITION TO UPPER EXTREMITY PROSTHESIS, GLOVE FOR TERMINAL DEVICE, ANY
HAND RESTORATION (CASTS, SHADING AND MEASUREMENTS INCLUDED), PARTIAL HAND, WITH
HAND RESTORATION (CASTS, SHADING AND MEASUREMENTS INCLUDED), PARTIAL HAND, WITH
HAND RESTORATION (CASTS, SHADING AND MEASUREMENTS INCLUDED), PARTIAL HAND, WITH
HAND RESTORATION (SHADING, AND MEASUREMENTS INCLUDED), REPLACEMENT GLOVE FOR
WRIST DISARTICULATION, EXTERNAL POWER, SELF-SUSPENDED INNER SOCKET, REMOVABLE FO
WRIST DISARTICULATION, EXTERNAL POWER, SELF-SUSPENDED INNER SOCKET, REMOVABLE
BELOW ELBOW, EXTERNAL POWER, SELF-SUSPENDED INNER SOCKET, REMOVABLE FOREARM
BELOW ELBOW, EXTERNAL POWER, SELF-SUSPENDED INNER SOCKET, REMOVABLE FOREARM
ELBOW DISARTICULATION, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE HUMERAL
ELBOW DISARTICULATION, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE HUMERAL
ABOVE ELBOW, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE HUMERAL SHELL,
ABOVE ELBOW, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE HUMERAL SHELL,
SHOULDER DISARTICULATION, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE
SHOULDER DISARTICULATION, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE
INTERSCAPULAR-THORACIC, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE SHOULDER
INTERSCAPULAR-THORACIC, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE SHOULDER
ELECTRIC HAND, SWITCH OR MYOELECTRIC CONTROLLED, ADULT
ELECTRIC HAND, SWITCH OR MYOELECTRIC, CONTROLLED, PEDIATRIC
ELECTRIC HOOK, SWITCH OR MYOELECTRIC CONTROLLED, ADULT
PREHENSILE ACTUATOR, SWITCH CONTROLLED
ELECTRIC HOOK, SWITCH OR MYOELECTRIC CONTROLLED, PEDIATRIC
ELECTRONIC ELBOW, HOSMER OR EQUAL, SWITCH CONTROLLED
ELECTRONIC ELBOW, MICROPROCESSOR SEQUENTIAL CONTROL OF ELBOW AND TERMINAL DEVICE
ELECTRONIC ELBOW, MICROPROCESSOR SIMULTANEOUS CONTROL OF ELBOW AND TERMINAL
ELECTRONIC ELBOW, ADOLESCENT, VARIETY VILLAGE OR EQUAL, SWITCH CONTROLLED
ELECTRONIC ELBOW, CHILD, VARIETY VILLAGE OR EQUAL, SWITCH CONTROLLED
ELECTRONIC ELBOW, ADOLESCENT, VARIETY VILLAGE OR EQUAL, MYOELECTRONICALLY
ELECTRONIC ELBOW, CHILD, VARIETY VILLAGE OR EQUAL, MYOELECTRONICALLY CONTROLLED
ELECTRONIC WRIST ROTATOR, OTTO BOCK OR EQUAL
ELECTRONIC WRIST ROTATOR, FOR UTAH ARM
SIX VOLT BATTERY, EACH
BATTERY CHARGER, SIX VOLT, EACH
TWELVE VOLT BATTERY, EACH
BATTERY CHARGER, TWELVE VOLT, EACH
LITHIUM ION BATTERY, REPLACEMENT
LITHIUM ION BATTERY CHARGER
ADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/WRIST DISARTICULATION, ULTRA
ADDITION TO UPPER EXTREMITY PROSTHESIS, ABOVE ELBOW DISARTICULATION, ULTRALIGHT
