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					CODE    FULL_DESCRIPTION
        Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral
22520   injection; thoracic
        Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral
22521   injection; lumbar
        Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral
        injection; each additional thoracic or lumbar vertebral body (List separately in
22522   addition to code for primary procedure)
        Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral
22526   including fluoroscopic guidance; single level
        Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral
        including fluoroscopic guidance; one or more additional levels (List separately
22527   in addition to code for primary procedure)
        Cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral,
30801   any method; superficial
        Cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral,
30802   any method; intramural

31231   Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)
        Donor nephrectomy (including cold preservation); from cadaver donor,
50300   unilateral or bilateral
        Symphysiotomy for horseshoe kidney with or without pyeloplasty and/or other
50540   plastic procedure, unilateral or bilateral (one operation)
        Corpora cavernosa-saphenous vein shunt (priapism operation), unilateral or
54420   bilateral
        Corpora cavernosa-corpus spongiosum shunt (priapism operation), unilateral
54430   or bilateral
        Vasotomy, cannulization with or without incision of vas, unilateral or bilateral
55200   (separate procedure)
        Vasectomy, unilateral or bilateral (separate procedure), including
55250   postoperative semen examination(s)
        Vasotomy for vasograms, seminal vesiculograms, or epididymograms,
55300   unilateral or bilateral
        Ligation (percutaneous) of vas deferens, unilateral or bilateral (separate
55450   procedure)
        Ligation or transection of fallopian tube(s), abdominal or vaginal approach,
58600   unilateral or bilateral
        Ligation or transection of fallopian tube(s), abdominal or vaginal approach,
        postpartum, unilateral or bilateral, during same hospitalization (separate
58605   procedure)

58700   Salpingectomy, complete or partial, unilateral or bilateral (separate procedure)
        Salpingo-oophorectomy, complete or partial, unilateral or bilateral (separate
58720   procedure)
        Drainage of ovarian cyst(s), unilateral or bilateral (separate procedure);
58800   vaginal approach
        Drainage of ovarian cyst(s), unilateral or bilateral (separate procedure);
58805   abdominal approach
58900   Biopsy of ovary, unilateral or bilateral (separate procedure)
58920   Wedge resection or bisection of ovary, unilateral or bilateral
58925   Ovarian cystectomy, unilateral or bilateral
58940   Oophorectomy, partial or total, unilateral or bilateral;
        Oophorectomy, partial or total, unilateral or bilateral; for ovarian, tubal or
        primary peritoneal malignancy, with para-aortic and pelvic lymph node
        biopsies, peritoneal washings, peritoneal biopsies, diaphragmatic
58943   assessments, with or without salpingectomy(s), with or without omentectomy

61000   Subdural tap through fontanelle, or suture, infant, unilateral or bilateral; initial
        Subdural tap through fontanelle, or suture, infant, unilateral or bilateral;
61001   subsequent taps
61253   Burr hole(s) or trephine, infratentorial, unilateral or bilateral
        Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with
        decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal
63045   or lateral recess stenosis]), single vertebral segment; cervical
        Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with
        decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal
63046   or lateral recess stenosis]), single vertebral segment; thoracic
        Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with
        decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal
63047   or lateral recess stenosis]), single vertebral segment; lumbar
        Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with
        decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal
        or lateral recess stenosis]), single vertebral segment; each additional
        segment, cervical, thoracic, or lumbar (List separately in addition to code for
63048   primary procedure)
        Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral
76514   (determination of corneal thickness)
        Ultrasound, breast(s) (unilateral or bilateral), real time with image
76645   documentation
        Computerized corneal topography, unilateral or bilateral, with interpretation
92025   and report

        Visual field examination, unilateral or bilateral, with interpretation and report;
        limited examination (eg, tangent screen, Autoplot, arc perimeter, or single
92081   stimulus level automated test, such as Octopus 3 or 7 equivalent)

        Visual field examination, unilateral or bilateral, with interpretation and report;
        intermediate examination (eg, at least 2 isopters on Goldmann perimeter, or
        semiquantitative, automated suprathreshold screening program, Humphrey
92082   suprathreshold automatic diagnostic test, Octopus program 33)

        Visual field examination, unilateral or bilateral, with interpretation and report;
        extended examination (eg, Goldmann visual fields with at least 3 isopters
        plotted and static determination within the central 30 degrees, or quantitative,
        automated threshold perimetry, Octopus program G-1, 32 or 42, Humphrey
92083   visual field analyzer full threshold programs 30-2, 24-2, or 30/60-2)
        Needle electromyography; limited study of muscles in one extremity or non-
        limb (axial) muscles (unilateral or bilateral), other than thoracic paraspinal,
95870   cranial nerve supplied muscles, or sphincters

        Percutaneous intradiscal annuloplasty, any method except electrothermal,
0062T   unilateral or bilateral including fluoroscopic guidance; single level
        Percutaneous intradiscal annuloplasty, any method except electrothermal,
        unilateral or bilateral including fluoroscopic guidance; 1 or more additional
0063T   levels (List separately in addition to 0062T for primary procedure)
        Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s),
        unilateral or bilateral for pelvic bone fracture patterns which do not disrupt the
G0412   pelvic ring includes internal fixation, when performed
        Percutaneous skeletal fixation of posterior pelvic bone fracture and/or
        dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or
G0413   bilateral, (includes ilium, sacroiliac joint and/or sacrum)
        Open treatment of anterior pelvic bone fracture and/or dislocation for fracture
        patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal
        fixation when performed (includes pubic symphysis and/or superior/inferior
G0414   rami)
        Open treatment of posterior pelvic bone fracture and/or dislocation, for
        fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes
        internal fixation, when performed (includes ilium, sacroiliac joint and/or
G0415   sacrum)

        Nasal endoscopy for postoperative debridement following functional
S2342   endoscopic sinus surgery, nasal and/or sinus cavity(s), unilateral or bilateral
        Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral
S2360   injection; cervical
CODE    FULL_DESCRIPTION
27158   Osteotomy, pelvis, bilateral (eg, congenital malformation)
27392   Tenotomy, open, hamstring, knee to hip; multiple tendons, bilateral
27395   Lengthening of hamstring tendon; multiple tendons, bilateral

32853   Lung transplant, double (bilateral sequential or en bloc); without cardiopulmonary bypass

32854   Lung transplant, double (bilateral sequential or en bloc); with cardiopulmonary bypass
        Backbench standard preparation of cadaver donor lung allograft prior to transplantation,
        including dissection of allograft from surrounding soft tissues to prepare pulmonary
32856   venous/atrial cuff, pulmonary artery, and bronchus; bilateral
35549   Bypass graft, with vein; aortoiliofemoral, bilateral
40701   Plastic repair of cleft lip/nasal deformity; primary bilateral, one stage procedure
40702   Plastic repair of cleft lip/nasal deformity; primary bilateral, one of two stages
40843   Vestibuloplasty; posterior, bilateral
42507   Parotid duct diversion, bilateral (Wilke type procedure);
        Parotid duct diversion, bilateral (Wilke type procedure); with excision of one
42508   submandibular gland
        Parotid duct diversion, bilateral (Wilke type procedure); with excision of both
42509   submandibular glands
        Parotid duct diversion, bilateral (Wilke type procedure); with ligation of both submandibular
42510   (Wharton's) ducts
54861   Epididymectomy; bilateral
54901   Epididymovasostomy, anastomosis of epididymis to vas deferens; bilateral
55041   Excision of hydrocele; bilateral
        Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and
58953   radical dissection for debulking;
        Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and
        radical dissection for debulking; with pelvic lymphadenectomy and limited para-aortic
58954   lymphadenectomy
        Bilateral salpingo-oophorectomy with total omentectomy, total abdominal hysterectomy for
58956   malignancy
70330   Radiologic examination, temporomandibular joint, open and closed mouth; bilateral
71060   Bronchography, bilateral, radiological supervision and interpretation
71110   Radiologic examination, ribs, bilateral; three views
        Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of four
71111   views
        Radiologic examination; acromioclavicular joints, bilateral, with or without weighted
73050   distraction
        Radiologic examination, hips, bilateral, minimum of two views of each hip, including
73520   anteroposterior view of pelvis
        Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by
75630   serialography, radiological supervision and interpretation
        Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower
        extremity runoff, with contrast material(s), including noncontrast images, if performed, and
75635   image postprocessing
        Angiography, external carotid, bilateral, selective, radiological supervision and
75662   interpretation
75671   Angiography, carotid, cerebral, bilateral, radiological supervision and interpretation
75680   Angiography, carotid, cervical, bilateral, radiological supervision and interpretation
75716   Angiography, extremity, bilateral, radiological supervision and interpretation
        Angiography, renal, bilateral, selective (including flush aortogram), radiological supervision
75724   and interpretation