ADDITION TO UPPER EXTREMITY PROSTHESIS, SHOULDER DISARTICULATION/INTERSCAPULAR T
ADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/WRIST DISARTICULATION, ACRYL
ADDITION TO UPPER EXTREMITY PROSTHESIS, ABOVE ELBOW DISARTICULATION, ACRYLIC MAT
ADDITION TO UPPER EXTREMITY PROSTHESIS, SHOULDER DISARTICULATION/INTERSCAPULAR T
UPPER EXTREMITY PROSTHESIS, NOT OTHERWISE SPECIFIED
REPAIR OF PROSTHETIC DEVICE, REPAIR OR REPLACE MINOR PARTS
REPAIR PROSTHETIC DEVICE, LABOR COMPONENT, PER 15 MINUTES
PROSTHETIC DONNING SLEEVE, ANY MATERIAL, EACH
BREAST PROSTHESIS, MASTECTOMY BRA
BREAST PROSTHESIS, MASTECTOMY BRA, WITH INTEGRATED BREAST PROSTHESIS FORM,
BREAST PROSTHESIS, MASTECTOMY BRA, WITH INTEGRATED BREAST PROSTHESIS FORM,
BREAST PROSTHESIS, MASTECTOMY SLEEVE
EXTERNAL BREAST PROSTHESIS GARMENT, WITH MASTECTOMY FORM, POST MASTECTOMY
BREAST PROSTHESIS, MASTECTOMY FORM
BREAST PROSTHESIS, SILICONE OR EQUAL, WITHOUT INTEGRAL ADHESIVE
BREAST PROSTHESIS, SILICONE OR EQUAL, WITH INTEGRAL ADHESIVE
NIPPLE PROSTHESIS, REUSABLE, ANY TYPE, EACH
CUSTOM BREAST PROSTHESIS, POST MASTECTOMY, MOLDED TO PATIENT MODEL
BREAST PROSTHESIS, NOT OTHERWISE SPECIFIED
NASAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN
MIDFACIAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN
ORBITAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN
UPPER FACIAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN
HEMI-FACIAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN
AURICULAR PROSTHESIS, PROVIDED BY A NON-PHYSICIAN
PARTIAL FACIAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN
NASAL SEPTAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN
UNSPECIFIED MAXILLOFACIAL PROSTHESIS, BY REPORT, PROVIDED BY A NON-PHYSICIAN
REPAIR OR MODIFICATION OF MAXILLOFACIAL PROSTHESIS, LABOR COMPONENT, 15 MINUTE
TRUSS, SINGLE WITH STANDARD PAD
TRUSS, DOUBLE WITH STANDARD PADS
TRUSS, ADDITION TO STANDARD PAD, WATER PAD
TRUSS, ADDITION TO STANDARD PAD, SCROTAL PAD
PROSTHETIC SHEATH, BELOW KNEE, EACH
PROSTHETIC SHEATH, ABOVE KNEE, EACH
PROSTHETIC SHEATH, UPPER LIMB, EACH
PROSTHETIC SHEATH/SOCK, INCLUDING A GEL CUSHION LAYER, BELOW KNEE OR ABOVE
PROSTHETIC SOCK, MULTIPLE PLY, BELOW KNEE, EACH
PROSTHETIC SOCK, MULTIPLE PLY, ABOVE KNEE, EACH
PROSTHETIC SOCK, MULTIPLE PLY, UPPER LIMB, EACH
PROSTHETIC SHRINKER, BELOW KNEE, EACH
PROSTHETIC SHRINKER, ABOVE KNEE, EACH
PROSTHETIC SHRINKER, UPPER LIMB, EACH
PROSTHETIC SOCK, SINGLE PLY, FITTING, BELOW KNEE, EACH
PROSTHETIC SOCK, SINGLE PLY, FITTING, ABOVE KNEE, EACH
PROSTHETIC SOCK, SINGLE PLY, FITTING, UPPER LIMB, EACH