75733   Angiography, adrenal, bilateral, selective, radiological supervision and interpretation

75743   Angiography, pulmonary, bilateral, selective, radiological supervision and interpretation

75803   Lymphangiography, extremity only, bilateral, radiological supervision and interpretation

75807   Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation
75822   Venography, extremity, bilateral, radiological supervision and interpretation
75833   Venography, renal, bilateral, selective, radiological supervision and interpretation

75842   Venography, adrenal, bilateral, selective, radiological supervision and interpretation
        Radiologic examination, complex motion (ie, hypercycloidal) body section (eg, mastoid
76102   polytomography), other than with urography; bilateral
77056   Mammography; bilateral
77057   Screening mammography, bilateral (2-view film study of each breast)

77059   Magnetic resonance imaging, breast, without and/or with contrast material(s); bilateral
78458   Venous thrombosis imaging, venogram; bilateral
        Noninvasive physiologic studies of extracranial arteries, complete bilateral study (eg,
        periorbital flow direction with arterial compression, ocular pneumoplethysmography,
93875   Doppler ultrasound spectral analysis)
93880   Duplex scan of extracranial arteries; complete bilateral study
        Noninvasive physiologic studies of upper or lower extremity arteries, single level, bilateral
        (eg, ankle/brachial indices, Doppler waveform analysis, volume plethysmography,
93922   transcutaneous oxygen tension measurement)

        Noninvasive physiologic studies of upper or lower extremity arteries, multiple levels or with
        provocative functional maneuvers, complete bilateral study (eg, segmental blood pressure
        measurements, segmental Doppler waveform analysis, segmental volume
        plethysmography, segmental transcutaneous oxygen tension measurements,
93923   measurements with postural provocative tests, measurements with reactive hyperemia)
        Noninvasive physiologic studies of lower extremity arteries, at rest and following treadmill
93924   stress testing, complete bilateral study

93925   Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study

93930   Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study
        Noninvasive physiologic studies of extremity veins, complete bilateral study (eg, Doppler
        waveform analysis with responses to compression and other maneuvers,
93965   phleborheography, impedance plethysmography)
        Duplex scan of extremity veins including responses to compression and other maneuvers;
93970   complete bilateral study
95868   Needle electromyography; cranial nerve supplied muscles, bilateral
        Visual function screening, automated or semi-automated bilateral quantitative
        determination of visual acuity, ocular alignment, color vision by pseudoisochromatic
        plates, and field of vision (may include all or some screening of the determination[s] for
99172   contrast sensitivity, vision under glare)
99173   Screening test of visual acuity, quantitative, bilateral
99174   Ocular photoscreening with interpretation and report, bilateral
        Electrical impedance scan of the breast, bilateral (risk assessment device for breast
0060T   cancer)
0168T   Rhinophototherapy, intranasal application of ultraviolet and visible light, bilateral
        Corneal hysteresis determination, by air impulse stimulation, bilateral, with interpretation
0181T   and report
D1515   Space maintainer - fixed-bilateral
D1525   Space maintainer - removable-bilateral
G0202   Screening mammography, producing direct digital image, bilateral, all views
G0204   Diagnostic mammography, producing direct digital image, bilateral, all views
L1085   Addition to CTLSO or scoliosis orthosis, outrigger, bilateral with vertical extensions
L8002   Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral
S3000   Diabetic indicator; retinal eye exam, dilated, bilateral
V5100   Hearing aid, bilateral, body worn
V5110   Dispensing fee, bilateral