UNLISTED PROCEDURE FOR MISCELLANEOUS PROSTHETIC SERVICES
ARTIFICIAL LARYNX, ANY TYPE
TRACHEOSTOMY SPEAKING VALVE
ARTIFICIAL LARYNX REPLACEMENT BATTERY / ACCESSORY, ANY TYPE
TRACHEO-ESOPHAGEAL VOICE PROSTHESIS, PATIENT INSERTED, ANY TYPE, EACH
TRACHEO-ESOPHAGEAL VOICE PROSTHESIS, INSERTED BY A LICENSED HEALTH CARE
VOICE AMPLIFIER
INSERT FOR INDWELLING TRACHEOESOPHAGEAL PROSTHESIS, WITH OR WITHOUT VALVE,
GELATIN CAPSULES OR EQUIVALENT, FOR USE WITH TRACHEOESOPHAGEAL VOICE
CLEANING DEVICE USED WITH TRACHEOESOPHAGEAL VOICE PROSTHESIS, PIPET, BRUSH, OR
TRACHEOESOPHAGEAL PUNCTURE DILATOR, REPLACEMENT ONLY, EACH
GELATIN CAPSULE, APPLICATION DEVICE FOR USE WITH TRACHEOESOPHAGEAL VOICE
HEADSET/HEADPIECE FOR USE WITH COCHLEAR IMPLANT DEVICE, REPLACEMENT
MICROPHONE FOR USE WITH COCHLEAR IMPLANT DEVICE, REPLACEMENT
TRANSMITTING COIL FOR USE WITH COCHLEAR IMPLANT DEVICE, REPLACEMENT
TRANSMITTER CABLE FOR USE WITH COCHLEAR IMPLANT DEVICE, REPLACEMENT
COCHLEAR IMPLANT, EXTERNAL SPEECH PROCESSOR AND CONTROLLER, INTEGRATED SYSTEM, R
ZINC AIR BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE, REPLACEMENT, EACH
ALKALINE BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE, ANY SIZE, REPLACEMENT,
LITHIUM ION BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE SPEECH PROCESSOR, OTHER
LITHIUM ION BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE SPEECH PROCESSOR, EAR L
COCHLEAR IMPLANT, EXTERNAL SPEECH PROCESSOR, COMPONENT, REPLACEMENT
COCHLEAR IMPLANT, EXTERNAL CONTROLLER COMPONENT, REPLACEMENT
TRANSMITTING COIL AND CABLE, INTEGRATED, FOR USE WITH COCHLEAR IMPLANT DEVICE, R
PATIENT PROGRAMMER (EXTERNAL) FOR USE WITH IMPLANTABLE PROGRAMMABLE NEUROSTIMULA
RADIOFREQUENCY TRANSMITTER (EXTERNAL) FOR USE WITH IMPLANTABLE NEUROSTIMULATOR R
RADIOFREQUENCY TRANSMITTER (EXTERNAL) FOR USE WITH IMPLANTABLE SACRAL ROOT NEURO
EXTERNAL RECHARGING SYSTEM FOR BATTERY (INTERNAL) FOR USE WITH IMPLANTABLE NEURO
AUDITORY OSSEOINTEGRATED DEVICE, EXTERNAL SOUND PROCESSOR, REPLACEMENT
AUDITORY OSSEOINTEGRATED DEVICE, EXTERNAL SOUND PROCESSOR, USED WITHOUT OSSEOINT
AUDITORY OSSEOINTEGRATED DEVICE ABUTMENT, ANY LENGTH, REPLACEMENT ONLY
EXTERNAL RECHARGING SYSTEM FOR BATTERY (EXTERNAL) FOR USE WITH IMPLANTABLE NEURO
BRIEF OFFICE VISIT FOR THE SOLE PURPOSE OF MONITORING OR CHANGING DRUG
PROLOTHERAPY
INTRAGASTRIC HYPOTHERMIA USING GASTRIC FREEZING
CEPHALIN FLOCULATION, BLOOD
CONGO RED, BLOOD
THYMOL TURBIDITY, BLOOD
MUCOPROTEIN, BLOOD (SEROMUCOID) (MEDICAL NECESSITY PROCEDURE)
SCREENING PAPANICOLAOU SMEAR, CERVICAL OR VAGINAL, UP TO THREE SMEARS, BY TECHNI
SCREENING PAPANICOLAOU SMEAR, CERVICAL OR VAGINAL, UP TO THREE SMEARS,
CULTURE, BACTERIAL, URINE; QUANTITATIVE, SENSITIVITY STUDY
BLOOD (WHOLE), FOR TRANSFUSION, PER UNIT
BLOOD, SPLIT UNIT
CRYOPRECIPITATE, EACH UNIT
RED BLOOD CELLS, LEUKOCYTES REDUCED, EACH UNIT
FRESH FROZEN PLASMA (SINGLE DONOR), FROZEN WITHIN 8 HOURS OF COLLECTION, EACH
PLATELET CONCENTRATE
PLATELET RICH PLASMA, EACH UNIT
RED BLOOD CELLS, EACH UNIT
RED BLOOD CELLS, WASHED, EACH UNIT
PLASMA, POOLED MULTIPLE DONOR, SOLVENT/DETERGENT TREATED, FROZEN, EACH UNIT
PLATELETS, LEUKOCYTES REDUCED, EACH UNIT
PLATELETS, IRRADIATED, EACH UNIT
PLATELETS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT
PLATELETS, PHERESIS, EACH UNIT
PLATELETS, PHERESIS, LEUKOCYTES REDUCED, EACH UNIT
PLATELETS, PHERESIS, IRRADIATED, EACH UNIT
PLATELETS, PHERESIS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT
RED BLOOD CELLS, IRRADIATED, EACH UNIT
RED BLOOD CELLS, DEGLYCEROLIZED, EACH UNIT
RED BLOOD CELLS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT
INFUSION, ALBUMIN (HUMAN), 5%, 50 ML
INFUSION, PLASMA PROTEIN FRACTION (HUMAN), 5%, 50 ML
PLASMA, CRYOPRECIPITATE REDUCED, EACH UNIT
INFUSION, ALBUMIN (HUMAN), 5%, 250 ML
INFUSION, ALBUMIN (HUMAN), 25%, 20 ML
INFUSION, ALBUMIN (HUMAN), 25%, 50 ML
INFUSION, PLASMA PROTEIN FRACTION (HUMAN), 5%
GRANULOCYTES, PHERESIS, EACH UNIT
WHOLE BLOOD OR RED BLOOD CELLS, LEUKOCYTES REDUCED, CMV-NEGATIVE, EACH UNIT
PLATELETS, HLA-MATCHED LEUKOCYTES REDUCED, APHERESIS/PHERESIS, EACH UNIT
PLATELETS, PHERESIS, LEUKOCYTES REDUCED, CMV-NEGATIVE, IRRADIATED, EACH UNIT
WHOLE BLOOD OR RED BLOOD CELLS, LEUKOCYTES REDUCED, FROZEN, DEGLYCEROL, WASHED,
PLATELETS, LEUKOCYTES REDUCED, CMV-NEGATIVE, APHERESIS/PHERESIS, EACH UNIT
WHOLE BLOOD, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT
RED BLOOD CELLS, FROZEN/DEGLYCEROLIZED/WASHED, LEUKOCYTES REDUCED, IRRADIATED,
RED BLOOD CELLS, LEUKOCYTES REDUCED, CMV-NEGATIVE, IRRADIATED, EACH UNIT
FRESH FROZEN PLASMA BETWEEN 8-24 HOURS OF COLLECTION, EACH UNIT
FRESH FROZEN PLASMA, DONOR RETESTED, EACH UNIT
TRAVEL ALLOWANCE ONE WAY IN CONNECTION WITH MEDICALLY NECESSARY LABORATORY SPECI
TRAVEL ALLOWANCE ONE WAY IN CONNECTION WITH MEDICALLY NECESSARY LABORATORY
CATHETERIZATION FOR COLLECTION OF SPECIMEN, SINGLE PATIENT, ALL PLACES OF
CARDIOKYMOGRAPHY
OXYGEN CONCENTRATOR, HIGH HUMIDITY
INFUSION THERAPY, USING OTHER THAN CHEMOTHERAPEUTIC DRUGS, PER VISIT
CHEMOTHERAPY ADMINISTRATION BY OTHER THAN INFUSION TECHNIQUE ONLY (EG
CHEMOTHERAPY ADMINISTRATION BY